Study Notes on Nursing Roles and Maternal, Newborn, and Child Health Nursing
Advanced Nursing Roles
Nurse Practitioner (NP)
- Education Required: Must have a Doctor of Nursing Practice (DNP) or a master's degree.
- Roles and Responsibilities: Provides ambulatory care services.
- Specialization: The area of specialization determines the specific title (e.g., Family NP, Pediatric NP).
Clinical Nurse Specialist (CNS)
- Education Required: Must have a master's degree.
- Specialized Knowledge: Possesses specific competence in a defined area of practice.
- Typical Settings: Mainly found in mother-baby units, pediatric units, and Intensive Care Units (ICUs), assisting staff in delivering evidence-based care.
Certified Nurse Midwife (CNM)
- Education Required: Educated in nursing and midwifery and must be certified by the American College of Nurse-Midwives (ACNM).
- Responsibilities: Manages care independently for women at low risk for complications during pregnancy and childbirth, as well as care for healthy newborns.
Nurse Researcher
- Education Required: Typically holds a doctoral degree, usually a PhD.
- Leadership Role: Plays a key role in advancing evidence-based practices that improve patient outcomes and the quality of patient care.
- Research Setting: Often found in university settings, focusing on creating new research.
- Definition: Informed consent is necessary before touching a person; doing so without consent is considered battery.
- Criteria for Informed Consent: Consent is not informed unless the patient or guardian understands the procedures, treatments, rationale, benefits of each alternative treatment, and any associated risks.
- Consent in Minors: Minors can consent independently if they are parents or pregnant. In most states, a pregnant teen is considered emancipated. Afterward, nurses must document the teaching and learning outcomes in the patient’s record.
Chapter 1: Contemporary Maternal, Newborn, & Child Health Nursing
Types of Families
- Nuclear Family: Comprises a mother, father, and children.
- Childfree Family: A couple without children.
- Extended Family: Involves additional relatives such as grandparents, aunts, and uncles.
- Extended Kin Network Family: Two nuclear families living near each other providing assistance to one another.
- Single Parent Family: A single mother or father with their children.
- Single Mother by Choice Family: A woman who decides to raise a child without a partner.
- Blended or Reconstituted Nuclear Family: A family composed of a mother, father, and stepchildren.
- Binuclear Family: A co-parenting arrangement with two households.
- Heterosexual Cohabitating Family: A couple that lives together without being married, potentially with children.
- Gay and Lesbian Families: Same-sex couples raising children together.
- Transfamilies: Include families with transgender parents or children.
Cultural Influences Affecting the Family
- Combination of Knowledge, Belief, and Behavior: Teaching highlights the importance of including grandparents and cultural health practices in the teaching plan.
- Signs of Illness in Newborns: Signs that require immediate follow-up.
- Safety Alert: The use of herbs and natural products raises many health issues, hence individuals interested in using herbs should consult a physician before usage.
Chapter 2: Culture and the Family
Chapter 3: Genetic & Genomic Influences in Maternal, Newborn, & Child Health
Inheritance Patterns
- Monosomic: Refers to a missing chromosome; associated with Turner Syndrome.
- Trisomic: Refers to an extra chromosome; associated with Down Syndrome.
- Autosomal Dominant: Inheritance of only one gene can cause the disorder.
- Autosomal Recessive: Takes two alleles to cause the disorder; both parents must carry the allele.
- Example: Heterozygous individuals may have one recessive allele and one dominant allele, such as in Achondroplasia (dwarfism), where an abnormal growth allele causes short stature.
- Neurofibromatosis (NF1): Demonstrates variable expression including café-au-lait spots and benign tumors.
Genetic Conditions
- Sickle Cell Disease: Characterized by abnormal hemoglobin leading to vaso-occlusive events and chronic anemia.
- X-Linked Conditions: These conditions are carried on the X chromosome, leading to different inheritance patterns in males (XY) and females (XX).
- Hemophilia A: A bleeding disorder due to deficient factor VIII clotting activity.
Contraception
- Fertility Awareness-Based (FAB) Methods: Natural family planning methods where the fertile window is monitored. Typically occurs during days 8-13 of a 26 to 32-day cycle, requiring barrier methods during this window.
- Other Situational Contraceptives: Include withdrawal and douching. However, these methods are ineffective in preventing pregnancy.
- Spermicides: Nonoxynol-9 (N9) acts rapidly and must dissolve before providing effective protection.
- Barrier Methods: Consist of male and female condoms, diaphragms, cervical caps, and sponges, all of which may provide varying levels of pregnancy and STI protection.
- Long-Acting Reversible Contraception (LARC): Includes methods like IUDs and hormonal implants (e.g., Nexplanon) that offer extended duration of contraceptive efficacy.
- Breast Exam: Monthly exams are crucial for early detection of masses. Clinical breast exams are recommended every 1-3 years for women aged 25-39, annually after 40.
- Domestic Violence: Statistics indicate that approximately 1 in 5 women experience severe physical violence in their lifetime.
- Cycle of Violence: Consists of three phases: tension-building, acute battering incident, and the tranquil/loving phase.
Chapter 5: Common Gynecologic Problems
Vaginal Infections
- Bacterial Vaginosis: Results from bacterial overgrowth seen with symptoms such as thin, watery white or grayish discharge with a foul odor. Treatment typically involves antibiotics like Flagyl or Clindamycin.
- Vulvovaginal Candidiasis (Yeast Infection): Characterized by thick, curdy discharge and severe itching, often treated with antifungal agents. Malepartners usually do not require treatment.
- STIs: Include various conditions such as chlamydia, gonorrhea, and trichomoniasis, each with specific diagnostic and treatment protocols.
Chapter 6: Reproductive Physiology, Conception, & Fetal Development
Events in Fertilization
- Moment of Fertilization: The nuclei of the sperm and ova unite to produce a diploid zygote, determining sex.
- Pre-Embryonic Stage: Rapid cellular multiplication occurs, leading to implantation.
- Implantation Timeline: Takes place between 7-10 days after fertilization, when the embryonic membranes such as chorion and amnion begin to form.
- Umbilical Cord: Connects the embryo to the placental circulation and protects blood vessels.
Functions of the Placenta
- Nutrient Exchange: Facilitates metabolic functions and nutrient exchange between the mother and the fetus, along with hormone production critical during pregnancy.
Chapter 7: Physical & Psychological Changes of Pregnancy
Signs of Pregnancy
- Presumptive Changes: Symptoms indicating possible pregnancy include amenorrhea, nausea and vomiting, excessive fatigue, and urinary frequency.
- Probable Changes: Include signs confirmed by a healthcare provider such as softening of the cervix or Chadwick's sign.
Diagnostic (Positive) Changes
- Include the detection of fetal heartbeat, fetal movement, and visualization through ultrasound, which confirm pregnancy.
Chapter 8: Antepartum Nursing Assessment
Assessment Guide
- Initial Prenatal Assessment: Examine physical signs, including pigmentation changes (linea nigra), breast changes (darkening of the nipple), and abdominal changes (enlargement of the uterus).
- Screening Tests: Necessary tests include CBC, urinalysis, Rh typing, and screening for gestational diabetes, with specific guidelines for when these tests should be performed.
High-Risk Factors in Pregnancy
- Factors influencing pregnancy risks include maternal age (under 16 or over 35), multiparity, history of genetic disorders, and lack of antenatal care, which can affect both maternal and fetal health outcomes.