Maternal and Child Health Nursing Framework

Framework for Maternal and Child Health Nursing (MCN)

• Maternal, Newborn, and Child Health (MNCH) faces challenges and requires improvements
• Progress in reducing maternal, newborn, and child mortality has stagnated since 2015
• Factors include inadequate access to clean water, sanitation, and hygiene (WASH), conflicts, economic hardships, and climate change
• The primary goal of Maternal and Child Health Nursing (MCN) emphasizes promotion and maintenance of optimal family health

Philosophy of Maternal and Child Health Nursing

• Family-centered approach: Assessment data includes both family and individual aspects
• Community-centered approach: Family health is influenced by and influences community health
• Research-oriented approach: Research is the means to advance critical knowledge
• Nursing theory and evidence-based practice provide a foundation for nursing care

Maternal and Child Health Nurse Roles

• Advocating for the rights of all family members, including the fetus
• Demonstrating independent nursing functions due to frequent teaching and counseling requirements
• Promoting health to protect the health of future generations
• Acknowledging that pregnancy or childhood illness can cause stress and alter family life
• Respecting personal, cultural, and religious beliefs, as they influence the perception and impact of illness on the family
• Playing a challenging role in promoting high-level wellness in families

Standards of Maternal and Child Health Nursing Practice

• Nurses help attain optimum health and assist families in balancing personal growth needs with family functioning
• Interventions are provided for vulnerable families, and healthy environments are promoted
• Nurses detect changes and deviations, carry out treatments, and assist during coping periods while actively pursuing strategies
• Continuing to improve MCN practice

Global Health Goals (UN & WHO, 2000)

• Establishing global health goals is a major step in improving health worldwide because diseases, poverty, and inequality affect all nations
• The goals encompass ending poverty and hunger, achieving universal primary education, promoting gender equality, reducing child mortality, improving maternal health
• They also include combating HIV/AIDS and other diseases, ensuring environmental sustainability, and developing global partnerships for development

Framework for Maternal and Child Health Nursing Care

• Maternal and child health nursing occurs within a framework where nurses use nursing process, theory, and Quality and Safety Education for Nurses (QSEN)
• Nurses care for families during childbearing and childrearing through four phases: health promotion, health maintenance, health restoration, and health rehabilitation

The Nursing Process

• Nursing care is designed and implemented thoroughly, using organized steps for quality and consistency
• Problem-solving uses the scientific method as the basis to assess, diagnose, plan, organize, and evaluate care
• The method is applicable to all health care settings

Nursing Theory

• A profession requires member-set standards, practice quality monitoring, and research participation
• A discipline's knowledge is based on established theory
• Nursing theorists offer views to best meet client needs

Statistics on Philippines MCN

• Population increased from about 73 million to almost 106 million
• Crude birth rate decreased from 22.3 to 15.8
• Crude death rate increased from 4.8 to 5.6
• Infant death rate declined from 17.3 to 12.6
• Maternal death rate remained the same
• Fetal death ratio increased from 3.8 to 5.2
• Maternal mortality ratio in the Philippines was 114 per 100,000 live births
• 86% of Filipino women received antenatal care from skilled providers
• 78.4% of women received sufficient tetanus toxoid injections for neonatal tetanus
• Neonatal mortality rate was 13 deaths per 1,000 live births
• Approximately 71 stillbirths occurred every day in 2015
• Under-five mortality rate was 28 per 1,000 live births
• During pregnancy, 86.2% of women took some form of iron supplementation

Genetics and Genetic Counseling

• Genetics is the study of how disorders occur, and nurses should stay current
• Genetic counseling gives information about how genetic conditions might affect you or your family
• A counselor collects personal and family health histories to determine the likelihood of genetic conditions
• Genetic counselors help decide if a genetic test might be right

Nursing Process, Genetic Assessment, and Counseling

• Assessment involves family history preferably for three generations
• Physical assessment includes both parents and any affected children
• Series of laboratory assays includes blood, amniotic fluid, and maternal and fetal cells
• First trimester includes routine sonogram screening (nuchal translucency scan)
• Analysis of maternal serum levels includes Alpha-fetoprotein A(PAPP-A)
• Measurement of free beta hCG helps evaluate chromosomal disorders in the fetus

Nuchal Translucency Scan

• Screening for chromosomal abnormalities via ultrasound
• Part of the routine ultrasound at around 12 weeks
• Normal nuchal translucency measurement falls below 3 mm, indicating a lower risk for chromosomal abnormalities
• Increased thickness suggests a higher risk for genetic conditions, prompting further testing
• The NT scan alone detects approximately 62% of Down syndrome cases
• Combining NT scan with blood tests improves detection rates to 90% while reducing false positives to around 3%

Alpha Fetoprotein A(PAPP-A)

• AFP is a glycoprotein produced by the fetal liver, measured in maternal serum to assess the risk of certain fetal conditions
• Elevated AFP levels are associated with neural tube defects, spina bifida, and anencephaly
• Low AFP levels indicate an increased risk for Down syndrome (Trisomy 21) & Edwards syndrome (Trisomy 18)
• These tests measure beta human chorionic gonadotropin(beta-hCG) and pregnancy-associated plasma protein A (PAPP A)
• Beta-hCG is a hormone made by the placenta, may indicate certain birth defects
• PAPP-A is a protein in the blood; may indicate certain birth defects
• Papp-A level ≥ 0.5 MOM is considered normal, < 0.5 MOM marked as low
• Chromosomes that carry genetic information in the form of genes

Genetic Disorders

• Inherited or genetic disorders are passed from one generation to the next due to gene or chromosome disorders
• Genetic disorders occur more in some ethnic groups because people marry within their own cultural group
• Cytogenetics is the study of chromosomes by light microscopy and the method by which the chromosomal aberrations are identified

Genes

• Genes are the basic units of heredity with physical and cognitive characteristics
• Genes consists of DNA segments woven into strands in the nucleus of all body cells to form chromosomes
• Human cells (except sperm and Ovum) contain 46 chromosomes (44 autosomes and two sex chromosomes)
• Sex chromosomes: two type X (large symmetric) means the individual is genetically female
• Sex chromosomes: one X and one a Y (a smaller type), the individual is genetically male
• Phenotype means person's outward appearance or the expression of genes
• Genotype means person's actual gene composition
• Genome means person's complete set of genes present (50,000 to 100,000)
• A designation of a normal genome is abbreviated as 46XX or 46XY

Genetic Counseling and its Advantages

• Genetic counseling at a preconception health visit is helpful for people who might transmit a disease to their children for advice on the inheritance of disease
• It provides concrete, accurate information about the process of inheritance and inherited disorders
• It reassures people concerned their child may inherit a disorder and may allow people affected by inherited disorders to make informed choices
• It also allows people to pursue potential intervention, allow families to begin preparation for a child with special needs

Genetic Counseling Considerations

• Genetic counseling can free people from guilt if they discover a disorder occurred by chance
• Confidentiality in genetic screening is essential to avoid damaging a person's reputation, career, or relationship
• Ideal time for discussing the possibility of genetic disorder before a first pregnancy
• If counseling is not received before a first pregnancy, receive it before a second

Nursing Responsibilities

• Nurses assess for signs and symptoms of genetic disorders, offer support, and help with testing procedures
• Time are needed to support grieving couples confronted with the reality of inheritance affects
• Individuals or couples being counseled need a clear understanding of the information provided
• Not appropriate for care providers to impose values or opinions, individuals face decisions such as how much genetic testing to undergo or whether to terminate

Genetic Counseling and Testing

• Family history, physical examination, and lab analysis help define the problem
• Obtain DNA analysis from a private lab

Common Chromosomal Disorders: Trisomy 13 Syndrome

• Trisomy 13 syndrome (Patau syndrome) include kidney, heart, CNS malformations, polydactyly and 80% die within 1st year
• It called Patau syndrome, is associated with intellectual disability and physical abnormalities
• Individuals with trisomy 13 often have heart defects, brain or spinal cord abnormalities small eyes, extra fingers or toes, cleft lip and weak muscle tone

Common Chromosomal Disorders: Trisomy 18 Syndrome

• Trisomy 18 Syndrome with extra chromosome 18
• Most cases are due to maternal errors and The risk for trisomy 18 increases with maternal age

Common Chromosomal Disorders: Turner Syndrome

• Turner Syndrome or 45,X is a genetic condition where has partly or completely missing an X chromosome
• Symptoms vary among those affected

High Risk Prenatal Client

• A concurrent disorder, pregnancy related complication or external factor jeopardizes the health of mother and/or fetus
• The woman or baby is more likely to become ill or die than usual
• This includes complications before/after delivery are more likely to occur than usual
• Can be grouped into: women with preexisting or newly acquired illness and those who develop complications of pregnancy

High Risk Client: Women with Illness or Complications

• Medical issues: CVD, DM, Substance Abuse, HIV/AIDS, RH Incompatibility, Anemia
• Obstetrical issues: Hyperemesis Gravidarum, PROM, Ectopic Pregnancy, PIH, Hydatidiform Mole, Multiple Pregnancies, Premature Cervical Dilatation, DIC, Abortion, APAS, Placenta Previa, HELLP Syndrome, Abruptio Placenta

Risk Factors

• Biophysical originate within mother or fetus
• Psychosocial: maternal behaviors and lifestyles that affect the health of the mother or fetus
• Sociodemographic: factors arising from the mother's condition and her family, place
• Environmental: include hazards of the workplace/environment

Screening and Diagnostic Tests

• Rhythm strip: Assess for baseline rate and variability
• Variability: Absent - None apparent, Minimal - Extremely small fluctuation, Moderate Range: 6-25 bpm, Marked Range: > 25 bpm
• Non Stress: Measures response of FHR to fetal movement done for 10-20 min

Interpretation of test results

• Reactive: 2 accelerations by 15 beats lasting 15 sec after movement
• Nonreactive: No accelerations occur with the fetal movements or low variability
• Vibroacoustic: Producing sharp sound of 80 decibels at 80 Hz, done with non-stress test with response of FHR acceleration

Contraction Stress Testing

• FHR analysis accompanied by contractions and Apply external fetal heart monitor
• Done if NST results are non-reassuring
• Involves nipple stimulation until uterine contraction begin
• Negative: No fetal heart rate decelerations are present
• Positive: >50% of contractions cause late deceleration

Comparison Nonstress & Contraction

• Assesment Area : Response of FHR in relation to (NST) fetal movement/ (CST) uterine contractions to stimulation
• Normal findings :
• Non Stress: 2 accelerations of FHR 15 bpm lasting 15 secs following fetal movement in 20 min
• Contraction ST: No late decelerations with contractions

Ultrasonography

• Diagnoses presence of pregnancy, Confirm the size and location of the placenta, and amniotic fluid

Placental Grading

• Assessment of normal/abnormal of Placenta

Amniotic Fluid Volume Assessment

• Measure vertical diameter of amniotic fluid pocket in cm
• Index: 12-15 cm between 28-40 wks, > 20-24 cm = hydramnios and < 5-6 cm = oligohydramnios

Electrocardiography

• Fetal ECG's can be recorded as early as the 11th week

Magnetic Resonance Imaging

• Replaces or complements ultrasonography to assess and helpful dx complications
• MSAT (maternal serum alpha-fetoprotein): begins to rise 11 wks, level abnormaly high with spinal defect or abnormally low for fetus with a chromosomal defect

Triple and Quad Screening

• Triple Screening: Estriol, Beta-human chorionic gonadotropin and Alpha-fetoprotein
• Quad Screening: Estriol, Beta-human chorionic gonadotropin, Alpha-fetoprotein and Inhibin A
• Estimate risk of down syndrome (Screening @ 15-20 weeks of pregnancy)

CHORIONIC VILLUS SAMPLING

• Diagnose some fetal disorders, between 10-12 weeks

AMNIOCENTESIS

• Scheduled between 14-16 weeks of pregnancy where Amniotic Fluid is Analyzed for: AFP, Bilirubin Determination, Chromosome Analysis and more

PUBS (Percutaneous umbilical blood sampling)

• a.k.a. cordocentesis or funicentesis, Performed @17 weeks of pregnancy

FETOSCOPY

• Visualize fetus Through fetoscope

AMNIOSCOPY

• Visual inspection of the amniotic fluid For meconium staining

BIOPHYSICAL PROFILE

• Combines 5 parameters into one assessment are of fetal heart reactivity, breathing, body movement, fetal tone and amniotic fluid volume
• A score of 8-10 indicates that the fetus is doing well, whereas A score of 4 denotes a fetus probably in jeopardy

Daily Fetal Movement Count/Kick Count

• Maternal assessment of fetal movement
• Fetal alarm signal includes movements cease entirely for 12 hrs, count < 3 within one hour warrant further evaluation

Additional Laboratory Examinations & Significance

• Blood Grouping in order to identify possible causes
• Hgb which detects anemia if <11g/dl or <10.5g/dl for additional Iron
• CBC which detects >12.000/um or ore (infection to follow up)

VDRL and RPR

• VDRL and RPR which screens for positive Syphilis and to retest at 36 weeks
• Rubella Titer: tests immunity, must be immunize
• Hemoglobin Electrophoresis to check African Descent
• Screening hepatitis: Infants to be given hepatitis immune globulin soon after birth Test To detect infection needs reasses, treat and check anemia

Overview of Diabetes Mellitus (DM)

• DM is an endocrine disorder where the pancreas cannot regulate body glucose level (hyperglycemia) and which Affects 3% to 5% of all pregnancies
• Glucaon: is released by A cells which raises blood and promote gycogen breakdown
• Insulin are produced by the B cells helps lower glucose by taking glucose to the cells

1 Type/Classification of Diabetes Mellitus

• Characterized by the destruction of the beta cells in the pancreas
• Immune mediate, there Auto destruction
• II: Arises from Resisting INsulinc and a Def in production
• Gesstional: A condition of metabolism then increased risk

Imparied Glucose Homeostasis

• A state between normal diabetee, but no longer can Be secret • F: Is done within 8 • R: Is checked any tome •0. : Measures the Body after 2 <140mgdl
• . Has an %

Diagnostic, Etiology & Pathophys

1: Genetics and HLA's and infecitous 2: elev blood glucose levels and high tri Glycerides also increased presssure 3: exess of audpose tissue and genetics all lead resistance

Diabetes Diagnosis Test

• The diabetes Test is blood, RBS, OGTT and A1 •FBS : to give it test, 8hours with at • R: Is Checks any time then over 2. • F: The body process to get test done for 2 hrs

Assessing A women with

• Confussion dizzying hyoglyerdaemia a hramiosis
• It is to determine where • 50 .50 • fast: 95+ , 1hr: , • 3 : 140+
• The risk is ineffective tissue. Risk for Infection

Gestational: Medical managemnt

• Insulin, monitoring with is glucose of 90mdpl and 140+ a pump w thin tubing then monitors 174 •Non-tests
• Ultrasounds. And the
• 2)The diet

3. Exercise for 30 m

Substance Abuse

• Any pregnancy then assessment is a good start to see and help if there is abuse • If the DRugs cross, They hurt with the cord by oxygenating
• Nicotine affects by construction and leads
• Alcoh leads to cna and fetal

Common Drugs to abuse during pregnancy

• Occasion: The causes constrict which leads to increase heart rate •Anfetemine: causes harm like infection and Blackkened teeth