Transcript Maternal-Child Nursing Care Optimizing Outcomes for Mothers

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Chapter 1
Traditional and Community
Nursing Care for Women,
Families, and Children
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Traditional Nursing Care
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Historical Perspective
 Medical Model
 Ethnopluralism
 Ethnocentrism
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Shifts in Nursing
 Health-Wellness Continuum
 Linear: illness to wellness
 Circular: motivate family to health promotion,
maintenance, and restoration
 Nursing aesthetics
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Changing Demands
and Demographics
 Engaging transpersonal care
 Social and technological advances
 Family structure, function, and definition
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Contemporary Nursing Care
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Current Health
Care Settings
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Acute Care
Regional and Tertiary Centers
Birthing Centers
Home Care
Nurse-Managed Clinics
Increase in Nursing Responsibility and Judgment
Primary Care
Community-Based Care
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Family-Centered Care
 Nurse as facilitator
 Assists family in making informed choices
toward outcome of patient/family
 Cultural sensitivity
 Cultural competence
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Modern Technology
and the Caring Touch
 Complementary/Alternative Medicine
 Low-tech, high-touch interventions
 Supports whole mind, body, energy,
environment, and spiritual healing
 Goal: patient-centered autonomy
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Touch vs. Tech
 Evidence-Based Practice
 Health Informatics
 Professional Organizations/Standards of Care
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Professional Nursing Roles
 Teacher
 Collaborator
 Provider of care
 Nursing process
 NIC
 NOC
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Caring Theories
 Nightingale’s model
 Watson: Theory of Human Caring
 Leininger: Theory of Transcultural Care
Diversity and Universality
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Essential Caring Characteristics
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Trust
Provide sense of empowerment
Communication
Spirituality
 Meaning of life
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Additional Professional
Nursing Roles
 Critical thinker
 Effective communicator
 Advocate
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Nursing Process—
Concept Map
 Analyze assessment data to determine
nursing problems/diagnoses
 Analyze relationships, prioritize patient
responses
 Work with patient/family to develop goals
 Select interventions
 Evaluate progress
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Chapter 2
Contemporary Issues in
Women’s, Family’s, and
Children’s Health Care
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Public Health Intervention Model
(The Intervention Wheel)
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Population-based
Defines levels of practice
Comprehensive prevention focus
17 categories of intervention tactics
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Public Health Intervention Model
The Intervention Wheel
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
How the Intervention Wheel
Works
 Childhood Obesity
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Healthy People 2010
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Defines health care priorities
Guide progress toward the ultimate goal of
optimal health
 Goals:
 To increase the quality and years of healthy
life
 To eliminate health disparities within
America’s population
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Healthy People 2010 (cont’d)
 Comprehensive set of 467 measurable
disease prevention and health promotion
objectives
 28 focus areas
 Leading health indicators
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Three Levels of Prevention
 Primary prevention
 Health promotion
 Secondary prevention
 Early identification and prompt treatment
 Tertiary prevention
 Restore health
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
U.S. Health Care
 Population is healthier than ever before
 Heart disease declining
 World Health Organization
 U.S. is 37th in health care status
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Health Care Spending
 U.S. spends more per capita
 U.S. health care budget—1/7 of GNP
 Health care disparities
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Selected Societal Trends
 Epidemiology
 Morbidity rates
 Mortality rates
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Societal Trends (cont’d)
 Aging population with more chronic
illnesses
 Increased racial and ethnic diversity
 Health care disparities
 Childbirth trends
 Patterns of physical fitness
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Current Health Status
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Infants and Children
 Decreasing infant mortality
 Change to health prevention and early
intervention
 Health trends
 Increase in asthma
 Increased ADHD
 Increased autism
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Current Health Status
 Families
 Access to health insurance
 Women
 Increased heart disease
 Perinatal health
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Political Influences and Trends
 Health Policy Decisions
 Abortion
 National Economic Policies
 Access to care
 Health Care Delivery
 Managed care
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Public Policies and Programs
 Women, Infants, and Children (WIC)
 Medicaid
 Newborn and Mothers Health Protection
Act
 Family and Medical Leave Act
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Socioeconomic Trends
 Inequalities
 Increasing rate of poverty
 Wage gap
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Communications and
the Digital Divide
 Access to the Internet and information
 Limited or no access to the Internet
 Poor
 Elderly
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Vulnerable Populations
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Homeless
Undocumented immigrants and refugees
People who live in rural areas
Abused/neglected children
Victims of sexual violence
Victims of intimate partner violence
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Vulnerable Populations (cont’d)
 Gay/lesbian/transgendered individuals
 Incarcerated women
 Substance abusers
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Personal and Cultural Trends
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Technology
Language barriers
Cultural differences
Self-care/patient involvement
 Autonomy
 Social participation
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Complementary and
Alternative Therapies
 Integrative health care
 Integrating CAM with conventional health care
 NANDA-I diagnoses for holistic nursing
 www.ahna.org
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Health Care for the Nation
 Growth of information and knowledge
 Access to current and accurate knowledge
critical
 Community-based programs
 High-tech medical care
 Telemedicine
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Challenges for Nurses
 An ethical framework for
 professional practice
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Four Basic Ethical Principles
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Beneficence
Nonmaleficence
Respect for autonomy
Justice or fairness
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
HIPAA Implications
 Procedural mandates for privacy
 Portability
 Precautions against health care fraud
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Current Trends in
Clinical Practice
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Electronic pumps
Paperless records
Unit dosing
Aging population
Evidence-based practice
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
NANDA-I Nursing Diagnoses
 NANDA-I
 Nursing Interventions Classification
 Nursing Outcomes Classification
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Chapter 3
The Evolving Family
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
The Evolving Family
 Viewing the family in a nursing context
 Family is contextual background for
patient
 Healthy People 2010 National Initiative
 Social policies
 Access to health care
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Families Today
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Definition of family
Family of origin/family of choice
Family changes as reflected in media
Family as a basic social unit
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Family Structure—Changes
 Traditional nuclear families
 Single head of household
 The “skip” generation
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Stressors on Families
 Health care
 Financial stressors—uninsured
 Homelessness
 Mental illness
 Societal pressures
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Family Theories and Models
 Family Systems Theory
 Boundaries
 Subsystems
 Balance and homeostasis
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Duvall’s Family
Developmental Theory
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The Beginning Stage
Childbearing Stage
Preschool Stage
School Age and Adolescent/Teenage
Stages
 Launching, Middle-Age, and Retirement
Stages
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Structural-Functional Theory
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Provider role
Housekeeper
Child-care giver
Socializer and recreational organizer
Sexual partner
Therapist
Kinship
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Communication Theory
 Healthy communication patterns
 Unhealthy communication patterns
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Group Theory
 Norms (rules of conduct)
 Stages of groups
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Forming
Storming
Performing
Adjourning/terminating
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Bowen’s Family Systems Theory
 Nuclear family emotional system
 Differentiation of self
 Emotional cut-off
 Triangulation
 Multigenerational transmission process
 Family projection process
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Nursing Theories
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Nightingale
King
Roy
Neuman
Rogers
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Integrated Theories
 Friedman
 Hansen
 Calgary family model
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Family Assessment
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Nursing Role
Assess:
 Family size and structure
 Parenting style
 Authoritarian (dictatorial)
 Laissez-faire (permissive)
 Authoritative (democratic)
 Religious, cultural, and social-economic
orientation
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Tools to Facilitate the
Family Assessment
 Qualitative and quantitative surveys
 Genogram and ecomap
 Strengths and problems lists
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Components of the
Family Assessment
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Communication patterns
Roles and relationships
Family developmental stage
Family rituals
Triangulation
Dyads and other subsystems
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Family-Centered Care
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Nursing Diagnosis
 Altered Family Processes
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Families with Special Needs
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Situational crisis
Developmental crisis
Hospitalization of family member
Chronic mental illness
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Chronic Mental Illness
 Social isolation
 Caregiver strain
 Respite care
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Substance Abuse
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Enabling behaviors
Codependency issues
Roles assumed by children
Family rules
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Abuse
 Physical abuse
 Sexual abuse
 Elder abuse
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Post traumatic Stress Disorder
 Individual family member
 Family members share a traumatic event
 Flood
 Tornado
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Chronic Physical Illness
 Education—aspects of daily care
 Transition: dependence on health care
worker to family member independence
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Death of a Family Member
 Developmental stage of family
 Nurse’s role
 Stages of grieving
 Accepting/searching for answers phase
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Family Care Settings
 Inpatient
 Outpatient
 Home health and hospice
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Family Cultural Characteristics
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Acculturation and assimilation
Identity
Time orientation
Connectedness
Communication patterns
Socioeconomic class
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Culturally Sensitive Care
 Holistic care
 Developing a knowledge base
 Self-awareness
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Chapter 5
Reproductive Anatomy and
Physiology
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Sexual Differentiation
in the Embryo
 Male gender
 Female gender
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Female Reproductive System
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
The Pelvic Floor
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Internal Structures
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
The Bony Pelvis
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Pelvic Types
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Gynecoid—traditional female pelvis
Android
Anthropoid
Platypelloid
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Breasts
 Accessory organs of reproductive system
 Primarily glandular, fibrous, and adipose
tissue
 Primary function: lactation
 Parts: nipples, areola, Montgomery
tubercles
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Interplay of Hormones and
Reproduction
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Hypothalamus Hormones
 Gonadotropin-releasing hormone (GnRH)
 Corticotropin-releasing hormone (CRH)
 Growth hormone-releasing hormone (GH-RH)
 Growth hormone-inhibiting hormone (GH-IH)
 Thyrotropin-releasing hormone (TRH)
 Prolactin-inhibiting factor (PIF)
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Pituitary Gland Hormones
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Thyroid-stimulating hormone (TSH)
Adrenocorticotropic hormone (ACTH)
Prolactin (PRL)
Growth hormone (GH)
Gonadotropins: follicle-stimulating
hormone (FSH); luteinizing hormone (LH)
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Hormones Released by
the Gonads
 Estrogen
 Progesterone
 Testosterone
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Other Hormones
 Human chorionic gonadotropin (hCG)
 Prostaglandins
 Relaxin
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Sexual Maturation
 Puberty
 Females: thelarche, menarche
 Males: testicular enlargement
 Female secondary sexual characteristics
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
The Menstrual Cycle
and Reproduction
 Uterine (endometrial) cycle
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Menstrual phase
Proliferative phase
Secretory phase
Ischemic phase
 Hypothalamic-pituitary-ovarian cycle
 Follicular and luteal phases
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Body Changes
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Spinnbarkheit: elasticity of cervical mucus
Ferning: crystallization of cervical mucus
Increased basal body temperature
Mittelschmerz: abdominal cramping during
ovulation
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Natural Cessation of Menses
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Climacteric phase
Perimenopausal phase
Menopause
Postmenopausal phase
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Male Reproductive
System
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Male Hormonal Influences
 Androgens—Male sex hormones
testosterone: secondary sexual characteristics
 Fertility: related to sperm number, size, shape,
and motility
 Age-related development of male reproductive
system
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Chapter 6
Human Sexuality and Fertility
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Sexuality &
Reproductive Health Care
 Community-based perspective
 Reproduction implications
 Pregnancy
 Health concerns
 Nurse’s role
 Educator
 Counselor
 Care provider
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Human Sexual
Response
 Masters and Johnson
 Four phases of sexual response
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Excitement
Plateau
Orgasmic
Resolution
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Dimensions of Sexuality
 Sexual orientation
 Heterosexual
 Homosexual
 Bisexual
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Promoting Women’s
Sexual and Reproductive Health
 Assessment
 Establishing trust
 Obtaining the sexual history
 Nursing diagnosis
 Planning and implementation of care
 Evaluation
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Achieving Healthy People 2010
National Goals
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Intended and unintended pregnancy
Repeat births within 24 months
Emergency contraception
Male involvement in family planning
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Providing Contraception Care
Methods of Contraception
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Medication-Free Methods
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Natural family planning
Fertility awareness
Coitus interruptus
Lactational amenorrhea method
(breastfeeding)
 Abstinence—0% failure rate
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Barrier Methods
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Inexpensive
Protect against STIs
Must be used prior to intercourse
Water-based lubricant
Few side effects
Key: consistent and correct use
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Barrier Methods
 Diaphragm
 Cervical cap
 Condoms (male and female)
 Latex allergies
 Spermicides
 Contraceptive sponge
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Hormonal Methods
 Oral contraceptives
 Monophasic, biphasic, triphasic
 Warning signs: ACHES
 Low-dose progestin-only
 Transdermal contraceptive patch
 Vaginal contraceptive ring
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Mandatory Health Care
 Initial examination
 3-month follow-up after beginning OCPs
 Yearly examination
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Noncontraceptive Benefits
 Regulate menstrual bleeding
 Mediate menopausal symptoms
 Hot flashes
 Vaginal dryness
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Contraindications
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Smoking and age greater than 35 years
Moderate/severe hypertension (BP 160/100)
Undiagnosed uterine bleeding
Diabetes of more than 20 years’ duration or
with vascular complications
 History of pulmonary embolism or deep
venous thrombosis
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Troublesome Side Effects
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Headaches
Breakthrough bleeding
Nausea
Breast tenderness
Cyclic weight gain
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Emergency Postcoital
Contraception
 Hormonal methods (two FDA-approved)
 Preven
 Plan B
 Copper-releasing intrauterine device
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Injectable Hormonal
Contraceptive Methods
 Depo-Provera
 Injected every 3 months
 Reversible after 10 months
 Side effects: irregular bleeding, weight gain,
depression
 Safe for breastfeeding mothers
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Subdermal Hormonal Implant
 Implanon
 Single rod
 Effective for 3 years
 Side effects: bleeding irregularities, emotional
lability, depression, weight gain
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Intrauterine Device (IUD)
 Warning signs: PAINS
 Benefits:
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No continued expense
No daily attention
No interference with intercourse
May decrease risk of endometrial cancer
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Side Effects/Contraindications
 Side effects
 Irregular bleeding
 Amenorrhea
 Pelvic infections
 Contraindications
 Current STI
 Genital tract cancer
 Uterine anomalies, fibroids
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Sterilization
 Female
 Bilateral tubal ligation
 Nonincisional hysteroscopic tubal ligation
 Male
 Vasectomy
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Clinical Termination
of Pregnancy
 Ends pregnancy before fetus reaches age
of viability (20 to 24 weeks)
 1973—Roe v. Wade
 Elective abortion
 Therapeutic abortion
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
The Nurse’s Role
 Guidance—pregnancy testing,
ultrasonography
 Emotional support
 Counseling—options, potential
complications
 Information about contraception
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Surgical Termination
 Menstrual extraction, endometrial aspiration
 5 to 7 weeks gestation
 No anesthesia
 Vacuum aspiration
 Up to 12 weeks gestation
 Laminaria for cervical dilation
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Surgical Termination
 Between 8 and 12 weeks of gestation
 Mechanical dilation of cervix
 Local anesthetic
 Complications: uterine perforation, cervical
lacerations, hemorrhage, infection, and
adverse reactions to the anesthetic agent
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Surgical Termination
 Second trimester
 Cervical dilation and uterine evacuation
 Laminaria—24 hours preprocedure
 Possible long-term adverse effects from
cervical trauma
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Nursing Care
 Assessment
 Emotional support
 Observe for complications
 Excessive bleeding and cramping
 Schedule follow-up appointment
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Medical Termination
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Up to 63 days of gestation
Medications induce uterine contractions
Mifepristone (Mifeprex, RU-486)
Methotrexate
Misoprostol (Cytotec)
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Medical Abortion
 Several days after medication—painless,
heavy bleeding, expulsion of tissue
 Encourage friend/relative for emotional
and physical support
 Follow-up visits
 Ultrasonography
 hCG levels
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Medical Termination
 Second trimester
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Vaginal or intrauterine prostaglandins
Repeated doses
Side effects: nausea, vomiting, diarrhea, cramping
Intrauterine hypertonic solutions (rare)
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Pregnancy Termination
Complications
 Cramping, bleeding
 Rare: infection, incomplete abortion,
hemorrhage, Asherman syndrome, postabortal syndrome
 Nurse’s role
 Educate regarding signs of short-term
complications
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
The Nurse’s Role in
Infertility Care
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Initial Assessment
 Sterility
 Infertility
 Nurse’s role
 Educate—overview of infertility evaluation,
basal body temperature
 Counseling
 Assess understanding of fertile times
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Later Assessments
 Female
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Thyroid function test
Glucose tolerance test
Serum prolactin levels
Specific hormonal assays
Ultrasonography
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Other Diagnostic Tests
 Female (cont’d)
 Endometrial biopsy
 Hysterosalpingography
 Laparoscopy
 Male
 Semen analysis
 Additional tests (endocrine, postcoital test,
ultrasonography)
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Treatment Options—Infertility
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Medications to induce ovulation
Surgical options
Therapeutic insemination
Advanced reproductive technologies
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Advanced Reproductive
Technologies
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Gamete intrafallopian transfer (GIFT)
Zygote intrafallopian transfer (ZIFT)
Tubal embryo transfer (TET)
In vitro fertilization (IVF)
Embryo cryopreservation
Micromanipulation
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Ethical/Legal Considerations
 Factual information—advantages and
limitations
 Financial implications
 Donor confidentiality
 Ongoing education and counseling
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Potential Effects on the
Couple’s Relationship
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Emotional stress
Feelings of disappointment and failure
Sense of loss and grief
Intercourse changes to goal-oriented
procedure
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Lifestyle Choices and Infertility
 Healthy lifestyle choices
 Physical activity, nutrition, stress
management, adequate rest
 Holistic/complementary alternatives
 Herbal supplements
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Additional Options
 Surrogacy—gestational carrier
 Ethical/legal implications
 Adoption
 Child-free lifestyle
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Nurse’s Role
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Empowerment
Advocacy
Education
Appropriate care to encompass the cultural,
spiritual, and environmental domains