November 14, 2019

FRAMEWORK FOR MATERNAL AND CHILD

HEALTH NURSING **In all setting and types of care keeping the family at
- shows the purpose and philosophy for caring of the center of care or considering family as the
mothers
primary unit of care is an essential goal because
the level of a family’s functioning affects the health
• Obstetrics - care of women during childbirth; status of its members. A family centered approach
derived from Greek word “obstare” (to keep watch)
enables nurses to better understand individuals and
• P e d i a t r i c s - d e r i v e d f ro m G re e k w o rd , their effect on others and in turn to provide holistic
“pais” (child)
care**

• Focus of MCN - care of childbearing (mother and

father in one home) and childrearing families
FRAMEWORK FOR MCN

• Primary goal of MCN - promotion and • Nursing Process (ADPIE)

maintenance of optimal family health through • Evidenced - Based practice

health education
• Nursing research

• Nursing theory

Goals of MCN are broad b/c the scope of practice or

range of practice includes the ff:
4 PHASES OF HEALTH CARE

• Preconceptual health care

• Health promotion - health teaching

• Care of women during 3 trimesters of pregnancy

• Health maintenance - self awareness/ community
✓ 1st trimester (1-3rd month)
awareness

✓ 2nd trimester (4-6th month)

• Health restoration - diagnosing & treating clients
✓ 3rd trimester (7-9th month)
with the use of interventions

• Care of women during puerperium or 4th

• Health rehabilitation - prevent further
trimester (6 weeks after birth)
complications; bringing back the patient into
• Care of infants during perinatal period (6 weeks optimal wellness

before conception and 6 weeks after birth)

• Care of children from birth to adolescence TRENDS IN MATERNAL AND VHILD HEALTH
• Neonatal (28 days of life); Infancy (1-12 months); NURSING POPULATION

Adolescence (after 18 y/o)

• Care setting varied as the birthing room, the

Trends Nursing Implications
PICU and the home
Families are smaller in size • Fewer family members
PHILOSOPHIES OF MCN
are present as support
MCN is… in times of crisis

• Role of nurses: fulfill the

• Family centered - assessment must include both
role
family and individual assessment (all the members
of the family)
Increased single parents • Fewer financial
• Community centered - the health of the families (most common type of resourses esp. women

d e p e n d s o n & i n fl u e n c e s t h e h e a l t h o f parent in US) • Role of nurses: Inform

communities (i.e dengue/measles outbreak)
parents of care options
and back-up opinion
• Evidence based - because critical knowledge
increases when you are in the community and Increased mothers working • Healthcare must ne
including the family
outside home at least part- scheduled at times a
• Independent Nursing Functions - because time (90%) working parent can
teaching and counseling are major interventions
care for her own self or
bring child for care

• MCN Nurse and advocate - protects the rights of

• Role of nurses: Discuss
family members including the fetus
selection of child care
• Health promotion and diseases prevention - to centers
protect health of new generation

• MCN is a challenging roles for nurses

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Trends Nursing Implications procedure carried out and no. of refferals whie
maintaining quality of care

Families are more obile; Good interviewing & health

Increased no. homeless monitoring are necessary INCREASING ALTERNATIVE SETTING AND STYLES
women and children so health database can be FOR HEALTH CARE

established and continuity • L D R P R O O M S ( L a b o r- d e l i v e r y - re c o v e r y -

of care
p o s t p a r t u m ) - a m o re n a t u r a l c h i l d b i r t h
Child and intimate partner Screening for child or environment as a birthing room. Family members
abuse intimate partner abuse; are invited to stay to be a part of childbirth

Nurses must be aware of • Retail Clinics or Emergent Care Clinics located

legal responsibilities for
in shopping malls

Families are more health Provide health education • Ambulatory Clinics or at home to avoid long
conscious hospital stays for women and children

Health care should respect Comprehensive care is • Including family in health care

cost containment necessary in primary care • Increasing Intensive Care Units

setting because referral to • NICU (Neonatal Intensive Care Units) or ICN

specialists may no longer • PICU (Pediatric Intensive Care Units)

be an option; health • Regionalizing Intensive Care - ex. Premature

insurance infant transferred o regional hospital

• Increasing the Use of Alternative Treatment

MEASURING MATERNAL AND CHILD HEALTH/ Modalities - alternative method of therapies such
STATISTICAL TERMS USED TO REPORT MATERNAL as acupuncture and therapeutic touch; herbal
AND CHILD HEALTH
remedies - decreased hospital stay

• Birth Rate - no. of births per 1000 population

• Increasing use of technology - use of internet,
• Fertility Rate - no. of pregnancies per 1000 charting in computer, using doppler

women of childbearing age

• Free birthing - women giving birth without health
• Fetal Death Rate - no. of fetal deaths weighing care provider supervision; unassisted birth

more than 500 g or more per 1000 live births

• LAMAS - breathing techniques

• Neonatal Period - 1st 28 days of life; Infant is

called neonate
LEGAL CONSIDERATIONS OF MCN PRACTICE

• No. Of deaths per 1000 live births occurring in the 1. Identifying and reporting child abuse

1st 28 days of life

2. Child can bring a lawsuit when they reach legal
• Perinatal Death Rate age

• Perinatal Period - 6 weeks before conception and 3. Informed Consent for invasive procedure and any
6 weeks after childbirth
risk that may harm the fetus

• No. Of deaths of fetuses weighing >500g and 4. In divorced or blended families, nurse has the
within the first 28 days of life per 1000 birth
right to give consent

• Neonatal death Rate

• Infant Mortality rate - no. of deaths per 1000 live ETHICAL CONSIDERATIONS OF PRACTICE

birth in the first 12 months of life.

Conception Issues…

• Childhood Mortality Rate - no. of deaths per • In Vitro Fertilization

1000 population in children; 1 - 14y/o

• Embryo Transfer

• Maternal Mortality Rate - no. of maternal deaths • Cloning

• Stem Cell Research

per 1000 live births that occur as direct result of

reproductive process
• Surrogate Mothers

• Abortion

• Fetal Rights vs Rights of the Mother

TREND IN HEALTH CARE ENVIRONMENT

• Use of fetal tissue for research

• Cost containment - reducing the cost of health by • Resuscitation

closely monitoring the cost of personnel, use and • No. Of procedures or degree of pain that a child
brands of supplies, length of hospital stays, no. of
should asked to achieve better health

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• Balance between modern technology and quality FETAL DIAGNOSTIC TEST

of life

1. Fetal Well-Being
HIGH RISK PREGNANCY - Fetal movements are directly related to the infant’s
sleep-wake cycle and vary from the maternal
- Defined as one in which the health of the mother sleep-wake cycle

and fetus is in jeopardy

- The typical active fetal period lasts 40 minutes and
peaks between 9:00 PM and 1:00 AM in response
NURSING CARE OF WOMEN WITH to maternal hypoglycemia

COMPLICATIONS DURING PREGNANCY

2. Ultrasound
- Early and consistent assessment for risk factors - Uses high frequency sound waves to visualize fetal
during prenatal visits is essential for a positive structures within the body

outcome for the mother and the fetus

- Abdominal ultrasound during early pregnancy
requires a full bladder for proper visualization (1-2
Identifying Clients at Risk quarts of water; first three months)

Ways for identifying clients at risks:

- Non-invasive procedure that uses intermittent
• Assessment of risk factors
ultrasonic waves (high frequency sound waves)
a. Physiological - bodily functions
which are transmitted by an alternating abdomen

b. Psychological
- The ultrasonic waves deflect off tissues within the
c. Social
woman’s abdomen, showing structures of varying
densities

Categories
a. Biophysical - genes
3. Transvaginal Ultrasound
b. Behavioral
- Uses a probe inserted into the vagina

c. Psychological status
- Internal visualization can also be used as a
d. Socio-demographic
predictor for preterm birth in high-risk cases

- Maternal age
- Use to detect shortened cervical length or
- Parity - viable birth (20-24 weeks)
funneling is helpful in predicting preterm labor,
- Marital status
especially in women who have a history of preterm
- Residence
birth

- Ethnicity

- Income
4. Transabdominal Ultrasound
- Racial and ethnic origin
- the transducer is moved across the woman’s
- Occupational hazard
abdomen

- Is often scanned with a full bladder -> drink a full

What is the role of the nurse? glass of water every 15 mins, 90 mins before the
- identify risk factors and estimate the potential examination

effect of the pregnancy outcome

Nursing Responsibility

- Inform the patient about the procedure

Causes of maternal mortality - Provide comfort and privacy

- Normal delivery and other complications related to • Empty bladder (transvaginal UTZ)

pregnancy occurring in the course of labor, delivery • Full bladder (transabdominal UTZ)

and puerperium
• Proper positioning = supine

- Hypertension complicating pregnancy, childbirth • Proper draping

and puerperium

- Postpartum hemorrhage
5. Alpha-Fetoprotein Testing (AFP)
- Pregnancy with abortive outcome (prepare the - Determines the level of fetal protein in the pregnant
mother)
woman’s serum or in a sample of amniotic fluid

- Hemorrhage related to pregnancy

- Correct interpretation requires an accurate
gestational age

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 November 14, 2019
- Identify high levels , which are associated with - Obtain informed consent - what, why, how,
chromosome abnormalities such as spina bifida possible complications?

(open spine) or anencephaly (incomplete - Provide comfort and privacy - full bladder, position,
development of the skull and brain); gastroschisis draping

(open abdominal cavity)

- Aseptic technique handwashing, sterile gloving

✦ Spina bifida - folic acid deficiency & chromosomal - Skin preparation

abnormalities

- Identify low levels, which are associated with

chromosome abnormalities or gestational
trophoblastic diseases (hydatidiform mole)

6. Chorionic Villi sampling

- Obtaining a small part of the developing placenta
to analyze fetal cells at 10-12 weeks of gestation

- Results of chromosome studies are available 24-48

later

- Cannot be used to determine spina bifida or

anencephaly

- Identify chromosome abnormalities or other

defects that can be determined by analysis of cells

- Reports of limb reduction defects in newborn

- Rh(D) immune globulin (RhoGam) is given to the

Rh-negative woman

- Higher rate of spontaneous abortion after

procedure than after amniocentesis

✦ Hyperbilirubemenia - incompatibility of Rh;

Rhogam must be injected within 72 hours.

7. Amniocentesis
- insertion if thin needle through the abdominal and
uterine walls to obtain a sample of amniotic fluid,
which contains cast-off fetal cells and various other
fetal products

- Standard genetic amniocentesis is done at 15-17

weeks of gestation

- Early genetic amniocentesis is done at 11-14

weeks of gestation for some disorders

Usage of amniocentesis

• Early pregnancy
- Identify chromosome abnormalities, biochemical
disorders (such as Tay-Sachs’ diseases) and level
of AFP

- A fetus can’t be tested for every possible disorder

- Spontaneous abortion following the procedure is

the primary risk

• Late pregnancy
- Identify severity of maternal-fetal blood
incompatibility and assess fetal lung maturity

- Rh(D) immune globulin is given to the Rh-negative

woman

Nursing Responsibility

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