BOOK
Maternity Nursing - Revised Reprint - E-Book
Deitra Leonard Lowdermilk | Shannon E. Perry | Mary Catherine Cashion
(2014)
Additional Information
Book Details
Abstract
Designed to meet the needs of today’s students, Lowdermilk’s Maternity Nursing, 8th Edition — Revised Reprint addresses the fundamentals of maternity nursing with a concise, focused presentation of the care of women during the childbearing years. Integrating considerations for family, culture, and health promotion into the continuum of care, it also addresses community-based care to emphasize that nursing care takes place in many settings. Maternity Nursing focuses on childbearing issues and concerns, including care of the newborn, as well as wellness promotion and management of common women’s health problems.
- Critical thinking exercises present case studies of real-life situations and corresponding critical thinking questions to help you develop your analytical skills.
- NEW! A helpful appendix identifies text content that reflects the QSEN competencies — patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics — to assist you in developing competencies to provide safe and effective nursing care.
- NEW! Focus on the family recognizes the nurse’s need to integrate the family in the care of the mother and newborn and the importance of the role of the mother to the wellbeing of the family.
- NEW! Content updates throughout, including information on the late preterm infant and associated concerns such as feeding; guidelines on prioritization and delegation where relevant; and centering pregnancy, a new model of health care that brings women together in groups for their care.
- NEW! Evidence-based practice content focuses your attention on how to use current research to improve patient outcomes.
- NEW! Improved readability helps you learn more efficiently with shorter, more focused content discussions.
- NEW! 21st Century Maternity Nursing: Culturally Competent, Community Focused chapter combines introductory material, culture, and community into one chapter to help you focus on key content and concepts.
- NEW! Streamlined content highlights the most essential, need-to-know information.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| AD page | IFC2 | ||
| Maternity Nursing 8/e - Revised Reprint | i | ||
| Copyright page | ii | ||
| About the Authors | iii | ||
| ABOUT THE ASSOCIATE EDITOR\t | iv | ||
| Contributors | v | ||
| INSTRUCTOR AND STUDENT ANCILLARIES\t | v | ||
| Reviewers | vi | ||
| Preface | vii | ||
| Approach | vii | ||
| Features | viii | ||
| Organization | ix | ||
| TEACHING/LEARNING PACKAGE\t | x | ||
| ACKNOWLEDGMENTS\t | x | ||
| Table of Contents | xii | ||
| Introduction to Maternity Nursing | 1 | ||
| 1 21st Century Maternity Nursing: | 1 | ||
| LEARNING OBJECTIVES | 1 | ||
| KEY TERMS AND DEFINITIONS | 1 | ||
| WEB RESOURCES | 2 | ||
| CONTEMPORARY ISSUES AND TRENDS\t | 2 | ||
| Healthy People 2020 Goals | 2 | ||
| Millennium Development Goals | 4 | ||
| Integrative Health Care | 4 | ||
| Problems with the U.S. Health Care System | 4 | ||
| Structure of the health care delivery system | 4 | ||
| Reducing medical errors | 4 | ||
| High cost of health care | 5 | ||
| Limited access to care | 5 | ||
| Efforts to reduce health disparities | 5 | ||
| Trends in Fertility and Birthrate | 6 | ||
| Low Birth Weight and Preterm Birth | 6 | ||
| Infant Mortality in the United States | 6 | ||
| International Trends in Infant Mortality | 7 | ||
| Maternal Mortality Trends | 7 | ||
| Increase in High Risk Pregnancies | 7 | ||
| High-Technology Care | 7 | ||
| Care during Pregnancy and Childbirth | 7 | ||
| Safe motherhood | 7 | ||
| Childbirth practices | 8 | ||
| Involving Consumers and Promoting Self-Management | 8 | ||
| International Concerns | 8 | ||
| TRENDS IN NURSING PRACTICE\t | 9 | ||
| Evidence-Based Practice | 9 | ||
| Cochrane Pregnancy and Childbirth Database | 9 | ||
| Joanna Briggs Institute | 9 | ||
| A Global Perspective | 10 | ||
| STANDARDS OF PRACTICE AND LEGAL ISSUES IN DELIVERY OF CARE\t | 10 | ||
| Risk Management | 11 | ||
| Sentinel Events | 11 | ||
| ETHICAL ISSUES IN PERINATAL NURSING\t | 11 | ||
| RESEARCH IN PERINATAL NURSING\t | 12 | ||
| Ethical Guidelines for Nursing Research | 12 | ||
| THE FAMILY IN CULTURAL AND COMMUNITY CONTEXT\t | 12 | ||
| The Family in Society | 12 | ||
| Family Organization and Structure | 12 | ||
| FAMILY NURSING\t | 13 | ||
| Family Assessment | 13 | ||
| Family Theories | 13 | ||
| Graphic Representations of Families | 13 | ||
| CULTURAL FACTORS RELATED TO FAMILY HEALTH\t | 13 | ||
| Cultural Context of the Family | 13 | ||
| Childbearing Beliefs and Practices | 15 | ||
| Communication | 15 | ||
| Use of interpreters | 15 | ||
| Personal space | 16 | ||
| Time orientation | 17 | ||
| Family roles | 17 | ||
| Developing Cultural Competence | 17 | ||
| Integrating Cultural Competence with the Nursing Care Plan | 18 | ||
| COMMUNITY AND HOME CARE\t | 18 | ||
| COMMUNITY HEALTH PROMOTION\t | 18 | ||
| Assessing the Community | 18 | ||
| Data Collection and Sources of Community Health Data | 18 | ||
| VULNERABLE POPULATIONS IN THE COMMUNITY\t | 20 | ||
| Women | 20 | ||
| Adolescent girls | 21 | ||
| Older women | 21 | ||
| Incarcerated women | 21 | ||
| Women and the migrant work force | 21 | ||
| Homeless women | 21 | ||
| Refugees and immigrants | 21 | ||
| Individuals with low literacy | 22 | ||
| HOME CARE IN THE COMMUNITY\t | 22 | ||
| References | 23 | ||
| Unit One Reproductive Years | 25 | ||
| 2 Assessment and Health Promotion | 25 | ||
| LEARNING OBJECTIVES | 25 | ||
| KEY TERMS AND DEFINITIONS | 25 | ||
| WEB RESOURCES | 26 | ||
| FEMALE REPRODUCTIVE SYSTEM\t | 26 | ||
| External Structures | 26 | ||
| Internal Structures | 27 | ||
| Bony Pelvis | 28 | ||
| Breasts | 28 | ||
| Menstruation | 32 | ||
| Menarche and puberty | 32 | ||
| Menstrual cycle | 32 | ||
| Hypothalamic-pituitary cycle. | 33 | ||
| Ovarian cycle. | 34 | ||
| Endometrial cycle. | 34 | ||
| Other cyclic changes. | 34 | ||
| Climacteric. | 34 | ||
| Prostaglandins | 34 | ||
| Sexual Response | 35 | ||
| REASONS FOR ENTERING THE HEALTH CARE SYSTEM\t | 36 | ||
| Preconception Counseling | 36 | ||
| Pregnancy | 36 | ||
| Well-Woman Care | 36 | ||
| Fertility Control and Infertility | 36 | ||
| Menstrual Problems | 36 | ||
| Perimenopause | 36 | ||
| BARRIERS TO SEEKING HEALTH CARE\t | 37 | ||
| Financial Issues | 37 | ||
| Cultural Issues | 38 | ||
| Gender Issues | 38 | ||
| HEALTH RISKS IN THE CHILDBEARING YEARS\t | 38 | ||
| Age | 38 | ||
| Adolescence | 38 | ||
| Teenage pregnancy. | 39 | ||
| Young and middle adulthood | 39 | ||
| Parenthood after age 35 years. | 39 | ||
| Late reproductive age | 39 | ||
| Social and Cultural Factors | 39 | ||
| Substance Use and Abuse | 39 | ||
| Smoking | 40 | ||
| Caffeine | 40 | ||
| Alcohol | 40 | ||
| Prescription drugs | 40 | ||
| Psychotherapeutic drugs. | 40 | ||
| Illicit drugs | 40 | ||
| Cocaine. | 40 | ||
| Heroin. | 40 | ||
| Marijuana. | 40 | ||
| Other illicit drugs. | 40 | ||
| Nutrition | 41 | ||
| Nutritional deficiencies | 41 | ||
| Obesity | 41 | ||
| Other considerations | 41 | ||
| Anorexia nervosa | 41 | ||
| Bulimia nervosa | 41 | ||
| Physical Fitness and Exercise | 41 | ||
| Stress | 42 | ||
| Sexual Practices | 42 | ||
| Medical Conditions | 42 | ||
| Gynecologic Conditions Affecting Pregnancy | 42 | ||
| Environmental and Workplace Hazards | 42 | ||
| Violence against Women | 42 | ||
| Intimate partner violence | 44 | ||
| Characteristics of women in battering relationships. | 44 | ||
| Cycle of violence: the dynamics of battering. | 44 | ||
| Sexual abuse and rape | 44 | ||
| HEALTH ASSESSMENT\t | 44 | ||
| Interview | 44 | ||
| Women with Special Needs | 45 | ||
| Abused women | 45 | ||
| Adolescents | 46 | ||
| History | 46 | ||
| Physical Examination | 46 | ||
| Pelvic Examination | 47 | ||
| External inspection | 49 | ||
| External palpation | 49 | ||
| Vulvar self-examination. | 50 | ||
| Internal examination | 50 | ||
| Collection of specimens. | 50 | ||
| Papanicolaou (Pap) test. | 50 | ||
| Vaginal examination | 50 | ||
| Bimanual palpation | 50 | ||
| Rectovaginal palpation | 52 | ||
| Laboratory and Diagnostic Procedures | 52 | ||
| ANTICIPATORY GUIDANCE FOR HEALTH PROMOTION AND PREVENTION\t | 52 | ||
| Nutrition | 54 | ||
| Exercise | 54 | ||
| Kegel exercises | 54 | ||
| Stress Management | 54 | ||
| Substance Use Cessation | 55 | ||
| Sexual Practices that Reduce Risk | 56 | ||
| Health Screening Schedule | 56 | ||
| Health Risk Prevention | 56 | ||
| Health Protection | 56 | ||
| References | 59 | ||
| 3 Common Concerns | 60 | ||
| LEARNING OBJECTIVES | 60 | ||
| KEY TERMS AND DEFINITIONS | 60 | ||
| WEB RESOURCES | 61 | ||
| MENSTRUAL PROBLEMS\t | 61 | ||
| Amenorrhea | 61 | ||
| Management | 61 | ||
| Cyclic Perimenstrual Pain and Discomfort | 62 | ||
| Dysmenorrhea | 62 | ||
| Primary dysmenorrhea | 62 | ||
| Management. | 63 | ||
| Secondary dysmenorrhea | 63 | ||
| Premenstrual Syndrome and Premenstrual Dysphoric Disorder | 65 | ||
| Management | 65 | ||
| Endometriosis | 66 | ||
| Management | 67 | ||
| Alterations in Cyclic Bleeding | 68 | ||
| Dysfunctional uterine bleeding | 69 | ||
| CARE MANAGEMENT\t | 70 | ||
| INFECTIONS\t | 70 | ||
| Sexually Transmitted Infections | 71 | ||
| Prevention | 71 | ||
| Risk-reduction measures. | 72 | ||
| Bacterial Sexually Transmitted Infections | 73 | ||
| Chlamydial infection | 73 | ||
| Screening and diagnosis. | 73 | ||
| Management. | 73 | ||
| Gonorrhea | 73 | ||
| Screening and diagnosis. | 74 | ||
| Management. | 74 | ||
| Syphilis | 74 | ||
| Unit Two Pregnancy | 135 | ||
| 5 Genetics, Conception, and Fetal Development | 135 | ||
| LEARNING OBJECTIVES | 135 | ||
| KEY TERMS AND DEFINITIONS | 135 | ||
| WEB RESOURCES | 136 | ||
| GENETICS\t | 136 | ||
| Genomics | 137 | ||
| Genetics and Nursing | 137 | ||
| Genetic History-Taking and Genetic Counseling Services | 138 | ||
| Estimation of risk | 138 | ||
| Interpretation of Risk | 140 | ||
| Ethical Considerations | 140 | ||
| The Human Genome Project | 140 | ||
| Genetic testing | 141 | ||
| Pharmacogenomics | 142 | ||
| Gene therapy (gene transfer) | 142 | ||
| Ethical, legal, and social implications | 142 | ||
| Factors Influencing the Decision to Undergo Genetic Testing | 142 | ||
| Clinical Genetics | 143 | ||
| Genetic transmission | 143 | ||
| Genes and Chromosomes | 143 | ||
| Chromosomal Abnormalities | 144 | ||
| Autosomal abnormalities | 144 | ||
| Abnormalities of chromosome number. | 144 | ||
| Abnormalities of chromosome structure. | 145 | ||
| Sex chromosome abnormalities | 145 | ||
| Patterns of Genetic Transmission | 145 | ||
| Multifactorial Inheritance | 147 | ||
| Unifactorial inheritance | 147 | ||
| Autosomal dominant inheritance. | 147 | ||
| Autosomal recessive inheritance. | 147 | ||
| X-linked dominant inheritance. | 148 | ||
| X-linked recessive inheritance. | 148 | ||
| Inborn errors of metabolism | 148 | ||
| Nongenetic Factors Influencing Development | 148 | ||
| Behavioral genetics | 150 | ||
| CONCEPTION\t | 150 | ||
| Cell Division | 150 | ||
| Gametogenesis | 150 | ||
| Conception | 150 | ||
| Ovum | 150 | ||
| Sperm | 151 | ||
| Fertilization | 152 | ||
| Implantation | 153 | ||
| THE EMBRYO AND FETUS\t | 153 | ||
| Primary Germ Layers | 153 | ||
| Development of the Embryo | 154 | ||
| Membranes | 154 | ||
| Amniotic Fluid | 154 | ||
| Yolk Sac | 154 | ||
| Umbilical Cord | 154 | ||
| Placenta | 155 | ||
| Structure | 155 | ||
| Functions | 156 | ||
| Fetal Maturation | 157 | ||
| Respiratory system | 157 | ||
| Fetal circulatory system | 158 | ||
| Hematopoietic system | 158 | ||
| Hepatic system | 159 | ||
| Gastrointestinal system | 159 | ||
| Renal system | 160 | ||
| Neurologic system | 160 | ||
| Sensory awareness. | 160 | ||
| Endocrine system | 161 | ||
| Reproductive system | 161 | ||
| Musculoskeletal system | 161 | ||
| Integumentary system | 161 | ||
| Immunologic system | 162 | ||
| Multifetal Pregnancy | 162 | ||
| Twins | 162 | ||
| Dizygotic Twins. | 162 | ||
| Monozygotic twins. | 162 | ||
| Other multifetal pregnancies | 162 | ||
| References | 167 | ||
| 6 Anatomy and Physiology of Pregnancy | 168 | ||
| LEARNING OBJECTIVES | 168 | ||
| KEY TERMS AND DEFINITIONS | 168 | ||
| WEB RESOURCES | 169 | ||
| GRAVIdiTY AND PARITY\t | 169 | ||
| PREGNANCY TESTS\t | 170 | ||
| ADAPTATIONS TO PREGNANCY\t | 172 | ||
| Signs of Pregnancy | 172 | ||
| Reproductive System and Breasts | 172 | ||
| Uterus | 172 | ||
| Changes in size, shape, and position. | 172 | ||
| Changes in contractility. | 173 | ||
| Uteroplacental blood flow. | 174 | ||
| Cervical changes. | 175 | ||
| Changes related to the presence of the fetus. | 175 | ||
| Vagina and vulva | 176 | ||
| Breasts | 176 | ||
| General Body System Changes | 177 | ||
| Cardiovascular system | 177 | ||
| Blood pressure. | 178 | ||
| Blood volume and composition. | 178 | ||
| Cardiac output. | 179 | ||
| Circulation and coagulation times. | 179 | ||
| Respiratory system | 179 | ||
| Pulmonary function. | 181 | ||
| Basal metabolic rate. | 182 | ||
| Acid-base balance. | 182 | ||
| Renal system | 182 | ||
| Anatomic changes. | 182 | ||
| Functional changes. | 182 | ||
| Fluid and electrolyte balance. | 183 | ||
| Integumentary system | 183 | ||
| Musculoskeletal system | 184 | ||
| Neurologic system | 185 | ||
| Gastrointestinal system | 186 | ||
| Appetite. | 186 | ||
| Mouth. | 186 | ||
| Esophagus, stomach, and intestines. | 186 | ||
| Gallbladder and liver. | 186 | ||
| Abdominal discomfort. | 187 | ||
| Endocrine system | 187 | ||
| Pituitary and placental hormones. | 187 | ||
| Thyroid gland. | 188 | ||
| Parathyroid gland. | 188 | ||
| Pancreas. | 188 | ||
| Adrenal glands. | 188 | ||
| References | 188 | ||
| 7 Nursing Care of the Family during Pregnancy | 190 | ||
| LEARNING OBJECTIVES | 190 | ||
| KEY TERMS AND DEFINITIONS | 190 | ||
| WEB RESOURCES | 191 | ||
| DIAGNOSIS OF PREGNANCY\t | 191 | ||
| Signs and Symptoms | 191 | ||
| Estimating Date of Birth | 191 | ||
| ADAPTATION TO PREGNANCY\t | 192 | ||
| Maternal Adaptation | 192 | ||
| Accepting the Pregnancy | 192 | ||
| Identifying with the mother role | 193 | ||
| Reordering personal relationships | 193 | ||
| Establishing a relationship with the fetus | 194 | ||
| Preparing for childbirth | 194 | ||
| Paternal Adaptation | 195 | ||
| Accepting the pregnancy | 195 | ||
| Identifying with the father role | 196 | ||
| Reordering personal relationships | 196 | ||
| Establishing a relationship with the fetus | 196 | ||
| Preparing for childbirth | 196 | ||
| Sibling Adaptation | 196 | ||
| Grandparent Adaptation | 198 | ||
| CARE MANAGEMENT\t | 198 | ||
| Initial Assessment | 199 | ||
| Interview | 199 | ||
| Reason for seeking care | 199 | ||
| Current pregnancy | 199 | ||
| Obstetric and gynecologic history | 199 | ||
| Medical history | 199 | ||
| Nutritional history | 200 | ||
| History of drug and herbal preparations use | 200 | ||
| Family history | 201 | ||
| Social, experiential, and occupational history | 201 | ||
| History of physical abuse | 201 | ||
| Review of systems | 202 | ||
| Physical examination | 202 | ||
| Laboratory tests | 202 | ||
| Follow-Up Visits | 202 | ||
| Interview | 202 | ||
| Physical examination | 204 | ||
| Fetal assessment | 205 | ||
| Fundal height | 205 | ||
| Gestational age | 206 | ||
| Health status | 206 | ||
| Laboratory tests | 207 | ||
| Collaborative Care | 207 | ||
| Care Paths | 207 | ||
| Education about maternal and fetal changes | 208 | ||
| Nutrition. | 209 | ||
| Personal hygiene. | 209 | ||
| Prevention of urinary tract infections. | 209 | ||
| Kegel exercises. | 209 | ||
| Preparation for breastfeeding. | 209 | ||
| Dental care. | 210 | ||
| Physical activity. | 211 | ||
| Posture and body mechanics. | 211 | ||
| Rest and relaxation. | 211 | ||
| Employment. | 213 | ||
| Clothing. | 215 | ||
| Travel. | 216 | ||
| Medications and herbal preparations. | 217 | ||
| Immunizations. | 217 | ||
| Alcohol, cigarette smoke, caffeine, and drugs. | 217 | ||
| Normal discomforts. | 217 | ||
| Recognizing potential complications. | 221 | ||
| Recognizing preterm labor. | 224 | ||
| Sexual counseling. | 224 | ||
| Countering misinformation. | 224 | ||
| Suggesting alternative behaviors. | 224 | ||
| Psychosocial support | 225 | ||
| Variations in prenatal care | 226 | ||
| Cultural Influences | 226 | ||
| Emotional responses | 226 | ||
| Clothing | 227 | ||
| Physical activity and rest | 227 | ||
| Sexual activity | 227 | ||
| Diet | 227 | ||
| Age Differences | 227 | ||
| Adolescents | 227 | ||
| Women older than 35 years | 228 | ||
| Multiparous women. | 228 | ||
| Primiparous women. | 228 | ||
| Multifetal pregnancy | 230 | ||
| CHILDBIRTH AND PERINATAL EDUCATION\t | 230 | ||
| Childbirth Education Programs | 231 | ||
| Current practices in childbirth education | 231 | ||
| Pain management | 232 | ||
| Perinatal care choices | 232 | ||
| Options for care providers | 232 | ||
| Physicians. | 232 | ||
| Nurse-midwives. | 232 | ||
| Direct-entry midwives. | 232 | ||
| Independent midwives. | 232 | ||
| Doulas. | 232 | ||
| Birth plans | 233 | ||
| Birth setting choices | 233 | ||
| Labor, delivery, recovery, and postpartum (birthing) rooms. | 233 | ||
| Birth centers. | 234 | ||
| Home birth. | 235 | ||
| References | 235 | ||
| 8 Maternal and Fetal Nutrition | 238 | ||
| LEARNING OBJECTIVES | 238 | ||
| KEY TERMS AND DEFINITIONS | 238 | ||
| WEB RESOURCES | 239 | ||
| NUTRIENT NEEDS BEFORE CONCEPTION\t | 240 | ||
| NUTRIENT NEEDS DURING PREGNANCY\t | 240 | ||
| Energy Needs | 240 | ||
| Weight gain | 240 | ||
| Pattern of weight gain | 243 | ||
| Hazards of restricting adequate weight gain | 243 | ||
| Protein | 244 | ||
| Fluids | 245 | ||
| Minerals and Vitamins | 247 | ||
| Iron | 247 | ||
| Calcium | 247 | ||
| Other Minerals and Electrolytes | 248 | ||
| Magnesium | 248 | ||
| Sodium | 248 | ||
| Potassium | 248 | ||
| Zinc | 249 | ||
| Fluoride | 249 | ||
| Fat-soluble vitamins | 249 | ||
| Water-soluble vitamins | 249 | ||
| Folate and folic acid | 249 | ||
| Pyridoxine | 249 | ||
| Vitamin C | 250 | ||
| Multivitamin and multimineral supplements during pregnancy | 250 | ||
| Other Nutritional Issues during Pregnancy | 251 | ||
| Pica and food cravings | 251 | ||
| Adolescent pregnancy needs | 252 | ||
| Nutrition needs related to physical activity during pregnancy | 252 | ||
| NUTRIENT NEEDS DURING LACTATION\t | 252 | ||
| CARE MANAGEMENT\t | 252 | ||
| Diet History | 252 | ||
| Obstetric and gynecologic effects on nutrition | 252 | ||
| Medical history | 253 | ||
| Usual maternal diet | 254 | ||
| Physical Examination | 254 | ||
| Laboratory Testing | 254 | ||
| Adequate Dietary Intake | 254 | ||
| Pregnancy | 257 | ||
| Postpartum nutrition needs | 257 | ||
| Medical nutrition therapy. | 257 | ||
| Counseling about Iron Supplementation | 257 | ||
| Coping with Nutrition-Related Discomforts of Pregnancy | 257 | ||
| Nausea and vomiting | 259 | ||
| Constipation | 259 | ||
| Pyrosis | 259 | ||
| Cultural Influences | 259 | ||
| Vegetarian diets | 262 | ||
| References | 264 | ||
| Unit Three Childbirth | 265 | ||
| 9 Labor and Birth Processes | 265 | ||
| LEARNING OBJECTIVES | 265 | ||
| KEY TERMS AND DEFINITIONS | 265 | ||
| WEB RESOURCES | 266 | ||
| FACTORS AFFECTING LABOR\t | 266 | ||
| Passenger | 266 | ||
| Size of the fetal head | 266 | ||
| Fetal presentation | 266 | ||
| Fetal Lie | 267 | ||
| Fetal Attitude | 268 | ||
| Fetal position | 268 | ||
| Passageway | 270 | ||
| Bony pelvis | 270 | ||
| Soft tissues | 271 | ||
| Powers | 274 | ||
| Primary powers | 274 | ||
| Secondary powers | 275 | ||
| Position of the Laboring Woman | 275 | ||
| PROCESS OF LABOR\t | 277 | ||
| Signs Preceding Labor | 277 | ||
| Onset of Labor | 277 | ||
| Stages of Labor | 277 | ||
| Mechanism of Labor | 278 | ||
| Engagement | 278 | ||
| Asynclitism. | 278 | ||
| Descent | 278 | ||
| Flexion | 279 | ||
| Internal rotation | 280 | ||
| Extension | 280 | ||
| Restitution and external rotation | 280 | ||
| Expulsion | 280 | ||
| PHYSIOLOGIC ADAPTATIONS TO LABOR\t | 280 | ||
| Fetal Adaptation | 280 | ||
| Fetal heart rate | 280 | ||
| Fetal circulation | 280 | ||
| Fetal respiration | 280 | ||
| Maternal Adaptation | 280 | ||
| Cardiovascular changes | 280 | ||
| Respiratory changes | 281 | ||
| Renal changes | 281 | ||
| Integumentary changes | 281 | ||
| Musculoskeletal changes | 281 | ||
| Neurologic changes | 281 | ||
| Gastrointestinal changes | 282 | ||
| Endocrine changes | 282 | ||
| References | 282 | ||
| 10 Management of Discomfort | 284 | ||
| LEARNING OBJECTIVES | 284 | ||
| KEY TERMS AND DEFINITIONS | 284 | ||
| WEB RESOURCES | 285 | ||
| DISCOMFORT DURING LABOR AND BIRTH\t | 285 | ||
| Neurologic Origins | 285 | ||
| Perception of Pain | 285 | ||
| Expression of Pain | 285 | ||
| Factors Influencing Pain Response | 286 | ||
| Physiologic factors | 286 | ||
| Culture | 286 | ||
| Anxiety | 286 | ||
| Previous experience | 287 | ||
| Gate-control theory of pain | 287 | ||
| Comfort | 288 | ||
| Support. | 288 | ||
| Environment. | 288 | ||
| NONPHARMACOLOGIC MANAGEMENT OF DISCOMFORT\t | 288 | ||
| Childbirth Preparation Methods | 288 | ||
| Relaxing and Breathing Techniques | 289 | ||
| Focusing and relaxation | 289 | ||
| Breathing techniques | 290 | ||
| Effleurage and Counterpressure | 291 | ||
| Music | 291 | ||
| Water Therapy (Hydrotherapy) | 292 | ||
| Transcutaneous Electrical Nerve Stimulation | 293 | ||
| Acupressure and Acupuncture | 293 | ||
| Application of Heat and Cold | 293 | ||
| Touch and Massage | 294 | ||
| Hypnosis | 294 | ||
| Biofeedback | 294 | ||
| Aromatherapy | 294 | ||
| Intradermal Water Block | 295 | ||
| PHARMACOLOGIC MANAGEMENT OF DISCOMFORT\t | 295 | ||
| Sedatives | 295 | ||
| Analgesia and Anesthesia | 295 | ||
| Systemic analgesia | 296 | ||
| Opioid agonist analgesics. | 296 | ||
| Opioid agonist-antagonist analgesics. | 298 | ||
| Opioid (narcotic) antagonists. | 299 | ||
| Nerve block analgesia and anesthesia | 299 | ||
| Local perineal infiltration anesthesia. | 300 | ||
| Pudendal nerve block. | 300 | ||
| Spinal anesthesia. | 300 | ||
| Epidural anesthesia or analgesia (block). | 303 | ||
| Combined spinal-epidural analgesia. | 305 | ||
| Epidural and intrathecal (spinal) opioids. | 305 | ||
| Contraindications to epidural blocks. | 306 | ||
| Epidural block effects on the neonate. | 306 | ||
| Nitrous oxide for analgesia | 306 | ||
| General anesthesia | 306 | ||
| Care Management\t | 307 | ||
| Nonpharmacologic Interventions | 307 | ||
| Pharmacologic Interventions | 309 | ||
| Informed consent | 309 | ||
| Timing of administration | 310 | ||
| Preparation for procedures | 310 | ||
| Administration of medication | 310 | ||
| Intravenous route. | 310 | ||
| Intramuscular route. | 310 | ||
| Regional (epidural or spinal) anesthesia. | 311 | ||
| Safety and general care | 312 | ||
| References | 313 | ||
| 11 Fetal Assessment during Labor | 315 | ||
| LEARNING OBJECTIVES | 315 | ||
| KEY TERMS AND DEFINITIONS | 315 | ||
| WEB RESOURCES | 316 | ||
| BASIS FOR MONITORING\t | 316 | ||
| Fetal Response | 316 | ||
| Uterine Activity | 317 | ||
| Fetal Compromise | 317 | ||
| MONITORING TECHNIQUES\t | 318 | ||
| Intermittent Auscultation | 318 | ||
| Electronic Fetal Monitoring | 319 | ||
| External monitoring | 319 | ||
| Internal monitoring | 321 | ||
| FETAL HEART RATE PATTERNS\t | 321 | ||
| Baseline Fetal Heart Rate | 322 | ||
| Variability | 322 | ||
| Tachycardia | 322 | ||
| Bradycardia | 322 | ||
| Periodic and Episodic Changes in Fetal Heart Rate | 323 | ||
| Accelerations | 324 | ||
| Decelerations | 325 | ||
| Early decelerations. | 325 | ||
| Late decelerations. | 325 | ||
| Variable decelerations. | 326 | ||
| Prolonged decelerations. | 327 | ||
| CARE MANAGEMENT\t | 328 | ||
| Electronic Fetal Monitoring Pattern Recognition | 329 | ||
| Nursing Management of Abnormal Patterns | 330 | ||
| Other Methods of Assessment and Intervention | 330 | ||
| Assessment techniques | 330 | ||
| Fetal scalp stimulation and vibroacoustic stimulation. | 330 | ||
| Umbilical cord acid-base determination. | 331 | ||
| Fetal scalp blood sampling. | 331 | ||
| Fetal pulse oximetry. | 331 | ||
| Interventions | 332 | ||
| Amnioinfusion. | 332 | ||
| Tocolytic therapy. | 332 | ||
| Patient and family teaching | 332 | ||
| Documentation | 333 | ||
| References | 335 | ||
| 12 Nursing Care of the Family during Labor and Birth | 336 | ||
| LEARNING OBJECTIVES | 336 | ||
| KEY TERMS AND DEFINITIONS | 336 | ||
| WEB RESOURCES | 337 | ||
| FIRST STAGE OF LABOR\t | 337 | ||
| CARE MANAGEMENT \t | 337 | ||
| Assessment | 337 | ||
| Prenatal data | 339 | ||
| Interview | 340 | ||
| Psychosocial factors | 342 | ||
| Women with a history of sexual abuse. | 342 | ||
| Stress in labor | 342 | ||
| Cultural factors | 343 | ||
| The non–English-speaking woman in labor. | 344 | ||
| Physical examination | 345 | ||
| General systems assessment. | 345 | ||
| Vital signs. | 345 | ||
| Leopold maneuvers (abdominal palpation). | 347 | ||
| Assessment of fetal heart rate. | 347 | ||
| Assessment of uterine contractions. | 347 | ||
| Vaginal examination. | 350 | ||
| Laboratory and diagnostic tests | 351 | ||
| Analysis of urine specimen. | 351 | ||
| Blood tests. | 351 | ||
| Other tests. | 351 | ||
| Assessment of amniotic membranes and fluid. | 351 | ||
| Signs of potential problems | 352 | ||
| Nursing Diagnoses | 352 | ||
| Expected Outcomes of Care | 352 | ||
| Plan of Care and Interventions | 352 | ||
| General hygiene | 352 | ||
| Nutrient and fluid intake | 352 | ||
| Oral intake. | 352 | ||
| Intravenous Intake. | 355 | ||
| Elimination | 355 | ||
| Voiding. | 355 | ||
| Catheterization. | 355 | ||
| Bowel elimination. | 355 | ||
| Ambulation and positioning | 355 | ||
| Supportive care during labor and birth | 357 | ||
| Labor support by the nurse. | 357 | ||
| Labor support by the father or partner. | 359 | ||
| Labor support by doulas. | 359 | ||
| Labor support by the grandparents. | 360 | ||
| Siblings during labor and birth | 360 | ||
| Emergency interventions | 360 | ||
| Evaluation | 360 | ||
| SECOND STAGE OF LABOR\t | 360 | ||
| CARE MANAGEMENT\t | 360 | ||
| Assessment | 362 | ||
| Nursing Diagnoses | 363 | ||
| Expected Outcomes of Care | 364 | ||
| Plan of Care and Interventions | 364 | ||
| Maternal position | 364 | ||
| Bearing-down efforts | 367 | ||
| Fetal heart rate and pattern | 368 | ||
| Support of the father or partner | 369 | ||
| Supplies, instruments, and equipment | 370 | ||
| Birth in a delivery room or birthing room | 370 | ||
| Mechanism of birth: vertex presentation. | 371 | ||
| Immediate assessments and care of the newborn | 372 | ||
| Perineal trauma related to childbirth | 372 | ||
| Perineal lacerations. | 375 | ||
| Vaginal lacerations. | 375 | ||
| Cervical injuries. | 375 | ||
| Episiotomy | 375 | ||
| Evaluation | 376 | ||
| THIRD STAGE OF LABOR\t | 376 | ||
| CARE MANAGEMENT\t | 376 | ||
| Assessment | 376 | ||
| Placental separation and expulsion | 376 | ||
| Nursing Diagnoses | 376 | ||
| Expected Outcomes of Care | 376 | ||
| Plan of Care and Interventions | 377 | ||
| Evaluation | 378 | ||
| FOURTH STAGE OF LABOR\t | 378 | ||
| Care Management\t | 378 | ||
| Assessment | 379 | ||
| Postanesthesia recovery | 379 | ||
| Nursing Diagnoses | 379 | ||
| Expected Outcomes of Care | 379 | ||
| Plan of Care and Interventions | 380 | ||
| Care of the new mother | 380 | ||
| Care of the family | 380 | ||
| Family-newborn relationships. | 381 | ||
| Evaluation | 381 | ||
| References | 382 | ||
| Unit Four Postpartum Period | 383 | ||
| 13 Maternal Physiologic Changes | 383 | ||
| LEARNING OBJECTIVES | 383 | ||
| KEY TERMS AND DEFINITIONS | 383 | ||
| WEB RESOURCES | 383 | ||
| REPRODUCTIVE SYSTEM AND ASSOCIATED STRUCTURES\t | 384 | ||
| Uterus | 384 | ||
| Involution process | 384 | ||
| Contractions | 384 | ||
| Afterpains | 384 | ||
| Placental site | 384 | ||
| Lochia | 384 | ||
| Cervix | 385 | ||
| Vagina and Perineum | 386 | ||
| Pelvic Muscular Support | 387 | ||
| ENDOCRINE SYSTEM\t | 387 | ||
| Placental Hormones | 387 | ||
| Pituitary Hormones and Ovarian Function | 387 | ||
| ABDOMEN\t | 387 | ||
| URINARY SYSTEM\t | 388 | ||
| Urine Components | 388 | ||
| Postpartal Diuresis | 388 | ||
| Urethra and Bladder | 388 | ||
| GASTROINTESTINAL SYSTEM\t | 388 | ||
| Appetite | 388 | ||
| Bowel Evacuation | 388 | ||
| BREASTS\t | 388 | ||
| Breastfeeding Mothers | 388 | ||
| Non-Breastfeeding Mothers | 389 | ||
| CARDIOVASCULAR SYSTEM\t | 389 | ||
| Blood Volume | 389 | ||
| Cardiac Output | 389 | ||
| Vital Signs | 389 | ||
| Blood Components | 389 | ||
| Hematocrit and hemoglobin | 389 | ||
| White blood cell count | 389 | ||
| Coagulation factors | 389 | ||
| Varicosities | 390 | ||
| NEUROLOGIC SYSTEM\t | 390 | ||
| MUScULOSKELETAL SYSTEM\t | 391 | ||
| INTEGUMENTARY SYSTEM\t | 391 | ||
| IMMUNE SYSTEM\t | 391 | ||
| References | 391 | ||
| 14 Nursing Care of the Family during the Fourth Trimester | 392 | ||
| LEARNING OBJECTIVES | 392 | ||
| KEY TERMS AND DEFINITIONS | 392 | ||
| WEB RESOURCES | 392 | ||
| TRANSFER FROM THE RECOVERY AREA\t | 393 | ||
| PLANNING FOR DISCHARGE\t | 393 | ||
| Laws Relating to Discharge | 393 | ||
| Criteria for Discharge | 394 | ||
| CARE MANAGEMENT— PHYSIOLOGIC NEEDS\t | 395 | ||
| Plan of Care and Interventions | 395 | ||
| Prevention of infection | 399 | ||
| Prevention of excessive bleeding | 399 | ||
| Maintenance of uterine tone | 401 | ||
| Prevention of bladder distention | 401 | ||
| Promotion of comfort, rest, ambulation, and exercise | 402 | ||
| Comfort. | 402 | ||
| Rest. | 403 | ||
| Ambulation. | 403 | ||
| Exercise. | 404 | ||
| Promotion of nutrition | 404 | ||
| Promotion of normal bladder and bowel patterns | 404 | ||
| Bladder function. | 404 | ||
| Bowel function. | 404 | ||
| Breastfeeding promotion and lactation suppression | 406 | ||
| Breastfeeding promotion. | 406 | ||
| Lactation suppression. | 406 | ||
| Health promotion for future pregnancies and children | 406 | ||
| Rubella vaccination. | 406 | ||
| Varicella vaccination. | 406 | ||
| Tetanus-diphtheria-acellular pertussis vaccine. | 406 | ||
| Prevention of Rh isoimmunization. | 406 | ||
| CARE MANAGEMENT—PSYCHOSOCIAL NEEDS\t | 407 | ||
| Impact of the birth experience | 408 | ||
| Maternal self-image | 409 | ||
| Adaptation to parenthood and parent-infant interactions | 409 | ||
| Family structure and functioning | 409 | ||
| Impact of cultural diversity | 410 | ||
| DISCHARGE TEACHING\t | 411 | ||
| Self-Management and Signs of Complications | 411 | ||
| Sexual Activity and Contraception | 412 | ||
| Prescribed Medications | 413 | ||
| Follow-Up after Discharge | 413 | ||
| Routine mother and baby follow-up visits | 413 | ||
| Home visits | 414 | ||
| Telephone follow-up | 414 | ||
| Warm lines | 414 | ||
| Support groups | 414 | ||
| Referral to community resources | 414 | ||
| References | 415 | ||
| 15 Transition to Parenthood | 416 | ||
| LEARNING OBJECTIVES | 416 | ||
| KEY TERMS AND DEFINITIONS | 416 | ||
| WEB RESOURCES | 417 | ||
| PARENTAL ATTACHMENT, BONDING, AND ACQUAINTANCE\t | 417 | ||
| Assessment of Attachment Behaviors | 419 | ||
| PARENT-INFANT CONTACT\t | 421 | ||
| Early Contact | 421 | ||
| Extended Contact | 421 | ||
| COMMUNICATION BETWEEN PARENT AND INFANT\t | 421 | ||
| The Senses | 421 | ||
| Touch | 421 | ||
| Eye contact | 422 | ||
| Voice | 422 | ||
| Odor | 422 | ||
| Entrainment | 422 | ||
| Biorhythmicity | 422 | ||
| Reciprocity and Synchrony | 422 | ||
| PARENTAL ROLE AFTER CHILDBIRTH\t | 423 | ||
| Transition to Parenthood | 423 | ||
| Parental Tasks and Responsibilities | 423 | ||
| Becoming a Mother | 424 | ||
| Postpartum “blues” | 425 | ||
| Becoming a Father | 426 | ||
| Adjustment for the Couple | 428 | ||
| Resuming sexual intimacy | 428 | ||
| Postpartum adjustment in the lesbian couple | 429 | ||
| DIVERSITY IN TRANSITIONS TO PARENTHOOD\t | 429 | ||
| Age | 429 | ||
| Adolescent mother | 429 | ||
| Adolescent father | 430 | ||
| Maternal age older than 35 years | 430 | ||
| Paternal age older than 35 years | 431 | ||
| Social Support | 431 | ||
| Culture | 431 | ||
| Socioeconomic Conditions | 432 | ||
| Personal Aspirations | 432 | ||
| PARENTAL SENSORY IMPAIRMENT\t | 433 | ||
| Visually Impaired Parent | 433 | ||
| Hearing-Impaired Parent | 433 | ||
| SIBLING ADAPTATION\t | 434 | ||
| GRANDPARENT ADAPTATION\t | 434 | ||
| CARE MANAGEMENT\t | 436 | ||
| References | 437 | ||
| Unit Five The Newborn | 438 | ||
| 16 Physiologic and Behavioral Adaptations of the Newborn | 438 | ||
| LEARNING OBJECTIVES | 438 | ||
| KEY TERMS AND DEFINITIONS | 438 | ||
| WEB RESOURCES | 439 | ||
| TRANSITION TO EXTRAUTERINE LIFE\t | 439 | ||
| PHYSIOLOGIC ADAPTATIONS\t | 439 | ||
| Respiratory System | 439 | ||
| Signs of Respiratory Distress | 439 | ||
| Maintaining adequate oxygen supply | 440 | ||
| Cardiovascular System | 440 | ||
| Heart rate and sounds | 441 | ||
| Blood pressure | 442 | ||
| Blood volume | 442 | ||
| Hematopoietic System | 442 | ||
| Red blood cells and hemoglobin | 442 | ||
| Leukocytes | 442 | ||
| Platelets | 443 | ||
| Blood groups | 443 | ||
| Thermogenic System | 443 | ||
| Thermogenesis | 443 | ||
| Heat loss | 443 | ||
| Temperature regulation | 443 | ||
| Renal System | 444 | ||
| Fluid and electrolyte balance | 445 | ||
| Gastrointestinal System | 445 | ||
| Digestion | 445 | ||
| Stools | 446 | ||
| Hepatic System | 446 | ||
| Iron storage | 446 | ||
| Carbohydrate metabolism | 446 | ||
| Jaundice | 446 | ||
| Coagulation | 446 | ||
| Immune System | 446 | ||
| Integumentary System | 447 | ||
| Caput succedaneum | 447 | ||
| Cephalhematoma | 447 | ||
| Subgaleal hemorrhage | 448 | ||
| Sweat glands | 449 | ||
| Desquamation | 449 | ||
| Mongolian spots | 449 | ||
| Nevi | 449 | ||
| Erythema toxicum | 450 | ||
| Reproductive System | 450 | ||
| Female | 450 | ||
| Male | 450 | ||
| Swelling of breast tissue | 450 | ||
| Skeletal System | 451 | ||
| Neuromuscular System | 457 | ||
| Newborn reflexes | 457 | ||
| PHYSICAL ASSESSMENT\t | 457 | ||
| General Appearance | 457 | ||
| Vital Signs | 457 | ||
| Baseline Measurements of Physical Growth | 473 | ||
| Weight | 473 | ||
| Head circumference and body length | 473 | ||
| Neurologic Assessment | 473 | ||
| BEHAVIORAL CHARACTERISTICS\t | 473 | ||
| Sleep-Wake States | 474 | ||
| Other Factors Influencing Newborn Behavior | 474 | ||
| Gestational age | 474 | ||
| Time | 474 | ||
| Stimuli | 474 | ||
| Medication | 475 | ||
| Sensory Behaviors | 475 | ||
| Vision | 475 | ||
| Hearing | 475 | ||
| Smell | 475 | ||
| Taste | 475 | ||
| Touch | 476 | ||
| Response to Environmental Stimuli | 476 | ||
| Temperament | 476 | ||
| Habituation | 476 | ||
| Consolability | 476 | ||
| Cuddliness | 476 | ||
| Irritability | 476 | ||
| Crying | 476 | ||
| References | 477 | ||
| 17 Assessment and Care of the Newborn and Family | 478 | ||
| LEARNING OBJECTIVES | 478 | ||
| KEY TERMS AND DEFINITIONS | 478 | ||
| WEB RESOURCES | 478 | ||
| BIRTH THROUGH THE FIRST 2 HOURS\t | 479 | ||
| NURSING CARE MANAGEMENT\t | 479 | ||
| Assessment | 479 | ||
| Initial Assessment and Apgar Scoring | 479 | ||
| Apgar score | 480 | ||
| Initial physical assessment | 480 | ||
| Interventions | 481 | ||
| Airway maintenance | 481 | ||
| Maintaining an adequate oxygen supply. | 482 | ||
| Maintaining body temperature | 482 | ||
| Immediate interventions | 484 | ||
| Eye prophylaxis. | 484 | ||
| Vitamin K prophylaxis. | 485 | ||
| Umbilical cord care. | 485 | ||
| Promoting parent-infant interaction | 486 | ||
| FROM 2 HOURS AFTER BIRTH UNTIL DISCHARGE\t | 486 | ||
| NURSING CARE MANAGEMENT\t | 486 | ||
| Assessment | 486 | ||
| Physical assessment | 486 | ||
| Gestational age assessment | 487 | ||
| Classification of newborns by gestational age and birth weight | 487 | ||
| Late preterm infant. | 490 | ||
| Common Newborn Problems | 490 | ||
| Physical injuries | 490 | ||
| Soft-tissue injuries. | 490 | ||
| Physiologic problems | 490 | ||
| Conjugation of bilirubin. | 490 | ||
| Physiologic jaundice | 491 | ||
| Jaundice associated with breastfeeding | 493 | ||
| Hypoglycemia. | 494 | ||
| Hypocalcemia. | 495 | ||
| LABORATORY AND DIAGNOSTIC TESTS\t | 495 | ||
| Collection of Specimens | 495 | ||
| Heel stick | 495 | ||
| Venipuncture | 499 | ||
| Obtaining a urine specimen | 499 | ||
| Restraining the infant | 501 | ||
| Restraint without appliance. | 501 | ||
| Interventions | 501 | ||
| Protective environment | 501 | ||
| Environmental factors. | 502 | ||
| Measures to control infection. | 502 | ||
| Safety: Preventing infant abduction. | 502 | ||
| Supporting parents in the care of their infant | 502 | ||
| Social interaction. | 502 | ||
| Infant feeding. | 503 | ||
| THERAPEUTIC AND SURGICAL PROCEDURES\t | 503 | ||
| Intramuscular Injection | 503 | ||
| Therapy for Hyperbilirubinemia | 504 | ||
| Phototherapy | 504 | ||
| Parent education. | 506 | ||
| Home phototherapy. | 506 | ||
| Circumcision | 506 | ||
| Procedure | 507 | ||
| Procedural pain management | 507 | ||
| Care of the newly circumcised infant | 508 | ||
| NEONATAL PAIN\t | 508 | ||
| Neonatal Responses to Pain | 508 | ||
| Assessment of Neonatal Pain | 509 | ||
| Management of Neonatal Pain | 509 | ||
| Nonpharmacologic management | 509 | ||
| Pharmacologic management | 510 | ||
| DISCHARGE PLANNING AND TEACHING\t | 511 | ||
| Temperature | 512 | ||
| Respirations | 512 | ||
| Feeding Schedules | 512 | ||
| Elimination | 512 | ||
| Positioning and Holding | 512 | ||
| Rashes | 512 | ||
| Diaper rash | 512 | ||
| Other rashes | 513 | ||
| Clothing | 513 | ||
| Safety: Use of Car Seat | 513 | ||
| Nonnutritive Sucking | 515 | ||
| Sponge Bathing, Cord Care, and Skin Care | 515 | ||
| Cord care | 516 | ||
| Infant Follow-Up Care | 516 | ||
| Immunizations | 516 | ||
| Cardiopulmonary resuscitation | 516 | ||
| Practical Suggestions for the First Weeks at Home | 519 | ||
| Instructions for the first days at home | 519 | ||
| Activities of daily living. | 519 | ||
| Visitors. | 521 | ||
| Activity and rest. | 521 | ||
| Anticipatory guidance regarding the newborn | 521 | ||
| Development of day-night routines. | 521 | ||
| Interpretation of crying and quieting techniques. | 521 | ||
| Developmental milestones. | 522 | ||
| Infant stimulation. | 522 | ||
| Recognizing signs of illness. | 522 | ||
| References | 526 | ||
| 18 Newborn Nutrition and Feeding | 528 | ||
| LEARNING OBJECTIVES | 528 | ||
| KEY TERMS AND DEFINITIONS | 528 | ||
| WEB RESOURCES | 529 | ||
| RECOMMENDED INFANT NUTRITION\t | 529 | ||
| BREASTFEEDING RATES\t | 529 | ||
| BENEFITS OF BREASTFEEDING\t | 529 | ||
| CHOOSING AN INFANT FEEDING METHOD\t | 530 | ||
| Cultural Influences on Infant Feeding | 532 | ||
| NUTRIENT NEEDS\t | 533 | ||
| Fluids | 533 | ||
| Energy | 533 | ||
| Carbohydrate | 533 | ||
| Fat | 533 | ||
| Protein | 534 | ||
| Vitamins | 534 | ||
| Minerals | 534 | ||
| ANATOMY AND PHYSIOLOGY OF LACTATION\t | 535 | ||
| Anatomy of the Lactating Breast | 535 | ||
| Lactogenesis | 536 | ||
| Uniqueness of Human Milk | 537 | ||
| CARE MANAGEMENT: THE BREASTFEEDING MOTHER AND INFANT\t | 538 | ||
| Positioning | 538 | ||
| Latch | 539 | ||
| Milk Ejection or Let-Down | 541 | ||
| Frequency of Feedings | 541 | ||
| Duration of Feedings | 542 | ||
| Indicators of Effective Breastfeeding | 542 | ||
| Supplements, Bottles, and Pacifiers | 543 | ||
| Special Considerations | 544 | ||
| Sleepy baby | 544 | ||
| Fussy baby | 544 | ||
| Slow weight gain | 544 | ||
| Jaundice | 545 | ||
| Preterm infants | 546 | ||
| Late preterm infants | 546 | ||
| Breastfeeding multiple infants | 546 | ||
| Expressing and storing breast milk | 546 | ||
| Hand expression. | 547 | ||
| Mechanical expression (pumping). | 547 | ||
| Types of pumps. | 547 | ||
| Storage of breast milk. | 548 | ||
| Being away from the infant (maternal employment) | 548 | ||
| Weaning | 549 | ||
| Milk banking | 549 | ||
| Care of the mother | 549 | ||
| Diet. | 549 | ||
| Weight loss. | 550 | ||
| Rest. | 550 | ||
| Breast care. | 550 | ||
| Sexual sensations. | 550 | ||
| Breastfeeding and contraception. | 550 | ||
| Breastfeeding during pregnancy. | 550 | ||
| Medications and breastfeeding. | 551 | ||
| Environmental contaminants. | 551 | ||
| Common concerns of the breastfeeding mother | 551 | ||
| Engorgement. | 551 | ||
| Sore nipples. | 552 | ||
| Monilial infections. | 553 | ||
| Plugged milk ducts. | 553 | ||
| Mastitis. | 553 | ||
| Follow-up after hospital discharge | 554 | ||
| FORMULA FEEDING\t | 554 | ||
| Parent Education | 554 | ||
| Readiness for feeding | 554 | ||
| Feeding patterns | 554 | ||
| Feeding technique | 554 | ||
| Common concerns | 555 | ||
| Bottles and nipples | 555 | ||
| Infant formulas | 556 | ||
| Commercial formulas. | 556 | ||
| Formula preparation | 556 | ||
| Vitamin and mineral supplementation | 557 | ||
| Weaning | 558 | ||
| Introducing solid foods | 558 | ||
| References | 558 | ||
| Unit Six Complications of Childbearing | 560 | ||
| 19 Assessment of High Risk Pregnancy | 560 | ||
| LEARNING OBJECTIVES | 560 | ||
| KEY TERMS AND DEFINITIONS | 560 | ||
| WEB RESOURCES | 560 | ||
| ASSESSMENT OF RISK FACTORS\t | 561 | ||
| Psychologic Considerations Related to High Risk Pregnancy | 561 | ||
| Antepartum Testing | 563 | ||
| BIOPHYSICAL ASSESSMENT\t | 563 | ||
| Daily Fetal Movement Count | 563 | ||
| Ultrasonography | 564 | ||
| Levels of ultrasonography | 565 | ||
| Indications for use | 565 | ||
| Fetal heart activity. | 565 | ||
| Gestational age | 566 | ||
| Fetal growth. | 566 | ||
| Fetal anatomy. | 566 | ||
| Fetal genetic disorders and physical anomalies. | 566 | ||
| Placental position and function. | 566 | ||
| Adjunct to other invasive tests. | 567 | ||
| Fetal well-being | 567 | ||
| Doppler blood flow analysis. | 567 | ||
| Amniotic fluid volume. | 568 | ||
| Biophysical profile. | 568 | ||
| Nursing role | 568 | ||
| Magnetic Resonance Imaging | 569 | ||
| BIOCHEMICAL ASSESSMENT\t | 569 | ||
| Amniocentesis | 569 | ||
| Indications for Use | 571 | ||
| Genetic concerns. | 571 | ||
| Fetal maturity. | 571 | ||
| Fetal hemolytic disease. | 571 | ||
| Chorionic Villus Sampling | 571 | ||
| Percutaneous Umbilical Blood Sampling | 572 | ||
| Maternal Assays | 574 | ||
| Alpha-fetoprotein | 574 | ||
| Coombs test | 574 | ||
| ANTEPARTAL ASSESSMENT USING ELECTRONIC FETAL MONITORING\t | 574 | ||
| Indications | 574 | ||
| Nonstress Test | 575 | ||
| Procedure | 575 | ||
| Interpretation | 575 | ||
| Vibroacoustic Stimulation | 576 | ||
| Contraction Stress Test | 576 | ||
| Procedure | 577 | ||
| Nipple-stimulated contraction test. | 577 | ||
| Oxytocin-stimulated contraction test. | 577 | ||
| Interpretation | 577 | ||
| NURSING ROLE IN ASSESSMENT OF THE HIGH RISK PREGNANCY\t | 578 | ||
| References | 579 | ||
| 20 Pregnancy at Risk: | 580 | ||
| LEARNING OBJECTIVES | 580 | ||
| KEY TERMS AND DEFINITIONS | 580 | ||
| WEB RESOURCES | 581 | ||
| METABOLIC DISORDERS\t | 581 | ||
| Diabetes Mellitus | 581 | ||
| Pathogenesis | 581 | ||
| Classification | 582 | ||
| White’s classification of diabetes in pregnancy. | 582 | ||
| Metabolic changes associated with pregnancy | 582 | ||
| Pregestational Diabetes Mellitus | 583 | ||
| Preconception counseling | 584 | ||
| Maternal risks and complications | 584 | ||
| Fetal and neonatal risks and complications | 586 | ||
| CARE MANAGEMENT\t | 586 | ||
| Antepartum | 586 | ||
| Diet | 589 | ||
| Exercise | 591 | ||
| Insulin therapy | 591 | ||
| Monitoring blood glucose levels | 593 | ||
| Urine testing | 594 | ||
| Complications requiring hospitalization. | 594 | ||
| Fetal surveillance. | 594 | ||
| Determination of birth date and mode of birth. | 595 | ||
| Intrapartum | 595 | ||
| Postpartum | 596 | ||
| Gestational Diabetes Mellitus | 597 | ||
| Fetal risks | 597 | ||
| Screening for gestational diabetes mellitus | 597 | ||
| CARE MANAGEMENT\t | 597 | ||
| Antepartum | 597 | ||
| Diet. | 598 | ||
| Exercise. | 598 | ||
| Monitoring blood glucose levels. | 598 | ||
| Medications for controlling blood glucose levels. | 598 | ||
| Fetal surveillance. | 598 | ||
| Intrapartum | 599 | ||
| Postpartum | 599 | ||
| Thyroid Disorders | 599 | ||
| Hyperthyroidism | 599 | ||
| Hypothyroidism | 600 | ||
| Nursing care | 600 | ||
| Maternal Phenylketonuria | 600 | ||
| CARDIOVASCULAR DISORDERS\t | 601 | ||
| Selected Cardiovascular Disorders | 602 | ||
| Congenital cardiac diseases | 602 | ||
| Atrial septal defect. | 602 | ||
| Coarctation of the aorta. | 602 | ||
| Tetralogy of Fallot. | 602 | ||
| Acquired cardiac diseases | 602 | ||
| Mitral valve prolapse. | 602 | ||
| Mitral stenosis. | 603 | ||
| Aortic stenosis. | 603 | ||
| Myocardial infarction. | 603 | ||
| Other cardiac diseases and conditions | 604 | ||
| Peripartum cardiomyopathy. | 604 | ||
| Infective endocarditis. | 604 | ||
| Eisenmenger syndrome. | 604 | ||
| Marfan syndrome. | 604 | ||
| Heart Transplantation | 605 | ||
| CARE MANAGEMENT\t | 605 | ||
| Antepartum | 605 | ||
| Intrapartum | 607 | ||
| Postpartum | 609 | ||
| Anemia\t | 610 | ||
| Iron Deficiency Anemia | 610 | ||
| Folate Deficiency | 611 | ||
| Sickle Cell Hemoglobinopathy | 611 | ||
| Thalassemia | 612 | ||
| PULMONARY DISORDERS\t | 612 | ||
| Asthma | 612 | ||
| Cystic Fibrosis | 613 | ||
| INTEGUMENTARY DISORDERS\t | 614 | ||
| NEUROLOGIC DISORDERS\t | 615 | ||
| Epilepsy | 615 | ||
| Multiple Sclerosis | 616 | ||
| Bell Palsy | 616 | ||
| AUTOIMMUNE DISORDERS\t | 616 | ||
| Systemic Lupus Erythematosus | 616 | ||
| SUBSTANCE ABUSE\t | 617 | ||
| CARE MANAGEMENT\t | 618 | ||
| Screening | 618 | ||
| Assessment | 618 | ||
| Initial Care | 618 | ||
| Follow-Up Care | 620 | ||
| References | 621 | ||
| 21 Pregnancy at Risk: | 623 | ||
| LEARNING OBJECTIVES | 623 | ||
| KEY TERMS AND DEFINITIONS | 623 | ||
| WEB RESOURCES | 624 | ||
| HYPERTENSION IN PREGNANCY\t | 624 | ||
| Significance and Incidence | 624 | ||
| Classification | 624 | ||
| Gestational hypertension | 625 | ||
| Preeclampsia | 625 | ||
| Eclampsia | 626 | ||
| Chronic hypertension | 626 | ||
| Chronic hypertension with superimposed preeclampsia | 626 | ||
| Preeclampsia | 627 | ||
| Etiology | 627 | ||
| Pathophysiology | 627 | ||
| HELLP Syndrome | 629 | ||
| CARE MANAGEMENT\t | 629 | ||
| Identifying and preventing preeclampsia | 629 | ||
| Physical Examination | 629 | ||
| Mild Gestational Hypertension and Mild Preeclampsia | 631 | ||
| Home care | 631 | ||
| Maternal and fetal assessment | 632 | ||
| Activity restriction | 633 | ||
| Diet | 633 | ||
| Severe Gestational Hypertension or Severe Preeclampsia | 633 | ||
| Intrapartum care | 635 | ||
| Magnesium sulfate. | 636 | ||
| Control of blood pressure. | 636 | ||
| Postpartum care | 637 | ||
| Eclampsia | 639 | ||
| Immediate care | 639 | ||
| Chronic hypertension | 640 | ||
| Hyperemesis Gravidarum | 641 | ||
| Etiology | 641 | ||
| Clinical manifestations | 641 | ||
| Management | 641 | ||
| Assessment. | 641 | ||
| Initial care. | 642 | ||
| Follow-up care. | 642 | ||
| HEMORRHAGIC COMPLICATIONS\t | 643 | ||
| Early Pregnancy Bleeding | 643 | ||
| Miscarriage | 643 | ||
| Incidence and etiology. | 643 | ||
| Types. | 643 | ||
| Clinical manifestations. | 643 | ||
| Management | 644 | ||
| Initial care. | 644 | ||
| Follow-up care at home. | 647 | ||
| Recurrent Premature Dilation of the Cervix (Incompetent Cervix) | 647 | ||
| Etiology | 647 | ||
| Diagnosis | 647 | ||
| Management | 647 | ||
| Follow-up care at home | 648 | ||
| Ectopic Pregnancy | 648 | ||
| Incidence and etiology | 648 | ||
| Clinical manifestations | 649 | ||
| Tubal Pregnancy Management | 649 | ||
| Immediate care | 650 | ||
| Surgical management. | 650 | ||
| Medical management. | 650 | ||
| Follow-up care. | 650 | ||
| Hydatidiform Mole (Molar Pregnancy) | 650 | ||
| Incidence and etiology | 651 | ||
| Types | 651 | ||
| Clinical manifestations | 651 | ||
| Diagnosis | 652 | ||
| Management | 652 | ||
| Follow-up care | 652 | ||
| Late Pregnancy Bleeding | 653 | ||
| Placenta previa | 653 | ||
| Incidence and etiology. | 654 | ||
| Clinical manifestations. | 654 | ||
| Maternal and fetal outcomes. | 654 | ||
| Diagnosis. | 654 | ||
| Management | 655 | ||
| Expectant management. | 655 | ||
| Home care. | 656 | ||
| Active management. | 656 | ||
| Premature separation of placenta (abruptio placentae) | 656 | ||
| Incidence and etiology. | 656 | ||
| Classification. | 657 | ||
| Clinical manifestations. | 657 | ||
| Maternal and fetal outcomes. | 657 | ||
| Diagnosis. | 658 | ||
| Management | 658 | ||
| Expectant management. | 658 | ||
| Active management. | 658 | ||
| Cord insertion and placental variations | 658 | ||
| CLOTTING DISORDERS IN PREGNANCY\t | 659 | ||
| Normal Clotting | 659 | ||
| Clotting Problems | 659 | ||
| Disseminated intravascular coagulation | 659 | ||
| Management. | 659 | ||
| INFECTIONS ACQUIRED DURING PREGNANCY\t | 660 | ||
| Sexually Transmitted Infections | 660 | ||
| Management | 660 | ||
| TORCH Infections | 660 | ||
| Urinary Tract Infections | 660 | ||
| Asymptomatic bacteriuria | 664 | ||
| Cystitis | 665 | ||
| Pyelonephritis | 665 | ||
| Patient education | 665 | ||
| SURGICAL EMERGENCIES DURING PREGNANCY\t | 666 | ||
| Appendicitis | 666 | ||
| Cholelithiasis and Cholecystitis | 666 | ||
| Gynecologic Problems | 667 | ||
| Management | 667 | ||
| TRAUMA DURING PREGNANCY\t | 667 | ||
| Significance | 668 | ||
| Maternal Physiologic Characteristics | 668 | ||
| Fetal Physiologic Characteristics | 668 | ||
| Mechanisms of Trauma | 669 | ||
| Blunt-force abdominal trauma | 669 | ||
| Penetrating abdominal trauma | 670 | ||
| Thoracic trauma | 670 | ||
| Management | 670 | ||
| Immediate stabilization | 670 | ||
| Primary survey | 670 | ||
| Cardiopulmonary resuscitation (CPR) for the pregnant woman | 671 | ||
| Secondary survey | 672 | ||
| Follow-up care | 673 | ||
| References | 674 | ||
| 22 Labor and Birth at Risk | 676 | ||
| LEARNING OBJECTIVES | 676 | ||
| KEY TERMS AND DEFINITIONS | 676 | ||
| WEB RESOURCES | 677 | ||
| PRETERM LABOR AND BIRTH\t | 677 | ||
| Preterm Birth versus Low Birth Weight | 678 | ||
| Predicting Spontaneous Preterm Labor and Birth | 678 | ||
| Biochemical markers | 679 | ||
| Cervical length | 679 | ||
| Causes of spontaneous preterm labor and birth | 679 | ||
| CARE MANAGEMENT\t | 679 | ||
| Prevention | 679 | ||
| Early Recognition and Diagnosis | 680 | ||
| Lifestyle Modifications | 682 | ||
| Activity restriction | 682 | ||
| Restriction of sexual activity | 682 | ||
| Home care | 682 | ||
| Suppression of Uterine Activity | 683 | ||
| Promotion of Fetal Lung Maturity | 684 | ||
| Antenatal glucocorticoids | 684 | ||
| Management of Inevitable Preterm Birth | 684 | ||
| Fetal and Early Neonatal Loss | 688 | ||
| PREMATURE RUPTURE OF MEMBRANES\t | 689 | ||
| Management | 689 | ||
| DYSTOCIA\t | 690 | ||
| Dysfunctional Labor | 690 | ||
| Hypertonic uterine dysfunction | 690 | ||
| Hypotonic uterine dysfunction | 690 | ||
| Secondary powers | 691 | ||
| Abnormal labor patterns | 691 | ||
| Precipitous labor. | 691 | ||
| Alterations in Pelvic Structure | 691 | ||
| Pelvic dystocia | 691 | ||
| Soft-tissue dystocia | 692 | ||
| Fetal Causes | 692 | ||
| Anomalies | 692 | ||
| Cephalopelvic disproportion | 692 | ||
| Malposition | 692 | ||
| Malpresentation | 693 | ||
| Multifetal pregnancy | 693 | ||
| Position of the Woman | 695 | ||
| Psychologic Responses | 695 | ||
| CARE MANAGEMENT\t | 695 | ||
| Obstetric Procedures | 695 | ||
| Version | 695 | ||
| External cephalic version. | 695 | ||
| Internal version. | 696 | ||
| Induction of labor | 696 | ||
| Cervical ripening methods | 698 | ||
| Chemical agents. | 698 | ||
| Mechanical methods. | 698 | ||
| Amniotomy. | 699 | ||
| Oxytocin. | 700 | ||
| Nursing considerations. | 701 | ||
| Augmentation of labor | 702 | ||
| Operative vaginal birth | 703 | ||
| Forceps-assisted birth | 703 | ||
| Management. | 703 | ||
| Nursing considerations. | 703 | ||
| Vacuum-assisted birth | 704 | ||
| Management. | 704 | ||
| Nursing considerations. | 704 | ||
| Cesarean birth | 705 | ||
| Indications. | 706 | ||
| Elective cesarean birth. | 706 | ||
| Forced cesarean birth. | 706 | ||
| Surgical techniques. | 706 | ||
| Complications and risks. | 707 | ||
| Anesthesia. | 707 | ||
| Scheduled cesarean birth | 707 | ||
| Unplanned cesarean birth | 708 | ||
| Prenatal preparation. | 708 | ||
| Preoperative care. | 708 | ||
| Intraoperative care. | 708 | ||
| Immediate postoperative care. | 710 | ||
| Postoperative or postpartum care. | 710 | ||
| Trial of labor | 713 | ||
| Vaginal birth after cesarean | 713 | ||
| POSTTERM PREGNANCY, LABOR, AND BIRTH\t | 714 | ||
| Maternal and Fetal Risks | 714 | ||
| CARE MANAGEMENT\t | 715 | ||
| OBSTETRIC EMERGENCIES\t | 715 | ||
| Meconium-Stained Amniotic Fluid | 715 | ||
| Shoulder Dystocia | 716 | ||
| Management | 716 | ||
| Prolapsed Umbilical Cord | 717 | ||
| Management | 718 | ||
| Rupture of the Uterus | 718 | ||
| Appendix Quality and Safety Competencies | 812 | ||
| Chapter 1 | 812 | ||
| Chapter 2 | 812 | ||
| Chapter 3 | 812 | ||
| Chapter 4 | 813 | ||
| Chapter 5 | 813 | ||
| Chapter 6 | 813 | ||
| Chapter 7 | 813 | ||
| Chapter 8 | 813 | ||
| Chapter 9 | 813 | ||
| Chapter 10 | 813 | ||
| Chapter 11 | 814 | ||
| Chapter 12 | 814 | ||
| Chapter 13 | 814 | ||
| Chapter 14 | 814 | ||
| Chapter 15 | 815 | ||
| Chapter 16 | 815 | ||
| Chapter 17 | 815 | ||
| Chapter 18 | 815 | ||
| Chapter 19 | 815 | ||
| Chapter 20 | 815 | ||
| Chapter 21 | 816 | ||
| Chapter 22 | 816 | ||
| Chapter 23 | 817 | ||
| Chapter 24 | 817 | ||
| References | 817 | ||
| Glossary | 818 | ||
| Index | 825 | ||
| A | 825 | ||
| B | 828 | ||
| C | 830 | ||
| D | 835 | ||
| E | 836 | ||
| F | 839 | ||
| G | 842 | ||
| H | 844 | ||
| I | 847 | ||
| J | 849 | ||
| K | 849 | ||
| L | 850 | ||
| M | 852 | ||
| N | 855 | ||
| O | 857 | ||
| P | 858 | ||
| Q | 864 | ||
| R | 864 | ||
| S | 865 | ||
| T | 869 | ||
| U | 871 | ||
| V | 873 | ||
| W | 874 | ||
| X | 874 | ||
| Y | 874 | ||
| Z | 874 | ||
| Special Features | IBC5 | ||
| CARE PATH | IBC5 | ||
| Critical Thinking/Clinical Decision Making | IBC5 | ||
| Cultural Considerations | IBC5 | ||
| EMERGENCY | IBC5 | ||
| EVIDENCE-BASED PRACTICE | IBC6 | ||
| Medication Guide | IBC6 | ||
| NURSING CARE PLAN | IBC6 | ||
| NURSING PROCESS | IBC6 | ||
| PATIENT INSTRUCTIONS FOR SELF-MANAGEMENT | IBC7 | ||
| Procedure | IBC7 | ||
| signs of POTENTIAL COMPLICATIONS | IBC7 | ||
| TEACHING GUIDELINES | IBC7 |