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Nursing Care Plan (NCP) for Preterm Labor / Premature Labor

Nursing Care Plan (NCP) for Preterm Labor / Premature Labor

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Outline

Lesson Objectives for Preterm Labor / Premature Labor

 

  • Define Preterm Labor:
    • Understand the definition of preterm labor, also known as premature labor, as labor that occurs before 37 weeks of gestation.
  • Identify Risk Factors:
    • Recognize risk factors associated with preterm labor, including multiple pregnancies, infections, uterine abnormalities, and previous preterm births.
  • Recognize Signs and Symptoms:
    • Identify the signs and symptoms of preterm labor, such as regular uterine contractions, lower back pain, pelvic pressure, and changes in vaginal discharge.
  • Understand Complications:
    • Comprehend the potential complications of preterm labor, including respiratory distress syndrome in the newborn, developmental challenges, and other neonatal issues.
  • Learn Preventive and Management Strategies:
    • Familiarize oneself with preventive measures to reduce the risk of preterm labor, such as progesterone supplementation and lifestyle modifications.
    • Understand management strategies, including tocolytic medications and corticosteroids for fetal lung maturation.

Pathophysiology of Preterm Labor / Premature Labor

  • Uterine Contractions:
    • Preterm labor is characterized by regular and painful contractions of the uterus before 37 weeks of gestation.
    • These contractions lead to cervical dilation and effacement, initiating the process of labor prematurely.
  • Cervical Changes:
    • The cervix undergoes changes, including softening (effacement) and opening (dilation), allowing the fetus to descend into the birth canal prematurely.
    • These cervical changes contribute to the progression of labor.
  • Amniotic Membrane Rupture:
    • In some cases of preterm labor, there may be premature rupture of the amniotic membranes (premature rupture of membranes, PROM), leading to the release of amniotic fluid.
  • Incomplete Fetal Lung Development:
    • Preterm birth may result in insufficient time for the fetus’s lungs to fully develop, increasing the risk of respiratory distress syndrome and other neonatal complications.
  • Placental Insufficiency:
    • Preterm labor can lead to inadequate placental perfusion and function, potentially compromising fetal oxygen and nutrient supply.
    • Placental insufficiency may contribute to fetal distress and other complications.

Etiology of Preterm Labor / Premature Labor

  • Multiple Pregnancies:
    • The presence of twins, triplets, or higher-order multiples increases the risk of preterm labor due to increased uterine stretching and hormonal changes.
  • Infections:
    • Infections of the reproductive tract, such as bacterial vaginosis or urinary tract infections, can trigger an inflammatory response leading to preterm labor.
  • Uterine Abnormalities:
    • Structural abnormalities of the uterus, including bicornuate or septate uterus, may increase the risk of preterm labor.
  • Previous Preterm Birth:
    • Individuals with a history of preterm birth are at an increased risk of experiencing preterm labor in subsequent pregnancies.
  • Cervical Insufficiency:
    • Cervical incompetence, where the cervix is unable to support the growing fetus, can lead to premature cervical dilation and preterm labor.
  • Maternal Lifestyle Factors:
    • Certain lifestyle factors, such as smoking, substance abuse, and inadequate prenatal care, can contribute to an increased risk of preterm labor. Assess the patient’s lifestyle choices and habits to identify potential modifiable risk factors.
  • Maternal Medical Conditions:
    • Certain maternal medical conditions, such as diabetes, hypertension, and autoimmune disorders, may predispose individuals to preterm labor. Evaluate the patient’s medical history for the presence of such conditions that may impact pregnancy outcomes.
  • Placental Abnormalities:
    • Structural or functional abnormalities of the placenta, such as placental previa or placental abruption, can disrupt the normal blood flow to the uterus and contribute to preterm labor. Investigate the patient’s history for any indications of placental abnormalities.

Desired Outcome in the Management of Preterm Labor / Premature Labor

  • Delay or Prevention of Preterm Birth:
    • Aim to delay or prevent preterm birth, allowing for optimal fetal development and reducing the risk of neonatal complications.
  • Fetal Lung Maturation:
    • Facilitate fetal lung maturation through the administration of corticosteroids, improving respiratory outcomes for the newborn if preterm birth is imminent.
  • Management of Complications:
    • Manage and minimize complications associated with preterm labor, such as infections, placental insufficiency, and fetal distress.
  • Psychosocial Support:
    • Provide emotional support to the individual and their support system, addressing anxieties and concerns related to preterm labor.
  • Patient Education:
    • Educate the individual on signs and symptoms of preterm labor, preventive measures, and the importance of seeking prompt medical attention.

Preterm Labor / Premature Labor Nursing Care Plan

 

Subjective Data:

  • Regular/frequent contractions 
  • Dull backache
  • Pelvic pressure
  • Change in type of vaginal discharge

Objective Data:

  • Vaginal spotting or light bleeding 
  • Premature rupture of membranes 
  • Cervical dilation greater than 4cm

Nursing Assessment for Preterm Labor / Premature Labor

 

  • Contraction Monitoring:
    • Continuously monitor uterine contractions, assessing their frequency, duration, and intensity.
    • Use electronic fetal monitoring to evaluate fetal heart rate patterns during contractions.
  • Cervical Assessment:
    • Assess cervical dilation and effacement regularly to determine the progression of labor.
    • Use the Bishop score or other tools to assess cervical readiness for labor.
  • Amniotic Membrane Integrity:
    • Monitor for signs of premature rupture of membranes (PROM) through assessment of amniotic fluid leakage.
    • Test vaginal fluid for pH and ferning patterns to confirm rupture.
  • Fetal Well-being:
    • Implement continuous electronic fetal monitoring to assess fetal heart rate patterns.
    • Assess for signs of fetal distress, such as variable decelerations or decreased variability.
  • Maternal Vital Signs:
    • Monitor maternal vital signs regularly, including blood pressure, heart rate, and temperature.
    • Assess for signs of infection, such as fever or chills.
  • Laboratory Tests:
    • Perform laboratory tests, including a complete blood count (CBC) and cultures if infection is suspected.
    • Monitor for signs of systemic inflammatory response.
  • Psychosocial Assessment:
    • Assess the individual’s emotional well-being and coping mechanisms.
    • Identify concerns, fears, and stressors related to preterm labor.
  • Patient Education:
    • Educate the individual on the importance of adhering to prescribed bed rest or activity restrictions.
    • Provide information on medications, potential side effects, and signs requiring immediate medical attention.

 

Implementation for Preterm Labor / Premature Labor

 

  • Tocolytic Medications:
    • Administer tocolytic medications as prescribed to inhibit uterine contractions and delay preterm labor.
    • Monitor the individual’s response to medications and assess for any adverse effects.
  • Corticosteroid Administration:
    • Administer corticosteroids (e.g., betamethasone) to enhance fetal lung maturity.
    • Educate the individual on the purpose and potential benefits of corticosteroid therapy.
  • Hydration and Bed Rest:
    • Encourage adequate hydration to maintain amniotic fluid levels and uterine perfusion.
    • Prescribe and reinforce the importance of bed rest or modified activity to reduce uterine activity.
  • Antibiotic Therapy:
    • Administer antibiotics if indicated for the management of infections associated with preterm labor.
    • Monitor for signs of infection resolution and potential side effects.
  • Psychosocial Support:
    • Provide emotional support and counseling to address anxiety and concerns related to preterm labor.
    • Collaborate with social services or support groups for additional psychosocial support.

Nursing Interventions and Rationales

 

Nursing Intervention (ADPIE) Rationale
Obtain gynecological and obstetrical history from the patient Previous preterm labor or pregnancies too close together can increase the risk of preterm labor. Determine what symptoms began and when. 
Assess the patient’s vital signs Get a baseline set of vitals before any interventions
Place external fetal monitoring device to monitor fetal activity/ heart rate and contractions This allows you to observe and monitor the frequency and quality of contractions as well as notice any signs of fetal distress 
Place the patient in a position of comfort on the left side Positioning patient in the left side-lying position may help with comfort, reduce contractions and maintain maternal-fetal blood flow 
Initiate IV access and administer medications:

Magnesium sulfate

Antiemetics

Tocolytics

Corticosteroids

Antibiotics

Analgesics

 IV fluids should be given to prevent or treat dehydration, which can cause premature labor. Medications are given to try to stop labor from progressing, or to prepare for delivery.

Magnesium sulfate- to relax the uterus and stop contractions

Antiemetics – to control nausea

Tocolytics – to stop labor from progressing

Corticosteroids – to speed up fetal lung maturity

Antibiotics – prophylactic if membranes have ruptured

Analgesics – to manage pain
Perform vaginal exam to assess for dilation and effacement Avoid multiple digital exams if membranes have ruptured. Determine progression, if any, of labor. If the cervix is dilated >4 cm, it may not be possible to stop labor from progressing. 
Provide patient education:

Symptoms of early labor

When to notify the doctor

How to time contractions

Avoid smoking

Avoid alcohol and substance abuse

Nutrition

Chronic condition management

 Educate patients and caregivers regarding warning signs and symptoms, a healthy diet, and lifestyle choices to help prevent repeat preterm labor.

Encourage patients to properly manage chronic medical conditions to prevent further labor symptoms.
If labor cannot be stopped, prepare the patient for delivery In cases where labor cannot be stopped, prepare patients for delivery by providing education and information, resources for family members, and emotional support. 

Evaluation

 

  • Effectiveness of Tocolytic Therapy:
    • Evaluate the effectiveness of tocolytic medications in inhibiting uterine contractions and delaying preterm labor.
    • Assess the need for adjustments in medication dosage or type.
  • Fetal Lung Maturity:
    • Monitor the timing and effectiveness of corticosteroid administration in enhancing fetal lung maturity.
    • Evaluate the impact on neonatal respiratory outcomes.
  • Maternal and Fetal Well-being:
    • Assess maternal vital signs regularly to ensure stability and monitor for signs of complications.
    • Evaluate continuous electronic fetal monitoring to assess fetal well-being.
  • Resolution of Signs and Symptoms:
    • Monitor for the resolution of signs and symptoms associated with preterm labor.
    • Assess for a decrease in uterine contractions and improvements in cervical status.
  • Psychosocial Well-being:
    • Evaluate the impact of psychosocial support interventions on the individual’s emotional well-being.
    • Assess coping mechanisms and adjust support strategies as needed.

References

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Example Nursing Diagnosis For Nursing Care Plan (NCP) for Preterm Labor / Premature Labor

  1. Risk for Preterm Birth: Preterm labor is a risk factor for delivering a premature infant. This diagnosis highlights the potential for preterm delivery.
  2. Anxiety: Patients experiencing preterm labor may feel anxious about the health of the baby. This diagnosis addresses their emotional well-being.
  3. Risk for Maternal Injury: Preterm labor can have maternal risks, including infection and uterine rupture. This diagnosis emphasizes potential maternal harm.

Transcript

Hey guys, today, we are going to be creating a nursing care plan for preterm labor and premature labor. So, let’s get started. First, we want to talk about the pathophysiology. So, when the body begins preparing for earlier than expected; normal pregnancy usually lasts around 40 weeks, but in preterm labor contractions cause the cervix to begin to change and open before 37 weeks’ gestation nursing considerations, you want to be sure you’re going to get a full gynecological obstetric history, assess vital signs, place the fetus on a monitor, position the patient on their left side. Make sure you have IV access for fluids, medications, complete a vaginal exam, and provide patient education. Some desired outcomes: labor will be suppressed, and pregnancy maintained until fetal maturity. 

So, we’re going to go ahead and get started on the care plan. We’re going to make sure that we’re going to put in here some subjective data of what the patient may tell you or some objective data that we’re going to see in a patient. So, one of the big things is going to be some frequent contractions. Mom will have frequent contractions and also any sort of vaginal spotting or bleeding. And also, you’re going to notice for any sort of preterm labor that the cervix is going to be dilated greater than four centimeters. So, if you think for a full centimeter, like the 10 centimeters across here, it’s just going to be dilated just a little bit, to like, probably about here. So, some nursing interventions that we’re going to do for this patient, we want to make sure we’re getting a full history from the mom. So, you want to know if they’ve had any preterm labor or pregnancies that have been too close together in the past, because that can increase the risk of preterm labor and also determine what symptoms began and when they began. You also want to make sure we’re getting vital signs on the mom. So, you want to get a baseline set of vitals before any sort of intervention. Other things we want to do we want to place an external fetal monitor on the mom. This is going to allow you to observe and monitor the frequency and quality of the contractions that the mom is having as well as notice any sort of signs of fetal distress – very, very important. We want to make sure we’re placing the patient in a comfortable position on the left side, which is important. This will provide comfort as well as making sure we’re reducing contractions and maintaining the maternal fetal blood flow. We want to make sure we have IV access for fluids and medications. Certain medications that we might give are some magnesium sulfate, antiemetics, tocolytics, corticosteroids, antibiotics, or analgesics. So, fluids, we want to make sure that we’re treating for dehydration as dehydration can be a major cause of preterm labor also if medications are given and able to stop the preterm labor and also progress from having delivery. We want to perform a vaginal exam, so we want to make sure we’re assessing for that dilation, and again, dilation preterm is greater than four centimeters. We want to make sure we’re providing patient education. So, any symptoms of early labor, we want to make sure we’re educating the patient on when to notify the physician and how time she has been contracting for or how much time that has been between the contractions for the mom, making sure she’s avoiding smoking, she’s avoiding any sort of alcoholic intake and making sure that she’s having proper nutrition throughout her pregnancy. And so, if preterm labor cannot be stopped, we want to make sure we’re preparing the patient for delivery. So, we’re going to give them education resources and above all give them emotional support, because this can be pretty stressful for the mom, especially since she’s not at that 40-week mark and is a lot earlier. So, we want to make sure that we’re there for her in addressing any sort of questions or concerns that she or any family member may have. 

So key points we want to go back over. So, the body begins preparing for delivery earlier than expected. Normal pregnancy lasts about 40 weeks, but in preterm, contractions cause the cervix to begin and open before 37 weeks. Causes that may cause the preterm labor: hypertension, pregnancy with multiple babies, previous babies, abdominal trauma, poor prenatal care, and the use of alcohol or street drugs, which is very common. Some subjective and objective data that you will see with these moms: they’ll have regular frequent contractions, a dull back ache, pelvic pressure, change in the type of discharge, vaginal spotting, lightly pre rupture of the membrane. So, PROM and cervical dilation greater than four centimeters. We want to assess vital signs and we want to make sure that we’re monitoring the fetus. Make sure that there’s no fetal distress. We want to give them some medications and of course education. So, we want to give fluids, make sure that the mom is hydrated, because dehydration is a major cause of preterm labor and any medications to stop preterm labor. We want to educate the patient on decreasing preterm labor and surgery if they end up having surgery. 

So, you guys are doing great. It was a great care plan for today. We love you guys. Go out, be your best self today and as always happy nursing.

 

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Nursing Care Plan (NCP) for Hemophilia
Nursing Care Plan (NCP) for Hepatitis
Nursing Care Plan (NCP) for Herpes Zoster – Shingles
Nursing Care Plan (NCP) for Hydrocephalus
Nursing Care Plan (NCP) for Hyperemesis Gravidarum
Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Hypoglycemia
Nursing Care Plan (NCP) for Hypoparathyroidism
Nursing Care Plan (NCP) for Hypothyroidism
Nursing Care Plan (NCP) for Impaired Gas Exchange
Nursing Care Plan (NCP) for Imperforate Anus
Nursing Care Plan (NCP) for Impetigo
Nursing Care Plan (NCP) for Incompetent Cervix
Nursing Care Plan (NCP) for Infection
Nursing Care Plan (NCP) for Infective Conjunctivitis / Pink Eye
Nursing Care Plan (NCP) for Inflammatory Bowel Disease (Ulcerative Colitis / Crohn’s Disease)
Nursing Care Plan (NCP) for Influenza
Nursing Care Plan (NCP) for Leukemia
Nursing Care Plan (NCP) for Lymphoma (Hodgkin’s, Non-Hodgkin’s)
Nursing Care Plan (NCP) for Marfan Syndrome
Nursing Care Plan (NCP) for Maternal-Fetal Dyad Using GTPAL
Nursing Care Plan (NCP) for Meningitis
Nursing Care Plan (NCP) for Mood Disorders (Major Depressive Disorder, Bipolar Disorder)
Nursing Care Plan (NCP) for Multiple Sclerosis (MS)
Nursing Care Plan (NCP) for Nephrotic Syndrome
Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida
Nursing Care Plan (NCP) for Neutropenia
Nursing Care Plan (NCP) for Newborns
Nursing Care Plan (NCP) for Nutrition Imbalance
Nursing Care Plan (NCP) for Omphalocele
Nursing Care Plan (NCP) for Osteoarthritis (OA), Degenerative Joint Disease
Nursing Care Plan (NCP) for Osteoporosis
Nursing Care Plan (NCP) for Otitis Media / Acute Otitis Media (AOM)
Nursing Care Plan (NCP) for Paranoid Disorders
Nursing Care Plan (NCP) for Parkinson’s Disease
Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice
Nursing Care Plan (NCP) for Pericarditis
Nursing Care Plan (NCP) for Personality Disorders
Nursing Care Plan (NCP) for Pertussis / Whooping Cough
Nursing Care Plan (NCP) for Phenylketonuria (PKU)
Nursing Care Plan (NCP) for Pneumonia
Nursing Care Plan (NCP) for Pneumothorax/Hemothorax
Nursing Care Plan (NCP) for Polycystic Ovarian Syndrome (PCOS)
Nursing Care Plan (NCP) for Post-Traumatic Stress Disorder (PTSD)
Nursing Care Plan (NCP) for Postpartum Hemorrhage (PPH)
Nursing Care Plan (NCP) for Preterm Labor / Premature Labor
Nursing Care Plan (NCP) for Psoriasis
Nursing Care Plan (NCP) for Pulmonary Embolism
Nursing Care Plan (NCP) for Respiratory Failure
Nursing Care Plan (NCP) for Restrictive Lung Diseases
Nursing Care Plan (NCP) for Reye’s Syndrome
Nursing Care Plan (NCP) for Rhabdomyolysis
Nursing Care Plan (NCP) for Rheumatic Fever
Nursing Care Plan (NCP) for Rheumatoid Arthritis (RA)
Nursing Care Plan (NCP) for Risk for Fall
Nursing Care Plan (NCP) for Schizophrenia
Nursing Care Plan (NCP) for Scoliosis
Nursing Care Plan (NCP) for Seizures
Nursing Care Plan (NCP) for Sepsis
Nursing Care Plan (NCP) for Sickle Cell Anemia
Nursing Care Plan (NCP) for Skin cancer – Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma
Nursing Care Plan (NCP) for Skull Fractures
Nursing Care Plan (NCP) for Somatic Symptom Disorder (SSD)
Nursing Care Plan (NCP) for Spinal Cord Injury
Nursing Care Plan (NCP) for Stomach Cancer (Gastric Cancer)
Nursing Care Plan (NCP) for Stroke (CVA)
Nursing Care Plan (NCP) for Suicidal Behavior Disorder
Nursing Care Plan (NCP) for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)
Nursing Care Plan (NCP) for Tonsillitis
Nursing Care Plan (NCP) for Transient Tachypnea of Newborn
Nursing Care Plan (NCP) for Tuberculosis
Nursing Care Plan (NCP) for Urinary Tract Infection (UTI)
Nursing Care Plan for (NCP) Autism Spectrum Disorder
Nursing Care Plan for (NCP) Fetal Alcohol Syndrome (FAS)
Nursing Care Plan for Amputation
Nursing Care Plan for Cirrhosis (Liver)
Nursing Care Plan for Endometriosis
Nursing Care Plan for Fibromyalgia
Nursing Care Plan for Macular Degeneration
Nursing Care Plan for Newborn Reflexes
Nursing Care Plan for Scleroderma
Nursing Case Study for (PTSD) Post Traumatic Stress Disorder
Nursing Case Study for Breast Cancer
Overview of Childhood Growth & Development
Overview of Developmental Theories
Palliative Care for Progressive Care Certified Nurse (PCCN)
Patient and Healthcare Team Safety (Disasters, Environmental Hazards) for Certified Perioperative Nurse (CNOR)
Patient Communication Techniques for Certified Perioperative Nurse (CNOR)
Patient Safety for Certified Emergency Nursing (CEN)
Patients with Communication Difficulties
Pediatric Oncology Basics
Phases of Nurse-Client Relationship
Phenylketonuria
Piaget’s Theory of Cognitive Development
Pituitary Adenoma
Planning Community Health Interventions Nursing Mnemonic (PRECEDE-PROCEED)
Post-Traumatic Stress Disorder (PTSD)
PPE Precautions (Personal Protective Equipment) for Certified Perioperative Nurse (CNOR)
Practice Settings
Preoperative (Preop)Assessment
Product Evaluation and Selection for Certified Perioperative Nurse (CNOR)
Program Planning
Response to Diversity for Progressive Care Certified Nurse (PCCN)
RN to MSN
Schizophrenia Case Study (45 min)
Septic Shock (Sepsis) Case Study (45 min)
Social Effects on Health, Illness, and Disability
Stress and Crisis
Surgical Attire Guideline Adherence (Surgical, Perioperative Zones) for Certified Perioperative Nurse (CNOR)
Transportation and Storage (Single Use Items) for Certified Perioperative Nurse (CNOR)
Trauma Surgery – Medical History Nursing Mnemonic (AMPLE)
Absolute Reticulocyte Count (ARC) Lab Values
Access to Care
Adult Vital Signs (VS)
Advance Directives
Brief CPR (Cardiopulmonary Resuscitation) Overview
Community Aggregates
Continuity of Care
Day in the Life of a Community Health Nurse
Developmental Considerations for the Hospitalized Individual
Erikson’s Theory of Psychosocial Development
Family Structure and Impact on Development
Famotidine (Pepcid) Nursing Considerations
Growth & Development – Early Adulthood
Growth & Development – Late Adulthood
Growth & Development – Middle Adulthood
Growth & Development -Transitioning to Adult Care
Head to Toe Nursing Assessment (Physical Exam)
Human Trafficking for Certified Emergency Nursing (CEN)
Kohlberg’s Theory of Moral Development
Macro and Micronutrients
Nursing Care and Pathophysiology for Chlamydia (STI)
Nursing Care and Pathophysiology for Gonorrhea (STI)
Nursing Care and Pathophysiology for Human Papilloma Virus (HPV STI)
Nursing Care and Pathophysiology for Influenza (Flu)
Nursing Care Delivery Models
Nursing Care Plan (NCP) for Anxiety
Nursing Care Plan (NCP) for Aortic Aneurysm
Nursing Care Plan (NCP) for Appendicitis
Nursing Care Plan (NCP) for Asthma
Nursing Care Plan (NCP) for Asthma / Childhood Asthma
Nursing Care Plan (NCP) for Bowel Obstruction
Nursing Care Plan (NCP) for Burn Injury (First, Second, Third degree)
Nursing Care Plan (NCP) for Dehydration & Fever
Nursing Care Plan (NCP) for Epiglottitis
Nursing Care Plan (NCP) for Gastroesophageal Reflux Disease (GERD)
Nursing Care Plan (NCP) for Herpes Zoster – Shingles
Nursing Care Plan (NCP) for Hydrocephalus
Nursing Care Plan (NCP) for Lymphoma (Hodgkin’s, Non-Hodgkin’s)
Nursing Care Plan (NCP) for Mood Disorders (Major Depressive Disorder, Bipolar Disorder)
Nursing Care Plan (NCP) for Nephrotic Syndrome
Nursing Care Plan (NCP) for Newborns
Nursing Care Plan (NCP) for Nutrition Imbalance
Nursing Care Plan (NCP) for Osteoporosis
Nursing Care Plan (NCP) for Otitis Media / Acute Otitis Media (AOM)
Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice
Nursing Care Plan (NCP) for Personality Disorders
Nursing Care Plan (NCP) for Pertussis / Whooping Cough
Nursing Care Plan (NCP) for Pneumonia
Nursing Care Plan (NCP) for Reye’s Syndrome
Nursing Care Plan (NCP) for Risk for Fall
Nursing Care Plan (NCP) for Scoliosis
Nursing Care Plan (NCP) for Urinary Tract Infection (UTI)
Nursing Care Plan for Macular Degeneration
Nutritional Requirements
Patient Education
Piaget’s Theory of Cognitive Development
Pituitary Gland