MCN REVIEWER QSEN Competencies

 QSEN Learning Collaborative created 6

Framework for Maternal and Child Health competencies necessary for quality care. 5
Nursing competencies originated from a study by
the Institute of Medicine.
Global Health Goals
1. Patient-Centered Care
 The United Nations (UN) and World Health
2. Teamwork and Collaboration
Organization (WHO) established
3. Quality Improvement
millennium health goals in 2020 in an
4. Informatics
effort to improve health worldwide.
5. Evidenced-Based Practice
 Goals concentrate on improving the health
6. Safety
of women and children because increasing
the health in these 2 populations can have
*viewed in SKILLS, KNOWLEDGE & ATTITUDE
such long-ranging effects on general health.
 To end poverty and hunger.
Evidence-Based Practice
 To achieve universal primary education.
 The conscientious, explicit and judicious
 To promote gender equality and empower
use of current best evidence to make
women.
decisions about the care of patients.
 To reduce child mortality.
 To improve maternal health.
Nursing Research
 To combat HIV/AIDS, malaria and other
 The systematic investigation of problems
diseases.
that have implications for nursing practice
 To ensure environmental sustainability.
usually carried out by nurses.
 To develop a global partnership for
development.
 Roles and Responsibilities of a Maternal
Child Health Nurse
Framework for M&C Health Nursing Care
M&C health nursing carries some legal
Framework utilizes Nursing Process, Nursing
concerns above and beyond other areas of
Theory and Quality and Safety Education for
nursing because care is often given to
Nurses (QSEN) competencies to care for families
patients who are not of legal age for giving
during childbearing and childrearing years
consent.
through the 4 phases of health care.
 Reproductive healthcare rights and laws
are complex and varies.
 Health Promotion
 Understanding scope practice
 Health Maintenance
 Documentation
 Health Restoration
 Informed Consent
 Health Rehabilitation
 “Wrongful Birth” – birth of a disabled child
Nursing Process
whose parents would have chosen to end
“ADPIE”
if they have been informed about the
1. Assessment
disability during pregnancy.
2. Nursing Diagnosis
 “Wrongful Life” – claim that negligent
3. Planning
prenatal testing on the part of a healthcare
4. Implementation
provider resulted in the birth of a disabled
5. Evaluation
child
 “Wrongful Conception” – denotes that a
Nursing Theory
contraceptive measure failed, allowing an
 Designed to offer helpful ways to view
unwanted child to be conceived and born.
patients so nursing activities can be
created to best meet the patient needs.
 If a nurse knows the care provided by
another practitioner was inappropriate or
 Calista Roy
insufficient, he or she is legally responsible
 Dorothea Orem
for reporting the incident.
 Patricia Benner
 Failure to do so can lead to a charge of
negligence or breech of duty.
Ethical Considerations of Practice
 Conception issues ( IVF, embryo transfer,
cryopreservation, surrogacy).
 Pregnancy termination
 Fetal rights vs. Maternal rights
 Stem cell research
 Resuscitation (DNR, length of continuation)
 Number of procedures and degree of pain
 Confidentiality of record with multiple
caregivers.
The 17 Sustainable Development Goals (SDGs)
to Transform Our World:
GOAL 1: No Poverty- To end poverty, everyone
should have basic healthcare, security and
education.
GOAL 2: Zero Hunger- Globally, one in nine
people are undernourished. This goal aims to
end hunger.
GOAL 3: Good Health and Well-being- Ensuring
people live healthy lives can cut child mortality
and raise life expectancy.
GOAL 4: Quality Education- The UN wants
everyone to have access to inclusive, equitable
quality education.
GOAL 5: Gender Equality- Gender equality is a
human right, and is vital for a peaceful,
prosperous world.
GOAL 6: Clean Water and Sanitation- Clean
water protects people from disease, yet three in
10 people lack access to it.
GOAL 7: Affordable and Clean Energy- Targets
for 2030 include using more renewable,
affordable energy.
GOAL 8: Decent Work and Economic Growth-
The aim is for sustainable economic growth and
decent employment for all.
GOAL 9: Industry, Innovation and
Infrastructure- This involves building resilient
infrastructure and fostering innovation.
GOAL 10: Reduced Inequality- The poorest 40
per cent of the population should be able to
grow their income faster than average.
GOAL 11: Sustainable Cities and Communities-
The UN wants to increase affordable housing
and make settlements inclusive, safe and
sustainable.
GOAL 12: Responsible Consumption and
Production- This goal aims to foster eco-friendly
production, reduce waste and boost recycling.
GOAL 13: Climate Action- Urgent action is
needed, by regulating emissions and promoting
renewable energy.
GOAL 14: Life Below Water- The aim is to
conserve and sustainably use the oceans, seas
and marine resources.
GOAL 15: Life on Land- To stop degradation, we
must preserve forest, desert and mountain
ecosystems.
GOAL 16: Peace and Justice Strong Institutions-
The aim is inclusive societies with strong
institutions that provide justice for all.
GOAL 17: Partnerships to achieve the Goal- If
all countries are to achieve the goals,
international cooperation is vital.
Family and Family Health
Family
 “... a group of persons united by ties of
marriage, blood, or adoption; constituting
a single household; interacting and
communicating with each other in their
respective social roles of husband and wife,
mother and father, son and daughter,
brother and sister, and creating and
maintaining a common culture.” (Burgess
and Locke, 1953).
 “ ... A basic unit of kinship composed of
two or more members who are united by
ties of blood, marriage or adoption, and
who live together constituting a single
household.” (Wong, 1975)
 “The family is a social group characterized
by common residence, economic co-
operation and reproduction. It includes
adults of both sexes, at least two of whom
maintain a socially approved sexual
relationship, and one or more children,
own or adopted, of the usually co-habiting
adults.” (George Peter Murdock, 1949).
 “... a social group made up of members
related to one another by blood or marital
ties and usually constituting a
household.”(Lee, 1991, p.42)
Concepts of the Family
 Karpel and Strauss summarizes different
concepts of the family: (1) the functional
family - defined by shared household,
shared activities, shared responsibility for
daily life and child rearing; (2) the legal
family - defined by legal structure, altered
by divorce and adoptive placement of
children; (3) the family as seen by its
members - defined by the perceptions of
its members; and seen as “in” the family
by family members; (4) the family of long-
term commitments - defined by long-term
expectations of loyalty and commitment;
trust, reliability, and fairness are basic
expectation; (5) the biological family -
defined by blood relationships; parent-
 child relationship. What are the strengths
and weaknesses of these definitions?
WHAT IS MARRIAGE?
- A legal bond or union between a man &
woman.
 Commitment
 Intimacy and sexually unite
(a defining reason why many marriages
stay together)
 Cooperate economically
 May give birth or adopt
 50 years ago this was central reason for
marriage.
 Purpose for marriage has become much
more diverse.
 Legally recognized union
 Marriage license
 Not open on Saturday.
 Fee: $50 in the USA
 City & County offices on 21st S. State.
 Good for 30 days, good immediately.
 18 years without parents consent.
 Second cousins may marry.
 No blood tests or physical exams required.
 Both bride & groom must be present place
of birth.
 Need to know mothers maiden name &
parents.
CULTURE DEFINES WHAT A MARRIAGE IS OR
NOT
 Monogamy - one man, one woman. All 1st
world countries are monogamous.
 Polygamy - more than one wife or
husband. Example: Islam & Fundamental
Mormons
 Bigamy – Marrying another person while
still married to someone else. It is against
the law.
 Serial Monogamy or Modified Polygamy –
Succession of marriages over time. Typical
of US marriages.
Family Structure
2 Basic Family Structures
a) Family of Orientation – the family one is
born into; or oneself, mother, father and
siblings if any
b) Family of Procreation – a family one
establishes; or oneself, spouse or
significant other and children.
Family Types
1. The Dyad Family
 refers to 2 people living together, usually a
woman and a man without children.
 Many young adults live together as a dyad
in shared apartments, dorms or homes for
companionship and financial security while
completing school or beginning their
careers.
 Generally viewed as temporary
arrangements.
2. The Nuclear Family
 traditional structure that is composed of a
husband, wife and children.
3. The Cohabitation Family
 composed of heterosexual couples who
live together like a nuclear family but
remain unmarried.
4. The Extended (Multigenerational) Family
 includes not only the nuclear family but
also other family members such as
grandparents, aunts, uncles, cousins and
grandchildren.
5. The Single-Parent Family
 as the name implies, one parent only
6. The Blended Family
 the remarriage or reconstituted family.
7. The Communal Family
 groups of people who have chosen to live
together as an extended family. Usually
motivated by social, religious values rather
than kinship.
8. The Gay or Lesbian Family
 Having gay or lesbian parents
9. The Foster Family
 Adoption
Family Functions and Roles
 The family roles that people view as
appropriate are the ones they saw their
own parents fulfilling.
 As new generations takes on the values of
the previous generation, traditions and
culture pass from generation to
generation.
 As nurse, it is important to identify the
roles that the family members assume
because family roles are changing and
often not as well defined as in the past.
Family Task
1. Physical Maintenance
2. Socialization of Family Members
3. Allocation of Resources
4. Maintenance of Order
5. Division of Labor
6. Reproduction, Recruitment and Release of
Family
7. Placement of Members into the Larger
Society
8. Maintenance of Motivation and Morale
Family Stages/ Life Cycles
Stage 1: Marriage and the Family
Stage 2: The Early Child-Bearing Family
Stage 3: The Family with Preschool Children
Stage 4: The Family with School-Age Children
Stage 5: The Family with Adolescent Children
Stage 6: The Family of Middle Years
Stage 7: The Family in Retirement or Older Age
Universal Characteristics of Families
A. Universality:
There is no human society in which
some form of the family does not appear.
Malinowski writes the typical family a group
consisting of mother, father and their progeny is
found in all communities, savage, barbarians
and civilized. The irresistible sex need, the urge
for reproduction and the common economic
needs have contributed to this universality.
B. Emotional basis:
The family is grounded in emotions and
sentiments. It is based on our impulses of
mating, procreation, maternal devotion,
fraternal love and parental care. It is built upon
sentiments of love, affection, sympathy,
cooperation and friendship.
C. Limited size:
The family is smaller in size. As a
primary group its size is necessarily limited. It is
a smallest social unit.
D. Formative influence:
The family welds an environment
which surrounds, trains and educates the child.
It shapes the personality and molds the
character of its members. It emotionally
conditions the child.
E. Nuclear position in the social structure:
The family is the nucleus of all other
social organizations. The whole social structure
is built of family units.
F. Responsibility of the members:
The members of the family has certain
responsibilities, duties and obligations. Maclver
points out that in times of crisis men may work
and fight and die for their country but they toil
for their families all their lives.
G. Social regulation:
The family is guarded both by social
taboos and by legal regulations. The society
takes precaution to safeguard this organization
from any possible breakdown.
Functions of Families
 Family ties like intimacy.
 Economic cooperation - families are
consuming and producing units.
 Reproduction and socialization.
 Only a family can produce a socialized
adult.
WHAT SHOULD A CHILD LEARN IN A FAMILY?
 Values, moral
 Culture and traditions
 Self concept
 How to solve problems/conflict resolution
 Commitment to family is first
 Each member must contribute
 Change is possible
 How to make a decision
 Communication
Assignment of Social Roles and Status (Identity)
We belong to two families in our lifetime:
Family of Origin: You were the child
Family of Procreation: You are the parent
WHY LIVE IN A FAMILY?
 Love and closeness
 Offer continuity in emotional attachments,
rights, and obligations.
 Close proximity which facilitates
cooperation and communication.
 Abiding familiarity with others. Can know
ourselves and others well.
 Economic benefits.
CHARACTERISTICS OF HEALTHY FAMILIES
 Appreciation – notice the less obvious
things, express appreciation often.
 Kindness –tends to be catching.
 Communication – listen so others will talk,
talk so others will listen.
 Time Together – plan it, don’t wait to find
it, need quantity to have quality.
 Values and Standards – communicate
them clearly, follow them consistently.
 Strictness & Permissiveness – firm, fair,
and friendly.
 Problem Solving – look for solutions, not
for blame.
 Traditions –give a sense of identity.
 Fun & laughter – plan it, use props, bring
home jokes.
Mother & Child Health
Sociocultural Assessment
a) Communication Pattern
- (not only what people say but also how they
say it) are determined by culture and are
increasingly important during times of stress.
b) Use of Conversational Space
– being aware of that use of space is culturally
determined helps you to respect the use of
space. Respect to modesty is a way to respect
close space.
c) Time Orientation
- Cultural pattern that is geared toward
punctuality regarding appointments or concern
for time.
- Differs whether a culture concentrates on the
past, present & future.
d) Work Orientation
-Predominant culture stresses that everyone
should be employed productively and work
should be pleasurable and valued in itself.
-Do not interpret this behavior as lazy or
unproductive; it is merely a cultural or individual
variation.
j) Pain Responses
- A person’s response to pain is both individually
and culturally determined.
- Threshold sensation
- Pain Threshold
- Pain Tolerance
Reproductive and Sexual Health
Reproductive Development
 Intrauterine Development
 The sex of an individual is determined at
the moment of conception by the
chromosome information of the particular
ovum and sperm that joined.
 Week 5 of intrauterine life- primitive
gonad is formed. Mesonephric (wolffian) &
Paramesonephric (műllerian) ducts are
present.
 Week 7 or 8 – in chromosomal males, early
gonadal tissues differentiates into
primitive testes and begins formation of
testosterone.
 Week 10 – if testosterone is not present,
the gonadal tissue differentiates into
ovaries.

e) Family Orientation
- Family and structure and roles may be
culturally determined.
- Identifying the family decision-maker is
important.
f) Male and Female Roles
- In most culture, man is the dominant figure.
- In contrast, in some culture, the woman may
be the dominant person in the family, esp. the
oldest woman.

g) Religion
- because religion guides a person’s overall life
philosophy, it influences how he or she feels
about health and illness.

h) Health Belief
- Health beliefs are not universal

i) Nutrition Practices
- Food and methods of preparation are strongly
culturally related.
 Pubertal Development Anatomy & Physiology of the Reproductive
 For males, it was said that the System
Hypothalamus, under the direction of the
Central Nervous System may serve as a
gonadostat or regulation mechanism set
to “turn on” gonad functioning.
 The theory that the girl must reach a
critical weight of approximately 95 lbs (43
kg) or develop a critical mass of fat before
the hypothalamus is triggered to send
initial stimulation to APG to begin
gonadotropic hormone formation.

Pubertal Development
Role of Androgen
 Responsible for muscular developement,
physical growth and increase in sebaceous
gland secretions.
 Males- produced by the adrenal cortex and
testes Female Reproductive System
 Females- produced by the adrenal cortex
and ovaries
 Adrenarche- development of pubic and
axillary hair

Role of Estrogen
 Increse in levels during puberty (females)
influences the development of the uterus,
fallopian tubes and vagina; typical fat
distribution; hair pattern; breast
development and end to growth
(epiphesial closure).
 Thelarche- the beginning of breast
development.

Secondary Sex Characteristics

Females
 Growth Spurt Male Reproductive System
 Increase in the transverse diameter of
pelvis Menstruation
 Breast development Defined as episodic uterine bleeding in response
 Growth of Pubic Hair to cyclic hormonal changes.
 Onset of Menstruation
 Growth of Axillary Hair
 Vaginal Secretions
 Menarche – first menstrual period

Males
 Increase in Weight
 Growth of Testes
 Growth of face, axillary and pubic hair
 Voice Changes
 Penile Growth
 Increase in Height
 Spermatogenesis
Menstrual Cycle
 First Phase of Menstrual Cycle
(Proliferative Phase)
 Immediately after a menstrual flow (which
occurs during the first 4 or 5 days of a
cycle), the endometrium, or lining of the
uterus, is very thin, approximately one cell
layer in depth. As the ovary begins to
produce estrogen (in the follicular fluid,
under the direction of the pituitary FSH),
the endometrium begins to proliferate so
rapidly the thickness of the endometrium
increases as much as eightfold from day 5
to day 14. This first half of a menstrual
cycle is interchangeably termed the
proliferative, estrogenic, follicular, or
postmenstrual phase.
 Second Phase of Menstrual Cycle
(Secretory Phase)
 After ovulation, the formation of
progesterone in the corpus luteum
(under the direction of LH) causes the
glands of the uterine endometrium to
become corkscrew or twisted in
appearance and dilated with quantities
of glycogen (an elementary sugar) and
mucin (a protein). It takes on the
appearance of rich, spongy velvet. This
second phase of the menstrual cycle is
termed the progestational, luteal,
premenstrual, or secretory phase.
 Third Phase of Menstrual Cycle
(Ischemic Phase)
 If fertilization does not occur, the corpus
luteum in the ovary begins to regress after
8 to 10 days, and therefore, the production
of progesterone decreases. With the
withdrawal of progesterone, the
endometrium of the uterus begins to
degenerate (at about day 24 or day 25 of
the cycle). The capillaries rupture, with
minute hemorrhages, and the
endometrium sloughs off.
 Fourth/Final Phase of Menstrual Cycle
(Menses)
 Menses, or a menstrual flow, is composed
of a mixture of blood from the ruptured
capillaries; mucin; fragments of
endometrial tissue; and the microscopic,
atrophied, and unfertilized ovum. Menses
is actually the end of an arbitrarily defined
menstrual cycle. Because it is the only
external marker of the cycle, however, the
first day of menstrual flow is used to mark
the beginning day of a new menstrual
cycle. Contrary to common belief, a
menstrual flow contains only 30 to 80 ml
of blood; if it seems to be more, it is
because of the accompanying mucus and
endometrial shreds. 248 The iron loss in a
typical menstrual flow is approximately 11
mg. This is enough loss that many
adolescent women could benefit from a
daily iron supplement to prevent iron
depletion during their menstruating years
(Bitzer, Sultan, Creatsas, et al., 2014).
Characteristics of Normal Menstrual Cycle
CHARACTERISTICS DESCRIPTION
Beginning (menarche) Average age onset, 12-
13 years; average range 9-17 years
Interval between cycles Average of 28 days; cycles of 23 to 35 d
ays not usual
Duration of menstrual flow Average flow, 2-7 days; ranges 1-
9 days not abnormal
Amount of menstrual flow Difficult to estimate; average 30-80 ml
Color of menstrual flow Dark red; a combination of blood mucus
and endometrial cells
Odor Similar to that of marigolds
Education Regarding Menstruation
 Vital to girls’ future child-bearing and their
self concept as women.
 Equally important for boys so that they can
appreciate the cyclic process of women’s
reproductive system and can be active
participants in helping plan or prevent
conception of children
Menopause
 The cessation of menstrual cycles.
 Usually occurs between 40-55 years old.
 Both age of menarche and age of
menopause is familial.
 The earlier the age of menarche, he earlier
the age of menopause.
Sexuality and Sexual Identity
 Sexuality is a multidimensional
phenomenon that includes feelings,
attitudes and actions.
 It encompasses and gives direction to a f) Voyeurism
person’s physical, emotional, social and g) Sadomasochism
intellectual responses throughout life h) Other types of sexual expression
 Each person is born a sexual being and his  Exhibitionism
or her gender identity and role behavior  Pedophiles
evolve from and usually conform to the
societal expectations within that person’s Disorders of Sexual Function
culture. A. Primary Sexual Dysfunction
 Nurses can play a major role in promoting  Erectile Dysfunction
sexual health through education and  Premature Ejaculation
discussion.  Failure to achieve orgasm/ decreased
sexual desire
Development of Gender Identity  Vaginismus
 Infancy  Dyspareunia
 Preschool Period  Inhibited sexual desire
 School-Age Child
 Adolescent B. Secondary Sexual Dysfunction
 Young Adult  Caused by chronic diseases such as pepticc
 Middle-Age Adult ulcers, chronic pulmonary ds, obesity, STDs
 Older Adult and other debilitating ds.

Human Sexual Response Reproductive Life Planning

 Includes all the decisions an individual or
Sexual Response Cycle couple make about having children.
a) Excitement  An individual or couples choice of
b) Plateau contraceptive method should be made
c) Orgasm carefully with complete knowledge about
d) Resolution the advantages, disadvantages, and side
effects of the various options.
 Things to consider are
 Personal Values
 Ability to use method correctly
 How the method will affect sexual
enjoyment
 Financial factors
 Status of couple’s relationship
 Prior experiences
 Future plans

Family planning methods

1. Natural Methods of Reproductive Life
Female Sexual Response Cycle Planning
a. Calendar/ Rhythm Method
Male Sexual Response Cycle  Requires a couple to abstain from coitus
on the days of a menstrual cycle when the
Types of Sexual Orientation woman is most likely to conceived (3 to 4
 Heterosexuality days before and 3 to 4 days after
 Homosexuality ovulation).
 Bisexuality  Woman should keep a diary of six
 Transsexuality menstrual cycles.
 To calculate “safe days “ she subtracts 18
Types of Sexual Expression from the shortest cycle and 11 from her
a) Celibacy longest cycle documented.
b) Masturbation
c) Erotic Stimulation b. Basal Body Temperature Method
d) Fetishism  Before the day of ovulation, a woman’s
e) Transvestism BBT falls about half a degree and at the
 time of ovulation, her BBT rises a full
degree because of the influence of
progesterone.
 To use the method, a woman takes her
body temp. each morning immediately
after waking before she undertakes any
activity
c. Cervical Mucus (Billings) Method
 Uses the changes in cervical mucus that
occur naturally with ovulation. Before
ovulation each month, the cervical mucus
is thick and does not stretch when pulled
between the thumb and finger
(Spinnbarkeit).
 Just before ovulation, mucus secretion
increases.
 With ovulation (the peak day), cervical
mucus before copious, thin, watery and
transparent. It feels slippery and stretches
at least 1 inch before the strand breaks.
d. Symptothermal Method
 Combines the cervical mucus and BBT
methods
f. Ovulation Awareness
 This is the use of over-the-counter
ovulation detection kit. It detect the
midcycle surge of luteinizing hormone that
can be detected in urine 12 to 24 hours
before ovulation.
g. Lactation Amenorrhea
 As long as a woman is breast-feeding an
infant , there is some natural suppression
of ovulation.
 However, the method is not dependable
because a woman may ovulate but not
menstruate.
 After 6 months of breast-feeding the
woman should be advised to choose
another method of contraception.
h. Coitus Interruptus
 The couple proceeds with coitus until the
moment of ejaculation. The man
withdraws and spermatozoa are emitted
outside the vagina.
 Unfortunately, ejaculation may occur
before withdrawal is complete and despite
the care used, some spermatozoa may be
deposited in the vagina.
 It offers little protection against
conception.
i. Fertility Beads/ Cycle Beads
 A hands-on visual tool used by millions of
women worldwide, Cycle Beads is the
original way to identify your fertile days
using the Standard Days Method® of family
planning.
 Cycle Beads is a color-coded string of
beads representing a woman's menstrual
cycle. It helps a woman track her cycle,
identify when are fertile days and non-
fertile days, and monitor that her cycles
are in range for effective use of this family
planning method.
 A woman can plan or prevent pregnancy
easily and effectively with this easy to use
tool.
j. Two-Day Method
 A woman assess for vaginal secretions
daily. If she feels secretions for 2 days in a
row, she avoids coitus that day and the
day following as the presence of secretions
suggests fertility.
 The method requires conscientious daily
assessment.
2. Artificial Methods of Reproductive Life
Planning
a. Oral Contraceptives / Pills
 Composed of varying amount of synthetic
estrogen combined with small amount of
progesterone.
 Available in monophasic, biphasic and
triphasic preparations.
 Commonly packed in 28 pills (21 active pill
and 7 placebo pills)
b. Mini Pills
 Known as the progestin only pills.
 Taken by women who cannot take an
estrogen-based pill because of the dangrer
of thrombophlebitis.
c. Emergency Postcoital Contraceptives
 Known as the morning after pills.
 Usually taken within 72 hours of
unprotected intercourse
d. Subcutaneous/ Subdermal Implants
 The implants slowly release the hormone,
suppressing ovulation, stimulating thick
cervical mucus, and changing the
endometrium so that implantation is
difficult.
 Inserted and removed using local
anethesia.
 Implanon and Norplant are the common
brands
e. Intramuscular Injections
 A single injection of medroxyprogesterone
acetate (DMPA or Depo-Provera).
 Given every 12 weeks to inhibit ovulation,
alter the endometrium and change the
cervical mucus.
f. Intrauterine Devices
 A small plastic device inserted into the
uterus through the vagina.
g. Vaginally Inserted Spermicidal Products
 Agents cause the death of spermatozoa
before they can enter the cervix.
 The agent also change the vaginal pH to a
strong acid level, a condition not
conducive to sperm survival.
h. Diaphragms
 A circular rubber disc that is placed over
the cervix prior to intercourse.
 They should be left in place for 6 hours
afterwards.
 Should not be place longer than 24 hours
l. Female Condom
 Latex sheaths made by polyurethane and
lubricated by nonoxynol-9.
 The inner ring (closed end) covers the
cervix and the outer ring (open end) rests
against the vaginal opening.
 Male and female condom should not be
used together.
m. Estrogen/Progesterone Transdermal Patch
 Refers to the patches that slowly, but
continuously release a combination of
estrogen and progesterone.
 May be applied to one of four areas: upper
outer arm, upper torso (front or back,
excluding the breast), abdomen or
buttocks.
3. Surgical Methods of Reproductive Life
Planning
a. Vasectomy
 A small incision is made in each side of the
scrotum. The vas deferens is then cut and
tied , cauterized or plugged, blocking the
passage of spermatozoa.
 Done in an ambulatory setting such as
physician’s office or reproductive life
planning clinic.

i. Cervical Caps b. Tubal Ligation

 Caps are made of soft rubber, are shaped  The fallopian tubes are occluded by
like a thimble and fit snugly over the cautery, crushing, clamping or blocking the
uterine cervix. tubes (Essure), thereby preventing passage
 Many women cannot use cervical cap of both sperm and ova.
because their cervix is too short for the cap  Should not be undertaken unless the
to fit properly. woman does view it as a permanent
 It can remain longer than diaphragms irreversible procedure.
because they do not put pressure on the
vaginal walls or urethra. 4. Abstinence
 Length of time should not exceeds to 24-
48 hours. Effects on Sexual Enjoyment
The couple with a physical challenge
j. Vaginal Rings
 Commonly known as the NuvaRings
 Consist of a thin, flexible plastic ring that Nursing Role in Caring for the Pregnant Family
contains a combination of estrogen and
progestin. Assessment for the Presence of Genetic
 Inserted in the vagina and left in place for Disorder
21 days then removed for 7 days.
 History Taking
k. Male Condoms  Physical Assessment
 A latex rubber or synthetic sheath that is  Diagnostic Testing
placed over the erect penis before coitus. 1. Karyotyping
 Prevents pregnancy by depositing the 2. Barr Body Determination
spermatozoa in the tip of the condom. 3. Alpha Fetoprotein Analysis
4. Chorionic Villi Sampling
5. Amiocentesis
6. Percutaneous Umbilical Blood Sampling “Nagele’s Rule”
7. Sonography To calculate the date of birth, count backward 3
8. Fetoscopy calendar months from the first day of the last
9. Preimplantation Diagnosis menstrual period and add 7 days

Stages of Fetal Development Assessing Fetal Well-Being

1. Fertilization – depends on 3 separate factors
a. Equal maturation of both sperm and ovum  Fetal Movement
b. Ability of the sperm to reach the ovum  Fetal Heart Rate
c. Ability of the sperm to penetrate the zona  Ultrasound
pellucida and cell membrane  Placental Grading
 Amniotic Fluid Volume Assessment
2. Implantation  Electrocardiography
 Magnetic Resonance Imaging
3. Embryonic and Fetal Structures  Maternal Serum Alpha-Fetoprotein
a. The Decidua  Triple Screening
b. Chorionic Villi  Chorionic Villi Sampling
c. The Placenta  Amniocentesis
d. The Umbillical Cord  Lecithin/Sphingomyelin Ration
e. The Membranes and Amiotic Fluid  Percutaneous Umbillical Blood Sampling
 Amnioscopy
Term Used to Denote Fetal Growth  Fetoscopy

Stages of Fetal Development Name Time Period

Origin and Development of Organ Systems Ovum From ovulation to fertilization
 Primary Germ Layers
Zygote From fertilization to implantation
a. Ectoderm
Embryo From implantation to 5-8 weeks
b. Mesoderm
c. Entoderm Fetus From 5-8 weeks until term
 Cardiovascular System Conceptus Developing embryo or fetus and placenta structu
 Fetal Circulation res throughout pregnancy
 Fetal Hemoglobin Psychological & Physiological Changes
 Respiratory System of Pregnancy
 Nervous System
 Endocrine System The Diagnosis of Pregnancy
 Digestive System I. Presumptive Signs of Pregnancy
 Musculoskeletal System  Signs that are least indicative of pregnancy
 Reproductive System  Largely subjective in that they are
 Urinary System experienced by the woman but cannot be
 Integumentary System documented by the examiner.
 Immune System
II. Probable Signs of Pregnancy
Determination of Estimated Birth Date  In contrast with the Presumptive Signs of
 EDC – estimated date of confinement pregnancy, these can be documented by
 EDD – estimated date of delivery the examiner.
 EDB - estimated date of birth  Although they are more reliable than
presumptive signs, they are not positive or
“It is impossible to predict the day of birth with true diagnostic findings.
a high degree of accuracy.”
III. Positive Signs of Pregnancy
 Gestational Age Wheels  There are only 3 positive signs of
 Birth Date Calculators pregnancy
 Nagele’s Rule 1. Demonstration of fetal heart separate
from the mother’s
2. Fetal movements felt by the examiner
3. Visualization of the fetus by ultrasound
Psychological Changes of Pregnancy 8. Vaginal Inspection
 Social Influences 9. Rectovaginal Examination
 Cultural Influences 10. Estimating Pelvic Size
 Individual Influence a. Diagonal Conjugate
b. True Conjugate/ Conjugate Vera
Psychological Tasks of Pregnancy c. Ischial tuberosity
11. Laboratory Studies
 First Trimester: Accepting the Pregnancy  Blood Studies
 Second Trimester: Accepting the Baby  Urinalysis
 Third Trimester: Preparing for Parenthood  Ultrasonography
- Reworking developmental task  Tuberculosis Screening
- Role-Playing and Fantasizing
Promoting Fetal and Maternal Health
Emotional Responses to Pregnancy
 Ambivalence Health Promotion During Pregnancy
 Grief 1. Self- Care Needs- bathing, breast care,
 Narcissism dental care, perineal hygiene, dressing
 Introversion vs. Extroversion 2. Exercise
 Body Image and Boundary 3. Sleep
 Stress 4. Sexual Activity
 Couvade Syndrome 5. Employment
 Emotional Lability 6. Travel
 Changes in Sexual Desire
 Changes in the Expectant Family Discomforts of Early Pregnancy

Physiologic Changes of Pregnancy The First Trimester

1. Reproductive System Changes  Breast tenderness
- Uterine Changes  Palmar Erythema
- Amenorrhea  Constipation
- Cervical Changes  Nausea, Vomiting and Pyrosis
- Vaginal Changes  Fatigue
- Ovarian Changes  Muscle Cramps
2. Changes in the breast  Hypotension
3. Systemic Changes  Varicosities
 Integumentary System  Hemorroids
 Respiratory System  Heart Palpitation
 Temperature  Urinary Frequency
 Cardiovascular System  Abdominal Discomfort
 GI/GU System  Leukorrhea
 Skeletal System  Backache
 Immune System  Headache
 Dyspnea
Assessment During Prenatal Visit  Ankle Edema
1. Initial Interview  Braxton Hicks Contraction
2. Components of Health History-
Demographic data, chief concerns, family Danger Signs of Pregnancy
profile, hx of past illness, hx of family  Vaginal Bleeding
illness, day history/social profile,  Persistent Vomiting
gynecologic hx, obstetric hx, baseline  Chills and Fever
height and weight and vital signs  Sudden escape of fluid from the vagina
measurement,review of systems  Abdominal or chest pain
3. Measurement of fundal height and fetal  Pregnancy-Induced Hypertension
heart sounds  Increase or Decrease in Fetal Movement
4. Pelvic Examination
5. External Genitalia Prevention of Fetal Exposure to Teratogens
6. Internal Genitalia 1. Teratogenic Maternal Infections
7. Pap Smear 2. Potential Teratogenicity of Vaccines
3. Teratogenicity of Drugs c) The Woman with decreased nutritional
4. Teratogenicity of Alcohol stores
5. Teratogenicity of Cigarettes d) The woman who is underweight
6. Environmental Teratogens e) The woman who is overweight
7. Teratogenicity of Maternal Stress f) The woman who is a vegetarian
g) The woman with PKU
Preparation for Labor h) The woman with a multiple pregnancy
 Lightening i) The woman who smokes or uses drugs and
 Show alcohol
 Rupture of the Membranes j) The woman with concurrent health
 Excess Energy problems
 Uterine Contraction k) The woman who eats many eats many
fast-food meals
Promoting Nutritional Health During Pregnancy l) The woman with lactose intolerance
m) The woman with Hyperemesis Gravidarum
Relationship of Maternal Diet to Infant Health
 Recommended Weight Gain During NTRAPARTUM:
Pregnancy Labor and Birth
 Calculating Body Mass Index
Theories of Labor Onset
NORMAL PREGNANCY BMI  Uterine Muscle Stretching
 Pressure on the Cervix
Underweight Under 19.8  Oxytocin Stimulation
Normal Weight 19.8 – 26.0  Change in the Ratio of Estrogen and
Overweight 26.1 – 29.0 Progesterone
Obese Above 29.0  Placental Age
 Rising Fetal Cortisol Levels
NORMAL PREGNANCY BMI  Fetal Membrane Production of
1. Calorie Needs Prostaglandin
2. Protein Needs  Seasonal and Time Influences
3. Fat Needs
4. Vitamin Needs Preliminary Signs of Labor
5. Mineral Needs  Lightening
6. Fluid Needs  Increase Level in Activity
7. Fiber Needs  Braxton Hicks Contraction
 Ripening of the
 Foods to Avoid in Pregnancy  Cervix
Foods with Caffeine
 Artificial Sweeteners Signs of True Labor
 Weight Loss Diets  Uterine Contraction
 Show
Promoting Nutritional Health During Pregnancy  Rupture of the Membranes
 Family Consideration
 Financial Consideration Differentiation Between True and False Labor
 Cultural Consideration
TRUE LABOR FALSE LABOR
Managing Common Problems Affecting Begin and remain irregular Begin irregularly but remai
Nutritional Health n regular and predictable.
1. Nausea and Vomiting Felt first abdominally and remai Felt first in lower back and s
n confined to the abdomen and g wept around to the abdomen
2. Cravings roin. in a wave.
3. Pyrosis Often disappear with ambulation Continue no matter what the
4. Hypercholesterolemia and sleep. woman’s level of activity.
Do not increase in duration, freq Increase in duration, frequen
Promoting Nutritional Health in Women with uency or intensity. cy and intensity.
Special Needs Do not achieve cervical dilation. Achieve cervical dilatation.
a) The Adolescent
b) The Woman Over Age 40
Process and Stages of Labor and Birth  Attitude
 Lie
Critical Factors in Labor/ Components of Labor  Presentation
 The birth passage 
 The fetus
 The relationship between the passage and Top: Fetal Attitude flexion, fetal lie
the fetus longitudinal
 Primary forces of labor
 Psychosocial considerations

Components of Labor

Bottom: Fetal Attitude flexion, fetal

lie transverse

The Birth Passage

 Implications of Pelvic types for Labor and
Delivery

Relationship between the passage and the

fetus

 Engagement
 Station
 Fetal position

The Fetus

 Head The Forces of Labor

 Primary
 Secondary
 Phases of Contractions
 Increment
 Acme
 Decrement
 Characteristics of contractions
 Frequency
 Duration  Late
 Intensity  Variable
 Contractions
Psychosocial Considerations  Frequency
 Motivation for pregnancy  Intensity
 Support  Duration
 Preparation  Vaginal exam
 Trust in staff
 Maintaining control The Family in Childbirth: Needs and Care
 Cultural influences
 Nursing management
Stages of Labor and Birth  The admission process
 First stage  The first stage of labor
 Latent  Family expectations
 Active  Cultural beliefs
 Transition  Pain, modesty
 Promotion of comfort
 Second stage  Clinical Pathways
 Crowning  Nursing management
 Positional changes of the fetus  Second stage
 comfort
Cardinal Movements  Third stage
 Descent  Initial care of newborn
 Flexion  Apgar
 Internal rotation  Umbilical cord
 Extension  Warmth
 Restitution  Newborn identification
 External rotation  Fourth stage
 Expulsion  Delivery of placenta
 Enhancing attachment
 Third stage
 Placental separation Danger Signs of Labor
 Placental delivery  Fetal Danger Signs
 Maternal Danger Signs
 Fourth stage
 1-4 hours Fetal Danger Signs
 High or Low Fetal Heart Rate
 Maternal responses to labor  Meconium Staining
 Cardio, B/P  Hyperactivity
 Respiratory  Fetal Acidosis
 Renal, GI
 Immune/blood Maternal Danger Signs
 Pain  Raising or Falling Blood Pressure
 Causes  Abnormal Pulse
 Fetal responses  Inadequate or Prolonged Contraction
 Pathologic Retraction Ring
Intrapartal Nursing Assessment  Abnormal Lower Abdominal Contour
 Increasing Apprehension
 Admission assessment
 Data Collection Care of Woman During the Second Stage of
 Assessments Labor
 Evaluating labor progress  Preparing the birth place
 Leopold’s Maneuvers  Positioning for birth
 FHR and Pattern  Promoting Effective Second-Stage Pushing
 Accelerations  Perineal Cleaning
 Decelerations  Episiotomy
 Early  Birth
 Cutting and Clumping the Cord
 Introducing the Infant
Care of Woman During the Third and Fourth
Stage
 Oxytocin
 Placental Delivery
 Perineal Repair
 Immediate Postpartal Assessment
 After Care
For the Woman Having a Cesarean Birth
Cesarean Birth
 Scheduled C-Section
 Emergency C-Section
Immediate Preoperative Care Measures
 Informed Consent
 Overall Hygiene
 Gastrointestinal Tract Preparation
 Baseline Intake and Output Determination
 Hydration
 Preoperative Medication
 Patient Chart and Presurgery Checklist
 Transport to Surgery
 Role of the Support Person
Intraoperative Care Measures
 Administration of Anethesia
 Skin Preparation
 Surgical Incision
 Birth of Infant
 Introduction of the Newborn
Types of Cesarean Incision
 Classic Cesarean Incision
 Low Segment Cesarean Incision
(Pfannenstiel Incision or Bikini Incision)
Postpartum Nursing Care
Pathophysiology of Postpartum
 Involution - rapid reduction in size of
uterus and return to prepregnant state
 Subinvolution = failure to descent
 Uterus is at level of umbilicus within 6 to
12 hours after childbirth - decreases by
one finger breadth per day
 Exfoliation - allows for healing of placenta
site and is important part of involution –
may take up to 6 weeks
 Enhanced by
 uncomplicated labor and birth
 complete expulsion of placenta or
membranes
 breastfeeding
 early ambulation
Involution of the uterus.
A. Immediately after expulsion of the
placenta, the top of the fundus is in the
midline and approximately halfway
between the symphysis pubis and the
umbilicus.
B. About 6 to 12 hours after birth, the fundus
is at umbilicus. The height of the fundus
then decreases about one finger breadth
(approximately the level of the 1cm) each day.
Pathophysiology of Postpartum
 Uterus rids itself of debris remaining after
birth through discharge called lochia
 Lochia changes:
 Bright red at birth
 Rubra - dark red (2 – 3 days after delivery)
 Serosa – pink (day 3 to 10 after delivery)
 Alba – white
 Clear
 If blood collects and forms clots within
uterus, fundus rises and becomes boggy
(uterine atony)
Ovulation and Menstruation/Lactation
 Return of ovulation and menstruation
varies for each postpartal woman
 Menstruation returns between 6 and 10
weeks after birth in nonlactating mother -
Ovulation returns within 6 months
 Return of ovulation and menstruation in
breastfeeding mother is prolonged related
to length of time breastfeeding continues
 Breasts begin milk production
 a result of interplay of maternal hormones
Bowel Elimination
 Intestines sluggish because of lingering
effects of progesterone and decreased
muscle tone
 Spontaneous bowel movement may not
occur for 2 to 4 days after childbirth
 Mother may anticipate discomfort because
of perineal tenderness or fear of
episiotomy tearing
 Elimination returns to normal within one
week
 After cesarean section, bowel tone return
in few days and flatulence causes
abdominal discomfort
Urinary tract
 Increased bladder capacity, decreased
bladder tone, swelling and bruising of
tissue.
 Puerperal diuresis leads to rapid filling of
bladder - urinary stasis increases chance of
urinary tract infection.
 If fundus is higher than expected on
palpation and is not in midline, nurse
should suspect bladder distension
The uterus becomes displaced and deviated to
the right when the bladder is full.
Laboratory Values
 White blood cell count often elevated
after delivery
 Leukocytosis
 Elevated WBC to 30,000/mm3
 Physiologic Anemia
 Blood loss – 200 – 500 Vaginal delivery
 Blood loss 700 – 1000 ml C/S
 RBC should return to normal w/in 2 - 6
weeks
 Hgb – 12 – 16, Hct – 37% - 47%
 Activation of clotting factors (PT, PTT, INR)
predispose to thrombus formation -
hemostatic system reaches non-pregnant
state in 3 to 4 weeks
 Risk of thromboembolism lasts 6 weeks
Weight Loss
 10 –12 pounds w/ delivery
 5 pounds with diuresis
 Return to normal weight by 6 – 8 weeks if
gained 25 - 30 pounds
 Breastfeeding will assist with weight loss
even with extra calorie intake
Psychosocial Changes
 Taking in - 1 to 2 days after delivery
 Mother is passive and somewhat
dependent as she sorts reality from
fantasy in birth experience
 Food and sleep are major needs
 Taking hold - 2 to 3 days after delivery
 Mother ready to resume control over her
life
 She is focused on baby and may need
reassurance
 Maternal Role Attachment
 Woman learns mothering behaviors and
becomes comfortable in her new role
 Four stages to maternal role attainment
 Anticipatory stage - During pregnancy
 Formal stage - When baby is born
 Informal stage - 3 to 10 months after
delivery
 Personal stage - 3 to 10 months after
delivery
 Father-Infant Interaction
 Engrossment
 Sense of absorption
 Preoccupation - Interest in infant
Postpartum Assessment
 Vital signs: Temperature elevations should
last for only 24 hours – should not be
greater than 100.4°F
 Bradycardia rates of 50 to 70 beats per
minute occur during first 6 to 10 days due
to decreased blood volume
 Assess for BP within normal limits: Notify
MD for tachycardia, hypotension,
hypertension
 Respirations stable
 Breath sounds should be clear
 Complete systems assessment
 BUBBLEHE assessment
 Postpartum chills or shivers are common
Breasts Assessment
 Assess if mother is breast- or bottle-
feeding - inspect nipples and palpate for
 engorgement or tenderness – should not
observe redness, blisters, cracking
 Breasts should be soft, warm, non-tender
upon palpation
 Secrete colostrum for 1st 2-3 days –
yellowish fluid - protein and antibody
enriched to offer passive immunity and
nutrition
 Milk comes in around 3 – 4 days – feel firm,
full, tingly to client
Uterus Assessment
 Monitor uterus and vaginal bleeding, every
30 minutes x 2 for first PP hour, then
hourly for 2 more hours, every 4 hours x 2,
then every 8 hours or more frequently if
there is bogginess, position out of midline,
heavy lochia flow.
 Determine firmness of fundus and
ascertain position approximate descent of
1 cm or 1 fingerbreadth per day
 If boggy (soft), gently massage top of
uterus until firm – notify health care
provider if does not firm
 Displaced to the right or left indicates full
bladder – have client void and recheck
fundus
 Measurement of descent of fundus for
the woman with vaginal birth. The fundus
is located two finger-breadths below the
umbilicus. Always support the bottom of
the uterus during any assessment of the
fundus.
Bladder and Bowel Assessment
 Anesthesia or edema may interfere with
ability to void – palpate for bladder
distention - may need to catheterize –
measure voided urine
 Assess frequency, burning, or urgency
 Diuresis will occur 12 – 24 hours after
delivery – eliminate 2000 – 3000 ml fluid,
may experience night sweats and nocturia
 Bowel: Assess bowel sounds, flatus, and
distention
Lochia – Rubra Assessment
 Lochia = blood mucus, tissue vaginal
discharge
 Assess amount, color, odor, clots
 If soaking 1 or > pads /hour, assess uterus,
notify health care provider
 Total volume – 240 – 270 ml
 Resume menstrual cycle within 6 – 8
weeks, breast feeding may be 3 months
Episiotomy, Lacerations, C/S Incisions
 Inspect the perineum for
episiotomy/lacerations with REEDA
assessment
 Inspect C/S abdominal incisions for REEDA
 R = redness (erythema)
 E = edema
 E = ecchymosis
 D = drainage, discharge
 A = approximation
Postpartum Nursing Interventions
 Relief of Perineal Discomfort
 Ice packs for 24 hours, then warm sitz bath
 Topical agents - Epifoam
 Perineal care – warm water, gently wipe
dry front to back
 After pains
 Uterine contractions as uterus involutes
 Relief of after pains
 Positioning (prone position)
 Analgesia administered an hour before
breastfeeding
 Encourage early ambulation - monitor for
dizziness and weakness
A sitz bath promotes healing and provides
relief from perineal discomfort during the
initial weeks following birth.
Hemorrhoids, Homan’s Sign
 Assess for hemorrhoids
 Relief of hemorrhoidal discomfort may
include
 Sitz baths
 Topical anesthetic ointments
 Rectal suppositories
 Witch hazel pads - Tucks
 Extremities
 Assess for pedal edema, redness, and
warmth
 Check Homan's sign – dorsiflex foot with
knee slightly bent
 Homans’ sign: With the woman’s knee
flexed, the nurse dorsiflexes the foot. Pain
in the foot or leg is a positive Homans’ sign.
Emotional Status/Bonding Assessment
 Describe level of attachment to infant
 Determine mother's phase of adjustment
to parenting
 Postpartum Blues
 Transient period of depression
 Occurs first few days after delivery
 Mother may experience tearfulness,
anorexia, difficulty sleeping, feeling of
letdown
 Usually resolves in 10 to 14 days
 Causes:
 Changing hormone levels, fatigue,
discomfort, overstimulation
 Psychologic adjustments
 Unsupportive environment, insecurity
Medications
 Bleeding
 oxytocin (Pitocin) – watch for fluid
overload and hypertension
 methylergonovine (Methergine) – causes
hypertension
 prostaglandin F (Hemabate, carboprost) –
n/v, diarrhea
 Pain Medications
 NSAIDS – GI upset
 Oxycodone/acetaminophen (Percocet) –
dizziness, sleepiness
 PCA – Morphine for C/S – respiratory
distress
 Docusate (Senna) – causes diarrhea
 Rubella Vaccine – titer 1:10, do NOT get
pregnant for 3 months
 Rh Immune Globulin (RhoGAM) – Rh
negative mother – do not administer
rubella vaccine for 3 months
Mother and Family Needs
 Nurse can assist in restoration of physical
well-being by
 Assessing elimination patterns
 Determining mother's need for sleep and
rest
 Encourage regular diet as tolerated and
increasing fluids
 Identify available support persons -
involve support person and siblings in
teaching as appropriate
 Determine family's knowledge of normal
postpartum care and newborn care
Breastfeeding Pathophysiology
 Before delivery, increased estrogen
stimulates duct formation, progesterone
promotes development of lobules and
alveoli
 After delivery, estrogen and progesterone
decrease, prolactin increases to promote
milk production by stimulating alveoli
 Newborn suck releases oxytocin to
stimulate let-down reflex
Composition of Breast Milk
 Breast milk is 90% water; 10% solids
consisting of carbohydrates, proteins, fats,
minerals and vitamins
 Composition can vary according to
gestational age and stage of lactation
 Helps meet changing needs of baby
 Foremilk – high water content, vitamins,
protein
 Hindmilk - higher fat content
Immunologic and Nutritional Properties
 Secretory IgA, immunoglobulin found in
colostrum and breast milk, has antiviral,
antibacterial, antigenic-inhibiting
properties
 Contains enzymes and leukocytes that
protect against pathogens
 Composed of lactose, lipids,
polyunsaturated fatty acids, amino acids,
especially taurine
 Cholesterol, long-chain polyunsaturated
fatty acids, and balance of amino acids in
breast milk help with myelination and
neurologic development
Advantages of Breastfeeding
 Provides immunologic protection
 Infants digest and absorb component of
breast milk easier
 Provides more vitamins to infant if
mother's diet is adequate
 Strengthens mother-infant attachment
 No additional cost
 Breast milk requires no preparation
 AAP= Only food for 6 months, w/ foods
for 12 months
Disadvantages of Breastfeeding
 Many medications pass through to breast
milk
 Father unable to equally participate in
actual feeding of infant
 Mother may have difficulty being
separated from infant
Breastfeeding Mother
 Breastfeeding mother needs to know
 How breast milk is produced
 How to correctly position infant for feeding
 Procedures for feeding infant
 Number of times per day breastfed infant
should be put to the breast
 How to express and store breast milk
 How and when to supplement with
formula
 How to care for breasts
 Medications that pass through breast milk
 Support groups for breastfeeding
 Review signs and symptoms of
engorgement, plugged milk ducts,
mastitis
Breastfeeding Assessment
Four common breastfeeding positions.
A, Football hold.
B, Lying down.
C, Cradling.
D, Across the lap.
Formula Preparations
 Three categories of formulas based on cow
milk proteins, soy protein-based formulas,
specialized or therapeutic formulas - all are
enriched with vitamins, particularly
vitamin D
 Most common cow milk protein-based
formulas attempt to duplicate same
concentration of carbohydrates, proteins,
fats as 20kcal/oz same as breast milk
Bottle-Feeding Advantages
 Provides good nutrition to infant.
 Father can participate in infant feeding
patterns.
Bottle-Feeding Disadvantages
 May need to try different formulas before
finding one that is well-tolerated by infant.
 Proper preparation necessary for nutrition
adequacy.
Bottle-Feeding Mother
 Bottle-feeding mother needs to know
 Types of formula available and how to
prepare each type
 Procedure for feeding infant
 How to correctly position infant for bottle-
feeding
 How to safely store formula
 How to safely care for bottles and nipples
 Amount of formula to feed infant at each
feeding
 How often to feed infant
 Expected weight gain
 Teach to wear a binder or tight-fitting
sports bra day and night for two weeks.
 Do not allow hot water from shower to
run over breasts
 Avoid manual stimulation
 Apply cabbage leaves (dries up breast)
 Use acetaminophen for discomfort
Cesarean Section Needs
 Assess vital signs
 Assess breasts
 Assess location and firmness of uterine
fundus
 Assess lochia
 Assess incision site – REEDA
 Assess breath sounds
 Assess indwelling urinary catheter - color
and amount of urine noted
 Assess bowel sounds: present, hypoactive
or hyperactive
 Cesarean birth is major abdominal
surgery - if general anesthesia used,
abdominal distension may cause
discomfort, assess for bowel obstruction
 Position client on left side, include exercises,
early ambulation, increase po intake, avoid
carbonated beverages, avoid straws - may
need enemas, stool softeners, antiflatulent
meds
 Pulmonary infections may occur related
to immobility and use of narcotics
because of altered immune response
 TCDB, use incentive spirometer q 2 hours
Pain and Comfort
 Administer analgesics within the first 24 to
72 hours - allows woman to become more
mobile and active
 Comfort is promoted through proper
positioning, back rubs, and oral care -
reduce noxious stimuli in environment
 Encourage visits by family and newborn,
which provides distraction from painful
stimuli
 Encourage non-pharmacologic methods of
pain relief (breathing, relaxation, and
distraction) - encourage rest
Attachment After a Cesarean Birth
 Physical condition of mother and
newborn and maternal reactions to stress,
anesthesia, and medications may impact
mother-infant attachment
 By second or third day, cesarean birth
mother moves into "taking-hold period“
 Emphasize home management and
encourage mother to allow others to
assume housekeeping responsibilities
 Stress how fatigue prolongs recovery and
may interfere with attachment process
Discharge Instructions
 S/S complications
 PP Exercises
 Rest
 Avoid overexertion
 Sexual activity
 Hygiene
 Sitz baths
 Incision care
 Referral numbers
 Nutrition
 PP appointment
 Birth certificate info
 Infant care
 Infant complications
 Infant follow-up
 Family bonding
Discharge Teaching
 New mother should gradually increase
activities and ambulation after birth
 Avoid heavy lifting, excessive stair climbing,
strenuous activity, vacuuming
 Resume light housekeeping by second
week at home
 Delay returning to work until after 6-week
postpartum examination
 Recommend exercise to provide health
benefits to new mother
 Nurse should encourage client to begin
simple exercises while on nursing unit
 Inform her that increased lochia and pain
may necessitate a change in her activity
Sexual Activity and Contraception
 Sleep deprivation, vaginal dryness, and
lack of time together may impact
resumption of sexual activity
 Usually sexual intercourse is resumed once
episiotomy has healed and lochia has
stopped (about 3 – 6 weeks)
 Breastfeeding mother may have leakage of
milk from nipples with sexual arousal due
to oxytocin release
Contraception
 Information on contraception should be
part of discharge planning
 Nursing staff need to identify advantages,
disadvantages, risk factors, any
contraindications
 Breastfeeding mothers concerned that
contraceptive method will interfere with
ability to breastfeed - they should be given
available options – progesterone only
Parent-Infant Attachment
 Tell parents it is normal to have both
positive and negative feelings about
parenthood
 Stress uniqueness of each infant
 Provide time and privacy for the new
family
 Include parents in nursing intervention
Reaction of Siblings
 Sibling visits reassure children their mother
is well
 Father may need to hold new baby, so
mother can hug older children
 Suggest to parent that bringing doll home
allows young child to "care for" and
identify with parents
Infant Care
 New mother and family should know
basic infant care
 Information about tub baths
 Cord treatment, When to anticipate cord
will fall off
 Family should be comfortable in feeding
and handling infant, as well as safety
concerns
 Immunizations
 When to call the doctor
Discharge Teaching
 Nurse should review with new mother any
information she has received regarding
postpartum exercises, prevent of fatigue,
sitz bath and perineal care, etc. - nurse
should spend time with parent to
determine if they have any last-minute
questions before discharge
 Printed information about local agencies
and support groups should be given to
new family
Types of Follow-Up Care
 Telephone calls - nurses must listen
carefully and ask open-ended questions
 Return visits - Within one week after first
visit
 Telephone follow-up - Within 3 days of
discharge
 Baby care/postpartum classes
 New mother support groups
 Need to have a caring attitude in these
activities
Main Purpose of the Home Visit
 Assessment
 Status of mother and infant
 Adaptation and adjustment of family to
new baby
 Determine current informational needs
 Teaching
 Self-care
 Infant Care
 Opportunity to answer additional
questions related to infant care and
feeding
 Counseling
 Provide emotional support to mother and
family
 Referrals
Maternal Assessments at Home
 Vital signs: Should be at prepregnancy
level
 Weight: Expect weight to be near
prepregnancy level at 6 weeks postpartum
 Condition of breasts
 Condition of abdomen, including healing
cesarean incision if applicable
 Elimination pattern: should return to
normal by 4 to 6 weeks postpartum
Maternal Assessment
 Lochia
 Should progress from lochia rubra to lochia
alba
 If not breastfeeding, menstrual pattern
should return about 6 weeks postpartum
 Fundus
 Uterus should return to normal size by 6
weeks postpartum
 Perineum: Episiotomy and lacerations
should show signs of healing
Breastfeeding Assessment
 Nipple soreness - Peaks on days 3 and 6,
then recedes
 Cracked nipples
 Allow nipples to air dry after breastfeeding
 Nurse frequently
 Alternate breasts
 Change infant's position regularly
 Breast engorgement, plugged ducts
 Effect of alcohol and medications
 Return to work
 Weaning
Family Assessment
 Bonding: Appropriate demonstration of
bonding should be apparent
 Level of comfort: parents should display
appropriate levels of comfort with the
infant
 Siblings should be adjusting to new baby
 Parental role adjustment
 Parents should be working on division of
labor
 Changes in financial status
 Communication changes
 Readjustment of sexual relations
 Adjustment to new daily tasks
 Contraception: Parents understand need
to choose and use a method of
contraception
Relinquishing a Baby
 Many reasons why a woman decides she
cannot parent her baby
 Emotional crisis may arise as woman
attempts to resolve her concerns
 As she faces these concerns, social
pressures against giving up baby
 Mother may need to complete grieving
process to work through her decision -
she may have made considerable
adjustments to her lifestyle to give birth
 Nursing staff need to honor any special
requests after birth and encourage
mother to express her feelings
 Seeing newborn may assist mother in
grieving process
 Some mothers may request early
discharge or transfer to another unit
The Normal Newborn
Assessment and Care
Three transition phases
 Phase One: the first hour
 Phase Two: from one to three hours
 Phase Three: from two to 12 hours
Priorities in first hour
 Cardiovascular assessment and support
 Thermoregulation
 Assessment and support of blood glucose
 Identification
 Observing urinary/meconium passage
 Observing for major anomalies and for
apparent gestational age concerns
APGAR ASSESSMENT
 One and five minutes
 Meant to identify the need for neonatal
resucitation
APGAR SCORE
APGAR SCORING
 Heart rate – above 100
 Respiratory Effort – spontaneous with cry
 Muscle tone – flexed with movement
 Reflex response – active, prompt cry
 Color – pink or acrocyanosis
 0-3 infant needs resuscitation
 4-7 Gentle stimulation – Narcan
 8-10 – no action needed
Additional signs of respiratory distress
 Persistant cyanosis
 Grunting respirations
 Flaring of the nostrils
 Retractions
 Respiratory rate >60
 Heart rate >160 or <110
Ballard’s Assessment/ Scoring
Maintaining thermoregulation
 Referred to as maintaining a neutral
thermal environment
 Heat loss is minimal
 Oxygen consumption needs are at their
lowest
 Hypothermia can cause
 Hypoglycemia
 Increased oxygen needs
Mechanisms of heat loss
Four mechanisms of heat loss
and corresponding interventions
 Evaporation
 Dry infant immediately
 Conduction
 Place on mothers body skin to skin
 Convection
 Cover with a blanket, wear a cap
 Radiation
 Keep away from cold windows and cold
objects
Vital Sign Normals
 97.7-98.6 F (36.5-37 C)- temp
 110-160 - heart rate
 A soundly sleeping baby can go to 80 bpm
 A crying baby may be as high as 180
 30-60- pulse rate
Voids and Stools
 Document from the moment of birth
 Urination sometimes missed in early
minutes
 Generally expect both within the first 24
hours
 One really wet diaper per day of age until
milk is fully in.
Observation for Gestational Age
 Thorough assessment with Ballard Scale
done later
 A quick assessment is done in the delivery
room
This enaQuick Assessment of Gestational Age
 bles infants earlier admission to the
nursery and anticipatory intervention to
the problems of pre and post term infants
Quick Assessment of Gestational Age
 Skin
 Vernix
 Hair
 Ears
 Breast tissue
 Genitalia
 Sole Creases
 Resting Posture
 Cracked Skin
 Abundant Lanugo
 fine, soft hair, especially that which covers
the body and limbs of a human fetus or
newborn.
 Ear of a preterm infant
 Areola and increased lanugo
 Sole creases
 Female genitalia, very preterm
 Preterm and Term Genitalia-female
 Male Genitalia
 Comparison of resting posture
 Preterm and Term Male Genitalia
Hypoglycemia
 Criteria vary from source to source
 LPN book says <40
 RN book says <36 but a threapuetic
objective of 45 mg/dl or greater
 The brain is dependent on a steady supply
of glucose for its metabolism
Infants at Increased Risk for Hypoglycemia
 Preterm/postterm
 Infants of diabetic mothers
 Large for gestational age
 Small for gestational age
 Infants with Intrauterine growth
retardation
 Asphyxiated infants
 Infants who are cold stressed
 Infants whose Moms took ritodrine or
tgerbutaline to stop preterm labor
Symptoms of Hypoglycemia
 Jitteriness
 Poor muscle tone
 Sweating
 Respiratory difficulty
 Apnea
 Low temperature
 Poor suck
 Feeding difficulties  The palmar grasp reflex is found in the
 High pitched cry palms of the hands, while the plantar grasp
 Weak cry reflex is found in the soles of the feet.
 Lethargy  Babinski
 Seizures  one of the normal reflexes in infants.
Reflexes are responses that occur when
Hypoglycemia protocol the body receives a certain stimulus. The
 Low risk infants have a serum glucose Babinski reflex occurs after the sole of the
drawn only if symptomatic foot has been firmly stroked. The big toe
 High risk infants will have one per a then moves upward or toward the top
hospital protocol surface of the foot.
 Protocol typically at birth and q 1 hour x 3  Trunk incurvation
 It is elicited by holding the newborn in
Routine Medications ventral suspension (face down) and
 Erythromycin Eye Ointment stroking along the one side of the spine.
 Aquamephyton (vitamin K) The normal reaction is for the newborn to
 First Hepatitis B vaccine laterally flex toward the stimulated side.
 HBIG if Mother is Hep B surface antigen  Observe for symmetry
positive
Early Assessments
Physical Characteristics  Assess for anomalies
(During Phases Two and Three)  Head- anterior fontanelle closes 12-18 mos
posterior fontanelle closes 2-3 mos
Nervous System: Reflexes  Neck and clavicles
 Head lag fracture of clavicle – large infant, lump,
 When a newborn is pulled by the arms tenderness, crepitus, decreased
from a lying to a sitting position, the head movement
lags at first.  Cord
 Moro reflex  Extremities
 often called a startle reflex. flexed and resist extension
 Rooting assess fractures, clubfeet
 starts when the corner of the baby's hips
mouth is stroked or touched vertebral column
 Tonic Neck reflex
 is often called the fencing reflex. Measurements
 Dancing reflex  Weight – loss of 10% normal
 Stepping reflex happens when you hold  Length
the baby upright with his/her feet touching  Head and chest circumference
a flat surface.  Normal VS
 Magnet reflex temp 97.7-99.5F axillary
 A reflex in which light finger pressure on a apical pulse 120-160bpm
toe pad causes a slow reflex contraction of respirations 30-60/min
the lower extremity, which seems to follow
the examiner's hand, as if drawn by a A, Measuring the head circumference of the
magnet. newborn.
 Rooting reflex B, Measuring the chest circumference of the
 is one of the involuntary primitive motor newborn.
reflexes, which are also known as the
frontal release reflexes, that are mediated Thermoregulation Assessment
by the brainstem.  Check soon after birth
 Suck  Set warmer controls
 said to be seen in utero by the third month  Take temp q 30 min until stable
of fetal life so that by the end of gestation  Rectal for first temp
it can be put to use.  Insert only 0.5 inch
 Hand and foot grasp  Axillary route rest of time
Axillary temperature measurement. The  Abdominal breathing; nose breathers
thermometer should remain in place for 3
minutes  Femoral Pulses
 Brachial Pulses
Head  Assessment of Respiratory Status
 Head circumference
 Molding Musculoskeletal
 Caput succedaneum  Symmetry!!
 Cephalohematoma  Five finger and five toes!!!
 Fontanelles  Clavicles
 Anterior closes between 12-18 months  Movement of arms
 Posterior closes by the end of the 2nd  Hips for developmental hip dysplasia
month  Lower legs/feet for “club foot”
 Back: curvatures, cysts or dimples
 Molding
 pressure on the head caused by the tight  Hip Check
birth canal may 'mold' the head into an  Hip Check Skin Folds
oblong rather than round shape.
 Cehpalhematoma GenitoUrinary
 an accumulation of blood under the scalp.  Male or female
 Caput Succedaneum and  Male
Cephalhematoma  Testes descended
 Caput succedaneum is similar to  Proper placement of meatus
cephalohematoma as both involve unusual  Female
bumps or swelling on the newborn's head.  Teach parents about pseudomenstruation
However, the main difference is that lumps  Always watch for and record voids!!!
caused by bleeding under the scalp is
cephalohematoma, whereas lumps caused Gastrointestinal
by scalp swelling due to pressure is known  Passage of meconium
as caput succedaneum.  Placement and patency of anus
 Abdomen should be soft and non tender
Eyes  Round but not distended
 Eye placement  Bowel sounds are present after first hour
 Epicanthal folds of birth
 Blink reflex  Umbilical cord inspection
 Discharge
 Pupil reaction Skin, many normal findings
 Follows to midline  Acrocyanosis
 Desquamation
Hearing  Epstein’s Pearls
 Check overall response to sudden sound  Erythema toxicum
 Moro reflex  Harlequin Color
 Check for placement of ears  Milia
 Low set ears may indicate a congenital  Mongolian Spots
anomaly  Port Wine Stains *
 Most infants receive hearing screening
within the first week of life The Normal Newborn
(Care measures for the normal newborn plus a
Respiratory and Cardiovascular little more.)
 Ongoing assessment of cardio respiratory
status that has occurred since birth Jaundice
 More thorough heart assessment  Yellow coloring of an infants skin
 Murmur may be present until fetal  Common and is caused by the natural
openings have completely closed however breakdown of RBCs in the infant after
they must be carefully verified by birth
pediatrician  Is never considered normal in the first 24
 Femoral and brachial pulses hours.
Physiologic Jaundice Causes of Pathologic Jaundice
 Most jaundice in newborns is physiologic  Excessive hemolysis
 It peaks between 48-72 hours  Rh incompatibility
 Usually disappears within a week  ABO incompatibility
 Usually benign  G6PD defficiency
 Can become elevated to a point of concern  Infection
for the baby  Metabolic/endocrine abnormalities
 Delayed defecation/intestinal obstruction
Significance of Jaundice  Liver/biliary disease
 Bilirubin is toxic to the brain.  Spleen pathology
 Bilirubin is prevented from entering the  Polycythemia
brain by blood brain barrier under normal
circumstances. PHOTOTHERAPY
 However the blood brain barrier isn’t well  Phototherapy is treatment with a special
developed in the newborn. Unconjugated type of light (not sunlight). It's sometimes
bilirubin (lipid soluble) could cross to the used to treat newborn jaundice by making
newborn and would cause encephalopathy. it easier for your baby's liver to break
(Kernicterus) down and remove the bilirubin from your
baby's blood. Phototherapy aims to expose
Physiologic Jaundice your baby's skin to as much light as
 Infants have extra RBCs due to fetal life possible.
 They need to be broken down by the body
 Bilirubin is a component of the Care of Infant on Phototherapy
degradation of the RBCs.  Risk of injury to eyes
 The liver is immature and does not  Risk of injury to gonads
conjugate and get rid of the bilirubin fast  Risk of impaired skin integrity
enough.  Risk for fluid volume deficiency
 Risk for hyperthermai or hypothermia
More data on Physiologic Jaundice  Risk of neurological injury
 RBC/Hgb level is higher than required  Imbalance nutrition
 Neonatal RBC: 4.8-7.1 Infant: 4.2-5.2  Parental anxiety
 Neonatal Hbg 14-24 Infant 11-17
 Cells containing fetal hemoglobin have a Exchange Transfusion
shorter life span  Exchange transfusion involves the
sequential withdrawal and injection of
Other factors that will exacerbate physiologic aliquots of blood, through arterial and
jaundice venous lines, either peripheral or central.
 Drugs Note arterial lines (umbilical or peripheral)
 Bruises should only be used for withdrawal of
 Caput infant blood, not for injection of donor
 Cephalohematoma blood.
 Fetal hypoxia
 Polycythemia Growth and Development
 Hypoglycemia  Infancy
 Hypothermia  Early Childhood
 Poor feeding  Middle Childhood
 Delayed passage meconium  Adolescent
 Trisomy 21
Stages of Growth and Development
Care to prevent hyperbilirubinemia  Infancy
 Early feeding  Neonate
 Frequent feeding  Birth to 1 month
 Neutral thermal environment  Infancy
 Prevention of hypoglycemia  1 month to 1 year
 Prevention of hypoxia
 Early Childhood
 Toddler
 1-3 years
 Preschool
 3-6 years
 Middle Childhood
 School age
 6 to 12 years
 Late Childhood
 Adolescent
 13 years to approximately 18 years
Principles of Growth and Development
 Growth is an orderly process, occurring in
systematic fashion.
 Rates and patterns of growth are specific
to certain parts of the body.
 Wide individual differences exist in growth
rates.
 Growth and development are influenced
by multiple factors.
 Development proceeds from the simple to
the complex and from the general to the
specific.
 Development occurs in a cephalocaudal
and a proximodistal progression.
 There are critical periods for growth and
development.
 Rates in development vary.
 Development continues throughout the
individual's life span.
Growth Pattern
 The child’s pattern of growth is in a head-
to-toe direction, or cephalocaudal, and in
an inward to outward pattern called
proximodistal.
Why developmental assessment?
 Early detection of deviation in child’s
pattern of development
 Simple and time efficient mechanism to
ensure adequate surveillance of
developmental progress
 Domains assessed: cognitive, motor,
language, social / behavioral and adaptive
Gross Motor Skills
 The acquisition of gross motor skill
precedes the development of fine motor
skills.
 Both processes occur in a cephalocaudal
fashion
 Head control preceding arm and hand
control
 Followed by leg and foot control.
Gross Motor Development
 Newborn: barely able to lift head
 6 months: easily lifts head, chest and
upper abdomen and can bear weight on
arms
Head Control
Sitting up
 2months old: needs assistance
 6 months old: can sit alone in the tripod
position
 8 months old: can sit without support and
engage in play
Ambulation
 9 month old: crawl
 1 year: stand independently from a crawl
position
 13 month old: walk and toddle quickly
 15 month old: can run
Fine Motor - Infant
 Newborn has very little control. Objects
will be involuntarily grasped and dropped
without notice.
 6 month old: palmar grasp – uses entire
hand to pick up an object
 9 month old: pincer grasp – can grasp
small objects using thumb and forefinger
Speech Milestones
 1-2 months: coos
 2-6 months: laughs and squeals
 8-9 months babbles: mama/dada as
sounds
 10-12 months: “mama/dada specific
 18-20 months: 20 to 30 words – 50%
understood by strangers
 22-24 months: two word sentences, >50
words, 75% understood by strangers
 30-36 months: almost all speech
understood by strangers
Hearing Pre-School
 BAER (Brainstem auditory evoked response)
hearing test done at birth Fine motor and cognitive abilities
 Ability to hear correlates with ability  Buttoning clothing
enunciate words properly  Holding a crayon / pencil
 Always ask about history of otitis media –  Building with small blocks
ear infection, placement of PET – tubes in  Using scissors
ear  Playing a board game
 Early referral to MD to assess for possible  Have child draw picture of himself
fluid in ears (effusion)
 Repeat hearing screening test  Pre-school tasks
 Speech therapist as needed
Red flags: preschool
Fine Motor Development  Inability to perform self-care tasks, hand
washing simple dressing, daytime toileting
Red Flags in infant development  Lack of socialization
 Unable to sit alone by age 9 months  Unable to play with other children
 Unable to transfer objects from hand to  Unable to follow directions during exam
hand by age 1 year  Performance evaluation of pre-school
 Abnormal pincer grip or grasp by age 15 teacher for kindergarten readiness
months 
 Unable to walk alone by 18 months Pool Safety
 Failure to speak recognizable words by 2  School-Age
years.
School Years: fine motor
Fine Motor - toddler  Writing skills improve
 1 year old: transfer objects from hand to  Fine motor is refined
hand  Fine motor with more focus
 2 year old: can hold a crayon and color  Building: models – legos
vertical strokes  Sewing
 Turn the page of a book  Musical instrument
 Build a tower of six blocks  Painting
 Typing skills
Fine Motor – Older Toddler  Technology: computers
 3 year old: copy a circle and a cross – build
using small blocks School performance
 4 year old: use scissors, color within the  Ask about favorite subject
borders  How they are doing in school
 5 year old: write some letters and draw a  Do they like school
person with body parts  By parent report: any learning difficulties,
attention problems, homework
Toddler  Parental expectations
 Safety becomes a problem as the toddler
becomes more mobile. Red flags: school age
 School failure
Issues in parenting - toddlers  Lack of friends
 Stranger anxiety – should dissipate by age  Social isolation
2 ½ to 3 years  Aggressive behavior: fights, fire setting,
 Temper tantrums: occur weekly in 50 to animal abuse
80% of children – peak incidence 18
months – most disappear by age 3 School Age: gross motor
 Sibling rivalry: aggressive behavior towards  8 to 10 years: team sports
new infant: peak between 1 to 2 years but  Age ten: match sport to the physical and
may be prolonged indefinitely emotional development
 Thumb sucking
 Toilet Training
School Age: cognitive Freud’s Psychosexual Stages of Development
 Greater ability to concentrate and
participate in self-initiating quiet activities
that challenge cognitive skills, such as
reading, playing computer and board
games.

13 to 18 Year Old
Adolescent
 As teenagers gain independence they
begin to challenge values
 Critical of adult authority
 Relies on peer relationship  Jean Piaget's theory of cognitive
 Mood swings especially in early development suggests that children move
adolescents through four different stages of mental
development. His theory focuses not only
Adolescent behavioral problems on understanding how children acquire
 Anorexia knowledge, but also on understanding the
 Attention deficit nature of intelligence.
 Anger issues  Sensorimotor stage (birth to 2 years)
 Suicide  Preoperational stage (2 to 7 years)
 Concrete operational stage (7 to 11 years)
Adolescent Teaching  Formal operational stage (12 years and up)
 Relationships
 Sexuality – STD’s / AIDS The Sensorimotor Stage
 Substance use and abuse Ages: Birth to 2 Years
 Gang activity
 Driving Major Characteristics and Developmental
 Access to weapons Changes:
 The infant knows the world through their
Developmental Theories and other Relevant movements and sensations
Theory  Children learn about the world through
basic actions such as sucking, grasping,
looking, and listening
 Infants learn that things continue to exist
even though they cannot be seen (object
permanence)
 They are separate beings from the people
and objects around them
 They realize that their actions can cause
things to happen in the world around them

The Preoperational Stage

SIGMUND FREUD
 Freud’s Psychoanalytic Theory
 (3 components of personality)
1. The id is “the primitive, instinctive
component of personality that operates
according to the pleasure principle”.
2. The ego is “the decision-making
component of personality that operates
according to the reality principle”.
3. The superego is “the moral component of
personality that incorporates social
standards about what represents right and
wrong”
Ages: 2 to 7 Years
Major Characteristics and Developmental
Changes:
 Children begin to think symbolically and
learn to use words and pictures to
represent objects.
 Children at this stage tend to be egocentric
and struggle to see things from the
perspective of others.
 While they are getting better with
language and thinking, they still tend to
think about things in very concrete terms.
The Concrete Operational Stage Lawrence Kohlberg’s Stages of Moral
Ages: 7 to 11 Years Development

Major Characteristics and Developmental

Changes:
 During this stage, children begin to
thinking logically about concrete events
 They begin to understand the concept of
conservation; that the amount of liquid in
a short, wide cup is equal to that in a tall,
skinny glass, for example
 Their thinking becomes more logical and
organized, but still very concrete
 Children begin using inductive logic, or
reasoning from specific information to a
general principle

The Formal Operational Stage

Ages: 12 and Up

Major Characteristics and Developmental

Changes:
 At this stage, the adolescent or young
adult begins to think abstractly and reason
about hypothetical problems
 Abstract thought emerges
 Teens begin to think more about moral,
philosophical, ethical, social, and political
issues that require theoretical and abstract
reasoning
 Begin to use deductive logic, or reasoning
from a general principle to specific
information
 Lev Vygotsky’s theory of language
development focused on social learning
and the zone of proximal development
(ZPD). The ZPD is a level of development
obtained when children engage in social
interactions with others; it is the distance
between a child’s potential to learn and
the actual learning that takes place.

Erikson’s Psychosocial Stages

Urie Bronfenbrenner’s Ecological Theory

 Microsystem (immediate environment) is
the smallest and most immediate
environment in which children live. As such,
the microsystem comprises the daily home,
school or daycare, peer group and
community environment of the children.
 Interactions within the microsystem
typically involve personal relationships
with family members, classmates, teachers
and caregivers. How these groups or
individuals interact with the children will
affect how they grow.
 The Bronfenbrenner theory suggests that
the chronosystem (changes over time)
adds the useful dimension of time, which
demonstrates the influence of both change
and constancy in the children’s
environments. The chronosystem may
include a change in family structure,
address, parents’ employment status, as
well as immense society changes such as
economic cycles and wars.

 The mesosystem (connections) Cameon, Chariza Mae E.--SN

encompasses the interaction of the
different microsystems which children find
themselves in. It is, in essence, a system of
microsystems and as such, involves
linkages between home and school,
between peer group and family, and
between family and community.

 According to Bronfenbrenner’s theory, if a

child’s parents are actively involved in the
friendships of their child, for example they
invite their child’s friends over to their
house from time to time and spend time
with them, then the child’s development is
affected positively through harmony and
like-mindedness.

 The exosystem (indirect environment)

pertains to the linkages that may exist
between two or more settings, one of
which may not contain the developing
children but affect them indirectly
nonetheless.

 Based on the findings of Bronfenbrenner,

people and places that children may not
directly interact with may still have an
impact on their lives. Such places and
people may include the parents’
workplaces, extended family members,
and the neighborhood the children live in.

 The macrosystem (social and cultural

values) is the largest and most distant
collection of people and places to the
children that still have significant
influences on them. This ecological system
is composed of the children’s cultural
patterns and values, specifically their
dominant beliefs and ideas, as well as
political and economic systems.