MCN Lecture

8/14/2019 MCN Lecture

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Maternal and Child Nursing

Maria Jessica de Guzman- Areja RNManuelito Cantos RN

Michael Emman Orbe RNLuzviminda Porte RN, MAN

Team Lecturer


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Maternal and Child Nursing or

Maternal Newborn Nursing

Involves care of the woman and familythroughout pregnancy and childbirth and thehealth promotion and illness care of the childrenand families

It refers to the relationship of mother and childto one another and consideration of the entirefamily, as well as the culture and socio-economic

environment, as framework of the clients.


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Nursing/Maternal

NewbornNursing

Promotion and maintenanceof optimum health of thewoman and the newborn


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PHILOSOPHY OF MCN

MATERNAL CHILD NURSING : Is family centered Is community centered Is research oriented Is based on nursing theory Protects the rights of all family members

Uses a high degree of independent functioning Places importance on promotion of health Is based on the belief that pregnancy or childhood

illness are stressful because they are crises Is based on the belief that personal, cultural and

religious attitudes and beliefs influence themeaning of illness and its impact on the family

Is a challenging role for the nurse and is a majorfactor in promoting high-level wellness in families


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The family is the basic unit of

society Families represent racial, ethnic,

cultural and socioeconomic

diversity Children grow both individually and

as part of a family

Principles to consider in

MCN


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Health promotion- educating clients to be aware of

good health through teaching

and role modeling

Health maintenance

- intervening to maintain health when risk

of illness is present

Health rehabilitation

- preventing further complications from anillness; bringing ill client back to optimalstate of wellness or helping the clientaccept inevitable death

PHASES OF HEALTH CARE INMCN


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Trends in Maternal and ChildHealth Care

Families are smaller in size than inprevious decades

Single parents are increasing in number

An increasing number of mothers workoutside the home

Families are more mobile than previously

Abuse is more common than ever before

Families are more health conscious thanpreviously


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Physiology Female Reproductive System

A. The External Reproductive Organs

1. Mons pubis or mons veneris is a pad of fat whic

lies over the symphysis pubis which protects the

surrounding delicate tissues from trauma

2. Labia majora a two folds of skin with fat

underneath; contain Bartholins glands ( believed tosecrete a yellowish mucus that acts as a lubricant

during sexual activity

3. Labia minora two thin folds of delicate tissues tha

forms the upper fold encircling the clitoris (called theprepuce)

and unite posteriorly ( called the fourchette )

which is highly sensitive to manipulation and trauma

why it is often torn during delivery.


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4. Glans clitoris small, erectile structure at the anteriorjunction of the labia minora, which is comparable to the

penis and extremely sensitive to sexual manipulation5. Vestibule narrow space seen when the labia minora isseparated

6. Urethral meatus external opening of the urethra;slightly behind to the side are the openings of the Skenes

glands( often involved in infections of the external genitalia)

7. Vaginal orifice/introitus/vaginal opening- externalopening of the vagina, covered by a thin membrane ( calledhymen ) in virgins

8. Perineum area from the lower border of the vaginalorifice to the anus; contains the muscles which supportsthe pelvic organs, the pudendal nerves which are importantduring delivery under anesthesia


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B. Internal Reproductive System1. Vagina: a 3 6 inch long dilatable canal located between the bladder and the rectum;

contains rugae ( which permit considerable stretching without tearing; passageway formenstrual discharges; receives penis during sexual intercourse ( organ of copulation ),and forms part of birth canal

: vascular and acidic pH; Doderleins bacilli makes the vagina acidic 2. Uterus: a hollow pear shaped fibro muscular organ 3 inches long, 2 inches wide, 1

inch thick, weighing 50 Gms. in a non pre-pregnant state, hold in place by the ligamentsof the uterus

: Organ of menstruation: Site of implantation and retainment and nourishment of the products

of conception 2.1 Ligaments of the uterus:

2.1.1 Broad ligaments: extend from the lateral margin of the uterus to thepelvic sidewall

2.1.2 Round ligaments: Dense bands of connective tissue that extend from thelateral uterine fundus to the upper portion of the labia majora

2.1.3 Uterosacral ligaments: dense bands of connective tissue that extend from theinferior and posterior portion of the uterus and attach to the fascia over the

sacrum

2.2 Source of blood supply:2.2.1 uterine ovaries2.2.2 ovarian arteries


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2.3 Parts of the uterus:2.3.1 Fundus: uppermost convex portion

located between the insertions of the

fallopian tubes:The most muscular area of the uterus; as such itis thickest and most contractile portion: Ideal site for implantation of the zygote: Used as an obstetrical landmark during pregnancy through thetechnique of physical examination by palpation of its height toassess the uterine growth: during labor, being the mot contractilearea is palpated to assess the uterine contractions and laborprogress and during postpartum period, to assess for uterine involution

2.3.2 Cornua: areas of the uterus at which the fallopian tubes are attached

2.3.3 Corpus: the body of the uterus which makes up two-third of the said organ;it houses the fetus during pregnancy

2.3.4 Isthmus: the upper third of the cervix which is very thin orareas betweencorpus and cervix which forms part of the lower uterine segment


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2.3.5 Cervix: neck of the uterus; it measures 2.5cm long and 2.5cm in diameter, it contains sebaceous glands that secretes a clear,viscid and alkaline mucus

2.3.5.1 Parts of the cervix2.3.5.1 Internal os which opens to the corpus2.3.5.2 Cervical canal located between internal and

external os2.3.5.3 External os which opens to vagina

2.4 Muscle layers of the uterus:2.4.1 Peritmetrium: serosal outer layer of the uterus attached tothe broad

ligaments2.4.2 Myometrium: muscular layer of the uterus; thickest at thefundal area2.4.3 Endometrium: inner layer/ mucosal layer of the uterus thatcontains

numerous uterine glands that secrete a thin alkaline fluid tokeep the

uterine cavity moist.


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3. Fallopian tubes: 4 inches long/ eight to 14 cm. muscular tubes that extendlaterally from the cornua of the uterus from each side of the fundus

3.1 Functions:

3.1.1 Responsible for transport ofmature ovum from ovary touterus

3.1.2 The site of fertilization3.1.3 Provides nourishment to the

ovum during its journey

3.2 Parts of the fallopian tube3.2.1 Interstitial/Intramural: thick walled, located

inside the uterus3.2.2 Isthmus: the narrowest portion of the uterus and is

about 1 cm. long; the site for tubal ligation3.2.3 Ampulla: the middle portion and the widest part; the site for

fertilization3.2.4 Infundibulum: the most distal portion; it has a fingerlike projections

called fimbria. The longest fimbria, called fimbria ovarica is attachedto the ovary to guide the ovum to the oviduct during the ovulation


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3.3 Layers of the fallopian tubes:

3.1 Mucosal layer: composed of secretory cells

that secretes alkaline mucus which lubricates the fallopian

tube and ciliated cells that move in sweeping motion to

assist in the transportation of the ovum from the ovary to

the uterus

3.2 Muscular layer: this layer is responsible for the peristaltic

movement of the fallopian tube, rhythmic contractions of

the fallopian tubes are strongest at the time of ovulationand weakest during pregnancy

3.3 Peritoneal layer: the outermost layer attached to the

ligaments that keep the fallopian tube suspended in its

normal position


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Fallopian Tube


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4. Ovaries: are almond-shaped glandular organs located on either side ofthe uterus

:are movable organs on palpation

4.1Function of the ovaries:4.1.1 Oogenesis ovaries are responsible

for development and maturation ofovum

4.1.2 Ovulation: refers to the release of ovumfrom the ovary

4.1.3 Hormone production: the ovaries the mainsource of estrogen and progesterone in non-pregnant women

4.2 Layers of the ovaries:4.2.1 Tunica albuginea: the outermost protective layer

4.2.2 Cortex: the functional layer because it is the site of ovumformationand maturation

4.2.3 Medulla: this layer contains blood vessels, lymphatics,nerves andmuscle fibers.


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OvaryOvary


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Female Reproductive SystemFemale Reproductive System


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THE PELVIS


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Structure of pelvisStructure of pelvis

A. Two hip bones (right and leftinnominate: Sacrum, coccyx).
http://images.google.com/imgres?imgurl=http://www.dartmouth.edu/~anatomy/HAE%2520pages/lab%2520exercise%2520answers/answers%2520to%2520pp%2520images/pelvis%2520superior%2520answers.jpg&imgrefurl=http://www.dartmouth.edu/~anatomy/HAE%2520pages/lab%2520exercise%2520answers/answers%2520pp1%252006.htm&h=312&w=400&sz=75&hl=en&start=11&tbnid=6Tdm74Zur5ulLM:&tbnh=97&tbnw=124&prev=/images%3Fq%3Dgynecoid%2Bpelvis%26gbv%3D2%26svnum%3D10%26hl%3Den%26sa%3DG


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1. False pelvis this is the part of thepelvis situated above the pelvic

brim. It is formed by the upperflared out portion of the iliac bonesand protects the abdominal organs.

- supportive structure for uterusduring last half of pregnancy.
http://www.in-balance.com/PELVIC2.JPGhttp://www.in-balance.com/PELVIC2.JPG


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2.True pelvis Is the bony canal throughwhich the fetus must pass during birth.It has a brim, a cavity and outlet.

- below brim; pelvic inlet, midplane,

pelvic outlet. Fetus passes throughduring birth


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Pelvic measurementsPelvic measurements
http://www.in-balance.com/PELVIC2.JPG


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Pelvic measurementsPelvic measurementsA. Diagonal conjugate 12.5 cm or greater

is adequate size, evaluated by examiner

B. Conjugate vera 11 cm is adequate size;can be measured by x-ray (not commonlyperformed)


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C. Obstetric conjugate measured

by x ray (not commonlyperformed)

D. Tuber-ischial diameter 9 -11cm indicates adequate size;evaluated by examiner.

PELVIS
http://www.in-balance.com/PELVIC2.JPGhttp://www.in-balance.com/PELVIC2.JPG


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PELVIS

Four Types:

1.Gynecoid Pelvis

2. Android Pelvis

3. Anthropoid Pelvis

4. Platypelloid Pelvis

1 G id P l i


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1.Gynecoid Pelvis

Inlet is round, circular

Wide

This is the typical FEMALEPELVIS

Most favorable for normalspontaneous delivery or

ideal for childbirth The anteroposterior and

transverse diameters arerelatively equal, withstraight pelvic sidewalls.

The ischial spines are notusually prominent

The pubic arch is wide

2 A d id P l i


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2. Android Pelvis

Wide

HEART-SHAPEDThis is the typical

MALE PELVIS

It is characterized byconvergent sidewalls,prominent ischial

spines, and narrowpubic arch

May result to forcepsdelivery or CS


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3. Anthropoid Pelvis

Wide

NarrowThis is the typical APE

PELVIS

It is characterized bythe anteroposteriordiameter being greater

than the transversediameter

4 Pl t ll id P l i


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4. Platypelloid Pelvis

Opposite of AnthropoidPelvis

Wide Narrow

The pelvis is characterizedby the transverse diameterbeing greater than theanteroposterior diameterwith wide sidewalls

Flattened gynecoid shapeof flat pelvis

M t l C l


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Menstrual Cycle It refers to female reproductive cycle

It is a periodic uterine bleeding in response to cyclicalhormonal changes

Menstruation is being ushered in by menarche (onsetof menstruation ) and ends with menopause

( permanent cessation of menstruation) age of onsetand termination vary widely depending on heredity,racial background, nutrition and even climate.

Normal menstrual period ( days when there is

menstrual flow) last for3 6 days; menstrual cycle(from first day of menstruation to the first day of nextmenstruation) may be anywhere from 25 35 days,but accepted average length is 28 days


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Body structuresinvolved

Hypothalamus

Pituitary gland

Ovaries

Uterus

ormones w c regu a e cyc c


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ormones w c regu a e cyc cactivities

GNRH ( APG ) initiates the menstrual cycle

A. FSH- stimulate the development of primordial

follicles (immature follicles) into graafian

( mature follicles )

B. LH- it stimulates ovulation and development of

corpus luteum ( source of progesterone )

- thickens the endometrial lining of the

uterus


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