This is completed downloadable of Downloadable Test Bank for Maternity And Womens Health Care 10th Edition Lowdermilk
Product Details:
- 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:
- Unit One Introduction to Maternity & Women’s Health Care
- Interactive Review—Unit 1
- Chapter 1 21st Century Maternity and Women’s Health Nursing
- Learning Objectives
- BOX 1-1 HISTORIC OVERVIEW OF MILESTONES IN THE CARE OF MOTHERS AND INFANTS
- Contemporary Issues and Trends
- Healthy People 2020 Goals
- Millennium Development Goals
- BOX 1-2 HEALTHY PEOPLE 2020 PERINATAL PROPOSED OBJECTIVES
- Objectives Retained from Healthy People 2010
- Objectives Retained but Modified from Healthy People 2010
- Objectives New to Healthy People 2020
- BOX 1-3 UNITED NATIONS MILLENNIUM DEVELOPMENT GOALS
- Integrative Health Care
- FIG. 1-1 Healing touch with pregnant woman.
- Problems with the U.S. Health Care System
- Structure of the Health Care Delivery System
- BOX 1-4 NATIONAL QUALITY FORUM “NEVER EVENTS” PERTAINING TO MATERNAL AND CHILD HEALTH
- Reducing Medical Errors
- High Cost of Health Care
- BOX 1-5 SELECTED SAFE PRACTICES FOR BETTER HEALTH CARE
- Limited Access to Care
- Health Care Reform
- Efforts to Reduce Health Disparities
- Health Literacy
- Trends in Fertility and Birth Rate
- Low Birth Weight and Preterm Birth
- BOX 1-6 MATERNAL-INFANT BIOSTATISTICAL TERMINOLOGY
- Infant Mortality in the United States
- International Infant Mortality Trends
- Maternal Mortality Trends
- Increase in High Risk Pregnancies
- Regionalization of Perinatal Health Care Services
- High-Technology Care
- Community-Based Care
- Childbirth Practices
- CLINICAL REASONING
- Safety and Efficacy of Midwifery Care
- FIG. 1-2 Father “catching” newborn son. Mother is reaching down to help birth the baby.
- Involving Consumers and Promoting Self-Management
- International Concerns
- Health of Women
- Trends in Nursing Practice
- Nursing Interventions Classification
- Evidence-Based Practice
- Cochrane Pregnancy and Childbirth Database
- BOX 1-7 CHILDBEARING CARE INTERVENTIONS
- Level 1 Domain: Family
- Level 2 Class: Childbearing Care
- Level 3: Interventions
- EVIDENCE-BASED PRACTICE
- Searching for and Evaluating the Evidence
- Joanna Briggs Institute
- TABLE 1-1 NURSING OUTCOMES CLASSIFICATION
- Outcomes-Oriented Practice
- A Global Perspective
- Standards of Practice and Legal Issues in Delivery of Care
- FIG. 1-3 Nurse examining client on a medical mission in China.
- LEGAL TIP
- Standard of Care
- Risk Management
- BOX 1-8 STANDARDS OF CARE FOR WOMEN AND NEWBORNS
- Standards that Define the Nurse’s Responsibility to the Client
- Assessment
- Diagnosis
- Outcome Identification
- Planning
- Implementation
- Evaluation
- Standards of Professional Performance that Delineate Roles and Behaviors for Which the Professional Nurse is Accountable
- Quality of Care
- Performance Appraisal
- Education
- Collegiality
- Ethics
- Collaboration
- Research
- Resource Utilization
- Practice Environment
- Accountability
- Sentinel Events
- TABLE 1-2 THE JOINT COMMISSION “DO NOT USE” LIST
- Failure to Rescue
- Quality and Safety Education for Nurses
- Teamwork and Communication
- Situation, Background, Assessment, Recommendation
- TeamSTEPPS
- BOX 1-9 INSTITUTE OF MEDICINE COMPETENCIES FOR NURSING
- Ethical Issues in Perinatal Nursing and Women’s Health Care
- Research in Perinatal Nursing and Women’s Health Care
- BOX 1-10 SAMPLE SBAR REPORT TO PHYSICIAN OR MIDWIFE ABOUT A CRITICAL SITUATION
- Ethical Guidelines for Nursing Research
- KEY POINTS
- References
- Chapter 2 Community Care: The Family and Culture
- Learning Objectives
- Introduction to Family, Culture, Community, and Home Care
- COMMUNITY ACTIVITY
- The Family in Cultural and Community Context
- Defining Family
- FIG. 2-1 Nuclear family.
- Family Organization and Structure
- FIG. 2-2 Extended family.
- The Family in Society
- Theoretic Approaches to Understanding Families
- Family Nursing
- Family Assessment
- Family Theories
- NURSING CARE PLAN
- Incorporating the Infant into the Family
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- TABLE 2-1 THEORIES AND MODELS RELEVANT TO FAMILY NURSING PRACTICE
- Graphic Representations of Families
- The Family in a Cultural Context
- Cultural Factors Related to Family Health
- Implications for Nursing
- FIG. 2-3 The Friedman Family Assessment Model (short form).
- FIG. 2-4 Example of a family genogram.
- CLINICAL REASONING
- Providing Culturally Appropriate Care
- FIG. 2-5 Example of an ecomap. An ecomap describes social relationships and depicts available supports.
- Childbearing Beliefs and Practices
- BOX 2-1 WORKING WITH AN INTERPRETER
- Remember
- Personal Space
- Time Orientation
- Family Roles
- BOX 2-2 STRATEGIES FOR CARE DELIVERY AND PROVIDING CULTURALLY APPROPRIATE CARE
- Strategies for Care Delivery
- Providing Appropriate Care
- TABLE 2-2 TRADITIONAL∗ CULTURAL BELIEFS AND PRACTICES: CHILDBEARING AND PARENTING
- CULTURAL CONSIDERATIONS
- Questions to Ask to Elicit Cultural Expectations About Childbearing
- Developing Cultural Competence
- Community Health Promotion
- Levels of Preventive Care
- Promoting Family Health
- Assessing the Community
- Data Collection and Sources of Community Health Data
- FIG. 2-6 Community health assessment wheel.
- BOX 2-3 COMMUNITY WALK-THROUGH
- Vulnerable Populations in the Community
- Women
- Racial and Ethnic Minorities
- Adolescent Girls
- Older Women
- Incarcerated Women
- Refugee and Migrant Women
- Rural Versus Urban Community Settings
- Homeless Women
- Low Literacy
- Implications for Nursing
- Home Care in the Community
- Communication and Technology Applications
- FIG. 2-7 Perinatal continuum of care.
- Guidelines for Nursing Practice
- Perinatal Services
- Client Selection and Referral
- Care Management
- Preparing for the Home Visit
- First Home Care Visit
- Assessment and Nursing Diagnoses
- BOX 2-4 PROTOCOL FOR PERINATAL HOME VISITS
- Previsit Interventions
- In-Home Interventions: Establishing a Relationship
- In-Home Interventions: Working with the Family
- FIG. 2-8 Home care nurse visits with a woman in preterm labor at home on bed rest.
- In-Home Interventions: Ending the Visit
- Postvisit Interventions
- Nursing Considerations
- BOX 2-5 PSYCHOSOCIAL ASSESSMENT
- Language
- Community Resources/Access to Care
- Social Support
- Interpersonal Relationships
- Caregiver
- Stress and Coping
- Safety Issues for the Home Care Nurse
- NURSING CARE PLAN
- Community and Home Care
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Personal Safety
- Woman’s Home
- Infection Control
- SAFETY ALERT
- KEY POINTS
- References
- Chapter 3 Clinical Genetics
- Learning Objectives
- Nursing Expertise in Genetics and Genomics
- Essential Competencies in Genetics and Genomics for All Nurses
- Expanded Roles for Maternity and Women’s Health Nurses
- Human Genome Project and Implications for Clinical Practice
- Importance of Family History
- Gene Identification and Testing
- Pharmacogenomics
- Gene Therapy
- Ethical, Legal, and Social Implications
- Factors Influencing the Decision to Undergo Genetic Testing
- Clinical Genetics
- Genetic Transmission
- Genes and Chromosomes
- FIG. 3-1 Chromosomes during cell division. A, Example of photomicrograph. B, Chromosomes arranged in karyotype; female and male sex-determining chromosomes.
- Chromosomal Abnormalities
- Autosomal Abnormalities
- Abnormalities of Chromosome Number
- FIG. 3-2 Infant with Down syndrome. Note upward slant to eyes, flat nasal bridge, slightly protruding tongue, and mottled skin.
- NURSING CARE PLAN
- The Family Living with a Child with Down Syndrome
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Abnormalities of Chromosome Structure
- Sex Chromosome Abnormalities
- Patterns of Genetic Transmission
- Multifactorial Inheritance
- Unifactorial Inheritance
- Autosomal Dominant Inheritance
- 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.
- Autosomal Recessive Inheritance
- Inborn Errors of Metabolism
- X-linked Dominant Inheritance
- X-linked Recessive Inheritance
- Cancer Genomics
- Gene Mutations That Can Lead to Cancer
- Hereditary Breast and Ovarian Cancer
- Colon Cancer
- Genetic Counseling
- Definition of Genetic Counseling
- Access and Referral to Genetic Counseling
- Estimation of Risk
- Interpretation of Risk
- Multiple Roles for Nurses in Genetics
- CLINICAL REASONING
- Counseling About Genetic Risk
- Future Promise of Genetics
- COMMUNITY ACTIVITY
- KEY POINTS
- References
- Unit Two Women’s Health
- Interactive Review—Unit 2
- Chapter 4 Assessment and Health Promotion
- Learning Objectives
- Female Reproductive System
- FIG. 4-1 External female genitalia.
- External Structures
- Internal Structures
- FIG. 4-2 Midsagittal view of female pelvic organs with woman lying supine.
- FIG. 4-3 Schematic arrangement of directions of muscle fibers. Note that uterine muscle fibers are continuous with supportive ligaments of uterus.
- FIG. 4-4 Adult female pelvis. A, Anterior view. B, External view of innominate bone (fused).
- The Bony Pelvis
- FIG. 4-5 Female pelvis. A, Cavity of false pelvis is shallow. B, Cavity of true pelvis is an irregularly curved canal (arrows).
- Breasts
- FIG. 4-6 Anatomy of the breast, showing position and major structures.
- TEACHING FOR SELF-MANAGEMENT
- Breast Self-Examination
- EVIDENCE-BASED PRACTICE
- Teaching Women Breast Self-Examination: Is It Worthwhile?
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- TABLE 4-1 FEMALE REPRODUCTIVE PHYSICAL ASSESSMENT ACROSS THE LIFE CYCLE
- Menstruation And Menopause
- Menarche and Puberty
- Menstrual Cycle
- Hypothalamic-Pituitary Cycle
- Ovarian Cycle
- Endometrial Cycle
- FIG. 4-7 Menstrual cycle: hypothalamic-pituitary, ovarian, and endometrial.
- Other Cyclic Changes
- Prostaglandins
- Climacteric and Menopause
- Sexual Response
- Reasons for Entering the Health Care System
- TABLE 4-2 FOUR PHASES OF SEXUAL RESPONSE
- Preconception Counseling and Care
- BOX 4-1 COMPONENTS OF PRECONCEPTION CARE
- Health Promotion: General Teaching
- Risk Factor Assessment
- Interventions
- Pregnancy
- Well-Woman Care
- BOX 4-2 MAJOR GOALS OF PRENATAL CARE
- Fertility Control and Infertility
- BOX 4-3 CONTRACEPTIVE HEALTH PROMOTION
- Menstrual Problems
- Perimenopause
- Barriers to Seeking Health Care
- Financial Issues
- Cultural Issues
- Gender Issues
- CULTURAL CONSIDERATIONS
- Female Genital Mutilation
- Health Risks in the Childbearing Years
- Age
- Adolescence
- Teenage Pregnancy
- Young and Middle Adulthood
- Parenthood After Age 35
- Late Reproductive Age
- Socioeconomic Status
- Substance Use and Abuse
- Smoking
- COMMUNITY ACTIVITY
- Alcohol
- Prescription Drugs
- Illicit Drugs
- Nutrition
- Nutritional Deficiencies
- Obesity
- Other Considerations
- Anorexia Nervosa
- BOX 4-4 SCREENING FOR EATING DISORDERS
- Scoff Questions
- Bulimia Nervosa
- Binge Eating Disorder
- Physical Fitness and Exercise
- SAFETY ALERT
- Stress
- BOX 4-5 STRESS SYMPTOMS
- Physical
- Behavior
- Psychologic
- Sexual Practices
- NURSING ALERT
- Medical Conditions
- Gynecologic Conditions
- BOX 4-6 TOP 10 LEADING CAUSES OF DEATH IN WOMEN IN THE UNITED STATES
- Environmental and Workplace Hazards
- Violence Against Women
- Health Assessment
- FIG. 4-8 Nurse interviews woman as part of history taking prior to physical examination.
- Interview
- CULTURAL CONSIDERATIONS
- Communication Variations
- Cultural Considerations
- Women with Special Needs
- Women with Disabilities
- Abused Women
- FIG. 4-9 Lithotomy and variable positions for women who have a disability.
- FIG. 4-10 Abuse assessment screen.
- Adolescents (Ages 13 to 19 Years)
- Midlife and Older Women (Ages 50 Years and Older)
- BOX 4-7 SPIRITUAL WELLNESS SELF-ASSESSMENT
- Healthy Aging
- History
- Physical Examination
- BOX 4-8 HEALTH HISTORY AND REVIEW OF SYSTEMS
- Pelvic Examination
- FIG. 4-11 External examination. Separation of the labia.
- External Inspection
- External Palpation
- Vulvar Self-Examination
- Internal Examination
- 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.
- PROCEDURE
- Assisting with Pelvic Examination
- Collection of Specimens
- Papanicolaou (Pap) Test
- Vaginal Examination
- Bimanual Palpation
- Rectovaginal Palpation
- Pelvic Examination During Pregnancy
- PROCEDURE
- Papanicolaou Test
- A, Collecting cells from endocervix using a Cytobrush. B, Obtaining cells from the transformation zone using a wooden spatula.
- FIG. 4-13 Bimanual palpation of the uterus.
- Pelvic Examination After Hysterectomy
- Laboratory and Diagnostic Procedures
- Anticipatory Guidance for Health Promotion and Illness Prevention
- FIG. 4-14 Rectovaginal examination.
- Nutrition
- TABLE 4-3 HEALTH SCREENING GUIDELINES AND IMMUNIZATION RECOMMENDATIONS FOR WOMEN AGES 18 YEARS AND OLDER
- CLINICAL REASONING
- Cardiovascular Disease—the Leading Cause of Death in Women
- 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.
- Exercise
- Kegel Exercises
- TEACHING FOR SELF-MANAGEMENT
- Kegel Exercises
- Description and Rationale
- Technique
- Specific Instructions
- Other Suggestions for Implementation
- Stress Management
- Substance Use Cessation
- Sexual Practices That Reduce Risk
- Health Screening Schedule
- BOX 4-9 INTERVENTIONS FOR SMOKING CESSATION: THE FIVE A’S
- Ask
- Assess
- Advise
- Assist
- ARrange Follow-Up
- Health Risk Prevention
- Health Protection
- KEY POINTS
- Female External Genitalia (read text)
- Female Reproductive Ducts (read text)
- Ovaries (read text)
- Ovulation (read text)
- Breasts (read text)
- Menstrual Cycle: Uterine (read text)
- Ovarian Cycle (read text)
- References
- Chapter 5 Violence Against Women
- Learning Objectives
- CLINICAL REASONING
- Intimate Partner Violence
- Historical Perspective
- Conceptual and Theoretic Perspectives
- Biologic Factors
- Psychologic Perspective
- BOX 5-1 CHARACTERISTICS OF A POTENTIAL MALE BATTERER
- Sociologic Perspective
- Feminist Perspective
- FIG. 5-1 Model of how power and control issues perpetuate battering.
- Ecological Model
- FIG. 5-2 Ecological framework for intimate partner violence.
- Women Experiencing Intimate Partner Violence
- Characteristics of Women in Abusive Relationships
- TABLE 5-1 COMPARISON OF CHARACTERISTICS OF POSTTRAUMATIC STRESS SYNDROME, BATTERED WOMAN SYNDROME, AND RAPE-TRAUMA SYNDROME
- Cultural Considerations
- TABLE 5-2 MYTHS AND FACTS ABOUT INTIMATE PARTNER VIOLENCE
- African-American Culture
- Hispanic (and Latino) Cultures
- Native American Culture
- Asian Women
- Intimate Partner Violence During Pregnancy
- Care Management
- LEGAL TIP
- Mandatory Reporting of Domestic Violence
- EVIDENCE-BASED PRACTICE
- Interventions for Intimate Partner Violence
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- Nursing Interventions
- NURSING PROCESS
- Intimate Partner Violence
- Assessment
- Nursing Diagnoses
- Hopelessness related to
- Powerlessness related to
- Fear related to
- Risk for Post-trauma Syndrome related to
- Social Isolation related to
- Ineffective Family Coping related to
- Injury related to
- Situational Low Self-esteem related to
- Deficient Knowledge related to
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- BOX 5-2 DOCUMENTING ABUSE
- NURSING CARE PLAN
- The Woman Experiencing Intimate Partner Violence
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- FIG. 5-3 Danger assessment tool.
- Prevention
- Sexual Violence
- Why Do Some Men Rape?
- Mental Health Consequences of Sexual Assault
- Rape-Trauma
- Acute Phase: Disorganization
- Outward Adjustment Phase
- Long-Term Process: Reorganization Phase
- Collaborative Care
- Psychologic First Aid
- BOX 5-3 ADULT SEXUAL ASSAULT PROTOCOL: EMERGENCY DEPARTMENT
- Purpose
- Assessment
- Safety
- Care
- Client/Significant Other (SO) Teaching
- Documentation
- The Sexual Assault Examination
- LEGAL TIP
- Collector of Evidence
- History
- LEGAL TIP
- Documentation
- Physical Examination and Laboratory Tests
- Immediate Care
- BOX 5-4 NURSING DIAGNOSES FOR THE RAPE VICTIM DURING THE IMMEDIATE AND LATER POSTTRAUMA PERIODS
- Immediate Posttrauma Period
- Later Posttrauma Period
- Discharge
- After Discharge
- COMMUNITY ACTIVITY
- KEY POINTS
- References
- Chapter 6 Reproductive System Concerns
- Learning Objectives
- Common Menstrual Disorders
- Amenorrhea
- Management
- Cyclic Perimenstrual Pain and Discomfort
- Dysmenorrhea
- Primary Dysmenorrhea
- Management
- CLINICAL REASONING
- Relief for Menstrual Discomfort
- NURSING ALERT
- TABLE 6-1 NONSTEROIDAL ANTIINFLAMMATORY AGENTS USED TO TREAT DYSMENORRHEA
- NURSING ALERT
- Secondary Dysmenorrhea
- Premenstrual Syndrome and Premenstrual Dysphoric Disorder
- TABLE 6-2 HERBAL THERAPIES FOR MENSTRUAL DISORDERS
- Management
- NURSING CARE PLAN
- Premenstrual Syndrome
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Endometriosis
- FIG. 6-1 Common sites of endometriosis.
- Management
- Alterations in Cyclic Bleeding
- NURSING CARE PLAN
- Endometriosis
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Oligomenorrhea/Hypomenorrhea
- Metrorrhagia
- EVIDENCE-BASED PRACTICE
- Heavy Menstrual Bleeding: Treatments to Improve Quality of Life
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- TABLE 6-3 CAUSES OF INTERMENSTRUAL BLEEDING
- Menorrhagia
- NURSING ALERT
- Dysfunctional Uterine Bleeding
- BOX 6-1 POSSIBLE CAUSES OF ABNORMAL UTERINE BLEEDING
- Anovulation
- Pregnancy-Related Conditions
- Lower Reproductive Tract Infections
- Neoplasms
- Trauma
- Systemic Diseases
- Iatrogenic Causes
- Care Management
- Menopause
- NURSING PROCESS
- Menstrual Disorders
- Assessment
- Nursing Diagnoses
- Risk for Ineffective Individual Coping related to:
- Deficient Knowledge related to:
- Risk for Disturbed Body Image related to:
- Risk for Situational Low Self-Esteem related to:
- Acute or Chronic Pain related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- Physiologic Characteristics
- Physical Changes During the Perimenopausal Period
- Bleeding
- Genital Changes
- Vasomotor Instability
- Mood and Behavioral Responses
- Health Risks of Perimenopausal Women
- Osteoporosis
- 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.
- COMMUNITY ACTIVITY
- Coronary Heart Disease
- Menopausal Hormonal Therapy
- Decision to Use Hormone Therapy
- Side Effects
- Treatment Guidelines
- TABLE 6-4 HORMONE MEDICATIONS FOR MENOPAUSAL SYMPTOMS
- Bioidentical and Custom-Compounded Hormones
- Alternative Therapies
- SAFETY ALERT
- TEACHING FOR SELF-MANAGEMENT
- Comfort Measures for Menopausal Symptoms
- Hot Flashes/Flushes
- During the Day
- At Night
- Insomnia
- Headaches
- Urogenital Symptoms
- Nervousness, Irritability
- Care Management
- Sexual Counseling
- NURSING PROCESS
- The Perimenopausal Woman
- Assessment
- Nursing Diagnoses
- Deficient Knowledge related to:
- Readiness for Enhanced Family Coping related to:
- Risk for Injury related to:
- Sexual Dysfunction related to:
- Risk for Situational Low Self-Esteem related to:
- Expected Outcomes of Care
- Pland of Care and Interventions
- Evaluation
- Nutrition
- Exercise
- Medications for Osteoporosis
- 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.
- BOX 6-2 PREVENTION OF OSTEOPOROSIS
- NURSING ALERT
- Midlife Support Groups
- FIG. 6-4 Midlife women can develop a supportive network.
- KEY POINTS
- References
- Chapter 7 Sexually Transmitted and Other Infections
- Learning Objectives
- Prevention
- BOX 7-1 SEXUALLY TRANSMITTED INFECTIONS
- Bacteria
- Viruses
- Protozoa
- Parasites
- BOX 7-2 ASSESSING STI AND HIV RISK BEHAVIORS
- Sexual Risk
- Drug Use—Related Risk
- Blood-Related Risks
- Other
- Risk Reduction Measures
- TABLE 7-1 RISK-REDUCTION PRACTICES
- Sexually Transmitted Bacterial Infections
- Chlamydia
- Screening and Diagnosis
- CLINICAL REASONING
- STI Counseling in Pregnancy
- Management
- Gonorrhea
- Screening and Diagnosis
- Management
- TABLE 7-2 SEXUALLY TRANSMITTED INFECTIONS AND DRUG THERAPIES FOR WOMEN∗
- LEGAL TIP
- Reporting Communicable Diseases
- Syphilis
- FIG. 7-1 Syphilis. A, Primary stage: chancre with inguinal adenopathy. B, Secondary stage: condylomata lata.
- Screening and Diagnosis
- Management
- NURSING ALERT
- Pelvic Inflammatory Disease
- Screening and Diagnosis
- Management
- TABLE 7-3 TREATMENT OF PELVIC INFLAMMATORY DISEASE
- Sexually Transmitted Viral Infections
- Human Papillomavirus
- FIG. 7-2 Human papillomavirus infection. Genital warts or condylomata acuminata.
- Screening and Diagnosis
- Management
- Prevention
- Genital Herpes Simplex Virus
- Screening and Diagnosis
- FIG. 7-3 Herpes genitalis.
- Management
- Viral Hepatitis
- Hepatitis A
- Hepatitis B
- Screening and Diagnosis
- Management
- Hepatitis C
- Human Immunodeficiency Virus
- Screening and Diagnosis
- Counseling for HIV Testing
- NURSING ALERT
- LEGAL TIP
- HIV Testing
- Management
- HIV and Pregnancy
- EVIDENCE-BASED PRACTICE
- Venus and Mars and HIV/STD Prevention Interventions
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- COMMUNITY ACTIVITY
- Vaginal Infections
- Bacterial Vaginosis
- Screening and Diagnosis
- TABLE 7-4 WET SMEAR TESTS FOR VAGINAL INFECTIONS
- Management
- Candidiasis
- TABLE 7-5 VAGINAL INFECTIONS AND DRUG THERAPIES FOR WOMEN
- Screening and Diagnosis
- Management
- TEACHING FOR SELF-MANAGEMENT
- Prevention of Genital Tract Infections
- Trichomoniasis
- Screening and Diagnosis
- Management
- Group B Streptococci
- Effects of Sexually Transmitted Infections on Pregnancy and the Fetus
- TORCH Infections
- TABLE 7-6 PREGNANCY AND FETAL EFFECTS OF COMMON SEXUALLY TRANSMITTED INFECTIONS
- Toxoplasmosis
- TABLE 7-7 TORCH INFECTION: MATERNAL AND FETAL
- Other Infections
- Rubella
- Cytomegalovirus
- NURSING ALERT
- Herpes Simplex Virus
- Care Management
- TEACHING FOR SELF-MANAGEMENT
- Sexually Transmitted Infections
- NURSING PROCESS
- The Woman with a Sexually Transmitted Infection
- Assessment
- Nursing Diagnoses
- Anxiety/Situational Low Self-Esteem/Disturbed Body Image related to:
- Deficient Knowledge related to:
- Acute Pain/Impaired Tissue Integrity related to:
- Sexual Dysfunction related to:
- Social Isolation and Impaired Social Interaction related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- LEGAL TIP
- STI Reporting
- Infection Control
- BOX 7-3 STANDARD PRECAUTIONS
- KEY POINTS
- Pelvic Inflammatory Disease (read text)
- References
- Chapter 8 Contraception and Abortion
- Learning Objectives
- Contraception
- Care Management
- NURSING PROCESS
- Contraception
- Assessment
- Nursing Diagnoses
- Decisional Conflict related to:
- Fear related to:
- Risk for Infection related to:
- Ineffective Sexuality Patterns related to:
- Acute Pain related to:
- Risk for Spiritual Distress related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- LEGAL TIP
- Informed Consent
- NURSING ALERT
- Methods of Contraception
- FIG. 8-1 Nurse counseling woman about contraceptive methods.
- BOX 8-1 FACTORS AFFECTING METHOD CONTRACEPTIVE EFFECTIVENESS
- Coitus Interruptus
- Fertility Awareness Methods (Natural Family Planning)
- NURSING CARE PLAN
- Sexual Activity and Contraception
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Calendar-Based Methods
- Calendar Rhythm Method
- 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.
- BOX 8-2 POTENTIAL PITFALLS OF USING FERTILITY AWARENESS METHODS OF CONTRACEPTION
- Standard Days Method
- TEACHING FOR SELF-MANAGEMENT
- Cervical Mucus Characteristics
- Setting the Stage
- Content Related to Cervical Mucus
- Assessment Technique
- Symptoms-Based Methods
- TwoDay Method
- Ovulation Method
- 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.
- Basal Body Temperature Method
- Symptothermal Method
- Biologic Marker Methods
- Home Predictor Test Kits for Ovulation
- FIG. 8-4 Example of a completed symptothermal chart.
- FIG. 8-5 Examples of ovulation prediction tests.
- The Marquette Model
- Spermicides and Barrier Methods
- Spermicides
- Condoms
- FIG. 8-6 Spermicides.
- NURSING ALERT
- FIG. 8-7 A, Mechanical barriers. From the top left corner, clockwise: female condom, male condom, cervical cap, diaphragm. B, Contraceptive sponge.
- BOX 8-3 MALE CONDOMS
- Mechanism of Action
- Failure Rate
- Advantages
- Disadvantages
- STI Protection
- Nursing Considerations
- Diaphragms
- TEACHING FOR SELF-MANAGEMENT
- Use and Care of the Diaphragm
- Inspection of the Diaphragm
- Preparation of the Diaphragm
- Positions for Insertion of the Diaphragm
- Insertion of the Diaphragm
- General Information
- Removal of the Diaphragm
- Care of the Diaphragm
- NURSING ALERT
- Cervical Caps
- TEACHING FOR SELF-MANAGEMENT
- Insertion and Removal of the Cervical Cap
- TABLE 8-1 HORMONAL CONTRACEPTION
- Contraceptive Sponge
- Hormonal Methods
- Combined Estrogen-Progestin Contraceptives
- Oral Contraceptives
- Advantages
- Disadvantages and Side Effects
- NURSING ALERT
- Nursing Considerations
- Oral Contraceptive 91-Day Regimen
- FIG. 8-8 Flowchart for missed active contraceptive pills, 2010.
- SIGNS OF POTENTIAL COMPLICATIONS
- Oral Contraceptives
- Transdermal Contraceptive System
- FIG. 8-9 Hormonal contraceptive transdermal patch and vaginal ring.
- Vaginal Contraceptive Ring
- Progestin-Only Contraceptives
- Oral Progestins (Minipill)
- Injectable Progestins
- CLINICAL REASONING
- Vaginal Bleeding on Depo-Provera
- NURSING ALERT
- Implantable Progestins
- NURSING ALERT
- Emergency Contraception
- TABLE 8-2 ORAL EMERGENCY CONTRACEPTIVES
- NURSING ALERT
- FIG. 8-10 Intrauterine devices (IUDs). A, Copper T 380A. B, Levonorgestrel-releasing IUD.
- Intrauterine Devices
- EVIDENCE-BASED PRACTICE
- An Ideal Solution: The Intrauterine Device
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- Nursing Considerations
- Sterilization
- SIGNS OF POTENTIAL COMPLICATIONS
- Intrauterine Devices (IUDs)
- FIG. 8-11 Sterilization. A, Uterine tubes severed and ligated (tubal ligation). B, Sperm duct severed and ligated (vasectomy).
- Female Sterilization
- Tubal Occlusion
- FIG. 8-12 Use of minilaparotomy to gain access to uterine tubes for occlusion procedures. Tenaculum is used to lift uterus (arrow) toward incision.
- TEACHING FOR SELF-MANAGEMENT
- What to Expect After Tubal Ligation
- Transcervical Sterilization
- Tubal Reconstruction
- Male Sterilization
- Tubal Reconstruction
- Laws and Regulations
- LEGAL TIP
- Sterilization
- Nursing Considerations
- Breastfeeding: Lactational Amenorrhea Method
- Future Trends
- Induced Abortion
- LEGAL TIP
- Induced Abortion
- Incidence
- The Decision to Have an Abortion
- LEGAL TIP
- Institutional Policies for Nurses’ Rights and Responsibilities Related to Abortion
- Care Management
- BOX 8-4 SELECTED NURSING DIAGNOSES FOR WOMEN HAVING ELECTIVE ABORTION
- CLINICAL REASONING
- Abortion
- First-Trimester Abortion
- Aspiration
- SAFETY ALERT
- Medical Abortion
- Methotrexate and Misoprostol
- Mifepristone and Misoprostol
- Second-Trimester Abortion
- Dilation and Evacuation
- Nursing Considerations
- COMMUNITY ACTIVITY
- KEY POINTS
- References
- Chapter 9 Infertility
- Learning Objectives
- Incidence
- CLINICAL REASONING
- Infertility Counseling
- Factors Associated with Infertility
- Female Infertility
- Congenital or Developmental Factors
- Hormonal and Ovulatory Factors
- BOX 9-1 FACTORS AFFECTING FEMALE FERTILITY
- Ovarian Factors
- Uterine, Tubal, and Peritoneal Factors
- Other Factors
- BOX 9-2 FACTORS AFFECTING MALE FERTILITY
- Structural or Hormonal Disorders
- Other Factors
- Age-Related Infertility
- Tubal/Peritoneal Factors
- EVIDENCE-BASED PRACTICE
- Endometriosis Treatments for Infertility
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- 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.
- Uterine Factors
- Vaginal-Cervical Factors
- Male Infertility
- Care Management
- BOX 9-3 RELIGIOUS AND CULTURAL CONSIDERATIONS OF FERTILITY
- Religious Considerations
- Cultural Considerations
- Assessment of Female Infertility
- Diagnostic Tests for Female Infertility
- BOX 9-4 INSURANCE COVERAGE FOR INFERTILITY
- Detection of Ovulation
- NURSING PROCESS
- Infertility
- Assessment
- Assessment of female infertility
- Assessment of male infertility
- Nursing Diagnoses
- Anxiety related to
- Disturbed Body Image or Situational Low Self-esteem related to
- Risk for Ineffective Individual Coping related to
- Interrupted Family Processes related to
- Acute Pain related to
- Ineffective Sexuality Patterns related to
- Deficient Knowledge related to
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- TABLE 9-1 Tests for Impaired Fertility Revised
- BOX 9-5 SUMMARY OF FINDINGS FAVORABLE TO FERTILITY
- Hormone Analysis
- Ultrasonography
- Hysterosalpingography
- FIG. 9-2 Vaginal ultrasonography. Major scanning planes of transducer. H, Horizontal; V, vertical.
- FIG. 9-3 Hysterosalpingography. Note that contrast medium flows through intrauterine cannula and out through the uterine tubes.
- Hysteroscopy
- Timed Endometrial Biopsy
- Laparoscopy
- FIG. 9-4 Laparoscopy.
- BOX 9-6 SEMEN ANALYSIS
- Assessment of Male Infertility
- Semen Analysis
- Ultrasonography
- Assessment of the Couple
- Postcoital Test
- Interventions
- Psychosocial
- NURSING CARE PLAN
- Infertility
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- TABLE 9-2 Nursing Actions in Response to Behavior Associated with Impaired Fertility
- Nonmedical
- Herbal Alternative Measures
- Medical
- MEDICATION GUIDE
- Infertility Medications
- Surgical
- BOX 9-7 ISSUES TO BE ADDRESSED BY INFERTILE COUPLES BEFORE TREATMENT
- Assisted Reproductive Therapies
- In Vitro Fertilization–Embryo Transfer
- TABLE 9-3 Assisted Reproductive Therapies
- LEGAL TIP
- Cryopreservation of Human Embryos
- Gamete Intrafallopian Transfer
- 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.
- Zygote Intrafallopian Transfer
- Complications
- Oocyte Donation
- Embryo Donation
- Surrogate Mothers/Embryo Hosts
- Therapeutic Donor Insemination
- Adoption
- COMMUNITY ACTIVITY
- KEY POINTS
- References
- Chapter 10 Problems of the Breast
- Learning Objectives
- Benign Conditions of the Breast
- Fibrocystic Changes
- Etiology
- Clinical Manifestations and Diagnosis
- Therapeutic Management
- Fibroadenomas
- Nipple Discharge
- Mammary Duct Ectasia
- Intraductal Papilloma
- Macromastia and Micromastia
- Collaborative Care
- TABLE 10-1 COMPARISON OF COMMON MANIFESTATIONS OF BENIGN BREAST MASSES
- Malignant Conditions of the Breast
- Incidence
- Etiologic Factors
- FIG. 10-1 Female breast cancer incidence and mortality rates by race and ethnicity, U.S. 2002-2006
- Determining a Woman’s Risk of Genetically Related Breast Cancer
- EVIDENCE-BASED PRACTICE
- Genetic Risk Assessment for Breast Cancer
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- Chemoprevention
- Pathophysiology
- BOX 10-1 RISK FACTORS INCLUDED IN THE BREAST CANCER RISK ASSESSMENT TOOL
- Clinical Manifestations and Diagnosis
- TABLE 10-2 STAGING FOR BREAST CANCER∗
- FIG. 10-2 Relative location of malignant lesions of the breast.
- FIG. 10-3 Mammography.
- CULTURAL CONSIDERATIONS
- Breast Screening Practices
- TABLE 10-3 SCREENING GUIDELINES FOR EARLY BREAST CANCER DETECTION
- BOX 10-2 SCREENING FOR BREAST CANCER
- FIG. 10-4 Diagnosis. A, Needle aspiration. B, Open biopsy.
- Prognosis
- FIG. 10-5 Lymphatic spread of breast cancer.
- Care Management
- BOX 10-3 DECISION-MAKING QUESTIONS TO ASK
- CLINICAL REASONING
- Breast Cancer Treatment Options
- Surgery
- FIG. 10-6 Surgical alternatives for breast cancer. A, Lumpectomy. B, Partial mastectomy. C, Total (simple) mastectomy. D, Radical mastectomy.
- Breast Reconstruction
- TABLE 10-4 RECONSTRUCTIVE BREAST SURGERY OPTIONS
- Radiation
- Adjuvant Systemic Therapy
- Hormonal therapy
- MEDICATION GUIDE
- Tamoxifen (Nolvadex)
- Action
- Indication
- Dosage and Route
- Adverse Reactions
- Nursing Considerations
- Chemotherapy
- MEDICATION GUIDE
- Raloxifene Hydrochloride (Evista)
- Action
- Indications
- Dosage
- Adverse Reactions
- Nursing Considerations
- MEDICATION GUIDE
- Letrozole (Femara)
- Action
- Indication
- Dosage and Route
- Adverse Reactions
- Nursing Considerations
- BOX 10-4 COMMON CHEMOTHERAPY REGIMENS FOR ADJUVANT TREATMENT OF BREAST CANCER
- Care Management
- Nursing Considerations
- Emotional Support After Diagnosis
- Preoperative Care
- Immediate Postoperative Care
- NURSING PROCESS
- The Woman with Breast Cancer
- Assessment
- Nursing Diagnoses
- Fear/Anxiety related to:
- Decisional Conflict related to:
- Sexual Dysfunction related to:
- Compromised/Disabled Family Coping related to:
- Anticipatory Grieving related to:
- Fatigue related to:
- Acute Pain related to:
- Impaired Skin Integrity related to:
- Disturbed Body Image related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- NURSING ALERT
- NURSING CARE PLAN
- The Woman Having Breast-Conserving Surgery and Axillary Node Dissection
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- BOX 10-5 ARM EXERCISES AFTER LYMPH NODE DISSECTION
- Exercises After Breast Surgery
- Exercises in Lying Position
- Wand Exercise
- Elbow Winging
- Exercises in Sitting Position
- Shoulder Blade Stretch
- Shoulder Blade Squeeze
- Side Bending
- Exercises in Standing Position
- Chest Wall Stretch
- Shoulder Stretch
- Discharge Planning and Follow-up Care
- Teaching Needs for the Client and Family Undergoing Adjuvant Therapies
- COMMUNITY ACTIVITY
- TEACHING FOR SELF-MANAGEMENT
- After a Mastectomy Without Reconstruction
- Additional Nursing Care for Women Undergoing Mastectomy with Reconstruction
- KEY POINTS
- References
- Chapter 11 Structural Disorders and Neoplasms of the Reproductive System
- Learning Objectives
- Structural Disorders of the Uterus and Vagina
- Alterations in Pelvic Support
- Uterine Displacement and Prolapse
- FIG. 11-1 Types of uterine displacement. A, Anterior displacement. B, Retroversion (backward displacement of the uterus).
- FIG. 11-2 Prolapse of uterus.
- FIG. 11-3 A, Cystocele. B, Rectocele.
- Clinical Manifestations
- Cystocele and Rectocele
- Clinical Manifestations
- Urinary Incontinence
- Clinical Manifestations
- FIG. 11-4 Urethrovesical angle. A, Normal angle. B, Widening (absence) of angle.
- Genital Fistulas
- Clinical Manifestations
- Collaborative Care
- FIG. 11-5 Types of fistulas that may develop in the vagina, uterus, or rectum.
- 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.
- Benign Neoplasms
- Ovarian Cysts
- Follicular Cysts
- FIG. 11-7 Ovarian cyst.
- Corpus Luteum Cysts
- Theca-Lutein Cysts
- Polycystic Ovary Syndrome
- Collaborative Care
- Other Benign Ovarian Cysts and Neoplasms
- FIG. 11-8 Endometrial polyps.
- Uterine Polyps
- Collaborative Care
- Leiomyomas
- CLINICAL REASONING
- Informed Decision Making for Treatment of Leiomyoma
- Clinical Manifestations and Diagnosis
- FIG. 11-9 Types of leiomyomas. A, Subserous. B, Intramural. C, Submucosal. D, Cervical. E, Pedunculated.
- Care Management
- Medical Management
- Medications
- NURSING PROCESS
- The Woman with a Leiomyoma
- Assessment
- Nursing Diagnoses
- Anxiety related to:
- Acute or Chronic Pain related to:
- Sexual Dysfunction related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- Uterine Artery Embolization
- Surgical Management
- TEACHING FOR SELF-MANAGEMENT
- Care After Uterine Artery Embolization
- Laser Surgery
- Myomectomy
- FIG. 11-10 Hysterectomy. A, Vaginal. B, Abdominal.
- Hysterectomy
- Preoperative Care
- BOX 11-1 QUESTIONS FOR A WOMAN TO ASK TO ENSURE INFORMED CONSENT
- BOX 11-2 PREOPERATIVE PROCEDURES FOR HYSTERECTOMY
- BOX 11-3 POSTOPERATIVE CARE AFTER HYSTERECTOMY
- Postoperative Care
- Discharge Planning and Teaching
- TEACHING FOR SELF-MANAGEMENT
- Care After Myomectomy or Hysterectomy
- Vulvar Problems
- Bartholin Cysts
- Collaborative Care
- Vulvodynia
- Collaborative Care
- Malignant Neoplasms
- Cancer of the Endometrium
- Incidence and Etiology
- Care Management
- Assessment and Nursing Diagnoses
- NURSING ALERT
- TABLE 11-1 FIGO CLASSIFICATION OF ENDOMETRIAL CARCINOMA∗
- TABLE 11-2 Common Side Effects of Chemotherapy Agents Used for Gynecologic Cancers∗
- Expected Outcomes of Care
- Plan of Care and Interventions
- Therapeutic Management
- Nursing Management
- CULTURAL CONSIDERATIONS
- Meaning of Cancer
- Preoperative Care
- Postoperative Care
- Discharge Planning and Teaching
- Evaluation
- Cancer of the Ovary
- Incidence and Etiology
- NURSING CARE PLAN
- Hysterectomy for Endometrial Cancer
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Clinical Manifestations and Diagnosis
- BOX 11-4 NUTRITIONAL MANAGEMENT FOR COMMON PROBLEMS RELATED TO GYNECOLOGIC CANCER OR TREATMENT
- Altered Taste
- Anorexia
- Nausea and Vomiting
- Stomatitis
- Constipation
- Diarrhea
- Postoperative Recovery
- Therapeutic Management
- Nursing Implications
- LEGAL TIP
- Advance Directives
- Cancer of the Cervix
- Incidence and Etiology
- FIG. 11-11 Diagram of cervical epithelium showing progressive changes and various terminology.
- 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.
- TABLE 11-3 FIGO Classification of Cervical Carcinoma
- Clinical Manifestations and Diagnosis
- BOX 11-5 2001 BETHESDA SYSTEM FOR REPORTING CERVICAL CYTOLOGY RESULTS
- Results/Interpretations
- Negative for Intraepithelial Malignancy
- Epithelial Cell Abnormalities
- Glandular Cell
- 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.
- Care Management
- Medical and Surgical Management
- NURSING PROCESS
- The Woman Having Radiation Therapy
- Assessment
- Nursing Diagnoses
- Deficient Knowledge related to:
- Fear/Anxiety related to:
- Disturbed Sensory Perception related to:
- Risk for Impaired Skin Integrity related to:
- Risk for Injury related to:
- Acute Pain related to:
- Sexual Dysfunction related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- Cryosurgery
- EVIDENCE-BASED PRACTICE
- Cervical Cancer Treatment Options: Conventional and Complementary
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- FIG. 11-14 Electrosurgical excision. The electric loop vaporizes quickly and removes cone of tissue.
- Laser Ablation
- Electrosurgical Excision
- Radical Hysterectomy
- Nursing Management
- Radiation Therapy
- FIG. 11-15 Intracavitary implant. Applicator in place in uterus is loaded with radium source.
- Nursing Management
- External Therapy
- FIG. 11-16 Interstitial-intracavitary implant.
- TEACHING FOR SELF-MANAGEMENT
- Care After External Radiation Therapy
- Internal Therapy
- SAFETY ALERT
- TEACHING FOR SELF-MANAGEMENT
- Care After Internal Radiation Therapy
- Complications of Radiation Therapy
- Recurrent and Advanced Cancer of the Cervix
- Pelvic Exenteration
- Nursing Management
- FIG. 11-17 Pelvic exenteration procedures. A, Anterior exenteration. B, Posterior exenteration. C, Total exenteration.
- Chemotherapy
- Cancer of the Vulva
- Incidence and Etiology
- Clinical Manifestations and Diagnosis
- Collaborative Care
- Therapeutic Management
- FIG. 11-18 Radical vulvectomy. Note dotted lines denoting vulvectomy incision and inguinal groin incisions.
- Nursing Management
- TEACHING FOR SELF-MANAGEMENT
- Care After Radical Vulvectomy
- Cancer of the Vagina
- Cancer of the Uterine Tubes
- Cancer and Pregnancy
- Cancer of the Breast
- Cancer of the Cervix
- Leukemia
- Hodgkin’s Disease
- Melanoma
- Thyroid Cancer
- NURSING ALERT
- Colon Cancer
- Other Gynecologic Cancers
- Cancer of the Vulva
- Cancer of the Vagina
- Cancer of the Uterus
- Cancer of the Uterine Tube
- Cancer of the Ovary
- Cancer Therapy and Pregnancy
- Ethical Considerations
- Timing of Therapy
- Pregnancy After Cancer Treatment
- Gestational Trophoblastic Disease
- BOX 11-6 CLASSIFICATION OF GESTATIONAL TROPHOBLASTIC NEOPLASIA
- COMMUNITY ACTIVITY
- KEY POINTS
- References
- Unit Three Pregnancy
- Interactive Review—Unit 3
- Chapter 12 Conception and Fetal Development
- Learning Objectives
- Conception
- Cell Division
- Gametogenesis
- 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.
- Ovum
- 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.
- FIG. 12-3 Sperm and ovum.
- Sperm
- Fertilization
- 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.
- Implantation
- Embryo and Fetus
- 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.
- Primary Germ Layers
- Development of the Embryo
- Membranes
- 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.
- 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.
- Amniotic Fluid
- 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.
- Yolk Sac
- Umbilical Cord
- 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.
- 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.
- Placenta
- Structure
- 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.
- Functions
- FIG. 12.12 Plasma level of progesterone, estradiol, estrone, and estriol in women during the course of gestation.
- BOX 12-1 DEVELOPMENTALLY TOXIC EXPOSURES IN HUMANS
- Fetal Maturation
- Fetal Circulatory System
- 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.
- Hematopoietic System
- Gastrointestinal System
- Hepatic System
- Respiratory System
- Pulmonary Surfactants
- Renal System
- Neurologic System
- Sensory Awareness
- Endocrine System
- Reproductive System
- Musculoskeletal System
- CLINICAL REASONING
- Ultrasound Examination During Pregnancy
- Integumentary System
- Immunologic System
- FIG. 12-14 Formation of dizygotic twins, with fertilization of two ova, two implantations, two placentas, two chorions, and two amnions.
- TABLE 12-1 MILESTONES IN HUMAN DEVELOPMENT BEFORE BIRTH SINCE LAST MENSTRUAL PERIOD
- Multifetal Pregnancy
- Twins
- Dizygotic Twins
- FIG. 12-15 Diamniotic dichorionic (separate) twin placenta.
- Monozygotic Twins
- Conjoined Twins
- 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.
- Other Multifetal Pregnancies
- Nongenetic Factors Influencing Development
- KEY POINTS
- Oogenesis and Meiosis (read text)
- Spermatogenesis (read text)
- Testes (read text)
- Male Accessory Sex Glands (read text)
- Male External Genitalia (read text)
- Male Reproductive Ducts (read text)
- Pathway of Ovum (read text)
- Pathway of Sperm (read text)
- Fertilization and Implantation (read text)
- Maternal and Fetal Circulation (read text)
- First Trimester, Fetal Development (read text)
- Second Trimester, Fetal Development (read text)
- Third Trimester, Fetal Development (read text)
- References
- Chapter 13 Anatomy and Physiology of Pregnancy
- Learning Objectives
- Gravidity and Parity
- TABLE 13-1 OBSTETRIC HISTORY USING FIVE-DIGIT SYSTEM AND TWO-DIGIT SYSTEM
- NURSING ALERT
- Pregnancy Tests
- FIG. 13-1 Many pregnancy test products are available over the counter.
- TEACHING FOR SELF-MANAGEMENT
- Home Pregnancy Testing
- CLINICAL REASONING
- Pregnancy Testing
- Adaptations to Pregnancy
- TABLE 13-2 SIGNS OF PREGNANCY
- Signs of Pregnancy
- Reproductive System and Breasts
- Uterus
- Changes in Size, Shape, and Position
- FIG. 13-2 Comparison of abdomen, vulva, and cervix in nullipara (A), and multipara (B), at the same stage of pregnancy.
- Changes in Contractility
- Uteroplacental Blood Flow
- FIG. 13-3 Height of fundus by weeks of normal gestation with a single fetus. Dashed line, height after lightening.
- Cervical Changes
- FIG. 13-4 Displacement of internal abdominal structures and diaphragm by the enlarging uterus at 4, 6, and 9 months of gestation.
- Changes Related to the Presence of the Fetus
- FIG. 13-5 Hegar sign. Bimanual examination for assessing compressibility and softening of the isthmus (lower uterine segment) while the cervix is still firm.
- FIG. 13-6 Internal ballottement (18 weeks).
- Vagina and Vulva
- FIG. 13-7 A, Cervix in nonpregnant woman. B, Cervix during pregnancy.
- Breasts
- General Body Systems
- Cardiovascular System
- FIG. 13-9 Changes in position of heart, lungs, and thoracic cage in pregnancy. Broken line, nonpregnant; solid line, change that occurs in pregnancy.
- BOX 13-1 BLOOD PRESSURE MEASUREMENT
- Blood Pressure
- BOX 13-2 CALCULATION OF MEAN ARTERIAL PRESSURE
- Blood Volume and Composition
- FIG. 13-10 Hemorrhoids.
- Cardiac Output
- Circulation and Coagulation Times
- Respiratory System
- Pulmonary Function
- Basal Metabolic Rate
- TABLE 13-3 LABORATORY VALUES FOR PREGNANT AND NONPREGNANT WOMEN
- TABLE 13-4 CARDIOVASCULAR CHANGES IN PREGNANCY
- Acid-Base Balance
- Renal System
- Anatomic Changes
- TABLE 13-5 RESPIRATORY CHANGES IN PREGNANCY
- Functional Changes
- Fluid and Electrolyte Balance
- Integumentary System
- FIG. 13-11 Striae gravidarum and linea nigra in a dark-skinned woman.
- NURSING ALERT
- Musculoskeletal System
- FIG. 13-12 Postural changes during pregnancy. A, Nonpregnant posture. B, Incorrect posture during pregnancy. C, Correct posture during pregnancy.
- Neurologic System
- FIG. 13-13 Possible change in rectus abdominis muscles during pregnancy. A, Normal position in nonpregnant woman. B, Diastasis recti abdominis in pregnant woman.
- Gastrointestinal System
- Appetite
- Mouth
- Esophagus, Stomach, and Intestines
- Gallbladder and Liver
- Abdominal Discomfort
- Endocrine System
- Pituitary and Placental Hormones
- FIG. 13-14 Change in position of appendix in pregnancy. Note McBurney’s point.
- Thyroid Gland
- Parathyroid Gland
- Pancreas
- Adrenal Glands
- KEY POINTS
- References
- Chapter 14 Maternal and Fetal Nutrition
- Learning Objectives
- Nutrient Needs Before Conception
- FIG. 14-1 Factors that affect the outcome of pregnancy.
- Nutrient Needs During Pregnancy
- Energy Needs
- BOX 14-1 FOOD SOURCES OF FOLATE
- Foods Providing 500 Micrograms or More Per Serving
- Foods Providing 200 Micrograms or More Per Serving
- Foods Providing 100 Micrograms or More Per Serving
- Foods Providing 50 Micrograms or More Per Serving
- Foods Providing 20 Micrograms or More Per Serving
- Weight Gain
- FIG. 14-2 Prenatal weight-gain chart for plotting weight gain of normal-weight women.
- TABLE 14-1 RECOMMENDATIONS FOR DAILY INTAKES OF SELECTED NUTRIENTS DURING PREGNANCY AND LACTATION
- Pattern of Weight Gain
- BOX 14-2 WEIGHT GAIN DURING PREGNANCY
- Hazards of Restricting Adequate Weight Gain
- CLINICAL REASONING
- Imbalanced Nutrition
- Excessive Weight Gain
- TABLE 14-2 TISSUES CONTRIBUTING TO MATERNAL WEIGHT GAIN AT 40 WEEKS OF GESTATION
- BOX 14-3 BARIATRIC OBSTETRIC CARE
- Protein
- TABLE 14-3 DAILY FOOD GUIDE FOR PREGNANCY AND LACTATION
- SAFETY ALERT
- Fluids
- Minerals and Vitamins
- TABLE 14-4 CAFFEINE CONTENT OF COMMON BEVERAGES AND FOODS
- Iron
- BOX 14-4 USE OF ARTIFICIAL SWEETENERS DURING PREGNANCY
- Calcium
- BOX 14-5 INDICATORS OF NUTRITIONAL RISK IN PREGNANCY
- EVIDENCE-BASED PRACTICE
- What Else Should We Tell Our Pregnant Clients to Take, Besides Folic Acid?
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Evidence
- Implications for Practice
- References
- Other Minerals and Electrolytes
- Magnesium
- Sodium
- BOX 14-6 CALCIUM SOURCES FOR WOMEN WHO DO NOT DRINK MILK
- Fish
- Beans and Legumes
- Greens
- Baked Products
- Fruits
- Sauces
- Potassium
- Zinc
- Fluoride
- Fat-Soluble Vitamins
- Water-Soluble Vitamins
- Folate/Folic Acid
- Pyridoxine
- Vitamin C
- 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.
- Other Nutritional Issues During Pregnancy
- Pica and Food Cravings
- Adolescent Pregnancy Needs
- Preeclampsia
- Physical Activity During Pregnancy
- Nutrient Needs During Lactation
- Care Management
- Diet History
- Obstetric and Gynecologic Effects on Nutrition
- NURSING PROCESS
- Excessive Gestational Weight Gain
- Assessment
- Nursing Diagnoses
- Imbalanced Nutrition: More than Body Requirements related to:
- Deficient Knowledge related to:
- Risk for Injury (to the Fetus) related to:
- Ineffective Health Maintenance related to:
- Disturbed Body Image related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Home Care
- Evaluation
- Health History
- Usual Maternal Diet
- SAFETY ALERT
- Physical Examination
- Laboratory Testing
- Client Education
- BOX 14-7 FOOD INTAKE QUESTIONNAIRE
- Adequate Dietary Intake
- TABLE 14-5 PHYSICAL ASSESSMENT OF NUTRITIONAL STATUS
- COMMUNITY ACTIVITY
- Pregnancy
- Postpartum
- NURSING CARE PLAN
- Nutrition During Pregnancy
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Daily Food Guide and Menu Planning
- Medical Nutrition Therapy
- Counseling About Iron Supplementation
- Coping with Nutrition-Related Discomforts of Pregnancy
- Nausea and Vomiting
- TEACHING FOR SELF-MANAGEMENT
- Iron Supplementation
- Constipation
- Pyrosis
- Cultural Influences
- BOX 14-8 SUGGESTIONS FOR MANAGING NAUSEA AND VOMITING DURING PREGNANCY
- Vegetarian Diets
- TABLE 14-6 POPULAR FOODS OF VARIOUS CULTURAL AND ETHNIC GROUPS AND THEIR PLACE IN MYPYRAMID
- KEY POINTS
- References
- Chapter 15 Nursing Care of the Family During Pregnancy
- Learning Objectives
- Diagnosis of Pregnancy
- Signs and Symptoms
- Estimating Date of Birth
- BOX 15-1 USE OF NÄGELE’S RULE
- Adaptation to Pregnancy
- Maternal Adaptation
- Accepting the Pregnancy
- Identifying with the Mother Role
- Reordering Personal Relationships
- FIG. 15-1 A pregnant woman and her mother enjoying their walk together.
- Establishing a Relationship with the Fetus
- Preparing for Childbirth
- FIG. 15-2 Four-year-old likes to examine the pregnant abdomen of his mother.
- Paternal Adaptation
- Accepting the Pregnancy
- Identifying with the Father Role
- FIG. 15-3 A prospective mother and father walk together. Women respond positively to their partner’s interest and concern.
- Reordering Personal Relationships
- Establishing a Relationship with the Fetus
- Preparing for Childbirth
- Sibling Adaptation
- FIG. 15-4 A sibling class of preschoolers learns infant care using dolls.
- BOX 15-2 SIBLING ADAPTATION
- Tips for Sibling Preparation
- Prenatal
- During the Hospital Stay
- Going Home
- Adjustment After the Baby Is Home
- Grandparent Adaptation
- Care Management
- FIG. 15-5 A grandfather getting to know his grandson.
- BOX 15-3 PRENATAL VISIT SCHEDULE
- Initial Visit
- Prenatal Interview
- NURSING PROCESS
- Nursing Care During Pregnancy
- Assessment
- Nursing Diagnoses
- Anxiety related to
- Interrupted Family Processes related to
- Deficient Knowledge related to
- Disturbed Sleep Pattern related to
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- Reason for Seeking Care
- Current Pregnancy
- Childbearing and Female Reproductive System History
- Health History
- Nutritional History
- History of Drug and Herbal Preparations Use
- Family History
- Social, Experiential, and Occupational History
- History of Physical Abuse
- Review of Systems
- Physical Examination
- TABLE 15-1 LABORATORY TESTS IN PRENATAL PERIOD
- Laboratory Tests
- BOX 15-4 HIV SCREENING
- Follow-up Visits
- FIG. 15-6 A prenatal interview.
- Interview
- Physical Examination
- EMERGENCY
- Supine Hypotension
- Signs and Symptoms
- Interventions
- Fetal Assessment
- Listening for Fetal Heart Tones
- Measuring Fundal Height
- SIGNS OF POTENTIAL COMPLICATIONS
- First, Second, and Third Trimesters
- 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.
- Gestational Age
- 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.
- Health Status
- Laboratory Tests
- Collaborative Care
- Education About Maternal and Fetal Changes
- Education for Self-Management
- Nutrition
- Personal Hygiene
- Prevention of Urinary Tract Infections
- Kegel Exercises
- Preparation for Breastfeeding
- FIG. 15-9 A, Normal nipple everts with gentle pressure. B, Inverted nipple inverts with gentle pressure.
- FIG. 15-10 Breast shell in place inside bra to evert nipple.
- Dental Care
- Physical Activity
- Posture and Body Mechanics
- TEACHING FOR SELF-MANAGEMENT
- Exercise Tips for Pregnant Women
- Riding a recumbent bicycle provides exercise while supplying back support.
- 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.
- FIG. 15-12 Correct body mechanics. A, Squatting. B, Lifting.
- TEACHING FOR SELF-MANAGEMENT
- Posture and Body Mechanics
- To Prevent or Relieve Backache
- To Restrict the Lumbar Curve
- To Prevent Round Ligament Pain and Strain on Abdominal Muscles
- Rest and Relaxation
- FIG. 15-13 Side-lying position for rest and relaxation. Some women prefer to support upper part of leg with pillows.
- FIG. 15-14 Squatting for muscle relaxation and strengthening and for keeping leg and hip joints flexible.
- Employment
- BOX 15-5 CONSCIOUS RELAXATION TIPS
- TEACHING FOR SELF-MANAGEMENT
- Safety During Pregnancy
- FIG. 15-15 Position for resting legs and for reducing edema and varicosities. Encourage woman with vulvar varicosities to include pillow under her hips.
- Clothing
- Travel
- 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.
- FIG. 15-17 Proper use of seat belt and headrest.
- Medications and Herbal Preparations
- NURSING ALERT
- Immunizations
- SAFETY ALERT
- Alcohol, Cigarette Smoke, Caffeine, and Drugs
- EVIDENCE-BASED PRACTICE
- Perinatal Smoking Cessation
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- Normal Discomforts
- CLINICAL REASONING
- Nausea in pregnancy
- BOX 15-6 COMPLEMENTARY AND ALTERNATIVE THERAPIES USED IN PREGNANCY
- Morning Sickness and Hyperemesis
- Relaxation and Muscle-Ache Relief
- Recognizing Potential Complications
- FIG. 15-18 Pericardium 6 (p6) acupressure point for nausea.
- TEACHING FOR SELF-MANAGEMENT
- Sexuality in Pregnancy
- TABLE 15-2 DISCOMFORTS RELATED TO PREGNANCY
- NURSING CARE PLAN
- Discomforts of Pregnancy and Warning Signs
- First Trimester
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Second Trimester
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Third Trimester
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Recognizing Preterm Labor
- Sexual Counseling
- Using the History
- Countering Misinformation
- Suggesting Alternative Behaviors
- 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.
- Psychosocial Support
- Variations in Prenatal Care
- Cultural Influences
- Emotional Response
- Clothing
- Physical Activity and Rest
- FIG. 15-20 A young woman from Honduras wearing a muñeco given to her by her mother to ensure a safe birth.
- Sexual Activity
- Diet
- Age Differences
- Adolescents
- Women Older Than 35 Years
- Multiparous Women
- FIG. 15-21 Pregnant adolescents reviewing fetal development.
- NURSING CARE PLAN
- Adolescent Pregnancy
- NURSING DIAGNOSIS
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Primiparous Women
- Multifetal Pregnancy
- Childbirth and Perinatal Education
- Childbirth Education Programs
- FIG. 15-22 Learning relaxation exercises with the whole family.
- Current Practices in Childbirth Education
- Pain Management
- Perinatal Care Choices
- Physicians
- Nurse-Midwives
- Direct-Entry Midwives
- Doulas
- COMMUNITY ACTIVITY
- Birth Plans
- Birth Setting Choices
- BOX 15-7 QUESTIONS TO ASK WHEN CHOOSING A DOULA
- Labor, Delivery, Recovery, Postpartum (Birthing) Rooms
- Birth Centers
- 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.
- FIG. 15-24 Birth center. A, Note double bed, baby crib, and birthing stool. B, Lounge and kitchen.
- Home Birth
- KEY POINTS
- Abdomen / Fundal Height (read text)
- References
- Unit Four Childbirth
- Interactive Review—Unit 4
- Chapter 16 Labor and Birth Processes
- Learning Objectives
- Factors Affecting Labor
- Passenger
- Size of the Fetal Head
- FIG. 16-1 Fetal head at term. A, Bones.B, Sutures and fontanels.
- Fetal Presentation
- Fetal Lie
- Fetal Attitude
- Fetal Position
- FIG. 16-2 Examples of fetal vertex (occiput) presentations in relation to front, back, or side of maternal pelvis.
- Passageway
- FIG. 16-3 Fetal presentations. A through C, Breech (sacral) presentations. D, Shoulder presentation.
- 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.
- Bony Pelvis
- 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.
- FIG. 16-7 Female pelvis. A, Pelvic brim from above. B, Pelvic outlet from below.
- 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.
- FIG. 16-9 Estimation of angle of subpubic arch. With both thumbs, examiner externally traces descending rami down to tuberosities.
- Soft Tissues
- Powers
- Primary Powers
- 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.
- TABLE 16-1 OBSTETRIC MEASUREMENTS
- TABLE 16-2 COMPARISON OF PELVIC TYPES
- 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.
- Secondary Powers
- Position of the Laboring Woman
- Process of Labor
- Signs Preceding Labor
- FIG. 16-12 Positions for labor and birth. A, Positions for labor. B, Positions for birth.
- Onset of Labor
- BOX 16-1 SIGNS PRECEDING LABOR
- Stages of Labor
- CLINICAL REASONING
- Second Stage Labor in a Woman with an Epidural
- Mechanism of Labor
- 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.
- Engagement
- Asynclitism
- Descent
- FIG. 16-14 Synclitism and asynclitism. A, Anterior asynclitism. B, Normal synclitism. C, Posterior asynclitism.
- Flexion
- Internal Rotation
- Extension
- Restitution and External Rotation
- Expulsion
- Physiologic Adaptation to Labor
- Fetal Adaptation
- Fetal Heart Rate
- Fetal Circulation
- Fetal Respiration
- Maternal Adaptation
- Cardiovascular Changes
- BOX 16-2 MATERNAL PHYSIOLOGIC CHANGES DURING LABOR
- Respiratory Changes
- Renal Changes
- Integumentary Changes
- Musculoskeletal Changes
- Neurologic Changes
- Gastrointestinal Changes
- Endocrine Changes
- KEY POINTS
- Presentation (read text)
- Fetal Lie (read text)
- Position (read text)
- References
- Chapter 17 Pain Management
- Learning Objectives
- Pain During Labor and Birth
- Neurologic Origins
- Perception of Pain
- Expression of Pain
- 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.
- Factors Influencing Pain Response
- Physiologic Factors
- Culture
- CULTURAL CONSIDERATIONS
- Some Cultural Beliefs About Pain
- Anxiety
- Previous Experience
- Gate-Control Theory of Pain
- Comfort
- Support
- BOX 17-1 SUGGESTED MEASURES FOR SUPPORTING A WOMAN IN LABOR
- Environment
- Nonpharmacologic Pain Management
- EVIDENCE-BASED PRACTICE
- Complementary and Alternative Pain Management in Labor
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- CLINICAL REASONING
- Making Decisions Regarding Pain Management for Labor
- Childbirth Preparation Methods
- BOX 17-2 NONPHARMACOLOGIC STRATEGIES TO ENCOURAGE RELAXATION AND RELIEVE PAIN
- Cutaneous Stimulation Strategies
- Sensory Stimulation Strategies
- Cognitive Strategies
- COMMUNITY ACTIVITY
- Relaxation and Breathing Techniques
- Focusing and Relaxation Techniques
- FIG. 17-2 A laboring woman using focusing and breathing techniques during a uterine contraction with coaching from her partner.
- Breathing Techniques
- FIG. 17-3 Expectant parents learning relaxation techniques.
- BOX 17-3 PACED BREATHING TECHNIQUES
- Cleansing Breath
- Slow-Paced Breathing (Approximately 6 to 8 Breaths per Minute)
- Modified-Paced Breathing (Approximately 32 to 40 Breaths per Minute)
- Patterned-Paced or Pant-Blow Breathing (Same Rate as Modified)
- Effleurage and Counterpressure
- Music
- 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.
- Water Therapy (Hydrotherapy)
- SAFETY ALERT
- Transcutaneous Electrical Nerve Stimulation
- Acupressure and Acupuncture
- FIG. 17-5 Placement of transcutaneous electrical nerve stimulation (TENS) electrodes on back for relief of labor pain.
- 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.
- Application of Heat and Cold
- Touch and Massage
- Hypnosis
- Biofeedback
- Aromatherapy
- 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.
- Intradermal Water Block
- Pharmacologic Pain Management
- Sedatives
- Analgesia and Anesthesia
- BOX 17-4 PHARMACOLOGIC CONTROL OF DISCOMFORT BY STAGE OF LABOR AND METHOD OF BIRTH
- First Stage
- Second Stage
- Vaginal Birth
- Cesarean Birth
- Systemic Analgesia
- Opioid Agonist Analgesics
- SAFETY ALERT
- Opioid (Narcotic) Agonist-Antagonist Analgesics
- MEDICATION GUIDE
- Opioid Agonist Analgesics
- Action
- Indication
- Dosage and Route
- Adverse Effects
- Nursing Considerations
- MEDICATION GUIDE
- Opioid Agonist-Antagonist Analgesics
- Action
- Indication
- Dosage and Route
- Adverse Effects
- Nursing Considerations
- SIGNS OF POTENTIAL COMPLICATIONS
- Maternal Opioid Abstinence Syndrome (Opioid/Narcotic Withdrawal)
- Opioid (Narcotic) Antagonists
- NURSING ALERT
- MEDICATION GUIDE
- Opioid Antagonist
- Action
- Indication
- Dosage and Route
- Adult
- Newborn
- Adverse Effects
- Nursing Considerations
- Nerve Block Analgesia and Anesthesia
- Local Perineal Infiltration Anesthesia
- 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.
- Pudendal Nerve Block
- Spinal Anesthesia
- FIG. 17-9 Pudendal nerve block. Use of needle guide (Iowa trumpet) and Luer-Lok syringe to inject medication.
- SAFETY ALERT
- 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.
- 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.
- EMERGENCY
- Maternal Hypotension with Decreased Placental Perfusion
- Signs and Symptoms
- Interventions
- FIG. 17-12 Blood-patch therapy for spinal headache.
- Epidural Anesthesia or Analgesia (Block)
- NURSING ALERT
- BOX 17-5 SIDE EFFECTS OF EPIDURAL AND SPINAL ANESTHESIA
- Combined Spinal-Epidural (CSE) Analgesia
- Epidural and Intrathecal (Spinal) Opioids
- Contraindications to Subarachnoid and Epidural Blocks
- Epidural Block Effects on Newborn
- Nitrous Oxide for Analgesia
- General Anesthesia
- 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.
- Care Management
- Nonpharmacologic Interventions
- Pharmacologic Interventions
- Informed Consent
- LEGAL TIP:
- Informed Consent for Anesthesia
- Timing of Administration
- Preparation for Procedures
- NURSING PROCESS
- Pain Management
- Assessment
- Nursing Diagnoses
- Acute Pain related to:
- Risk for Ineffective Tissue Perfusion related to:
- Situational Low Self-esteem related to:
- Anxiety or Fear related to:
- Risk for Fetal Injury related to:
- Risk for Maternal Injury related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- NURSING CARE PLAN
- Nonpharmacologic Pain Management
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Administration of Medication
- Intravenous Route
- Intramuscular Route
- BOX 17-6 NURSING INTERVENTIONS FOR THE WOMAN RECEIVING EPIDURAL OR SPINAL ANESTHESIA
- Prior to the Block
- During Initiation of the Block
- While the Block is in Effect
- While the Block is Wearing off After Birth
- Regional (Epidural or Spinal) Anesthesia
- NURSING ALERT
- FIG. 17-14 Modified throne position for labor.
- SAFETY ALERT
- Safety and General Care
- KEY POINTS
- References
- Chapter 18 Fetal Assessment During Labor
- Learning Objectives
- Basis for Monitoring
- Fetal Response
- BOX 18-1 THREE-TIER FETAL HEART RATE CLASSIFICATION SYSTEM
- Category I
- Category II
- Category III
- Uterine Activity
- Fetal Compromise
- TABLE 18-1 NORMAL UTERINE ACTIVITY DURING LABOR
- Monitoring Techniques
- Intermittent Auscultation
- EVIDENCE-BASED PRACTICE
- Fetal Monitoring and the Machine That Goes “Beep”
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Evidence
- Implications for Practice
- References
- FIG. 18-1 A, Ultrasound fetoscope. B, Ultrasound stethoscope. C, DeLee-Hillis fetoscope.
- BOX 18-2 PROCEDURE FOR INTERMITTENT AUSCULTATION OF THE FETAL HEART RATE
- NURSING ALERT
- Electronic Fetal Monitoring
- External Monitoring
- Internal Monitoring
- TABLE 18-2 EXTERNAL AND INTERNAL MODES OF MONITORING
- 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.
- FIG. 18-3 Diagrammatic representation of internal invasive fetal monitoring with intrauterine pressure catheter and spiral electrode in place (membranes ruptured and cervix dilated).
- Display
- 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.
- Fetal Heart Rate Patterns
- Baseline Fetal Heart Rate
- Variability
- 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.
- FIG. 18-6 Sinusoidal FHR pattern.
- Tachycardia
- FIG. 18-7 Fetal tachycardia.
- TABLE 18-3 TACHYCARDIA AND BRADYCARDIA
- Bradycardia
- FIG. 18-8 Fetal bradycardia.
- Periodic and Episodic Changes in Fetal Heart Rate
- Accelerations
- FIG. 18-9 Fetal accelerations.
- BOX 18-3 ACCELERATIONS
- Causes
- Clinical Significance
- Nursing Interventions
- Decelerations
- Early Decelerations
- FIG. 18-10 Early decelerations.
- BOX 18-4 EARLY DECELERATIONS
- Cause
- Clinical Significance
- Nursing Interventions
- Late Decelerations
- FIG. 18-11 Late decelerations.
- BOX 18-5 LATE DECELERATIONS
- Cause
- Clinical Significance
- Nursing Interventions
- Variable Decelerations
- FIG. 18-12 Variable decelerations.
- CLINICAL REASONING
- Admission of an Emergency Client to Labor and Delivery
- BOX 18-6 VARIABLE DECELERATIONS
- Cause
- Clinical Significance
- Nursing Interventions
- Prolonged Decelerations
- FIG. 18-13 Prolonged decelerations.
- NURSING ALERT
- Care Management
- Electronic Fetal Monitoring Pattern Recognition and Interpretation
- Categorizing FHR Tracings
- BOX 18-7 CHECKLIST FOR FETAL MONITORING EQUIPMENT
- Preparation of Monitor
- Ultrasound Transducer
- Tocotransducer
- Spiral Electrode
- Internal Catheter or Strain Gauge
- NURSING PROCESS
- Electronic Fetal Heart Rate Monitoring
- Assessment
- Nursing Diagnoses
- Decreased Maternal Cardiac Output related to:
- Anxiety related to:
- Impaired Fetal Gas Exchange related to:
- Risk for Fetal Injury related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- LEGAL TIP
- Fetal Monitoring Standards
- Nursing Management of Abnormal Patterns
- BOX 18-8 MANAGEMENT OF ABNORMAL FETAL HEART RATE PATTERNS
- Basic Interventions
- Interventions for Specific Problems
- Other Methods of Assessment and Intervention
- Assessment Techniques
- Fetal Scalp Stimulation and Vibroacoustic Stimulation
- Umbilical Cord Acid-Base Determination
- TABLE 18-4 APPROXIMATE NORMAL VALUES FOR CORD BLOOD
- TABLE 18-5 TYPES OF ACIDEMIA
- Fetal Scalp Blood Sampling
- Fetal Pulse Oximetry
- Interventions
- Amnioinfusion
- Tocolytic Therapy
- FIG. 18-14 A nurse explains electronic fetal monitoring as ultrasound transducer monitors the fetal heart rate.
- Client and Family Teaching
- BOX 18-9 CLIENT AND FAMILY TEACHING WHEN ELECTRONIC FETAL MONITOR IS USED
- Documentation
- BOX 18-10 CHECKLIST FOR FETAL HEART RATE AND UTERINE ACTIVITY ASSESSMENT WITH ELECTRONIC FETAL MONITORING
- KEY POINTS
- Fetal Heart Rate (read text)
- References
- Chapter 19 Nursing Care of the Family During Labor and Birth
- Learning Objectives
- First Stage of Labor
- Care Management
- Assessment
- TEACHING FOR SELF-MANAGEMENT
- How to Distinguish True Labor from False Labor
- True Labor
- False Labor
- FIG. 19-1 Woman being assessed for admission to the labor and birth unit.
- COMMUNITY ACTIVITY
- Prenatal Data
- FIG. 19-2 Admission screens in an electronic medical record. A, General admission screen. B, Current admission screen.
- Interview
- PROCEDURE
- Tests for Rupture of Membranes
- Nitrazine Test for pH
- Procedure
- Read Results
- Document Results
- Test for Ferning or Fern Pattern
- Document Results
- BOX 19-1 THE BIRTH PLAN
- Psychosocial Factors
- Women with a History of Sexual Abuse
- Stress in Labor
- TABLE 19-1 EXPECTED MATERNAL PROGRESS IN FIRST STAGE OF LABOR
- BOX 19-2 PSYCHOSOCIAL ASSESSMENT OF THE LABORING WOMAN
- Verbal Interactions
- Body Language
- Perceptual Ability
- Discomfort Level
- Cultural Factors
- 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.
- Culture and Father Participation
- The Non–English-Speaking Woman in Labor
- Physical Examination
- BOX 19-3 STANDARD PRECAUTIONS DURING CHILDBIRTH
- General Systems Assessment
- Vital Signs
- Leopold Maneuvers (Abdominal Palpation)
- Assessment of Fetal Heart Rate and Pattern
- Assessment of Uterine Contractions
- FIG. 19-4 Portion of the labor flowsheet screen in an electronic medical record.
- 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.
- LEGAL TIP
- Obstetric Triage and EMTALA
- CULTURAL CONSIDERATIONS
- Birth Practices in Different Cultures
- South Korea
- Japan
- China
- India
- Iran
- Mexico
- Laos
- NURSING PROCESS
- First Stage of Labor
- Assessment
- Nursing Diagnoses
- Acute Pain related to
- Anxiety related to
- Impaired Urinary Elimination related to
- Impaired Gas Exchange (Fetal) related to
- Situational Low Self-esteem (Maternal) related to
- Situational Low Self-esteem (father or partner) related to
- Expected Outcomes of Care
- Plan of Care and Interventions
- Latent phase
- Active and transition phase
- Evaluation
- PROCEDURE
- Leopold Maneuvers
- NURSING ALERT
- NURSING ALERT
- Vaginal Examination
- PROCEDURE
- Vaginal Examination of the Laboring Woman
- Laboratory and Diagnostic Tests
- Analysis of Urine Specimen
- Blood Tests
- FIG. 19-7 Assessment of uterine contractions. A, Abdominal contour before and during uterine contraction. B, Wavelike pattern of contractile activity.
- 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.
- Other Tests
- Assessment of Amniotic Membranes and Fluid
- NURSING ALERT
- Infection
- Nursing Care
- SIGNS OF POTENTIAL COMPLICATIONS
- Labor
- BOX 19-4 EVIDENCE-BASED CARE PRACTICES DESIGNED TO PROMOTE, PROTECT, AND SUPPORT NORMAL LABOR AND BIRTH
- General Hygiene
- NURSING CARE PLAN
- Labor and Birth
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- TABLE 19-2 PHYSICAL NURSING CARE DURING LABOR
- Nutrient and Fluid Intake
- Oral Intake
- Intravenous Intake
- NURSING ALERT
- Elimination
- Voiding
- Catheterization
- Bowel Elimination
- FIG. 19-10 Woman preparing to walk with partner.
- Ambulation and Positioning
- SAFETY ALERT
- FIG. 19-13 Woman laboring using birth ball.
- EVIDENCE-BASED PRACTICE
- Benefits of Continuous Labor Support
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Evidence
- Implications for Practice
- References
- Supportive Care During Labor and Birth
- CLINICAL REASONING
- Encouraging Evidence-Based Birth Practices
- BOX 19-5 COMMON MATERNAL POSITIONS∗ DURING LABOR AND BIRTH
- Semirecumbent Position (See Figs. 19-15, B; Fig. 19-16, B)
- Lateral Position (See Figs. 19-12, B, and 19-15, A)
- Upright Position
- Hands-and-Knees Position—Position for Posterior Positions of the Presenting Part (See Figs. 19-11, B; Fig. 19-13)
- Labor Support by the Nurse
- FIG. 19-14 Partner providing comfort measures.
- Labor Support by the Father or Partner
- BOX 19-6 GUIDELINES FOR SUPPORTING THE FATHER∗
- Labor Support by Doulas
- Labor Support by Grandparents
- Siblings During Labor and Birth
- Emergency Interventions
- Second Stage of Labor
- Care Management
- EMERGENCY
- Interventions for Emergencies During Labor
- TABLE 19-3 EXPECTED MATERNAL PROGRESS IN THE SECOND STAGE OF LABOR
- Preparing for Birth
- Maternal Position
- NURSING PROCESS
- Second Stage of Labor
- Assessment
- Nursing Diagnoses
- Risk for Injury (to Mother and Fetus) related to
- Acute Pain related to
- Anxiety related to
- Risk for Infection related to
- Situational Low Self-Esteem (maternal) related to
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- 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.
- BOX 19-7 GUIDELINES FOR ASSISTANCE AT THE EMERGENCY BIRTH OF A FETUS IN THE VERTEX PRESENTATION
- 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.
- Bearing-Down Efforts
- FIG. 19-17 Birth bed.
- Fetal Heart Rate and Pattern
- Support of the Father or Partner
- Supplies, Instruments, and Equipment
- FIG. 19-18 Instrument table.
- FIG. 19-19 Radiant warmer for newborn.
- Birth in a Delivery Room or Birthing Room
- FIG. 19-20 Delivery room.
- Mechanism of Birth: Vertex Presentation
- FIG. 19-21 Beginning birth with vertex presenting. A, Anteroposterior slit. B, Oval opening. C, Circular shape. D, Crowning.
- FIG. 19-22 Birth of head with modified Ritgen maneuver. Note control to prevent too-rapid birth of head.
- Fundal Pressure
- Immediate Assessments and Care of the Newborn
- LEGAL TIP
- Documentation
- BOX 19-8 NORMAL VAGINAL CHILDBIRTH
- First Stage
- Anteroposterior slit. Vertex visible during contraction.
- Oval opening. Vertex presenting. NOTE: Nurse (on left) is wearing gloves, but support person (on right) is not.
- Second Stage
- Crowning.
- Nurse-midwife using Ritgen maneuver as head is born by extension.
- After nurse-midwife checks for nuchal cord, she supports head during external rotation and restitution.
- Use of bulb syringe to suction mucus.
- Birth of posterior shoulder.
- Birth of newborn by slow expulsion.
- Second stage complete. Note that newborn is not completely pink yet.
- Third Stage
- Newborn placed on mother’s abdomen while cord is clamped and cut.
- Note increased bleeding as placenta separates.
- Expulsion of placenta.
- Expulsion is complete, marking the end of the third stage.
- The Newborn
- Newborn awaiting assessment. Note that color is almost completely pink.
- Newborn assessment under radiant warmer.
- Parents admiring their newborn.
- Perineal Trauma Related to Childbirth
- Perineal Lacerations
- Vaginal and Urethral Lacerations
- Cervical Injuries
- Episiotomy
- FIG. 19-23 Types of episiotomies.
- Third Stage of Labor
- Placental Separation and Expulsion
- NURSING PROCESS
- Third Stage of Labor
- Assessment
- Nursing Diagnoses
- Risk for Deficient Fluid Volume related to
- Risk for Infection related to
- Anxiety related to
- Fatigue related to
- Compromised Family Coping related to
- Situational low self-esteem (maternal and paternal) related to
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- 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.
- FIG. 19-25 Examination of the placenta.
- Fourth Stage of Labor
- Care Management
- Assessment
- FIG. 19-26 Big brother becomes acquainted with new baby sister.
- BOX 19-9 ASSESSMENT DURING THE FOURTH STAGE OF LABOR
- Blood Pressure
- Pulse
- Temperature
- Fundus
- Bladder
- Lochia
- Perineum
- Postanesthesia Recovery
- NURSING ALERT
- Care of the New Mother
- Care of the Family
- Family-Newborn Relationships
- KEY POINTS
- Leopold’s Maneuvers (First) (read text)
- Leopold’s Maneuvers (Second) (read text)
- Leopold’s Maneuvers (Third) (read text)
- Leopold’s Maneuvers (Fourth) (read text)
- Normal Delivery (read text)
- References
- Unit Five Postpartum
- Interactive Review—Unit 5
- Chapter 20 Postpartum Physiology
- Learning Objectives
- Reproductive System and Associated Structures
- Uterus
- Involution Process
- Contractions
- 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.
- Afterpains
- Placental Site
- Lochia
- TABLE 20-1 LOCHIAL AND NONLOCHIAL BLEEDING
- Cervix
- Vagina and Perineum
- CLINICAL REASONING
- Assessment of Postpartum Bleeding
- Pelvic Muscular Support
- Endocrine System
- Placental Hormones
- Pituitary Hormones and Ovarian Function
- FIG. 20-2 Abdominal wall 6 weeks after vaginal birth is almost back to prepregnancy appearance. Note that the linea nigra is still visible.
- Abdomen
- Urinary System
- Urine Components
- Postpartal Diuresis
- Urethra and Bladder
- Gastrointestinal System
- Appetite
- Bowel Evacuation
- Breasts
- Breastfeeding Mothers
- Nonbreastfeeding Mothers
- TABLE 20-2 VITAL SIGNS AFTER CHILDBIRTH
- Cardiovascular System
- Blood Volume
- Cardiac Output
- Vital Signs
- Blood Components
- Hematocrit and Hemoglobin
- White Blood Cell Count
- Coagulation Factors
- FIG. 20-3 Varicosities in legs.
- Varicosities
- Neurologic System
- Musculoskeletal System
- Integumentary System
- Immune System
- KEY POINTS
- References
- Chapter 21 Nursing Care of the Family During the Postpartum Period
- Learning Objectives
- Transfer from the Recovery Area
- FIG. 21-1 Portion of a vaginal birth recovery screen in an electronic record.
- Planning for Discharge
- Laws Relating to Discharge
- TABLE 21-1 RECOVERY NURSE’S REPORT
- BOX 21-1 CRITERIA FOR EARLY DISCHARGE
- Mother
- Infant
- General
- Criteria for Discharge
- TABLE 21-2 POSTPARTUM ASSESSMENT AND SIGNS OF POTENTIAL COMPLICATIONS
- LEGAL TIP
- Early Discharge
- Care Management: Physical Needs
- Ongoing Physical Assessment
- NURSING PROCESS
- Postpartum Physical Concerns
- Assessment
- Initial assessment
- Ongoing assessment
- Nursing Diagnoses
- Risk for Constipation related to:
- Acute Pain related to:
- Ineffective Breastfeeding related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- Routine Laboratory Tests
- Nursing Interventions
- NURSING CARE PLAN
- Postpartum Care—Vaginal Birth
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationale
- Prevention of Infection
- BOX 21-2 INTERVENTIONS FOR EPISIOTOMY, LACERATIONS, AND HEMORRHOIDS
- Cleansing
- Ice Pack
- Squeeze Bottle
- Sitz Bath
- Built-in Type
- Disposable Type
- Topical Applications
- Prevention of Excessive Bleeding
- NURSING ALERT
- NURSING ALERT
- Maintenance of Uterine Tone
- 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).
- 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.
- EMERGENCY
- Hypovolemic Shock
- Signs and Symptoms
- Interventions
- Prevention of Bladder Distention
- Promotion of Comfort, Rest, Ambulation, and Exercise
- Comfort
- Nonpharmacologic Interventions
- Pharmacologic Interventions
- NURSING ALERT
- Rest
- Ambulation
- SAFETY ALERT
- Exercise
- Promotion of Nutrition
- 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.
- EVIDENCE-BASED PRACTICE
- Kegel, Kegel, Kegel!
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- Promotion of Normal Bladder and Bowel Patterns
- Bladder Function
- Bowel Function
- NURSING ALERT
- Breastfeeding Promotion and Lactation Suppression
- Breastfeeding Promotion
- Lactation Suppression
- Health Promotion for Future Pregnancies and Children
- Rubella Vaccination
- Varicella Vaccination
- Tetanus-Diphtheria-Acellular Pertussis Vaccine
- MEDICATION GUIDE
- Rh Immune Globulin, RhoGAM, Gamulin Rh, HypRho-D, Rhophylac
- Action
- Indications
- Dosage and Route
- Adverse Effects
- Nursing Considerations
- LEGAL TIP
- Rubella and Varicella Vaccination
- Prevention of Rh Isoimmunization
- NURSING ALERT
- Care Management: Psychosocial Needs
- Effect of the Birth Experience
- Maternal Self-Image
- NURSING PROCESS
- Postpartum Psychosocial Concerns
- Assessment
- Nursing Diagnoses
- Readiness for Enhanced Family Processes related to:
- Risk for Impaired Parenting related to:
- Risk for Situational Low Self-esteem related to:
- Risk for Caregiver Role Strain related to:
- Risk for Ineffective Coping related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- SIGNS OF POTENTIAL COMPLICATIONS
- Postpartum Psychosocial Concerns
- Adaptation to Parenthood and Parent-Infant Interactions
- Family Structure and Functioning
- FIG. 21-5 A mother’s adjustment is eased with acceptance of infant by other children. Smile indicates acceptance of the baby.
- Effect of Cultural Diversity
- Discharge Teaching
- Self-Management and Signs of Complications
- CULTURAL CONSIDERATIONS
- Postpartum Period and Family Planning
- Postpartum Care
- Family Planning
- NURSING ALERT
- Sexual Activity and Contraception
- TEACHING FOR SELF-MANAGEMENT
- Resumption of Sexual Activity
- CLINICAL REASONING
- Family Planning and Contraceptive Use
- Prescribed Medications
- Follow-Up After Discharge
- Routine Mother and Baby Follow-up Care
- Home Visits
- Telephone Follow-up
- Warm Lines
- Support Groups
- Referral to Community Resources
- COMMUNITY ACTIVITY
- KEY POINTS
- References
- Chapter 22 Transition to Parenthood
- Learning Objectives
- Parental Attachment, Bonding, and Acquaintance
- FIG. 22-1 Hands.
- TABLE 22-1 INFANT BEHAVIORS AFFECTING PARENTAL ATTACHMENT
- TABLE 22-2 PARENTAL BEHAVIORS AFFECTING INFANT ATTACHMENT
- FIG. 22-2 Early acquaintance between parents and newborn as mother holds infant in en face position.
- FIG. 22-3 Father looks for resemblance between newborns and older daughter.
- TABLE 22-3 EXAMPLES OF PARENT-INFANT ATTACHMENT INTERVENTIONS
- CULTURAL CONSIDERATIONS
- Fostering Bonding in Women of Varying Ethnic and Cultural Groups
- Assessment of Attachment Behaviors
- BOX 22-1 ASSESSING ATTACHMENT BEHAVIOR
- Parent-Infant Contact
- Early Contact
- Extended Contact
- Communication Between Parent and Infant
- The Senses
- Touch
- Eye Contact
- FIG. 22-4 Father interacts with his newborn son.
- Voice
- Odor
- Entrainment
- FIG. 22-5 Infant in alert state.
- Biorhythmicity
- Reciprocity and Synchrony
- FIG. 22-6 Sharing a smile: an example of synchrony.
- Parental Role After Birth
- Transition to Parenthood
- Parental Tasks and Responsibilities
- NURSING CARE PLAN
- Home Care Follow-up: Transition to Parenthood
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Becoming a Mother
- TABLE 22-4 PHASES OF MATERNAL POSTPARTUM ADJUSTMENT
- Postpartum “Blues”
- TEACHING FOR SELF-MANAGEMENT
- Coping with Postpartum Blues
- Becoming a Father
- TABLE 22-5 EARLY DEVELOPMENT OF THE INVOLVED FATHER ROLE
- FIG. 22-7 Engrossment. Father is absorbed in looking at his newborn.
- Adjustment for the Couple
- Resuming Sexual Intimacy
- Infant-Parent Adjustment
- Rhythm
- 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.
- EVIDENCE-BASED PRACTICE
- Education for Family Planning
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- Behavioral Repertoires
- Responsivity
- Diversity in Transitions to Parenthood
- Age
- The Adolescent Mother
- CLINICAL REASONING
- Transition to Parenthood for the Adolescent Couple
- The Adolescent Father
- Maternal Age Older Than 35 Years
- Paternal Age Older Than 35 Years
- Parenting in the Lesbian Couple
- Social Support
- Culture
- Socioeconomic Conditions
- Personal Aspirations
- Parental Sensory Impairment
- Visually Impaired Parent
- Hearing-Impaired Parent
- BOX 22-2 NURSING APPROACHES FOR WORKING WITH VISUALLY IMPAIRED PARENTS
- Sibling Adaptation
- 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.
- BOX 22-3 NURSING APPROACHES FOR WORKING WITH HEARING-IMPAIRED PARENTS
- BOX 22-4 STRATEGIES FOR FACILITATING SIBLING ACCEPTANCE OF A NEW BABY
- Grandparent Adaptation
- FIG. 22-10 Father, grandfather, and new grandson get acquainted.
- NURSING PROCESS
- Transition to Parenthood
- Assessment
- Nursing Diagnoses
- Readiness for Enhanced Family Coping related to:
- Risk for Impaired Parenting related to:
- Parental Role Conflict related to:
- Risk for Impaired Parent/Child Attachment related to:
- Readlines for Enhanced Family Processes related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- Care Management
- COMMUNITY ACTIVITY
- KEY POINTS
- References
- Unit Six The Newborn
- Interactive Review—Unit 6
- Chapter 23 Physiologic and Behavioral Adaptations of the Newborn
- Learning Objectives
- Transition to Extrauterine Life
- Physiologic Adaptations
- Respiratory System
- Initiation of Breathing
- Chemical Factors
- Mechanical Factors
- Thermal Factors
- Sensory Factors
- NURSING ALERT
- Signs of Respiratory Distress
- TABLE 23-1 CHARACTERISTICS OF THE RESPIRATORY SYSTEM OF THE NEONATE
- Cardiovascular System
- TABLE 23-2 CARDIOVASCULAR CHANGES AT BIRTH
- Heart Rate and Sounds
- Blood Pressure
- Blood Volume
- Signs of Risk for Cardiovascular Problems
- Hematopoietic System
- Red Blood Cells
- Leukocytes
- Platelets
- Blood groups
- Thermogenic System
- Heat Loss
- FIG. 23-1 Infant in skin-to-skin contact with mother.
- Thermogenesis
- 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.
- Cold Stress
- Hyperthermia
- Renal System
- NURSING ALERT
- Fluid and Electrolyte Balance
- Signs of Risk for Renal System Problems
- Gastrointestinal System
- Digestion
- Stools
- BOX 23-1 CHANGE IN STOOLING PATTERNS OF NEWBORNS
- Meconium
- Transitional Stools
- Milk Stool
- Feeding Behaviors
- Signs of Risk for Gastrointestinal Problems
- Hepatic System
- Iron Storage
- Carbohydrate Metabolism
- Conjugation of Bilirubin and Newborn Jaundice
- FIG. 23-3 Formation and excretion of bilirubin.
- Physiologic Jaundice
- NURSING ALERT
- Pathologic Jaundice
- TABLE 23-3 CAUSES OF NEONATAL UNCONJUGATED (INDIRECT) HYPERBILIRUBINEMIA
- Jaundice Related to Breastfeeding
- Coagulation
- Signs of Risk for Hepatic System Problems
- Immune System
- Risk for Infection
- Integumentary System
- Sweat Glands
- Desquamation
- Mongolian Spots
- Nevi
- FIG. 23-4 Mongolian spot.
- Erythema Toxicum
- Signs of Risk for Integumentary Problems
- FIG. 23-5 A, Telangiectatic nevi (stork bite). B, Erythema toxicum (flea bite dermatitis).
- Reproductive System
- Female
- Male
- Swelling of Breast Tissue
- Signs of Risk for Reproductive System Problems
- 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.
- Skeletal System
- FIG. 23-7 Swelling of the genitals and bruising of the buttocks after a breech birth.
- FIG. 23-8 Molding. A, Significant molding, soon after birth. B, Schematic of bones of skull when molding is present.
- 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.
- FIG. 23-10 Position of infant’s legs after breech birth.
- SAFETY ALERT
- Signs of Risk for Skeletal Problems
- 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).
- Neuromuscular System
- Newborn Reflexes
- Signs of Risk for Neuromuscular Problems
- Behavioral Characteristics
- BOX 23-2 CLUSTERS OF NEONATAL BEHAVIORS IN THE BRAZELTON NEONATAL BEHAVIORAL ASSESSMENT SCALE (BNBAS)
- TABLE 23-4 ASSESSMENT OF NEWBORN’S REFLEXES∗
- Classic pose in spontaneous tonic neck reflex.
- Moro reflex.
- Stepping reflex.
- Crossed extension reflex.
- Babinski reflex.
- Trunk incurvation reflex.
- Magnet reflex.
- Sleep-Wake States
- 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.
- Other Factors Influencing Newborn Behavior
- Gestational Age
- Time
- Stimuli
- Medication
- Sensory Behaviors
- Vision
- Hearing
- Smell
- Taste
- Touch
- Response to Environmental Stimuli
- Temperament
- Habituation
- Consolability
- Cuddliness
- Irritability
- Crying
- KEY POINTS
- Rooting and Sucking (read text)
- Plantar Grasp (read text)
- Moro Reflex (read text)
- Babinski Reflex, Male Infant (read text)
- References
- Chapter 24 Nursing Care of the Newborn and Family
- Learning Objectives
- Care Management: Birth Through the First 2 Hours
- Assessment
- Initial Assessment and Apgar Scoring
- BOX 24-1 ASSESSMENT OF PRECONCEPTION, PRENATAL, AND INTRAPARTUM RISK FACTORS
- Preconception
- Prenatal
- Intrapartum
- Apgar Score
- TABLE 24-1 APGAR SCORE
- BOX 24-2 INITIAL PHYSICAL ASSESSMENT OF THE NEWBORN
- Initial Physical Assessment
- Physical Assessment
- TABLE 24-2 PHYSICAL ASSESSMENT OF NEWBORN
- Weighing the infant. The nurse never leaves the infant alone on a scale. The scale is covered to protect against cross-infection.
- 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.
- Measuring circumference of head.
- Measuring circumference of chest.
- 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.
- 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.
- BOX 24-3 SIGNIFICANCE OF THE APGAR SCORE
- BOX 24-4 PERFORMING A PHYSICAL EXAMINATION OF THE NEWBORN
- General Appearance
- Vital Signs
- Baseline Measurements of Physical Growth
- Weight
- Head Circumference and Body Length
- NURSING CARE PLAN
- The Normal Newborn
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Neurologic Assessment
- Gestational Age Assessment
- 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.
- Classification of Newborns by Gestational Age and Birth Weight
- BOX 24-5 MANEUVERS USED IN ASSESSING GESTATIONAL AGE
- Posture
- Square Window
- Arm Recoil
- Popliteal Angle
- Scarf Sign
- Heel to Ear
- Late Preterm Infant
- NURSING PROCESS
- Care of the Newborn and Family
- Assessment
- Nursing Diagnoses
- Ineffective Airway Clearance related to:
- Impaired Gas Exchange related to:
- Risk for Imbalanced Body Temperature related to:
- Acute Pain related to:
- Readiness for Enhanced Parenting related to:
- Readiness for Enhanced Family Coping related to:
- Risk for Impaired Parent-Infant Attachment related to:
- Situational Low Self-Esteem related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- Interventions
- Airway Maintenance
- PROCEDURE
- Suctioning with a Bulb Syringe
- FIG. 24-2 Bulb syringe. Bulb must be compressed before insertion.
- Maintaining an Adequate Oxygen Supply
- PROCEDURE
- Suctioning with a Nasopharyngeal Catheter with Mechanical Suction Apparatus
- SIGNS OF POTENTIAL COMPLICATIONS
- Abnormal Newborn Breathing
- Maintaining Body Temperature
- EVIDENCE-BASED PRACTICE
- Hypothermia Prevention and Skin-to-Skin Contact
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- Immediate Interventions
- Eye Prophylaxis
- 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.
- MEDICATION GUIDE
- Eye Prophylaxis: Erythromycin Ophthalmic Ointment, 0.5%, and Tetracycline Ophthalmic Ointment, 1%
- Action
- Indication
- Neonatal Dosage
- Adverse Reactions
- Nursing Considerations
- Vitamin K Prophylaxis
- MEDICATION GUIDE
- Vitamin K: Phytonadione (AquaMEPHYTON, Konakion)
- Action
- Indication
- Neonatal Dosage
- Adverse Reactions
- Nursing Considerations
- SAFETY ALERT
- Umbilical Cord Care
- FIG. 24-4 With special tool, remove clamp after cord dries (approximately 24 hours).
- FIG. 24-5 Cord separation. A, Cord separated with some dried blood still in the umbilicus. B, Umbilicus cleansed and beginning to heal.
- Promoting Parent-Infant Interaction
- Care Management: from 2 Hours After Birth Until Discharge
- Common Newborn Problems
- Birth Injuries
- Soft Tissue Injuries
- 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.
- Physiologic Problems
- Jaundice
- Physiologic Jaundice
- FIG. 24-7 Transcutaneous monitoring of bilirubin with a transcutaneous bilirubinometry (TcB) monitor.
- 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.)
- Hypoglycemia
- NURSING ALERT
- Hypocalcemia
- Laboratory and Diagnostic Tests
- BOX 24-6 STANDARD LABORATORY VALUES IN THE NEONATAL PERIOD
- Newborn Hearing Screening
- TABLE 24-3 NEWBORN SCREENING SUMMARY
- Collection of Specimens
- Heelstick
- Venipuncture
- FIG. 24-9 Newborn hearing screening. A, Evoked otoacoustic emissions (EOAE) test. B, Auditory brain response (ABR)) test.
- FIG. 24-10 Heelstick sites (shaded areas) on infant’s foot for obtaining samples of capillary blood.
- NURSING ALERT
- FIG. 24-11 Venipuncture using a butterfly needle.
- Obtaining a Urine Specimen
- 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.
- FIG. 24-13 Alternate methods of infant restraint. A, Restraining infant for femoral vein puncture. B, Modified side-lying position for lumbar puncture.
- 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.
- Restraining the Infant
- Restraint Without Appliance
- Interventions
- Protective Environment
- Environmental Factors
- Infection Control Factors
- NURSING ALERT
- FIG. 24-15 Neonatal safety device.
- Safety Factors
- Therapeutic and Surgical Procedures
- Intramuscular Injection
- MEDICATION GUIDE
- Hepatitis B Vaccine (Recombivax HB, Engerix-B)
- Action
- Indication
- Neonatal Dosage
- Adverse Reactions
- Nursing Considerations
- MEDICATION GUIDE
- Hepatitis B Immune Globulin
- Action
- Indication
- Neonatal Dosage
- Adverse Reactions
- Nursing Considerations
- Therapy for Hyperbilirubinemia
- Phototherapy
- 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.
- FIG. 24-17 Infant under phototherapy lights while in incubator
- FIG. 24-18 Infant with eyes covered while receiving phototherapy.
- Parent Education
- Home Phototherapy
- Circumcision
- FIG. 24-19 Proper positioning of infant for circumcision.
- FIG. 24-20 Circumcision with Yellen clamp. After hemostasis occurs, the prepuce (over cone) will be cut away.
- 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.
- Procedural Pain Management
- Care of the Newly Circumcised Infant
- Neonatal Pain
- BOX 24-7 CARE OF THE CIRCUMCISED NEWBORN AT HOME
- Check For Bleeding
- Observe for Urination
- Keep Area Clean
- Check for Infection
- Provide Comfort
- Neonatal Responses to Pain
- FIG. 24-22 Signs of discomfort: note eye squeeze, brow bulge, nasolabial furrow, and wide-spread mouth
- Assessment of Neonatal Pain
- Management of Neonatal Pain
- Nonpharmacologic Management
- Pharmacologic Management
- Promoting Parent-Infant Interaction
- FIG. 24-23 Baby swaddled snugly with one hand near face and other held close to body
- TABLE 24-4 CRIES NEONATAL POSTOPERATIVE PAIN SCALE∗
- CULTURAL CONSIDERATIONS
- Cultural Beliefs and Practices Related to Infant Care
- FIG. 24-24 Great-grandmother and infant enjoying social interaction.
- Discharge Planning and Teaching
- FIG. 24-25 Mother supervising contact of older sibling with newborn.
- Temperature
- Respirations
- BOX 24-8
- Infant Safety
- Feeding Patterns
- Elimination
- Positioning and Holding
- 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.
- Rashes
- Diaper Rash
- Other Rashes
- Clothing
- FIG. 24-27 Sunglasses protect the infant’s eyes.
- Car Seat Safety
- SAFETY ALERT
- FIG. 24-28 Rear-facing car seat in rear seat of car. Infant is placed in seat when going home from the hospital.
- Nonnutritive Sucking
- Bathing, Cord Care, and Skin Care
- Bathing
- FIG. 24-29 Safe pacifiers for term and preterm infants. Note one-piece construction, easily grasped handle, and large shield with ventilation holes.
- FIG. 24-30 Mother giving newborn a sponge bath at home.
- Cord Care
- BOX 24-9 BATHING, CORD CARE, SKIN CARE, AND NAIL CARE
- Fit Baths into the Family’s Schedule
- Prevent Heat Loss
- Gather Supplies and Clothing Before Starting
- Bathe the Baby
- Wash hair with baby wrapped to limit heat loss.
- Skin Care
- Cord Care
- Nail Care
- Clean Genitals
- Infant Follow-up Care
- Immunizations
- Cardiopulmonary Resuscitation
- Practical Suggestions for the First Weeks at Home
- BOX 24-10 NEWBORN PROGRESS AFTER EARLY DISCHARGE
- Activities of Daily Living
- TABLE 24-5 IMMUNIZATION SCHEDULE—2010∗
- Visitors
- Activity and Rest
- EMERGENCY
- Relieving Airway Obstruction
- Back blows and chest thrust in infant to clear airway obstruction. A, Back blow. B, Chest thrust.
- Back Blows
- Turn the Infant
- Chest Thrusts
- Open the Airway
- Development of Day-Night Routines
- EMERGENCY
- Cardiopulmonary Resuscitation (CPR) for Infants
- Assess Responsiveness
- Position Infant
- Airway
- 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.
- Breathing
- Circulation
- Interpretation of Crying and Use of Quieting Techniques
- Developmental Milestones
- BOX 24-11 INFANT QUIETING TECHNIQUES
- Infant Stimulation
- TABLE 24-6 GROWTH AND DEVELOPMENT DURING INFANCY
- Recognizing Signs of Illness
- TABLE 24-7 PLAY DURING INFANCY: SUGGESTED ACTIVITIES FOR BIRTH THROUGH 3 MONTHS
- BOX 24-12 TEACHING YOUR NEWBORN
- BOX 24-13 TEACHING YOUR 1-MONTH-OLD
- BOX 24-14 SIGNS OF ILLNESS
- COMMUNITY ACTIVITY
- KEY POINTS
- Neck, posterior (read text)
- Male Breasts (supine position) (read text)
- Cremasteric Reflex (read text)
- Upper Extremities (read text)
- Legs: Symmetry, length (read text)
- Buttocks (read text)
- Circumcision (read text)
- References
- Chapter 25 Newborn Nutrition and Feeding
- Learning Objectives
- Recommended Infant Nutrition
- Breastfeeding Rates
- Benefits of Breastfeeding
- Choosing an Infant Feeding Method
- TABLE 25-1 BENEFITS OF BREASTFEEDING
- Supporting Breastfeeding Mothers
- FIG. 25-1 Breastfeeding mothers support group with lactation consultant.
- Cultural Influences on Infant Feeding
- BOX 25-1 TEN STEPS TO SUCCESSFUL BREASTFEEDING FOR HOSPITALS
- Nutrient Needs
- Fluids
- Energy
- Carbohydrate
- Fat
- Protein
- Vitamins
- Minerals
- Anatomy and Physiology of Lactation
- Anatomy of the Lactating Breast
- FIG. 25-2 Anatomy of the lactating breast.
- FIG. 25-3 Enhanced view of milk glands and milk ducts.
- Lactogenesis
- FIG. 25-4 Maternal breastfeeding reflexes. A, Milk production. B, Milk ejection (let-down).
- NURSING ALERT
- Uniqueness of Human Milk
- Care Management: the Breastfeeding Mother and Infant
- Positioning
- NURSING PROCESS
- Breastfeeding Mother-Infant Pair
- Assessment
- Nursing Diagnoses
- Effective Breastfeeding related to:
- Risk for Ineffective Breastfeeding related to:
- Risk for Imbalanced Nutrition: Less than Body Requirements related to:
- Risk for Deficient Fluid Volume related to:
- Expected Outcomes of Care
- Infant
- Mother
- Plan of Care and Interventions
- Evaluation
- FIG. 25-5 Breastfeeding positions. A, Football or clutch (under the arm) hold. B, Across the lap (modified cradle). C, Cradling. D, Lying down.
- NURSING ALERT
- Latch
- 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.
- FIG. 25-7 Removing infant from the breast.
- NURSING CARE PLAN
- Breastfeeding and Infant Nutrition
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Milk Ejection or Let-Down
- Frequency of Feedings
- Duration of Feedings
- Indicators of Effective Breastfeeding
- BOX 25-2 SIGNS OF EFFECTIVE BREASTFEEDING
- Mother
- Infant
- Supplements, Bottles, and Pacifiers
- EVIDENCE-BASED PRACTICE
- Supplemental Feeding
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- Special Considerations
- Sleepy Baby
- Fussy Baby
- BOX 25-3 WAKING THE SLEEPY NEWBORN
- Slow Weight Gain
- BOX 25-4 CALMING THE FUSSY BABY
- BOX 25-5 WARNING SIGNS OF INEFFECTIVE BREASTFEEDING
- FIG. 25-8 Supplemental nursing system.
- Jaundice
- Preterm Infants
- FIG. 25-9 Hospital-grade electric breast pump.
- Late Preterm Infants
- Breastfeeding Multiple Infants
- Expressing and Storing Breast Milk
- FIG. 25-10 Breastfeeding twins.
- Hand Expression
- Mechanical Expression (Pumping)
- Types of Pumps
- FIG. 25-11 Bilateral breast pumping.
- Storage of Breast Milk
- FIG. 25-12 Manual breast pumps.
- SAFETY ALERT
- Being Away from the Baby
- Maternal Employment
- TEACHING FOR SELF-MANAGEMENT
- Breast Milk Storage Guidelines for Home Use for Full-Term Infants
- Human Milk Storage Guidelines for Full-Term Infants
- Weaning
- FIG. 25-13 Lactation room. Note the breast pump, rocking chair, nursing foot stool, changing table, books, and supplies.
- Milk Banking
- Care of the Mother
- Diet
- Weight Loss
- Rest
- Breast Care
- Sexual Sensations
- FIG. 25-14 Breast shells.
- Breastfeeding and Contraception
- Breastfeeding During Pregnancy
- Breastfeeding After Breast Surgery
- Medications and Breastfeeding
- Environmental Contaminants
- Common Concerns of the Breastfeeding Mother
- Engorgement
- CLINICAL REASONING
- Breastfeeding: Engorgement and Nipple Soreness
- FIG. 25-15 Cabbage leaves to treat engorgement.
- Sore Nipples
- Candidiasis
- Plugged Milk Ducts
- Mastitis
- Follow-up After Hospital Discharge
- Formula Feeding
- Parent Education
- Readiness for Feeding
- Feeding Patterns
- Feeding Technique
- FIG. 25-16 Father bottle feeding infant son. Note angled bottle that ensures that milk covers nipple area.
- SAFETY ALERT
- Common Concerns
- Bottles and Nipples
- FIG. 25-17 Positions for burping an infant. A, Sitting. B, On the shoulder. C, Across the lap.
- Infant Formulas
- Commercial Formulas
- SAFETY ALERT
- Formula Preparation
- SAFETY ALERT
- Vitamin and Mineral Supplementation
- Weaning
- Complementary Feeding: Introducing Solid Foods
- TEACHING FOR SELF-MANAGEMENT
- Formula Preparation and Feeding
- Formula Preparation
- Feeding Techniques and Tips
- Safety Tips
- COMMUNITY ACTIVITY
- KEY POINTS
- References
- Unit Seven Complications of Pregnancy
- Interactive Review—Unit 7
- Chapter 26 Assessment for Risk Factors in Pregnancy
- Learning Objectives
- Assessment of Risk Factors
- BOX 26-1 CATEGORIES OF HIGH RISK FACTORS
- BIOPHYSICAL FACTORS
- PSYCHOSOCIAL FACTORS
- SOCIODEMOGRAPHIC FACTORS
- ENVIRONMENTAL FACTORS
- BOX 26-2 SPECIFIC PREGNANCY PROBLEMS AND RELATED RISK FACTORS
- POLYHYDRAMNIOS
- INTRAUTERINE GROWTH RESTRICTION
- OLIGOHYDRAMNIOS
- CHROMOSOMAL ABNORMALITIES
- Psychologic Considerations Related to High Risk Pregnancy
- Antepartum Testing
- BOX 26-3 COMMON INDICATIONS FOR ANTEPARTUM TESTING
- OBSTETRIC INDICATIONS
- MEDICAL INDICATIONS
- Biophysical Assessment
- Daily Fetal Movement Count
- NURSING ALERT
- Ultrasonography
- 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.
- TABLE 26-1 MAJOR USES OF ULTRASONOGRAPHY DURING PREGNANCY
- Levels of Ultrasonography
- Indications For Use
- FIG. 26-2 Appropriate planes of sections (dotted lines) for head circumference (HC) and abdominal circumference (AC).
- Fetal Heart Activity
- Gestational Age
- Fetal Growth
- Fetal Anatomy
- Fetal Genetic Disorders and Physical Anomalies
- Placental Position and Function
- 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.
- Adjunct to Other Invasive Tests
- Fetal Well-being
- FIG. 26-4 Umbilical artery velocity waveform.
- Doppler Blood Flow Analysis
- Amniotic Fluid Volume
- TABLE 26-2 BIOPHYSICAL PROFILE SCORING
- Biophysical Profile
- TABLE 26-3 BIOPHYSICAL PROFILE MANAGEMENT
- EVIDENCE-BASED PRACTICE
- “How’s My Baby Doing?”
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- Nursing Role
- CLINICAL REASONING
- Fetal Assessment Using the Biophysical Profile
- Magnetic Resonance Imaging
- Biochemical Assessment
- Amniocentesis
- NURSING ALERT
- Indications for Use
- Genetic Concerns
- FIG. 26-5 A, Amniocentesis and laboratory use of amniotic fluid aspirant. B, Transabdominal amniocentesis.
- TABLE 26-4 SUMMARY OF BIOCHEMICAL MONITORING TECHNIQUES
- BOX 26-4 FETAL RIGHTS
- BOX 26-5 ELIMINATION OF MATERNAL AGE AS AN INDICATION FOR INVASIVE PRENATAL DIAGNOSIS
- Fetal Maturity
- Fetal Hemolytic Disease
- Chorionic Villus Sampling
- FIG. 26-6 Transcervical chorionic villus sampling.
- FIG. 26-7 Transabdominal chorionic villus sampling.
- NURSING ALERT
- Percutaneous Umbilical Blood Sampling
- FIG. 26-8 Technique for percutaneous umbilical blood sampling guided by ultrasound.
- Maternal Assays
- Alpha-Fetoprotein
- FIG. 26-9 Umbilical cord as seen on ultrasound at 26 weeks of gestation.
- Multiple Marker Screens
- Coombs Test
- Antepartal Assessment Using Electronic Fetal Monitoring
- Indications
- BOX 26-6 INDICATIONS FOR ELECTRONIC FETAL MONITORING ASSESSMENT USING THE NONSTRESS TEST AND THE CONTRACTION STRESS TEST
- Nonstress Test
- Procedure
- Interpretation
- FIG. 26-10 Reactive nonstress test.
- FIG. 26-11 Nonnreactive nonstress test.
- Vibroacoustic Stimulation
- Contraction Stress Test
- BOX 26-7 INTERPRETATION OF THE NONSTRESS TEST
- NURSING ALERT
- Procedure
- Nipple-Stimulated Contraction Test
- 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.
- FIG. 26-13 Contraction stress test (CST). A, Negative CST. B, Positive CST.
- Oxytocin-Stimulated Contraction Test
- Interpretation
- BOX 26-8 INTERPRETATION OF THE CONTRACTION STRESS TEST
- Nurses’ Role in Assessment of the High Risk Pregnancy
- KEY POINTS
- References
- Chapter 27 Hypertensive Disorders in Pregnancy
- Learning Objectives
- Significance and Incidence
- Morbidity and Mortality
- Classification
- TABLE 27-1 CLASSIFICATION OF HYPERTENSIVE STATES OF PREGNANCY
- Gestational Hypertension
- TABLE 27-2 DIFFERENTIATION BETWEEN MILD AND SEVERE PREECLAMPSIA
- TABLE 27-3 COMMON LABORATORY CHANGES IN PREECLAMPSIA
- Preeclampsia
- Eclampsia
- COMMUNITY ACTIVITY
- Chronic Hypertension
- Chronic Hypertension with Superimposed Preeclampsia
- Preeclampsia
- Etiology
- BOX 27-1 RISK FACTORS FOR PREECLAMPSIA
- Pathophysiology
- FIG. 27-1 Etiology of preeclampsia: disruptions in placental perfusion and endothelial cell dysfunction
- FIG. 27-2 Consequences of endothelial cell dysfunction. DIC, Disseminated vascular coagulation; IUGR, intrauterine growth restriction, N/V, nausea/vomiting; RUQ, right upper quadrant.
- HELLP Syndrome
- CLINICAL REASONING
- Severe Complications of Preeclampsia
- NURSING ALERT
- Care Management
- Identifying and Preventing Preeclampsia
- EVIDENCE-BASED PRACTICE
- Preeclampsia Risk Factors and Prevention
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- Health Assessment and Screening
- Interview
- NURSING PROCESS
- Mild Preeclampsia
- Assessment
- Nursing Diagnoses
- Anxiety related to:
- Ineffective Individual and Family Coping related to:
- Powerlessness related to:
- Ineffective Tissue Perfusion related to:
- Risk for Injury (to fetus) related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- Physical Examination
- FIG. 27-3 Assessment of pitting edema of lower extremities. A, +1; B, +2; C, +3; D, +4.
- 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.
- TABLE 27-4 ASSESSING DEEP TENDON REFLEXES
- Mild Gestational Hypertension and Mild Preeclampsia
- Home Care
- Maternal and Fetal Assessment
- TEACHING FOR SELF-MANAGEMENT
- Assessing and Reporting Clinical Signs of Preeclampsia
- Activity Restriction
- Diet
- Severe Gestational Hypertension and Severe Preeclampsia
- TEACHING FOR SELF-MANAGEMENT
- Coping with Activity Restriction
- At Home
- In the Hospital
- TEACHING FOR SELF-MANAGEMENT
- Diet for Preeclampsia
- Intrapartum Care
- NURSING CARE PLAN
- Severe Preeclampsia
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Other Possible Nursing Diagnoses
- Expected Outcomes
- Nursing Interventions/Rationales
- Pharmacologic Therapy
- Magnesium Sulfate
- BOX 27-2 HOSPITAL PRECAUTIONARY MEASURES
- NURSING ALERT
- NURSING ALERT
- BOX 27-3 CARE OF THE WOMAN WITH PREECLAMPSIA RECEIVING MAGNESIUM SULFATE
- Client and Family Teaching
- Administration
- Maternal and Fetal Assessments
- Reportable Conditions
- Emergency Measures
- Documentation
- SAFETY ALERT
- Antihypertensive Medications
- Postpartum Care
- TABLE 27-5 PHARMACOLOGIC CONTROL OF HYPERTENSION IN PREGNANCY
- Future Health Care
- Eclampsia
- EMERGENCY
- Eclampsia
- Tonic-Clonic Convulsion Signs
- Intervention
- After Convulsion
- Immediate Care
- NURSING ALERT
- Chronic Hypertension
- KEY POINTS
- References
- Chapter 28 Antepartum Hemorrhagic Disorders
- Learning Objectives
- Early Pregnancy Bleeding
- Miscarriage (Spontaneous Abortion)
- Incidence and Etiology
- FIG. 28-1 Miscarriage. A, Threatened. B, Inevitable. C, Incomplete. D, Complete. E, Missed.
- Types
- Clinical Manifestations
- TABLE 28-1 ASSESSING MISCARRIAGE AND THE USUAL MANAGEMENT
- Management
- Initial Care
- NURSING PROCESS
- Miscarriage
- Assessment
- Nursing Diagnoses
- Anxiety or Fear related to:
- Deficient Fluid Volume related to:
- Acute Pain related to:
- Anticipatory Grieving related to:
- Situational Low Self-Esteem related to:
- Risk for Infection related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- EVIDENCE-BASED PRACTICE
- The Precarious First Trimester
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- Follow-up Care at Home
- NURSING ALERT
- TEACHING FOR SELF-MANAGEMENT
- Discharge Teaching for the Woman After Early Miscarriage
- COMMUNITY ACTIVITY
- Recurrent Premature Dilation of the Cervix (Incompetent Cervix)
- Etiology
- Diagnosis
- Management
- FIG. 28-2 A, Cerclage correction of premature dilation of the cervical os. B, Cross-sectional view of closed internal os.
- Follow-up Care at Home
- 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).
- Ectopic Pregnancy
- Incidence and Etiology
- FIG. 28-4 Ectopic pregnancy, abdominal.
- Clinical Manifestations
- Tubal Pregnancy Management
- Initial Care
- Medical Management
- NURSING ALERT
- BOX 28-1 NURSING CONSIDERATIONS FOR WOMEN UNDERGOING METHOTREXATE TREATMENT FOR ECTOPIC PREGNANCY
- ADMINISTRATION
- CLIENT AND FAMILY TEACHING
- FOLLOW-UP
- Surgical Management
- Follow-up Care
- Hydatidiform Mole (Molar Pregnancy)
- Incidence and Etiology
- Types
- 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).
- Clinical Manifestations
- FIG. 28-6 Gross specimen in a woman treated for complete hydatidiform mole with primary hysterectomy.
- 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.
- Diagnosis
- Management
- NURSING ALERT
- Follow-up Care
- Late Pregnancy Bleeding
- Placenta Previa
- Incidence and Etiology
- Clinical Manifestations
- FIG. 28-8 Types of placenta previa. A, Complete. B, Marginal.
- TABLE 28-2 SUMMARY OF FINDINGS: ABRUPTIO PLACENTAE AND PLACENTA PREVIA
- Maternal and Fetal Outcomes
- Diagnosis
- Management
- Expectant Management
- NURSING PROCESS
- Placenta Previa
- Assessment
- Nursing Diagnoses
- Decreased Cardiac Output related to:
- Deficient Fluid Volume related to:
- Ineffective Peripheral Tissue Perfusion related to:
- Anxiety or Fear related to:
- Grieving related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- Home Care
- Active Management
- Premature Separation of Placenta (Abruptio Placentae [Placental Abruption])
- Incidence and Etiology
- FIG. 28-9 Abruptio placentae. Premature separation of normally implanted placenta. A large retroplacental clot is present.
- CLINICAL REASONING
- Third-Trimester Vaginal Bleeding
- Classification
- Clinical Manifestations
- FIG. 28-10 Abruptio placentae, showing partial and complete placental separation.
- Maternal and Fetal Outcomes
- Diagnosis
- Management
- Expectant Management
- Active management
- Cord Insertion and Placental Variations
- Clotting Disorders in Pregnancy
- Normal Clotting
- Clotting Problems
- Disseminated Intravascular Coagulation
- FIG. 28-11 Vasa previa (velamentous insertion of cord). Arrow shows velamentous cord insertion in the placenta.
- FIG. 28-12 Cord insertion and placental variations A, Battledore placenta. B, Placenta succenturiate.
- Management
- BOX 28-2 CLINICAL MANIFESTATIONS AND LABORATORY SCREENING RESULTS FOR WOMEN WITH DISSEMINATED INTRAVASCULAR COAGULATION
- POSSIBLE PHYSICAL EXAMINATION FINDINGS
- LABORATORY COAGULATION SCREENING TEST RESULTS
- KEY POINTS
- References
- Chapter 29 Endocrine and Metabolic Disorders in Pregnancy
- Learning Objectives
- Diabetes Mellitus
- Pathogenesis
- Classification
- White’s Classification of Diabetes in Pregnancy
- Metabolic Changes Associated with Pregnancy
- TABLE 29-1 WHITE’S CLASSIFICATION OF DIABETES IN PREGNANCY (MODIFIED)
- 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.
- Pregestational Diabetes Mellitus
- Preconception Counseling
- COMMUNITY ACTIVITY
- Maternal Risks and Complications
- TABLE 29-2 DIFFERENTIATION OF HYPOGLYCEMIA (INSULIN SHOCK) AND HYPERGLYCEMIA (DIABETIC KETOACIDOSIS)
- Fetal and Neonatal Risks and Complications
- Care Management
- Antepartum
- NURSING PROCESS
- Pregestational Diabetes
- Assessment
- History
- Interview
- Physical Examination
- Laboratory Tests
- Nursing Diagnoses
- Deficient Knowledge related to:
- Anxiety, Fear, Dysfunctional Grieving, Powerlessness, Disturbed Body Image, Situational Low Self-esteem, Spiritual Distress, Ineffective Role Performance, and Interrupted Family Processes related to:
- Risk for Injury (to Fetus) related to:
- Risk for Injury (to Mother) related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Antepartum
- Intrapartum
- Postpartum
- Evaluation
- FIG. 29-2 A, Clinic nurse collects blood to determine glucose level. B, Nurse interprets glucose value displayed by monitor.
- TABLE 29-3 TARGET BLOOD GLUCOSE LEVELS DURING PREGNANCY
- Diet
- TEACHING FOR SELF-MANAGEMENT
- Dietary Management of Diabetic Pregnancy
- Exercise
- NURSING ALERT
- Insulin Therapy
- TEACHING FOR SELF-MANAGEMENT
- Self-Administration of Insulin
- Procedure for Mixing Nph (Intermediate-Acting) and Regular (Short-Acting) Insulin
- Procedure for Self-Injection of Insulin
- BOX 29-1 HELPFUL HINTS FOR USING INSULIN
- TABLE 29-4 COMMON INSULIN PREPARATIONS
- FIG. 29-3 Insulin pump shows basal rate for pregnant women with diabetes.
- Monitoring Blood Glucose Levels
- SAFETY ALERT
- NURSING ALERT
- TEACHING FOR SELF-MANAGEMENT
- Self-Testing of Blood Glucose Level
- TEACHING FOR SELF-MANAGEMENT
- Treatment for Hypoglycemia
- TEACHING FOR SELF-MANAGEMENT
- What to Do When Illness Occurs
- Urine Testing
- Complications Requiring Hospitalization
- Fetal Surveillance
- Determination of Birth Date and Mode of Birth
- Intrapartum
- Postpartum
- Gestational Diabetes Mellitus
- Fetal Risks
- Screening for Gestational Diabetes Mellitus
- Care Management
- Antepartum
- Diet
- Exercise
- EVIDENCE-BASED PRACTICE
- Stricter Glucose Tolerance Test in Pregnancy Will Mean Increased Diagnoses of Gestational Diabetes
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- Monitoring Blood Glucose Levels
- Medications for Controlling Blood Glucose Levels
- NURSING CARE PLAN
- The Pregnant Woman with Gestational Diabetes
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- FIG. 29-4 Screening and diagnosis for gestational diabetes.
- CLINICAL REASONING
- Causes of Hyperglycemia in a Woman with Gestational Diabetes Mellitus (GDM)
- Fetal Surveillance
- Intrapartum
- Postpartum
- Hyperemesis Gravidarum
- Etiology
- Clinical Manifestations
- Care Management
- Assessment
- Initial Care
- Follow-up Care
- TEACHING FOR SELF-MANAGEMENT
- Diet for Hyperemesis
- Thyroid Disorders
- Hyperthyroidism
- NURSING ALERT
- Hypothyroidism
- NURSING ALERT
- Nursing Care
- Maternal Phenylketonuria
- KEY POINTS
- References
- Chapter 30 Medical-Surgical Problems in Pregnancy
- Learning Objectives
- Cardiovascular Disorders
- BOX 30-1 MATERNAL CARDIAC DISEASE RISK GROUPS
- Group I (Low Risk)
- Group II (Moderate Risk)
- Group III (High Risk)
- Congenital Cardiac Disease
- Septal Defects
- Atrial Septal Defect
- Ventricular Septal Defect
- Patent Ductus Arteriosus
- Acyanotic Lesions
- Coarctation of the Aorta
- Cyanotic Lesions
- Tetralogy of Fallot
- Acquired Cardiac Disease
- Mitral Valve Stenosis
- BOX 30-2 PROPHYLAXIS FOR BACTERIAL ENDOCARDITIS DURING LABOR AND BIRTH
- High Risk Clients
- Penicillin-Allergic Clients
- Moderate Risk Clients
- Penicillin-Allergic Clients
- Mitral Valve Prolapse
- Aortic Stenosis
- Ischemic Heart Disease
- Myocardial Infarction
- Other Cardiac Diseases and Conditions
- Primary Pulmonary Hypertension
- Marfan Syndrome
- Infective Endocarditis
- Eisenmenger Syndrome
- Peripartum Cardiomyopathy
- Valve Replacement
- Heart Transplantation
- Care Management
- Antepartum
- SIGNS OF POTENTIAL COMPLICATIONS
- Cardiac Decompensation
- Pregnant Woman: Subjective Symptoms
- Nurse: Objective Signs
- NURSING PROCESS
- Cardiac Disease
- Assessment
- Interview
- Physical Examination
- Laboratory and Diagnostic Tests
- Nursing Diagnoses
- Prenatal Period
- Fear related to
- Deficient Knowledge related to
- Activity Intolerance related to
- Risk for Self-care Deficit (bathing, grooming, and dressing) related to
- Impaired Home Maintenance related to
- Intrapartum Period
- Anxiety related to
- Fear related to
- Risk for Impaired Gas Exchange related to
- Postpartum Period
- Risk for Impaired Gas Exchange related to
- Risk for Excess Fluid Volume related to
- Ineffective Breastfeeding related to
- Expected Outcomes of Care
- Plan of Care and Interventions
- The woman with class I or II heart disease
- The woman with class II cardiac disease
- The woman with class III cardiac disease
- Other considerations
- Evaluation
- TABLE 30-1 SELECTED DRUGS USED IN TREATMENT OF CARDIAC DISORDERS IN THE PREGNANT WOMAN
- Heart Surgery During Pregnancy
- Intrapartum
- NURSING CARE PLAN
- The Pregnant Woman with Heart Disease
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- NURSING ALERT
- LEGAL TIP
- Cardiac and Metabolic Emergencies
- Postpartum
- NURSING ALERT
- Cardiopulmonary Resuscitation of the Pregnant Woman
- EMERGENCY
- Cardiopulmonary Resuscitation for the Pregnant Woman
- Airway
- Breathing
- Circulation
- Defibrillation
- Relief of Foreign Body Airway Obstruction
- 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
- Other Medical Disorders in Pregnancy
- Anemia
- Iron Deficiency Anemia
- Folate Deficiency Anemia
- Sickle Cell Hemoglobinopathy
- COMMUNITY ACTIVITY
- SAFETY ALERT
- Thalassemia
- Pulmonary Disorders
- Asthma
- Cystic Fibrosis
- EVIDENCE-BASED PRACTICE
- The 2009 Influenza A (H1N1) Pandemic and Pregnancy
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- NURSING PROCESS
- Asthma
- Assessment
- History
- Physical examination
- Laboratory tests
- Nursing Diagnoses
- Risk for Injury (to the fetus) related to
- Anxiety related to
- Ineffective Airway Clearance related to
- Deficient Knowledge related to
- Expected Outcomes of Care
- Plan of Care and Interventions
- Home care
- Evaluation
- TABLE 30-2 MEDICATIONS USED IN PREGNANCY IN WOMEN WITH ASTHMA
- Acute Respiratory Distress Syndrome
- NURSING ALERT
- Integumentary Disorders
- SAFETY ALERT
- FIG. 30-2 Woman with pruritic urticarial papules and plaques of pregnancy. Lesions also are present on her arms, back, abdomen, and buttocks.
- Neurologic Disorders
- Epilepsy
- SAFETY ALERT
- Multiple Sclerosis
- Bell Palsy
- Autoimmune Disorders
- Systemic Lupus Erythematosus
- Myasthenia Gravis
- Gastrointestinal Disorders
- Cholelithiasis and Cholecystitis
- TEACHING FOR SELF-MANAGEMENT
- Nutritional Counseling for the Pregnant Woman with Cholecystitis or Cholelithiasis
- Inflammatory Bowel Disease
- Urinary Tract Infections
- Asymptomatic Bacteriuria
- Cystitis
- CLINICAL REASONING
- Asymptomatic Bacteriuria
- Pyelonephritis
- Client Education
- TEACHING FOR SELF-MANAGEMENT
- Prevention of Urinary Tract Infections
- Surgery During Pregnancy
- Appendicitis
- Care Management
- Hospital Care
- Home Care
- BOX 30-3 DISCHARGE TEACHING FOR HOME CARE AFTER SURGERY
- KEY POINTS
- References
- Chapter 31 Obstetric Critical Care
- Learning Objectives
- Obstetric Intensive Care Unit
- LEGAL TIP
- Nursing Assignments
- LEGAL TIP
- Client Care Standards
- Equipment and Expertise
- LEGAL TIP
- Legal Review
- BOX 31-1 COMPLICATIONS OF PREGNANCY THAT INDICATE THE NEED FOR CRITICAL CARE
- Physiologic Changes in Pregnancy
- Cardiovascular Changes
- TABLE 31-1 CARDIOVASCULAR CHANGES DURING PREGNANCY
- Colloid Osmotic Pressure
- TABLE 31-2 COLLOID OSMOTIC (ONCOTIC) PRESSURE VALUES
- Respiratory Changes
- Hematologic Changes
- Systemic Vascular Resistance
- TABLE 31-3 CARDIAC OUTPUT IN RELATION TO MATERNAL POSITION
- Hemodynamic Monitoring
- Anatomic and Physiologic Characteristics of Circulation
- FIG. 31-1 Diagram of heart with position of pulmonary artery catheter.
- Cardiac Output
- Positional Changes
- NURSING ALERT
- Cardiac Output Determinants
- FIG. 31-2 Relation of preload to cardiac output. Ventricular function (Starling) curve for heart, showing both normal function and during failure.
- SAFETY ALERT
- FIG. 31-3 Relation of afterload to cardiac output when preload is maintained constant. As afterload increases, cardiac output decreases.
- Invasive Hemodynamic Monitoring
- Pulmonary Artery Catheter
- FIG. 31-4 Standard triple-lumen flow-directed pulmonary artery catheter.
- Venous Access
- PROCEDURE
- How to Set Up, Calibrate, and Zero-Reference Pressure Lines
- Waveforms and Pressure Readings
- FIG. 31-5 Location of phlebostatic axis and zeroing.
- BOX 31-2 PULMONARY ARTERY CATHETER (PAC) PROTOCOL
- Setup
- Client Preparation for Insertion
- Nursing Management During Insertion
- Nursing Assessments
- Nursing Management for Catheter Removal
- Documentation
- FIG. 31-6 Components of hemodynamic monitoring system: pressurized tubing, pressure transducer, and hemodynamic monitor.
- Arterial Pressure Catheter
- 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).
- PROCEDURE
- Obtaining a Pulmonary Capillary Wedge Pressure Reading
- BOX 31-3 TROUBLESHOOTING PULMONARY ARTERY CATHETER PROBLEMS
- Spontaneous Wedging: Pcwp Waveform Appears on Monitor Screen
- Migration of Catheter Backward: Right Ventricular Waveform on Screen
- Suspected Balloon Rupture: Absence of Resistance Felt When Inflating Balloon or Inability to Obtain Pcwp Reading
- BOX 31-4 ALLEN’S TEST PROCEDURE
- FIG. 31-8 Arterial waveform.
- Pressure Lines
- Data Collection
- PROCEDURE
- Making and Recording Hemodynamic Assessments
- Oxygenation
- SaO2 Monitoring
- PROCEDURE
- Thermodilution Procedure for Measuring Cardiac Output
- SvO2 Monitoring
- NURSING ALERT
- Central Venous Pressure Lines
- Interpretation of Hemodynamic Data
- TABLE 31-4 NORMAL HEMODYNAMIC VALUES IN PREGNANCY
- TABLE 31-5 CENTRAL HEMODYNAMIC NORMAL VALUES
- BOX 31-5 CASE STUDIES
- Case 1
- Evaluation
- Case 2
- Evaluation
- Case 3
- Evaluation
- Pulmonary Edema
- CLINICAL REASONING
- Nursing Care of the Critically Ill Pregnant Woman
- Case I
- Case II
- Trauma During Pregnancy
- Significance
- Maternal Physiologic Characteristics
- NURSING ALERT
- TABLE 31-6 MATERNAL ADAPTATIONS DURING PREGNANCY AND RELATION TO TRAUMA
- Fetal Physiologic Characteristics
- Mechanisms of Trauma
- Blunt Abdominal Trauma
- NURSING ALERT
- Penetrating Abdominal Trauma
- Thoracic Trauma
- Immediate Stabilization
- NURSING ALERT
- Primary Survey
- NURSING ALERT
- Secondary Survey
- BOX 31-6 GLASGOW COMA SCALE
- BOX 31-7 PHYSICAL EXAMINATION OF THE PREGNANT TRAUMA VICTIM
- Head
- Neck
- Chest
- Abdomen
- Lower Back
- Extremities
- Vagina
- Urinary Tract
- Electronic Fetal Monitoring
- LEGAL TIP
- Care of the Pregnant Woman Involved in a Minor Trauma Situation
- Fetal-Maternal Hemorrhage
- Ultrasound
- Radiation Exposure
- Perimortem Cesarean Birth
- Family-centered Obstetric Critical Care
- Maternal Death
- KEY POINTS
- References
- Chapter 32 Mental Health Disorders and Substance Abuse in Pregnancy
- Learning Objectives
- Mental Health Disorders During Pregnancy
- Mood Disorders
- NURSING ALERT
- COMMUNITY ACTIVITY
- Collaborative Care
- Antidepressant Medications
- TABLE 32-1 ANTIDEPRESSANT MEDICATIONS
- Anxiety Disorders
- Collaborative Care
- TABLE 32-2 ANTIANXIETY MEDICATIONS
- Special Considerations for Medications During Pregnancy
- TABLE 32-3 MOOD STABILIZERS
- Substance Abuse During Pregnancy
- Prevalence
- Risk Factors
- Barriers to Treatment
- Legal Considerations
- LEGAL TIP
- Drug Testing During Pregnancy
- Commonly Abused Drugs
- Nicotine and Caffeine
- Alcohol
- Marijuana
- Cocaine and Methamphetamine
- Opiates
- BOX 32-1 CAGE QUESTIONNAIRE
- Care Management
- Screening
- BOX 32-2 SCREENING WITH THE 4P’s PLUS
- Assessment
- Collaborative Care
- NURSING PROCESS
- Substance Abuse
- Assessment
- Nursing Diagnoses
- Risk for Imbalanced Nutrition: Less than Body Requirements related to:
- Risk for injury (to self, fetus, or newborn) related to:
- Risk for infection related to:
- Self-care deficit (bathing or hygiene) related to:
- Ineffective coping related to:
- Risk for Impaired Parent-infant Attachment related to:
- Hopelessness related to:
- Powerlessness related to:
- Risk for suicide related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- Intrapartum and Postpartum Care Considerations
- Postpartum Psychologic Complications
- Mood Disorders
- Etiology and Risk Factors
- BOX 32-3 RISK FACTORS FOR POSTPARTUM DEPRESSION
- Postpartum Depression Without Psychotic Features
- Medical Management
- Postpartum Depression with Psychotic Features
- NURSING ALERT
- Medical Management
- TABLE 32-4 ANTIPSYCHOTIC MEDICATIONS
- Care Management
- SAFETY ALERT
- Postpartum Depression Screening Tools
- NURSING CARE PLAN
- Postpartum Depression (PPD)
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Care on the Postpartum Unit
- TEACHING FOR SELF-MANAGEMENT
- Activities to Prevent Postpartum Depression
- NURSING PROCESS
- Postpartum Depression
- Assessment
- Nursing Diagnoses
- Situational Low Self- esteem (in the mother) related to:
- Disabled Family Coping related to:
- Risk for Impaired Parenting related to:
- Risk for Injury (to the newborn) related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- NURSING ALERT
- Nursing Care in the Home and Community
- Referral
- EVIDENCE-BASED PRACTICE
- Assessing for Postpartum Depression
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Evidence
- Implications for Practice
- References
- Providing Safety
- Psychiatric Hospitalization
- NURSING ALERT
- SAFETY ALERT
- Psychotropic Medications
- LEGAL TIP
- Commitment for Psychiatric Care
- Psychotropic Medications and Lactation
- CLINICAL REASONING
- Postpartum Depression
- Other Treatments for PPD
- NURSING ALERT
- Postpartum Onset of Anxiety Disorders
- Medical Management
- Nursing Considerations
- KEY POINTS
- References
- Chapter 33 Labor and Birth Complications
- Learning Objectives
- Preterm Labor and Birth
- Preterm Birth Versus Low Birth Weight
- BOX 33-1 RISK FACTORS FOR SPONTANEOUS PRETERM LABOR
- BOX 33-2 COMMON CAUSES OF INDICATED PRETERM BIRTH
- Predicting Spontaneous Preterm Labor and Birth
- Biochemical Marker
- Cervical Length
- Causes of Preterm Labor and Birth
- NURSING CARE PLAN
- Preterm Labor
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Care Management
- Prevention
- Early Recognition and Diagnosis
- BOX 33-3 SIGNS AND SYMPTOMS OF PRETERM LABOR
- Uterine Activity
- Discomfort
- Vaginal Discharge
- TEACHING FOR SELF-MANAGEMENT
- What to Do If Symptoms of Preterm Labor Occur
- FIG. 33-1 A nurse teaching a couple signs and symptoms of preterm labor.
- COMMUNITY ACTIVITY
- Lifestyle Modifications
- Activity Restriction
- Restriction of Sexual Activity
- BOX 33-4 ADVERSE EFFECTS OF BED REST
- Maternal Effects (Physical)
- Maternal Effects (Psychosocial)
- Effects on Support System
- Home Care
- EVIDENCE-BASED PRACTICE
- Preterm Labor: Is Bed Rest (Especially in the Hospital) Really Best?
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- 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.
- TEACHING FOR SELF-MANAGEMENT
- Activities for Children of Women on Activity Restriction
- BOX 33-5 CONTRAINDICATIONS TO TOCOLYSIS
- Maternal
- Fetal
- Suppression of Uterine Activity
- SAFETY ALERT
- BOX 33-6 NURSING CARE FOR THE WOMAN RECEIVING TOCOLYTIC THERAPY
- MEDICATION GUIDE
- Tocolytic Therapy for Preterm Labor
- SAFETY ALERT
- Promotion of Fetal Lung Maturity
- MEDICATION GUIDE
- Antenatal Glucocorticoid Therapy with Betamethasone or Dexamethasone
- Action
- Indication
- Dosage and Route
- Adverse Effects
- Nursing Considerations
- NURSING ALERT
- Management of Inevitable Preterm Birth
- Fetal and Early Neonatal Loss
- Premature Rupture of Membranes
- Care Management
- TEACHING FOR SELF-MANAGEMENT
- Home Care Instructions for the Woman with Preterm Premature Rupture of Membranes
- Chorioamnionitis
- Dysfunctional Labor (Dystocia)
- Abnormal Uterine Activity
- Hypertonic Uterine Dysfunction
- Hypotonic Uterine Dysfunction
- TABLE 33-1 DYSFUNCTIONAL LABOR: PRIMARY AND SECONDARY POWERS
- Secondary Powers
- Abnormal Labor Patterns
- TABLE 33-2 ABNORMAL LABOR PATTERNS
- Precipitous Labor
- Alterations in Pelvic Structure
- Pelvic Dystocia
- Soft-Tissue Dystocia
- Fetal Causes
- Anomalies
- Cephalopelvic Disproportion
- Malposition
- BOX 33-7 MEASURES TO REDUCE BACK PAIN AND FACILITATE ROTATION OF FETAL HEAD DURING BACK LABOR-OCCIPUT POSTERIOR POSITION
- Measures to Reduce Back Pain During a Contraction
- Measures to Facilitate the Rotation of the Fetal Head (may also Reduce Back Pain)
- Malpresentation
- FIG. 33-3 Breech presentation. A, Frank breech. B, Complete breech. C, Single footling breech.
- 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.
- Multifetal Pregnancy
- Position of the Woman
- Psychologic Responses
- Care Management
- LEGAL TIP
- Standard of Care—Labor and Birth Complications
- Obesity
- Care Management
- NURSING PROCESS
- Dysfunctional Labor
- Assessment
- Past History
- Physical
- Psychologic
- Nursing Diagnoses
- Risk for Injury (maternal or fetal) related to
- Powerlessness related to
- Risk for Infection related to
- Ineffective Individual Coping related to
- EXPECTED OUTCOMES OF CARE
- Plan of Care and Interventions
- Evaluation
- 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.
- 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.
- Obstetric Procedures
- Version
- External Cephalic Version
- Internal Version
- Induction of Labor
- BOX 33-8 INDICATIONS AND CONTRAINDICATIONS FOR LABOR INDUCTION
- Indications
- Contraindications
- Relative Contraindications
- TABLE 33-3 BISHOP SCORE
- Cervical Ripening Methods
- Chemical Agents
- Mechanical and Physical Methods
- MEDICATION GUIDE
- Prostaglandin E1 (PGE1): Misoprostol (Cytotec)
- Action
- Indications
- Dosage and Administration
- Adverse Effects
- Nursing Considerations
- Alternative Methods
- MEDICATION GUIDE
- Prostaglandin E2 (PGE2): Dinoprostone (Cervidil Insert; Prepidil Gel)
- Action
- Indications
- Dosage and Route
- Adverse Effects
- Nursing Considerations
- Amniotomy
- PROCEDURE
- Assisting with Amniotomy
- Procedure
- Documentation
- NURSNG ALERT
- LEGAL TIP: Performing Amniotomy
- Oxytocin
- SAFETY ALERT
- MEDICATION GUIDE
- Oxytocin (Pitocin)
- Action
- Indications
- Dosage
- Adverse effects
- Nursing Considerations
- Nursing Considerations.
- FIG. 33-7 Woman in side-lying position receiving oxytocin.
- EMERGENCY
- Uterine Tachysystole with Oxytocin
- Signs
- Interventions (With Normal [Reassuring] Fhr)
- Interventions (Wth Abnormal [Nonreassuring] FHR)
- Resumption of Oxytocin After Resolution of Tachysystole
- NURSING ALERT
- Augmentation of Labor
- Operative vaginal birth
- Forceps-Assisted Birth
- Management
- NURSING ALERT
- Nursing Considerations
- FIG. 33-8 Types of forceps. Piper forceps are used to assist delivery of the head in a breech birth.
- FIG. 33-9 Outlet forceps-assisted extraction of the head.
- TABLE 33-4 DEFINITIONS FOR FORCEPS- AND VACUUM-ASSISTED BIRTHS
- Vacuum-Assisted Birth
- 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.
- Management
- BOX 33-9 ASSISTING WITH BIRTH BY VACUUM EXTRACTION
- Nursing Considerations
- Cesarean Birth
- BOX 33-10 SELECTED MEASURES TO REDUCE THE CESAREAN BIRTH RATE AND INCREASE THE RATE OF VAGINAL BIRTH AFTER CESAREAN
- Educate Women Regarding
- Establish Admission Criteria for Women in Labor that
- Use Appropriate Assessment Techniques to
- Initiate a Doula Program that
- Develop a Philosophy of Labor Management that
- Indications
- BOX 33-11 INDICATIONS FOR CESAREAN BIRTH
- Maternal
- Fetal
- Maternal-fetal
- Elective Cesarean Birth
- CLINICAL REASONING
- The Woman Seeking Elective Cesarean Birth
- Forced Cesarean Birth
- Surgical Techniques
- FIG. 33-11 Skin incisions for cesarean birth. A, Vertical. B, Horizontal (Pfannenstiel).
- FIG. 33-12 Uterine incisions for cesarean birth. A, Low transverse incision. B, Low vertical incision. C, Classic incision
- Complications and Risks
- Anesthesia
- Scheduled Cesarean Birth
- Unplanned Cesarean Birth
- Prenatal Preparation
- Preoperative Care
- 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.
- Intraoperative Care
- LEGAL TIP
- Disclosure of Client Information
- Immediate Postoperative Care
- 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.
- Postoperative or Postpartum Care
- TEACHING FOR SELF-MANAGEMENT
- Postpartum Pain Relief After Cesarean Birth
- Incisional
- Gas
- SAFETY ALERT
- SAFETY ALERT
- TEACHING FOR SELF-MANAGEMENT
- Signs of Postoperative Complications After Discharge Following Cesarean Birth
- Trial of Labor
- BOX 33-12 SELECTION CRITERIA FOR VAGINAL BIRTH AFTER CESAREAN
- Vaginal Birth After Cesarean
- Postterm Pregnancy, Labor, and Birth
- Maternal and Fetal Risks
- Care Management
- TEACHING FOR SELF-MANAGEMENT
- Postterm Pregnancy
- Obstetric Emergencies
- Meconium Stained Amniotic Fluid
- Care Management
- EMERGENCY
- Immediate Management of the Newborn with Meconium-Stained Amniotic Fluid
- Prior to Birth
- Immediately after Birth
- NURSING ALERT
- Shoulder Dystocia
- FIG. 33-15 Application of suprapubic pressure
- FIG. 33-16 McRoberts maneuver.
- Care Management
- Prolapsed Umbilical Cord
- Care Management
- 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.
- 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.
- Rupture of the Uterus
- EMERGENCY
- Prolapsed Umbilical Cord
- Signs
- Interventions
- Care Management
- Anaphylactoid Syndrome of Pregnancy
- EMERGENCY
- Anaphylactoid Syndrome of Pregnancy
- Signs
- Respiratory Distress
- Circulatory Collapse
- Hemorrhage
- Interventions
- Oxygenate
- Maintain Cardiac Output and Replace Fluid Losses
- Care Management
- KEY POINTS
- Breech Presentation Examination (read text)
- Breech Birth, Face (read text)
- Cesarean Delivery (read text)
- Shoulder Dystocia (read text)
- Umbilical Cord Prolapse (read text)
- References
- Chapter 34 Postpartum Complications
- Learning Objectives
- Postpartum Hemorrhage
- Definition and Incidence
- Etiology and Risk Factors
- CLINICAL REASONING
- Postpartum Hemorrhage
- Uterine Atony
- Lacerations of the Genital Tract
- BOX 34-1 RISK FACTORS AND CAUSES OF POSTPARTUM HEMORRHAGE
- Retained Placenta
- Nonadherent Retained Placenta
- Adherent Retained Placenta
- Inversion of the Uterus
- Subinvolution of the Uterus
- Care Management
- Medical Management
- Hypotonic Uterus
- NURSING ALERT
- MEDICATION GUIDE
- Drugs Used to Manage Postpartum Hemorrhage
- Bleeding with a Contracted Uterus
- Uterine Inversion
- BOX 34-2 HERBAL REMEDIES FOR POSTPARTUM HEMORRHAGE∗
- Subinvolution
- Herbal Remedies
- Nursing Interventions
- FIG. 34-1 Nursing assessments for postpartum bleeding. CBC, Complete blood count; IV, intravenous; uterotonics, medications to contract the uterus.
- BOX 34-3 NONINVASIVE ASSESSMENTS OF CARDIAC OUTPUT IN POSTPARTUM WOMEN WHO ARE BLEEDING
- Palpation Of Pulses (Rate, Quality, Equality)
- Auscultation
- Inspection
- Observation
- Measurement
- NURSING PROCESS
- Postpartum Hemorrhage
- Assessment
- Nursing Diagnoses
- Deficient Fluid Volume related to:
- Risk for Imbalanced Fluid Volume related to:
- Risk for Infection related to:
- Risk for Injury related to:
- Fear or Anxiety related to:
- Risk for Impaired Parenting related to:
- Ineffective (Peripheral) Tissue Perfusion related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- NURSING ALERT
- Hemorrhagic (Hypovolemic) Shock
- NURSING CARE PLAN
- Postpartum Hemorrhage
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- EMERGENCY
- Hemorrhagic Shock
- Intervention
- Medical Management
- Nursing Interventions
- Fluid or Blood Replacement Therapy
- LEGAL TIP
- Standard of Care for Bleeding Emergencies
- Coagulopathies
- Idiopathic Thrombocytopenic Purpura
- von Willebrand Disease
- Thromboembolic Disease
- Incidence and Etiology
- Clinical Manifestations
- FIG. 34-2 Deep venous thrombophlebitis.
- Medical Management
- Nursing Interventions
- NURSING ALERT
- Postpartum Infections
- BOX 34-4 PREDISPOSING FACTORS FOR POSTPARTUM INFECTION
- Preconception or Antepartal Factors
- Intrapartal Factors
- Endometritis
- Wound Infections
- Urinary Tract Infections
- FIG. 34-3 Postpartum infection—endometritis.
- FIG. 34-4 Mastitis.
- Mastitis
- BOX 34-5 NURSING DIAGNOSES FOR WOMEN EXPERIENCING POSTPARTUM INFECTION
- Deficient Knowledge related to:
- Impaired Tissue Integrity related to:
- Acute Pain related to:
- Interrupted Family Processes related to:
- Risk for Impaired Parenting related to:
- Care Management
- KEY POINTS
- References
- Unit Eight Newborn Complications
- Interactive Review—Unit 8
- Chapter 35 Acquired Problems of the Newborn
- Learning Objectives
- Birth Trauma
- Soft-Tissue Injuries
- TABLE 35-1 ANATOMIC CLASSIFICATION OF BIRTH INJURIES
- 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.
- FIG. 35-2 Swelling of the genitals and bruising of the buttocks after a breech birth. Note the position of the infant’s legs.
- FIG. 35-3 Fractured clavicle after shoulder dystocia.
- Skeletal Injuries
- FIG. 35-4 Erb-Duchenne palsy in newborn infant. The Moro reflex was absent in right upper extremity. Recovery was complete.
- Peripheral Nervous System Injuries
- FIG. 35-5 Facial paralysis 15 minutes after forceps birth. Absence of movement on affected side is especially noticeable when infant cries.
- Central Nervous System Injuries
- Infants of Mothers With Diabetes
- Pathophysiology
- NURSING PROCESS
- Birth Injury
- Assessment
- Nursing Diagnoses
- Infant
- Impaired Physical Mobility related to:
- Impaired Gas Exchange related to:
- Acute Pain related to:
- Injury related to:
- Parents and Family
- Anxiety related to Deficient Knowledge Regarding:
- Grieving related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- Congenital Anomalies
- FIG. 35-6 Macrosomia.
- Macrosomia
- Birth Trauma and Perinatal Hypoxia
- Respiratory Distress Syndrome
- Hypoglycemia
- Hypocalcemia and Hypomagnesemia
- Cardiomyopathy
- Hyperbilirubinemia and Polycythemia
- Nursing Care
- TABLE 35-2 RISK FACTORS FOR NEONATAL SEPSIS
- Neonatal Infections
- Sepsis
- NURSING CARE PLAN
- The Infant of the Mother with Pregestational or Gestational Diabetes
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Care Management
- NURSING PROCESS
- The Infant with Suspected Sepsis
- Assessment
- Nursing Diagnoses
- Risk for Infection related to:
- Ineffective Thermoregulation related to:
- Impaired Tissue Integrity related to:
- Acute Pain related to:
- Parents and Family
- Anxiety, Fear, or Grieving related to:
- Risk for Impaired Parenting related to:
- Expected Outcomes of Care
- Newborn
- Parents
- Plan of Care and Interventions
- Evaluation
- TABLE 35-3 SIGNS OF SEPSIS∗
- Preventive Measures
- Curative Measures
- NURSING ALERT
- Transplacental Infections
- Toxoplasmosis
- BOX 35-1 TRANSPLACENTAL (TORCH) INFECTIONS AFFECTING NEWBORNS
- Gonorrhea
- Syphilis
- FIG. 35-7 Neonatal syphilis lesions on hands and feet.
- Medical Management
- Prognosis
- Varicella-Zoster
- Hepatitis B Virus
- NURSING ALERT
- Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome
- Rubella Infection
- SAFETY ALERT
- Cytomegalovirus Infection
- FIG. 35-8 Neonatal cytomegalovirus infection. Typical rash seen in a severely affected infant.
- Herpes Simplex Virus
- FIG. 35-9 Neonatal herpes simplex virus oral lesions.
- Parvovirus B19
- Enterovirus
- Bacterial Infections
- Group B Streptococci
- 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.
- Escherichia coli
- Staphylococcus aureus
- Listeriosis
- Chlamydia Trachomatis
- Fungal Infections
- Candidiasis
- COMMUNITY ACTIVITY
- Substance Abuse
- TABLE 35-4 SUMMARY OF NEONATAL EFFECTS OF COMMONLY ABUSED SUBSTANCES
- TABLE 35-5 SIGNS OF NEONATAL ABSTINENCE SYNDROME
- Tobacco
- Alcohol
- FIG. 35-11 Critical periods in human embryogenesis. Infant with fetal alcohol syndrome.
- BOX 35-2 DIAGNOSTIC CRITERIA FOR FETAL ALCOHOL SYNDROME AND ALCOHOL-RELATED EFFECTS
- FIG. 35-12 Infant with fetal alcohol syndrome.
- Heroin
- NURSING ALERT
- SAFETY ALERT
- Methadone
- Marijuana
- Cocaine
- BOX 35-3 FETAL AND NEONATAL EFFECTS OF MATERNAL COCAINE USE DURING PREGNANCY
- Methamphetamine
- MDMA/Ecstasy
- Other Drugs of Concern
- Caffeine
- Selective Serotonin Reuptake Inhibitors
- Care Management
- Nursing Care
- FIG. 35-13 Neonatal Abstinence Scoring System.
- BOX 35-4 CARE OF THE INFANT EXPERIENCING WITHDRAWAL (NEONATAL ABSTINENCE SYNDROME)
- NURSING CARE PLAN
- The Infant Experiencing Drug Withdrawal (Neonatal Abstinence Syndrome)
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- CLINICAL REASONING
- Narcotic Exposure in a Newborn
- KEY POINTS
- References
- Chapter 36 Hemolytic Disorders and Congenital Anomalies
- Learning Objectives
- Hyperbilirubinemia
- Physiologic Jaundice
- Pathologic Jaundice
- BOX 36-1 MONITORING FOR JAUNDICE AFTER EARLY DISCHARGE
- BOX 36-2 POTENTIAL CAUSES OF PATHOLOGIC HYPERBILIRUBINEMIA IN NEONATES
- Maternal Factors
- Fetal/Newborn Factors
- Hemolytic Disease of the Newborn
- Rh Incompatibility
- ABO Incompatibility
- Other Causes of Hemolytic Jaundice
- Acute Bilirubin Encephalopathy
- Care Management
- BOX 36-3 INDICATIONS FOR AMOUNT OF RHO(D) IMMUNOGLOBULIN TO BE ADMINISTERED
- 50 mcg
- 300 mcg
- More Than 300 mcg
- NURSING CARE PLAN
- The Infant with Hyperbilirubinemia
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Congenital Anomalies
- Cardiovascular System Anomalies
- TABLE 36-1 PHYSIOLOGIC CLASSIFICATION OF CARDIAC DEFECTS
- FIG. 36-1 Congenital heart abnormalities.
- Central Nervous System Anomalies
- Encephalocele and Anencephaly
- Spina Bifida
- FIG. 36-2 A, Myelomeningocele. Note absence of vertebral arches. B, Myelomeningocele (spina bifida).
- NURSING ALERT
- Hydrocephalus
- 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.
- Microcephaly
- Respiratory System Anomalies
- Laryngeal Web and Choanal Atresia
- Congenital Diaphragmatic Hernia
- 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.
- 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.
- Gastrointestinal System Anomalies
- Cleft Lip and Palate
- 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.
- Esophageal Atresia and Tracheoesophageal Fistula
- 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.
- NURSING ALERT
- 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.
- Omphalocele and Gastroschisis
- Gastrointestinal Obstruction
- FIG. 36-9 A, Omphalocele. B, Gastroschisis of bowel and stomach.
- Imperforate Anus
- 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.
- FIG. 36-11 Imperforate anus.
- Musculoskeletal System Anomalies
- Developmental Dysplasia of the Hip
- FIG. 36-12 Configuration and relationship of structures in developmental dysplasia of the hip.
- NURSING ALERT
- NURSING ALERT
- CLINICAL REASONING
- Developmental Dysplasia of the Hip (DDH)
- Clubfoot
- Polydactyly
- Genitourinary System Anomalies
- Hypospadias and Epispadias
- FIG. 36-13 Classification of hypospadias by position of the urethral meatus.
- FIG. 36-14 Hypospadias.
- Exstrophy of the Bladder
- FIG. 36-15 Exstrophy of bladder.
- FIG. 36-16 Ambiguous external genitals (i.e., structure can be enlarged clitoral hood and clitoris or malformed penis).
- Ambiguous Genitalia
- Care Management
- Prenatal Diagnosis
- Perinatal Diagnosis
- Postnatal Diagnosis
- Genetic Diagnosis
- Newborn Screening
- FIG. 36-17 A, Clinical features of Down syndrome. B, Simian crease.
- NURSING ALERT
- Cytogenetic Studies
- Dermatoglyphics
- Newborn Care
- NURSING PROCESS
- The Newborn with a Congenital Anomaly
- Assessment
- Newborn
- Parents
- Nursing Diagnoses
- Newborn
- Risk for Injury related to
- Risk for Infection related to
- Impaired Gas Exchange related to
- Imbalanced Nutrition: Less than Body Requirements related to
- Delayed Growth and Development related to
- Parents and Family
- Grieving or Spiritual Distress related to
- Compromised Family Coping related to
- Deficient Knowledge related to
- Anxiety related to
- Risk for Impaired Parenting related to
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- Parents and Family Support
- COMMUNITY ACTIVITY
- KEY POINTS
- References
- Chapter 37 Nursing Care of the High Risk Newborn
- Learning Objectives
- Preterm Infants
- BOX 37-1 CLASSIFICATION OF HIGH RISK INFANTS
- Classification According to Size
- Classification According to Gestational Age
- Classification According to Mortality
- Late Preterm Infants
- Physiologic Functions
- Respiratory Function
- NURSING ALERT
- Cardiovascular Function
- Maintaining Body Temperature
- BOX 37-2 SIGNS OF HYPOTHERMIA AND HYPERTHERMIA
- Hypothermia
- Hyperthermia
- Central Nervous System Function
- Maintaining Adequate Nutrition
- Maintaining Renal Function
- Maintaining Hematologic Status
- Resisting Infection
- Growth and Development Potential
- BOX 37-3 SIGNS AND SYMPTOMS OF INFECTION
- Care Management
- NURSING PROCESS
- Late Preterm and Preterm Infant Care
- Assessment
- Nursing Diagnoses
- Ineffective Breathing Pattern related to:
- Ineffective Thermoregulation related to:
- Risk for Infection related to:
- Anxiety (parental) related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- NURSING CARE PLAN
- The High Risk Preterm Newborn
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Physical Care
- Maintaining Body Temperature
- Care of the Hypothermic Infant
- FIG. 37-1 Preterm infant in polyethylene bag to protect against heat loss.
- Oxygen Therapy
- NURSING ALERT
- Hood Therapy
- Nasal Cannula
- FIG. 37-2 A, Infant under hood. B, Infant with nasal cannula.
- Continuous Positive Airway Pressure Therapy
- Mechanical Ventilation
- FIG. 37-3 Infant receiving ventilatory assistance with nasal continuous positive airway pressure (CPAP).
- FIG. 37-4 Infant intubated and on ventilator.
- Neonatal Resuscitation
- TABLE 37-1 COMMON METHODS FOR ASSISTED VENTILATION IN NEONATAL RESPIRATORY DISTRESSlowast;
- NURSING ALERT
- FIG. 37-5 Neonatal resuscitation flow algorithm.
- Surfactant Administration
- High-Frequency Ventilation.
- Additional Therapies
- Nitric Oxide Therapy.
- Extracorporeal Membrane Oxygenation (ECMO).
- MEDICATION GUIDE
- Surfactant Replacement
- Drug/Source
- Action
- Indications
- Dosage and Route
- Adverse Reactions
- Nursing Considerations
- Partial Liquid Ventilation (PLV).
- Weaning from Respiratory Assistance.
- Nutritional Care
- Type of Nourishment
- SAFETY ALERT
- Weight and Fluid Loss or Gain
- BOX 37-4 CALCULATION OF A WEIGHT LOSS OR GAIN
- Example 1
- Example 2
- Elimination Patterns
- Oral Feeding
- Gavage Feeding
- Gastrostomy Feedings
- 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.
- PROCEDURE
- Inserting a Gavage Feeding Tube
- Parenteral Nutrition
- Advancing Infant Feedings
- FIG. 37-7 Nonnutritive sucking.
- Nonnutritive Sucking
- Skin Care
- 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.
- Environmental Concerns
- NURSING ALERT
- Developmental Care
- Positioning
- FIG. 37-9 Developmental care: positioning of preterm infant using containment while undergoing phototherapy.
- Reducing Inappropriate Stimuli
- Infant Communication
- Infant Stimulation
- Kangaroo Care
- FIG. 37-10 Father holding infant in kangaroo care
- Parental Adaptation to Preterm Infant
- Parental Tasks
- Parental Responses
- Parental Support
- Fig. 37-11 A, Mother and father touch preterm infant. B, Mother caresses preterm infant.
- Parental Maladaptation
- 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.
- Parent Education
- Complications in High Risk Infants
- Respiratory Distress Syndrome
- FIG. 37-13 Pathogenesis of respiratory distress syndrome (RDS).
- TABLE 37-2 NORMAL ARTERIAL BLOOD GAS VALUES FOR NEONATES
- NURSING ALERT
- Complications Associated with Oxygen Therapy
- Retinopathy of Prematurity
- Bronchopulmonary Dysplasia
- Patent Ductus Arteriosus
- Germinal Matrix Hemorrhage–Intraventricular Hemorrhage
- Necrotizing Enterocolitis
- BOX 37-5 PROPOSED RISK FACTORS FOR NECROTIZING ENTEROCOLITIS
- Infant Pain Responses
- Pain Assessment
- NURSING ALERT
- BOX 37-6 MANIFESTATIONS OF ACUTE PAIN IN THE NEONATE
- Physiologic Responses
- Vital Signs
- Oxygenation
- Skin
- Other Observations
- Behavioral Responses
- Vocalizations: Observe Quality, Timing, and Duration
- Facial Expression
- Body Movements and Posture
- Change in State
- Memory of Pain
- Consequences of Untreated Pain in Infants
- Pain Management
- EVIDENCE-BASED PRACTICE
- Non-Pharmacologic Pain Relief Measures for Newborns
- Ask the Question
- Search for Evidence
- Search Strategies
- Databases Searched
- Critically Analyze the Data
- Implications for Practice
- References
- TABLE 37-3 LATE PRETERM INFANT ASSESSMENT AND INTERVENTIONS
- Late Preterm Infants
- Respiratory Distress
- Thermoregulation
- Nutrition
- Hypoglycemia
- Hyperbilirubinemia
- Infection
- Postmature Infants
- CLINICAL REASONING
- The Late Preterm Infant
- Meconium Aspiration Syndrome
- 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.
- Persistent Pulmonary Hypertension of the Newborn
- Other Problems Related to Gestation
- Small for Gestational Age and Intrauterine Growth Restriction
- Perinatal Asphyxia.
- Hypoglycemia
- Hyperglycemia
- Polycythemia
- Heat Loss
- Large for Gestational Age Infants
- Discharge Planning
- Transport to and from a Regional Center
- FIG. 37-15 Total life support system for transport of high risk newborns
- BOX 37-7 S.T.A.B.L.E. PROGRAM ON POST-RESUSCITATION AND POST-TRANSPORT STABILIZATION CARE OF SICK INFANTS
- Anticipatory Grief
- Loss of an Infant
- COMMUNITY ACTIVITY
- KEY POINTS
- References
- Chapter 38 Perinatal Loss and Grief
- Learning Objectives
- Perinatal Loss
- Grief Responses
- Acute Distress
- BOX 38-1 CONCEPTUAL MODEL OF PARENTAL GRIEF
- Phase of Acute Distress
- Phase of Intense Grief
- Reorganization
- Intense Grief
- Reorganization
- Family Aspects of Grief
- Grandparents and Siblings
- Care Management
- NURSING PROCESS
- Perinatal Grief
- Assessment
- Nursing Diagnoses
- Anxiety related to:
- Ineffective Coping related to:
- Powerlessness related to:
- Interrupted Family Processes related to:
- Ineffective Sexuality Pattern (between the mother and father) related to:
- Fatigue and Disturbed Sleep Pattern related to:
- Complicated Grieving related to:
- Situational Low Self-esteem related to:
- Spiritual Distress related to:
- Expected Outcomes of Care
- Plan of Care and Interventions
- Evaluation
- FIG. 38-1 Sample checklist for assisting parents experiencing miscarriage/ectopic pregnancy.
- FIG. 38-2 Sample checklist for assisting parents experiencing stillbirth or newborn death.
- Help the Mother, the Father, and Other Family Members Actualize the Loss
- CLINICAL REASONING
- The Bereaved Couple
- NURSING ALERT
- FIG. 38-3 Laura.
- FIG. 38-4 Laura’s family members say a special good-bye.
- FIG. 38-5 Door card for room of mother who has had a perinatal loss.
- Help the Parents with Decision Making
- LEGAL TIP
- Laws Regarding Live Birth
- Help the Bereaved Parents Acknowledge and Express Their Feelings
- BOX 38-2 WHAT TO SAY AND WHAT NOT TO SAY TO BEREAVED PARENTS
- What to Say
- What not to Say
- Normalize the Grief Process and Facilitate Positive Coping
- Meet the Physical Needs of the Postpartum Bereaved Mother
- Assist the Bereaved in Communicating with, Supporting, and Getting Support from Family
- 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.
- Create Memories for Parents to Take Home
- Communicate Using a Caring Framework
- Be Concerned About Cultural and Spiritual Needs of Parents
- Provide Sensitive Care At and After Discharge
- FIG. 38-7 Burial cradle.
- Provide Postmortem Care
- Special Losses
- Prenatal Diagnoses with Negative Outcome
- NURSING CARE PLAN
- Fetal Death: 24 Weeks of Gestation
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcomes
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Nursing Diagnosis
- Expected Outcome
- Nursing Interventions/Rationales
- Loss of One in a Multiple Birth
- Adolescent Grief
- Complicated Grief
- COMMUNITY ACTIVITY
- KEY POINTS
- References
- Glossary
- A
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- X
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- Index
- Index
- A
- B
- C
- D
- E
- F
- G
- H
- I
- J
- K
- L
- M
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