# data[].attributes.body
Obstare - to keep watch
Pais- child

GOAL: “Promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and childrearing.”

# data[].attributes.headline
Expected to do as maternal and childhealth nurses

# data[].attributes.subject
Expected to do as maternal and childhealth nurses

# data[].attributes.body
• independent
• interrelated

Cephalo - head
Caudal - tail

10 Principles

1.  Continuous processes from conception until death
2. Proceed in an orderly sequence
3. Different children pass through the predictable stages at different rates
4. All body systems do not develop at the same rate
5. Development is cephalocaudal
6. Development proceeds from proximal to distal body parts
7. Development proceeds from gross to refined skills
8. There is an optimum time for initiation of experiences or learning
9. Neonatal reflexes must be lost before development can proceed
10. A great deal of skill and behavior is learned by practice

# data[].attributes.body
The Family with an Infant

Weight
2x | 4-6 months
3x | 1 year

Weight Gain
1st 6 months  | 2 lbs/month
2nd 6 months | 1lb/Average weight
1 yr/o male | 10 kg.
1 yr/o female  | 9.5 kg.

MOTOR DEVELOPMENT

Gross Motor

Ability to accomplish large body movements.

Fine Motor

Measured by observing or testing prehensile

Gross Motor Development

Ventral Suspension

The newborn allows the head to hang down with little effort or control.

1 month-old child:

Can lift the head momentarily

3 months: can maintain lifting the head.

Landau Reflex

3 months: when held at ventral suspension, infant’s head, legs & spine extend.

When head’s in depressed: hips, knee & elbows flex

Parachute Reflex

6-9 months:

When infants are suddenly lowered toward a table from ventral suspension, the arms extend as if to protect themselves from falling.

Prone Position

When lying at their stomach, newborns can tum their heads to move it out of position where breathing is impaired.

Neck Righting

4 months:

When the infant turns the head to the side, shoulders, trunk & pelvis turn in that same direction.

Sitting Position

1 month:

When placed on his/her back & pulled to a sitting position, the child has gross head lag in the first days of life.

6 months:

Can sit momentarily with support.

Standing Position

Stepping Reflex:

In a standing position, the infant’s knees & hips flex rather than support more than momentary weight.

Fades at 3 months

# data[].attributes.headline
ACCORDING TO ERIKSON, THE DEVELOPMENTAL TASK OF AN INFANT IS TRUST VS MISTRUST.

# data[].attributes.subject
ACCORDING TO ERIKSON, THE DEVELOPMENTAL TASK OF AN INFANT IS TRUST VS MISTRUST.

# data[].attributes.body
Safety is important

Infants must be protected from falls and aspiration of small objects.

A skill an infant cannot accomplish one day, may be accomplished the next.

Solid food is generally introduced into an infant’s diet at 4-6 months of age.

Before they can eat solid food, they must lose their extrusion reflex.

# data[].attributes.body
• Rapid brain growth, increase in bone length and muscle growth
• Uses fingers to pick up small objects
• Walks, runs, kicks, climb, rides tricycle, drinks from cup
• Four times birth weight
• Bladder control during the day, sometimes at night
• Turns pages in book, and by age 3 draws stick people

# data[].attributes.body
An important period of growth for parents -Setting limits
the physical growth slows considerably during this period, personality and cognitive growth continue at a rapid rate

# data[].attributes.body
o If children are criticized or punished for attempts at initiative, they develop a sense of guilt for wanting to try new activities or have new experiences
o need exposure to a wide variety of experiences and play materials so they can learn as much about the world as possible ready to reach outside their homes for new experiences, such as a trip to the zoo or an amusement park

# data[].attributes.body
Urge parents to provide play materials that encourage creative play, such as finger paints, soapy water to splash or blow into bubbles, mud to make into pies, sand to build castles, and modeling clay or homemade dough to mold into figures or make into pretend cookies

# data[].attributes.body
• Significant others now include grandparents, siblings, and preschool teachers (although parents remain central)
• Regular interaction with same-age children is necessary to further develop social skills

# data[].attributes.body
refers to the stage of a child’s life from ages

6 to 12 years

The school-age years can be a spectacular journey filled with joys and successes as the child continues to grow and mature

time of slow physical growth, cognitive growth and development continue to proceed at rapid rates

# data[].attributes.body
Preconventional Level of Morality (ages 2 to 7)
o Punishment & Obedient Orientation
the child attempts to follow rules set by those in authority

Egocentric focus (Preschooler to School Age)
Instrumental Relativist Orientation
Carries out actions to satisfy own needs rather thansociety’s
“I’ll do something if I get something for it or because it pleases you.”

SENSORIMOTOR (birth to age 2)
o The child progresses from reflex activity, through
simple repetitive behaviors, to imitative behaviors

PREOPERATIONAL (ages 2 to 7)
o marked by egocentricity (the child can’t comprehend
a point of view different from his own)
o time of magical thinking and increased ability to use symbols and language

CONCRETE OPERATIONAL (ages 7 to 11)
o the child’s thought processes become more logical and coherent
o can use inductive reasoning

# data[].attributes.body
annual average weight gain is approximately 3 to 5 lb (1.3 to 2.2 kg); the increase in height is 1 to 2 in
(2.5 to 5 cm

Malocclusion - (a deviation from the normal) with teeth malalignment
Scoliosis - May become apparent for the first time in late childhood
o over age 8 should be screened
Maturation of the respiratory system leads to increased oxygen–carbon dioxide exchange

# data[].attributes.body
6-YEAR-OLDS
• talk in full sentences, using language easily and with
meaning
• define objects by their use: a key is to unlock a door; a
fork is to eat with
7-YEAR-OLDS
• can tell the time in hours, but they may have trouble with
concepts such as “half past” and “quarter to,” especially
with the prevalence of digital clocks and watches
• know the months of the year and can name the months in
which holidays fall
• can add and subtract and make simple change
9-YEAR-OLDS
• discover “dirty” jokes
• Like to tell them to friends or try to understand those told
by adults
• use swear words to express anger or just to show other
children they are growing up
• have a short period of intense fascination with “bathroom
language
12-YEAR-OLDS
• a sense of humor is apparent
• can carry on an adult conversation, although stories are
limited because of their lack of experience

# data[].attributes.body
child behaves according to socially acceptable norms
because an authority figure tells him to do so

This obedience is compelled by the threat of punishment
(external factors)

# data[].attributes.body
The period between 13 and 18 or 20 years
• Time that serves as a transition between childhood and
young adulthood
• Defined not so much by chronologi age but by physiologic,
psychological, and sociologic changes
• Divided into:
o Early period (13 to 14 years)
o Middle Period (15 to 16 years)
o Late period (17 to 20 years)

# data[].attributes.body
• Grow both rapidly and mature dramatically

• recognizing that adolescents may have differing
responsibilities and life experiences based on cultural
expectations can be useful when making an • include factors such as occupational hazards or the effects
of job, family, and financial stress on an adolescent assessment
• readiness for early childbearing may also be important

# data[].attributes.body
Apocrine sweat glands
• heart and lungs increase in size more slowly than the rest
of the body
• PR:70 beats per minute
• RR: 20 breaths per minute
• BP: 120/70 mm Hg
• Major milestone: Onset of puberty at 9 to 12 years of age
and the cessation of body growth at 16-20 years of age

# data[].attributes.body
HYPERTENSION
• blood pressure is above the 95th percentile, or 127/81 mm
hg for 16-year-old girls and 131/81 for 16-year-old boys for
two consecutive readings in different settings
• obese
• who are african american
• who eat a diet high in salt
• who have a family history • new medication plus education
in risk factors makes treatment at this age successful

POOR POSTURE
• Tendency to round shoulders, and a shambling, slouchy
walk

BODY PIERCING AND TATTOOS
• Strong mark of adolescence
• both sexes have ears, lips, chins, navels, and breasts
pierced and filled with studs, or tattoos applied to arms,
legs, or their central body

FATIGUE
• Investigate as a legitimate concern and not
underestimated

ACNE
• Self-limiting inflammatory disease that involves the
sebaceous glands that empty into hair shafts (the
pilosebaceous unit)
• most common skin disorder of adolescence, occurring in
as many as 80% to 95% of adolescents

OBESITY
• Both inheritance and environment play a part

# data[].attributes.body
Adulthood is often divided into three phases:
o young adulthood- young adults are defined as
people 20 to 40 years old

Middle adulthood- middle-aged adults as 40 to 65

years old

Late adulthood
• Adult Age Span includes three very different generations:
o Baby Boomers(born in years 1945–1964)
o Generation X(birth years 1965–1978)
o Generation Y or the Millennials (birth years 1979–
2000)

# data[].attributes.body
PHYSICAL DEVELOPMENT
• Human body is at its most efficient functioning at about
age 25 years
• musculoskeletal system is well developed and coordinated
• period when athletic endeavors reach their peak. All other
systems of the body (e.g., cardiovascular, visual, auditory,
and reproductive) are also functioning at peak efficiency
• physical changes are minimal during this stage, weight
and muscle mass may change as a result of diet and
exercise.
• extensive physical and psychosocial changes occur in
pregnant and lactating women

PSYCHOSOCIAL DEVELOPMENT
• psychosocial development of the young adult is great
• basic developmental task is establishing intimacy or very
close friendship
• Occupational choice and education are largely inseparable
• Sense of intimacy VS isolation

COGNITIVE DEVELOPMENT
• Young adults are able to use formal operations,
characterized by the ability to think abstractly and employ
logic
• For example, young adults are able to generate
hypotheses about what will happen, given a set of
circumstances and do not have to engage in trial-and-error
behavior

MORAL DEVELOPMENT
• Young adults who have mastered the previous stages of
Kohlberg’s theory of moral development enter the
postconventional level
• At this time, the person is able to separate self from the
expectations and rules of others and to define morality in
terms of personal principles
• When individuals perceive a conflict with society’s rules or
laws, they judge according to their own principles

SPIRITUAL DEVELOPMENT
• According to Fowler (1981), the individual enters the
individuating reflective period sometime after 18 years of
age
• the individual focuses on reality
• The religious teaching that the young adult had as a child
may now be accepted or redefined

HEALTH RISKS
• Young adulthood is generally a healthy time of life Health
risks that do occur and are common in this age group
include:
o injury and violence
o Suicide
o hypertension
o substance abuse
o sexually transmitted infections (STIs)
o eating disorders
o certain malignancies

# data[].attributes.body
OLDER ADULTHOOD
• 65 – 74 years
• Adaptation to retirement and changing physical abilities
often necessary
• Chronic illness may develop.
• Assist to keep physically and socially active and maintain
peer group interactions
MIDDLE ADULTHOOD
• 75 – 84 years
• Adaptation to decline in speed of movement, reaction time
and increasing dependence on others may be necessary
• Assist to cope with loss. Provide necessary safety
measures
OLD-OLD
• 85 and over
• Increasing physical probs
• Assist with self-care and maintaining independence

# data[].attributes.body
PURPOSE

• to confirm general health and rule out sexually transmitted
infection that could injure the growing fetus

BLOOD STUDIES
1. COMPLETE BLOOD COUNT
2. A GENETIC SCREEN
3. A SEROLOGIC TEST FOR SYPHILIS (VDRL OR
RAPID PLASMA REAGIN TEST)
4. BLOOD TYPING (INCLUDING RH FACTOR)
5. MATERNAL SERUM FOR ALPHA-FETOPROTEIN
(AFP) (MSAFP)
6. AN INDIRECT COOMBS’ TEST (DETERMINATION
IF RH ANTIBODIES ARE PRESENT IN AN RH-
NEGATIVE WOMAN)
7. Antibody titers for rubella and hepatitis B (HBsAg)
8. HIV SCREENINGURINALYSIS
TUBERCULOSIS SCREENING

ULTRASONOGRAPHY

• If the date of the last menstrual period is unknown, a
woman will be scheduled for an ultrasound to confirm the
pregnancy length and document healthy fetal growth

FETAL MOVEMENT

• fetal movements or “kick counts” may be evaluated daily
by the pregnant woman to provide reassurance of fetal
well-being.

# data[].attributes.headline
PROTOCOLS HAVE BEEN DEVELOPED BYDIFFERENT INSTITUTIONS

# data[].attributes.subject
PROTOCOLS HAVE BEEN DEVELOPED BYDIFFERENT INSTITUTIONS

# data[].attributes.body
SANDOVSKY METHOD
• lie in a left recumbent position after a meal and record how
many fetal movements over the next hour

“COUNT-TO-TEN” (THE CARDIFF METHOD)
• the woman records the time interval it takes for her to feel
10 fetal movements
• usually, this occurs within 60 minutes

# data[].attributes.body
PHYSIOLOGIC

Systemic- all systems in the body except reproductive

Local- changes in the REPRODUCTIVE ALSO INCLUDE THE BREAST

PSYCHOLOGIC

Hormones or actual physical changes

Ambivalence- feeling uncertain (normal)

# data[].attributes.body
Full term- 39-40weeks

Trimester - 3 divisions.  first (1-3 mos) 2nd (4-6) 3rd (7-9)

Diagnosis of pregnancy- depends on the signs and symptoms

The early the diagnosis the better

3 classifications - presumptive, probable, positive.

Presumptive- highly subjective. Nothing that another person can verify. Breasts tenderness. Enlarged uterus.

Probable- more reliable. It has objective signs. However, there may be indications of medical conditions. Pregnancy tests detects hormones it detects HCG (hormone the presence or highest during the pregnancy)

Positive- fetal outline in ultrasound, fetal heart tone, fetal movements felt by the examiner.

# data[].attributes.body
BARTHOLOMEW’S RULE:

When reached the Xiphoid process - 36 wks

Umbilical-  20wke

Above the symphysis pubis - 12 weeks

16 weeks - symphysis pubis and umbilicus

38 wk - process of lightening, descend or go down. Head of the fetus is settling into the uterus of the mother.

# data[].attributes.body
MCDONALD’S RULE:

Estimating the AOG by measuring the height of the fundus in centimeters. Get tape measure from pubis bone to the height of the fundus. The check in cm.

Position the client properly-supine position w/ legs or knees slightly flex to relax abdominal muscles- with a small pillow behind the right pelvis.

# data[].attributes.body
Cardiovascular system:

High volume state- blood volume increases by 30-50%

Hematocrit rbs goes down

Heart rate goes up by 20bpm- increase cardiac output

Mild hypertrophy- goes away after pregnancy. INNOCENT MURMUR.

EXPECTED FINDINGS DURING PREGNANCY: Heart sound mitral valve is faster by tricuspid. Presence of extra heart sounds, increase hr, palpitations, innocent murmur.

# data[].attributes.body
8 visits during pregnancy

4 e’s in pre-natal care: educate, emphasize the importance, ensure privacy & comfort, engage & involve.

VISITS:

1-2nd trimester- once a month

3rd tri- twice  a month

9th month- once a week

Past due date- twice a week

Estimated date of delivery: EDD

Naegele’s rule- standard method used to predict length of pregnancy.

When is the first day of your last menstrual period?

Subtract 3 to the month, plus 7 to the day, plus 1 to the year

# data[].attributes.body
focus of the pregnancy and reproductive health of the mother.

Important to determine presence of risk of the patient

Components of the obstetric history

1. Past pregnancy review

2. Obstetric scoring

3. Determining AOG and EGG

4. Assessing for pregnancy risks & danger signs

1. Medical conditions- DM, hypothyroidism, epilepsy, VTE, blood borne virus, genetic disease

2. Family history- medical conditions

3. Social History- smoking, alcohol use, recreational drugs, occupation, domestic abuse

4. Exposure to teratogens- medications/ drugs throughout the pregnancy, exposure in infection diseases

# data[].attributes.body
Gravida- how many times pregnant

Para- need to be born before include in para.. No matter what weeks.

Term- born 37wks and above

Pre term-  born before 37wks

Aborted- pregnancy terminated before 24wks/less than 400grams

Living- born alive

Multiple- If twins counted as 2 in living  but multiple pregnanceis as 1