Maternal Book by Kennedy Dela Cruz MCNP

DEDICATION

With deepest admiration, this book entitled “ Maternal and Child Nursing: A Family Centered Approach” is dedicated to my significant others that includes my late father, my mother, my sisters and my brother and to my friends who have stood by me over the years who provided inspirations to achieve this accomplishment..

And to Almighty God for His unending and immeasurable love for me.

Titles you can't find anywhere else

Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.

















ACKNOWLEDGMENTS

Grateful acknowledgement is made to my parents for their unending support and wholeheartedly given their love and concern in many ways. The author is greatly indebted to my client who shared her understanding and some classified information necessary for this book. Likewise my deepest appreciation and gratitude for her cooperation most especially during the documentation, without her this book would not have been completed. Special acknowledgment to Ms. who both assisted me during the prenatal and in documenting during the delivery and in the newborn care. My sincerest thanks to my Clinical Instructor, who imparted her knowledge, skills and assistance throughout the duration of this book.

And above all, to Almighty God, for the strength, love and grace in writing this book.

















INTRODUCTION Obstetrics Branch of medicine concerned with the treatment of women during pregnancy, labor la bor,, ch child ildbir birth th an and d the tim time e aft after er ch child ildbir birth th.. Ob Obste stetri trici cians ans wo work rk to en ensu sure re tha thatt pregnancy culminates in the delivery of a healthy baby, without impairing the health of the moth mother. er. The mot mother' her's s med medical ical his history tory and hea health lth stat status us are init initially ially evaluated. evaluated. Physical examination discloses the mother's uterine size and estimates the length of her pregnancy. If the obstetrician detects abnormalities, prenatal testing may need to be done on the fetus. An important modern development development has been ultrasonography, ultrasonography, which allows the obstetrician to non-invasively diagnose intra-uterine conditions. Delivery of the baby is helped by the use of a Friedman's chart, which shows the patterns of cervical dilation. The care of women during childbirth was originally in the hands of wome wo men n bu butt in th the e 16 16th th ce cent nt.. ph phys ysic icia ians ns gr grew ew in inte tere rest sted ed in th the e fi fiel eld. d. Of sp spec ecia iall importance were the invention of the delivery forceps by Peter Chamberlen in the 17th cent. and the introduction of anesthesia in the 19th cent. The adoption of antiseptic methods according to the theories of Joseph Lister and Ignaz Semmelweis reduced the incidenc inci dence e of infe infectio ction n in chil childbir dbirth th and made possible possible suc success cessful ful cesarean section. section . Obstetrics is often combined with gynecology as a medical specialty

Gynecology Branch of med Branch medicin icine e spec speciali ializing zing in the dis disorde orders rs of the fem female ale rep reprodu roductiv ctive e system. syst em. Mod Modern ern gyne gynecolo cology gy dea deals ls with men menstru strual al diso disorder rders, s, men menopau opause, se, infe infectio ctious us disease dise ase and mal maldeve developm lopment ent of the repr reprodu oductiv ctive e orga organs, ns, dis disturb turbanc ances es of the sex hormones, hormone s, benign and maligna malignant nt tumor formation formation,, and the prescription of contrac contraceptive eptive devices. A branch of gynecology, reproductive medicine, deals with infertility and utilizes artifi art ificia ciall ins insem emina inatio tion n an and d inin-vi vitro tro fer fertil tiliza izatio tions, ns, wh where ere a hum human an eg egg g is har harve veste sted, d, fertilized in a test tube, then implanted into the womb. Some gynecologists also practice obstetrics.. Surgical gynecology began to make progress in the 19th cent., when the obstetrics introduction introduc tion of anesthesia and ant antisep isepsis sis (see antiseptic antiseptic)) paved the way for many advances. The American physician J. M. Sims was larg largely ely resp respons onsible ible for gain gaining ing acceptance of gynecology as a medical and surgical specialty. Until then there had been opposition to it on moral grounds from midwives, the clergy and the medical profession. In recent years, because of controversies over abortion and birth control, control , government has become involved in gynecological practice.

Pregnancy

















breasts begins, and alteration of renal function, blood volume, and blood cell count occur. Movement of the fetus and fetal heartbeat can be detected early in pregnancy. One On e te test st th that at has be been en use used d to de deter termi mine ne pr pregn egnan ancy cy us uses es bl bloo ood d or ur urine ine samples to detect a hormone known as BhCG, found exclusively in pregnant women. Later, prenatal diagnostic tests such as alpha fetoprotein, amniocentesis amniocentesis,, and chorionic villus vill us sam samplin pling g ma may y be per perfor forme med d as sc scre reen ening ing me measu asure res s fo forr con conge genit nital al de defe fects cts.. Ultrasound,, a sonar device using high-frequency wavelengths, is used to detect defects, Ultrasound measure fetal fetal heartbeat, heartbeat, and monitor growth growth of a fetus. Complic Complications ations of pregnancy pregnancy include eclampsia eclampsia,, pre premat mature ure birt birth, h, and erythrob erythroblastosis lastosis fetalis (Rh incompa incompatibility). tibility). Ectopic pregnancy, in which the fetus begins to develop outside the uterus, often in a fallopian tube, tube , is another complication. It is often the result of scarring from a sexually transmitted disease. disease . Smoking has been linked to low—birth weight infants; alcohol consumption during pregnancy has been linked to a group of defects called fetal alcohol syndrome.. syndrome The technology relating to pregnancy has made great advances and has created a number of ethical issues. Many women in their 40s are now able to sustain successful pregnancies, due to technological devices that carefully monitor the progress of the fetus. In vi vitro tro fer fertil tiliza izatio tion n an and d ot othe her r infertility tr trea eatm tmen ents ts ha have ve al allo lowe wed d ev even en postmenopausal women to give birth. The use of fertility drugs has led to a marked increase in multiple births. births . Abortion Abortion,, in which pregnancy pregnancy is terminat terminated ed prior to birth, has long lo ng be been en a sub subjec jectt of he heate ated d deb debat ate, e, an and d su surro rroga gate te mo moth therh erhoo ood d (se (see e surrogate mother ) has also raised ethical issues in recent years Reproduction is the process by which organisms produce more organisms like themselves. All living things, including humans, reproduce: it's one of the things that set us ap apart art fro from m no nonl nlivi iving ng ma matte tter. r. An And d bec becau ause se all liv living ing thi things ngs eve eventu ntuall ally y di die, e, ne new w creatures of the same kind must constantly be born to perpetuate a particular species. Interestingly, although the reproductive system is essential to keeping a species alive, unlike other body systems, it is not essential to keeping an individual being alive.

Early Signs of Pregnancy The signs of pregnancy can vary from person to person. You may have none, some, or all of the following signs of pregnancy: • • • • • •

A missed period, spotting, or a period with less bleeding than normal Nausea or vomiting Tender, swollen, or tingling breasts Fatigue Changes in appetite or digestion Frequent urination and urgency

Although some of these signs may be due to factors other than pregnancy, you

















Anatomy and Physiology Ovary, in an Ovary, anat atom omy, y, or orga gan n of fe fema male le an anim imal als, s, in incl clud udin ing g hu huma mans ns,, th that at pr prod oduc uces es reproductive cells called eggs, or ova. In humans they are oblong, flattened, ductless glands, about 3.8 cm (about 1.5 in) long, on either side of the uterus, to which they are connected by the Fallopian tubes. Each ovary is composed of two portions: an external, or cortical, portion, and a deep, medullary portion. The cortical portion in the adult contains an enormous number of follicles, or sacs, varying in size. called Graafian follicles, they contain the ova, the female reproductive cells. The interior of the ovary is distinctly divided into an outer cortex, where the germ cells develop, and a central medulla occupied by the major arteries and veins. Each egg cell develops in its own fluid-filled follicle and is released by ovulation. The ovary is supplied with an ovarian artery, ovarian veins, and ovarian nerves, which travel through the suspensory ligament.

Left Ovary

Right Ovary

The ovary is held in place by the ovarian, suspensory, and broad ligaments as well as a peritoneal fold called the mesovarium. The ovary secretes hormones that, together with secretions from the pituitary gland, contribute to secondar secondary y female sexual characteristics and also regulate menstruation. The union of the male sperm cell with the ovum results in fertilization. The ovary may be the site of several disease conditions. It can be the site of acute and chronic inflammation; this may arise from injuries during labor, operations in the pelvic area, or gonorrheal infection spreading from the vagina. The ovary also may be the site of neoplasms (tumors) of several varieties. Some are fluidic enlargements enlargements of one or more Graafian follicles and may attain an enormous size; these are known as ovarian cysts. Other growths, of a solid nature, are known as derm de rmoi oid d cy cyst sts. s. Th Thes ese e en enla larg rgem emen ents ts,, us usua uall lly y be beni nign gn,, oc occa casi sion onal ally ly pr prov ove e to be cancerous.

















Ovary and Fallopian Tube

Uterine Tube and Ovary with

Ligaments Most species have male and female organisms. Each sex has its own unique reproductive reproduc tive system. They are different in shape and structur structure, e, but both are specifically designed to produce, nourish, and transport either the egg or sperm. Unlike its male counterpart, the female reproductive system is almost entirely hidden within the pelvis. It cons co nsist ists s of or organ gans s tha thatt ena enable ble a wom woman an to pr produ oduce ce eg eggs gs (o (ova) va),, to hav have e se sexua xuall intercourse, to nourish and house the fertilized egg (ovum) until it is fully developed, and to give birth.

`Females



















top of the vaginal opening is called the mons pubis. pubis . A thin sheet of tissue called the hymen partially covers the opening of the vagina. Two pairs of skin flaps, the labia (which means "lips") surround the vaginal opening. The clitoris clitoris,, which is located toward the front of the vulva where the folds of the labia join, is a small cylindrical structure similar to the male penis; it also contains erectile tissue. Inside the labia are openings to the urethra (the canal that carries urine from the bladder to the exterior of the body) and vagina. The outer labia and the mons pubis are covered by pubic hair in the sexually mature female. The female internal organs are the vagina, uterus, fallopian tubes, and ovaries. The vagina is a 3- to 6-inch-long tubular structure that extends from the vaginal opening to the uterus. It has muscular walls lined with mucous membrane, and it serves as the female organ of copulation (sexual intercourse) as well as the birth canal. It connects with the uterus, or womb, which houses the fetus during pregnancy. About 3 inches long and 2 inches wide and shaped like an inverted pear, the uterus is a muscular, expandable organ with thick walls At the lower part of the uterus is the cervix, which opens into the vagina. At the upper part, the fallop fallopian ian tubes connect the uterus with the ovaries ovaries,, two oval-shaped organs that lie to the right and left of the uterus. They produce, prod uce, store, and rele release ase egg eggs s thro through ugh the fall fallopia opian n tube tubes s into the uter uterus. us. The ovari ov aries es als also o pr prod oduce uce th the e hor hormo mone nes s es estro troge gen n an and d pr prog ogest estero erone ne.. Als Also o pa part rt of th the e reproductive system are the breasts breasts.. Mammary glands inside the breasts secrete milk after childbirth.

Normal Physiology The organs of sexual reproduction are the gonads, which are the ovaries in females and the testes in males. Females produce female gametes, or eggs; males produce male gametes, or sperm. Sexual reproduction is the fertilization of a female gamete by a male gamete. When a female is born, each of her ovaries has hundreds of thousands of eggs, but they remain dormant until her first menstrual cycle, which occurs during puberty. At this time, during adolesce adolescence, nce, the pituitary gland secretes hormones that stimulate the ovaries to produce female sex hormones, including estrogen, which

















blastocyst, a pinhead-sized hollow ball with fluid inside, now housed in the uterus. The blastocyst burrows itself into the lining of the uterus, called the endometrium. Estrogen causes the endometrium to thicken and become rich with blood, and progesterone, another hormone released by the ovaries, maintains the thickness of the endometrium so that the blastocyst can attach to the uterus and absorb nutrients from it. This process is called implantation. As ce cells lls fro from m the bla blasto stocy cyst st tak take e in no nouri urishm shmen ent, t, th the e em embr bryo yonic nic st stag age e of devel dev elopm opment ent be begin gins. s. Th The e inn inner er ce cells lls for form m a fl flatt attene ened d cir circu cular lar sh shap ape e ca calle lled d th the e embryonic disk, which will develop into a baby. The outer cells become thin membranes that form around the baby. The embryonic cells multiply thousands of times, move to new positions, and eventually become the embryo. After approximately 8 weeks, the embryo is about the size of an adult's thumb, but all of its parts - the brain and nerves, the heart and blood, the stomach and intestines, and the muscles and skin - have formed. form ed. Dur During ing the fetal stage, which which lasts from 9 wee weeks ks after fertiliza fertilization tion to birth, development continues as cells multiply, move, and differentiate. The fetus floats in amniotic fluid inside the amniotic sac. Its oxygen and nourishment come from the mother's blood via the placenta, a disk-like structure that adheres to the inner lining of the uterus and is connected to the umbilical cord. The umbilical cord attaches the embryo at its navel to the mother's uterus. The umbilical arteries in the cord carry blood from the fetus to the placenta, and an umbilical vein returns blood from the placenta to the fetus. The amniotic fluid and membrane cushion the fetus against bumps and jolts to the mother's body. Pregnancy lasts an average of 266 days. When the baby is ready for birth, its head presses on the cervix, which begins to relax and widen to get ready for the baby to pass into and through the vagina, which has enlarged to become the birth canal. The mucus that has formed a plug in the cervix loosens, and with amniotic fluid, comes out through the vagina when the mother's "water" breaks. When contractions begin, the uterine walls contract as they are stimulated by the pituitary hormone oxytocin. The contractions cause the cervix to widen and begin to open. After several hours of this widening, the cervix is dilated (opened) enough for the baby to come through. The baby is pushed out of the uterus, through the cervix, and along the birth canal. The baby's

















responsible for its growth should it be fertilized. Menarche, the first menstrual menstrual period in girls, may occur as early as age 8- 9 or as late as 17 and still be within normal limits. Because menarche may occur as early as age 9 years, it is good to include health teaching informat information ion on menstru menstruation ation to both girls and their parents as early as 4 th grade as part of routine care. It It is a poor introducti introduction on to sexuality and womanhoo womanhood d for a girl to begin begin mens menstru truatio ation n unwar unwarned ned and and unpre unprepar pared ed for the the imp importa ortant nt inter internal nal function it represents. The length of menstrual cycle differs from woman to woman, but the accepted average length length is 28 days (from the beginning of one menstrual menstrual flow to the beginning beginning of the next). However, it is not unusual for cycles to be as short as 23 days or as long as 35 days. The length of the average menstrual flow is (termed memses) is 2 to 7 days although women may have periods as short as 1 day or as long as 9 days. Because there is such variation in length, frequency, and amount of menstrual flow and such variation in he onset of menarche, many women have questions about what is considered normal. Contact with health care personnel during the yearly health examination or prenatal visit is often the first opportunity some women have to ask question they have had for sometime.

PHASES OF MENSTRUAL CYCLE

1. Proliferative Phase Immediately after a menstrual flow (occurring Immediately (occurring the first 4 or 5 days of a cycle), the endometrium, or lining of the uterus, is very thin, only approximately one cell layer in depth. As the ovary begins to produce estrogen (in follicular fluid,under the direction of the pituitary FSH), the endometrium begins to proliferate. This growth is very rapid and increase incr ease the thic thicknes kness s of the end endomet ometrium rium appr approxim oximatel ately y eig eightfo htfold. ld. This incr increase ease continues for the first half of the menstrual cycle (from approximately day 5 to 14). This half ha lf of me mens nstru trual al cyc cycle le is ter terme med d int interc ercha hange ngeab ably ly the pro prolife liferati rative, ve, est estrog rogenic enic,, follicular or post menstrual phase.

















3. Ischemic Phase If fertilization does not occur. The corpus luteum in the ovary begins to regrets after aft er 8 to 10 da days. ys. As it re regr gress esses, es, th the e pr produ oducti ction on of pro proge geste steron rone e an and d est estrog rogen en decreases. With the withdrawal of progesterone stimulation, the endometrium of the uterus begins to degenerate (approximately day 24 or 25 of the cycle). The capillaries rupture, with minute hemorrhages, and the endometrium sloughs off.

4. Menses: Menses: Final Phase of Menstrual Cycle The following following products are discharged discharged from the uterus uterus as the menstrual menstrual flow or mens me nses: es: blood blood fro from m ru ruptu ptured red capilla capillarie ries; s; mu mucin cin from the gla glands nds,, fra fragm gment ents s of edometrial tissues, microscopic, atrophied and unfertilized ovum. Menses is actually the end of an arbitrarily defined menstrual cycle. Because it is the only external external marker of the cycle, however, however, the first day of menstrual menstrual flow is used to mark the beginning day of a new menstrual cycle. Contrary to common belief, menstrual flow contains only approximately 30 to 80 ml of bloods, it may seem more because of the accompanying mucus and endometrial shreds. The iron loss during menstrual flow is approximately 11 mg, this is enough that many woman need to take daily iron supplement to prevent iron depletion during their menstruating years. In women who are going through menopauses, menses may typically be a few days of spotting before a heavy flow or heavy flow followed by a few days of spotting, because progesterone withdrawal is more sluggish or tends to “staircase” rather than withdraw.

TEACHING ABOUT MENSTRUAL HEALTH Exercise It’s good to continue moderate exercise during menses because it increases abdominal tone. Sustained excessive exercise, such as professional athletes maintain, can cause amenorrhea.

















Rest More rest may be helpful if dysmenorrhea interferes with sleep at night.

Nutrition.. Nutrition Many women may need iron supplementation to replace iron lost in menses. Eating pickles or cold food does not cause dysmenorrhea.

Stages of Fetal Development In just 38 weeks, a fertilized egg matures from a single cell carrying all the necessary genetic material to a fully developed fetus ready to born. Fetal growth and development is typically divided into three periods. Pre- embryonic (First 2 weeks beginning with fertilization); embryonic (from 3 weeks through 8), and fetal (from week 8 through birth). Ovum Zygote Embryo Fetus Conceptus

From ovulation to fertilization From fertilization to implantation From implantation to 5 – 8 weeks From 5 – 8 weeks until term Deve De velop loping ing em embry bryo o or fe fetus tus and pla placen centa tall structures throughout pregnancy

Milestones of Fetal Growth and Development The li The life fe of th the e fe fetu tus s is ge gene nera rall lly y me meas asur ured ed fr from om th the e ti time me of ov ovul ulat atio ion n or fertilization fertilizat ion (ovulation age), but the length of pregnanc pregnancy y is genera generally lly measured from the first fir st da day y of th the e las lastt me menst nstrua ruall pe perio riod d (ge (gesta statio tional nal age). age). Be Beca caus use e ov ovula ulati tion on an and d fertilization take place about 2 weeks after the last menstrual period, the ovulation age



















• • • • •

• • • •

Length: 0.75 to 1 cm. Weight: 400 mg. The spinal cord is formed and fused at the midpoint. Lateral wings that will form the body are folded forward to fuse at the midline. Head folds forwards, becoming prominent, comprising about one third of the entire structure. The back is bend so the head almost touches the tip of the tail. The rudimentary heart appears as a prominent budge on the anterior surface. Arms and legs are bud like structures. Rudimentary eyes, ears and nose are discernible.

End of 8 Gestation Weeks • • • • • • • • • •

Length: 2.5 cm (1cm). Weight: 20 g. Organogenesis is complete. The heart, with a septum and values, is beating rhythmically. Facial features are definitely discernible. Extremities have developed. External genitalia are present, but sex is not distinguished by simple observation. Primitive tail regressing. Abdomen appears large as the fetal intestine is growing rapidly. Sonogram shows gestational sac, diagnostic of pregnancy.



















• •

•

Liver and pancreas are functioning. Fetus actively swallows amniotic fluid, demonstrating an intact but uncoordinated swallowing reflex, urine is present in amniotic fluid. Sex can be determined by ultrasound.

End of 20 Gestation weeks • • • • • • •

• •

•

Length: 25 cm. Weight: 223 g. The mother can sense spontaneous fetal movements. Antibody production is possible. Hair forms, extending to include eyebrows and hair on the head. Meconium is present in the upper intestine. Brown fat, a special fat that will aid in temperature regulation at birth, begins to be formed behind the kidneys, sternum and posterior neck. Fetal heart beat is strong – enough to be audible Vernix caseosa, a cream cheese -like substance produced by the sebaceous gland that serves as a protective skin covering intrauterine life, begins to form. Defin Def inite ite sl sleep eeping ing an and d act activi ivity ty pa patte tterns rns are dis distin tingui guish shabl able e (th (the e fet fetus us ha has s developed biorhythms that will guide sleep /wake patterns throughout life).

End of 24 Gestation Weeks (Second Trimester)



















•

•

The blood vessels of the retina are extremely susceptible to damage from high oxygen oxyg en con concent centrati rations ons (an impo importa rtant nt cons consider ideratio ation n whe when n cari caring ng for pret preterm erm infants who need oxygen). The eyes open.

End of 32 Gestations Weeks • • •

• • • •

•

Length: 38-43 cm. Weight: 1,600 g. Subcutaneous fat begins to be deposited (the former is stringy “ Little old man” appearance is lost). Fetus is aware of sounds outsides the mothers body. Active Moro reflex is present. Birth position (vertex or breech) may be assumed. Iron stores that provide iron for the time during which the neonate will ingest only milk after the birth are beginning to be developed. Finger nails grow to reach the end of the fingertips.

End of 36 Gestation weeks • • •

Length: 42 to 49 cm. Weight: 1,900 to 2,700 g (5 – 6 lbs). Body stores of glycogen, iron, carbohydrate and calcium are augmented.



















CONCEPT OF FAMILY Family A basic unit of social structure, the exact definition of which can vary greatly from time to time and from culture to culture. How a society defines family as a primary group, and the functions it asks families to perform, are by no means constant. There has been much recent discussion of the nuclear family, which consists only of parents and children, but the nuclear family is by no means universal. In the United States, the percentage of households consisting of a nuclear family declined from 45% in 1960 to 23.5% in 2000. In pre-industrial societies, the ties of kinship bind the individual both to the family of orientation, into which one is born, and to the family of procreation, which one founds at marriage and which often includes one's spouse's relatives. The nuclear fami fa mily ly al also so ma may y be ex exte tend nded ed th thro roug ugh h th the e ac acqu quis isit itio ion n of mo more re th than an on one e sp spou ouse se (polygamy and polygyny), or through the common residence of two or more married couples and their children or of several generations connected in the male or female line. This is called the extended family; it is widespread in many parts of the world, by



















unwed parents and children, especially in Scandinavia and other part of N Europe. Another factor affecting the modern Euro-American family was the Industrial Revolution, which removed from the home to the factory many economic tasks, such as baking, spinning, and weaving. Economic and social conditions have discouraged the presence of the husband and father in the home; in industrial communities the wife and mother also is often employed outside the home, leaving the children to be cared for by others. Sociologists and psychologists find in these changed relations of the members of the family to each other and of the family to the community at large the source of many problems such as divorce divorce,, mental illness, and juvenile delinquency.

RESPONSIBLE PARENTHOOD Responsible Parenthood We affi affirm rm the prin principl ciple e of resp respons onsible ible parenthood parenthood.. The family, in its vary varying ing forms, constitutes the primary focus of love, acceptance, and nurture, bringing fulfillment to pa pare rents nts and ch child ild.. Hea Health lthfu full an and d wh whole ole pe perso rsonh nhoo ood d de deve velop lops s as on one e is lo loved ved,, responds to love, and in that relationship comes to wholeness as a child of God. Each couple has the right and the duty prayerfully and responsibly to control





















poses other serious problems concerning the life, health, or mental capability of the child to be, is not a moral necessity. In such cases, we believe the path of mature Christian judgment may indicate the advisability of abortion. We support the legal right to abortion as establis established hed by the 1973 Suprem Supreme e Court decision decision.. We encourage women in counsel with husbands, doctors, and pastors to make their own responsible decisions concerning the personal and moral questions surrounding the issue of abortion . We therefore encourage our churches and common society to: 



provide to all education on human sexuality and family life in its varying forms, including means of marriage enrichment, rights of children, responsible and joyful expression of sexuality, and changing attitudes toward male and female roles in the home and the marketplace; provide prov ide cou counsel nseling ing oppo opportun rtunities ities for marr married ied cou couples ples and thos those e app approac roaching hing



























the development of all socially responsible responsible and life-enhan life-enhancing cing expressions of the extended family, including families with adopted children, single parents, those with no children, and those who choose to be single; view vie w pa paren rentho thood od in th the e wid widest est po poss ssibl ible e fr fram amewo ework, rk, rec recogn ognizi izing ng th that at ma many ny children of the world today desperately need functioning parental figures, and also al so un unde ders rsta tand ndin ing g th that at ad adul ults ts ca can n re real aliz ize e th the e ch choi oice ce an and d fu fulf lfil illm lmen entt of parenthood through adoption or foster care; encou enc ourag rage e me men n an and d wo wome men n to act active ively ly dem demon onstr strate ate the their ir res respon ponsib sibili ility ty by creating a family context of nurture and growth in which the children will have the opportunity to share in the mutual love and concern of their parents; be aware of the fears of many in poor and minority groups and in developing nations about imposed birth-planning, oppose any coercive use of such policies and services, and strive to see that family-planning programs respect the dignity of each individual person as well as the cultural diversities of groups.





















Intervention- is putting the nursing care plan into action. During the implementation phase, the nurse carries out the prescribed nursing activities or delegates the care to an appropriate person, and validates the nursing care plan. This phase ends when the nurse records the care given and the client’s responses to care in the client record. measures ures the clie client’s nt’s response response to nurs nursing ing actions and the clie client’s nt’s Evaluation- it meas progress toward achieving achieving goals. Evaluat Evaluation ion is the ongoing and occurs when the nurse has contact with a client. The emphasis is on client outcomes. The nurse evaluates whether whe ther the clie client’s nt’s behavior behavior or resp respons onses es refl reflect ect a reve reversa rsall or impr improve ovemen mentt in a nursing diagnosis or maintenance of a healthy state.

Maternal Data Base Assessment Guide





















1. LMPLMP- De Dec. c. 29 29,, 200 2006 6 2. EDD- October 06, 2005: 2005: date date of delivery: Septemb September er 30,2005 30,2005 3. AO AOGG- 36 1/ 1/7 7 wee week k

3. Physiological and Psychological Changes of Pregnancy a. First Trimester o Patient did suffer from UTI during her 1 st month of pregnancy. She never had episodes of dizziness or vomiting. There were no visible changes in the body that was noted. She only went to the RHU once during her pre-natal check up. She was only given 1 dose of Tetanus toxoid immunization. She was never given any vitamins(ferrous sulfate) for her supplement. She is thin and anemic. b. Second Trimester She had difficulties during this stage of her pregnancy. She was confined at the o





















A. they were so very very happy because another member of the family was Added to them and they thank god because it is a healthy baby boy.

8. Reactions /feelings about breastfeeding? A. this is her 3 rd baby and the mother mother planned to breastfeed breastfeed her her baby, t he Mo Mothe therr ha has s alr alrea eady dy aw aware are ab about out br breas eastfe tfeed ed be beca cause use she alw alway ays s attend The meeting/seminar every Monday at the BHC which was attended By























o

She has a good sleeping habit during the entire pregnancy except for interrupted sleep prior to the delivery of her baby. She usually wakes up at night due to impending delivery. The patient had no night sweats.

6. Cognitive-Perceptual























coherent and oriented oriented into spheres of time, place, and person, she is not also in cardiorespiratory distress. V/S: 110/80 mmHg T: 36.7 c

RR: 18 cpm PR: 85bpm























and tenderness The pinna is firm and there is no pain when it is touched. The color is same as the other body























/tenderness at the RLQ /tenderness due to her operation. The umbilicus is in the center. No discoloration and























finger pads. A very hard round well defined shape which can be moved back and forth (balloted) usually indicates a fetal head.

Second Maneuver

















































































































































































































































































































































































































































































































Intervention 1. Gently massage the fundus. Willll st Wi stimu imulat late e the ut uteru erus s to co contr ntract act wh which ich wi willll lea lead d to ut uteri erine ne inv invol oluti ution on an and d prevent excessive bleeding. 2. Ice pack apply over the abdomen. Cold compress promotes vasoconstriction will lead to involution of the uterus. It also provides local anesthesia. 3. Encouraged Kegel’s exercise. Aids in healing and recovery of pubococcygeal muscle tone and prevent urinary stasis. 4. Advised early activity and ambulation as early as possible. It enhances circulation, facilitates bowel and bladder function thereby promoting healing. 5. Explained reason why discomfort occur. For the understanding of the mother that it is the normal occurrence it would ease discomfort and anxiety. •

•

•

•

•

Evaluation The client after three days would feel comfortable because of uterine pain as evidenced by relaxed appearance and verbalization of “ di na masyadong masakit”.

Assessment Subjective: “Nasakit toy susok” as verbalized by the patient. Objective: Breast fullness Shiny skin Redness of skin • • •

Nursing Diagnosis Alteration in Comfort: Breast engorgement Alteration engorgement r/t venous and lymphatic filling of the alveolar cells with milk.

Planning After 3 days, the patient will experience lesser degree of pain as evidenced by letdown reflex, and client verbalization of being relieved from pain.

















To numb the nerve endings. 2.Let the baby suck the breast of the mother. To lessen the volume of milk in the alveolar duct which will lessen the breast engorgement. 3. Advised the mother mother to to avoid avoid putting putting pressure pressure on the breast. Pressure will just add to the degree of pain felt. 4. Enco Encoura uraged ged the clie client nt to to use use fitt fitting ing bras brassier siere. e. For support of breast. •

•

•

•

Evaluation The client was relieved from the pain she felt after three days of implementing the nursing intervention as evidenced by patient verbalization of being relieved from pain.

Assessment Subjective: “Nabayag pay” as verbalized by the patient. Objective Diaphoresis Restlessness Irritability Nervousness • • • •

Nursing Diagnosis Anxiety r/t birthing process, fear from self and infant urgency in micturation, increase muscle tension.

Planning The patient will be able to reduced the level of anxiety in 3 hours .

Intervention 1. Explain the physiology of labor and delivery. Increase awareness of birthing process contribute to her comfort. 2. Give emotional support such as touch and smoothing words. For the clients emotional equilibrium. •

•

















Client anxiety level was lessened after 3 hours as manifested by clients feeling little okay.

CONTENTS Acknowledgement Dedication Introduction The Female Reproductive System Menstruation •

Phases of Menstrual Cycle

•

Teaching About Menstrual Health

Stages of Fetal Development •

Milestones of Fetal Growth and Developmen t

Nursing Assessment Form Maternal Data- based Assessment Guide Leopold’s Manuever

















•

Mc Donald’s Rule

•

Haase’s Rule

•

Johnson’s Rule

•

Bartholomew’s Rule

Risk Indication Form Laboratory Examination Beliefs and Practices General Physical Assessment Tool Stages of Labor Mechanisms of Labor The Placenta Immediate Care for the Newborn APGAR Scoring Puerperium Postpartal Assesstment Breastfeeding •

Beginning of Breastfeeding

•

How to Feed

Health Teachings •

Nutrition during Pregnancy

•

Rest, Sleep and Exercise

•

Sexual Activity

•

Care of the Teeth

















•

Travel

•

Bathing

•

Immunization

•

Perineal Hygiene

Exercises During Pregnancy Postpartal Exercises Nursing Care Plan Documentation

Medical Colleges of Northern Philippines Alimannao Hills, Penablanca, Cagayan



















Is Hereby Presented To The Faculty of College of Nursing

Submitted by:

Khenedy Dela Cruz BSN-III

THE AUTHOR

Being a nursing student is one of the greates greatestt courses in the entire universe. It offer you sacrifices and hardship in order to pass. Being one in the college of nursing n ursing is i s an honor to me as a student nurse like me. As they always say many are called but few are chosen. I’m Knenedy Dela Cruz a BSNIII student. Simple and industrious and luck enough to reach at this level. May th e almight almighty y God may guide me

















APPROVAL SHEET This book entitled “Maternal and child Nursing approach” a family centered and child bearing family family Authored by JENILYNE JENILYNE CASTILLO CASTILLO ROL BSNIV is presented presented to the college of Nursing in partial Fulfillment of the requirement in Maternal and Child Nursing.

Presented to:

Mr.Christopher Gunacao RN ADVISER

















Approved by: Ms.Cheryll JM Gumabay RM,RN,MSN Dean of Colleges of Nursing

Maternal Book by Kennedy Dela Cruz MCNP

Recommend Documents