MATERNAL 1

THE FAMILY AND FAMILY HEALTH

The family has traditionally been a central focus of nursing. As the basic unit of society,
the family profoundly influences its individual members.
Definition of family
The definitions of family are as diverse as families themselves and the
situations they are found in. Viewed simply, the definitions can be
categorized in two ways:
1. Structural definitions of the family - define the
characteristics of family members such as those who share a place of
residence, or who are related through blood ties or legal contracts.
“a householderand one or more other persons living in the same household who are
related to the householder by birth, marriage, or adoption”
2. Functional Definitions of the Family – away from blood relationships or a legal
definition
and focus instead on the functions families perform
a family is any unit in which there exists:
Sharing of resources and economic property
A caring and supportive relationship
Commitment to or identification with other family members
Preparation of children born to or raised by the members to
become adult members of the society
Family dynamics refer to the patterns of interactions between family
members. It also includes the family alignments (closer connections) and
hierarchies (positions of power), roles, and ascribed characteristics. They
are influenced by things like the structure of the family, the personalities of
each family member, cultural background, values, and personal or family
issues (e.g. divorce).
Family structure is the number of children and adults and how they are
related.
TYPES OF FAMILY STRUCTURES:
1. Dyad Family
Consists of two people living together, usually a woman and a man
without children
Ex) newly married couple
Also refers to single young same sex adults who live together as a
dyad in shared apartments, dormitories, or homes for
companionship and financial security while completing school or
beginning their careers.
2. Cohabitation Family
 Composed of heterosexual couples and perhaps children who live
together but remain unmarried
Although such a relationship may be temporary, it may also be as
long-lasting and as meaningful as a more traditional alliance.
3. Nuclear Family

Composed of husband, wife, and children.

Traditionally it is the most common structure seen worldwide.
4. Polygamous Family
Polygamy – a marriage in which a spouse of either sex may have
more than one mate at the same time.
Middle Easterners
types of polygamy:
a. Polygyny – a marriage with having more than one wife
b. Polyandry – a marriage with having more than one
husband.
5. Extended (Multigenerational) Family
An extended family includes not only the nucleus family but also
other family members such as grandparents, aunts, uncles, cousins,
and grandchildren.
6. Single-Parent Family
A single parent is a parent who cares for one or more children
without the assistance of the other biological parent.
married couples divorce, or as unmarried couples have children.
7. Blended Family
A remarriage or reconstituted family, a divorced or widowed person
with children marries someone who also has children.
8. Communal Family
Communal families are formed by groups of people who choose to
live together as an extended family.
9. Gay or Lesbian Family
In homosexual unions, individuals of the same sex live together as
partners for companionship, financial security, and sexual fulfillment.
10. Foster Family
Children whose parents can no longer care for them may be placed
in a foster or substitute home by a child protection agency.
11. Adoptive Family -Many types families adopt children today.
No matter what the family structure, adopting.
Family functions are described as:
1. Affective
o One of the most vital and focuses on meeting family member’s
needs for affection and understanding.
2. Socialization
o This refers to the learning experiences provided within the family
to teach children their culture and how to function and assume
adult social roles and is a lifelong process.
3. Reproductive
o This ensures family continuity over the generations and the
survival of society.
4. Economic
o Involves the family’s provision and allocation of sufficient
resources.
5. Health care
o This is met by the provision of such physical necessities like
food, clothing, shelter, and healthcare.

UNIVERSAL CHARACTERISTICS OF FAMILIES

1. A family is a social system. –
The family is a group of individuals who are interdependent; the choices and
actions of one family member often influence other family members.
2. A family perform certain basic function –
Each member of the family has a responsibility towards other family
members, towards family and towards society.
3. A family has structure-
reflects relationships of members of a household who are
linked by biological relatedness, marital and partnership status, and
living arrangements.
4. A family has its own values and rules
Family is bound to run by certain family and social regulations.
These various rules called taboos, customs, laws etc., vary in
different cultures.
5. A family moves through stages its life cycle
The development of the family consists of the family life cycle, a
series of stages that encompass roles and tasks. A family passes
stages such as marriage, birth of children, children leaving home,
the “empty nest”

Characteristics of a healthy family

Physical maintenance: A healthy family provides food, shelter,
clothing, and health care for its members.
Socialization of family members: A healthy family involves preparing
children to live in the community and to interact with people outside
the family.
Allocation of resources: In healthy families, there is justification,
consistency, and fairness in the distribution of resources.
Maintenance of order: In healthy families, members know the family
rules and values and respect and follow them.
Division of labor: Healthy families evenly divide the work load
among members and are flexible enough that they can change
workloads as needed.
Placement of members into the larger society: Healthy families
realize that they do not have to operate alone but can reach out to
other families or their community for help when needed.
Maintenance of motivation and morale: Healthy families are able to
maintain a sense of unity and pride in the family.
 (1) MARRIAGE :beginning families (the establishment phase),
Task: a. establish a mutually satisfying relationship
b. learn to relate well to families of orientation
c. if applicable, engage in reproductive life planning
2) The childbearing families (the transition to parenthood),
Task: birth of first child; new role as parents; integrating new
family member into the existing family
3) families with preschool children,
Task: establishing family network; socialization of children;
reinforcing independence in children when separating from parents
4) families with school children,
Task: facilitating peer relationships while maintain family dynamics; adjusting to
outside influences
5) families with teenagers –
Task: Increase in children’s independence and autonomy;
parents concern shift to aging parents, career, and marital
relationships
(6) families as launching centers The Family with a Young Adult (from
departure of first child to last child)
Task: Readjustment of marital relationships; parents and
2children establish separate identities outside the family unit
(7) families in the middle years(after children have left home)
Task:1. Adjusting to the body’s physical and physiological changes.
2. Adjusting to the reality of the work situation
3. Helping children leave home and become responsible
adults
4. Maintaining
(8) aging families/ retirement or older age
Task: End of career, shift to retirement functioning during the
aging process, maintain marital relationship, adjust to
potential loss of spouse, friends, and siblings, prepare for
eventual death.

FAMILY ROLES:
Nurturing figure– primary caregiver to children or any
dependent member.
Provider – provides the family’s basic needs.
Decision maker– makes decisions particularly in areas such as
finance, resolution, of conflicts, use of leisure time etc.
Problem-solver– resolves family problems to maintain unity
and solidarity.
Health manager– monitors the health and ensures that members return to health
appointments.
Gate keeper- Determines what information will be released from
the family or what new information can be introduced.
members return to health appointments.

PROCREATIVE HEALTH
Procreation is defined as the sexual activity of conceiving and bearing offspring.
Reproduction is usually defined as the action of making a copy of something, or
the production of offspring by sexual intimacy.
THEORIES RELATED TO PROCREATION
1.) Biblical Statement of Procreation
Psalm 127:3 says, “Behold, children are a heritage from the LORD, The fruit of the
womb is a reward”
2.) The Natural Law Theory
Humans have a natural drive to eat, drink, sleep and procreate. These actions are
in accord with a natural law for species to survive and procreate.
3.) Stork Theory and Sexual Reproduction Theory
Two different theories exist concerning the origin of children: the theory of sexual
reproduction, and the theory of the stork.

PROCESS OF HUMAN REPRODUCTION

Egg to Embryo to Fetus: The Reproduction and Development Process
In the reproductive process, a male sperm and a female egg provide the
information required to produce another human being. Conception occurs when
these cells join as the egg is fertilized. Pregnancy begins once the fertilized egg
implants in the uterus.

RISK FACTORS THAT WILL LEAD TO GENETIC DISORDERS

TERMINOLOGY:
Some specific terms from the field of genetics are important for describing
chromosomal anomalies:
Genetic disorders are disorders caused by abnormalities in one or more genes or
chromosomes. Some genetic disorders are hereditary and others are spontaneous.
Hereditary genetic disorders are passed down from generation to generation.
Spontaneous genetic disorders are not passed down from one generation to
another, but they occur when genetic material in the father’s sperm or mother's egg
cells or in the cells of the developing embryo is damaged by chance or by drugs,
chemicals, or other damaging substances (such as x-rays).
Genetics is the study of the way such disorders occur.
Cytogenetics is the study of chromosomes by light microscopy and the method by
which chromosomal aberrations are identified.
Chromosomes are structures within cells that contain a person's genes.
Genes are the basic units of heredity that determine both the physical and
cognitive characteristics of people. Composed of segments of DNA
(deoxyribonucleic acid), they are woven into strands in the nucleus of all body cells
to form chromosomes.
Phenotype refers to the outward appearance or the expression of genes.
Genotype refers to the actual gene composition. It is impossible to predict a
person’s genotype from the phenotype, or outward appearance.
Trisomy - an extra chromosome
Monosomy - a missing chromosome

RISK FACTORS:
a.) Old age
b.) multifactorial inheritance (abnormalities in one or more genes plus
exposure to certain other factors)
c.)There is a family history of a genetic disorder.
d.) Had a baby born with birth defect or a stillborn baby
e.) Previous miscarriages
f.) One parent has a chromosome abnormality.
 g.) Parents who are closely related or part of a distinct ethnic or living at
the same geographic location

COMMON CHROMOSOMAL DISORDERS RESULTING IN PHYSICAL OR

COGNITIVE DEVELOPMENT DISORDER
There are three types of genetic disorders:
Single-gene disorders, where a mutation affects one gene. Sickle cell anemia is
an example.
Chromosomal disorders, where chromosomes (or parts of chromosomes) are
missing or changed. Chromosomes are the structures that hold our genes. Down
syndrome is a chromosomal disorder.
Complex disorders, where there are mutations in two or more genes. Often your
lifestyle and environment also play a role. Colon cancer is an example.

NONDISJUNCTION ABNORMALITIES.
Chromosomal abnormalities. A nondisjunction abnormality occurs during the meiosis stage of
cell division, when sperm and ova halve their number of chromosomes.
Ex.) Turner syndrome, Klinefelter syndrome (47XXY), Down syndrome (trisomy 21)

DELETION
This is when part of a chromosome is missing, or part of the DNA code is missing.
Ex.) CRI-DU-CHAT SYNDROME or Cat’s Cry is due to a missing piece (deletion) of a specific
part of chromosome 5 known as the 'p' arm.

TRANSLOCATION
This is when a chromosome segment rearranges from one location to another. It can
happen either within the same chromosome or move to another chromosome.
Ex.) A Translocation Down syndrome.

MOSAICISM
Mosaicism is an abnormal condition that is present when the nondisjunction disorder
occurs after fertilization of the ovum, as the structure begins mitotic (daughter-cell) division.
If this occurs, different cells in the body will have different chromosome counts.
Ex.) Mosaic trisomy 21.

ISOCHROMOSOMES
If a chromosome accidentally divides not by a vertical separation but by a horizontal one,
a new chromosome with mismatched long and short arms can result.

DIAGNOSTIC TESTS TO DETERMINE GENETIC ABNORMALITIES

1. Karyotyping -
When chromosomes are photographed and displayed, the resulting arrangement is
termed a karyotype. The number of chromosomes and specific parts of
chromosomes can be identified by karyotyping or by a process termed
fluorescent in situ hybridization (FISH).

2. Maternal Serum Screening (MSS)

The maternal serum screening test is a blood test offered to pregnant women to
measure the levels of 4 different chemicals that are present in their blood:

3. Chorionic Villi Sampling (CVS)

Chorionic Villi Sampling is a diagnostic technique that involves the retrieval and
analysis of chorionic villi from the growing placenta for chromosome or DNA
analysis.

4. Amniocentesis
Amniocentesis is the withdrawal of amniotic fluid through the abdominal wall for
analysis at the 14th to 16th week of pregnancy.

5. Percutaneous Umbilical Blood Sampling (PUBS)

Percutaneous Umbilical Blood Sampling (PUBS) or Cordocentesis is the removal
of blood from the fetal umbilical cord at about 17 weeks using an amniocentesis
technique.

6. Fetal Imaging
Fetal imaging thru Magnetic Resonance Imaging (MRI) and ultrasound are
diagnostic tools used to assess a fetus for general size and structural disorders of
the internal organs, spine, and limbs.

7. Fetoscopy
Fetoscopy is the insertion of a fiberoptic fetoscope through a small incision in the
mother’s abdomen into the uterus and membranes to visually inspect the fetus for
gross abnormalities.

8. Preimplantation studies
Preimplantation studies also called preimplantation genetic diagnosis (PGD), is a
specialized technique that can reduce the risk of having a child with a particular
genetic or chromosomal disorder.
9. Newborn screening
Newborn Screening is used just after birth to identify genetic disorders that can be
treated early in life such as phenylketonuria