* NLE * NCLEX * HAAD * PROMETRICS * DHA * MIDWIFERY * LET * RAD TECH * CRIMINOLOGY * DENTISTRY * PHARMACY * MED TECH
REFRESHER PHASE
HANDOUTS
NORMAL OBTETRICS
Prepared by: Ms. Lorelie Pomentil, RN
NOVEMBER 2024 Philippine Nurse Licensure Examination Review
I. The MENSTRUAL CYCLE
- Episodic uterine bleeding in response to cyclic hormonal changes
- Purpose: 1.
2.
Menarche –
Average length of menstrual cycle:
Average length of menstrual flow:
Color of menstrual flow:
Odor:
“The Menstrual Cycle”
The 4 body structures involved in menstrual cycle and their hormones
1. Hypothalamus
2. Pituitary gland
3. Ovaries
4. Uterus
Ovulation – ovum is set free from the ovaries; most fertile period __________ before and after
S & Sx:
1. Inc. In Basal Body temp. –
2. Mittelschmerz –
3. Spinbarkeit –
4. Fern test –
5. Cervical mucus –
II. STAGES OF FETAL DEVELOPMENT
Embryonic and Fetal Structure
1. Decidua –
2. Placenta –
Endocrine Fx of placenta:
a. Estrogen
b. Progesterone
-
-
c. Human Placental Lactogen (HPL)
- lactation:
- growth- promoting:
3. Amniotic membranes – compose of 2 layers that support the amn. Fluid:
- Chorionic membrane:
- Amniotic membrane:
4. Amniotic Fluid
-
-
-
-
-
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hydramnios –
oligohydramnios –
Nitrazine test – fluid from the mother in tested with nitrazine paper, if the test strip appears:
o Yellow –
o Blue –
5. Umbilical Cord –
- provides circulatory pathway between fetus and placenta
III. Physiologic Changes of Pregnancy
Common Discomforts Nursing Intervention
1.Nause & Vomiting - eat:
- avoid:
- SFF; fluid in between
2. Pyrosis - SFF
- avoid:
- avoid:
3. Constipation - inc. OFI & high fluid intake
- stool softeners:
- *safe laxatives: 1.
2.
3.
4.
4. Breast tenderness - wear:
5.Palmar erythema - use:
6.Fatigue
7. Leg cramps
8. Leg varicosities and Ankle - elevate the legs
edema - avoid crossing legs while sitting
- use elastic support stocking (medical support hose)
- take ____________ at least twice a day
- left side lying position
9. Hemorrhoids - adequate OFI & fiber in diet
- position:
- for pain:
10. Lordosis and backache - low to moderate heels
- walk pelvis tilting forward
- for pain:
- _________ rather bending over
- lift object _______________
- sleep on flat ______ mattress
-_________________ – best exercise to relieve back pain
11. Leukorrhea - daily bath or shower
- wear:
- NO:
- may wear perineal pad
12. Urinary Frequency - ___________ in pregnancy
- emphasize to:
13. Supine hypotension - Position:
- if can’t sleep in side-lying;
Major Contraindications in Pregnancy:
1.
2.
3.
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IV. The Psychological Tasks of Pregnancy
1st Trimester:
Two opposing feelings; wanting & not wanting the pregnancy:
Husband experiencing s & sx of pregnancy; results from stress, anxiety & empathy:
2nd Trimester:
- accepting the baby usually happens at _____________
*Primi:
*Multi:
- the woman’s acceptance of her coming baby can be well measured by her ________________________________
- partner becomes overly absorbed in work to compensate feelings of helplessness
3rd Trimester:
Evidence that the couple is completing the 3rd tri task: _________________
- choosing name for the infant, buying stuff, planning sleeping arrangement
V. Confirmation of Pregnancy
Presumptive ____________ symptoms –
- Breast changes
- N&V
- Amenorrhea
- Fatigue
- Urinary frequency
- Uterine enlargement
- Quickening
- All skin discoloration:
melasma/chloasma -
linea nigra –
striae gravidarum –
Probable ___________ Signs
- Chadwick’s sign:
- Goodell’s sign:
- Hegar’s sign:
- Ballottement:
- Braxton-hicks contractions:
- Sonographic evidence of
- Fetal _________ felt by examiner
- Positive Pregnancy test
Positive __________ of Pregnancy
Fetal heart rate –
Fetal movement –
Fetal outline –
VI. Obstetrical Formula & Computation
Naegele’s Rule – standard method to predict length of pregnancy
Pre-requisite:
Jan – Mar:
Apr – Dec:
Bartholomew’s Method – through palpation of Fundal height
From 20th week to 31st week:
Fundic height in cm = ___________
Rapid growth may indicate
-
-
-
Lesser than expected
-
-
-
VII. OBSTETRIC HISTORY
Gravida – no. of pregnancies REGARDLESS of __________________
Para – no. of pregnancies that reached the age of viability: dead or alive. Para is broken down as follows:
o Term:
o Pre-term:
o Abortion:
o Living:
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Leopold’s Manuever
Purpose:
Instruction:
Position:
Weight changes
1st tri:
2nd tri:
s3rd tri:
Total allowance wg gain:
*Pattern of weight gain is more important than the amount of weight gain
Sudden increase:
1st manuever: Fundal grip 3rd manuever: Pawlick’s grip
Purpose: Pupose:
• Hard & round – Movable – not engaged
• Soft & moves dependent – Not movable: engaged
2nd manuever: Umbilical grip 4th manuever: Pelvic grip
Purpose: Purpose:
• Hard & smooth – Good attitude:
• Irregular & feels bumpy –
Loss of weight:
VIII. Fetal assessments
1. Fetal movement count
Daily Fetal Movement (Kick Counts)
Normal =
Instructions:
Position:
Count fetal movement until ______
Record the time
- No 10 fetal movement in the first hr; walk around a little and repeat counting
- No 10 fetal movement in the second period: contact health care provider
2. Fetal Heart tone monitoring
Principles & Equipment
Doppler –
Fetoscope –
Stethoscope -
*note: if a woman is obese –
*Promote bonding:
*Normal FHR:
- any situation where FHR is above or below normal:
Nonstress Test
- FHR in response to _________________
- First step:
- Reactive – GOOD reaction; FHR should inc. in response to movement
- Inc. should be ______ for ______ for _____________ readings;
“FHR ACCELERATION”
Nonreactive – No inc in FHR in response to movement or less than 15 bpm
If the result of Nonstress test is Nonreactive; perform:
Contraction Stress Test
- FHR in response to ________________
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- Simulates labor contractions by administering ___________
- Purpose: to det. if baby can tolerate the drop in blood and oxygen during labor contractions
Findings and Interpretations
Early Decelerations –
- Cause:
- Intervention:
Late Decelerations –
- Cause:
- Intervention: 1.
2.
3.
4.
Variable Decelerations –
- Cause:
- Intervention:
IX. PREPARATION FOR CHILDBIRTH & LABOR
Exercises during pregnancy
Walking –
Squatting –
Tailor sitting –
Kegel Exercise –
Pelvic Rocking –
Signs of Labor
Preliminary Signs of Labor
1. Lightening (engagement) – relief of diaphragmatic pressure
Primipara:
Multipara:
2. Ripening of Cervix –
3. Increase in energy –
4. Increased Braxton Hicks contractions –
True Signs of Labor
1. Show –
2. Uterine Contractions -
3. Rupture of membranes –
X. LABOR & BIRTH
Stages of Labor
1. 1st Stage of Labor: Stage of ___________– from the onset of true labor contractions to full cervical
dilatation; divided into 3 phases
Phase Cervical Dilatation Duration of Interval
Contraction
1.Latent
2. Active
3.Transition
Nursing Considerations for each Phase:
Latent –
Active –
Transition –
By the end of the 1st stage :
2. 2nd Stage of Labor: Stage of __________
- from ________________ & ___________________ to _____________________
*_________________ – the fetal scalp appears at the opening of the vagina
3. 3rd Stage of Labor: _______________
– from infant birth to the delivery of the placenta; divided into 2 phases
Placental separation
Signs of placental separation
1.
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2.
3.
4.
Presentation of the placenta:
o Schultz –
o Duncan –
Placental Expulsion
- placenta deliver by
1. Natural bearing down effort of the mother
2. Crede maneuver –
Nursing action:
XI. PUERPERIUM
- the postpartal period:
- characterized by:
- Uterine involution – accomplished by
“Normal Location”
• Afterpains –
Postpartal Psychological Adaptation: 3 phases by Reva Rubin
1.Taking In –
2. Taking Hold -
3. Letting Go –
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