PRELIM NOTES COM APP 1

MATERNAL AND CHILD NURSING

APPLICATION REVIEW GUIDE
BY: MS ALVIOR

A. FEMAL EXTERNAL ORGAN

(External Genitalia – are collectively called the “VULVA”)
1. Mons Veneres – to protect the symphysis
2. Labia majora – covers and protect the labia minira
3. Clitoris –small erective tissue
4. Hymen – thin membrane at the opening of the vagina
5. Urinary meatus – opening of the urethra
6. Bartholin glands – this produce alkaline to enhance sperm motility and viability
7. Vestibule – between the labia minora into which the urinary meatus (urethral opening) and vaginal
opening opens
8. Perineum:
a) Female – located between the anus and vulva
b) Male – located between the anus and Scrotum

B. FEMAL INTERNAL ORGANS OF REPRODUCTION

(These are located in the PELVIC CAVITY)
1. Uterus – most popular organ
o A muscular organ that houses the fetus during gestation.
o It is also the….
2. Fallopian tube – known as “Oviduct”
o It provides suitable environment for fertilization where fertilization takes place
o It is a passageway of OVU before reaches the uterus
o The fertilize ovum stays here for 3 days to develop with in the tube in preparation for normal
implantation to the top portion of uterus
3. Ovaries – it produces “OVUM” and “HORMONES” (estrogen and progesterone)
o There is a 2 oval shape
o Counter part of the male testes
4. Vagina – passageway for menstrual blood and vaginal deliveries (fetus) and considered as organ of
copulation (coitus)
5. Breast – it produces prolactin
a) Prolactin – a hormone that stimulate to produce milk from posterior pituitary gland
• Other name – “Lactogenic Hormone”
b) Oxytocin – will stimulate milk ejection
• Only hormone stimulate during pregnancy and child birth (other areas of life, this
hormone is not produce)
• “let down reflex”
• During labor, it increase the force of uterine contraction
• Once the mother is breast feeding and complain nga sakit iya pus-on, it is a normal
finding because oxytocin cause uterine contraction
• It decreases the chance of uterine atony
NOTES!
• Lower Uterine Segment (isthmus) – thinnest part of the uterus
• Cervix – portion of the uterus that stretches during vaginal birth
• Ampulla – longest portion of fallopian tube
• Distal third of oviduct – part of fallopian tube where fertilization mostly occurs
• Myometrium – largest portion of uterus
 PRELIM NOTES COM APP 1
MATERNAL AND CHILD NURSING
APPLICATION REVIEW GUIDE
BY: MS ALVIOR

• Fundus – upper triangular portion of uterus

FOUR (4) Parts of Uterus

1. Fundus (upper rounded segment)

• Fetal growth is measured via fundal height
• Fundal height:
✓ 20 weeks – level of the umbilicus (can fundus be palpated)
✓ 36-37 weeks – level of the xiphoid process
• Lightening - caused by the pressure and position of the baby as they descend into the birth
canal to get ready for delivery
✓ There is an increase frequent urination because the fetus causes pressure to the
bladder
✓ It ease breathing because there is no pressure in the diaphragm anymore
• Remember, before lightening – the fundal height is in the xiphoid process and causes
difficulty in breathing because of the pressure
• Immediately after delivery – you can palpate the fundus midway between the umbilicus
and symphysis pubis
• After 1-2 hours post-partum – the fundus can be palpated at the level of umbilicus
(midline)
NOTES!
• If the uterus when palpated is hard – means uterus is contracting
• If the uterus when palpated is soft and boggy – means uterine atony or the uterus is not contracting
and can cause postpartum hemorrhage
• Fundal height is 1 finger breath/1 cm per day below the umbilicus (post partum)
• When palpated: the fundus is hard but not in the midline and is in the above the umbilicus and
deviated in the side
• Hard deviated to the side, below the fundus – means that he bladder is distended. Assess the
woman to urinate
• Boggy fundus – management: massage the fundus
• Fetal height is measured by the funday height and correspond to the # of weeks of gestation
o Weeks of gestation correspond to the height of fundus

2. Body of Uterus “Corpus”

- Main portion of uterus. Located between the cervix and fundus

3. Isthmus
- Lay man’s term “neck”
- Lower uterine segment
- Portion that is cut during CS because this will decrease the chance of bleeding and post-
partum hemorrhage
4. Cervix
- Compose of 3 parts: internal OS, cervical canal, external OS
- The progression of labor is measured by cervical dilation

NOTES!
• Dilation vs Dilatation:
 PRELIM NOTES COM APP 1
MATERNAL AND CHILD NURSING
APPLICATION REVIEW GUIDE
BY: MS ALVIOR

o Dilation – passive progression

o Dilatation – active progression
These two can be used interchangeably

THREE (3) Layers of uterus

• Perimetrium – external
• Myometrium – middle layer
• Endometrium – internal

C. REPRODUCTIVE HORMONES
1. Follicle stimulating hormone – secreted during the first half of cycle.
o This stimulate the gravian follicle
o Anterior pituitary gland
2. Interstitial cell- stimulating hormone, luteinizing hormone (ICSH/LH) – by anterior pituitary gland
3. Estrogen – stimulates endometrial thickening
o Maintains endometrium during pregnancy
Secrete by ovary and placenta(during pregnancy)
4. Progesterone – maintains uterine lining for implantation, maintains pregnancy, relaxes the smooth
muscle
o Produced by corpus luteum
5. Prostaglandin – stimulates pain receptor and stimulate uterine contraction and can lead to
ABORTION (e.g. Cytotec)

NOTES!
• HCG - Human chorionic gonadotropin is a hormone that confirms pregnancy. It is the hormone
that Pregnancy test are trying to detect
• Anterior pituitary gland – adenohypophysis
• Posterior pituitary – known as neurohypophysis. It releases oxytocin

NOTES!
4 SHAPES OF PELVIS
1. GYNECOID – normal female pelvis
▪ 50% women have this
2. ANDROID – normal male pelvis
▪ 20% of women have this
3. ANTHROPOID – egg like pelvis
▪ This is easy delivery
▪ 25% of women have this
4. PLATYPELOID – flat pelvis (female)
▪ Labor progress is poor
▪ 5% of women have this

UNDERSTANDING MENSTRUAL CYCLE

• Days 1 to 5 are the menstrual phase of the cycle.

 PRELIM NOTES COM APP 1
MATERNAL AND CHILD NURSING
APPLICATION REVIEW GUIDE
BY: MS ALVIOR

• Days 5 to 13 are the follicular phase. Under the influence of the follicle stimulating hormone A from
the anterior pituitary gland, the ovum is stimulated to mature.
• The maturing ovum produces estrogen, which slows down the production of FSH and stimulates the
anterior pituitary to produce luteinizing hormone
• On day 12 (approximately), Luteinizing Hormone surges; this lasts for 48 hours.
• On day 14, ovulation occurs.
• Some women can feel ovulation; this is called Mittelschmerz
• The corpus luteum, which is left behind in the ovary, now produces estrogen and progesterone, and
the Progesterone raises the body temperature 0.5 F. (if the woman is using the BBT, increase of the
temperature of 0.5 F means that the woman is ovulating because of progesterone
• On days 14 to 28, estrogen and progesterone levels rise, suppressing LH and preparing the
endometrium for implantation of the ovum.
• If implantation does not take place, the endometrial lining breaks down by day 28, the woman's
menstrual period begins, and that starts the cycle all over again.

NOTES!
• Progesterone – decrease smooth muscle
▪ Is a hormone that maintains pregnancy
▪ Constipation during pregnancy is normal because progesterone decreases the function
of smooth muscle
✓ Intervention: Increase fiber diet, increase roughage (fiber) diet, Increase
residue (fiber)diet, increase fluid

D. METHOD OF CONTRACEPTION
1. Matching: Match the BC method to the mechanism by which it works (some may fit in more than
one category).
A. Condom B. NuvaRing C. Tubal ligation D. Silicone tubal occlusion procedure (plug)
E. Estrogen pills F. Estrogen and progesterone pills G. Copper intrauterine contraception
H. Minerva intrauterine contraception I. Male vasectomy J. Implanon K.Birth control patch
L. Diaphragm M. Cervical cap N. Depo-Provera

Types of contraception
• Mechanical : A G H L M
• Hormonal: B , E , F , J , K , N
• Surgical: C,D,I

TYPES OF CONTRACEPTION:
a) Mechanical – provides barrier between the sperm and the egg
o Example: condom, copper intrauterine contraception, Minerva intrauterine contraception,
diaphragm, cervical cap
b) Hormonal – suppress the secretion of gonadotropin (FSH and LH)
o Example: Nuvaring, estrogen pills, estrogen and progesterone pills, birth control patch,
Implanon, depo-provera
c) Surgical – undergo surgery
o Example: tubal ligation, Silicone tubal occlusion procedure (plug), Male vasectomy
NOTES!
 PRELIM NOTES COM APP 1
MATERNAL AND CHILD NURSING
APPLICATION REVIEW GUIDE
BY: MS ALVIOR

• NuvaRing – is inserted to the vagina for 21 days and during the 7 days ring free (day 22-28),
menstruation occurs
• Copper intrauterine contraception – lasts for 10 years. Copper is toxic to sperms
• Minerva intrauterine contraception – lasts for 5 years
• OCP – Oral contraceptive pills
o It is a potent vasoconstriction
o Estrogen and progesterone
o Contraindicated to those who have hx of hypertension, bleeding, etc.
o OCP is a risk factor for stroke. Which is why we have to assess the patient for OCP use
• IUD/ intrauterine device – is contraindicated to women who have a multiple coitus partner
o Contraindicated with bleeding problems
o It is a foreign body that is inserted to the person’s body
• If the client is diabetic (pregnant) in the presence of infection, blood glucose increases because of
body’s hypermetabolic state
• The more dehydrated the person, the more increase the blood glucose level is

NOTES: MEDICAL TERMS

• Headache – medical term “cephalgia”
• Sensation - medical term “esthesia”
• High blood pressure - medical term “hypertension”
• Normal blood pressure - medical term “normotension”
• Normal breathing – medical term”eupnea”
• Fever - medical term “pyrexia”

Sample questions
1. Which BC or Birth control method is most effective against sexually transmitted infections (STIs)?
• Condom
2. Which BC or Birth control method may be ineffective if the patient is using the antibiotic rifampin?
• Estrogen-progesterone pills (because the antibiotic will decrease the effect of oral
contraceptive. If this happen, the women need to find a back-up method or abstain)
3. Which BC or Birth control method is left in place for 10 years?
• Copper intrauterine contraception
4. Which BC or Birth control method is left in place for 5 years?
• Minerva intrauterine contraception
5. Which BC or Birth control method may not be effective if the patient weighs over 200 pounds?
• Birth control path (because the fats impede the effect of the patch on the skin)
6. Which BC or Birth control method is placed under the skin?
• Implanon (place in the upper arm)
7. Which BC or Birth control method is given intramuscularly?
• Depo-Provera (for 3 months)

3. Select all that apply: What are the common side effects of high-dose progesterone pills:

A. Nausea B.)Vomiting C. Rash O.)Diarrhea E.)Vaginal bleeding

-Ans: all except letter c. rash

 PRELIM NOTES COM APP 1
MATERNAL AND CHILD NURSING
APPLICATION REVIEW GUIDE
BY: MS ALVIOR

NOTES!
• Alert woman to discontinue use of OCP (oral contraceptives) and report any of the following
symptoms: ACHES
o A – abdominal pain (liver/gallbladder)
o C – chest pain or shortness of breath (there is a possible clog in the heart
o H – head ache that is sudden and persistent (may indicate stroke or hypertension)
o E – eye problem (may indicate possible vascular incident/ hypertension
o S - severe leg pain (calf) ( may indicate possible thromboembolic process (DVT)
• Signs of potential prob;ems related to IUD use: PAINS
o P - Period (menstrual). it can be late, abnormal spotting/ bleeding
o A- abdominal pain/pain during coitus (dyspareunia)
o I - infection. Abdominal vaginal discharge
o N - not feeling well. Fever/chill
o S - String missing

E. CONCEPTION:
1. Egg – life span: 24 hours after ovulation
2. Sperm - life span: 72 hours after ejaculation into the female reproductive tract
3. Conception / fertilization - occurs 12-24 hours after ovulation with in the Fallopian tube
4. Implantation (nidation) - occurs with in 7-9 days of conception
- if the woman is in 28 day cycle - implantation occurs 21-23 days of cycle
5. Ovum - period of conception until the primary villi appear
- Usually 12-14 days
6. Embryo – period from end of ovum stage
- The ovum becomes embryo
- Reaches 3cm length in 54-56 days
7. Fetus – the embryo becomes fetus until it comes out from the mother’s womb
- A period from end of embryo unto birth

NOTES!
• During pregnancy:
o The erythrocyte increases by 30%
o Plasma increases by 50%
o Hemoglobin drops 10.5 below (physiologic anemia)
o There is hemodilution – since plasma exceeds the RBC solution
o Body is in state of hypometabolism
o Heart – experience most change. Even if the patient is at rest, its pulse rate is still increases
o Respiratory rate also increases

CHANGES IN FETUS:
1. FIRST TRIMESTER (0-3 MONTHS)
• Period of organogenesis
• Organogenesis – is a period of organ formation. It is also the time of highest risk of teratogen
(fetogenic)
• Heart function – 3 weeks
• Eye formation – 4-5 weeks
 PRELIM NOTES COM APP 1
MATERNAL AND CHILD NURSING
APPLICATION REVIEW GUIDE
BY: MS ALVIOR

• Arm and leg buds – 4-5 weeks

• Recognizable face – 8 weeks
• External genetalia – 8 weeks
• Placenta form – 12 weeks
• Bone ossification – 12 weeks (natural process of bone formation

2. SECOND TRIMESTER (4-6 MONTHS)

• Less danger than 1st trimester
• Face formation – 16 weeks
• Fetal heart beat – 18-20 weeks/ after the 16th week (fetoscope). Using doppler
• Quickening – depends if the client is primi/multi gravida.
o It can be felt after 16 weeks
• Vernix – present
• Length – 10 inches
• Weight – 8-10 ounces (1oz = 30ml)

3. THIRD TRIMESTER
• Iron – fetus stored this on 3rd trimester
• Baby is not given iron supplement for the 1 st 3 months of life. On the 4th month, it is the time that
the baby is given iron supplement
• Iron should not be taken with milk because milk decreases the absorption of iron
• Surfactant production – begins to increase
o If premature (37 weeks below)– 1st problem is respiratory distress syndrome because
surfactant production is not enough
o If mom is in premature contracture, mom is given steroid (Betamethoxol
/dexamethoxol) this will hasten fetal lung maturity
• Calcium is stored (28-32 weeks)
• Reflexes (28-32 weeks).
o Moro reflex – is the most important reflex
• Subcutaneous fat deposit (36 weeks)
o If baby is born less than 36 weeks, the baby’s skin is like a transparent because of
lack of subcutaneous fat
• Lanugo shedding (38-40 weeks)
o The more the lanugo, the more pre-term the baby is
o If the baby is overstaying, the lanugo is much lesser and the skin is dry

NOTES!
• Best position during delivery – left side-lying position

F. SIGNS of PREGNANCY
• Presumptive Signs of Pregancy
1. Fatigue (12 weeks) 2. Breast tenderness (3-4 weeks)
3. Nausea and vomiting (4-14 weeks) 4. amenorrhea (4 weeks)
5. Urinary frequency (6-12 weeks) 6. Hyperpigmentation (16 weeks)
7. Quickening (16-20 weeks) 8. Uterine enlargement (7-12 weeks)
9. Breast enlargement (6 weeks) 10.
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MATERNAL AND CHILD NURSING
APPLICATION REVIEW GUIDE
BY: MS ALVIOR

• PROBABLE SIGNS OF PREGNANCY:

1. Braxton-hicks contractions (16-28 weeks) 2. Positive pregnancy test (4-12 weeks)
3. Abdominal enlargement (14 weeks) 4. Ballottement (16-28 weeks)
5. Goodell’s sign (5 weeks) 6. Chadwick’s sign (6-8 weeks)
7. Hegar’s sign (6-12 weeks) 8.

• POSITIVE SIGNS OF PREGNANCY (3)

1. Ultrasound Verification of embryo of fetus
2. Auscultation of fetal heart tones via doppler (because doppler uses high frequesncy sound waves
to detect fetal heart tones
3. Fetal movement felt by the experienced physician

G. Matching
Match the symptom or finding its etiology:
• Ballottement – reflex of the fetus moving away from the examiner’s finger
• Goodell’s sign – softening of the cervix
• Quickening – maternal perception of the baby’s movement
• Hegar’s sign – softening of the lower uterine segment
• Braxton-hicks contractions – false labor contractions
o Characterized by irregular, painless intermittent contraction
• Chadwick’s sign – increased vascularity and blueness of the cervix

H. SELECT ALL THAT APPLY

At first prenatal visit, several assessment are completed and a care plan is begun. Select all the
components of the first prenatal visit that you would expect.

Answer (Right) Wrong

a. Blood drawn for type and Rh – this is used to
determine the blood of the mother if it is Rh+ or
Rh-
• if mom is Rh-, she is given rhogam
• if Rh- mom gave birth to Rh+ baby, she is
given rhogam after birth to avoid
erythroblastosis fetalis for her future child
• if Rh- mother gave birth to Rh- child, no
rhogam is needed
b. Complete physical
c. Baseline vital signs
d. Hemoglobin and hematocrit
e. Weight check
f. Rubella Titer – to determine if the mother
needed this
• if the mother is given this vaccine,
she should not get pregnant for 3
months
g. Teaching about child (it is too early for the
first prenatal visit of the mother)
h. Quad screen (because it is done during
second prenatal visit)
• Quad screen component:
• AFP- alphafetoprotein – is a protein that
is made by the developing baby
• HCG – hormone made by the placenta
• Estriol – made by placenta and baby
liver
• Inhibin A – hormones made by placenta
i. Glucose tolerance test (because it is done
during second prenatal visit)
• this should be checked at 28 weeks
• GDM mom should not be given oral
hypoglycemic agent/anti-diabetic agent
• If DM type 2 patient got pregnant –
patient should not be given OHA
because it crosses placental barrier,
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MATERNAL AND CHILD NURSING
APPLICATION REVIEW GUIDE
BY: MS ALVIOR

- congenital rubella syndrome – is a instead give insulin because it does not

condition if the mother get pregnant cause the placental barrier
within 3 months after given a shot • If breastfeeding – the insulin requirement
j. Teaching about nutrition should decrease because breast feeding
k. Antibody titer - make sure that mom has no cause blood glucose level / anti-diabetic
blood exposure to antigen effect
l. medical and social history m. amniocentesis
o. Ultrasound for fetal heart tones n. nonstress test (NST) (because it is done
p. VDRL (veneral Disease Research Laboratory during second prenatal visit)
test) or RPR (Rapid plasma regain) test t. teaching about postpartum care
• syphilis – during the 1st 3 months,the
lunghans layer protects tah fetus
• causative agent: treponema pallidum
• in 4th months, the disease can be
transmitted to the fetus
q. urinalysis
r. teaching about organogenesis
s. teaching about danger signs

I. SIGNS TO BE REPORTED IMMEDIATELY

1. Persistent Vomiting beyond the 1st trimester.
• Possible cause: hypoemisis gravidum

2. Fluid discharge from vagina except leucorrhea

• Either it is bleeding or amniotic fluid
• Lochorrhea discharges – whitish, thin colorless and begins isn 1 st trimester (normal all throughout
pregnancy
• Amniotic fluid – clear without odor. This is needs to be reported
o Confirmed by :fern test
3. Severe/unusual pain – especially in Abdomen
• May indicate abroptio placenta – there is a severe pain. Associated with cocaine use
• Placenta previa – painless

4. Chills and Fever – if occurs more than 24 hours, it may indicate infection

5. Urinary frequency – burning in urination

• UTI is considered as a sexually transmitted
• Intervention: use 100% cotton under wear
6. Absence of fetal movement after quickening (more than 24 hours)
• Indicate: intrauterine death (fetal demise)
• Factor: 27910 activated during pregnancy
• Fetal demise – woman is increased risk for DIC or deciminated intravascular coagulation (bleeding

7. Visual disturbances – blurring, double vision/ spots over sites

• Cause: pre-eclampsia

8. Swelling of fingers, ankles

• Normal: occur at end of the day
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MATERNAL AND CHILD NURSING
APPLICATION REVIEW GUIDE
BY: MS ALVIOR

• Abnormal: occur all throughout the day

9. Severe Frequent/continual headache – may indicate pre-eclampsia

10. Muscle irritability and convulsion – indicate pre-eclampsia

 PRELIM NOTES COM APP 1
MATERNAL AND CHILD NURSING
APPLICATION REVIEW GUIDE
BY: MS ALVIOR

11. Rapid weight gain not associated with eating

• Normal weight gain: 25-35 lbs (for whole pregnancy)
o 1lbs per month in 1st trimester
o 1lbs per week for 2nd and 3rd trimester
• Rapid weight gain – indicate fluid retention and possible pre-eclampsia
• 3 Manifestation of PIH
o Hypertension
o Edema
o Proteinuria

12. More than 4 uterine contractions per hour before 38 weeks – indicate possible pre-term labor

NOTES!
• Respiratory Distress Syndrome causes:
o Preterm labor
o Born through CS (because the neonate does not undergo vaginal squeezing)
• Back ache management – pelvic tilt exercise (to strengthen the perineal muscles

J. COMPLICATIONS OF PREGNANCY
1. Fever (over 101 F) – indicate infection
2. Abdominal pain – placental abruption (separation of placenta before the fetus is delivered. The
likelihood of this is increased with vasoconstriction, as with maternal hypertension, smoking,
abdominal trauma, and cocaine usage
3. Sudden gush of fluid from the vagina – preterm or premature rupture of membranes
4. Muscular irritability, severe head ache, edema of hands, face, legs and feet – pregnancy
induced hypertension (PIH – elevated BP after 20 weeks; 140/90 or above, in a previously
normotensive woman – taken twice, 6 hours apart)
5. Bright, painless vaginal bleeding – placenta previa (implantation of the placenta in the lower
uterine segment, can be complete, covering all of the OS, partial, covering part of OS or marginal,
sometimes called low-lying
6. Persistent vomiting - hyperemesis grqavidum (persistent vomiting with 5% weight loss,
dehydration, ketosis and acetonuria

Additional Notes for complications of pregnancy:

• Placental Abruption – board like abdomen
o Associate with cocaine use
o Abdominal rigidity but have uterine tenderness
• Rupture of membrane
o Intervention: check the fetal heart rate because there is tendency of cord prolapse
o While assessing the perineum and there is a cord protruding in vagina, do not touch the cord
• Placenta previa – painless
o There is an increase risk of uterine atony, so monitor the contraction
• Pregnancy Induced Hypertension (PIH)
o There is a persistent headache and hypertension
o This can lead to pre-eclampsia then eclampsia (with seizure)
o If there is eclampsia – administer Magnesium sulfate
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MATERNAL AND CHILD NURSING
APPLICATION REVIEW GUIDE
BY: MS ALVIOR

o Incase of Magnesium sulfate toxicity – administer calcium gluconate (magnesium sulfate

antidote)
o Magnesium toxicity sign: Deep tendon reflex, decrease Respi, Decrease urine output
o Magnesium sulfate uses: tocolytic (inhibit premature contraction) and anticonvulsant
o If the Pre-eclampsia is getting worse – expect patient to complain severe head ache and
blurry of vision. Watch out of Bleeding
• GDM (Gestational Diabetes Mellitus) – is a condition in which a hormone made by the placenta
prevents the body from using insulin effectively
o Monitor the patient’s glucose
o Advice patient to diabetic diet
• HELLP (Hemolysis Elevated Liver Enzymes Low Platelet) – is an acronym that refers to a
syndrome in pregnant and postpartum individuals characterized by hemolysis with a
microangiopathic blood smear, elevated liver enzymes, and low platelet count
• Hydatidiform mole (H. Mole) – is a rare complication of pregnancy characterized by the abnormal
growth of trophoblasts, the cells that normally develop into the placenta
o Trophoblastic disease
o Grape-like structure
o Occur on 2nd trimester
o Management:
▪ Mole evacuation (a girl cannot get pregnant for one year
▪ Uses of OCP
o Complication:
▪ Choriocarcinoma – a fast growing cancer that occurs in a womans uterus. This can
happen if the girl gets pregnant within 1 year after her H.mole pregnancy
• Ectopic pregnancy – occurs when a fertilized egg implants and grows outside the main activity of
the uterus
o Extrauterine pregnancy – there is a slight abdominal and sudden lower abdominal pain (1
sided)
o During this pregnancy, once the fallopian tube cannot accommodate the size of the embryo,
it will rupture without bleeding because it is in the fallopian

K. CLASSIFICATION OF SEVERITY OF CARDIAC INVOLVEMENT

1. CLASS I – least effective. Asymptomatic (can go on with ordinary activity)
2. CLASS II – activity are somewhat limited (ordinary activity can cause fatigue, dyspnea, angina)
3. CLASS III – moderate mark limitation of activity (ordinary activity causes severe fatigue)
4. CLASS IV – most affected. Even at rest, patient has chest pain, dyspnea and severe fatigue
- In this case, you have to avoid pregnancy

NOTES!
CARDIAC DECOMPENSATION:
• Subjective symptoms – spoken, subjective, covert data (SSC)
o Palpitation
o Increase fatigue/ difficulty of breathing
o Feeling of smothering (feeling of suffocation)
o Frequent cough/gag
o Peri-orbital edema (e.g. wedding ring cannot be removed because fingers are too swollen)
• Objective signs – Objective, observed, Overt (OOO)
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o Irregular, weak, rapid pulse (>110)

o Rapid respi (>25)
o Progressive edema
o Crackles (rails)
o Orthopnea (difficulty of breathing when lying down)
o Cyanosis on lips and nail bed

L. A mother’s perception of feeling the baby move for the first time is called “Quickening”

NOTES!
• If it is SEROSA and sudden changed to RUBRA – advice rest
• Subinvolution – when the uterus didn’t go back to normal
• AFP – is a principle screening detection to determine NTD (neural tube defects) and down
syndrome
• In GTPAL – G (gravida), T (term), P (pre-term), A (abortion), L (living)
• If placing the patient is the stirrup, it should only be done within 90 minutes and remember to place
both feet at the same time.

M. Matching
1. Nulligravida – a woman who has yet to conceive
2. Lochia – maternal discharge of blood mucus and tissue from the uterus, which will last for several
weeks after delivery.
3. Multipara – a woman who has had two or more pregnancies in which the fetus reached a viable
age, regardless of whether the infant was born dead or alive
4. Lactation – a process of producing and supplying milk
5. Intrapartum – the time form the onset of true labor until delivery of the infant and placenta
6. Neonatal – infant from birth through the first 28 days of life
7. Gravida – refers to the number of times that a woman has been pregnant regardless of the
outcome
8. Postpartum – the period following the child birth or delivery
9. Para – refers to past pregnancies that have lasted through the 20 weeks or gestation regardless of
whether the infant was bord dead or alive
10. Primipara – a woman who has delivered one viable infant
11. Nullipara – a woman who has yet to deliver a viable infant
12. After birth – placenta and membranes expelled during the third stage of labor, after delivery of the
infant
13. Multigravida – a woman who has been pregnant two or more pregnancies
14. Colostrum – secretions from the breast before the onset of true lactation. It contains serum and
white blood corpuscles, is high in proteins and contains immunoglobulin
15. Puerperium – another name for the post partum period
16. Primigravida – a woman who is pregnant for the first time
17. Involution – contracting of the uterus after delivery
18. Antepartum – time period between conception and the onset of labor

*EXERCISES: figure out the gravida and para status

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MATERNAL AND CHILD NURSING
APPLICATION REVIEW GUIDE
BY: MS ALVIOR

1. Client is pregnant for 7th time. She has a 13 year old daughter who has delivered at 34 weeks gestational
age and it’s doing well. she had a set of twins at 38 weeks GA who are you now 10 years old. She has a 10
years old and five years old who were term babies. she has a miscarriage and then a preterm baby three
years ago who has mild cerebral palsy what is the client GTPAL.

2. A woman who is pregnant for the first time and is currently undelivered is………..after giving birth to a
full term neonate she became….
N. fill in the blanks
1. A low AFP may indicate what group of congenital anomalies – Trisomy 21(Down syndrome)
2. A high AFP One group of congenital anomalies- neural tube defect

O. MATCHING. NATCH THE NAME OF THE TEST TO THE PROCEDURE

• Doppler study – It’s done by ultrasound to visualized the velocity of blood flow and measure the
number of red blood cells or RBC. it can start at 16 to 18 weeks and continue serially if There is an
indication that the fetus is anemic
• Percutaneous umbilical cord sampling (PUBS) – Done after 16 weeks to sample fetal blood of
which 1 to 4 ml is collected near the cord insertion look for hemolytic disease of the newborn. This
is guided by ultrasound.
• Amniocentesis – Amniotic fluid is remove to test cells or genetic makeup. It is done at 16 to 18
weeks under ultrasoud.

P. SELECT ALL THAT APPLY: Nursing geared for a second trimester trans abdominal ultrasound
include the following interventions
a) patient must have a full bladder
b) patients lacked must be placed in stirrups
c) patient should be tilted to the left side
d) A Gel conducer is applied

Q. MATCHING: Match the correct description the uterine contractions the correct definition

• Interval- Time in seconds in between contractions

• Intensity – the firmness of the uterus each can be demonstrated in three ways. First, by external
fetal monitor it rises and falls with contractions but is not Exact pressure because of different
abdominal thickness. By an internal uterine pressure catheter, which is inserted through the vagina
into a pocket of fluid after range of motion. By palpation, miles is the consistency of the tip of your
nose, moderate is the consistency of your chin, strong is the consistency of your forehead.
• Frequency- From the on set of one contraction to the onset of the next contraction

R. matching. Match the term to the definition

1. Threatened abortion. Bleeding and cramping that subside and the pregnancy continues
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2. Infected abortion. a abortion in which retained tissue has caused an infection

3. Missed abortion. An abortion in which the fetus died in the utero but the products of conception are
retained for eight weeks or longer
4. incomplete abortion. on abortion in which they some of the product of conception are retained
5. Abortion. Termination of pregnancy before 20 to 24 weeks of gestation
6. Induced abortion. Intentional termination of pregnancy by means of dilating the cervix and
evacuating the contents of the uterus
7. Complete abortion. In which the total product of conception are expelled
8. Habitual aborter – a woman who had three or more consecutive abortion
9. Partial birth abortion. second Or third trimester abortion
10. Therapeutic abortion- Performed then the pregnancy endanger the mother or the fetus condition
that is incapable with life
11. Inevitable abortion. an abortion that cannot be stopped
12. Spontaneous abortion. Loss of a pregnancy that has not been intentionally interfered with before
the fetus become viable. symptoms are cramping and bleeding. most often caused by genetic
disorder of the embryo,, hormonal imbalances, infections, and abnormalities of placenta
S. presentation. Set the part entering inlet first
1. Cephalic – the baby is positioned head down, facing the mother’s back
2. Breech – when the baby’s buttocks or feet or both are in place to come out first during birth.

• 3 TYPES OF BREECH:
o Complete – feet and buttocks are presenting
o Frank – buttocks is presenting
o Footling- single or double foot are presenting

T. LEOPARD’S MANEUVER – abdominal palpation

• In 1,2,3rd maneuver – the nurse is facing the head of the patient

• In 4th maneuver – the nurse is facing the foot of the patient
• 4 maneuver:
o 1st maneuver – locating the part of the fetus that is presenting into the pelvis
o 2nd maneuver – locating the fetal back and small parts (hands, feet, etc.). in here, you are
also locating the heart rate
o 3rd maneuver – determine the part of fetus in the fundus
o 4th maneuver – determine the degree of flexion and engagement

U. LOCATION OF FETAL HEART TONES

• In breech – above the umbilicus

• In vertex (cephalic) – below the umbilicus

V. STAGES OF LABOR:4 STAGES

True Labor - happens when there is increased contraction and there is cervical dilation
I. FIRST STAGE OF LABOR – CERVICAL STAGE

• Determine cervical dilation

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• Chorioamnionitis – infection cause by prolong rupture of membrane

3 PHASES in the First Stage:
1) LATENT PHASE (0-3cm)
o Contractions are mild and intermittent
o This is the best time to teach the mother about “breathing technique” because they are still
receptive to learning
o The patient’s breathing should be slow, deep chest breathing
o The patient are still in the “minus station” (station -1, -2, -3, etc.)
2) ACTIVE PHASE (4-7 cm)
o Contraction accelerates
o Cervix dilate to 3-7 cm
o Is already in station 0 to +1
o There is a patterned breathing
o Pain medication is given
NOTES!

• 3 Types of Deceleration
a. EARLY – it is normal, expected, may indicate head compression
b. Variable deceleration – indicate cord compression. Occur in breech/ after rupture
c. Late deceleration – considered as an EMERGENCY
o Indicate “Uteroplacental insufficiency” where in the fetus will have absence of oxygen
o There is decreased blood flow from uterus to placenta
o Intervention: Administer O2
• When giving epidural anesthesia – you have to monitor the BP because of possible hypotension
o Upon giving this medication and the patient complain of “lightheadedness” – turn the patient
to left side lying and elevate the feet

3) TRANSITION PHASE
o There is an intense contraction
o Patient is IRRITABLE
o In this stage, do not give medication because it can affect the fetus (fetal distress)
o Management: help woman to establish control
NOTES!

• PANTING – is what the nurses advised to the mother who are not yet 10cm (indi sila pag pa bun-a ha
danay) to avoid fatigue to the mother and swelling of the cervix

II. 2nd (SECOND) STAGE OF LABOR - EXPULSION

• Cervix is completely dilated

• Mom has the strong urge to push (Furguson Reflex)
• Ritgen maneuver – when the delivery of the head is done
• When the head is already out, instruct the mother not to push
Sample question
1. What is their propriate nursing care for the active stage of Labor
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a. catheter or void every four hours (Full bladder will impede the descent of fetal head. The mother should
void every two hours)
b. change blue pads every 30 minutes.(This prevents ascending infection. it is considered as the safest
option)
C. Allow the patient to order a regular full lunch. (The letter C is not an answer because NPO in case of
emergency surgery)
D. turn lights on so she is alert. (The is not correct because in order to promote bonding light should be
dim.

Mechanism of labor and delivery

• Engagement – the biparietal diameter passes the pelvic inlet (less chance of CPD or Cephalopelvic
Disproportion). The head enters the pelvis
• Descent
• Flexion
• Internal rotation
• Extension
• External rotation
• Expulsion

5 P’s of Labor
a) Passages – hard and soft passages
- Hard passages – bony pelvis
- Soft passages – lower uterine segment (cervix, vagina, pelvic floor and perineum)
b) Power – Primary and 2nd power
- Primary – involuntary uterine contraction
- 2nd power – voluntary use of thoracic, diaphragm and abdominal muscles (used when mother’s
bears down). Effectively use on 2 nd stage of labor (push stage)
c) Passenger – fetus
d) Person – mother
e) Position – refers to maternal position during delivery

NOTES!

• Fetal Lie – relationship of long axis of fetus to the long axis of mother (spine)
• Transverse lie – shoulder resends
• Longitudinal lie – vertex/breech present
• Kick count – mom seated and concentrating or lying quietly
o 2 hours = 6-10 kicks

WARNING SIGNS OF LABOR

1. contraction - contractions exceeding more than two minutes in duration.
- Hypertonic or tetanic contractions
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- There is poor relaxation

2. abdominal pain – described as sharp, rigid and boards like abdomen
3. vaginal bleeding – profuse

• Normal vaginal delivery – less than 500ml of blood

• Normal CS delivery – less than 1000 ml of blood
• Check the hematocrit and hemoglobin
4. FHR – normal: 120-160 bpm
- Late deceleration means – fetal distress
5. maternal hypertension - eclampsia
6. meconium stained amniotic fluid – fetal distress
- Intervention: administer O2 8-IOL via face mask
7. PROM (Premature Rupture of Membrane)
- Check fetal heart rate
- Normal Amniotic fluid: clear with white specks
- Amniotic fluid color indication:
o Yellow – bilirubin
o Clear white specks – normal
o Green – meconium and fetal distress
- Amniotic fluid allows fetal movement, it also surrounds, protect and maintains body temperature and
measure kidney function of the fetus.
NOTES!

• Episiotomy- incision of perineum to facilitate infants birth

o Done in second stage of labor
o REEDA – Redness, Edema, Ecchymosis, Discharge, Approximation
o Approximation (check if suture is intact, close or separated)
• Nitrazine paper – if it turns blue, it mean positive amniotic fluid

III. Third stage – placental stage

• From birth to expulsion of placenta

• Lasts for 5-20 minutes after delivery
• 4 signs of placental separation
a. uterus contract
b. uterus changes from discoid to globular in shape
c. a slight gush of blood
d. upward displacement of uterus and lengthening of the cord
NOTES!

• Placenta shiny – Schultz (fetal side)

• Dirty Placenta – Duncan (Mother side)
• AVA – 2 arteries, 1 vein. If lacking, it may indicate congenital anomalies
• Expulsion of placenta – 1 to 4 hours after delivery. Immediate post-partum
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• Fetal lung maturity - betamethazone

4. Stage 4 – Recovery
NOTES!

• Ordering: The client’s fundus is boggy at 2 hours postpartum. Order the intervention steps the
nurse should take:
1. Massage the uterus
2. Empty the bladder
3. Reassess
4. call for help if needed

W. application:
--Anna, who is a Class 2 cardiac patient is in active labor. She had rheumatic heart disease When
she was young and has had a valve replacement. her pregnancy has gone well exact she was
placed on modified bed rest her third trimester to decrease the stress on her heart muscle.
1. Select all that apply. The nurse should be aware of all the following signs of cardiac decompensation:
.A. cough
b. Dyspnea
C. Edema
D. Heart murmur
E. Palpation
F. Weight loss – it should be weight gain
G. Rales- because of fluid accumulation

2. What kind of delivery would you most expect for Anna in order to conserve cardiac output and
maintain more even thoracic pressure?
A. CeCesarean
B. Natural Vaginal birth
C. Low forceps delivery
D. Mild forceps delivery
3. The first action that the registered nurse should do in case of umbilical cord prolapse is to:
A. Check the FH
B. Raise the patient’s hips – it keeps the presenting part from compressing the cord
C. Call the HCP
D. Explain to the patient that the baby will probably be born dead
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X. Complications of labor and delivery

• Fetal distress- Prepare emergency cesarean section, turn left side lying, NPO preparation for CS,
oxygen
• Vena cava syndrome (Supine hypotension syndrome)
o Risk:Multiple pregnancy, obesity,, polyhydramnios, assess for shock like symptoms (hypo
tension, tachycardia, tachypnea) Narrow pulse pressure between 30 to 40
o Management: Left side lying position
• PROM (amniotic fluid)
• Preterm labor and delivery. labor that of occur prior to the end Of the 37th week of gestation
o Regular contraction with cervical dilation
o Client complain back ache and pelvic pressure not relieved by rest
o Intervention: mom is given TOCOLYTIC (e.g. Terbutaline) to inhibit premature contraction
• prolonged pregnancy. Over 42 weeks Degeneration of placenta, thus decreased blood to fetus
o Management: induce OXYTOXIN IV to stimulate uterine contraction
▪ Side effect: Hypotension
o Methergine – is given if oxytocin should not be given and if the patient is hypotensive
▪ Side effect: hypertension
• Prolapse umbilical cord- Management is oxygen by mask and emergency CS
• Amniotic fluid embolism
o 85% mortality rate
• Rupture of uterus
o Monitor tetanic contraction
o Stop oxytocin
• Dysfunctional labor (dystocia)
o Dystocia means a slow or difficult labor or birth.
o Cephalopelvic disproportion – there is an increased risk for ICP due to intracranial hemorrhage
o Management: Cesarian Section
• Precipitate delivery
o Lasting less than 3 hours
o Increased risk of uterine atony because of overstretching of uterus (esp. in multigravida)
Y. Cesarean delivery
o Is surgical delivery of an infant through an incision cut into the abdominals wall in the uterus
Z. postpartum period: puerperium
o measure fundal height
STAGES OF POST PARTUM
1.) Taking in
o the mother is focus in her own needs
o Mother is usually talk about her labor and delivery experience
o This is the best time to teach the mother about herself
2.) Taking hold (2-7 days)
o The focus of the mother is the neonate
o Teach the mom how to care the neonate
3.) Letting go
o Mom feel a sense of loss because the baby is not part of her body anymore
o Mom is independent
o Mom is in the stage to accept her part as a wife and a as a mother
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o Mom may feel upset and depressed

Z1. Postpartum complications:

• Postpartum hemorrhage
o May lead to uterine atony and placenta previa
• Puerperal infection /post delivery infection
• Deep vein thrombosis (thrombophlebitis)
o Inflammation in the lining of blood vessels
o Warn, tenderness and redness of calf
o Complication: pulmonary embolus
o Signs of pulmonary embolus: sudden sharp chest pain, increase Heart rate, cyanosis,
tachypnea
• Subinvolution
o Failure of uterus to revert or go back to normal post partum state
o Cause: retained placental fragment (can also cause bleeding)
NOTES!

• Slight increase of temperature – related to dehydration is normal

o Management: increase fluid intake

A1. Newborn care: apgar scoring

APGAR CHECK – Done during the first 5 minutes of life
• 7-10 score – good adjustment
• 4-6 score – moderately depressed (need airway clearance and supplemental O2)
• 0-3 score – severely depressed. Need resuscitation

NOTES!
o otoacoustic Screening – done after 2 day or 48 hours of life

1. SATA. The DR Nurse finishes the immediate care of the newborn. what interventions are normally
completed in the delivery room
A. Blood pressure
B. Vital signs
C. Identification bracelets and foot prints
D. Vitamin K
E. Erythromycin
F. Circumcision
G. Physical exam
H. Initiating of bottle feeding (only done if the neonate is developing hypoglycemia. The signs
and symptom is gitting movement)
2. The nurse understands that the preferred side for injection of vitamin K to the newborn is
A. The deltoid
B. The dorsal gluteal
C. The vastus lateralis
D. Dorsal ventral
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NEWBORN ASSESSMENT
Babies eyes are symmetrical and gray blue in color with some edema on the lids but no subconjunctival
hemorrhage. his face is symmetrical and his ears are assessed for replacement. A universal newborn
hearing screening (UNHS) Will be completed on him after 24 hours to rule out congenital deafness. His
nares are Patent and there are no precocious teeth. Epstein pearls or White spots are noted on his hard
palate. His rooting and sucking reflex is assessed and found out to be strong. His tongue is normal for size
and movement and his frenulum Is not short. His palate and lip are intact. His neck is short, straight and
moves freely, his skin has many folds. His clavicles are intact and no crepitus is felt. His chest measures 1
to 2cm smaller than his head and he has a protruding xiphoid, Which is normal. His respirations are
irregular, shallow and unlabored, with symmetrical chest movement. His arms are symmetrical with good
brachial pulses There are five fingers on each hand. His breast secrete small amount of whitish fluid due to
maternal hormones and he has 5 millimeter of breast tissue. His abdomen is round and protrudes slightly.
Bowel sounds are positive. His umbilical cord is clamped and kept clean to prevent infection. His abdominal
circumference should be 1 to 2 centimeter smaller than his chest. His femoral pulses are present and equal
bilaterally. His legs are straight with equal gluteal folds. Ortolani maneuver thus not produce a hip click
And his feet are straight. There are five toes on each foot. His scrotum is relatively large, denoting a possible
hydrocele. His testes are palpable in the scrotum And the urinary meatus is at the tip of the penis. In a prone
position, his spine is closed and straight, without a pilonidal dimple. His anus is visually patent, rectal
temperature is taken initially in some nurseries to ensure patency. He is reflexes are also assessed. His moro
Reflex is strong, repeated attempts to elicit it show habituation. Palmar and plantar reflex are present.
The babinski reflex is elicited when the nurse strokes from the heel to the ball of the foot.
3. Hemolysis of fetal cells increases The likelihood of what neonatal condition
a. Hypoglycemia
b. Hyperglycemia
c. Hyperbilirubinemia
d. Hypocalcemia
4. The most important nursing interventions to decrease the incidence of Hyperbilirubinemia in
the new born is to:
a. Prevent cold stress
b. offer early frequent feedings – to stimulate peristalsis and GIT excretion of
bilirubin
c. Please baby near the window of the nursery
d. Keep the baby in the nursery at night
5. Appropriate nursing interventions when caring for a newborn under phototherapy.
a. Cover the eye and Genitalia
b. Maintain a neutral thermal environment
c. provide early and frequent feedings
d. dress newborn to prevent cold stress
e. Check strength of light source with a light meter
NOTES!

• Normal: Intake and output is 6 to 8 wet diapers per day for babies
• Remember to when to wear gloves. it is when your first contact to baby, admission bath, urine
and meconium diaper change.