MATERNAL AND CHILD HEALTH NURSING

RATIONALES
 Regular contractions coupled with bloody show suggest that cervical changes are
occurring as result of contractions.
 The nurse after delivering the placenta must ensure that all the cotyledons and the
membranes of the placenta are complete. Also, the nurse must check if the
umbilical cord is normal which means it contains the 3 blood vessels, 2 veins and 1
artery.
 Human milk contains only small amounts of vitamin D. Neither breastfed nor
formula-fed infants need to be given water, even in very hot climates.
 During the first 3 months, formula-fed infants consume more energy than do
breastfed infants and therefore tend to grow more rapidly.
 Vitamin K shots are required for all infants because the bacteria that produce it are
absent from the baby's stomach at birth
 Vitamin E should not be used because it is a fat-soluble vitamin that the infant
could ingest when breastfeeding
 Nipples should not be washed using soap; No soap should be used because it
could dry the areola and increase the risk for irritation
 Plastic liners can keep nipples and areola moist and increase the risk for tissue
breakdown; can trap moisture and lead to sore nipples
 Bring baby to breast, not breast to baby.
 Lanolin or colostrum/milk are the preferred substances to be applied to the area
 It is important for the nurse to assist parents in assessing speech development in
their child so that developmental delays can be identified early.
 According to the Denver Developmental Screening Examination, at 8
months of age, the child should say “mama” and “dada” nonspecifically and
imitate speech sounds. A child cannot say “dada” or “mama” specifically or use
more than three words until they are about 12 months of age. A child cannot
respond to specific commands or point to objects when requested until about 17
months of age
 For Infancy and Toddlers, one of the priorities is SAFETY. One good example is
putting medicines on the highest shelf in the kitchen, because 1-year old child will
soon learn how to climb and might reach any form of medicines which could lead
to ingestion or as much as possible you may have lock it.
 Well baby clinics or even in barangay health center, parents are then provided
with guidelines with regards to the appropriate age and appropriate food to be
given to the baby, as early as 4 months Infant cereals is generally introduced first
because of its high iron content.
 The infant is able to accept spoon feeding at around 4 to 5 months when the
tongue thrust or extrusion reflex fade.
 At 4-6 months, baby’s head control is well established and no more head lags,
especially when pulled to a sitting position.
 For the Infancy, some of their organs are not yet fully developed or established
like for example the kidneys. Normal urine output is 1-2 ml/kg/hour.
 Sleeping pattern of a baby varies or depends to the condition of a baby, the
Normal Sleeping time for 12months old is equivalent to 14 hours a day.
 Infants should be kept on formula or breast milk until 1 year of age
 The protein in cow’s milk is harder to digest than that found in formula
 The infant cannot digest fats well, so some foods from the four food groups are
not necessary in his diet during infancy
 Solids are introduced into the infant’s diet around 4 to 6 months, after the
extrusion reflex has diminished and when the child will accept new textures.
 Iron deficiency develops in term infants between 4 to 6 months when the prenatal
iron stores are depleted.
 Fortified cereals can be added to the infant’s diet at 4 to 6 months to prevent iron
deficiency anemia.
 During the Oral stage, infants tend to complete the exploration of all objects by
putting the object in the mouth
 Babinski Reflex – present at birth and should remain positive throughout the first
12 months of life
 Readiness for toilet training is based on neurological, psychological, and physical
developmental readiness. The nurse can introduce concepts of readiness for toilet
training and encourage parents to look for adaptive and psychomotor signs such
as the ability to walk well, balance, climb, sit in a chair, dress oneself, please the
parent, and communicate awareness of the need to urinate or defecate.
Chronological age is not an indicator for toilet training. Two-year-old children
engage in parallel play, which is not an indicator of readiness for toilet training.
 Too much strict during bowel training could result to strict personalities like
Obsessive compulsive behaviors whereas lenient to the training can result to
opposite to strict training.
 Parents can be asked to assist when their child becomes uncooperative during a
procedure. Most commonly, the child’s difficulty in cooperating is caused by fear.
In most situations, the child will feel more secure when a parent is present. Other
methods, such as asking another nurse to assist or waiting until the child calms
down, may be necessary, but obtaining a parent’s assistance is the recommended
first action. Restraints should be used only as a last resort; after all other attempts
have been made to encourage cooperation
 In a child younger than 3 years of age, the pinna is pulled back and down,
because the auditory canals are almost straight in children. In an adult, the pinna
is pulled up and backward because the auditory canals are directed inward,
forward, and down.
 Time out is the most appropriate discipline for toddlers. It helps to remove them
from the situation and allows them to regain control. Structuring interactions with
3-year-olds helps minimize unacceptable behavior. 
 This approach involves setting clear and reasonable rules and calling attention to
unacceptable behavior as soon as it occurs.  Physical punishment, such as
spanking, does cause a dramatic decrease in a behavior but has serious negative
effects. However, slapping a child’s hand is effective when the child refuses to
listen to verbal commands.
 Reasoning is more appropriate for older children, such as preschoolers and those
older, especially when moral issues are involved. Unfortunately, reasoning
combined with scolding often takes the form of shame criticism and children take
such remarks seriously, believing that they are “bad.”
 Toddlers usually express pain through such behaviors as restlessness, facial
grimaces, irritability, and crying. It is not particularly helpful to ask toddlers about
pain. In most instances, they would be unable to understand or describe the
nature and location of their pain because of their lack of verbal and cognitive
skills. However, preschool and older children have the verbal and cognitive skills to
be able to respond appropriately. Numeric pain scales are more appropriate for
children who are of school age or older. Changes in vital signs do occur as a result
of pain, but behavioral changes usually are noticed first.
  School-age children are concerned about justice and fair play. They become upset
when they think someone is not playing fair. Physical affection makes them
embarrassed and uncomfortable. They are concerned about others and are
cooperative in play and school.
 During the school-age years, children learn to socialize with children of the same
age. The “best friend” stage, which occurs around age 9 or 10 years of age, is
important in providing a foundation for self-esteem and later relationships.
Thinking independently, organizing, and planning are cognitive skills. Active play
relates to motor skills
 Snacks are necessary for school-age children because of their high energy level.
School-age children are in a stage of cognitive development in which they can
learn to categorize or classify and can also learn cause and effect. By preparing
their own snacks, children can learn the basics of nutrition (such as what
carbohydrates are and what happens when they are eaten). The mother and child
should make the decision about appropriate foods together. School-age children
learn to make decisions based on information, not instinct. Some knowledge of
nutrition is needed to make appropriate choices.
 Vaccines are preventative in nature and ideally given before exposure. Focusing on
the benefits of cancer prevention is most appropriate, as opposed to discussing
with parents the potential that their child may become sexually active without
their knowledge. It is true HPV is most common in adolescents and women in their
late twenties, but parents still may not perceive that their child is at risk.
Discussing the possibility of exposure through assault raises fears and does not
focus on prevention.
 The nurse should provide the adolescent with information about toxic shock
syndrome because of the identified relationship between tampon use and the
syndrome’s development. Additionally, about 95% of cases of toxic shock
syndrome occur during menses. Most adolescent females can use tampons safely
if they change them frequently. Using tampons are not related to menstrual flow
or sexual activity. There is no need to refer the girl to a gynecologist; a nurse can
provide health teaching about tampon use.
 Information about why adolescents choose to use alcohol or other drugs can be
used to determine whether they are becoming responsible users or problem users.
The senior students likely know the legal implications of drinking, and the nurse
will establish a more effective relationship with the students by understanding
motivations for use. The type of alcohol and when and with whom they are using it
are not the first data to obtain when assessing the situation.
 Parents need to discuss with their adolescent how they perceive his behavior and
how they feel about it. Moodiness is characteristic of adolescents. The adolescent
may have a reason for or not be aware of his behavior. Restricting the
adolescent’s activities will not change his mood or the way he responds to others,
it may increase his unacceptable responses. Counseling may not be needed at this
time if the parents are open to communicating and listening to the adolescent.
Talking to other parents may be of some help, but what is helpful to others may
not be helpful to their child.

An episiotomy helps prevent tearing of the rectum but it does not necessarily relieve
pressure on the rectum. Tearing may still occur.
Purposes of Episiotomy
 It shortens the second stage of labor
  substitutes a clean surgical incision for a tear, and
 decreases undue stretching of perineal muscles.

When the client says the baby is coming, the nurse should first inspect the perineum
and observe for crowning to validate the client’s statement. If the client is not delivering
precipitously, the nurse can calm her and use appropriate breathing techniques.

DURING SECOND TRIMESTER OF PREGNANCY

Pregnancy creates changes in the mother and father. Being considerate, accepting
changes, and being supportive of the current situation are considered acceptable
responses by the father, rather than feeling irritation about these changes. Expressing
concern with the financial changes pregnancy and an expanded family include is normal.
The first trimester involves the client and family feeling ambivalent about pregnancy and
moving toward acceptance of the changes associated with pregnancy. Maternal
acceptance of the pregnancy and a subsequent change in her focus are normal
occurrences.