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Flashcards by Elizabeth Then, updated more than 1 year ago
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Created by Elizabeth Then
almost 6 years ago
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| Question | Answer |
| Models of care Biomedical and Social model | Biomedical: viewed as illness, managed according to timelines, reactive to symptoms, birth in hospital Social: normal physiological process, sensitive to issues, partnership with women and HCWs, family involved, place of birth somewhere comfortable |
| Models of care Choices of caregivers | public hospital, various professionals, private obstetrician, GP, mixed mode, midwife hospital, home, community |
| How often should the woman vist? | follow pattern traditionally - confirmed with GP First visit - history taken USS at 18 weeks to confirm dates Visits: 12-18 1st visit US, BP, uterine growth, listen to FH 4 weekly until 36 weeks then 2 weekly until 38 weeks then weekly 24 -26 weeks Blood sugar testing |
| Reminder - principles of ANC | open and reg communication - sharing info involve significant others accurate history assessment and screening of mother and baby information about pregnancy health promotion advice and education |
| Antenatal history | General health - cervical smears, smoking status, alcohol/drug, BP, pulse, urinalysis, meds, supplements, weight Medical illnesses- operations, procedures, blood transfusions, allergies, infections, physical sexual abuse mental health - depression, anxiety obsteric - contraceptives used, previous pregnancies and their outcomes social - supports, resources, employment, relationship (partner) |
| Antenatal history (cont) | family history - medical health probelms (cardiac, renal, resp, congenital, chromosomal) emotional - feelings, parenthood, feelings about preg, was it planned? cultural - identity, race, isolation, safety spiritual - beliefs, any that influence choices, needs current preg - last period, menstrual cycle history, expected date of birth, preg test confirmed or not |
| antenatal test - at each vist | feelings of mother information/education re preg, birth, feeding, parentiing, partner growth of foetus BP monitoring nutritional status Blood tests, scans, results Common probelms and their management questions from mother and partner or support person |
| Maternal and foetal well-being | weight prn gestation BP abdominal palpation Symphysial fundal height (measure of top of uterus to top of symphisis pubis to assess growth and development of baby) after 30 weeks - presentation and position of fetus fetal movements - 16- 20 weeks fetal HR - 12 weeks of more anti - D prophylaxis - rh -ve at 28 + 34 weeks |
| antenatal screening | blood screen maternal serum screening harmony prenatal test ? 18-20 week USS 26-28 week OGCT, CBP, Ab screen 35-39 week GBS ) Group B strep status) |
| Education | integral to good ANC may be organised or planned classes may be question - based discussion groups or individuals conducted by midwife, physio, dietician etc may be held in hospital, home, community information also gained by social media, books, family, friends |
| education should/could include | health promotion - nutrition, exercise, reduction in hazard substance use preparation for child birth - plans, process of birth, expectation, coping preparation for early parenting - care of new born, settling, crying, sleeping, SIDs risk |
| Discomforts during pregnancy | * mostly due to hormonal changes and growing uterus - nausea, vomiting, due to rise in beta HCG - reduced GIT motility -constipation, haemorrhoids - progesterone effects -pruritis in vagina -fluid retention/oedema - changes in CV (increased venous pressure) |
| Nausea and vomiting | 80-85% of pregnant women onset 5-6 weeks - 8 most resolved by 12-14 weeks or 16-18 weeks cause: raised beta HCG/changes in BSL not confined to morning altered sense of taste and smell |
| Nutrition for discomfort and pregnancy common disorders | N/V - small frequent meals, avoid spicy foods, eat carbs, eat protein before heading to bed, reduce coffee/tea constipation - mild laxative okay (lactulose), increase water intake, high fibre reflux- small frequent meals, eat slowly, avoid fatty spicy foods |
| management of other discomforsts | Haemorrhoids - reduce constipation, topical creams pigmentation - ? bio oil gum bleeding - rinse mouh, cool fluids, soft brush pruritus - good hygiene, wear cotton underwear, use topical creams lordosis - good posture |
| anaemia in pregnancy | blood volume increases 30-50% between 7 - 34 weeks gestation plasma increases at a faster rate leads to haemodilution hb conc is decreased 100-150g/l fetus needs iron for growth iron supplements if low hb 26-28 week screen |
| Infections during pregnancy | can lead to maternal and foetal morbidity and mortality reduced foetal growth risk of transfer to foetus - intra-uterine transfer vertically during birth can be bacteria, viruses, parasites, fungus identified through antenatal screening treated with abx |
| effects of infections maternal and foetal | maternal: miscarriage, still birth, ectopic preg, septicaemia, meningitis foetal: neonatal sepsis, death, low birth weight, resp distress, blind, deaf |
| Labour definition | process by which fetus, placenta, and membranes are dispelled from the uterus through the birth canal |
| Labour defined - normal | spotaneous term onset foetus presents head down (vertex) completed in 12- 18 hours no complications |
| pre labour | changes in last few weeks of pregnancy braxton hicks contractions |
| signs of false labour | contractions are not regular cervix does not dilate no progress |
| Onset of labour | less precise in human species not fully understood numerous hypotheses foetal trigger, uterine stretch, role of hormones |
| four essential forces of labour | passage, passenger, powers, psyche |
| passage defined | pelvis: critical measures are width and length curve and length of sacrum angle bones |
| passenger defined | foetus: skull size, diameter flexion of body and head presentation - head first or buttocks position - back of head (occiput) versus maternal pelvis foetus adjusts position when they negotiate the birth canal |
| foetus negotiating positions in birth canal | descends, flexes, rotates, extends, expulsion |
| powers defined | contractions: start at top of uterus stronger in upper area weakest in lower area uterine muscles retract become shorter and thicker cervix opens electrical and contraction activity - controlled by: muscles, nerves, hormones slow rhythmic fluctuations of pressure that can be graphed monitor FHR in response to contractions |
| Maternal position | standing, squatting, kneeling, sitting - relaxes uterine wall, enhances descent of uterus, reduces backache, improves placental perfusion, increases cervical pressure side lying - does not optimise foetal alignment with pelvis and descent of foetal forehead does not maximise pelvic diameters lengthens labour |
| psyches -defined | factors affecting - self confidence, pattern of coping with stress, expectations of birth, attitudes to birth, response to stress, anxiety, pain |
| signs of true labour | contractions: reg, rhythmic, increase in length, strength, frequency show: pink/red mucous vaginal discharge, detaching chorion from cervis |
| Stages of labour - stage one | contractions become longer, frequent, stronger dilatation of cervix - 0-10 cm |
| care during first stage of labour | encourage mobility change position often keep up food/fluids provide support manage discomfort monitor maternal + foetal well-ceing watch for signs of birth and prepare |
| management of discomfort | diversion therapy breathing exercises meditation hypnotherapy inhalation - nitrous oxide IM analgesia=pethidine epidural /spinal |
| Stages of labour - stage 2 | from full dilatation of cervis until expulsion of foetus |
| care during stage 2 of labour | monitor maternal wellbeing monitor foetal heart rate and rhythm watch for signs of foetal head crowning |
| stage of labour - stage 3 | expulsion of placenta and membranes |
| care during third stage | watch for signs of separation cord lengthens gush of fresh blood placenta visible at vaginal opening watch for bleeding (normal up to 500mls) |
| variations on normal | spotaneous vaginal birth (normal) induced vaginal birth breech birth (normally LSCS) instrument birth - forceps/ventouse elective caesarian section (LSCS) emergency caesarean section |
| pueperium | the time period from end of labour and birth until reproductive organs have returned to their pre-pregnant state usually takes 6 weeks also called postpartum or postnatal period |
| involution | reproductive organs return to pre-pregnant state uterus contracts immediately after birth starts involution takes 6 weeks in total |
| Involution - uterus | uterine contractions: reduce bulk and size over time, from 1000gms to 50gms, fundus at umbilicus after birth - very firm, slowly decreased until non-palpable placental site: sealed off by muscle contractions, thrombi form within uterine blood sinuses and seal off area, endometrial tissue covers site, no scar left |
| Involution - lochia | vaginal discharge after giving birth decidua (uterine lining during pregnancy) is shed and new endometrium begins to grow vagina blood flow after childbirth up to 6 wks postnatal consists of decidua cells, wbc, mucus, bacteria |
| Involution cont | clotting factors raised - potentional for thrombis cervix softens and reduces blood vessels ovaries, vagina, vulva, pelvic floor return to normal menstrual cycle returns 12-18weels breast feeding takes longer |
| Breasts | reproductive organ in a progressive state oestrogen and progesterone withdrawal after birth stimulates- prolactin to produce milk, oxytocin to contract milk ducts |
| other changes | cardiac reduction of blood volume through urine output and perspiration - 48 hours watch bladder tone * WCC increase as body defense against infection and aids healing abdo and pelvic floor gain tone falling progesterone - GIT increases motility less constipation * watch first few days of reflex inhibiton of defecation by perineal trauma and discomfort |
| Maternal health assessment/ care | fundal height - firm, reducing 1cm a day (top of pubic bone to tip of uterus) lochia - amount, color vital signs - infection bowel use bladder use - tone, output perineum/wound - clean legs breasts/nipples hydration/diet |
| perineal care | pain relief important and underestimated ice packs 20 min onn/off hygiene frequent pad changes observe for healing, bruising, haematoma avoid constipation encourage pelvic floor exercises |
| bladder care | encourage voiding ensure sufficient voiding (200-300 mls) 4-6 times a day incontinence a hidden probelm pelvic floor exercises important |
| post natal fatique | common can take 2 months related to sleep disturbance before and into postnatal period loss of energy |
| postnatal exercises | perineal trauma and pain can add loss of sensation, pelvic floor care, back care, abdominal care |
| education | lactation physiology infant care pelvic floor/back exercises feeding community resourses |
| psychosocial care | hormonal changes physical changes social and cultural expectations bond with baby eye, physical contact early breast feeding/care |
| breast feeding | best and healthiest way for infant and mother formula not the same as breast mile unique formula of nutrients and other substances needed for the baby's growth and cell function |
| nursing process | assessment - during pregnancy, labour, birth, post natal periods important planning- care with woman, partner, HCW implementation - evidence based care, safety of mother and baby evaluate - effectiveness of care reflection - on care and overall process |
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