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A Comprehensive Textbook of Midwifery
Annamma Jacob
SECTION 1: MIDWIFERY
CHAPTER 1:
Historical Review
CHAPTER 2:
Development of Maternity Services and Current Trends
CURRENT TRENDS
Trends
Changing Patterns of Childbirth and their Effects on Maternal-infant Mortality Statistics
Perinatal Risk Factors
Technological Advances
Current Problems
Decreased Length of Hospital Stay
Higher Patient Acuities
Lack of Facilities in the Rural Areas
Changes in Maternal-Newborn Nursing
Family-Centered Care
Labor, Delivery, Recovery and Postpartum Care (LDRP)
Mother-baby Couplet Care
CHAPTER 3:
The Midwife
DEFINITION
DEVELOPMENT OF MIDWIFERY EDUCATION IN INDIA
Skills of the Midwife
Responsibilities of the Midwife
CHAPTER 4:
The Nursing Process in Maternal-Newborn Care
THE FIVE PHASES OF NURSING PROCESS
Assessing
Collecting Data
A Database
Type of Data
Sources of Data
Data Collection Methods
Observing
Interviewing
Examining
Validating Data
Documenting Data
DIAGNOSIS
Definition
Type of Nursing Diagnoses
Components of a Nanda Nursing Diagnosis
Problem and Definition (Diagnostic label)
Qualifiers
Etiology (Related factors and risk factors)
Defining Characteristics
Differentiating Nursing Diagnoses from Medical Diagnoses
The Diagnostic Process
Formulating Diagnostic Statements
Variations of Basic Formats
Avoiding Errors in Diagnostic Reasoning
PLANNING
Types of Planning
Initial Planning
Ongoing Planning
Discharge Planning
Developing Nursing Care Plans
Standardized Approaches to Care Planning
Standardized Care Plans
Formats for Nursing Care Plan
Guidelines for Writing Nursing Care Plans
The Planning Process
Setting Priorities
Establishing Desired Outcomes/Client Goals
Purposes of Desired Outcomes/Goals
Guidelines for Writing Desired Outcomes/Goals
Computerized Care Plans
NURSING INTERVENTIONS
Types of Nursing Interventions
Independent Interventions
Dependent Interventions
Collaborative Interventions
Writing Nursing Orders
Date
Action Verb
Content Area
Time Element
Signature
IMPLEMENTING
Implementing
Relationship of Implementing to other Phases of Nursing Process
Implementing Skills
The Process of Implementing
Reassessing the Client
Determining the Nurse's Need for Assistance
Implementing the Nursing Interventions
Supervising Delegated Care
Documenting Nursing Activities
EVALUATING
Relationship of Evaluating to other Nursing Process Phases
Process of Evaluating
Collection of Data
Comparing Data with Outcomes
Relating Nursing Activities to Outcomes
Drawing Conclusions about Problem Status
Continuing, Modifying and Terminating the Nursing Care Plan
SECTION 2: REPRODUCTIVE SYSTEM
CHAPTER 5:
The Female Pelvis and Generative Organs
PELVIS
Innominate Bone
The Sacrum
The Coccyx
Pelvic Joints
Pelvic Ligaments
The True Pelvis
a. The Pelvic Brim
b. The Pelvic Cavity
c. The Pelvic Outlet
The False Pelvis
Pelvic Inclination
TYPES OF PELVIS
The Gynecoid Pelvis fifty percent
The Justo Minor Pelvis
Android Pelvis twenty percent
Anthropoid Pelvis twenty percent
Platypelloid Pelvis five percent
OTHER PELVIC VARIATIONS
High Assimilation Pelvis
Deformed Pelvis
Muscles and Fascia
Functions
Nerve Supply
The Perineal Body
Evaluation of Pelvis
GENERATIVE ORGANS
The External Genitalia (Vulva) (Fig. 5.10)
The Mons Pubis or Mons Veneris
The Labia Majora (greater lips)
The Labia Minora (lesser lips)
The Clitoris
The Vestibule
Blood Supply
Lymphatic Drainage
Nerve Supply
The Internal Genital Organs
The Vagina
Vaginal Walls
Relations
Structures
Layers
Contents
Blood Supply
Lymphatic Drainage
Nerve Supply
The Uterus (Fig. 5.11)
Relations
Supports
Structure
Layers
Blood Supply
Lymphatic Drainage
Nerve Supply
Functions
The Uterine Tubes
Relations
Supports
Structure
Blood Supply
Lymphatic Drainage
Functions
The Ovaries
Position
Relations
Supports
Structure
Blood Supply
Lymphatic Drainage
Nerve Supply
Functions
Accessory Reproductive Organs
Breasts
Structures (Non-lactating breasts) (Fig. 5.13)
Blood Supply
Nerve Supply
CHAPTER 6:
Hormonal Cycles
THE OVARIAN CYCLE
Graafian Follicle (Fig. 6.1)
Ovulation
Corpus Luteum
Hormonal Control (Fig. 6.2)
Prolactin
Ovarian Hormones
Estrogen
Progesterone
Relaxin
MENSTRUAL CYCLE
Early Proliferative Phase
Late Proliferative Phase
The Secretory Phase
The Premenstrual Phase
The Menstrual Phase
Clinical Aspects of Menstruation
Menarche and Puberty
Menopause and Climacteric
Normal Menstrual Cycle
CHAPTER 7:
The Male Reproductive System
SECTION 3: EMBRYOLOGY AND FETOLOGY
CHAPTER 8:
Fertilization, Implantation and Development of the Fertilized Ovum
FERTILISATION
Development of Fertilized Ovum (Fig. 8.1)
IMPLANTATION
Postimplantation Changes in the Uterus
DEVELOPMENT OF THE FERTILIzED OVUM
The Trophoblast
The Inner Cell Mass
The Embryo
CHAPTER 9:
Development of the Placenta and Fetus
DEVELOPMENT OF THE PLACENTA (Fig. 9.1)
Circulation through the Placenta (Fig. 9.3)
The Mature Placenta
Functions of the Placenta
Respiration
Nutrition
Storage
Excretion
Protection
Endocrine
Mechanisms of Transfer of Materials
Amniotic Fluid
Constituents
Source
Volume
The Umbilical Cord (Fig. 9.5)
Variations, Anomalies and Abnormalities of Placenta
Variations, Anomalies and Abnormalities of the Umbilical Cord and its Insertion
DEVELOPMENT OF THE FETUS (Fig. 9.11)
First Trimester
Second and Third Trimester
Fourth Month (13 to 16 weeks)
Fifth Month (17 to 20 weeks)
Sixth Month (21 to 24 weeks)
Seventh Month (25 to 28 weeks)
Eighth Month (29 to 32 weeks)
Ninth Month (33 to 36 weeks)
37 to 40 weeks
CHAPTER 10:
Fetal Organs and Fetal Circulation
FETAL ORGANS
Blood
The Urinary Tract
The Liver
The Alimentary Tract
The Lungs
The Central Nervous System
The Skin
FETAL CIRCULATION (Fig. 10.1)
Characteristics
Structures
Pattern of Altered Blood Flow
Normal Circulatory Changes at Birth
Closure of the Umbilical Arteries
Closure of the Ductus Arteriosus
Closure of the Umbilical Vein
Closure of the Ductus Venosus
Closure of Foramen Ovale
CHAPTER 11:
The Fetal Skull
SECTION 4: NORMAL PREGNANCY
CHAPTER 12:
Physiological Changes due to Pregnancy
CHANGES IN THE REPRODUCTIVE SYSTEM
The Body of Uterus
Changes in Uterine Shape
Decidua
Myometrium
Muscle Layers (Fig. 12.1)
Blood Supply
The Fallopian Tubes
The Cervix
The Vagina
CHANGES IN THE CARDIOVASCULAR SYSTEM
The Heart
The Blood Volume
Plasma Protein
Iron Metabolism
Clotting Factors
White Blood Cells
Immunity
CHANGES IN THE RESPIRATORY SYSTEM
CHANGES IN THE URINARY SYSTEM
CHANGES IN THE GASTROINTESTINAL SYSTEM
CHANGES IN METABOLISM
Maternal Weight Changes
Skeletal Changes
Skin Changes
Breast Changes
CHANGES IN THE ENDOCRINE SYSTEM
Placental Hormones
Pituitary Hormones
Thyroid Function
Adrenal Glands
Nervous System
CHAPTER 13:
Physiology of the First Stage of Labor
DIAGNOSIS OF PREGNANCY
Presumptive Signs
Probable Signs
Positive Signs
Uterine Enlargement
Other Signs of Pregnancy
Fetal Contributions to the Diagnosis of Pregnancy
Anatomic
Hormonal Pregnancy Tests
CHAPTER 14:
Minor Disorders in Pregnancy
DIGESTIVE SYSTEM
Nausea and Vomiting
Heartburn
Excessive Salivation (Ptyalism)
Pica
Constipation
MUSCULOSKELETAL SYSTEM
Backache
Cramps
GENITOURINARY SYSTEM
Frequency of Micturition
Leukorrhea
CIRCULATORY SYSTEM
Fainting
Varicosities
Edema
INTEGUMENTARY SYSTEM
Skin
NERVOUS SYSTEM
Carpal Tunnel Syndrome
Insomnia
DISORDERS THAT REQUIRE IMMEDIATE ACTION
CHAPTER 15:
Antenatal Care
MEANING
OBJECTIVES
ANTENATAL VISITS
THE INITIAL EXAMINATION
Health History
Family History
Menstrual History
Obstetric History
Gravida
Para
PRESENT PREGNANCY
PHYSICAL EXAMINATION
Assessments and Laboratory Tests
Urinalysis
Blood Tests
Abdominal Examination
INSPECTION
Measurements of the Fundal Height (Table 15.1 and Fig. 15.1)
First Method
Second Method
Third Method (Fig. 15.3)
ABDOMINAL PALPATION AND LEOPOLD'S MANOEUVRES
Inspection of the Abdomen
Leopold's Manoeuvres (Fig. 15.3 and Table 15.4)
Auscultation (Fig. 15.5)
Other Findings
Gestational Age
Lie
Presentation
Attitude
Denominator
Position
Engagement
Pelvic Examination
Ongoing Antenatal Care
NURSING PROCESS FOR THE ANTENATAL MOTHER
Risk Factors
Record Keeping
Indicators of Fetal Well-being
Preparation for Labor
CHAPTER 16:
Specialized Investigations and Fetal Evaluation in the Antenatal Period
ULTRASONOGRAPHY
Diagnostic Uses in Obstetrics
AMNIOCENTESIS AND AMNIOTIC FLUID STUDIES
Reasons for Amniocentesis
Technique of Amniocentesis
Diagnostic Studies Possible with Amniotic Fluid
ALPHA-FETOPROTEIN (AFP) TESTING
AMNIOSCOPY AND FETOSCOPY
ESTRIOL LEVEL DETERMINATION
FETAL BLOOD SAMPLING (CORDOCENTESIS)
FETAL EVALUATION PROCEDURES
Fetal Movement
Non-stress Test (NST)
Contraction Stress Test (CST)
Procedure
Nipple Stimulation Test
Oxytocin Challenge Test
Other Categories of Interpretation of CST
SECTION 5: NORMAL PREGNANCY
CHAPTER 17:
Physiology of the First Stage of Labor
PHYSIOLOGICAL PROCESSES IN THE FIRST STAGE OF LABOR
Uterine Action
Fundal Dominance
Polarity
Contraction and Retraction (Fig.17.1)
Formation of Upper and Lower Uterine Segments
The Retraction Ring
Cervical Effacement
Cervical Dilatation
Ripening of the Cervix
Mechanical Factors that Contribute to the Progress of Labor in the First Stage
Formation of the Forewaters (Fig.17.5)
General Fluid Pressure
Rupture of the Membranes
Fetal Axis Pressure
Descent of the Presenting Part
INITIAL ASSESSMENT AND DIAGNOSIS
History
Age
Gravida and Para
Physical Examination
Vital Signs
Physical Measurements
Fetal Heart Tones
Contraction Pattern
Engagement
Estimated Fetal Weight (EFW) and Fundal Height
Lie, Presentation, Position and Variety
Edema of Extremities
Pelvic Examination / Vaginal Examination
Position of the Cervix
Station
Whether or not the Membranes have Ruptured
Vaginal Examination for the Woman in Labor
Purposes
Procedure
Findings
Condition of the Vagina
The Cervix
Level or Station of the Presenting Part
Identity of the Presentation
Position
Moulding
Completion of the Examination
CHAPTER 18:
Management of the First Stage of Labor
ADMISSION TO LABOR AND DELIVERY UNIT
Enema
Perineal Shave
Food and Fluids by Mouth
Intravenous Infusion
Position and Ambulation
Medication
Monitoring Maternal Physiological Changes
Monitoring of Fetal Well-being
CONTINUING CARE AND EVALUATION
Evaluation of Maternal Well-being
Evaluation of Fetal Well-being
Electronic Fetal Monitoring
Nursing Care of the Monitored Patient
Evaluation of the Progress of Labor
PARTOGRAM (Fig. 18.6)
Uses of Partogram
Screening for Maternal and Fetal Complications
Fetal Blood Sampling
Fetal Distress
Bodily Care of the Woman
Supportive Care of the Woman and her Significant Other
Records
NURSING PROCESS DURING THE FIRST STAGE OF LABOR
Assessment
Analysis/Nursing Diagnosis
Planning
Implementation
Evaluation
CHAPTER 19:
Physiology of the Second Stage of Labor
PHYSIOLOGICAL PROCESSES
Descend
Uterine Action
Rupture of Membranes
Soft Tissue Displacement
PRESUMPTIVE SIGNS OF SECOND STAGE AND DIFFERENTIAL DIAGNOSIS
Expulsive Contractions
Rupture of Membranes
Dilatation and Gaping of Anus and Perineal Bulging
Progressive Visibility of the Fetal Head at the Introitus
Congestion of the Vulva
MATERNAL PHYSIOLOGICAL CHANGES IN THE SECOND STAGE
Blood Pressure
Metabolism
Pulse Rate
Temperature
Gastrointestinal Changes
Renal and Hematological Changes
THE MECHANISM OF NORMAL LABOUR
Positional Movements (Fig. 19.1)
Degrees of Internal Rotation in Transverse and Posterior Positions
The Curve of Carus
SUMMARY OF MECHANISMS IN LEFT OCCIPUT ANTERIOR POSITION (LOA)
Principles
FETAL NORMALITY DURING THE SECOND STAGE
DURATION OF THE SECOND STAGE
CHAPTER 20:
Management of the Second Stage of Labor
EVALUATION OF MATERNAL WELL-BEING
Vital Signs
Bladder Care
Hydration and General Condition
Maternal Pushing Effort
Analgesia and Anesthesia
Local Infiltration
Pudendal Block
Lumbar Epidural Block
Perineal Integrity
EPISIOTOMY
Indications
Types of Episiotomies (Fig. 20.1)
Midline or Median
Mediolateral Episiotomy
Principles
Perineal Tears
Anterior Labial Tears
Posterior Perineal Trauma
EVALUATION OF THE FETAL WELL-BEING
EVALUATION OF THE PROGRESS OF LABOR
BODILY AND SUPPORTIVE CARE OF THE WOMAN
Breathing
Pushing
PREPARATION FOR DELIVERY
Location of the Delivery
Positions for the Delivery
General Preparation
CONDUCTING THE DELIVERY
Delivery of the Baby's Head
Delivery of the Head between Contractions
Ritgen's Manoeuvre
Clamping and Cutting the Umbilical Cord
Immediate Care of the Newborn
Records
NURSING PROCESS DURING THE SECOND STAGE OF LABOR
Assessment
Analysis/Nursing Diagnosis
Planning
Implementation
Evaluation
CHAPTER 21:
Physiology and Management of the Third Stage of Labor
PHYSIOLOGICAL PROCESSES OF PLACENTAL SEPARATION AND EXPULSION
Placental Separation (Fig. 21.1)
Descend of the Placenta
Expulsion of the Placenta
Hemostasis
MANAGEMENT OF THE THIRD STAGE OF LABOR
Delivery of the Placenta and Membranes
Expectant Management
Steps of the method
Controlled Cord Traction (modified Brandt-Andrews method) (Fig. 21.5)
Expression by Fundul Pressure
USE OF OXYTOCIC AGENTS
Prophylactic Use
Therapeutic Administration
FUNDAL HEIGHT DURING THIRD STAGE
COMPLETION OF THE THIRD STAGE
Examination of Placenta and Membranes
Assessment of the Placenta
Immediate Care to Mother and Baby
Records
COMPLICATIONS OF THE THIRD STAGE
Postpartum Hemorrhage
Primary Postpartum Hemorrhage
Clinical Features
Prophylaxis
Management of Postpartum Hemorrhage
Observations of the Mother following Postpartum Hemorrhage
Secondary Postpartum Hemorrhage
Clinical Manifestations
Management
Hematoma Formation
NURSING PROCESS DURING THE THIRD STAGE
Assessment
Analysis/Nursing Diagnosis
Planning
Implementation
Evaluation
CHAPTER 22:
Management of the Fourth Stage of Labor
EVALUATION AND INSPECTION
Evaluation of the Uterus
Hemostasis
Inspection of the Cervix and Upper Vaginal Vault
Repairs
Perineal Cleansing and Positioning of Legs
CONTINUING CARE AND MONITORING
Vital Signs
Palpation of the Fundus of Uterus for Contractility
Massage of the Uterus and Expression of Clots
Measurement of the Fundus
Inspection of the Perineum
Inspection of the Bladder (Fig. 22.3)
Inspection and Change of Perineal Pad
Fluids and Food
USE OF OXYTOCIC DRUGS
Determination of the Need
Action and Effect
Dosage and Route
SUMMARY
NURSING PROCESS DURING THE FOURTH STAGE OF LABOR
Assessment
Nursing Diagnosis
Planning
Implementation
Evaluation
SECTION 6: THE NORMAL PUERPERIUM
CHAPTER 23:
Physiology and Management of the Normal Puerperium
DEFINITION
DURATION
ANATOMICAL AND PHYSIOLOGICAL CHANGES OF THE PUERPERIUM
Uterus
Cervix
Lochia
Vagina and Perineum
Breasts
Physiology of Lactation
Milk Production
Stimulation of Lactation
Suppression of Lactation
Drugs
GENERAL PHYSIOLOGICAL CHANGES
Vital Signs
Renal System Changes
Gastrointestinal Changes
Weight Loss
Fluid Loss
Abdominal Wall
Hematologic Changes
Menstruation and Ovulation
MANAGEMENT OF EARLY PUERPERIUM
Immediate Attention
Rest and Ambulation
Diet
Perineal Care
Care of the Bladder
Care of the Bowel
Sleep
Care of the Breasts
Uterus and Involution
Rooming-in or Bedding-in
Immunization
Monitoring and Charting of Postpartum Events
Postpartum Exercises
DISCOMFORTS OF THE PUERPERIUM AND RELIEF MEASURES
After-birth Pains
Excessive Perspiration
Breast Engorgement
Relief Measures for Non-breastfeeding Mothers
Relief Measures for Breastfeeding Mothers
Perineal (Stitch) Pain
Constipation
Hemorrhoids
BREASTFEEDING DIFFICULTIES AND MANAGEMENT
Guidance and Instructions in Preparation for Home Care
Self
Baby
Self in relation to others:
NURSING PROCESS DURING THE PUERPERIUM
Assessment
Analysis/Nursing Diagnosis
Planning
Implementation
Evaluation
CHAPTER 24:
Family Planningm
MAGNITUDE OF THE PROBLEM
The Impact of Population Increase
FAMILY PLANNING
Definition
BASIC HUMAN RIGHTS
The Modern Concept of Family Planning
The Health Aspects of Family Planning
Women's Health
Fetal Health
Child Health
The Small Family Norm
Objectives of Family Planning Program in India
Conception Control
Maternity and Child Health Services
Other Services
Birth Control, Contraception and Family Planning
The Role of the Midwife in Family Planning
METHODS OF CONTRACEPTION
Temporary Methods of Contraception
Barrier Methods
Male Condom
Instructions for Use
Use of Condom
Advantages
Disadvantages
Female Condom (Fem shield) (Fig. 24.1)
Diaphragm (Fig. 24.2)
Instructions for Use
Advantages
Disadvantages
Vaginal Contraceptives
Vaginal Contraceptive Sponge (Today)
NATURAL CONTRACEPTION
The Rhythm Method
Advantages
Disadvantages
Coitus Interruptus
Disadvantages
Breastfeeding
Contraceptive Effectiveness of Conventional Methods of Contraception
INTRAUTERINE CONTRACEPTIVE DEVICES (IUD)
Types of IUD
Advantages of copper devices
Description of Devices
Levonorgesterel Intrauterine System (LNG-IUS)
Mode of Action of IUDs
Time of Insertion
Follow-up and Client Instructions
Side Effects and Complications
Indications for Removal of IUD
Advantages of Third Generation IUDs over the Others (Cu T-380 A, Multiload 375, Levonorgesterel IUS)
Disadvantages of Third Generation IUDs
HORMONAL CONTRACEPTIVES
Gonadal Steroids
CLASSIFICATION OF HORMONAL CONTRACEPTIVES
Combined Pill
Types of Pills
Contraindications
Follow-up
Length of Pill Use
Beneficial Effects
Non-contraceptive Benefits
Adverse Effects
Major complications
Effects on reproduction
Progestogen-only Pill (POP)
Mechanism of action
Advantages
Drawbacks
Post-coital Contraception
Once-a-month (long acting) Pill
DEPOT (SLOW-RELEASING) FORMULATIONS
Injectable Contraceptives
Mechanism of action
Advantages
Drawbacks
Subdermal Implants (Fig. 24.6)
Insertion
Removal
Advantages
Disadvantages
Implanon
PERMANENT METHODS (STERILIZATION)
Guidelines for Sterilization
Vasectomy or Male Sterilization
Advantages
Drawbacks
Selection of Candidates
Post-operative Advices
Complications
No-scalpel Vasectomy
Open-ended Vasectomy
Female Sterilization
Indications
Time of Operation
Methods of Female Sterilization
Laparoscopic Sterilization
Advantages
Disadvantages
Minilap Operation
Vaginal Tubal Ligation
Complications Related to Sterilization
Failure Rate
POSTCONCEPTION METHODS OF BIRTHCONTROL (TERMINATION OF PREGNANCY)
Menstrual Regulation
Menstrual induction
Abortion
Abortion Hazards
SECTION 7: ABNORMALITIES OF PREGNANCY, LABOR AND PUERPERIUM
CHAPTER 25:
Abnormalities of Early Pregnancy
CLASSIFICATION OF ABORTION
ABORTION
DEFINITION
SPONTANEOUS ABORTION
Causes
Threatened Abortion (Fig. 25.1)
Management
Inevitable Abortion (Fig. 25.2)
Management
Incomplete Abortion (Fig. 25.3)
Complete Abortion (Fig. 25.4)
Missed Abortion
Habitual Abortion
Treatment
INDUCED ABORTION
MEDICAL TERMINATION OF PREGNANCY (LEGAL ABORTION)
Septic Abortion
Causes
Clinical Manifestations
Treatment
NURSES’ ROLE WITH PATIENTS UNDERGOING ABORTION
NURSING PROCESS FOR CLIENTS WITH ABORTION
Assessment
Analysis /Nursing Diagnosis
Implementation
Evaluation
ECTOPIC PREGNANCY/ ECTOPIC GESTATION
Tubal Pregnancy
Causes of Tubal Pregnancy
Physiology of Tubal Pregnancy
Outcomes of Tubal Pregnancy (Fig. 25.6)
Clinical Presentation
Treatment
Abdominal Pregnancy
Cervical Pregnancy
NURSING PROCESS FOR CLIENTS WITH ECTOPIC PREGNANCY
Assessment
Analysis /Nursing Diagnosis
Implementation
Evaluation
HYDATIDIFORM MOLE
Incidence
Pathology
Complete Hydatidiform Mole
Partial Mole
Clinical Features
Investigations
Possible Complications
Treatment
Choriocarcinoma
NURSING PROCESS FOR CLIENTS WITH HYDATIDIFORM MOLE
Assessment
Analysis/Nursing Diagnosis
Planning
Implementation
Evaluation
HYPEREMESIS GRAVIDARUM
Causes
Clinical Presentation
Complications
Treatment
SUMMARY OF NURSING PROCESS FOR CLIENTS WITH HYPEREMESIS
Assessment
Analysis /Nursing Diagnosis
Planning
Implementation
Evaluation
RH ISOIMMUNIZATION AND ABO INCOMPATIBILITY
Investigations
RETROVERSION OF THE GRAVID UTERUS
Incarceration of the Retroverted Gravid Uterus
CHAPTER 26:
Sexually Transmissible and Reproductive Tract Infections
EXTENT OF THE PROBLEM IN INDIA
Host Factors
Age
Sex
Marital Status
Socioeconomic Status
Social Factors
Prostitution
Broken Homes
Sexual Disharmony
Easy Money
Emotional Immaturity
Urbanization and Industrialization
Social Disruption
International Travel
Changing Behavioral Patterns
Social Stigma
Relevance for Women
Control of STDs
Case Detection
Case Holding and Treatment
Epidemiological Treatment
Personal Prophylaxis
LOCAL INFECTIONS OF THE VAGINA AND VULVA
FUNGAL INFECTIONS
Clinical Presentation and Diagnosis
Treatment
Female
Male
Instructions
PROTOZOAL INFECTIONS
Clinical Presentation and Diagnosis
Treatment
BACTERIAL INFECTIONS
VIRAL INFECTIONS
Herpes Simplex Virus (HSV)
Presentation of Infection with HSV
Management of HSV in Pregnancy
Cytomegalovirus (CMV)
Infection in Pregnancy
Hepatitis B Infection
Diagnosis
Screening
Management
Rubella (German Measles)
Genital Warts
Acquired Immunodeficiency Syndrome (AIDS) in Pregnancy
Incidence in India
Mode of Transmission
HIV Infection in Pregnancy
Clinical Presentation
Diagnosis of HIV Infection
Management
Care during Intrapartum Period
Postpartum Care
Contraception
Follow-up Care of the Baby
NURSING PROCESS FOR PREGNANT WOMEN WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME
Assessment
Analysis /Nursing Diagnosis
Planning
Implementation
Evaluation
CHAPTER 27:
Disorders of Pregnancy
ANTEPARTUM HEMORRHAGE
Definition
Types of Antepartum Hemorrhage
PLACENTA PREVIA
Definition
Incidence
Causes
Dropping Down Theory
Multiple Pregnancy
Defective Decidua
Degrees of Placenta Previa (Fig. 27.1)
Predisposing Factors
Signs of Placenta Previa
Risk to Mother and Fetus
Diagnosis
Management
Possible Complications
SUMMARY OF NURSING PROCESS
Assessment
Analysis /Nursing Diagnosis
Planning
Implementation
Evaluation
ABRUPTIO PLACENTAE
Definition
Types of Placental Abruption
Revealed
Concealed
Mixed
Causes
Grading of Placental Abruption
Grade 1
Grade 2
Grade 3
Signs and Symptoms
Diagnosis
Management
Possible Complications
Nursing Care
SUMMARY OF NURSING PROCESS
Assessment
Analysis /Nursing Diagnosis
Planning
Implementation
Evaluation
DISSEMINATED INTRAVASCULARCOAGULATION (DIC)
Etiology
Obstetric Conditions which mayPrecipitate DIC
Placental Abruption
Intrauterine Fetal Death
Amniotic Fluid Embolism
Intrauterine Infection
Preeclampsia and Eclampsia
Management
Nursing Care
DISORDERS OF THE AMNIOTIC FLUID
Polyhydramnios (Hydramnios)
Causes
Signs and Symptoms
Complications
Management
Oligohydramnios
Causes
Complications
Clinical Signs and Symptoms
Management
SUMMARY OF NURSING PROCESS
Assessment
Analysis/Nursing Diagnosis
Planning
Implementation
Evaluation
CHAPTER 28:
Hypertensive Disorders of Pregnancy
PREGNANCY INDUCED HYPERTENSION
Definition
Incidence
Etiology
Pathophysiology
Clinical Classification of Preeclampsia
Clinical Features
Alarming Symptoms and Signs
Effects on the Fetus
Complications
Immediate
Remote complications
Preventive Measures
Management and Nurse's Role
Rest
Diet
Antihypertensive Therapy
Sedatives
Laxative
Abdominal Examination
Fetal Assessment
Assessment of Treatment
Favorable Signs
Treatment
Indications for Induction
Indications for Cesarean Section
Management of Labor
First Stage
Second Stage
Third Stage
Puerperium
Signs of Impending Eclampsia
Acute Fulminant Pre-eclampsia
Treatment
Obstetric Management
HELLP Syndrome
Diagnosis
Hemolysis
Elevated Liver Enzymes
Low Platelets
Complications
Treatment
ECLAMPSIA
Incidence
Pathophysiology
Onset of Convulsions
Eclamptic Convulsions
Premonitory Stage
Tonic Stage
Clonic Stage
Stage of Coma
Management
Administration of Magnesium Sulphate
Prichard Regimen
Zuspan Regimen
Sibai Regimen
The Role of the Midwife
Management during a Fit
Complications of Eclampsia
Mortality
Prevention
Future Management
SUMMARY OF NURSING PROCESS
Assessment
Analysis /Nursing Diagnosis
Planning
Implementation
Evaluation
GESTATIONAL HYPERTENSION
CHRONIC HYPERTENSION IN PREGNANCY
Diagnosis
Complications
ESSENTIAL HYPERTENSION IN PREGNANCY
Diagnosis
Effects of Pregnancy on the Disease
Risks to Mother and Fetus
Management
SUMMARY OF NURSING PROCESS FOR PREGNANT WOMEN WITH HYPERTENSION
Assessment
Planning
Analysis /Nursing Diagnosis
Implementation
Evaluation
CHAPTER 29:
Medical Disorders Associated with Pregnancy
CARDIAC DISEASE
Changes in Cardiovascular Dynamics during Pregnancy and their Effects on Heart Lesion
Gradings
Rheumatic Heart Disease
Mitral and Aortic Valve Incompetence
Mitral Stenosis
Congenital Heart Disease
Risk to Mother and Fetus
Antenatal Care
General Management
Management
Hospitalization
Intrapartum Care
The Place of Induction
The Place of Cesarean Section
The Puerperium
SUMMARY OF NURSING PROCESS
Assessment
Analysis /Nursing Diagnosis
Planning
Implementation
Evaluation
RESPIRATORY DISORDERS
SUMMARY OF NURSING PROCESS
Assessment
Analysis/Nursing Diagnosis
Planning
Implementation
Evaluation
THYROID DYSFUNCTION IN PREGNANCY
HYPERTHYROIDISM
Diagnosis
Treatment
Preconceptional Counselling
HYPOTHYROIDISM
Diagnosis
Antenatal Care
Postnatal Care
Postpartum Thyroiditis
ANEMIA IN PREGNANCY
Classification of Anemia
Physiological Anemia of Pregnancy
Erythropoiesis
Causes of Increased Prevalence of Anemia in the Tropics
Iron Requirements in Pregnancy
Routine Screening for Anemia
IRON DEFICIENCY ANEMIA
Causes
Signs and Symptoms
Effects of Anemia on the Mother
Effects of Anemia on the Fetus/Baby
Investigations
Prevention of Iron Deficiency Anemia
Management
Curative Management
Oral Iron
Side Effects of Oral Iron
Parenteral Iron
Management during Labor
Puerperium
FOLIC ACID DEFICIENCY ANEMIA(Megaloblastic anemia)
Causes
Clinical Features and Diagnosis
Effects of Megaloblastic Anemia
Management
VITAMIN B12 DEFICIENCY
HEMOGLOBINOPATHIES
SICKLE CELL DISORDERS
Sickle Cell Trait
Sickle Cell Disease
Diagnosis
Effects on Pregnancy
Effects of Pregnancy on the Disease
Management
Postnatal Care
THALASSEMIA SYNDROMES
Alpha Thalassemia Major
Beta Thalassemia Major
Alpha and Beta Thalassemia Minor
RENAL PROBLEMS IN PREGNANCY
AUTOIMMUNE DISEASES
Systemic Lupus Erythematosus (SLE)
Effects of Pregnancy on SLE
Effects on Pregnancy
Investigation
Management
Intrapartum Care
Postnatal Care
Idiopathic Thrombocytopenic Purpura (ITP)
Diagnosis
Effects of ITP on Pregnancy and the Fetus
Antenatal Care
Intrapartum Care
Postnatal Care
Epilepsy in Pregnancy
Management
CHAPTER 30:
Multiple Pregnancy
INCIDENCE
TWIN PREGNANCY
Varieties of Twins
Genesis of Twins
Etiology
Rare Forms
Determination of Zygosity
Examination of Placenta and Membranes
Uniovular twins
Sex
Genetic Features (Dominant blood group)
Diagnosis of Twin Pregnancy
History
Symptoms
General Examination
Abdominal Examination
Palpation
Auscultation
Investigations
Duration of Pregnancy
Maternal
During pregnancy
During labor
During puerperium
Effects on fetus
Antenatal Management
Advice
Hospitalization
Management during Labor
During the first stage of labor
Management of Delivery
Management of the Third Stage
Indications for Cesarean Section
Associated Causes
Fetal Causes
Complications Associated with Multiple Pregnancy
Polyhydramnios
Fetal Abnormality
Malpresentations
Premature Rupture of Membranes
Prolapse of the Cord
Prolonged Labor
Monoamniotic Twins
Locked Twins (Fig. 30.2)
Delay in the Birth of the Second Twin
Premature Expulsion of the Placenta
Postpartum Hemorrhage
Undiagnosed Twins
Management of Postnatal Period
Care of the Babies
Care of the Mother
Triplets and Higher Order Births
Disability and Bereavement
Embryo Reduction/Selective Reduction
Selective Fetocide
CHAPTER 31:
Preterm Labor, Premature Rupture of Membranes and Intrauterine Fetal Death
PRETERM LABOR
Definition
Causes of Preterm Labor
History
Complications in Previous Pregnancy
Presentation of the Woman
Management of Preterm Labor
Management Approaches
Prevention
Preventive Measures
Investigations
To Arrest Preterm Labor
Shortterm Therapy
Longterm Therapy
Glucocorticoid Therapy
Management of Preterm Labor
First Stage
Second Stage
Immediate Management of the Preterm Baby Following Birth
Support for the Mother
PREMATURE RUPTURE OF MEMBRANES (PROM)
Definition
Incidence
Causes
Manifestations
Risks of PROM
Management
INTRAUTERINE FETAL DEATH (IUD)
Etiology
Pregnancy Complications
Pre-existing Medical Diseases and Acute Illnesses during Pregnancy
Fetal Causes
Iatrogenic
Idiopathic
Signs and Symptoms
Investigations
Complications
Prevention
Management
Expectant Management (Non-interference)
Interference
Bereavement Management
CHAPTER 32:
Postterm Pregnancy, Induction of Labor, Prolonged Labor and Disorders of Uterine Action
POSTTERM PREGNANCY
Incidence
Etiology
Diagnosis
Clinical Findings
Clinical Presentation for Retrospective Diagnosis
Dangers of Postterm Pregnancy
During Pregnancy
During Labor
Following Birth
Management of Postterm Pregnancy
Expectant Management
Elective Induction
Care during Labor
INDUCTION OF LABOR
Indications for Induction
Maternal Indications
Fetal Indications
Combined Indications
Contraindications to Induction of Labor
Dangers of Induction
Maternal
Fetal
Methods of Ripening of the Cervix
Assessment of the Cervix
Methods of Induction
a. Medical Induction
Indications for medical induction
Oxytocin Induction
Calculation of the infusion dose
Observations during oxytocin induction
Indications for Stopping the Infusion
Side effects of oxytocin
Induction using Prostaglandins
Advantages
Drawbacks
b. Surgical Induction of Labor
Methods
1. Artificial rupture of membranes or Amniotomy
Hazards of ARM
Immediate beneficial effects of ARM
Low Rupture of Membranes (LRM)
Contraindication
Observations
Hazards
High Rupture of Membranes (HRM)
Conditions to be fulfilled
Contraindications
Hazards
2. Stripping the Membranes
c. Combined Method
Advantages of Combined Methods
PROLONGED LABOR
Causes of Prolonged Labor
First Stage
Second Stage
Diagnosis
First Stage Labor
Second Stage
Dangers of Prolonged Labor
Fetal
Maternal
Management
Prolonged Second Stage of Labor
Management of a Prolonged Second Stage
Options for Delivery
Maternal Distress
DISORDERS OF UTERINE ACTION
Precipitate Labor (Over-efficient Uterine Action)
Maternal Risks
Fetal Risks
Management
Cervical Dystocia
Management
Generalised Tonic Contraction (Uterine Tetany)
Causes
Clinical Manifestations
Treatment
Tonic Uterine Contraction and Retraction (Bandl's Ring)
Clinical Features
Prevention
Management
Constriction Ring (Syn Contraction Ring)
Diagnosis
Management
Obstructed Labor
Causes
Signs of Obstructed Labor
Late Signs
Effects on Mother
Effects on the Fetus
Management of Obstructed Labor
Measures of Management
Obstetric Management
CHAPTER 33:
Malpositions and Malpresentations
OCCIPITO-POSTERIOR POSITION
Postulated Causes of Occipito-posterior Positions
Palpation
Auscultation
Vaginal Examination
Course of Labor
Mechanisms of Labor in Occipito-Posterior Position
Possible Courses of Labor
Long Arc Rotation
Posterior Rotation of the Occiput
Short Arc Rotation
Non-rotation of the Occiput
Mechanism of Labor in Right Occipito-Posterior Position (ROP)
Positional Movements
Mechanism of Labor with Posterior Rotation of the Occiput
FACE PRESENTATION
Causes
Diagnosis of Face Presentation
Mechanisms of Labor
Engagement
Extension
Descent Occurs Throughout
Mentum Anterior Position
Restitution
Internal Rotation of the Shoulders
External Rotation of the Head
Birth of the Shoulders and Body by Lateral Flexion
Midwifery Management of a Face Presentation
Possible Complications
Obstructed Labor
Cord Prolapse
Facial Bruising
Cerebral Hemorrhage
Maternal Trauma
BROW PRESENTATION
Causes
Diagnosis
On Abdominal Palpation
On Vaginal Examination
Management
BREECH PRESENTATION
Positions of Breech Presentation
Types of Breech Presentation (Fig. 33.7)
Breech with Extended Legs (Frank breech)
Complete Breech
Footling Breech
Knee Presentation
Antenatal Diagnosis
Auscultation
Diagnosis during Labor
External Cephalic Version
Method
Complications
Contraindications
Assessment for Vaginal Delivery
Mechanism of Labor for Left Sacroanterior Position
Types of Breech Delivery
Management of Delivery
Delivery of the Shoulders
Delivery of the Head
Methods of Delivering the After-coming Head
Forceps Delivery
Burns Marshall Method
Mauriceau-Smellie-Veit Manoeuvre (Jaw flexion and shoulder traction)
Delivery of Extended Legs
Complications of Breech Presentation
SHOULDER PRESENTATION (Fig. 33.11)
Maternal Causes
Lax Abdominal and Uterine Muscles
Uterine Abnormality
Contracted Pelvis
Fetal Causes
Preterm Pregnancy
Multiple Pregnancies
Polyhydramnios
Macerated Fetus
Placenta Previa
Diagnosis
Antenatal
Intrapartum
Possible Outcome
Management in the Antenatal Period
Management in the Intrapartum Period
Complications
Management
COMPOUND PRESENTATION (Fig. 33.12)
SHOULDER DYSTOCIA
Incidence
Risk Factors
Warning Signs and Diagnosis
Management
Other Manipulative Procedures
The McRobert's Maneuver
Suprapubic Pressure
Complications following Shoulder Dystocia
Maternal Complications
Fetal Complications
UNSTABLE LIE
Causes
Management
CHAPTER 34:
Obstetric Operations
DILATATION AND EVACUATION
One-Stage Operation
Indications
Preparation for the Operation
Procedure
Two-Stage Operation
Indications
Procedure
Steps
Steps of the Evacuation Procedure
Dangers of Dilatation and Evacuation Operation
Immediate Dangers
Late Complications
FORCEPS DELIVERY
Basic Construction of the Forceps
Types of Obstetric Forceps Currently Used
Long-Curved Obstetric Forceps
Short-Curved Forceps (Wrigley's Forceps)
Kielland's Forceps
Classification According to the Level of the Fetal Head at which the Forceps are Applied
Indications of Forceps Operation
Prerequisites for Forceps Delivery
Preparation of the Woman
Procedure of Low Forceps Operation
Manual Rotation of the Fetal Head Followed by Mid-forceps Operation
Difficulties in Forceps Operation
Causes of Failure
Complications of Forceps Operation
In the Mother
In the Infant
Prophylactic Forceps (Elective)
Trial Forceps
Failed Forceps
Cause for Failed Forceps
Management
VACUUM EXTRACTION (VENTOUSE DELIVERY)(Fig. 34.6)
The Equipment
Indications
Advantages of Ventouse Over Forceps
Advantages of Forceps Over Ventouse
Contraindications for Ventouse
Conditions to be Fulfilled
The Procedure (Fig. 34.7)
Step-1, Application of the Cup
Step-2, Traction
Complications
Fetal
Maternal
Failure
CESAREAN SECTION
Incidence
Indications for Cesarean Section
Elective Cesarean Section
Emergency Cesarean Section
Contraindications
Types of Operations
Lower Segment Cesarean Section (LSCS)
Classical Cesarean Section
Preparation of the Mother
Psychological Preparation
Physical Preparation
Anesthesia
Position
Incision on the Abdomen
Delivery of the Head
Delivery of the Trunk
Removal of the Placenta and Membranes
Suturing of the Uterine Wound
Postoperative Care
Immediate Care (4-6 hours)
First 24 Hours
After 24 Hours
Complications of Cesarean Section
Cesarean Hysterectomy
DESTRUCTIVE OPERATIONS(EMBRYOTOMIES)
Craniotomy
Indications
Sites of Perforation
Procedure
Decapitation
Indications
Procedure
Eviceration
Indications
Cleidotomy
Postoperative Care Following Destructive Operations
Complications
CHAPTER 35:
Obstetric Emergencies
VASA PREVIA
Diagnosis
Management
PRESENTATION AND PROLAPSE OF THE UMBILICAL CORD (Fig. 35.1)
Incidence
Predisposing Factors
Mal-presentations
Prematurity
Multiple Pregnancy
Polyhydramnios
High Head
Multiparity
Diagnosis
Occult Prolapse
Cord Presentation
Cord Prolapse
Risks to Mother and Fetus
Maternal
Fetal
Management of Cord Presentation
Management of Cord Prolapse
Immediate Action
Definitive Management
DYSTOCIA CAUSED BY FETAL ANOMALIES
Fetal Macrosomia (Generalized fetal enlargement)
Shoulder Dystocia
Hydrocephalus
Diagnosis
Management
Outcome
Neural Tube Defects
Anencephaly
Diagnosis
Complications
Management
Prevention
Enlargement of Fetal Abdomen
Conjoined Twins
AMNIOTIC FLUID EMBOLISM
Predisposing Factors
Clinical Features
Emergency Management
Complications
Effect on the Fetus
SHOCK
Classification of Shock
Hypovolemic Shock
Cardiogenic Shock
Neurogenic Shock
Septic Shock (endotoxic shock)
Hypovolemic Shock
Management
Clinical Observations for the Mother in Shock (monitoring)
Septic Shock
Clinical Signs of Septic Shock
Management of Septic Shock
BASIC LIFE SUPPORT / CARDIOPULMONARY RESUSCITATION (CPR)
Steps of Basic Life Support
CHAPTER 36:
Complications of Third Stage of Labor
POSTPARTUM HEMORRHAGE
Definition
Incidence
Classification
Causes of Postpartum Hemorrhage
a. Atonic Uterus
b. Traumatic Hemorrhage in Third Stage
c. Blood Coagulation Disorders
Signs of Postpartum Hemorrhage
Prophylaxis
Management of Third Stage Bleeding
Manual Removal of Placenta (Figs 36.1 and 36.2)
Difficulties
Complications
Observation of the Mother Following Third Stage Hemorrhage
MANAGEMENT OF PRIMARY POSTPARTUM HEMORRHAGE
Principles
Immediate Measures
Management Steps
Prognosis
Breaking of the Cord
SECONDARY POSTPARTUM HEMORRHAGE
Causes
Clinical Features
Management
Nursing Considerations
RETAINED PLACENTA
Causes
Signs of Retained Placenta
Dangers
Management
Complications Accompanying Retained Placenta and Management
PLACENTA ACCRETA
Diagnosis
Management
INVERSION OF THE UTERUS
Classification of Inversion (Fig. 36.4)
Causes
Dangers
Diagnosis (Signs and Symptoms)
Management
CHAPTER 37:
Injuries to the Birth Canal
LACERATIONS OF PERINEUM
Injuries to Vulva
Perineal Tears
Classification
First Degree
Second Degree
Third Degree (Complete Tear)
Fourth Degree (Central Tear)
Prevention
Management
Repair
Aftercare
Vaginal Tears
Management
Colporrhexis
Cervical Tears
Causes
Signs of Cervical Tear
Management
PELVIC HEMATOMAS
Anatomical Types
Infralevator Hematoma
Causes
Manifestations
Treatment
Supralevator Hematoma
Causes
Diagnosis
Management
RUPTURE OF THE UTERUS
Definition
Classification of Rupture
Scar Rupture and Dehiscence
Complete and Incomplete Rupture
Spontaneous and Traumatic Rupture
Risk Factors
Signs and Symptoms
Management
Nursing Care
Once a Rupture is Diagnosed
VISCERAL INJURIES
Clinical Manifestations
Traumatic
Sloughing fistula
Management
Injury to the Rectum
Injury to the Urethra
CHAPTER 38:
Complications of Puerperium
PUERPERAL PYREXIA
Causes
PUERPERAL SEPSIS
Definition
Conditions that Favor the Development of Sepsis
Predisposing Factors of Puerperal Sepsis
Antepartum Factors
Intrapartum Factors
Organisms
Mode of Infection
Pathology
Clinical Features
Local infection
Uterine Infection
With Severe Infection
Parametritis
Pelvic Peritonitis
General Peritonitis
Thrombophlebitis
Septicemia
Investigations
Prevention
Antenatal
Intrapartum
Postpartum
Treatment
Surgical Treatment
NURSING PROCESS FOR MOTHERS WITH PUERPERAL SEPSIS
Assessment
Analysis/Nursing Diagnosis
Planning
Implementation
Evaluation
SUBINVOLUTION OF THE UTERUS
Causes of Subinvolution
Predisposing Factors
Aggravating Factors
Clinical Features
Management
BREAST COMPLICATIONS
Breast Engorgement
Symptoms
Preventive Measures
Management
Cracked and Retracted Nipple
Causes
Treatment
Retracted Nipple
Acute Mastitis
Clinical Features
Treatment
Breast Abscess
Failing Lactation
Causes
Treatment
VENOUS THROMBOSIS
Causes
Types
Superficial Vein Thrombosis
Deep Vein Thrombosis (DVT)
Investigations
Management
Thrombophlebitis
Clinical Features of Phlegmacia Alba Dolens
Prevention and Management
PULMONARY EMBOLISM
Signs and Symptoms of Small Pulmonary Emboli
Signs and Symptoms of Major Pulmonary Embolism
Diagnostic Procedures
Treatment and Management
PSYCHOLOGICAL DISTURBANCES IN THE PUERPERIUM
Postpartum Blues (Baby Blues)
Postpartum Depression
Causes
Diagnosis
Management
Puerperal Psychosis
Diagnosis
Treatment
Prognosis
Role of the Midwife
SECTION 8: THE NORMAL NEONATE
CHAPTER 39:
The Baby at Birth
EXTRAUTERINE ADAPTATION
Respiratory Changes
Circulatory Changes
Other Systems
Thermal Regulation
IMMEDIATE CARE OF THE BABY AT BIRTH
Initial Care
Clearing the Airway
Clamping and Cutting the Cord
Identification
Evaluation of the Newborn at Birth
Prevention of Heat Loss (Fig. 39.4)
NORMAL CHARACTERISTICS AND PHYSICAL FEATURES OF A HEALTHY NEWBORN
INITIAL ASSESSMENT OF THE NEWBORN
General Appearance
Measurements
Activity
Colour
Skin
Head
Eyes
Nose
Ears
Mouth
Neck
Chest
Abdomen
Genitalia
Male
Female
Back
Anus
Upper Extremities
Arms
Lower extremities
Feet
Neurologic Examination
Cardiovascular Examination
Failure to Establish Respirations at Birth
Causes of Respiratory Depression in the Neonate
RESUSCITATION OF THE NEWBORN
Rationale for Resuscitation
Degrees of Resuscitation
Supplies and Equipment
Suctioning Equipment
Bag and Mask Equipment
Intubation Equipment
Medications
Miscellaneous
Initial Steps
Preventing heat loss
Positioning
Suctioning
Evaluation
Bag and Mask Ventilation/Positive Pressure Ventilation (Fig. 39.10)
Indications
Procedure
Evaluation
Signs of Improvement
Chest Compressions
Indications
Procedure
Endotracheal Intubation
Indications
Procedure
CHAPTER 40:
Physiology, Screening, Daily Care and Observation of the Newborn
PHYSIOLOGY
Respiratory System
Cardiovascular System
Thermal Regulation
Renal System
Gastrointestinal System
Reproductive System
Musculoskeletal System
Immunological Adaptations
Neurological System
Moro Reflex or Embracing Reflex (Fig. 40.1)
Tonic Neck Reflex (Fig. 40.2)
Palmar Grasp Reflex (Fig. 40.3A), Grasp Reflex (Fig. 40.3B)
Walking/Stepping Reflex (Fig. 40.4)
Reflexes of the Eyes
Reflexes of the Mouth
Special Senses and Behavior Pattern
Vision
Hearing
Smell and Taste
Touch
Sleeping and Waking
Two Sleep States are Identifiable
Awakening States
Crying
Growth and Development
PHYSICAL EXAMINATION (SCREENING)
DAILY CARE AND OBSERVATION OF THE NEWBORN
Vaccination and Immunization
CHAPTER 41:
Infant Feeding
THE BREASTS AND LACTATION
PROPERTIES AND COMPONENTS OF BREAST MILK
MANAGEMENT OF BREASTFEEDING
Antenatal Preparation
The Commencement of Breastfeeding
Preparation and Position of the Mother
Preparation and Position of the Baby
Helping the Mother to Begin
Feeding Behaviors
Timing and Frequency of Feeding
Care of the Breasts
Benefits of Breastfeeding to the Mother
Benefits to the Baby
Volume of the Feed
Difficulties in Breastfeeding and Management
Difficulties due to Mother
Difficulties due to Baby
Contraindications to Breastfeeding
Underfeeding and Overfeeding
Features of Underfeeding
Features of Overfeeding
Suppression of Lactation
Complementary and Supplementary Feeds
The Babyfriendly Hospital Initiative
Artificial Feeding
Indications of Artificial Feeding
FOOD USED
Cow's Milk
Qualitative Differences
Modification of Cow's Milk
Preparation of a Feed
Dried Milk
Preparation of the Mother for Artificial Feeding
Weaning from the Breast
CHAPTER 42:
Physiology, Screening, Daily Care and Observation of the Newborn
DEFINITION
INCIDENCE OF LOW BIRTHWEIGHT
SMALL FOR GESTATIONAL AGE TERM INFANT
Clinical Appearance
Causes of Intrauterine Growth Retardation
Management at Birth
Feeding
Temperature Control
Skin Care
THE PRETERM BABY
Incidence
Causes of Prematurity
Multiple Pregnancy
Maternal Disease in Pregnancy
Previous Obstetric History
Low Socioeconomic and Nutritional Status
Uterine Anomalies
Infections
Chronic Diseases
Fetal Causes
Clinical Appearance
Risks Associated with Prematurity
Asphyxia
Hypothermia
Pulmonary Problems
Cerebral Hemorrhage
Infection
Jaundice
Anemia
Retrolental fibroplacia (Retinopathy of prematurity)
Care of the Preterm Baby at Birth
Principles of Care
Body Temperature
Respiratory Support
Prevention of Infection
Nutritional Needs
Feeding Methods
Tube Feeding or Gavage
Dropper or Spoonfeeding
Bottlefeeding
Intravenous Fluid Therapy
Nature of Food
Skin Care
Promotion of Growth and Development
Kangaroo Care
Favorable Signs of Progress
Advice to Mother on Discharge
INTRAUTERINE GROWTH RETARDATION (IUGR)
Incidence
Types of IUGR Fetuses
Causes of Intrauterine Growth Retardation
Maternal
Fetal
Placental
Physical Features of the Baby at Birth
Neonatal Complications
Immediate Care of the Baby at Birth
SECTION 9: THE III BABY
CHAPTER 43:
Recognizing the III Baby
INTRODUCTION
ASSESSMENT OF GESTATIONAL AGE
WARNING SIGNS
Pallor
Cause of Anemia
Causes of Pallor other than Anemia
Plethora
Cyanosis
Jaundice
Other Factors that Affect the Appearance of the Skin
Skin Rashes
Infectious Lesions
Respiratory System
Body Temperature
Normal body temperature range for term infants
Hyperthermia
Cardiovascular System
Central Nervous System
Neurological Disorders
Manifestations of Neurological Disorders
Genitourinary System
Common causes of reduced urinary output
Gastrointestinal Tract
Vomiting and Diarrhea
Duodenal Atresia
Malrotation of the Gut
Volvulus
Meconium Ilius
Necrotising Enterocolitis (NEC)
Imperforate Anus
Rectal Fistulas
Hirschsprung's Disease
Metabolic Disorders
Nursing Management of the Hospitalized Newborn and the Family
Involvement of Parents of the Hospitalized Baby
CHAPTER 44:
Respiratory Problems of the Newborn
ANATOMY AND PHYSIOLOGY OF THE RESPIRATORY SYSTEM
CLINICAL SIGNS OF RESPIRATORY PROBLEMS
CAUSES OF RESPIRATORY PROBLEMS
Infection
Generalized Infection
Congenital or Acquired Pneumonia
Aspiration
Meconium Aspiration
Other Aspiration Problems
Lung Immaturity
Respiratory Distress Syndrome (RDS)/Hyaline Membrane Disease
Clinical Features
Prevention
Management
Complications
Transient Tachypnea of the Newborn (TTN)
Pneumothorax
Clinical Signs of Pneumothorax
Congenital Problems
Upper Airway Problems
Lower Airway Problems
Central Nervous System Disorders
Cardiovascular and Circulatory Problems
Patent Ductus Arteriosus (PDA)
Persistent Pulmonary Hypertension of the Newborn/Persistent Fetal Circulation
Structural Heart Defects
Apnea of Prematurity
PRINCIPLES OF CARING FOR A BABY WITH RESPIRATORY PROBLEM
Positioning
Observation
Oxygenation
Ambient or Head Box Oxygen
Nasal Cannula
Mechanical Ventilation
Nutrition and Hydration
Basic Physical Care Needs
Meeting the Emotional and Psychological Needs of the Baby and Family
CHAPTER 45:
Birth Trauma, Hemorrhage and Convulsions
TRAUMA DURING BIRTH
Trauma to Skin
Trauma to Superficial Tissues
Caput Succedaneum (Figs 45.1A; to C)
Other Injuries
Muscle Trauma
Torticollis
Nerve Trauma
Facial Nerve Palsy
Brachial Palsy
Bone Trauma
Clavicle Fracture
Humerus Fracture
Femur Fracture
Treatment
Skull Fracture
Dislocations
Visceral Injuries
HEMORRHAGE
Hemorrhage due to Trauma
Cephalhematoma (Figs 45.4A and B)
Subaponeurotic Hemorrhage (Fig. 45.5)
Subdural Hemorrhage
Hemorrhage due to Hypoxia
Subarachnoid Hemorrhage
Periventricular or Intraventricular Hemorrhage
Hemorrhage Related to Coagulopathies
Hemorrhagic Disease of the Newborn
Thrombocytopenia
Disseminated Intravascular Coagulation (DIC)
Inherited Coagulation Factor Deficiencies
Hemorrhage Related to Other Causes
PREVENTION OF TRAUMA IN THE NEWBORN
Antenatal Period
Intranatal Period
Preterm Delivery
Instrumental Delivery
Vaginal Breech Delivery
CONVULSIONS IN THE NEWBORN
Manifestations
Types of Neonatal Convulsions
Causes of Convulsion in the Newborn
Investigations
Management
Control of Convulsions
Treatment of the Underlying Pathology
Observation and Recording
Managing Parents
CHAPTER 46:
Congenital Abnormalities
CAUSES OF CONGENITAL ABNORMALITIES
Chromosome Abnormalities
Genetic Disorder (Mendelian inheritance)
Teratogenic Causes
Multifactorial Causes
Unknown Causes
PRENATAL GENETIC COUNSELLING
Candidates for Screening
Risk Factors
Detection
Management of at Risk Couples
COMMON MALFORMATIONS AND SYNDROMES
Gastrointestinal Malformations
Gastroschisis and Exomphalos
Atresias
Rectal Atresia and Imperforate Anus
Pyloric Stenosis
Cleft Lip and Cleft Palate
Pierre Robin Syndrome
ABNORMALITIES RELATING TO RESPIRATION
Diaphragmatic Hernia
Choanal Atresia
Laryngeal Strider
CONGENITAL CARDIAC DEFECTS
Detection of Cardiac Defects
Cardiac Defects Presenting with Cyanosis
‘Acyanotic’ Cardiac Defects
CENTRAL NERVOUS SYSTEM ABNORMALITIES
Anencephaly
Spina Bifida Aperta
Meningocele (Fig. 46.1)
Meningomyelocele (Fig. 46.2)
Spina Bifida Occulta
Hydrocephalus
Microcephaly
MUSCULOSKELETAL DEFORMITIES
Limb Reduction Anomalies
Talipes Equinovarus (Fig. 46.5)
Talipes Calcaneovalgus (Fig. 46.6)
Congenital Hip Dysplasia
Streeter's Dysplasia
Achondroplasia
ABNORMALITIES OF THE URINARY SYSTEM
Polycystic Kidneys
Hypospadias and Epispadias
Cryptorchidism
Ambiguous Genitalia
Intersex
COMMONLY OCCURRING SYNDROMES
Trisomy 21 or Down's Syndrome
Trisomy 18 (Edward's syndrome)
Trisomy 13 (Patau syndrome)
Potter Syndrome
Turner Syndrome (XO)
Klinefelter Syndrome (XXY)
CHAPTER 47:
Jaundice and Infections in the Newborn
JAUNDICE
Formation of Bilirubin
Excretion of Bilirubin
Complications of Hyperbilirubinemia
TYPES OF JAUNDICE
Physiological Jaundice
Causes of Physiological Jaundice
Management
Pathological Jaundice
Features of Pathological Jaundice
Cause of Pathological Jaundice
Management of Jaundice
Assessment and Diagnosis
Risk Factors
Laboratory Evaluation
TREATMENT
Phototherapy (Fig. 47.2)
Indications for Phototherapy
Types of Phototherapy
Care of the Baby Undergoing Phototherapy
Exchange Transfusion
Indications
Objectives
Nature and Amount of Blood Transfused
Care of the Baby Undergoing Exchange Transfusion
Complications
Drug Therapy
HEMOLYTIC DISEASES OF THE NEWBORN
Rhesus Incompatibility
Effects on the Fetus
Management
ABO Incompatibility
NEONATAL INFECTIONS
Natural or Innate Immunity
Acquired Immunity
Modes of Acquiring Infection
Organisms in Newborn Infection
Management of Infection in the Baby
Prevention
Assessment and Diagnosis
Treatment of Infection
INFECTIONS ACQUIRED BEFORE OR DURING BIRTH
Toxoplasmosis
Rubella
Cytomegalovirus (CMV) Infection
Herpes Simplex Virus (HSV)
Acquired Immune Deficiency Syndrome (AIDS)
Varicella Zoster Virus
Chlamydia
Hepatitis B Virus
Syphilis
Gonococcal Infections
Ophthalmia Neonatorum
Candida Infections
INFECTIONS ACQUIRED AFTER BIRTH
Skin Infections
Omphalitis
RESPIRATORY INFECTIONS
Nasopharyngitis and Rhinitis
Neonatal Pneumonia
GASTROINTESTINAL INFECTIONS
Gastroenteritis
Necrotising Enterocolitis
URINARY INFECTIONS
MENINGITIS
CHAPTER 48:
Metabolic and Endocrine Disorders in the Newborn
INBORN ERRORS OF METABOLISM
Common features of IEM
Possible Indicators of IEM
Diagnosis of IEM
PHENYLKETONURIA (PKU)
Clinical Features
Diagnosis
Management
GALACTOCEMIA
GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD) DEFICIENCY
CYSTIC FIBROSIS
ENDOCRINE DISORDERS
CONGENITAL HYPOTHYROIDISM
Clinical Presentation
Diagnosis and Treatment
HYPOGLYCEMIA
Etiology
Clinical Signs of Hypoglycemia
Management of Hypoglycemia
HYPERGLYCEMIA
ELECTROLYTE IMBALANCE
HYPERNATREMIA
HYPONATREMIA
HYPOCALCEMIA
HYPERCALCEMIA
DIARRHEA IN NEWBORN
Causes
Clinical Features
Dietetic Causes of Diarrhea (Non-infective)
Treatment of Infective Diarrhea
Severe Diarrhea with Dehydration
VOMITING IN NEWBORN
Causes of Vomiting
Treatment
DRUG OR SUBSTANCE WITHDRAWAL
NEONATAL ABSTINENCE SYNDROME (NAS) OR WITHDRAWAL SIGNS
Treatment
FETAL ALCOHOL SYNDROME (FAS)
Characteristics of Babies with FAS
Management
SECTION 10: COMMUNITY MIDWIFERY
CHAPTER 49:
Preventive Obstetrics and Domiciliary Care in Maternity Nursing
ANTENATAL CARE
Objectives of Antenatal Care
Antenatal Visits
Preventive Services for Mothers in the Prenatal Period
Risk Approach
Home Visits
Prenatal Advice
Diet
Personal Hygiene
Drugs
Radiation
Warning Signs
Childcare
Specific Health Protection
Other Nutritional Deficiencies
Tetanus Protection
Syphilis
German Measles
Rh Status
HIV Infections
Prenatal Genetic Screening
Mental Preparation
Family Planning
INTRANATAL CARE
Domiciliary Care
Advantages of the Domiciliary Midwifery Service
Disadvantages of Domiciliary Midwifery
Preparation for Home Delivery
The Room
The Danger Signals
Equipments for Conducting Home Delivery
From Home for Mother
For Baby
From the Bag and Midwifery Kit (As suggested by UNICEF)
Other Items from the Health Center
POSTNATAL CARE
Breastfeeding
Family Planning
Health Education
CHAPTER 50:
Primary Health Care in India
LEVELS OF HEALTH CARE
Health Care at the Village Level
Health Care at the Sub-Centres Level
Primary Health Centres Level
Community Health Centres
MATERNAL AND CHILD HEALTH (MCH) SERVICES
Objectives of MCH Services
Components of MCH Services
Maternal Health Care
Neonatal Care
Job Functions of the Female Health Worker for Implementing MCH Services
Registration
Care at Home
At the Health Centres
In the Community
Other Responsibilities
Specific Job Functions of the Female Health Assistant
REPRODUCTIVE AND CHILD HEALTH PROGRAMME (RCH)
Specific Features of the RCH Approach
Services included in the Programme for Care of Mothers and Children
Essential Care for all Pregnant Women
Early Detection of Complications
Emergency Care for those who need it
Care for Women in the Reproductive Age Group
Provision of Clean and Safe Delivery Practices at the Community Level
Newborn Care
Immunization
Children (1-3 years)
Children (3-5 years)
Prevention of Deaths Due to Diarrheal Diseases
Prevention of Deaths Due to Pneumonia
SECTION 11: SPECIAL TOPICS
CHAPTER 51:
Pain Relief and Comfort in Labor
PERCEPTION OF PAIN
CAUSES OF PAIN
Analgesics and Anesthesia
Analgesics and their Fetal and Maternal Side Effects
Patient Controlled Analgesia (PCA)
Assessment and Intervention
ANESTHESIA
Regional
Pudendal Block
Paracervical Block
Peridural (epidural) Anesthesia
Spinal Anesthesia (Subarachnoid)
Advantages and Disadvantages of Regional Anesthesia
Nursing Considerations
Actions Specific to Blocks
General Anesthesia
Types of General Anesthesia
Recovery
Balanced Anesthesia
NON-PHARMACEUTICAL METHODS OF PAIN RELIEF
The Gate Control Theory
Acupuncture
Acupressure
Yoga and Meditation
Therapeutic Touch
Transcutaneous Electrical Nerve Stimulation (TENS)
Bathing, Showering, Warmth
POSITIONING
HYGIENE AND COMFORT
CHAPTER 52:
Childbirth Education and Preparation
THE NATURAL CHILDBIRTH APPROACH
CHILDBIRTH PREPARATION PROGRAM
GOALS OF EDUCATIONAL PROGRAMS
METHODS OF CHILDBIRTH PREPARATION
Read Method
Lamaze Method (Psychoprophylaxis)
Kind and Rate of Breathing Change with Advancing Stages of Labor
Modified Lamaze Method
Bradley Method
Teaching Content
First Trimester Classes
Second and Third Trimester Classes
Refresher Courses
Cesarean Birth Preparation
Prenatal Exercise Classes
EFFECTIVENESS OF PRENATAL EDUCATION
THE ROLE OF COACH OR SUPPORT PERSON
THE ROLE OF THE CHILDBIRTH EDUCATOR
CHAPTER 53:
Special Exercises for Pregnancy, Labor and Puerperium
POSTURAL CHANGES IN PREGNANCY
POSTURE FOR COMFORT IN DIFFERENT POSITIONS
Sitting
Standing
Lying
Household Activities
Walking
Cycling
Swimming
POSTURE FOR RELIEF OF ACHES AND PAINS
Back and Pelvic Pain
Cramp
Rib Discomfort
ANTENATAL EXERCISES
Abdominal Tightening
Pelvic Floor Exercise (Kegel exercise)
Foot and Leg Exercises
Breathing Exercise
POSITIONS FOR COMFORT DURING LABOR
Early First Stage of Labor
Later First Stage of Labor
Second Stage of Labor
POSTNATAL EXERCISES
Circulatory Exercises
Pelvic Floor Exercises (Kegel exercise)
Abdominal Exercises
Abdominal Breathing
Head and Shoulder Raising
Leg Raising
Pelvic Tilting or Rocking
Knee Rolling
Hip Hitching
EXERCISES FOLLOWING CESAREAN SECTION
Care of the Back Postnatally
IMMEDIATE POSTNATAL PHYSICAL PROBLEMS
Diastasis Symphysis
Diastasis Recti
Painful Perineum
Incontinence
Backache
Coccydynia
CHAPTER 54:
Drugs Used in Obstetrics
OXYTOCICS
Oxytocin
Ergot Derivatives
Prostaglandins (PGs)
ANTIHYPERTENSIVE DRUGS
Methyldopa
Labetalol
Propranolol (Inderal)
Hydralazine
Nifedipine
Diazoxide
Sodium Nitroprusside
DIURETICS
Furosemide (Lasix)
Hydrochlorothiazide
Spironolactone (Aldactone)
TOCOLYTIC AGENTS
Isoxsuprine (Duvadilan)
Ritodrine Hydrochloride (Yutopar)
ANTICONVULSANTS
Magnesium Sulphate
Diazepam (Valium)
Phenytoin (Dilantin)
Phenobarbitone (Luminal)
ANTICOAGULANTS
Heparin Sodium
Warfarin Sodium (Cumadin)
ANALGESICS
Pethidine (Meperidine)
Fentanyl
Promethazine (Phenergan)
EFFECTS OF MATERNAL MEDICATIONS ON FETUS AND BREASTFEEDING INFANTS
Maternal Medications with Established Teratogenic Properties and their Effects
Possible Teratogens
Fetotoxic Drugs
Maternal Drug Intake and Breastfeeding
CHAPTER 55:
Vital Statistics in Obstetrics
MATERNAL VITAL STATISTICS
MATERNAL MORTALITY
Maternal Mortality Rate
Classification of Maternal Deaths
Direct Maternal Deaths (75%)
Indirect Maternal Deaths (25%)
Non-obstetric or Unrelated Deaths
Reproductive Mortality
Magnitude of the Problem
Factors Associated with Maternal Mortality
Age
Parity
Socio-economic Strata
Antenatal Care
Social Factors
Causes of Maternal Death
Hemorrhage
Sepsis
Hypertensive Disorders in Pregnancy
Anemia
Infective Hepatitis
Thromboembolism
Lack of Assistance of Trained Personnel
Preventive Measures
MATERNAL MORBIDITY
Classification
Direct Obstetric Morbidity
Indirect Morbidity
Reproductive Morbidity
PERINATAL MORTALITY
Causes of Perinatal Mortality
Antenatal Causes
Intranatal Causes
Postnatal Causes
Measures for Reduction of Perinatal Mortality
Preventive Measures
STILLBIRTHS
Causes
Antepartum Deaths
Intrapartum Deaths
NEONATAL MORTALITY
Causes of Neonatal Deaths
INFANT MORTALITY RATE (IMR)
RECORD KEEPING
General Guidelines for Maintaining Records
CHAPTER 56:
Perinatal Loss and Grief
LOSS, GRIEF AND MOURNING
Mourning
GRIEF SITUATIONS IN THE PERINATAL PERIOD
THE NATURE OF PERINATAL LOSS AND GRIEF
PHASES OF MOURNING (GRIEVING)
HELPING GRIEVING PARENTS
CARING FOR THE CAREGIVER
Record Keeping
Continued Care
NURSING PROCESS FOR THE CLIENT EXPERIENCING A LOSS
Assessment
Grief Behaviors
Support System
Analysis/Nursing Diagnosis
Planning and Implementation Goals
Client/Family Will
Interventions
Evaluation
Client/Family
CHAPTER 57:
Radiology and Ultrasonics in Obstetrics
RADIOLOGY IN OBSTETRICS
Indications
Fetal
Radiation Hazards
Measures that Help to Reduce Radiation
ULTRASONICS IN OBSTETRICS
How Does Ultrasound Work?
The Use of Ultrasound in Obstetrics
Transvaginal Ultrasonography (TVS)
Doppler Ultrasound (Audible Signal)
The Midwife's Responsibility Regarding Prenatal Screening
APPENDIX:
Nursing Care Plans for Maternal-Neonatal Clients
NURSING DIAGNOSES FOR LABOR AND DELIVERY CLIENTS
Acute Pain–Related to Physiological Response to Labor
Definition
Assessment
Defining Characteristics
Expected Outcomes
Nursing Interventions
Evaluations
Documentation
Deficient Knowledge Related to Information About Birth Process
Definition
Assessment
Defining Characteristics
Expected Outcomes
Nursing Interventions
Evaluations for Expected Outcomes
Documentation
Ineffective Coping Individual Related to Labor and Delivery
Definition
Assessment
Defining Characteristics
Expected Outcomes
Nursing Interventions
Evaluation for Expected Outcomes
Documentation
Anxiety Related to Hospitalization and Birth Process
Definition
Assessment
Defining Characteristics
Expected Outcomes
Nursing Interventions
Evaluation for Expected Outcomes
Documentation
Risk for Infection Related to Labor and Delivery
Definition
Assessment
Associated Medical Conditions
Expected Outcomes
Nursing Interventions
Evaluation for Expected Outcome
Documentation
Risk for Injury Related to Induction of Labor
Definition
Assessment
Risk Factor
Expected Outcomes
Nursing Interventions
Evaluation of Expected Outcome
Documentation
Deficient Knowledge Related to Premature Labor
Definition
Assessment
Defining Characteristics
Expected Outcomes
Nursing Interventions
Evaluation for Expected Outcomes
Documentation
Deficient Fluid Volume Related to Altered Intake during Labor
Definition
Assessment
Defining Characteristics
Associated Medical Conditions
Expected Outcomes
Nursing Interventions
Evaluation
Documentation
NURSING DIAGNOSES FOR POSTPARTUM CLIENTS
Deficient Knowledge Related to Postpartum Care
Definition
Assessment
Defining Characteristics
Expected Outcomes
Nursing Interventions
Evaluation for Expected Outcomes
Documentation
Pain Related to Postpartum Physiological Changes
Definition
Assessment
Defining Characteristics
Expected Outcomes
Nursing Interventions
Evaluations for Expected Outcomes
Documentation
Deficient Fluid Volume Related to Postpartum Hemorrhage
Definition
Assessment
Defining Characteristics
Expected Outcomes
Nursing Interventions
Evaluations for Expected Outcomes
Documentation
Risk for Infection Related to Altered Primary Defenses during Postpartum Period
Definition
Assessment
Risk Factors
Expected Outcomes
Nursing Interventions
Evaluation for Expected Outcomes
Documentation
Pain Related to Episiotomy or Cesarean Incision
Definition
Assessment
Defining Characteristics
Expected Outcomes
Nursing Interventions
Evaluations for Expected Outcomes
Documentation
Impaired Skin Integrity Related to Episiotomy or Abdominal Incision
Definition
Assessment
Defining Characteristics
Expected Outcomes
Nursing Interventions
Evaluations for Expected Outcomes
Documentation
NURSING DIAGNOSES FOR NEONATaL CLIENTS
Risk for Aspiration Related to Immature Cough or Gag Reflex
Definition
Assessment
Risk Factors
Expected Outcomes
Nursing Interventions
Evaluations for Expected Outcomes
Documentation
Ineffective Breastfeeding Related to Difficulty with Breastfeeding Process
Definition
Assessment
Defining Characteristics
Expected Outcomes
Nursing Interventions
Evaluations for Expected Outcomes
Documentation
Interrupted Breastfeeding Related to Contraindicating Conditions
Definition
Assessment
Expected Outcomes
Nursing Interventions
Evaluations for Expected Outcomes
Documentation
Ineffective Breathing Pattern Related to Adjustment to Extrauterine Existence
Definition
Assessment
Defining Characteristics
Expected Outcomes
Nursing Interventions
Evaluations for Expected Outcome
Documentation
Ineffective Breastfeeding Related to Limited Maternal Experience
Definition
Assessment
Defining Characteristics
Expected Outcomes
Nursing Interventions
Evaluations for Expected Outcomes
Documentation
Risk for Infection Related to Neonate's Immature Immune System
Definition
Assessment
Risk Factors
Expected Outcomes
Nursing Interventions
Evaluations for Expected Outcomes
Documentation
Imbalanced Nutrition less than Body Requirement Related to Ineffective Suck Reflex
Definition
Assessment
Defining Characteristics
Expected Outcomes
Nursing Interventions
Evaluations for Expected Outcomes
Documentation
Hypothermia Related to Cold Stress or Sepsis
Definition
Assessment
Defining Characteristics
Expected Outcomes
Nursing Interventions
Evaluations for Expected Outcomes
Documentation
GLOSSARY:
GLOSSARY
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