Mother and Child by Vandana Faith Luedtke

Module 1 - Introduction

200140c — 2021-09-01 06:13:54 UTC

Family-Centered Care ➞ Involves the relationship of many individuals with internal and external factors surrounding them. Each factor affects the individual independently and those surrounding them as an aspect. The course aims to tailor all these aspects to help a family grow in all areas, be prepared, provide education, support, provide healthy settings - for both parents, children, and the like.

New terms...

200140c — 2021-09-01 06:16:30 UTC

Obstare ➞ To keep watch
Pais ➞ Child

Birth Rate ➞ Number of births per 1000 population
Fertility Rate ➞ Number of pregnancies per 1000 women of childbearing age
Fetal Death Rate ➞ Number of fetal deaths per 1000 live births weighing more than 500g
Neonatal Death Rate ➞ Number of deaths per 1000 live births occurring at birth or in the first 28 days of life.
Perinatal Death Rate ➞ Number of deaths of fetuses weighing more than 500g and within the first 28 days of life per 1000 live births.
Maternal Mortality Rate ➞ Number of maternal deaths per 100,000 live births that occur because of the reproductive process.
Infant Mortality Rate ➞ Number of deaths per 1000 live births occurring at birth or in the first 12 months of life.
Childhood Mortality Rate ➞ Number of deaths per 1000 population in children, 1-14 years of age.

Childrearing ➞ to raise a child
Childbearing ➞ To give birth

Expectations of a Maternal and Child Health Nurse

200140c — 2021-09-01 06:19:03 UTC

Provide Preconceptual ➞ Given to men and women of reproductive age (even if they are not planning parenthood). Provides focus on the mother and father to ensure the health of the baby and parents such as; nutrition, diet, supplementation, and lifestyles.

Care of women during 3rd trimester of pregnancy and Puerperium ➞ Antenatal/prenatal care through: 1st trimester= 1-3 months, 2nd trimester= 4-6 months, 3rd trimester= 7-9 months. This includes before labor, during labor, and after labor (recovery/post-partial care of 6 weeks after birth.

Care of infants during perinatal period ➞ A period of 6 weeks before conception to 6 weeks after birth. This includes pre-conceptual care, assessing the fetus during the pregnancy (throughout), and actual care that is direct to the newborn once they are birthed.

Care of children from birth through adolescence ➞ This stage allows growth and development that pertains to knowledge, all the way from infancy up to the stages of the elderly. This may look like health promotional activities dealing with nutrition, or exercise, providing prevention and management with illness or injury, and other conditions that may affect the individual in the overall development through mental and physical health.

Care in settings as varied ➞ Knowing and know-how from infancy to elderly is important when providing the proper setting for an individual. Through different stages of development, different ages of development, we require proper environments and individuals that can aid in the holistic, maternal; individuals, and family members. This is direct care for what they require at the time of the circumstances, patients, and family.

Principals

200140c — 2021-09-01 06:23:47 UTC

Family ➞ Basic UNIT of society
Family ➞ all different types, races, ethnicity, cultures, socioeconomic diversities, and functions.
Children grow individually, and as part of a whole (family).

Childbearing + Childrearing

200140c — 2021-09-01 06:25:45 UTC

Promotion ➞ educating a client to be aware of good health, where we teach and role model our actions and thoughts that one can mirror, reciprocate and think on.

Maintenance ➞ To upkeep or intervene to provide a lack of progression

Health Restoration ➞ To provide a diagnosis, treat an illness by using an intervention that can restore the client to a state of wellness faster.

Health Rehabilitation ➞ This is to provide further complications from occurring, by bringing them back to the state of wellness or helping the client accept the worse that may occur.

Questions about the class?

200140c — 2021-09-01 06:28:50 UTC

Do we have to learn any calculations for this class (like do we memorize them?).

Are we going to write any research papers based on this topic in the upper years or even this year?

Do we have to know any other statistics other than mother and child? Like mortality rates regarding disease-specific incidents (infectious diseases).

Module 2 - Theories of Developement

200140c — 2021-09-01 06:36:33 UTC

Provide roadmaps to explain
- shows skill or growth from a particular time in a life (developmental tasks)

-Physical tasks = anything bodily (sit, crawl)
- Psychological Tasks= mental and emotional
- Cognitive Tasks = concepts of time, space, and above thinking

* Psychosexual Dev = instincts or sensual (Freud)
-> Physical, emotional, cultural aspects of society (nature has two sides rational + irrational)

-> Id, Ego, Superego= continuous battle with the ID
-> Instinctual libido focuses on different areas of the body
-> Oral stage (birth-age 1)= suck, enjoyment and release of tensions.
-> Anal stage (1-3)= holding on and obsessive-compulsive behavior
-> Phallic stage (3-6) = interested in genitalia, has fears.
-> Latency Period (6-12) = Oedipal/ Electra complex resolves allowing close relationships, however, school Phobia occurs.
-> Genitalia stage (12+) = sex hormones intensify, and repro reach max maturation.

* Psychosocial Dev= personality (Erickson)
-> Thought and behavior, immediate controls with social and biological process
-> Trust Vs Mistrust (Infancy), satisfy needs on time to security
-> Autonomy vs Shame + Doubt (Toddler)= child learns control of body functions and becomes more dependent (this offers decision making)
-> Initiative vs Guilt (age 3-6) where a child learns through play by adapting a conscience. They are imaginative and creative (fine motor dev)
-> Industry vs Inferiority (age 6-12). Here, they manage things well.
-> Identity vs Role confusion (12-20ag). Self discovers and accepts a new form of self and body image, seeking freedom.

-> Intimacy vs Isolation (20-30) where they search for lifetime partner/career-focused
-> Generativity vs Stagnation (30-65)
-> Ego integrity vs Despair (65-death)

* Moral Dev= right vs wrong applied to life (Kohlberg)
-> children gain knowledge of right and wrong or moral reasoning
-> Moral behavior mature as well through the ability to interact
-> Preconventional level of morality (2=7) = Punishment and obedient orientation - child attempts to follow rules set by authority, egocentric focus (preschooler). Instrumental relativist orientation, satisfies own need rather than society.
-> Conventional level of morality (7-12) = decision and behaviors are based on concerns about others reaction, societal focus, and try to make the system work
-> Postconventional Autonomous Level of Morality (12+) = Follows standard for the good of all people, universal focus (middle age)
* Cognitive Dev= comprehension of gained knowledge retained in response or to solve (Piaget)
-> adapting and organizing through 4 stages
-> Sensorimotor (birth- age 2). Concepts that need to be mastered are object permanence (to understanding objects and events continue even when we can't see/hear, spatial relationships)
-> Preoperational (2-7). The child can't comprehend a point of view different from their own.
-> Concrete operational (7-11), thought process becomes more logical and coherent, inductive reasoning happens
-> Formal operational thought (11-20), adaptability and flexibility. Can think abstractly and draw conclusions

Factors Influencing Growth and Developement

200140c — 2021-09-01 06:37:50 UTC

- Genetic Inheritance = inherent from parents' chromosomes; race, intelligence etc
-> Related mannerisms, health, intelligence, and temperament
- Environmental Influences= contact of surroundings and individuals affect personality

Patterns of Developement

200140c — 2021-09-01 06:38:54 UTC

Cephalocaudal = head to toe direction of growth
Proximodistal = inward and outward pattern
General to specific = simple to more complex tasks

Development proceeds from gross to refined skills (distal portions are in control, then they can perform finer motor skills)

Optimum time for initiation of experiences/learning = You cannot pressure a child to have certain skills as their own body will regulate when they are prepared to function or progress.

A great deal of skill and behavior is learned by practice = practice makes perfect, as a child still needs to practice basic movements and functions to naturally do something. For example, walking- they still have to practice as they don't get up one day and know how to do so.

Principals of Growth and Development

200140c — 2021-09-01 06:40:06 UTC

1) Continuous process of conception until death = A child is constantly growing and learning new skills physically and mentally.

2) Proceed in an orderly sequence = Each stage is predictable, and this is how we measure if a child is functioning accurately. The only time that one sequence may vary is if the parents do not process it, or if the child is more established in a certain area, usually only by one step and no more.

3) Different children pass through the predictable stages at different rates
- With this, not all body parts grow the same as different body tissues mature more rapidly than others. This ties in with number 4 of not all body systems do not develop at the same rate.

5) Development is cephalocaudal = Cephalo means head, while caudal means tail. This means that motor development is processed from the head first to the lower extremities, causing the lower extremities to be used later on with more growth.

6) Development proceeds from proximal to distal = as mentioned, this ranges from the closer the body is to the center develops first, while farther away develops last. (Arms are used before feet, holding things before walking).

What is Development?

200140c — 2021-09-01 06:41:25 UTC

Development is the process/skill or ability to function that is constantly growing and changing

Maturation ➞ aging where one adapts and shows comprehension of the new situation with skills and knowledge that have been perceived/taught.
➞ These involve the processes of= qualitative change, capacity and skill to adapt, the behavioral aspect of growth, and the ability of an individual to perform the specific tasks

Behavior and Maturation slightly differ as behavior is comprehensive in showing the status of development in a child.

Terms to know

200140c — 2021-09-01 06:42:33 UTC

Independent ->
Interrelated ->

^ As stated above, these terms correspond with growth and development as processes. A good example of this is how an infant needs muscles, bones, and nerves to grow to a point where they can sit up, walk, and stand.

(Growth) Physical Changes ->
- To correspond with physical the physical diameter of someone has to equate to the vertical diameter, where they are growing similarly.
- Growth can change at different stages, different external factors can play a role, and it is different in each individual.
- Height = in/cm, weight= lbs/kg, bone size = dentition
- Highest speed of physical growth is during infancy and adolescence
- Slows down during childhood and is very minimal during adulthood.

Module 3 - Family With An Infant

200140c — 2021-09-01 06:48:39 UTC

Describe normal infant growth, development, and parental concerns.

Analyze methods of care for an infant, specifically famaily-centered care.

Asses infant growth milestones.

Identify areas that could benefit from more nursing research and practice.

Integrate knowledge of infant growth and development with nursing process to achieve quality maternal and child health nursing.

1st Year - Organ & Systemic Growth

200140c — 2021-09-01 07:08:19 UTC

Weight [1 yr] ➞ 10 kg
Height [1 yr] ➞ 25 in. or 76 cm.
Head Circumference ➞ 66% of adult size
Cardio ➞ slower, 110 bpm
Respi ➞ slower, 25 breaths/min
Immune ➞ good at 2 months, IgG and IgM
Teeth ➞ Age [months] - 6

Motor Skills

200140c — 2021-09-01 07:10:26 UTC

Ventral Suspension Position ➞ 3 mth. maintiain head lift
Landau Reflex ➞ 3 mth. ➞ Extend head, leg, spine
- Head depressed ➞ Flex hip, knee, elbow
Parachute Reflex ➞ 6-9 mths. ➞ ventral, lower baby ➞ arm extend
Prone Position ➞ baby on stomach ➞ turn head to breath
Neck Righting Reflex ➞ 4 mths ➞ turn neck ➞ shoulder, trunk, & pelvis turn same way
Sitting Position ➞ 1 month ➞ head lag trying to sit up
- 6 mth ➞ support sit temporarily
Stepping Reflex ➞ before 3 mths ➞ standing ➞ knees & hips flex ➞ no support
Grasp Reflex
- 1 mth ➞ strong grasp
- 2 mth ➞ grasp then release
- 4 mth ➞ thumb opposition
- 10 mth ➞ pincer grasp

Milestones

200140c — 2021-09-01 07:26:46 UTC

Language ➞ cooing ➞ Vowel ➞ first word ➞ 2 words meaning
Play ➞ mobiles and face ➞ stimulant toys ➞ transfer toys ➞ peek-a-boo
Vision ➞ binocular vision ➞ familiar objects ➞ depth perception ➞ object permanence
Hearing ➞ Quiets ➞ Turns head ➞ recognize ➞ locate direction
Socialization ➞ Knows face ➞ mad at stuff gone ➞ stranger anxiety ➞ tones of voice ➞ join family

Safety Precaution

200140c — 2021-09-01 07:36:09 UTC

Aspiration
- most common death
- avoid round, cynlinder at arms length, and removable
- Buttons, popcorn, & peanuts
Falls
- 2nd common
- no raised surface, roll over at 2 mths
Car
- use rear facing seat
Bathing
- Never leave alone

What I learned...

200140c — 2021-09-01 07:38:17 UTC

I actually enjoy knowing some of these are common sense, but can see why they are applicable in assessing potential issues and pathologies for babies.

Questions I have...

200140c — 2021-09-01 07:40:19 UTC

When a baby comes in, do we have to follow a toolkit or questionaire for assessing all functions?

What assessments are similar to adult patients?

Module 4 - Family with a Toddler

200140c — 2021-09-01 07:44:22 UTC

Describe normal growth and development of a toddler.

Explain the developmental tasks appropriate for a toddler.

Apply nursing process for toddler.

Growth Milestones

200140c — 2021-09-01 07:58:36 UTC

15 mths
- Language ➞ 6 words
- Play ➞ blocks, read to, permanence
- Motor ➞ transfer games, pencil, turn spoon
18 mths
- Language ➞ jargon, body parts
- Play ➞ chores, parallel play
- Motor ➞ run/jump in place, stairs, don't rotate spoon
24 mths [2 years]
- Language ➞ 50 words, 2 word sentence
- Play ➞ parallel play
- Motor ➞ open door, stairs, lids
30 mths
- Language ➞ Full name, color, finger age
- Play ➞ imitate, play rough
- Motor ➞ jump off chair, pencil line

Toddler Cognitive & Psychosocial

200140c — 2021-09-01 08:00:12 UTC

Cognition
- Tertiary Circular Reaction stage ➞ 12-18 mths ➞ trial & error method
- Deferred Imitation ➞ 18-24 mths ➞ remember and imitate ➞ problem solving
- Preoperational Thought ➞ Assimilation ➞ perception, fit with thoughts
Psychosocial
- Freud ➞ anal stage, potty train
- Erikson ➞ autonomy vs shame
- Havighurst ➞ control elimination, sex difference, right vs wrong
Behavior
- Temper Tantrum
- ambivalence (won't do as told)

Nursing Process for a Toddler

200140c — 2021-09-01 08:08:43 UTC

Assessing ➞ Ask parents ➞ healthy history ➞ ADLs and child-parent relationship
Diagnosis ➞ Teach normal growth milestones to parents and what to anticipate from toddler.
Planning ➞ Family education and setting realistic goals.
Implementation
- "Toddler is traveling visitor"
- Good communication skills
Evaluation ➞ toddlers can change quickly ➞ set appropriate goals frequently to build routine.

What I learned...

200140c — 2021-09-01 08:18:06 UTC

It seems at this stage of development, things slow down. That might makes things easier, but it is actually harder now for the parents, as they have to learn communication skills as well as parenting skills in taking care of their toddler. Gears shift from locomotive to psychologic.

Questions I have...

200140c — 2021-09-01 08:20:50 UTC

Being that the nursing process for toddlers are focused on preventative and health promoting, what are the most common pathologic nursing diagnosis for toddlers?

Module 5: Family with a Preschooler.

200140c — 2021-09-06 07:28:15 UTC

* Describe the normal growth and development as well as common parental concerns during the preschool stage

* Identify the different milestones during preschool stage

* Integrate knowledge of preschool growth and devleopment with the nursing process to achieve quality maternal & child health nursing care.

Growth & Development:

200140c — 2021-09-06 08:41:04 UTC

> Physiological Development
- Head is size of 6yr
- PR = 85beats per/min
- BP = 100/60 mm Hg
- Voids often (9/10 per day)
- 20 teeth
- Slight weight +

>Psychosocial Development
- Initiative vs Guilt (develope sense of guilt)

> Socialization
- other relatives become closer
- same age children interaction needed

> Emotional Development
- encourage creative play
- Imitation = roles, events, activities
- Fantasy = let children know they are still recognizable
- Oedipus & Electra Complex= competes againsame sex parents, jealous + anger arise
- Gender roles= exposure to opssite gender
- Socialization = sensitive and critical time for socialization, developed best friendships (odd numbers will have a hard time playing together)

> Cognitive Development
- preoperational, intuitional thought/phase, centering, important points to remember, conservation and implications
- Egocentrism increase, curiosity, language

> Moral + Spiritual Dev
- right vs wrong
- difficulty seeing that the rules they know may also apply to new situations
- Conscience

Milestones:

200140c — 2021-09-06 08:56:10 UTC

3 yr:
- Gross motor = runs, stands
- Fine motor = undresses, stacks, draws
- language = 900 words
- Play = very imaginative/takes turns

4 yr:
- play pretend = imaginative
- language = 1500 words
- Gross motor = jumps, in motion
- fine motor = simple buttons

5 yr:
- fine motor = draw and can lace things
- language = 2100 words
- gross motor = throws overhand
- play = numbers/letters

Common Health Problems:

200140c — 2021-09-06 09:00:14 UTC

- Automobile accidents
- poisoning and falls
- minor/ colds/ ear/ flu

*Important to give reasurance*

Fears:

200140c — 2021-09-06 09:03:07 UTC

- Fear of the dark
- Fear of mutilation
- Fear of separation/ Abandonment

Behavior Variations:

200140c — 2021-09-06 09:06:58 UTC

- Telling Tall Tales
- Imaginary Friends
- Difficulty Sharing
- Regression (related to stress)
- Sibling Rivalry

Special Problems:

200140c — 2021-09-06 09:10:05 UTC

- Thumbsucking
- Food dislike/likes
- Encropresis (fecal soiling)
- Bruxism (grinding teeth)

Nursing Process:

200140c — 2021-09-06 09:21:32 UTC

> Assessment:
- Perform physical + Dev assessment
- Child weight + height
- Teeth
- Evaluate symmetrical gait
- Respy infections

> Nursing Diagnosis:
- development expectations
- parenting related
- delay in growth + dev r/t frequent illness
- risks at that age
- parent anxiety r/t lack of understanind of childhood dev

> Risks:
- cant take care of own needs
- keep guns away, and stand away from back or front of cars

> Imbalanced nutrition r/t child dislike food
- food should be on pyramid bases
- offer small servings/ no snacks
- give fruit, cheese + milk (make eating fun)

> Outcome Identification + planning:
- schedule should be made
- accident prevent + plan opportunities

> Implementation:
- role playing
- suggest music, coloring etc
- mimic positive actions

> Outcome Evaluation:
- hold parents hand
- parents state expectations of motor for child
- mother preps older children for new child

Module 6 : School Aged Child

200140c — 2021-09-07 11:09:59 UTC

Describe growth and development of school aged children

Analyze methods of care focused on family centered

Assess school age children growth and development milestones

Integrate research, practice, and knowledge with understanding nursing process for school aged children

School Aged Children Characteristics

200140c — 2021-09-07 11:15:59 UTC

Physical
- Complete brain growth ➞ 10 years
- Adult levels ➞ Brain growth, IgG, IgA, Lymphatics, LV, Respi
- Sexual maturation
  - Girls ➞ 12-18 years
    - Breasts, Waistline, Hips, & Menses
  - Boys ➞ 14-20
    - Shoulders, Voice, Semen, Hair
Emotional
- Industry & Accomplishment
- Problem Solving
- Living with others
- Skills
Cognitive
- Concrete operational thought (5-7) ➞ Reason by visualizing
- Decentering ➞ seeing other viewpoints
- Accommodation ➞ adapt reasoning, understanding, other possibilities
- Conservation ➞ understand dimensions
- Class inclusion ➞ multiple classifications for one object
Spiritual & Moral
- nice and fair
  - but not... the wrongness of it

School Age Children Milestones

200140c — 2021-09-07 11:27:48 UTC

6 years
- Bicycle, Print letters, Define by use, Roughplay/ Quiet books
7 years
- Quieter, act based on gender
8 years
- Graceful, more sports, table games, comic books, script
9 years
- Energy, hand-eye coordinated sports, gang age
10 years
- Athletic improve, groups or private
11 years
- Growth spurt, no sports (embarrassed), insecurities
12 years
- Humor, Focused, cooperative & responsible

Nutrition & Concerns

200140c — 2021-09-07 12:09:13 UTC

Nutrition

Breakfast - enough for active bodies
Lunch - give them choices

Concerns

Most problems ➞ Accidents and cancer
Aritculation ➞ hard time pronouncing s, z, th, l, r, & w
- Post 3rd grade ➞ Speech therapy
Stealing ➞ 7 years ➞ importance of money
- Set firm rules ➞ if any change, then explain
Recreational drug use, Cigarettes, Glue sniffing
- Be good role models

Questions I have...

200140c — 2021-09-07 12:11:10 UTC

Unlike toddler, preschool, and infant stages - why does the school age stage have such a wide inclusion from 6 up to 12?

Today I learned...

200140c — 2021-09-07 12:12:55 UTC

I didn't know that moral dilemmas can start so young, even at 7. I wonder if there is a way to address this in a nursing setting. Is there a need to? What are some ways to make parents aware of it?

Module 7 - Care of Family with Adolescents

200140c — 2021-09-14 04:45:44 UTC

Learning Outcomes:
Describe normal growth and development and common parental concerns of the adolescent period.

Adolescent Growth and Development, integrated with the Nursing Process.

Discuss different health concerns of an adolescent.

Nursing Process

200140c — 2021-09-14 04:57:10 UTC

Assessment

Obtain separate Hx of parents and adolescent ➞ promotes indpendence.
PE can be awkward

Diagnosis

Health-seeking behaviors related to normal growth and development.
Low self-esteem related to facial acne
Anxiety about normal growth and development.
Risk for injury to peer pressure to use alcohol and drugs.
Readiness of parents.

Identification and Planning

Respect adolescent independence
Include them in planning but establish limits
Teach by peers.

Implementation

Evaluate from the adolescent's standpoint before teaching.

Evaluation

Client states she is able to feel good.
Client states he has not consumed alcohol in 2 weeks.
Parents state that they feel more comfortable raising their adolescent.

Development of Adolescent

200140c — 2021-09-14 05:17:09 UTC

Physical

Grow rapidly in preperation for childbearing.
Factors like occupational hazards, family, and financial, can affect effect.
Heart & Lung slower
Girls menstruate, Boys produce sperm
Puberty start 9-12, stops around 16-20

Emotional

Developmental Task - Identity vs. Role confusion
Give adolescents freedom but place restrictions, to teach responsibility
Be aware of sense of intamacy and isolation

Moral and Spiritual

Formal operations

Health Promotion and Prevention

200140c — 2021-09-14 05:26:28 UTC

Safety

Vehicle accidents
Drowning
Homocide & Suicide
Sports

Diet

Lots of vegetables
Glycogen loading

Daily Activities

Sleep
Hygiene & Dress
Exercise
Teeth

Health problems

HTN
Posture
Body piercings and Tattoos
Fatigue
Acne
Obesity
STI
Substance Abuse
Hazing
Stalking

Question?

200140c — 2021-09-14 05:27:32 UTC

Are there noticeable differences between young, mid, and older adolescents groups?

Module 8 - Young, Mid, and Older Adult

200140c — 2021-09-14 05:30:56 UTC

Younger
1.Describe the physical development occurring during
young and middle adulthood.
2.Identify characteristic tasks of psychosocial
development during young and middle adulthood
3.Explain changes in cognitive development
throughout adulthood.
4.Describe moral and spiritual development throughout
adulthood.

Older
1. Identify the different categories of older adults as they
range from 65 to 100 years of age.
2. Compare and contrast gerontology and geriatrics.
3. List the common biological theories of aging.
4. Describe the physical, psychosocial, cognitive, moral
and spiritual changes that occur during older
adulthood.
5. Describe the development of gerontological nursing and
the roles of the gerontological nurse.
6. Describe the different care settings for older adults

Development

200140c — 2021-09-14 05:45:09 UTC

Young Adult [20-40]

Physical
- Peak at 25
- Large changes in women lactating or pregnant
Psychosocial
- Developmental task = intamacy vs isolation
Cognitive
- Formal operations = thing abstract and employ logic
Moral & Spiritual
- Postconventional level
- Use their own principles
- Individuating reflective period
- Focus on reality

Middle-Aged Adult [40-65]

Physical
- Hair gray, less turgor, fat in abdomen
- IV disks thinning, Ca loss, still have muscle growth
- CV vessels more thick less elastic
Psychosocial
- Developmental Task = Generativity vs Stagnation
Cognitive
- little change
Moral & Spiritual
- Post-conventional
- paradoxical-consolidative stage

Older Adult [65-85]

Physical
- Integumentary
  - dry skin, pallor, age spots, slow nail
- Neuromuscular
  - slow reaction, muscle contract, low bone mass
  - sarcopenia
  - kyphosis
  - osteoporosis
- Sensory
  - Loss visual acuity, hearing, smell
  - thresholds are increased (withstand)
  - Presbyopia & presbycusis
- Pulmo and CV
  - reduced CO and SV
  - rigid arteries
  - increase BP (orthostatic HTN)
- GI & urinary
  - indigestion and constipationu
  - urinary urgency and frequency
  - impaired renal
Psychosocial
- Disengagement theory
- Activity thoery
- Continuity theory
- Developmental task = Ego integrity vs Despair
Cognitive
- Formal operations phase
  - interpret the environment
Moral & Spiritual
- Pre conventional level

Health Risks

200140c — 2021-09-14 05:50:48 UTC

Young Adult

Injuries
- 5th leading cause of death
Suicide
- Leading cause in young adult
HTN
Substance abuse
STI
Eating disorders
Cancer
- Testicular cancer

Middle age Adult

Injuries
Cancer
CVD
Obesity
Alcoholism
Mental Health alteration

Older age Adult

Memory
- Dementia (Alzheimers)
Alcoholism/ Drug abuse
Chronic illness
Mistreatment

Module 9 - Care of Pregnant Women & her family; Assessing maternal & fetal health:

200140c — 2021-09-18 07:29:48 UTC

1. Describe a healthy community and usual nursing and client concerns when home care is required during pregnancy or childhood.
2. Identify National Health Goals related to home care during pregnancy or childhood that nurses can help the nation achieve.
3. Assess a pregnant woman or child and their community for likely success for home care.
4. Use critical thinking to analyze how home care influences family functioning, and develop ways to make home nursing care more family-centered.
5. formulate nursing diagnoses related to the care of a child or pregnant client at home.
6. Identify expected outcomes for a family requiring home care.
7. Plan nursing care appropriate to meet the needs of a home care client such as suggesting ways to keep in contact with significant others.
8. Implement nursing care to meet the needs of a pregnant woman or child in home care, such as teaching techniques of intravenous therapy.
9. Evaluate expected outcomes for effectiveness and achievement of care.
10. Identify areas of home care nursing that could benefit from additional nursing research or the application of evidence-based practice.
11. Integrate knowledge of home care with the nursing process to achieve quality maternal and child health nursing care

Key Points to Recall

200140c — 2021-09-18 07:41:06 UTC

- Families exist within communities; assessment of the community and the family's place in the community yields further information on the family functioning

- Home care is increasing as a way of providing care to chronically ill children and women with complications of pregnancy. It has advantages of being cost effective and providing meaningful comfort + support.

- Disadvantages of home care are that families can become fatigued, losing a job for the primary caregiver can cause financial hardship, and social isolation and disruption of normal home life may occur

- Home care requires careful planning and combined effort of home care agency + health care provider
Not all homes are ideal for home care. Assessing that a primary care provider is present; the family is knowledgeable about the care necessary; necessary resources are available; and safety features, such as a smoke detector, a safe area for 02 storage, and a safe refrigerator for food and medicine

- Home care can be exhausting. Certain family devises a schedule of care that allows them enough rest. Advocate for medicine or treatment schedules.
-Parents may need respire care to continue to be effective care providers for children the same as professions need time off.

Assessing Pregnant Women or Child on Home Care

200140c — 2021-09-18 07:47:37 UTC

Being able to assess communities becomes more and more important as, because of personal preferences or short hospital stays, more children spend time at home recuperating from illnesses than ever before.

- Home care is not a level of care adequate for everyone or every situation, so evaluating whether a family is a fit candidate for home care is the first assessment needed.

- Assessment of home care begins with an interview. This includes a wide range of situations such as increased expenses, the need for one parent to take a leave from work to care for an ill child or spouse at home, the need to schedule frequent ambulatory visits, consultation to handle body image changes, and the need to arrange for child care for other children

- A first home visit usually includes a thorough health history and physical examination

- Environmental considerations also can add to the stress of the situation. Assess if the home’s physical surroundings are adequate for home care.

- Assess at-home care visits not only the results of the measurements but whether they are being done correctly and consistently

- Know how the family cooperates with and connects to each other

- Understand culture and the dominant head of the family to know what they need + lifestyle.

Encouraging Pre-Natal Care:

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E-ducate
E-mphasize the importance
E-nsure privacy & comfort
E-ngage & involve

Frequency of Visits:

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1-7: Once a month
8-9: Twice a month
10 month: weekly
Post-term: Twice a week

Components:

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Demography:
- Name
- Address
- Age
- Telephone #
- Health Insurance

Chief Concern:
- Planned pregnancy?
- Last menstrual?
- Exposure of infection or ingestion of drugs?

Family & Social:
- Family composition
- Support person
- Nutrition & sleep
- Occupation/source of income
- Exercise level, hobbies, recreation
- Living conditions

Past Medical HX:
- Abdominal surgeries
- Kidney/Heart disease
- STI
- Hypertension, Diabetes
- Allergies
- Immunization

Gynecologic HX:
- menarche
- Length + duration of menstruation
- Sexual history
- STI's?

Obstetric HX:
- Past pregnancy
- When
- Outcome + type birth
- Miscarriages?
- Obstetric score
- EDD +A0G

EDD + A0G:

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Naegele's rule:
- Method used for predicting length of pregnancy

Gravida = # of pregnancies including the current

Term= born at 37 weeks and +

Pre-term= born before 37 weeks

Aborted= age of viability (before 24 weeks/<400g)

Living

Multiple pregnancies= One para

Para= birthed and reached the age of viability, born alive or not

Expectations During Pregnancy:

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Weigh + vitals:
-> weight gain of 30-35lbs
-> Increase BP + weight gain (hypertension danger)
-> PR or RR increase (possible bleeding)
-> eyes swelling
-> Nasal stuffiness
- Melasma/chloasma
- Fissues on lips, dental caries, gingival, hyperplasia, swelling
-> Enlargment of thyroid slightly
-> Breast tenderness, darkening + protrusion of tubercle
-> Inc in HR (70-80)
-> Slight INC in RR DEC Diaphragmatic Excursion
-> Enlarged, firm, globular abdomen
= 12 symphysis
= 20-22 umbilicus
= 36 xiphoid
= 40 xiphoid d/t lightening
-> Lordosis (back pain)
-> Hemorrhoids
-> Palmar erythema
-> LE varicosity + edema
-> waddling gait
-> vagina purple in color (vag infection)
-> rectocele or cystocele
-> Cervix purple in color, tender, edema, inflammation, lesions etc..
->

Estimation of fetal growth:

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Bartholomew's rule:
- fundus reaches typical milestone measurements

Mcdonald's Rule:
- Measuring fundic/uterine height
- Measurement (cm) from fundus to symphysis pubis = week of gestation

Assess fetal well-being:

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1) Fetal movement
2) Fetal Heart tone

- Position women correctly in lithotomy position

Pap Smears:
- Endocervical
- Cervical OS
- Vagina pool
= Vervicograms

Internal Pelvic Measurements:

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- True conjugate
-> 10.5 cm-11cm

Diagonal conjugate
-> 12.5cm

Ischial tuberosity
-> 11cm

Labratory:

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Confirms health + rules out STI's

Complete Blood Count

Genetic screen
Serologic test for syphilis
Blood typing (including Rh factor
Maternal serum for alpha- fetoprotein
Indirect coomb's test
Antibody titers for rubella + hepatitis B
HIV screening
Glucose loading/tolerance test

Urinalysis:

TB screening
Ultrasonography

Module 10 - The Growing Fetus

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1. Describe Gestation Week
2. How to make care Family-centered
3. Fetal growth via permanency landmarks
4. Create expected outcomes for fetus
5. Develop nursing care plan for fetal growth
6. Implement NCP for safe fetal environment
7. Evaluate NCP effectiveness
8. Integrate knowledge of fetal growth into making NCP.

Fetal Development - Terms & Timeline

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Terms

Pre-embryonic - fertilization to 2 wks
Embryonic - wks 3-8
Fetal - wks 8+
Ovum (till fertilization) ➞ Zygote (till implant) ➞ Embryo (5-8 wks) ➞ Fetus (5-8 till term)
Age of Viability ➞ earliest age could survive if born (24 wks.) or if 400g

Timeline

Fertilization ➞ Zygote ➞ Cleavage ➞ Morula ➞ Blastocyst ➞ Trophoblast ➞ Implantation

Embryonic and Fetal Structures

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Decidua

Endometrium that keeps growing due to hCG from trophoblast.
Basalis = edometrium under embryo
capsularis = edometrium that hugs (capsulates) trophoblast
vera = other lining
After birth, the endo is stripped and prone to bleeding + infection

Chorionic villi

Day 11
Double layer trophoblast
- outer = syncytial, hCG, hPL, E/PG
- inner = cyto trophoblast/ Langhans, protect from infections

Placenta

Acts as lungs, kidney, GI, and hormone for fetus

Umbilical cord

Made from fetus (amnion + chorion)
Moves O2 and nutrients from placenta, and wastes back to placenta
Artery, Vein, Artery (AVA)
- Artery = Deoxy blood + nutrient poor
- Vein = O2 blood + nutrient rich

Amniotic Membrane and Fluid

2 membranes
- Chorion = outer, supports amniotic sac
- Amnion = inner, makes amniotic fluid and PGs that could start labor
Am. Fluid
- Absorbed by swallowing (mostly), fetal surface, or its intestine.

Fetal Organs

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8 weeks gestation (2 months) = All organs complete

Germ Layers (derms)

Ecto =
- CNS + PNS
- Senses
- skin/hair/nails
Meso =
- Support (muscle + bone)
- Upper uro (kidney, ureter) + Reproductive
- Heart + Circulation + Lymph
Endo =
- Digestive
- Linings
  - pericardial = heart
  - pleura = lungs
  - peritoneal = abdomen, gut
- Low uro (bladder, urethra)

Week Milestones

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1
2
3 - Heartbeat (120-160 bpm)
4 - CNS + PNS
5
6 - Gonads (testosterone)
7
8 - Brain waves, Organogenesis complete (all organs done)
9
10
11 - Movement
12 - Doppler check, Urine form
__________________________________________________________
13
14
15
16 - Meconium (fetal poop), Urine excrete, can know sex
17
18 - Movement (quick)
19
20
21
22
23
24 - Lung surfactant (to breath), IgG immunity
__________________________________________________________
25
26
27
28
29
30
31
32 - Suck & swallow reflex
33
34
35
36 - Skin more thick with fat
37

Fetal Well Being

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Fetal Movement

Sandovsky = 2/10 min or 10/hour
Cardiff = 10/hour

Heart rate

120-160 at 12th week Doppler check.
Contractions Stress Testing = if FHR does not decelerate = negative

Ultrasound

Make sure mother has full bladder

Maternal a-Fetoprotein

High = spinal or abdominal defect
Low = Down's Syndrome

Chorionic Villi sampling
Amniocentesis

Withdraw am. fluid.
Make sure mother voids and do not let her take a deep breath if needle inserts (can move and puncture fetus)
If woman Rh-negative = give Rhogam
Am fluid
- Color = water/slight yellow
- Lecithin (2) to Sphingomyelin (1) = fetal lung
- PSG and Desaturated phosphatidycholine = Best indicator for fetal lung.

Cordo/Dunicentesis
APGAR

8-10 = good
4-6 = jeopardy

Module 11 - Presentation

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4 Ps of labor
Ideal birth of 4Ps
Nurse role
Mechanisms of labor
Stages of Labor and nursing interventions

The 4Ps of Labor

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Passage

Good size and contour
Bony Pelvis = explain pelvis too small
Bony Pelvic Ring = important
AP inlet = Diagonal Conjugate
Outlet = Transverse Diameter
Smallest inlet (important) = True Conjugate

Passenger

Fetus good size and in position and presentation
AP (back to front, 9.5 cm) is larger than transverse (9.25 cm)
Fontanelle = helps tell where fetal head is
Molding = uterine crushes = goes away 1-2 days
Presentation
- Cephalic = 95%, vertex is best
- Breech = 3%, poor attitude is knees extend
- Shoulder = 1%, horizontal to pelvis, needs C-section
LOA = most common and gavoruable
+4 = crowning = head is below ischial spines

Power

Uterine contractions are good

Psyche

Good association with labor

Mechanisms of Labor

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D F IR E ER E

Dscent

Ends at birth

Flexion

Head to chest

Internal Rotation

Occipito-transverse ➞ Occipito-anterior

Extension

Crown until head passess Sym. pubis

Extrernal Rotation

Restitution and realign with its body

External Rotation

Rotate shoulder

Expulsion

Entire body

Stages of Labor

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Stage 1

Active labor to Dilation
If Latent = mother excited and communicative, have her walk and pee
If Active = Ready meds, assess cervix and fetus. Make her comfortable due to dry lips, and with dry linens

Stage 2

Dilation to Delivery
Patient dysnpnea, lightheaded, carpopedal spasm, circumoral numb
Ritgen's Maneuver - Support the perineum to prevent laceration
Nursing Intervention
- Suction secretions
- Show baby even if stillborn
- Skin to skin interaction
- Support Head
- Dry Baby

Stage 3
Delivery to Placenta
Placetal separation = cord lengthen, vaginal blood, uterus shape, placenta presentation
Placenta Expulsion = check completeness and BP. Give methergine or Oxytocin IV

Stage 4
Placenta to 4 hours