Maternal and Child Health Nursing

• The content focuses on maternal and child healthcare, covering topics from basic nursing principles to specific complications during pregnancy and labor.
• It includes national health statistics, nursing standards, global health goals, and genetic counseling processes.

Framework for Maternal and Child Health Nursing (MCN)

• The primary goal of maternal and child health nursing centers on promoting and maintaining optimal family health.
• This approach is family-centered, where assessments include both family and individual data.
• Community health is interconnected with family health, influencing and depending on each other. Nursing practice is rooted in research, utilizing both nursing theories and evidence-based practices.

Roles of a Maternal and Child Health Nurse

• MCN's role is to advocate for the rights of all family members, including the fetus and to provide independent nursing functions through teaching and counseling.
• Nursing also promotes health to protect the well-being of future generations.
• MCN acknowledges that pregnancy and childhood illness create stress, which can subtly and extensively change the family dynamic.
• Nurses respect personal, cultural, and religious diversity, understanding that these factors shape the meaning of illness and its effects on the family.
• In families, maternal and child health nursing is vital for promoting high-level wellness.

Standards of Maternal and Child Health Nursing Practice

• Nurses assist families in balancing personal growth with family functioning and intervene with vulnerable families, proactively pursuing improvement strategies and promoting healthy environments.

Global Health Goals

• Global health goals aim to improve the health of all people across national boundaries, focusing on contagious diseases, poverty, and gender inequality.
• The key goals: end poverty and hunger, achieve universal primary education, promote gender equality, reduce child mortality, improve maternal health, combat HIV/AIDS, ensure environmental sustainability, and develop global partnerships.

Maternal Health Statistics in the Philippines

• In 2015, the Maternal Mortality Ratio (MMR) in the Philippines was 114 deaths per 100,000 live births.
• In 2022, 86% of Filipino women received antenatal care from skilled providers.
• Also in 2022, 78.4% of women received sufficient tetanus toxoid injections to protect against neonatal tetanus.

Genetics, Genetic Counseling, and Testing

• Genetics studies how disorders occur, informing nurses to stay updated on new findings.
• Genetic counseling informs individuals and families about potential genetic conditions, helping them understand inheritance patterns.
• This involves gathering personal and family health histories, assessing the risk of genetic conditions, and deciding on genetic testing.

Assessment in Genetic Counseling

• Assessment includes obtaining a detailed family history, conducting physical exams on parents and affected children, and performing lab tests.
• During the first trimester, assessments involve routine sonograms (nuchal translucency scans) and maternal serum analysis for Alpha-fetoprotein A (PAPP-A) and free beta hCG levels.
• Nuchal translucency scans detect chromosomal abnormalities, with normal measurements typically below 3 mm.

Genetic Disorders and Genes

• Genetic disorders result from gene or chromosomal structural abnormalities passed from one generation to the next.
• Genes composed of DNA segments are the basic heredity units and form chromosomes.
• Human cells have 46 chromosomes, and sex is determined by X and Y chromosomes.

Nursing Role in Genetic Counseling

• Nurses assess for signs and symptoms of genetic disorders, support individuals seeking counseling, and assist with genetic testing, ensuring confidentiality and respect for individual values.

Chromosomal Disorders

• Trisomy 13 (Patau syndrome) involves an extra 13th chromosome.
• Trisomy 18 (Edward's syndrome) is caused by an extra 18th chromosome and the risk increases with maternal age.
• Turner syndrome (45X0) is a genetic condition in females where one X chromosome is missing or partially missing.

High-Risk Pregnancy

• A high-risk pregnancy involves a concurrent disorder, pregnancy-related complication, or external factor that jeopardizes the mother and/or fetus health.
• Variability categories include absent, minimal, moderate (6-25 bpm), and marked (>25 bpm).
• A nonstress test measures the response of FHR to fetal movement over 10-20 minutes.

Biophysical and Psychosocial Risk

• Biophysical risks originate within the mother or fetus and affect development.
• Psychosocial risks are maternal behaviors and lifestyles (e.g., smoking and poor diet) negatively affecting the health of the mother and/or fetus.

Biophysical Variables During Pregnancy

• Biophysical variables range from ultrasound, electrocardiography, amniotic fluid testing, etc
• Triple/Quad screening estimates risk of Down Syndrome and is done at 15-20 weeks of pregnancy.

Placenta and Biophysical Variables

• Placental grading by visual inspection assesses placental maturity/calcification.
• Nuchal translucency measures fluid at the back of the fetal neck to assess risk of fetal abnormalities.
• A biophysical profile combines five parameters into a single assessment: fetal heart reactivity, breathing, body movement, tone, and amniotic fluid volume.

Diabetes Mellitus

• Diabetes mellitus is a condition of abnormal glucose metabolism that arises during pregnancy, with types including Type 1, Type 2, and gestational diabetes.
• Key hormones, like insulin and glucagon, regulate blood glucose levels.
• The diagnostic tests: fasting blood sugar (FBS), random blood sugar (RBS), oral glucose tolerance test (OGTT), and HbAlc (glycated hemoglobin test).

Assessment and intervention for Diabetes

• Nurses should use non-stress and Alpha-fetoprotein (AFP) tests and ultrasounds to monitor fetal, placental, and amniotic fluid function.
• Nurses should also encourage health educational advice about nutrition.

Substance Abuse

• Substance abuse, including alcohol and illicit drugs, during pregnancy can lead to significant maternal and fetal effects, including neonatal complications, fetal alcohol syndrome, and sudden infant death syndrome.

HIV/AIDS in Pregnancy

• HIV/AIDS is spread through unprotected sexual contact, sharing needles, or from mother to child.
• Preventative steps, like taking antiretrovirals can help prevent or mitigate the issue.

Rh Incompatibility

• Rh incompatibility becomes significant during pregnancy when the mother is Rh-negative and the baby is Rh-positive, leading to immune responses in the mother that endanger subsequent fetuses.
• RhoGAM shots help prevent this and are a routine prevention

Nursing Care of Patient w/ Hyperemesis

• Interventions include small portions of food presented attractively, oral hygiene, and putting emesis basin out of sight.

Ectopic Pregnancy

• Ectopic pregnancy can cause uterine rupture, internal bleeding, and hemodynamic instability.
• Immediate treatment includes Methotrexate therapy, IV Therapy, and/or laproscopic surgery to tie off vessles

Abortions

• Spontaneous: Unexpected loss of a fetus.
• Induced: Intended conclusion to the pregnancy using clinical techniques.
• Complications include hemorrhaging and infections.

Apas

• Antiphospholipid Antibody Syndrome: in APAS, the immune system creates specific antibodies that: Attack proteins bound to phospholipids (fat cells), Cause these proteins to become damaged and Lead to increased blood clotting
• The three antibodies that can cause APAS include: Anti-B2 glycoprotein 1, Anticardiolipin, Lupus anticoagulant.
• APAS manifests in two primary forms: PRIMARY APAS and SECONDARY APS.

PROM

• Premature Rupture of Membrane = spontaneous membrane rupture before labor.
• PROM occurs from bacteria, STI's, Poor nutrition ,and low economic status
• Nurses should monitor vs, perform ferning test, and monitor amniotic fluid volume.

Placenta Previa

• Placenta Previa = the placenta is in the lower uterus over the cervical os.
• Risk includes lack of protein, older aged mother, asian heritage
• Perform pain assessment, side lying, administer medication.
• Uterus pain, the pt wont have pain

Abruption Placentae

• Abruption leads to constricted vasocontriction = bad for health.
• Rupture caused by trauma, cocaine use htn.
• Check platelets and monitor bleeding.

Placenta Accreta

• Placenta adhered too severely to placenta,
• Test hct, admin blood test/IV.

Vertex Malpresentation

• Can lead to uterine abnormalities

Breech Presentation

• Breech can lead too trauma and low levels of potassium, also causes issues for the mother.
• A baby's butt comes out first before their head
• perform internal fetal manipulations in attempt to fix it