Legal Consideration of Maternal and Child Practice
Informed Consent
- The process by which a patient learns
about and understands the purpose,
benefits, and potential risks of
a medical or surgical intervention,
including clinical trials, and then agrees to
receive the treatment or participate in the
trial.
Legal Concerns
New Technologies
- (e.g., assisted reproduction, surrogate
motherhood, umbilical cord sampling, and
end-of-life decisions).
Assisted reproductive technology (ART)
- is used to treat infertility. It
includes fertility treatments that handle
both a woman's egg and a man's sperm. It
works by removing eggs from a woman's
body. The eggs are then mixed with
sperm to make embryos. The embryos
are then put back in the woman's body.
Surrogate motherhood
- practice in which a woman
(the surrogate mother) bears a child for
a couple unable to produce children in the
usual way, usually because the wife is
infertile or otherwise unable to undergo
pregnancy.
Percutaneous umbilical cord blood
sampling (PUBS)
- also called cordocentesis, fetal blood
sampling, or umbilical vein sampling is
a diagnostic genetic test that examines
blood from the fetal umbilical cord to
detect ;
 Chromosomal abnormalities.
 Blood disorders such as anemia.
 Some metabolic disorders.
 Infections such as toxoplasmosis and rubella.
 Some causes of structural problems or
intrauterine growth restriction.
End-of-life decision making
- is the process that healthcare providers,
patients, and patients’ families go through
when considering what treatments will or
will not be used to treat a life-threatening
illness.
“Wrongful Birth”
- is the birth of a disabled child whose
pregnancy the parents would have chosen
to end if they have been informed about
the disability during pregnancy.
“Wrongful Life”
- is a claim that negligent prenatal testing
on the part of a healthcare provider
resulted in the birth of a disabled child.
“Wrongful Conception”
- denotes that a contraceptive measure
failed, allowing an unwanted child to be
conceived and born.
Confidentiality
- means that personal and medical
information given to a health
care provider will not be disclosed to
others unless the individual has given
specific permission for such release.
Republic Act No. 10173,
- otherwise known as the Data Privacy
Act is a law that seeks to protect all forms
of information, be it private, personal, or
sensitive.The patient has the right to
demand that all information,
communication and records pertaining to
his care be treated as confidential.
Information
- In the course of
his/her treatment and hospital care, the
patient or his/her legal guardian has a
right to be informed of the result of the
evaluation of the nature and extent of
his/her disease, any other additional or
further contemplated medical treatment
on surgical procedure or procedures,
including any other additional medicines
to be administered.
Medical Records
- serves as the central repository for
planning patient care and documenting
communication among patient and health
care provider and professionals
contributing to the patient's care.
- Includes a variety of types of "notes"
entered over time by health care
professionals, recording observations and
administration of drugs and therapies,
 orders for the administration of drugs and
therapies, test results, x-rays, reports, etc.
Documentation
- Essential for justifying actions.
- Good documentation promotes patient
safety and quality of care. Complete and
accurate medical recordkeeping can help
ensure that your patients get the right care
at the right time.
- Good documentation is important to
protect you the provider. Good
documentation can help you avoid liability
and keep out of fraud and abuse trouble.
SCOPE AND STANDARD OF MATERNAL
CHILD PRACTICES
MATERNAL AND CHILD HEALTH.
- The Maternal and child health (MCH)
refers to the health of mothers, infants,
children, and adolescents.
- It is a profession within the public health
committed to promoting the health status
and future challenges of this vulnerable
population.
- 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.
Two main national health goals are:
• To increase quality and years of healthy life
• To eliminate health disparities
Components of maternal and child health
1. Family planning and reproductive health
services
2. Maternal, newborn, and child health services
3. Health communications
4. Health commodities and supplies
5. Health system strengthen
Examples of Scope of practice include:
- Serves an advocate to protect the rights of
all family members, including the fetus
- Demonstrates a high degree of
independent nursing functions because
teaching and counseling are major
interventions
- Promotes health and disease prevention
because these protect the health of the
next generation.
- Respects personal, cultural, and spiritual
attitudes and beliefs.
- Encourages family bonding through
rooming in and family visiting in maternal
and child health care settings.
STANDARDS OF CARE
1. Every woman and new born receives
routine, evidence based care and
management of complications during
labor, childbirth and the early postnatal
period
2. The health of information system enables
use of data to ensure early, appropriate
action to improve the care of every
woman and newborn
3. Every woman and newborn with condition
that cannot be dealt with effectively with
the available resources is appropriately
referred.
4. Communication with women and their
families is effective and responds to their
needs and preferences.
5. Women and newborns receive care with
respect and preservation of their dignity.
6. Every woman and her family are provided
with emotional support that is sensitive to
their needs and strengthens the woman's
capability
7. For every woman and newborn,
component, motivated staff are
consistently available to provide routine
care and management complications.
8. The health facility has an appropriate
physical environment, with adequate
water, sanitation and energy supplies and
equipment for routine maternal and
newborn care.
Health Promotion and Diseases Prevention in
different Stage of growth and development
Nurse role in health promotion
– Model healthy life style behaviors and
attitude
– Facilitate client involvement in assessment,
implementation, evaluation of health goal
– Teach the client health care strategies to
enhance fitness, improve nutrition, manage
stress and enhance relationship
– Assist individual, families and communities
to increase their level of health
 – Educate the client to be effective health care
costumers
– Assist the client, families and communities
to develop and choose health promoting
option.
Nursing Care of a Family With an
Infant
 Growth and development of infant
- nfants grow rapidly both in size and in
their ability to perform task during their
first year.
- A standard schedule for healthcare visit is
for 2 weeks, 2months, 4month, 6months,
9 month, and 12month visit. These visits
are important for the infant because they
provided time for immunization and health
assessment; They are also important for
parents because they provided an
opportunity for parents to ask questions
about their child growth pattern and
developmental progress, they provide
opportunities for healthcare provider to
assess for potential problems as they first
appear.
 Physical growth
– The psysiologic change that occure in the
infant year reflect both increasing maturity
and growth of the body organs.
– Height averag of bith lenght of 20 in to
about 30in ( 50.8 to 76.2 cm )
– Weight 4 to 6 months and triple it by
1year. 6 months avarge 21lb per months
• Boy - weight 10 (22lb)
• Girls - 9.5 (21lb)
– Head circumference measures about 13
3⁄4 inches (35 cm), growing to about 15
inches (38 cm) by one month.
– Body portion
– Body System cardiovascular system
heart rate slow from 110 to 160 beats/
mins to 100 to 120 beats/ mins by the end
of the first years.
 Development milestones
The Nursing role in health promotion of an
infant and family
 Promoting infant safety
- Unintentional injury is leading cause of
death in children from 1 month Through 24
years
- Of age. These second only to acute
infection as a cause of acute morbidity and
primary care Provider visit.
- Aspiration prevention
- Fall Prevention
- Car safety
- Safety with siblings
- Bathing and swimming Safety
- Childproofing
 Promoting nutritional health of an infant
- The best Food for infant during 12 months
of life is breast feeding.
- A breasfeed or partially Breastfeed for
infant should receive 400 IU of vitamin D
supplement starting with 2 weeks of age.
- Recommended Dietary allowance for
Infant
- Introduction of solid food
- Introducing solid foods to your infant is an
exciting milestone.
- there's no need to rush this milestone.
Most babies are ready to start solids
between 5 and 6 months. Don't start solids
before 4 months
- 4 to 8 months: Pureed veggies, fruits, and
meats
- You may have heard that eating fruits
before vegetables can cause a lifelong
preference for sweet foods, but there's no
research to back that up. So it's up to you
whether you begin with bananas or carrots,
or pureed chicken for that matter.
- 6 to 8 months: Single-ingredient finger
foods
- Whether you've begun with purees or are
starting solids just with finger foods, may
babies enjoy experimenting with self-
 feeding from an early age. Don't offer any
hard, raw foods, such as apple slices or
carrot sticks at this point. Make sure fruits
and veggies are soft enough to mash with
gentle pressure between your thumb and
forefinger.
- 9 to 12 months: Chopped, ground, or
mashed foods
- As soon as your child is able, transition
him away from smooth purees. Incorporate
more finger foods and make sure there's
texture in any mash. It's also safe to feed
your child soft rice and casseroles at this
point.
- Solid Foods Not to Give Baby
- You should avoid giving infants the
following foods:
- Honey: It can cause botulism, a serious
illness, if introduced too early.
- Cow's Milk: Stick with breast milk and
formula as a primary beverage until your
baby is a year old. It's fine to use cow's
milk in cooking or baking, though.
- Nuts, Popcorn, Whole Grapes, and Globs
of Nut Butter: These foods are choking
hazards.
 Promoting Infant Development in Daily
Activities
- In the First years, Caring for and infant
Feeding, bathings, Dressing and so forth
OccupiesWhat may seem like nearly all of
the parents walking hours. All of these
basic related care activities Provide
informatant Opportunities for parents and
infant to get to know one another and to
become use to each other unique
Personalities and patterns. Nurse can play
a a key roll in teaching Parents about
these activities and stressing There
important:
- Bathiing - Except in every hot weather an
infant does not need a bath everday
- Diaper area care
- Dressing
- Sleep
- Excercise
 Parental concern and Problem related to
normal infant development
– Teething
– Thump sucking
– Use of pacifers
– Head baging
– Constipation
– Loss stool
– Diaper Dermatitis
– Maliaria
– Baby bottles tooth decay syndrome
– Obesity in infant
Nursing Care of a Family With a
Toddler
– Your child is advancing from infancy
toward and into the preschool years.
During this time, his or her physical
growth and motor development will slow,
but you can expect to see some
tremendous intellectual, social, and
emotional changes.
– Toddler Growth & Development
– Physical Skills
– Social Skills
– Cognitive Thinking
Physical growth
– Physical Growth: While toddlers are making
great strides developmentally, their physical
growth begins to slow. Weight: – A child
gains only about 2.5 kg and 12cm a year
during the toddler period. – A toddler‘s
appetite decreases accordingly, yet
adequate intake of all nutrients is still
essential to meet energy needs.
– Head circumference: – Increases only about
2 cm during the second year compared to
about 12 cm during the first year. – Head
circumference equals chest circumference
at 6 months to 1 year of age; By 2 years,
chest circumference has grown greater than
that of the head. Physical Growth:
– Body Contour: – Toddlers tend to have a
prominent abdomen – because although
they are walking well, their abdominal
muscles are not yet strong enough to
support abdominal contents. – They have a
forward curve of the spine at the sacral area
(lordosis). Physical Growth:
– Body systems: – Body systems continue to
mature during this time. – Respirations slow
slightly but continue to be mainly abdominal.
– The heart rate slows from 110 to 90 bpm;
 blood pressure increases to about 99/64
mm Hg. – The brain develops to about 90%
of its adult size. – In the respiratory system,
the lumens of vessels enlarged
progressively so the threat of lower
respiratory infection becomes less. Physical
Growth:
– Body systems: – Stomach secretions
become more acids; therefore,
gastrointestinal infections also become less
common. – Stomach capacity increases to
the point a child can eat three meals a day.
– Control of the urinary and anal sphincters
becomes possible with complete myelination
of the spinal cord. – IgG and IgM antibody
production becomes mature at 2 years of
age. – The passive immunity obtain during
intrauterine life is no longer operative.
Physical Growth:
– Teeth: – Eight new teeth (the canines and
first molars) erupt during the 2 nd year. All
20 deciduous teeth are generally present by
2.5 – 3 years of age. Physical Growth:
Development milestones
– Language development
– Language Development: – Toddler hood
is a critical time for language
development, although even this varies
among children, because in order to
master language, children need practice
time. – A word that is used frequently by
toddlers and that is a manifestation of
their developing autonomy is a “no”.
Toddlers may use the word to mean they
are refusing a task, or they do not
understand it.
– A child who is 2 years old and does not
talk in two words, noun verb simple
sentence need a careful assessment to
determine the cause because this implies
underdevelopment.
– Parents are offen worried a lack of
language means theirs child has ang
autism Sperculum disorder. It is true that a
delay in language can represent the first
syndrom of autism, but it also may be only
be a temporary phenomenon until the
child fully graps the essence of speech.
– Emotional development
– Children Change a great deal in their
ability to Understand the world and how
they relate to people during toddler years
– Socialization
– Play behavior
Health Promotion for Toddler
– Toddlers trend to develop many upper
respiratory and ear infection but otherwise
come to health care facilities most often
for health maintenance visit,and for
important immunizations.
– Routine health maintenance visit also
provide opportunities to support parents
through,the normal crise of the toddler
period. Way to encourage parents to
promote healthy development of
independence in their toddlers include
listening carefully to their concerns, asking
questions to help separate the objectives
possible emotional biases, and providing
guidelines on how to handle specific
problems.
The Nursing role in health promotion of an
toddler and family
 Health promotion for safety
– Accident are the major cause of death in
infant through late adolesecent.
Unintentional ingestion (poisoning) and
auto accident are types of unintentional
injuries that occur most frequently in
toddlers.
– Although Poisoning can involve medicine
such as acetaminophen, it most often
occurs from ingestion of cleaning
products.
– Apiration – is major danger for children of
this age.
– Motor vehicle, burns, falls, drowining and
playground injuries. These occur because
toddlers motor ability jumps ahead of their
judgement.
Promoting Nutritional Health of a Toddler
– Toddlers usually do not like food that is
“mixed up” such as casseroles; they often
prefer that different foods do not touch
one another on their plate. – Toddler
Nutrition: Children ages 1 – 3 years
should consume 1,300 kcal daily. Protein
and carbohydrates needs are often easily
 met during the toddler period; diets in high
sugar must be avoided.
– Because growth slow abruptly after the
first years of life, a toddlers appetite is
usually less than ang infant. Children who
are hungrily 2 months earlier now may sit
and play with their food. It is important to
educate parents that, while the child is still
an infant, this decline in food intake will
occur, so they will not be concern when it
happens. Because the actual amount of
food eaten daily variea from one child to
another,,teach parents to place a small
amount of food on a plate and allow their
child cannot finish. One tablepoonful of
each food server is a good start. Also,
cleaning a plate gives a child a feeeling of
independent fuctioning, wheres leaving
food uneaten suggest that parents
expected something more.
– Bottle feeding – recommend that mothers
do this gradually in order to avoid
confrontation.
– Self Feeding – is a major ways to both
strength independence in a toddler and
improve the amount of food consumed.
Offering finger food.
– A Vegetarian Diet
Promotion Daily Activities
– Dressing: By the end of the toddler
period, most children can put on their own
socks, underpants and undershirt. When
toddlers dress themselves, they invariably
put shoes in the wrong feet and shirt and
pants on backwards.
– Sleep: They may begin the toddler period
napping twice a day and sleeping 12
hours each night, and end it with one nap
a day and only 8 hours sleep at night.
– Bathing: The time for a toddler’s bath
should depend on the parents and the
child wishes and schedule. Toddlers
usually enjoy bath time and parents
should make an effort to make it fun by
providing a toy such as rubber duck, boat
or a toy fish. Remind parents that
although toddlers can sit well in a bathtub,
it is not safe to leave them unsupervise
– Care of Teeth: Toddlers need to have a
tooth brush they recognized as their own.
Toward the end of Toddler period, they
can begin to do brushing themselves
under supervision. Remind parents it is
better for a child to brush thoroughly once
a day, probably at bedtime, than do it
poorly many times a day. After brushing,
parents can use dental floss to clean
between the child’s teeth and remove
plaque. Urge parents to schedule a visit to
a dentist skilled in pediatric dental care by
2.5 years of age for assessment of
dentition
Parental Concerns Associated with the
Toddler Period:
– Toilet Training: – Toilet training is one of
the biggest tasks a toddler must achieve.
– Before children can begin to be toilet
trained, they must have reached important
developmental levels one physiologic and
the other cognitive: They must have
control of rectal and urethral sphincters,
usually achieved at the time they walk
well. They must have cognitive
understanding of what it means to hold
urine and stools until they can release
them at a certain place and time.
– Ritualistic Behavior: Negativism: – As
part of establishing their identities as
separate individuals, toddlers typically go
through a period of extreme negativism. –
They do not want to do anything a parent
wants them to do. Their reply to every
request is a definite “no.”
– Discipline: – Remind parents that
“discipline” and “punishment” are not
interchangeable terms. – Discipline
means setting rules or road signs so
children know what is expected of them. –
Punishment is a consequence that results
from a breakdown in discipline, from the
child’s disregard or the rules that were
learned. – Two general rules to follow:
Parents need to be consistent. Rules are
learned best if corrected behavior is
praised rather than wrong behavior
punished. Ritualistic Behavior:
 – Separation Anxiety: – Fear of being
separated from parents begins at about 6
months of age and persists throughout the
preschool period. – This universal fear of
this age group is known as separation
anxiety. – Parents may ask what they can
do about this problem. They believe they
have a right to leave their child in a
babysitter’s or center’ care. Ritualistic
Behavior:
– Temper Tantrums: – Almost every
toddler has a temper tantrum at one time
or another. – The child may kick, scream,
stamp feet, shout “No,no,no” lie on the
floor, flail arms and legs and bang the
head against the floor. – Children may
hold their breath until they become
cyanotic and slump to the floor. Ritualistic
Behavior:
Nursing Care of a Family With a Preschool
Child
Preschool Period
– Traditionally include the years 3, 4, and 5.
– It is an important period of growth for
parents because they may be unsure how
much independence and responsibility for
self-care they should allow their rapidly
maturing child.
– Most children want to do things for
themselves
Physical Growth
– Definite change in body contour occurs
during this preschool years. Wide-legged
gait, prominent lordosis and protuberant
abdomen of the toddler change to
slimmer, taller, and much more childlike
proportion.
– Contour changes are so definite that
future body type – Ectomorphic Body
Build (slim body build) or Endomorphic
Body Build (large body build).
– Child’s ability to learn extended language
– Lymphatic Tissue increases in size,
particularly the tonsils, immune globulin
(Ig)G and IgA antibodies increase
– Physiologic Splitting of heart sound may
be present from auscultation; innocent
heart murmur may be heard
– Bladder is easily palpable above the
symphysis pubis; voiding is frequent
enough (9 to 10 times a day)
– Child had an in determine longitudinal
arch in the foot generally demonstrates a
well-formed arch
– Muscles are noticeable stronger
– Many children at this period exhibits Genu
Valgus (knock-knees); disappears with
increase skeletal growth
– Weight (average gain 4.5lb(2kg), Height 2
to 3.5 inches (6-8cm), Body Mass Index,
and Head Circumference and Teeth (age
of 3 they have their 20 deciduous teeth)
Developmental Milestone
 Language Development
- Egocentrism or perceiving that one’s
thoughts and need are better or more
important than those others
 Play
 Emotional Development
– Initiative
– Imitation
– Fantasy
– Oedipus and Electra Complexes
 Oedipus Complex refers to the strong
emotional attachment a preschool boy
demonstrates towards his mother
 Electra Complex refers to the
attachment of a preschool girl to her
father.
– Gender roles
– Socialization
– Cognitive Development (Intuitional Thought)
– Moral and Spiritual Development
Parental Concerns Associated with Preschool
Period
 Common Health Problems
Common Colds, Ear infection, GIT disturbances
(vomiting and diarrhea) and upper respiratory
infection
 Common Fears
Fear of the Dark, Fear of Mutilation, Fear of
Separation or Abandonment
 Behavior Violation
Telling Tall Tales, Imaginary Friend, Difficulty
Sharing, Regression, Sibling Rivalry
 Preparing for a New Sibling
 Sex Education
 Choosing a Preschool or Child Care Center
 Preparing a Child for School
 Broken Fluency
Nursing Care of a Family With a School Age
Child
– Between the ages of 6 to 12 years.
– Represent a time of slow physical growth
but a rapid growth for the child’s cognitive
and developmental growth.
– At this period, children tends to select
activities based on the interest of peers.
– It is the initiation of independent decision
making.
Physical Growth
– Physical growth
Weight 3-5lb(1.3-2.2kg), Height 1 to 2inches(2.5-
5cm), children who did not lose a lordosis and
knock-kneed appearance during the preschool is
now lose.
At 10 yrs of age, brain growth is complete, fine
motor coordination, Eye globe reaches its final
shape
Immune Globulins IgG and IgA reaches adult
level and Lymphatic tissue grows in size until
about age of 9.
Left ventricle of the heart enlarges, pulse rate
decreases to 70 to 80 bpm, BP rises to about
112/60mmHg
– Sexual maturation
Sexual and Physical Concerns
Concerns of Girls and Boys
– Teeth
Permanent Teeth erupts
Developmental Milestone
– Gross Motor Development
– Fine Motor Development
– Play
Language Development
Emotional Development (industry vs
Inferiority)
Cognitive Development
 Decentering – ability to project one’s self
into other people’s situation
 Accommodation – ability to adapt thought
processes to fit what is perceived such as
understanding that there can be more
other reason for the people’s action
 Conservation – ability to appreciate that a
change in shape does not necessarily
change in size
 Class Inclusion – ability to understand that
objects can belong to more than one
classification.
Moral and Spiritual Development
Common Health Problems of the School-Age
Period
 Dental Cavities
Caries (Cavities) are progressive, destructive
lesions or decalcification of the tooth enamel and
dentin.
 Malocclusion
A deviation of tooth position from the normal. It
can be congenital due to condition such as cleft
palat, small lower jaw, or familial traits tending
towards maloclussion.
Concerns and Problems of School-Age
Period
 ADHD (attention deficit hyperactivity disorder)
 ASD (Autistic Spectrum Disorder)
 Problems Associated with Language
Development
 Common Fears and Anxieties of School-Age
Child
Anxiety Related tp Beginning School, School
Refusal or Phobia,
 Children who Spend Time Independently
 Sex Education
 Stealing
 Violence or Terrorism
 Bullying
 Recreational Drug Use
 Child of Alcoholic Parent
Nursing Care of a Family With an Adolescent
– The period between the age of 13 and up to
20 years, a time that serves as a transition
between childhood and becoming a late
adolescent.
Early Period (13 – 14 yrs)
Middle Period (15 -16 yrs)
Late Period (17 to 20 yrs)
– Drastic Changes in physical appearance and
expectations of others
– Physical Growth
Physiologic growth and Development of
adult coordination occur, mostly in weight.
– Girls – 1-2 inch taller than boys coming in
adolescence but stop growing within 3 yrs
from menarche. Weight 15-55lb(7-25kg) and
growth of epiphyseal lines of the long bones
stops at 16 or 17 yrs of age.
– Boys – grow about 4-12inches in height and
gain weight of 15-65lb(7-30kg). Growth of
epiphyseal lines of the long bones stop at 18
to 20 yrs of age.
– Pulse Rate and Respiratory Rate decrease
slightly to 70bpm and 20breathspm
– Blood Pressure increases slightly to
120/70mmHg by late adolescence
– Sebaceous glands becomes active due to
androgen which sometimes resulting in acne
– Apocrine Sweat glands which are present in
axillae and genital area form shortly after
puberty, which produces strong odor in
response to emotional stimulation.
– Teeth
– Puberty
-time which an individual first becomes
capable of sexual reproduction. Female –
menstruation; Male – produce spermatozoa,
events usually occur at ages between 11 to
14 yrs.
– Secondary Sex Changes
Developmental Milestone
– Play or Recreation
Emotional Development
(Identity vs Role Confusion)
-Body Image, Self-Esteem, Value System,
Social Coupling, Career Decisions, Emancipation
from Parent
(Intimacy vs Isolation)
-Socialization
Cognitive Development (Formal Operational
Thought)
Moral and Spiritual Developement
Common Health Problems of An Adolescent
 Hypertension
 Poor Posture
 Body Piercing and Tattoos
 Fatigue
 Menstrual Irregularities
 Acne
 Obesity
Concerns Regarding Sexuality and Sexual
Activity
 Stalking
Concerns regarding Hazing or Bullying
 Bullying – usually began during school
age.
 Hazing – organized bullying, refers to
demeaning or humiliating rituals that
prospective members have undergo to
join sororities, fraternities, adolescent
gangs, or sports team.
Concerns regarding Substance Use Disorder
Types of Abused Substances
 Prescription and Over-the-Counter Drug
 Alcohol
 Tobacco
 Performance-Enhancing Substance Use
Disorder
 Marijuana
 Amphetamines
 Cocaine
 Hallucinogens
 Opiates
Concerns Regarding Depression and Self-
Injury
Self-Injury – a range of self-destructive actions
from cutting to suicide, the planned intent to end
one’s life.
Successful suicide occurs more frequently in
males than females, although more females
frequently attempt suicide than males.
Nursing Process for Promotion of Normal
Growth and Development
ASSESSMENT
- To assess growth, measure and plot
height and weight on a standard growth
chart for children at well child care visits.
Obtain a developmental health history from
both parents. Observe specific activities
the child can accomplish to establish
whether developmental milestones are
achieved.
OUTCOME IDENTIFICATION AND PLANNING
- Consider all aspects of a child's health,
remembering that each child's
developmental progress is unique.
Children achieve milestones at a
predictable age range and identifying
delays encourages prompt evaluation and
treatment to promote the child's optimal
potential.
IMPLEMENTATION
- Encouraging age-appropriate self-care in a
child and suggesting age-appropriate toys
or activities to parents. Role modeling is
an important ongoing intervention to help
parents accept a child's delayed growth or
appreciate a child who is scoring extremely
high on standard scales and needs
increased stimulation.
OUTCOME EVALUATION
- It must be conducted throughout childhood
and repeated if there are any concerns
regarding a delay. The evaluation must be
comprehensive and include all physical
gwoth parameters and all aspects of
development.
FACTORS INFLUENCING GROWTH AND
DEVELOPMENT
• Genetics
– From the moment of conception when a
sperm and ovum fuse, the basic genetic
makeup of an individual is cast.
• Gender
– Girls are born lighter than boys. Girls begin
their puberty growth 6 months to 1 year
earlier than boys.
• Health
– A child who inherits a genetically
transmitted disease may noty grow as
rapidly or develop as fully as a healthy
child.
• Intelligence
– Children with high intelligence, do not
generalloy grow faster physically than
other children, but they do tend to advance
faster in skills.
• Temperament
– Inborn characteristic set at birth. It is the
usual reaction pattern of an individual's
characteristic manner of thinking.
• Activity Level
– The level of activity among children differs
widely right from birth.
• Rhythmicity
– Manifests a regular rythm in physiologic
functions.
• Approach
– Response to initial contact to a new
stimulus.
• Adaptability
– Ability to change one's reaction to stimuli
over time.
• Intensity of Reaction
– They meet new situations with their whole
being.
• Distractability
– Children who is easily distracted to a new
situation are easy to care for.
• Attention Span and Persistence
– Ability to maintain interested in a project or
activity for an average length of time.
• Mood Quality
– A child who is always happy and laughing
is said to have a positive mood quality. It
will make a big difference since the parents
tend to spend some time with a child of
positive mood quality than a child who
always seems to be unhappy.
THE FAMILY WITH AN INFANT
ASSESSMENT
- It begins with an interview with the primary
caregiver. Important areas to discuss
include nutrition, elimination, growth
patterns and development. Height, weight
and head circumference is also important
that they had to be plotted on standard
growth charts.
NURSING DIAGNOSIS
- Much of the assessment of an infant and
family will focus on basic needs such as
sleep, nutrition, and activity and the
parents' adjustment to their new role.
• Ineffective breastfeeding related to
maternal fatigue
• Disturbed sleep pattern related to baby's
need to nurse every 2 hours
• Imbalanced nutrition, less than body
requirements, related to infant's difficulty
sucking.
OUTCOME IDENTIFICATION AND PLANNING
- Outcomes established for infant care need
to be realistic based on the family's new
circumstances. Parents of infants specially
 new parents must do a lot of adjusting
and this takes time. Try to suggest
activities that can be easily incorporated
into the family's lifestyle.
IMPLEMENTATION
- One of the most important interventions of
the infant period is teaching new parents
about normal growth and development
milestones such as the age range for
rolling over or reaching objects. This
information is anticipatory so that parents
are not surprised by a new skill and
instead are prepared for changes and
development before they occur.
OUTCOME EVALUATION
- Evaluate expected outcomes at each visit
to detect that changes in growth and
development are occuring.
THE FAMILY WITH A TODDLER
ASSESSMENT
- It begins with a careful health history.
Careful observation is another crucial
element of the nursing assessment of a
toddler.
NURSING DIAGNOSIS
- It usually focuses on the parents'
eagerness to learn more about the
parameters of normal growth
• Health seeking behaviours related to normal
toddler development
• Disturbed sleep pattern related to lack of
bedtime routine
• Risk for imbalanced nutrition, more than body
requirements, related to fast food choices
OUTCOME IDENTIFICATION AND PLANNING
- Focuses largely on family education and
anticipatory guidance. Urge the to
establish realistic goals and outcomes so
they can meet the rapidly changing needs
of their toddler and learn to cope with
typical toddler behaviours. Otherwise,
parents can expect too much of a toddler
and grow frustrated instead of enjoying
being a parent of a child this age.
IMPLEMENTATION
- Teach parents that a good rule is to think
of a toddler as a visitor from a foreign land
who wants to participate in everything the
family is doing but doesn't know the
customs or the language.
OUTCOME EVALUATION
- It must be evaluated frequently during the
toddler period because children change so
much and learn so many skills during this
time that their abilities and associated
parental concerns can change from day to
day.
THE FAMILY WITH A PRE SCHOOLER
ASSESSMENT
- Includes obtaining of helath history and
performing both physical and
developmental evaluation at healthcare
visits. A history that details their usual
performance level is therefore important for
accurate evaluation. Assess a child's
weight, height and body mass index. Also
assess for general appearance.
OUTCOME IDENTIFICATION AND PLANNING
- It often begins with establishing a schedule
for discussing normal preschool
development with parents. Planning for
unintentional injury prevention. It is also
important to plan opportunities for
adventurous activities and interaction with
other children.
IMPLEMENTATION
- Preschool children imitate moods as well
as actions. An important nursing
intervention, therefore is role playing a
mood or attitude you would like a child to
learn.
EVALUATION
- Evaluation of expected outcomes needs to
be continous and frequent. Because
growth during this period is more cognitive
and emotional than physical.
FAMILY WITH A SCHOOL AGE CHILD
- Assess children as individuals to
understand the particular developmental
needs of each child based on what
developmental status has been achieved,
not on what stage you think the child
should have reached
ASSESSMENT
- History and physical examination are used
to assess growth and development of
school age children. School age child can
 contribute to their own health history. This
is a time when children begin to express
their own opinions and beliefs.
OUTCOME IDENTIFICATION AND PLANNING
- They tend to enjoy small or short term
projects rather than long, involved ones.
Behaviour problems need to be well
defined before outcomes are identified and
interventions planned. Parents need to
accept that problems are consistent with
normal growth and development.
IMPLEMENTATION
- They are interested in learning about adult
roles so they will watch you to note your
attitude as well as your actions in a given
situation. They will feel comfortable
knowing the “hows” and “whys” of actions.
EVALUATION
- Yearly health visits covering both physical
and psychosocial development are
important at this age.
FAMILY WITH AN ADOLESCENT
- Transition between childhood and
becoming a late adolescent
ASSESSMENT
- Health visits may become irregular.
OUTCOME IDENTIFICATION AND PLANNING
- Respect the fact that they have a strong
desire to exert independence or do things
their own way.
IMPLEMENTATION
- Adolescents tend to do poorly with tasks
someone tells them they must do.
Evaluate how an intervention appears
from an adolescent's standpoint before
beginning teaching.
EVALUATION
- Individuals will have difficulty
accomplishing desired goals as adults
unless they have high self-esteem that
includes feeling secure in their new body
image.
IMMEDIATE CARE ESSENTIALS
1. Establish air way
- Top priority
- After extension of fetal head and before
chest is delivered mouth and nose
should right away be cleared
- Best preventive measure for meconium
aspiration, which results in lung infection
(aspiration pneumonia)
- Place newborn in slight Trendelenburg
(10-15 degree angle) in order drain
secretions from the oro-nasopharynx
- Position of newborn at birth is one that
promotes drainage of secretions.
- Slight head down is enough
- Avoid acute Trendelenburg, cause
abdominal contents to exert pressure to
diaphragm, causing DOB
- Head-down position is contraindicated in
presence of signs increased intracranial
pressure
- Suction the newborn
- Start with the mouth and then the nose
- Plenty nerve receptor in nose, cause
newborn to gasp for breath and aspirate
the oropharyngeal secretions
- Press/ deflate the rubber ball of the bulb
syringe before inserting its tip into mouth
and nostrils
- Suction shallowly using bulb syringe
- Deep suctioning cause vagal stimulation,
bradycardia and laryngospasm
- Suction briefly
- It also aspirates much needed air oxygen
- Preterm: less than 5 secs/ST
- Full Term: 5-10 secs/ST
- Oxygenation is not routine. Just ensure a
patent airway and good supply of
atmospheric air
Retrolental Fibroplasia
- Injudicious use of oxygen can result in
damage to the retina, causing neonatal
blindness
2. Keep the newborn warm
- Newborn temperature at birth: 37.3-35.5
- Minimum temp 36.5
- Normal body temperature range
- Axillary: 36.5-37
 - Safest way to check the initial temp.
minimizes risk to mucus membrane of
rectum, especially preterm
- Rectal: 36.7-37.2
Mechanism of Heat Loss
 Evaporation – as liquid leaves NB body
 Conduction – loss of heat from NB
warm body to a cool surface, direct
contact
 Convection – to cool air
 Radiation – not in contact, most NB
heat is lost through radiation
- Dry newborn right away after birth to
prevent heat loss by evaporation.
Initial/priority action of the caregiver after
the baby is expelled out
- Wrap body and promote flexion to
minimize the surface are of the body
exposed to cool air and cool surfaces
- Never place newborn on cold and
unlined surfaces to prevent heat loss
through conduction.
- Placed under the floor lamp primarily to
keep him warm
Effects of Cold Stress
1. Increased brown fat metabolism, causing
increase in the amount of fatty acids in
circulation resulting in metabolic acidosis
2. Increased activity/metabolic rate, causing
greater utilization of glucose and oxygen,
resulting in low sugar (hypoglycemia) and
respiratory distress.
3. Do APGAR Scoring
- Scoring method that gives a numerical
expression of the newborn’s adaptation
to extra uterine life performed at 1- 5
mins after birth
- 1-minute scoring : defects the
cardiorespiratory function of newborn,
general condition and need for
resuscitation, evaluation of NB heart
rate, respiratory activity and color
- 5-minutes scoring: defects NB
adjusments to new environment and
defecrs the prognosis. In nursing care
planning, use the second APGAR score
4. Identify the newborn properly
- Greatest disadvantage of hospital
delivery is the risk of exchanging babies.
Newborn identifies before the cord is cut
- Home deliveries do not required NB
identification
- Bracelets and food tags are enough.
Best way to identify by taking footprints
- Proper Identification of NB is legal and
moral responsibility of the health
caregiver
5. Provide skin care
- Immediate soap and water bath, given to
normal fullterm NB. Primarily to cleanse
the skin of mucus, blood and at time
meconium, prevent infection
- An oil bath is given to preterm and high-
risk NB
6. Perform cord dressing
- Cord dressing must be performed under
strict aseptic technique to prevent
tetanus neonatorum
- Cord examine presence of 3 vessels. 1
umbilical vein and 2 umbilical arteries
- Presence of incomplete report to
physician to assessed for congenital
defect
- Leave 1 inch of cord from the base
- Longer is left of cord stump longer is
drying and dropping off time. More risk to
local bacterial infection of the cord called
omphalitis
- First 24hrs, cord inspected for bleeding
(omphalanghia)
- Likely the site of bleeding
7. Inject vitamin K intramuscularly
- Prophylactic vitamin K is injected to
prevent bleeding/ hemorrhagic disease in
newborn by improving blood coagulation
- NB GIT is initially sterile, having no E.
Coli to synthesize vitamin K.
- Best site for intramuscular injection,
infants and young children is thigh
muscle, mid-antero-lateral aspect called
vastus lateralis
8. Give Crede’s prophylaxis
- Crede’s prophylaxis is given to all NB
prevent ophthalmia neonatorum. Can
 be delayed for 1-2hrs inorder not to
interfere w/ maternal-NB bonding
9. Take the weight and other
anthropometric measurements
- Weight: Normal weight – 3000-3400g
with lowest limit at 2500-4000g
- AGA(Appropriate for gestational age)
weight between 10th and 90th percentile
- Lowest limit normal weight: 2500 5 ½
lb
- Less than 2500g is small for SGA and
over 4000-4100 9lb I LGA
- SGA – weight below 10 th percentile.
Infant who has not achieved genetic
growth potential
- Synonyms: dysmaturity, intrauterine
growth restriction
- LGA – above 90th percentile
- LBW- low birth weight – less than 2500g
independent of GA assessments
- Height: NB height 19-20 inches average
50 cm. heel to crown
- Head circumference: biggest part ¼ of
body. 33-35 cm / 13-14 inches
- Chest circumference: equal to
abdomen 31-33cm (12-13)
- Abdominal circumference: 31-33cm
12-13in
Provide gentle, minimal handling and keep a
watchful eye