MATERNAL AND CHILD NURSING II
WEEK 1 ONLINE LECTURE | Prof. Maria Lourdes B. Balleza.RN.MAN
OUTLINE:
A. National Health Situation on MCN
B. Statistics on MCN
C. Genetics and Genetic Counseling
FRAMEWORK FOR MCN: FOCUSING ON AT-RISK
HIGH RISK AND SICK CLIENT
Obstetrics
- Care of woman
- Derived from the greek word, “obstare”
meaning to keep watch
Pediatrics
- Care of the child
- Derived from the greek world, “pais” meaning
child
● One of the most important public health goals is
the improvement of well-being of mothers
infants, and children
● The health of filipino mothers and children
determine the health of the next gen filipinos
● Primary of goal of MCHNC is promotion and
maintenance of optimaL family health to ensure
cycles of childbearing and childrearing
Focus of MCN
● care of childbearing and childrearing families
Primary Goal of MCN
● Promotion and maintenance of optimal family
health
Scope of Practice
1. Preconceptual health care
2. Care of women during 3 trimester of pregnancy
a. 1st trimester (1-3 months)
b. 2nd trimester (4-6 months)
c. 3rd trimester (7-9 months)
3. Care of women during puerperium or 4th
trimester (6 weeks after childbirth)
4. Care of infant during perinatal period (6 week
before conception and 6 weeks after birth)
5. Care of children from birth to adolescence
a. Neonatal (28 days of life)
b. Infancy (1-12 months)
c. Adolescence (after 18 y/o)
6. Care in settings as varied as the birthing room,
the PICU and the home
The care of Childbearing and Childrearing is a MAJOR
FOCUS of Nursing Practice
1. Promote the health of childbearing woman and
her family from before the child is born until it
reaches adulthood
2. Continuous health provision and support as the
child grows
3. New cycle and new support begins as the child
matures and plans for his own family
Philosophies of MCN
1. MCN is family centered; assessment must
include both family and individual assessment
2. Mcn is community centered; health of families
depends on and influences the health of
communities
3. MCN is evidence based because critical
knowledge increases
4. MCN includes independent nursing functions
because teaching and counseling are major
interventions
5. MCN nurse, advocates (protects the rights of
family members, including fetus)
6. Health promotion and disease prevention to
protect health of new generation
7. MCN is a challenging role for nursing
REMEMBER: Keep the family at the center of care.
Family as the primary unit of care. Family centered
approach enables nurses to better understand individuals
and their effect on others, and in turn, provide holistic
care
Framework for MCN
1. Nursing Process (ADPIE)
2. Evidenced Based Practice
3. Nursing Research
4. Nursing Theory
 MATERNAL AND CHILD NURSING II
WEEK 1 ONLINE LECTURE | Prof. Maria Lourdes B. Balleza.RN.MAN
Four phases of health care
1. Health promotion
- Educating clients to be aware of good
health through teaching and role
modeling
- Family planning , teach importance of
safe sex practice and immunizations
2. Health maintenance
- Intervening to maintain health when
risk of illness is present
- Geared clients attitude towards health
- Ex. encourage prenatal care,
importance of safeguarding homes by
childproofing it against poisoning
3. Health restoration
- Diagnosing and treating illness using
interventions that will return client to
wellness fast
- Ex. care of child during illness, care of
woman during pregnancy complications
4. Health rehabilitation
- Bringing client back to a optimal state
of wellness
- Preventing further complications from
an illness
- Helping client accept inevitable death
- Ex. encourage continuous and
medications
Trends in MCN Population
Families are smaller in Fewer family members
size are present as support
people in times of crisis
Role of Nurse: Fulfill the
role
Increased Single Parents Fewer financial resources
(most common type of esp. woman
parent in US)
Role of Nurse: Inform
parents of care options
and back-up opinion.
Increased mothers Healthcare must be
working outside home at scheduled at times a
least part-time (90%) working parent can care
for ger own self or bring a
child for care.
Role of Nurse: Discuss
selection of child care
centers
Families are more mobile; Good interviewing and
Increases no. of homeless health monitoring are
women and children necessary so health
database can be
established and
continuity of care
Child and Intimate Screening for Child or
Partner Abuse Intimate partner abuse;
Nurses must be aware of
legal responsibilities for
reporting abuse.
Families are more health Provide Health education
conscious
Health care should Comprehensive care is
respect cost containment necessary in primary care
Measuring the Maternal And Child Health/ Statistical
Terms used to report maternal and child health
● We believe in numbers as nurses, we go after
numbers. If it is not measured then we don’t
believe na yun ang tamang data
● Basehan ng quality of care in a hospital
1. Birth rate - no. of births per 1000 population
2. Fertility rate - no. of pregnancies per 1000
women of childbearing age
3. Fetal Death Rate- no. of fetal deaths weighing
more than 500g or more per 1000 live births.
4. Neonatal Death Rate- neonatal period (1st 28
days of life). No. of deaths per 1000 live births
occurring in the 1st 28 days of life.
a. to declare a neonatal death rate, it
must be based on the age of gestation
and weight (dead )
5. Perinatal Death Rate - Perinatal period (6 weeks
before conception and 6 weeks after childbirth).
 MATERNAL AND CHILD NURSING II
WEEK 1 ONLINE LECTURE | Prof. Maria Lourdes B. Balleza.RN.MAN
No. of deaths of fetuses weighing > 500g and
within the 1st 28 days of life per 1000 birth.
6. Infant Mortality Rate - no. of deaths per 1000
live births in the first 12 months of life
7. Childhood Mortality Rate - no. of deaths per
1000 population in children 1-14 y/o
8. Maternal Mortality Rate - no. maternal deaths
per 100,000 live births that occur as a direct
result of the reproductive process.
Risk of Maternal Death are Affected by many Factors
● Frequency and spacing of births
● Nutrition level (maternal undernutrition)
● Sta ture and maternal age
● Appropriate medical and midwife support
● Access to emergency and intensive treatment if
were necessary
● Lack of management capacity in the health
system
● No political will and lack of management
capacity in the health system
> Majority of the deaths and disabilities are preventable,
being mainly due to insufficient care during pregnancy
and delivery.
> HIV infection is an increasing threat. Mother-to-child
transmission of HIV continues to be a major problem,
with up to 45 percent of HIV infected mother’s
transmitting infections to their children
Three Delays that Lead to Maternal and Neonatal
Deaths
1. DELAY IN IDENTIFICATION OF COMPLICATIONS
a. failure to recognize danger signs
b. lack of money
c. unplanned/ unwanted pregnancy
d. lack of companion in going to health
facility
e. no person to take care of children/
home
f. fear of being ill treated in health facility
2. DELAY IN REFERRAL
a. distance from a woman’s home to
health facility/ provider (malayo)
b. lack of/ poor condition of roads (nasa
barrio nakatira, lubak-lubak na daan)
c. lack of emergency transportation
(ambulance use for life and death
situation which is not for labor in
pregnancy, lack of physical ambulance )
d. lack of awareness of existing services
(hindi nalalaman ng pasyente na pwede
pala siya sa barangay health center, not
informed)
e. lack of community support (lack of
trainees and volunteers, kakaunti na
lang yung nae-engage o naiingganyo)
3. DELAY IN MANAGEMENT OF COMPLICATIONS
a. lack of health care providers (may mga
namatay na doktor, dahil sa fear of
covid before marami ang hindi
nagtrabaho as healthcare provider)
b. shortage of supplies (dahil sa demand)
c. lack of equipment (hindi nakakabili ang
ospital, kaya dun pupunta yung
pasyente sa isang hospital na kumpleto
at kayang gampanan ang kanilang
pangangailangan)
d. lack of competence of health providers
(dahil sa nagsarang training centers
kaya most of the practices ay natutunan
online and reading books, which are
not effective enough)
e. weak referral system
DOH’s Essential Package of Child Survival Interventions
● Skilled attendance during pregnancy, childbirth
and the immediate postpartum
● care of the newborn
● breastfeeding and complementary feeding
● micronutrient supplementation
● immunization of children and mothers
● integrated management of sick children
● birth spacing
DOH Program/ Interventions for Child Care
● Early essential newborn care
● Infant and young child feeding
● newborn screening (na ginawang law, required
to be done sa isang newborn)
● integrated management of childhood illness
● immunization program
 MATERNAL AND CHILD NURSING II
WEEK 1 ONLINE LECTURE | Prof. Maria Lourdes B. Balleza.RN.MAN
Trends in Healthcare Environment
nauuso yung birthing room sa mga hospitals kung saan
naka set-up to na parang nanganganak sa bahay, which is
allowed kapag meron siyang health care provider na
masasandalan in throughout pregnancy
1. Cost containment - reducing the cost of health
by closely monitoring the cost of personnel, use
and brands of supplies, length of hospital stays,
no. of procedures carried out, and no. of
referrals while maintaining quality care
2. Increasing Alternative Settings and Styles for
Health Care
a. LDRP Rooms (Labor→ delivery→
Recovery→ Postpartum) a more natural
childbirth environment as a birthing
room. Family members are invited to
stay to be a part of childbirth.
b. retail clinics or Emergent Care Clinics
located in shopping malls
c. Ambulatory clinics or at home long
hospital stays for woman and children.
3. Including Family in Heath care
4. Increasing Intensive are units (ngayon
binibigyan ng budget ang bawat hospitals to
have their onw NICU at PICU dahil sa census
maraming nanganganak ng wala sa buwan, isa
itong requirement sa isang hospital para
makapag-open, at dapat kumpleto ang gamit sa
loob)
a. NICU (Neonatal Intensive Care Unit) or
ICN (Intensive care Nursery)
b. PICU (pediatric Intensive Care Unit)
5. Recognizing Intensive Care- ex: Premature
infant transferred to regional hospital.
6. Increasing the use of alternative treatment
modalities- alternative method of therapies
such as acupunture and therapeutic touch;
herbal remedies
7. Increasing relience on home care- decreased
hospital stay (kapag normal pareho ang baby at
mother, dapat pinapauwi na to prevent ather
complications, basta normal sila, as much as
possible in normal delivery 24hrs-36 hrs pede na
umuwi, sa CS naman 4 days- 6 days post CS
pede naumuwi minsan hindi na pinapaabot ng 4
days)
8. Increasing use of technology- use of internet,
charting in computer, using doppler
9. Free Birthing- women giving birth without
health care provider supervision health care
provider supervision; unassisted birth
10. LAMAS - breathing techniques
Legal Considerations of MCN Practice
1. Identifying and Reporting Child abuse (sa ibang
bansa they have their own kits and forms for
this. )
2. Informaed consent and my risk that may harm
the fetus. (make sure na everything you see sa
fetus are recorded or documented)
a. kapag may mga procedures na mabigan
always have informed consent.
REMEMBER!!
● Nurses are legally responsible to protect the
rights of their client and documentation is
essntial to protect nurse and justify hid or
her actions.
● yan yung mag poprotecta sa atin as health
care workers in the profession.
Ethical Considerations of Practice
1. Conception issues
a. In vitro fertilization
b. embryo transfer
c. cloning
d. stem cell research
e. surrogate mothers
2. Abortion
3. Fetal right VS the rights of the mother
4. Use of Fetal Tissue for Research
5. Resuscitation
6. No. of procedures or degree of pain that a child
should asked to achieve better health
 MATERNAL AND CHILD NURSING II
WEEK 1 ONLINE LECTURE | Prof. Maria Lourdes B. Balleza.RN.MAN
7. Balance between modern technology and
quality
NOTE: we as nurses, we should be sure that everything is
documented and we cannot judge or dictate the mother
on what will be her decision. Kung anong gusto niyang
gawin sa anak niya bahala siya, and how will you protect
yourself as a nurse, may mga consent forms to prevent
you from being involved by law. Ex: The doctor wants a
tissue from the placenta of the mother, as nurse we are
the patient’s advocate, bago magawa ng doctor ang
pagkuha ng tissues or any part of the body we should
always ask their permission with a consent form, with
that we could prevent ourselves as nurses from being
involved sa lawsuit na tinatawag na (BATTERY)
GENETICS AND GENETIC COUNSELING
Genetics disorders
● are disorders that can be passed from one
generation to the next
● result from some disorder in gene or
chromosome structure and occur in 5% to 6% of
newborn
Genetics
● study of heredity, and the variation of inherited
characteristics
Cytogenetics
● study of chromosomes by light microscopy and
the method by which chromosomal aberrations
are identified
A. Nature of Inheritance
Genes
● basic units of heredity that determines both the
physical and cognitive characteristics of people
● it is composed of segments of DNA, they are
woven into strands in the nucleus
Chromosomes
● are threadlike structures of nucleic acids and
protein found in the nucleus of most living cells,
carrying genetic information in the form of
genes
● In humans, each cell, except for the sperm and
ovum, contains 46 chromosomes (22 pairs of
autosomes and 1 pair of sex chromosomes)
● Spermatozoa and ova each carry only half of
the chromosomes number or 23 chromosome.
For each chromosome cell, there is a like
chromosome of similar size and shape and
function (autosome or homologous
chromosome) in the ovum
● Because genes are always located at fixed
positions on chromosomes, two like gene
(alleles) for every trait that are represented in
the ovum and sperm on autosomes. The one
chromosome in which this does not occur is the
chromosome for determining gender
● if the sex chromosomes are both type X (large
symmetric) in the zygote formed from the union
of a sperm and ovum = FEMALE
● if one sex chromosome is an X and one is a U
(smaller type), = MALE
○ ang tatay ang nagdedetermine ng
gender ng bata
● A person’s phenotype refers to his or her
outward appearance or the expression of genes
● A person’s genotype refers to his or her actual
gene composition
○ impossible to predict a person’s
genotype from the phenotype
● A person’s genome is the complete set of genes
present or a normal genome is abbreviated as
46XX or 46XY
●
LEA:
4. X-Linked Recessive Inheritance
● Most X-linked inherited disorders are NOT
Dominant, but Recessive.
● When the inheritance of a recessive gene comes
from both parents (homozygous recessive), it
appears to be incompatible with life. Therefore,
females who inherit the affected gene will be
heterozygous, and, because a normal gene is
also present, the expression of the disease will
be blocked. On the other hand, because males
have only one x chromosome, the disease will
be manifested in any male children who receive
the affected gene from their mother.
 MATERNAL AND CHILD NURSING II
WEEK 1 ONLINE LECTURE | Prof. Maria Lourdes B. Balleza.RN.MAN
● So, sa x-linked recessive, ang nagkakaroon ng
manifestation ay yung mga male children.
a. 50% that a male child will manifest the disease
b. 50% that a female child will carry the disease
gene
● If the father has the disease, and chooses a
sexual partner who is free of the disease gene,
the chances are 100% that a daughter will have
the sex linked recessive gene, but there is no
chance that a son will have the disease.
5. Multifactorial (Polygenic ) Inheritance
● Many childhood disorders such as heart disease,
diabetes, pyloric stenosis, cleft lip, and palate,
neural tube disorders, hypertension and mental
illness tend to have a higher than usual
incidence in some families. They appear to occur
from multiple gene combinations possibly
combined with environmental factors.
● Pag sinabi natin na idiopathic (means na
unknown yung cause) yung reason bakit meron
siyang diabetes, it because of the multifactorial
inheritance. Hindi siya masyadong kinoconsider
as part of Mendelian Inheritance because this
one is affected not primarily because of the
chromosomes and genes, but because of
environmental factors like stress, diet, pollution.
Natritriger lang siya lumabas (yung condition)
dahil sa mga environmental factors.
● Diseases caused by multiple factors this way do
not follow Mendelian Laws because more than a
single gene or Human Lymphocyte Antigen (HLA)
is involved. Their incidence is so unpredictable.
Chromosomal Abnormalities
(Cytogenic Disorders)
In some instances of genetic disease, the
abnormality occurs not because of dominant or recessive
gene patterns but through a fault in the number or
structure of chromosomes, which results in missing or
distorted genes. When chromosomes are photographed
and displayed, the resulting arrangement is termed as
KARYOTYPE.
NONDISJUNCTION ABNORMALITIES
● Meiosis is the type of cell division in which the
number of chromosomes in the cell is reduced
to the haploid (Half) number for reproduction
(i.e 23 rather than 46 chromosomes)
● All sperm and ova undergo a meiosis cell
division early in formation. The cell then divides
cleanly, with 23 chromosomes in the first new
cell and 23 chromosomes in the second new
cell.
● Chromosomal abnormalities occur if the division
is uneven (nondisjunction). The results may be
that one new sperm cell or ovum has 24
chromosomes and the other has only 22.
● If a spermatozoon or ovum with 24 or 22
chromosomes fuses with a normal
spermatozoon or ovum, the zygote (sperm and
ovum combined) will have either 47 or 45
chromosomes, not the normal 46.
Chromosomal Abnormalities because of Nondisjunction.
a. Down Syndrome / Trisomy 21 Syndrome
(47XY21 + or 47XX21+)
● Trisomy 21, the most frequently occurring
chromosomal disorder, occurs in about 1 in 800
pregnancies. In women who are older than 35
years of age, the incidence is as 1 in 100 live
births. The physical features of children with
down syndrome.
● Kadalas na tinitingnan or chinecheck para
malaman if mongoloid ay ang “Single Palm
Crease”. Also facial features: Abnormal ears, Flat
back of head.
 MATERNAL AND CHILD NURSING II
WEEK 1 ONLINE LECTURE | Prof. Maria Lourdes B. Balleza.RN.MAN

- Heart disorders: Ventricular Septal Defects -

birth defect in which there is a hole in the wall
(septum) that separates the two lower chambers
(ventricles) of the heart.
- Abnormal genitalia
- Microcephaly (smaller head)
- Microphthalmos (small eyes) or absent
- Low-set ears
- Supernumerary digits (Polydactyly) extra fingers
- Most children do not survive beyond early
childhood because of microcephaly and heart
disorder.

c. Edwards Syndrome / Trisomy 18 Syndrome

(47XY18+ OR 47XX18+)
● Children with trisomy 18 syndrome have three
Management of Children with Trisomy 21
copies of chromosome 18. The incidence is
- Early educational and play programs so they can
approx. 0.23 per 1,000 live births.
develop to their full capacity
- Good hand washing since they are prone to
infection
- Feed slowly. The enlarged tongue may interfere
with swallowing and cause choking
- Physical examination at birth to enable the
detection of genetic disorder and the initiation
of parental counseling, support, and future
planning.

b. Patau Syndrome / Trisomy 12 Syndrome

(47XY13+ OR 47XX13+)

● Unusually small head

● Back of the head is prominent
● ears are malformed and low-set
● mouth and jaw are small (may also have a cleft
● In trisomy 12, the child has an extra
lip or cleft palate
chromosome 13 and is severely cognitively
● hands are clenched into fists, and the index
challenged. The incidence of the syndrome is
finger overlaps the other fingers
low. Approx. 0.45 per 1,000 births.
● Clubfeet (or rocker bottom feet) and toes may
> Common Findings are:
be webbed or fused
- Midline body disorders such as cleft lip and
palate
 MATERNAL AND CHILD NURSING II
WEEK 1 ONLINE LECTURE | Prof. Maria Lourdes B. Balleza.RN.MAN
d. Klinefelter Syndrome (47 XXY)
● Children with klinefelter syndrome are male
with an extra X-chromosome.
● The incidence of the syndrome is 1 per 1,000
live births.
● The syndrome may not be noticeable at birth. At
puberty the following are observed:
○ Small testes and produce ineffective
sperm
○ Gynecomastia (increased breast size)
○ an increased risk of male breast cancer
e. Turner Syndrome (45 XO)
● The child with turner syndrome (Gonadal
Dysgenesis) has only one functional X
chromosome. The incidence is approx. 1 per
10,000 live births. The disorder can be identified
during pregnancy because of the extra skin at
the side of the neck.
● Missing an X chromosome on the 23rd pair.
> Characteristics of Turner Syndrome:
- Gonadal dysgenesis
- Only one functional ovaries
- Sterile (Baog)
- Secondary sex characteristics do not develop at
puberty dahil nga sa impaired gonadal
development
- Edema of the hands and feet
- Coarctation (stricture) of the Aorta
- Kidney disorders
- Hairline at the nape is low-set
- Webbed and short neck
- congenital heart defect
- Severely cognitive challenged
Management of Child with Turner Syndrome
- Human Growth hormone
- Estrogen at 13 years old
- To become pregnant IVF with surrogate oocyte
transfer
- In vitro, artificial means for reproduction
- Pero kadalas di na sila inaadvice na mag
reproduce kasi pwedeng maulit.
Deletion Abnormalities
Deletion abnormalities are a form of chromosome
disorder in which part of a chromosome breaks during
cell division, causing the affected person to have the
 MATERNAL AND CHILD NURSING II
WEEK 1 ONLINE LECTURE | Prof. Maria Lourdes B. Balleza.RN.MAN

number of chromosomes plus or minus an extra portion
of a chromosome, such as 45.75 chromosomes or 47.5.
a. Cri-du-chat syndrome (46xy5p-)
● in cri-du-chat syndrome (46xy5q), one portion of
chromosome 5 is missing.
○ abnormal cry (sound of a cat than
human)
○ small head
○ wide-set eyes
○ downward slant palpebral fissure of the
eye
○ recessed mandible
○ severely cognitively challenge
1. provide concrete accurate information about the
process of inheritance and inherited disorders.
2. reassure people who are concerned that their
children may inherira particular disorder.
3. allow people who are affected by inherited
disorders to make informed choices about
future reproduction.
4. allow people to pursure potential intervention
that may exist such fetal surgery
5. allow families to begin preparation for a child
with special needs

b. fragile x syndrome (46xy23q-)- fragile x syndrome is

the most common cause of cognitive challenge in:
FRAMEWORK FOR MCN: FOCUS
ING ON AT-RISK
● males. it is an x-linked disorder in which on long HIGH RISK AND SICK CLIENT
arm of an x chromosome FRAMEWORK FOR MCN: FOCUSING ON AT-RISK
● is defective, which results in inadequate protein HIGH RISK AND SICK CLIENT
synaptic responses. the
● incidence of the syndrome is about 1 in 4,000
males.
● there is no medication if it is already persisted

Genetic Counseling and Testing

It is advantageous for an individual concerned with the

possibility of transmitting a disease to his or her children
to ask for genetic counseling at a preconception health
visit for advice on the inheritance of disease because
counseling can serve so many purpose.