Professional Documents
Culture Documents
• CARDIOVASCULAR DISEASES
I – UNCOMPROMISED
• No angina pain
II – SLIGHTLY COMPROMISED
• Marked palpitations
IV – SEVERELY COMPROMISED
• Increase in pressure in the pulmonary vein ( more than 25 mmHg ) resulting to:
Ø PULMONARY HYPERTENSION
• Fluid begins to pass from the pulmonary capillary membranes into the
• Woman cannot assume any position other than sitting because the left ventricle
cannot accommodate increase in increase in venous return
• Right ventricle is weak so that the blood the blood that the right atrium receives
• Decrease blood output to the lungs decreasing also the blood to the aorta
• Accumulation of blood in the venous system also causes an increase in the pressure
of the portal vein and later causing enlargement of the spleen and Liver.
• Distended abdominal vessels also alters its permeability causing water to shift to the
peritoneal cavity causing Ascites.
• Fluids from systemic circulation also moves towards the interstitial spaces of the
lower extremity causing Peripheral Edema.
EFFECTS TO PREGNANCY:
• Starts with obtaining a baseline health history of the mothers pre-pregnant life
• Always alert the woman to report cough during pregnancy ( this is the earliest
manifestation of left sided heart failure during pregnancy )
• Ask the patient what activities would contribute to her dyspnea and chest pain
• Take note of edema ( Normally found in the feet and ankles ), this should not
progress to other parts of the body
• HEMATOLOGIC DISORDERS
A ) ANEMIA
• Low supply of iron will lower hemoglobin and thus make a pregnant woman
develop easy fatigability
MGT:
Ø The ureters normally dilate in pregnancy due to progesterone causing urine stasis
Ø Because there is sugar in the urine during pregnancy, this allows growth of bacteria
Ø Because the kidneys are impaired, the don’t produce erythropotein resulting
ANEMIA.
Effects:
• RESPIRATORY DISORDERS
A ) WOMAN WITH INFLUENZA
Ø High fever, extreme prostration, aching pain and soar , raw throat.
Treatment of choice:
• Oseltamivir ( TamiFlu )
B ) ASTHMA
BEST CHOICE
• Inhalled Corticosteroids
C ) TUBERCULOSIS
• Mother must have 3 negative sputum cultures if she has a history of tuberculosis
before she hold or cares for her infant.
E ) CYSTIC FIBROSIS
• The lack of this essential amino acid contributes to the characteristic sign of C.F,
which is Mucosal Thickening of the Respiratory and Intestinal Tracts.
• RHEUMATOID DISORDERS
Ø Chronic inflammation of the joints that may lead to permanent loss of joint mobility
and function
• Chronic Disease that affects connective tissues and has the potential to cause multi-
organ failure
Dangers:
• GASTROINTESTINAL PROBLEMS
A ) APPENDICITIS
• NEUROLOGIC DISORDERS
Ø Neostigmin ( Prostigmin )
Ø Pyridostigmine ( Mestinon )
• MULTIPLE SCLEROSIS ( demyelination )
• SEIZURE DISORDERS
8 ) DEVELOPMENTAL CARE
7 ) BONDING
6 ) INFECTION PREVENTION
4 ) ADEQUATE NUTRITION
2 ) PROPER CIRCULATION
1 ) PROPER RESPIRATIONS
PRENATAL VISIT
GENERAL CONSIDERATIONS:
Duration of Pregnancy:
Ø 266-280 days
PRE-TERM
• ANY BABY BORN AFTER 42 WEEKS IS CALLED
POST-TERM
DIAGNOSIS OF PREGNANCY:
Ø HCG is present from the 40th day through the 100th day reaching a peek on the 60th day.
1 ) HISTORY TAKING
Ø patient’s name
Ø Family diseases
Ø Wed or unwed?
D ) TPAL
• P – remature babies
• A – bortion
• L – iving children
EXAMPLE:
1 ) PATIENT X
VISIT
GET THE:
G –PA T-P-A-L
2 ) PATIENT Y
Ø 1 MISCARRIAGE
GET THE:
G –PA T-P-A-L
Ø NSVD OR C/S?
2 ASSESSMENT
Ø A review of systems is indicated, especially the teeth because they are usually a source
of infection.
2.2 PELVIC EXAMINATION
Ø To determine C / G / H
B ) BALLOTEMENT
Ø Fetus will bounce when the lower uterine segment is tapped sharply especially during
the 5th month of pregnancy.
CLASSIFICATION OF FINDINGS:
D ) LEOPOLD’S MANEUVER’S
PURPOSES:
PREPARATORY STEPS:
Ø WARM HANDS
Ø DORSAL RECUMBENT
1ST MANEUVER
2nd MANEUVER
Ø PALPATE the sides of the uterus to determine the location of THE FETAL BACK
• The fetal back is the BEST PLACE to hear fetal heart tones
3rd MANEUVER
Ø Grasp lower portion of abdomen just above the symphysis pubis to find out degree of
ENGAGEMENT.
4th MANEUVER
> Facing the feet part of the patient, press fingers downwards on both sides of the uterus
to determine ATTITUDE ( DEGREE OF FLEXION OF THE FETAL HEAD )
E ) VITAL SIGNS
F ) URINE EXAMINATIONS
IMPORTANT
ESTIMATES IN
PREGNANCY
A ) NAGELE’S RULE
Ø Count BACK 3 MONTHS from the first day of the LMP then ADD 7 DAYS.
LMP = SEPTEMBER 8
(8+7) = 15
EDC = JUNE 15
B ) McDONALD’S METHOD
Ø Determines Age of Gestation by measuring from the fundus to the symphysis pubis in
CENTIMETERS then DIVIDE by 4.
C ) BARTHOLOMEW’S RULE
Ø Estimate AOG by the relative position of the uterus in the abdominal cavity.
JUST REMEMBER:
• By the 3rd LM, the fundus is palpable slightly ABOVE THE SYMPHYSIS PUBIS
D ) HAASE’S RULE
TIP:
E ) JOHNSON’S RULE
FORMULA:
N is = 12 ( if fetus in engaged )
HEALTH TEACHINGS
FOR A
PREGNANT WOMAN
Ø Pregnant teenagers
Ø Vegetarians
= MULTIPLY BY 4
FATS
= MULTIPLY BY 9
FOOD SOURCES:
PROTEIN-RICH FOODS
VITAMIN A
VITAMIN D
VITAMIN E
FOLIC ACID
VITAMIN B
CALCIUM/PHOSPHORUS
IRON
A ) CALORIES ( kcal )
B ) PROTEINS ( g )
Ø 46 grams
D ) VITAMIN D
Ø Remains at 400 IU
E ) VITAMIN E
Ø From 12 IU to 15 IU
F ) VITAMIN C
Ø From 45 mg to 60 mg
G ) FOLIC ACID
I ) IRON
Ø 18 mg to 36 mg
J ) MAGNESIUM
K ) IODINE
Ø 100 ug to 125 ug
SMOKING
DRUGS
• THALIDOMIDES
Ø Causes amelia or phocomelia ( short or no extremities )
• STEROIDS
• IODINE
Ø A common content in OTC drugs, causes enlargement of fetal thyroid gland, leading to
tracheal compression and dyspnea ar birth
• ASPIRIN
Ø Bleeding disorders
• TETRACYCLINES
Contraindication in sex:
1. vaginal spotting
2. incompetent cervix
3. preterm labor
EMPLOYMENT
TRAVELING
EXERCISES
Ø SHOULD BE INDIVIDUALIZED
RECOMMENDED EXERCISE:
• PELVIC ROCK
• SHOULDER-CIRCLING
• WALKING
• KEGEL
CHILDBIRTH PREPARATION
PSYCHOPHYSICAL
1. Bradley Method – Dr. Robert Bradley – advocated active participation of husband at
delivery process. Based on imitation of nature.
Features:
• 1.) darkened rm
2. Grantly Dick Read Method – fear leads to tension while tension leads to pain
PSYCHOSEXUAL
1. Kitzinger method – preg, labor & birth & care of newborn is an impt turning pt
in woman’s life cycle
• Features:
– Conscious relaxation
FREQUENCY OF VISITS:
• 8 – 9 months – 2 x a month
• 10 – once a week
GESTATIONAL DIABETES
Ø Many women who have no evidence of diabetes in the past develop abnormalities of
glucose tolerance during pregnancy.
Ø Toxemia
Ø Infection
Ø Hemorrhage
Ø Polyhydramnios
Ø Spontaneous abortion
Ø Dystocia
PROCEDURE:
INTERPRETATION OF RESULTS:
MGT:
A ) DIET
Ø Highly individualized
2 ) INSULIN REQUIREMENTS
Ø Highly individualized
Ø Increase need especially in the 3rd trimesters due to increase effectiveness of hormones
C )METHOD OF DELIVERY
Ø Often by C/S
• HYPOGLYCEMIA
Clinical signs:
Ø Hypothermia
CONSEQUENCE:
Ø If hypoglycemia is not treated, will lead to brain damage and even death.
TREATMENT:
GLUCOSE I.V.
MULTIPLE PREGNANCY
CLASSIFICATION
1 ) MONOZYGOTIC / IDENTICAL
Ø In the process of meiosis the zygote divides into two identical BUT separate
individuals.
CHARACTERISTICS:
INCIDENCE:
2 ) DIZYGOTIC / FRATERNAL
CHARACTERISTICS:
Ø Exagerated quickening
Ø 2 sets of fetal heart tones are heared
• MANAGEMENT
A) PIH
B) PLACENTA PREVIA
C) PRETERM LABOR
D) ANEMIA
• CONJOINING OF TWINS
• CONTRACEPTIONS
METHODS OF CONTRACEPTION:
1 ) FOLK METHODS
2) MECHANICAL METHODS
1. CONDOMS
B. DIAPHRAGM
C. SPONGE
3. CHEMICAL METHOD
4. HORMONAL METHOD
1. CONTRACEPTIVE PILLS
TYPES:
• COMBINED
• SEQUENTIAL
• MINI PILL
5 ) SURGICAL METHODS
CLASSIFICATIONS:
• AS TO DECISION
• AS TO PURPOSE
METHODS:
1. TUBAL LIGATION
2. VASECTOMY
C. HYSTERECTOMY
• Predicting your first fertile day. If your shortest cycle is 26 days long, subtract 18
from 26. That leaves 8. If day one was the fourth day of the month, the day you will mark
X will be the 11th. That's the first day you're likely to be fertile. So on that day, you
should start abstaining from sex or start using a cervical cap, condom, diaphragm, or
female condom.
• Predicting your last fertile day. If your longest cycle is 30 days, subtract 11 from
30. That leaves 19. If day one was the fourth day of the month, the day you will mark X
will be the 22nd. That's the last day you're likely to be fertile during your current cycle.
So you may start to have unprotected vaginal intercourse after that day.
7. ABORTIFACIENTS
1. INTRAUTERINE DEVICE
Copper = 10 years
Progestasert = 5 years
C. PROSTAGLANDINS
D. ANTI-PREGNANCY VACCINE
- END -
INFECTIONS
AND
PREGNANCY
• CANDIASIS / MONILIASIS
• MANAGEMENT
• Avoid intercourse
• COMPLICATIONS
• TRICHOMONIASIS
• protozoa
• MANAGEMENT
Important Teachings:
• DANGERS
• PRETERM LABOR
• PROM
• BACTERIAL VAGINOSIS
S/S:
• Grayish discharge
Mgt: Flagyl
• CHLAMYDIA
Mgt:
• TOXOPLASMOSIS
• Rubella
• Cytomegalovirus
• TOXOPLASMOSIS
• Hydro/microcephaly
• INSTRUCTIONS
• OTHERS
• HEPATITIS B
Ø Sexual contact
Ø If the mother is infected, fetus can also be infected
• MANAGEMENT
• Suction gently
• MUMPS / PAROTITIS
MGT:
Ø Soft Meals
Ø Analgesic / Antipyretic
• Crosses Placenta and destroys RBC. Early trimester will cause Fetal Death and Late
Trimester will cause Anemia.
• SYPHILIS
Ø Sexually transmitted
Ø Mgt: Penicillin
• DANGERS
Ø Congenital anomalies
• GONORRHEA
• DANGERS
• Women with gonorrhea puts her infant at risk for Ophthalmia neonaorum
S/S:
• Edematous eyelids
• MANAGEMENT
COMPLICATION: BLINDNESS
• Known as a teratogen
• May cause deafness, mental abnormalities, and has a potential to cause facial clefts.
• MANAGEMENT
• After birth, immunize e mother, instruct not to get pregnant for 3 months.
• CYTOMEGALOVIRUS ( CMV )
• Droplet transmission
• Crosses the placenta and may cause nuerologic abnormalities and eye damage. Also
has the potential to cause chornic liver disease and large petechiae ( BLUEBERRY-
MUFFIN LESIONS )
Ø Genital herpes
Ø Sexually transmitted
Ø Crosses the placenta and will cause Spontaneous abortion on the 1st trimester and
Preterm birth on the second trimester.
• PRETERM LABOR
Ø Braxton-Hicks Contraction is said to be one of the reasons why preterm labor is not
commonly diagnosed at an early time.
CAUSE: IDIOPATHIC
RELATED FACTORS:
A ) DEHYDRATION
B ) INFECTIONS
Common Symptoms:
• Vaginal Spotting
• Uterine contractions
• Vaginal discharges
• REMAIN IRREGULAR
STRONG CONTRACTIONS
DILATATION
Management:
• ADMINISTERING TOCOLYTICS:
A ) TERBUTALINE ( Brethine )
B ) RITORDINE ( Yutopar )
D ) MAGNESIUM SULFATE *
Ø Once detected, a woman must begin Steroid Therapy to hasten fetal lung maturity.
1 )UTERINE INERTIA
Ø Sluggishness contractions
Causes:
• Fetal positions
TYPES:
Ø Uterine muscles are tensed so that the latent phase OF THE 1ST PHASE OF LABORis
prolonged.
STAGES OF LABOR
I – STAGE OF DILATATION
PHASES OF DILATATION:
Ø Contractions are of short duration and occur regularly 5-10 minutes apart.
2 ) ACTIVE / ACCELERATED
3 ) TRANSITION
Ø Cervical dilatation is 8-10 cm
L=C
A=A
T=P
• Suddenly Stops
• Dilatation stops
• Or Amniotomy if possible
2 ) PRECIPITATE LABOR
Causes:
• Multiple pregancy
• HEMORRHAGE
• ABRUPTIO PLACENTA
• SHOCK
3 ) PROLONGED LABOR
May Cause:
A ) Maternal exhaustion
B ) Uterine Atony
C ) Capput Succedaneum
4 ) UTERINE RUPTURE
R/F:
• Oxytocin
• Prolonged labor
Mgt: Hysterectomy
PRIORITY 1: INFECTION
PRIORITY 2: CORD PROLAPSE
Predisposing Factors:
2 ) Multipara
3 ) L.S.E.S.
CLASSIFICATIONS:
A ) GESTATIONAL HYPERTENSION
B ) MILD PRE-ECLAMPSIA
C ) SEVERE PRE-ECLAMPSIA
D ) ECLAMPSIA
TRIAD OF SYMPTOMS
H E P
GESTATIONAL HYPERTENSION
MILD PRE-ECLAMPSIA
• Proteinuria +1 or +2
SEVERE PRE-ECLAMPSIA
• BP 160/110
• PROTEINURIA +3 OR +4
+4 PITTING EDEMA = Indentation is so deep that it remains after the finger is removed.
ECLAMPSIA
PLUS
4 ) ENVIRONMENTAL MANIPULATION
• Control noise
STAGES:
• TONIC
• CLONIC
• POSTICTAL
• MEDICATIONS
MAGNESIUM SULFATE
ACTIONS:
Ø CNS Depressant- lessens the possibility of convulsions
Ø VASODILATOR – decreases BP
DOSAGE:
• RR at least 12 cpm
B ) DEPRESSED RESPIRATIONS
C ) DECREASED CONSCIOUSNESS
CALCIUM GLUCONATE
• H.E.L.L.P. SYNDROME
HEMOLYSIS –
LOW PLATELET
CAUSE = UNKNOWN
• INITIAL SYMPTOMS
• NAUSEA
• EPIGASTRIC PAIN
• GENERALIZED MALAISE
• THROMBOCYTOPENIA
• IMMEDIATE MGT:
• CORRECT HYPOGLYCEMIA
TYPES OF G.T.D.
A ) HYDATIDIFORM MOLE
B ) INVASIVE MOLE
C ) CHORIOCARCINOMA
2 TYPES:
A ) COMPLETE
· The father’s chromosomes are duplicated since the egg of the mother is empty.
· Trophoblastic villi continuous to grow but degenerates due to the absence of the
chromosomes.
· It will swell and becomes fluid filled resulting to the characteristic Grape-Like
structures.
B ) PARTIAL
• SOME of the villi form normally BUT it is the Syncitiotrophoblast that is swollen.
INVASIVE MOLE
• A type of GTD that grows into the MYOMETRIUM (the muscle part of the uterus )
Risks:
• Delayed treatment
• Large uterus
CHORIOCARCINOMA
ASSESSMENT FINDINGS
1 ) UTERUS
Ø Proliferation of trophoblast occurs at a very fast rate and the uterus expands faster that
normally.
umbillicus
GTD: 1-2 IU
MANAGEMENT
2 ) PHROPHYLAXIS: METHOTREXATE
• Antineoplstic
• 15-30 mg PO/IM daily for 5 days, repeated after 1 week. ( Avoid Sunlight. May
cause alopecia )
IMPORTANT REMINDERS
INCOMPETENT CERVICAL OS
Ø Refers to a cervix that dilates prematurely before term making it impossible to hold a
fetus.
Causes: Connective tissue structure around the cervix is not strong enough to maintain
closure. MOTHER of patient used DES during her pregnancy.
CERVICAL CIRCLEAGE
PLACENTA PREVIA
Ø Defined as low implantation of the placenta so that it is in the way of the presenting
part.
Types:
• LOW IMPLANT
Causes:
• Increasing Parity
• Past C/S
• Multiple Gestation
MGT:
• CBR
• The site of bleeding, the decidua, places the mother at risk for hemorrhage
Ø Compromised oxygenation
Ø Preterm labor
ABRUPTIO PLACENTA
Predisposing Factor:
• Trauma
Signs and Symptoms: