NCM 107- M1.pdf

NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 1 NCM 107 – M1 UNIT 1 A Maternal and Child Health Nurse: Framework for Maternal and Child Health Nursing o Considers the family as a whole and as a i. Goals and Philosophies of Maternal and partner in care Child Health Nursing o Serves as an advocate ii. Maternal and Child Health Goals and o Demonstrates a high degree of independent Standards nursing functions iii. Theories Related to Maternal and Child o Promotes health and disease prevention Nursing o Serves as an important resource for families iv. Roles and Responsibilities of a Maternal o Respects personal, cultural and religious Child Nurse attitudes and beliefs v. WHO’s 17 Sustainable Development Goals o Encourages developmental stimulation o Assess families for strengths as well as i. GOALS AND PHILOSOPHIES OF MATERNAL specific needs or challenges AND CHILD HEALTH NURSING o Encourages family bonding o Encourages early hospital discharge options Maternal and Child Health Nursing Practice o Encourages families to reach out to their Throughout the Childbearing- Childrearing community Continuum o Provision of preconception, health care Primary Goal of Maternal and Child Health Nursing: o Provision of nursing care of women Promotion and maintenance of optimal throughout pregnancy, birth, and family health to ensure a cycle of optimal postpartum period childbearing and child rearing. o Provision of nursing care of children from Scope of Practice birth through adolescence ▪ Pre-conceptual Health care o Provision of nursing care to families in all ▪ Care of women during three trimesters of settings pregnancy and puerperium ( the 6 weeks o Encourages developmental stimulation after childbirth) during both health and illness so children ▪ Care of infants (perinatal period) can reach their ultimate capacity in adult ▪ Care of children (birth – young adulthood) life. ▪ Care in settings (birthing room, Pediatric o Assesses families for strengths as well as Intensive Care Unit (PICU) or home specific needs or challenges. Encourages family bonding through rooming-in and ii. MATERNAL AND CHILD HEALTH GOALS AND family visiting in maternal and child STANDARDS healthcare settings. 2020 NATIONAL HEALTH GOALS: o Encourages early hospital discharge options The Two Pillars: to reunite families as soon as possible in 1. To increase quality and years of healthy life. order to create a seamless, helpful 2. To eliminate health disparities. transition process. o New objective recommends that all o Encourages families to reach out to their prelicensure programs in nursing include community so the family can develop a core content on: wealth of support people they can call on in ▪ Counseling for health promotion a time of family crisis. and disease prevention ▪ Cultural diversity Maternal and child health nursing: ▪ Evaluation of health sciences o Family centered, (Assessment should literature include the family as well as the individual) ▪ Environmental health o Community centered, (The health of the ▪ Public health systems families is both affected by and influences ▪ Global health the health of communities.) National Health Goals o Evidenced based,(Critical knowledge increases ) o A challenging role for nurses and a major factor in keeping families well and optimally functioning DIAMANTE, P.M. BSN 2F NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 1 2020 NATIONAL HEALTH GOALS: o AmBisyon Natin 2040 represents the o are intended to help citizens more easily collective aspirations of Filipinos to enjoy a understand the importance of health "matatag, maginhawa at panaiag na buhay." promotion and disease prevention and to This was the result of various focus group encourage wide participation in improving discussions and nationally representative health in the next decade. survey undertaken by the National o nurses play such a vital role in helping the Economic and Development Authority nation achieve (NEDA) in early 2016. o these objectives through both practice and o AmBisyon Natin 2040 reveals the many research dimensions of well-being that Filipinos value o serve as the basis for grant funding and the most: strong family and community ties, financing of evidence-based practice a comfortable lifestyle, and a secure future. It should then be the mission of government Children living beyond infancy, higher number of to steer development processes to enable women delivering in health care facilities and more and empower every Filipino lo achieve these births are attended by professional service aspirations. providers. By means of sustaining and improving we The same EO adopted the following vision for the must be guided by these goals Philippines: o By 2040, the Philippines shall have been a prosperous, predominantly middle-class society where no one is poor; our peoples live long and heaithy lives, are smart and innovative, and live in a high-trust society. GLOBAL HEALTH GOALS o To end poverty and hunger o To achieve universal primary education. The government's vision for the Philippines has been o To promote gender equality and empower translated by the DOH into the Philippine Health women. Agenda 2016-2022 which is the All for Health o To reduce child mortality. towards health for all. Lahat para sa kalusugan! o To improve maternal health. Tungo sa kalusugan para sa lahat. o To combat HIV/AIDS, malaria, and other diseases. o To ensure environmental sustainability. o To develop a global partnership for development iii. THEORIES RELATED TO MATERNAL AND CHILD NURSING A Framework for Maternal and Child Health Nursing Care Nurses use Nursing Process, Nursing Theory, and Quality a Safety Education for Nurses (QSEN) competencies to care for families during childbearing and childrearing years. Embracing AmBisyon Natin 2040 Provisions of the four phases of health care: o Early into his administration, President ▪ Health promotion Rodrigo Roa Duterte issued Executive Order ▪ Health maintenance No. 5, s.2016 "approving and adopting the ▪ Health restoration twenty five-year long-term vision entitled ▪ Health rehabilitation AmBisyon Natin 2040 as guide for development planning." DIAMANTE, P.M. BSN 2F NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 1 Quality & Safety Education for Nurses (QSEN) NURSING THEORY The overall goal is to address the challenge Designed to offer helpful ways to view of preparing future nurses with the abilities patients so nursing activities can be created necessary to continuously improve the to best meet patient needs quality and safety of the healthcare systems Examples of Theories Related to Maternal and Child in which they work Nursing: Six Competencies: o Role Attainment Theory - Becoming a ▪ Patient-Centered Care Mother ❖ The patient or designee is thought of o Chery Tatano Beck - Postpartum Depression as the source of control and full Theory partner in the provision of compassionate and coordinated iv. ROLES AND RESPONSIBILITIES OF A care based on respect for the MATERNAL CHILD NURSE patient's preferences, values, and Caregivers needs. nurse provides direct patient-centered care ▪ Teamwork & Collaboration to women, infants, children, and their ❖ Nurses function effectively within families in times of childbearing, illness, nursing and interprofessional injury, recovery, and wellness. teams, fostering open Client Advocates communication, mutual respect, one who speaks on behalf of another. As an and shared decision making as they advocate the nurse considers the family's achieve quality patient care wishes and preferences when planning and ▪ Evidence-Based Practice implementing care. ❖ Nurses integrate the best current Researcher evidence with clinical expertise and Nurses contribute to their profession's patient/family preferences and knowledge base by systematically values for delivery of optimal health investigating theoretic or practice issues in care. nursing. ▪ Quality Improvement Teacher ❖ Nurses use data to monitor the Education is an essential role of today's outcomes of care and use nurse. Teaching begins early, before and improvement methods to design during a woman’s prenatal care, and and test changes to continuously continues through her recovery from improve the quality and safety of childbirth and learning to care for her healthcare systems. newborn, and into her care in women's ▪ Safety health ❖ Nurses minimize the risk of harm to Collaborator patients and providers through both Care is improved by an interdisciplinary system effectiveness and individual approach as nurses work together with performance. dietitians, social workers, physicians, and ▪ Informatics others ❖ Nurses use information and technology to communicate, v. WHO’S 17 SUSTAINABLE DEVELOPMENT manage knowledge, mitigate error, GOALS and support decision making. 1. No poverty/ End Poverty in all Its Forms everywhere NURSING PROCESS 2. End hunger/Zero hunger, achieve food A scientific form of problem solving Steps: security and improved nutrition and ▪ Assessment promote sustainable agriculture ▪ Nursing diagnosis 3. Good health and well-being ▪ Planning 4. Quality education ▪ Implementation 5. Gender equality ▪ Evaluation 6. Clean water and sanitation 7. Affordable and clean energy DIAMANTE, P.M. BSN 2F NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 1 8. Decent work and economic growth 9. Industry, innovation, infrastructure 10. Reduced inequalities 11. Sustainable cities and communities 12. Responsible consumption, production 13. Climate action will 14. Life below water 15. Life on land 16. Peace, justice and strong institutions 17. Partnerships for the goals DIAMANTE, P.M. BSN 2F NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 1 NCM 107 – M1 UNIT 2 and develops into female reproductive Reproductive and Sexual Health organs. i. Concept of Unitive and Procreative Health o When ovaries form, all of the oocytes (cells ii. Intrauterine Development that will develop into eggs throughout the iii. Pubertal Development woman’s mature years) are already present iv. Female/Male Reproductive System External (Edmonds, 2012). and Internal Structures v. Cervical Changes iii. PUBERTAL DEVELOPMENT vi. Human Sexuality Puberty is the stage of life at which vii. Sexual Response Cycle secondary sex changes begin. viii. Sexual Harassment and Violence In most girls, these changes are stimulated ix. Individuals with Unique Needs or Concerns when the hypothalamus synthesizes and x. Responsible Parenthood releases gonadotropin-releasing hormone xi. Family Planning (GnRH), which then triggers the anterior pituitary to release follicle-stimulating i. CONCEPT OF UNITIVE AND PROCREATIVE hormone (FSH) and luteinizing hormone HEALTH (LH). Unitive : FSH and LH are termed gonadotropin ▪ Union of two individuals that is mutually (gonad = “ovary”; tropin = “growth”) agreed to become one hormones not only because they begin ▪ Marriage, Man and woman unite as one flesh theproduction of androgen and estrogen, (sex is unitive) which in turn initiate secondary sex characteristics, but also because they Procreative : continue to cause theproduction of eggs ▪ Create and produce another life and influence menstrual cycles throughout ▪ Needs to be open to possibility of having women’s lives children (sex is procreative) The Role Of Estrogen THEORY OF EVOLUTION o When triggered at puberty by FSH, ovarian o Asserts that all life forms are the result of follicles in females begin to excrete a high procreation. level of the hormone estrogen. This increase o It is based on the idea that all species are influences the development of the uterus, related and gradually change over time. fallopian tubes, and vagina; typical female o It is based on the idea that all species are fat distribution; hair patterns; and breast related and gradually change over time. development. o The theory is defended on common features o It also closes the epiphyses of long bones in and ascending complexity. girls the same way testosterone closes the growth plate in boys. The beginning of breast ii. INTRAUTERINE DEVELOPMENT development is termed thelarche , which o Gonad - is a body organ that produces the usually starts 1 to 2 years before cells necessary for reproduction (the ovary menstruation. in females, the testis in males). At approximately week 5 of intrauterine life, The Role of Androgen mesonephric (wolffian) and o Androgenic hormones are the hormones paramesonephric (müllerian) ducts, the responsible for muscular development, tissue that will become ovaries and testes, physical growth, and the increase in have already formed. sebaceous gland secretions that cause o By week 7 or 8, in chromosomal males, this typical acne in both boys and girls during early gonadal tissue begins formation of adolescence. In males, androgenic testosterone. Under the influence of hormones are produced by the adrenal testosterone, the mesonephric duct cortex and the testes, and, in females, by the develops into male reproductive organs and adrenal cortex and the ovaries. the paramesonephric duct regresses. If o The level of the primary androgenic testosterone is not present by week 10, the hormone, testosterone, is low in males until paramesonephric duct becomes dominant puberty (between ages 12 and 14 years) when it rises to influence pubertal changes DIAMANTE, P.M. BSN 2F NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 1 in the testes, scrotum, penis, prostate, and iv. FEMALE/MALE REPRODUCTIVE SYSTEM seminal vesicles; the appearance of male EXTERNAL AND INTERNAL STRUCTURES pubic, axillary, and facial hair; laryngeal Woman’s reproductive lifespan begins after enlargement with its accompanying voice menarche and terminates with menopause; change; maturation of spermatozoa; and o typically a span of 35 to 40 years. closure of growth plates in long bones o A large store of germ cells present at (termed adrenarche ). In girls, testosterone birth decreases by puberty to influences enlargement of the labia majora 300,000. A woman releases no more and clitoris and formation of axillary and than 500 ova during ovulation pubic hair. throughout her lifetime. Reproductive activity in the male begins SECONDARY SEX CHARATERISTICS with sperm production at the onset of Adolescent sexual development has been puberty and is continuous throughout his categorized into stages (Tanner, 1990). lifetime. There is wide variation in the time required New sperm is generated every 74 days and for adolescents to move through these the capacity to reproduce is associated with developmental stages; however, the sexual excitement, penile erection and sequential order is fairly constant. ejaculation. The average age of menarche (the first menstrual period) occurs is 12.5 years. It Male Reproductive System may occur as early as 9 years or as late as Andrology is the study of the male 17, however, and still be within a normal age reproductive organs. The male reproductive range. Irregular menstrual periods are the system consists of both external and rule rather than the exception for the first internal divisions year.(Mc. Evoy et.al, 2004). Menstrual periods do not become regular until ovulation consistently occurs with them (menstruation is not dependent on ovulation) and this does not tend to happen until 1 to 2 years after menarche. This is one reason why estrogen-based oral contraceptives are not commonly recommended until a girl’s menstrual period has become stabilized or are ovulatory (to prevent administration of a compound to halt ovulation before it is firmly established). External structures In girls, pubertal changes typically occur as: ▪ Scrotum ▪ Growth spurt ▪ Testes ▪ Increase in the transverse diameter ▪ Penis of the pelvis ▪ Breast development Internal structures ▪ Growth of pubic hair ▪ Epididymis ▪ Onset of menstruation ▪ Vas deferens ▪ Growth of axillary hair ▪ Seminal vesicles ▪ Vaginal secretions ▪ Ejaculatory duct In boys: ▪ Prostate gland ▪ Increase in weight ▪ Bulbourethral glands ▪ Growth of testes ▪ Urethra ▪ Growth of face, axillary, and pubic hair Spermatogenesis occurs continually after ▪ Voice changes puberty; spermatozoa are released from the ▪ Penile growth seminiferous tubules. It is a heat – sensitive ▪ Increase in height process which takes about 75 days. ▪ Spermatogenesis (production of sperm) DIAMANTE, P.M. BSN 2F NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 1 Female Reproductive System v. CERVICAL CHANGES Gynecology: study of the female o Bicornuate uterus: oddly shaped “horns” at reproductive system the junction of the fallopian tubes External structures o Anteversion: the entire uterus tips far ▪ Mons veneris forward ▪ Labia minora o Retroversion: the entire uterus tips far back ▪ Labia majora o Anteflexion: the body of the uterus is bent ▪ Vestibule o sharply forward at the junction with the ▪ Clitoris cervix ▪ Skene glands o Retroflexion: the body of the uterus is bent ▪ Bartholin glands sharply back just above the cervix ▪ Fourchette ▪ Hymen Fern Test. When high levels of estrogen are present in the body, as they are just before ovulation, the cervical mucus forms fern- like patterns when it is placed on a glass Internal structures slide and allowed to dry. The patterns are ▪ Ovaries caused by the crystallization of sodium ▪ Maturation of oocytes chloride on mucus fibers (arborization or ▪ Fallopian tubes ferning) ▪ Uterus Spinnbarkeit Test. At the height of estrogen ▪ Uterine wall layers secretion, the cervical mucus not only ▪ Uterine blood supply becomes thin and watery, but it also can be ▪ Uterine nerve supply stretched into long strands. Performing this ▪ Uterine supportive structures test at the midpoint of the menstrual cycle is ▪ Vagina another way to demonstrate that high levels of estrogen are being produced and, by implication vi. HUMAN SEXUALITY Sexuality o Is a multidimensional phenomenon that includes feelings, attitudes, and actions. o Has both biologic and cultural diversity Internal breast structures: components. Glandular tissue (parenchyma) o It encompasses and gives direction to a o Acinar cells produce milk person’s physical, emotional, social, and Lactiferous ducts or sinuses intellectual responses throughout life o Transport milk to the nipple Adipose and fibrous tissues Biologic Gender: External breast structures o is the term used to denote a person’s Nipple chromosomal sex: male (XY) or female (XX). o Transmits sensations to the posterior pituitary gland to release Gender Identity or Sexual Identity: Oxytocin o is the inner sense a person has of being male or female, which may be the same as or Areola different from biologic gender. o Pigmented area surrounding the nipple area Gender Role: Montgomery’s tubercles o is the male or female behavior a person o Sebaceous glands that provide exhibits, which, again, may or may not be lubrication to the nipple area. DIAMANTE, P.M. BSN 2F NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 1 the same as biologic gender or gender identity. vii. SEXUAL RESPONSE CYCLE Human Sexual Response The sexual experience is unique to each individual; how body responds to sexual arousal has common features Human Sexual Responses Cycle a. Excitement b. Plateau c. Orgasm The Influence of Pregnancy on Sexual Response d. Resolution Following a pregnancy, many women continue to experience increased sexual A. EXCITEMENT PHASE interest because the new growth of blood o begins with the onset of erotic feeling and vessels during pregnancy lasts for some sensation which occurs with physical and time and continues to facilitate pelvic psychological stimulation (sight, sound, vasocongestion emotion, or thought) that causes parasympathetic nerve stimulation viii. SEXUAL HARASSMENT AND VIOLENCE Sexual Harassment Two primary physiologic changes: is unwanted, repeated sexual advances, ▪ Vasocongestion – increased blood supply remarks, or behavior toward another that is (arterial dilation and venous constriction in offensive to the recipient or interferes with genital area and other different body parts) job or school performance. ▪ Myotonia – an increased muscular tension It can involve actions as obvious as a job (contraction) superior demanding sexual favors from an employee, or it could be a man or woman sending sexist jokes by e-mail to another person in the department. In school, it can refer to bullying (Marks, Mountjoy, & Marcus, 2011). Rules apply to same-gender as well as opposite-gender harassment. In addition to causing occupational disruption, sexual harassment may be so distressing that it can lead to short- or long-term psychosocial consequences for victims and their families B. PLATEAU PHASE such as emotional distress (e.g., anxiety, o period during which sexual tension depression, posttraumatic stress disorder, increases to levels nearing orgasm, which substance abuse), interpersonal conflict, may last from 30 seconds to 3 minutes. and impaired intimacy and sexual functioning (Stock & Tissot, 2012). C. ORGASM PHASE Two Types of Sexual Harrasment o is the involuntary climax of sexual tension, a. Quid pro quo (an equal exchange) - in which accompanied by physiologic and an employer asks for something in return for psychologic release. sexual favors, such as a hiring or promotion o It lasts for 3 – 10 seconds; shortest stage in preference. the sexual response cycle; intense pleasure b. Hostile work environment - in which an affecting the whole body. employer creates an environment in which D. RESOLUTION PHASE an employee feels uncomfortable and o is the 30-minute period during which the exploited (such as being addressed as external and internal genital organs return to “honey” or “babe,” asked to wear revealing unaroused state or pre-coital stage. DIAMANTE, P.M. BSN 2F NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 1 clothing, or working where walls are x. RESPONSIBLE PARENTHOOD decorated with sexist posters). is the will and ability of parents to respond to the needs and aspirations of the family ix. INDIVIDUALS WITH UNIQUE NEEDS OR and children. CONCERNS It is a shared responsibility of the husband 1. INDIVIDUAL WITH A DISABILITY and the wife to determine and achieve the ▪ Individuals who are physically challenged desired number, spacing, and timing of their have sexual desires and needs the same as children according to their own family life all others (Meaney-Tavares & GavidiaPayne, aspirations, considering psychological 2012). preparedness, health status, socio-cultural, ▪ Manual stimulation of the penis or and economic concerns. psychological stimulation can, however, achieve erection in most men with spinal Elements of Responsible Parenthood cord lesions, allowing the man a satisfying o Awareness and preparedness of duties and sexual relationship with his partner. Most responsibilities of parents women with spinal cord injuries cannot o Promotion and protection of the rights of experience orgasm but are able to conceive children and have children o Nurturing parent and child relationship and ▪ Sexuality is a facet of rehabilitation that has observance of effective communication not always received attention. If a person o Effective shared home management can accomplish activities of daily living o Practicing family planning such as eating, elimination, and mobility, o Promoting safe motherhood and child then he or she is often considered to be health nutrition leading a normal or near-normal life. o Fostering community involvement and However, establishing a satisfying sexual participation relationship is an important part of living as well and so should be included in xi. FAMILY PLANNING assessments of clients in rehabilitation Reproductive Life Planning programs. Includes all the decisions an individual or 2. INDIVIDUAL WITH A HYPOACTIVE SEXUAL couple make about whether and when to DESIRE have children, how many children to have, ▪ Decreased sexual desire can also be a side and how they are spaced. effect of many medicines. Chronic Counseling may include the topics of diseases, such as peptic ulcers or chronic avoiding conception, increasing fertility, pulmonary disorders that cause frequent and/or what to do if contraception has failed pain or discomfort, may interfere with a man’s or a woman’s overall well-being and FAMILY PLANNING METHODS interest in sexual activity. Kinds of Contraceptive Techniques: ▪ Obese men and women may not feel as a. Natural Methods much satisfaction from sexual relations as b. Hormonal Methods others because they have difficulty c. Barrier Methods achieving deep penetration due to the bulk d. Intrauterine Device of their abdomens. e. Permanent Methods ▪ An individual with an STI such as genital herpes may choose to forgo sexual relations a. Natural Methods rather than inform a partner of the disease. ▪ is based on sexual abstinence at the time of Some women experience a decrease in ovulation to prevent conception. As the sexual desire during perimenopause. name implies, are those that involve no ▪ Administration of androgen (testosterone) to introduction of chemical or foreign material both women and men may be helpful at that into the body. time, because it can improve interest in Advantages: sexual activity (Shelton & Rajfer, 2012; ✓ Safe and has no side effects White, Grady, Giudice, et al., 2012). ✓ Inexpensive ✓ Acceptable to religious affiliations that do not accept artificial methods of contraception. DIAMANTE, P.M. BSN 2F NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 1 ✓ Helpful for planning pregnancy and avoiding activity. Ovulation occurs as soon as pregnancy she notices a dip followed by an ✓ Promotes communication about family increase in temperature planning and contraception between iv. Cervical Mucus Method (Billings Method) couples. o Before ovulation, the cervical mucus ▪ Also called “periodic abstinence methods” is thick and does not stretch when ▪ No chemical or foreign material into body pulled between the thumb and ▪ Failure rate ranges from 3% to 25% finger (spinnbarkeit). ▪ Need for couple to be conscious of time o With ovulation, cervical mucus is period when woman is most likely to be copious, thin, watery, and fertile transparent. It feels slippery, Abstinence stretches 1 inch and is 0% failure rate accompanied by breast tenderness. Most effective method to v. Symptothermal Method prevent sexually transmitted o Combines the cervical mucus infections (STIs) changes and BBT methods. Woman Periodic Abstinence watches her temperature daily and a method to avoid pregnancy analyzes her cervical mucus at the by avoiding sex on the days a same time. woman may conceive o Couples abstain for about 3 to 4 Coitus interruptus days. 25% effective; does not vi. Lactation Amenorrhea Method prevent STIs o There appears to have some form of i. Fertility Awareness Methods natural suppression of ovulation as o Rely on detecting when a woman is long as the woman is breastfeeding capable of impregnation (fertile) and and after 6 months of breastfeeding using periods of abstinence or a woman should be advised to use contraceptive use during that time. another form of contraception. ii. Calendar (Rhythm) Method vii. Coitus Interruptus (Withdrawal) o Requires the couple to abstain from o The man withdraws at the moment coitus on the days of menstrual of ejaculation and spermatozoa are period when the woman is most emitted outside the vagina. likely to conceive (3 to 4 days before o This method offers little protection until 3 to 4 days after ovulation) against conception because the o To calculate “safe days”, she man can have ejaculation before subtracts 18 from the shortest cycle withdrawal is complete documented. This number represents her first fertile day. She b. Barrier Methods subtracts 11 from her longest cycle. ▪ Works by placement of chemical or other This represents her last fertile day. barriers between the cervix and advancing o To avoid pregnancy, she would avoid sperm so that it cannot enter the uterus or coitus or use contraceptives during fallopian tube and fertilize the ovum. the fertile period. i. Vaginally-inserted spermicidal products iii. Basal Body Temperature (BBT) o These agents cause the death of the o Requires a predictable menstrual spermatozoa before they enter the cycle to predict the occurrence of cervix. ovulation. o Major advantage is that: it lacks the o Basis is that just before ovulation, side effects of hormonal products. women's BBT falls about half a o Contraindicated in women with degree and at the time of ovulation acute cervicitis, because it may her BBT rises a full degree because further irritate the cervix of the influence of progesterone. o Inserted 15 minutes before coitus. o To use this method, the woman ii. Diaphragm takes her temperature each morning o Circular rubber disk placed over the immediately after waking, before cervix prior to intercourse that forms any activity. Ovulation occurs DIAMANTE, P.M. BSN 2F NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 1 a barricade against the entrance of Saf T coil and Lippes loop = the spermatozoa. until menopause if there are o Woman must return for second no problems fitting because the cervix changes o IUD is checked by a physician once with pregnancy, miscarriage, a month after insertion then after 6 cervical surgery (Dilatation and months and yearly curettage) or therapeutic abortion and weight gain/loss of 15 lbs. c. HORMONAL METHOD o Should be kept in place for at least 6 i. Oral contraceptive pills hours after coitus, because o Prevent ovulation spermatozoa remain viable in the o Consist of hormonal agents: vagina for that duration, should not estrogen and progesterone. exceed 24 hours. o They come in two type of packets: iii. Cervical Caps The 21 day pill has a rest day o Made of soft rubber and shaped like of 7 days and a woman starts a thimble that fits snugly over the a new packet after 7 days of uterine cervix but can remain in the last pill. place longer than the diaphragms 28 day pill, the woman takes should not exceed 48 hours to the pill continuously for 28 prevent cervical irritation. days. However the last 7 pills o They are contraindicated in clients do not contain hormones with abnormally short or long cervix. and are either composed of Previous abnormal pap smear, iron supplement or lactose. history of TSS (Toxic shock Side effects: bloating, syndrome), allergy to latex, history of nausea and weight gain PID (pelvic inflammatory disease), Adverse effect: leg cramps, cervicitis or papillomavirus infection headache, abdominal pain and with history of cervical cancer. Should not be given to iv. Condoms women who smoke or with o Latex rubber or synthetic sheath coagulation problems. placed over the erect penis before If one dose is missed, take it coitus. Latex condoms have the as soon as remembered or potential of preventing the spread of take two the following day; if STD. two doses were missed, v. Intrauterine Device (IUD) double the dose for two days o Mechanism of action is not fully then resume regular dose; if understood but newer information 3 or more doses were suggests that it interferes with missed, stop the pills and fertilization. The loop is inserted start a new pack after during menses to ensure that she is withdrawal bleeding occurs not pregnant at the time of insertion. ii. Estrogen patch o Teach women to check for the string o Applied to the trunk, chest and periodically and to have an annual extremity. pelvic exam. o Effective for three weeks after which o Amenorrhea and spotting are a new patch is applied. common side effects. iii. Depo-provera o In case pregnancy occurs, IUD o Medroxyprogesterone or DMPA should be removed. An IUD left in o IM injections given every 12 weeks. uterus during pregnancy increases o Exert their contraceptive effect by the risk of abortion and infection. inhibiting ovulation, altering cervical o The IUD are replaced: mucus and preventing endometrial Copper-T = every 4 years growth. Copper-T 380 = every 8 years o Can be given 5 days postpartum if Progestasert = every year not breastfeeding; if breastfeeding given 6 weeks postpartum. DIAMANTE, P.M. BSN 2F NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 1 o Adverse effects: irregular bleeding, headache, weight gain, depression. iv. Norplant (Subcutaneous implant) o Are made up of synthetic progesterone (levonorgestrel) o Timed release dosage of progesterone o Inserted surgically into the subcutaneous tissue simultaneously with menses. o Effective for 5 years o Decrease in menstruation o Adverse effects: irregular bleeding, headache, weight gain, depression. v. Morning after pill (RU 486) o Can be used up to 8 weeks gestation o Not 100% effective and teratogenic o Consent taken for elective abortion if not effective d. Surgical Method i. Vasectomy (Male) o A small incision is made on each side of the scrotum. The vas deferens at that point is then cut and tied, cauterized, or plugged, blocking the passage of spermatozoa. o Sperm no longer enters the vas deferens. o Use additional birth control method for 6 weeks or after 20 ejaculations o Does not alter performance ii. Tubal ligation (Female) o The fallopian tubes are ligated, occluded by cautery, crushing, clamping, or blocking and thereby preventing passage of both sperm and ova. o Has 99.5% effectiveness rate. o Permanent procedure but ovulation and menstruation continues o Sexual activity may resume as soon as incision is healed. o Adverse effect; gas/bloating, bleeding (rare) DIAMANTE, P.M. BSN 2F NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 1 NCM 107 – M1 UNIT 3 increased effectiveness and efficiency, Evidence-based Practice (EBP) in Maternal and timeliness, and more appropriate Child Health focus of research-based data within the i. EBP Organizational Culture and Environment framework of the patient's current situation ii. Purpose of EBP and needs. iii. Steps of EBP iv. PICOT questions iii. STEPS OF EBP v. Barriers of EBP i. EBP ORGANIZATIONAL CULTURE AND ENVIRONMENT o Evidence-based practice (EBP) is an approach to health care that combines best available evidence, healthcare professionals' expertise, and patient preferences, yielding benefits for patients, healthcare professionals, and organization. However, globally, EBP implementation remains inconsistent among nurses. o Research studies show that evidence-based practice (EBP) leads to higher quality care, improved patient outcomes, reduced costs, iv. BARRIERS OF EBP and greater nurse satisfaction than o Lack of nurses' knowledge", "skills and traditional approaches to care awareness regarding use the Evidence- based practice", Purpose of PICOT Question o Lack of professional characteristic o It is the mechanism to identify the terms to Nurses' attitude and experience in be used to search for the best evidence to using" and "language barrier in answer a burning clinical question. In other using or implementing Evidence- words, the PICOT question is the search based practice" strategy. The search strategy leads to an unbiased and effective search. How is PICOT used in EBD o PICO is a mnemonic device used in nursing that helps a person remember the components of a well focused clinical question. It is a strategy used in the first step of Evidence Based Practice (EBP) to assess and ask when researching to formulate a searchable clinical question by helping to develop key terms. ii. PURPOSE OF EBP o Evidence-based practice provides the foundation for safe care, leading to DIAMANTE, P.M. BSN 2F

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