NCM 207 Lecture 1 PDF

GOALS AND PHILOSOPHIES PF MATERNAL AND 4.
Both nursing theory and evidence-based practice

CHILD HEALTH NURSNG provide a foundation for nursing care.
5. A maternal and child health nurse serves as an
advocate the rights of all family members, including
OUTLINE
the FETUS.
I. GOALS 6. Maternal and child health nursing includes a high
II. PHILOSOPHIES degree of independent nursing functions.
III. MATERNAL AND CHILD HEALTH GOALS 7. Promoting health is an important nursing role.
AND STANDARD 8. PREGNANCY OR CHILDHOOD ILLNESS can be
IV. THEORIES RELATED TO MATERNAL AND stressful and can alter family life in both subtle and
CHILD NURSING extensive ways.
V. ROLES AND RESPONSIBILITIES OF A
MATERIAL CHILD NURSE 9. Personal, cultural, and religious attitudes and
VI. THE 17 SUSTAINABLE DEVELOPMENT beliefs influence the meaning of illness and its
GOALS (SDGS) TO TRANSFORM OUR impact on the family.
WORLD 10. Maternal and child health nursing is a challenging
role for a nurse and is a major factor in promoting
high-level wellness in families
GOALS
MATERNAL AND CHILD HEALTH GOALS AND
Primary goals of maternal and child health nursing care can STANDARDS
be stated simply as promotion and maintenance of optimal
family health to ensure cycles of optimal childbearing and Association
childrearing. standards, and guidelines standards of professional
performance.
THE GOALS OF MATERNAL AND CHILD HEALTH
NURSING CARE ARE NECESSARILY BROAD STANDARD I: QUALITY OF CARE. The nurse
BECAUSE THE SCOPE OF PRACTICE IS SO BROAD. systematically evaluates the quality and effectiveness of
THE RANGE OF PRACTICE INCLUDES: nursing practice.
PRECONCEPTUAL HEAL CARE STANDARD II: PERFORMANCE APPRAISAL. The nurse

CARE OF WOMEN DURING THREE evaluates his/her own nursing practice in relation to
TRIMESTER OF PREGNANCY AND THE professional practice standards and relevant statutes and
PUERPERIUM (THE 6 WEEKS AFTER regulations.
CHILDBIRTH, SOMETIMES TERMNED THE
FOURTH TRIMESTER OF PREGNANCY.
CARE OF CHILDREN DURING THE PERINATAL STANDARD III: EDUCATION. The nurse acquires and
PERIOD (6 WEEKS BEFORE CONCEPTION TO maintains current knowledge in nursing practice.
6 WEEKS AFTER BIRTH)
CARE OF CHILDREN FROM BIRTH THROUGH STANDARD IV: COLLEGIALITY. The nurse contributes to
ADOLESCENCE the professional development of peers, colleagues, and
CARE IN SETTINGS AS VARIED AS THE others.
BIRTHING ROOM, THE PEDIATRIC INTENSIVE
CARE UNIT, AND THE HOME IN ALL SETTINGS STANDARD V: ETHICS.
AND TYPES OF CARE, KEEPING THE FAMILY on behalf of patients are determined in an ethical manner.
AT THE CENTER OF CARE DELIVERY IS AN
ESSENTAL GOAL.
STANDARD VI: COLLABORATION. The nurse
collaborates with the patient, significant others, and health
PHILOSOPHIES care providers in providing patient care.
1. Maternal and child health nursing is FAMILY STANDARD VII: RESEARCH. The nurse uses research
CENTERED. findings in practice.
2. Maternal and child health nursing is COMMUNITY
CENTERED. STANDARD VIII: RESOURCE UTILIZATION. The nurse
3. Maternal and child health nursing is RESEARCH considers factors related to safety, effectiveness, and cost
ORIENTED. in planning and delivering the patient care.
ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN 2D 1

STANDARD IX: PRACTICE ENVIRONMENT. The nurse 10. HILDEGARD PEPLAU
contributes to the environment of care delivery within the The promotion of health is viewed as the forward
practice settings. movement of the personality; this is accomplished
through an interpersonal process that includes
STANDARD X: ACCOUNTABILTY. The nurse is orientation, identification, exploitation, and resolution.
professionally and legally accountable for his/her practice. 11. MARTHA ROGERS
The professional registered nurse may delegate to and The purpose of nursing is to move the client toward
supervise qualified personnel who provide patient care. optimal health; the nurse should view the client as whole
and constantly changing and help people to interact in the
best way possible with the environment.
A FRAMEWORK FOR MATERNAL AND CHILD 12. SISTER CALLISTA ROY
HEALTH NURSING CARE The role of the nurse is to aid clients to adapt to the
change caused by illness; Levels of adaptation depend
Maternal and child health nursing can be visualized within a on the degree of environmental change and state of
framework in which nurses, using nursing process, nursing coping ability; Full adaptation includes physiologic
theory, and evidence-based practice, care for families during interdependence.
childbearing and childbearing years through four phases of
health care: ROLES AND RESPONSIBILITIES OF A MATERNAL
CHILD NURSE
Health Promotion
Health Maintenance 1. CLINICAL NURSE SPECIALIST
Health Restoration 2. CASE MANAGER
Health Rehabilitation 3.
4. FAMILY NURSE PRACTITIONER
THEORIES RELATED TO MATERNAL AND CHILD 5. NEONATAL NURSE PRACTITIONER
NURSING 6. PEDIATRIC NURSE PRACTITIONER
1. PATRICIA BENNER 7. NURSE-MIDWIFE
Nursing is a caring relationship. Nurses grow from novice
to expert as they practice in clinical settings. 17 SUSTAINABLE DEVELOPMENTAL GOALS
2. DOROTHY JOHNSON (SDGS) TO TRANSFORM OUR WORLD
A person compromises subsystems that must remain in
balance for optimal functioning. Any actual or potential 1. GOAL 1: NO POVERTY
threat to this system balance is a nursing concern. 2. GOAL 2: ZERO HUNGER
3. IMOGENE KING 3. GOAL 3: GOOD HEALTH AND WELL-BEING
Nursing is a process of action, reaction, interaction, and 4. GOAL 4: QUALITY EDUCATION
5. GOAL 5: GENDER EQUALITY
system, perceptions, and health; the role of the nurse is 6. GOAL 6: CLEAN WATER AND SANITATION
to help the client achieve goal attainment. 7. GOAL 7: AFFORDABLE AND CLEAN ENERGY
4. MADELIEINE LININGER 8. GOAL 8: DECENT WORK AND ECONOMIC
The essence of nursing is care. To provide transcultural GROWTH
care, the nurse focuses on the study and analysis of 9. GOAL9: INDUSTRY, INNOVATION AND
different cultures with respect to caring behavior. INFRASTRUCTURE
5. FLORENCE NIGHTINGALE 10. GOAL 10: REDUCED INEQUALITY
The role of the nurse is viewed as changing or structuring 11. GOAL 11: SUSTAINABLE CITIES AND
elements of the environment such as ventilation, COMMUNITIES
temperature, odors, noise, and light to put the client into 12. GOAL 12: RESPONSIBLE CONSUMPTION AND
the best opportunity for recovery. PRODUCTION
6. BETTY NEUMAN 13. GOAL 13: CLIMATE ACTION
A person is a open system that interacts with the 14. GAOL 14: LIFE BELOW WATER
environment; Nursing is aimed at reducing stressors 15. GOAL 15: LIFE ON LAND
through primary, secondary, and tertiary prevention. 16. GOAL 16: PEACE AND JUSTICE STRONG
7. DOROTHEA OREM INSTITUTIONS
The focus of nursing is on the individual; clients are 17. GOAL 17: PARTNERSHOPS TO ACHIEVE THE
assessed in terms of ability to complete self-care. Care GOAL
given may be wholly compensatory (Client has no role);
partly compensatory (Client participates in care); or
supportive-educational (Client performs own care). REFERENCES
8. IDA JEAN ORLANDO
The focus of the nurse is interaction with the client; I. PowerPoint presentation
effect
should define his or her own needs.

9. ROSEMARIE RIZZO PARSE
Nursing is a human science. Health is a lived experience.
Man-living-health as a single unit guides practice.

SEXUALITY / PREGNANCY - Eye Prophylaxis
- Cord Care
- Vitamin K
OUTLINE CONCEPT OF SEXUALITY
1. SEXUALITY
I. Procreative Health Refers to sexual behaviour in all sexual organisms. A
II. Antepartum / Pregnancy
III. Intrapartum attitudes, preferences, and behaviours related to
IV. Postpartum expression of the sexual self and eroticism
V. The Newborn
2. ASEXUALITY
VI. Concept of Sexuality
VII. Principles Relevant to Sexuality Absence = no attraction between opposite sex
VIII. Sexual Stimulation and Response Patterns Is a general term or a self-designation for people who
IX. Patters of Sexual Responses lack sexual attraction or otherwise find sexual behaviour
X. Sexual Relationships unappealing
3. AUTOSEXUALITY
People are attractive to own self but that mean
PROCREATIVE HEALTH
Principles of Sexuality and Procreation Prefer masturbation
not attracted to other people
Sexuality
Or Autoerocitism is the sexual stimulation of, or sexual
Genetics
body
Risk Factors that will lead to Genetic Disorders
Common Tests for determination of Genetic
4. HUMAN SEXUALITY
Abnormalities Refers to the expression of sexual sensation and related
intimacy between human beings, as well as the
Nursing Process
expression of identity through sex
Involves social interaction of individual and physical as
ANTEPARTUM / PREGNANCY
well
Anatomy and Physiology of the Reproductive system
- Spermatogenesis
PRINCIPLES RELEVANT TO SEXUALITY
-
- Oogenesis
1. Human sexuality provides for reproduction (Human
Physiology of Menstrual Cycle
fertilization) of human species
Fertilization - 2 persons are involved in the act, and they should
know the purpose of their action and aware of
INTRAPARTUM responsibility, family panning should be involved
Concept of Labor and Delivery 2. Sexual fulfilments is a basic human need
Concepcion -
Fetal Development physiological need includes sexual fulfilment; use
Normal Adaptation in Pregnancy ethics with patients
Assessment 3. Sexuality pervades virtually every aspect of life from
Theories of Labor birth to death
Components of Labor - starts at birth
Signs of Labor 4. All human cultures have sanctions, often legal as
Stages of Labor well as moral, controlling expressions of sexual drive
- Different cultures have different sanctions like in
POSTPARTUM certain agreements
Puerperium 5. Individuals have strong cultural, religious, ethical
convictions regarding the expression of human
Family Planning Methods
sexuality
Legal Implication of MCN
6. Moral values concerning appropriate sexual
behaviors have undergone considerable
THE NEWBORN liberalizations in most western cultures in recent
Profile of the Newborn years
- Function and Appearance - According to Max Weber, culturing values are
- Apgar score enduring and autonomous influence in the society
- Anthropometric Measurements (weight, HC, CC, regarding sex
Abdominal C, Body Length) 7. Successful gender identification in early childhood is
- Vital Signs, Airway important -being
Nursing Care of the Newborn throughout life

- It is important for emotional and mental stability, a A relationship outside of marriage where an ellicit
clear gender will help you develop more romantic or sexual relationship or passionate attachment
8. Actual or potential damage to the integrity of an occurs; kabit.
threat to 4. NON-TRADITIONAL
his self-esteem Can be look in many different ways. They can be non
- Prone to suicidal sexual
large disparity in money or age
SEXUAL STIMULATION AND RESPONSE
PATTERNS FACTORS AFFECTING SEXUAL FUNCTIONING:
A. PHYSICAL STIMULATION 1. BIOLOGICAL
Usually consists of touching the erogenous zones or the sexual differentiation, brain mechanisms involved in
excitement area of the human body sexual responses, role of sex hormones, sexual effects of
Ex. Male female= nipples, neck, back of ears, clitoris, drugs, sexually transmitted disease
lips 2. SOCIAL
B. PSYCHOLOGICAL STIMULATION role of parents, social media
B1 Visual- pictures of nudity and romantic photo 3. MORAL
B2 Auditory- classical music beliefs of each culture regarding sexual functioning
B3 Olfactory- perfumes and scented candles
4. PSYCHOLOGICAL
the impact of body image, sexual abuse in childhood, and
PATTERNS OF SEXUAL RESPONSES mental health history, interpersonal problems
1. DESIRE RESPONSIBLE PARENTHOOD
It is a prelude to sexual excitement & sexual activity. It
As defined in the directional plan of POPCOM, is the will
occurs in the mind rather than the body and may not
and ability of parents to respond to the needs and
progress to sexual excitement without further physical or
mental stimulation. It is communicated between potential aspirations of the family and children. It is a shared
sexual partners either verbally or through body language responsibility of the husband and wife to determine and
or behavior. achieve the desired number, spacing & timing of their
Ex. A woman preparing herself, putting lotion and children according to their own family life and
perfume aspirations, taking into account the psychological
2. EXCITEMENT / AROUSAL preparedness, health status, socio cultural, and
response to desire. A person who economic concerns
manifests the physical indications of excitement is termed
to be or . It can be communicated PRINCIPLES OF PROCREATION
between partners verbally or through body language, 1. Sex is a search for sensual pleasure and satisfaction,
behavior, or anybody changes. releasing physical and psychic tensions.
3. PLATEAU 2. Sex is a search for the completion of the human
The highest moment of sexual excitement before person through an intimate personal union of love
orgasm maybe achieved, lost and regained several times expressed by bodily union for the achievement of a
without the occurrence of orgasm more complete humanity
During intercourse already, there is excitement 3. Sex is a social necessity for procreation of children
and education in the family so as to expand the
4. ORGASM
human community and guarantee its future beyond
Occurs at the peak of the plateau phase. The sexual
death.
tension that has been building throughout the body is
4. Sex is a symbolic (sacramental) mystery, somehow
released, and the body releases chemical called
revealing the cosmic order. In short, this Christian
which causes a sense of wellbeing. This
principle is all about pleasure, love, reproduction and
can achieve through mental stimulation and fantasy
the sacramental meaning of sex.
alone, but more commonly is a result of direct physical
stimulation or sexual intercourse
MECHANISM OF HEREDITY
Time where ejaculation of sperm into vagina of female,
brings satisfaction OVA SPERM
5. RESOLUTION
Is a period following orgasm, during which muscles relax
and the body begins to its pre-excitement state 23 23
Relaxation of both reproductive systems CHROMOSOMES CHROMOSOMES
SEXUAL RELATIONSHIPS
1. PREMARITAL
Is a period for two different person who do not know each
other, understand each other and create bonds of love 46
which are necessary to live together before they take CHROMOSOMES
decision to marry.
2. POSTMARITAL
Occurring, existing, or taking effect after the end of
marriage. 22 PAIR 1 PAIR (SEX
CHROMOSOME) (23RD PAIR)
3. EXTRAMARITAL (AUTOSOME)

INHERITANCE SCREENING TEST FOR GENETIC TRAITS AND
1. GENOTYPE DISEASE
complete set of inherited traits 1. KARYTYPING
2. PHENOTYPE l chromosomes
how these traits are expressed pattern.
3. ALLELES 2. HETEROZYGOTE SCREENING
are pair of genes the use of specific assays to determine the genetic status
- 1 from ovum of individuals already suspected to be at higher risk for an
- 1 from sperm inherited disorder caused by family history
4. HOMOZYGOUS 3. MATERNAL SERUM ALPHA
the same alleles Fetoprotein
5. HETEROZYGOUS amniotic fluid)
different versions of the trait It is a rare procedure because it is an invasive procedure)
4. TRIPLE SCREENING
GENETIC DISORDER analysis of 3 indicators from MSAF (Meconium- stained
1. CHROMOSOMAL INHERITANCE DISORDERS amniotic fluid), Estriol (estrogen), HCG (Human Chrionic
A. AUTOSOMAL DOMINANT DISORDER gonadotropin)
- (single copy of disease mutationof the genes)
- dwarfism HISTORY OF GENETIC DISORDER
- disease (progressive breakdown of Anencephaly
nerve cells causing to have problem in the brain that Spina bifida (the spine of the baby is not straight, there is
has one copy of defective genes), a curvature at the back the protrude)
- Gastroschisis
fibers that supports or anchor the different organs right or left causing the intestine to come out)
also this disease will limit the ability to make protein
to build a connective tissue.) DIAGNOSTIC TESTS
1. CHRIONIC VILLI SAMPLING
B. AUTOSOMAL RECESSIVE DISORDER 5th week of pregnancy (earliest), but mostly done at 8th
(Two copies of mutation are needed to cause the to 10th week
disease) Prenatal test that involves taking a sample of tissue from
- cystic fibrosis (Affecting the lungs as well as the the placenta to test for some chromosomal abnormalities
digestive system, produces a thick sticky mucus on certain genetic problem
membrane in the lungs thus it has a difficulty to
2. AMNIOCENTESIS (REFER TO THE AMNIOTIC
inflate and deflate. This also affects the pancreas
regarding its function) FLUID)
taking down 2-5 ML to test some abnormalities at 14 and
C. X- LINKED DOMINANT DISORDER 16 weeks
- fragile x syndrome (A mental retardation or disorder 3. SONOGRAPHY (ULTRASOUND)
in which the brain needs more protein. It occurs not an invasive procedure but uses a high waves of
because there are some changes in the formation of frequency sound waves
the genes.) 4. FETOSCOPY
an incision done to the mother
D. X-LINKED RECESSIVE DISORDER 3-4 incision
- haemophilia (it is a disorder in which the blood
CHRIONIC VILLI SAMPLING
- Fabry disease (raising the risk of heart attack, stroke
and kidney failure)
E. MULTIFACTORIAL INHERITANCE
- CLEFT LIP
- PALATE
2. CHROMOSOMAL ABNORMALITY DISORDERS

A. NUMERIC ABNORMALITY- Klinefelter Syndrome
B. STRUCTURAL DISORDER Translocations
RISK FACTORS OF GENETIC DISORDER

1. Age (mother and father)
2. Race
3. Family history of disease
4. OB History of pregnancy issue: like exposure to
teratogens (chemicals that affect the growth of the
fetus in the womb) such as radiation,
certain drugs, viruses, toxins and chemicals Fig 1. The needle is inserted to the abdomen up to the
placenta with the guide of an ultrasound

AMNIOCENTESIS
Fig 2. The needle is inserted to the abdomen up to the

amniotic fluid with the guide of an ultrasound.
NURSING PROCESS
A. ASSESSMENT
1. Health history - genetic history, ethnic background,
2. Laboratory and diagnostic studies

B. NURSING DIAGNOSES
1. Knowledge Deficit
2. Decisional Conflict
3. Anticipatory Grieving
C. PLANNING
1. The couple will receive education
2. The couple will receive emotional support
D. IMPLEMENTATION
1. Provide education - information about genetic
problem; testing required; possible treatment; and
available resources
2. Provide emotional support - Counseling
healthcare facilities. Assist in coping
E. EVALUATION
REFERENCES
I. PowerPoint presentation

2. Scrotum - A bag of skin that holds and help to protect
THE ANATOMY AND PHYS IOLOGY OF THE the testicles also it provides a proper temperature for
REPRODUCTIVE SYSTEM the viable sperm
Additional notes:
OUTLINE
When the environment is cold the scrotum
I. Male Reproductive Organ will retreat up towards the body and will
II. Spermatogenesis
constrict however if the environment is hot
III. Female External Reproductive Organ
the scrotum will descend due to the
IV. Oogenesis
V. Menstruation temperature that maintain the viability of
VI. The Menstrual Cycle the sperm.
VII. Pregnancy Cryptorchidism - Failure of the scrotum to
VIII. Stages of Pregnancy descend. This is one of the most common
endocrine problems in newborn males
B. INTERNAL STRUCTUR ES
M ALE REPRODUCTIVE SY STEM
1. Testes
2. Epididymis - extend 10-20 ft; 2-4 weeks sperm
maturation
- Temporary site for immature sperm
3. Vas Deferens - 16 inches
Ampulla of the Vas Deferens
4. Ejaculatory duct
5. Urethra
Three regions of the urethra:
- Prostatic Urethra
- Membranous Urethra
- Penile Urethra
C. ACCESSORY GLANDS
1. Seminal vesicles - 2 inches; secrete alkaline
fluid and fructose
Aspermia - Lack or absence of the
reproduction of the sperm
Fig 1. Parts of the Male Reproductive System Oligospermia - The sperm is fewer
than 20 million per ml
The male reproductive system produce, nourish and
2. Prostate gland - walnut
transport sperm into the female reproductive system
Prostatic Urethra - Help to control
for reproduction.
the mixing of the urine into the sperm
It secretes the male sex hormone called testosterone.
during the sexual intercourse.
3. / Bulbourethral - 2 pea sized
A. EXTERNAL STRUCTURES structure
1. Penis - Transport the semen into the female secrete an alkaline mucus-like fluid
reproductive tract. that helps to counter act the acidity of
the urethra and ensure the passage of
- Passage of urine the spermatozoa.
Parts of the Penis:
- Shaft D. M ALE BREASTS
- Glands Penis
- Prepuce/ Foreskin
ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN-2D 7

SPERM ATOGENESIS
The formation of sperm cell that undergo mitotic and
meiotic divisions
Hypothalamus
Gonadotropin Releasing Hormone
Fig 2. Parts of the sperm cell

Anterior Pituitary Gland
FEM ALE EXTERNAL REPRO DUCTIVE
FSH (Follicle LH ORG AN
Stimulating (Luteinizing
Hormone) Hormone)
Androgen Binding Protein
Testosterone
SPERMATOGENESIS
SEMEN
60%- Prostate gland
Fig 3. External parts of the Female Reproductive system
30%- Seminal Vesicle
5%- Epididymis Produces the egg cell
5%- Bulbourethral gland Site for fertilization
3-5 cc (1tsp) per ejaculation Nourish,
womb
SPERM ATOZO A It produces the hormone Estrogen and Progesterone
Produced by testicles
40-80 million per cc of semen A. EXTERNAL STRUCTURE
300-500 million per ejaculation 1. Mons Veneris/ Mons Pubis
300-500 million per ejaculation 2. Labia Majora - An adipose tissue that helps to protect
12-20 days travel mature after 64 days and cover the inner structure of the female genitalia
3. Labia Minora
4. Clitoris
5. Urethral Meatus
6. Perineum

4. OVARIES
2 almond shaped glands

Female gonads are located in the superior portion of the
pelvic cavity lateral to the uterus
It produces secondary oocytes, discharge secondary
oocytes (the process of ovulation) and secretes
hormones such as estrogens, progesterone, relaxing
and inhibin
Oogenesis begins in the ovaries
Regulate and initiate the menstrual cycle
Within the ovary, it has tiny sac structures
Ovarian follicle = consist of immature egg which we
called oocytes
Cells surrounded by oocytes inside which we call as the
Fig 4. Internal Parts of the Female Reproductive System follicular cells in which mature and become the ovarian
follicle
B. INTERNAL STRUCTUR ES The mature follicle is called graafian follicle which
discharge mature ovum from the graafian follicle during
1. VAGINA
3-4 inches long 5. CERVIX

Vaginal rugae = become thin because this will be the
passageway of the baby during delivery Cervical os has internal and external os
Passageway for sperm and menstrual flow, the
receptacle of the penis during sexual intercourse and the 6. FIMBRIAE
inferior portion of birth canal. It is capable of considerable
distension Help catch the sperm during penetration
Is finger-like projection and can be found at the end of
2. UTERUS the fallopian tube
Creates current that acts to carry the oocytes or the
fertilized egg into the uterine tube where it usually begins
- its journey towards the uterus
Where the baby develops
The layers of the uterus are an outer perimetrium, 7. BRO AD LIG AM ENT
middle myometrium, inner endometrium
Help the uterus in place, no matter what position you
3. FALLOPIAN TUBE will do during sexual intercourse = locked
Additional notes:
4 inches
Transport the egg from the ovary to the uterus If the egg during sexual intercourse/excitement is
Has 3 parts: not fertilized, it will eventually deteriorate and
1. Isthmus = site of fertilization excreted from the body in the form of
menstruation
2. Ampulla
The journey from the tube into the uterus of a
3. Infundibulum fertilized is about 4-5 days; the egg is fertilized in
Some mothers have ectopic pregnancy wherein during the tube and implanted in the uterus and fully
fertilization it is stuck in the tube and not in the uterus. developed particularly in the endometrium
This will cause rupture of the blood vessel in the tube If there is tubal ligation, it is the isthmus that is
resulting bleeding to the pregnant mother surgically cut off

C. ACCESSORY GLANDS Has internal os and external os and is expressed in cm
(dilation of cervix)
1. BREASTS (M AMM ARY GLAND) Vaginal canal is rugated and becoming thin during the
process of delivery or as labor progresses. It is expressed
Are modified sweat glands lying superficial to the in percentage by the doctor
pectoralis major muscles. Their function is to
synthesize, secrete and eject milk (lactation) after the FEM ALE INTERNAL REPRODUCTIVE
birth of the baby SYSTEM: LATERAL VIEW
Mammary gland development depends on estrogen
and progesterone. The milk production is stimulate by
hormones such as prolactin, estrogens and
progesterone, milk ejection is stimulated by oxytocin
2. BARTHOLIN OR VULVOVAGINAL GLAND
Produces fluid to the stimulation
3. SKENE OR PARAURET HRAL GLAND
D. PELVIS
Is NOT an accessory gland

Part of the skeletal system
Involved in the process of delivery
INTERNAL PART OF THE UTERU

r
Fig 6. Internal Part of the Uterus in Lateral view
Uterus = overlying into the urinary bladder and rectum

A full bladder and rectum will hinder the passageway of
the baby or paglabas ng baby
The pelvic bone plays a role in pregnancy
OOGENESIS
This is the process in which there is formation and

development of the oocyte or the ovum
Fig 5. Internal Part of the Uterus
The layers of the uterus are an outer perimetrium, middle

myometrium, inner endometrium (site of implantation)

Uma di ti ni
na dat ly atay
lawngon lay
jvdnakog data
Underdeveloped cell This will provide internal protection for the oocytes
PRIMITIVE OOGANIA
ZONA PELLUCIDA
During proliferation
phase, the cells of the The one that supports the communication between the
PRIMORDIAL OR generative layer of the
ovary divides to produce oocytes and the follicular cells during the oogenesis
PRIMITIVE FOLLICLE Regulates the ovulated eggs and free-swimming during
follicle which is the
(before birth) Undergo secondary oocyte and following of fertilization
Meiosis I
Further develop to HY ALURENIC ACID
become the oocytes or
the haploid of the Important part of the extracellular matrix that function in
SECONDARY OOCYTES chromosomes = 46 cells during signalization
Provides for the MENSTRUATION

maturation as well as the
GRAAFIAN FOLLICLE release of the fertilized
Shedding of Corpus Luteum
oocytes. Forms the
corpus luteum (CL) Periodic discharges of the female which is composed of
which promote and blood, mucos, and dead endometrial cells of the uterus
maintains the implantation Blood coming from the ruptured capillaries in the uterus
of the embryo. If there is
OVUM no fertilization the CL will Menarch (onset) early as 14 yrs. old some 10,
progress its function and menopause (termination) 50 years old and above
turns into menstrual cycle. 300,000 - 400,000 oozytes per ovary, they are the
If there is ovum, it is the one If there is fertilization, the immature oozytes that is present at birth. It is formed
capable of developing a new graafian follicle will
during the first month of the intrauterine life. This maybe
individual with the sperm being maintain the CL in
fertilized preparation for the coming degenerate and be atresia
of fertilized ovum Average cycle is 28 days but, in some cases, it reaches
up to 31 days. Duration of 3-5 days however in some
books it says up to 7 days
Unovulatory state after menarch
OOCYTES / FERTILIZED EGG
Menstrual flow contains 30-80 ml of blood, sometimes
more due to intake, problem in hormone, or not properly
shed off
Structures involve hypothalamus, APG, ovaries, uterus,
vagina (excretion of the menstrual cycle)
Hormones that regulate FSH and LH
ESTROGEN
PROGESTERONE
Mittelschmerz = abdominal cramping pain that occurs
after the time of ovulation. It is different from
dysmenorrhea in which is an abdominal cramping pain
that occurs during the course of menstruation.
ESTROGEN
Fig 7. Oocytes / fertilized egg Inhibits production of FSH

Causes hypertrophy of the myometrium
CORONA RADIAT A
Stimulates growth of breasts ducts
Is a follicle cell that surrounds the zona pellucida - Thelarche

Increases ph of cervical mucus causing it to become thin B. PHASES OF MENSTRU AL CYCLE
and watery (Spinnbarkhelt test), occurs during ovulation
Proliferates the endometrium A. Proliferative/ Preovulatory/ Follicular Phase
(16-14 days)
PROGESTERONE In a 28 days cycle begins with the end
of menstruation
Inhibits production of LH
Increases endometrial tortuosity Additional notes:
Increases endometrial secretions
The first day of menstruation is the last day
Inhibits uterine motility of menstrual period.
Facilitate transport of fertilized ovum through fallopian
tube
Increases body temperature after ovulation which means
you are fertile levels of estrogen and progesterone
Hypothalamus senses the decrease, thus

THE MENSTRUAL CYCLE
stimulates the APG to secrete GnRH
prompting the release of FSH which
stimulates the ovaries to produce follicles
A.THE FOUR LEVELS (10-20)
1. CNS RESPONSE- Hypothalamic-pituitary gland Follicles ripen but only one will mature
action (FSH and LH) which is known as the Graafian follicle.
-stimulation of the hypothalamus
2. OVARIAN RESPONSE (2 phases)- Proliferative B. Ovulatory Phase (14-15) Peak
phase (1-14 days); Secretory (15-22 days)
ENDOMETRIAL RESPONSE (4 phases) Graafian follicle ruptures and releases the mature
o Menstrual phase (1-5 days) ovum near the fallopian tube.
o Proliferative phases (6-14 days) 2 ova matures- both fertilized (Fraternal twins)
o Secretory ( 15-26 days)
1 fertilized ovum divides into 2 separate zygotes
o Ischemic ( 27-28 days)
(Identical twins)
CERVICAL MUCUS RESPONSE (OVULATORY)
15 23 days BEFORE OVULATION
Spinnbarkeit/Spinnbarkheit; mittelschmerts AFTER
Hypothalamus senses increase level of estrogen
OVULATION.
triggers the APG to release LH which acts with FSH
to cause OVULATION and enhance Corpus
Additional notes: Luteum formation
Body structures involved in menstrual cycle:
Hypothalamus C. Secretory / Luteal Phase (16-28)

Anterior Pituitary Gland
Ovary Corpus luteum secretes Progesterone that
Uterus maintains the vascularity (also the thickness) of the
endometrium
Decrease level of estrogen and increase

progesterone (hormone of pregnancy)

Cause glands in the endometrium to secrete Increased in hormones in preparation for the
nutrients to sustain a fertilized ovum that is implanted coming of the fertilized ovum. But if there is no
in the uterine wall fertilization the hormones start to decrease
If no implantation- Hypothalamus signal the because there is no pregnancy to maintain.
Pituitary gland to stop producing FSH and LH
Additional Notes:
Decrease in FSH and LH causes the Corpus
luteum to decompose in the ovary and nourishment Obstetric nursing defined as the art and
of the endometrium stops. (THIS WILL HAPPEN 2 science that would take care of the
DAYS BEFORE MENSTRUATION) childbearing as well child rearing mothers.
Also take care the woman and the unborn
baby.
Addition notes:
Maternity nursing this is a practice of
Corpus luteum become necrotic and nursing care given to the woman before,
ischemic. After 2 days the necrotic will during, and after pregnancy.
separate and degenerate from basal layer Maternal and childcare nursing is branch of
of corpus luteum and it turns another nursing that is family centered and that
cycle of menstruation would assume responsibility for the whole
cycle of the pregnant mother to include the
family member or the entire family itself.
PREGNANCY
D. Menstrual Phase (1-5): an end and a beginning
Normal amount of semen/ ejaculation :3.5 cc
Number of sperm per cc of semen: 40 -80 million
Decrease in estrogen and progesterone
Mature ovum is capable of being fertilized for 12 to
Lining disintegrates and discharges from the body 24 hours after ovulation
Sperm is capable of fertilizing for 3 to 4 days after
MENSTRUAL FLOW ejaculation
Normal lifespan of sperm is 7 days
Sperm can reach ovum in 1 -5 minutes.
Fallopian tube will contract due to estrogen
Sperm must remain in female genital tract for 4 -6
hours before they are capable of fertilizing the ovum
Sperm have 22 autosomes and 1 X or Y sex
chromosomes
Ova contains 22 autosomes and 1 X sex
chromosomes.
STAGES OF PREGNANCY
1. Fertilization

The Process in which a sperm penetrates outer
Additional Notes:
layer of the ovum
Decidua Casularis portion of endometrium that
Additional Notes: stretches/encapsulates the trophoblast surface
Fertilization Union of sperm and Decidua Vera lines the remaining area of the
ovum, sperm penetrates layer of uterus
ovum. Which then turns into a
zygote. Then begins a chain of 1. Amniotic fluid (100 2200)
division that result in the -serves as a protective mechanism
development of an embryo and of growing fetus
usually occurring at the fallopian -protects fetus from changes of
tube. The total time span is about 24 temperature
48 hr. Mature ovum is surrounded -aids in muscular development
by 2 plasma which binds together -during delivery it will aid in the
and where the sperm needs to
descent of the baby
penetrate.
-serves as a lubricant
another term for fertilization is
Impregnation -allows the fetus to move freely
Fertilization occurs during the mid- -protects umbilical cord from
cycle of the menstruation, 14th days pressure
after menstruation is the ovulation -Protects fetus from infection
process. The woman is Fertile. Polyhydramnios too much
production of Amniotic fluid
Intervention: Less fluid intake
2. Implantation Oligohydramnios less
when the blastocyst attaches the endometrium (7 production of Amniotic fluid
9 days after fertilization) Intervention: increase fluid intake
Additional Notes:
2. Chorionic villi
Endometrium where implantation of -involve in the function the placenta
fertilized ovum -surround trophoblast, and produce
Morola 6 collection of cells coded hormones
that undergone mitotic division, takes
about 3 - 4 days. Continues to undergo Hormones:
mitosis until the end of the 5th day, - Human gonadotropin
then turn into a blastocyst. - (Hpnl) Human placental lactogen
Apposition when blastocyst -Estrogen
reaches/brushes unto the -Progesterone
endometrium
Adhesion when blastocyst attaches 2. Yolk sac
to the endometrium -Produce RBC, develops sperm or
Invasion when blastocyst settles in egg cells, Becomes a part of the
the soft fold of the endometrium umbilical cord
Decidua thickening of the
endometrium and also vascularity 3. Allantois
3 separate areas: -Contribute function of urinary
Decidua Basalis portion where the late trophoblast bladder, blood vessels, but become
cells are establishing communication with a part of the umbilical cord
maternal blood vessels which forms maternal
side of the placenta

3. Pre-Placental stage
When the endometrium becomes highly vascular
(week 2)
4. Placental and Fetal development
IMPLANT ATION
50% of zygote never achieve implantation
Small amount of vaginal spotting is occasionally
present
Endometrium turned to decidua: decidua Basalis,
decidua capsularis, decidua vera
3 Processes: apposition, adhesion, invasion
REFERENCES
I. Power point presentation

II. Notes from Discussion

PLACENTA
FETAL DEVELOPMENT 1. Respiratory System
2. Renal System
3. Gastrointestinal System
OUTLINE 4. Endocrine System
Human Chorionic gonadotropin (HCG) -
I. Umbilical Cord Maintain the corpus luteum to keep producing
II. Amniotic Fluid
estrogen and progesterone
III. Amniotic Membrane
IV. Placenta Human Placental Lactogen/ Human Chronic
V. Fetal Development Somatomammotropin Promotes mammary
gland necessary for lactation
Estrogen - Promote the development of the
mammary gland.
UMBILICAL CORD Progesterone/ Hormone of pregnancy -
21 inches long from the mother to the placenta Maintains the endometrium lining of the uterus to
2 arteries and 1 vein (AVA) hold the fetus inside.
Jelly- White substance that protects the two
veins and the artery from any compression Additional notes:
Transport oxygen, nutrient, minerals, and waste
products If the production of Progesterone is
less, thus, there is a tendency that the
AMNIOTIC FLUID
500-1000 ml inside the amniotic sac (BOW) womb especially if it is not full term.
Produced by the amniotic membrane Helps in the contraction of the uterus
Shields fetus from pressure or blow during labor and delivery
Protects fetus from sudden change in temperature
Aids in muscular development 5. Protective function - It inhibits the Passage of
Aids in decent bacteria as well as the large molecule to the fetus.
Protects umbilical cord from pressure Additional notes:
Protects fetus from infection
Teratogens - Toxic subs such as
ROH drugs, and certain placental
membrane and can cause severe
birth defects
The critical time for brain
development 16 weeks of AOG.
FETAL DEVELOPMENT
Zygote (1st 14 Days)
Embryo - 1st 15 days
(3rd to 8th Week) - Major organs of the

Fig 1. Amniotic membrane embryo are formed during the first 8 weeks
Additional notes:
The Pregnancy duration has a three Fetus

trimester that has 38 weeks or 266
days each. (8th week to birth)-The fetus has a sufficient
development inside the

Additional notes:
Abortion - The fetus is delivered

before 9 months or 20 to 22 weeks
Preterm/ Premature Delivery - The
fetus is delivered in more than 20 to 22
weeks but less than 38 weeks. The
fetus is not fully developed
Different types of abortion

1. Spontaneous Abortion - Nothing is done to the
pregnant mother it just occurs naturally without any
artificial interferences that cause some fetal Fig 4. The two arteries and the vein inside the
abnormalities Jelly are visible and the formation of the fetus is improving in
2. Induced Abortion - Any abortion that are Cause by which its head is developing and some of its features are
some mechanical or artificial means to remove the already visible
baby and this is true to any unwanted pregnancy.
3. Therapeutic Abortion - This is performed by a
physician or a doctor as a form of treatment to the
mother
Fig 5. The external feature of the fetus is already in

position
Fig 2. Bean like Structure
During this week the liver is already formed and is a
major site of RBC production but after the succeeding
months it is already the bone marrow that will produce
the RBC
For 9-12 weeks there is already urine production
Fig 3. During the 4th week of the fetus, some organs are
forming and there is an increase in fetal size

The baby produces Vernix carseosa (a white cheesy
like substance that is found all over the body to
maintain temp.)
Fig 6. Rapid Growth of the Fetus and has a coordinated

movement
During this week external Reproduction is already

visible thus in this week we can already determine the
gender of the fetus
Fig 9. There is already weight gain in the fetus and the skin
becomes pinkish or reddish. Eye movement and growth of
fingernails happens in this week
Fig 7. There is already osification of the skeleton
Fig 10. During this time the lungs of the baby is starting to
produce surfactant/ lung surfactant (Substance that
decreases the surface tension of alveoli in the lungs which is
necessary for survival on the outside world)
By this week the bone marrow will take over the

production of RBC/ Erethropoiesis (by the spleen)
Fig 8. During this week the Growth of the baby is slowing

down also in this week there is already quickening (1st
movement felt by the mother) as well as some fine hair called
lanugo (Fine hair that can be found all over the body except
palm, sole and lips)

Fig 11. The baby already have capillary reflex to light Fig 13. Fullterm baby, the head and the body of the baby
is fully proportionate as well as its features.
The weight of the baby should be 7.5 pounds which is

equal to 3000- 3800 grams and the legnth is about 45-
50 cm
Additional notes:
if the baby is delivered during his

32 weeks it is called post term
baby
The baby should be 40-42 weeks
When the Placenta starts to

regress its function, the baby will
be delivered
Fig 12. The body of the fetus is already proporional to the

head and the subcutaous fats are already deposited in some
parts that helps to maintain the temp of the baby after birth
REFERENCES
Additional notes:
I. PowerPoint Presentation
For 35 weeks, II.
already strong for gripping and
has a strong orientation towards
light

FETAL CIRCULATION FLOW CHART
PLACENTA
UMBILICAL PULMONARY
VEIN TRUNK
DUCTUS 40% LIVER LUNGS

VENOSUS
INFERIOR VENA PULMONARY DUCTUS

CAVA VEINS ANTERIOSUS
RIGHT ATRIUM FOREMEN LEFT ATRIUM LEFT AORTA

OVALE VENTRICLE
TRICUSPID MITRAL VALVE DESCENDING

VALVE AORTA
RIGHT COMMON
VENTRICLE ILLIAC ARTERY
UMBILICAL
ARTERY
PLACENTA
ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO 1

5. Ductus Arteriosus
FET AL CIRCULATION Is between the Pulmonary artery and the
Aorta
OUTLINE In some cases, after delivery it will close
after 3 months, but in other cases, it will not
I. FETAL CIRCULATION close leading to Patent ductus arteriosus
II. FOCUS OF FETAL DEVELOPMENT (PDA) = abnormal connection between the
III. NORMAL ADAPTATION OF PREGNANCY aorta and the pulmonary artery in the heart
Additional notes:
Foramen Ovale, Ductus Venosus, Ductus

Arteriosus = will close before delivery but in
some cases it will not close (like foramen ovale)
it will lead to disorder of a baby
Blue baby syndrome = mix of oxygenated and
unoxygenated blood
FET AL CIRCULATION FLOW CHART
Refer to the fig_

Oxygenated blood from the placenta returns via the
umbilical vein
The umbilical vein distributes
Fig 1: Fetal Circulation o 40% of its flow to the liver
Inferior vena cava drains into the right atrium
FEATURES IN FETAL CIRCULATION From the right atrium, the flow splits into right
ventricle and left atrium via foramen ovale
1. Umbilical Artery From the left ventricle, into the aorta
Transport the blood from the baby to the o From the aorta, upper body blood flow
placenta going back to the mother (brain and arms) is purely from the left
circulation ventricle, whereas lower body blood flow is
2. Umbilical Vein the combined output of the left ventricle and
Transports the blood and nutrients from the right ventricle via the ductus arteriosus
mother to the placenta going to the fetus From the common iliac arteries, via the umbilical
Collection between the mother and fetus arteries to the placenta
3. Foramen Ovale
Septum between the right atrium and the FOCUS OF FET AL DEVELOPMENT
left atrium
Like prick of a needle but it will allow the FIRST TRIMESTER
shunting of the blood from right to left
4. Ductus Venosus Organogenesis
Is the one that carries the blood
between the umbilical vein and the inferior SECOND TRIMESTER
vena cava that allows the blood bypassing
the liver Period of continued growth and development

THIRD TRIMESTER o Increase blood flow in cervix or the vagina that
causes engorgement of the vagina or the cervix
Period of most rapid growth and development as well, and vulva that produces discoloration
th week)
NORM AL ADAPT ATION OF PREGNANCY o Cause by an increase of secretion of

estrogen and progesterone that produces a
REPRODUCTIVE SYSTEM cervical softening of cervix
o Softening of the lower uterine segment that
Undergoes greatest changes in size as well in its is caused by of pelvic congestion
function th to 10th week)
Uterus o One of the earliest signs of pregnancy that

o Uterine growth and enlargement the discoloration bluish-purple hue that
o Length 6.5 cms to 32 cms appears on the cervix, vaginal, and vulva
o Width 4 cms to 24 cms o estrogen and progesterone
o Depth 2.5 cms to 22 cms Ovaries = no ovulation, during pregnancy, the ovary
o Weight 50 gms to 1000 gms stops to produce ova but continues to produce
o Volume 1-2 ml to 1000 ml hormone progesterone
Vagina = more acidic (ph 3.5 to 6) help control the
Additional notes: growth of pathogens in the vaginal canal to prevent
ascending infections like UTI, Leukorrhea = whitish,
Uterus increases as the baby grows: it can yellowish discharge
accommodate Breasts = as the fetus enlarges in the uterus,
Uterus is under the influence of estrogen and estrogen and progesterone produces number of
myometrial cells as well as the muscle fibers, changes to the mammary glands
undergoes changes: Hypertrophy, with the
process that allows the uterus to enlarge and
Additional notes:
stretch as the fetus enlarges also
Estrogen = cause hypertrophy of uterus and Melanotropin = a hormone that is secreted
enhance the uterus contractility, prepares the by the pituitary gland that causes the nipple
muscles during pregnancy; myometrium contracts become tender and darkening of areola
Progesterone = enables the pregnancy to thrive Colostrum = whitish, appeared in 3rd
the effect by relaxation on a smooth muscle, trimester, it is creamy whitish yellow liquid
prevent the labor if the baby is not on full term, help that have antibodies that help create natural
in the contractility to expel the baby outside, immunity of the baby; encourages baby to
decrease of progesterone - the baby will be suck the breast of mother to get colostrum
Braxton Hicks Contraction
expelled
o Irregular and painless contraction or fetal
movement felt by the mother during the 16
weeks or for 4 months
Becomes globular (4th month) MUSCULOSKELET AL SYST EM
o Abdomen, as the baby increase in its size and
This involves the pelvic joint. The pelvis of the mother
growth the uterus of the mother becomes
during pregnancy normally relaxes causing a waddling
globular in shape and seen physically
th week)
walk (walking like a duck).
- Waddling walk
o Cervix/cervical softening is caused by the
- Symphysis pubis may separate slightly
stimulation from the hormone estrogen and
progesterone
CIRCULATORY SYSTEM

Increased blood volume 40% to 50% - because there - Darkening of neck, under arms, and color changes
is a need to increase this amount due to metabolic of the palm which termed as Palmar Erythema.
demands of the new tissues of the growing fetus - The breast also darkens especially the areola.
Physiologic anemia- occurs due to hemodilution of the - Abdomen also have a line which is termed as
hemoglobin content of the blood volume. There is Linea Negra is the dark streak down midline in the
decrease RBC during pregnancy which is term as abdomen
PSEUDOANEMIA. Chloasma/ Melasma
Heart is displaced upward to the left because of the - darkening of skin especially on the face.
growing fetus. - MASK OF PREGNANCY
Increased cardiac output to 30 % - that is why we ask Stria Gravidarum this the stretch mark found the
the mother to position to left lateral. abdomen sometimes due to the scratching of the
Supine hypotension mother
- if the CO increase to 30 %. Linea Negra- dark streak down midline in the abdomen
- It also causes the mother to have difficulty in Increased Perspiration- during pregnancy causes the
breathing. mother to take bath several times a day.
- They experienced due to the enlarging fetus and the
location of the inferior vena cava. G ASTROINTESTINAL SYSTEM
- The mother has difficulty to lie on supine position
because of compression. Morning Sickness
- If the mother is in flat position, it compresses inferior - vomiting in the morning
vena cava that causes Cardiac Venous Return that - Caused by the hormone HCG (Human
decreases cardiac output and that would lead to chorionic gonadotropin)
Supine Hypotension or Vena Cava Syndrome. - An increased salivary secretion because of
Increased WBC enzyme Ptyalin that helps in mastication but also
CR & PR increased to 10 -15 beats/min causes morning sickness due to increase level
of HCG, Estrogen, and progesterone
Heartburn
- due to the relaxation of the sphincter between
the stomach and the esophagus that causing a
reflux of the gastric content
- Medical term for heartburn is Pyrosis
Constipation
- caused by the decrease motility of the
gastrointestinal tract which is brought about by
increased progesterone.
- additional Ferrous sulfate(sulphate) to
increase the RBC content of the body and one
of the side effects of this constipation.
Fig.2 Growth of baby and enlargement of the uterus.
INTEGUMENT ARY SYSTEM
Increased pigmentation

RESPIRATORY SYSTEM
Increased RR: up to 23 RR
-Normal: 12-16 RR
-Other Factors: Chest Contractions
Dyspnea Difficulty in breathing
-diaphragm is being displaced about 2 cm upward.
Increased tidal volume amount of air breathe of
the mother per minute
-Caused by the increase of estrogen and
progesterone
*Estrogen increase causes hypertrophy

(increased muscle cells) and hyperplasia (increase
of cells) of the lung tissue
*Progesterone increase causes relaxation of
Fig. 3 Mask of Pregnancy (Melasma or Chloasma) smooth muscle of the bronchi, bronchioles, and
alveoli.
Increase vital lung capacity force of respiration is

increased.
Decreased residual volume
URINARY SYSTEM
Urinary frequency compress bladder
Increased GFR (Glomerular Filtration Rate)
-Caused by increased progesterone:
-Mothers are advised to increase fluid intake during
the day
-includes relaxation of the sphincter
-causes asymptomatic bacteriuria and UTI (urinary
tract infection)
*Careful during this time if there is glycosuria result.
It is the inability of the kidney to reabsorb glucose.
ENDOCRINE SYSTEM
Increase metabolism of CHON and ChO
-Caused by the pancreas
-Pancreas increase insulin during pregnancy
Increased insulin production
WEIGHT G AIN
Weight distribution:
Fetus - 7lbs
Placenta - 1lbs
Amniotic fluid - 1.5lbs
Uterus - 2lbs
Blood Volume - 1lbs

Breast - 1.5 3lbs
Fluid - 2lbs REFERENCE:
Fats - 4 6lbs
I. Power Point Presentation
Total: - 20 25lbs
II. Notes From Discusion
FLOWCHART OF FET AL CIRCULATION
Placenta
Umbilical vein
(oxygenated Blood)
Liver (40% Blood)
Ductus Venosus Hepatic Vein
Inferior Vena
cava
Right Atrium
Foramen Ovale Tricuspid Valve
Ductus Arteriosus
Right Ventricle
Left Atrium
Mitral Valve
Left Ventricle Pulmonary Circulation

Aortic Valve
Ascending Aorta Descending Aorta
Brain and Upper Body Parts Lower Body Parts

Common Iliac Artery
Superior Vena Cava

Umbilical Artery
Umbilical Cord

SIGNS OF PREGNANCY Probable signs:
, (+) HCG
OUTLINE Additional Notes:
I. Signs of Pregnancy In contrast to the presumptive sign this can be

II. Prenatal Care documented by the examiner, but they are more
reliable than the presumptive signs however they
are still not a positive indication of pregnancy
because some patient has a ring formation of white

FIRST TRIMESTER secretion in the cervix that is cause by an infection
Presumptive signs:
Positive sign:
Amenorrhea, morning sickness, breast changes,
fatigue, urinary frequency, enlarging of uterus Ultrasound result
Additional Notes: Additional Notes:
Presumptive signs are not reliable or would not A true indication of pregnancy
indicate pregnancy. This are signs that are taken as a
single entity for it indicate other conditions.
Different terms that involve in menstruation SECOND TRIMESTER
Menopause - End or termination of menstruation
Menarche - The beginning of the menstrual cycle On the second trimester it is already proven that the
Amenorrhea - Absence of menstruation mother is pregnant
Dysmenorrhea - Painful menstruation. Some may
Presumptive Signs:
occur before the menstruation but there are some
that it occurs after the menstruation but in some Quickening, skin pigmentation, chloasma, linea negra,
cases, it occurs during menstruation. striae gravidarum
Morning sickness - For pregnant mother it is due to
the secretion of the hormone HCG (Human Chorionic Additional Notes:
Gonadotropin) however not all pregnant mothers will
experience morning sickness but 50% of the pregnant Skin Pigmentation- Increase color of the skin
mother will experience morning sickness that will The linea negra and the striae gravidarum is a
disappear during its 3rd month presumptive sign during 2nd trimester maybe due to
Breast Changes - The left breast is larger than the obesity
right breast also during menstruation there are some
changes in the breast that occurs Probable Signs:
Fatigue - Pregnant mothers experience fatigue
Ballottement
because of the demand of the blood volume and the
work of the heart but a person with low RBC will
Additional Notes:
experience fatigue
Urinary Frequency - It can be found to nonpregnant Ballottement - returning of the fetus when the
mothers that have problems in the urinary system uterus is pushed with the finger.
Enlarging Uterus - This can be felt by the examiner
enlarging that the patient is pregnant because there This can only be seen through internal examination
are some cases that the patient has myoma that
cause the enlargement of the uterus. During Positive Sign:
pregnancy test the result will be positive due to the
increase production of HCG especially if the person Most Reliable signs
has myoma FHT, Fetal movement, fetal X- ray

THIRD TRIMESTER 30 April
31 May
30 June
PRENATAL CARE
31 July
DATA GATHERING
31 August
1. Demographic Data
30 September
Personal data
Name, age, address, marital status, main complaint, 31 October
weight, height
5 days of November
2. Obstetrical data
TOTAL: 221 Days ÷ 7 = 31.4 (Should be
LMP (Last Menstrual Period) First day of cycle done manually)
AOG (Age of Gestation)
AOG: 31 weeks and 4 days
- by weeks based on LMP
- done after week-based
- distance of the fundus to
the xiphoid process FH Fundic Height
TPAL (Term, Pre-termed, abortion, living) scoring
done when assessment is finished. *Fundic height is measured from the top of the abdomen
EDC down to the top of the Mons pubis. The Abdomen when
measured must be pushed a bit downward.
Solving the AOG: (week-based)
Example 1:
LMP the no. of days in the specific month + no. of
days in the months before the present month + no. of 32 cm
Present days = Days ÷ 7 (No. of days in a week) 32 ÷ 4 = 8 Months of pregnancy
Example 1: *This method is done after the AOG solving.
LMP: March 19, 2021 Present day: August 11, 2021
BARTHOLOMEW'S RULE
19th - 31 days of March = 12 days
Estimated AOG by a relative position of the uterus in
30 days of April the abdominal cavity which is done by the doctor and
the distance between of the fundus to the xiphoid
31 days of May process
Undergo process of IE or internal examination
30 days of June
TPAL SCORING
31 days of July
Term-preterm-abortion-living
11 days of August
Compute when you have already done an assessment
TOTAL: 145 days ÷ 7 = 20.5 (Should be of the client
done manually)
EDC (Expected date of Confinement)
AOG: 20 weeks and 5 days
Estimated one, not the exact date of the delivery
Example 2: Forced pregnancy = ahead/delayed for 1 week
If you have EDC, the mother can prepare for the
LMP: March 29, 2021 Present day: November 5, 2021
coming of the baby
29th 31 days of March = 2 days

rule (-3 (month)+7 (days)+1 (year)) = 2 - 24 - 21
constant
LMP over (-3, +7, +1)
Example 1: = 14
LMP: March 19, 2021 = 03/19/21 -3 + 7 + 1 constant
Solution: - 31 - 22
(1) 3 19 21 = 11 - 31 - 21 22 becomes 21 since it is borrowed
-3 + 7 + 1 constant Additional Notes:

0 26 22 February has 28 days; we need to subtract the
number of days of February (28) to 31 days
Additional Notes:
Since there is no Month 0, we borrow 12 months

from the year (22), when borrowing a year, subtract 31 days - 28 days of February = 3 days/3rd day
the year by 1. (22-1=21)
(3) 12
(2) 12 2 - 24 - 21
3 - 19 - 21 minus 1 year, then add/carry to months = 14
= 15 -3 + 7 + 1 constant
-3 + 7 + 1 constant - 31 - 22
- 26 - 22 = 11 - 31 21 22 becomes 21 since it is borrowed
= 12 - 26 - 21 0 now becomes 12 or the Month of 28

December and 22 becomes 21; count the months if it = 11 - 03 - 21
reached 9 months
EDC: December 26, 2021 Additional Notes:
Example 2: Since we subtracted days, we need to add another

month to (11)
LMP: Feb 24, 2021 = 2/24/21
Solution:
11 months + 1 month = 12 months/12th month
(1) 2 24 21
EDC: December 3, 2021
-3 + 7+ 1 constant
Example 3:
X 31 22
LMP: March 29, 2021 = 03/29/21
Additional Notes:
Solution:
Since the months cannot be subtracted, we borrow
12 months from the year (22), when borrowing a (1) 3 29 21
year, subtract the year by 1. (22-1=21) -3 +7 +1
0 36 22
(2) 12

Additional Notes:
Since there is no month that end in 36 days, we

prioritize the days by subtracting the no. of days of
31 days of March - 36 days = 5 days/5th day
Additional Notes:
Since we subtracted days, we need to add a month.
(2) 1
3 29 21
=4
-3 +7 +1
36 22
31 22
= 01- 05 - 22
EDC: January 5, 2022
EFW - Estimated fetal weight
FH N x K = EFW
K Constant is 155
N Either be: 11 if baby not engaged, 12 if baby
engaged
To know if engaged, patient undergo internal
examination by the doctor; Engaged means if the baby
is floating
Example 1:
32cm, engaged
(1) 32 12 = 20
(2) 20 x 155 = 3100g or 3.1 kg
To convert in pounds:
(1) 3.1 kg x 2.2 kg (constant) = 6.82 lbs.

ADDITIONAL INFORMATION IN THE FETAL Parity- this number of pregnancies that
CIRCULATION reaches age of viability that is 28 weeks (28
weeks in Philippine setting but in abroad
and in books 20-21 weeks)
OUTLINE Additional Notes:

I. Prenatal Care reach the age viability but if
II. Sample Computation its weights is more than the age of viability it can
III. Computation
survive
IV. Assessment
Abortion- termination of pregnancy before

PRENATAL CARE the age of viability (before 28 weeks in
Philippine setting)
DATA GATHERING
G. TPAL-
1. Demographic data (the name, age, sex etc.) TERM-38-42 weeks AOG
2. Obstetrical data: Preterm-28-37 weeks
A. LMP (Last Menstrual Period) 1st day of LMP Abortion- below 28 weeks
B. AOG (Age of Gestation)- to estimate the number of Post term- 42 weeks above
days of pregnancy Living- Number of children alive
H. Past Pregnancies methods of delivery and place
a. 1 by weeks- based on LMP
of delivery
b. Primigravid- first pregnancy
Segundi gravid - second
c. 3 Barthol (done by the examiner) pregnancy
Multi gravid- pregnant more than 2
C. TPAL scoring (Term, Preterm, Abortion, living)
or more.
D. EDC (expected date of confinement)
-3+7+1) METHODS OF PREGNANCY
E. EFW (estimated fetal weight)
FH-N x K (constant 155) NSVD- Normal Spontaneous Vaginal Delivery
Caesarian Section
FH- Fundic height
Vacuum Extraction- delivered by instrumentation like
N- engage (12)/ not engage (11) a normal delivery but uses a vacuum machine.
Forceps delivery- uses a forceps inserted in the
K- 155 genitalia of the mother and lock on the neck of the
baby.
Additional Notes: PLACE DELIVERY
Duration of Pregnancy
Must be specific
9 calendar months Ask the question who delivers at home if the delivery
280 days happens at home (barangay health worker, nurse,
doctor, etc.)
40 weeks
E.g., Hospitals, birthing clinic, home etc.
10 Lunar months
F. GPA-Gravidity, Parity, Abortion in pregnancy PRESENT PREGNANCY
Gravidity- is the number of pregnancies Ask what the problems of the present pregnancy are
regardless of if it reaches the viability (even E.g., If she encounters vomiting, nausea (what she
if the baby dead) feel) etc. and what time

3. Medical Data illness before, during pregnancy.
Notes and ask if there occurrence e.g., UTI during or
before of pregnancy. 3. Another patient is pregnant for the 4th time. At home she
has a child who was born at term and her second
pregnancy ended 10 weeks gestation. She then gave
SAMPLE COMPUTATION birth to twins at 35 weeks 1 twin died soon after the
delivery.
1. Mrs. K, a mother of 7 children, visits a health center for
prenatal checkup. History is taken she had her LMP on Answers:
October 16, 2009. She has abortion in 1996, 1999, and
A. GPA= 4-2-1
2001. She had a couple of identical twins whom she
B. TPAL=1-2-1-2
delivered prematurely in the year 2000 and 2004.
G-number of pregnancies in (GTPAL)
(Use March 16, 2010, as the date of visit)
CALCULATE THE ESTIMATED DATE OF
A. EDC
B. AOG in weeks
C. GPA 1. Lynne is a 28-year-old woman who comes to the clinic
D. TPAL with a history of amenorrhea and a positive pregnancy
test result. Her last menstrual period began on May 31,
Answers: 2021. She bleeds for the usual amount of time and
reports that the amount of blood loss was normal
A. 7-23-10
assuming that Lynne had a 28-day cycle. Use the
B. 21 4/7 or 21 weeks and 4 days
naegele
C. G (9)P(5)A(3)
D. T (3)P(4)A(3)L(7) Solutions:
5-31-21
Solutions:
-3+7+1
A. 10 16 09 -2-38-22
-3 +7 +1
31+1
7 23 10
(2+1)-7-22
B. October - 15
November - 30
December - 31
January - 31 Answer = 3-7-22
February - 28
COMPUTATION
March- 16
1. The mother has 4 living children, and she is 38 weeks
Total = 151/7 pregnant. The mother delivered the 1st child at 36
= 21 4/7 weeks weeks, the 2nd at 37 weeks, the rest at 40 weeks and
39 weeks. She had two abortions at 20 weeks. She had
2. Mrs. Sanchez has 1 child born at 38 weeks and is also had a twin gestation at 38 weeks but died after
pregnant for the second time at her initial obstetric history delivery.
is having gravida 2 parity1 abortion 0. Mrs. Sanchez
present pregnancy terminated at16 weeks gestation. Answers:
Answers: A. GPA = 8-7-2

B. TPAL = 4-2-2-4
A. GPA = 2-1-1
B. TPAL = 1-0-1-1 ASSESSMENT

1. Physical Exam: (head to toe), (cephalocaudal),
(general to specific), (distal to proximal).
Additional Notes:
for the teeth if she has problems orally (e.g., Cavity,

plaque etc.) because during pregnancy the fetus will
take calcium from the mother. Teeth during pregnancy
increase hormones causes the gum to edematous and
some to bleeding.
Checked also for the tonsils if it is inflamed or

not. If it is inflamed, it has pathogens that
going to circulation that will to cardiac problem
that could lead to rheumatic heart disease
2. Pelvic Exam doctor will be the one to assisted by the

nurse (prep: gloves, k-y jelly(lubricant), light, and do
external douche and shaving of external genitalia)
a. Internal examination (IE) - helps also
b. Vaginal Speculum - inserted into external
c. Transvaginal Ultrasound - to have a full

bladder
d. Ballotement
e. Papaniculou Test (PAP Smear)
STAGING MALIGNANT CELLS:
STAGE 1 - confined to the cervix

STAGE 2 - extend beyond the cervix
STAGE 3 - extend to pelvic wall
STAGE 4 - beyond pelvic floor to other
organs
f. Pelvic Measurement - Pelvimetry
Additional Notes:
Dilation of the opening of cervix is in

cm
Vaginal canal (thinning of canal during
pregnancy) is in percentage
Bag of water- intact, leaking, or
ruptured
*GPA counts the pregnancy while TPAL counts

the heads, meaning TPAL counts the number of
babies.
GPA=Pregnancy
TPAL=Heads

ASSESSMENT OF THE PREGNANT MOTHER 2 PELVIC EXAMS
A. Internal Examination (IE) - Done by the doctor to
OUTLINE examine
B. Vaginal Speculum - Use by the doctor to examine the
I. Assessment pelvic area
II. C. Transvaginal Ultrasound - Make sure that the patient
III. Danger Signs of Pregnancy has a full bladder
D. Ballottement - Can be examine by the examiner
through the IE
E. Papanicolaou test (PAP Smear) - This is advised for
the pregnant mother for cervical cancer is very
common to the younger generation.
o Staging of malignant cell
Stage 1 - Confined to the cervix
Stage 2 - extend beyond the cervix
Stage 3 - extend to pelvic wall
Stage 4 - beyond pelvic floor to the organ
Additional notes:
Metastasized malignant cells will

occur in the rectum or the bladder
because of the anatomical location
of the uterus in which it lay down in
the bladder, and at the side is the
rectum.
F. Pelvic Measurement Pelvimetry

Fig 1. Abdomen of the mother when there is an increasing
Additional notes:
fetus.
Used to check if the fetal presenting
Additional notes: part is appropriate to the pelvis of
the mother if the baby can go out
The growing abdomen of the
safely and this can be done through
mother is expressed by weeks
PELVIMETRY (used to check the
When the baby reaches the full
anteroposterior diameter of the
term the contour of the abdomen
pelvis of the mother)
will descend because the baby will
This is usually done 2 weeks before
descend as well in preparation for
the EDC
the delivery
If the pelvic measurement is not
appropriate to the pelvis of the
ASSESSMENT mother, then she will have to go the
caesarean section
G. Leopold s Maneuver - This procedure is done by the

1 PHYSICAL EXAM nurse
The cephalocaudal Assessment must be done to the g.1 Fundal grip - fetal position
pregnant mother to know if there are some changes in g.2 Umbilical grip - fetal back & extremities
her body. g.3 Pawlic - engagement
g.4 Pelvic grip - fetal attitude

3 VITAL SIGNS
The vital sign of the pregnant mother is high especially

in the Respiratory Rate cardiac rate and the blood
pressure of the mother.
Additional notes:
Normal RR for the mother is 24 bmp
4 BLOOD STUDIES
Includes blood typing in preparation if the mother needs

blood transfusion during the delivery because there are
times that it will exceed to its 500 NSVD or extreme loss
of blood to the mother. Fig 3. IE of the doctor to check for the signs of disease
Additional notes:
Includes CBC (Normal hemoglobin of

the female 16-18; for the male 12-14)
and the level of hemoglobin
If the mother has a high hemoglobin
upon admission, then she is expected
to have blood transfusion
5 URINE EXAM
This is a routine procedure during pregnancy to know if

the mother has any bacterial invasion into the genital
area also to know if there are infection to the
reproductive system, commonly the UTI for this can Fig 4. Cervix
cause deformities to the baby
Additional notes:
Can be seen if a speculum is inserted to the vagina to

see if there is a whitish or a bluish-purple hue which
n
Fig 5. Speculum Inserted to the vagina

Fig 2. Vaginal Speculum

Additional notes:
are non-invasive method of assessing fetal To determine where the back is, if
presentation, position, and attitude. This technique can right or left quadrant
also be used to locate the fetal back before applying the If you push your left hand, and palpate using
fetal monitor your right hand, and you palpate something
EQUIPMENT the back portion

You must locate which quadrant is the fetal
warm, clean hands (for palpation)
back because this is where you place your
FUNDAL GRIP stethoscope or fetoscope as well as your
EFM machine if you are going to check for
1. Determine Presentation the FHT (fetal heart tones)
If you cannot hear, you must inform CI
- stand beside the woman. Facing her place both honestly
hands on the uterine fundus and palpate the contents If mother is on full term, there is no FHT on
of the fundus. If the buttocks are in the fundus the upper portion because the baby is
indicating a vertex presentation (which is true 96% of descending already, FHT should be at the
the time). you will feel a soft, irregular object that
does not move easily. However, if the head is in the is only on the left or right quadrant unless it
fundus indicating a breech presentation. You will is a twin
palpate a smooth, hard, round, mobile object For twins, you can hear FHT at the lower
and upper quadrant depending on the
position since there are twins where both
heads are presenting and there are twins
where the one head is at the upper quadrant
and the other at the lower quadrant
Additional notes:
The other hand pushing, and the other

palpating
Do not palpate using both hands
If there is no curvature in the
extremities, it is the buttocks, and the
head is presenting
UMBILICAL GRIP 2. Confirm Presentation
1. Determine Position - Place one hand over the symphysis pubis and
attempt to grasp the part that is presenting to the
- Place both hands on the maternal abdomen, one pelvis between your thumb and fingers of one hand.
on each side. Use one hand to support the abdomen In the vast majority of cases, you will fill a hard, round
while you palpate the opposite side with the other fetal head. If the part moves easily, it is unengaged.
hand. Repeat the procedure so that both sides of the If the part is nit movable, engagement probably has
occurred. If the breech is presenting, you will feel a
soft irregular object.

DANGER SIGNS OF PREGNANCY
PELVIC GRIP
Check if the head engaged A. VAGINAL BLEEDING

Place your hand above mons pubis Patient in Trendelenburg position, even small drop of
If the head of the baby is still moving means not blood should be reported
o Placenta previa low implantation of the
already placenta
Check for the presentation if is engaged or not o Abruption placenta abrupt separation of the
placenta
4. Determine Attitude
o Premature labor
- o Threatened pregnancy
feet. Using the finger pads of the first three fingers of
each hand, palpate in downward motion in the B. PERSISTENT VOMITING
direction of the symphysis pubis. If a hard bony
Vomit is normal unless it is 2 or more times a day
prominence is felt on the side opposite the fetal back,
o Hyperemesis Gravidarum due to HCG, can
you are palpating the occiput, and the fetus is an
cause nutritional deficiency Intervention: regulate
attitude of extension.
IVF
o Persistent infection
*Amount of vomit should also be monitored
Check for the attitude
You are still side on the mother but facing on the
C. CHILLS AND FEVER
feet and palpate both sides Intrauterine Infection
Check degree of laceration of the fetus Dehydration cause nutrition depletion of the mother
and the fetus
looking on feet you will feel hollow portion Benign Gastroenteritis
The head is more on extension. If head reflexed the
one that present is occiput and if perplex the D. SUDDEN ESCAPE OF FLUID FROM THE
presenting part is mendum. VAGINA
Before doing this procedure allow the mother to
urinate first. PROM Premature Rupture of the Membrane,
indicates pre-term labor, baby risk of ascending
infection, umbilical cord might also come down

E. ABDOMINAL OR CHEST PAIN
Ectopic Pregnancy baby forms at the fallopian tube

Abruption placenta
Uterine rupture
Pulmonary embolism air that enters the body, into
the lungs
F. SWELLING OF FACE AND FINGERS
Some say it is sign of impending delivery if it is on the

lower extremities
o Pregnancy induced hypertension
G. RAPID GAIN WEIGHT
Should only be a gradual increase
H. FLASHES OF LIGHT OR DOTS BEFORE EYES

Could be hypertension
I. DIMNESS OR BLURRING OF VISON
Could also be hypertension
J. SEVERE HEADACHE
A
interventions
K. DECREASE URINE OUTPUT
Could be kidney problems

DISCOMFORTS IN PREGNANCY - Small frequent feeding - Due to the
nutritional depletion and the fetus needs more
nutrition the mother needs to eat more some
OUTLINE small amount of food frequently to help the
body recover
I. Discomforts in Pregnancy
- Low fat meal/ Avoid fried foods- oils can trigger
II. Recommended Exercise
III. Labor vomiting
IV. Theories of Labor
- Avoid Antiemetics (Anti-vomiting drugs)- Any
V. Components of Labor
medications2.should
SYNCOPE
not be (FAINTING)
given to pregnant mothers
VI. The Pelvis
VII. The Cervix unless it is prescribed by the doctor.
a. Sit With Feet Elevated
VIII. Dilatation b. Change Position Slowly
IX. Effacement c. Left Lateral Position
X. The Vagina
XI. The Fetal Skull Additional Notes:
XII. Membrane Spaces
XIII. The Fontanelles Pregnant mother can experience syncope due
XIV. Anterior posterior Diameter to hormonal, increased blood volume, anemia,
XV. Fetal Attitude and fatigue
XVI. Fetal Lie This can cut the oxygen to the baby from the
XVII. Presentation mother and can disrupt the brain growth
XVIII. Position Nursing Intervention
XIX. Fetal Landmark
- Elevated feet can help the blood to return
XX. Methods to determine Fetal Position
from the brain
- Change position/ Left lateral Position- This
can help to impede the circulation of
1. NAUSEA AND VOMITING (FIRST TRIMESTER) blood. Place the patient in this position to
relieve the uterus with the use of pressure
a. Eat Dry Crackers so that the inferior vena cava will not be
b. Small Frequent Feeding compressed.
c. Low Fat Meal
d. Avoid Fried Foods
e. Avoid Antiemetics
Additional Notes: 3. BREAST TENDERNESS (FIRST TO THIRD

TRIMESTER)
Nausea and Vomiting is due to the increase level
of human chorionic gonadotropin hormone and a. Use supportive bra with elastic strap
changes in carbohydrate metabolism b. Avoid soap in the nipples and areola
Nausea and Vomiting can lead to dehydration that
can deplete the nutritional status of the fetus inside. Additional Notes:
If it is consistent and below normal which is more
than 1-2 times a day, it is referred as hyperemesis Due to increase estrogen and progesterone
gravidarum that causes dehydration that could lead hormone for the preparation in lactation or
to hospitalization to replace the lost fluids and milking process
electrolytes Nursing Interventions
Nursing Interventions - Use supportive bra with elastic strap- to
- let patient eat dry crackers like the original support the breast
flavor of sky flakes because different flavors - Avoid soap in the nipples and areola-
can trigger the nausea and vomiting clean the breast with plain water or
lukewarm
ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO, ROMARATE,

37
RUBIO, SANTOS, SERO, SILVA
4. INCREASED VAGINAL DISCHARGE d. Sleep on the side at night
e. Wear perineal pads if necessary - Should be
Due to estrogen and increase blood supply to the 4hrs interval
vaginal epithelium and to the cervix
a. Proper Cleaning and Hygiene 8. HEARTBURN KNOWN AS PYROSIS/DYSPEPSIA
b. Wear Cotton Underwear
c. Avoid Douching due to increase progesterone level that could cause a
d. Consult Physician if infection is suspected reflux in the stomach content and decrease the
gastrointestinal motility
Additional Notes: a. Small frequent feeding
b. Sit upright for 30 minutes after meal - not on
Nursing Interventions: bed immediately after meals
- Proper cleaning and hygiene- Have a daily c. Drink milk between meals - help to coat the
bath or shower to wash away the abdominal wall in the stomach that would
accumulated secretions prevent the reflux of the gastric content
- Wear Cotton underwear - this is to d. Avoid fatty and spicy foods - this can trigger
decrease the moisture heartburn
- Avoid douching- The fluid could be forced e. Avoid antacids (for hyperacidity) unless
to the uterine cervix that can cause prescribed by physician
infection
- Consult physician if infection is suspected- 9. ANKLE EDEMA/ SWELLING OF ANKLES
If it has odor and change in color
As long as proteinuria is not present in the course of
5. NASAL STUFFINESS the edema, we will forget the hypertension
hypertension cause relaxation of the blood vessel,
due to increase estrogen that can cause swelling of vasodilation, venous stasis and increase pressure in
the nasal tissues as well as dryness the uterus that would lead to ankle edema
a. Use Humidifier a. Elevate legs at least twice a day - to relieve
b. Avoid nasal spray and antihistamines edema
b. Wear support stockings - During walking time
Additional Notes: to prevent edema
c. Avoid one position for long periods of time -
Use of humidifier - use it without
can cause spasm or gastrocnemius fail
medications only steam inhalation
d. Avoid Diuretics (Medications that allow to
excrete fluid)
6. FATIGUE Two types of diuretics:
o Loop Diuretics - to eliminate the
a. Frequent Rest Periods fluids in the body
b. Regular Exercise - Which is suited for the o Potassium Sparing Diuretics - the
pregnant mother fluids will be excreted in the body, but
c. Avoid Stimulants the medicine will spare the potassium
7. URINARY FREQUENCY AND URGENCY Additional Notes:
This can happen more likely during the third trimester. Mother is not advised to have a prolong
The more the baby grow the more the urinary standing for this will cause ankle edema and
frequency avoid pressure in the lower tights
a. Increase oral fluid Intake - During the day
only
b. Limit fluid intake in the evening
10. VARICOSE VEINS
c. Void at regular intervals - to avoid urinary
frequency the mother needs to condition its a. Wear support stockings
bladder to have normal interval of urine b. Elevate feet when sitting

38
c. Lying with feet and hips elevated - d. Avoid Laxatives
Trendelenburg position
d. Move out while standing - do note stand 14. SHORTNESS OF BREATH
directly
a. Rest Periods - Common problem in enlarging
e. Avoid pressure on lower legs
fetus especially during the third trimester that
f. Avoid leg crossing
can push the diaphragm upward
g. Avoid standing or sitting in long periods of
b. Elevate Head While Sleeping
time
c. Avoid overexertion - Avoid too much work
h. Avoid constricting clothing
during the day.
Additional Note: 15. BACKACHE
Varicose Veins cannot only be seen in the
due to the exaggerated lumbosacral curvature,
lower extremities but can also be seen
resulting to the enlarging fetus
especially in the pregnant mother to the
causes the waddling walk of the mother
external genitalia
a. Encourage Rest
b. Use Body Mechanics
11. HEADACHES - Ex. Sitting properly
c. Wear low-heeled shoes
Due to changes in blood volume as well as the
- Especially during the 3rd trimester
vascular tone
d. Exercise
a. Change Position Slowly - do not turn directly
- To relieve back pain
to the other side
e. Sleep on firm mattress
b. Apply Cool Cloth at Forehead
c. Eat Small Snack 16. LEG CRAMPS
d. Use Pain Relievers When Prescribed - This
can be an indicator of an increased blood Due to altered calcium intake, phosphorus balance,
pressure to the pregnant mother and pressure of uterus and nerve.
Due to fatigue
12. HEMORRHOIDS If there is frequent occurrence, external use of
aluminum hydroxide gel can be given to the lower
this is enlarged blood vessel that protrudes to the
extremities usually prescribed is Asphodel
annus due to an increase blood pressure or
a. Exercise
constipation
b. Elevate and dorsi flex the feet while resting
a. Warm Sitz Bath - This is a common procedure
c. Increase calcium Intake
in the hospital especially in the surgery
- If the mother refuses milk, use remedy that
department in which the haemorrhoids will be
cause increase of calcium intake like cheese
submerge in a lukewarm water
b. High Fiber Diet SAFETY PRECAUTIONS
c. Increase Oral Fluid Intake
d. Exercise 1. Never exercise to the point of fatigue.
e. Apply ointments/ suppositories as prescribed 2. Always if
slowly with help/assistance with your partner to
13. CONSTIPATION prevent orthostatic hypotension, you can roll over
then push before standing up to relieve abdominal
This is due to decrease intestinal motility and the
muscle of strain.
displacement of the intestine and increase
3. hyper extend
progesterone secretion as well as the relaxation of the
the lower back to prevent muscle strain.
smooth muscle of the intestine the cause the decrease
4.
contractility of the lower GI tract
pregnancy occur.
a. High Fiber Diet
b. Increase Oral Fluid Intake
c. Exercise

39
5. Do not practice stage pushing this may increase LABOR
the intrauterine pressure and could rupture bag of Series of events when the product of conception is
water.
Regular uterine contractions cause progressive
RECOMMENDED EXERCISES dilation of the cervix and sufficient muscular force to
allow the baby to be pushed outside.
1. TAILOR SITTING Usually begins when the fetus is sufficiently mature
and when the placenta reaches its peak of maturity
Sit in this position with the legs parallel so that one
cannot compress the abdominal portion. THEORIES OF LABOR
Help strengthen the thigh and stretches the perineal
muscles. Help in the process of delivery. 1. UTERINE STRETCH THEORY
2. SQUATTING contraction of the uterus would indicate labor begins.
Should be on the floor with feet flat on the floor for
optimum balance. Additional Notes:
Done 15 minutes only per day. To strengthen the
The uterus is a hollow organ when stretch to
pelvic muscles and help during delivery.
full capacity it will necessarily contract as
Done during the 3rd trimester not on 1st and 2nd
well as empty that result in the release of the
because risk of abortion.
prostaglandin hormone.
3. PELVIC FLOOR C
EXERCISE) 2. OXYTOCIN AND PROSTAGLANDIN THEORY
Like expelling urine but holding it in, squeezing the works together to inhibit calcium binding in muscle
muscle of the surrounding the vagina as if stopping cells raising intracellular calcium thus activating
the flow of urine. contractions.
Designed to tighten the muscles of the perineum
during pregnancy. Additional Notes:
This is done during the 3rd trimester
Oxytocin - causes the pressure on the cervix
4. ABDOMINAL MUSCLE CONTRACTION that stimulate the posterior pituitary gland to
release oxytocin that would initiate labor by
The woman will be tightening her abdominal contracting the uterus which will work with the
muscles then relax as if blowing a candle. prostaglandin.
5. PELVIC ROCKING
This is for the lumbar spine to make the spine more 3. PROGESTERONE DEPRIVATION THEORY
flexible and the pain on her back relieved.
a decrease in progesterone causes uterine changes
Hold the position for 1 minutes standing up. Making labor pains occur.
a hollow portion on the back for 1 minutes.
Can be done at the end of the day 5 times to relax
Additional Notes:
back muscles.
Can be done before the 3rd trimester Progesterone is believed to inhibit the
uterine motility, if there is a decrease
Addition Notes: progesterone level it will cause labor already.
Uterine changes that cause labor pain which
Labor is where the uterus starts to tighten
help in the delivery of the fetus as well.
and relax in rhythmic pattern.

40
4. PROSTAGLANDIN THEORY 5. POSITION
prostaglandin stimulates myometrium thus labor onset In Philippines, we use the lithotomy position.
occurs. In other countries and some in Manila, they use the
standing position/water deliver
Additional Notes:
THE PELVIS
It is believed that prostaglandin causing the
interplay between the adrenal glands of the
fetus and the uterus which result in the
production of prostaglandin that will cause
contraction of the myometrium thus labor will
start. Prostaglandin will stimulate the
myometrium and causing the labor process
5. PLACENTAL AGING THEORY
insufficient nutrients to reach fetus, no longer produce

estrogen and progesterone thus, labor begins
Additional Notes:
when the placenta reaches its peak of

performance it also starts to degenerate. The Fig 1: measurement of human pelvis
degeneration of the placenta in a certain age
which is usually 40 weeks our full term AOG Transverse = 13.5 cms
will cause the placenta to decrease its Oblique = 12 cms
function it causes the start of labor. Anteroposterior Diameter = 11 cms
Additional notes:
1. PASSAGEWAY normal range and to compute for the

estimated weight of the fetus if it could be
appropriate for the measurement of the
Includes the cervical canal human pelvis
When you are going to have Cesarean
2. PASSENGER section, the only indication is cephalopelvic
disproportion, which means the baby is too
Fetus and placenta
big and cannot pass through the
3. POWER passageway of the mother because the
passageway of the mother is not
appropriate to the size of baby
ability to push bone cannot stretch already compared to
The very sensation of the mother uterus
Uterus will extend according to the size of
4. PSYCHE the fetus
on
Is the

41
most appropriate for normal delivery
anteroposterior as well as the lateral diameter
enhance the feasibility of the vaginal birth which is
about 50 % unless the baby is too big (macrosomia)
, and the mother having Diabetes Milletus
if the baby is within the normal weight as well as
normal size, it will allow child birth with this type of
pelvis
Heart-shaped pelvis
Fig 2: Pelvis
PLATYPELOID
Broad and flat

it will have any resemblance usual transverse
presentation of pelvis
not appropriate for normal delivery
ANTHROPOID
; opposite of the platypeloid

Resembles the pelvis of the ape according to study
when fetal descend, the posterior presentation on
mothers pelvis is facing towards the mothers front,
which is about 24% deliver of the presentation of
baby
not appropriate for normal delivery
Fig 3: Pelvis ANDROID
Diagonal Conjugate = 9-12.5 cms common to the male pelvis

True Conjugate = 10.5-11 cms inlet is triangular, like a heart shape, laterally narrow
Ischial Tuberosity = 11 cms can cause difficulty in fetal descend, which is about
23% delivery of the fetus
THE CERVIX
Fig 4: different types of pelvis
GYNECOID
Fig 5: The cervix
traditional female pelvis which is best suited for child
birth or the delivery of the baby one of the passageways

42
Vagina is rugated, as the labor progresses it will Fig 7: The pelvis
become thin and the rugae will straighten
When expressed in percentage, the doctor is If the head of the baby is leveled in the ischial spine
referring to the effacement means station 0 (already enter the pelvis)
If it is negative number, it is still above the ischial
spine and if it is positive, it means below ischial
spine
If it in the level of positive 3 or 4 indicate ready to
receive the delivery of the baby.
If it is negative e.g., -5 (baby still floating) the doctor
can tell you can go home and maybe you will
deliver the baby, but it is also depending on the
pushing effort of the mother.
If doctor tell 0 or +3 it indicates GESTATION and if
the doctor tells 70 percent, it indicates
ENGAGEMENT.
Percentage also referring to the thinning of vaginal
Fig 6: Location of an episiotomy. (A) Midline episiotomy. (B) canal.
Right and left mediolateral episiotomies (In the cervix) If the Dr. tell 50% surrogated but as
the labor progresses it will become thin and the
rugae will be straightened it will become as thin as a
is almost out of the external paper
canal of the mother Document the result of the IE and note the
To ease the delivery, the doctors will do some tear or characteristics
surgically cut on either right or left, but it is usually
mediolateral, it is not directly into the anus
Episiotomy will also help to facilitate delivery of fetus
Additional notes:
In figure: the doctor used forceps
ENGAGEMENT
settling of the fetal presenting into the ischial spine

(Express in percentage)
STATION
relationship of the fetal presenting part to the level

of the ischial spine. (expressed in + or and 0 Fig 8: Cephalic presentation
This illustration is -3 and the baby is still floating

inside the womb

43
Site of episiotomy (cutting of the perinium)
a. Median Episiotomy (seldom done by the Dr.)
b. Right Mediolateral
c. Left mediolateral
Additional Notes:
Effacement express in percentage

Bag of water - express if it is ruptured, leaking
or intact
Station - of positive or negative
Dilatation - in cm
PASSENGER
fetus and placenta
o Fetal skull of the fetus is the largest part of the
Fig 9: Cephalic presentation body

o The least compressible of all parts
The presenting part is the head
Single baby o The most frequent presenting part
DILATATION Additional Notes:
Opening of the cervical os Fetal skull/head of the fetus

From 1 cm- 10 cm (fully dilated cervix) - Most common presenting part
Due to uterine contraction and amniotic fluid - Largest in diameter among the body of the
When the baby descends the amniotic fluid fetus
descend also but it already on the cervical internal - Undergoes a molding process during
the bag of water will rupture delivery; goes back to its normal size when
Sometimes it will rupture so the Doctor created an delivered
artificial rupturing which is called as AMNIOTOMY. Molding Process
- Caused by the suture or suture lines of the
EFFACEMENT baby
During delivery, one shoulder will go out first
Thinning of the cervical canal followed by the other shoulder
Expressed in % (100% is a fully dilated cervix) 4 Cranial Bones:
- Temporal
THE VAGINA - Parietal
- Occipital
- Frontal - will be the one to fuse together
VAGINAL CANAL
the bones to allow easy delivery of the
Has a rugae and capable of stretching but can be fetus
lacerated. Anterior Fontanelle
- Diamond shaped indention: will close at 18
a. 1st degree skin months which is equal to 1 year and 6
b. 2nd degree skin and muscles months; also referred to as BREGMA
c. 3rd degree external sphincter of the rectum. Posterior Fontanelle
d. 4th degree mucus membrane of the rectum - Will close immediately after delivery, but
on some cases closes after 3 months
PERINIUM
Outer portion between vaginal canal and rectum

44
Vertex
- Space in between of the anterior and
posterior fontanelle
Vertex Cephalic Position
- Ideal fetus presentation during
delivery
Sagittal Suture Line
- Joined with 2 parietal bones
Lambdoid Suture Line
- Joined by the occiput and parietal
bone
Coronal Suture Line
- Junction between the 1 frontal bone
and 2 parietal bones
Suture Lines
Fig 11: Membrane Spaces
- Are important in birth because they
allow the cranial bones to move and
overlap allowing the head to pass
through the pelvis which we call the
process of MOLDING
Parietal Bone and Eminence
- Checked through the ultrasound if it
can pass through the pelvis of the
mother
Fig 12: The fontanelles
Fig 10: Fetal Skull
Fig 13: Diameters of the fetal head ate term. Cephalic

Presentations and cephalic diameters

45
C. PARTIAL EXTENSION
Brow presentation
Largest diameter (occipitomental)
Presents-13.5cm
D. FULL EXTENSION
Face presentation
Submentobregmatic
diameter presents-9.5cm
GOOD ATTITUDE
Suboccipitobregmatic
Vertex Presentation
Fig 14: Diameters of fetal head at term. Biparietal diameter
FETAL ATTITUDE
The degree of flexion that the fetus assumes
A B C D MILITARY ATTITUDE
Figure 15: Relationship of fetal attitude and the diameter of Occipitofrontal
the fetal skull that presents to the maternal pelvis.
o All the fetuses are in a cephalic presentation and

are exhibiting a longitudinal lie. The
presentations can be further differentiated as
vertex, military, brow, and face presentations,
respectively. Notice the varying degrees of fetal
flexion.
A. WELL-FLEXED ATTITUDE
Vertex presentation
Smallest diameter
Presents-9.5
B. NO FLEXION OR EXTENSION
Military presentation POOR ATTITUDE

Occipitofrontal diameter
Partial extension
presents-11cm
Occipitomentum
Brow presentation

46
POOR ATTITUDE PRESENTATION
Body parts that will first contact with the cervix
Full extension
Submentobregmatic 1. VERTICAL CEPHALIC PRESENTATION
Face presentation
The baby will be Vertex (Full Flexion)
when the bag of water (BOW) will rupture, tendency
is the baby will come out having difficulty in
breathing because the airway is blocked with the
amniotic fluid
When the baby is out, wipe the face of the baby first
before the body
Fig 16: Fetus in full flexion presents smallest

(suboccipitobregmatic) anteroposterior diameter of skull to
inlet in this good attitude.
Sinciput (Moderate Flexion [Military Attitude])
FETAL LIE
Relationship of the long axis of the fetus to the long
axis of the mother
Fig 17: Fetus is not well as well flexed (military attitude) as
in A and presents occipitofrontal diameter to inlet (sinciput
presentation)

47
Fetus In Partial Extension (Brow Presentation) Footling Breech
Fig 18.
Face Presentation
Fig 21. B
Complete Breech
Fig 19.
2. VERTICAL BREECH PRESENTATION
Frank Breech
Fig 22. C
Fig 20. A

48
Transverse Presentation BREECH-BREECH PRESENTATION
Both are breech.
Fig 23. D
Additional Notes:
Figure B Can be delivered normally by

inserting the foot back and push again
together with the pushing force of the
mother. CEPHALIC-TRANSVERSE PRESENTATION
Figure C & D
delivery, it should be delivered via cesarean The other one is cephalic, as the other is transverse.
section.
CEPHALIC-CEPHALIC PRESENTATION
CEPHALIC-BREECH PRESENTATION

49
BREECH-TRANSVERSE PRESENTATION
The other one is breech, as the other is transverse.
Fetal Landmarks:
o Occiput - vertex/cephalic presentation (O)
o Mentum - chin/face presentation (M)
o Sacrum - in breech presentation (Sa)
o Acromion - scapula/shoulder presentation (A)
Fetal Position (represented by 3-letter abbreviations):

o 1st letter - L (left), R (right),
4. TRANSVERSE-TRANSVERSE PRESENTATION o 2nd letter - fetal landmarks
o 3rd letter - A (anterior), P (posterior), T (transverse)
Both are transverse.
METHODS TO DETERMINE FETAL POSITION
LEOPO
are methods to determine position, presentation, and

engagement of fetus
o First Maneuver
- to determine presenting part at the fundus
- head is more firm, hard, and round that moves
independently of the body
- Breech is less well defined that moves only in
conjunction with the body
o Second Maneuver
- to determine fetal back
- one hand: will feel smooth, hard resistant
surface (the back)
- the opposite side, several angular
nodulations (knees and elbows of fetus)
POSITION
o Third Maneuver
Position of the fetal presenting part to the specific - to determine position and mobility of presenting
part by grasping the lower portion of the
Divided into Four Quadrants: abdomen (just above the symphysis pubis).
o Lower Right Quadrant - if the presenting part moves upward so the
o Lower Left Quadrant
o Upper Right Quadrant presenting part is not engaged
o Upper Left Quadrant

50
o Fourth Maneuver PRESENTATIONS
- to determine fetal descent
- fingers are pressed in both side of the uterus Positions for labor and birth
approximately 2 inches above the inguinal
ligaments, then press upward and inward.
- the fingers of the hand that do not meet
obstruction palpates the fetal neck, as the
fingers of the other hand meet an obstruction
above the ligaments palpates the fetal brow.
- Good attitude if brow correspond to the side
(2nd maneuver) that contained the elbows
and knees.
- Poor attitude if examining fingers will meet an
obstruction on the same side as fetal back
(hyperextended head).
-
If brow is very easily palpated, fetus is at
posterior position (occiput pointing towards
Additional Notes:
Left Occiput Anterior
IE/ Vaginal Exam - are usually carried - means your baby is entering your pelvis head down,
out after a contraction finishes and facing the area between your spine and right hip.
when the woman says she is ready.
Auscultation of FHT - is performed by
external or internal means.
Sonography (USD) - the analysis of
sound using an instrument which
produces a graphical representation
of its component frequencies.
Another term for ultrasound.
Right Occiput Anterior

-
side than on her left side. In other words, the back
towards the roomy sciatic notch in the back left of

her pelvis.

51
Left Occiput Posterior
- has the
Left Occiput Transverse back.
- is an
on your left.
temporarily and back to the left.
could be on your upper left until baby is large
enough for the spine to reach up and curl to the
right.
Right Occiput Posterior

- baby is head down and the back is to the side- the
right side. ROP is the most common of the
four posterior positions.
Additional Note:
Right Occiput Transverse
- is when the baby enters the pelvic brim completely The ROP baby may need a longer time
sideways, facing the left hip of the mother. It is head for fetal rotation in labor.
down, with the baby facing sideways.

52
Direct Occiput Posterior
- is the classic posterior position with the baby
facing straight forward. A head-down position of
the baby facing your abdomen (and not the back)
REFERENCES
I. Notes from: Mrs. Atillo

II. Power Point Presentation

53
THE PLACENTA
OUTLINE
I. III Power
II. Difference Between False and True Labor
III. Preliminary Signs of Labor
IV. Stages Of Labor
V. First Stage of Labor
VI. Nursing Care During The 1st Stage
VII. When To Position Patient for Delivery
VIII. Cardinal Movements or Mechanism of
Labor
IX. Nursing Care on 2nd Stage A. UTERINE CONTRACTION
X. Head Is Visible
XI. Crowning Different monitoring of the contractions: Hand above
XII. Easing The Head Out abdomen. Facing the clock.
XIII. Assist In the External Rotation
o Increment rise of the abdomen and it will
XIV. Initial Suctioning of Mouth and Nose
XV. Deliver The Shoulder harden
XVI. Deliver The Body o Acne Peak hardening of the abdomen
XVII. Clamping And Cutting the Umbilical Cord o Decrement - Relaxing of the hardened
XVIII. Thorough Suctioning of The Newborn abdomen then goes down
XIX. Deliver The Placenta
XX. Third Stage of Labor TERMS:
XXI. Nursing Care During 3rd Stage
XXII. Nursing Care During 4th Stage Duration the beginning of one contraction up to the
end of the same contraction and is expressed in
seconds.
- In early labor, dilation takes 20-30 seconds, in
1. PLACENTAL SEPARATION late labor/about to delivery it is 60-70 seconds
but not more than 90 seconds, if it exceeds
a. Calkin Sign/ Globular Sign of The Fundus that will cause uterine rupture.
b. The Fundus Rising in The Abdomen Frequency - The beginning of one contraction up to the
c. Sudden Gush of Blood beginning of another contraction.
d. Lengthening Of the Cord Intensity the strength of the contraction which is
measured by the consistency of the fundus to the peak
2. PLACENTAL DELIVERY of the contraction, if it is in the increment, it is called mild
and when reached the peak it is very strong. Check for
a. Duncan delivery
the increase or rise of abdomen, how hard at the peak.
b. Schultz delivery
If abdomen is as hard as the forehead, it is the peak of
III. POWER the contraction, if as soft as your face it is still in the
Pushing effort of the mother that help the fetus the fetus increment phase. Expressed in mild, moderate, or
itself. Supplied by the fundus of the uterus that are strong.
implemented by the uterine contraction. Intervals end of one contraction to the beginning of
It is the process that causes cervical dilatation, which is the next contraction and is expressed in minutes. In
early labor, takes 40-45 min, in late labor, takes 2-3 min.
expressed in intensity and centimeters as well, it will be
followed by the expulsion of the fetus from the uterus. Electrical Fetal Monitoring (EFM) connect to the
After a full dilatation the primary power is supplemented patient, where doctors look for the monitoring, not
using the abdominal muscles. The mother should not taught to students.
bear down with their abdominal muscles until the cervix
DIFFERENCE BETWEEN FALSE AND TRUE
is fully dilated.
LABOR

FALSE LABOR 4. BRAXTON H
Irregular interval contractions irregular intermittent contraction that occurs

Pain in the abdomen throughout the pregnancy without pain.
Intensity remains in the same
Intervals remain long 5. RIPENING OF THE CERVIX/CERVICAL
Walking gives relief CHANGES
No bloody show
cervix becomes soft, described as butter soft. As the
No cervical changes AOG reaches its peak, the collagen fibers are broken
Contractions stop with sedation
bind together decrease while the water content
TRUE LABOR
increases.
Regular interval of contractions
6. RUPTURE OF THE MEMBRANES
Starts at the back to abdomen
Contractions are intensified
Intervals gradually shorten]
Intensified by walking 7. BLOODY SHOW
With bloody show Cervical dilation and effacement
discharges of the mother that is sticky with blood.
Does not stop with sedation
Within 24-38 hours labor will begin. The descending
PRELIMINARY SIGNS OF LABOR of the presenting part causes pressure on the pelvis
and cause rupture of the minute capillaries.
1. LIGHTENING SIGNS OF TRUE LABOR
Setting/descent of the fetal presenting part into the

pelvis. Lightening for primi mothers, will take for 10- UTERINE CONTRACTIONS
14 before labor begins. For multi-para it will take not
Will help the dilation of the cervix
more than 10 before labor begins.
During it, there will be engagement the presenting EFFACEMENT
part has descended to the pelvic inlet, causes
vaginal discharges by congestion of the vaginal shortening and thinning of the cervical canal
mucous membranes, as well as pelvic pressure. expressed in percentage (fully effaced cervix 100%)
Urinary frequency increases as well. Patient will Seen during IE
complain of shooting leg pains due to the increase
pressure of the sciatic nerve. DILATATION
About 38-40 weeks the abdominal contour
descends, and the mother will be relieved of the Opening of the cervical os from 1cm-10cm (fully
abdominal tightness and diaphragmatic pressure. dilated cervix)
Dilation for the primi mothers, it first effaces then it
2. LOSS OF WEIGHT dilates, for multi gravid, it first dilates then effaces.
occurring 1-2 days, will lose weight before labor. Due UTERINE CHANGES
to the increase progesterone production that led to
decrease fluid retention. Upper uterine segment
Lower uterine segment
3. INCREASE IN ACTIVITY LEVEL
related to the increase in epinephrine which is

released when there is a decrease in progesterone
level produced by the placenta. Causes mother to be
active. But mother has fatigue in the previous month.
Encouraged the mother to have much rest.

- Time where you can ask for data from the
Additional Notes: mother.
During this time the uterine contraction is the surest - Upon admission, get the personal data. Ask
sign that labor has begun already, or the initiation what last name the baby will use. Ask of the
of the effective and productive uterine contraction. obstetrical data.
Accompanied by pain during uterine contraction - Check for the bloody show.
which results in contraction of the uterine muscle - Do the physical examination by the doctor and
when it is in ischemic stage there is an inadequate
blood flow to the organs particularly the uterus there - Take down notes and assist doctor for the IE.
is pain because of the pressure of the nerve in the - Gestation is more of negative but less than 3
cervix as well as the lower uterine segment. or 4
Pain also because of the stretching of the ligaments - Check for the position
that are adjacent with the uterus and the pelvic - Monitor and evaluate the aspects of labor like
joints. Ligaments are the one that hold the uterus in the contractions, blood pressure as there
place but if there will be contraction causing might be an increase and BP not taken when
stretching there will be pain experienced. there is uterine contraction
The stretching and the displacement of the tissue of - There is an increase blood pressure during
the vulva and perineum will also cause pain to the contraction because of the increase pressure
mother. on the peripheral blood vessels that would
increase the blood of the client.
- f there is contraction. Check
PHYSIOLOGICAL RETRACTION RING every hour if no contraction (120 is the normal
FHT, lower than 120=fetal bradycardia, above
Formed and is a boundary of the upper and lower
160= fetal tachycardia) if the FHT is high turn
uterine segment. The upper becomes thick and
the mother in the left lateral. There is also
active to expel out the fetus during labor lower
Fetal thrashing for fetus moves most of the
becomes thin and pressure will increase so that the
time because of lack of oxygen.
fetus can be push out easily to the cervical opening
- Make mother take a bath.
of the vagina.
- Encourage ambulation or walking as it helps
STAGES OF LABOR the descent of the baby unless the water is
ruptured.
- Mother encouraged to defecate before and
FIRST STAGE DILATION STAGE avoid solid foods.
- Mother encourage to urinate before or have an
Will begin with true labor contractions and with the empty bladder 2-3 hours before.
complete and full dilatation of the cervix 10cm which - Promote relaxation after each contraction.
is the longest stage of labor for about 6-12 hours. ACTIVE PHASE
Characterized by rhythmic and forceful contraction - The mother is already in an accelerated phase
as well as the rupture of the amniotic fluid or sac and - The cervix is already at 4-7 cm dilated which is
the cervical dilatation. almost fully dilated.
- Mother is usually having increase duration in
LATENT PHASE contraction as well as the intensity, and
- This is the early time in labor which is 3-4 cm frequency, intensity is moderate
cervical dilatation. - Mother is afraid of losing herself for the pain is
- Dilation is minimal as effacement is occurring also increasing
- Contractions are of short duration which occur -
regularly about 15-30 min apart then 15-30 but let them use the hand grip
sec duration with mild intensity of contractions. - Monitor closely with the contraction as well as
- Where the pregnant mother will seek hospital the FHT, check for every 30 min
attention, with some excitement and some - If there is severe pain, give analgesics if
degree of apprehensions. The mother can still ordered by doctor to relieve patient but not
communicate with others given at latent phase.

- Check the circulation of the mother like the NURSING CARE DURING THE 1ST STAGE
nails. 1. Admission care
- If the mother experience spinal headache due 2. Data gathering
to anesthesia, make the patient lie flat on bed 3. Assisting in IE
and increase fluid by IVF if not it might cause 4.
hypotension if already hypotensive put the 5. Fetal heart tine (FHT) Monitoring
legs upward. 6. Uterine contraction Monitoring
TRANSITIONAL PHASE 7. Promote change on position
- Check for the FHT every 15 min 8. Empty Bladder
- 8-10 cm dilation 9. Hygiene
- Where the baby is already out 10. Enema administration
- Mother is resting 11. Perineal preparation
- When the woman has changes 12. Analgesic administration as ordered
- Doctor might rupture the fetal membrane by 13. Assist in the administration of regional anesthesia
amniotomy then bloody show becomes 14. Start with IVF as ordered
prominent. 15. Assist in amniotomy
- Mother will experience profuse sweating. 16. Watch out for SUBIRBA
- Should be 10 contractions when letting the 17. Emotional support
baby out.
- Let the mother control breathing.
SECOND STAGE FETAL EXPULSION STAGE
Complete dilatation of the cervix to deliver the

infant.
Instruct the mother to push with the abdomen and
not with the neck.
THIRD STAGE PLACENTAL STAGE
FOURTH STAGE RECOVERY
WHEN TO POSITION PATIENT FOR DELIVERY?

S Severe uterine contraction
U Urge to defecate
B Bearing down sensation
I Increase bloody show
R Ruptured Bag of water
B Bulging of the perineum
A Anal dilation

CARDINAL MOVEMENTS OR MECHANISMS OF 3. Drape aseptically
LABOR 4. Teach breathing technique during uterine relaxation
During labor, the assigned passage of the fetus will 5. Teach pushing technique during uterine contraction
happen 6. Assist episiotomy
7.
8. Ease head out, wipe face and do initial suctioning
D = DESCENT 9. Wait for external rotation
10. Pull head downward and upward to deliver the
Stations of the presentation causing fetal head to shoulders
move downward, if downward movement of the 11. Deliver the body
biparietal diameter of the fetal head in pelvic inlet of 12. Take note of time of delivery and sex of the baby
the mother, the head is engaged which is aided by 13.
abdominal muscle contraction, when the mother 14. Palpate for the pulsation of the cord if pulsations
contract, the head of baby will go down to the inlet stop.
15. Clamp the cord 1 inch using plastic clamp from
F = FLEXION
When already descended in inlet, knee is touching 16. Milk the cord at least 2 cms towards the vulva
the chest of the fetus, if it descended and reached 17. Clamp with a force
the pelvic floor, the head will bend 18. Cut the cord between the 2 clamps but should be
near the plastic clamp
the anteroposterior diameter of the presented part is
already at the birth canal MANUAL SUPPORT OF THE PERINEUM
I & R = INTERNAL ROTATION
aided by the abdominal muscle contraction, during

the pushing effort of the mother
extension Beginning (rotation complete)
E = EXTENSION
extension complete
rotate of baby, the head will go out
external rotation extension as the occiput is born, the
back of neck is stop beneath the public part, and act
as a pivot for the rest of the head
E & R = EXTERNAL ROTATION

external rotation (restitution)
external rotation (shoulder rotation)
allowing the 1st shoulder to come out, followed by
the other, then the body
E = EXPULSION
when both shoulders are out of the inlet already, you

must be watchful because it is slippery with the
RBOW (Ruptured Bag of Water)
BOW = will also aid in the expulsion of the fetus, like
a lubricant
NURSING CARE ON 2nd STAGE

1. Lithotomy position
2. Perineal flushing

CROWNING
to identify the labia minora and majora because it

traumatizes.
EASING THE HEAD OUT

Use the head of the baby so that it could get out
through pushing the back and to take out the face of
the baby because we need to wipe it first to remove
the membrane.
HEAD IS VISIBLE
This is the +3, in which you can see the head of the
baby.

DELIVER THE BODY DELIVER THE SHOULDER
Wipe the face of the baby when you can see its The doctor holds the umbilical cord of the baby then
head to allow the baby to breathe the doctor will cut the umbilical cord first so that the
baby will not be deprive of oxygen
INITIAL SUCTIONING OF MOUTH AND NOSE DELIVER THE BODY

The rubber suction will be deflated first then insert to Upon the delivery of the baby, it is the nurse duty to
the nose of the baby to remove the secretions that check the apgar scoring to assess the color of the
accumulate to the nose to allow the baby to breath baby from the face and body
The white part in the head of the baby is called the
vernix caseosa this is for the maintenance of the
temperature of the baby.
When the baby is already out and cry this is an

indication that the lung of the baby is already
functioning however if the baby did not cry the nurse
needs to stimulate the back through massaging it.

CLAMPING AND CUTTING THE UMBILICAL CORD DELIVER THE PLACENTA
When the baby is out it is already in its second stage
of labor expulsion. The baby is still connected to the
mother through the umbilical cord, so we must cut it
by clumping it first by two inches above the umbilical
cord.
Pulsate the umbilical cord first before clumping it, if
there is no pulsation that is the time the nurse can
clump it with the opposite side is clamp with the
forceps instrument while the other side is being
clamp by the cord clamp then cut at the center of the
cord clump and the forceps
The third stage is the placental expansion at this time
the student nurse will monitor the sign of fatal
expansion
Signs of Placental Separation
- If the uterus becomes firm or it is in a globular
shape also known as
- Uterus rises above the abdomen
- Sudden gush of blood
- Lenghtening of the cord
3rd STAGE OF LABOR (PLACENTAL STAGE)
1.PLACENTAL SEPARATION (SIGNS)

a. -uterus becomes globular and firm
b. Uterus rises above the abdomen
c. Sudden gush of blood
d. Lengthening of the cord
Additional Notes:
Need to coil the cord to forceps and

slowly pull gently and catch it with a
THOROUGH SUCTIONING OF NEWBORN basin
When it was delivered observed
whether the maternal or fetal side of the
placenta
When Maternal side that comes first we
called it as a DUNCAN DELIVERY OF
PLACENTA
when fetal side comes first, we called it
as SCHULTZ DELIVERY
2. PLACENTAL DELIVERY
Schultz Delivery fetal, shiny

Duncan Delivery maternal, dirty, rough

You need to open the (A). and check if the
cotyledons is complete. You need to palpate area in
(B) if there is hollow part or any unsualities. If there
is no hollow portion you need to declare to the
doctor that the cotyledons in the placenta is
complete.
During the expulsion of the placenta the nursing
care is do not pull or focibly pulling the cord just wait
to placenta to separate fom the uterus of the
mother. Nurse need to massage the abdomen and
do the wil help in expulsion
of the placenta.
Coiling of the cord is what we called BRANDT-
ANDREW MANUEVER. Do the rotating motion or
coiling of the cord to prevent the cord to dangle on
floor.
Do contiounous massage on the abdomen after the
expulsion of the placenta to help the uterus to
contract. If the doest contract after the expulsion of
the placenta the mother will remain bleeding and
might cause hemmorhage.
Additional Notes:
During the suturing you need also to observe

the degree of laceration
a. 1st degree involves only the vagina
and the skin
b. 2nd degree involves the vagina, skin,
and muscles
c. 3rd degree involves the vagina, skin,
muscles, and the external sphincter
of the rectum
d. 4th degree involves the vagina, skin,
muscles, external sphincter of the
rectum, and mucus membrane of
the rectum
A. Episiorrhaphy - repair of episiotomy
Do perineal care before putting sanitary pad
(adult diaper) then place the flat on bed with
a pillow to prevent dizziness. Dizziness will
occur due to the decrease intra-abdominal
pressure.
Observe the vital signs continuously. First
hour is Q15min, second hour is Q30min, and
third hour is Q1hr and until the patient will be
stable before transferring into a room
B. The first 4 hours is crucial stage of recovery
of the mother
Figure 1. A healthy placenta after delivery.(A). Notice the
shiny surface of the fetal side. The umbilical cord is inserted
in the center of the fetal surface. (B). The maternal side is
rough and divided into segments (cotyledons).

NURSING CARE ON 3rd STAGE NURSING CARE ON 4th STAGE
1. Wait For Signs of Placental Separation 1. Assess fundus
2. 2. Check for bleeding
3. Manuever 3. Check the bladder
4. Gently Pull the Placenta Downward 4. Check the perineum
5. Take Not for The Time of Placental Delivery 5. Take vital signs every 15 minutes
6. Check For Type of Placental Delivery: 6. Promote rest
7. Take BP
8. Check For Completeness of Cotyledons
9. Promote Uterine Contraction:
- Massage The Hypogastric Area REFERENCES
- Apply Ice Pack on The Hypogastric Area
- Administer Medication: Oxytocin/Maleate I.
- Empty The Bladder II. Power Point Presentation
10. Inspect Perineum for Lacerations
11. Assist In Episiorrhapy
12. Do Perineal Care
13. Apply Contoured Brief/Adult Diaper
14. Make Patient Comfortable

NEONATAL PERIOD
crying and is cyanotic, baby should be placed in the
incubator , you have to check the incubator if it is
properly prepared with the water before you set the
OUTLINE
machine, temperature should be warm and not 1st
degree heat
I. Neonatal period
II. Score interpretation
3. PROPER IDENTIFICATION
III. Molding
IV. Mongolian Spots name bond = boy = blue; girl = pink., you can find the
V. Milia
portion and pediatricians name for follow up and time
of delivery, in SPC = name bond composed of name
of baby, time and date of delivery, mother and
1. AIRWAY doc name
wipe mouth and nose footprints = not taken in some hospitals, but usually
suction = done only if it is needed taken both right and left foot because through the
footprint we will also identify if the bb is with
stimulate to cry = if the baby will not cry when you put
abnormalities, if 1 crease in foot, indicatory of down
it at the abdomen of the mother, massage the back
syndrome bb
portion in a circular motion to stimulate the lungs to
function, first cry of the baby is an indicator that the 4. CARE OF THE CORD
lungs of the newborn is already prepared to function
after the cry, cry = inflate lungs, need to assess milking the cord = this is done during the delivery
immediately, APGAR scoring in 1 min after delivery cord dress aseptically = cord dressing is done after
and 5 min after delivery = twice to assess delivery, done at the nursery, or sometimes if it is
oxygen administration = if the bb is not crying, that is cesarean section, within the OR (has warmer) itself
the time to and resuscitate the baby into the warmer
and put oxygen 5. CARE OF THE EYES
hook to respiratory machine = if it is badly needed,
look at the general color of the baby, if the baby is crede's prophylaxis (prevent ophthalmia neonatorum
crying and pinkish then the nailbeds are okay, so the from the inner to outer canthus) - terramycin =
baby will adjust with the external environment, baby medication is place per head (sariling gamot), found
will undergo abrupt changes when out, the baby has at the crib, during delivery, there are some
difficulty to adjust so we have to observe microorganisms that is present in the canal of the
mother which causes infection of the eyes,
2. TEMPERATURE prophylaxis is an advanced action to prevent
microorganisms, medication to prevent infection
dry the baby from occurring
wrap with towel = layette
goose neck lamp = since the DR is airconditioned, 6. VITAMIN K INJECTION
the baby has difficulty to adjust so we have to place
the baby under goose neck lamp, vernix caseosa = using phenytoin or the konakion even on the
anterolateral portion of the bb
white substance found in the head (prominent) and
body, will not be removed because it will help in the 7. NEWBORN ASSESSMENT
maintenance of the temperature of the newborn right
after delivery, it will just melt in the body APGAR scoring - done on the after 1 and 5
avoid unnecessary exposure = when getting the minutes of life
temperature, we have to do it faster. we have to do
the vs faster assessment because sometimes the status of bb is
place inside incubator = if the bb need to place in the deteriorating
incubator, if not, you can place the baby in the baby
screen, there is crib in the nursery, baby will be put

0 1 2
Heart rate Absent <100 >100 - The knees (lower extremities) must be straightened
RR Absent Slow/irregular Good cry when measuring
Muscle Absent/limp Some flexion Active - Put the baby on the crib
tone - Zero point is from the heel going to the head
reflexes No grimace Cry - When measuring the head, the tape should be in
response line with the eyebrow.
color Blue/pale Acrocyanosis All pink
Score Interpretation 9. VITAL SIGNS
o 0-4 = POOR (in serious danger and needs
resuscitation) Heart rate = 120 160 bpm
o 5-6= CONDITION IS GUARDED (may need Respiratory = 40 60 bpm
airway clearing and Oxygen), Temp(rectal) = 36 37.6 C
= (we can put the baby in the incubator)

Additional Notes:
o 7-10 = GOOD (newborn is doing well)
Rectal temperature must be taken upon
8. ANTROPOMETRIC MEASUREMENTS the initial temperature to check if there is
a rectal opening
Birth weight = 2.5 3.5 kgs Anal Imperforate - no hole in the anus of
Length = 45 55 cm the baby
Head circumference = 32 35.5 cm
Chest circumference = 30-33 cm
Abdominal circumference = 28 30 cm
Additional Notes:
the baby and put it on the mother chest or above

the abdomen for 90 seconds (or 1 hour and 30
mins????). Also take the baby weight with no
clothes
Also used a tape measure
Hydrocephalus - enlargement of the head
Chest circumference is in lined with the nipple.
Fig 2: Measuring the size ,head and chest of the baby
Abdominal circumference - above umbilicus of
the baby - When measuring the size of the baby the zero point
Report findings on staff nurse on duty. of the tape measure should be at the heel of the
baby going to its head
- When measuring the head, the tape measure
should be in line with the eyebrow
- The chest circumference should be in line with the
nipples
- To facilitate an easy delivery, the suture will mold
to allow the head to become small so that the baby
will come out then followed by the rest of the body
10. HEAD TO TOE ASSESSMENT

A. Head
Moldings
Fontanels
Fig 1: How to get Anthropometric Measurements

Caput succedaneum (bulging
the pressure in delivery)
Cephalhematoma (Discoloration in the head D. Abdomen = check the umbilical cord if it has foul
of the baby) odor
Suture Lines
jelly or the 2 arteries and vein
Anencephaly (The baby has no skull)
If the scoring of the baby is low or poor, the
doctor will insert the umbilical catheter into the
Additional Notes: umbilical vein. The doctor will also use the cut
umbilical cord of the baby for emergencies like
Molding will automatically close and return
for when the baby is premature.
into its position after the baby will be
Gastroschisis absence of abdominal wall
delivered
The head is the biggest part of the newborn
E. Genitals = should void within the 1st 24 hours
The posterior fontanels will close after the
delivery but in some cases, it will close in
voiding there is something with the baby
three months. While the anterior fontanels
which is a diamond shape will close at 18 Pseudo Menses is normal, blood coming out
months or 1yr and 6 months of the external genitalia, which is also
Check the suture lines if it returns in its temporary
position after the molding testes should be descended (Cryptorchidism
Anencephaly - The skull of the baby does undescended testes)
not form during the development which is preterm male has less rugae in scrotum, thin
caused by deficiency in vitamins. This is one rugae
of the disorders that can be seen during the labia minora is prominent
alpha fetoprotein examinations
F. Extremities = flexed
Creases on the palm (Simian Crease only
B. Face one crease)
Blink reflex Polydactyl extra toes or fingers
Strabismus Syndactyly webbing of fingers
Ears should be even or above outer eye Amelia absence of upper extremities,
canthus because of teratogens ingested by mother
during labor.
Topophilia absence of lower extremities
clubfoot
G. Skin = color
Mongolian Spots seen at the butt
Vernix Caseosa - white cheesy substance that
is present during delivery that help control
temperature
Lanugo fine hair, can be found on the
shoulder, thigh, except the lips, and ear.
Milia white spots
Fig 3: Molding with suture line
C. Chest = witch milk

On the breast of the baby, but is temporary

Fig 4: Mongolian Spots
Fig 5. Milia
REFERENCES
I.
II. Power Point Presentation

4TH STAGE OF LABOR-PUERPERIUM: sleep, and other areas to be monitored. It identifies
the needs, potential problems and treat possible
complications.
OUTLINE
PREVENT POSTPARTAL COMPLICATIONS
I. 4th Stage of Labor-Puerperium
II. Principles If Puerperium Nurses and other health members must be alert to
III. Post-Partum Assessment (AV any findings that area different or unusual such as
BUBBLEHER)
bleeding and infections because they may indicate
IV. RH Incompatibility
another problem. The nurse uses vigilance to apply
V. Physiology Of Milk Production and
Ejection nursing knowledge and implement the informed
VI. Proper Attachment and Proper Positioning nursing actions
VII. Different Position of The Baby While
Breastfeeding ESTABLISH SUCCESSFUL LACTATION
VIII. BREASTFEEDING
IX. Common Post-Partum Complications Breast feeding has been established with optimal
X. Nursing Interventions method and decision of breastfeeding must be done
by the mother herself. Based on what pleases the
XI. Source Of Infection
mother and what makes the mother feel
comfortable in both the mother and the baby will
benefit from the experienced. It is supported by the
PUERPERIUM/POSTPARTUM PERIOD Republic act 7600 which known as the rooming in
and breast-feeding act of 1992, wherein the
6 week period after birth mothers are motivated to do breast feeding. This
act is amended by the Republic act 10028 which is
INVOLUTION an expanded breast-feeding program act of 2009.
Its executive order is the executive order 51, which
reproductive organs return to its non-pregnant state is the milk code. This comes out previously from
different companies or manufacturer of milk will give
SUB-INVOLUTION sample to post-partum mothers. Because of the
failure of the reproductive organ to return to its non- executive order companies are not allowed to give
pregnant state, especially the uterus sample. Even though the milk of the mother comes
out 3-4 days after delivery, it is still encouraged to
EXFOLIATION do breast feeding of the sucking of the baby which
increase the milk production.
placental site heals by scaling off of dead tissues
MOTIVATE USE OF FAMILY PLANNING METHOD
ATONY
Encouraged to have natural family planning. but for
uterus does not have good muscle tone and public hospitals they use implants which stays for 3
consequently relaxes, because uterus is expected years unless wanted to extend can be replaced on
to be contracted, If it is relaxed it will feel baggy the 3rd year.
when palpating the abdomen and could cause post-
partum hemorrhage. PROVIDE EMOTIONAL AND PSYCHOLOGICAL
SUPPORT
PRINCIPLES OF PUERPERIUM
Fulfilled through the rooming in and breast feeding.
Now we have the kangaroo breast feeding wherein
the father is the one with the skin to skin contact
PROMOTION OF HEALING AND PREVENTION OF with the baby. The first 3 months after birth are
ILLNESS recognized as the vulnerable emotional period of
the mother. The time that there are rapid hormonal
The nurse can promote maternal well-being by
changes so even for the first several days there are
closely monitoring the uterine status, VS,
changes in emotion. Since there is changes it will
cardiovascular status, elimination patterns, rest and

give rise to emotional and psychological problems - Dehydration/effort in labor
for post-partum mothers. Where the blues are - It is expected after labor.
experienced which is are treated with support. The - Mother placed in NPO
time to tell the mother and significant other and that After 24 hrs infection, examine from head to toe
she will have mood swings. Encourage to do again because it is not normal.
activities to alleviate blues or to let the blues pass - If there is engorgement place warm compress
without the mother even knowing. - Check for the perineum of the mother if there are
any infection because of the cut but also check
Additional Notes: for any discharges found on the perineum.
- Nurses has only little time to check for NSVD
Mostly mothers feel roller-coaster of emotions after patients because they are discharged after
delivery, and these feelings can stem from different 24hrs
influences and are often linked to perceptions After 3-4 days Milk production
concerning the fulfillment or expectations
surrounding the childbirth. The first 4 hours is the Pulse
most crucial stage of the mother this is the time
where the vital signs are unstable that is why Decreases due to decrease cardiac output
during the first four hours the student the nurses - normal range is 80-90 bpm
will closely monitor the client
Blood pressure
Q 15 for first hour
Q 30 for the second hour Slightly decrease because of the estimated blood
Q hour until the succeeding hour until stable. loss of 200-500 ml. Expect for lower blood pressure,
check the before and after blood pressure.
POST-PARTUM ASSESSMENT (AV BUBBLEHER) - if it increases it possibly is hypertension
- normal range is 120/80
A Appearance
Respiratory rate No changes
V Vital signs
BREAST
B Breasts
Drop in estrogen and progesterone excreted
U Uterus during pregnancy
Lactating breast are preparing for lactation
B Bladder
Colostrum is present
B Bowel Let-down reflex happens during the sucking
process
L Lochia Warm and tender
E Episiotomy/Episiorrhaphy Engorged
Milk produced by the 3rd 4th day
H Veins are apparent
E Emotion Additional Notes:

R Rhogam Undergoes changes for the preparation of lactation.
observe the nipple if cracked or not for it is nipple
APPEARANCE when breast feeding
Before allowing feeding to clean the nipple with
plain water
eyes or the head to toe assessment.
baby can still suck even the nipple is inverted but let
VITAL SIGNS it protrude first by letting the mother stimulate it by
herself, use of rubber suction or letting the father
Temperature suck it.
Increase on the 1st 24 hrs

UTERUS FUNDAL HEIGHT POST PARTUM
Undergoes drastic changes, rapid drop-in rate and

size
Size is reduced:
- Immediately after delivery 1000 gms
- After end of 1st week - 500 gms
- After 6 weeks - 50 gms
- After delivery contour of the abdomen returns to

normal as the uterus returns to its
non-pregnant state.
- can palpate the uterus in the abdomen in line with
the umbilicus
-may appear slightly larger
-palpate the lower quadrant form left to right if it is still
hard.
- allow the mother to urinate to allow the uterus to
return to the center
You can still palpate the uterus after delivery
Placental site is sealed off
Right after delivery it will contract and can be
Cervical os are narrowed
palpated between umbilicus and symphysis pubis
-every day the fundus will slowly lower until it
reaches normal and it moves in 1 finger size every After that it will rise mostly at the level of umbilicus
day. Everyday it will go down1 finger line until on the 9
-if it deviates let the mother urinate to let it return to days until you cannot palpate the uterus because it
center. is already in the level of symphysis pubis (already
-it should not be relaxed for it will feel baggy and inside the pelvis
cause hemorrhage and let it be contracted.
BOWEL
- Uterus firm and located at midline and follows the
process of involution. Becomes more active soon after birth (gastric
-fundus remains contracted during massage. motility will increase or will become active and since
-massage the abdomen to contract uterus or apply the mother is on NPO during active labor the
ice bag onto the hypogastric area or fundus to allow mother not expected to defecate after delivery)
the uterus to contract. Peptide hormone relaxin, - high circulating levels
-if it is still relaxed let the mother tickle their nipple during pregnancy, depresses bowel motility (and
to let oxytocin be secreted which help in the causes constipation)
contraction the uterus. Continued effects of progesterone on the smooth
muscles decreases bowel motility
Additional Notes: Bowel movement typically delayed until 2nd or 3rd
puerperal date
After labor/delivery it should be between the
Bowel tone is slowed
umbilicus and the symphysis pubis but
During labor, restriction of food
eventually grow up until 9 days where it
Fear of tearing stitches

Additional Notes: EPISIOTOMY
Regardless of activities the nutrition of the post- - Cut of perennial Midline or mediolateral to facilitate
partum mother is important throughout the delivery of the baby. Use also ritgen maneuver.
Right after the delivery as soon as the mother is - Lacerations
FULLY awake, she can already have her meal 1st degree skin, mucus membrane
(DAT) unless there is contraindication 2nd degree skin, mucus membrane, fascia
Assessment technique is AUSCULTATION and 3rd degree skin, mucus membrane,
normally should have normal bowel by the second muscles, and rectal sphincter
or third day after delivery. 4th degree involve all these structures plus
anal wall
NURSING Responsibilities is to encourage fluid
intake and high fiber and ambulate the mother this Assessment
will help the gastrointestinal tract to return to its
normal state. REEDA redness, edema, ecchymosis,
You can offer sitz bath to the mother because it will discharges, and approximation (of sutures)
help healing of wounds
Additional Notes:
Inspect the perennial

LOCHIA Offer to do perennial cleaning and observe the
perennial
- Discharges of the uterus Bruises is normal due to pushing
- Composed of erythrocytes, epithelial cell, some Note if there is hematoma that would cause vulva
fragments of the decidua basalis hematoma indicate alterations in episiotomy
- Indicator if mother have more problems Apply ice application for the 24 hours and give
Lochia rubra = 1 3 days bloody red in color analgesic
Lochia serosa = 4 10 days, pink or brown If there capping of the wound about 1-3 stiches is
color (amount must decrease) remove and the wound is not healed (referral to the
Lochia alba = creamy, yellowish color doctor to do repair)
(composed decidual cells)
.3rd week after childbirth but some up to 6 week
- Pattern should not be reverse
Used in assessment of deep venous thrombosis
- Increase in activity
(DVT) in the leg
- Not offensive in odor
Varicosities and signs of thrombophlebitis
- Decrease breastfeeding (if there is an increase in
Inflammatory process that causes blood clot to form
discharges)
and block one or more veins
- Without large clots (large clots indicate
hemorrhage) Pedal pulses may be obstructed by
- Present in CS thrombophlebitis and should be palpate with each
assessment.
If doing Homan sign the patient legs should be
Additional Notes:
extended, relax, straightened, and dorsiflexed. If the
blood cloths are an indicator no uterine mother complain of pain over the calf that would
contraction. (Hemorrhage and foul odor indicate positive for Homan sign
(indication of infection)) Check for inflammation and varicosities
assess the firmness of the uterus and we need
to express additional blood clots and begin the Additional Notes:
perennial count already (how many pads have
Pain in the calf=positive signs of Homan
been used)
signs
if there no decreasing discharges we must
No pain= negative
report to the physician or the CI.
Thrombophlebitis= pain due to obstruction

EMOTIONAL STATUS o After 1 week prepregnant state
Urinary system
Sense of elation immediately after birth. o The bladder is expected to pass out urine
Mother wanted to talk about labor and delivery after 6-8 hrs.
Exhausted, need rest and sleep to restore body to o Voiding maybe difficulty immediately after
health birth
Normally during the 1st 24 hours passive, o Due to trauma = urinary retention
preoccupied, with own needs, talkative if unable to o After 12 hours diuresis
sleep o Voiding time should be after 4-6 hours post-
1 - 2 days beginning to assume responsibility partum
RH INCOMPATIBILITY Additional notes:
Possible when 2 specific circumstances exist: Includes plasma volume, ovulation process, blood
o Mother is Rh negative values
o Fetus is Rh positive the father is the Rh Diuresis = increase of excretion of urine flow to the
positive mother
RhoGam = Rh immune globulin, unsensitized - 4 weeks after delivery the kidney returns to the
28/7AOG, or after 72 hrs. PP-IM deltoid muscle normal state, both the protein and acetone maybe
present in the urine for the first few postpartum hours
Icterus Gravis = RBC are destroyed, fetal bilirubin
Acetone = suggests dehydration and often occurs
increases = kernicterus-bilirubin encephalopathy
during the insertion of labor, causes bad breath of
Erythroblastosis fetalis
mother
Sugar in the form of lactose also may be present in
identify Rh incompatibility
the urine, expected
Additional notes: Changes during the pregnancy that cause the
bladder of the postpartum woman to have the
Causes no harm to the mother, but affects the increase capacity and decrease muscle tone during
fetus during the successive pregnancy childbirth
During the first pregnancy, the antigen of the During childbirth, the urethra, bladder, and tissues
mother cannot identify or quickly recognize the around the urinary meatus of the pregnant mother
presence of Rh positive will become edematous and traumatized as the fetal
During the second pregnancy, the antigen can head passes beneath the bladder during delivery
now recognize the Rh positive that enters the diminished sensitivity of the fluid pressure in the
circulation, it will destroy the fetus later, causing bladder of the postpartum mother, many mothers will
death of the fetus not have a sensation to void even if the bladder is
To prevent the occurrence of the effects into the distended diuresis after 12 hours
fetus during the successive pregnancy, the
The bladder is being filled with urine rapidly
mother diagnosed with Rh compatibility will
receive RhoGam mother risk of overdistention of the bladder
If not treated with RhoGam, it can cause Icterus Risk of bladder distention during this time and
Gravis difficulty in voiding are a particular risk for woman
who just received some regional anesthesia or those
1. CARDIOVASCULAR CHANGES who are undergoing painless delivery, and cesarean
section (use catheter)
The mother experiences substantial blood lost For the NSVD, sometimes because of local
during childbirth, there will be hypervolemia that will anesthesia given to the pregnant mother
produce above 45% increase blood volume, enable 2 complications for the urinary system: urinary
the mother tolerate blood lost without ill effects retention and overdistension of the bladder
during delivery Most common: Urinary Tract Infection (UTI) occur
when there is retention of urine into the bladder
2. SYSTEMIC CHANGES
urinary stasis that allows time of bacteria to multiply
Hormonal in the bladder
o Occurs during post-partum week

3. CIRCULATORY SYSTEM PHYSIOLOGY OF MILK PRODUCTION
Decrease blood volume

Return to normal at 1st 2nd week
Blood loss: NSVD 300-500 ml; CS 500-1000 ml
Increase plasma fibrinogen
Placental delivery Suckling
4. RETROGRESSIVE CHANGES
Decrease estrogen &
Stimulate PPG
Exhaustion progesterone
o Sleeplessness
o Fetal movements
Stimulates APG OXYTOCIN
o Labor pains
o Energy expenditures
o NPO
Weight Loss PROLACTIN Collecting tubules
o Diuresis
o Diaphoresis
Milk ejection
o Return to prepregnant weight at 6th week Acinar cells
LET DOWN REFLEX
Additional Notes:
If there is labor pain after delivery of the baby, Milk Production

mothers continue to experience pain it is
because of the contraction of the uterus
contract postpartum, mother experience after Collecting tubules
pain
Pain during labor = labor pain; pain during
postpartum = after pain
HEALTH TEACHINGS FOR BREAST FEEDING
5. PROGRESSIVE CHANGES
1. Handwashing before and after
Lactation 2. Clean nipple with water (look for cracks or pain)
3. Expose nipple to air
4. Feed the baby in short frequent intervals and
lengthen gradually
5. Alternate the breasts
6. Proper positioning
7. Adequate maternal nutrition and increase OFI = on
the part of mother, there are 2 will consume the
nutrition
8. Wear well-fitted bra
PROPER ATTACHMENT
Baby grasp not only the nipple but also the areola
Lower lip turned outward
Mouth wide open
PROPER POSITIONING
a. Head and lower body part must be aligned
b. Baby is Facing the mother

c. Tummy to Tummy
DIFFERENT POSITION OF THE BABY WHILE

BREASTFEEDING
Additional Note:
In this position the mother should be in a

cross-sitting position then put a pillow into
BREASTFEEDING
B - Best for baby, also for mommy
R - Reduce the incdence of allergies
E - Economical- no waste
A - Antibodies to protect baby againts infection
S - Sterile and pure; stool inoffensive
T - Temperature is always ideal
F - Freshmilk never goes off
E - Easy to prepare and to digest
E - Eradicates feeding difficulties
D - Develops mother and child bonding
I - Immediately available
N - Nutrionally optimal; No mixing required
G - Gastroenteritis greatly reduced
EMOTIONAL PHASES OF PUERERIUM

Additional Note:
1. Taking-in-Phase
In this position the mother will cuddle the
- Woman is passive and dependent
baby while in sitting position
- Prefers talking about pregnancy, labor and
delivery
- Uncertain in caring for newborn

- Energies are focused on bodily concern b. Late Postpartum Hemorrhage
- Uninterupted sleep is important - Retained Placentaal fragments
- Additional nourishment is necessary - Hematoma
2. Taking-hold Phase Additional Notes:
- Woman begin to initiate action
- Interested in taking care of newborn Late Postpartum Hemorrhage - after 24 hrs or
- Asserst Independence before the 6 weeks postpartum happens
3. Letting-Go Phase This occur because the nurse has a less process of
- Give up old role assessment to the mother due to her short stay in
- Ready for her new role the hospital
COMMON POST PARTUM COMPLICATION NURSING INTERVENTIONS
Post-Partum Hemorrhage - This is the most 1. Monitor fundus frequently

common complications that cause the death of the 2. Massage the uterus
mother 3. Apply ice pack in the abdomen
Hemorrhage - Blood loss more than 500cc 4. Empty the blabber
5. Regulate IVF as order
Additional Notes:
6. Administer oxytocic agent ( Oxytocin/ Maleate)
500 cc for NSVD while 1200 cc for cesarean 7. Initiate Breastfeeding
section, this is just an estimated blood loss 8. Monitor VS and watch for indication of hypolemic
This will occur within 6 weeks in post-partum, if shick
it occurs in the first 24 hrs this is just caused by 9. Prepare and assisst for repair of laceration,removal
some clots of fragements or evacuation f hematoma
10. Emotional Support
a. Early post partum hemorrhage
- Uterine atony - relaxed or boggy uterus Additional Notes:
o Cause:
Uterine atony
o Large babies
- Massage the abdomen or the lower portion of the
o Cesarean birth
umbilicus
o Placental Accident
- Apply ice packs over the hypogastric area
o Dystocia
- Ask the mother to tickle then nipples to stimulate
Additional Notes: the posterior pituitary gland to release oxytocin
that will help to the contraction of the uterus
Uterine atony - The uterus does not contract after Retain Placental Fragment
the delivery of the baby and the placenta - Try to check the perennial pads when the
Dystocia - this is the Difficulty in delivering the baby patient arrives to know the degree of bleeding
because of broad shoulder but mostly it is cause by or the estimated amount of blood loss
relaxed or boggy uterus - Prepare the patient and the instrument that is
- Laceration: needed for the dilation and curettage or
o Cervix to remove the placental fragments
o Vagina for it will result more bleeding
o Labia - If the fragments of the cotyledons remain in
o Perineum the uterus this can cause more bleeding or
o continues bleeding thus this should be
Additional Notes: removed by dilation and curettage (D&C) and
include the degree of discharges
Laceration is cause by a 4th degree laceration
Hematoma
causes laceration in the cervix, labia and Perineum
- Apply ice packs over the area where you can
The perineum is being cut by the doctor or the
find hematoma to lessen the pain while the
episiotomy to facilitate the delivery if the baby if it
warm pack will help to lessen the hematoma
is too large
- Warm and ice pack should be given
alternately

Additional Notes:
1. Post Partum Infection
a. Infection of the perineum If the perineum has infection due to improper
o Pain, heart, feeling of pressure in the cleaning of the perineum when suturing or the
perineum, inflammation,redness,1-2 fragments if not completely remove
sutures slough off, febrile
o Remove the suture, drain and resuture 2. EXOGENOUS SOURCE
o Hot sitz or warm compress
o Perilight Hospital personnel
Excessive obstetric manipulation
Additional Notes: Break in aseptic technique
Coitus in late pregnancy
Remove the suture to check the infection and re- PROM
suture the episiotomy
Peri light is used to light the Perineum of the Additional Notes:
mother while in a lithotomy position, the radiation
When the nurses or medical personnel is doing
of the peri light will cause the healing of the
some cleaning in the perineal area is not using the
Perineum
aseptic technique and not observing the sterile
process that will cause some infection which is
called HOSPITAL ACQUIRED INFECTION
b. Endometritis - Infection of the lining of the
An interaction between the husband and wife that
uterus
the suture in perineum is not totally healed this can
o Abdominal tenderness
cause coitus in late pregnancy
o Uterine atony
o Dark brown foul smelling lochia
o 3 .THROMBOPHLEBITIS
Position
Sign and symptoms
Additional Notes: - Pain, stuffiness, redness, swelling
- Fever and chills
Fowler position - the patient should be place -
in this position because this will cause difficulty Management
in breathing - Bed rest
Oxytocin As ordered by the doctor to help in - Elevate affected part
the contraction o& the uterus - Analgesics
- Anticoagulant
c. Mastitis Avoid
- Frequent mobilization
Additional Notes: - Massage
- Thrombolytic agents
An inflammation in the breast that can cause
fever to the mother thus she cannot do Additional Notes:
breastfeeding
Thrombophlebitis - Inflammation in the lower
extremities that causes blood cloth
SOURCE OF INFECTION (+) Homan sign - strengthen the legs and flex the
dorsal part, if there is pain that means the patient
is positive to Homans sign
Analgesics - a painkillers that helps to relieves
1. ENDOGENOUS (PRIMARY) any kinds of pain
Anticoagulants - A medication to help prevent
Caused by Normal flora clothing of the blood
The analgesics and ani coagulation needs doctors
order

POST PARTUM DEPRESSION
giving birth related to the magnitude of the birth

experience and doubts about the ability to cope
effectively with the demands of childbearing
This depression is mild and transient, beginning 2 to
3 days after delivery and resolving 1to 2 weeks
REFERENCES
I. Notes from: Mrs. Atillo

II. PPT

GROWTH AND DEVELOPMENT Is a synonym for development
An increase in competence and adaptability
To function at a higher level
OUTLINE
I. Growth and Development PSYCHOSEXUAL DEVELOPMENT

II.
Development A specific type of development that refers to developing
III. Psychosocial Development instincts or sensual pleasure
Freudian theory
GROWTH Psychosexual Age Description

Stage
Is physical change and increase in size
It can be measured quantitatively ORAL 0-2 Infant achieves
Indicators of growth include height, weight, bone size, gratification through
and dentition oral activities such as
Pattern of physiological growth is similar for all people feeding, thumb
but growth rates vary during different stages of growth sucking and babbling.
and development ANAL 2-3 The child learns to
Growth rate is rapid during the prenatal, neonatal, respond to some of
infancy, and adolescent stages and slows during the demands of
childhood society (such as bowel
Physical growth is minimal during adulthood and bladder control).
Generally, takes place during the first 20 years of life PHALLIC 3-7 The child learns to
Development takes place during that time and also realize the differences
continues after that point. between males and
females and becomes
aware of sexuality.
DEVELOPMENT LATENCY 7-11 The child continues his
or her development
Is an increase in the complexity of function and skill but sexual urges are
progression relatively quiet.
Used to indicate an increase in skill or the ability to
function (a qualitative change) (Development of ego
and superego,
specific tasks such as how well a child picks up small development of
objects friends, explore some
Is the behavioral aspect of growth sexual energy,
intellectual pursuits
o Ex. a person develops the ability to walk, talk, run,
with other sex,
and think
confidence is building
Growth and development are independent, interrelated in this stage)
processes GENITAL 11-Adult The growing
adolescent shakes off
o old dependencies and
must grow to a certain point before the infant is able learns to deal maturely
to sit up, walk, or talk with the opposite sex.
Table 1. elopment
MATURATION
ROMARATE, RUBIO, SERO, SILVA, SANTOS BSN 2D 1

PSYCHOSOCIAL DEVELOPMENT
Figure 1.
Additional Notes:
Early Childhood Introduction to
independence, sense of independence; ex:
Bathing oneself and going to school alone.
Preschool Social interaction develops; child
becomes participative.
Adolescence
Middle Adulthood Remember to still have

life outside of work and academics
Maturity
Integrity elders who are retired, on
pensions, and some elders who are still
active and still participates with community
activities; elders who are still productive/
Despair If the partner has already died,
despair would take place
REFERENCES
I.

GROWTH AND DEVELOPMENT taller and heavier than
girls.
B. HEALTH A child who inherits
OUTLINE genetically transmitted
disease may not grow
I. Principles of Growth and Development as rapidly or develop
II. Factors Affecting Growth and as fully as a healthy
Development child, depending on
III. Stages of Human Development the type of illness and
IV. Methods of Studying Children the therapy or care
V. Patterns of Growth and Development available for the
VI. Biologic Growth and Physical disease.
Development Diabetes, cystic
fibrosis, etc.
C. INTELLIGENCE Children with high
PRINCIPLES OF GROWTH AND DEVELOPMENT intelligence do not
generally grow faster
G&D are continuous process from conception until death. physically than other
G&D proceed in an early manner. child, but they do tend
Children pass through the predictable stages at different to advance faster in
rates. skills.
All body systems do not develop at the same rate Occasionally,
Development is cephalocaudal. children of high
Development proceeds from proximal to distal body parts. intelligence fall
Development proceeds from gross to refined skills. behind in the
There is an optimum time for initiation of experiences or physical skills
learning. because they spend
their time with books
Neonatal reflexes must be lost before development.
or mental games.
A great deal of skill and behavior is learned by practice.
FACTORS AFFECTING GROWTH AND 2. NUTRITION

DEVELOPMENT
The greatest influence on physical and intellectual
development.
1. GENETICS Breastmilk for infants which provide micronutrients,
immunologic properties, and several enzymes that
Family history of diseases may be inherited. enhance digestion and absorption of nutrients.
Chromosomes carry genes that determine physical Poor maternal nutrition may limit growth and intelligence
characteristics, intellectual potential, and personality. potential.
Sex, race, and nationality o
placenta.
A. GENDER Girls are born lighter
(by an ounce or two) 3. ENVIRONMENT
and shorter (by an inch
or two) than boys. A. HARMFUL PRENATAL ENVIRONMENT
Boys tend to keep this o Nutritional deficiencies - mother did not eat
height and weight healthy diet.
advantage pre- o Mechanical problems
puberty, at which o Metabolic endocrine disturbances
times girls surge o Medical treatment
ahead because they o Infectious diseases/illness during pregnancy -
begin their puberty most common is Urinary Tract Infection (UTI)
growth spurt 6 o Faulty placental implantation/malfunction
months to 1 year o Smoking, alcoholism, use of certain drugs
earlier than boys.
By the end of puberty, B. NATAL ENVIRONMENT
boys again tend to be
ROMARATE, RUBIO, SERO, SANTOS, SILVA BSN 2D 1

o Immediate factors that the child is exposed A. PARENTAL ATTITUDES
during birth.
Anesthesia o Upbringing, financial attitudes, and marital status
Method of delivery (CS, NSVD, VBAC) o Task-related needs that affect their children.
Immediate care
B. CHILD-REARING PHILOSOPHIES
C. POST-NATAL ENVIRONMENT
o Permissive - very emotionally responsive; do not
o Internal provide structure or enforce rules.
Intelligence o Authoritative - emotionally responsive; also sets
Hormonal imbalance boundaries and enforces rules.
Emotions o Authoritarian - emotionally unresponsive;
demanding in enforcing boundaries and rules.
o External o Uninvolved - very emotionally unresponsive;
Socioeconomic status of the family does not provide structure or rules.
Nutrition
Illness and injury STAGES OF HUMAN DEVELOPMENT
Parent-child relationship
Ordinal position in the family STAGES AGE
4. TEMPERAMENT NEWBORN Birth to 28 days

INFANCY 1 to 12 months
The way individuals respond to their internal and external
environment. TODDLER 1 to 3 years
Inborn characteristics set at birth. PRESCHOOL AGE 3 to 6 years
Not developed by stages.
SCHOOL AGE 6 to 12 years
Reaction patterns.
ADOLESCENCE 12 to 20 years
o Activity Level - level of activity among children
differs widely. EARLY ADULT 20 to 40 years
o Rhythmicity - it manifests a regular rhythm a MIDDLE ADULT 40 to 65 years
physiologic function.
o Approach - OLDER ADULTHOOD
with a new stimulus. YOUNG-OLD 65 to 74 years
o Intensity of Reaction - some react to situation
with their whole being, others rarely demonstrate. MIDDLE-OLD 74 to 84 years
o Distractibility - children who are easily distracted OLD-OLD 85 and over
are easy to care for.
o Attention Span and Persistence - ability to
remain interested. METHODS OF STUDYING CHILDREN
o Threshold of Response - intensity level of
stimulation. CROSS-SECTIONAL STUDIES
o Mood Quality - a happy child has a positive mood
quality. Participants of different ages studies at the same time.
o Adaptability -
t stimuli overtime. LONGITUDINAL STUDIES
5. CULTURE One group of people studied over a period of time.
Habits, beliefs, language, values, and attitudes of cultural PATTERNS OF GROWTH AND DEVELOPMENT
A. DIRECTIONAL TRENDS
6. HEALTH
Cephalocaudal - head to tail
Illness, injury, or other congenital conditions can affect Proximodistal - near to far
growth and development.
Differentiation - from simple to more complex operations
and functions
7. FAMILY
B. SEQUENTIAL TRENDS
The purpose of the family is to provide support, and
safety for the child.
Orderly sequence
The family is the major constant
Each stage is affected by the preceding stage
physiological well-being and development.
C. DEVELOPMENTAL PACE
The parents set expected behaviors and model
appropriate behavior.
Does not progress at the same time or pace
ROMARATE, RUBIO, SANTOS, SERO, SILVA BSN 2D 2

Periods of accelerated growth and periods of decelerated
growth
D. SENSITIVE PERIODS
Positive or negative stimuli enhance or defer the

achievement of a skill or function.
E. INDIVIDUAL DIFFERENCES
Rates of growth vary
BIOLOGIC GROWTH AND PHYSICAL

DEVELOPMENT
LINEAR GROWTH OR HEIGHT
Occurs as a result of skeletal growth.
WEIGHT
Birthweight is a reflection of intrauterine environment.

In general,
o It doubles by 4-7 months
o Triples by the end of the 1st year
o By 2-2.5 years birthweight quadruples.
BONE AGE
Determined by comparing the mineralization of

ossification centers.
Interpretation of skeletal maturity.
DENTITION
Major stages:
o Growth
o Calcification
o Eruption
o Attrition
REFERENCES
I.

DEVELOPMENT OF ORGAN SYSTEMS Nursing Implications
State examples or situations
OUTLINE THEORIES OF DEVELOPMENT

I. Difinition of Development of Organ A. THEORY
Systems
II. Factors under Development of Organ - A systematic statement of principles that provides a
System framework for explaining some phenomenon
III. Definition of Motor Development
IV. Motor Theories of Development
B. DEVELOPMENTAL TASK
V. Theories of Development
- A skill or growth responsibility arising at a particular
will provide a provide a foundation for the

DEFINITION OF DEVELOPMENT OF ORGAN accomplishment of future tasks.
SYSTEMS o Biophysical
o Personality
Respiratory, digesstive, renal & musculoskeletal -Phychosocial
- Growth proceeds fairly in childhood -Psychosexual
o Temperament
SKELETAL GROWTH & MATURATION o Attachment
- Provides the best estimate of bioloical age o Cognitive
o Behaviorist
o Social Learning
FACTORS UNDER DEVELOPMENT OF ORGAN SYSTEM o Ecologic Systems
o Moral Development
1. NEUROLOGIC TISSUES o Spiritual Development
Grow rapidly in the first 2 years C. ARNOLD GESELL (1880-1961

Brain reaches matire proportions by 2 5 years
- Describe the development of the physical body
- Theory states that development is directed by
2. LYMPHOID TISSUES genetics
-
Grow rapidly during infancy and childhood - 10 stages of development were identified
-
3. SKELETAL GROWTH & MATURATION PSYCHOSOCIAL THEORIES
Psychosocial Development
Provides the best estimate of biological age - Refers to the development of personality
o Personality can be considered as the
outward expression of the inner self
MOTOR DEVELOPMENT
SIGMUND FREUD (1856-1939)
- Process wherein children learn to control and
integrate their muscles in puposeful movements - An Austrian Neurologist founder od Psychoanalysis
MOTOR BEAHAVIOR SKILLS Psychoanalytic/Psychosexual Theory

introduced number of concepts about development that are
Reflexive or rudimentary still in used today:
o General fundamental skill o Concepts of unconsciousness minds
o Specific skills o Defense mechanism
o Specialized skills o Id, ego, and superego
o Proposed that the underlying motivation to
STAGES OF HUMAN DEVELOPMENT
which he called
Significant characteristics

o Perdonality develops in five overlapping - Identity vs. role confusion
stages from birth to adulthood - Developing sense of identity
- Opportunities to discuss feelings; offer support and
FRUED FIVE STAGES OF DEVELOPMENT praise for decision making
ORAL (birth 1 ½ years) EARLY ADULTHOOD

- Pleasure in accomplished by exploring the mouth - 20 25 years
and by sucking - intimacy vs. isolation
- Striving for immediate gratification of needs - establishing intimate bonds of love nad friendship
- Ego begins to emerge
MIDDLE ADULTHOOD
ANAL (1 ½ - 3 years) - 35 65 years
- Pleasure is accomplished by exploring the organs of - Generativity vs. stagnation
elimination - Fulfilling life goals that involve family, caree and
- Conflict is between those demands of society and the society
parents
LATE ADULTHOOD
PHALLIC (4-6 years) - 65 tyears to death
- Pleasure is accomplished by exploring the genitals - Integrity vs. despair
- Child is attracted to the parent of the opposite sex -
LATENCY (6 years puberty) ROBERT HAVIGHURST (1900-1991)

- Pleasure is durected by focusing on relationships
with same-sex peers and the parents of the same- THEORY
sex - Learning is basic of life and that people continue to
- Ability to care and relate to others learn throughout life
- Describe G &D to 10 tasks to be learned
GENITALS (puberty and after)
- Pleasure is directed in the development of sexual HAVIGHURST S AGE PERIOD
relationships
- Plans life goals and gains strong sense of identity Infancy & Early Childhood
Middle Childhood
ERIK H. ERIKSON (1902-1994) Adolescence
Early Adulthood
Theory of Psychosocial Development Middle Age
- Later Maturity
THEORY OF PSYCHOSOCIAL DEVELOPMENT ROBERT PECK

INFANCY THEORY
- Birth to 18 months - Believes that although physical capabilities and
- Trust vs. Mistrust function decrease with old agae, metal and social
- Attachment to the mother capacitites tend to increase in te latter part of life
- Soft sound and touch; visual stimulation
3 DEVELOPMENTAL TASK DURING OLD AGE
TODDLER
- 18 months to 3 years o Ego differentiation vs. Work-role
- Autonomy vs. shame and doubt preoccupation
- o Body transcendence vs. Body
- Opportunities for decision making; praise for the preoccupation
ability to make decisions o Ego transcendence vs. Ego preoccupation
PRE-SCHOOL ROGER GOULD

- 3 6 years
- Initiative vs. guilt - Transformation is a central theme during adulthood
- Becoming purposeful and directive - 20 s, time when a person assumes new role
- Explore new activities; allow to play - 30 s, role confusion often occurs
- 40 s person becomes aware of the time limitation
SCHOOL AGE - 50 s acceptance of each stage as a natural
- 6 to 12 years progression of life marks the path to adult maturity
- Industry vs. inferiority
- Developing social, physical and learning skills 7 STAGES OF ADULT DEVELOPMENT
- Allowing to assemble and complete short projects
Stage 1 (AGES 16-18)
ADOLESCENCE Stage 2 (AGES 18-22)
- 12 to 20 years

REFERENCES
I.

GROWTH AND DEVELOPMENT STAGE 3 (AGES 22-28)
Individuals feel established as adults and autonomous
from their families
They see themselves as well defined but still feel the

OUTLINE
need to prove themselves to their parents
I. Roger Gould
They see this as the time for growing and building for the
II. 7 Stages of adult development
future
III. Temperament Theories
IV. Stella Chess and Alexander Thomas
STAGE 4 (AGES 28- 34)
V. Attachment Theory
Marriage and careers are well established
VI. John Bowlby
question what life is all about and wish to be
VII. Cognitive Theory
accepted as they are, no longer finding it necessary to
VIII. Jean Piaget
prove themselves
IX. 5 major phases of Cognitive Development
X. Schemes of learning
XI. Behaviorist Theory STAGE 5 (AGES 34- 43)
XII. Albert Bandura This is a period of self-reflection
XIII. Lev Vygotsky Individuals question values and life itself
XIV. Social Learning Theory They see time as finite, with little time left to shape the
XV. lives of adolescent children
XVI. B.F Skinner
STAGE 6 (AGES 43- 50)
Personalities are seen as set
Time is accepted as finite
Individuals are interested in social activities with friends
ROBERT GOULD (1935-PRESENT) and spouse and desire both sympathy and affection from
spouse.
Another theorist who studied adult development
Believes that transformation is a central theme during STAGE 7 (AGES 50- 60)
adulthood:
o This is a period of transformation, with a realization of
considered to be adulthood and development mortality and a concern for health
There is an increase in warmth and a decrease in
According to Gould: negativism
o - the time when a person assumes new roles; The spouse is seen as a vulnerable companion
o - role confusion often occurs;
o - the person becomes aware of the time
and;
o - acceptance of each stage as a natural
progression of life marks the path to adult maturity.
7 STAGES OF ADULT DEVELOPMENT
STAGE 1 (AGES 16-18)

Individuals consider themselves part of the family rather
than individuals and want to separate from their parents
STAGE 2 (AGES 18-22)

Although the individuals have established autonomy,
Adult Development
they feel it is in jeopardy; they feel they could be pulled
back into their families

TEMPERAMENT THEORIES (stimuli) must exist before intellectual abilities can
develop
Temperament
o Is multidimensional leading to the development of
personality traits 5 MAJOR PHASES OF COGNITIVE DEVELOPMENT
o Has a role in the development of anxiety,
depression, attention deficit disorder, and other 1. THE SENSORIMOTOR PHASE (BIRTH - 2 Y.O)
types of behavior.
Consists of six substages that are governed by sensations in
STELLA CHESS & ALEXANDER THOMAS which simple learning takes place
Conducted research on temperament in the 1950s Stage 1 - Use of Reflexes (Birth-1 month)
Identified nine temperament qualities seen i The use of reflexes
behavior Stage 2 - Primary Circular Reaction (1-4 months)
- Sucking habits are developed such as thumb sucking
ATTACHMENT THEORY and the protrusion of the tongue when the infant is
hungry
Stage 3 - Secondary Circular Reaction (4-8 months)
theories that early childhood experiences have a strong - The infant begins to discover and rediscover the
external environment
Stage 4 - Coordination of Secondary Schemata (8-
JOHN BOWLBY (1907- 1990) 12months)
- First actual intellectual behavior patterns emerge
- The infant begins to distinguish the ends and the means
- The infant is utilizing cognitive development to attain a
o The desire to be near to the attachment figure goal
Stage 5 - Tertiary Circular Reaction (12-18 months)
o A return to the attachment figure when threatened - The child discovers new ways of solving problems by
or for comfort utilizing experimentation
Stage 6 - Inventions of New Means (18-24 months)
o The use of attachment figure as a security base - Possesses mental images of the environment and
from which the child can explore the surrounding utilizes cognitive skills to solve problems
environment -T
leading to pretend play
o Expression of anxiety (separation anxiety or
2. THE PRECONCEPTUAL PHASE (2- 4 Y.O)
Additional Note: Uses an egocentric approach to accommodate the

demands of an environment
Imitation of children is based through observation Everything is signific
or what they see from the elders or their Explores the environment
surroundings Language development is rapid
Associates words with objects
Signs of attachment is when they are bubbly and
giggling Additional note:
School age
COGNITIVE THEORY
Symbolic or abstract thinking
Manner in which people learn to think, reason, and use
language and other symbols Pre-operational phase, hence, some children
has their own imaginary friend
ability to process information 3. THE INTUITIVE THOUGHT PHASE (4- 7 Y.O)
Egocentric thinking diminishes
Additional Note: Thinks of one idea at a time
Includes others in the environment
Critical thinking here is being established. Words express thoughts
4. THE CONCRETE OPERATIONS PHASE (7-11 Y.O)

JEAN PIAGET (1896 - 1980) Solves concrete problems
Begins to understand relationships such as size
A Swiss psychologist Understands right and left
According to him, cognitive development is an orderly, Cognizant of viewpoints
sequential process in which a variety of new experiences

5. THE FORMAL OPERATIONS PHASE (11-15 Y.O) The individual actively interacts with the environment to
Uses rational thinking learn new skills and behaviors
Reasoning is deductive and futuristic
Additional Note:
SCHEMES AND ORGANIZATION
More like imitation
CENTERING
Look at an object and see only one characteristic of that
object. LEV VYGOTSKY (19896-1934)
E.g., the color of the leaves are green, then the green color is
the only color identified.
Adults guide children to learn and that development
CONSERVATION depends on the use of language, play, and extensive
Change in form does not change the size or amount of social interaction
content He supported social learning and reinforcement through
The ability to discern truth, even though physical work, group discussion, and other means of interaction
properties change
SOCIAL LEARNING THEORY
REVERSIBILITY
Ability to retrieve steps Individuals learn by observing and thinking about the
behavior of the self and others
ASSIMILATION JOHN THEORY OF BEHAVIORISM
thoughts John Watson- American scientist who applied the

Taking in information and changing it to fit their existing research of animal behaviors to children
ideas Behaviors can be elicited by positive reinforcement, such
as food treat, or extinguished by negative reinforcement,
ACCOMODATION such as by scolding or withdrawing attention.
Adapt thoughts perceived to fit what is perceived
They change their ideas to fit reality rather than the B.F. SKINNNER (1904-1990)
reverse
Believes that organisms learn as they respond to or
BEHAVIORIST THEORY
His research led to the term operant conditioning
stimulus is either positively or negatively reinforced o In which he maintained that rewarded or reinforced
behavior will be repeated
o Behavior that is punished will be suppressed
REFERENCES
I.
Fig. 2 Behaviorist Theory
ALBERT BANDURA
In contrast to operant conditioning, he believes that

learning occurs through imitation and practice and
requires more awareness, self-motivation, and self-
regulation of the individual\

GROWTH AND DEVELOPMENT
4. MACROSYSTEM
OUTLINE
A
I. Social Learning Theory society
II. 5 Levels/Systems of Ecologic Systems
Theory 5. CHRONOSYSTEM
III. 3 Levels of Moral Development Time period in which the child is growing up.
IV. 6 Stages of Moral Development
V. Carol Gilligan THEORIES OF MORAL DEVELOPMENT
VI. 3 Levels of Moral
VII. Theories of Spiritual Moral development - learning ought to be and
VIII. 7 Stages of the Development of Faith what not ought to be done.
IX. Westerhoff Moral -
Morality - requirements necessary for people to
live together in society
SOCIAL LEARNING THEORY Moral behavior the way a person perceives
those requirements and responds to them
Individual learn by observing and thinking Moral development the pattern of change in
about the behavior of the self and others. moral behavior with age
URIE BRONFENBRENNER 1. LAWRENCE KOHLBERG (1927-1987)
He viewed the child as interacting with the Focused on the reasons an individual makes a
environment at different levels, or systems decision
Believed each child brings a unique set of genes. Moral development progresses through three
and specific attributes such as age, gender, levels and six stage
health, and other characteristics
to his or her interactions with the 3 LEVELS OF MORAL DEVELOPMENT
environment.
1. PREMORAL OR PRECONVENTIONAL LEVEL
5 LEVELS/STAGES OF ECOLOGIC SYSTEMS
THEORY Egocentric focus
A person begins to understand the rule of right or
1. MICROSYSTEM wrong
Birth to 7 years
Close relationships on a daily basis
Home, school, friends 2. CONVENTIONAL LEVEL
2. MESOSYSTEM Societal focus

A person is concerned about other people and
Relationships of microsystems with one another their feelings
Relationship between family and school 7 to 12 years
3. EXOSYSTEM 3. POSTCONVENTIONAL, AUTONOMOUS OR

PRINCIPLED LEVEL
Settings that may influence the child but the child
may not have daily contact. Universal focus

Older than 12 years old
The person upholds basic rights, values, and legal
contracts of the society
6 STAGES OF MORAL DEVELOPMENT
1. PUNISHMENT AND OBEDIENCE
Actions are judged in terms of physical

consequences
2. INDIVIDUAL INSTRUMENTAL PURPOSE &

EXCHANGE
An individual engages in actions that are right to

meet his or her needs
The individual separates his or her own interests
from the interest of authorities
CAROL GILLIGAN (1936-PRESENT)
3. MUTUAL INTERPERSONAL EXPECTATIONS,
RELATIONSHIPS, AND COMFORMITY
Most frameworks for research in moral
development do not include the concepts of caring
An individual is in relationships with other people
and responsibility
The individual is paying attention to the feelings of
Moral development proceeds through 3 levels and
2 transitions
More on the side of women morality
4. SOCIAL SYSTEM AND CONCSCIENCE
3 LEVELS OF MORAL
MAINTENANCE
STAGE 1: CARING FOR ONESELF
An individual fulfills the duties assigned by
authority figures, thus fulfilling obligations set forth
The person is concerned only with caring for the
self
5. PRIOR RIGHTS AND SOCIAL CONTRACT
The individual feels isolated, alone, and
unconnected to others
An individual has an obligation to obey the law
There is no concern or conflict with the needs of
There is a commitment to family and work
others because the self is the most important
obligations
The focus of this stage is survival
The individual has a responsibility to consider the
The transition of this stage occurs when the
moral and legal point of view in ascertaining what
individual begins to view this approach as selfish
will provide the greatest good for people
and moves toward responsibility
The person begins to realize a need for
6. UNIVERSE ETHICAL PRINCIPLE
relationships and connections with other people
STAGE 2: CARING FOR OTHERS

An individual follows what is right in accordance
with ethical principles
During this stage, the individual recognizes the
selfishness of earlier behavior and begins to
understand the need for caring relationships with
others
Caring relationships bring with them responsibility
The definition of responsibility includes self-
sac
The individual now approaches relationships with a

focus of not hurting others
This approach causes the individual to be more

excluding any thoughts
needs STAGE 2: MYTHICAL-LITERAL FAITH
A transition from goodness to truth occurs when
the individual recognize that this approach can School age
cause difficulties with relationships because of the Spiritual development parallels cognitive
lack of balance between caring for oneself and
caring for others experiences and social interaction
Most children have the strongest interest in religion
STAGE 3: CARING FOR SELF AND OTHERS during this age
They accept the existence of deity, and petitions to
During this last stage, a person sees the need for an omnipotent being are important and expected to
a balance between caring for other and caring for be answered; good behavior is rewarded, and bad
the self behavior is punished
The concept of responsibility now includes Their developing conscience bothers them when
responsibility for the self and for other people they disobey
Care remains the focus on which decisions are They have a reverence for thoughts and matters
made and are able to articulate their faith
They may even question the validity of their faith
THEORIES OF SPIRITUAL
STAGE 3: SYNTHETIC-CONVENTIONAL FAITH
I
the universe and their perceptions about the Adolescence
direction and meaning of life They become increasingly aware of spiritual
disappointment
JAMES FOWLER They recognize that prayers are not always
answered (at least on their own terms) and may
Development of faith as a force that gives meaning begin to abandon or modify some religious
to a practices
Faith a form of knowing, a way of being in relation They begin to reason, to question some of the
established parental religious standards, and to
drop and modify some religious practices
7 STAGES OF THE DEVELOPMENT OF FAITH
STAGE 4: INDIVIDUATIVE-REFLECTIVE FAITH
PRESTAGE: UNIDENTIFIED FAITH
Late adolescence-young adulthood
Infant Become more skeptical and begin to compare the
Encompasses the period of infancy during which religious standards of their parents with those of
children have no concept of right or wrong, no others
beliefs, and no convictions to guide their behavior They attempt to determine which standards to
However, the beginnings of a faith are established adopt and incorporate into their own set of values
with the development of basic trust through their They also begin to compare religious standards
relationships with the primary caregiver with the scientific viewpoint
STAGE 1: INTUITIVE-PROJECTIVE FAITH It is a time of searching rather than reaching
Are uncertain about many religious ideas but will
not achieve profound insights until late
Toddler-preschool adolescence or early adulthood
Toddlerhood is primarily a time of imitating the
behavior of others STAGE 5: CONJUNCTIVE FAITH
Children imitate the religious gestures and
behaviors of others without comprehending any Adult
meaning or significance to the activities Occurs after 30 years of age with the awareness of
During the preschool years, children assimilate truth from many different viewpoints
some of the values and beliefs of their parents STAGE 6: UNIVERSALIZING FAITH
Parental attitudes toward moral codes and
religious beliefs convey to children what they Adult
consider to be good and bad An individual may not ever reach this stage
Children still imitate behavior at this age and follow In this stage, the individual expresses the
parental beliefs as part of their daily lives rather principles of love and justice in their life
than a through an understanding of their basic
concepts

4. OWNED FAITH
This is when a child passes through the searching
faith
REFERENCES
I.
WESTERHOFF
Describes faith as a way of being and infancy and

childhood behaving that evolves from an
experienced faith guided by parents and others.
4 STAGES OF FAITH
1. EXPERIENCED FAITH
Infants assume the faith of their caregivers, as it is

what they are first exposed to- their first and vital
exposure to Christianity
2. AFFILIATIVE FAITH
Children start copying what they see in those

around them; they will join in because
3. SEARCHING FAITH
Children start asking questions, trying to

understand the thing they have already been
taught, so they can decide whether they believe
this themselves

THE NEWBORN
OUTLINE
I. Principles of Newborn Care
1ST 28 DAYS OF LIFE
MAINTAINING APPROPRIATE BODY

TEMPERATURE
Figure 1. APGAR Scoring
oxygen.
APGAR SCORING INTERPRETATION
COLD STRESS - large losses of heat.
EFFECTS:
0-3 - serious danger and needs resuscitation
1. METABOLIC ACIDOSIS - due to the
accumulation of fatty acids because of the 4-6 - condition is guarded and needs clearing of
breakdown of brown fat. airway and supplementary oxygen
2. HYPOGLYCEMIA - due to excessive use of 7-10 - good
glucose
Dry the newborn immediately BALLARD SCORING
Wrap warmly.
A revised assessment of Dubowitz scale or the
IMMEDIATE ASSESSMENT OF THE NEWBORN Maturity scale.
Can be completed in 3 to 4 minutes.
APGAR SCORING - standardized evaluation of Assessment for gestational age.
Total score of both portions is compared with the
baseline for future evaluation and is performed standard scale.
at 1 minute and 5 minutes after birth.
BALLARD SCORING - a revised assessment 2 PORTIONS OF BALLAD SCORING
if Dubowitz scale or Maturity scale.
PHYSICAL MATURITY
APGAR SCORING CONSIDERATIONS
Heart rate - auscultation

Respiratory effort - a mature newborn usually
cries spontaneously at about 30 seconds after
birth
Muscle tone - mature newborns hold the
extremities tightly flexed
Reflex irritability - may be evaluated by the
nostrils or the response to having soles of the

feet slapped.
Color - all newborns appear cyanotic at the
moment of birth. They grow pink shortly after
the first breath. Figure 2. Physical Maturity Assessment Criteria

NEUROMUSCULAR MATURITY 8. Physical assessment
Pulse - 120-140 bpm
Observe or position the newborn to elicit Using apical heartbeat
different parameters. Irregular due to immaturity of the cardian
Numeric score from 0 to 5 is given. regulatory center of the medulla
Femoral pulses should also be checked
Respiration - 30-60 cpm
Irregular with periodic respirations (short
periods of apnea, no cyanosis)
Gentle, quiet, rapid, shallow,
diaphragmatic, abdominal
Blood pressure - at birth 80/46 mmHg; by 10th
day - 110/50 mmHg
Not routinely measured unless cardiac
anomaly is suspected
Cuff size - no more than 2/3 the length of
upper arm or thigh
Tends to increase with crying
Figure 3. Neuromuscular Maturity Assessment Criteria HEAD
PROPER IDENTIFICATION Fontanels - spaces or openings where the skull

bones join
Done in the delivery room. a) Anterior fontanel
Use of ID band with permanent lock - Located at the junction of the
two parietal bones and the two
date and time of birth fused frontal bone.
Diamond in shape, 2-3 cm in
NICU CARE width and 3-4 cm in length.
Closes at 12-18 months.
1. Check identification of the newborn. Abnormal findings:
2. Take the temperature. o Indented or sunken - sign
At birth - 37.2 °C; must be maintained at 35.5 of dehydration
- 36.5 °C o Bulging - sign of increased
Rectal route preferred to check anal patency. ICP.
b) Posterior fontanel
3. Take anthropometric measurement Located at the junction of the
Abdominal circumference - 31-33 cm parietal and occipital bones
Chest circumference - 31-32 cm Triangular in shape; 1cm in
Average length - 50cm (20in) length
4. Weight taking Closes at 2-3 months
Average birth weight - 3000 - 3400 grams (6.7-
7.5 lbs)
Physiologic weight loss - 5-10% of birth weight
in the first 10 days of life
5. Do not bathe the newborn within the first 6 hours

of life.
6. Vitamin K administration
facilitates production of clotting factors to
prevent bleeding.
0.5-1mg IM into the lateral aspect of the thigh
(vastus lateralis)
7. Feeding
Initial feeding - after having skin to skin
contact.
Subsequent feeding - per demand.
Figure 4. Anatomy of the Normal Skull of the Newborn

Short and chubby with creased skin folds.
Head should rotate firmly on the neck and
c) Molding should be able to flex forward and back.
a part of the head (usually
vertex) that engages, molds to CHEST
fit the cervix contour leading to Symmetrical, breast may be engorged
prominent and asymmetric Witch s milk thin, watery fluid secreted by the
appearance after birth. newborn s breast
Restored to its normal shape Retraction should not be present
within few days after birth. Abnormal sounds:
d) Craniotabes o Grunting suggestive of RDS
Localized softening of the o High crowning sound
cranial bones. suggestive of stridor or
o The condition corrects immature tracheal
itself without treatment development.
after a few months.
Abnormal findings:
o Cephalhematoma -
accumulation of blood
under the scalp
o Caput succedaneum -
swelling of the scalp in a
newborn.
EYES
Usually cries without tears.
Small subconjunctival hemorrhage (due to Figure 5. Sternal Retractions
pressure during birth causing rupture of
conjunctival capillary SKIN
Completely absorbed in 2-3 weeks. A. Color
Edema around the orbit or on eyelids (remain o Normally with ruddy complexion
for 1st 2-3 days.) o Generalized mottling
o Cyanosis
EARS
Top part of the external ear should be in line Acrocyanosis body pink, extremities blue;
with the outer canthus of the eye. normal during the 1st 24-28 hour.
Small tags of skin associated with Central cyanosis cyanosis of the trunk and
abnormalities but are isolated findings. indicates underlying disease state or
Test hearing by ringing a bell 6 inch from each oxygenation problems.
ear. o Gray color indicates infection.
Newborn hearing screening test Jaundice due to the inability to conjugate
bilirubin.
NOSE a) Pathologic jaundice 1st 24 hours after
Appear large for the face birth
Test for choanal atresia b) Physiologic jaundice from the 2nd to
Presence of milia small pinpoint white or the 7th day of life.
yellow dots usually found in the nose, forehead - Breasted babies have long periods
and cheeks. of physiologic jaundice because
the human milk has pregnanediol
MOUTH which depresses the action of
pearls small round glistening, well glucoronyl transferase.
circumscribed cysts on the palate. o Pregnanediol main
Thrush a candida infection, white or gray metabolite of progesterone.
patches on the tongue and sides of the cheeks. Kernicterus Accumulation of bilirubin in the
Blowing bubbles of mucus suggestive of TEF bloodstream that could interfere with the
Natal teeth teeth present at birth. chemical synthesis of brain cells resulting to
permanent cell damage.
o Pallor due to anemia.
NECK

Harlequin sign A newborn that has been lying Mongolian spots Collections of pigment cells
on his side will appear red on the dependent that appears as slate-gray patches across the
side of the body and pale on the upper side. sacrum or buttocks and possibly the arms and
legs.
B. Birthmarks Vernix caseosa A white, cream cheese-like
Hemangiomas Vascular tumors of the skin. substance that serves as a skin lubricant.
Three types: Take color of the amniotic fluid
1. Nevus flammeus a muscular purple or o Yellow bilirubin
dark red lesion. o Green meconium
o Port-wine stain
o May appear lighter, pink Lanugo Fine, downy hair that cover a
patches at the nape of the neck newborn s shoulders, back, and upper arms;
o Telangiectasia or Stork s may also be found on the forehead and ear.
beak marks . o Post mature infants (over 42 weeks)
rarely have lanugo; disappears by 2
weeks.
Desquamation Drying of skin; dryness is
particularly evident on the palms of the hands
and soles of the feet.
o May result in areas of peeling similar to
sunburn.
o Normal and needs no treatment; may
apply lotion.
Erythema toxicum Newborn rash

Appears in the first to fourth day of life,
but may appear up to 2 weeks; flea
Figure 6. Nevus flammeus bite rash .
C. Skin turgor
Resilient, feel elastic, fall back to form smooth
surface after being grasped.
ABDOMEN
Slightly protuberant
Bowel sounds should be present within an hour
after birth.
Figure 7. Telangiectasia
2. Strawberry hemangiomas Elevated areas formed

by immature capillaries and endothelial cells.
o Usually not present in preterm infant due to
immaturity of the epidermis
o Formation is due to high estrogen levels of
pregnancy Figure 8. Protuberant Abdomen
o Tend to be absorbed and shrink in size after 1
year.
o Hydrocortisone ointment may be applied.
3. Cavernous hemangioma Dilated vascular spaces.

o Usually raised and resemble a strawberry
hemangioma in appearance
o Surgical management, especially if it interferes
with eyesight.
o Do not disappear.

ANOGENTIAL AREA
Male genitalia
Scrotum may be edematous and has
rugae.
Testes should be present; if not
descended, the condition is called
cryptorchidism.
Elicit cremasteric reflex to test for the
integrity of spinal nerves T8 through
T10.
May be absent in newborns less than
10 days old.
Urethral opening should be open at the
tip of the glans
o Epispadias Opening at the
dorsal surface.
o Hypospadias Opening at the
ventral surface.
REFERENCES
I.

PRINCIPLES OF NEWBORN CARE Meconium passed within 24 hours
after birth; sticky tarlike, blackish-gree,
odorless material
OUTLINE
Transitional Stool 2nd or 3rd day of
I. Principles of Newborn Care life; green and loose, may resemble
II. Newborn Screening Test diarrhea to the untrained eye
III. Nursing Care of Newborn Breastfed babies stool golden
IV. Breastfeeding yellow, mushy, sweet smelling, 3-4x a
day
Bottle-f pale
1st 28 Days of Life yellow, firm, slightly more noticeable
odor, 2-3x per day
Physical Assessment
Urinary System
o Anogenital Area
- Female Genitalia Must void within 24 hours after birth
vulva may be swollen 1st void may be pink or dusky because
- Psuedomenstration of uric acid crystals that were formed
mucus vaginal secretion, in the bladder in utero
sometimes blood-tinged
o Spine of newborn flat in the Immune System
lumbar and sacral areas Prone to infection d/t the diff. in
o Extremitis arms and legs are forming antibodies against invading
short; hands are clenched to antigens until about 2 mos.
fists Passive natural immunity may
- Unusually short arems have antibodies from mother against
may signify poliomyelitis, diphtheria, tetanus,
achondroplastic dwarfisn pertussis, rebella an measles but with
- Arms and legs should be little or no immunity against chicken
symmetrical pox
*Erb-Duchenne paralysis
*Congenital his Nueromuscular System
dislocation
Reflex present at birth:
Physiologic Function - rooting
- extrusion
- palmar grasp
Gastrointestinal System - step in place
- tonic neck
Cardiac sphincter of stomach is not - parachute
well developed; regurgilates if stomach
is over full
SERO, ROMARATE, RUBIO, SANTOS, SILVA 1

Should be done before feeding
Should proceed from the cleanest to
the most soiled areas
Talcum powder is not advisable
Sleeping
Should be positioned on the back
Sleeps an average of 16 hours a day
in the first week of life
By 4 months sleeps an average of
15 hours a day and through the night
Cord Care
Fold down diaper so that the cord does
nit get wet during voiding
Do not use 70% alcohol
Diaper Area Care
NURSING CARE OF NEWBORN
With each diaper change, the area
should be washed with a clean water
Feeding and dried well
Wear gloves for diaper care as part of
Term Newborn
standard precautions
o Breastfed may be fed
immediately Clothing
o Formula fed 1st feeding at 2-4
hours after birth
loss
Feed per demand, but can be fed as
often as every 2 hours in the 1st few As a rule to be comfortable:
days o If the mother feels cold-keep
the baby warm
Should be burped at least 2x during
o If the mother feels warm, help
feeding
the baby cool
Bathing
Elimination
Initial complete bath
Weigh a diaper before it is place, then
Bath once a day, best done by parent
weigh it again after it is wet and
subtract the difference to determine
Room should be warm, water
the amount of urine output
temperature (37 38 °C)
Difference will be in grams, 1 g =1 ml

Cuddling PROBLEMS ASSOCIATED WITH BREAST
FEEDING:
Teach parents to handle infants with
assurance and getleness o breast engorgement
Infants need to be kept warm while o sore nipples
being held
Advise the parents to cuddle them next
to their bare chest ( )
o Effective in promoting close
physical contact.
BREASTFEEDING
EO 51 National Code of Marketing of
Breastmilk Substitutes,Breast Milk
Supplements & Other related products
NEWBORN SCREENING TEST
RA 7600 The Rooming-In & Breastfeeding
Act of 1992 Legal Basis
RA 10028 Expanses Breastfeeding Act RA 92288 (NEWBORN SCREENING ACT
OF 2004)
-
An act promulgating a comprehensive
policy and national system for ensuring
The natural and ideal nourishment that
newborn screening
will supply an infant with adequate
Is the process of collecting blood onto
nutrition as well as immunologic and
an appropriate collection card and
anti-infection properties
performing biochemical testing to
Can be continued through most illness
determine heritable conditions from the
and hospitalizations of infants
genes of either or both biological
Mother can pump her breast so that
parents
milk can be given to the infant by the
These conditions can result in mental
way of bottle when she is not available
retardation, physical deformity or death
Breast milk can be frozen for up to 6
if left undetected and untreated
months
Stress of new motherhood or illness in CONSIDERED IN THE PERFORMANCE OF
the infant or mother may decrease the NEWBORN SCREENING:
-
down reflex, as well as increase or 1. Newborn screening shall be Peroumed
after twenty-four (24) hours of life but not later
Pumping may be initiated to help than three (3) days from complete delivery of
the newborn.

2. Anewborn that must be placed in intensive One out of 55 babies may be affected
care in order to ensure survival may be Children with this condition may have
-day requirement but hemolysis, jaundice, and
must be tested by seven days of age. splenomegaly and may have aplastic
crises.
3. It shall be the joint responsibility of the
parents and the practitioner or other person Congenital Hypothyroidism
delivering the newborn to ensure the newborn
screening is performed. This is a lack of thyroid hormone,
which is needed to grow.
4, An appropriate information brochure for Treatment required within the first four
parents to assist in fulfilling this weeks of life to prevent stunted
responsibilityshall be made available by the physical growth and mental retardation
Department of health. 1 out of 3,369 babies is at risk.
Child sleeps excessively, tongue
5. Aparent or legal guardian may refuse becomes enlarged , causing
testing on the grounds of religious beliefs, but respiratory difficulty, noisy respiration
shall acknowledge in writing their or obstruction.
understanding that retusal for testing places Poor suck, hypothermia, prolonged
their newborn at risk tor undiagnosed jaundice, slow pulse and respiratory
heritable conditions. A copy of this refusal rate, anemia andneck appears short
documentation shall be made part of the and thick
newborn's medical report and refusal shall be Oral administration of synthetic thyroid
indicated in the national newborn screening hormone.
database. Congenital Adrenal Hyperplasia
GENETIC DISORDERS THAT CAN BE An endocrine disorder that causes
DETECTED THROUGH NEWBORN severe salt loss, dehydration and
SCREENING: abnormally high levels of male sex
hormones (androgens)
Fatal within seven to 14 days
Glucose-6- Phosphate Dehydrogenase in 7,960 babigs is at risk
(G6PD) Deficiency Female - clitoris so enlarged that it
Acondition where the body lacks the appears more like a penis
enzyme called G6PD Male- may appear normal at birth, but
May cause hemolytic anemia, when by 6 months of age signs of sexual
the body is exposed to oxidative precocity appear
substances found in certain drugs, Both are given a corticosteroid agent
foods such as oral hydrocortisone, to replace
Mil what they cannot produce naturally.
covered in Newborn Screening Galactosemia

A condition in which babies cannot 1 in 109,666 babies may be at risk
process the sugar present in milk prevent the child from becoming
(galactose) severely
Deficient in the liver enzyme galactose
1-phosphate uridyltransferase, brain References:
damage. I.
It also causes cataracts to develop II. LECTURE VIDEO
lethargy, hypotonia, diarrhea and
vomiting, liver enlargement, jaundice
If left untreated, child may die by 3
days of age
Management is to place the infant on a
diet that is free of galactose
1 in 82,250 babies may be affected.
Phenylketonuria
A disease of metabolism due to the
absence of the liver enzyme
phenylalanine hydroxylase that
prevents conversion of phenylalanine,
and essential amino acid, into tyrosine.
Results to excessive build up of
phenylalanine in the bloodstream and
tissues , causing permanent brain
damage
Early identification prevent the child
form becoming severly cognitively
challenged
Management is to place on a formula
that is extremely low in phenylalanine
such as Lofenalac

INFANCY first 6 months, average gain 2 lb/month - second 6
months, weight gain 1 lb. /month - average 1-year-
old-boy weighs 10 kg (22lbs)
average girl weighs 9.5 kg. (21lb)

OUTLINE
B. HEIGHT
I. Definition of Self-Concept
first year increases by 50%, growth more in the
II. Body Image trunk
III. Child 2nd half of first year, lengthening of the legs
IV. Self-Esteem end of first year, legs disproportionately short, and

bowed
V. Interventions for health promotion
C. HEAD CIRCUMFERENCE
VI. Patterns variation
Increases rapidly reflecting rapid brain growth
VII. Sleep promotion
End of first year, brain reached two thirds of an
VIII. Nutritional support
adult size
IX. Filipino beliefs on G & D
Head - asymmetric due to one sleeping position
causing the skull bones to flatten on that side
INFANCY Gradually corrects as the child sleeps less and

spends more time with the head in an erect
(1 to 12 months of age) position
Psychosexual stage: Oral D. BODY PROPORTION
Psychosocial Stage: Trust vs. Mistrust Changes from newborn to a typical infant
appearance.
Cognitive Stage: Sensorimotor
Mandible becomes more prominent
( 0-2 years) FEAR: Stranger Anxiety
One year old - lower jaw - more prominent
Chest circumference less than head by 2 cm.

PHYSICAL GROWTH
A. WEIGHT Abdomen remains protuberant
double birth weight at 4 to 6 months and triples it Cervical, thoracic and lumbar vertebral curves
by 1 year develop
Lengthening of the lower extremities during the

last six months

E. BODY SYSTEM 6. IMMUNE SYSTEM
1. CARDIOVASCULAR SYSTEM Functional by 2 months; produce IgG and IgM

by 1 year
Heart rate - 100-120 bpm by the end of 1st year
Ability to adjust to cold mature by six months
Pulse rate slows with inhalation
(can shiver)
Blood pressure (from an average of 80/40 to
Develops additional adipose tissue for
100/60 mm Hg)
insulation
Heart is becoming more efficient
Extracellular fluid -35% of body weight,
2. RESPIRATORY SYSTEM intracellular fluid 40% which increases
susceptibility to dehydration
Respiratory rate - 30-60 breaths / min. to 20-30
breaths /min 7. TEETH
Respiratory infections occur often - lumen First baby tooth erupts at six months, followed
(tubal cavity) of the respiratory tract - small and by a new one monthly.
mucous production by is inefficient
Natal teeth - present at birth * Neonatal teeth
erupt in the first 4 weeks of life
3. GASTROINTESTINAL SYSTEM Deciduous teeth (baby teeth) protects the

growth of the dental arch.
Immature ability to digest food & mechanically
move it .
Amylase for digestion of complex MOTOR DEVELOPMENT

carbohydrates deficient until 3 mo.
Ability to move and to control the body
Lipase for digestion of saturated fat decreased
Body movement is uncoordinated
during entire first year
Reflects the principles of cephalocaudal
Liver remains immature causing inadequate
development & gross to fine motor
conjugation of drugs & inefficient formation of
development
carbohydrates protein, and vitamins for storage
Control proceeds from head to trunk to lower
extremities in a progressive and predictable
4. URINARY SYSTEM sequence
Kidneys immature, inefficient at eliminating Different infants accomplish different tasks at

body wastes different ages
5. ENDOCRINE SYSTEM GROSS MOTOR DEVELOPMENT
Immature response to pituitary stimulation Ability to accomplish large body movements
Ex. adrenocorticotropic hormone, or insulin production

from the pancreas - infant is unable to respond to stress
effectively

4 POSITIONS USED TO ASSESS DEVELOPMENT
1. VENTRAL SUSPENSION POSITION 3. SITTING POSITION
Fig. 1 Ventral Suspension Position
Measures the strength of the infant's trunk and Fig. 3 Sitting Position
neck. The infant is held in a suspended prone
position in the air by placing a hand under the When placed on his or her back and then pulled
chest. to a sitting position, a newborn has extreme
head lag; this lag is present until about 1 month
Landau reflex - develops at 3 months
4. STANDING POSITION
When held in ventral suspension - head, legs
and spine extend
Head is depressed - hip
2. PRONE POSITION
Fig. 4 Standing Position
A newborn stepping reflex can still be

demonstrated at 1 month of age. In a standing
position, the infants knees and hips flex rather
than support more than momentary weight.
Fig. 2 Prone Position FINE MOTOR DEVELOPMENT
When lying on their stomach, newborns can Ability to use smaller muscles to accomplish
turn their head to move it out of a position where small body movements.
breathing is impaired, but they cannot hold their Palmar Grasp
head raised for an extended time Neat Pincer Grasp (10 months)
Transfer objects from hand to hand
Holds cup & spoon well

LANGUAGE DEVELOPMENT
1 month - begins to make small, cooing sounds
2 months - make throaty, gurgling, or cooing

sounds
3 months- will squeal with pleasure.
4 months-
Fig. 5 Palmar Grasp
gurgling
5 months - says simple vowel sounds
6 months - learn the art of imitating
7 months - can imitate vowel sounds well
9 months - - -
Fig. 2 Neat Pincer Grasp (10 months) 10 months - masters another word such as
12 months - -
-
meaning.
PLAY
Solitary play wherein they play with their own

body
Age Play Toys

0-1 Enjoys watching Black and white
face of primary or brightly
Fig. 3 Transfer objects from hand to hand
caregiver, listening colored
to soothing sounds mobiles;
Musical mobiles
2 Enjoys bright- Small rattles
colored mobiles held for a short
period of time;
Mobiles or
cradle gyms
strung on cribs
3 Spends time Small blocks or
looking at hands or small rattles
uses them as toy
during the month
(hand regard)
Fig. 4 Holds cup & spoon well
4 Needs space to Playpen or a
turn sheet spread on

the floor to COGNITIVE DEVELOPMENT
exercise their
PRIMARY CIRCULAR REACTIONS
news kill of
rolling over Infants explore the world by mouthing objects
5 Handles rattles Objects small or by grasping. They also help them separate
well enough so that self from environment.
infant can lift
with one hand,
yet big enough SECONDARY CIRCULAR REACTIONS
that the baby
Infants begin to discover and rediscover their
cannot possibly
external environment.
swallow
6 Enjoys bathtub Rubber toys OBJECT PERMANENCE
toys, rubbering for such as ducks;
teething teething rings 10-month-old infants became aware that an
7 Likes objects that Blocks, rattles, object out of sight still exist
are good size for plastic keys;
transferring brightly colored DEVELOPMENTAL LIMESTONE
balls or toys that
rolled out of 1 MONTH
reach.
Weight gain about 150- 210g/week during the
8 Enjoys Toys made of
1st 6 months.
manipulation, rough or smooth
rattles and toys of items such as Can turn head side to side when prone
different texture velvet, fur, etc
9 Needs space for Toys that go Lifts head momentarily from bed
creeping inside one Primitive reflexes still present
another; pots
and pans that Hands closed
stack.
10 Games like patty- Peek-a-boo; Eye movements coordinated most of the time
cake and peek-a- can clap; play - follows light to midline
boo patty-cake
11 Cruise or walk Visual acuity 20/100
along low tables
Watches face intently while being spoken to
by holding on
12 Likes toys that fit Boxes that fit Utters small, throaty sounds
inside each other; inside one
nursery rhymes; another, 2-3 MONTHS
will like pull toys as dropping blocks
Posterior fontanel closed
soon as walking into a cardboard
box; pull toys; Lift head for short time & raise chest supported
listening to on forearms
nursery rhymes
or music. Primitive reflexes fading
Plays with fingers and hands
Follows light to the periphery

Listens to sounds Sits steadily alone (8 mos.)
Social smile Pincer grasp (9 months)
Shed tears Crawls
Laughs aloud, show pleasure in making sounds Displays interest on small objects
Definite social attachments

4-5 MONTHS
Responds to own name
Drools
Has imitative and repetitive speech
Can raise both head & chest on prone (4 mos.)
10-12 MONTHS
Can roll over from abdomen to back (5 mos.)
Recognizes familiar objects and people Weight triples
Coos & gurgles when talked to With total of 6-8 teeth
Enjoys social interaction Creeping
Vocalizes displeasure when an object is taken Stands with support (10 mos.)
away Stands without support (12 mos.)
Walks with support (12 mos.)

6-7 MONTHS
Can eat from spoon and drink from cup but
Weight doubles needs help
Teething begins with eruption of 2 lower Prefers using fingers Visual acuity 20/50
incisors
Shows emotions such as jealousy, affection &
Sits with support (6 mos.) anger Fear with strangers & strange situations
Can turn over well equally from stomach or -
back - Palmar grasp (6mos) Can say 2 words with meaning
Can approach a toy & grasp it with 1 hand to Understands simple request
the other from hand to mouth
HEALTH PROMTION DURING INFANCY
Plays with feet &puts them to mouth
1. NUTRITION
Has taste preference
Object permanence Guidelines for infant feeding:

Strangers anxiety Breast milk is the most complete diet for the
1st 6 months but requires supplementation
Cries easily but laughs quickly
after Iron-fortified commercial formula is an
8-9 MONTHS acceptable alternative.
Weight Doubles Teething begins with eruption Solid foods can be introduced 6 months.
of 2 lower incisors
First food is often commercially prepared iron-
fortified cereals up to 18 months

Introduce food one at a time and allow the 7-9 MONTHS
child to eat that item for one week before
1. Introduce finger foods and cup when infant is able to
introducing another food; vegetables, fruits,
sit up.
then meats.
2. Allow infant to join family meal times 3. Allow self-
First solid foods are strained, pureed, or
feeding with supervision.
mashed.
4. Offer fluids after solid foods.
Finger foods such as toast, crackers, or raw
fruits are introduced at 6 to 8 months 5. Introduce limited amount of diluted juice in a cup.
Chopped table food or commercially prepared 6. Avoid sugary desserts and soda.
foods can be started by 9-12 mos.
10-12 MONTHS
2. GUIDELINES IN WEANING
1. Offer 3 meals and healthy snacks.
Giving up the bottle or breast for a cup is
psychologically significant. 2. Begin to wean from bottle, begin table foods.
Usually, readiness develops during 2nd half of 3. Avoid fruit drinks and flavored milk
the first year because of pleasure from 4. Allow infant to feed self with spoon.
receiving food by a spoon and desire for more
freedom and control over body and IMMUNIZATIONS
environment
If breastfeeding must be terminated before 6

EXPANDED IMMUNIZATION PROGRAM DOH
months of age, a bottle should be used to allow
for continued sucking needs; after about 6 BACILLUS CALMETTE-GUERIN (BCG)
months wean directly to a cup.
Birth or anytime after birth
HEALTH PROMOTION DURING INFANCY
1 dose
0-3 MONTHS
0.05 mL
1. Feeding only breast milk or formula for the first 6
ID
months of life.
Right deltoid region of the arm
2. Always hold infant when feeding and never prop
bottle when feeding BCG given at earliest possible age protects the
possibility of TB meningitis and other TB
3. Limit water intake to ½ to 1 oz. at a time. infections in which infants are prone.
4. Avoid use of honey or corn syrup DIPHTHERIA-PERTUSSIS-TETANUS VACCINE

(DPT)
5. Allow non-nutritive sucking (dummy/pacifier) Not for
babies who are breastfeeding nipple confusion 6 weeks
4-6 MONTHS 3 doses
1. Introduce solid foods without added salt or sugar. 0.5 mL

Give iron-fortified cereal, one type of food at a time. 4 wks interval
2. Avoid use of juice or sweetened drinks. IM
3. Feed with the use of spoon only

Upper Vastus Lateralis or outer middle third of complications of Hepatitis B. 10% of Filipinos
the thigh have Hepatitis B infection.
An early start with DPT reduces the chance of SAFETY PROMOTION AMONG INFANCY
severe pertussis
Accidents are a leading cause of death from 1
month through 2 years of age.
ORAL POLIO VACCINE (OPV)
Most accidents occur because parents either
6 weeks
3 doses ability-base
2-3 drops
COMMON HEALTH RELATED PROBLEMS
4 weeks interval
A. CONSTIPATION
Oral
Mouth Hard, dry stools that are difficult to pass or

infrequent
The extent of protection against polio is
increased the earlier the OPV is given. Keeps Usually a result of diet, may have psychological
the Philippines polio-free component
MEASLE VACCINE (AMV) Indicative of Hirschsprun
9 Mos ASSESSMENT
0.5 ml Stool withholding behavior
SC ROUTE Pain on defecation

Upper outer portion of the arms MANAGEMENT
At least 85% of measles can be prevented by 1. Increase fiber and fluid
immunization at this age.
2. If mineral oil is used, it should not be given
HEPATITIS B VACCINE
with food, it decreases the absorption of
At birth nutrients.
3 doses 3. Avoid enemas; bowel retraining should be

instituted.
0.5 ml
4. Place infant in knee
6 weeks interval from 1st dose to 2nd dose, 8
weeks interval from 2nd dose to third dose 5. chest position if distention and cramping is
present.
IM
6. History of constipation for more than 1 week
Outer middle third of the thigh or vastus lateralis should be examined for an anal fissure or tight
sphincter
An early start of Hepatitis vaccine reduces the
chance of being infected and becoming a B. DIARRHEA
carrier. Prevents liver cirrhosis and liver cancer
Frequent watery stools caused by increase
which are more likely to develop if infected with
peristalsis
Hepatitis B early in life. About 9,000 die of
Classification:

ACUTE - sudden change in the frequency and MANAGEMENT
consistency of stools
1. Eliminate offending dairy products.
CHRONIC - persists longer than 2 weeks, often
caused by chronic conditions such as 2. Administer an enzyme replacement
inflammatory bowel disease, food allergy, lactose 3. Substitute milk with lactose free milk
intolerance, etc.
4. Provide calcium and vitamin D supplements to
ASSESSMENT prevent deficiency
1. Frequent watery stools 5. May drink milk with other foods rather by itself
2. If fluid loss is severe 6. Encourage consumption of cheese or yogurt
A. Weight loss greater than 10% 7. Encourage consumption of small amounts of dairy
B. Diminished skin turgor and dry mucous foods to help colonic bacteria adapt to ingested lactose.
membranes
C. Depressed fontanels and sunken eyeballs
D. Decreased urine output
E. Irritability REFERENCES
F. Metabolic acidosis Management
3. Monitor intake and output, weight and frequency of I.

stool Weigh clean diaper (minus the weight of the clean
diaper with the soiled diaper) 1gm=1ml/cc
4. Correct fluid and electrolyte imbalance
- electrolyte count = extract blood
5. Identify causative agent and institute proper therapy
C. CONSTIPATION
Inability to tolerate lactose as a result of the

absence or deficiency of lactase, an enzyme
found in the secretions of the small intestines
that is required for digestion of lactose
ASSESSMENT
1. Symptoms usually occur after the ingestion of milk

products
2. Abdominal distention
3. Crampy or colicky abdominal pain
4. Diarrhea and excessive flatus.

INFANCY Desitin/calmoseptine/zinc oxide -
clean the area well before adding more
diaper cream.
OUTLINE 3. Exposing the diaper area to air.
4. Change of diaper brand because infant may have
I. Common Health Related Problems allergy on the material used.
II. Other Parental Concerns 5. If diaper area is covered with lesions that are bright
III. Eruption Pattern of Deciduous Teeth red, with or without oozing, last longer than 3 days,
IV. Overview of MMDST and appear as red pinpoint lesions, suspect a
fungal infection; referral to the pediatrician for
medication.
I. COMMON HEALTH RELATED PROBLEMS SPITTING
COLIC The baby who spits up a mouthful of milk 2-3 times

a day is normal.
Paroxysmal abdominal pain or cramping. May be interpreted as vomiting.
Common to infants under 3 months of age. Projectile vomiting and large amount of spitting up
Associated with excessive swallowing of air, size of each meal need attention.
nipple opening or shape of, too rapid feeding or
overfeeding, maternal diet or anxious caregiver. MANAGEMENT
ASSESSMENT 1. Burping thoroughly after feeding. Let child burp at

least 2-3 times.
1. Pulling up of arms and legs. 2. Maintain in an upright position for half an hour after
2. Red-faced crying over long period of time. feeding.
3. Presence of excessive gas
II. OTHER PARENTAL CONCERNS
ADDITIONAL NOTES:
TEETHING
- check or palpate the abdomen to see if it is bloated.
Gums are sore and tender before a new tooth
MANAGEMENT break to the surface.
Acetaminophen 10-15mg/kg every 4 hours may be
1. Watch the parent or caregiver feed the child before used
attempting to counsel. Ex. 20kg x 10 or 20 kg x 15 = 200-300mg
2. Provide smaller but frequent feedings. every 4 hours
3. Offering a pacifier may be comforting. Teething rings that can be placed in the
4. Teach the parent to burp infant after feeding. refrigerator.
DIAPER DERMATITIES (NAPPY RASH) THUMB SUCKING
Sensitive skin Begin to suck a thumb or finger at about 3 months

Urine that is left in diapers too long breaks down of age.
into ammonia. Sucking reflex peaks at 6 to 8 months.
Ammonia - a chemical that is extremely Thumb sucking peaks at 18 months.
irritating to in Thumb sucking is normal, stops by school age.
MANAGEMENT USE OF PACIFIER
1. Frequent diaper change at least every 2 hours. Depending on how parents feel about them and
2. Applying prescribed ointment.

Wean a child from a pacifier anytime after 3 months Modification and standardization of the original
of age. Denver Developmental Screening Test by Dr.
Sucking reflex is fading at 6 to 9 months. William K. Frankenburg.
Designed to detect developmental delays in
HEAD BANGING children 2 weeks 6 ½ years.
Rhythmic banging of heads against the bars of a 1. Personal social

crib for a period of time before sleeping. 2. Fine motor-adaptive
To relax and fall asleep. 3. Language
Advise parents to pad the rails of the cribs so 4. Gross motor behavior
infants cannot hurt themselves. Not an intelligence test, it is a screening instrument
A normal mechanism for relief of tension in children
of this age. normal.
SLEEP PROBLEMS REFERENCES
Due to colic or difficulty in adjusting to sleeping I.

through the night.
Delay bedtime by one hour; shorten afternoon
sleep period.
Do not respond immediately to infants at night so
that they will have time to fall back to sleep on their
own.
Provide soft toy or music so that they could play
quietly alone.
III. ERUPTION PATTERN OF DECIDUOUS

TEETH
Figure 1. Eruption Pattern of Deciduous Teeth
BABY-BOTTLE SYNDROME
A condition wherein decay of all the upper teeth

and the lower posterior teeth occurs when a bottle
is proposed continuously causing the liquid to
continuously soak the teeth.
Advise parents never to put the baby to bed with a
bottle.
If parents insist, fill it with water and use a small
nipple to minimize the amount of fluid the baby will
receive.
IV. OVERVIEW OF MMDST
Metro Manila Development Screening Test - a

simple, clinically useful tool used in the early
detection of children with serious developmental
delays.
Developed by Dr. Phoebe D. Williams.

PRESCHOOLER AND FAMILY
I. PHYSICAL/BIOLOGICAL DEVELOPMENT
OUTLINE
PHYSICAL GROWTH
I. Physical/Biological
Development Body Contour - ectomorphic (slim
II. Developmental Milestones of body built) or endomorphic (large body
Preschoolers built) handedness begins
III. Parental Concerns in Preschool
Period WEIGHT, HEIGHT AND HEAD
IV. Promotion of Health during CIRCUMFERENCE
Preschool
gains about 4.5 lb. (2 kg.) a year height
gain. 2 to 3.5 in.(6 to 8 cm) a year head
PRESCHOOL circumference not routinely measured
on children over 2
3 to 6 years of age
TEETH
PSYCHOSOCIAL THEORY
all 20 deciduous teeth present by 3
Initiative vs. Guilt years
CHARACTERISTICS OF A PRESCHOOLER
PSYCHOSEXUAL THEORY
Love to watch adults and imitate their
Phallic Stage behavior.
Very creative and curious.
COGNITIVE THEORY
Imaginary playmates are common.
Preoperational thought Period Love to tell lies and brag or boast in
order to impress others.
MORAL THEORY Love to use offensive language
Sibling rivalry at this stage is common
Pre-Conventional (Stage II) Oedipal and Electra complex can be
Fear observed.
- Castration, Body mutilation, Fear of Questions about sex should be
the dark answered honestly, at the level of their
Play understanding.
- Associative or Cooperative

Masturbation may be seen in some do provide opportunities for exploring new
not make fuss about it or punish the places or activities.
child, give toys to play or divert the
attention. III. COGNITIVE DEVELOPMENT
May exhibit genu valgus or knock-knee-
disappears with increased skeletal lack the insight to view themselves as
growth at the end of the preschool others see them
period. feel that they are always right - arguing
Length at birth is doubled at 4 years most of the time
Preschoolers are interested in sharing unaware of the property of conservation
activities with others - ability to comprehend that a procedure
Preschoolers like to imitate the roles of done two separate ways is the same
adults procedure
DEVELOPMENTAL MILESTONES OF IV. SOCIAL DEVELOPMENT

PRESCHOOLERS
sensitive and critical time for
socialization
4 years old argues a lot - aware of
role in the group
5 years old begin to develop "best"
friendships
V. MORAL DEVELOPMENT
determine right from wrong based on

their parent's rules little understanding
of the rationale of the rules
II. PSYCHOSOCIAL DEVELOPMENT VI. SPIRITUAL DEVELOPMENT
PHALLIC STAGE begin to have an elemental concept of

God enjoy religious holidays and
child learns sexual identity through religious rituals such a prayer and
awareness of grace before meals
genital area
PARENTAL CONCERNS IN PRESCHOOL
DEVELOPMENTAL TASK PERIOD
initiative versus guilt (Psychosocial I. BEAHVIOR VARIATION

Theory)
learns how to do things, doing things is Telling Tall Tales - stretching stories
desirable to make them seem more interesting

not lying but merely supplying an FEAR OF MULTILATION
expected answer
do not encourage this kind of intense reaction to even a simple injury
storytelling, help separate fact such as falling and scraping a knee do
from fiction not know which body parts are
essential and which ones can easily be
IMAGINARY FRIENDS replaced
Boys - fear of castration -are more
normal, as long as they do not take attuned with their body parts , starts to
center stage in children's minds, does identify with the same sex parent.
not prevent them from socializing afraid that if blood is taken out of their
Parents should help separate fact from body, they will all leak out dislike
imagination. invasive procedures need good
explanations on the limits of health care
DIFFICULTY SHARING procedures in order to feel safe.
start to understand that some things are

theirs and some belong to others, some FEAR OF SEPARATION OR
can belong to both a difficult concept, ABANDONMENT
needs practice to understand and learn
it III. NURSERY SCHOOL OR DAY CARE
accompany experiences with EXPERIENCE
experiences in learning property rights.
take time to prepare physically and
SIBLING RIVALRY mentally discuss school as rewarding
Jealousy of a brother or a sister ,satisfying experience
have enough vocabulary to express
how they feel, aware of family roles IV. REGRESSION
responsibilities help the to feel secure
and promote self esteem reverting to behaviors previously
outgrown, such as thumb sucking,
II. FEARS negativism, loss of bladder control,
inability to separate from parents
FEAR OF THE DARK a result of stress such as a new baby in
the family, a new school experience,
result of the heightened vivid imagination seeing frightening and graphic
monitor stimuli that the child had been television news, hospitalization, etc.
exposed to before bedtime dim night lamp remove the stress to help discontinue
can be left on this behavior
explain that nightmares are dreams -
assure that he is safe. V. DISCIPLINE
have definite opinions on things which

maybring them into opposition guide

without discouraging the child's right to offer small servings of food
n have an opinion make mealtime a happy and enjoyable
"Timeout" part of the day
offer variety of foods based on the food
VI. SPEECH PROBLEM pyramid
Broken Fluency PRESCHOOL SAFETY

repetition ,prolongation of sounds,
syllables, words Pseudo- independence attitude to
secondary stuttering - child begin to have ability to take care of their own
speak without problem ,during needs
preschool years, develops it. must be repeatedly reminded about
Simple rules to follow to resolve the problem: automobile safety
1. Do not discuss in child's presence the they imitate adults, never take
difficulty, do not label as a "Stutterer"- medicines in front of children
becomes conscious of speech patterns and
compounds the problem. DENTAL HEALTH
2. Listen with patience . Do not interrupt or fill
in a word . Do not tell to speak more slowly or start independent tooth brushing as a
to start over- make a child conscious of her daily practice
speech-broken fluency increases. drink fluoridated water or receive a
3. Talk to the child in a calm, simple way. If prescribed fluoride supplement serve
adults talk slowly to her, she sees no need to fruits rather than candies during snack
rush and so speaks more clearly. first visit to a dentist by 2.5 years of
4. Provide space for her to talk if there are age
other children in the family. Rushing to say
something before a second child interrupts is DAILY ACTIVITIES
the same as rushing to conform to adult a. Dressing
speech can dress themselves except for
5. Do not force a child to speak if she does not difficult buttons
want to. Do not ask her to recite or sing for prefer bright colors or prints may select
strangers. items that do not match
6. Do not reward her for fluent speech or b. Rest and Activity
punishher for non fluent speech. aware of their needs when they are
NOTE : Broken fluency is a developmental tired
stage in language formation, not an indication often curl up in a couch and fall asleep
of regression or a chronic speech pattern. may refuse to go to sleep because of
fear of the dark.
PROMOTION OF HEALTH DURING Promote active games - help children
PRESCHOOL develop motor skills to prevent
childhood obesity.
NUTRITION Associative or Cooperative Play - a
loosely organized group play where
not a time for fast growth membership and rules changes readily

child deals with reality, control feelings
, expresses emotions more through
action than words
Play is physically oriented but is also
imitative and imaginary.
BATHING
can wash , dry their hands , if faucet is
regulated
should not be left alone unsupervised
during bath begin to be interested in
taking showers rather than baths
REFERENCES
I.

TODDLERHOOD appetite decreases, adequate intake of all
OUTLINE nutrients is essential

head circumference increases about 2 cm
I. Development Milestone of a Toddler
II. Behavioral Characteristics during the second year
III. Parental Concerns with Toddlerhood by 2 years, chest circumference is now
IV. Promotion of Health During
bigger than the head circumference.
Toddlerhood
V. Stages of Separation Anxiety 2. Body Contour
pouchy belly
forward curve of the spine at the sacral area
DEVELOPMENTAL MILESTONE OF A TODDLER
(lordosis) waddle or walk with a wide stance.
AGE 1-3 YEARS OLD 3. Body Systems
Continue to mature
PSYCHOSOCIAL STAGE Respiration slow slightly, continue to be abdominal

Heart rate slows from 110 to 90 bpm; blood
Autonomy vs. Shame and Doubt
pressure increases to 99/64 mmHg
PSYCHOSEXUAL STAGE
Brain develops to about 90% of its adult size
Anal Respiratory System - the lumens of vessels
COGNITIVE STAGE enlarge progressively threat to lower respiratory
Tertiary Circular Reaction/Preoperational Thought infection becomes less.

Period Stomach secretions become more acid;
Pre-conceptual Stage gastrointestinal infections less common
MORAL STAGE Stomach capacity increases, can eat meals a day

Control of urinary and anal sphincters due to the
Pre-conventional Stage
complete myelination of the spinal cord
FEAR: Separation Anxiety
PLAY: Parallel Play 4. Teeth
A. PHYSICAL/ BIOLOGICAL DEVELOPMENT 8 new teeth (canines and first molars) erupt
1. Weight, Height and Head Circumference during second year
gains only about 5 to 6 lb. (2.5 kg) and 5 in. 20 deciduous teeth are present by 2.5 to 3
(12 cm.) a year years old
changes from a plump baby into a leaner,
more muscular body

B. LANGUAGE DEVELOPMENT set limits, exert external control when
Critical time for language development, necessary
rate varies Love and consistency must be considered at all
Need enough practice time fimes.
Frequently use the word "NO" manifestation of

autonomy 3. Decrease in appetite because of slower growth
rate
C. PSYCHOSOCIAL DEVELOPMENT
dawdling with meals
Recognize that they are separate individuals fetish with foods
Realize that they do not always have to do what appetite of 3-year-old more capricious than a
others want them to do 1-year-old.
Negativistic, obstinate and difficult to manage 4. Repetitive, rigid, ritualistic, stereotyped in their
behavior.
TERTIARY CIRCULAR
REACTION/PREOPERATIONAL THOUGHT PERIOD 5. Go into temper tantrums in order to control self
PRE-CONCEPTUAL STAGE and others.
Egocentrism - the inability to differentiate between
self and other. Ignore the behavior
direct them to activities that they can master
Centration - focus on one shape/thing, if circle, so
it is. 6. Need for independence without over-
protection.
Conservation - focuses on the quantity rather than
the value. reinforce desired behavior
D. COGNITIVE DEVELOPMENT be constructive, geared to teach self-control
punish immediately and appropriately for wrong
Little - the interest in trying to doing
7. Poor sense of time, time schedules revolve
discover new ways to handle objects or new
around activities, not around the clock.
results that different actions can achieve.
8. Adults should talk to toddlers at eye level.
deal more constructively with symbols
begin to use of assimilation - to change the 9. All deciduous teeth are out at 2 ½ to 3 years old.
situation to fit their thoughts. 10. Anterior fontanel closes at 12 to 18 months.
11. Tend to have a pouchy belly.

E. SOCIAL DEVELOPMENT
12. Have a forward curve at the spine at the sacral
resistant to sitting in laps and being cuddled area - lordosis
15-month old are enthusiastic about interacting with
13. Waddle or walk with a wide stance.
people
PARENTAL CONCERNS ASSOCIATED WITH
imitates things they see a parent do. TODDLER
by 2 or more years - aware of gender differences.
1. TOILET TRAINING
BEHAVIORAL CHARACTERISTICS Physical maturation must be reached before
training is possible.
1. Head strong and negativistic.
2. Active, mobile, and curious.

Sphincter control adequate when the child can independent enough to know what they want,
walk but do not have the vocabulary or wisdom to
Able to sit, squat and walk express feelings in a more socially acceptable
Able to retain urine for at least 2 hours way.
Psychological readiness occurs more often when they are tired,

unrealistic by parents, parents saying NO to
Aware of the act of elimination
requests.
Able to inform the need to defecate or urinate
3. NEGATIVISM
Desire to please the parent
Able to remove clothing do not want to do anything a parent wants them
to do
PROCESS OF TRAINING reply to every request is a definite

NORMAL PHENOMENON - a positive stage in
Bowel control develops first before bladder control.
development indicates they are learning that
Choose specific word for the act.
they are a separate individual with separate
Have a specific time and place.
needs.
Do not punish for accidents.
May use potty chair. 4. RITUALISTIC BEHAVIOR
Do not allow to use potty chair to eat or play.
way of relieving anxiety.
Do not allow to remain in potty chair for more
they will use only spoon at mealtime,
than 10 minutes.
their wash cloth at bath time, will only go outside
Praise child.
when they have their favorite cap.
Remind to wash hands.
5. DAWDLING
Do not wake the child during the night and carry the
move at their own slow-motion pace
child to the bathroom to void.
used to help develop independence and
NOTE: TODDLERS ARE INTERESTED IN TOILET
TRAINING AS AN EXPRESSION OF AUTONOMY security.
do whatever catches their attention at that
ADDITIONAL INFORMATION:
particular moment.
AGE OF ACHIEVEMENT: time is an abstract concept.
A. Bowel control - 18 months 6. DISCIPLINE
means setting rules or road signs so they will

B. Daytime bladder control - 2 ½ years
know what is expected of them
C. Night time bladder training - 3 years Punishment - is a consequence that results
from a breakdown in discipline
2. TEMPER TANTRUMS
may kick, scream, stamp feet, shout, lie on the 2 GENERAL RULES TO FOLLOW
floor or bang their heads. Parents need to be consistent

.

Rules are learned best if correct behavior is
praised rather than punishing wrong behavior 19 24 months
PROMOTION OF HEALTH DURING TODDLERHOOD 1. Use of drinking water for thirst

2. Limit fluids before meals
1. HEALTH EXAMINATION
3. Include iron and protein rich foods
tend to develop upper respiratory and ear
4. Regular meal time
infections.
brought to the health facilities only for health 25 36 months
maintenance visits and immunization.
1. Healthy food choices including
early detection of any growth and development
vegetables
delays.
2. Healthy snacks in between meals
parents should be encouraged to promote the
healthy development of independence in their
3. SAFETY
toddler.
accounts for over half of all accidental deaths
2. NUTRITION during childhood
Physiologic Anorexia is normal Supervise child

Use small plates, spoon and fork, let child feed 1. Dangers of throwing and hitting
himself
2. Safe way to interact with pets
Be calm and relax in feeding
Offer choices when possible, offer variety of 3. Street dangers
nutritious foods 4. DANGERS OF WEAPONS AND FIRES
Small, frequent feeding, provide finger foods
How to get help when feeling scared or in danger
OBJECTIVES Stranger danger
Provide adequate nutritional intake to meet Preventing access to electrical outlets, cords,
continuing G & D needs.
appliances and tools
Provide a basis for support of psychosocial
development in relation to food patterns, eating Secure gates and doors
behaviors and attitudes. Store all chemicals, cleaners, personal care
Provide sufficient calories for increasing physical
activities and energy needs. products, matches and lighters out of reach
Use of car seats
13 18 months Ensure multiple barriers to pools and hot tubs
1. Discontinuation of bottle feeding

2. Offering of textured solids in small recommendations
portions & frequent feeding Use of appropriate helmet for bike riding
3. Continued use of spoon and self-
5. DENTAL HEALTH
feeding
4. Avoid force feeding Reduce high carbohydrate snacks -promotes
5. Give healthy snacks tooth decay

High calcium for strong teeth
Tooth brushing under supervision E. Bathing
First visit to the dentist by age 2
Provide toy - rubber duck, boat, or plastic fish
6. DAILY ACTIVITIES Should not be left alone in a bath tub without
A. Dressing supervision
can put on their socks, underpants, and 7. HOSPITALIZATION

undershirt. experience fear of loss of love, fear of the
put shoes on the wrong feet, shirt and pants on unknown or fear of punishment
backwards. immobilization and isolation represent
if able to walk, need shoe soles that are firm additional crises
enough to provide protection from rough may result to regression in some cases
surfaces.
STAGES OF SEPARATION ANXIETY

B. Rest and Sleep 1. PROTEST
sleep gradually decreases as they grow older.
Prolonged crying, consoled by no one but the
starts with nap twice a day, sleep 12 hours at
parent or usual caregiver
night.
Continually asks to go home
end it with one nap a day, 8 hours sleep at night.
Rejection of the nurse or any stranger
if unable to sleep at night-omit or shorten the
afternoon nap.
2. DESPAIR
C. Play Alteration in sleep pattern
Parallel play - play alongside other children,
Decreased appetite and weight los
but not with them
Diminished interest in environment and play
Free, spontaneous, no rules or regulations
Relative immobility and listlessness
Attention span very short, like to change toys
No facial expression
frequently
Unresponsive to stimuli
Safety in selecting the type of toys
Suggested toys: play furniture, dishes, 3. DETACHMENT OR DENIAL
cooking utensils, telephone, clay, sandbox,
Cheerful, undiscriminating friendliness
toys, crayons, pounding toys, blocks, push and
Lack of presence for parents
pull toys
By age 2, imitate adult actions in their play REFERENCES
D. Elimination I.
Some toddlers smear or play with feces
Provide with play substances of similar texture
Change diapers immediately after defecation.

GROWTH & DEVELOPMENT & FAMILY PHYSICAL G & D
Annual average weight gain - 3 to 5lb. (1.3 to 2.2.kg)
OUTLINE Increase in height - 1 to 2 inches (2.5 to 5cm)
I. SCHOOL AGE & FAMILY Posture more erect

II. CONCRETE OPERATIONAL THOUGHT
III. PHYSICAL G & D By 10 years of age, brain growth is compete
IV. PROMOTION OF HEALTH
IgG and igA reach adult levels
V. PARENTAL CONCERNS
Sexual maturation
o Girls -12 and 18 years

SCHOOL AGE & FAMILY o Boys 14 and 20 years
SCHOOL AGE - 6-12 years of age Girls taller by 2 inches (5cm) or more than boys
Psychosexual Stage: Industry vs. Inferiority
Gains 28 permanent teeth between 6 and 12 years of
Cognitive stage: Concrete Operational Thought
age
Fear: Fear of replacement/ displacement in school, loss
of privacy, fear of death Central and lateral incisors; first, second and third
Play: Competitive Play cuspids; and first and second molars
LATENCY STAGE GROSS MOTOR DEVELOPMENT
6 years to puberty 6 - endlessly jump, tumble, skip and hop
It occurs at approximately between 6 years of age until can walk a straight line, ride a bicycle and skip rope
puberty
7 - quieter, gender differences are manifested in play
At this age, the child represses all the interest in sexuality
8 - more graceful, ride a bicycle well, enjoy sports
and develops social and intellectual skills.
9 - always on the go, have enough eye-hand
INDUSTRY VS. INFERIORITY
coordination.
School-age Psychosocial Development
FINE MOTOR DEVELOPMENT
Erikson
6 - can tie shoes, cut and paste well, draw a person with
Industry good details
developing a sense of competence at useful skills and 7 - concentrate on fine motor skills
tasks
eraser year- never content with what they have done
school provides many opportunities
can read regular size type well
Inferiority
PSYCHOSEXUAL STAGE
pessimism and lack of confidence in own ability to do
Latency Stage
things well
Libido appears to be diverted into concrete thinking
negative responses from family, teachers, and peers can
contribute to negative feelings PSYCHOSOCIAL DEVELOPMENT
CONCRETE OPERATIONAL THOUGHT Industry vs. Inferiority
Competitive play Industry is learning how to do things well
Inferiority is the feeling that they cannot do things they

actually can do.
SERO, ROMARATE, RUBIO, SANTOS, SILVA BSN 2D 1

A. Socialization Stay by themselves after school
6 - play in groups, when tired, prefer to 1-to-1 contact Know how to use seat belts in car and bicycle safety
around cars
7 - aware of family roles and responsibility, promises
must be kept Sexual abuse is also a common hazard for children
8- actively seek the company of other children 2. NUTRITION
9 - take values of peer group, ready for activities away With good appetite, meal is influenced by the day
from home activity
10 - enjoys privacy Food is also influenced by peers and mass media
11- increasingly interested in the opposite sex Very fond of junk foods, fast food - result to obesity
12 - feels more comfortable in social situations 3. DAILY ACTIVITIES
B. Play A. Dress
Competitive play - games with rules due to increased Can fully dress themselves
mental abilities
Have definite opinions about clothing styles often based
Like athletic competition due to increased motor ability on likes of friends or a popular sports or rock star
Boys and girls play together, gradually separate into sex- C. Exercise
oriented type of activities
Need daily exercises like games, walking with parents,
Language Development or bicycle riding.
6 - talk in full sentences, use language easily and with D. Hygiene

meaning
6-7 - need help in regulating bath water temperature and
7 - can tell the time in hours, months in cleaning ears and nails
9 - like to tell dirty jokes, use swear words to express 8- capable of bathing, become interested in showering
anger
E. Care of the teeth
12- with a sense of humor, can carry on adult
conversation Should visit a dentist at least twice yearly
Emotional Development PARENTAL CONCERNS
- has the ability to trust others 1. SCHOOL EXPERIENCE
- with a sense of respect for their own worth Adjusting to grade school is a big task
-can accomplish small tasks independently (sense of Health assessment should include an inquiry about
autonomy) progress in school
MORAL & DEVELOPMENT DEVELOPMENT Biggest task is learning to read
Pre-conventional stage 2. LATCHKEY CHILDREN
Concrete on Children who are without adult supervision for part of

each weekday
Cannot see yet the highest level of moral reasoning
3. DISCIPLINE
Begin to learn about rituals and meaning behind their
religious practices Punishments are avoided, withdrawal of privileges is
used
Distinction between right and wrong becomes important
Parents should be consistent in implementing discipline
4. DISHONESTY BEHAVIOR/STEALING
PROMOTION OF HEALTH
Occurs when a child is gaining an appreciation for
1. SAFETY money, but not yet balanced by strong moral principles.
Ready for time on their own without direct adult Important of property rights should also be reviewed
supervision

5. ACQUISITION SKILLS B. Aggressive temperament
Biggest tasks is learning to read C. Parents who are indifferent, permissive with an aggressive
child, may resort to physical punishment
Prepare the school age child for this by reading to them
since infancy D. Presence of a child who is a natural victim.
6. DENTAL HEALTH
A. Dental caries
Progressive, destructive lesions or decalcification of the REFERENCE

tooth enamel and dentin
I. MS. PUNO
Preventable with proper brushing, use of fluoridated
water or fluoride application
B. Malocclusion
Deviation from the normal alignment of the teeth,

congenital or related to conditions such as cleft palate, a
small lower jaw, or other familiar traits
7. SEX EDUCATION
Educate about pubertal changes and responsible sexual

practices
Sex education should be incorporated into health

education
8. SCHOOL HEALTH
A. Anxiety related to beginning school
Adjusting to grade school is a big task
Spend time with child after school or in the evening, to

feel secure in the family and does not feel pushed out by
being sent to school
B. School phobia
Fear of attending school
May develop physical illness such as vomiting, diarrhea,

headache, or abdominal pain on school days
Management
1. coordination among the school, school nurse and health

care provider who can diagnose the problems
2. Parents must make proper preparations for school
9. INJURY PREVENTION
Parents should be able to talk to their children about a

disaster plan for the family for the major effect of
increasing a feeling of safety
10. BULLYING
Frequent reason for feeling so unhappy
Traits commonly associated with school-age bullies:
A. Advanced physical size and strength for their age

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NCM 207 Lecture 1 PDF

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GOALS AND PHILOSOPHIES PF MATERNAL AND 4.

Both nursing theory and evidence-based practice

PRECONCEPTUAL HEAL CARE STANDARD II: PERFORMANCE APPRAISAL. The nurse

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should define his or her own needs.

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2. CHROMOSOMAL ABNORMALITY DISORDERS

RISK FACTORS OF GENETIC DISORDER

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Fig 2. The needle is inserted to the abdomen up to the

2. Laboratory and diagnostic studies

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Gonadotropin Releasing Hormone

Fig 2. Parts of the sperm cell

Androgen Binding Protein

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2 almond shaped glands

3-4 inches long 5. CERVIX

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2. BARTHOLIN OR VULVOVAGINAL GLAND

Produces fluid to the stimulation

3. SKENE OR PARAURET HRAL GLAND

Is NOT an accessory gland

INTERNAL PART OF THE UTERU

Fig 6. Internal Part of the Uterus in Lateral view

Uterus = overlying into the urinary bladder and rectum

This is the process in which there is formation and

Fig 5. Internal Part of the Uterus

The layers of the uterus are an outer perimetrium, middle

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Provides for the MENSTRUATION

Fig 7. Oocytes / fertilized egg Inhibits production of FSH

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Hypothalamus senses the decrease, thus

Body structures involved in menstrual cycle:

Hypothalamus C. Secretory / Luteal Phase (16-28)

Decrease level of estrogen and increase

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4. Placental and Fetal development

I. Power point presentation

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Embryo - 1st 15 days

(3rd to 8th Week) - Major organs of the

The Pregnancy duration has a three Fetus

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Abortion - The fetus is delivered

Different types of abortion

Fig 5. The external feature of the fetus is already in

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Fig 6. Rapid Growth of the Fetus and has a coordinated

During this week external Reproduction is already

Fig 7. There is already osification of the skeleton