A Blessed Christmas and a Prosperous New Year to all of us!

Christmas is truly in the air!

With all the food we have prepared for the holidays and the gifts wrapped and to be given away in a few hours, truly Christmas never fails to give a wonderful feeling to each one of us! Our kids are to eager to get their Christmas presents and was able to make cards for Santa Claus because they said they were good kids this year! Charlize, my 9 year old daughter still believes in Santa Claus.  She believes that Santa is Jesus Christ's alliance.  He will only give gifts to good girls and boys because Jesus would tell him so.

I was taught too that way, that Santa is Christ's little helper.  My mom would let us sleep and wake us up before midnight. And alas, all the gifts are there! Exactly what I have written to Santa.  A note always there in every gift, "Be a good girl always. Jesus loves you."

Santa is truly Christ's little helper. (Well yeah I know he is huge!) He is giving gifts to kids and these gifts are enveloped with an attitude that kids do develop when they received it.  I have developed a positive attitude to be hopeful in everything and that everything will soon pass.  Everything will be alright as long as you do good things to yourself and to others.

I never would want that Santa spirit to be out of the family tradition and I am fearful that in a few years, my daughter Charlize (or maybe after reading this blog since she has a facebook account) will know who is Santa Claus.  But it does not matter who or where is Santa... what matters is what this person brings us... It brings us the spirit that we need to do good all throughout the year to prepare for the coming of a birthday celebrant. We need to do good things to prepare our spirits and spread the good news... the birth of Jesus Christ. 

May we never fail to remember the essence of this season. Forgive those who failed us, continue to hope that we will win in every endeavor that may come along our way and have faith that everything will all be alright.

Christmas is our Father's gift to us. Jesus Christ is our Father's gift,  giving us Faith, Hope and Love.  And I believe these are also the best gifts we are giving our kids and our loved ones this Christmas! May we share these gifts this holiday season and continue to share these all year round!

Again, a Blessed Christmas and a Prosperous New Year to all of us!!!

Christmas 2010

My Sibs

My Family

Our Princesses

NEW BEGINNINGS ARE NEVER LATE

I have been out of this personal blog for months.  New blogs again... Going back to my system.  It has been months of deep coma.  I was too busy updating my status and forgot that there is better space in this blog than sinking my thoughts in  less than 460 bytes in my facebook account or less than 160 bytes in my twitter account.  I have learned a lot lately and since the purpose of this blog is to educate.  This is what I intend to do.  Again, welcome to my personal blog! Learn from my experiences about God, my family, travel, my nursing career or simply about life :)


"Knowledge and wisdom are two different terms. Knowledge to know and wisdom to understand." -maritessmanalangquintorn-

Great beginnings comes from God...

Today marks the end of sacrifices. Nursing students from all over the Philippines will be gathered tomorrow in their designated testing centers to mark the end of all the sacrifices they had in their nursing education and harvest the fruits of their hard work. Every student nurse dreams to be a licensed nurse... This will mark the beginning of their nursing career and continue their mission to be bearers of faith, hope and confidence.

As I always say, nursing is not an easy job. You may be a nurse in the academe, in the hospital or in the community, yet we all share a certain responsibility in the environment we live in. I am amazed by the number of individuals, that for so many years that I have been in this profession, a lot of people would like to be a nurse. We may all have our own reasons why we chose this field but I fervently hope and pray that we nurses should continue our mission and vision... Care for the well and sick, be a role model, inspire and motivate other people and most of all, serve as a living testimony of hope to everyone who is in need.

Tomorrow and the next day after tomorrow is the beginning of a career. May GOD give everyone wisdom and strength to conquer their examination and may HE grant our prayers that nurses who will take their oaths after their examination will continue to uplift the standards of the nursing profession.

It is in the hands of NURSES, that no matter how poor our country may be, NURSES like us will continue to be professional, hard working and globally competitive. We may be serving our country or some may be serving other nationalities, but one thing is for sure... A FILIPINO NURSE will conquer the nursing world and will continue to share light to his/her clients, acknowledging God for the wisdom and skills in accomplishing our tasks and stay on the ground while harvesting success in our chosen fields.

Truly, great beginnings comes from God... Wisdom comes from God... HE is true to HIS promises... Trust in HIS ways... God bless you us all NURSES and may we all be a shining light in the Nursing profession!

xoxo,

M'Q. :D

A Student's Plea

"Ma'am please ipasa nyo na po ako... Inaatake na po ang lola nung nalaman nya na di ako aakyat sa entablado. Hindi ko na po alam ang gagawin ko... Hindi na po ako mag-aaral ulit dahil bumagsak ako." (Ma'am please let me pass the subject. My lola is having a cardiac arrest when she found out that I cannot go to the stage and graduate. I do not know what to do anymore. I will not study anymore because I failed.)

-- This is only one of the usual text message I receive every end of the semester. Heartbreaking... I feel like I want to cry...Sympathize...

Accept the fact that they are graduating students and somehow deserve to end their sufferings from school.

But then I realize, If I pass this student, I should pass everybody else... even though they lack knowledge,skills and attitude... even though they don't even know how to simply spell the word "Received" in the chart(when they usually spell it as "recieved")... and even though they simply have just the heart but their neurons can't just ingest each and every concept that we teach. Truly heartbreaking. I pity their parents, who would break bones just to let them graduate. Borrow money from Mr. Visa and Mastercard, get a loan from all the banks and microfinancing companies, sell the car, the house, the farmland...

Realizing all these, the love of nursing, my profession trickles me. If I will pass all of these students who I think lacks the appropriate standard to become a nurse, what will happen to my profession. With the status of nursing profession nowadays and I would let this happen, I would further aggravate the poor health care system that we have.

I remember, when I talked to the nurse who took care of my mom before she died and asked her of the postmortem care she was about to do, she just said that her eyes was closed. Nothing else.. nothing more... And so I cried. Realized, I am a nurse. I could have done more. Spiritual care. Cleaned her. Positioned her well. Even when I asked them what they have done when she had an arrest, they just said that they have done everything that they can possibly do. Specifically what? Just CPR... no defibrillations... no intubations... no medications... just because nurses were the only ones left in the ER, no doctors. And the nurses left in the ER probably just know CPR nothing more...

The grading system is a good tool to evaluate a student objectively. Logically, 74 is not 75 right? So 74 is considered failed. Deliberate the grades? If we deliberate the grades because of effort or attitude, this defeats the purpose of the grading system. We might as well not give grades anymore and let the students just finish the course. Then this would be the start of the downfall of the nursing education.

It is very difficult to be an educator. It is not different with show business. We need to let our students laugh during lecture so that they would easily understand and sometimes let them cry to let them realize the importance of their education.

I joined the academe because I want to do more with this profession. I want to share my knowledge so that my students would be better than me... I want them to be successful just like me and be proud that they graduated nursing because they deserve it. Not because of a bribe and not because of a plea.

CONGRATULATIONS TO ALL OUR FUTURE NURSES! and to those who did not make it this March... we will all see each other in the roster of nurses... Take time, take it easy. Hurrying things would not make you brilliant.
Just like a diamond, it takes careful steps to see it shine. God bless :)

INTEROGRATIS

Registration for interogratis is until March 27, 2010 only. Limited to 50 slots only.

COMMUNICABLE DISEASES

See Link. Thank you :)

www.maritessmanalangquintorn.weebly.com

NOVEMBER BOARD EXAM RESULTS: CONGRATULATIONS NURSES! :)

The long wait is over... NEW NURSES marching in the red carpet. (Click below for the complete list of new nurses)

CONGRATULATIONS TO ALL OF YOU!

With the number of nurses who took the board exam last November, it is bit sad to know that less than half of the examinees passed the nursing board exam.

Personally as an academician, it makes me think what really happened in the nursing education. Must it be because of the students, the instructors, the curriculum, or the passion for nursing itself.

A colleague told me, "I hope that would serve as an encouragement to continue inspiring and motivating students to exert effort and take their studies seriously.." May this message reminds us that every success is a joint effort. We can never attain success on our own nor by the help of other people only. We have to strive, reach the top and use whatever resources we have to attain what we want to achieve.

With a total of 94,462 examinees, only 37, 527 nursing graduates passed the November 2009 licensure examination. Again, a failure for many or success for some. But then, what is important is that, may it be a challenge for each and everyone that whether, you passed or you failed this examination, this is the start of a challenge... for those who failed the licensure exam, it is a challenge to take the exam again and conquer it and for those who passed the examination, it is a challenge to prove that truly you are a registered nurse.

To my students, I am so proud of you and I am overwhelmed to be part of your success! Continue to carve your way to your chosen field and you will surely be a good nurse.

Let's continue to uplift our profession! CONGRATULATIONS NURSES! :)


For the complete list of passers, Click here:

List of November Nursing Board Exam Passers

ONGOING TUTORIAL SCHEDULES FOR JANUARY

BATCH 1: Psychiatric Nursing
Mondays 6:30 pm to 7:30 pm
Tuesday 6:30 pm to 7:30 pm
Wednesdays 1:00 pm to 2:00 pm
Thursdays 1:00 pm to 2:00 pm
Fridays 10:00 am to 11:00am
Saturdays 5:30 pm to 6:30 pm
Every other Sundays 9:00am to 10:00 am


BATCH 2: Medical Surgical Nursing
Mondays 11:30am to 12:30 pm
Tuesdays 11:30am to 12:30 pm
Wednesdays 11:30am to 12:30 pm
Thursdays 11:30am to 12:30 pm
Fridays 11:30am to 12:30 pm
Saturdays 8:00 pm to 9:00 pm
Every other Sundays 8:00am to 9:00am


*Full slots for January. No requests for extensions at the moment :( Sorry...
**Enrollees who wish to extend their tutorials should register again for scheduling. Thank you.

***Kindly update your modules. Modules are already sent via email. Follow instructions. See you! :)


NEW SCHEDULE FOR OTHER BOARD SUBJECTS UPON REQUEST.
Email: academic.advancement.institute@gmail.com for details

MATERNAL ASSESSMENT

NOTES IN MATERNAL AND CHILD NURSING
Reference: NURSE’S NOTES: MATERNAL and CHILD NURSING
Maritess Manalang-Quinto, RN, MAN(c)


MATERNAL ASSESSMENT
Signs of Labor
Preliminary signs
- Lightening
- ↑ in level of activity
- Braxton hicks contractions
- Ripening of the cervix
Signs of True Labor
- Uterine contractions
- Show or bloody show
- Rupture of the membranes
Maternal assessment
- initial interview: EDC
: Duration, intensity, frequency of contractions
: amt & character of show
: Rupture of membranes
: vital signs, time of last meal
: drug allergies
: past pregnancy history
- Physical Exam
- Abdominal Assessment
: Fundic height
: Leopolds maneuver
- Laboratory analysis
Fetal assessment
a. FHR
- Auscultation
- Electronic monitoring
- Acid-base assessment
: pressure application on fetal scalp in dilated cervix
: absence of fetal acceleration suggests fetal distress
- Fetal reactivity
b. Fetal blood
- Blood sampling

MATERNAL ANESTHESIA

NOTES IN MATERNAL AND CHILD NURSING
Reference: NURSE’S NOTES: MATERNAL and CHILD NURSING
Maritess Manalang-Quinto, RN, MAN(c)

Maternal Regional Anesthesia
Spinal
Subarachnoid
L3-L5
Side effect on the lower extremities and spinal headache
Epidural
L3-L4
Involves the vagina and perineum
No postpartum headache side effect
Pudendal
Transvaginal route
Takes effect for 30 minutes
Local Infiltration
No side effect
Given just before giving birth

NURSING CARE DURING THE STAGES OF LABOR

NOTES IN MATERNAL AND CHILD NURSING
Reference: NURSE’S NOTES: MATERNAL and CHILD NURSING
Maritess Manalang-Quinto, RN, MAN(c)

Nursing Care of the Mother
1. Care of the Woman During the First Stage
Stage Profile: Marked by duration and stress of labor
Nursing interventions:
- Reduce anxiety and offer assistance
- Do not interrupt breathing during contractions
- Promote change of positions
- Encourage voiding and promote bladder care
- Encourage client to suck on hard candy, ice chips
- Apply cream on dry lips of client
- Administer IV solution in case of DHN
- When hyperventilating, keep paper bag nearby and teach on how to use it

2. Care of the Woman During the Second Stage
Stage Profile: Marked by intense contractions
Nursing Interventions:
- Provide client support
- Assess and record v/s, FHR, uterine contractions
- Prepare place of birth in advance
- Convert the labor room to birth room
- Make the client select positioning for birth
- Promote second stage pushing
- Clean perineum with warm antiseptic before birth

As soon as head is about 8cm across:
Perform the Ritgen’s maneuver
Encourage the woman to continue pushing until the occiput of fetal head is firmly a the pubic arch
Once head is delivered
Note time of birth, announce sex of infant
Cut and clamp the cord
Introduce infant to initiate parent child relationship

3. Care of the Woman in the Third and Fourth Stages of Labor
Stage Profile: Placental separation and delivery
Nursing interventions:
- Administer oxytocin (IM or IV
- Inspect delivered placenta
- Monitor vital signs (q 15 minutes)
- Palpate fundus
- Observe character and amount of lochia

Non Pharmacologic Pain relief
Relaxation
Focusing on imagery
Support from a doula or coach
Breathing techniques
Bathing/ hydrotherapy : C/I in ruptured membranes
Therapeutic touch and massage
Hypnosis: deep form of relaxation
Biofeedback: based on belief that people can control and
regulate internal events like HR and pain response
Acupressure and acupuncture
Heat or cold application
Pharmacologic pain relief
Local infiltration
Pudendal nerve block
Spinal anesthesia
Epidural anesthesia

LANDMARKS OF THE FETAL SKULL

NOTES IN MATERNAL AND CHILD NURSING
Reference: NURSE’S NOTES: MATERNAL and CHILD NURSING
Maritess Manalang-Quinto, RN

LANDMARKS OF THE FETAL SKULL
FETAL POSITIONS
OCCIPUT ANTERIOR
Usually the easiest position for the fetal head to traverse the maternal pelvis.
Shown here is the "direct OA" position. While some fetuses deliver in this position, others deliver slightly rotated clockwise (LOA) or counterclockwise (ROA). Either way, the fetus is still considered to be an "anterior" position.

RIGHT OCCIPUT ANTERIOR (ROA)
The fetal occiput is directed towards the mother's left, anterior side.

LEFT OCCIPUT ANTERIOR
normal and usually are the easiest way for the fetus to traverse the birth canal.

LEFT OCCIPUT TRANSVERSE
This LOT position and its' mirror image, ROT, are common in early labor.

RIGHT OCCIPUT TRANSVERSE

OCCIPUT POSTERIOR
Occiput posterior positions, including direct OP, LOP (Left Occiput Posterior) and
ROP (Right Occiput Posterior) are positions favored by certain internal pelvic shapes. This position has some obstetrical significance.

LEFT OCCIPUT POSTERIOR

RIGHT OCCIPUT POSTERIOR

RIGHT SACRUM POSTERIOR

LABOR PROCESS

NOTES IN MATERNAL AND CHILD NURSING
Reference: NURSE’S NOTES: MATERNAL and CHILD NURSING
Maritess Manalang-Quinto, RN

INTRAPARTUM AND POSTPARTUM
LABOR PROCESS
Components of labor
a. Passage
b. Passenger
c. Powers of Labor (uterine factors)
Passage
Fetal Presentation: Cephalic
Attitude
Vertex Sinciput Brow Face
Complete Moderate Partial Poor
flexion flexion extension flexion
Presentation: Breech
POSITION
Position
Refers to the relation of a chosen portion of the presenting part to the right or left side of the maternal birth canal
Positions (side of the mother)
Right
Left
Determining points (in the fetus)
Occiput
Mentum (chin)
Sacrum

DANGER SIGNS AND SYMPTOMS DURING PREGNANCY

NOTES IN MATERNAL AND CHILD NURSING
Reference: NURSE’S NOTES: MATERNAL and CHILD NURSING
Maritess Manalang-Quinto, RN, MAN(c)

Danger Signs and Symptoms
- ↑ or ↓ fetal movements
- Persistent vomiting
- Sudden escape of fluid from the vagina
- PIH
- Facial or finger swelling
- Dimness or blurring of vision
- ↓ urine output

PERINEAL AND ABDOMINAL EXERCISES

NOTES IN MATERNAL AND CHILD NURSING
Reference: NURSE’S NOTES: MATERNAL and CHILD NURSING
Maritess Manalang-Quinto, RN, MAN(c)

PERINEAL AND ABDOMINAL EXERCISES
Tailor Sitting
Squatting
Pelvic Floor Contractions
Abdominal Muscle Contractions
Pelvic Rocking
The Bradley Method
The Lamaze Method

PSYCHOLOGICAL CHANGES DURING PREGNANCY

NOTES IN MATERNAL AND CHILD NURSING
Reference: NURSE’S NOTES: MATERNAL and CHILD NURSING
Maritess Manalang-Quinto, RN, MAN(c)

Psychological Changes
First trimester
- Accepting pregnancy
- Common reaction: Ambivalence
Second trimester
- Accepting the baby; concentrates on
the new role
- Common Reactions: narcissism,
introversion, role playing, ↑
dreaming
Third trimester
- preparing for the baby and end of pregnancy
- Common reaction; impatience on the upcoming birth

Other psychological changes
Attitude towards body image
Increased stress
COUVADE syndrome: physical s/sx of pregnancy manifested in the woman’s husband
Emotional lability: mood swing bec of hormones
Changes in sexual desire: ↑ or ↓ libido

DIAGNOSTICS FOR A PREGNANT WOMAN

NOTES IN MATERNAL AND CHILD NURSING
Reference: NURSE’S NOTES: MATERNAL and CHILD NURSING
Maritess Manalang-Quinto, RN, MAN(c)

DIAGNOSTICS FOR PREGNANT WOMEN on the FIRST PRENATAL VISIT
Gravidity and Parity
Gravidity: number of pregnancies
Parity: number of births
Use of GTPALM
G: number of pregnancies
T: term births
P: preterm births
A: abortions (included in gravida is before 20 weeks
L: living children
M: Multiple Pregnancies

Clean Catch Urine
Used to check the presence of urinary tract infection during pregnancy
Pain upon urination is a common sign of urinary tract infection especially during pregnancy
Able to identify presence of HCG as indicative of pregnancy

Laboratory Tests
Radioimmunoassay test
Enzyme linked immunosorbent assay
Radioreceptor assay
Test for the first 24-48 hours after implantation
50 mIU/ml 7 to 9 days after conception
Peaks to 100 ml between 60th and 80th week of gestation

Pelvic Examination
Bimanual examination
Notes ovarian cysts, enlarged fallopian tubes, enlarged uterus, Hegar’s sign
Estimating Pelvic Size
Type of Pelvis: Android, Anthropoid, Gynecoid, Platypelloid
Diagonal conjugate: distance between the anterior surface of the inferior margin of the symphysis pubis
more than 12.5 cm
Ischial Tuberosity diameter: distance between the ischial tuberosities or transverse diameter of the outlet
9-11 cm is adequate

Assessment of Fetal Growth
Nagele’s Rule
- determines estimated birth date
McDonald’s Rule
- estimates fetal growth in utero
- fundic height or uterine height
Assessment of Fetal Well Being
- FHR
- Fetal movement
- Fetal presentation and position
-Leopolds maneuver
Late decelerations
Uteroplacental insufficiency
Begins well after the contraction but returns to baseline after 30 to 40 seconds

VARIABLE DECELERATIONS
Occurs at any time during uterine contracting phase
Decrease is usually >15bpm, lasts 15secs, return to baseline in <2mins from onset = indicates cord compression
NSG INTERVENTIONS:
Change in the mother’s position
Administer O2
D/C oxytocin

Alpha fetoprotein screening test
Assess the quantity of fetal serum proteins
Elevated levels of protein are associated with open neural tube and abdominal defects
Blood sample drawn at 15 to 18 weeks AOG

Amniocentesis
Aspiration of amniotic fluid done 13 to 14 weeks AOG
Performed to determine genetic disorders, metabolic defects and fetal lung maturity
Risks:
Maternal hemorrhage
Infection
Isoimmunization
Abruptio placentae
Amniotic fluid embolism
PROM

Nitrazine Test
Used to detect the presence of amniotic fluid
Amniotic has ph of 7 to 7.5 and turns yellow nitrazine to blue to blue green
Vaginal secretions have a ph of 4.6 to 7

Non stress test
Evaluates fetal heart rate in response to fetal movement
Results:
Unsatisfactory
Cannot be interpreted as a result of poor fetal tracing
Reactive: (negative)
Healthy fetus
2 or more FHR accelerations of at least 15 beats per minute lasting at least 15 seconds during a 20minute period
Non reactive: (positive)
No accelerations of at least 15 beats per minute or lasting less than 15 seconds in duration during a 40minute period

KICK COUNTS
Pregnant client should sit or lie quietly on her side.
Place hands on the largest area of the abdomen & concentrate on fetal movements.
Record the number of movements felt during a specific time period.
< 10 kicks in 12hr-period = NOTIFY MD

Fetal Monitoring
Displays the fetal heart rate
Monitors uterine activity which assesses the frequency, duration and intensity of contractions
A tocotransducer is placed over the fundus where contractions are felt strongest
Percutaneous Umbilical Cord Sampling
Cordocentesis or funicentesis
Blood studies to check blood count, blood gases, and isoimmunization
Changes during Pregnancy

FERTILIZATION AND IMPLANTATION

NOTES IN MATERNAL AND CHILD NURSING
Reference: NURSE’S NOTES: MATERNAL and CHILD NURSING
Maritess Manalang-Quinto, RN, MAN(c)

FERTILIZATION AND IMPLANTATION
Occurs in the upper region of the fallopian tubes
Occurs within 2 hours of ovulation within 2 to 3 days of insemination
Takes place when sperm and ovum unite
Zygote is propelled toward the uterus
Zygote is implanted 6 to 8 days after ovulation
Blastocyts secretes chorionic gonadotropin to ensure that corpus luteum remains viable and secretes estrogen and progesterone for the first 2 to 3 months of gestation

GERM LAYERS

ECTODERM
- CNS, PNS, skin hair, nails,
sebaceous glands sense organs,
mucous membranes of anus, mouth,
nose, tooth enamel, mammary glands
MESODERM
- Body supporting structures,
dentin of teeth, kidneys ureters, repro syst,
heart, circ syst, blood, lymph vessels
ENDODERM
- bladder, urethra, lining of pericardial,
pleural peritoneal cavities,
lining of GIT, RT, tonsils, thyroid,
parathyroid, thymus
Signs and Symptoms of Pregnancy
1. Indications of Pregnancy
Presumptive signs
Probable signs
Positive signs

CONTRACEPTION

NOTES IN MATERNAL AND CHILD NURSING
Reference: NURSE’S NOTES: MATERNAL and CHILD NURSING
Maritess Manalang-Quinto, RN, MAN(c)

Ideal Contraceptive
Safe
100% effective
Free of side effects
Easily obtainable
Affordable
Acceptable to the user and sexual partner
Free of effects on future pregnancies
Abstinence
Most effective way of preventing contraception and sexually transmitted diseases
0% failure rate

Natural family planning methods
Calendar rhythm
Basal body temperature method
Billings Method (Cervical Mucus Method)
Symptothermal

Artificial Family Planning methods
Oral contraception
Subcutaneous Implants (Norplant)
Medroxyprogesterone acetate (Depo Provera)
IUD

Barrier methods:
Condom
Diaphragm/Cervical caps

Surgical Methods
Vasectomy: vas deferens
Tubal Ligation: fallopian tube

Birth Control Methods Failure Rate
Oral steroidal contraceptives FR: 3%
IUD’s FR: 2-4%
Vaginal spermicides FR: 30%
Hormonal implants FR: 0.04%
Diaphragm FR: 5-8%
Female and male condom FR: 2% ideal
Cervical cap FR: 8-18%
Vasectomy FR: 0.1%
Tubal ligation FR: 0.1%

BIOPHYSICAL ASPECTS OF HUMAN REPRODUCTION

NOTES IN MATERNAL AND CHILD NURSING
Reference: NURSE’S NOTES: MATERNAL and CHILD NURSING
Maritess Manalang-Quinto, RN, MAN(c)

Obstetrics
Branch of medicine that deals with parturition, its antecedents and sequel
Etymology
Comes from the word “OBSTETRIX” which means “midwife”

Biophysical Aspects of Human Reproduction
Reproductive Development
- occurs during intrauterine life, gender determined through chromosome information
- Puberty (childhood-sexual maturity transitional age)
Girls: 10-13y/o Boys: 12-14y/o
- Androgen and estrogen production
- Secondary sex characteristics

Secondary Sex characteristics
Growth spurt
Increase in the transverse diameter of the pelvis
Growth of pubic hair
Onset of Menstruation
Growth of Axillary hair
Vaginal secretions
Increase in weight
Growth of testes
Growth of face, axillary and pubic hair
Voice changes
Penile growth
Increase in height
Spermatogenesis

Human Sexual Response
Excitement
Plateau
Orgasm
Resolution

THE MENSTRUAL CYCLE

Menstruation
Also termed as the female reproductive cycle
Menarche: average age of onset 12-13 years old; average range or 9-17 years old
Interval between cycles: average of 28 days; cycles of 23 to 35 days
Duration of the menstrual flow: average of 30-80ml per menstrual period
Color: dark red
Odor: like marigolds

Menstrual Cycle
Proliferative phase
Immediately after menstrual flow
Ovary produces estrogen
Endometrium thickens
Approx 5 to 14 days
Also known as estrogenic, follicular or postmenstrual
Secretory phase
Formation of progesterone in the corpus luteum
Capillaries of the endometrium increase in amount until the lining takes on the appearance of a rich spongy velvet
Ischemic
Decrease in both estrogen and progesterone occurs
Capillaries ruptures and corpus luteum degenerates
Menstrual
Degenerated portion of the endometrium is shed

CARE OF THE NEWBORN

CARE OF THE NEWBORN
Immediate care of the newborn
 Cord Care
 Alcohol only
 Vitamin K administration
 Crede’s prophylaxis
 Erythromycin drops or ointment
 Promotion of warmth
 Minimum oxygenation
APGAR SCORING
 Appearance
 pink
 Pulse Rate
 100 bpm
 Grimacing
 Cough or sneeze, cry or withdraw foot
 Activity
 Well flexed
 Respiratory Rate
 Good, strong cry
Newborn measurements
 HC: 34-35 cm
 CC: 32-33 cm
 HR: 120-140 bpm
 RR: 30-60 cpm
 Weight: 2.5 to 3.4 kg
 Length: 46-54 cm
Cold stress
 Mottling of the skin and acrocyanosis with irregular respirations
 Occurs within 24 hours after birth

THE COMPLICATED POSTPARTAL EXPERIENCE

THE COMPLICATED POSTPARTAL EXPERIENCE
Postpartum Hemorrhage
 Bleeding of 500mL of more following delivery
 Caused by uterine atony, lacerations and retained placental fragments
 Nursing interventions:
 Massage the fundus
 Monitor vital signs every 5 to 15 minutes
 Maintain asepsis
 Do pad counts
 Prepare to administer oxytocin if prescribed
 Administer fluids and monitor intake and output
Disseminated Intravascular Coagulation (DIC)
Assessment findings
 Bleeding may range from massive, unanticipated blood loss to localized bleeding (purpura and petechiae)
 Presence of special maternity problems
Interventions
 Assist with medical mgt. of underlying condition.
 Administer blood component therapy (white blood cells, packed cells, fresh frozen plasma, cryoprecipitate) as ordered.
 Observe for signs of insidious bleeding (oozing IV site, petechiae, lowered hematocrit).
 Institute nursing measures for severe bleeding /shock if needed.
 Provide emotional support to client and family as needed.
Postpartum Infection
 Any infection of the reproductive organs that occurs within 28 days of delivery or abortion
 Signs:
 Fever
 Chills
 Anorexia
 Pelvic discomfort or pain
 Vaginal discharge
 Elevated white blood cell count
Urinary tract infection (UTI)
Interventions
 Encourage high fluid intake
 Provide warm baths to relieve discomfort and promote perineal hygiene
 Administer and monitor intake of prescribed medications (antibiotics, urinary analgesics)
 Stress good bladder-emptying schedule
 Monitor for signs of premature labor from severe or untreated infection
Interventions for Postpartum Infection
 Monitor vital signs
 Make the mother comfortable as possible
 Keep the mother warm if chilled
 Encourage fluids to 3000 to 4000 mL per day if not contraindicated
 Encourage frequent voiding and monitor intake and output
 Administer antibiotics as prescribed
Interventions for Thrombophlebitis
 Avoid pressure behind the knees
 Avoid prolonged sitting
 Avoid constrictive clothing
 Avoid crossing of legs
 Never massage the legs
 Use support hose if prescribed
 Comply with an anticoagulant as prescribed
Interventions for Hematoma
 Monitor vital signs
 Place ice at the hematoma site
 Administer analgesics and antibiotics as prescribed
 Encourage fluids and voiding
 Prepare for incision and evacuation of hematoma if necessary
Mastitis
 Inflammation of the breast as a result of infection
 Primarily occurs in breast feeding mothers 2-3 weeks after delivery
 Signs:
 Localized heat and swelling
 Pain
 Elevated temperature
 Complains of flu-like symptoms
 Nursing interventions:
 Good hand washing
 Wear support bras
 Do manual expression of breast milk or use breast pump every 4 hours
 Administer pain relievers and antibiotics as prescribed

THE NORMAL POSTPARTAL EXPERIENCE

THE NORMAL POSTPARTAL EXPERIENCE
Postpartum Chills
 May be the result of sudden release of pressure on pelvic nerves of excess epinephrine production during labor
 Signs and symptoms:
 Elevated Temperature
 Tachycardia
 Tachypnea
 Hypotension
 Nursing Interventions:
 Monitor the vital signs every 2 to 4 hours
 Make the client comfortable as possible
 Keep the mother warm
 Encourage fluids 3000-4000mL if not contraindicated
Breast Engorgement
 Caused by vascular and lymphatic congestion
 Encourage wearing of a support bra at all times even while the client is sleeping
 Encourage to use ice packs between feedings if the client is breast feeding
 Encourage warm soaks or a warm shower before breast feeding
 Massage the breasts before feeding to stimulate let- down
 Administer analgesics as prescribed if comfort measures are unsuccessful
Positive mother-neonate interaction
 Speaks of infant as desirable and attractive
 Is not upset by the drooling and vomiting of the infant
 Holds baby warmly
 Makes eye contact with the neonate
 Plays with and soothes the infant
 Talks or sings to the baby
 Expresses confidence that the infant is well
 Is able to discriminate the needs of the infant
Rubin’s postpartum Phases of Regeneration
 Taking-in phase: first 3 days
 Mother focuses on own primary needs such as s sleep and food
 Baby care teaching is not effective at this time
 Taking-hold phase: 3 to 10 days
 More in control of independence
 Begins to assume tasks of mothering
 Letting-go phase
 Deep loss of separation from the baby
 Mothers may be caught in a dependent/independent role
After birth pains
 Results from the contractions of the uterus
 More common in:
 Multiparas
 Breast feeding mothers
 Treated with oxytocin
 Over distended uterus during pregnancy such as carrying twins
Carunculae Mystiformes/Carunculae Hymenales
 Fibrous nodules of mucosa resulting from the healing of a torn hymen
 Remnants of a ruptured hymen that appears as irregular projections of a normal skin around the vagina

CESAREAN DELIVERY

CESAREAN DELIVERY

Indications of Cesarean Section

pMaternal Factors

nActive genital herpes or papilloma

nAIDS or HIV positive status

nCephalocaudal disproportion

nCervical cerclage

nSevere HPN

nFailure to progress in labor

nObstructive malignant tumor

nPrevious CS

Indications of Cesarean Section

pPlacental Factors

nPlacenta Previa

nPremature separation of the placenta

nCord Prolapse

pFetal Factors

nBreech lie

nLow birth Weight

nFetal distress

nMajor fetal anomalies

nTwins

nTransverse presentation

Caesarian Delivery: Types

pClassical – vertical incision

pLow uterine – “bikini”, for aesthetic purposes

Notes about Anxiety Disorders

NOTES ABOUT ANXIETY DISORDERS
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)

Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines


STRESS
• : is an inevitable part of a human’s life
• : causes wear and tear in the body, both physical and psychological
• : known to occur whenever a person has difficulty with life situations, experiences, problems and goals.

GENERAL ADAPTATION SYNDROME by Hans Selye

3 Stages of reaction to stress:
1. Alarm reaction stage
• : Stress stimulates the bodily systems to send messages to the brain which serves as the body’s defense mechanism
• : The body tries to struggle and cope up with the stress felt by the individual
• : The individual is very much alert
• : Activation of sympathetic nervous system happens

2. Resistance stage
• : The bodily system adapts to stress felt; has the tendency to fight or flight.

3. Exhaustion stage
• : Happens when a person has negatively responded to stress such as inability to cope up with life situations and experiences

Anxiety
• :a vague feeling of dread, apprehension or death
• :an unexplainable response to external or internal stimuli that can have either behavioral, emotional, cognitive, and physical symptoms.
• :it is a feeling of apprehension caused by anticipation of danger.

Etiology
• Genetic
• Neurochemical
• Psychoanalytic
• Interpersonal

Levels of Anxiety
1. Mild Level of Anxiety +1
• -the individual will feel that something is different and warrants special attention.

2. Moderate level of anxiety +2
• -disturbing feeling of an individual indicating that something is definitely wrong and needs immediate attention
Levels of Anxiety
3. Severe Level of Anxiety +3
• -has trouble thinking and reasoning
• -crying with ritualistic behavior

4. Panic Level of Anxiety +4
• -perceptual field may be reduced to focus on self
• -may be suicidal

TYPES OF ANXIETY DISORDER
PANIC DISORDERS
• -composed of discrete episodes of panic attacks that is 15 to 30 minutes of rapid, intense, escalating anxiety in which the person experiences great emotional fear as well a physiologic discomfort.

TYPES OF ANXIETY DISORDER
PHOBIA
• -It is an illogical, irrational and an intense persistent fear of a specific object, a social situation or any stimuli that causes extreme distress which alters normal functioning and behavior.
3 Categories of Phobia
a. Agoraphobia
-fear of open spaces such as going out of the house and characterized by inability to keep up with appointments, doing activities outside the home or simply having attacks when leaving home.
b. Specific Phobia
• -Natural environmental phobia
(eg. natural disasters, floods, rain)
• Blood-injection phobia
(eg. surgical procedures, immunization)
• -Situational Phobia
(eg. speaking in front, singing, stage freight)
• -Animal phobia
(eg. snakes, spider, rats)
• c. Social Phobia
(eg. speech, stage freight)
Behavioral Therapy

Systematic desensitization

Flooding

TYPES OF ANXIETY DISORDER
OBSSESSIVE COMPLULSIVE DISORDERS
• Ritualistic Behaviors
• Touching Rituals
• Hoarding Rituals
• Counting Rituals
• Chanting/Praying Rituals
• Checking Rituals

Behavioral Therapy
• Exposure
• Response Prevention


TYPES OF ANXIETY DISORDER
GENERALIZED ANXIETY DISORDER
• It is an anxiety disorder characterized by 6 months or more of excessive worrying and anxiety over an impulse or stimuli

TYPES OF ANXIETY DISORDER
ACUTE STRESS DISORDER
It is a disorder which occurs when the individual experiences dissociative symptoms during, or immediately after a distressing symptom or situation by using dissociation as common coping mechanism.

ANXIOLYTICS
BENZODIAZEPINES
NON-BENZODIAZEPINES

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