Maternal and Child Health Nursing Framework PDF

Chapter 1:​ health through teaching and role Framework for Maternal and Child Health modelling​ Nursing Ex. Family planning, teach the importance...

Chapter 1:​ health through teaching and role Framework for Maternal and Child Health modelling​ Nursing Ex. Family planning, teach the importance of safe sex practice, importance of Obstetrics – Care of woman during childbirth; immunizations derived from Greek word “obstare” (to keep 2.​ Health Maintenance​ watch)​ Intervening to maintain health when Pediatrics – derived from Greek word, “pais” risk of illness is present​ (child)​ Ex. Encourage prenatal care, importance Focus of MCN – Care of childbearing and of safeguarding homes by childproofing it childrearing families.​ against poisoning Primary Goal of MCN – Promotion and 3.​ Health Restoration​ maintenance of Optimal Family Health. Diagnosing and treating illness using interventions that will return client to Goals of MCN are broad because the scope of wellness fast​ practice or range of practice includes the ff: Ex. Care of child during illness, care of 1.​ Preconceptual Health Care woman during pregnancy complications 2.​ Care of women during 3 trimesters of 4.​ Health Rehabilitation​ pregnancy​ Preventing further complications from 1st trimester (1st – 3rd month)​ an illness​ 2nd trimester (4th – 6th month)​ Bringing client back to an optimal state 3rd trimester (7th – 9th month) of wellness​ 3.​ Care of women during Puerperium or 4th Helping client accept inevitable death​ Trimester (6 weeks after childbirth) Ex. Encourage continuous therapies and 4.​ Care of infants during Perinatal Period (6 medications weeks before conception and 6 weeks after birth) 78 women die per 100,000 live births due to 5.​ Care of children from birth to adolescence​ pregnancy-related causes in the Philippines​ Neonatal (28 days of life); Infancy (1 – 12 months); Adolescence (after 18 y/o) The maternal mortality ratio in the Philippines has 6.​ Care in settings as varied as the birthing improved from 129 in 2000 to 78 in 2020. room, the NICU, and the home. ​ 48 of every 1,000 girls ages 15-19 gave birth in Philosophies of MCN the Philippines in 2021 1.​ MCN is Family Centered; assessment must include both family and individual GENETIC COUNSELING assessment. Genetics is the study of how genes and how traits 2.​ MCN is Community Centered; health of are passed down from one generation to the next.​ families depends on & influences the Genetic counseling refers to guidance relating to health of communities. genetic disorders that a specialized healthcare 3.​ MCN is Evidence Based because critical professional (genetic counselor) provides to an knowledge increases individual or family. 4.​ MCN includes independent nursing As members of a healthcare team, genetic functions because teaching & counselling counselors provide information and support to are major interventions. families affected by or at risk for a genetic 5.​ MCN Nurse, Advocate (protects the rights disorder. They serve as a central resource of of family members, including fetus) information about genetic disorders for other 6.​ Health Promotion and Disease Prevention healthcare professionals, patients, and the to protect health of new generation. general public. 7.​ MCN is a challenging role for nurses A genetic counseling session aims to: ​ Increase the family’s understanding about Framework for MCN a genetic disease(s), the risks and 1.​ Nursing Process (ADPIE) benefits of genetic testing and disease 2.​ Evidence Based Practice management, and available options. 3.​ Nursing Research ​ Identify with the individual and family the 4.​ Nursing Theory psychosocial tools required to adjust to potential outcomes. 4 Phases of Health Care ​ Reduce the family’s anxiety. 1.​ Health Promotion​ Educating clients to be aware of good II. Care of At-Risk/High Risk and Sick Mother ​ Inadequate support systems ​ Lack of acceptance to pregnancy HIGH-RISK PREGNANCY ​ Inadequate housing Risk of disability (morbidity) or death (mortality) is ​ Unwed when the life or well-being of a woman or fetus ​ Minority status has significantly increased—disorder coincidental ​ Parental occupation with or unique to pregnancy. ​ No help at home Is one in which a concurrent disorder, ​ Psychiatric history pregnancy-related complications or external 5. Demographic factors factor jeopardizes the health of a pregnant ​ Maternal age, age 35, person, the fetus, or both. ​ Education < 11 years Some Complications may lead to: ​ Ethnic background ​ Early pregnancy loss or preterm delivery 6. Lifestyle ​ Arise due to age, use of substance ​ Smokes >10 cigarettes/day ​ Substance use/abuse ASSESSMENT OF RISK FACTORS ​ Number of sex partners 1. Obstetric history ​ Excessive Alcohol intake ​ Hx of infertility ​ Usual stress ​ Grand multiparity ​ Father of infant not involved ​ Incompetent cervix ​ Preterm birth The Amniotic Sac and Fluid ​ Previous pregnancy like still births, ★​ 4-8 weeks 20ml habitual abortion, ★​ 20 weeks 350ml ​ Cesarian Section birth, ★​ 37 weeks 700-1000ml ​ RH or blood group sensitization, ★​ 40 weeks 600ml ​ Large baby. ​ Previous ectopic pregnancy COMMON DIAGNOSTIC PROCEDURES IN ​ Previous multiple gestation MCN ​ Previous prolonged labor 1. Alpha-feto protein levels ​ Previous LBW infant ​ assesses the presence of neural tube ​ DES (Diethylstilbestrol) exposure in utero defects (increased) and down’s 2. Medical history syndrome(decreased) ​ Cardiac disease, ​ Anemia, 2. Amniocentesis ​ HPN, ​ to assess fetal growth and maturity, ​ Metabolic disease-Thyroid disorder, determine genetic disorders. Hypothyroidism ​ Renal disease and Diethylstilbestrol 3. Apgar scoring exposure ​ the 1st apgar score detects the ​ Seizure disorders cardiorespiratory-nervous functioning ​ Emotional disorders ​ 2nd apgar is used for planning nursing ​ Family hx of inherited disorders care. ​ Pulmonary disease o​ 0-3 - poor - needs resuscitation ​ STD o​ 4-6 - fair - needs suctioning and ​ Mental retardation oxygenation ​ Surgery during pregnancy o​ 7-10 - good - needs only 3. Current OB status admission care ​ Inadequate prenatal care ​ LGA 4. Assessment of lochia ​ Intrauterine growth-restricted infant ​ to detect the presence of infection and ​ Rh sensitization bleeding ​ Gravida, Para, stillbirths o​ Rubra - dark red - 3 to 4 days ​ Fetal manipulation o​ Serosa - pinkish brown - 4 to 10 ​ Polyhydramnios days ​ Fetal/placental malformation o​ Alba - whitish yellow - 10 to 28 ​ Abnormal presentation days 4. Psychosocial factors ​ Inadequate finances 5. Chorionic Villi sampling ​ Social problems ​ to determine some genetic aberrations ​ Poor nutrition 6. Contraction stress test (oxytocin challenge Left-Sided Heart Failure vs Right-Sided Heart test) Failure ​ indicates uteroplacental insufficiency and Left-Sided Heart Right-Sided Heart identifies pregnancies at risk Failure Failure The left ventricle The right ventricle 7. Coombs’s test cannot pump blood cannot pump blood ​ Direct: used to test antibodies on patient's as it should. This effectively, which leads erythrocytes - baby (if positive, there’s an causes blood to build to a buildup of fluid that antibody attacking) up in the veins of the causes swelling in the ​ Indirect: used to test antibodies on lungs. lower body. patient's serum - mother (if positive, nasa Left heart failure is Isolated right heart plasma pa lang, di pa narreach si baby) more common. failure is less common. Symptoms typically Symptoms typically 8. Fetal heart monitoring include congestion in include swelling and ​ assesses FHR abnormalities the lungs, which can fluid retention in the affect breathing. body. 9. Guthrie capillary blood test ​ used as screening test for phenylketonuria Symptoms of Heart Failure Left-Sided: 10. Hysterosalpingography ​ Dyspnea ​ determines patency of fallopian tubes and ​ Orthopnea detect pathology in the uterine cavity. ​ Rales ​ Cough 11. Laparoscopy ​ Chest pain ​ evaluates pelvic pain and infertility and ​ Cardiac arrhythmias treats endometriosis lesions. ​ Syncope during or after exertion ​ Extreme fatigue, pallor 12. Mammography ​ Cyanosis ​ detects the presence of breast tumor ​ Paroxysmal nocturnal dyspnea ​ Poor fetal heart tone variability 13. Non-stress test Right-Sided: ​ assesses fetal activity and well being ​ Neck-vein engorgement (JVD) ​ Hepatomegaly 14. Pelvic ultrasound ​ Peripheral edema ​ detects abnormalities of the organs in the abdomen 1. ASSESSMENT a.​ Assess the stress of pregnancy on the 15. Percutaneous umbilical cord blood hearts functioning every antepartal visit. sampling b.​ Take Vital signs and compare with the ​ Removal of blood from the umbilical vein normal values expected during using an amniocentesis pregnancy. ​ technique for analysis. c.​ Determine the woman's activity level including rest and any changes in the vital Monitoring Of High Risk Clients signs since previous visit. IMPORTANCE: d.​ Identify and evaluate other factors that 1.​ To help identify potential complication would increase strain on the heart like 2.​ To ensure early treatment anemia, infection, anxiety, lack of support 3.​ To improve maternal-fetal outcomes system and household and career demand. PRE-GESTATIONAL CONDITIONS CARDIAC DISEASE CLASSIFICATIONS ​ Pregnancy results in increased cardiac Class I – Uncompromised output, heart rate, and blood volume ​ show no signs of cardiac insufficiency, no ​ Normal heart is able to adapt to these anginal pain changes without difficulty. ​ ordinary physical activity cause no ​ The woman with heart disease, however, discomfort has decreased cardiac reserve, making it ​ No limitation of activity more difficult for her heart to handle the Class II – Slightly compromised higher workload of pregnancy. ​ ordinary physical activity causes excessive fatigue, palpitation, and  dyspnea or anginal pain (signs of cardiac ​ Educate Regarding Medication insufficiency) ​ Educate Regarding Avoidance of Infection ​ Slight limitation of activity ​ Be Prepared for Emergency Actions Class III – Markedly compromised ​ During less than ordinary activity, woman 3. EVALUATION/EXPECTED OUTCOMES experiences excessive fatigue, palpitation, ​ The woman participates in developing an and dyspnea or anginal pain appropriate healthcare regimen and follow ​ Marked limitation of activity. it throughout her pregnancy Class IV – Severely compromised ​ The woman gives birth to a healthy infant. ​ Woman is unable to carry out any physical ​ The woman avoids congestive heart activity without experiencing discomfort failure thromboembolism, and infection. ​ Even at rest, symptoms of cardiac ​ The woman is able to identify signs and insufficiency or anginal pain are present o symptoms of possible postpartum Signs of cardiac insufficiency maybe complications experienced even at rest; physical activity ​ The woman is able to care effectively for increases discomfort. her newborn infant. Class I and II clients usually do well in pregnancy ENDOCRINE DISORDERS IN PREGNANCY Endocrine disorders have the potential to be MANAGEMENT IN THE CARE OF PREGNANT serious complications of pregnancy because WOMEN WITH CARDIAC DISEASE enzymes or hormones control so many specific ​ Reduction in cardiac workload: body functions. o​ promoting rest, infection prophylaxis, prevention of anemia, HYPOTHYROIDISM provision of adequate calories, ​ Hypothyroidism happens when the thyroid fiber, nutrients and no added salt: gland doesn't make enough thyroid o​ reporting signs of cardiac hormone. decompensation, reduction in ​ Women with symptoms of untreated stress and anxiety, delivery without hypothyroidism are often unable to bearing down i.e., forceps conceive. delivery, pain relief. ​ Maternal hypothyroidism has been shown ​ Strengthening of cardiac function: to be significantly associated with: o​ administration of medication e.g., o​ Miscarriage digoxin o​ Preterm birth ​ Prevention of volume overload: o​ Fetal growth restriction o​ remobilization of fluid in the intravascular compartments after Signs and characteristics of women with delivery; thrombus prophylaxis. hypothyroidism: ​ Monitoring of fetal well-being is very ​ Fatigue easily important. ​ Tend to be obese ​ Skin is dry 2. NURSING DIAGNOSIS ​ Little tolerance for cold 1.​ Potential for decreased cardiac output: ​ May be associated with increased easy fatigability incidence of extreme nausea and vomiting 2.​ Impaired gas exchange related to (hyperemesis gravidarum) pulmonary edema secondary to cardiac decompensation Management: 3.​ Fear related to the effects of the maternal ​ Most women with hypothyroidism take cardiac condition on fetal well being levothyroxine to supplement their lack of 4.​ Activity intolerance thyroid hormone. 5.​ Risk for infection ​ A woman who is taking levothyroxine 6.​ Potential for fetal injury needs to: 7.​ Deficient knowledge regarding steps to o​ Consult with her obstetrician and take to reduce the effects of maternal internist when planning pregnancy cardiovascular disease on the pregnancy o​ Come for early diagnosis and close and fetus follow-up as soon as she suspects she is pregnant (1 week past INTERVENTIONS missed menstrual period) ​ Promote Rest ​ Promote Healthy Nutrition Complications if untreated: ​ Preterm birth ​ Low birth weight ​ Respiratory distress in the neonate HYPERTHYROIDISM ​ Overproduction of thyroid hormone Signs and Symptoms: ​ Rapid heart rate ​ Exophthalmos (protruding eyeballs) ​ Heat intolerance ​ Nervousness ​ Heart palpitations ​ Weight loss Complications: ​ If undiagnosed, a woman may develop heart failure during pregnancy because her heart rate—already high at the beginning of pregnancy—cannot increase enough to handle the increased blood volume. Treatment: ​ Doctors prescribe anti-thyroid medications like: o​ Propylthiouracil (PTU) o​ Methimazole How does hyperthyroidism affect pregnancy? ​ Uncontrolled hyperthyroidism may lead to: o​ Preterm birth (before 37 weeks) o​ Low birth weight o​ Increased risk of pregnancy-induced hypertension (PIH) Thyroid Storm: ​ A severe, life-threatening form of hyperthyroidism ​ Characterized by: o​ Extremely high levels of thyroid hormone o​ High fever o​ Dehydration o​ Diarrhea o​ Rapid and irregular heart rate o​ Shock o​ Death, if not treated