Obstetric and Gynecological Nursing - The Carter Center

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CHAPTER EIGHT ABNORMAL PUERPERIUM At the end of this chapter the students will be able to: - Describe complication of the puerperium. - Define puerperal sepsis - State breast problems during puerperium 8.1 Urinary Complications Urinary tract infection is a common problem during pregnancy. Its cause lies in the stasis of urine which occurs during pregnancy and encourages the formation of a reservoir of organisms. Trauma during labor or inadequate Vulval hygiene leading to an ascending infection predisposes to its recurrence during the puerperium. Such recurrent infections may lead to chronic pylonephritis. Cause - usually Escherichia coli Sign and symptom - Malaise - ache and pains in the back and flank - pain on micturation in some cases 218
More severe infection may consist of either acute cystitis characterized by scalding on micturation, or pylonephritis which causes a raised temperature, pain over the kidney and haematuria. Investigation - A midstream specimen of urine for bacteriological investigation Treatment - Antibiotic ampicillin, nitrofurantion or nalidixic acid 8.2 Breast Infections 8.2.1 Acute Puerperal Mastitis Is inflammation of the breast and externally painful and may lead to abscess formation. The most common infectious organism is staphylococcus aureus. The most likely source of the infection is the baby and out breaks of skin and eye infections among babies are frequently due to staphylococcus aureus. Organisms are transmitted by cross infection and can easily affect a whole part. Sign and symptoms - Occurs after the 8 th postnatal day - The onset is rapid with a sharp rise in temperature which can reach as high as 40 0 C. 219
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LECTURE NOTES For Nursing Students
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Preface This lecture note offers nu
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Acknowledgement My deepest apprecia
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2.3.5 Fallopian tube or uterne tube
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CHAPTER SIX : ABNORMAL PREGNANCY 12
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8.5 Subinvolution 225 Review Questi
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LIST OF FIGURES Figuer 1. Normal Fe
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ABBRIVATIONS ACTH Adreno cortico tr
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CHAPTER ONE INTRODUCTION Care of ch
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Hemorrhage, sepsis (infection), tox
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CHAPTER TWO ANATOMY OF FEMALE PELVI
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sacrum is concave and is referred t
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diamond in shape. The obstretrical
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Table 2 .Features of the four types
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The Fetal Skull The fetal head is t
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Regions of the Skull A. The occiput
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. Suboccipitofrontal 10cm from belo
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Figure 6 . Female external genitali
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Position:- In the non-pregnant fema
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• Round ligament - Ligaments form
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• provides a site for fertilizati
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maturation of reproductive organs a
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Thispain, called mitlelschmerz may
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2.5. The Breast Anatomy The female
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Amplulla: the widened-out portion o
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Review Questions 1. List different
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the ampullar portion. The functiona
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Blastocyst Trophoblast Inner cell m
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penetrate. Viruses, however, can cr
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Figure 10 . The fetal circulation (
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Appearance of the Placenta at Term
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Identification On inspection, the p
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Placenta infarction Placental infar
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Oarl cavity feels salivation Gums-
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• Creatinine and BUN decrease bec
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- Increase in the lower extermities
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- Lower part cervix and isthmus cha
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6. Fainting: - In early pregnancy f
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women feels it at 18-20 weeks the m
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Multipara a woman who has given bir
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The Obstetric History 1. Past Obste
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Breast Examination Asses the size,
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1.2 Fundal Palpation Purpose- To kn
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3. Deep pelvic Palpation: (3 rd Leo
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Auscultation: Check Fetal heart, ra
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• Rest at least 10 hrs at night a
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CHAPTER FOUR NORMAL LABOUR At the e
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- Labour is said to be established
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To assess progress of labour - Stat
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Relief of pain & promotion of comfo
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Uterine contraction - Frequency per
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advanced labour women may be assess
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Method - by abdominal palpation ide
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Eg. Partograph Name _______________
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- Caput - Sutures and Fontanelles.
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Echanism of Labour in a Normal Vert
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ERGOMETRINE: 0.5mgs. in a syringe w
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1. Separation of the placenta Mecha
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3. Controlled cord traction with ou
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Advantage: It allows the placenta t
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Inspect the umbilical cord a) Check
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Ergometrine Route Time to act Durat
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The guiding principles is to watch
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B. Delayed cord clamping The cord c
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- Method of delivery- spontaneous o
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4.4. Episiotomy Definition: The mak
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4. Lateral: The incision is begun o
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Layers to be repaired 1. Vaginal wo
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CHAPTER FIVE THE NORMAL PUERPERIUM
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Lochia- discharge from the uterus d
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5.2 Management of the Puerperium An
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answer her questions and through ou
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CHAPTER SIX ABNORMAL PREGNANCY At t
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One fetus may be died and be retain
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Management of Pregnancy - Early dia
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are labeled as ‘ Twin one ‘ and
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a) Both twins presenting by the ver
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- The urine will smell of acetone,
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The liver is affected in sever case
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Moderate - Preeclampsia is usually
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Management during labour The nurse/
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35% with in the first few hours aft
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- The volume of urine and the album
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Type 1 placenta praevia - The major
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Diagnosis - Using ultrasonic scanni
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Complications • Post partam haemo
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If the blood loss is revealed; More
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- Rarely, Rhesus- isoimmunization -
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The mother should rest in bed. An u
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The first encounter may not result
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The degree of haemolysis and the nu
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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 and 192: Review Questions 1. List the differ
Page 193 and 194: All ill fitting part is associated
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: Review Questions 1. What are the co
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
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Risk Factor Studies have indicates
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ecto vaginal fistula. Other types m
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12.6 Prolaps of the Uterus A descen
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- If no symptoms are present and th
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Forced inversion caused by excessiv
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therapy may be initiated to prevent
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Local disorders of the genital trac
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. Missed abortion This is the term
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The membranes may have ruptured and
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operation. Many mothers do not make
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I. Septic abortion Infection may oc
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Dysmenorrhea Definition-Dysmenorrhe
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esult from tension, anxiety (stress
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Implantation may occur in the fimbr
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the rupture is on the mesenteric si
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Diagnosis - The presence of interna
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Causes of infertility Female - Vagi
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Benign A. Fibrocystic breast diseas
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- Pain in the breast - Blood staine
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Treatment - Oestrogen - Progesteron
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E. Gently squeeze the nipple of eac
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- Poor uterine contraction - Subinv
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cervical canal and are multiple. Th
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Vulval Cysts Bartholin’s cyst- It
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GLOSSARY Abortion Termination of pr
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Intra uterine growth retardation Fe
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