HUMAN DEVELOPMENT – Decrease iodine causes goiter can cause

NUTRITION hypothyroidism in infant (mental retardation) and

• Normal Prepregnancy BMI is 18.5-24.9 thyroid enlargement in infant can cause airway
• Normal weight gain is problem.
– 1lbs/month on first trimester, – Iodine best source is seafood
– 1lbs/week on second and third trimester • Iron for hemoglobin, 20 weeks fetus stores iron in liver for 3
• Underweight causes preterm labor and LBW months in life, to increase red cell volume for blood lost
• Overweight causes fetal death during delivery
Calories (kcal) 2,200 2,500 – Iron rich foods organ meat, green leafy
vegetables, whole grains, enriched breads
Protein (g) 46-50 60 • Fluoride for teeth formation. Can be found in water.
Excessive fluoride causes brown stained teeth.
• Sodium causes water retention (increase heart strain and
CALORIES
blood volume)
• Increase calories for
• Zinc for synthesis DNA and RNA. Usually on protein
– fetal energy and placenta,
sources (meat, liver, eggs, milk, seafood),
– for elevated metabolism (thyroid function and
– antagonistic with iron and folic acid, causes fetal
increase workload due to increase weight) and
CNS malformation
milk production
Fluid
• Sources are from protein, CHON, fats
• Remove toxins
• Decrease calories lead to ketoacidosis (causes fetal and
• 6 glasses for more
neurologic disorder)
Fibers
• Indicator of adequate caloric intake: weight gain
• Common constipation due to decrease peristalsis from
Protein
pressure
• For fetus (growth, amniotic fluid, placenta)
• Vegetables
• For mother (uterus, mammary glands, RBC, plasma
• Lowers cholesterols and removes carcinogens
volume and protein, milk protein during lactation, uterus
Foods to Avoid
• Protein sources are meat, poultry, fish, legumes (beans,
• Caffeine is CNS stimulant (increase HR, urine production
peas, peanuts) yogurt, eggs and milk.
and stomach acid secretion)
• Women with history of hypercholesterolemia should modify
• > 8 cups causes stillbirth
diet
• Can be found in chocolates, softdrinks, tea
FATS
• 120 mg (1 cup coffee)
• Can be consumed through food
Common Problems
• Linoleic acid for new cell growth
• Nausea and Vomiting
• Best sources are vegetable oils (corn, olive, peanut,
– r/t high Hcg,
cottonseed)
– high estrogen/progesterone,
Vitamins
– low blood sugar,
• Vitamin A for cell development and tooth bud and bone
– lack Vit B6,
growth
– decrease gastric motility
– Deep green, dark yellow vegetables and fruits,
• Intense first 3 months, usually upon rising, smelling and
liver
preparing food
– Vitamin A toxicity can cause fetal malformation
• Small frequent meals, dry crackers upon rising.
• Vitamin D for maternal-fetal bone density
• Avoid skipping meals
– Absorption of calcium and phosphorus
• Decrease intake of fatty foods
– Milk, margarine, egg yolk, butter, liver, seafood
• Avoid cooking odors
• Vitamin E for antioxidant, prevents hemolysis of RBC
• No antacids may cause fluid retention
– Vegetable oils, green vegetables, whole grains,
• Avoid excessive fluid early in the day or when nausea in
liver
present
• Vitamin C for tissue formation and iron absorption
Hyperemesis gravidarium/ pernicious vomiting
• Folic acid found in fruits, vegetables and liver necessary for
• More than 12 weeks causes dehydration, ketonuria, weight
RBC formation, decrease causes megaloblastic anemia,
loss
neural tube defect
• Due to increase thyroid fxn, H.pylori
• Vitamin A, B and folic acid intake should be more for
• Shows elevated Hct (hemoconcentration) decrease fluid
women who used oral contraceptives.
retention
• No mineral oil laxative inhibits Vit ADEK absorption
• Hypokalemic acidosis (vomiting)
• Megadoses of water soluble (Vitamin C) can cause scurvy
• Polyneuritis due to B deficiency
Minerals
• Ketones in urine
• Calcium for skeletal (12 weeks) and teeth formation (8
• Can cause intrauterine growth restriction or preterm birth
weeks)
due to decrease fluid
– Maternal bone and tooth mineralization
• IV fluid, antiemetic, NPO 24 hrs then clear fluid then
– Milk, cheese, yogurt, green leafy vegetables
cereals
– Can take calcium supplement if not provided in
Cravings
diet or lactose intolerant (lactase enzyme)
• Cravings or aversion are normal
• Phosphorus for fetal skeleton and tooth bud formation.
• Pica – abnormal nonfood cravings, supplement with iron.
– Can be taken from protein sources
Pyrosis
– Milk, cheese, yogurt, meats, whole grains, nuts,
• Caused by decrease gastric motility causing slow gastric
legumes
emptying and pressure on stomach by uterus.
• Iodine for formation of thyroxine for increase thyroid
• Eat small frequent meal
function
• Avoid fluid with meals but plenty of fluid between feedings
• 2-3 pillows sleeping, do not lie down after eating
 • Loose clothing Instead of using whole organisms, vaccines can be composed of
antigen molecules (often located on the surface of the
Expanded Program on Immunization microorganism) extracted from the pathogen or prepared by
Definition of Terms: recombinant DNA techniques.
1) Immunization Toxoids
The protection of individuals from disease by vaccination These are derivatives of bacterial exotoxins that can be produced by
Induction or introduction of specific protective antibodies in a chemically altering the natural toxin, or by engineering bacteria to
susceptible person or production of cellular immunity in such a person produce harmless variants of the toxin
Is the provision of an individual with antibodies, which possess the Six (6) EPI Diseases
power to destroy or inactivate disease producing agent to neutralize Poliomyelitis
its toxins Measles
2) Immunity Diphtheria
A condition of being able to or the capacity to resist a particular Pertusis
disease Tetanus
Is the resistance that an individual has against a disease Tuberculosis
A condition of being secure against any particular disease, Coverage
particularly, the powers to which a living organism possesses to resist The three population of EPI consists of the following:
and overcome infection Infants below one year old
3) Antibodies / Immunoglobulins School entrants
Any of various body globulins that normally prevent or are produced Pregnant Women
in response to infection or administration of suitable antigens Starts from the Manufacturer
4) Antigen ▼▼▼▼▼
A protein substance (as a toxin, enzyme, or any certain constituent of Airport
blood), that when introduced into the body stimulates the production ▼▼▼▼▼
of antibodies Central Vaccine Store
5) Attenuated ▼▼▼▼▼
Refers to weakening, thinning or decreasing the pathogenicity Regional Store
(capability of causing a disease) or vitality of microorganisms ▼▼▼▼▼
District Hospital
A) PASSIVE IMMUNIZATION ▼▼▼▼▼
Is achieved by injecting a recipient with preformed immunoglobulins Health Center or Outreach Service
directed against an already present infection ▼▼▼▼▼
State of relative temporary protection produced by the injection of Discrepancy
serum containing antibodies which have formed in another host. ▼▼▼▼▼
B) ACTIVE IMMUNIZATION Immunizing Staff or Mother and Child
Involves injection of modified or purified pathogens or their products,
prompting the immune system to respond as if the body were being Vaccine Dose/Route Baby Mother
attacked by an intact infectious microorganism TT1 0.5 R 80%
TT2 0.5 L Protected 80% 3 yrs
PASSIVE IMMUNITY TT3 0.5 R Protected
Immunity transferred from another person 90 % 5 yrs
▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼ TT4 0.5 L Protected
▼▼▼▼▼ ▼▼▼▼▼ 99% 10 yrs
Natural Passive Immunity Artificial Passive TT5 0.5 R Protected
Immunity 99% Lifetime
Transferred by mother to child through Antibodies produced
by another Vaccine Contents Form Condition when
milk or through the placenta person or animal exposed to Heat /
is injected Freezing
Examples are gamma globulin, antitoxin and antiserum
BCG Live, attenuated Freeze dried and Destroyed by
bacterial vaccine; reconstituted with heating, sunlight but
ACTIVE IMMUNITY Bacillus Calmette a special diluent not by freezing
Individual’s own system is the cause of the immunity and Guerin
▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼ DPT Toxoid which is a Liquid Destroyed by
▼▼▼▼▼ ▼▼▼▼▼ Diphtheria weakened toxin freezing, heat
Natural Active Immunity Artificial Pertussis Killed bacteria Damaged by heat,
Active Immunity Tetanus Toxoid which is a freezing
Example is natural exposure Deliberately introduced weakened toxin Damaged by heat
Polio Vaccine Live attenuated Liquid Easily damaged by
in a vaccine
virus heat but not
Example is measles vaccine, DPT or Toxoids like Tetanus toxoid destroyed by freezing

Formulations for Active Immunity Measles Live attenuated Freeze dried and Easily damaged by
Live Pathogens virus reconstituted with heat but not
When live pathogens are used, they are attenuated to prevent clinical a special diluent destroyed by freezing
consequences of infection
Killed Microorganisms Tetanus Weakened toxin Liquid Damaged by heat,
Killed vaccines have the advantage over attenuated microorganisms Toxoid freezing
Hepatitis B Plasma derived; Liquid Damaged by heat,
in that they pose no risk of vaccine-associated infection
RNA recombinant freezing
Microbial Extracts
METHODS Lactation Amenorrhea Method
• As long as woman breastfeed, there is natural suppression
ARTIFICIAL to ovulation.
-Temporary • Must be exclusive breastfeeding (may ovulate without
Hormones menstruate while breastfeeding)
Pills Coitus Interruptus
Estrogen/Progesterone Patch • Man withdraws and sperm emitted outside the vagina
Implants • May fertilized during preejaculation fluid.
DMPA Injections
Barriers
Spermicides ARTIFICIAL FAMILY PLANNING METHOD
Diaphragm Pills / Oral Contraceptives/ Combination Oral Contraceptives
Cervical Caps • Combination of synthetic estrogen and progesterone
Female Condom • Estrogen suppress FSH and LH, suppressing ovulation
Male Condom • Progesterone decreases permeability of cervical mucus,
-Permanent prevents transport of ovum tubal transport and endometrial
Tubal Ligation proliferation to prevent implantation.
Vasectomy • Must be given only after Papanicolaou Smear and pelvic
-Natural examination.
Calendar (Rhythm) Method • Not effective on first 7 days must take other contraceptive
Basal Body Temperature methods
Cervical Mucus (Billings) Method • Take 21 pills everyday at the same time then rest for 1
Symptothermal Method week (mense begins on 4th day) then start new 21 packs.
Lactation Amenorrhea Method Some have 28 pills (7 are placebo to prevent forgetting the
Coitus Interruptus gap) (menstrual flow begins on 7th day of placebo)
• If woman does not want to have a menstrual flow, she can
NATURAL FAMILY PLANNING METHOD immediate take the new 21 day pill or do not take the 7
Calendar (Rhythm) Method days placebo and start with 28 days pills immediately once
• Requires couple to abstain from coitus during menstrual the previous pills are consumed.
cycle where conception is possible (3 days before or after • Decreases incidence of:
ovulation) • Dysmenorrhea (due to lack of ovulation)
• Keep 6 months diary of menstrual cycle • Iron deficiency anemia (reduce menstrual flow)
• Subtract 18 from shortest cycle (25 days) represents the • Pelvic Inflammatory Disease (PID) and tubal
first fertile day scarring
• Subtract 11 from longest cycle (29 days) represents last • Endometrial and ovarian cancer/cysts
fertile day • Fibrocystic breast disease
• Use contraceptive or avoid coitus on fertile days • Osteoporosis and uterine myomata
Basal Body Temperature • Colon cancer
• A day before ovulation the temp drops 0.5 F • Side effects
• On the ovulation day it rises to 1 F because of • Weight gain (estrogen interferes with lipid
progesterone and is maintained throughout the cycle metabolism lowers LDL and increase HDL)
• Take the temperature every morning upon waking up • Nausea (r/t estrogen)
before any activity • Headache
• Refrain from sex for 3 days (life of ovum), once notices a • Breast tenderness
slight drop and rise • Breakthrough bleeding (spotting outside mense
• Temperature can be affected by illness (fever), daily activity period)
(metabolism rate) • Monilial vaginal infections
• Women working at night must take temperature once • Mild hypertension
awake from longer sleep period, no matter what time of the • Depression
day. • Danger signs of myocardial or thromboembolic
Cervical Mucus (Billings) Method complication
• Before ovulation, cervical mucus is thick, non stretchable. • Chest pain (MI/TE)
• Peak ovulation mucus becomes copious, thin, watery, and • Shortness of breath (Pulmonary embolism)
transparent. Feels slippery and stretches atleast 1 inch • Severe headaches (CVA)
before it breaks (Spinnbarkeit properties). • Severe leg pain (thrombophlebitis)
• Breast is also tender • Blurred vision (HPN, CVA)
• 3 days after peak days or until mucus is copious is • Contraindications:
considered fertile days and avoid coitus. • Breastfeeding/ < 6 weeks postpartum (weight
• Vaginal secretion after intercourse is unreliable and can loss in brestfeed infants, estrogen decreases
give watery consistency because of the seminal fluid and breast milk)
can be mistaken as fertile. • >35 years old and smoker (>15 cigarettes/day)
Symptothermal Method • Risk factor for arterial cardiovascular disease (old
• Combination of cervical mucus and BBT age,smoking, diabetes, hypertension)
• Abstain 3 days after rise of temperature or 4 days after • HPN >160 mmHg systolic or 100 mmHg diastolic
peak of mucus change or higher
• Ovulation Kit • History of deep vein thrombosis or pulmonary
• Detects Luteinizing Hormone in urine 12-24 hours before embolism
ovulation. • Major surgery with prolonged immobilization
• Expensive • History of ischemic heart disease
 • Stroke
• Valvular heart disease
• Migraine with aura; migraine without aura but >35
years old
• Current breast cancer
• Diabetes with nephropathy, retinopathy,
neuropathy, vascular disease (estrogen
interferes with glucose metabolism)
• Severe cirrhosis
• Liver tumors
Estrogen/Progesterone Patch
• Transdermal (upper outer arm, upper torso-front and back,
abdomen, buttocks) patches continuously release estrogen
and progesterone applied once a week for 3 weeks. During
week patchfree, menstrual flow resume.
• Same as pills but less effective for women more than 90 kg
• Does not need to remember daily, easy concealment, mild
breast discomfort and irritation at the site.
• Can be used bathing, swimming, shower. If becomes loose
just replace (within 24 hours). But if unsure or more than 2
hours, woman should start a new 4 week cycle and use
other contraceptive method for 1 week.
Vaginal Rings
• Silicone ring surrounding cervix (absorbed by mucous
membrane of vagina avoiding first pass on the liver) and
continuously releasing estrogen and progesterone left for 3
weeks then removed for 1 week. (fertility resumes
immediately).
• Menstrual bleeding occurs once ring free
Emergency Postcoital Contraception.
• Called morning after pills contains high level estrogen
inhibiting progesterone and implantation
• 2 dose within 72 hours after unprotected intercourse
followed by 2 pills after 12 hours.
• Used for rape, kit contains pregnancy test and 4 pills
Subcutabeous Implants
• Norplant is a nonbiodegradable silastic implants filled with
levonorgestrel (synthetic progesterone) embedded under
the skin of upper arm
• Looks like small veins and release hormones, thickens
cervical mucus (making endometrial implantation difficult)
for 5 years.
• Inserted during menses for first 7 days at the start of
menstrual cycle to make sure woman is not pregnant. Can
be inserted immediately after abortion or 6 weeks
postpartum.
• No effect on breastmilk
• Return fertility after 3 months from removal.
• Contraindicated to pregnancy (causes birth defects),
uterine bleeding,
Disadvantage
– Costly
– Weight gain
– Irregular menstrual cycle (spotting, breakthrough
bleeding, amenorrhea, prolonged periods)
Intramuscular Injections
• Single injection of medroxyprogesterone acetate (Depo-
Provera) inhibit ovulation, alter endometrium, change
cervical mucus.
• Contains only progesterone so safe for breastfeeding
• Given every 3 months and fertility resume after 6-12
months
• Side effects:
– Irregular menstruation
– Headache
– Weight gain
– Depression
– Impair glucose tolerance (diabetes)
– At risk osteoporosis (take calcium and weight
bearing exercises)
Intrauterine Device (IUD)
• T shape plastic place in uterus via the vagina prevents
sperm form reaching uterus and ovum
• Must be inserted by MD, Nurse practitioner, nurse-midwife
after pap smear and pelvic examination
• Inserted after menstruation before coitus to ensure patient
is not pregnant, and can be inserted after delivery
• The T shape plastic with copper, a drug reservoir with
progesterone (prevents endometrial proliferation and
thickens cervical mucus) and a monofilament string
• Effective 1, 5 or 10 years depending on the brand.
• Once time insertion, no effect on sex, should have monthly
check up to see if IUD is still in place after menstrual flow,
and have yearly pelvic examination.
• Side effect:
– Spotting/ uterine cramping on first 2-3 weeks and
should use other contraceptive.
– High risk for PID (IUD + multiple partner)
– Increase risk of STI (women with IUD and
multiple partner)
• Contraindicated
– Distorted uterus
– Severe dysmenorrheal
– Menorrhagia (bleeding inbetween menstrual
periods)
– History of ectopic pregnancy
– Valvular disease (PID increases bacterial
endocarditis)
– Anemia
• If pregnant must remove to prevent infection and
spontaneous abortion. (detected by ultrasound the
placement and pregnancy)
Spermicides
• makes vagina acidic and kills sperms. Inserted 1 hour
before coitus (foam, gel, cream, sponges, films,
suppositories) and no douche 6 hours after coitus
• contraindicated
– acute cervicitis
– bothersome
• can be irritating to penile or vaginal mucous
• does not cause birth defect or abortion if pregnant.
Diaphragm
• circular rubber disc inserted on cervix before intercourse
prevents sperm
• must check if weight gain/loss of 15 lbs, because change
cervical contour.
• Must be kept 6-24 hours after coitus. If left more than 24
hours may cause fluid stasis and cause urethral and
cervical inflammation.
• Reusable (wash soap and water and place on case) and
can be reused for 2-3 years.
• Side effects:
– Increase UTI
• Contraindications
– History staph infection
– Rubber/spermicide allergy
– Recurrent UTI
Cervical caps
• Soft rubber shaped like a thimble and fitted on uterine
cervix
• Can be dislodged but can stay longer than diaphragm (bec
does not put pressure on vaginal walls or urethra) but not
>48 hours to prevent cervical infection.
Female Condom
• Latex sheath with spermicides
• The inner ring (closed end) covers the cervix, outer ring
(open end) rest against vaginal opening
• One time use, inserted before and remove after coitus
• Protect against conception and STI
 • Difficult to use Values are tested behaviors, conflict
Male Condom Increase stress and resolutions
• Latex rubber placed on erect penis before coitus conflicts
• Contraindicated on latex allergy Young 20 – 40 years Develop personal Adjustment relating
adulthood lifestyles to health caused by
Vasectomy Builds relationships lifestyle
• Small incision on each side of scrotum. Middle 40 – 65 years Changes in lifestyles Anticipated changes
• Cut, cauterized or plugged vas deferens adulthood in life
• Done ambulatory but doctor under local anesthesia Identify risk factors
• Sperm in vas deferens can last upto 6 months Older
• Can resume coitus after a week surgery but must use other adulthood
method until 2 negative sperm report (10-20 ejaculations) Young old 65 – 74 years Retirement and Keep physical and
• Does not interfere with sperm production, can still have changes in physical social activity active
abilities Maintain peer
erection, can still ejaculate seminal fluid but without sperm. Development of interaction
• Hematoma on site, 70-80% can be reanastemosed, can chronic illness
develop autoimmunity to sperm, can develop urolithiasis Middle old 75 – 84 years Decline in speed Coping with loss
Tubal Ligation movement, reaction Safety measures
• Fallopian tubes are occluded by cautery, crushing, time, senses
clamping (metal/plastic clips), or blocking Slight dependence on
• Done via laparoscopy/culdoscopy/colpotomy after others
menstrual flow and before ovulation. Make sure no contact Old old 85 years and Increase physical Assists self care and
over problems and maintain
before procedure to prevent ectopic pregnancy dependence independence
• Incision under umbilicus
• Abnormal bloating after 24 hours (until carbon dioxide is
absorbed) Psychoanalytic Theories: Sigmund Freud
• Can resume coitus 2-3 days after, will still have menstrual Major Components of Freud’s theory
flow,
• Can be done 4-6 hours or 12-24 hoursafter a. Unconscious mind – contains memories, motives, fantasy,
delivery/abortion and fears that are not accessible to recall but directly affect
• No sexual effect behavior.
b. Id – part of psyche concern with self-gratification
Growth – means an increase in physical size of the whole body and c. Ego – conscious part of psyche; Mediator for id and
parts, can be measured an quantified. supergo; contains intelligence, memory, problem solving,
incorporation of learning and experiences. Develops by 1
Development – progressive increase in skills, capacity and years old.
functioning. d. Superego – one’s conscience; represents rules and values.

General Principles of Growth and Development Stage Age Characteristics Implications

Oral Birth – 1 Pleasure Center: Mouth Develop
1. Children are competent year Sexual Activities: sucking, Narcissistic – focus
2. children resemble one another swallowing, chewing, on self
3. Each child is unique biting Fixation: Mistrust,
Greatest need: Security nail bitting, drug
a. Heredity and constitutional make-up Greatest fear: Anxiety abuse, smoking,
b. Social and national characteristics overeating,
c. Sex Anal 2 – 3 years Pleasure Center: Anus &
d. Environment Rectum
4. Growth and development are directional Sexual Activities:
a. Cephalocaudal – growth is advanced near head Expulsion and retention of
gradually progresses down to the neck, trunks waste products
and extremities Phallic 4 – 5 years Pleasure Center: Genitals Develop Gender
Sexual Activities: awareness &
b. Proximo-distal – growth proceeds outward, from Masturbation differences,
central axis of body to the periphery experience Oedipus
c. General to Specific & Electra Complex
d. Simple to Complex Latency 6 – 12 years Pleasure Center: None
Sexual Activities: None
Stages of Growth and Development Genital 13 years Pleasure Center: Genital
Stage Age Characteristics Nursing Implication and after Sexual Activities:
Neonatal Birth – 28 Behavior are reflective Parental education Masturbation, Sexual
days and guidance intercourse, feelings for
Infancy 1 month – 1 Rapid physical growth Provision of physical others
year old and psychological
needs
Toddlerhood 1 – 3 years Motor development and Safety and growth
increase psychosocial Psychosocial Theory: Erik Erikson
skills Stage Age Developmental Task to be
Preschool 3 – 6 years Increase social roles; Provide play and Task achieved
slowed physical growth social activity Infancy Birth – 1 Trust vs. Mistrust Gain trust in others
School age 6 – 12 years Preadolescent stage Pursue school year old
Increase peer influence activity and hobbies Toddler 1-3 years Autonomy vs. Toilet train and self
Increase physical, Recognize and old Shame & Doubt control
cognitive, social support Preschool 3-6 years Initiative vs. Guilt Gain independence;
development achievements old Initiate spontaneous
Adolescence 12 – 20 years Physical growth fastest Develop coping activities
School-age 6-12 Industry vs. Gain achievement and Preconven Birth – Stage 1: Punishment Based on intuitive
years old Inferiority necessary social skills tional 9 and Obedience thoughts; Right if
Adolescence 13-18 Identity vs. Role Integrate childhood years Orientation not punished,
years old Confusion experiences into
old Wrong if punished
personal identity; Gain
new roles and self Stage 2: Instrumental Right is defined as
acceptance relativist orientation which is acceptable
Young adult 18-40 Intimacy vs. Make commitments to to and approved by
Isolation others and to life work
(career)
self or when they
Middle adult 40-65 Generativity vs. Establish a family and satisfy one’s needs.
stagnation become productive; Conventio 9-13 Stage 3: Interpersonal Approval of others
Share community and nal years Concordance (Good is sought through
world old boy- good girl one’s actions.
Late adult 65 and Ego integrity vs. Sense of fulfillment, orientation) Authority is
over despair meaning and purpose respected.
Stage 4: Law and Individual feels duty
Order Orientation bound to maintain
Cognitive Development: Jean Piaget social order.
Stage Age Description Behavior is right
Sensorimotor 0 – 1 Stage 1: Use Movements are when it conforms to
months reflex reflexes the rules
1-4 Stage 2: Primary Perceptions center Postconve 13 and Stage 5: Social It is wrong to violate
months Circular reaction around self; objects ntional above contract/ Utilitarian others’ rights
are extension of Orientation
self
4-8 Stage 3: Aware external Stage 6: Universal The person
months Secondary environment; ethical principle understands the
Circular reaction initiates act to orientation principles of human
change rights and personal
environment conscience. Person
8-12 Stage 4: Differentiates goals believes that trust is
months Coordination of and goal directed the basis of
secondary activities relationships.
schemata
12-18 Stage 5: Tertiary Develops rituals
months circular reaction Faith Development: James Fowler
18-24 Stage 6: Uses mental Stage Age
months Invention of new imagery and uses Intuitive-projective 3-7 years old Imitate religious
means fantasy to Faith gestures of
understand parents without
environment understanding
Preoperation 2- 7 Emerging ability to Mythical-Literal Faith 7-12 years Religious stories
al years old think old and existence of
2-4 years Preconceptual Thinking is diety is accepted;
old Stage egocentric; use Concept of
symbols reciprocal fairness
4-7 years Intuitive Stage Unable to break Synthetic- 13-18 years Ideology
old down whole to Conventional Faith old emerged;
parts; can classify questions god,
objects according to values, morality
traits. and religious
Concrete 7 – 11 Manipulate tangible practices
Operational years old objects, can classify Individuative- Late Search for self
objects, starts Reflective Faith adolescent identity; assumes
logical reasoning, and young responsibilitiy for
reversibility, adult own attitudes and
relations between beliefs
numbers Conjunctive Faith Adult Integrates others
Formal 11 and Abstract thinking viewpoints about
Operational above and deductive faith into own truth
reasoning Universalizing Faith Adult Makes tangible
values of love and
justice for
humankind.

Moral Development: Lawrence Kohlberg

Stage Age

HUMAN BEHAVIOR
 the worth attributed to him by significant others on the basis of his
The World Health Organization defines mental health own presentation to the world. (e.g.suicidal)
as "a state of well-being in which the individual realizes his or her own Role performance – expression of self concept, totality of how one is
abilities, can cope with the normal stresses of life, can work known to others, one’s representation and public roles.
productively and fruitfully, and is able to make a contribution to his or
her community”. It was previously stated that there was no one 2. Growth, development, and self-actualization
"official" definition of mental health. Cultural differences, subjective Individual seeks new experiences to more fully experience aspects of
assessments, and competing professional theories all affect how oneself.
"mental health" is defined. Maslows self actualization and Rogers fully functioning person.
MINIMAL OPTIMUM
MENTAL HEALTH MENTAL HEALTH 3. Integration
Balance between what is expressed and what is repressed, between
outer and inner conflicts.
Balance of ID, EGO and SUPEREGO
Includes regulation of emotional responses and a unified philosophy
in life.
MAXIMAL MINIMAL Can be measured by the person’s ability to withstand stress and cope
MENTAL ILLNESS MENTAL ILLNESS with anxiety.
OR DISORDER Ego enables person to handle change and grow as a result.

4. Autonomy
HIGH
WELL BEING
Self determination
Balance between dependence and independence, and acceptance of
the consequences of one’s action.
Implies person is self-responsible for ones decisions, actions,
thoughts and feelings.
As a result person can respect autonomy and freedom in others.

HIGH LOW 5. Reality perception

ILL HEALTH ILL HEALTH Individuals ability to test assumptions about world by empirical
though.
The mentally healthy person can change perceptions in light of new
information.
This criterion makes empathy or social sensitivity, a respect for the
feelings and attitudes of others.

6. Environmental mastery
LOW Enables a mentally healthy person to feel success in an approved
WELL BEING role in society.
Deal effectively with world, work out personal problems, and obtain
Criteria for Mental Health satisfaction from life.
Can able to cope with loneliness, aggression, and frustration without
1. Positive attitude towards self being overwhelmed.
Acceptance of self and self awareness. Can respond to others, loved and be loved, and cope with reciprocal
Must have objectivity about self and realistic aspirations that relationships.
necessarily change with age. Can build new friendship and have satisfactory social involvement
Must have a sense of identity, wholeness, belongingness,
security, and meaningfulness.
Self acceptance – regard for oneself with realistic concept of Influencing Factors for Mental Health
strengths and weaknesses. Depends on self concept Genes
Depression and Mania
Self awareness – involves noticing how the self feels, thinks and Linking DNA markers on chromosome 11 to bipolar
behaves at any given time. Different from introspection which involves disorders and increased risk of disorder in familial
evaluation or determining why the self reacts as it does. descendants.
Self-concept – part of self that lies within conscious awareness. It Special case of depression “postpartum blues” due to sudden
represents collection of attitudes and ideas about the self. It is a drop in hormones can range from mild to clinical depression to
product of life experiences. It encompasses all that a person psychosis.
perceives, knows and hold to be true about his/her identity. Environmental factors may increase genetic vulnerability.
Four aspect of self-concept Schizophrenia
Body Image – physical dimension. How we present ourselves to Children with 1 schizoprenic parents have 15% chance
others physically affects how others perceives us socially and Children with 2 parents have 40%
emotionally as well as intellectually. (anorexia, bulimia Only 2% in general population
Personal Identity – psychological aspect. Unconscious Personality, Conduct, Character Disorder
stratum/unaware. Perception of internal/external reality. It is the Children of alcoholic parents diagnosed with depression, anxiety
innerworld of the client encased by feelings, thoughts, previous disorder, personality disorder.
learning. (personality disorder)
Self-esteem – emotional component. Degree of value or worth
ascribed to the self. It is based on the ability, attributes in
interpersonal relationships. It represents an individual’s perception of
Environment » Fear and needs company until the end
Childhood Nurturing Denial Reflecting feelings
Life Circumstances “This isnt happening”
Life Circumstances “You are wrong”
• Major Life Events Anger Understand and Support
• Life strains (definition) occurs in 4 Areas “Its your fault” Give what patient needs
– Strife association with marital relations. Listen and ventilate feelings
– Parental challenges associated with teenage and young Acceptance of anger
adult children.
– Strains associated with household economics. Bargaining Act upon request if possible
– Overloads and dissatisfactions associated with the work Listen
overload. Depression Avoid reassuring cliches
• Hassles – irritating, frustrating, or distressing incidents that Therapeutic touch
occur in everyday life. Crying
Early Signs of Failing Mental Health
Acceptance Remain close to patient
1.Sleep disturbances.
2. Dramatic weight fluctuations/changes in eating patterns.
3. Unexplained physical symptoms.
4. Difficulty managing anger or controlling your temper. • Attitude towards death
5. Compulsive/obsessive behaviors. Under 5 years old
6. Chronic fatigue, tiredness, and lack of energy. Does not understand concept of death
7. Memory problems. Believes death is reversible, temporary departure or sleep
8. Shunning social activity. Emphasizes immobility and inactivity as attributes of death
9. Loss of satisfaction. .
10. Mood swings and erratic behavior noticed by more than one Nursing approaches
person. Utilize play to express feelings
Death and Dying Explain death is final
• Grief – refers to the subjective emotions and affect that a Permit choice to attend funeral
normal response to the experience of loss. Toddler (1-3)
• Grieving/Bereavement – refers to the process by which a No concept of death
person experiences the grief. Reacts more to pain and discomfort of illness
• Mourning – the outward expression of grief. Religious Experience separation anxiety
ceremonies. Assists parents to deal with feelings
• Anticipatory Grieving – emotional work begun before the Encourage parents participation in child care
actual loss of a valued person, object or concept. It is an • Preschooler (3-5)
adaptive response to an expected loss and helps prepare Death is sleep. Form of punishment
both patients and families for the actual moment of death. May bury pets and request burials
• Disfranchised grief – grief over a loss that is not or cannot be Play for expression of feelings
acknowledged openly, mourned publicly, or supported socially Explain death is final not sleep
because: Choice in attending funeral
• a relationship has no legitimacy 5-9 year old
• the loss itself is not recognized » Understands death is final
• the griever is not recognized » Believes own death can be avoided
• Classification » Associates death with aggression or violence
– Timely versus Untimely » Believes wishes or unrelated actions can be related to
– Intentional versus Unintentional versus Subintentional death
STAGES OF DEATH AND DYING
Denial and Isolation Nursing Approaches
» A necessary and protective mechanism that may be present for Accept regressive or protest behavior
a few minutes or months Encourage verbalization of feelings
» Patient avoids 9-10 years old
confirmation » Understands death as inevitable end of life
Anger » Begins to understands own mortality, expressed as interest
» Directed at self, God, and others who have a future and who do in afterlife or fear of death
not face the loss of existence. » Expresses ideas about death from parents/older adults
Bargaining
» The client attempts to postpone or reverse the dreaded Nursing approaches
movement of death. » Encourage verbalization of feelings
Pray to complete things, etc. » Respect need for privacy and personal expression of fear,
» Make promises to alter lifestyle, be extra nice and charitable, anger, sadness
etc. School age (5-12)
Depression Death is personified
Full effect of diagnosis and loss can no longer be delayed. Fears mutilation and punishment
» A therapeutic state that aids the client to detach from life and Anxiety alleviated by nightmares and superstitions
living thereby accepting death. Death as final process
» Different from pathologic depression. Accepts regressive/protest behavior
Necessary stage of growth rather than a regression. Verbalization of feelings
Acceptance
» Complete unfinished business
» Comfort who will be left behind
 Temper tantrums
Sibling relationship Dictatorial attitude
• The narrower the space between sibling the more the children • Adolescent
influence one another, the wider the gap the more the parent – Disengage from parental conflicts
influence. – Feel profound sense of loss – family, childhood
• Siblings of same gender and closer age are high access. – Anxiety
• Eldest – Worry about self, parents, siblings
Achievement oriented – May withdraw from family and friends
More dominant – Disturbed concept of sexuality
Receive more physical punishment – Acting-out behaviors (violence, smoking alcohol delinquency)
Show more aggression to siblings Inferiority complex/ inferior organ
Stronger conscience, more self-disciplined, inner directed School age (Industry vs. Inferiority)
More socially anxious All children will feel sense of inadequacy in performance of certain
Prone to guilt feelings task
Identify more with parents than peers Repeated failure may cause reluctance to try new skills
More conservative Comparison to others (peers, siblings)
Have greater parental expectations Feelings of doubt and guilt
Begin to speak early in life Affects confidence and self esteem
Demonstrate higher intellectual achievement Adolescent risk taking behavior
Plan better and experience fewer frustrations. • Common reasons
• Middle child • Biologic
More demands for household help • Results
Praised less often Risk factor to childhood psychopathology
Receive less of parents time • Poverty and homelessness
Learn to compromise and be adaptable • Child abuse and neglect
Less stimulated towards achievement • Out of home placement
More difficult to characterized due to varied • Children of alcoholics
• Youngest child • Poverty
Are less dependent than firstborn. • Two Types of Poverty (visible vs. invisible)
Less tense, more affectionate, more good-natured • Present in urban and rural areas
Identify more with peers than parents • Poor nutrition, no preventive health care, limited access to
More flexible in thinking health services
Popular with classmates • High infant mortality rate
Fewer demands in household help • Health care least priority
• Only child • Health problems: nutritional deficiency, growth retardation,
Resembles first born dental problems, communicable disease (lack
More mature and cultivated vaccine/decrease resistance)
• Greater parental pressure for mature behavior and • Homelessness
achievements – Reasons for homelessness are physical/substance
Superior in language facility abuse, poor living conditions, parental mental illness,
Stereotyped as spoiled and selfish domestic conflict, economic crises.
Enjoy a rich fantasy life due to isolation – Runaways are often physically/sexually abuse. Possible
Separation and divorce effects reasons also includes poor parent-child relationship,
Reaction of age groups: extreme family contact, feelings of alienation,
• Reaction 3-6 years old inconsistency in supervision, unpredictability in discipline
– Fear of abandonment – Homelessness deprives children of basic needs
– Blame self for divorce; decreases self-esteem – It disrupts friendship and schooling
– Becomes more aggressive in relationships with others (siblings, – Suffer from physical and mental illness.
peers, etc) • Child neglect
– Engage in fantasy to seek understanding of the divorce. – Failure to provide basic needs and adequate level of
– Establish a sense of stability care
– Assure child will not be deserted and left alone. – Reason includes physical abuse, ignorance in child
– Inform and be specific on details of new life rearing
– Focus on reality – Includes physical and emotional neglect (rejection,
• 6-8 years old isolation, terrorizing, ignoring, verbal assault, over
Panic reactions pressure)
Feel deprive – parent, attention, money, future • Child abuse
Profound fear, depression, insecurity Physical abuse
Difficulty expressing anger towards parents Bruises and welts (in various stages of healing)
Intense desire for reconciliation of parents Burns
Decline school performance Fractures and dislocations
Loss appetite and sleep disturbances Lacerations and abrasions
9-12 years old Wariness of physical adult contact
Anger directed at one or both parents Fear or parent or going home
Divided loyalties Apprehensive when hearing other children cry
Can express feelings of anger Superficial relationships
Feel the need for revenge Acting-out (animal, playmate assault)
Feel lonely, rejected, and abandoned Withdrawal behavior
Decline school performance • Child abuse
Engage in aberrant behavior – stealing, lying Sexual abuse
 • Bruises, bleeding, laceration (genital, mouth, anus, throat) a. This involves assessment of the knowledge of patient by
• Torn, stained, bloody underclothing checking the vocabulary and educational background of
• Sexually transmitted disease patients.
• Difficulty walking or sitting
• Recurrent UTI The Dying patient’s Bill of Rights (American Journal of Nursing)
• Pregnancy in young adolescent
• Withdrawn behavior sI have the right to be treated as a living human being until I die.
• Poor relationships with peers I have the right to maintain a sense of hopefulness however
• Excessive anger at mother (incest) changing its focus may be.
• Regressive behavior I have the right to be cared for by those who can maintain a
• Phobias (men, dark places) sense of hopefulness, however changing this might be.
• Running away from home I have the right to express my feelings and emotions about
• Substance abuse my approaching death in my own way.
• Poor school performance I have the right to participate in decisions concerning my
• Suicidal attempts and ideation care.
• Poverty and homelessness I have the right to expect continuing medical and nursing
• Child abuse and neglect attention even though "cure" goals must be changed to "comfort"
• Out of home placement goals.
• Children of alcoholics I have the right not to die alone. I have the right to be free from
pain.
Communication – the process of transmitting thoughts, feelings, facts I have the right to have my questions answered honestly.
and other information, includes verbal and non-verbal behavior. I have the right not to be deceived.
Levels of Communication I have the right to have help from and for my family in
1. Intrapersonal Communication – the message one sends to accepting my death.
oneself, including self-talk, communication with one self. I have the right to die in peace and dignity.
2. Interpersonal Communication – process occurs between I have the right to retain my individuality and not be judged
two people either face to face encounters, over the phone, for my decisions which may be contrary to beliefs of others.
or other media. I have the right to discuss and enlarge my religious and/or
3. Public Communication – 3 or more people meet in face to spiritual experiences, whatever these may mean to others.
face encounters or through another communication I have the right to expect that the sanctity of the human body
medium such as conference will be respected after death.
Elements of Communication: I have the right to be cared for by caring, sensitive,
1. Sender – generates the message; the source of information knowledgeable people who will attempt to understand my needs
2. Message – is a stimulus produced by a sender and responded to and will be able to gain some satisfaction in helping me face
by a receiver. It may be verbal, nonverbal, written materials, and arts. death.
3. Channel – medium through which a message is transmitted. POST MORTEM CARE
a. Visual channel – sight and observation
b. Auditory channel – spoken words and cues Definition:
c. Kinesthetic channel – experiencing sensations. Post mortem care refers to the care of the body after death.
4. Receiver – the person who intercepts the sender’s message. Purposes:
5. Referent - feedback 1. To keep the body clean and odor free.
6. Variables 2. To prepare the body for discharge from the health facility
Modes of communication 3. To make the dead presentable for viewing by the
1. verbal significant others.
2. Nonverbal Special Considerations:
a. Kinesics 1. Respect the family’s emotional state and their religious
b. Proxemics – is the study of the distance between people beliefs.
and object 2. Start post mortem care only after the patient has been
i. Intimate distance – 0-18 inches; vital pronounced legally dead.
signs, massage 3. Requires a signed receipt from the next of kin who received
ii. Personal distance – 1.5 – 4 feet; the dead’s personal effects.
teaching, counseling, interview 4. Follow the institutions policy as regards the following:
iii. Social distance – 4 feet and beyond; 5. Always handle the body gently and apply tags loosely to
rounds, class teaching prevent skin dents and discoloration.
c. Paralanguage 6. Be sure the dead body is properly identified.
Factors influencing communications 7. Provide privacy for the deceased and his relatives.
1. Development Equipments and Supplies
a. The nurse must know how to communicate with different Shroud or extra bed sheet
age groups (children, adult, elderly) Identification tags (2)
2. Perception Roller bandage
a. How the person interprets the information on their own Bath towel
words or understanding Equipment for bed and perineal care
3. Values Dressing tray
a. Refers to the social norms, religion and moral standards Loin cloth
of the person Safety pins (2)
4. Emotions
a. Nurse be aware of own feelings and deal with patient in
calm manner.
5. Socio-Cultural Backgrounds
6. Knowledge
PROCEDURE
1. Close the door, if in the private
room, or pull a screen around the
dying patient’s bed.
2. Assist in the religious ritual that
may be done
3. As soon as the body is
pronounced dead
a. Elevate the head either on a
pillow or on a low back rest
b. Gently close the eyes and close
the mouth by placing a small rolled
towel under the chin.
c. Depending on the institutions
policy and the wishes of the family,
dentures may or may not be
replaced at this time
d. Remove valuables, make an
inventory and endorse to next of
kin.
e. Notify the following: Attending
Physician, Nursing Supervisor,
Admitting or Census Department,
Appropriate Agency for Organ
Procedures, Medical Examiner,
Designated Mortician
4. Wash hands and gather
equipments and put on clean
gloves
5. Remove contraptions.
a. Some contraptions are not
pulled out completely; they are cut
close to the skin.
b. Contraptions may not be
removed if the body is for autopsy.
6. With the dead body properly
draped, clean the dirty parts.
a. Wash peri-anal area with soap
and water if soiled with feces.
b. Change soiled
dressing/bandages and ostomy
bags.
c. Pack/ plug draining orifices with
disposable pads
7. Place arms along the side of the
body in normal functional position.
8. Remove and put on another
clean gloves
9. Put on under pants or a loin
cloth and loose clean clothes or
gown. Leave the identification
band in place.
10. Attaches a properly
accomplished identification tag on
one wrist or leg (ankle or great toe)
containing the following data:
a. Full name of the deceased
b. Sex and Age
c. Date and time of death
d. Name of AMD
e. Name of health facility
11. Bind the legs together with
RATIONALE
To provide privacy for the
patient and significant others &
protect the sensitivity of the
other patients.
To show respect for the family’s
religious beliefs
To prevent pooling of blood on
the face that causes
discoloration.
To give the body a more
peaceful and natural
appearance.
Some morticians prefer that the
dentures be replaced by them
for a better fit.
To prevent possible legal
problems later.
Contraptions impair the natural
appearance of the body
Keep the body clean, odor free
an presentable for viewing by
significant others.
Crossing the arms over the
chest makes their repositioning
difficult when rigor mortis has
set in.
To provide privacy
To ensure proper indentification
To prevent dangling of a leg
bandage applied loosely or when the body is lifted for
provided with padding. transport. Padding will prevent
dents on the skin.
12. Cover the body with a shroud To provide privacy during
or mummify with a bed sheet. transport to the morgue
13. Pin another name tag on the To ensure proper identification
shroud or bed sheet. in case one name tag is lost.
14. Complete the patient’s record The patient’s record will be the
and send to the appropriate basis of death certificate
department of health facility
15. Have the dead body Institutional policy may require
transported to the morgue. that the body be transported to
the morgue within 1-2 hours
after death.
16. Put away or dispose
equipment and supplies used.
17. Wash hands
18. Accomplish discharge
responsibilities and Document
Post Mortem activities including:
A. Time of cessation of Vital Signs.
B. Persons notified and time of
notification.
C. List and documentation of
valuable and personal effects.
D. Time body removed from unit,
destination and by whom removed.
E. Other information required by
faculty.
Rigor mortis is the state of partial contraction of muscles after
death due to lack of ATP; myosin heads (cross bridges)
remain attached to actin thus preventing relaxation. Cellular
membranes becomes leaky calcium ions leak out of the
sarcoplasmic reticulum into the cytosol and allows myosin
heads to bind to actin. Begins 3-4 hours after death and last
24 hours then disappears as proteolytic enzymes from
lysosomes digest the crossbridges