Chapter 1

A framework for maternal and child health nursing

Primary Goal of maternal and child health nursing:
 The promotion and maintenance of optimal family health to ensure cycles of
optimal childbearing and childrearing.
Maternal and Child Health Nursing Practice throughout the childbearing – childrearing
continuum.
 Provision of preconception health care
 Provision of nursing care of women throughout pregnancy , birth, and postpartum
period
 Provision of nursing care of children from birth through adolescence
 Provision of nursing care to families in all settings
A philosophy of Maternal and child health Nursing
Includes the following concepts:
 Family – centered
 Community – centered
 Evidence – based
Two pillars of the 2020 national health goals:
 Increase quality and years of healthy life
 Eliminate health disparities
 New objective recommends that all prelicensure programs nursing include core content
on
 Counselling for health promotion and disease prevention
 Cultural diversity
 Evaluation of health sciences literature
 Environmental health
 Public health systems
 Global health

Framework for maternal and child health nursing care #1

Phases of health care:
 Health promotion
 Health maintenance
 Health restoration
 Health rehabilitation
Framework for maternal and child health nursing care #2
The steps of the nursing process:
 Assessment
 Nursing diagnosis
 Planning
 Implementation
 Evaluation
Quality & Safety Education for Nurses (QSEN)
 Patient – centered care
 Teamwork & collaboration
 Evidence – based practice
 Quality improvement
 Safety
 Informatics
Legal considerations specific to maternal – child nursing practice
 Informed consent related to fetal well – being
 Informed consent and legal guardianship for procedures performed on children
 Length of time between healthcare incident and child’s ability to bring lawsuit
 Identifying and reporting suspected child abuse
 Concepts of “wrongful birth,” “wrongful life,” and “wrongful conception”
Alternative healthcare practices commonly used:
 Acupuncture
 Homeopathy
 Therapeutic touch
 Chiropractic care
 Herbalism
Statistics related to the measurement of maternal and child health #1
 Birth rate
 Fertility rate
 Fetal death rate
 Neonatal death rate
 Perinatal death rate
Statistics related to the measurement of maternal and child health #2
 Maternal mortality rate
 Infant mortality rate
 Childhood mortality rate
 Childhood morbidity rate
Trends impacting maternal and child health nursing:
 Families contain fewer member
 The number of single parents is increasing
 Ninety percent of women work outside the home; many are the primary wage earner
 The number of homeless women and children is increasing
 Families are becoming more mobile
 Families are more informed
 Child and intimate partner violence is increasing
 Balancing quality and cost containment in health care is an increasing initiative
Procreative health
Procreative
Capable of procreating (Webster medical dictionary)
Preconception education and care are the focused in helping a couple prepare to conceive
and identifying risks before conception:
 Protect the fetal development
 Avoid unhealthy lifestyle ; adopt a healthy lifestyle
 Help couple identify genetic factors that may affect pregnancy
Theories related to procreation:
1. Creation
 Creation is the act of creating or making of all things from nothing by an act of God,
at some time in the past God’s action could have taken a second, or 6 days or a
million of years
 Mark 10:6
 But from the beginning of the creation God made them male and female
2. Evolution
 Is the theory that all things came about by the repeated random actions of natural
selection, whereby;
 A. life came into existence
 B. primitive life evolved into more and more complex organisms , and eventually
producing mankind, evolutionary theory requires the assumption of billion of
years for its processes

Human reproduction
 Male and female reproductive systems are quite different, their joint purpose is to
produce an offspring.
Sexuality
Sex roles or gender role:
Our biological nature determines our sex role.
1. Biological sex determines our anatomical and physiological femaleness and maleness
XX chromosome develop ovaries
XY chromosome develop testes
2. Sexual behaviour also differs between male and female
Gender identity:
 It is a person’s awareness that one is biologically male or female
 Sex role or gender role is the outward expression of gender identity
 How we present ourselves publicly through our behaviour be it in speech, dress and
others.
 Feminine for female role and masculine for male role as society deems.
Nature or Nurture:
 Are we feminine or masculine because of our biological makeup or because of how we
are raised coupled with the present environment
 A modern theory of gender identity and sex roles describes a continuous interaction of
both biological and social influences
 This fascinating topic still has to undergo revisions. There is still much to learn

Sexual Arousal:
 A person is sexually aroused when environmental factors and internal thoughts are
stimulated
1. Cultural influence and individual variation
Ex. Some men experience sexual arousal when they see a half-naked woman, but this may not be
so in cultures where women wear nothing on their upper bodies
2. Erotic stimuli
Ex. Sounds, like soft music, hard rock, certain taste of food or drink can be associated with past
sexual encounter and can be sexually arousing
Visual images are erotic to many.
Smell can also be associated with past sexual encounters and arousing as evidenced by the
commercials sales of perfumes, colognes.
3. Erogenous zones
Erotic stimuli can be perceived by all our senses; vision, hearing, smell, touch, and even taste.
Erogenous zones:
In males: glans, corona, lower side of the penis.
In females: clitoris, mon, labia minora, and lower third of the vagina..
4. proceptive behaviour
It is the scientific term describing courtship, flirting, seduction and even foreplay in humans.
The human sexual response
Phases Female
Excitement Vaginal lubrication, vagina
widens, body of the uterus
rises causing increase vaginal
length, vaginal walls become
darker in color, swelling of
clitoris, labia minor increase
in size, labia majora flattens,
sex flush, nipples erect,
muscle tension
Plateau Outer third of vagina and
minora engorged, clitoris
retracts & is covered by
clitoral hood, uterus elevates
further, nipples erect more &
breast reach full size
Orgasm Strong muscular contractions
occur in the outer one – third
of the vaginal wall, vagina
facilitates entry of penis by
expansion, rhythmic uterine
contractions, BP, HR, RR
increases, sex flush
intensifies, strong involuntary
muscle contractions
Resolution Return to normal
Male
Erection of penis, urethral
opening ( urethral orifice )
widens, scrotal skin becomes
congested and thickened,
testes become elevated, sex
flush, BP, HR , RR increases
Slight increase of the glans
penis, and its color deepens,
prostate gland enlarges, sex
flush intensifies, further
increase in BP, HR, RR
increase involuntary mov’t
Loss of voluntary control of
muscles and a release of
neuromuscular tension,
ejaculation, testes are at their
maximal elevation, further
increase BP, HR, RR, sex
flush
Return to normal
Risk factors that will lead to genetic abnormalities:
Couples who have a higher risk for conceiving a child with a genetic disorder
include:
 Maternal age older than 35
 History of previous pregnancy resulting in a genetic disorder or new-born abnormalities
 Man and/or woman who has a genetic disorder
 Family history of a genetic disorder
GENETIC TESTS:
Genetic Diagnostic Tests:
1. Genetic ultrasound
 This is to assess the fetus for genetic and congenital problems (ex. Anencephaly,
hydrocephalus & etc.)
 This is done on the 18th to 20th week of gestation since fetal structures have completed
development.
2. Maternal serum screening
 The risk for Down syndrome, trisomy 18, or open spina bifida can be detected by
measuring specific hormones and proteins in the maternal serum during the first and/or
second trimester.
Genetic diagnostic tests:
3. Genetic amniocentesis
4. Chorionic villus sampling
 Chorionic villi tissue from the placenta is obtained either Trans abdominally or
transcervially. It is similar to amniocentesis. Information is available at 10-13 weeks.

5. Percutaneous umbilical blood sampling

 Blood is obtained from the umbilical cord during pregnancy
Role of nurses
 Be supportive by answering questions and clarifying information and options.
 Explain/clarify diagnostic procedures used in genetic testing (i.e., purpose, findings, and
possible side effects
 Clarify or reinforce information the couple received from their health care provider or
genetic counsellor.
Utilization of the ursing process in the prevention of genetic alteration and in the care of
clients seeking services before and during conception.
Nursing Process
Assessment
 Obtain health and sexual history
 Through head-toe assessment
Diagnosis
 Analyze the assessment data in determining diagnoses and identifying problems of
women
Planning
 Develop a plan of care that prescribes interventions to attain expected outcomes for
women
 An effective nursing care plan for pregnant patients should include assessment,
promoting autonomy and patient teaching implementation.
Implementation
 Implement identified interventions
 Evaluation
Evaluate the progress of women’s health as well as the fetus.
How to promote autonomy
 As the pregnant patient watches their body change, she may begin to feel at a loss of
control of her body or well- being.
 A pregnancy nursing care plan acknowledges and respects those feelings, while focusing
on promoting patient autonomy
 Interventions that the patient can perform for themselves should be included in the
nursing care plan

What about patient education

 Teaching the pregnant patient how to recognize normal and abnormal symptoms in her
body provides an extra line of defense against fetal health risks that might otherwise go
unnoticed or addressed too late.
 This may include patient information about proper diet, the risk , benefits of medications
and activities that should be avoided during pregnancy & immediate postpartum
 Patient teaching also should include information on the birthing options, breastfeeding
and bottle feeding.

Reproduction and sexuality

Anatomy and physiology
Male reproductive system:
1. Testes (male gonad)
 Paired oval glands measured 2 inches in length and 1 inch in diameter
 Consists of smaller compartments called lobules.
 Each lobule contains 1-3 tightly coiled tubules called convoluted seminiferous tubules
Spermatogenesis (production & development of mature spermatozoa) happens in the
seminiferous tubules.
 Sertoli cells – nourishes the sperm cells
 Cells of leydig – produces male sex hormone testosterone
Testosterone
Functions:
 It controls growth and development of male sex organs
 Growth & development of the secondary male sexual characteristics
 Develops adult male sexual behaviours
 Regulates metabolism – growth of skeletal muscles and bones
 Stimulates maturation of sperm cells.
2. Scrotum
 It is a supporting structure of the testes,
 It is made of a single pouch of skin separated into lateral portions by a median ridge
called raphe.
 The scrotum is divided into two sacs called septum. Each containing a single testis.
 When the testes is exposed to cold temperature the smooth muscle contracts and elevates
the testes to the pelvic cavity where it absorbs more body heat.
 A reverse process happens when the testes is exposed to heat making the scrotal sac hang
well below the pelvic cavity to avoid heat.
3. The ducts of the systems: ductus epididymis
 It is a comma – shaped structure that lies in the posterior border of the testis. A tightly
coiled tube.
Functions of epididymis
 Site for sperms to continue its maturation
 It stores the maturing sperm until they develop their capability to swim using their
flagellum.
 It thrusts the sperm to the next excretory duct when the smooth muscle contracts by
peristalsis.
3. The ducts of the systems: vas deferens
 It is commonly called the seminal duct
 18 inches long, vas deferens is enclosed in a connective sheath known as spermatic cord.
 The ampulla or the terminal portion of each vas deferens empties into its ejaculatory duct.
Functions of the vas deferens
 It conveys sperm into the ejaculatory duct
 It also store sperms
3. The ducts of the systems:
Ejaculatory duct
 It lies posterior to the urinary bladder.
 Each vas deferens is connected to its ejaculatory duct.
Function:
 It ejects sperm into the urethra
The ducts of the system: urethra
 It is the terminal duct of the system
 It passers through the prostate gland, diaphragm, and the penis.
3 parts:
A. prostatic urethra – surrounded by the prostate gland & is 1 inch long.
B. membranous urethra – ½ inch long, it runs from prostatic urethra to the penis.
C. spongy or cavernous urethra – 6 inches long; found within the penis.
Functions of urethra:
 It functions as the pathway for both spermatozoa from the testes and urine from the
bladder.

4. The accessory glands seminal vesicle

 Paired seminal vesicles are convoluted pouch like structures that are located posterior to
and at the base of the urinary bladder.
Functions:
 In secrete an alkaline, viscous fluid that helps neutralize acid in the female reproductive
tract.
 It provides fructose for ATP production by sperm, contributes to sperm motility and
viability, and helps semen coagulate after ejaculation
The accessory gland prostate gland
 It is a single donut shaped gland about the size of a golf ball
 It lies inferior to the bladder and surrounds the superior portion of the urethra.
Functions:
 It secretes a milky, slightly acidic fluid that contains enzymes that break down clotting
proteins from the seminal vesicles.
 Prostatic secretions contribute to sperm motility and viability.
The accessory gland bulbourethral gland (Cowper’s gland)
 It is about the size of a pea
 Located under the prostate gland on either side of the membranous urethra.
Functions:
 During sexual arousal, it secrete an alkaline fluid into the urethra which neutralizes acids
from urine thereby by protecting the passing sperm.
 The secretion also serve as lubricant for sexual intercourse.

Semen
 Other name is seminal fluid. Semen is a mixture of sperm and secretions from the
seminiferous tubules, seminal vesicles, the prostate & the bulbourethral gland.
 A milky appearance due to prostatic secretions; a sticky consistency due to fluids from
seminal vesicles and bulbourethral glands.
 Volume of semen per ejaculation is 2.5 – 5 ml, with 50-150 millions sperm per ml.
 Semen has slightly alkaline pH of 7.2 – 7.7
Functions
 Semen is a transportation medium of sperm, it gives nutrients, and protects sperm from
the hostile acidic environment of the male’s urethra and female’ vagina.
Penis
 It is the organ of copulation. It contains urethra.
 It introduces the sperm into the female reproductive tract and is also use for the excretion
of urine.
 It consists of a shaft, glans penis and the prepuce.
 During sexual arousal the parasympathetic nerves from the sacral region of the spinal
cord stimulates the arteries that supplies blood to the erectile tissues to relax or dilate
while other arteries of the penis constricts to shunt blood to the erectile tissues. This in
turn enlarges the penis and it becomes firm a condition called erection.
 Once sexual stimulation ceases, the arteries supplying the blood constricts and the veins
drain the blood making the penis limp and erection stops.
Puberty
 A series of events that transformed a child into an adult.
 It commonly begins at 12-14 years of age.
 Testosterone (male sex hormone) secretion continues after puberty.
 Testosterone is responsible for the development of secondary sex characteristics:
1. increased body hair growth on the face, chest, axilla & pubic region.
2. Enlargement of the larynx, deeper masculine voice
3. Thickening of skin; increased rate of secretion sebaceous gland (acne prone skin); increased
secretion of sweat glands.
4. Increased muscular growth, broad shoulders, narrow waist.
5. Thickening and strengthening of the bones.
Question #3
The primary focus of which of these phases of health care is that of education related to
preventing complications?
a. health promotion
b. health maintenance
c. health restoration
d. health rehabilitation
Answer # D. rehabilitation
Rationale: the goal of health rehabilitation is to prevent complications related to existing illness
and to allow clients to achieve an optimum state of wellness. Health promotion is concerned with
prevention disease/illness and promotion of continued good health, health maintenance occurs
when the client is at risk for disease/injury, and health restoration is concerned with intervention
when disease/injury has occurred.
Answer #2
A. informatics
Rationale: although use of EHRs would make the monitoring of outcomes easier (quality
improvement), minimize risk through system effectiveness (safety), and allow local data to be
collected to better guide practice (evidence- based practice), the competency of informatics,
which is the use of information and technology to manage knowledge, prevent error, and support
decision making, is the competency most relevant to this example.