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LECTUREOBJECTIVES &OUTLINES

TABLE OF CONTENTS-PART II

CONTENT PAGE

I.Overview of Maternity Nursing .................................................................3

II.Normal Pregnancy. .........................................................................5

III.Fetal Assessment......9

IV.Uncomplicated Labor and Delivery....11

V.Analgesia and Anesthesia ....14

VI.Nursing in the Normal Puerperium...................................................................16

VII.Nursing Care of the Normal Newborn........20

VIII.High Risk Neonate......23

I.OVERVIEW OF MATERNITY NURSING

1.OBJECTIVES:At the completion of this class the student will be able to:

A.Compare and contrast expanded nursing roles in this specialty.

B.Delineate significant legal and ethical issues that influence the practice ofmaternalchild nursing.

C.Summarize the use of communitybased nursing care in meeting the needs ofchildbearing and childrearing families

D.Define various statistical terms relevant to health care: birth rate, infant mortalityrate, neonatal mortality rate, and maternal mortality rate.

E.Identify the current JCAHO patient safety goals.

F.Summarize the actions of the hormones that affect reproductive functioning.

G.Describe the phases and dominant hormones of the menstrual cycle.

H.Discuss the process of conception, implantation and embryo development.

I.List the embryonic changes occurring in early pregnancy.

J.Describe the functions of the placenta and umbilical cord.

K.Explain fetal developmental changes for the various body systems.

L.Discuss the functions of the major fetal circulatory structures.

2.LECTURE OUTLINE

A.Role of the Perinatal Nurse

1.Registered Nurses: L&D, PP, and NSY/SCN/NICU

2.Expanse roles in perinatal nursing

a.OB/Gyn NP-Ob/Gyn Nurse Practitioner

b.FNP-Family Nurse Practitioner

c.CNS-Clinical Nurse Specialist/Nurse Consultant

d.CNM-Certified Nurse Midwife

e.CRNA-Certified Registered Nurse Anesthetist

B.Legal and Ethical Issues

1.Litigious nature of this specialty

2.Informed Consent

3.Common Legal Pitfalls

4.Standards of Care

1.Standardized Procedures

2.Supervision of Unlicensed Assistive Personnel

5.Ethical Dilemmas Unique to Perinatal Nursing

6.Nursing Role

C.Review of Conception and Fetal Development

1. Fertilization

2. Cellular multiplication

3. Placenta and umbilical cord

a.Development

b.Structure

c.Function

4. Embryonic and fetal growth and development

II.NORMAL PREGNANCY

1.OBJECTIVES:At the end of this class the student will be able to:

A.Describe the anatomical and physiological changes that occur during pregnancy.

B.Differentiate among presumptive, probable, and positive signs of pregnancy.

C.Correctly calculate gravida, para, and estimated date of delivery.

D.Describe nursing assessment for confirmation visits and ongoing visits.

E.Identify common maternal and paternal psychological responses to pregnancy.

F.Explain the process of role transition to motherhood and the maternal tasks ofpregnancy.

G.Describe the process of paternal role transition.

H.Describe typical sibling and grandparent reactions to a pregnancy.

I.Identify the impact of culture and socioeconomic status on a pregnancy.

J.List the required nutritional components of a pregnancy diet.

K. Identify various nutritional risk factors and explain their effects on a pregnancy.

L.List various education topics, especially safety issues, such as substance abuse, travel,vaccinations, violence and battering in the family, and warning signs.

M.Define common obstetrical terminology.

2.LECTURE OUTLINE

A.Anatomic and Physiologic Changes and Assessment

1.Reproductive organs6.Musculoskeletal

2.Cardiovascular7.Neurological

3.Respiratory8.Gastrointestinal

4.Genitourinary9.Endocrine

5.Integumentary

B.Pregnancy Diagnosis

1.Terminology

a.gravida, para

b.nulli, primi, multi

2. Pregnancy test

3.Nageles Rule

4.Classic Indicators

a.Presumptive findings (subjective)

b.Probable changes (objective)

c.Positive changes (diagnostic)

C.Prenatal History

1.First Trimester

a.History taking

b.Physical Exam

c.Lab tests

d.Educational topics

2.Second Trimester

a.Physical Exam and Gestational Age assessment

b.Lab tests

c.Potential complications

d.Interventions for discomfort

e.Ongoing educational topics

3.Third Trimester

a.History and Physical

b.Lab tests

c.Interventions for discomfort

d.Emotional and psychological changes-Family adjustments

1.Mother

2.Father

3.Siblings

4.Grandparents

5.Adolescents/Older moms (AMA)

e.Ongoing educational topics-childbirth prep classes

D.Safety Issues

1.Travel and exercise

2.Medications

3.Immunizations

E.Multifetal pregnancies

1.Maternal concerns

a.physiological

b.social and psychological

2.Fetal concerns

a.risk of PTL/PROM

b.types

c.delivery complications

F. Cultural variations

1.Types of variations

2. Nursing care

G.Maternal Nutrition

1.Nutritional requirements

2.Weight gain recommendation

3.Nutritional risk factors

CRITICAL THINKING EXERCISES FOR A PREGNANT PATIENT

Ms. T. is a 15-year-old patient who visits the clinic for the first time at 24 weeks gestation. She tells the RN that she doesnt know why she didnt get prenatal care sooner. She works part time at a local fast food outlet, and eats one meal a day at the restaurant. She now weighs 128 pounds. She tells the RN that she weighed about 110 pounds before the pregnancy. She lives at home with her parents, and her mother does most of the cooking. She is from a low-income family.

Develop a nursing care plan that focuses on assisting the patient to improve her nutrition patterns from now until delivery of the neonate.

III.FETAL ASSESSMENT

1.OBJECTIVES:At the end of this class the student will be able to:

A.Identify indications for fetal diagnostic testing

B.Discuss the purpose, procedure, advantages, and potential risks for each specificfetal diagnostic procedure.

C.Discuss the nurses role in patient education regarding fetal assessment testing.

D.List advantages and limitations of various methods of fetal monitoring.

E.Begin to apply interpretation of electronic fetal monitoring to the care plan.

F.Identify appropriate nursing interventions and rationales for various fetal heart patterns.

2.LECTURE OUTLINE

A.Fetal Assessment

1.Indications for fetal diagnostic testing

a.biophysicalc.sociodemographic

b.psychosociald.environmental

2.Nursing interventions

B.Fetal diagnostic tests

1.Biophysical Assessment

a.Daily fetal movement count /fetal activity

b.Ultrasound/Doppler Blood Flow Studies

c.MRI

2.Biochemical Assessment

a.amniocentesis

b.PUBS

c.CVS

d.maternal blood sampling

C.Electronic FHR Assessment

1.FHR tracing-assessment and interpretation

2.Deceleration patterns & reasons

3.Nursing role

D.Electronic Fetal Monitoring

1.NST-Non-stress test-reactive vs non-reactive

2.CST-Contraction stress test

3.Fetal oxygen saturation

E.Biophysical Profile

1.Fetal breathing movements

2.Fetal movements of body or limb

3.Fetal tone

4.Reactive NST

5.AFI/AFV

F.Role of the Nurse in Fetal Assessment Testing

CRITICAL THINKING EXERCISES FOR A PREGNANT PATIENT HAVING A PROCEDURE

Prepare care plans for:

a.a patient at 32 weeks gestation, G3, P2, who is scheduled for an ultrasound

b.a 42 yr old patient at 15 weeks gestation who is scheduled for an amniocentesis

IV.UNCOMPLICATED LABOR AND DELIVERY

1.OBJECTIVE:At the completion of this class, the student will be able to:

A.Identify the critical factors affecting the labor process.

B.Describe the physiological effects of labor on the woman and fetus.

C.Describe how each mechanism of labor to the birth process.

D.Identify the premonitory signs of labor.

E.Compare and contrast true and false labor.

F.Compared and contrast the labors of nulliparous and multiparous women.

G.List and describe the phases and stages of labor

H.Apply the nursing process to care for a laboring woman with electronic fetal heart rate monitoring.

I.Apply the nursing process to the care of the laboring woman from admission to thepostpartum period.

J. Describe situations in which obstetrical procedures or instrumentation are required.

K.Apply the nursing process to the care of a woman experiencing a surgical birth.

2.LECTURE OUTLINE

A.Physiological effects of the birth process

1.Maternal response

2.Fetal response

B. Essential Components of the Birth Process

1.Passageway

2.Passenger

3.Powers

4.Placenta

5

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