CMCA-NOTES.pdf

CMCA I 2ND YEAR | 1ST SEMESTER KOLEHIYO NG LUNGSOD NG DASMARINAS – INSTITUTE OF NURSING WEEK 2: NURSING PERSONNEL PHILOSOPHY OF Care of Mother, Child and Adolescent AS PRECEPTOR AND CLINICAL According to WHO, CMCA is: INS...

CMCA I 2ND YEAR | 1ST SEMESTER KOLEHIYO NG LUNGSOD NG DASMARINAS – INSTITUTE OF NURSING WEEK 2: NURSING PERSONNEL PHILOSOPHY OF Care of Mother, Child and Adolescent AS PRECEPTOR AND CLINICAL According to WHO, CMCA is: INSTRUCTOR FAMILY CENTERED - Nurses assessment should not only focus on the CARE OF MATERNAL AND CHILD, ADOLESCENT individual client but for the members of the family as well “Maternal and child health services can be defined as - The nurses should work with patients and their promoting, preventing, therapeutic or rehabilitation families rather than working to or for the patients facility or care for the mother and child” and their families - According to WHO COMMUNITY CENTERED - The basic unit of the community is the family. Thus, the health of the community RESEARCH ORIENTED Nursing research is very important because it help nurses improve their knowledge and clinical expertise in the clients to provide quality nursing care MATERNAL AND CHILD HEALTH (MCH) BASED ON NURSING THEORIES - refer to a package of comprehensive health care Evidence based practice this provides a services which are developed to meet promotive, foundation and basis for nursing functions and preventive, curative, rehabilitative needs of nursing care pregnant women before, during and after delivery and of infants, pre-school, school age, adolescent STANDARDS OF CARE OF MOTHER, CHILD AND children from birth to 18-19 years. ADOLESCENT PRACTICE GOALS AND PHILOSOPHIES OF MATERNAL AND CHILD Standards of Care Comprehensive pediatric HEALTH NURSING nursing care focuses on helping children and their families and communities achieve their optimum The primary goal of maternal and child health health potential. This is best achieved within the nursing care can be stated simply as the framework of family-centered care and the promotion and maintenance of optimal family nursing process, including primary, secondary, health to ensure cycles of optimal childbearing. and tertiary care coordinated across health care The goals of maternal and child health nursing care are and community settings. necessarily broad because the scope of practice is so Theorist Major Concepts of Emphasis of Care broad. The range of practice includes Theory Preconceptual health care Patricia Benner Nursing is a caring Assess Terry as a Care of women during three trimesters of relationship. Nurses whole. An expert grow from novice to nurse is able to do pregnancy and the puerperium (the 6 weeks after expert as they this intuitively from childbirth, sometimes termed the fourth trimester practice in clinical knowledge gained of pregnancy) settings. from practice. Care of children during the perinatal period (6 Dorothy Johnson A person comprises Assess the effect of weeks before conception to 6 weeks after birth) subsystems that lack of arm function Care of children from birth through adolescence must remain in on Terry as a whole; balance for optimal modify care to functioning. Any maintain function to actual or potential all systems, not just threat to this system musculoskeletal. balance is a nursing concern. OREJANA, ROMMEL C. 1 PATRICIA BENNER Hildegard The promotion of Plan care together with THEORY Peplau health is viewed as Terry. Encourage her to the forward speak of school and Novice movement of the accomplishments in Beginner personality; this is Girl Scouts to retain Competent accomplished self-esteem. Proficient through an Expert interpersonal process that Theorist Major Concepts of Emphasis of Care includes Theory orientation, identification, exploitation, and Florence The role of the nurse Turn Terry’s bed into resolution. Nightingale is viewed as the sunlight; changing or provide adequate Martha Rogers The purpose of Help Terry to make use structuring covers for warmth; nursing is to move of her left side as much elements of the leave her the client toward as possible so that she environment such comfortable with optimal health; the returns to school and to as ventilation, electronic games to nurse should view her previous level of temperature, odors, occupy her time. the client as whole functioning as soon as noise, and light to and constantly possible put the client into changing and help the best opportunity people to interact in for recovery the best way possible with the Betty Neuman A person is an open Assess for stressors environment. system that such as loss of self- interacts with the esteem and derive Dorothea Orem The focus of nursing Arrange overbed table environment; ways to prevent is on the individual; so Terry can feed nursing is aimed at further loss such as clients are assessed herself; urge her to reducing stressors praising her for in terms of ability to participate in care by through primary, combing her own complete self-care. doing as much for secondary, and hair. Care given may be herself as she can. tertiary prevention. wholly compensatory Imogene King Nursing is a process Discuss with Terry (client has no role); of action, reaction, the way she views partly interaction, and herself and illness. compensatory transaction; needs She views herself as (client participates are identified based a well child, active in care); or on client’s social in Girl Scouts and supportive- system, school; structure educational (client perceptions, and care to help her performs own care). health; the role of meet these the nurse is to help perceptions. SisterCalista The role of the nurse Assess Terry’s ability to the client achieve Roy is to aid clients to use her left hand to goal attainment. adapt to the change replace her right-hand caused by illness; functions, which are Madeleine The essence of Assess Terry’s levels of adaptation now lost; direct nursing Leininger nursing is care. To family for beliefs depend on the care toward replacing provide about healing. degree of deficit with other transcultural care, Incorporate these environmental factors, self concept, the nurse focuses into care. change and state of role function, and skills. on the study and coping ability; full analysis of different adaptation include cultures with physiologic respect to caring interdependence. behavior. OREJANA, ROMMEL C. 2  Ida Jean The focus of the Ask Terry what she feels Orlando nurse is interaction is her main need. Terry with the client: says that returning to effectiveness of school is what she care depends on the wants most. Stress client’s behavior activities that allow her and the nurse’s to maintain contact reaction to that with school, such as behavior. The client doing homework or should define his or telephoning friends. her own needs. Rosemarie Nursing is a human Ask Terry what being Rizzo Parse science. Health is a sick means to her. Allow lived experience. her to participate in Man-living health as care decisions based a single unit guides on her response. Plan practice. care together with Terry. ROLES AND RESPONSIBILITIES OF A MATERNAL AND CHILD HEALTH NURSE 1. Provide evidence-based assessments with emphasis on health promotion and well being 2. Provide information, support, advice and appropriate referrals relating to children and parents’ wellbeing - Health - Breastfeeding - Antenatal - Immunization - Postnatal care CONT. ROLES AND RESPONSIBILITIES 3. Acts as an advocate for children, parents, and the community. 4. Recognize and facilitate the access to families of cultural and linguistic diverse backgrounds. 5. Provide prenatal care to pregnant women and health WHO’S 17 SUSTAINABLE DEVELOPMENT GOALS GOAL 1. No Poverty GOAL 2. Zero Hunger GOAL 3. Good Health and well- being GOAL 4. Quality Education GOAL 5. Gender Equality GOAL 6. Clean Water and Sanitation GOAL 7. Affordable and Clean Energy GOAL 8.Decent Work and Economic Growth GOAL 9. Industry, Innovation and Infrastructure GOAL 10. Reduced Inequality GOAL 11. Sustainable Cities and Communities GOAL 12. Responsible Consumption and Production GOAL 13. Climate Action GOAL 14. Life Below Water GOAL 15. Life on Land GOAL 16. Peace and Justice Strong Institutions GOAL 17. Partnerships to achieve the goal OREJANA, ROMMEL C. 3 WEEK 3: HUMAN SEXUALITY ADULTHOOD - Responsibility & Choice - Marriage - Legitimate sexual expression Occurrence of: TRANSSEXUALITY MIDLIFE - Re-examination of life goals, careers, accomplishments, value systems & familial or social relationships RELATED TERMINOLOGIES: Sex OLDER ADULTHOOD Sexual Behavior Sexuality - Can still enjoy active sexual relationships. Biological Gender SEXUAL ATTITUDES Gender Identity Gender Role Influenced by the following: DEVELOPMENT OF SEXUALITY - Home environment - Cultural background - Educational background - Socioeconomic level - Previous sexual experiences - Personal characteristics - Variations in sex drive or libido Starts at conception… SEXUAL SENSORS INFANCY - Mucocutaneous system Satisfaction through: - Nipple-areolar system - oral stimuli - Pressure sensitive receptors - contact with another - Touch receptors of the skin - cuddling / holding - Visceral receptor - AUTOSEXUALITY - Other senses TODDLER HUMAN SEXUAL RESPONSE - Toilet Training - Feelings and attitudes about sex vary widely - Masturbation - Sexual experience is unique to each individual - Sexual Identity - Response of the body to sexual arousal has common features CHILDHOOD THE SEXUAL RESPONSE CYCLE - Homosexuality - Heterosexuality ADOLESCENT - Psychological immaturity - Sexual experimentation Relationships: - Homosexual - Heterosexual OREJANA, ROMMEL C. 4  EXCITEMENT CONTROVERSIES ABOUT THE FEMALE ORGASM WOMEN: Two Types of Female Orgasm: - Clitoris increases in size - Clitoral - Mucoid fluid appears in the vaginal walls - Vaginal - Vagina widens in diameter and length Occurrence of the G-spot - Fine rash or “sex flush” appears - Nipples become erect INFLUENCE OF THE MENSTRUAL CYCLE ON SEXUAL - HR, RR, & BP increases RESPONSE MEN: - During the 2nd half of the menstrual cycle, there is increased fluid retention and vasocongestion in the - Penile erection occurs woman’s lower pelvis. In line with this, sexual - Scrotum thickens response during this time enables the woman to - Testes elevate achieve plateau more quickly and achieve orgasm - Motor restlessness more readily. - HR, RR, & BP increases INFLUENCE OF THE PREGNANCY ON SEXUAL PLATEAU RESPONSE WOMEN: - Pregnancy is another time in life where there is - Clitoris is drawn forward & retracts under the vasocongestion of the lower pelvis clitoral prepuce - Following pregnancy, many women experience - Lower part of the vagina becomes congested increased sexual interest - There is increased nipple elevation - For some women, increased breast engorgement results in extreme breast sensitivity during coitus MEN: TYPES OF SEXUAL ORIENTATION - Distention of the penis - HR incr. to 100-175 bpm Heterosexuality - RR incr. approx. 40 cpm Homosexuality Bisexuality ORGASM Transsexuality WOMEN: - Uterine contractions from fundus to the lower uterine segment happens - There is minimal relaxation of the cervical os - There is external sphincter contraction MEN: - Ejaculation of semen occurs through a series of muscular contractions RESOLUTION REFRACTORY PERIOD WOMEN: - Do not go through this period MEN: - Further orgasm becomes Impossible OREJANA, ROMMEL C. 5 WEEK 4: ANTEPARTUM THE FEMALE REPRODUCTIVE ANATOMY & PHYSIOLOGY THE BONY PELVIS THE INNOMINATE BONES The female bony pelvis has two unique functions: The ILIUM is the broad, upper prominence of the hip. To support and protect the pelvic contents ILIAC CREST – the margin of the ilium. To form the relatively fixed axis of the birth passage ANTERIOR SUPERIOR ILIAC SPINE - the anterior terminal point of the iliac crest ANTERIOR INFERIOR ILIAC SPINE- the anterior lower point in the iliac crest. POSTERIOR SUPERIOR ILIAC CREST - the posterior terminal point of the iliac crest ILIAC FOSSA - the concave anterior portion ILEOPECTINEAL LINE OR LINEA TERMINALIS - an imaginary line or ridge which divides the false from the true pelvis THE 4 BONES OF THE PELVIS: 2 INNOMINATE BONES 1 SACRUM 1 COCCYX OREJANA, ROMMEL C. 6 The ISCHIUM, the strongest bone, is under the ilium and THE COCCYX below the acetabulum. ISCHIAL TUBEROSITY – where the weight of the seated body rests. ISCHIAL SPINES – serve as reference points during labor The shortest diameter of the pelvic cavity is between the ischial spines. CLINICAL SIGNIFICANCE OF THE ISCHIAL SPINES: - Somewhat encroached on the pelvic cavity, so if they are too prominent, they may offer some degree of obstruction to the passage of the baby. The small triangular bone last on the vertebral column is - Serves as a useful landmark when making a the coccyx. vaginal examination to assess the progress of SACROCOCCYGEAL JOINT – point of coccygeal and descent of the fetal presenting part (determining sacral articulation. the “station”). THE PELVIC JOINT The PUBIS forms the slightly bowed front portion of the innominate bone. RIGHT AND LEFT SACROILIAC JOINTS – the points of union between the sacrum and the ilium. SYMPHYSIS PUBIS - point of union of the two SACROCOCCYGEAL JOINT – between the sacrum pubic bones at the anterior midline and the coccyx PUBIC ARCH – the triangular space below the SYMPHYSIS PUBIS – the junction of the two pubic junction of the symphysis pubis bones which are united by a pad of cartilage. CLINICAL SIGNIFICANCE: If the angle formed is acute , it is very possible that the ischial spines are too close to one another resulting in a narrow pelvic cavity. THE SACRUM The SACRUM is a wedge-shaped bone formed by the fusion of five vertebrae. SACRAL PROMONTORY – a projection into the pelvic cavity on the anterior upper portion THE PELVIC LIGAMENTS SACROILIAC LIGAMENTS – the strongest in the whole body; connects the sacrum to the iliac bones on each side. SACROTUBEROUS LIGAMENTS – between the sacrum and the ischial tuberosities; one on each side SACROSPINOUS LIGAMENTS – between the sacrum and the ischial spines one on each side INTERPUBIC LIGAMENTS – strengthens the symphysis pubis SACROCOCCYGEAL LIGAMENTS – between the 5th sacral vertebrae and the coccyx. OREJANA, ROMMEL C. 7  THE PELVIC FLOOR THE PELVIC DIVISIONS Pelvic Diaphragm: Iliococcygeus FALSE PELVIC Deep fascia Pubococcygeu - The portion above the pelvic brim: s Supports the weight of the enlarged Levator ani pregnant uterus. Puborectalis Coccygeal muscles Directs the presenting fetal parts into the Pubovaginalis true pelvis. TRUE PELVIS - The portion above the pelvic brim: Made up of the sacrum, coccyx, and innominate bones and represents the bony limits of the birth canal. THE TRUE PELVIS - The shape and size of the true pelvis must be adequate for normal fetal passage during labor and birth. - Consist of three parts: Pelvic Inlet Pelvic Cavity Pelvic Outlet OREJANA, ROMMEL C. 8  PELVIC INLET Diagonal Conjugate - 12.5 cm Obstetric Conjugate - 10.5 – 11cm True Conjugate - 11 cm Transverse Diameter - 13.5 cm Right Oblique Diameter - 12.5 cm - The distance between the right sacroiliac joint and the left iliopectineal eminence Left Oblique Diameter - 12.5 cm - The distance between the left sacroiliac joint and the right iliopectineal eminence. THE PELVIC CAVITY A curved canal with a longer posterior than anterior wall. OREJANA, ROMMEL C. 9  THE PELVIC OUTLET Situated at the lower border of the true pelvis Size can be determined through the assessment of the transverse diameter Interspinous diameter (10.5 cm) THE 4 PELVIC TYPES The Caldwell-Maloloy Classification PASSAGEWAY GYNECOID PELVIS PELVIS Most common female pelvis (50%) Inlet is rounded, with the AP diameter a little shorter than the T diameter Posterior segment is broad, deep, and roomy, and the anterior segment is well rounded Has a wide and round pubic arch OREJANA, ROMMEL C. 10 ANDROID PELVIS PLATYPELLOID PELVIS Normal male pelvis Refers to the flat female pelvis Inlet is heart shaped Inlet is a distinctly transverse oval AP and T diameters adequate for birth Short AP and extremely short T diameter Posterior sagittal diameters is too short, and the Short posterior & anterior sagittal diameters anterior sagittal diameter is long Has variable ischial spines, parallel side walls, Midpelvis has prominent ischial spines, and a wide sacrum with a deep curve inward convergent sidewalls, and a long, heavy sacrum Outlet has an extremely wide pubic arch inclining forward Only 5% of female pelvis Android outlet has a narrow, sharp, and deep pubic arch AP diameter is short, T diameter is narrow Approximately 20% of female pelvis Arrest of labor is frequent, requiring difficult forceps manipulation Prone to extensive perineal laceration ANTHROPOID PELVIS Inlet is oval Long AP diameter, short T diameter Posterior and anterior segments are deep Posterior and anterior sagittal diameters extremely long Variable ischial spines, straight side walls, and a narrow and long sacrum Outlet has a normal or moderately narrow pubic arch Approximately 25% of female pelvis THE FEMALE HORMONES ESTROGEN - contributes to “femaleness” - 3 classical estrogens: Estrone, B-Estradiol, and Estriol - Controls the development of the female secondary sex characteristics: Breast development Widening of the hips Deposits of tissue (fat) in the buttocks and mons pubis. OREJANA, ROMMEL C. 11  - Assists in the maturation of the ovarian follicles and Cumulus Oophorus cause endometrial proliferation Zona Pellucida - Amount is greatest during the proliferative (follicular - Just before ovulation, the mature oocyte completes or estrogenic) phase of the menstrual cycle its first meiotic division, yielding a: - Estrogens inhibit FSH production and stimulate LH Polar body: a small cell production Secondary oocyte: which matures into an - Myometrial contractility increases in both uterus and ovum fallopian tubes Increases - As the graafian follicle matures and enlarges, it - -Uterine sensitivity to oxytocin increases comes close to the surface of the ovary PROGESTERONE - The ovum is discharged near the fimbria of the fallopian tube and is pulled into the tube. - Secreted by the corpus luteum - Mittelschmerz: mid-cycle pain (for some) - Found in greatest amounts during the secretory - Body temperature increases about 0.3-0.6oC 24-48 (luteal or progestational) phase of the menstrual hours after ovulation cycle - The ovum takes several minutes to travel through the - Decreases uterine motility and contractility caused ruptured follicle to the fallopian tube opening by estrogens - Causes the endometrium to further increase its supply of nutrients LUTEAL PHASE - Hormone of pregnancy - Prepares the breast for lactation - Begins when the ovum leaves its follicle - Corpus luteum develops from the ruptured follicle PROSTAGLANDINS - If the ovum is fertilized and implants in the - Oxygenated fatty acids that are produced by the cells endometrium, the fertilized egg begins to secrete of the endometrium hCG - Two primary types of prostaglandins are groups E - If fertilization does not occur, within about a week and F: after ovulation, the corpus luteum begins to PGE – relaxes smooth muscles & potent degenerate into corpus albicans vasodilator PGF – potent vasoconstrictor; increases muscular and arterial contractility - Critical to the rupture of the graafian follicle, thereby releasing the mature egg cell NEUHORMONAL BASIS Organs that play a great part: - HYPOTHALAMUS - ANTERIOR PITUITARY GLAND - OVARIES - UTERUS THE OVARIAN CYCLE Has two phases: - The follicular phase (days 1 to 14) - The luteal phase (days 15 to 28) ***For a typical 28-day cycle FOLLICULAR PHASE - The immature follicle matures as a result of FSH - The mature graafian follicle appears on about the 14th day under dual control of FSH and LH OREJANA, ROMMEL C. 12  ILLUSTRATION OF OVARIAN CYCLE CLINICAL ASPECTS - Characteristics of discharge: dark, reddish color & has a musty odor due to the decomposition of blood elements & a mixture of ↑ secretion of vulvar sebaceous gland. - Amount of blood loss – 30-80mL - Amount of iron loss – 0.5-1mg daily Average Length of The Cycle 28 days range: 23-35 days Average Length of Menses 4-6 days range: 2-9 days Age of Onset 11-13 years SYMPTOMS 1. Sensation of heaviness & weight in the pelvic region, mild backache & cramping 2. Slight nervous irritability – feeling of tenderness and anxiety 3. Bladder & GIT irritability 4. Changes in body weight – 1 to 3 lbs. shortly before the onset of menstruation w/c they lose promptly as menstruation begins PHASES OF MENSTRUAL PERIOD MENSTRUAL PHASE ✔ Days 1 – 7 with an average of at least 5 days in the menstrual cycle ✔ The following products are discharged from the uterus during menstrual flow or menses: ❑ Blood from the ruptured capillaries ❑ Mucin from the glands ❑ Fragments of endometrial tissue ❑ Microscopic, atrophied, and unfertilized ovum PROLIFERATIVE PHASE ✔ Days 8-14 of the menstrual cycle ✔ Estrogen peaks just prior to ovulation, ✔ Cervical mucus at ovulation is clear, thin, watery, THE MENSTRUAL CYCLE alkaline, shows ferning pattern; and has spinnbarkeit greater than 5cm - The menstruation is an episodic uterine bleeding in ✔ Body temperature may drop slightly, then rises response in cyclic hormonal changes. sharply at ovulation and remains elevated under - The process that allows for conception and influence of progesterone implantation of a new life. SECRETORY PHASE ✔ Days 15-26 of the menstrual cycle OREJANA, ROMMEL C. 13  ✔ Estrogen drops sharply, and progesterone dominates ✔ Uterine endometrium becomes corkscrew or twisted in appearance and dilated with quantities of glycogen and mucin ✔ The capillaries of the endometrium increase in amount until the lining takes on the appearance of rich, spongy velvet ISCHEMIC PHASE ✔ Days 27-28 of the menstrual cycle ✔ Both estrogen and progesterone levels drop. ✔ If fertilization does not occur, the corpus luteum in the ovary begins to regress. ✔ The endometrium of the uterus begins to degenerate. ✔ The capillaries rupture, with minute hemorrhages, and the endometrium sloughs off. CHANGES IN THE CERVIX During the first half of the cycle: – Cervical mucus is thick and scant SPINNBARKEIT TEST – Sperm survival is poor At the time of the ovulation: – Cervical mucus becomes thin and copious – Sperm penetration and survival is excellent During the second half of the cycle: – Cervical mucus becomes thick and sperm survival is again poor FERN TEST An interesting property of cervical mucus just before ovulation when estrogen levels are high is the ability to form fernlike patterns on a microscope slide when allowed to dry. OREJANA, ROMMEL C. 14