LECTURE OBJECTIVE
S & OUTLINES
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I. OVERVIEW OF MATERNITY NURSING
OBJECTIVES
At the completion of this class the student will be able to:
1. Compare and contrast expanded nursing roles in this specialty.
2. Delineate significant legal and ethical issues that influence the practice of
maternal – child
nursing.
3. Summarize the use of community–based nursing care in meeting the needs of
childbearing
and childrearing families
4. Define various statistical terms relevant to health care: birth rate, infant
mortality rate,
Neonatal mortality rate, and maternal mortality rate.
5. Identify the current JCAHO patient safety goals.
6. Summarize the actions of the hormones that affect reproductive functioning.
7. Describe the phases and dominant hormones of the menstrual cycle.
8. Discuss the process of conception, implantation and embryo development.
9. List the embryonic changes occurring in early pregnancy.
10. Describe the functions of the placenta and umbilical cord.
11. Explain fetal developmental changes for the various body systems.
12. Discuss the functions of the major fetal circulatory structures.
LECTURE OUTLINE
I.
Role of the Perinatal Nurse
A. Expanse roles in perinatal nursing
1. Ob/Gyn Nurse Practitioner
2. Family Nurse Practitioner
3. Clinical Nurse Specialist
4. Certified Nurse Midwife
II.
Legal and Ethical Issues
A. Litigious nature of this specialty
B. Informed Consent
C. Common Legal Pitfalls
D. Standards of Care
1. Standardized Procedures
2. Supervision of Unlicensed Assistive Personnel
E. Discussion of Case Studies
F. Ethical Dilemmas Unique to Perinatal Nursing
G. Nursing Role
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III.
Review of Conception and Fetal Development
A. Fertilization
B. Cellular multiplication
C. Placenta and umbilical cord
1. Development
2. Structure
3. Function
D. Embryonic and fetal growth and development
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II.
NORMAL PREGNANCY
OBJECTIVES:
At the end of this class the student will be able to:
1. Describe the anatomical and physiological changes that occur during
pregnancy.
2. Differentiate among presumptive, probable, and positive signs of pregnancy.
3. Correctly calculate gravida, para, and estimated date of delivery.
4. Describe nursing assessment for confirmation visits and ongoing visits.
5. Identify common maternal and paternal psychological responses to
pregnancy.
6. Explain the process of role transition to motherhood and the maternal tasks
of pregnancy.
7. Describe the process of paternal role transition.
8. Describe typical sibling and grandparent reactions to a pregnancy.
9. Identify the impact of culture and socioeconomic status on a pregnancy.
10. List the required nutritional components of a pregnancy diet.
11. Identify various nutritional risk factors and explain their effects on a
pregnancy.
12. List various education topics, especially safety issues, such as substance
abuse, travel, vaccinations, violence and battering in the family, and warning
signs.
13. Define common obstetrical terminology.
OUTLINE
I.
Anatomic and Physiologic Changes and Assessment
A. Reproductive organs
B. Respiratory
C. Cardiovascular
D. Gastrointestinal
E. Genitourinary
F. Skin and jair
G. Musculoskeletal
H. Metabolism
I. Weight gain
J. Endocrine
II.
Pregnancy Diagnosis
A. Presumptive findings (subjective)
B. Probable changes (objective)
C. Positive changes (diagnostic)
D. Pregnancy test
E. Emotional and psychological changes
1. Mother
2. Father
3. Siblings
III.
Cultural Assessment
IV.
Prenatal History
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A. Patient
B. Father of baby
V.
VI.
VII.
VIII.
IX.
X.
XI.
XII.
XIII.
XIV.
XV.
Obstetrical Terminology
Psychosocial and Cultural Factors
Normal Physiological Changes
A. Vital signs
B. Weight
C. Respiratory
D. Skin
E. Breast
F. Abdomen
G. Musculoskeletal
H. Cervix
Methods to Establish Estimated Date of Birth
A. Nagele’s rule
B. Fundal height
C. Ultrasound
D. Pelvic Assessment
Danger Signs
Prenatal Assessment Schedule
Nursing Process
Discomforts of Pregnancy
First trimester
A. Second trimester
B. Third trimester
C. Accompanying nursing interventions/self-care measure
Self-Care Regime
A. Fetal activity monitoring
B. Breast care
C. Other factors
D. Exercises
E. Sexual activity
Maternal Nutrition
A. Weight gain recommendation
B. Weight gain patterns
C. Nutritional requirements
D. Factors affecting nutritional intake
E. Cultural factors
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CASE STUDY
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 doesn’t know why she didn’t 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 doe
s
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
OBJECTIVES
At the end of this class the student will be able to:
1. Identify indications for fetal diagnostic testing
2. Discuss the purpose, procedure, advantages, and potential risks for each specific
fetal diagnostic procedure.
3. Discuss the nurse’s role in patient education regarding fetal assessment testing.
OUTLINE
I.
The High Risk Pregnancy
A. Indications for fetal diagnostic testing
B. Nursing interventions
II.
Fetal diagnostic tests
A. Biophysical Assessment
a. Daily fetal movement count /fetal activity
b. Ultrasound
1. indicators
2. data
III.
Doppler Blood Flow Studies
A. Umbilical artery velocity waveforms
B. Examples
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IV.
V.
VI.
VII.
VIII.
IX.
Non stress test
A. Reactive nonstress
B. Non reactive nonstress
C. Management scheme
Biophysical Profile
A. Fetal breathing movements
B. Fetal movements of body or limb
C. Fetal tone
D. Amniotic fluid volume
E. Reactive FHR
F. Scoring
G. Criteria
Contraction Stress Test
Amniocentesis
A. Procedure
B. Indications
C. Nursing Implications
Amniotic Fluid Analysis
A. Triple test
B. L/S Ratio/P6
C. Analysis
D. Quadruple test
Chorionic Villus sampling
CASE STUDY
Prepare a care plan for a patient at 32 weeks’ gestation, G3, P2, who is scheduled for an ultrasound.
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IV. UNCOMPLICATED LABOR AND DELIVERY
OBJECTIVES
At the completion of this class, the student will be able to:
1. Identify the critical factors affecting the labor process.
2. Describe the physiological effects of labor on the woman and fetus.
3. Describe how each mechanism of labor to the birth process.
4. Identify the premonitory signs of labor.
5. Compare and contrast true and false labor.
6. Compared and contrast the labors of nulliparous and multiparous women.
7. List and describe the phases and stages of labor
8. Apply the nursing process to the care of the laboring woman from admission to the postpartum
period.
9. List advantages and limitations of various methods of fetal monitoring.
10. Begin to apply interpretation of electronic fetal monitoring to the care plan.
11. Identify appropriate nursing interventions and rationales for various fetal heart patterns.
12. Apply the nursing process to care for a laboring woman with electronic fetal heart rate
monitoring.
OUTLINE
I. Physiological effects of the birth process
A. Maternal response
B. Fetal response
II. Essential Components of the Birth Process
A. Passageway
B. Passenger
C. Powers
D. Placenta
E. Psyche
F. Position (maternal)
III. Labor Physiology
A. Labor Onset Theories
B. Mechanism of Labor
C. Prodromal Labor Signs
D. True vs. False Labor
E. Effacement, Dilatation, Station
F. Stages and Phases of Labor
G. Labor Duration
H. Maternal Physiological Response
1. High risk screening
2. Physical assessment
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3. Cultural assessment
4. Psychosocial assessment
5. Labor assessment
IV.
V.
VI.
Plan of Care
A. Assessment-Data Collection
B. Nursing Diagnosis
C. Interventions – Priority Setting
D. Evaluation
Electronic Fetal Monitoring – see skills lab
Related Pharmacology
CRITICAL THINKING EXERCISE FOR LABOR AND DELIVERY
1. Describe the data you would need to collect with a patient who has called in to
the unit stating that her “membranes have ruptured.” List any tests or
procedures that you would want to perform.
2. The father of the baby in #1 scenario arrives with the patient, who is experiencing
experiencing an early labor pattern. He appears uncomfortable and in the way.
Explain how you can incorporate him into the plan of care.
3. Another patient calls into the LDR unit because she believes that she is in labor.
She states, “My contractions started three hours ago and they are about 10 minutes
apart. Should I come to the hospital?” Her due date is this week. What other
information would you need in order to advise the patient?
4. Based upon the information you obtain, you ask the patient in #3 to come to the
hospital. What other information can you now obtain to further confirm that she is
in labor?
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