Lesson 1
Friday, 26 August 2022 8:02 pm
Main Goal of Maternal Neonatal Nursing
• To provide comprehensive family oriented or family centered care.
Scope of Maternal Neonatal Nursing
• Nurses need to focus the care of the patient or the pregnant woman, also the husband, family,
and the baby.
3 Pregnancy Periods
1. Antepartum- also known as "prenatal period" refers to the period of conception to the onset of
labor. From onset to the confirmation of pregnancy to the mother's uterine contraction until labor
2. Intrapartum- period that stems from the onset of contraction that causes cervical dealation to
the first 1-4 hours after the birth of neonate or the placenta. Cervix will not dilate if the uterus
does not contract. If cervix does not contract cesarian is needed. If the woman gives birth to the
fetus and the neonate, nurses should deliver the placenta as well.
3. Postpartum- this refers to the 6 weeks after the labor of the neonate and the placenta. And also
called as puerperium it is also the stage ends when the reproductive organ returns to its non-
pregnant stage.
Neonatal Rules and Functions
• In the United States or other foreign countries, the have a specialization unlike in the Philippines
not having a variety of specialization. These specialization such as:
○ Practical nurse- support patients by providing basic nursing and medical care, provide
routine care for sick, injured, or disabled patients and coordinate with and assist physicians
and registered nurses
○ Traveling nurse- take temporary nursing positions in high-need areas. They jump into
hospitals, clinics, and other facilities, giving patients across the country quality care.
○ Surgical nurse- assist the operating room staff during surgery and provide care to patients
recovering from a procedure. Their primary responsibilities are to provide patient care,
assist the operating room staff, and document observations and procedures.
○ Maternal and neonatal nursing- these nurses involved, assumes a lot of roles these
include caregiver or care provider, care educator (teaching the mother breast feeding), and
could be a counsellor (advice the mother what to do of the baby and what to expect from
the baby, and also can teach the mother about the reproductive health such as family
planning/health)
▪ Nurses involve in maternal and neonatal nursing are:
□ Registered nurse, is graduate of a credited nursing program and has
successfully passed the licensure exam for nurses or board certified nurses. If
RN want to work in a maternal and neonatal department, nurses should go under
extensive care training or extensive onsite training and also a competency check
as well as ongoing education.
□ Certified nurse midwife, to be a certified nurse midwife, nurse should be
registered, achieved advance education at a master's level and passing the
exam. Certified nurse midwife works independently, they are able to care of low
risk of obstetric patient throughout the pregnancy.
□ Nurse practitioner, also called a NP, also a registered with advance education
at the master's level at the same time obtain the certification. NP performs at an
expanded advance practice role performs such as health history, physical
assessment and manages care also can prescribe treatment with the
consultation of the physician. NP could practice as a woman's health, family,
neonate and pediatric patients. Serve as a primary health care provider
□ Clinical nurse specialist, serve as consultant for registered nurses working in
the maternal and neonatal department. They are trained also to provide care to
neonatal ICU, they could be a child educator, lactation consultant (they teaches
or assist women as she learns about breast feeding)
, • Family centered care- meaning maternal and neonatal care are responsible of providing
comprehensive care that includes ethical and legal care to the pregnant woman, her fetus and
her family member.
• Family- a group consist of 2 or more persons who possibly live together in the same house hold
and they perform certain interrelated social task and they share emotional bond.
Family Structures
- Consist of different structures that change the life cycle of the family. Because of a lot of factors
of the baby, divorcement, separation or work.
Different Type of Family Structures
1. Nuclear Family- the traditional family structure, it is made up with a wife, husband and a
child/children. Family that can provide support and affection for the family members.
2. Extended Family- also called multi-generational family these include the nuclear family and
other family members such as grandparents, aunts, uncles, cousins and grandchildren. The most
common problem is financial stability, sometimes the family's income maybe stretch to
accommodate more people.
3. Broken Family- is one that includes unhealthy or severed relationships within the family unit.
4. Step Family- also called a blended family, two separate family joined as one as a result of
remarriage. Usual problem are conflicts and rivalries developed in these type of family especially
the children exposing in the new parenting method.
5. Communal Family- they choose to live together does not consider related or married together
usually in church. They are related in social and belief factors.
6. Gay or Lesbian Family- it may be same-sex family. Usually these couples choose to include
children in their family either they adopt or come from surrogate mothers. Or in lesbian come
from artificial insemination. Or the children came from the recent union or marriage.
7. Foster Family- provides custody or guardianship for children whose parents are dead or unable
to look after them. The foster parents are responsible to send them to school and all the needs of
the whole family.
8. Adoptive Family- families of all types can become an adoptive family, families adopt children for
various reason one they are unable to have children of their own, or second families prefer adopt
their own foster child. Or they adopt their foster children because their parents because they are
unable to care and they are willing to have their children to be adoptive. Sometimes adoptive
child are from their biological siblings or relatives.
Nursing Process
A- Assessment (involves continually collecting data to identify patient actual and potentially health
needs) (Data can be collected through: Health History, Physical Examination, Review of Pertinent
Laboratory Results and Medical Intervention) (A maternal & neonatal should include the assessment
of the pregnant woman, family and the baby)
D- Diagnosis (develop diagnosis after assessment of the patient, family and the neonate) (when
making a diagnosis make sure that the patient is appropriate for the prenatal, intrapartum and
postpartum period)
P- Planning (the health care plan serves as a communication tool among health care team members,
by doing this ensures the continuity of care) (make sure to include the family when planning the care
plan) (for the care plan be successful the care plan should be realistic, tailor the approach to each
patient's problem) (avoid big terms when making care plan best use the quantitative terms rather
vague terms)
I- Implementation (it encompasses all nursing intervention directed from solving the patient's problem
as well as patient's health care needs) (after implementing the care plan continue to monitor the
patient in order to engage effectiveness of the intervention) (if it is not effective, change and adjust
them, ask the patient conditions changes)
E- Evaluation/Outcome (it is a step of the nursing process evaluate how well the patient met her
care plan goals) (outcome evaluate the care plan as well as the effectiveness) (to evaluate effectively
you must establish criteria to measuring the goals and the outcome of the plan this will allow changes
and reevaluations as the needs of the patient's arises or family and this will accurately reflect the
patient and family's current needs) (the care plan must be in current need of the patient, family and
the neonate)
,Focus of the Reproductive System
Conception in Fetal Development
• The development of the functioning human being starts with the fertilization of the human egg
or ovum, it undergoes complex cell division, differentiation and organization.
• The development begins with union of the spermatozoon and the ovum, when they're united it
is called conception to form the composite cell containing the chromosomes coming from the
mother and the father, these composite cell called the zygote it will keep dividing.
• Groups of differentiated cells will organized to complete structures developing organs that
functions as a integrating unit.
Female Reproductive System
External Female Genitalia
○ The structures that form the female external genitalia are termed the vulva (from the Latin
word for “covering”)
Labia Minora
▪ Posterior to the mons veneris spread two hairless folds of connective tissue, the labia
minora.
▪ It consist of 2 parts the upper lamella and the lower lamella they will join to form he
prepuce, it is a wood-like covering for the clitoris
▪ It contains sebaceous glands, it secretes lubricant and also acts as bacteria site.
Contains a lot of vessels and nerve endings, both labia are responsive to stimulation.
During stimulation they swell
Labia Majora
▪ Also known as Big Lips, these are large two raised folds of adipose tissue composed
of loose connective tissue and positioned lateral to the labia minora.
▪ They are found broadening the vulva on either side, it extends from Mons Pubis to
the Perineum.
▪ The outer surface of the labia is covered with pubic hair, whereas the inner surface
are pink and moist
Mons Veneris
▪ The mons veneris is a pad of adipose tissue located over the symphysis pubis, the
pubic bone joint.
▪ It is covered by a triangle of coarse, curly hairs. The purpose of the Mons Veneris is
to protect the junction of the pubic bone from trauma
Mons Pubis
▪ It is a tissue mound made up of fat located directly anterior to the pubic bones. This
mound of tissue is prominent in females and is usually covered in pubic hair.
▪ The mons pubis functions as a source of cushioning during sexual intercourse.
Clitoris
▪ Is a small (aprx. 1-2cm) protuberant organ just beneath the arch of the Mons Pubis, it
contains a rectal tissue, it contains cavernous spaces and contains sensory corpuscle
and it is usually stimulated.
Vestibule
▪ It is an oval area which is anterior to the clitoris, it is a flat opening to the bladder and
uterus arise it is the opening of the vagina originate.
Skene's Gland
▪ They are found both sides of the ureteral opening.
▪ Secretions from both of these glands help to lubricate the external genitalia during
coitus.
Bartholin's Gland
▪ Can be found laterally and posteriorly on either each side of the vaginal orifice.
, Urethral Meatus
▪ Slit-like opening, it is where the urine leaves.
▪ Urine leaves your body through a hole at the end of your urethra.
Vaginal Orifice
▪ Located center of the vestibule, can be covered partially by the Hymen.
▪ It is used to birth a baby and for sexual intercourse.
Hymen
▪ is a tough but elastic semicircle of tissue that covers the opening to the vagina in
childhood. It is often torn during the time of first sexual intercourse.
Fourchette
▪ It is the joining of two labia minora and the labia majora and this is where you cut to
perform episiotomy during childbirth to enlarge the vaginal opening.
Perineum
▪ Is made up of muscles, blood vessels, fascia nerves and lymphatic. Found between
the mons pubis, the buttocks and the thigh.
▪ Located posterior to the fourchette, it is easily stretched during childbirth to allow for
enlargement of the vagina and passage of the fetal head.
Vulvar Blood Supply.
▪ The blood supply of the external genitalia is mainly from the pudendal artery and a
portion of the inferior rectus artery
▪ This ready blood supply also contributes to the rapid healing of any tears in the area
after childbirth.
Vulvar Nerve Supply
▪ The anterior portion of the vulva derives its nerve supply from the ilioinguinal and
genitofemoral nerves (L1 level).
▪ The posterior portions of the vulva and vagina are supplied by the pudendal nerve
(S3 level).
▪ Such a rich nerve supply makes the area extremely sensitive to touch, pressure, pain,
and temperature.
Internal Female Genitalia
▪ Main function is to reproduction
Vagina
▪ Is a highly muscular tube located between the urethra and the rectum.
▪ The vaginal wall has three tissue layers such as epithelial tissue, loose connective
tissue and muscle tissue
▪ Main function of the vagina is to serve as the birth canal during child birth,
accommodate the penis during intercourse, channel blood discharge from the uterus
during menstruation
▪ The upper, lower and middle vaginal section has different blood supplies they are
supplies by the uterine arteries of the inferior vesicle arteries.
Cervix
▪ Located between the uterus and it is the lowest portion of the uterus, projects in the
upper part of the vagina.
▪ Cervix has two opening, the end of the cervix opens to the vagina called the external
os, and the end that opens to the uterus called internal os,
□ When doing internal examination, poking the finger inside the first thing you go
inside it is the external os, when going in further it is the internal os.
▪ The cervix is sealed with thick mucus, preventing the entry of the sperm. Except few
days around the ovulation where in the mucus plug becomes thinner.
▪ Childbirth permanently alters the cervix because when a women did not deliver a
Friday, 26 August 2022 8:02 pm
Main Goal of Maternal Neonatal Nursing
• To provide comprehensive family oriented or family centered care.
Scope of Maternal Neonatal Nursing
• Nurses need to focus the care of the patient or the pregnant woman, also the husband, family,
and the baby.
3 Pregnancy Periods
1. Antepartum- also known as "prenatal period" refers to the period of conception to the onset of
labor. From onset to the confirmation of pregnancy to the mother's uterine contraction until labor
2. Intrapartum- period that stems from the onset of contraction that causes cervical dealation to
the first 1-4 hours after the birth of neonate or the placenta. Cervix will not dilate if the uterus
does not contract. If cervix does not contract cesarian is needed. If the woman gives birth to the
fetus and the neonate, nurses should deliver the placenta as well.
3. Postpartum- this refers to the 6 weeks after the labor of the neonate and the placenta. And also
called as puerperium it is also the stage ends when the reproductive organ returns to its non-
pregnant stage.
Neonatal Rules and Functions
• In the United States or other foreign countries, the have a specialization unlike in the Philippines
not having a variety of specialization. These specialization such as:
○ Practical nurse- support patients by providing basic nursing and medical care, provide
routine care for sick, injured, or disabled patients and coordinate with and assist physicians
and registered nurses
○ Traveling nurse- take temporary nursing positions in high-need areas. They jump into
hospitals, clinics, and other facilities, giving patients across the country quality care.
○ Surgical nurse- assist the operating room staff during surgery and provide care to patients
recovering from a procedure. Their primary responsibilities are to provide patient care,
assist the operating room staff, and document observations and procedures.
○ Maternal and neonatal nursing- these nurses involved, assumes a lot of roles these
include caregiver or care provider, care educator (teaching the mother breast feeding), and
could be a counsellor (advice the mother what to do of the baby and what to expect from
the baby, and also can teach the mother about the reproductive health such as family
planning/health)
▪ Nurses involve in maternal and neonatal nursing are:
□ Registered nurse, is graduate of a credited nursing program and has
successfully passed the licensure exam for nurses or board certified nurses. If
RN want to work in a maternal and neonatal department, nurses should go under
extensive care training or extensive onsite training and also a competency check
as well as ongoing education.
□ Certified nurse midwife, to be a certified nurse midwife, nurse should be
registered, achieved advance education at a master's level and passing the
exam. Certified nurse midwife works independently, they are able to care of low
risk of obstetric patient throughout the pregnancy.
□ Nurse practitioner, also called a NP, also a registered with advance education
at the master's level at the same time obtain the certification. NP performs at an
expanded advance practice role performs such as health history, physical
assessment and manages care also can prescribe treatment with the
consultation of the physician. NP could practice as a woman's health, family,
neonate and pediatric patients. Serve as a primary health care provider
□ Clinical nurse specialist, serve as consultant for registered nurses working in
the maternal and neonatal department. They are trained also to provide care to
neonatal ICU, they could be a child educator, lactation consultant (they teaches
or assist women as she learns about breast feeding)
, • Family centered care- meaning maternal and neonatal care are responsible of providing
comprehensive care that includes ethical and legal care to the pregnant woman, her fetus and
her family member.
• Family- a group consist of 2 or more persons who possibly live together in the same house hold
and they perform certain interrelated social task and they share emotional bond.
Family Structures
- Consist of different structures that change the life cycle of the family. Because of a lot of factors
of the baby, divorcement, separation or work.
Different Type of Family Structures
1. Nuclear Family- the traditional family structure, it is made up with a wife, husband and a
child/children. Family that can provide support and affection for the family members.
2. Extended Family- also called multi-generational family these include the nuclear family and
other family members such as grandparents, aunts, uncles, cousins and grandchildren. The most
common problem is financial stability, sometimes the family's income maybe stretch to
accommodate more people.
3. Broken Family- is one that includes unhealthy or severed relationships within the family unit.
4. Step Family- also called a blended family, two separate family joined as one as a result of
remarriage. Usual problem are conflicts and rivalries developed in these type of family especially
the children exposing in the new parenting method.
5. Communal Family- they choose to live together does not consider related or married together
usually in church. They are related in social and belief factors.
6. Gay or Lesbian Family- it may be same-sex family. Usually these couples choose to include
children in their family either they adopt or come from surrogate mothers. Or in lesbian come
from artificial insemination. Or the children came from the recent union or marriage.
7. Foster Family- provides custody or guardianship for children whose parents are dead or unable
to look after them. The foster parents are responsible to send them to school and all the needs of
the whole family.
8. Adoptive Family- families of all types can become an adoptive family, families adopt children for
various reason one they are unable to have children of their own, or second families prefer adopt
their own foster child. Or they adopt their foster children because their parents because they are
unable to care and they are willing to have their children to be adoptive. Sometimes adoptive
child are from their biological siblings or relatives.
Nursing Process
A- Assessment (involves continually collecting data to identify patient actual and potentially health
needs) (Data can be collected through: Health History, Physical Examination, Review of Pertinent
Laboratory Results and Medical Intervention) (A maternal & neonatal should include the assessment
of the pregnant woman, family and the baby)
D- Diagnosis (develop diagnosis after assessment of the patient, family and the neonate) (when
making a diagnosis make sure that the patient is appropriate for the prenatal, intrapartum and
postpartum period)
P- Planning (the health care plan serves as a communication tool among health care team members,
by doing this ensures the continuity of care) (make sure to include the family when planning the care
plan) (for the care plan be successful the care plan should be realistic, tailor the approach to each
patient's problem) (avoid big terms when making care plan best use the quantitative terms rather
vague terms)
I- Implementation (it encompasses all nursing intervention directed from solving the patient's problem
as well as patient's health care needs) (after implementing the care plan continue to monitor the
patient in order to engage effectiveness of the intervention) (if it is not effective, change and adjust
them, ask the patient conditions changes)
E- Evaluation/Outcome (it is a step of the nursing process evaluate how well the patient met her
care plan goals) (outcome evaluate the care plan as well as the effectiveness) (to evaluate effectively
you must establish criteria to measuring the goals and the outcome of the plan this will allow changes
and reevaluations as the needs of the patient's arises or family and this will accurately reflect the
patient and family's current needs) (the care plan must be in current need of the patient, family and
the neonate)
,Focus of the Reproductive System
Conception in Fetal Development
• The development of the functioning human being starts with the fertilization of the human egg
or ovum, it undergoes complex cell division, differentiation and organization.
• The development begins with union of the spermatozoon and the ovum, when they're united it
is called conception to form the composite cell containing the chromosomes coming from the
mother and the father, these composite cell called the zygote it will keep dividing.
• Groups of differentiated cells will organized to complete structures developing organs that
functions as a integrating unit.
Female Reproductive System
External Female Genitalia
○ The structures that form the female external genitalia are termed the vulva (from the Latin
word for “covering”)
Labia Minora
▪ Posterior to the mons veneris spread two hairless folds of connective tissue, the labia
minora.
▪ It consist of 2 parts the upper lamella and the lower lamella they will join to form he
prepuce, it is a wood-like covering for the clitoris
▪ It contains sebaceous glands, it secretes lubricant and also acts as bacteria site.
Contains a lot of vessels and nerve endings, both labia are responsive to stimulation.
During stimulation they swell
Labia Majora
▪ Also known as Big Lips, these are large two raised folds of adipose tissue composed
of loose connective tissue and positioned lateral to the labia minora.
▪ They are found broadening the vulva on either side, it extends from Mons Pubis to
the Perineum.
▪ The outer surface of the labia is covered with pubic hair, whereas the inner surface
are pink and moist
Mons Veneris
▪ The mons veneris is a pad of adipose tissue located over the symphysis pubis, the
pubic bone joint.
▪ It is covered by a triangle of coarse, curly hairs. The purpose of the Mons Veneris is
to protect the junction of the pubic bone from trauma
Mons Pubis
▪ It is a tissue mound made up of fat located directly anterior to the pubic bones. This
mound of tissue is prominent in females and is usually covered in pubic hair.
▪ The mons pubis functions as a source of cushioning during sexual intercourse.
Clitoris
▪ Is a small (aprx. 1-2cm) protuberant organ just beneath the arch of the Mons Pubis, it
contains a rectal tissue, it contains cavernous spaces and contains sensory corpuscle
and it is usually stimulated.
Vestibule
▪ It is an oval area which is anterior to the clitoris, it is a flat opening to the bladder and
uterus arise it is the opening of the vagina originate.
Skene's Gland
▪ They are found both sides of the ureteral opening.
▪ Secretions from both of these glands help to lubricate the external genitalia during
coitus.
Bartholin's Gland
▪ Can be found laterally and posteriorly on either each side of the vaginal orifice.
, Urethral Meatus
▪ Slit-like opening, it is where the urine leaves.
▪ Urine leaves your body through a hole at the end of your urethra.
Vaginal Orifice
▪ Located center of the vestibule, can be covered partially by the Hymen.
▪ It is used to birth a baby and for sexual intercourse.
Hymen
▪ is a tough but elastic semicircle of tissue that covers the opening to the vagina in
childhood. It is often torn during the time of first sexual intercourse.
Fourchette
▪ It is the joining of two labia minora and the labia majora and this is where you cut to
perform episiotomy during childbirth to enlarge the vaginal opening.
Perineum
▪ Is made up of muscles, blood vessels, fascia nerves and lymphatic. Found between
the mons pubis, the buttocks and the thigh.
▪ Located posterior to the fourchette, it is easily stretched during childbirth to allow for
enlargement of the vagina and passage of the fetal head.
Vulvar Blood Supply.
▪ The blood supply of the external genitalia is mainly from the pudendal artery and a
portion of the inferior rectus artery
▪ This ready blood supply also contributes to the rapid healing of any tears in the area
after childbirth.
Vulvar Nerve Supply
▪ The anterior portion of the vulva derives its nerve supply from the ilioinguinal and
genitofemoral nerves (L1 level).
▪ The posterior portions of the vulva and vagina are supplied by the pudendal nerve
(S3 level).
▪ Such a rich nerve supply makes the area extremely sensitive to touch, pressure, pain,
and temperature.
Internal Female Genitalia
▪ Main function is to reproduction
Vagina
▪ Is a highly muscular tube located between the urethra and the rectum.
▪ The vaginal wall has three tissue layers such as epithelial tissue, loose connective
tissue and muscle tissue
▪ Main function of the vagina is to serve as the birth canal during child birth,
accommodate the penis during intercourse, channel blood discharge from the uterus
during menstruation
▪ The upper, lower and middle vaginal section has different blood supplies they are
supplies by the uterine arteries of the inferior vesicle arteries.
Cervix
▪ Located between the uterus and it is the lowest portion of the uterus, projects in the
upper part of the vagina.
▪ Cervix has two opening, the end of the cervix opens to the vagina called the external
os, and the end that opens to the uterus called internal os,
□ When doing internal examination, poking the finger inside the first thing you go
inside it is the external os, when going in further it is the internal os.
▪ The cervix is sealed with thick mucus, preventing the entry of the sperm. Except few
days around the ovulation where in the mucus plug becomes thinner.
▪ Childbirth permanently alters the cervix because when a women did not deliver a
