NP-2 Nursing review

🤰 Signs of Pregnancy

Signs of pregnancy are traditionally grouped into Presumptive, Probable, and Positive.
This classification helps differentiate subjective symptoms (reported by mother), objective findings (not conclusive), and definitive proof (fetus is present).

1⃣ Presumptive Signs (Subjective – felt by the mother)

These are not reliable, since other conditions can cause them.

  • Amenorrhea → absence of menstruation, usually first noticed.

  • Nausea and Vomiting (“Morning sickness”) → due to ↑ hCG and estrogen.

  • Breast changes → tenderness, tingling, enlargement, darkened areola, Montgomery’s tubercles.

  • Urinary frequency → pressure of enlarging uterus on bladder.

  • Fatigue → early hormonal changes.

  • Quickening → first perception of fetal movement (felt ~16–20 weeks).

  • Skin changes (chloasma, linea nigra) sometimes appear early.

👉 Memory Aid: “FAB-NUQ”

  • Fatigue

  • Amenorrhea

  • Breast changes

  • Nausea/vomiting

  • Urinary frequency

  • Quickening

2⃣ Probable Signs (Objective – observed by examiner, but not 100% proof)

These are stronger indicators, but may still result from other causes (e.g., tumors, hormone issues).

  • Pregnancy test (hCG detection) → urine/blood test positive.

  • Chadwick’s sign → bluish-purple discoloration of cervix/vagina (↑ vascularity).

  • Goodell’s sign → softening of cervix (~6 weeks).

  • Hegar’s sign → softening of isthmus (between cervix & uterus).

  • Ballottement → fetus rebounds when examiner taps cervix through vagina.

  • Uterine enlargement → palpable above pubic symphysis at 12 weeks.

  • Braxton Hicks contractions → irregular, painless contractions.

  • Abdominal striae / pigmentation changes.

👉 Memory Aid: “HCG-BUBB”

  • Hegar’s

  • Chadwick’s

  • Goodell’s

  • Ballottement

  • Uterine enlargement

  • Braxton Hicks

  • Biochemical (hCG test)

3⃣ Positive Signs (Definitive proof of pregnancy)

These are 100% reliable and confirm the presence of a fetus.

  • Fetal heartbeat

    • Detected by Doppler at 10–12 weeks.

    • Detected by fetoscope at 18–20 weeks.

  • Fetal movement → palpated by examiner after 20 weeks.

  • Ultrasound visualization → gestational sac seen as early as 5 weeks.

👉 Memory Aid: “3 Fs = Fetus is Fact”

  • Fetal heart tones

  • Fetal movements palpated

  • Fetus on ultrasound

📝 Exam Tips (20/80 Focus)

  • Presumptive = mother feels.

  • Probable = examiner observes.

  • Positive = proof of fetus.

  • Naegele’s rule often comes next when dating pregnancy (LMP + 7 days – 3 months).

🤰 Length of Pregnancy

Pregnancy is measured in days, weeks, months, and trimesters, using the mother’s last menstrual period (LMP) as the starting point.

1⃣ Standard Duration

  • Average pregnancy: 280 days

  • Equivalent to:

    • 40 weeks

    • 9 calendar months

    • 10 lunar months (4 weeks each)

👉 Memory Aid: “40 = 280 = 9” (40 weeks = 280 days = 9 months)

2⃣ Trimesters (Divisions of Pregnancy)

Pregnancy is divided into 3 trimesters, each with distinct changes:

  • First Trimester: 0–13 weeks → organogenesis, highest teratogen risk.

  • Second Trimester: 14–26 weeks → “golden period” (energy ↑, N/V ↓), quickening felt.

  • Third Trimester: 27–40 weeks → rapid fetal growth, maternal discomforts ↑.

3⃣ Important Landmarks in Length of Pregnancy

  • 12 weeks: uterus palpable above pubic symphysis.

  • 20 weeks: fundus at umbilicus, quickening felt.

  • 36 weeks: fundus at xiphoid process (dyspnea).

  • 40 weeks: fetus descends (lightening), fundus drops.

4⃣ Estimated Date of Delivery (EDD)

Calculated using Naegele’s Rule:

  • Formula: LMP + 7 days – 3 months (+1 year if needed)

  • Example:

    • LMP = July 10, 2024

    • +7 days = July 17

    • –3 months = April 17, 2025

    • EDD = April 17, 2025

👉 Tip: Works best if cycles are 28 days & regular.

5⃣ Variations in Length

  • Preterm: <37 completed weeks.

  • Term: 37–42 weeks.

  • Post-term: >42 weeks.

📝 Exam Focus (20/80)

  • Average = 280 days / 40 weeks / 9 months.

  • Naegele’s Rule = +7 days – 3 months.

  • Term pregnancy = 37–42 weeks.

📝 Exam-Focused Quick Table

Trimester

Maternal Highlights

Fetal Highlights

Key Nursing Care

1st (0–13 wks)

N/V, fatigue, ambivalence

Organogenesis, heart beats, sex organs

Avoid teratogens, nutrition, rest

2nd (14–26 wks)

Energy ↑, quickening, skin changes

Lanugo, surfactant begins, viability

Fetal movement, GDM screening

3rd (27–40 wks)

Dyspnea, back pain, Braxton Hicks

Rapid weight gain, lung maturity

Preeclampsia watch, labor prep

🧼 Hygiene During Pregnancy

  • Bathing: Daily for comfort & circulation. Avoid very hot baths → risk of fainting & preterm labor.

  • Dental Care: Brush/floss regularly → gum disease common (pregnancy gingivitis).

  • Perineal Care: Clean vulva with mild soap & water (↑ discharge). Avoid douching.

  • Breast Care: Wash with plain water (no harsh soap), support with well-fitting bra.

  • Clothing: Loose, comfortable, cotton underwear. Avoid high heels (back strain).

  • Rest & Sleep: 8–10 hrs/night, naps as needed. Left side-lying best (↑ placental blood flow).

👉 Memory Aid: “B-D-P-B-C-R”

  • Bathing

  • Dental care

  • Perineal care

  • Breast care

  • Clothing

  • Rest

🤰 Physiologic Adaptations of Pregnancy

Pregnancy causes widespread changes in nearly all organ systems. These adaptations ensure maternal health and fetal growth.

1⃣ Reproductive System

  • Uterus: enlarges from 50 g → 1,000 g; blood flow ↑ 10×; Braxton Hicks contractions appear.

  • Cervix: Goodell’s sign (softening), Chadwick’s sign (bluish), ↑ mucus (mucus plug).

  • Vagina & Vulva: ↑ vascularity, ↑ secretions (acidic pH to prevent infection).

  • Ovaries: ovulation stops due to high progesterone & estrogen.

  • Breasts: hypertrophy, dark areola, Montgomery’s tubercles, colostrum secretion by 3rd trimester.

2⃣ Cardiovascular System

  • Blood volume: ↑ 40–50% → supports uteroplacental circulation.

  • Cardiac output: ↑ 30–50%.

  • Heart rate: ↑ by 10–15 bpm.

  • Blood pressure: slight ↓ mid-pregnancy, returns to normal later.

  • Physiologic anemia: plasma ↑ > RBCs → hemodilution (Hgb 11 g/dL is normal).

  • Clotting tendency: ↑ clotting factors → DVT risk.

👉 Nursing: Monitor for supine hypotension syndrome (vena cava compression) → advise left side-lying.

3⃣ Respiratory System

  • Tidal volume & O₂ consumption ↑.

  • Diaphragm elevates → dyspnea common.

  • Progesterone causes hyperventilation (mild respiratory alkalosis).

4⃣ Gastrointestinal System

  • Nausea & vomiting: ↑ hCG, estrogen.

  • Constipation: ↓ peristalsis (progesterone).

  • Heartburn (pyrosis): relaxed esophageal sphincter.

  • Hemorrhoids: from constipation & pelvic pressure.

5⃣ Urinary System

  • Kidneys: ↑ GFR by 50%.

  • Urinary frequency: early (uterus pressing bladder) & late pregnancy (fetal head pressure).

  • Risk: UTIs from urinary stasis.

6⃣ Endocrine System

  • Placenta = major endocrine organ.

  • hCG: maintains corpus luteum until placenta takes over.

  • Progesterone: relaxes smooth muscle, prevents contractions.

  • Estrogen: uterine growth, breast changes.

  • Relaxin: softens ligaments, pelvic joints.

  • hPL (human placental lactogen): insulin resistance → prepares fetus for glucose use.

7⃣ Musculoskeletal System

  • Lordosis: posture changes due to uterus weight.

  • Relaxed joints & ligaments: from relaxin.

  • Waddling gait common.

8⃣ Integumentary System

  • Linea nigra: dark line from umbilicus to pubis.

  • Chloasma (mask of pregnancy): dark facial pigmentation.

  • Striae gravidarum: stretch marks.

  • Spider nevi & palmar erythema: from ↑ estrogen.

9⃣ Immune System

  • Immunity suppressed → prevents fetal rejection but ↑ infection risk.

📝 Exam Focus (20/80 Rule)

  • Blood volume ↑ → physiologic anemia.

  • Supine hypotension → left side-lying position.

  • Progesterone → constipation, heartburn.

  • Placenta → major endocrine organ.

  • Skin changes → linea nigra, chloasma, striae.

🧠 Memory Trick: “CRG-UEMII”

  • Cardiovascular

  • Respiratory

  • GI

  • Urinary

  • Endocrine

  • Musculoskeletal

  • Integumentary

  • Immune

    🌸 Dimensions of Maternal Development

    Pregnancy = developmental crisis. The mother adapts in multiple domains to prepare for her role.

    1⃣ Physical Dimension

    • All physiological changes in body systems (uterus growth, breast changes, fatigue, back pain).

    • ↑ Nutritional needs, rest requirements, and attention to hygiene.

    • Nursing: teach proper diet, exercise, and discomfort relief.

    2⃣ Psychological Dimension

    • Emotional reactions vary per trimester:

      • 1st Trimester: ambivalence, uncertainty, mood swings.

      • 2nd Trimester: acceptance, excitement, bonding begins (quickening is meaningful).

      • 3rd Trimester: anxiety about labor, fear of complications, nesting instinct.

    • Nursing: provide reassurance, address fears, encourage expression of feelings.

    3⃣ Social Dimension

    • Family role changes → spouse, siblings, grandparents adjust.

    • Possible role conflict (esp. working mothers).

    • Support systems crucial for healthy adaptation.

    • Nursing: involve family in prenatal education, discuss partner’s role.

    4⃣ Spiritual Dimension

    • Some women ↑ faith and reliance on God/higher power.

    • Others may question meaning of life and suffering.

    • Rituals, prayers, cultural practices influence pregnancy experience.

    • Nursing: respect beliefs, provide culturally sensitive care.

    📝 20/80 Focus (Exam-High Yield)

    • Physical: body changes, nutrition, hygiene.

    • Psychological: ambivalence → acceptance → anxiety.

    • Social: role adjustment, family support.

    • Spiritual: ↑ faith or questioning.

    🧠 Memory Trick: “PPSS”

    • Physical

    • Psychological

    • Social

    • Spiritual

🤰 Discomforts of Pregnancy & Relief Measures

🔹 First Trimester (Weeks 1–13)

  1. Nausea & Vomiting (Morning Sickness)

    • Cause: ↑ hCG & estrogen → gastric sensitivity.

    • Relief:

      • Small, frequent meals.

      • Dry crackers before rising.

      • Avoid greasy/spicy food.

      • ↑ Fluids (between meals, not during).

  2. Urinary Frequency

    • Cause: Uterus presses on bladder.

    • Relief:

      • Void regularly.

      • Limit fluids before bedtime.

      • Kegel exercises.

  3. Breast Tenderness

    • Cause: Hormonal changes (↑ estrogen, progesterone).

    • Relief:

      • Supportive bra.

      • Avoid harsh soaps on nipples.

  4. Fatigue

    • Cause: ↑ metabolic demands & progesterone.

    • Relief:

      • Rest/naps.

      • Balanced diet, moderate exercise.

🔹 Second Trimester (Weeks 14–26)

  1. Backache

    • Cause: Lumbar lordosis, ligament relaxation.

    • Relief:

      • Good posture, avoid high heels.

      • Squat instead of bending.

      • Heat packs, pelvic tilt exercises.

  2. Varicose Veins

    • Cause: Venous congestion, pressure from uterus.

    • Relief:

      • Elevate legs.

      • Avoid prolonged standing.

      • Support stockings.

  3. Hemorrhoids

    • Cause: Venous congestion, constipation.

    • Relief:

      • High-fiber diet, fluids.

      • Warm sitz baths.

      • Avoid prolonged sitting/straining.

  4. Leukorrhea (Increased Vaginal Discharge)

    • Cause: Hormonal changes, ↑ vaginal secretions.

    • Relief:

      • Cotton underwear.

      • Daily hygiene.

      • Avoid douching.

🔹 Third Trimester (Weeks 27–40)

  1. Dyspnea

    • Cause: Uterus pushes diaphragm upward.

    • Relief:

      • Sleep propped up with pillows.

      • Side-lying position.

  2. Edema (Dependent Swelling)

    • Cause: Uterine pressure on venous return.

    • Relief:

      • Elevate legs when resting.

      • Left lateral recumbent position.

      • Avoid tight clothing.

  3. Heartburn (Pyrosis)

    • Cause: Progesterone relaxes LES + pressure on stomach.

    • Relief:

      • Small frequent meals.

      • Avoid lying down right after eating.

      • Avoid spicy/greasy foods.

  4. Constipation

    • Cause: Progesterone slows peristalsis.

    • Relief:

      • ↑ Fiber, fluids, exercise.

      • Avoid laxatives unless prescribed.

  5. Leg Cramps

    • Cause: Pressure on nerves, calcium/phosphorus imbalance.

    • Relief:

      • Dorsiflex foot, stretch calf.

      • Adequate calcium intake.

📝 Quick 20/80 Focus (Most Asked in NLE)

  • N/V → dry crackers, small frequent meals.

  • Backache → posture, pelvic tilts.

  • Heartburn → small meals, no lying after eating.

  • Constipation → fiber, fluids, exercise.

  • Leg cramps → dorsiflex foot, ↑ calcium.

  • Supine hypotension → left side-lying.

🧠 Memory Trick: "BACK-HELPC" (Common Discomforts)

  • Backache

  • Anxiety/Fatigue

  • Cramps (Leg)

  • Kidney/Urinary frequency

  • Heartburn

  • Edema

  • Leukorrhea

  • Pyrosis (Acidity)

  • Constipation

👩‍🍼 Prenatal Management

1⃣ Goals of Prenatal Care

  • Promote maternal & fetal health.

  • Detect early complications.

  • Educate mother & family.

  • Prepare for safe delivery & parenting.

2⃣ Schedule of Prenatal Visits (DOH/WHO Standard)

  • First visit: As soon as pregnancy is suspected.

  • Up to 28 weeks: Every 4 weeks.

  • 29–36 weeks: Every 2 weeks.

  • 37 weeks–delivery: Weekly until birth.

👉 Minimum of 4 visits required by WHO, but ideal is 8–12 visits.

3⃣ Initial Visit Assessment

  • History Taking: Obstetric (GTPAL), menstrual history (Naegle’s rule).

  • Physical Exam: Baseline weight, BP, general health, pelvic exam.

  • Laboratory Tests:

    • CBC, urinalysis, blood type & Rh factor.

    • VDRL/RPR (syphilis), HIV, HBsAg (hepatitis B).

    • Rubella immunity, Pap smear.

4⃣ Ongoing Assessments at Each Visit

  • Weight, BP.

  • Fundal height (after 20 wks = weeks of gestation ± 2 cm).

  • Fetal heart tones (by Doppler at 10–12 wks).

  • Urinalysis (proteinuria, glycosuria).

  • Fetal movement monitoring (after 20 wks).

5⃣ Medications / Immunizations

  • Iron + folic acid: Prevent anemia & neural tube defects.

  • Calcium: Prevent preeclampsia.

  • TT immunization (Tetanus Toxoid):

    • TT1: First contact (no protection yet).

    • TT2: At least 4 weeks after TT1 (3 years protection).

    • TT3: 6 months after TT2 (5 years protection).

    • TT4: 1 year after TT3 (10 years protection).

    • TT5: 1 year after TT4 (lifetime protection).

6⃣ Health Education (Mother & Family)

  • Diet: Balanced, ↑ protein, ↑ iron, ↑ folic acid. Avoid alcohol, raw fish, caffeine excess.

  • Exercise: Moderate (walking, swimming). Avoid strenuous/heavy lifting.

  • Warning Signs (Danger Signs):

    • Vaginal bleeding, severe headache, blurring vision, edema, ↓/absent fetal movement, severe abdominal pain.

  • Birth Preparedness: Transport, funds, companion, blood donor, facility choice.

7⃣ Special Considerations (Others)

  • Psychological prep: Address anxiety, body image issues.

  • Cultural practices: Respect traditions if safe.

  • Adolescent pregnancy: More risk of anemia, preterm birth → needs more counseling/support.

  • High-risk mothers: Hypertension, diabetes, multiple gestation → closer monitoring.

📝 Exam 20/80 Highlights

  • Visit schedule (Q4wks → Q2wks → weekly).

  • Naegle’s Rule (LMP + 7 days – 3 months).

  • Fundal height = weeks of gestation after 20 weeks.

  • TT immunization schedule (TT2 = 3 years, TT5 = lifetime).

  • Danger signs: bleeding, headache, vision changes, edema, ↓ fetal movement.

🧠 Memory Tricks

  • Prenatal Visits: “4–2–1” (Every 4 wks, then 2, then 1).

  • Danger Signs: “B HEAD”

    • Bleeding

    • Headache (severe)

    • Edema

    • Abdominal pain

    • Decreased fetal movement


👩‍🍼 Care of Mother – Intrapartum

1⃣ Theories of Labor

Labor begins due to a combination of maternal and fetal factors:

  • Progesterone Withdrawal Theory → ↓ progesterone → uterine irritability.

  • Estrogen Stimulation Theory → ↑ estrogen → ↑ uterine contractility.

  • Prostaglandin Theory → ↑ prostaglandins soften cervix & stimulate contractions.

  • Oxytocin Theory → ↑ oxytocin receptors late in pregnancy.

  • Fetal Role Theory → fetal adrenal glands release cortisol → triggers labor.

2⃣ Signs of Labor

  • True Labor:

    • Regular, increasing contractions.

    • Pain starts in back → radiates to abdomen.

    • Cervical changes: effacement + dilation.

    • Not relieved by rest.

  • False Labor (Braxton Hicks):

    • Irregular, mild contractions.

    • No cervical change.

    • Pain only in abdomen.

    • Relieved by rest or walking.

3⃣ Physiologic Alterations During Labor

  • ↑ BP, HR, RR during contractions.

  • ↑ WBC count (normal).

  • GI activity ↓ → risk of aspiration (NPO or clear liquids).

  • Bladder capacity ↓ due to pressure → encourage voiding.

4⃣ 5 P’s of Labor

  1. Passenger → fetus & placenta.

  2. Passageway → bony pelvis & soft tissues.

  3. Powers → uterine contractions & maternal pushing.

  4. Position → maternal posture (upright aids descent).

  5. Psyche → maternal emotional state & coping ability.

5⃣ Stages of Labor

  • First Stage (Cervical dilation 0–10 cm):

    • Latent (0–3 cm, mild contractions).

    • Active (4–7 cm, stronger contractions).

    • Transition (8–10 cm, very strong, shortest but most intense).

  • Second Stage (10 cm – delivery of baby): pushing stage.

  • Third Stage (delivery of placenta): 5–30 minutes.

  • Fourth Stage (recovery): 1–4 hours post-delivery, monitor for hemorrhage.

6⃣ Duration of Labor

  • Primigravida: ~12–20 hrs.

  • Multigravida: ~7–10 hrs.

  • Second Stage: ~1–2 hrs (primis), <1 hr (multis).

7⃣ Partograph

  • WHO tool to monitor labor progress & detect dystocia.

  • Plots: cervical dilation, fetal HR, contractions, maternal vitals.

  • Alert line: expected progress.

  • Action line: need intervention if crossed.

8⃣ Leopold’s Maneuvers (to determine fetal position & presentation)

  1. Fundal Grip → fetal part in fundus (head or buttocks).

  2. Umbilical Grip → fetal back vs limbs.

  3. Pawlik’s Grip → presenting part above inlet.

  4. Pelvic Grip → descent & attitude (flexion/extension).

9⃣ Cardinal Movements of Labor (Mechanisms of Delivery)

  1. Engagement – head enters pelvis.

  2. Descent – downward movement.

  3. Flexion – chin to chest.

  4. Internal Rotation – occiput moves anteriorly.

  5. Extension – head delivers.

  6. External Rotation (Restitution) – head realigns with shoulders.

  7. Expulsion – shoulders & body delivered.

👉 Mnemonic: “Every Darn Fool In Egypt Eats Eggs”

🔟 Natural Childbirth

  • Delivery without medical interventions (drugs, C-section).

  • Focus on breathing, relaxation, mobility, supportive environment.

1⃣1⃣ Psychoprophylaxis (Lamaze Method)

  • Based on conditioning & breathing techniques.

  • Goal: reduce fear, pain, and need for anesthesia.

1⃣2⃣ Essential Newborn Care (ENC, DOH protocol)

  • Immediate drying (prevent hypothermia).

  • Early skin-to-skin contact.

  • Delayed cord clamping (1–3 mins).

  • No immediate bathing (protect vernix).

  • Early initiation of breastfeeding (within 1 hr).

  • Rooming-in & continuous mother-infant contact.

📝 20/80 Focus (High-Yield NLE Points)

  • Theories of Labor → progesterone ↓, estrogen/prostaglandin ↑.

  • True vs false labor differences.

  • 5 P’s of labor.

  • Stages of labor (esp. transition phase = most painful).

  • Partograph = alert/action lines.

  • Leopold’s maneuvers (fundal → umbilical → Pawlik’s → pelvic).

  • Cardinal movements = “Every Darn Fool In Egypt Eats Eggs.”

  • Essential Newborn Care sequence (dry → skin-to-skin → delayed clamp → breastfeed).

    🩺 Care of Male & Female with Problems in Reproductive Health

    1⃣ Menstrual Cycle

    The menstrual cycle is a cyclic event (≈28 days) preparing the uterus for possible pregnancy. It is regulated by the hypothalamus–pituitary–ovarian axis.

    🔹 Phases of Menstrual Cycle

    1. Menstrual Phase (Days 1–5):

      • Shedding of endometrium → menstruation (blood loss ~30–50 mL).

      • Hormones: ↓ estrogen, ↓ progesterone.

    2. Follicular/Proliferative Phase (Days 6–14):

      • FSH stimulates follicle growth.

      • Estrogen ↑ → thickens endometrium.

      • Ovulation occurs ~Day 14 → triggered by LH surge.

    3. Luteal/Secretory Phase (Days 15–28):

      • Corpus luteum secretes progesterone → prepares endometrium for implantation.

      • If no fertilization → corpus luteum degenerates → hormone drop → menstruation restarts.

    👉 Nursing Relevance: Education about cycle, fertility awareness, contraception timing.

    Exam Tip (20/80):

    • Ovulation = Day 14 (mid-cycle, 14 days before next period).

    • Best fertility = 3 days before & after ovulation.

    • Hormones: FSH → follicle growth, LH → ovulation, Estrogen → proliferation, Progesterone → implantation.

    2⃣ Genetic Disorders (Reproductive Relevance)

    Genetics plays a major role in infertility, congenital anomalies, and hereditary diseases.

    🔹 Common Genetic Disorders

    • Turner’s Syndrome (XO): Female, short stature, streak ovaries, infertility.

    • Klinefelter’s Syndrome (XXY): Male, small testes, gynecomastia, infertility.

    • Down Syndrome (Trisomy 21): Risk ↑ with maternal age >35.

    • Cystic Fibrosis: Autosomal recessive, thick secretions → male infertility (blocked vas deferens).

    • Sickle Cell Disease, Thalassemia: May affect pregnancy outcomes.

    👉 Nursing Relevance:

    • Provide genetic counseling for couples with family history of disorders.

    • Offer screening (amniocentesis, chorionic villus sampling, newborn screening).

    3⃣ Fertility Assessment

    Fertility = couple’s ability to achieve pregnancy after 1 year of unprotected intercourse.

    🔹 Female Fertility Assessment

    • History: Menstrual regularity, past pregnancies, pelvic infections.

    • Basal Body Temperature (BBT): ↑ by 0.3–0.6°C after ovulation (due to progesterone).

    • Cervical Mucus Test (Spinnbarkeit): Clear, stretchy mucus during ovulation.

    • Hormone Tests: FSH, LH, prolactin, thyroid hormones.

    • Imaging/Procedures: Ultrasound, hysterosalpingogram (HSG), laparoscopy.

    🔹 Male Fertility Assessment

    • Semen Analysis:

      • Volume ≥ 2 mL.

      • Count ≥ 20 million/mL.

      • Motility ≥ 50%.

      • Morphology ≥ 30% normal.

    👉 Nursing Relevance: Counsel both partners (infertility is 40% male, 40% female, 20% both/unknown).

    4⃣ Alternatives to Childbirth (Assisted Reproductive Technologies & Options)

    When natural conception is not possible, several alternatives exist:

    • Artificial Insemination (AI): Sperm introduced into female reproductive tract.

    • In Vitro Fertilization (IVF): Fertilization outside body → embryo transfer.

    • Intracytoplasmic Sperm Injection (ICSI): Sperm injected directly into egg.

    • Surrogacy: Another woman carries the pregnancy.

    • Adoption: Alternative for couples with infertility.

    👉 Nursing Relevance: Provide emotional support, discuss ethical/legal considerations, support informed decision-making.

    5⃣ Other Concepts Related to Reproductive Health

    • Contraception:

      • Natural: calendar, BBT, cervical mucus.

      • Barrier: condoms, diaphragm.

      • Hormonal: pills, injectables, implants.

      • Permanent: tubal ligation, vasectomy.

    • Sexually Transmitted Infections (STIs): Education on prevention, safe sex.

    • Reproductive Health Laws (Philippines): RH Law ensures access to family planning, maternal care, and education.

    • Cancer Screening: Pap smear (cervical), mammography (breast), PSA (prostate).

    • Menopause & Andropause: Hormonal decline, counseling for healthy aging.

    📝 Exam 20/80 High-Yield Focus

    • Menstrual cycle hormones & ovulation timing.

    • Genetic disorders: Turner’s = female infertility, Klinefelter’s = male infertility.

    • Fertility assessment: semen analysis = gold standard for male infertility.

    • ART (IVF, ICSI, surrogacy).

    • RH Law = access to family planning, maternal, and reproductive health services.

    🧠 Memory Tricks

    • Menstrual Hormones: “FEEL Proud”

      • FSH – Follicle growth

      • Estrogen – Endometrium thickens

      • Egg release (LH surge)

      • LH – Ovulation

      • Progesterone – Prepares uterus

    • Semen Analysis Normal Values = “2-20-50-30”

      • 2 mL, 20 million/mL, 50% motile, 30% normal morphology.

👩‍🍼 Care of Mother Postpartum (8 pts)

1⃣ Normal Puerperium

  • Definition: Period from delivery of placenta → return of reproductive organs to pre-pregnant state.

  • Duration: ~ 6 weeks (42 days).

👉 Nursing focus: promote healing, prevent complications, support maternal role adaptation.

2⃣ Physiologic Changes

🔹 Uterus (Involution)

  • Returns to pre-pregnant size in ~6 weeks.

  • Fundus immediately after delivery: at level of umbilicus.

  • Descends 1 cm/day → not palpable after day 10.

⚠ Subinvolution = uterus fails to contract → prolonged bleeding.

🔹 Lochia (Postpartum Discharge)

  • Lochia Rubra (Days 1–3): Red, bloody.

  • Lochia Serosa (Days 4–10): Pink/brown.

  • Lochia Alba (Days 11–21+): Yellow/white.

⚠ Foul odor or return to rubra = infection/hemorrhage.

🔹 Cervix, Vagina, Perineum

  • Cervix soft after birth, closes gradually.

  • Vagina returns but less elastic.

  • Perineum may be swollen/tender (esp. with episiotomy).

🔹 Breasts

  • Colostrum first (rich in antibodies).

  • Mature milk by day 3–5.

  • Engorgement common if not breastfeeding.

🔹 Cardiovascular

  • Blood volume decreases due to diuresis/diaphoresis.

  • Risk of postpartum hemorrhage (PPH) & thrombophlebitis.

🔹 Urinary & GI

  • Diuresis = normal first 2–3 days.

  • Constipation common due to ↓ tone + fear of pain.

🔹 Emotional/Psychological

  • Maternal Role Adaptation:

    • Taking-In Phase (1–2 days): Dependent, focused on self.

    • Taking-Hold Phase (2–10 days): Begins to assume care of newborn.

    • Letting-Go Phase: Adapts to motherhood role.

⚠ Postpartum Blues: Normal, transient mood swings.
⚠ Postpartum Depression: Persistent sadness, requires intervention.
⚠ Postpartum Psychosis: Emergency.

3⃣ Nursing Care in Early Postpartal Period

  • Monitor VS, lochia, uterine fundus (firm, midline, contracted).

  • Prevent infection: perineal care, handwashing.

  • Pain relief: sitz bath, analgesics, perineal support.

  • Breast care:

    • Encourage breastfeeding within 1 hr (rooming-in, skin-to-skin).

    • For non-breastfeeding moms → tight bra, ice packs, avoid stimulation.

  • Promote ambulation: Prevent DVT, enhance uterine involution.

  • Nutrition: Balanced diet, ↑ fluids.

  • Emotional support: Encourage bonding with newborn.

4⃣ Family Planning Methods

🔹 Natural Methods

  • Calendar, Basal Body Temp (BBT), Cervical Mucus.

  • Lactational Amenorrhea Method (LAM): Effective up to 6 months if exclusive breastfeeding + amenorrheic.

🔹 Artificial/Barrier Methods

  • Condom (also prevents STIs).

  • Diaphragm, cervical cap.

🔹 Hormonal Methods

  • Pills, injectables (Depo-Provera), implants.

  • Safe after 6 weeks postpartum (esp. if breastfeeding).

🔹 Intrauterine Device (IUD)

  • Inserted after 6 weeks.

🔹 Permanent Methods

  • Tubal ligation, vasectomy.

5⃣ Other Key Concepts

  • Postpartum Hemorrhage (PPH): Leading cause of maternal death in PH.

    • Causes: Uterine atony (most common), retained placenta, trauma, coagulopathy.

    • Nursing: Fundal massage, oxytocin, monitor VS.

  • Rooming-in & Kangaroo Care: Strengthen bonding, support breastfeeding.

  • Essential Newborn Care (ENC):

    • Immediate drying, skin-to-skin, early breastfeeding, delayed cord clamping (1–3 min).

📝 Exam 20/80 High-Yield Focus

  • Involution: uterus descends 1 cm/day, not palpable after day 10.

  • Lochia sequence = Rubra → Serosa → Alba.

  • Taking-in / Taking-hold / Letting-go phases.

  • PPH = leading cause of maternal death.

  • LAM = effective for 6 months postpartum if exclusive breastfeeding.

🧠 Memory Tricks

  • Lochia Order: “RSA” (Rubra → Serosa → Alba).

  • Uterus Descent: “1 finger a day” (fundus drops 1 cm/day).

  • Danger signs postpartum: “FALL”

    • Fever

    • Abnormal lochia (foul, heavy)

    • Large clots

    • Low uterine tone

👩‍⚕ Care of Mother with Complications of Childbearing (8 pts)

1⃣ Hypertensive Disorders in Pregnancy (PIH / Preeclampsia-Eclampsia)

  • Definition: BP ≥ 140/90 after 20 weeks, with proteinuria & edema.

  • Eclampsia: Preeclampsia + seizures.

  • Complications: HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets).

  • Nursing: Monitor BP, urine protein, seizure precautions, MgSO₄ (antidote: Ca gluconate).

👉 Memory Trick: PIH = “High BP + Protein + Swelling.”

2⃣ Gestational Diabetes (GD)

  • Definition: Glucose intolerance first detected in pregnancy.

  • Risks: LGA baby, neonatal hypoglycemia, maternal DM later.

  • Management: Diet, exercise, insulin (not oral meds).

3⃣ Hyperemesis Gravidarum

  • Definition: Severe vomiting → dehydration, ketonuria, electrolyte imbalance.

  • Tx: IV fluids, antiemetics, small frequent meals.

4⃣ Placental Problems

  • Placenta Previa: Painless vaginal bleeding, placenta covers cervix.

  • Placental Abruption: Painful vaginal bleeding, rigid uterus.

  • Nursing: NO vaginal exam in previa, prepare for C-section if severe.

👉 Trick: Previa = Painless, Abruption = Abdominal Pain.

5⃣ Nutritional Deficiencies

  • Iron Deficiency Anemia: Pale, fatigue, Hgb <11 g/dL → give FeSO₄ + Vit C.

  • Folic Acid Deficiency: Risk of neural tube defects → 400–600 mcg/day supplement.

6⃣ Management of High-Risk Pregnancy

  • Early prenatal checkups.

  • Identify & manage risk factors (teen pregnancy, multiparity, DM, HTN).

  • Multidisciplinary care.

7⃣ BeMONC & CEmONC

  • BeMONC (Basic Emergency Obstetric & Newborn Care): 6 signal functions (e.g., parenteral antibiotics, oxytocin, MgSO₄, manual placenta removal, assisted delivery, newborn resuscitation).

  • CEmONC (Comprehensive): BeMONC + C-section + blood transfusion.

8⃣ Preterm & Precipitate Labor

  • Preterm: <37 weeks. Risk for RDS, sepsis. Tx: tocolytics, steroids (betamethasone).

  • Precipitate Labor: <3 hrs from onset → risk for trauma, hemorrhage.

9⃣ Dystocia

  • Abnormal/prolonged labor (5Ps mismatch).

  • Tx: Oxytocin, C-section if obstructed.

🔟 Premature Rupture of Membranes (PROM)

  • Rupture before labor.

  • Risks: Infection, preterm birth.

  • Nursing: Sterile technique, monitor temp, avoid vaginal exams.

1⃣1⃣ Uterine Rupture

  • Severe abdominal pain, loss of fetal station, shock.

  • Emergency laparotomy.

1⃣2⃣ Fetal Distress

  • Abnormal FHR (<110 or >160), late decels.

  • Nursing: Left lateral, O₂, stop oxytocin.

1⃣3⃣ IUFD (Intrauterine Fetal Death)

  • Fetal demise after 20 weeks.

  • Nursing: Support grieving, prepare for induction.

1⃣4⃣ Hemorrhage

  • Causes: Uterine atony, trauma, retained placenta, coagulation issues (4 T’s).

  • Nursing: Fundal massage, oxytocin, fluids, blood transfusion.

1⃣5⃣ Cord Prolapse

  • Cord slips below presenting part.

  • Nursing: Knee-chest/Trendelenburg, manually lift presenting part, prepare C-section.

👉 Trick: “Cord = Knee-Chest.”

1⃣6⃣ Vena Cava Syndrome (Supine Hypotension)

  • Compression of IVC when supine → ↓ BP, dizziness.

  • Nursing: Position mother on left side.

1⃣7⃣ Amniotic Fluid Embolism

  • Rare, fatal. Amniotic fluid enters maternal circulation → DIC, shock, dyspnea.

  • Nursing: O₂, fluids, CPR.

1⃣8⃣ Operative Obstetrics

  • Forceps/Vacuum: Assist difficult deliveries.

  • C-section: Indicated for CPD, previa, distress.

1⃣9⃣ Analgesia in Labor

  • Systemic: Opioids (risk of neonatal resp. depression).

  • Regional: Epidural (risk of hypotension).

  • General anesthesia: Only for emergencies.

2⃣0⃣ Sepsis

  • Infection after childbirth → fever, foul lochia, tachycardia.

  • Tx: IV antibiotics, fluids.

2⃣1⃣ Mastitis

  • Breast infection (usually staph). Pain, fever, redness.

  • Tx: Antibiotics, continue breastfeeding unless abscess.

2⃣2⃣ DVT

  • Pain, swelling, redness in leg.

  • Nursing: Bed rest, heparin, avoid massage.

2⃣3⃣ Cystitis

  • UTI postpartum. Dysuria, frequency.

  • Tx: Hydration, antibiotics.

2⃣4⃣ Uterine Prolapse

  • Uterus descends into vagina.

  • Tx: Kegel’s, pessary, surgery.

2⃣5⃣ Postpartum Psychosis, Reproductive Loss & Grieving

  • Psychosis: Hallucinations, delusions → medical emergency.

  • Grieving: Support stages of loss.

📝 Exam 20/80 High-Yield

  • PIH: MgSO₄ antidote = Ca gluconate.

  • Placenta Previa = painless, Abruption = painful.

  • BeMONC = 6 signal functions, CEmONC = +C/S + blood.

  • Preterm → steroids, tocolytics.

  • Cord prolapse → knee-chest position.

  • PPH causes = 4 T’s (Tone, Trauma, Tissue, Thrombin).

🧠 Memory Tricks

  • HELLP Syndrome = “Hemolysis, Elevated Liver, Low Platelets.”

  • Placenta: Previa = Painless, Abruption = Abdominal Pain.

  • PPH Causes = 4 T’s: Tone, Trauma, Tissue, Thrombin.

  • Danger positions: Cord prolapse = knee-chest; Vena cava syndrome = left side.

  • taff/resources.

  • Staffing: Recruitment, delegation, assignment.

  • Directing/Leading: Motivating, supervising.

  • Controlling/Evaluating: Monitoring outcomes, quality assurance.

2⃣ Leadership Styles

  • Autocratic: Quick decisions, good in emergencies.

  • Democratic: Participative, encourages input.

  • Laissez-Faire: Minimal direction, works if staff highly skilled.

3⃣ Decision-Making & Prioritization

  • Use Maslow’s Hierarchy: Physiologic > Safety > Love > Esteem > Self-actualization.

  • Apply ABC: Airway, Breathing, Circulation.

  • Delegation: Only RNs handle unstable patients, IV meds, teaching.

👉 Exam Tip: Never delegate assessment, evaluation, or patient teaching.

🟢 Human Growth & Development (10 pts)

1⃣ Freud – Psychosexual Development

  • Oral (0–1 yr): Mouth = pleasure (feeding, sucking).

  • Anal (1–3 yr): Toilet training, control.

  • Phallic (3–6 yr): Oedipus/Electra complex, gender identity.

  • Latency (6–12 yr): Socialization, skills.

  • Genital (12+): Sexual maturity, relationships.

👉 Trick: “Old Age People Love Grapes” (Oral, Anal, Phallic, Latency, Genital).

2⃣ Piaget – Cognitive Development

  • Sensorimotor (0–2 yr): Object permanence, reflexes.

  • Preoperational (2–7 yr): Egocentric, symbolic play.

  • Concrete Operational (7–11 yr): Logic, conservation, cause-effect.

  • Formal Operational (12+): Abstract reasoning, problem solving.

👉 Trick: “Some People Can Fly” (Sensorimotor, Preoperational, Concrete, Formal).

3⃣ Bandura – Social Learning Theory

  • Modeling & Imitation: Children learn by observing others.

  • Self-efficacy: Belief in one’s ability to succeed influences behavior.
    👉 Example: Child copies parent’s actions → basis of role modeling in nursing.

4⃣ Erikson – Psychosocial Development

  • Infant (0–1): Trust vs. Mistrust.

  • Toddler (1–3): Autonomy vs. Shame/Doubt.

  • Preschool (3–6): Initiative vs. Guilt.

  • School-age (6–12): Industry vs. Inferiority.

  • Adolescence (12–18): Identity vs. Role Confusion.

  • Young Adult (18–40): Intimacy vs. Isolation.

  • Middle Adult (40–65): Generativity vs. Stagnation.

  • Older Adult (65+): Integrity vs. Despair.

👉 Trick: “Trusty Auto In Industry Identifies Intimate Generous Integrity.”

5⃣ Bowlby – Attachment Theory

  • Secure Attachment: Caregiver responsive → child confident.

  • Insecure-Avoidant: Caregiver distant → child avoids closeness.

  • Insecure-Ambivalent: Caregiver inconsistent → child anxious, clingy.

  • Disorganized: Caregiver abusive/neglectful → child confused, fearful.

👉 Nursing Relevance: Bonding, maternal separation anxiety, NICU care.

📝 Exam 20/80 High-Yield Focus

  • Ethics: Autonomy, Beneficence, Non-maleficence.

  • Management: Never delegate assessment, teaching, evaluation.

  • Freud: Anal = toilet training, Phallic = Oedipus/Electra.

  • Piaget: Object permanence (sensorimotor), Conservation (concrete).

  • Erikson: Know all 8 stages!

  • Bowlby: Secure vs. insecure attachments.

🧠 Memory Tricks

  • Freud = “Old Age People Love Grapes.”

  • Piaget = “Some People Can Fly.”

  • Erikson = “Trusty Auto In Industry Identifies Intimate Generous Integrity.”

  • Ethics = “JAV-FAB” → Justice, Autonomy, Veracity, Fidelity, Autonomy, Beneficence.

    👶👧🧒👦 Care of the Growing Child (15 pts)

    1⃣ Neonate (0–28 days)

    🔹 Health Promotion:

    • Support bonding (rooming-in, breastfeeding within 1 hr).

    • Promote thermoregulation (skin-to-skin, warm environment).

    🔹 Disease Prevention:

    • Encourage exclusive breastfeeding.

    • Screen for congenital disorders (newborn screening, hearing test).

    🔹 Restoration (If Ill):

    • Supportive care for neonatal jaundice, sepsis.

    🔹 Rehabilitation:

    • Follow-up for high-risk neonates (premature, LBW).

    🔹 Safety:

    • Back to sleep (prevent SIDS).

    • Avoid co-sleeping.

    🔹 Communication:

    • Crying is main form; respond promptly.

    🔹 Immunization:

    • At birth: BCG, Hepatitis B, OPV 0.

    2⃣ Infant (1–12 months)

    🔹 Health Promotion:

    • Exclusive breastfeeding for 6 months.

    • Introduce complementary food at 6 months.

    • Promote play (peek-a-boo, rattles).

    🔹 Disease Prevention:

    • Vitamin A (6–11 months).

    • Prevent accidents (falls, choking, burns).

    🔹 Restoration:

    • ORS for diarrhea.

    • Manage infections promptly.

    🔹 Rehabilitation:

    • Monitor growth (weight should triple by 1 year).

    🔹 Safety:

    • Keep crib rails up, supervise feeding.

    🔹 Communication:

    • Cooing → babbling → first words.

    • Respond to name by 6–9 months.

    🔹 Immunization:

    • Penta, OPV, IPV, PCV, Rotavirus, Influenza.

    3⃣ Toddler (1–3 yrs)

    🔹 Health Promotion:

    • Encourage autonomy (toilet training, self-feeding).

    • Provide nutritious diet, avoid choking hazards.

    🔹 Disease Prevention:

    • Deworming starting at 1 yr (every 6 mos).

    • Handwashing, oral hygiene.

    🔹 Restoration:

    • Manage otitis media, diarrhea, common URTI.

    🔹 Rehabilitation:

    • Developmental screening (speech delay, autism red flags).

    🔹 Safety:

    • Prevent poisoning, burns, drowning.

    🔹 Communication:

    • Short sentences, rapid vocabulary growth.

    • Encourage expressive speech.

    🔹 Immunization:

    • Measles (MCV1 at 9 mos, MCV2 at 12–15 mos).

    • Hepatitis A, Varicella (depending on DOH/local protocol).

    4⃣ Preschooler (3–6 yrs)

    🔹 Health Promotion:

    • Balanced diet, regular sleep.

    • Encourage imaginative play, peer interaction.

    🔹 Disease Prevention:

    • Annual dental check-up.

    • Deworming (every 6 mos).

    🔹 Restoration:

    • Asthma care, nutrition management (obesity/underweight).

    🔹 Rehabilitation:

    • Vision/hearing screening.

    • Speech therapy if needed.

    🔹 Safety:

    • Stranger danger education.

    • Road & water safety.

    🔹 Communication:

    • Speak in complete sentences.

    • Ask many “why” questions.

    🔹 Immunization:

    • DTaP booster, IPV, MMR, Varicella, Influenza yearly.

    5⃣ School-age (6–12 yrs)

    🔹 Health Promotion:

    • Encourage physical activity & healthy eating.

    • Support learning (school performance monitoring).

    🔹 Disease Prevention:

    • Annual physical exam.

    • Deworming programs (DOH every Jan & July in PH schools).

    🔹 Restoration:

    • Manage common illnesses (tonsillitis, allergies).

    🔹 Rehabilitation:

    • Orthopedic follow-up for scoliosis screening.

    🔹 Safety:

    • Teach road safety, sports safety gear.

    🔹 Communication:

    • Logical thinking, can express needs.

    • Encourage open discussion.

    🔹 Immunization:

    • Booster doses (Tdap, MMR, Varicella).

    • HPV vaccine for girls (9–14 yrs).

    6⃣ Adolescent (12–18 yrs)

    🔹 Health Promotion:

    • Promote healthy body image, self-esteem.

    • Sexual health education.

    • Balanced nutrition, avoid smoking, alcohol, drugs.

    🔹 Disease Prevention:

    • HPV vaccine (girls, some boys).

    • Safe sex practices, STI prevention.

    🔹 Restoration:

    • Acne management, nutrition-related concerns (eating disorders).

    🔹 Rehabilitation:

    • Counseling for mental health issues.

    • Substance abuse rehabilitation programs.

    🔹 Safety:

    • Road safety, cyber safety, peer pressure awareness.

    🔹 Communication:

    • Respect privacy, encourage independence.

    • Open, honest discussion.

    🔹 Immunization:

    • HPV, Tdap booster, Meningococcal vaccine if available.

    📝 Exam 20/80 High-Yield

    • At birth immunization: BCG, HepB, OPV 0.

    • Exclusive breastfeeding = 6 months.

    • Weight milestones: Double at 5–6 mos, triple at 1 yr.

    • Deworming: Start at 1 yr, then every 6 mos.

    • HPV vaccine: Girls 9–14 yrs.

    • Safety issues:

      • Infant = choking/falls.

      • Toddler = poisoning/burns.

      • Preschool = stranger danger.

      • School-age = sports, accidents.

      • Adolescent = risk behaviors.

    🧠 Memory Tricks

    • Growth Weight Rule:

      • 5–6 mos = double, 12 mos = triple, 24 mos = quadruple.

    • Immunization at Birth = “BHO” → BCG, Hep B, OPV 0.

    • Lochia order (for postpartum review tie-in): “RSA” = Rubra → Serosa → Alba.

    • Safety focus by age: “Falls, Poison, Stranger, Sports, Sex”.