NCM 109: Care of Mother and Child PDF
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Summary
This document is a handout for the NCM 109 course on care of mother and child, covering topics like maternal and child health nursing, the national health situation in the Philippines, genetics, and nursing management of conditions such as Down syndrome and sickle cell disease. It includes health teachings and common nursing diagnoses for various conditions.
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**COURSE TITLE: Care of Mother and Child at Risk or with Problems (Acute and Chronic)** **Course Code: NCM 109** Credit Units and Contact Hours: Theory 6 units (108 hours); RLE: Skills Lab- 1; unit (51 hours); Clinical (255 hours) Pre-requisite/s: NCM107 Year Level Course: 2^nd^ Year (second sem...
**COURSE TITLE: Care of Mother and Child at Risk or with Problems (Acute and Chronic)** **Course Code: NCM 109** Credit Units and Contact Hours: Theory 6 units (108 hours); RLE: Skills Lab- 1; unit (51 hours); Clinical (255 hours) Pre-requisite/s: NCM107 Year Level Course: 2^nd^ Year (second semester) Course Description: This course deals with concepts, principle, theories and techniques in the nursing care of at-risk clients during childbearing and childrearing years toward health promotion, disease prevention, restoration and maintenance, and rehabilitation. The learners are expected to provide safe, appropriate and holistic nursing care to clients utilizing the nursing process. **Course Requirement: Lecture** 1. Examinations: a. Quizzes- 30% b. Unit Exams-30% c. Major Exams-40% **OBJECTIVES of the COURSE** At the end of the second semester the students will be able to: 1. Identify the framework of Maternal and Child Health Nursing focusing on at-Risk Clients. 2. Explain the care of At-Risk Mother and Child. 3. Describe the Nursing Care of Children with Alterations in Health Status (Acute and Chronic). 4. Summarize the Nursing Care of a Child with Life Threatening Conditions/Acutely Ill/Multi -Organ Problems/High Acuity Emergency Situations (Acute and Chronic). **Introduction** **What is Maternal and Child Health Nursing?** Maternal and Child Health (MCH) nursing focuses on promoting health, preventing diseases, and providing holistic care to: 1. Women of reproductive age (preconception, pregnancy, childbirth, postpartum) 2. Newborns (neonatal period) 3. Children (infancy) to adolescence) 4. Families and communities **Key Focus Areas** 1. Reproductive health 2. Maternal and infant mortality reduction 3. Child development and growth 4. Nutrition and breastfeeding 5. Immunization and infectious diseases prevention 6. Mental Health and well-being 7. Health disparities and equity **Nursing Specialties** 1. Obstetrics (OB) 2. Gynecologic (GYN) 3. Neonatal Intensive Care (NICU) 4. Pediatric intensive care (PICU) 5. Pediatric Nursing 6. Midwifery 7. Perinatal nursing A. **What is the National Health Situation on MCN in the Philippines?** The current health situation for Maternal and Child Health Nursing (MCN) in the Philippines shows a mix of progress and challenges. **Key Indicators:**. Infant Mortality Rate: 10.36 per 1,000 live births'. Maternal Mortality Rate: 64.68 per 100,000 live births. Adolescent Birth Rate: 24.36 per 1,000 females aged 15-19 years **Initiatives and Progress:**. The DOH, World Health Organization (WHO), and Korea International Cooperation Agency (KOICA) partnership has strengthened healthcare provider networks and community linkages, improving reproductive, maternal newborn, child, and adolescent health.. Laws like the **Universal Health Care Act and first 1000 Days Act** aim to enhance care for mothers and children.. Increased facility-based deliveries and skilled birth attendance have contributed to declining maternal and child mortality rates. B. **Statistics on Maternal and Child Nursing (MCN) in the Philippines:** **Maternal Health:**. Maternal Mortality Rate: 64.68 per 100,000 live births. Facility-based deliveries: 92.3% in Davao region. Antenatal care visits: 94% of women in Aklan had at least 4 visits **Child Health:**. Infant Mortality Rate: 10.36 per 1000 live births. Under-five mortality rate: available data shows improvement, but exact figures vary. **Adolescent Health:** **.** Adolescent birth rate: 24.36 per 1,000 females aged 15-19. Breastfeeding initiation: 96.9% of newborns in Agusan del Sur were breastfed immediately after birth C. **Genetics and Genetic Counseling in MCN** 1. Inheritance patterns: Autosomal dominant, autosomal recessive, X-linked, and mitochondrial. 2. Genetic disorder: Chromosomal (ex. Down syndrome), single gene (ex. Cystic fibrosis, and multifactorial (ex. Heart defects) 1. Chromosomal disorders: 2. Single-gene disorders: 3. Congenital anomalies: 4. Genetic syndromes: 1. Prenatal Screening 2. Newborn Screening 3. Carrier Screening I. **CHROMOSOMAL ABNORMALITIES:** **DOWN SYNDROME**: (DS) is a genetic disorder caused by an extra copy of chromosomes 21 (trisomy 21), characterized by intellectual disability, physical growth delays, and distinct facial features. **Etiology:** 1. Trisomy 21: extra copy of Chromosomes 21 (95% of cases) 2. Mosaicism: Mix of normal and trisomic cells (3-4% of cases) 3. Translocation: Chromosomes 21 breaks and attaches to another chromosome (1-2% of cases) 4. Genetic Mutations: rare mutations **Disease Process:** 1. Abnormal cell division during fertilization or early embryonic development 2. Extra genetic material disrupts normal development 3. Affects multiple system: neurological, cardiovascular, gastrointestinal, immune **Signs and Symptoms:** 1. Physical characteristics: Flat face, short neck, protruding tongue, small ears 2. Intellectual disability: mild to severe cognitive impairment 3. Growth delays: short stature, delayed puberty 4. Developmental delays: speech, language, motor skills 5. Health issues: Congenital heart defects, respiratory problems, vision and hearing impairment 6. Behavioral characteristics: friendly, outgoing, stubborn **Nursing management:** 1. Assessment: Physical, developmental and cognitive evaluations 2. Individualized care plans: addressing specific needs and goals 3. Supportive care: Feeding, bathing, dressing, grooming 4. Medication management: for associated medical conditions (ex. Epilepsy, hypertension) 5. Family support: Education, counseling, emotional support 6. Interdisciplinary collaboration: healthcare team, therapists, educators **Treatment:** 1. Prenatal testing: Diagnosis during pregnancy (amniocentesis) 2. Surgical interventions: correcting congenital heart defects, other anomalies 3. Medications: Managing associated medical conditions 4. Therapies: Physical, occupational, speech, behavioral 5. Early Intervention programs: developmental services for infants and toddlers 6. Inclusive education: Inclusive educational settings **Health Teachings:** 1. Genetic counseling: Understanding risks, inheritance patterns 2. Prenatal care: regular check-ups, fetal monitoring 3. Parenting strategies: Managing behavior, encouraging independence 4. Health maintenance: regular check-ups, vaccinations, dental care 5. Developmental milestones: Monitoring progress, addressing delays 6. Community resources: Support groups, advocacy organizations **Common Nursing Diagnoses:** **Physical Health** 1. Ineffective airway clearance: related to respiratory muscle weakness, excessive mucus production. 2. Impaired Gas Exchange: related cardiac anomalies, pulmonary hypertension. 3. Risk for respiratory failure: related to chronic lung disease. 4. Imbalanced Nutrition: Less than Body requirements: related to feeding difficulties, gastrointestinal anomalies. 5. Constipation: related to decreased bowel motility. **Developmental/Cognitive** 1. Delayed Development: related to intellectual instability 2. Impaired verbal communication: related to speech difficulties. 3. Impaired Social interaction: related to cognitive impairment. **Safety:** 1. Risk for injury: related to balance and coordination difficulties. 2. Risk for Falls: related to muscle weakness. **TRISOMY 13:** also known as Patau syndrome, is rare genetic disorder caused by an extra copy of chromosome 13, resulting in severe intellectual disability, physical abnormalities and life-threatening medical conditions. **Etiology:** 1. Trisomy 13: Extra copy of chromosome 13 (80% of cases) 2. Mosaicism: Mix of normal and trisomic cells (10-15% of cases) 3. Translocation: Chromosome13 breaks and attaches to another chromosome (5-10% of cases) 4. Genetic mutations: rare genetic mutations 5. Advanced Maternal age: increased risk **Disease Process:** 1. Abnormal cell division during fertilization or early embryonic development 2. Extra genetic material disrupts normal development 3. Affects multiple systems: Neurological, cardiovascular, gastrointestinal, immune **Signs and Symptoms:** 1. Severe intellectual disability 2. Physical abnormalities: microcephaly, cleft lip/palate 3. Congenital heart defects 4. Respiratory problems 5. Vision and hearing impairments 6. Seizures 7. Feeding difficulties 8. Growth delays 9. Increased risk of infection **Nursing Management**: 1. Assessment: Physical, developmental, and cognitive evaluations 2. Individualized care plans 3. Supportive care: feeding, bathing, dressing, grooming 4. Pain management: for associated medical conditions 5. Family support: Education, counseling, emotional support 6. Interdisciplinary collaboration: Healthcare team, therapists, educators **Treatment:** 1. Surgical Interventions: correcting congenital heart defects, cleft palate 2. Medications: Managing associated medical conditions (ex, Seizures, HPN) 3. Respiratory therapy: Oxygen therapy, ventilation 4. Nutritional Support: Gastrostomy tube feeding 5. Physical, occupational, and speech therapies: enhancing quality of life 6. Genetic Counseling: understanding risks, inheritance patterns **Health Teachings:** 1. Genetic counseling 2. Prenatal testing 3. Parenting Strategies: Managing care, addressing developmental delays 4. Health Maintenance: regular check-ups, vaccinations, dental care 5. End-of-life care: Palliative care, hospice services II. **INHERITED DISORDERS:** **SICKLE CELL DISEASE (SCD**): is a genetic disorder affecting hemoglobin production, causing RBC to become misshapen, rigid, and prone to breakdown. **Etiology:** 1. Genetic Mutation: Defect in HBB gene encoding beta-globulin subunit of hemoglobin. 2. Autosomal recessive inheritance: both parents must be carriers. 3. Chromosomal location: HBB gene on Chromosome 11. **Disease Process:** 1. Abnormal hemoglobin polymerization. 2. Red blood cells become sickled-shape, rigid and fragile. 3. Increased RBC destruction(hemolysis) 4. Vaso-occlussion: Sickled cell block blood vessels, reducing oxygen delivery. **Signs and Symptoms:** 1. Anemia 2. Pain Crises: sudden, severe pain in joints, back and abdomen. 3. Jaundice: yellow skin and eyes. 4. Increased risk of infections: Pneumonia, osteomyelitis 5. Delayed growth and development: Pubertal delay. 6. Organ damage: kidney, liver, heart, lung and brain. **Nursing Management:** 1. Pain management: analgesics, comfort measures. 2. Fluid therapy: hydration, electrolyte balance. 3. Oxygen therapy: Oxygen supplementation. 4. Rest and relaxation: Reducing stress. 5. Infection prevention: vaccinations, antibiotic prophylaxis. 6. Nutritional Support: folic acid, Vitamin B12 supplements. **Treatment:** 1. Blood transfusions 2. Antibiotics 3. Pain management 4. Stem cell transplantation: curative option. **Health Teaching:** 1. Disease explanation. 2. Symptoms recognition 3. Pain management 4. Hydration 5. Infection prevention 6. Follow-up care. **Nursing Diagnoses:** 1. Acute pain: related to vaso-occlusion. 2. Anxiety; related to uncertainty fear 3. Ineffective coping: related to chronic illness. 4. Impaired physical mobility; related to pain, weakness. 5. Risk for infection: related to compromised immune system 6. Deficient Fluid volume: related to dehydration. **CYSTIC FIBROSIS (CF):** is a genetic disorder affecting respiratory, digestive and reproductive systems due to abnormal mucus production. **Etiology:** 1. Genetic mutation 2. Autosomal recessive inheritance: both parents must be carriers. 3. Defect in Chromosome 7. **Disease Process** 1. Thick, sticky mucus accumulates in lungs, pancreas, and other organs. 2. Respiratory tract obstruction, inflammation and infection. 3. Pancreatic enzyme insufficiency, malabsorption, and nutritional deficiencies. **Signs and symptoms:** 1. Respiratory: recurrent coughing, wheezing, and pneumonia 2. Chest tightness, bronchitis 3. Hemoptysis 4. Gastrointestinal: Diarrhea, abdominal pain, steatorrhea (fatty stools) 5. Failure to thrive, weight loss 6. Gastrointestinal reflux **Nursing Management:** 1. Respiratory care: Chest physiotherapy, Nebulized medications (bronchodilators, mucolytic), oxygen therapy 2. Nutritional Support: pancreatic enzyme replacement, high-calorie diet, vitamin supplements, gastrostomy tube feeding 3. Infection management: antibiotics (oral, IV), vaccination (pneumococcal) 4. Emotional support 5. Family education **Health Teaching:** 1. Medication adherence: 2. Chest physiotherapy techniques 3. Nutritional guidance 4. Infection prevention: hand hygiene, avoiding close contact with infected individuals. 5. Vaccination importance 6. Regular follow-ups 7. Support system from family and counseling **Nursing Diagnoses:** **Respiratory:** 1. Ineffective Airway Clearance: related to thick, sticky mucus and bronchial secretions. 2. Impaired gas Exchange: related to Chronic lung disease, bronchiectasis. 3. Activity intolerance: related to dyspnea and fatigue. 4. Risk for Respiratory failure: related to progressive lung disease. **Nutritional:** 1. Imbalanced Nutrition Less Than Body Requirements: related to malabsorption, and pancreatic insufficiency. 2. Risk for Deficient Fluid Volume: related to dehydration, electrolyte imbalance. 3. Risk for infection: related to compromised immune system, chronic lung disease 4. Hyperthermia: related to infection, inflammation. **THALASSEMIA:** is genetic disorder affecting hemoglobin production leading to anemia, fatigue, and other complications. **Etiology:** 1. Genetic mutation. 2. Autosomal recessive inheritance: both parents must be carriers. 3. Chromosomal location: (Chromosome 16 on Chromosome 11). **Disease process:** 1. Abnormal hemoglobin production. 2. Insufficient hemoglobin leads to anemia. 3. Ineffective erythropoiesis (RBC production) 4. Increased RBC destruction(hemolysis) 5. Iron overload from frequent blood transfusion. **Signs and Symptoms:** 1. Anemia 2. Jaundice 3. Splenomegaly 4. Bone deformities: skull, facial, and spinal abnormalities. 5. Growth retardation: delayed puberty. 6. Increased risk of infections: Pneumonia, osteomyelitis. 7. Heart problems: Cardiac failure and arrhythmias. 1. Blood transfusion. Regular transfusion to maintain hemoglobin levels. 2. Pain management: analgesics for bone pain. 3. Fluid therapy: hydration, electrolyte balance. 4. Rest and relaxation: reducing stress. 5. Infection prevention: vaccinations, antibiotics prophylaxis. **Health Teaching:** 1. Disease explanation 2. Transfusion schedule: adherence to transfusion regimen. 3. Iron chelation therapy: adherence to medication. 4. Dietary counseling: Avoiding iron rich foods. 5. Infection prevention: hand hygiene, vaccination. 6. Regular follow-ups: Monitoring hemoglobin levels. **Nursing Diagnosis:** 1. Anemia: related to ineffective erythropoiesis. 2. Activity intolerance: related to fatigue. 3. Pain: related to bone deformities. 4. Risk for infection: related to compromised immune system. 5. Deficient fluid volume: related to dehydration. 6. Impaired Physical Mobility: related to bone deformities. III. **CONGENITAL ANOMALIES:** I. **HEART DEFECTS**: are congenital heart defects (CHDs) that are structural or functional abnormalities of the heart present at birth. 1. **Ventricular Septal Defect (VSD):** is a congenital heart defect characterized by an opening in the septum separating the right and left ventricles. ***Etiology:*** 1. Environmental factors: Maternal diabetes, rubella infection. 2. Family history: increased risk if parents or siblings have VSD. 3. Chromosomal abnormalities: Turner syndrome **Disease Process:** 1. Abnormal fetal development during embryogenesis. 2. Failure of septal closure between ventricles. 3. Left-to-right shunting: oxygenated blood flows from left ventricle to right ventricle. 4. Increased pulmonary blood flow, potential for pulmonary hypertension. **Signs and Symptoms:** 1. Cyanosis: bluish discoloration of skin and mucous membranes. 2. Shortness of breath: respiratory distress. 3. Fatigue: decreased energy 4. Failure to thrive: Poor weight gain. 5. Feeding difficulties: Difficulty feeding. 6. Sweating: Excessive sweating. 7. Palpitations: irregular heartbeats. 8. Recurrent respiratory infections. **Nursing Management:** 1. Oxygen Therapy: Oxygen supplementation. 2. Cardiac monitoring: Continuous ECG monitoring 3. Medications Management: Diuretics, vasodilators. 4. Fluid management: Balancing fluid intake 5. Nutritional support: High-calorie diet, 6. Infection prevention: vaccinations, antibiotic prophylaxis. 1. Surgical repair: Closure of VSD (patch or direct closure) 2. Catheter-based interventions: Device closure 3. Heart transplantation: Replacement of the heart (in severe cases). **Health Teaching:** 1. Disease explanation: understanding VSD. 2. Medication adherence: importance of medication regimen. 3. Follow-up care: regular heart checks. 4. Infection prevention: hand hygiene, vaccination. 5. Nutritional counseling: balanced diet. 6. Activity restrictions: avoiding strenuous activities. **Nursing Diagnoses:** 1.Decreased cardiac output: related to VSD. 2\. Impaired gas exchange: related to respiratory distress. 3\. Activity intolerance: related to fatigue. 4\. Anxiety: related to uncertainty. 5\. Risk for infection: related to compromised immune system. 2. **Atrial Septal Defect (ASD):** is a congenital heart defect characterized by an opening in the septum separating the right and left atria. **Etiology:** 1. Genetic mutations: Chromosomal abnormalities (ex. Down syndrome). 2. Environmental factors: Maternal diabetes, rubella infection. 3. Family history: Increased risk if parents or siblings have ASD. 4. Chromosomal abnormalities: Turner syndrome **Disease Process:** 1. Abnormal fetal development during embryogenesis, 2. Failure of septal closure between atria. 3. Left-to-right shunting: oxygenated blood flows from left atrium to right atrium. 4. Increased pulmonary blood flow, potential for pulmonary hypertension. **Signs and Symptoms** 1. Cyanosis: 2. Shortness of breath\` 3. Fatigue 4. Failure to thrive: poor weight gain 5. Feeding difficulties 6. Sweating 7. Palpitations: irregular heartbeats 8. Recurrent respiratory infections **Nursing Management:** 1. Oxygen therapy 2. Cardiac monitoring: Continuous ECG monitoring. 3. Medication management: diuretics, vasodilators. 4. Fluid management: balancing fluid intake. 5. Nutritional support: high-calorie diet. 6. Infection prevention: vaccinations, antibiotic prophylaxis. **Treatment:** 1. Surgical repair: Closure of ASD (patch or direct closure) 2. Catheter-based intervention: 3. Heart transplantation: replacement of the heart (in severe cases). **Health Teaching:** 1. Disease explanation: understanding ASD. 2. Medication adherence: importance of medication regimen. 3. Follow-up care: regular health checks. 4. Infection prevention: Hand hygiene, vaccination. 5. Nutritional counseling: balanced diet: 6. Activity restrictions: avoiding strenuous activities. **Nursing Diagnoses:** 1. Decreased cardiac output: related to ASD. 2. Impaired gas exchange: related to respiratory distress. 3. Activity intolerance: related to fatigue. 4. Anxiety: related to uncertainty. 5. Risk for infection: related to compromised immune system. 3. **TETRALOGY OF FALLOT (TOF):** is a congenital heart defect characterized by four main anomalies: Ventricular septal defect (VSD), Pulmonary stenosis, Right Ventricular hypertrophy, and overriding of the aorta. **Etiology:** 1. Genetic mutations: Chromosomal abnormalities (Down syndrome) 2. Environmental factors: Maternal diabetes, rubella infection. 3. Family history: Increased risk if parents or siblings have TOF. 4. Chromosomal abnormalities: Deletion of Chromosomes 22q11. **Disease Process:** 1. Abnormal fetal development during embryogenesis. 2. Four characteristics anomalies: 3. Right-to-left shunting: deoxygenated blood flows from right ventricle to left ventricle. 4. Decreased pulmonary blood flow, potential for cyanosis. **Signs and Symptoms:** 1. Cyanosis: bluish discoloration of skin and mucous membrane. 2. Shortness of breath. 3. Fatigue 4. Failure to Thrive 5. Feeding difficulties 6. Sweating 7. Palpitations 8. Recurrent respiratory infections 9. Clubbing: enlarged fingertips 10. Polycythemia: increased RBC **Nursing Management:** 1. Oxygen therapy 2. Cardiac monitoring 3. Medication management 4. Fluid replacement: balance fluid intake 5. Nutritional support 6. Infection prevention 7. Comfort measures: pain management, relaxation techniques. **Treatment:** 1. Surgical repair: complete repair (Closure of VSD) 2. Heart transplantation: replacement of the heart (in severe cases) **Nursing diagnoses:** 1. Decreased cardiac output: related to TOF 2. Impaired gas exchange: related to respiratory distress 3. Activity intolerance: related to fatigue 4. Anxiety 5. Risk for infection: related to compromised immune system 6. Deficient fluid volume: related to dehydration 4.**TRANSPOSITION OF THE GREAT ARTERIES (TGA**)- is a congenital heart defect where the two main arteries carrying blood away from the heart are reversed. The aorta arises from the right ventricle, and the pulmonary artery arises from the left ventricle. **Etiology:** 1. Genetic mutations. (Down syndrome) 2. Environmental factors (maternal diabetes, rubella infection). 3. Family history 4. Chromosomal abnormalities: deletion of chromosome 22q11. **Disease Process:** 1. Reversal of the great arteries during fetal development. 2. Oxygenated blood from the lungs returns to the left ventricle, then flows back to the lungs. 3. Deoxygenated blood from the body returns to the right ventricle then flows to the aorta and systemic circulation. 4. Severe cyanosis: Inadequate oxygenation of blood. **Signs and Symptoms:** 1. Severe cyanosis 2. Respiratory distress: shortness of breath 3. Fatigue 4. Failure to thrive 5. Feeding difficulties 6. Sweating 7. Palpitations 8. Clubbing: enlarged fingers **Nursing Management:** 1. Oxygen therapy 2. Cardiac monitoring 3. Medication management 4. Fluid management 5. Nutritional support 6. Infection prevention 7. Comfort measures **Treatment:** 1. Arterial switch operation: Surgical correction (reversing the great arteries). 2. Rastelli procedure: creating a tunnel between the left ventricle and aorta. 3. Heart transplantation. **Health Teaching:** 1. Disease explanation. 2. Medication adherence. 3. Follow-up care. 4. Infection prevention. 5. Nutritional counseling 6. Activity restrictions **Nursing Diagnoses:** 1. Decreased cardiac output: related to TGA 2. Impaired gas exchange: related to respiratory distress. 3. Activity intolerance: related to fatigue. 4. Anxiety: related to uncertainty. 5. Risks to infection: related to compromised immune system. 6. Deficient fluid volume: related to dehydration. 5. **PATENT DUCTUS ARTERIOSUS (PDA):** is a congenital heart defect where the ductus arteriosus, a fetal blood vessel connecting the aorta and pulmonary artery, fails to close at birth. **Etiology:** 1. Genetic mutations: (down syndrome) 2. Environmental factors. 3. Family history: increased risk if parents or siblings have PDA. 4. Premature birth: increased risk in preterm infant. 5. Chromosomal abnormalities: deletion of Chromosome 22q11. **Disease Process:** 1. Failure of ductus arteriosus closure after birth. 2. Left-to-right shunting: Oxygenated blood from the aorta flows into pulmonary artery. 3. Increased pulmonary blood flow, potential for pulmonary hypertension. 4. Overload on left heart, potential for cardiac failure. **Signs and Symptoms:** 1. Cyanosis 2. Respiratory distress 3. Fatigue 4. Failure to Thrive 5. Feeding difficulties 6. Sweating 7. Palpitations 8. Recurrent respiratory infections 9. Bounding pulse: strong, forceful pulses. **Nursing management:** 1. Oxygen therapy 2. Cardiac monitoring 3. Medication Management: diuretics, vasodilators 4. Fluid management 5. Nutritional support 6. Infection prevention 7. Comfort measures: pain management, relaxation techniques **Treatment:** 1. Surgical ligation: Surgical closure of PDA 2. Pharmacological closure: Indomethacin or Ibuprofen therapy **Health Teaching:** 1. Disease explanation 2. Medication adherence 3. Follow-up care 4. Infection prevention 5. Nutritional counseling 6. Activity restrictions **Nursing Diagnoses:** 1. Decreased cardiac output: related to PDA. 2. Impaired gas exchange: related to respiratory distress. 3. Activity intolerance: related to fatigue 4. Anxiety: related to uncertainty 5. Risk for infection: related to compromised immune system. 6. Deficient fluid volume: related to dehydration. **Etiology:** 1. Genetic mutations: Chromosomal abnormalities (ex. Turner syndrome) 2. Environmental factors 3. Family history: increased risk if parents of siblings have coarctation. 4. Chromosomal abnormalities: deletion of chromosome 22q11. **Disease Process:** 1. Narrowing of the aortic isthmus during fetal development. 2. Obstruction of blood flow from the aorta to the lower body. 3. Increased blood pressure above the coarctation. 4. Decreased blood pressure below the coarctation. 5. Potential for cardiac failure, hypertension, and stroke. **Signs and Symptoms:** 1. Hypertension: 2. Weak or delayed pulses: in lower extremities. 3. Shortness of breath: 4. Fatigue 5. Headaches: due to hypertension. 6. Dizziness: Lightheadedness. 7. Cold extremities: decreased blood flow. **Nursing Management:** 1. Blood pressure monitoring 2. Cardiac monitoring 3. Medication management: antihypertensive, beta-blockers. 4. Fluid management 5. Nutritional support 6. Infection prevention 7. Comfort measures **Treatment:** 1. Surgical repair: Resection of coarctation with end-to-end anastomosis. 2. Stent replacement: maintaining patency. 3. Bypass grafting: Creating alternative blood flow pathway. **Nursing Diagnoses:** 1. Decreased cardiac output: related to coarctation. 2. Hypertension: related to increased blood pressure. 3. Activity intolerance: related to fatigue 4. Anxiety 5. Risk for infection: related to compromised immune system. 6. Deficient fluid volume: related to dehydration. **Other Chromosomal Abnormalities:** **TURNER SYNDROME (TS):** is genetic disorder affecting females, characterized by the absence or abnormality of one X chromosome (45, X or 45, X46, XX mosaicism). **Etiology:** 1. Monosomy X: Loss of one X chromosome. (45, X). 2. Mosaicism: Mix of 45, X and 46, XX cells. 3. X chromosome deletion: Partial or complete deletion of X chromosome. 4. Family history: Increased risk if family members have TS. 5. Advanced Maternal age: Increased risk. **Disease Process:** 1. Abnormal X chromosome formation during meiosis. 2. Hormonal imbalances: Estrogen deficiency. 3. Growth and development delays. 4. Reproductive system abnormalities. **Signs and Symptoms:** 1. Short stature: Growth hormone deficiency. 2. Delayed puberty: Hormonal imbalances. 3. Infertility: Ovarian dysgenesis. 4. Heart defect: Coarctation of the aorta. 5. Kidney abnormalities: Horseshoe kidney. 6. Hearing and vision problems: Strabismus 7. Cognitive impairment: Learning disabilities. 1. Growth hormone therapy monitoring. 2. Hormone replacement therapy. 3. Cardiac monitoring. 4. Blood pressure monitoring 5. Infection prevention. 6. Nutritional support **Treatment:** 1. Growth hormone therapy: stimulate growth. 2. Hormone replacement therapy: Estrogen replacement. 3. Surgery: correcting heart defects, reproductive system abnormalities. 4. Speech and language therapy: communication skills development. 5. Physical therapy: motor skills development. 6. Psychological counseling; coping strategies. **Nursing Diagnoses:** 1. Disturbed body image: related to physical characteristics. 2. Delayed growth and development: related to hormonal imabalance. 3. Anxiety 4. Deficient knowledge: related to disease understanding. 5. Impaired social interaction: related cognitive impairment. 6. Risk for infection: related to compromised immune system. **NEURAL TUBE DEFECTS (NTDs):** are congenital anomalies resulting from incomplete closure of the neural tube during embryogenesis, leading to defects un the brain, spine, or spinal cord. **Etiology:** 1. Genetic mutations: (ex. Trisomy 13). 2. Environmental factors: maternal diabetes, rubella infection, exposure to toxins. 3. Nutritional deficiencies: folic acid deficiency 4. Family history: increased risk in family members have NTDs. 5. Advance Maternal age: increased risk. **Disease Process:** 1. Failure of neural tube closure during embryogenesis (22-28 days post conception). 2. Abnormalities in brain, spine, or spinal cord development. 3. Potential for hydrocephalus, and spinal cord damage. **Types OF NTDs:** 1. Spina Bifida: incomplete closure of spinal cord and vertebrae. 2. Meningocele: Protrusion of meninges through the spinal defect. 3. Myelomeningoecele: Protrusion of spinal cord and meninges. 4. Encephalocele: protrusion of brain tissue through skull defect. 5. Anencephaly: absence of brain and skull development. **Signs and Symptoms:** 1. Visible defects: Spinal or cranial abnormalities. 2. Motor dysfunction: Weakness, paralysis. 3. Sensory deficits: Numbness, loss of sensation. 4. Bladder and bowel dysfunction: Incontinence. 5. Hydrocephalus: Increased intracranial pressure. 6. Seizures: due to brain abnormalities. 7. Developmental delays: Cognitive and motor impairment. **Nursing Management:** 1. Neurosurgical evaluation. 2. Wound care: Protecting exposed neural tissue. 3. Infection prevention: antibiotic prophylaxis. 4. Pain management 5. Bladder and bowel management: catheterization, bowel training. 6. Physical therapy: Maintaining mobility. 7. Occupational therapy: promoting independence. **Treatment:** 1. Surgical repair: closure of defect. 2. Rehabilitation therapy: Physical, occupational, speech. 3. Medication management: Seizure control, pain management. **Health Teaching:** 1. Disease explanation. 2. Wound care 3. Infection prevention. 4. Bladder and bowel management 5. Medication adherence. 6. Follow-up care. **Nursing Diagnoses:** 1. Impaired physical Mobility: related to motor dysfunction. 2. Deficient knowledge: related to disease understanding. 3. Anxiety 4. Risk for infection: related to compromised immune system. 5. Impaired urinary elimination: related to bladder dysfunction. 6. Impaired skin integrity: related to wound complications. **CLEFT LIP (CL) and CLEFT PALATE (CP):** are congenital anomalies characterized by abnormal development of the upper lip and palate, **Etiology:** 1. Genetic mutations: Chromosomal abnormalities. 2. Environmental factors: Maternal smoking, alcohol consumption, and exposure to toxins, 3. Nutritional deficiencies: Folic acid deficiency. 4. Family history: Increased risk if family members have Cleft lip/cleft palate. 5. Advance maternal age: increased risk. **Disease Process:** 1. Abnormal fusion of facial structures during embryogenesis (6-12 weeks' gestation). 2. Clefting of the lip, palate, or both. 3. Potential for feeding difficulties, speech impairment, and hearing loss. **Signs and Symptoms:** 1. Visible clefting 2. Feeding difficulties 3. Speech impairment 4. Hearing loss 5. Dental abnormalities 6. Nasal regurgitation. **Nursing Management:** 1. Initial assessment: evaluate airway, breathing, and feeding. 2. Feeding support: specialized bottles, nipples, and feeding techniques. 3. Infection prevention: antibiotic prophylaxis. 4. Pain management 5. Parental support: emotional and educational support. **Treatment:** 1. Surgical repair: Cleft lip (3-6 months), palate (6-12 months). 2. Orthodontic management: dental alignment. 3. Speech therapy 4. Hearing aids 5. Dental restoration. **Health Teaching:** 1. Disease explanation. 2. Feeding techniques. 3. Infection prevention. 4. Follow-up care 5. Speech and hearing development monitoring. **Nursing Diagnoses:** 1. Impaired oral membranes: related to clefting. 2. Deficient knowledge: related to disease understanding. 3. Anxiety 4. Impaired verbal communication: related to speech impairment. 5. Risk for infection: related to compromised immune system. 6. Imbalanced Nutrition: related to feeding difficulties. **Problems in Reproduction and Sexuality of Male and Female Clients:** 1. **Male Reproductive and Sexual Health Issues:** 1. **ERECTILE DYSFUNCTION (ED):** is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. **Etiology:** 1. Vascular diseases: Atherosclerosis, hypertension, diabetes. 2. Neurological disorders: Parkinson's disease, multiple sclerosis, spinal cord injury. 3. Hormonal imbalances: Low testosterone, thyroid disorders. 4. Psychological factors: Anxiety, depression, stress. 5. Medications: Antidepressants, antihypertensive, sedatives. 6. Lifestyle factors: smoking, alcohol consumption, obesity. **Disease Process:** 1. Reduced blood flow to the penis. 2. Smooth muscle relaxation. 3. Decreased erectile tissue responsiveness. **Signs and Symptoms:** 1. Inability to achieve erection: 2. Reduced erectile rigidity: Soft or partial erection. 3. Decreased libido: low sexual desire. 4. Premature ejaculation: Uncontrolled ejaculation. 5. Performance anxiety: fear of failure. **Nursing Management:** 1. Assessment: Medical history, Physical examination, Laboratory test. 2. Education: disease explanation, treatment options. 3. Counseling: addressing psychological factor. 4. Lifestyle modifications: quit smoking, exercise, weight management. 5. Medication management. Phosphodiesterase inhibitors (ex. Sildenafil). **Treatment:** 1. Phosphodiesterase inhibitors: Sildenafil, tadalafil, vardenafil. 2. Vacuum erection devices: Mechanical devices. 3. Penile implants: surgical implantation. 4. Couples therapy: Addressing relationships dynamics. **Health Teaching:** 1. Disease understanding 2. Treatment options: Medications, lifestyle modifications. 3. Stress management: relaxation techniques. 4. Communication: open communication with partner, 5. Follow-up care. **Nursing Diagnoses:** 1. Impaired sexual dysfunction: related to ED. 2. Anxiety: related to performance anxiety. 3. Deficient knowledge: related to disease understanding. 4. Disturbed body image: related to ED. 5. Impaired relationship: related to partner dynamics. **PREMATURE EJACULATION (PE):** is involuntary ejaculation within 1-2 minutes of vaginal penetration, causing distress and impacting quality of life. **Etiology:** 1. Psychological factors: anxiety, stress, depression. 2. Neurological disorders: multiple sclerosis, spinal cord injury. 3. Hormonal imbalances: low serotonin, thyroid disorders. 4. Urological conditions: Prostatitis, Urethritis. 5. Medications: antidepressants, blood pressure medications. 6. Lifestyle factors: smoking, alcohol consumption. 1. Overactive sympathetic nervous system. 2. Increased serotonin reuptake. 3. Reduced ejaculatory threshold. 4. Impaired pelvic floor muscle control. **Signs and Symptoms:** 1. Involuntary ejaculation: 2. Rapid ejaculation. 3. Lack of control. 4. Distress: emotional distress, anxiety. 5. Relationships problems: Partner dissatisfaction. **Nursing Management:** 1. Assessment 2. Education: treatment option. 3. Counseling 4. Relaxation techniques: deep breathing, progressive muscle relaxation. **Treatment:** 1. Selective serotonin reuptake inhibitors: Fluoxetine, sertraline 2. Phosphodiesterase inhibitors. 3. Couples therapy. **Health Teaching:** 1. Disease understanding. 2. Treatment options: Medications 3. Relaxation techniques 4. Communication: open discussion with partner. 5. Follow-up care. **Nursing Diagnoses:** 1. Impaired Sexual function: related to PE. 2. Anxiety: related to performance anxiety, 3. Deficient knowledge. 4. Disturbed body image: related to PE. 5. Impaired relationship: related to partner dynamics. **PROSTATE CANCER:** is a malignant tumor that develops in the prostate gland, affecting men primarily over 50 years old. **Etiology:** 1. Genetic mutation: BRCA1/2, TP53, and androgen receptor genes. 2. Age: Risk increases after 50 years. 3. Family History: first-degree relatives with prostate cancer. 4. Ethnicity: higher risk in African American men. 5. Diet: High-fat, low vitamin D. 6. Obesity: Increased risk. 7. Environmental factors: Exposure to pesticides, radiation. **Disease Process:** 1. Uncontrolled cell growth in the prostate gland. 2. Tumor development and potential metastasis. 3. Compression of the urethra, bladder, and rectum. 4. Disruption of urinary gland and reproductive functions. **Signs and Symptoms:** 1. Urinary frequency: increased urination. 2. Urinary urgency: sudden need to urinate. 3. Weak or interrupted urine flow: difficulty starting or stopping urination. 4. Painful urination: dysuria 5. Painful ejaculation: discomfort during orgasm. 6. Blood in the urine or semen: hematuria or hematospermia. 7. Pelvic pain: pain in the lower back, hips, or pelvis. **Nursing Management:** 1. Assessment 2. Education 3. Supportive care: pain management, urinary catheterization. 4. Nutritional support: balanced diet, hydration. 5. Psychological support: counseling, stress management. **Treatment:** 1. Active surveillance: monitoring tumor growth. 2. Surgery: Radical prostatectomy. 3. Radiation therapy: 4. Hormone therapy: androgen deprivation therapy; 5. Chemotherapy: combination therapy. 6. Immunotherapy: Vaccines, checkpoint inhibitors. **Nursing Diagnoses:** 1. Anxiety: related to diagnosis and treatment uncertainty. 2. Fear: related to potential outcomes. 3. Impaired Urinary elimination: related to urinary symptoms. 4. Pain: related to prostate cancer and treatment. 5. Deficient Knowledge: related to disease understanding. 6. Disturbed Body Image: related to surgery or treatment. **HYDROCELE:** is an accumulation of serous fluid in the tunica vaginalis, surrounding the testicle. **Etiology:** 1. Idiopathic: most common, unknown reason. 2. Trauma: injury to the testicle or scrotum. 3. Infection: Epididymis, orchitis. 4. Tumor: testicular cancer. 5. Congenital: patent processus vaginalis. 6. Surgery: complication of inguinal hernia repair. 7. Age: more common in men over 40. **Disease Process:** 1. Fluid accumulation in the tunica vaginalis. 2. Compression of the testicle and surrounding tissues. 3. Potential for testicular atrophy. **Signs and Symptoms:** 1. Scrotal swelling 2. Testicular heaviness: feeling of weight. 3. Discomfort: mild pain or pressure. 4. Gurgling of fluid wave: palpable fluid movement. **Nursing Management:** 1. Assessment: Medical history, physical examination. 2. Pain management: analgesics, scrotal support. 3. Scrotal elevation: Reducing swelling. 4. Monitoring: Watching for signs of infection. 5. Surgical preparation: preparing for potential surgery. **Treatment**: 1. Watchful waiting: monitor for complications. 2. Needle aspiration: temporarily relieving fluid buildup. 3. Hydrocylectomy: surgical removal of the hydrocele. 4. Lord's procedure: plication of the tunica vaginalis. **Health Teaching:** 1. Disease understanding. 2. Symptom management: scrotal support, pain relief. 3. Follow-up care 4. Testicular self-examination: monthly self-checks. 5. Surgical preparation: preoperative instructions. **Nursing Diagnoses:** 1. Acute pain: related to scrotal swelling. 2. Anxiety 3. Deficient knowledge 4. Impaired Physical Mobility: related to scrotal discomfort. 5. Risk for infection: related to surgical intervention. 2. **FEMALE REPRODUCTIVE DISORDERS:** **DYSMENORRHEA:** is painful menstrual cramps in the lower abdomen, occurring during or before menstruation. **Etiology:** 1. Hormonal Imbalance: Prostaglandins, estrogen, and progesterone fluctuations. 2. Uterine Contractions: Increased uterine tone and contractions. 3. Pelvic Inflammatory Disease (PID): infection of the reproductive organs. 4. Endometriosis: Growth of endometrial tissue outside the uterus. 5. Adenomyosis: Growth of endometrial tissue into the uterine wall. 6. Uterine anomalies: Septate or bicornuate uterus. 7. Family History: Genetic predisposition. 8. Nutritional factors: Low calcium, magnesium, and vitamin B6. **Disease Process:** 1. Prostaglandin release stimulates uterine contraction. 2. Uterine ischemia and pain. 3. Increased prostaglandin production exacerbate pain. **Signs and Symptoms:** 1. Pelvic pain: Cramping, sharp, or dull pain. 2. Lower back pain: radiating pain. 3. Abdominal cramps: menstrual cramps. 4. Nausea and vomiting 5. Diarrhea and constipation. 6. Headache 7. Fatigue. 8. Mood swings **Nursing Management:** 1. Pain assessment: Evaluate pain intensity and duration. 2. Pain Management: NSAIDs, acetaminophen. 3. Heat therapy: warm compresses. 4. Relaxation techniques: deep breathing, progressive muscle relaxation. 5. Dietary Modifications: Increase calcium, magnesium, and vitamin B6. 6. Hydration: Encourage fluid intake. 7. Rest: encourage relaxation. **Health Teaching:** 1. Disease understanding 2. Pain management 3. Lifestyle modifications: exercise, stress reduction. 4. Nutritional guidance: balanced diet. 5. Menstrual tracking: Monitoring symptoms. **Nursing Diagnoses:** 1. Acute Pain: related to menstrual cramps. 2. Anxiety: related to pain uncertainty. 3. Deficient knowledge: related to disease understanding 4. Impaired Physical Mobility: related to pain. 5. Disturbed body image: related to menstrual symptoms. **AMENORRHEA:** is the absence or cessation of menstrual periods, categorized into: 1. Primary amenorrhea: No menarche (first menstrual period) by age 16. 2. Secondary amenorrhea: Absence of menstruation for 3-6 months in women with previous regular periods. **Etiology:** 1. Hormonal Imbalances: Hypothalamic, pituitary, thyroid, or ovarian disorders. 2. Genetic disorders: Turner syndrome. 3. Anatomical abnormalities: Uterine or vaginal agenesis. 4. Systemic disease: Diabetes, Thyroid disorders. 5. Medications: Hormonal contraceptives, antidepressants. 6. Lifestyle factors: Stress, weight changes. 7. Nutritional Deficiencies: low body mass index (BMI). 8. Pregnancy and breastfeeding. **Disease Process:** 1. Disrupted hypothalamic-pituitary- ovarian axis. 2. Reduced gonadotrophin-releasing hormone secretion. 3. Decreased estrogen and progesterone production. 4. Uterine lining atony. **Signs and Symptoms:** 1. Absence of menstruation. 2. Infertility. 3. Weight changes. 4. Hirsutism (excessive hair growth) 5. Acne 6. Breast changes (reduced size or tenderness) 7. Vaginal dryness. 8. Mood swings. **Nursing Management:** 1. Assessment 2. Hormone replacement therapy (HRT): estrogen and progesterone. 3. Fertility medications: Clomiphene citrate. 4. Stress management, Relaxation techniques. 5. Nutritional Counseling: balanced diet. 6. Exercise guidance: Regular physical activity. 7. Psychological support: counseling **Health Teaching:** 1. Disease understanding: Amenorrhea explanation. 2. Hormone therapy: Medication management. 3. Fertility options: Pregnancy planning. 4. Menstrual tracking: monitoring symptoms. 5. Healthy lifestyle: balanced diet, exercise. **Nursing Diagnoses:** 1. Deficient knowledge: related to disease understanding. 2. Anxiety: 3. Disturbed body image: related to hormonal changes. 4. Impaired fertility: related to hormonal imbalance. 5. Risk for complications; related to untreated amenorrhea. **POLYCYSTIC OVARY SYNDROME (PCOS):** is a hormonal disorder characterized by ovulation dysfunction, polycystic ovaries and hyperandrogenism. **Etiology:** 1. Genetic predisposition: Family history. 2. Hormonal imbalance: Insulin resistance, androgen excess. 3. Environmental factors: Obesity, stress. 4. Insulin resistance: Leading to hyperinsulinemia. 5. Abnormal fetal development: Prenatal exposure to androgens. **Disease Process:** 1. Insulin resistance -- Hyperinsulinemia. 2. Hyperinsulinemia -- Androgen production. 3. Androgen excess -- Ovulation dysfunction. 4. Ovulation dysfunction -- Irregular menstrual cycle. 5. Hyperandrogenism -- Clinical symptoms. **Signs and Symptoms:** 1. Irregular menstrual cycle: Oligomenorrhea or amenorrhea. 2. Weight gain: Obesity. 3. Hirsutism: Excessive hair growth. 4. Acne: Pimples, oily skin. 5. Male pattern baldness: Androgenetic alopecia. 6. Cysts on ovaries: Polycystic ovaries. 7. Infertility: Anovulation. 8. Mood swings: Anxiety, depression. **Nursing Management:** 1. Assessment. 2. Hormonal regulation: Birth control pills. 3. Insulin-sensitizing medications: Metformin. 4. Weight management: Diet, exercise. 5. Stress management: relaxation techniques. 6. Skin care: acne treatment. **Health Teaching:** 1. Disease understanding. 2. Hormone management 3. Lifestyle modifications: Diet, exercise, stress reduction. 4. Fertility options: Pregnancy planning. 5. Menstrual tracking: monitoring symptoms. **Nursing Diagnoses:** 1. Deficient knowledge: related to disease understanding. 2. Anxiety: related to uncertainty. 3. Disturbed body image: related to physical changes. 4. Impaired infertility: related to anovulation. 5. Risk for complications: related to untreated PCOS. **ENDOMETRIOSIS:** is a chronic, estrogen dependent inflammatory condition characterized by the growth of endometrial tissue outside the uterus, leading to pain, infertility, and other symptoms. **Etiology:** 1. Coelomic metaplasia: Transformation of peritoneal cells into endometrial cells. 2. Retrograde menstruation: Menstrual blood flowing back through the fallopian tubes. 3. Genetic predisposition: Family history. 4. Hormonal imbalance: estrogen dominance. 5. Environmental factors: exposure to toxins, stress. 6. Immunological factors: Abnormal immune system. **Disease Process:** 1. Endometrial tissue implantation outside the uterus. 2. Hormonal stimulation- proliferation and inflammation. 3. Scarring, adhesions, and fibrosis. 4. Chronic pain and infertility. **Signs and Symptoms:** 1. Pelvic pain: cramping, sharp, or dull pain. 2. Dysmenorrhea: Painful urination. 3. Heavy or irregular bleeding: Menorrhagia or menorrhagia. 4. Infertility: difficulty conceiving. 5. Painful intercourse: Dyspareunia. 6. Bowel or urinary symptoms: constipation, diarrhea, or dysuria. **Nursing Management:** 1. Pain assessment: Evaluate pain intensity and duration. 2. Pain management: NSAIDS, opioids. 3. Hormonal therapies: Birth control pills. 4. Surgical interventions: Laparoscopic surgery or hysterectomy. 5. Supportive care: Emotional support, counseling. **Health Teaching:** 1. Disease understanding. 2. Pain management. 3. Hormonal therapies. 4. Lifestyle modifications 5. Fertility options: Pregnancy planning. **Nursing Diagnoses:** 1. Acute pain: related to endometrial implants. 2. Chronic pain: related to inflammation and scarring. 3. Anxiety. 4. Deficient knowledge 5. Impaired fertility: related to endometrial implants. 6. Disturbed body image: related to physical changes. **SEXUALLY TRANSMITTED INFECTIONS (STIs) IN FEMALES:** The following are the Sexually Transmitted Infections in females: I. **Bacterial STIs** 1. **Chlamydia:** 2. **Gonorrhea:** 3.**Syphilis:** II. **Viral STIs** 1. **Human Papillomavirus (HPV)** 2. **Herpes Simplex Virus (HSV)** 3. **HIV/AIDS** III. **Parasitic STIs** 1. Assessment 2. Pharmacologic interventions: antibiotics. 3. Pain management: Analgesics, comfort measures. 4. Supportive care: Emotional support, counseling. 5. Health Education: Safe sex practices, STI prevention. 1. Anxiety: related to STI diagnosis. 2. Deficient knowledge: related to STI transmission. 3. Impaired Sexual Function: related to STI symptoms. 4. Disturbed body image: related to physical changes. **MENOPAUSE:** is the natural cessation of menstruation, occurring typically between ages 45-55, making the end of reproductive capability. **Etiology:** 1. Natural aging: Decline in ovarian function. 2. Premature ovarian failure: Early menopause (Less than 40 years). 3. Surgical menopause: Hysterectomy or oophorectomy. 4. Chemotherapy: Ovarian damage. 5. Genetic disorders. **Disease Process:** 1. Decreased estrogen production. 2. Follicular depletion. 3. Hormonal imbalance. 4. Ovarian atrophy. **Signs and Symptoms:** 1. Hot flashes: Sudden sweating, flushing. 2. Night sweats: Norturnal hot flashes. 3. Vaginal dryness: Dyspareunia. 4. Mood changes: Anxiety, depression. 5. Sleep disturbances: Insomia. 6. Thinning hair: alopecia. 7. Decreased libido: Reduced sexual desire. **Nursing management:** 1. Hormonal replacement therapy (HRT): Estrogen, progesterone. 2. Non-hormonal medications: Selective estrogen receptor modulators (SERMs). 3. Vaginal lubricants: Moisturizers. 4. Pain management: Analgesics. 5. Stress management: Relaxation techniques. 6. Sleep hygiene: establishing routine. 7. Nutritional Counseling: balanced diet. 8. Exercise guidance: regular physical activity. **Health Teaching:** 1. Menopause explanation: 2. HRT management. 3. Lifestyle modifications. 4. Vaginal health: Hygiene, lubricants. 5. Osteoporosis prevention: calcium, Vitamin D. 6. Cardiovascular health: risk factor management. **Nursing Diagnoses:** 1. Anxiety: related to menopausal symptoms. 2. Deficient knowledge: related to menopause management. 3. Disturbed body image: related to physical changes. 4. Impaired sexual function: related to vaginal dryness. 5. Risk for osteoporosis: related to hormonal changes. **TYPES OF FEMALE SEXUAL DYSFUNCTIONS:** 1. Hypoactive Sexual Desire Disorder (HSDD): Low libido. 2. Female Sexual Arousal Disorder (FSAD): difficulty achieving arousal. 3. Female Orgasmic Disorder (FOD). 4. Dyspareunia: Painful intercourse. 5. Vaginismus: Involuntary vaginal muscle contraction. **Etiology:** 1. Hormonal Imbalance: (estrogen and progesterone). 2. Psychological factors: Anxiety, depression, trauma. 3. Relationship Issues: Communication problems, partner conflict. 4. Medical conditions: Diabetes, hypertension, Thyroid disorders. 5. Medications: Antidepressants, antihypertensive. 6. Trauma: Sexual abuse, pelvic surgery. **Disease Process:** 1. Neurotransmitter imbalance (dopamine, serotonin) 2. Hormonal dysregulation. 3. Vascular and smooth muscle dysfunction. 4. Pelvic floor muscle tension. **Signs and Symptoms:** 1. Low libido. 2. Difficulty in achieving arousal. 3. Painful intercourse: dyspareunia. 4. Inability to achieve orgasm: Anorgasmia. 5. Vaginal tightness: Vaginismus. 6. Avoidance of sexual activity: Fear or anxiety. **Nursing Management:** 1. Assessment. 2. Counseling: Individual or couples therapy. 3. Education: sexual health, anatomy, and physiology. 4. Hormonal replacement therapy (HRT): estrogen and progesterone. 5. Pharmacological interventions: Sildenafil, tadalafil. 6. Pain management: Analgesics, topical analgesics. **Treatment:** 1. Cognitive-behavioral therapy (CBT): Addressing behavioral thoughts. 2. Sensate focus therapy: Enhancing therapy. 3. Hormonal therapies: Estrogen, testosterone replacement. 4. Topical treatments: Lubricants, vaginal moisturizers. **Health Teaching:** 1. Sexual health education: 2. Communication skills: Expressing desires and needs. 3. Intimacy enhancement: Sensate focus exercise. 4. Stress Management 5. Healthy lifestyle: balanced diet, exercise. **Nursing Diagnoses:** 1. Sexual dysfunction: related to hormonal imbalance. 2. Anxiety: related to sexual performance. 3. Deficient knowledge: related to sexual health. 4. Disturbed body image: related to physical changes. 5. Impaired relationship: related to communication problems. II. **CARE OF AT-RISK MOTHER AND CHILD:** A. **Nursing Care of the Pregnant Client:** 1. Initial Assessment: Medical History, PE, and Lab Tests. 2. Nutritional Counseling: Folic acid Supplement, balanced diet. 3. Prenatal education: Pregnancy, childbirth, and parenting. 4. Risk assessment: Identify high risk factors (ex. Age, medical conditions). 1. Fetal development education: Pregnancy Progression. 2. Monitoring sickness management: Dietary changes, antiemetics. 3. Urinary Frequency management: fluid management. 4. Breast changes education: Breas tenderness, nipple preparation. **Second Trimester (Weeks 27-38)** 1. Fetal movement monitoring: Kick counts, fetal heart rate. 2. Body changes education: back pain, varicose, varicose veins, stretch marks. 3. Nutrition counseling: increased caloric intake, iron supplements. 4. Pregnancy-induced hypertension (PIH) screening: blood pressure monitoring. **Third trimester (Weeks 39-40 weeks)** 1. Fetal monitoring: Non- stress-tests, biophysical profiles. 2. Labor preparation: signs of labor, breathing techniques. 3. Birth planning: Birth plan development, informed consent. 4. Postpartum education: Recovery, breastfeeding, newborn care. B. **Nursing Care of Client During labor and Delivery:** 1. Labor Support: Emotional Support, pain management. 2. Fetal monitoring: Continuous fetal heart rate monitoring. 3. Pain management: Breathing techniques, analgesics, epidural anesthesia. 4. Delivery assistance: Positioning, perineal support. C. **Nursing Care of Client During Postpartum:** 1. Physical assessment: Vital signs, bleeding, pain. 2. Breastfeeding support: Latch-on assistance, milk expression. 3. Newborn care education: Bathing, feeding, safety. 4. Emotional support: Postpartum blues, anxiety, depression. **Nursing Diagnoses:** 1. Anxiety: related to pregnancy, childbirth, or parenting. 2. Deficient knowledge: related to pregnancy, childbirth, or parenting. 3. Pain: related to labor, delivery, or postpartum recovery. 4. Risk for complications: related to high-risk factors. 5. Impaired physical mobility: related to pregnancy-related discomfort. 1. **HYPERTENSION: (GESTATIONAL HPN, PREECLAMPSIA):** 1. Placental factors: Abnormal placental development, placental ischemia. 2. Genetic predisposition: Family history of hypertension or preeclampsia. 3. Pre-pregnancy factors: Obesity, age above 35, multiple pregnancy. 4. Medical conditions: Chronic hypertension, kidney disease, diabetes. 5. Lifestyle factors: Physical inactivity, smoking. 1. **Placental Ischemia --**Endothelial dysfunction. 2. **Vasoconstriction --** increased blood pressure. 3. **Renal and vascular strain** -- potential complications. **Signs and Symptoms:** 1. High blood pressure: More than 140/90 mmHg. 2. Headaches: sever, persistent. 3. Visual disturbances: Blurred vision, double vision. 4. Abdominal pain: Epigastric or right upper quadrant. 5. Nausea and vomiting: Severe. 6. Edema: Sudden, significant weight gain. **Nursing Management:** 1. Assessment: Vital signs, fetal monitoring, lab tests. 2. Blood pressure management: Medications (ex. Methyldopa, labetalol). 3. Fetal surveillance: Non-stress tests, biophysical profiles. 4. Maternal rest: Bed rest, activity restriction. 5. Fluid management: hydration, electrolyte imbalance. 6. Pain management: Analgesics, comfort measures. 1. Blood pressure monitoring: self-monitoring techniques. 2. Symptom recognition: Reporting headaches, visual disturbances. 3. Lifestyle modifications: Diet, exercise, stress reduction. 4. Fetal movement monitoring: Kick counts. 5. Postpartum care: Hypertension management, breastfeeding. **Nursing Diagnoses:** 1. Hypertension: related to placental ischemia. 2. Anxiety: related to uncertainty. 3. Deficient knowledge: related to GHTN management. 4. Impaired Physical mobility: related to bed rest, 5. Risk for complications: related to uncontrolled hypertension. 2. **GESTATIONAL DIABETES (GDM**): is a pregnancy complications characterized by high blood sugar levels, first recognized during pregnancy, typically after 24-28 weeks of gestation. **Etiology:** 1. Hormonal changes: Placental hormones (ex. Human placental lactogen) block insulin action. 2. Insulin resistance: Reduced insulin sensitivity. 3. Genetic predisposition: Family history of GDM. 4. Obesity: BMI Greater than 30. 5. Age: more than 35 years. 6. Ethnicity: African American, Hispanic, Native American, or Asian. 7. Previous history: Previous GDM, delivering macrosomic baby. 8. Multiple pregnancy: twins or multiples. 1. Insulin resistance -- Hyperglycemia. 2. Pancreatic beta-cell dysfunction result to insulin deficiency. 3. Glucose builds up in the bloodstream result to hyperglycemia. 4. Fetal growth acceleration will result to macrosomia. **Signs and Symptoms:** 1. Increased thirst and urination. 2. Fatigue. 3. Blurred vision. 4. Recurring infections (ex. Yeast infections). 5. Slow healing of cuts or wounds. 6. Excessive hunger. 7. Weight gain. **Nursing Management**: 1. Assessment: Medical history, PE, Lab tests (Ex. glucose screening). 2. Dietary modifications: Balanced diet, carbohydrate counting. 3. Exercise: Regular physical activity. 4. Blood glucose monitoring. 5. Insulin therapy. 6. Fetal surveillance: biophysical profiles. 7. Support and education: Dietary management, blood glucose monitoring. **Treatment:** 1. Dietary management: 30-40% carbohydrate, 20-30% protein, 30-40% fat. 2. Insulin Therapy: Short acting (ex. regular) or long acting (ex. NPH). 3. Oral hypoglycemics: Metformin. (rarely used). 4. Glycemic control: Target blood glucose levels (ex. 90-130 mg/dl). **Nursing Diagnoses:** 1. Imbalanced Nutrition: more than body requirements: related to dietary habits. 2. Deficient knowledge: related to GDM management\> 3. Anxiety: related to uncertainty, fear. 4. Risk for complications: related to uncontrolled blood glucose. 5. Impaired Physical Mobility: related to fatigue. 3. **Nausea and Vomiting**: during pregnancy, also known as morning sickness, is a common complication affecting up to 80% of pregnant women. 1. Hormonal changes: Increased levels of human chorionic gonadotropin (hCG), estrogen, and progesterone. 2. Gastrointestinal slowing: Relaxation of gastric muscles. 3. Vitamin deficiencies: Folate, Vitamin B6. and iron deficiencies. 4. Genetic predisposition: Family history of morning sickness. 5. Multiple pregnancy: Twins or multiples. 6. History of motion sickness or migraines. **Disease Process:** 1. Hormonal changes stimulate the vomiting center of the brain. 2. Gastrointestinal slowing leads to gastric distention. 3. Vomiting occurs due to stomach contractions. **Signs and Symptoms:** 1. Nausea: feeling queasy or sick to the stomach. 2. Vomiting: expelling stomach contents. 3. Fatigue: physical exhaustion. 4. Weight loss: Inadequate nutrition. 5. Dehydration: excessive thirst, dark urine. 6. Headaches: frequent or severe headaches. 7. Dizziness: Lightheadedness or fainting. **Nursing Management:** 1. Assessment. 2. Dietary modifications: Frequent small meals, bland diet. 3. Hydration: Encourage fluid intake, electrolyte rich drinks. 4. Rest. 5. Medications: Vitamin B6 supplements. Antiemetics. 6. Alternative therapies: acupressure, ginger, peppermint oil. **Treatment:** 1. Vitamin B6 supplements. 2. Antiemetics: metoclopramide (Reglan). 3. Anti-reflux medications: Ranitidine (Zantac). 4. Hospitalization: Severe dehydration, electrolyte, electrolyte imbalance. **Health Teaching:** 1. Dietary management: eat small frequent meals. 2. Hydration: Drink electrolyte-rich fluids. 3. Rest. 4. Medications management: 5. Symptoms reporting: Inform healthcare provider of severe symptoms. **Nursing Diagnoses:** 1. Nausea: related to hormonal changes. 2. Deficient fluid volume: related to dehydration. 3. Fatigue: related to inadequate rest. 4. Anxiety: related to uncertainty, fear. 5. Impaired Nutrition: related to inadequate dietary intake. 5. **URINARY TRACT INFECTION (UTIs**): are bacterial infections affecting the kidneys, bladder, ureters, or urethra. 1. Bacterial invasion: Escherichia coli (E-coli), Klebsiella, Pseudomonas, Enterococcus. 2. Anatomical abnormalities: Urinary retention, obstructive uropathy. 3. Hormonal changes: Pregnancy, menopause. 4. Medical conditions: Diabetes, immunosuppression. 5. Catheterization: Urinary catheter use. 6. Poor hygiene: Inadequate cleaning, wiping incorrectly. 1. Bacteria enter the urinary tract through the urethra. 2. Bacteria multiply, causing inflammation and infection. 3. Infection spreads to the bladder (cystitis), kidneys (pyelonephritis) 1. Dysuria: painful urination: 2. Frequency: frequent urination. 3. Urgency: sudden need to urinate. 4. Suprapubic pain: pain above the pubic bone. 5. Hematuria: blood in the urine. 6. Fever: elevated temperature. 7. Chills: feeling cold. 8. Flank pain: pain in the lower back. 1. Assessment. 2. Pain management: analgesics, warm compresses. 3. Fluid management: encourage hydration. 4. Urinary elimination management: urinary catheter care. 5. Infection control: antibiotics, antiseptics. 6. Supportive care: rest and relaxation. **Treatment:** 1. Antibiotics: Trimethoprim-sulfamethoxazole, ciprofloxacin, amoxicillin. 2. Pain relief medications: Ibuprofen, acetaminophen. 3. Urinary analgesics: Phenazopyridine (Pyridium). 4. Hospitalization: Sever infections, sepsis. **Health Teaching:** 1. Hydration: Drink plenty of water. 2. Urinary hygiene: wipe correctly, clean genital area. 3. Avoid irritants: avid spicy foods, caffeine. 4. Urinate regularly: Avoid holding urine. 5. Catheter care: Proper catheter maintenance. **Nursing Diagnoses:** 1. Acute pain: related to dysuria, suprapubic pain. 2. Deficient Fluid volume: related to dehydration. 3. Anxiety: related to uncertainty, fear. 4. Impaired urinary elimination: related to infection. 5. Risk for infection: related to bacterial invasion. 6. **ANEMIA:** in pregnancy is a condition characterized by low RBC count or hemoglobin levels, affecting approximately 20-50% of pregnant women. 1. Nutritional deficiencies: Iron, folate. Vitamin B12 deficiencies. 2. Increased demand: Pregnancy-related increased blood volume. 3. Chronic diseases: Chronic kidney disease, rheumatoid arthritis. 4. Infections: Malaria, HIV. 5. Genetic disorders: Sickle cell anemia, thalassemia. 6. Multiple pregnancy: Twins, multiple. 1. Insufficient erythropoiesis (red blood cell production). 2. Inadequate iron absorption or utilization. 3. Increased blood volume and cardiac output. 4. Reduced oxygen delivery to tissues. **Signs and Symptoms:** 1. Fatigue. 2. Weakness. 3. Shortness of breath: Dyspnea. 4. Dizziness: Lightheadedness. 5. Headaches: Frequent or severe headaches. 6. Pale skin: pallor. 7. Poor appetite. **Nursing Management**: 1. Assessment: Medical history, PE, Lab Tests (CBC, Iron studies). 2. Dietary counseling: Iron rich foods, Vitamin C enhancement. 3. Supplementation: Iron, folate, Vitamin B12 supplements. 4. Rest and relaxation 5. Monitoring: Regular blood tests, fetal monitoring. 6. Supportive care: providing emotional support.. **Treatment:** 1. Iron Supplements: Ferrous Sulfate, Ferrous Gluconate. 2. Folate supplements: folic acid. 3. Vitamin B12 injections: For deficiency or malabsorption. 4. Blood transfusions: Severe anemia **Health Teaching:** 1. Iron-rich foods: Red meat, spinach, beans. 2. Vitamin C enhancement: citrus fruits. 3. Folate-rich foods: Leafy greens. 4. Supplemental adherence: Regular intake. 5. Rest and relaxation techniques: deep breathing, meditation. 1. Activity intolerance: related to fatigue. 2. Deficient knowledge: related to anemia management. 3. Anxiety 4. Impaired gas exchange: related to reduced oxygen delivery. 5. Risk for complications: related to untreated anemia. **PLACENTA PREVIA** is a pregnancy complication where the placenta partially or completely covers the internal cervical os (opening), causing bleeding during pregnancy or labor. 1. Previous uterine surgery: Cesarean section, dilatation and curettage (D and C). 2. Multiparity: Multiple pregnancies. 3. Advanced maternal age: More than 45 years. 4. Multiple gestations: Twins or multiples. 5. Placenta accrete: abnormal placental attachment. 6. Uterine abnormalities: Congenital or acquired uterine abnormalities. 7. Smoking: Tobacco use. **Disease Process:** 1. Placental implantation over or near internal cervical os. 2. Bleeding from placental separation or cervical dilatation. 3. Maternal-fetal hemorrhage. 1. Painless vaginal bleeding: bright red or dark blood. 2. Abdominal pain: Mild to severe. 3. Uterine contractions: Regular or Irregular. 4. Fetal distress: Decreased fetal movement. 5. Hypovolemic shock: severe bleeding. **Nursing Management:** 1. Assessment: Medical history, PE, Lab tests (ultrasound). 2. Bleeding Management: Monitor bleeding, administer IV fluids. 3. Pain Management: Analgesics, comfort measures. 4. Fetal monitoring: Continuous fetal heart rate monitoring. 5. Bed rest: Activity restriction. 6. Corticosteroids: Promote fetal lung maturity. 1. Expectant management: Bed rest monitoring. 2. Corticosteroids: Fetal lung maturity. 3. Blood transfusion: Sever bleeding. 4. Cesarean Section: Emergency or elective. **Health Teaching**: 1. Bleeding recognition: Report bleeding immediately. 2. Activity restriction: avoid heavy lifting, bending. 3. Pain management: Use analgesics as directed. 4. Fetal movement monitoring: Report decreased movement. 5. Emergency preparedness: Know emergency contact numbers. 1. Deficient fluid volume: related to bleeding. 2. Anxiety. 3. Acute pain: related to abdominal pain. 4. Fear: related to potential fetal compromise. 5. Risk for complications: related to untreated bleeding. **Etiology:** 1. Cephalopelvic disproportion: Fetal head too large for maternal pelvis. 2. Uterine dysfunction: weak or ineffective uterine contractions. 3. Fetal malposition: Abnormal fetal presentation (ex. Breech, transverse). 4. Multiple gestations: Twins or multiples. 5. Previous uterine surgery: Cesarean section, dilatation and curettage D and C). 6. Maternal medical conditions: Hypertension, diabetes. 7. Obesity: Maternal obesity. 8. Induction of labor: Artificially inducing labor. **Disease Process:** 1. Prolonged labor causes maternal physical exhaustion. 2. Increased risk of infections (Chorioamnionitis). 3. Fetal distress due to prolonged compression. 4. Potential for uterine rupture. **Signs and Symptoms:** 1. Prolonged labor duration: Beyond 18-24 hours (primiparas) or 12-14 hours (multiparas). 2. Severe pain: Intense contractions. 3. Fetal distress: Decreased fetal movement. 4. Maternal exhaustion: Physical and emotional fatigue. 5. Vaginal bleeding: Abnormal bleeding. 6. Fever: Elevated maternal temperature. **Nursing Management:** 1. Assessment: Monitor fetal heart rate, contractions\< and maternal vital signs. 2. Pain management: Administer analgesics, epidural anesthesia. 3. Hydration: Encourage fluid intake. 4. Rest and positioning 5. Fetal monitoring. 6. Supportive care: Emotional support, comfort measures. **Health Teaching:** 1. Labor progression: Understand normal labor progression. 2. Pain Management options: Discuss analgesics options. 3. Positioning techniques: Demonstrate effective positioning. 4. Hydration importance: Emphasize fluid intake. 5. Signs of fetal distress: Recognize decreased fetal distress. **Nursing Diagnoses:** 1. Acute pain: related to intense contractions. 2. Anxiety: related to fear. 3. Deficient fluid volume: related to dehydration. 4. Fear: related to potential fetal compromise. 5. Risk for complications: related to prolonged labor. 1. **FETAL DISTRESS**: also known as non-reassuring fetal status, is condition where the fetus experiences oxygen deprivation, leading to potential compromise. **Etiology:** 1. Placental abruption: Premature placental separation. 2. Placenta Previa: Placenta covering the cervix. 3. Umbilical cord compression: Cord entanglement or prolapse. 4. Uterine hypertension: Excessive uterine contractions. 5. Maternal medical conditions: Hypertensions, diabetes, anemia. 6. Fetal growth restriction: Intrauterine growth restriction. 7. Multiple gestations: Twins or multiples. 8. Postdate pregnancy: Pregnancy beyond 42 weeks. 1. Reduced oxygen supply to the fetus. 2. Increased fetal carbon dioxide levels. 3. Fetal acidosis and metabolic acidosis. 4. Potential fetal brain damage or death. 1. Abnormal fetal heart rate: Bradycardia, tachycardia. 2. Decreased fetal movement: Reduced or absent fetal movement. 3. Meconium-stained amniotic fluid: presence of meconium. 4. Uterine contractions: Increased frequency and intensity. 5. Maternal hypertension: Elevated blood pressure. **Nursing Management:** 1. Fetal monitoring: 2. Maternal positioning: Left lateral decubitus position. 3. Oxygen therapy: Administer oxygen to the mother. 4. Hydration: Encourage maternal fluid intake. 5. Pain management: Administer analgesics or epidural anesthesia. 6. Emergency preparedness: Prepare for potential cesarean section. **Health Teaching:** 1. Fetal movement monitoring: Educate on recognizing decreased movement. 2. Signs of fetal distress: Inform about abnormal heart rate, meconium. 3. Importance of prenatal care: Regula prenatal check-ups. 4. Risk factors: Discuss potential risk factors (Ex. Postdate pregnancy) 5. Emergency procedures: Explain potential interventions (Ex. Cesarean section). **Nursing Diagnoses:** 1. Anxiety: related to uncertainty, fear. 2. Fear: related to potential fetal compromise. 3. Deficient fluid volume: Related to dehydration. 4. Acute pain: related to uterine contractions. 5. Risk for complications: related to untreated fetal distress. 2. **POSTPARTUM HEMORRHAGE (PPH):** is excessive bleeding (more than 500 ml) within 24 hours after childbirth affecting approximately 5% of births. 1. Uterine atony: Weak or ineffective uterine contractions. 2. Retained placental tissue: Placenta or placental fragments remaining in the uterus. 3. Lacerations: Vaginal, cervical, or perineal tears. 4. Uterine Inversion: Uterus turning inside out. 5. Placenta accrete: Abnormal placental attachment. 6. Multiple gestations: twins or multiples. 7. Previous uterine surgery: Cesarean section, dilation and curettage. 8. Coagulopathy: Bleeding disorders (Ex. Hemophilia). 9. Hypertension: Maternal hypertension. **Disease Process:** 1. Blood loss leads to hypovolemic shock. 2. Decreased blood pressure and oxygen delivery. 3. Potential organ failure (Ex. Kidney, liver). **Signs and Symptoms:** 1. Excessive bleeding: Heavy vaginal bleeding (greater than 500 ml). 2. Pallor: pale skin. 3. Tachycardia: Rapid heart rate. 4. Hypotension: Low blood pressure. 5. Dizziness: Lightheadedness. 6. Headache: Sever headache. 7. Nausea and vomiting: Severe symptoms. 1. Assessment: Monitor VS, bleeding, and fundal height. 2. Bleeding control: Apply pressure, uterine massage. 3. Fluid resuscitation: Administer IV fluids, blood products. 4. Pain management: Analgesics, epidural anesthesia. 5. Uterine stimulants: Oxytocin. 6. Surgical intervention: Hysterectomy, embolization. 1. Bleeding recognition: Report heavy bleeding immediately. 2. Uterine massage: Teach-self massage techniques. 3. Pain management: Use analgesics as directed. 4. Follow-up care: schedule postpartum check-ups. 5. Future pregnancy planning: Discuss risk factors. **Nursing Diagnoses:** 1. Deficient fluid volume: related to bleeding. 2. Anxiety 3. Acute pain: related to uterine cramping. 4. Fear: related to potential complications. 5. Risk for complications: related to untreated bleeding. 4. **EPISIOTOMY:** is a surgical incision made in the perineum (the area between the vagina and anus) during childbirth to enlarge the vaginal opening and prevent severe tears. 1. Induced labor: Artificially inducing labor. 2. Fetal distress: Non-reassuring fetal heartrate. 3. Prolonged second stage: Prolonged pushing phase. 4. Macrosomia: Large fetal size. 5. Multiparity: Multiple pregnancies. 6. Previous vaginal trauma: Previous episiotomy or tears. 7. Instrumental delivery: Forceps extraction. **Disease Process:** 1. Incision made in the Perineum. 2. Enlargement of vaginal opening. 3. Potential complications (infection, hemorrhage, prolonged healing). 1. Pain: Perineal discomfort or pain. 2. Swelling: Perineal edema. 3. Bleeding: Vaginal bleeding. 4. Difficulty urinating: Dysuria. 5. Perineal tenderness: Painful perineum. 1. Assessment: Monitor perineal healing, pain, and bleeding. 2. Pain management: Administer analgesics. 3. Perineal care: Cleanse and apply ice packs. 4. Urinary catheterization: Assist with urination. 5. Wound care: Promote healing and prevent infection. 6. Supportive measures: Provide emotional support. 1. Perineal care: Teach proper cleansing and wound care. 2. Pain management: Educate on analgesics use. 3. Urination techniques: Demonstrate proper urination. 4. Follow-up care: Schedule postpartum check-ups. 5. Future pregnancy planning: Discuss potential risks. 1. Acute pain: related to perineal incision. 2. Deficient knowledge: related to perineal care. 3. Anxiety 4. Impaired urinary elimination; related to dysuria. 5. Risk for infection: related to surgical incision. 1. **URINARY RETENTION**: is the inability to urinate or empty the bladder completely, affecting 1-5% of postpartum women. **Etiology:** 1. Perineal trauma: Episiotomy, vaginal tears, or hemorrhoids. 2. Pain and discomfort: Perineal pain, episiotomy, or cesarean section. 3. Swelling and edema: Vaginal or perineal swelling. 4. Anesthesia: Epidural or spinal anesthesia. 5. Hormonal changes: Decreased estrogen levels. 6. Bladder atony: Weal bladder muscle. 7. Neurological Factors: Pelvic nerve damage. 1. Bladder distention and overfilling. 2. Incomplete bladder emptying. 3. Urine retention and potential infection. 4. Renal damage (if left untreated). **Signs and Symptoms:** 1. Inability to urinate: despite feeling urge. 2. Painful urination: dysuria. 3. Frequent urination: Urinary frequency. 4. Straining during urination: difficulty initiating urine flow. 5. Abdominal discomfort: Suprapubic pain. 6. Bladder distention: Palpable bladder. **Nursing Interventions:** 1. Assessment: Monitor urine output, bladder distension, and pain. 2. Catheterization: intermittent or indwelling catheter. 3. Pain Management: Administer analgesics. 4. Perineal care: Cleanse and apply ice packs. 5. Fluid management: Encourage hydration. 6. Bladder training: gradually increase voiding interval. 7. Supportive measures: provide emotional support. **Health Teaching:** 1. Urination techniques: demonstrate proper urination. 2. Perineal care: Educate on proper cleansing. 3. Follow-up care. 4. Signs of complications: Inform about urinary retention symptoms. **Nursing Diagnoses:** 1. Impaired urinary elimination: related to urinary retention. 2. Acute Pain: related to perineal discomfort. 3. Deficient knowledge: related to urinary retention management. 4. Anxiety 5. Risk for infection: related to urinary retention. 1. Hormonal changes: rapid decrease in estrogen and progesterone. 2. Sleep deprivation: Fatigue and exhaustion. 3. Social support: Lack of emotional support from family/partners. 4. Previous trauma: History of abuse, anxiety, or depression. 5. Infant care stress: Difficulty breastfeeding or caring for the baby. 6. Socioeconomic factors: Financial stress, single parenthood. 1. Emotional overwhelm and anxiety. 2. Decreased self-esteem and confidence. 3. Impaired mother-infant bonding. 4. Increased risk of postpartum depression. 5. Potential impact on infant's emotional development. 1. Anxiety: Excessive worry, fear, or panic. 2. Depression: sadness, hopelessness, or loss of interest. 3. Mood swings: irritability, anger, or emotional reactivity. 4. Appetite changes: Increased or decreased appetite. 5. Sleep disturbances: Insomnia, or excessive sleepiness. 6. Fatigue: Physical or emotional exhaustion. 7. Difficulty bonding: Feeling disconnected from the baby. 8. Physical Symptoms: headaches, stomachaches, or muscle tension. 1. Assessment: Evaluate emotional status, sleep patterns, and support system. 2. Emotional support: Active listening, empathy, and validation. 3. Education: Provide resources on postpartum emotions and self-care. 4. Referral: Connect with mental health professionals, or support groups. 5. Self-care encouragement: Promote relaxation techniques (Ex. Deep breathing, meditation). 6. Partner/family involvement: Encourage support and understanding. 7. Follow-up care. Schedule of regular check-ups. 1. Normalizing emotions: Acknowledge common postpartum feelings. 2. Self-care strategies: Teach relaxation techniques and stress management. 3. Support systems: Encourage social connections and support groups. 4. Infant care: provide guidance on bonding and caregiving. 5. Signs of Complications: Inform about postpartum depression. **Nursing Diagnoses:** 1. Anxiety: related to emotional distress. 2. Deficient knowledge: related to postpartum emotions and self-care. 3. Impaired parenting: related to difficulty bonding. 4. Sleep deprivation: related to fatigue. 5. Risk for complications: related to untreated emotional distress. 1. Trauma: Physical trauma, such as car accident or fall, can cause placental separation. 2. Hypertension: High blood pressure can lead to blood vessel damage and placental separation. 3. Smoking: Smoking during pregnancy increases the risk of placental abruption. 4. Cocaine use: Cocaine use during pregnancy can cause blood vessel constriction and placental separation. 5. Multiple gestation: Carrying twins or other multiples increases the risk of placental abruption. 6. Previous uterine surgery: Women who have had previous uterine surgery, such as a cesarean section, maybe at higher risk. **Disease Process:** 1. Placental separation: the placenta partially or completely separates from the uterus. 2. Maternal Bleeding; Bleeding occurs between the placenta and the uterus. 3. Fetal Distress: The fetus may experience distress due to decreased oxygen and nutrient supply. 1. Vaginal bleeding: Sudden painless vaginal bleeding. 2. Abdominal pain: Severe persistent abdominal pain. 3. Back pain: Back pain or tenderness 4. Uterine tenderness: Uterine tenderness or rigidity. 5. Fetal Distress: Fetal heart rate abnormality. **Diagnostic Tests:** 1. Ultrasound: confirms placental separation and evaluates fetal well-being. 2. Non-stress test: Evaluates fetal heart rate and well-being. **Nursing Interventions:** 1. Assess maternal and fetal status: Continuously monitor maternal vital signs, fetal heart rate, and uterine contractions. 2. Provide emotional support: Reassure the woman and her family. 3. Administer oxygen: Provide oxygen therapy as needed. 4. Prepare for surgery: Prepare the woman for possible cesarean section or hysterectomy. **Health Teaching:** 1. Recognize signs and symptoms: Educate the patient to recognize signs and symptoms of placental abruption 2. Seek immediate medical attention: Instruct the patient to seek immediate medical attention if symptom occur. 3. Follow --up care: Educate the patient on follow --up care and potential complications. 1. Risk for maternal injury: related to placental abruption. 2. Risk for fetal injury: related to decreased oxygen and nutrient supply. 3. Anxiety: related to uncertainty and fear. 4. Deficient Knowledge: related to lack of understanding of placental abruption. 1. Maternal Hemorrhage: Severe bleeding can lead to shock and organ failure. 2. Fetal Distress Decreased oxygen and nutrient supply can lead to fetal compromised. 3. Preterm Labor: Placental abruption can stimulate preterm Labor. 4. Placental Infarction: Placental tissue death can occur due to decreased blood flow. III. **A. CHILDREN WITH ALTERED CARDIAC AND TISSUE PERFUSION RELATED TO OXYGENATION EXIBIT VARIOUS RESPONSES:** 1. **CARDIOVASCULAR RESPONSES:** 1. Tachycardia: increased heart rate (greater than 160 bpm in infants, greater than 120 bpm in children. 2. Bradycardia: Decreased heart rate (less than 80 bpm in infants, less than 60 bpm in children). 3. Hypotension: Low blood pressure. 4. Cardiac arrhythmias: abnormal heart rhythms. 5. Decreased cardiac output: Reduced blood flow. 2. **RESPIRATORY RESPONSES**: 1. Tachypnea: Rapid breathing rate (greater than 40 breaths/minute in infants, greater than 20 breaths/minute in children. 2. Dyspnea: Difficulty breathing. 3. Grunting: Inspiratory effort. 4. Retractions: Chest wall indrawing. 5. Apnea: pauses in breathing. 3. **Neurological Responses:** 1. Altered mental status: Confusion, lethargy, or coma. 2. Seizures: Convulsions. 3. Decreased consciousness: Reduced responsiveness. 4. Irritability: Restlessness or agitation. 4.**Hemodynamic Responses:** 1. Vasoconstriction: decreased peripheral blood flow. 2. Vasodilation: Increased peripheral blood flow. 3. Increased systemic vascular resistance: Elevated blood pressure. 1. Oliguria: Decreased urine output (less than1 ml/kg/h). 2. Anuria: Absent urine output. 3. Fluid overload: Excess fluid accumulation. 1. Metabolic acidosis: Increased lactic production, 2. Hypoglycemia: Low blood glucose. 3. Hyperglycemia: Elevated blood glucose. 1. Cool or clammy skin: Decreased peripheral perfusion. 2. Cyanosis: Blue discoloration of skin and mucous membranes. 3. Pallor: Pale skin. 8. **Gastrointestinal Responses:** 1. Nausea and vomiting. 2. Abdominal distension. 3. Diarrhea or constipation. **Nursing Considerations:** 1. Monitor vital signs and oxygen saturation. 2. Assess respiratory and cardiac function. 3. Provide oxygen therapy and respiratory support. 4. Administer medications to support cardiac function. 5. Maintain fluid and electrolyte balance. 6. Provide emotional support and comfort measures. **Diagnostic Tests:** 1. Arterial blood gas (ABG) analysis. 2. Electrocardiogram. 3. Echocardiogram. 4. Chest radiograph. 5. Pulse oximetry. **Nursing Diagnoses:** 1. Impaired gas exchange. 2. Decreased cardiac output. 3. Ineffective tissue perfusion. 4. Anxiety. 5. Fear. 1. Diarrhea and vomiting: Gastroenteritis, food poisoning. 2. Fever: increased fluid loss through sweating. 3. Inadequate fluid intake: Poor oral hydration, neglect. 4. Excessive urine output: Diabetes insipidus, kidney disease. 5. Excessive sweating: Heat exhaustion, strenuous exercise. 6. Medications: Diuretics, laxatives. 7. Underlying medical conditions: Diabetes, kidney disease, heart failure. 1. Fluid loss exceeds fluid intake. 2. Electrolyte imbalance (sodium, potassium, chloride). 3. Decreased blood volume (hypovolemia). 4. Decreased blood pressure (hypotension). 5. Impaired kidney function. 6. Potential organ failure (kidney, liver, brain). 1. **Mild dehydration:** 2. **Moderate dehydration:** 3. **Severe dehydration:** **Nursing Interventions:** 1. Assessment: Monitor fluid intake/output, vital signs, and electrolyte levels. 2. Fluid replacement: Oral rehydration therapy (ORT) or intravenous fluids. 3. Electrolyte Management: Administer electrolyte supplements. 4. Medication management: Adjust medications contributing to dehydration. 5. Vital Signs monitoring: Continuously monitor vital signs. 6. Supportive care: provide emotional support and comfort measures. 1. Fluid intake: Encourage adequate fluid consumption. 2. Electrolyte balance: Educate on electrolyte-rich foods. 3. Fever management: Teach fever reduction techniques. 4. Medications management: Instruct on proper medication use. 5. Follow-up care: Schedule regular check-ups 1. Fluid volume deficit: related to inadequate fluid intake. 2. Electrolyte Imbalance: related to excessive loss. 3. Risk for complications: related to untreated dehydration. 4. Anxiety: related to uncertainty, fear. 5. Deficient knowledge: related to inadequate fluid management. 1. Excessive fluid administration: IV fluids, blood transfusions. 2. Heart failure: Decreased cardiac output, increased fluid retention. 3. Kidney disease: Impaired fluid regulation, electrolyte imbalance. 4. Liver disease: Cirrhosis, ascites. 5. Nephrotic syndrome: Excessive fluid retention. 6. Medications: Steroids, NSAIDs. 7. Respiratory distress syndrome: Pulmonary edema. 1. Excess fluid accumulates in tissues and organs. 2. Increased blood volume and cardiac workload. 3. Pulmonary congestion and edema. 4. Decreased oxygenation and perfusion. 5. Potential organ failure (heart, lungs, kidneys). 1. **Mild Fluid Overload** 2. **Moderate Fluid Overload** 3. **Severe Fluid Overload** 1. Monitor fluid intake/output and vital signs. 2. Restrict fluid intake. 3. Administer diuretics. 4. Provide oxygen therapy. 5. Elevate head of bed. 6. Monitor electrolyte levels. 7. Supportive care (comfort measures). 1. Fluid management techniques. 2. Medication management. 3. Monitoring weight and blood pressure. 4. Recognizing signs of fluid overload. 5. Follow-up care. 1. Excess fluid volume: related to excessive fluid administration. 2. Impaired gas exchange: related to pulmonary congestion. 3. Decreased cardiac output: related to fluid overload. 4. Anxiety. 5. Deficient Knowledge: related to fluid management. 1. Fluid overload: Excessive IV fluids, blood transfusions. 2. Heart failure: Decreased cardiac output, increased fluid retention. 3. Kidney disease: Nephrotic syndrome, acute kidney injury. 4. Liver disease: Cirrhosis, ascites. 5. Medications: Steroids, INSAIDs. 6. Infections: Cellulitis, abscesses. 7. Allergic reactions: Anaphylaxis. 8. Genetic disorders: Turner syndrome. 1. Fluid accumulation in tissues. 2. Increased hydrostatic pressure. 3. Decreased oncotic pressure. 4. Capillary leakage. 5. Swelling and tissue damage. 1. Mild Edema: 2. Moderate Edema: 3. Sever Edema: 1. Monitor fluid intake/output and vital signs. 2. Elevate affected limbs. 3. Administer diuretics (as prescribed). 4. Provide comfort measures (Ex. Positioning) 5. Monitor electrolyte levels. 6. Supportive care (oxygen therapy). 7. Document changes in swelling. 1. Fluid management techniques. 2. Medication management. 3. Monitoring weight and blood pressure. 4. Recognizing signs of edema. 5. Elevation techniques. 6. Compression bandaging (if applicable). 1. Excess Fluid Volume: related to fluid overload. 2. Impaired Skin Integrity: related to edema. 3. Decreased cardiac Output: related to fluid overload. 4. Anxiety. 5. Deficient Knowledge: related to edema management. 1.**ELECTROLYTE IMBALANCE:** 1. **Sodium (Na+): 135-145 mmol/L** 2. **Potassium (K+): 3.5-145 mmol/L** 3. **Chloride (Cl-): 95-110 mmol/L** 4. **Calcium (Ca2+): 8.5-10.5 mg/dL** 5. **Magnesium (Mg2+): 1.6-2.4 mg/dL** 6. **Phosphate (PO42-): 4.5-6.5 mg/dL** 7. **Bicarbonate (HCO3-): 22-28 mmol/L** 1. **Neonates (0-28 days):** 2. **Infants: (29 days-1 year):** 3. **Children (1-18 years)** 1. Hyponatremia (low sodium): Dehydration, diarrhea, vomiting, and excessive fluid administration, kidney disease, heart failure, syndrome of inappropriate antidiuretic hormone secretion (SIADH). 2. Hypernatremia (high sodium): Dehydration, diabetes insipidus, excessive sodium intake, kidney disease, certain medications. **Disease Process:** 1. Hyponatremia: Excess water dilutes sodium levels, causing swelling of brain and nerve cells. 2. Hypernatremia: Excess sodium draws water out of cells, causing dehydration. 1. Hyponatremia: 2. Hypernatremia: 1. Monitor sodium levels and vital signs. 2. Administer fluids (oral/IV) as prescribed. 3. Restrict sodium intake (hypernatremia) or provide sodium supplements. 4. Provide supportive care (oxygen therapy, pain management). 5. Monitor urine output and electrolyte levels. 6. Educate parents on sodium management. 1. Hyponatremia: Fluid restriction, sodium supplements, medication adjustment. 2. Hypernatremia: Fluid administration, sodium restriction, medication adjustment. 1. Electrolyte Imbalance: related to Sodium imbalance. 2. Fluid volume deficit: related to dehydration. 3. Risk for seizures: related to electrolyte imbalance. 4. Anxiety 5. Deficient knowledge: related to sodium management. 1. **Hypokalemia (low potassium**): diarrhea, vomiting, excessive urine output, certain medications (diuretics), kidney disease, metabolic alkalosis. 2. **Hyperkalemia (high Potassium):** kidney disease, excessive potassium intake, certain medications (ACE inhibitors), metabolic acidosis, cell destruction (hemolysis). 1. **Hypokalemia:** Potassium deficiency affects muscle contractions, leading to weakness, fatigue, and cardiac arrhythmias. 2. **Hyperkalemia:** Excess potassium affects heart function, leading to arrhythmias cardiac arrest. **Nursing Intervention:** 1. Monitor Potassium levels and vital signs. 2. Administer potassium supplements(hypokalemia) or potassium-bbinding medications (hyperkalemia). 3. Provide supportive care (oxygen therapy, pain management). 4. Monitor urine output and electrolyte levels. 5. Educate parents on Potassium management. 6. Encourage dietary modifications (bananas, avocados for hypokalemia; Low potassium diet for hyperkalemia. **Health Teaching:** 1. Potassium-rich foods (bananas, avocados). 2. Potassium supplement administration. 3. Medication management 4. Monitoring Potassium levels. 5. Recognizing signs of imbalance. 1. Electrolyte Imbalance: related to Potassium imbalance. 2. Activity Intolerance: related to muscle weakness. 3. Risk for Cardiac Dysfunction: related to Potassium Imbalance. 4. Anxiety 5. Deficient knowledge: related to Potassium management. 1. Hypocalcemia (low calcium): Vitamin D deficiency, kidney disease, hypoparathyroidism, magnesium deficiency, certain medications. 2. Hypercalcemia (high calcium): Vitamin D toxicity, hyperparathyroidism, kidney disease, certain medications, malignancies. 1. Hypocalcemia: Calcium deficiency affects muscle contractions, leading to weakness, tetany, and cardiac arrhythmias. 2. Hypercalcemia: Excess calcium affects kidney function, leading to nephrocalcinosis, kidney stones, and bone demineralization. 1. **Hypocalcemia:** 2. **Hypercalcemia:** **Nursing Interventions:** 1. Monitor calcium levels and vital signs. 2. Administer calcium supplements (hypocalcemia) or calcium-lowering medications (hypercalcemia). 3. Provide supportive care (oxygen therapy), pain management). 4. Monitor urine output and electrolyte levels. 5. Educate parents on calcium management. 6. Encourage dietary modifications (dairy products, leafy green for hypocalcemia; low-calcium diet for hypercalcemia. 1. Calcium-rich foods (dairy products, leafy greens). 2. Vitamin D supplementation. 3. Medication management. 4. Monitoring calcium levels. 5. Recognizing signs of imbalance. 1. Electrolyte Imbalance: related to calcium imbalance. 2. Activity Intolerance: related to muscle weakness. 3. Risk for cardiac Dysfunction: related to calcium imbalance. 4. Anxiety 5. Deficient knowledge: related to calcium management. **Etiology:** 1. **Hypomagnesemia (low magnesium):** Diarrhea, vomiting, inadequate dietary intake, kidney disease, certain medications (diuretics, antibiotics). 2. **Hypermagnesemia (High Magnesium) :** Excessive intake, kidney disease, certain medications (laxatives, antacids). **Disease Process:** 1. Hypomagnesemia: Magnesium deficiency affects muscle contractions, leading to weakness, cramps, and cardiac arrhythmias. 2. Hypermagnesemia: Excess magnesium affects heart function, leading to bradycardia, respiratory depression. 1. **Hypomagnesemia** 2. **Hypermagnesemia** **Nursing Interventions**: 1. Monitor magnesium levels and vital signs. 2. Administer magnesium supplements (hypomagnesemia) or magnesium --lowering medications (hypermegnesemia). 3. Provide supportive care (oxygen therapy, pain management). 4. Monitor urine output and electrolyte levels. 5. Educate parents on magnesium management. 6. Encourage dietary modifications (dark leafy greens, nuts for hypomagnesemia; low magnesium diet for hypermagnesemia. 1. Magnesium --rich foods (dark leafy greens, nuts). 2. Medications Management. 3. Monitoring magnesium levels. 4. Recognizing signs of imbalance. 5. Avoiding excessive magnesium intake. 1. Electrolyte Imbalance: related magnesium imbalance. 2. Activity Intolerance: related to muscle weakness. 3. Risk for cardiac Dysfunction: related to magnesium imbalance. 4. Anxiety 5. Deficient knowledge: related to magnesium management. **Etiology:** 1. **Hypochloremia (low chloride):** Diarrhea, vomiting, excessive sweating, cystic fibrosis, certain medications (diuretics). 2. **Hyperchloremia (high Chloride):** Dehydration, excessive chloride intake, kidney disease. Metabolic acidosis. **Disease Process:** 1. **Hypochloremia;** 2. **Hyperchloremia:** 1. Monitor chloride level and vital signs. 2. Administer chloride supplements (hypochloremia) or Chloride-lowering medications (hyperchloremia). 3. Provide supportive care (oxygen therapy, pain management). 4. Monitor urine output and electrolyte levels. 5. Educate parents on chloride management. 6. Encourage dietary modifications (bananas, avocados for hypochloremia; low chloride diet for hyperchloremia). 1. Chloride-rich foods (bananas, avocados). 2. Medications management. 3. Monitoring chloride levels. 4. Recognizing signs of imbalance. 5. Avoiding excessive chloride intake. 1. Electrolyte Imbalance: related to chloride imbalance. 2. Acid-base imbalance: related to metabolic alkalosis/acidosis. 3. Activity intolerance: related muscle weakness. 4. Anxiety 5. Deficient Knowledge: related to chloride management. 3. **ACID-BASE IMBALANCE IN CHILDREN:** 1. **Metabolic Acidosis in children:** is a condition where the body produces excessive acid or cannot effectively remove excess acid, leading to an imbalance in the body's acid-base balance. 1. Diabetic ketoacidosis: High blood pressure levels, dehydration. 2. Lactic acidosis: Infection, sepsis, liver disease. 3. Renal failure: Kidney disease, acute kidney injury. 4. Respiratory disorders: Respiratory distress syndrome. 5. Medications: Salicylates, acetaminophen overdose. 6. Gastrointestinal disorders: Diarrhea, vomiting. 1. Excess acid production (ketoacids, lactic acid). 2. Impaired acid secretion (kidney disease). 3. Buffering mechanisms overwhelmed. 4. pH imbalance (acidosis). 1. **Mild:** 2. **Moderate:** 3. **Severe:** **Nursing Interventions:** 1. Monitor vital signs, pH and electrolyte levels. 2. Administer IV fluids and electrolytes. 3. Provide oxygen therapy. 4. Manage pain and discomfort. 5. Supportive care (nutrition, hydration). 6. Monitor urine output and kidney function. 7. Collaborate with healthcare team for medication management. **Health Teaching:** 1. Recognizing signs of metabolic acidosis. 2. Managing underlying conditions (diabetes, kidney disease). 3. Medication Management. 4. Hydration and nutrition strategies. 5. Follow-up care and monitoring. 1. Acid-Base Imbalance: related to metabolic acidosis. 2. Respiratory Distress: related compensatory mechanisms. 3. Anxiety. 4. Deficient Knowledge: related to acid-base management. 5. Risk for Cardiac Dysfunction: related to acidosis. **Etiology:** 1. Vomiting or nasogastric suction: Loss of hydrochloric acid. 2. Diuretics: Excessive Potassium and chloride loss. 3. Cystic fibrosis: Respiratory alkalosis and metabolic alkalosis. 4. Hypokalemia: Potassium depletion. 5. Hypocalcemia: Calcium depletion. 6. Milk- alkali syndrome: Excessive calcium intake. 7. Respiratory alkalosis: Hyperventilation. 8. Kidney disease: Impaired acid excretion. 1. Excess bicarbonate production or retention. 2. Hydrogen ion loss or depletion. 3. pH imbalance (alkalosis). 4. Compensatory mechanisms (hyperventilation). **Signs and Symptoms:** 1. **Mild:** 2. **Moderate:** 3. **Severe:** **Nursing Interventions**: 1. Monitor vital signs, pH, and electrolyte levels. 2. Administer IV fluids and electrolytes (potassium, Chloride). 3. Provide supportive care (nutrition, hydration). 4. Manage pain and discomfort. 5. Encourage deep breathing exercises. 6. Collaborate with healthcare team for medication management. 1. Recognizing signs of metabolic alkalosis. 2. Managing underlying conditions (cystic fibrosis, kidney disease). 3. Medication management. 4. Hydration and nutrition strategies.
