Care of Mother and Child Reviewer

RHEUMATIC HEART DISEASE  Electrocardiogram (ECG/EKG)- rhythm, rate of electrical impulses

ANATOMY AND PHYSIOLOGY  Echocardiogram- heart can be seen through sound waves
Inferior Vena Cava Superior Vena Cava
Right Atrium MEDICAL MANAGEMENT
 Penicillin G. – inhibits bacteria cell wall synthesis
Tricuspid Valve  Aspirin- it is given because there is a stenosis (makipot ang daanan kaya need
palabnawin ang dugo); anti-platelet
Right Ventricle
SURGICAL MANAGEMENT
Pulmonary Semilunar Valve  Mitral Valve Surgery- it is repaired through cardiac catheterization (through jugular
vein)
Pulmonary Artery -cardiac catheterization can measure the pressure in the heart
(only artery that carries un-oxygenated blood)
NURSING MANAGEMENT
 Pregnant supervision- They are given prophylaxis
LUNGS  Bed rest (lack of oxygen)
 Provide oxygen if needed
Backflow of blood Pulmonary Vein  To reduce anxiety, allow the patient to express his concerns about the effects of activity
causes difficulty of (only vein that carries oxygenated blood) restrictions on his responsibilities and routines. Reassure him that the restrictions are
breathing temporary.
Left atrium  Focus on monitoring (Mother: Vital Signs; Baby: Fetal Heart Rate (to know if there is a
fetal distress because of the lack of oxygen)
Bicuspid Valve
Stenosis- narrowing
(Primary problem of RHD) NURSING DIAGNOSIS
of bicuspid valve
1. Ineffective tissue perfusion related not enough circulation of oxygen to the body
Left Ventricle 2. Acute pain related to inflammation
3. Hyperthermia related to inflammatory disease
Aortic Semilunar Valve 4. Activity intolerance related to decrease cardiac output
5. Deficient knowledge related to lack of information
Aorta 6. Risk for infection related to chronic recurrence of disease
COMPLICATIONS
 Heart Disease GESTATIONAL DIABETES MELLITUS
 Congestive Heart Failure A. TYPE 1: Insulin Dependent Diabetes Mellitus (IDDM)- not enough production of insulin
 Stenosis of mitral/ bicuspid in the pancreas
 Inflammation of myocardium and pericardium (Cardiomegaly) -main problem is the pancreas
 Exocrine- production of pancreatic lipase
RIGHT SIDE OF THE HEART LEFT SIDE OF THE HEART -aid for digestion
- It manifest in the body - It manifest in the lungs  Endocrine- Islet of Langerhans (B-I; A-G)
- Vena cava and coronary sinus - Congested (backflow of blood to Beta cells- Insulin; Alpha cells- Glucagon
- Hepatomegaly (liver) lungs) -Puno ang glucose ang blood or hyperglycemia that
- Facial edema - Crackles (abnormal breath produce insulin (beta cells); starving need enough energy so it produce
- Jugular distention sounds) glucagon (alpha cells)
- Bipedal edema -Pancreatitis- auto digestion; produce more pancreatic lipase (thru eating fatty
foods)
Streptococcal infection- is the causative agent of RHD -NO TO ORAL HYPOGLYCEMIC AGENTS (OHA) because this type needs insulin
-causes sore throat B. TYPE 2: Non-dependent Diabetes Mellitus)- for adult
MODIFIABLE RISK FACTORS NON-MODIFIABLE RISK FACTORS -there’s a production of Insulin but not enough for them (kain ng kain)
 Lifestyle  Age -fat (mataba)
 Stress  Family History (Genetics) -NEED ORAL HYPOGLYCEMIC AGENTS (OHA)
 Environmental Factors  Pregnancy ATP= Glucose (food of the cell) + Oxygen

SIGNS AND SYMPTOMS SIGNS AND SYMPTOMS

 Fever  Polydypsia- excessive thirst
 Tender joints -Ang iniihi ang watery kapag naubos makakaramdam ng uhaw
 Chest Pain  Polyuria- frequent urination
 Heart Murmur -High sugar; maraming finifilter si kidney kaya marami lagi ang iniihi
 Polyphagia- rise in appetite (cellular starvation)
ASSESSMENT FINDINGS (Cardiac Disorders)
F- fatigue C. TYPE 3: Gestational Diabetes Mellitus (GDM)
R- rales (abnormal breath sounds) -increase hormone prone to DM (women); for pregnancy
E- edema of the face (right sided heart) -resistant to insulin
E- edema of the upper and lower extremities (right sided heart) -hormonal imbalance
P- palpitations and pulmonary distention -GDM (mommy)- baby has hypoglycemia since mommy’s sugar is high the
H- heart murmur baby will produce insulin
O- orthopnea (difficulty of breathing during supine) -high insulin; low sugar (causes the baby not to cry and grimace)
N- neck vein distention (jugular veins)
E- edema of eyelids COMPLICATIONS
C- cardiomegaly  Diabetic nepropathy- cause of death: CKD
D- dyspnea -kidney is overused
 Diabetic retrinopathy- nerves in the eyes will be destructed since there’s no enough
Fetus: oxygen
1. 2-4% of acquisition of disease -malapot ang dugo tapos dinaluyan kaya pumuputok; kadalasan nabubulag
2. Fetus may die -no oxygen to baby since sobrang liit ng ugat kaya pumuputok ang ugat
3. Intrauterine Growth Retardation (IUGR)- stenosis is present so there is a deprived in (Retrolental fibroplasia)
oxygen and nutrients; not enough circulation to the baby)  Diabetic neuropathy- cramps (namamanhid)
4. Miscarriage
5. Anemia- not enough circulation; stenosis Complications to Mother
6. Severe Fetal Distress- not enough oxygen (circulation)  Urinary Tract Infection (UTI)- high glomerular filtration; high sugar in urine
7. Prematurity- placenta has no blood supply  Diabetic ketoacidosis (DKA)- Type 1 DM; it has acidosis (has ketones)
-Protein is used instead of CHO; Ketones is acidic and product of protein
Ductus arteriosus- will close if the baby can breathe alone (cut the umbilical cord) metabolism that causes acidosis
-kapag di nagclose yun ang sinasabing may butas ang puso -Respiratory acidosis- has Kussmaul’s respiration (Death battle- naghihingalo)
-no enough blood supply so the placenta will detach  Hyperglycemic Hyperosmolar Non-ketotic Coma (HHNC) – Type 2 DM; no ketones
Glucose- simplest sugar (CHO)
MODE OF TRANSMISSION  Birth Injury light laceration
 Group A beta-hemolytic Streptococci  Preterm labor
 Airborne droplets  Spontaneous abortion- not enough blood supply
 Sharing of food or drink with sick person
Complications to Baby
DIAGNOSTIC PROCEDURES  Macrosomia
 Physical Examination  Respiratory distress- Doppler or stethoscope
 Medical History  Congenital anomalies
 Chest-X-ray  Fetal Death
 Blood Tests  Growth retardation- not enough circulation of blood
 Swab Test- Culture and Sensitivity (C and S)  Neonatal hypoglycemia
 Care of Mother and Child Reviewer
DIAGNOSTIC PROCEDURES MEDICAL MANAGEMENT
 Random Blood Sugar (RBS)- using glucometer  Rh immune globulin (RhoGAM) as prophylaxis
 Fasting Blood Sugar (FBS)- 6 - 8 hrs
-80 – 120 mg/dL NURSING MANAGEMENT
-<80 hypoglycemia  Coomb’s test or early detection
- using glucometer  Psychological care to mother
 HBA1C- Glycocylated hemoglobin  Peri Light or sunlight if the baby has jaundice
-sugar attached to RBC or Hgb  Amniocentesis for bilirubin levels
-high sugar than RBC (means you are not taking your meds)  Serial ultrasound
-RBC- will live for 120 days  Measurement of antibody levels in titers
 Oral Glucose Tolerance Test (OGTT)- may iispray tapos ichecheck kung ilan ang glucose
IRON DEFICIENCY ANEMIA
Oral Hypoglycemic Agents (OHA)- Type 2 DM -develops when body stores iron drop too low to support normal red blood cell (RBC)
-Biguanide- metformin production
The baby will undergo Cesarean Section since baby is microsomia (di kasya sa pelvic inlet)
Anemia- decrease RBC; RBC is absorbed; iron is absorbed in the stomach (B-complex)
Pelvimitri- measure the pelvic inlet
B9 (Folic Acid)- maturation of RBC
Hypergylcemia- lack of insulin in the body but more than insulin to blood -possible to have anemia

NURSING CONSIDERATIONS CAUSES

 Self-administration in fatty parts (abdomen and arm)  Nutritional deficiency- iron and B9
-it can cause lipodystrophy if the administration is not put in different area of  Surgical procedure in the stomach- the intestine factor is destroyed (absorbed folic acid
fatty parts and B6)
 Avoid fruits; since fruits is CHO  Inadequate level of hemoglobin- because of bleeding; Girls are prone to anemia
-fruits (fructose) to glucose (END) NSD: 500ml of blood (Blood loss)
 Swimming is good for pregnant women; no pressure and good for breathing CS: 1L of blood
 Check the onset, peak (kalian pwede kumain), duration (susunod na administration) of  Smoking
insulin  Medications
 CKD- prone to anemia
Peak Kidney- RAA System (blood pressure)
-bicarbonate (acid-base balance)
-filtration of wastes
-Erythropoietin- bone marrow

Onset DURATION SIGNS AND SYMPTOMS

C- cheilosis (inflammation in the lips)
INSULIN H- headache (decrease oxygen)
E- easy fatigue (decrease oxygen)
C- craving (PICA eating- un-edible eating)
K-koilonychia (spoon shape nail)
P-pallor (paleness)
A- a persistent ringing in the ears(Tinnitus)
D- dizziness
S- smooth and sore tongue

Maternal Effects
 Infection- no nourishment
Hypo Dehydration Hyper Intracranial
Tachy Anemia Brady pressure
Tachy Brady
RH SENSITIZATION
 Preeclampsia- hypertension before pregnancy
If you are Rh negative, your red blood cells do not have a marker called RH FACTOR on them, Rh
 Post-partal hemorrhage
positive blood does have this marker, if your blood mixes with Rh-positive blood, and your immune
 Delayed healing of episiotomy
system will react to the Rh factor, by making antibodies to destroy it. This immune system, response is
-low RBC not capable of healing (di narereach ng circulation)
called RH SENSITIZATION
BLOOD
Fetal Effects
 Low nourishment- low birth weight
protein in  Prematurity and preterm
ABO RHESUS (RH)
the blood  Still birth- pinanganak ng patay
 Neonatal death of infants
Antigen Antibody Negative Positive
Hindi parehas ang Rh sensitization DIAGNOSTIC PROCEDURES
Rh – (asawa) lalabanan ni Rh + o Complete Blood Count (CBC)- check hemoglobin- 10g/dL
A+ A-
B+ B- yung Rh- na meron sa katawan -Hematocit- checks concentration and dilution of blood (33%)
O+ O- universal donor which is si abby; Unang anak -Hemoconcentration- high HCT
AB+ AB- universal recipient buhay dahil doon palang agagwa -Hemodilation- low HCT
28 weeks- may sarili ng blood supply; organogenesis ng antibodies
NURSING MANAGEMENT
Hemolysis- fight yung antigen through human antibody  Monitor BP and HCG level
 Iron through nutrition
SIGNS AND SYMPTOMS  Oral iron supplement and folic acid supplement
 Jaundice- build up of bilirubin created from the breakdown of RBC  Packed RBC- transfusion or PRBC
a. Physiologic jaundice- may baby na madilaw na talaga paglabas Fresh whole blood- parang puputok (hemorrhage)
-pinapainitan sa araw Packed RBC0 medyo walang laman (anemia)
-unconjugated to conjugated  Dextran (IV fluids)- plasma expander
b. Pathologic jaundice- cause of a disease kaya may jaundice
 Lethargy- low oxygen because of destruction of RBC that causes anemia NURSING CONSIDERATIONS
 Low muscle tone  Take with Vitamin C when taking iron before meal
 Spenomegaly- bloated si baby; full of destructed RBC  Liquid: Taken with straw since it stains in the teeth
-Spleen- storage of destructed RBC
HYPEREMESIS GRAVIDARUM
DIAGNOSTIC PROCEDURES -pregnancy complication that is characterized by severe nausea, vomiting, weight loss, and
 Blood Tests (Coomb’s Test)- repeated between 24 and 28 weeks of pregnancy possibly dehydration
a. Indirect- 24 to 28 weeks kukuha ng blood sample kay moyher to -1st trimester: morning sickness; 2 nd trimester: hyperemesis
determine Rhesus of the baby
-kapag hindi nagganto pwede malaglag yung next baby CAUSES
b. Direct- paglabas ni baby directly na kay baby kukuha  unknown (idiopathic) associated with H. pylori *Helicobacter pylori) that causes peptic
ulcer
Rhogam- injected to mother so that the antibody will not grow (28 weeks)  Human Chorionic Gonadotrophin (HCG)- rapid growing cells produce HCG
-as prophylaxis
-next dose is after delivery Metabolic alkalosis- because of acidity
 Doppler ultrasound -decrease potassium (vomiting)
 Amniocentesis after 15 weeks Vomiting- alkalosis
Diarrhea- acidosis
 Care of Mother and Child Reviewer
SIGNS AND SYMPTOMS -FSH and LH- production of egg cell
 Dehydration
 Nutritional disorders CAUSES
 Physical and emotional stress- decrease energy -main is inflammation; previous D and C
 Metabolic acidosis C- congenital anomaly (problem sa body ni mother); common to those who has scoliosis
 Low body weight A- advance maternal age (sobrang tanda wala ng cilia)
U- use of ovulation inducing drug (if you take it magproproduce ng egg cell)
H- headache and hypotension- low blood volum e S- salpingectomy (removal of fallopian tube)
A- acetone urine E- endometriosis (cancer in the uterus)
V- vertigo - oxygenation H- high level of progesterone (DMPA- Depomedroxy progesterone acetate)
E- eventual weight loss I- Infertility
T- thirst- high PR and RR P- pelvic inflammatory disease (having inflammation has problem to implantation)
H- hiccups- acid gas forming S- smoking (cilia is being removed)
E-electrolyte imbalance- potassium
M- metabolic akalosis SIGNS AND SYMPTOMS
J- jaundice A- amenorrhea (pregnant kasi siya and increase hormones to supply the pregnancy)
O-oliguria- decrease urine production A- abdomen rigid (peritonitis- inflammation of peritoneum); wood like abdomen (matigas)
I- increase hematocrit- hemoconcentration because loss of H2O B- bleeding (1st trimester = ectopic pregnancy); over stretched may bleeding
N- nausea and vomiting D- decreased hemoglobin (bleeding)
S- starvation I- increased hematocrit (lack of fluids; hemoconcentration)
N- nausea and vomiting (increase HCG due to growing fetus; pain)
Blood Urea Nitrogen (BUN)- kidney function test through urine P- pain (sharp stabbing); Paghindi na masakit ibig sabihin nagrupture na
-nilalabas ang di dapat ilabas P- pulse rate (Hypo, Tachy, Tachy because of bleeding)
S- syncope (fainting, decrease oxygen because of low Hgb)
Creatinine- through blood C-allen’s Sign (bluish discoloration of the umbilicus; signal hemorrhage in the abdomen; lack of
-hindi nalabas si creatinine oxygen in the abdomen)

MEDICAL MANAGEMENT Sufficient supply- iyan yung nagrurupture; continuous ang growth ni embryo
 Intravenous Fluid
 Anti-emetics Insufficient supply- hindi continuous ang growth ni embryo
 Metoclopramide- antiemetic (Placil)
Bonamine- antivertigo Uterus- capable to stretch so kapag sa fallopian tube nafertilized magrurupture yon
 Antacid- anti-acid; Al Mag-aluminum magnesium
COMPLICATIONS
H2 Receptor Antagonist- before and after meal H- hemorrhage (rupture)
-Histamine 2; Antihistamine- low HCl I- infection (bleeding)
-Ranitidine- prophylaxis; prevent hyper acidity production P- pain
S- shock (Hypovolemic shock); because there is bleeding
Proton Pump Inhibitors (PPI)- before meal
-Omeprazole- inhibits HCl DIAGNOSTIC PROCEDURES
◦ Pelvic exam - to check the size of your uterus and feel for growths or tenderness in your
Cytoprotective Coater- sucralfate (Gaviscon) belly.
◦ Blood test - that checks the level of the pregnancy hormone (hCG). (Repeated 2days
HNBB- Buscopan; Antispasmodic- prevents spasms; given before for giving birth for the quick later)
effacement of cervix ◦ Ultrasound - This test can show pictures of what is inside your belly. A doctor can see a
-not given to patient with Hyperemesis gravidarum pregnancy in the uterus 6 weeks after your last menstrual period.
a. Transvaginal sonography (TVS)
Protaglandin Analogue- cytolec (abortion) b. Pelvic ultraouns Ultrasound
-antiulcer drug ◦ Magnetic resonance imaging (MRI) - may be used to safely monitor your baby. It may
-not given to patient with hyperemesis gravidarum it can cause abortion to the baby be used to help diagnose or monitor treatment for ectopic pregnancy.

NURSING MANAGEMENT MEDICAL MANAGEMENT

1. Monitor and Correct the electrolyte imbalance  Methotrexate- it works by stopping the growth of the fertilized egg before a rupture
2. Make sure patient is in NPO (30 min to 1 hr) occurs. Sometimes, methotrexate is combined with surgery to treat an ectopic
3. Provide good oral and care before meals pregnancy; chemotherapeutic drug
4. Try frequent meals high in protein and potassium
5. Prevent highly seasoned foods SURGICAL MANAGEMENT
6. Provide emotional support  Laparoscopic procedure- In this procedure, a small incision is made in the abdomen,
7. Adequate nutrition and rest near or in the navel. Then the doctor uses a thin tube equipped with a camera lens and
light (laparoscope) to view the tubal area.
ECTOPIC PREGNANCY  Salpingostomy- removal of some part of the fallopian tube
-it is the implantation outside the uterine cavity  Salpingectomy- removal of the whole fallopian tube
-loss of cilia; for aged women
NURSING MANAGEMENT
Luteinizing Hormone- responsible for the production of stimulation of FSH 1. Ensure that appropriate physical needs are addressed and monitor for complications.
Assess vital signs, bleeding, and pain.
Follicle Stimulating Hormone- responsible production and maturation of egg cell 2. Provide client and family teaching to relieve anxiety.
 Explain the condition and expected outcome.
Pregnancy= if the ovum is fertilized  Describe self-care measures, which depend on the treatment.
3. Address emotional and psychosocial needs.
Menstruation= if the ovum is not fertilized= menstruation
NURSING DIAGNOSIS
LOCATION  Risk for Deficient Fluid Volume related to bleeding from a ruptured ectopic pregnancy.
F- fallopian tube- ampular or tubular; common site of ectopic pregnancy  Grieving
F- fimbrial (indifundibular)
O- ovarian (move to ovaries)
C- cervical (common with patient who use contraceptives HYDATIDIFORM MOLE/ GESTATIONAL TROPHOBLASTIC DISEASE
A- abdominal (common to patients who undergone surgery in the uterus) SIGNS AND SYMPTOMS
I- isthmic or infundibular (same with fimbrial)  Abnormal uterine bleeding accompanied by discharge of the clear fluid-filled vesicles
I- interstitial- dangerous ectopic pregnancy; ruptured fallopian tubes and uterus; Total  Ovarian enlargement
Abdominal Hysterectomy Bilateral Salpingectomy Oophorectomy (TAHBSO)  Absence of fetus
 Hyperemesis gravidarum- increase HCG; one cause of anemia
 Anemia- bleeding; one cause of preelampsia
 Respiratory distress
 Preeclampsia signs such as proteinuria, hypertension, and edema before 24 weeks of
gestation- increase HCG;

COMPLICATIONS
P- pulmonary embolus (kumakalat sa lungs (blood clot))
A- anemia- high HCG and bleeding
T- thromboplastic embolization
C- choriocarcinoma- prone to cancer
H- hyperthyroidism (high in hormones or HCG; since thyroid is producing hormones)
Bleeding- bright red because fresh blood is released
E-embedded infection- bleeding
D- disseminated intravascular coagulation- coagulate
Hypothalamus-releases HCG
 Care of Mother and Child Reviewer
PATHOPHYSIOLOGY
st
1 trimester- no organogenesis happen; best time to do ultrasound (hindi pa affected yung growth ng Pregnancy
embryo); wala pang symptoms Trigger uterus
Increase growing weight
2nd trimester- organogenesis Increase pressure- it happens during 2 nd trimester
Passive opening of the uterus
Bleeding- kasi di makabuo ng embryo; walang embryoblast puro trophoblast; instead na mabuo si baby Membrane protruding
nabubuo ang grapelike fluid vesicles; prune juice like bleeding with vesicles (violet color) Pregnancy low

FACTORS PREDISPOSING FACTORS

 Genetics  Genetics/ Congenital
 Age- under 17 and over 35; another disease for older adult  Age
 Pregnancy  Lifestyle
 Ethnicity- common to Asian because of low of protein intake (panay CHO)  Stress
 Previous mole
 Previous abortion SIGNS AND SYMPTOMS
 Lifestyle- low protein intake and folic acid  Pelvic pressure
 Rh Sensitization  Cervical dilation
 Pink-tinged vaginal fluid
Diagnostic PROCEDURES
 Transvaginal ultrasound- most accurate tool for diagnosing the presence of a mole DIAGNOSTIC PROCEDURES
 Serum HCG- it is assessed every 4 weeks for the next 6 to 12 months to see if it is  Ultrasound- 1st trimester
declining. If the plateau increases, it suggests a malignant transformation is occurring.  Pap Test- Papa Nicolau Smear (possible may tumor kaya laging may miscarriage)
 Chest X-ray or Lung Computerized Topography- these tests will be ordered if H mole  Cervical Biopsy
pregnancy is already confirmed and metastasis is a big concern since Choriocarcinoma  Coloscopy
and other GTD spreads really fast  MRI Scan
 HPV Scan- Human Papilloma Virus (no. 1 cause of cancer)
MEDICAL MANAGEMENT
 HCG Monitoring- it is done after a molar tissue is removed, the doctor will repeat SURGICAL MANAGEMENT
measurements of your HCG level until it returns to normal. o McDonald’s Cervical Cerclage
 Methotrexate- prophylactic course given to women who have had gestational o Shirodkar Cervical Cerclage
trophoblastic disease; drug choice of choriocarcinoma; chemotherapeutic drug
 Dactinomycin- added to regimen if metastasis occurs Complications of Cerclage- there is a complication since Cerclage is a foreign material
 Premature Rupture of Membranes (PROM)- nabubutas kaya ang end kailangan
SURGICAL MANAGEMENT ideliver si baby
 Dilatation and curettage (D & C)- is a process of evacuating abnormal tissues from the  Rupture of the urinary bladder- malapit ang bladder sa uterus kaya pwede
uterus. The curette is used to scrape the walls of the uterus. The doctor will measure a magrupture since nylon/bakal an cerclage
patients hormone levels for 8 weeks to a year to ensure that the treatment has been
fully successful. If hormone levels rise, further treatment, often with chemotherapy may NURSING INTERVENTIONS
be needed. 1. Monitor vital signs
 Hysterectomy- is used to remove benign moles when the woman being treated does 2. Convey empathy and establish therapeutic relationship
not wish to have anymore children. It may also be used to treat placental site 3. Anxiety
trophoblast tumors which are often resistant to chemotherapy. 4. Trendelenburg position- 2nd trimester; para iwas pressure
 Chemotherapy- the doctor commence this as a last resort due to the toxic effects of CBR š BP (Complete bed rest without bathroom privileges
chemotherapy medications.  -you can use diaper or catheter but, catheter can cause CAUTI (Catheter
 Biopsy- to determine if it is cancerous Associated Urinary Tract Infection) that can cause miscarriage infection; so better use
bed pan
NURSING MANAGEMENT
o Advise that they need an early screening with ultrasound NURSING DIAGNOSIS
o Monitor for evidence of hemorrhage such as abnormal vital signs, abdominal pain,  Activity intolerance- because of hospital constriction
uterine status, and vaginal bleeding  Anxiety r/t loss of pregnancy
o Teach deep breathing techniques to alleviate the pain. Use diversional activities if  Risk for maternal injury
possible.  Risk for fetal injury
o Prepare for surgery according to preoperative protocol and type and cross-match 2 to 4  Anticipation grieving
U of fresh whole blood as ordered.
o Provide emotional support and explain to the patient that it is not her fault. ABRUPTIO PLACENTA
o Discuss family planning methods available for her -premature separation of placenta occurs during late pregnancy
o Advise to use reliable contraceptive method such as an oral contraceptive agent -suddenly it begins to spate causing bleeding
o Remember to reiterate the importance of monitoring the hcG levels and follow-ups. -3rd trimester (1st or 2nd stages of labor)
a. Concealed- if separation is at the center there is a bleeding; No s/sx
Post-evacuation Nursing Intervention b. Hemorrhage- detachment at the corner
o Monitor for postoperative complications such as hemorrhage, respiratory compromise,
and altered urinary elimination related to the antidiuretic effect of oxytocin SIGNS OF PLACENTAL SEPARATION
o Do not massage a boggy uterus if ovaries are enlarged because the massage can cause  sudden gush of blood
 lengthening of the cord
ovarian rupture
 changing shape of the uterus
o After D & C patient is at risk for infection. Make sure the patient has good perineal
hygiene
There is a detachment of placenta since there is not enough circulation; no blood supply; detachment
on the endometrium
NURSING DIAGNOSIS
 Anticipatory grieving related to loss of pregnancy
 Anxiety related to maternal condition and pregnancy outcome CAUSES
 Powerlessness related to complex treatment C- cigarette (nicotine- potent vasoconstrictor) (decrease perfusion)
 Hopelessness related to deteriorating physiological condition A- advance maternal age
T- thrombophilitic disorder (Disseminated Intravascular Coagulation or DIC)
C- chronic hypertensive disease (decrease perfusion)
H- high parity (no. of deliveries)
INCOMPETENT CERVIX S- short umbilical cord
-is a condition that refers to the inability of the cervix to hold the baby until term because it P- pregnancy induced hypertension
dilated prematurely D- direct trauma
-2nd trimester
STAGES OF LABOR
Cervix- it is the cylinder shape like that of tissues that connects the vagina to the uterus; fibromascular L- latent (0-3 cm)
tissue detachment of placenta (Abruptio placenta)
A- active (4-7 cm)
-responsible for pregnancy and menstrual cycle; it dilates during pregnancy and menstruation T- transitional (8-10 cm)
-it is the one that effaced and dilated
-10 cm (fully dilated) To determine if the baby has no enough oxygen you will monitor it through FHT (Fetal Heart Tone)
-NO EFFACEMENT BUT CERVIX IS DILATED baka kasi may Abruptio Placenta na
a. Endocervix- opening of the cervix that leads into the uterus. It is covered
with glandular cells. SIGNS AND SYMPTOMS
b. Ectocervix- outer part of the cervix that can be seen by the doctor during a speculum  Tearing pain
exam. It is covered in squamous cells.  Heavy bleeding
 Uterus is tense and rigid
COMPLICATION
H- habitual miscarriage DIAGNOSTIC PROCEDURES
 Hemoglobin level and fibrinogen level
 Care of Mother and Child Reviewer
 Prothrombin Time (PT)- warfarin  Prolapsed umbilical cord- Caesarean Section
High PT- prone to bleeding Normal: Contraction  Rupture of bag of water
Low PT Warfarin
Warfarin Toxicity = Vitamin K If the mother has infection:
-how fast the blood coagulate  Increase WBC- Normal during pregnancy
-mahaba ang oras mas tumatagal ang coagulation  Continuous high grade fever
 Partial Thromboplastic Time (PTT)- Heparin  Amniotic fluid- cloudy (presence of infection)
Low PTT- heparin; prone to coagulation -Normal color: clear
Heparin Toxicity = Protamine Sulfate -Bad odor (infection)
 Abdominal Ultrasound
 Complete Blood Count (CBC)- low RBC (Hgb); high HCT (Hemoconcentration) Kapag may presence of infection kailangan mag-antibiotics and deliver of baby

MEDICAL MANAGEMENT Choroamnionitis- common infection of amniotic fluid; possible of fetal death
 Intravenous Therapy
 Oxygen Inhalation SIGNS AND SYMPTOMS
 Fibrinogen determination  Increase Fetal Heart Tone

COMPLICATIONS DIAGNOSTIC PROCEDURES

 Hemorrhage  pH level
 Shock (Hypovolemic shock)- treatment for it is oxygen therapy and fresh blood  Speculum examintation
 Ultrasongraphy
SURGICAL MANAGEMENT  Check fr ferning (ferning test: color blue)
 Caesarean Section (CS)  Check for Nitrazine paper- for pH level
 Hysterectomy -check if the amniotic fluid that turns into blue
Acidic: red
NURSING MANAGEMENT Neutral: yellow
 Monitor Fetal Heart Tone (FHT) Alkali: blue
 Place the pregnant woman in left lateral position to avoid stress -vaginal secretion: 4.5- 6  acidic
 Avoid performing any vaginal or abdominal examination to prevent injury -urine: 6  acidic

NURSING DIAGNOSIS MEDICAL MANAGEMENT

Deficient fluid volume r/tbleeding during premature placental separation  Corticosteroids- lungs maturation; produce surfactant
 Betamethasone
Shock  Dexamethasone- possible premature si baby pero kahit hindi premature bibigyan parin;
pass through blood brain barrier
PLACENTA PREVIA  Antibiotics- infection; Ampicillin and Amoxicillin
-lies low in the uterus; low lying placenta
-third trimester SURGICAL MANAGEMENT
-has painless bleeding  Caesarean Section (CS)- sign of infection and prolapsed of the cord

CAUSES NURSING MANAGEMENT

H- history of suction curettage and Dilatation Curettage (may scar kaya di nagiimplant doon 1. Assess for signs of infection
kaya sa baba nagiimplant para maraming supply of oxygen) 2. Corticosteroids
A- advance maternal age 3. Perform single digital (NO IE)- isang daliri (introduce infection)
S- smoking (decrease circulation) 4. Vaginal examination
P- poor vascularity (kakapal ang endometrium because of blood supply para doon magaattach 5. Induced labor- Tocolytics (efface) and Oxytocin (contract)
kaso nagkukulang sa ibang part kaya sa baba nagiimplant si placenta 6. Prophylactic antibiotics- asymptomatic (prevention); prevent infection
U- uterine fibroid tumor (baka may tumor kaya di sa ibang part nagaattach) 7. Magnesium sulfate (MgSO4)- cause muscle relaxation; anticonvulsant
M- multiple pregnancy (twins) (sa sobrag sikip sa baba nagimplant) -seizure
P- previous uterine surgery -for pH (Pregnancy Induced Hypertension)
-given IM (buttock)
TYPES OF PLACENTA PREVIA -s/sx: hot flushed hyporeflexia
a. Normal -Toxicity: Hyporeflexia- check for deep tendon reflex
b. Low Implantation Placenta Previa- walang nakaharan sa dadaanan ng baby -Calcium Gluconate- antidote for MgSO4 toxicity
c. Partial Placenta Previa- may konting space na pwedeng daanan High Mg Low Ca
d. Total Placenta Previa- may nakaharang sa dadaanan ng baby; No to Normal Delivery Low MG High Ca

SIGNS AND SYMPTOMS NURSING DIAGNOSIS

 Painless bleeding  Anxiety
 Presenting part has difficulty to descent  Activity intolerance
 Fetal Distress- either high(early sign of distress) or low(late sign of distress) FHT  Risk for poisoning
 Uterus us soft and not tender (it is not contracted)  Risk for fetal injury
 Risk for maternal injury
DIAGNOSTIC PROCEDURES
 Ultrasound
PREGNANCY INDUCED HYPERTENSION
MEDICAL MANAGEMENT -is a condition where vasospasm occurs
 Oxygen Therapy -TRIAGE:
 Intravenous fluids- Plain NSS (possible Blood Transfusion (BT); gauge 18 or 16 is used o High Blood Pressure (Hypertension)
since possible for bleeding o Proteinuria
 Betamethasone- steroid; helps to mature the lung surfactant; kailangan ilabas kahit o Edema
premature kaya nagbibigay nito
FACTORS
SURGICAL MANAGEMENT  Lifestyle
 Caesarean Section (CS)- may pressure sa placenta kaya CS  Obesity
 Smoking
 Age
NURSING MANAGEMENT (Assessment)  Genetics
 Count of pads  Pregnancy
 Disseminated Intravascular Coagulation (DIC)
 Prepare patient for Blood Transfusion Prostaglandin: vasodilator
 Maintain sterile
 Rectal and Vaginal Examination is not allowed (Avoid IE) Decrease perfusion on Kidneys
 Assess fetal well-being
PREMATURE RUPTURE OF MEMBRANES (PROM) Pregnant- perfusion is not enough since may baby
-rupture breaking down open of the membranes (amniotic sac) before labor beigns
-one dysfunction during delivery Midifable: (Smoking)-constricted blood vessels
hindi pa nagefface si cervix pero nagrupture siya agad; hindi pa well dilated
-may portal of entry pwede magkaroon ng infection (FETAL DEATH) kaya nagCS kasi mamatay si Obesity- fat deposits (di makadaloy)
baby pero kung wala pang sign of infection pwede pa idelay ang delivery (hindi pwede matagal na oras
dahil may Oligohydramnios kulang ang amniotic fluid may fetal distress) Perfusion is decrease

COMPLICATIONS Kidneys are affected- filtration; temperature regulation; produce renin, activate RAA system,
 Fetal Death- infection Bicarbonate for acid balance, Erythropoietin; RBC production
 Oligohydramnios- kulang sa amniotic fluid magkakaroon ng fetal distress
 Prematurity Due to low perfusion= decrease function of RAA System
 Care of Mother and Child Reviewer
 Face Presentation- the head diameter of the fetus present to the pelvis is often
Renin Angiotensin Aldosterone System too large for birth to proceed
Kapag low perfusion madedetect ni kidneys  Brow Presentation- it occurs in multipara or a woman with relaxed abdominal
Low BP- kapag walang flow ng dugo muscles. It results in obstructed labor, because the head is trapped in the brim of
Low perfusion madedetect mi kidneys kaya magproproduce ng Renin (stimulated aldosterone and the pelvis as the occipitomental diameter present. Often caesarian section is the
angiotensin I); angiotensin I through the use of Angiotensin enzymes = Angiotensin II (potent safest delivery of the fetus
vasoconstrictor – pinapakipot); Aldosterone (responsible for fluid and sodium retention)
 Shoulder Dystocia- the problem occurs at the second stage of labor, when the
fetal head is born but the shoulder are too broad to enter and be born through
Kapag nagproduce si kidney ng renin at nagpriduce ng aldosterone hindi na siya iihi dahil may sodium
(it attracts water) kaya high ang blood volume; the pelvic outlet. It can lead to vaginal or cervical tears to the mother and can
fracture clavicle or brachial plexus of the fetus
High blood volume vasoconstricted - high BP dahil kulang sa perfusion kay kidneys.  Macrosomia (Oversized Fetus)- an oversized infant cause uterine dysfunction
during labor and birth because of overstretching of the fibers of myometrium
Function is decrease di siya makakfilter ng maayos kaya naiwan yung mga substances tulad ng protein  Transverse Lie- lie occurs in women with pendulous abdomens, with uterine
(Proteinuria); Kapag may hypertension sobrang taas ng pressure through diffusion si fluid ay lumalabas masses that obstruct the lower uterine segment, contraction of the pelvic brim,
sa interstitial space (Edema) congenital abnormalities of the uterus or with hydramnios
 Breech Presentation- fetal buttocks and legs take more space instead of fetal
OBJECTIVE SIGNS head
 Check weight (bipedal edema) TYPES OF BREECH PRESENTATION
 Rapid breathing  Complete Breech- 2 feet are flexed downward
 Incomplete Breech- 1 foot is flexed upward and 1 foot is placed
Chronic HTN- meron ng dating HTN
downward
PIH- noong pregnany nagkaroon ng HTN
 Frank Breech- 2 extended feet upward (buttocks is the presenting part)
TYPES OF PREGNANCY INDUCED HYPERTENSION  Footling Breech- 1 foot was the first part that comes outside
 Gestational- proteinuria, edema, HTN
 Preeclampsia- manifestations in heart, kidney, liver CAUSES:
a. Mild  Gestational age less than 40 weeks
b. Severe  Abnormality in the fetus (Anencephaly, hydrocephalus)
 Eclampsia- seizures that lead to coma  Hydramnios
-Magnesium Sulfate  Congenital anomaly of the uterus
-deprivation of oxygen seizures  Mass in the pelvis
 Pendulous abdomen
SUBJECTIVE SIGNS
 Multiple gestation
D- dimnesss and blurring of vision (decrease perfusion)
O- oliguria (sodium and water retention)
E- epigastric pain (deprived oxygen) !! DIAGNOSTIC PROCEDURES
S- severe continuous headache (high BP)  Ultrasound
N- nausea and vomiting (due to HTN)  Leopold’s maneuver
T- tachycardia
F- fever (high blood production) NURSING MANGEMENT
E- ear ringing (tinnitus) because of pressure 1. Maneuver/ Birth technique
D- dizziness 2. Caesarian Section

CAUSE
2. Passageway- birth canal/ pelvis
 Idiopathic (unknown)
-the third reason for dystocia can occur is a contraction or narrowing of the
passageway or birth canal. This may happen on the inlet or in the midpelvis or at
COMPLICATIONS
C- Congestive Heart Failure (puno ng fluids) the outlet. This problem causes CPD.
R- renal damage
A- abruption placenta (low perfusion) PROBLEMS IN THE PASSAGEWAY
M- maternal death  Inlet contraction- narrowing of the anteroposterior diameter of the pelvis less
P- pulmonary edema than 11cm, or the transverse diameter to 12 cm or less
E- eclampsia  Outlet contraction- outlet contraction is narrowing of the transverse diameter.
D- Disseminated Intravascular Coagulation (DIC) The distance between the ischial tuberosities at the outlet to less than 11 cm

DIAGNOSTIC PROCEDURES 3. Power- uterine contraction

 Urine Test- decrease GFR
 Dystocia/ dysfunctional labor/ inertia- defined as difficult labor, maybe due to
 BP Monitoring
either mechanical or functional factors or to a combination of both. It results
 Blood test
 Liver and Kidney function tests from differences in the normal relationship between any of the 5 essential
Liver: HGPT and HGOT factors of labor
Kidney: BUN, Crea a. Mechanical Dystocia
 Maternal Causes
MEDICAL MANAGEMENT o Contracted pelvis
 Nifedipine- hypertension o Obstructive tumor
 Methydopa- anticonvulsant; muscle relaxant o Ineffective contractions include fatigue, exhaustion,
 Labetalus- anticonvulsant; muscle relaxant electrolyte imbalance and hypoglycemia
 Clonidine o Excessive analgesia or anesthesia
 Hydralazine- antihypertensive; muscle relaxant; nakaka-antok; NO FOR OPD
 Fetal Causes
 MgSO4- NO FOR OPD
o Failure of the vertex to rotate (occiput posterior, occiput
Low Platelet- watch for bleeding transverse)
o Malpresentation (Shoulder, Brow, face, or breech)
SURGICAL MANAGEMENT o Disproportion between fetal presentation and pelvis (CPD)
 Caesarean Section (CS)
DIAGNOSTIC PROCEDURES
NURSING MANAGEMENT Assessment
 Provide Emotional support  Evaluate for fetal presentation
 administer medication  Non-engagement of fetal head may indicate contracted pelvis
 Antiplatelet therapy (PT and PTT)  Note any known uterine or fetal anomalies
 X-ray pelvimetry is used for evaluation of CPD
NURSING DIAGNOSIS
 Monitor maternal vital signs, contraction pattern and fetal heart
 Ineffective tissue perfusion r/t vasoconstriction (renal tissue perfusion)
 Deficient fluid volume rate every 15 minutes if the woman is to undergo trial labor (6
 Risk for fetal injury hours labor)
 Risk for maternal injury
 Social isolation r/t prescribed bed rest (medication) NURSING MANAGEMENT
If occiput posterior position
FACTORS AFFECTING PROCESS OF LABOR 1. Relieve back pain as much as possible by sacral pressure, back
1. Passenger- fetus rubs, frequent change in position from side to side (may also
 Occipito Posterior Position- posterior position occurs in women with an android, assist fetal head to rotate)
anthropoid, or contracted pelvis. In this position, during internal rotation the 2. Observe the character and frequency of contractions and monitor
fetus must rotate, not through 90 degrees but through a 135 degrees arc fetal heart rate.
-Gynecoid- is the normal pelvis that is compatible 3. IV fluids are used glucose needed for effective contractions
 Care of Mother and Child Reviewer
4. When cervix is completely dilated, fetal head may be rotated by 3. Assist and coach the woman in labor using breathing and
physician relaxation technique
5. Provide encouragement and reassurance to the woman 4. Administer sedatives or analgesic as prescribed
throughout the labor 5. Advise the woman to rest between contractions
6. Position comfortably
If breech presentation
1. Labor maybe longer, since in a breech delivery, the soft buttocks
do not aid in cervical dilatation as well as the head does in vertex c. Pre-term Labor- uterine contraction occurring after 20 weeks gestation
presentation. and before 37 weeks gestation before 37 weeks completed gestation.
2. Analgesia may be limited in order not to interfere with the others Contractions are less than 10 minutes apart, resulting in progressive
ability to push effectively cervical changes or cervical dilatation of 2 cm or effacement of 75%.
3. Amniotomy is not done until breech is well engaged because
there is greater danger of prolapsed umbilical cord RISK FACTORS:
4. Breech maybe delivered spontaneously with strong contraction  Socio economic status
particularly in multipara  Medical risk factors
5. CEASAREAN BIRTH commonly used during dysfunctional labor  Lifestyle risk factors
 Current pregnancy risk factors
b. Functional Dystocia- sluggishness of contractions or the force of labor, a
condition in which, uterine contractions deviate from the normal. NURSING MANAGEMENT
1. Admit the patient and place on side lying position
CAUSES: 2. Monitor the uterine contractions
 Uterine anomalies 3. Monitor cervical consistency, dilatation, and effacement
 Overdistension such as hydramnios, multiple pregnancy, chronic 4. Start iv fluids for medications
disease 5. Keep the client informed
 Cervical scar tissue from previous surgery 6. Provide relaxation techniques
 Excessive anesthesia and analgesia
Medication:
DIAGNOSTIC PROCEDURES
Magnesium SO4 (Beta Adrenergic Blockers)
Assessment
- Interferes with muscle contractility
 Contraction may differ in quality and synchronization of activity.
- Must be monitored with magnesium toxicity (headache,
Contractions maybe strong but localize to one portion of the
nausea, diarrhea, dizziness, nystagmus and lethargy
uterus or may begin in lower segment and move upward rather
than downward that may result in decrease pressure in the cervix Terbutaline (Beta adrenergic drug)
 Contractions may also have inadequate intensity (hypotonic) - Decrease effects of calcium on muscle activation to slow or
 Evaluate contractions quality and pattern by manual evaluation stop uterine contractions
of fingers on the fundus and lower portion of uterine body - Monitor for side effects (increased HR, nervousness,
 Prolonged labor maybe evident within 6-8 hours if labor has been tremors, nausea and vomiting, hypokalemia, arrhythmias)
plotted with graph with normal curve for comparison Nifedipine (Calcium channel blocker)
 Monitor and evaluate progress of cervical dilatation, descent and - Monitor for side effects ( Hypotension, reflex tachycardia,
rotation in birth canal headache, nausea)
Indomethacin (Prostaglandin inhibitors)
Patterns of Ineffective Uterine Contraction - Monitor for side effects (Naussea, vomiting, dyspepsia)
 Hypertonic Uterine Dysfunction- muscle of the uterus is in a state
Betamethasone (Anti-inflammatory)
of greater than normal tension, so that contraction are painful
and ineffective for accomplishing dilatation.
d. Prolonged Labor- a type of dysfunctional labor that results from
-Erratic in frequency, duration and intensity. It usually
problems with any of the factors in the birth process
occurs in latent phase and the number of contractions are usually
After woman reaches the active phase of labor, cervical dilatations should
low or infrequent
proceed at a minimum rate of 1.2 cm per hour in the nullipara and 1.5 cm
 Hypotonic Uterine Dysfunction- contractions are inadequate (lack
per hour in the parous woman
of intensity); ineffective, irregular, painless coordinated but are
too weak to be effective, usually occurs in active phase of labor
CAUSES:
 Maternal infection
NURSING MANAGEMENT
 Neonatal infection
Hypertonic Uterine Contraction
 Maternal exhaustion
1. Provide rest with aid of sedatives
 Anxiety
2. Provide fluids to maintain hydration and electrolyte balance
 CPD and ineffective uterine dysfunctional
3. Observe for normal contractions
4. Darkening room light, decreasing noise and stimulation are also
NURSING MANAGEMENT
helpful
1. Provide comfort
5. Prepare patient for caesarian section
2. Instruct conservation of energy
3. Position changes
Hypotonic Uterine Contraction
4. Monitor for fetal distress
1. Pelvis is reevaluate for size
5. Assess for fetal and maternal infection
2. IV fluids are provided to maintain hydration and electrolyte
balance
e. Precipitous Labor- labor less than 3 hours; Emergency delivery without
3. Oxytocin administration is begun if pelvic size is adequate and
client’s physician and midwife; As labor is progressing quickly,
fetal position presentation and station is normal
assessment may be need to be done rapidly
a. Monitor FHR and contractions
b. If contraction last for 60-70, stop the infusion
PREDISPOSING FACTORS
c. Observe IV drip
 History of precipitous labor
d. Report maternal or fetal distress
 Multiparity
4. Prolapsed cord caused by rupture of membranes when presenting
 Large pelvis
part is not engaged in pelvis
 Unresistant soft tissue
a. Relieve pressure
 Small baby in good position
b. Notify physician immediately
 Induction of labor by rupture of membranes
c. Do not attempt to replace cord into uterus
d. If cord protrudes outside the vagina cover the UC with
NURSING MANAGEMENT
saline moistened with sterile water
1. Monitor for fetal distress every 15 minutes
e. Monitor FHR closely
2. Induction of anesthesia as ordered
f. Prepare caesarian section
3. Stay with mother at all times
g. Give supplemental oxygen
4. Do not prevent birth of the baby
h. Increase IV rate
5. Maintain sterile environment
6. Support baby’s head as it emerges
Anxiety Reducing Measures 7. Evaluate infant after delivery for possible injury
1. Keep room lights low and noise to a minimum and limit the 8. Observe for vaginal laceration
number of visitors 9. Perform ICN
2. Give frequent back rubs and massage sacral area 10. Check fundal firmness
11. Reduce anxiety
 Care of Mother and Child Reviewer
4. Psyche- emotional/ response of the mother
 Postpartum blues- the feelings of sadness immediately 1-10 days or the first 2
weeks or after childbirth
-most severe in primiparas
-caused by hormonal changes in estrogen and progesterone after the
delivery of the placenta
-it may response to dependence and low self-esteem caused by
exhaustion, being away from home physical discomfort and assuming new roles

Assessment (MATE GOD FIRST)

 Mood swings
 Anorexia
 Tearfulness
 Exhaustion
 Gradual withdrawal
 Out of coping
 Discomfort
 Fatigue
 Irritability
 Restlessness
 Sleep disturbances
 Tension

NURSING MANAGEMENT
1. Reassure the mother
2. Her support person also need reassurance
3. Anticipatory guidance
4. Promote verbalization of feelings

 Postpartum depression- an intense and pervasive sadness with severe mood

swing and more persistent than post-partum blues
-Immediate feeling of sadness from 1-12 months
-Related to hormonal shift at the levels of estrogen and progesterone

RISK FACTORS:
 History of depression
 Troubled childhood
 Low self esteem
 Stress
 Lack of support

Assessment (SEMI DOWN)

 Sleeping heavily
 Extreme fatigue
 Manic mood
 Inability to stop crying
 Diarrhea
 Overall feeling of sadness
 Weight gain and cravings
 Nausea and vomiting

NURSING MANAGEMENT
1. Counselling might be able to prevent symptoms
2. Discovery of the problem as soon as symptoms develop is the nursing
priority
3. Antidepressant as ordered
4. Encourage verbalization of feelings

 Postpartum psychosis- syndrome most often characterized by depression,

delusions, and thoughts by the mother of either infant or herself
-its onset is within 1st year after birth

Assessment (CEASE FIRE)

 Confusion
 Episodes of tearfulness
 Auditory hallucination
 Suspiciousness
 Emotional lability
 Fatigue
 Insomnia
 Restlessness
 Exceptional sadness

Other Symptoms
 Obsessive concern about baby’s welfare
 Psychosis
 Deny that she has a child
 Voice thoughts of infacide
 Disturbed sensory perception

5. Placenta
 Placenta Succenturiata- has one or more accessory lobe connected to the main
placenta by blood vessels.
 Battledore Placenta- the cord is inserted marginally rather than centrally
 Vasa Previa- the umbilical vessels cross the cervical OS
 Placenta Accreta- deep attachment of the placenta to the myometrium