NCM 107 – CARE OF MOTHER, CHILD, ADOLESCENT (WELL CLIENT)

→ Preventing further complications from an illness;

FRAMEWORK OF MATERNAL AND CHILD HEALTH NURSING
DEFINITION
• Obstetrics: Greek word means ostare, which means “to
keep watch”
• Pediatrics: Greek word pais, meaning child
PRIMARY GOAL
“Promotion and maintenance of optimal family health to ensure
cycles of optimal child bearing and child rearing”
bringing back to optimal state of wellness or
helping client to accept inevitable death.
MILLENNIUM DEVELOPMENT GOALS (MDGS)
▪ The United Nations Millennium Declaration, signed in
September 2000, commits world leaders to combat poverty,
hunger, disease, illiteracy, environmental degradation, and
discrimination against women.

The range of practice includes:

• Preconception health care
• Care of woman during three trimesters of pregnancy and
the puerperium.
• Care of children during the perinatal period (6 weeks
before conception to 6 weeks after birth.
PHILOSOPHY OF MATERNAL AND CHILD HEALTH NURSING ▪ Goal #4 target of reducing under-five mortality. Still,
• Care of children from birth through adolescent. some 40,000 Filipino newborns die every year. Half of
• Care in settings as varied as the birthing room, pediatric these die in the first two days of life.
intensive care unit, and the home. ▪ To dramatically reduce the number of fatalities, The
• Maternal and child health nursing is family centered, Department of Health implemented the Essential
assessment data include a family and individual Newborn Care Protocol (ENC) on December 7, 2009 under
assessment. Administrative Order 2009-0025.
• Maternal and child health nursing is community ▪ Immediate drying, Uninterrupted skin-to-skin contact,
centered; the health of families depends on and Proper cord clamping and cutting and non-separation of
influences the health of communities. the newborn from the mother for early breastfeeding
• Maternal and child health nursing is research oriented, initiation and rooming-in has the potential to avoid
because research is the means whereby critical knowledge approximately 70% of newborn deaths due to preventable
increases. causes.
▪ OUTCOME
• A maternal and child health nurse serves as an advocate
to protect the rights of all family members, including the
fetus.
• A maternal and child health nursing includes a high
degree of independent nursing functions, because
teaching and counselling are needed.
• Promoting the health is an important nursing role this
protects the health of the next generation.
• Pregnancy can be stressful and can alter family life in
both subtle and extensive ways.
• Personal, cultural and religious attitudes and beliefs
influences the meaning of illness and its impact to the
family.
• Maternal and child health nursing is a challenging role for
a nurse and its major factor in promoting high-level
wellness in families.
FRAMEWORK FOR MATERNAL AND CHILD HEALTH NURSING CARE
Maternal and child Health Nursing can be visualized within a WHO 17 SUSTAINABLE GOALS
framework in which nurses can:
• Use nursing process
• Nursing theory
• Evidence-based practice
• Care for families during child bearing and child rearing
FOUR PHASES OF HEALTH CARE
• Health promotion
→ Educating clients to be aware of good health
teaching and role modelling.
• Health Maintenance
→ Intervening to health when risk of illness is present.
• Health Restoration → The Sustainable Development Goals (SDGs) are also known as
→ Intervening to health when risk of illness is present. the Global Goals. The SDGs are new, universal set of goals,
• Health Rehabilitation targets and indicators that UN member states will be

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 expected to use to frame country agendas and policies over
the next 15 years.
→ LEAVE NO ONE BEHIND. This is what guided world leaders of
193 countries to solving the globe’s most pressing problems of
today
→ Targets:
• Reduce the global maternal mortality ratio to less than
70 per 100,000 live births
• End preventable deaths of newborns and children
under 5 years of age, with all countries aiming to ⎯ Orchidopexy is a surgery to move a testicle that has
reduce neonatal mortality to at least as low as 12 per not descended or moved down to its proper place in
1,000 live births and under-5 mortality to at least as the scrotum
low as 25 per 1,000 live births
PENIS
• Serves as the outlet for both the urinary and the
ANATOMY AND PHYSIOLOGY OF MALE REPRODUCTIVE SYSTEM
reproductive tract in men
EXTERNAL STRUCTURES
• Composed of 3 cylindrical masses of erectile tissue in
• Includes the penis, scrotum, testes
penis shaft: 2 corpus cavernosa, corpus spongiosum.
• The urethra passes through the layers of erectile tissue
➢ Corpus cavernosa
➢ Corpus spongiosum
➢ Urethra

SCROTUM
• Rugated, skin-covered, muscular pouch suspended from
the perineum
• Supports the testes and help regulate the temperature
of the testes to promote the production and viability
of the sperm.
• During very cold weather, the scrotal muscle contract
to bring the testes closer to the body, in very hot
weather or in the presence of fever, the muscle relaxes,
allowing the testes to fall away from the body. ISCHIOCAVERNOSUS MUSCLE
• helps stabilize the erect penis and (in females) tense
TESTES the vagina during orgasm.
• Two ovoid glands, 2-3 cm wide, that lie in the scrotum • Ischiocavernosus compresses the penis, and retards the
• Each testes is composed of a number of Leydig’s cells return of the blood through the veins, and thus serves
and seminiferous tubule. to maintain the organ erect.
• Leydig’s cell are responsible for production of the male
hormone testosterone
• Seminiferous tubules produce spermatozoa.
• Within each lobe are 3 to 10 coiled tubules, called
seminiferous tubules, which produce the sperm cells.
• Testis is slightly larger than the other and slightly
lower in the scrotum than the other (slide pass each
other on sitting or muscular activity

• Spermatozoa does not survive in temperature as high

as that of the body.
• Testes in fetus first form in the pelvic cavity, then
descend late in the intrauterine life (34th and 38th)
into the scrotal sac
• Male preterm may have undescended testes
(cryptorchidism)

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 INTERNAL STRUCTURES
• Epididymis
• Vas deferens (Ductus deferens)
• Seminal vesicles
• Ejaculatory ducts
• Prostate gland
• Bulbourethral glands
• Urethra
EPIDIDYMIS
• is responsible for conducting sperm from testis to vas
deferens
• Narrow tightly coiled tube, approximately 2o ft long
• It takes at least 12-20 days for the sperm to travel the
length of the epididymis, 64 days to mature
⎯ Because the epididymis is so narrow, an infection can
easily led to scarring of lumen that prevent passage
way of the sperm. It takes 12-20 days for sperm to
travel and 64 days to mature, this is one reason why
decrease in sperm is problem that does not respond
immediately to therapy but rather only after two
months.
• Sperm is immobile and incapable of fertilization as
they pass or are stored at the epididymis level
➢ Aspermia
➢ Oligospermia (20 million sperm/mL)
VAS DEFERENS (DUCTUS DEFERENS)
• Additional hallow tube surrounded by arteries and
veins and protected by a thick fibrous coating.
• Vas deferens and blood vessels together are referred to
as the spermatic cord.
• Carries the sperm from epididymis through the inguinal
canal into abdominal cavity, where it ends at the
seminal vesicles and the ejaculatory ducts.
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VARICOCELES
➢ enlargement of the veins within the scrotum.
VARICOCELECTOMY
➢ a surgery performed to remove those enlarged veins.
VASECTOMY
➢ is a surgical procedure for male sterilization or
permanent contraception.
➢ vasa deferentia are cut and tied or sealed so as to
prevent sperm from entering into the urethra and
thereby prevent fertilization of a female through sexual
intercourse.
SEMINAL VESICLES
• are two pouches that lie along the lower portion of the
posterior surface of bladder and empty into the
urethra by way of the ejaculatory ducts.
• These glands secrete a viscous portion of the semen,
which has a high content of a basic sugar, protein and
is alkaline.
• Sperm become increasingly motile with added fluid and
nutrient and more favorable ph.
EJACULATORY DUCTS
• The two ejaculatory ducts pass through the prostate and
join in the seminal vesicles to the urethra
PROSTATE GLAND
• Is a chestnut sized gland that lies below the bladder.
• Secretes a thin alkaline fluid, this alkaline fluid further
protects the sperm from being immobilized by the
naturally low ph level of the urethra.
BULBOURETHRAL GLANDS (COWPER’S GLANDS)
• The two bulbourethral glands lie beside the prostate
gland and empty by a short duct into urethra.
• Like seminal vesicles, and prostate gland, they secrete
an alkaline fluid that helps counteract the acid
secretion of urethra, and ensure safe passage of
spermatozoa.
Semen is derived from the prostate gland (60%), seminal vesicles
(30%), epididymis (5%), and the bulbourethral glands (5%);
alkaline and contains basic sugar and mucin (protein)
➢ Normal amount of semen per ejaculation: averages
2.5ml= 1 tsp
➢ Number of sperms in an ejaculate: 50-200 million/cc or
400 million per ejaculation
➢ Sperms are capable of being fertilizing even for 3-4
days after ejaculation.
➢ Sperms, once deposited in the vagina, will generally
reach the cervix 80 seconds and the outer end of
fallopian tube within 5 after deposition.
URETHRA
• Hallow tube leading from the base of the bladder, to
the outside through shaft and glans penis
• Approximately 8 in (18-20 cm) long.
ANATOMY AND PHYSIOLOGY OF FEMALE REPRODUCTIVE SYSTEM BARTHOLIN’S GLANDS (VULVO-VAGINAL GLANDS)
EXTERNAL STRUCTURES • Are located just lateral to the vaginal opening
• Mons Veneris • Ducts open in the distal vagina
• Labia Minora
• Labia Majora
• Vestibule
• Urethra
• Vagina
• Clitoris
• Skene’s glands (paraurethral glands)
• Bartholin’s Glands (Vulvovaginal glands)
• Fourchette SKENE’S GLANDS (PARAURETHRAL GLANDS) AND BARTHOLIN’S
• Perineal muscle/ body GLAND
• Hymen • Secretions from both of these glands help to lubricate
the external genitalia during coitus
• Alkaline ph of their secretion helps improve sperm
survival in the vagina.
• Both may become infected and produce a discharge and
local pain

MARSUPIALIZATION

MONS PUBIS OR MONS VENERIS

• pad of fat which lies over the symphysis pubis,
• Covered by triangle of course, curly hair
• Protects the junction of pubic bone from trauma
LABIA MAJORA
• Two folds of adipose tissue, covered by pubic hair
• Serves as protection for the external genitalia, the
distal urethra and vagina
• They are fused anteriorly but separated posteriorly
LABIA MINORA
• Two hairless folds of connective tissue;
• Before menarche, fold are fairly small, child bearing
age becomes firm and full, after menopause they
atrophy and become much smaller again
• Pink in color
• Internal structure is covered with mucous membrane
and external surface is covered with skin
• Abundant sebaceous gland, sebaceous cyst may occur
CLITORIS
• Is a small (1-2cm), rounded organ of erectile tissue at
the forward junction of the labia minora.
• Sensitive to touch and temperature, the center of
arousal and orgasm in female.
• Comparable to penis for being sensitive to sexual
manipulation.
• during sexual arousal, arterial blood supply increases,
and venous outflow is blocked, leading to clitoral
erection.
TWO SKENE’S GLANDS (PARAURETHRAL GLANDS)
• Located just lateral to the urinary meatus, one on each
side
• Ducts open in the urethra
FOURCHETTE
• Is the ridge of tissue formed by the posterior joining of
two labia minora and the labia majora
• This is the structure that is sometimes cut during child
birth to enlarge vaginal opening
PERINEUM
• Posterior to the fourchette is the perineal muscle
• Muscular area, easily stretched during childbirth to
allow passage of fetal head
• Contains muscles which support the pelvic organs, the
pudendal artery that supply blood, and pudendal
nerves which are important during delivery under
anesthesia
• Episiotomy – is performed during the second stage of
labor by making an enlarged opening so that baby can
pass out easily.
• Exercises to make perineal muscles flexible to allow the
optimal expansion during birth to prevent tearing of
tissue
➢ Kegel exercise
➢ Squatting
➢ Tailor sitting

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VULVAR BLOOD SUPPLY
• Pudendal artery and a portion of the inferior rectus
artery– blood supply of the external genitalia
• PUDENDAL VEIN – venous return
• VARICOSITIES – pressure of the pudendal vein by the
fetal head that cause extensive back-pressure
• Easily cause large hematomas and rapid healing of any
tears in the areas following birth
• VESTIBULE - Is flattened smooth surface inside the
labia
• URETHRAL MEATUS - External opening of the urethra
• VAGINAL ORIFICE - External opening of the vagina,
covered by a thin membrane(hymen) in children
INTERNAL STRUCTURES
• Fallopian tubes
• Ovaries
• Uterus
• Ovaries
• Fallopian tubes
• Uterus
OVARY
• Approx. 4 cm long by 2 cm in diameter and 1.5cm thick,
size or shape of an almonds
• Located close to and on both sides of the uterus in the
lower abdomen
• The ovaries of girls are small but become larger after
puberty.
• They also change in appearance from smooth surface,
dull white organ, to pitted grayish dull organ to pitted
gray organs.
• This pitting is caused by scarring due to ovulation
• On the surface you can see ovum that is about to be
discharge, and the low corpus luteum or the structure
left after the ovum has been discharge.
➢ since this is located on lower portion of abdomen it
is difficult to identify its location. If an
abnormality is present such as ovarian cyst, the
resulting tenderness, may be evident on the lower
left or lower right
• The ovaries are held suspended and in close contact
with the end of the fallopian tubes.
• They are unique among pelvic structure, in that they are
not covered by peritoneum
➢ Because they are suspended rather than being
firmly fixed in place, abnormal tumor growing on
them can enlarge to a size twice the ovary before it
leads to symptoms of compression. This is why
ovarian cancer continues to be one of the leading
causes of death in women.
Functions:
1. Produce mature and discharge ova
2. Produce estrogen and progesterone and initiate and
regulate menstrual cycles.
PROGESTERONE
• is often called the hormone of pregnancy
ESTROGEN
• Estrogen responsible for the maturation and
maintenance of secondary sexual characteristics of
females;
• Estrogen prevents osteoporosis, or weakness of bone due
to withdrawal of calcium from the bones
• Estrogen tends to reduce cholesterol level because it is
incorporated in the production of estrogen.
➢ Estrogen also prescribed in menopausal women to
prevent osteoporosis.
➢ Long term estrogen therapy, may contribute to
breast cancer.
• Estrogen prevents bone breakdown
• Osteoporosis: loss of bone density, bones become, brittle
and fragile, may lead to fracture,
• Estrogen decreases cholesterol level, thus preventing
atherosclerosis, plaque formation in the artery causing
occlusion of the artery.
• One risk factor in devt of breast cancer is exposure to
estrogen due to menstruation, early menarche and late
menopausal contribute
DIVISION OF REPRODUCTIVE CELLS
Maturation:
• Oocyte is surrounded by a protective sac of cells—
follicles; immature ova
• Under develop follicle-premordial follicle.
• One definition of menopause “no functioning oocytes
remain in the ovaries”
• Underdeveloped state—primordial follicle
FALLOPIAN TUBE
• Arise from each upper corner of the uterine body

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 • it opens at the distal end next to an ovary
• Approx 10 cm in length in mature women
• Fallopian tube is open at their distal ends, that makes
conception possible, however can lead to infection of
peritoneum if germs spread from uterus to peritoneum
Function: convey the ovum from the uterus and to provide a
place for fertilization of the ovum by the sperm
ANATOMICALLY DIVIDED INTO A PART:
• Interstitial portion – most proximal portion and lies
within the uterine wall, 1 cm in length, 1mm in diameter
• Isthmus – next distal part, extremely narrow, 2cm
length; part of the tube that is cut or sealed in a tubal
ligation
• Ampulla – 3rd and longest portion, 5 cm; Fertilization
occurs
• Infundibulum – most distal part, 2 cm, funnel-shaped;
The rim of the funnel is covered by fimbria (small hair)
that helps to guide the ovum into the fallopian tube
LINING THE FALLOPIAN TUBE:
• Inner Mucous Membrane (mucus secreting and ciliated
cells)
➢ Ciliated cells (hair covered)
➢ Peristaltic motion helps the help conduct the
ovum the length to the tube. This migration is
aided by the action of ciliated lining and the
mucus, which act as lubricant and nourishment
(water, protein and salts.)
• Connective Tissue and Circular Muscle Layer – produce
peristaltic motion
UTERUS
• Hollow muscular, pear-shaped organ located in the
lower pelvis, posterior to the bladder and anterior to
the rectum
• At childhood- olive-size
• 8 years of age, increase in size of uterus begins
• Maximum increase in size at 17 yrs. old
• Mature: 5 to 7 cm long, 5 cm wide, widest upper part is
2.5cm deep, weighs 60 grams
FUNCTIONS TO RECEIVE THE OVUM FROM THE FALLOPIAN TUBE
• Receive the ovum from the fallopian tube provide a
place for implantation nourishment during fetal
growth protection to growing fetus & at maturity of the
fetus, expel it from the woman’s body.
3 DIVISIONS ANATOMICALLY:
1. Body/ corpus
• uppermost part forming the bulk of the uterus
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• Fundus- points of attachment of the fallopian
tube
➢ During pregnancy, the body of uterus is the
portion of the structure that expands to
contain the growing fetus
➢ Fundus is the area palpated to determine the
uterine growth occurring during pregnancy, to
measure the uterine contractions during labor,
and if uterus s returning to its pre pregnant
state after child birth
2. Isthmus
• short segment between the body & the cervix
• 2 mm in length
• Also enlarges to accommodate the growing fetus
• Most commonly cut during CS delivery
3. Cervix
• lowest portion of the uterus,
• approximately 2-5 cm long
• Central Canal: central cavity
• Internal Cervix: at the junction of isthmus
• External Cervix: the distal opening to the vagina.
LININGS OF THE UTERUS:
• Endometrium
➢ inner layer; menstrual function and childbirth
➢ 2 layers
⎯ Basal layer- closest to the uterine wall, not
influenced by hormones
⎯ Glandular layer – inner layer, greatly
influenced by estrogen and progesterone;
grows and become thick—shed if no
pregnancy occurs
• Endocervix
➢ Mucous membrane that lines the cervix cervical
lining secretes mucus, to provide a lubricated a
lubricated surface so that the spermatozoa can
readily pass the cervix, mucus is an alkaline, this
helps decrease the acidity of the vagina, aiding
sperm survival secretes mucus depends on the
stimulation of the hormones.
➢ At the point in the in the menstrual cycle when
estrogen level is peak, 700ml of mucus is produced
per day. When estrogen level is low, few milliliters is
produced.
• Myometrium
➢ Muscle layer of the uterus
➢ 3 interwoven muscles functions:
⎯ Constrict the tubal junction, thus prevent the
regurgitation of menstrual blood to the tube
⎯ Hold the cervical os during pregnancy
⎯ Uterine contraction to expel fetus during
delivery
⎯ Constrict blood vessel after birth
• Perimetrium
➢ outer one of connective tissue
➢ Provides additional support and strength to the
structure
DEVIATION IN SHAPE and push milk forward into the ducts that lead to the
• Bicornuate – oddly shape “horns” at the junction of nipple.
the fallopian tube. • Milk is produced in the acinar cell and deliver it to the
• Septum dividing uterus nipple by lactiferous duct
• Double uterus • Nipple is surrounded dark pigmented are approximately
• Any of these may result to decrease ability to conceive 4 cm in diameter, areola
• Montgomery’s tubercle – sebaceous glands surrounding
the areola
• Blood supply is profuse because it is formed by thoracic
branches of the axillary, internal mammary, and
intercostal arteries
• Nipples appears rough on the surface because of
Montgomery tubercle
• Increase blood supply is important in bringing the
nutrients to the milk glands, and makes it possible to
produce plentiful supply of milk during breast feeding
• However, it also aids in spread of breast cancer. Self-
breast examination is no longer advise but a yearly
breast examination by the professional.
DEVIATION IN POSITIONS
• Anteversion- fundus is tipped forward
• Retroversion – fundus is tipped back
• Anteflexion – body of the uterus is bent supply forward
at the junction with the cervix
• Retroflexion – body is bent sharply back just above the
cervix

VAGINA
• a hallow, Musculo membranous canal located posterior
to the bladder and anterior to the rectum
• conveys sperm to the cervix so that the sperm can meet
with the ovum in the fallopian tube
• Contains folds or rugae, it expands at the end of
pregnancy to allow passage of baby
• Folds or rugae makes vagina elastic to enable the
passage of full-term baby without tearing
• Women is instructed not to use douche or spray on a
regular basis because it alters the ph, may result to
infection
• After menopause the ph becomes alkaline resulting to
frequent infection
• Ph is acidic, detrimental to the growth of pathologic
bacteria
• Mucus produced in the by vaginal lining has a rich
glycogen content, when glycogen is broken down by
lactose fermenting bacteria Doderlein’s bacillus, lactic
acid if form
BREAST
Mammary glands
• Located anterior to the pectoral muscle
• Nipple is composed of erectile tissue, on stimulation, it
transmits sensation to the posterior pituitary gland to
release oxytocin which acts to constrict milk gland cells

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