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Care of Mother and Child at Risk or with Problems (Acute and Chronic)

• This course focuses on concepts, principles, theories, and techniques for nursing at-risk clients during childbearing and childrearing years.
• Aims to promote health, prevent disease, restore health, maintain wellness, and rehabilitate clients, using a safe, holistic nursing process.
• Course requirement is lecture based

Credit Units and Contact Hours:

• Theory comprises 6 units (108 hours)
• RLE: Skills Lab - 1 unit (51 hours)
• Clinical is 255 hours

Examinations and Requirements:

• Examinations account for 85% of the grade:
• Quizzes are 30%
• Unit Exams are 30%
• Major Exams are 40%
• Requirements account for 15% of the grade:
• ECG Strip Analysis for prelim
• Case Study Analysis for Midterm
• Emergency cases (Video Presentation) for Final

Course Objectives:

At the end of the second semester, students will be able to:

• Identify the framework of Maternal and Child Health Nursing, focusing on at-risk clients.
• Explain the nursing care of at-risk mothers and children.
• Describe nursing care for children with acute and chronic alterations in health status.
• Summarize nursing care for children with life-threatening conditions, acute illnesses, multi-organ problems, and high-acuity emergency situations.

Introduction to Maternal and Child Health Nursing

• Maternal and Child Health (MCH) nursing focuses on promoting health, preventing diseases, and providing holistic care to women of reproductive age (preconception, pregnancy, childbirth, postpartum), newborns, children (infancy to adolescence), families, and communities.

Key Focus Areas:

• Reproductive health.
• Reduction of maternal and infant mortality.
• Child development and growth.
• Nutrition and breastfeeding.
• Immunization and infectious disease prevention.
• Mental health and well-being.
• Health disparities and equity.

Nursing Specialties:

• Obstetrics (OB).
• Gynecologic (GYN).
• Neonatal Intensive Care (NICU).
• Pediatric Intensive Care (PICU).
• Pediatric Nursing.
• Midwifery.
• Perinatal nursing

National Health Situation on MCN in the Philippines:

• The current health situation for Maternal and Child Health Nursing (MCN) in the Philippines shows a mix of progress and challenges.
• Infant Mortality Rate: 10.36 per 1,000 live births.
• Maternal Mortality Rate: 64.68 per 100,000 live births.
• Adolescent Birth Rate: 24.36 per 1,000 females aged 15-19 years.

Initiatives and Progress:

• Partnerships between DOH, WHO, and KOICA strengthen healthcare provider networks and community linkages, improving maternal, newborn, child, and adolescent health.
• Laws like the Universal Health Care Act and First 1000 Days Act aim to enhance care for mothers and children.
• Increased facility-based deliveries and skilled birth attendance have contributed to declining maternal and child mortality rates.

Statistics on Maternal and Child Nursing (MCN) in the Philippines:

• Maternal Mortality Rate: 64.68 per 100,000 live births.
• Facility-based deliveries: 92.3% in Davao region.
• Antenatal care visits: 94% of women in Aklan had at least 4 visits.
• Infant Mortality Rate: 10.36 per 1000 live births.
• Under-five mortality rate: available data shows improvement, but exact figures vary.
• Adolescent birth rate: 24.36 per 1,000 females aged 15-19.
• Breastfeeding initiation: 96.9% of newborns in Agusan del Sur were breastfed immediately after birth.

Genetics and Genetic Counseling in MCN

• Genetics and genetic counseling play crucial roles in MCN.
• Inheritance patterns: Autosomal dominant, autosomal recessive, X-linked, and mitochondrial.
• Genetic disorders: Chromosomal (ex. Down syndrome), single gene (ex. Cystic fibrosis), and multifactorial (ex. Heart defects).

Genetic Disorders in MCN:

• Chromosomal disorders: Down syndrome and Trisomy 13.
• Single-gene disorders: Cystic fibrosis, Sickle cell disease, and Thalassemia.
• Congenital anomalies: Heart defects and Neural tube defects.
• Genetic syndromes: Turner syndrome and Klinefelter syndrome.

MCN Genetic Screening:

• Prenatal Screening
• Newborn Screening
• Carrier Screening

Chromosomal Abnormalities - Down Syndrome (DS):

• Genetic disorder caused by an extra copy of chromosome 21 (trisomy 21), characterized by intellectual disability, physical growth delays, and distinct facial features.

Etiology of Down Syndrome:

• Trisomy 21: extra copy of Chromosome 21 in 95% of cases.
• Mosaicism: Mix of normal and trisomic cells in 3-4% of cases.
• Translocation: Chromosome 21 breaks and attaches to another chromosome in 1-2% of cases.
• Genetic Mutations: rare mutations.

Disease Process of Down Syndrome:

• Abnormal cell division during fertilization or early embryonic development.
• Extra genetic material disrupts normal development.
• Affects multiple systems: neurological, cardiovascular, gastrointestinal, immune.

Signs and Symptoms of Down Syndrome:

• Physical characteristics: Flat face, short neck, protruding tongue, small ears.
• Intellectual disability: mild to severe cognitive impairment.
• Growth delays: short stature, delayed puberty.
• Developmental delays: speech, language, motor skills.
• Health issues: Congenital heart defects, respiratory problems, vision and hearing impairment.
• Behavioral characteristics: friendly, outgoing, stubborn.

Nursing Management for Down Syndrome:

• Assessment: Physical, developmental, and cognitive evaluations.
• Individualized care plans: addressing specific needs and goals.
• Supportive care: Feeding, bathing, dressing, grooming.
• Medication management: for associated medical conditions (ex. Epilepsy, hypertension).
• Family support: Education, counseling, emotional support.
• Interdisciplinary collaboration: healthcare team, therapists, educators.

Treatment for Down Syndrome:

• Prenatal testing: Diagnosis during pregnancy (amniocentesis).
• Surgical interventions: correcting congenital heart defects, other anomalies.
• Medications: Managing associated medical conditions.
• Therapies: Physical, occupational, speech, behavioral.
• Early Intervention programs: developmental services for infants and toddlers.
• Inclusive education: Inclusive educational settings.

Health Teachings for Down Syndrome:

• Genetic counseling: Understanding risks, inheritance patterns.
• Prenatal care: regular check-ups, fetal monitoring.
• Parenting strategies: Managing behavior, encouraging independence.
• Health maintenance: regular check-ups, vaccinations, dental care.
• Developmental milestones: Monitoring progress, addressing delays.
• Community resources: Support groups, advocacy organizations.

Common Nursing Diagnoses for Down Syndrome:

• Physical Health: Ineffective airway clearance, impaired gas exchange, risk for respiratory failure, imbalanced nutrition, constipation.
• Developmental/Cognitive: Delayed development, impaired verbal communication, impaired social interaction.
• Safety: Risk for injury, risk for falls.

TRISOMY 13 (Patau syndrome):

• Rare genetic disorder caused by an extra copy of chromosome 13, resulting in severe intellectual disability, physical abnormalities, and life-threatening medical conditions.

Etiology of Trisomy 13:

• Trisomy 13: Extra copy of chromosome 13 (80% of cases).
• Mosaicism: Mix of normal and trisomic cells (10-15% of cases).
• Translocation: Chromosome 13 breaks and attaches to another chromosome (5-10% of cases).
• Genetic mutations: rare genetic mutations.
• Advanced Maternal age: increased risk.

Disease Process of Trisomy 13:

• Abnormal cell division during fertilization or early embryonic development.
• Extra genetic material disrupts normal development.
• Affects multiple systems: Neurological, cardiovascular, gastrointestinal, immune.

Signs and Symptoms of Trisomy 13:

• Severe intellectual disability.
• Physical abnormalities: microcephaly, cleft lip/palate.
• Congenital heart defects.
• Respiratory problems.
• Vision and hearing impairments.
• Seizures.
• Feeding difficulties.
• Growth delays.
• Increased risk of infection.

Nursing Management of Trisomy 13:

• Assessment: Physical, developmental, and cognitive evaluations.
• Individualized care plans.
• Supportive care: feeding, bathing, dressing, grooming.
• Pain management: for associated medical conditions.
• Family support: Education, counseling, emotional support.
• Interdisciplinary collaboration: Healthcare team, therapists, educators.

Treatment of Trisomy 13:

• Surgical Interventions: correcting congenital heart defects, cleft palate.
• Medications: Managing associated medical conditions (ex, Seizures, HPN).
• Respiratory therapy: Oxygen therapy, ventilation.
• Nutritional Support: Gastrostomy tube feeding.
• Physical, occupational, and speech therapies: enhancing quality of life.
• Genetic Counseling: understanding risks, inheritance patterns.

Health Teachings for Trisomy 13:

• Genetic counseling.
• Prenatal testing.
• Parenting Strategies: Managing care, addressing developmental delays.
• Health Maintenance: regular check-ups, vaccinations, dental care.
• End-of-life care: Palliative care, hospice services.

Inherited Disorders - Sickle Cell Disease (SCD):

• Genetic disorder affecting hemoglobin production, causing RBCs to become misshapen, rigid, and prone to breakdown.

Etiology of Sickle Cell Disease:

• Genetic Mutation: Defect in HBB gene encoding beta-globin subunit of hemoglobin.
• Autosomal recessive inheritance: both parents must be carriers.
• Chromosomal location: HBB gene on Chromosome 11.

Disease Process of Sickle Cell Disease:

• Abnormal hemoglobin polymerization.
• Red blood cells become sickled-shape, rigid and fragile.
• Increased RBC destruction (hemolysis)
• Vaso-occlusion: Sickled cell block blood vessels, reducing oxygen delivery.

Signs and Symptoms of Sickle Cell Disease:

• Anemia
• Pain Crises: sudden, severe pain in joints, back and abdomen.
• Jaundice: yellow skin and eyes.
• Increased risk of infections: Pneumonia, osteomyelitis
• Delayed growth and development: Pubertal delay.
• Organ damage: kidney, liver, heart, lung and brain.

Nursing Management of Sickle Cell Disease:

• Pain management: analgesics, comfort measures.
• Fluid therapy: hydration, electrolyte balance.
• Oxygen therapy: Oxygen supplementation.
• Rest and relaxation: Reducing stress.
• Infection prevention: vaccinations, antibiotic prophylaxis.
• Nutritional Support: folic acid, Vitamin B12 supplements.

Treatment of Sickle Cell Disease:

• Blood transfusions
• Antibiotics
• Pain management
• Stem cell transplantation: curative option.

Health Teaching for Sickle Cell Disease:

• Disease explanation.
• Symptoms recognition
• Pain management
• Hydration

Nursing Diagnoses for Sickle Cell Disease:

• Acute pain: related to vaso-occlusion.
• Anxiety: related to uncertainty fear
• Ineffective coping: related to chronic illness.
• Impaired physical mobility: related to pain, weakness.
• Risk for infection: related to compromised immune system
• Deficient Fluid volume: related to dehydration.

Cystic Fibrosis (CF):

• Genetic disorder affecting respiratory, digestive, and reproductive systems due to abnormal mucus production.

Etiology of Cystic Fibrosis:

• Genetic mutation
• Autosomal recessive inheritance: both parents must be carriers.
• Defect in Chromosome 7.

Disease Process of Cystic Fibrosis:

• Thick, sticky mucus accumulates in lungs, pancreas, and other organs.
• Respiratory tract obstruction, inflammation and infection.
• Pancreatic enzyme insufficiency, malabsorption, and nutritional deficiencies.

Signs and Symptoms of Cystic Fibrosis:

• Respiratory: recurrent coughing, wheezing, and pneumonia
• Chest tightness, bronchitis
• Hemoptysis
• Gastrointestinal: Diarrhea, abdominal pain, steatorrhea (fatty stools)
• Failure to thrive, weight loss
• Gastrointestinal reflux

Nursing Management of Cystic Fibrosis:

• Respiratory care: Chest physiotherapy, Nebulized medications (bronchodilators, mucolytic), oxygen therapy
• Nutritional Support: pancreatic enzyme replacement, high-calorie diet, vitamin supplements, gastrostomy tube feeding
• Infection management: antibiotics (oral, IV), vaccination (pneumococcal)
• Emotional support
• Family education

Health Teaching for Cystic Fibrosis:

• Medication adherence:
• Chest physiotherapy techniques
• Nutritional guidance
• Infection prevention: hand hygiene, avoiding close contact with infected individuals.
• Vaccination importance
• Regular follow-ups
• Support system from family and counseling

Nursing Diagnoses for Cystic Fibrosis:

• Respiratory: Ineffective Airway Clearance, Impaired gas Exchange, Activity intolerance, Risk for Respiratory failure.
• Nutritional: Imbalanced Nutrition Less Than Body Requirements, Risk for Deficient Fluid Volume, Risk for infection, Hyperthermia.

Thalassemia:

• Genetic disorder affecting hemoglobin production leading to anemia, fatigue, and other complications.

Etiology of Thalassemia:

• Genetic mutation.
• Autosomal recessive inheritance: both parents must be carriers. Chromosomal location: (Chromosome 16 on Chromosome 11).

Disease process of Thalassemia:

• Abnormal hemoglobin production.
• Insufficient hemoglobin leads to anemia.
• Ineffective erythropoiesis (RBC production)
• Increased RBC destruction (hemolysis)
• Iron overload from frequent blood transfusion.

Signs and Symptoms of Thalassemia:

• Anemia
• Jaundice
• Splenomegaly
• Bone deformities: skull, facial, and spinal abnormalities.
• Growth retardation: delayed puberty.
• Increased risk of infections: Pneumonia, osteomyelitis.
• Heart problems: Cardiac failure and arrhythmias.

Nursing Management of Thalassemia:

• Blood transfusion. Regular transfusion to maintain hemoglobin levels.
• Pain management: analgesics for bone pain.
• Fluid therapy: hydration, electrolyte balance.
• Rest and relaxation: reducing stress.
• Infection prevention: vaccinations, antibiotics prophylaxis.

Health Teaching for Thalassemia:

• Disease explanation
• Transfusion schedule: adherence to transfusion regimen.
• Iron chelation therapy: adherence to medication.
• Dietary counseling: Avoiding iron rich foods.
• Infection prevention: hand hygiene, vaccination.
• Regular follow-ups: Monitoring hemoglobin levels.

Nursing Diagnosis of Thalassemia:

• Anemia: related to ineffective erythropoiesis.
• Activity intolerance: related to fatigue.
• Pain: related to bone deformities.
• Risk for infection: related to compromised immune system.
• Deficient fluid volume: related to dehydration.
• Impaired Physical Mobility: related to bone deformities.

CONGENITAL ANOMALIES:

• Heart Defects: structural or functional abnormalities of the heart present at birth.

Ventricular Septal Defect (VSD):

• Congenital heart defect characterized by an opening in the septum separating the right and left ventricles.

Etiology of VSD:

• Genetic mutations: chromosomal abnormalities (ex. Down syndrome, Trisomy 13)
• Environmental factors: Maternal diabetes, rubella infection.
• Family history: increased risk if parents or siblings have VSD.
• Chromosomal abnormalities: Turner syndrome

Disease Process of VSD:

• Abnormal fetal development during embryogenesis.
• Failure of septal closure between ventricles.
• Left-to-right shunting: oxygenated blood flows from left ventricle to right ventricle.
• Increased pulmonary blood flow, potential for pulmonary hypertension.

Signs and Symptoms of VSD:

• Cyanosis: bluish discoloration of skin and mucous membranes.
• Shortness of breath: respiratory distress.
• Fatigue: decreased energy.
• Failure to thrive: Poor weight gain.
• Feeding difficulties: Difficulty feeding.
• Sweating: Excessive sweating.
• Palpitations: irregular heartbeats.
• Recurrent respiratory infections.

Nursing Management of VSD:

• Oxygen Therapy: Oxygen supplementation.
• Cardiac monitoring: Continuous ECG monitoring
• Medications Management: Diuretics, vasodilators.
• Fluid management: Balancing fluid intake
• Nutritional support: High-calorie diet,
• Infection prevention: vaccinations, antibiotic prophylaxis.

Treatment of VSD:

• Surgical repair: Closure of VSD (patch or direct closure)
• Catheter-based interventions: Device closure
• Heart transplantation: Replacement of the heart (in severe cases).

Health Teaching of VSD:

• Disease explanation: understanding VSD.
• Medication adherence: importance of medication regimen.
• Follow-up care: regular heart checks. Infection prevention: hand hygiene, vaccination.
• Nutritional counseling: balanced diet.
• Activity restrictions: avoiding strenuous activities.

Nursing Diagnosis of VSD:

• Decreased cardiac output: related to VSD.
• Impaired gas exchange: related to respiratory distress.
• Activity intolerance: related to fatigue.
• Anxiety: related to uncertainty.
• Risk for infection: related to compromised immune system.

Atrial Septal Defect (ASD):

• Congenital heart defect characterized by an opening in the septum separating the right and left atria.

Etiology of ASD:

• Genetic mutations: Chromosomal abnormalities (ex. Down syndrome).
• Environmental factors: Maternal diabetes, rubella infection.
• Family history: Increased risk if parents or siblings have ASD.
• Chromosomal abnormalities: Turner syndrome

Disease Process of ASD:

• Abnormal fetal development during embryogenesis,
• Failure of septal closure between atria.
• Left-to-right shunting: oxygenated blood flows from left atrium to right atrium.
• Increased pulmonary blood flow, potential for pulmonary hypertension.

Signs and Symptoms of ASD:

• Cyanosis:
• Shortness of breath
• Fatigue
• Failure to thrive: poor weight gain
• Feeding difficulties
• Sweating
• Palpitations: irregular heartbeats
• Recurrent respiratory infections Nursing Management of ASD:
• Oxygen therapy
• Cardiac monitoring: Continuous ECG monitoring.
• Medication management: diuretics, vasodilators.
• Fluid management: balancing fluid intake.
• Nutritional support: high-calorie diet.
• Infection prevention: vaccinations, antibiotic prophylaxis.

Treatment of ASD:

• Surgical repair: Closure of ASD (patch or direct closure)
• Catheter-based intervention:
• Heart transplantation: replacement of the heart (in severe cases).

Health Teaching of ASD:

• Disease explanation: understanding ASD.
• Medication adherence: importance of medication regimen.
• Follow-up care: regular health checks.
• Infection prevention: Hand hygiene, vaccination.
• Nutritional counseling: balanced diet: Activity restrictions: avoiding strenuous activities.

Nursing Diagnoses of ASD:

• Decreased cardiac output: related to ASD.
• Impaired gas exchange: related to respiratory distress.
• Activity intolerance: related to fatigue.
• Anxiety: related to uncertainty.
• Risk for infection: related to compromised immune system.

Tetralogy of Fallot (TOF):

• Congenital heart defect characterized by four main anomalies: Ventricular septal defect (VSD), Pulmonary stenosis, Right Ventricular hypertrophy, and overriding of the aorta.

Etiology of TOF:

• Genetic mutations: Chromosomal abnormalities (Down syndrome)
• Environmental factors: Maternal diabetes, rubella infection.
• Family history: Increased risk if parents or siblings have TOF.
• Chromosomal abnormalities: Deletion of Chromosomes 22q11.

Disease Process of TOF:

• Abnormal fetal development during embryogenesis.
• Four characteristics anomalies:
• Ventricular septal defect (VSD)
• Pulmonary Stenosis (narrowing of the pulmonary valve)
• Right Ventricular hypertrophy (thickening of the ventricles)
• Overriding aorta (aorta positioned over VSD).
• Right-to-left shunting: deoxygenated blood flows from right ventricle to left ventricle.
• Decreased pulmonary blood flow, potential for cyanosis.

Signs and Symptoms of TOF:

• Cyanosis: bluish discoloration of skin and mucous membrane.
• Shortness of breath.
• Fatigue
• Failure to Thrive
• Feeding difficulties
• Sweating
• Palpitations
• Recurrent respiratory infections
• Clubbing: enlarged fingertips
• Polycythemia: increased RBC

Nursing Management of TOF:

• Oxygen therapy
• Cardiac monitoring
• Medication management
• Fluid replacement: balance fluid intake
• Nutritional support
• Infection prevention
• Comfort measures: pain management, relaxation techniques.

Treatment of TOF:

• Surgical repair: complete repair (Closure of VSD)
• Heart transplantation: replacement of the heart (in severe cases)

Nursing diagnoses of TOF:

• Decreased cardiac output: related to TOF
• Impaired gas exchange: related to respiratory distress
• Activity intolerance: related to fatigue
• Anxiety

Transposition of the Great Arteries (TGA):

• Congenital heart defect where the two main arteries carrying blood away from the heart are reversed.
• The aorta arises from the right ventricle, and the pulmonary artery arises from the left ventricle.

Etiology of TGA:

• Genetic mutations (Down syndrome)
• Environmental factors (maternal diabetes, rubella infection).
• Family history
• Chromosomal abnormalities: deletion of chromosome 22q11.

Disease Process of TGA:

• Reversal of the great arteries during fetal development.
• Oxygenated blood from the lungs returns to the left ventricle, then flows back to the lungs.
• Deoxygenated blood from the body returns to the right ventricle then flows to the aorta and systemic circulation.
• Severe cyanosis: Inadequate oxygenation of blood.

Signs and Symptoms of TGA:

• Severe cyanosis
• Respiratory distress: shortness of breath
• Fatigue
• Failure to thrive
• Feeding difficulties
• Sweating
• Palpitations
• Clubbing: enlarged fingers

Nursing Management of TGA:

• Oxygen therapy
• Cardiac monitoring
• Medication management
• Fluid management
• Nutritional support
• Infection prevention
• Comfort measures

Treatment of TGA:

• Arterial switch operation: Surgical correction (reversing the great arteries).
• Rastelli procedure: creating a tunnel between the left ventricle and aorta.
• Heart transplantation.

Health Teaching of TGA:

• Disease explanation.
• Medication adherence.
• Follow-up care.
• Infection prevention. Nutritional counseling
• Activity restrictions

Nursing Diagnoses of TGA:

• Decreased cardiac output: related to TGA
• Impaired gas exchange: related to respiratory distress.
• Activity intolerance: related to fatigue.
• Anxiety: related to uncertainty.
• Risks to infection: related to compromised immune system.
• Deficient fluid volume: related to dehydration.

Patent Ductus Arteriosus (PDA):

• Congenital heart defect where ductus arteriosus, a fetal blood vessel connecting the aorta and pulmonary artery, fails to close at birth.

Etiology of PDA:

• Genetic mutations: (Down syndrome)
• Environmental factors
• Family history: increased risk if parents or siblings have PDA.
• Premature birth: increased risk in preterm infant.
• Chromosomal abnormalities: deletion of Chromosome 22q11.

Disease Process of PDA:

• Failure of ductus arteriosus closure after birth.
• Left-to-right shunting: Oxygenated blood from the aorta flows into pulmonary artery.
• Increased pulmonary blood flow, potential for pulmonary hypertension.
• Overload on left heart, potential for cardiac failure.

Signs and Symptoms of PDA:

• Cyanosis
• Respiratory distress
• Fatigue
• Failure to Thrive
• Feeding difficulties
• Sweating
• Palpitations
• Recurrent respiratory infections
• Bounding pulse: strong, forceful pulses.

Nursing management of PDA:

• Oxygen therapy
• Cardiac monitoring
• Medication Management: diuretics, vasodilators
• Fluid management
• Nutritional support
• Infection prevention
• Comfort measures: pain management, relaxation techniques

Treatment of PDA:

• Surgical ligation: Surgical closure of PDA
• Pharmacological closure: Indomethacin or Ibuprofen therapy

Health Teaching of PDA:

• Disease explanation
• Medication adherence
• Follow-up care
• Infection prevention
• Nutritional counseling
• Activity restrictions

Nursing Diagnoses of PDA:

• Decreased cardiac output: related to PDA.
• Impaired gas exchange: related to respiratory distress.
• Activity intolerance: related to fatigue
• Anxiety: related to uncertainty
• Risk for infection: related to compromised immune system.
• Deficient fluid volume: related to dehydration.

Coarctation of the Aorta:

• Congenital heart defect characterized by narrowing of the aortic isthmus, typically at the junction of the aortic arch and descending aorta.

Etiology of Coarctation of the Aorta:

• Genetic mutations: Chromosomal abnormalities (ex. Turner syndrome) Environmental factors Family history: increased risk if parents of siblings have coarctation.
• Chromosomal abnormalities: deletion of chromosome 22q11.

Disease Process of Coarctation of the Aorta:

• Narrowing of the aortic isthmus during fetal development.
• Obstruction of blood flow from the aorta to the lower body.
• Increased blood pressure above the coarctation.
• Decreased blood pressure below the coarctation.
• Potential for cardiac failure, hypertension, and stroke.

Signs and Symptoms of Coarctation of the Aorta:

• Hypertension:
• Weak or delayed pulses: in lower extremities.
• Shortness of breath:
• Fatigue
• Headaches: due to hypertension.
• Dizziness: Lightheadedness.
• Cold extremities: decreased blood flow.

Nursing Management of Coarctation of the Aorta:

• Blood pressure monitoring
• Cardiac monitoring
• Medication management: antihypertensive, beta-blockers.
• Fluid management
• Nutritional support
• Infection prevention
• Comfort measures

Treatment of Coarctation of the Aorta:

• Surgical repair: Resection of coarctation with end-to-end anastomosis.
• Stent replacement: maintaining patency.
• Bypass grafting: Creating alternative blood flow pathway.

Nursing Diagnoses of Coarctation of the Aorta:

• Decreased cardiac output: related to coarctation.
• Hypertension: related to increased blood pressure.
• Activity intolerance: related to fatigue
• Anxiety
• Risk for infection: related to compromised immune system.
• Deficient fluid volume: related to dehydration.

Other Chromosomal Abnormalities - Turner Syndrome (TS):

• Genetic disorder affecting females, characterised by the absence or abnormality of one X chromosome (45, X or 45, X46, XX mosaicism).

Etiology of Turner Syndrome:

• Monosomy X: Loss of one X chromosome. (45, Χ).
• Mosaicism: Mix of 45, X and 46, XX cells.
• X chromosome deletion: Partial or complete deletion of X chromosome.
• Family history: Increased risk if family members have TS.
• Advanced Maternal age: Increased risk.

Disease Process of Turner Syndrome:

• Abnormal X chromosome formation during meiosis.
• Hormonal imbalances: Estrogen deficiency.
• Growth and development delays.
• Reproductive system abnormalities.

Signs and Symptoms of Turner Syndrome:

• Short stature: Growth hormone deficiency.
• Delayed puberty: Hormonal imbalances.
• Infertility: Ovarian dysgenesis.
• Heart defect: Coarctation of the aorta.
• Kidney abnormalities: Horseshoe kidney.
• Hearing and vision problems: Strabismus
• Cognitive impairment: Learning disabilities.

Nursing Management for Turner Syndrome:

• Growth hormone therapy monitoring.
• Hormone replacement therapy.
• Cardiac monitoring.
• Blood pressure monitoring
• Infection prevention.
• Nutritional support

Treatment for Turner Syndrome:

• Growth hormone therapy: stimulate growth.
• Hormone replacement therapy: Estrogen replacement.
• Surgery: correcting heart defects, reproductive system abnormalities.
• Speech and language therapy: communication skills development.
• Physical therapy: motor skills development. Psychological counseling; coping strategies.

Nursing Diagnoses for Turner Syndrome:

• Disturbed body image: related to physical characteristics.
• Delayed growth and development: related to hormonal imbalance.
• Anxiety
• Deficient knowledge: related to disease understanding.
• Impaired social interaction: related cognitive impairment.
• Risk for infection: related to compromised immune system.

Neural Tube Defects (NTDs):

• Congenital anomalies resulting from incomplete closure of the neural tube during embryogenesis, leading to defects in the brain, spine, or spinal cord.

Etiology of Neural Tube Defects:

• Genetic mutations: (ex. Trisomy 13).
• Environmental factors: maternal diabetes, rubella infection, exposure to toxins.
• Nutritional deficiencies: folic acid deficiency
• Family history: increased risk in family members have NTDs.
• Advance Maternal age: increased risk.

Disease Process of Neural Tube Defects:

• Failure of neural tube closure during embryogenesis (22-28 days post conception).
• Abnormalities in brain, spine, or spinal cord development.
• Potential for hydrocephalus, and spinal cord damage.

Types of Neural Tube Defects:

• Spina Bifida: incomplete closure of spinal cord and vertebrae.
• Meningocele: Protrusion of meninges through the spinal defect.
• Myelomeningoecele: Protrusion of spinal cord and meninges.
• Encephalocele: protrusion of brain tissue through skull defect.
• Anencephaly: absence of brain and skull development.

Signs and Symptoms of Neural Tube Defects:

• Visible defects: Spinal or cranial abnormalities.
• Motor dysfunction: Weakness, paralysis.
• Sensory deficits: Numbness, loss of sensation.
• Bladder and bowel dysfunction: Incontinence.
• Hydrocephalus: Increased intracranial pressure.
• Seizures: due to brain abnormalities.
• Developmental delays: Cognitive and motor impairment.

Nursing Management of Neural Tube Defects:

• Neurosurgical evaluation.
• Wound care: Protecting exposed neural tissue.
• Infection prevention: antibiotic prophylaxis.
• Pain management
• Bladder and bowel management: catheterization, bowel training.
• Physical therapy: Maintaining mobility.
• Occupational therapy: promoting independence.

Treatment of Neural Tube Defects:

• Surgical repair: closure of defect.
• Rehabilitation therapy: Physical, occupational, speech.
• Medication management: Seizure control, pain management.

Health Teaching of Neural Tube Defects:

• Disease explanation.
• Wound care
• Infection prevention.
• Bladder and bowel management
• Medication adherence.
• Follow-up care.

Nursing Diagnoses of Neural Tube Defects:

• Impaired physical Mobility: related to motor dysfunction.
• Deficient knowledge: related to disease understanding.
• Anxiety
• Risk for infection: related to compromised immune system.
• Impaired urinary elimination: related to bladder dysfunction.
• Impaired skin integrity: related to wound complications.

Cleft Lip (CL) and Cleft Palate (CP):

• Congenital anomalies characterised by abnormal development of the upper lip and palate.

Etiology of Cleft Lip and Cleft Palate

• Genetic mutations: Chromosomal abnormalities.
• Environmental factors: Maternal smoking, alcohol consumption, and exposure to toxins.
• Nutritional deficiencies: Folic acid deficiency.
• Family history: Increased risk if family members have Cleft lip/cleft palate.
• Advance maternal age: increased risk.

Disease Process Cleft Lip and Cleft Palate

• Abnormal fusion of facial structures during embryogenesis ( 6-12 weeks' gestation).
• Clefting of the lip, palate, or both.
• Potential for feeding difficulties, speech impairment, and hearing loss.

Signs and Symptoms of Cleft Lip and Cleft Palate

• Visible clefting
• Feeding difficulties
• Speech impairment
• Hearing loss
• Dental abnormalities
• Nasal regurgitation.

Nursing Management of Cleft Lip and Cleft Palate

• Initial assessment: evaluate airway, breathing, and feeding.
• Feeding support: specialized bottles, nipples, and feeding techniques.
• Infection prevention: antibiotic prophylaxis.
• Pain management
• Parental support: emotional and educational support.

Treatment of Cleft Lip and Cleft Palate

• Surgical repair: Cleft lip (3-6 months), palate (6-12 months).
• Orthodontic management: dental alignment.
• Speech therapy
• Hearing aids
• Dental restoration.

Health Teaching of Cleft Lip and Cleft Palate

• Disease explanation.
• Feeding techniques.
• Infection prevention.
• Follow-up care
• Speech and hearing development monitoring.

Nursing Diagnoses of Cleft Lip and Cleft Palate

• Impaired oral membranes: related to clefting.
• Deficient knowledge: related to disease understanding.
• Anxiety
• Impaired verbal communication: related to speech impairment.
• Risk for infection: related to compromised immune system.
• Imbalanced Nutrition: related to feeding difficulties.

Male Reproductive and Sexual Health Issues - Erectile Dysfunction (ED):

• The inability to achieve or maintain an erection sufficient for satisfactory sexual performance.

Etiology of ED:

• Vascular diseases: Atherosclerosis, hypertension, diabetes.
• Neurological disorders: Parkinson's disease, multiple sclerosis, spinal cord injury.
• Hormonal imbalances: Low testosterone, thyroid disorders.
• Psychological factors: Anxiety, depression, stress.
• Medications: Antidepressants, antihypertensive, sedatives.
• Lifestyle factors: smoking, alcohol consumption, obesity.

Disease Process of ED:

• Reduced blood flow to the penis.
• Smooth muscle relaxation.
• Decreased erectile tissue responsiveness.

Signs and Symptoms of ED:

• Inability to achieve erection.
• Reduced erectile rigidity: Soft or partial erection.
• Decreased libido: low sexual desire.
• Premature ejaculation: Uncontrolled ejaculation.
• Performance anxiety: fear of failure.

Nursing Management of ED:

• Assessment: Medical history, Physical examination, Laboratory test.
• Education: disease explanation, treatment options.
• Counseling: addressing psychological factor.
• Lifestyle modifications: quit smoking, exercise, weight management.
• Medication management. Phosphodiesterase inhibitors (ex. Sildenafil).

Treatment of ED:

• Phosphodiesterase inhibitors: Sildenafil, tadalafil, vardenafil.
• Vacuum erection devices: Mechanical devices.
• Penile implants: surgical implantation.
• Couples therapy: Addressing relationships dynamics.

Health Teaching of ED:

• Disease understanding
• Treatment options: Medications, lifestyle modifications.
• Stress management: relaxation techniques.
• Communication: open communication with partner,
• Follow-up care.

Nursing Diagnoses of ED:

• Impaired sexual dysfunction: related to ED.
• Anxiety: related to performance anxiety.
• Deficient knowledge: related to disease understanding.
• Disturbed body image: related to ED.
• Impaired relationship: related to partner dynamics.

Premature Ejaculation (PE):

• Involuntary ejaculation within 1-2 minutes of vaginal penetration, causing distress and impacting quality of life.

Etiology of PE:

• Psychological factors: anxiety, stress, depression.
• Neurological disorders: multiple sclerosis, spinal cord injury.
• Hormonal imbalances: low serotonin, thyroid disorders.
• Urological conditions: Prostatitis, Urethritis.
• Medications: antidepressants, blood pressure medications. Lifestyle factors: smoking, alcohol consumption.

Disease Process of PE:

• Overactive sympathetic nervous system.
• Increased serotonin reuptake.
• Reduced ejaculatory threshold.
• Impaired pelvic floor muscle control.

Signs and Symptoms of PE:

• Involuntary ejaculation:
• Rapid ejaculation.
• Lack of control.
• Distress: emotional distress, anxiety.
• Relationships problems: Partner dissatisfaction.

Nursing Management of PE:

• Assessment
• Education: treatment option.
• Counseling
• Relaxation techniques: deep breathing, progressive muscle relaxation.

Treatment of PE:

• Selective serotonin reuptake inhibitors: Fluoxetine, sertraline
• Phosphodiesterase inhibitors.
• Couples therapy.

Health Teaching of PE:

• Disease understanding.
• Treatment options: Medications
• Relaxation techniques
• Communication: open discussion with partner.
• Follow-up care.

Prostate Cancer:

• Malignant tumor that develops in the prostate gland, affecting men primarily over 50 years old.

Etiology of Prostate Cancer:

• Genetic mutation: BRCA1/2, TP53, and androgen receptor genes.
• Age: Risk increases after 50 years.
• Family History: first-degree relatives with prostate cancer.
• Ethnicity: higher risk in African American men.
• Diet: High-fat, low vitamin D.
• Obesity: Increased risk.
• Environmental factors: Exposure to pesticides, radiation.

Disease Process of Prostate Cancer:

• Uncontrolled cell growth in the prostate gland.
• Tumor development and potential metastasis.
• Compression of the urethra, bladder,