MCN

1. How can you care for a pregnant woman who are physically challenged? Ans: *Transportation Ask if a woman has transportation for prenatal care and for emergencies.
Pregnancy counseling Assess the special modifications of care that will need to be made depending on a womans special challenge. Use additional visual or auditory aids to make your teaching points clear. *Support person Determine who is the womans support person. In some instances, a womans condition requires so much assistance during pregnancy that one support person will not be enough. If necessary, contact community agencies to lend additional support, with her consent. *Health Do not lose track of a womans primary health problem. For example, a woman with cerebral palsy may need to continue an active muscle exercise program during pregnancy for her primary illness *Work Assess whether a woman works outside her home and, if work is discontinued during pregnancy, what she could substitute for a social contact activity. Women with physical or cognitive challenges may be lonely because they do not have a wide range of friends or social contacts. *Recreation Assess whether her level of activity is adequate, and make concrete suggestions within her limitations for increasing it. Many women with a physically challenging condition lead a rather sedentary life (partly because they do not have many social contacts). *Self-esteem Assess a womans level of self-esteem: it may be low because of repeated failures in her life. Give praise at prenatal visits and help her make pregnancy a growth experience

2. Consider the fourfold developmental tasks of the average adolescent. How can you help a pregnant adolescent in terms of giving medication, sexual relationship, and establishing her sense of identity? Provide concrete examples. Ans: for example, the decision that the adolescent must make about where to place a medication reminder chart: if it hangs in the kitchen, her mother may monitor it; in her bedroom or in her school locker, she alone will monitor it. Pregnancy may interfere with the development of a healthy sexual relationship and cause difficulty in establishing future intimate relationships if a girl realizes that her current relationship has led to a situation detrimental to her. To prevent this, it is useful to help her view the pregnancy as a growth-producing experience. Encouraging her to continue school is crucial to her self-esteem and to her future, as well as to the future of her unborn child. 3. List 6 factors that contribute to lack of prenatal care among adolescent pregnant women. Ans:
Denial she is pregnant Lack of knowledge of the importance of prenatal care Dependence on others for transportation Feeling awkward in a prenatal setting (an adult setting) Fear of a first pelvic examination Difficulty relating to authority figures

4. Explain nest building. Ans: Third Trimester: preparing for parenthood Woman: 1. couples usually begin nest-building activities such as planning the infants sleeping arrangements, buying clothes, choosing a name for the infant, and ensuring a safe passage by learning about birth. 2. Preparations are evidence that women are completing the task of preparing for parenthood. 5. How can you help pregnant teens tell their parents about their pregnancy? Ans: step 1: plan things out first, its always great to have a plan on how things might go before u actually do it step 2: try to let them know as soon as possible step 3: it helps if the parents are in a good mood step 4: sit them down and tell them in a cool, calm, respective matter 6. How important is the family profile information? Ans: Asking about home life may reveal a dysfunctional family or an incest relationship as the cause of the pregnancy. If the girl is under legal age, incest is considered child abuse. Know your local and state laws on this topic and make the necessary report. 7. What can you teach pregnant teens regarding pregnancy education, nutrition and activity and rest? The pregnant woman over age 40. Ans: Eat a high-protein diet because protein makes your hair shiny (or prevents split fingernails) often leads to better adherence than a statement such as Protein is good for your baby. Taking the iron supplement should make you feel less tired is better than It will help build the babys blood supply, for the same reason.
Age 40: Assess the number of meals a woman eats outside her home each week, including those she packs for lunch or eats in restaurants. She may need tips on how to adjust pregnancy nutrition so she can obtain the same nutrition whether she prepares meals at home or eats them at an office or community function. Urge her to substitute a caffeine-free soft drink in place of an alcoholic beverage. In some offices, large amounts of coffee are consumed. Urge her to substitute milk or juice or decaffeinated coffee. Many women this age normally

drink little milk. Rather than getting used to milk again, a woman may appreciate suggestions on other ways to ingest calcium, such as puddings or yogurt.

1. Explain the developmental challenge of this age group. a. How can you help her in her feelings of ambivalence,. b. Site important issues related to her work priorities or career.

Ans: Pregnancy Options Counseling Points for the Ambivalent Patient 1. Clarify the facts the actual timing of pregnancy and possibility that the patient may not need to decide today. 2. Normalize feelings of ambivalence. 3. Acknowledge common feelings such as shame, disappointment, guilt and regret. 4. Reframe the situation she may be making the most responsible decision by NOT continuing the pregnancy. 5. Reassure and encourage her to trust and respect herself and her decision.
2. How important is chromosomal assessment during pregnancy at these ages? Ans: Women over 35 are offered a triple-screen (alpha-fetoprotein [AFP], human chorionic gonadotropin, and unconjugated estriol levels) drawn on blood serum at the 15th week of pregnancy to detect whether an open spinal cord or chromosomal defect could be present in the fetus, because their risk for Down syndrome is so much higher than it is in younger women, an incidence of about 1 in 1000 compared to 1 in 1500 in younger women. 3. List 4 complications/ difficulties among pregnant woman over age 40 Trauma and pregnancy Ans. 1. Do not stand on stepstools or stepladders (it is difficult
to maintain balance on a narrow base). 2. Keep small items such as footstools out of pathways (a pregnant woman has difficulty seeing her feet). 3. Always use a seat belt while driving or as a passenger in an automobile 4. Refuse to ride with anyone in an automobile who has been drinking alcohol or whose judgment might be impaired

1. Why are pregnant woman of this age prone to trauma especially in the last trimester. How can you help prevent accidents Ans. A high incidence occurs during the last trimester because of poor balance and fainting from hyperventilation. Accidents occur more frequently in people under stress than in those with little stress in their lives because, under stress, people concentrate on the stressor, not their immediate surroundings. Because pregnancy is a life event that may cause stress in a familys life, a woman and her family should take extra precautions for safety during this time. Pregnancy counseling should include education about ways to avoid accidents and trauma such as automobile seat belt use.

2. List 5 nursing diagnosis with etiology for pregnant woman with trauma. Ans.
Fear related to threat of injury to the fetus Risk for fetal injury related to apparent suicide attempt Ineffective tissue perfusion related to severed artery Ineffective breathing pattern related to lung lacerated by gunshot wound Situational low self-esteem related to occurrence of accident

Chapter 24 Nursing care of a family during Cesarean birth 1. List indications for cesarean birth. Ans:
Maternal Factors Active genital herpes or perhaps human papillomavirus AIDS or HIV-positive status Cephalopelvic disproportion Maternal Factors Active genital herpes or perhaps human papillomavirus AIDS or HIV-positive status Cephalopelvic disproportion Cervical cerclage Disabling conditions, such as severe hypertension of pregnancy, that prevent pushing to accomplish the pelvic division of labor Failed induction or failure to progress in labor Obstructive benign or malignant tumor Previous cesarean birth by classic incision Electiveno indicated risks Placenta Factors Placenta previa Premature separation of the placenta Umbilical cord prolapse Fetal Factors Compound conditions such as macrosomic fetus in a breech lie Extreme low birth weight Fetal distress Major fetal anomalies, such as hydrocephalus Multigestation or conjoined twins Transverse fetal lie .

2.Effects of surgery on a woman: How does the Adrenal medulla respond to pregnancy?
Ans: Whenever the body is subjected to stress, either physical or

psychosocial, it responds with measures to preserve the function of major body systems. This results in release of epinephrine and norepinephrine from the adrenal medulla. Epinephrine causes an increased heart rate, bronchial dilatation, and elevation of the blood glucose level. It also leads to peripheral vasoconstriction, which forces blood to the central circulation and increases blood pressure. These normally positive responses (the person is tensed or ready for action with good heart and lung function and glucose for energy) may antagonize anesthetic action, which is aimed at minimizing body activity. In the pregnant woman, such responses may minimize blood supply to the lower extremities. The woman is already prone to thrombophlebitis from stasis of blood flow, so these responses compound or greatly increase the risk of thrombophlebitis. Combined with interferences to major body systems, these effects can add to the risks of surgery.

2. What is the usual amount of blood that is lost with CS? Ans: During a vaginal birth, a woman loses 300 to 500 mL of blood. This loss increases to 500 to 1000 mL with a cesarean birth. 3. How can deep breathing help to prevent complications preoperatively? Ans: Periodic deep breathing exercises fully aerate the lungs and help to prevent the stasis of lung mucus from the prolonged time spent in the supine position during surgery. Because stasis always has the potential to cause infection, preventing this helps prevent lung infection such as pneumonia. A typical exercise is to take 5 to 10 deep breaths every hour. Teach a woman to do this simply by inhaling as deeply as possible, holding her breath for a second or two, and then exhaling as deeply as possible. Be certain she inhales and exhales fully. Otherwise, she might experience lightheadedness from hyperventilation.

Chapter 25 nursing care of a family experiencing a postpartal complications 1. List assessment of postpartal complications. What are its indications? Refer to box 25.2 Ans: 1. Elevated
temperature

2.

Pallor

3.Pain and swelling

4. relaxed uterus

5. uterine hemorrhage 6.Abdominal pain 7. Pain of symphysis pubis on walking 8. Lochia with foul odor
9. Feeling of extreme sadness or unreality 10. Thready, rapid, weak pulse 11. Decreased blood pressure 12. Pain and tenderness in calf of leg 13. Positive Homans sign 14. Perineal pain

Chapter 28
1. Explain the following factors that influence growth and development. In few words a. Genetics ans: Although each child is unique, certain gender-related characteristics will influence growth and development. In addition to physical characteristics such as eye color and height potential, inheritance determines other characteristics such as learning style and temperament. An individual may also inherit a genetic abnormality, which could result in disability or illness at birth or later in life. B. Gender Ans: On average, girls are born lighter (by an ounce or two) and shorter (by an inch or two) than boys. Boys tend to keep this height and weight advantage until prepuberty, at which time girls surge ahead because they begin their puberty growth spurt 6 months to 1 year earlier than boys. By the end of puberty (14 to 16 years), boys again tend to be taller and heavier than girls.

c. Ordinal position in the family ans: The position of a child in the family (first-born child, middle child, youngest child, only child) and the size of the family have some bearing on a childs growth and development. An only child or the oldest child in a family, for example, generally excels in language development because conversations are mainly with adults. Youngest children may develop language more slowly, especially if older children talk baby talk with them. Children learn by watching other children, however, so a youngest child who has many examples to watch may excel in other skills, such as toilet training at an early age.

d. socio economic ans: Because health care and good nutrition both cost money, children born into families of low socioeconomic means may not receive adequate health supervision or good nutrition. Poor health supervision can leave them without immunization against measles or other childhood illnesses and therefore vulnerable to diseases that could cause permanent neurologic damage if complications occur. Poor nutrition can also leave them vulnerable to disease as antibody formation depends on a good protein intake