Maternal and Child Nursing Updates

Source of 2012 Updates: Pillitteri, A. (2009) Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family, 6th Edition. Lippincott Williams & Wilkins. DOH & WHO (2010) Unang Yakap: Essential Intrapartum Newborn Care ULG 2008 Edition Page 239 1. Airway 2. Warm Page 474 UPDATES: Prioritization: 1. Warm (Risk for ineffective thermoregulation related to newborns transition to extra uterine environment) 2. Airway (Risk for ineffective airway clearance related to presence of mucus in mouth and nose at birth) UNANG YAKAP: Immediate and thorough drying of the newborn -For 30 seconds warms the newborn and stimulates breathing 1. Early skin-to-skin contact between mother and newborn 2. Properly-timed cord clamping and cutting prevents anemia and protects against brain hemorrhage in premature babies. 3. Non-separation of newborn from the mother for early breastfeeding protects infants from dying from infection. Page 239 Page 474 UPDATES: 2. Airway *Neonate maintains a respiratory rate of 30 to 60 breaths per minute without evidence of retraction or grunting by 5 minutes after birth. * Use a bulb syringe or a soft, small (no. 10 or 12) catheter to suction. UNANG YAKAP *No suctioning, unless newborn needs resuscitation. Page 239 2. Warm *Rub dry...... Page 474 Additional information: 1. Warm *Be certain to place a cap on the infants head. *Put newborn on mothers breast/chest for skin-to-skin contact. Page 475 UPDATES: *Vigorous crying also helps blow off the extra carbon dioxide that makes all newborns slightly acidotic, so it helps to correct this condition. Page 475 2012 UPDATES

1. Airway * Maintain respiration at 30-50 breaths/min...... *Suction secretion gently.....

Page 239 3. Monitor character of crying *Vigorous crying blows off extra carbon dioxide, making all newborns slightly acidotic Page 239

 4. Umbilical Cord Care *Assess cord for possible bleeding apply antibiotic or triple dye...... *dabbing with rubbing alcohol..... UPDATES: * Every time you handle a newborn, inspect the cord to be certain it is clamped securely. If a clamp loosens before thrombosis obliterates the umbilical vessels, hemorrhage could result. *Putting antibiotic or triple dye is no longer included. * Some health care agencies recommend applying rubbing alcohol to the cord site once or twice a day to hasten drying. Others prefer the cord be left strictly alone, because manipulation could invite infection. UNANG YAKAP Properly-timed cord clamping and cutting prevents anemia and protects against brain hemorrhage in premature babies. Page 239 5. Eye care Page 476 UPDATES: * Formerly, eye prophylaxis was applied immediately after birth. Many parents today prefer to visit with their infant before the procedure. *Parents who know that they are free of a gonococcal or chlamydial infection can ask to have eye prophylaxis omitted entirely. Page 477 UPDATED: * A baby who is to be formula-fed may receive a first feeding at about 2 to 4 hours of age. UNANG YAKAP *Delayed washing for at least 6 hours prevents hypothermia, infection and hypoglycemia. Page 478 Additional information: *Sleeping Position Stress to parents that a newborn should be positioned on the back for sleep. Although the specific cause of SIDS cannot be explained, placing infants to sleep in a supine position with a pacifier has been shown to decrease the incidence of the syndrome. *Hepatitis B Vaccine All newborns receive a first vaccination against hepatitis B within 12 hours after birth; a second dose is administered at 1 month and a third at 6 months.

Page 240 6. Initial Feeding *For baby who is to be formula-fed....

Page 240 7. Bathing *Complete bath within an hour.... Page 239-240 Care of Newborn

Page 249 Denver Developmental Screening Test (DDST)

Additional: METRO MANILA DEVELOPMENT SCREENING TEST (Specific tool for Filipinos) Overview Modified and standardized DDST to MMDST by Dr. Phoebe D.

 Williams Screening is a presumptive identification of unrecognized disease or defect Early detection model , Detection of developmental disabilities Test children with problem Facilitates early referral and treatment Children 6 years and below WHAT IS MMDST FOR? Developed for health professionals (MDs, RNs, etc) It is not an intelligence test It is a screening instrument to determine if childs development is within normal. Purposes Measures developmental delays Evaluates 4 aspects of development Aspects of development Personal-social Fine-motor adaptive Language Gross motor behavior MMDST Kit 1.Manual 2. Sample test form 3. Test materials 4. MMDST bag Test materials A bright red yarn pom-pom A rattle with narrow handle Eight 1-inch colored wooden blocks (red, yellow, blue green) A small clear glass/bottle with 5/8 inch opening A small bell with 2 inch-diameter mouth A rubber ball 12 inches in circumference Cheese curls A pencil Cheese curls Important considerations Childs age is crucial= initial step in test administration Test items will be dependent on age of child Age = guide the selection of test items and subsequent interpretation of results Scoring the Test Passed Failed Refused, or No opportunity Failure of an item that is completely to the left of the childs age is considered a developmental delay

Page 250-256 Behavior Inventory Newborn Fine Motor Skills 3 months Fine Motor Skills 4 months Fine Motor Skills

Additional Information Keeps hand fisted (Page 817) Reach for attractive objects in front of them (Page 815) Thumb opposition begins

 5 months Fine Motor Skills 6 months Fine Motor Skills 15 months Physical & Gross Motor Skills 3 years Language Skills 5 years Personal-Social Skills Page 282 Calendar (Rhythm) Method Palmar and Plantar Grasp disappears (Page 815) Play with their toes as objects (Page 816) Grasps feet Can seat self in chair (Page 844) Asks many questions, up to 400 a day (Page 865) Likes games with numbers and letters (Page 865) Additional Information Page 120 The calendar method requires a couple to abstain from coitus (sexual relations) on the days of a menstrual cycle when the woman is most likely to conceive (3 or 4 days before until 3 or 4 days after ovulation). Page 120 Additional Information Just before the day of ovulation, a womans basal body temperature (BBT), or the temperature of her body at rest, falls about 0.5 F. At the time of ovulation, her BBT rises a full degree because of the influence of progesterone. This higher level is then maintained for the rest of her menstrual cycle. Page 122-123 Additional Information The symptothermal method of birth control combines the cervical mucus and BBT methods. The woman takes her temperature daily, watching for the rise in temperature that marks ovulation. She also analyses her cervical mucus every day and observes for other signs of ovulation such as mittelschmertz (midcycle abdominal pain). The couple must abstain from intercourse until 3 days after the rise in temperature or the fourth day after the peak of mucus change, because these are the womans fertile days. Page 123 UPDATE: As a rule, after 3 months of breastfeeding, the woman should be advised to choose another method of contraception. Page 124-125 UPDATES and Additional Information: COCs are packaged with 21 or 28 pills in a convenient dispenser. It is generally recommended that the first pill be taken on a Sunday (the first Sunday after the beginning of a menstrual flow), although a woman may choose to begin on any day. Beginning pills as soon as they are prescribed this way (a Quick Start system) rather than have to wait for a set day may increase compliance. *After childbirth, a woman should start the contraceptive on the Sunday closest to 2 weeks after birth; after an elective termination of pregnancy, she should start on the first Sunday after the procedure. Progesterone interferes with tubal transport and endometrial proliferation to such degrees that the possibility of implantation is

Page 282 Use of BBT Method

Page 282 Sympthotermal Method

Page 283 Lactational Amenorrhea Method Effective for 6 months

Page 284 Combined Oral Contraceptives contains estrogen and progestin..

 significantly decreased. A new generation of pills are designed to be taken for 91 days (an extended-use regimen) or using these, a woman will only have a menstrual flow every 3 months or 4 times a year. Page 126 Additional Information Oral contraceptives containing only progestins are popularly called mini-pills. Page 128-129 Additional Information A single intramuscular injection of medroxyprogesterone acetate (Depo-Provera [DMPA]), a progesterone, given every 12 weeks inhibits ovulation, alters the endometrium, and changes the cervical mucus. UPDATES Advantages: -reduction in ectopic pregnancy, endometrial cancer, endometriosis, and, -for unknown reasons, reduction in the frequency of sickle cell crises Disadvantages: -irregular menstrual cycle, headache, weight gain, and depression. -may impair glucose tolerance in women at risk for diabetes -increase in the risk for osteoporosis from loss of bone mineral density Page 136-137 UPDATES The fallopian tubes are occluded by cautery, crushing, clamping, or blocking, thereby preventing passage of both sperm and ova. A new system, Essure, consists of a spring-loaded mechanism that, when inserted through the vagina and uterus into the outer end of a fallopian tube (a hysteroscopy procedure), releases a soft microinsert into the tube that effectively seals the tube. This can be done as an office procedure. Postoperatively, women should not have sex for at least 1 week

Page 284 Progestin-Only Oral Contraceptive contains only one-half.. Page 285 DMPA Injectable contraceptive

Advantages and Disadvantages

Page 286 BTL A safe and simple.

Page 286 Vasectomy A simple, safe, and quick.

A woman may return to having coitus as soon as 2 to 3 days after the procedure. Be certain that they understand that tubal ligation, unlike a hysterectomy, does not affect the menstrual cycle, so they will still have a monthly menstrual flow. Page 135-136 UPDATES In a vasectomy, a small incision or puncture wound is made on each side of the scrotum. The vas deferens at that point is then located, cut and tied, cauterized, or plugged, blocking the passage of spermatozoa. Additional birth control method should be used until two negative

 Page 287 Condom Disadvantages: Allergy of some to latex. sperm reports have been obtained. Page 134 Additional Information If either the male or his partner has sensitivity to latex, he can use a polyurethrane or natural membrane condom type. Caution him that these types do not give the same level of protection against STIs as does latex. Page 132 UPDATES A diaphragm is a circular rubber disk that is placed over the cervix before intercourse. A Leas Shield, made of silicone rubber and bowl shaped, is a new design. A Leas Shield has an attached rubber loop to grasp for easy removal. After use, a diaphragm should be washed in mild soap and water, dried gently, and stored in its protective case. With this care, a diaphragm will last for 2 to 3 years. Page 133 Additional Information An advantage is that cervical caps can remain in place longer than diaphragms, because they do not put pressure on the vaginal walls or urethra. Cervical caps -time period should not exceed 48 hours, to prevent cervical Irritation. Page 129 UPDATES The device is inserted before a woman has had coitus after a menstrual flow, so the health care provider can be assured that the woman is not pregnant at the time of insertion. Teach women to regularly check after each menstrual flow, to make sure the IUD string is in place, and to obtain a yearly pelvic examination. *Two common types of IUDs used in the United States are the Copper T380 (ParaGard), a T-shaped plastic device wound with copper, and LNG-IUS (Mirena), which holds a drug reservoir of progesterone in the stem. * The Mirena type is effective for 5 years (possibly as long as 7 years). It has a failure rate as low as 0.1% to 1.5%. * The Copper T380, because of the added copper, has a comparable failure rate. It is effective for 10 years, after which it should be removed and replaced with a new IUD.

Page 287 Vaginal Methods: Diaphragms

Page 287 Vaginal Methods: Cervical Caps, Advantages

Page 288 IUD

Use: Advise woman to check