Team Faculty Of Nursing internship 💙

تاني تاني😂

خلال الحمل ال placenta بتشتغل كغده وبتفرز هرومونات تساعد علي استمرار الحمل.. 🔵hCG 》 ●ودا بيبدا بيظهر في دم الام بدايه من (اليوم العاشر) 🔟 وبيتقاس عن طريق الدم او البول ●وممكن ياكد الحمل لو موجود في البول بنسبه اكبر من > 50IU/L ●Peaks at 9-10 weeks ●بيحفز الجسم الاصفر يفرز الاستروجين والبروجستيرون الي حين نضوج الplacenta ●if hCG is high >> twins hydatidiform mole Choriocarcinoma Embryonal carcinoma ● if levels are low>> ectopic pregnancy , threatened abortion , or missed abortion can occur. 🔵progesterone 》 ●اهم وظيفه ليه انه بيسهل ال implantation وبيقلل الutrine contraction ●بيفرزه الجسم الاصفر لحد اليوم 35 بعد كدا بيتفرز من الPlacenta ●promotes smooth muscle relaxation  and raises body temperature. ●prevents preterm labor 🔵Estrogen (oestradiol) 》 ●Breast and nipple growth, ● and pigmentation of the areola ●Promote uterine blood flow, myometrial growth, cervical softening ●بيزود الحساسيه لمستقبلات الاوكسيتوسين في عضلات الرحم ●Water retention and protein synthesis. 🔵hPL/HCS》 📌ودا الهرمون اللي بيجهز جسم الام للbreast feeding ●Produced by syncytiotrophoblast ●له وظيفه وتركيب كميائي شبهه ال growth hormone ●بيظبط عمليه الايض (metabolism) عند الام عشان يزود الenergy اللي بتروح للجنين ●بيزود افراز الانسولين ولكنه بيقلل تأثيره المحيطي وبيقلل الحساسيه للانسولين 📌If levels are low>> , threatened abortion or intrauterine growth restriction (IUGR) can occur. ●Promotes fetal growth by regulating glucose available to the developing human. ●Stimulates breast development in preparation for lactation. 🔵Prostaglandin 📌بيزود الcontraction  اللي بتحصل في الuterus ودا اللي بدوره بيسهل الtransport of sperm 🔵الpitutary gland بيحصل فيها تضخم وهينتج عن التضخم دا زياده في شويه هرمونات🤏  >prolactin > plasma adreno _corticotrophic hormone (ACTH) >cortisone ◀️بس الكلام دا مش هيمشي علي كل الكورتيزون تؤ تؤ في مستويات اسمها unbound ودي من اسمها غير مقيده يعني مش مجبره دي مستواها هيفضل ثابت عادي مش هيزيد ❗️بس فيه هرمون بيحصله inhibit يعني تثبيط ودا ال Gonadotrophin هرمون الغدد التناسليه 📌اخر حاجه بالنسبه للغده النخاميه انها بتفرز الاوكسيتوسين من الفص الخلفي خلال الfirst stage of labor و خلال الsuckling عشان بيزود الكونتراكشن زي ما عرفت في العملي 🔵ال thyroid gland 👈كذلك بيحصل فيها تضخم ودا هيزود افراز ال T3 و الT4  (ثروكسين ) بس هيرجعو طبيعي بعد الحمل والهرمومات دي بتعدي للplacenta ولكن بنسب ضئيله جدا 👈اما الTSH هيقل شويه ولكن في المستوي الطبيعي 👈ال(thyroid-bindung globulin (TBG هيتضاعف 👈وال iodide هيقل 📌بالمختصر كله هيزيد ماعدا اتنينTSH و iodide __ ___ 💥مهم جداً 💥 🔵Estradiol »»»» during the nonpregnant 🔵 Estriol = estrogen »»»» during the pregnancy 🔵 Estrone »»»» during menopause

تعالى معايا هقولك حدوتة الهرمونات دي كلها 🙈 هتبدا معانا من ال menstrual بتبدا من👈 ال follicular phase ▶️ which starts on the first day of the period and ends with ovulation بيحصل فيها pituitary gland release ⟩⟩ FSH بيعمل ايه دا 🔻stimulates the growth of follicles Peak > before ovulation طب هي ايه ال follicles دي؟ 🔻Each follicle contains an egg. لما يحصل لواحده منهم development و تبقى mature بتبدا تفرز estrogen و اللي بدوره 🔻causes the endometrium to thicken و تبدا المرحلة التانية 👉ovulation phase when the dominant follicle releases its egg into the fallopian tube غالبا بنكون في ال 📌14 days before the next period egg can be fertilized > 12 to 24 hours after ovulation. 🔵The release of the egg also triggers a surge of another hormone called luteinizing hormone (LH) طب و الاخ دا بيعمل ايه دل اللي بيحول ال 🔻follicle to transform into a structure called the corpus luteum و  ايه لازمته ال corpus luteum دا في المرحلة التالتة واللي هي  The final phase 👉luteal phase 🔻The corpus luteum produces »  progesterone طب و انا ايه اللي وصلني ل هنا مهو دا اللي 📌maintain the endometrium for a potential pregnancy يعني نظريا دا اللي جابك هنا 👈👉 و هنا نخش بقى في حالتين اما يحصل fertilization او لا لو لا 🔻the corpus luteum degenerates "" 22-24th day of the cycle. "" and the levels of estrogen and progesterone drop. 🔻FSH and LH increase 🔻This causes the endometrium to break down and the cycle to start over again بملخص سريع تاني 🔵FSH > development follicles >Help follicle > to produce estrogen 🔵LH > Formation of corpus luteum >stimulates the corpus luteum to > produce progesterone ....... 👈اما لو حصل fertilization فا اولا 🔵FSH and LH: decrease; produced by the pituitary gland 🔵Progesterone and estrogen: increase; produced by the corpus luteum and the placenta و تبدا حياة الزيجوت كالاتي..

🔵Goodle's sign :softning of cervix 🔵Shadwik's sign: Bluish color of cervix and vagina 🔵 Ripening: Softning, shortening and dilation of cervix 🔵Hager's sign : Softning of isthmus of cervix 🔵Retraction: Cervical shortening

شابتر physiology of normal pregnancy • 3⃣ week 》 [  " 3⃣ " layer formation ] • Pre-embryonic stage》⟩ fertilization to 2⃣ WeeK • Fetal stage 》9⃣ WeeK to birth • Embryonic 》 2⃣ WeeK :  8⃣ WeeK • Ovum》》 24 to 48 h 🔘 • Sperm  》 24 : 72 h 〰〰 Sperm 300 : 600 million 〰〰 • seminal fluid 》3⃣ ml 🔵Miotic division ➗ 》 [ كل 12 ساعة ] • Morula . 》》 3⃣rd Day • Blastocyst 》》5⃣th Day • trophoblast development finger 》> 6⃣th Day • blastocysts تنغرس " implantation" بشكل كامل في بطانه الرحم وتسمي decidua  》 10th Day 🔻أول سته أسابيع تحديد الجنس indistinguishable يعني لا يمكن تحديده • surface of blastocyst covered by branching villi which best development at embryonic 》 16 to17 day 🔻1 trimester amniotic fluid produce b amniotic membrane 🔺2 , 3 trimester amniotic fluid produce by fetal kidney 🔵Peak of amniotic fluid 34 week 》 800:1000 "Decrease" 》 500:600 📌Hcg first appear 🔟 day Peak 9⃣ : 🔟 Week Falls 20:22 week • Corpus lutem produce Estrogen and progesterone for》 35 day • Placenta fully developed 8:10 week • 9 month : placenta 15:25 lobe thick 3 ,, weight 600g 🔻Positive > sign حاجه بنسمعها ونشوفها ونحسها 🔺Probable > هاجر بالونه ايجابيه Hagar's sign • ballotment " second movement of fetus "  positive pregnancy test • Uterine softer and thinner at term ○ 0,5 cm • Hypertrophy of uterus 》 20 Week • At term blood flow》 500:600ml/m • Increase Blood flow increase 40:50% ↗️Increase Plasma. 》》 30% ↘️Decrease Hgb 80% ⤴️Coagulability slightly increase Plug operculum (show) dislodge: early signs of pregnancy + formed 8w ↗️Breast increase 500 each one Veins in breast visible.   》》🎱  , 8⃣ WeeK • Montgomery's tubercles at 12th w,, (غدد بارزه حولين الحلمه ) 🤰Lordosis وضع للأم في نهايه الحمل • Last trimester dyspnea • Fetal sac 6⃣ : 7⃣ w . - بنشوفه بال ultra sound • measured head 》 13 WeeK ✦ Weight: Total Weight gain》 9:12 kg ,  و ممكن 》gain 17 kg First trimester >>> 1:2 kg - Second trimester >>> 6:7 kg - Third trimester >>> 3:4 kg

🔻 Position

أرقام postpartum

↳ Stages after delivery Acute phase first 24 h • Early phase first one week • Late Phase up to 6 weeks ↳ Stages after abortion • Early stage ten days • Late stage after 10 days • Uterus weight become 50mg • Healing Placenta site at 7th weeks ( 40 days ) ↳ Lochia • during first 4-6 weeks • Healing Large raw area left on inner uterine 2 Weeks • Maximum Bleeding in first 2-3 days ↳ Amount of lochia • Scanty 1 inch 2.5 cm • Light 4 inch 10 cm • moderate 6 inch 15.2 cm • Heavy one pad saturated whitin 1 hours • Excessive one pad saturated whitin 15 hours ↳ Cervix • immediately after delivery opening 2-3 cn • After 7 days opening for just tip of finger ↳ Vagina • Rugea reappear in third week ↳ Bowel elimination ↣ 2 to 3 days ↳ Cardiac output return ↣ 2 to 3 weeks ↳ Wight الست الحامل بتزيد ١٠ كجم Time of delivery of the baby 4kg After delivery loss due elimination of water 3kg ↳ Postpartum diuresis began within 12h continue 2-5 day • Spontaneous voiding 6-8 h • urine should be passed approximately 8-12h ↳ involution • Immediate after delivery ↣ halfway between the umbilicus and symphysis pubis • at 1h postpartum ↣ below slightly the level of the umbilicus • about 6-12h ↣ at level of umbilicus • within 12h ↣ Above 1/2 inch umbilicus • by 24 h ↣below 1/4 inch umbilicus • 10 - 14 days ↣ pelvic cavity

اهم نقاط  part 2 postpartum 🔵 Phases of maternal role(3): 👉.taking in phase: It takes 2-3 days, the woman reacts passively, most dependent on others 👉taking hold phase : Starts from 3rd day postpartum And lasts about 10 days Woman progress from passive individual to the one who is in command of the situation 👉.letting - go phase Generally occurs when mother returns home Characterstics :level of trust, level of self esteem, reactions to present pregnancy, interest in child rearing 🔵First priority for: 📌After pains :simple uterine massage 📌Engorged breast :apply moist warm packs before each feeding 📌Constipation :diet rich in roughage 📌Cracked nipple :proper technique of breastfeeding 📌Perineal discomfort :Frequent Perineal care Under aseptic technique 👉Breast :firm, heavy, swollen, tender, hot(37,80c)➡️breast engorgement 🔵في ال subsequent postpartum Assessment بتشوف ال REEDA R: redness E:edema E:eccymosis D: discharge A: approximation 🔵 Position Prone, sitting, knee chest✔️ Supine, semi setting ❌ 📌If women is not rubella immune :A rubella vaccination may be given and pregnancy must be Avoided for at least 3 months (12 week) الله المستعان الشابتر خلص ❤️😂

اهم نقاط part 1 postpartum 📌 👉Postpartum phases: 🔵Acute phase:  the first 24 hours after delivery of the placenta  🔵Early phase: up to 7 days  🔵 Late phase: up to 6 weeks to 6 months.   📌Involution of the uterus is the return of the uterus to its pre-pregnant 📌Immediately after birth the top of the fundus is in the midline and approximately halfway between the symphysis pubis and the umbilicus. 📌About 6 to 12 hours after birth, the fundus is at the level of the umbilicus. 📌At 7 days the fundus should be at the symphysis pubis. 📌 At 10-14 days the fundus should be back in the pelvic cavity and can't be palpated. 📌 At 6 weeks the uterus will be back at its size before pregnancy. 🔵Lochia Is the uterine discharge coming through the vagina during the first 3-4 weeks of the postpartum. 🔵 Is alkaline in reaction 👉Lochia rubra occurs in the first 3-4 days after childbirth. It is reddish in color . 👉Lochia serosa Brown color and then yellow over a period of about 1 week. 👉Lochia alba It is a whitish, turbid fluid which drains from the vagina for about another 1 - 2 weeks 🔵After pains It is more common ▪️in Multiparas  ▪️Multiple pregnancy ▪️Polyhydraminius ▪️ large-sized infant in diabetic mothers ▪️ Breastfeeding 📌Anew endometrium is finally healed and covered by a new endometrium by the end of 7th week approximately (40 days). 👉Postpartum diuresis begins within 12 hours after birth and continues for 2 to 5 days 👉A rapid pulse or increase pulse may indicate hypovolemia as result of hemorrhag 📌Ovulation may occur as early as 27 days after delivery. The average time is 70 to 75 days post-delivery and 190 days post-delivery if breastfeeding 👉 The first menses occurs approximately 4to 6 weeks after delivery in non-lactating mothers 👉In lactating mothers, menstruation usually reappears not earlier than 4-5 months 📌Loss of 4 kg.weight in time of delivery. 📌Colostrum is secreted in small quantities but is sufficient to meet the caloric needs of a normal newborn 🔵Transition milk : 1-2 weeks ⬇️ protein.. ⬆️Fat, ⬆️sugar Breast becomes full, hard, heavy 🔵Mature milk: This milk is thinner and watery

😌المهم ف محاضره Antenatal : اول حاجه الزيارات 👇: 1-6. ➡️Every month. 7-8➡️ every 2 weeks. 9 ➡️ every weeks. ✨ التحاليل اللي بتتعمل : Urine test Hemoglobin Hematocrit WBC. ✨ Allergic condition من ضمن Family history زي Asthma, eczema and fever. ازاي احسب يوم الولاده؟ لو اخر menstrual period كانت ف شهور السنه الاولي من شهر واحد لشهر سته : 1 day of LMP + 7days +9 months. لو اخر menstrual period كانت ف شهر السنه الاخيره : 1 day of LMP + 7 days - 3 months + 1 year. ➡️ The hair of healthy women is shiny and glossy. 💜 Healthy eyes are bright and clear. ⬅️ Height of over 150 cm indication of average sized pelvis. الام بتزيد من 10 الي 12 kg. ✨ Little or no maternal weight gain lead to fetal jeopardy. 🌸 Fetal heart is heard by sonicaid 10 weeks of Pregnancy. 🙃 Fetal heart is heard by pinard after 20 Week of Pregnancy. ✨ The Pregnancy woman report at least 10 movement in 12 hours. 💕 Absence of fetal movement preceds fetal death by 48 hours. ✨ Weight gain : First trimester 1-2 kg Second trimester 6-7 kg. Third trimester 3-4 kg. اهم حاجه ف ال Diet الكالسيوم والحديد. لازم تتجنب السكريات والدهون. ✨ Folic acid مسموح بيه ف First trimester لان بيمنع congenital anomalies. 💕 Kegal's exercise strengthen and tighten the perineal muscles. ✨ Pregnant woman should visits dentist twice during Pregnancy. ➡️ Side Lying position is recommended as it promotes uterine perfusion and fetoplacental oxygenation. Woman sleep 8 hours every nightand one to two hours afternoon. ✨ Not recommended to Massage the breast as this may stimulate oxytocin hormone secretion and possibly lead yo Abortion. 💜 The nipple shouldn't be touched during Pregnancy for the same reason. وبس كدا 😂 ♥️.

بالنسبه لجدول الزيارات لو جاب بالاسابيع بدل الشهور 🔻من  1 : 27 اسبوع يبقي اول 6 شهور تبقي الاجابه Once every moth 🔻من 28 : 36 اسبوع تبقي ف الشهر ال 7,8 و الاجابه هتكون Once every 2 weeks 🔻 من اول 36 ف الشهر9 لحد الولاده الاجابه هتبقي Once every week

بالنسبه لجدول الزيارات لو جاب بالاسابيع بدل الشهور 🔻من  1 : 27 اسبوع يبقي اول 7 شهور تبقي الاجابه Once every moth 🔻من 28 : 36 اسبوع تبقي ف الشهر ال 8 و الاجابه هتكون Once every 2 weeks 🔻 من اول 36 لحد الولاده الاجابه هتبقي Once every week

اهم نقاط  part 2 postpartum 🔵 Phases of maternal role(3): 👉.taking in phase: It takes 2-3 days, the woman reacts passively, most dependent on others 👉taking hold phase : Starts from 3rd day postpartum And lasts about 10 days Woman progress from passive individual to the one who is in command of the situation 👉.letting - go phase Generally occurs when mother returns home Characterstics :level of trust, level of self esteem, reactions to present pregnancy, interest in child rearing 🔵First priority for: 📌After pains :simple uterine massage 📌Engorged breast :apply moist warm packs before each feeding 📌Constipation :diet rich in roughage 📌Cracked nipple :proper technique of breastfeeding 📌Perineal discomfort :Frequent Perineal care Under aseptic technique 👉Breast :firm, heavy, swollen, tender, hot(37,80c)➡️breast engorgement 🔵في ال subsequent postpartum Assessment بتشوف ال REEDA R: redness E:edema E:eccymosis D: discharge A: approximation 🔵 Position Prone, sitting, knee chest✔️ Supine, semi setting ❌ 📌If women is not rubella immune :A rubella vaccination may be given and pregnancy must be Avoided for at least 3 months (12 week) الله المستعان الشابتر خلص ❤️😂

اهم نقاط part 1 postpartum 📌 👉Postpartum phases: 🔵Acute phase:  the first 24 hours after delivery of the placenta  🔵Early phase: up to 7 days  🔵 Late phase: up to 6 weeks to 6 months.   📌Involution of the uterus is the return of the uterus to its pre-pregnant 📌Immediately after birth the top of the fundus is in the midline and approximately halfway between the symphysis pubis and the umbilicus. 📌About 6 to 12 hours after birth, the fundus is at the level of the umbilicus. 📌At 7 days the fundus should be at the symphysis pubis. 📌 At 10-14 days the fundus should be back in the pelvic cavity and can't be palpated. 📌 At 6 weeks the uterus will be back at its size before pregnancy. 🔵Lochia Is the uterine discharge coming through the vagina during the first 3-4 weeks of the postpartum. 🔵 Is alkaline in reaction 👉Lochia rubra occurs in the first 3-4 days after childbirth. It is reddish in color . 👉Lochia serosa Brown color and then yellow over a period of about 1 week. 👉Lochia alba It is a whitish, turbid fluid which drains from the vagina for about another 1 - 2 weeks 🔵After pains It is more common ▪️in Multiparas  ▪️Multiple pregnancy ▪️Polyhydraminius ▪️ large-sized infant in diabetic mothers ▪️ Breastfeeding 📌Anew endometrium is finally healed and covered by a new endometrium by the end of 7th week approximately (40 days). 👉Postpartum diuresis begins within 12 hours after birth and continues for 2 to 5 days 👉A rapid pulse or increase pulse may indicate hypovolemia as result of hemorrhag 📌Ovulation may occur as early as 27 days after delivery. The average time is 70 to 75 days post-delivery and 190 days post-delivery if breastfeeding 👉 The first menses occurs approximately 4to 6 weeks after delivery in non-lactating mothers 👉In lactating mothers, menstruation usually reappears not earlier than 4-5 months 📌Loss of 4 kg.weight in time of delivery. 📌Colostrum is secreted in small quantities but is sufficient to meet the caloric needs of a normal newborn 🔵Transition milk : 1-2 weeks ⬇️ protein.. ⬆️Fat, ⬆️sugar Breast becomes full, hard, heavy 🔵Mature milk: This milk is thinner and watery

قال ﷺ " أفضل أيام الدنيا العشر" - يعني عشر ذي الحجة🤎. ــ ﴿وَذَكِّر فَإِنَّ الذِّكرَىٰ تَنفَعُ المُؤمِنِينَ﴾ 🤎.

. ' مُـحـاضـرات فـاينـل تولـيـد نـظـري ' . ↳ Orientation to midwifery course ↳ Normal post partum ↳ Physiology of Pregnancy ↳ Antenatal Care ↳ Labor

وكما قال الشاعر لما أسيب قسم التمريض في الإدارة، لازم أقول بوضوح إن الفترة اللي قضيتها هنا كانت مليانة مرارة. الإدارة فاشلة وتنظيمهم مفيش له أية اعتباره، كله عشوائية ومفيش احترام، والنظام زي الهبارا. أتمنى لكم التوفيق، عشان تحتاجوا معجزة حقيقية لتعدلوا أوضاعكم البعيدة عن الاستقامة، وداعًا بلا ندامة.

Types of skills 1.Cognitive (mental) هعرفك معلومات وعلوم اساسيه knowledge 2. Affective ( mental awareness ) اخد المعلومه ف مستوي الوعي وبقا عارف يعملها بس لسه مطبقهاش ودي بتغير من attitude , behaviour, values مكنش عارف يعمل حاجه بس بقا بيعرف يعملها 3.Psychomotor ( manuals movements ) مهاره اتعلمتها ف بطبقها ب ايدي واشتغل بيها بقا بيعرف يعمل بروسدجر ب ايده 4.Teaching بعلمها لغيري 5.Communication skills