NCM 107 Maternal and Child Health Nursing Preliminary Long Exam & Midterm Exam PDF

NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025...

NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 3. Fetal Death Rate – Number of Fetal deaths MODULE 1 UNIT 1 weighing more than 500 g or more per 1000 live FRAMEWORK FOR MATERNAL AND CHILD births HEALTH NURSING 4. Neonatal Death Rate – Number of deaths per 1000 live births occurring in the 1st 28 days of life. Obstetrics – or the care of women during childbirth, is derived from the Greek word obstare, which Neonatal Period – 1st 28 days of life; Infant is called means “to keep watch.” Neonate. No. of deaths per 1000 live births occurring in the 1st 28 days of life. Pediatrics – Is a word derived from the Greek word pais, meaning “child.” The care of childbearing and 5. Perinatal Death Rate – Number of deaths of childrearing families is a major focus of nursing fetuses weighing greater than 500g and within the practice, because to have healthy adults you must first 28 days of life per 1000 birth. have healthy children. To have healthy children, it is important to promote the health of the childbearing Perinatal Period – 6 weeks before conception and 6 woman and her family from the time before children weeks after childbirth are born until they reach adulthood. PRIMARY GOAL OF MATERNAL AND CHIL FRAMEWORK OF MATERNAL AND CHILD HEALTH NURSING NURSING The primary goal of maternal and child health nursing Maternal and child health nursing can be visualized care can be stated simply as the promotion and within a framework in which nurses, using nursing maintenance of optimal family health to ensure process, nursing theory, and evidence-based practice, care for families during childbearing and cycles of optimal childbearing and childrearing. Major childrearing years through four phases of philosophical assumptions about maternal and child health care: health nursing are listed in. The goals of maternal and child health nursing care are necessarily broad Health promotion - Educating clients to be aware of because the scope of practice (the range of services good health through teaching and role modelling. Ex. and care that may be provided by a nurse based on Family planning, teach the importance of safe sex state requirements) is so broad. The range of practice, importance of immunizations practice includes Health maintenance - Intervening to maintain health when risk of illness is present. Ex. Encourage Preconceptual health care - The care received. by prenatal care, importance of safeguarding homes by a mother before getting pregnant including: childproofing it against poisoning. Care of women during three trimesters of Health restoration - Diagnosing and treating illness pregnancy: using interventions that will return client to wellness 1st trimester (1st –3rd month) fast Ex. Care of child during illness, care of woman 2nd trimester (4th –6th month) during pregnancy complications. 3rd trimester (7th –9th month) Health rehabilitation - Preventing further Care of women during puerperium (the 6 complications from an illness. Bringing client back to weeks after childbirth, sometimes termed an optimal state of wellness. Helping client accept the fourth trimester of pregnancy. inevitable death Ex. Encourage continuous therapies and medications Puerperium (Postpartum period) - refers to the time after delivery when maternal physiologic MEASURING MATERNAL AND CHILD changes related to pregnancy return to the non- HEALTH / STATISTICAL TERMS THAT USED pregnant state. TO REPORT MATERNAL AND CHILD Care of infants during Perinatal Period (6 HEALTH NURSING weeks before conception and 6 weeks after birth). 1. Birth Rate – Number of births per 1000 population 2. Fertility Rate – number of pregnancies per 1000 Care of children from birth to adolescence women of childbearing age Neonatal (28 days of life); Infancy (1–12 months); Adolescence (after 18 y/o). PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 Care in settings as varied as the birthing information about preventive measures and room, the Pediatric Intensive Care Unit preparation for normal pregnancy and childbirth. PICU, and the home. Clinical Nurse Specialists - Clinical specialists are PHILOSOPHIES OF MATERNAL AND CHILD registered nurses who, through study and supervised HEALTH NURSING practice at the graduate level (master’s or doctorate), have become expert in the care of childbearing families or pediatric patients. 1. MCHN is Family Centered; assessment must include both family and individual assessment. Clinical Nurse Leaders - All CNLs receive the same 2. MCHN is Community Centered; health of basic preparation in a master’s program, which includes advanced pathophysiology, pharmacology, families depends on & influences the health of and health assessment, among other courses that communities. prepare them to assume leadership roles within their 3. MCHN is Evidence Based because critical specific practice settings. knowledge increases. WORLD HEALTH ORGANIZATION 4. MCHN includes independent nursing functions because teaching & counselling are In 1977 the World Health Assembly decided major interventions. that the main social target of Background 5. MCN Nurse, Advocate (protects the rights of governments and of WHO should be the family members, including fetus). attainment by all the people of the world by the 6. Health Promotion and Disease Prevention to year 2000 of a level of health that will permit protect health of new generation. them to lead a socially and economically 7.MCN is a challenging role for nurses productive life, popularly known as “health for all by the 2020. A family centered approach enables nurses to better understand individuals and their effect on 17 SUSTAINABLE DEVELOPMENT GOALS others, and in turn, to provide holistic care. In September 2015, the General Assembly Family – basic unit of society adopted the 2030 Agenda for Sustainable Development that includes 17 Sustainable ROLES AND RESPONSIBILITIES OF A Development Goals (SDGs). Building on the MATERNAL CHILD NURSE principle of “leaving no one behind”, the new Agenda emphasizes a holistic approach to Collaborator - Care is improved by an achieving sustainable development for all. interdisciplinary approach as nurses work together with dietitians, social workers, 1. End poverty in all its forms everywhere physicians, and others. 2. End hunger, achieve food security and improved nutrition and promote sustainable agriculture Researcher - Nursing does much more than simply 3. Ensure healthy lives and promote well- “borrow” scientific knowledge from medicine and being for all at all ages. basic sciences. Nursing generates and answers its 4. Ensure inclusive and quality education for own questions based on evidence within its unique all and promote lifelong learning subject area. 5. Achieve gender quality and empower women and girls. Advocate - An advocate is one who speaks on 6. Ensure access to water and sanitation for behalf of another. The wishes and needs of children all. and families are sometimes discounted or ignored in 7. Ensure access to affordable, reliable, the effort to treat and to cure. sustainable and modern energy for all. 8. Promote inclusive and sustainable Manager of Care - Because of shorter stays in economic growth, employment and decent acute-care facilities, nurses often are unable to work for all. provide total direct patient care. Instead they 9. Build resilient infrastructure, promote delegate concrete tasks, such as giving a bath or sustainable industrialization and foster taking vital signs, to others. innovation. 10. Reduce inequality within and among Certified Nurse-Midwives - CNMs are registered countries. nurses who have completed an extensive program of study and clinical experience. They provide PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 11. Make cities inclusive, safe, resilient and EXTERNAL ANATOMY OF GENETALIA sustainable. 12. Ensure sustainable consumption and production patterns. 13. Take urgent action to combat climate change and its impacts. 14. Conserve and sustainably use the oceans, seas and marine resources. 15. Sustainably manage forests, combat desertification, halt and reverse land degradation, halt biodiversity loss. 16. Promote just, peaceful and inclusive societies. 17. Revitalize the global partnership for sustainable development Each goal is important in itself. And they are all connected because: Vulva – pudendum; external female genitalia Vestibule – the space into which the vagina and First, and most important, these Goals apply to every nation and every sector. Cities, businesses, schools, urethra open organizations, all are challenged to act. This is called Labia minora – thing, longitudinal skin folds Universality. Clitoris – small, erectile structure; well supplied with sensory receptors, made up of erectile tissue. A Second, it is recognized that the Goals are all inter- small, pea shaped bump at the front of the labia. It connected, in a system. We cannot aim to achieve contains a small amount of erectile tissue. The just one Goal. We must achieve them all. This is clitoris increases sexual pleasure called Integration. Greater vestibular glands – produce a And finally, it is widely recognized that achieving lubricating fluid that helps maintain the moistness of these Goals involves making very big, fundamental the vestibule changes in how we live on Earth. This is called Labia majora – prominent, rounded folds of skin Transformation. mons pubis – an elevation of tissue over the pubic symphisis MODULE 1 UNIT 2 Pudendal cleft – space bet. the labia majora CONCEPT OF UNITIVE AND PROCREATIVE Clinical perineum – region bet. the vagina and the HEALTH anus Episiotomy – an incision made the clinical Procreation - is the creation of a new human perineum to avoid tearing during childbirth. person, by the act of sexual intercourse, by a Urethra – Opening of the bladder man and a woman. The sexual activity of conceiving and bearing biological offspring INTERNAL ANATOMY OF GENETALIA Unitive - is characterized by or tending to produce union; capable of causing unity or serving to unite. HUMAN REPRODUCTION Both sexes have reproductive organs called genitals or genitalia designed for the purpose of intercourse and conception. FEMALE REPRODUCTIVE SYSTEM Female reproductive organs are for intercourse, reproduction, urination pregnancy and childbirth. PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 lengthen during arousal. The vaginal walls are made of many small folds of membrane that stretch greatly to accommodate a baby during birth. The vaginal wall also secreteD a fluid that helps to make intercourse easier. FEMALE MENSTRUAL CYCLE series of changes that occur in sexually mature, non- pregnant females, and that culminate in menses. Day 1 – Menstruation begins (bleeding) Ovaries - Two solid egg-shaped structures. They are Day 5 – Menstruation is usually ended attached to the uterus by ligaments. They are the Day 14 – Ovum has matured and bursts out of counterpart of the male testicles. Store and release the ovary the ova or female egg cell. Some of the ova Day 15 – After 24 hours the egg is done disappear; others are dormant until each is ripened Day 26 – In the absence of fertilization, and released after puberty. Produce female sex estrogen/progesterone levels drop hormones estrogen and progesterone. and the endometrium lining breads down Ova - The female reproductive cell. They are the Day 28 – Menstruation begins again. largest cells in the female body. (about the size of a grain of sand.) The female baby is born with all the Menstrual cycle can be divided into 3 phases: ova she will ever have (about 200,000 in each ovary). Menstrual phase About 400-500 ova mature and are released over a Proliferative / follicular (estrogen) phase lifetime. Secretory / luteal phase (progesterone) phase. Ovulation - When the egg is released from the ovary, at the age of puberty the ovum moves to the Menses – a period of mild hemorrhage; part of the surface of the ovary in bursts out. The ova fall into endometrium is sloughed and expelled from the the fallopian tube and waits for fertilization. This uterus; day 1 – 4: menstrual fluid is produced by happens every 28 days. It happens at about the 14th degeneration of the endometriumThe menses phase day of the cycle. of the menstrual cycle is the phase during which the lining is shed; that is, the days that the woman Fallopian Tube - Two tubes attached on either side menstruates. Although it averages approximately of the uterus. They are about four inches long and five days, the menses phase can last from 2 to 7 3/16 inch in diameter (the size of a cooked spaghetti days, or longer noodle). The oviducts carry egg cells toward the uterus and sperm cells toward the egg cell. Proliferative phase – day 5 – ovulation: epithelial Fertilization takes place in the upper third of the cells multiply and form glands. It occurs when the oviduct. granulosa and theca cells of the tertiary follicles begin to produce increased amounts Uterus - A hollow, muscular organ (shaped of estrogen. These rising estrogen concentrations somewhat like an upside-down pear, about the size stimulate the endometrial lining to rebuild. of a fist). The uterus is lined with endometrium (a blood lining.) The uterus has one main function—to Secretory Phase – day of ovulation – 28: protect and nourish a fetus. The walls of the uterus endometrium becomes thicker, endometrial glands have the ability to stretch to the size of a small secreted. In addition to prompting the LH surge, high watermelon. After childbirth the uterus shrinks back estrogen levels increase the uterine tube to the original shape in 6-8 weeks, but it can take up contractions that facilitate the pick-up and transfer of to nine months for the uterus to fully recover. the ovulated oocyte. High estrogen levels also slightly decrease the acidity of the vagina, making it Cervix - The neck or opening of the uterus. A normal more hospitable to sperm. In the ovary, the healthy cervix is the strongest muscle in the body. It luteinization of the granulosa cells of the collapsed dips down about half an inch into the vagina. It is follicle forms the progesterone producing corpus normally plugged by mucus. It stays tightly closed luteum, marking the beginning of the luteal phase of during pregnancy, but thins and opens for the the ovarian cycle. In the uterus, progesterone from delivery of the baby. the corpus luteum begins the secretory phase of the menstrual cycle, in which the endometrial lining Vagina - Female organ used for intercourse, it is an prepares for implantation. empty passageway leading from the vaginal opening to the uterus. It is only 3-4 inches long, but will PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 Most fertile in next few days! Able to get pregnant Egg gets fertilized while traveling through oviduct. If fertized Zygote begins to divide as it travels through oviduct Implants into lining of uterus CHEMICAL HORMONES Estrogen - This hormone plays a crucial role in the development and regulation of the female reproductive system and secondary sexual characteristics. It helps regulate the menstrual cycle, supports the growth of the uterine lining, and is involved in various bodily functions beyond reproduction. Is responsible for the secondary sex characteristics and the sex drive in females. It spurs the onset of puberty and is responsible for ovulation. Progesterone - Often called the "pregnancy hormone," progesterone prepares the uterus for a fertilized egg and helps maintain pregnancy. It also Menarche - a woman's first menstruation typically regulates the menstrual cycle and supports early occurs around age 12. Occurrence depends on stages of pregnancy. Builds up the lining of the overall health and diet uterus called the endometrium in preparation for the fertilized ovum Menopause - end of a woman's reproductive phase commonly occurs between ages 45 and 55 age of LH (Luteinizing Hormone) - LH is essential for menopause is largely the result of genetics regulating the menstrual cycle and ovulation. In women, a surge in LH triggers ovulation, the release TIMELINE of an egg from the ovary. In men, LH stimulates the production of testosterone. Ages 9-12 - Secondary sex characteristics appear FSH (Follicle Stimulating Hormone) - FSH is Ages 11-14 - Menstrual cycle begins involved in the growth and maturation of ovarian Late 20-30’s - Peak sexual urge follicles in women and the production of sperm in Ages 45-55 - Menopause (cycle stops, but sex urge men. It works closely with LH in regulating the continues. menstrual cycle and reproductive processes. HCG (Human Chorionic Gonadotropin) - This Complex combination of 10-12 chemicals hormone is produced by the placenta shortly after (hormones) Usually one egg once a month implantation of the fertilized egg. It is crucial for All about timing!!! Uterus must be ready when egg maintaining the corpus luteum, which produces gets there in case it was fertilized If no fertilization progesterone during the early stages of pregnancy. occurs, lining of uterus tears down and rebuilds for 1st hormone released during pregnancy HCG is also next month Uterus must be ready when egg gets the hormone detected by pregnancy tests. there in case it was fertilized. If no fertilization occurs, lining of uterus tears down and rebuilds for next month Pre – Ovulation. First menstrual blood & tissue No baby = breaks down lining of uterus 5-7 days of blood/tissue exits body Post-Ovulation Ovulation = Egg released Temp spikes slightly PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 MALE REPRODUCTIVE SYSTEM ANATOMY Seminal Vesicles - two small glands that secrete a fluid that nourishes and enables the sperm to move. Prostate Gland - surround the urethra beneath the bladder. The gland secretes an alkaline fluid that neutralizes the acid found in the male urethra and the female reproductive tract. Without the action of the secretions of the prostate gland, many sperm would die and fertilization of an ovum would be impossible. Prostate Gland - A dual purpose tube that both semen and urine pass through to leave the body. Semen and urine never mix. Special muscles or sphincters surround the urethra. During urination, one sphincter will relax so that the pressure from the bladder will push urine out from the body. During Scrotum - A sac-like pouch located behind the penis ejaculation, another sphincter will relax so that that holds each testes and helps regulate semen can flow through the urethra to the outside of temperature for sperm production. the body. Testicles or Testes - The two testes are small Urethra - A dual purpose tube that both semen and organs that lie in the scrotum and produce sperm and urine pass through to leave the body. Semen and the male hormone testosterone. The testicles are urine never mix. Special muscles or sphincters the male sex gland. The testicles are outside the surround the urethra. During urination, one sphincter body because the male sperm that is manufactured will relax so that the pressure from the bladder will in the testes need cooler-than-body temperature for push urine out from the body. During ejaculation, normal growth and development. They are the another sphincter will relax so that semen can flow counterpart to the female ovary. Loss of one does not through the urethra to the outside of the body. impair the function of the other. Four to five billion sperm cells are produced each month. Penis - The male organ for sexual intercourse, reproduction, and urination. The reproductive Testosterone - the male reproductive hormone purpose of the penis is to deposit semen in the made by the testicles which causes the changes of vagina during sexual intercourse. The head of the puberty. penis or glans contains many nerve endings. At birth This hormone causes secondary sex characteristics, the glans is covered by a loosely fitting skin called production of sperm and sexual urge. It is produced the foreskin. When the penis is erect it is 5-7 inches in the testicles and enters the bloodstream at a fairly long An erection occurs when the sponge-like constant rate. chambers in the penis fill with blood. Sperm - the male reproductive hormone made by the Semen - a combination of fluid that is produced in testicles which causes the changes of puberty. This the seminal vesicles, prostate gland, and Cowper's hormone causes secondary sex characteristics, gland. This fluid nourishes and helps sperm move production of sperm and sexual urge. It is produced through the urethra. in the testicles and enters the bloodstream at a fairly constant rate. TIMELINE Epididymis - the structure that forms a mass over the back and upper part of each testes. Sperm are Infancy - Erections begin stored there for as long as six weeks while they ripen Ages 11-14 - Secondary sex characteristics appear to maturity. Ages 13-16 - Sperm produced in adult amounts (puberty). Cowpers gland - two small pea-sized glands located Late teens - Peak sexual urges for boys beneath the prostate gland on both sides of the base Throughout life - If good health is present, there is of the penis. They secrete a clear, sticky fluid that the sex urge and ability to father children helps to neutralize the acidity of the urethra. Vas Deferens - two long, thin tubes that serve as a SIMILARITIES passageway for sperm and a place for sperm storage. The contraction of the vas deferens along 2 pouches with the action of the cilia help transport the sperm Testicles through the vas deferens. Ovaries PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 Start out inside body Testicles “descend” before birth. DETERMINE BY SEX DNA determines baby’s gender XX = Female XY = Male Depends on which egg & sperm get together. Father determines baby’s gender. Anatomy – similarities Function – different Male Uncomplicated Produce sperm 2-4 MILLION every day Outside body – why? Sperms like temps 1-2 cooler than body temp Vas Deferens Tube - sperms travel through Symptoms of Down Syndrome Vasectomy - Cut/tie off tube – sperms can’t get out! Upward slant to eyes. Small ears that fold over at the top. Female Small, flattened nose. Very Complicated! Small mouth, making tongue appear large. One egg Short neck. Once a month Small hands with short fingers Careful coordination of hormones & body Timing perfect! Kleinfelter’s Syndrome - Disorder occurring due to nondisjunction of the X chromosome. The Sperm Tubal ligation - is surgery to close a woman's containing both X and Y combines with an egg fallopian tubes. (It is sometimes called "tying the containing the X, results in a male child. The egg may tubes."). contribute the extra X chromosome. Fertilization - The union of egg cell and sperm cell and the result is zygote BIRTH CONTROL PILLS BIRTH CONTROLS Birth control, also known as contraception, is the use of medicines, devices, or surgery to prevent pregnancy. There are many different types. Some are reversable, while others are permanent. Some types can also help prevent sexually transmitted diseases (STDs). Abstinence Birth control pills Intrauterine device Male condom XXY syndrome - Males with some development of Contraceptive implants breast tissue normally seen in females.Little body hair is present, and such person are typically tall, The morning after pills have small testes. Infertility results from absent sperm.Evidence of mental retardation may or may GENETICS DISORDERS not be present. Down’s Syndrome - Caused by non-disjunction of the 21st chromosome. This means that the individual has a trisomy (3 – 2lst chromosomes). Trisomy 21. PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 GENETIC DISORDERS INHERITANCE OF GENETIC TRAITS First there was Gregor Mendel, a monk who studied inherited characteristics. This was followed by Francis Crick and James Watson who unraveled the DNA molecule. This has led us to understanding the human genome sequence Gregor Mendel (1866) - published the results of his investigations of the inheritance of "factors" in pea plants. Turner syndrome - Turner syndrome is associated Watson and Crick - made a model of the DNA with underdeveloped ovaries, short stature, webbed, molecule and proved that genes determine heredity and is only in women.Bull neck, and broad chest. Individuals are sterile, and lack expected secondary (1950's) Maurice Wilkins (1916), Rosalind sexual characteristics. Mental retardation typically Franklin (1920-1957), Francis H. C. Crick (1916) of not evident. Chromosomal or monogenic Britain and James D. Watson (1928) of the U.S. - Discover chemical structure of DNA, starting a new branch of science--molecular biology. Arthur Kornberg (1918) - of the U.S. produced DNA in a test tube. 1966 - The Genetic code was discovered; scientists are now able to predict characteristics by studying DNA. This leads to genetic engineering, genetic counseling. 1983 - Barbara McClintock (1902-1992) of the U.S. was awarded the Nobel Prize for her discovery that genes are able to change position on chromosomes. The late 1980's - An international team of scientists began the project to map the human genome. The first crime conviction based on DNA fingerprinting, in Portland Oregon. 1995 - DNA testing in forensics cases gains fame in the O.J. Simpson trial. PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 MODULE 1 UNIT 3 HCG - Human Chorionic Gonadotropin - 1st ANATOMY AND PHYSIOLOGY OF hormone present in the blood and urine to detect pregnancy. PREGNANCY Braxton Hicks contractions - painless contractions Chadwick’s sign - a bluish discoloration of the that occur intermittently throughout pregnancy and cervix, vagina, and labia resulting from increased can be felt by the woman by the 4th month. blood flow. Goodell’s sign - softening of the vaginal portion of Gravida - refers to the number of pregnancies you’ve the cervix from increased vascularization. got, no matter they’re completed or not. Hegar’s sign – softening of the lower uterine segment. Primigravida - First pregnancy Ballottement - in which the uterus is pushed with a Nulligravida - a woman who has never finger to feel whether a fetus moves away and been pregnant. returns again. Multigravida – Pregnant 2 or more times Braxton Hicks contractions - tightening in the abdomen that comes and goes. Para - refers to the number of deliveries, that is the number of pregnancies finally leading to live births 3 DIFFERENT CATEGORIES FOR THE SIGNS Example: G1P1; G2P1; G2P0 OF PREGNANCY: Chloasma or Melasma - mask of pregnancy Presumptive (subjective) - Amenorrhea, fatigue, characterized by symmetrical patches of dark skin, nausea & vomiting, breast changes, quickening, commonly seen on the cheeks, upper lip, forehead, urinary frequency. and chin. Probable (observable) - Goodell’s sign, Chadwick’s sign, Hegar’s signs, ballottement, positive pregnancy tests (serum, urine), Braxton Hicks ctx. Positive (confirmatory) - Hearing fetal heart tones, visualization of the fetus, and palpating fetal movement, visualizing fetal movements. Fetal Heart Rate Fetal heart beat is audible at 10 to 12 weeks’ gestation by Doppler ultrasound and 16 to 20 weeks’ gestation with a fetoscope. The normal FHT is 120 to 160 beats per minute. Naegele’s Rule To determine the Expected Date of Delivery Linia Nigra - a dark vertical line that appears on the (EDD), take the date of the last menstrual period, abdomen during about three quarters of all add 7 days to that date, & count back 3 months. pregnancies. SHORT COMPUTATION: Months – Minus 3 Days – Add 7 Year – Add 1 Example: 1. LMP – June 16, 2021 EDD – March 23, 2022 2. LMP – May 19, 2022 EDD – February 26, 2023 3. LMP – Aug. 22, 2022 EDD – May 29, 2023 4. LMP – January 20, 2022 EDD – October 27, 2023 5. LMP – December 23, 2021 EDD - September 30, 2022 PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 Striae Gravidarum - pregnancy stretch marks, is a GTPAL: Assessing Parity form of scarring of the skin of the abdominal due to An acronym, GTPAL: sudden weight gain during pregnancy. G - Gravidity – Number of all pregnancies including the present pregnancy. If have multiple gestation like twins, triplets, quadruplets are equivalent to 1 pregnancy. regardless on the outcome death or alive. T - Term of birth(s) – Number of pregnancies carried 37 – 42 weeks include all regardless on the outcome death or alive. If twins, triplets, quadruplets are equivalent to 1 pregnancy. P - Preterm birth(s) – Number of pregnancies carried between 20 and 37 weeks. If multiple gestation like twins, triplets, quadruplets are equivalent to 1 pregnancy. regardless on the outcome death or alive. 5 Digit System: Assessing Gravidity A - Abortion(s) / Miscarriage(s) – Number of losses before 20 weeks. Less than 20 weeks. If multiple An acronym, GTPAL gestation like twins, triplets, quadruplets are G - Gravidity (including the present pregnancy) equivalent to 1 pregnancy. T - Total number of term births P - Total number of preterm births L - Living childrens – Number of living children but A -Total number of abortions not include in the present baby in womb just in case L - Total number of living children pregnant. If multiple gestation like twins, triplets, quadruplets are counted individually if the mother Example: have multiple gestation. 1. When taking an obstetrical history on a pregnant Example: client who states, “I had a son born at 38 weeks’ gestation, a daughter born at 30 weeks’ gestation, and I lost a baby at about 8 weeks,” the nurse should record her obstetrical history as which of the following? A. G2 T2 P0 A0 L2 B.G3 T1 P1 A0 L2 C.G3 T2 P0 A0 L2 D.G4 T1 P1 A1 L2 2. A 35 years old female is currently pregnant with twins. She has 10 years old triplets who were born at 32 weeks gestation, and a 16 year old who was born at 41 week gestation. Twelve year ago she had a Physiologic Adaptation of Reproductive miscarriage at 19 weeks gestation. What is her System to Pregnancy GTPAL? A. G=4, T=1, P=2, A=1, L=1 Breasts - Changes are due to increased production B. G=3, T=1, P=1, A=0, L=4 of estrogen & progesterone. Become full & tender C. G=4, T=1, P=1, A=1, L=4 early in pregnancy. The number of mammary alveoli D. G=4, T=1, P=1, A=1, L=1 increase & breasts become larger (in preparation of breastfeeding). The prepregnant size of the breasts 3. A 39 year old female is currently 18 weeks has no effect on the ability to breastfeed! pregnant. She has two sets of twin daughters that were born at 38 and 39 weeks gestation and an 11 Skin - Alterations in hormonal balance & mechanical year-old son who was born at 32 weeks gestation. stretching are responsible for several changes. She has no history of miscarriage or abortion. What is her GTPAL? Musculoskeletal - The gradually changing body & A. G=4, T=2, P=2, A=1, L=5 increasing weight of the pregnant woman cause B. G=4, T=1, P=1, A=0, L=4 noticeable alterations in posture and way of walking. C. G=4, T=1, P=2, A=1, L=4 D. G=4, T=2, P=1, A=0, L=5 PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 Neurologic - Physiologic alterations resulting from Follow-up Visits: During Pregnancy pregnancy may cause neurologic or neuromuscular symptoms. Visits every 4 weeks up to 28 weeks gestation (during the 1st & 2nd trimesters). Discomforts of Pregnancy 29-36 weeks visits are scheduled q2 weeks. Nausea & vomiting 37-40 weeks gestation visits are q week. Heartburn-burning sensation in the chest Although less intense, visits include Constipation additional interview data & physical Fatigue examination. Frequent Urination Additional Prenatal Assessments Epistaxis & nasal congestion Pelvic Exams Varicosities - veins that have become Laboratory Tests enlarged and twisted Nutritional Assessment Hemorrhoids-inflamed rectal veins Back pain Fetal Assessment and Prenatal Visits Leg cramps Fundal Height Initial Nursing Examination Measurement of the height of the uterus above the symphysis pubis, includes the Initial interview upper curve of the fundus. Reason for seeking care; current Gestational Age pregnancy; Ob/Gyn Hx; medical Hx; Determined from the menstrual Hx, Nutritional Hx; drug use; family Hx; social & contraceptive Hx, pregnancy test result, experiential Hx; review of systems. and other clinical evaluations. Physical exam Health Status Provides a baseline for assessing Includes consideration of fetal movement, subsequent changes; pelvic examination; the FHR & rhythm & abnormal maternal & assessment of the bony pelvis. fetal symptoms. Laboratory tests Analysis of specimens obtained during Potential Warning Signs examination 1st Trimester - Severe vomiting, chills, fever, burning on urination, diarrhea, abd. cramping; vag. Fetoscope - specialized stethoscope used to closely bleeding. monitor the heartbeat and well-being of an unborn child. Detection is easiest after 20 weeks of 2nd and 3rd Trimesters - Persistent severe pregnancy. vomiting, PROM, UTI, severe backache or flank pain, change in fetal movement pattern, ctx, visual disturbances, swelling of face or fingers. H/A, convulsions, epigastric pain, glycosuria, sudden wt gain 2+kg/wk. Potential Warning Signs Periodic tightening or hardening of the uterus. Regular, frequent, hard. Suprapubic cramping, abdominal cramping, Doppler Ultrasound - of ultrasound that uses sound backache waves to measure blood flow in the body, and is often Uterine ctx q10 min or more frequently for 1 used during pregnancy to assess blood flow between hour. the mother and baby. It can also be used to check A bloody spotting or leaking of fluid from the baby's blood flow. vagina. Fundal height that measures smaller or larger than expected or increases more or less quickly than expected could indicate conditions such as: Slow fetal growth (intrauterine growth restriction) Rapid fetal growth Too little amniotic fluid (oligohydramnios) PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 Too much amniotic fluid (polyhydramnios) Uterine fibroids A baby prematurely descending into the pelvis or settling into a breech or other unusual position. Potential Warning Signs Ultrasonography The Zygote Month 1 Chorionic villi sampling (CVS) Amniocentesis Fertilized egg reaches the uterus and Alpha-fetoprotein attaches itself to the uterus. Lecithin – Spingomylelin Ratio Cell multiplication begins Internal organs and circulatory system begins to form. MODULE 1 UNIT 4 Cell Division takes place and at the end of FETAL DEVELOPMENT two weeks the zygote is the size of a pin- head Prenatal Baby Development Heart begins to beat Small bumps show the beginnings of arms Development of the baby during the period before and legs birth. Develops in three stages I. Zygote - the result of fertilization ll. Embryo - The embryonic period is the most critical period of development because of the formation of internal and external structures. The four stages of embryonic development are: Morula - forms 2 to 3 days after fertilization; solid mass of 12 to 16 cells Blastula - day 6; when a cavity, the blastocele, begins to appear in the mass of cells Gastrula - Cell migration and formation of mesoderm Organogenesis - When organ systems develop. Week 2 to 8. Gastrointestinal tract begins forming about day 28. Heart develops from 2 blood vessels about day 21 and starts to beat. III. Fetus The heart - The first organ system to develop during 4 Weeks organogenesis is the cardiovascular system. The embryo is about 1/6-inch long and has CONCEPTION developed a head and a trunk. Once a month an ovum is released, The Egg moves Structures that will become arms and legs, through the Fallopian Tube to the uterus called limb buds, begin to appear. Ovum - A female egg The brain develops into five areas and Uterus - Where the baby develops during pregnancy some cranial nerves are visible. If not fertilized it disintegrates and is flushed away The eyes and ear begin to form. with menstruation. Tissue forms that develops into the vertebra and some other bones. If it is fertilized in the Fallopian Tube by a sperm The heart continues to develop and now Conception occurs. This Union is what we call a beats at a regular rhythm. zygote. Rudimentary blood moves through the main vessel PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 The fetus begins small, random movements, too slight to be felt. The fetus’s heartbeat can be detected electronically. The baby’s face now has a human profile. 12 weeks The fetus is about 31/2-inches from head to rump and weighs about 1½ ounces. The fetus can swallow, the kidneys make urine, and blood begins to form in the bone marrow. For females, ovarian follicles begin forming. For males, the prostate appears. A doctor 5 weeks may be able to identify the sex through special tests. 3 months The fetus is about 1 inch long Nostrils, mouth, lips, teeth buds, and eyelids form 8 weeks Fingers and toes are almost complete Eyelids are fused shut The fetus, until now called an embryo, is Arms, legs, fingers, and toes have about 11/4-inches long, with the head developed making up about half this size. All internal organs are present—but aren’t The beginnings of all key body parts are ready to function present, although they are not completely positioned in their final locations. The genital organs can be recognized as male or female Eyes, ears, arms and legs are identifiable. The neck begins to develop, and the baby’s eyelids begin to close to protect his or her developing eyes 2 Months 10 weeks The fetus is about 21/2-inches from head to rump and weighs about 1/2 ounce. Fingers and toes are distinct and have nails. PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 4 months Fetus is 3 inches long and weights 5 oz. The baby is covered with a layer of thick, downy hair called lanugo. His heartbeat can be heard clearly. This may be when you feel the baby's first kick. The baby can suck thumb, swallow and hiccup 7 months Fetus is 10-12 inches long and weighs about 1-2 pounds. Fetus is active and then rests. The baby now uses the four senses of vision, hearing, taste and touch 8 months The fetus is 14-16 inches long and weighs 2-3 pounds Layers of fat are piling on. Fetus has probably turned head-down in Month 5 preparation for birth. The Fetus is about 6 inches long and Fetus may react to noises with a jerking weighs 4-5 oz. action A protective coating called vernix begins to form on baby's skin. 9 months Fetus is about 17-18 inches long and Hair eyelashes and eyebrows appear weighs 5-6 pounds Organs keep maturing Skin is smooth because of the fat Fetus is very active Baby’s movement slows down due to lack The eyes can open and blink of room “Lightening” occurs when the baby drops in Month 6 the pelvis The fetus is 8-10 inches long and weighs 4- Disease fighting antibodies are taken from 5 oz. the mother’s blood The baby's lungs are filled with amniotic fluid, and he has started breathing motions. Lanugo - is the first hair produced by fetal hair If you talk or sing, he can hear you. follicles, usually appearing around 16 weeks of Fat is starting to deposit under the skin gestation and abundant by week 20. It helps protect and keep the fetus warm. Lanugo sticks to a thick, white, greasy substance called vernix caseosa that coats the baby's skin, helping it stay in place. Smallest baby in the world She was 10 OUNCES when born and 9.5 inches. That's just longer than the length of your hand. She weighed less than a can of soda! ADULT BLOOD CIRCULATION Blood comes into the right atrium from the body, moves into the right ventricle and is pushed into the pulmonary arteries in the lungs. After picking up oxygen, the blood travels back to the heart through PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 the pulmonary veins into the left atrium, to the left ventricle and out to the body's tissues through the aorta. FETAL CIRCULATION Blood vessels of the umbilical cord 1 umbilical vein – carries oxygenated blood from placenta to the fetus 2 umbilical arteries – carry deoxygenated blood or waste products of the baby from Ductus venosus - fetal blood vessel connecting the fetus to the placenta umbilical vein to the inferior vena cava. Blood flow in the unborn baby follows this pathway Oxygen and nutrients from the mother's blood are transferred across the placenta to the fetus through the umbilical cord. 3 SHUNTS IN FETAL CIRCULATION This enriched blood flows through the umbilical vein toward the baby’s liver. There Foramen ovale - oxygenated blood flows from right it moves through a shunt called the ductus atrium to left atrium. venosus. This allows some of the blood to go to the liver. But most of this highly oxygenated blood flows to a large vessel called the inferior vena cava and then into the right atrium of the heart. When oxygenated blood from the mother enters the right side of the heart it flows into the upper chamber (the right atrium). Most of the blood flows across to the left atrium through a shunt called the foramen ovale. Ductus arteriosus - protects lungs against circulatory overload. allows the right ventricle to From the left atrium, blood moves down into strengthen. the lower chamber of the heart (the left ventricle). It's then pumped into the first part of the large artery coming from the heart (the ascending aorta). PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 From the aorta, the oxygen-rich blood is Low Birthweight sent to the brain and to the heart muscle itself. Blood is also sent to the lower body. Pregnancy Blood returning to the heart from the fetal Prenatal care or antenatal care – health care given body contains carbon dioxide and waste during pregnancy or before delivery. products as it enters the right atrium. It flows down into the right ventricle, where it Fundal height – measurement of the height of the normally would be sent to the lungs to be uterus above the symphysis pubis. Measurement of oxygenated. Instead, it bypasses the lungs fundal height may aid in the identification of high risk and flows through the ductus arteriosus into factors. the descending aorta, which connects to the umbilical arteries. From there, blood flows back into the placenta. There the carbon dioxide and waste products are released into the mother's circulatory system. Oxygen and nutrients from the mother's blood are transferred across the placenta. Then the cycle starts again. At birth, major changes take place. The umbilical cord is clamped and the baby no IUGR (Intrauterine Growth Restriction) - longer receives oxygen and nutrients from decreased fundal height or SGA (small for the mother. With the first breaths of air, the gestational age) lungs start to expand, and the ductus arteriosus and the foramen ovale both LGA (Large for Gestational Age) - an excessive close. The baby's circulation and blood flow increase could indicate the presence of more than through the heart now function like an adult. one fetus or hydramnios MODULE 1 UNIT 5 Macrosomia - condition in which a fetus is larger PRENATAL CARE than average—the birth weight is between 4,000 grams (8 pounds, 13 ounces) and 4,500 grams (9 AOG – age of gestation pounds, 15 ounces). NSD – Normal Spontaneous Delivery CS – Cesarean Section PROM – Premature Rupture of Membrane NIL – Not in Labor What is Prenatal Care and the Purpose? Prenatal care is a woman receives while she is pregnant. Is usually provided by an OB/GYN, family practice physician, nurse midwife, or other health professional. Fundal height landmark Monitors how the pregnancy is progressing 12 - 14 weeks – Symphysis pubis and identifies potential health problems. 16 weeks – Fundus halfway between Mothers are given information on prenatal symphysis and umbilicus tests, maternal vaccinations, healthy 20 - 22 weeks – Umbilicus nutrition, alcohol and substance abuse, 24 weeks – 2 cm above Umbilicus smoking, and environmental and 28 weeks – Fundus above umbilicus or reproductive hazards. between umbilicus and xyphoid process 32 weeks – below xyphoid process Role of Prenatal Care 36 weeks - Xiphoid process 37- 40 weeks - Regression of fundal height Prenatal care can reduce: bet. 36-32cm below xyphoid process. Infant Mortality Birth Defects Preterm Birth PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 LABOR AND BIRTH PROCESSES Labor - is a series of continuous, progressive contractions of the uterus which help the cervix to open (dilate) and to thin (efface), allowing the fetus to move through the birth canal and expel from the women’s body. Childbirth - includes both labor (the process of birth) and delivery (the birth itself) SIGNS OF LABOR Lightening - a drop in the level of the uterus during the last weeks of pregnancy as the head of the fetus Preliminary engages in the pelvis. Lightening - the descent of the fetus presenting part into the pelvis. NORMAL WEIGHT GAIN DURING Sudden burst of energy Braxton-Hicks contraction PREGNANCY Cervical ripening A woman who was average weight before getting True signs pregnant should gain 25 to 35 pounds after Regular contractions becoming pregnant. Underweight women should Show – is a vaginal discharge of pink, jelly- gain 28 to 40 pounds. And overweight women may like mucus that can occur in the last week need to gain only 15 to 25 pounds during pregnancy. of pregnancy ROM – rupture of membrane IMMUNIZATION COMPONENTS OF LABOR Tetanus toxoid (TT) is a vaccine which helps THE 5 “P’S” prevent a person from getting a tetanus infection. A TT vaccine can also prevent a pregnant woman and her baby from getting a tetanus infection. During Passenger - (fetus) pregnancy, the doctor will also recommend this The fetal head & Molding: vaccine. After administering this vaccine, antibodies Molding - the change in shape of the fetal will get formed in the body which will then get passed skull on to the child and protect him for some time. produced by the uterine contractions Fontanel's - Intersection of sutures, allows 1 Tetanus Immunization of Pregnant for molding, helps identify position of head Women The two most important fontanels are the 2 Iron and Iodine Supplementation During anterior and posterior ones. Pregnancy The anterior fontanel - is diamond shaped and closes by 12-18 months after birth. Tetanus toxoid During First Pregnancy The posterior fontanel - is triangular and closes 2 to 3 months after birth. The first dosage will be administered in the third trimester, that will be somewhere around the seventh month of pregnancy. The second dosage will be administered after 4 weeks of the first vaccine. The World Health Organization recommends a third dosage which is given after 6 months of the second dose. This is provided to offer a shield against the tetanus bacteria for at least 5 years. If the second pregnancy is within 2 years of the first pregnancy, and she has been administered 2 doses of vaccine in the first Anterior Fontanel pregnancy, then she will only be given 1 The bones of the fetal scalp are soft and booster vaccine. meet at "suture lines." PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 The anterior fontanel is an obstetrical FETAL LIE landmark because of its' distinctive diamond shape. Lie – is the relation of the long axis (spine) of the Early in labor, it is usually difficult (if not fetus to the long axis (spine) of the mother impossible) to feel the anterior fontanel. After the patient is nearly completely 2 primary lies: dilated, it becomes easier to feel the 1. Longitudinal or vertical - in which the long axis fontanel. of the fetus is parallel with the long axis of the mother 2. Transverse, horizontal, or oblique – in which the long axis of the fetus is at a rightangle diagonal to the long axis of the mother. Posterior Fontanel The occiput of the baby has a similar obstetric landmark, the "posterior fontanel." This junction of suture lines in a Y shape that is very different from the anterior fontanel. FETAL ATTITUDE Fetal attitude - The relationship of the fetal parts to each other. An example is the "military" attitude, in which the fetal head is not flexed and the chin is not on the chest as usual but is held straight up. Compare fetal position, fetal presentation. Powers - (uterine contractions) Passage - (the pelvis & maternal soft parts) Position - (maternal) Psyche (maternal psychological status) FETAL PRESENTATION Presentation – refers to the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor at term. 3 main presentations 1.Cephalic presentation – head first 2.Breech presentation – buttocks or feet first 3.Shoulder presentation – shoulder first PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 FETAL ENVIRONMENT FETAL POSITION Amnion Fetal position - is the positioning of the body of a 1. Encloses the amniotic cavity prenatal fetus as it develops. In this position, the 2. Is the inner membrane that forms about the back is curved, the head is bowed, and the limbs are second week of embryonic development. bent and drawn up to the torso. This position is used 3. Forms a fluid-filled sac that surrounds the embryo in the medical profession to minimize injury to the and later the fetus neck and chest. Chorion 1. Is the outer layer 2. Becomes vascularized and forms the fetal part of the placenta AMNIOTIC FLUID 1.Consists of 800-1200 ml by the end of pregnancy 2.Surrounds, cushions and protects the fetus and allows for fetal movement 3.Maintains the body temperature of the fetus 4.Contains fetal urine and is a measure of fetal kidney function 5.The fetus modifies the amniotic fluid through the processes of swallowing, urinating and movement through the respiratory tract. Oligohydramnios - is when you have too little amniotic fluid. Amniotic fluid is the fluid that surrounds your baby while they're in your body before birth. Your baby needs amniotic fluid to grow. Normohydramnios - is a medical term for a normal LEOPOLD’S MANEUVER amount of amniotic fluid surrounding a fetus in the womb. Leopold's maneuvers are four specific steps in palpating the uterus through the abdomen in order to Polyhydramnios – when there to much amniotic determine the lie and presentation of the fetus. fluid surrounded on the baby,s womb during Leopold's maneuvers are named after Christian pregnancy. Gerhard Leopold, a German Obstetrician who lived from 1846 to 1911. The Leopold Maneuvers are used to help nurses determine fetus’ presentation and position. The maneuvers have 4 specific actions that nurses must perform. Nurses use this process along with the assessment of the maternal pelvis’ shape to determine if complications will occur during the delivery and if the patient will require a Cesarean section. PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 HOW TO PERFORM LEOPOLD’S Step 4. Pelvic Grip MANEUVER IN STEP BY STEP This step should be done while facing the patient’s feet. The process involves locating the fetus’ brow. The nurse should gently move the fingers on both Step 1. Fundal Grip Using both hands and facing the patient, palpate the hands toward the pubis by sliding the hands over the sides of the patient’s uterus, and the side where the upper abdomen. The nurse should use this method greatest resistance to the descending fingers is the to determine the shape, size, mobility, and location of the brow. A well-flexed fetal head is consistence of what he or she feels. The nurse should feel that the limbs and shoulders contain little located on the opposite side of the fetal back. If the head is extended, the back of the head is felt on the bone processes that move with the fetus’ trunk; the side that the back is located. A head that cannot be head is firm, hard, round and moves separately from felt has likely descended. the trunk; and the buttocks is symmetric and feels soft. Step 2. Umbilical Grip While still facing the patient, the nurse should apply DIFFERENT TYPES OF PELVIS deep pressure with the palm of his or her hands to palpate the abdomen gently. Perform this maneuver by placing the right hand on one side of the patient’s abdomen while using the left hand to explore the woman’s uterus on the right side. Repeat this step on the opposite side using the opposite hand. Step 3. Pawlick’s Grip Android Using the thumb and fingers of one hand the lower A android, or “male,” pelvis, the pubic arch forms an abdomen is grasped just above the pubic symphysis acute angle, making the lower dimensions of the to establish if the presenting part is engaged. If not pelvis extremely narrow. A fetus may have difficulty engaged a movable body part will be felt. The exiting from this type of pelvis. It is a typical pelvis presenting part is the part of the fetus that is felt to shape for people It’s more cone- or wedge-like than be in closest proximity to the birth canal. a gynecoid pelvis. Android pelvises may appear wider at the top and narrower at the bottom. This pelvic shape is more common in tall people. Android pelvis can make it harder for the baby to move through the birth canal. People AFAB with android pelvises may require a Cesarian Section or C – Section. Gynecoid A gynecoid, or “female,” pelvis has an inlet that is well rounded forward and backward and a wide pubic arch. This pelvic type is ideal for childbirth. Lead to Smoother Viginal Delivery. PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 Anthropoid History of Past Illness An anthropoid, or “ape-like,” pelvis, the transverse Heart & kidney diseases, UTI, HTN, DM, diameter is narrow, and the anteroposterior diameter asthma, common infectious diseases, etc. of the inlet is larger than normal. This structure does Immunizations not accommodate a fetal head as well as a gynecoid Allergies pelvis. It usually narrower than gynecoid pelvises, Past surgical procedures but vaginal birth may still be possible. People with anthropoid pelvises may have longer labor than Family Illness those with gynecoid pelvises. Changing positions Cardiovascular throughout labor may help people with anthropoid Renal pelvises have smoother deliveries. Cognitive blood disorders Platypelloid Genetically inherited diseases A platypelloid, or “flattened,” pelvis has a smoothly curved oval inlet but the anteroposterior diameter is Congenital anomalies shallow. A fetal head might not be able to rotate to match the curves of the pelvic cavity in this type of Social Profile pelvis. The pelvis is flat. It may be very wide but it’s Nutrition typically also very shallow. This is the least common Elimination pelvis shape. Only about 5% of people have this Sleep/rest, exercise pelvic type.can make vaginal childbirth extremely Recreation, hobbies difficult. Most people with this pelvic shape require a Interpersonal interactions C-section. Habits Involvement in abusive relationship MODULE 1 UNIT 6 Medication History ASSESSMENT OF A PREGNANT WOMEN Gynecologic History Prenatal Assessment Menarche Thorough Assessment of health history Usual menstrual cycle & discomforts Physical exam Monthly perineal self-examination Laboratory and Diagnostic exams. Past reproductive tract surgery Hx of frequent D & C FP methods INITIAL QUESTIONS ASK FOR Sexual hx Stress incontinence LMP (Last Menstrual Period) Pregnancy test Obstetric History Signs of early pregnancy Previous pregnancy Discomforts of pregnancy Previous miscarriages or therapeutic abortions Danger signs of pregnancy Blood transfusion HEALTH HISTORY GTPAL MODULE 1 UNIT 6 PHYSICAL EXAMINATION Demographic Data / Family ackground Family Background Name, Client’s age, occupation Baseline Height, Weight & V/S Measurement Financial status Educational level Assessment of Systems Partner’s age, occupation, educational level Marital status Support person/s House size Difficult situations that can be a problem during pregnancy. Main Concern Ask for main concern about visiting on the Hospital/Clinic. PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 Measurement of Fundal Height & Fetal LEOPOLD’S MANEUVER Heart Sounds Pelvic Examination & Estimating Pelvic size Use Leopold’s maneuvers to determine fetal position, presentation, and attitude. Bartholomew’s Rule - estimates Age of Gestation (AOG) of a fetus depending on the height of the Step 1. Fundal Grip fundu and relative position of the uterus in the abdominal cavity. Location 12 - 14 weeks – Symphysis pubis 16 weeks – Fundus halfway between symphysis and umbilicus 20 - 22 weeks – Umbilicus 24 weeks – 2 cm above Umbilicus 28 weeks – Fundus above umbilicus or between umbilicus and xyphoid process 32 weeks – below xyphoid process Place your hands over the patient’s 36 weeks - Xiphoid process abdomen and curl your fingers around the 37- 40 weeks - Regression of fundal height fundus. bet. 36-32cm below xyphoid process. When the fetus is in the vertex position (head first), the buttocks should feel irregularly shaped and firm. When the fetus is in the breech position (feet first), the head should feel hard, round, and completely moveable. Step 2. Umbilical Grip Move your hands down the side of the abdomen, applying gentle pressure. If the fetus is in the vertex position, you’ll feel a smooth, hard surface on one side the fetal back. Mc Donald’s Rule – also known as fundal height, is Opposite, you’ll feel lumps and knobs the a method for measuring the size of a pregnant knees, hands, feet, and elbows. mother's uterus to assess the growth and development of the fetus. The measurement is taken If the fetus is in the breech position, you from the top of the uterus to the top of the pubic may not feel the back at all. symphysis. Step 3. Pawlick’s Grip Fundal Height is measured by the tape measure Spread your thumb and fingers of one hand, place them just above the patient’s symphysis pubis, and then bring your fingers together. PRELIMINARY LONG TEST AND MIDTERM EXAM TRANSCRIBE BY: JOAB S. STA. INES (BSN BATCH 2027)  NCM 107: MATERNAL AND CHILD HEALTH NURSING (CARE OF MOTHER, CHILD, ADOLESCENT) BSN 2 – C PRELIMINARY LONG EXAM AND MIDTERM EXAM SAINT MICHAEL’S COLLEGE OF LAGUNA - SCHOOL OF NURSING 1st SEMESTER A.Y. 2024 – 2025 If the fetus is in the vertex position and hasn’t descended, you’ll feel the head. If the fetus is in the vertex position and has descended, you’ll feel a less distinct mass. If the fetus is in the breech position, you’ll feel a less distinct mass, which could be the feet or knees. Step 4. Pelvic Grip PELVIC EXAMINATION Before the pelvic exam ask to void assist to lie in a lithotomy position During the pelvic exam drape properly with a draw sheet over Use the fourth maneuver to determine abdomen that extends over the legs flexion or extension of the fetal head and Suggest to breath in and out neck. Place your hands on both sides of the lower abdomen. Gently apply pressure with your fingers as you slide downward toward the symphysis pubis. If the head is the