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Promoting Maternal & Child Health: Family-Centered Care

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                                     INTRODUCTION

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                                     INTRODUCTION

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• Obstare = “to keep watch”
• Pais = “child”

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

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WHAT ARE WE EXPECTED TO DO AS MATERNAL AND CHILD HEALTH NURSES?

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WHAT ARE WE EXPECTED TO DO AS MATERNAL AND CHILD HEALTH NURSES?

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Keeping the family at the center of care or recognizing the family as the primary unit of care is an important goal in all contexts and forms of care. This is because the functioning of a family has an impact on the health of its members (Vonderheid, Norr, & Handler, 2007). Individuals' emotional, physical, and social health and potential might be negatively affected if a family's level of functioning is low. A healthy family, on the other hand, creates an environment that promotes growth and health-promoting activities, as well as providing support to family members during times of crisis.

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Principles

The family is the basic unit of the society

Come in many different forms and sizes

Represent racial, ethnic, cultural, and socioeconomic diversity.

Children grow both individually and as part of a family.

CONTEXTUALIZATION OF PRACTICE: PHILIPPINES
SITUATION

Vital Statistics- These are numerical recordings of significant "events" that affect the population's general health state and serve as a basis for determining the appropriateness of health care.

1. Four phases of Health Care- can be envisioned as a framework in which nurses care for families during their childbearing and childrearing years through four phases of health care, employing nursing method, nursing theory, and evidence-based practice.

2. Statistical terms used to report Maternal and Child
Health- Declining live births, increased births attended by health professionals, >50% born to unwed mothers, more babies born to adolescent mothers, infant mortality remains unchanged, and relatively low maternal mortality ratio.

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Principles of Growth & Development

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Definition of terms:
Growth and Development
- Independent
- Interrelated

Growth - "physical change" e.g. height, weight, bone size
General Growth

Neurologic system - first 2 years

Lymphatic system - infancy and childhood

Reproductive system - puberty

Musculoskeletal system - childhood

Development - increase in skill or ability to function
- qualitative change
- capacity and skill to adapt
- behavioral aspect of growth –( walk, run, talk)

Behavior - the most complete indicator of developmental state

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Factors Influencing Growth and Development
Genetic Inheritance - characteristics that babies inherent from the parents through the chromosomes
Environmental Influences - regular contact with a baby, as well as the type of care he or she receives, has an impact on the development of the infant's personality.

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Psychosexual Development – developing instincts or sensual pleasure (Freud)

Psychosocial Development – personality development (Erickson)

Moral Development – know right from wrong and apply in real-life situations (Kohlberg)

Cognitive Development – learn or understand from experience, to acquire and retain knowledge to respond to new situation and solve problems (Piaget)

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Preconventional Level of Morality (ages 2 to 7)"Punishment & Obedient Orientation"- must determine whether acts are appropriate.

Egocentric focus (Preschooler to School Age)"Instrumental Relativist Orientation" - unable to grasp that similar events necessitate similar responses.

Conventional Level of Morality (ages 7 to 12)"Interpersonal Concordance Orientation" - because it is considered "pleasant," the child enjoys assisting others.

Societal Focus (Adolescence and Adulthood) "Law and Order Orientation" - frequently inquires about the rules and whether something is “right.”

Postconventional Autonomous Level of Morality (ages 12 and older) "Social Contract Legalistic Orientation" - because he/she sees it as a standard of adult behavior, an adolescent can be responsible for self-care.

Universal Focus (Middle-Age or Older Adult) "Universal Ethical Principle Orientation" - many adults never achieve this level of moral maturity.

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Family with a Toddler

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Physiological Development
- This involves rapid brain growth, increased bone length and muscular growth, picking up little items with their fingers, walking, running, kicking, climbing, riding a tricycle, and drinking from a cup.

Cognitive Development
- Tertiary Circular Reaction Stage/Stage 5 (between 12 and 18 months) : experiments by trial and error methods
- Deferred Imitation/Stage 6 (between 18 and 24 months) : remember an action and imitate it later
- Preoperational Thought : deal much more  with symbols
- Assimilation : change the situation

Psychosocial Development
- Freud's, Erikson's, and Havighurst's theory

Personality Traits
☆ Negativism
☆ Ritualistic Behavior
☆ Slowness in carrying out requests/ambivalence
☆ Temper Tantrums

* Accidental ingestions - are the most common types of accidents, such as car accidents, falls, poisoning, drowning, and animal bites.

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Applying the Nursing Process in caring for Toddler

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Applying the Nursing Process in caring for Toddler

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Assessment

- Health history: child-parent relationship

Diagnosis

- Normal toddler growth and health-seeking habits

- Deficient knowledge related to best method of toilet
training

- Disturbed sleep pattern related to lack of bedtime routine

Planning

- Establish realistic goals and outcomes

Implementation

- Teach parents a good rules

- Health visits

- Demonstrating good communication skills

Evaluation

- Children grow so much throughout this time and gain so
many new skills that their capacities and accompanying
parental concerns can shift from day to day.

TAKE NOTE !!!
☆ The child should be permitted to explore the surroundings with the primary caregiver's encouragement throughout the critical stage of AUTONOMY vs. SHAME and DOUBT.

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Family with a Pre-Schooler

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Preschool Stage
- a crucial phase of development for parents
- physical growth slows
- setting limits

National Health Goals

Increase the number of states with legislation requiring bicycle riders under the age of 15 to 50 from a starting point of ten.

Reduce infectious diarrhea among children in licensed child care centers by at least 25%.

Increase the percentage of children aged 4 and younger who utilize kid car restraints from 92 percent to 100 percent.

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Physiologic Development
- Head is close to adult size by six years old
- Motor abilities include jumping, skipping, throwing a
ball, printing letters and numbers
- Average child gains: 4.5 lb (2 kg)/ a year

Psychosocial development
- Developmental Task: Initiative Versus Guilt
- Need exposure to a wide variety of experiences
and play materials

Socialization - Grandparents, siblings, and preschool teachers are now important others (but parents remain the most important).

Emotional Development

Imitation - replicate the activities that kids see their parents doing at home the best.

Fantasy - remind kids that they are still recognizable.

Oedipus and Electra Complexes - each child competes with the same-sex parent for the other parent's affection and attention.

Gender Roles - need to be exposed to an adult of the other gender in order to become familiar with the roles of the opposite gender

Socialization - much more time is spent with other kids their age.

Cognitive Development

According to Piaget, cognitive development is still preoperational at three years.

Begin a second phase of thought known as intuitional thought.

Centering - lack the ability to perceive themselves through the eyes of others or to put themselves in the shoes of others

Moral and Spiritual Development

Determine what is correct and what is incorrect depending on

Conscience

Common Health Problems

1. Automobile accidents

2. Poisoning and falls

3. Minor illnesses, such as colds, ear infections, and flu symptoms

Common Fears

1. Fear of the Dark -reassure they are safe

2. Fear of Mutilation - need good explanations of the limits of health care procedures

3. Fear of castration

4. Fear of Separation or Abandonment - most effective, “Mommy will pick you up from preschool after you have had your snack”

Behavior Variations

1. Telling Tall Tales - parents should be warned not to encourage this type of storytelling, but rather to assist their children in distinguishing between fact and fantasy.

2. Imaginary Friends - discussing their imagined acquaintance, they must distinguish between fact and imagination

3. Difficulty Sharing - assure parents that sharing is a challenging concept to grasp and that, like most things, it takes practice for toddlers to understand and develop.

4. Regression - greatest strategy to assist a child stop this behavior is to remove the stress.

5. Sibling Rivalry - feel secure and promote self-esteem, by supplying them with a private drawer or box for their things

Special Problems

1. Thumbsucking

2. Food likes and dislikes

3. Enuresis – bed-wetting

4. Encopresis - fecal incontinence or soiling

5. Bruxism - grinding the teeth at night

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Applying the Nursing process in caring for Preschooler

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Applying the Nursing process in caring for Preschooler

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Assessment
- Obtaining a health history and performing both a physical and developmental evaluation

child’s weight and height

assess a child for general appearance (alert, happy, active, healthy)

teeth for presence of cavities

symmetrical gait

frequent upper respiratory infections

Diagnosis

health-seeking behaviors related to  developmental expectations

readiness for enhanced parenting related to parent’s
pride in child

risk for poisoning related to maturational age of
child

Planning
- Developing a schedule for talking with parents about normal preschool growth

accident prevention

opportunities for adventurous activities or messy play

Implementation
- Children imitate moods as well as actions

role playing a mood or attitude you would like a child to learn

suggest preschoolers participate by listening to their heart or coloring the table paper

Evaluation

When crossing roadways, a child emphasizes the significance of holding his or her parent's hand.

By the next appointment, the mother says that she has prepared her 4-year-old for the arrival of the new baby.

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CHILD CARE CENTER
- child care is provided when parents are at work or otherwise occupied.

PRESCHOOL
- committed to encouraging children's creativity and initiative, as well as exposing them to fresh experiences and social interactions that they might not otherwise encounter at home

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Family with a School-aged Child

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What is School Age?
School age, often known as middle childhood, refers to the period of a child's life between the ages of 6 and 12. As the child grows and matures, the school-age years can be a remarkable adventure filled with joys and accomplishments.

Physical Growth

Annual average weight gain - 3 to 5 lb (1.3 to 2.2 kg)

Increase in height - 1 to 2 in (2.5 to 5 cm)

Posture - slims down, becomes more agile and graceful

Immunoglobulins IgG and IgA - reach adult levels & lymphatic tissue continues to grow up until about age 9

Pulse rate - ↓ to 70 - 80 beats/minute

Blood pressure - ↑  about 112/60 mm Hg

Maturation of respiratory system - ↑ oxygen–carbon dioxide exchange

10 years of age: brain growth is complete, fine motor coordination becomes refined.

Malocclusion - a deviation from the normal with teeth alignment

Scoliosis - may become apparent for the first time in late childhood

➤ Girls develop slightly faster than boys, despite the fact that boys are taller and heavier on average until the adolescent growth spurt.
➤ The first area of the body to experience a growth spurt is the feet.

Sexual Maturation

girls: occurs between 12 & 18 years

boys: between 14 and 20 years

➤  The levels of gonadal hormones rise, causing the sexual organs to mature.

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Sexual and Physical Concerns
- Discuss the physical changes that will occur as well as sexual responsibility with your children.
- Reinforce previous teaching
Concerns of Girls
* Prepubertal girls are usually taller, by about 2 in (5cm)
* Change in pelvic contour
* Conscious of breast development
Concerns of Boys
* Aware of increasing genital size
* Testicular development precedes penis gro
* Seminal fluid is produced, boys begin to notice ejaculation during sleep, termed nocturnal emissions

Menarche: first menstruation, usually starts around age 12 but can occur as early as age 9

1. Physiological Development (6 to 12 Years)
➤ Brain reaches 90% to 95% of adult size
➤ Motor abilities progress to writing in script and in sentences by age 12
➤ All permanent teeth present except for 2nd and
3rd molars by age 12

Psychological development
➤ Attending school
➤ Introduces the child to a new set of authority figures

2. Psychosocial development - Erikson’s stage of industry versus inferiority
➤ Wants to work and produce, accomplishing and achieving tasks
➤ Negative attributes of inadequacy and inferiority may prevail

Language development and Socialization
➤ Efficient vocabulary and begins to correct previous mistakes
➤ Begins to understand the double meanings of words
Age 6: talk in full sentences
Age 7: know the months of the year and can name the months
Age 9: discover “dirty” jokes
Age 12: sense of humor is apparent
First and Second Grades: peers are increasingly significant to the child

Play
➤ Discover reading as an enjoyable activity
➤ Playing challenging video game
Age 7: collecting items such as baseball cards
Age 8: sorting and cataloging
Age 10: interested in rules and fairness

3. Cognitive development
➤ Achievement in school and peer acceptance are two significant developmental challenges at this time.
➤ Uses inductive reasoning to solve new problems

New Concepts Learned
Decentering - to put oneself in other people's shoes
Accommodation - to change one's mental processes to fit the situation
Conservation - to recognize that a change in shape is a good thing
Class Inclusion - to recognize that objects might belong to multiple categories

4. Emotional Development
➤ Ability to trust others and with a sense of respect
➤ Can accomplish small tasks

5. Moral and Spiritual Development - Kohlberg’s Conventional Level
➤ Behaves according to socially acceptable norms
➤ Ages 11-12: Begins to approach adolescence, school and parental authority is questioned
➤ Peer group intensifies
➤ Parental guidance, love, and support are essential

☆ Keys to health: PEDS
Proper nutrition
Exercise
Dental hygiene
Sleep

Proper Nutrition
➤ Encouraged to eat a variety of healthy foods
➤ Encouraging healthy eating habits

Exercise and activity
➤ Help the child begin healthy habits
➤ Sport teams or sporting events

Dental hygiene
➤ Teeth should be brushed at least twice a day, do flossing
➤ Drinking water should contain fluoride
➤ Regular dental cleanings, every 6 months

Sleep and rest
➤ Don’t require an afternoon nap, and compliance at bedtime becomes easier
➤ Develop healthy sleep habits by not having a television

Coping with concerns

1. School Phobias - school refusal or school avoidance, sign of a separation anxiety. Possible reasons could be being the target of a bully

2. Stealing - wants items for himself. Possible reason could be financial means

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Applying the Nursing process in caring for School-Aged child

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Applying the Nursing process in caring for School-Aged child

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Assessment
- History and physical examination: Growth & development
- School activities and progress

Diagnosis (possible ND)
- Anxiety related to slow growth pattern of child
- Imbalanced nutrition, more than body requirements,
related to frequent consumption of snack foods

Planning
- They tend to enjoy small or short term projects rather than long
- Behavior problems need to be well
defined

Implementation
- May not cooperate with a procedure until they are given a satisfactory explanation

Evaluation (possible outcome)
- Parent states he allows child to make own decisions
about how to spend allowance
- Child does not sustain injury from sports activities
during the summer recess

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Family with an Adolescents

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Applying the Nursing process in caring for an Adolescence

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Applying the Nursing process in caring for an Adolescence

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ASSESSMENT

HEALTH HISTORY SEPARATELY FROM PARENTS TO PROMOTE INDEPENDENCE AND RESPONSIBILITY FOR SELF-CARE

DIAGNOSIS

HEALTH-SEEKING BEHAVIORS RELATED TO NORMAL

LOW SELF-ESTEEM RELATED TO FACIAL ACNE

RISK FOR INJURY RELATED TO PEER PRESSURE TO USE ALCOHOL AND DRUGS

PLANNING

ESTABLISHING A CONTRACT

RESPECT THE FACT THEY HAVE A STRONG DESIRE TO EXERT INDEPENDENCE OR DO THINGS THEIR OWN WAY

IMPLEMENTATION

EVALUATE HOW AN INTERVENTION APPEARS FROM AN ADOLESCENT’S STANDPOINT BEFORE BEGINNING TEACHING

EVALUATION

PARENTS STATE THEY FEEL MORE CONFIDENT ABOUT THEIR ABILITY TO PARENT AN ADOLESCENT

CLIENT STATES HE HAS NOT CONSUMED ALCOHOL IN 2 WEEKS

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ADOLESCENCE

PERIOD BETWEEN 13 AND 18 OR 20 YEARS

TRANSITION BETWEEN CHILDHOOD AND YOUNG ADULTHOOD

PHYSIOLOGIC, PSYCHOLOGICAL, AND SOCIOLOGIC CHANGES

DIVIDED INTO: (1) EARLY PERIOD (13 TO 14 YEARS), (2) MIDDLE PERIOD (15 TO 16 YEARS), (3) LATE PERIOD (17 TO 20 YEARS)

GROWTH AND DEVELOPMENT OF AN ADOLESCENT

1. GROW BOTH RAPIDLY AND MATURE DRAMATICALLY

2. INCLUDE FACTORS SUCH AS OCCUPATIONAL HAZARDS OR THE EFFECTS OF JOB, FAMILY, AND FINANCIAL STRESS ON AN ADOLESCENT

PHYSICAL GROWTH

1. Apocrine sweat glands

2. Heart and lungs increase in size more slowly

3. PR: 70 beats per minute

4. RR: 20 breaths per minute

5. BP: 120/70 mm Hg than the rest of the body

Major milestone: Onset of puberty at 9 to 12 years of age
and the cessation of body growth at 16-20 years of age

PHYSICAL DEVELOPMENT: body structures that make reproduction possible

PLAY OR RECREATION

AGE 14: cannot work non-agricultural jobs unless employed by parents

AGE 15: may spend a great deal of time in their room

AGE 16: no hours limit

AGE 18: no hours limit

EMOTIONAL DEVELOPMENT

Developmental Task: Identity Versus Role Confusion

Establishing a value system or what kind of person they want to be

SENSE OF INITIMACY

Strongly correlated with the sense of trust, the first developmental task in infancy

SOCIALIZATION

Early teenagers may feel more self doubt than self confidence

Adolescents watch adults carefully during this period, searching for good role models with whom they can identify

MORAL AND SPIRITUAL DEVELOPMENT

Adolescents start to show interest in learning about other cultures and beliefs

They can be responsible for self-care because they view this as a standard of an adult behavior

HEALTH PROMOTION FOR AN ADOLESCENT AND FAMILY

1. PROMOTING ADOLESCENT SAFETY

2. DROWNING IS ANOTHER CHIEF ACCIDENT

3. HOMICIDE AND SUICIDE

4. ATHLETIC INJURIES

RECOMMENDED DIETARY REFERENCE INTAKES

↑ NUMBER OF CALORIES

↑ CALCIUM PLUS PHYSICAL EXERCISE

LARGE AMOUNTS OF IRON

PROMOTING NUTRITIONAL HEALTH WITH A VARIED DIET

1. VEGETARIAN DIETS

2. GLYCOGEN LOADING

PROMOTING DEVELOPMENT OF AN ADOLESCENT IN DAILY ACTIVITIES

ADEQUATE SLEEP

DRESS AND HYGIENE

EXERCISE

CARE OF TEETH

PROMOTING HEALTHY FAMILY FUNCTIONING: MAY FOLLOW HEALTH ADVICE POORLY BECAUSE THEY VIEW HEALTH CARE PERSONNEL IN THE SAME LIGHT

COMMON HEALTH PROBLEMS

HYPERTENSION

POOR POSTURE

BODY PIERCING AND TATTOOS

FATIGUE

ACNE

OBESITY

CONCERNS REGARDING SEXUALITY AND SEXUAL ACTIVITY

INCREASING EXPOSURE TO AND ACCEPTANCE OF PREMARITAL SEXUAL RELATIONS IN SOCIETY, MORE ADOLESCENTS THAN EVER

DIFFICULTY TELLING THEIR PARENTS ABOUT THEIR PERCEIVED SEXUAL ORIENTATION

CONCERNS REGARDING HAZING
- HAZING: DEMEANING OR HUMILIATING RITUALS THAT PROSPECTIVE MEMBERS HAVE TO UNDERGO TO JOIN SORORITIES, FRATERNITIES, ADOLESCENT GANGS, OR SPORTS TEAMS

CONCERNS REGARDING SUBSTANCE ABUSE
- USE OF CHEMICALS TO IMPROVE A MENTAL STATE OR INDUCE EUPHORIA
TYPES OF ABUSED SUBSTANCES

1. PRESCRIPTION AND OVER-THE-COUNTER DRUGS

2. TOBACCO

3. ALCOHOL

4. PERFORMANCE-ENHANCING DRUG ABUSE

5. MARIJUANA

6. AMPHETAMINES

7. COCAINE

8. OPIATES

ASSESSMENT OF SUBSTANCE ABUSE
- IF ADOLESCENTS TRUST HEALTH CARE PERSONNEL, THEY WILL GENERALLY ADMIT THEY HAVE ENGAGED IN DRUG EXPERIMENTATION

CONCERNS REGARDING DEPRESSION AND ATTEMPTED SUICIDE
SUICIDE: DELIBERATE SELF-INJURY WITH THE INTENT TO END ONE’S LIFE
: SUICIDE IS SO COMMON IN ADOLESCENTS THAT IT RANKS THIRD AS A CAUSE OF DEATH IN THE 15-TO 19-YEAR-OLD GROUP

CONCERNS REGARDING RUNAWAYS
RUNAWAY: CHILD BETWEEN THE AGES OF 10 AND 17 YEARS WHO HAS BEEN ABSENT FROM HOME AT LEAST OVERNIGHT WITHOUT PERMISSION OF A PARENT OR GUARDIAN

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Family with Young and Middle Aged Adult

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Adulthood: is divided into three phases - (1) young adults: 20 to 40 years old, (2) middle adulthood: 40 to 65 years old, (3) late adulthood

Adult Age Span includes three very different generations:
➤ Baby boomers: more highly educated and have a large percentage of women in the workforce
➤ Generation X: raised in two worker households
➤ Generation Ys (or Millennials): technologically sophisticated

YOUNG ADULTS (20 TO 40 YEARS)
-social context of the individual, and this defining age is changing
-boomerang kids have evolved
-criterion of adulthood is financial independence

Physical Development

the musculoskeletal system is well developed and coordinated

period when athletic endeavors reach their peak

Psychosocial Development

basic developmental task is establishing intimacy

sense of intimacy versus isolation

Cognitive Development

use formal operations, characterized by the ability to think abstractly and employ logic

Moral Development

mastered the previous stages of Kohlberg’s theory of moral

development enter the post-conventional level

able to separate self from the expectations and rules of others

Spiritual Development

reflective period sometime after 18 years of age

individual focuses on reality

Health Risks

1. injury and violence

2. suicide

3. hypertension

4. substance abuse

5. sexually transmitted infections (STIs)

6. eating disorders

7. certain malignancies

Health Assessment and Promotion
➤ usually interested in meeting their health needs
➤throughout the 20-year period from ages 20 to 40, the nurse needs to offer teaching and guidance in several health care areas

MIDDLE-AGED ADULTS (40 TO 65 YEARS)
- the years of stability and consolidation
- mature individuals are guided by an underlying philosophy of life
- many perspectives into account and are tolerant of the views of others

Physical Development

At 40, most adults can function as effectively as they did in their 20s

At 40-65, many physical changes take place

Psychosocial Development

Generativity versus Stagnation

Generativity: the concern for establishing and guiding the next generation

Marriage partners have more time for companionship and recreation

Cognitive Development

include reaction time, memory, perception, learning, problem solving, and creativity

life experiences of middle-aged individuals will be reflected in their cognitive performance

Moral Development

can move beyond the conventional level to the post-conventional level

extensive experience of personal moral choice and responsibility is required before people can reach the post-conventional level

Spiritual Development

not all adults progress through Fowler’s stages to the fifth, called the paradoxical-consolidative stage

can view “truth” from a number of viewpoints

Health Risks

1. injuries

2. cancer

3. cardiovascular disease

4. obesity

5. alcoholism

6. mental health alternations

Health Assessment and Promotion
➤ shown in the accompanying Developmental Assessment
Guidelines
➤  usually take care of their health needs and are interested in maintaining health

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Care of pregnant woman and her family

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ASSESSING MATERNAL AND FETAL HEALTH

How to encourage pre-natal care?
E-ducate
E-mphasize the importance
E-nsure privacy & comfort
E-ngage & involve

Frequency of visit

1-7: once/month

8-9: twice/month

10: weekly

Post-term: twice/week

COMPONENTS
1.Health History
- Demography
- Chief concern
- Family & social
- Post medical Hx
- Gynecologic Hx
- Obstetric Hx (past pregnancies, obstetric score, EDD & AOG)

Estimation of EDD

Naegel's rule: standard method used to predict length of pregnancy

Formula: Month (-3), Day (+7), Year (+1)
Obstetric Score

GTAPL/GTPALM: Gravida, term, pre-term, aborted, living children, and multiple pregnancies

Changes in Pregnancies

Weight & Vital signs: 30-35 lbs.

Eyes: (-)BOV, (-)swelling of eyelids

Nasal stuffiness: (+,-)

Melasma/Chloasma: (+,-)

Fissures on the lips: (-)

Dental caries: (-)

Gingival hyperplasia: (-)

Swelling (+)

Slight enlargement of thyroid

Breast tenderness, darkening & protrusion of tubercle; production of colostrum

Slight Inc in HR (70-80); Palpitations may be present

Slight INC in RR

Enlarged, firm, globular abdomen

Findings

Lordosis, back pain (+)

Hemorrhoids  (+)

Palmar Erythema  (+)

LE varicosity & edema (+)

Waddling gait (+)

Vagina: purple in color, (-) signs of vaginal infection, (-) vesicles/ulcerations

Rectocele/cystocele (-)

Cervix purple in color, tender: (+) edema, (-) inflammation, (-) vesicles/lesions/ulcerations

Assessment procedures

1. measurement of fundal heights & fht

2. pelvic examination

3. PAPanicolau smear

4. pelvic measurement

Estimation of fetal growth

1. Bartholomew's rule: fundus reaches typical measurement

2. Mcdonald's rule: measure cm -> SYMPHYSIS PUBIS = week of gestation

Assessing fetal well-being

1. Fetal movement

2. Fetal heart tone

Pelvic Examination: Position the woman correctly; lithotomy position with pillow under her head and ask to void
Pap Smear: 3 sites for smear- Endocervical,Cervical os, Vagina pool

Estimating pelvic size
- detecting if the pelvis is adequate for fetus to pass through its center
- must be done by 24th week
Internal Pelvic Measurement

1. True conjugate: 10.5cm-11 cm

2. Diagonal conjugate: >12.5 cm

3. Ischial tuberosity: 11 cm

Laboratory Assessment

1. Blood studies: cbc, vdrl, HIV screening

2. Urinalysis: (+) albumin/protein/glucose/urine

3. Tuberculin screening: PPD/tuberculin skin test

Danger sign of Pregnancy

Vaginal bleeding

Chills & fever

Increase/decrease Fetal movement

Sudden Escape of clear fluid from the vagina

Pregnancy-induced HTN

Abdominal/chest pain

Persistent vomiting

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Laboratory Assessment
: to confirm general health and rule out sexually transmitted infection

Blood Studies

Complete Blood Count: (1)hemoglobin or hematocrit and red cell index: (+)anemia, (2)white blood cell count: (+)infection, (3)platelet count: estimate clotting ability

Genetic screen: for common ethnically inherited diseases

Serologic test for syphilis

Blood typing (including Rh factor)

Indirect Coombs’ test

Antibody titers for rubella and hepatitis B

HIV screening

Urinalysis: performed to test for proteinuria, glycosuria, and pyuria
Tuberculosis Screening: physician or nurse-midwife may order a purified protein derivative (PPD) - chest radiograph (+)
Ultrasonography: Be certain that women know an ultrasound done this early in pregnancy will show only the presence of a  gestation sac, not a moving, kicking fetus so their expectations of what they will see are realistic

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