MCN LEC Midterm Transes PDF

MCN LEC TRANSES MIDTERMS LESSON 3: MANAGEMENT AND CARE OF THE NORMAL NEWBORN PROFILE OF A NEWBORN - The bowel sounds can be heard after the first 15 minutes...

MCN LEC TRANSES MIDTERMS LESSON 3: MANAGEMENT AND CARE OF THE NORMAL NEWBORN PROFILE OF A NEWBORN - The bowel sounds can be heard after the first 15 minutes of life and becomes present PHYSIOLOGIC FUNCTION AND APPEARANCE afterward. - varies according to their race, genetics, and nutritional factors. PHYSIOLOGIC FUNCTION AND APPEARANCE - a neonatal graph should be used in plotting - Increased concentration of red blood cells in the newborn’s weight. newborns, and decreased amount of - Plotting the height and head circumference of the newborn also helps determine any subcutaneous fat give newborns a ruddy disproportions. complexion. - In the first month, this ruddy complexion slightly VITAL STATISTICS fades. - Newborns cry tearlessly until three months of age when the lacrimal ducts mature. PARAMETER AVERAGE - Permanent eye color appears in the 3rd to Weight 6.5 to 7.5lbs (2.9kg to 3.4kg) 12th month of age. - The newborn’s external ear is not yet fully Length 50cm (20in) formed, and the top part of the external ear should be on a line drawn from the inner Head Circumference 33 to 35cm (13 to 13.7in) canthus to the outer canthus of the eye and Chest Circumference 31 to 33cm or 2cm less than back across the side of the head. head circumference - The newborn’s nose tends to look large for the face but the rest of the face will grow more Abdominal Circumference 31 to 33cm than the nose does. - The newborn’s mouth must open evenly when he or she cries. ACROCYANOSIS - a condition that causes a newborn’s hands or feet (and sometimes other areas of the body) to turn a bluish, white or gray color. Central cyanosis - decrease oxygenation. JAUNDICE VITAL SIGNS - appears on the second or third day of life as a result of the breakdown of fetal red blood cells. VITAL SIGN IMMEDIATE AT AFTER BIRTH - Formation of bilirubin, yellow pigment. BIRTH - The insufficient filtering of bilirubin due to immature liver. TEMPERATURE 36.5 to 37.2 - Early feeding to speed the passage of feces Celsius through the intestine and prevent reabsorption of bilirubin from the bowel may PULSE 180 beats/minute 120-140 beats/minute diminish physiologic jaundice. average PALLOR RESPIRATION 80 30-50 - is a sign of anemia, and the newborn must be breathe/minute breaths/minute watched closely for signs of blood in the stool or BP 80/46mmHg 100/50mmHg (by vomitus. 10th day) HARLEQUIN SIGN - The newborn would be alert in the first 15 to - when a newborn who is lying on his or her side 30 minutes of life, and later on, will alternate appears red on the dependent side and pale on between sleeping and awakening phases. the upper side does not have a clinical - Just a few minutes after birth, the newborn significance. would respond to stimulation vigorously but would be difficult to arouse while it is still on a resting period until it becomes responsive again 2 to 6 hours after birth. VERNIX CASEOSA which gives it a diamond shape, and normally closes at 12 to 18 months of age. POSTERIOR FONTANELLE - located at the junction of the parietal bones and the occipital bone and is triangular in shape, and closes at the end of the second month. BIRTHMARKS - Hemangiomas are vascular tumors of the skin. - Nevus flammeus are muscular purple or dark red lesions. Generally appear on the face and thighs. - Strawberry hemangiomas - elevated areas - the white cream cheese-like substance is formed by immature capillaries and endothelial washed away in the first bath, but never rub cells. harshly as it will only come off gradually. - Cavernous hemangiomas - these are dilated vascular spaces. - Mongolian spots - slate gray patches across the sacrum or buttocks and consist of a LANUGO collection of pigment cells. - the fine, downy hair that covers the shoulders, - Forceps marks - these are circular or linear arms and back of the newborn would be rubbed contusion matching the rim of the blade forceps away by the friction of the bedding and clothes on the infant’s cheeks. of the newborn. BEHAVIORAL ASSESSMENT - Newborns are inherently active and emotionally ready to engage with those around them. - The Brazelton Neonatal Behavioral Assessment Scale consists of six behavior categories: - Habituation MILIA - Orientation - White, pinpoint papule - Motor maturity - Found mainly on the cheek or the bridge of the - Variation nose, and they disappear by 2 to 4 weeks of - Self-soothing ability age. - Social behavior BRAZELTON NEONATAL BEHAVIORAL ASSESSMENT - assess a newborn's behavioral capabilities and their ability to respond to specific stimuli (Brazelton, 1973). - The assessment of a baby’s capabilities involves a comprehensive scale with 28 behavioral and 18 reflex items. SKULL OF THE NEWBORN - focuses on four developmental tasks. - Autonomic Regulation - Motor Control - State Regulation - Social Interaction AUTONOMIC REGULATION - newborn’s ability to regulate basic bodily functions like breathing and temperature. - High-risk infants may struggle here, which can prevent them from focusing on other developmental areas. - The exam checks for signs of stress, like FONTANELLES changes in breathing or skin color. - the spaces or openings where the skull bones join are soft spots on the newborn’s head. MOTOR CONTROL - how the infants need to control their movements ANTERIOR FONTANELLE - located between the to conserve energy for other growth tasks. two parietal bones and the two frontal bones - If a baby has difficulty here, caregivers can help by providing support like holding or swaddling.  - The exam assesses muscle tone, activity levels, 2 months Lifts head when lying prone and reflexes. Head lags when pulled from supine position STATE REGULATION 4 months Lifts head when lying prone - involves the baby’s ability to control levels of Head lags when pulled from supine consciousness, from sleep to being fully awake. position - The ability to regulate these states helps the baby process sensory information. 6 months Sits alone - The exam tests how the baby responds to Leads with the head when pulled from stimuli like light or sound during different states, a supine position which can indicate how well the baby can ignore 9 months Rakes objects with the whole hand unnecessary stimuli. Transfers object from hand to hand SOCIAL INTERACTION 12 months walks - interaction will happen once the first three areas are stable, the baby can begin interacting RED FLAGS IN MOTOR DEVELOPMENT socially. 1. persistent fisting beyond 3 months which - The exam checks how well the baby follows indicate neuromotor problems; visual and auditory cues, such as tracking a 2. early rolling over, early pulling to stand instead moving object, voice, or face. of sitting, and persistent toe walking which may all indicate spasticity; and APGAR SCORING 3. early hand dominance (before 18 months of - quick assessment done at 1&5 minutes after age), which may signify weakness of the birth to evaluate a newborn’s color, heart opposite upper extremity associated with rate, muscle tone, reflex irritability and hemiparesis. respiratory effort ; assess the Physical condition at birth - developed by Dr Virginia Apgar in 1952 FINE MOTOR MILESTONE Birth Keeps hands tightly fisted 3-4 months Brings hands together to the midline and then to the mouth 4-5 months Reaches for objects A. Appearance (skin color) 6-7 months Uses immature pincer (ability to hold a a. 0: blue or pale all over small object between thumb and index b. 1: body is pink, but extremities are blue finger) c. 2: pink all over B. Pulse (heart rate) 9 months Uses mature pincer (ability to hold a a. 0: Absent small object between thumb and the b. 1: Below 100 bpm index finger) c. 2: above 100 bpm 12 months Uses mature pincer (ability to hold small C. Grimace (Reflex Irritability) object between thumb and the index a. 0: No response to stimulation finger) b. 1: Grimace or weak cry cry when stimulated NORMAL LANGUAGE DEVELOPMENT c. 2: Vigorous cry or pull away when stimulated D. Activity (Muscle Tone) a. 0: Limp or floppy AGE MILESTONE b. 1: Some flexion of arms and legs c. 2: Active motion and flexed arms and Birth legs 2-3 months Cooing (runs of vowels), musical sounds E. Respiration (e.g. ooh-ooh, aah-aah) a. 0: Absent b. 1: Weak or irregular 6 months Babbling (mixing vowels with mixed c. 2: Strong Cry consonants) [e.g. ba-ba-ba] 9-12 months Jargoning (e.g. babbling with mixed NORMAL MOTOR DEVELOPMENT consonants, inflection, and cadence) Begins using mama, dada (nonspecific) 12 months 1-3 words, mama and dada (specific) Gross Motor Milestone Age 18 months 20-50 words Beginning to use two-word phrases Birth Turns head side to side 2 years Two-word telegraphic sentences (e.g. PALMAR GRASP Mommy come) - if you place a finger or object in a baby’s palm, 25-50% of child’s speech should be they will automatically grasp it tightly intelligible 3 years three-word sentences PLANTAR REFLEX More than 75% of the child’s speech - If you stroke the sole of a baby’s foot from heel should be intelligible to toe, their toes will fan out and their big toe will curl upward COGNITIVE DEVELOPMENT - It is about thinking, memory, learning, and NEWBORN SCREENING TEST problem-solving. - This is done 24-48 hours after birth - three parts to newborn screening: - the blood test (or heel stick, When the AGE MILESTONE baby's heel is pricked to collect a sample 9 months Object permanence (people and objects of blood for newborn screening); continue to exist even when an infant - the hearing screen; cannot see them). This ability to - and pulse oximetry. maintain an image of a person is the reason why separation anxiety (6-18 NURSING CARE PLAN months) develops when a loved one 1. Imbalanced Nutrition: Less Than Body leaves the room. Requirements 9-15 months Cause and effect (understanding which 2. Risk for Hypothermia actions cause certain results). 3. Risk for Impaired Gas Exchange 4. Risk for Impaired Skin Integrity 1-3 years Magical thinking 5. Risk for Infection SOCIAL DEVELOPMENT IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS AGE MILESTONE - Imbalanced nutrition in newborns can occur due to various reasons including inadequate 12-36 months Attachment (bonding with a primary breast milk, chronic illnesses, infections, caregiver begins at birth and empathy environmental factors, genetics, neglect, development is critical during this and insufficient parental knowledge. period). - RELATED TO 15 months A sense of self and independence - Inadequate breast milk intake (process of separation and individuation - Inadequate knowledge of breast milk begins). requirements - Inadequate breast milk production 12-24 months Social play (exhibit parallel play during - Ineffective breastfeeding the first 2 years of life). - Interrupted breastfeeding - Underlying health condition INFANT REFLEXES - Prematurity - AS EVIDENCED BY: - Body weight below the ideal weight range for age and gender - Inadequate height increase for age and gender - Inadequate head circumference growth for age and gender - Neonatal weight gain < 30 g (1 ounce) per day - Constipation - Poor output - Pale mucous membranes - Lethargy - Muscle hypotonia - EXPECTED OUTCOME - Newborn will gain at least 5 to 7 ounces per week for the first three months of life. - Newborn will exhibit signs of nutrition and hydration as evidenced by 6-8 wet diapers per day, sleeping well, and alertness when awake. - ASSESSMENT  - Assess the frequency and duration - Expressed breast milk through of breastfeeding. pumping can still provide infants - While mothers may choose to with the nutrients and bottle feed for a variety of antibodies of breast milk if reasons, the newborn should breastfeeding is difficult be fed 8-12 times for the - Monitor the newborn’s hydration first month. Most breastfed and overall health status. babies will feed every 2 to 4 - Dehydration can further affect hours and nurse for 10 to 15 newborn nutrition and overall minutes on each breast. well-being. - Assess the newborn’s ability to - Monitor the newborn’s feed. fontanelles, skin turgor, - Newborns who are sick or mucous membranes, and premature have significantly urine and stool output. higher demands when it comes - It is also important to note to nutrients and energy and signs of lethargy and may exhibit difficulties with weakness in newborns, as this feeding by mouth due to can signal inadequate nutrition decreased intestinal maturation - Offer resources as needed. and reduced coordination with - Women, Infants, and Children sucking, swallowing, and (WIC) is a federally funded breathing. nutrition program that provides - Assess the parent’s knowledge about food, nutrition counseling, and feeding cues breastfeeding support for free. - These include lip smacking, Women who meet low-income sticking out their tongue, requirements can receive food rooting, and putting a fist in and formula for themselves and their mouth. Crying is often a their infants to support late sign of hunger. nutrition. - INTERVENTIONS RISK FOR HYPOTHERMIA - Instruct the mother on - related to a high surface area to volume breastfeeding positions and ratio latching. - This ratio is higher in low-birth-weight - Assess for any breast newborns, causing rapid heat loss and complications like mastitis or hypothermia. engorgement that interrupt - It can also be caused by the transition from a breastfeeding. warm environment inside the uterus to one that - Aid the mother in finding the is considerably cooler. most comfortable positions to support breastfeeding. RELATED TO: - Observe the mother and infant - Large surface area compared to mass for latching difficulties. Proper - Inadequate insulating subcutaneous fat latching will not hurt. - Exhaustible brown fat sources - The nipple should be high and - Few white fat reserves deep in the mouth with the - Thin epidermis susceptible to increased heat loss mouth open wide and the lower - Inability to shiver lip turned outward against the - Infectious process breast. - Impaired thermoregulation - The chin is touching the breast, - Environmental concerns and the nose is very close. The - Cesarean delivery mother will hear the infant suck and swallow. AS EVIDENCED BY: - Monitor the baby’s weight, growth, - A risk diagnosis is not evidenced by signs and and development. symptoms as the problem has not yet occurred. - Newborn babies lose Nursing interventions are aimed at prevention. approximately 10% of their weight after birth and EXPECTED OUTCOMES: regain it within one to two - Newborn will be able to maintain a body weeks. Infants should gain five temperature within normal limits. to seven ounces per week until - Parents/caregiver will verbalize the about four months when weight understanding of hypothermia and its gain starts to slow. prevention. - Educate how to express and store breast milk if breastfeeding is not ASSESSMENT: possible. - Assess the client’s respiratory status.  - The respiratory assessment reflects the - Note the presence of symptoms of labored effectiveness of alveolar ventilation. breathing Low Pao2 levels may indicate the need - Review the results of hemoglobin and arterial for ventilatory support. blood gas (ABG) tests - Note the presence of symptoms of labored - Assess the newborn’s caregiver’s knowledge of breathing. identifying symptoms of respiratory distres - Observe for nasal flaring, grunting, INTERVENTIONS: chest wall retractions, and cyanosis. - Elevate the head of the bed. These symptoms may suggest increased - Suction the airway as needed oxygen usage and energy expenditures. - Administer oxygen - Review the results of hemoglobin and - Prepare equipment for emergency ventilation arterial blood gas (ABG) tests. - ABGs are influenced by the newborn’s RISK FOR IMPAIRED SKIN INTEGRITY respiratory, circulatory, and metabolic - Newborn skin problems like diaper rash and processes. Hemoglobin levels show the cradle cap are common. status of the oxygen-carrying capacity of the blood. RELATED TO: - Assess the newborn’s caregiver’s - Inadequate caregiver knowledge about knowledge of identifying symptoms of maintaining tissue integrity respiratory distress. - Malnutrition - The parents/caregiver need to be aware - Fluid and electrolyte imbalance of the infant’s expected behaviors, - Thermoregulation problems responses, and activities. - Moisture - Newborn respiratory distress includes - Immunodeficiency tachypnea, nasal flaring, periods of apnea, cyanosis, noisy breathing, AS EVIDENCED BY: grunting, and chest retractions. - A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. INTERVENTIONS: Nursing interventions are aimed at prevention. - Elevate the head of the bed. - Suction the airway as needed INTERVENTION: - Administer oxygen - Encourage the use of appropriate infant - Prepare equipment for emergency ventilation cleansers - Change diapers immediately RISK FOR IMPAIRED GAS EXCHANGE - Encourage the parents to limit the newborn’s - can be caused by delayed or poor adaptation sun exposure to life outside the uterus. - Encourage the mother to avoid applying skin - It may also be caused by pre-existing conditions care products to newborns’ skin like congenital defects, or acquired disorders like - Instruct on when to seek further assistance lung infections that develop before or after delivery. RISK FOR INFECTION - related to the increased susceptibility to RELATED TO: infection. - Low lung function and compliance - The newborn’s immune system is immature and - Significant increased metabolic rate can not yet protect against pathogens – at least - The tendency for reduced functional residual for the first few months. capacity (FRC) - Increased resistance by excess production of RELATED TO: mucus - Inadequate acquired immunity - Cold stress - Deficiency of neutrophils and specific immunoglobulins AS EVIDENCED BY: - Environmental exposure - A risk diagnosis is not evidenced by signs and - Broken skin symptoms as the problem has not yet occurred. - Traumatized tissues Nursing interventions are aimed at prevention. - Decreased ciliary action - As evidenced by: EXPECTED OUTCOMES: - A risk diagnosis is not evidenced by signs and - Newborn will be able to maintain ABGs within symptoms as the problem has not yet occurred. normal limits. Nursing interventions are aimed at prevention. - Newborn will be able to maintain oxygen saturation within normal limits. EXPECTED OUTCOME: - Newborn will remain absent of nasal flaring and - Parents/caregiver will verbalize two infection chest wall retractions prevention or risk reduction measures. - Parents/caregiver will demonstrate a protected ASSESSMENT: environment for the newborn. - Assess the client’s respiratory status - Patient will remain free from infection.  PARENTAL EDUCATION ASSESSMENT: - Educate parents on recognizing danger signs, - Assess for contributing factors such as difficulty breathing, poor feeding, or - Assess for presence or absence of immunity jaundice, and when to seek medical help. - Monitor for symptoms of infection - Provide guidance on breastfeeding, safe sleeping practices, and basic hygiene. INTERVENTIONS: FOLLOW-UP CARE - Ensure strict compliance to infection control and - Schedule follow-up visits to monitor the baby’s hand hygiene growth, development, and any health concerns. - Encourage breastfeeding - Monitor caregivers and visitors for any existing BIRTH REGISTRATION illnesses - Provide health teaching about infection control - Ensure the newborn is registered and has a birth measures certificate. NURSING CARE OF THE NEWBORN NEWBORN CARE PRIOR TO DISCHARGE - key steps are taken to ensure that the baby is IMMEDIATE NEWBORN CARE healthy, the parents are prepared, and any potential issues are addressed. IMMEDIATE CARE AFTER BIRTH PHYSICAL EXAMINATION - Warmth: Dry the newborn immediately and ensure they are kept warm. - Comprehensive Check-Up: A thorough - Use skin-to-skin contact with the mother physical examination is performed by a (kangaroo care) or wrap the baby in warm healthcare provider to assess the newborn’s blankets. overall health. This includes checking vital signs - Clear Airway: Ensure the baby’s airway is clear (heart rate, respiratory rate, temperature), by gently suctioning if needed. weight, length, and head circumference. - Apgar Scoring: Assess the baby’s condition at - Screening for Congenital Conditions: The 1 and 5 minutes using the Apgar score. baby is screened for conditions such as congenital heart disease, hearing loss, and metabolic disorders like phenylketonuria EARLY INITIATION OF BREASTFEEDING (PKU). - Begin breastfeeding within the first hour of - inborn error of metabolism that results life. in decreased metabolism of the amino - It is rich in nutrients and antibodies essential for acid phenylalanine. the baby’s immune system. - Untreated PKU can lead to intellectual - Support the mother in establishing and disability, seizures, behavioral problems, maintaining breastfeeding. and mental disorders. - It may also result in a musty smell and HYGIENE AND INFECTION PREVENTION lighter skin. - Cord Care: Keep the umbilical cord clean and MONITPRING FEEDING AND WEIGHT dry. Avoid applying anything to the stump unless - Breastfeeding Assessment: Ensure the baby medically advised. is breastfeeding effectively, with proper latch - Hand Hygiene: Ensure that anyone handling and suckling. If formula-fed, ensure the baby is the newborn washes their hands to prevent feeding well. infections. - Weight Monitoring: The baby's weight is - Eye Care: Apply antibiotic ointment to the monitored to ensure they are gaining weight baby’s eyes to prevent infections. From inner appropriately or that any weight loss is within canthus to outer canthus the expected range. VITAMIN K AND IMMUNIZATION - Administer a vitamin K injection shortly after birth to prevent bleeding disorders. - Provide the first dose of hepatitis B vaccine according to local guidelines. ROUTINE MONITORING - Temperature: Regularly monitor the newborn’s temperature to ensure they are warm enough. - Breathing and Color: Observe the baby’s breathing and skin color for any signs of SCREENING TESTS distress. - Newborn Metabolic Screening: A blood test - Feeding: Ensure the baby is feeding well and (heel prick) is done to screen for various passing urine and stools regularly. metabolic, genetic, and endocrine disorders. ; detect genetic and metabolic disorders  - Hearing Screening: The newborn's hearing is FINAL ASSESSMENTS checked to identify any early hearing loss. - Final Health Check: Conduct a final health - Jaundice Assessment: The baby is checked check to ensure the baby is stable and ready for for jaundice. If present, bilirubin levels are discharge. ; Heart, lungs, and general physical monitored, and appropriate treatment is initiated condition - typically assessed during the final if needed. newborn physical exam before discharge. - Family Preparedness: Confirm that the family IMMUNIZATIONS feels confident and prepared to care for the - Hepatitis B Vaccine: typically given before newborn at home. discharge. CONCEPT OF GROWTH AND DEVELOPMENT - BCG Vaccine: In some regions, the BCG vaccine (for tuberculosis) may be administered. GROWTH Newborn 0.05 ml , intradermal - Process of increasing in size, developing, or maturing over time. PARENTAL EDUCATION - Referred to physical growth in terms of gaining - Feeding: Provide guidance on breastfeeding or height, weight, or strength but it can also formula feeding, including frequency and encompass mental, emotional, or social recognizing hunger cues. development - Bathing and Cord Care: Educate parents on how to bathe the baby safely and care for the DEVELOPMENT umbilical cord stump until it falls off. - process of gradual growth, change or - Safe Sleep: Instruct parents on safe sleep advancement over time practices, such as placing the baby on their - involves acquisition of new skills, knowledge, or back to sleep, using a firm mattress, and abilities avoiding soft bedding in the crib. ; important - generally signifies progress, evolution, or step in newborn care before discharge enhancement - Recognizing Warning Signs: Teach parents - Occurs in various areas of life, such as personal to recognize signs of illness or distress, such development, organizational development, as difficulty breathing, poor feeding, excessive community development crying, or jaundice. - Follow-Up Appointments: Ensure parents PRINCIPLES OF GROWTH AND know the schedule for the baby's first DEVELOPMENT pediatric visit and any follow-up care needed. CEPHALOCAUDAL PRINCIPLE CIRCUMCISION (IF APPLICABLE) - pattern of growth and development that - Post-Circumcision Care: If the baby has been proceeds from head downward to the rest of the circumcised, provide instructions on how to care body for the circumcision site to prevent infection and - example: infants gain control of their head promote healing. before control of truck and limbs and and neck muscles BIRTH REGISTRATION AND DOCUMENTATION PROXIMODISTAL PRINCIPLE - Birth certificate - pattern of growth and development that starts - Provide a discharge summary to the parents, at the center of the body (proximal regions) and which includes details of the newborn’s care, moves outward the extremities screening results, immunizations, and follow-up - example: infants develop control of their torso care instructions. before developing fine motor skills in their fingers and toes CAR SEAT SAFETY - Ensure that the parents have a proper car seat PRINCIPLE OF CONTINUITY installed correctly. Some hospitals may offer or - - emphasizes that development is a continuous require a car seat safety check before discharge. and ongoing process that builds upon previous stages ; development is a gradual SUPPORT AND RESOURCES process that moves from simple to more - Lactation Support: If the mother needs complex behaviors ; each stage of additional help with breastfeeding, refer her to a development lays the foundation for the next lactation consultant. leading to a gradual progression toward maturity - Community Resources: Provide information on local resources, such as parenting classes, PRINCIPLE OF INDIVIDUAL DIFFERENCES support groups, and emergency contact - it recognizes that every individual is unique and numbers. may progress through stages of growth and development at their own pace  - individual differences in genetics, environment, - Prefrontal cortex - part of the brain and experiences can influence the timing and undergoes significant development during manner in which growth and development occur adolescence, influencing decision-making PRINCIPLE OF READINESS ADULTHOOD - individuals are more receptive to learning and - characterized by the completion of physical mastering new skills when they are growth and the maintenance of existing developmentally ready and have reached a structures certain level of physical, cognitive and emotional - biological structures still continue throughout maturity adulthood including cellular repair, hormone regulation, and metabolic changes MAJOR FACTORS INFLUENCING GROWTH - the ossification of bones typically complete AND DEVELOPMENT 1. Genetics AGING AND SENESCENCE 2. Nutrition - characterize by gradual decline in physical and 3. Environment cognitive functioning over time 4. Health - factors such as genetics, lifestyle choices, and 5. Stimulatio and learning environmental influences can impact the rate of 6. Parenting and caregiving aging 7. Culture and society 8. Trauma and adversity NEURODEVELOPMENT - Growth and maturation of the nervous system, BIOLOGICAL GROWTH AND DEVELOPMENT including brain and spinal cord - systematic changes that occur in an individual’s - early experiences and environmental stimuli play physical structure and functioning as they a crucial role progress through different stages of life NUTRITION AND HEALTH INFLUENCED BY: - essential for supporting biological growth and - genetic factors (the primary factor that development at all ages influences biological growth in humans) - adequate nutrients, vitamins and minerals - environmental stimuli promotes overall health and well-being and poor - internal and external factors nutrition leads to growth delays and health problems PRENATAL DEVELOPMENT - begins at conception and continues after birth DEVELOPMENT OF MENTAL FUNCTION AND - involves the rapid and complex growth of the PERSONALITY embryo and fetus in the womb - important developmental milestones, such as PERSONALITY DEVELOPMENT cell division, organ formation, and development - process by which the organized thought and of bodily systems take place behavior patterns that make up a person's unique personality emerge over time. Many INFANCY AND EARLY CHILDHOOD factors influence personality, including genetics - period of rapid growth and development and environment, how we were parented, and characterized by milestones such as motor skills societal variables. development, language acquisition, and sensory awareness. - TEMPERAMENT - key part of personality that - considered the most critical for brain is determined by inherited traits. development in humans ; - pituitary gland - produces growth - CHARACTER - is an aspect of personality hormone to stimulate overall growth influenced by experience and social learning that - sets the foundation for future physical, cognitive continues to grow and change throughout life. and social development - Growth Hormone - primarily responsible for THEORIES OF PERSONALITY DEVELOPMENT regulating growth during childhood - Differentiation - describes the process where SIGMUND FREUD’S STAGES OF cells become specialized in structure and PSYCHOSEXUAL DEVELOPMENT function during development - stage theory of psychosexual development - personality develops in stages that are related to ADOLESCENCE/PUBERTY specific erogenous zones - a transitional period marked by significant - Freud also believed that failure to complete physical changes, including puberty and these stages would lead to personality sexual maturation problems in adulthood - Hormonal changes influence growth spurts, secondary sexual characteristics, and brain development  Stage 3: Initiative versus guilt (3 to 5 years) Stage 4: Industry versus inferiority (6 to 11 years) – Individuals develop a sense of competence and achievement in their abilities Stage 5: Identity versus role confusion (12 to 18 years) Stage 6: Intimacy versus isolation (19 to 40 years) Stage 7: Generativity versus stagnation (41 to 64 years) Stage 8: Integrity versus despair (65 years to death) FREUD’S STRUCTURAL MODEL OF PERSONALITY LIBIDO - the basic driving force of personality and behavior. - This libidinal energy fuels the three components that make up personality: the id, the ego, and the superego. - these three elements of personality ALBERT BANDURA’S SOCIAL LEARNING work together to create complex human THEORY behaviors - a conflict that arises between id and - sexuality is learned through observation, superego can lead to anxiety and imitation, and modeling behavior from others, psychological distress particularly through media, family, and peers ID - is the aspect of personality present at birth. It is VICARIOUS LEARNING - learning can occur through the most primal part of the personality and drives people observation without direct experience to fulfill their most basic needs and urges. - driven by instinctual desires and - Children and adolescents learn sexual behaviors immediate gratification by observing and imitating others and by - operating on Pleasure Principle ; receiving positive or negative reinforcement for irrational and impulsive their actions. EGO - the aspect of personality charged with MODELING – term to describe the process where an controlling the urges of the id and forcing it to individual imitates a behavior being observed behave in realistic ways. - component of the personality that mediates - Media exposure, especially regarding sexual between the desires of the id and constraints of norms and behaviors, plays a significant role in the superego shaping sexual attitudes and practices - mediate reality and desires, operates on reality principle LAWRENCE KOHLBERG’S COGNITIVE DEVELOPMENT THEORY SUPEREGO - the final aspect of personality to - individuals develop their understanding of develop and contains all of the ideals, morals, and gender and sexuality in stages through cognitive values imbued by our parents and culture. maturation. - responsible for moral standards and social rules - Gender identity development: By around - develops primarily through socialization and age three, children can identify themselves as parenting male or female, and by age six or seven, they understand that gender is stable and consistent ERIKSON’S STAGES OF PSYCHOSOCIAL over time. DEVELOPMENT - Self-Socialization: As children grow, they seek - Erikson chose to focus on how social out gender-appropriate activities and roles, relationships impact personality which influences their sexual development. development. - The theory also extends beyond childhood to JOHN BOWLBY’S ATTACHMENT THEORY look at development across the entire lifespan. - early bonds formed with caregivers influence emotional and relational patterns, including Erikson's eight stages are: sexual relationships in adulthood. - Impact on Sexuality: Secure attachments in Stage 1: Trust versus mistrust (birth to 1 year) childhood lead to healthier adult relationships, Stage 2: Autonomy versus shame and doubt (1 to 2 including sexual intimacy, while insecure years)  attachments can lead to difficulties in forming - Social Factors: Cultural norms, family intimate sexual connections. upbringing, religion, and peer influences shape attitudes toward sexuality and sexual behaviors. JUDITH BUTLER’S GENDER PERFORMATIVITY THEORY NURSING CARE OF THE CHILDBEARING - the traditional binary understanding of gender FAMILY and sexuality, arguing that gender is not innate - THIS FOCUSES ON… but is performed based on social expectations. - maintaining health for the woman who - fluidity of gender and sexual identity, suggesting may become pregnant, that individuals continuously construct their - assisting the family that is preparing for sexual identity through repeated behaviors, the addition of a new family member, rather than adhering to rigid categories of - promoting healthy families, and sexuality. - providing safe care to the woman and her newborn before birth (antepartum), QUEER THEORY during labor and delivery, and immediately following delivery - It critiques traditional views of sexuality and (postpartum-monitor vital signs and argues that sexual identities are not fixed but uterine contractions). socially constructed and fluid - reject rigid categories of heterosexuality, homosexuality, and bisexuality, focusing instead on the diversity and fluidity of sexual desires and practices. BIOPSYCHOSOCIAL MODEL AND SEXUALITY DEVELOPMENT - Core Idea: This integrative model suggests that biological, psychological, and social factors interact to shape sexual development. - Biological Factors: Genetic, hormonal, and neurodevelopmental influences play a role in CHILDBEARING determining sexual orientation and behavior. - the process of conceiving, being pregnant with, - Psychological Factors: Personal experiences, and giving birth to children emotional development, and mental health contribute to the development of sexuality. LESSON 4: FAMILY PLANNING AND CONTRACEPTION FAMILY PLANNING Contraceptive patches - the practice of controlling the number and Vaginal rings (e.g., NuvaRing) timing of children in a family through the use of Injectable contraceptives (e.g., Depo-Provera) - contraceptive methods and other techniques. administered Every 3 months Implants (e.g., Nexplanon) CONTRACEPTION - also known as birth control, is the deliberate use BARRIER METHODS of various methods or devices to prevent - These methods physically block sperm from pregnancy. reaching the egg. Male condoms - provides protection DIFFERENT METHOD against sexually transmitted infections Female condoms HORMONAL METHODS Diaphragms - alter a woman's hormonal balance to prevent Cervical caps ovulation, thicken cervical mucus to block Spermicides sperm, or thin the uterine lining to prevent implantation INTRAUTERINE DEVICES (IUDS) - These are small, T-shaped devices inserted into Birth control pills - contains hormone Estrogen and the uterus to prevent fertilization and Progestin. implantation. - morning-after pill - used for emergency contraception, must be taken within 72 hours of unprotected sex. Hormonal IUDs (e.g., Mirena) - thickening cervical mucus is the primary mechanism by which hormonal IUDs prevent pregnancy ; placed inside the uterus to prevent pregnancy PERMANENT METHODS Hormone imbalances - These methods provide long-term contraception and are typically irreversible. Examples include: Infection/Varicocele - medical condition commonly - Tubal ligation (female sterilization)- associated with male infertility due to abnormal sperm permanent and involves surgery production - Vasectomy (male sterilization) POLYCYSTIC OVARY SYNDROME (PCOS) NATURAL METHODS - common cause of female infertility - These methods involve tracking the natural fertility cycle and avoiding intercourse during the PREMATURE OVARIAN INSUFFICIENCY (POI) fertile window. Examples include: - reproductive disorders can cause female - Fertility awareness-based methods infertility by affecting egg release (e.g., tracking basal body temperature, cervical mucus, or menstrual cycle) LUPUS - Withdrawal method (coitus - autoimmune disorder may cause infertility in interruptus) women by affecting ovarian function EMERGENCY CONTRACEPTION PELVIC INFLAMMATORY DISEASE (PID) - is used after unprotected sex to prevent - common cause of blocked fallopian tubes in pregnancy. Examples include: women, leading to infertility - Emergency contraceptive pills (e.g., Plan B, Ella) OBESITY AND HORMONAL IMBALANCES - Copper IUD (when inserted within five AFFECTING OVULATION days after unprotected sex) - can also cause infertility BEHAVIORAL METHODS LOW SPERM COUNT - involve altering sexual behavior to reduce the - common cause of male infertility ; Overheating risk of pregnancy of testicles can negatively impact male sperm - Abstinence (refraining from sexual production intercourse) - Outercourse (engaging in non-penetrative sexual activities) EXPOSURE TO PESTICIDES - environmental factors that can affect male ROLE OF THE NURSES fertility 1. Education and counseling 2. Clinical care SMOKING 3. Advocacy and support - negatively affect fertility in both men and 4. Health promotion women; risk factor for infertility due to oxidative 5. Research and continuous improvement stress in sperm FERTILITY PROBLEMS CHRONIC STRESS - can affect both male and female fertility by FERTILITY disrupting hormone production - the ability to have babies or to reproduce EXCESSIVE ALCOHOL CONSUMPTION CAUSES - lifestyle factors can contribute to male infertility by reducing sperm motility Ovulation disorders - disturbances in the production of an egg (also known as oocyte or ovum) during a ENDOMETRIOSIS woman’s menstrual cycle - condition that may lead to infertility due to the formation of scar tissue in the uterus Age - A woman in her early to mid-20s has a 25–30% chance of getting pregnant every month. Fertility CHLAMYDIA generally starts to slowly decline when a woman is in - sexually transmitted infection (STI) that can her early 30s, and after the age of 35 the decline speeds lead to infertility in both men and women up. By age 40, the chance of getting pregnant in any monthly cycle is around 5%. ; Fertility decreases as women age THYROID HORMONE - hormone imbalance can cause ovulation Uterine fibroids non-cancerous growths in the muscle problems in women, leading to infertility layer of your uterus (womb) and endometrial polyps (a projecting growth of tissue from a surface in the HYPERTHYROIDISM body, usually a mucous membrane) - can lead to decreased fertility by affecting a woman’s menstrual cycle  - long-term untreated diabetes EMBRYONIC STAGE - can cause erectile dysfunction and lower sperm - The development of the neural tube (expands production in the head to form the brain and in the trunk to form the spinal cord) and organs; the placenta is DIAGNOSTIC TESTS formed; limbs start to form ; - begins After implantation is complete How do you know you are pregnant? - the embryo develops its primary body structure, - Missed period (symptoms of headache, fatigue including the head, arms, and legs; All major and breast tenderness may occur) body structures are formed - Home pregnancy test (detects HCG) - Blood test (6-8 days after ovulation) FETAL STAGE - Continued growth of organs and physical Quantitative blood test - measures the exact amount development in preparation for birth; begins of hCG in your blood. After 8 weeks; Lungs – organs that begin Qualitative HCG blood tests - just check to see if the functioning pregnancy hormone is present or not - Rapid growth and development of organ systems NURSING CARE - Placenta - protects and nourishes the embryo 1. Emotional support - bones of the fetus begin to harden 2. Education and counseling - baby’s heartbeat be detected through ultrasound 3. Coordination of care - fetus responds to stimuli, like sound and light 4. Advocacy 5. Monitoring and support during treatment FERTILIZATION AND FETAL GROWTH AND DEVELOPMENT AND GENETICS FERTILIZATION - the process of combining the mate gamete (sperm) with the female gamete (ovum) SPERMATOGENESIS - the process of sperm development OOGENESIS - the process of formation of female gametes. MONTH 1 - WEEK 1-4 After an egg has been fertilized and implanted FERTILIZATION PROCESS into the uterine lining, a sac grows around it. This becomes the amniotic sac and will hold - the union of an egg and sperm, occurring the amniotic fluid and cushion the embryo. primarily in the ampulla of the fallopian tube The PLACENTA (an organ that forms in the - The result of this union leads to the production womb, also called the uterus, during pregnancy) of a fertilized egg called a zygote, initiating is formed embryonic development face and eyes begin to develop, and the heart begins to beat; brain and spinal cord MITOSIS begin to form - a process of cell duplication, or neural tube develops - forms the foundation reproduction, during which one cell gives rise of the baby’s future organs to two genetically identical daughter cells MONTH 2 - WEEK 5-9 FETAL DEVELOPMENT baby’s face continues its development; Facial - how a fetus grows during pregnancy ; baby features like eyes and ears begin to form continues to grow and mature until birth limbs begin to develop, Limb buds appear and start forming hands and feet 3 STAGES OF FETAL DEVELOPMENT Organs such as the brain, sensory organs, and the digestive tract begin to take shape GERMINAL STAGE After about 6 weeks, heartbeat can be - The division of cells and zygote implantation of detected with an ultrasound. the blastocyst. (a cluster of dividing cells made by a fertilized egg) ; implantation occur ; lasts MONTH 3 - WEEK 10-14 for 2 weeks ; Zygote - developing baby The limbs, as well as the hands, feet, fingers, - Fertilization and implantation – the major and toes, become well developed ; baby’s ears developmental milestone and nose take shape  fingernails and toenails begin to form ; can see at this stage and will begin to kick cardiovascular system - major system begins to more function Most of the internal organs and systems are By the end of the 3rd month, baby is fully fully developed formed (with all organs and extremities By month 8, your baby is close to 18 inches present), he or she weighs about an ounce and long and can weigh close to 5 lbs ; baby’s is 4 inches long head begins to move into the pelvis MONTH 4 - WEEK 15-19 MONTH 9 - WEEK 35-40+ Hair, eyelids, eyelashes, and nails become well lungs become mature; baby’s organs fully developed; baby’s fingers and toes are fully mature for birth formed - baby starts kicking and moving Reflexes become more coordinated, allowing heartbeat is now clearly audible through a the baby to respond to sounds, blink, grasp, Doppler instrument and turn his or her head Baby begins to stretch, yawn and make other baby may move less during the last few weeks movements and will move into a position for birth, with the reproductive organs are now visible on an head down near the birth canal ultrasound baby is now about 18-20 inches long and can weigh at least 7 lbs MONTH 5 - WEEK 20-24 may start to feel the baby move; baby begins TRIMESTERS OF PREGNANCY sucking its thumb; baby develops the ability to swallow FIRST TRIMESTER (WEEK 1-12) Hair growth continues on the baby’s head and - major organ systems of the baby start to form; body the risk of miscarriage highest shoulders and back become covered with a thin - fetus is vulnerable to teratogens (substances hair called lanugo that can cause birth defects ) A thick substance, called vernix caseosa, - MOTHER: morning sickness (common covers the skin to keep it protected from symptom), fatigue, breast tenderness, frequent exposure to amniotic fluid. This layer will shed urination before the baby is born At the end of month 5, your baby is about 10 SECOND TRIMESTER (WEEKS 13-26) inches long and can weigh anywhere from.5 - most comfortable period; baby begins to move lbs – 1 lb and kick; baby’s gender usually be determined via ultrasound MONTH 6 - WEEK 25-30 - baby’s organs have developed, the fetus grows fingerprints and toe prints become rapidly; fetus typically begins to hear sounds well-developed from outside the womb baby’s eyelids become parted, and the eyes - MOTHER: feels the baby’s movements, less can be opened nausea, increased energy Baby will respond to external stimuli such as sounds by increasing their pulse or moving you may experience your baby’s hiccups in THIRD TRIMESTER (WEEKS 27-40) jerk-like motions - significant fetal growth and final preparations for At the end of month 6, your baby is about 12 birth; baby’s lungs mature and prepare for inches long and can weigh close to 2 lbs breathing Vernix caseosa (a waxy substance) - - mother's abdomen continues to expand as the protective layer begins to form on the baby's baby grows; baby starts to grow rapidly skin - MOTHER: back pain, frequent urination, shortness of breath, difficulty sleeping MONTH 7 - WEEK 26-29 hearing is fully developed ; baby’s movements BRAXTON’S HICKS contraction - "false labor" or become stronger and more defined "practice contractions," are irregular, usually painless will react to sound, pain, and light and contractions of the uterus often changes position amount of amniotic fluid that cushions the FETAL CIRCULATION baby begins to decrease as the baby grows - The circulation of blood from placenta to and larger through the fetus and back to the placenta. At the end of this month, your baby is about 14 - A circulation of oxygenated blood, deoxygenated inches long and can weigh between 2 – 4 lbs blood, nutritive material, etc in the fetus from If born prematurely after week 27, your baby mother. has a better chance of survival. HOW DOES THE FETAL CIRCULATORY MONTH 8 - WEEK 30-34 SYSTEM WORK? continues to mature , adding to fat stores and - During pregnancy, the unborn baby (fetus) experiencing a rapid development of the brain depends on its mother for nourishment and  oxygen. Since the fetus doesn’t breathe air, their blood circulates differently than it does after birth: The placenta is the organ that develops and implants in the mother's womb (uterus) during pregnancy. The unborn baby is connected to the placenta by the umbilical cord. All the necessary nutrition, oxygen, and life support from the mother’s blood goes through the placenta and to the baby through blood vessels in the umbilical cord. Waste products and carbon dioxide from the baby are sent back through the umbilical cord blood vessels and placenta to the mother's circulation to be eliminated. BLOOD CIRCULATION AFTER BIRTH - The closure of the ductus arteriosus, ductus venosus, and foramen ovale completes the change of fetal circulation to newborn circulation. BLOOD FLOW OF THE UNBORN BABY 1. Oxygen and nutrients from the mother's blood are transferred across the placenta to the fetus through the umbilical cord. 2. This enriched blood flows toward the baby’s liver through the umbilical vein (the vessel carries oxygenated blood from the placenta to the fetus) There it moves through a shunt called the ductus venosus (structure allows blood to bypass the liver in fetal circulation). 3. This allows some of the blood to go to the liver. But most of this highly oxygenated blood flows to a large vessel called the inferior vena cava and then into the heart’s right atrium. 4. When oxygenated blood from the mother enters the right side of the heart, it flows into the upper chamber (the right atrium). Most of the blood flows across to the left atrium through a shunt called the foramen ovale (allows blood to pass from the right atrium to the left atrium). 5. Ductus arteriosus - structure allows blood to bypass the lungs in fetal circulation; forms the ligamentum arteriosum after birth What happens inside the fetal heart? Blood circulation after birth The closure of the ductus arteriosus, ductus venosus, and foramen ovale completes the change of fetal circulation to newborn circulation