Maternal and Child Nursing

Maria Jessica de Guzman- Areja RN Manuelito Cantos RN Michael Emman Orbe RN Luzviminda Porte RN, MAN Team Lecturer

Maternal and Child Nursing or Maternal Newborn Nursing

Involves care of the woman and family throughout pregnancy and childbirth and the health promotion and illness care of the children and families It refers to the relationship of mother and child to one another and consideration of the entire family, as well as the culture and socio-economic environment, as framework of the clients.

Nursing/ Maternal Newborn Nursing

Promotion and maintenance of optimum health of the woman and the newborn

PHILOSOPHY OF MCN MATERNAL CHILD NURSING :  Is family centered  Is community centered  Is research oriented  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 pregnancy or childhood illness are stressful because they are crises  Is based on the belief that personal, cultural and religious attitudes and beliefs influence the meaning of illness and its impact on the family  Is a challenging role for the nurse and is a major factor in promoting high-level wellness in families

Principles to consider in MCN

The family is the basic unit of society Families represent racial, ethnic, cultural and socioeconomic diversity Children grow both individually and as part of a family

PHASES OF HEALTH CARE IN MCN

Health promotion - educating clients to be aware of good health through teaching and role modeling Health maintenance - intervening to maintain health when risk of illness is present Health rehabilitation - preventing further complications from an illness; bringing ill client back to optimal state of wellness or helping the client accept inevitable death

Trends in Maternal and Child Health Care

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Families are smaller in size than in previous decades Single parents are increasing in number An increasing number of mothers work outside the home Families are more mobile than previously Abuse is more common than ever before Families are more health conscious than previously

Anatomy and Physiology Female Reproductive System

A. The External Reproductive Organs 1. Mons pubis or mons veneris – is a pad of fat which lies over the symphysis pubis which protects the surrounding delicate tissues from trauma 2. Labia majora – a two folds of skin with fat underneath; contain Bartholin’s glands ( believed to secrete a yellowish mucus that acts as a lubricant during sexual activity 3. Labia minora – two thin folds of delicate tissues that forms the upper fold encircling the clitoris (called the prepuce) and unite posteriorly ( called the fourchette ) which is highly sensitive to manipulation and trauma t why it is often torn during delivery.

4. Glans clitoris – small, erectile structure at the anterior junction of the labia minora, which is comparable to the penis and extremely sensitive to sexual manipulation 5. Vestibule – narrow space seen when the labia minora is separated 6. Urethral meatus – external opening of the urethra; slightly behind to the side are the openings of the Skene’s glands ( often involved in infections of the external genitalia) 7. Vaginal orifice/introitus/vaginal opening- external opening of the vagina, covered by a thin membrane ( called hymen ) in virgins 8. Perineum – area from the lower border of the vaginal orifice to the anus; contains the muscles which supports the pelvic organs, the pudendal nerves which are important during delivery under anesthesia

B. Internal Reproductive System 1. Vagina: a 3 – 6 inch long dilatable canal located between the bladder and the rectum; contains rugae ( which permit considerable stretching without tearing; passageway for menstrual discharges; receives penis during sexual intercourse ( organ of copulation ), and forms part of birth canal : vascular and acidic pH; Doderleins bacilli makes the vagina acidic 2. Uterus: a hollow pear shaped fibro muscular organ 3 inches long, 2 inches wide, 1 inch thick, weighing 50 Gms. in a non pre-pregnant state, hold in place by the ligaments of the uterus : Organ of menstruation : Site of implantation and retainment and nourishment of the products of conception 2.1 Ligaments of the uterus: 2.1.1 Broad ligaments: extend from the lateral margin of the uterus to the pelvic sidewall 2.1.2 Round ligaments: Dense bands of connective tissue that extend from the lateral uterine fundus to the upper portion of the labia majora 2.1.3 Uterosacral ligaments: dense bands of connective tissue that extend from the inferior and posterior portion of the uterus and attach to the fascia over the sacrum 2.2 Source of blood supply: 2.2.1 uterine ovaries 2.2.2 ovarian arteries

2.3 Parts of the uterus: 2.3.1 Fundus: uppermost convex portion located between the insertions of the fallopian tubes :The most muscular area of the uterus; as such it is thickest and most contractile portion : Ideal site for implantation of the zygote : Used as an obstetrical landmark during pregnancy through the technique of physical examination by palpation of its height to assess the uterine growth: during labor, being the mot contractile area is palpated to assess the uterine contractions and labor progress and during postpartum period, to assess for uterine involution 2.3.2 Cornua: areas of the uterus at which the fallopian tubes are attached 2.3.3 Corpus: the body of the uterus which makes up two-third of the said organ; it houses the fetus during pregnancy 2.3.4 Isthmus: the upper third of the cervix which is very thin or areas between corpus and cervix which forms part of the lower uterine segment

2.3.5 Cervix: neck of the uterus; it measures 2.5cm long and 2.5 cm in diameter, it contains sebaceous glands that secretes a clear, viscid and alkaline mucus 2.3.5.1 Parts of the cervix 2.3.5.1 Internal os – which opens to the corpus 2.3.5.2 Cervical canal – located between internal and external os 2.3.5.3 External os – which opens to vagina 2.4 Muscle layers of the uterus: 2.4.1 Peritmetrium: serosal outer layer of the uterus attached to the broad ligaments 2.4.2 Myometrium: muscular layer of the uterus; thickest at the fundal area 2.4.3 Endometrium: inner layer/ mucosal layer of the uterus that contains numerous uterine glands that secrete a thin alkaline fluid to keep the uterine cavity moist.

3. Fallopian tubes: 4 inches long/ eight to 14 cm. muscular tubes that extend laterally from the cornua of the uterus from each side of the fundus 3.1 Functions: 3.1.1 Responsible for transport of mature ovum from ovary to uterus 3.1.2 The site of fertilization 3.1.3 Provides nourishment to the ovum during its journey 3.2 Parts of the fallopian tube 3.2.1 Interstitial/Intramural: thick walled, located inside the uterus 3.2.2 Isthmus: the narrowest portion of the uterus and is about 1 cm. long; the site for tubal ligation 3.2.3 Ampulla: the middle portion and the widest part; the site for fertilization 3.2.4 Infundibulum: the most distal portion; it has a fingerlike projections called fimbria. The longest fimbria, called fimbria ovarica is attached to the ovary to guide the ovum to the oviduct during the ovulation

3.3 Layers of the fallopian tubes: 3.1 Mucosal layer: composed of secretory cells that secretes alkaline mucus which lubricates the fallopian tube and ciliated cells that move in sweeping motion to assist in the transportation of the ovum from the ovary to the uterus 3.2 Muscular layer: this layer is responsible for the peristaltic movement of the fallopian tube, rhythmic contractions of the fallopian tubes are strongest at the time of ovulation and weakest during pregnancy 3.3 Peritoneal layer: the outermost layer attached to the ligaments that keep the fallopian tube suspended in its normal position

Fallopian Tube

4. Ovaries: are almond-shaped glandular organs located on either side of the uterus :are movable organs on palpation 4.1Function of the ovaries: 4.1.1 Oogenesis – ovaries are responsible for development and maturation of ovum 4.1.2 Ovulation: refers to the release of ovum from the ovary 4.1.3 Hormone production: the ovaries the main source of estrogen and progesterone in nonpregnant women 4.2 Layers of the ovaries: 4.2.1 Tunica albuginea: the outermost protective layer 4.2.2 Cortex: the functional layer because it is the site of ovum formation and maturation 4.2.3 Medulla: this layer contains blood vessels, lymphatics,nerves and muscle fibers.

Ovary

Female Reproductive System

THE PELVIS

Structure of pelvis
A.

Two hip bones (right and left innominate: Sacrum, coccyx).

1.

False pelvis – this is the part of the pelvis situated above the pelvic brim. It is formed by the upper flared out portion of the iliac bones and protects the abdominal organs. - supportive structure for uterus during last half of pregnancy.

2.True pelvis – Is the bony canal through which the fetus must pass during birth. It has a brim, a cavity and outlet. - below brim; pelvic inlet, midplane, pelvic outlet. Fetus passes through during birth

Pelvic measurements

Pelvic measurements
A.

Diagonal conjugate – 12.5 cm or greater is adequate size, evaluated by examiner Conjugate vera – 11 cm is adequate size; can be measured by x-ray (not commonly performed)

B.

C. Obstetric conjugate – measured by x –ray (not commonly performed) D. Tuber-ischial diameter – 9 -11 cm indicates adequate size; evaluated by examiner.

PELVIS Four Types: 1.Gynecoid Pelvis 2. Android Pelvis 3. Anthropoid Pelvis 4. Platypelloid Pelvis

1.Gynecoid Pelvis  Inlet is round, circular  Wide  This is the typical FEMALE PELVIS  Most favorable for normal spontaneous delivery or ideal for childbirth  The anteroposterior and transverse diameters are relatively equal, with straight pelvic sidewalls.  The ischial spines are not usually prominent  The pubic arch is wide

2. Android Pelvis  Wide  HEART-SHAPED  This is the typical MALE PELVIS  It is characterized by convergent sidewalls, prominent ischial spines, and narrow pubic arch  May result to forceps delivery or CS

3. Anthropoid Pelvis  Wide  Narrow  This is the typical APE PELVIS  It is characterized by the anteroposterior diameter being greater than the transverse diameter

4. Platypelloid Pelvis  Opposite of Anthropoid Pelvis  Wide  Narrow  The pelvis is characterized by the transverse diameter being greater than the anteroposterior diameter with wide sidewalls  Flattened gynecoid shape of flat pelvis

Menstrual Cycle
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It refers to female reproductive cycle It is a periodic uterine bleeding in response to cyclical hormonal changes Menstruation is being ushered in by menarche (onset of menstruation ) and ends with menopause ( permanent cessation of menstruation) age of onset and termination vary widely depending on heredity, racial background, nutrition and even climate. Normal menstrual period ( days when there is menstrual flow) last for3 – 6 days; menstrual cycle (from first day of menstruation to the first day of next menstruation) may be anywhere from 25 – 35 days, but accepted average length is 28 days

Body structures involved
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Hypothalamus Pituitary gland Ovaries Uterus

Hormones which regulate cyclic activities

GNRH ( APG ) – initiates the menstrual cycle A. FSH - stimulate the development of primordial follicles (immature follicles) into graafian ( mature follicles ) B. LH - it stimulates ovulation and development of corpus luteum ( source of progesterone ) - thickens the endometrial lining of the uterus

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