NCMA217 Prelim Lecture PDF

lOMoARcPSD|35586112 NCMA217- Prelim - lecture Maternal and Child Health Nursing (Our Lady of Fatima University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or u...

lOMoARcPSD|35586112 NCMA217- Prelim - lecture Maternal and Child Health Nursing (Our Lady of Fatima University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Elaine Negapatan ([email protected])  lOMoARcPSD|35586112 NCMA217  The health information system enables use COVERAGE: of data to ensure early, appropriate 1. Framework for Maternal and Child Health Nursing action. 2. Human Sexuality  Every woman and new born has a 3. Menstruation 4. Concept Map complete, accurate, standardized 5. Family Planning medical record during labour, childbirth 6. Care of the Fetus and the early postnatal period. 7. Prenatal Care  Every health facility has a mechanism for data collection, analysis and feedback as FRAMEWORK FOR MATERNAL AND CHILD part of its activities for monitoring and HEALTH NURSING improving performance around the time STANDARDS OF MATERNAL AND CHILD HEALTH of childbirth to improve the care of every NURSING woman and new born.  HEALTH PROMOTION - Educating clients to be aware of good health through STANDARD 3: teaching and role modelling.  Every woman and new born with  HEALTH MAINTENANCE - Intervening to condition(s) that cannot be dealt with maintain health when risk of illness is effectively with the available resources is present. appropriately referred.  HEALTH RESTORATION – Promptly  Every woman and new born is diagnosing and treating illness using appropriately assessed on admission, interventions that will return client to during labor and in the early postnatal wellness most rapidly. period to determine whether referral is  HEALTH REHABILITATION - Preventing required, and the decision to refer is made further complications from an without delay. illness; bringing an ill client back to an  For every woman and new born who optimal state of wellness or requires referral, the referral follows a pre- helping a client to accept inevitable established plan that can be death. implemented without delay at any time. STANDARD 1:  For every woman and new born referred  Every woman and new born receives within or between health facilities, there is routine, evidence-based care and appropriate information exchange and management of complications during feedback to relevant health care staff. labor, childbirth and the early postnatal STANDARD 4: period, according to WHO guidelines.  Communication with women and their  Women are assessed routinely on families is effective and responds to their admission and during labor and childbirth needs and preferences. and are given timely, appropriate care.  All women and their families receive  New-borns receive routine care information about the care and have immediately after birth. effective interactions with staff.  Mothers and new-borns receive routine  All women and their families experience postnatal care. coordinated care, with clear, accurate  Women with pre-eclampsia or eclampsia information exchange between relevant promptly receive appropriate health and social care professionals. interventions, according to WHO guidelines. STANDARD 5:  Women with postpartum haemorrhage  Women and new-borns receive care with promptly receive appropriate respect and preservation of their dignity. interventions, according to WHO  All women and new-borns have privacy guidelines. around the time of labour and childbirth, and their confidentiality is respected. STANDARD 2:  No woman or new born is subjected to mistreatment, such as physical, sexual or ANGELIQUE REYES 1 Downloaded by Elaine Negapatan ([email protected])  lOMoARcPSD|35586112 NCMA217 verbal abuse, discrimination, neglect, born can be cared for according to their detainment, extortion or denial of services. needs in private, to facilitate the continuity  All women have informed choices in the of care. services they receive, and the reasons for  An adequate stock of medicines, supplies interventions or outcomes are clearly and equipment is available for routine explained. care and management of complications. STANDARD 6: ADVANCE PRACTICE ROLES FOR NURSES IN  Every woman and her family are provided MATERNAL AND CHILD HEALTH with emotional support that is sensitive to CLINICAL NURSE SPECIALISTS their needs and strengthens the woman’s  Are nurses prepared at the master’s or capability. doctorate degree level who are capable  Every woman is offered the option to of acting as consultants in their area of experience labor and childbirth with the expertise, as well as serving as role models, companion of her choice. researchers, and teachers of quality  Every woman receives support to nursing care. strengthen her capability during childbirth.  Neonatal nurse specialists -manage the care of infants at birth and in intensive STANDARD 7: care settings; they provide home follow-up  For every woman and new born, care to ensure the new born remains well. competent, motivated staff are Childbirth educators teach families about consistently available to provide routine normal birth and how to prepare for labor care and manage complications. and birth.  Every woman and child has access at all  Lactation consultants-educate women times to at least one skilled birth attendant about breastfeeding and support them and support staff for routine care and while they learn how to do this. Genetic management of complications. nurse counsellors-consult with families  The skilled birth attendants and support about patterns of inheritance and offer staff have appropriate competence and support to families with a child who has skills mix to meet the requirements of inherited a genetic disorder. labour, childbirth and the early postnatal period. CASE MANAGER  Every health facility has managerial and  A graduate-level nurse who supervises a clinical leadership that is collectively group of patients from the time they enter responsible for developing and a health care setting until they are implementing appropriate policies and discharged from the setting. fosters an environment that supports  Case management can be a vastly facility staff in continuous quality satisfying nursing role, because if the improvement. healthcare setting is “seamless,” or one that follows people both during an illness STANDARD 8: and on their return to the community.  The health facility has an appropriate physical environment, with adequate NURSE PRACTITIONERS water, sanitation and energy supplies,  Are nurses educated at the master’s or medicines, supplies and equipment for doctoral level. Recent advances in routine maternal and new born care and technology, research, and knowledge management of complications. have amplified the need for longer and  Water, energy, sanitation, hand hygiene more in-depth education for nurse and waste disposal facilities are functional, practitioners as they play pivotal roles in reliable, safe and sufficient to meet the today’s health care system. needs of staff, women and their families. WOMAN’S HEALTH NURSE PRACTITIONER  Areas for labor, childbirth and postnatal  Has advanced study in the promotion of care are designed, organized and health and prevention of illness in women. maintained so that every woman and new ANGELIQUE REYES 2 Downloaded by Elaine Negapatan ([email protected])  lOMoARcPSD|35586112 NCMA217 Such a nurse plays a vital role in educating management of women with women about their bodies and sharing uncomplicated pregnancies. with them methods to prevent illness; in LEGAL CONSIDERATIONS OF MATERNAL-CHILD addition, they care for women with PRACTICE illnesses such as sexually transmitted  Maternal and child health nursing carries infections, and offer information and some legal concerns that extend above counsel them about reproductive life and beyond other areas of nursing, planning. because care is often given to an “unseen PEDIATRIC NURSE PRACTTIONER (PNP) client”—the fetus—or to clients who are  Is a nurse prepared with extensive skills in not of legal age for giving consent for physical assessment, interviewing and well- medical procedures. In addition, labor child counselling and care. In this role, a and birth of a neonate are considered nurse interviews parents as part of an “normal” events, so the risks for a lawsuit extensive health history and performs a are greater when problems arise (O’Grady physical assessment of the child. et al., 2007)  If the PNP determines that a child has a  Nurses are legally responsible for common illness (such as iron deficiency protecting the rights of their clients, anemia), he or she orders the necessary including confidentiality, and are laboratory tests and prescribes accountable for the quality of their appropriate drugs for therapy. individual nursing care and that of other  If the PNP determines that the child has a health care team members major illness (such as congenital  Understanding the scope of practice and subluxatedhip, kidney disease, heart standards of care can help nurses disease), he or she consults with an practice within appropriate legal associated pediatrician; together. parameters.  Documentation is essential for protecting NEONATAL NURSE PRACTITIONER a nurse and justifying his or her actions.  Is an advanced-practice role for nurses  Nurses need to be conscientious about who are skilled in the care of new-borns, obtaining informed consent for invasive both well and ill. NNPs may work in level 1, procedures and determining that level 2, or level 3 new born nurseries, pregnant women are aware of any risk to neonatal follow-up clinics, or physician the fetus associated with a procedure or groups. test. FAMILY NURSE PRACTITIONER (FNP)  Adolescents who support themselves or  Is an advanced-practice role that who are pregnant are termed provides health care not only to women “emancipated minors” or “mature minors” and children but also to the family as a and have the right to sign for their own whole. In conjunction with a physician, an health care. FNP can provide prenatal care for a ETHICAL CONSIDERATIONS OF PRACTICE woman with an uncomplicated  Some of the most difficult ethical pregnancy. quandaries in health care today are those CERTIFIED NURSE-MIDWIFE (CNM) that involve children and their families.  Is an individual educated in the two Examples are: disciplines of nursing and midwifery and  Conception issues, especially those licensed. related to in vitro fertilization,  Plays an important role in assisting women embryo transfer, ownership of with pregnancy and childbearing. Either frozen oocytes or sperm, cloning, independently or in association with a stem cell research, and surrogate physician, the nurse-midwife assumes full mothers responsibility for the care and  Abortion, particularly partial-birth abortions ANGELIQUE REYES 3 Downloaded by Elaine Negapatan ([email protected])  lOMoARcPSD|35586112 NCMA217  Fetal rights versus rights of the STATISTICAL TERMS USED TO REPORT MATERNAL mother. Use of fetal tissue for AND CHILD HEALTH research  Birth rate: Number of births per 1000  Resuscitation (for how long should population. it be continued?)  Fertility rate: Number of pregnancies per  Number of procedures or degree 1000 women of childbearing age. of pain that a child should be  Fetal death rate: Number of fetal deaths asked to endure to achieve a (weighing more 500 g) per 1000 live births. degree of better health  Neonatal death rate: Number of deaths  Balance between modern per 1000 live births occurring at birth or in technology and quality of life the first 28 days of life.  Perinatal death rate: Number of deaths of PHILOSOPHY OF MATERNAL AND CHILD HEALTH fetuses weighing more than 500g and NURSING within the first 28 days of life per 1000 live  Maternal and child health nursing is family births. centered; assessment must include both  Maternal mortality rate: Number of family and individual assessment data. maternal deaths per 100,000 live births that  Maternal and child health nursing is occur as a direct result of the reproductive community centered; the health of process. families depends on and influences the  Infant mortality rate: Number of deaths per health of communities. 1000 live births occurring at birth or in the  Maternal and child health nursing is first 12 months of life. evidence based, because this is the  Childhood mortality rate: Number of means whereby critical knowledge deaths per 1000 population in children, 1 increases. to 14 years of age.  A maternal and child health nurse serves as an advocate to protect the rights of all INFANT MORTATLITY RATE family members, including the fetus.  Maternal and child health nursing includes a high degree of independent nursing functions, because teaching and counselling are major interventions.  Promoting health and disease prevention are important nursing roles because these protect the health of the next generation.  Maternal and child health nurses serve as important resources for families during childbearing and childrearing as these  The infant mortality rate for Philippines in can be extremely stressful times in a life 2019 was 19.239deaths per 1000 live births, cycle. a2.16% decline from 2018.  Personal, cultural, and religious attitudes  The top three leading causes of infant and beliefs influence the meaning and mortality were: impact of childbearing and childrearing Pneumonia (3,146; 14.3%); on families. Bacterial sepsis of newborn (2,731; 12.4%);  Circumstances such as illness or and Respiratory distress of newborn pregnancy are meaningful only in the (2,347; 10.7%). context of a total life.  Maternal and child health nursing is a MATERNAL MORTATLITY RATE challenging role for nurses and a major  Philippines maternal mortality ratio was at factor in keeping families well and level of 121 deaths per 100,000 live births in optimally functioning. 2017, down from 124 deaths per 100,000 live births previous year, this is a change of 2.42%. ANGELIQUE REYES 4 Downloaded by Elaine Negapatan ([email protected])  lOMoARcPSD|35586112 NCMA217 HUMAN SEXUALITY - The ability to concentrate on the  Multidimensional concept. means of giving and receiving love  Can be defined broadly by stating that other than through sexual expressions. sexuality integrates the somatic (bodily),  TRANSVESTISM – individual who dresses to emotional, intellectual, &social aspects of take on the role of the opposite sex. being a human sexual being.  VOYEURISM – sexual arousal by looking at another’s body. Almost all children and BIOLOGIC GENDER adolescents pass through a stage when  Is the term used to denote chromosomal voyeurism is appealing. sexual development: male (XY) or female  SADOMASOCHISM – involves inflicting pain (XX). (sadism) or receiving pain (masochism) to achieve sexual satisfaction. GENDER/SEXUAL IDENTITY  MASTURBATION – self-stimulation for erotic  The inner sense a person has of being pleasure. male or female. - Children between ages 2 to 6 years GENDER ROLE discover masturbation as an enjoyable  Is the behaviour a person conveys about activity as they explore their bodies. being a male or female.  EXHIBITIONISM – revealing one’s genitals in public. COMPONENTS OF SEXUALITY  PEDOPHILES – interested in sexual  REPRODUCTIVE SEXUALITY – involves the encounters with children. biological aspects of conception & procreation. It also includes the sexual DISORDER OF SEXUAL FUNCTIONING response.  ERECTILE DYSFUNCTION – formerly referred  GENDER SEXUALITY – deals with the social to as impotence. & emotional aspects of being a man or a - Inability to produce or maintain an woman. erection long enough for vaginal  EROTIC SEXUALITY – refers to sexual love penetration or partner satisfaction. and arousing sexual desires.  PREMATURE EJACULATION – ejaculation before penile contact. TYPES OF SEXUAL ORIENTATION - Can be unsatisfactory and frustrating  HETEROSEXUALITY – a person who finds to both partners. sexual fulfilment with a member of - Can be psychological. opposite gender.  FAILURE TO ACHIEVE ORGASM – can be  HOMOSEXUALITY – a person who finds due to poor sexual technique. sexual fulfilment with a member of his or - Or possible negative attitudes toward her own sex. sexual relationship. - Usually they prefer to be called “gay”  VAGINISMUS – involuntary contraction of for men & “lesbian” for women. muscles at the outlet of the vagina when  BISEXUALITY – people are bisexual if they coitus is attempted. achieve sexual satisfaction from both - This muscle contraction prohibits penile homosexual and heterosexual relationship. penetration.  TRANSEXUALITY – is an individual who,  DYSPAREUNIA – pain during coitus. although one biologic gender, feels as is - Can be due to endometriosis. he or she should be of the opposite  INHIBITED SEXUAL DESIRE – lack of desire for gender. sexual relations may be a concern of - Sex change operations (synthetic young or middle-aged adults. Support or a vagina/penis) caring sexual partner or relief of the SEXUAL EXPRESSIONS tension causing the stress allows a return to  CELIBACY – abstinence from sexual sexual interest. activity. HUMAN SEXUAL RESPONSE  Sexuality has always been a part of human life, but it is only in the past few ANGELIQUE REYES 5 Downloaded by Elaine Negapatan ([email protected])  lOMoARcPSD|35586112 NCMA217 decades that it has been studied ORGASM scientifically. One common finding of  Orgasm occurs when stimulation proceeds researchers has been that feelings and through the plateau stage to a point at attitudes about sex vary widely: the sexual which the body suddenly discharges experience is unique to each individual, accumulated sexual tension. but sexual physiology (i.e., how the body  A vigorous contraction of muscles in the responds to sexual arousal) has common pelvic area expels or dissipates blood and features. fluid from the area of congestion. The average number of contractions for a woman is 8 to 15 contractions at intervals of 1 every 0.8 seconds.  In men, muscle contractions surrounding the seminal vessels and prostate project semen into the proximal urethra. These contractions are followed immediately by three to seven propulsive ejaculatory contractions, occurring at the same time interval as in the woman, which force semen from the penis. EXCITEMENT  Occurs with physical and psychological RESOLUTION stimulation (i.e., sight, sound, emotion, or  Resolution is a 30-minute period during thought) that causes parasympathetic which the external and internal genital nerve stimulation. This leads to arterial organs return to an unaroused state. dilation and venous constriction in the  For the male, a refractory period occurs genital area. The resulting increased blood during which further orgasm is impossible. supply leads to vasocongestion and  Women do not go through this refractory increasing muscular tension. period, so it is possible for women who are  In women, this vasocongestion causes the interested and properly stimulated to have clitoris to increase in size and mucoid fluid additional orgasms immediately after the to appear on vaginal walls as lubrication. first. The vagina widens in diameter and MENSTRUATION increases in length. The nipples become  This is the monthly menstrual bleeding (also erect. called menstruation or menstrual period)  In men, penile erection occurs, as well as that you have from your early teen years scrotal thickening and elevation of the until menstrual periods end around age 50 testes. In both sexes, there is an increase in (menopause). heart and respiratory rates and blood  About once a month, the uterus grows a pressure. new, thickened lining (endometrium) that PLATEAU can hold a fertilized egg.  The plateau stage is reached just before  Menstrual cycle is measured from the first orgasm. In the woman, the clitoris is drawn day of menstrual bleeding, Day 1, up to forward and retracts under the clitoral Day 1 of your next menstrual bleeding. prepuce; the lower part of the vagina  A teen's cycles tend to be long (up to 42 becomes extremely congested (formation days), growing shorter over several years. of the orgasmic platform), and there is  The average menstrual period is 5 days. increased nipple elevation.  The amount of blood loss every menstrual  In men, the vasocongestion leads to period is 30 to 80 ml. The normal color of distention of the penis. Heart rate the menses is dark red that contains increases to 100 to 175 beats per minute mucus and endometrial cells. and respiratory rate to approximately 40 ORGANS INVOLVED IN MENSTRUATION respirations per minute. ANGELIQUE REYES 6 Downloaded by Elaine Negapatan ([email protected])  lOMoARcPSD|35586112 NCMA217  HYPOTHALAMUS – stimulates anterior - At about day 14, in response to a surge pituitary gland to begin production of of luteinizing hormone, the egg is gonadotropic hormones. released from the ovary.  PITUITARY GLAND – under the influence of - The egg travels through the fallopian LHRH, the anterior pituitary gland produces tube toward the uterus. 2 hormones that act on the ovaries to  THE LUTEAL PHASE: Days 14 through 28 further influence menstruation. - The remains of the follicle become the - FSH: a hormone that is active early in a corpus luteum which releases cycle & is responsible for maturation of progesterone. the ovum. - LH: a hormone that becomes most UTERINE CYCLE active at the midpoint of the cycle & is  PROLIFERATIVE PHASE: Days 5 -14 responsible for ovulation or release of - The uterine lining increases rapidly in the mature egg cell from the ovary, thickness, and the uterine glands and growth of uterine lining. proliferate and grow.  OVARIES – one ovum matures in one or the  SECRETORY PHASE: Days 14 through 28 other ovary & is discharge from it each - When an egg is not fertilized, the month. corpus luteum gradually disappears,  UTERUS – stimulation from the hormones estrogen and progesterone levels produced by the ovaries causes specific drop, and the thickened uterine lining monthly effects on the uterus. is shed. This is menses (your period). ESTROGEN (Hormone for Woman)  Stimulate the growth, development, and maintenance of female reproductive structures, secondary sex characteristics and the breast.  They help regulate fluid and electrolyte balance.  The stimulate protein synthesis.  They lower blood cholesterol levels.  Spinnbarkeit and ferning.  Thickening of the endometrium. PROGESTERONE  Is secreted mainly by the corpus luteum and works with estrogen to prepare the endometrium for implantation and mammary glands for lactation. TIME OF OVULATION  Decrease GI motility.  An easy way to approximate the time of  Increase permeability of kidney to lactose ovulation for women with regular cycles is & dextrose. to subtract 16 from the number of days in  Responsible for the mood swings of the the cycle and then add 4. This will mother. calculate the span of days in which  Mammary gland development. ovulation is most likely to occur. OVARIAN CYCLE SIGNS & SYMPTOMS OF OVULATION  THE FOLLICULAR PHASE: Days 1 through 13.  MITTLELSCHMERZ – abdominal tenderness - In response to follicle stimulating on left/right iliac regions, brought about by hormone (FSH) released from the peritoneal irritation due to blood coming pituitary gland in the brain, ultimately out from the graafian follicle. one egg matures  SPINNBARKEIT – vaginal secretion is clear &  OVULATION: Day 14 transparent.  CHANGE IN VAGINAL MUCUS ANGELIQUE REYES 7 Downloaded by Elaine Negapatan ([email protected])  lOMoARcPSD|35586112 NCMA217  GOODEL’S SIGN  At the time of ovulation, there is a  MOOD CHANGES reduction in the viscosity (thickness) of the  BREAST TENDERNESS cervical mucus, which makes it easy for  INCREASED LEVELS OF PROGESTERONE spermatozoa to penetrate it. Sperm  CHANGE IN BASAL BODY TEMPERATURE transport is so efficient close to ovulation that spermatozoa deposited in the vagina ANTEPARTAL PERIOD generally reach the cervix within 90  OVUM – from ovulation to fertilization seconds and the outer end of a fallopian  ZYGOTE – from fertilization to implantation tube within 5 minutes after deposition.  EMBRYO – from implantation to 5-8 weeks  Spermatozoa move through the cervix  FETUS – from 5-8 weeks until term and the body of the uterus and into the  CONCEPTUS – developing embryo or fetus fallopian tubes, toward the waiting ovum and placental structure throughout by the combination of movement by their pregnancy. flagella (tails) and uterine contractions. PROCESS OF FERTILIZATION  CAPACITATION is a final process that  FERTILIZATION (CONCEPTION, sperm must undergo to be ready for FECUNDATION) fertilization. This process, which happens as - Is the union of an ovum and a the sperm move toward the ovum, consists spermatozoon. This usually occurs in of changes in the plasma membrane of the outer third of fallopian tube. the sperm head, which reveal the sperm  Usually only one of a woman’s ova will binding receptor sites. reach maturity each month. Once the  HYALURONIDASE (a proteolytic enzyme) is mature ovum is released, fertilization must released by the spermatozoa and occur fairly quickly because an ovum is dissolves the layer of cells protecting the capable of fertilization for only 24 hours (48 ovum. Under ordinary circumstances, only hours at the most). one spermatozoon is able to penetrate  After that time, it atrophies and becomes the cell membrane of the ovum. Once it nonfunctional. Because the functional life penetrates the cell, the cell membrane of a spermatozoon is also about 48 hours, changes composition to become possibly as long as 72 hours, the total impervious to other spermatozoa. critical time span during which sexual relations must occur for fertilization to be successful is about 72 hours (48 hours before ovulation plus 24 hours afterward).  As the ovum is extruded from the graafian follicle of an ovary with ovulation, it is surrounded by a ring of mucopolysaccharide fluid (the zona pellucida) and a circle of cells (the corona radiata).  The ovum and these surrounding cells (which increase the bulk of the ovum and serve as protective buffers against injury) are propelled into a nearby fallopian tube by currents initiated by the fimbriae—the fine, hair like structures that line the IMPLANTATION openings of the fallopian tubes. A  Once fertilization is complete, a zygote combination of peristaltic action of the migrates over the next 3 to 4 days toward tube and movements of the tube cilia the body of the uterus, aided by the help propel the ovum along the length of currents initiated by the muscular the tube. contractions of the fallopian tubes. During ANGELIQUE REYES 8 Downloaded by Elaine Negapatan ([email protected])  lOMoARcPSD|35586112 NCMA217 this time, mitotic cell division, or cleavage,  INVASION – the blastocyst settles begins. down into its soft folds.  The first cleavage occurs at about 24  ***once the zygote hours; cleavage divisions continue to implanted it is an EMBRYO. occur at a rate of about one every 22 hours. By the time the zygote reaches the CONCEPT MAPPING body of the uterus, it consists of 16 to 50  A visual representation that allows you cells. At this stage, because of its bumpy graphically show the connections outward appearance, it is termed a between a client’s many products. morula (from the Latin word morus,  An effective learning strategy to meaning “mulberry”). understand the relationship that exist  Large cells tend to collect at the periphery between client problems. of the ball, leaving a fluid space  Allows the student to organize and link surrounding an inner cell mass. At this information about a client in unique and stage, the structure becomes a blastocyst. meaningful ways. It is this structure that attaches to the APPLICATION TO NURSING PRACTICE uterine endometrium. The cells in the outer  A concept map allows the student to ring are trophoblast cells. organize and link information about a  Implantation, or contact between the client in unique and meaningful ways. growing structure and the uterine  The relationship seen between multiple endometrium, occurs approximately 8 to nursing diagnoses allow students to plan 10 days after fertilization. interventions that are therapeutic for more  The structure brushes against the rich than one problem area. uterine endometrium (in the second  Use of concept maps helps students to [secretory] phase of the menstrual cycle), reflect and critically think about a process termed apposition. It attaches relationships between clinical information to the surface of the endometrium in a way that promotes clinical decision (adhesion) and settles down into its soft making. folds (invasion).  The blastocyst is able to invade the ETIOLOGY endometrium because, as the trophoblast  Is defined as the science of finding causes cells on the outside of the structure touch and origins. the endometrium, they produce  An example of etiology is knowing that proteolytic enzymes that dissolve any some of the causes of high blood pressure tissue they touch. This action allows the are smoking, lack of exercise, stress and a blastocyst to burrow deeply into the diet high in salt and fats. endometrium and receive some basic COMPONENTS OF CONCEPT MAP nourishment of glycogen and  RISK FACTORS – are conditions that mucoprotein from the endometrial glands. increase your risk of developing a disease. As invasion continues, the structure  MODIFIABLE RISK FACTORS – meaning you establishes an effective communication can take measures to change them. network with the blood system of the Examples: endometrium. - Alcohol consumption  Implantation or contact between the - Overweight and obesity growing structure and the uterine - Physical activity endometrium occurs approximately 8 to - Health eating 10 days after fertilization.  NON – MODIFIABLE RISK FACTOR – which  APPOSITION – the blastocyst means they cannot be changed. brushes against the rich uterine Examples: endometrium - AGE – according to American Heart  ADHESION – it attaches to the Association computations, about 80% surface of the endometrium ANGELIQUE REYES 9 Downloaded by Elaine Negapatan ([email protected])  lOMoARcPSD|35586112 NCMA217 of people who die from cardiovascular  NURSING INTERVENTIONS – are the actual disease are 65 years and older. treatments and actions that are performed - GENDER – heart disease has long been to help the patient to reach the goals that considered to be primarily a men’s are set for them. disease. - INDEPENDENT – auscultate apical - FAMILY HISTORY pulse, assess heart rate, rhythm. - RACE Document dysrhythmia if telemetry is  PATHOPHYSIOLOGY – is the study of the available. physical and biological abnormalities - DEPENDENT – administer diuretics as occurring within the body as a result of the indicated. Administer IV solutions, disease. restricting total amount as indicated.  MEDICAL DIAGNOSIS – the process of - COLLABORATIVE – refer to dietitian for identifying disease, condition, or injury counselling specific to individual from its signs and symptoms. dietary customs. - A health history, physical exam, and COMPONENTS OF CONCEPT MAP: NURSING tests, such as blood tests, imaging INTERVENTIONS tests, and biopsies, may be used to help make a diagnosis.  ENVIRONMENT – means anything that  DIAGNOSTIC TEST – is any approach used surround us. It includes physical, chemical to gather clinical information for the and other natural forces. purpose of making a clinical decision.  SPIRITUALITY – involves the recognition of a  MEDICAL AND SURGICAL MANAGEMENT feeling or sense of belief that there is - MEDICAL – a medical condition something greater than myself. involves a more systematic, - An opening of the heart is an essential pharmaceutical approach to aspect of true spirituality. treatment.  DISCHARGE PLANNING – is when the - SURGICAL – a surgical disease is one patient, career, family and any staff that requires some form of localized involved make the necessary intervention such as, of course, surgery, arrangements to ensure there is a smooth although various vascular interventions transition from hospital to home, residential and radiation techniques would also care or somewhere else. fall into this category. - It involves taking into account things  SIGNIFICANCE/PERTINENT FINDINGS like follow up tests and appointments. - HISTORY AND PHYSICAL EXAMINATION - Outpatient follow up – was defined as – that formulate a differential an office visit with any primary care or diagnosis. specialist physician. - For example: if the patient’s chief complaint is chest pain, pertinent FAMILY PLANNING findings would include things like:  The concept of enhancing the quality of POSITIVE FINDINGS – clinical families w/c includes: significance is essentially a subjective - Regulating & spacing childbirth interpretation of research findings as - Helping sub fertile couples beget meaningful for patient under care, children and therefore likely to influence the - Counselling parents and would-be behaviour of healthcare provider. parents  NURSING DIAGNOSIS – is a clinical - The privilege and the obligation of the judgement concerning human response to (married) couple exclusively to decide health conditions/life process. w/ love when and how many children  EXPECTED OUTCOMES – are forecasted provided: the motive is justified and results-relate directly to program goals the means are moral. and objectives. - Involves personal decisions based on each individual’s background, ANGELIQUE REYES 10 Downloaded by Elaine Negapatan ([email protected])  lOMoARcPSD|35586112 NCMA217 experiences and sociocultural beliefs.  Requires considerable control over the It involves thorough planning to be sexual urge. certain that the method chosen is RHYTHMIC ABSTINENCE acceptable and can be used  Identification of the periods of fertility and effectively. the periods of sterility in the menstrual FUNCTION OF THE HEALTH PROFESSIONAL IN cycle of a woman and the restriction of FAMILY PLANNING sexual intercourse to the sterile periods or  To counsel, reassure, give information and the time when the pregnancy is unlikely allow an individual/couple to decide because the woman is biologically his/her/their course of action according to unprepared to conceive. what he/she think is appropriate for them  Also known as “safe or infertile period” and in accordance to their own personal, technique and “natural birth control” or societal, religious beliefs & values. NFP because there is nothing artificial used to prevent conception. FAMILY PLANNING SERVICES  These methods are based on the ff. TEMPORARY CONCEPTION CONTROL principles:  Methods used to prevent conception - The human ovum is susceptible to  Methods used to prevent ovulation fertilization for approx. 18-24 hours after  Methods used to prevent implantation ovulation STERILIZATION/PERMANENT CONCEPTION - The sperms deposited in the vagina CONTROL are ordinarily capable of fertilizing the  Tubal Occlusion / Bilateral Tubal Ligation ovum for no more than 72 hours  Vasectomy or Vas Ligation - Present methods of determining ovulation time are inexact and seldom METHODS USED TO PREVENT CONCEPTION: sufficiently predictive (by at least 48 NATURAL METHODS hours) so that in practice, it is COITUS INTERRUPTUS necessary to avoid intercourse for a far  Oldest type of birth control practiced by longer period of time than 72 hours man. before ovulation and 24 hours after  The premature withdrawal of the penis ovulation. before ejaculation during sexual intercourse. CALENDAR METHOD  Reliability is low because sperms are  The use of mathematical calculations to emitted in varying quantities in the normal predict the probable time of ovulation. lubricating fluid secreted throughout “Ovulation most often takes place 14 days intercourse. before the onset of the next menstruation.”  Psychological disadvantage.  Ogino-knaus formula:  Not accepted by the Catholic Church. 1. Determine the shortest and longest cycle WITHDRAWAL ex. Shortest cycle = 28 days  Removal of penis from the vagina before Longest cycle = 36 days ejaculation occurs. 2. If the cycle is irregular, subtract 18 from  NOT a sufficient method of birth control by the shortest and 11 from the longest itself. ex. 28-18=10 ex. 25-18=7  Effectiveness rate is 80% (very 36-11=25 29-11=18 unpredictable in teens, wide variation). 3. The difference between the shortest  1 of 5 women practicing withdrawal cycle and 18 determines the earliest become pregnant. time when ovulation occur.  Very difficult for a male to ‘control’. 4. The difference between the longest cycle and 11 determines the last day COITUS RESERVATUS when ovulation can occur.  Male does not reach orgasm and therefore no ejaculation occurs. ANGELIQUE REYES 11 Downloaded by Elaine Negapatan ([email protected])  lOMoARcPSD|35586112 NCMA217 5. Ovulation can occur anytime  This type of mucus is described as “clear in between. and translucent and about the consistency 6. In a regular 28 day cycle, abstinence of raw egg white.” should be observed from day 9 to day  A particular type of cervical mucus felt by 17. (count 5 days before the earliest the woman at the vaginal opening is a ovulation and 3 days after the last signal of ovulation. day)  Research shows this type of mucus appears necessary for conception. Without the mucus, sperm transport is impeded.  PHASES OF WETNESS/DRYNESS - WET – menstruation - DRY - basic infertile pattern  Sequence of dry days (or days of unchanging mucus) indicating low level of estrogen and present infertility.  Duration is invariable, could be days, weeks, months or zero (if cycle is short). - WET – days of possible fertility BASAL BODY TEMPERATURE  Changing mucus; non-slippery  This relies on slight changes (0.3 to at first later becoming slippery. 0.6ºC) in basal body temperature that  Peak: last day of slippery may occur just before ovulation mucus.  Pre-ovulatory temperature is low because  Days 1-3 after the peak are of high estrogen levels part of fertile period.  Post-ovulatory temperature rise is due to - DRY – infertile days high progesterone  Day 4 after the peak till the end  The temperature is taken every morning at of the cycle. the same time with the same thermometer  Ends about 2 weeks after the just before arising and after at least 4-6 peak. hours of continuous sleep. LACTATIONAL AMENORRHEA METHOD  3 days of elevation indicate temperature  LAM is based on scientific evidence that a change is due to ovulation. woman is not fertile and unlikely to  Abstinence should be observed 5 days become pregnant during full lactation or before and 3 days after temperature rise. exclusive breastfeeding. BILLINGS OR CERVICAL MUCUS METHOD  Full lactation describes breastfeeding when no regular supplemental feeding of any type is given (not even water) and the infant is feeding both day and night with little separation from the mother.  LAM provides maximum protection as long as: - Menstruation has not resumed and - Bottle feeds or regular food supplements are not introduced and - Baby is less than 6 months of age. ANGELIQUE REYES 12 Downloaded by Elaine Negapatan ([email protected])  lOMoARcPSD|35586112 NCMA217  Emergency contraception pills can reduce the chance of a pregnancy by 75% if taken within 72 hours of unprotected sex!  Must be taken within 72 hours of the act of unprotected intercourse or failure of contraception method  Must receive ECP from a physician  75 – 84% effective in reducing pregnancy  Floods the ovaries with high amount of hormone and prevents ovulation  Alters the environment of the uterus,  Successful use of natural methods to making it disruptive to the egg and sperm prevent pregnancy depends upon:  Two sets of pills taken exactly 12 hours - The accuracy of the method in apart identifying the woman's actual fertile days. METHODS USED TO PREVENT CONCEPTION: LOCAL - A couple's ability to correctly identify BARRIER METHODS the fertile time. CONDOM - The couple's ability to follow the rules  A thin stretchable rubber sheath worn over of the method they are using the penis by the man during intercourse.  Pregnancy rate is 7- 28% ADVANTAGES  Added potential of preventing STD’s  Safe and has no side-effects.  Inexpensive.  Acceptable to religious affiliations that do not accept artificial methods of contraception.  Helpful for planning pregnancy and avoiding pregnancy.  Promotes communication about family planning and contraception between couples. DISADVANTAGES  Involves long preparation and intensive recording before it can be used.  There is a need to abstain on certain days which may be inconvenient for the couple.  Not ideal to women with irregular cycles.  Not very reliable because of menstrual cycle variations thay may occur anytime. OVULATION DETECTION TEST KITS  Test kits that measures the level of LH and VAGINAL DIAPHRAGM predict ovulation are now available in USA  A shallow, dome-shaped rubber device and other countries. with a flexible wire rim that covers the  These kits detect the level of LH in the urine cervix; maybe inserted several hours w/c surges 12-24 hours before ovulation. before intercourse and left in place for at  It is 98 to 100% effective. least 6 hours after the last intercourse  When a woman sees that her LH level is  Initially fitted by a health professional high, she should avoid coitus.  Weight loss/gain of 15 lbs may require EMERGENCY CONTRACEPTION re-fitting ANGELIQUE REYES 13 Downloaded by Elaine Negapatan ([email protected])  lOMoARcPSD|35586112 NCMA217  Inserted before intercourse with the INTRAVAGINAL CONTRACEPTIVES (SPERMICIDES) woman in squatting or supine position, or with one leg elevated on a chair.  May cause cervicitis if left in place for too long.  Washed with mild soap & water, lasts for 2-3 years.  97% efficiency.  SIDE EFFECTS OF SPERMICIDES - You or your partner may be allergic to materials in spermicide. This can cause genital irritation, rash, or itchiness. If this happens and your spermicide has nonoxynol-9, try a spermicide without this chemical. PREVENTION OF OVULATION  Use of contraceptives: CERVICAL CAP - Pills - Injectable - Implant  Comes in 2 types: presized (S-M-L) and custom fitted (a plastic cap fitted to conform to the individual woman’s cervix made after making a mold of cervix with non-toxic substance used to make contact lenses) CONTRACEPTIVE PILLS  Contraindications: hx of TSS, PID, cervicitis,  Estrogen & progesterone prevent cervical cap, vaginal bleeding, an allergy pregnancy by inhibiting the hypothalamus to latex/spermicide and anterior pituitary so that ovulation does not occur. They also inhibit fertility by: 1. Altering the motility of the fallopian tubes 2. Inadequately developing the endometrium 3. Keeping cervical mucus unreceptive and unsupportive of sperm TYPES OF PILLS ANGELIQUE REYES 14 Downloaded by Elaine Negapatan ([email protected])  lOMoARcPSD|35586112 NCMA217  COMBINATION PILLS – contain both INJECTIBLE CONTRACEPTIVE (DEPO-PROVERA, progesterone & estrogen; taken from day NORISTERAT, ETC) 5 to day 25 of the menstrual cycle  Synthetic progestin hormones injected into  SEQUENTIAL muscle: administered every 3 months. - 2 TYPES OF PILLS ARE TAKEN:  Contains estrogen alone – taken from day 5-19  Contains progestin – taken from day 20-25  ALL PROGESTIN (MINIPILL) – taken everyday. - Does not necessarily inhibit ovulation; prevents implantation of the zygote.  SIDE EFFECTS: - Thrombo-embolic disorders and other  DEPO-PROVERA vascular problems including CVA & MI - Birth control shot given once every - Oral pills should be discontinued for 4-8 three months to prevent pregnancy weeks before anticipated surgery - 99.7% effective preventing pregnancy - Alterations in metabolism, esp. of CHOs - No daily pills to remember and B-vitamins (pyridoxine & folic acid) - Fetal effects after discontinuing the pill- evidence of increased of chromosomal changes - Amenorrhea after discontinuing the pill - Neoplastic disease (breast, liver- hepatocellular adenoma) - Hypertension - Adverse drug interactions IMPLANT (NORPLANT)  6 tiny silicone rubber capsules or 2 rods containing progestin (evonorgestiel), ESTROGEN EXCESS surgically implanted under the skin of the  Nausea & vomiting upper arm; removed surgically in about 5  Dizziness years or when the woman wishes to  Edema discontinue the method.  Leg cramps  Increase in breast size  Chloasma  Visual changes  Hypertension  Vascular headache ESTROGEN DEFICEIT  Early spotting (days 1-14)  Hypo menorrhea  Nervousness  Atrophic vaginitis leading to painful intercourse PROGESTERONE EXCESS  Increased appetite ANGELIQUE REYES 15 Downloaded by Elaine Negapatan ([email protected])  lOMoARcPSD|35586112 NCMA217  Tiredness CONTRAINDICATIONS OF IUD  Depression  Any inflammatory condition or infection of  Breast tenderness the reproductive tract or PID  Vaginal yeast infection  Abnormalities of the uterus  Oily skin and scalp  Severe dysmenorrhea  Hirsutism  Uterine bleeding of unknown origin  Postpill amenorrhea  Suspected pregnancy PROGESTERONE DEFICIENCY COMPLICATIONS / ADVERSE REACTIONS  Late spotting and break-through  Syncope during insertion bleeding (days 15-21)  Increased risk of PID w/c may result in  Heavy flow with clots  Sterility or infertility  Decreased breast size  Medical-surgical intervention for complications such as twisted ovary, PREVENTION OF IMPLANTATION bowel obstruction, unilateral tubo-ovarial INTRA-UTERINE DEVICE (IUD) abscess  An object made of plastic or non-reactive  Perforation of the uterus metal (nickel-chromium alloy) that fits  Dysmenorrhea inside the uterine cavity  Increased blood loss (anemia)  Manufactured in several shapes (loop,  Ectopic pregnancy coil, spiral)  Expulsion  Causes a chronic inflammatory response in the endometrium, discouraging IUD DANGER SIGNS implantation of a fertilized ovum  P – period late or skipped period  Conception may occur; if implantation  A – abdominal pain takes place, it causes early abortion  I – increased temperature (fever)  N - noticeable vaginal discharge; foul- smelling  S – spotting, heavy periods, bleeding VAGINAL RING (NUVA RING)  95-99% Effective A new ring is inserted into the vagina each month  Does not require a "fitting" by a health care provider, does not require spermicide, can make periods more regular and less painful, no pill to take daily, ability to become pregnant returns quickly when use is stopped.  Nuva Ring is a flexible plastic (ethylene- TYPES OF IUD vinyl acetate copolymer) ring that  NON-MEDICATED releases a low dose of a progestin and an - Lippes-Loop- available in 4 sizes (A estrogen over 3 weeks. small to D- large); has been withdrawn from the market - Saf-T-coil – available in 2 sizes (small & large)  MEDICATED - Copper 7 (Cu 200) – copper has direct spermicidal effect; has been withdrawn from the market - Copper-T (T-Cu 200, tatum copper bearing IUD) - Progestasert-T ANGELIQUE REYES 16 Downloaded by Elaine Negapatan ([email protected])  lOMoARcPSD|35586112 NCMA217 STERILIZATION/PERMANENT CONCEPTION CONTROL TUBAL OCCLUSION/BILATERAL TUBAL LIGATION  Involves tying, cutting or cauterizing the fallopian tubes  Usually done immediately after delivery (within 24- 48 hours) when the incidence of morbidity & failure are lowest  May also be done in any phase of the menstrual cycle METHODS: 1. Mini-laparotomy 2. Laparoscopy or “Band-Aid surgery” 3. Vaginal tubal sterilization CARE OF THE FETUS EMBRYONIC STRUCTURE THE DECIDUA  After fertilization, the corpus luteum in the ovary continues to function rather than atrophying, because of the influence of human chorionic gonadotropin (hCG), a hormone secreted by the trophoblast cells. This causes the uterine endometrium to continue to grow in thickness and vascularity, instead of sloughing off as in a usual menstrual cycle. The endometrium is now termed the decidua (the Latin word for “falling off”), because it will be discarded after the birth of the child. VASECTOMY / VAS LIGATION  Accomplished without entry into the abdominal cavity; twin incisions are made in the area where the scrotum joins the body, just over the vas deferens  The tubes are tied and separated; portions maybe excised.  Follow-up sperm counts maybe done after. 3 SEPARATE ARES OF DECIDUA 1. DECIDUA BASALIS - the part of the endometrium that lies directly under the embryo (or the portion where the trophoblast cells establish communication with maternal blood vessels) 2. DECIDU