Additional Concept notes:

● Regular contractions coupled with bloody show

suggest that cervical changes are occurring as result
of contractions.

● An episiotomy serves several purposes. It shortens

the second stage of labor, substitutes a clean surgical
incision for a tear, and decreases undue stretching of
perineal muscles. An episiotomy helps prevent tearing of
the rectum
but it does not necessarily relieves pressure on the
rectum. Tearing may still occur.

When the client says the baby is coming, the nurse should
first inspect the perineum and observe for crowning
to validate the client’s statement. If the client is not
delivering precipitously, the nurse can calm her and use
appropriate breathing techniques.

● During the third trimester of pregnancy, the woman

experiments with maternal and caregiver roles and
 maymake plans for changes in employment,
managing household tasks, and/ or childcare. The
woman is also concerned about safety and passage
through labor and delivery.. Other psychological tasks
include preparation of the nursery, being tired of the
pregnancy, and being introspective. A woman will
begin to see herself as someone different from the
fetus in

the second trimester. Additionally, the mother may

fantasize about the infant during the second trimester
and be concerned about her changing body image.
She may experience ambivalence about pregnancy in
the first trimester.

Pregnancy creates changes in the mother and father.

Being considerate, accepting changes, and being
supportive of the current situation are considered
acceptable responses by the father, rather than feeling
irritation about these changes. Expressing concern with
the fi nancial changes pregnancy and an expanded family
include is normal. The fi rst trimester involves the client
and family feeling ambivalent about pregnancy and
moving toward acceptance of the
changes associated with pregnancy. Maternal acceptance
of the pregnancy and a subsequent change in her focus
are normal occurrences.
 ● An episiotomy serves several purposes. It shortens
the second stage of labor, substitutes a clean surgical
incision for a tear, and decreases undue stretching of
perineal muscles. An episiotomy helps prevent tearing of
the rectum but it does not necessarily relieves pressure on
the rectum. Tearing may still occur.

● The nurse after delivering the placenta must ensure

that all the cotyledons and the membranes of the
placenta are complete. Also the nurse must check if the
umbilical cord is normal which means it contains the 3
blood vessel, 2 veins and 1 artery.

● (Human milk contains only small amounts of vitamin

D. Neither breastfed nor formula-fed infants need to
begiven water, even in very hot climates. During the
first 3 months formula-fed infants consume more
energy than dobreastfed infants and therefore tend to
grow more rapidly. Vitamin K shots are required for all
infants because the bacteria that produce it are
absent from the baby's stomach at birth.)

(Nipples should not be washed using soap; plastic liners

can keep nipples and areola moist andincrease the
risk for tissue breakdown; bring baby to breast, not breast
to baby.)

(No soap should be used because it could dry the areola

and increase the risk for irritation; vitamin Eshould
not be used because it is a fat-soluble vitamin that the
infant could ingest when breastfeeding; lanolin or
colostrum/milk
are the preferred substances to be applied to the area;
plastic liners can trap moisture and lead to sore nipples.)

● It is important for the nurse to assist parents in

assessing speech development in their child so that
developmental delays can be identified early. According to
the Denver Developmental Screening Examination, at 8
months of age, the child should say “mama” and “dada”
nonspecifically and imitate speech sounds. A child cannot
say “dada” or “mama” specifically or use more than three
words until they are about 12 months of age. A child
cannot respond to specific commands or point to objects
when requested until about 17 months of age

● Infants should be kept on formula or breast milk until

1 year of age. The protein in cow’s milk is harder to
digest than that found in formula. The infant cannot digest
fats well, so some foods from the four food groups are not
necessary in his diet during infancy. Solids are introduced
into the infant’s diet around 4 to 6 months, after the
extrusion reflex has diminished and when the child will
accept new textures. Iron deficiency develops in term
infants between 4 to 6 months when the prenatal iron
stores are depleted. Fortified cereals can be added to the
infant’s diet at 4 to 6 months to prevent iron deficiency
anemia.

● For Infancy and Toodlers one of the priority is

SAFETY, on good example putting medicines on the
highest shelf in the kitchen, because 1 year old child
will soon learn how to climb and might reach any form
of medicines which could lead to ingestion. Or as
much as possible you may have lock it.

● Well baby clinics or even in barangay health center ,

parents are then provided with guidelines with regards
to the appropriate age and appropriate food to be
given to the baby, As early as 4 months Infant cereals
is generally introduced first because of its high iron
 content. The infant is able to accept spoon feeding at
around 4 to 5b months when the tongue thrust or
extrusion reflex fade.

● 4-6 months babby’s head control is well established

no more head lags.especially when pulled to a sitting
position.

● For the Infancy, some of their organs are not yet

fully developed or established like for example the
kidneys. Normal urine out is 1-2 ml/kg/hour.

● Sleeping pattern of a baby varies or depends to the

condition of a baby, The Normal Sleeping of time for
12months old equivalent to 14 hours a day.

● During the Oral stage, Infants tend to complete the

exploration of all objects by putting the object in the
mouth
● Babinski Reflex- present at birth and should remain
positive throughout the first 12 months of life

● Readiness for toilet training is based on neurological,

psychological, and physical developmental readiness.
The nurse can introduce concepts of readiness for
toilet training and encourage parents to look for
 adaptive and psychomotor signs such as the ability to
walk well, balance, climb, sit in a chair, dress oneself,
please the parent, and communicate awareness of
the need to urinate or defecate. Chronological age is
not an indicator for toilet training. Two-year-olds
engage in parallel play, which is not an indicator of
readiness for toilet training.

This could lead to an impact later in life, ttoo much

strict during bowel training could result to strict
personalities like Obsessive compulsive behaviors
whereas lenient to the training can result to opposite to
strict training.

● Parents can be asked to assist when their child

becomes uncooperative during a procedure. Most
commonly, the child’s difficulty in cooperating is
caused by fear. In most situations, the child will feel
more secure with
a parent present. Other methods, such as asking
another nurse to assist or waiting until the child calms
down, may be
necessary, but obtaining a parent’s assistance is the
recommended fi rst action. Restraints should be used
only as a
 last resort; after all other attempts have been made to
encourage cooperation

● In a child younger than 3 years of age, the pinna is

pulled back and down, because the auditory canals
are
almost straight in children. In an adult, the pinna is
pulled up and backward because the auditory canals
are directed inward, forward, and down.

● Time out is the most appropriate discipline for

toddlers. It helps to remove them from the situation
and allows
them to regain control. Structuring interactions with 3-
year-olds helps minimize unacceptable behavior.

This approach

involves setting clear and reasonable rules and calling

attention to unacceptable behavior as soon as it
occurs. Physical punishment, such as spanking, does
cause a dramatic decrease in a behavior but has
serious negative effects. However, slapping a child’s
hand is effective when the child refuses to listen to
verbal commands. Reasoning is more appropriate for
 older children, such as preschoolers and those older,
especially when moral issues are involved.
Unfortunately, reasoning combined with scolding
often takes the form of shame criticism and children
take such
remarks seriously, believing that they are “bad.”

● Toddlers usually express pain through such behaviors

as restlessness, facial grimaces, irritability, and
crying.
It is not particularly helpful to ask toddlers about pain.
In most instances, they would be unable to
understand
or describe the nature and location of their pain
because of their lack of verbal and cognitive skills.
However, preschool and older children have the
verbal and cognitive skills to be able to respond
appropriately. Numeric pain scales are more
appropriate for children who are of school age or
older. Changes in vital signs do occur as a result of
pain, but behavioral changes usually are noticed first.

● School-age children are concerned about justice and

fair play. They become upset when they think
someone is not playing fair. Physical affection makes
them embarrassed and uncomfortable. They are
concerned about others and
are cooperative in play and school.

During the school-age years children learn to

socialize with children of the same age. The “best
friend” stage, which occurs around age 9 or 10 years
of age, is important in providing a foundation for self-
esteem and later relationships. Thinking
independently, organizing, and planning are cognitive
skills. Active play relates to motor skills

Snacks are necessary for school-age children

because of their high energy level. School-age
children are in a
stage of cognitive development in which they can
learn to categorize or classify and can also learn
cause and effect. By
preparing their own snacks, children can learn the
basics of nutrition (such as what carbohydrates are
and what happens
when they are eaten). The mother and child should
make the decision about appropriate foods together.
School-age
children learn to make decisions based on
information, not instinct. Some knowledge of nutrition
is needed to make
 appropriate choices.

Vaccines are preventative in nature and ideally given

before exposure. Focusing on the benefits of cancer
prevention is most appropriate, as opposed to discussing
with parents the potential that their child may become
sexually active without their knowledge. It is true HPV is
most common in adolescents and women in their late
twenties, but parents still may not perceive that their child
is at risk. Discussing the possibility of exposure through
assault raises fears and does not focus on prevention.

● The nurse should provide the adolescent with

information about toxic shock syndrome because of
the identified relationship between tampon use and
the syndrome’s development. Additionally, about 95%
of cases of toxic shock syndrome occur during
menses. Most adolescent females can use tampons
safely if they change them frequently. Using
tampons is not related to menstrual fl ow or sexual activity.
There is no need to refer the girl to a gynecologist; a nurse
can provide health teaching about tampon use.

● Information about why adolescents choose to use

alcohol or other drugs can be used to determine
whether they are becoming responsible users or
 problem users. The senior students likely know the
legal implications of drinking,and the nurse will
establish a more effective relationship with the
students by understanding motivations for use. The
type of alcohol and when and with whom they are
using it are not the first data to obtain when assessing
the situation.
Parents need to discuss with their adolescent how they
perceive his behavior and how they feel about it.
Moodiness is characteristic of adolescents. The
adolescent may have a reason for or not be aware of his
behavior.
Restricting the adolescent’s activities will not change his
mood or the way he responds to others. It may increase
his
unacceptable responses. Counseling may not be needed
at this time if the parents are open to communicating and
listening to the adolescent. Talking to other parents may
be of some help, but what is helpful to others may not be
helpful to their child.