MATERNAL AND CHILD NURSING ⚫ UTERINE LIGAMENTS

Human Sexuality – Broad and Round

⚫ Human Sexuality-behavior of being a boy or a girl, female/male Ligaments – provide
⚫ An entity subject to a lifelong dynamic change upper support for the
⚫ Developed at the time of birth uterus.
⚫ Involves emotions, attitudes, sexual self eroticism – Cardinal, Pubocervical,
Related concepts: and Uterosacral
⚫ Sex- biologic male or female Ligaments – suspensory
⚫ Gender identity-sense of femininity or and provide middle
musculinity support.
⚫ Developed between 2-4 years of age – Pelvic Muscular Floor
⚫ Role identity- attitudes, behavior and attributes that differentiate role Ligaments – provide
EXTERNAL ORGANS lower support.
⚫ MONS PUBIS – mound of fatty tissue over the symphysis pubis that cushion and ⚫ FALLOPIAN TUBES – extend
protects the bone. from the upper outer angles of the
⚫ LABIA MAJORA – longitudinal folds of pigmental skin extending from the mons uterus and end near the ovary.
pubis to the perineum. Passageway for the ovum to travel
⚫ LABIA MINORA – soft longitudinal skin folds between the labia majora. to the uterus.
⚫ CLITORIS – erectile tissue located at the upper end of the labia minora. ⚫ OVARIES – female sex glands
⚫ URETHRAL MEATUS – small opening of the urethra. Located between the clitoris located on each side of the uterus.
and the vaginal orifice. Stage 3: 12-13 y/o
⚫ SKENE OR PARAURETHRAL GLANDS – small mucus-secreting glands that ⚫ hair becomes
lubricate the vagina darker that develop along the pubic symphysis
⚫ VESTIBULE – almond-shaped area between the labia minora containing the vaginal Stage 4: 13-14 y/o
introitus, hymen, and Bartholin glands. ⚫ hair assumes the normal appearance of an adult but not
⚫ VAGINAL INTROITUS – external opening of the vagina. so thicked
⚫ HYMEN – membranous tissue ringing the vaginal introitus. ⚫ doesn’t appear in the inner aspect of the upper
⚫ BARTHOLIN OR VULVOVAGINAL GLANDS – mucus-secreting glands located thigh
on either side of the vaginal orifice. Stage 5: Sexual maturity, hair assumes the normal
⚫ PERINEUM – area of tissue between the anus and vagina. appearance of an adult
⚫ appears on the inner aspect of the upper thigh
PELVIS AND BREASTS
Pubic hair development: Tanner’s stages ⚫ TYPES OF PELVES:
Stage 1: Pre adolescent – GYNECOID – typical female pelvis with a ROUNDED INLET.
⚫ No pubic hair except for fine body hair – ANDROID – normal male pelvis with a HEART-SHAPED INLET.
– ANTHROPOID – an “APELIKE” pelvis with an OVAL INLET.
Stage 2: – PLATYPELLOID – is a flat, female-type pelvis with a TRANSVERSE
11-12 y/o OVAL INLET.
sparse, long slightly pigmented and
curly hair that develop along the labia ⚫ BREASTS:
INTERNAL ORGANS – Are specialized sebaceous glands that produce milk after childbirth.
⚫ VAGINA – female organ of – Internal breast structures include glandular tissue, lactiferous ducts or
copulation and also serves as the sinuses, Cooper ligaments and adipose and fibrous tissues.
birth canal. Lies between the – External structures include the nipple, areola and Montgomery tubercles.
rectum and the urethra and bladder.
⚫ UTERUS – hollow, muscular
organ with three muscle layers
(perimetrium, myometrium and
endometrium). Located between
the bladder and rectum. Consists of
the fundus, body(corpus) and
cervix.
 ⚫ Dysmenorrhea- painful menstruation due to increase
prostaglandin
⚫ Amenorrhea- absence of menstruation
⚫ Metrorrhagia- bleeding in between menstruation
⚫ Menorrhagia- excessive bleeding during
menstruation
⚫ Menopause- cessation of menstruation
- 47 y/o average menopausal age
- decrease estrogen osteoporosis
2. Plateau phase- increased congestion to sustained tension nearing orgasm
- Vs are high
- lasting 30 seconds to 3 minutes
3. Orgasmic phase- diminished sensory awareness
- involuntary release of sexual tension accompanied by physiologic & psychologic
release known as the peak of sexual experience
- VS peak
MENSTRUAL CYCLE AND HORMONES - 3-1o seconds
⚫ MENARCHE – (onset of menstruation) typically occurs between 10 and 13 years old. Sexual Responses
⚫ MENSTRUAL CYCLE – is a monthly pattern of ovulation and menstruation. Initial – Vasocongestion and Myotonia
– OVULATION – is the discharge of a mature ovum from the ovary. muscle tension
– MENSTRUATION – is the periodic shedding of blood, mucous, and Phases:
epithelial cells form the uterus (average blood loss is 50 ml) 1. Excitement phase- “ Foreplay “
⚫ HORMONES - erotic stimuli increases sexual tension
– ESTROGEN – contributes to the characteristics of femaleness - VS moderate
– PROGESTERONE – (hormone of pregnancy) quiets or decreases the - may last from minutes to hours
contractility of the uterus. ⚫ 4. Resolution phase- dangerous phase in cardiac patient
– PROSTAGLANDINS – regulate the reproductive process by stimulating – Bp suddenly returns to normal
the contractility of uterine and other smooth muscles. ⚫ 5. Refractory phase- period where men cannot
⚫ LEVELS OF THE MENSTRUAL CYCLE be re stimulated within 10-15 minutes
– CNS RESPONSE – Follicle Stimulating Hormone (FSH) and Luteinizing Ejaculation sperm deposited in the fornix of vagina travel thru the uterus FT
Hormone (LH) Ampulla Fertilization of egg
– OVARIAN RESPONSE – Follicular phase (days 1 – 14) due to FSH;
Luteal phase (days 15 – 22) corpus luteum develops FETAL STAGES OF DEVELOPMENT
– ENDOMETRIAL RESPONSE ⚫ ZYGOTE = union of ovum and sperm
⚫ Menstrual phase (days 1 – 5) estrogen level is low ⚫ MORULA = 16 – 50 cells; 3 – 4 days after fertilization
⚫ Proliferative phase (days 1 -14) estrogen level is high – ovulation ⚫ BLASTOCYST = enlarged cell w/ fluid filled structure; trophoblast ( becomes
occurs on day 14 of a 28-day cycle placenta and membrane )
⚫ Secretory phase (days 14 – 26) progesterone is high ⚫ EMBRYO = 3 – 8 weeks; embryonic structures
⚫ Ischemic phase (days 27 – 28) estrogen and progesterone levels ⚫ FETUS = 2 months – birth
recede – menstruation begins PRENATAL PERIOD
– CERVIX AND CERVICAL MUCOUS RESPONSE FIRST, SECOND AND THIRD TRIMESTERS OF PREGNANCY
⚫ Before ovulation – estrogen levels rise, high spinnbarkeit, excellent FIRST TRIMESTER OF PREGNANCY
sperm penetration ⚫ The first trimester (from 0-12 Weeks) allows the pregnant woman’s body to undergo
⚫ After ovulation – progesterone levels rise, low spinnbarkeit, poor many changes as it adjusts to the growing baby.
sperm penetration ⚫ It is important to understand that these are all normal events and that most of these
⚫ During pregnancy – cervical circulation increases and a protective discomforts will go way as the pregnancy progresses.
mucus plug forms. ⚫ So included here are some of the symptoms experienced during pregnancy and how
⚫ CLIMACTERIC PERIOD AND MENOPAUSE best to deal with them:
– Climacteric Period – is a transitional period during which ovarian function – Breast changes
and hormonal production decline. – Tiredness
– Menopause – refers to a woman’s last menstrual period. – Mood Changes
Menstrual problems – Nausea and Vomiting
 – Frequency of Urination ⚫ Recommend frequent rest if possible
– Gastrointestinal Symptoms – Patient Teaching: Teach patient the differences and meaning of presumptive,
– Dizziness probable and positive signs.
– Varicose Veins and Hemorrhoids PROBABLE SIGNS OF PREGNANCY
– Leg Cramps ⚫ First Trimester
– Increased heart rate Chadwick’s sign (vagina)
SECOND TRIMESTER OF PREGNANCY • Goodell’s sign ( cervix )
⚫ The second trimester (13-28 Weeks) is the most physically enjoyable for most women. • Hegar’s sign ( uterus )
⚫ While some symptoms such as a morning sickness and nausea can abate, new ones can • Elevated BBT
begin. • Positive HCG
⚫ What follows is a list of changes that could be seen in a pregnant woman’s body during Second Trimester
this trimester. Ballottement
– Appetite Increase Enlarged abdomen
– Increase belly size, stretch marks and skin changes Braxton-Hicks contractions
– Abdominal and low back pain PROBABLE SYMPTOMS
– Return to normal urination frequency OBSERVABLE SYMPTOMS
– Nosebleeds and gum bleeds ⚫ Nursing Intervention:
– Vaginal Discharge – Use first voided morning urine to identify HCG
– Tingling and Itching ⚫ Patient Teaching:
– Continuation of other symptoms – Linea nigra will disappear when pregnancy ends
THIRD TRIMESTER OF PREGNANCY – Striae may not disappear; use cream or Vitamin A daily
⚫ As your fetus continues to grow, preparation for the delivery of the baby should be at – Chloasma is related to hormonal changes
hand. An uncomfortable feeling would arise as weight gain continues and your false – HCG in the urine is not diagnostic
labor contractions continue. EASY ASSOCIATION
⚫ Childbirth classes and breastfeeding classes around this time are started. ⚫ UTERUS - Hegar’s Sign
⚫ Included below is a list of some of the changes and symptoms this final trimester: ⚫ CERVIX - Goodel’s Sign
– Increased temperature ⚫ VAGINA - Chadwick’s Sign
– The increased frequency of the bladder POSITIVE SIGNS OF PREGNANCY
– Swelling ⚫ Demonstration of fetal heart rate separate from the mother
– Hair ⚫ Fetal movement felt by the examiner
– Breast tenderness and colostrum ( 20TH – 24TH WKS AOG )
– Braxton Hicks contractions (false labor) ⚫ Visualization of the fetus by ultrasound
PRESUMPTIVE SIGNS OF PREGNANCY – Transabdominal
⚫ First Trimester – Transvaginal Undeniable signs
B-reast changes Nursing Interventions:
U-rinary frequency – Calculate EDC/ EDD
F-atigue – Calculate gestational age
A-menorrhea Patient Teaching:
( after 10 days) – Avoid x – ray during pregnancy, or protect abdomen as necessary.
M-orning Sickness DISCOMFORTS OF PREGNANCY
E- nlarged Uterus ( 1 ) ANKLE EDEMA
⚫ Second Trimester ⚫ Elevate feet when sitting or resting
C -hloasma ⚫ Practice frequent dorsiflexion of feet
L -inea Nigra ⚫ Avoid standing for a long period of time.
I -ncreased skin pigmentation 2 ) BACK ACHE
Q –uickening ⚫ Practice good body mechanics
S -triae gravidarum ⚫ Practice pelvic tilt exercise
PRESUMPTIVE SYMPTOMS ⚫ Avoid long standing, high heels, heavy lifting, over fatigue and excessive bending or
⚫ Subjective: reaching
– Client Need: Health promotion and maintenance ( 3 ) BREAST TENDERNESS
– Nursing Intervention: ⚫ Wear a well – fitting supporting bra
⚫ Instruct patient to eat dry crackers before arising ⚫ Decrease the amount of caffeine and carbonated beverages ingested.
( 4 ) CONSTIPATION DANGER SIGNS OF PREGNANCY
⚫ Increase fiber in the diet ⚫ Chills and fever
⚫ Drink additional fluids ⚫ Cerebral disorders (dizziness )
⚫ Have a regular time for bowel movement ⚫ Abdominal pain
⚫ Exercise ⚫ Boardlike Abdomen
⚫ Use stool softeners as needed ⚫ Blood pressure elevation
( 5 ) FATIGUE ⚫ Blurred Vision
⚫ Plan a rest period regularly ⚫ Bleeding
⚫ Have a regular bedtime routine and use extra pillow for comfort ⚫ Swelling
6 ) FAINTNESS ⚫ Scotoma ( blind spot on the retina )
⚫ Arise and move slowly ⚫ Sudden gush of fluid
⚫ Avoid prolonged standing RISK CONDITIONS IN PREGNANCY
⚫ Remain in a cool environment; avoid crowded places FACTORS THAT CATEGORIZE HIGH RISK PREGNANCIES
⚫ Lie on left side when lying down. FACTORS THAT CATEGORIZE A PREGNANCY AS HIGH RISK
( ( 7 ) HEADACHE Psychological Social Physical
⚫ Avoid eye strain
⚫ Rest with a cool cloth on the forehead Prepregnancy - Occupation involving - Visual or hearing impaired
⚫ Report frequent and peristent headache to the doctor - History of drug handling of toxic substances - Pelvic inadequacy or
( 8 ) HEARTBURN (PYROSIS) dependence (including raidation and malshape
⚫ Eat small, frequent meals (including anesthesia gases) - Uterine incompetency,
⚫ Avoid spicy, greasy foods alcohol) - Environmental position or structure
⚫ Refrain from lying down immediately after eating - History of abusive contaminants at - Secondary major illness
⚫ Use low – sodium antacids behavior home (heart disease,
( 9 ) HEMORRHOIDS - Survivor of - Isolated hypertension,
⚫ Avoid constipation and straining with BM battering - Lower economic level tuberculosis, blood
⚫ Take hot sitz bath, apply topical anesthetics, ointments, ice packs - History of mental - Poor access to disorder, malignancy)
10 ) LEG CRAMPS illness transportation for - Poor gynecologic or
⚫ Dorsiflex feet; Apply heat to affected muscle - History of poor care obstetric history
⚫ Evaluate calcium to phosphorous ratio in diet. coping - High altitude - History of previous poor
( 11 ) NAUSEA mechanisms - Highly mobile lifestyle pregnancy outcome
⚫ Avoid strong odors; drink carbonated beverages - Cognitive - Poor Housing - History of child with
⚫ Avoid drinking while eating impairment - Lack of support people congenital anomalies
⚫ Eat crackers, avoid spicy and greasy food, eat small frequent meals - Survivor of - Obesity
( 12 ) NASAL STUFFINESS childhood sexual - Pelvic inflammatory
⚫ Use cool air vaporizer abuse disease (PID)
⚫ Increase fluid intake, place moist towel on the sinuses; massage the sinuses - History of inherited
( 13 ) PTYALISM disorder
⚫ Use mouthwash as needed - Small stature
⚫ Chew gum or suck on hard candy. - Potential of blood
( 14 ) ROUND LIGAMENT PAIN incompatibility
⚫ Avoid twisting motions, - Younger than age 18 or
⚫ rise up slowly, older than 35
⚫ and bend forward to relieve pain - Cigarette smoker
( 15 ) SHORTNESS OF BREATH - Substance abuser
⚫ Proper posture; Use pillows under head & shoulders at night
(16) URINARY FREQUENCY
⚫ Void at least q 2 hrs; Avoid caffeine; Practice Kegel exercise
(17) LEUKORRHEA
⚫ Wear cotton underwear; bath daily; avoid tight panty hose
(18) VARICOSE VEINS
⚫ Walk regularly; rest with feet elevated; avoid long standing; don’t cross legs; avoid
knee high stocking; wear support hosiery
Pregnancy Period -Refusal of or neglected - Subject to trauma 1. LIGHTENING
- Loss of support prenatal care - Fluid or electrolyte ◼ Descent of fetal presenting part; 10 – 14 days before labor onset
person - Exposure to imbalance 2. INCREASE IN LEVEL OF ACTIVITY
- Illness of a environmental - Intake of teratogen such as ◼ Due to increase epinephrine as a result of decrease progesterone
family member teratogens a drug 3. BRAXTON HICK’S CONTRACTION
- Decrease in self- - Disruptive family - Multiple gestation ◼ Painless uterine contraction; few days or weeks before labor onset
esteem incident - A bleeding disruption 4. RIPENING OF THE CERVIX
- Drug abuse - Decreased economic - Poor placental formation ◼ Internal sign seen in pelvic examination; buttersoft ( softer than Goodell’s
(including alcohol and support or position Sign )
cigarette smoking) - Conception under 1 year - Gestational diabetes SIGNS OF TRUE LABOR
- Poor acceptance from last pregnancy - Nutritional deficiency of 1. PRODUCTIVE UTERINE CONTRACTION
of pregnancy and pregnancy iron, folic acid, or ◼ longer duration, greater intensity, regular
within 12 months of protein 2. BLOODY SHOW ( PINKISH )
the first pregnancy - Poor weight gain ◼ Due to expulsion of the mucus plug(operculum)mixed with ruptured
- Pregnancy-induced capillaries as cervix softens
hypertension 3. RUPTURE OF THE MEMBRANE
- Infection ◼ Gush or seeping
- Amniotic fluid ◼ Risk for intrauterine infection and cord prolapse
abnormality CHARACTERISTICS OF TRUE LABOR
- Postmaturity ⚫ Contractions occur at regular intervals
⚫ Contractions start in the back and sweep around to the abdomen, increase in intensity
Labor and Delivery - Lack of support person - Hemorrhage and duration, and gradually have shortened intervals
Period - Inadequate home for - Infection ⚫ Walking intensifies contractions
- Severely frightened infant care - Fluid and electrolyte ⚫ “Bloody Show”
by labor and - Unplanned cesarean imbalance ⚫ Cervix becomes effaced and dilated
delivery experience birth - Dystocia ⚫ Sedation does not stop contractions
- Lack of - Lack of access to - Precipitous delivery CHARACTERISTICS OF FALSE LABOR
participation due to continued health care - Lacerations of cervix or ⚫ Contractions occur at irregular intervals
anesthesia - Lack of access to vagina ⚫ Contractions are located chiefly in the abdomen, the intensity remains the same or is
- Separation of emergency personnel or - Cephalopelvic variable, and the intervals remain long
infant at birth equipment disproportion ⚫ Walking does not intensify contractions and often gives relief
- Lack of preparation - - Internal fetal monitoring ⚫ “Bloody Show” usually is not present; if present, usually brownish rather than bright
for labor - Retained placenta red
- Delivery of infant - ⚫ There are no cervical changes
who is ⚫ Sedation tends to decrease the number of contractions
disappointing in COMPONENTS OF LABOR
some way 4 P’s OF LABOR:
- Illness in newborn 1. PASSAGEWAY – adequacy of the woman’s pelvis and birth canal in
allowing fetal decent
2. PASSENGER – ability of the fetus to move through the passageway
LABOR AND DELIVERY 3. POWERS - frequency, duration, and strength of uterine contractions to
INTRAPARTAL NURSING CARE MANAGEMENT cause complete cervical effacement and dilation
THEORIES OF THE ONSET OF LABOR 4. PSYCHE – psychological state, available support systems, preparation for
⚫ UTERINE STRETCH - any hollow object when stretch to maximum will contract childbirth, experiences, and coping strategies
and empties. THE POWERS
⚫ OXYTOCIN - labor stimulates PPG to produce oxytocin that causes uterine Uterine Contractions
contraction. ⚫ Phases:
⚫ PROSTAGLANDIN - labor causes release of arachidonic acid which in turn increases a. Increment or Crescendo
the production of prostaglandin -> uterine contraction b. Acme or Apex
⚫ AGING PLACENTA - decrease blood supply causes uterine contraction c. Decrement or Decrescendo
⚫ PROGESTERONE DEPRIVATION – decrease causes uterine contraction Important Aspects:
PRELIMINARY SIGNS OF LABOR – Duration = beginning to end of same
 ⚫ Early labor = 20 – 30 secs; late: 60 – 70 secs. – Mother and newborn recover from physical process of birth
– Interval = end of one contraction to beginning of one – Maternal organs undergo initial readjustment
⚫ Early labor: 40 – 45 mins.; late: 2 – 3 mins. – Newborn body systems begin to adjust to extrauterine life and stabilize
– Frequency = beginning to beginning – Uterus contracts in the midline of the abdomen with the fundus midway
⚫ Time 2 – 3 contractions to come up with clearer view between the umbilicus and symphysis pubis
– Intensity = strength of contractions FETAL PRESENTATION AND POSITION
⚫ ATTITUDE
– degree of flexion of head, body, extremities; Complete Flexion
⚫ ENGAGEMENT
– settling of the presenting part
– the presenting part ( widest diameter ) has pass through the pelvic inlet
⚫ STATION
– relationship of fetal presenting part with the ischial spine of the mother
⚫ FETAL LIE
– relationship of long axis of mother with long axis of fetus
FETAL STATION
⚫ Relationship of the presenting part to ischial
spine
⚫ -1: 1 cm above ischial spine
⚫ -3: needs therapeutic rest
⚫ 0: level of ischial spine, ENGAGEMENT
⚫ +3, 4, 5: crowning (2nd stage of labor)

PRESENTATION/FETAL LIE
⚫ Longitudinal
– Cephalic
STAGES OF LABOR ⚫ Vertex: face, brow, chin
⚫ FIRST STAGE – Breech
– Latent Phase: onset of contractions; effacement and dilation of cervix at 3 to ⚫ Complete
4 cms ⚫ Incomplete: frank, footling, kneeling
– Active Phase: dilation continuous from 3 to 4 to 7 cms; contractions are – Shoulder
stronger ⚫ Transverse
– Transition Phase: cervix dilates from 8 to 10 cms; irresistible urge to push – Horizontal or perpendicular
⚫ SECOND STAGE (EXPULSIVE STAGE)
– Cardinal Movements or Mechanisms
⚫ Engagement
⚫ Descent
⚫ Flexion
⚫ Internal Rotation
⚫ Extension
⚫ External Rotation (Restitution)
⚫ Expulsion
⚫ THIRD STAGE (PLACENTAL STAGE
⚫ Placental Separation
⚫ Signs of Placental Separation:
⚫ Uterus becoming globular
⚫ Fundus rising in the abdomen
⚫ Lengthening of the cord
⚫ Increased bleeding (trickle or gush)
⚫ Placental Expulsion
FOURTH STAGE (RECOVERY AND BONDING)
– First 1 to 4 hours after birth
 ⚫ Engagement
⚫ Descent
⚫ Flexion
⚫ Internal Rotation
⚫ Extension
⚫ External Rotation
⚫ Expulsion

Complete Single
breech Footling

NURSING CONSIDERATIONS: FIRST STAGE OF LABOR

⚫ Bath patient as necessary
Shoulder - ⚫ Monitor patient’s Vital Signs, especially Blood Pressure
acromium – If patients has the same BP → rest
Frank – If elevated BP → notify immediate attending physician
Breech
⚫ Place patient on Nothing Per Orem (NPO)
⚫ Encourage mother to void
⚫ Do perineal preparation or cleansing
⚫ Administer Enema (as per hospital policies)
– Cleanse bowel to prevent infection
MECHANISM OF LABOR
 – Place patient in Lateral Sidelying (Sims) Position, elevated enema can to FOURTH STAGE: RECOVERY AND BONDING
about 12-18 inches, insert catheter slowly and pull out slowly if with ⚫ Maternal observations: monitor for body system (reproductive system changes,
resistance to allow water flow to rectum cardiovascular system changes, respiratory system changes, etc.) stabilization
– Clamp rectal tube if (+) contraction
– Check FHT before and after (120-160, irregular) ⚫ Placement of the Fundus: shoulde be at the level of the umbilicus
SECOND STAGE OF LABOR – Check bladder, assist in voiding
⚫ Fetal stage or Expulsion Stage – Check for uterine atony as this may lead to hemorrhage
⚫ Primigravida: transfer at 10 cm dilatation – 10 to 14 days is the period of involution
⚫ Multigravida: transfer at 7 - 8 cm dilatation ⚫ Perineum: check for REEDA
⚫ Lift legs simultaneously ( Lithotomy ) – Redness, Edema, Ecchymoses, Discharges, Approximation
⚫ Bulging of perineum – best sign of delivery initiation ⚫ Monitor vital signs every 15 minutes
⚫ Pant and blow breathing, push with open glottis ⚫ Pain Management
DELIVERY ⚫ Psychological state (postpartum blues )
⚫ Support head and remove secretions ⚫ Bonding or Rooming-in of Baby
⚫ Check for cord coil – Strict – 24 hours with mother
⚫ Maintain temperature – Partial – with mother during the morning, at nursery during the afternoon
⚫ Put on abdomen of mother to facilitate contractions ⚫ Check for Lochia:
⚫ Clamp cord, don’t milk, wait for the pulsation to stop the cut cord – Lochia Rubra is the dark red discharge occurring in the first 2 to 3 days
⚫ Administration of vitamin K and tetracycline eye ointment – Lochia Serosa is pink to brownish discharge, occurring from 3 to 10 days
⚫ Proper identification after delivery
THIRD STAGE: BIRTH TO EXPULSION OF PLACENTA (PLACENTAL STAGE) – Lochia Alba is an almost colorless to creamy yellowish discharge occurring
⚫ First sign: fundus rises → Calkin’s sign from 10 days to 3 weeks after delivery
⚫ Signs of placental separation
– Fundus becomes globular and rises
– Gush of blood
– Cord descends several inches out of vagina
TYPES OF PLACENTAL DELIVERY
⚫ Shultz (Shiny)
– From center to edges
– Presents fetal side that is shiny
⚫ Duncan (Dirty)
– from edges to center
– Presents maternal side that is beefy red and dirty
NURSING CONSIDERATIONS
⚫ Check Placenta (cotyledons) for completeness
⚫ Assess firmness of fundus
⚫ Monitor patient’s blood pressure
⚫ Administer Methergine as ordered by physician
⚫ Administer Oxytocin as ordered by physician
⚫ Check for laceration
⚫ Check on patient’s Episiorrhapy for any signs of bleeding
⚫ Do proper aftercare of equipments and delivery room after delivery
NURSING CONSIDERATIONS: RECOVERY ROOM
⚫ Maintain patient flat on bed until instructed otherwise in order to prevent dizziness
⚫ Monitor patient’s vital signs, if with chills provide additional warm blanket to prevent
hypothermia
⚫ Keep patient properly oxygenated
⚫ Give nourishment as ordered:
– Clear liquids
– Full liquids
– Soft diet
– Regular diet