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Review of Maternal-Infant Nursing

Review of Maternal-Infant Nursing

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Review of Maternal-Infant Nursing

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  1. Review of Maternal-Infant Nursing 徐丽华 上海交通大学护理学院 2006-4-27

  2. Trends in Maternal-Infant Nursing Care • Development standard of care, certification, advanced practice nurses • Home Health care for postpartum women, discharge from Hops. 12-24 hours after delivery, high risk infants discharge home earlier than before • Consumer involved in the childbearing care: Child birth class, sibling present, breast-feeding, birthing environment (LDR, LDRP), father’s involvement, parents leave option for family with newborn

  3. Maternal Nursing concerns areas • Prenatal care • Low birth weight • Mother and infant with HIV infection • Adolescent pregnancy • Drug and substance abuse during pregnancy • Social/family stress and impacts to pregnant women and family • Use and care for pregnant women

  4. Special Issues in Women’s Health • Violence • Sexual Transmitted Diseases: HIV/AIDS 86% of pediatric AIDS cases are transmitted through vertical transmission of HIV • Substance abuse • Other diseases: Heart diseases, cancer, osteoporosis, eating disorders

  5. The Menstrual Cycle Ovarian Cycle: 1. Follicular phase: stimulated with FSH to promote the development of follicles Estrogen-follicle mature-negative feedback to hypothalamus and anterior pituitary gland – inhibiting FSH secretion 2. Ovulation: increase in body temperature (progesterone secretion), fern pattern of the cervical mucus, spinnbarkeit “elasticity of the ovulatory”due to secretion of the estrogen

  6. The Menstrual Cycle 3.Luteal Phase: Corpus luteum and anterior pituitary gland will secret luteinizing hormones (the decrease in Estrogen and progesterone – positive feedback to Hypothalamus and anterior pituitary- stimulating the secretion of FSH 4. Premenstrual phase: Decline in estrogen and progesterone

  7. The Menstrual Cycle Endometrial Cycle: • Proliferative phase • Secretary phase • Menstrual phase

  8. Question FSH stimulates which processes in the menstrual Cycle? • Thinking of endometrium • Maturation of follicle • Decrease in basal body temperature • Increase in progesterone production

  9. Infertility Care • Infertility affects 15-20% of the populations in the reproductive yearsTerms to be understood: • Artificial insemination • Endometriosis • Laparoscopy • Primary Infertility • Secondary Infertility • Varicocele • Endometriosis

  10. Terms related to Infertility Treatment • In vitro Fertilization/embryo Transfer • Gamete intrafallopian tube transfer (GIFT) • Zygote Intrafallopian Transfer (ZIFT) • Testing of infertility: • Ovulatory Analysis • Sperm Analysis • Testing of STDS • Tubal Patency test

  11. Question In which phase of the menstrual cycle is thick, scant cervical mucus and an elevated BBT seen? • Estrogenic phase • Menstrual Phase • Ovulatory phase • Luteal Phase

  12. Names of the infertility drugs • Clomiphene “Clomid”-risk of multiple ovulation • hCG: to facilitate the ovulation , side effect ovarian over-stimulation • hMG + Menotropin: Human Menopausal gonadotropin • Danazol: suppresses ovulation and secretion of FSH and Luteinizing hormone to inactive ectopic endometrial tissue. Side effect-Wt gain, hot flashes, decreased breast size, vaginitis

  13. Nursing care for infertile couple • Identify problems and strengths: • Self-esteem disturbance related to diagnosis • Personal Identity disturbance, related to unsuccessful infertility treatment • Ineffective family coping, compromised live and decision making • Nurse =supporter, advocate, counseling,

  14. Pregnancy Termination • Legal/ethical Decision making dilemmas • Counseling regarding pregnancy termination • Psychological impact of pregnancy termination • Risk and complication associated • Grief/guilt/ambivalence/uncertainty feeling after terminating of pregnancy

  15. Sexually Transmitted Diseases • Chamydia trachmatis infection • Gonorrhea • Human Papillomavirus • Herpes Simplex Virus type 2 infection • Cytomegalovirus infection • Syphilis • Vaginitis • Human Immunodeficiency Virus Infection

  16. Quesiton Women should be taught to be aware of early warning signs of HIV infection which are: • Dyspareunia • Severe dysmenorrhea • Occasional Candida infection • Recurrent episodes of genital warts

  17. Question The purpose of taking Tamoxifen after a mastectomy is to: • Alleviate cancer pain • Act as hormonal replacement therapy • Block tissue uptake and utilization of estrogen • Destroy any stray cancer cells in remaining breast tissue

  18. Family System Changes During The Childbearing Cycle • Structure • Power • Boundaries • Affect or feelings • Intergenerational patterns and roles • Communication patterns • Cultural background and riturals

  19. Bonding and Attachement • Bonding is affected by Maternal-Sensitive period. • Attachment is developed through out the first year of life. • Important for nursing practice: do not make inaccurate judgment, understand that childbearing is a major transition I the life of a family

  20. Nursing intervention for the three Phases of crisis Precrisis: Predictable and development events in the life cycle • Discuss change with family structure, adding new member • Assess risk factors, past coping and problem solving • Implement health teaching • Implement health promotion and maintenance strategies

  21. Nursing intervention for the three Phases of crisis Crisis: Coping strategies not sufficient to deal with changes in family structure and problem in development • Clarify the problem • Assist the family in going an understanding of the situation • Acceptance of the family • Use appropriate interpersonal and institutional resources • Assess family to express feeling & ways of solving problem

  22. Nursing intervention for the three Phases of crisis Postcrisis: Crisis has been resolved, leading to a higher, the same, or lower of family function • Support the family in its new strategies of resolution • Emphasize growth potential in solutions • Attempt to reverse or lessen effects of maladaptation through appropriate rehabilitative effort or therapy

  23. Psychosocial aspects of childbearing Theories 1. Psychosocial Change in the mother: Accepting the pregnancy • Symbolic meaning of the pregnancy • Self-image and body image during pregnancy

  24. Psychosocial aspects of childbearing Theories 2. Role Assumption and maternal Adaptation • Maternal Identity • Maternal role attainment: Motivation for motherhood, preparation for motherhood, conflict resolution, maternal attachment behavior, relationship with mother • Role conflict and attainment of the maternal role

  25. Role conflict and attainment of the maternal role • Inability to achieve the “good Mother”role • Lack of knowledge and preparation for the maternal role • Establishing a relationship with the fetus

  26. Maternal Ambivalence in Pregnancy • No questions asked about pregnancy, labor and delivery, infant care • No interest in fetus • Past negative experience with pregnancy or labor and delivery • Denial of pregnancy and fetal movement • Pregnancy and parenthood interfering with life style • Continue activities that may hurt the fetus (smoking or drinking) • Reporting persistent and many physical complains.

  27. Rh Immunization • Check by Indirect Coombs test to detect antibodies in the serum that target red blood antigens to cause fetus hemolysis • Antibody titer > 1:16 indicates possibility of severe hemolytic diseases • Mother with Rh-negative: should receive Rhogam within 72 hours (any invasive procedure that may cause the mixing of the maternal blood with fetus)

  28. Psychosocial aspects of childbearing Theories 3. Psychosocial Change in the father: • Development of the father role • Participation in the childbearing cycle • Father-infant interactions and the father role • “The Couvade Syndrome”-bodily symptoms experienced by a father during the course of his partner’s pregnancy. 4. Psychosocial Change in Sibling view

  29. Adaptation to Pregnancy • Key terms: • Acquaintance • Ambivalence • Attachment • Avoidance • Bonding

  30. Mrs. H. 33 wks shared that her husband was afraid of harming the unborn baby during intercourse. Which is the best response of the nurse? • “Gentle vaginal intercourse is safe throughout pregnancy” • “each couple has a unique situation, bring your husband in for a talk with the doctor” • “The baby is well protected by your tissues, but if contractions occur, abstain and notify the doctor” • “vaginal Penetration is prohibited anyway during the last month of pregnancy because of the dangers of infection” 3

  31. When teaching prospective fathers about pregnancy and birth, the nurse should plan to include which priority information? • The possible difficulties in each trimester • The cost of caring and raising a child • The normal range of feeling that may experienced in different stages of pregnancy • The importance of his role in the act of conception and in the determination of the sex of the fetus. 3

  32. Pregnancy and weight gain • First Trimester: 2-4 pounds (0.9-1.8 kg), 1 pound per week (0.45 kg) during 1st & 2nd trimester • Total weight gain 13.18 kg or 29 pounds

  33. Pregnancy and Nutrition • Obesity: recommend to gain wt 7-11.5 kg • Underweight • Teenage pregnancy: low wt gain during pregnancy, associated with LBW infant 19% of the baby wt < 2000 gram decrease 7.4% of LWB infant if wt gain improve to 11kg (25 lbs). Frequent meal skipping and consumption of fast food (high salt, sugar, low vit and minerals)

  34. Risk of Obesity to pregnancy • Gestational diabetes • Urinary tract infections • Inadequate weight gain • Wound infection • Thromboembolism • PIH • Fetal monitoring difficulty • Prolonged labor • Fetal Macrosomia • Birth trauma

  35. Question-Nutrition In comparison with a single fetus pregnancy, nutrition needs when there are twins much include: • Increased calorie intake of 300 per fetus each day • Low-salt foods to prevent edema • Additional fluid intake of 2-3 glasses per day • Iron and folic acid needs for 10% more per day

  36. Warning Signs in Pregnancy • Headache • Altered vision: blurring, double vision, seeing spots • Nausea/vomiting • Epigastric pain/abdominal pain • Muscular irritability/seizures • Signs of infection:fever, burning in urination, flank pain, diarrhea, • Vaginal bleeding • Decrease or cessation of fetal movement

  37. Assessment for Neural Tube Defects • “open” neural tube defects leak alpha-fetoprotein (AFP) • Elevate AFP level in maternal serum and amniotic fluid may indicate the fetus has neural tube defects

  38. Amniocentesis • Performed around 15-18 weeks of gestation to identify genetic abnormality • Risk: • Trauma to the fetus, placenta, umbilical cord, or maternal structures • Infection • Premature labor and spontaneous abortion

  39. Amniocentesis Warning signs after receiving amniocentesis: • Body temperature elevation • Fluid leaking from the vaginal • Mild Cramping and abdominal aching • Decreased fetal movement

  40. Chorionic Villus Sampling • To detect genetic or chromosomal defects • Can be done in early pregnancy 9-10 weeks gestation • Risk: miscarriage 3.7-7.7%, 1.7% discrepancy of result between villus karyotype and fetus, rupture amniotic sac, chorioamnionitis, oligohydramnios, intrauterine growth retardation

  41. The Nonstress test • Check fetus well-being • Check fetal movement in relation to fetal heart rate acceleration • Reactive: HR acceleration with fetus movement • Non reactive: no HR acceleration with fetus movement

  42. Genetic Problem • Autosomal Recessive Disorders: 25% of the Risk of passing the disorder to each of their offspring. 1:4 chance of demonstrating the disorder, 50% change of being a carrier to the recessive trait, each child has 25% chances of not having the diseases and not being a carrier -Cystic fibrosis, PKU, Sickle cell anemia, -X-linked disorders: Hemophilia, color blindness, G6PD

  43. Nursing and family with Genetic disorders • Perform Karyotype examination • Genetic Counseling-support for decision making • Genetic screen for potential risk

  44. Assisting the client to cope with First-Trimester Discomforts • Nausea/vomiting-morning sickness • Ptyalism “excess saliva in the mouth” • Altered taste • Bleeding gums • Breast tenderness • Urinary frequency • Nasal stuffiness and Epistaxis • Increased vaginal secretion • Fatigue

  45. Ensure Safety and removing barriers to care • Promoting client safety: home, work, lifestyle, environment, danger/warning signs of pregnancy • Removing barriers: Social Economic factors, lack of insurance, inability to pay, lack of free prenatal service, limit access to prenatal care for economically poor women, limited or expensive transportation, small children, cultural

  46. Psychologic changes and concerns of a mother at 2nd Trimester • Aware of that the pregnancy can be recognized by others • Acceptance of pregnancy • Maternal role attainment: fetus movement fosters internalization and fantasy • Fantasies: binding to infants • Relationship with mother • Body image: begins to view fetus as separate form own body, change the perception of body boundary as protective barrier to fetus

  47. Question The nurse should assess for which developmental task of the pregnant women in her third trimester? • Bonding to the fetus in preparation for birth • Accepting the fetus as a wanted responsibility • Understanding the baby is an independent being • Preparing to separate from the fetus through the birth process

  48. Question-DM mother The nurse teaches the newly pregnant diabetic the importance of self glucose monitoring in the first trimester to prevent: • Hypoxia in the fetus • The onset of diabetes in fetus • Unusually large fetal development • Teratogenic effects of hyperglycemia

  49. Question- Preterm Labor Magnesium Sulfate may be prescribed as a tocolytic drug because one of the expected actions is: • Promoting diuresis • Lowering blood pressure • Inducing sedation and rest • Promoting smooth muscle relaxation

  50. Pain during labor • Analgesia: demerol (meperidine) • Sedative: Seconal and Nembutal • Narcotic analgesics: Fentanyl, Stabol • Anesthesia: Marcaine (Bupavacaine) Alfenta (Alfentani)