Republic of the Philippines CAVITE STATE UNIVERSITY Don Severino Delas Alas Campus Indang, Cavite COLLEGE OF NURSING

TAKE HOME EXAM

Submitted by: Maglupay, Venus C. BSN 4-2

Submitted to: Mary Antoniette D. Viray Clinical Instructor

1. What are the three diagnostic signs of pregnancy? The diagnosis of pregnancy requires a multifaceted approach using three main diagnostic tools. These are history and physical examination, laboratory evaluation, and ultrasonography.

2. Outline four discomforts that tend to present in the first trimester, explain the physiologic basis and appropriate health teaching. Bleeding. About 25% of pregnant women experience slight bleeding during their first trimester. Early in the pregnancy, light spotting may be a sign that the fertilized embryo has implanted in the uterus. However, if significant bleeding, cramping, or sharp pain in the abdomen is happening it is one of the warning sign and must be refer to the doctor.These could be signs of a miscarriage or ectopic pregnancy (a pregnancy in which the embryo implants outside of the uterus). Breast tenderness. Sore breasts are one of the earliest signs of pregnancy. They're triggered by hormonal changes, which are preparing your milk ducts to feed the baby, and will probably last through the first trimester. Going up a bra size (or more) and wearing a support bra can make feel the pregnant more comfortable; mothers can go back to the lacy bras after their baby is finished nursing. Constipation . During pregnancy, the muscle contractions that normally move food through the intestines slow down because of higher levels of the hormone progesterone. Add to that the extra iron pregnant that are getting from prenatal vitamin, and the result is uncomfortable constipation and gas that can feel bloated throughout the pregnancy. Increasing fiber intake and drinking extra fluids can keep things moving more smoothly. Physical activity can also help. Fatigue . Pregnants body is working hard to support a growing fetus, which can wear them out more easily than usual. Taking naps or rest can be a great help. Also taking enough iron (too little can lead to anemia, which can cause excess fatigue).

3. Outline three primary changes that occurs for each of the following: Mother, fetus and 2nd trimester. Mother:

The uterus has risen in the abdomen decreasing pressure on the bladder The mother may feel the baby's movements now. The mother may experience back and leg pain, constipation, varicose veins, or mild swelling of the ankles, feet, hands, and face.

Baby:

The head has hair, as do the eyebrows and eyelashes. The baby's heartbeat can be heard with a stethoscope. The baby's movements can be felt by the mother.

4. In the third trimester, outline which of the following occurs and why each is a concern during third trimester. What warning signs should woman know? Third trimester of pregnancy is a time of rapid weight gain for the fetus. The fetuss increasing size and the many changes of pregnant body goes through to prepare for labor and delivery may cause the following to occur.

Feeling the baby's movements strongly. Shortness of breath because the top of uterus now rests under the rib cage. Need to urinate more often as the baby drops and puts more pressure on the bladder. Colostrum (a yellow, watery pre-milk) may leak from nipples. Irregular contractions. These can signal false labor or real labor.

Warning Signs

Heavy vaginal bleeding or clotting Lighter bleeding that lasts for more than one day Any amount of bleeding that is accompanied by pain, fever, chills, or severe abdominal or shoulder pain A severe or persistent headache, particularly one that is accompanied by dizziness, faintness, or visual disturbances Dehydration A fever of more than 101F Painful urination A watery discharge from the vagina Sudden swelling of the face, hands, or feet A significant decrease in fetal movement after the 24th week of pregnancy.

5. Identify three pregnancy complications that are common during the third trimester. What warning signs should women know? Irregular contractions Frequent urination (Lightening) Fatigue Warning Signs

The signs of premature labor: regular uterine contractions, lower back pain, a feeling of heaviness in the lower pelvis or abdomen, diarrhea, slight spotting or bleeding, or a watery fluid or mucus discharge Painful urination A severe or persistent headache, particularly one that is accompanied by dizziness, faintness, or visual disturbances

6. Define the three stages of labor. Define engagement,effacement,dilatation and crowning. The Three Stages Of Labor Labor is described in three stages, and together these stages complete the delivery and the passage of the placenta. Stage One The first stage is the process of reaching full cervical dilatation. This begins with the onset of uterine labor contractions, and it is the longest phase of labor. The first stage is divided into three phases: latent, active, and transition.

In the latent phase, the contractions become more frequent, stronger, and gain regularity, and most of the change of the cervix involves thinning, or effacement. The latent phase is the most variable from woman to woman, and from labor to labor. It may take a few days, or be as short as a few hours. We typically expect the latent phase to be 10 to 12 hours for a woman who has had children. For first pregnancies, it may last closer to 20 hours. For many women, the latent phase of labor can be confused with Braxton Hicks contractions. Membranes may spontaneously rupture in the early- to midportion of the first stage of labor. If they rupture, the labor process usually speeds up.

The next portion of the first stage of labor is the active phase, which is the phase of the most rapid cervical dilatation. For most women this is from 3 to 4 centimeters of dilatation until 8 to 9 centimeters of dilatation. The active phase is the most predictable, lasting an average of five hours in first-time mothers and two hours in mothers who have birthed before. Finally, there is the transition phase, during which the cervical dilation continues, but at a slower pace, until full dilation. In some women the deceleration phase is not really noticeable, blending into the

active phase. This is also a phase of more rapid descent, when the baby is passing lower into the pelvis and deeper into the birth canal. The deceleration phase is also called transition, and, in mothers with no anesthesia, its often punctuated by vomiting and uncontrollable shaking. These symptoms can be frightening to watch, but theyre a part of normal birth, and they signal that the first state is almost completed. Stage Two The second stage is the delivery of the infant. During the second stage, mom actively pushes out the baby. For first time mothers, this can take two to three hours, so its important to save your energy and pace yourself. For second babies and beyond, the second stage often lasts less than an hour and sometimes, only a few minutes. Stage Three The third stage of labor is the passage of the placenta, which can be immediate, or take up to thirty minutes. The process may be sped up naturally by breastfeeding (which releases oxytocin), or medically by administering a drug called pitocin.

Engagement The entrance of the fetal head or presenting part into the upper opening of the maternal pelvis. Effacement The thinning out of the cervix that normally occurs along with dilation shortly before delivery. Cervical Dilatation The enlargement or expansion of cervix. Crowning The appearance of a large segment of the fetal scalp at the vaginal orifice in childbirth 7. Identify two pharmacological measures used to control pain and increase comfort and two nonpharmacological measures to help support the laboring woman. Pharmacological Measures

1. MORPHINE is frequently used when the labor is expected to continue for a number of hours. It can be given by injection, in an IV, or in an epidural catheter. It produces drowsiness as well as a perception of decreased pain. 2. MEPERIDINE (DEMEROL OR PETHIDINE), despite studies that show it does not actually decrease labor pain, is still used frequently on many labor units. It can cause respiratory depression (slower and shallower

breathing, resulting in less oxygen intake) in both mother and baby; this effect is increased with increasing doses Non Pharmacological Measures 1. PSYCHOSOCIAL SUPPORT IN LABOR The presence of a professional support person in labor has been shown to be a significant help to laboring women in managing their pain. In addition, a doula's presence will shorten labor by an average of 2.8 hours, result in a decreased use of oxytocin, result in a decrease in operative and instrumental deliveries, and decrease requests for epidural anesthesia 2. POSITION CHANGES DURING LABOR The ability of the mother to change her position during labor, that is, to walk around, sit in a rocking chair or on a birthing ball or birth stool, squat on her haunches, get on her hands and knees, or assume whatever position feels most comfortable to her, has been shown to shorten the length of labor, decrease the use of oxytocin to augment labor, and decrease the use of epidural and opioid pain medications in labor.

8. Describe the mechanisms of birth or cardinal movements. Describe the sequence of the movements.

Descent: As the fetal head engages and descends, it assumes an occiput transverse position because that is the widest pelvic diameter available for the widest part of the fetal head. Flexion: While descending through the pelvis, the fetal head flexes so that the fetal chin is touching the fetal chest. This functionally creates a smaller structure to pass through the maternal pelvis. When flexion occurs, the occipital (posterior) fontanel slides into the center of the birth canal and the anterior fontanel becomes more remote and difficult to feel. The fetal position remains occiput transverse.

Internal Rotation: With further descent, the occiput rotates anteriorly and the fetal head assumes an oblique orientation. In some cases, the head may rotate completely to the occiput anterior position. Extension: The curve of the hollow of the sacrum favors extension of the fetal head as further descent occurs. This means that the fetal chin is no longer touching the fetal chest. External Rotation: The shoulders rotate into an oblique or frankly anterior-posterior orientation with further descent. This encourages the fetal head to return to its transverse position. This is also known as restitution.

9. Identify risks and benefits of epideural anesthesia. Epidural is a process of relieving pain during labor. It is a process whereby a combination of drugs is injected into the spinal canal but outside the spinal nerve. Thus the nerve dedicated to the lower back, pelvis, womb and perineum gets anesthetized and the patient is relieved of pain during labor. Once the epidural is administered, it begins to work in ten to fifteen minutes and numbness remains through the entire period of labor and till delivery of the child. As this is an induced procedure and a departure from the phenomenon created by nature the process has its share of risks and benefits. BENEFITS o It relieves women of the pain that at times could be unbearable and worrying. o The patient enjoys peace of mind and remains free from undue anxiety. o Depending on the state of the patient, application of medicine can be modulated. o High blood pressure in the patient in labor can be kept under control. o While this process is in progress the baby remains absolutely unaffected o Helps the patient retain her confidence and does not give any unsteady feeling. o Process is now quite developed and the side effects are minimal. o During the course of the process the lower limb still remains somewhat sensitive.

RISKS o Causes blood pressure to drop thereby reduces oxygen flow to the baby in the womb. o Baby position at the time of delivery is often deviated due to epidural application. o Drip has to be compulsorily applied to control the blood pressure if needed. o Generally two transducers are affix to the body to monitor baby's heartbeat etc. o An IV and monitor is also attached and will have to be carried when on the move. o As the bladder becomes senseless one needs to have a catheter to empty bladder. o Due to numbness the managing labor is somewhat left to the doctor or midwife. o Patient thus remains unaware of the time of giving the push, causing delay of labor. o This unconsciousness may increasingly necessitate delivery by forceps. o Accidental release of cerebro-spinal fluid can give severe headache. o Hole created by the epidural needle needs to be sealed after the needle is taken out. o Urinary disorder and burning sensation all over their body are not unusual.

10. Identify the meaning of APGAR rating, why it is done and its significance.
Activity: muscle tone 0 Limp; no movement 1 Some flexion of arms and legs 2 Active motion Pulse: heart rate 0 No heart rate 1 Fewer than 100 beats per minute 2 100+ beats per minute Grimace: reflex response 0 No response to airways being suctioned 1 Grimace during suctioning 2 Grimace and pull away, cough, or sneeze during suctioning Appearance: color 0 The baby's whole body is completely bluish-gray or pale 1 Good color in body with bluish hands or feet 2 Good color all over Respiration: breathing 0 Not breathing 1 Weak cry; may sound like whimpering, slow or irregular breathing 2 Good, strong cry; normal rate and effort of breathing

APGAR scoring helps the practitioner decide whether the baby needs immediate medical help. If the baby scores between 7 and 10, it usually means he/she is in good shape and doesn't need more than routine post-delivery care. It's unusual for a baby's hands and feet to have good color one minute or so after birth.

If the baby scores between 4 and 6, he may need some help breathing. This could mean something as simple as suctioning his nostrils or massaging him, or it could mean giving him oxygen. If the baby scores 3 or less, he may need immediate lifesaving measures, such as resuscitation. Keep in mind, though, that a low score at one minute doesn't mean that your baby won't eventually be just fine. Sometimes babies born prematurely or delivered by cesarean section, for example, have lower-thannormal scores, especially at the one-minute testing.

11. Identify the risk associated with cesarean birth and forcep delivery. Risks for Cesarean Section Delivery:

Infection. Heavy blood loss. A blood clot in the legs or lungs. Nausea, vomiting, and severe headache after the delivery (related to anesthesia and the abdominal procedure). Bowel problems, such as constipation or when the intestines stop moving waste material normally (ileus). Maternal death (very rare). The risk of death for women who have a planned cesarean delivery is very low (about 6 in 100,000). For emergency cesarean deliveries, the rate is higher, though still very rare (about 18 in 100,000). Fetal Injury during the delivery. Need for special care in the neonatal intensive care unit (NICU). Immature lungs and breathing problems, if the due date has been miscalculated or the infant is delivered before 39 weeks of gestation. Risks with Forcep Delivery:

Pain in the perineum the tissue between your vagina and your anus after delivery Lower genital tract tears and wounds Difficulty urinating or emptying the bladder Short-term or long-term urinary or fecal incontinence Anemia a condition in which there is deficit in healthy red blood cells to carry adequate oxygen to tissues due to blood loss during delivery Injuries to the bladder or urethra the tube that connects the bladder to the outside of the body Uterine rupture when the baby breaks through the wall of the uterus into the mother's abdominal cavity Weakening of the muscles and ligaments supporting pelvic organs, causing pelvic organs to slip out of place (pelvic organ prolapse)