MATERNAL AND CHILD NURSING
Goals and Philosophies of Maternal and Child health
>Obstetric- care of women during childbirth
Greek word “obstare”: to keep watch
>Pediatrics- Greek word “pais”: child
>The care for childbearing and child rearing families is
a major focus of nursing practice because to have
healthy adults, you must have healthy children
Primary goal of Maternal and child health nursing
-promotion and maintenance of optimal family health
to ensure cycles of optimal child bearing and child
rearing
-keeping family at the center of care or keeping family
as primary unit of are
Scope of practice
1. Pre-conceptual health care
2. Care of woman during 3 trimesters of
pregnancy and puerperium
*puerperium- 6 weeks after the childbirth or
4th trimester of pregnancy
3. Care of infants during perinatal period
*perinatal period- 6 weeks before conception
and 6 weeks after birth
4. Care of children from birth to adolescence
5. Care in settings as varied as the birthing room,
pediatric intensive care unit, home
Philosophies of Maternal and Child Health Nursing
(MCHN)
1. MCHN is family centered
2. MCHN is community centered
3. MCHN is research oriented
4. Both nursing theory and evidence based
practice provide a foundation for nursing care
5. MCH nurse serves as advocate to protect
rights of all family members, including fetus
6. MCHN includes high degree of independent
nursing functions
7. 7. Promoting health is an important nursing
role
8. Pregnancy or childhood illness can be stressful
and can alter family life in subtle and extreme
ways
9. Personal, cultural and religious attitudes and
beliefs influence the meaning of illness and its
impact on the family
10. MCHN is a challenging role for a nurse and is a
major factor in promoting high level wellness
in families
“MCHN is evidenced based because this is the
means where by critical knowledge increases”
American Nurses Association/Society of Pediatric
Nurses Standards of Care and
Professional Performance:
Standards of Care
-Comprehensive pediatric nursing care focuses on
helping children and their families and communities
achieve their optimum health potentials. This is best
achieved within the framework of family-centered care
and the nursing process, including primary, secondary,
and tertiary care coordinated across health
care and community settings.
Standard I: Assessment
>The pediatric nurse collects patient health data.
Standard II: Diagnosis
>The pediatric nurse analyzes the assessment data in
determining diagnoses.
Standard III: Outcome Identification
>The pediatric nurse identifies expected outcomes
individualized to the child and the family.
Standard IV: Planning
>The pediatric nurse develops a plan of care that
prescribes interventions to obtain expected outcomes.
Standard V: Implementation
>The pediatric nurse implements the interventions
identified in the plan of care.
Standard VI: Evaluation
>The pediatric nurse evaluates the child’s and family’s
progress toward attainment of outcomes.
Standards of Professional Performance
Standard I: Quality of Care
>The pediatric nurse systematically evaluates the
quality and effectiveness of pediatric nursing practice.
Standard II: Performance Appraisal
>The pediatric nurse evaluates his or her own nursing
practice in relation to professional practice standards
and relevant statutes and regulations.
Standard III: Education
>The pediatric nurse acquires and maintains current
knowledge and competency in pediatric nursing
practice.
Standard IV: Collegiality
>The pediatric nurse interacts with and contributes to
the professional development of peers, colleagues,
and other health care providers.
Standard V: Ethics
>The pediatric nurse’s assessment, actions, and
recommendations on behalf of children and their
families are determined in an ethical manner.
Standard VI: Collaboration
>The pediatric nurse collaborates with the child,
family, and other health care providers in providing
client care.
 MATERNAL AND CHILD NURSING

Standard VII: Research Nursing theories related to MCN

>The pediatric nurse contributes to nursing and 1. Ramona T. Mercer (1929-present)
pediatric health care through the use of research >Maternal Role Attainment theory
methods and findings. -becoming a mother
Standard VIII: Resource Utilization >the process of becoming a mother requires
>The pediatric nurse considers factors related to extensive psychological, social, physical work
safety, effectiveness, and cost in planning and >a woman experiences heightened
delivering patient care. vulnerability and faces tremendous challenges
as she makes this transition. Nurse help
Association of Women’s Health, Obstetric, and women learn, gain confidence and experience
Neonatal Nurses Standards and Guidelines growth as they assume the mother identity
Association of Women’s Health, Obstetric, and
Neonatal Nurses. (1998). 4 stages of becoming a mother
Standards of Professional Performance: 1. Anticipatory
Standard I: Quality of Care -commitment, attachment and
>The nurse systematically evaluates the quality and preparation
effectiveness of nursing practice. -begins during pregnancy and includes
Standard II: Performance Appraisal initial social and psychological adjustment
>The nurse evaluates his/her own nursing practice in to pregnancy
relation to professional practice standards and 2. Formal
relevant statutes and regulations. -acquaintance, learning, physical
Standard III: Education restoration
>The nurse acquires and maintains current knowledge -birth-2 weeks
in nursing practice. -begins with birth of infant and includes
Standard IV: Collegiality learning and taking on role of mother
>The nurse contributes to the professional 3. Informal
development of peers, colleagues, and others. -approaching towards anew normal
Standard V: Ethics -2 weeks-4 months
>The nurse’s decisions and actions on behalf of -begins as mother develop unique ways of
patients are determined in an ethical manner. dealing with the role not conveyed by
Standard VI: Collaboration social system
>The nurse collaborates with the patient, significant 4. Personal
others, and health care providers in providing patient -achievement of maternity identity
care. -after 4 months
Standard VII: Research -woman internalizes her role
>The nurse uses research findings in practice.
Standard VIII: Resource Utilization 2. Cheryl Tatano Beck
>The nurse considers factors related to safety, >post partum depression
effectiveness, and cost in planning and delivering >the birth of a baby is an occasion for joy-or so
patient care. the saying goes-but for some women, joy is
Standard IX: Practice Environment not an option
>The nurse contributes to the environment of care >Symptoms:
delivery within the practice settings. -Tearfulness; excessive crying
Standard X: Accountability -Extreme mood changes
>The nurse is professionally and legally accountable for -Loss of appetite
his/her practice. The professional registered nurse may -Suicial ideation
delegate to and supervise qualified personnel who -Feelings of inadequacy and inability
provide patient care. to cope with infant
*post-partum: after birth-6 weeks
>Predictors:
o Prenatal depression
o Child care stress
o Prenatal anxiety-strong predictor
o Life stress
 MATERNAL AND CHILD NURSING

o Social support Male Reproductive Organ

o Marital relationship *urethra-passage way of urine and semen
o History of previous depression *penile shaft-contains 3 cylinders: erection
o Infant temperament >corpus cavernosum (2 cylinders)
o Maternity blues >corpus spongiosum (1 cylinder)
o Low self-esteem *fore skin-skin flap
o Single marital status *scrotum-sack like, hanging at root of penis
o Low socio-economic status -regulate temperature
o Unplanned or unwanted pregnancy *testis-contain lobules in seminiferous tubules
for sperm production
17 developmental goals (WHO) *seminiferous tubules-produce sperm
1. End poverty in all its forms everywhere >Sertoli-for sperm production
2. End hunger, achieve food security and >Leydig-for hormones
improved nutrition and promote sustainable *Epididymis-first part of duct system
agriculture -tightly coiled (if stretched: up to 20ft long)
3. Ensure health lives and promote well-being for >body: stores immature sperm until mature
all at all ages *vas deferens-transport sperm
4. Ensure inclusive and equitable quality *seminal vesicle-pear shape, behind bladder
education and promote lifelong learning -secretes to ejaculatory duct
opportunities for all -secretes thick fluid for nutrition and
5. Achieve gender equality and empower all energy of sperm (fructose, prostaglandin)
women and girls -composes 60% of sperm
6. Ensure availability and sustainable *prostate gland-doughnut shape
management of water and sanitation for all -produces milky fluid for motility and
7. Ensure access to affordable, reliable, viability of sperm
sustainable and modern energy for all -compose 25% of semen
8. Promote sustained, inclusive and sustainable *bulbourethral gland (Cowper’s gland)
economic growth, full and productive -below prostate
employment and decent work for all -secretes alkaline fluid (precum) to
9. Build resilient infrastructure, promote neutralize urethra
inclusive and sustainable industrialization and Spermatogenesis-process of spermatogonia
foster innovation into mature sperm
10. Reduce inequality within and among countries -more or less 74 days
11. Make cities and human settlements inclusive, *spermatogonia-inactive in
safe, resilient and sustainable seminiferous tubules
12. Ensure sustainable consumption and -immature sperm cells
production patterns -increase in number during
13. Take urgent action to combat climate change Puberty
and its impacts -continues to replenish
14. Conserve and sustainably use the oceans, seas
and marine resources SPERMATOGENESIS
15. Protect, restore and promote sustainable use |
of terrestrial ecosystems, sustainably manage HYPOTHALAMUS
forests, combat desertification and half and |
reverse land degradation and half biodiversity GONADOTROPIN RELEASING HORMONES
loss |
16. Promote peaceful and inclusive societies for ANTERIOR PITUITARY GLAND
sustainable development, provide access to / \
justice for all and build effective, accountable FSH LH
and inclusive institutions at all levels | |
17. Strengthen means of implementation and ANDROGEN BINDING PROTEIN TESTOSTERONE
revitalize global partnership for sustainable
development
 MATERNAL AND CHILD NURSING

SPREMATOGONIA (immature cells) *uterus-hallow organ below pelvis

| -pear shape
1ST DEGREE SPREMATOCYTES -posterior to bladder
| -inferior to intestine or rectum
2ND DEGREE SPERMATOCYTES (23 chromosomes) >parts of the uterus:
| a. fundus-feel contraction on
4 SPERMATIDS (23 chromosomes each) longitudinal muscle
| b. body
4 SPERMATOZOA (for fertilization of ovum) c. isthmus-narrow
d. cervix
Semen: >parts of cervix
30% prostate gland +internal os-opening towards
60% seminal vesicle Uterus
5% seminiferous tubules +cervical canal-opening in the
5% bulbourethral gland Middle
*3-5 cc (1 tsp.) per ejaculation +external os-opening towards
Vagina
Spermatozoa-produced by testicles >layers of the uterus
>40-80 million/cc of semen a. endometrium-inner layer
>300-500 million/ejaculation -make secretions
>12-20 days travel >layers of endometrium
>Mature after 64 days +zona functionalis
>length: 60um -functional layer
>PH 7.2-7.7 +zona basalis-basal layer
>Ejaculated during orgasm b. myometrium-middle and thickest
*less than 20 million: infertile layer
>layers of myometrium
Female External Reproductive Organ +longitudinal muscles
*mons pubis/veneris-adipose tissue on -push during delivery
symphysis pubis +oblique/crisscross muscles
*labia majora-fatty loose connective tissue -squeeze/contract
*labia minors-thinner and medial uterus after delivery
-starts from clitoris +circular muscles
-helps protect vestibule -dilate during delivery
*vestibule-almond shape; starts from clitoris -contract during
*Bartholin’s glands-lubrication pregnancy
*scenesSkene’s gland-moist appearance c. perimetrium-serous outer layer
*clitoris-erectile tissue like male glans penis connected to fascia
*episiotomy-tearing of perineum *circular muscles of the fallopian tube
*elevator ani-muscle under perineum -Prevent backflow that would result to endometriosis
*round ligament-holds fundus of uterus
*ovaries-produce egg cells, progesterone, OOGENESIS
estrogen |
*fallopian tube-trumpet shape PRIMITIVE OOGONIA
-transport and catches ovum |
>parts of the fallopian tube PRIMORDIAL OR PRIMITIVE FOLLICLE (before birth)
a. interstitial portion-near uterus |
b. ampulla-wide and curved SECONDARY OOCYTES
(where fertilization occurs) |
c. infundibulum-before fimbriae GRAAFIAN FOLLICLE
-funnel shape |
d. isthmus-narrow portion OVUM
 MATERNAL AND CHILD NURSING

*zona pellucida-layer of polysaccharide Ovarian cycle:

*corona radiate-must be dissolved by sperm Primary follicle>secondary follicle>Graafian follicle
*nucleus Or vesicular
|
Corpus albicans<corpus luteum<ovulation
(degrading corpus luteum)
Menstruation *lutein-protein that changes graafian cell color
-menarch-onset
-menopause-termination Ovarian cycle:
-300,00-400,000 oozytes per ovary 1. Follicular phase
-average cycle:28 days a. Primary follicle
-duration:3-5 days b. Secondary follicle
-unovulatory state after menarch c. Graafian follicle
-menstrual flow contains 30-80ml of blood 2. Ovulation
-structures involve: hypothalamus, APG, ovaries, 3. Luteal phase
uterus, vagina a. Corpus luteum
-hormones that regulate: FSH and LH -Release progesterone
-estrogen
-progesterone Endometrial changes:
-mittelschmerz 1. Menstrual phase-endometrium sloughs off
-1st 14 days: variable; last 14 days: fixed 2. Proliferative phase-start thickening due to
-menstruation can occur without ovulation Estrogen
*mucorrhea-runny secretion like egg white 3. Secretory phase-thick due to progesterone
>signs of ovulation: (tortuosity)
1. cervical mucorrhea 4. Ischemic phase-before menstrual phase
2. mittelschmerz-ovulatory pain at
suprapubic area Human sexuality
-peak at ovulation *sexual stimulation-eroticphysical and emotional
-unilateral pain *sexually answering stimulus-arousing in nature
>objective signs: (real or symbols)
-change in basal body temperature *physical stimulation-involves touch and pressure on
-spinnbarkeit-mucus is sticky and stretchable body of self or from another person
-fern pattern of cervical mucus -prelude to precoital stimulations
-viewed under slide of microscope (foreplay)
Estrogen -for sexual pleasure (sex play)
-inhibits production of FSH Erogenous zones:
-causes hypertrophy (enlarge) of myometrium -ear lobes
-stimulates growth of breasts ducts -mouth
-increase Ph of cervical mucus causing it to become -neck
thin and watery (spinnbarkeit) -breasts
-proliferates the endometrium (at functional layer) -thigh
-genitals
Progesterone *manual stimulations-masturbation (self or mutual)
-inhibits production of LH *psychologic sexual stimulation-in response to thought
-increase endometrial tortuosity (twisted) and feelings (seeing naked body, sexual fantasies)
-increases endometrial secretions Sexual responses (william master and Virginia jhonson)
-inhibits uterine motility >Stages:
-facilitate transport of fertilized ovum through 1. Excitement-stimulate parasympathetic
fallopian tube (for implantation) nervous system
-increases body temperature after ovulation -arterial dilation and venous
*hypothalamus-release gonadotropin releasing congestion/ constriction leading to
hormone to anterior pituitary FSH and LH to ovaries erection, vaso congestion and
which produces Estrogen and Progesterone muscular tension
-females: clitoris increase in size and
 MATERNAL AND CHILD NURSING

mucoid fluid on vaginal walls by Fertilization process:

Bartholins gland CAPACITATION
-vagina will loosen and widen |-conditioning in female
to increase in length | tract wwwwwwwwwiii
-nipples are erected Acrosome coating in --|
2. Plateau-stage before orgasm sperm detach |
-females: prepuce on clitoris exposes |-decapitated head canii
Clitoris |Only penetrate coronaii
-males: full distention of penis | cells
3. Orgasm-shortest stage ACROSOME REACTIONS
-intense pleasure (personalized) |-binding of zonaiiiiiiiiiiiii
-female: vigorous contraction of pelvic | pellucidaiiiiiiiiiiiiiiiiiii
area muscles (1 per 0.8 seconds) Sperm release enzyme-|
-8-15 contractions to penetrate zona |
-male: propelling of sperm pellucida |
-3-7 muscle contraction (acrsoin and trypsin |
4. Resolution-genitals return to unaroused like substance) |
State FERTILIZATION
-30 minutes for both male and female / | \
-male: refractory period CORTICAL AND 2ND MEOTIC METABOLIC
-further orgasm is impossible ZONA REACTION DIVISION CELL DIVISION
-female: possible of additional orgasm |
ZYGOTE (day 1)
Pregnancy |
-normal amount of semen/ ejaculation: 3-5cc CLEAVAGE (day 1-3)
-number of sperm per cc of semen: 40-80 million |
-number of sperm per ejaculation: 300-500 million
-mature ovum: capable of being fertilized for 12-24 hrs
-sperm: capable of fertilizing for 3-4 days after 2 CELL 4 CELL 8 CELL
Ejaculation DIVISION DIVISION DIVISION
-normal lifespan of sperm: 7 days |
-sperm can reach ovum: 1-5 minutes
-fallopian tube contracts due to estrogen
-sperm must remain in female genital tract: 4-6 hours MORULA (day 3-4)
before they are capable of fertilizing the ovum 16-50 cells
-sperm has 22 autosomes and 1X or Y chromosome *morus-latin: mulberry
-ova has 22 autosomes and 1X chromosome |
>XX-female baby (X-slow but long life span) BLASTOCYST
>xy-male baby (y-fast but shorter life span) |-outer ring containsiiiiii
>stages of pregnancy | trophoblast cells
1. fertilization (impregnation, conception, EARLY BLASTOCYST (day 4-6)
fecundation) Degenerating zona pellucida
-process which sperm penetrates Embryoblast (baby)
outer layer of ovum Blastocyst cavity
2.implantation-blastocyst attaches to Trophoblast (placenta and membrabes)
endometrium at functional layer |
(7-9 days after fertilization) LATE BLASTOCYST (6th day)
-blood discharge can still be present Becomes embryo and amnion
3. pre-coital stage-endometrium becomes
highly vascular (2 weeks after fertilization) Becomes chorion
4.placental and fetal development |
EMBRYO
 MATERNAL AND CHILD NURSING

Primary germ layers Umbilical cord

-ectoderm -chorionic villi form large vessels eventually forming
-mesoderm the umbilical cord
-endoderm -length: 21 inches/53 cm
*yolk sac-source of nutrition until implantation in -width: ¾ inches/2cm
uterine wall -2 arteries and 1 vein (AVA)
>vein-from mother to baby (bigger)
Implantation >arteries-from baby to mother (smaller)
-50% of zygote never achieve implantation *whartons jelly-mucopolysaccharide that gives
-vaginal spotting (small amount) is occasionally present shape to the body of the cord
-endometrium turned to decidua: -protect and cushions body of cord
>decidua basalis-basal layer; attached directly -transport oxygen, nutrients, minerals and waste
for maternal blood products
>decidua capsularis-covers body and stretches -umbilical cord has no nerve to avoid discomfort when
>decidua vera-what is left it is going to be cut
-it has 3 processes: -low numbers of arteries of umbilical cord indicate
APPOSITION congenital abnormality of heart and kidneys
|-brush against uterine wall
ADHESION Amniotic fluid
|-attach to endometriumiiii -content of bag of water (amniotic sac)
INVASION -500-1000ml inside the amniotic sac (bag of water)
|-settle deep into soft tissue -produced by amniotic membrane and constantly
*decidua-latin: fall off newly formed
-shield fetus from pressure or blow
Human development -protects fetus from sudden change in temperature
Late blastocyst -aids in muscular development
-cell begin to differentiate into: -clear color liquid
>inner cell mass (embryo) -aids in descent of baby
>trophoblast cells (attach to uterus) -protects umbilical cord from pressure
-trophoblast cells erode the endometrium of uterus -protects fetus from infection
-blastocyst burrows into uterine wall -pH 7.2: important to know to differentiate amniotic
-endometrium covers embryo and blood supply fluid from urine
becomes established -specific gravity 1.007-1.025
*meconium stain-amniotic fluid with fetus of aby
HCG-human chorionic gonadotropine *test pH by acid-base test (litmus paper)
-hormone secreted by trophoblast
-inhibit ovulation and menstruation AMNIOTIC MEMBRANE
-basis for pregnancy test |
AMNIOTIC FLUID
*chorionic villi-minature villi/ probing fingers that / \
reach out from single layer of cells into the uterine REABSORBED BY MEMBRANE SWALLOWED BY FETUS
endometrium / \
-2 layers of trophoblast cells: BLOOD FETAL
>syncytiotrophoblast/syncytial layer-outer STREAM KIDNEY
-produces hormone: progesterone, | |
HCG, somatomammotropin UMBILICAL CORD URINE
>cytotophoblast/langhans layer-inner | |
-serves as functional layer protecting PLACENTA REABSORBED
embryo from infectious
microorganisms
-protect from bacteria only, not viral
or fungal
 MATERNAL AND CHILD NURSING

*urine-adds up amniotic fluid 7 weeks-brain parts form

*oligohydramnios-amniotic fluid less than 1000ml -has fetal features
(kidney problem) -baby starts to practice moving
-pockets of fluid in ultrasound=less than 1cm -has own blood type different from mother
-give pressure on umbilical cord coming from liver
*polyhydramnios-amniotic fluid more than 2000ml -weight: less than aspirin tablet
(swallowing problem/esophageal obstruction) 8 weeks-brain continues to develop
-pockets of fluid in ultrasound=more than 8cm -longer hands but still webbed
-cord coil -lymphatic system develops
-1/2 inch in size
Placenta -listen to heartbeat using Doppler
-bridge between mother nad fetus -brain waves measurable
-15-20 cotyledons 9 weeks-eyes, nose and respiratory system begin to
-1/4 of uterine wall Form
-fetus to placenta ratio= 1:6 -mouth starts to open
-mother may transmit igG providing immunity for baby -hair follicles produce pigments
1. respiratory system 16 weeks-5 ½ inch tall
2. renal system -6 ounces
3. gastrointestinal system-process of simple diffusion -hands and feet grasp and kick
4. endocrine system: human chorionic gonadotropin -facial expression
>human placental lactogen-development of 18 weeks-vernix caseosa
mammary gland -white particle covering baby
>estrogen-development of mammary gland -protective material
and growth of uterus 19 weeks-lanugo (fine hairs)
>progesterone-hormone of pregnancy -8 inches tall
(pampakappit) -nails on fingers and toes
-maintain endometrial lining 20 weeks-has quickening (move baby)
-reduce ability of uterus to contract -FHR heard using stethoscope
and promote relaxation 24 weeks-baby practice breathing
5.protective functions -sweat glands form mucus
-protects against bacterial not viral or fungal 30 weeks-alveoli in lungs mature; surfactant develops
Infections -help expansion of lungs
-male: testis descend
Fetal development: *cryptorchidism-undescended testis
ZYGOTE (1st-14 days) -blood vessels of retina are very thin
| -oxygen must be regulated or else, premature
EMBRYO (3rd-8th week) infant will go blind because of rupture of blood
| vessels of retina
FETUS (8th week-born) -eyelids can open and close but are very thin
-complete baby -toenails are long
-respiratory movements are practiced
4 weeks-0.2 inch size 31 weeks-bones develop but can still bend
5 weeks-primitive heart tube develops -store iron
-blood vessel -female: clitoris is enlarged
-neural tube becomes spinal cord later on -male: testicles descend to permanent
-brain development position
*folic acid-for brain development -baby moves on rhythm of music
-has eyes and nose 32 weeks-mother produces colostrum
-uterus has mucus plug (operculum) -baby sleeps 90%-95%
6 weeks-“C” shape -rapid eye movement (dreaming)
-heartbeat seen in ultrasound 40 weeks-kick actively, hard enough for mother to feel
-fetal hemoglobin convert to adult hemoglobin
-creases on hands and feet (2/3 of sole)
*shiny sole-prematurity
 MATERNAL AND CHILD NURSING

*due date: only 5% of women deliver on due date 5 Structures unique to fetal circulation
-given range: 38-42 weeks -umbilical vein
-umbilical arteries
Fetal circulation: -ductus venosus
-ductus arteriosus
PLACENTA -foramen ovale
|
UMBILICAL VEIN Oxygenation process:
/ \ -umbilical vein: become ligamentum peres
DUCTUS VENOSUS HEPATIC VEIN -umbilical arteries: become umbilical ligaments
\ / -ductus venosus: become ligamentum venosum
INFERIOR VENA CAVA -ductus arteriosus: become ligamentum arteriosum
| -foramen ovale: becomes fossa ovales
RIGHT ATRIUM
| Location:
FORAMEN OVALE -umbilical vein: between placenta and ductus venosus
| -umbilical arteries: between placenta and body system
LEFT ATRIUM -ductus venosus: between umbilical vein and inferior
| vena cava
LEFT VENTRICLE -ductus arteriosus: between pulmonary artery and
| aorta
ASCENDING AORTA -foramen ovale: wall septum of right and left atrium
|
BRAIN AND UPPER BODY PARTS Focus of fetal development
| 1st trimester: organogenesis (organ formation)
SUPERIOR VENA CAVA 2nd trimester: period of continued growth and
| Development
RIGHT ATRIUM 3rd trimester: period of most rapid growth and
| Development
RIGHT VENTRICLE
| Pregnancy duration:
RIGHT ARTERY 280 days
/ \ 40 weeks
LUNGS DUCTUS ARTERIOSUS 9 calendar months
| | 10 lunar months
PULMONARY VEIN | 3 trimesters
| |
LEFT ATRIUM | Normal adaptation in pregnancy
| | a. Reproductive system
LEFT VENTRICLE--------DESCENDING AORTA *uterus-uterine growth and enlargement
\ / -becomes globular (4th month)
LOWER BODY PARTS >length: 6.5cm-32cm
| >width: 4cm-24cm
UMBILICAL ARTERY >depth: 2.5cm-22cm
| >weight: 50grams-1000grams
UMBILICAL CORD >volume: 1-2ml-1000ml
| +Braxton hicks contraction-mid
PLACENTA intermittent painless contraction of
uterus
+Goodell’s sign (4th week)-softening of
cervix (like an earlobe) due to increase
of estrogen levels
+Hegar’s sign (8th week)-lower portion
of uterus becomes soft
 MATERNAL AND CHILD NURSING
+Chadwick’s sign (8th-10th week)
-mucus membrane of reproductive
system is blueish or purple in color
due to increased vascularity and blood
supply
*ovaries-no ovulation
*vagina-more acidic (Ph 3.5-6)
-acidic urine to kill bacteria but may be
prone to fungal infection
*breasts-enlarged
b. Musculoskeltal system
-waddling walk
-symphysis pubis may separate slightly
-increased calcium and phosphorus demand
for baby’s bone formation
-lordotic posture resulting to lower back pain
*diastasis recti-separation of muscle fibers of
the abdomen (rectus abdominis) resulting to
pendulous abdomen
c. Circulatory system
-increase in clotting factors: may be prone to
Thrombosis
-increased blood volume 40%-50% to provide
adequate exchange of blood and nutrients
-preparation for blood loss in delivery
-physiologic anemia: due to imbalance of
plasma and hemoglobin
-iron supply of mother is low resulting
to lower plasma volume
-heart is displaced upward
-increased cardiac output to 30%
-supine hypotension/ venacaval syndrome
-due to pressure of gravid uterus to
superior vena cava
-increased WBC
-increased CR and PR: 10-15bpm
-varicosities
*pregnancy induced hypertension-due to high
blood pressure
d. Integumentary system
-increased pigmentation:
-melanocyte stimulating hormone
increases melanin production
-melasma/ chloasma: mask of pregnancy
-striae gravidarum (stretch mark)-reduced
connective tissue strength
-linea nigra-brown line at middle of stomach
-increased perspiration
e. Gastrointestinal system
-morning sickness: caused by hormonal
changes decreasing digestion and peristalsis
-heartburn: acid reflux
*progesterone: cause heart burn
-cause relaxation of GI tract
making decreased digestion
-constipation
-flatulence
-prolonged emptying of gallbladder: increasing
cholesterol and possible gal stone formation
f. Endocrine system
-increased metabolism of CHO and CHON
-increased insulin production
*pancreas- decrease insulin during early
pregnancy
-after 1st trimester, increase insulin
because of insulin antagonist
properties: estrogen, progesterone,
HPL
*pituitary-decrease FSH and LH
-increase prolactin, MSH, human
growth hormone
*placenta-produce estrogen and progesterone
-increase relaxin: softens cervix and
Joints
-HPL: Increase glucose for fetus
-increased fetal growth
-decreased utilization
of protein for energy
g. Respiratory system
-increased RR
-dyspnea (shortness of breathing)
-increase tidal volume (40%) {inhale-exhale}
-increase vital lung capacity-volume exhaled
after maximum inhalation
-decreased residual volume-air remaining in
system after exhalation
-diaphragm misplaced up to 4cm upward
*stuffy nose-due to estrogen levels
h. Urinary system
-urinary frequency
-increased glomerular filtration rate
-increased aldosterone: sodium reabsorption
-increase fluid intake for ease of transfer of
nutrients to baby
i. Immune response-decreased:
-foreign object (baby) to not be expelled
-mother prone to infection
 MATERNAL AND CHILD NURSING

j. Weight gain Prenatal care-care of women before delivery

>weight distribution 1) Data gathering
*fetus-7lbs a) Demographic data-basic questions
*placenta-1lb b) Obstetrical data-all about reproductive system
*amniotic fluid-1.5lbs c) Medical health history-hypertension, DM
*uterus-2lbs 2) Physical assessment
*blood volume-1lb 3) Pelvic examination
*breasts-1.5-3lbs 4) Leopold’s maneuver
*fluid-2lbs 5) Fetal heart tone monitoring
*fats-4-6lbs 6) Laboratory examinations
Total: 10-11lbs
>1st trimester: 1.5-3lbs (no calorie increase) Purpose of prenatal care
>2nd trimester: 10-11lbs (300 calories per day) -overall health of mother and baby
>3rd trimester: 10-11lbs (300 calories per day) -early detection
-establish baseline data
Signs of pregnancy -educate family of mother
>Presumptive-least indicative of pregnancy -minimize risk of sickness and complication
-could indicate other condition -see doctor the moment you know you are pregnant
-largely subjective >1st 6 lunar months: see doctor 1 a month
>Probable-documented by examiner >7-8 months: see doctor 2 a month
(lab test, pregnancy test) >9-10 months: see doctor weekly
-objective manifestation >1st trimester: see doctor 1 a month
>Positive-fetal heartbeat >2nd trimester: see doctor 2 a month
-fetal movement felt by examiner > 3rd trimester: see doctor weekly
-ultra sound visualization of fetus
Obstetrical data
First trimester: Age of gestation (AOG)
>presumptive signs: -by weeks
irritability, emotional temperament, -Mc donald’s method (months)
amenorrhea, morning sickness, breast -Bartholomew’s rule-non-numerical value but
changes, fatigue, urinary frequency, enlarging use landmarks
of uterus Gravida Para Abortion (GPA)
>probable signs: Term Preterm Abortion Living (TPAL)
Chadwick’s sign, Goodels, hegars, (+)HCG Expected Date of Confinement (EDC)
*HCG-Hydatidiform mole=placenta develops -Naegel’s rule
but baby did not that could lead to cancer Obstetrical history
>positive signs:
Ultrasound results: *Bartholomew’s rule-palpate for fundus
-fetal outline and movement 12 weeks old-fundus near symphysis pubis
-fetal heart tone 16 weeks old-fundus between umbilicus and
symphysis pubis
Second trimester: 20 weeks old-fundus near umbilicus
>presumptive signs: 36 weeks old-fundus at xyphoid process
Quickening, skin pigmentation, chloasma, linea 40 weeks old-fundus at 4cm below xyphoid process
negra, striae gravidarum
>probable signs:
Enlarged abdomen, Braxton hicks,
ballottement
-rebound feeling of examiner
>positive signs:
FHT, detal movement, fetal Xray
 MATERNAL AND CHILD NURSING

Age of Gestation Estimated weight-using johnsons rule

*by weeks -results in grams
Ask: Last menstrual period (LMP) Formula:
-first day of last menstruation FH – N x K
Ex.1 Fundic height constant (155)
Given: 12(engaged) or 11(not engaged)
LMP=May 27, 2019 *engaged-descended into pelvic brim
Date of examination=August 3, 2019 Ex.1
Solution: Given:
FH=34cm (engaged)
Solution:

Ex.2
Given:
LMP=February 1, 2019 {not leap year} Ex.2
Date of examination=October 8, 2019 Given: FH=34cm (not engaged)
Solution: Solution:

Mc Donalds Method-measure in cm the symphysis Estimated date of confinement-base on LMP

pubis to fundus (Fundic Height) -give allowance of 2 weeks
-use lunar months (4 weeks/month) -follow Naegel’s rule:
Formula: Month Date Year
FH=Fundic Height in cm -3 +7 +1
FH/4= age of gestation Ex.1
Ex.1 Given:
Given: LMP=May 27, 2019 (not leap year)
FH=16 cm Solution:
Solution:

Ex.1
Haase rule-estimated fetal length Given:
-square each month, stop at 4th month LMP=January 1, 2019 (not leap year)
-multiply by 5 starting 5th month to 9th month Solution:
-results in cm
 MATERNAL AND CHILD NURSING

Terms related to pregnancy status Observe for danger signs during pregnancy:
*para-number of pregnancies that have reached a) Vaginal bleeding-starts with mild bleeding
viability, regardless of whether the infant were born *placenta previa-placenta implanted
alive low (painless vaginal bleeding)
>viability-capacity of baby to live in extra *abruption placenta-premature
uterine life separation of placenta
`>age of viability: (painful vaginal bleeding)
20 weeks=foreign country *premature labor
28 weeks=Philippines *threatened abortion-early part of
-based on presence of pregnancy
surfactants in lungs b) Persistent vomiting
*gravida-woman who is or has been pregnant *hyperemesis gravidarum-due to
*primigravida-woman who is pregnant for the 1st time increase HCG levels
*primipara-woman who is pregnant to one child past (dehydration and loss of
age of viability nutrition)
*multigravida-woman who has been pregnant *persistent infection
previously c) Chills and fever
*multipara- woman who has carried 2 or more *infection
pregnancies to viability *dehydration
*nulligravida-woman who has never been and is not *gastroenteritis
currently pregnant d) Sudden escape of fluid from the vagina
>abortion-termination of pregnancy -ruptured bag of water or leakage
-below 28 weeks -cause cord prolapse
-umbilical cord goes with the
TPALM-based on head count flow of fluid going out the
T-term-37 weeks and above vagina
P-preterm-28-37 weeks -always check pH of fluid
A-abortion-27 weeks and below *PROM-premature rupture of membranes
L-living-currently living children e) Abdominal or chest pain
M-multiple-multiple babies per pregnancy *ectopic pregnancy
*abruption placenta
GPA-based on number of pregnancies *uterine rupture
*pulmonary embolism
Ex.1 f) Swelling of face and fingers-PIH, edema
Situation: g) Rapid weight gain-PIH
G1-NSVD at home h) Flashes of light or dots before the eyes-PIH
G2-twins (abrupt CS) i) Dimness or blurring of vision-PIH
G3-spontaneous abortion j) Severe headache-PIH
G4-Scheuled Cs k) Decrease urine output-edema, dehydration
G5-current at womb l) Increase or decrease fetal movement
>increase=baby lacks oxygen
Physical assessment (cephalocaudal) >decrease=may be FDIU
-void (MSCC): midstream clean catch
-baseline height, weight Pelvic examination
-VS: 1. Internal examination (IE)
>sudden increase of BP and weight gain: 2. Vaginal speculum
danger signs of hypertension in pregnancy 3. Transvaginal ultrasound
>sudden drop of pulse or respirations: 4. Papanicolou(pop smear)–tests cervical cancer
may suggest bleeding
>FHT increase 120-160bpm
*FDIU=fetal death in utero
*blood and puss in urine=UTI leads to premature labor
*protein-kidney problem leads to HIL
*glucose-gestational diabetes
 MATERNAL AND CHILD NURSING

Leopolds maneuver -second and third trimester

-non-invasive procedure to determine fetal >heart burn
presentation, position and attitude -small frequent feeding
-used to locate fetal back before applying the fetal -sit upright for 30 minutes after meal
monitor -drink milk between meals
-equipment: warm, clean hands -avoid fatty and spicy foods
*fundal grip-smooth at top (presentation) -avoid antacids unless prescribed by physician
*umbilical grip-smooth at right and rounded >ankle edema
(fetal lie) -elevate legs at least 2 days
*pelvic grip-head to bottom (engagement) -wear support stockings
-side to side (not yet engaged) -avoid one position for long periods of time
*pawlick’s grip-face foot part of mother -avoid diuretics
(attitude) >varicose veins
Fetal Heart monitoring -wear support stockings
-stethoscope, Doppler, fetoscope, exteral/internal -elevate feet when sitting
electronic membrane -lying with feet and hips elevated
-FHR every 30 minutes-beginning of labor -move out while standing
15 minutes-during active labor -avoid pressure on lower legs
5 minutes-2nd stage of labor -avoid leg crossing
-avoid standing/sitting for long periods of time
Discomforts in pregnancy -avoid constricting clothing
-first trimester >headaches
>nausea and vomiting -change position slowly
-eat dry crackers -apply cool cloth on forehead
-small frequent feeding -eat small snack
-low fat meals -use pain relievers when prescribed
-avoid fried foods >hemorrhoids
-avoid antiemetics -warm sitz bath
>syncope-lack of oxygen -high fiber diet
-sit with feet elevated -increase oral fluid intake
-change position slowly -exercise
-left lateral position (no pressure on venacava) -apply ointments/suppositories as prescribed
-first-third trimester >constipation
>breast tenderness -high fiber diet
-use supportive bra with elastic strap -increase oral fluid intake
-avoid soap in the nipples and areola (dryness) -exercise
>increased vaginal discharges -avoid laxatives
-proper cleaning and hygiene >shortness of breath
-wear cotton underwear -rest periods
-avoid douching -elevate head while sleeping
-consult physician if infection is suspected -avoid over exertion
>nasal stuffiness >backache
-use humidifiers -encourage rest
-avoid nasal sprays and antihistamines -use body mechanics
>fatigue -wear low-heeled shoes
-frequent rest periods -exercise
-regular exercise -sleep on firm mattress
-avoid stimulants >leg cramps
>urinary frequency and urgency -exercise
-increase oral fluid intake -elevate and dorsiflex the feet while resting
-limits fluid intake in the evening -increase calcium intake
-void at regular intervals -avoid pointing toes
-sleep on the left side at night *cauvadant syndrome-physical and psychological
-wear perineal pads if necessary change in males during pregnancy
 MATERNAL AND CHILD NURSING
Recommended Exercise
1. Tailor sitting-butterfly sit
(15 min./day for thigh and perineum)
2. Squatting-stretch muscle of pelvic floor
3. Kegel’s exercise-pelvic floor contraction
(post partum)
4. Abdominal muscle contraction
-prevents constipation
-tighten and relax abdominal muscles
5. Pelvic rocking-spine flexibility (otso-otso)
Labor
-a series of events when the product of conception is
expelled out from the woman’s body
-regular uterine contractions cause progression
dilation of the cervix and sufficient muscular face to
allow the body to be pushed outside
-usually begins when the fetus is sufficiently mature
Goal:
-safe delivery
-effective delivery
-comfortable delivery
Theories of labor
*maternal factors
1. Uterine stretch theory
-when organ is full, it will empty the content
-when uterus is stretch full, release
prostaglandin stimulating contraction and
starting delivery
2. Oxytocin theory
-released by posterior pituitary gland
-stimulate contraction
*ferguson reflex
-pressure on cervix stimulating nerve
plexus releasing oxytocin resulting to
constriction
3. Progressive deprivation theory
-decreased progesterone, increased estrogen
exciting uterine response
*fetal factors
4. Prostaglandin theory
-delivery caused by adrenal gland of fetus and
uterus of mother interaction
5. Placental aging theory
-fetus degenerates at 40% decreasing its
function and interpreted by the mothers body
as foreign object and interpreted by mother’s
body as foreign object thus expelling the fetus
Components of labor
*passageway-adequate and contoured pelvic bone,
vagina, cervix
*passenger-appropriate size, position of fetus,
umbilical cord, amniotic sac, placenta
*power-contratcon of mother influenced by position
*psyche-preserve positive view on labor and delivery
*dystocia-slow and difficult labor
A, passageway-route where the baby will travel
1. Pelvis (pelvic ring-bony structure)
2. Cervix
3. Vagina
1. Pelvis
*diagonal conjugate
-subpubic area to sacral promontory
-12.5 cm
-measurement done manually by pelvic
Examination
*obstetric conjugate
-middle of sacral promontory
-1cm below pelvic crest
-deduct/subtract 1.5cm from diagonal
conjugate (11cm)
-determines whether fetus can move down or
Not
*conjugate vera
-middle of sacral promontory to middle of
pelvic crest
pelvic outlet:
-diagonal conjugate (9-12.5cm)
-true conjugate (10.5-11cm)
-biischial/intertuberus diameter (11cm)
interspinous diameter (10.5cm)
 MATERNAL AND CHILD NURSING
different types of pelvis
*gynecoid
-inlet rounded
-good/favorable for vaginal birth
-common to women
*platypeloid
-inlet oval in shape; long transverse
-mid pelvis and outlet reduce
(funnel shape)
-not favorable for vaginal birth
*anthropoid
-AP diameter oval in shape; short
Transverse
-outlet and mid pelvis: inadequate
*android
-heart shape inlet
-short sagittal diameter
-common to males
-possible arrest during labor
>lightening-fetal presenting part into pelvis
>engagement-fetal presenting part into ischial spine
>station-fetal presentation up to level of ischial spine
(-)=floating ; (+)=outlet
2. Cervix
>dilation-opening of cervical os
-from 1cm-10cm (fully dilated cervix)
-due to uterine contraction and
amniotic fluid
*vaginal show-cervical secretions during
Dilation (vaginal mucoid secretions)
-amount increases as cervix dilates
>effacement-thinning of cervical canal
-expressed in %
-fully dilated-100%
-midway-50%
-starts when baby goes down
-cervix becomes soft and thin
3. Vagina
>Vaginal canal-has rugae and capable of
stretching but can be lacerated
*1st degree-skin
*2nd degree-skin and muscles
*3rd degree-external sphincter of
Rectum
*4th degree-mucus membrane of
rectum
>perineum-site of episiotomy
-incision at perineal area to
help delivery of baby
a. Median episiotomy
b. Right mediolateral
c. Left mediolateral
B. Passengers
1. fetus
2. umbilical cord
3. amniotic sac
4. palcenta
1.the fetus
-fetal skull (largest part of fetal body)
-fetal attitude
-fetal lie
-fetal presentation
-fetal position
*anterior frontanel (bregma)
-between coronal and sagittal suture
-diamond shape
*posterior frontanel (lambda)
-close 2-3 months
-triangular shape
*membrane spaces
>suture lines-allow bases to move and overlap
as it passes through pelvic bone
>biparietal diameter
-transverse diameter (9.5cm)
>bitemporal diameter (8cm)
*molding-overlaping of cervical bases
-smaller skull when passing through pelvis
>suboccipitobregmatic (9.5cm)
>occipitofrontal (12cm)
>occipitomental (13.5cm)
>submentobregmatic (9.5cm)
Fetal attitude-degree of flexion the fetus assumes
a. Well flexed: good attitude
-vertex presentation=space between anterior
and posterior frontanel
smallest diameter
-suboccipitobregmatic diameter
9.5 cm
b. No flexion: military attitude
-military presentation
-occipitofrontal diameter
-12.5 cm
c. Partial flexion: poor attitude
-brow presentation
-occipitomentum diameter
-13.5 cm
d. Full extension: poor attitude
-face presentation
-submentobregmatic diameter
-9.5+cm
 MATERNAL AND CHILD NURSING

Face lie-relationship of long axis of fetus and long axis 3.transverse presentation
of mother lie: horizontal
Vertical/longitudinal lie presentation: shoulder, head, elbow
presenting part: scapula
Transverse/horizontal lie attitude: flexion
*cephalic vertex-ideal position for vaginal birth
Oblique lie
Possible dangers:
Presentation-part of fetus that will first contact the -cord compression
cervix -abruptio placenta
*presenting part specific part that covers internal
cervical os and first comes in contact with pelvis Fetal position-position of the fetal presenting part of
the specific quadrant of mother’s pelvis
1. vertical cephalic presentation-most frequent type -division of pelvis:
-head is most favorable for birth
*FHT-right lower quadrant
a. vertex (full flexion)
b. sinciput (moderate flexion)
c. brow (partial extension)
d. face (poor flexion, complete extension) Fetal landmarks:
e. mentum presentation (very poor attitude) Occiput-vertex/cephalic presentation (O)
-hyperextension of the head Mentum-chin/face presentation (M)
-chin=presenting part Sacrum-breech position (Sa)
*cone head-caput succedaneum (2-3 days) Acromion-scapula/shoulder presentation (A/Sc)
-whole head becomes edematous
*cephal hematoma-located at bruising site Fetal position-represented by 3 letter abbreviation
-only one side is inflamed (2-3 weeks) 1st letter=L (left) or R (right)
-instruct patient not to push when not yet due 2nd letter=fetal landmarks (O,M,Sa,A)
3rd letter=A (anterior), P (posterior), T (transverse)
2.vertical breech position If vertex: LOA, LOP, LOT, ROA, ROP, ROT
*FHT-left upper quadrant If breech: LSA, LSP, LST, RSA, RSP, RST
a. complete breech-show buttocks and legs If face/chin: LMA, LMP, LMT, RMA, RMP, RMT
lie: longitudinal If shoulder: LAA, LAP, RAA, RAP
presentation: breech (complete) *identical twins-monozygote
presenting part: sacrum and feet *fraternal twins-dizygote
attitude: general flexion
b.frank breech-show buttocks only
lie: longitudinal
presentation: breech (incomplete)
presenting part: sacrum
attitude: flexion, except for legs, knees
c.single footling-show foot only
lie: longitudinal
presentation: breech (incomplete)
presenting part: sacrum
attitude: flexion, except for
oneleg extended
d.double footling-show 2 feet
lie: longitudinal
presentation: breech (incomplete)
presenting part: sacrum
attitude: flexion, except for
one leg extended
 MATERNAL AND CHILD NURSING

Placenta
1. Placental separation (5 min. after birth)
Signs:
a. Calkin sign/globular sign of fetus
-as placenta detaches, oblique
fibers contract becoming globular
b. Sudden gush of blood
c. Lengthening of cord
2. Placental delivery
a. Duncan delivery-dirty side Difference between false and true labor
-sharing cotyledons False labor True labor
-mother side Irregular interval Regular interval
-attached to mother contractions contractions
-side detaches first Pain in abdomen Starts at back to
b. Schultz delivery-clean side abdomen
-one with umbilical cord Intensity remains Contractions are
-shiny, usual the same intensified
-center detaches first Intervals remain Intervals gradually
long shorten
Power Walking gives relief Intensified by
a. Uterine contraction walking
*uncoordinated contraction-slow labor No bloody show With bloody show
No cervical changes Cervical dilatation
and effacement
Contractions stop Does not stop with
with sedation sedation

-start with myometrial contractility

-prolonged contraction results to rupture of
uterus
-baby increase FHT to compensate decrease
oxygen Preliminary signs of labor
>duration-beginning to end of same 1. Lightening
contraction 2. Loss of weight (1-3lbs)
-measured in seconds 3. Increase in activity level: high epinephrine
>frequency-beginning of one to beginning of 4. Braxton hicks contraction
another contraction 5. Rioening of cervix
-measured in minutes 6. Rupture of membranes: associated with
>interval-end of one contraction to the infection or cord prolapse
beginning of another 7. Bloody show: operculum (mucus plug) is
-measured in minutes removed
>intensity-strength of contraction *labor components
-duration and intensity increases as labor Dilatation
progresses Effacement
-interval and frequency decreases as labor Station (engagement)
progresses Presentation
*acme-highest intensity Presenting part
*intensity:
Mid=press 1 inch
Moderate=press ½ inch
Strong=no pressing
 MATERNAL AND CHILD NURSING

Stages of labor 15. Assist in amniotomy (meconium stain)

1. Dilatation stage 16. Watch out for SUBIRBA
a. Latent phase 17. Emotional support
b. Active phase *SUBIRBA:
c. Transitional phase S-severe uterine contraction
2. Fetal expulsion stage U-urge to defecate
3. Placental stage B-bearing down sensation
4. Recovery and bonding I-increased bloody show
(1st 4 hours after placenta) R-ruptured bag of water
B-bulging of perineum
I. Dilatation A-anal dilation
-starts: onset of true labor
-ends: expulsion of fetus II. Expulsion
*maximum dilation=8-10cm -starts: full dilation of cervix
-phases of labor -ends: delivery of fetus
i. Latent phase-if long, CPD *primi-longer (2hrs)
(cephalo pelvic disproportion) *multi-shorter (15min.)
may occur -mechanism of labor
ii. Active phase-cervix dilate -perineal and vaginal laceration
rapidly; operculum moves How to prevent: ritgens maneuver
-rupture of membrane, -promote effective pushing
stronger and longer -nursing responsibilities
contractions, discomfort *crowning-presenting part appears
iii. Transitional phase-full dilation -anal dilation
and amniotomy -perineum bulge
*amniotomy-artificial rupture -episiotomy
of membrane >Mechanism of labor:
criteria latent active transitional D-descent-engagement; assume flexion
Dilation 0-3cm 4-7cm 8-10cm position
Intensity mild moderate Strong F-flexion
Duration 15-30 sec. 30-60 sec. 60-90 sec. IR-internal rotation
Interval 15-30 min. 3-5 min. 2-3 min. E-extension
Length 8-12 hrs. 2-3 hrs. 1 hr. ER-external rotation
Emotion Excited fear irritable E-expulsion
diet DAT-soft NPO NPO *get time and gender when delivered
Bag of Intact bag Ruptured Amniotomy -skin to skin contact
water of water bag of ruptured *New born care-promote breathing
water membrane -avoid hypothermia
Nursing care during first stage -ensure a safe environment
1. Admission care -dry baby well (first 30 seconds of life)
2. Data gathering >warm cloth to dry baby (5 sec. each)
3. Assisting IE 1. nose, mouth, face (1st5sec.)
4. Leopold’s maneuver 2. head
5. Fetal heart tone monitoring (largest; thermoregulating
6. Uterine contraction monitoring center)
7. Promote change in position (left lateral) 3. body
8. Empty the bladder 4.back
9. Hygiene 5. upper extremities
10. Enema administration 6. lower extremities
11. Perineal preparation -clamping and cutting the umbilical cord
12. Analgesic administration as ordered after 2-3 min. or after no pulsation is felt
13. Assist in administration of vaginal *plastic clamp-1 inch after baby’s
anesthesia Stomach
14. Start IVF as ordered -milk from after the clamp for 1 inch using
 MATERNAL AND CHILD NURSING

forceps to clamp again if placenta will not let go, uterine inversion
-cut in the middle of the plastic clamp and occurs
Forceps -assist doctor in episioraphy
-place baby skin to skin (frog like position) with -monitor VS of baby q15 min.
mother near stomach Nursing care during third stage
-place bonnet and linen at head and back for 1. Perform credes maneuver
60-90 sec. a. Apply pressure on hypogastric
-breast feeding: stimulate oxytocin preventing area
bleeding of mother b. Gentle traction of the cord
-place identification tag on leg of baby 2. Do brandt Andrew maneuver
Nursing care during second stage 3. Gently pull the placenta downward
1. Lithotomy position 4. Take note for the time of placental
2. Perineal flushing delivery
3. Drape aseptically 5. Check for type of placental delivery
4. Teach breathing technique during uterine 6. Take BP q5 min.
relaxation 7. Check for completeness of cotyledons
5. Teach pushing technique during uterine 8. Promote uterine contraction
contraction a. Massage the hypogastric area
6. Assist episiotomy b. Apply ice pack on hypogastric area
7. Do ritgen’s maneuver c. Administer medication:
8. Ease head out, wipe face oxytocin/maleate
9. Assist for external rotation d. Empty bladder
10. Pull head downward then upward to deliver 9. Inspect perineum for laceration
the shoulder 10. Assist in episioraphy/ repair of laceration
11. Deliver the body 11. Perineal care
12. Take note of time of delivery and sex of baby 12. Apply contoured brief/ adult diaper
13. Place baby on mother’s adomen 13. Make patient comfortable
14. Dry baby thoroughly 14. Monitor vital signs q5 min.
15. Palpate pulsation of cord *oxytocin-given (IM IV) to mother after
16. Clamp cord 1 inch from the base once placental delivery or when baby has
pulsation stops been delivered (unang yakap)
17. Milk cord from cord clamp up to 2 inches -prevents bleeding
towards mother IV. Recovery and bonding
18. Clamp 1 inch apart from initial clamping using -first 4 hours
forceps -start: delivery of placenta
19. Cut the cord -end: 2hours post partum
III. Placental -most critical period of mother
-start: baby goes out -skin to skin contact atleast 90 min.
-end: placenta goes out -undergo initial readjustment
1. Placental separation -feel fundus at midway of symphysis pubis
a. Calkin sign and umbilicus after 1 hour
b. Sudden gush of blood *uterine atony-relaxation of uterus
c. Lengthening of cord leading to bleeding
2. Placental delivery
>Duncan delivery-dirty side Nursing care during fourth stage
>Schultz delivery-clean side 1. Assess fundus
*traction and contraction: 2. Check for bleeding
>crede’s maneuver-pressure on 3. Check the bladder
hypogastric area 4. Check the perineum
>brandt andrew’s maneuver-roll long 5. VS q5 min. for 15 min., q15min. for 30
cord around forceps min., q30 min. for 1 hour
*apply only when uterus is contracting 6. Promote rest
If you pull too hard, detachment occurs
making a retained placenta
 MATERNAL AND CHILD NURSING

Neonatal period 8. Antoropometric measurements

1. Airway
a. Wipe mouth and nose
b. Suction
c. Stimulate to cry
d. Oxygen administration
e. Hook to respiratory machine
2. Temperature
a. Dry the baby
b. Wrap with towel
c. Goose neck lamp
d. Avoid uneccessary exposure
e. Place inside incubator
f. Skin to skin contact
3. Proper identification
a. Name band
b. Foot prints (not doen anymore)
4. Care of the cord
a. Keep the cord dry (or infection)
5. Care of the eyes
a. Credes prophylaxis: prevents
opthalmia neonatorum
6. Vitamin K injection
-prevents bleeding (0.1cc; IM)
-left vastus lateralis
-produced by intestine:
Baby cant still produce vitamin K
because intestines are still sterile
-normal flora of GI tract
7. Newborn assessment
-APGAR scoring- done after 1-5min. of life
0 1
Heat rate Absent <100
RR Absent Slow/irregular
Muscle Absent/limp Some flexion
tone
Reflexes No Grimace
response
color Blue/pale acrocyanosis
A-appearance
P-pulse
G-grimace
A-activity
R-respiration
*hepatitis B- right thigh
Score interpretation:
0-4: poor
In serious danger and needs
Respiration
5-6: condition is guarded
May need airway clearing and oxygen
7-10: good
New born is doing well
Birth weight= 2.5-3.5 kg
Length= 45-55cm
Head circumference= 32-35.5cm
Chest circumference= 30-33cm
Abdominal circumference= 28-30 cm
*kg.>lbs= (kg X 2.2)
>AGA-appropriate for gestational age
>LGA-large for gestational age
>SGA-small for gestational age
9. Vital signs
Heart rate= 110-160bpm
Respiratory= 30-60 breaths/minute
Temperature (rectal)= 36-37.6 C
*imperforate anus-check anus
if there is a hole
-stimulate vagus nerve making
heart bradycardic
-HR and RR decrease with growth
10. Head to toe assessment
a. Head
i. Moldings
ii. Frontanel
iii. Caput seccedaneum (fluid)
iv. Cephalhematoma (blood)
v. Suture lines
vi. Unencephaly- absence of skull
b. Face
i. Blink reflex
ii. Nystagmus (side to side)
iii. Strabismus (cross eyed)
2 iv. Ears should be even or above
>100 eye canthus
Good c. Chest
cry i. Witch milk-thin watery fluid
Active from breast due to hormones
d. Abdomen
Cry i. Check umbilical cord
ii. Gastroschysis-absence of
Al pink abdominal wall
e. Genitals
i. Should void within 1st 24
hours
ii. Pseudomenses (2-3 days)
1. Discharge from vagina
due to hormones
iii. Testes should be descended
1. Cryptorchidism-
undescended testes
iv. Preterm male has less rugae in
scrotum
v. Labia minora is prominent
 MATERNAL AND CHILD NURSING
f.Extremities
i. Flexed
ii. Creases on palm
iii. Polydactyl-extra toes or
fingers
iv. Syndactyly-webbing of fingers
v. Amelia-absence of upper
extremities
vi. Tocophilia-absence of lower
extremities
vii. Club foot
g. Skin
i. Color
ii. Mongolian spots
iii. Vernix caseosa
iv. Lanugo
v. Milia (white heads on nose)
*puerperium-6 weeks after delivery
Termination of labor
*involution-progressive change of uterus after
delivery back to its pre-pregnant state
goals:
1. Maintain infection free environment
2. Promote healing
3. Watch for bleeding
4. Encourage early ambulation (promotes
circulation of blood)
5. Promote comfort and rest
6. Provide emotional support
7. Establish successful lactation
Physiologic changes in post partal period
1. Reproductive changes (prone to hemorrhage)
Uterus
i. Size reduce:
>Immediately after delivery:
1000 grams
>After end of first week: 500
grams
>After 6 weeks: 50 grams
-complete involution
-placental site is sealed off
-cervical os are narrowed
-painful during contraction
-contracted
2. fundal height post partum
-6-12 hours post partum
-immediately after birth
>after birth-between umbilicus and symphysis
Pubis
>1 hour after birth to 24 hours-umbilicus
*palpate daily if it is going down one
finger breadth
*8th day-cant be palpated anymore
3. lochia (1st 3 weeks)
-discharges of uterus
>lochia rubra (red)
-1-3 days post partum
-decidua and blood
>lochia serosa (lighter color/ pinkish brown)
-4-10 days post partum
-little blood and mostly serum
>lochia alba (white, yellow, colorless)
-11-21 days post partum
-minimal
-pattern should not reverse
-increase in activity
-decrease in breast feeding
-not offensive in odor
-without large clots
-present in os
*CS-lesser lochia
4.vagina
-soft, swollen
-hymen is permanently torn
5.perineum
-edematous
-with laceration or episioraphy
-labia minora and majora remains atrophic
*ecchymosis-rupture of tiny capilliaries forming tiny
Hematomas
6.abdomen
-soft and flobby
-striae gravidarum lightens
-linea negra disappears in 6th week
7.breasts
-drop in estrogen and progesterone
-lactating resulting to breast enlargement
-colostrum is present (first milk)
-yellowish in color but most important
-contains IgA
-let down reflex (sucking reflex of baby)
-warm and tender
-engorged
-milk is produced by 3rd-4th day
-veins are apparent
Systemic changes
1. Hormonal-no HCG; decrease FSH
a. After 1 week-prepregnant state
2. Urinary system
a. Preserves 2000-3000ml excess fluid
accumulation
b. Voiding may be difficult immediately
after birth
c. Urinary retention
d. After 1 hours: diuresis (frequent
urination)
 MATERNAL AND CHILD NURSING

e. Voiding time should be within 4-6 Physiology of milk production and ejection
hours post partum or dehydration for Production:
first 24 hours PLACENTAL DELIVERY
3. Circulatory system |
a. Decrease blood volume DECREASE ESTROGEN AND PROGESTERONE
b. Return to normal at 1st-2nd week |
c. Blood loss: STIMULATE ANTERIOR PITUITARY GLAND
i. NSVD: 300-500ml |
ii. CS: 500-1000ml PROLACTIN
d. Increase plasma fibrinogen and WBC |
*fibrinogen-protective mechanism STIMULATE ACINI CELLS
against bleeding |
-for clotting: prone to thrombus MILK PRODUCTION
formation |
*WBC-promote healing and prevent COLLECTING TUBULES
infection
4. Gastrointestinal system Ejection:
a. Hungry and thirsty SUCKLING REFLEX
b. Slow passage of stool |
c. Positive bowel sounds STIMULATE POSTERIOR PITUITARY GLAND
d. Difficult bowel evacuation |
5. Integumentary system OXYTOCIN
a. Linea negra and chloasma barely |
detectable in 6th week COLLECTING TUBULES
Vital signs |
1. Temperature MILK EJECTION
a. Increase 15-24 hours-dehydration |
b. Increase after 24 hours-infection LET DOWN REFLEX
c. After 3-4 days-milk production
2. Pulse-decrease due to decrease cardiac output Health teaching for breast feeding
3. Blood pressure 1. Hand wash before and after
a. Slight decrease 2. Clean nipple with water
b. Extreme decrease: bleeding or 3. Expose nipple to air
hemorrhage 4. Feed the baby in short frequent intervals and
4. Respiratory rate-no changes lengthen gradually
Retrogressive change 5. Alternate the breast
1. Exhaustion 6. Proper positioning
a. Sleeplessness 7. Adequate material nutrition in increase oral
b. Fetal movements fluid intake
c. Labor pains 8. Proper positioning
d. Energy expenditures 9. Wear well fitted bra
e. NPO *mastitis-infection of the breast with puss
2. Weight loss Proper attachment
a. Diuresis-increase urination -baby grasp not only the nipple but also areola
b. Diaphoresis-increase sweating -lower lip turned outward
c. Return to pregnant weight at 6th week -chin of the baby touches mothers breast
Progressive change Proper positioning
*lactation-formation of breast milk -head and lower body part must be aligned
*engorgement-tension on breast -baby is facing mother
*prolactin-hormone of milk production -tummy to tummy
*oxytocin-hormone of milk release *football hold
-no scissor hold; just support baby *lying down position
*cradle hold
*modified cradle/ across the lap
 MATERNAL AND CHILD NURSING

Why breast milk is best c. Interested in taking care of the new

B-best for babies born
R-reduces incidence of allergies d. Asserts independence; gains control of
E-economical body functions
A-antibodies (IgA) e. Accepts the responsibility of taking
S-stool has inoffensive odor care of baby
T-temperature is ideal 3. Letting go phase (at home)
F-fresh milk never goes off a. Gives up old role
E-easy once established b. Ready for her new role
E-emotional bonding c. Reorganization of family structure
D-digested easily *post partum-feel let down feeling because of
I-immediately available experience; doubting self if you are ready
N-no mixing required -decrease self confidence
G-gastroenteritis reduced -only transient (2-3 days)
Shelf life: -resolve at 2 weeks after pregnancy
*3 hours-not in reff *post partum psychosis- if post partum is not resolved
*24 hours-in reff after 1-2 weeks

Post partum assessment (AVBUBBLEHER) Family planning method

A-appearance 1. Natural method:
V-vital signs a. Fertility awareness method
B-breasts: large shape and size i. calendar method
U-uterus: size and consistency, location ii. rely on detecting when
B-bladder: must reduce for normal uterine contraction woman is capable of
B-bowel: I and O for 1st 24 hours impregnation (fertile)
L-lochia: minimal and amount iii. uses abstinence or
E-episiotomy/episioraphy: contraceptive (fertile period)
-sims lateral position/ lithotomy iv. free to go during the rest of
-REEDA: the month
R-redness v. no contact 3-4 days before
E-edema and after ovulation
E-echymosis vi. have diary of menstruation for
D-discharge 6 months
A-appropriation of suture line 1. shortest cycle=
H-homan’s sign: assess thrombophlebitis 18 days
E-emotion: take in, take hold, letting go 2. longest cycle=11 days
R-rhogam: given in ABO incompatibility b. lactation-amenorrhea method
-antivirus (28 weeks of pregnancy) i. breastfeeding-natural
-immunoglobulin suppression of ovulation
-within 72 hours of delivery ii. 1st 6 months breastmilk
*positive artificial immunity-it will just wear off formation-natural
contraceptive
Emotional phases of puerperium c. Billings method
1. Taking in phase i. Aka cervical mucus method
a. First 2 days after delivery ii. During ovulation: cervical
b. Woman is passive and dependent mucus becomes copious,
c. Prefers talking about pregnancy, labor watery and transparent
and delivery iii. Feels slippery and stretches at
d. Uncertain in caring for new born least 1 inch (spinnbarkeit)
e. Focus on bodily concern d. Basal body temperature (BBT)
f. Provide additional nourishment i. Before ovulation, BBT
2. Taking hold phase decreases 0.5 F
a. 2-4 days after delivery
b. Woman begin to initiate action
 MATERNAL AND CHILD NURSING
ii. During ovulation, BBT
increases (influence of
progesterone)
iii. Monitor temperature
e. Symptothermal method
i. Combination of BBT and
billings method
2. Artificial family planning method
a. Intrauterine device
i. Small T shaped device with
bendable arms for insertion
through cervix
ii. Long term protection
iii. Source of inflammation,
infection and bleeding
b. Oral contraceptive pills
i. Commonly known as “pills”
ii. Composed of synthetic
estrogen combined with small
amounts of synthetic
progesterone (progestin)
1. Mono-fixed doser
2. Bi-last 11 days
increase progesterone
3. For hormonal
imbalance
iii. If stopped, become fertile for
1-2 months
c. Depo-provera injectibles
i. Depot medoxyprogesterone
acetate (DMPA) 150 mg given
IM at deltoid or
gluteusmaximus
ii. Should be initiated during the
1st 5 days of menstrual cycle
and administered every 11-12
weeks
iii. If taken for a year-bone
density decreases or gets
fatter increasing risk for
thrombosis
iv. No STD protection
v. 3 months effect
d. Implants
i. Embedded under the skin
(subcutaneous) on the inside
of upper arm
ii. No ovulation for 3 years
iii. If removed, 3 months to wait
for ovulation
e. Condoms
i. Male condom-thin stretchable
sheath that covers penis and
is removed from partners
orifice after ejaculation
ii. Female condoms-lubricated
vaginal sheath. Close end of
pouch is inserted into vagina
and anchored around cervix
and open ring covers labia
*do not use together-creates
friction making a hole
f. Cervical cap and diaphragm
i. Made of sot rubber, shaped
like a thimble and fit snugly
over the uterine cervix
ii. Loose or gain 15lbs-go back to
doctor to have measurements
iii. Coat with spermicidal gel
before insertion
iv. Positions: Squat, Leg-up, Sit on
chair, Reclined
g. Spermicidal gel
i. Ex. Nonoxynol-9
ii. Work by reducing sperm
motility
iii. Destroys the sperm’s cell
membrane (flagella)
iv. Should be inserted high into
vagina (comes in contact with
cervix)
v. Reapply 2-3 times a day
vi. Increase probability of STD if
anal
3. Surgical contraceptive methods
-permanent and irreversable
a. Tubal ligation
i. Fallopian tubes are occluded
by cautery, crushing, clamping
or blocking thereby
preventing passage of both
sperm and ova
ii. Do after 4-6 hours after
delivery; 12-24 hours after
abortion
b. Vasectomy
i. Vas deferens is cut and tied
and cauterized or plugged
blocking sperm passage
ii. Sperm is still viable for 6
months
iii. Coitus after 1 week
iv. Must have 2 negative sperm
report (10-12 ejaculations
should do)
 MATERNAL AND CHILD NURSING
Legal implications of maternal and newborn health
RA 10028
>expanded breastfeeding promotion act of 1996
-lactation stations
-deductive expenses
-lactation period for breastfeeding employees
-milk bank storage
-inclusion of breastfeeding in curriculum
RA 9281
>newborn screening act
-ideally done on 48th-72nd hour of life
-done 1-2 hours from birth
-uses heel prick method of collection
-detects:
1.congenital hypothyroidism
2.congenital adrenal hyperplasia
3.galactosemia
4.phenylketonuria
5.glucose-6-phosphate dehydrogenase
deficiency (G6PD)
EO 51
>milk code of the Philippines
-ensures adequate and safe nutrition for
infants through promotion of breastfeeding
and the regulation of promotion, distribution,
selling, advertising, product public relations,
information services artificial milk formulas
and other covered products
AO 2009-0025
>essential newborn care (unang yakap campaign,DOH)
-immediate drying of newborn (30 sec.)
-uninterrupted skin to skin contact (60-90 min)
-proper cord clamping and cutting (2-3 min or
until no pulsation is felt)
-non-separation of newborn from the mother
for breastfeeding initiation and rooming in
7 reasons why responsible parenthood is so important
in the society
1. Teaching morally
a. Good citizens need to be people who
act according to moral principles.
Rather than being selfish or trying to
deceive each other, they ought to deal
in a kind and upright way with each
other
b. Part of a parent’s responsibility is
ensuring that they bring up the next
generation of citizens properly
c. Bringing children up well, such as
teaching children the differences
between right and wrong, and
teaching them that they must always
do the right thing
d. It encompasses on the individual child:
Their personality and their interests
2. Teaching social interactions
a. Being polite, making friends and
reaching out to others are all
important things in society
b. Parents can teach children to be
comfortable when socializing from an
early age
3. Budgeting and finances
a. In order to keep the economy of a
given society going, the citizens need
to have good control of their finances
b. Parents can help to get their child into
good financial habits early on
4. Showing children the ropes
a. A responsible parent will teach their
child how to move in society: how to
pay for things in shops and get the
correct change, for example, or how
to take public transport
5. Encouraging independent thought
a. In a democratic society, or indeed in
any society, good citizenship involves
expressing one’s opinions and also
respecting the pinions of others
b. This is seen not least in the voting
process. Responsible parenthood,
then, also involves teaching children
to respect others’ opinions-and
develop their own opinions too
c. Tolerance of others is a true civic
virtue
6. Appreciating the society
a. Children will not grow up to become
responsible citizens unless they
appreciate the society in which they
live
b. Part of responsible parenting may well
include taking children out to enjoy
public parks, theatre productions and
so on in the city
7. Becoming responsible parents
a. Our parenting style will often inspire
our children when they become
parents in their turn
b. Being responsible parents is so
important if we want our children to
become responsible parents in their
own right
 MATERNAL AND CHILD NURSING

c. In so doing, we become part of an Disorder Effect if not Effect if

established tradition of good screened screened screened
parenting that helps to shape our and
society to get better and better treated
d. Is the will and ability of parents to Congenital Severe Normal
respond to needs and aspirations of hypothyroidism mental
the family and children retardation
e. It is a shared responsibility of the Congenital death Alive and
husband and the wife to determine adrenal normal
and achieve the desired number, hyperplasia
spacing and timing of their children Galactosemia Death of Alive and
according to their own family life cataracts normal
aspirations, taking into account: Phenylketonuria Severe Normal
i. Psychological preparedness mental
ii. Health status retardation
iii. Socio-cultural concerns G6PD deficiency Severe normal
iv. Economic concerns anemia,
Conclusion: kemicterus
• Responsible parenting and civic virtues are
intimately linked
• It is from our parents that we most often learn
social values such as kindness, honesty,
altruism and so on
• Our parents can also teach us practical things
about how to exist in society
• Our parents’ values and parenting style can
shape us fundamentally as people
• It is evident, then, that if we want to ensure
that our society is a just and tolerant one,
governed by moral principles, that we must all
strive to be good and responsible parents

What are the genetic diseases included in the NBS

panel?
*Maple syrup urine disease (MSUD)
-candidate genetic disorder to be added to the
NBS
-autosomal recessive disorder caused by
decreased activity of branched-chain-alpha-
ketoacid dehydrogenase, one of the enzymes
involved in the degeneration of leucine,
isoleucine and valine. If left untreated, the
clinical course of classical MSUD is often
progressively severe, including overwhelming
neonatal illness and eventually death
-cases where incidentally detected in
phenylketonuria screening and these
confirmed MSUD cases were significantly
higher in the Philippine NBS population than
PKU