NCM 107n L Sim Final

College of Health Sciences Education
3rd Floor, DPT Building

Matina Campus, Davao City
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UNIVERSITY OF MINDANAO
Program Bachelor of Science in Nursing
Physically Distanced but Academically Engaged
Self-Instructional Manual (SIM) for Self-Directed Learning (SDL)
Course/Subject: NCM 107n/L:

CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS)
Name of Teacher: Majella L. Gonzales, RN, MAN
THIS SIM/SDL MANUAL IS A DRAFT VERSION ONLY; NOT FOR REPRODUCTION

AND DISTRIBUTION OUTSIDE OF ITS INTENDED USE. THIS IS INTENDED ONLY FOR
THE USE OF THE STUDENTS WHO ARE OFFICIALLY ENROLLED IN THE
COURSE/SUBJECT.
EXPECT REVISIONS OF THE MANUAL.
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TABLE OF CONTENTS
Pages
Title page 1
Table of Contents 2
Quality Assurance Policy 3
Instruction Proper 6
Big Picture 1. Framework for Maternal and Child Health Nursing 7
Big Picture 2. Reproductive and Sexual Health 15
Big Picture 3. Evidence-Based Practice in Maternal and Child Health 33
Big Picture 4. Post-partal Care 69
Big Picture 5. Growth and Development 89
Big Picture 6. Scope and Standards 118
Big Picture 7. Patient’s Bill of Rights and Obligations 125
Communication and Teaching with Children and Families 127
Nursing Care Planning: Interprofessional Care Maps 135
Big Picture 8. Related Studies on Maternal and Child Nursing 138
Filipino Culture, Values and Practices in relation to
Maternal and Child Care 142
Maternal and Child Care Entrepreneurial Opportunities 147
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NCM 107n/L: CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS)
Course Coordinator: MAJELLA L. GONZALES

Email: mgonzales@umindanao.edu.ph
Student Consultation: Done online (LMS) or traditional contact
(texts, calls, emails)
Mobile: 09957295031
Phone: (082) 305-0645 loc. 117
Effectivity Date: August 2020
Mode of Delivery: Blended (On-Line with face to face or virtual
sessions)
Time Frame: Lecture: 72 hours; RLE: 255 hours
Student Workload: Expected Self-Directed Learning
Requisites: NCM 101nL , NCM 103/L
Credit: 4 units Lecture / 5 units Skills Lab.
Attendance Requirements: A minimum of 95% attendance is required at all
scheduled Virtual or face to face sessions.
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COURSE OUTLINE POLICY

Areas of Details
Concern
Contact and This 5-unit course self-instructional manual is designed for Blended
Non-contact Learning Mode of Instructional delivery with scheduled face to face or
Hours virtual sessions.
Including the face to face or virtual sessions, the expected number of hours
will be 72 hours for the lecture components and 255 hours for the skills
laboratory/Related Learning Experience (RLE).
The face to face sessions shall include the summative assessment tasks
(exams) since this course is crucial in the Nurse Licensure Exam.
Assessmen The submission of assessment tasks shall be on 3rd, 5th ,7th , 9th , 11th ,13th ,
t Task 15th and 17th week of the semester. The assessment paper shall be
Submission attached with a cover page indicating the title of the assessment task (if the
task is performance), the name of the course coordinator, date of
submission and name of the student. The document should be emailed to
the course coordinator. It is also expected that you already paid your tuition
and other fees before the submission of the assessment task.
If the assessment task is done in real time through the features in the
Blackboard Learning Management System, the schedule shall be arranged
ahead of time by the course coordinator.
Turnitin To ensure honesty and authenticity, all assessment tasks are required to
Submission be submitted through TURNITIN with a maximum similarity index of 30%
(if allowed. This means that if your paper goes beyond 30%, the students will
necessary) either opt to redo her/his paper or explain in writing addressed to the
course coordinator the reasons for the similarity. In addition, if the paper
has reached more than 30% similarity index, the students may be called for
a disciplinary action in accordance with the University’s OPM on Intellectual
and Academic Honesty.
Please note that academic dishonesty such as cheating and commissioning

other students or people to complete the task for you have severe
punishments (reprimand, warning, expulsion).
Penalties The score of the assessment item submitted after the designated time on
for Late the due date, without an approved extension of time, will be reduced by 5%
Assignment of the possible maximum score for that assessment item is late.
s/
Assessmen However, if the late submission of assessment paper has a valid reason, a
ts letter of explanation should be submitted and approved by the course
coordinator. If necessary, you will also be required to present/ attach
evidences.
Return of Assessment tasks will be returned to you two (2) weeks after the
Assignment submission. This will be returned by email or via Blackboard portal.
s/
Assessmen For the group assessment task, the course coordinator will require some or
ts few of the students for online or virtual sessions to ask clarificatory
questions to validate the originality of the assessment task submitted and to
ensure that all the group members are involved.
Assignment You should request in writing addressed to the course coordinator his/her
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Resubmissi intention to resubmit an assessment task. The resubmission is premised on
on the student’s failure to comply with similarity index and other reasonable
ground such as academic literacy standards or other reasonable
circumstances e.g. illness, accidents, financial constraints.
Re-marking You should request in writing addressed to the program coordinator your
of intention to appeal or contest the score given to an assessment task. The
Assessmen letter should explicitly explain the reasons/points to contest the grade. The
t Paper and program coordinator shall communicate with the students on the approval
Appeal and disapproval of the request.
If disapproved by the course coordinator, you can elevate your case to the
program head or the dean with the original letter of request. The final
decision will come from the dean of the college.
Grading All culled from the Black Board sessions and traditional contact:
System
Class Participation 40%
Assignments 5%
Quizzes 10%
Recitation 10%
Requirements 15%
Examinations 60%
First Exam 5%
Second Exam 5%
Third Exam 5%
Fourth Exam 5%
Fifth Exam 5%
Sixth Exam 5%
Seventh Exam 5%
Final Exam 25%
TOTAL 1100% 100%
Submission of the final grades shall follow the usual University system and
procedures.
Preferred APA 6th Edition.
Referencing
Style
Student You are required to create a umindanao email account which is a
Communica requirement to access the BlackBoard portal. Then, the course coordinator
tion shall enroll the students to have access to the materials and resources of
the course. All communication formats: chat, submission of assessment
tasks, requests etc. shall be through the portal and other university
recognized platforms.
You can also meet the course coordinator in person through the scheduled
face to face sessions to raise your issues and concerns.
For students who have not created their student email, please contact the
course coordinator or program head.
Contact Ofelia C. Lariego, RN, MAN
Details of the Email: ofelia_lariego@umindanao.edu.ph
Dean Phone: 082-3050645 loc. 117
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Contact Dennis C. Padernilla, RN, MN
Details of the Email: dennis_padernilla@umindanao.edu.ph
Program Phone: 082-3050645 loc. 117
Head
Students with Students with special needs shall communicate with the course coordinator
Special Needs about the nature of his or her special needs. Depending on the nature of the
need, the teacher with the approval of the program head may provide
alterative assessment task or extension of the deadline of submission of the
assessment tasks. However the alternative assessment tasks should still be
in the service of achieving the desired course learning outcomes.
Instructional Ofelia C. Lariego, RN, MAN
Help Desk Email: ofelia_lariego@umindanao.edu.ph
Contact Phone: 082-3050645 loc. 117
Details
CHSE LMS Administrators:
1. Dennis C. Padernilla, RN, MN
Email: dennis_padernilla@umindanao.edu.ph
Phone: 082-3050645 loc. 117
2. John Michael G. Balaba,RPh

Email: john balaba@umindanao.edu.ph
Phone: 082-3050645 loc. 117
Library Brigida E. Bacani

Contact Email: library@umindanao.edu.ph
Details Phone: 082-3050645 loc. 117
Website: http://library.umindanao.edu.ph
Facebook page: https://www.facebook.com/UM-Learningand-
Information-Center-Davao-City-962331877193048/
Well-being Ronadora E. Deala,RPm,RPsy, LPT, RGC(GSTC Head)
Welfare Email: ronadora deala@umindanao.edu.ph
Support Help Phone: 221-0190 loc 130
Desk
Patricia Karyl Ambrocio (CHSE Guidance Facilitator )
Email: pk_ambrosio1015@gmail.com
Mobile No.: 0966-331-7365/09504665431
Course Information – see/download course syllabus in the Black Board LMS
CC’s Voice: Hello! Welcome to this course: NCM 107n/L: Care of Mother, Child and
Adolescent (Well Client). By now, I am confident that you really wanted to
become a Registered Nurse someday, and that you have visualized yourself
being part of the health care team, taking care of the mother, child and
adolescent (well clients) in varied clinical settings.
CO
This course deals with the concept, principles, theories and techniques in the
nursing care of individuals and families during childbearing and childrearing years
toward health promotion, disease prevention, restoration and maintenance and
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rehabilitation. The learners are expected to provide safe, appropriate and holistic care
to provide safe, appropriate and holistic nursing care to clients utilizing the nursing
process.
Let us begin!
Textbook: Pillitteri, Adele (2015). Maternal and child health nursing: care of the childbearing & childbearing
family 6th Edition. Lippincott Williams & Wilkins. Philadelphia.
Big Picture 1
Week 1: Unit Learning Outcomes (ULO): At the end of the unit, you are expected to:
I. Explain the framework for Maternal and Child Health Nursing.
A.1Goal and Philosophies of Maternal and Child Nursing
A.2 Maternal and Child Health Goals and Standards
A.3 Theories related to Maternal and Child Nursing
A.4 Roles and Responsibilities of a Maternal and Child Nurse
A.5 WHO’s 17 Sustainable Development Goal
Big Picture in Focus: ULO I (week1): Explain the framework for Maternal and Child Health Nursing
Metalanguage
This course deals with the concept, principles, theories and techniques in the nursing care of
individuals and families during childbearing and childrearing years toward health promotion, disease
prevention, restoration and maintenance, and rehabilitation. The learners are expected to provide
safe, appropriate and holistic nursing care to provide safe, appropriate and holistic nursing care to
clients utilizing the nursing process.
Furthermore, this topic ULO 1 will give knowledge in the discussion will explain the different Goals
and Standard; different Theories; Roles and responsibilities in the care of Maternal and Child clients.
Included also are the WHO17 Sustainable Developmental Goal in dealing towards worldwide
concerns.
Please proceed immediately to the “Essential Knowledge” part since the first lesson is also
introduction to Maternal Child Health Nursing.
Essential Knowledge
To perform the aforesaid big picture (unit learning outcomes) for the first week of the course,
you need to fully understand the following essential knowledge that will be laid down in the
succeeding pages. Please note that you are not limited to exclusively refer to these resources. Thus,
you are expected to utilize other books, research articles and other resources that are available in the
university’s library e.g. ebrary, search.proquest.com etc.
I. FRAMEWORK FOR MATERNAL AND CHILD HEALTH NURSING:
Maternal and child health nursing can be visualized within a framework in which nurses, using
nursing process, nursing theory, and evidence-based practice.
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Care for families during childbearing and childrearing years through four phases of health
care:
1. Health promotion
2. Health maintenance
3. Health restoration
4. Health rehabilitation
1. The promotion and maintenance of optimal family health to ensure cycles of optimal
childbearing and childrearing. The range of practice includes:
a. Preconceptual health care
b. Care of women during three trimesters of pregnancy and the puerperium (the
6 weeks after childbirth, sometimes termed the fourth trimester of pregnancy)
PHILOSOPHY OF MATERNAL AND CHILD HEALTH NURSING:
1. Maternal and child health nursing is family centered; assessment must include both family
and individual assessment data.
2. Maternal and child health nursing is community centered; the health of families depends
on and influences the health of communities.
3. Maternal and child health nursing is evidence based, because this is the means whereby
critical knowledge increases.
4. A maternal and child health nurse serves as an advocate to protect the rights of all family
members, including the fetus.
5. Maternal and child health nursing includes a high degree of independent nursing functions,
because teaching and counseling are major interventions.
6. Promoting health and disease prevention are important nursing roles because these
protect the health of the next generation.
7. Maternal and child health nurses serve as important resources for families during
childbearing and childrearing as these can be extremely stressful times in a life cycle.
8. Personal, cultural, and religious attitudes and beliefs influence the meaning and impact of
childbearing and childrearing on families.
9. Circumstances such as illness or pregnancy are meaningful only in the context of a total
life.
10. Maternal and child health nursing is a challenging role for nurses and a major factor in
keeping families well and optimally functioning.
THEORIES RELATED TO MATERNAL AND CHILD NURSING

THEORIST THEORY EVALUATION THEORY
1. FLORENCE NIGHTINGALE THEORY (1860) ENVIRONMENT THEORY
2. HILDEGARD PEPLAU THEORY (1952, 1988) INTERPERSONAL THEORY
3. VIRGINIA HENDERSON THEORY (1955, 1966) NEED THEORY
4. FAYE ABDELLAH THEORY (1960) TWENTY ONE NURSING PROBLEMS
5. IDA JEAN ORLANDO THEORY (1961, 1962) NURSING PROCESS THEORY
6. MARTHA ROGERS THEORY (1970) UNITARY HUMAN BEINGS
7. DOROTHEA OREM THEORY (1971) SELF-CARE THEORY
8. IMOGENE KING THEORY (1971, 1981, 1989) GOAL ATTAINMENT THEORY
9. BETTY NEUMAN THEORY (1974, 1996, 2002) SYSTEM MODEL
10. SISTER CALISTA ROY THEORY (1980) ADAPTATION THEORY
ROLES AND RESPONSILITIES OF A MATERNAL AND CHILD NURSE:

1. Provide health care to child-bearing women and their families.
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2. Competent in basic nursing skills including pain management, patient and family education,
assessment, diagnosis and communication.
3. Approach the birth process as a natural life event rather than a medical procedure.
4. Gives care to both prenatal care to pregnant women and health care to mothers and their
newborn infants also extend to the entire family.
5. Apply skills and knowledge to allow them to assist the patient during the entire hospital stay.
6. Watch out for client during labor, delivery, recovery, operational, postpartum and management
of high-risk pregnancies.
7. Do specific roles, including fetal monitoring, assisting in cesarean delivery and identifying
postpartum complications.
8. Do technical skills in order to effectively understand advanced equipment and procedures.
9. Update self thru continuing education in order to stay up-to-date on the latest innovations and
new practices in the field.
10. Expert in treating a pregnant teenager, a critically ill child, or other group within the community.
11. Involves in caring for a mother and baby simultaneously rather than newborn in nursery away
from mother and taken care by different nurse.
12. Encourages family bonding and facilitates education and apply family-centered care before
and after delivery.
WHO (WORLD HEALTH ORGANIZATION) SUSTAINABLE DEVELOPMENT GOAL:
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THE 17 SUSTAINABLE DEVELOPMENT GOALS AND ITS FOCUS ARE:
GOALS FOCUS
1. No Poverty "End poverty in all its forms everywhere."
2. Zero Hunger "End hunger, achieve food security and improved
nutrition, and promote sustainable agriculture."
3. Good Health and Well-being "Ensure healthy lives and promote well-being for all
at all ages."
4. Quality Education "Ensure inclusive and equitable quality education and
promote lifelong learning opportunities for all."
5. Gender Equality "Achieve gender equality and empower all women
and girls."
6. Clean Water and Sanitation "Ensure availability and sustainable management of
water and sanitation for all."
7. Affordable and Clean Energy "Ensure access to affordable,
reliable, sustainable and modern energy for all."
8. Decent Work and Economic "Promote sustained, inclusive and sustainable
Growth economic growth, full and productive employment
and decent work for all."
9. Industry, Innovation and "Build resilient infrastructure, promote inclusive and
Infrastructure sustainable industrialization, and foster innovation."
10. Reducing Inequality "Reduce income inequality within and among
countries."[
11. Sustainable Cities and "Make cities and human settlements inclusive, safe,
Communities resilient, and sustainable."
12. Responsible Consumption and "Ensure sustainable consumption and production
Production patterns."
13. Climate Action "Take urgent action to combat climate change and its
impacts by regulating emissions and promoting
developments in renewable energy."
14. Life Below Water "Conserve and sustainably use the oceans, seas and
marine resources for sustainable development."
15. Life On Land "Protect, restore and promote sustainable use of
terrestrial ecosystems, sustainably manage forests,
combat desertification, and halt and reverse land
degradation and halt biodiversity loss."
16. Peace, Justice, and Strong "Promote peaceful and inclusive societies
Institutions for sustainable development, provide access to
justice for all and build effective, accountable and
inclusive institutions at all levels."
17. Partnerships for the Goals "Strengthen the means of implementation and
revitalize the global partnership for sustainable
development."
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a. Pillitteri, Adele (2015). Maternal and Child Health Nursing: Care of the Childbearing &
Childbearing Family 6th Edition. Lippincott Williams & Wilkins. Philadelphia.
b. Silbert-Flagg. (2018). Maternal and Child Health Nursing: Care of the Childbearing and
Childrearing family. 8th Ed. Wolters Kluwer. Philadelphia.
c. Schuling (2017). Women’s Gynecology health. 3rd edition. Jones & Bartlett Learning.
Burlington.
d. Johnson, JY. (2014). Study guide for maternal & child health nursing: care of the childbearing
and childrearing family. 7th edition. Philadelphia: Wolters Kluwer.
e. Berman, A. (2014). Kozier & Erb’s fundamentals of Nursing: Concepts, Process, and
Practice. 9th Edition. London: Pearson.
f. Glasper, A. et.al. (2018). Children and Young people’s Nursing at a Glance. 1st Edition. Joh
Wiley & Sons, Inc.
http://site.ebrary.com/lib/uniofmindanao/detail.action?docID=1813816
g. Loschiavo, J. (2015). Fast Facts for the School Nurse: School Nursing in a Nutshell. Springer
Publishing Company
h. Pediatric Nursing: Content Review plus Practice Questions. F.A. Davis
Company.http://site.ebrary.com/lib/uniofmindanao/detail.action?docID=1809022
Let’s Check:
Activity 1 – QUIZ 1 - Multiple Choice Questionnaire Type.
Instruction: Read the following questions carefully. Select only the correct answer for each question.
Select the letter of the correct answer.
1. Self-care theory was proposed by?

A. Virginia Henderson C. Betty Neuman
B. Imogene King D. Dorothea Orem
2. Which theory defines nursing as the science and practice that expands adaptive abilities and enhances
person and environment transformation?
A. Goal Attainment theory C. Henderson's definition of nursing
B. Roy's Adaptation theory D. Faye Abdellah's theory
3. Twenty- one Nursing problems theory was explained by?
A. Imogene King C. Virginia Henderson’s
B. Faye Abedellah D. Lydia E. Hall
4. Interpersonal theory was proposed by?
A. Hildegard Peplau C. Jean Watson
B. Faye Abdellah D. M. Rogers
5. Which of the following statements is related to Florence Nightingale?
A. Nursing is therapeutic interpersonal process.
B. The role of nursing is to facilitate "the body’s reparative processes" by manipulating client’s
environment.
C. Nursing is the science and practice that expands adaptive abilities and enhances person and
environment transformation
D. Nursing care becomes necessary when client is unable to fulfill biological, psychological,
developmental, or social needs.
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6. Unitary Human Beings theory" was explained by?

A. Rogers (1970) C. Ida Orlando (1960)
B. Nightingale (1860) D. Neuman (1972)
7. Imogene King's theory is which of the following?
A. Adaptation theory C. Goal Attainment theory
B. Need theory D. Self-Care theory
8. System Model of Nursing was proposed by?
A. Betty Neuman C. Rosemarie Rizzo Parse
B. Madeleine Leininger D. Ida Jean Orlando
9. Goal Attainment theory was explained by?
A. Imogene King C. Virginia Henderson’s
B. Faye Abdellah D. Lydia E. Hall
10. Nursing Process theory was proposed by?
A. Lydia Hall theory C. Florence Nightingale theory
B. Ida Jean Orlando theory D. Sister Calista Roy theory
In a Nutshell:
Activity 2. Essay Type
Instruction: Choose only three (3) among the 12 Roles and Responsibilities of a Maternal and Child
Nurse, then discuss each in 1 paragraph (5-7 sentences).
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Let’s Check:
Activity 3. QUIZ - Multiple Choice Questionnaire Type
Instruction: Read the following questions carefully. Select only the correct answer for each question.
Select the letter of the correct answer.
1. How many Sustainable Development Goals (SDGs) have been agreed to, by all the world’s nations, as part of the 2030
Agenda?
a. 17
b. 8
c. 10
d. 16 plus a few statements about implementation that are not actually a Goal nation, as part of the 2030
Agenda.
2. Each SDG is supported by a set of Targets — specific objectives that are associated with that Goal. How many Targets
are there in total?
a. 99 c. 1,169
b. 169 d. 51
3. Goal 1 is about poverty. What is the aim of this Goal?

a. Cut poverty in half by 2030
b. Reduce poverty by 75% by 2030
c. End poverty in all its forms everywhere
d. Help each nation make progress on reducing poverty
4. Goal 17 is about strengthening the “means of implementation” and revitalizing the “Global Partnership” for realizing
all the other Goals. Which of the following is not part of Goal 17?
a. Mobilizing the financial resources necessary to achieve the Goals
b. Creating international sports tournaments and festivals to promote the Goals
c. Helping developing countries build the capacities they need in areas such as technology, public policy, and
data for reporting on progress
d. Enhancing trade, especially to help developing countries increase their exports and grow their economies
5. In the 2030 Agenda, Sustainable Development Goal #13, on climate change, has an “ * ” (asterisk) after it. Why?
a. Because addressing climate change is more important than all the other Goals.
b. Because the negotiators were unable to come to an agreement on a climate change Goal.
c. Because the UN Framework Convention on Climate Change (which is meeting in
Paris in late 2015) is the forum where more detailed decisions on climate will be
made.
d. Because the Goal on climate change is constantly shifting.
6. Which of the following is not part of the Sustainable Development Goals?

a. Access to sustainable energy for all
b. Availability of water and sanitation for all
c. Provision of internet services for all
d. Promotion of decent jobs for all
7. Equality issues are specifically mentioned in how many of the Sustainable Development Goals (not including the
targets)?
a. In two of them: Goal 6 on water, and Goal 12 on sustainable production and consumption
b. In four of them: Goal 2 on hunger, Goal 7 on energy, Goal 8 on economic growth and jobs, and Goal 14
on preserving the oceans and seas
c. In three of them: Goal 4 on education, Goal 5 on gender, and Goal 10 on reducing inequality within and
among countries
d. In one of them: Goal 16 on promoting peaceful and just societies for all
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8. Which of the following is not part of Goal 15, on ecosystems?

a. Halt and reverse land degradation
b. Halt biodiversity loss
c. Halt the use of biotechnology and genetic engineering
d. Use ecosystems sustainably while protecting and restoring them
9. Which of the following is not true about the SDGs?

a. They encourage the promotion of health, well-being, and education for all, at all ages
b. They explicitly promote innovation
c. They include the development of sustainable cities, infrastructure, and industry
d. They are a legally binding international treaty that all nations are required to follow
10. What can individuals do to help realize the achievement of the Sustainable Development Goals?
a. Hold their governments and the private sector accountable and support reputable civil society
organizations
b. Create projects and partnerships of their own and participate in existing initiatives to help achieve one
or more of the goals
c. Use their positions in society — as teachers, decision-makers, consumers, role-models, and ordinary
citizens — to voice support for the Goals, to make decisions that advance the Goals, and to take
actions help to implement the Goals
d. All of the above ... and more.
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Big Picture 2
Week 2: Unit learning Outcome (ULO): At the end of the unit you are expected to:
II. Discuss Reproductive and Sexual Health and its sub topics.
I.A Concept of Unitive and Procreative Health
I.B Female / Male Reproductive System
I.C Human Sexuality
I.D Responsible Parenthood
Big Picture in Focus: ULO 2 (Week 2): Reproductive and Sexual Health
Metalanguage:
This course deals with the concept, principles, theories and techniques in the nursing care of
individuals and families during childbearing and childrearing years toward health promotion,
disease prevention, restoration and maintenance, and rehabilitation. The learners are
expected to provide safe, appropriate and holistic nursing care to provide safe, appropriate
and holistic nursing care to clients utilizing the nursing process. Furthermore, this topic will
give knowledge in the discussion in ULO 2 will widen your learnings by understanding the
importance of Reproductive and Sexual Health and able to give proper care to clients with
normal or alterations in Reproductive and Sexual Health.
Please proceed immediately to the “Essential Knowledge” part since the lesson is about human
Reproductive & Sexual Health.
Essential Knowledge
To perform the aforesaid big picture (unit learning outcomes) for the second week of
the course, you need to fully understand the following essential knowledge that will be laid
down in the succeeding pages. Please note that you are not limited to exclusively refer to
these resources. Thus, you are expected to utilize other books, research articles and other
resources that are available in the university’s library e.g. ebrary, search.proquest.com etc.
II. REPRODUCTIVE ANS SEXUAL HEALTH
II.A CONCEPT OF UNITIVE AND PROCREATIVE HEALTH
• Marriage is when a man and woman unite “as one flesh” Sex is unitive
• Marriage needs to be open to the possibility of having children. Sex is procreative
• The unitive and procreative aspects of the sexual act are inseparable.
• All marital acts must respect both the unitive and procreative purposes of the marital
act.
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PROCREATION, CREATION AND EVOLUTION:
Procreation: is the creation of a new human person, by the act of sexual intercourse, by a
man and a woman.
Creation: is the making of all things from nothing, by an act of God, at some time in the past.
God’s action could have taken a second, or 6 days, or a million years.
Evolutionary theory: is the theory that all things came about by the repeated ramdom
actions of natural selection, whereby:
1. Life came into existence, and then
2. Primitive life evolved into more and more complex organism, and
eventually producing mankind.
Evolutionary theory requires the assumption of billions of years for its
processes.
Sexual identity describes how a person identifies related to their sexual orientation. Hence a man
who exclusively prefers women will usually have a straight or heterosexual sexual identity, and a
woman who exclusively prefers women usually a lesbian or homosexual sexual identity.
Gender identity describes the gender with which a person identifies (i.e, whether one perceives
oneself to be a man, a woman, or describes oneself in some less conventional way. Gender identity
may be affected by a variety of social structures, including the person's ethnic group, employment
status, religion or irreligion, and family.
Gender role a set of perceived behavioral norms associated particularly with males or females, in a
given social group or system.
Family of Orientation – the family to which one is born, reared and socialized. It consists of a father,
mother, brothers and sisters.
Family of Procreation – the family established by the person by his/her marriage, consists of a
husband, wife, sons and daughters.
CHARACTERISTICS OF THE FAMILY AS A CLIENT

1. The family is behaving, functioning organism.
2. The family develops its own lifestyle.
3. The family operated as a group.
4. The family accommodates to the need of the individual.
CHARACTERISTICS OF HEALTHY FAMILIES:

1. Communicates and listens
2. Supports its members
3. Teaches respect for others
4. Develops trust
5. Plays and shares a sense of humor
6. Strong sense of family
7. Seeks help when necessary
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II.B Female / Male Reproductive System
Retrieved from Tate, Philip.(2012). Seeley’s Principles of Anatomy & Physiology.2nd edition. New York: Mc. Graw Hill
Companies
Retrieved from Tate, Philip (2012). Seeley’s Principles of Anatomy & Physiology.2 nd edition. New York: Mc. Graw Hill
Companies
Male Reproductive Structures:

Sagittal section of the male pelvis showing the male reproductive structures. Some structures are
shown as a modified sagittal section so that the structure of the testis, seminal vesicles can be shown,
and to show the relationship of the ductus deferens to the ureter and urinary bladder.
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Male Perineum: Inferior view of the male perineum.

Retrieved from: Tate, Philip. (2012). Seeley’s Principles of Anatomy & Physiology.2nd edition. New York: Mc. Graw Hill Companies
ANATOMY OF THE MALE REPRODUCTIVE SYSTEM:
The male reproductive system produces sperm cells and transfers them to the female.
The male reproductive system includes the testes, ducts, accessory glands, and supporting
structures.
SCROTUM
1. The scrotum is a two-chambered sac that contains the testes.
2. The dartos and cremaster muscles help regulate testicular temperature.
PERINEUM
The perineum, the diamond-shaped area between the thighs, consists of a urogenital triangle and an
anal triangle.
Testes
1. The tunica albuginea is the outer connective tissue capsule of the testes.
2. The testes are divided by septa into compartments that contain the seminiferous tubules and the
interstitial cells.
3. The seminiferous tubules become straight to form the tubuli recti, which lead to the rete testis. The
rete testis opens into the efferent ductules of the epididymis.
4. During development, the testes pass from the abdominal cavity through the inguinal canal to the
scrotum.
SPERM CELL DEVELOPMENT

1. Sperm cells (spermatozoa) are produced in the seminiferous tubules.
2. Spermatogonia divide (mitosis) to form primary spermatocytes.
3. Primary spermatocytes divide (first division of meiosis) to form secondary spermatocytes, which
divide (second division of meiosis) to form spermatids.
4. Spermatids develop an acrosome and a flagellum to become sperm cells.
5. Sertoli cells nourish the sperm cells, form a blood–testes barrier, and produce hormones.
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DUCTS
1. Efferent ductules extend from the testes to the head of the epididymis.
2. The epididymis is a coiled tube system located on the testis that is the site of sperm cell maturation.
It consists of a head, body, and tail.
3. The ductus deferens passes from the epididymis into the abdominal cavity.
4. The end of the ductus deferens, called the ampulla, and the seminal vesicle join to form the
ejaculatory duct.
5. The prostatic urethra extends from the urinary bladder to join with the ejaculatory ducts to form the
membranous urethra.
6. The membranous urethra extends through the urogenital diaphragm and becomes the spongy
urethra, which continues through the penis.
7. The spermatic cord consists of the ductus deferens, blood and lymphatic vessels, nerves, and
remnants of the process vaginalis. Coverings of the spermatic cord consist of the external spermatic
fascia, cremaster muscle, and internal spermatic fascia.
8. The spermatic cord passes through the inguinal canal into the abdominal cavity.
PENIS
1. The penis consists of erectile tissue.
■ The two corpora cavernosa form the dorsum and the sides of the penis.
■ The corpus spongiosum forms the ventral part and the glans penis.
2. The bulb of the penis and the crura form the root of the penis and the crura attaches the penis
to the coxae.
3. The prepuce covers the glans penis.
ACCESSORY GLANDS
1. The seminal vesicles empty into the ejaculatory ducts.
2. The prostate gland consists of glandular and muscular tissue and empties into the prostatic urethra.
3. The bulbourethral glands are compound mucous glands that empty into the spongy urethra.
4. Semen
■ Semen is a mixture of gland secretions and sperm cells.
■ The bulbourethral glands and the urethral mucous glands produce mucus, which neutralizes
the acidic pH of the urethra.
■ The testicular secretions contain sperm cells.
■ The seminal vesicle fluid contains fructose and fibrinogen.
■ The prostate secretions make the seminal fluid more pH-neutral. Clotting factors activate
fibrinogen, and fibrinolysin breaks down fibrin.
PHYSIOLOGY OF MALE REPRODUCTION

Normal function of the male reproductive system depends on hormonal and neural mechanisms.
Regulation of Sex Hormone Secretion
1. GnRH is produced in the hypothalamus and released in surges.
2. GnRH stimulates LH and FSH release from the anterior pituitary.
■ LH stimulates the interstitial cells to produce testosterone.
■ FSH stimulates sperm cell formation.
3. Inhibin, produced by sustentacular cells, inhibits FSH secretion.
PUBERTY
1. Before puberty, small amounts of testosterone inhibit GnRH release.
2. During puberty, testosterone does not completely suppress GnRH release, resulting in increased
production of FSH, LH, and testosterone.
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EFFECTS OF TESTOSTERONE
1. Interstitial cells, the adrenal cortex, and possibly the sustentacular cells produce testosterone. 2.
Testosterone causes the development of male sex organs in the embryo and stimulates the descent
of the testes.
3. Testosterone causes enlargement of the genitals and is necessary for sperm cell formation.
4. Other effects of testosterone occur.
■ Hair growth stimulation (pubic area, axilla, and beard) and inhibition (male pattern baldness)
occur.
■ Enlargement of the larynx and deepening of the voice occur.
■ Increased skin thickness and melanin and sebum production occur.
■ Increased protein synthesis (muscle), bone growth, blood cell synthesis, and blood volume
occur.
■ Metabolic rate increases.
MALE SEXUAL BEHAVIOR AND THE MALE SEX ACT

1. Testosterone is necessary for normal sex drives.
2. Stimulation of a sexual act can be physical or psychological.
3. Afferent action potentials pass through the pudendal nerve to the sacral region of the spinal cord.
4. Parasympathetic stimulation;
▪ The erection is caused by the vasodilation of the blood vessels that supply the erectile tissue.
▪ The glands of the urethra and the bulbourethral gland
5. Sympathetic stimulation causes erection, emissions, and ejaculation.
Medial View
Sagittal Section of the Female Pelvis

Retrieved from Tate,Philip.(2012). Seeley’s Principles of Anatomy & Physiology.2nd edition. New York:Mc. Graw Hill Companies
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Retrieved from Tate, Philip. (2012). Seeley’s Principles of Anatomy & Physiology.2nd edition. New York: Mc. Graw Hill Companies
Uterus, Vagina, Uterine Tubes, Ovaries, and Supporting Ligaments
The uterine and uterine tubes are cut in part (on the left side) and the vagina is removed to
reveal the internal anatomy. The inset illustrates the relationship between the ovaries, the
uterine cord, and the ligaments that are suspended in the pelvic cavity.
Female External Genitalia

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Inferior View of the Female Perineum

ANATOMY OF THE FEMALE REPRODUCTIVE SYSTEM:
The female reproductive system produces the oocyte and nurtures the developing child.
The female reproductive system includes the ovaries, uterine tubes, uterus, vagina, external genitals,
and summary glands.
OVARIES:
1. The broad ligament, the mesovarium, the suspensory ligaments, and the ovarian ligaments
hold the ovaries in place.
2. The peritoneum (ovarian epithelium) covers the surface of the ovaries.

3. The ovary has an outer capsule (tunica albuginea) and is divided internally into a cortex
(contains follicles) and a medulla (receives blood and lymph vessels and nerves).
4. Oocyte development and fertilization
■ Oogonia proliferate and become primary oocytes that are in prophase I of meiosis.
■ Ovulation is the release of an oocyte from an ovary.
■ Prior to ovulation, a primary oocyte continues meiosis and produces a secondary oocyte,
which in metaphase II of meiosis, and a polar body, which degenerates or divides to form two
polar bodies.
■ Fertilization is the joining of a sperm cell and a secondary oocyte to form a zygote. A sperm
cell enters a secondary oocyte, which then completes the second meiotic division and
produces a polar body. A zygote is formed when the nuclei of the sperm cell and oocyte fuse
to form a diploid nucleus.
■ The haploid nuclei then fuse to form a diploid nucleus.
5. Follicle development
■ Primordial follicles are surrounded by a single layer of flat granulosa cells.
■ Primary follicles are primary oocytes surrounded by cuboidal granulosa cells.
■ The primary follicles become secondary follicles as granulosa cells increase in number and
fluid begins to accumulate in the vesicles. The granulosa cells increase in number, and theca
cells form around the secondary follicles.
■ Mature follicles are enlarged secondary follicles at the surface of the ovary.
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6. Ovulation occurs when the follicle swells and ruptures and the secondary oocyte is released
from the ovary.
7. Fate of the follicle
■ The mature follicle becomes the corpus luteum.
■ If pregnancy occurs, the corpus luteum persists. If no pregnancy occurs, it becomes the
corpus albicans.
UTERINE TUBES:
1. The mesosalpinx holds the uterine tubes.
2. The uterine tubes transport the oocyte or zygote from the ovary to the uterus.
3. Structures:
■ The ovarian end of the uterine tube is expanded as the infundibulum. The opening of the
infundibulum is the ostium, which is surrounded by fimbriae.
■ The infundibulum connects to the ampulla, which narrows to become the isthmus. The
isthmus becomes the uterine part of the uterine tube and passes through the uterus.
4. The uterine tube consists of an outer serosa, a middle muscular layer, and an inner mucosa
with simple ciliated columnar epithelium.
5. Movement of the oocyte
■ Cilia move the oocyte over the fimbriae surface into the infundibulum.
■ Peristaltic contractions and cilia move the oocyte within the uterine tube.
■ Fertilization occurs in the ampulla, where the zygote remains for several days.
UTERUS:
1. The uterus consists of the body, the isthmus, and the cervix. The uterine cavity and the
cervical canal are the spaces formed by the uterus.
2. The uterus is held in place by the broad, round, and uterosacral ligaments.
3. The wall of the uterus consists of the perimetrium (serous membrane), the myometrium
(smooth muscle), and the endometrium (mucous membrane).
VAGINA:
1. The vagina binds the cervix to the vestibule.
2. The vagina consists of a sheet of smooth muscle and an inner lining of moist stratified
squamous epithelium.
3. The vagina is folded into a rug and a longitudinal fold.
4. The hymen is covered by the vestibular opening of the vagina.
EXTERNAL GENITALIA:
1. The vulva, or pudendum, comprises the external genitalia.
2. The vestibule is the space into which the vagina and the urethra open.
3. Erectile tissue
■ The two corpora cavernosa form the clitoris.
■ The corpora spongiosa form the bulbs of the vestibule.
4. The labia minora are folds that cover the vestibule and form the prepuce.
5. The greater and lesser vestibular glands produce a mucous fluid.
6. When closed, the labia majora cover the labia minora.
■ The pudendal cleft is a space between the labia majora.
■ The mons pubis is an elevated fat deposit superior to the labia majora.
PERINEUM:
The clinical perineum is the region between the vagina and the anus.
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MAMMARY GLANDS:
1. The mammary glands are modified sweat glands located in the breasts.
■ The mammary glands consist of glandular lobes and adipose tissue.
■ The lobes consist of lobules that are divided into alveoli.
■ The lobes connect to the nipple through the lactiferous ducts.
■ The areola surrounds the nipple.
2. Cooper’s ligaments support the breasts.
PHYSIOLOGY OF FEMALE REPRODUCTION

PUBERTY:
1. Puberty begins with the first menstrual bleeding (menarche).
MENSTRUAL CYCLE:
1. Ovarian cycle
■ FSH initiates the development of the primary follicles.
■ The follicles secrete a substance that inhibits the development of other follicles.
■ LH stimulates ovulation and completion of the first meiotic division by the primary oocyte.
■ The LH surge stimulates the formation of the corpus luteum. If fertilization occurs, HCG
stimulates the corpus luteum to persist. If fertilization does not occur, the corpus luteum
becomes the corpus albicans.
2. A positive-feedback mechanism causes FSH and LH levels to increase near the time of
ovulation.
■ Estrogen produced by the theca cells of the follicle stimulates GnRH secretion.
■ GnRH stimulates FSH and LH, which stimulate more estrogen secretion, and so on.
■ Inhibition of GnRH levels causes FSH and LH levels to decrease after ovulation. Inhibition is
due to the high levels of estrogen and progesterone produced by the corpus luteum.
3. Uterine cycle
■ Menses (day 1 to day 4 or 5). The spiral arteries constrict, and endometrial cells die. The
menstrual fluid is composed of sloughed cells, secretions, and blood.
■ Proliferation phase (day 5 to day 14). Epithelial cells multiply and form glands, and the spiral
arteries supply the glands.
■ Secretory phase (day 15 to day 28). The endometrium becomes thicker, and the
endometrial glands secrete.
■ Estrogen stimulates proliferation of the endometrium and synthesis of progesterone
receptors.
■ Increased progesterone levels cause hypertrophy of the endometrium, stimulate gland
secretion, and inhibit uterine contractions. Decreased progesterone levels cause the spiral
arteries to constrict and start menses.
FEMALE SEXUAL BEHAVIOR AND THE FEMALE SEX ACT:

1. Female sex drive is partially influenced by androgens (produced by the adrenal gland) and steroids
(produced by the ovaries).
2. Parasympathetic effects
■ The erectile tissue of the clitoris and the bulbs of the vestibule become filled with blood.
■ The vestibular glands secrete mucus, and the vagina extrudes a mucus like substance.
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FEMALE FERTILITY AND PREGNANCY:
1. Intercourse must take place 5 days before to 1 day after ovulation if fertilization is to occur.
2. Sperm cell transport to the ampulla depends on the ability of the sperm cells to swim and possibly
on contractions of the uterus and the uterine tubes.
3. Implantation of the developing embryo into the uterine wall occurs when the uterus is most
receptive.
4. Estrogen and progesterone secreted first by the corpus luteum and later by the placenta are
essential for the maintenance of pregnancy.
Menopause The female climacteric begins with irregular menstrual cycles and ends with menopause,
the cessation of the menstrual cycle.
SPERM CELL MOVEMENT:
Sperm cells are deposited into the vagina as part of the semen when the male ejaculates.
Sperm cells pass through the cervix, the body of the uterus, and the uterine tube. Fertilization
normally occurs when the oocyte is in the upper one third of the uterine tube (the ampulla).
II.C HUMAN SEXUALITY
Sexuality has always been a part of human life, but it is only in the past few decades that
it has been studied scientifically. One common finding of researchers has been that
feelings and attitudes about sex vary widely: the sexual experience is unique to each
individual, but sexual physiology (i.e., how the body responds to sexual arousal) has
common features (Baram & Basson, 2007).
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HUMAN SEXUAL RESPONSE AS A CYCLE WITH FOUR DISCRETE STAGES:

1.Excitement
2.Plateau
3.Orgasm
4.Resolution
TYPES OF SEXUAL ORIENTATION:

1. Heterosexuality
2. Homosexuality
3. Bisexuality
4. Transsexuality
TYPES OF SEXUAL EXPRESSION:

1. Sexual Abstinence
2. Masturbation
3. Erotic Stimulation
4. Voyeurism
5. Sadomasochism
6. Exhibitionism
7. Pedophiles
DISORDERS OF SEXUAL FUNCTIONING:

1. Inhibited Sexual Desire
2. Failure to Achieve Orgasm
3. Erectile Dysfunction
4. Premature Ejaculation
5. Persistent Sexual Arousal Syndrome
6. Pain Disorders (vaginismus, dyspareunia, vestibulitis)
Remember !!!
Teach adolescents that with sexual maturity comes sexual responsibility. They need to be
aware of safer sex practices as protection against both an STI or an unintentional pregnancy.
II.D RESPONSIBLE PARENTHOOD:
D.1 DEFINING THE CONCEPT OF FAMILY:
A family is defined by the U.S. Census Bureau (2009) as “a group of people related by blood,
marriage, or adoption living together.” This definition is workable for gathering comparative statistics
but is limited when assessing a family for its health concerns or the support people available, because
some families are made up of unrelated couples, and at certain points in life not all family members
may live together. Allender and Spradley (2008) define the family in a much broader context as “two
or more people who live in the same household (usually), share a common emotional bond, and
perform certain interrelated social tasks.” This is a better working definition for health care providers
because it addresses the broad range of types of families that could be encountered in any health
care setting.
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Family Types Many types or structures of families exist, and family structures change over time as
they are affected by birth, work, death, divorce, and the growth of family members. For the purposes
of assessing families in maternal and child health nursing, two basic family types can be described: •
Family of orientation (the family one is born into; or oneself, mother, father, and siblings, if any) •
Family of procreation (a family one establishes; or oneself, spouse or significant other, and children)
Almost all families, regardless of type, share common activities (Cherlin, 2008). They influence the
health and activities of their members (Chen, Shiao, & Gau, 2007). Specific descriptions of family
types vary greatly depending on family roles, generational issues, means of family support, and
sociocultural influences.
D.2 FAMILY TYPES:
Many types or structures of families exist, and family structures change over time as they are affected
by birth, work, death, divorce, and the growth of family members. For the purposes of assessing
families in maternal and child health nursing, two basic family types can be described:
• FAMILY OF ORIENTATION (the family one is born into; or oneself, mother, father, and
siblings, if any)
• FAMILY OF PROCREATION (a family one establishes; or oneself, spouse or significant
other, and children)
Almost all families, regardless of type, share common activities (Cherlin, 2008). They influence the
health and activities of their members (Chen, Shiao, & Gau, 2007). Specific descriptions of family
types vary greatly depending on family roles, generational issues, means of family support, and
sociocultural influences.
D.3 FAMILY TASKS:
Eight tasks that are essential for a family to perform to survive as a healthy unit. These tasks differ in
degree from family to family and depend on the growth stage of the family, but they are usually
present to some extent in all families. Wellness behaviors such as these may decrease during periods
of heightened stress. Therefore, assessing families for these characteristics is helpful in establishing
the extent of stress on a family and empowering the family to move toward healthier behaviors.
• Physical maintenance
• Socialization of family members
• Allocation of resources
• Maintenance of order
• Division of labor
• Reproduction, recruitment, and release of family (having to accept a new infant into an already
crowded household may make a pregnancy a less-than-welcome event or cause reworking of this
task)
• Placement of members into the larger society: - select community activities, such as schools,
religious affiliation, or a political group, that correlate with the family’s beliefs and values.
• Maintenance of motivation and morale: Healthy families are able to maintain a sense of unity and
pride in the family -a sense of pride helps members defend the family against threats as well as serve
as support people for each other during crises
THINGS TO REMEMBER:
A family is a group of people who share a common emotional bond and perform certain interrelated
social tasks.
● Because families work as a unit, the unmet needs of any member can spread to become the unmet
needs of all family members.
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● Common types of families include nuclear, extended, single-parent, blended, cohabitation, single
alliance, gay and lesbian, foster, and adopted families.
● Common family tasks are physical maintenance, socialization of family members, allocation of
resources, maintenance of order, division of labor, reproduction, recruitment and release of members,
placement of members into the larger society, and maintenance of motivation and morale.
● Common life stages of families are marriage; early childbearing; families with preschool,
school-age, and adolescent children; launching stage; middle-years families; and the family
in retirement.
● Changes in patterns of family life that are occurring are increased mobility, dual-parent employment,
increased divorce, social problems such as abuse and poverty, reduced family size, and the addition
of technology.
● Considering a family as a unit (a single client) helps in planning nursing care that meets the family’s
total needs.
● Families exist within communities; assessment of the community and the family’s place in the
community yields further information on family functioning and abilities.
● Families do not always function at their highest-level during periods of crisis; reassessing them
during a period of stability may reveal a stronger family than appeared on first assessment.
RESPONSIBLE PARENTHOOD, as defined in the Directional Plan of POPCOM, is the will and
ability of parents to respond to the needs and aspirations of the family and children.
It is a shared responsibility of the husband and the wife to determine and achieve the desired
number, spacing, and timing of their children according to their own family life aspirations, considering
psychological preparedness, health status, socio-cultural, and economic concerns.
Responsible parenthood is simply defined as the “will” and ability of parents to respect and do the
needs and aspirations of the family and children. It is the ability of a parent to detect the need,
happiness and desire of the children and helping them to become responsible and reasonable
children.
What does the Church mean by responsible parenthood?

social conditions, responsible parenthood is exercised by those who prudently and generously
decide to have more children, and by those who, for serious reasons and with due respect to moral
precepts, decide not to have additional children for either a certain or an indefinite period of time.
Why is responsible parenthood important?

"Parenthood" is certainly important in shaping a human. Look at the world around, all men
owe their life to the way their parents brought them up. Parents should take care that their
child grows up to become a caring, understanding, respectful and humble individual at the
least.
What is the role of responsible parenthood?

(A) Definition of Responsible Parenthood Responsible parenthood is the act or process of
effective discharge of duties and obligations of upbringing/rearing of children/wards by
parents/guardian. ... It trains children to be peace loving. It trains children to uphold law and
order/rule of law.
What is the Role of a Parent? The Roles of Being a Parent

• Take Care of the Biological Needs of Children. ...
• Provide an Optimal Environment. ...
• Protect Your Children. ...
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• Teach and Educate Your Child. ...
• Provide Guidance, Direction, Assistance and Help. ...
• Support and Motivate the Child. ...
• Take Care of the Social Emotional Skills. ...
• Discipline Gently.
Here are child-rearing tips that can help you feel more fulfilled as a parent:
1. Boosting Your Child's Self-Esteem. ...
2. Catch Kids Being Good. ...
3. Set Limits and Be Consistent with Your Discipline. ...
4. Make Time for Your Kids. ...
5. Be a Good Role Model. ...
6. Make Communication a Priority. ...
7. Be Flexible and Willing to Adjust Your Parenting Style.
What are the duties and responsibilities of parents?

Parents are responsible to provide the necessary food, clothing, shelter and medical care
insofar as they are able. They are equally responsible for providing sound education and a
sound knowledge of their religion as well as moral training of their children.
Rights and Duties of Parents

(1) To keep them in their company, to support, educate and instruct them by right
precept and good example, and to provide for their upbringing in keeping with their
means;
(2) To give them love and affection, advice and counsel, companionship and
understanding;
What is RA 7610 in the Philippines?

• AN ACT PROVIDING FOR STRONGER DETERRENCE AND SPECIAL
PROTECTION AGAINST CHILD ABUSE, EXPLOITATION AND
DISCRIMINATION, PROVIDING PENALTIES FOR ITS VIOLATION AND FOR
OTHER PURPOSES. Section 1. Title. - This Act shall be known as the "Special
Protection of Children Against Abuse, Exploitation and Discrimination Act."
FAMILY PLANNING:
What is family planning in the Philippines?

Family Planning (FP) is having the desired number of children and when you want to have
them by using safe and effective modern methods. Proper birth spacing is having children 3 to
5 years apart, which is best for the health of the mother, her child, and the family.
Why family planning is important in Philippines?

The capacity of the parents to care for and provide for the children's needs, both present and
future, are also important considerations in family planning. Family planning is
important for the health of the mother and her children.
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When did family planning started in the Philippines?
1970s
“The Philippines started its family planning program in the 1970s, when we had a similar
population to Thailand of around 40 million
What is the purpose of family planning?

Family planning / contraception reduces the need for abortion, especially unsafe
abortion. Family planning reinforces people's rights to determine the number and spacing of
their children. By preventing unintended pregnancy, family planning /contraception prevents
deaths of mothers and children.
What is the goal of family planning?

Family planning creates benefits in areas such as, gender quality and women's health,
access to sexual education and higher education, and improvements in maternal and child
health. Note that the Millennium Development Goals have been superseded by the
Sustainable Development Goals.
What are the disadvantages of family planning?

Disadvantages: Natural family planning does not protect against STIs such as chlamydia or
HIV. You'll need to avoid sex, or use contraception such as condoms, during the time you
might get pregnant, which some couples can find difficult.
What is the natural family planning method?

Fertility awareness or Natural Family Planning is a method of birth control that does not use
any drugs or devices. It combines the calendar/rhythm method, the basal body temperature
method, and the cervical mucus method
What are the family planning methods in the Philippines?

Modern methods include female sterilization, male sterilization, pill, IUD, injectable, condom,
mucus/Billings/ovulation methods, Standard Days Method and Lactational
Amenorrhea Method. Traditional methods include calendar method, rhythm or periodic
abstinence, and withdrawal.
What are the types of family planning?

Contraception methods
• long-acting reversible contraception, such as the implant or intra uterine device (IUD)
• hormonal contraception, such the pill or the Depo Provera injection.
• barrier methods, such as condoms.
• emergency contraception.
• fertility awareness.
• permanent contraception, such as vasectomy and tubal ligation.
What is advantage and disadvantage of family planning?

Advantages of hormonal methods of birth control include that they are all highly effective and
their effects are reversible. They do not rely on spontaneity and can be used in advance of
sexual activity.
Disadvantages of hormonal methods for birth control include: The necessity of taking
medications continuously.
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a. Silbert-Flagg. (2018). Maternal and Child Health Nursing: Care of the Childbearing and
Childrearing family. 8th Ed. Wolters Kluwer. Philadelphia.
b. Schuling (2017). Women’s Gynecology health. 3rd edition. Jones & Bartlett Learning.
Burlington.
c. Johnson, JY. (2014). Study guide for maternal & child health nursing: care of the childbearing
and childrearing family. 7th edition. Philadelphia: Wolters Kluwer.
d. Berman, A. (2014). Kozier & Erb’s fundamentals of Nursing: Concepts, Process, and
Practice. 9th Edition. London: Pearson.
e. Glasper, A. et.al. (2018). Children and Young people’s Nursing at a Glance. 1st Edition. Joh
Wiley & Sons, Inc.
f. Loschiavo, J. (2015). Fast Facts for the School Nurse: School Nursing in a Nutshell. Springer
Publishing Company
g. Pediatric Nursing: Content Review plus Practice Questions. F.A. Davis
Company.http://site.ebrary.com/lib/uniofmindanao/detail.action?docID=1809022
Let’s Checks!
Activity 1: Draw the Male and Female Reproductive System. Label its part and indicate their
function/s.
Let’s Analyze!
Activity2:
Choose which of the following contraceptive method is explained. Write the letter of the correct
answer.
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1. Deciding to refrain from sexual intercourse.

a. Abstinence
b. IUD
c. Condom
2. A slipcover made out of rubber for the penis in erection.

a. Female condom
b. Condom
c. IUD
3. A thin rubber which needs to be placed in the vagina before having sexual intercourse.
a. Female condom
b. Condom
c. Diaphragm
4. A soft latex or silicon dome which is placed in the vagina before having sexual intercourse.
a. Diaphragm
b. Female condom
c. Condom
5. Small T-shaped device which is placed in the uterus by a professional doctor.

a. IUD
b. Diaphragm
c. Contraceptive injection
7. Oral method for women which prevents the liberation of an egg.

a. The pill
b. Contraceptive injection
c. IUD
8. Injection of hormones which prevents the liberation of an egg.

a. Contraceptive injection
b. IUD
c. The pill
In a Nutshell!
Activity 3: ESSAY Activity

Discuss question 1 & 2 in 10 sentences each:12
1. Why is family planning important for young people?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
2. What are the advantages of good family planning?

_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
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Big Picture 3
Week 3-4 Unit Learning Outcomes (ULO). At the end of the unit you are expected to:
III. Discuss the Evidence-based Practice in Maternal and Child Health.
IV. Enumerate and give the proper Care of the Mother and the Fetus during the Prenatal &
Intrapartal Period once exposed to the Maternal and Child Care facilites.
Big Picture in Focus: ULO3: Weeks 3-4

III. EVIDENCE BASED PRACTICE IN MATERNAL AND CHILD HEALTH
IV. CARE OF THE MOTHER AND THE FETUS DURING THE PRENATAL & INTRAPARTAL PERIOD
Metalanguage:
The topic for the 3rd and 4th week focuses on the discussion of Evidence based practice in Maternal &
Child; Prenatal Care for the mother such Assessment, Nursing diagnosis, Planning and Intervention,
Evaluation and Documentation. Care for the fetus is also discuss such as Assessment, Development
& Functions of the Placenta & Fetal Membranes. Included also is the care during Intrapartal stage
(Theories of labor, Assessment, Nursing Diagnosis, Planning & Intervention, Early Essential Newborn
Care (EENC), Evaluation and Documentation. You will be equipped on how to give appropriate care
to pregnant mothers during the prenatal and intra-natal period and the Immediate Essential Newborn
Care after birth. May this ULO 3 topic help the nursing student when they will be expose to the
Maternal Child institution (Delivery Room) and apply what they have learned during the lecture.
Essential Knowledge:
To perform the aforesaid big picture (unit learning outcomes) for the third week of the course,
you need to fully understand the following essential knowledge that will be laid down in the
III. EVIDENCE -BASED PRATICE IN MATERNAL & CHILD HEALTH
Introduction:
• Maternal health refers to the health of women during pregnancy, childbirth and the
postpartum period.
• Good maternal a health and nutrition are important contributors to child survival.
• Lack of essential interventions to address maternal health and nutrition, and other
health conditions often contribute to indices of neonatal morbidity and mortality.
• Poor maternal, newborn and child health remains a significant problem in developing
countries.
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Statistics:
• Worldwide, 385,000 women die during pregnancy and childbirth annually.
• Estimated 7.6 million of children under the age of five.
• Majority of maternal deaths occur during or immediately after childbirth.
• Common medical causes for maternal death include bleeding, high blood pressure,
prolonged and obstructed labor, infections and unsafe abortions.
• A child’s risk of dying is highest during the first 28 days of life.
• 40% of under-five deaths take place, translating into three million deaths.
• Up to one half of all newborn death occurs within the first 24 hours of life and 75%
occur within the first week.
• Globally, the main causes of neonatal death are preterm birth, severe infections and
asphyxia.
• Children in low-income countries are nearly 18 times more likely to die before the age
of five than children in high-income countries.
FACTS:
• Every day, approximately 800 women die from preventable causes related to pregnancy and
childbirth.
• 99% of all maternal deaths occur in developing countries.
• Maternal mortality is higher in women living in rural areas and among poorer communities.
• Skilled care before, during and after childbirth can save the lives of women and newborn
babies.
• Between 1990 and 2010, maternal mortality worldwide dropped by almost 50%.
• Every day, +8000 newborn babies die from preventable causes.
• Nearly 99% of all neonatal death occur in low- and middle-income countries.
• 70% of global deaths among newborn babies happen in just two WHO regions:(AFRICA&
SOUTH-EAST ASIA).
• Essential maternal and newborn care and access to care for complications can save the lives
of mothers and newborn babies.
SIX EVIDENCE-BASED CARE PRACTICES OF PREGNANT CLIENT DURING LABOR PERIOD:

1. Promote physiological birth.
2. Avoiding medically unnecessary induction of labor.
3. Allowing freedom of movement for the laboring woman.
4. Providing continuous labor support.
5. Avoiding routine interventions and restrictions.
6. Encouraging spontaneous pushing in non-supine positions.
FOUR EVIDENCE BASED CARE PRACTICES FOR NEWBORN AFTER DELIVERY: (WHO)
1. Immediate and thorough drying: provides warmth to the child and prevents hypothermia
from setting in.
2. Early skin-to-skin contact: establishes mother and child bonding and minimizes the risk of
sepsis and hypoglycemia
3. Properly timed cord clamping and cutting: prevents anemia and hemorrhage
4. Non-separation of the newborn and mother for early initiation of breastfeeding
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REVIEW:
• The ability of a woman to accept her pregnancy depends on social, cultural, family, and
individual influences.
• The psychological tasks of pregnancy are centered on ensuring safe passage for the fetus.
These consist of, in the first trimester, accepting the pregnancy; in the second trimester,
accepting the baby; and in the third trimester, preparing for parenthood.
• Common emotional responses that occur with pregnancy include grief, narcissism,
introversion or extroversion, stress, couvade syndrome, body image and boundary confusion,
emotional lability, and changes in sexual desire.
• Physiologic changes that occur with pregnancy are both local (uterine, ovarian, and vaginal
changes) and systemic (respiratory, cardiovascular, urinary, and skin changes).
• Women may have read about the expected psychological and physiologic changes of
pregnancy, but once these changes are actually being experienced, they may find them more
intense than anticipated.
• The diagnosis of pregnancy is based on three types of findings: presumptive (subjective),
probable (objective), and positive (documented).
• The positive signs of pregnancy are demonstration of a fetal heartbeat separate from the
mother’s, fetal movement felt by an examiner, and visualization of the fetus by ultrasound.
• Although a woman may be in a physician’s office or prenatal clinic for only an hour, if her
pregnancy was confirmed at that visit, she invariably feels “more pregnant” when she leaves.
Early diagnosis is important so that a woman can begin to change unhealthy habits or, if she
desires, have adequate time to carry out a therapeutic termination of pregnancy.
IV. CARE OF THE MOTHER AND THE FETUS DURING THE PERINATAL PERIOD:
A. PRENATAL CARE:
Key Terms:
• chloasma • nulligravida
• gravida • para
• lithotomy position • primigravida
• multigravida • primipara
• multipara • speculum
I.CARE OF THE MOTHER:

a. Assessment:
- ANTENATAL VISIT
FIRST PRENATAL VISIT is a time to establish baseline data relevant to health assessment and
health-promotion strategies that will be important at every prenatal visit.
• Obtaining a health history, including screening for the presence of teratogens (any factor that
may adversely affect the fetus) and any concerns a woman may be experiencing.
• Explaining why specific assessment data are relevant to the pregnancy is important.
a. Weighing a woman - discussing what routine weight gain she can expect in the coming
months and why monitoring weight gain is important supplies information to a woman as
well as allowing you to obtain baseline data.
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b. Relating assessment information and health-promotion activities this way throughout the
pregnancy helps keep a woman and her family well informed and eager to comply with
further health care recommendations.
PURPOSES OF PRENATAL CARE:

• Establish a baseline of present health
• Determine the gestational age of the fetus
• Monitor fetal development and maternal well being
• Identify women at risk for complications
• Minimize the risk of possible complications by anticipating and preventing problems before they
occur
• Provide time for education about pregnancy, lactation, and newborn care
PRECONCEPTUAL VISIT:
• Women should schedule an appointment with a physician or nurse-midwife before becoming
pregnant to obtain accurate reproductive life planning information, receive reassurance about
fertility (as much as can be given based on a health history and a routine physical
examination)
• Detect any problems that may need correction through a thorough health history, and physical
and pelvic examinations, hemoglobin level and blood type (including Rh factor) can be
determined; a Papanicolaou (Pap) test can be taken, and minor vaginal infections such as
those arising from Candida or chlamydia can be corrected to help ensure fertility.
• Woman can be counseled on the importance of a good protein diet, adequate intake of folic
acid and other vitamins, and early prenatal care if she does become pregnant. More often,
however, women arriving for their first prenatal visit will not have had a recent health care
appointment oriented toward reproduction this way.
Choosing a Health Care Provider for Pregnancy and Childbirth

Once a woman is or suspects that she may be pregnant, her next step is to choose a primary health
care provider to care for her throughout the pregnancy and birth. Various options are available,
including a prenatal clinic, her health maintenance organization (HMO) or preferred provider (PPO), a
certified nurse-midwife, an obstetrician, or a family practitioner. Regardless of the type of health care
provider chosen, prenatal care needs to be initiated early and continued throughout pregnancy.
Nurses contribute to the success of prenatal care by listening, counseling, and teaching, three areas
of nursing expertise (Box 11.2). Many clinics and group practices provide an initial educational
seminar for women in the early stages of their pregnancy, often led by a nurse or nurse practitioner.
Some practices form cohorts of women to meet monthly and discuss their concerns to be certain that
women will have support from others all through pregnancy. Box 11.3 summarizes ways that prenatal
care can be improved and individualized so that all women can be interested in obtaining it.
Suggestions for Improving Prenatal Care Services

• Schedule appointments for women within a week after they first call the health care setting. This
initial contact can be done through a group orientation session, individually by a health team member
or, if risk status warrants, by a physician. Try to schedule further appointments at times convenient for
a woman and her support people to encourage attendance.
• Make waiting time educational by providing materials such as pamphlets or videotapes in the
waiting room.
• Provide privacy for assessments such as blood pressure and weight.
• Be certain that pregnant women meet health care providers while fully clothed and upright, not
exposed or in a lithotomy position on an examining table.
• Encourage women to feel responsible for their health record. If a woman’s first language is not
English, be sure to record pregnancy information so she can read it.
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• Encourage family members and friends to accompany a woman for prenatal care. Allow them to
enter the examination room and participate in all aspects of care to the extent they and the woman
desire.
• Schedule appointments to provide continuity of care. Be certain that women have a specific
person’s name as a telephone or e-mail contact for pregnancy-related questions. Without this
information, they tend not to call.
• Educate pregnant women about care options and encourage them to participate in making
decisions about their care.
MAJOR CAUSES OF DEATH DURING PREGNANCY

1. Ectopic pregnancy,
2. Hypertension,
3. Hemorrhage,
4. Embolism,
5. Infection, and
6. Anesthesia-related complications such as intrapartum cardiac arrest
7. An important focus of all prenatal visits, therefore, in addition to education about pregnancy, is
to screen for danger signs that might reveal any of these conditions
An initial interview serves several purposes:

• Establishing rapport
• Gaining information about a woman’s physical and psychosocial health
• Obtaining a basis for anticipatory guidance for the pregnancy
SCREENING INCLUDES:
a. Health history (extensive)
• Demographic Data – name, age, address, contact nos., religion and health
insurance.
• Chief Concern – she thinks she is pregnant; LMP; pregnancy test; signs of
pregnancy; discomforts of pregnancy; wanted pregnancy)
• Family profile – marital status; support people; size of house; financial status; jobs
• History of Past Illnesses – past conditions can become active during/immediately
following pregnancy – kidney, heart disease; HPN; STIs; Diabetes; Hepa B; HIV;
Thyroid problem; UT; TB ; Asthma ; Seizures ; Varicella -chickenpox ; mumps and
etc.
• History of Family illnesses – cardiovascular; renal diseases; cognitive impairment;
blood disorders; genetically inherited diseases.
• Day History/Social Profile – current nutrition; elimination; recreation and
interpersonal interactions
• Gynecological History – reproductive system problem; menstrual history; perineal
self-examination; BSE; Surgery on the reproductive tract; reproductive planning
method used; stress incontinence- Kegel’s exercise
• Obstetric History - Don’t assume that the current pregnancy is a woman’s first
pregnancy simply because she is very young or says she has only recently been
married. She may have had an adolescent pregnancy or this could be a second
marriage. For each previous pregnancy, document the child’s sex and the place
and date of birth.
a. Was it planned?
b. Did she have any complications, such as vaginal spotting, swelling of her
hands or feet, falls, or surgery?
c. Did she take any medication? If so, what and why?
d. Did she receive prenatal care? If so, when did she start?
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e. What was the duration of the pregnancy?
f. What was the duration of labor?
TERMS RELATED TO PREGNANCY STATUS
TERM DEFINITION
Para Number of pregnancies that have reached viability, regardless

of whether the infants were born alive
Gravida Woman who is or has been pregnant
Primigravida Woman who is pregnant for the first time
Primipara Woman who has given birth to one child past age of viability
Multigravida Woman who has been pregnant previously
Multipara Woman who has carried two or more pregnancies to viability
Nulligravida Woman who has never been and is not currently pregnant
A more comprehensive system for classifying pregnancy status (GTPAL or GTPALM) provides
greater detail on a woman’s pregnancy history. By this system,
the gravida classification remains the same, but para
classification is broken down into:
T: Number of full-term infants born (infants born at 37 weeks or after)
P: Number of preterm infants born (infants born before 37 weeks)
A: Number of spontaneous miscarriages or therapeutic abortions
L: Number of living children
M: Multiple pregnancies
Review of Systems - The following body systems and questions about conditions constitute the
minimum information to be addressed in a review of systems for a
first prenatal visit:
• Head: Headache? Head injury? Seizures? Dizziness? Fainting?
• Eyes: Vision? Glasses needed? Diplopia or double vision? Infection?
Glaucoma? Cataract? Pain? Recent changes?
• Ears: Infection? Discharge? Earache? Hearing loss? Tinnitus? Vertigo?
• Nose: Epistaxis (nose bleeds)? Discharge? How many colds a year? Allergies?
Postnasal drainage? Sinus pain?
• Mouth and pharynx: Dentures? Condition of teeth? Toothaches? Any bleeding of
gums? Hoarseness? Difficulty in swallowing? Tonsillectomy? Last dental exam?
• Neck: Stiffness? Masses?
• Breasts: Lumps? Secretion? Pain? Tenderness?
• Respiratory system: Cough? Wheezing? Asthma? Shortness of breath? Pain?
Serious chest illness, such as tuberculosis or pneumonia?
• Cardiovascular system: History of heart murmur? History of heart disease such
as rheumatic fever or Kawasaki disease? Hypertension? Any pain? Palpitations?
Anemia? Does she know her blood pressure? Has she ever had a blood
transfusion?
• Gastrointestinal system: What was her pre-pregnancy weight? Vomiting?
Diarrhea? Constipation? Change in bowel habits? Rectal pruritus? Hemorrhoids?
Pain? Ulcer? Gallbladder disease? Hepatitis? Appendicitis?
• Genitourinary system: Urinary tract infection? Hematuria? Frequent urination?
Sexually transmitted infection? Pelvic inflammatory disease? Hepatitis B? HIV?
Was subfertility a concern? Did she have a problem getting pregnant?
• Extremities: Varicose veins? Pain or stiffness of joints? Any fractures or
dislocations?
• Skin: Any rashes? Acne? Psoriasis?
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• Conclusion - End an interview by asking if there is something you have not covered that a woman
wants to discuss. This gives her one more chance to ask any questions she has about this new
life experience.
b. Complete physical examination- pelvic examination

c. Blood and urine specimens for laboratory work.
d. Manual pelvic measurements can be taken to determine pelvic adequacy.
BIRTHING PLAN
What is a birth plan?
A birth plan is a document that lets your medical team know your preferences for things such as how to
manage labor pain. Keep in mind that you can't control every aspect of labor and delivery, and you'll
need to stay flexible in case something comes up that requires your birth team to depart from your plan.
But a printed document gives you a place to make your wishes clear.
A birth plan also helps refresh your healthcare provider's memory when you're in labor. And it informs
new members of your medical team – such as your labor and delivery nurse – about your preferences
when you're in active labor.
Most hospitals and birth centers provide a birth plan worksheet or brochure to explain their policies and
philosophy of childbirth, and to let you know what your birth options might be. That information can help
guide you and your provider in a discussion about your labor and delivery preferences.
In the "Labor" and "After delivery" sections below, we explain what typically happens at the hospital and
what alternatives you may have. Not all the options will be available in every setting or make sense for
your situation, especially if your pregnancy is high risk. But this should give you a place to start your
discussion. It can be wise to consider your preference in all situations, in case you are faced with an
unexpected choice.
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Birth plan worksheet
Here's a checklist to note your preferences and guide your discussion with your provider. Give a
completed copy to your provider well before your due date, and bring another to the hospital when you
go into labor.
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LABOR:
• When you arrive at the hospital, a health practitioner evaluates you to see how far your labor has
progressed. You may be asked to walk around a bit or even to return home for a while before being
admitted.
• Once you're admitted, the hospital may allow you to invite family and friends to be with you, bring in
comfort objects (such as photographs, flowers, or pillows) or food and drink for your support team, play
music, dim the lights, and move around as you need to for comfort. If you plan to have the birth
photographed or filmed, ask ahead of time what the hospital's policy is. Not all hospitals allow it.
• To enable your ability to move around freely during labor, most hospitals won't routinely start an
IV when you're admitted. (You'll be encouraged to drink clear liquids to stay hydrated.)
• Most hospitals no longer order enemas or shave you before delivery.
• You may want to ask about the hospital's policy on fetal monitoring. Your baby will likely be monitored
externally for 20 or 30 minutes when you're admitted. If your baby's heart rate is reassuring, you might
only need to be intermittently monitored after that. Not being tied to a monitor allows you to move
around more easily during labor. (And some hospitals have wireless monitors, so patients can walk
around while being continuously monitored.)
• Discuss your preferences for pain management with your healthcare provider. If you're trying for
an unmedicated birth, you might plan to work with a support team or use various labor props, such as a
shower, tub, birthing ball, birthing stool, squatting bar, and so on. (You may want to ask your provider
what kinds of props you're allowed to bring with you and which ones the hospital can provide.) If you
prefer to use pain medication or have an epidural, it's a good idea to discuss your options ahead of time.
• If your labor stops progressing, your medical team may recommend interventions such as breaking your
amniotic sac (if your water hasn't already broken) or augmenting your labor with Pitocin.
• When it's time to push, your medical team can coach you on when and how to bear down. Another
option might be to follow your body's natural urges and push when and how you feel is right for you.
• You may be able to choose the position you deliver in, such as squatting, semi-sitting, lying on your
side, or on your hands and knees.
• Most hospitals don't routinely perform episiotomies, so you probably won't need to communicate your
preference. But be aware that your provider may recommend one in some situations.
• If an assisted delivery is required, your provider will use a vacuum device or forceps to help your baby
out of the birth canal.
• If you end up having a c-section, it's likely that you'll be awake and your support person will be able stay
with you. In rare cases, you'll need general anesthesia, and your support person will be asked to wait
outside the operating room.
• You may want to ask your practitioner if you can view your c-section delivery through a clear plastic
drape or have the drape lowered and have your baby placed directly on your chest afterward.
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AFTER DELIVERY:
• After a vaginal delivery, the baby is usually placed on you and covered with a warm blanket. You can let
your provider know if you prefer to hold your baby skin to skin immediately after delivery or if want your
baby dried off or bathed first.
• Unless your baby needs special medical care, you can usually ask for all procedures and tests to be
done while your baby is in the room with you. Some procedures (such as bathing and measuring) can
be delayed for an hour to give you a chance to feed and bond with your baby. If your baby does need to
be taken from you for special medical care, your partner or attendant can usually go along.
• The umbilical cord is clamped in two places and cut between the two clamps. Let your provider know if
your support person wants to cut the cord.
• You may want to ask your caregiver about delaying the clamping and cutting of the umbilical cord.
Recent research shows that waiting a few minutes allows extra blood to flow from the placenta to the
baby and reduces the risk of newborn anemia and iron deficiency.
• If you've chosen to bank your baby's cord blood, the blood will be collected at this time. (You'll need to
arrange for the process well in advance.)
• Whether you choose to breastfeed or formula-feed, you can begin whenever you and your baby are
ready. If you're nursing, let your medical team know if you'd like a lactation consultant to help you get
started.
• Consider whether you want your baby to have a pacifier, and let the hospital staff know your
preferences.
• Most hospitals encourage you to be with your baby as much as possible during your stay. They tend to
support "rooming in" – rather than keeping the baby in the nursery – to promote bonding. Ask about
your hospital's policy on this if you have any questions.
Sample of a Birth Plan: MLG
Birth Attendant: AC, MD, or nurse-midwife KD, whoever is on call for the big day.
Birth Setting: DR at SPMC
Support Person: Husband P (if out of town, my sister A).
Activities During Labor:

I want to walk around or rock in the rocking chair or play Monopoly.
I want to wear my own nightgown, and listen to a Garth Brooks CD.
I want to eat “anything chocolate” during labor.
I want an epidural for pain management.
Birth:
Position for birth: on my side.
No episiotomy
Husband wants to cut cord and videotape the birth.
I want my son to watch if he wants to.
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Postpartum:
I want to breastfeed immediately.
I want to use skin-to-skin care to keep baby warm.
I want to room in.
Husband wants to sleep over on bedside
b. NURSING DIAGNOSIS:
The first prenatal visit officially confirms this, so nursing diagnoses usually focus on the response of a
woman and her family to that information:
• Decisional conflict related to desire to be pregnant

• Risk for ineffective coping related to confirmation of unplanned pregnancy Nursing diagnoses
appropriate to prenatal care include:
• Health-seeking behaviors related to guidelines for nutrition and activity during pregnancy
• Deficient knowledge regarding exposure to teratogens during pregnancy
• Risk for injury to fetus related to current lifestyle behaviors.
• Risk for deficient fluid volume related to vomiting secondary to hyperemesis gravidarum
c. OUTCOME IDENTIFICATION AND PLANNING:

Be certain to reserve sufficient time at prenatal visits so care can be thorough and there is enough
time to set realistic goals and expected outcomes with both a woman and her partner, if desired.
Make sure that a woman leaving an initial prenatal visit schedules an appointment for a following visit,
as this may not occur to a woman who may be extremely excited or overwhelmed by all the new
things that are happening to her and her family; establishing a pattern of regular appointments is
crucial to providing effective prenatal care. Although many settings are looking at whether the number
of prenatal visits traditionally scheduled is needed during a normal pregnancy, return appointments
are usually scheduled every 4 weeks through the 28th week of pregnancy, every 2 weeks through the
36th week, and then every week until birth. Women categorized as high risk are followed more
closely. Reliable Internet sites to use for referral on preconceptual or prenatal care are the National
Institute of Health and Human Development.
IMPLEMENTATION:
An important nursing intervention at prenatal visits is teaching women and their families about a safe
pregnancy lifestyle. It may be helpful to give a woman and her partner pamphlets or books that cover
the same topics. Be certain that you have read all the printed material you give families. This helps to
ensure that a pamphlet’s advice is consistent with what you have said and with the views of a
woman’s primary care physician or nurse-midwife. A pretty picture on the cover of a pamphlet does
not ensure the quality of the advice inside. In addition, reinforce with a woman that she should call, e-
mail, or text message the health care setting if she has any problems or questions between visits.
Some women may feel reluctant to “bother” a health care provider outside of scheduled visits unless
you give them permission to do so.
D. OUTCOME EVALUATION:
Evaluation during prenatal visits should concentrate on a woman’s initial progress toward
understanding goals of care for pregnancy and assessing outcomes established for specific concerns.
Examples of expected outcomes are: • Couple states they have reached a mutual decision to both
stop smoking. • Client states she feels well informed about the common discomforts of pregnancy and
actions to take to relieve them. • Client lists ways to avoid exposure to teratogens during pregnancy.
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PATIENT EDUCATION AND HEALTH PROMOTION
Practice issues — Women should be informed about the following:

●When to call the provider: ( eg, vaginal bleeding or change in vaginal discharge, leakage of fluid
from the vagina, fever, pain, vomiting, acute shortness of breath, calf or leg pain, headache,
visual changes, dysuria, pruritus, uterine contractions, crampy abdominal pain, decreased fetal
activity [after perception of fetal activity has become established fainting or dizziness, or personal
concern about a change in health status).
●How to reach the provider after business hours, coverage arrangements, and the role of various
office personnel.
●The hospital where delivery will occur.
Practice issues:
a. Diet, supplements, and weight gain
• Vitamins and minerals
• Diet
• Gestational weight gain
2. Healthy behaviors
• Use of seat belts and air bags
• Oral health
• Avoidance of alcohol, cigarettes, and misuse of drugs
• Exercise and physical activity
• Hot tubs, saunas, and pools
• Precautions against infection
o Immunization
o Preventive measures for other infections
• Sleep position
3. Intimate partner violence
4. Common patient concerns
• Risk of birth defects
• Employment issues
• Sexual activity
• Travel
o Airline travel
o Travel to moderate and high altitudes
• Hair dyes and other cosmetic products
• Shortness of breath
• Airborne pollutants
• Use of insect repellants
• Stretch marks and other normal changes of skin, nails and hair
• Tattoos and body piercing
5. Management of common discomforts
• Nausea and vomiting
• Gastroesophageal reflux disease
• Constipation
• Hemorrhoids
• Rhinitis and epistaxis
• Gingivitis
• Difficulty sleeping
• Headache
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• Back pain and sciatica
• Leg cramps
• Peripheral edema
• Varicose veins
• Diarrhea
• Urinary frequency and nocturia
SAFETY OF SELECTED COMMON MEDICATIONS USED TRANSIENTLY IN PREGNANCY:

1. Pain and fever medications
• Acetaminophen
• NSAIDS
• Opioids
2. Antibiotics
3. Cold and allergy medications
Points for Review:

● Assessment of nutritional health should include a health history (24-hour recall) and physical
examination.
● Nutrition during pregnancy should include about 300 additional calories daily to provide energy,
spare protein, and provide for fetal growth requirements.
● Important minerals necessary for pregnancy include iron, iodine, calcium, fluoride, sodium, and
zinc. Most women need to take an iron supplement to prevent iron deficiency anemia.
● Women should monitor their intake of caffeine, fish, and artificial sweeteners during pregnancy.
● Prenatal vitamins contain additional folic acid supplements and iron, so these should be used
instead of over the-counter vitamins during pregnancy. Be certain that women regard pregnancy
vitamins as medication and follow the medication rule: take nothing other than medications
specifically recommended by their primary care providers, or else toxicity could result.
● Advise pregnant women not to go longer than 12 hours between meals, to avoid hypoglycemia.
● Women who are at high risk for inadequate nutrition include those who are adolescent or over age
40; those who have decreased nutrition stores; those with a multiple pregnancy; those who are
lactose intolerant; those who are underweight or overweight; those on a special diet; those using
recreational drugs, including alcohol or cigarettes; and those with hyperemesis gravidarum (extreme
nausea and vomiting).
● Common nutrition concerns associated with pregnancy include nausea and vomiting, constipation,
cravings (including pica), and pyrosis.
● Hyperemesis gravidarum is nausea and vomiting of pregnancy that extends past 12 weeks of
pregnancy or is too extreme to allow for adequate nutrition. Women with this condition may need their
nutrition supplemented by total parenteral nutrition or enteral feedings.
● Couples should be encouraged to make a childbirth plan early in pregnancy that includes birth
attendant, setting, desired method of pain management, and any special wishes.
● Common exercises taught in pregnancy to strengthen perineal muscles are tailor sitting, squatting,
and Kegel exercises. Abdominal muscle-contraction and pelvic rocking exercises strengthen the
abdominal muscles and help relieve backache.
● Types of childbirth preparation include the Bradley (partner-coached), psychosexual (Kitzinger),
Dick-Read, yoga, and Lamaze methods. Lamaze is the most common method used in the United
States.
● Commonly used nonpharmacologic techniques for pain relief in labor are conscious relaxation,
consciously controlled breathing, effleurage, focusing, imagery, and hydrotherapy.
● Classes for expectant parents provide information on pregnancy, birth, and childcare.
● Common sites for childbirth include hospitals, alternative birthing centers, and homes.
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● Couples should ask birth settings if they are rated as mother-friendly before choosing them as a
birth site
1. CARE OF THE FETUS:
How can you assess the condition of the fetus during pregnancy?
o Documenting fetal growth (Weight of the mother; Leopold’s maneuver-fetal size versus
duration of pregnancy; fundic height measurement; Ultrasound; Incorrect LMP= not correct
fetal size; Intra- uterine growth restrictions is suspected if less in size)
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Maternal factors
1. Intra-uterine growth restriction may be associated with either maternal, fetal or placental
factors.
2. Low maternal weight, especially a low body-mass index (BMI) resulting from
undernutrition.
3. Tobacco smoking.
4. Alcohol intake.
5. Strenuous physical work.
6. Poor socio-economic conditions.
7. Pre-eclampsia and chronic hypertension.
8. Poor maternal weight gain is of very little value in diagnosing intra-uterine growth
restriction.
Fetal factors
• Multiple pregnancy.
• Chromosomal abnormalities, e.g. trisomy 21.
• Severe congenital malformations.
• Chronic intra-uterine infection, e.g. congenital syphilis.
Placental factors
• Poor placental function (placental insufficiency) is usually due to a maternal problem such as pre-
eclampsia.
• Smoking. Poor placental function is uncommon in a healthy woman who does not smoke.
o If severe intra-uterine growth restriction is present, it is essential to look for a maternal

or fetal cause. Usually a cause can be found.
o Recording fetal movements (ask mother the no. of times it moves and compare to
previous)
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a. Assessment:
Prenatal genetic diagnosis
1.Amniocentesis
2.Chorion villous Sampling (CVS)
4.Cordocentesis.
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b. Development and Functions of the Placenta and Fetal

Membrane:
The fetal membranes are membranes associated with the developing fetus. The two
chorioamniotic membranes are the amnion and the chorion, which make up the
amniotic sac that surrounds and protects the fetus.
The fetal membranes surround the developing embryo and form the fetal-maternal interface.
The fetal membranes are derived from the outer trophoblast layer of the implanting blastocyst.
The trophoblast layer differentiates into amnion and the chorion, which then comprise the fetal
membranes. The amnion is the innermost layer and, therefore, contacts the amniotic fluid,
the fetus and the umbilical cord. The internal pressure of the amniotic fluid causes the amnion
to be passively attached to the chorion. The chorion functions to separate the amnion from the
maternal decidua and uterus.
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Function:
The fetal membrane surrounds the fetus during the gestational period and ensures maintenance of
pregnancy to delivery, protection of the fetus as well as being critical in maintaining the conditions
necessary for fetal health.
Barrier function
The fetal membranes separate maternal tissue from fetal tissue at a basic mechanical level.
Signaling of fetal maturation and parturition

As pregnancy advances to term, the fetal membranes undergo weakening.
MAKING THE PLACENTA
• By 8 weeks - chorionic stem villi over the entire surface of the chorionic sac
Those villi associated with the decidua basalis increase in size and more villi
form.
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• Enlargement includes further branching of the anchoring villus - chorion

frondosum.
• The villi continue to enlarge during most of gestation.
• The villi project into a blood filled intervillous space resulting from the erosion
of the decidua basalis.
• Endometrial vessels - spiral arteries and endometrial veins
• Villi associated with the decidua capsularis degenerate - this region is called
the chorion laeve
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For a healthy pregnancy, your doctor will probably want to see you on the following
recommended schedule of prenatal visits:
Weeks 4 to 28: 1 prenatal visit a month.
Weeks 28 to 36: 1 prenatal visit every 2 weeks.
Weeks 36 to 40: 1 prenatal visit every week
B. INTRA-PARTAL CARE :
1. Theories of Labor:
Labor and delivery require a woman to utilize her coping methods psychologically and physiologically.
Normally, labor begins when the fetus reaches a mature age (38-42 weeks age of gestation). This is
to ensure survival of the fetus with the extrauterine life. The mechanism that converts Braxton Hicks
Contractions (painless contractions) to strong and coordinated uterine contractions is unknown. In
some cases, labor occurs before the fetus reaches the mature age (preterm birth) while in others it is
delayed (post term birth).
Although the exact mechanism that initiates labor is unknown. Theories have been proposed to
explain how and why labor occurs.
▪ Uterine Stretch theory

The idea is based on the concept that any hollow body organ when stretched to its capacity will
inevitably contract to expel its contents. The uterus, which is a hollow muscular organ, becomes
stretched due to the growing fetal structures. In return, the pressure increases causing physiologic
changes (uterine contractions) that initiate labor.
▪ Oxytocin theory
Pressure on the cervix stimulates the hypophysis to release oxytocin from the maternal posterior
pituitary gland. As pregnancy advances, the uterus becomes more sensitive to oxytocin. Presence of
this hormone causes the initiation of contraction of the smooth muscles of the body (uterus is
composed of smooth muscles).
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▪ Progesterone deprivation theory
Progesterone is the hormone designed to promote pregnancy. It is believed that presence of this
hormone inhibits uterine motility. As pregnancy advances, changes in the relative effects estrogen
and progesterone encourage the onset of labor. A marked increase in estrogen level is noted in
relation to progesterone, making the latter hormone less effective in controlling rhythmic uterine
contractions. Also, in later pregnancy, rising fetal cortisol levels inhibit progesterone production from
the placenta. Reduce progesterone formation initiates labor.
▪ Prostaglandin theory
In the latter part of pregnancy, fetal membranes and uterine decidua increase prostaglandin levels.
This hormone is secreted from the lower area of the fetal membrane (forebag). A decrease in
progesterone amount also elevates the prostaglandin level. Synthesis of prostaglandin, in return,
causes uterine contraction thus, labor is initiated.
▪ Theory of Aging Placenta

Advance placental age decreases blood supply to the uterus. This event triggers uterine contractions,
thereby, starting the labor.
Fetal Growth - Fundal Height Measurement
Explain the procedure to the mother and gain verbal consent
• Wash hands
• Have a non-elastic tape measure to hand
• Ensure the mother is comfortable in a semi-recumbent position, with an empty bladder
• Expose enough of the abdomen to allow a thorough examination
1. Mother semi-recumbent, with bladder empty.
• Ensure the abdomen is soft (not contracting)

• Perform abdominal palpation to enable accurate identification of the uterine fundus.
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2. Palpate to determine fundus with two hands.
• Use the tape measure with the centimetres on the underside to reduce bias
• Secure the tape measure at the fundus with one hand
3. Secure tape with hand at top of fundus.
• Measure from the top of the fundus to the top of the symphysis pubis
• The tape measure should stay in contact with the skin
4. Measure to top of symphysis pubis.
• Measure along the longitudinal axis without correcting to the abdominal midline
• Measure only once
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5. Measure along longitudinal axis of uterus, note metric measurement.
• Record the metric measurement and plot it on the growth chart.
6. Plot on customized chart, record in notes
2. Assessment:
The time period spanning childbirth, from the onset of labor through delivery of the
placenta. Intrapartum can refer to both the woman and the fetus.
What is intrapartum fetal monitoring?

Intrapartum fetal monitoring to assess fetal well-being during the labor and delivery process has
been a central component of intrapartum care for decades. Today, electronic fetal
monitoring (EFM) is the most common method used to assess the fetus during labor.
What you must do for a rapid assessment

Things you need to have
1. Her Antenatal Care Card (if she has been in your care previously); if she has come to you for the
first time and she is already in labor, start a new health record for her
2. Partograph for recording the progress of labor
3. Sterile gloves
4. Fetoscope/doppler to listen to the baby’s heart beat
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5. Thermometer to take the mother’s temperature
6. Watch or other timer to help you measure the fetal heart rate and the mother’s pulse rate
7. Blood pressure measuring cuff with stethoscope
8. Swabs (3-4 balls of gauze soaked with antiseptic solution such as chlorhexidine 2-4% to clean
the perineum before doing a vaginal examination. You can prepare warm water and soap if you
have no antiseptic solution.
Sometimes a woman may come to you at the Health Post already in the Second stage of labor.
Take her to the delivery couch immediately and make her as comfortable as possible. If you are
seeing her at home, select an appropriate place and make it as clean and safe as you can in the
available time.
Equipment for attending a Normal delivery: (Home Delivery)

• Check her vital signs
a. Blood pressure: normal values range between 120/80 mmHg.
b. Maternal pulse rate: normal range is 80-100 beats/minute, but should not be greater than 110
beats/minute in a woman in labor.
c. Temperature: average 37˚C; if it is between 37.5-38.4˚C the woman has a low grade fever; if
it is 38.5˚C or above, she has a high grade fever.
d. Learned how to assist in starting IV fluids line.
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If the woman is losing a lot of blood, she needs urgent help.

• Look at and listen to the woman
• Is there blood on her clothing or on the floor beneath her?
• Is she grunting, moaning, or bearing down?
Ask her, or someone who is with her, whether she has now or has recently had:
• Vaginal bleeding
• Severe headache/blurred vision
• Convulsions or loss of consciousness
• Difficulty breathing
• Fever
• Severe abdominal pain
• Premature leakage of amniotic fluid (waters breaking early).
If the woman currently has any of these symptoms, immediately:

• Shout for help
• Stay calm and focus on the woman
• Stay with her — do not leave her alone
• Take immediate action to give the necessary pre-referral treatments and refer her urgently to the
nearest hospital or health center.
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Physical examination in labor:
When you physically examine a woman in labor, your focus will be on her abdomen, vagina and
cervix, so remember to:
• Maintain her privacy
• Follow the principles of woman-friendly care
• Examine her comprehensively (head to toe)- scar, linea negra etc….
• Look for signs of anemia (paleness inside the eyelids, pale fingernails and gums)
• Look for yellowish discoloration of the eyes (jaundice), which indicates liver disease.
• Palpation of the abdomen- Leopold’s maneuver
• Measuring fetal heart rate
• Measuring contractions
• Vaginal examination
3. Nursing Diagnosis:
• Impaired Sleep and rest to change of environment
• Impaired physical mobility related to the hospital admission process
• Anxiety related to the threat of death
• Risk for infection related to invasive procedures
• Risk for puerperal infection related to changes in body temperature
• Hypothermia related to blood loss
• Pain related to uterine contractions
• Risk for shock due massive bleeding
4. PLANNING & INTERVENTION DURING INTRAPARTAL PERIOD:
• Determine the woman’s response and her progress in labor

• Maternal Vital Signs, uterine contractions
• Review of prenatal record
• Uteroplacental circulation
• Vaginal exam upon admission, the when necessary to identify progress in labor (infection)
• Discomfort along with strategies at regular intervals (Pharma and non-pharma)
• Psychological status of patient and family
• Do Leopold’s Maneuver prior to admission
• Pain management during labor
NURSING CARE DURING 1ST STAGE OF LABOR (first signs of labor to full dilation of the cervix) 14-
20 hours
1. Monitor mother and fetus
2. Standing and walking shorten the first stage of labor by > 1 hour and reduce the
rate of cesarean delivery (1). If the membranes have not spontaneously ruptured,
some clinicians use amniotomy (artificial rupture of membranes) routinely during
the active phase.
3. Prepare the labor room (instrument, linen, drugs)
4. Follow all universal precautions
5. Take consent, provide nursing support, collect history
6. Monitor mother’s VS/FHT/uterine contractions/I&O
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7. Be aware of mother’s blood type & Hemoglobin.
8. Send urine for analysis of protein and glucose.
9. Monitor for the Vaginal Examination (Internal Examination-I.E.)
-dilatation, effacement, position, station, amniotic fluid, caput formation, fetal
distress.
9. Restriction of invasive techniques
10. Maintain general hygiene (perineal wash, mouth wash etc…)
11. Elimination (urine and stool)
12. Rest, comfort and sleep ( abdominal rub, efflurage, leg cramps
13. Proper diet and nutrition ( fluid intake – oral or IVF)
NURSING CARE DURING 2nd STAGE OF LABOR (The second stage is that of expulsion of the
fetus. It begins when the cervix is fully dilated and the woman feels the urge to expel the
baby)2 hours
1. Monitoring of the fetal heart beat must be continued during the second stage to
allow early detection of bradycardia.
2. Routine episiotomy is harmful and should not be practiced.
3. Women should not be forced or encouraged to push until they feel an urge to
push.
NURSING CARE DURING 3rd STAGE OF LABOR ( final stage, when you deliver the placenta, is
relatively quick)15 minutes to an hour
1. Active management of the third stage of labor involves giving a
prophylactic uterotonic(Oxytocin)
2. Early cord clamping and controlled cord traction to deliver the
placenta .
3. With expectant management, signs of placental separation are awaited
and the placenta is delivered spontaneously.
NURSING CARE DURING 4th STAGE of labor (the first few hours after birth. It signals
the beginning of dramatic changes because it marks the beginning of a new
family.
a. Assist in Perineal repair (NSVD)
b. Vital Signs monitoring both the mother and newborn
c. Palpate woman’s fundus if contracted – check for characteristics of LOCHIA
Lochia rubra – Days 2-4.
Lochia serosa - Day 4, lasts about 2 weeks.
Lochia alba – 2 to 6 weeks postpartum.
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d. Perform perineal care and apply pads

e. Do after care of the birthing room
f. Transport mother to her room accommodation
g. Room -in newborn as ordered
h. Initiate breastfeeding(latched-on)
6. EVALUATION: MOTHER DURING INTRAPARTAL STAGE:

a. Vital Signs is normal
b. Absence of bleeding
c. Pain and comfort of the patient
d. Intake & Output
e. Maternal fever
7. DOCUMENTATION:
MOTHER:
• PATIENT HISTORY
• OBSTETRICAL ASSESSMENT/TRIAGE RECORD
• LABOR FLOWSHEET – admission, VS, I&O, Meds given, Partograph form)
• BIRTH RECORD
NEWBORN:
o BIRTH DATA
o APGAR SCORE
o BIRTH OUTCOME (live birth or loss)
o BIRTH CONDITION & COMPLICATIONS
o NEWBORN CONGENITAL ANOMALIES
o SKIN-TO-SKIN CONTACT
o TYPE OF FEEDING GIVEN
o NEONATAL TRANSFER
5. EARLY ESSENTIAL NEWBORN CARE (EENC):

Definition: early initiation and exclusive breastfeeding, thermal care (including prompt drying and
covering at birth, maximizing skin-to-skin contact, delayed bathing, maintaining “warm chain”) hygiene
practices (including cord-care and caregiver handwashing)
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PURPOSE OF EARLY ESSENTIAL NEWBORN CARE (EENC):

To render the basic needs of normal baby at birth such as:
1. To minimize the risk of illness
2. To maximize their growth and development.
3. To provide warmth
4. To normal breathing
5. To be fed with mother's milk initially
6. To prevent infection
NEWBORN or neonate - usually refers to a baby from birth to about 2 months of age.
INFANTS - can be considered children anywhere from birth to 1 year old.
BABY - can be used to refer to any child from birth to age 4 years old, thus
encompassing newborns, infants, and toddlers.
NEWBORN DURING INTRAPARTAL STAGE:

a. Vital Signs is normal
b. Bleeding of the umbilical cord
c. Intake & Output
d. Color of the cord and amniotic fluid
y2mate.com - Age y2mate.com - y2mate.com -

of Gestation and Estimated Date of DeliveryLeopold
(EDD)_iYt5j_fawh4_240p.mp4 Unang Yakap Training (Essential Ne
Maneuvers_6y7XKFiBpfo_360p.mp4
AOG & EDD computation Leopold’s Maneuver WHO Unang Yakap

(VIDEO) Procedure (video) (Video)
Self-Help: You can also refer to the sources below to help you further understand the lesson:
1. Pillitteri, Adele (2015). Maternal and Child Health Nursing: Care of the Childbearing &
Childbearing Family 6th Edition. Lippincott Williams & Wilkins. Philadelphia.
2. Centers for Disease Control and Prevention. Traveler's health: Vaccines, medicines,
advice. www.cdc.gov/travel/bugs.htm (Accessed on August 29, 2018).
3. Centers for Disease Control and Prevention. Recommendations to prevent and control iron
deficiency in the United States. www.cdc.gov/mmwr/preview/mmwrhtml/00051880.htm
(Accessed on May 07, 2017).
4. Maloni JA. Lack of evidence for prescription of antepartum bed rest. Expert Rev Obstetrics
& Gynecology 2011; 6:385.
5. Biggio JR Jr. Bed rest in pregnancy: time to put the issue to rest. Obstetrics & Gynecology
2013; 121:1158.
6. Tate,Philip.(2012). Seeley’s Principles of Anatomy & Physiology.2nd edition. New York:
Mc. Graw Hill Companies
7. https://www.babycenter.com/calculators-birthplan
8. http://www.nichd.nih.gov/ health/topics/preconception care. cfm
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In a Nurshell!
Activity 1 – DISCUSSION TYPE (Focus on Evidence-Based Practice):
Situation: A Multigravida client 37 years, G5P4 visited for Prenatal visit in a maternal birth center.
She claimed that she’s been smoking and drinking alcohol prior to becoming pregnant. Answer the
following questions in order to be able proper care and understand what are complication for such
problem.
1. Can drinking and smoking affect early pregnancy? Why?

2. During which stage of pregnancy does drinking alcohol put the fetus at least risk?
3. What is the possible complication to the unborn child if the mother smokes or drinks during her
pregnancy?
4. Enumerate and discuss the nursing management applicable when taking care of Smoker’s and
Alcoholic pregnant woman.
Let’s Analyze!
Activity 2: CALCULATION OF EDD / AOG:
Situation:
Client LC, 25 years, a G2P1 was admitted in the labor room. Internal Examination reveals a 2 cms.
Cervical dilation, 40% effaced, station +1, cephalic in presentation. With mild uterine contractions
noted occurring at irregular interval at 30-40 seconds duration. Whitish vaginal show noted small in
amount.
Instructions: Compute for the Estimated Date of Delivery and Age of Gestation
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Let’s Check!
Activity 3: Practice measuring cervical dilatation:
Allow about 20 minutes for this activity. You will need a piece of hard paper or thin card, a ruler,
compass (for drawing circles), pencil and scissors.
1.Make 10 circles on the hard paper, with increasing diameters: 1 cm, 2 cm, 3 cm, etc. up to 10 cm.
2.Leave a wide margin around each circle and cut the card into 10 squares of the same size.
3.Remove the inside of each circle with scissors.
4.Write the diameter of each circle on the card.
5.Choose a circle and place one or both your examining fingers into the hole. Can you get both
fingers into the hole? Then cover your eyes and try to estimate the diameter of the hole in
centimeters.
6.Try to estimate the diameter of each hole with your eyes closed.
7.Then check to see if you are correct. Try this repeatedly.
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Big Picture 4
Week 4: Unit Learning Outcome (ULO): At the end of the unit you are expected to:
1. Apply different knowledge on the Care of both the mother and fetus when exposed to the
Maternal Child Care institution during postpartal period.
2. Give appropriate health teaching to the mother and newborn one discharged from the hospital.
1. Mother
2. Immediate Care of the Newborn
3. Health Education on Post-partum and Newborn Care
4. Discharged Planning
Big Picture in Focus: ULO 4 (Weeks 5-7): C. POST-PARTAL CARE
Metalanguage:
The topic for the 5th-7th week focuses on the discussion of the Post-partum given to the mother after
delivery and during puerperium stage such as monitoring for complications like postpartum bleeding
and hypertension. Early essential immediate care for the newborn is very important to be applied to
prevent further complications such as hypothermia, hypoglycemia and infection of the eyes and
umbilical stump. Health teachings should be instructed to the mother and family to prevent the
complication during postpartum period. ULO 4 will help a student nurse to be well equipped when
exposed in your Related Learning Experience, you will be helping the mother, newborn and family in
the prevention of the occurrence of a preventable side effect during the postpartal period.
To perform the aforesaid big picture (unit learning outcomes) for the fifth to seventh week of the
course, you need to fully understand the following essential knowledge that will be laid down in the
C. POST-PARTAL CARE
The postpartum period, or puerperium, is the 6-week interval from childbirth to the return of the uterus
and other organs to a prepregnant state. An arbitrary time frame divides the period into the immediate
postpartum (first 24 hours), early postpartum (first week), and late postpartum (second to sixth
weeks). Care during this time presents a challenge to nurses. With the short hospital stay, the time
must be well planned to assist in maternal recovery, newborn care, family preparation, and intensive
patient teaching. Many hospitals offer extended postpartum care by home visits, hospital outpatient
clinic visits, and telephone communication to assist the woman and family during the postpartum
recovery period
THE REPRODUCTIVE SYSTEM

• The reproductive system, which includes the uterus, cervix, vagina, and
perineum, undergoes dramatic changes during the 6 weeks after the
birthing experience. Women are at risk for hemorrhage and infection.
Nursing assessments and interventions are aimed at reducing these risks.
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Key Terms:
afterpains
diaphoresis
diastasis recti
diuresis
episiotomy
exfoliation
Homans’ sign
involution
letting-go phase
lochia alba
lochia rubra
lochia serosa
postpartum blues
postpartum fatigue
puerperium
REEDA scale
sitz bath
subinvolution
taking-hold phase
taking-in phase
THE POSTPARTAL PERIOD
1. MOTHER :
UTERUS:
• After delivery of the placenta, the uterus begins the process of involution, by which the uterus
returns to a pre-pregnant size, shape, and location; and the placental site heals. This occurs
through uterine contractions and atrophy of the uterine muscle. Primiparous women usually do not
experience discomfort related to uterine contractions during the postpartum period. Multiparous
women or women who are breastfeeding may experience “afterpains” during the first few
postpartum days. Afterpains are moderate to severe cramp-like pains that are related to the
uterus working harder to remain contracted and/or to the increase of oxytocin that is released in
response to infant suckling. The uterus needs to be in a contracted state during the postpartum
period to decrease the risk of postpartum hemorrhage. The contracted uterine muscle
compresses the open vessels at the placental site and decreases the amount of blood loss.
NURSING ACTIONS:
■ Assess the uterus for location, position, and tone of the fundus.
■ After the third stage of labor, assess the uterus:
■ Every 15 minutes for the first hour
■ Every 30 minutes for the second hour
■ Every 4 hours for the next 22 hours
■ Every shift after the first 24 hours
■ More frequently if the assessment findings are not within normal limits
Before assessment:
■ Inform the woman that you will be palpating her uterus.
■ Explain the procedure.
■ Instruct the woman to void.
■ Provide privacy.
■ Lower the head and foot of the bed so that the woman is in a supine position and flat.
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■ Support the lower uterine segment by placing one hand just above the symphysis pubis
■ Locate the fundus with the other hand using gentle downward pressure.
■ Determine the tone of the fundus: Firm (contracted) or soft (boggy)
■ A boggy uterus indicates that the uterus is not contracting and places the woman at risk
for excessive blood loss.
If the uterus is boggy the nurse should:
1. Massage the fundus with the palm of the hand.

2. Give oxytocin as per the physician’s or midwife’s orders.
3. Notify the physician or midwife if the uterus does not respond to massage.
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Patient education:
■ Teach the woman how to assess the uterus and explain the normal involutional process.
■ Teach the woman how to massage her uterus if boggy and instruct her to notify the nurse while in
the hospital and health care provider after discharge.
■ Provide information regarding “afterpains.”
■ Uterine cramps are caused by the contraction and relaxation of the uterus as it decreases in size.
■ Afterpains occur within the first few days and last 36 hours.
■ They occur more commonly with multiparous women and increase with each additional
pregnancy/birth.
■ The condition may increase when breastfeeding during the first few postpartum days.
■ A distended bladder can increase afterpains.
Comfort measures:
■ Empty bladder
■ Warm blanket to abdomen
■ Analgesia (ibuprofen is commonly used for postpartum discomfort)
■ Relaxation techniques
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■ Provide information on the stages of lochia.
■ Explain that the flow of lochia can increase when getting up in the morning or after sitting for
prolonged periods of time due to vaginal pooling of lochia, or from excessive physical activity.
■ Instruct the woman to notify the nurse, physician, or midwife if she experiences:
■ A sudden increase in the amount of lochia
■ Bright red bleeding after the rubra stage
■ Foul odor
■ Provide information for reducing the risk of infection.
■ Instruct the patient to change the peripad frequently because lochia is a medium for bacterial
growth.
■ Document the stage and amount of lochia and nursing interventions.
■ Sample charting: Scant amount of lochia serosa; teaching provided on stages of lochia
VAGINA AND PERINEUM

■ The vagina and perineum experience changes related to the birthing process ranging from mild
stretching and minor lacerations to major tears and episiotomies.
■ The woman may experience mild to severe pain depending on the degree and type of vaginal
and/or perineal trauma.
■ The primary complication is infection at the lacerations or episiotomy sites.
■ The vagina and perineum undergo healing and restoration during the postpartum period.
Nursing Actions:
■ Assess the perineum every shift using the acronym REEDA (redness, edema, ecchymosis,
discharge, approximation of edges of episiotomy or laceration).
■ Explain the procedure.
■ Provide privacy.
■ Assist the woman to her side.
■ Lower the peripad and separate the buttocks to expose the perineum for assessment.
■ Expected assessment findings:
■ Mild edema
■ Minor ecchymosis
■ Approximation of the edges of the episiotomy or laceration
■ Mild to moderate pain
■ Assess for discomfort.
Provide comfort measures:
■ Apply ice to the perineum for the first 24 hours to decrease edema and provide an anesthetic effect.
■ Encourage the woman to lie on her side to decrease pressure on perineum.
■ Instruct the woman to tighten her gluteal muscles as she sits down and to relax muscles after she is
seated. This helps cushion the perineum and increases comfort when assuming a sitting position.
■ Instruct the woman to wear peripads snugly to prevent rubbing.
■ Instruct the woman to take Sitz baths starting 24 hours after delivery twice a day for 20 minutes to
promote circulation, healing, and comfort.
■ Administer analgesia per the physician’s or midwife’s order.
■ Administer a topical anesthetic per the physician’s or midwife’s order.
■ Reduce the risk for infection.
■ Instruct the woman to use a peribottle with warm water and rinse the perineum after elimination.
■ Instruct the woman to change the peripad frequently due to lochia being a medium for bacterial
growth.
■ Instruct the woman to properly dispose of soiled pads and to wash her hands.
■ Document findings and interventions.
■ Sample charting: Perineum intact with no signs of bruising or edema. Patient reports a 2 on the pain
scale of 0–10. An ice pack is applied to the perineum.
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BREASTS:
During pregnancy, the breasts undergo changes in preparation for lactation. Around the third
postpartum day all women, breastfeeding and non-breastfeeding, experience some degree of primary
breast engorgement. Primary engorgement, which is an increase in the vascular and lymphatic
system of the breasts, precedes the initiation of milk production. The woman’s breasts become larger,
firm, warm, and tender and the woman may feel a throbbing pain in the breasts. Primary engorgement
subsides within 24 to 48 hours. Women who breastfeed experience subsequent breast engorgement
related to distention of milk glands that is relieved by having the baby suckle or by expressing milk.
The primary complication is mastitis, which is an infection of the breast
COLOSTRUM, a clear, yellowish fluid, precedes milk production. It is higher in protein and lower in
carbohydrates than breast milk. It contains immunoglobulins G and A that provides protection for the
newborn during the early weeks of life.
CRITICAL COMPONENT:
Mastitis
Mastitis is an inflammation or infection of the breast. The infection may be due to bacterial entry
through cracks in nipples.
Symptoms: Fever, malaise, unilateral breast pain, and tenderness in the infected area.
Treatment: Antibiotic therapy, analgesia, rest, and hydration.
The woman should continue to breastfeed or pump her breasts as per the physician’s or midwife’s
recommendation.
Nursing Actions for the Breastfeeding Woman:

■ Assess the breasts for engorgement.
■ Inspect the breasts for signs of engorgement: tenderness, firmness, warmth, and/or enlargement.
■ In the first 24 hours postpartum, the breasts are soft and nontender.
■ On postpartum day 2, the breasts are slightly firm and nontender.
■ On postpartum day 3, the breasts are firm, tender, and warm to touch.
■ Assess the nipples for signs of irritation and nipple tissue breakdown.
■ Signs of irritation and tissue breakdown are cracked, blistered, or reddened areas. (See Chapter 16
for interventions to decrease risk of nipple irritation and breakdown.)
■ Assess for mastitis.
■ Inspect the breasts for localized tenderness to touch, increased warmth, and redness.
■ Note signs of increased temperature and feeling of malaise.
■ Report signs and symptoms of mastitis to the physician or midwife.
Patient education
■ Apply heat to the breasts to increase circulation and comfort.
■ Encourage the woman to wear a supportive bra.
■ Instruct the woman to examine nipples before feedings for signs of irritation.
■ Instruct the woman to feed her infant or express milk if she is experiencing breast engorgement.
■ Sample charting: The breasts are soft and nontender. There are no signs of nipple irritation. The
patient is wearing a supportive bra.
Nursing Actions for the Non-breastfeeding Woman:

■ Assess the breasts for primary engorgement.
■ Inspect the breasts for signs of engorgement: Tenderness, firmness, warmth, and/or enlargement.
■ Expected assessment findings
■ During the first 24 hours postpartum, the breasts are soft and nontender.
■ On postpartum day 2, the breasts are slightly firm and nontender.
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■ On postpartum day 3, the breasts are firm and tender.
Patient education:
■ Instruct the woman to wear a supportive bra 24 hours a day until her breasts become soft.
■ Instruct the woman who is experiencing engorgement to:
■ Apply ice to the breasts.
■ Not express milk because this stimulates milk production.
■ Avoid heat to the breast because this can stimulate milk production.
■ Take an analgesic for pain.
■ Inform the woman that breast engorgement will subside within 48 hours.
■ Sample charting: Breasts are soft and nontender. The patient is wearing a supportive bra.
THE CARDIOVASCULAR SYSTEM:

Women have an average blood loss of 400 to 500 mL related to the vaginal birthing experience. This
has a minimal effect on a woman’s system due to pregnancy-induced hypervolemia. There is an
increase
in cardiac output during the first few postpartum hours related to blood that was shunted through the
uteroplacental unit returning to the maternal system. Cardiac output returns to pre-pregnant levels
within 48 hours. White blood cell (WBC) levels may increase to 25,000/mm within a few hours of birth
and returns to normal levels within 7 days.
There is an increased risk of orthostatic hypotension, a sudden drop in the blood pressure when the
woman stands up, which is due to decreased vascular resistance in the pelvis. Most women will
experience an episode of feeling cold and shaking during the first few hours following birth. This
phenomenon is referred to as postpartum chills and is related to vascular instability.
Nursing Actions:
■ Assess pulse and blood pressure:
Expected assessment findings:
■ Pulse and blood pressure within normal ranges
■ Assess for orthostatic hypotension
Expected assessment findings

■ May experience orthostatic hypotension during the first few postpartum days when moving from a
sitting or lying position to a standing position. During first 24 hours postpartum, women need
assistance when ambulating.
CRITICAL COMPONENT:
Orthostatic Hypotension
Women are at risk for orthostatic hypotension during the first postpartum week.
• Explain cause and incidence of orthostatic hypotension.
• Instruct the patient to rise slowly to a standing position.
• Assist the woman when ambulating during the first few hours post birth.
• Assist the woman to a sitting position if she becomes dizzy or faint. Use an ammonia ampule if
the woman faints.
■ Assess for excessive blood loss.
■ An increase in pulse rate may be an indicator of excessive blood loss.
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■ Blood loss within normal ranges; pulse rate normal
■ Hemoglobin and hematocrit within normal ranges.
■ Assess for Homans’ sign each shift.
■ Assess the legs for calf tenderness and sensation of warmth each shift.
■ Negative Homans’ sign
■ No tenderness or sensation of warmth
■ Assess for postpartum chills.
■ Assess temperature.
■ Women who are experiencing chills with temperature within normal ranges should be offered a
warm blanket and reassurance that it is normal.
■ Women who are experiencing chills with elevated temperature need to be evaluated further for
possible infection, and the physician or midwife needs to be notified.
PATIENT EDUCATION:
■ Instruct the woman on ways to reduce risk of orthostatic hypotension.
■ Instruct the woman to take temperature if she experiences chills and report temperature elevations
to her physician or midwife.
■ Document findings and nursing interventions.
■ Sample charting: The patient states that she is cold and shaking. Temperature is 98.6°F (37°C). A
warm blanket is placed over the patient. Teaching is provided regarding postpartum chills.
THE RESPIRATORY SYSTEM:

There is a return of chest wall compliance after the birth of the infant due to reduction of pressure on
the diaphragm. The respiratory system returns to a pre-pregnant state by the end of the postpartum
period.
NURSING ACTIONS:
■ Assess the respiratory rate:
■ Within normal limits
■ Document findings and intervention.
THE IMMUNE SYSTEM:

■ Temperature
■ It is common for the postpartum woman to experience mild temperature elevations during the first
24 hours post-birth related to muscular exertion, exhaustion, dehydration, or hormonal changes.
■ A temperature greater than 100.4°F (38°C) after the first 24 hours on two occasions may be
indicative of postpartum infection and requires further evaluation.
■ Rubella
■ Women who are rubella-nonimmune should be immunized for rubella before discharge.
■ Rh isoimmunization
■ Rh isoimmunization occurs when an Rh-negative woman develops antibodies to Rh-positive blood
related to exposure to Rh positive blood either by blood transfusion or during pregnancy with an Rh-
positive fetus.
■ Women who are sensitized produce IgG anti-D (antibody) which crosses the placenta and attacks
the fetal red blood cells, causing hemolysis.
■ Rh isoimmunization is preventable.
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NURSING ACTIONS:
■ Assess temperature:
■ Temperature elevations less than 100.4°F (38°C) during the first 24 hours post-birth:
■ Hydrate the woman.
■ Promote relaxation and rest.
■ Reassess in 1 hour after interventions.
■ Temperature elevation 100.4°F (38°C) or higher after 24 hours post-birth:
■ Hydrate the woman.
■ Notify the physician or midwife for further evaluation.
■ Administer rubella vaccine as indicated.
■ Administer Rho(D) immune globulin (RhoGAM) as indicated.
THE URINARY SYSTEM:

Bladder distention, incomplete emptying bladder, and inability to void are common during the first few
days post-birth. These are related to a decreased sensation of the urge to void and/or edema around
the urethra. Diuresis, caused by decreased estrogen and oxytocin levels, occurs within 12 hours post-
birth and aids in the elimination of excess tissue fluids. Primary complications are bladder distention
and cystitis.
CRITICAL COMPONENT:
Cystitis: Bladder inflammation/infection.
Symptoms: Frequency, urgency, pain/burning on urination, and malaise

Treatment: Antibiotic therapy, increased hydration, rest.
Nursing Actions:
■ Assess for urinary disturbances.
■ Measure voidings during the first 24 hours post-birth.
■ If voiding is less than 150 mL, the nurse needs to palpate for bladder distention. This may indicate
incomplete emptying of the bladder and the woman may need to be catheterized.
■ If unable to void within 12 hours post-birth the woman may need to be catheterized. A Foley
catheter is recommended when inability to void is related to edema.
■ Assess for frequency, urgency, and burning on urination.
■ Notify the physician or midwife if the patient reports frequency, urgency and/or burning on urination.
These are signs of possible cystitis.
Expected assessment findings:

■ The woman spontaneously voids within 6 to 8 hours post-birth.
■ Each voiding is a minimum of 150 ml.
■ The woman does not experience frequency, urgency, and burning on urination.
■ Assist the woman to the bathroom and encourage her to void within 6 hours post-birth.
■ Early voiding decreases the risk of cystitis.
■ Instruct the woman to increase fluid intake to a minimum of 8 glasses per day.
Document findings and interventions:

■ Sample charting: The patient spontaneously voided 250 ml. The patient states no burning on
urination.
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THE ENDOCRINE SYSTEM:
Abrupt changes occur in the endocrine system after the delivery of the placenta. Estrogen,
progesterone, and prolactin levels decrease. Estrogen levels begin to rise after the first week of
postpartum.
■ Nonlactating women: Prolactin levels continue to decline throughout the first 3 postpartum weeks.
Menses begins 6 to 10 weeks post-birth. The first menses is usually anovulatory. Ovulation usually
occurs by the fourth cycle.
■ Lactating women: Prolactin levels increase in response to the infant’s suckling. Lactation
suppresses menses. Return of menses depends on the length and amount of breastfeeding.
Ovulation is suppressed longer for lactating women than for nonlactating women.
CRITICAL COMPONENT:
Contraception:
All women, nonlactating and lactating, are advised to use a form of contraception when they resume
sexual intercourse as ovulation can precede their first menses. Breastfeeding is not an effective
means of contraception.
Diaphoresis:
Diaphoresis occurs during the first few postpartum weeks in response to the decreased estrogen
levels. This profuse sweating, which often occurs at night, assists the body in excreting the increased
fluid accumulating during pregnancy.
Nursing Actions:
■ Assess for diaphoresis.
■ If present, assess for infection by taking the patient’s temperature.
■ Diaphoresis with temperature within normal ranges
■ Patient education
■ Instruct the patient regarding the cause of diaphoresis.
■ Discuss comfort measures such as wearing cotton nightwear.
■ Instruct the woman to check the temperature and notify the physician or midwife if elevated.
■ Provide information regarding return of menses and ovulation.
■ Encourage the couple to use contraception when they resume sexual intercourse.
■ Sample charting: The patient reports that she is feeling hot and is sweating. The patient’s
temperature is 98.2°F (36.8°C). Patient education is provided on hormonal changes during the
postpartum period.
THE MUSCULAR AND NERVOUS SYSTEMS:

After birth, the abdominal muscles have a reduction in tone and the abdomen appears soft and flabby.
Some women experience a separation of the rectus muscle, which is noted as diastasis recti
abdominis.
This separation becomes less apparent as the body returns to a pre-pregnant state.
■ Women may experience muscular soreness related to the labor and birth experience.
■ Lower body nerve sensation may be diminished for women who have received an epidural during
labor.
■ Delay ambulation until full sensation returns.
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Nursing Actions:
■ Assess for diastasis recti abdominis.
■ The nurse can feel the separation of the rectus muscle when assessing the fundus.
■ Reassure the woman that this is normal and will diminish over time.
■ Assess for muscle tenderness.
■ None to mild muscle soreness
■ Comfort measures for muscle soreness:
■ Ice pack to area for 20 minutes
■ Heat to area
■ Warm shower
■ Analgesia
■ Assess for decreased nerve sensation.
■ Full sensation of lower extremities for women who did not receive an epidural during labor
■ Diminished lower body sensation for women who received an epidural during labor with full
sensation returning within a few hours post-birth
■ Delay ambulation or assist the woman when ambulating until full sensation has returned.
■ Sample charting: The patient ambulates in the room without difficulty.
THE GASTROINTESTINAL SYSTEM:

There is a decrease in gastrointestinal muscle tone and motility post birth with a return to normal
bowel function by the end of the second postpartum week.
■ Constipation
■ Women are at risk for constipation due to:
■ Decreased GI motility
■ Decreased physical activity
■ Dehydration and fluid loss from labor
■ Perineal pain and trauma
■ Hemorrhoids
■ It is common for women to develop hemorrhoids during pregnancy and/or the birthing process.
■ Hemorrhoids will slowly resolve, but can be painful.
■ Appetite
■ Women are hungry after the birthing experience and can be given a regular diet, unless they are on
a prescribed diet such as for diabetes.
■ Women are exceptionally hungry during the first few postpartum days and may require snacks.
■ Weight loss
■ Most women will experience a significant weight loss during the first 2 to 3 weeks postpartum.
■ The average American woman at the end of 6 months postpartum is approximately 3 to 4 pounds
above her pre-pregnancy weight.
Nursing Actions:
■ Assess bowel sounds at each shift.
■ Notify the physician or midwife if bowel sounds are faint or absent.
■ Assess for constipation.
■ Ask the woman if and when she had a bowel movement.
DISCHARGE TEACHING:
Discharge teaching for the woman and her partner focuses on:
■ Signs of complications that need to be reported to the physician or midwife:
■ Excessive lochia indicates possible late postpartum hemorrhage.
■ Foul smelling lochia indicates possible infection
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■ Increased temperature (100.4°F [38°C] or higher) indicates possible infection.
■ Pelvic or abdominal tenderness/pain is possible sign of infection
■ Frequency, urgency, or burning on urination indicates possible cystitis
■ Breast tender, warm, and reddened indicates possible mastitis
■ Health promotion
■ Nutrition and fluids
■ Instruct the woman about nutritional needs for lactating and nonlactating women.
■ Lactating women should increase their caloric intake by 500 calories per day and have a fluid intake
of approximately 2 liters per day.
■ Explain the food pyramid and how this can assist the woman in meeting her nutritional needs.
■ Activity and exercise
■ Explain the importance of activity to decrease risk of constipation and to promote circulation and a
sense of well-being.
■ Instruct the woman about appropriate exercises in the postpartum.
■ Rest and comfort
■ Teach the woman the importance of rest in promoting healing and lactation.
■ Problem solve with the woman ways to increase rest time (e.g., nap when the baby is napping).
■ Encourage the woman to take pain medication as ordered by the physician or midwife.
■ Routine health check-ups
■ Stress the importance of following through with follow-up visits to her physician or midwife.
■ Contraception
■ Assess the couple’s desire for future pregnancies.
■ Assess satisfaction with previous method of contraception.
■ Provide information on various methods of contraception
Medication:
Docusate (Colace)
Indication: Prevention of constipation
Action: Promotes incorporation of water into the stool
Common side effects: Mild abdominal cramps
Route and dose: PO; 100 mg twice a day
Assess for hemorrhoids:

■ Instruct the woman to lie on her side, then separate the buttocks to expose the anus.
■ If hemorrhoids are present:
■ Instruct the woman to increase fluid intake and increase fiber and roughage in diet to decrease risk
of constipation.
■ Encourage the woman to avoid sitting for long periods of time by lying on her side.
■ Instruct the woman to take Sitz baths, which are helpful in promoting circulation and reducing pain.
■ Assess appetite.
■ Assess the amount of food eaten during meals.
■ Ask the woman if she is hungry.
■ Ask the woman if she is nauseous or has vomited.
■ Patient education
■ Instruct the woman to increase fluid intake, and increase fiber and roughage in diet to decrease risk
of constipation.
■ Provide nutritional education. This is especially important for lactating women.
■ Encourage the woman to ambulate to increase GI motility and decrease risk of gas pains.
■ Instruct the woman to increase fluid intake to a minimum of 8 glasses per day.
■ Sample charting: Bowel sounds are present in all quadrants.
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2.A IMMEDIATE CARE OF THE NEWBORN:
PROFILE OF THE NEWBORN

Physiologic functions & appearance
1. APGAR SCORE – VIRGINIA APGAR
• is an assessment of overall newborn well being.

• done after delivery and scores are recorded one to five minute from birth.
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TEMPERATURE REGULATION
• Newborn shift from warm environment to cold and fluctuating temperatures.

• PRESERVING CORE TEMPERATURE - VASOCONSTRICTION - Physiologic mechanism
(decrease blood flow to the skin).
• Occurs "BROWN FAT “- adipose tissue with a high concentration fatty acid - generate
metabolic heat
BASIC TECHNIQUES
• newborns warm
• keeping them dry,
• wrapping them in blankets,
• giving them hats and clothing, or
• increasing the temperature.
ADVANCED TECHNIQUES include
• incubators (at 36.5 °C)
• humidity
• heat shields
• thermal blankets
• double-walled incubators
• radiant warmers
• use of skin-to-skin "kangaroo care" interventions for low birth-weight infants have started
to spread world-wide use as a solution in developing countries.
ASSESSMENT:
ANTHROPOMETRIC MEASUREMENTS
Assessing the Average Newborn
• Length: 46 to54 cm
• Head circumference: 34 to 35 cm
• Chest circumference: 32 to 33 cm
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• Weight: 2.5 to 3.4 kg
Assess also :
• Heart rate: 120 to 140 bpm
• Respirations: 30 to 60 breaths per minute
• Temperature 36.5- 37.5 ᵒC
2.B EARLY ESSENTIAL NEWBORN CARE
DEFINITION :
Newborn Care is defined as the management of the neonate during the transition to extrauterine life
and subsequent period of stabilization.
PURPOSES :
1. To prevent bleeding from the cord.
2. To prevent infection of the cord and eyes.
3. To establish airway patency.
4. To maintain thermoregulation in the newborn’s immature integumentary system to prevent cold
stress leading to hypoglycemia, hypoxia and brain damage.
EQUIPMENTS :
1. OPHTHALMIC ointment ( Crede’s Prophylaxis)
2. 2 DISPOSABLE TUBERCULIN SYRINGE
with gauge 25-27 ½ inch disposable needle
3. VITAMIN K – Injection ampule Phytomenadione)
4. HEPATITIS B VACCINE vial
5. BABY’S layette - blanket, mittens, booties, disposable diaper
6. 1 PAIR WORKING GLOVES
7. DROPLIGHT OR GOOSE NECK LAMP
IMMEDIATE BASIC NEWBORN CARE:

Newborn care Includes:
• Maintenance of temperature
• Establishment of open airway & circulation
• Identification of newborn
• Vitamin K / Hepa B vaccine injection
• Instillation of Crede’s prophylaxis
• Initiation of breastfeeding.
Suction the Airway :

• When babies are born -need to clear the mucous and amniotic fluid from their
lungs.
• Natural mechanisms - fetal chest passes through the birth canal it is compressed,
squeezing fluid out of the lungs prior to the baby taking its' first breath.
• This is noticed most often after the fetal head is delivered but prior to delivery of the
shoulders. After several seconds in this "partly delivered" position, fluid can be seen
streaming out of the baby's nose and mouth.
• After birth, babies cough and sneeze, mobilizing additional fluid that may be in their
lungs.
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• After birth, babies cry loudly/repeatedly - clearing fluid and opening air sacs in the
process.
• Crying is a reassuring event and does not indicate distress.
• Newborn grunting actions may further mobilize fluid, in addition to opening the air sacs
in the lungs.
• Check the Heart beat - over 120 BPM
BATHING OF NEWBORNS
• Initial bath could be given 6 hrs after delivery.

• Given only when already thermoregulated
• Partial bathing could be given if the baby is dirty or with history of infection.
• Thorough drying and keeping the baby warm is done after birth
• BATHING OF NEWBORNS
• Initial bath could be given 6 hrs after delivery.
• Given only when already thermoregulated
• Partial bathing could be given if the baby is dirty or with history of infection.
• Thorough drying and keeping the baby warm is done after birth
Newborn Identification:
• Before a baby leaves the delivery area, identification bracelets with identical numbers are
placed on the baby and mother.
• Babies often have two, on the wrist and ankle.
EYE PROPHYLAXIS:
CREDE’S PROPHYLAXIS :
• Apply / instill on both eyes ( inner canthus)
• Terramycin ophthalmic ointment ( Silver Nitrate drops, Penicillin)
• Watch for perforation of the eyes
• Prevents OPHTHALMIA NEONATORUM
CARE OF UMBILICAL CORD:

• Keep the cord stump clean and dry.
• Daily wiping of the cord with alcohol 70% Isopropyl and leaving it open to the air facilitates
drying and discourages bacterial growth.
• Topical application of antiseptics is usually not necessary unless the baby is living in a highly
contaminated area.
VITAMIN K / HEPA B VACCINE INJECTION:
• Vitamin K (Phytomenadione)
• Prevent neonatal hemorrhage during first few days of life
• Route of administration: Intramuscular Dose:
• Term baby - 1mg (0.1 ml.)
• Preterm baby - 0.5mg.
Hepatitis B vaccine:
• Route of administration:
• Intramuscular Dose: Term baby - 0.5 ml(cc)
• VASTUS LATERALIS site
MAINTENANCE OF TEMPERATURE:
• Immediately dry the infant after birth and place under a radiant warmer or apply skin to skin
contact with the mother
• Keep neonates head covered - bonnet
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• The baby should not be separated from the mother.(roomed-in) skin to skin contact
INITIATION OF BREASTFEEDING:
• Babies can be breast-fed (airway is cleared/ breathing normally)
• DO NOT breast-fed babies with respiratory difficulties until the breathing problems are
resolved.
• Apply “Unang Yakap” program
• COLOSTRUM – first MILK - antibody
BURPING OF NEWBORNS:
-ON YOUR CHEST
-Hold your baby against your chest so her chin is resting on your shoulder.
-Support her head and shoulders with your hand.
-Gently rub or pat her back with your other hand.
SITTING ON YOUR LAP

-Sit your baby on your lap facing away from you.
-Use one arm to support your baby's body, the palm of your hand supporting her chest while
your fingers gently support her chin and jaw. Keep your fingers away from her throat.
-Lean your baby slightly forwards and gently pat or rub her back for a while with your free
hand.
FACE DOWN ACROSS YOUR LAP

-Lie your baby face down on your legs, at a right angle to your body so she's lying across your
knees.
-Support your baby's chin and jaw with one hand.
-Keep your baby's head slightly higher than the rest of her body, so blood doesn't rush to her
head.
-Rub or pat your baby's back gently with the other hand.
- Talk or sing softly to your baby as you gently rub or pat her back. Hearing your voice will help
her to relax.
- If your baby hasn't burped after a couple of minutes, it probably means she doesn't need to.
But if she seems obviously uncomfortable, keep trying, or swap to a different position.
SENSORY STIMULATION OF NEWBORNS:

• Tactile stimulation- touching, rubbing, or massage
• Vestibular stimulation - rocking and positioning
• Auditory stimulation - listening to soft music or a human voice
• Visual stimulation - looking at high-contrast pictures or mobiles.
o The stimulation is usually presented on a regular schedule for specific amounts of time
(e.g., 30 minutes per day for 20 days).
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o The most frequently used stimulations for ill infants kept in an NICU environment are
tactile, vestibular, and auditory.
ELIMINATION OF NEWBORNS:
URINATION
• Urinate - as often every 1-3 hours or as infrequently as 4-6 times a day
• If ill or feverish, weather extremely hot- output of urine may drop by half and still be normal.
• If you notice any signs of distress while your infant is urinating, notify your pediatrician, as this
could be a sign of infection or some other problem in the urinary tract.
• In a healthy child urine is light to dark yellow in color
• The presence of actual blood in the urine or a bloody spot on the diaper is never normal
BOWEL MOVEMENTS
• first day of life and lasting for a few days, your baby will have her first bowel movements,
which are often referred to as MECONIUM ( blackish –greenish)
• Breastfed -light mustard with seed like particles.
• Until starts to eat solid foods -very soft to loose
• Whether your baby is breastfed or bottle-fed, hard or very dry stools may be a sign that she is
not getting enough fluid or that she is losing too much fluid due to illness, fever, or heat.
• Once started solids, hard stools might indicate that she’s eating too many constipating foods,
such as cereal or cow’s milk
THE NORMAL NEWBORN'S PATTERN FOR ELIMINATION:

a. STOOLS
• Meconium consists of black, tarry stools passed after birth, changing to brownish green.
• At the fourth or fifth day, stools change according to the type of feeding.
• Human milk produces watery stools that may sometimes be light green.
• Cow's milk (formula) produces firmer stools than those of infants fed by human milk / 1-3
times a day - yellow but not the bright yellow of breastfed infants
• Document the number of stools and if no stools are passed.
b. VOIDING (urinating)
• 6 or more wet diapers / 24-hour period show that the infant is getting enough fluids.
• The color of the urine should be pale yellow.
• If the infant has not wet in an 8-hour shift -inform physician
CUDDLING OF NEWBORN:
BENEFITS
• early skin-to-skin contact leads to improved -neurodevelopment
▪ -higher IQ
▪ -lower rates of aggression
• Skin-to-skin contact has also been shown to increase breastfeeding success even make
certain medical procedures less painful for infants.
• Discharge planning/ health teachings
• Infant feeding - importance of breastfeeding
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NORMAL NEWBORN BEHAVIOR AND CARE:

• Recognition of early signs of illness - jaundice and dehydration
• Infant safety, including car seat use, safe sleep practices and other measures to decrease risk
of sudden infant death syndrome
• Infection control measures
• Importance of a smoke-free environment
MATERNAL READINESS:
-Mother provides routine infant care, including feeding, in a safe and confident manner
-Mother demonstrates knowledge of how to recognize illness in her infant and when to seek help
-Psychosocial and environmental risk-factors have been assessed, with an appropriate follow-up
plan
INFANT HEALTH:
• Physical examination by health care provider
• Birth weight, length and head circumference measurements obtained
• Normal, stable temperature, heart rate and respiratory rate
• Passed urine
• Passed meconium
• Weight loss <10%; if approaching or >10%, a follow-up plan has been arranged
• Minimum of 2 successful feeds
• Antenatal and perinatal risk factors (e.g., sepsis) have been evaluated
• Maternal serology reviewed
• If circumcision performed, no excessive bleeding at site
1.Pillitteri, Adele (2015). Maternal and Child Health Nursing: Care of the Childbearing & Childbearing
Family 6th Edition. Lippincott Williams & Wilkins. Philadelphia.
2. Silbert-Flagg. (2018). Maternal and Child Health Nursing: Care of the Childbearing and Childrearing
family. 8th Ed. Wolters Kluwer. Philadelphia.
3. Schuling (2017). Women’s Gynecology health. 3rd edition. Jones & Bartlett Learning. Burlington.
4. Johnson, JY. (2014). Study guide for Maternal & Child Health Nursing: Care of the Childbearing
and Childrearing Family. 7th edition. Philadelphia: Wolters Kluwer.
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Let’s Check!
Activity 1 :
Instruction : Define the following terms:
Afterpains :_______________________________________________________________________
Diaphoresis :______________________________________________________________________
Diastasis recti : ____________________________________________________________________
Diuresis : _________________________________________________________________________
Episiotomy : _______________________________________________________________________
Exfoliation : ________________________________________________________________________
Homans’ sign : ______________________________________________________________________
Involution : ________________________________________________________________________
Letting-go phase : ___________________________________________________________________
Lochia alba : _______________________________________________________________________
Lochia rubra : ______________________________________________________________________
Lochia serosa : _____________________________________________________________________
Postpartum blues : __________________________________________________________________
Postpartum fatigue : _________________________________________________________________
Puerperium : _______________________________________________________________________
REEDA scale _______________________________________________________________________
Sitz bath : __________________________________________________________________________
Subinvolution : ______________________________________________________________________
Taking-hold phase : __________________________________________________________________
Taking-in phase : ____________________________________________________________________
Let’s Analyze!
Activity 2 : Essay type

1.Discuss the different changes of women will undergo after delivery of the newborn and during the
puerperium stage.( discuss in 10 sentences):
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
______________________________________________________
2. Enumerate the Early Essential Newborn care given as World Health Organization protocol. ( discuss in
10 sentences):
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
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Big Picture 5
Weeks 8-9: Unit Learning Outcome (ULO): At the end of the unit you are expected to:
V. Discuss and differentiate Growth and Development and the subtopics.
A. Theoretical Approaches to the Growth and Development of Children
B. Nursing Process for Promotion and Normal Growth and Development
1.The Family with an Infant
2.The Family with a Toddler
3.The Family with a Pre-schoolers
4.The Family with a School-Age Child
5.The Family with an Adolescent
a. Assessment
b. Nursing Diagnosis
c. Planning and Intervention
d. Evaluation
e. Documentation
C. Health Promotion and Disease Prevention in Different Stages of
Growth and Development.
Big Picture in Focus: ULO 5: Weeks 8-9 - IV. GROWTH & DEVELOPMENT
Metalanguage:
The topic for the 8th-9thweeks focuses on the discussion of the Growth and Development. Included is
the different theorist that are of great help on this particular topic. The Nursing Process for Promotion
and Normal Growth and Development of families with an Infant up to Adolescent was discussed,
including various health promotion and disease prevention in Different Stages of Growth &
Development. ULO 5 will help nursing student during their exposure to basic education schools in the
nursery, elementary and high school department understanding their behavior and be able to provide
proper guidance and appropriate interventions when dealing with the different stages of the growth
and development.
To perform the aforesaid big picture (unit learning outcomes) for the eighth and ninth week of the
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V. GROWTH AND DEVELOPMENT
GROWTH & DEVELOPMENT:

Definition:
• Growth refers to the quantitative changes in physical size of the body and its parts.(Increase in
HT-cms and WT- kgs.)
• Development refers to behavioral changes and increasing competency in functional abilities
and skills.(maturation) DENVER TEST/MMDST
• Child development theories focus on explaining how children change and grow over the
course of childhood.
• Such theories center on various aspects of development including social, emotional, and
cognitive growth.
• The study of human development is a rich and varied subject.
PRINCIPLES OF GROWTH & DEVELOPMENT

• Growth and development are continuous processes from conception until death. (birth WT
triples/ HT increases 50% on the first year and later in life)
• Growth and development proceed in an orderly sequence. (growth -smaller to larger;
development –predictable order – sit-creep-stand-walk-run)
• Different children pass through the predictable stages at different rates (motor sequence -
different rate – walking start at 9 mos. others 14 mos. old - but both dev. normally)
• All body system does not develop at the same rate (neurologic peaks at 1 yr. old; genital
tissues grows little until puberty)
• G & D occurs in cephalocaudal direction (NB lift head when prone / 2mos.- lift head/chest off
the bed) head to toe
• Development proceeds from proximal to distal body parts. (progress of upper extremity
development, thumb to mouth/arm control –support body WT. –hand to scoop object)
• Development proceeds from gross to refined skills. (control distal parts- finger / fine motor skill
– 3 yrs. color best with big crayon)
• There is an optimum time for initiation of experiences or learning. – unable to sit if back control
not matures)
• Neonatal reflexes must be lost before development can proceed. ( grasp reflex – grasp ; stand
reflex- walk)
• A great skill and behavior is learned by practice. ( infant practice walking over and over)
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Factors Influencing Growth and Development

1. GENETICS INHERITANCE
a. Gender – girls born lighter/shorter than boys; girls during puberty
stage – growth spurt
b. Health - genetic diseases not grow rapidly /unhealthy.
c. Intelligence child with High IQ – don’t grow rapidly physically / but dev. mental
games
2. TEMPERAMENT
- usual reaction pattern of indv.( manner of thinking , behaving , reacting to stimuli in the environment.
a) Approach – response to stimuli
b) Adaptability – ability to change reaction to stimuli
c) Intensity - react to situations (cry loud if wet/hungry/ left by parents)
d) Attention Span – ability to remain interested
e) Threshold of Response – intensity level of stimulation to evoke reaction
f) Mood quality – positive mood / if parent spend more time with parents
3. ENVIRONMENT
a) Socioeconomic level
b) Parent-child relationship
c) Ordinal Position in the Family
d) Health
e) Nutrition
BIOLOGIC GROWTH & DEVELOPMENT

• Changes in general body growth
• Changes results from different rates of growth in different parts of the body during consecutive
stages of development
• Growth rate is slow until growth spurt of puberty
• Average WT gain is 2.5-3.2 kg. per year
• Average HT gain is 5 cm per year
• At 6 years old average HT is 150cm tall and 21 kg WT
• At 12 years old average HT is 150cm tall and 40 kg WT
• Loss of primary teeth begins at about age 6; the lower central incisor is normally the first to be
lost/4 permanent teeth erupt per year.
A. THEORETICAL APPROACHS TO THE GROWTH & DEVELOPMENT OF CHILDREN:
Theorist & Theories

a. Psychosocial Theory
b. Psychosexual Theory
c. Cognitive Theory
d. Morality Theory
e. Interpersonal Theory
f. Development Tasks
THEORIES OF GROWTH & DEVELOPMENT

a. Psychosocial Theory- Erik Erikson
b. Psychosexual Theory – Sigmund Freud (1856-1939) Australian Neurologist
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c. Cognitive Theory – Jean Piaget (1896-1980) Swiss Psychologist
d. Morality Theory – Lawrence Kohlberg (1927-1987) Psychologist
e. Interpersonal Theory -
e. Development Tasks -
SIGMUND FREUD PSYCHOSEXUAL STAGES OF DEVELOPMENT

Psychosexual Personality
Stage Age Attribute
Oral 0-2 ID
Anal 2-4 EGO
Phallic 4-6 SUPEREGO
Latency 6-11+
Genital 12+
JEAN PIAGET - COGNITIVE THEORY
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LAWRENCE KOHLBERG MORALITY THEORY
Developmental / Physiologic Task Theory: ROBERT HAVIGHURST

• Emphasized that learning is basic and that it continues throughout life span. Growth and
Development occurs in six stages.
• When people successfully accomplish the developmental tasks at a stage, they feel pride and
satisfaction.
• They also earn the approval of their community or society. This success provides a sound
foundation that allows these people to accomplish the developmental tasks that they will
encounter.
B. NURSING PROCESS FOR PROMOTION AND NORMAL GROWTH & DEVELOPMENT
Infancy and Early Childhood (0-6 Years of Age)

• Learning to walk
• Learning to take solid foods
• Learning to talk
• Controlling elimination of body wastes
• Learning sex differences
• Forming concepts and learning language to describe social and physical reality
Infancy and Early Childhood (0-6 Years of Age)

• Getting ready to read; Vocabulary of several thousand words
• Learning to distinguish right and wrong and beginning to develop a conscience
Middle Childhood (6-12 Years of Age)

• Learning physical skills necessary for ordinary games
• Building wholesome attitudes toward oneself as a growing organism
• Learning to get along with age mates (recurrent)
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• Learning an appropriate masculine or feminine social role (recurrent)
Middle Childhood (6-12 Years of Age)

• Developing fundamental skills in reading, writing, and math
• Developing concepts necessary for everyday living
• Developing conscience, morality, and a scale of values
• Achieving personal independence from a parental/teacher dependence to dependence on self
• Developing attitudes toward social groups and institutions
Adolescence (12-18 Years of Age)

• Achieving new and more mature relationships with age-mates of both sexes
• Achieving a masculine or feminine social role
• Accepting one’s physique and using the body effectively
• Achieving emotional independence of parents and other adults
Adolescence (12-18 Years of Age)

• Preparing for marriage and family life
• Preparing for an economic career
• Acquiring a set of values and an ethical system as a guide to behavior-developing an ideology
• Desiring and achieving socially responsible behavior
Developmental Tasks Normal Adolescence

• Must adjust to a new physical sense of self
• Must adjust to new intellectual abilities
• Must adjust to increase cognitive demands at school
• Must develop expanded verbal skills
• Must develop a sense of identity
• Must establish adult vocational goals
• Must establish emotional and psychological independence from parents
• Must develop stable and productive peer relationships
• Must learn to manage sexuality
• Must adopt a personal value system
• Must develop increased impulse control and behavioral maturity
1. THE FAMILY WITH AN INFANT:

• The infant period is from 1 month to 12 months
• Children typically double their birth weight at 4 to 6 months and triple it at 1 year.
• Infants develop their first tooth at about 6 months by 12 months, they have six to eight teeth.
IMPORTANT GROSS MOTOR MILESTONES DURING THE INFANT YEAR ARE:
• lifting the chest off a bed at 2 months,
• sitting at 6 to 8 months,
• creeping at 9 months,
• “cruising” at 10 to 11 months, and
• walking at 12 months
IMPORTANT FINE MOTOR ACCOMPLISHMENTS ARE:

• the ability to pass an object from one hand to the other (7 months) and
• a pincer grasp (10 months).
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IMPORTANT MILESTONES OF LANGUAGE DEVELOPMENT:
• During the first year are differentiating a cry (2 months),
• Making simple vowel sounds (5 to 6 months)
• saying two words besides “ma-ma” and “da-da” (12 months).
• The more infants are spoken to, the easier it is for them to acquire language.
PROVIDING INFANTS WITH PROPER TOYS FOR PLAY HELPS DEVELOPMENT:

• All infant toys need to be checked to be certain they are too large to be aspirated.
• Reflexes of Newborns:
IMAGES OF DIFFERENT INFANT REFLEXES:
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POINTS FOR REVIEW:

● Knowledge of growth and development is important in health promotion and illness
prevention because it lays the basis for assessment and anticipatory guidance.
● Genetic factors that influence growth and development are gender, ethnicity, intelligence,
and health.
● Environmental influences include quality of nutrition, socioeconomic level, parent–child
relationship, ordinal position in the family, and environmental health.
● To meet growth and development milestones, children need to follow basic guidelines for a
healthy diet, such as eating a variety of foods; maintaining ideal weight; avoiding extreme
levels of saturated fat and cholesterol; eating foods with adequate starch and fiber; and
avoiding too much sugar, the same as adults.
● Temperament is a child’s characteristic manner of thinking, behaving, or reacting. Helping
parents understand the effect of temperament is a nursing role.
● Common theories of development are Freud’s psychoanalytic theory and Erikson’s theory of
psychosocial development. Both of these theories describe specific tasks children must
complete at each stage of development to become a well-adapted adult.
● Piaget’s theory of cognitive development describes ways that children learn. Kohlberg
advanced a theory of moral development, or how children use moral reasoning to solve
problems they face.
● Although growth and development occur in known patterns, their rate varies from child to
child. Caution parents not to be concerned because two siblings are very different as long as
they both fit within usual parameters.
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2.THE FAMILY WITH A TODDLER:
Basic Guideline for a Healthy Diet of a Toddler:

1. 5 portions of fruit and vegetables/day -strawberries and blueberries (Vit C)
2. Wholegrain cereals – hot/ cold cereal (oatmeal); French toast; waffles; pancakes
3. Protein and dairy foods – egg (aids brain development); milk; cheese; yogurt
4. Portion of oily fish/week
5. Limit fatty and sugary foods
6. Drink enough water to stay hydrated
Physical Development of the Toddler:

Height and Weight
• Genes determine height which influences weight (heredity)
• However, the environment (diet, exercise, health, and even emotions) affect a person’s weight
more than genes
• Because of these factors, toddlers grow at different rates
• Years One and Two
• Body growth begins to slow after the first year
• Babies grow about half as much in height during the second year as compared with the first
year
• Most babies triple their birth weight in a year, then gain only ¼ that amount during the second
• After Year Two
• Growing a slower but steadier rate
• Tend to gain 2-3 inches and about 6 pounds per year throughout childhood (1 pound
(lb)=0.45359237 kilograms (kg))
• This rate of growth continues for girls until age 11 and 13 for boys.
Other Body Changes
• At 24 months, the head is ¼ of the total height
• The child’s body-build type will become visible during the toddler years.
Bones and Teeth
• Bones are becoming harder
• The degree of born formation is not the same throughout the body
• Due to the cartilage, the toddler’s bones are more flexible and less likely to break than
an adult’s.
• However, the softer bones are more prone to disease or deformation
• Shortly after 2 years, a child has the full set of deciduous teeth (baby teeth!!☺).
• The Brain
• The brain is closer to maturity than any other organ.
• The other body organs continue to mature, but they do so at a slower rate than the brain.
• This is an example of the head-to-foot principle– development is completed from the
brain down the spine!
Fat and Muscle Tissue
• Fat deposits under the skin decrease rapidly between 9 and 30 months.
• The chubby baby becomes a slender child!
• Muscle development (the lengthening and thickening of muscles) is slow during the toddler
stage.
• Motor Development
• Large-Muscle Development
• Refers to the development of the trunk, arm and leg muscles
• The following movements depend mainly on the large muscles:
• Crawling
• Walking
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• Jumping
• Running
Walking
• Begins within two to three months before or after first birthday
• Girls tend to walk before boys
• Babies learn to walk in their own time and way. To do so, they need:
• Warm adult support
• Positive reaction to attempts
• Safe Area
• Pushing a baby to walk early… will not help!
• Walking at Two Years
• A child’s walk may look like a run, but it is not a run
• Toddlers take about 170 steps a minute
• Walking at Two Years
• Toddlers rarely go around small obstacles on the floor such as a toy or book, they simply walk
over it= which increases their chances of falling
• Toddlers must watch their foot placement while walking (They must watch every step the
same way you would if you were walking on stones)
• Being distracted is another reason toddlers fall
Running
• Begins around age 2
• Toddlers can not start or stop quickly
• Jumping
• Stepping off low objects about 18 months is the way children learn to jump!
• At two years, children can jump off low objects with two feet
Climbing
• Begin climbing as soon as they can crawl or creep
• Between 15 and 18 months, babies will climb onto furniture
• They will walk up and down stairs with help
• Going up stairs is easier for them than going down
• Toddlers do not change feet while climbing until after their second birthday
• A courageous baby is more likely to try climbing than a timid baby
• A toddler’s environment also encourages or discourage climbing
Throwing and Catching
• Infants begin throwing by accident because they forget to hold onto an object while swinging
their arms
• They enjoy seeing the object move and hearing the sound it makes when it lands
• Then, babies start to throw on purpose
• Planned throwing begins around age 1
• Children under age 3 are not skillful throwers
• When they “catch” an object, they squat and pick it up, until about age 2
Small-Muscle Development
• Refers to the development of small muscles, especially those in the hands and fingers
• The movements that depend on these muscles are called fine-motor skills. Fine motor skills
depend upon a child’s level of eye-hand coordination!
• Eye-hand coordination = the ability to coordinate what a person sees with the way the person
moves his or her hand
• By the end of the first year, babies can hold objects between the thumb and index finger
• Between 12 and 18 months, toddlers can hold spoons in their firsts.
• They can feed themselves and drink from cups
• By 15 months, they can fill and empty containers
• They can also make marks on paper by holding a pencil or crayon in their fists
• They can also:
• Remove a hat and socks
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• Insert rather large objects into holes
• Turn pages of a book (several at a time)
• Begin to fit objects together
• Build a tower of two to three soft blocks
• Between 18 months and 2 years, fine motor skills improve even more!
They can:
• String large beads on cords
• They can turn the pages of books one at a time
• They can open doors by turning knobs
• They can hit pegs with a hammer
• By age 2, most show a definite hand preference
• 95% of all children are right-handed and use their right hand for most activities
Foods that toddlers should avoid:
• Avoid foods that may cause choking:
• Slippery foods - whole grapes
• Large pieces of meats, poultry, and hot dogs
• Candy and cough drops
• Small, hard foods -nuts, seeds, popcorn, chips, pretzels, raw carrots, and
raisins
• Sticky foods -peanut butter and marshmallows
Ways to Encourage Motor or Physical Development:
• Let your baby turn the pages of a book when you read with him/her.
• Provide toys with moving parts that stay attached.
• Play games and sing songs with movements that your child can imitate.
• Development table: 18 months to 2 years
COGNITIVE
• Development table: 18 months to 2 years
• The Family with a Toddler:
• Erikson’s developmental task for the toddler period is to form a sense of Autonomy or
Independence versus Shame or Doubt.
● Toddlers make great strides forward in development, but their physical growth slows.
● A critical milestone of toddler development is being able to form two-word sentences (a noun and a
verb) by 2 years of age.
● Toddlers are capable of preoperational thought or are able to deal much more constructively with
symbols than they could while infants.
● Important aspects of care are promoting toddler safety, including screening for lead poisoning;
promoting toddler development, such as promoting daily activities; and healthy family functioning.
● Toddler appetites decrease from those of the infant, so children eat proportionally less than they did
as infants.
● Common concerns of parents during the toddler period are toilet training, ritualistic behavior,
negativism, temper tantrums, discipline, and separation anxiety.
● Promoting autonomy in the child who is physically challenged or chronically ill calls for creative
planning, because there may be many tasks that must be done for the
child to be certain they are done safely.
PROMOTING SAFETY TO TODDLER:
Poisoning - curious about everything!

• Keep all medicines (and vitamins as well) out of the reach of children.
• Never refer to medicine as "candy."
• Store all cleaning products or other dangerous products out of the reach of children and/or in a
locked cabinet.
Burns - Little fingers want to touch everything
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• Keep your child in a safe place while you are cooking or ironing.
• Turn pot/pan handles inward on the stove.
• Never allow children to be unsupervised in the kitchen.
• Keep items such as matches, lighters, curling irons, candles, and hot foods and liquids out of a
child's reach.
Falls - still a little unsteady on their feet, or because they are enjoying the thrill of climbing.
• Keep doorways leading to dangerous areas, such as basements or attics, locked.
• Keep safety gates at the top and bottom of each stairway.
• Keep window guards on all windows.
• Put skid-proof pads underneath all rugs.
• When grocery shopping, use the safety strap to buckle your child into the seat, and remain
close to the cart at all times.
• Keep a close eye on your child when they are climbing on furniture or at the playground so
you can react quickly in case of a fall.
Choking- foods and non-foods - go into their mouths.
• Until age 4 avoid foods that can block the airways -peanut butter, hot dogs, popcorn, whole
grapes, raw carrots, raisins, nuts, hard candies or toffees, and chewing gum.
• Provide safe finger foods such as bananas, well-cooked pasta and vegetables, o-shaped low-
sugar cereals.
• Keep items such as coins, buttons, balloons, safety pins and rocks out of your child's reach.
• Follow age recommendations on toys –no to small parts and make sure toys are in good
repair.
• Be vigilant. Small children put many things in their mouths. A watchful adult is often the best
defense.
TODDLERS:
Children should be able to:
• Ride a tricycle –( running , jumping, throwing , etc …. gross- motor skills )
• Use safety scissors – (stringing beads, drawing,etc …. Fine-motor skills)
• Notice a difference between girls and boys
• Help to dress and undress themselves
• Play with other children
• Recall part of a story
• Sing a song
• As preschoolers' bodies develop over time, areas in their brains that control movement
continue to mature.
• The Family with Preschoolers:
• Preschoolers (3-5 years of age)
• Developmental Milestones
• Skills such as naming colors,
• showing affection, and
• hopping on one foot
• Children reach milestones in how they play, learn, speak, behave, and move (like crawling,
walking, or jumping).
• Become more independent ; begin to focus more on adults and children outside of the family.
3.THE FAMILY WITH A PRE-SCHOOLER:
Things a parent can do to help their Preschooler:

• Continue to read to your child-love for books by taking her to the library or bookstore.
• Let your child help with simple chores.
• Encourage your child to play with other children -value of sharing and friendship.
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• Be clear and consistent when disciplining your child. Explain and show the behavior that you
expect from her. Whenever you tell her no, follow up with what he should be doing instead.
• Help your child develop good language skills - speaking to him in complete sentences and
using “grown up” words.
• Help your child through the steps to solve problems when she is upset.
• Give your child a limited number of simple choices- deciding what to wear, when to play, and
what to eat for snack).
Child Safety First
• Tell your child why it is important to stay out of traffic; not to play in the street or run after stray
balls.
• Be cautious when letting your child ride her tricycle; stay on the sidewalk; away from the street
; always wear a helmet.
• Check outdoor playground equipment. Make sure there are no loose parts or sharp edges.
• Watch your child at all times, especially when he is playing outside.
• Be safe in the water. Teach your child to swim, but watch her at all times when she is in or
around any body of water (this includes kiddie pools).
• Teach your child how to be safe around strangers.
• Keep your child in a forward-facing car seat with a harness until he reaches the top height or
weight limit allowed by the car seat’s manufacturer.
Preschooler Healthy Bodies include:

• Eat meals with your child whenever possible -fruits, vegetables, and whole grains at meals
and snacks; drink only a limited amount of added sugars, solid fats, or salt.
• Keep television sets out of your child’s bedroom. Set limits for screen time for your child to no
more than 1 hour per day
• Provide your child with age-appropriate play equipment - balls and plastic bats, but let them
choose what to play -moving and being active is fun for preschooler.
• Make sure your child gets the recommended amount of sleep each night: 10–13 hours per 24
hours (including naps)
• Preschoolers have a number of universal fears, including fear of the dark, mutilation, and
abandonment.
• Appetite is not large in this age group because this is not a rapid growth time. Preschoolers
can be interested in helping with food preparation.
• Common parental concerns during the preschool period are broken fluency, imaginary friends,
difficulty sharing, and sibling rivalry.
• Preschool is often the time when a new sibling is born. Good preparation for this is necessary
to prevent intense sibling rivalry.
• Preschoolers are self-centered (egocentric).
KEY FOR REVIEW:
● Although preschoolers grow only slightly and gain just a little weight, they seem much taller than
when they were toddlers because their contour changes to more childlike proportions.
● Erikson’s developmental task for the preschool period is to gain a sense of initiative or learn how
to do things. Play materials ideal for this age group are those that stimulate creativity, such as
modeling clay or colored markers.
● Promoting childhood safety is a major role because preschoolers’ active imaginations can lead
them into dangerous situations.
● Appetite is not large in this age group because this is not a rapid growth time. Preschoolers can be
interested in helping with food preparation.
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● Common parental concerns during the preschool period are broken fluency, imaginary friends,
difficulty sharing, and sibling rivalry.
● Preschool is often the time when a new sibling is born. Good preparation for this is necessary to
prevent intense sibling rivalry.
● Preschoolers have a number of universal fears, including fear of the dark, mutilation, and
abandonment. All care provided for this age group should include active measures to reduce these
fears as much as possible.
● Preschoolers are still operating at a cognitive level that prevents them from understanding
conservation (objects have not changed substance although they have changed appearance). This
means they need an explanation, for example, of how they will be the same person postoperatively as
they were preoperatively.
● Preschoolers are self-centered (egocentric). This makes it difficult for them to share and view
someone else’s side of a problem. They need good explanations of how a procedure will benefit them
before they can agree to it.
● Many preschoolers begin preschool programs or child care. Late in the preschool period, they may
be enrolled in kindergarten. Parents often appreciate guidance on how to prepare their children for
these new experiences.
● Preschoolers who are physically challenged or who have chronic illnesses may have difficulty
achieving a sense of initiative, because they may be limited in their ability to participate in activities
that stimulate initiative. They may need special playtimes set aside for stimulation and learning.
4.THE FAMILY WITH A SCHOOL AGE CHILD:

Body Growth
• Slow, regular pattern
• Girls often grow faster than boys
• Lower portion of body growing fastest
• Bones lengthen
• Muscles very flexible
• All permanent teeth erupted
• Auditory perception is fully developed
• Sense of touch -fully developed
• Prepuberty changes
Fine Motor Skills

• Writing skills improved
• Fine motor is refined
• Fine motor with more focus
• Building: models – legos
• Sewing
• Musical instrument
• Painting
• Typing skills
• Technology: computers
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Gross Motor Skills
• 8 to 10 years: team sports
Age Ten: match sports to the physical and emotional development
• Preoperational to concrete operations (Piaget)- focus to 1 problem only / arithmetic concept

(minus and plus)
• Latency (Freud)- no psychosexual development – focus on school work, hobbies and friends.
• Industry vs. Inferiority (Erikson)- self skills vs lack of confidence
Erikson’s Theory: Industry versus Inferiority:

Industry
• Developing a sense of competence at useful skills.
• School provides many opportunities.
Inferiority
• Pessimism and lack of confidence in own ability to do things well.
• Family environment, teachers, peers, can contribute to negative feelings.
Changes in Self-Understanding during Middle Childhood

• Self-Concept- belief about himself or herself, including the person's attributes and who and what the self is.
• Self-Esteem - confidence in one's own worth or abilities; self-respect.

1. Inflated self-esteem -think they are better than others and have no doubts about
underestimating everyone else.
2. High self-esteem. People with this type of self-esteem accept and value themselves.
3. Low self-esteem
Influences on Self-Esteem:
• Culture
• Child-rearing Practices
• Messages from adults
• Attributions- your success might be hard work and the support of family and friends.
✓ Mastery-oriented
✓ Learned Helplessness
Nursing Implications & Wellness Promotion

• Health education focus –
a. Communication in school, families and communities ( healthy eating and activities )
b. Involve families and community members in school health council
• Healthy lifestyle Habits –
a. Eating balance diet; regular exercise (parent factor)
b. Be active by playing together.
c. Make family mealtimes a special time together.
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d. Eat breakfast
e. Don't forbid foods or use food as a reward.
f. Dine out responsibly.
g. Enjoy a rainbow of fruits and vegetables.
h. Encourage mindful eating.
i. Choose healthful beverages.
• Regular Dental Checkups
• Safety-
a. CPR & first aid
b. Home & pet
c. Outdoor
d. Water
e. Burn, scald & fire
f. Choking
g. Poison
h. On line safety – net safety / porno
i. Car & pedestrian
j. Child sexual abuse
• Nutrition-
a. Vegetables. 3-5 servings per day.
b. Fruits. 2-4 servings per day.
c. Whole Grains. 6-11 servings per day.
d. Protein. 2-3 servings of 2-3 ounces of cooked lean meat, poultry, or fish per day. ...
e. Dairy products. 2-3 servings (cups) per day of low-fat milk or yogurt, or natural cheese (1.5 ounces=one
serving).
f. Zinc.
g. Water.
h. Healthy fat.
• Elimination –
a. Encopresis – constipation
b. Enuresis – bladder control problem
• Rest & Sleep-
a. School-age children get from 9 to 11 hours of sleep each night.
• Activity & Exercise-
a. walking to school, riding bikes or scooters
b. playing outside in your backyard or local park
• Sexuality-
a. Sexual behavior is a mostly typical and healthy part of your child's development.
b. School-age children might touch their genitals, want privacy, and talk with other children about sex.
c. Your approach to school-age sexual behavior depends on your values.
d. Parents staying calm is very important.
• Social Interactions-
a. Early social interaction is particularly beneficial for child development
b. Right environment can help develop strong language skills, creativity, empathy, communication and
confidence.
• Cognitive Stimulation-
a. Play games together, like board games, simple crosswords, word-finders and card games – for
example, 'Go fish', 'Snap' or 'I spy'.
b. Provide puzzles and encourage your child to work on them independently.
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5.THE FAMILY WITH AN ADOLESCENT
This is the transition from childhood to adulthood

ADOLESCENCE
➢ The time for formulating a sense of personal identity
➢ The time for gaining emancipation from the family unit
➢ The time for driving moms and/or dads out of their minds
ADOLESCENCE
➢ The age of adolescence is generally regarded as 12 - 20 years (this is very flexible)
➢ Some persons continue to function as adolescents well into the 20’s or more
PUBERTY
➢ This is the beginning of the transition from childhood to adulthood
➢ The term puberty is restricted to PHYSIOLOGIC phenomena
➢ Notice the difference between the definition of adolescence and puberty
➢ Puberty is a stage of adolescence
TRUE PUBERTY
➢ This the point at which reproduction is possible
➢ Reproductive capabilities are internal phenomena
➢ True puberty, therefore, is not noticeable externally
HORMONAL CHANGES IN PUBERTY
➢ Growth Hormone and Thryoxine – increase around age 8 – 9
Estrogens
➢ More in girls
➢ Adrenal estrogens
Androgens
➢ More in boys
➢ Testosterone
SEXUAL MATURATION:
Primary Sexual Characteristics
➢ Maturation of the reproductive organs
➢ Girls: menarche
➢ Boys: spermarche
Secondary Sexual Characteristics
➢ Other visible parts of the body that signal sexual maturity
➢ Girls: breasts
➢ Boys: facial hair, voice change
➢ Both: underarm hair
ERIKSON’S THEORY : IDENTITY VS ROLE CONFUSION

Identity
➢ Defining who you are, what you value and direction in life.
➢ Commitments to vocation, personal relationships, sexual orientation, ethnic group, ideals.
Identity Confusion
➢ Lack of direction and definition of self.
➢ Restricted exploration in adolescence
➢ Earlier psychosocial conflicts not resolved
➢ Society restricts choices
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➢ Unprepared for stages of adulthood
FACTORS THAT AFFECT IDENTITY DEVELOPMENT

➢ Child-rearing practices
➢ Authoritative, attached
➢ Peers, friends
➢ Schools
➢ Communities
PARENT-CHILD RELATIONSHIPS IN ADOLESCENCE
Autonomy
➢ De-idealize parents
➢ Shift from parents to selves and peers for guidance
Authoritative Parenting
➢ Balances autonomy with monitoring as needed
➢ Extra challenging during adolescence
FRIENDSHIPS IN ADOLESCENCE
➢ Fewer “best friends”
➢ More intimacy, loyalty
➢ Closeness, trust,
➢ Self-disclosure - get to know friend’s personality
➢ Friends are similar or get more similar
➢ Identity status, aspirations, politics, deviant behavior
➢ Gender differences
➢ Girls – emotional closeness
➢ Boys – activities, status
BENEFITS OF ADOLESCENT FRIENDSHIPS

➢ Opportunities to explore self
➢ Form deep understanding of another
➢ Foundation for Afuture intimate relationships
➢ Help deal with life stress
➢ Can improve attitude and school involvement
PEER COMFORMITY:
Pressures to conform to:

➢ Dress, grooming, social activities
➢ Pro adult behavior
➢ Misconduct
➢ Rises in early adolescence, but low overall
➢ More conformity in early adolescence
➢ Authoritative parenting helps resist pressures
Cognitive Development
Formal operations (ages 12-15)
➢ Child develops capacity to
make free use of hypothetical
reasoning
➢ Learns to attack problems from
the angle of all possible combinations
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of relations
➢ Can systematically isolate variables
➢ Become INTROSPECTIVE
Criteria indicating the presence of formal
operations include:
➢ Ability to manipulate two or more variables at once
➢ Must be able to demonstrate changes that come with time
➢ Ability to hypothesize about the logical consequences of events
Formal operations (continued)
➢ Ability to foresee the consequences of his or her actions
➢ Must be able to detect the logical consistency within a statement
➢ Must think realistically about self, others, and their world
➢ Must be able to think without egocentrism (thinks about the whole and not the self)
GENDER DIFFERENCES
Menarche
➢ The first menstrual period
➢ This event separates the prepubertal from the postpubertal girl
Nocturnal Emissions
➢ This is a guy thing
➢ More arbitrary
➢ This is the division between prepubertal and postpubertal boys
REPRODUCTIVE MATURITY
Gametogenesis is usually delayed for one to two years after external phenomena are exhibited.
GENERALITIES OF CHANGES IN ADOLESCENCE

➢ Rapid growth (early in adolescence)
➢ Confused by changes
➢ Curious about final outcome
➢ Personal interest in their own development
➢ Measure my height!
➢ I need a new bra!
Puberty - Early Adolescence
➢ Rebellion against home
➢ Vacillation between considerable maturity and babyishness
➢ Absorption with close friend of same age and sex
➢ Moodiness
➢ Establishment of independence of self: “Who am I?” “ What kind of person am I?”
➢ Rapid growth
➢ Body-conscious
➢ Appearance of sexual maturity
➢ Skin problems
➢ Constantly hungry (more than during young years)
➢ Companionship at meals and at after-school snacks provides dining pleasure
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➢ Sleeps more than during younger years
➢ Sleepy at “getting up” times
➢ Wants to sit up at night as sign of increasing maturity
➢ Clash between physiology and culture
Special Characteristics of Boys
➢ Boisterous
➢ Clumsy
➢ Secretive, “clams up at home.”
➢ Aggressive
➢ Dirty - Can’t seem to get the kid near the bathroom
Special characteristics of boys
➢ Boys in puberty gain more weight and height than girls
➢ Much talk about sex and girls
➢ Out of house more and more
➢ Much talk about sex and girls
➢ Out of house more and more
➢ More talk about sex and girls

Special Characteristics of Girls
➢ Vague and diffuse
➢ Crush on older men
➢ Interested in romantic love
➢ Playacting
➢ Talkative, but not communicative
➢ Giggly!!
Early Adolescence
➢ Boys express their sexuality through masturbation
➢ Same-gender sexual encounters are relatively common
➢ These occur frequently enough to be considered as a variant of normal sexual development
Early Adolescence
➢ Questions that adolescents have about erotic feelings or behaviors toward the same sex need
to be addressed directly and fully explored
➢ NOT HELPFUL: Tell the adolescent that this is no more than a passing stage of development
Middle Adolescence
➢ Often the greatest experimental, risk-taking time
➢ Drinking, drugs, smoking, and sexual experimentation are often of the highest interest to those
between 12 and 16 years
➢ This is when first intercourse, first drink, or first pregnancy occur
➢ Adolescents in this phase of development often have little concept of cause and effect
➢ Omnipotence and invulnerability are the rule
➢ This results in an inability to link drinking with auto accidents - drinking with pregnancy or
STD’s
➢ Sexual development results in unpredictable surges in sexual drive
➢ This is accompanied by unavoidable sexual fantasies and impulses
➢ Sexuality is the MAJOR preoccupation of the middle adolescent
➢ Sexual activity occurs more frequently among boys than girls. Possibly because:
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➢ Females less likely to discover sexual responses spontaneously because their sexual organs
are less prominent and less subject to manipulation
➢ Testosterone increases are found in both boys and girls but much more abundant in boys
➢ High testosterone found in males may result in greater sexual aggressiveness and more
purely physical drives and gratifications
➢ Girls tend to view sexual gratification as secondary to fulfillment of other needs such as love,
affection, self-esteem, and reassurance
➢ Girls, thus, are less likely to abstain from sex in a relationship
Motivation to participate in sexual
activity can arise for two reasons:
➢ To gratify true sexual impulses
➢ To gratify nonsexual needs (achieve sense of closeness to someone, bolster self-esteem, to
consolidate gender identity, or to act out against authority
Late Adolescence -
Both Sexes
➢ Rebellious
➢ Concerned with personal appearance (can’t get them out of the bathroom)
➢ Moody
➢ Interest in opposite sex
Late Adolescence - Both Sexes
➢ Establishment of ego identity - “Where do I fit into the world?”
➢ Ambiguity of society toward adolescent helps to compound the problem
➢ Growth finally subsided
➢ Full stature almost attained
➢ Sleep requirements approaching adult level
➢ Food requirements approaching adult level
➢ Companionship when eating
➢ Intimate relation with buddy fades
➢ Greater interest with opposite sex
➢ Needs acceptance by society, in job, and in college
➢ Needs parental respect for opinion and acceptance of maturity
➢ The big question: “Who am I as a vocational being?”
➢ Work opportunities during the late adolescent years allow exploration of tentative career
choices
➢ A choice of a vocation reinforces the adolescent’s self-concept and is important to identity
formation
➢ Factors influencing vocational choice:
➢ Family values
➢ Social class
➢ Socioeconomic conditions
➢ Need for prestige
➢ Volitional independence
➢ Special abilities
➢ Motivation
Vocational indecision commonly caused by:
➢ Family influence: Dad’s a doctor and I want to be a rock star
➢ The individual’s interests: This is when the adolescent is talented and/or interested in more
than one area, thus, what should that person chose as a vocation
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Special Characteristics of Boys in Late Adolescence
➢ Sexual problems prominent and demanding
➢ Interest in plans for career
➢ Less interested than girls in mate seeking
Special Characteristics of Girls in Late Adolescence

➢ Interest in boys, now directed toward mate seeking
➢ Absorbed in fantasies of romantic love
➢ Less interested than boys in plans for career
➢ Sexual problems less demanding than in boys
Negative Identities
➢ These are non-optimal adjustments to the stressors of adolescence
➢ These are adjustments which delay the growth process, at least temporarily
Social Enslavement
➢ The identity of the person is too closely enmeshed with the total group
➢ Person conforms compulsively to the groups expectations
Negative Identity
Social Isolation
➢ Person changes schools and gets the immediate feeling that he or she must have leprosy
➢ No one is noticing this boy or girl
Negative Identity
Overidentification
➢ Take on many traits of other person
➢ May take on many of parents traits
➢ Delays the adolescent’s resolution of his or her own identity crisis
Identity confusion
➢ There seems to be no meeting of the past and the future
➢ Kids in conflict with everyone
➢ Do crazy things (girl dating 45 year old man)
Communication Barriers
➢ Adolescents often distrust adults and authority figures
➢ They question whether adults actually listen to them or understand their feelings and
behaviors
➢ Often won’t talk for fear of revealing their vulnerabilities
➢ Adolescents are typically fearful of adults asking questions
➢ Privacy is a great issue with adolescents
➢ Adolescents want to be treated as young adults - with respect and trusted
➢ Most adolescents fear parental involvement as they fear punitive consequences
C. HEALTH PROMOTION
Health Maintenance
➢ Routine health assessment, laboratory screening & periodic dental exam
➢ Immunization
Safety
➢ Accidents
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➢ Homicides
➢ Suicides
➢ Substance Abuse
DEPRESSION IN ADOLESCENCE
➢ Most common psychological problem of adolescence – 15–20%
➢ Twice as many girls as boys
➢ Early-maturing girls
➢ Factors influencing depression:
➢ Genetics
➢ Child-rearing practices
➢ Learned helplessness
ADOLESCENT SUICIDE
➢ A leading cause of youth death
➢ 4-5 times as many boys as girls
➢ Girls more attempts
➢ Greatest risk: males, gay, lesbian, bisexual
➢ Highly intelligent & socially withdrawn, or antisocial youth at risk
TWO ROUTES TO ADOLESCENT DELINGQUENCY:

➢ Early-Onset – behavior begins in middle childhood
➢ Biological risk factors and child-rearing practices combine
➢ Late-Onset – behavior begins around puberty
➢ Peer influences
NUTRITION IN ADOLESCENCE:
➢ Calorie needs increase
➢ Poor food choices common
➢ Less fruits, vegetables, milk, breakfasta
➢ More soda, fast food
➢ Iron, vitamin deficiencies
➢ Eating Disorders
➢ Anorexia nervosa
➢ Bulimia nervosa
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SLEEP HABITS IN ADOLESCENCE:

➢ Sleep needs decline
➢ 10 hours in middle childhood
➢ 7.5 – 8 hours in adolescence
➢ Go to bed later
➢ Biological changes
➢ Social habits
➢ Daytime sleepiness
➢ Achievement, mood problems
➢ More sleep disruption
Activity & Exercise

➢ Active in sports activities
Sexual Activity in Adolescence:

➢ Sex education
➢ STD (changing sexual morals, sense of invulnerability, increase number in sexual partners)
➢ Birth control & pregnancy
➢ Substantial percentage sexually active

➢ Males start earlier than females
➢ Few partners
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1.Pillitteri, Adele (2015). Maternal and Child Health Nursing: Care of the Childbearing & Childbearing Family
6th Edition. Lippincott Williams & Wilkins. Philadelphia.
2. Silbert-Flagg. (2018). Maternal and Child Health Nursing: Care of the Childbearing and Childrearing family.
8th Ed. Wolters Kluwer. Philadelphia.
4. Johnson, JY. (2014). Study guide for Maternal & Child Health Nursing: Care of the Childbearing and
Childrearing Family. 7th edition. Philadelphia: Wolters Kluwer.
Let’s Check!
Activity 1 – Quiz 1 (Multiple Choice Question)

Instruction: Read the following questions carefully. Select only the correct answer for each question. Select the
letter of the correct answer.
1. The nurse is aware that the age at which the posterior fontanelle closes is _____ months.
a. 2 to 3
b. 3 to 6
c. 6 to 9
d. 9 to 12
2. Which stage of development is most unstable and challenging regarding development of personal identity?
a. Adolescence
b. Toddler hood
c. Childhood
d. Infancy
3. A maternity nurse is providing instruction to a new mother regarding the psychosocial development of the
newborn infant. Using Erikson's psychosocial development theory, the nurse would instruct the mother to:
a. Allow the newborn infant to signal a need
b. Anticipate all of the needs of the newborn infant
c. Avoid the newborn infant during the first 10 minutes of crying
d. Attend to the newborn infant immediately when crying
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4. A mother of a 3-year-old tells a clinic nurse that the child is rebelling constantly and having temper
tantrums. The nurse most appropriately tells the mother to:
a. Punish the child every time the child says "no", to change the behavior
b. Allow the behavior because this is normal at this age period
c. Set limits on the child's behavior
d. Ignore the child when this behavior occurs
5. A nurse is evaluating the developmental level of a 2-year-old. Which of the following does the nurse expect
to observe in this child?
a. Uses a fork to eat
b. Uses a cup to drink
c. Uses a knife for cutting food
d. Pours own milk into a cup
6. A clinic nurse assesses the communication patterns of a 5-month-old infant. The nurse determines that the
infant is demonstrating the highest level of developmental achievement expected if the infant:
a. Uses simple words such as "mama"
b. Uses monosyllabic babbling
c. Links syllables together
d. Coos when comforted
7. A nurse is preparing to care for a 5-year-old who has been placed in traction following a fracture of the
femur. The nurse plans care, knowing that which of the following is the most appropriate activity for this child?
a. Large picture books
b. A radio
c. Crayons and coloring book
d. A sports video
8. A 16-year-old is admitted to the hospital for acute appendicitis, and an appendectomy is performed. Which
of the following nursing interventions is most appropriate to facilitate normal growth and development?
a. Allow the family to bring in the child's favorite computer games
b. Encourage the parents to room-in with the child
c. Encourage the child to rest and read
d. Allow the child to participate in activities with other individuals in the same age group when the
condition permits
9. The mother of a toddler asks a nurse when it is safe to place the car safety seat in a face-forward position.
The best nursing response is which of the following?
a. When the toddler weighs 20 lbs
b. The seat should not be placed in a face-forward position unless there are safety locks in the car
c. The seat should never be place in a face-forward position because the risk of the child unbuckling
the harness
d. When the weight of the toddler is greater than 40 lbs
10. The nurse knows that an infant's birth weight should be tripled by:
a. 9 months c. 18 months
b. 1 year d. 2 years
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11. The nurse is aware that the earliest age at which an infant is able to sit steadily alone is _____ months.
a. 4 c. 8
b. 5 d. 15
12. The nurse is aware that the earliest age at which the infant should be able to walk independently is _____
months.
a. 8 to 10 c. 15 to 18
b. 12 to 15 d. 18 to 21
13. The nurse would advise a parent when introducing solid foods to:
a. begin with one tablespoon of food.
b. mix foods together.
c. eliminate a refused food from the diet.
d. introduce each new food 4 to 7 days apart.
14. The statement made by a parent that indicates correct understanding of infant feeding is:
a. "I've been mixing rice cereal and formula in the baby's bottle."
b. "I switched the baby to low-fat milk at 9 months."
c. "The baby really likes little pieces of chocolate."
d. "I give the baby any new foods before he takes his bottle."
15. The nurse observes a 10-month-old infant using her index finger and thumb to pick up pieces of cereal. This
behavior is evidence that the infant has developed:
a. the pincer grasp c. prehension ability
b. a grasp reflex d. the parachute reflex
Let’s Check !
Activity 2 - Collage Activity
Instruction: Please do this activity and submit on the prescribe date and time.
1. Make a collage out of your pictures from Infancy until the present time according to its sequential
stages.
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In a Nutshell!
Activity 3 – ESSAY TYPE
SITUATION:
A is a 21 ⁄2-year-old boy you see at a pediatric clinic. His mother tells you he has changed completely
in the past 6 months from an easy-to-care-for baby into a “monster” who refuses to do anything she
asks. The only word he says anymore is “no.” He has a temper tantrum every night at dinner over
some type of food. She tells you this has changed parenting from “fun” to “a real chore.”
Instruction: Answer the three (3) questions in not less than 10 sentences each.
1. What are the dramatic changes, both physical and psychosocial, that occur during the toddler
years.____________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
2. Enumerate the nursing care and health teaching for this age group?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
2. What advice could you give A’s mother to help her regain a positive view of parenting?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
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Let’s Check!
Activity 4 – PICTURE COLLAGE
1. Make a picture collage of the Different toys appropriate for Child’s Developmental Stages.
Let’s Analyze !
Activity 5 – Journal Reading
1.Research for a Journal Reading on Health Promotion and Disease Prevention in Different Stages of
Growth & Development. Included on your submission are the summary, reflection and book
reference/s. Submit this on the prescribed date and time.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
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Big Picture 6
Weeks 10-12: Unit Learning Outcomes (ULO): At the end of the unit, you are expected to:
VI. Explain the Scope and Standards of Maternal and Child Practices in the Philippines and
the rest of the subtopics.
A. Scope and Standards of Maternal and Child Practices in the Philippines
B. Legal Considerations of Maternal-Child Practice
C. Ethico-moral Considerations of Maternal-Child Practice
D. Ethical and Social Issues in Peri-natal Nursing
E. Contraception
F. Advances in Genetics and Genetic Technology
G. Alternative Methods of Birth
H. Common Reproductive Issues
I. Reproductive Health Bill and other existing DOH Programs on Maternal Child Care
Big Picture in Focus: ULO 6 (weeks 10-12) – SCOPE AND STANDARDS
Metalanguage:
The topic for the 10th to 12th weeks focuses on the discussion of the Scope and Standards of Maternal
and Child Nursing. Topics included in this unit in the would help the nursing student when they will
assigned in the Delivery Room, OB Ward; Private Birthing centers and government City Health
Offices-Health Centers. They will base their action in functioning according to the protocols and ethco-
moral standard. They can give good lecture about Contraception in particular. Following this ULO 6
guidelines for Scope & Standard in the practice of Maternal & Child Health Nursing the nursing
student will not commit malpractice in the future.
To perform the aforesaid big picture (unit learning outcomes) for the tenth to twelfth week of the
VI. SCOPE AND STANDARDS
A.SCOPE & STANDARDS IN MATERNAL CHILD PRACTICES IN THE PHILIPPINES
INTRODUCTION:
• Maternal and Child Health refer to philo-mother and child relationship to one another and
consideration of the entire family as well as the culture and socio-economic environment as
framework of the patient.
• It involves the care of the woman and family throughout pregnancy and childbirth and the
health promotion and illness care for the children and families.
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GOAL OF MATERNAL CHILD HEALTH

• To ensure that every expectant and nursing mother maintains good health, learns the art of
child care, has normal delivery and bears healthy child.
• That every child, wherever possible lives and grows up in a family unit with love and security,
in healthy surroundings, receives adequate nourishment, health supervision and efficient
medical attention, and is taught the elements of healthy living
PHILOSOPHY OF MATERNAL CHILD NURSING:

• Is community-centered
• Is research-centered
• Is based on nursing theory
• Protects the rights of all family members
• Uses a high degree of independent functioning
• Places importance on promotion of health
• Is based on the belief that pregnancies or childhood illness are stressful because they are
crises.
• Is a challenging role for the nurse and is a major factor in promoting high level wellness in
families
• Pregnancy, labor and delivery and the puerperium are part of the continuum of the total life
cycle.
• Personal, cultural and religious attitudes and beliefs influence the meaning of pregnancy for
individuals and make each experience unique.
• Maternal-child nursing is family centered. The father of the child is as important as the mother.
STRATEGIC THRUSTS (2005-2010):

• Launch and implement the Basic Emergency Obstetric Care strategy in coordination with
the DOH.
• It entails the establishments of facilities that provide emergency obstetric care for every
125,000 population and which are located strategically.
• Improves the quality of prenatal and postnatal care.
• LGUs and NGOs and other stakeholders must advocate for health through resource
generation and allocation for health services to be provided for the mother and the unborn.
Essential Health Services available in the Health Care Facilities

A. Antenatal Registration/ Prenatal Care
OBJECTIVE: to reach all pregnant women, to give sufficient care to ensure a healthy pregnancy and
the birth of a fullterm healthy baby.
Normal Patients- following the initial evaluation they will be given healthy instructions and
counseling.
• This will include advice for prompt prenatal care examination. Patients with mild
complications- a thorough evaluation of the needs of patients with mild complications will
determine the frequency of follow-up of these cases by the rural health unit, city health clinic or
puericulture center
Patients with potentially serious complications-
• These patients shall be referred to the most skilled source of medical and hospital care.
• As a first choice they will be referred if at all possible for continuing care or consultation.
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• Second choice will be followed carefully by the rural health unit, city health clinic or
puericulture center.
• First prenatal visits should be made as early in pregnancy as possible, during the first
trimester.
• Second during the second trimester
• Third and subsequent visits during the third trimester.
• More frequent visits should be done for those at risk or with complications.
Tetanus Toxoid Immunization
• Neonatal tetanus is one of the public health concerns, that is why it is important for pregnant
women and child bearing age women to get a tetanus toxoid immunization in order to protect
them from this deadly disease.
• A series of 2 doses of TT vaccination must be received by woman one month before
delivery to protect baby from neonatal tetanus. 5 doses –fully immunized mother
MICRONUTRIENT SUPPLEMENTATION
• prevent anemia, vitamin A deficiency and other nutritional disorders.
• Vitamin A - Dose: 10,000 IU Given a week starting on the 4th month of pregnancy.
• Do not give it before the 4th month of pregnancy because it might cause congenital problems
in the baby.
• Iron -Dose: 60mg/400 ug tablet - Schedule: Daily
CLEAN AND SAFE DELIVERY

A. Check for Emergency signs
• Unconsciousness; Vaginal bleeding; Severe abdominal bleeding; Looks very ill; Severe
headache with visual disturbance; Severe breathing difficulty; Fever; Severe vomiting
B. Made woman comfortable
C. Assess the woman in labor - LMP; Number of pregnancies; Start of labor pains; Age/height;
Danger signs of pregnancy
D. Determine the stage of labor
E. Decide of the woman can safely deliver
F. Give supportive care throughout labor
G. Monitor and manage labor
H. Monitor closely after delivery
I. Continue care for at least two hours postpartum
B. LEGAL CONSIDERATIONS OF MCN PRACTICE
1. Identifying and reporting child abuse

2. Child can bring a lawsuit when they reach legal age
3. Informed consent for invasive procedure and any risk that may harm the fetus
4. In divorced or blended families, nurse has the right to give consent Note: Nurses are legally
responsible to protect the rights of their client and documentation is essential to protect nurse and
justify his or her actions."
C. ETHICAL CONSIDERATIONS OF PRACTICE
1. Conception Issues or In Vitro Fertilization
2. Embryo Transfer
3. Cloning
4. Stem Cell Research
5. Surrogate Mothers
6. Abortion
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7. Fetal Rights vs. Rights of the Mother
8. Use of Fetal Tissue for Research
9. Resuscitation
10. No. of procedures or degree of pain that a child should be asked to achieve better health
11. Balance between modern technology and quality of life"
D.Ethical principles related to patient care:

• Autonomy: The right to self determination
• Respect for others: Principle that all persons are equally valued
• Beneficence: Obligation to do good
• Nonmaleficence: Obligation to do no harm
• Justice: Principle of equal treatment of others or that others be treated fairly
• Fidelity: Faithfulness or obligation to keep promises
• Veracity: Obligation to tell the truth
• Utility: The greatest good for the individual or an action that is valued.
Clinical examples of perinatal ethical dilemmas

• Court-ordered treatment
• Withdrawal of life support
• Harvesting of fetal organs or tissue
• In vitro fertilization and decisions for disposal of remaining fertilized ova
• Allocation of resources in pregnancy care during the previable period
• Fetal surgery
• Treatment of genetic disorders or fetal abnormalities found on prenatal screening
• Equal access to prenatal care
• Maternal rights versus fetal rights
• Extraordinary medical treatment for pregnancy complications
• Using organs from an anencephalic infant
• Genetic engineering
• Cloning
• Surrogacy
• Drug testing in pregnancy
• Sanctity of life versus quality of life for extremely premature or severely disabled infants
• Substance abuse in pregnancy
• Borderline viability: to resuscitate or not
• Fetal reduction
• Preconception gender selection
• Ethical issues and challenges in maternal and
child health nursing
• Abortion
• Substance abuse
• Fetal therapy –correct fetal lesions
• Informed consent
• Refusal of medical treatment
• Confidentiality
• Intrauterine treatment of fetal conditions- fetal surgery
• Mandated contraception -
• Fetal injury – mother causing harm to fetus
• Infertility treatment – expensive; low success
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E.Contraception:
• Contraception allows them to put off having children until their bodies are fully able to support
a pregnancy.
• It can also prevent pregnancy for older women who face pregnancy-related risks.
• Contraceptive use reduces the need for abortion by preventing unwanted pregnancies.
Most used contraceptive:

• Oral contraceptive pill
• Female sterilization
Methods of contraception:
• Long-acting reversible contraception-implant or intra uterine device (IUD)
• Hormonal contraception-pill or the Depo Provera injection.
• Barrier methods- condoms
• Emergency contraception - ELLA (delaying ovulation) will not harm to fetus
• Fertility awareness
• Permanent contraception- vasectomy and tubal ligation.
• Advances in Genetics & Genetic Technology
• Human Cloning- Research / Reproductive cloning (egg cell of mother)
• Genetic trait selection- certain genes of interest are determined in eggs, sperm and early
embryos.
• Human genetic modification -genetic modification in humans can potentially take place at
therapeutic(cure)and enhancement (make better) levels.
• Evidence provided in this article strongly suggests that many governments and organizations
throughout the world have agreed to prohibit human reproductive cloning, inheritable genetic
modification and social trait selection.
• In many countries, it is now against the law to pay for women’s eggs for research or assisted
reproduction and commercial surrogacy.
G.Alternative Methods of Birth:
The Bradley Method

• In this technique, women are encouraged to give birth in the presence of their partners,
without the use of epidural anesthesia, intravenous drugs, surgery, or tools. The technique is
taught in a 12-week class conducted in the last trimester of pregnancy.
HypnoBirth
• HypnoBirth trains mothers-to-be to achieve complete relaxation during labor and delivery. The
method involves courses with an instructor, along with home self-hypnosis exercises that
teach women how to eliminate the pain of labor by staying completely focused and in control
of the birthing process.
Lamaze
• Lamaze is a birthing technique that emphasizes breathing. Women are generally taught to
control their breathing, change positions and walk around at certain points during labor.
Partners are also encouraged to participate in the delivery. While Lamaze is generally a
natural technique, a woman can have an epidural if she feels she needs it.
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Water Delivery
• Some women may find that giving birth in a warm tub of water will help them relax and the
buoyancy may help alleviate discomfort and pressure.
• "Water delivery is not recommended for women with high-risk pregnancies and preparation
should be made for delivery to occur out of the water if complications arise," according to the
American Pregnancy Association.
• Common Reproductive Issues:
H. Common Reproductive Health Concerns for Women:

• Endometriosis- problem affecting a woman’s uterus
• Uterine Fibroids - noncancerous tumors in women of childbearing age
• Gynecologic Cancer- cancer that starts in a woman’s reproductive organs.
• HIV/AIDS - destroy so many cells that the body can’t fight off infection.
• Interstitial Cystitis -chronic bladder condition resulting in recurring discomfort or pain in the
bladder or pelvic region.
• Polycystic Ovary Syndrome (PCOS)- woman’s ovaries or adrenal glands produce more male
hormones than normal.
• Sexually Transmitted Diseases (STDs) -cause serious health problems for the baby as well.
I. Health Reproduction Bill and other DOH programs

• The Responsible Parenthood and Reproductive Health Act of 2012, also known as the
Reproductive Health Law or RH Law, and officially designated as Republic Act No. 10354, is
a law in the Philippines, which guarantees universal access to methods on contraception,
fertility control, sexual education, and maternal care.
DEPARTMENT OF HEALTH PROGRAMS:

• Essential Newborn Care (ENC)
• Newborn Screening
• Infant and Young Child Feeding (IYCF)
• Breastfeeding
• Child Health
• Adolescent Health
• Oral Health
• Reproductive Health
• Women’s Health
• Iron Deficiency Anemia (IDA)
• Vitamin A Deficiency (VAD)
• Neonatal Tetanus
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Let’s Check !
Activity 1 -
1.Research for a journal reading on the “Scope and Standards and legalities of Maternal and Child
practices in the Philippines”. Write the summary, reflection and book reference of your chosen
reading.
_________________________________________________________________________________
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_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
In a nutshell !
Activity 2 - Do a research project on the Different Contraceptive methods and advances in Genetic
Technology.
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Big Picture 7
Weeks 13-14 : Unit Learning Outcomes (ULO): At the end of the unit, you are expected to:
VII. Explain the Patient’s Bill of Rights and Obligations
VIII. Discuss the Communication and Teaching with Children and Families
IX. Expound Nursing Care Planning: Interprofessional Care Maps
Big Picture in Focus: ULO 7: (Weeks 13-14)

VII. Patient’s Bill of Rights and Obligations
VIII. Communication and Teaching with Children and Families
IX. Nursing Care Planning: Interprofessional Care Maps
Metalanguage:
The topic for the 13th to 14th weeks ULO7 focuses on the discussion on the patient’s health care
benefits thru the Patient’s Bill of Rights and Obligations. The student Nurse will be able to learn how
to communicate both with the children and families during sickness and while admitted in a health
facility. On this topic nursing students can make a Nursing Plan for the care of various clients with
data gathered during assessment.
To perform the aforesaid big picture (unit learning outcomes) for the thirteenth to fourteenth week of
the course, you need to fully understand the following essential knowledge that will be laid down in
the succeeding pages. Please note that you are not limited to exclusively refer to these resources.
Thus, you are expected to utilize other books, research articles and other resources that are available
in the university’s library e.g. ebrary, search.proquest.com etc.
VII. PATIENT’S BILL OF RIGHTS AND OBLIGATIONS
Definition:
Patient's Bill of Rights is a document that provides patients with information on how they can
reasonably expect to be treated during the course of their hospital stay.
These documents are, in almost all cases, not legally-binding.
They simply provide goals and expectations for patient treatment
PURPOSE OF PATIENT BILL OF RIGHTS:

Patient's Bill of Rights was created to try to reach 3 major goals:
1. Assures that the health care system is fair.
2. Works to meet patients' needs.
3. Gives patients a way to address any problems they may have.
PATIENT’S BILL OF RIGHTS:
1. Right to information: Every patient has the right to know what is the illness that they are suffering,
its causes, the status of the diagnosis (provisional or confirmed), expected costs of treatment.
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Furthermore, service providers should communicate this in a manner that is understandable for the
patient.
2. Right to records and reports: The patient has the right to access his/her medical records and
investigation reports. Service providers should make these available upon the patients' payment of
any photocopy fees as applicable.
3. Right to emergency care: Public and private hospitals have an obligation to provide emergency
medical care regardless of the patients' capacity to pay for the services.
4. Right to informed consent: Patients have the right to be asked for their informed consent before
submitting to potentially hazardous treatment. Physicians should clearly explain the risks from
receiving the treatment and only administer the treatment after getting explicit written consent from
the patient.
5. Right to confidentiality, human dignity and privacy: Doctors should observe strict confidentiality
of a patient's condition, with the only exception of potential threats to public health. In case of a
physical inspection by a male doctor on a female patient, the latter has the right to have a female
person present throughout the procedure. Hospitals also have an obligation to secure patient
information from any external threats.
6. Right to second opinion: Patients are entitled to seek a second opinion and hospitals should
facilitate any information or records that the patient requires to do so.
7. Right to transparency in rates, and care according to prescribed rates wherever relevant:
Hospitals should display the rates that they charge in a visible manner and patients should receive an
itemized bill when payment is required. Essential medicines, devices and implants should comply with
rates established by the National Pharmaceutical Pricing Authority (NPPA).
8. Right to non-discrimination: Service providers cannot deny treatment on the basis of gender,
caste, religion, age, sexual orientation or social origins. Additionally, it is against the Charter to deny
treatment on the basis of a patients' health condition, including HIV status.
9. Right to safety and quality care according to standards: Hospitals must ensure a hygienic and
sanitized environment to provide their services.
10. Right to choose alternative treatment options if available: Patients have the right to consider
treatment alternatives and even refuse treatment.
11. Right to choose source for obtaining medicines or tests: Any registered pharmacy and
laboratory is eligible to provide patients with goods and services they require.
12. Right to proper referral and transfer, which is free from perverse commercial influences: In
case of transfers or referrals, the patient has the right to an explanation that justifies the transfer, as
well as confirmation from the hospital receiving the patient about their acceptance of the transfer.
13. Right to protection for patients involved in clinical trials: Clinical trials should comply with all
the standards and protocols under the Directorate General of Health Services.
14. Right to protection of participants involved in biomedical and health research: Studies
involving patients should follow the National Ethical Guidelines for Biomedical and Health Research
Involving Human Participants.
15. Right to take discharge of patient, or receive body of deceased from hospital: Patients have
the right to be discharged and may not be detained at a health service provider facility because of
procedural reasons such as payment disputes.
16. Right to Patient Education: In addition to information about their condition, patients have the
right to know about public health services such as insurance schemes and charitable hospitals.
17. Right to be heard and seek redressal: Patients have the right to provide feedback and
comments to their health service providers and file complaints as required. They additionally have the
right to redressal in cases where any of their rights are violated.
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VIII. COMMUNICATION AND TEACHING WITH CHILDREN AND FAMILIES
INTRODUCTION:
To work effectively with children and their families, nurses need to develop keen communication skills.
Because parents and other family members play a crucial role in the lives of children, nurses need to
establish rapport with the family in order to identify mutual goals and facilitate positive outcomes. An
awareness of body language, eye contact, and tone of voice must accompany good verbal
communication skills when one is listening to children and their families. The same awareness helps
nurses assess their own communication styles.
COMPONENTS OF EFFECTIVE COMMUNICATION
1. TOUCH
2. PHYSICAL PROXIMITY & ENVIRONMENT
3. LISTENING
a. Attentiveness
b. Clarification through Reflection
c. Empathy
d. Impartiality
4. VISUAL COMMUNICATION
Communication is much more than words going from one person’s mouth to another person’s ears.
In addition to the words themselves, the tone and quality of voice, eye contact, physical proximity,
visual cues, and overall body language convey messages. These nonverbal communications are
often undervalued, yet comprise a significant portion of total communication. In choosing
communication techniques to be used with children and families, the nurse considers cultural
differences, particularly with regard to touch and personal space. Communication provides an
important linkage between parents and providers that is based on honesty, caring, respect, and a
direct approach (Fisher & Broome, 2011). Good communication is key to the identification of health
issues, adherence to a treatment plan, and improved psychological and behavioral outcomes. Optimal
communication addresses both the cognitive and emotional needs of children and families.
COMPONENTS OF EFFECTIVE COMMUNICATION:

1. Touch
• Touch can be a positive, supportive technique that is effective from birth through adulthood.
Touch can convey warmth, comfort, reassurance, security, trust, caring, and support.
• In infancy, messages of love, security, and comfort are conveyed through holding, cuddling,
gentle stroking, and patting. Infants do not have cognitive understanding of the words they
hear, but they sense the emotional support, and they can feel, interpret, and respond to
gentle, loving, supportive hands caring for them. Toddlers and preschoolers find it soothing
and comforting to be held and rocked, as well as stroked gently on the head, back, arms, and
legs.
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Communication with children is enhanced by direct eye contact and by body language that conveys attentiveness
2. PHYSICAL PROXIMITY AND ENVIRONMENT

• Children’s familiarity and comfort with their physical surroundings affect communication.
Normally, children are most at ease in their home environments. Once they enter a clinic,
emergency department, or patient care unit, they are in an unfamiliar environment, and they
experience heightened anxiety. Hospital and clinic staff members have a tremendous
advantage in knowing their clinic or unit as a familiar workplace. Nurses can gain a better
picture of what a child is experiencing by trying to place themselves in the child’s position and
imagining the child’s first impression of the triage desk, the reception desk, the admitting
office, the treatment room, and the hospital room. A child’s perspective is probably very
different from an adult. Creating a supportive, inviting environment for children includes the
use of child-size furniture, colorful banners and posters, developmentally appropriate toys, and
art displayed at a child’s eye level.
• Individuals have different comfort zones for physical distance. The nurse should be aware of
differences and should move cautiously when meeting new children and families, respecting
each individual’s personal space. For example, standing over the child and family can be
intimidating. Instead, the nurse should bring a chair and sit near the child and family. This
action puts the nurse at eye level. If a chair is not accessible, the nurse may stoop or squat.
The important part is to be at eye level while remaining at a comfortable distance for the child
and family
• For effective communication, the nurse needs to be at the child’s eye level. (Courtesy Pat Spier, RN-C. In Leifer, G.
[2011]: Introduction to maternity & pediatric nursing, [6th ed.]. St. Louis: Saunders.)
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The nurse should not overlook privacy or underestimate its importance. A room should be
available for conducting private conversations away from roommates or family members and
visitors. Privacy is particularly critical in working with adolescents, who typically will not discuss
sensitive topics with parents present. The nurse’s skill and ease with parents of adolescents
will increase the adolescents’ trust in the nurse. Nurses need to avoid hallway conversations,
particularly outside a child’s room, because children and parents may overhear only some
words or phrases and misinterpret the meaning. Overhearing may lead to unnecessary stress
and mistrust between the health care providers and the child or family.
3. LISTENING:
• Messages given must be received for communication to be complete. Therefore, listening is
an essential component of the communication process. By practicing active listening skills,
nurses can be effective listeners.
ACTIVE LISTENING SKILLS ARE AS FOLLOWS:1
1.Attentiveness:
• The nurse should be intentional about giving the speaker undivided attention.
Eliminating distractions whenever possible is important. For example, the nurse should
maintain eye contact, close the room door, and eliminate potential distractions (e.g.,
television, computer, video games, smartphones).
2. Clarification through Reflection:
• Using similar words, the nurse expresses to the speaker what was heard and
understood about the content of the message. For example, when the child or family
member says, “I hate the food that comes on my tray,” a reflective response would be,
“When you say you are unhappy with the food you’ve been given, what can we do to
change that?” As the conversation progresses, the nurse can move the child through a
dialogue that identifies those nutritional foods the child would eat.
3. Empathy
• The nurse identifies and acknowledges feelings expressed in the message. For
example, if a child is crying after a procedure, the nurse might say, “I know it is
uncomfortable to have this procedure. It is okay to cry. You did a great job holding still.”
4. Impartiality
• To understand and avoid prejudicing what is heard with personal bias, the nurse listens
with an open mind. For example, if a young adolescent share that she is sexually active
and is mainly concerned about sexually transmitted diseases, the nurse remains a
supportive listener. The nurse can then provide her with educational materials and
resources as well as discuss the possible outcomes of her actions in a manner that is
open and not judgmental, regardless of the nurse’s personal values and beliefs.
• During shift handoff, descriptions of family must be shared objectively and impartially.
Otherwise, perceptions of families may negatively affect how colleagues’ approach and
interact with families.
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• To enhance the effectiveness of communication and maximize normal language
patterns that contribute to language development, the nurse focuses on talking with
children rather than to them and develops conversations with children.
• The nurse must be prepared to listen with the eyes as well as the ears. Information will
not always be audible, so the nurse must be alert to subtle cues in body language and
physical closeness. Only then can one fully understand the messages of children. For
example, when the nurse enters the room to complete an initial assessment of a 4-
year-old child and observes the child turning away and beginning to suck her thumb,
the child is communicating about her basic security and comfort level, although she
has not said a word.
4. VISUAL COMMUNICATION
• Eye contact is a communication connector.
• Making eye contact helps confirm attention and interest between the individuals
communicating.
• Direct eye contact may be uncomfortable, however, for people in some cultures, so the nurse
needs to be sensitive to responses when making eye contact.
TIPS TO ENHANCE LISTENING AND COMMUNICATION SKILLS
• Children understand more clearly than they can speak.
• To develop conversations with children, ask open-ended questions rather than questions requiring
yes-or-no responses.
• Comprehension is increased when the nurse uses different methods to present and share
information.
• Use “people-first” language (e.g., “Sally in 428 has cystic fibrosis” instead of “The CF patient in 428
is Sally”).
• Encourage the child to be an active participant through creating a respectful listening environment
where children can express concerns, ask questions and participate in the development of a plan of
care.
• Clothing, physical appearance, and objects being held are visual communicators. Children
may react to an individual’s presence on the basis of a white lab coat, a bushy beard, or a
syringe or video game in the hand. The nurse needs to think ahead and anticipate visual
stimuli a child may find startling and those that may be pleasing and to make appropriate
adjustments when possible. For example, it is a routine practice for nurses to bring a
medication in a syringe for insertion into an intravenous (IV) line. Unless the purpose of the
syringe is immediately explained, children might quickly assume they are about to receive
an injection.
• Some children, and some adults, are visual learners. They learn best when they can see
or read instructions, demonstrations, diagrams, or information. Using various methods of
presenting and sharing information will increase comprehension for such children.
• Concepts can be presented more vividly by using developmentally appropriate
photographs, videos, dolls, computer programs, charts, or graphs than by using written or
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spoken words alone. The nurse needs to select teaching tools and materials that
appropriately match the child’s growth and developmental level.
TONE OF VOICE
• The spoken word comes to mind most often when communication is the topic.
Communication, however, consists of not only what is said but also the way it is said. The tone
and quality of voice often communicate more than the words themselves.
• Because infants’ cognitive understanding of words is limited, their understanding is based on
tone and quality of voice. A soft, smooth voice is more comforting and soothing to infants than
a loud, startling, harsh voice. Infants can sense from the tone of voice whether the caregiver is
angry or happy, frustrated or calm. The nurse can assess how aware of and sensitive to these
messages’ infants are by observing their body language. Infants are relaxed when they hear a
calm, happy caregiver and tense and rigid when they hear an angry, frustrated caregiver.
• Children can detect anger, frustration, joy, and other feelings that voices convey, even when
the accompanying words are incongruent. This incongruity can be very confusing for children.
The nurse should strive to make words and their intended meanings match.
• Verbal communication extends beyond actual words. All audible sounds convey meaning. An
infant’s primary mode of audible communication is crying. Crying is a cue to check basic
needs, including hunger, pain, discomfort (e.g., wet diaper), and temperature. Cooing and
babbling, also heard during the first year of life, generally convey messages of comfort and
contentment. As children develop and mature, they have larger vocabularies to express their
ideas, thoughts, and feelings.
• The choice of words is critical in verbal communication. The nurse needs to avoid talking down
to children but should not expect them to understand adult words and phrases. Technical
health care terms should be used selectively, and jargon should be avoided
BODY LANGUAGE
• From the gentle caress of holding an infant to sitting and listening intently to an adolescent’s
story, body language is a factor in communication. An open body stance and positioning invite
communication and interaction, whereas a closed body stance and positioning impede
communication and interaction.
• Using an open body posture improves the nurse’s understanding of children and the children’s
understanding of the nurse. Nurses need to learn to read children’s body language and should
become more aware of their own body language.
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OPEN AND CLOSED BODY POSTURES

OPEN CLOSED
Leaning toward other person Leaning away from other person
Arms loose at sides Arms folded across chest
Frequent eye contact No eye contact
Hands moving freely Hands on hips
Soft stance, body swaying slightly Rigid stance
Head up Head bowed
Calm, slow movements Constant motion, squirming
Smiling, friendly facial cues Frowning, negative facial cues
Conversing at eye level Conversing at a level that requires the child to move to
listen
TIMING :
• Recognizing the appropriate time to communicate information is a developed skill. A distraught
child whose parents have just left for work is not ready for a diabetic teaching session. The
session will be much more productive and the information better understood if the child has a
chance to make the transition. The convenience of meeting a schedule should be secondary
to meeting a child’s needs.
• In the well or outpatient setting, scheduling teaching sessions that adapt to a parent’s
schedule can enhance child’s or parent’s understanding of information (Li & Chung, 2009). For
example, scheduling a teaching session during the late afternoon or early evening, or on a
Saturday, at the parent’s convenience assures increased attention because the parent is not
distracted with needing to be at work or other demands on time.
Family-Centered Communication:
• Any discussion about effective ways to communicate with children must also include a
discussion of effective communication with families. Family-centered care emphasizes that the
family is intimately involved in the care of the child. Parents need to be supported while
sustaining their parental role during their child’s hospitalization. Family-centered care is
achieved when health care professionals can create partnerships with families, recognizing
that the family is essential to the child and that the family has the right to participate fully in
planning, implementing, and evaluating the child’s plan of care.
• Commitment to family-centered care means that the nurse respects the family’s diversity.
Children and parents live in a variety of family structures. An expanded definition of family is
required in the twenty-first century, because the term no longer refers to only the intact,
nuclear family in which parents raise their biologic children. Contemporary family structures
include adolescent parents; extended families with aunts, uncles, or cousins parenting;
intergenerational families with grandparents parenting; blended families with stepparents and
stepsiblings; gay or lesbian parents; foster parents; group homes; and homeless children. The
nurse should be prepared to identify the foundational strengths in all family structures. Family-
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centered care also means that the nurse truly believes that the child’s care and recovery are
greatly enhanced when the family fully participates in the child’s care.
COMMUNICATING WITH FAMILIES:
• Include all involved family members. One essential step toward achieving a family-centered care
environment is to develop open lines of communication with the family.
• Encourage families to write down their questions.
• Remain nonjudgmental.
• Give families both verbal and nonverbal signals that send a message of availability and openness.
• Respect and encourage feedback from families.
• Recognize that families come in various shapes, sizes, colors, and generations.
• Avoid assumptions about core family beliefs and values.
• Respect family diversity.
The child’s continuing health care, both preventive and during illness, is enhanced by participation of the family. The
nurse explains a child’s test results to his mother and grandmother. Including all important family members in the child’s
health care reflects commitment to family-centered care. (Courtesy University of Texas at Arlington College of Nursing,
Arlington, TX.) This nurse practitioner has learned Spanish to communicate better with her many Spanish-speaking
patients. Speaking with family members in their own language encourages the family to remain in the health care system.
The nurse is also using eye contact and has positioned herself at the mother’s eye level. (Courtesy Parkland Health and
Hospital System Community Oriented Primary Care Clinic, Dallas, TX.)
Establishing Rapport
• Critical to establishing rapport with families is the nurse’s ability to convey genuine respect and
concern during the first encounter. A nonjudgmental approach and a willingness to assist
family members in effectively caring for their child demonstrate the nurse’s interest in their
well-being.
Availability and Openness to Questions
• A nurse who does not take time to see how a child and family are doing—such as a nurse who
leaves a room immediately after a treatment or administration of a medication—will
not encourage or invite families to ask questions. Families want and need unrushed and
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uninterrupted time with the nurse. Sometimes this time can be made available only by
purposefully scheduling it into the day. Encouraging families to write down their questions will
enable them to take full advantage of their time with the nurse.
• The nurse might encourage effective use of time by saying, “I know you have a lot of
questions and are very anxious to learn more about your son’s condition. I have another
patient who has an immediate need, but I will be available in 10 minutes to meet with you. In
the meantime, here is a parent handbook that gives general information about seizures.
Please feel free to review it and write down any questions that we can discuss when I return.”
Family Education and Empowerment
• Nurse and other health providers take time to educate parents about their child’s condition
and the skills needed to participate continued involvement in planning and evaluating the
plan of care.
• Families need support as they gain confidence in their skills, and they need guidance to assist
them as they navigate through the health care experience. Communication is enhanced when
families feel competent and confident in their abilities.
Effective Management of Conflict
• Needs to be addressed in an desirable manner to prevent further breakdown in
communication.
• Suggests strategies for managing conflict.
• Highlights the importance of choosing words carefully to make families feel welcome and
to further facilitate family-centered care.
STRATEGIES FOR MANAGING CONFLICT:
• Understand the parents’ perspective (walk in their shoes). Imagine yourself as the parent of a child
in a hospital where your values and beliefs are exposed and scrutinized. Try to understand the
parents’ perspective better by encouraging them to share it.
• Determine a common goal and stay focused on it. Determine the agreed-on result, and work toward
it. By staying focused on a common goal, the parties involved are more likely to find workable
strategies to achieve the identified goal.
• Seek win-win solutions. Conflict should not be about who is right and who is wrong. Effective conflict
management focuses on finding a solution whereby both parties “win.” By establishing a common
goal, both parties win when this goal is achieved.
• Listen actively. Critical to resolving situations of conflict is the ability to listen and understand what
the other person is saying and feeling. In active listening, the receiver actively and empathically
listens to gain a better understanding of the actual and the implied message.
• Openly express your feelings. Talking about feelings is much more constructive than acting them
out. The nurse might say, “I am very concerned about Jamie’s safety when you leave his side rails
down.”
• Avoid blaming. Each party owns part of the problem. Pointing fingers and blaming others will not
solve the problem. Instead, identify the part of the problem that each party owns and work together to
resolve it. Seek win-win solutions.
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• Summarize the decision. At the end of any discussion, summarize what has been decided and
identify who is responsible for follow-up. This process ensures that everyone is clear about the
decision and facilitates accountability for implementing solutions.
CHOOSING WORDS CAREFULLY
POOR WORDS RATIONALE BETTER WORDS RATIONALE
Policies allowed or Convey attitude that Guidelines, working Convey openness and
not permitted hospital personnel have together, welcome appreciation for position
authority over parents in and importance of families
matters concerning their
children
Noncompliant, Imply that health care Partners, colleagues, joint Acknowledge that families
uncooperative, providers make decisions decision makers, experts bring important information
difficult (when and give instructions that about their child and insight and that families
referring to parents families must follow and professionals form a
and other family without input team
members)
Dysfunctional, in Pronounce judgment that Coping (describing Remain open to reaching a

denial, may not incorporate full family’s reactions with more complete and
overprotective, understanding of family’s care and respect) appreciative understanding
uninvolved, situation, reactions, or of families over time
uncaring (labeling perspective
families)
FEEDBACK FROM CHILDREN AND FAMILIES

• Nurse needs to be alert for both verbal and nonverbal cues.
• Checking with family members about their experiences, satisfaction with communications,
teaching sessions, and health care goals to ensure that health care providers obtain
appropriate feedback.
• Enhance the delivery of care. The nurse should listen and observe carefully to make sure
that what family members are saying is truly what they are feeling.
• Transparent communication between parents and nurses is integral to providing family-
centered care.
IX. IMPLEMENTATION OF INTERPROFESSIONAL CARE PLANNING

For Children
Established to:
• Ensure that children and their families can access safe, high quality services in an appropriate location,
within an appropriate timeframe, irrespective of their geographical location or social background without
duplication or fragmentation of services.
• Its purpose is to place children and their families at the center of service design.
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The Importance of Child Health
• A vital and productive society is built on the foundation of its children’s health and development. Health
in the earliest years – beginning with the future mother’s health before she becomes pregnant
• Healthy children need strong community pediatrics with immunization, screening, nutrition and
developmental/cognitive assessment. Children need a seamless acute hospital service.
• Children with care and support needs should be provided with a continuum of services such as primary,
community and ambulatory care to avoid unnecessary hospital admissions, and have their required
treatments and supports delivered within their local community as much as possible.
Mother-baby care
Phillips (1998) built on the work of the task force by using its definition of family‐centered care to define
mother‐baby care as:
• “the delivery of safe, quality health care that recognizes, focuses on and adapts to the physical and
psychosocial needs of the new mother, the family and the newborn.
• The emphasis is on providing maternal‐newborn care that fosters family unity while maintaining physical
safety.”
• Thus, the terms family‐centered care and mother‐baby care have come to be synonymous.
Advances in Mother‐ Baby Care
One of the first descriptions of the transition from a traditional care model to mother‐baby nursing described
implementation in Canadian hospitals, which reported many benefits of their transition to mother‐baby care,
including financial savings and increased patient and nurse satisfaction. In addition, they reported more staffing
flexibility and higher levels of accountability and competence from staff members.
• This model promotes more continuity of care, as the same nurse is caring for both mother and baby and
is aware of their shared health history. This aids in ongoing care as well as in discharge planning
Patient Satisfaction
Women who experience care in a mother‐baby model have a more positive outlook on that care than women
within any other model of care
Nurse Satisfaction
• Nurses reported more satisfaction with the physical environment of care, along with an enhanced ability
and time to respond to patient needs for physical care and education.
• When compared with nurses in a traditional model of care, nurses practicing in a mother‐baby model of
care rated their job satisfaction significantly higher
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Let’s Analyze!
ACTIVITY 1– Journal Reading
1.Research for a journal reading on the “Patient’s Bill of Rights and Obligations”. Write the summary,
reflection and book reference of your chosen reading.
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In a Nutshell!
ACTIVITY 2 - VIDEO ROLE PLAYING
1.Make video presentation on “Communication in the Family” (Ensure working relationship with
individual and family based on trust, respect and shared decision-making using appropriate
communication/interpersonal techniques/strategies.)
❖ SUBMIT YOUR VIDEO PRESENTATION AT OUR BLACKBOARD LMS PAGE
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Big Picture 8
Weeks 15-16: Unit Learning Outcomes (ULO): At the end of the unit, you are expected to:
X. Explain the Related Studies on Maternal & Child Nursing
a. Researchable Topics/Problems
b. Related Literature Search
XI. Discuss the Filipino Culture, Values and Practices in relation to Maternal and Child
Care.
A. Care Planning to Respect Cultural Diversity
B. Myths and Beliefs related to Pregnancy
1.Birth Practices of Selected Cultural Groups
XII. Maternal and Child Care Entrepreneurial opportunities
A. Birthing Clinics
B. Day Care
Big Picture in Focus: ULO 8 ( Weeks 15-16)

X. Explain the Related Studies on Maternal & Child Nursing;
XI. Discuss the Filipino Culture, Values and Practices in relation to Maternal and Child Care and
XII. Maternal and Child Care Entrepreneurial opportunities
Metalanguage:
The topic for the 15th to 16th weeks focuses on the discussion on the Related Studies on Maternal &
Child Nursing. The student Nurse will be able to learn what are the updated Trends, Issues thru
Research collaboration of the health care team in Maternal Child Nursing. Thru the ULO 8 discussion
of the practices in relation to childbearing, birthing and childrearing, you will be able to give thorough
care and give appropriate health teaching with regards to Maternal and Child concerns.
To perform the aforesaid big picture (unit learning outcomes) for the Fifteenth to Sixteenth week of the
IX . RELATED STUDIES ON MATERNAL AND CHILD NURSING
A SUGGESTED STUDY ON PREGNANCY AND LABOR:
• Research on induction of synthetic form of oxytocin for augmentation and administration during labor,
and the possible risks of the same.
• Study of how VBAC or Vaginal Birth after Cesarean can serve as an option for women who have had C-
section deliveries previously.
• A research on the pathophysiology of pregnancy and the effect that risky delivery circumstances can
have on the child and the mother
Studies for the Mother:
Prenatal food and micronutrient supplementation to malnourished women in the Philippines Effects,
Equity, and Cost-effectiveness
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• Maternal nutrition is closely linked to child health and survival. In the Philippines there is a high
prevalence of undernutrition in the form of chronic energy deficiency [CED, Body Mass Index <18.5
(kg/m2)] in women and low birth weight.
Prenatal food and micronutrient supplementation to malnourished women in the Philippines Effects,
Equity, and Cost-effectiveness
• Maternal nutrition is closely linked to child health and survival. In the Philippines there is a high
prevalence of undernutrition in the form of chronic energy deficiency [CED, Body Mass Index <18.5
(kg/m2)] in women and low birth weight.
Genetic factors affecting pregnancy duration in humans
• This thesis investigates the mechanisms behind human pregnancy duration. Too short gestation is a
direct cause of perinatal, neonatal, and infant mortality. Deviation from normal pregnancy length is also
associated with a child's morbidity, even in the adulthood.
Alcohol consumption during pregnancy Prevalence, predictors and prevention
• It is well established that fetal alcohol exposure can disturb the development of the fetus and cause a
range of effects for the affected child. However, research on the effects of exposure to lower levels is
inconclusive and the subject is debated.
Pregnancy weight gain: family studies on the effects on offspring’s body size and blood pressure
• Increasing maternal weight gain during pregnancy, gestational weight gain (GWG), is associated with
several adverse outcomes in the child, e.g. high birth weight, childhood overweight and obesity, as well
as adult blood pressure (BP)
STUDIES FOR CHILDREN:
• Epidemiological studies of sociodemographic factors, early life factors, health, and medical care
consumption among small children
• Stunted growth in children from fetal life to adolescence Risk factors, consequences and entry points
for prevention
• Overweight and Obesity in Preschool Children: Early Risk Factors and Early Identification
• IRON NUTRITION DURING EARLY CHILDHOOD.

• Factors influencing iron status and iron intake
• The overall aim of this thesis was to describe the prevalence of iron deficiency (ID) and factors
influencing iron status and iron intake among otherwise healthy children. The specific aim in paper I+II
was to describe the prevalence of ID among 2 ½-year-old children in relation to intake of cow's milk and
follow-on formula.
• Intervention for improved newborn feeding and survival where HIV is common Perceptions and
effects of a community-based package for maternal and newborn care in a South African
township
• South Africa recently changed infant feeding policy within Prevention of Mother to Child Transmission
(PMTCT) of HIV from free formula to recommendation of breastfeeding for all. The country is evaluating
the role of Community Health Workers (CHWs) in supporting mothers and newborns.
• Children in families where the mother has an intellectual or developmental disability incidence,
support and first-person narratives
• The aim of this thesis was to increase the knowledge about children born to mothers with an intellectual
or developmental disability by investigating incidence (Study I), support at the strategic level (Study II),
support at the family level (Study III), and experiences of having grown up with a mother with a
developmental disability (Study IV). The first study investigated the 5-year incidence of children being
born to mothers with an intellectual disability in a Swedish county.
• Skin-to-skin contact and suckling in early postpartum: Effects on temperature, breastfeeding
and mother-infant interaction
• The overall aim of this thesis was to explore the role of closeness versus separation on infant and
maternal temperature adaptation, breastfeeding outcome and mother-infant interaction. In addition, we
aimed to study a potential influence of swaddling on all outcomes measured. Material and design.
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LATEST MATERNAL HEALTH RESEARCH:
Interventions to Prevent Perinatal Depression US Preventive Services Task Force Recommendation

Statement
• US Preventive Task Force | February 2019
Gestational Weight Gain and Severe Maternal Morbidity at Delivery Hospitalization
• Obstetrics & Gynecology | March 2019
Pregnancy Outcomes in US Prisons, 2016–2017
• American Public Health Association | March 2019
The role of male partner in utilization of maternal health care services in Ethiopia: a community-based
couple study
• BMC Pregnancy and Childbirth | January 2019
Prior dengue virus infection and risk of Zika: A pediatric cohort in Nicaragua
• PLOS Medicine | January 2019
Association of Maternal Social Relationships with Cognitive Development in Early Childhood

• JAMA Network Open January 2019
Introduction of genomics into prenatal diagnostics
• The Lancet | January 2019
Low-income Texas women’s experiences accessing their desired contraceptive method at the first
postpartum visit
• Perspectives on Sexual and Reproductive Health | December 2018
Maternal immunization to improve the health of HIV-exposed infants
• The Lancet | December 2018
Temporal trends in spatial inequalities of maternal and newborn health services among four east
African countries, 1999–2015
• BMC Public Health | December 2018
Breast cancer risk after recent childbirth: A pooled analysis of 15 prospective studies
• Annals of Internal Medicine | December 2018
Health systems’ capacity to provide post-abortion care: a multicountry analysis using signal functions
• Lancet Global Health | November 2018
Medical abortion in the late first trimester: A systematic review
• Contraception | November 2018
Cannabis abuse or dependence during pregnancy: A population-based cohort study on 12 million births
• Journal of Obstetrics and Gynecology Canada | November 2018
Related Literature Research
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STEPS IN THE CREATION OF A LITERATURE REVIEW:

1. Scanning documents
2. Making notes
3. Structuring the literature review
4. Writing the literature review
5. Building the bibliography
What is literature review and example?
• A literature review is a survey of scholarly sources that provides an overview of a particular

topic. It generally follows a discussion of the paper's thesis statement or the study's goals or
purpose.
*This sample paper was adapted by the Writing Center from Key, K.L., Rich, C., DeCristofaro, C.,
Collins, S. (2010).
How many references do you need for a literature review?

• Enough! Maybe – as a very rough and ready rule of thumb – 8-10 significant pieces (books
and/or articles) for a 8,000 word dissertation, up to 20 major pieces of work for 12-15,000
words, and so on. But use your judgement! Skim through the books and articles identified as
potentially relevant.
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XI.FILIPINO CULTURE VALUES AND PRACTICES IN RELATION TO DIFFICULT

CHILDBEARING
CULTURE
• the arts and other manifestations of human intellectual achievement regarded collectively.
• the customs, arts, social institutions, and achievements of a particular nation, people, or other
social group. "CARIBBEAN CULTURE"
• the customary beliefs, social forms, and material traits of a racial, religious, or social group
e.g popular culture Southern culture
• the set of shared attitudes, values, goals, and practices that characterizes an institution or
organization e.g a corporate culture focused on the bottom line
• the set of values, conventions, or social practices associated with a particular field, activity, or
societal characteristic e.g Changing the culture of materialism will take time …
COMMON CHARACTERISTICS SEEN AMONG DIFFERENT CULTURES:

• Culture is learned from birth through language and socialization.
• Culture is dynamic and ever changing, but it remains stable.
• Members of the same cultural group have same patterns of socialization than other cultural
groups.
Cultural Competence
• is the ability to understand, communicate with and effectively interact with people across
cultures.
• Cultural competence encompasses being aware of one's own world view, developing positive
attitudes towards cultural differences.
Be aware of client’s cultural differences.

• Nurse's ability to understand another person's culture, demonstrate knowledge of it, and
accept and respect the difference between his/her culture
• Religion, (Jehovah’s witness)
• Cultural competence is about our will and actions to build understanding between people, to
be respectful and open to different cultural perspectives, strengthen cultural security and work
towards equality in opportunity.
• Relationship building is fundamental to cultural competence and is based on the foundations
of understanding each other’s expectations and attitudes, and subsequently building on the
strength of each other’s knowledge, using a wide range of community members and resources
to build on their understandings.
Cultural Awareness
• Someone's cultural awareness is their understanding of the differences between themselves
and people from other countries or other backgrounds, especially differences in attitudes and
values.
• Background, recognizing her biases and prejudices.
Cultural Sensitivity
• is being aware that cultural differences and similarities between people exist without
assigning them a value – positive or negative, better or worse, right or wrong.
5 steps anyone can take to become more culturally sensitive

1. Be aware of why you want to learn more about other cultures
2. Educate yourself on intercultural communication
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3. Become aware of your own culture and biases. ...
4. Let go of any ethnocentric beliefs
5. Ask questions during intercultural exchanges
Cultural motivation
• An individual's actions, desires, and needs to learn about and engage with culture based
incentives which plays an important role in the generation of agripreneurs decision to venture
into agripreneurship for e.g. a sense of loyalty to support the family, a sense of nationalistic
pride.
Ethnocentrism
• Evaluation of other cultures according to preconceptions originating in the standards and
customs of one's own culture.
• When a person tries to judge the culture of other people from the point of view of their own
culture.
Cultural Background
• NO Generalizations about the behavior of a particular group
• Identify how these cultural variables affect the health problem.
Cultural Imposition
is the tendency of a person or group to impose their values and patterns of behavior onto other
persons.
CULTURALLY-CONGRUENT CARE can occur when the provider and client levels fit well together.
It is the process through which providers and clients create an appropriate fit between
professional practice and what patients and families need and want in the context of relevant
cultural domains.
CULTURAL ASSIMILATION
• is the process in which a minority group or culture comes to resemble a dominant group or
assume the values, behaviors, and beliefs of another group
• The process of assimilating involves taking on the traits of the dominant culture to such a
degree that the assimilating group becomes socially indistinguishable from other members of
the society.
STEREOTYPE
• a generalization about a form of behavior, an individual, or a group
• In social psychology, a positive stereotype refers to a subjectively favorable belief held about a
social group.
• Asians with better math ability, African Americans with greater athletic ability, and women with
being more warm and communal.
ETHNICITY
• is the term for a group of people who share a common social and cultural heritage based on
shared traditions, national origin, and physical and biologic characteristics
• Race
• Refers to a person's physical characteristics, such as bone structure and skin, hair, or eye
color.
• An example of race is brown, white, or black skin (all from various parts of the world), while an
example of ethnicity is German or Spanish ancestry (regardless of race) or Han Chinese. Your
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race is determined by how you look while your ethnicity is determined based on the social and
cultural groups you belong to.
HEALTH RELATED BELIEFS AND PRACTICES

• In the Philippines, biomedical services may be supplemented by herbalists and other healers
who specialize in herbal remedies, massage or healing by spiritual means, through power
derived from devotion to Christian saints.
• People may use the concepts of ‘hot’ and ‘cold’ to classify and explain illnesses. Foods,
medicines and temperature/weather conditions are classified according to their hot or cold
qualities and their effects on the body.
• Sudden changes in body temperature may be perceived as harmful.
PREGNANCY
• According to some Filipino beliefs, cravings for food during pregnancy should be satisfied.
• Some pregnant women may avoid eating black foods to avoid the birth of an infant with a dark
skin tone.
• Some pregnant women may place great emphasis on being tidy and beautiful, believing that
these practices will influence the beauty of their child.
• Unpleasant emotions experienced by pregnant women may be blamed for causing birthmarks.
BIRTH
• The most common birthing position is to lie down. Some women may prefer a squatting
position.
• In some regions of the Philippines, it is believed that putting squash leaves on the abdomen of
a laboring woman can facilitate labor.
• Some women believe that drinking coconut water can facilitate a fast labor.
• Some fathers may prefer to be close to their laboring wife, so they can bury the placenta.
AFTER BIRTH
• In some regions a father is responsible for the burial of the placenta.
• He usually buries the placenta very quickly, because the burial of the placenta indicates the
end of the labor, and therefore the end of pain and blood loss experienced by the laboring
woman. The placenta should be offered to the postpartum woman or the father.
• Traditional custom in the Philippines dictates that women should not bathe for about ten days
after giving birth and during menstruation.
• Bathing during these times is seen as a cause of ill health and rheumatism in old age. Sponge
baths and steam baths could be used as alternatives. Women may object to having a show
immediately after giving birth.
• Traditionally, after labor women wear heavy clothes or wrap themselves in blankets to prevent
exposure to ‘cold’ and ‘wind’.
• Some Filipinas bind their abdomen tightly, believing that this practice helps to prevent bleeding
and helps the uterus to retract.
• New and lactating mothers are often given rice porridge (rice boiled soft to a consistency
halfway between soup and puree). This may be served with sweet, salty or spicy
accompaniments. Soup made of meat and vegetables is also believed to help promote
lactation.
• Women fear what is referred to as a ‘relapse’ if they become active too soon. This involves
extreme tiredness, weakness and chronic headache.
• In the Philippines when a woman has a baby, she usually rests while her relatives do all the
housework and cooking.
• Many women can have difficulty coping with the daily routine of looking after a baby in a
country where they may not have the support of an extended family.
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• Postpartum women may be massaged with coconut oil, with the aim of restoring their lost
health, expelling blood clots from the uterus, returning the uterus into a normal position and
promoting lactation
• Some women perform various practices for the purpose of ‘drying out’ the womb.
• For example, ‘mother roasting’ can involve lying beside a stove for up to 30 days, squatting
over a burning clay stove, sitting on a chair over a heated stone or a pot with steaming water,
or bathing in smoke from smoldering leaves.
INFANT CARE
• Infants and small children are thought to be susceptible to fright, which causes crying and
trembling.
• A traditional belief is that an infant may be hexed by an admiring
• Colds and rashes may be accepted as natural in young children, although some may be
regarded as serious.
• In rural Philippines, women will often take a child with a cough to a traditional healer.
• Filipino women should be educated to contact health services if they notice any unusual
symptoms.
• Traditionally, parents sleep with their children or have their children sleep with another relative,
and do not separate them when they are ill.
INFANT FEEDING
• Colostrum is usually considered ‘dirty milk’ and discarded. Some women may be reluctant to
feed colostrum to their newborn, despite encouragement by health professionals.
• Breast feeding on demand is normal practice for rural Filipinas. Women may adopt mixed
feeding because of the demands of work outside the home.
• Some mothers believe that a mother’s mood can be transmitted through breast milk and
therefore do not feed if they feel sorrow or anger.
• Breast feeding may also cease if the child contracts diarrhea, in case the illness becomes
worse.
OTHER BELIEFS
1. Needs to eat double because she is carrying a fetus.
2. Will give birth to a baby boy if her belly is pointy and , and if it spreads out to the sides, her baby
will be a girl.
3. Should expect her baby to come out on her due date .
4. Will give birth to a baby girl if her face looks rounder.
5. Woman’s navel is connected to her fetus’ umbilical cord
6. Will give birth to a boy if her weight increases towards end of third trimester.
7. Must not go out alone in the night because it is dangerous .
8. Will bear a child with a cleft lip if she watches the lunar eclipse , to protect herself she should
carry a key or safety pin.
9. should drink lots of milk during her pregnancy so that she will have the lighter complexion.
10. should sleep with a Bible under her bed to scare away the evil .
11. Should not sit with cross legs on the floor because her fetus’ head will flatten.
12. Should not pull her stomach in, because her fetus will be suffocated inside.
13. Will bear a female if she feels difficulty on her left side if she usually listens to music and
sings, and if she is fond of watching a dance.
14. Should not hide her pregnancy because her child will become deaf or powerless.
15. Should not look to dead people or attend funerals because her fetus will die before delivery.
can avoid giving birth to twins if she will not eat twin fruit like bananas.
17. Should not mingle with deaf and tongue-tied person because she will give birth to a child with
same characteristics.
18. Should not kiss the cross of a rosary, or a statue, because her baby will become mute.
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19. Should eat round fruits and vegetables to give birth to a girl must eat long vegetables like
carrots or cucumbers if she likes to deliver a boy.
20. Will deliver a baby boy if her fetus in her womb have fast heartbeat and will give birth to a
baby girl if have the slower heartbeat.
BELIEFS DURING LABOR AND DELIVERY

• Be attended by female family members.
• Rub her abdomen into a wooden post to facilitate delivery of the fetus
• Eat fresh native egg as a source of energy
• Not be visited by a person born via breech because it will complicate labor.
• Prohibit her guest/s to stand too near or at the door and at the stairs to prevent complications
in labor.
BELIEFS ON POSTPARTUM CARE

1. Should recover after delivery and her responsibility in the house should be taken cared by her
family and relatives.
2. Must be protected from cold wind, rest completely and stay inside the house for 30 to 40 days after
delivery. This will help her heal, facilitate and keeps “cold” or “wind” from getting inside her body.
3. Must not stay under the rain, must not take in cold drinks after giving birth so that she will not get
easily chill.
4. Should be given hot soup and nutritious foods to eat so she can make the most nourishing milk.
5. Can be freed from labor pains and bleeding if the placenta will be buried immediately by the
baby’s father just after expulsion.
BELIEFS ON INFANT CARE NEWBORN BABIES

1. Are protected from cold wind and from anything that might startle or frighten them.
2. Are applied with baby oil into the fontanelle and aciete de manzanilla into the abdomen, back and
sole early in the morning and in the late afternoon to protect them from chills.
3. Should be breastfeed since breastmilk is the best source of nutrients for the baby.
4. Has the same temperature with that of the mother, and this could serve as a guide of the mother in
determining when to provide warmth to the baby.
5. Must have a rosary beside them when they are left by the mother alone in the room.
HOW TO PROVIDE CULTURALLY COMPETENT CARE TO FILIPINO PATIENTS DURING LABOR

AND DELIVERY
1. Perform hand hygiene and don PPE as appropriate
2.Identify the patient according to facility protocol
3. Establish privacy by closing the door to the patient’s room and/or drawing the curtain surrounding
the bed
4. If the patient is alert and oriented and one or more family members are at the bedside, introduce
yourself and explain your clinical role;
Determine whether the patient/family require special considerations regarding communication.
5. Assess for knowledge deficits and anxiety regarding provision of CC care during labor and delivery;
answer any questions and provide emotional support, as needed.
6. Assess/verify the cultural identity and cultural beliefs, attitudes, and traditions of the patient/family
7. Educate about the importance of feeding colostrum by breastfeeding during the first few days of the
child’s life to promote immunity, a healthy intestinal environment, and normal neurologic development.
8. Explain that the health qualities of colostrum are not affected by its color or how long it has been
present in the breast
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MYTHS & BELIEFS RELATED TO PREGNANCY
Myth #1: "Paglilihi" or Pregnancy Cravings

• Many Filipinos, to this day, believe that what you eat and crave for during pregnancy has a
direct influence on the physical attributes of the baby.
• However, scientific studies prove that there is no link between paglilihi and the unborn baby's
physical attributes.
• As Genetics tell us, our physical attributes are inherited from our parents' and grandparents'
set of genes and not from food cravings.
Myth #2: Post-labor Stomach Binding

• It is a common practice for Filipina women to bind their abdomen tightly after pregnancy,
believing that this practice helps the uterus to retract and gets the stomach back into shape.
• However, scientific evidence suggests otherwise. Tying a cloth around one’s tummy can put
pressure on the uterus, causing it to bleed. It can also lead to further complications, especially
if you’ve experienced a C-section.
Myth #3: Eating twin bananas may lead to twins

• This myth has many variations, with some claiming that bananas lead to regular twins while
others insist on Siamese twins, which is a serious condition wherein twins are born with part of
their bodies joined together.
• However, this myth has no scientific basis, as twin development happens purely by chance or
because of your genes (for non-identical twins).
Myth #4: "Usog" or the Stranger's Evil Eye

• Usog is an age-old Filipino superstition. The belief states that discomfort (fever, bloating,
nausea/vomiting) is brought to the baby by a stranger or visitor who is said to have an evil eye.
A simple greeting from the visitor is said to be enough to cause this curse.
• To counter the curse, the stranger would need to say "pwera usog" while licking his thumb and
applying saliva while tracing a cross on the infant's forehead.
• no scientific basis or proof regarding the occurrences of usog,
XII . MATERNAL AND CHILD CARE ENTERPRENEURIAL OPPORTUNITIES:

A. BIRTHING CLINICS
B. DAY CARE
Entrepreneurship in nursing:
Entrepreneurship means that salaried nurse develops, promotes, and delivers an innovative health
care or nursing practice.
For entrepreneurship to be improved severity in nursing, nursing education must ensure that students
are provided with the opportunity to develop the necessary knowledge and skills.
The motivation to start a business or be self-employed requires vision, a creative idea for
solving a problem, and a strong desire for success. Success will more often be achieved if
the reason for seeking change is positive and not just a reaction to negative work issues.
Nurses contemplating a new venture will begin by conducting a thorough assessment of

their motives and their capacity to handle the demands of the enterprise they have in mind.
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For a nurse entrepreneur who wants to start her own business or private practice, the
advantages and disadvantages of owning a business should be carefully considered.
‘Being your own boss’ is liberating, exciting, rewarding, motivating and empowering. It may
also be difficult and lonely, and it requires taking risks. It may be necessary to work long
hours, assume multiple roles, risk uncertain income, and negotiate continually with others
as providers or receivers of services. According to Traynor et al. (2006) ‘agency’ and ‘risk
taking’ are often said to be defining characteristics of entrepreneurial activity.
Entrepreneurs need to be motivated and disciplined as well as very organized. Most have a
good measure of self-confidence, a strong self-image and a need for achievement.
According to the American Institute of Small Business, a successful entrepreneur has
"desire, diligence, details, discipline and determination” (Papp 2000, p. 137). In the often difficult world
of business, it is important for the nurse entrepreneur to display integrity,
reliability, patience and enthusiasm to earn the respect of business and professional
colleagues, as well as that of financial partners and the target clientele.
Schulmeister (1999) Recommends that nurses examine their goals and resources and answer
several important questions before venturing on Entrepreneurial.
• Why does starting a business interest me?
• What are my clinical strengths?
• What are my personal strengths and weaknesses?
• How well do I cope with uncertainty?
• How essential is a steady income?
• Do I have necessary financial, emotional and physical reserves?
• Do I have the support of those closest to me?
• Do I have the time and energy required to get the business started?
• What sacrifices am I willing to make to pursue this activity?
BENEFICIAL ATTRIBUTES FOR ENTREPRENEURS INCLUDE THE ABILITY:

• to make decisions independently
• to take risks in order to achieve a clear set of goals
• to plan ahead
• to be flexible and adaptable to unexpected changes and opportunities,
ready to deal with failure and uncertainty
• to get things done on time
• to take advice from others
• to be persistent
• to communicate well
• to know when and when not to compromise
Career planning and development assists nurses to develop and utilize the knowledge, skills, and
attitudes necessary for them to create a work content and environment that is meaningful, productive
and satisfying.
The career planning and development process helps answer the following four questions:
1. Where have I been?
2. Where am I now?
3. Where would I like to go?
4. How will I get there?
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Step-by-step procedure for how the business will be established, taking into account:
• Who are the customers?
• Who are the competitors?
• What will customers require from the business?
• What are the start-up costs?
• What business structures are needed?
• When will the services/products be required?
• What advantages will this business have over the competitors?
FOR A NURSE TO START A BUSINESS YOU SHOULD:

• EDUCATE THEMSELVES ABOUT BUSINESS PRINCIPLES
• IDENTIFIES BUSSINESS PLAN (target market, services offered, competitors, facilities,
equipment and personnel, identify risk; time frame; financial plan)
• FINANCING THE START-UP OF BUSINESS (DEBT/LOAN/EQUITY)
• SPONSORSHIP FOR INTRAPRENEURS – find a sponsor on your organization/firm)
• MARKETING – public relations and advertising to the identified market
• PUBLICITY – if with good record – will share to others by means of newsletter, interview to
local media – lection and forum engagement
• INSURANCE COVERAGE. LICENSES AND PERMITS
• SERVICE ISSUES – within the Scope & Standard only
• CONTINUING EDUCATION – attend seminar, tech shop and etc.
• PERSONAL SUPPORT – family and friends
• WORKING FROM HOME – home based or consultancy
• CREDIBLE TIMEFRAMES – start from small scale and grow slowly (would even seek for
partners to market aggressively)
CRITERIA USED FOR CALCULATING FEES INCLUDE:

• the complexity of the task;
• the professional responsibility implied;
• the level of expertise required;
• the time involved (including travel); and
• the equipment needed.
CONSIDERATIONS:
• Evaluating Costs
• Tax Issues
• Record keeping & documentation – accurate ( pts chart/ financial accounts)
• Negotiating contracts – consultancy / business project
• Reimbursement systems and policy – politics of payment – govt. insurances
➢ Nurses are facing a world in which global changes are affecting our industry and profession.
➢ There are opportunities for innovation that did not previously exist.
➢ There are opportunities for independent practice, private practice, joint ventures with
physicians or other health professionals, consultancies, staffing businesses or invention of a
new piece of equipment for patient care.
➢ Most of all, there are opportunities for personal and professional growth.
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➢ Nurse employees can still develop innovative practice ideas and become intrapreneurs within
their workplace setting.
5. International Journal of Scientific & Engineering Research Volume 8, Issue 9, September-2017.
ISSN 2229-5518
6. Sanders- Kingma (2012). Handbook on Entrepreneurial Practice Nurses creating opportunities as
Entrepreneurs and Intrapreneurs. ICN -International Council of Nurses: Geneva (Switzerland)
Let’s Check!
ACTIVITY 1: ENUMERATION TYPE- Fill in the blanks
1. Define Entrepreneurship?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
2. According to Schulmeister (1999). What the several questions that a nurse examines before
venturing to Entrepreneurial? Enumerate at least 5.
1.__________________________________________________________________________
2.__________________________________________________________________________
3.__________________________________________________________________________
4.__________________________________________________________________________
5.__________________________________________________________________________
3. Enumerate at least 5 abilities that are beneficial attributes for Entrepreneurs.

1. _________________________________________________________________________
2. _________________________________________________________________________
3. _________________________________________________________________________
4. _________________________________________________________________________
5._________________________________________________________________________
4. For a Nurse to start a business she/he should take several considerations. Give only 5
important things to remember
1._________________________________________________________________________
2._________________________________________________________________________
3._________________________________________________________________________
4._________________________________________________________________________
5._________________________________________________________________________
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Let’s Analyze!
ACTIVITY 2 – Journal Reading
1. Research for a journal reading on Birthing Practices of any cultural group in the Philippines.
Submit a summary, reflections and indicate the book reference.( 15 points)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
In a Nutshell!
ACTIVITY 3 – PROJECT PROPOSAL OF A BIRTHING CLINIC
1. Make a project proposal of a birthing clinic considering the guidelines that were given during your
lecture session. Base your proposal on your lecture output. (20 points)
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
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College of Health Sciences Education

3rd Floor, DPT Building

Physically Distanced but Academically Engaged

Self-Instructional Manual (SIM) for Self-Directed Learning (SDL)

Course/Subject: NCM 107n/L:

Name of Teacher: Majella L. Gonzales, RN, MAN

THIS SIM/SDL MANUAL IS A DRAFT VERSION ONLY; NOT FOR REPRODUCTION

NCM 107n/L: CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS)

Course Coordinator: MAJELLA L. GONZALES

COURSE OUTLINE POLICY

Please note that academic dishonesty such as cheating and commissioning

2. John Michael G. Balaba,RPh

Library Brigida E. Bacani

Course Information – see/download course syllabus in the Black Board LMS

I. FRAMEWORK FOR MATERNAL AND CHILD HEALTH NURSING:

PHILOSOPHY OF MATERNAL AND CHILD HEALTH NURSING:

THEORIES RELATED TO MATERNAL AND CHILD NURSING

ROLES AND RESPONSILITIES OF A MATERNAL AND CHILD NURSE:

WHO (WORLD HEALTH ORGANIZATION) SUSTAINABLE DEVELOPMENT GOAL:

1. Self-care theory was proposed by?

6. Unitary Human Beings theory" was explained by?

3. Goal 1 is about poverty. What is the aim of this Goal?

6. Which of the following is not part of the Sustainable Development Goals?

8. Which of the following is not part of Goal 15, on ecosystems?

9. Which of the following is not true about the SDGs?

II. REPRODUCTIVE ANS SEXUAL HEALTH

II.A CONCEPT OF UNITIVE AND PROCREATIVE HEALTH

PROCREATION, CREATION AND EVOLUTION:

CHARACTERISTICS OF THE FAMILY AS A CLIENT

CHARACTERISTICS OF HEALTHY FAMILIES:

II.B Female / Male Reproductive System

Male Reproductive Structures:

Male Perineum: Inferior view of the male perineum.

ANATOMY OF THE MALE REPRODUCTIVE SYSTEM:

SPERM CELL DEVELOPMENT

PHYSIOLOGY OF MALE REPRODUCTION

MALE SEXUAL BEHAVIOR AND THE MALE SEX ACT

Sagittal Section of the Female Pelvis

Uterus, Vagina, Uterine Tubes, Ovaries, and Supporting Ligaments

Female External Genitalia

Inferior View of the Female Perineum

ANATOMY OF THE FEMALE REPRODUCTIVE SYSTEM:

2. The peritoneum (ovarian epithelium) covers the surface of the ovaries.

PHYSIOLOGY OF FEMALE REPRODUCTION

FEMALE SEXUAL BEHAVIOR AND THE FEMALE SEX ACT:

SPERM CELL MOVEMENT:

II.C HUMAN SEXUALITY

HUMAN SEXUAL RESPONSE AS A CYCLE WITH FOUR DISCRETE STAGES:

TYPES OF SEXUAL ORIENTATION:

TYPES OF SEXUAL EXPRESSION:

DISORDERS OF SEXUAL FUNCTIONING:

II.D RESPONSIBLE PARENTHOOD:

D.1 DEFINING THE CONCEPT OF FAMILY:

D.2 FAMILY TYPES:

D.3 FAMILY TASKS:

What does the Church mean by responsible parenthood?

Why is responsible parenthood important?

What is the role of responsible parenthood?

What is the Role of a Parent? The Roles of Being a Parent

What are the duties and responsibilities of parents?

Rights and Duties of Parents

What is RA 7610 in the Philippines?