FRAMEWORK FOR MATERNAL AND CHILD NURSING

Goals of Maternal and Child Health Nursing

 Preconceptual health care
 Care of women during three trimesters of pregnancy and the puerperium (the 6 weeks after
childbirth, sometimes termed the fourth trimester of pregnancy)
 Care of children during the perinatal period (6 weeks before conception to 6 weeks after birth)
 Care of children from birth through adolescence
 Care in settings as varied as the birthing room, the pediatric intensive care unit, and the home
Philosophy of Maternal and Child Health Nursing
 Maternal and child health nursing is family-centered; assessment data must include a family
and individual assessment.
 Maternal and child health nursing is community-centered; the health of families depends on
and influences the health of communities.
 Maternal and child health nursing is research-oriented, because research is the means
whereby critical knowledge increases.
 Both nursing theory and evidence-based practice provide a foundation for nursing care.
 A maternal and child health nurse serves as an advocate to protect the rights of all family
members, including the fetus.
 Maternal and child health nursing includes a high degree of independent nursing functions,
because teaching and counseling are so frequently required.
 Promoting health is an important nursing role, because this protects the health of the next
generation.
 Pregnancy or childhood illness can be stressful and can alter family life in both subtle and
extensive ways.
 Personal, cultural, and religious attitudes and beliefs influence the meaning of illness and its
impact on the family. Circumstances such as illness or pregnancy are meaningful only in the
context of a total life.
 Maternal and child health nursing is a challenging role for a nurse and is a major factor in
promoting high-level wellness in families.

THEORIST MAJOR CONCEPT OF THEORY

1. Patricia Benner Nursing is a caring relationship. Nurses grow
from novice to expert as they practice in clinical
settings.
2. Dorothy Johnson A person comprises subsystems that must
remain in balance for optimal functioning. Any
actual or potential threat to this system balance
is a nursing concern.
3. Imogene King Nursing is a process of action, reaction,
interaction, and transaction; needs are identified
based on client’s social system, perceptions, and
health; the role of the nurse is to help the client
achieve goal attainment
4. Madeleine Leininger The essence of nursing is care. To provide
transcultural care, the nurse focuses on the
study and analysis of different cultures with
respect to caring behavior.
5. Florence Nightingale The role of the nurse is viewed as changing or
structuring elements of the environment such as
ventilation, temperature, odors, noise, and light
to put the client into the best opportunity for
recovery
 6. Betty Neuman A person is an open system that interacts with
the environment; nursing is aimed at reducing
stressors through primary, secondary, and
tertiary prevention
7. Dorothea Orem The focus of nursing is on the individual; clients
are assessed in terms of ability to complete self-
care. Care given may be wholly compensatory
(client has no role); partly compensatory (client
participates in care); or supportive-educational
(client performs own care).
8. Ida Jean Orlando The focus of the nurse is interaction with the
client; effectiveness of care depends on the
client’s behavior and the nurse’s reaction to that
behavior. The client should define his or her own
needs
9. Hildegard Peplau The promotion of health is viewed as the
forward movement of the personality; this is
accomplished through an interpersonal process
that includes orientation, identification,
exploitation, and resolution
10. Martha Rogers The purpose of nursing is to move the client
toward optimal health; the nurse should view
the client as whole and constantly changing and
help people to interact in the best way possible
with the environment.
11. Sister Callista Roy The role of the nurse is to aid clients to adapt to
the change caused by illness; levels of
adaptation depend on the degree of
environmental change and state of coping
ability; full adaptation includes physiologic
interdependence.

ROLE & RESPONSIBILITIES OF MATERNAL AND CHILD NURSE

Clinical Nurse Specialists – are nurses prepared at the master’s-degree level who are capable of
acting as consultants in their area of expertise, as well as serving as role models, researchers, and
teachers of quality nursing care. Examples of areas of specialization are neonatal, maternal, child, and
adolescent health care; childbirth education; and lactation Consultation
Case Manager – is a graduate-level nurse who supervises a group of patients from the time they enter
a health care setting until they are discharged from the setting, or, in a seamless care system, into
their homes as well, monitoring the effectiveness, cost, and satisfaction of their health care
Women’s health nurse practitioner – is a nurse with advanced study in the promotion of health and
prevention of illness in women. Such a nurse plays a vital role in educating women about their bodies
and sharing with them methods to prevent illness; in addition, they care for women with illnesses
such as sexually transmitted infections, offering information and counseling them about reproductive
life planning.
Family Nurse Practitioner (FNP) – is an advanced practice role that provides health care not only to
women but to total families. In conjunction with a physician, an FNP can provide prenatal care for a
woman with an uncomplicated pregnancy.
Neonatal Nurse Practitioner (NNP) – is an advanced practice role for nurses who are skilled in the
care of newborns, both well and ill.
Pediatric Nurse Practitioner (PNP) – is a nurse prepared with extensive skills in physical assessment,
interviewing, and well-child counseling and care. In this role, a nurse interviews parents as part of an
extensive health history and performs a physical assessment of the child.
Nurse-Midwife – an individual educated in the two disciplines of nursing and midwifery and licensed
according to the requirements of the American College of Nurse-Midwives (ACNM), has played an
important role in assisting women with pregnancy and childbearing. 

WHO’S 17 SUSTAINABLE DEVELOPMENT GOALS

GOAL
1 NO TO POVERTY – End poverty in all its forms everywhere
2 ZERO HUNGER – End hunger, achieve food security and improved nutrition and promote
sustainable agriculture
3 GOOD HEALTH & WELL BEING – Ensure healthy lives and promote well-being for all at all
ages
4 QUALITY EDUCATION – Ensure inclusive and equitable quality education and promote
lifelong learning opportunities for all

5 GENDER EQUALITY – Achieve gender equality and empower all women and girls
6 CLEAN WATER & SANITATION – Ensure availability and sustainable management of
water and sanitation for all
7 AFFORDABLE AND CLEAN ENERGY – Ensure access to affordable, reliable, sustainable
and modern energy for all
8 DECENTY WORK & ECONOMIC GROWTH – Promote sustained, inclusive and sustainable
economic growth, full and productive employment and decent work for all
9 INDUSTRY, INNOVATION & INFRASTRACTURE – Build resilient infrastructure, promote
inclusive and sustainable industrialization and foster innovation
10 REDUCE INEQUALITIES – Reduce inequality within and among countries
11 SUSTAINABLE CITIES & COMMUNITIES – Make cities and human settlements inclusive,
safe, resilient and sustainable
12 RESPONSIBLE COMSUMPTION & PRODUCTION – Ensure sustainable consumption and
production patterns
13 CLIMATE ACTION – Take urgent action to combat climate change and its impacts
14 LIFE BELOW WATER – Conserve and sustainably use the oceans, seas and marine
resources for sustainable development
15 LIFE ON LAND – Protect, restore and promote sustainable use of terrestrial ecosystems,
sustainably manage forests, combat desertification, and halt and reverse land
degradation and halt biodiversity loss
16 PEACE, JUSTICE & STRONG INSTITUTIONS – Promote peaceful and inclusive societies for
sustainable development, provide access to justice for all and build effective,
accountable and inclusive institutions at all levels
17 PARTNERSHIP – Strengthen the means of implementation and revitalize the global
partnership for sustainable development

REPRODUCTIVE AND SEXUAL HEALTH

DEFINITION OF TERMS:
 PROCREATION – is the creation of new human person, by the act of sexual intercourse, by a
man and woman.
 CREATION – is the making of all things from nothing, by an act of God, at some time in the
past. God’s action could have taken in a second, or 6 days or a million years.
 EVOLUTION THEORY – is the theory that all things came about by the repeated random actions
of natural selection, whereby:
1. Life came into existence and then
2. Primitive life evolved into more and more complex organisms and eventually producing
mankind.
Evolution Theory requires the assumption of billions of years for its processes.
FUNCTIONS OF FEMALE REPRODUCTIVE SYSTEM
 Formation of Ova
 Reception of spermatozoa
 Provision of suitable environment for fertilization and fetal development
 Parturition
 Lactation – the production of breast milk, which provides complete nourishment for the baby
in its early life.
FUNCTION OF THE EXTERNAL FEMALE REPRODUCTION
 To enable the sperm to enter the body
 To protect the internal genital organs from infectious organisms.
EXTERNAL FEMALE REPRODUCTIVE STRUCTURE
MONS PUBIS
 A region of adipose tissue above the vagina that is covered with hair.
LABIA
 Rich in blood vessels and nerves endings, protects the internal organs against pathogen, and
function in sexual arousal.
LABIA MAJORA
 It has two folds of adipose tissue that border each side of the vagina.  It encloses and protects
other external reproductive organs.
 Literally translated as “Large Lips”
 Relatively large and fleshy.
 It contains sebaceous glands.
 After puberty, it is covered with hair.
LABIA MINORA
 Smaller folds (forchette) of the skin that lie inside the labia minora.
 It does not contain hair follicle or sweat glands.
 The folds contain connective tissues, numerous sebaceous glands, erectile muscle
 fibers and numerous vessels and nerve endings.
 It surrounds the opening to the vagina and urethra.
CLITORIS
 It is a small erectile cylindrical body.
 Measures about 1.5 to 2 cm.
 Situated in the most anterior part of the vulva
 The two labia minora meets at the clitoris.
 A small, sensitive protrusion.
 The clitoris is covered by a fold of skin called, the prepuce, richly supplied with nerve.
 The clitoris is very sensitive to stimulation and can become erect.
 Seat of a woman sexual arousal and orgasm.
 It is surrounded by many sebaceous glands that produce a cheese like secretion called”
Smegma”
VESTIBULE
 Triangular space between labia minora and where the urethral meatus, bartholin’s glands and
skene’s glands are located.
 It encloses the urethral opening, vaginal orifice and hymen and duct from the greater
vestibules.
URETHRAL OPENING
 Situated in the midline just in front of the vaginal orifice, just below the clitoris.  About 1-
1.5cm below the pubic arch.
VAGINAL ORIFICE AND HYMEN
 Lies on the posterior ends of the vestibules.
 The GRAFENBURG or the G SPOT is a very sensitive area located at the inner anterior surface of
the vagina.
 Vaginal Orifice or Introitus is the external opening of the vagina located just below the urethral
meatus.
 It is completely enclosed by a septum of mucous membrane called Hymen.
 Hymen is located just inside the vaginal opening.
 Hymen no known function, not always present.
 It is usually ruptured at the consummation of marriage.
BARTHOLIN’s GLAND
 There are two Bartholin’s gland, one in each side.
 Each gland has a duct which measures about 2 cm and open into vestibular outside.
 Close to the posterior end of vestibular bulb.
 During sexual excitement it secretes abundant alkaline mucus which helps in lubrication.
 Pair of glands also known as vulvovaginal gland or paravaginal gland.
SKENE’S GLAND
 The largest paraurethral gland.
 A pair of gland known as Paraurethral and minor vestibular gland.

INTERNAL STRUCTURE OF FEMALE REPRODUCTIVE

FUNCTIONS OF THE INTERNAL ORGANS OF FEMALE REPRODUCTIVE SYSTEM
 The internal genital organs form a pathway (the genital Tract).
 This pathway consists of the following functions.
o VAGINA – Part of the birth canal, where the sperm are deposited and from which the
baby can emerge.
o UTERUS – Where embryo can develop into a fetus
 o FALLOPIAN TUBES (Oviducts) – Where a sperm can fertilize an egg.
o OVARIES- which produce and release eggs
VAGINA
 A birth canal
 A tube like, muscular but elastic organ
 About 4-5 inches long in an adult woman.
 pH is 4- acidic
 It is the passageway for the sperm to the egg and for menstrual bleeding.
 Organ of copulation and forms the birth canal for parturition.
 Posterior wall of vagina is 10cm long
 Anterior wall is only 7.5cm length
 The upper end of the vagina is known as the Vault
 Pink in appearance
 It connects the external genital organs to the uterus.
 The organ of sexual intercourse in woman
UTERUS
 Pear shaped, Site of menstruation, egg implantation and labor
 Changes occurring during pregnancy
 Endometrium lining during pregnancy becomes deciduas (lining of the pregnant uterus)
 Endometrium is the lining of the NON-PREGNANT UTERUS
 Cervix – cone-shaped neck of the uterus that protrudes into the vagina
There are three (3) types of DECIDUA
1. Decidua Basalis
 Decidua immediately beneath the implantation of the blastocyst
2. Decidua Capsularis
 Decidua covering the blastocyst
3. Decidua Vera
 This is the remaining portion of the decidua
 Decidua that is not Basalis nor Capsularis

OVARY
 Ovulation is the most important function of the ovary
 Production of the female hormone
 Situated retroperitoneally
 Held in position by ligaments (Broad, Mesovarian, Suspensory, Ovarian)
 Contained in the OVARIAN FOSSA
 In times of abdominal new growth in the ovary – these are always detected late due to
anatomical location
o Example:
 Ovarian carcinoma
 Ovarian malignancy
 Not easily palpable
FALLOPIAN TUBE
 Site of fertilization
 More specifically, the AMPULLA of the Fallopian Tube is the site of fertilization
 Distal Third of the Fallopian Tube
 Composed of the
o Ampulla
 o Fimbriae

AMPULLA
 Has the widest diameter among the segments of the fallopian tube
 Middle Third of the Fallopian Tube
 Composed of the ISTHMUS
 Proximal Third of the Fallopian Tube
 Composed of the INTERSTITIAL SEGMENT or the INSTERSTITIAL PART

Reproductive hormones
1. Follicle stimulating hormone (FSH) – secreted during the first half of cycle; stimulates
development of graafian follicle; secreted by anterior pituitary gland.
2. Interstitial cell – stimulating hormone, luteinizing hormone (ICSH, LH) stimulates ovulation and
development of corpus luteum; secreted by pituitary gland.
3. Estrogen – assists in ovarian follicle maturation; stimulates endometrial thickening; responsible
for development of secondary sex characteristics; maintains endometrium during pregnancy,
secreted by ovaries and adrenal cortex during cycle and by placenta during pregnancy.
4. Progesterone – aids in endometrial thickening; facilitates secretory changes; maintains uterine
lining for implantation and early pregnancy; relaxes smooth muscle. Secreted by corpus luteum
and placenta.
5. Prostaglandins – substances produced by various body organs that act hormonally on the
endometrium to influence the onset and continuation of labor. Used to efface the cervix
before induction of labor in term pregnancies.