Obstetric and Gynecological Nursing - The Carter Center

More documents

Recommendations

Info

CHAPTER SEVEN ABNORMAL LABOUR At the end of this chapter students will be able to: - Define malpresentation and malposition - Identify causes of Post partun Heamorrage. (P.P.H). - Define prolonged labour - Diagnose Cephalo pelvic disproportion (C.P.D). - List the cause of rupture of uterus - Differentiate degrees of laceration with their managements. 7.1. Malpresentation and Malpostion Mal-presentation - A presentation other than vertex Eg. Shoulder, face, brow and breech Mal-position and mal-presentations have ill fitting presenting parts compared to a well flexed vertex presentations in a normal pelvis. - Causes: - polyhydraminous • Abnormality of pelvis • Abnormal shape of uterus • Laxcity of uterine muscles • Multiple pregnancy 176
All ill fitting part is associated with (results in): 1. Early rupture of membrane with risk of cord prolapsed 2. Premature labour 3. Slow, irregular, short-lived contractions 4. Uncoordinated and excessively painful labour after rupture of membranes 5. Prolonged and obstructed labour 6. Post partum hemorrhage 7. Fetal and maternal distress 7.1.1 Breech Presentation Definition: When the fetus lies with his buttock in the lower pole of the uterus. It occurs in 1: 40 cases of labor after 34 weeks 1. Breech with extended legs or frank breech- in this type of breech the thighs are flexed and the legs are extended along the fetal abdomen. It is the common one. 2. Complete breech the fetus lies in a flexed attitude and the legs are flexed on the abdomen. The presenting part is bulky and consists of buttocks external genitalia and both feet. 3. Footling- one or both feet present because neither hips nor knees are fully flexed. 4. Knee presentation. On this case both the hips are extended with the knees flexed. 177
Page 1 and 2:
LECTURE NOTES For Nursing Students
Page 3 and 4:
Preface This lecture note offers nu
Page 5 and 6:
Acknowledgement My deepest apprecia
Page 7 and 8:
2.3.5 Fallopian tube or uterne tube
Page 9 and 10:
CHAPTER SIX : ABNORMAL PREGNANCY 12
Page 11 and 12:
8.5 Subinvolution 225 Review Questi
Page 13 and 14:
LIST OF FIGURES Figuer 1. Normal Fe
Page 15 and 16:
ABBRIVATIONS ACTH Adreno cortico tr
Page 17 and 18:
CHAPTER ONE INTRODUCTION Care of ch
Page 19 and 20:
Hemorrhage, sepsis (infection), tox
Page 21 and 22:
CHAPTER TWO ANATOMY OF FEMALE PELVI
Page 23 and 24:
sacrum is concave and is referred t
Page 25 and 26:
diamond in shape. The obstretrical
Page 27 and 28:
Table 2 .Features of the four types
Page 29 and 30:
The Fetal Skull The fetal head is t
Page 31 and 32:
Regions of the Skull A. The occiput
Page 33 and 34:
. Suboccipitofrontal 10cm from belo
Page 35 and 36:
Figure 6 . Female external genitali
Page 37 and 38:
Position:- In the non-pregnant fema
Page 39 and 40:
• Round ligament - Ligaments form
Page 41 and 42:
• provides a site for fertilizati
Page 43 and 44:
maturation of reproductive organs a
Page 45 and 46:
Thispain, called mitlelschmerz may
Page 47 and 48:
2.5. The Breast Anatomy The female
Page 49 and 50:
Amplulla: the widened-out portion o
Page 51 and 52:
Review Questions 1. List different
Page 53 and 54:
the ampullar portion. The functiona
Page 55 and 56:
Blastocyst Trophoblast Inner cell m
Page 57 and 58:
penetrate. Viruses, however, can cr
Page 59 and 60:
Figure 10 . The fetal circulation (
Page 61 and 62:
Appearance of the Placenta at Term
Page 63 and 64:
Identification On inspection, the p
Page 65 and 66:
Placenta infarction Placental infar
Page 67 and 68:
Oarl cavity feels salivation Gums-
Page 69 and 70:
• Creatinine and BUN decrease bec
Page 71 and 72:
- Increase in the lower extermities
Page 73 and 74:
- Lower part cervix and isthmus cha
Page 75 and 76:
6. Fainting: - In early pregnancy f
Page 77 and 78:
women feels it at 18-20 weeks the m
Page 79 and 80:
Multipara a woman who has given bir
Page 81 and 82:
The Obstetric History 1. Past Obste
Page 83 and 84:
Breast Examination Asses the size,
Page 85 and 86:
1.2 Fundal Palpation Purpose- To kn
Page 87 and 88:
3. Deep pelvic Palpation: (3 rd Leo
Page 89 and 90:
Auscultation: Check Fetal heart, ra
Page 91 and 92:
• Rest at least 10 hrs at night a
Page 93 and 94:
CHAPTER FOUR NORMAL LABOUR At the e
Page 95 and 96:
- Labour is said to be established
Page 97 and 98:
To assess progress of labour - Stat
Page 99 and 100:
Relief of pain & promotion of comfo
Page 101 and 102:
Uterine contraction - Frequency per
Page 103 and 104:
advanced labour women may be assess
Page 105 and 106:
Method - by abdominal palpation ide
Page 107 and 108:
Eg. Partograph Name _______________
Page 109 and 110:
- Caput - Sutures and Fontanelles.
Page 111 and 112:
Echanism of Labour in a Normal Vert
Page 113 and 114:
ERGOMETRINE: 0.5mgs. in a syringe w
Page 115 and 116:
1. Separation of the placenta Mecha
Page 117 and 118:
3. Controlled cord traction with ou
Page 119 and 120:
Advantage: It allows the placenta t
Page 121 and 122:
Inspect the umbilical cord a) Check
Page 123 and 124:
Ergometrine Route Time to act Durat
Page 125 and 126:
The guiding principles is to watch
Page 127 and 128:
B. Delayed cord clamping The cord c
Page 129 and 130:
- Method of delivery- spontaneous o
Page 131 and 132:
4.4. Episiotomy Definition: The mak
Page 133 and 134:
4. Lateral: The incision is begun o
Page 135 and 136:
Layers to be repaired 1. Vaginal wo
Page 137 and 138:
CHAPTER FIVE THE NORMAL PUERPERIUM
Page 139 and 140:
Lochia- discharge from the uterus d
Page 141 and 142: 5.2 Management of the Puerperium An
Page 143 and 144: answer her questions and through ou
Page 145 and 146: CHAPTER SIX ABNORMAL PREGNANCY At t
Page 147 and 148: One fetus may be died and be retain
Page 149 and 150: Management of Pregnancy - Early dia
Page 151 and 152: are labeled as ‘ Twin one ‘ and
Page 153 and 154: a) Both twins presenting by the ver
Page 155 and 156: - The urine will smell of acetone,
Page 157 and 158: The liver is affected in sever case
Page 159 and 160: Moderate - Preeclampsia is usually
Page 161 and 162: Management during labour The nurse/
Page 163 and 164: 35% with in the first few hours aft
Page 165 and 166: - The volume of urine and the album
Page 167 and 168: Type 1 placenta praevia - The major
Page 169 and 170: Diagnosis - Using ultrasonic scanni
Page 171 and 172: Complications • Post partam haemo
Page 173 and 174: If the blood loss is revealed; More
Page 175 and 176: - Rarely, Rhesus- isoimmunization -
Page 177 and 178: The mother should rest in bed. An u
Page 179 and 180: The first encounter may not result
Page 181 and 182: The degree of haemolysis and the nu
Page 183 and 184: Transmission of infection to the fe
Page 185 and 186: Post natal care Separation of the b
Page 187 and 188: giving several short pushes during
Page 189 and 190: - Maternal hyperglycemia should be
Page 191: Review Questions 1. List the differ
Page 195 and 196: On auscultation The fetal heart bea
Page 197 and 198: cord prolapse). - Sedation often ne
Page 199 and 200: up gently delivery slowly taking 2
Page 201 and 202: Diagnosis On palpation - the head i
Page 203 and 204: Complications Maternal Fetal - Obst
Page 205 and 206: make sure no cord prolapsed and to
Page 207 and 208: If diagnosed during the first stage
Page 209 and 210: Management Encourage the mother to
Page 211 and 212: 7.2.1 Atonic Postpartum Hemorrhage
Page 213 and 214: Cause - Delivery through partially
Page 215 and 216: Management of Severe PPH in a Healt
Page 217 and 218: Cause in 1 st stage 1) In-efficient
Page 219 and 220: 4 Reduced pelvic out let. A forceps
Page 221 and 222: - If the fetus is not alive and the
Page 223 and 224: Methods of determining C.P.D. 1. De
Page 225 and 226: 3 Placenta percrata- through muscle
Page 227 and 228: 2. Tonic contraction and Bandl’s
Page 229 and 230: Condition of the baby - Usually sti
Page 231 and 232: 3. Control head, keep it flexed, so
Page 233 and 234: Review Questions 1. What are the co
Page 235 and 236: More severe infection may consist o
Page 237 and 238: Prevention The best method of treat
Page 239 and 240: Managing Puerperal sepsis 1. Isolat
Page 241 and 242: 8.5 Subinvolution Sub involution is
Page 243 and 244:
CHAPTER NINE INDUCTION OF LABOUR At
Page 245 and 246:
Table 6 .Bishops Score System Induc
Page 247 and 248:
- Fluid balance chart - Urine test
Page 249 and 250:
Nipple stimulation, which releases
Page 251 and 252:
Conditions in which trial of scar i
Page 253 and 254:
CHAPTER TEN OBSTETRIC OPERATIONS At
Page 255 and 256:
Indication for forceps delivery - F
Page 257 and 258:
In the infant: Bruising: Severe bru
Page 259 and 260:
10.2 Caesarean Section Caesarean se
Page 261 and 262:
Possible indications include: - The
Page 263 and 264:
types of decapitating hooks and kni
Page 265 and 266:
procedure is extremely rare in cont
Page 267 and 268:
- The head must be engaged. - The w
Page 269 and 270:
CHAPTER ELEVEN CONGENITAL ANOMALIES
Page 271 and 272:
A single remiuterus results when on
Page 273 and 274:
E. Persistence of male (Wolffcan) d
Page 275 and 276:
CHAPTER TWELVE INFECTION OF THE FEM
Page 277 and 278:
Sign Major Minor Cervical motion Ab
Page 279 and 280:
- Gentamycin iv or in loading dose
Page 281 and 282:
In those persons with recurrent les
Page 283 and 284:
Presentation Sign and symptom A wom
Page 285 and 286:
Risk Factor Studies have indicates
Page 287 and 288:
ecto vaginal fistula. Other types m
Page 289 and 290:
12.6 Prolaps of the Uterus A descen
Page 291 and 292:
- If no symptoms are present and th
Page 293 and 294:
Forced inversion caused by excessiv
Page 295 and 296:
therapy may be initiated to prevent
Page 297 and 298:
Local disorders of the genital trac
Page 299 and 300:
. Missed abortion This is the term
Page 301 and 302:
The membranes may have ruptured and
Page 303 and 304:
operation. Many mothers do not make
Page 305 and 306:
I. Septic abortion Infection may oc
Page 307 and 308:
Dysmenorrhea Definition-Dysmenorrhe
Page 309 and 310:
esult from tension, anxiety (stress
Page 311 and 312:
Implantation may occur in the fimbr
Page 313 and 314:
the rupture is on the mesenteric si
Page 315 and 316:
Diagnosis - The presence of interna
Page 317 and 318:
Causes of infertility Female - Vagi
Page 319 and 320:
Benign A. Fibrocystic breast diseas
Page 321 and 322:
- Pain in the breast - Blood staine
Page 323 and 324:
Treatment - Oestrogen - Progesteron
Page 325 and 326:
E. Gently squeeze the nipple of eac
Page 327 and 328:
- Poor uterine contraction - Subinv
Page 329 and 330:
cervical canal and are multiple. Th
Page 331 and 332:
Vulval Cysts Bartholin’s cyst- It
Page 333 and 334:
GLOSSARY Abortion Termination of pr
Page 335 and 336:
Intra uterine growth retardation Fe
show all

Obstetric and Gynecological Nursing - The Carter Center

Create successful ePaper yourself

Delete template?

Save as template?