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  • ISBN-10 ‏ : ‎ 0323074294
  • ISBN-13 ‏ : ‎ 978-0323074292
  • Author:  Lowdermilk

With comprehensive coverage of maternal, newborn, and women’s health nursing, Maternity & Women’s Health Care, 10th Edition provides evidence-based coverage of everything you need to know about caring for women of childbearing age. It’s the #1 maternity book in the market — and now respected authors Dr. Deitra Leonard Lowdermilk, Dr, Shannon E. Perry, Kitty Cashion, and Kathryn R. Alden have improved readability and provided a more focused approach! Not only does this text emphasize childbearing issues and concerns, including care of the newborn, it addresses wellness promotion and management of common women’s health problems. In describing the continuum of care, it integrates the importance of understanding family, culture, and community-based care. New to this edition is the most current information on care of the late preterm infant and the 2008 updated fetal monitoring standards from the National Institute of Child Health and Human Development.

 

Table of Content:

  1. Unit One Introduction to Maternity & Women’s Health Care
  2. Interactive Review—Unit 1
  3. Chapter 1 21st Century Maternity and Women’s Health Nursing
  4. Learning Objectives
  5. BOX 1-1 HISTORIC OVERVIEW OF MILESTONES IN THE CARE OF MOTHERS AND INFANTS
  6. Contemporary Issues and Trends
  7. Healthy People 2020 Goals
  8. Millennium Development Goals
  9. BOX 1-2 HEALTHY PEOPLE 2020 PERINATAL PROPOSED OBJECTIVES
  10. Objectives Retained from Healthy People 2010
  11. Objectives Retained but Modified from Healthy People 2010
  12. Objectives New to Healthy People 2020
  13. BOX 1-3 UNITED NATIONS MILLENNIUM DEVELOPMENT GOALS
  14. Integrative Health Care
  15. FIG. 1-1 Healing touch with pregnant woman.
  16. Problems with the U.S. Health Care System
  17. Structure of the Health Care Delivery System
  18. BOX 1-4 NATIONAL QUALITY FORUM “NEVER EVENTS” PERTAINING TO MATERNAL AND CHILD HEALTH
  19. Reducing Medical Errors
  20. High Cost of Health Care
  21. BOX 1-5 SELECTED SAFE PRACTICES FOR BETTER HEALTH CARE
  22. Limited Access to Care
  23. Health Care Reform
  24. Efforts to Reduce Health Disparities
  25. Health Literacy
  26. Trends in Fertility and Birth Rate
  27. Low Birth Weight and Preterm Birth
  28. BOX 1-6 MATERNAL-INFANT BIOSTATISTICAL TERMINOLOGY
  29. Infant Mortality in the United States
  30. International Infant Mortality Trends
  31. Maternal Mortality Trends
  32. Increase in High Risk Pregnancies
  33. Regionalization of Perinatal Health Care Services
  34. High-Technology Care
  35. Community-Based Care
  36. Childbirth Practices
  37. CLINICAL REASONING
  38. Safety and Efficacy of Midwifery Care
  39. FIG. 1-2 Father “catching” newborn son. Mother is reaching down to help birth the baby.
  40. Involving Consumers and Promoting Self-Management
  41. International Concerns
  42. Health of Women
  43. Trends in Nursing Practice
  44. Nursing Interventions Classification
  45. Evidence-Based Practice
  46. Cochrane Pregnancy and Childbirth Database
  47. BOX 1-7 CHILDBEARING CARE INTERVENTIONS
  48. Level 1 Domain: Family
  49. Level 2 Class: Childbearing Care
  50. Level 3: Interventions
  51. EVIDENCE-BASED PRACTICE
  52. Searching for and Evaluating the Evidence
  53. Joanna Briggs Institute
  54. TABLE 1-1 NURSING OUTCOMES CLASSIFICATION
  55. Outcomes-Oriented Practice
  56. A Global Perspective
  57. Standards of Practice and Legal Issues in Delivery of Care
  58. FIG. 1-3 Nurse examining client on a medical mission in China.
  59. LEGAL TIP
  60. Standard of Care
  61. Risk Management
  62. BOX 1-8 STANDARDS OF CARE FOR WOMEN AND NEWBORNS
  63. Standards that Define the Nurse’s Responsibility to the Client
  64. Assessment
  65. Diagnosis
  66. Outcome Identification
  67. Planning
  68. Implementation
  69. Evaluation
  70. Standards of Professional Performance that Delineate Roles and Behaviors for Which the Professional Nurse is Accountable
  71. Quality of Care
  72. Performance Appraisal
  73. Education
  74. Collegiality
  75. Ethics
  76. Collaboration
  77. Research
  78. Resource Utilization
  79. Practice Environment
  80. Accountability
  81. Sentinel Events
  82. TABLE 1-2 THE JOINT COMMISSION “DO NOT USE” LIST
  83. Failure to Rescue
  84. Quality and Safety Education for Nurses
  85. Teamwork and Communication
  86. Situation, Background, Assessment, Recommendation
  87. TeamSTEPPS
  88. BOX 1-9 INSTITUTE OF MEDICINE COMPETENCIES FOR NURSING
  89. Ethical Issues in Perinatal Nursing and Women’s Health Care
  90. Research in Perinatal Nursing and Women’s Health Care
  91. BOX 1-10 SAMPLE SBAR REPORT TO PHYSICIAN OR MIDWIFE ABOUT A CRITICAL SITUATION
  92. Ethical Guidelines for Nursing Research
  93. KEY POINTS
  94. References
  95. Chapter 2 Community Care: The Family and Culture
  96. Learning Objectives
  97. Introduction to Family, Culture, Community, and Home Care
  98. COMMUNITY ACTIVITY
  99. The Family in Cultural and Community Context
  100. Defining Family
  101. FIG. 2-1 Nuclear family.
  102. Family Organization and Structure
  103. FIG. 2-2 Extended family.
  104. The Family in Society
  105. Theoretic Approaches to Understanding Families
  106. Family Nursing
  107. Family Assessment
  108. Family Theories
  109. NURSING CARE PLAN
  110. Incorporating the Infant into the Family
  111. Nursing Diagnosis
  112. Expected Outcome
  113. Nursing Interventions/Rationales
  114. Nursing Diagnosis
  115. Expected Outcome
  116. Nursing Interventions/Rationales
  117. TABLE 2-1 THEORIES AND MODELS RELEVANT TO FAMILY NURSING PRACTICE
  118. Graphic Representations of Families
  119. The Family in a Cultural Context
  120. Cultural Factors Related to Family Health
  121. Implications for Nursing
  122. FIG. 2-3 The Friedman Family Assessment Model (short form).
  123. FIG. 2-4 Example of a family genogram.
  124. CLINICAL REASONING
  125. Providing Culturally Appropriate Care
  126. FIG. 2-5 Example of an ecomap. An ecomap describes social relationships and depicts available supports.
  127. Childbearing Beliefs and Practices
  128. BOX 2-1 WORKING WITH AN INTERPRETER
  129. Remember
  130. Personal Space
  131. Time Orientation
  132. Family Roles
  133. BOX 2-2 STRATEGIES FOR CARE DELIVERY AND PROVIDING CULTURALLY APPROPRIATE CARE
  134. Strategies for Care Delivery
  135. Providing Appropriate Care
  136. TABLE 2-2 TRADITIONAL∗ CULTURAL BELIEFS AND PRACTICES: CHILDBEARING AND PARENTING
  137. CULTURAL CONSIDERATIONS
  138. Questions to Ask to Elicit Cultural Expectations About Childbearing
  139. Developing Cultural Competence
  140. Community Health Promotion
  141. Levels of Preventive Care
  142. Promoting Family Health
  143. Assessing the Community
  144. Data Collection and Sources of Community Health Data
  145. FIG. 2-6 Community health assessment wheel.
  146. BOX 2-3 COMMUNITY WALK-THROUGH
  147. Vulnerable Populations in the Community
  148. Women
  149. Racial and Ethnic Minorities
  150. Adolescent Girls
  151. Older Women
  152. Incarcerated Women
  153. Refugee and Migrant Women
  154. Rural Versus Urban Community Settings
  155. Homeless Women
  156. Low Literacy
  157. Implications for Nursing
  158. Home Care in the Community
  159. Communication and Technology Applications
  160. FIG. 2-7 Perinatal continuum of care.
  161. Guidelines for Nursing Practice
  162. Perinatal Services
  163. Client Selection and Referral
  164. Care Management
  165. Preparing for the Home Visit
  166. First Home Care Visit
  167. Assessment and Nursing Diagnoses
  168. BOX 2-4 PROTOCOL FOR PERINATAL HOME VISITS
  169. Previsit Interventions
  170. In-Home Interventions: Establishing a Relationship
  171. In-Home Interventions: Working with the Family
  172. FIG. 2-8 Home care nurse visits with a woman in preterm labor at home on bed rest.
  173. In-Home Interventions: Ending the Visit
  174. Postvisit Interventions
  175. Nursing Considerations
  176. BOX 2-5 PSYCHOSOCIAL ASSESSMENT
  177. Language
  178. Community Resources/Access to Care
  179. Social Support
  180. Interpersonal Relationships
  181. Caregiver
  182. Stress and Coping
  183. Safety Issues for the Home Care Nurse
  184. NURSING CARE PLAN
  185. Community and Home Care
  186. Nursing Diagnosis
  187. Expected Outcome
  188. Nursing Interventions/Rationales
  189. Nursing Diagnosis
  190. Nursing Interventions/Rationales
  191. Nursing Diagnosis
  192. Expected Outcome
  193. Nursing Interventions/Rationales
  194. Personal Safety
  195. Woman’s Home
  196. Infection Control
  197. SAFETY ALERT
  198. KEY POINTS
  199. References
  200. Chapter 3 Clinical Genetics
  201. Learning Objectives
  202. Nursing Expertise in Genetics and Genomics
  203. Essential Competencies in Genetics and Genomics for All Nurses
  204. Expanded Roles for Maternity and Women’s Health Nurses
  205. Human Genome Project and Implications for Clinical Practice
  206. Importance of Family History
  207. Gene Identification and Testing
  208. Pharmacogenomics
  209. Gene Therapy
  210. Ethical, Legal, and Social Implications
  211. Factors Influencing the Decision to Undergo Genetic Testing
  212. Clinical Genetics
  213. Genetic Transmission
  214. Genes and Chromosomes
  215. FIG. 3-1 Chromosomes during cell division. A, Example of photomicrograph. B, Chromosomes arranged in karyotype; female and male sex-determining chromosomes.
  216. Chromosomal Abnormalities
  217. Autosomal Abnormalities
  218. Abnormalities of Chromosome Number
  219. FIG. 3-2 Infant with Down syndrome. Note upward slant to eyes, flat nasal bridge, slightly protruding tongue, and mottled skin.
  220. NURSING CARE PLAN
  221. The Family Living with a Child with Down Syndrome
  222. Nursing Diagnosis
  223. Expected Outcome
  224. Nursing Interventions/Rationales
  225. Nursing Diagnosis
  226. Expected Outcome
  227. Nursing Interventions/Rationales
  228. Nursing Diagnosis
  229. Expected Outcomes
  230. Nursing Interventions/Rationales
  231. Nursing Diagnosis
  232. Expected Outcome
  233. Nursing Interventions/Rationales
  234. Nursing Diagnosis
  235. Expected Outcome
  236. Nursing Interventions/Rationales
  237. Abnormalities of Chromosome Structure
  238. Sex Chromosome Abnormalities
  239. Patterns of Genetic Transmission
  240. Multifactorial Inheritance
  241. Unifactorial Inheritance
  242. Autosomal Dominant Inheritance
  243. FIG. 3-3 Possible offspring in three types of matings. A, Homozygous-dominant parent and homozygous-recessive parent: children all heterozygous, displaying dominant trait. B, Heterozygous parent and homozygous recessive parent: children 50% heterozygous, displaying dominant trait; 50% homozygous, displaying recessive trait. C, Both parents heterozygous: children 25% homozygous, displaying dominant trait; 25% homozygous, displaying recessive trait; 50% heterozygous, displaying dominant trait.
  244. Autosomal Recessive Inheritance
  245. Inborn Errors of Metabolism
  246. X-linked Dominant Inheritance
  247. X-linked Recessive Inheritance
  248. Cancer Genomics
  249. Gene Mutations That Can Lead to Cancer
  250. Hereditary Breast and Ovarian Cancer
  251. Colon Cancer
  252. Genetic Counseling
  253. Definition of Genetic Counseling
  254. Access and Referral to Genetic Counseling
  255. Estimation of Risk
  256. Interpretation of Risk
  257. Multiple Roles for Nurses in Genetics
  258. CLINICAL REASONING
  259. Counseling About Genetic Risk
  260. Future Promise of Genetics
  261. COMMUNITY ACTIVITY
  262. KEY POINTS
  263. References
  264. Unit Two Women’s Health
  265. Interactive Review—Unit 2
  266. Chapter 4 Assessment and Health Promotion
  267. Learning Objectives
  268. Female Reproductive System
  269. FIG. 4-1 External female genitalia.
  270. External Structures
  271. Internal Structures
  272. FIG. 4-2 Midsagittal view of female pelvic organs with woman lying supine.
  273. FIG. 4-3 Schematic arrangement of directions of muscle fibers. Note that uterine muscle fibers are continuous with supportive ligaments of uterus.
  274. FIG. 4-4 Adult female pelvis. A, Anterior view. B, External view of innominate bone (fused).
  275. The Bony Pelvis
  276. FIG. 4-5 Female pelvis. A, Cavity of false pelvis is shallow. B, Cavity of true pelvis is an irregularly curved canal (arrows).
  277. Breasts
  278. FIG. 4-6 Anatomy of the breast, showing position and major structures.
  279. TEACHING FOR SELF-MANAGEMENT
  280. Breast Self-Examination
  281. EVIDENCE-BASED PRACTICE
  282. Teaching Women Breast Self-Examination: Is It Worthwhile?
  283. Ask the Question
  284. Search for Evidence
  285. Search Strategies
  286. Databases Searched
  287. Critically Analyze the Data
  288. Implications for Practice
  289. References
  290. TABLE 4-1 FEMALE REPRODUCTIVE PHYSICAL ASSESSMENT ACROSS THE LIFE CYCLE
  291. Menstruation And Menopause
  292. Menarche and Puberty
  293. Menstrual Cycle
  294. Hypothalamic-Pituitary Cycle
  295. Ovarian Cycle
  296. Endometrial Cycle
  297. FIG. 4-7 Menstrual cycle: hypothalamic-pituitary, ovarian, and endometrial.
  298. Other Cyclic Changes
  299. Prostaglandins
  300. Climacteric and Menopause
  301. Sexual Response
  302. Reasons for Entering the Health Care System
  303. TABLE 4-2 FOUR PHASES OF SEXUAL RESPONSE
  304. Preconception Counseling and Care
  305. BOX 4-1 COMPONENTS OF PRECONCEPTION CARE
  306. Health Promotion: General Teaching
  307. Risk Factor Assessment
  308. Interventions
  309. Pregnancy
  310. Well-Woman Care
  311. BOX 4-2 MAJOR GOALS OF PRENATAL CARE
  312. Fertility Control and Infertility
  313. BOX 4-3 CONTRACEPTIVE HEALTH PROMOTION
  314. Menstrual Problems
  315. Perimenopause
  316. Barriers to Seeking Health Care
  317. Financial Issues
  318. Cultural Issues
  319. Gender Issues
  320. CULTURAL CONSIDERATIONS
  321. Female Genital Mutilation
  322. Health Risks in the Childbearing Years
  323. Age
  324. Adolescence
  325. Teenage Pregnancy
  326. Young and Middle Adulthood
  327. Parenthood After Age 35
  328. Late Reproductive Age
  329. Socioeconomic Status
  330. Substance Use and Abuse
  331. Smoking
  332. COMMUNITY ACTIVITY
  333. Alcohol
  334. Prescription Drugs
  335. Illicit Drugs
  336. Nutrition
  337. Nutritional Deficiencies
  338. Obesity
  339. Other Considerations
  340. Anorexia Nervosa
  341. BOX 4-4 SCREENING FOR EATING DISORDERS
  342. Scoff Questions
  343. Bulimia Nervosa
  344. Binge Eating Disorder
  345. Physical Fitness and Exercise
  346. SAFETY ALERT
  347. Stress
  348. BOX 4-5 STRESS SYMPTOMS
  349. Physical
  350. Behavior
  351. Psychologic
  352. Sexual Practices
  353. NURSING ALERT
  354. Medical Conditions
  355. Gynecologic Conditions
  356. BOX 4-6 TOP 10 LEADING CAUSES OF DEATH IN WOMEN IN THE UNITED STATES
  357. Environmental and Workplace Hazards
  358. Violence Against Women
  359. Health Assessment
  360. FIG. 4-8 Nurse interviews woman as part of history taking prior to physical examination.
  361. Interview
  362. CULTURAL CONSIDERATIONS
  363. Communication Variations
  364. Cultural Considerations
  365. Women with Special Needs
  366. Women with Disabilities
  367. Abused Women
  368. FIG. 4-9 Lithotomy and variable positions for women who have a disability.
  369. FIG. 4-10 Abuse assessment screen.
  370. Adolescents (Ages 13 to 19 Years)
  371. Midlife and Older Women (Ages 50 Years and Older)
  372. BOX 4-7 SPIRITUAL WELLNESS SELF-ASSESSMENT
  373. Healthy Aging
  374. History
  375. Physical Examination
  376. BOX 4-8 HEALTH HISTORY AND REVIEW OF SYSTEMS
  377. Pelvic Examination
  378. FIG. 4-11 External examination. Separation of the labia.
  379. External Inspection
  380. External Palpation
  381. Vulvar Self-Examination
  382. Internal Examination
  383. FIG. 4-12 Insertion of speculum for vaginal examination. A, Opening of the introitus. B, Oblique insertion of the speculum. C, Final insertion of the speculum. D, Opening of the speculum blades.
  384. PROCEDURE
  385. Assisting with Pelvic Examination
  386. Collection of Specimens
  387. Papanicolaou (Pap) Test
  388. Vaginal Examination
  389. Bimanual Palpation
  390. Rectovaginal Palpation
  391. Pelvic Examination During Pregnancy
  392. PROCEDURE
  393. Papanicolaou Test
  394. A, Collecting cells from endocervix using a Cytobrush. B, Obtaining cells from the transformation zone using a wooden spatula.
  395. FIG. 4-13 Bimanual palpation of the uterus.
  396. Pelvic Examination After Hysterectomy
  397. Laboratory and Diagnostic Procedures
  398. Anticipatory Guidance for Health Promotion and Illness Prevention
  399. FIG. 4-14 Rectovaginal examination.
  400. Nutrition
  401. TABLE 4-3 HEALTH SCREENING GUIDELINES AND IMMUNIZATION RECOMMENDATIONS FOR WOMEN AGES 18 YEARS AND OLDER
  402. CLINICAL REASONING
  403. Cardiovascular Disease—the Leading Cause of Death in Women
  404. FIG. 4-15 Exercise should be a part of one’s regular health routine. A cycle class is fun and provides moderate to vigorous exercise.
  405. Exercise
  406. Kegel Exercises
  407. TEACHING FOR SELF-MANAGEMENT
  408. Kegel Exercises
  409. Description and Rationale
  410. Technique
  411. Specific Instructions
  412. Other Suggestions for Implementation
  413. Stress Management
  414. Substance Use Cessation
  415. Sexual Practices That Reduce Risk
  416. Health Screening Schedule
  417. BOX 4-9 INTERVENTIONS FOR SMOKING CESSATION: THE FIVE A’S
  418. Ask
  419. Assess
  420. Advise
  421. Assist
  422. ARrange Follow-Up
  423. Health Risk Prevention
  424. Health Protection
  425. KEY POINTS
  426. Female External Genitalia (read text)
  427. Female Reproductive Ducts (read text)
  428. Ovaries (read text)
  429. Ovulation (read text)
  430. Breasts (read text)
  431. Menstrual Cycle: Uterine (read text)
  432. Ovarian Cycle (read text)
  433. References
  434. Chapter 5 Violence Against Women
  435. Learning Objectives
  436. CLINICAL REASONING
  437. Intimate Partner Violence
  438. Historical Perspective
  439. Conceptual and Theoretic Perspectives
  440. Biologic Factors
  441. Psychologic Perspective
  442. BOX 5-1 CHARACTERISTICS OF A POTENTIAL MALE BATTERER
  443. Sociologic Perspective
  444. Feminist Perspective
  445. FIG. 5-1 Model of how power and control issues perpetuate battering.
  446. Ecological Model
  447. FIG. 5-2 Ecological framework for intimate partner violence.
  448. Women Experiencing Intimate Partner Violence
  449. Characteristics of Women in Abusive Relationships
  450. TABLE 5-1 COMPARISON OF CHARACTERISTICS OF POSTTRAUMATIC STRESS SYNDROME, BATTERED WOMAN SYNDROME, AND RAPE-TRAUMA SYNDROME
  451. Cultural Considerations
  452. TABLE 5-2 MYTHS AND FACTS ABOUT INTIMATE PARTNER VIOLENCE
  453. African-American Culture
  454. Hispanic (and Latino) Cultures
  455. Native American Culture
  456. Asian Women
  457. Intimate Partner Violence During Pregnancy
  458. Care Management
  459. LEGAL TIP
  460. Mandatory Reporting of Domestic Violence
  461. EVIDENCE-BASED PRACTICE
  462. Interventions for Intimate Partner Violence
  463. Ask the Question
  464. Search for Evidence
  465. Search Strategies
  466. Databases Searched
  467. Critically Analyze the Data
  468. Implications for Practice
  469. References
  470. Nursing Interventions
  471. NURSING PROCESS
  472. Intimate Partner Violence
  473. Assessment
  474. Nursing Diagnoses
  475. Hopelessness related to
  476. Powerlessness related to
  477. Fear related to
  478. Risk for Post-trauma Syndrome related to
  479. Social Isolation related to
  480. Ineffective Family Coping related to
  481. Injury related to
  482. Situational Low Self-esteem related to
  483. Deficient Knowledge related to
  484. Expected Outcomes of Care
  485. Plan of Care and Interventions
  486. Evaluation
  487. BOX 5-2 DOCUMENTING ABUSE
  488. NURSING CARE PLAN
  489. The Woman Experiencing Intimate Partner Violence
  490. Nursing Diagnosis
  491. Expected Outcomes
  492. Nursing Interventions/Rationales
  493. Nursing Diagnosis
  494. Expected Outcome
  495. Nursing Interventions/Rationales
  496. Nursing Diagnosis
  497. Expected Outcomes
  498. Nursing Interventions/Rationales
  499. FIG. 5-3 Danger assessment tool.
  500. Prevention
  501. Sexual Violence
  502. Why Do Some Men Rape?
  503. Mental Health Consequences of Sexual Assault
  504. Rape-Trauma
  505. Acute Phase: Disorganization
  506. Outward Adjustment Phase
  507. Long-Term Process: Reorganization Phase
  508. Collaborative Care
  509. Psychologic First Aid
  510. BOX 5-3 ADULT SEXUAL ASSAULT PROTOCOL: EMERGENCY DEPARTMENT
  511. Purpose
  512. Assessment
  513. Safety
  514. Care
  515. Client/Significant Other (SO) Teaching
  516. Documentation
  517. The Sexual Assault Examination
  518. LEGAL TIP
  519. Collector of Evidence
  520. History
  521. LEGAL TIP
  522. Documentation
  523. Physical Examination and Laboratory Tests
  524. Immediate Care
  525. BOX 5-4 NURSING DIAGNOSES FOR THE RAPE VICTIM DURING THE IMMEDIATE AND LATER POSTTRAUMA PERIODS
  526. Immediate Posttrauma Period
  527. Later Posttrauma Period
  528. Discharge
  529. After Discharge
  530. COMMUNITY ACTIVITY
  531. KEY POINTS
  532. References
  533. Chapter 6 Reproductive System Concerns
  534. Learning Objectives
  535. Common Menstrual Disorders
  536. Amenorrhea
  537. Management
  538. Cyclic Perimenstrual Pain and Discomfort
  539. Dysmenorrhea
  540. Primary Dysmenorrhea
  541. Management
  542. CLINICAL REASONING
  543. Relief for Menstrual Discomfort
  544. NURSING ALERT
  545. TABLE 6-1 NONSTEROIDAL ANTIINFLAMMATORY AGENTS USED TO TREAT DYSMENORRHEA
  546. NURSING ALERT
  547. Secondary Dysmenorrhea
  548. Premenstrual Syndrome and Premenstrual Dysphoric Disorder
  549. TABLE 6-2 HERBAL THERAPIES FOR MENSTRUAL DISORDERS
  550. Management
  551. NURSING CARE PLAN
  552. Premenstrual Syndrome
  553. Nursing Diagnosis
  554. Expected Outcome
  555. Nursing Interventions/Rationales
  556. Nursing Diagnosis
  557. Expected Outcome
  558. Nursing Interventions/Rationales
  559. Nursing Diagnosis
  560. Expected Outcome
  561. Nursing Interventions/Rationales
  562. Nursing Diagnosis
  563. Expected Outcome
  564. Nursing Interventions/Rationales
  565. Endometriosis
  566. FIG. 6-1 Common sites of endometriosis.
  567. Management
  568. Alterations in Cyclic Bleeding
  569. NURSING CARE PLAN
  570. Endometriosis
  571. Nursing Diagnosis
  572. Expected Outcome
  573. Nursing Interventions/Rationales
  574. Nursing Diagnosis
  575. Expected Outcome
  576. Nursing Interventions/Rationales
  577. Nursing Diagnosis
  578. Expected Outcome
  579. Nursing Interventions/Rationales
  580. Nursing Diagnosis
  581. Expected Outcome
  582. Nursing Interventions/Rationales
  583. Nursing Diagnosis
  584. Expected Outcome
  585. Nursing Interventions/Rationales
  586. Oligomenorrhea/Hypomenorrhea
  587. Metrorrhagia
  588. EVIDENCE-BASED PRACTICE
  589. Heavy Menstrual Bleeding: Treatments to Improve Quality of Life
  590. Ask the Question
  591. Search for Evidence
  592. Search Strategies
  593. Databases Searched
  594. Critically Analyze the Data
  595. Implications for Practice
  596. References
  597. TABLE 6-3 CAUSES OF INTERMENSTRUAL BLEEDING
  598. Menorrhagia
  599. NURSING ALERT
  600. Dysfunctional Uterine Bleeding
  601. BOX 6-1 POSSIBLE CAUSES OF ABNORMAL UTERINE BLEEDING
  602. Anovulation
  603. Pregnancy-Related Conditions
  604. Lower Reproductive Tract Infections
  605. Neoplasms
  606. Trauma
  607. Systemic Diseases
  608. Iatrogenic Causes
  609. Care Management
  610. Menopause
  611. NURSING PROCESS
  612. Menstrual Disorders
  613. Assessment
  614. Nursing Diagnoses
  615. Risk for Ineffective Individual Coping related to:
  616. Deficient Knowledge related to:
  617. Risk for Disturbed Body Image related to:
  618. Risk for Situational Low Self-Esteem related to:
  619. Acute or Chronic Pain related to:
  620. Expected Outcomes of Care
  621. Plan of Care and Interventions
  622. Evaluation
  623. Physiologic Characteristics
  624. Physical Changes During the Perimenopausal Period
  625. Bleeding
  626. Genital Changes
  627. Vasomotor Instability
  628. Mood and Behavioral Responses
  629. Health Risks of Perimenopausal Women
  630. Osteoporosis
  631. FIG. 6-2 Skeletal changes secondary to osteoporosis assessed by height and body shape at A, age 55 years; B, age 65 years; and C, age 75 years.
  632. COMMUNITY ACTIVITY
  633. Coronary Heart Disease
  634. Menopausal Hormonal Therapy
  635. Decision to Use Hormone Therapy
  636. Side Effects
  637. Treatment Guidelines
  638. TABLE 6-4 HORMONE MEDICATIONS FOR MENOPAUSAL SYMPTOMS
  639. Bioidentical and Custom-Compounded Hormones
  640. Alternative Therapies
  641. SAFETY ALERT
  642. TEACHING FOR SELF-MANAGEMENT
  643. Comfort Measures for Menopausal Symptoms
  644. Hot Flashes/Flushes
  645. During the Day
  646. At Night
  647. Insomnia
  648. Headaches
  649. Urogenital Symptoms
  650. Nervousness, Irritability
  651. Care Management
  652. Sexual Counseling
  653. NURSING PROCESS
  654. The Perimenopausal Woman
  655. Assessment
  656. Nursing Diagnoses
  657. Deficient Knowledge related to:
  658. Readiness for Enhanced Family Coping related to:
  659. Risk for Injury related to:
  660. Sexual Dysfunction related to:
  661. Risk for Situational Low Self-Esteem related to:
  662. Expected Outcomes of Care
  663. Pland of Care and Interventions
  664. Evaluation
  665. Nutrition
  666. Exercise
  667. Medications for Osteoporosis
  668. FIG. 6-3 Posture exercises. A, Wall standing and pelvic tilt. B, Isometric posture correction. C, Standing back bend. D, The bridge. E, The elbow prop. F, Prone press-ups with deep breathing.
  669. BOX 6-2 PREVENTION OF OSTEOPOROSIS
  670. NURSING ALERT
  671. Midlife Support Groups
  672. FIG. 6-4 Midlife women can develop a supportive network.
  673. KEY POINTS
  674. References
  675. Chapter 7 Sexually Transmitted and Other Infections
  676. Learning Objectives
  677. Prevention
  678. BOX 7-1 SEXUALLY TRANSMITTED INFECTIONS
  679. Bacteria
  680. Viruses
  681. Protozoa
  682. Parasites
  683. BOX 7-2 ASSESSING STI AND HIV RISK BEHAVIORS
  684. Sexual Risk
  685. Drug Use—Related Risk
  686. Blood-Related Risks
  687. Other
  688. Risk Reduction Measures
  689. TABLE 7-1 RISK-REDUCTION PRACTICES
  690. Sexually Transmitted Bacterial Infections
  691. Chlamydia
  692. Screening and Diagnosis
  693. CLINICAL REASONING
  694. STI Counseling in Pregnancy
  695. Management
  696. Gonorrhea
  697. Screening and Diagnosis
  698. Management
  699. TABLE 7-2 SEXUALLY TRANSMITTED INFECTIONS AND DRUG THERAPIES FOR WOMEN∗
  700. LEGAL TIP
  701. Reporting Communicable Diseases
  702. Syphilis
  703. FIG. 7-1 Syphilis. A, Primary stage: chancre with inguinal adenopathy. B, Secondary stage: condylomata lata.
  704. Screening and Diagnosis
  705. Management
  706. NURSING ALERT
  707. Pelvic Inflammatory Disease
  708. Screening and Diagnosis
  709. Management
  710. TABLE 7-3 TREATMENT OF PELVIC INFLAMMATORY DISEASE
  711. Sexually Transmitted Viral Infections
  712. Human Papillomavirus
  713. FIG. 7-2 Human papillomavirus infection. Genital warts or condylomata acuminata.
  714. Screening and Diagnosis
  715. Management
  716. Prevention
  717. Genital Herpes Simplex Virus
  718. Screening and Diagnosis
  719. FIG. 7-3 Herpes genitalis.
  720. Management
  721. Viral Hepatitis
  722. Hepatitis A
  723. Hepatitis B
  724. Screening and Diagnosis
  725. Management
  726. Hepatitis C
  727. Human Immunodeficiency Virus
  728. Screening and Diagnosis
  729. Counseling for HIV Testing
  730. NURSING ALERT
  731. LEGAL TIP
  732. HIV Testing
  733. Management
  734. HIV and Pregnancy
  735. EVIDENCE-BASED PRACTICE
  736. Venus and Mars and HIV/STD Prevention Interventions
  737. Ask the Question
  738. Search for Evidence
  739. Search Strategies
  740. Databases Searched
  741. Critically Analyze the Data
  742. Implications for Practice
  743. References
  744. COMMUNITY ACTIVITY
  745. Vaginal Infections
  746. Bacterial Vaginosis
  747. Screening and Diagnosis
  748. TABLE 7-4 WET SMEAR TESTS FOR VAGINAL INFECTIONS
  749. Management
  750. Candidiasis
  751. TABLE 7-5 VAGINAL INFECTIONS AND DRUG THERAPIES FOR WOMEN
  752. Screening and Diagnosis
  753. Management
  754. TEACHING FOR SELF-MANAGEMENT
  755. Prevention of Genital Tract Infections
  756. Trichomoniasis
  757. Screening and Diagnosis
  758. Management
  759. Group B Streptococci
  760. Effects of Sexually Transmitted Infections on Pregnancy and the Fetus
  761. TORCH Infections
  762. TABLE 7-6 PREGNANCY AND FETAL EFFECTS OF COMMON SEXUALLY TRANSMITTED INFECTIONS
  763. Toxoplasmosis
  764. TABLE 7-7 TORCH INFECTION: MATERNAL AND FETAL
  765. Other Infections
  766. Rubella
  767. Cytomegalovirus
  768. NURSING ALERT
  769. Herpes Simplex Virus
  770. Care Management
  771. TEACHING FOR SELF-MANAGEMENT
  772. Sexually Transmitted Infections
  773. NURSING PROCESS
  774. The Woman with a Sexually Transmitted Infection
  775. Assessment
  776. Nursing Diagnoses
  777. Anxiety/Situational Low Self-Esteem/Disturbed Body Image related to:
  778. Deficient Knowledge related to:
  779. Acute Pain/Impaired Tissue Integrity related to:
  780. Sexual Dysfunction related to:
  781. Social Isolation and Impaired Social Interaction related to:
  782. Expected Outcomes of Care
  783. Plan of Care and Interventions
  784. Evaluation
  785. LEGAL TIP
  786. STI Reporting
  787. Infection Control
  788. BOX 7-3 STANDARD PRECAUTIONS
  789. KEY POINTS
  790. Pelvic Inflammatory Disease (read text)
  791. References
  792. Chapter 8 Contraception and Abortion
  793. Learning Objectives
  794. Contraception
  795. Care Management
  796. NURSING PROCESS
  797. Contraception
  798. Assessment
  799. Nursing Diagnoses
  800. Decisional Conflict related to:
  801. Fear related to:
  802. Risk for Infection related to:
  803. Ineffective Sexuality Patterns related to:
  804. Acute Pain related to:
  805. Risk for Spiritual Distress related to:
  806. Expected Outcomes of Care
  807. Plan of Care and Interventions
  808. Evaluation
  809. LEGAL TIP
  810. Informed Consent
  811. NURSING ALERT
  812. Methods of Contraception
  813. FIG. 8-1 Nurse counseling woman about contraceptive methods.
  814. BOX 8-1 FACTORS AFFECTING METHOD CONTRACEPTIVE EFFECTIVENESS
  815. Coitus Interruptus
  816. Fertility Awareness Methods (Natural Family Planning)
  817. NURSING CARE PLAN
  818. Sexual Activity and Contraception
  819. Nursing Diagnosis
  820. Expected Outcome
  821. Nursing Interventions/Rationales
  822. Nursing Diagnosis
  823. Expected Outcome
  824. Nursing Interventions/Rationales
  825. Nursing Diagnosis
  826. Expected Outcome
  827. Nursing Interventions/Rationales
  828. Calendar-Based Methods
  829. Calendar Rhythm Method
  830. FIG. 8-2 CycleBeads. Red bead marks the first day of the menstrual cycle. White beads mark days that are likely to be fertile days; therefore, unprotected intercourse should be avoided. Brown beads are days when pregnancy is unlikely and unprotected intercourse is permitted.
  831. BOX 8-2 POTENTIAL PITFALLS OF USING FERTILITY AWARENESS METHODS OF CONTRACEPTION
  832. Standard Days Method
  833. TEACHING FOR SELF-MANAGEMENT
  834. Cervical Mucus Characteristics
  835. Setting the Stage
  836. Content Related to Cervical Mucus
  837. Assessment Technique
  838. Symptoms-Based Methods
  839. TwoDay Method
  840. Ovulation Method
  841. FIG. 8-3 A, Special thermometer for recording basal body temperature, marked in tenths to enable person to read more easily. B, Basal temperature record shows drop and sharp rise at time of ovulation. Biphasic curve indicates ovulatory cycle.
  842. Basal Body Temperature Method
  843. Symptothermal Method
  844. Biologic Marker Methods
  845. Home Predictor Test Kits for Ovulation
  846. FIG. 8-4 Example of a completed symptothermal chart.
  847. FIG. 8-5 Examples of ovulation prediction tests.
  848. The Marquette Model
  849. Spermicides and Barrier Methods
  850. Spermicides
  851. Condoms
  852. FIG. 8-6 Spermicides.
  853. NURSING ALERT
  854. FIG. 8-7 A, Mechanical barriers. From the top left corner, clockwise: female condom, male condom, cervical cap, diaphragm. B, Contraceptive sponge.
  855. BOX 8-3 MALE CONDOMS
  856. Mechanism of Action
  857. Failure Rate
  858. Advantages
  859. Disadvantages
  860. STI Protection
  861. Nursing Considerations
  862. Diaphragms
  863. TEACHING FOR SELF-MANAGEMENT
  864. Use and Care of the Diaphragm
  865. Inspection of the Diaphragm
  866. Preparation of the Diaphragm
  867. Positions for Insertion of the Diaphragm
  868. Insertion of the Diaphragm
  869. General Information
  870. Removal of the Diaphragm
  871. Care of the Diaphragm
  872. NURSING ALERT
  873. Cervical Caps
  874. TEACHING FOR SELF-MANAGEMENT
  875. Insertion and Removal of the Cervical Cap
  876. TABLE 8-1 HORMONAL CONTRACEPTION
  877. Contraceptive Sponge
  878. Hormonal Methods
  879. Combined Estrogen-Progestin Contraceptives
  880. Oral Contraceptives
  881. Advantages
  882. Disadvantages and Side Effects
  883. NURSING ALERT
  884. Nursing Considerations
  885. Oral Contraceptive 91-Day Regimen
  886. FIG. 8-8 Flowchart for missed active contraceptive pills, 2010.
  887. SIGNS OF POTENTIAL COMPLICATIONS
  888. Oral Contraceptives
  889. Transdermal Contraceptive System
  890. FIG. 8-9 Hormonal contraceptive transdermal patch and vaginal ring.
  891. Vaginal Contraceptive Ring
  892. Progestin-Only Contraceptives
  893. Oral Progestins (Minipill)
  894. Injectable Progestins
  895. CLINICAL REASONING
  896. Vaginal Bleeding on Depo-Provera
  897. NURSING ALERT
  898. Implantable Progestins
  899. NURSING ALERT
  900. Emergency Contraception
  901. TABLE 8-2 ORAL EMERGENCY CONTRACEPTIVES
  902. NURSING ALERT
  903. FIG. 8-10 Intrauterine devices (IUDs). A, Copper T 380A. B, Levonorgestrel-releasing IUD.
  904. Intrauterine Devices
  905. EVIDENCE-BASED PRACTICE
  906. An Ideal Solution: The Intrauterine Device
  907. Ask the Question
  908. Search for Evidence
  909. Search Strategies
  910. Databases Searched
  911. Critically Analyze the Data
  912. Implications for Practice
  913. References
  914. Nursing Considerations
  915. Sterilization
  916. SIGNS OF POTENTIAL COMPLICATIONS
  917. Intrauterine Devices (IUDs)
  918. FIG. 8-11 Sterilization. A, Uterine tubes severed and ligated (tubal ligation). B, Sperm duct severed and ligated (vasectomy).
  919. Female Sterilization
  920. Tubal Occlusion
  921. FIG. 8-12 Use of minilaparotomy to gain access to uterine tubes for occlusion procedures. Tenaculum is used to lift uterus (arrow) toward incision.
  922. TEACHING FOR SELF-MANAGEMENT
  923. What to Expect After Tubal Ligation
  924. Transcervical Sterilization
  925. Tubal Reconstruction
  926. Male Sterilization
  927. Tubal Reconstruction
  928. Laws and Regulations
  929. LEGAL TIP
  930. Sterilization
  931. Nursing Considerations
  932. Breastfeeding: Lactational Amenorrhea Method
  933. Future Trends
  934. Induced Abortion
  935. LEGAL TIP
  936. Induced Abortion
  937. Incidence
  938. The Decision to Have an Abortion
  939. LEGAL TIP
  940. Institutional Policies for Nurses’ Rights and Responsibilities Related to Abortion
  941. Care Management
  942. BOX 8-4 SELECTED NURSING DIAGNOSES FOR WOMEN HAVING ELECTIVE ABORTION
  943. CLINICAL REASONING
  944. Abortion
  945. First-Trimester Abortion
  946. Aspiration
  947. SAFETY ALERT
  948. Medical Abortion
  949. Methotrexate and Misoprostol
  950. Mifepristone and Misoprostol
  951. Second-Trimester Abortion
  952. Dilation and Evacuation
  953. Nursing Considerations
  954. COMMUNITY ACTIVITY
  955. KEY POINTS
  956. References
  957. Chapter 9 Infertility
  958. Learning Objectives
  959. Incidence
  960. CLINICAL REASONING
  961. Infertility Counseling
  962. Factors Associated with Infertility
  963. Female Infertility
  964. Congenital or Developmental Factors
  965. Hormonal and Ovulatory Factors
  966. BOX 9-1 FACTORS AFFECTING FEMALE FERTILITY
  967. Ovarian Factors
  968. Uterine, Tubal, and Peritoneal Factors
  969. Other Factors
  970. BOX 9-2 FACTORS AFFECTING MALE FERTILITY
  971. Structural or Hormonal Disorders
  972. Other Factors
  973. Age-Related Infertility
  974. Tubal/Peritoneal Factors
  975. EVIDENCE-BASED PRACTICE
  976. Endometriosis Treatments for Infertility
  977. Ask the Question
  978. Search for Evidence
  979. Search Strategies
  980. Databases Searched
  981. Critically Analyze the Data
  982. Implications for Practice
  983. References
  984. FIG. 9-1 Abnormal uterus. A, Complete bicornuate uterus with vagina divided by a septum. B, Complete bicornuate uterus with normal vagina. C, Partial bicornuate uterus with normal vagina. D, Unicornuate uterus.
  985. Uterine Factors
  986. Vaginal-Cervical Factors
  987. Male Infertility
  988. Care Management
  989. BOX 9-3 RELIGIOUS AND CULTURAL CONSIDERATIONS OF FERTILITY
  990. Religious Considerations
  991. Cultural Considerations
  992. Assessment of Female Infertility
  993. Diagnostic Tests for Female Infertility
  994. BOX 9-4 INSURANCE COVERAGE FOR INFERTILITY
  995. Detection of Ovulation
  996. NURSING PROCESS
  997. Infertility
  998. Assessment
  999. Assessment of female infertility
  1000. Assessment of male infertility
  1001. Nursing Diagnoses
  1002. Anxiety related to
  1003. Disturbed Body Image or Situational Low Self-esteem related to
  1004. Risk for Ineffective Individual Coping related to
  1005. Interrupted Family Processes related to
  1006. Acute Pain related to
  1007. Ineffective Sexuality Patterns related to
  1008. Deficient Knowledge related to
  1009. Expected Outcomes of Care
  1010. Plan of Care and Interventions
  1011. Evaluation
  1012. TABLE 9-1 Tests for Impaired Fertility Revised
  1013. BOX 9-5 SUMMARY OF FINDINGS FAVORABLE TO FERTILITY
  1014. Hormone Analysis
  1015. Ultrasonography
  1016. Hysterosalpingography
  1017. FIG. 9-2 Vaginal ultrasonography. Major scanning planes of transducer. H, Horizontal; V, vertical.
  1018. FIG. 9-3 Hysterosalpingography. Note that contrast medium flows through intrauterine cannula and out through the uterine tubes.
  1019. Hysteroscopy
  1020. Timed Endometrial Biopsy
  1021. Laparoscopy
  1022. FIG. 9-4 Laparoscopy.
  1023. BOX 9-6 SEMEN ANALYSIS
  1024. Assessment of Male Infertility
  1025. Semen Analysis
  1026. Ultrasonography
  1027. Assessment of the Couple
  1028. Postcoital Test
  1029. Interventions
  1030. Psychosocial
  1031. NURSING CARE PLAN
  1032. Infertility
  1033. Nursing Diagnosis
  1034. Expected Outcome
  1035. Nursing Interventions/Rationales
  1036. Nursing Diagnosis
  1037. Expected Outcome
  1038. Nursing Interventions/Rationales
  1039. Nursing Diagnosis
  1040. Expected Outcome
  1041. Nursing Interventions/Rationales
  1042. TABLE 9-2 Nursing Actions in Response to Behavior Associated with Impaired Fertility
  1043. Nonmedical
  1044. Herbal Alternative Measures
  1045. Medical
  1046. MEDICATION GUIDE
  1047. Infertility Medications
  1048. Surgical
  1049. BOX 9-7 ISSUES TO BE ADDRESSED BY INFERTILE COUPLES BEFORE TREATMENT
  1050. Assisted Reproductive Therapies
  1051. In Vitro Fertilization–Embryo Transfer
  1052. TABLE 9-3 Assisted Reproductive Therapies
  1053. LEGAL TIP
  1054. Cryopreservation of Human Embryos
  1055. Gamete Intrafallopian Transfer
  1056. FIG. 9-5 Gamete intrafallopian transfer. A, Through laparoscopy, a ripe follicle is located and fluid containing the egg is removed. B, The sperm and egg are placed separately in the uterine tube, where fertilization occurs.
  1057. Zygote Intrafallopian Transfer
  1058. Complications
  1059. Oocyte Donation
  1060. Embryo Donation
  1061. Surrogate Mothers/Embryo Hosts
  1062. Therapeutic Donor Insemination
  1063. Adoption
  1064. COMMUNITY ACTIVITY
  1065. KEY POINTS
  1066. References
  1067. Chapter 10 Problems of the Breast
  1068. Learning Objectives
  1069. Benign Conditions of the Breast
  1070. Fibrocystic Changes
  1071. Etiology
  1072. Clinical Manifestations and Diagnosis
  1073. Therapeutic Management
  1074. Fibroadenomas
  1075. Nipple Discharge
  1076. Mammary Duct Ectasia
  1077. Intraductal Papilloma
  1078. Macromastia and Micromastia
  1079. Collaborative Care
  1080. TABLE 10-1 COMPARISON OF COMMON MANIFESTATIONS OF BENIGN BREAST MASSES
  1081. Malignant Conditions of the Breast
  1082. Incidence
  1083. Etiologic Factors
  1084. FIG. 10-1 Female breast cancer incidence and mortality rates by race and ethnicity, U.S. 2002-2006
  1085. Determining a Woman’s Risk of Genetically Related Breast Cancer
  1086. EVIDENCE-BASED PRACTICE
  1087. Genetic Risk Assessment for Breast Cancer
  1088. Ask the Question
  1089. Search for Evidence
  1090. Search Strategies
  1091. Databases Searched
  1092. Critically Analyze the Data
  1093. Implications for Practice
  1094. References
  1095. Chemoprevention
  1096. Pathophysiology
  1097. BOX 10-1 RISK FACTORS INCLUDED IN THE BREAST CANCER RISK ASSESSMENT TOOL
  1098. Clinical Manifestations and Diagnosis
  1099. TABLE 10-2 STAGING FOR BREAST CANCER∗
  1100. FIG. 10-2 Relative location of malignant lesions of the breast.
  1101. FIG. 10-3 Mammography.
  1102. CULTURAL CONSIDERATIONS
  1103. Breast Screening Practices
  1104. TABLE 10-3 SCREENING GUIDELINES FOR EARLY BREAST CANCER DETECTION
  1105. BOX 10-2 SCREENING FOR BREAST CANCER
  1106. FIG. 10-4 Diagnosis. A, Needle aspiration. B, Open biopsy.
  1107. Prognosis
  1108. FIG. 10-5 Lymphatic spread of breast cancer.
  1109. Care Management
  1110. BOX 10-3 DECISION-MAKING QUESTIONS TO ASK
  1111. CLINICAL REASONING
  1112. Breast Cancer Treatment Options
  1113. Surgery
  1114. FIG. 10-6 Surgical alternatives for breast cancer. A, Lumpectomy. B, Partial mastectomy. C, Total (simple) mastectomy. D, Radical mastectomy.
  1115. Breast Reconstruction
  1116. TABLE 10-4 RECONSTRUCTIVE BREAST SURGERY OPTIONS
  1117. Radiation
  1118. Adjuvant Systemic Therapy
  1119. Hormonal therapy
  1120. MEDICATION GUIDE
  1121. Tamoxifen (Nolvadex)
  1122. Action
  1123. Indication
  1124. Dosage and Route
  1125. Adverse Reactions
  1126. Nursing Considerations
  1127. Chemotherapy
  1128. MEDICATION GUIDE
  1129. Raloxifene Hydrochloride (Evista)
  1130. Action
  1131. Indications
  1132. Dosage
  1133. Adverse Reactions
  1134. Nursing Considerations
  1135. MEDICATION GUIDE
  1136. Letrozole (Femara)
  1137. Action
  1138. Indication
  1139. Dosage and Route
  1140. Adverse Reactions
  1141. Nursing Considerations
  1142. BOX 10-4 COMMON CHEMOTHERAPY REGIMENS FOR ADJUVANT TREATMENT OF BREAST CANCER
  1143. Care Management
  1144. Nursing Considerations
  1145. Emotional Support After Diagnosis
  1146. Preoperative Care
  1147. Immediate Postoperative Care
  1148. NURSING PROCESS
  1149. The Woman with Breast Cancer
  1150. Assessment
  1151. Nursing Diagnoses
  1152. Fear/Anxiety related to:
  1153. Decisional Conflict related to:
  1154. Sexual Dysfunction related to:
  1155. Compromised/Disabled Family Coping related to:
  1156. Anticipatory Grieving related to:
  1157. Fatigue related to:
  1158. Acute Pain related to:
  1159. Impaired Skin Integrity related to:
  1160. Disturbed Body Image related to:
  1161. Expected Outcomes of Care
  1162. Plan of Care and Interventions
  1163. Evaluation
  1164. NURSING ALERT
  1165. NURSING CARE PLAN
  1166. The Woman Having Breast-Conserving Surgery and Axillary Node Dissection
  1167. Nursing Diagnosis
  1168. Expected Outcome
  1169. Nursing Interventions/Rationales
  1170. Nursing Diagnosis
  1171. Expected Outcome
  1172. Nursing Interventions/Rationales
  1173. Nursing Diagnosis
  1174. Expected Outcome
  1175. Nursing Interventions/Rationales
  1176. Nursing Diagnosis
  1177. Expected Outcome
  1178. Nursing Interventions/Rationales
  1179. BOX 10-5 ARM EXERCISES AFTER LYMPH NODE DISSECTION
  1180. Exercises After Breast Surgery
  1181. Exercises in Lying Position
  1182. Wand Exercise
  1183. Elbow Winging
  1184. Exercises in Sitting Position
  1185. Shoulder Blade Stretch
  1186. Shoulder Blade Squeeze
  1187. Side Bending
  1188. Exercises in Standing Position
  1189. Chest Wall Stretch
  1190. Shoulder Stretch
  1191. Discharge Planning and Follow-up Care
  1192. Teaching Needs for the Client and Family Undergoing Adjuvant Therapies
  1193. COMMUNITY ACTIVITY
  1194. TEACHING FOR SELF-MANAGEMENT
  1195. After a Mastectomy Without Reconstruction
  1196. Additional Nursing Care for Women Undergoing Mastectomy with Reconstruction
  1197. KEY POINTS
  1198. References
  1199. Chapter 11 Structural Disorders and Neoplasms of the Reproductive System
  1200. Learning Objectives
  1201. Structural Disorders of the Uterus and Vagina
  1202. Alterations in Pelvic Support
  1203. Uterine Displacement and Prolapse
  1204. FIG. 11-1 Types of uterine displacement. A, Anterior displacement. B, Retroversion (backward displacement of the uterus).
  1205. FIG. 11-2 Prolapse of uterus.
  1206. FIG. 11-3 A, Cystocele. B, Rectocele.
  1207. Clinical Manifestations
  1208. Cystocele and Rectocele
  1209. Clinical Manifestations
  1210. Urinary Incontinence
  1211. Clinical Manifestations
  1212. FIG. 11-4 Urethrovesical angle. A, Normal angle. B, Widening (absence) of angle.
  1213. Genital Fistulas
  1214. Clinical Manifestations
  1215. Collaborative Care
  1216. FIG. 11-5 Types of fistulas that may develop in the vagina, uterus, or rectum.
  1217. FIG. 11-6 Examples of pessaries. A, Smith. B, Hodge without support. C, Incontinence dish without support. D, Ring without support. E, Cube. F, Gellhorn.
  1218. Benign Neoplasms
  1219. Ovarian Cysts
  1220. Follicular Cysts
  1221. FIG. 11-7 Ovarian cyst.
  1222. Corpus Luteum Cysts
  1223. Theca-Lutein Cysts
  1224. Polycystic Ovary Syndrome
  1225. Collaborative Care
  1226. Other Benign Ovarian Cysts and Neoplasms
  1227. FIG. 11-8 Endometrial polyps.
  1228. Uterine Polyps
  1229. Collaborative Care
  1230. Leiomyomas
  1231. CLINICAL REASONING
  1232. Informed Decision Making for Treatment of Leiomyoma
  1233. Clinical Manifestations and Diagnosis
  1234. FIG. 11-9 Types of leiomyomas. A, Subserous. B, Intramural. C, Submucosal. D, Cervical. E, Pedunculated.
  1235. Care Management
  1236. Medical Management
  1237. Medications
  1238. NURSING PROCESS
  1239. The Woman with a Leiomyoma
  1240. Assessment
  1241. Nursing Diagnoses
  1242. Anxiety related to:
  1243. Acute or Chronic Pain related to:
  1244. Sexual Dysfunction related to:
  1245. Expected Outcomes of Care
  1246. Plan of Care and Interventions
  1247. Evaluation
  1248. Uterine Artery Embolization
  1249. Surgical Management
  1250. TEACHING FOR SELF-MANAGEMENT
  1251. Care After Uterine Artery Embolization
  1252. Laser Surgery
  1253. Myomectomy
  1254. FIG. 11-10 Hysterectomy. A, Vaginal. B, Abdominal.
  1255. Hysterectomy
  1256. Preoperative Care
  1257. BOX 11-1 QUESTIONS FOR A WOMAN TO ASK TO ENSURE INFORMED CONSENT
  1258. BOX 11-2 PREOPERATIVE PROCEDURES FOR HYSTERECTOMY
  1259. BOX 11-3 POSTOPERATIVE CARE AFTER HYSTERECTOMY
  1260. Postoperative Care
  1261. Discharge Planning and Teaching
  1262. TEACHING FOR SELF-MANAGEMENT
  1263. Care After Myomectomy or Hysterectomy
  1264. Vulvar Problems
  1265. Bartholin Cysts
  1266. Collaborative Care
  1267. Vulvodynia
  1268. Collaborative Care
  1269. Malignant Neoplasms
  1270. Cancer of the Endometrium
  1271. Incidence and Etiology
  1272. Care Management
  1273. Assessment and Nursing Diagnoses
  1274. NURSING ALERT
  1275. TABLE 11-1 FIGO CLASSIFICATION OF ENDOMETRIAL CARCINOMA∗
  1276. TABLE 11-2 Common Side Effects of Chemotherapy Agents Used for Gynecologic Cancers∗
  1277. Expected Outcomes of Care
  1278. Plan of Care and Interventions
  1279. Therapeutic Management
  1280. Nursing Management
  1281. CULTURAL CONSIDERATIONS
  1282. Meaning of Cancer
  1283. Preoperative Care
  1284. Postoperative Care
  1285. Discharge Planning and Teaching
  1286. Evaluation
  1287. Cancer of the Ovary
  1288. Incidence and Etiology
  1289. NURSING CARE PLAN
  1290. Hysterectomy for Endometrial Cancer
  1291. Nursing Diagnosis
  1292. Expected Outcomes
  1293. Nursing Interventions/Rationales
  1294. Nursing Diagnosis
  1295. Expected Outcome
  1296. Nursing Interventions/Rationales
  1297. Nursing Diagnosis
  1298. Expected Outcome
  1299. Nursing Interventions/Rationales
  1300. Nursing Diagnosis
  1301. Expected Outcome
  1302. Nursing Interventions/Rationales
  1303. Nursing Diagnosis
  1304. Expected Outcome
  1305. Nursing Interventions/Rationales
  1306. Nursing Diagnosis
  1307. Expected Outcome
  1308. Nursing Interventions/Rationales
  1309. Clinical Manifestations and Diagnosis
  1310. BOX 11-4 NUTRITIONAL MANAGEMENT FOR COMMON PROBLEMS RELATED TO GYNECOLOGIC CANCER OR TREATMENT
  1311. Altered Taste
  1312. Anorexia
  1313. Nausea and Vomiting
  1314. Stomatitis
  1315. Constipation
  1316. Diarrhea
  1317. Postoperative Recovery
  1318. Therapeutic Management
  1319. Nursing Implications
  1320. LEGAL TIP
  1321. Advance Directives
  1322. Cancer of the Cervix
  1323. Incidence and Etiology
  1324. FIG. 11-11 Diagram of cervical epithelium showing progressive changes and various terminology.
  1325. FIG. 11-12 Location of squamocolumnar junction according to age. The location where the endocervical glands meet the squamous epithelium becomes progressively higher with age. A, Puberty. B, Reproductive years. C, Postmenopausal.
  1326. TABLE 11-3 FIGO Classification of Cervical Carcinoma
  1327. Clinical Manifestations and Diagnosis
  1328. BOX 11-5 2001 BETHESDA SYSTEM FOR REPORTING CERVICAL CYTOLOGY RESULTS
  1329. Results/Interpretations
  1330. Negative for Intraepithelial Malignancy
  1331. Epithelial Cell Abnormalities
  1332. Glandular Cell
  1333. FIG. 11-13 A, Cone biopsy for endocervical disease. Limits of lesion were not seen colposcopically. B, Cone biopsy for cervical intraepithelial neoplasia of the exocervix. Limits of lesion were identified colposcopically.
  1334. Care Management
  1335. Medical and Surgical Management
  1336. NURSING PROCESS
  1337. The Woman Having Radiation Therapy
  1338. Assessment
  1339. Nursing Diagnoses
  1340. Deficient Knowledge related to:
  1341. Fear/Anxiety related to:
  1342. Disturbed Sensory Perception related to:
  1343. Risk for Impaired Skin Integrity related to:
  1344. Risk for Injury related to:
  1345. Acute Pain related to:
  1346. Sexual Dysfunction related to:
  1347. Expected Outcomes of Care
  1348. Plan of Care and Interventions
  1349. Evaluation
  1350. Cryosurgery
  1351. EVIDENCE-BASED PRACTICE
  1352. Cervical Cancer Treatment Options: Conventional and Complementary
  1353. Ask the Question
  1354. Search for Evidence
  1355. Search Strategies
  1356. Databases Searched
  1357. Critically Analyze the Data
  1358. Implications for Practice
  1359. References
  1360. FIG. 11-14 Electrosurgical excision. The electric loop vaporizes quickly and removes cone of tissue.
  1361. Laser Ablation
  1362. Electrosurgical Excision
  1363. Radical Hysterectomy
  1364. Nursing Management
  1365. Radiation Therapy
  1366. FIG. 11-15 Intracavitary implant. Applicator in place in uterus is loaded with radium source.
  1367. Nursing Management
  1368. External Therapy
  1369. FIG. 11-16 Interstitial-intracavitary implant.
  1370. TEACHING FOR SELF-MANAGEMENT
  1371. Care After External Radiation Therapy
  1372. Internal Therapy
  1373. SAFETY ALERT
  1374. TEACHING FOR SELF-MANAGEMENT
  1375. Care After Internal Radiation Therapy
  1376. Complications of Radiation Therapy
  1377. Recurrent and Advanced Cancer of the Cervix
  1378. Pelvic Exenteration
  1379. Nursing Management
  1380. FIG. 11-17 Pelvic exenteration procedures. A, Anterior exenteration. B, Posterior exenteration. C, Total exenteration.
  1381. Chemotherapy
  1382. Cancer of the Vulva
  1383. Incidence and Etiology
  1384. Clinical Manifestations and Diagnosis
  1385. Collaborative Care
  1386. Therapeutic Management
  1387. FIG. 11-18 Radical vulvectomy. Note dotted lines denoting vulvectomy incision and inguinal groin incisions.
  1388. Nursing Management
  1389. TEACHING FOR SELF-MANAGEMENT
  1390. Care After Radical Vulvectomy
  1391. Cancer of the Vagina
  1392. Cancer of the Uterine Tubes
  1393. Cancer and Pregnancy
  1394. Cancer of the Breast
  1395. Cancer of the Cervix
  1396. Leukemia
  1397. Hodgkin’s Disease
  1398. Melanoma
  1399. Thyroid Cancer
  1400. NURSING ALERT
  1401. Colon Cancer
  1402. Other Gynecologic Cancers
  1403. Cancer of the Vulva
  1404. Cancer of the Vagina
  1405. Cancer of the Uterus
  1406. Cancer of the Uterine Tube
  1407. Cancer of the Ovary
  1408. Cancer Therapy and Pregnancy
  1409. Ethical Considerations
  1410. Timing of Therapy
  1411. Pregnancy After Cancer Treatment
  1412. Gestational Trophoblastic Disease
  1413. BOX 11-6 CLASSIFICATION OF GESTATIONAL TROPHOBLASTIC NEOPLASIA
  1414. COMMUNITY ACTIVITY
  1415. KEY POINTS
  1416. References
  1417. Unit Three Pregnancy
  1418. Interactive Review—Unit 3
  1419. Chapter 12 Conception and Fetal Development
  1420. Learning Objectives
  1421. Conception
  1422. Cell Division
  1423. Gametogenesis
  1424. FIG. 12-1 Gametogenesis. A, Oogenesis. Gametogenesis in the female produces one mature ovum and three polar bodies. Note the relative difference in overall size between the ovum and sperm. B, Spermatogenesis. Gametogenesis of the male produces four mature gametes, the sperm. C, Fertilization results in the single-cell zygote and the restoration of the diploid number of chromosomes.
  1425. Ovum
  1426. FIG. 12-2 Abnormal gametogenesis: nondisjunction. A, When nondisjunction occurs during the first meiotic division of spermatogenesis, one secondary spermatocyte contains 22 autosomes plus an X and a Y chromosome, whereas the other one contains 22 autosomes and no sex chromosomes. B, Nondisjunction during oogenesis may give rise to an oocyte with 22 autosomes and two X chromosomes (as shown) or one with 22 autosomes and no sex chromosome.
  1427. FIG. 12-3 Sperm and ovum.
  1428. Sperm
  1429. Fertilization
  1430. FIG. 12-4 Fertilization. A, Ovum fertilized by X-bearing sperm to form female zygote. B, Ovum fertilized by Y-bearing sperm to form male zygote.
  1431. Implantation
  1432. Embryo and Fetus
  1433. FIG. 12-5 First weeks of human development. A, Follicular development in the ovary, ovulation, fertilization, and transport of the early embryo down the uterine tube and into the uterus, where implantation occurs. B, Blastocyst embedded in endometrium. Germ layers forming.
  1434. Primary Germ Layers
  1435. Development of the Embryo
  1436. Membranes
  1437. FIG. 12-6 Extravillous trophoblasts are found outside the villus and can be subdivided into endovascular and interstitial categories. Endovascular trophoblasts invade and transform spiral arteries during pregnancy to create low-resistance blood flow that is characteristic of the placenta. Interstitial trophoblasts invade the decidua and surround spiral arteries.
  1438. FIG. 12-7 Development of the fetal membranes. Note gradual obliteration of intrauterine cavity as decidua capsularis and decidua vera meet. Also note thinning of uterine wall. Chorionic and amniotic membranes are in apposition to each other but may be peeled apart.
  1439. Amniotic Fluid
  1440. FIG. 12-8 Sensitive or critical periods in human development. During the first 2 weeks of development the embryo usually is not susceptible to teratogens. At that time a teratogen damages all or most of the cells, resulting in death of the embryo, or damages only a few cells, allowing the conceptus to recover and the embryo to develop without birth defects. The dark color denotes highly sensitive periods; the light color indicates stages that are less sensitive to teratogens.
  1441. Yolk Sac
  1442. Umbilical Cord
  1443. FIG. 12-9 Term placenta. A, Maternal (or uterine) surface, showing cotyledons and grooves. B, Fetal (or amniotic) surface, showing blood vessels running under amnion and converging to form umbilical vessels at attachment of umbilical cord. C, Amnion and smooth chorion are arranged to show that they are (1) fused and (2) continuous with margins of placenta.
  1444. FIG. 12-10 Schematic drawing of the placenta illustrating how it supplies oxygen and nutrition to the embryo and removes its waste products. Deoxygenated blood leaves the fetus through the umbilical arteries and enters the placenta, where it is oxygenated. Oxygenated blood leaves the placenta through the umbilical vein, which enters the fetus via the umbilical cord.
  1445. Placenta
  1446. Structure
  1447. FIG. 12-11 Distinct profile for the concentrations of human chorionic gonadotropin (hCG) and human chorionic somatomammotropin (hcs) in serum of women through normal pregnancy. IU, International units.
  1448. Functions
  1449. FIG. 12.12 Plasma level of progesterone, estradiol, estrone, and estriol in women during the course of gestation.
  1450. BOX 12-1 DEVELOPMENTALLY TOXIC EXPOSURES IN HUMANS
  1451. Fetal Maturation
  1452. Fetal Circulatory System
  1453. FIG. 12-13 Schematic illustration of the fetal circulation. The colors indicate the oxygen saturation of the blood, and the arrows show the course of the blood from the placenta to the heart. The organs are not drawn to scale. Observe that three shunts permit most of the blood to bypass the liver and lungs: (1) ductus venosus, (2) foramen ovale, and (3) ductus arteriosus. A small amount of highly oxygenated blood from the inferior vena cava remains in the right atrium and mixes with poorly oxygenated blood from the superior vena cava. This medium oxygenated blood then passes into the right ventricle. The poorly oxygenated blood returns to the placenta for oxygen and nutrients through the umbilical arteries.
  1454. Hematopoietic System
  1455. Gastrointestinal System
  1456. Hepatic System
  1457. Respiratory System
  1458. Pulmonary Surfactants
  1459. Renal System
  1460. Neurologic System
  1461. Sensory Awareness
  1462. Endocrine System
  1463. Reproductive System
  1464. Musculoskeletal System
  1465. CLINICAL REASONING
  1466. Ultrasound Examination During Pregnancy
  1467. Integumentary System
  1468. Immunologic System
  1469. FIG. 12-14 Formation of dizygotic twins, with fertilization of two ova, two implantations, two placentas, two chorions, and two amnions.
  1470. TABLE 12-1 MILESTONES IN HUMAN DEVELOPMENT BEFORE BIRTH SINCE LAST MENSTRUAL PERIOD
  1471. Multifetal Pregnancy
  1472. Twins
  1473. Dizygotic Twins
  1474. FIG. 12-15 Diamniotic dichorionic (separate) twin placenta.
  1475. Monozygotic Twins
  1476. Conjoined Twins
  1477. FIG. 12-16 Formation of monozygotic twins. A, One fertilization: blastomeres separate, resulting in two implantations, two placentas, and two sets of membranes. B, One blastomere with two inner cell masses, one fused placenta, one chorion, and separate amnions. C, One blastomere with incomplete separation of cell mass, resulting in conjoined twins.
  1478. Other Multifetal Pregnancies
  1479. Nongenetic Factors Influencing Development
  1480. KEY POINTS
  1481. Oogenesis and Meiosis (read text)
  1482. Spermatogenesis (read text)
  1483. Testes (read text)
  1484. Male Accessory Sex Glands (read text)
  1485. Male External Genitalia (read text)
  1486. Male Reproductive Ducts (read text)
  1487. Pathway of Ovum (read text)
  1488. Pathway of Sperm (read text)
  1489. Fertilization and Implantation (read text)
  1490. Maternal and Fetal Circulation (read text)
  1491. First Trimester, Fetal Development (read text)
  1492. Second Trimester, Fetal Development (read text)
  1493. Third Trimester, Fetal Development (read text)
  1494. References
  1495. Chapter 13 Anatomy and Physiology of Pregnancy
  1496. Learning Objectives
  1497. Gravidity and Parity
  1498. TABLE 13-1 OBSTETRIC HISTORY USING FIVE-DIGIT SYSTEM AND TWO-DIGIT SYSTEM
  1499. NURSING ALERT
  1500. Pregnancy Tests
  1501. FIG. 13-1 Many pregnancy test products are available over the counter.
  1502. TEACHING FOR SELF-MANAGEMENT
  1503. Home Pregnancy Testing
  1504. CLINICAL REASONING
  1505. Pregnancy Testing
  1506. Adaptations to Pregnancy
  1507. TABLE 13-2 SIGNS OF PREGNANCY
  1508. Signs of Pregnancy
  1509. Reproductive System and Breasts
  1510. Uterus
  1511. Changes in Size, Shape, and Position
  1512. FIG. 13-2 Comparison of abdomen, vulva, and cervix in nullipara (A), and multipara (B), at the same stage of pregnancy.
  1513. Changes in Contractility
  1514. Uteroplacental Blood Flow
  1515. FIG. 13-3 Height of fundus by weeks of normal gestation with a single fetus. Dashed line, height after lightening.
  1516. Cervical Changes
  1517. FIG. 13-4 Displacement of internal abdominal structures and diaphragm by the enlarging uterus at 4, 6, and 9 months of gestation.
  1518. Changes Related to the Presence of the Fetus
  1519. FIG. 13-5 Hegar sign. Bimanual examination for assessing compressibility and softening of the isthmus (lower uterine segment) while the cervix is still firm.
  1520. FIG. 13-6 Internal ballottement (18 weeks).
  1521. Vagina and Vulva
  1522. FIG. 13-7 A, Cervix in nonpregnant woman. B, Cervix during pregnancy.
  1523. Breasts
  1524. General Body Systems
  1525. Cardiovascular System
  1526. FIG. 13-9 Changes in position of heart, lungs, and thoracic cage in pregnancy. Broken line, nonpregnant; solid line, change that occurs in pregnancy.
  1527. BOX 13-1 BLOOD PRESSURE MEASUREMENT
  1528. Blood Pressure
  1529. BOX 13-2 CALCULATION OF MEAN ARTERIAL PRESSURE
  1530. Blood Volume and Composition
  1531. FIG. 13-10 Hemorrhoids.
  1532. Cardiac Output
  1533. Circulation and Coagulation Times
  1534. Respiratory System
  1535. Pulmonary Function
  1536. Basal Metabolic Rate
  1537. TABLE 13-3 LABORATORY VALUES FOR PREGNANT AND NONPREGNANT WOMEN
  1538. TABLE 13-4 CARDIOVASCULAR CHANGES IN PREGNANCY
  1539. Acid-Base Balance
  1540. Renal System
  1541. Anatomic Changes
  1542. TABLE 13-5 RESPIRATORY CHANGES IN PREGNANCY
  1543. Functional Changes
  1544. Fluid and Electrolyte Balance
  1545. Integumentary System
  1546. FIG. 13-11 Striae gravidarum and linea nigra in a dark-skinned woman.
  1547. NURSING ALERT
  1548. Musculoskeletal System
  1549. FIG. 13-12 Postural changes during pregnancy. A, Nonpregnant posture. B, Incorrect posture during pregnancy. C, Correct posture during pregnancy.
  1550. Neurologic System
  1551. FIG. 13-13 Possible change in rectus abdominis muscles during pregnancy. A, Normal position in nonpregnant woman. B, Diastasis recti abdominis in pregnant woman.
  1552. Gastrointestinal System
  1553. Appetite
  1554. Mouth
  1555. Esophagus, Stomach, and Intestines
  1556. Gallbladder and Liver
  1557. Abdominal Discomfort
  1558. Endocrine System
  1559. Pituitary and Placental Hormones
  1560. FIG. 13-14 Change in position of appendix in pregnancy. Note McBurney’s point.
  1561. Thyroid Gland
  1562. Parathyroid Gland
  1563. Pancreas
  1564. Adrenal Glands
  1565. KEY POINTS
  1566. References
  1567. Chapter 14 Maternal and Fetal Nutrition
  1568. Learning Objectives
  1569. Nutrient Needs Before Conception
  1570. FIG. 14-1 Factors that affect the outcome of pregnancy.
  1571. Nutrient Needs During Pregnancy
  1572. Energy Needs
  1573. BOX 14-1 FOOD SOURCES OF FOLATE
  1574. Foods Providing 500 Micrograms or More Per Serving
  1575. Foods Providing 200 Micrograms or More Per Serving
  1576. Foods Providing 100 Micrograms or More Per Serving
  1577. Foods Providing 50 Micrograms or More Per Serving
  1578. Foods Providing 20 Micrograms or More Per Serving
  1579. Weight Gain
  1580. FIG. 14-2 Prenatal weight-gain chart for plotting weight gain of normal-weight women.
  1581. TABLE 14-1 RECOMMENDATIONS FOR DAILY INTAKES OF SELECTED NUTRIENTS DURING PREGNANCY AND LACTATION
  1582. Pattern of Weight Gain
  1583. BOX 14-2 WEIGHT GAIN DURING PREGNANCY
  1584. Hazards of Restricting Adequate Weight Gain
  1585. CLINICAL REASONING
  1586. Imbalanced Nutrition
  1587. Excessive Weight Gain
  1588. TABLE 14-2 TISSUES CONTRIBUTING TO MATERNAL WEIGHT GAIN AT 40 WEEKS OF GESTATION
  1589. BOX 14-3 BARIATRIC OBSTETRIC CARE
  1590. Protein
  1591. TABLE 14-3 DAILY FOOD GUIDE FOR PREGNANCY AND LACTATION
  1592. SAFETY ALERT
  1593. Fluids
  1594. Minerals and Vitamins
  1595. TABLE 14-4 CAFFEINE CONTENT OF COMMON BEVERAGES AND FOODS
  1596. Iron
  1597. BOX 14-4 USE OF ARTIFICIAL SWEETENERS DURING PREGNANCY
  1598. Calcium
  1599. BOX 14-5 INDICATORS OF NUTRITIONAL RISK IN PREGNANCY
  1600. EVIDENCE-BASED PRACTICE
  1601. What Else Should We Tell Our Pregnant Clients to Take, Besides Folic Acid?
  1602. Ask the Question
  1603. Search for Evidence
  1604. Search Strategies
  1605. Databases Searched
  1606. Critically Analyze the Evidence
  1607. Implications for Practice
  1608. References
  1609. Other Minerals and Electrolytes
  1610. Magnesium
  1611. Sodium
  1612. BOX 14-6 CALCIUM SOURCES FOR WOMEN WHO DO NOT DRINK MILK
  1613. Fish
  1614. Beans and Legumes
  1615. Greens
  1616. Baked Products
  1617. Fruits
  1618. Sauces
  1619. Potassium
  1620. Zinc
  1621. Fluoride
  1622. Fat-Soluble Vitamins
  1623. Water-Soluble Vitamins
  1624. Folate/Folic Acid
  1625. Pyridoxine
  1626. Vitamin C
  1627. FIG. 14-3 Nonfood substances consumed in pica: red clay from Georgia, Nzu from East Nigeria, baking powder, cornstarch, baking soda, laundry starch, and ice. Some individuals practice poly-pica, consuming more than one of these or other nonfood substances.
  1628. Other Nutritional Issues During Pregnancy
  1629. Pica and Food Cravings
  1630. Adolescent Pregnancy Needs
  1631. Preeclampsia
  1632. Physical Activity During Pregnancy
  1633. Nutrient Needs During Lactation
  1634. Care Management
  1635. Diet History
  1636. Obstetric and Gynecologic Effects on Nutrition
  1637. NURSING PROCESS
  1638. Excessive Gestational Weight Gain
  1639. Assessment
  1640. Nursing Diagnoses
  1641. Imbalanced Nutrition: More than Body Requirements related to:
  1642. Deficient Knowledge related to:
  1643. Risk for Injury (to the Fetus) related to:
  1644. Ineffective Health Maintenance related to:
  1645. Disturbed Body Image related to:
  1646. Expected Outcomes of Care
  1647. Plan of Care and Interventions
  1648. Home Care
  1649. Evaluation
  1650. Health History
  1651. Usual Maternal Diet
  1652. SAFETY ALERT
  1653. Physical Examination
  1654. Laboratory Testing
  1655. Client Education
  1656. BOX 14-7 FOOD INTAKE QUESTIONNAIRE
  1657. Adequate Dietary Intake
  1658. TABLE 14-5 PHYSICAL ASSESSMENT OF NUTRITIONAL STATUS
  1659. COMMUNITY ACTIVITY
  1660. Pregnancy
  1661. Postpartum
  1662. NURSING CARE PLAN
  1663. Nutrition During Pregnancy
  1664. Nursing Diagnosis
  1665. Expected Outcomes
  1666. Nursing Interventions/Rationales
  1667. Nursing Diagnosis
  1668. Expected Outcome
  1669. Nursing Interventions/Rationales
  1670. Nursing Diagnosis
  1671. Expected Outcome
  1672. Nursing Interventions/Rationales
  1673. Daily Food Guide and Menu Planning
  1674. Medical Nutrition Therapy
  1675. Counseling About Iron Supplementation
  1676. Coping with Nutrition-Related Discomforts of Pregnancy
  1677. Nausea and Vomiting
  1678. TEACHING FOR SELF-MANAGEMENT
  1679. Iron Supplementation
  1680. Constipation
  1681. Pyrosis
  1682. Cultural Influences
  1683. BOX 14-8 SUGGESTIONS FOR MANAGING NAUSEA AND VOMITING DURING PREGNANCY
  1684. Vegetarian Diets
  1685. TABLE 14-6 POPULAR FOODS OF VARIOUS CULTURAL AND ETHNIC GROUPS AND THEIR PLACE IN MYPYRAMID
  1686. KEY POINTS
  1687. References
  1688. Chapter 15 Nursing Care of the Family During Pregnancy
  1689. Learning Objectives
  1690. Diagnosis of Pregnancy
  1691. Signs and Symptoms
  1692. Estimating Date of Birth
  1693. BOX 15-1 USE OF NÄGELE’S RULE
  1694. Adaptation to Pregnancy
  1695. Maternal Adaptation
  1696. Accepting the Pregnancy
  1697. Identifying with the Mother Role
  1698. Reordering Personal Relationships
  1699. FIG. 15-1 A pregnant woman and her mother enjoying their walk together.
  1700. Establishing a Relationship with the Fetus
  1701. Preparing for Childbirth
  1702. FIG. 15-2 Four-year-old likes to examine the pregnant abdomen of his mother.
  1703. Paternal Adaptation
  1704. Accepting the Pregnancy
  1705. Identifying with the Father Role
  1706. FIG. 15-3 A prospective mother and father walk together. Women respond positively to their partner’s interest and concern.
  1707. Reordering Personal Relationships
  1708. Establishing a Relationship with the Fetus
  1709. Preparing for Childbirth
  1710. Sibling Adaptation
  1711. FIG. 15-4 A sibling class of preschoolers learns infant care using dolls.
  1712. BOX 15-2 SIBLING ADAPTATION
  1713. Tips for Sibling Preparation
  1714. Prenatal
  1715. During the Hospital Stay
  1716. Going Home
  1717. Adjustment After the Baby Is Home
  1718. Grandparent Adaptation
  1719. Care Management
  1720. FIG. 15-5 A grandfather getting to know his grandson.
  1721. BOX 15-3 PRENATAL VISIT SCHEDULE
  1722. Initial Visit
  1723. Prenatal Interview
  1724. NURSING PROCESS
  1725. Nursing Care During Pregnancy
  1726. Assessment
  1727. Nursing Diagnoses
  1728. Anxiety related to
  1729. Interrupted Family Processes related to
  1730. Deficient Knowledge related to
  1731. Disturbed Sleep Pattern related to
  1732. Expected Outcomes of Care
  1733. Plan of Care and Interventions
  1734. Evaluation
  1735. Reason for Seeking Care
  1736. Current Pregnancy
  1737. Childbearing and Female Reproductive System History
  1738. Health History
  1739. Nutritional History
  1740. History of Drug and Herbal Preparations Use
  1741. Family History
  1742. Social, Experiential, and Occupational History
  1743. History of Physical Abuse
  1744. Review of Systems
  1745. Physical Examination
  1746. TABLE 15-1 LABORATORY TESTS IN PRENATAL PERIOD
  1747. Laboratory Tests
  1748. BOX 15-4 HIV SCREENING
  1749. Follow-up Visits
  1750. FIG. 15-6 A prenatal interview.
  1751. Interview
  1752. Physical Examination
  1753. EMERGENCY
  1754. Supine Hypotension
  1755. Signs and Symptoms
  1756. Interventions
  1757. Fetal Assessment
  1758. Listening for Fetal Heart Tones
  1759. Measuring Fundal Height
  1760. SIGNS OF POTENTIAL COMPLICATIONS
  1761. First, Second, and Third Trimesters
  1762. FIG. 15-7 Measurement of fundal height from symphysis that (A), includes the upper curve of the fundus and (B), does not include the upper curve of the fundus. Note position of hands and measuring tape.
  1763. Gestational Age
  1764. FIG. 15-8 Detecting fetal heart rate. A, Father listens to the fetal heart (first detectable around 18 to 20 weeks) with a fetoscope. B, Doppler ultrasound stethoscope (fetal heartbeat detectable at 12 weeks). C, Pinard fetoscope. Note: Hands should not touch fetoscope while listening.
  1765. Health Status
  1766. Laboratory Tests
  1767. Collaborative Care
  1768. Education About Maternal and Fetal Changes
  1769. Education for Self-Management
  1770. Nutrition
  1771. Personal Hygiene
  1772. Prevention of Urinary Tract Infections
  1773. Kegel Exercises
  1774. Preparation for Breastfeeding
  1775. FIG. 15-9 A, Normal nipple everts with gentle pressure. B, Inverted nipple inverts with gentle pressure.
  1776. FIG. 15-10 Breast shell in place inside bra to evert nipple.
  1777. Dental Care
  1778. Physical Activity
  1779. Posture and Body Mechanics
  1780. TEACHING FOR SELF-MANAGEMENT
  1781. Exercise Tips for Pregnant Women
  1782. Riding a recumbent bicycle provides exercise while supplying back support.
  1783. FIG. 15-11 Exercises. A-C, Pelvic rocking relieves low backache (excellent for relief of menstrual cramps as well). D, Abdominal breathing aids relaxation and lifts abdominal wall off uterus.
  1784. FIG. 15-12 Correct body mechanics. A, Squatting. B, Lifting.
  1785. TEACHING FOR SELF-MANAGEMENT
  1786. Posture and Body Mechanics
  1787. To Prevent or Relieve Backache
  1788. To Restrict the Lumbar Curve
  1789. To Prevent Round Ligament Pain and Strain on Abdominal Muscles
  1790. Rest and Relaxation
  1791. FIG. 15-13 Side-lying position for rest and relaxation. Some women prefer to support upper part of leg with pillows.
  1792. FIG. 15-14 Squatting for muscle relaxation and strengthening and for keeping leg and hip joints flexible.
  1793. Employment
  1794. BOX 15-5 CONSCIOUS RELAXATION TIPS
  1795. TEACHING FOR SELF-MANAGEMENT
  1796. Safety During Pregnancy
  1797. FIG. 15-15 Position for resting legs and for reducing edema and varicosities. Encourage woman with vulvar varicosities to include pillow under her hips.
  1798. Clothing
  1799. Travel
  1800. FIG. 15-16 Relief of muscle spasm (leg cramps). A, Another person dorsiflexes foot with knee extended. B, Woman stands and leans forward, thereby dorsiflexing foot of affected leg.
  1801. FIG. 15-17 Proper use of seat belt and headrest.
  1802. Medications and Herbal Preparations
  1803. NURSING ALERT
  1804. Immunizations
  1805. SAFETY ALERT
  1806. Alcohol, Cigarette Smoke, Caffeine, and Drugs
  1807. EVIDENCE-BASED PRACTICE
  1808. Perinatal Smoking Cessation
  1809. Ask the Question
  1810. Search for Evidence
  1811. Search Strategies
  1812. Databases Searched
  1813. Critically Analyze the Data
  1814. Implications for Practice
  1815. References
  1816. Normal Discomforts
  1817. CLINICAL REASONING
  1818. Nausea in pregnancy
  1819. BOX 15-6 COMPLEMENTARY AND ALTERNATIVE THERAPIES USED IN PREGNANCY
  1820. Morning Sickness and Hyperemesis
  1821. Relaxation and Muscle-Ache Relief
  1822. Recognizing Potential Complications
  1823. FIG. 15-18 Pericardium 6 (p6) acupressure point for nausea.
  1824. TEACHING FOR SELF-MANAGEMENT
  1825. Sexuality in Pregnancy
  1826. TABLE 15-2 DISCOMFORTS RELATED TO PREGNANCY
  1827. NURSING CARE PLAN
  1828. Discomforts of Pregnancy and Warning Signs
  1829. First Trimester
  1830. Nursing Diagnosis
  1831. Expected Outcome
  1832. Nursing Interventions/Rationales
  1833. Nursing Diagnosis
  1834. Expected Outcome
  1835. Nursing Interventions/Rationales
  1836. Nursing Diagnosis
  1837. Expected Outcome
  1838. Nursing Interventions/Rationales
  1839. Second Trimester
  1840. Nursing Diagnosis
  1841. Expected Outcome
  1842. Nursing Interventions/Rationales
  1843. Nursing Diagnosis
  1844. Expected Outcomes
  1845. Nursing Interventions/Rationales
  1846. Third Trimester
  1847. Nursing Diagnosis
  1848. Expected Outcomes
  1849. Nursing Interventions/Rationales
  1850. Nursing Diagnosis
  1851. Expected Outcome
  1852. Nursing Interventions/Rationales
  1853. Nursing Diagnosis
  1854. Expected Outcomes
  1855. Nursing Interventions/Rationales
  1856. Recognizing Preterm Labor
  1857. Sexual Counseling
  1858. Using the History
  1859. Countering Misinformation
  1860. Suggesting Alternative Behaviors
  1861. FIG. 15-19 Positions for sexual intercourse during pregnancy. A, Female superior. B, Side by side. C, Rear entry. D, Side-lying, facing each other.
  1862. Psychosocial Support
  1863. Variations in Prenatal Care
  1864. Cultural Influences
  1865. Emotional Response
  1866. Clothing
  1867. Physical Activity and Rest
  1868. FIG. 15-20 A young woman from Honduras wearing a muñeco given to her by her mother to ensure a safe birth.
  1869. Sexual Activity
  1870. Diet
  1871. Age Differences
  1872. Adolescents
  1873. Women Older Than 35 Years
  1874. Multiparous Women
  1875. FIG. 15-21 Pregnant adolescents reviewing fetal development.
  1876. NURSING CARE PLAN
  1877. Adolescent Pregnancy
  1878. NURSING DIAGNOSIS
  1879. Expected Outcome
  1880. Nursing Interventions/Rationales
  1881. Nursing Diagnosis
  1882. Expected Outcomes
  1883. Nursing Interventions/Rationales
  1884. Nursing Diagnosis
  1885. Expected Outcomes
  1886. Nursing Interventions/Rationales
  1887. Nursing Diagnosis
  1888. Expected Outcome
  1889. Nursing Interventions/Rationales
  1890. Nursing Diagnosis
  1891. Expected Outcome
  1892. Nursing Interventions/Rationales
  1893. Nursing Diagnosis
  1894. Expected Outcome
  1895. Nursing Interventions/Rationales
  1896. Primiparous Women
  1897. Multifetal Pregnancy
  1898. Childbirth and Perinatal Education
  1899. Childbirth Education Programs
  1900. FIG. 15-22 Learning relaxation exercises with the whole family.
  1901. Current Practices in Childbirth Education
  1902. Pain Management
  1903. Perinatal Care Choices
  1904. Physicians
  1905. Nurse-Midwives
  1906. Direct-Entry Midwives
  1907. Doulas
  1908. COMMUNITY ACTIVITY
  1909. Birth Plans
  1910. Birth Setting Choices
  1911. BOX 15-7 QUESTIONS TO ASK WHEN CHOOSING A DOULA
  1912. Labor, Delivery, Recovery, Postpartum (Birthing) Rooms
  1913. Birth Centers
  1914. FIG. 15-23 A, Labor, delivery, and recovery (LDR) unit. B, Labor, delivery, recovery, and postpartum (LDRP) unit. Note sofa in background that converts to a bed.
  1915. FIG. 15-24 Birth center. A, Note double bed, baby crib, and birthing stool. B, Lounge and kitchen.
  1916. Home Birth
  1917. KEY POINTS
  1918. Abdomen / Fundal Height (read text)
  1919. References
  1920. Unit Four Childbirth
  1921. Interactive Review—Unit 4
  1922. Chapter 16 Labor and Birth Processes
  1923. Learning Objectives
  1924. Factors Affecting Labor
  1925. Passenger
  1926. Size of the Fetal Head
  1927. FIG. 16-1 Fetal head at term. A, Bones.B, Sutures and fontanels.
  1928. Fetal Presentation
  1929. Fetal Lie
  1930. Fetal Attitude
  1931. Fetal Position
  1932. FIG. 16-2 Examples of fetal vertex (occiput) presentations in relation to front, back, or side of maternal pelvis.
  1933. Passageway
  1934. FIG. 16-3 Fetal presentations. A through C, Breech (sacral) presentations. D, Shoulder presentation.
  1935. FIG. 16-4 Diameters of the fetal head at term. A, Cephalic presentations: occiput, vertex, and sinciput; and cephalic diameters: suboccipitobregmatic, occipitofrontal, and occipitomental. B, Biparietal diameter.
  1936. Bony Pelvis
  1937. FIG. 16-5 Head entering pelvis. Biparietal diameter is indicated with shading (9.25 cm). A, Suboccipitobregmatic diameter: complete flexion of head on chest so that smallest diameter enters. B, Occipitofrontal diameter: moderate extension (military attitude) so that large diameter enters. C, Occipitomental diameter: marked extension (deflection), so that the largest diameter, which is too large to permit head to enter pelvis, is presenting.
  1938. FIG. 16-7 Female pelvis. A, Pelvic brim from above. B, Pelvic outlet from below.
  1939. FIG. 16-8 Pelvic cavity. A, Inlet and midplane. Outlet not shown. B, Cavity of true pelvis. C, Note curve of sacrum and axis of birth canal.
  1940. FIG. 16-9 Estimation of angle of subpubic arch. With both thumbs, examiner externally traces descending rami down to tuberosities.
  1941. Soft Tissues
  1942. Powers
  1943. Primary Powers
  1944. FIG. 16-10 A, Uterus in normal labor in early first stage, and B, in second stage. Passive segment is derived from lower uterine segment (isthmus) and cervix, and physiologic retraction ring is derived from anatomic internal os. C, Uterus in abnormal labor in second-stage dystocia. Pathologic retraction (Bandl) ring that forms under abnormal conditions develops from the physiologic ring.
  1945. TABLE 16-1 OBSTETRIC MEASUREMENTS
  1946. TABLE 16-2 COMPARISON OF PELVIC TYPES
  1947. FIG. 16-11 Cervical effacement and dilation. Note how cervix is drawn up around presenting part (internal os). Membranes are intact, and head is not well applied to cervix. A, Before labor. B, Early effacement. C, Complete effacement (100%). Head is well applied to cervix. D, Complete dilation (10 cm). Cranial bones overlap somewhat, and membranes are still intact.
  1948. Secondary Powers
  1949. Position of the Laboring Woman
  1950. Process of Labor
  1951. Signs Preceding Labor
  1952. FIG. 16-12 Positions for labor and birth. A, Positions for labor. B, Positions for birth.
  1953. Onset of Labor
  1954. BOX 16-1 SIGNS PRECEDING LABOR
  1955. Stages of Labor
  1956. CLINICAL REASONING
  1957. Second Stage Labor in a Woman with an Epidural
  1958. Mechanism of Labor
  1959. FIG. 16-13 Cardinal movements of the mechanism of labor. Left occipitoanterior (LOA) position. Pelvic figures show the position of the fetal head as seen by the birth attendant. A, Engagement and descent. B, Flexion. C, Internal rotation to occipitoanterior position (OA). D, Extension. E, External rotation beginning (restitution). F, External rotation.
  1960. Engagement
  1961. Asynclitism
  1962. Descent
  1963. FIG. 16-14 Synclitism and asynclitism. A, Anterior asynclitism. B, Normal synclitism. C, Posterior asynclitism.
  1964. Flexion
  1965. Internal Rotation
  1966. Extension
  1967. Restitution and External Rotation
  1968. Expulsion
  1969. Physiologic Adaptation to Labor
  1970. Fetal Adaptation
  1971. Fetal Heart Rate
  1972. Fetal Circulation
  1973. Fetal Respiration
  1974. Maternal Adaptation
  1975. Cardiovascular Changes
  1976. BOX 16-2 MATERNAL PHYSIOLOGIC CHANGES DURING LABOR
  1977. Respiratory Changes
  1978. Renal Changes
  1979. Integumentary Changes
  1980. Musculoskeletal Changes
  1981. Neurologic Changes
  1982. Gastrointestinal Changes
  1983. Endocrine Changes
  1984. KEY POINTS
  1985. Presentation (read text)
  1986. Fetal Lie (read text)
  1987. Position (read text)
  1988. References
  1989. Chapter 17 Pain Management
  1990. Learning Objectives
  1991. Pain During Labor and Birth
  1992. Neurologic Origins
  1993. Perception of Pain
  1994. Expression of Pain
  1995. FIG. 17-1 Discomfort during labor. A, Distribution of labor pain during first stage. B, Distribution of labor pain during transition and early phase of second stage. C, Distribution of pain during late second stage and actual birth.
  1996. Factors Influencing Pain Response
  1997. Physiologic Factors
  1998. Culture
  1999. CULTURAL CONSIDERATIONS
  2000. Some Cultural Beliefs About Pain
  2001. Anxiety
  2002. Previous Experience
  2003. Gate-Control Theory of Pain
  2004. Comfort
  2005. Support
  2006. BOX 17-1 SUGGESTED MEASURES FOR SUPPORTING A WOMAN IN LABOR
  2007. Environment
  2008. Nonpharmacologic Pain Management
  2009. EVIDENCE-BASED PRACTICE
  2010. Complementary and Alternative Pain Management in Labor
  2011. Ask the Question
  2012. Search for Evidence
  2013. Search Strategies
  2014. Databases Searched
  2015. Critically Analyze the Data
  2016. Implications for Practice
  2017. References
  2018. CLINICAL REASONING
  2019. Making Decisions Regarding Pain Management for Labor
  2020. Childbirth Preparation Methods
  2021. BOX 17-2 NONPHARMACOLOGIC STRATEGIES TO ENCOURAGE RELAXATION AND RELIEVE PAIN
  2022. Cutaneous Stimulation Strategies
  2023. Sensory Stimulation Strategies
  2024. Cognitive Strategies
  2025. COMMUNITY ACTIVITY
  2026. Relaxation and Breathing Techniques
  2027. Focusing and Relaxation Techniques
  2028. FIG. 17-2 A laboring woman using focusing and breathing techniques during a uterine contraction with coaching from her partner.
  2029. Breathing Techniques
  2030. FIG. 17-3 Expectant parents learning relaxation techniques.
  2031. BOX 17-3 PACED BREATHING TECHNIQUES
  2032. Cleansing Breath
  2033. Slow-Paced Breathing (Approximately 6 to 8 Breaths per Minute)
  2034. Modified-Paced Breathing (Approximately 32 to 40 Breaths per Minute)
  2035. Patterned-Paced or Pant-Blow Breathing (Same Rate as Modified)
  2036. Effleurage and Counterpressure
  2037. Music
  2038. FIG. 17-4 Water therapy during labor. A, Use of shower during labor. B, Woman experiencing back labor relaxes as partner sprays warm water on her back. C, Laboring woman relaxes in Jacuzzi. Note that fetal monitoring can continue during time in the Jacuzzi.
  2039. Water Therapy (Hydrotherapy)
  2040. SAFETY ALERT
  2041. Transcutaneous Electrical Nerve Stimulation
  2042. Acupressure and Acupuncture
  2043. FIG. 17-5 Placement of transcutaneous electrical nerve stimulation (TENS) electrodes on back for relief of labor pain.
  2044. FIG. 17-6 Ho-Ku acupressure point (back of hand where thumb and index finger come together) used to enhance uterine contractions without increasing pain.
  2045. Application of Heat and Cold
  2046. Touch and Massage
  2047. Hypnosis
  2048. Biofeedback
  2049. Aromatherapy
  2050. FIG. 17-7 Intradermal injections of 0.1 ml of sterile water in the treatment of women with back pain during labor. Sterile water is injected into four locations on the lower back, two over each posterior superior iliac spine (PSIS) and two 3 cm below and 1 cm medial to the PSIS. The injections should raise a bleb on the skin. Simultaneous injections administered by two clinicians will decrease the pain of the injections.
  2051. Intradermal Water Block
  2052. Pharmacologic Pain Management
  2053. Sedatives
  2054. Analgesia and Anesthesia
  2055. BOX 17-4 PHARMACOLOGIC CONTROL OF DISCOMFORT BY STAGE OF LABOR AND METHOD OF BIRTH
  2056. First Stage
  2057. Second Stage
  2058. Vaginal Birth
  2059. Cesarean Birth
  2060. Systemic Analgesia
  2061. Opioid Agonist Analgesics
  2062. SAFETY ALERT
  2063. Opioid (Narcotic) Agonist-Antagonist Analgesics
  2064. MEDICATION GUIDE
  2065. Opioid Agonist Analgesics
  2066. Action
  2067. Indication
  2068. Dosage and Route
  2069. Adverse Effects
  2070. Nursing Considerations
  2071. MEDICATION GUIDE
  2072. Opioid Agonist-Antagonist Analgesics
  2073. Action
  2074. Indication
  2075. Dosage and Route
  2076. Adverse Effects
  2077. Nursing Considerations
  2078. SIGNS OF POTENTIAL COMPLICATIONS
  2079. Maternal Opioid Abstinence Syndrome (Opioid/Narcotic Withdrawal)
  2080. Opioid (Narcotic) Antagonists
  2081. NURSING ALERT
  2082. MEDICATION GUIDE
  2083. Opioid Antagonist
  2084. Action
  2085. Indication
  2086. Dosage and Route
  2087. Adult
  2088. Newborn
  2089. Adverse Effects
  2090. Nursing Considerations
  2091. Nerve Block Analgesia and Anesthesia
  2092. Local Perineal Infiltration Anesthesia
  2093. FIG. 17-8 Pain pathways and sites of pharmacologic nerve blocks. A, Pudendal nerve block: suitable during second and third stages of labor and for repair of episiotomy or lacerations. B, Epidural block: suitable for all stages of labor and types of birth, and for repair of episiotomy and lacerations.
  2094. Pudendal Nerve Block
  2095. Spinal Anesthesia
  2096. FIG. 17-9 Pudendal nerve block. Use of needle guide (Iowa trumpet) and Luer-Lok syringe to inject medication.
  2097. SAFETY ALERT
  2098. FIG. 17-10 A, Membranes and spaces of spinal cord and levels of sacral, lumbar, and thoracic nerves. B, Cross section of vertebra and spinal cord. C, Level of anesthesia necessary for cesarean birth and for vaginal births.
  2099. FIG. 17-11 Positioning for spinal and epidural blocks. A, Lateral position. B, Upright position. C, Catheter for epidural is taped to woman’s back with port segment located near her shoulder.
  2100. EMERGENCY
  2101. Maternal Hypotension with Decreased Placental Perfusion
  2102. Signs and Symptoms
  2103. Interventions
  2104. FIG. 17-12 Blood-patch therapy for spinal headache.
  2105. Epidural Anesthesia or Analgesia (Block)
  2106. NURSING ALERT
  2107. BOX 17-5 SIDE EFFECTS OF EPIDURAL AND SPINAL ANESTHESIA
  2108. Combined Spinal-Epidural (CSE) Analgesia
  2109. Epidural and Intrathecal (Spinal) Opioids
  2110. Contraindications to Subarachnoid and Epidural Blocks
  2111. Epidural Block Effects on Newborn
  2112. Nitrous Oxide for Analgesia
  2113. General Anesthesia
  2114. FIG. 17-13 Technique of applying pressure on cricoid cartilage to occlude esophagus to prevent pulmonary aspiration of gastric contents during induction of general anesthesia.
  2115. Care Management
  2116. Nonpharmacologic Interventions
  2117. Pharmacologic Interventions
  2118. Informed Consent
  2119. LEGAL TIP:
  2120. Informed Consent for Anesthesia
  2121. Timing of Administration
  2122. Preparation for Procedures
  2123. NURSING PROCESS
  2124. Pain Management
  2125. Assessment
  2126. Nursing Diagnoses
  2127. Acute Pain related to:
  2128. Risk for Ineffective Tissue Perfusion related to:
  2129. Situational Low Self-esteem related to:
  2130. Anxiety or Fear related to:
  2131. Risk for Fetal Injury related to:
  2132. Risk for Maternal Injury related to:
  2133. Expected Outcomes of Care
  2134. Plan of Care and Interventions
  2135. Evaluation
  2136. NURSING CARE PLAN
  2137. Nonpharmacologic Pain Management
  2138. Nursing Diagnosis
  2139. Expected Outcomes
  2140. Nursing Interventions/Rationales
  2141. Nursing Diagnosis
  2142. Expected Outcome
  2143. Nursing Interventions/Rationales
  2144. Administration of Medication
  2145. Intravenous Route
  2146. Intramuscular Route
  2147. BOX 17-6 NURSING INTERVENTIONS FOR THE WOMAN RECEIVING EPIDURAL OR SPINAL ANESTHESIA
  2148. Prior to the Block
  2149. During Initiation of the Block
  2150. While the Block is in Effect
  2151. While the Block is Wearing off After Birth
  2152. Regional (Epidural or Spinal) Anesthesia
  2153. NURSING ALERT
  2154. FIG. 17-14 Modified throne position for labor.
  2155. SAFETY ALERT
  2156. Safety and General Care
  2157. KEY POINTS
  2158. References
  2159. Chapter 18 Fetal Assessment During Labor
  2160. Learning Objectives
  2161. Basis for Monitoring
  2162. Fetal Response
  2163. BOX 18-1 THREE-TIER FETAL HEART RATE CLASSIFICATION SYSTEM
  2164. Category I
  2165. Category II
  2166. Category III
  2167. Uterine Activity
  2168. Fetal Compromise
  2169. TABLE 18-1 NORMAL UTERINE ACTIVITY DURING LABOR
  2170. Monitoring Techniques
  2171. Intermittent Auscultation
  2172. EVIDENCE-BASED PRACTICE
  2173. Fetal Monitoring and the Machine That Goes “Beep”
  2174. Ask the Question
  2175. Search for Evidence
  2176. Search Strategies
  2177. Databases Searched
  2178. Critically Analyze the Evidence
  2179. Implications for Practice
  2180. References
  2181. FIG. 18-1 A, Ultrasound fetoscope. B, Ultrasound stethoscope. C, DeLee-Hillis fetoscope.
  2182. BOX 18-2 PROCEDURE FOR INTERMITTENT AUSCULTATION OF THE FETAL HEART RATE
  2183. NURSING ALERT
  2184. Electronic Fetal Monitoring
  2185. External Monitoring
  2186. Internal Monitoring
  2187. TABLE 18-2 EXTERNAL AND INTERNAL MODES OF MONITORING
  2188. FIG. 18-2 A, External noninvasive fetal monitoring with tocotransducer and ultrasound transducer. B, Ultrasound transducer is placed below umbilicus, over the area where fetal heart rate is best heard, and tocotransducer is placed on uterine fundus.
  2189. FIG. 18-3 Diagrammatic representation of internal invasive fetal monitoring with intrauterine pressure catheter and spiral electrode in place (membranes ruptured and cervix dilated).
  2190. Display
  2191. FIG. 18-4 Display of fetal heart rate and uterine activity on monitor paper. A, External mode with ultrasound and tocotransducer as signal source. B, Internal mode with spiral electrode and intrauterine catheter as signal source. Frequency of contractions is measured from the beginning of one contraction to the beginning of the next.
  2192. Fetal Heart Rate Patterns
  2193. Baseline Fetal Heart Rate
  2194. Variability
  2195. FIG. 18-5 Fetal heart rate variability. A, Absent variability; amplitude range undetectable. B, Minimal variability; amplitude range detectable up to and including 5 beats/min. C, Moderate variability; amplitude range 6 to 25 beats/min. D, Marked variability; amplitude range >25 beats/min.
  2196. FIG. 18-6 Sinusoidal FHR pattern.
  2197. Tachycardia
  2198. FIG. 18-7 Fetal tachycardia.
  2199. TABLE 18-3 TACHYCARDIA AND BRADYCARDIA
  2200. Bradycardia
  2201. FIG. 18-8 Fetal bradycardia.
  2202. Periodic and Episodic Changes in Fetal Heart Rate
  2203. Accelerations
  2204. FIG. 18-9 Fetal accelerations.
  2205. BOX 18-3 ACCELERATIONS
  2206. Causes
  2207. Clinical Significance
  2208. Nursing Interventions
  2209. Decelerations
  2210. Early Decelerations
  2211. FIG. 18-10 Early decelerations.
  2212. BOX 18-4 EARLY DECELERATIONS
  2213. Cause
  2214. Clinical Significance
  2215. Nursing Interventions
  2216. Late Decelerations
  2217. FIG. 18-11 Late decelerations.
  2218. BOX 18-5 LATE DECELERATIONS
  2219. Cause
  2220. Clinical Significance
  2221. Nursing Interventions
  2222. Variable Decelerations
  2223. FIG. 18-12 Variable decelerations.
  2224. CLINICAL REASONING
  2225. Admission of an Emergency Client to Labor and Delivery
  2226. BOX 18-6 VARIABLE DECELERATIONS
  2227. Cause
  2228. Clinical Significance
  2229. Nursing Interventions
  2230. Prolonged Decelerations
  2231. FIG. 18-13 Prolonged decelerations.
  2232. NURSING ALERT
  2233. Care Management
  2234. Electronic Fetal Monitoring Pattern Recognition and Interpretation
  2235. Categorizing FHR Tracings
  2236. BOX 18-7 CHECKLIST FOR FETAL MONITORING EQUIPMENT
  2237. Preparation of Monitor
  2238. Ultrasound Transducer
  2239. Tocotransducer
  2240. Spiral Electrode
  2241. Internal Catheter or Strain Gauge
  2242. NURSING PROCESS
  2243. Electronic Fetal Heart Rate Monitoring
  2244. Assessment
  2245. Nursing Diagnoses
  2246. Decreased Maternal Cardiac Output related to:
  2247. Anxiety related to:
  2248. Impaired Fetal Gas Exchange related to:
  2249. Risk for Fetal Injury related to:
  2250. Expected Outcomes of Care
  2251. Plan of Care and Interventions
  2252. Evaluation
  2253. LEGAL TIP
  2254. Fetal Monitoring Standards
  2255. Nursing Management of Abnormal Patterns
  2256. BOX 18-8 MANAGEMENT OF ABNORMAL FETAL HEART RATE PATTERNS
  2257. Basic Interventions
  2258. Interventions for Specific Problems
  2259. Other Methods of Assessment and Intervention
  2260. Assessment Techniques
  2261. Fetal Scalp Stimulation and Vibroacoustic Stimulation
  2262. Umbilical Cord Acid-Base Determination
  2263. TABLE 18-4 APPROXIMATE NORMAL VALUES FOR CORD BLOOD
  2264. TABLE 18-5 TYPES OF ACIDEMIA
  2265. Fetal Scalp Blood Sampling
  2266. Fetal Pulse Oximetry
  2267. Interventions
  2268. Amnioinfusion
  2269. Tocolytic Therapy
  2270. FIG. 18-14 A nurse explains electronic fetal monitoring as ultrasound transducer monitors the fetal heart rate.
  2271. Client and Family Teaching
  2272. BOX 18-9 CLIENT AND FAMILY TEACHING WHEN ELECTRONIC FETAL MONITOR IS USED
  2273. Documentation
  2274. BOX 18-10 CHECKLIST FOR FETAL HEART RATE AND UTERINE ACTIVITY ASSESSMENT WITH ELECTRONIC FETAL MONITORING
  2275. KEY POINTS
  2276. Fetal Heart Rate (read text)
  2277. References
  2278. Chapter 19 Nursing Care of the Family During Labor and Birth
  2279. Learning Objectives
  2280. First Stage of Labor
  2281. Care Management
  2282. Assessment
  2283. TEACHING FOR SELF-MANAGEMENT
  2284. How to Distinguish True Labor from False Labor
  2285. True Labor
  2286. False Labor
  2287. FIG. 19-1 Woman being assessed for admission to the labor and birth unit.
  2288. COMMUNITY ACTIVITY
  2289. Prenatal Data
  2290. FIG. 19-2 Admission screens in an electronic medical record. A, General admission screen. B, Current admission screen.
  2291. Interview
  2292. PROCEDURE
  2293. Tests for Rupture of Membranes
  2294. Nitrazine Test for pH
  2295. Procedure
  2296. Read Results
  2297. Document Results
  2298. Test for Ferning or Fern Pattern
  2299. Document Results
  2300. BOX 19-1 THE BIRTH PLAN
  2301. Psychosocial Factors
  2302. Women with a History of Sexual Abuse
  2303. Stress in Labor
  2304. TABLE 19-1 EXPECTED MATERNAL PROGRESS IN FIRST STAGE OF LABOR
  2305. BOX 19-2 PSYCHOSOCIAL ASSESSMENT OF THE LABORING WOMAN
  2306. Verbal Interactions
  2307. Body Language
  2308. Perceptual Ability
  2309. Discomfort Level
  2310. Cultural Factors
  2311. FIG. 19-3 Birthing room specific to a Native-American population. Note the arrow pointing east, the rug on the wall, and the rope or sash belt hanging from the ceiling.
  2312. Culture and Father Participation
  2313. The Non–English-Speaking Woman in Labor
  2314. Physical Examination
  2315. BOX 19-3 STANDARD PRECAUTIONS DURING CHILDBIRTH
  2316. General Systems Assessment
  2317. Vital Signs
  2318. Leopold Maneuvers (Abdominal Palpation)
  2319. Assessment of Fetal Heart Rate and Pattern
  2320. Assessment of Uterine Contractions
  2321. FIG. 19-4 Portion of the labor flowsheet screen in an electronic medical record.
  2322. FIG. 19-6 Location of the fetal heart tones (FHTs). A, FHTs with fetus in right occipitoanterior (ROA) position. B, Changes in location of point of maximal intensity of FHTs as fetus undergoes internal rotation from ROA to OA and descent for birth. C, FHTs with fetus in left sacrum posterior position.
  2323. LEGAL TIP
  2324. Obstetric Triage and EMTALA
  2325. CULTURAL CONSIDERATIONS
  2326. Birth Practices in Different Cultures
  2327. South Korea
  2328. Japan
  2329. China
  2330. India
  2331. Iran
  2332. Mexico
  2333. Laos
  2334. NURSING PROCESS
  2335. First Stage of Labor
  2336. Assessment
  2337. Nursing Diagnoses
  2338. Acute Pain related to
  2339. Anxiety related to
  2340. Impaired Urinary Elimination related to
  2341. Impaired Gas Exchange (Fetal) related to
  2342. Situational Low Self-esteem (Maternal) related to
  2343. Situational Low Self-esteem (father or partner) related to
  2344. Expected Outcomes of Care
  2345. Plan of Care and Interventions
  2346. Latent phase
  2347. Active and transition phase
  2348. Evaluation
  2349. PROCEDURE
  2350. Leopold Maneuvers
  2351. NURSING ALERT
  2352. NURSING ALERT
  2353. Vaginal Examination
  2354. PROCEDURE
  2355. Vaginal Examination of the Laboring Woman
  2356. Laboratory and Diagnostic Tests
  2357. Analysis of Urine Specimen
  2358. Blood Tests
  2359. FIG. 19-7 Assessment of uterine contractions. A, Abdominal contour before and during uterine contraction. B, Wavelike pattern of contractile activity.
  2360. FIG. 19-8 Partograms for assessment of patterns of cervical dilation and descent. Individual woman’s labor patterns (colored) are superimposed on prepared labor graph (black) for comparison. A, Labor of a nulliparous woman. B, Labor of a multiparous woman. The rate of cervical dilation is plotted with the circled plot points. A line drawn through these symbols depicts the slope of the curve. Station is plotted with Xs. A line drawn through the Xs reveals the pattern of descent.
  2361. Other Tests
  2362. Assessment of Amniotic Membranes and Fluid
  2363. NURSING ALERT
  2364. Infection
  2365. Nursing Care
  2366. SIGNS OF POTENTIAL COMPLICATIONS
  2367. Labor
  2368. BOX 19-4 EVIDENCE-BASED CARE PRACTICES DESIGNED TO PROMOTE, PROTECT, AND SUPPORT NORMAL LABOR AND BIRTH
  2369. General Hygiene
  2370. NURSING CARE PLAN
  2371. Labor and Birth
  2372. Nursing Diagnosis
  2373. Expected Outcome
  2374. Nursing Interventions/Rationales
  2375. Nursing Diagnosis
  2376. Expected Outcome
  2377. Nursing Interventions/Rationales
  2378. Nursing Diagnosis
  2379. Expected Outcome
  2380. Nursing Interventions/Rationales
  2381. Nursing Diagnosis
  2382. Expected Outcome
  2383. Nursing Interventions/Rationales
  2384. Nursing Diagnosis
  2385. Expected Outcome
  2386. Nursing Interventions/Rationales
  2387. TABLE 19-2 PHYSICAL NURSING CARE DURING LABOR
  2388. Nutrient and Fluid Intake
  2389. Oral Intake
  2390. Intravenous Intake
  2391. NURSING ALERT
  2392. Elimination
  2393. Voiding
  2394. Catheterization
  2395. Bowel Elimination
  2396. FIG. 19-10 Woman preparing to walk with partner.
  2397. Ambulation and Positioning
  2398. SAFETY ALERT
  2399. FIG. 19-13 Woman laboring using birth ball.
  2400. EVIDENCE-BASED PRACTICE
  2401. Benefits of Continuous Labor Support
  2402. Ask the Question
  2403. Search for Evidence
  2404. Search Strategies
  2405. Databases Searched
  2406. Critically Analyze the Evidence
  2407. Implications for Practice
  2408. References
  2409. Supportive Care During Labor and Birth
  2410. CLINICAL REASONING
  2411. Encouraging Evidence-Based Birth Practices
  2412. BOX 19-5 COMMON MATERNAL POSITIONS∗ DURING LABOR AND BIRTH
  2413. Semirecumbent Position (See Figs. 19-15, B; Fig. 19-16, B)
  2414. Lateral Position (See Figs. 19-12, B, and 19-15, A)
  2415. Upright Position
  2416. Hands-and-Knees Position—Position for Posterior Positions of the Presenting Part (See Figs. 19-11, B; Fig. 19-13)
  2417. Labor Support by the Nurse
  2418. FIG. 19-14 Partner providing comfort measures.
  2419. Labor Support by the Father or Partner
  2420. BOX 19-6 GUIDELINES FOR SUPPORTING THE FATHER∗
  2421. Labor Support by Doulas
  2422. Labor Support by Grandparents
  2423. Siblings During Labor and Birth
  2424. Emergency Interventions
  2425. Second Stage of Labor
  2426. Care Management
  2427. EMERGENCY
  2428. Interventions for Emergencies During Labor
  2429. TABLE 19-3 EXPECTED MATERNAL PROGRESS IN THE SECOND STAGE OF LABOR
  2430. Preparing for Birth
  2431. Maternal Position
  2432. NURSING PROCESS
  2433. Second Stage of Labor
  2434. Assessment
  2435. Nursing Diagnoses
  2436. Risk for Injury (to Mother and Fetus) related to
  2437. Acute Pain related to
  2438. Anxiety related to
  2439. Risk for Infection related to
  2440. Situational Low Self-Esteem (maternal) related to
  2441. Expected Outcomes of Care
  2442. Plan of Care and Interventions
  2443. Evaluation
  2444. FIG. 19-15 A, Pushing, side-lying position. Perineal bulging can be seen. B, Pushing, semisitting position. Midwife assists mother to feel top of fetal head.
  2445. BOX 19-7 GUIDELINES FOR ASSISTANCE AT THE EMERGENCY BIRTH OF A FETUS IN THE VERTEX PRESENTATION
  2446. FIG. 19-16 The versatility of today’s birthing bed makes it practical in a variety of settings. NOTE: OB table used for lithotomy position. A, Labor bed. B, Birth chair. C, Birth bed. D, OB table. E, Squatting or birth bar.
  2447. Bearing-Down Efforts
  2448. FIG. 19-17 Birth bed.
  2449. Fetal Heart Rate and Pattern
  2450. Support of the Father or Partner
  2451. Supplies, Instruments, and Equipment
  2452. FIG. 19-18 Instrument table.
  2453. FIG. 19-19 Radiant warmer for newborn.
  2454. Birth in a Delivery Room or Birthing Room
  2455. FIG. 19-20 Delivery room.
  2456. Mechanism of Birth: Vertex Presentation
  2457. FIG. 19-21 Beginning birth with vertex presenting. A, Anteroposterior slit. B, Oval opening. C, Circular shape. D, Crowning.
  2458. FIG. 19-22 Birth of head with modified Ritgen maneuver. Note control to prevent too-rapid birth of head.
  2459. Fundal Pressure
  2460. Immediate Assessments and Care of the Newborn
  2461. LEGAL TIP
  2462. Documentation
  2463. BOX 19-8 NORMAL VAGINAL CHILDBIRTH
  2464. First Stage
  2465. Anteroposterior slit. Vertex visible during contraction.
  2466. Oval opening. Vertex presenting. NOTE: Nurse (on left) is wearing gloves, but support person (on right) is not.
  2467. Second Stage
  2468. Crowning.
  2469. Nurse-midwife using Ritgen maneuver as head is born by extension.
  2470. After nurse-midwife checks for nuchal cord, she supports head during external rotation and restitution.
  2471. Use of bulb syringe to suction mucus.
  2472. Birth of posterior shoulder.
  2473. Birth of newborn by slow expulsion.
  2474. Second stage complete. Note that newborn is not completely pink yet.
  2475. Third Stage
  2476. Newborn placed on mother’s abdomen while cord is clamped and cut.
  2477. Note increased bleeding as placenta separates.
  2478. Expulsion of placenta.
  2479. Expulsion is complete, marking the end of the third stage.
  2480. The Newborn
  2481. Newborn awaiting assessment. Note that color is almost completely pink.
  2482. Newborn assessment under radiant warmer.
  2483. Parents admiring their newborn.
  2484. Perineal Trauma Related to Childbirth
  2485. Perineal Lacerations
  2486. Vaginal and Urethral Lacerations
  2487. Cervical Injuries
  2488. Episiotomy
  2489. FIG. 19-23 Types of episiotomies.
  2490. Third Stage of Labor
  2491. Placental Separation and Expulsion
  2492. NURSING PROCESS
  2493. Third Stage of Labor
  2494. Assessment
  2495. Nursing Diagnoses
  2496. Risk for Deficient Fluid Volume related to
  2497. Risk for Infection related to
  2498. Anxiety related to
  2499. Fatigue related to
  2500. Compromised Family Coping related to
  2501. Situational low self-esteem (maternal and paternal) related to
  2502. Expected Outcomes of Care
  2503. Plan of Care and Interventions
  2504. Evaluation
  2505. FIG. 19-24 Third stage of labor. A, Placenta begins to separate in central portion, accompanied by retroplacental bleeding. Uterus changes from discoid to globular shape. B, Placenta completes separation and enters lower uterine segment. Uterus has globular shape. C, Placenta enters vagina, cord is seen to lengthen, and there may be an increase in bleeding. D, Expulsion (delivery) of placenta and completion of third stage.
  2506. FIG. 19-25 Examination of the placenta.
  2507. Fourth Stage of Labor
  2508. Care Management
  2509. Assessment
  2510. FIG. 19-26 Big brother becomes acquainted with new baby sister.
  2511. BOX 19-9 ASSESSMENT DURING THE FOURTH STAGE OF LABOR
  2512. Blood Pressure
  2513. Pulse
  2514. Temperature
  2515. Fundus
  2516. Bladder
  2517. Lochia
  2518. Perineum
  2519. Postanesthesia Recovery
  2520. NURSING ALERT
  2521. Care of the New Mother
  2522. Care of the Family
  2523. Family-Newborn Relationships
  2524. KEY POINTS
  2525. Leopold’s Maneuvers (First) (read text)
  2526. Leopold’s Maneuvers (Second) (read text)
  2527. Leopold’s Maneuvers (Third) (read text)
  2528. Leopold’s Maneuvers (Fourth) (read text)
  2529. Normal Delivery (read text)
  2530. References
  2531. Unit Five Postpartum
  2532. Interactive Review—Unit 5
  2533. Chapter 20 Postpartum Physiology
  2534. Learning Objectives
  2535. Reproductive System and Associated Structures
  2536. Uterus
  2537. Involution Process
  2538. Contractions
  2539. FIG. 20-1 Assessment of involution of uterus after childbirth. A, Normal progress, days 1 through 9. B, Size and position of uterus 2 hours after childbirth. C, Two days after childbirth. D, Four days after childbirth.
  2540. Afterpains
  2541. Placental Site
  2542. Lochia
  2543. TABLE 20-1 LOCHIAL AND NONLOCHIAL BLEEDING
  2544. Cervix
  2545. Vagina and Perineum
  2546. CLINICAL REASONING
  2547. Assessment of Postpartum Bleeding
  2548. Pelvic Muscular Support
  2549. Endocrine System
  2550. Placental Hormones
  2551. Pituitary Hormones and Ovarian Function
  2552. FIG. 20-2 Abdominal wall 6 weeks after vaginal birth is almost back to prepregnancy appearance. Note that the linea nigra is still visible.
  2553. Abdomen
  2554. Urinary System
  2555. Urine Components
  2556. Postpartal Diuresis
  2557. Urethra and Bladder
  2558. Gastrointestinal System
  2559. Appetite
  2560. Bowel Evacuation
  2561. Breasts
  2562. Breastfeeding Mothers
  2563. Nonbreastfeeding Mothers
  2564. TABLE 20-2 VITAL SIGNS AFTER CHILDBIRTH
  2565. Cardiovascular System
  2566. Blood Volume
  2567. Cardiac Output
  2568. Vital Signs
  2569. Blood Components
  2570. Hematocrit and Hemoglobin
  2571. White Blood Cell Count
  2572. Coagulation Factors
  2573. FIG. 20-3 Varicosities in legs.
  2574. Varicosities
  2575. Neurologic System
  2576. Musculoskeletal System
  2577. Integumentary System
  2578. Immune System
  2579. KEY POINTS
  2580. References
  2581. Chapter 21 Nursing Care of the Family During the Postpartum Period
  2582. Learning Objectives
  2583. Transfer from the Recovery Area
  2584. FIG. 21-1 Portion of a vaginal birth recovery screen in an electronic record.
  2585. Planning for Discharge
  2586. Laws Relating to Discharge
  2587. TABLE 21-1 RECOVERY NURSE’S REPORT
  2588. BOX 21-1 CRITERIA FOR EARLY DISCHARGE
  2589. Mother
  2590. Infant
  2591. General
  2592. Criteria for Discharge
  2593. TABLE 21-2 POSTPARTUM ASSESSMENT AND SIGNS OF POTENTIAL COMPLICATIONS
  2594. LEGAL TIP
  2595. Early Discharge
  2596. Care Management: Physical Needs
  2597. Ongoing Physical Assessment
  2598. NURSING PROCESS
  2599. Postpartum Physical Concerns
  2600. Assessment
  2601. Initial assessment
  2602. Ongoing assessment
  2603. Nursing Diagnoses
  2604. Risk for Constipation related to:
  2605. Acute Pain related to:
  2606. Ineffective Breastfeeding related to:
  2607. Expected Outcomes of Care
  2608. Plan of Care and Interventions
  2609. Evaluation
  2610. Routine Laboratory Tests
  2611. Nursing Interventions
  2612. NURSING CARE PLAN
  2613. Postpartum Care—Vaginal Birth
  2614. Nursing Diagnosis
  2615. Expected Outcome
  2616. Nursing Interventions/Rationales
  2617. Nursing Diagnosis
  2618. Expected Outcome
  2619. Nursing Interventions/Rationales
  2620. Nursing Diagnosis
  2621. Expected Outcome
  2622. Nursing Interventions/Rationales
  2623. Nursing Diagnosis
  2624. Expected Outcome
  2625. Nursing Interventions/Rationale
  2626. Prevention of Infection
  2627. BOX 21-2 INTERVENTIONS FOR EPISIOTOMY, LACERATIONS, AND HEMORRHOIDS
  2628. Cleansing
  2629. Ice Pack
  2630. Squeeze Bottle
  2631. Sitz Bath
  2632. Built-in Type
  2633. Disposable Type
  2634. Topical Applications
  2635. Prevention of Excessive Bleeding
  2636. NURSING ALERT
  2637. NURSING ALERT
  2638. Maintenance of Uterine Tone
  2639. FIG. 21-2 Blood loss after birth is assessed by the extent of perineal pad saturation as (from left to right) scant (<2.5 cm), light (<10 cm), moderate (>10 cm), or heavy (one pad saturated within 2 hours).
  2640. FIG. 21-3 Palpating fundus of uterus during the postpartum period. Note that upper hand is cupped over fundus; lower hand dips in above symphysis pubis and supports uterus while it is massaged gently.
  2641. EMERGENCY
  2642. Hypovolemic Shock
  2643. Signs and Symptoms
  2644. Interventions
  2645. Prevention of Bladder Distention
  2646. Promotion of Comfort, Rest, Ambulation, and Exercise
  2647. Comfort
  2648. Nonpharmacologic Interventions
  2649. Pharmacologic Interventions
  2650. NURSING ALERT
  2651. Rest
  2652. Ambulation
  2653. SAFETY ALERT
  2654. Exercise
  2655. Promotion of Nutrition
  2656. FIG. 21-4 Postpartum exercise should begin as soon as possible. The woman should start with simple exercises and gradually progress to more strenuous ones.
  2657. EVIDENCE-BASED PRACTICE
  2658. Kegel, Kegel, Kegel!
  2659. Ask the Question
  2660. Search for Evidence
  2661. Search Strategies
  2662. Databases Searched
  2663. Critically Analyze the Data
  2664. Implications for Practice
  2665. References
  2666. Promotion of Normal Bladder and Bowel Patterns
  2667. Bladder Function
  2668. Bowel Function
  2669. NURSING ALERT
  2670. Breastfeeding Promotion and Lactation Suppression
  2671. Breastfeeding Promotion
  2672. Lactation Suppression
  2673. Health Promotion for Future Pregnancies and Children
  2674. Rubella Vaccination
  2675. Varicella Vaccination
  2676. Tetanus-Diphtheria-Acellular Pertussis Vaccine
  2677. MEDICATION GUIDE
  2678. Rh Immune Globulin, RhoGAM, Gamulin Rh, HypRho-D, Rhophylac
  2679. Action
  2680. Indications
  2681. Dosage and Route
  2682. Adverse Effects
  2683. Nursing Considerations
  2684. LEGAL TIP
  2685. Rubella and Varicella Vaccination
  2686. Prevention of Rh Isoimmunization
  2687. NURSING ALERT
  2688. Care Management: Psychosocial Needs
  2689. Effect of the Birth Experience
  2690. Maternal Self-Image
  2691. NURSING PROCESS
  2692. Postpartum Psychosocial Concerns
  2693. Assessment
  2694. Nursing Diagnoses
  2695. Readiness for Enhanced Family Processes related to:
  2696. Risk for Impaired Parenting related to:
  2697. Risk for Situational Low Self-esteem related to:
  2698. Risk for Caregiver Role Strain related to:
  2699. Risk for Ineffective Coping related to:
  2700. Expected Outcomes of Care
  2701. Plan of Care and Interventions
  2702. Evaluation
  2703. SIGNS OF POTENTIAL COMPLICATIONS
  2704. Postpartum Psychosocial Concerns
  2705. Adaptation to Parenthood and Parent-Infant Interactions
  2706. Family Structure and Functioning
  2707. FIG. 21-5 A mother’s adjustment is eased with acceptance of infant by other children. Smile indicates acceptance of the baby.
  2708. Effect of Cultural Diversity
  2709. Discharge Teaching
  2710. Self-Management and Signs of Complications
  2711. CULTURAL CONSIDERATIONS
  2712. Postpartum Period and Family Planning
  2713. Postpartum Care
  2714. Family Planning
  2715. NURSING ALERT
  2716. Sexual Activity and Contraception
  2717. TEACHING FOR SELF-MANAGEMENT
  2718. Resumption of Sexual Activity
  2719. CLINICAL REASONING
  2720. Family Planning and Contraceptive Use
  2721. Prescribed Medications
  2722. Follow-Up After Discharge
  2723. Routine Mother and Baby Follow-up Care
  2724. Home Visits
  2725. Telephone Follow-up
  2726. Warm Lines
  2727. Support Groups
  2728. Referral to Community Resources
  2729. COMMUNITY ACTIVITY
  2730. KEY POINTS
  2731. References
  2732. Chapter 22 Transition to Parenthood
  2733. Learning Objectives
  2734. Parental Attachment, Bonding, and Acquaintance
  2735. FIG. 22-1 Hands.
  2736. TABLE 22-1 INFANT BEHAVIORS AFFECTING PARENTAL ATTACHMENT
  2737. TABLE 22-2 PARENTAL BEHAVIORS AFFECTING INFANT ATTACHMENT
  2738. FIG. 22-2 Early acquaintance between parents and newborn as mother holds infant in en face position.
  2739. FIG. 22-3 Father looks for resemblance between newborns and older daughter.
  2740. TABLE 22-3 EXAMPLES OF PARENT-INFANT ATTACHMENT INTERVENTIONS
  2741. CULTURAL CONSIDERATIONS
  2742. Fostering Bonding in Women of Varying Ethnic and Cultural Groups
  2743. Assessment of Attachment Behaviors
  2744. BOX 22-1 ASSESSING ATTACHMENT BEHAVIOR
  2745. Parent-Infant Contact
  2746. Early Contact
  2747. Extended Contact
  2748. Communication Between Parent and Infant
  2749. The Senses
  2750. Touch
  2751. Eye Contact
  2752. FIG. 22-4 Father interacts with his newborn son.
  2753. Voice
  2754. Odor
  2755. Entrainment
  2756. FIG. 22-5 Infant in alert state.
  2757. Biorhythmicity
  2758. Reciprocity and Synchrony
  2759. FIG. 22-6 Sharing a smile: an example of synchrony.
  2760. Parental Role After Birth
  2761. Transition to Parenthood
  2762. Parental Tasks and Responsibilities
  2763. NURSING CARE PLAN
  2764. Home Care Follow-up: Transition to Parenthood
  2765. Nursing Diagnosis
  2766. Expected Outcomes
  2767. Nursing Interventions/Rationales
  2768. Nursing Diagnosis
  2769. Expected Outcomes
  2770. Nursing Interventions/Rationales
  2771. Nursing Diagnosis
  2772. Expected Outcome
  2773. Nursing Interventions/Rationales
  2774. Nursing Diagnosis
  2775. Expected Outcome
  2776. Nursing Interventions/Rationales
  2777. Becoming a Mother
  2778. TABLE 22-4 PHASES OF MATERNAL POSTPARTUM ADJUSTMENT
  2779. Postpartum “Blues”
  2780. TEACHING FOR SELF-MANAGEMENT
  2781. Coping with Postpartum Blues
  2782. Becoming a Father
  2783. TABLE 22-5 EARLY DEVELOPMENT OF THE INVOLVED FATHER ROLE
  2784. FIG. 22-7 Engrossment. Father is absorbed in looking at his newborn.
  2785. Adjustment for the Couple
  2786. Resuming Sexual Intimacy
  2787. Infant-Parent Adjustment
  2788. Rhythm
  2789. FIG. 22-8 Holding newborn in en face position, mother interacts with her daughter, six hours old. A, Infant is quiet and alert. B, Mother begins talking to daughter. C, Infant responds, opens mouth like her mother. D, Infant gazes at her mother. E, Infant waves hand. F, Infant glances away, resting; hands relax.
  2790. EVIDENCE-BASED PRACTICE
  2791. Education for Family Planning
  2792. Ask the Question
  2793. Search for Evidence
  2794. Search Strategies
  2795. Databases Searched
  2796. Critically Analyze the Data
  2797. Implications for Practice
  2798. References
  2799. Behavioral Repertoires
  2800. Responsivity
  2801. Diversity in Transitions to Parenthood
  2802. Age
  2803. The Adolescent Mother
  2804. CLINICAL REASONING
  2805. Transition to Parenthood for the Adolescent Couple
  2806. The Adolescent Father
  2807. Maternal Age Older Than 35 Years
  2808. Paternal Age Older Than 35 Years
  2809. Parenting in the Lesbian Couple
  2810. Social Support
  2811. Culture
  2812. Socioeconomic Conditions
  2813. Personal Aspirations
  2814. Parental Sensory Impairment
  2815. Visually Impaired Parent
  2816. Hearing-Impaired Parent
  2817. BOX 22-2 NURSING APPROACHES FOR WORKING WITH VISUALLY IMPAIRED PARENTS
  2818. Sibling Adaptation
  2819. FIG. 22-9 First meeting. Sister with mother during first meeting with new sibling. A, First tentative touch with fingertip. B, Relationship is more secure; touching with whole hand is now okay. C, Smiles indicate acceptance.
  2820. BOX 22-3 NURSING APPROACHES FOR WORKING WITH HEARING-IMPAIRED PARENTS
  2821. BOX 22-4 STRATEGIES FOR FACILITATING SIBLING ACCEPTANCE OF A NEW BABY
  2822. Grandparent Adaptation
  2823. FIG. 22-10 Father, grandfather, and new grandson get acquainted.
  2824. NURSING PROCESS
  2825. Transition to Parenthood
  2826. Assessment
  2827. Nursing Diagnoses
  2828. Readiness for Enhanced Family Coping related to:
  2829. Risk for Impaired Parenting related to:
  2830. Parental Role Conflict related to:
  2831. Risk for Impaired Parent/Child Attachment related to:
  2832. Readlines for Enhanced Family Processes related to:
  2833. Expected Outcomes of Care
  2834. Plan of Care and Interventions
  2835. Evaluation
  2836. Care Management
  2837. COMMUNITY ACTIVITY
  2838. KEY POINTS
  2839. References
  2840. Unit Six The Newborn
  2841. Interactive Review—Unit 6
  2842. Chapter 23 Physiologic and Behavioral Adaptations of the Newborn
  2843. Learning Objectives
  2844. Transition to Extrauterine Life
  2845. Physiologic Adaptations
  2846. Respiratory System
  2847. Initiation of Breathing
  2848. Chemical Factors
  2849. Mechanical Factors
  2850. Thermal Factors
  2851. Sensory Factors
  2852. NURSING ALERT
  2853. Signs of Respiratory Distress
  2854. TABLE 23-1 CHARACTERISTICS OF THE RESPIRATORY SYSTEM OF THE NEONATE
  2855. Cardiovascular System
  2856. TABLE 23-2 CARDIOVASCULAR CHANGES AT BIRTH
  2857. Heart Rate and Sounds
  2858. Blood Pressure
  2859. Blood Volume
  2860. Signs of Risk for Cardiovascular Problems
  2861. Hematopoietic System
  2862. Red Blood Cells
  2863. Leukocytes
  2864. Platelets
  2865. Blood groups
  2866. Thermogenic System
  2867. Heat Loss
  2868. FIG. 23-1 Infant in skin-to-skin contact with mother.
  2869. Thermogenesis
  2870. FIG. 23-2 Effects of cold stress. When an infant is stressed by cold, oxygen consumption increases, and pulmonary and peripheral vasoconstriction occurs, thereby decreasing oxygen uptake by the lungs and oxygen to the tissues; anaerobic glycolysis increases; and the PO2 and pH decrease, leading to metabolic acidosis.
  2871. Cold Stress
  2872. Hyperthermia
  2873. Renal System
  2874. NURSING ALERT
  2875. Fluid and Electrolyte Balance
  2876. Signs of Risk for Renal System Problems
  2877. Gastrointestinal System
  2878. Digestion
  2879. Stools
  2880. BOX 23-1 CHANGE IN STOOLING PATTERNS OF NEWBORNS
  2881. Meconium
  2882. Transitional Stools
  2883. Milk Stool
  2884. Feeding Behaviors
  2885. Signs of Risk for Gastrointestinal Problems
  2886. Hepatic System
  2887. Iron Storage
  2888. Carbohydrate Metabolism
  2889. Conjugation of Bilirubin and Newborn Jaundice
  2890. FIG. 23-3 Formation and excretion of bilirubin.
  2891. Physiologic Jaundice
  2892. NURSING ALERT
  2893. Pathologic Jaundice
  2894. TABLE 23-3 CAUSES OF NEONATAL UNCONJUGATED (INDIRECT) HYPERBILIRUBINEMIA
  2895. Jaundice Related to Breastfeeding
  2896. Coagulation
  2897. Signs of Risk for Hepatic System Problems
  2898. Immune System
  2899. Risk for Infection
  2900. Integumentary System
  2901. Sweat Glands
  2902. Desquamation
  2903. Mongolian Spots
  2904. Nevi
  2905. FIG. 23-4 Mongolian spot.
  2906. Erythema Toxicum
  2907. Signs of Risk for Integumentary Problems
  2908. FIG. 23-5 A, Telangiectatic nevi (stork bite). B, Erythema toxicum (flea bite dermatitis).
  2909. Reproductive System
  2910. Female
  2911. Male
  2912. Swelling of Breast Tissue
  2913. Signs of Risk for Reproductive System Problems
  2914. FIG. 23-6 External genitalia. A, Genitals in female term infant. Note mucoid vaginal discharge. B, Genitals in male infant. Uncircumcised penis. Rugae cover scrotum, indicating term gestation. Cord has been swabbed with ethylene blue to prevent infection.
  2915. Skeletal System
  2916. FIG. 23-7 Swelling of the genitals and bruising of the buttocks after a breech birth.
  2917. FIG. 23-8 Molding. A, Significant molding, soon after birth. B, Schematic of bones of skull when molding is present.
  2918. FIG. 23-9 Differences between caput succedaneum, cephalhematoma, and subgaleal hemorrhage. A, Caput succedaneum: edema of scalp noted at birth; crosses suture lines. B, Cephalhematoma: bleeding between periosteum and skull bone appearing within first 2 days; does not cross suture lines. C, Subgaleal hemorrhage: bleeding into the subgaleal compartment; bleeding extends beyond bone, often posteriorly into the neck and continuous after birth.
  2919. FIG. 23-10 Position of infant’s legs after breech birth.
  2920. SAFETY ALERT
  2921. Signs of Risk for Skeletal Problems
  2922. FIG. 23-11 Signs of developmental dysplasia of the hip. A, Asymmetry of gluteal and thigh folds with shortening of the thigh (Galeazzi sign). B, Limited hip abduction, as seen in flexion (Ortolani maneuver). C, Apparent shortening of the femur, as indicated by the level of the knees in flexion (Allis sign). D, Ortolani maneuver with femoral head moving in and out of acetabulum (in infants 1 to 2 months of age).
  2923. Neuromuscular System
  2924. Newborn Reflexes
  2925. Signs of Risk for Neuromuscular Problems
  2926. Behavioral Characteristics
  2927. BOX 23-2 CLUSTERS OF NEONATAL BEHAVIORS IN THE BRAZELTON NEONATAL BEHAVIORAL ASSESSMENT SCALE (BNBAS)
  2928. TABLE 23-4 ASSESSMENT OF NEWBORN’S REFLEXES∗
  2929. Classic pose in spontaneous tonic neck reflex.
  2930. Moro reflex.
  2931. Stepping reflex.
  2932. Crossed extension reflex.
  2933. Babinski reflex.
  2934. Trunk incurvation reflex.
  2935. Magnet reflex.
  2936. Sleep-Wake States
  2937. FIG. 23-12 Summary of newborn sleep-wake states. States of consciousness: A, Deep sleep. B, Light sleep. C, Drowsy. D, Quiet alert. E, Active alert. F, Crying.
  2938. Other Factors Influencing Newborn Behavior
  2939. Gestational Age
  2940. Time
  2941. Stimuli
  2942. Medication
  2943. Sensory Behaviors
  2944. Vision
  2945. Hearing
  2946. Smell
  2947. Taste
  2948. Touch
  2949. Response to Environmental Stimuli
  2950. Temperament
  2951. Habituation
  2952. Consolability
  2953. Cuddliness
  2954. Irritability
  2955. Crying
  2956. KEY POINTS
  2957. Rooting and Sucking (read text)
  2958. Plantar Grasp (read text)
  2959. Moro Reflex (read text)
  2960. Babinski Reflex, Male Infant (read text)
  2961. References
  2962. Chapter 24 Nursing Care of the Newborn and Family
  2963. Learning Objectives
  2964. Care Management: Birth Through the First 2 Hours
  2965. Assessment
  2966. Initial Assessment and Apgar Scoring
  2967. BOX 24-1 ASSESSMENT OF PRECONCEPTION, PRENATAL, AND INTRAPARTUM RISK FACTORS
  2968. Preconception
  2969. Prenatal
  2970. Intrapartum
  2971. Apgar Score
  2972. TABLE 24-1 APGAR SCORE
  2973. BOX 24-2 INITIAL PHYSICAL ASSESSMENT OF THE NEWBORN
  2974. Initial Physical Assessment
  2975. Physical Assessment
  2976. TABLE 24-2 PHYSICAL ASSESSMENT OF NEWBORN
  2977. Weighing the infant. The nurse never leaves the infant alone on a scale. The scale is covered to protect against cross-infection.
  2978. Measuring length crown to heel. To determine total length, include length of legs. If measurements are taken before the infant’s initial bath, wear gloves.
  2979. Measuring circumference of head.
  2980. Measuring circumference of chest.
  2981. Eyes. In pseudostrabismus, inner epicanthal folds cause the eyes to appear misaligned; however, corneal light reflexes are perfectly symmetric. Eyes are symmetric in size and shape and are well placed.
  2982. Placement of ears on the head in relation to a line drawn from the inner to the outer canthus of the eye. A, Normal position. B, Abnormally angled ear. C, True low-set ear.
  2983. BOX 24-3 SIGNIFICANCE OF THE APGAR SCORE
  2984. BOX 24-4 PERFORMING A PHYSICAL EXAMINATION OF THE NEWBORN
  2985. General Appearance
  2986. Vital Signs
  2987. Baseline Measurements of Physical Growth
  2988. Weight
  2989. Head Circumference and Body Length
  2990. NURSING CARE PLAN
  2991. The Normal Newborn
  2992. Nursing Diagnosis
  2993. Expected Outcomes
  2994. Nursing Interventions/Rationales
  2995. Nursing Diagnosis
  2996. Expected Outcome
  2997. Nursing Interventions/Rationales
  2998. Nursing Diagnosis
  2999. Expected Outcome
  3000. Nursing Interventions/Rationales
  3001. Nursing Diagnosis
  3002. Expected Outcome
  3003. Nursing Interventions/Rationales
  3004. Nursing Diagnosis
  3005. Expected Outcomes
  3006. Nursing Interventions/Rationales
  3007. Neurologic Assessment
  3008. Gestational Age Assessment
  3009. FIG. 24-1 Estimation of gestational age. A, New Ballard Score for newborn maturity rating. Expanded scale includes extremely premature infants and has been refined to improve accuracy in more mature infants. (From Ballard, J., Khoury, J., Wang, L., Eilers-Walsman, B., & Lipp, R. [1991]. New Ballard score, expanded to include extremely premature infants, Journal of Pediatrics, 119[3], 424.) B, Intrauterine growth: birth weight percentiles based on live single births at gestational ages 20 to 44 weeks.
  3010. Classification of Newborns by Gestational Age and Birth Weight
  3011. BOX 24-5 MANEUVERS USED IN ASSESSING GESTATIONAL AGE
  3012. Posture
  3013. Square Window
  3014. Arm Recoil
  3015. Popliteal Angle
  3016. Scarf Sign
  3017. Heel to Ear
  3018. Late Preterm Infant
  3019. NURSING PROCESS
  3020. Care of the Newborn and Family
  3021. Assessment
  3022. Nursing Diagnoses
  3023. Ineffective Airway Clearance related to:
  3024. Impaired Gas Exchange related to:
  3025. Risk for Imbalanced Body Temperature related to:
  3026. Acute Pain related to:
  3027. Readiness for Enhanced Parenting related to:
  3028. Readiness for Enhanced Family Coping related to:
  3029. Risk for Impaired Parent-Infant Attachment related to:
  3030. Situational Low Self-Esteem related to:
  3031. Expected Outcomes of Care
  3032. Plan of Care and Interventions
  3033. Evaluation
  3034. Interventions
  3035. Airway Maintenance
  3036. PROCEDURE
  3037. Suctioning with a Bulb Syringe
  3038. FIG. 24-2 Bulb syringe. Bulb must be compressed before insertion.
  3039. Maintaining an Adequate Oxygen Supply
  3040. PROCEDURE
  3041. Suctioning with a Nasopharyngeal Catheter with Mechanical Suction Apparatus
  3042. SIGNS OF POTENTIAL COMPLICATIONS
  3043. Abnormal Newborn Breathing
  3044. Maintaining Body Temperature
  3045. EVIDENCE-BASED PRACTICE
  3046. Hypothermia Prevention and Skin-to-Skin Contact
  3047. Ask the Question
  3048. Search for Evidence
  3049. Search Strategies
  3050. Databases Searched
  3051. Critically Analyze the Data
  3052. Implications for Practice
  3053. References
  3054. Immediate Interventions
  3055. Eye Prophylaxis
  3056. FIG. 24-3 Instillation of medication into eye of newborn. Thumb and forefinger are used to open the eye; medication is placed in the lower conjunctiva from the inner to the outer canthus.
  3057. MEDICATION GUIDE
  3058. Eye Prophylaxis: Erythromycin Ophthalmic Ointment, 0.5%, and Tetracycline Ophthalmic Ointment, 1%
  3059. Action
  3060. Indication
  3061. Neonatal Dosage
  3062. Adverse Reactions
  3063. Nursing Considerations
  3064. Vitamin K Prophylaxis
  3065. MEDICATION GUIDE
  3066. Vitamin K: Phytonadione (AquaMEPHYTON, Konakion)
  3067. Action
  3068. Indication
  3069. Neonatal Dosage
  3070. Adverse Reactions
  3071. Nursing Considerations
  3072. SAFETY ALERT
  3073. Umbilical Cord Care
  3074. FIG. 24-4 With special tool, remove clamp after cord dries (approximately 24 hours).
  3075. FIG. 24-5 Cord separation. A, Cord separated with some dried blood still in the umbilicus. B, Umbilicus cleansed and beginning to heal.
  3076. Promoting Parent-Infant Interaction
  3077. Care Management: from 2 Hours After Birth Until Discharge
  3078. Common Newborn Problems
  3079. Birth Injuries
  3080. Soft Tissue Injuries
  3081. FIG. 24-6 Marked bruising on the entire face of an infant born vaginally after face presentation. Less severe ecchymoses were present on the extremities. Phototherapy was required for treatment of jaundice resulting from the breakdown of accumulated blood.
  3082. Physiologic Problems
  3083. Jaundice
  3084. Physiologic Jaundice
  3085. FIG. 24-7 Transcutaneous monitoring of bilirubin with a transcutaneous bilirubinometry (TcB) monitor.
  3086. FIG. 24-8 Nomogram for designation of risk in 2840 well newborns at 36 or more weeks of gestational age with birth weight of 2000 g or more or 35 or more weeks of gestational age and birth weight of 2500 g or more based on the hour-specific serum bilirubin values. (This nomogram should not be used to represent the natural history of neonatal hyperbilirubinemia.)
  3087. Hypoglycemia
  3088. NURSING ALERT
  3089. Hypocalcemia
  3090. Laboratory and Diagnostic Tests
  3091. BOX 24-6 STANDARD LABORATORY VALUES IN THE NEONATAL PERIOD
  3092. Newborn Hearing Screening
  3093. TABLE 24-3 NEWBORN SCREENING SUMMARY
  3094. Collection of Specimens
  3095. Heelstick
  3096. Venipuncture
  3097. FIG. 24-9 Newborn hearing screening. A, Evoked otoacoustic emissions (EOAE) test. B, Auditory brain response (ABR)) test.
  3098. FIG. 24-10 Heelstick sites (shaded areas) on infant’s foot for obtaining samples of capillary blood.
  3099. NURSING ALERT
  3100. FIG. 24-11 Venipuncture using a butterfly needle.
  3101. Obtaining a Urine Specimen
  3102. FIG. 24-12 Application of mummy restraint (swaddling). A, Infant is placed on folded corner of blanket. B, One corner of blanket is brought across body and secured beneath the body. C, Lower corner is folded and tucked and second corner is brought across body and secured. D, Modified mummy restraint with one hand uncovered.
  3103. FIG. 24-13 Alternate methods of infant restraint. A, Restraining infant for femoral vein puncture. B, Modified side-lying position for lumbar puncture.
  3104. FIG. 24-14 Collection of urine specimen. A, Protective paper is removed from the adhesive surface. B, Applied to female infant. C, Applied to male infant.
  3105. Restraining the Infant
  3106. Restraint Without Appliance
  3107. Interventions
  3108. Protective Environment
  3109. Environmental Factors
  3110. Infection Control Factors
  3111. NURSING ALERT
  3112. FIG. 24-15 Neonatal safety device.
  3113. Safety Factors
  3114. Therapeutic and Surgical Procedures
  3115. Intramuscular Injection
  3116. MEDICATION GUIDE
  3117. Hepatitis B Vaccine (Recombivax HB, Engerix-B)
  3118. Action
  3119. Indication
  3120. Neonatal Dosage
  3121. Adverse Reactions
  3122. Nursing Considerations
  3123. MEDICATION GUIDE
  3124. Hepatitis B Immune Globulin
  3125. Action
  3126. Indication
  3127. Neonatal Dosage
  3128. Adverse Reactions
  3129. Nursing Considerations
  3130. Therapy for Hyperbilirubinemia
  3131. Phototherapy
  3132. FIG. 24-16 Intramuscular injection. A, Acceptable intramuscular injection site for newborn infant. X, Injection site. B, Infant’s leg stabilized for intramuscular injection. Nurse is wearing gloves to give injection.
  3133. FIG. 24-17 Infant under phototherapy lights while in incubator
  3134. FIG. 24-18 Infant with eyes covered while receiving phototherapy.
  3135. Parent Education
  3136. Home Phototherapy
  3137. Circumcision
  3138. FIG. 24-19 Proper positioning of infant for circumcision.
  3139. FIG. 24-20 Circumcision with Yellen clamp. After hemostasis occurs, the prepuce (over cone) will be cut away.
  3140. FIG. 24-21 Circumcision using Hollister PlastiBell. A, Suture around rim of PlastiBell controls bleeding. B, Plastic rim and suture drop off in 7 to 10 days.
  3141. Procedural Pain Management
  3142. Care of the Newly Circumcised Infant
  3143. Neonatal Pain
  3144. BOX 24-7 CARE OF THE CIRCUMCISED NEWBORN AT HOME
  3145. Check For Bleeding
  3146. Observe for Urination
  3147. Keep Area Clean
  3148. Check for Infection
  3149. Provide Comfort
  3150. Neonatal Responses to Pain
  3151. FIG. 24-22 Signs of discomfort: note eye squeeze, brow bulge, nasolabial furrow, and wide-spread mouth
  3152. Assessment of Neonatal Pain
  3153. Management of Neonatal Pain
  3154. Nonpharmacologic Management
  3155. Pharmacologic Management
  3156. Promoting Parent-Infant Interaction
  3157. FIG. 24-23 Baby swaddled snugly with one hand near face and other held close to body
  3158. TABLE 24-4 CRIES NEONATAL POSTOPERATIVE PAIN SCALE∗
  3159. CULTURAL CONSIDERATIONS
  3160. Cultural Beliefs and Practices Related to Infant Care
  3161. FIG. 24-24 Great-grandmother and infant enjoying social interaction.
  3162. Discharge Planning and Teaching
  3163. FIG. 24-25 Mother supervising contact of older sibling with newborn.
  3164. Temperature
  3165. Respirations
  3166. BOX 24-8
  3167. Infant Safety
  3168. Feeding Patterns
  3169. Elimination
  3170. Positioning and Holding
  3171. FIG. 24-26 Holding baby securely with support for head. A, Holding infant while moving infant from one place to another. Baby is undressed to show posture. B, Holding baby upright in “burping” position. C, “Football” (under the arm) hold. D, Cradling hold.
  3172. Rashes
  3173. Diaper Rash
  3174. Other Rashes
  3175. Clothing
  3176. FIG. 24-27 Sunglasses protect the infant’s eyes.
  3177. Car Seat Safety
  3178. SAFETY ALERT
  3179. FIG. 24-28 Rear-facing car seat in rear seat of car. Infant is placed in seat when going home from the hospital.
  3180. Nonnutritive Sucking
  3181. Bathing, Cord Care, and Skin Care
  3182. Bathing
  3183. FIG. 24-29 Safe pacifiers for term and preterm infants. Note one-piece construction, easily grasped handle, and large shield with ventilation holes.
  3184. FIG. 24-30 Mother giving newborn a sponge bath at home.
  3185. Cord Care
  3186. BOX 24-9 BATHING, CORD CARE, SKIN CARE, AND NAIL CARE
  3187. Fit Baths into the Family’s Schedule
  3188. Prevent Heat Loss
  3189. Gather Supplies and Clothing Before Starting
  3190. Bathe the Baby
  3191. Wash hair with baby wrapped to limit heat loss.
  3192. Skin Care
  3193. Cord Care
  3194. Nail Care
  3195. Clean Genitals
  3196. Infant Follow-up Care
  3197. Immunizations
  3198. Cardiopulmonary Resuscitation
  3199. Practical Suggestions for the First Weeks at Home
  3200. BOX 24-10 NEWBORN PROGRESS AFTER EARLY DISCHARGE
  3201. Activities of Daily Living
  3202. TABLE 24-5 IMMUNIZATION SCHEDULE—2010∗
  3203. Visitors
  3204. Activity and Rest
  3205. EMERGENCY
  3206. Relieving Airway Obstruction
  3207. Back blows and chest thrust in infant to clear airway obstruction. A, Back blow. B, Chest thrust.
  3208. Back Blows
  3209. Turn the Infant
  3210. Chest Thrusts
  3211. Open the Airway
  3212. Development of Day-Night Routines
  3213. EMERGENCY
  3214. Cardiopulmonary Resuscitation (CPR) for Infants
  3215. Assess Responsiveness
  3216. Position Infant
  3217. Airway
  3218. A, Opening airway with head tilt–chin lift method. B, Checking pulse of brachial artery. C, Side-by-side thumb placement for chest compression in newborn.
  3219. Breathing
  3220. Circulation
  3221. Interpretation of Crying and Use of Quieting Techniques
  3222. Developmental Milestones
  3223. BOX 24-11 INFANT QUIETING TECHNIQUES
  3224. Infant Stimulation
  3225. TABLE 24-6 GROWTH AND DEVELOPMENT DURING INFANCY
  3226. Recognizing Signs of Illness
  3227. TABLE 24-7 PLAY DURING INFANCY: SUGGESTED ACTIVITIES FOR BIRTH THROUGH 3 MONTHS
  3228. BOX 24-12 TEACHING YOUR NEWBORN
  3229. BOX 24-13 TEACHING YOUR 1-MONTH-OLD
  3230. BOX 24-14 SIGNS OF ILLNESS
  3231. COMMUNITY ACTIVITY
  3232. KEY POINTS
  3233. Neck, posterior (read text)
  3234. Male Breasts (supine position) (read text)
  3235. Cremasteric Reflex (read text)
  3236. Upper Extremities (read text)
  3237. Legs: Symmetry, length (read text)
  3238. Buttocks (read text)
  3239. Circumcision (read text)
  3240. References
  3241. Chapter 25 Newborn Nutrition and Feeding
  3242. Learning Objectives
  3243. Recommended Infant Nutrition
  3244. Breastfeeding Rates
  3245. Benefits of Breastfeeding
  3246. Choosing an Infant Feeding Method
  3247. TABLE 25-1 BENEFITS OF BREASTFEEDING
  3248. Supporting Breastfeeding Mothers
  3249. FIG. 25-1 Breastfeeding mothers support group with lactation consultant.
  3250. Cultural Influences on Infant Feeding
  3251. BOX 25-1 TEN STEPS TO SUCCESSFUL BREASTFEEDING FOR HOSPITALS
  3252. Nutrient Needs
  3253. Fluids
  3254. Energy
  3255. Carbohydrate
  3256. Fat
  3257. Protein
  3258. Vitamins
  3259. Minerals
  3260. Anatomy and Physiology of Lactation
  3261. Anatomy of the Lactating Breast
  3262. FIG. 25-2 Anatomy of the lactating breast.
  3263. FIG. 25-3 Enhanced view of milk glands and milk ducts.
  3264. Lactogenesis
  3265. FIG. 25-4 Maternal breastfeeding reflexes. A, Milk production. B, Milk ejection (let-down).
  3266. NURSING ALERT
  3267. Uniqueness of Human Milk
  3268. Care Management: the Breastfeeding Mother and Infant
  3269. Positioning
  3270. NURSING PROCESS
  3271. Breastfeeding Mother-Infant Pair
  3272. Assessment
  3273. Nursing Diagnoses
  3274. Effective Breastfeeding related to:
  3275. Risk for Ineffective Breastfeeding related to:
  3276. Risk for Imbalanced Nutrition: Less than Body Requirements related to:
  3277. Risk for Deficient Fluid Volume related to:
  3278. Expected Outcomes of Care
  3279. Infant
  3280. Mother
  3281. Plan of Care and Interventions
  3282. Evaluation
  3283. FIG. 25-5 Breastfeeding positions. A, Football or clutch (under the arm) hold. B, Across the lap (modified cradle). C, Cradling. D, Lying down.
  3284. NURSING ALERT
  3285. Latch
  3286. FIG. 25-6 Latch. A, The mother tickles baby’s lower lip with the nipple until he or she opens wide. B, Once baby’s mouth is opened wide, she quickly “hugs” the baby to the breast. C, Baby should have as much areola (dark area around nipple) in his or her mouth as possible, not just the nipple.
  3287. FIG. 25-7 Removing infant from the breast.
  3288. NURSING CARE PLAN
  3289. Breastfeeding and Infant Nutrition
  3290. Nursing Diagnosis
  3291. Expected Outcomes
  3292. Nursing Interventions/Rationales
  3293. Nursing Diagnosis
  3294. Expected Outcome
  3295. Nursing Interventions/Rationales
  3296. Nursing Diagnosis
  3297. Expected Outcomes
  3298. Nursing Interventions/Rationales
  3299. Milk Ejection or Let-Down
  3300. Frequency of Feedings
  3301. Duration of Feedings
  3302. Indicators of Effective Breastfeeding
  3303. BOX 25-2 SIGNS OF EFFECTIVE BREASTFEEDING
  3304. Mother
  3305. Infant
  3306. Supplements, Bottles, and Pacifiers
  3307. EVIDENCE-BASED PRACTICE
  3308. Supplemental Feeding
  3309. Ask the Question
  3310. Search for Evidence
  3311. Search Strategies
  3312. Databases Searched
  3313. Critically Analyze the Data
  3314. Implications for Practice
  3315. References
  3316. Special Considerations
  3317. Sleepy Baby
  3318. Fussy Baby
  3319. BOX 25-3 WAKING THE SLEEPY NEWBORN
  3320. Slow Weight Gain
  3321. BOX 25-4 CALMING THE FUSSY BABY
  3322. BOX 25-5 WARNING SIGNS OF INEFFECTIVE BREASTFEEDING
  3323. FIG. 25-8 Supplemental nursing system.
  3324. Jaundice
  3325. Preterm Infants
  3326. FIG. 25-9 Hospital-grade electric breast pump.
  3327. Late Preterm Infants
  3328. Breastfeeding Multiple Infants
  3329. Expressing and Storing Breast Milk
  3330. FIG. 25-10 Breastfeeding twins.
  3331. Hand Expression
  3332. Mechanical Expression (Pumping)
  3333. Types of Pumps
  3334. FIG. 25-11 Bilateral breast pumping.
  3335. Storage of Breast Milk
  3336. FIG. 25-12 Manual breast pumps.
  3337. SAFETY ALERT
  3338. Being Away from the Baby
  3339. Maternal Employment
  3340. TEACHING FOR SELF-MANAGEMENT
  3341. Breast Milk Storage Guidelines for Home Use for Full-Term Infants
  3342. Human Milk Storage Guidelines for Full-Term Infants
  3343. Weaning
  3344. FIG. 25-13 Lactation room. Note the breast pump, rocking chair, nursing foot stool, changing table, books, and supplies.
  3345. Milk Banking
  3346. Care of the Mother
  3347. Diet
  3348. Weight Loss
  3349. Rest
  3350. Breast Care
  3351. Sexual Sensations
  3352. FIG. 25-14 Breast shells.
  3353. Breastfeeding and Contraception
  3354. Breastfeeding During Pregnancy
  3355. Breastfeeding After Breast Surgery
  3356. Medications and Breastfeeding
  3357. Environmental Contaminants
  3358. Common Concerns of the Breastfeeding Mother
  3359. Engorgement
  3360. CLINICAL REASONING
  3361. Breastfeeding: Engorgement and Nipple Soreness
  3362. FIG. 25-15 Cabbage leaves to treat engorgement.
  3363. Sore Nipples
  3364. Candidiasis
  3365. Plugged Milk Ducts
  3366. Mastitis
  3367. Follow-up After Hospital Discharge
  3368. Formula Feeding
  3369. Parent Education
  3370. Readiness for Feeding
  3371. Feeding Patterns
  3372. Feeding Technique
  3373. FIG. 25-16 Father bottle feeding infant son. Note angled bottle that ensures that milk covers nipple area.
  3374. SAFETY ALERT
  3375. Common Concerns
  3376. Bottles and Nipples
  3377. FIG. 25-17 Positions for burping an infant. A, Sitting. B, On the shoulder. C, Across the lap.
  3378. Infant Formulas
  3379. Commercial Formulas
  3380. SAFETY ALERT
  3381. Formula Preparation
  3382. SAFETY ALERT
  3383. Vitamin and Mineral Supplementation
  3384. Weaning
  3385. Complementary Feeding: Introducing Solid Foods
  3386. TEACHING FOR SELF-MANAGEMENT
  3387. Formula Preparation and Feeding
  3388. Formula Preparation
  3389. Feeding Techniques and Tips
  3390. Safety Tips
  3391. COMMUNITY ACTIVITY
  3392. KEY POINTS
  3393. References
  3394. Unit Seven Complications of Pregnancy
  3395. Interactive Review—Unit 7
  3396. Chapter 26 Assessment for Risk Factors in Pregnancy
  3397. Learning Objectives
  3398. Assessment of Risk Factors
  3399. BOX 26-1 CATEGORIES OF HIGH RISK FACTORS
  3400. BIOPHYSICAL FACTORS
  3401. PSYCHOSOCIAL FACTORS
  3402. SOCIODEMOGRAPHIC FACTORS
  3403. ENVIRONMENTAL FACTORS
  3404. BOX 26-2 SPECIFIC PREGNANCY PROBLEMS AND RELATED RISK FACTORS
  3405. POLYHYDRAMNIOS
  3406. INTRAUTERINE GROWTH RESTRICTION
  3407. OLIGOHYDRAMNIOS
  3408. CHROMOSOMAL ABNORMALITIES
  3409. Psychologic Considerations Related to High Risk Pregnancy
  3410. Antepartum Testing
  3411. BOX 26-3 COMMON INDICATIONS FOR ANTEPARTUM TESTING
  3412. OBSTETRIC INDICATIONS
  3413. MEDICAL INDICATIONS
  3414. Biophysical Assessment
  3415. Daily Fetal Movement Count
  3416. NURSING ALERT
  3417. Ultrasonography
  3418. FIG. 26-1 Fetus seen on three-dimensional ultrasound. A, Full body view of fetus at 11 weeks and 6 days of gestation. B, Close-up view of fetal face later in pregnancy.
  3419. TABLE 26-1 MAJOR USES OF ULTRASONOGRAPHY DURING PREGNANCY
  3420. Levels of Ultrasonography
  3421. Indications For Use
  3422. FIG. 26-2 Appropriate planes of sections (dotted lines) for head circumference (HC) and abdominal circumference (AC).
  3423. Fetal Heart Activity
  3424. Gestational Age
  3425. Fetal Growth
  3426. Fetal Anatomy
  3427. Fetal Genetic Disorders and Physical Anomalies
  3428. Placental Position and Function
  3429. FIG. 26-3 Fetal nuchal translucency. A, Nuchal lucency (calipers) and nasal bone (arrow) in 12-week fetus. B, Increased nuchal translucency. Transvaginal ultrasound performed at 12 weeks demonstrates a sonolucent area (asterisk) over the posterior neck and upper thorax.
  3430. Adjunct to Other Invasive Tests
  3431. Fetal Well-being
  3432. FIG. 26-4 Umbilical artery velocity waveform.
  3433. Doppler Blood Flow Analysis
  3434. Amniotic Fluid Volume
  3435. TABLE 26-2 BIOPHYSICAL PROFILE SCORING
  3436. Biophysical Profile
  3437. TABLE 26-3 BIOPHYSICAL PROFILE MANAGEMENT
  3438. EVIDENCE-BASED PRACTICE
  3439. “How’s My Baby Doing?”
  3440. Ask the Question
  3441. Search for Evidence
  3442. Search Strategies
  3443. Databases Searched
  3444. Critically Analyze the Data
  3445. Implications for Practice
  3446. References
  3447. Nursing Role
  3448. CLINICAL REASONING
  3449. Fetal Assessment Using the Biophysical Profile
  3450. Magnetic Resonance Imaging
  3451. Biochemical Assessment
  3452. Amniocentesis
  3453. NURSING ALERT
  3454. Indications for Use
  3455. Genetic Concerns
  3456. FIG. 26-5 A, Amniocentesis and laboratory use of amniotic fluid aspirant. B, Transabdominal amniocentesis.
  3457. TABLE 26-4 SUMMARY OF BIOCHEMICAL MONITORING TECHNIQUES
  3458. BOX 26-4 FETAL RIGHTS
  3459. BOX 26-5 ELIMINATION OF MATERNAL AGE AS AN INDICATION FOR INVASIVE PRENATAL DIAGNOSIS
  3460. Fetal Maturity
  3461. Fetal Hemolytic Disease
  3462. Chorionic Villus Sampling
  3463. FIG. 26-6 Transcervical chorionic villus sampling.
  3464. FIG. 26-7 Transabdominal chorionic villus sampling.
  3465. NURSING ALERT
  3466. Percutaneous Umbilical Blood Sampling
  3467. FIG. 26-8 Technique for percutaneous umbilical blood sampling guided by ultrasound.
  3468. Maternal Assays
  3469. Alpha-Fetoprotein
  3470. FIG. 26-9 Umbilical cord as seen on ultrasound at 26 weeks of gestation.
  3471. Multiple Marker Screens
  3472. Coombs Test
  3473. Antepartal Assessment Using Electronic Fetal Monitoring
  3474. Indications
  3475. BOX 26-6 INDICATIONS FOR ELECTRONIC FETAL MONITORING ASSESSMENT USING THE NONSTRESS TEST AND THE CONTRACTION STRESS TEST
  3476. Nonstress Test
  3477. Procedure
  3478. Interpretation
  3479. FIG. 26-10 Reactive nonstress test.
  3480. FIG. 26-11 Nonnreactive nonstress test.
  3481. Vibroacoustic Stimulation
  3482. Contraction Stress Test
  3483. BOX 26-7 INTERPRETATION OF THE NONSTRESS TEST
  3484. NURSING ALERT
  3485. Procedure
  3486. Nipple-Stimulated Contraction Test
  3487. FIG. 26-12 Reactive nonstress test after vibroacoustic stimulation. The stimulus was applied at the point marked by the musical notes. A sustained fetal heart rate acceleration was produced.
  3488. FIG. 26-13 Contraction stress test (CST). A, Negative CST. B, Positive CST.
  3489. Oxytocin-Stimulated Contraction Test
  3490. Interpretation
  3491. BOX 26-8 INTERPRETATION OF THE CONTRACTION STRESS TEST
  3492. Nurses’ Role in Assessment of the High Risk Pregnancy
  3493. KEY POINTS
  3494. References
  3495. Chapter 27 Hypertensive Disorders in Pregnancy
  3496. Learning Objectives
  3497. Significance and Incidence
  3498. Morbidity and Mortality
  3499. Classification
  3500. TABLE 27-1 CLASSIFICATION OF HYPERTENSIVE STATES OF PREGNANCY
  3501. Gestational Hypertension
  3502. TABLE 27-2 DIFFERENTIATION BETWEEN MILD AND SEVERE PREECLAMPSIA
  3503. TABLE 27-3 COMMON LABORATORY CHANGES IN PREECLAMPSIA
  3504. Preeclampsia
  3505. Eclampsia
  3506. COMMUNITY ACTIVITY
  3507. Chronic Hypertension
  3508. Chronic Hypertension with Superimposed Preeclampsia
  3509. Preeclampsia
  3510. Etiology
  3511. BOX 27-1 RISK FACTORS FOR PREECLAMPSIA
  3512. Pathophysiology
  3513. FIG. 27-1 Etiology of preeclampsia: disruptions in placental perfusion and endothelial cell dysfunction
  3514. FIG. 27-2 Consequences of endothelial cell dysfunction. DIC, Disseminated vascular coagulation; IUGR, intrauterine growth restriction, N/V, nausea/vomiting; RUQ, right upper quadrant.
  3515. HELLP Syndrome
  3516. CLINICAL REASONING
  3517. Severe Complications of Preeclampsia
  3518. NURSING ALERT
  3519. Care Management
  3520. Identifying and Preventing Preeclampsia
  3521. EVIDENCE-BASED PRACTICE
  3522. Preeclampsia Risk Factors and Prevention
  3523. Ask the Question
  3524. Search for Evidence
  3525. Search Strategies
  3526. Databases Searched
  3527. Critically Analyze the Data
  3528. Implications for Practice
  3529. References
  3530. Health Assessment and Screening
  3531. Interview
  3532. NURSING PROCESS
  3533. Mild Preeclampsia
  3534. Assessment
  3535. Nursing Diagnoses
  3536. Anxiety related to:
  3537. Ineffective Individual and Family Coping related to:
  3538. Powerlessness related to:
  3539. Ineffective Tissue Perfusion related to:
  3540. Risk for Injury (to fetus) related to:
  3541. Expected Outcomes of Care
  3542. Plan of Care and Interventions
  3543. Evaluation
  3544. Physical Examination
  3545. FIG. 27-3 Assessment of pitting edema of lower extremities. A, +1; B, +2; C, +3; D, +4.
  3546. FIG. 27-4 Location of tendons for evaluation of deep tendon reflexes. A, Biceps. B, Brachioradial. C, Triceps. D, Patellar. E, Achilles, F, Evaluation of ankle clonus.
  3547. TABLE 27-4 ASSESSING DEEP TENDON REFLEXES
  3548. Mild Gestational Hypertension and Mild Preeclampsia
  3549. Home Care
  3550. Maternal and Fetal Assessment
  3551. TEACHING FOR SELF-MANAGEMENT
  3552. Assessing and Reporting Clinical Signs of Preeclampsia
  3553. Activity Restriction
  3554. Diet
  3555. Severe Gestational Hypertension and Severe Preeclampsia
  3556. TEACHING FOR SELF-MANAGEMENT
  3557. Coping with Activity Restriction
  3558. At Home
  3559. In the Hospital
  3560. TEACHING FOR SELF-MANAGEMENT
  3561. Diet for Preeclampsia
  3562. Intrapartum Care
  3563. NURSING CARE PLAN
  3564. Severe Preeclampsia
  3565. Nursing Diagnosis
  3566. Expected Outcome
  3567. Nursing Interventions/Rationales
  3568. Nursing Diagnosis
  3569. Expected Outcome
  3570. Nursing Interventions/Rationales
  3571. Other Possible Nursing Diagnoses
  3572. Expected Outcomes
  3573. Nursing Interventions/Rationales
  3574. Pharmacologic Therapy
  3575. Magnesium Sulfate
  3576. BOX 27-2 HOSPITAL PRECAUTIONARY MEASURES
  3577. NURSING ALERT
  3578. NURSING ALERT
  3579. BOX 27-3 CARE OF THE WOMAN WITH PREECLAMPSIA RECEIVING MAGNESIUM SULFATE
  3580. Client and Family Teaching
  3581. Administration
  3582. Maternal and Fetal Assessments
  3583. Reportable Conditions
  3584. Emergency Measures
  3585. Documentation
  3586. SAFETY ALERT
  3587. Antihypertensive Medications
  3588. Postpartum Care
  3589. TABLE 27-5 PHARMACOLOGIC CONTROL OF HYPERTENSION IN PREGNANCY
  3590. Future Health Care
  3591. Eclampsia
  3592. EMERGENCY
  3593. Eclampsia
  3594. Tonic-Clonic Convulsion Signs
  3595. Intervention
  3596. After Convulsion
  3597. Immediate Care
  3598. NURSING ALERT
  3599. Chronic Hypertension
  3600. KEY POINTS
  3601. References
  3602. Chapter 28 Antepartum Hemorrhagic Disorders
  3603. Learning Objectives
  3604. Early Pregnancy Bleeding
  3605. Miscarriage (Spontaneous Abortion)
  3606. Incidence and Etiology
  3607. FIG. 28-1 Miscarriage. A, Threatened. B, Inevitable. C, Incomplete. D, Complete. E, Missed.
  3608. Types
  3609. Clinical Manifestations
  3610. TABLE 28-1 ASSESSING MISCARRIAGE AND THE USUAL MANAGEMENT
  3611. Management
  3612. Initial Care
  3613. NURSING PROCESS
  3614. Miscarriage
  3615. Assessment
  3616. Nursing Diagnoses
  3617. Anxiety or Fear related to:
  3618. Deficient Fluid Volume related to:
  3619. Acute Pain related to:
  3620. Anticipatory Grieving related to:
  3621. Situational Low Self-Esteem related to:
  3622. Risk for Infection related to:
  3623. Expected Outcomes of Care
  3624. Plan of Care and Interventions
  3625. Evaluation
  3626. EVIDENCE-BASED PRACTICE
  3627. The Precarious First Trimester
  3628. Ask the Question
  3629. Search for Evidence
  3630. Search Strategies
  3631. Databases Searched
  3632. Critically Analyze the Data
  3633. Implications for Practice
  3634. References
  3635. Follow-up Care at Home
  3636. NURSING ALERT
  3637. TEACHING FOR SELF-MANAGEMENT
  3638. Discharge Teaching for the Woman After Early Miscarriage
  3639. COMMUNITY ACTIVITY
  3640. Recurrent Premature Dilation of the Cervix (Incompetent Cervix)
  3641. Etiology
  3642. Diagnosis
  3643. Management
  3644. FIG. 28-2 A, Cerclage correction of premature dilation of the cervical os. B, Cross-sectional view of closed internal os.
  3645. Follow-up Care at Home
  3646. FIG. 28-3 Sites of implantation of ectopic pregnancies. Order of frequency of occurrence is ampulla, isthmus, interstitium, fimbria, tuboovarian ligament, ovary, abdominal cavity, and cervix (external os).
  3647. Ectopic Pregnancy
  3648. Incidence and Etiology
  3649. FIG. 28-4 Ectopic pregnancy, abdominal.
  3650. Clinical Manifestations
  3651. Tubal Pregnancy Management
  3652. Initial Care
  3653. Medical Management
  3654. NURSING ALERT
  3655. BOX 28-1 NURSING CONSIDERATIONS FOR WOMEN UNDERGOING METHOTREXATE TREATMENT FOR ECTOPIC PREGNANCY
  3656. ADMINISTRATION
  3657. CLIENT AND FAMILY TEACHING
  3658. FOLLOW-UP
  3659. Surgical Management
  3660. Follow-up Care
  3661. Hydatidiform Mole (Molar Pregnancy)
  3662. Incidence and Etiology
  3663. Types
  3664. FIG. 28-5 A, Chromosomal origin of complete mole. Single sperm (color) fertilizes an “empty” ovum. Reduplication of sperm’s 23, X set gives completely homozygous diploid 46,XX. B, Uterine rupture with hydatidiform mole. 1, Vaginal expulsion of mole through cervix. 2, Rupture of uterus and spillage of mole into peritoneal cavity (rare).
  3665. Clinical Manifestations
  3666. FIG. 28-6 Gross specimen in a woman treated for complete hydatidiform mole with primary hysterectomy.
  3667. FIG. 28-7 Chromosomal origin of triploid partial mole. Normal ovum with 23,X haploid set is fertilized by two sperms to give total of 69 chromosomes. Sex configuration of XXY, XXX, or XYY is possible.
  3668. Diagnosis
  3669. Management
  3670. NURSING ALERT
  3671. Follow-up Care
  3672. Late Pregnancy Bleeding
  3673. Placenta Previa
  3674. Incidence and Etiology
  3675. Clinical Manifestations
  3676. FIG. 28-8 Types of placenta previa. A, Complete. B, Marginal.
  3677. TABLE 28-2 SUMMARY OF FINDINGS: ABRUPTIO PLACENTAE AND PLACENTA PREVIA
  3678. Maternal and Fetal Outcomes
  3679. Diagnosis
  3680. Management
  3681. Expectant Management
  3682. NURSING PROCESS
  3683. Placenta Previa
  3684. Assessment
  3685. Nursing Diagnoses
  3686. Decreased Cardiac Output related to:
  3687. Deficient Fluid Volume related to:
  3688. Ineffective Peripheral Tissue Perfusion related to:
  3689. Anxiety or Fear related to:
  3690. Grieving related to:
  3691. Expected Outcomes of Care
  3692. Plan of Care and Interventions
  3693. Evaluation
  3694. Home Care
  3695. Active Management
  3696. Premature Separation of Placenta (Abruptio Placentae [Placental Abruption])
  3697. Incidence and Etiology
  3698. FIG. 28-9 Abruptio placentae. Premature separation of normally implanted placenta. A large retroplacental clot is present.
  3699. CLINICAL REASONING
  3700. Third-Trimester Vaginal Bleeding
  3701. Classification
  3702. Clinical Manifestations
  3703. FIG. 28-10 Abruptio placentae, showing partial and complete placental separation.
  3704. Maternal and Fetal Outcomes
  3705. Diagnosis
  3706. Management
  3707. Expectant Management
  3708. Active management
  3709. Cord Insertion and Placental Variations
  3710. Clotting Disorders in Pregnancy
  3711. Normal Clotting
  3712. Clotting Problems
  3713. Disseminated Intravascular Coagulation
  3714. FIG. 28-11 Vasa previa (velamentous insertion of cord). Arrow shows velamentous cord insertion in the placenta.
  3715. FIG. 28-12 Cord insertion and placental variations A, Battledore placenta. B, Placenta succenturiate.
  3716. Management
  3717. BOX 28-2 CLINICAL MANIFESTATIONS AND LABORATORY SCREENING RESULTS FOR WOMEN WITH DISSEMINATED INTRAVASCULAR COAGULATION
  3718. POSSIBLE PHYSICAL EXAMINATION FINDINGS
  3719. LABORATORY COAGULATION SCREENING TEST RESULTS
  3720. KEY POINTS
  3721. References
  3722. Chapter 29 Endocrine and Metabolic Disorders in Pregnancy
  3723. Learning Objectives
  3724. Diabetes Mellitus
  3725. Pathogenesis
  3726. Classification
  3727. White’s Classification of Diabetes in Pregnancy
  3728. Metabolic Changes Associated with Pregnancy
  3729. TABLE 29-1 WHITE’S CLASSIFICATION OF DIABETES IN PREGNANCY (MODIFIED)
  3730. FIG. 29-1 Changing insulin needs during pregnancy. A, First trimester: Insulin need is reduced because of increased insulin production by pancreas and increased peripheral sensitivity to insulin; nausea, vomiting, and decreased food intake by mother and glucose transfer to embryo or fetus contribute to hypoglycemia. B, Second trimester: Insulin needs begin to increase as placental hormones, cortisol, and insulinase act as insulin antagonists, decreasing insulin’s effectiveness. C, Third trimester: Insulin needs may double or even quadruple but usually level off after 36 weeks of gestation. D, Day of birth: Maternal insulin requirements decrease drastically to approach prepregnancy levels. E, Breastfeeding mother maintains lower insulin requirements, as much as 25% less than those of prepregnancy; insulin needs of nonbreastfeeding mother return to prepregnancy levels in 7 to 10 days. F, Weaning of breastfeeding infant causes mother’s insulin needs to return to prepregnancy levels.
  3731. Pregestational Diabetes Mellitus
  3732. Preconception Counseling
  3733. COMMUNITY ACTIVITY
  3734. Maternal Risks and Complications
  3735. TABLE 29-2 DIFFERENTIATION OF HYPOGLYCEMIA (INSULIN SHOCK) AND HYPERGLYCEMIA (DIABETIC KETOACIDOSIS)
  3736. Fetal and Neonatal Risks and Complications
  3737. Care Management
  3738. Antepartum
  3739. NURSING PROCESS
  3740. Pregestational Diabetes
  3741. Assessment
  3742. History
  3743. Interview
  3744. Physical Examination
  3745. Laboratory Tests
  3746. Nursing Diagnoses
  3747. Deficient Knowledge related to:
  3748. Anxiety, Fear, Dysfunctional Grieving, Powerlessness, Disturbed Body Image, Situational Low Self-esteem, Spiritual Distress, Ineffective Role Performance, and Interrupted Family Processes related to:
  3749. Risk for Injury (to Fetus) related to:
  3750. Risk for Injury (to Mother) related to:
  3751. Expected Outcomes of Care
  3752. Plan of Care and Interventions
  3753. Antepartum
  3754. Intrapartum
  3755. Postpartum
  3756. Evaluation
  3757. FIG. 29-2 A, Clinic nurse collects blood to determine glucose level. B, Nurse interprets glucose value displayed by monitor.
  3758. TABLE 29-3 TARGET BLOOD GLUCOSE LEVELS DURING PREGNANCY
  3759. Diet
  3760. TEACHING FOR SELF-MANAGEMENT
  3761. Dietary Management of Diabetic Pregnancy
  3762. Exercise
  3763. NURSING ALERT
  3764. Insulin Therapy
  3765. TEACHING FOR SELF-MANAGEMENT
  3766. Self-Administration of Insulin
  3767. Procedure for Mixing Nph (Intermediate-Acting) and Regular (Short-Acting) Insulin
  3768. Procedure for Self-Injection of Insulin
  3769. BOX 29-1 HELPFUL HINTS FOR USING INSULIN
  3770. TABLE 29-4 COMMON INSULIN PREPARATIONS
  3771. FIG. 29-3 Insulin pump shows basal rate for pregnant women with diabetes.
  3772. Monitoring Blood Glucose Levels
  3773. SAFETY ALERT
  3774. NURSING ALERT
  3775. TEACHING FOR SELF-MANAGEMENT
  3776. Self-Testing of Blood Glucose Level
  3777. TEACHING FOR SELF-MANAGEMENT
  3778. Treatment for Hypoglycemia
  3779. TEACHING FOR SELF-MANAGEMENT
  3780. What to Do When Illness Occurs
  3781. Urine Testing
  3782. Complications Requiring Hospitalization
  3783. Fetal Surveillance
  3784. Determination of Birth Date and Mode of Birth
  3785. Intrapartum
  3786. Postpartum
  3787. Gestational Diabetes Mellitus
  3788. Fetal Risks
  3789. Screening for Gestational Diabetes Mellitus
  3790. Care Management
  3791. Antepartum
  3792. Diet
  3793. Exercise
  3794. EVIDENCE-BASED PRACTICE
  3795. Stricter Glucose Tolerance Test in Pregnancy Will Mean Increased Diagnoses of Gestational Diabetes
  3796. Ask the Question
  3797. Search for Evidence
  3798. Search Strategies
  3799. Databases Searched
  3800. Critically Analyze the Data
  3801. Implications for Practice
  3802. References
  3803. Monitoring Blood Glucose Levels
  3804. Medications for Controlling Blood Glucose Levels
  3805. NURSING CARE PLAN
  3806. The Pregnant Woman with Gestational Diabetes
  3807. Nursing Diagnosis
  3808. Expected Outcome
  3809. Nursing Interventions/Rationales
  3810. Nursing Diagnosis
  3811. Expected Outcomes
  3812. Nursing Interventions/Rationales
  3813. Nursing Diagnosis
  3814. Expected Outcomes
  3815. Nursing Interventions/Rationales
  3816. FIG. 29-4 Screening and diagnosis for gestational diabetes.
  3817. CLINICAL REASONING
  3818. Causes of Hyperglycemia in a Woman with Gestational Diabetes Mellitus (GDM)
  3819. Fetal Surveillance
  3820. Intrapartum
  3821. Postpartum
  3822. Hyperemesis Gravidarum
  3823. Etiology
  3824. Clinical Manifestations
  3825. Care Management
  3826. Assessment
  3827. Initial Care
  3828. Follow-up Care
  3829. TEACHING FOR SELF-MANAGEMENT
  3830. Diet for Hyperemesis
  3831. Thyroid Disorders
  3832. Hyperthyroidism
  3833. NURSING ALERT
  3834. Hypothyroidism
  3835. NURSING ALERT
  3836. Nursing Care
  3837. Maternal Phenylketonuria
  3838. KEY POINTS
  3839. References
  3840. Chapter 30 Medical-Surgical Problems in Pregnancy
  3841. Learning Objectives
  3842. Cardiovascular Disorders
  3843. BOX 30-1 MATERNAL CARDIAC DISEASE RISK GROUPS
  3844. Group I (Low Risk)
  3845. Group II (Moderate Risk)
  3846. Group III (High Risk)
  3847. Congenital Cardiac Disease
  3848. Septal Defects
  3849. Atrial Septal Defect
  3850. Ventricular Septal Defect
  3851. Patent Ductus Arteriosus
  3852. Acyanotic Lesions
  3853. Coarctation of the Aorta
  3854. Cyanotic Lesions
  3855. Tetralogy of Fallot
  3856. Acquired Cardiac Disease
  3857. Mitral Valve Stenosis
  3858. BOX 30-2 PROPHYLAXIS FOR BACTERIAL ENDOCARDITIS DURING LABOR AND BIRTH
  3859. High Risk Clients
  3860. Penicillin-Allergic Clients
  3861. Moderate Risk Clients
  3862. Penicillin-Allergic Clients
  3863. Mitral Valve Prolapse
  3864. Aortic Stenosis
  3865. Ischemic Heart Disease
  3866. Myocardial Infarction
  3867. Other Cardiac Diseases and Conditions
  3868. Primary Pulmonary Hypertension
  3869. Marfan Syndrome
  3870. Infective Endocarditis
  3871. Eisenmenger Syndrome
  3872. Peripartum Cardiomyopathy
  3873. Valve Replacement
  3874. Heart Transplantation
  3875. Care Management
  3876. Antepartum
  3877. SIGNS OF POTENTIAL COMPLICATIONS
  3878. Cardiac Decompensation
  3879. Pregnant Woman: Subjective Symptoms
  3880. Nurse: Objective Signs
  3881. NURSING PROCESS
  3882. Cardiac Disease
  3883. Assessment
  3884. Interview
  3885. Physical Examination
  3886. Laboratory and Diagnostic Tests
  3887. Nursing Diagnoses
  3888. Prenatal Period
  3889. Fear related to
  3890. Deficient Knowledge related to
  3891. Activity Intolerance related to
  3892. Risk for Self-care Deficit (bathing, grooming, and dressing) related to
  3893. Impaired Home Maintenance related to
  3894. Intrapartum Period
  3895. Anxiety related to
  3896. Fear related to
  3897. Risk for Impaired Gas Exchange related to
  3898. Postpartum Period
  3899. Risk for Impaired Gas Exchange related to
  3900. Risk for Excess Fluid Volume related to
  3901. Ineffective Breastfeeding related to
  3902. Expected Outcomes of Care
  3903. Plan of Care and Interventions
  3904. The woman with class I or II heart disease
  3905. The woman with class II cardiac disease
  3906. The woman with class III cardiac disease
  3907. Other considerations
  3908. Evaluation
  3909. TABLE 30-1 SELECTED DRUGS USED IN TREATMENT OF CARDIAC DISORDERS IN THE PREGNANT WOMAN
  3910. Heart Surgery During Pregnancy
  3911. Intrapartum
  3912. NURSING CARE PLAN
  3913. The Pregnant Woman with Heart Disease
  3914. Nursing Diagnosis
  3915. Expected Outcome
  3916. Nursing Interventions/Rationales
  3917. Nursing Diagnosis
  3918. Expected Outcome
  3919. Nursing Interventions/Rationales
  3920. Nursing Diagnosis
  3921. Expected Outcome
  3922. Nursing Interventions/Rationales
  3923. NURSING ALERT
  3924. LEGAL TIP
  3925. Cardiac and Metabolic Emergencies
  3926. Postpartum
  3927. NURSING ALERT
  3928. Cardiopulmonary Resuscitation of the Pregnant Woman
  3929. EMERGENCY
  3930. Cardiopulmonary Resuscitation for the Pregnant Woman
  3931. Airway
  3932. Breathing
  3933. Circulation
  3934. Defibrillation
  3935. Relief of Foreign Body Airway Obstruction
  3936. FIG. 30-1 Abdominal thrust maneuver (formerly known as the Heimlich maneuver). Clearing airway obstruction in woman in late stage of pregnancy (can also be used in markedly obese victim). A, Standing behind victim, place your arms under woman’s armpits and across chest. Place thumb side of your clenched fist against middle of sternum, and place other hand over fist. B, Perform backward chest thrusts until foreign body is expelled or woman becomes unconscious. If pregnant woman becomes unconscious because of foreign body airway obstruction, place her on her back and kneel close to her side. (Be sure uterus is displaced laterally by using, for example, a rolled blanket under her hip.) Open mouth with tongue-jaw lift, perform finger sweep, and attempt rescue breathing. If unable to ventilate, position hands as for chest compression. Deliver five chest thrusts firmly to remove obstruction. Repeat this sequence of abdominal thrust maneuver, finger sweep, and attempt to ventilate. Continue sequence until pregnant woman’s airway is clear of obstruction or help has arrived to relieve you. If the woman is unconscious, give chest compressions as for the woman without pulse
  3937. Other Medical Disorders in Pregnancy
  3938. Anemia
  3939. Iron Deficiency Anemia
  3940. Folate Deficiency Anemia
  3941. Sickle Cell Hemoglobinopathy
  3942. COMMUNITY ACTIVITY
  3943. SAFETY ALERT
  3944. Thalassemia
  3945. Pulmonary Disorders
  3946. Asthma
  3947. Cystic Fibrosis
  3948. EVIDENCE-BASED PRACTICE
  3949. The 2009 Influenza A (H1N1) Pandemic and Pregnancy
  3950. Ask the Question
  3951. Search for Evidence
  3952. Search Strategies
  3953. Databases Searched
  3954. Critically Analyze the Data
  3955. Implications for Practice
  3956. References
  3957. NURSING PROCESS
  3958. Asthma
  3959. Assessment
  3960. History
  3961. Physical examination
  3962. Laboratory tests
  3963. Nursing Diagnoses
  3964. Risk for Injury (to the fetus) related to
  3965. Anxiety related to
  3966. Ineffective Airway Clearance related to
  3967. Deficient Knowledge related to
  3968. Expected Outcomes of Care
  3969. Plan of Care and Interventions
  3970. Home care
  3971. Evaluation
  3972. TABLE 30-2 MEDICATIONS USED IN PREGNANCY IN WOMEN WITH ASTHMA
  3973. Acute Respiratory Distress Syndrome
  3974. NURSING ALERT
  3975. Integumentary Disorders
  3976. SAFETY ALERT
  3977. FIG. 30-2 Woman with pruritic urticarial papules and plaques of pregnancy. Lesions also are present on her arms, back, abdomen, and buttocks.
  3978. Neurologic Disorders
  3979. Epilepsy
  3980. SAFETY ALERT
  3981. Multiple Sclerosis
  3982. Bell Palsy
  3983. Autoimmune Disorders
  3984. Systemic Lupus Erythematosus
  3985. Myasthenia Gravis
  3986. Gastrointestinal Disorders
  3987. Cholelithiasis and Cholecystitis
  3988. TEACHING FOR SELF-MANAGEMENT
  3989. Nutritional Counseling for the Pregnant Woman with Cholecystitis or Cholelithiasis
  3990. Inflammatory Bowel Disease
  3991. Urinary Tract Infections
  3992. Asymptomatic Bacteriuria
  3993. Cystitis
  3994. CLINICAL REASONING
  3995. Asymptomatic Bacteriuria
  3996. Pyelonephritis
  3997. Client Education
  3998. TEACHING FOR SELF-MANAGEMENT
  3999. Prevention of Urinary Tract Infections
  4000. Surgery During Pregnancy
  4001. Appendicitis
  4002. Care Management
  4003. Hospital Care
  4004. Home Care
  4005. BOX 30-3 DISCHARGE TEACHING FOR HOME CARE AFTER SURGERY
  4006. KEY POINTS
  4007. References
  4008. Chapter 31 Obstetric Critical Care
  4009. Learning Objectives
  4010. Obstetric Intensive Care Unit
  4011. LEGAL TIP
  4012. Nursing Assignments
  4013. LEGAL TIP
  4014. Client Care Standards
  4015. Equipment and Expertise
  4016. LEGAL TIP
  4017. Legal Review
  4018. BOX 31-1 COMPLICATIONS OF PREGNANCY THAT INDICATE THE NEED FOR CRITICAL CARE
  4019. Physiologic Changes in Pregnancy
  4020. Cardiovascular Changes
  4021. TABLE 31-1 CARDIOVASCULAR CHANGES DURING PREGNANCY
  4022. Colloid Osmotic Pressure
  4023. TABLE 31-2 COLLOID OSMOTIC (ONCOTIC) PRESSURE VALUES
  4024. Respiratory Changes
  4025. Hematologic Changes
  4026. Systemic Vascular Resistance
  4027. TABLE 31-3 CARDIAC OUTPUT IN RELATION TO MATERNAL POSITION
  4028. Hemodynamic Monitoring
  4029. Anatomic and Physiologic Characteristics of Circulation
  4030. FIG. 31-1 Diagram of heart with position of pulmonary artery catheter.
  4031. Cardiac Output
  4032. Positional Changes
  4033. NURSING ALERT
  4034. Cardiac Output Determinants
  4035. FIG. 31-2 Relation of preload to cardiac output. Ventricular function (Starling) curve for heart, showing both normal function and during failure.
  4036. SAFETY ALERT
  4037. FIG. 31-3 Relation of afterload to cardiac output when preload is maintained constant. As afterload increases, cardiac output decreases.
  4038. Invasive Hemodynamic Monitoring
  4039. Pulmonary Artery Catheter
  4040. FIG. 31-4 Standard triple-lumen flow-directed pulmonary artery catheter.
  4041. Venous Access
  4042. PROCEDURE
  4043. How to Set Up, Calibrate, and Zero-Reference Pressure Lines
  4044. Waveforms and Pressure Readings
  4045. FIG. 31-5 Location of phlebostatic axis and zeroing.
  4046. BOX 31-2 PULMONARY ARTERY CATHETER (PAC) PROTOCOL
  4047. Setup
  4048. Client Preparation for Insertion
  4049. Nursing Management During Insertion
  4050. Nursing Assessments
  4051. Nursing Management for Catheter Removal
  4052. Documentation
  4053. FIG. 31-6 Components of hemodynamic monitoring system: pressurized tubing, pressure transducer, and hemodynamic monitor.
  4054. Arterial Pressure Catheter
  4055. FIG 31-7 Pressure waveform in relation to catheter position from right atrium (RA), to right ventricle (RV), to pulmonary artery (PA), to pulmonary capillary wedge pressure (PCWP).
  4056. PROCEDURE
  4057. Obtaining a Pulmonary Capillary Wedge Pressure Reading
  4058. BOX 31-3 TROUBLESHOOTING PULMONARY ARTERY CATHETER PROBLEMS
  4059. Spontaneous Wedging: Pcwp Waveform Appears on Monitor Screen
  4060. Migration of Catheter Backward: Right Ventricular Waveform on Screen
  4061. Suspected Balloon Rupture: Absence of Resistance Felt When Inflating Balloon or Inability to Obtain Pcwp Reading
  4062. BOX 31-4 ALLEN’S TEST PROCEDURE
  4063. FIG. 31-8 Arterial waveform.
  4064. Pressure Lines
  4065. Data Collection
  4066. PROCEDURE
  4067. Making and Recording Hemodynamic Assessments
  4068. Oxygenation
  4069. SaO2 Monitoring
  4070. PROCEDURE
  4071. Thermodilution Procedure for Measuring Cardiac Output
  4072. SvO2 Monitoring
  4073. NURSING ALERT
  4074. Central Venous Pressure Lines
  4075. Interpretation of Hemodynamic Data
  4076. TABLE 31-4 NORMAL HEMODYNAMIC VALUES IN PREGNANCY
  4077. TABLE 31-5 CENTRAL HEMODYNAMIC NORMAL VALUES
  4078. BOX 31-5 CASE STUDIES
  4079. Case 1
  4080. Evaluation
  4081. Case 2
  4082. Evaluation
  4083. Case 3
  4084. Evaluation
  4085. Pulmonary Edema
  4086. CLINICAL REASONING
  4087. Nursing Care of the Critically Ill Pregnant Woman
  4088. Case I
  4089. Case II
  4090. Trauma During Pregnancy
  4091. Significance
  4092. Maternal Physiologic Characteristics
  4093. NURSING ALERT
  4094. TABLE 31-6 MATERNAL ADAPTATIONS DURING PREGNANCY AND RELATION TO TRAUMA
  4095. Fetal Physiologic Characteristics
  4096. Mechanisms of Trauma
  4097. Blunt Abdominal Trauma
  4098. NURSING ALERT
  4099. Penetrating Abdominal Trauma
  4100. Thoracic Trauma
  4101. Immediate Stabilization
  4102. NURSING ALERT
  4103. Primary Survey
  4104. NURSING ALERT
  4105. Secondary Survey
  4106. BOX 31-6 GLASGOW COMA SCALE
  4107. BOX 31-7 PHYSICAL EXAMINATION OF THE PREGNANT TRAUMA VICTIM
  4108. Head
  4109. Neck
  4110. Chest
  4111. Abdomen
  4112. Lower Back
  4113. Extremities
  4114. Vagina
  4115. Urinary Tract
  4116. Electronic Fetal Monitoring
  4117. LEGAL TIP
  4118. Care of the Pregnant Woman Involved in a Minor Trauma Situation
  4119. Fetal-Maternal Hemorrhage
  4120. Ultrasound
  4121. Radiation Exposure
  4122. Perimortem Cesarean Birth
  4123. Family-centered Obstetric Critical Care
  4124. Maternal Death
  4125. KEY POINTS
  4126. References
  4127. Chapter 32 Mental Health Disorders and Substance Abuse in Pregnancy
  4128. Learning Objectives
  4129. Mental Health Disorders During Pregnancy
  4130. Mood Disorders
  4131. NURSING ALERT
  4132. COMMUNITY ACTIVITY
  4133. Collaborative Care
  4134. Antidepressant Medications
  4135. TABLE 32-1 ANTIDEPRESSANT MEDICATIONS
  4136. Anxiety Disorders
  4137. Collaborative Care
  4138. TABLE 32-2 ANTIANXIETY MEDICATIONS
  4139. Special Considerations for Medications During Pregnancy
  4140. TABLE 32-3 MOOD STABILIZERS
  4141. Substance Abuse During Pregnancy
  4142. Prevalence
  4143. Risk Factors
  4144. Barriers to Treatment
  4145. Legal Considerations
  4146. LEGAL TIP
  4147. Drug Testing During Pregnancy
  4148. Commonly Abused Drugs
  4149. Nicotine and Caffeine
  4150. Alcohol
  4151. Marijuana
  4152. Cocaine and Methamphetamine
  4153. Opiates
  4154. BOX 32-1 CAGE QUESTIONNAIRE
  4155. Care Management
  4156. Screening
  4157. BOX 32-2 SCREENING WITH THE 4P’s PLUS
  4158. Assessment
  4159. Collaborative Care
  4160. NURSING PROCESS
  4161. Substance Abuse
  4162. Assessment
  4163. Nursing Diagnoses
  4164. Risk for Imbalanced Nutrition: Less than Body Requirements related to:
  4165. Risk for injury (to self, fetus, or newborn) related to:
  4166. Risk for infection related to:
  4167. Self-care deficit (bathing or hygiene) related to:
  4168. Ineffective coping related to:
  4169. Risk for Impaired Parent-infant Attachment related to:
  4170. Hopelessness related to:
  4171. Powerlessness related to:
  4172. Risk for suicide related to:
  4173. Expected Outcomes of Care
  4174. Plan of Care and Interventions
  4175. Evaluation
  4176. Intrapartum and Postpartum Care Considerations
  4177. Postpartum Psychologic Complications
  4178. Mood Disorders
  4179. Etiology and Risk Factors
  4180. BOX 32-3 RISK FACTORS FOR POSTPARTUM DEPRESSION
  4181. Postpartum Depression Without Psychotic Features
  4182. Medical Management
  4183. Postpartum Depression with Psychotic Features
  4184. NURSING ALERT
  4185. Medical Management
  4186. TABLE 32-4 ANTIPSYCHOTIC MEDICATIONS
  4187. Care Management
  4188. SAFETY ALERT
  4189. Postpartum Depression Screening Tools
  4190. NURSING CARE PLAN
  4191. Postpartum Depression (PPD)
  4192. Nursing Diagnosis
  4193. Expected Outcomes
  4194. Nursing Interventions/Rationales
  4195. Nursing Diagnosis
  4196. Expected Outcomes
  4197. Nursing Interventions/Rationales
  4198. Nursing Diagnosis
  4199. Expected Outcomes
  4200. Nursing Interventions/Rationales
  4201. Nursing Care on the Postpartum Unit
  4202. TEACHING FOR SELF-MANAGEMENT
  4203. Activities to Prevent Postpartum Depression
  4204. NURSING PROCESS
  4205. Postpartum Depression
  4206. Assessment
  4207. Nursing Diagnoses
  4208. Situational Low Self- esteem (in the mother) related to:
  4209. Disabled Family Coping related to:
  4210. Risk for Impaired Parenting related to:
  4211. Risk for Injury (to the newborn) related to:
  4212. Expected Outcomes of Care
  4213. Plan of Care and Interventions
  4214. Evaluation
  4215. NURSING ALERT
  4216. Nursing Care in the Home and Community
  4217. Referral
  4218. EVIDENCE-BASED PRACTICE
  4219. Assessing for Postpartum Depression
  4220. Ask the Question
  4221. Search for Evidence
  4222. Search Strategies
  4223. Databases Searched
  4224. Critically Analyze the Evidence
  4225. Implications for Practice
  4226. References
  4227. Providing Safety
  4228. Psychiatric Hospitalization
  4229. NURSING ALERT
  4230. SAFETY ALERT
  4231. Psychotropic Medications
  4232. LEGAL TIP
  4233. Commitment for Psychiatric Care
  4234. Psychotropic Medications and Lactation
  4235. CLINICAL REASONING
  4236. Postpartum Depression
  4237. Other Treatments for PPD
  4238. NURSING ALERT
  4239. Postpartum Onset of Anxiety Disorders
  4240. Medical Management
  4241. Nursing Considerations
  4242. KEY POINTS
  4243. References
  4244. Chapter 33 Labor and Birth Complications
  4245. Learning Objectives
  4246. Preterm Labor and Birth
  4247. Preterm Birth Versus Low Birth Weight
  4248. BOX 33-1 RISK FACTORS FOR SPONTANEOUS PRETERM LABOR
  4249. BOX 33-2 COMMON CAUSES OF INDICATED PRETERM BIRTH
  4250. Predicting Spontaneous Preterm Labor and Birth
  4251. Biochemical Marker
  4252. Cervical Length
  4253. Causes of Preterm Labor and Birth
  4254. NURSING CARE PLAN
  4255. Preterm Labor
  4256. Nursing Diagnosis
  4257. Expected Outcome
  4258. Nursing Interventions/Rationales
  4259. Nursing Diagnosis
  4260. Expected Outcomes
  4261. Nursing Interventions/Rationales
  4262. Nursing Diagnosis
  4263. Expected Outcome
  4264. Nursing Interventions/Rationales
  4265. Nursing Diagnosis
  4266. Expected Outcome
  4267. Nursing Interventions/Rationales
  4268. Care Management
  4269. Prevention
  4270. Early Recognition and Diagnosis
  4271. BOX 33-3 SIGNS AND SYMPTOMS OF PRETERM LABOR
  4272. Uterine Activity
  4273. Discomfort
  4274. Vaginal Discharge
  4275. TEACHING FOR SELF-MANAGEMENT
  4276. What to Do If Symptoms of Preterm Labor Occur
  4277. FIG. 33-1 A nurse teaching a couple signs and symptoms of preterm labor.
  4278. COMMUNITY ACTIVITY
  4279. Lifestyle Modifications
  4280. Activity Restriction
  4281. Restriction of Sexual Activity
  4282. BOX 33-4 ADVERSE EFFECTS OF BED REST
  4283. Maternal Effects (Physical)
  4284. Maternal Effects (Psychosocial)
  4285. Effects on Support System
  4286. Home Care
  4287. EVIDENCE-BASED PRACTICE
  4288. Preterm Labor: Is Bed Rest (Especially in the Hospital) Really Best?
  4289. Ask the Question
  4290. Search for Evidence
  4291. Search Strategies
  4292. Databases Searched
  4293. Critically Analyze the Data
  4294. Implications for Practice
  4295. References
  4296. FIG. 33-2 Woman at home on restricted activity for preterm labor prevention. Note how she has arranged her daytime resting area so that needed items are close at hand.
  4297. TEACHING FOR SELF-MANAGEMENT
  4298. Activities for Children of Women on Activity Restriction
  4299. BOX 33-5 CONTRAINDICATIONS TO TOCOLYSIS
  4300. Maternal
  4301. Fetal
  4302. Suppression of Uterine Activity
  4303. SAFETY ALERT
  4304. BOX 33-6 NURSING CARE FOR THE WOMAN RECEIVING TOCOLYTIC THERAPY
  4305. MEDICATION GUIDE
  4306. Tocolytic Therapy for Preterm Labor
  4307. SAFETY ALERT
  4308. Promotion of Fetal Lung Maturity
  4309. MEDICATION GUIDE
  4310. Antenatal Glucocorticoid Therapy with Betamethasone or Dexamethasone
  4311. Action
  4312. Indication
  4313. Dosage and Route
  4314. Adverse Effects
  4315. Nursing Considerations
  4316. NURSING ALERT
  4317. Management of Inevitable Preterm Birth
  4318. Fetal and Early Neonatal Loss
  4319. Premature Rupture of Membranes
  4320. Care Management
  4321. TEACHING FOR SELF-MANAGEMENT
  4322. Home Care Instructions for the Woman with Preterm Premature Rupture of Membranes
  4323. Chorioamnionitis
  4324. Dysfunctional Labor (Dystocia)
  4325. Abnormal Uterine Activity
  4326. Hypertonic Uterine Dysfunction
  4327. Hypotonic Uterine Dysfunction
  4328. TABLE 33-1 DYSFUNCTIONAL LABOR: PRIMARY AND SECONDARY POWERS
  4329. Secondary Powers
  4330. Abnormal Labor Patterns
  4331. TABLE 33-2 ABNORMAL LABOR PATTERNS
  4332. Precipitous Labor
  4333. Alterations in Pelvic Structure
  4334. Pelvic Dystocia
  4335. Soft-Tissue Dystocia
  4336. Fetal Causes
  4337. Anomalies
  4338. Cephalopelvic Disproportion
  4339. Malposition
  4340. BOX 33-7 MEASURES TO REDUCE BACK PAIN AND FACILITATE ROTATION OF FETAL HEAD DURING BACK LABOR-OCCIPUT POSTERIOR POSITION
  4341. Measures to Reduce Back Pain During a Contraction
  4342. Measures to Facilitate the Rotation of the Fetal Head (may also Reduce Back Pain)
  4343. Malpresentation
  4344. FIG. 33-3 Breech presentation. A, Frank breech. B, Complete breech. C, Single footling breech.
  4345. FIG. 33-4 Mechanism of labor in breech presentation. A, Breech before onset of labor. B, Engagement and internal rotation. C, Lateral flexion. D, External rotation or restitution. E, Internal rotation of shoulders and head. F, Face rotates to sacrum when occiput is anterior. G, Head is born by gradual flexion during elevation of fetal body.
  4346. Multifetal Pregnancy
  4347. Position of the Woman
  4348. Psychologic Responses
  4349. Care Management
  4350. LEGAL TIP
  4351. Standard of Care—Labor and Birth Complications
  4352. Obesity
  4353. Care Management
  4354. NURSING PROCESS
  4355. Dysfunctional Labor
  4356. Assessment
  4357. Past History
  4358. Physical
  4359. Psychologic
  4360. Nursing Diagnoses
  4361. Risk for Injury (maternal or fetal) related to
  4362. Powerlessness related to
  4363. Risk for Infection related to
  4364. Ineffective Individual Coping related to
  4365. EXPECTED OUTCOMES OF CARE
  4366. Plan of Care and Interventions
  4367. Evaluation
  4368. FIG. 33-5 Room specifically designed to accommodate obese pregnant clients. Note lift attached to ceiling for use in transferring women from the bed to chairs or stretchers.
  4369. FIG. 33-6 External version of fetus from breech to vertex presentation. This must be achieved without force. A, Breech is pushed up out of pelvic inlet while head is pulled toward inlet. B, Head is pushed toward inlet while breech is pulled upward.
  4370. Obstetric Procedures
  4371. Version
  4372. External Cephalic Version
  4373. Internal Version
  4374. Induction of Labor
  4375. BOX 33-8 INDICATIONS AND CONTRAINDICATIONS FOR LABOR INDUCTION
  4376. Indications
  4377. Contraindications
  4378. Relative Contraindications
  4379. TABLE 33-3 BISHOP SCORE
  4380. Cervical Ripening Methods
  4381. Chemical Agents
  4382. Mechanical and Physical Methods
  4383. MEDICATION GUIDE
  4384. Prostaglandin E1 (PGE1): Misoprostol (Cytotec)
  4385. Action
  4386. Indications
  4387. Dosage and Administration
  4388. Adverse Effects
  4389. Nursing Considerations
  4390. Alternative Methods
  4391. MEDICATION GUIDE
  4392. Prostaglandin E2 (PGE2): Dinoprostone (Cervidil Insert; Prepidil Gel)
  4393. Action
  4394. Indications
  4395. Dosage and Route
  4396. Adverse Effects
  4397. Nursing Considerations
  4398. Amniotomy
  4399. PROCEDURE
  4400. Assisting with Amniotomy
  4401. Procedure
  4402. Documentation
  4403. NURSNG ALERT
  4404. LEGAL TIP: Performing Amniotomy
  4405. Oxytocin
  4406. SAFETY ALERT
  4407. MEDICATION GUIDE
  4408. Oxytocin (Pitocin)
  4409. Action
  4410. Indications
  4411. Dosage
  4412. Adverse effects
  4413. Nursing Considerations
  4414. Nursing Considerations.
  4415. FIG. 33-7 Woman in side-lying position receiving oxytocin.
  4416. EMERGENCY
  4417. Uterine Tachysystole with Oxytocin
  4418. Signs
  4419. Interventions (With Normal [Reassuring] Fhr)
  4420. Interventions (Wth Abnormal [Nonreassuring] FHR)
  4421. Resumption of Oxytocin After Resolution of Tachysystole
  4422. NURSING ALERT
  4423. Augmentation of Labor
  4424. Operative vaginal birth
  4425. Forceps-Assisted Birth
  4426. Management
  4427. NURSING ALERT
  4428. Nursing Considerations
  4429. FIG. 33-8 Types of forceps. Piper forceps are used to assist delivery of the head in a breech birth.
  4430. FIG. 33-9 Outlet forceps-assisted extraction of the head.
  4431. TABLE 33-4 DEFINITIONS FOR FORCEPS- AND VACUUM-ASSISTED BIRTHS
  4432. Vacuum-Assisted Birth
  4433. FIG. 33-10 Use of vacuum extraction to rotate fetal head and assist with descent. A, Arrow indicates direction of traction on the vacuum cup. B, Caput succedaneum formed by the vacuum cup.
  4434. Management
  4435. BOX 33-9 ASSISTING WITH BIRTH BY VACUUM EXTRACTION
  4436. Nursing Considerations
  4437. Cesarean Birth
  4438. BOX 33-10 SELECTED MEASURES TO REDUCE THE CESAREAN BIRTH RATE AND INCREASE THE RATE OF VAGINAL BIRTH AFTER CESAREAN
  4439. Educate Women Regarding
  4440. Establish Admission Criteria for Women in Labor that
  4441. Use Appropriate Assessment Techniques to
  4442. Initiate a Doula Program that
  4443. Develop a Philosophy of Labor Management that
  4444. Indications
  4445. BOX 33-11 INDICATIONS FOR CESAREAN BIRTH
  4446. Maternal
  4447. Fetal
  4448. Maternal-fetal
  4449. Elective Cesarean Birth
  4450. CLINICAL REASONING
  4451. The Woman Seeking Elective Cesarean Birth
  4452. Forced Cesarean Birth
  4453. Surgical Techniques
  4454. FIG. 33-11 Skin incisions for cesarean birth. A, Vertical. B, Horizontal (Pfannenstiel).
  4455. FIG. 33-12 Uterine incisions for cesarean birth. A, Low transverse incision. B, Low vertical incision. C, Classic incision
  4456. Complications and Risks
  4457. Anesthesia
  4458. Scheduled Cesarean Birth
  4459. Unplanned Cesarean Birth
  4460. Prenatal Preparation
  4461. Preoperative Care
  4462. FIG. 33-13 Cesarean birth. A, “Bikini” incision has been made, the muscle layer is separated, the abdomen is entered, and the uterus has been exposed and incised; suctioning of amniotic fluid continues as head is brought up through the incision. Note small amount of bleeding. B, The neonate’s birth through the uterine incision is nearly complete. C, A quick assessment is performed; note extreme molding of head resulting from cephalopelvic disproportion.
  4463. Intraoperative Care
  4464. LEGAL TIP
  4465. Disclosure of Client Information
  4466. Immediate Postoperative Care
  4467. FIG. 33-14 A, Parents and their newborn. The physician manually removes the placenta, suctions the remaining amniotic fluid and blood from the uterine cavity, and closes the uterine incision, peritoneum, muscle layer, fatty tissue, and finally the skin, while the new family shares some time together. B, Parents become better acquainted with their newborn while mother rests after surgery.
  4468. Postoperative or Postpartum Care
  4469. TEACHING FOR SELF-MANAGEMENT
  4470. Postpartum Pain Relief After Cesarean Birth
  4471. Incisional
  4472. Gas
  4473. SAFETY ALERT
  4474. SAFETY ALERT
  4475. TEACHING FOR SELF-MANAGEMENT
  4476. Signs of Postoperative Complications After Discharge Following Cesarean Birth
  4477. Trial of Labor
  4478. BOX 33-12 SELECTION CRITERIA FOR VAGINAL BIRTH AFTER CESAREAN
  4479. Vaginal Birth After Cesarean
  4480. Postterm Pregnancy, Labor, and Birth
  4481. Maternal and Fetal Risks
  4482. Care Management
  4483. TEACHING FOR SELF-MANAGEMENT
  4484. Postterm Pregnancy
  4485. Obstetric Emergencies
  4486. Meconium Stained Amniotic Fluid
  4487. Care Management
  4488. EMERGENCY
  4489. Immediate Management of the Newborn with Meconium-Stained Amniotic Fluid
  4490. Prior to Birth
  4491. Immediately after Birth
  4492. NURSING ALERT
  4493. Shoulder Dystocia
  4494. FIG. 33-15 Application of suprapubic pressure
  4495. FIG. 33-16 McRoberts maneuver.
  4496. Care Management
  4497. Prolapsed Umbilical Cord
  4498. Care Management
  4499. FIG. 33-17 Prolapse of umbilical cord. Note pressure of presenting part on umbilical cord, which endangers fetal circulation. A, Occult (hidden) prolapse of cord. B, Complete prolapse of cord. Note that membranes are intact. C, Cord presenting in front of the fetal head may be seen in vagina. D, Frank breech presentation with prolapsed cord.
  4500. FIG. 33-18 Arrows indicate direction of pressure against presenting part to relieve compression of prolapsed umbilical cord. Pressure exerted by examiner’s fingers in A, vertex presentation, and B, breech presentation. C, Gravity relieves pressure when woman is in modified Sims position with hips elevated as high as possible with pillows. D, Knee-chest position.
  4501. Rupture of the Uterus
  4502. EMERGENCY
  4503. Prolapsed Umbilical Cord
  4504. Signs
  4505. Interventions
  4506. Care Management
  4507. Anaphylactoid Syndrome of Pregnancy
  4508. EMERGENCY
  4509. Anaphylactoid Syndrome of Pregnancy
  4510. Signs
  4511. Respiratory Distress
  4512. Circulatory Collapse
  4513. Hemorrhage
  4514. Interventions
  4515. Oxygenate
  4516. Maintain Cardiac Output and Replace Fluid Losses
  4517. Care Management
  4518. KEY POINTS
  4519. Breech Presentation Examination (read text)
  4520. Breech Birth, Face (read text)
  4521. Cesarean Delivery (read text)
  4522. Shoulder Dystocia (read text)
  4523. Umbilical Cord Prolapse (read text)
  4524. References
  4525. Chapter 34 Postpartum Complications
  4526. Learning Objectives
  4527. Postpartum Hemorrhage
  4528. Definition and Incidence
  4529. Etiology and Risk Factors
  4530. CLINICAL REASONING
  4531. Postpartum Hemorrhage
  4532. Uterine Atony
  4533. Lacerations of the Genital Tract
  4534. BOX 34-1 RISK FACTORS AND CAUSES OF POSTPARTUM HEMORRHAGE
  4535. Retained Placenta
  4536. Nonadherent Retained Placenta
  4537. Adherent Retained Placenta
  4538. Inversion of the Uterus
  4539. Subinvolution of the Uterus
  4540. Care Management
  4541. Medical Management
  4542. Hypotonic Uterus
  4543. NURSING ALERT
  4544. MEDICATION GUIDE
  4545. Drugs Used to Manage Postpartum Hemorrhage
  4546. Bleeding with a Contracted Uterus
  4547. Uterine Inversion
  4548. BOX 34-2 HERBAL REMEDIES FOR POSTPARTUM HEMORRHAGE∗
  4549. Subinvolution
  4550. Herbal Remedies
  4551. Nursing Interventions
  4552. FIG. 34-1 Nursing assessments for postpartum bleeding. CBC, Complete blood count; IV, intravenous; uterotonics, medications to contract the uterus.
  4553. BOX 34-3 NONINVASIVE ASSESSMENTS OF CARDIAC OUTPUT IN POSTPARTUM WOMEN WHO ARE BLEEDING
  4554. Palpation Of Pulses (Rate, Quality, Equality)
  4555. Auscultation
  4556. Inspection
  4557. Observation
  4558. Measurement
  4559. NURSING PROCESS
  4560. Postpartum Hemorrhage
  4561. Assessment
  4562. Nursing Diagnoses
  4563. Deficient Fluid Volume related to:
  4564. Risk for Imbalanced Fluid Volume related to:
  4565. Risk for Infection related to:
  4566. Risk for Injury related to:
  4567. Fear or Anxiety related to:
  4568. Risk for Impaired Parenting related to:
  4569. Ineffective (Peripheral) Tissue Perfusion related to:
  4570. Expected Outcomes of Care
  4571. Plan of Care and Interventions
  4572. Evaluation
  4573. NURSING ALERT
  4574. Hemorrhagic (Hypovolemic) Shock
  4575. NURSING CARE PLAN
  4576. Postpartum Hemorrhage
  4577. Nursing Diagnosis
  4578. Expected Outcome
  4579. Nursing Interventions/Rationales
  4580. Nursing Diagnosis
  4581. Expected Outcomes
  4582. Nursing Interventions/Rationales
  4583. Nursing Diagnosis
  4584. Expected Outcome
  4585. Nursing Interventions/Rationales
  4586. Nursing Diagnosis
  4587. Expected Outcomes
  4588. Nursing Interventions/Rationales
  4589. EMERGENCY
  4590. Hemorrhagic Shock
  4591. Intervention
  4592. Medical Management
  4593. Nursing Interventions
  4594. Fluid or Blood Replacement Therapy
  4595. LEGAL TIP
  4596. Standard of Care for Bleeding Emergencies
  4597. Coagulopathies
  4598. Idiopathic Thrombocytopenic Purpura
  4599. von Willebrand Disease
  4600. Thromboembolic Disease
  4601. Incidence and Etiology
  4602. Clinical Manifestations
  4603. FIG. 34-2 Deep venous thrombophlebitis.
  4604. Medical Management
  4605. Nursing Interventions
  4606. NURSING ALERT
  4607. Postpartum Infections
  4608. BOX 34-4 PREDISPOSING FACTORS FOR POSTPARTUM INFECTION
  4609. Preconception or Antepartal Factors
  4610. Intrapartal Factors
  4611. Endometritis
  4612. Wound Infections
  4613. Urinary Tract Infections
  4614. FIG. 34-3 Postpartum infection—​endometritis.
  4615. FIG. 34-4 Mastitis.
  4616. Mastitis
  4617. BOX 34-5 NURSING DIAGNOSES FOR WOMEN EXPERIENCING POSTPARTUM INFECTION
  4618. Deficient Knowledge related to:
  4619. Impaired Tissue Integrity related to:
  4620. Acute Pain related to:
  4621. Interrupted Family Processes related to:
  4622. Risk for Impaired Parenting related to:
  4623. Care Management
  4624. KEY POINTS
  4625. References
  4626. Unit Eight Newborn Complications
  4627. Interactive Review—Unit 8
  4628. Chapter 35 Acquired Problems of the Newborn
  4629. Learning Objectives
  4630. Birth Trauma
  4631. Soft-Tissue Injuries
  4632. TABLE 35-1 ANATOMIC CLASSIFICATION OF BIRTH INJURIES
  4633. FIG. 35-1 Marked bruising on the entire face of an infant born vaginally after face presentation. Less severe ecchymoses were present on the extremities. Phototherapy was required for treatment of jaundice resulting from the breakdown of accumulated blood.
  4634. FIG. 35-2 Swelling of the genitals and bruising of the buttocks after a breech birth. Note the position of the infant’s legs.
  4635. FIG. 35-3 Fractured clavicle after shoulder dystocia.
  4636. Skeletal Injuries
  4637. FIG. 35-4 Erb-Duchenne palsy in newborn infant. The Moro reflex was absent in right upper extremity. Recovery was complete.
  4638. Peripheral Nervous System Injuries
  4639. FIG. 35-5 Facial paralysis 15 minutes after forceps birth. Absence of movement on affected side is especially noticeable when infant cries.
  4640. Central Nervous System Injuries
  4641. Infants of Mothers With Diabetes
  4642. Pathophysiology
  4643. NURSING PROCESS
  4644. Birth Injury
  4645. Assessment
  4646. Nursing Diagnoses
  4647. Infant
  4648. Impaired Physical Mobility related to:
  4649. Impaired Gas Exchange related to:
  4650. Acute Pain related to:
  4651. Injury related to:
  4652. Parents and Family
  4653. Anxiety related to Deficient Knowledge Regarding:
  4654. Grieving related to:
  4655. Expected Outcomes of Care
  4656. Plan of Care and Interventions
  4657. Evaluation
  4658. Congenital Anomalies
  4659. FIG. 35-6 Macrosomia.
  4660. Macrosomia
  4661. Birth Trauma and Perinatal Hypoxia
  4662. Respiratory Distress Syndrome
  4663. Hypoglycemia
  4664. Hypocalcemia and Hypomagnesemia
  4665. Cardiomyopathy
  4666. Hyperbilirubinemia and Polycythemia
  4667. Nursing Care
  4668. TABLE 35-2 RISK FACTORS FOR NEONATAL SEPSIS
  4669. Neonatal Infections
  4670. Sepsis
  4671. NURSING CARE PLAN
  4672. The Infant of the Mother with Pregestational or Gestational Diabetes
  4673. Nursing Diagnosis
  4674. Expected Outcome
  4675. Nursing Interventions/Rationales
  4676. Nursing Diagnosis
  4677. Expected Outcome
  4678. Nursing Interventions/Rationales
  4679. Nursing Diagnosis
  4680. Nursing Diagnosis
  4681. Expected Outcome
  4682. Nursing Interventions/Rationales
  4683. Care Management
  4684. NURSING PROCESS
  4685. The Infant with Suspected Sepsis
  4686. Assessment
  4687. Nursing Diagnoses
  4688. Risk for Infection related to:
  4689. Ineffective Thermoregulation related to:
  4690. Impaired Tissue Integrity related to:
  4691. Acute Pain related to:
  4692. Parents and Family
  4693. Anxiety, Fear, or Grieving related to:
  4694. Risk for Impaired Parenting related to:
  4695. Expected Outcomes of Care
  4696. Newborn
  4697. Parents
  4698. Plan of Care and Interventions
  4699. Evaluation
  4700. TABLE 35-3 SIGNS OF SEPSIS∗
  4701. Preventive Measures
  4702. Curative Measures
  4703. NURSING ALERT
  4704. Transplacental Infections
  4705. Toxoplasmosis
  4706. BOX 35-1 TRANSPLACENTAL (TORCH) INFECTIONS AFFECTING NEWBORNS
  4707. Gonorrhea
  4708. Syphilis
  4709. FIG. 35-7 Neonatal syphilis lesions on hands and feet.
  4710. Medical Management
  4711. Prognosis
  4712. Varicella-Zoster
  4713. Hepatitis B Virus
  4714. NURSING ALERT
  4715. Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome
  4716. Rubella Infection
  4717. SAFETY ALERT
  4718. Cytomegalovirus Infection
  4719. FIG. 35-8 Neonatal cytomegalovirus infection. Typical rash seen in a severely affected infant.
  4720. Herpes Simplex Virus
  4721. FIG. 35-9 Neonatal herpes simplex virus oral lesions.
  4722. Parvovirus B19
  4723. Enterovirus
  4724. Bacterial Infections
  4725. Group B Streptococci
  4726. FIG. 35-10 Sample algorithm for management of a newborn whose mother received intrapartum antimicrobial agents for prevention (IAP) of early-onset group B streptococcal disease or suspected chorioamnionitis. This algorithm is not an exclusive course of management. Variations that incorporate individual circumstances or institutional preferences may be appropriate.
  4727. Escherichia coli
  4728. Staphylococcus aureus
  4729. Listeriosis
  4730. Chlamydia Trachomatis
  4731. Fungal Infections
  4732. Candidiasis
  4733. COMMUNITY ACTIVITY
  4734. Substance Abuse
  4735. TABLE 35-4 SUMMARY OF NEONATAL EFFECTS OF COMMONLY ABUSED SUBSTANCES
  4736. TABLE 35-5 SIGNS OF NEONATAL ABSTINENCE SYNDROME
  4737. Tobacco
  4738. Alcohol
  4739. FIG. 35-11 Critical periods in human embryogenesis. Infant with fetal alcohol syndrome.
  4740. BOX 35-2 DIAGNOSTIC CRITERIA FOR FETAL ALCOHOL SYNDROME AND ALCOHOL-RELATED EFFECTS
  4741. FIG. 35-12 Infant with fetal alcohol syndrome.
  4742. Heroin
  4743. NURSING ALERT
  4744. SAFETY ALERT
  4745. Methadone
  4746. Marijuana
  4747. Cocaine
  4748. BOX 35-3 FETAL AND NEONATAL EFFECTS OF MATERNAL COCAINE USE DURING PREGNANCY
  4749. Methamphetamine
  4750. MDMA/Ecstasy
  4751. Other Drugs of Concern
  4752. Caffeine
  4753. Selective Serotonin Reuptake Inhibitors
  4754. Care Management
  4755. Nursing Care
  4756. FIG. 35-13 Neonatal Abstinence Scoring System.
  4757. BOX 35-4 CARE OF THE INFANT EXPERIENCING WITHDRAWAL (NEONATAL ABSTINENCE SYNDROME)
  4758. NURSING CARE PLAN
  4759. The Infant Experiencing Drug Withdrawal (Neonatal Abstinence Syndrome)
  4760. Nursing Diagnosis
  4761. Expected Outcome
  4762. Nursing Interventions/Rationales
  4763. Nursing Diagnosis
  4764. Expected Outcome
  4765. Nursing Interventions/Rationales
  4766. Nursing Diagnosis
  4767. Expected Outcome
  4768. Nursing Interventions/Rationales
  4769. Nursing Diagnosis
  4770. Expected Outcomes
  4771. Nursing Interventions/Rationales
  4772. CLINICAL REASONING
  4773. Narcotic Exposure in a Newborn
  4774. KEY POINTS
  4775. References
  4776. Chapter 36 Hemolytic Disorders and Congenital Anomalies
  4777. Learning Objectives
  4778. Hyperbilirubinemia
  4779. Physiologic Jaundice
  4780. Pathologic Jaundice
  4781. BOX 36-1 MONITORING FOR JAUNDICE AFTER EARLY DISCHARGE
  4782. BOX 36-2 POTENTIAL CAUSES OF PATHOLOGIC HYPERBILIRUBINEMIA IN NEONATES
  4783. Maternal Factors
  4784. Fetal/Newborn Factors
  4785. Hemolytic Disease of the Newborn
  4786. Rh Incompatibility
  4787. ABO Incompatibility
  4788. Other Causes of Hemolytic Jaundice
  4789. Acute Bilirubin Encephalopathy
  4790. Care Management
  4791. BOX 36-3 INDICATIONS FOR AMOUNT OF RHO(D) IMMUNOGLOBULIN TO BE ADMINISTERED
  4792. 50 mcg
  4793. 300 mcg
  4794. More Than 300 mcg
  4795. NURSING CARE PLAN
  4796. The Infant with Hyperbilirubinemia
  4797. Nursing Diagnosis
  4798. Expected Outcomes
  4799. Nursing Interventions/Rationales
  4800. Nursing Diagnosis
  4801. Expected Outcomes
  4802. Nursing Interventions/Rationales
  4803. Nursing Diagnosis
  4804. Expected Outcomes
  4805. Nursing Interventions/Rationales
  4806. Nursing Diagnosis
  4807. Expected Outcome
  4808. Nursing Interventions/Rationales
  4809. Congenital Anomalies
  4810. Cardiovascular System Anomalies
  4811. TABLE 36-1 PHYSIOLOGIC CLASSIFICATION OF CARDIAC DEFECTS
  4812. FIG. 36-1 Congenital heart abnormalities.
  4813. Central Nervous System Anomalies
  4814. Encephalocele and Anencephaly
  4815. Spina Bifida
  4816. FIG. 36-2 A, Myelomeningocele. Note absence of vertebral arches. B, Myelomeningocele (spina bifida).
  4817. NURSING ALERT
  4818. Hydrocephalus
  4819. FIG. 36-3 Mother providing kangaroo care to preterm twins; the one on the right has hydrocephalus. The characteristic appearance is an enlarged head, thinning of the scalp, distended scalp veins, and a full fontanel.
  4820. Microcephaly
  4821. Respiratory System Anomalies
  4822. Laryngeal Web and Choanal Atresia
  4823. Congenital Diaphragmatic Hernia
  4824. FIG. 36-4 Choanal atresia. Posterior nares are obstructed by membrane or bone either bilaterally or unilaterally. Infant becomes cyanotic at rest. With crying, newborn’s color improves. Nasal discharge is present. Snorting respirations often are observed with increased respiratory effort. Newborn may be unable to breathe and eat at the same time. Diagnosis is made by noting inability to pass small feeding tube through one or both nares.
  4825. FIG. 36-5 A, Normal diaphragm separating the abdominal and thoracic cavities. B, Diaphragmatic hernia with a small lung and abdominal contents in the thoracic cavity.
  4826. Gastrointestinal System Anomalies
  4827. Cleft Lip and Palate
  4828. FIG. 36-6 Variations in clefts of lip and palate at birth. A, Notch in vermilion border. B, Unilateral cleft lip and cleft palate. C, Bilateral cleft lip and cleft palate. D, Cleft palate. E, Infant with complete unilateral cleft lip. Note the feeding tube.
  4829. Esophageal Atresia and Tracheoesophageal Fistula
  4830. FIG. 36-7 Aids in feeding infants with cleft lip and palate 1, Mead Johnson bottle and nipple for cleft palate. Cleft palate nipple system (2a) with valve (2b) to regulate flow. Haberman feeder (3a) with disk (3b) to control flow of milk. 4, Ross cleft palate assembly. Nipple can be trimmed to accommodate palate size.
  4831. NURSING ALERT
  4832. FIG. 36-8 Congenital atresia of esophagus and tracheoesophageal fistula. A, Upper and lower segments of esophagus end in blind sac, occurring in 5% to 8% of such infants. B, Upper segment of esophagus ends in atresia and connects to trachea by fistulous tract, occurring rarely. C, Upper segment of esophagus ends in blind pouch; lower segment connects with trachea by small fistulous tract, occurring in 80% to 95% of such infants. D, Both segments of esophagus connect by fistulous tracts to trachea, occurring in less than 1% of such infants. Infant may aspirate with first feeding. E, Esophagus is continuous but connects by fistulous tract to trachea; known as H-type.
  4833. Omphalocele and Gastroschisis
  4834. Gastrointestinal Obstruction
  4835. FIG. 36-9 A, Omphalocele. B, Gastroschisis of bowel and stomach.
  4836. Imperforate Anus
  4837. FIG. 36-10 Types of imperforate anus. Anal sphincter muscle may be present and intact. A, High lesion opening onto perineum through narrow fistulous tract. B, High lesion ending in fistulous tract to urinary tract. C, Low lesion in bowel passes through puborectal muscle. D, High lesion ending in fistulous tract to vagina.
  4838. FIG. 36-11 Imperforate anus.
  4839. Musculoskeletal System Anomalies
  4840. Developmental Dysplasia of the Hip
  4841. FIG. 36-12 Configuration and relationship of structures in developmental dysplasia of the hip.
  4842. NURSING ALERT
  4843. NURSING ALERT
  4844. CLINICAL REASONING
  4845. Developmental Dysplasia of the Hip (DDH)
  4846. Clubfoot
  4847. Polydactyly
  4848. Genitourinary System Anomalies
  4849. Hypospadias and Epispadias
  4850. FIG. 36-13 Classification of hypospadias by position of the urethral meatus.
  4851. FIG. 36-14 Hypospadias.
  4852. Exstrophy of the Bladder
  4853. FIG. 36-15 Exstrophy of bladder.
  4854. FIG. 36-16 Ambiguous external genitals (i.e., structure can be enlarged clitoral hood and clitoris or malformed penis).
  4855. Ambiguous Genitalia
  4856. Care Management
  4857. Prenatal Diagnosis
  4858. Perinatal Diagnosis
  4859. Postnatal Diagnosis
  4860. Genetic Diagnosis
  4861. Newborn Screening
  4862. FIG. 36-17 A, Clinical features of Down syndrome. B, Simian crease.
  4863. NURSING ALERT
  4864. Cytogenetic Studies
  4865. Dermatoglyphics
  4866. Newborn Care
  4867. NURSING PROCESS
  4868. The Newborn with a Congenital Anomaly
  4869. Assessment
  4870. Newborn
  4871. Parents
  4872. Nursing Diagnoses
  4873. Newborn
  4874. Risk for Injury related to
  4875. Risk for Infection related to
  4876. Impaired Gas Exchange related to
  4877. Imbalanced Nutrition: Less than Body Requirements related to
  4878. Delayed Growth and Development related to
  4879. Parents and Family
  4880. Grieving or Spiritual Distress related to
  4881. Compromised Family Coping related to
  4882. Deficient Knowledge related to
  4883. Anxiety related to
  4884. Risk for Impaired Parenting related to
  4885. Expected Outcomes of Care
  4886. Plan of Care and Interventions
  4887. Evaluation
  4888. Parents and Family Support
  4889. COMMUNITY ACTIVITY
  4890. KEY POINTS
  4891. References
  4892. Chapter 37 Nursing Care of the High Risk Newborn
  4893. Learning Objectives
  4894. Preterm Infants
  4895. BOX 37-1 CLASSIFICATION OF HIGH RISK INFANTS
  4896. Classification According to Size
  4897. Classification According to Gestational Age
  4898. Classification According to Mortality
  4899. Late Preterm Infants
  4900. Physiologic Functions
  4901. Respiratory Function
  4902. NURSING ALERT
  4903. Cardiovascular Function
  4904. Maintaining Body Temperature
  4905. BOX 37-2 SIGNS OF HYPOTHERMIA AND HYPERTHERMIA
  4906. Hypothermia
  4907. Hyperthermia
  4908. Central Nervous System Function
  4909. Maintaining Adequate Nutrition
  4910. Maintaining Renal Function
  4911. Maintaining Hematologic Status
  4912. Resisting Infection
  4913. Growth and Development Potential
  4914. BOX 37-3 SIGNS AND SYMPTOMS OF INFECTION
  4915. Care Management
  4916. NURSING PROCESS
  4917. Late Preterm and Preterm Infant Care
  4918. Assessment
  4919. Nursing Diagnoses
  4920. Ineffective Breathing Pattern related to:
  4921. Ineffective Thermoregulation related to:
  4922. Risk for Infection related to:
  4923. Anxiety (parental) related to:
  4924. Expected Outcomes of Care
  4925. Plan of Care and Interventions
  4926. Evaluation
  4927. NURSING CARE PLAN
  4928. The High Risk Preterm Newborn
  4929. Nursing Diagnosis
  4930. Expected Outcomes
  4931. Nursing Interventions/Rationales
  4932. Nursing Diagnosis
  4933. Expected Outcome
  4934. Nursing Interventions/Rationales
  4935. Nursing Diagnosis
  4936. Expected Outcome
  4937. Nursing Interventions/Rationales
  4938. Nursing Diagnosis
  4939. Expected Outcomes
  4940. Nursing Interventions/Rationales
  4941. Nursing Diagnosis
  4942. Expected Outcome
  4943. Nursing Interventions/Rationales
  4944. Nursing Diagnosis
  4945. Expected Outcome
  4946. Nursing Interventions/Rationales
  4947. Nursing Diagnosis
  4948. Expected Outcome
  4949. Nursing Interventions/Rationales
  4950. Nursing Diagnosis
  4951. Expected Outcomes
  4952. Nursing Interventions/Rationales
  4953. Nursing Diagnosis
  4954. Expected Outcomes
  4955. Nursing Interventions/Rationales
  4956. Physical Care
  4957. Maintaining Body Temperature
  4958. Care of the Hypothermic Infant
  4959. FIG. 37-1 Preterm infant in polyethylene bag to protect against heat loss.
  4960. Oxygen Therapy
  4961. NURSING ALERT
  4962. Hood Therapy
  4963. Nasal Cannula
  4964. FIG. 37-2 A, Infant under hood. B, Infant with nasal cannula.
  4965. Continuous Positive Airway Pressure Therapy
  4966. Mechanical Ventilation
  4967. FIG. 37-3 Infant receiving ventilatory assistance with nasal continuous positive airway pressure (CPAP).
  4968. FIG. 37-4 Infant intubated and on ventilator.
  4969. Neonatal Resuscitation
  4970. TABLE 37-1 COMMON METHODS FOR ASSISTED VENTILATION IN NEONATAL RESPIRATORY DISTRESSlowast;
  4971. NURSING ALERT
  4972. FIG. 37-5 Neonatal resuscitation flow algorithm.
  4973. Surfactant Administration
  4974. High-Frequency Ventilation.
  4975. Additional Therapies
  4976. Nitric Oxide Therapy.
  4977. Extracorporeal Membrane Oxygenation (ECMO).
  4978. MEDICATION GUIDE
  4979. Surfactant Replacement
  4980. Drug/Source
  4981. Action
  4982. Indications
  4983. Dosage and Route
  4984. Adverse Reactions
  4985. Nursing Considerations
  4986. Partial Liquid Ventilation (PLV).
  4987. Weaning from Respiratory Assistance.
  4988. Nutritional Care
  4989. Type of Nourishment
  4990. SAFETY ALERT
  4991. Weight and Fluid Loss or Gain
  4992. BOX 37-4 CALCULATION OF A WEIGHT LOSS OR GAIN
  4993. Example 1
  4994. Example 2
  4995. Elimination Patterns
  4996. Oral Feeding
  4997. Gavage Feeding
  4998. Gastrostomy Feedings
  4999. FIG. 37-6 Gavage feeding. A, Measurement of gavage feeding tube from tip of nose to earlobe and to midpoint between end of xiphoid process and umbilicus. Tape may be used to mark correct length on tube. For accurate measure, the infant should be facing up. B, Insertion of gavage tube using orogastric route. C, Indwelling gavage tube, nasogastric route. After feeding by orogastric or nasogastric tube, infant is propped on right side or placed prone (preterm infant) for 1 hour to facilitate emptying of stomach into small intestine.
  5000. PROCEDURE
  5001. Inserting a Gavage Feeding Tube
  5002. Parenteral Nutrition
  5003. Advancing Infant Feedings
  5004. FIG. 37-7 Nonnutritive sucking.
  5005. Nonnutritive Sucking
  5006. Skin Care
  5007. FIG. 37-8 Although necessary, neonatal intensive care unit equipment can contribute to significant environmental stimulation. Note bed, wall oxygen attachments, monitor, ventilator, incubator, and pumps, all of which have alarm systems.
  5008. Environmental Concerns
  5009. NURSING ALERT
  5010. Developmental Care
  5011. Positioning
  5012. FIG. 37-9 Developmental care: positioning of preterm infant using containment while undergoing phototherapy.
  5013. Reducing Inappropriate Stimuli
  5014. Infant Communication
  5015. Infant Stimulation
  5016. Kangaroo Care
  5017. FIG. 37-10 Father holding infant in kangaroo care
  5018. Parental Adaptation to Preterm Infant
  5019. Parental Tasks
  5020. Parental Responses
  5021. Parental Support
  5022. Fig. 37-11 A, Mother and father touch preterm infant. B, Mother caresses preterm infant.
  5023. Parental Maladaptation
  5024. FIG. 37-12 Sibling visits newborn in the neonatal intensive care unit. A, Father prepares older child for visit. B, Sibling observes neonate at a safe distance. C, He reaches out to touch the infant.
  5025. Parent Education
  5026. Complications in High Risk Infants
  5027. Respiratory Distress Syndrome
  5028. FIG. 37-13 Pathogenesis of respiratory distress syndrome (RDS).
  5029. TABLE 37-2 NORMAL ARTERIAL BLOOD GAS VALUES FOR NEONATES
  5030. NURSING ALERT
  5031. Complications Associated with Oxygen Therapy
  5032. Retinopathy of Prematurity
  5033. Bronchopulmonary Dysplasia
  5034. Patent Ductus Arteriosus
  5035. Germinal Matrix Hemorrhage–Intraventricular Hemorrhage
  5036. Necrotizing Enterocolitis
  5037. BOX 37-5 PROPOSED RISK FACTORS FOR NECROTIZING ENTEROCOLITIS
  5038. Infant Pain Responses
  5039. Pain Assessment
  5040. NURSING ALERT
  5041. BOX 37-6 MANIFESTATIONS OF ACUTE PAIN IN THE NEONATE
  5042. Physiologic Responses
  5043. Vital Signs
  5044. Oxygenation
  5045. Skin
  5046. Other Observations
  5047. Behavioral Responses
  5048. Vocalizations: Observe Quality, Timing, and Duration
  5049. Facial Expression
  5050. Body Movements and Posture
  5051. Change in State
  5052. Memory of Pain
  5053. Consequences of Untreated Pain in Infants
  5054. Pain Management
  5055. EVIDENCE-BASED PRACTICE
  5056. Non-Pharmacologic Pain Relief Measures for Newborns
  5057. Ask the Question
  5058. Search for Evidence
  5059. Search Strategies
  5060. Databases Searched
  5061. Critically Analyze the Data
  5062. Implications for Practice
  5063. References
  5064. TABLE 37-3 LATE PRETERM INFANT ASSESSMENT AND INTERVENTIONS
  5065. Late Preterm Infants
  5066. Respiratory Distress
  5067. Thermoregulation
  5068. Nutrition
  5069. Hypoglycemia
  5070. Hyperbilirubinemia
  5071. Infection
  5072. Postmature Infants
  5073. CLINICAL REASONING
  5074. The Late Preterm Infant
  5075. Meconium Aspiration Syndrome
  5076. FIG. 37-14 Infant being resuscitated at birth. Meconium was present on the abdomen, and umbilical cord. Infant was not breathing, and heart rate was 65 beats/min at birth. Respirations and heart rate were normal at 2 minutes.
  5077. Persistent Pulmonary Hypertension of the Newborn
  5078. Other Problems Related to Gestation
  5079. Small for Gestational Age and Intrauterine Growth Restriction
  5080. Perinatal Asphyxia.
  5081. Hypoglycemia
  5082. Hyperglycemia
  5083. Polycythemia
  5084. Heat Loss
  5085. Large for Gestational Age Infants
  5086. Discharge Planning
  5087. Transport to and from a Regional Center
  5088. FIG. 37-15 Total life support system for transport of high risk newborns
  5089. BOX 37-7 S.T.A.B.L.E. PROGRAM ON POST-RESUSCITATION AND POST-TRANSPORT STABILIZATION CARE OF SICK INFANTS
  5090. Anticipatory Grief
  5091. Loss of an Infant
  5092. COMMUNITY ACTIVITY
  5093. KEY POINTS
  5094. References
  5095. Chapter 38 Perinatal Loss and Grief
  5096. Learning Objectives
  5097. Perinatal Loss
  5098. Grief Responses
  5099. Acute Distress
  5100. BOX 38-1 CONCEPTUAL MODEL OF PARENTAL GRIEF
  5101. Phase of Acute Distress
  5102. Phase of Intense Grief
  5103. Reorganization
  5104. Intense Grief
  5105. Reorganization
  5106. Family Aspects of Grief
  5107. Grandparents and Siblings
  5108. Care Management
  5109. NURSING PROCESS
  5110. Perinatal Grief
  5111. Assessment
  5112. Nursing Diagnoses
  5113. Anxiety related to:
  5114. Ineffective Coping related to:
  5115. Powerlessness related to:
  5116. Interrupted Family Processes related to:
  5117. Ineffective Sexuality Pattern (between the mother and father) related to:
  5118. Fatigue and Disturbed Sleep Pattern related to:
  5119. Complicated Grieving related to:
  5120. Situational Low Self-esteem related to:
  5121. Spiritual Distress related to:
  5122. Expected Outcomes of Care
  5123. Plan of Care and Interventions
  5124. Evaluation
  5125. FIG. 38-1 Sample checklist for assisting parents experiencing miscarriage/ectopic pregnancy.
  5126. FIG. 38-2 Sample checklist for assisting parents experiencing stillbirth or newborn death.
  5127. Help the Mother, the Father, and Other Family Members Actualize the Loss
  5128. CLINICAL REASONING
  5129. The Bereaved Couple
  5130. NURSING ALERT
  5131. FIG. 38-3 Laura.
  5132. FIG. 38-4 Laura’s family members say a special good-bye.
  5133. FIG. 38-5 Door card for room of mother who has had a perinatal loss.
  5134. Help the Parents with Decision Making
  5135. LEGAL TIP
  5136. Laws Regarding Live Birth
  5137. Help the Bereaved Parents Acknowledge and Express Their Feelings
  5138. BOX 38-2 WHAT TO SAY AND WHAT NOT TO SAY TO BEREAVED PARENTS
  5139. What to Say
  5140. What not to Say
  5141. Normalize the Grief Process and Facilitate Positive Coping
  5142. Meet the Physical Needs of the Postpartum Bereaved Mother
  5143. Assist the Bereaved in Communicating with, Supporting, and Getting Support from Family
  5144. FIG. 38-6 A memory kit assembled at John C. Lincoln Hospital, Phoenix, AZ. Memory kits may include pictures of the infant, clothing, death certificate, footprints, identification bands, fetal monitor printout, and ultrasound picture.
  5145. Create Memories for Parents to Take Home
  5146. Communicate Using a Caring Framework
  5147. Be Concerned About Cultural and Spiritual Needs of Parents
  5148. Provide Sensitive Care At and After Discharge
  5149. FIG. 38-7 Burial cradle.
  5150. Provide Postmortem Care
  5151. Special Losses
  5152. Prenatal Diagnoses with Negative Outcome
  5153. NURSING CARE PLAN
  5154. Fetal Death: 24 Weeks of Gestation
  5155. Nursing Diagnosis
  5156. Expected Outcome
  5157. Nursing Interventions/Rationales
  5158. Nursing Diagnosis
  5159. Expected Outcomes
  5160. Nursing Interventions/Rationales
  5161. Nursing Diagnosis
  5162. Expected Outcome
  5163. Nursing Interventions/Rationales
  5164. Nursing Diagnosis
  5165. Expected Outcome
  5166. Nursing Interventions/Rationales
  5167. Loss of One in a Multiple Birth
  5168. Adolescent Grief
  5169. Complicated Grief
  5170. COMMUNITY ACTIVITY
  5171. KEY POINTS
  5172. References
  5173. Glossary
  5174. A
  5175. B
  5176. C
  5177. D
  5178. E
  5179. F
  5180. G
  5181. H
  5182. I
  5183. J
  5184. K
  5185. L
  5186. M
  5187. N
  5188. O
  5189. P
  5190. Q
  5191. R
  5192. S
  5193. T
  5194. U
  5195. V
  5196. W
  5197. X
  5198. Y
  5199. Z
  5200. Index
  5201. Index
  5202. A
  5203. B
  5204. C
  5205. D
  5206. E
  5207. F
  5208. G
  5209. H
  5210. I
  5211. J
  5212. K
  5213. L
  5214. M
  5215. N
  5216. O
  5217. P
  5218. Q
  5219. R
  5220. S
  5221. T
  5222. U
  5223. V
  5224. W
  5225. X
  5226. Y
  5227. Z

 

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