Maternal 1

CARE OF MOTHER, CHILD, &
2nd Year, 1st Semester

ADOLESCENT (WELL CLIENTS) FINALS
PREPARATION FOR CHILDBIRTH AND PARENTING
ASSESSING A WOMAN’S PREPARATION FOR LABOR 4. Prenatal Yogaa

• Plan for birth attendant and setting in mind 5. Perineal and abdominal Exercises
o Birth attendant – OB Gyne, midwife, anyone who helps 6. Pelvic Floor contraction
them in the labor process 7. Abdominal Muscle Contraction
• Prepared to use imaging or focusing 8. Pelvic Rocking
o Listening to music for focus, looking at pictures, basta 9. Birthing Aids
anything to help them focus and stay calm
• Breathing exercises to reduce pain during labor GOOD RULES TO FOLLOW
o Yoga, walking, breathing, exercises, abdominal/perineal • Always rise from the floor slowly to prevent feeling dizzy from
exercises, tailor sitting (parang Indian sit), pelvic-rocking orthostatic hypotension
(for back ache) • To rise from the floor, roll over to the side first and then push up
• Flexible lumbar spine from pelvic rocking to avoid strain on the abdominal muscles or round ligaments
• Strengthened abdominal muscles in preparation for labor because this can cause intense pain
• Strengthened perineal muscles from tailor sitting • To prevent leg cramps when doing leg exercises, never point
the toes (extend the heel instead)
• To prevent back pain, do not attempt exercises that
hyperextend the lower back
• Don not hold your breath while exercising, because this
increases intra-abdominal and intrauterine pressure
• Do not continue with exercises if any danger signal of
pregnancy occurs
• Never exercise to a point of fatigue
• Never practice second-stage pushing. Pushing increases
intrauterine pressure and could rupture membranes
PRECONCEPTION
VISITS
CHILDBIRTH PLAN
• Choice of setting
• Birth attendant NUTRITION PRENATAL VISITS
• Special needs – extent of family participation they wish during
labor
• Birthing positions Green leafy veggies Meat, tofu, and WK 8 TO 28
WK 28 TO 36
• Medication options (analgesic for respiration) (folic acid) – spine beans (protein) – 1 prenatal visit a
1 visit every 2 wks
and brain tissue month
• Plans for the immediate postpartum period
• Baby care
• Family visitation Iron & calcium rich
3RD TRIMESTER
1 visit every week to
food monitor contractions
All of these must be done at least 1 month before the dues date
ULTIMATE GOAL : healthy baby and baby’s parents CLASSES

1. Expectant Parenting
SITTING POSITIONS & EXERCISES TO PRACTICE • For couples early in pregnancy
1. Tailor Sitting • Focus is on a woman’s health
• Stretches perineal muscles to make them more supple. • TOPICS : psychological, physical change, nutrition, routine
Notice that the legs are parallel so one does not compress health care such as dental checkups, and newborn
the other. A woman could use this position for television
watching, telephone conversations, or playing with an older
child.
2. Squatting
• Squatting helps to stretch the muscles of the pelvic floor.
Notice the feet are flat on the floor for optimal perineal
stretching
3. Pelvic Rocking
• Helpful for relieving backache during pregnancy and labor.
To do this, the woman first hollows her back and then
arches it
(1) (2) (3)
2. Breastfeeding
• To help women learn more about breastfeeding
• Breastfeeding for at least 6 months following their child’s
birth
• Physiology of breastfeeding as well as the psychological
aspects
TRANSCRIBED BY: @wondeulz on twitter

• Positive effects in uterine contraction and there will be a • Effleurage – gentle massaging on the abdomen (or other parts
decrease in getting hemorrhage of the body) ; circular movement ;
• Note that it is painful to continue breastfeeding kapag di na
talaga kaya esp to the point na the nipple is bleeding
3. Preparation for Childbirth Classes

• Focus mainly on explaining the psychological and
physiologic changes that occur with childbirth
• To prevent or reduce the pain of childbirth
• Exercises to ready the body of labor
• Prenatal yoga, perineal and abdominal exercises, tailor
sitting, squatting, pelvic floor contractions (kegel exercises),
abdominal muscles contractions, pelvic rocking, birthing
aids
METHODS TO MANAGE PAIN IN CHILDBIRTH

• Taught in the prenatal period related to the gating control • Focusing imagery –
method of pain relief • Second-stage breathing –
• Concepts are stressed:
a) Labor should begin on its own, not be induced. PREPARATON FOR CESAREAN BIRTH
b) Women should walk, move around, and change positions • Scheduled or an emergent procedure
throughout labor. • Establishing surgical risk, including an assessment of nutritional
c) Women should bring a loved one, friend, or doula for status, age, general health, fluid and electrolyte balance, and
continuous support. psychological condition
d) Interventions that are not medically necessary should be • Vital sign determination; urinalysis; blood studies such as
avoided. complete blood count, electrolytes, blood typing, and cross-
e) Women should be allowed to give birth in other positions matching; and ultrasound
than on their back and should follow their body's urges to • Adequate pain management is important to allow a woman a
push. sense of control and comfort and bonding with her newborn
f) Mother and baby should be kept together after birth; it is • Provide rest time to relieve the physical strain and a chance to
best for the mother, for the baby, and for breastfeeding verbalize the experience to help relieve the psychological strain
• Understands the process of labor and birth, they can enter labor • Early ambulation to prevent complications. Incisional pain may
with decreased tension make this difficult, so strong nursing support and adequate pain
• Concentrating on breathing patterns or imagery management are necessary
• Conditioned reflexes
BIRTH SETTING
BRADLEY METHOD (PARTNER-COACHED) 1. Choosing a birth attendant and support person
• Robert Bradley • Obstetrician, family practitioner, nurse-midwife
• Based on the. Premise that pregnancy and childbirth are
joyful, natural processes and that a woman's partner should 2. Choosing a birth setting
play an active role during pregnancy, labor, and the early • The Hospital Birth, labor-birth recovery-postpartum rooms
newborn period. (LBRPs). Alternative Birthing Centers, Home Birth
• Encouraged to walk as a disassociation technique o LBRP = Labor Birthing Recovery and Post-Partum
• Reduces pain in labor by abdominal breathing Room
DICK-READ METHOD 3. Children attending birth

• Grantly Dick-Read • If children will be present, a person separate from the main
• Fear leads to tension, which leads to pain. support person needs to be designated to provide
entertainment, explanations, food, and a place for them to
• Focusing on abdominal breathing during contractions
nap.
LAMAZE PHILOSOPHY
HOSPITAL BIRTH SETTING
• Ferdinand Lamaze
• Experience a healthy and joyous birth experience, regardless of
• Based on the gating control theory of pain relief
her age or circumstances
• Stimulus-response conditioning, women can learn to use
• Give birth as she wishes in an environment in which she feels
controlled breathing to reduce pain during labor
nurtured and secure
• Psychoprophylactic method by use of the mind
• Have access to the full range of options for pregnancy, birth,
and nurturing her baby
EXTRA :
Ø Psychosexual Method • Receive accurate and up-to-date information about the benefits
- Sheila Kitzinger and risks of all
- The method stresses pregnancy, labor and birth, and the • Procedures, drugs, and tests suggested for use during
early newborn period are some of the most important pregnancy, birth, and the
points in a woman's life. • Postpartum period, with the right to informed consent and
- Encourage a woman to "flow with" informed refusal
• Receive support for making informed choices about what is best
LAMAZE CLASSES for her and her baby
• Conscious relaxation – you aim for the muscles to loosen up; • Based on her individual values and beliefs
support person needs to put a therapeutic touch on the body
and then tell the patient to relax Contractions → birthing room → LBRPs →
• Cleansing breath – pts are prone to hyperventilation (you
breathe out too much co2 and you lack o2) or hypoventilation
Delivery process → Postpartum Care
(kabaligtaran ng hyperventilation) ; rapid breathing pattern can
interfere with the O2 supply
• Consciously controlled breathing –slow breathing to rapid ;
breathing has smth to do with the dilatation of the cervix
(wide=faster breaths)

NURSING DX
1. Health-seeking behaviors related to learning more about
childbirth and newborn care
2. If there is a lack of a support person, the following diagnoses
might apply:
• Ineffective coping related to lack of a
• Support person.
• Anxiety related to absence of significant other.
3. For a couple unable to decide about a childbirth setting, an
appropriate diagnosis might be decisional conflict related to lack
of information about advantages and disadvantages of various
childbirth settings.
4. If there are older children in the family, a nursing diagnosis
might be anxiety related to sibling role in pending birth event
Ø Semi-fowler’s is more comfortable daw for the mommy
and sibling ability to welcome a new family member.
ALTERNATIVE METHODS OF BIRTH
OUTCOME IDENTIFICATION & PLANNING
a. Leboyer Method
• Goals that are set should seem both realistic and flexible.
b. Hydrotherapy & Water Birth
c. Unassisted birth • Assure them that learning about medications or other methods
to reduce the pain of childbirth does not mean they have to use
LEBOYER METHOD one or the other of these methods.
• Frederick Leboyer
IMPLEMENTATION
• The birthing room is darkened so there is no sudden contrast in
• Referring couples to a childbirth preparation course can provide
light
many answers for them in a sympathetic group setting, where
• The environment is kept pleasantly warm, not chilled
feelings and anxieties can be shared.
• Soft music is played, or at least harsh noises are kept to a
• Be certain a woman has thought through arrangements for
minimum
transportation to the hospital or birthing center and for child care
• Infant is handled gently if she has other children at home
• The cord is cut late • Be certain a woman who anticipates a home birth has organized
o Supplies more WBC her home and purchased supplies for birth well in advance of
• The infant is placed immediately after birth into warm bath her expected due date.
water.
o Reduce respi and increased levels of acidosis (?) OUTCOME EVALUATION
• The couple states they feel prepared for childbirth.
HYDROTHERAPY AND WATER BIRTH
• The patient states she feels confident she can use breathing
• Reclining or sitting in warm water during labor can be soothing; exercises for contractions as long as 70 seconds.
the feeling of weightlessness that occurs under water as well as
• The patient has made preparations for a doula to support her
the relaxation from the warm water both can contribute to
during labor.
reducing discomfort in labor
• The sibling states she is ready to welcome a new brother or
• DISADVANTAGE: water bath may become contaminated
sister into the family.
• The couple states they were well prepared for birth and that it
UNASSISTED BIRTH
was both a satisfying and a growth experience for them.
• Free birthing, or couples birth refers to women giving birth
without healthcare provider supervision
• Natural process that no medical supervision is necessary.
• Usually in rural areas where health care centers / hospitals are
super far (like need pa nila mag boat or smth)
• Differs from home birth because sa home birth, meron paring
assistance pero ito, as in mag-isa ka lang talaga
• No one can supervise and oversee if may complications ba
• DISADVANTAGE: potentially dangerous
• Woman with Disability

• Woman with Cultural Concerns
• Woman who is Obese
NURSING CARE PLANNING TO RESPECT CULTURAL

DIVERSITY
• The advice of a friend or family member carries more weight
than the advice of a professional healthcare practitioner.
• Certain women are fully informed about the options available
are two ways to be certain all women receive as much advice
and knowledge as they wish about childbirth.
• Who women choose as a support person or coach in labor also
differs depending on one’s cultural background
NCP :
Ø Increase the proportion of pregnant women who attend a series
of prepared childbirth classes (Developmental).
Ø Increase the proportion of pregnant women who receive early
and adequate prenatal care from a baseline of 70.5% to a target
of 77.6%.
Ø Increase the proportion of women delivering a live birth who
received preconception care services and practiced key
recommended preconception health behaviors

ADOLESCENT (WELL CLIENTS) PRELIMS
GENETIC ASSESSMENT AND COUNSELING
OUTLINE NATURE OF INHERITANCE

I. Definition of Terms
II. Respect to Cultural Diversity
III. Nature of Inheritance
IV. Genetic Counseling & Testing
V. Assessment for Genetic Disorders
VI. Reproductive Alternatives
VII. Legal and Ethical Aspects of Genetic Screening and
Counseling
VIII. Common Chromosomal Disorders Resulting in Physical or
Cognitive Developmental Disorders
DEFINITION OF TERMS
GENETICS
• Study of the way such disorders occur
GENES
• Basic units of heredity that determine both the physical and
cognitive characteristics of people.
Genome: Phenotype vs If (+) excess or missing result to
GENETIC DISORDER Genotype abbreviation (huh)
• Can be passed from one generation to the next because they Normal Genome: 46XX / 46YY
result from some disorder in the gene or chromosome structure.
• May occur due to occupational hazards, toxic substances in the MENDELIAN INHERITANCE
environment of workplaces • Dominant and recessive
• Gregor Mendel – Genetic Inheritance
CYTOGENETICS • The principles of genetic inheritance of disease are the same as
• Study of chromosomes by light microscopy and the method by those that govern genetic inheritance of other physical
which chromosomal aberrations are identified characteristics
• Karyotyping, IVF, Stem cells • Heterozygous – 2 different genes ( Yy + yY )
o Dominant manifests more
CHROMOSOMES o Brown eyes (D) + Blue eyes (R) = Brown eyes
• Are threadlike structures of nucleic acids and proteins found in • Homozygous – 2 like genes ( YY + yy )
the nucleus of most living cells, carrying genetic information in o H. Dominant – (YY + YY)
the form of genes. o H. Recessive – (yy + yy)
• We have 46 chromosomes
GENETIC COUNSELING AND TESTING
RESPECT TO CULTURAL DIVERSITY • Provide concrete, accurate information about the process
of inheritance and inherited disorders
ETHNICITY DISORDER DESCRIPTION • Reassure people who are concerned their child may inherit a
Body makes less particular disorder that the disorder will not occur
Greek or Blood disorder B-
hemoglobin than • Allow people who are affected by inherited disorders to make
Mediterranean thalassemia
normal informed choices about future reproduction
Inherited blood • Allow people to pursue potential interventions that may exist
disorder that such as fetal surgery
Philippines or causes body to • Allow families to begin preparation for a child with special needs
Thalassemia
SEA countries have less than • Serves as support + health teaching for them – offer them info
hemoglobin than & alternatives for them to decide what is right for them
normal
Red blood cells are NOTE : information revealed in genetic screening be kept confidential
African Sickle-cell anemia shaped like sickles
or crescent moon. COMMON CONCERNS
Absence of an 1. Patient is anxious to have her fetus’ health confirmed: “Why do
enzyme that helps I have to wait so late in pregnancy for genetic studies by
breakdown fatty amniocentesis?”
substances, called - Done on skin cells obtained from the amniotic fluid
Eastern Jewish Tay-Sachs Disease gangliosides - 15 to 18 wks of pregnancy (requires enough amount of
amniotic fluid)
A deterioration of
muscle and mental 2. Why do laboratory take so long to return karyotyping results
facilities - The laboratory is necessarily done during the center phase
of division
• Most of these are manifested through blood - New techniques are available– hence, results are available
• Ex: Monarchy – incest – blood diseases – may problem na sa sooner’
may chromosomes (kasi related yung genes) – hemophilia
3. Should I undergo karyotyping even if we do not have any family
history of inherited disease ?
- Not routinely recommended, unless there is evidence or

suspicion of genetic disease in the family

- Karyotyping reveals only diseases present on

chromosomes
- Doesn’t guarantee a newborn will not be ill in a non-
inherited way
Ex of teratogen : alcohol, cigs, recreational substances
The more closer the couple are (genetically), it increases the risk of
them having a child who has a chromosome disorder
(consanguineous)
- We cannot impose ; it’s our duty to help and serve alternatives
- We can respect it by respecting their decision
Couples who are most apt to benefit from a referral for genetic
testing or counseling include
Ø A couple who has a child with a congenital disorder or an
inborn error of metabolism.
Ø A couple whose close relatives have a child with a genetic SCREENING AND DIAGNOSTIC TESTING
disorder such as a chromosomal disorder or an inborn error • Before pregnancy
of metabolism. o DNA analyzing or karyotyping
Ø Any individual who is a known carrier of a chromosomal • During pregnancy
disorder. o Trimester nuchal translucency
o Hormonal screening
ideal time for discussing whether the possibility of a genetic o cfDNA (cell free DNA) testing
disorder exists is before a first pregnancy at a preconception health o Quadruple test analysis
visit o CVS (chronic villi sampling >35yo / abnormal genetic
testing)
ASSESSMENT FOR GENETIC DISORDERS o Amniocentesis (>35yo / abnormal genetic testing)
§ 15 to 18 wks
HISTORY o Percutaneous umbilical blood sampling (PUBS)
• Obtain information and document diseases in family members o Sonography
for a minimum of three generations. Include half brothers and
sisters or anyone related in any way as family. NOTE : >35yo may be offered a more accurate noninvasive blood test
• Mother's age, consanguineous, ethnic background = screen for Chromosomal disorders
• Child is born dead, parents are advised to have a chromosomal
analysis and
• Autopsy performed on the infant
• Age (mother 23 above; father 55 above)
• Ethnic background
• Consanguinity
• History of infertility (procedures used, if successful or not)
• If couple doesn’t know, you can tell them na they can ask their
relatives for info
• Get accurate info by getting medical records (tell them the
importance why u need it)
PHYSICAL ASSESSMENT
• Pay particular attention to certain body areas, such as
o The space between the eyes (inner & outer canthus – check
if slightly upward or downward)
o The height, contour, and shape of ears
o The number of fingers and toes
o Sole of the feet
o Presence of webbing because these often suggest
structural genetic disorders
• Dermatoglyphics – the study of surface markings of the skin
• Fingerprints, abnormal palmar creases, hair whorls, or coloring
of hair are also present with some disorders
• Close assessment: born at < 35 weeks gestation ; multiple
congenital anomalies

partner’s sperm in the

laboratory and implanted into a
woman’s uterus.
A woman who agrees to be
alternately inseminated,
Surrogate Mother typically by the male partner’s
sperm, and bear a child for the
couple
FUTURE POSSIBILITIES
STEM CELL
• Immature cells from a healthy embryo (stem cells) could be
implanted into an embryo with a known abnormal genetic
makeup, replacing the abnormal cells or righting the affected
child’s genetic composition
o They study the cell structure first ; they extract the healthy
cells from a healthy embryo and replace them dun sa may
abnormal genetic makeup
o Genetic manipulation
• Is it ethical to change the life course of a fetus who has no rights?
Is it ethical to use embryo cells as a source of stem cells?
LEGAL AND ETHICAL ASPECTS OF GENETIC SCREENING AND

COUNSELING
• Participation by couples or individuals in genetic screening must
be elective. – we can’t just force them
• People desiring genetic screening must sign an informed
consent for the procedure – consent !!!
• Results must be interpreted correctly yet provided to the
individuals as quickly as possible. – couples feel anxious kaya
give the info to them directly, asap
• The results must not be withheld from the individuals and must
be given only to those persons directly involved. – wag ibibigay
sa relatives dapat sa couple lang mismo
• After genetic counseling, persons must not be coerced to
undergo procedures such as abortion or sterilization. Any
procedure must be a free and individual decision. – we shouldn’t
impose !!
Failure to heed these guidelines could result in charges of invasion

of privacy, breach of confidentiality, or psychological injury caused
TERMINATION by “labeling”
• Decision making (CVS or amniocentesis)
• Support if couple does not want to go through the pregnancy COMMON CHROMOSOMAL DISORDERS RESULTING IN
• Can result in a long-lasting depression PHYSICAL OR COGNITIVE DEVELOPMENTAL DISORDERS
REPRODUCTIVE ALTERNATIVES
• Helping them to realize viable alternatives for having a family • Trisomy 13 Syndrome / Patau’s Syndrome
exist can allow them to seek the help they need o 47XX13
o 13 yung excessive chromosome
An option for couples if the o Cleft lip
genetic disorder is one o Cognitive level : severely cognitive
Alternative Insemination by inherited by the male partner or • Trisomy 18 / Edwards Syndrome
Donor is a recessively inherited o 47XY18
disorder carried by both o Lower chances of survival in the infancy period as
partners compared to those who have Trisomy 13
Inherited problem is one arising o 18 yung excessive chromosome
from the female partner. o Cognitive level : severely cognitive
• Cri-du-chat
Surrogate Embryo Transfer The Oocyte is donated by a o 46XX5P or 46XY5P
friend or relative or provided by o Defect chromosome is 5
an anonymous donor, which is o Cat sound cry (very distinct)
then fertilized by the male o Narrow & elongated head

o Eyes are slanted
• Klinefelter Syndrome
o Problem w/ secondary sex characteristics (including
pubic hair)
o Excessive X chromosome
o Mostly on males
o 47xxY
o Ineffective amount of sperm
o Gynecomastia – soggy (?) male breast → increases risk
for breast cancer
• Turner Syndrome / Gonadal Dysgenesis
o 45XO – only has 1 functional chromosome
o Stature is quite short
o They have problem with their reproductive – can get
pregnant but they undergo estrogen therapy to reproduce
(3 out of 4 wks irregular)
§ Starts at 13 y/o
o Long life – can reach the age of adulthood
o Wide neck – has extra flap of skin (not muscle)
o Decreased level of estrogen = low calcium levels
o There are moments where they do not have bleeding
(irreg cycle)
o They don’t have pubic hair
o Diagnostic Test : IVF, surrogacy
• Trisomy 21 Syndrome / Down Syndrome
o 21 stands for the number of chromosomes
o Higher risk if they were born by mothers aged 35 above
o COGNITIVE
§ Still very functional – nurses must encourage
parents and patient to enhance the child’s skill
§ IQ level is 50-70
§ Early childhood development classes !
o FACE
§ Large protruding tongue – due to narrow or smaller
oral cavity
• Risk for choking – teach to eat slowly
§ Brushfield spots – White specks sa eyes
§ Eyes are slanted
§ Ears are lower
o Back part of the head is flat
o Neck (back part) has extra fat (you wont be able to identify
the edge of the head and yung connection sa neck)
o Can develop heart prob (aortic stenosis) ; joints are
hyperflexible + more joint mobility than average
o Simian Line
• Fragile X Syndrome
o Protein synapses response problem
o 46XY23Q
o Maladaptive behaviors during childhood or before puberty
(aggression, autism, hyperactive)
o Cognitive level : delayed speech
o High, broad forehead
o Immunofunction is decreased – prone to developing
o Big, protruding ears
diseases or infection (teach proper hygiene)
o Obese
§ Risk for getting URTI (upper respi tract infection)
§ Risk of developing leukemia
o Kaya magkakamukha is bc of their chromosomes
o Muscle tone problems – neck is short

§ Even if they skills for sports (Paralympics) they still
need to get their cray bc of their neck
o Diagnostic test : fetal sonogram
• Hands and feet for newborn – presence of edema
• Decreased function of heart and kidneys

ASSESSMENT
• Family Hx
• Physical Examination
• Laboratory Assays
• Chronic Villi sampling (CVS)
NURSING DIAGNOSIS
• Decisional conflict related to continuation of genetic-affected
pregnancy
• Fear related to outcome of genetic screening tests
• Situational low self-esteem related to identified chromosomal
disorder
• Deficient knowledge related to inheritance pattern of the family's
inherited disorder
• Readiness for enhanced knowledge related to potential for
genetic transmission of disease
• Altered sexuality pattern related to fear of conceiving a child with
a genetic disorder
OUTCOME IDENTIFICATION AND PLANNING

• Assessment
• Counseling
• Short term goals
• Follow up
• Healthcare personnel/ provider
• Support people
IMPLEMENTATION
• Parental reactions
• Support couple
OUTCOME EVALUATION
• Couple states they feel capable of coping no matter what the
outcome of genetic testing.
• Patient accurately states the chances of a genetic disorder
occurring in her next child.
• Couple states they have resolved their feelings of low self-
esteem related to birth of a child with a genetic

GROWING FETUS
STAGES OF FETAL DEVELOPMENT o This is where ectopic pregnancy happens (most of the
• 38 weeks = ovum matures (single cell → fully developed fetus times)
ready to be born) o Ectopic = outside the uterus
o Ovum is a fertilized egg • Only 1 ova will reach maturity & the mature ovum will be
released
THE THREE PERIODS OF FETAL GROWTH AND o Fertilization will occur quickly kasi 24 to 40 hours lang
DEVELOPMENT pwede yung ovum (sperm is as long as 72 hrs)
Pre-Embryonic First 2 weeks (begins w/ fertilization) o More than the certain time, it will be atrophied (wasted)
Embryonic Wk 3 to 8 • The total critical time span during which sexual relations must
Fetal Wk 8 to birth occur for fertilization to be successful is about 72 hours (48
hours before ovulation plus 24 hours afterward
DEFINITION OF TERMS • SPECIES-SPECIFIC REACTION = sperm are drawn toward an
OVUM Ovulation to fertilization ovum (similar to antibody-antigen reaction)
ZYGOTE Fertilization to implantation • CAPACITATION = final process for sperm before being ready
EMBRYO Implantation to wk 5-8 for fertilization
FETUS Wk 5-8 until term o This is the part where sperm heads are chemically
Earliest age at which fetuses could survive if changed kaya they become hyperactive
AGE OF they were born at that time o This reveals the sperm-binding receptor sites
VIABILITY o All sperms that achieve this reach the ovum and cluster
24 wks / if fetus weights >400 g around corona radiata
• Hyaluronidase – proteolytic enzyme that is released by
SEQUENCE OF EVENTS sperm and dissolves layer of cells that protect the ovum
https://www.youtube.com/watch?v=_5OvgQW6FG4&ab_channel=N o One reason that an ejaculation contains such a
ucleusMedicalMedia large number of sperm is probably to provide
sufficient enzymes to dissolve the corona cells.
1. Sexual intercourse → sperm enters vagina • Only ONE spermatozoon is able to penetrate ovum cell
a. Some flow out membrane (then, the membrane will change its composition
b. Some die in its acidic environment so other sperm cells wont enter)
c. Many survive bc of a protective fluid surrounding • EXPEPTION TO THE RULE : Formation Of Hydatidiform
them Mole
2. Sperm passes through cervix (it’s open if woman is o Multiple sperm cells enter the ovum
ovulating) tas papunta uterus o Abnormal zygote is formed
a. Many die sa may mucus area thingy or sa folds
ng cervix Fertilization is NOT a certain occurrence
3. @ uterus – muscular uterine contractions assist sperm
a. Immune system cells destroy other sperm cells 1. Equal maturation of both sperm & ovum
(kala foreign body) 2. Ability of sperm to reach ovum
4. Separation – half papunta sa empty fallopian tube, half 3. Ability of sperm to penetrate z. pellucida and
papunta sa tube w/ unfertilized egg cell membrane
5. @ FT – cilla pushes sperm towards uterus (so like parang
gusto nila mag-backing si sperm)
a. Sperm must surge against this motion to reach • Ovum is removed from graafian follicle (@ovary) with ovulation
the egg –– surrounded by zona pellucida & corona radiata
b. Chemicals cause the membrane @ sperm head • They are propelled into the opening of a fallopian tube (with
to change at mas magiging hyperactive (faster help of fimbriae kasi it propelled them there)
na) • The cilia and its movements within the tube help the ovum
6. Sperm reaches the egg move further
7. Membrane covering (corona radiata) → outer layer of egg • From the zygote(ovum is already fertilized), both child +
(zona pellucida) → attachment to sperm receptors accessory structures like placenta, fetal membranes, amniotic
¨ Zona pellucida – mucopolysaccaride flud fluid, umbilical cord are formed
¨ Corona radiate – circle of cells o Has 46 chromosomes (23 from sperm + 23 from ovum)
¨ These are both protective buffers of the the ovum o XX – female
against injury o XY - male
8. Acrosomes are triggered → digestive enzymes are
released → sperm is burrowed 1. Blastocyst (fertilized egg) will make its way to the uterus
9. @ inside Z. Pellucida → first sperm to make contact with 2. Cells in the egg arrange themselves
fluid filled space will fertilize the egg (siya ang champion) a. Inner
10. Single sperm attaches to membrane ; their membranes
fuse and the egg pulls the sperm inside IMPLANTATION
11. No more sperm can attach (chemicals are released) ; zona • Contact between the growing structure and the uterine
pellucida hardens and traps other sperms ; outside the egg, endometrium, occurs approximately 8 to 10 days after
wala na makaka enter ng z.p fertilization.
12. Genetic material is created → 23 chromosomes
13. Cilia and FT gently sweep the zygote (!!!!) towards uterus EVENTS AFTER FERTILIZATION
for implantation @ uterine lining 1. Zygote travels toward the body of the uterus for 3-4 days
- Currents (due to F.T muscular contractions) help in moving
FERTILIZATION the zygote
• 24 – 72 hours - Zygote = a fertilized ovum has 46 chromosomes.
• Aka conception and impregnation - Child has 2 x chromosomes (xx) = female
• Union of an ovum and a spermatozoon - if a y-carrying sperm (xy) child = male
• LOCATION : outer third of a fallopian tube (amuplla)

THE GROWING FETUS
2. Mitotic cell division begins

- @ 24 h – first cleavage
- 1 cleavage division every 22 hours
- By the time the zygote reaches the body of the uterus, it
consists of 16 to 50 cells.
3. Zygote can be called “Morula”

- Morus (latin) = mulberry
- Bumpy outward appearance
- Morula continues to multiply as it floats free in the uterine
cavity for 3 or 4 additional days.
4. Structure becomes a blastocyst and will attach to uterine wall /

endometrium soon
- Large cells tend to collect at the periphery of the ball,
leaving a fluid space surrounding an inner cell mass.
Ø Outer ring – they are trophoblast cells; will from the placenta
and membranes
Ø Inner cell mass – embryoblast cells ; it will form the embryo
5. Uterine endometrium attachment

Ø Target Point: High in the uterus; posterior surface
Ø If low implantation = growing placenta may occlude the
cervix and make birth of the child difficult (placenta previa)
6. Touching or implantation points !!

- Contact between the growing structure and the uterine
endometrium
- 8-10 days after fertilization = usually high in the uterus on
the posterior surface. DIFFERANTIATION & IMPLANTATION
7. Occasionally, a small amount of vaginal spotting appears on the

day of implantation because capillaries are ruptured by the
implanting trophoblast cells.
- Women w/ scant menstrual flow may mistake this as
bleeding for her period
- If this happens, the predicted date of birth of her baby
(based on the time of her last menstrual period) will be
calculated 4 weeks late.
8. After implantation, zygote → embryo

TROPHOBLAST INVASION
TRAVELLING AND FLOATING
• 8 days
Implantation invasion
EMBRYONIC AND FETAL STRUCTURES

Amazing Animation of a Fetus Growing in the Womb
https://www.youtube.com/watch?v=W_twY PeBSRg
Development of the embryo

THE GROWING FETUS
https://www.youtube.com/watch?v=dgPCD XmcQjM o @ fetal intestine –– absorbed into fetal blood

stream → umbilical arteries → placenta and it is
DECIDUA exchanged across the placenta
• Corpus luteum in the ovary continues to function because
of the influence of HCG / Human Chronic Gonadotropin DEVELOPMENT OF ORGAN SYSTEMS
o HCG = hormone secreted by trophoblast cells • All organ system are complete at 8 weeks gestation. During
• Endometrium continues to grow in thickness and early time of organogenesis, the growing structures is most
vascularity and is now termed decidua vulnerable
AREAS OF THE DECIDUA PRIMARY GERM LAYER – each germ layer develops into specific
body system
Part of the endometrium that lies directly
Decidua basalis DEVELOPMENT OF EMBRYO
under the embryo.
Part that stretches or encapsulates the
Decidua capsularis GASTRULATION – cell mass of blastocyst starts differentiating to
portion of the trophoblast
form the primary germ layers
Decidua vera Remaining portion of the uterine lining.
• Established the body pattern
During birth entire surface of uterus is stripped away (risk for
hemorrhage & infection)
CHORIONIC VILLI
• Mini villi / probing “fingers” reach out to endometrium
• 11th or 12th day
• Surrounded by a double layer of trophoblast cells
LAYERS
Needed in the production of

hormones
• HCG
• Somatomammotropin
Syncytial Layer (Outer layer) 1. Primary Germ Layers
• hPL / human placenyal
lactogen a. Inner - Endoderm
b. Middle - Mesoderm
• Estrogen
c. Outer – Ectoderm
• Progesterone
2. Embryo is now called the gastrula
Presents as early as 12 days 3. Each tissue an organ of the adult originates in one of the
gestation three layers
4. Organogenesis – development of major organ systems
Cytotrophoblast (Langhan’s Protects the growing embryo & 5. Development is protected by fetal membranes (they are not
layer) fetus from infectious organisms part of the embryo; they are extraembryonic membranes)
(e.g. spirochete of syphilis) a. Yolk Sac
b. Amnion
c. Chorion
d. Allantois
PLACENTA
• Latin for pancake (bc of its size and appearance)
•
• Fetal lungs, kidneys, GI tract, & endocrine organ throughout
pregnancy
UMBILICAL CORD
• Formed from fetal membranes (amnion & chorion)
• Provides circulatory pathway that connects embryo to the
chorionic villi (probing fingers !!) of the placenta
• FUNCTION : transport O2 & nutrients to the fetus from the
placenta & to return waste products from fetus to placenta
• AVA – 2 arteries ; 1 vein 6. Extra embryonic membranes functions
a. Protect the embryo
AMNIOTIC MEMBRANE b. Prevent the embryo from drying out
c. Help in obtaining food and o2 and eliminating
Chorionic Membrane Offers support to the sac that wastes
contains the amniotic fluid 7. Amniotic cavity (sac bet. embryo and amnion) contains the
Amniotic Membrane / Forms beneath the chorion amniotic fluid which cushions the embryo from external
Amnion blows
Produces amniotic fluid and 8. There are three trimesters in embryonic development (280
prostaglandins –– can cause days or 9 calendar months + 10 days)
uterine contractions and may 9. Gestation Period – This is counted from the first day of the
trigger or initiate labor last menstrual cycle until parturition/birth
10. 1st month of pregnancy – formation of heartbeat
AMNIOTIC FLUID 11. End of the 2nd month – formation of limbs and digits
• Constantly being formed by amnion 12. 3rd month / End of 1st trimester – most of organ systems
• Some may be absorbed by direct contact with the fetal develop; limbs and external genitalia are well developed by
surface of the placenta now
o Major absorption happens bc fetus continually 13. 5th month – signs of movement + appearance of hair
swallows this 14. 6th month / End of 2nd trimester – formation of fine hair,
eyelashes, and separation of eyelids

THE GROWING FETUS
Allows blood to go from
15. 9th month – fetus is fully developed & ready for delivery pulmo artery → aorta due
to high pressure
EXTRA INFO:
https://www.youtube.com/watch?v=-
• Some stem cells are present in the inner cell mass IRkisEtzsk&ab_channel=khanacademymedicine
o Stem cells are pluripotent = can give rise to any
type of tissue (except those of the placenta &
extra embryonic membranes)
• Amniotic fluid contains fetal cells and amniocentesis
happens when amniotic fluid is drawn out and examined to
detect abnormalities in the fetus
ORIGIN OF BODY TISSUE
• Central nervous system (brain and SC)

• Peripheral nervous system
• Skin, hair, nails
• Sebaceous glands
Ectoderm
• Sense organs
• Mucous membrane of the anus, nose, and
mouth
• Tooth enamel mammary glands
• Supporting structures of the body
• Dentin of the teeth
• Upper portion of the urinary system (kidneys
and ureter)
• Reproductive system
Mesoderm • Heart
• Circulatory system
• Blood cells - Placenta has mom’s blood & baby’s capillaries sticks itself sa
• Lymph vessels blood (oxygen is getting picked up)
• Dermis (?) - Blood (@ umbilical vein) is going to carry O2 and blood back
• Muscular and connective tissue towards the liver area
• Lining of pericardial, pleura, & peritoneal o Branch to the left – it will enter the liver and it
cavities will take a while to come out on the other side
Endoderm
• Lining of the GI tract, RT, tonsils, parathyroid, bc it has to go though all the capillaries
/ Entoderm
thyroid, and thymus gland o Branch to Ductus Venosus – allows blood from
• Lower urinary system (bladder, urethra) the umbilical v go through it and meets with the
IVC (inferior vena cava)
IMPORTANT § Large vein getting blood from lower
• 24th day – heart beats extremities (deO2)
• 3rd to 4th wk – formation of nervous system § Blood is dumped to the right atrium
o Ear responsive to sound & sight is present (mixed o2 and deO2)
• 6th week – Gonads form § @ the R.A, it is mixed with SVC blood
• 8th wk – brain waves - From R.A → R.V → squeezed to go to the Pulmonary
Artery → branch to lungs
• 11th wk – Fetal movement
o In the lungs, there are air sacs that are filled
• 12th week – doppler
with fluid (if pregnant) → narrow → not much o2
o HR 120-160 bpm
→ hypoxic pulmonary vasoconstriction
• 16th wk – excretion; Meconium forms 16th week, sterile GI
§ Alveolus tries to help constrict the
tract
arteriole
• 18th to 20th wk – quickening § Increased resistance of alveolus = lot
• 24th wk – Surfactant formed & excreted of resistance in the lung
• 32nd wk – mature sucking and swallowing reflex o Lot of resistance = pressure in pulmonary artery
• 35TH wk – reaches normal ratio is high
• 36th wk – Skin appears thin and almost translucent until § Dapat high ang pressure sa right side
sebaceous fat begins to be deposited ng heart
• IgG gives fetus a temporary passive immunity during the 3rd - Foramen ovale allows RA blood to go across to LA
trimester chamber
o There also isn’t much returning sa may
FETAL CIRCULATION pulmonary artery bc its hard to get blood flow
thru the lungs due to its resistance
§ Also bc of ductus arteriosus
- LA → LV → Squeezed into the aorta → blood is
distributed
- Aorta → distributed → internal iliac arteries → umbilical
artery
o Will bring blood back to the placenta
- The placenta has a very low resistance (makes blood
divert towards it)

MILESTONE OF FETAL DEVELOPMENT
TIME DESCRIPTION MEASUREMENTS SIGNIFICNAT DEVELOPMENTS

• SC formed and fused
• Lateral wings folded forward to fuse at midline
Rapidly growing • Head fold forward and becomes prominent
L: .75-1 cm
4th Week Does not yet • Back is bent
W: 400 mg
resemble human • Rudimentary heart appears as prominent bulge
• Arms and legs are budlike structures
• Rudimentary eyes, ears and nose are discernable
Organogenesis is complete
• The heart with septum and valves is beating rhythmically
• Facial features are discernable
Organogenesis is
• Arms and legs have developed
8th week complete L: 2.5cm W: 20 g
• External genitalia are present
• Primitive tail is regressing
• Abdomen appears large
• Sonogram shows a gestational sac
• Nail beds are forming on finger and toes
• Spontaneous movements are possible
Heartbeat is
• Some reflexes present Bone ossification centers are forming
12th week audible through L: 7-8cm W: 45 g
• Tooth buds are present
Doppler
• Sex is distinguishable
• Kidney secretion has begun
• Fetal heart sounds audible with an ordinary stethoscope
• Lanugo is well formed (fine, soft hair)
Lanugo is well L: 10-17 cm W: 55-120 • Liver and pancreas are functioning
16th week
formed g • Fetus actively swallows
• Urine is present in amniotic fluid
• Sex can be determined by UTZ
• Spontaneous fetal movements can be sensed by mother Antibody production
is possible
• Hair forms, extending to include eyebrows and hair on the head
L: 25 cm W: 223 g
20th week Meconium is present in the upper intestine
• Brown fat begins to be formed
• Vernix caseosa begins to form
• Definite sleeping and activity patterns are distinguishable
• Passive antibody transfer Meconium is present as far as the rectum
• Eyebrows and eyelashes are well defined
• Eyelids are now open
24th week L: 28-36 cm W: 550 g
• Pupils are capable of reacting to light
• Achieved a practical low-end age of viability
• Hearing can be demonstrated by response to sudden sound
• Lung alveoli begin to mature, and surfactant can be demonstrated in amniotic
fluid
28th week L: 35-38 cm W: 1,200 g Testes begin to descend into the scrotal sac
• The blood vessels of the retina are thin and extremely susceptible to damage
from high oxygen concentration
• SQ fat begins to be depsited
L:38-43 cm W: 1,600 g • Fetus responds by movement to sounds outside the mother’s body
32nd week
• Active moro reflex is present
• Birth position may be assumed
• Body stores of glycogen, iron, carbohydrates, and calcium are deposited
• Additional amounts of SQ fat are deposited
36th week • Sole of the foot has only one or two crisscross creases
L:42-48 cm • Amount of lanugo begins to diminish
W: 1,800-2,700 g • Most babies turn into a vertex or head-down presentation
• Fetus kicks actively, hard enough to cause the mother considerable discomfort
• Fetal hemoglobin begins its conversion to adult hemoglobin
40th week L:48-52cm W: 3,000 g
• Vernix caseosa is fully formed Fingernails extend over the fingertips
• Creases on the soles of the feet cover at least 2/3 of the surface

THE GROWING FETUS
ASSESSING FETAL WELL-BEING

THE GROWING FETUS
1. FETAL MOVEMENT
• Fetal movement should have consistency
• Ask mother to observe & record the # of movements the
fetus makes daily
o Should be at least 10x a day
b. Sandovsky Method – 2x every 10 mins OR 10-12 per hour

c. Cardiff Method – 10 movements in 1 hour
2. FETAL HEART RATE

• 120-160 bpm
• Can be heard with doppler at 12th week
TECHNIQUES
Rhythm Strip Testing FHR for 20 mins
Non-Stress Testing FHR inc by 15 bpm for 15 secs
upon movement (reactive)
Vibroacoustic Stimulation Sound to startle and wake the fetus
Contractions Stress 3 contractions with a duration of 40
Testing sec or more for 10 mins
FHR does not decelerate

(negative)
3. ULTRASOUND
• Sound waves displayed as visual image
• It confirms structures and position
• Placental grading
• Amniotic fluid volume (800-1200)
• Biparietal diameter
• Instructions
o What to expect during procedure
o Ensure full bladder
4. MATERNAL SERUM ALPHA-FECTOPROTEIN

• Present in amniotic fluid and maternal serum
• Increase = open spinal / abdominal defect
• Low = Down’s syndrome
5. CHORIONIC VILLI SAMPLING

• Biopys and analysis of CV for chromosomal analysis (10-
12 wks)
6. AMNIOCENTESIS
• Aspiration of amniotic fluid to test for genetic abnormalities
and fetal maturity (12-13 weeks)
• Preparation / Instructions
o Explain the procedure
o Ask the woman to void
o Place in a supine position
o Drape properly
o Place a towel under her right thigh
o Attach monitors and take maternal BP and
o FHR (baseline)
• Do NOT ask the client to take a deep breath while the
needle is being inserted
• Administer Rhogan if the woman is Rh-negative
• Used to determine the following :
o Color – water → slightly yellow
o Lecithin / Sphingomyelin ratio – to determine fetal
lung maturity (2:1) via

PROMOTING FETAL AND MATERNAL HEALTH
MISCONCEPTIONS FACT CAUTION HEALTH EDUC

WOF risk of slipping due to
Tub bath are restricted
difficulty in maintaining
because water can enter Daily baths are
balance
the vagina and cervix and recommended to cleanse Change to sponge bath or
BATH contaminate the uterine the mother from excessive showering if with problem
Not recommended when
contents perspiration and vaginal in balance
there is vaginal bleeding or
discharge
ROM. Also during the last
It may also initiate labor
month of pregnancy
Constant moisture next to
Inform that colostrums
the nipple can cause
A woman should wear a may be discharged from
nipple excoriation, pain
firm, supportive bra with the breast at 16 weeks
and fissuring.
BREAST CARE wide strap to spread the
weight across the Instruct to wash breasts
Place gauze pad or breast
shoulders with clear tap water daily
pad inside the bra if
then dry nipple by patting
necessary
Encourage the woman to
brush teeth regularly
Gingival tissue tends to
hypertrophy during Encourage to snack on
X-ray for dental purposes
pregnancy nutritious food such as
Dental care is not part of can be done as long as the
DENTAL CARE fresh fruits and vegetables
prenatal care woman wears a
Dentist should be seen for
lead apron
routine examination and If sweets are unavoidable,
cleaning ask to eat sweets that can
easily dissolve in the
mouth
Douching is not
recommended bc it can
enter the cervix and lead
PERINEAL HYGIENE to infection
Douching alters the

vaginal pH
Women should avoid
Wear shoes with a
garters, extremely firm
moderate to low heel to
girdles with panty legs and
DRESSING minimize
knee high stockings
pelvic tilt and possible
because these may
backache
impede LE circulation
Coitus on expected date of
her period will initiate labor
Assure that coitus is not
Orgasm will initiate labor Women with history of harming the child
but participating in sexual miscarriages
relations without orgasm A side by side or woman in
will not Women with ROM and a superior position may be
SEXUAL ACTIVITY
vaginal bleeding comfortable
Coitus during the fertile
days of a cycle will cause Oral-genital sex could Use of water soluble
a second pregnancy or cause air embolism lubricant maybe
twins necessary
Coitus might cause ROM

A woman should exercise
everyday for 30
consecutive minutes with
For HR pregnant women,
Exercise is important to 5-min warm up 20- min
they need to be cautioned
Exercise is prevent circulatory stasis active and 5-min cool-
to restrict
EXERCISE contraindicated in in LE down
pregnancy
Make sure the woman has
Offers well-being Exercise that focus on
consulted her physician
large muscle groups such
as walking is
recommended
Advise to drink a glass of
Women need enough milk if there is difficulty of
sleep during pregnancy for Avoid lying flat on bed or sleeping
SLEEP
fetal growth & bc of with knees sharply bent
increased BMR Relaxation exercises may
also be effective

Modified Sim’s position is

a good resting position
Only women who are Preterm birth may occur
Counsel women to reserve
exposed to work hazards more frequently in women
periods during the day for
Women should not work that might affect who work at
EMPLOYMENT rest and to eat a healthy
during pregnancy pregnancy should not strenuous jobs or those
diet than telling them to
continue work (toxic who stand for a prolonged
resign from their jobs
substances, lifting, etc) period
Educate not to eat raw
fruits, vegetables and
meat or drink unpurified
water
Advise a woman taking a

long trip by automobile to
There are no restrictions Regardless of the AOG, plan for frequent rest or
early in pregnancy the pregnant woman must stretch periods every hour
be familiar with the nearest or 2 hours
TRAVEL Pregnant women can drive health care facility Shoulder harness should
as long as they are be worn across the
comfortable and use seat Vaccines may be shoulder, chest and upper
belts necessary if traveling abdomen
A pad maybe placed under

the shoulder harness at
the neck
Traveling by plane is not

contraindicated
DISCOMFORTS OF EARLY PREGNANCY

BREAST TENDERNESS HEMORRHOIDS
• Encourage to wear bra that provides support • Daily bowel evacuation
• Dress warmly • Resting in modified Sim’s position
• Rule out other conditions if persistent • Assume a knee-chest position for 10-15minutes
• Cold compress
PALMAR ERYTHEMA • Gentle finger pressure
• Explain • Stool softeners
• Calamine lotion may be soothing • PREVENTION
CONSTIPATION HEART PALPITATIONS

• Discuss preventive measures • Reassure that it is normal
• Reinforce the need for Iron even if it may cause constipation • Report if they occur very frequently or continuously or if
• Advise not to use mineral oil accompanied by pain
• Recommend avoiding gas-forming food • Advise gradual/slow movements
• Avoid enema and use of laxatives
NAUSEA, VOMITING, PYROSIS FREQUENT URINATION

• Advise to eat dry crackers • Decrease coffee intake
• Dry carbohydrate (CHO) diet • Explain that voiding frequently is normal
• Wait 30 minutes before arising from bed • Advise to perform Kegels’ exercises to decreases stress
incontinence and strengthen perineal muscles
FATIGUE
• Relieve by rest and sleep ABDOMINAL DISCOMFORTS
• Advise one short rest period per day • Advise to rise slowly
• Advise to elevate legs • Evaluate description of the pain carefully
MUSCLE CRAMPS LEUKHORREA

• Advise to lie on the back momentarily, extend the leg and • Advise daily bath/shower
dorsiflex the foot • Wearing cotton underwear and sleeping at night w/o one
• May also advise to decrease milk intake • May wear perineal pads but not tampons
• Advise to consult when there are changes in discharge
HYPOTENSION • Advise not to douche
• Assume left side-lying • Avoid tight underpants and pantyhose
o Right side lying will press the vena cava
DISCOMFORTS OF MIDDLE TO LATE PREGNANCY
VARICOSITIES
• Assume the Sim’s position or on the back with legs raised BACKACHE
against a wall or elevated on a footstool for 15-20 minutes • Advise to wear low- heeled shoes to reduce the amount of
• Caution not to cross legs spinal curvature
• Avoid wearing knee-high hose/garters • Encourage to walk with pelvis tilted forward
• Apply TEDS • Apply local heat
• Walk break 2x/day • Advise to squat rather than bend to pick up objects
• Exercise • Hold objects close to the body when lifting
• Vitamin C and fruits • Perform pelvic tilt/rocking

• Detailed account of women’s symptoms • Advise to report any changes

• Caution not to self- medicate
4. Sudden Escape of Clear Fluid from The Vagina
HEADACHE • Rupture of membrane and threatened mother and fetus →
• Resting with cold towels on forehead Infection
• Taking usual dose of acetaminophen • May cause cord prolapse → cord compression → fetal
• Caution that if HA is unusually intense or continuous, they hypoxia
should report it • Maybe confused with stress incontinence
• It may be a danger sign of high BP • Report
5. Persistent Vomiting
DYSPNEA • Continues past 12 weeks and more than 2x/day
• Advise to sleep upright • Depletes the nutritional supply
• May require 2 or more pillows
• Caution to limit her activities during the day 6. Abdominal or Chest Pain
• Abdominal pain maybe reported immediately
ANKLE EDEMA • A sign of a problem
• Advise to assume left-lateral position o Chest pain may indicate pulmonary embolus
• Sitting with legs elevated 2x/day for 30 min following thrombophlebitis
• Avoid wearing constrictive clothing 7. Pregnancy-Induced HTN
• Reassure • Symptoms are :
• Assess for other signs of PIH o Papid weight gain (> 2lbs/wk- 2nd ; >1 lb/wk 3rd
)
BRAXTON-HICKS CONTRACTION o swelling of face/fingers
Ø Braxton Hicks contractions are a tightening in your abdomen that o flashes of light
comes and goes. o dimness/BOV
Ø Usually lasts for 30 seconds o severe continuous headache
• Educate about these types of contraction o decrease UO
• Some women might be anxious • Make sure symptoms only developed during pregnancy
• Report to the primary care provider for evaluation Observe
for rhythmic pattern of even very light contractions TERATOGENIC MATERNAL INFECTION
• Teratogenic = Able to disturb the growth and development of an
PRELIMINARY SIGNS OF LABOR embryo or fetus.
1. Lightening • Can either be sexually transmitted or systemic infections
- Settling of the fetal head into the inlet of the true pelvis • Organisms cause the placental barrier (viral, bacterial,
- Occurs 2 weeks before EDD for primipara protozoan)
- Characterized by sciatic pain, decreased SOB, frequency • Maybe subclinical but still injure a fetus
of urination, change in abdominal contour • Common diseases that cross the placenta and cause fetal
harm:
o TORCH (Toxoplasmosis, Other Infections, Rubella,
2. Excess energy Cytomegalovirus, Herpes Simplex virus)
- Feeling extremely energetic
Maternal
- Physiologic preparation for labor Infections
- The woman might not recognize that the energy is meant
for labor so she can conserve Vaccines
3. Uterine contractions
- Labor begins with contractions. Strength Drugs
Affinity for specific
- True contractions start in the back and sweep forward isssue TERATOGEN
across the abdomen Timing Alcohol
- It increases in frequency and intensity
- Advise a woman to call her provider
Cigarettes
4. Show
- Release of cervical plug (operculum) •Consists of mucous, Environment
often blood-streaked vaginal discharge
- It indicates the beginning of cervical dilatation TOXOPLASMOSIS
• An infection caused by a single-celled parasite called
5. Rupture of the membrane
Toxoplasma gondii
- Sudden gush of clear fluid from the vagina
• MOT :
- Advise the woman to call her primary provider
o Handling raw meat, cat litter, or soil contaminated with cat
- There is a danger of cord prolapse and uterine infection
feces
after
o Eating inadequately prepared meat and animal products
o Eating inadequately washed vegetables that have come
DANGER SIGNS AND EXPOSURE RISKS
in contact with contaminated soil
• EFFECT :
DANGER SIGNS OF PREGNANCY
o CNS damage
o Hydrocephalus
1. Vaginal Bleeding
o Microcephaly
• Should always be reported no matter what
o Intracerebral calcification
o Retinal deformities – can lead to blindness
2. Chills & Fever
• If immune system is weakened, it can lead to seizure and life-
• May indicate intrauterine infection
threatening illnesses like encephalitis
• May be a symptom of benign gastroenteritis
• Toxoplasmosis can cause problems during pregnancy,
including miscarriage, preterm birth or stillbirt
3. Increased/Decreased Fetal Movement
• Responding to the need for oxygen
• Assess for changes

RUBELLA oUntreated Lyme disease during pregnancy can lead to

• Sx : low-grade fever, sore throat, and a rash that starts on the infection of the placenta.
face and spreads to the rest of the body. o Spread from mother to fetus is possible but rare.
• MOT : • Most cases of Lyme disease can be cured with a 2- to 4-week
o When an infected person coughs or sneezes. course of oral antibiotics,
o When a woman is pregnant, she can pass it to the baby
• EFFECT :
o Deafness
o Mental and motor challenges
o Cardiac defects
o Dental and facial clefts
CAUSE ILLNESS @ BIRTH

• Gonorrhea, candidiasis (yeast infection), chlamydia,
streptococcus B, and hepatitis B
• MOT :
CYTOMEGALOVIRUS o Not teratogenic to fetus but are harmful at birth
• Once infected, your body retains the virus for life • EFFECT :
• Not a sexually o Gonorrhea – pregnant women with gonorrhea can
• Babies born with CMV can have brain, liver, spleen, lung, and transmit the infection to their babies during vaginal
growth problems. delivery
o Candidiasis – Increased estrogen in your pregnant body
• MOT :
can throw off the normal balance of yeast and bacteria in
o By contact with contaminated saliva, respiratory
secretions, urine, semen, breastmilk, blood, cervical- your vagina.
o Chlamydia – Untreated chlamydial infection has been
vaginal secretions
linked to problems during pregnancy, including preterm
• EFFECT :
labor, premature rupture of membranes, and low birth
o Hemolytic anemia, jaundice, hydrocephaly,
weight.
microcephaly, pneumonitis, mental retardation, hepatitis
o Streptococcus B – caused by bacteria typically found in
a person's vagina or rectal area. Usually babies are born
HERPES SIMPLEX
healthy but there is a small risk that it can be passed on
• Causes genital and oral herpes
o Hepa B – easily passed from a pregnant woman with
• If you have your first outbreak of herpes in pregnancy, it is hepatitis B to her baby at birth..
possible to transmit herpes to your baby. This means that your
baby may be born prematurely or even die.
• MOT :
o Contact with contaminated genital secretions
o Trans-placentally – especially during a primary infection
o Contact with active lesions and contaminated secretions
during passage
• EFFECT :
o First trimester – severe congenital anomalies or
spontaneous miscarriages
o 2nd-3rd trimester – premature labor, intrauterine growth
restrictions, and continuation of infection
SYPHILIS
• Syphilis in pregnant women can cause miscarriage, stillbirth, or
the baby's death shortly after birth
• MOT :
o Syphilis is a highly contagious disease usually spread by
sexual activity
• EFFECT : TERATOGENIC VACCINES

o Congenital anomalies, extreme rhinitis, syphilitic rash
o Presence of Hutchinson teeth (oddly shaped) • Live virus vaccines cannot be administered during
o Babies born with congenital syphilis can have bone pregnancy
damage, severe anemia, enlarged liver and spleen, • They may transmit viral infection to a fetus
jaundice, nerve problems causing blindness or deafness, • Make sure that clients are not pregnant during routine
meningitis, or skin rashes. • immunizations
• Live virus vaccines include
LYME DISEASE o Measles
• MOT : o Mumps
o Tick bites o Rubella
• EFFECT : o Poliomyelitis
o Spontaneous miscarriage or severe congenital anomalies

TERATOGENIC DRUGS - CLASSIFICATIONS

• be cautious in taking any type of drug,
• whether it be OTC, herbal, or prescription drugs Metal & Chemical - includes pesticides, carbon
o Some herbal medicines may not be safe Hazards - monoxide, lead, paints, etc
• Recommendations - destroys rapidly growing cells
o Women should not take drugs/supplements that - all women should only be exposed to
are not prescribed/approved by their physician x-ray during the first 10 days of
Radiation
menstruation
• THALIDOMIDE – can cause amelia/phocomelia when
- pregnancy test should be done before
taken between 34th-45th day of pregnancy.
x-ray
• Harmful Recreational Drugs
- interferes with cell metabolism
o Narcotics and heroine – causes intrauterine
- results from the use of sauna, hot tub,
growth restriction
etc
o Marijuana – unstudied
o Cocaine – compromises fetal blood flow, Hyperthermia & Maternal fever may also cause
spontaneous miscarriage, preterm labor, Hypothermia
meconium staining and intrauterine growth • Abnormal fetal brain development
restriction • Possible seizure disorder
o Inhalants – limit oxygen supply • Hypotonia
• Skeletal deformities
DESCRIPTION E.G.
Risk during 1st trimester Thyroid TERATOGENIC MATERNAL STRESS
A • If pregnant woman is emotionally disturbed, it can cause
No evidence for risk in last trimester Hormone
Adverse effect on fetus on animal studies Insulin changes in her nervous system (autonomic system →
B sympathetic division)
but not on pregnant women
Adverse effect on the fetus on animals but Docusate • Constriction of blood vessels = interference with blood +
C not on humans. No adequate studies. sodium nutrient supply of fetus
Unknown pregnancy risk (Colace) • Caused by long-term extreme stress
There is evidence risk to human fetus but Lithium citrate
D maybe acceptable because of potential
benefits
Show abnormalities in humans and Isotretinoin
X
animals. Risk outweighs the benefits (Accutane)
TERATOGENICITY OF ALCOHOL
• Alcohol from the mother is passed on to the fetus through
the placenta
• Fetus cannot remove breakdown products of alcohol →
causes Vitamin B deficiency → neurologic damage
• Women should be screened for alcohol use
• Can cause fetal alcohol syndrome → baby becomes SGA
and may be cognitively challenged
• The infant is characterized by craniofacial deformity
TERATOGENICITY OF CIGARETTES
• Fetus experiences growth restriction
• Infants are at greater risk for sudden infant death syndrome
and they are born with LBW due to limited blood supply to
the fetus during pregnancy
• Educate the woman about the risks to themselves and to
their fetus at the first prenatal visit
ENVIRONMENTAL TERATOGENS
- Exposed @ home or work
- Equally damaging to the fetus as those that are ingested

FROM : https://www.registerednursern.com/menstrual-cycle-reproductive-cycle-nclex-review/
Maternity Nursing Review: Menstrual Cycle

Purpose of the Menstrual Cycle: is to release an egg for potential fertilization (from the ovary) so it can implant into the
endometrium…hence help develop a baby. If this doesn’t happen, the 28 day cycle starts all over (note cycle days vary among
women).
Two structures that play a vital role in the woman’s reproductive cycle:
• Ovary
o Ovarian Cycles: Follicular (occurs during the menstrual and proliferative phase), Ovulation, Luteal Phase
• Uterus (they work together)
o Uterine Cycles: Menstrual & Proliferative (both occur during the follicular phase), Secretory Phase
Each structure has three cycles (and these cycles correspond with each other)
Easy Recap of these Phases:

1. Follicular Phase (cycle day 1-13…ovarian changes) happens during Menstrual (cycle days 1-6…uterine changes) &
Proliferative Phase (cycle days 7-14….uterin changes)
2. Ovulation (day 14…the mid-point of the 28 day cycle)
3. Luteal Phase (cycle days 15-28….ovarian changes) happens during Secretory Phase (cycle days 15-28….uterine
changes)
*Typical menstrual cycle is 28 days
Cycle Day: 1-13: First Part of the Menstrual Cycle

• Menstrual (Cycle days 1-6)
• Follicular Phase (Cycle days 7-13)
• Proliferative Phase (Cycle days 7-14)
MENSTRUAL Phase: (uterine changes…cycle days 1-6)

Goal: shed the stratum functionalis layer of the endometrium
Woman has bleeding (consists of 1-6 days) where she is shedding the stratum functionalis (functional layer) of the endometrium. If
pregnancy did not occur during the last cycle, the progesterone and estrogen levels drop which causes the layer to shed.
During this same time, there are OVARY CHANGES known as the:
FOLLICULAR PHASE: (ovarian changes…..cycle days 1-13)
Goal: prepare a follicle to release a mature egg (ovum)
How does it do this? When hormone levels from the previous cycle drop (specifically progesterone and estrogen) the hypothalamus
releases Gonadotropin-Releasing Hormone (GnRH) and this causes the anterior pituitary gland to release FSH (follicle
stimulating hormone) and LH (luteinizing hormone).
The FSH released from the anterior pituitary gland stimulates the follicles in the ovary to grow. A woman has two ovaries (right and
left) and each contains MANY follicles.
Follicles are fluid-filled sacs in the ovary that contain an immature egg known as an oocyte. NOTE: FSH will cause several follicles
to develop but only ONE turns into a Graafian follicle (mature follicle) that will release a mature egg (ovum). The other follicles that
didn’t release an egg will die.
As the follicle matures, it will produce hormones such as ESTROGEN. The estrogen will steadily increase as the egg reaches
maturity. There will be a small dip in the production of FSH and LH because the body senses the extra estrogen which represents
that the egg must be mature and the follicle doen’t need to be stimulated to grow. This is the negative feedback loop where the
estrogen will signal to the hypothalamus to decrease production of GnRH so the anterior pituitary gland will quit releasing so much
FSH and LH.
However, the mature follicle is producing massive amounts of estrogen and the estrogen secretion from the follicle will peak to
a VERY HIGH POINT. This will actually cause the anterior pituitary gland to release a surge of LH (luteinizing hormone)…hence
positive feedback loop and this is what is called an LH surge (cycle day 11-13).
LH plays a huge role in causing the egg to be released from the follicle (which causes ovulation to happen). LH causes the egg to
mature and breaks down the wall of the Graafian follicle allowing the follicle to release the egg which is now called an ovum. 24-36
hours after the LH surge the ovary will release the ovum (usually happens mid-cycle…hence day 14).
In addition, LH helps the Graaifan follicle that released the egg turn into the CORPUS LUTEUM. The corpus luteum will be responsible
for releasing progesterone and estrogen to maintain a potential pregnancy until the placenta can take over.
NOTE: the development of the corpus luteum occurs in the LUTEAL Phase…note why it is
called LUTEAL…the LUTE of luteal corresponds with the word corpus LUTEum).
MENSTRUAL CYCLE
*The last 5 days of the follicular phase and during ovulation is the most fertile time for a woman to get pregnant…sperm live
approximately 5 days and the egg lives for 24 hours (so fertile cycle days would be days 9 -16).
PROLIFERATIVE Phase (uterine changes…cycle days 7-14)
Goal: to rebuild the stratum functionalis layer that was just shed during the menstrual phase (in case the ovum is fertilized) so it can
implant into the uterus.
What causes the layer to rebuild? Remember how during the follicular phase the maturing follicles are secreting estrogen? The
estrogen from the secretion of the maturing follicles is ALSO causing the stratum functionalis layer to rebuild. In addition, it causes
cervical mucous to thin which allows sperm to migrate easier to the egg.
OVULATION: Cycle day 14

The egg is released from the ovary. The ovum enters into the PERITONEAL CAVITY . It makes it journey to the fallopian tube with
the help of the fimbria which have cilia to help sweep the ovum into the fallopian tube. If sperm are present to fertilize the egg,
fertilization will occur in the fallopian tube most likely in the AMPULLA.
The egg will only live for 24 hours and disintegrate, if not fertilized. The woman will have a low basal body temperature before
ovulation and then increase 0.4-1’F around ovulation.
Cycle Days 15-28: Second Part of the Menstrual Cycle

• Luteal (cycle days 15-28)
• Secretory (cycle days 15-28)
LUTEAL PHASE (ovary changes….cycle day 15-28)
Goal: prepare the endometrium for a potential fertilized egg
Begins when the egg is releases from the ovary.

The corpus luteum forms which developed from the Graaifan follicle that released the ovum. The corpus luteum acts as a
temporary endocrine structure that secretes progesterone and estrogen. Progesterone prepares the endometrium for
implantation of the embryo, if the ovum is fertilized.
Role of Progesterone:
• stimulates estrogen production
• allows the endometrium to receive the fertilized ovum for implantation
• stops production of LH and FSH (so possible pregnancy can be maintained) and estrogen inhibits the hypothalamus from
releasing GnRH (hence new reproductive cycle….if the ovum is fertilize you want to prevent another menstrual cycle from
occuring so pregnancy can occur).
o This will help prevent the hypothalamus from releasing GnRH which will prevent LH and FSH from being secreted
in case fertilization has occurred.
Corpus luteum stays in place for about 14 days and if fertilization hasn’t occurred it disintegrates. It will turn into the corpus albicans.
When the corpus luteum dies, estrogen and progesterone will decrease and this leads to a new reproductive cycle….the
hypothalamus will release GnRH which will cause the anterior pituitary gland to release FSH and LH and the woman will shed the
uterine lining and new follicle will be stimulated to produce a new egg etc.
However, if fertilization occurs the fetus will start to produce HcG Human chorionic gonadotropin (hence what a pregnancy test
picks up) and this will prevent the corpus luteum from dying. So, until the placenta becomes fully functional, the corpus luteum will
help maintain steady levels of progesterone and estrogen to maintain the endometrium for the fetus. The placenta will take over will
progesterone and estrogen production at approximately 8 weeks.
SECRETORY Phase: (uterine changes….cycle days 15-28)
Goal: endometrium is receptive to the implantation of a fertilized ovum

The progesterone being released from the corpus luteum is allowing the endometrium to be receptive for implantation of the fertilized
ovum.
ADOLESCENT (WELL CLIENTS) MIDTERMS
PROMOTING MATERNAL HEALTH AND COMFORT
Our major role is being an educator and promoting comfort

• Promotion is based on assessment
• Education & empathy ! 9. EMPLOYMENT
• Can’t continue to work if the work requires strenuous physical
Things we need to watch out for are : activity, exposures to toxic chemicals
Ø Discomfort • Elevate feet after long hours of standing or walking
Ø Danger signs • Empty bladder every 2 hrs
Ø Exposure to teratogens
10. TRAVEL
SELF CARE NEEDS • Do not eat uncooked foods for camping,
1. BATHING unwashed fruits and veggies; Do not
• Daily showers and Tub baths are recommended drink unpurified water
• Hot tubs / saunas no advisable (<15mns) • Have frequent rest periods (every 2 hrs)
• Use car seatbelts & seatbelt extension
2. DENTAL CARE • >7 mos content from the Ob to board on
• Encourage to see dentist regularly plane
• Delay dental X-rays (with lead apron)
• Sack on nutritious foods to decrease sugar contact on teeth
TOP 10 RECOMMENDATION AS GUIDELINES FOR SAFE
3. PERINEAL HYGIENE EXERCISING
• No douching - Always start with 5mins warming up
• Always wipe from front to back - Eat protein and complex carbohydrates snack BEFORE
exercising
4. CLOTHING - Drink liquids before and after exercise
• Recommend loose fitting, comfortable garments - Check BP and heart rate prior and at times of peak activity
• Wear shoes with moderate to low heels to minimize - Perform scheduled exercise periods ( 30mns 3x/wk)
• pelvic tilt and backaches, knee high stockings - Environment temp: avoid hot humid
- Gradually standing up or change position when raising up
5. SEXUAL ACTIVITY - Avoid activities: Jumping, jarring motions, rapid, jogging,
• Allow the patient to voice out concerns related to sexual activity stretching with toes extended, Valsalva maneuver
• Few situations when sexual relations are contraindicated - Always End the exercise program gradually.
• Myths: - STOP if
o Coitus on the expected date will initiate labor. o (+) dizziness
o Orgasm will initiate pre term labor.But participating in o (+) bleeding
sexual relations will not.
o Coitus on during the fertile days of a cycle will cause FIRST TERM
a second and twin pregnancy
o Coitus might cause rupture of membrane BREAST TENDERNESS
• Often one of the first sx of
6. BREAST CARE • (+) tenderness but minimal
• Wear a firm, supportive bra with wide straps to spread the
breast weight across the shoulder Ø Encourage to wear bra with a wide shoulder strap for
• May need to buy large size of bra support
• Breastfeeding bra Ø Dress warmly to avoid cold drafts
• Wash with clear tap water Ø Rule out – nipple fissures / breast abscess
7. EXERCISE PALMAR ERYTHEMA OR PALMAR PRURITUS

• Moderate exercise • Caused by increased estrogen
o ave min. 3x/wk for 30 consecutive mins. • Normal
• Example walking, swimming, prenatal yoga
• Teach women how to assess quickly if they are exercising too Ø Calamine lotion can be soothing
strenuously by self-evaluating their ability to continue talking Ø Adjustment of the estrogen level
while exercising
CONSTIPATION
8. SLEEP • Peristalsis slows down weight of a growing uterus presses
• Drinking a glass of warm milk may help. against the bowel
• Relaxation exercises • Iron supplements causes constipation
• Rest period during the afternoon
• Modified Sim’s position Ø Increase fiber in her diet by eating fruits, bran and
o Avoid resting flat on bed vegetables
Ø Drink at least 8 glasses of water daily
Ø Iron causes constipation but it is needed. Taken with an
empty stomach and with juice

Ø Avoid enemas, over-the-counter laxatives, gas forming o Adds pressure on the veins returning blood from
foods the lower ext
Ø Avoid using mineral oil to relieve constipation
Vit A,D,K and E are necessary for both godo fetal and maternal health
NAUSEA, VOMITING, PYROSIS

• Decreased gastric motility r/t high estrogen
• Morning sicknes
Ø Increase carbohydrate
o Non-salted crackers ex. Saltines. Eat a few
before rising.
Ø Small frequent feeding
Ø Position: Moderate Semi-Fowler’s position upon waking up.
Ø Sleep on left side
Ø Do not lie down immediately after eating. Wait at least 2 hrs
after meal.
Ø The veins become enlarged, inflamed and painful
Ø Avoid fatty and fried food, coffee, citrus juices, carbonated
Ø At high risk = Pregnant and those with obesity
juice
Ø Urge to take active measures
Ø Resting in sims position or on the back with the legs raised
FATIGUE
against the wall or with small pillow under the right hip.
• Increased metabolic requirement Ø Elevated on a footstool for 15 to 20 mns 2x/ day
• Can increase the morning sickness Ø Avoid crossing legs
Ø Vit C,A, B complex: prenatal visits
Ø Increase the amt of rest and sleep
Ø Elevated legs HEMORRHOIDS
• (+) pressure on these veins from the bulk of the growing uterus
MUSCLE CRAMPS
• Decreased Ca levels
• Increased serum and phosphorus levels
Ø Increase fiber in her diet by eating fruits, bran and

vegetables
Ø Drink at least 8 glasses of water daily
Ø Iron causes constipation but it is needed. Taken with an
empty stomach and with juice
Ø Avoid enemas, over-the-counter laxatives, gas forming
foods
Ø Avoid using mineral oil to relieve constipation
(Vit A,D,K and E are necessary for both godo fetal and maternal
health).
Ø Daily bowel evacuation to prevent constipation
Ø Drink adequate fluids, fiber and resting in a modified Sims
position
Ø At day’s end, a knee chest position for 10 to 15 mins
Ø Stool softener such as docusate sodium (Colace)
Ø If with (+) hemorrhoids when entering pregnancy
o apply witch hazel, a cold compress or over the
counter hemorrhoid cream to relieve pain
Ø Hydrocortisone-pramoxine: prescribed
HEART PALPITATIONS
• May experience a bounding palpation of the heart on a sudden
movement
• Accommodates the inc blood supply due to circulatory
adjustment
HYPOTENSION
• When a woman lies on her back and the uterus presses on the Ø Reassure heart palpitations are normal and expected on
inferior vena cava… occasion
o Impairs the blood return to her heart Ø If continuous or very frequent and accompanied by pain
should be a concern
Ø Turn onto her side (left) Ø Intervention: gradual and slow movement to prevent
Ø Prevention: sleep on her side not back
o If sleeping on her back = insert a small firm FREQUENT URINATION
Ø Place pillow under their right hip to cause the weight of their • Due to the pressure of the growing uterus pressing the anterior
uterus to shift off their inferior vena cava. bladder
Ø Rising slowly and avoid extended period of standing
VARICOSITIES
• Common form in pregnancy
• Development of tortuous leg veins due to the weight fo the
distended uterus

HEADACHE
• Due to expanding blood volume causing pressure on cerebral
arteries
Ø Reduce possible causative

Ø Resting with an ice pack on the forehead
Ø Acetaminophen (not recommended Advil, Motrin or Class
C drugs)
Ø Report any unusual intense or continuous headache= may
indicate high BP
DYSPNEA
Ø Begins on the first or second missed menstrual period • Lung compression and SOB due to pressure on the diaphragm
Ø Disappears in midpregnancy as the uterus expand
Ø (+) as the woman lies flat
Ø Returns in late pregnancy
Ø Intervention: advise her to sleep with her head and chest
Ø Do not prolonged the urine = urine stasis can lead to
infection elevated
Ø Require two or more pillows to sleep at night
Ø (+) burning or pain upon urinating and blood = UTI.
Ø Limit her activities to prevent exertional dyspnea
Ø Avoid restricting fluid intake
Ø Decrease caffeine intake Ø If continuous = Respiratory disorder
Ø Reassure increase urination during pregnancy is normal
Ø (+) urinary incontinence = Kegel exercise
ANKLE EDEMA
ABDOMINAL DISCOMFORT • General fluid retention and reduced blood circulation in the lower
• Some women experience this in early pregnancy or multiple extremities due to uterine pressure
pregnancy may notice this throughout the pregnancy
Ø No Proteinuria and HPN or Gestational HPN
• Due to abdominal pressure
Ø Intervention: Rest in a left side-lying position
Ø Elevating legs
Ø (+)pulling pain, sharp, frightening in her right or left
Ø Avoid wearing constricting clothing
abdomen from tension around the ligament.
Ø Intervention: Rise slowly from a lying to a sitting or from
BRAXTON-HICKS CONTRACTIONS
sitting to a standing position.
Ø Requires evaluation as this could indicate ectopic • 8th to 12th wks, uterus periodically contracts and then relaxes
pregnancy again
Ø By the middles or late pregnancy, the contractions are

LEUKORRHEA
stronger. The sensation may experience pain similar to
• Viscous vaginal discharge
forceful menstrual cramp.
• Increase in the amt of normal vaginal secretions
Ø Signs of beginning labor
• Due to high estrogen and increased blood suplly Ø Women should call their primary care provider for
evaluation
Ø A rhythmic pattern of even very light but persistent
contractions could be a sign of preterm labor
PREVENTING FETAL EXPOSURE TO TERATOGENS

• Effects of Teratogens
• Teratogenic Maternal Infections
- Rubella, cytomegalovirus, varicella, herpes simplex,
toxoplasma, syphilis
• Teratogenic Maternal Exposures
- Radiation (xerox machines, x-rays)
- Second hand smoking
- Medications being taken
• Preliminary Signs of Labor
- Lightening
COMFORT, MEDICATIONS, AND PAIN RELIEF MEASURES

- Goal = to relax a woman and relieve her discomfort and yet
have minimal systemic effects on the uterine contractions, her
SECOND TO THRID TERM pushing effort or the fetus.
BACKACHE NON-PHARMACOLOGIC PAIN RELIEF MEASURES

• Lumbar lordosis and postural changes necessary to maintain • Support (Doula / Coach/ Family/ Healthcare Provider
balance lead to backache o Doula = woman who is experienced in childbirth and
postpartum support
Ø Wear shoes with low to moderate heels • Relaxation
Ø Encourage women to walk her pelvis tilted forward • Focus Imagery
Ø Apply local heat from a heating pad may aid in relieving • Spirituality
backache o Most women, before they give birth, they pray
Ø Advise to squat rather than bending over to pick up objects • Breathing Techniques
Ø Always lift objects by holding them close to the body • Herbal Preparations
Ø Pelvic rocking or tilting o Teas
Ø Tylenol (as prescribed) o Black cohosh/squawroot – not recommended since it
Ø Carpal Tunnel Syndrome induces uterine contractions and acute toxic effects to the
mother and uterus
• Aromatherapy/ Essential oils – as long as they do not have
allergic rhinitis

o Has an effect @ limbic system in such a way that it causes POSSIBLE COMPLICATIONS:
our memory and our body feel at ease ❖ Hypotension, pruritus, urinary retention, N&V
o Its component is not always compatible that is used for
the skin (topical) since it could be only for inhalation NOTE: Never position woman in Trendelenburg to help her restore
purposes and not okay sa skin ng tao (burning / skin her BP after spinal anesthesia.
irritation)
• Heat or Cold Application GOAL OF PRENATAL CARE
o Heat applied to the perineum = provide soothing and - Increase the proportion of pregnant who receive early and
softening the perineum; decreasing perineal tears. adequate prenatal care
o WITH STRICT PRECAUTION due to the pressure - Increase the proportion of pregnant women who attended a
anesthesia. series of prepared childbirth classes
o numbness ; di maffeel ni patient if too hot/cold and - Increase women delivering a live birth
makikita nalang kung reddish na or may 1st degree burn - Increase women of childbearing potential who have an intake of
na at least 400mg folic acid from fortified food or dietary
• Therapeutic Touch/ Massage (e.g. Effleurage) supplement
• Reflexology - Increase the proportion of mothers who achieve a
• Hypnosis recommended weight gain during their pregnancies.
• Biofeedback
o people have control and can regulate internal –– ASSESSMENTS
events such as heart rate and pain responses n Prenatal visits
o n Health history
• Intracutaneous Nerve Stimulation – medyo similar w n Screen risk for teratogen
acupuncture but here you use saline n BMI (weight gain and weight loss)
• Acupuncture and Acupressure n Health promotion
PHARMACOLOGIC PAIN RELIEF MEASURES HEALTH PROMOTION AND ASSESSMENT BEFORE AND
• Analgesia = Reduces or decreases awareness of pain DURING PREGNANCY
o Opioid ( Narcotics) risk: maternal respiratory depression - Establish a baseline of present health
§ Morphine sulfate, Nubain, Demerol, fentanyl, - Determine the gestational age of the fetus
butorphanol tartrate -2-3Hrs before birth, careful - Monitor fetal development and maternal well-being
assessment of the NB for the next 4hrs (respiration) - Identify women at risk for complications
o Nitrous Oxide inhalation - Minimize the risk of possible complication
• Anesthesia (partial or complete loss of pain sensation) - Provide education about pregnancy, lactation and newborn
o Regional – local anesthesia (eg. Nesacaine, Bupivacaine) care
§ Blocks sodium and potassium transport in the nerve
membrane Ø DURING THE 1st PRENATAL VISIT :
§ possible fetal effect: Bradycardia • First prenatal as soon as they are pregnant
§ eg. Lidocane • Every 4 wk 28th wk, every 2wk/ 36th wk, every week until
o Epidural Anesthesia – via Spine birth
§ Reduced reflexes • Importance and effects of food, exercise, hobbies, stress,
o General anesthesia vitamins, teratogens
§ Observe closely: Uterine relaxation and risk for • Screening (pelvic exam, blood and urine specimens, lab
uterine atony and pospartal hemorrhage analysis
• UTZ
Aspiration of Vomitus = FATAL • Hx : Family, illness, sexual, menstrual, physical Exam /
• IV ranitidine (Zantac) or Sodium citrate (before anesthesia) Obstetrics Hx
• Metoclopramide (Reglan) increase gastric emptying
• Risk for mechanical ventilation until her overall clinical AGE OF VIABILITY = 20wks
condition improves. Para #of pregnancies that have reached the
age of viability, regardless if the baby
PREPARATION FOR SAFE ADMINISTRATION OF GENERAL was born alive
ANESTHESIA Gravida Woman who is or has been pregnant
• To ensure safe general anesthesia administration, an Primigravida Pregnant for the first time
anesthesiologist or nurse anesthetist needs a minimum of 6
drugs readily available: Primipara Given birth to one child past age of
o Ephedrine viability
o Atropine sulfate Multigravida Has been pregnant previously
o Thiopental sodium (Pentothal) Grand multipara Who has carried five or more
o Succinylcholine (Anectine) pregnancies to viability
o Diazepam (Valium) Multipara Carried two or more pregnancies to
o Isoproterenol (Isuprel) viability
• Adult laryngoscope, endotracheal tube, breathing bag, suction Nulligravida Who has never been and is not currently
catheter and suction source pregnant
• The DISCOMFORT a woman experiences during childbirth is
related to the amount of support she receives from her family REVIEW OF SYSTEMS
and healthcare providers. • General appearance • Neck
• Mental status • Breasts
Ø Epidural blocks are usually delayed until woman’s cervix is 3-5 • Head • Respiratory
dilated • Scalp • Cardiovascular
Ø Infusion of Ringer’s Lactate is started • Eyes • GI
Ø Monitor BP and pulse • Ears • Genito-urinary
Ø A catheter is placed
• Nose • Extremities
Ø Observe for hypotension, slurred speech, rapid pulse
• Mouth • Skin
Ø Remind to void after 2 hrs monitor I&O
Ø Spinal headache: can be relieved by hydrocortisone to reduce
inflammation

Ø MEASUREMENT OF FUNDAL HEIGHT AND FETAL HEART

- 12 to 14 wks of pregnancy
o Uterus becomes palpable as a firm globular
sphere
o Showing over symphysis pubis
- 36 wks
o Xiphoid process of the sternum
o “LIGHTENING” = primiparas returns to about
4cm below the xiphoid process
- Past 10wks
o Doppler; Fetal Heart sound
- 12wks
o Assess the fundus of the uterus
- 28th wk
o Fetal outline and position
- Fetal Heart is usually 110 to 160 beats per min
- Do pelvic examination too !
SIGNS OF INDICATING POSSIBLE COMPLICATIONS OF

PREGNANCY
• Vaginal bleeding
• Persisting vomiting
• Chills/ Fever/Pain on urination
• Sudden escape of fluid from the vagina
• Abdominal or Chest pain
• Gestational HPN
• Increase/Decrease fetal movement
• Uterine Contractions before 37wks of Pregnancy

PHYSIOLOGIC CHANGES IN PREGNANCY
PREGNANCY - all the signs under presumptive may be signs of other conditions
• Period of heath aside from pregnancy and are highly subjective.
• Numerous changes (increase in abdominal size, hormonal
changes, etc.) PROBABLE
• More reliable than presumptive, they still are not positive or true
PURPOSE OF THE CHANGES HAPPENING WITHIN diagnostic findings
1. Support fetal growth • can be documented by a health care provider
2. Support and maintain maternal health • Observed by a HCP.
3. Prepare the body for childbirth
4. Prepare the body for lactation TIME
FROM
TYPES OF CHANGES PROBABLE DESCRIPTION
IMPLANT
1. Physiologic -ATION
- Result of bodily changes such as presence of 1 Serum Lab test or Tests of blood serum reveal
hormones pregnancy test presence of HCG
- Result of the actual physical changes that may lead to 6 • Chadwick’s • Vagina color changes
a woman’s ability to function or in their self-perception sign from pink → violet
2. Psychologic • Goodel’s sign • Softening of the cervix
• Hegar’s sign • Softening of the LUS ?
DIAGNOSIS OF PREGNANCY
• Sonographic • Characteristic ring is
• Based on the symptoms reported by the woman and the signs evidence of evident
elicited by the HCP gestational sac
• Serves to date the diagnosis of birth and helps predict the
existence of a high-risk status 16 Ballottement The fetus can be felt to rise
• The feeling/ experience of pregnancy highly depends if it has against the abdominal wall
been planned or not 20 Fatigue uterine • Periodic uterine
• Most common way to confirm : Pregnancy test enlargement tightening occurs
• CRYPTIC PREGNANCY – phenomenon whereby women do not • Fetal outline can be
become consciously aware of their pregnancy until the last week palpated through
of pregnancy or birth abdomen
IMPORTANCE
- Still not positive signs since they may be signs of another
- Ensure and secure the safety of mother + fetus
condition
- Allows woman to change their lifestyle
- Gestational Sac → blighted ovum (presence of sac but no
- Health promotive behavior can be assumed early on
embryo)
- Ballottement – done by tapping the lower uterine segment
PREGNANCY SIGNS
- Fetal outline is still probable bc a mass like Ca deposits can
resemble the shape of a fetus
PRESUMPTIVE
- Braxton Hicks / practice contractions = there are other
• Least indicative of pregnancy conditions that may cause uterine spasms or
• Could indicate other conditions - tightening.
• Highly subjective – they are reported by the woman and not
validated by a HCP PREGNANCY TESTS
TIME • Detects HCG / Human Chorionic Gonadotropin hormone

FROM o Produced by the cells surrounding the growing fetus
PRESUMPTIVE DESCRIPTION (trophoblast) at the early stage of pregnancy before the
IMPLANT
-ATION placenta is fully formed
1 Tests of blood serum reveal § Placenta takes over
presence of HCG § It will produce this hormone + other hormones
needed in pregnancy
2 Breast changes, • Feeling of tenderness,
o HCG maintains the corpus luteum which secretes large
N&V, fullness, or tingling,
amounts of progesterone needed for pregnancy to
Amenorrhea enlargement and darkening
continue
of the areola
• Best time to take a pregnancy test –– on the day of missed period
• Felt on arising
o If negative = repeat 1 wk after
• Absence of menstruation
• Accuracy may be altered by medication and conditions (False
3 Frequent Sense of having to void frequently Positive Result)
urination
12 Fatigue uterine • General feeling of tiredness a. Laboratory Test
enlargement • Uterus can be palpated over - Detects the presence of hCG (human chorionic
the symphysis pubis gonadotropin) in blood or urine
18 Quickening Fetal movement (16-20 wks) - Present as early as 24-48 H after implantation
24 Melasma Striae • Dark line pigmentation on - Measurable at 7-9 days after conception; highest at 60th-
Gravidarum the abdomen 90th day AOG
• Dark pigment on the face
• Red streaks on the abdomen b. Home Pregnancy Test
- 97% accuracy if followed properly
- Frequent urination = INC levels of HCG and not by the weight - Can detect as little as 35mIU/mL
of the uterus - Advise to wait until the day of the missed menstrual period
- Quickening is only a presumptive sign because fluttering may to test
be caused by other conditions such as presence of gas or flatus. - There maybe a FALSE POSITIVE result

Presumptive and Probable signs are not considered as positive Goodel’s Sign INC in estrogen causes cervix to soften
signs because they maybe present in conditions other than Chadwick’s Change in color @ vagina due to it being more
pregnancy Sign vascular
o Positive HGC in pregnancy test = hydatidiform mole Fetus can be felt to rise against the top
Ballottement
or H. mole examining hand after being tapped sharply
CERVICAL CHANGES
POSITIVE - Becomes more vascular and edematous
• Undeniable signs confirmed by the use of instrument - Coating of mucus fills the cervical canal called the Operculum
- Cervix softens (Goodell's sign)
TIME FROM - OPERCULUM = mucus plug ; protective mechanism against
IMPLANT POSITIVE DESCRIPTION ascending infection
-ATION - Non pregnant = tip of the nose
8 Evidence on Fetal outline can be seen and - Pregnant = earlobe ; “soft as butter” / ripening
ultrasound measured by ultrasound
of fetal B. OVARIES
outline • Ovulation stops (halt FSH and LH production)
10-12 Fetal Heart Doppler UTZ • Corpus luteum continues to INC in size
20 Fetal Fetal movement can be palpated • Regular ovulatory and menstrual cycle will not occur
movement o INC in estrogen & progesterone inhibit the positive
by examiner feedback mechanism that would initiate the process of
ovulation
- As early as 4th to 6th week, a fetal sac can be visualized through
UTZ C. VAGINA
- FHT / fetal heart tone • Presence of INC white vaginal discharge (Leukorrhea)
o 10th – 12th wk = doppler o WOF excessive vaginal discharge that is continuous and
o 18th – 20th wk = stethoscope clear OR has foul smelling odor
o FHT = 120 to 160 bpm, best heard at the location of the • INC vascularity → deep violet color (Chadwick's sign)
fetal back • Vaginal secretion changes during pregnancy from a PH of
greater than 7 (alkaline) to a 4 or 5 (acidic)
PHYSIOLOGIC CHANGES IN PREGNANCY o Prevents proliferation of microorganisms
• Changes in the woman’s preggy body can be attributed to the o This environment is more favorable to fungal infections
presence of hormones (e.g progesterone and estrogen) § Practice perineal hygiene
• Placenta is also making new hormones throughout the
pregnancy D. BREASTS
• Can be categorized as local or systemic • First physiologic change in pregnancy
a. LOCAL – confined to the reproductive organs • A feeling of fullness, tingling or tenderness in her breast tissue
b. SYSTEMIC – affecting the entire body • MONTGOMERY'S TUBERCLE – Breast size INC , areola
darkens, small projections on the areola begins to show
REPRODUCTIVE SYSTEM o Lubricates the nipples
→ uterus, ovaries, vagina, breasts
• Colostrum = earliest breastmilk produced by the 12th – 18th wk of
pregnancy
A. UTERUS
o Clear yellowish fluid
• The size (length, depth, width, weight, wall thickness and o Continuously produced for the first few weeks after birth
volume) steadily increases and is predictable depending on the
week of pregnancy.
• The exact shape of the uterus is influenced by the position of the
fetus inside.
• It is measured from top of the symphysis to the top of the uterine
fundus
- INC uterine blood flow (50 ml/min to 1L/min or more at a term)
- 90% of the flow is directed to the placental intervillous spaces
for transplacental exchange with the fetus
- INC uterus weight – 50g (nonpreg) to 1200g (full term)
- Uterine Growth - rises above the pubis at 12 weeks at the
umbilicus at 20 weeks.
o Growth rate is predictable
- Hormonal influence
o Estrogen = promote growth of muscle fibers to
accommodate fetus
o Progesterone = prevents uterine contraction
§ Also maintains uterine wall (endometrium) kasi
dapat thick and tortuous [highly vascularized] to
maintain pregnancy INTEGUMENTARY SYSTEM
§ Decidua = endometrium tuwing pregnancy - Skin changes are brought about by the stretching of the skin
- Breakdown of elastin and collagen (supports the skin)
extreme softening of the lower uterine
Hegar’s Sign • Striae gravidarum → striae albicans
segment
• False / practice contractions • Umbilicus becomes stretched and protrudes
• Felt by women as waves of hardness or • Appearance of skin pigmentations
tightening across her abdomen o LINEA NIGRA from the umbilicus to the symphysis pubis
o Serve as preparation for the actual § L.N that extends up to umbilicus = GIRL
Braxton-Hick’s § L.N beyond the umbilicus = BOY
labor.
Contraction o Darkened areas on the face known as melasma or mask
• As early as 16th wk
of pregnancy)
• Irregular, infrequent, relieved by rest, do
o INC pigmentation is a protective mechanism against UV
not INC in frequency and non-rhythmic
radiation
• Does not cause opening of cervix

o If anemia persists beyond this time, this may be

There is hyperpigmentation due to : attributed to iron deficiency and is considered
- INC production of melanocyte stimulating hormones / PATHOLOGIC or TRUE ANEMIA
MSH by the APG
- INC estrogen & progesterone Changes occur in order to supply the organs with INC blood flow
• Appearance of vascular spiders Ø Will result in improved function that will respond to the INC
o Vascular spiders = tiny red veins on the face, neck, and metabolic demands of pregnancy
arms
• INC activity of the sweat glands B. IRON NEEDS
o Caused by INC estrogen - Requirement of the fetus to grow (350-400mg)
- INC in circulatory RBC (400mg)
RESPIRATORY SYSTEM - Iron supplement to prevent true anemia
(Hgb<11.5g/100ml)/Hct<30%)
VARIABLE CHANGE - Folic Acid need also INC → prevents
Respiratory Rate INC, 1 or 2/min Megalohemoglobinemia
Tidal Volume INC by 30-40% - May also cause Neural tube defects
• Amt of air inhaled during a - Advise to eat food high in folic acid
normal breath
Vital Capacity No change C. HEART
- Cardiac output INC by 25-50%
• Max amt of air that can be
- HR INC by 10 bpm
inhaled + exhaled
- Happens mostly in the 2nd trimester
Residual Volume DEC 20%
- Has implications to a woman with cardiac disease
• The amt of air left in the o INC demands @ heart = more risks with cardiac
lungs
disease
Plasma pCO2 DEC 27-32 mmHg - Altered heart position → appear larger on CXR and
Plasma pH INC 7.40-7.45 presence of heart murmur (innocent)
Plasma pO2 INC 104-108 mmHg o Heart murmurs are innocent unless
accompanied by other symptoms
• There is an INC NEED for O2 and INC amount of CO2 that needs - May experience palpitations
to be eliminated
• Mild alteration in breathing – pressure exerted by growing uterus
on the lungs INC Blood vol à INC venous return à INC cardiac
o As uterus grows = occupies more space output
• Changes in respiratory effort Ø For the heart to push out the increased
o Lungs expands laterally since it is displaced upward blood return, the heart rate increases by
§ Reason why vital capacity doesn’t change
o DEC residual volume 10bpm
§ Extra push of uterus on lungs
§ Results to a fewer amt of air left in lungs during D. BLOOD PRESSURE
exhalation
• Placenta has full responsibility for O2 and CO2 transfer - Dose not normally rise
o Fetal lungs do not take part - DEC slightly during 2nd trimester → rise again to 1st
• Plasma pCO2 of a DEC from 34-45 to 27-32 mmHg trimester levels
o Fetals pCO2 is higher than the mom’s o Circulatory system expands with addition of
o Allows pCO2 from fetal blood to diffuse movement from uroplacental circulation
higher to lower concentration - INC in bP during pregnancy above normal (presence of
o It will go to the maternal blood where it can be excreted by protein in the urine, upper extremity edema) maybe a sign
the mother of pre-eclampsia.
• INC CO2 = mild hyperventilation
• INC maternal pH to INC O2 affinity anf improve placental E. PERIPHERAL BLOOD FLOW
exchange - DEC blood flow to extremities → edema and varicosities
• Mild hyperventilation = attempt to prevent acidosis from of the vulva, rectum, and legs
developing - Edema = caused by impaired blood flow going to the
lower extremity (it pools in the intravascular space)
CONGESTION = normal effect of ↑ estrogen levels o Weight of the gravid uterus impedes the venous
- No medication required return from the lower extremity
- If accompanied by other symptoms, advise to seek - When there is too much blood, pressure within will push
consult the fluid (hydrostatic pressure) outside of the
intravascular space and into the interstitial space
SOB when in supine position = assume lateral position to take o Same process w/ dilation of the vein in the vulva,
weight off the lungs rectum and legs (varicosities)
CARDIOVASCULAR SYSTEM F. SUPINE HYPOTENSION SYNDROME

A. BLOOD VOLUME • Supine Hypotension syndrome is when a woman’s blood pressure
- INC by 30% - 50% during the end of 3rd trimester up to drops while in a supine position.
28th-32nd week - Supine position → vena cava compression → obstruction
o INC in blood volume is necessary for adequate of BF from the LE → DEC blood return to the heart →
uteroplacental circulation. DEC CO → hypotension
o Peak is 20th week - Can cause fetal hypoxia
- May cause Pseudoanemia - Experienced as light headedness, faintness, and
o May be present up to the early part of the 2nd palpitations
trimester - Assume the left side-lying position
o Delayed increase in RBC in proportion to the o Relieves pressure off the vena cava
increase in blood volume is another factor o Prolonged compression = DEC uroplacental
- Compensated by INC production of RBC → near normal blood flow = result to fetal hypoxia
levels by 2nd trimester

o Urine is less acidic and contains more proteins,

sugar, and hormones (INC risk of UTI)
C. RENAL FUNCTION
VARIABLE CHANGE
Glomerular Filtration Rate INC by 50%
Renal plasma Flow INC by 25%-80%
Blood Urea Nitrogen DEC by 25%
Plasma Creatinine level DEC by 25%
Renal threshold for sugar DEC to allow slight spillage
Bladder Capacity INC by 1,000mL
Diameter of ureters INC by 25%
st
INC 1 trimester, last 2
Frequency of Urination weeks of pregnancy to 10-12
G. BLOOD CONSTITUTION times/day
- INC Fibrinogen to 50% as well as other clotting factors
(VII, VIII, IX, X) and platelet count ENDOCRINE
- INC Total WBC • Presence of placenta as hormone-producing structure (Estrogen,
o Protects the woman against infection despite the Progesterone, HPL, HCG and relaxin)
decreases in lgG to prevent fetal rejection o HPL / Human Placental Lactogen = similar function with
- DEC Total protein → osmotic = hydrostatic precure → GH (development of mammary gland)
ankle and foot edema § Makes insulin less effective which makes glucose
- Blood lipids INC by 1/3; cholesterol serum INC by 90% to more available for fetal use
100% o Relaxin – relaxes smooth muscles including the
esophageal sphincter, large intestines, and pelvic joints
GASTROINTESTINAL § leads to symptoms such as reflux, constipation and
• DEC intestinal peristalsis and stomach emptying time → waddling gait.
heartburn, constipation and flatulence o Melanocyte – increased; results to dargening of some
o Can be due to Relaxin, Progesterone and uterine areas of the skin
enlargement o Oxytocin – important in the late stage of pregnancy for
• HEMORRHOIDS = due to the pressure of the uterus‚ effective uterine contraction
compresses veins from LE o Prolactin – promotes lactation
• MORNING SICKNESS = INC in levels of Hcg and progesterone; o Sustained increased levels of estrogen and progesterone
INC in levels of estrogen and DEC glucose (subsides after 3 in pregnancy halts the release of FSH and LH thus
months) stopping the ovarian cycle.
• HEARTBURN = Upward displacement of stomach & relaxed o Also increases concentration of Prostaglandins in the
cardioesophageal sphincter Female reproductive tract
• Slow GI tract → delayed emptying of bile from gallbladder‚ →
absorption in blood stream → generalized itching A. PITUITARY GLAND
• INC estrogen → hyperptyalism with DEC pH → tooth decay - INC Progesterone and Estrogen‚ → halt in production of
FSH and LH
- Relaxin = relaxes smooth muscles including intestinal muscles - INC production of growth hormone and melanoctye
o DEC peristalsis = slow intestinal motility and constipation stimulating hormone
- Vomiting is normal during the first 3 mos of pregnancy (effect of - Produces Oxcytocin late in pregnancy, as well as
HCG). prolactin production
o Hyperemesis gravidarum – vomiting for more than 3mos
(loss of fluids and electrolytes) B. THYROID AND PARATHYROID GLANDS
• Thyroid hormones are critical for the development of fetal and
neonatal brain
URINARY SYSTEM • Changes here are attributed to the increased amt of estrogen and
• Frequent urination during pregnancy is normal HCG
• More demand due to increased metabolic reqs
A. FLUID RETENTION - Enlarged thyroid gland → INC BMR by 20% → INC Iodine
- Total body water INC to 7.5L for effective placental and thyroxine in blood serum
exchange - May be accompanied by emotional lability, tachycardia,
- Regulated by INC progesterone level → activation of RAA palpitations, and increased perspiration
system - Parathyroid gland also INC in size → to supply for
- To aid INC in blood volume and as a ready source of Calcium requirement
nutrients to the fetus; can also replenish mother’s blood
volume C. ADRENAL GLANDS
- INC activity
B. URETER AND BLADDER CHANGES o INC corticosteriods and aldosterone production →
- Urinary Frequency aids in suppressing inflammatory reaction
o Prescence of HCG in 1st trimester - Corticosteroid = involved in stress and immune response
o Compression of bladder by the growing uterus in o Has anti-inflammatory actions
the 3rd o Beneficial in preventing body to initiate an
o DO NOT limit fluid intake since it is helps INC the inflammatory response against the fetus
blood volume for better placental perfusion o Helps regulate glucose by making it available for
o It helps maintain normal amt of amniotic fluid fetus
- INC Progesterone → INC in diameter of ureters; - Help regulate glucose metabolism
bladder capacity to 1500L - INC Aldosterone → Sodium reabsorption→ maintains
- More prone to infection which may cause PRETERM osmolarity
LABOR
o bc of obstruction of urine flow due to bladder and
ureter compression (urine retention)

D. PANCREAS
- INC Insulin level but is LESS effective
o Due to effect of HCL
- Fat stores and glucose are utilized → maintains a fairly
steady glucose level
o Glucose is the main energy souce for intrauterine
growth
o Continuously being transmitted from mom to
fetus
o Body will always make sure glucose is available
and within normal level
- FBS80-85mg/100mL
- High calorie diet and no meal interval > 12hours
IMMUNE SYSTEM
• DEC immunologic competency
• DEC lgG production → prone to infection
o lgG = most common antibody in the blood & body fluids
that protects the abody against bacteria and viral
infections
o Fetus is still considered foreign = may initiate an immune
response that would cause the mother’s body to attack the
fetus
§ This is why lgG is DEC
• Maybe counteracted by INC WBC
o Since lgG is DEC, WBC is increased to protect the mother
from risk of infection
SKELETAL SYSTEM
• INC Ca and Phosphorus needs
• INC progesterone and presence of relaxin
• INC in pliability of pelvic joints and ligaments
o It relaxes and becomes more pliabe since its getting ready
for labor
o Pliability → leads to separation of symphysis pubis
§ Pain on walking, backache and change in posture
(lordosis)
• Lordosis is called pride in pregnancy
• Because of the increased weight of the uterus, the center of
gravity shifts therefore in order to maintain stability/balance, the
posture should be changed.

LABOR AND BIRTH
ONSET OF LABOR BRAXTON-HICKS CONTRACTIONS

• Unclear in humans • Begin and remain irregular
• Attributed to progesterone withdrawal in animals • Felt first abdominally & remain confined to the abdomen &
• Multiple theories groin
o Uterine muscle stretching releasing • Often disappear with ambulation & sleep
prostaglandins • Do not increase in duration, frequency, or intensity
o Cervical pressure causing release of oxytocin • Do not achieve cervical dilatation
o Oxytocin and progesterone balance
o Placental aging RIPENING OF THE CERVIX
o Fetal cortisol and prostaglandin • an internal sign seen only on pelvic examination
• Goodell’s sign – all throughout pregnancy, cervix has the
CONTRACTIONS same consistency as the earlobe
• A result of changes in the ff hormones and chemicals • at term it becomes still softer & described as “butter-soft”
o Decrease in progesterone • internal announcement that labor is close at hand
o Release of oxytocin
o Production of prostaglandins SIGNS OF TRUE LABOR
PRELIMINARY SIGNS OF LABOR 1. UTERINE CONTRACTIONS
- Subtle signs • Begin irregular but become regular & predictable
- Indicates imminent labor • Felt first in lower back & sweep around to the abdomen in
- Must educate patients for them to detect these signs a wave
1. Lightening
• Continue no matter what the woman’s level of activity
2. Braxton-Hicks Contractions
• Increase in duration, frequency & intensity
3. Nesting Instinct
4. Ripening of the cervix • Achieve cervical dilatation
5. Weight loss
6. Bloody show 2. SHOW
7. Rupture of membranes • Mucus plug that filled the cervical canal is expelled
• “Bloody show” exposed capillaries seep blood and mixed
LIGHTENING with mucus resulting to pink-tinged color
• Descent of the fetal presenting part into the pelvis
3. RUPTURE OF MEMBRANES
• Occurs 10-14 days before labor begins
• Changes woman’s abdominal contour • Sudden gush or as scanty, slow seeping of clear fluid from
the vagina
• Gives woman relief from diaphragmatic pressure & sob
• There is no such thing as “dry labor”
• It will cause shooting leg pains, increased vaginal discharge
& urinary frequencY • Early rupture is advantageous if it causes the fetal head to
settle snugly into the pelvis, resulting to short labor
INCREASE IN LEVEL OF ACTIVITY
• On the morning of labor, woman may be full of energy CRITERIA FALSE LABOR TRUE LABOR
Frequency of
• It is related to an increase in Irregular Regular
contractions
• Epinephrine release – prepares a woman’s body for the
work of labor Intensity of
No increase Increases
contractions
Pain is relieved byPain is intensified
Pain relief
walking by walking
Begins on lower
Confined on
Pain location back and radiates
abdomen
to abdomen
No cervical Effacement and
Cervical changes
changes dilation
Physiologic
Uterine Changes None
retraction ring
• In true labor, contractions are accompanied by cervical
dilatation and effacement
DURATION OF LABOR
Ø Primipara = 14 to 20 hrs
Ø Multipara = 8 to 14 hrs
EFFACEMENT
• Softening and thinning of cervical canal recorded in
percentage.
DILATATION
• The widening of the external cervical is to 10 cm
• Measured in cm
o Primipara: 1st effacement then dilation
o Multipara: Both processes occur at the same time
Differentiation of the uterus – fundus becomes firm (contracted) and

pushed the baby out ; lower part is supple and soft to expand easily
and let the baby go out

LABOR AND BIRTH
Physiologic Retraction Ring – middle part that separates up and

lower part of the uterus
FOUR FACTORS OF SUCCESSFUL LABOR
1. PASSAGE
2. PASSENGER
• Woman’s pelvis
• Fetus
• Should be adequate in size & contour
• Should be appropriate in size
• Should be in an advantageous position and presentation
–– BONY PELVIS
• Fetal head
- Uterus → Cervix → Vagina → External Perineum
o The body part that has the widest diameter
- emphasize to parents that it is the pelvis is that is too small,
o Least likely to be able to pass through the pelvic ring.
not that the fetal head is too big.
- Pelvic Shape = Gynecoid • AP > Transverse diameter of the skull
- True Pelvis • Important structures: fontanelles and sutures
o The bony passageway through which the fetus • Narrowest: suboccipitobregmatic (9.5 cm)
must pass during delivery • Widest: occipitomental (13.5)
- Obstetric / True Conjugate •
o The most important measurement of the inlet
because it has the smallest diameter (N-11cm)
- The route a fetus must travel
- Most important: bony pelvic ring
- Remember your pelvimetry
o Determinants of adequacy
§ Diagonal conjugate (a-p inlet)
pelvic inlet AP<T
§ Transverse diameter (outlet)
pelvic outlet AP>T
– MOLDING
• Change in contour of fetal head due to uterine force with
undilated cervix
• Overlapping of sutures
• May be palpable at birth, lasts 1-2 days
• Fontanelle spaces compresses during birth to aid in
molding of the fetal head.
• Can be assessed manually through the cervix.
• Helps to establish the position of the fetal head; to see if it
is in favorable position for birth.

LABOR AND BIRTH
o From this position, extreme edema and distortion

of the face may occur.
- The presenting diameter is so wide that birth may be
impossible
–– MENTUM
- Longitudinal
- Attitude : Very poor
- The fetus has completely hyperextended the head to
present the chin.
- The widest diameter (occipitomental) is presenting. As a
rule, a fetus cannot enter the pelvis in this presentation.
BREECH
• buttocks or feet are the first body parts that will contact the
cervix, 3% of births.
• affected by fetal attitude: good attitude - fetal knees up
against the umbilicus, poor attitude – knees are extended
• 3 TYPES
o Complete
o Frank
o Footling
SHOULDER
• Fetus lie horizontally (transverse) in the pelvis – longest
fetal axis is perpendicular to that of the mother, 1% of births
• Presenting part is usually the acromion process, iliac crest
or elbow.
• Caused by: relaxed abdominal walls, pelvic contraction,
placenta previa (placenta located low in the uterus).
• Must be born by caesarian birth
FETAL LIE
• Relationship between the spine of the fetus to the spine of
the mother; whether the fetus is lying in a horizontal
(transverse) or vertical (longitudinal) position.
• 99% assume a longitudinal lie
CEPHALIC
• most frequent type, 95%
• FOUR TYPES
o Vertex
o Face
o Brow
o Mentum presentation
• Vertex is the ideal part because the skull is capable of
molding effectively; aid in cervical dilatation & prevents
complications such as prolapsed cord.
• Fetal skull that contacts the cervix becomes edematous
(capput succedaneum) due to continued pressure against
it.
FETAL ATTITUDE
–– VERTEX • Degree of Flexion
- Longitudinal • Relationship of the fetal body parts to one another.
- Attitude : Good (full flexion) • Complete flexion
- The head is sharply flexed, making the parietal bones or the o The most common attitude; most favorable for
space between the fontanelles (the vertex) the presenting vaginal birth;
part. o Skull smallest diameter to the bony pelvis: Sub-
- This is the most common presentation occiptobregmatic
- Allows the suboccipitobregmatic diameter to present to the
cervix. Ø GOOD ATTITUDE
- ADV : helps the fetus present the smallest AP diameter of
–– BROW the skull to the pelvis
- Longitudinal - Puts the whole body into an ovoid shape, occupying the
- Attitude : Moderate (military) smallest space possible
- Because the head is only moderately flexed, the brow or - COMPLETE FLEXION: spinal column bowed forward,
sinciput becomes the presenting part. head is flexed forward, chin touches the sternum, arms are
flexed & folded on the chest, thighs are flexed onto the
–– FACE abdomen, and the calves are pressed against the posterior
- Longitudinal aspect of the thighs.
- Attitude : Poor
- The fetus has extended the head to make the face the
presenting part.

LABOR AND BIRTH
FETAL POSITION
• Relationship of reference point on fetal presenting part to
maternal specific pelvic quadrant.
• 1st: Maternal side
• 2nd: Fetal presentation
• 3rd: Maternal quadrant
• LOA – most common and favorable for birthing position
- The first letter denotes mother’s right (R) / left (L).

o The middle letter denotes the fetal landmark. (O =
occiput, M = mentum, Sa = sacrum, A = acromion
process)
o The last letter denotes whether the landmark points
anteriorly (A), posteriorly (P), or transversely (T).
FETAL STATION
• How far the presenting part descended into the pelvis
• Ischial spines → station 0 [ “engaged’ ]
• Above ischial spines → negative
• Below ischial spines → positive
o +3-+4 crowning
Ø ENGAGEMENT
• Settling of the presenting part into the pelvis (level of ischial
spines)
• Pelvic inlet has been traversed
• Pelvis is proven to be adequate
• Not engaged = floating
MECHANISMS OF LABOR
• E-D-F-IR-E-ER-E
o First E = Engagement

LABOR AND BIRTH
• Effective powers are essential

• Supplied by the fundus of the uterus through
• Contractions
• Remind women not to bear down until the cervix is fully
dilated
Each contraction squeezes the blood vessels that supply the

placenta, thereby decreasing the amount of oxygen that flows to the
fetus. The relaxation period allows the vessels to fill with oxygen-rich
blood to supply the placenta
4. PSYCHE
• refers to the psychological state or feelings that a
woman brings into labor
o A feeling of apprehension or fright, or it includes
a sense of excitement or awe.
• Woman’s psyche is preserved
• Should be preserved, so that afterward labor can be viewed
as a positive experience
• Woman who can manage best in labor are those who have
strong sense of self-esteem & meaningful support with
them
• Woman without adequate support can have an experience
so frightening & stressful
o Can develop to posttraumatic stress syndrome
• Nx Responsibility
o Encourage women to ask questions at prenatal
visits & to attend classes to prepare them for
labor.
REMEMBER: Fear, tension, and pain can interfere progress of labor.
LABOR
• Duration of Labor
o Primi = 14 hours-20 hours
o Multi = 8-14 hours
o 4 stages
3. POWERS OF LABOR
• Uterine factors
• Forceful contractions
• Nursing Responsibility: evaluate the rate, intensity &
pattern of contractions.
(1) Increment or Crescendo
(2) Acme or Apex
(3) Decrement or Decrescendo

LABOR AND BIRTH
FIRST STAGE / PREPARATORY DIVISION • Pant & blow breathing

• Onset of true contraction → full effacement and dilatation • Respiratory Alkalosis
• FUNCTIONS : contractions coordinated, cervix prepared • S/SX : Inc RR, Lightheadedness, Tingling, Carpopedal spasm,
• INTERVAL : latent phase Circumoral numbness
• MEASUREMENT : elapsed duration
• DIAGNOSABLE DISORDERS : prolonged latent phase
Ø LATENT
• 0-3 cm every 5-10 minutes
• 20-40 second duration
• Mild intensity
• Mother is excited, apprehensive, but can communicate
• Encourage the ff :
o Walking
o Encourage to void q 2-3 H
o Chest breathing
Ø ACTIVE
• 4-8 cm every 3-5 minutes
• 30-60 seconds
• Moderate intensity
• M.A.D.A
o Medications ready
o Assess VS/cervix/fetal status
o Dry lips, provide oral care, Dry linens
o Abdominal breathing NURSING MANAGEMENT
- Modified Ritgen’s
Ø TRANSITION - Support the head & (suction secretions?)
• 8-10 cm q 2-3 minutes - Dry the baby
• 40-90 seconds - Initiate skin to skin interaction
• Strong intensity - Wait for pulsation to stop
• Hyperesthesia - When there is still birth, let the mother see the baby
• Sacral pressure
• TIRED THIRD STAGE OF LABOR / PLACENTAL STAGE
• Up to 30 minutes after delivery
- Small snacks and sips of water • Two Phases
- Encourage to urinate 1. Placental separation
- Bathing is encouraged 2. Placental expulsion
- Perineal preparation • Signs of Placental Separation
- Left side-lying o Calkin’s sign = the fundus rises
- Monitor for fetal thrashing o Cord lengthens
o Sudden gush of blood
FOR PAIN: • Brandt-Andrews Maneuver
Ø Demerol @6-8 cm • Schultz vs. Duncan
o WOF Respiratory Depression • Uterus stays at the level of the umbilicus
Ø Epidural • Uterus contracts again assuming discoid shape
o WOF Hypotension • Retains discoid shape until placenta has separated
Ø X NPO, X Enema X Shaving • Approximately 5 minutes after birth
DILATATIONAL DIVISION PLACENTAL SEPARATION
• FUNCTIONS : cervix actively dilating • Lengthening of the umbilical cord
• INTERVAL : acceleration and phase of maximum slope • Sudden gush of vaginal blood
• MEASUREMENT : linear rate of dilatation • Change in the shape of the uterus
• DIAGNOSABLE DISORDERS : protracted dilatation; • Firm contraction of the uterus
protracted descent • Appearance of the placenta at the vaginal opening
SECOND STAGE / PELVIC DIVISION PLACENTAL EXPULSION
• Full cervical dilatation up to fetal delivery • Natural (Bearing-down)
• FUNCTIONS : Pelvis negotiated; mechanisms of labor; fetal • Gentle pressure (Crede’s maneuver)
descent; birth
• INTERVAL : Deceleration phase and maximum descent
• MEASUREMENT : Linear rate of descent
• DIAGNOSABLE DISORDERS : Prolonged deceleration;
secondary arrest of dilatation; arrest of descent; failure of
descent
• Complete effacement and dilatation to birth
• Crowning
• LITHOTOMY – put legs at the same time
• EPISIOTOMY- prevent laceration; not done
o Median = NX RESPONSIBILITIES
o Mediolateral = - Check completeness
o Complication: Urethroanal fistula - Check fundus
• Modified Ritgens Maneuever – Support the perineum to - BP Check
prevent laceration - Methergine, methylergonovine mallate (IM)
• Bulging of the perineum is the surest sign that delivery is - Oxytocin IV if methergine is not present
starting - Check perineum for lacerations

LABOR AND BIRTH
- Assist in episiorrhaphy
FOURTH STAGE OF LABOR / RECOVERY STAGE

• First 1-2 hours after placental delivery
• Observation/monitoring
o 1st hour-q 15 minutes
o 2nd hour- q 30 minutes
• Assess placement of fundus (empty bladder)
• Lochia- 30-40 cc fully saturated
• Perineum (REEDA)
–– NX RESPONSIBILITIES
- Flat on bed
- If with chills, give blanket
- Give nourishment (progression of meals)
o CL-juice, gelatins
o FL-milk, ice cream
o SD
o RD
- Check VS/Pain
- Psychological state
- Bonding (MBFH)

NURSING CARE OF A POST PARTAL WOMAN AND FAMILY
POST PARTAL CARE

• 6 week period after birth but it can be longer (it can extend to 6
months)
o Fully recovered body = 3 yrs
• Considered as the fourth trimester
• Time for maternal changes (retrogressive and progressive)
o Retrogressive Change – body going back to pre-pregnancy
state
o Progressive Change – development of new changes and
functions (new tissues, lactation)
• Post-partal care can influence her health for the rest of her life
• Also considered as the transition phase or puerperium
• Three Phases
o Initial / Acute – 8 to 9 hrs after childbirth
o Subacute Post-Partum Period – 2nd week – 6 wk = slower,
lesser risk
o Delayed post-partum period – 6th wk to 6 mos UTERUS
• Undergoes involution
CHANGES HAPPENING o Area where placenta was implanted is sealed off
Ø BUBBLESHEV o Organ is reduced to pre-pregnant size (approximately)
Breast, Uterus, Bowel, Bladder, Lochia, • Uterine contraction begins immediately after birth
Episiorrhapy/Episiotomy, Skin, Homan’s Sign/Hemorrhage, • Fundus of the uterus may be palpated at certain
Emotions, Vital Sign Changes
• areas/levels at a specified time to determine contraction
• Uterine involution maybe delayed in several conditions
BREAST CHANGES
Ø Uterus of a breast-feeding mother may contract more
• Formation of breast milk (lactation)→increase breast tissue quickly. Involution will occur most dependably if a woman
• Primary engorgement: On the 3rd day, breast feels tender, fuller is well nourished & who ambulates early
, enlarged & tensed as milk forms within breast ducts (the ducts
becomes dilated); feeling of heat/throbbing pain NX CONSIDERATIONS
• Breast may appear reddened - Position the patient supine: Assess for contour, striae &
• Breast milk production depends on the sucking (oxyctocin for diastasis; measure width & length in fingerbreadths
contraction & let-down) - What to expect?
o Uterus is firm/ contracted (if relaxed—uterine atony)
NX CONSIDERATIONS o At a specific location
- Assess woman’s breasts: Inspect & palpate for breast size, o Uterus is in midline
shape & color o Presence of after pains maybe normal
- What to expect? Ø The 1st hour after birth is potentially the most dangerous.
o Soft –1st- 2nd PPD Ø Ask the patient to empty bladder
o Firm & warm, reddened, with taut, shiny skin
(engorgement)– 3rd/4th PPD; hard, tensed & painful • If the uterus is boggy/not contracted, what will be the nursing
on palpation action?
§ If only one area of the breast is reddened or o Massage gently using gentle rotating motion
warmed, suspect for o Administer oxytocin as ordered/ place the infant on the
mastitis/inflammation/infection woman's breast to suck
o Note for a firm nodule. Take note of location & report o Assess the uterine fundus every 10 to 15 minutes
o Assess breast nipples — erect/inverted, o Assess for height less frequently after 1 hour
cracks/fissures/presence of caked milk. Do not
squeeze or manipulate nipple unnecessarily.
BLADDER
• Extensive diuresis & urine output increases to 3,000mL (2nd –
5th PPD)
• Transient loss of bladder tone+ edema surrounding the urethra
(4 weeks) + effect of anesthesia= decrease ability to sense
fullness of bladder
• Increases the possibility of permanent bladder damage &
urinary tract infection

NX CONSIDERATIONS
- Assess the bladder for fullness frequently & encourage
regular voiding habits
- What to expect?
o If bladder is full: Hard or firm above the symphysis
pubis, resonant on percussion, displaces the uterus.
Ask the patient to void
o Increase nitrogen and lactose levels
Ø Full bladder may cause uncontracted uterus
BOWEL
• Bowel sounds are active
• The woman feels hungry & thirsty immediately after giving birth
• If without GA, patient can eat without difficulty from nausea or
vomiting
• Hemorrhoids are often present
• May develop constipation because of presence of relaxin & pain
d/t episiotomy or hemorrhoids
• Urinary retention may occur or Diuresis can occur (within 12
hours)
• Bowel movements do not occur for a few days (2- 3 days
PP)
Ø Stool softeners, suppositories or an enema given as
ordered.
LOCHIA
• Layer adjacent to the uterine cavity becomes necrotic & is cast
off as uterine discharge similar to a menstrual flow
• Composed of blood, fragments of decidua, white blood cells,
mucus & some bacteria SKIN
• It takes 6 weeks for the placental implantation site to be • Striae lightens or becomes slightly darker (reddened) over 3-6
cleansed & healed months
• Chloasma and linea nigra will be barely detectable in 6 weeks
TYPE OF • Diastasis recti will appear as slight indentation or a bluish area
COLOR PPD COMPOSITION
LOCHIA
Blood, HOMAN’S SIGN
fragments of • Same high level of fibrinogen during the 1st postpartal weeks
Lochia rubra Red 1-3
decidua & • Pain on dorsiflexion
mucus
Blood, mucus & EMOTIONS
Lochia Pink or
3-10 invading • Taking In Phase
serosa bownish
leukocytes o A time for reflection where the woman is largely PASSIVE
Largely mucus, o Encourage to talk about the birth and help integrate it into
10-14—6
Lochia alba White leukocyte count life experiences
wks
is high
• Taking Hold
LOCHIA RUBRA SEROSA ALBA o Begins to initiate action
Pink or White, o Learning to make decisions and to do things well
Red “fleshy” with
COLOR brown, musty, o Give brief demonstration of baby care
clots
odorless odorless o Praise efforts
DURATION 1-3 days 4-9 days 10-21 days
blood, largely • Letting Go
blood, fragments
mucus, mucus, o Redefines new role and gives up old role
CONTAINS of decidua,
invading leukocyte o Extended and continues during the child's growing years
mucus
leukocytes count - high
AMOUNT moderate minimal scanty REVA RUBIN
DEPENDENT PHASE
• Mother is passive &
cannot make decisions.
She verbalizes her
Taking-In phase 1-3d
feelings of recent
delivery.
Focus of nursing care: proper
EPISIOTOMY hygiene
• Ask the woman to turn on her side (Sim's position) DEPENDENT TO
• Perineum develops : INDEPENDENT PHASE
o Edema & generalized tenderness • Mother is active & can
o Ecchymosis from rupture capillaries/hematoma make decision.
o Intactness of suture & presence of drainage/bleeding Taking-Hold Phase 4-7d • 4-5 days: Postpartum
• Labia majora & minora remain atophic & softened blues or baby blues
• Usually 1-2 inches long; inspect for laceration & clotted lochia • Management:
o Encourage family
support;

o Explain that crying

is normal and it is
therapeutic CARDIOVASCULAR
• Focus of HT: • Increase in plasma fibrinogen: protective measure
Care of the newborn and Family • against hemorrhage
Planning • Nursing care:
INTERDEPENDENT PHASE o Encourage early
• Mother redefines her new ambulation (4-8H)
roles and begin o Encourage exercise
Letting Go 7+ d interdependence with the o Dangle legs for 10-15
other members of the minutes prior to walking
family. May extend as the (prevent dizziness)
child grows. • Cervix remains slightly open –
forming a slit-like or star-shaped
• Vagina – returns to its pre-
pregnant stat
MATERNAL CONCERNS AND FEELINGS • Perineal pain: Sim’s position and cold compress
• ABANDONMENT • Episiorrhaphy pain: heat lamp for NOT more than 15 minutes
o Feeling less important/jealous
o Allow verbalization of feelings and make infant care a REPRODUCTIVE
shared responsibility • Uterus – intermittent contractions enhance involution.
• DISAPPOINTMENT Analgesics for after pains (3D)
o Difficult for parents to feel positive immediately about the • Uterine involution: assess by measuring the fundus by
child who does not meet their expectations. fingerbreadths.
o Nurses should handle the child warmly and comment on • Menstruation
the child's good points • 6 wks after birth in non-nursing moms; 24 wks in nursing
• POST PARTAL BLUES moms
o They burst into tears easily or feel let down or irritable • Breasts – lactation begins
o Maybe caused by hormonal changes or a response to • PROLACTIN – stimulates milk Production OXYTOCIN –
dependence and low self-esteem initiates the let-down reflex with milk ejection as the baby
o Can lead to postpartal depression suckles
o Reassure the woman and family and allow to verbalize • Women may ovulate without menstruating, so breastfeeding
feelings & low to make decisions should not be considered a form of birth control.
EFFECTS OF RETROGRESSIVE CHANGES
• Exhaustion – may have “sleep hunger”
• Weight loss = 5lbs for diuresis + 2-3 lb for lochial flow + 12 lb at
birth= 19 lbs
• Dependent on pregnancy weight gain
• The weight a woman achieves in 6 week s becomes her
baseline postpartal weight
All clients should be assessed for depression during

pregnancy and in the postpartum period.
VITAL SIGNS
V.S DESCRIPTION
• May increase to 100.40F –
Temperature
dehydrating effects of labor
• May decrease to 50 beats/min
Pulse
• >100 beats/min
Blood Pressure • Should be normal
• Rarely change
• Significantly increased
Respirations respirations: suspect pulmonary
embolism, uterine atony, or
hemorrhage.
• Temperature: slight increase 1st 24 hours

• Pulse: Usually slightly slower
o Thready & rapid pulse=signs of hemorrhage
• Blood Pressure: monitor for increased & decreased
- Profuse sweating (Diaphoresis) may occur

- Clients are usually hungry after delivery
- Hyperpigmented areas begin to fade but not completely return
to pre-pregnant state
- Weight loss of 10 lbs. occurs immediately after delivery
• Most critical period in mothers – the 1st few minutes after

delivery.
o 30-50% increase in total cardiac volume
o Nursing care: Monitor vital signs
• WBC normally increases
• Significant sign of infection 24º postpartum

PROFILE, PHYSIOLOGIC FUNCTION AND APPEARANCE OF A NEWBORN
• The Difficult Child
• Within minutes after being plunged into this environment, a o Difficult = irregular in habits, negative mood quality,
newborn initiates respirations and adapt a circulatory system and withdraw rather than approach
to extrauterine oxygenation o Only about 10% of children fall into this category
• The Slow to Warm Up Child
• Changes happen within 24 hrs with adjustments depending o Inactive, respond only to new situations, and have
on the genetic composition, competency with the intrauterine a general negative mood
environment, gestational age, presence of anomalies, care o About 15% of children display this pattern
received during labor and birth and neonatal period o Use positive terms such as “ways to find a healthy
fit for your child” rather than stressing ways the child
CHANGES WITHIN 24 HRS is hard to manage
• Neurologic
• Renal VITAL STATISTICS
• Endocrine • WEIGHT
• Gastrointestinal o Important – to determine maturity and establish
• Metabolic Function baseline
o Weigh nude one a day (same time everyday) during
ASSESSMENT a hospital or birthing center stay
• Review of mother’s pregnancy history o Depends on racial, nutritional, intrauterine, and
• PE of infant genetic factor
• Lab report : Hematocrit, bilirubin, blood type o Ave wt (50th percentile) of female Newborn = 3.4 kg
(7.5 lbs)
• Parent-child interactions thru bonding
o Male Newborn = 3.5kg (7.7 lbs)
• Assessment on teaching parents how to take temp, RR, and
o Macrocosmic weight : 4.7 kg
overall health
o During the first few days after birth, a newborn loses
5% to 10% of birth wt (6 to 10 oz)
§ Newborn recaptures wt within 7 to 10
days
§ All infants begin to gain wight about
2lb/month (6 to 8 oz) fort the first 6 mos
• LENGTH
o Ave 49 cm (19.2 in)
• HEAD CIRCUMFERENCE
o Ave 34 to 35 cm (13.5 to 14.8 in)
o <33 cm (13.2) needs careful neurologic
assessment
o Measure sa eyebrow area
• CHEST CIRCUMFERENCE
o 2 cm (0.75 to 1 in)
o At the level of nipples
TEMPERAMENT
• Refers to the inborn characteristic manner of thinking, PLOTTING : Weight in conjunction with height and HC to highlight
behaving, or reacting to stimuli in the environment disproportionate measurements
NINE TEMPERAMENT CHARACTERISTICS (Unit 5, p. 792) • TEMPERATURE

1. Activity Level o 37.2º / 99F at birth because they are confined in
2. Rhythmicity mother’s womb
3. Approach o Will fall to 21 to 22C / 68 to 72F due to heat loss
4. Adaptability o CONVECTION – flow of heat from the newborn’s
5. Intensity of Reaction body surface to cooler surrounding air
6. Distractibility § Eliminate air drafts (air con) is an
7. Attention Span and Persistence important way to reduce convection heat
8. Threshold of Response loss
9. Mood Quality o RADIATION – transfer of body heat to a cooler solid
object not in contact with the baby (cold
CATEGORIES window/aircon)
• The Easy Child § Move infant far away from the cold
o Predictable rhythmicity, approach, and adapt to o CONDUCTION – transfer of body heat to a cooler
new situations readily, have a mild-to-moderate solid object in contact with a baby
intensity of reaction, and have an overall positive § Cover surface with a warm blanket
mood quality. o EVAPORATION – loss of heat through conversion
o Most children are rated by their parents as being in of a liquid to a vapor
this category § Newborns are wet when born, so they
• The Intermediate Child can lose a great deal of heat as the
o Some characteristics of both easy and difficult amniotic fluid on their skin evaporates.
groups are present

§ Lay NB on the mother’s abdomen • Capillary blood sample <40mg/100mL of blood indicated
immediately after birth and cover with a hypoglycemia= immediate breastfeeding in required to
warm blanket for skin-to-skin contact prevent brain damage
RESPIRATORY FUNCTION
• NB Once alveoli have been inflated, breathing becomes much
easier for a baby requiring about 6 to 8cm H2O pressure
• Within 10 mins NB establish easy respirations
• By 10 to 12 Hrs of age, vital capacity is established at NB
proportions
o BROWN FAT – a special tissue found in mature
newborns NB birth via CS typically have more diff breathing due to excessive fluid
§ Behind the kidneys blocks air exchange space.
§ Helps to conserve or produce body heat
by increasing metabolism as well as Preterm NB alveoli collapse due to lack of pulmonary surfactant.
regulating body temperature similar to
that of a hibernating animal GASTROINTESTINAL FUNCTION
§ May influence the proportion of body fat • NB stomach holds 60 to 90mL
a person retains • NB easily regurgitate due to immature sphincter
o NB increase their metabolic rate and produce more • Meconium: first stool for NB passed within 24Hrs after birth.
heat include kicking and crying. Blackish-green odorless formed from mucus, vernixx, lanugo,
o As muscles become overstressed, they release hormones and Carbohydrates.
lactic acid • 2nd to 3rd day of life Stool changes loose and green
§ Every newborn is born slightly acidotic. • 4th day breastfed babies pass three or four light yellow
§ New buildup of acid created by cold stools/day with soft consistency
exposure → may lead to life-threatening - Breast fed – light yellow, sweet smelling stool
acidosis. o Bilirubin makes it yellow
- Fed on formula – bright yellow with more noticeable odor
• PULSE - Clay colored stool – NB with bile duct obstruction
o In utero → 110 to 60 bpm - Black tarry stool – Intestinal bleeding (may be
o After birth → 180 bpm differentiated by Dipstick = Apt Downey test)
o 1 hr after birth → 120 to 140 bpm - Loose watery stool – may lead to dehydration
o Asleep → 90 to 110 bpm - Blood flecked stool – anal fissure
o There is transient murmur due to incomplete
closure of the shunts URINARY FUNCTION
o Femoral pulses, radial, and temporal = more • NB voids 24hrs after birth (if - assess for possible urethral
difficult to palpate accurately stenosis or absent kidneys or ureters)
o Best for HR is apical • 15mL per day urine
• First 1 to 2 days 30 to 60mL ; by week 300mL
• RESPIRATION
• Protein is normal in the first few days of life until the kidney
o 90 breaths/min then it will become 30-60
glomeruli are more mature
breaths/min
o Periodic respirations
IMMUNE SYSTEM FUNCTION
o NB are obligate nose breathers
• NB have limited immunologic protection at birth because of
§ Sign of distress if nose is obstructed
lack of antibodies until 2months.
• NB born with passive antibodies IgG via placenta
• BP
o At birth → 80/46 mmHg • Hep B vaccine to promote antibody formation against disease.
o At 10th day → 100/50 mmHg and remains at that Care takers with herpes simplex (cold sores) should not care
level for the infant year for NB until the lesions have crusted
CARDIAC FUNCTION NEUROMUSCULAR FUNCTION

• Umbilical cord is clamped → stimulated a neonate to take in • Control of muscular
O2 thru lungs • REFLEXES: Blink, Rooting, Sucking , Swallowing Reflex,
• First breath – bP decreases in the pulmonary artery Extrusion, Palmar Grasp, Placing Reflex, Plantar Grasp,
Tonic Neck, Moro Reflex, Babinski, Magnet, Crossed
• Blood values
Extension, Trunk Incurvation, Landau, Deep tendon.
o NB blood volume is 80 to 110 ml/kg of the body wt
or 300 mL total • SENSES
o Hemoglobin 17 to 18 g/100 ml of blood o Hearing – recognition of mother’s voice 25 to 27 wk
o Hematocrit 45% to 50% gestation hearing functional and the fetus can hear
o RBC 6M cell/mm3 the mother’s heartbeat
o WBC 15 to 30K o Vision – pupillary reflex, blink or squint reflex. Black
Capillary heel sticks may reveal a false high hematocrit and white objects at a distance of 9 to 12in
and hemoglobin due to sluggish peripheral circulation o Touch – sucking, rooting reflexes elicited by touch.
o Taste – baby continues to show a preference for
• Once proper Lung oxygenation has been established, the
sweet over bitter tastes.
need for high Red cells diminishes and destroyed then
o Smell – NB turn toward their mother’s breasts due
bilirubin is released causing indirect bilirubin level rises.
to recognition of smell of breastmilk.
• Blood Coagulation: Vit K (AquaMEPHYTON) responsible for
prothrombin and proconvertin and plasma thromboplastin
component.
• Vit K given via IM lateral anterior thigh immediately after
births.

protect
oneself.
Babinski Reflex Striking sole of (+) Fanning 3 months.
food in an of toes in
inverted “J”. babies.
Flexion of
toes in
adults.
→ Suggests
immature
nervous
system.
Magnet Reflex Applying Pushes back
pressure to the against the
soles of the feet pressure.
when in supine.
→ Tests
spinal cord
integrity.
Crossed Irritating the sole Infant raises
Extension of one foot. other leg
Reflex and extends
trying to
push away
the irritating
object.
→ Tests
spinal cord
integrity.
Trunk Touching the Flexes the
Incurvation paravertebral trunk and
Reflex area of the baby swing the
when in prone. pelvis
towards the
touch.
→ Tests
spinal cord
integrity.
Landau Reflex Holding Baby should
newborn in demonstrate
prone with hand some
underneath, muscle tone,
supporting the should not
trunk. sag into
inverted “U”
position.
→ Sagging
indicates
extremely
poor muscle
tone.
Deep Tendon Tapping patella Leg moves
Reflex tendon. perceptibly.
Tapping the Biceps

tendon of contract.
biceps.
→ Patellar –
tests spinal
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@wondeulz
Biceps –
tests spinal Nerves C5-C9
PERIODS OF REACTIVITY : NORMAL ADJUSTMENT TO CLINICAL CRITERIA FOR GESTATIONAL ASSESSMENT

EXTRAUTERINE LIFE
• NB are said to be term if they are born between 37 to 42 wks

APGAR SCORING of gestation or within 2wks of their due date.
• Gestational age for an infant born 5 days after the due date
–– @ 1 to 5 mins after birth would recorded as 40 + 5
• NB are observed and rated according to an Apgar score • an infant born 3 days before the due date would be 40-3.
• Score 7 and above : vigorous
BALLARD OR DUBOWITZ
• Score less than 7: scoring is done every 5mins until the score
reaches 7. • Extensive criteria to assess gestational age

Cephalhematoma - Collection of blood under the periosteum of

ASSESSMENT
the bone. Appears 24h after birth.
HEALTH HX
- Resolves weeks after birth.
• Complication of pregnancy, length of pregnancy, labor, type
- Cephalhematoma – longer resolve,
of birth
develops under the scalp.
- Caput Succadenuem – shorter resolve,
SKIN develops above the scalp.
• Birthmark and Color
Kernicterus - Permanent neurologic damage caused by
• Term baby has ruddy complexion due to increased
build-up of indirect bilirubin that interferes with
concentration of RBC and decreased subcutaneous fats.
chemical synthesis of brain cells.
• Cyanosis – mottling of skin is common. (abnormal if central) - Mgt: Phototherapy to initiate maturation of
• Acrocyanosis – blueness of hands and feet (24h-48h). liver enzymes.
(normal)
• Central Cyanosis – indicates decreased oxygenation. - Lethargic, yellowish of the skin.
• Hyperbilirubinemia – leads to jaundice. Pallor - Maybe caused by excessive blood loss,
o Physiologic jaundice – 2nd to 3rd day of life. inadequate perfusion, fetal-maternal
o Pathologic jaundice – within 24h. transfusion, low iron stores, blood
o RBC breakdown. incompatibility.
o Indirect Bilirubin (fat soluble). Harlequin Sign - A newborn who has been lying on his side
o Glucoronyl transferase. appears red on the dependent side and pale
o Direct Bilirubin (water soluble). on the upper side.
• There are times baby appear yellowish due to breastfeeding, Birthmarks - Hemangiomas – vascular tumors of skin.
do not stop breastfeeding but expose the baby to sunlight. - Types:
• Nevus Flammeus – macular
purple or dark red lesion.
• Port-wine Stain – tend to fade.
• Stork’s Beak Marks – do not fade.
• Strawberry Hemangiomas –
elevated immature capillaries and
endothelial cells. Lesion disappears
at 7 years of age.
• Cavernous Hemangiomas –
dilated vascular spaces. They do
not disappear.
Hemangiomas – dilated blood vessles or

capillaries.
Cavernus – a type of hemangioma. Not
superficial, and extends beyond the skin.
For any type of birthmark, it is important to

assess its extent especially if hemangioma.
Mongolian Spots - Collection of melanocytes that appear slate
gray patches in sacrum or buttocks.
- Disappears at school age.
- observe spreading if confined in a certain

area only.
Vernix Caseosa - White cream cheese like substance that
Erythema - Flea bite rash. serves as lubricant.
Toxicum - Caused by newborn’s eosinophils reacting
to the environment as the immune system - do not remove it with a towel. Slowly reduce
matures. it by giving a bath. To protect against
- Red spots. lacerations in the womb.
Forceps Mark - A circular or linear contusion matching the Lanugo - Fine downy hair, disappears by 2 weeks of
rim of the blade of the forceps. age.
- Check for any potential facial never Desquamation - Newborn’s skin becomes extremely dry.
compression. This results in areas of peeling on the palms
Skin Turgor - Newborn’s skin should feel resilient and of hands and soles of feet.
elastic. - apply oil or moisturizer.
- Poor skin turgor is seen in newborns who Milia - A pinpoint white papule (plugged or
suffered malnutrition in utero. unopened sebaceous gland) on the cheeks
and nose of a newborn.
- Do not remove because will resolve on its
own as well.

• Test for choanal atresia (blockage at the rear of the nose).

HEAD MOUTH
• Disproportionately large • Should open evenly.
• Forehead is large and prominent • Tongue appears large and prominent in the mouth.
• The frenulum membrane is attached close to the tip of the
Fontanels - Anterior – diamond shaped, closes tongue.
at 12-18mos. o Epstein’s Pearls – small round, glistening, well
- Posterior – triangular, closes by end circumscribed cysts as a result of extra load of
of 2ndmonth. calcium.
- Indented fontanel – a sign of dehydration. o Thrush – a candida infection.
- Bulging fontanel – a sign of increased o Natal teeth.
ICP. • The neck of newborn is short and often chubby.
Sutures - The separating lines of the skull. • With creased skin folds:
- Subsides overriding in 24 to 48 hrs o Congenital Torticollis – injury to the sternocleido
mastoid muscle.
Abnormal : o Nuchal Rigidity – suggests meningitis.
- Wide separation – suggest
hydrocephalus,subdural bleeding. CHEST
- Fused suture lines – prevents head • Normal : Ave is 2cm smaller in circumference than the head ;
growthexpansion. as wide as anteroposterior diameter
Molding - The part of the infant’s head that • Supernumerary nipple may be present
engages the cervix is molded to fit the • Normal Respirations : 30 to 60 breaths/min
cervix contours. o Abnormal sounds : grunting, high, crowing =
- Resolved in few days after birth. respiratory distress syndrome
- Normal : Prominent and asymmetric within • Chests look smaller because the head is large in proportion.
a few days • 2 y/o → the chest exceeds the measurement of the head.
• Newborn’s breast may be engorged and secreting thin watery
fluid called “Witch’s milk”.
Drawing in of the chest wall with inspiration.

(shouldn’t be present)
Caput - Occurs in cephalic births

Succedaneum - Edema of the scalp at the presenting Retractions
part ofthe head.
- Disappears at about third day of life.
- No treatment is needed
Rhonchi Air passing over mucus.

Grunting Suggests respiratory distress syndrome.
Crowing Suggests stridor or immature trachea.
Cephalhematoma - Collection of blood between the ABDOMEN

periosteumof a skull bone and the bone • Normal : Slightly protuberant.
itself. • Abnormal : Scaphoid/sunken
- It appears 24 hours after birth. o Suggests missing abdominal contents of
- It disappears in weeks. diaphragmatic hernia.
• Bowel sounds present within 1 hour after birth (normal)
• Liver must be palpable 1-2cm below right costal margin.
• Spleen must be felt 1-2cm below left costal margin.
• Right kidney is located lower than the left.
• Cord care
Craniotabes - Localized softening of the cranial o Umbilical stump must have 1 vein, 2 arteries.
bonescaused by pressure of fetal o 1st hr – dry, shrink, turn brown
skull against mother’s pelvic bone in o 2nd / 3rd day – turn black
utero. o 6th to 10th day – breaks free
o NOTE : there should be no bleeding and odor +
EYES should be dry !
• Newborns cry tearlessly because their lacrimal ducts do not
fully mature until 3 months of age. ANOGENITAL AREA
• Their eyes assume permanent color by 3 to 12 mos. (other • Imperforate Anus
conditions to note). o infant should first passes meconium in 24 hours
o Ophthalmia neonatorum (Gonorrheal after birth.
conjunctivitis). Male Genitalia
o Subconjunctival hemorrhage • Scrotum is both palpable, edematous, dark, rough, and has
o Periorbital edema rugae.
o Congenital glaucoma • Both testes should be present in scrotum.
o Congenital cataract o Cryptorchidism – undescended testes / 1 or 2
testicles are missing
NOSE o Agenesis – absence of an organ
• Tends to appear large for the face.

oEctopic testes – testes cannot enter scrotum - Sleep Ave – 16 hrs out of 24 hrs
because the opening in scrotal sac is closed. - Car safety
Ø CREMASTERIC REFLEX - Usage of pillow/stuff toy
• Tests integrity of spinal nerve T8-T10. - Safety for co-sleeping
• As the skin of inner thigh was stroked, the testes moves - Cord Care
upward. - Care for babies – bottle fed
• Absent for newborns younger than 10 days old. - Support system
- Immunologic Care
Epispadias – urethral opening is on the dorsal surface of the glands.
Hypospadias – urethral opening is on the ventral surface of the glands. THEORIES OF CHILD DEVELOPMENT
• Circumcision should not be done with these conditions STAGE AGE PERIOD
because of the foreskin will be used to resolved these Neonate First 28 days of life
problems. Infant 1 month – 1 year
Toddler 1-3 years
FEMALE GENITALIA Preschooler 3-5 years
• Normal = swollen vulva School-age Child 6-12 years
• Pseudo menstruation – some female newborns have mucus Adolescent 13-17 years
vaginal secretion caused by maternal hormone. Late adolescent 18-21 years
o Disappears in 1-2 days
FREUD VS ERIKSON
BACK
• Normal : Flat in the lumbar and
• There must be no pinpoint, dimpling or sinus tract which
suggest dermal sinus or spina bifida occulta.
EXTREMITIES
• ABNORMAL : rapid alternating contraction and relaxation
(Clonus) suggests neurologic or Ca insufficiency
• NORMAL : Arms and legs short in proportion to the trunk
o Hands are typically clenched
o They appear short, hands are plump and
clenched into fists.
• Must have a good flexion, muscle tone and ROM:
o Simian crease.
o Syndactyly (webbing).
o Polydactyly (extra finger or toe).
• Legs are bowed, foot flat, and creases covers 2/3 of the sole
of foot.
o Talipes deformity (clubfoot).
- Test the UE for the muscle tone by unflexing the arms for
approx. 5 secs then letting them return to their flexed position
= GOOD
- Hold down arms and it should reach mid thighs = GOOD
- Movements should be symmetrical
- Test femur alignment
o Position the NB in a supine position
o Flex both hips ; Abduct legs as far as they will go
(180º) or when knees touch or nearly touch the
surface of the bed
- ABN : Ortolani Signa “clunk” of the femur head striking the
shallow acetabulum can be heard
o Barlow Sign – slips out of the socket
HIPS
• Both can be flexed and abducted 180 degrees.
• Hip Subluxation – shallow and poorly formed acetabulum.
o Ortolani’s Sign – can be heard.
o – can be felt.
NB CARE
- Breast Feeding : Positioning, proper cleaning, breast care,
correct pumping, q 2 hrs, burp baby after feeding
- Bathing : Check temp, 24ºC, wash cloth, basin, clean water,
no need for soap for NB (mild soap or shampoo siguro pede)
- Be extra careful with the cord
- Metabolic screening tests
- Hepa B w/in 12hrs after birth
- Vit K (coagulation) – 1cc left thigh, IM, w/in 1st hr
- Circumcision – not for baby with phimosis or foreskin
obstructing the urinary metal opening

FREUD – Described child development as a series of psychosexual

stages in which a child’s sexual gratification becomes focused on a
particular body part at each stage
ERICKSON – stresses the importance of culture and society in

development of the personality
- Person’s social view of self is more important than instinctual
drives in determining behavior, allows for a more optimistic
view of the possibilities for human growth.
- Conflict & resolution
Infant Trust vs. - Learning confidence vs learning

Mistrust to love
- Infant is hungry, parent feeds
and makes infant comfortable
again.// changing diaper
- Key: care should be consistent,
adequate and accepting.
Toddler Autonomy vs. - Self governance vs
Doubt independence
- They have a reputation for
negativistic, obstinate, and
difficult to manage
- IF children leave this stage with
less autonomy and shame or
doubt they can be disabled in
their attempts to achieve
independence and can lack
confidence in their abilities to
^^^ Pillitteri– Unit 5 The Nursing Role in Health Promotion for a Child
achieve well into adolescence
Bearing Family p. 804
and adulthood.
Preschooler Initiative vs. - Learning how to do things such
KOHLBERG – Theory on the way children gain knowledge of right and
Guilt as drawing wrong or moral reasoning
- Children are given much
freedom and opportunity to
initiate motor play such as
running, bike, sliding and
wrestling are exposed to play
such as modeling clay, finger
paints and
- water their sense of initiative is
reinforced.
School-age Industry vs. - Children learn initiative and learn
Inferiority how to do things well.
- Success or failure in those
settings can have as lasting an
impact as experiences at home.
Adolescent Identity vs. - Must bring together everything
Role they have learned about
Confusion themselves as a son or daughter,
an athlete, friend, cook, student,
musician and integrate these into
a whole that makes sense.
- If not, they are left with confusion
and left unsure of what kind of NUTRITIONAL NEEDS
person they are and who they
• Poor maternal nutrition may limit the growth and intelligence
want to become. potential of a child
- Others resort to negative identify
• Lack of energy and staminal prevents children from learning
such as drug abuser
at their best intellectual level
Late Intimacy vs. - Intimacy is the ability to relate
• Children with obesity may develop motor skills slowly than
Adolescent Isolation well with other people in
other children
preparation for developing future
o Linked to Type II diabetes in children as young as 6 y/o
relationships.
• Plays a vital role in preventing infection and diseases
- People need to have a strong
sense of identity before the can
ASSESSMENT
reach out
- Eating patterns
- fully and offer deep friendship or
- Vegetables, fruits, grains, dairy
love to others.
- Include physical activity
- Difference in calories for males and females start at age 9
PIAGET – Defined 4 stages of cognitive development within the stages
o 1,000 cal/day → 2 y/o male
of growth then finer units. Children recognize their thinking process to
2,400 cal/day → 18 y/o male
bring them closer to adult thinking
o 1,800 cal/day → 18 y/o female

- Choose a diet
o Plenty of grain products + veggies + fruits
o Low in saturated fats & trans fats
o Moderate amt of sugars
o Moderate amt of salt / sodium
COMPONENTS OF A HEALTHY DIET

Protein • Major components of bones, skin, hair, and
muscle
• Complete amino acids is important
Carbohydrates • Fuel for energy and brain development
Fat • 2nd source of energy in the body
• Necessary for infants to ensure myelination
of nerve fibers
Vitamins • Organic compounds necessary for specific
metabolic actions in cells
• Does NOT produce energy but is required by
cells to produce energy
• Fat Soluble – supplied by fortified foods,
fortified cereals, plant/fish oils and NOT
absorbed in the GI
• Water Soluble – do NOT need fat for
absorption; not stored well in the body = must
be taken daily

THE FAMILY WITH AN INFANT
PHYSICAL GROWTH Landau Reflex

• 3 months – when held at
WEIGHT 2x → 4-6 months ventral suspension, infant’s
3x → 1year head, legs and spine extends.
WEIGHT GAIN 1st 6 mos. → 2 lbs/month • When head is depressed →
2nd 6 mos. → 1 lb/month hips, knees and elbows flex
Average: Parachute Reflex

1 y/o male → 10kg • 6-9 months – when infants are
1 y/o female → 9.5kg suddenly lowered toward a notable
HEIGHT Increases during the 1st year by 50%. from ventral suspension, the arms
extends as if to protect themselves
Grows from average birth length of 20 from falling.
inches to 30 inches (50.8cm to
76.2cm). Prone Position
HEAD Increases rapidly: reflects brain
• When lying at their stomach,
CIRCUMFERENCE growth.
newborns can turn their heads to
move it out of position where
End of 1st year: brain reaches 2⁄3 of
breathing is impaired.
adult size.
Neck Righting Reflex
BODY SYSTEMS
1. Cardiovascular: HR slows down to 110-120 bpm by the • 4 months – when infants turns the
end of the 1st year. head to the side, shoulder, trunk
2. Respiratory: RR slows to 20-30 breaths/min. and pelvis turn in that same
3. Immune System: functional by 2 month of age; able to direction.
produce IgG (Immunoglobulin G) & IgM (Immunoglobulin
M) by 1 year of age. Sitting Position
4. Teeth • 1 month – when placed on
- Dentition begins at 6 months. their back and pulled to a sitting
- 2 lower incisors grows first position, the child has gross
- Milk/Deciduous Teeth (20): head lag in the first days of life.
o Completely by 2-3 years • 6 months – can sit
o Shedoffby6to7yearsold momentarily with support.
o Replaced by permanent teeth (32) • Hypotonia – decreased
- Formula: Age in months-6 (Ex: 10 months-6= 4 muscle tone
teeth)
Standing Position
• Stepping Reflex: in a standing position,
the infant’s knees and hips flex rather
than support more than momentary
weight.
• Fades at 3 months.
FINE MOTOR DEVELOPMENT

- Measured by observing / testing prehensile ability
Ø Ability to coordinate hand movements
MOTOR DEVELOPMENT
GROSS MOTOR DEVELOPMENT

• Ability to accomplish large body movements
Ventral Suspension Position

DEVELOPMENTAL MILESTONES
• The newborn allows the head
to hang down with little effort or LANGUAGE
control.
1 Cooing (dove-like) sounds.
• 1 month-old child – can lift
3 Squeals with pleasure.
the head momentarily.
4 Talkative, cooing, babbling, gurgling and able to laugh out
• 3 months – can maintain lifting
loud.
the head
5 Simple vowel sounds: goo-goo and gah-gah.
7 Can imitate simple vowel sounds: oh-oh, ah-ah and oo-oH
9 Speaks a first word: da-da or ba-ba.
12 Can say 2 words besides ma-ma and da-da
Use those 2 words with meaning.

PLAY MAJOR MILESTONES SUMMARY

1 Interested in watching mobile over crib; spends time • Universal language of child – Play
watching parent’s face. • Solitary play – Enjoys mobile/Teether/Music box/Rattle
3 Can handle small blocks or rattles. • Important – Safety
5 Handles plastic rings, keys and squeeze toys. • Stranger anxiety:
6 Enjoy teething rubber rings and bathtub toys. o Begins @ 6-7 months
7 Likes objects for transferring. o Peak @ 8months
8 Enjoys toys with different textures. o Diminishes @ 9 months
9 Needs space for creeping.
10 Plays games like Peek-a-boo. • (+) Head lag.
11 Cruises walks with support. 1 • Dance reflex disappears.
12 Enjoys put-in, take-out toys. • Regards an object in midline only.
• Can hold head up when in prone.
VISION • (+) Binocular vision.
1 Regards object in middle of vision. 2 • Start of social smile.
2 Focuses well and follows objects with eyes. Achieves • Coos “doing sound”
binocular vision: ability to fuse 2 images in one. • Cries with tears
3 Hand regard • Holds head and chest up on prone
4 Recognizes familiar objects • Can follow objects past midline
6 Capable of depth perception 3 • Grasp and tonic neck reflex fading
7 Object permanence • Hand regard
• Closure of posterior fontanel: 2-3 months
HEARING • Neck-righting reflex.
1 Quiets momentarily at a distinct sound (ex: bell). 4 • Complete head control
3 Turns head to attempt to locate a sound • Can laugh aloud: makes bubbling sounds
10 Can recognize his/her name and listen when spoken to • Can roll over
12 Can easily locate sound in any direction • Can pick up objects with whole hand.
5
• Can handle rattle well: Palmar grasp
EMOTIONAL DEVELOPMENT : SOCIALIZATION
• Moro reflex disappears (4-5 months)
1 Can differentiate between face of caregiver and other
• Can sit with support
objects.
• Learns to imitate
6w Social smile
6 • Peak of social smile
5 May show displeasure when object is taken away and
• Eruption of 1st milk teeth (5-6 months)
laughs when seeing a funny face.
8 Stranger anxiety • Can say vowel sounds “ah”, “oh”
9 Aware of changes in tone of tone (cries when scolded). • Can transfer object from one hand to the other
7
hand
12 Overcomes fear of strangers and likes to play interactive
games and joins family activities • Can sit without support.
8 • Peak of stranger anxiety.
COGNITIVE DEVELOPMENT • Plantar reflex disappears 8-9 months.
3 Primary Circular Reaction • Creeping or crawling.
- Explores objects by grasping or mouthing them. • Can stand with support
9
- Unware of what actions they can cause • Says 1st word: “dada”
6 Secondary Circular Reaction • Can combine 2 syllables “mama” and “papa”
- Realizes that his/her actions can initiate pleasurable • Can pull self to stand
sensations. • Understands “no”
10 Coordination of Secondary Scheme • Can recognize own name
- The infant discovers object permanence or realized 10 • Object permanence
that an object out of sign still exists • Peek a boo/ hide and seek, can clap
• Pincer grasp
CEPHALOCAUDAL DEVELOPMENT o ability to pick up smaller objects
Neonate No head control: lag. 11 • Cruising
2 Lifts head until chin. • Can stand alone momentarily
4 - Lifts head until chest. • Can drink from cup
6 Lifts head until buttocks (sits with support) 12
• Cooperates in dressing
8 Sits without support • Can say 2 words mama and dada
10 Stands with support
12 Stands alone, walks with support PROMOTING SAFETY
14-15 Walks alone
PROXIMO-DISTAL DEVELOPMENT ASPIRATION
- Leading cause of death in infants.
0 Hands closed - Parents either underestimate or overestimate the child’s
3 Can open hands ability.
6 Palmar grasp; can hold feeding bottle - Round, cylindrical objects are more dangerous.
9 Pincer grasp - Things within the child’s reach must be safe to put into the
NOTE mouth.
• CNS develops fastest - Toys should not have removable parts.
• Reproductive System = Slowest - XXX clothing with decorative buttons.
- XXX popcorn or peanuts for children under 5 years old.
FALLS
- Second major cause of infant accidents.
- Don’t leave the child unattended on a raised surface.
- Teach parents to be prepared for their infant to roll over by
2mos of age.

CAR SAFETY Important gross motor milestones during the infant year are:
- Always use car seats through toddlerhood.
- Infants up to 20 lbs should be placed in rear facing seats. 2 Lifting the chest off at bed
6-8 Sitting
9 Creeping
BATHING AND SWIMMING 10-11 Cruising
- Don’t leave an infant unattended in a tub, even when propped 12 Walking
up out of the water.
Important fine motor accomplishments during the first year are:
CHILDPROOFING
- Move furniture in front of electrical sockets or buy protective 7 Liability to pass an object from one hand to the other
caps for the outlets.
10 Pincer grasp
- Check for sources of lead paint on painted cribs and rails.
- Check stairways for safety.
Important milestones of language development during the first
- Check table tops for pins or sharp objects that could be
year are:
swallowed.
2 Differentiating a cry
PROMOTING NUTRITIONAL HEALTH
5-6 Simple vowel sounds.
• A baby who is overweight during the first year of life is
more likely to become an obese child. 12 Saying 2 words besides “mama” and “dada”.
Introducing Solid Foods • The more infants are spoken to, the easier it is for them to
- A normal term infant can thrive on breast milk or formula acquire a language.
milk without the addition of any solid food until 6 months • Providing infants with proper toys for play helps
- Chewing movements do not begin until 7 to 9 months thus development.
foods that require chewing are not given before this age • All infant toys need to be checked to be certain they are
too large to be aspirated.
Extrusion Reflex Important milestone of vision development during the first year
- The infant automatically thrusts with his/her tongue any are:
objects/foods placed on its anterior 2⁄3 of the tongue 3 Follows moving objects past midline focus securely
- Lifesaving reflex that prevents an infant from swallowing or without eyes crossing.
aspirating foreign objects
- This reflex fades at 3-4 months of age • According to Erikson, the developmental task of an infant
is Trust vs. Mistrust.
Complementary Feeding • Safety is important.
- Offer new food one at a time to discern possible food o Infants must be protected from falls and
allergies aspiration of small objects.
- Wait 5-7 days before introducing new items • A skill an infant cannot accomplish one day, may be
- Introduce small amounts of new food: 1 to 2 teaspoons at accomplished the next.
a time • Solid food is generally introduced into an infant’s diet at 4-
- Newborn: 30 ml (2 tablespoons) 6 months of age.
- 1 year: 240 ml (1 cup) o Before they can eat solid food, they must lose
their extrusion reflex.
QUANTITIES OF TYPES OF FOOD • Common concerns related to infant development includes:
• Teething • Colic
CEREAL • Thumb- • Diaper dermatitis
- First food given to infants sucking • Baby-bottle syndrome
- Unnecessary to add sugar in the cereal • Use of • Obesity
- Rich in iron pacifiers
- Children should ideally be fed cereal until age 3 or 4 years
• Sleep
problems
VEGETABLES AND FRUITS
• Constipation
- Vegetables have high iron content, they are usually the
2nd food added to the diet.
- Fruit is usually offered 1 month after beginning vegetables • Nurses play a key role in teaching parents about these
(approx 8 months). problems and measures to deal with the
MEAT AND EGGS
- Meat is introduced at 9 months and egg yolks at 10
months.
- Egg yolk alone should be given first.
- Protein of egg white may cause allergies or may be
difficult to digest.
- Cook eggs thoroughly: danger of salmonella.
WEANING
- Infants can approximate their lips to a cup effectively and
controlling the flow at 9 months.
- The sucking reflex begins to diminish in intensity between
ages 6 months to 9 months making this the time to
consider weaning.
KEY POINTS
• The infant period is from 1-12 months
• Children double their weight at 4-6 mos and triple it at 1
year
• Infants develop their first tooth at about 6 months
• By 12 months, they have 6-8 teeth.

NURSING CARE OF A FAMILY WITH A PRESCHOOL AND SCHOOL-AGE CHILD
- Teeth generally have 20 deciduous teeth by 3yrs of age

o Dentist check up.
- Play: Do not need MANY toys.
- Motor abilities include jumping, skipping, throwing a ball,
printing letters and numbers.
-
- 4-5 yo roughhousing & imitative play.
o Group games or reciting songs they have learned
• The preschooler period traditionally includes 3, 4, and 5 in kindergarten or preschool
years old. - Weight gain is slight.
• Physical growth slows during this period. o Average child gains only about 4.5 lb (2kg) a year
• However, personality and cognitive growth happen in this
crucial period at rapid rate. SUMMARY OF PRESCHOOL GROWTH AND DEVELOPMENT
• This is also an important period of growth for parents. In
which, they should set limits for the child.
• Parents may be unsure about how much independence and
responsibility for self-care they should give their child.
• Most children this age want to do things for themselves.
o Feed themselves completely, choose their own
clothing and dress themselves and wash their
own hair.
o As a result, parents may find their children end
up doing things the wrong way.
o Parents need to be reassured that this is typical
preschooler behavior.
• They just need to help children develop initiative and control
of life.
Ø Each year during the preschool period marks a major step
• Parents may also need guidance in separating tasks that a
in: FINE + GROSS Motor + Language Development
child can accomplish and those that need supervision so
Ø Play activities change focus as preschoolers learn new
they can set limits.
skills and understand more about the world.
• Setting limits protects children from harming
themselves or others.
OTHER PRE-SCHOOLER DEVELOPMENT
LANGUAGE DEVELOPMENT
• Questions: 400/day
• How?” and “Why?”
• Simple answers
• Curiosity
• Vocabulary building
• Questioning ¬
• Mealtime conversations
• Can describe something from their day in great detail
• Imitate language exactly
• Egocentric
ASSESSMENT PLAY
- Health hx ( Wt, Ht, Mood, Alertness, Infection, BMI, social • They enjoy games that use imitation such as pretending
interactions, number of words) they are a teacher, cowboy, firefighter or store clerk.
- Lymphatic tissue begins to increase in size: tonsils. • Imitate what they see (parents)
o IgG and IgA antibodies increases. • Don’t need many toys since they use their imagination
o URTI remains localized to the nose with little • Pretending
systemic fever. • Imaginary friends (normal)
- Physiologic – splitting heart sounds for the 1st time.
o Occurs due to changing size of heart in reference PSYCHOSOCIAL DEVELOPMENT
to the thorax of the anteroposterior and
transverse diameters of the chest. • Developmental Task : Initiative vs guilt
o Pulse rate: >85bpm • To gain sense of initiative: need exposure to a wide variety
o BP 100/60mmHg. of experiences and play materials so they can learn as
- Bladder – palpable on symphysis pubis, voiding 9-10x/day. much about how things work as possible.
- Muscles – stronger activities such as gyms • Explore outside home: zoo, amusements park, family vacay
o Genu valgus (knock knees) – disappears with • These experiences lead to increased vocabulary
increased skeletal growth at the end of pre school • Urge parents to provide play materials that encourage
period creative play, homemade dough, finger paint
- Ectomorphic body build = slim body build
- Endomorphic body build = large body build IMITATION
• Role modeling should be fun not accurate.
- Wt 4.5 lb (2kg) / year • ex. Police officer, fire fighter, doctor, use of objects like
- Ht 2 to 3.5 in (6 to 8cm) / year computer, wipes, calculator, type machine, doll
- Head circumference is not routinely measured at physical
assessments on children over 2 yo.
o Head is close to adult size by six years old.

FANTASY
• cannot differentiate fantasy vs reality HEALTH TEACHING TO A PRESCHOOLER
• - “magical thinking” intense involvement in play part.
Parents should be careful with this.
• -Ex. When you walk in the room you state is as, “That
strange, I don’t see Cathy anywhere, All I see is a teddy
bear” correct way: “What a nice teddy bear you’re
pretending to be.”
OEDIPUS & ELECTRA COMPLEXES

• Oedipus Complex – refers to the strong emotional
behavior attachment a preschool BOY demonstrates
toward his MOTHER
Electra complex – refers to strong attachment of a
preschool GIRL to her FATHER. “Daddy’s girl.”
• Assure parents that this competition and romance in
preschoolers is a normal part of maturing. Be cautious on FAMILY WITH A SCHOOL-AGE
act of jealousy, anger, vocal expressions. - Ages 6 to 12 y/o
GENDER ROLES MAJOR CHANGES
• Encourage single parents to plan opportunities for their • HR 70-80bpm
children to spend some time with adults other than • BP 112/60mmHg
themselves.
• Wt 3 to 5 lb ( 1.3 to 2.2 kg)
o Such as grandparents, friend, relative of the
• Ht 1 to 2 in (2.5 to 5cm)
opposite sex.
• Lymphatic tissue grows in size.
• Ex. Parents should state the importance for both boys and
o Tonsils seem to fill the entire back of the throat.
girls to do housework. BOTH in actions and in words.
o Resulting to temporary deafness from the
eustachian tube obstruction.
SOCIALIZATION
• 10 yrs of age brain growth is complete, refined fine motor
• Preschool period: sensitive and critical time for socializaton.
coordination Adult vision is achieved
• 4yo group play , more arguments than 3yo
• IgG and IgA reach adult levels
• 5yo begin to develop best friends
• Left ventricle of the heart enlarges to be strong enough to
pump blood to the growing body. Innocent heart murmurs
COGNITIVE DEVELOPMENT
may become apparent due to extra blood crossing the heart
• Second phase of development “Intuitional thought” How
valves.
come? Why?
• Piaget: “Intuitive Thought” CHRONOLOGIC DEVELOPMENT OF SECONDARY SEX
• Conservation: two balls of clay of equal size. One is CHARACTERISTICS
squashed flatter and wide while the other is intact. A
preschooler will insist as it is different.
MORAL AND SPIRITUAL DEVELOPMENT

• Determine right from wrong based on their parent’s rules.
• Preschool tend to do good out of self interest not strong
spiritual motivation. Important religious holiday and
religious rituals such as prayer before meals.
NUTRITION
• Do not give more vitamins than the recommended daily
dosage (esp. Fat soluble vitamins)
• IF vegetarian diet – be sure that the child is receiving
adequate amount from all food groups.
• Very important Vit Ca, Vit D , Vit B12 for growth and
development
PROMOTING SAFETY TO A PRESCHOOLER
Sexual Maturation :
Girls : 12 to 18 y/o
Boys : 14 to 20 y/o
CHANGES
–– SEXUAL AND PHYSICAL CONCERNS

• Prepubertal girls are usually taller by about 2 in (5cm) than
preadolescent boys
• Girls – changes in pelvic contour (broader) ; Breast
development, menstrual flow
• Boys – gynecomastia can occur in prepubescent boys.
Transgender children- not their natal sex.
• Studies on the mental health reports highest incidence of
psychosocial disorders such as depression and anxiety.

• Expose to positive interaction with adults and promote • The best time to teach children to be compassion and
health child develop thoughtful towards other is during the early school years.
–– TEETH COGNITIVE DEVELOPMENT

• Deciduous teeth are lost and permanent teeth erupt during
the school-age period. Children can use Concrete Operational Thought because they learn
• Ave teeth gains 28 teeth between 6 to 12 yo. several new concepts during school age, such as:
• DECENTERING
DEVELOPMENTAL MILESTONES - the ability to project one's self into other people's situations
and see the world from their viewpoint rather than focusing
GROSS MOTOR DEVELOPMENT only on their own view.
AGE PHYSICAL PSYCHOSOCIAL AND • ACCOMMODATION
(YRS) DEVELOPMENT COGNITIVE - the ability to adapt thought processes to fit what is
DEVELOPMENT perceived such as understanding that there can be more
• A year of constant • First-grade teacher than one reason for other people's actions.
• motion; skipping is a becomes authority figure o Preschooler – expect to see the same nurse in
new skill; first molars • Adjustment to all-day the morning who was there the evening before,
erupt. school may be difficult and o School-Age Child – understand that different
may lead to nervous nurses work different shifts.
6 • CONSERVATION
manifestations of
fingernail biting, etc. - the ability to appreciate that a change in shape does not
• Defines words by their use necessarily mean a change in size.
(e.G., a key is to unlock a o If you pour 30 ml of cough medicine from a thin
door, not a metal object) glass to a wide one
• Central incisors erupt • A quiet year; striving for § Preschooler – will say that one glass
• Difference between perfection leads to this holds more than the other
sexes becomes year being called an § School-Age Child – knows that both
apparent in play (e.g., eraser year. glasses hold an equal amount.
video games vs. • Learns conservation (e.g., • CLASS INCLUSION
7 dolls) water poured from tall - the ability to understand that objects can belong to more
• Spends time in quiet container to a wide, flat than one classification.
play. one is the same amt of o Preschooler – able to categorize items in only
water) one way, for example, stones and shells are
• Can tell time found at the beach
o School-Age Child – can categorize them in
• Can make simple change.
many ways such as by different materials or by a
• Coordination • "Best friends" develop; difference in sizes and shapes, not just that they
definitely improved whispering and giggling are found at the beach.
• Eyesight fully begin
8 develops • Can write in cursive as PROMOTING SAFETY TO SCHOOL-AGE
• Playing with friends well as print
becomes important. • Understands concepts of MOTOR VEHILE
past, present, and future. • Encourage children to use seat belts and a booster seat if
• All activities done • Friend or club age; a 9- needed; role model seatbelt use.
with friends year-old club is formed to • Teach street-crossing safety; stress that streets are no
spite someone place for roughhousing, pushing, or shoving.
9 • Has secret codes • Teach parking lot and school bus safety (e.g., do not walk
• Is all boy or all girl in back of parked cars, wait for crossing guard).
• Clubs disband and reform
quickly. BICYCLE
• Coordination • Ready for camp away • Teach bicycle safety, including wearing a helmet and not
improves from home giving “passengers” rides.
• Collecting age
10
• Likes rules COMMUNITY
• Ready for competitive • Teach to avoid unsafe areas, such as train yards, grain
games. silos, and back alleys.
• Active but awkward • Insecure with members of • Stress to not go with strangers (parents can establish a
11 and ungainly opposite sex code word with child
• Repeats off-color jokes. o child does not leave school with anyone who
• Coordination • A sense of humor is does not know the word).
12 improves present • Teach children to say “no” to anyone who touches them if
• Is social and cooperative. they do not wish it, including family members
o Most sexual maltreatment is by a family member,
EMOTIONAL DEVELOPMENT not a stranger)
Ø DEVELOPMENTAL TASK : Industry vs. Inferiority • Teach children not to arrange a meeting with people they
• IF children are prevented from achieving a sense of meet on the Internet.
industry or do not receive rewards for accomplishment, they o For older school-age children, teach rules of
can develop a feeling of inferiority or become convinced safer sex so they know these rules before they
they cannot do things they actually do. need to use them a first time
o Difficulty tackling new situations later in life (new
job, new school, new responsibility) BURNS
o Because they cannot envision how they will be • Teach safety with candles, matches, and campfires and
successful in handling them resulting in that fire is not fun.
frustration on school or work activities. • Also teach safety with beginning cooking skills (e.g., be
• School Age children needs reassurance that they are doing certain to include microwave oven safety, such as closing
things correctly immediately once task is completed firmly before turning on oven; not using metal containers).
• Teach safety with sun exposure; use sun block. Teach to
not climb electric poles.

FALLS
• Educate that roughhousing on fences or climbing on roofs
is hazardous. Teach skateboard, scooter, and skating
safety.
SPORTS INJURIES
• Teach that wearing appropriate equipment for sports is not
babyish, but smart management.
o e.g., face masks for hockey, mouthpiece and cup
for football, helmet for bicycle riding,
skateboarding, or in- line skating, batting helmets
for baseball
• Stress not to play to a point of exhaustion or in a sport
beyond physical capability
o no pitching baseballs or toe ballet for an early
grade-school child
• Use trampolines only with adult supervision to avoid serious
neck injury.
DROWNING
• Teach how to swim
o Dares and roughhousing when diving or
swimming are not appropriate
o Stress not to swim beyond limits of capabilities.
DRUGS
• Help your child avoid all recreational drugs; prescription
medicine should only be taken as directed. Teach to avoid
tobacco and alcohol.
COMMON PROBLEMS OF SCHOOL-AGE
Language Development:
• Normal difficulty: S, Z, Th, L, R but if persist speech therapy
might be necessary.
Fears
• Anxiety r/t Beginning of school
• Stealing vs Shoplifting
o Violence or Terrorism
o Bullying
o Recreational Drug use
o Child with Alcoholic parents
NUTRITION FOR SCHOOL-AGE

• Nutritious lunch to take to school
• Take note of food allergies
• Nutritious after-school snacks
• Vegetarian diet: alternatives
o Ca green leafy veggies such as spinach,
kangkong, bread, turnip, lima beans, corn.
o Vit D sunlight
• Poor eating habits developed in the school age years
may last through adulthood and lead to an increased
risk of health-related diseases
HEALTH TEACHING
• Dress – take care of their own belongings
• Sleep – 10 to 12 hrs each night
• Hygiene – regulate H2O temp, brushing of teeth. D
o Dental check ups, dental floss, proper wound
care or cleaning for post circumcision.
• CARIES – aka cavities are progressive destructive lesions
or decalcification of the tooth enamel and dentin.
• MALOCCLUSION: deviation of tooth position from the
normal
o should be evaluated by orthodontist

aTHE FAMILY WITH AN ADOLESCENT
• Adolescents both grow rapidly & mature dramatically during TANNER STAGES
this period.
• MAJOR MILESTONE: Onset of puberty at 9 to 12 years of
age and the cessation of body growth at 16-20 years of age
PHYSICAL AND PHYSIOLOGIC GROWTH

• Girls = 1-2 in taller than boys coming into adolescence but
generally stop growing within 3 years from menarche.
• Boys = 4-12 in & and gain 15-65 lbs
• Adult height: 2-8 in & gain 15- 55 lbs
–– TEETH
• 13 y/o – gain their second and
• 18-21 y/o – Their third molars (wisdom teeth)
• Jaw reaches adult size
• Pain: extraction of molars (X fit jaw) EMOTIONAL DEVELOPMENT
Ø Identity vs Role Confusion
GROWTH AND DEVELOPMENT OF AN ADOLESCENT • Mid adolescence: Identity - decide who they are and what
kind of person they will be.
ADOLESCENCE • In late adolescence : the task is INTIMACY VS ISOLATION
- Physiologic period between beginning puberty & cessation • If young people do not achieve a sense of identity, they
of bodily growth develop a sense of role confusion or can have little idea of
what kind of person they are.
PUBERTY • This can lead to their having difficulty functioning effectively
- 11 to 14 y/o as adults,
- Time where individual is 1st capable of sexual o They are unable to for example to decide what
reproduction stand to take on a particular issue or how to
• When the girl begins to menstruate. approach new challenges or situations.
• When boys begin to produce spermatozoa • Some adolescents may become delinquent or exhibit acting
out (attention getting) behavior
SECONDARY SEX CHARACTERISTICS o They believe it is better to have a negative image
• These are the characteristics which distinguish the sexes than to be nobody at all.
from each other but play no direct part in reproduction. Ø Four main areas in which adolescent must make gains to
• The secondary sex characteristics that began in the late achieve a sense of IDENTITY:
school-age period continue to develop during adolescence. 1. Accepting their changed body image.
✅ Body hair configuration 2. Establishing value system of what kind of person, they
✅ Breast growth want to be.
3. Making a career decision.
ESTROGEN = breasts grow, pubic hair grow, wide hips develop 4. Becoming emancipated from their parents.
TESTOSTERONE = body hair grows, voice breaks, muscle growth
increases DEVELOPMENTAL MILESTONES
Playing sports (intense team play)
13 Loud, boisterous, show off to opposite sex
Falls “in-love”
Quiet & introspective
14 Attachment & Imitation
Rejection
Privacy is important
15
Falls in love (5-6x/year)
Able to trust their bodies better
Part-time jobs: babysitting
16 Charitable endeavors
Willing to listen & talk about problems
Understands that adults are “humans”
More thoughtful about interactions
Childish behaviors left behind
17` Gynecomastia fades
Stormy year: Ambivalence: Clinging to security
Experimentation
Ø Formal Operational Stage
• Ability to think in abstract
• Use scientific method
• Problem solving
MORAL AND SPIRITUAL DEVELOPMENT

• “Why is it wrong to steal from your neighbor’s house?”
• “It would hurt my neighbor by requiring him to spend money
to replace what I stole.”
• Question existence of God & religious practices

THE FAMILY WITH AN ADOLESCENT
PROMOTING ADOLESCENT SAFETY TREATMENT FOR ACNE

• Accidents: most common cause of death
• Rebellion against authority EXTERNAL MEDICATIONS
• Gaining attention - applied externally peel away the superficial skin layer to
• Safety courses prevent sebum plugs from forming and sufficient only if
o Driver education classes (Safe driving, seat belts) comedones are present
o Wear safety helmets -
Benzoylperoxide - commonly used
PROMOTING NUTRITIONAL HEALTH - OTC
• Growth: may always feel hungry Faddish/quick snacks Tretinoin - common prescription medication
• Non-nutritive foods CAUTION
• Form of rebellion use sunblock for UV rays 1st few weeks: skin appears worse
• Slight obesity: starvation diets
• Eating disorders TOPICAL ANTIBIOTICS
• Weight loss diets with supervision Erythromycin - May used to reduce the bacterial level
and Clindamycin on the skin
PROMOTING HEALTHY FAMILY FUNCTIONING
SYSTEMIC MEDICATIONS
• Counsel parents to appreciate that although is not easy to
• For pustular and cystic acne
live with a teenager, it is equally difficult to be the teenager.
Tetracycline - Support teen (late effect)
• “Fallen Angel” syndrome Isotretinoin - For cystic acne
o Have trouble respecting parents who are so (Accutane)
obviously imperfect.
• May follow health advice poorly because they view health OTHER METHODS
care personnel in the same light. • Anti-Inflammatory Drugs
• Laser
CONCERNS
• Body & physiologic functioning OBESITY
• Feelings and emotional focus • Caused by enes + environment
• Social relationships • Difficult to achieve sense of identity
• Family & school expectations • Exclusion from groups
• Some may be unaware of excessive intake
POOR POSTURE • Diet: 1,800 cal/day
• Tendency to round shoulders, shambling, slouchy walk
• Imbalance of growth arises from the skeletal system SEXUALITY & SEXUAL ACTIVITY
growing a little more rapidly than the muscles attached to it. • Ask if child is Sexually active
• Height issues: girls may slouch to diminish their breast size • Difficult topic to discuss
and not to appear taller than the boys • Reasons for engaging in sexual activity
• Backpacks: too heavy • Myths – They do not engage in sex
• Assess: Normal posture VS Scoliosis • Health visit: underlying concern about sex How to ask teen
about sex issues
TATTOO • Safer sex measures
• Body piercing and tattoos are strong marks of adolescence
• “I am different from you.” STALKING
• Educate: Be certain that they know the symptoms of • Repetitive, intrusive, and unwanted actions directed at an
infection at a piercing or tattoo site (redness, warmth, individual to gain the individual’s attention or evoke fear
drainage, swelling, mild pain) • Males or females – stalkers or victims
• Report to Health care provider for the above signs and • Difficult to prevent
symptoms • Use of internet
• Caution: sharing of needles for piercing • Measures: same as avoiding rape
ACNE HAZING
• Self-limiting, inflammatory disease that involves the • Rituals that prospective members have to undergo to join
sebaceous glands that empty into hair shafts sororities, fraternities or adolescent gangs, “rites of
(pilosebaceous unit) passage”
• Most common skin disorder of the adolescence o Extreme measures
• Peak: • Parent awareness
o Girls = 14-17 y/o • Health care provider: help make decisions
o Boys = 16-19 y/o
SUBSTANCE ABUSE
• Mild: comedones are present • Use of chemicals to improve a mental state or induce
• Moderate: papules & pustules euphoria
• Severe: Cysts • Common in adolescents
• Common locations: Face, neck, back, upper arms and • Desire to expand consciousness; Feel more confident; Peer
chest pressure
• Flare-ups are associated with • Form of rebellion
o Emotional stress
o Menstrual period or the use of greasy hair TYPES OF ABUSED SUBSTANCES
creams or cosmetics 1. Sedatives for pain: overdosage
• Assessment – Is teen troubled with acne? Interference with o Methylphenidate (Ritalin): giddiness
Self-image Inspect for lesions (PE) o Caution: embolism, emphysema
• Goals of Therapeutic Mgt 2. Inhalants: cardiac failure
o Decrease sebum formation ✓Prevent
comedones ASSESSMENT
o Control bacterial proliferation - Trust in Health care provider: admission of drug use
- Initial signs:

THE FAMILY WITH AN ADOLESCENT
o Failure to complete assignments Poor reasoning

ability
o Decreased school attendance
o Frequent mood swings
o Deteriorating physical appearance ✓Recent
change in peer group
o Expressed negative perceptions of parents
- Substance abuse affects ability to solve problems: delay in

maturity
- Difficult for them to appreciate how much they depend on a
drug until they stop using it.
- GOAL – not use a drug in 24 hours (1st)
- Caution like it is about vehicle accidents
o Scare stories cloud the issue
- Teen may dismiss all advice given
- Counseling
- Substance use is illegal and harmful
- 24-hour facilities Evaluation: History & PE
- Continuing relationship: role modeling
ATTEMPTED SUICIDE
• May be r/t school stress
• Depression that increases at dark 3rd cause of death
• Assessment
o PE: signs of depression or behavior problems
o Self-destructive behavior
o Accident proneness
o Difficulties in school
o Family assessment
• Acting out with drugs, alcohol, sex
• Check : Constant activity VS isolation
• NO emotional support from friends
o Friends may be aware of desire for suicide
• Caution parents of typical danger signs
• Ask questions, give detailed suicide plan
• Serious suicide attempts
• Crisis intervention Alleviate pain & depression
• Counseling: form new perspective
• Find out things viewed as important
• Plan: life is worth living
• Changes that had to be made Probing
o So teen would think of alternative solutions to
the problem
• General measure:
o Let teen speak honestly about suicidal thoughts
and problems that led to that.
• For safety: observe
• Prevent infliction of self-injury
• Antidepressants: of little value
• Continuing evaluation: history & PE
RUNAWAY
• Adolescent between 10-17 y/o who has been absent from
home at least overnight without permission of a parent or
guardian.
• Most don’t go far
• Low or high-income families
• Assessment
o Preceded by argument with parents Last straw:
long-term disagreements “throwaways” Secure
thorough history
o Be nonjudgmental in questioning
o Ask if teen wants to go home

THE YOUNG AND MIDDLE AGE ADULT
ADULTHOOD • Intimacy vs Isolation

• The adult phase of development encompasses the years • Forms long-term relationships and close friendships
from the end of adolescence to death • Occupational choice and education are largely inseparable.
• 3 phases
o Young Adulthood (20-40 yrs)
o Middle Adulthood (40-65 yrs)
§ Young & Middle adulthood is a period
of challenges (demands of work and
raising families), rewards, and crisis
o Late adulthood (>65 yrs)
• Adults also face such crisis such as
o Caring for aging parents
o Job loss
o Dealing with own developmental needs + those
of their family members
• Developmental changes are based on earlier
characteristics that help shape subsequent behavior and
characteristics
• Adult age span includes 3 very different generations
o Baby Boomers (1945-1964)
§ Individualistic outlook
§ “workaholic” orientation
§ Want to be respected at work but feel
role overload • Formal Operational Thought
o Ability to think in abstract
o Generation X (1965-1978)
o Employ logic
§ Raised in 2-worker households
o Creativity and Intuition
§ Less impressed w/ corporate values
• Considers information in formulating ideas
• More skeptical
• Values and norms of social group
• Resist authority
§ Enjoy challenges and opportunities to • Young adults are able to generate hypotheses about what
creatively solve problems will happen, given a set of circumstances and do not have
o Generation Y to engage in trial-and-error behavior
§ Come of age
MORAL DEVELOPMENT
• Technologically
sophisticated • Post conventional level
§ Dependent • Separating self from others
§ Enjoy public affirmation of efforts o At this time, the person is able to separate self
from the expectations and rules of others and to
YOUNG ADULTHOOD define morality in terms of personal principles.
• Period between late teens and mid to late 30s • Morality is based on personal principles
• Separate from their families of origin o Principled reasoning
• Establish career goals • MEN – ethnic of justice (rules and rights)
• Decides whether to marry and begin a family or remain • WOMEN – obligation to care and avoid hurt
single
HEALTH RISKS
• Active and must adapt to new experiences
• Healthy time of life
• Pass thru alternating periods of stability and change
o Changes include – processes of maturation and • Health risks are still common in this age group
socialization • Behaviors : prevention through education
§ They reevaluate choices and consider
new alternatives INJURIES • 5th cause of death
o During periods of stability, they make certain • Safety pre-cautions and injury
choices and build structures around them prevention
SUICIDE • 3rd leading cause of death
DEVELOPMENTAL CHANGES • r/t problems – inability to cope
• Identify behaviors : potential
PHYSICAL DEVELOPMENT problems
• Prime physical years • Those who are in risk of doing this,
• Peak ; most efficient functioning refer immediately
• High-risk takers – at a risk for injury • Do not ignore suicide threats
• Health outcomes in older years • Educate self on early signs
• Personal lifestyle assessment for health risks HYPERTENSION • Modifiable vs non-modifiable factors
• Major cause for CV, CVA
- Human body is at its most efficient functioning at about age • BP – routine assessment
25 years. SUBSTANCE ABUSE • Major threat to health due to long
- Musculoskeletal system is well developed and coordinated. term effects
- Period when athletic endeavors reach their peak. All other • Drug abuse counseling
systems of the body (e.g., cardiovascular, visual, auditory. SEXUALLY • Chlamydia is the most prevalent
And reproductive) are also functioning at peak efficiency TRANSMITTED • Antibiotic resistance
DISEASES • Educate !
PSYCHOSOCIAL DEVELOPMENT
• Genital stage : mature sexual relationship • Do not be judgmental

• Confidential information ! DEVELOPMENTAL CHANGES

EATING DISORDERS • Assess nutritional concerns
• Discuss diet and exercise patterns PHYSICAL DEVELOPMENT
• Individual wellness • Aging causes changes in physical appearance
• Best to observe proper nutrition • Decreased organ function and horomonal production
during child-bearing years • Menopause – change of life in women, when menstruation
VIOLENCE • Homicide is the 2nd leading cause of ceased.
death o Occurred when a woman has not had a
• Educate on physical and sexual menstrual period for 12 months.
assault o Menopause usually occurs sometime between
ages 40 and 55.
• Abuse of women – ask explicitly
§ Average is about 47 years.
during assessment
o At this time, ovarian activity declines until
MALIGNANCIES • Monthly TSE ; Testicular exam
ovulation ceases.
yearly
o Common symptoms, related to a decline in
• Mammography for >40 y/o estrogen are:
• Annual breast exam § Hot flashes, chilliness, a tendency of
• Pap smear the breasts to become smaller and
• Check for high-risk factors less dense, and a decrease in
• Observe preventive measure for ppl metabolic rate that may lead to weight
aged 21 y/o gain. Insomnia and headaches may
also occur.
HEALTH PROMOTION
- Health tests and screenings
- Safety
- Nutrition and exercise
- Social interaction
PSYCHOSOCIAL DEVELOPMENT
• Generativity vs Stagnation
• GENERATIVITY – Focuses in establishing and guiding the
next generation
o The concern about providing for the welfare of
MIDDLE ADULTHOOD (40-65 yrs) humankind is equal to the concern of providing
• Occurs between mid to late 30s to the mid 60s for self.
• Aware that changes in reproductive & physical abilities • STAGNATION
signify the beginning of another stage in life o Boredom and impoverishment
• Time of continuing transitions when individuals may o Unable to expand interests
reassess their goals in life and add new goals o Difficulty accepting aging bodies
• “Years of stability and consolidation” o Social withdrawal & isolation
• Defy years : changes in the way they act and dress o Preoccupied with self
• New found freedom (independence) o Unable to give to others
• Follow individual interests o Regression
o Opinion of others is less important
• Ethical and moral standards + religious concerns = - People in their 20s and 30s tend to be self- and family-
important centered.
- In middle age, the individual collaborates with others.
MATURITY - Marriage partners have more time for companionship and
• State of maximal function and integration recreation; thus marriage may be more satisfying in the
• State of being fully developed middle years of life.
- Partners have time to work together in volunteer activities,
REPRESENTATIONS OF MATURITY and time for one partner to go out for lunch and for the other
• Mature individuals are guided by an underlying philosophy to go fishing.
of life. - Generative middle-aged persons are able to feel a sense of
• A comprehensive philosophy allows a person to make comfort in their lifestyle and receive gratification from
sense out of life and thus helps that person maintain a charitable endeavors
sense of purpose and hope in the face of human tragedies.
• Open to new experiences & continued growth COGNITIVE DEVELOPMENT
• Tolerates ambiguity • Little changes: abilities
• Flexible & can adapt to change • Maintaining mental abilities
• Self-acceptance • Personal experiences
• Reflective & Insightful
- Cognitive processes include reaction time, memory,
• Full responsibility for self
perception, learning, problem solving, and creativity
• Confront tasks realistically - Reaction time during the middle years stays much the same
• Owns decisions or diminishes during the latter part of the middle years.
o Memory and problem solving are maintained
through middle adulthood.
o Learning continues and can be enhanced by
increased motivation at this time in life.

- Genetic, environmental, and personality factors in early and • Screening guidelines for early detection of cancer are
middle adulthood account for the large difference in the constantly evolving as new data are analyzed
ways in which individuals maintain mental abilities.
- The professional, social, and personal life experiences of CARDIOVASCULAR DISEASE
middle-aged individuals will be reflected in their cognitive
performance.
• Heart disease and cancer are the leading causes of death
during middle adulthood.
o Approaches to problem solving and task
completion will vary considerably in a middle- • Risk factors for heart disease include smoking, obesity,
aged group. hypertension, hyperlipidemia, diabetes mellitus, sedentary
lifestyle, a family history of myocardial infarction or sudden
MORAL DEVELOPMENT death in a father less than 55 years old or in a mother less
• Post-conventional level than 65 years old, and the individual’s age.
o Based on universal ethical principles • A newly recognized cluster of risk factors that often occur
o Extensive experience together, termed metabolic syndrome, increases the risk for
o Few achieve this level heart disease.
• This syndrome includes the following risk factors: obesity
MIDLIFE CRISIS with excessive abdominal fat, hypertension, high lipid
• Realization : reached the half-way mark levels, and insulin resistance
• Time is at a premium & life is infinite • Lifestyle activities and behaviors, such as diet modifications
• Gives importance on youthfulness & physical strength and increasing physical activity play an important role in
preventing the development of metabolic syndrome risk
HEALTH PROBLEMS factors.
• Lifestyle patterns • Cancer
• Aging • CVD OBESITY
• Family Hx • Obesity • Middle-aged adults who gain weight may not be aware of
• Stressors • Alcoholism some common facts about this age period.
• Injuries • Mental Health Alterations
• Decreased metabolic activity and decreased physical
- NURSE’S ROLE : health promotion / prevention activity mean a decrease in caloric need.
o Health tests & screenings • The nurse’s role in nutritional health promotion is to counsel
o Safety clients to prevent obesity by reducing caloric intake and
o Nutrition and exercise participating in regular exercise.
o Social interaction : midlife crisis • Clients should also be educated that being overweight is a
risk factor for many chronic diseases such as diabetes and
- Leading causes of death in this age group include motor hypertension and for problems of mobility such as arthritis.
vehicle and occupational injuries, chronic disease such as
• Recent changes in the Food Guide Pyramid propagated by
cancer and cardiovascular disease. the U.S. Department of Agriculture now encourage nutrient
- Lifestyle patterns in combination with aging, family history, intake based on physical activity, age, and gender.
and developmental stressors (e.g., menopause,
climacteric) and situational stressors (e.g., divorce) are • Clients may be directed to the new MyPlate website to
often related to health problems that do arise. design a customized, healthy diet plan for themselves.
o Example: smoking and excessive alcohol • Clients should seek medical advice before considering any
consumption place an individual at greater risk of major changes in their diets.
developing chronic respiratory problems, lung
cancer, and liver disease. ALCOHOLISM
o Overeating can result in obesity, diabetes • Excessive use of alcohol can result in unemployment,
mellitus, atherosclerosis, and its associated risk disrupted homes, injuries, and diseases.
for hypertension and coronary artery disease • It is estimated that 4 million people in the United States are
o Many diseases of older age may be decreased dependent on alcohol and can be considered alcoholics.
by health-conscious and lifestyle decisions
made, and acted on, in midlife.
• Alcohol use may exacerbate other health problems.
• The nurse can play an important role in teaching middle-

• Nurses can help clients by providing information about the
dangers of excessive alcohol use, by helping the individual
aged clients about preventive health care to avoid or
clarify values about health, and by referring the client who
minimize the risk of such health problems.
abuses alcohol to special groups such as Alcoholics
Anonymous
INJURIES
• Changing physiological factors, as well as concern over MENTAL HEALTH ALTERATIONS
personal and work-related responsibilities, may contribute
to the injury rate of middle-aged people.
• Developmental stressors, such as menopause, the
climacteric, aging, and impending retirement, and
• Motor vehicle crashes are the most common cause of situational stressors, such as divorce, unemployment, and
unintentional death in this age group. death of a spouse, can precipitate increased anxiety and
• Decreased reaction times and visual acuity may make the depression in middle-aged adults.
middle-aged adult prone to injury. • Clients may benefit from support groups or individual
• Other unintentional causes of death for middle-aged adults therapy to help them cope with specific crises.
include falls, fires, burns, poisonings, and drownings. Work-
related injuries continue to be a significant safety hazard HEALTH ASSESSMENT
during the middle years.
CANCER
• Cancer is the leading cause of death in middle adulthood.
• The patterns of cancer types and incidences for men and
women have changed during the past several decades.
• The ACS (2014) states that men have a high incidence of
cancer of the lung, prostate, and colon.
• In women, lung cancer is highest in incidence, followed by
breast cancer and colon cancer.

KEY POINTS OF THE LESSON

- 3 distinct generations are included in adulthood
o Baby boomers
o Generation Xers
o Generation Ys
- Each has its own world view
- Physical growth and development peaks in the mid 20s and
then becomes decremental
- Intimacy vs Isolation – Emerging YA develop a sense of
identity and prepare for intimate relationships
- Post Conventional Level – Moral development continues
throughout adulthood and actions + life decisions are based
on universal and ethical principles
- Spirituality may be important to YA but it is considered a
private matter
- Health risks for YA are primarily r/t lifestyle and behavior
- MA begin to notice physical changes r/t aging
- Generativity vs Stagnation – concern for others ; passing
on values to the next generation
- Adults in midlife must balance the needs of many including
their own parents and children.
- Health decisions made by midlife adults may affect their
health in later life
- A variety of threats including cancer and CVD begin to
affect people in their middle age
- Physical activity, healthy nutrition & routine care by a health
provider are important throughout the adult years

THE FAMILY WITH AN OLDER ADULT
• Only 5% of older people live in nursing homes. SOCIOLOGIC

• Some elderly people have chronic disease but still functions
quite well. –– DISENGAGEMENT THEORY
• Older people should be challenged to stay mutually active. • As individuals age, they withdraw from society and society
• Older people who learn to play an instrument, a new supports this withdrawal.
language are less likely to get Alzheimer’s disease.
• It is never too late to late to start good lifestyle habits like –– ACTIVITY/DEVELOPMENTAL TASK THEORY
eating a healthy diet & exercise. • Individuals need to remain active to age successfully.
Activity is necessary to maintain life satisfaction and a
THEORIES OF AGING positive self-concept.
BIOLOGIC THEORIES OF AGING
- Concerned with answering basic questions regarding –– CONTINUITY THEORY
physiologic processes that occur in ALL LIVING organism • Individuals will respond to aging in the same way they have
as they chronically age responded to previous life events. The same habits,
commitments, preferences, and other personality
–– FREE RADICAL THEORY characteristics developed during adulthood are maintained
• Free radicals are byproducts of metabolism. When these in older adulthood.
byproducts accumulate, they damage the cell membrane,
which decreases its efficiency. –– PERSON-ENVIRONMENT THEORY
• The body produces antioxidants that scavenge the free • Each individual has personal competencies that assist the
radicals. person in dealing with the environment. These
competencies may change with aging, thus affecting the
–– CROSS-LINKAGE THEORY older person’s ability to interrelate with the environment.
• With age, according to this theory, some proteins in the
body become cross-linked. PSYCHOLOGIC
• This does not allow for normal metabolic actions and waste
products accumulate in the cells. –– MASLOW’S HIERARCHY OF HUMAN NEEDS
• The end result is that tissues do not function at optimum • Human motivation is viewed as hierarchy of needs that are
efficiency. critical to the growth and development of all people.
Individuals are viewed as active participants in life, striving
–– WEAR & TEAR THEORY for self-actualization.
• The wear and tear theory equates humans with machines.
It hypothesizes that aging is the result of use. –– JUNG’S THEORY OF INDIVIDUALISM
• Development is viewed as occurring throughout adulthood
–– ERROR THEORY with self-realization as the goal personality development.
• The Error Theory is based on the idea that errors can occur • As an individual ages, he or she is capable of transforming
in the transcription of the synthesis of DNA. into a more spiritual being.
• These errors are perpetuated and eventually lead to
systems that do not function at optimum level. –– ERIKSON’S EIGHT STAGES OF LIFE
• The organism’s aging and death are attributable to these • All people experience 8 psychological stages during the
events. course of a lifetime.
• Each stage represents a crisis, where the goal is to
–– PROGRAMMED THEORY integrate physical maturation and psychosocial demands.
• This theory states that normal cells divide a limited number • Successful mastery prepares an individual for continued
of times, therefore it is hypothesized that life expectancy development.
was preprogrammed.
–– EGO INTEGRITY VS DESPAIR
–– IMMUNITY THEORY • 65 years old to death
• Changes occur in the immune system, specifically in the T • Older adults can look back with a sense of satisfaction and
lymphocytes, as a result of aging. acceptance of life and death.
• These changes leave the individual more vulnerable to • Unsuccessful resolution of this crisis may result in a sense
disease. of despair in which individuals view life as a series of
misfortunes, disappointments and failures.
IMPLICATIONS FOR NURSING
Ø When interacting with the older population caregivers –– SELECTIVE OPTIMIZATION WITH COMPENSATION
must relate the key components of the Biologic theories • Physical capacity diminishes with age. An individual who
to the care being provided. ages successfully compensates for these deficits through
Ø Theories can explain some of the changes seen in the selection, optimization and compensation.
aging individual.
Ø Aging and disease do not necessarily go hand-in hand. The IMPLICATIONS FOR NURSING
nurse caring for older adults needs to have a clear Ø Integrating the psychologic aging theories into nursing
understanding of the difference between age-related practice becomes increasingly important as the population
changes & those that may be pathologic continues to age.
Ø Health care delivery system – begins to focus on disease Ø Present and future generations can learn from the past.
prevention and health promotion. Ø Older adults should be encouraged to engage in a ”life
Ø It is necessary for client teaching to STRESS the concept review” process.
that certain conditions or diseases are not inevitable Ø Looking back over life’s accomplishment or failures is
just because of advancing years. crucial in assisting older adults to accomplish
Ø Activities to minimize stress and to promote healthy coping developmental tasks to promote positive self-esteem.
mechanisms must be included in the client teaching plan for
older adults.

Ø In planning activities nurses need to remember that ALL NEUROLOGIC SYSTEM
individuals enjoy feeling needed and respected and being • Slowed reflexes
considered contributing member of society. • Slight tremors and difficulty with fine motor movement
Ø Programs promoting interaction between older and younger • Loss of balance
children might prove beneficial to ALL CONCERNED. • INC of awakening after sleep onset
Ø For some older adults, caring for small children represented • Short-term memory decline possible
a happy time in their lives- rocking, cuddling and playing • INC susceptibility to hypothermia & hyperthermia
with children might bring back feeling of being valued and • Long-term memory usually maintained
needed.
MUSCULOSKELETAL SYSTEM
MORAL/SPIRITUAL DEVELOPMENT
• DEC muscle mass and strength and atrophy of muscles
• Human beings seek to explain and validate their existence
• DEC mobility, range of motion, flexibility, coordination and
in the world.
stability
• For many individual this occurs through their development
• Change of gait, with shortened step and wider base
as moral and spiritual thinker.
• Posture and stature changes causing a decrease in height
• It is important for the nurse to acknowledge the spiritual
• INC brittleness of the bones
dimension of a person and support spiritual expression and
growth. • Deterioration of joint capsule components
• Illness, a life crisis, or even the recognition that our days on • Kyphosis of the dorsal spine
earth are limited may cause a person to contemplate o Increased convexity in the curvature of the spine)
spirituality.
CARDIOVASCULAR SYSTEM
• The nurse can assist clients in finding meaning in their life
crises. • Diminished energy and endurance with lowered tolerance
to exercise
GERONTOLOGICAL ASSESSMENT • DEC compliance of the heart muscle, wit heart valves
• Comprehensive Assessment of physical and psychosocial becoming thicker and more rigid
function is important because it can provide valuable clues • DEC cardiac output and decreased efficiency of blood
to a disease’s effect on functional status. return to the heart
• Self-report of vague signs and symptoms such as lethargy, • Weak peripheral pulses
incontinence, decreased appetite and weight loss can be • INC blood pressure but susceptibility to postural
an indicator of functional impairment. hypotension
BASIC COMPONENTS OF A NURSING HEALTH HISTORY RESPIRATORY SYSTEM

1. Client Profile/Biographic Data: Address and telephone • DEC stretch and compliance of the chest wall
number; date & place of birth, age, gender; race religion, marital • DEC strength and function of respiratory muscles
status; education; name; address and telephone number on • DEC ability to cough and expectorate sputum
nearest contact person; advance directives
2. Family profile: Family members’ names and addresses, year HEMATOLOGICAL SYSTEM
and cause of death of deceased spouse and children. • Hemoglobin and hematocrit average levels toward the low
3. Occupational profile: Current work or retirement status, end of normal
previous jobs, source of income and perceived adequacy for • Prone to increased blood clotting
needs
4. Living Environment Profile: Type of dwelling; number of IMMUNE SYSTEM
rooms, levels and people residing; degree of privacy; name, • DEC resistance to infection and disease
address and telephone number of nearest neighbor
5. Recreation/ Leisure Profile: Hobbies or interests, organization GASTROINTESTINAL SYSTEM
memberships, vacations or travel • DEC need for calories because of lowered basal metabolic
6. Resources/ Support Systems Used: Names of physicians, rate
hospital, clinics and other community services. • DEC appetite, thirst and oral intake
7. Description of typical day: Type and amount of time spent in • DEC lean body weight
each activity. • DEC emptying time
8. Present Health Status: Description of perception of Health in • INC tendency toward constipation
past 1 and 5 years, health screenings, chief complaint and full
symptom analysis, prescribed and self-prescribed medications, RENAL SYSTEM
immunizations, allergies, eating and nutritional patterns. • DEC kidney size, function and ability to concentrate urine
9. Past Health Status: Previous Illnesses throughout life,
• DEC glomerular filtration rate
traumatic injuries, hospitalizations, operations, obstetric history.
• DEC capacity of the bladder
10. Family History: Health Status of Immediate and living relatives,
causes of death of immediate relatives, survey for risk of • Impaired medication excretion
specific disease and disorders
11. Review Of Systems: Head to toe review of all body systems REPRODUCTIVE SYSTEM
and review of health promotion habits for some. • DEC testosterone production
• Changes in the prostate gland, leading to urinary problems
PHYSIOLOGICAL CHANGES • DEC secretion of hormones with the cessation of menses
• Impotence or sexual dysfunction for both genders
INTEGUMENTARY SYSTEM
• Loss of pigment in hair and skin SPECIAL SENSES
• Wrinkling of the skin • DEC visual acuity
• Thinning of the epidermis and easy bruising and tearing of • DEC peripheral vision and increased sensitivity to glare
the skin • Presbyopia and cataract formation
• DEC skin turgor, elasticity and subcutaneous fat • Possible loss of hearing ability, low pitched tones are heard
• DEC perspiration, dry, itchy scaly skin more easily
• DEC sense of smell, pain awareness
• Changes in touch sensation

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CARE OF MOTHER, CHILD, &

2nd Year, 1st Semester

ASSESSING A WOMAN’S PREPARATION FOR LABOR 4. Prenatal Yogaa

ULTIMATE GOAL : healthy baby and baby’s parents CLASSES

(1) (2) (3)

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3. Preparation for Childbirth Classes

METHODS TO MANAGE PAIN IN CHILDBIRTH

DICK-READ METHOD 3. Children attending birth

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• Woman with Disability

NURSING CARE PLANNING TO RESPECT CULTURAL

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GENETIC ASSESSMENT AND COUNSELING

OUTLINE NATURE OF INHERITANCE

- Not routinely recommended, unless there is evidence or

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- Karyotyping reveals only diseases present on

Ex of teratogen : alcohol, cigs, recreational substances

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partner’s sperm in the

LEGAL AND ETHICAL ASPECTS OF GENETIC SCREENING AND

Failure to heed these guidelines could result in charges of invasion

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o Eyes are slanted

o Muscle tone problems – neck is short

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OUTCOME IDENTIFICATION AND PLANNING

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2. Mitotic cell division begins

3. Zygote can be called “Morula”

4. Structure becomes a blastocyst and will attach to uterine wall /

5. Uterine endometrium attachment

6. Touching or implantation points !!

7. Occasionally, a small amount of vaginal spotting appears on the

8. After implantation, zygote → embryo

EMBRYONIC AND FETAL STRUCTURES

Development of the embryo

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https://www.youtube.com/watch?v=dgPCD XmcQjM o @ fetal intestine –– absorbed into fetal blood

Needed in the production of

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ORIGIN OF BODY TISSUE

• Central nervous system (brain and SC)

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MILESTONE OF FETAL DEVELOPMENT

TIME DESCRIPTION MEASUREMENTS SIGNIFICNAT DEVELOPMENTS

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ASSESSING FETAL WELL-BEING

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b. Sandovsky Method – 2x every 10 mins OR 10-12 per hour

2. FETAL HEART RATE

FHR does not decelerate

4. MATERNAL SERUM ALPHA-FECTOPROTEIN

5. CHORIONIC VILLI SAMPLING

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MISCONCEPTIONS FACT CAUTION HEALTH EDUC

Douching alters the

Coitus might cause ROM

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Modified Sim’s position is

Advise a woman taking a

A pad maybe placed under