c




 
High Cost of Health care
-Most researchers agree that caring for the increased number of LBW infants in NICU contributes significantly to the
overall health care cost.
-Midwifery care helped contain some health care cost.
-Nurses must become involved in the politics of cost containment b/c they, as knowledgeable experts, can provide
solutions to many car problems at a relatively low cost.
-Early postpartum discharge programs also are used to reduce cost.
Limited Access to Care
-the most significant barrier to access is the inability to pay.
-Lack of transportation and dependent child care is another barrier.
- In addition to a lack of insurance and high cost, lack of providers of low income women exist because either they
refuse pt or take only a few.
-This presents a serious problem because significant proportions of births are to mother who receive Medicaid.
Low Birth Weight and Preterm Birth
-African American infants are more than twice as likely as non-Hispanic white infants to be of LBW and to die in the
first year of life.
-Cigarette smoking is associated with LBW, prematurity and intrauterine growth restriction.
Evidence-Based Practice
-providing care based on evidence gained through research and clinical trials is increasly emphasized.
-AWHONN include and evidence-based approach to practice. Discussion of nursing care and evidence-based
practice boxes through this text provide examples of evidence-based practice in prenatal and women health care.
-this practice guideline incorporate evidence ±based practices for second-stage labor management, continence for
women, breastfeeding support, midlife well being, perianesthesia care, neonatal skin care, and cardiac health.
-using these guidelines and published reports nurses can develop protocols and procedures based on published
research and incorporate and evidence base into their own practice
-transition of the preterm infant to an open crib, management of women in second-stage labor, continence for
women, neonatal skin care, cyclic pelvic pain and discomfort management, setting universal cessation counseling,
education and screening standards.

c


-Holism (a philosophy that an integrated whole has an independent reality that is greater than the sum of its parts,
that patterns and processes combine to form the while, and that evaluation, acceptance, and modulation of those
patterns can lead to profound personal healing) encompasses attitude, acceptance, perception and purpose.
-Holistic nursing practice reflects the attitudes and philosophy brought to the nursing situation rather that the
techniques or modalities used during the course of nursing care. This also involves themselves in self-care activities
striving to attain their own levels of wellness and integration.
-Legal tip of practice for healing modalities although a vast array of alternative healing modalities are available not all
them are within the scope of nursing practice as defined by licensing bodies. Nurses are advised to consult their own
state¶s nurse practice act for details on the additional training required to integrate complementary healing into their
nursing partice. Body therapies including acupressure, healing touch, massage, therapeutic touch, reflexology. Mind
±body healing including art therapy, biofeedback, cognitive therapy, counseling ( in cases of addition, grief,
environment concerns, relationships, spiritual crisis, violence and sexual abuse and wellness issues¶(, exercise and
movement, goal setting and contracts, holistic self-assessment, journaling and self-reflection, meditation, prayer,
humor, and laughing, imagery, music and sound therapy, play therapy, rituals of healing ( combining several
modalities) Lifestyle modifications, including smoking cessation, weight management.
-Acupressure is a variation on massage and touch that has it¶s origin in traditional Chinese medicine. If energy is
blocked in anyway, illness, pain or other dysfunction can result. Energy travels on a certain path thought the bodies
called meridians and each one corresponds to body function and various organs. Practioners of TCM believe that by
massaging or compression a given point, the body energy to that corresponding organ or system can be restored or
change. When energy is restored healing can occur.
-Healing Touch is another energy-based touch healing modality. This combines a variety of techniques from a series
of disciplines. Practitioners are taught energetic diagnosis and treatment forms and the means for documenting the
client response and progress. These techniques are said to align and balance the human energy field, thereby
enhancing the body ability to heal itself. This can be useful for a variety of physical, mental, emotional, and spiritual
disorders. This touch focus on clients experiencing chronic and acute pain, wound infection, cancer, AIDS,
depression, fatigue, anxiety and other health problems are being conducted or have been completed.
-Guided imagery the purposeful development of mental images while in a deep state of relaxation, stress
management and enhancing immune function. This allows or guides the normal flow of thoughts within the
imagination. Imagery uses the power of the mind to induce positive images of healing improve performance and
reduce anxiety. Imagery can assist relaxation, reduce anxiety, minimize the need for pain medication and increase
the client¶s ability to focus e while enhancing creativity. By using recall to enhance change, imagery also may alter
emotional and biochemical process.
-Meditation is quiet listening these techniques can aid in the relaxation response and decrease HR and BP thereby
reducing stress, decreasing pain perception and increasing self-understanding. This is thought to allow insight,
cognitive awareness of body functioning and intuitive comprehension of what is needed for the individual healing
process.
-Biofeedback combines relaxation with consciously learning to regulate those body functions normally seen as
automatic to improve health and decrease pain, blood pressure and pulse rate. Biofeedback instruments provide
immediate information provide immediate information to the cline and show and show the progress made thus
reinforcing the clients behavior that brought about the desired change. This can also assist with muscle training.

c


áOnce ovulation begins in puberty, progesterone levels increase. The increase in progesterone causes maturation of
mammary gland tissue, specifically the lobules and acinar structures. During adolescence, fat deposition and growth
of fibrous tissue contribute to the increase in the gland¶s size. Full development of the breast is not achieved until
after the end of the first pregnancy or in the early period of lactation.
-Each mammary gland comprises 15 to 20 lobes, which are divided into lobules. Lobules are clusters of acini.
-Breast self examination( BSE) systematic palpation of breast to detect signs of breast cancer of other changes is
best carried out during this phase of the menstrual cycle.

á 
 
  
  
 



   !


 "


# $%

! !
 


p BSE systematic palpation of breasts to detect signs of breast cancer or other changes.
p The best time to do breast self-examination is about a week after your period, when breasts are not
tender or swollen. If you don¶t have regular periods than check the same time every month.
O Lie down and put a pillow under your right shoulder. Place your right arm behind your head.
O Use the finger pads of your three middle fingers on your left hand to feel for lumps or
thickening. Your finger pads are the top third of each finger.
O Press firmly enough to know how your breasts feels. If you¶re not sure how hard to press, ask
your health care provider or try to copy the way your health care provider uses the finger pads
during a breast examination. Learn what your breast feels like most of the time. A firm ridge in
the lower curve of each breast is normal.
O Move around the breast in a set way. You can choose circles, vertical lines, or wedges. Do it
the same way every time. It will help you to make sure that you¶ve gone over the entire breast
area and to remember how your breasts feels.
 O Gently compress the nipple between your thumb and forefinger and look for discharge
O Now examine your left breast using the finger pads of your right hand.
O If you find any changes, see your health care provider right away.
O You may want to check your breasts while standing in front of a mirror after you do your
breast self-examination each month. See if there are any changes in the way your breasts
look: dimpling of the skin, changes in the nipple, or redness or swelling.
O You may also want to do an extra BSE while you¶re in the shower. Your soapy hands will glide
over the wet skin, making it easy to check how your breasts feel.
O It is important to check the area between the breast and the underarm and the underarm itself.
Also examine the area above the breast.
?
-Climacteric is a transitional phase during which ovarian function and hormone production decline. This phase spans
the years from the onset of premenopausal ovarian decline to the postmenopausal time when systems stop.
-Preconception health promotion provides women and their partners with information that is needed to make
decisions about their reproductive future. Preconception counseling and care can be provided as part of routine
health examinations sucha s premarital, employment, school, and family planning. Preconception counseling guides
couples on how to avoid unintended pregnancies, how to identify and manage risk factors in their lives and their
environment and how to identify healthy behaviors that promote the well-being of the woman and her potential fetus.
- Papanicoulaou (Pap) smear nursing responsibilities (p. 114)
p Assemble equipment
p Ask woman to empty bladder before
p Assist with relaxation techniques. (Have woman place hands on chest at about the level of the
diaphragm, breathe deeply and slowly {in through nose and out through an O-shaped mouth},
concentrate on the rhythm of breathing, and relax all body muscles, with each exhalation.
p Encourage the woman to become involved with the examination.
p Assess for and treat signs of problems such as supine hypotension.
p Instruct woman to bear down when the speculum is being inserted.
p Assist with collection specimens
p Assist the woman at completion of the examination to a sitting position and then a standing
position.
p Provide tissues to wipe perineum.

Criteria re: first pelvic examination (p. 113-114)

A pelvic examination provides a good opportunity for the practitioner to emphasize the need for regular
vulvar self-examination (VSE). A VSE, should be performed as an integral part of preventive health care by
all women who are sexually active or aged 18 years or older, monthly between menses, or more frequently
if there are symptoms or history of serious vulvar disease.
p Make sure the woman has not douched, used vaginal medication or had sexual intercourse 24-48
hours before procedure
p Explain to the woman the purpose of the test and what sensation she will feel
p The woman is assisted in the lithotomy position, a speculum is inserted
p The cytologic specimen is collected before any digital exam, using a endocervical sampling device
(cytobrush cervix brush, spatula, or broom)
p The thin-prep pap test is a liquid based method of preserving cells that reduces blood, mucous,
and inflammation.
p Label slides include name, age, parity and chief complaint or reason for taking exam

Protocol for clinical breast exam

p Best time is a week after your period, when breasts are not tender or swollen
 p Lie down, and put a pillow under right shoulder. Place right arm behind head
p Use the finger pads of your three middle fingers on your left hand to feel for lumps
p Press firmly; a firm ridge in the lower curve of each breast is normal
p Move around in a set way: circular, vertical lines, or wedges
p Gently compress the nipple between your thumb and forefinger and look for discharge
p Now examine your left breast, you may want to examine standing, lying or in the shower
áExercise should be done 3 times a week for at least 30 minutes a day.
-Kegel exercise or pelvic muscle exercises were developed to strengthen the supportive pelvic floor muscles to
control or reduce incontinent urine loss. This is also beneficial during pregnancy and postpartum they strength the
muscles of the pelvic floor providing support for the pelvic organs and control of the muscles surrounding the vagina
and urethra.

Maternity (24 )
-The process by which parents come to love and accept a child and a child comes to love and accept a parent is
referred to as a attachment. Attachment is facilitated by positive feedback that indicates acceptance of one partner by
the others. This occurs through a mutually satisfying experience.
-Bonding as a sensitive period in the first minutes and hours after birth when mothers and fathers must have close
contact with their infants for later optimal development.
-Mutuality concept of attachment has been extended to include. The infant behaviors and characteristics call forth a
corresponding set of parental behaviors and characteristics. The infant displays signaling behaviors such as crying,
smiling and cooing that initiate the contact and brin the caregiver to the child.
-Eye contact appears to cement the development of trusting relationships and is an important factor in human
relationships at all ages. This is good for early bonding.
-Synchrony refers to the fit b/w the infant¶s cues and the parents¶ response. Ex. After a certain time the infant
develops a specific cry in response to different situations such as boredom, loneliness, hunger, and discomfort.
-Sibling rivalry or negative behavior is siblings may have been overemphasized in the past

Maternity ( 25 )
-Signs of respiratory distress once established breaths or shallow and irregular ranging from 30 to 60 breaths/ min,
with short pauses of less than 15 seconds.
-apneic episodes longer&' ! !!
á() !*''á*+',
-
  ! - !!

!-.
á/
 !!

!
/  !


á0 !

 
 !  !
! #

!  !
 ! )




   1  
 !


!
!





!
! !
- 




2
 

- !


!
  



!
!  !
á3

' 


-
 ! ! 




á2
4  !

! 
 !.1 !-
 ! !

&5 
#!
 -
.


!

!



'

 ?


?
á!
!

 


 

!.0
!!.




!&6-.   &á5-.   


.
 


.



 $.
-
.

 
 .

á7 


!!



 !! #
 
2
.! !   !2

 


- 

 
! 
78
 

-*&
!

!  &5
1  -

! & 



 -



. 




4!

4!


 


  ! 
!


 
% 
! !
 
&5
!
5 
9

:!
  #! 

 

.
á 
 -
!
!


 
!-
.! - ) 0!

  

á  8!&
O /

-
& 

!
! 
 
  

) 0#

! 
  8

! 



!
 

  
 #!

 ) 0
' /


-
&5 


!. & 

' 


+ *'
,!!
   !
' 1. .


;!/ !-
!
á
! !8!& 5! ! 
*' & 

!-
28!
! 
 
!!




!
!
!!.
!

.-
!

.8!!!

!




 !
-.  

 ! !.&-.
3 



 *-.#
-
Cephalonhematoma:
' extravasation of blood from ruptured vessels between a skull vone and it¶s external
convering, the periosteum.
' Does not cross the suture line
' RISK FOR INURY

Caput Succedaneum:
' swelling of the tissue over the presenting part of the fetal head caused by pressure
during labor
' caused from edema
' crosses the suture line
áIn males hydroceles caused by an accumulation of fluid around the testes may be present. They can be easily
transilluminated with a light and usually resolve without treatment

-Ortolani maneuver (1)

O Used to assess hip integrity when examining for the developmental dysplasia of the hips (DDH)
O Determines if the femoral head can be returned into the acetabulum
O Hip is abducted and upward leverage is applied, a dislocated hip will return to the acetabulum with
a clunk.
Reflexes
-Sucking and rooting touch infant¶s lips, cheek or corner of mouth with nipple infant turn toward stimulus opens mouth
takes hold and sucks
-Grasp palmar and planter place finger in palm of hand and place finger at base of toes. Infants fingers curl around
examiner¶s fingers, toes curl downward.
-Tonic neck or fencing with infant falling asleep or sleeping turn head quickly to one side. With infant facing left side
arm and leg on that side extend opposite arm and leg flex.
-Moro hold infant in semi-sitting position allow head an truck to fall backward to an angle of at least 30 degrees place
infant on the flat surface strike surface to startle infant. Symmetric abduction and extension of arms are seen fingers
fan out and form a C with thumb and forefinger slight tremor may be noted arms are adducted in embracing motion
and return to relaxed flexion and movement. Legs may follow similar pattern of response. Preterm infant does not
complete embrace instead arms fall backward because of weakness.
-Babinski reflexes planter on sole of foot beginning at heel stroke upward along lateral aspects of sole them move
finger across ball of foot. All toes hyper extended with dorsiflexion of big toe recorded as a positive sign.

Maternity (26)
-Apgar scoring/purpose/application (1)
O Permits a rapid assessment of the need for resuscitation based on five signs that indicate the
physiologic state of the neonate: 1.) heart rate, based on auscultation with a stethoscope; 2.)
respiratory rate, based on observed movement of the chest wall; 3.) muscle tone, based on degree
of flexion and movement of the extremities; 4.) reflex irritability, based on response to gentle slaps
on the soles of the feet; and 5.) generalized skin color, described as pallid, cyanotic, or pink.
O Evaluations are made 1 and 5 minutes after birth.
O Apgar Scoring:
O 0-3 indicate severe distress
O 4-6 indicate moderate difficulty in adjusting to extrauterine life
O 7-10 indicate that the infant is having no difficulty adjusting to extrauterine life.

- Ophthalmia neonatorum is an inflammation of the eye resulting from gonorrheal or chlamydial infection contracted
by the newborn during passage through the mother¶s birth canal.
-Vitamin K administration is given IM which is routine a single injection of 0.5 to 1 mg of vitamin. This is given soon
after birth to prevent hemorrhagic disease of the new born. Vitmain K is produced in the GI tract by bacteria stating
soon after microorganism are introduced. By the 8th day they are able to produce their own vitamin K.
-The umbilical cord care is clamped immediately after birth. The goal of care is prevention and early detection of
hemorrhage or infection. Apply and antiseptic solution such as triple dye or alcohol to the cord. The stump and base
of the cord should be assessed for edema, erthema and drainage with each diaper change. The average cord
separation time is 10 to 14 days. The cord clamp is removed once the stump has started drying and is no loner
bleeding typically in 24 hours.
Gestational Age Assessment
l This is important because prenatal morbidity and mortality rates are related to gestational age and birth
weight. This is common to assess gestational age of infants b/t 35 and 42 weeks it assess 6 external
physical and six neuromuscular sign and each one have a number score and the cumulative score
correlates with a maturity rating 26 to 44 weeks. The score is accurate to plus or minus 2 weeks and is
accurate for infants of all races. The New Ballard Score a revision of the original sale can be used with
newborns as young as 20 weeks. This has the same physical and neuromuscular section but include -1 to -
2 scores the reflect signs of extreme prematurity such as fused eyelids.
Classification of Newborn by Gestational age and birth weight
-this provides a more satisfactory method for predicting mortality risks and providing guideline for management of the
neonate than estimating by gestational age or birth weight alone. They are plotted on a standardized graphs that
identify normal values for gestational age.
l Large for gestational age (LGA) weight is above the 90th % at any week
l Appropriate for gestational age (AGA) weight falls b/t 10th and 90th % for infant age
l Small for gestational age (SGA) weight is below the 10th % at any week
 l Low birth weight (LBW) weight 2500 g or less at birth. These newborns have either less than the expected
rate or intrauterine growth or a shortened gestation period. Preterm birth and LBW commonly occur
together
l Very low birth weight (VLBW)- weight of 1500 g or less at birth
l Intrauterine growth restriction (IUGR) term applied to the fetus whose rate of growth does not meet
expected norms
-Fracture of the clavicle is the most common birth injury. A fractured clavicle usually heals without treatment.
-Circumcision formula Is usually held 4 hours before procedure to prevent vomiting and aspiration. Breast feed may
be allowed until procedure. Newborns do use 3 types of anesthesia ring block, dorsal penile and topical anesthesia .
Neonatal pain
á Care providers do acknowledge that newborns actually do feel pain and also remember pain. (read the rest
under this section I¶m sleeply)