妇产科护理-课件

ReviewofMaternal-InfantNursing妇产科护理_Review-of-Maternal-Infant-NursingTrendsinMaternal-InfantNursingCareDevelopmentstandardofcare,certification,advancedpracticenursesHomeHealthcareforpostpartumwomen,dischargefromHops.12-24hoursafterdelivery,highriskinfantsdischargehomeearlierthanbeforeConsumerinvolvedinthechildbearingcare:Childbirthclass,siblingpresent,breast-feeding,birthingenvironment(LDR,LDRP),father’sinvolvement,parentsleaveoptionforfamilywithnewborn妇产科护理_Review-of-Maternal-Infant-NursingMaternalNursingconcernsareasPrenatalcareLowbirthweightMotherandinfantwithHIVinfectionAdolescentpregnancyDrugandsubstanceabuseduringpregnancySocial/familystressandimpactstopregnantwomenandfamilyUseandcareforpregnantwomen妇产科护理_Review-of-Maternal-Infant-NursingSpecialIssuesinWomen’sHealthViolenceSexualTransmittedDiseases:HIV/AIDS86%ofpediatricAIDScasesaretransmittedthroughverticaltransmissionofHIVSubstanceabuseOtherdiseases:Heartdiseases,cancer,osteoporosis,eatingdisorders妇产科护理_Review-of-Maternal-Infant-NursingTheMenstrualCycleOvarianCycle:1.Follicularphase:stimulatedwithFSHtopromotethedevelopmentoffolliclesEstrogen-folliclemature-negativefeedbacktohypothalamusandanteriorpituitarygland–inhibitingFSHsecretion2.Ovulation:increaseinbodytemperature(progesteronesecretion),fernpatternofthecervicalmucus,spinnbarkeit“elasticityoftheovulatory”duetosecretionoftheestrogen妇产科护理_Review-of-Maternal-Infant-NursingTheMenstrualCycle3.LutealPhase:Corpusluteumandanteriorpituitaryglandwillsecretluteinizinghormones(thedecreaseinEstrogenandprogesterone–positivefeedbacktoHypothalamusandanteriorpituitary-stimulatingthesecretionofFSH4.Premenstrualphase:Declineinestrogenandprogesterone妇产科护理_Review-of-Maternal-Infant-NursingTheMenstrualCycleEndometrialCycle:ProliferativephaseSecretaryphaseMenstrualphase妇产科护理_Review-of-Maternal-Infant-NursingQuestionFSHstimulateswhichprocessesinthemenstrualCycle?ThinkingofendometriumMaturationoffollicleDecreaseinbasalbodytemperatureIncreaseinprogesteroneproduction妇产科护理_Review-of-Maternal-Infant-NursingInfertilityCareInfertilityaffects15-20%ofthepopulationsinthereproductiveyears

Termstobeunderstood:ArtificialinseminationEndometriosisLaparoscopyPrimaryInfertilitySecondaryInfertilityVaricoceleEndometriosis妇产科护理_Review-of-Maternal-Infant-NursingTermsrelatedtoInfertilityTreatmentInvitroFertilization/embryoTransferGameteintrafallopiantubetransfer(GIFT)ZygoteIntrafallopianTransfer(ZIFT)Testingofinfertility:OvulatoryAnalysisSpermAnalysisTestingofSTDSTubalPatencytest妇产科护理_Review-of-Maternal-Infant-NursingQuestionInwhichphaseofthemenstrualcycleisthick,scantcervicalmucusandanelevatedBBTseen?EstrogenicphaseMenstrualPhaseOvulatoryphaseLutealPhase妇产科护理_Review-of-Maternal-Infant-NursingNamesoftheinfertilitydrugsClomiphene“Clomid”-riskofmultipleovulationhCG:tofacilitatetheovulation,sideeffectovarianover-stimulationhMG+Menotropin:HumanMenopausalgonadotropinDanazol:suppressesovulationandsecretionofFSHandLuteinizinghormonetoinactiveectopicendometrialtissue.Sideeffect-Wtgain,hotflashes,decreasedbreastsize,vaginitis妇产科护理_Review-of-Maternal-Infant-NursingNursingcareforinfertilecoupleIdentifyproblemsandstrengths:Self-esteemdisturbancerelatedtodiagnosisPersonalIdentitydisturbance,relatedtounsuccessfulinfertilitytreatmentIneffectivefamilycoping,compromisedliveanddecisionmakingNurse=supporter,advocate,counseling,妇产科护理_Review-of-Maternal-Infant-NursingPregnancyTerminationLegal/ethicalDecisionmakingdilemmasCounselingregardingpregnancyterminationPsychologicalimpactofpregnancyterminationRiskandcomplicationassociatedGrief/guilt/ambivalence/uncertaintyfeelingafterterminatingofpregnancy妇产科护理_Review-of-Maternal-Infant-NursingSexuallyTransmittedDiseasesChamydiatrachmatisinfectionGonorrheaHumanPapillomavirusHerpesSimplexVirustype2infectionCytomegalovirusinfectionSyphilisVaginitisHumanImmunodeficiencyVirusInfection妇产科护理_Review-of-Maternal-Infant-NursingQuesitonWomenshouldbetaughttobeawareofearlywarningsignsofHIVinfectionwhichare:DyspareuniaSeveredysmenorrheaOccasionalCandidainfectionRecurrentepisodesofgenitalwarts妇产科护理_Review-of-Maternal-Infant-NursingQuestionThepurposeoftakingTamoxifenafteramastectomyisto:AlleviatecancerpainActashormonalreplacementtherapyBlocktissueuptakeandutilizationofestrogenDestroyanystraycancercellsinremainingbreasttissue妇产科护理_Review-of-Maternal-Infant-NursingFamilySystemChangesDuringTheChildbearingCycleStructurePowerBoundariesAffectorfeelingsIntergenerationalpatternsandrolesCommunicationpatternsCulturalbackgroundandriturals妇产科护理_Review-of-Maternal-Infant-NursingBondingandAttachementBondingisaffectedbyMaternal-Sensitiveperiod.Attachmentisdevelopedthroughoutthefirstyearoflife.Importantfornursingpractice:donotmakeinaccuratejudgment,understandthatchildbearingisamajortransitionIthelifeofafamily妇产科护理_Review-of-Maternal-Infant-NursingNursinginterventionforthethreePhasesofcrisisPrecrisis:PredictableanddevelopmenteventsinthelifecycleDiscusschangewithfamilystructure,addingnewmemberAssessriskfactors,pastcopingandproblemsolvingImplementhealthteachingImplementhealthpromotionandmaintenancestrategies妇产科护理_Review-of-Maternal-Infant-NursingNursinginterventionforthethreePhasesofcrisisCrisis:CopingstrategiesnotsufficienttodealwithchangesinfamilystructureandproblemindevelopmentClarifytheproblemAssistthefamilyingoinganunderstandingofthesituationAcceptanceofthefamilyUseappropriateinterpersonalandinstitutionalresourcesAssessfamilytoexpressfeeling&waysofsolvingproblem妇产科护理_Review-of-Maternal-Infant-NursingNursinginterventionforthethreePhasesofcrisisPostcrisis:Crisishasbeenresolved,leadingtoahigher,thesame,orloweroffamilyfunctionSupportthefamilyinitsnewstrategiesofresolutionEmphasizegrowthpotentialinsolutionsAttempttoreverseorlesseneffectsofmaladaptationthroughappropriaterehabilitativeeffortortherapy妇产科护理_Review-of-Maternal-Infant-NursingPsychosocialaspectsofchildbearingTheories1.PsychosocialChangeinthemother:AcceptingthepregnancySymbolicmeaningofthepregnancySelf-imageandbodyimageduringpregnancy妇产科护理_Review-of-Maternal-Infant-NursingPsychosocialaspectsofchildbearingTheories2.RoleAssumptionandmaternalAdaptationMaternalIdentityMaternalroleattainment:Motivationformotherhood,preparationformotherhood,conflictresolution,maternalattachmentbehavior,relationshipwithmotherRoleconflictandattainmentofthematernalrole妇产科护理_Review-of-Maternal-Infant-NursingRoleconflictandattainmentofthematernalroleInabilitytoachievethe“goodMother”roleLackofknowledgeandpreparationforthematernalroleEstablishingarelationshipwiththefetus妇产科护理_Review-of-Maternal-Infant-NursingMaternalAmbivalenceinPregnancy

Noquestionsaskedaboutpregnancy,laboranddelivery,infantcareNointerestinfetusPastnegativeexperiencewithpregnancyorlaboranddeliveryDenialofpregnancyandfetalmovementPregnancyandparenthoodinterferingwithlifestyleContinueactivitiesthatmayhurtthefetus(smokingordrinking)Reportingpersistentandmanyphysicalcomplains.妇产科护理_Review-of-Maternal-Infant-NursingRhImmunizationCheckbyIndirectCoombstesttodetectantibodiesintheserumthattargetredbloodantigenstocausefetushemolysisAntibodytiter>1:16indicatespossibilityofseverehemolyticdiseasesMotherwithRh-negative:shouldreceiveRhogamwithin72hours(anyinvasiveprocedurethatmaycausethemixingofthematernalbloodwithfetus)妇产科护理_Review-of-Maternal-Infant-NursingPsychosocialaspectsofchildbearingTheories3.PsychosocialChangeinthefather:DevelopmentofthefatherroleParticipationinthechildbearingcycleFather-infantinteractionsandthefatherrole“TheCouvadeSyndrome”-bodilysymptomsexperiencedbyafatherduringthecourseofhispartner’spregnancy.4.PsychosocialChangeinSiblingview妇产科护理_Review-of-Maternal-Infant-NursingAdaptationtoPregnancyKeyterms:AcquaintanceAmbivalenceAttachmentAvoidanceBonding妇产科护理_Review-of-Maternal-Infant-NursingMrs.H.33wkssharedthatherhusbandwasafraidofharmingtheunbornbabyduringintercourse.Whichisthebestresponseofthenurse?“Gentlevaginalintercourseissafethroughoutpregnancy”“eachcouplehasauniquesituation,bringyourhusbandinforatalkwiththedoctor”“Thebabyiswellprotectedbyyourtissues,butifcontractionsoccur,abstainandnotifythedoctor”“vaginalPenetrationisprohibitedanywayduringthelastmonthofpregnancybecauseofthedangersofinfection”3妇产科护理_Review-of-Maternal-Infant-NursingWhenteachingprospectivefathersaboutpregnancyandbirth,thenurseshouldplantoincludewhichpriorityinformation?ThepossibledifficultiesineachtrimesterThecostofcaringandraisingachildThenormalrangeoffeelingthatmayexperiencedindifferentstagesofpregnancyTheimportanceofhisroleintheactofconceptionandinthedeterminationofthesexofthefetus.3妇产科护理_Review-of-Maternal-Infant-NursingPregnancyandweightgainFirstTrimester:2-4pounds(0.9-1.8kg),1poundperweek(0.45kg)during1st&2ndtrimesterTotalweightgain13.18kgor29pounds妇产科护理_Review-of-Maternal-Infant-NursingPregnancyandNutritionObesity:recommendtogainwt7-11.5kgUnderweightTeenagepregnancy:lowwtgainduringpregnancy,associatedwithLBWinfant19%ofthebabywt<2000gramdecrease7.4%ofLWBinfantifwtgainimproveto11kg(25lbs).Frequentmealskippingandconsumptionoffastfood(highsalt,sugar,lowvitandminerals)妇产科护理_Review-of-Maternal-Infant-NursingRiskofObesitytopregnancyGestationaldiabetesUrinarytractinfectionsInadequateweightgainWoundinfectionThromboembolismPIHFetalmonitoringdifficultyProlongedlaborFetalMacrosomiaBirthtrauma妇产科护理_Review-of-Maternal-Infant-NursingQuestion-NutritionIncomparisonwithasinglefetuspregnancy,nutritionneedswhentherearetwinsmuchinclude:Increasedcalorieintakeof300perfetuseachdayLow-saltfoodstopreventedemaAdditionalfluidintakeof2-3glassesperdayIronandfolicacidneedsfor10%moreperday妇产科护理_Review-of-Maternal-Infant-NursingWarningSignsinPregnancyHeadacheAlteredvision:blurring,doublevision,seeingspotsNausea/vomitingEpigastricpain/abdominalpainMuscularirritability/seizuresSignsofinfection:fever,burninginurination,flankpain,diarrhea,VaginalbleedingDecreaseorcessationoffetalmovement妇产科护理_Review-of-Maternal-Infant-NursingAssessmentforNeuralTubeDefects“open”neuraltubedefectsleakalpha-fetoprotein(AFP)ElevateAFPlevelinmaternalserumandamnioticfluidmayindicatethefetushasneuraltubedefects妇产科护理_Review-of-Maternal-Infant-NursingAmniocentesisPerformedaround15-18weeksofgestationtoidentifygeneticabnormalityRisk:Traumatothefetus,placenta,umbilicalcord,ormaternalstructuresInfectionPrematurelaborandspontaneousabortion妇产科护理_Review-of-Maternal-Infant-NursingAmniocentesisWarningsignsafterreceivingamniocentesis:BodytemperatureelevationFluidleakingfromthevaginalMildCrampingandabdominalachingDecreasedfetalmovement妇产科护理_Review-of-Maternal-Infant-NursingChorionicVillusSamplingTodetectgeneticorchromosomaldefectsCanbedoneinearlypregnancy9-10weeksgestationRisk:miscarriage3.7-7.7%,1.7%discrepancyofresultbetweenvilluskaryotypeandfetus,ruptureamnioticsac,chorioamnionitis,oligohydramnios,intrauterinegrowthretardation妇产科护理_Review-of-Maternal-Infant-NursingTheNonstresstestCheckfetuswell-beingCheckfetalmovementinrelationtofetalheartrateaccelerationReactive:HRaccelerationwithfetusmovementNonreactive:noHRaccelerationwithfetusmovement妇产科护理_Review-of-Maternal-Infant-NursingGeneticProblemAutosomalRecessiveDisorders:25%oftheRiskofpassingthedisordertoeachoftheiroffspring.1:4chanceofdemonstratingthedisorder,50%changeofbeingacarriertotherecessivetrait,eachchildhas25%chancesofnothavingthediseasesandnotbeingacarrier-Cysticfibrosis,PKU,Sicklecellanemia,-X-linkeddisorders:Hemophilia,colorblindness,G6PD妇产科护理_Review-of-Maternal-Infant-NursingNursingandfamilywithGeneticdisordersPerformKaryotypeexaminationGeneticCounseling-supportfordecisionmakingGeneticscreenforpotentialrisk妇产科护理_Review-of-Maternal-Infant-NursingAssistingtheclienttocopewithFirst-TrimesterDiscomfortsNausea/vomiting-morningsicknessPtyalism“excesssalivainthemouth”AlteredtasteBleedinggumsBreasttendernessUrinaryfrequencyNasalstuffinessandEpistaxisIncreasedvaginalsecretionFatigue妇产科护理_Review-of-Maternal-Infant-NursingEnsureSafetyandremovingbarrierstocarePromotingclientsafety:home,work,lifestyle,environment,danger/warningsignsofpregnancyRemovingbarriers:SocialEconomicfactors,lackofinsurance,inabilitytopay,lackoffreeprenatalservice,limitaccesstoprenatalcareforeconomicallypoorwomen,limitedorexpensivetransportation,smallchildren,cultural妇产科护理_Review-of-Maternal-Infant-NursingPsychologicchangesandconcernsofamotherat2ndTrimesterAwareofthatthepregnancycanberecognizedbyothersAcceptanceofpregnancyMaternalroleattainment:fetusmovementfostersinternalizationandfantasyFantasies:bindingtoinfantsRelationshipwithmotherBodyimage:beginstoviewfetusasseparateformownbody,changetheperceptionofbodyboundaryasprotectivebarriertofetus妇产科护理_Review-of-Maternal-Infant-NursingQuestionThenurseshouldassessforwhichdevelopmentaltaskofthepregnantwomeninherthirdtrimester?BondingtothefetusinpreparationforbirthAcceptingthefetusasawantedresponsibilityUnderstandingthebabyisanindependentbeingPreparingtoseparatefromthefetusthroughthebirthprocess妇产科护理_Review-of-Maternal-Infant-NursingQuestion-DMmotherThenurseteachesthenewlypregnantdiabetictheimportanceofselfglucosemonitoringinthefirsttrimestertoprevent:HypoxiainthefetusTheonsetofdiabetesinfetusUnusuallylargefetaldevelopmentTeratogeniceffectsofhyperglycemia妇产科护理_Review-of-Maternal-Infant-NursingQuestion-PretermLaborMagnesiumSulfatemaybeprescribedasatocolyticdrugbecauseoneoftheexpectedactionsis:PromotingdiuresisLoweringbloodpressureInducingsedationandrestPromotingsmoothmusclerelaxation妇产科护理_Review-of-Maternal-Infant-NursingPainduringlaborAnalgesia:demerol(meperidine)Sedative:SeconalandNembutalNarcoticanalgesics:Fentanyl,StabolAnesthesia:Marcaine(Bupavacaine)Alfenta(Alfentani)妇产科护理_Review-of-Maternal-Infant-NursingEpiduralBlockGivetowomenin2-4cmCxdilationGivinganesthesiologistintoepidualspaceatL-2,L-3,L-4orL-5ProvidepainreliefinlowerpartofbodyLaborstimulationbyOxytocinmayneedPreventHypotensiveeffect(500-1000mlLactatedRinger’s)Monitoringuteruscontractionandfetuscondition妇产科护理_Review-of-Maternal-Infant-NursingSideEffectsofEpiduralAnalgesiaRespiratorydepressioninnewborn(Narcan)Pruitus(itching)NauseaandvomitingUrinaryretentionHypotensiveAffectlaborprocess,unabletopushduringsecondstageoflabor(assessmentimportant)妇产科护理_Review-of-Maternal-Infant-NursingQuestionAClienthasreceivedaneffectivedoseofepiduralanesthesia.TheIVrateis250ml/hourandpositionissemi-Fowler’s.Herbloodpressurehasdroppedsignificantly.Thefirstnursinginterventionisto:SlowtherateofIVinfusiontoavoidoverloadRetaketheBP,initialhypotensionisexpectedBeginoxygenbyfacemask,lowerhead,elevatelegs.Callbackanesthesiologisttodealwiththecondition妇产科护理_Review-of-Maternal-Infant-NursingInductionorAugmentationofLaborInduction:startinglaborartificiallybyoxytocinAugmentation:stimulationoflaboronceithasbegunnaturally.Amniotomy:coloroftheamnioticfluidAssessrisk:frequencyofcontraction,maternaltolerance,pain,fetuswell-being,discomfort,progressoflabor,complication妇产科护理_Review-of-Maternal-Infant-NursingLamazeTechniqueQuestionThenurseteachingtheLamazetechniqueevaluateshersuccesswhenthecoupledothefollowing:Breakthefear/tension/paincycleBondsuccessfullywiththenewbornUsepositivefeedbackwitheachotherduringlaborMaintaincontrolduringlaborbytheirtechniquesofbreathingandrelaxation妇产科护理_Review-of-Maternal-Infant-NursingQuestion

(painandchildbirthclass)Indevelopingchildbirthclassesthenurseplanstoincludetechniquesthatnormallyminimizepainperception,whichoftheseareinappropriate?UsingmusclerelaxationmethodsInvalidatingtheperceptionofpainRefocusingattentiononanothersubjectImplementinganxietyreductiontechniques妇产科护理_Review-of-Maternal-Infant-NursingIndevelopingchildbirthclassesthenurseplanstincludetechniquesthatnormallyminimizepainperception,whichoftheseareinappropriate?UsingmusclerelaxationmethodsInvalidatingthepainperceptionRefocusingattentiononanothersubjectImplementinganxietyreductiontechniques妇产科护理_Review-of-Maternal-Infant-NursingVaginalBirthAfterCesareanSection(VBAC)RepeatCSinUSA80%FearofweakeningtheuterinescareTwiceMaternalRiskinC/SthaninVaginalbirthQualification:primarycesareannotduetopelvicfactors.“Classicuterineincision???”Supportofstaffandwomen’sdesiretohavevaginalbirthareoptimalfactorfortryingVBAC妇产科护理_Review-of-Maternal-Infant-NursingQuestionWhenmembranesrupturespontaneouslyduringlabor,thenurseatthebedsidemustimme