Review of Maternal-Infant Review of Maternal-Infant Nursing Nursing
徐丽华上海交通大学护理学院
2006- 4- 27
Trends in Maternal-Infant Trends in Maternal-Infant Nursing CareNursing 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
Maternal Nursing concerns areasMaternal 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
Special Issues in Women’s Special Issues in Women’s Health 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
The Menstrual CycleThe 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
The Menstrual CycleThe 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
The Menstrual CycleThe Menstrual Cycle
Endometrial Cycle:
1. Proliferative phase
2. Secretary phase
3. Menstrual phase
QuestionQuestion
FSH stimulates which processes in the menstrual Cycle?
a. Thinking of endometrium
b. Maturation of follicle
c. Decrease in basal body temperature
d. Increase in progesterone production
Infertility CareInfertility Care Infertility affects 15-20% of the populations in the
reproductive yearsTerms to be understood:
1. Artificial insemination2. Endometriosis3. Laparoscopy4. Primary Infertility5. Secondary Infertility6. Varicocele7. Endometriosis
Terms related to Infertility Terms related to Infertility TreatmentTreatment
In vitro Fertilization/embryo Transfer Gamete intrafallopian tube transfer (GIFT) Zygote Intrafallopian Transfer (ZIFT) Testing of infertility:
1. Ovulatory Analysis 2. Sperm Analysis3. Testing of STDS4. Tubal Patency test
QuestionQuestion
In which phase of the menstrual cycle is thick, scant cervical mucus and an elevated BBT seen?
1. Estrogenic phase
2. Menstrual Phase
3. Ovulatory phase
4. Luteal Phase
Names of the infertility drugsNames 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
Nursing care for infertile Nursing care for infertile couplecouple
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,
Pregnancy TerminationPregnancy Termination
Legal/ethical Decision making dilemmas Counseling regarding pregnancy
terminationPsychological impact of pregnancy
termination Risk and complication associated Grief/guilt/ambivalence/uncertainty feeling
after terminating of pregnancy
Sexually Transmitted Sexually Transmitted DiseasesDiseases
Chamydia trachmatis infection Gonorrhea Human Papillomavirus Herpes Simplex Virus type 2 infection Cytomegalovirus infection Syphilis Vaginitis Human Immunodeficiency Virus Infection
QuesitonQuesiton
Women should be taught to be aware of early warning signs of HIV infection which are:
a. Dyspareunia
b. Severe dysmenorrhea
c. Occasional Candida infection
d. Recurrent episodes of genital warts
QuestionQuestion
The purpose of taking Tamoxifen after a mastectomy is to:
a. Alleviate cancer painb. Act as hormonal replacement therapyc. Block tissue uptake and utilization of
estrogend. Destroy any stray cancer cells in
remaining breast tissue
Family System Changes During The Family System Changes During The Childbearing CycleChildbearing Cycle
StructurePowerBoundariesAffect or feelingsIntergenerational patterns and rolesCommunication patternsCultural background and riturals
Bonding and AttachementBonding 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
Nursing intervention for the Nursing intervention for the three Phases of crisis three Phases of crisis
Precrisis: Predictable and development events in the life cycle
1. Discuss change with family structure, adding new member
2. Assess risk factors, past coping and problem solving
3. Implement health teaching4. Implement health promotion and maintenance
strategies
Nursing intervention for the Nursing intervention for the three Phases of crisisthree Phases of crisis
Crisis: Coping strategies not sufficient to deal with changes in family structure and problem in development
1. Clarify the problem2. Assist the family in going an understanding of the
situation3. Acceptance of the family4. Use appropriate interpersonal and institutional
resources5. Assess family to express feeling & ways of solving
problem
Nursing intervention for the Nursing intervention for the three Phases of crisisthree Phases of crisis
Postcrisis: Crisis has been resolved, leading to a higher, the same, or lower of family function
1. Support the family in its new strategies of resolution
2. Emphasize growth potential in solutions
3. Attempt to reverse or lessen effects of maladaptation through appropriate rehabilitative effort or therapy
Psychosocial aspects of Psychosocial aspects of childbearing Theorieschildbearing Theories
1. Psychosocial Change in the mother: Accepting the pregnancy– Symbolic meaning of the pregnancy– Self-image and body image during pregnancy
Psychosocial aspects of Psychosocial aspects of childbearing Theorieschildbearing Theories
2. Role Assumption and maternal AdaptationMaternal IdentityMaternal role attainment: Motivation for
motherhood, preparation for motherhood, conflict resolution, maternal attachment behavior, relationship with mother
Role conflict and attainment of the maternal role
Role conflict and attainment of Role conflict and attainment of the maternal rolethe maternal role
Inability to achieve the “good Mother”roleLack of knowledge and preparation for the
maternal roleEstablishing a relationship with the fetus
Maternal Ambivalence in PregnancyMaternal 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.
Rh ImmunizationRh 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)
Psychosocial aspects of Psychosocial aspects of childbearing Theorieschildbearing 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
Adaptation to PregnancyAdaptation to Pregnancy
Key terms: 1. Acquaintance
2. Ambivalence
3. Attachment
4. Avoidance
5. Bonding
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?
A. “Gentle vaginal intercourse is safe throughout pregnancy”
B. “each couple has a unique situation, bring your husband in for a talk with the doctor”
C. “The baby is well protected by your tissues, but if contractions occur, abstain and notify the doctor”
D. “vaginal Penetration is prohibited anyway during the last month of pregnancy because of the dangers of infection”
3
When teaching prospective fathers about pregnancy and birth, the nurse should plan to include which priority information?
A. The possible difficulties in each trimester
B. The cost of caring and raising a child
C. The normal range of feeling that may experienced in different stages of pregnancy
D. The importance of his role in the act of conception and in the determination of the sex of the fetus.
3
Pregnancy and weight gain 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
Pregnancy and NutritionPregnancy 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)
Risk of Obesity to pregnancy 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
Question-NutritionQuestion-Nutrition
In comparison with a single fetus pregnancy, nutrition needs when there are twins much include:
a. Increased calorie intake of 300 per fetus each day
b. Low-salt foods to prevent edema
c. Additional fluid intake of 2-3 glasses per day
d. Iron and folic acid needs for 10% more per day
Warning Signs in PregnancyWarning 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
Assessment for Neural Tube Assessment for Neural Tube DefectsDefects
“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
Amniocentesis Amniocentesis
Performed around 15-18 weeks of gestation to identify genetic abnormality
Risk: 1. Trauma to the fetus, placenta, umbilical cord,
or maternal structures
2. Infection
3. Premature labor and spontaneous abortion
AmniocentesisAmniocentesis
Warning signs after receiving amniocentesis:
1. Body temperature elevation
2. Fluid leaking from the vaginal
3. Mild Cramping and abdominal aching
4. Decreased fetal movement
Chorionic Villus SamplingChorionic Villus Sampling
To detect genetic or chromosomal defectsCan be done in early pregnancy 9-10 weeks
gestationRisk: miscarriage 3.7-7.7%, 1.7%
discrepancy of result between villus karyotype and fetus, rupture amniotic sac, chorioamnionitis, oligohydramnios, intrauterine growth retardation
The Nonstress test The Nonstress test
Check fetus well-beingCheck fetal movement in relation to fetal
heart rate acceleration Reactive: HR acceleration with fetus
movement Non reactive: no HR acceleration with fetus
movement
Genetic Problem 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
Nursing and family with Nursing and family with Genetic disordersGenetic disorders
Perform Karyotype examinationGenetic Counseling-support for decision
making Genetic screen for potential risk
Assisting the client to cope with Assisting the client to cope with First-Trimester DiscomfortsFirst-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
Ensure Safety and removing Ensure Safety and removing barriers to carebarriers 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
Psychologic changes and concerns Psychologic changes and concerns of a mother at 2of a mother at 2ndnd Trimester 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
QuestionQuestion
The nurse should assess for which developmental task of the pregnant women in her third trimester?
a. Bonding to the fetus in preparation for birth
b. Accepting the fetus as a wanted responsibility
c. Understanding the baby is an independent being
d. Preparing to separate from the fetus through the birth process
Question-DM motherQuestion-DM mother
The nurse teaches the newly pregnant diabetic the importance of self glucose monitoring in the first trimester to prevent:
a. Hypoxia in the fetus
b. The onset of diabetes in fetus
c. Unusually large fetal development
d. Teratogenic effects of hyperglycemia
Question- Preterm LaborQuestion- Preterm Labor
Magnesium Sulfate may be prescribed as a tocolytic drug because one of the expected actions is:
a. Promoting diuresis
b. Lowering blood pressure
c. Inducing sedation and rest
d. Promoting smooth muscle relaxation
Pain during labor Pain during labor
Analgesia: demerol (meperidine) Sedative: Seconal and Nembutal Narcotic analgesics: Fentanyl, Stabol Anesthesia: Marcaine (Bupavacaine)
Alfenta (Alfentani)
Epidural Block Epidural Block
Give to women in 2-4 cm Cx dilation Giving anesthesiologist into epidual space at L-2,
L-3, L-4 or L-5 Provide pain relief in lower part of body Labor stimulation by Oxytocin may need Prevent Hypotensive effect (500-1000 ml Lactated
Ringer’s) Monitoring uterus contraction and fetus condition
Side Effects of Epidural Side Effects of Epidural Analgesia Analgesia
Respiratory depression in newborn (Narcan)Pruitus (itching)Nausea and vomiting Urinary retentionHypotensive Affect labor process, unable to push during
second stage of labor (assessment important)
QuestionQuestion
A Client has received an effective dose of epidural anesthesia. The IV rate is 250 ml/hour and position is semi-Fowler’s. Her blood pressure has dropped significantly. The first nursing intervention is to:
a. Slow the rate of IV infusion to avoid overloadb. Retake the BP, initial hypotension is expectedc. Begin oxygen by face mask, lower head, elevate
legs. d. Call back anesthesiologist to deal with the condition
Induction or Augmentation of Induction or Augmentation of Labor Labor
Induction: starting labor artificially by oxytocin
Augmentation: stimulation of labor once it has begun naturally.
Amniotomy: color of the amniotic fluid Assess risk: frequency of contraction,
maternal tolerance, pain, fetus well-being, discomfort, progress of labor, complication
Lamaze Technique QuestionLamaze Technique Question
The nurse teaching the Lamaze technique evaluates her success when the couple do the following:
a. Break the fear/tension/pain cycle
b. Bond successfully with the newborn
c. Use positive feedback with each other during labor
d. Maintain control during labor by their techniques of breathing and relaxation
QuestionQuestion (pain and childbirth class) (pain and childbirth class)
In developing childbirth classes the nurse plans to include techniques that normally minimize pain perception, which of these are inappropriate?
a. Using muscle relaxation methods
b. Invalidating the perception of pain
c. Refocusing attention on another subject
d. Implementing anxiety reduction techniques
In developing childbirth classes the nurse plans t include techniques that normally minimize pain perception, which of these are inappropriate?
a. Using muscle relaxation methods
b. Invalidating the pain perception
c. Refocusing attention on another subject
d. Implementing anxiety reduction techniques
Vaginal Birth After Cesarean Vaginal Birth After Cesarean Section (VBAC)Section (VBAC)
Repeat CS in USA 80% Fear of weakening the uterine scare Twice Maternal Risk in C/S than in Vaginal birth Qualification: primary cesarean not due to pelvic
factors. “Classic uterine incision???” Support of staff and women’s desire to have
vaginal birth are optimal factor for trying VBAC
QuestionQuestion
When membranes rupture spontaneously during labor, the nurse at the bedside must immediately:
a. Monitor fetal heart rate b. Change the bed ped and give peri care c. Increase the flow rate of intravenous fluidd. Report the color and consistency of the
fluid
QuestionQuestion
During labor, while lying supine in bed, Millie M. States she feels dizzy and weak, vital signs show an elevated pulse and lowered BP, the nurse should first:
a. Notify the physicianb. Check for vaginal bleedingc. Apply oxygen by mask at 10 L/mind. Rotate her to the left side-lying position
QuestionQuestion
Five hours prior to arriving at the DR, your client’s amniotic membranes ruptured, which is a priority in the nursing planning?
a. Monitoring urinary output hourly
b. Providing frequent perineal care
c. Increasing fluid intake intravenously
d. Assessing temperature at least every 2 hours
QuestionQuestion
During transitional labor, when the fetal heart rate tracing shows a drop of 50 beats for 20 seconds and the rate returns to baseline, which is the first nursing action?
a. Call for physician at once
b. Turn client toward the left lateral position
c. Position client to relieve pressure on the cord
d. Do nothing, continue to observe since there is a rapid return to baseline
Postpartum Lactation Postpartum Lactation
Colostrum: contain Immunoglobulins G and A (Ig G, Ig A) to protect newborn’s gastrointestinal System
Secretion stage: prolactin hormone Let-down reflex: Neurohormonal Reflex
primary responds to infant’s sucking, posterior pituitary gland secretes oxytocin.
Question – Question – hypoglycemia newborn hypoglycemia newborn
Which would indicate to the nurse that the newborn may be hypoglycemic?
a. Hyperthemia with flushed skin
b. Residual tremors after movement
c. Vigorous sucking on nipple or on fist
d. Frequent loose stools
Please Keep your good work Please Keep your good work and study hard, maternal-and study hard, maternal-
infant nursing is an interesting infant nursing is an interesting subject for you to learn!subject for you to learn!