Republic of the Philippines

J.H. Cerilles State College

Pagadian Annex

NCM 107 A
CARE OF MATERNAL, CHILD, &
ADOLESCENT
(WELL CLIENTS)

Submitted by:

ADAVAN. YZEL V.

STUDENT NURSE

Submitted to:

ODESSA S. BUGARIN, RN, MAN

INSTRUCTOR
 2

Unit 1

Name: Adavan, Yzel V. Course & Yr: BSN 2A

Pretest

True or False
Directions: On the space provided before each item, write TRUE
when the statement is correct and FALSE when it is incorrect.

___TRUE__1. The primary goal of maternal and child health is the promotion of
optimal family health.
___TRUE__2. Pediatrics is derived from the Greek word ‘pais’.
___TRUE__3. A maternal and child health nurse serves as an advocate to
protect the rights of all family members, including the fetus.
___TRUE__4. The health of an individual and his or her ability to function as a
member of a family can strongly influences and improve overall family
functioning.
__FALSE__5. One of the Global Health Goals is to end poverty and increase self-
awareness.
__FALSE__6. Family centered, assessment should only include the family
assessment and not an individual assessment.
___TRUE__7. Maternal and child health nursing is research oriented, because
research are the means whereby critical knowledge increases.
___TRUE__8. To have healthy children, it is important to promote the health of
the childbearing woman and her family from the time before children are born
until they reach adulthood.
___TRUE__9. Maternal and child nursing is a challenging role for nurses.
__FALSE__10. Maternal and child nursing excludes independent nursing
functions.
 3

LESSON
Goals and Philosophies of Maternal and
V
Child Health Nursing
Name:

Learning Activities

Activity 1: Draw it!

Direction: Make or Draw an illustration, interpreting one of the philosophies and

further express you understanding of that certain philosophy.

The nurse provides assistance to the mother during her

pregnancy and her family in caring for the fetus. He or she assesses
the needs of the family and the infant in order to develop appropriate
interventions that will assist the family in caring for the fetus before or
p
 4

after birth. He or she will also determine what information the family
will need to learn in order to secure the baby's safety while still in the
mother's womb and to deliver the baby successfully. Families who
are experiencing problems can benefit from the additional support
and services provided by the nurse. Nurses have the vital role in giving
information about parenting, development and learning, child
health, family health and wellbeing, safety, immunization,
breastfeeding, nutrition and family planning. They play an important
role in helping with sleeping, feeding and behaviour problems as well.
They promote the health of pregnant women and their children.
Moreover, the nurse encourages the family to attend the needs of
the baby because he or she is the advocate that protects the rights
of the family members, including the fetus.
 5

Activity 2: Comprehend it!

Directions: Express your understanding of the different standards of nursing

care. Refer to appendix ___ for the rubric of essay.

In the nursing profession, standards of nursing care are an important

component in ensuring that nurses practice in a safe and competent manner.
They define the profession of nursing as well as the scope of practice for
professional nurses. A guideline that provides nurses with the competence in
providing high-quality patient care in an effort to ensure that the public is
treated correctly and ethically.

Because nursing practice has a substantial impact on health care

delivery, patient safety, and patient outcomes, it is vital to regulate the
profession and individual nursing practice. Nursing practice standards will
always be a part of the lives of nurses. These nursing practice standards explain
what nurses should and should not do in the field of nursing. For example, nurses
know that they should not expose one’s confidential information to other
people. If this is not followed, the nurse can face legal implications that can
stain their profession and the client will be disappointed to his or her action.
The excellent and competent care are achieved with the help of these
standards. Nursing standards of care are vital because they acknowledge the
trusted role that a nurse performs in the community. These guidelines are often
regarded as the starting point for providing high-quality care. They
are developed while assessing the state and federal rules, regulations and laws
that govern the practice of nursing. When nurses thoroughly understand and
comply with all of these standards, they will have confidence in the care that
they give to their clients. Its goal is to provide consistency in the nursing
practice, hence, nurses must strictly follow these standards in order to avoid
legal implications that may happen in the future.

Maintaining compliance with standards of care safeguards both the

patients and the nurses. Nurses will be less likely to face disciplinary action, and
patients will not be suffering from the negligent of nurses that may cause them
harm. In general, nurses are expected to conform to these standards of nursing
care in order to provide effective treatment and care. We must always
remember that as nurses, we are caring lives, so we must be mindful of our
actions and follow the different standards of care.
 6

LESSON

Learning Activities

Activity 2: Comprehension
Directions: Watch the video in YouTube about Sustainable Development goal
– action towards 2030 by CAFOD.

Answer the following.

Do you think the 17 sustainable goals the UN developed made a change in

the current situation in our country? Which sustainable goals do you think
made it? Why? Which timeline of our country did you notice? How? Explain.
Yes, the 17 sustainable goals developed by UN made a change in the
current situation in our country. The goal number 4, which is the quality
education, has drastically change the education system in the Philippines. It
was in 2017 when the president signed the Republic Act 10931 known as the
Universal Access to Quality Tertiary Education Act that gives underprivileged
Filipino students the opportunity to pursue college degrees through free tuition
and exemption of other fees in State Universities and Colleges. As for the goal
number 3, which is the good health and wellbeing, Filipinos have who have
insurance can lessen their hospital bills when they get admitted or one of their
covered family members is sick, which is a good way in encouraging and
making people come to healthcare when they face health problems. The goal
number 5, gender equality, has also been gave attention. Filipinos are open to
other sexual groups, and we began to accept them as another community,
the LGBTQ. Philippines has taken part or is moving for all the goals to be met, it
requires an ample amount of time but the hope to achieve the goal is high.

Do you think these 17 sustainable goals can make a country a better place to
live in for the next generation? Write your thoughts below.
Yes, with the help of the 17 sustainable goals, the world can continue to
progress, and people will continue to make this world a better place. There are
many problems that the world is going through, especially right now, and all
these problems are being addressed in the 17 sustainable goals. This ensures
that a country must develop in order to cope with the different problems. In
addition to ensuring the development by having these goals in every country,
a new set of goals emphasizes how development must be sustainable and
promote equality. While taking into consideration varied national realities,
development will need to be universally relevant to all countries and cannot
leave anyone behind in order to be successful.
 7

Activity 3: Relate!

Direction: Read the situation given and complete the table by identifying the
theorist that made the emphasis of care of the following ang provide the brief
description on the major concept of their theory.

Terry is a 7-year-old girl who is hospitalized because her right arm was severely
injured in an automobile accident. There is a high probability she will never have
full use of the arm again. Terry’s mother is concerned because Terry showed
promise in art. Previously happy and active in Girl Scouts, Terry has spent most of
every day since the accident sitting in her hospital bed silently watching television.
Emphasis of Care Theorist Concept of Theory
Assess Terry as a whole. An expert Patricia Benner Nursing is a caring
nurse is able to do this intuitively from relationship. Nurses
knowledge gained from practice. grow rom novice to
expert as they
practice in clinical
settings.
Discuss with Terry the way she views Imogene King Nursing is a process of
herself and illness. She views herself action, reaction,
as a well child, active in Girl Scouts interaction, and
and school; structure care to help transaction; needs are
her meet these perceptions. identified based on
client‟s social system,
perceptions, and
health; the role of the
nurse is to help the
client achieve goal
attainment.
Assess the effect of lack of arm Dorothy Johnson A person comprises
function on Terry as a whole; modify subsystems that must
care to maintain function to all remain in balance for
systems, not just musculoskeletal. optimum functioning.
Any actual or
potential threat to this
system balance is a
nursing concern.
Turn Terry’s bed into the sunlight; Florence The role of the nurse is
provide adequate covers for Nightingale viewed as changing
warmth; leave her comfortable with or structuring elements
electronic games to occupy her of the environment
time. such as ventilation,
temperature , odors,
noise , and light to put
the patient into the
best opportunity for
recovery.
 8

Arrange overbed table so Terry can Dorothea Orem The focus of nursing is
feed herself; urge her to participate on the individual;
in care by doing as much for herself clients are assessed in
as she can. terms of ability to
complete care. Care
given may be wholly
compensatory (client
has no role); partly
compensatory (client
participates in care);
or supportive-
educational (client
performs own care).
Plan care together with Terry. Hildegard Peplau The promotion of
Encourage her to speak of school health is viewed as the
and accomplishments in Girl Scouts forward movement of
to retain self-esteem. the personality; this is
accomplished
through an
interpersonal process
that includes
orientation,
identification,
exploitation, and
resolution.
Assess Terry’s ability to use her left Sister Callista Roy The role of the nurse is
hand to replace her right-hand to aid clients to adapt
functions, which are now lost; direct to the change on the
nursing care toward replacing degree of
deficit with other factors, self- environment change
concept, role function, and skills. and state of coping
ability; full adaptation
includes physiologic
interdependence.
 9

Mastery Test
Directions: Provide your answers on the space provided before each number.

Promoting Health for the Next Generation 1. The area of childbearing and
childrearing families is a major focus of nursing practice in?
Promotion and Maintenance of Optimal Family Health 2. The primary goal of
both maternal and child health nursing.
Preconception Health Care 3. Provide an example of the scope of nursing
practice
Puerperium 4. It is 6 weeks after child birth, sometimes termed as the 4th
trimester of pregnancy
Perinatal Period 5. It is 20 weeks of pregnancy to 4 weeks after birth
Family Centered Approach 6. Preferred focus of nursing care in maternal and
child health nursing, because the health of an individual and ability to function
as a member can strongly influence and improve overall family functioning
Scope of Practice 7. Understanding the ______: (the range of services and care
that may be provided by a nurse based on state requirements) and standards
of care can help nurses practice within appropriate legal parameters.
MRSA 8. An infection that often occurs in hospitals, causes skin infections or
pneumonia, and is also growing in incidence
Maternal Mortality Rate 9. The number of maternal deaths per 100,000 live
births that occur as a direct result of the reproductive process
Infant Mortality Rate 10. The number of deaths per 1,000 live births occurring at
birth or in the first 12 months of life.
Rosemarie Rizzo Parse’s Theory 11. Nursing is a human science. Health is a lived
experience. Man-living-health as a single unit guides practice.
Nursing Process 12. A scientific form of problem solving, serves as the basis for
assessing, making a nursing diagnosis, planning, implementing, and evaluating
care
Calistra Roy's Theory 13. Stresses that an important role of the nurse is to help
patients adapt to change caused by illness or other stressors
Health Rehabilitation 14. Helping prevent complications from illness; helping a
patient with residual effects to achieve an optimal state of wellness and
independence; helping a patient accept inevitable death
Health Restoration 15. Using conscientious assessment to be certain that
symptoms of illness are identified and interventions are begun to return patient
to wellness most rapidly
 10

Unit 2

Reproductive and Sexual Health

Pretest:
Directions: Identify the following statements and give your
answers on the space provided before each number.

Ovaries 1. a female reproductive organ in which ova or eggs are produced.

Semen 2. the male reproductive fluid

Estrogen 3. any of a group of steroid hormones that promote the development

and maintenance of female characteristics of the body

Prostate Gland 4. a gland surrounding the neck of the bladder in male

mammals and releasing prostatic fluid.
Abstinence 5. Refraining from indulging an appetite or activity

Nuclear Family 6. The most common family structure.

Family 7. Family is a small community group and, as such, works great if it can
assign certain members to carry out the necessary tasks.
Contraception 8. It is the voluntary prevention of pregnancy.
Mons Pubis 9. It is a mound of fatty tissue over the symphysis pubis.

Resolution Stage 10. This is the phase when erection is lost rapidly, with the penis
gradually returning to its unstimulated size.
 11

LESSON

Learning Activities

Activity 1: Create it

Directions: Create a genogram and a wellness ecomap of the family that you
belong to, and provide a short description of each illustration.

GENOGRAM

Maternal Side Paternal Side

Conchita Ramon Flavia Elpidio

82
60 84 84
Hypertension
Hypertension Gastritis Pneumonia

Emely Vic

45
47
Hypertension
A&W

Jen Yzel

27 19
A&W A&W

The shapes with ‘X’ behind their names are my grandfathers and
grandmothers who are deceased. They died with the disease of hypertension,
gastritis, and pneumonia. Our father also has and living with hypertension. Both of
our maternal and paternal side have the history of hypertension, but none of us
with my sibling got the disease.
 12

WELLNESS ECOMAP

CHURCH
OF CHRIST

KASAMANG YZEL’S
KATROPA COLLEGE
COMMUNITY

VASQUEZ
FAMILY

EYWARD’S EMELY YZEL’S JJC

GRADE JEN TUKURAN
SCHOOL DASIG
YZEL
HILARIO

EYWARD

JEN’S
MRS. PHILIPPINE
EMELY’S NATIONAL
WEM-RIC
POLICE
HILARIO’S
PAYONG-
PAYONG
ASSOCIATION

Our family is a member of Kasamang Katropa, a community in our

barangay that builds a helping-relationship within the members. Our religion is
Church of Christ. My cousin, Eyward, is a Grade 3 pupil of Tukuran Sped Center,
while I am a 2nd year college student of J.H. Cerilles State College-Pagadian and
a member of the JJC Tukuran Dasig Organization. Our mother is a member of
Women Empowerment Movement-Rural Improvement Club. My uncle, who is
Eyward’s father and a sibling of my mother, is a tricycle driver and a member of
the Payong-payong Association. Lastly, my older sister is a PNP law enforcer.
 13

Activity 2: Ask it!

Directions: Create relevant question about family task and create video
interview a family regarding the different family task. Write you possible
questions on the space provided below.

As parents, were you able to provide food, shelter, clothing and healthcare to
the members of the family?

Do you feel like you are a part of the family, or do you feel like you are falling
behind because you are the youngest? Do you have a friendly relationship
with people who are not your parents and siblings?

Were you able to identify the needs of every family member? Do you all give
time to address and meet these needs?

What are the regulations that your family has that are strictly enforced? What
are the specific roles that each member of the family plays in the household?

How do you split the workload among other members?

What are the other members of the family's community or groups, if any, and
what are these?

Do you have a family member who has been threatened in some way or
another? Did you stand up for this member of your family? In what ways do
you support each other?
 14

LESSON

Learning Activities:

Activity 1. Identify
Directions: Identify the different parts of the male and female reproductive
system and its function.

2. Ovary
1. Anus
3. Uterus

4. Cervix

5. Vagina

6. Clitoris

7. Labia minora

8. Labia majora

Clitoris
Urethral opening
Labia minora
Labia majora Vaginal opening

Fourchette
Anus
 15

1. Seminal vesicle
6. Prostate Gland
2. Bulbourethral
Gland
7. Urethra
3. Vas deferens

4. Epididymis
8. Glans Penis
9. Prepuce (Foreskin)
5. Testes

Female Reproductive System

Parts Functions
Mons veneris Provides cushioning during sexual contact. It has
sebaceous glands that produce pheromones to
induce sexual attraction.
Labia minora The inner folds are called the labia minora. These skin
folds protect the opening of the urethra and the
vagina.
Labia majora Relatively large, fleshy folds of tissue that enclose and
protect the other external genital organs. It contains
sweat and sebaceous glands, which produce
lubricating secretions.
Vestibule This is the area that’s located between the labia
minora. It contains the opening to the vagina and the
urethra.
Clitoris The main pleasure center for females during sex.
Two Skene Glands These glands are thought to secrete a lubricant for
the urethra. This substance may also be antibacterial.
Bartholin’s Glands These glands secrete a fluid (mucus) and located
next to the vaginal opening on each side.
Fourchette A ridge of tissue developed by the posterior joining of
the labia minora and the labia majora. During
childbirth, it is frequently lacerated or cut
(episiotomy) to widen the vaginal opening.
Vagina The vagina is a canal that joins the cervix (the lower
part of uterus) to the outside of the body. It also is
known as the birth canal.
 16

Perineal Muscle It is a muscle region that widens during birth to allow

the fetal head to pass.
Hymen A strong yet elastic semicircle of tissue that protects
the opening of the vagina during childhood. It is
often torn away at the time of the first sexual
intercourse.
Ovaries The ovaries produce eggs and hormones.
Fallopian Tube Fertilization of an egg by a sperm normally occurs in
the fallopian tubes.
Uterus The uterus has two parts: the cervix, which opens into
the vagina, and the corpus, which is the main body.
The corpus can easily accommodate a growing
baby. A canal through the cervix allows sperm to
enter and menstrual blood to exit.

Male Reproductive System

Parts Functions
Penis The organ used for urination and sexual intercourse.
It has spongy tissue which can fill with blood to cause
an erection. It contains the urethra, which carries
both urine and semen.
Scrotum It contains the testicles (also called testes), as well as
many nerves and blood vessels. It acts as a "climate
control system" for the testes.
Testes Responsible for making testosterone, the primary
male sex hormone, and for generating sperm.
Seminiferous tubules are coiled tubes found inside the
testes. These tubes produce sperm cells.
Epididymis It carries and stores sperm cells from the testes. The
epididymis also matures sperm, as the sperm that
emerges from the testes are immature and
incapable of fertilization.
Vas Deferens It transports mature sperm to the urethra, the tube
that carries urine or sperm to outside of the body, in
preparation for ejaculation.
Ejaculatory ducts These ducts are formed by the fusion of the vas
deferens and the seminal vesicles. The ejaculatory
ducts empty into the urethra.
Urethra It transports urine from the bladder to the outside of
the body. It also ejaculates semen in males during
orgasm. When the penis is erect, the urethra is
blocked, allowing only semen to be ejaculated at
orgasm.
 17

Seminal Vesicles It produces a sugary fluid (fructose) that helps sperm

move. The seminal vesicles' fluid makes up majority of
a man's ejaculatory fluid.
Prostate Gland It contributes additional fluid to the ejaculate.
Prostate fluids also help to nourish the sperm.
Bulbourethral Glands These glands produce a clear, slippery fluid that flows
into the urethra. This fluid lubricates the urethra and
neutralizes any acidity caused by remaining
residual urine drops in the urethra.
 18

LESSON

Learning Activities
Activity 1: Video Viewing
Direction: View a video in youtube
(https://www.youtube.com/watch?v=fKyljukBE70) about the development of
a fetus and create your own interpretation on how fetal development works
inside the womb of the mother.

The term fetal development refers to the sequence of events that begins
when sperm and egg join to make a baby. The womb is vital for fetal
development. The child is completely dependent on the mother and the
development depends on how she takes care of her body. During a normal
pregnancy, the fetus will undergo significant growth and development. The
pregnancy is divided into three trimesters: first, second, and third. Each
trimester consists of a period of around three months. Generally, the process of
fetal development is divided into three phases. The germinal stage is defined
as the first two weeks after conception, the embryonic stage is defined as the
third through eighth week, and the fetal stage is defined as the time from the
ninth week until delivery.
The germinal period lasts from conception to 2 weeks (implantation).
Conception happens when a sperm fertilizes an egg to generate a zygote. The
zygote quickly divides and multiplies in the first week. Mitosis is the process of
this cell division. The outer cells become the placenta, while the inner cells form
the embryo as the cells divide and they become more specialized, forming
different organs and body parts. The mass of cells has yet to adhere to the
uterine lining, once this happens, the next stage starts.

The embryonic stage lasts from implantation (2 weeks) to week 8 of

pregnancy. This is when the zygote reaches the uterine lining and becomes
the embryo. Blood vessels then grow, forming the placenta. Beginning with the
embryonic stage, the placenta and membranes begin to grow in in
coordination with embryo growth, in which they serve as the fetal lungs,
kidneys, and digestive system. The ectoderm, endoderm, and mesoderm
layers of cells are already present in the blastocyst, indicating differentiation.
The ectoderm develops the skin and nervous system, the endoderm generates
the digestive and respiratory systems, and the mesoderm produces the
muscular and skeletal systems. The first part of the embryo to develop is the
neural tube, which will become the spinal cord and brain. The tiny heart starts
 19

pumping blood, and other body parts like the digestive tract and backbone
emerge. Growth is rapid in the second half of the period. The intestines, the
heart, and the eyes all grow.
The fetal stage lasts from 9 weeks till birth. The fetus is roughly the size of
a kidney bean and is beginning to take on a human form. Between 9 and 12
weeks, sex organs develop and the arms and legs move. Fingers and toes
emerge around 16 weeks. The lungs, heart, stomach, and intestines have
grown enough for a fetus born prematurely at 24 weeks to survive outside the
womb and respond to sound. The brain matures at 28 weeks, followed by the
bones at 32 weeks. Around 30–32 weeks, growth slows, but tiny changes occur
until birth. By 36 weeks, the fetus' muscles are entirely formed, and by 37 weeks,
all of its organ systems are fully developed. Until 40 weeks, the fetus continues
to acquire weight and length.
It is important to keep track and be informed with this development in
all weeks or stages, so that we can know whether birth defect arises. A birth
defect is an abnormality in the baby's body that can be produced by
genetics, infection, radiation, drugs, or no reason at all.
 20

Activity 2: Interpret!
Direction: Using your own understanding, interpret the ovarian and uterine
cycle to your female friend or colleague or relative (not in medical field).
Provide evidence of the session. Create a draft of your interpretation on the
space provided below.

MENSTRUAL CYCLE

- Encompasses the ovarian and uterine cycles.

- The cycle is essential for oocyte production and uterine preparation for
pregnancy.
- If no pregnancy occurs, the ovarian and uterine cycles start over again.
- Menarche occurs between 12–15. They can start as early as eight, but
still be normal.
- Menopause is the end of menstruation. Women reach menopause at
an average age of 52, with 45-55 being usual.
- The average menstrual cycle lasts 28 days

OVARIAN CYCLE
The ovarian cycle describes changes that occur in the follicles of the
ovary. It consists of the follicular phase, ovulation, and luteal phase.

Follicular Phase

• First day of menstruation.

• Weeks 1-2 of 4 weeks cycle.
• The ovarian follicles mature and get ready to release an egg.
• consists of the development of a primordial follicle into a mature or
Graafian follicle.
• Through the influence of a rise in follicle stimulating hormone (FSH)These
follicles, which were present at birth.
Ovulation

• A mature egg is released from the ovarian follicles into the oviduct.
• Day 14 – rapid enlargement of follicle and rupture of the follicle with
extrusion of the oocyte and adherent cumulus oophorus.
• Some women get pain before rupture – called Mittelschmerz
 21

Luteal Phase
• The luteal phase is the final phase of the ovarian cycle, and it
corresponds to the secretory phase of the uterine cycle.
• During the luteal phase, the pituitary hormones FSH and LH promote the
transformation of the dominant follicle's remaining parts into the corpus
luteum, which produces progesterone. Adrenal progesterone levels rise,
stimulating the body's estrogen synthesis. The corpus luteum's hormones
also suppress the creation of FSH and LH, which the corpus luteum needs
to function effectively.
• As a result, FSH and LH levels fall rapidly, Falling levels of
progesterone trigger menstruation and the next cycle. From ovulation
until progesterone withdrawal triggers menstruation.

UTERINE CYCLE
The uterine cycle outlines the changes that occur in the endometrium during
a menstrual cycle. The uterine cycle has four phases: proliferative, secretory,
ischemic, and menses.

Proliferative Phase
• Referred as proliferative, estrogen, follicular or postmenstrual period.
• The latter part of the follicular phase overlaps with the proliferative phase
of the uterine cycle
• Estrogen causes the lining of the uterus to grow and proliferate.
• Ovarian follicles secrete more estrogen as they mature. The estrogens
cause the spiral arterioles to create a new layer of endometrium in the
uterus.
• As estrogen levels rise, cells in the cervix generate mucus with a higher
pH and reduced viscosity, making it more sperm-friendly. This enhances
the odds of fertilization between days 11 and 14. This cervical mucus
appears as a thick vaginal discharge like raw egg whites. It is a symptom
that ovulation may be imminent, although it does not guarantee
ovulation.
Secretory Phase

• Corresponds to the progestational, premenstrual, luteal phase of the

ovarian cycle.
• The corpus luteum generates progesterone, which helps prepare the
endometrium for blastocyst implantation (a fertilized egg, which has
begun to grow). The uterus secretes glycogen, lipids, and proteins,
thickening cervical mucus. Progesterone enhances blood flow, lowers
 22

uterine smooth muscle contractility, and boosts the woman's basal body
temperature early in pregnancy.

Ischemic Phase
• After 8–10 days without fertilization, the ovarian corpus luteum begins to
regress. Progesterone and estrogen production decreases. The uterine
endometrium begins to deteriorate when progesterone is removed
(around day 24 or day 25 of the cycle).
• The capillary ruptures, with minute hemorrhages, and the endometrium
sloughs.
Menses Phase

• Called menarche, the first period occurs at the age of around twelve
or thirteen years.
• The flow of menses normally serves as a sign that a woman has not
become pregnant.
• the first day of menstrual flow is used to mark the beginning of the new
menstrual cycle.
• Regular menstruation that lasts for a few days, usually 3 to 5 days, but
anywhere from 2 to 7 days is considered normal.
• The average blood loss during menstruation is 35 milliliters with 10–80 ml
considered normal.

EVIDENCE:
 23

LESSON

Mastery Test: Multiple Choice

Directions: Choose and provide the letter of the correct answer on the space
provided.
B 1. When assessing the adequacy of sperm for conception to occur, which
of the following is the most useful criterion?

a. Sperm count
b. Sperm motility
c. Sperm maturity
d. Semen volume
B 2. Contraceptive oral pills help in birth control by.

a. Killing of ova
b. Preventing ovulation
c. Killing of sperms
d. Forming barrier between sperms and ova
B 3. Copper-T/ loop prevents
a. Ovulation
b. Fertilization
c. Zygote formation
d. Cleavage
A 4. __________________ is found positive during fertlity period of menstrual
cycle, in which cervical mucus is slippery and can be drawn into a thread
when stretched between two fingers.
a. Spinnbarkeit test
b. Shick test
c. Ballottement test
d. Pyroglobulin test
 24

C 5. Failure of testis to descend into the scrotum is called

a. Paedogenesis
b. Castration
c. Cryptorchidism
d. Impotency
D 6. The site of fertilization in human is
a. Ovary
b. Uterus
c. Vagina
d. Fallopian tube

C 7. The nurse is assessing a client with a history of irregular periods. Which

condition does the nurse possibly correlate with this problem?
a. Childhood mumps
b. Past valve replacement surgery
c. Diabetes mellitus
d. Mild intermittent asthma
A, D 8. A young adult client is in the clinic for evaluation of amenorrhea lasting
3 months. She takes birth control pills but is on no other medications. Which
actions by the nurse are most appropriate? (Select all that apply.)
a. Instruct the client on collecting a urinalysis for a pregnancy test.
b. Assess the client's urinary and bowel habits.
c. Perform a physical assessment on the client's abdomen.
d. Weigh the client and calculate the body mass index.
e. Reassure the client that amenorrhea can occur with oral contraception.
A 9. A 33-year-old woman who uses oral contraceptives tells the nurse, "I want
to have children in a few years." Which response by the nurse is appropriate?
a. "You may have more difficulty becoming pregnant after about age 35."
b. "You have many years of fertility left, so there is no rush to have children."
c. "You should plan to stop taking oral contraceptives several years before you
want to become pregnant."
d. "If you do not have children within the next few years, it will be very difficult
for you to become pregnant."
D 10. It is a silicone ring which encircles the cervix and produces a combination
of estrogen and progesterone continuously.
a. Condom
b. Diaphragm
c. Cervical cap
d. Nuva ring

C 11. It is the standard method used to predict the length of a pregnancy.

 25

a. Wharton’s
b. Leopold’s
c. Naegele’
d. McDonald’s

B 12. It is composed of blood from the ruptured capillaries; mucin from the
glands; fragments of endometrial tissue; and microscopic, atrophied, and
unfertilized ovum.

a. Meconium
b. Menses
c. Lochia
d. Emesis
A 13. Two or more people who live in the same household, share a common
emotional bond, and perform certain interrelated social task.
a. Family
b. Community
c. Society
d. None of the above

A 14. This phase arises with physical and psychological stimulus (e.g., sight,
sound, emotion, or thought) that causes parasympathetic nervous stimulation.
a. Excitement
b. Plateau
c. Orgasm
d. Resolution
A 15. The medical record of a couple that has been trying to conceive for 2
years reveals no physiologic problem that would prevent conception. Which
of the following statements by the couple would indicate that they need
additional teaching about increasing the likelihood of conception by optimal
timing of intercourse?

a. “Ovulation usually occurs 14days before the onset of the menstrual

cycle.”
b. “An ovulated egg has a life span of 12 to 24 hours.”
c. “Daily sexual intercourse increases the likelihood of conception.”
d. “Ejaculated sperm have a life span of 24 to 48 hours.”
 26

Unit 3

Care of the Mother and the Fetus during the Perinatal Period

Pre- test: True or False

Direction: Write T if the statement is true and F if the statement is

false.

_T_ 1. The first task of a woman and a partner in the first trimester is to accept
the fact of pregnancy.

_T_ 2. Self-centeredness (narcissism) is usually an early response to pregnancy.

_F_ 3. Presumptive signs of pregnancy are objective so can be documented
by an examiner.

_F_ 4. The least noticeable change in the body of a woman during pregnancy
is a rise in the size of the uterus to accommodate the growing fetus.
_F_ 5. This extreme softening of the lower uterine segment is known as Goodel’s
sign.
_F_ 6. Amenorrhea occurs with pregnancy due to the increase production of
follicle-stimulating hormone (FSH) by limiting estrogen levels.
_T_ 7. Calcium and phosphorus requirements are raised during pregnancy as
the skeleton of the fetus must be developed.

_T_ 8. Nearly all women require some iron supplementation during pregnancy
due to a number of factors.

_T_ 9. Good respiratory function obviously has the highest priority in newborn
care.
_T_ 10. Breastmilk is the ideal food source for newborn.
 27

LESSON

Learning Activities

Activity 1: Create it!

Directions: Create a health teaching plan to a mother in a pre-natal setting in
a creative power point presentation. Attach your link in the box provided
below, and create a brief description of your presentation.

https://docs.google.com/presentation/d/1l-oiQ5obaB7R1Cy-
vD2DGrbcTVhrL2E8/edit?usp=drivesdk&ouid=107919777980727930896&rtpof=true&sd
=true

This presentation consists of a health teaching plan that a pregnant

woman needs to know during her pregnancy period.
 28

Activity 2: Create still.

Directions: In your community health center, get a data of a present a pre-natal patient and create your nursing care
plan with 2 Nursing diagnosis identified. (follow the College format for NCP)

NCPs are in the next page.

 29

JH CERILLES STATE COLLEGE

in consortium with
Western Mindanao State University
West Capitol Road, Balangasan District, Pagadian City

PATIENT INITIALS :_SME, 27

DATE : October 20, 2021
STUDENT NURSE :_Adavan, Yzel. V
CLINICAL INSTRUCTOR : Odessa S. Bugarin, RN, MAN
YEAR LEVEL and BATCH :_BSN2A - QUERENCIA

NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective data: Imbalanced Nutrition: Short Term Goal: • Carry out and review • Allows the client to After 30 minutes of
“Tambok gyud ko ay, More Than Body After 30 minutes of daily food diary (caloric focus on a realistic nursing interventions,
basig di ni healthy Requirements related nursing intake, types and amounts image of the amount goals were met. The
para sakong baby.” to excessive food interventions, client of food, eating habits). of food consumed, client expressed her
intake as evidenced will identify eating patterns, and realizations about her
by observed inappropriate sensations. Identifies inappropriate
Objective data:
dysfunctional eating behaviors and patterns that need to behaviors and
• Abnormal eating
patterns consequences be adjusted or a base consequences
pattern.
associated with for a dietary plan. associated with
• Doesn’t move much.
overeating or weight • Inform the mother that • Awareness about overeating or weight
• BMI of 31.2
gain. having a high BMI during this will get the gain.
• Obese
pregnancy increases the mother be concerned
risk of various pregnancy for her fetus. Within nursing care,
Long Term Goal:
complications client was able to
Within nursing care,
• Educate client on what to • Large intake of these enhance her eating
client will
avoid: foods rich in caffeine may be attributed to patterns, starts to
demonstrate a change
which is linked to some harmful effects exercise, and was able
in eating patterns and
structural anomalies and on the growing fetus. to lose weight.
will display weight

loss with optimal infertility, and meals with
maintenance of artificial sweeteners
health. • Educate client of the
foods necessary during
pregnancy like foods rich in
iron, iodine, fiber, folic
acid, calcium, and
phosphate, as well as other
vitamins and minerals.
• Encourage her to have at
least a minimum of 30-
minute walk per day or any
activity program fit her
health status it could be
yoga and some stretching
activities.
• Identify realistic
increment goals for weekly
weight loss.
• Weigh periodically as
individually indicated.
• Regarding cravings and
overeating, offering extra
calories or dietary choices
that include the item she
craves may assist.
30
• Provides the
nutrient needs for the
fetus to develop
healthily.
• Helps in promoting
healthy bodily
structure and
functions.
• Excessive and quick
loss might cause
weariness, irritation,
and failure to lose
weight. Meeting
“stair-step” targets
keeps motivation
going.
• Provides information
on therapeutic
regimen effectiveness
and visual evidence of
patient success.
• For her to not cheat
on the dietary plan.
 31

NCP 2:

JH CERILLES STATE COLLEGE

in consortium with
Western Mindanao State University
West Capitol Road, Balangasan District, Pagadian City

PATIENT INITIALS :_ SME, 27

DATE : October 20, 2021
STUDENT NURSE :_Adavan, Yzel. V
CLINICAL INSTRUCTOR :Odessa S. Bugarin, RN, MAN
YEAR LEVEL and BATCH :_BSN2A - QUERENCIA

NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective data: Disturbed body Short Term Goal: • Discuss the normalcy of • A patient with a After 30 minutes of
“Wa nagyud ko image related to After 30 minutes of body image issues changing body image nursing interventions,
ganahi sakong lawas, pregnancy as nursing disturbance and the needs new goals were met. The
daghan kaayog evidenced by interventions, grieving process. information to client feels positive and
enhance cognitive is ready to adjust to her
nabag-o.” change of patient will:
appraisal. new body image.
appearance. • The patient will use
• Acknowledge frustration, • Acknowledging
Objective data: learned coping
dependency, wrath, grief, these emotions as
• Change in social strategies to adjust to
and animosity. Observe typical reactions to
behaviour. a new reality.
withdrawn behavior and events helps resolve.
• Sad tone of voice. • The patient will
denial. It is not beneficial or
• Isolate herself when enhance her
practicable to push a
she has visitors. perception on her
patient before they
• Doesn’t move much. body image.
are ready. As a result
of the patient's
inability to deal with
personal issues, denial

• Help patient identify
actual changes.
• Encourage expression of
happy or negative thoughts
regarding a loss.
• Assist the client learn
new ADLs and other
essential lifestyle changes.
• Provide resources, such
as a list of support groups.
• Exhibit positive caring in
routine activities.
32
may persist for a long
time.
• Patients may
misperceive or
overvalue changes in
bodily structure or
function.
• Support in
expressing good or
negative emotions
over a loss.
• Many parts of the
patient's life may be
affected. Jobs, family
roles, and
independence may be
different now. Positive
encouragement and
support may assist
motivate and speed
up the transition.
• Client may benefit
from exchanging
experiences, feelings,
and thoughts with
people going through
the same hardships.
• Positive feedback
from the nurse may
help the patient adjust
to the changes in his
or her body.
 33

LESSON

Learning Activities
Activity 1: Comprehend it!
Directions: Explain in your own words how the fetal circulation works. (See
appendices for the essay rubrics)
Fetal circulation is different from adult circulation, as the fetus gets
oxygen and excretes carbon wastes products from the placenta, not the
lungs. The placenta, umbilical vein, ductus venosus, foramen ovale, ductus
arteriosus, and umbilical arteries are the specific structures involved with fetal
circulation. During pregnancy, the placenta is the organ that forms and
implants in the mother's womb or uterus. The umbilical cord is the cord that
connects the unborn infant to the placenta.

The blood that travels from the placenta to the fetus is

highly oxygenated. There it moves through a shunt called the ductus venosus,
accessory vessel that directs oxygenated blood directly to the fetal liver. Blood
flows from the ductus venosus into the inferior vena cava up to the right atrium.
From the right atrium, some of the blood flows to the right ventricle and some
of the blood flows through the foramen ovale, through the left atrium and into
the left ventricle where it is then pumped out into the aorta to the body. The
flow of blood from the right atrium to the left atrium via the foramen ovale
enables oxygenated blood from the placenta to reach the coronary arteries
in cerebral circulation. Following this, the blood will flow the right ventricle
and into the pulmonary artery.
Since the lungs are filled with fluid rather than air, the vessels in the lungs
are small, resulting in greater resistance to blood flow into the lungs. In part
because of the high resistance to blood flow in the pulmonary circulation and
the low resistance to blood flow in the systemic circulation, blood pumped into
the right ventricle's pulmonary artery is more likely to pass through the ductus
arteriosus and into the aorta. Since there is a high flow of blood flowing from
the superior vena cava and inferior vena cava up to the right atrium, pressures
in the right atrium are significantly higher than those in the left atrium. This helps
to increase blood flow through the foramen ovale at the level of the atrium. It
is estimated that just 8 percent of right ventricular output is sent into the lungs,
 34

where it provides nutrition to the developing lung tissue. Most of the blood
passes through the ductus arteriosus into the aorta and out to the body.

The umbilical arteries allow blood to flow from the body back to the
placenta. Waste products and carbon dioxide from the baby are sent back
through the umbilical cord blood vessels and placenta to the mother's
circulation to be eliminated. A clamp is placed around the umbilical cord and
the placenta is withdrawn from the systemic circulation once the infant is
delivered and has taken his or her first breath.
 35

Activity2: Make it!

Directions: Create an illustration, showing the development of the organ
system of the fetus, and explain the development of each system.

WEEK 6

Baby's tiny heart has started to beat. That heart sits inside
a body that's now almost 1/2-inch long from the top of
the head to the rump — about as wide as a pencil
eraser. Baby still looks like a tadpole but that won't last
for long. Baby is still a tadpole, but not for long. Two eyes
with lids are among the first human traits to appear. In a
few months, the lungs and digestive system will produce
the organs that help the infant breathe and feed.

WEEK 7 -10

Baby’s body is already forming every organ it will need —

including the heart, kidneys, liver, lungs, and intestines. Buds are
sprouting from baby's growing arms. Right now they look like
paddles, but eventually they'll form hands and feet.
The embryo is growing rapidly. They are now a fetus. We can
now see beginnings of face. An upper lip, nose, eyes, and two
eyes were seen. The fetus' body is also straightening.
The fetus weighs about 1/8 of an ounce — just bigger than a
penny. The tadpole-like tail is almost gone, and in its place are
two little legs. The head is still huge compared to the body, but
 36

it will get more proportional in the weeks to come. Inside, the

reproductive organs are forming.

That early appendage is now completely

gone. Also gone is the webbing between
baby's fingers and toes. Your baby now has a
real profile with well-defined eyes, mouth, and
ears. Baby's eyes are wide open now, but soon the eyelids will
close — at least temporarily. Inside baby's brain, the connections
are forming.

WEEK 11 -14
In a few weeks, baby's head and body will become more
proportional. Also happening this week — your baby is growing
fingernails and irises — the part of the eye that controls how
much light enters.

Baby's kidneys are getting ready to produce urine. He or she also

has teeth, as well as fingers and toes — complete with nails.

The fetus is right around 4 inches long from the top of the head
to the rump and weighs about 4 1/2 ounces — roughly the size of a small peach.
Like a peach, their body is covered with soft hairs. These are called lanugo, and
they're like a little coat providing warmth in the womb. Baby is also becoming an
individual, developing fingerprints, including on the thumb, which might have
already found its way into baby's mouth.

WEEK 15 -18

Baby's skin is so thin you can see right through it. Baby's muscles
are getting stronger, and they are testing them out by moving
around, making fists, and trying out different facial expressions.

The fetus is nearly 5 inches long from the top of the head to the
rump and weighs close to 4 ounces — about the size of a small
apple. The lungs are breathing in amniotic fluid. Blood is
pumping around the circulatory system. The kidneys are filtering
urine. Looks are changing.
 37

WEEKS 19 – 22
The body is now coated with a waxy, white substance called
vernix caseosa. Under the skin, a layer of fat is forming to
provide warmth. The fetus can hear and may respond to
sounds. By now, baby measures 6 1/2 inches from the top of
the head to the rump and weighs about 11 ounces — roughly
the size of a small banana.

The intestines are starting to produce meconium. Rapid eye

movements may occur. And the bone marrow is ramping up
its production of red blood cells, which will soon deliver oxygen
to baby's body.

WEEKS 23 – 26
Fetus has passed the 1-pound mark and is almost developed
enough to survive outside the womb. The lungs continue to
get ready to breathe by inhaling amniotic fluid. They're also
producing a substance called surfactant, which will allow the
lungs to inflate. Baby's brain is making the connections
needed to think. The skin is as wrinkled as a prune. But those
wrinkles are filling in and smoothing out as fat builds up
underneath. Fingernails are present. Heartbeat is becoming
clearer. For the first time since the baby's eyelids formed,
they've opened, revealing bluish-colored eyes.

WEEKS 27 – 30
Baby measures about 10 inches long from the top of the head
to the rump and weighs more than 2 pounds — about as large
as a squash. Baby is moving into position for childbirth, which is
getting closer every day. Baby's senses are also becoming
more aware of sound, light, and touch.

WEEKS 31- 34

Baby's lungs are still developing, and he or she will need the
help of a ventilator to breathe if the mother will give birth. The
fetus is making final preparations for their appearance. The fine
covering of body hair called lanugo is falling off, and hair only
remains where it's meant to be — on the eyelashes, eyebrows,
and head. Most of the major organs — digestive, respiratory,
 38

and nervous systems — are almost able to work on their own. Your baby may
already be in the head-down position, ready for delivery, settling into position
lower in your pelvis for delivery – this movement is called "lightening."

WEEKS 35 – 40
Fetus will be considered full-term. At almost 6 pounds — about
the size of a honeydew melon — your child's body is just about
ready for birth. The waxy, white substance called vernix caseosa
that covered much of their body during this 9-month journey has
dissolved. Immune system is also arming up, and will keep
developing after birth. growth has slowed down, but the organs
should all be working now. The brain has started to control the
functions of the entire body — from breathing to regulating the
heart rate. Reflexes are also active — including the grasping and
sucking. At just over 7 pounds, the is like a little watermelon.
 39

LESSON

Learning Activities
Activity 1: Create
Directions: Formulate a nursing care plan for a woman in labor ( 1 Nursing
Diagnosis) use the College Format.
NCP 1. In the next page.
 40

JH CERILLES STATE COLLEGE

in consortium with
Western Mindanao State University
West Capitol Road, Balangasan District, Pagadian City

PATIENT INITIALS :_J.Y.P. ________________________

DATE :October 25, 2021
STUDENT NURSE :_Adavan, Yzel. V ___ _
CLINICAL INSTRUCTOR :_Odessa S. Bugarin, RN, MAN
YEAR LEVEL and BATCH :_BSN2A - QUERENCIA _

NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective data: Anxiety related to Short Term Goal: • Discuss about • Anxiety and failure After 30 minutes of
“"This is my first lack of knowledge After 30 minutes of psychological and might be caused by any nursing interventions,
pregnancy, and I'm about labor nursing emotional status. disruption in normal goals were met. The
afraid about whether experience as interventions, labor progression. client participates the
These emotions might labor and is able to
or not I'll be able to evidenced by patient will:
discourage client cope.
deliver a baby." feelings of • Learn to control
cooperation and
inadequacy. anxiety with positive hinder client initiation.
Objective data: coping skills. Stress can create a
• Facial tension and • Will appear relaxed. hypertonic or
grimacing observed. • Recognize and • Monitor pattern of hypotonic contractile
• Preoccupied with express feelings of uterine contraction. pattern and causes
many thoughts. anxiety verbally. prolonged
• Exhibit poor eye • Have desire to catecholamine release.
contact. actively participate in • Client may be fearful
• Consistently labor. or unclear about the
need for inducing
worried about what • Learns about birth • Encourage labor. Failure to “labor
will happen next. and is better verbalization of feelings.
 41

prepared for future naturally” may cause a

births. sense of failure.
• Education may
reduce stress and
anxiety and promote
•Inform the client to the labor progress.
surroundings, people,
and policies. As needed,
explain the
psychological and • Regular treatment
physiological changes of and examination
labor. reduce stress. These
• Assist primary nurse or clients may require less
intrapartum pain medication,
professional as needed. resulting in shorter
labor.
• Helps to reduce
anxiety and enables
client to participate
• Demonstrate actively.
breathing and relaxation • Enhances nurse-
methods. Provide client relationship.
comfort measures.
• Employ a calm, caring, • This position aids in
confident, and non- the easy expulsion of
judgmental approach. the fetus, thus
• Assist patient in proper reducing stress and
positioning – Lithotomy anxiety from
position prolonged labor.
 42

Activity 2: View and Create it!

Directions: View on youtube the “Unang Yakap” video,

https://www.youtube.com/watch?v=AjcoR2tozyQ. Make a reaction video on
each protocol being shown, and make concluding statement at the end the
video regarding unang yakap. (See appendices for the rubric for the video
creation). Create a short essay about your understanding on unang yakap.
(see appendices for essay rubrics). Paste link of video on the box below.
Short Essay;

If the baby and mother are in good health at the time of delivery, it is
recommended that the infant will not be separated from the mother and that
he or she latch on as soon as possible. It is referred to as Unang Yakap, which
or "Essential Intrapartum Newborn Care." It was created with the goal of
allowing for the early onset of breastfeeding to take place.

During emergency situations, infants and children are more likely than
any other age group to contract disease and die. Formula fed to babies from
an unsterile bottle or teat, or formula produced with filthy water, can cause
severe diarrhoea and death within a few hours of being given the formula. In
order to encourage moms to breastfeed their infants and maintain a
relationship with one another, this program is being developed. It also assists
the baby in believing that the breasts are the source of food. As we all know,
breastfeeding works best for the infant. In order to ensure that the newborn is
able to feed as soon as he becomes hungry, the infant is carefully placed on
the mother's breast from the moment of delivery. Unang Yakap has the
advantage of recognizing and respecting the readiness of the baby to
breastfeed. One of the most significant outcomes of Unang Yakap's work has
been the promotion of breastfeeding among young women.

It is also important to note that we must ensure that the mother receives
the right support and guidance on proper infection and prevention control
measures. As a conclusion, this program has had a significant influence on the
prevention of infections and the promotion of breastfeeding, and it has been
in use for many years, which is a good indication that it is beneficial to both
mothers and infants.
 43

LESSON

Learning Activities

Activity 1: Creative Mind

Direction: Create a diagram showing the physiological changes that
is happening in the mother during the postpartum period.

Increased
Blood volume
cardiac
increases
Hard and output Hard time feeling
engorge breasts the urge to urinate

Cramping pain Physiological

diuresis (2nd and
5th days)
12 to 20 pounds
lighter Physiological Changes in Lochial discharge
the Mother’s body during
postpartum period
Vagina is swollen, Stretch marks on
sour, and more belly or breasts
stretched open

Dry skin
Bladder may be a bit
swollen and have
some loss of sensitivity Changing hormone Hair fall
levels
 44

Activity 2: Plan! Plan!

Direction: Create a health teaching plan regarding breastfeeding to
breastfeeding mother.

TEACHING PLAN DEVICED FOR A BREASTFEEDING MOTHER

DESCRIPTION OF THE LEARNER: The learner is in the postpartum period, who
recently gave birth to her first child. The target population are mothers in
Barangay San Carlos, Tukuran, Zamboanga del Sur.
LEARNING NEED: To identify the importance of breastfeeding and demonstrate
the ways on proper breastfeeding.
LEARNING DIAGNOSIS: Knowledge deficit. Breastfeeding information needs
related to mother's lack of experience in pregnancy.

GOALS:
• Identify the importance of breastfeeding.
• Learn ways on how to effectively breastfeed a baby.
• Apply these knowledge in breastfeeding the baby.
BEHAVIORAL LEARNING STRATEGY, TIME METHOD OF
LEARNING CONTENT METHODS AND ALLOTMENT EVALUATION
OBJECTIVES TEACHING ACTIVITIES
After 45-50
minutes of
health teaching,
the client will be
able to:

Define and state Definition and Lecture 5 minutes Instant oral

importance of importance of discussion, feedback:
breastfeeding. breastfeeding handouts Mothers were
able to express
her
realization about
the importance of
breastfeeding

Demonstrate 11 different Lecture 10 minutes Demo/ Return-

various breast breastfeeding discussion, Demo: Mothers
feeding positions demo-return were able to
positions. demo, handouts demonstrate the
breastfeeding
positions.

Enumerate steps Steps to a good Lecture 10 minutes Demo/ Return-

to a good latch latch; Signs of a discussion, Demo: Mothers
good latch were able to
 45

and signs of a demo-return demonstrate the

good latch demo, handouts steps to a good
latch and identify
the signs of good
latching.

Demonstrate on How to use a Lecture 10 minutes Demo/ Return-

how to use manual breast discussion, Demo: Mothers
breast pump pump demo-return were able to
demo, handouts demonstrate the
steps on how to
use a manual
breast pump.

Demonstrate Ways in burping Video 5 minutes Demo/ Return-

proper ways in babies presentation, Demo: Mothers
burping the demo-return were able to
child. demo, handouts demonstrate the
proper ways in
burping the child.

Know how to How to properly Video 5 minutes Demo/ Return-

store breast milk store breastmilk presentation, Demo: Mothers
demo-return were able to
demo, handouts demonstrate how
to store
breastmilk

IMPORTANCE OF BREASTFEEDING

Why is Breastfeeding Important for your Baby?

Breast milk helps keep your baby healthy.
➢ It supplies all the necessary nutrients in the proper proportions.
➢ It protects against allergies, sickness, and obesity.
➢ It protects against diseases, like diabetes and cancer.
➢ It protects against infections, like ear infections.
➢ It is easily digested – no constipation, diarrhea or upset stomach.
➢ Babies have healthier weights as they grow.
➢ Breastfed babies score higher on IQ tests.
Breast milk changes constantly to meet babies' needs.
➢ The milk changes in volume and composition according to the time of
day, nursing frequency, and age of baby to promote healthy growth.
Breast milk is the perfect food for your baby.
Breast milk is always ready and good for the environment.
 46

➢ It is available wherever and whenever your baby needs it.

➢ It is always at the right temperature, clean and free.
➢ No bottles to clean.
➢ Breastfeeding has no waste, so it is good for the environment.
Why is Breastfeeding Important for You?
Mothers who breastfeed:

➢ Have a reduced risk of Type 2 Diabetes and certain cancers such as

breast cancer.
➢ May find it easier to return to what they weighed before they got
pregnant.
➢ Strengthen the bond with their children.
11 DIFFERENT BREASTFEEDING POSITIONS
1: Laid-back breastfeeding or reclined position

The laid-back breastfeeding position, also

known as biological nurturing,1 is often the first
mums try. If your baby is placed on your chest
or tummy as soon as he’s born, all being well
he’ll instinctively work his way towards one of
your breasts and attempt to latch on – this is
known as the ‘breast crawl’. Skin-to-skin
contact helps stimulate his feeding instincts,
while gravity helps him to latch on well and keeps him in place.
2: Cradle hold

This is the classic position most of us picture

when we think of breastfeeding. It involves you
sitting upright, with your baby positioned on his
side, his head and neck laying along your
forearm and his body against your stomach, in
a tummy-to-mummy position. Although it’s a
very popular position, it’s not always easy with
a newborn because it doesn’t give your baby
as much support as some other holds. A pillow or cushion behind you and
a breastfeeding pillow across your lap propping up your baby or your arms
may give you more support and avoid strain on your back or shoulders. If
you use a breastfeeding pillow, make sure it doesn’t lift your baby too high
– your breasts should remain at their natural resting height to avoid sore
nipples and a strained latch.
 47

3: Cross-cradle hold
This looks similar to the cradle hold but your
arms switch roles, so your baby’s body lies
along your opposite forearm. The aim is to
support your baby around his neck and
shoulders to allow him to tilt his head prior to
latch. This is a great newborn breastfeeding
position and is also good for small babies and
those with latching difficulties. Because your
baby is fully supported on your opposite arm, you have more control over
his positioning, and you can use your free hand to shape your breast.

4: Rugby ball hold

In this position (also known as the underarm
or clutch), you sit with your baby resting along
your forearm. His body tucks alongside your
side, with his feet towards the back of the
chair, or whatever you’re sitting on. This is
another helpful early nursing position
because it supports your baby well, while
giving you plenty of control and a good view of his face. Being tucked in
closely alongside your body will help your baby feel safe too. Mums who’ve
had a c-section, twins, or a premature baby, along with those who have
larger breasts, may also like this position.
5: Side-lying position
Ideal for relaxed night feeds and breastfeeding in bed or
on the sofa, side-lying can also be more comfortable than
sitting if you’ve had a caesarean or stitches. You and your
baby need to lie on your sides next to one another, belly-
to-belly.
6: Laid-back breastfeeding after a c-section
If you’ve had a caesarean delivery and can’t
find a comfortable breastfeeding position, this
may help. Reclining with your baby’s body across
your shoulder will let you nurse comfortably
without any weight or pressure on your wound, or
you could also try side-lying.
 48

7: Upright breastfeeding or koala hold

In the upright or koala hold, your baby sits

straddling your thigh, or on your hip, with his
spine and head upright as he feeds. You can
do this hold with a newborn if you give your
baby plenty of support, and it’s also a
convenient way to feed an older baby who
can sit unaided. The upright or koala hold is
often the most comfortable breastfeeding position for babies who suffer
from reflux or ear infections (who often prefer to be upright), and it can also
work well with babies who have a tongue-tie or low muscle tone.

8: Dangle feeding

This breastfeeding position involves your baby lying

on his back, while you crouch over him on all fours
and dangle your nipple in his mouth. Some mums
say doing this for short periods helps if they have
conditions like mastitis and don’t want their breasts
to be squashed or touched; others claim that
gravity helps unplug blocked milk ducts, although
there’s no scientific evidence to support this yet. You can also dangle feed
while you’re sitting, kneeling up over your baby on a bed or sofa, or almost
lying down but propped up on your arms. You may need to use cushions
and pillows to support yourself so you don’t strain your back or shoulders.
9: Nursing in a sling
This method usually works best if your baby is an
experienced breastfeeder and can hold his head up by
himself. You can breastfeed in all sorts of slings, including
stretchy wraps, ring slings and front carriers. Whichever you
choose, make sure you can always see your baby’s face
and his chin is not pressed against his chest.
 49

10: Double rugby ball hold

The double rugby ball hold (also known as the
double clutch) is a great breastfeeding position
for twins, as you can feed them in tandem while
having your hands relatively free. You’ll
probably need to use a specially designed twin
breastfeeding pillow while feeding like this,
especially in the early days. This gives extra support to get both babies into
position, and also minimizes pressure on your belly if you’ve had a c-section.
You may also find that with your hands freer, you can tend to one baby
without disrupting the other’s feed.
11: Dancer hand nursing position

If your baby struggles to stay latched on or has

low muscle tone – perhaps because he was
born prematurely, has a condition such as
Down’s syndrome, or has an illness or disability –
try this hold to support both his head and
your breast. Start by cupping your breast with
your hand underneath, fingers on one side and
thumb on the other. Then edge your hand
forwards so your thumb and index finger form a ‘U’ shape just in front of the
breast. Your three remaining fingers should continue to support the breast
underneath. Rest your baby’s jaw on your thumb and index finger as he
feeds, with his chin at the bottom of the ‘U’, your thumb gently holding one
of his cheeks and your index finger the other. This hold gives your baby
plenty of support and you control over his position, as well as a great view
of his latch.
STEPS TO A GOOD LATCH
 50

SIGNS OF A GOOD LATCH

Some signs of a good latch may be:

• The latch is comfortable and pain free.

• Your baby's chest and stomach rest against your body, so that baby's
head is straight, not turned to the side.
• Your baby's chin touches your breast.
• Your baby's mouth opens wide around your breast, not just the nipple.
• Your baby's lips turn out.
• Your baby's tongue cups under your breast.
• You hear or see swallowing.
• Your baby's ears move slightly.
If you're having trouble getting a good latch, try:

• Moving to a quiet, calm place.

• Holding your baby skin to skin. While both you and your baby are
undressed, hold your baby against your chest.
• Letting your baby lead. Support your baby's neck, shoulders, and hips
with your hands. Offer your breast, but let your baby find your nipple on
their own.

HOW TO USE BREAST PUMPS

Read the instruction manual and familiarize yourself with your model.

• Wash your hands and make sure all parts of the breast pump are clean.
• Find a private place where you feel relaxed. Think about your baby; this
will trigger the hormones that help release your milk.
• Place the assembled breast shield on your breast. Make sure the shield
is centered over the nipple.
• Begin pumping. It may take a couple of minutes for the milk to start
flowing.
• Once the milk is released, adjust the rate of pumping to make it
inconsistent, similar to a baby's sucking motions.
• Switch breasts about every five minutes. Make sure that each breast gets
about 15 minutes of total stimulation. Don't worry if one breast produces
more milk than the other; this is completely normal.
• When you've finished pumping, remove the breast shield.
• Carefully unscrew the bottle and place a cap on it.
• If any parts of the manual breast pump have touched the breast or milk,
wash them in warm, soapy water.
• Set the pieces out to air-dry.
• The milk is safe at room temperature for four to six hours. Many women
prefer to refrigerate it right away; the Centers for Disease Control says it's
 51

safe to refrigerate breast milk for up to five days. When stored in a chest
or upright deep freezer, the milk keeps for six to 12 months.

WAYS IN BURPING BABIES

https://www.youtube.com/watch?v=RrkIF5OKcMY

HOW TO PROPERLY STORE BREASTMILK

https://www.youtube.com/watch?v=3wwzUSC5RU4
 52

Mastery Test: Multiple Choice

Directions: Choose and provide the letter of the correct answer on the space
provided.

B 1. Which of the following is an expected outcome of antepartum care?

a. Trimester-specific physiologic and psychosocial assessment
b. Increased expectant mother’s and family knowledge of
pregnancy.
c. Education and counseling for the pregnant woman and her
family.
d. Assessment of the client’s previous experiences and cultural
expectations.
A 2. Which of the following would cause a false-positive result on a
pregnancy test?
a. The test was performed less than 10days after abortion.
b. The test was performed too early or too late in the pregnancy.
c. The urine sample was stored too long at room temperature.
d. Spontaneous abortion or a missed
C 3. Quickening in primigravida usually can be detected during which of
the following weeks of gestation?
a. 10 to 14 weeks
b. 15 to 17 weeks
c. 18 to 20 weeks
d. 20 to 22 weeks
D 4. Which of the following danger signs should be reported promptly during
the antepartum period?
a. Constipation
b. Breast tenderness
c. Nasal stuffiness
d. Leaking amniotic fluid
A 5. Which of the following indicates less than 12 weeks gestation when the
date of the last menstrual period (LMP) is unknown?
a. Uterus in pelvis
b. Uterus at the xiphoid
c. Uterus in the abdomen
d. Uterus at the umbilicus
B 6. During which of the following stage would the nurse asses “crowning”?
a. First stage
b. Second stage
c. Third Stage
d. Fourth Stage
D 7. Immediately before expulsion which of the following cardinal
movements occur?
a. Descent
b. Flexion
c. Extension
d. External rotation
 53

B 8. When describing fetal position, the first letter in the series denotes which
of the following?
a. Presenting part of the fetus
b. Side of the maternal pelvis
c. Size of the maternal pelvis
d. Type of fetal delivery.
D 9. Which of the following nursing intervention would the nurse perform
during the third stage of labor?
a. Obtain urine specimen and other laboratory tests.
b. Assess uterine contractions every 30minutes.
c. Coach for effective client pushing.
d. Promote parent-newborn interaction.
A 10. Which of the following actions demonstrates the nurse’s understanding
about the newborn’s thermoregulatory ability?
a. Placing the newborn under the a radiant warmer
b. Suctioning with bulb syringe
c. Obtaining an APGAR score
d. Inspecting the newborn’s umbilical cord.
D 11. During which of the following periods would the new mother frequently
review her labor and delivery experience?
a. Letting-down
b. Letting-go
c. Taking-hold
d. Taking-in
B 12. Which of the following would the nurse expect to find when assessing a
client who delivered a newborn 12 hours ago.?
a. Lochia alba
b. Soft, boggy fundus
c. Transient tachycardia
d. Complaints of hunger
B 13. When assessing the newborn’s heart rate which of the following ranges
would be considered normal if the newborn were sleeping?
a. 80 beats per minute
b. 100 beats per minute
c. 120 beats per minute
d. 140 beats per minute
B 14. Which of the following group of newborn reflexes are present at birth
and remain unchanged through adulthood?
a. Blink, cough, rooting and gag
b. Blink, cough, sneeze and gag
c. Rooting, sneeze, swallowing and cough
d. Stepping, blink, cough and sneeze
B 15. Which of the following would the nurse identify as a presumptive sign of
pregnancy?
a. Hegar’s sign
b. Nausea and vomiting
c. Skin pigmentation changes
 54

d. Positive serum pregnancy test.