Maternal and Child Health Nursing (Skills Lab)

LGA

large for gestational age

SGA

small for gestational age

too much wt. of mother

-cesarean
-operative vaginal delivery
-shoulder dystocia
-low blood sugar of baby after delivery
-increase of childhood obesity

health education about wt.

weight gained will easily be loss after delivery

wt. gained every trimester of pregnancy

1st trimester- 1-2kg (2-4 lbs)
2nd trimester- 6kg (12 lbs)
3rd trimester- 6kg (12 lbs)

how much should the average mother should gain?

about 11kg to 15.9 kg (25 lbs to 35 lbs)

Highest to Lowest Wt. gain of a Pregnant Woman

Fetus- 7.5 lbs
Body fat- 7 lbs
Blood volume- 4 lbs
Body fluid- 4 lbs
Breast- 3 lbs
Uterine enlargement- 2.5 lbs
Amniotic fluid- 2 lbs
Placenta- 1.5 lbs

what is BMI

body mass index- measure of body fat based on weight and height.
weight/height
kg/m2

classification of BMI

under wt.= < 18.5
normal= 18.6 to 24.9
over wt.= 25 to 29.9
obese= >30

caloric value per gram

CHO 4
CHON 4
Fats 9

weight gain according to BMI in normal pregnancy

under wt.= 28-40lbs
normal= 25-45lbs
over wt.= 15-25lbs
obese= 11-15lbs

weight gain according to BMI in twin pregnancy

under wt.= 37-54lbs
normal= 37-54lbs
over wt.= 31-50lbs
obese= 25-42lbs

what happens if there is a sudden increase of wt.

indicate fluid retention or polyhydramnios (too much amniotic fluid) because the diet of the mother has too much salt in her diet

how to maintain a health wt. (pregnant mother)

1. do not exceed the +300 calories
2. stay active -- at least 30 mins moderate activities
3. check your wt.
4. do not skip prenatal visits
5. seek for consult to OBGYN

how many prenatal visit should be done?

at least 4 prenatal visit

when should each prenatal visit should occur?

1st- 1st trimester (month 0-3)
2nd- 2nd trimester
3rd- 3rd trimester
4th- after 8 months (with 2 weeks alternation)

vaccine protection

diphtheria vaccine - protects against diphtheria that affects the upper respiratory tract

diphtheria vaccine number of doses

5 doses (DT1, DT2, DT3, DT4, DT5)

diphtheria vaccination schedule

DT1- asap
DT2- 4 weeks ā DT1
DT3- 6 months ā DT2
DT4- 1 year ā DT3
DT5- 1 year ā DT4

years of protection of diphtheria every dose

DT1- 1 yr
DT2- 3 yr
DT3- 5 yr
DT4- 10 yr
DT5- lifetime

percentage of protection of diphtheria every dose

DT1- 0
DT2- 80
DT3- 90
DT4- 99
DT5- 99

FHT

Fetal Heart Tone

ranges of FHT

normal: 110-160 bpm
average: 140 bpm

when the FHT increase and decrease 110-160 bpm

indicate fetal distress (problem in heart in oxygenation)

types of FHT monitoring

1. intermittent auscultation
2. electronic fetal monitoring

intermittent auscultation

"on and off"
listen to FHT in one full minute; same as taking adult PR

electronic fetal monitoring

continuous monitoring of FHR

why is FHR done

- due to pregnancy complication
- high risk pregnancy of mothers
a. diabetes
b. high BP
c. if mother is taking meds (that cause labor/contract the uterus, e.g. oxytocin)
d. affect the growth and development of fetus

methods of FHR monitoring

external monitoring
internal monitoring

external monitoring

outside Mo of FHR e.g. doppler and stethoscope

internal monitoring

inside; usually done when BOW is ruptured
the electrodes are attached unto the baby's head (electronic fetal monitoring)

BOW

bag of water (amniotic sac)

purpose of FHR monitoring

-monitor progress of a woman's contraction pattern
-monitor condition of the fetus in response to the stress of uterine contracts

problems encountered when listening to FHR

1. obese (too much fat)
2. polyhydramnios (too much amniotic fluid)
3. wrong position of device upon auscultation

equipment for FHR monitoring

1. stethoscope
2. watch with second hand
3. drape

equipment for electronic monitoring

- monitor
- monitor belts
- tocodynamometer (TOCO)
- ultrasonic transducer

what to use when performing FHR

base on the months:
stethoscope- 5 months
fetoscope- 4 months
doppler- 3 months

what to do if device/baby is in the wrong position when taking FHR

Leopold's Maneuver

what are the Leopold's maneuver

1st maneuver- Fundal grip
2nd maneuver- Lateral grip (likod)
3rd maneuver- Pawlick's grip
4th maneuver- Pelvis grip

Tx for AB FHR

1. change position; left side-lying
2. give IV fluids
3. instruct on breathing
4. meds to relax uterus
5. immediate delivery (if the above are not helpful)

risk of FHR monitoring

1. external FHR monitoring
- low risk
2. internal FHR monitoring
- infection risk
- slight discomfort
- baby can get bruises and scratches