The document discusses the scope and standards of maternal and child health practices in the Philippines. It covers preconception care, care during pregnancy and postpartum, as well as care of infants and children. It also discusses legal and ethical considerations including informed consent, confidentiality, and clinical decision making. The document then provides information on family planning programs and methods in the Philippines, including contraception options. It concludes by covering genetic inheritance patterns such as autosomal dominant and recessive disorders.
The document discusses the scope and standards of maternal and child health practices in the Philippines. It covers preconception care, care during pregnancy and postpartum, as well as care of infants and children. It also discusses legal and ethical considerations including informed consent, confidentiality, and clinical decision making. The document then provides information on family planning programs and methods in the Philippines, including contraception options. It concludes by covering genetic inheritance patterns such as autosomal dominant and recessive disorders.
The document discusses the scope and standards of maternal and child health practices in the Philippines. It covers preconception care, care during pregnancy and postpartum, as well as care of infants and children. It also discusses legal and ethical considerations including informed consent, confidentiality, and clinical decision making. The document then provides information on family planning programs and methods in the Philippines, including contraception options. It concludes by covering genetic inheritance patterns such as autosomal dominant and recessive disorders.
The document discusses the scope and standards of maternal and child health practices in the Philippines. It covers preconception care, care during pregnancy and postpartum, as well as care of infants and children. It also discusses legal and ethical considerations including informed consent, confidentiality, and clinical decision making. The document then provides information on family planning programs and methods in the Philippines, including contraception options. It concludes by covering genetic inheritance patterns such as autosomal dominant and recessive disorders.
Scope and Standards of maternal and child health o Understand processes and resources
Practices in the Philippines available to assist them in ethical
decision making Scope of maternal and child health nursing o Be aware of the changing legal and Practices health care policy issues to be Preconceptional health care considered during ethical decision Care of woman during 3 trimesters of making. pregnancy and puerperium (sometimes Some ethical principles related to patients termed 4th trimester of pregnancy) care includes: Care of infants during the perinatal period Autonomy: the right to self-determination (beginning at 20 wks of pregnancy to 4 wks. Respect for others: Principle that all After birth) persons are equally valued Care of children from birth to young Beneficience: Obligation to do good adulthood Nonmaleficence: Obligation to do no Care in setting as diverse as a birthing room, harm a pediatric intensive care unit or the home. Justice: Principle of equal treatment of Legal considerations of maternal-child practices others or that others be treated fairly Nurses are legally responsible for protecting Fidelity: Faithfullness or obligation to keep the rights of clients including confidentiality promises and are accountable for the quality of the Veracity: obligation to tell the truth individual nursing care and that of other Utility: The greatest good for the individual health care team members. or an action that is valued Ethical consideration of maternal-child practices Note: a key way for nurses to respect Conception issues especially those related to autonomy is though support of surrogate motherhood. childbearing women, including Abortion adolescent women. Fetal rights versus rights of the mother Resuscitation (for how long should it be Family Planning continued?) Difficulty maintaining confidentiality of Remember: The total risk of birth control are much less records when there are multiple caregivers than the total risks of a pregnancy. Ethical and Social Issues in Perinatal Nursing Abortion The family planning program Substance; when it involves a pregnant EO 199: created the PFPP (Phil. Family woman, it can cause fetal injury and thus has planning program) legal and ethical implications. Goal is to provide universal access to family Informed consent; has 4 key components; planning information and services whenever disclosure, comprehension, competency, and wherever these are needed. and voluntariness. It occurs prior to initiation Family planning program enables couples and of the procedure or specific care and individuals to: addresses the legal and ethical requirement Decide freely and responsibly of informing the client about the procedure. Have information and means to do so The nurse’s responsibilities related to informed Have access to a full range of natural and consent includes; artificial methods of planning pregnancy Ensuring the informed consent form is Modern methods of family planning. completed with signatures from the Safe, effective, non-abortifacient and legal client (or parents or legal guardians if the methods, whether natural or artificial, that client is a child) are registered with FDA to plan pregnancy. Serving as a witness to the signature DOH states “family planning can reduce process maternal mortality” Determining whether the client or Reproductive Health (RH) – the state of parents or legal guardians understand complete physical, mental, and social well- what they are signing by asking them being. pertinent questions. Sexual health- state of physical, mental and The roles of nurse in clinical and ethical social well-being in relation to sexuality decision making. Reproductive health care – the access to a full Recognizing that nurses have both range of methods, facilities, services and responsibilities and rights to care for the supplies that contribute to reproductive health whole person, we believe that nurses and well-being. have a responsibility to: Reproductive health rights – rights of individuals o Be aware of personal values and how and couples to decide freely and responsibly they relate to professional practices whether or not to have children; the number, o Develop a basic knowledge of spacing and timing of their children. ethical principles and concepts Family Planning Genetic Inheritance of a disease Increase Education Empower Women Autosomal Dominant Disorders Improve infant health o Either a person has two unhealthy genes Improve maternal health (homozygous dominant or is heterozygous), Decrease HIV/Aids with the gene causing the disease. Save the environment o Common findings usually present in a family: Support partnership 1. One of the parents of a child with the End hunger and poverty disorder also will have the disorder (a vertical transmission picture) CONTRACEPTION 2. The sex of the affected individual is Types: unimportant 1. Natural contraception 3. There is usually a history of the disorder in 2. Mechanical Contraception other family members 3. Hormonal contraception 4. Surgical contraception Autosomal Recessive Disorders o Such diseases do not occur unless 2 genes for the disease are present (Rh incompatibility) o A recessively inherited disease is present in the family if: 1. Both parents of a child with the disorder are clinically free of the disorder 2. Sex of the affected individual is unimportant in terms of inheritance 3. The family history for the disorder is (-) that is, no one can identify anyone else who had it (horizontal transmission pattern) 4. A known common ancestor between the parents sometimes exists.
X-linked Dominant Inheritance
o Transmitted only by the female sex chromosome. Introduction to Genetics o Family characteristics seen with this type of inheritance: Genome- the complete copy of genetic material 1. All individuals with the gene are affected in an organism (abt. 50K-100K) (the gene is dominant) - A normal genome is abbreviated as 46XX or 2. All female children of affected men are 46XY. If a chromosomal aberration exists, it is affected; all male children of affected listed after the sex chromosome patter, men are unaffected. (down syndrome- extra chromosome 21, 3. It appears in every generation abbreviated as 47XX21 or 47XY21) 4. All children of homozygous affected Phenotype- the person’s outward appearance women are affected. Genotype – the person’s actual gene composition. X-Linked Recessive Inheritance Homozygous – a person who has two like genes o Because males have only one X for a trait on two like chromosomes chromosome, the disease will be manifested Heterozygous – if the genes differ (a healthy in any male children who receive the gene from the mother and an unhealthy gene affected gene from their mother from the father, or vice versa) o A family genogram will reveal: Inherited or genetic disorder – can be passed 1. Only males in the family wil have the from one generation to the next disorder. Karyotype – is the schematic arrangement of the 2. A history of girls dying at birth for chromosomes within a cell to demonstrate their unknown reasons often exists (females numbers and morphology who had the affected gene on both X Hereditary- derived from parents chromosomes) Familial- transmitted in the gametes through 3. Sons of an affected man are unaffected generations 4. The parents of affected children do not Congenital – present at birth (not always have the disorder genetically determined (e.g. congenital Multifactorial (Polygenic) Inheritance syphilis, toxoplasmosis) o Appears to occur from multiple gene combinations possibly combined with environmental factors o A family history, for instance, may reveal no set patter. Screening Tests o Some of these conditions have a 1. Carrier screening predisposition to occur more frequently in o Blood test that tries to determine if either one sex (cleft palate occurs more often in parent carries a genetic change for inherited girls than boys), but they can occur in either disorders that could be passed on to the sex. baby. can be performed on a saliva sample, best time to be done before getting RISK FACTORS FOR GENETIC DISORDERS pregnant, but can be done during pregnancy as well Factors that increase your risk of having a baby 2. Prenatal Genetic Screens with a genetic disorder include: o Series of first and second trimester screens o Family history of a genetic disorder that use blood samples from the mother as o Prior child with a genetic disorder well as ultrasounds to check the baby’s risk of o One parent has a chromosomal abnormality having certain common genetic disorders. o Advanced maternal age (35 or older) Examples include Down syndrome and o Advanced paternal age (40 or older) certain birth defects, such as spina bafida. o Multiple miscarriages or prior stillbirths 3. Noninvasive Prenatal Testing (NITP) or cell-free o It is important to know that some birth DNA screening defects, developmental delays, and/or o Blood test that checks DNA from the illnesses can be caused by prenatal placenta that is found in the mother’s blood. exposure to drugs, alcohol, or other This screens for the most common environmental factors. chromosome abnormalities, such as down syndrome and trisomy 18, and is most Types of Disorders that can be seen during pregnancy commonly used in high-risk pregnancies. 4. Diagnostic tests Single gene disorder o Performed during pregnancy to detect if o Occur when a change in one gene causes a certain genetic disorders are present in the disease. Examples include cystic fibrosis, baby, such as cystic fibrosis or down sickle cell anemia, and hemophilia. syndrome. Diagnostic tests are generally safe Chromosomal abnormalities procedures when performed by an o Occur when there are missing or extra experienced physician. chromosomes or pieces of chromosomes. Down syndrome, the most common Routine diagnostic tests include: chromosomal abnormality, is caused by an Chorionic villus sampling – tests a sample of extra chromosome #21. Chromosome tissue taken from the placenta in the first abnormalities can be inherited from a parent trimester. or they can happen by chance. Amniocentesis – tests a sample of the amniotic Multifactorial or complex disorders fluid taken from the womb in the second o Is caused by a combination of genetic trimester. predispositions and environmental factors, which makes it harder to predict who may Genetic Counseling be at risk. Examples include heart disease, cleft lip or cleft palate, and spina bifida. If you are pregnant or planning a pregnancy, Teratogenic Disorder you may be referred to a genetic counselor to: o Occurs when the baby is exposed to Assess your personal risk of having a baby with a substances during pregnancy that causes genetic disorder abnormalities, otherwise known as Review your testing options “teratogens”. Babies are very sensitive in the Coordinate genetic screenings and diagnostic first trimester, when all of the organs are tests and interpret the results developing. Teratogens include alcohol, Provide emotional support and educationa; drugs, lead, high levels of radiation exposure, resources for you and your family. and certain medications, infections and toxic Help you make informed decisions about your substances pregnancy and your baby’s treatment, and prepare for appropriate medical care Testing for Genetic Disorder 1. Screening tests – check the risk of your baby Treatment for fetal genetic Disorders having certain genetic disorders 2. Diagnostic Tests – can detect if certain genetic Treatment depends on the genetic disorder and disorders are actually present in the baby. the individual pregnancy. In general, if your baby Note: Screening and diagnostic tests are is diagnosed with a genetic disorder during optional. They are available to all women, even pregnancy your treatment will include: those who do not have any known risk factors. Specialized care from a maternal-fetal medicine physician Individualized care based on the genetic via the birth canal but fails to fully emerge disorder, your pregnancy, and your family’s out. This could be because of small references. obstructions, or the mother being tired and Treatment options ranging from medical therapy exhausted and hence being unable to push during pregnancy, such as fetal interventions, to the baby out. surgery immediately after birth o In these cases, the doctor makes use of A multidisciplinary, collaborative healthcare specially created tongs which resembles team, including genetic counselors, imaging forceps, and insert them slowly into the birth specialists, fetal specialists, fetal and neonatal canal. These are then used to gently grab surgeons as needed, and neonatologists and the baby’s head and guide it outwards pediatricians experienced in the treatment of through the canal. children with genetic disorders. 5. Vacuum Extraction Support services for you and your family. o Similar to the forceps delivery method, this delivery technique is used in the case of a Most common Types of Childbirth options vaginal birth. For example, if the baby is on its way out but has stopped moving further 1. Vaginal delivery down the canal, the vacuum end has a soft o Baby is born through the birth canal of a cup which is placed in the top of the baby’s woman’s body, the delivery is termed as a head. Vacuum is created so that the cup vaginal delivery. It may or may not be holds the head, and the baby is gently assigned with epidurals or pain-relieving guided outwards through the canal. medications. The exact time of birth cannot 6. Vaginal Birth After Caesarean (VBAC) be predicted in such a case, but most o Most of the time, after woman has had a vaginal births tend to happen once 40 weeks caesarean delivery, her chances of having a of pregnancy have been completed. vaginal delivery after that are pretty much 2. Natural Childbirths nullified. But VBAC technique are making it o This is one of the type of birth that is steadily possible to have successful vaginal deliveries. gaining popularity. In this method, there are no medical procedures or invasive therapies involved, and the process takes place in the most natural manner possible. This is mostly a personal choice and the mother needs to be committed throughout the way. o Various exercises and positions are taken into account while carrying out delivery in natural ways. A midwife usually stays with the mother to ensure the delivery is successful and the mother is in good spirits. The delivery can take place at the hospital or even at home, with all preparations done beforehand. o Water birthing or pool birthing with the help of upthurst (buoyancy) pressure of the water can alleviate labour pain in this procedure. Water birthing is the most natural and painless way of bringing new life to the world. 3. Caesarean Section o Things don’t always go according to plan. A mother might want to undertake vaginal delivery but if complications arise, caesarian delivery is an option. o In this method, baby is delivered by opening up the abdomen of the mother and surgically opening the uterus to remove the baby. The name is derived from the Latin word “caedare” which means “to cut”. Hence, this type of cur is called a C-section. o Parameters which make it necessary to undertake C-section are the presence of twins or triplets, breech or transverse presentation, or a very large baby. 4. Forceps delivery o This is a rather peculiar type of delivery method and is required in certain cases of vaginal birth. This is an assistance to the usual vaginal delivery when the baby is on its ways