1. Care of the Mother, Child and Family Mr. Jhessie Lawaan y Abella, RN, RM, MAN

2. Course Description/Objective/Outline Course Description: Principles and techniques of caring for the normal mothers, infants, children and family and the application of principles and concepts on family and family health nursing process. Course Objective: At the end of the course, given actual or simulated situations/conditions involving the client (normal pregnant woman, mother, and/or newborn baby, children and the family), the student will be ableto: 1. Utilize the nursing process in the holistic care of client for the promotion and maintenance of health. 1.1 Assess with the client his/her health condition and risk factors affecting health 1.2 Identify wellness /at risk nursing diagnosis 1.3 Plan with client appropriate interventions for health promotion and maintenance of health 1.4 Implement with client appropriate interventions for health promotion and health maintenance taking into consideration relevant principles and techniques 1.5 Evaluate with client the progress of one’s health condition and outcomes of care.

3. . I. The Family and Family Health II. The Family Health Nursing Process III. Methods of Data Gathering IV. Typology of Nursing Problems in Family Nursing Practice 1. 1st level assessment: identify health threats, foreseeable crisis, health deficits & wellness potential/state 2. 2nd level assessment: determining family’s ability to perform the family health tasks on each health threat, health deficit, foreseeable crisis or wellness potential V. Statement of a Family Health Nursing Problem- health problem and cause/ contributing factors or health condition and factors related with non-performance of family health tasks VI. Developing the Care Plan VII. Categories of nursing interventions in family nursing practice include: VIII. Categories of health care strategies and intervention IX. Evaluation X. Records in Family Health Nursing Practice XI. Mother and Child Health 1.Procreative Health a. Definition and theories related to procreation b. Process of human reproduction c. Risk factors that will lead to genetic disorders d. Common tests for determination of genetic abnormalities e. Utilization of the nursing process in the prevention of genetic alteration and in the care of clients seeking services before & during conception

4. XII. Antepartum/ Pregnancy 1. Anatomy & physiology of the male and female reproductive system 2. Physiology of menstrual cycle 3. The process of conception 4. Fetal circulation 5. Milestones of fetal development 6. Estimating the EDC 7. Common teratogens and their effects 8. Health history: past, present, potential, biographical data, menstrual history, current pregnancy (EDD, AOG, gravid, para), previous pregnancies & outcomes (TPAL score), gynecologic history, medical history, nutritional status 9. Normal changes during pregnancy a. Local & systematic physical changes including vitalsigns, review of systems b. Emotional changes including ‘angers in pregnancy’ c. Leopold’s maneuver 10. Danger signs of pregnancy 11. Normal diagnostic/laboratory findings & deviations Pregnancy test 12. Appropriate nursing diagnoses 13. Addressing the needs and discomforts of pregnant mothers 14. Prenatal exercises 15. Preparation for labor and delivery

5. XIII. Intrapartum (Process of Labor & Delivery) 1. Factors affecting labor & delivery process- passenger, passage, power (primary and secondary) and placenta 2. Functional relationships of presenting part 3. Theories of labor onset 4. Common signs of labor 5. Stages of labor & delivery 6. Common discomforts of the woman during labor and delivery 7. Danger signs during labor & delivery 8. Appropriate Nursing Diagnoses 9. Care of clients experiencing labor & delivery process 10. Physical & psychological preparation of the client: 11. Monitoring of progress of labor delivery 12. Provision of personal hygiene, safety & comfort measures e.g. perineal care, management of labor pain, bladder and bowel elimination 13. Coping mechanisms of woman’s partner and family of the stresses of pregnancy, labor and delivery & puerperium 14. Preparation of the labor & delivery room 15. Preparation of health personnel

7. “Taking Hold”

9. The Toddler & the Family

10. The Preschooler and the Family

11. The Schooler and the Family

12. The Adolescent & the Family

15. A family perform certain basic function

16. A family has structure

17. A family has its own cultural values and rules

18. A family moves through stages in its life cycle Key Points! The basic function and task of a family focus on providing physical health, providing for mental health, socializing its members, reproducing, and providing for economic well being.

20. Allocation of Resources: careful planning and use of family money, material good, space and abilities

21. Division of Labor: assigning the workload, including responsibility for household income and household management

22. Socialization: guiding towards acceptable standards of elimination, food intake, sexual drive, respect for others and their possession and sense of spirituality

23. Reproduction, recruitment and release: bearing or adopting children, adding new members by marriage, and allowing members to leave

24. Maintenance of Order: interaction and communication oppurtinities, discipline, affection, sexual expression

25. Assistance with fitting into the larger society: community, schools, spiritual center and organization

27. NUCLEAR FAMILY

29. MATRILINEAL FAMILY

31. MATRIARCHAL FAMILY

32. EGALITARIAN FAMILY

34. MATRILOCAL Residence

35. BILOCAL Residence

36. NEOLOCAL Residence

38. Gay or Lesbian Family intimate partners of the same sex may live together or own property together .

39. Communal Family several people together. They often strive to be self-sufficient and minimize contact with the outside society. Members share financial resources, work and child care responsibilities.

41. Healthy families make the family the top priority

42. Healthy families ask and give respect

43. Healthy families communicates and listen

44. Healthy families values service to others

46. STAGES OF FAMILY DEVELOPMENT Stage Three: Families with young children Emotionally we must now accept new members into the system. This isn't hard initially because babies come to us in sweet innocent packages that open our hearts. Unfortunately, in the middle of the night we may wonder what we've gotten ourselves into. Nevertheless, we adjust the marital system to make space for our children, juggling childrearing, financial and household tasks. Second-order change also occurs with the realignment of relationships with extended family as it opens to include the parenting and grand parenting roles. Stage Four: Families with adolescents Emotional transitions are hard here for the whole family because we need to increase the flexibility of families boundaries to include children's independence and grandparents' frailties. As noted above, second-order change is required in order for the shifting of the parent-child relationship to permit adolescents to move in and out of the system. Now there is a new focus on midlife marital and career issues and the beginning shift toward joint caring for the older generation when both children and aging parents demand our attention, creating what is now called the sandwich generation.

47. Stage Five: Launching children and moving on This is one of the transitions that can be most emotionally difficult for parents as they now need to accept a multitude of exits from and entries into the family system. If the choices of the children leaving the nest are compatible with the values and expectations of the parents, the transition can be relatively easy and enjoyable, especially if the parents successfully navigate their second-order changes, such as renegotiation of the marital system as a couple rather than as simply parents. Stage Six: Families in later life When Erikson discusses this stage, he focuses on how we as individuals either review our lives with acceptance and a sense of accomplishment or with bitterness and regret. Second-order changes require us to maintain our own interests and functioning as a couple in face of physiological decline. We shift our focus onto the middle generation (the children who are still in stage five) and support them as they launch their own children. In this process the younger generation needs to make room for the wisdom and experience of the elderly, supporting the older generation without over functioning for them. Other second-order change includes dealing with the loss of our spouse, siblings, and others peers and the preparation for our own death and the end of our generation.

48. OVERVIEW OF MALE AND FEMALE REPRODUCTIVE SYSTEM

49. REPRODUCTIVE DEVELOPMENT The chromosomal sex or biologic sex is formed at fertilization. Females have XX chromosomes and the male XY chromosomes. During early fetal life, primitive germ cells are formed in the 6th and 10th week in the yolk sac. The Gonads is a body organ that produces sex cells. At 5th weeks primitive Gonadal tissue is already formed.

50. REPRODUCTIVE DEVELOPMENT At 8th to 10th week, the human embryo has neutral gonads with two pairs of duct system. The MULLERIAN Ducts (Paramesonephric) and the WOLLFIAN Ducts (Mesonephric) joined at the lower end. If the germ cell are XX the gonads become the Ovaries If the germ cell is XY the gonads become the testes

53. REPRODUCTIVE DEVELOPMENT Female and Male Reproductive Homologues

54. Female and Male Reproductive Homologues

55. PUBERTY Is the stage of life at which secondary sex changes begins. Both boys and girls begin dramatic development and maturation of reproductive organs at approximately 12 to 13 years. The hypothalamus apparently serves as gonadostat or is set to “turn on” gonad functioning. It is believed though that the hypothalamus is turned on to release initial trigger hormones when a girl has developed enough body fat or has reached the critical weight that is believed to be around 95 lbs or 43 kgs. Under the stimulation hypothalamus the pituitary glands release GONADOTROPIN hormones. The first sign of pubescence in females is usually breast bud formation. Puberty ends with menarche which occurs approximately two years after thelarche .

57. Pubic and axillary hair process

58. Growth spurts

59. Increase in body fats as distributed in the breast, mons pubis, hips and thighs

60. Vagina lengthens and become rugated

61. Labia majora and minora becomes thickened and rugated

62. Testicular enlargement

63. Development of penis and scrotum to adult size and shape is achieved between 12 to 17

64. Deepening of the voice due to hormonal influence to the vocal cords

65. Onset of spermatogenesis

67. Female External Genitalia Vulva or Pudenda Mons Pubis or Mons Veneris Labia Majora Labia Minora Clitoris Vestibule Bartholin’s Glands Skenes’s Glands Vaginal Orifice Hymen Urethral Meatus

68. Female External Genitalia Vulva or Pudenda refers to the entire female genitalia. Mons Pubis is a fold of fats above the symphysis pubis that is an important obstetrical landmark and protects the symphysis pubis from trauma. It is richly supplied with sebaceous glands “Escutcheon” curly hair

70. Its functions is to provide covering and protection to the external organs located under it

71. Labia Minora are two thin folds of connective tissues that joins anteriorly to form the prepuce and posteriorly to form the fourchette

73. It is surrounded by many sebaceous glands that produce a cheese like secretion called “smegma”

74. Vestibule triangular space between the labia minora and where the urethral meatus, Bartholin's glands and Skene’s gland are located

77. The NERVE and BLOOD SUPPLY The anterior portion’s nerve supply is derived from L1 and the posterior portion is derived from S3 Blood supply to the vulva is provided by the pudenda artery and the inferior rectus artery

78. THE FEMALE INTERNAL ORGANS Vagina is a hollow membranous and muscular canal about 8 to 12 cm located in front of the rectum and behind the bladder The external opening of the vagina is encircled by the BULBOCAVENOUS muscle that acts as the voluntary sphincter.

79. THE FEMALE INTERNAL ORGANS Rugaeare transverse folds of skin in the vaginal wall Vaginal PH before puberty is 6.8 to 7.2. After puberty vaginal PH becomes acidic going down to a PH of 4-5. Doderlein Bacilli a bacteria that is normally present in the vaginal mucus into lactic acid.

80. The UTERUS The uterus is a hollow muscular, pear shaped organ located in the lower pelvis, posterior to the bladder and anterior to the rectum. With maturity the uterus is approximately 5 to 7cm long, 5 cm wide and in its widest upper part is 2.5cm deep.

82. Organ of menstruation

84. The ISTHMUS is the short segment between the isthmus and the cervix

86. MYOMETRIUM the middle muscular layer responsible for uterine contraction during labor

88. The UTERUS The large descending AORTA divides to form two iliac arteries, main division of the iliac arteries or hypo gastric arteries. Ovarian Artery is a direct branch of the aorta.

89. The FALLOPIAN Tube (OVIDUCTS) The oviducts are a pair of tube-like structure originating from the cornua of the uterus. Each tube is about four inches long and ¼ inch in diameter.

91. The site of fertilization

93. ISTHMUS the narrowest portion of the FT.

94. AMPULLA the middle portion and the widest part.

97. Before puberty the ovaries are smooth, flat ovoid organs.

99. OVULATION

101. The MAMMARY GLANDS

103. AREOLA

105. LOBULES

106. ACINI CELLS

107. LACTIFEROUS DUCTS

109. PROGESTERONE

110. HPL

111. OXYTOCIN

114. ISCHIUM forms the lower portion

115. PUBIS anterior portion of the bone.The Symphysis Pubis is the junction of the innominate bone at the front of the pelvis

116. The PELVIS For obstetrical purposes, the pelvis is further divided into the FALSE Pelvis (superior half) and the TRUE Pelvis (inferior half). The LINEA TERMINALIS divides the true and the false pelvis.

117. Male Reproductive System

118. Male Reproductive System Male External Organ Penis the male organ of copulation and urination Composed of longitudinal erectile tissue: Corposa Cavernosa and Corposa Spongiosum

120. Glans Penis

121. Prepuce or foreskin

125. Leydig Cells

127. EJACULATORY DUCT the two ED pass through the urethra and connect the urethra carrying the secretion of the SV. PROSTATE GLAND is a walnut shape body lying inf to the bladder surrounding the urethra and the ED. It secretes a thin milky alkaline fluid that enhance the sperm survival. COWPER’S GLAND these are small glands that are located inf to the PG and secretes an alkaline fluid

129. Phase II is the PLATEAU

130. Phase III is the ORGASM

132. PLATEAU With continued sexual stimulation this phase represents the time between the initial arousal and excitement, up until orgasm. For many men the plateau phase is very short, but this is the phase that men can extend as a way of controlling premature ejaculation. Physical changes during this phase may include: -An increase in the size of the head of the penis, and the head may also change color, becoming purplish. -The Cowper's gland secretes fluid, often referred to as pre-cum, which comes out of the tip of the penis. -The testes move further in towards the body, and increase in size. -There may be a sex flush, muscle tension, increase in heart rate and rising blood pressure.

133. ORGASM In the first stage: -Contractions in the vas deferens, seminal vesicles, and the prostate causes seminal fluid ("come" or ejaculate) to collect in a pool at the base of the penis, in the urethra. This collection is usually felt as a "tickling" type sensation. In the second stage of the orgasmic phase:-Contractions of muscles occur in a "throbbing" manner around the urethra, and propel ejaculate through the urethra and out of the body. -These contractions (which occur at different speeds, and in different amounts) are usually what are experienced as highly pleasurable feelings of release.

134. RESOLUTION Resolution phase refers to the period of time immediately following an orgasm, when the body begins to return to its "normal" state. This phase includes: -The loss of the erection as the blood flows out of the penis, which happens in two stages over the period of a few minutes. -The scrotum and testes return to normal size. -A general feeling of relaxation.

136. Menstrual Cycle Menstrual Cycle can be defined as periodic uterine bleeding in response to cyclic hormonal changes. Menarcheis the term applied to the first menstruation period of girls. Menopause is the cessation of menstrual cycle . Postmenopausalis the time of life following menopause. Premenopausal is the time when menopausal changes are occuring.

137. Body Structures and Hormones of the Menstrual Cycle Hypothalamus is the ultimate initiator of the menstrual cycle. (GNRH) The Pituitary Gland in response from the hypothalamus and low serum estrogen and progesterone level APG release the GH (FSH and LH) 3. The Ovaries during the first half of the cycle it produces estrogen and progesterone during the second half of the cycle. 4. The Uterus changes that occur in the uterine endometrial are due to the influence of the ovarian hormone estrogen and progesterone.

140. Breast growth

141. Development of the female reproductive organ

142. Pattern of hair growth

143. Stimulate the proliferation of the endometrium resulting in endometrial thickening

144. Causes mucus to be thin, transparent and highly stretchable

146. Relaxes uterine muscle

147. Promotes growth of the acini cells of the breast

148. Causing weight gain by promoting fluid retention

149. Causes tingling sensation and feeling of fullness in the breast before menstruation

151. hypertrophy of myometrium

153. increase osteoblast activities of long bones

154. increase in height in female

155. causes early closure of epiphysis of long bones

156. causes sodium retention

157. increase sexual desire

158. inhibit prod of LH (hormone for ovulation)

159. inhibit motility of GIT

160. mammary gland development

161. increase permeability of kidney to lactose & dextrose causing (+) sugar

162. causes mood swings in moms

164. Spinnbarkheit is characterized by cervical mucus that is thin, watery or transparent abundant and highly stretchable. When viewed under the microscope the mucus will reveal a fern pattern.

165. Increased basal body temperature

170. During the Proliferative Phase estrogen promotes the growth of new cells and capillaries in the endometrium. As a result the endometrium thickens by as much as 8th folds and become vascular. Leveling off of endometrium occurs at ovulation. Aside from this changes estrogen also stimulates the cervical glands to produce abundant amount of mucus that is thin watery, stretchable and transparent. Serum estrogen is lowest on the 3rd day and highest a day before ovulation. During the Proliferative Phase estrogen promotes the growth of new cells and capillaries in the endometrium. As a result the endometrium thickens by as much as 8th folds and become vascular. Leveling off of endometrium occurs at ovulation. Aside from this changes estrogen also stimulates the cervical glands to produce abundant amount of mucus that is thin watery, stretchable and transparent. Serum estrogen is lowest on the 3rd day and highest a day before ovulation. During the Proliferative Phase estrogen promotes the growth of new cells and capillaries in the endometrium. As a result the endometrium thickens by as much as 8th folds and become vascular. Leveling off of endometrium occurs at ovulation. Aside from this changes estrogen also stimulates the cervical glands to produce abundant amount of mucus that is thin watery, stretchable and transparent. Serum estrogen is lowest on the 3rd day and highest a day before ovulation.

171. Progesterone causes the blood vessels in the endometrium to dilate and assumes a spiral or corkscrew shape. The corpus Luteum has an average lifespan of about 7 to 8 days. If fertilization does not takes place the CL shrivels. Degeneration of the CL results in progesterone withdrawal which effect leads to the formation and released prostaglandin and possibly endothelin-1. These substance causes vasospasm of the spiral arteries and contraction of myometrium.

172. During the Proliferative Phase estrogen promotes the growth of new cells and capillaries in the endometrium. As a result the endometrium thickens by as much as 8th folds and become vascular. Leveling off of endometrium occurs at ovulation. Aside from this changes estrogen also stimulates the cervical glands to produce abundant amount of mucus that is thin watery, stretchable and transparent. Serum estrogen is lowest on the 3rd day and highest a day before ovulation. During the Proliferative Phase estrogen promotes the growth of new cells and capillaries in the endometrium. As a result the endometrium thickens by as much as 8th folds and become vascular. Leveling off of endometrium occurs at ovulation. Aside from this changes estrogen also stimulates the cervical glands to produce abundant amount of mucus that is thin watery, stretchable and transparent. Serum estrogen is lowest on the 3rd day and highest a day before ovulation. Spasm cuts off blood supply to the uterus causing tissues ischemia, necrosis and rupture of blood vessels that eventually leads to endothelial sloughing of the upper two layers of the endometrium. Near the end of the secretory phase, just before the start of menstrual flow, regeneration begins from the retained basal layer. Rebuilding the endometrium from the basal layer going upward is responsible for its healing and rejuvenation without scar formation.

176. Uterus: atrophy of uterus

178. Increased Cholesterol increased the risk of CVDIII. Mood irritability, loss of sexual desire, depression anxiety IV. Musculoskeletal: Osteoporosis

180. Allergies

181. Appearance of facial hair

182. Weight gain

183. Dizziness

185. Sex is the term used to denote chromosomal sexual development

186. Gender Identity is the inner sense a person has of being male or female. Sense of femininity or masculinity. 2-4 yrs/3 yrs gender identity develops.