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  • 1. WHAT YOU SHOULD KNOW BEFORE THE PNLE JULY  2012  PNLE  PEARLS  OF  SUCCESS    PART  2:  MATERNAL  AND  CHILD  HEALTH  NURSING    A.  Signs  of  Pregnancy   AMNIOCENTESIS   ü Possible   after   the   14th       week.  Ø Presumptive  Signs   Aspiration  of  amniotic   ü The  client  should  be   • Amenorrhea  –  absence  of  menses   fluid  for  examination.   supine  during  the   • Nausea  and  Vomiting     procedure   • Increased  breast  sensitivity  and  breast  changes     ü Afterward,  she  should  be   • Increased  pigmentation     placed  on  her  left  side.   • Constipation   ü The  patient  MUST   • Frequent  urination   EMPTY  THE  BLADDER.   • Quickening   ü Vital  signs  are  assessed   • Abdominal  enlargement   every  15  minutes.     ü CALL  THE  PHYSICIAN  Ø Probable  Signs   FOR  THE  FF:  Chills,  fever,   • Uterine  enlargement   leakage  of  fluid,  decrease   fetal  movement  or   • Hegar’s  Sign   uterine  contractions.   • Goodell’s  Sign     • Chadwick’s  Sign   X-­‐RAY   ü Done   only   2   weeks   • Ballottement   before  EDC   • Braxton  Hick’s  contraction     • Positive  Pregnancy  Test   ALPHA-­‐FETOPROTEIN       ü Test   done   between   16     SCREENING   and   18   weeks  Ø Positive  Signs     gestation.   • Fetal  Heart  Tone   Maternal  serum   ü Normal   Value:   10   • X-­‐ray  or  Ultrasound  of  fetus   screens  for  open   mg/dl     • Palpable  fetal  movements   neural  tube  defects.   ü LOW:  Chromosomal     defects       ü HIGH:  Neural  tube  B.  Maternal  and  Fetal  Diagnostic  Test   defects.       CHORIONIC  VILLI     ü Performed   between   the   LECITHIN  -­‐   ü Done  through   SAMPLING   8th   –   11th   weeks   of   SPHINGOMYELIN  – AMNIOCENTESIS     gestation.   (L/S  RATIO)   ü Perform  at  35-­‐36  weeks   Removal  of  a  small   ü Laboratory   results   are     ü Position:  Supine.     piece  of  Chorionic  villi     obtained  in  1  -­‐  7  days     Uses  amniotic  fluid  to   ü Place  folded  towel  on  the       ascertain  fetal  lung   right  buttocks.     Disadvantages:       maturity   ü Needle  insertion  in  a  20-­‐   • Risk  of  Abortion               22  gauge  spinal  needle,   • Infection                       withdrawing  amniotic   • Embryo-­‐fetal/placental   fluid.   damage           ü NORMAL  L/S  RATIO     • Spontaneous  abortion             (lecithin/sphingomyelin) • Premature  rupture  of  the   :  2:1  =  normal  fetal  lung   membranes     maturity  ratio         ü SHOULD  REFRAIN  FROM   LEOPOLDS   ü Palpate with warm hands. SEXUAL  INTERCOURSE   MANEUVER   ü Use palms, not fingertips. AND  PHYSICAL  ACTIVITY     ü Woman should lie in FOR  48  hours.     supine position with knees ü A  small  amount  of   flexed slightly. spotting  is  normal  for  the   ü Done with empty bladder. 1st  24-­‐48  hours.   1st:  Presenting  Part     2nd:  Fetal  Back   ULTRASOUND   ü Done   18-­‐40   weeks   for   3rd:  Engagement     fetal  abnormalities.   4th:  Descent   Use  of  sound  and   ü Best   Test   for   ECTOPIC   returning  echo   PREGNANCY     patterns  to  identify   ü Full  Bladder     intrabody  structures.   ü Use   to   locate   the   precise       location   of   the   fetus   and       its   membrane   during   CVS     and  amniocentesis    POSSIBLE  TOPICS  ON  MATERNAL  AND  CHILD  HEALTH  NURSING  FOR  THE  UPCOMING  JULY  2012  PNLE  *Patterned  on  the  previous  board  exams  from  December  2006  –  December  2011…  the  purpose  of  this  note  is  to  GUIDE  students  on  the  possible  topics  that  might  be  part  of  the  upcoming  July  2012  PNLE  
  • 2. WHAT YOU SHOULD KNOW BEFORE THE PNLE JULY  2012  PNLE  PEARLS  OF  SUCCESS    PART  2:  MATERNAL  AND  CHILD  HEALTH  NURSING    C.  Discomfort  of  Pregnancy   D.    Electronic  Monitoring       Changes   Reason   Health  Teachings   Non-­‐Stress  Test  Nausea  and   Increased  HCG   • Dry  crackers  30  min.   Ø Accelerations in heart rate accompany normal fetalVomiting   before  arising   movement.                           • Small,  frequent,  low  fat   Ø Observation   of   fetal   heart   rate   related   to   fetal   meals     movement.     • Avoid  anti-­‐emetics.   FHT:  Doppler:  8  weeks  Heartburn   Increased   • Pats  of  butter  before                        Fetoscope:  16  weeks  /  4  months     progesterone   meals                        Stethoscope:  20  weeks  /  5months   which  decrease   Ø Teach mother to count 2-3 times daily, 30-60 minutes • Avoid  fried,  fatty  foods   gastric  motility   each time, should feel 5-6 movements per counting • Sips  of  milk  at  frequent   causing   time   intervals.   esophageal   PREPARATION:   • Small,  frequent  meals   v Patient should eat snacks. reflux.   taken  slowly.   v Position:  Semi-­‐Fowlers  or  left  lateral  positions     • Bends  at  the  knees,  not   RESULTS:   at  the  waist   1.        Reactive  (Normal):  indicates  a  fetal  fetus  Constipation   Due  to   • Increased  fluids  and   § Greater than 15 beats per minute- occur with displacement   roughage  in  the  diet.   fetal movement in a 10 or 20 minute period. of  the  stomach   • Regular  elimination   2. Non-­‐Reactive  (Abnormal):     and  intestines;   time.   § No  fetal  movement  occurs     iron   • Increase  exercise   § The   doctor   will   order   an   Oxytocin   Test   supplements   • Avoid  enemas,  harsh   AFTER  the  patient  has  non-­‐reactive  test.   laxatives  and  mineral     oil.     Contraction  Stress  Test  (CST)    Hemorrhoids   Pressure  of   • Warm  sitz  bathing   Ø Response of the fetus to induced uterine contractions. growing  fetus,   • High  fiber  diet  and                PREPARATION:   Increase   increase  fluid.   v Woman in semi-Fowler’s or side-lying position. venous   • Sit  on  soft  pillow     v Monitor for post-test labor onset. pressure   v Indication: 28 weeks pregnancy high risk motherUrinary   Increase  blood   • Sleep  on  the  side  at   v Contraindicated: Pre Term LaborFrequency   supply  to  the   night.     kidney/   • Limit  fluid  intake   INTERPRETATION:   Pressure  of   during  evening   Early  Deceleration:  Head  Compression   enlarged   • Bladder  training   Late  Deceleration:  Utero-­‐placental  Insufficiency   uterus  in  the   Variable  Deceleration:  Cord  Compression   3rd  Tri    Backache   From   • Back  exercise  (pelvic   E.  Signs  of  Labor   exaggerated   rock)   1. Lightening  –  setting  of  fetal  head  into  pelvic  brim   lumbo-­‐sacral   • Wear  low-­‐heeled  shoes.   ± occurs  approximately  10-­‐14  days  before  labor  .   curving  during   • Avoid  heavy  lifting   ± mother  may  experience:  shooting   leg   pains  from   pregnancy.   the   increased   pressure   on   the   sciatic   nerve,  Leg  Cramps   Increase   • Frequent  rest  with  feet   increased   amounts   of   vaginal   discharge   and   pressure  of   elevated   urinary  frequency  from  pressure  on  the  bladder   gravid  fetus,   • Regular  exercise  like   2. Increased  in  Level  of  Activity     low  calcium   walking   3. Braxton  Hicks  Contractions   • Increase  milk  intake   4. Ripening  of  the  cervix    Ankle  Edema   From  venous   5. Weight  Loss     • Elevate  legs  at  least   stasis   6. Rupture  BOW   twice  a  day.   7. Effacement  and  Dilation   • Sleep  on  left  side    Fatigue   Due  to   • Get  regular  exercise   F.  Length  of  Labor   hormonal   • Sleep  as  much  as     changes   needed.   Stages  of  Labor   Primigravida   Multigravida   • Avoid  stimulants.  Breast   Increase   First  Stage   12  and  ½  hour   7hours  and  20   • Wear  well  fitted  bra  Tenderness   estrogen  and   minutes   • Warm  compress   progesterone   Second  Stage   80  minutes   30  minutes   level   Third  Stage   10  minute   10  minutes     TOTAL   14  hours   8  hours        POSSIBLE  TOPICS  ON  MATERNAL  AND  CHILD  HEALTH  NURSING  FOR  THE  UPCOMING  JULY  2012  PNLE  *Patterned  on  the  previous  board  exams  from  December  2006  –  December  2011…  the  purpose  of  this  note  is  to  GUIDE  students  on  the  possible  topics  that  might  be  part  of  the  upcoming  July  2012  PNLE  
  • 3. WHAT YOU SHOULD KNOW BEFORE THE PNLE JULY  2012  PNLE  PEARLS  OF  SUCCESS    PART  2:  MATERNAL  AND  CHILD  HEALTH  NURSING    G.    Nursing  Care  During  Labor   4th  Stage   • Promote  parent-­‐infant  bonding         • Assess   maternal   vital   signs,   fundal  1st  Stage   Latent   The  period  of   height,   lochia   and   bladder     • Monitor   frequency,   intensity,   and   immediate   distention  Onset  of  true  labor   patterns  of  uterine  contractions   recovery  and    pain  until   • Monitor  fetal  status  during  labor  by   observation  after  complete  cervical   monitoring  fetal  heart  rate   delivery  of  the  dilation  and   • Assess  bloody  show  (pink  or  blood   placenta  effacement   streaked   mucus),   perineal   bulging,     membrane  status     • Monitor  vital  signs   H.  Micronutrient  Supplementation   • Assess   client’s   ability   to   cope   with     contractions   Vitamin  A  Supplementation   • Provide  emotional  support       Target   Prep.   Dose   Duration   Active   Pregnant   100,000   1  cap   Start  from  the  4th  month   • Finds  assessment  techniques   Women   IU   2x  a   of  pregnancy  until   between  contractions   week   delivery   • Assists  with  frequent  position   Post   200,000   1  cap   One  dose  only  within  4   change   Partum   IU   weeks  after  delivery   • Applies  counter  pressure  to   Women   sacrococcygeal  area     • Encourages  and  praises   Iron  Supplementation   • Keeps  woman  aware  of  progress     • Check  bladder  and  encourages   Target   Prep.   Dose  /  Duration   Remarks   voiding   Pregnant   Coated   1  tab/day  for  6       Women   Tab.   months  or  180  days     Transitional   contains   during  pregnancy     • Woman  experiences  intense   60  mg   period     A  dose  of   discomfort  accompanied  by  nausea   elemental   OR   800  mcg   and  vomiting   iron  with   2  tab/day  if  prenatal   folic  acid  is   • Woman  may  also  experience  a   400  mg   consultation  are   still  safe  to   feeling  of  loss  of  control,  anxiety,   folic  acid   done  during  the   pregnant   panic  or  irritability   2nd/3rd  trimester   woman     Lactating   Coated   1  tab  /  day  for  3    2nd  Stage   • Prep  client  for  delivery   Women   Tab.   months  or  90  days     contains   • Immediate   assessment   of   the  From  complete   newborn   60  mg  dilation  and   elemental    effacement  to   iron  with    delivery  of  the   400  mg  fetus   folic  acid      3rd  Stage   • Assess  umbilical  cord  for  3  vessels       (2  arteries,  1  vein)   I.  Pregnancy  Complications  From  delivery  of     • Assess  placenta  for  intactness  the  fetus  to   ABORTION   • The   fundus   should   be   midline   at   or  delivery  of  the   Ø Threatened, the continuation of the pregnancy is in 2  cm.  below  the  umbilicus  placenta   doubt • Don’t   hurry   the   expulsion   of   the   Ø Inevitable, loss  that  can  be  prevented   placenta,  just  watch  for  the  signs  of   Ø Complete, products of conception are totally expelled placental  separation:   Ø Incomplete, some fragments are retained inside the Lengthening of the cord uterine cavity Sudden gush of blood Ø Missed, retention of the products of conception after Change of shape of the uterus fetal death • Palpate  the  uterus  to  determine   Ø Habitual, 3 spontaneous abortions occurring degree  of  contraction.  If  relaxed,   successively massage  gently  and  apply  ice  cap     • Inspect  for  lacerations     • The  fundus  should  descend     approximately  1-­‐2  cm  every  24     hours    POSSIBLE  TOPICS  ON  MATERNAL  AND  CHILD  HEALTH  NURSING  FOR  THE  UPCOMING  JULY  2012  PNLE  *Patterned  on  the  previous  board  exams  from  December  2006  –  December  2011…  the  purpose  of  this  note  is  to  GUIDE  students  on  the  possible  topics  that  might  be  part  of  the  upcoming  July  2012  PNLE  
  • 4. WHAT YOU SHOULD KNOW BEFORE THE PNLE JULY  2012  PNLE  PEARLS  OF  SUCCESS    PART  2:  MATERNAL  AND  CHILD  HEALTH  NURSING    GESTATIONAL  DIABETES   Ø Painful  vaginal  bleeding   Ø Diabetes  during  pregnancy.   Ø Board-­‐like  rigidity  of  abdomen   Ø 3-­‐P’s:  Polyuria,  Polydipsia  and  Polyphagia   Ø The  goal  of  management  in  abruption  placentae  is  to   Ø Because  insulin  does  not  pass  into  the  breast   control  the  hemorrhage  and  deliver  the  fetus  as  soon   milk,  breastfeeding  is  not  contraindicated  for  the   as  possible mother  with  diabetes     Ø Maternal  Complications:  PIH,  Placental  disorders,     stillbirth,  macrosomia,  neural  tube  defects.   J.  Care  of  the  Newborn   Ø Screen  clients  between  the  24th  and  28th  weeks  of     pregnancy   Ø Suction  the  mouth  first  before  the  nose   Ø If   a   pregnant   diabetic   is   in   labor,   her   blood   glucose   Ø Delay   initial   bath   until   temp.   has   stabilized   for   at   least  6  hours.   should  be  monitored  hourly.   Ø APGAR   scoring   is   taken   twice:   initially   @   1   minute,   Ø Treatment:  Insulin  therapy  (don’t  use  Oral   and  then  @  5  minutes  after  birth   hypoglycemics,  they  are  Teratogenic)   Ø Give  prophylactic  eye  treatment  (credes  ointment)     against   gonorrheal   conjunctivitis   or   ophthalmia     neonatorum  within  the  first  hour  after  delivery.  PREGNANCY  INDUCED  HYPERTENTION  (PIH)   Ø Prevent   hemorrhage   ,   give   0.5mg   (preterm)   to   1   Ø Blood  pressure  over  140/90,  or  increase  of  30  mm   mg   (full   term)   Vit.   K   or   Aquamephyton  is  injected   systolic,  15  mm  diastolic  over  pre-­‐pregnancy  level   IM   in   the   NB’s   vastus   lateralis   (lateral   anterior   Ø Pre  Eclampsia:  HPN,  Protenuria  ,  Edema   thigh)muscle   (face&hand)   Ø The  cord  is  clamped  and  cut  approximately  within   Ø Eclampsia:  HPN,  Protenuria,  Edema  plus  Fever  and   30  seconds  after  birth  when  cord  pulsation  stop   Epigastric  pain.   Ø The  cord  stump  usually  dries  and  fall  within  7  to   Ø During  pregnancy,  blurred  vision  may  be  a  danger   10  days   sign  of  preeclampsia  or  eclampsia.     Ø Monitor  VS,  I&O    and  breath  sound     Ø ECLAMPSIA:  to  prevent  aspiration,  turn  the   K.  Newborn  Assessment   woman  on  her  side  to  allow  secretions  to  drain     from  her  mouth.     CIRCULATORY   DUCTUS  ARTERIOSUS  constrict   Ø SEVERE  PRECLAMPSIA:  Lateral  recumbent   STATUS   with  establishment  of  respiratory   position   function,  remains  open  cause  PDA   Ø DOC:  Magnesium  Sulfate   (patent  ductus  arteriosus)   Ø Magnesium  Sulfate  Toxicity:   FORAMEN  OVALE  closes   • Decrease  urine  output   functionally  as  respirations   • Decrease  RR   established,  remains  open  cause   • Absence  of  reflexes   ASD  (atrial  septal  defect)   Ø Antidote:  CALCIUM  GLUCONATE   RESPIRATORY   RR  =  30-­‐80  breaths  /minutes  with     STATUS   short  periods  of  apnea  (<  15     seconds)    PLACENTA  PREVIA   RENAL  SYSTEM   Later  pattern  is  6-­‐10  voidings/   Ø Improperly  implanted  placenta  in  the  lower  uterine   day  –  indicative  of  sufficient  fluid   segment  near  or  over  the  internal  cervical  os   intake   Ø Total:  the  internal  os  is  entirely  covered  by  the   DIGESTIVE   IMMATURE  CARDIAC  SPHINCTER  –   placenta  when  cervix  is  fully  dilated   SYSTEM   may  allow  reflux  of  food,  burped,   Ø Marginal:  only  an  edge  of  the  placenta  extends  to   REGURGITATE-­‐placed  NB  right  side   the  internal  os   after  feeding   Ø Low-­‐lying  placenta:  implanted  in  the  lower  uterine   FIRST  STOOL  is  MECONIUM   segment  but  does  not  reach  the  os     - Black,  tarry  residue  from   Ø Painless  Bleeding   lower  intestine   Ø #1  Assessment  -­‐  Monitor  maternal  vital  signs,   - Usually  passed  within  12-­‐24   FHR,  and  fetal  activity   hours  after  birth   Ø Best  Position:  Left  Lateral     TRANSITIONAL  STOOLS  thin,     brownish  green  in  color      After  3  days  MILK  STOOLS:  ABRUPTIO  PLACENTA   a. MILK  STOOLS  for  BF  infant  –   Ø Premature  separation  of  the  placenta  from  the   loose  and  golden  yellow   uterine  wall  after  the  20th  week  of  gestation  and   b. MILK  STOOLS  for   before  the  fetus  is  delivered.   FORMULATED  FED-­‐  formed   Ø Abruptio  placentae  is  associated  with  conditions   and  pale  yellow   characterized  by  poor  uteroplacental  circulation,   HEPATIC   Pathologic  Jaundice,  yellowish   such  as  hypertension,  smoking  and  alcohol  or  cocaine   discoloration  immediately  after   abuse.  POSSIBLE  TOPICS  ON  MATERNAL  AND  CHILD  HEALTH  NURSING  FOR  THE  UPCOMING  JULY  2012  PNLE  *Patterned  on  the  previous  board  exams  from  December  2006  –  December  2011…  the  purpose  of  this  note  is  to  GUIDE  students  on  the  possible  topics  that  might  be  part  of  the  upcoming  July  2012  PNLE  
  • 5. WHAT YOU SHOULD KNOW BEFORE THE PNLE JULY  2012  PNLE  PEARLS  OF  SUCCESS    PART  2:  MATERNAL  AND  CHILD  HEALTH  NURSING     birth   Ä Play:  Parallel   Physiologic  Jaundice,  yellowish   Ä Child  learns  to  be  independent  and   discoloration  2-­‐3  days  after  birth   make  decisions  for  self   (normal)   Ä Favorite  word:  “I”,  “no”  TEMPERATURE   Axillary  temperature:  96.8  to  99F   Preschooler   Initiative  vs.  Guilt   Newborn  can’t  shiver  as  an  adult   (3-­‐6y/o)   Ä Ability  to  try  new  things   does  to  release  heat   Ä Bogus  playmates/imaginary   Cold  stress  increases  o2   Ä Fears:  dark,  being  left  alone,  large   consumption  –  may  lead  to   animals,  ghosts,  body  mutilation,   metabolic  acidosis  and  respiratory   pain  &  objects   distress   School-­‐Age   Industry  vs.  Inferiority     (6-­‐12  y/o)   Ä Makes  things  w/  others  IMMUNOLOGIC   NB  develops  own  antibodies  during   Ä Strives  to  achieve  success   1st  3  months  but  at  risk  for   Ä Child  learns  how  to  do  things  well   infection  during  the  first  6  weeks   Adolescent   Identity  vs.  Role  Confusion     (13-­‐20  y/o)   Ä Determines  own  sense  of  self     Ä Development  of  who,  what  &  where  L.  Freud’s  Theory   they  are  going     Ä Adjusting  to  a  new  body  and  seeking     Freud’s  Psychoanalytic  Theory   emancipation  from  parents,  choosing   Psychosexual  Development   a  vocation  &  determining  a  value   Infants   Oral  Stage   system   (birth  to  1   Ä Child  explores  the  world  by  using   Young   Intimacy  vs.  Isolation   year)   mouth,  especially  the  tongue   Adult   Ä Person  makes  commitments  to  one   Ä Baby  finds  pleasure  in  the  mouth   another   Toddler   Anal  Stage   Ä Isolation  and  self  absorption  if   (1-­‐3  y/o)   Ä Child  learns  to  control  urination  and   unsuccessful   defecation  (18  months)   Ä Independent  from  parents,  possible   Ä Toilet  training   marriage  /  partnership   Preschooler   Phallic  Stage   Ä Major  goals  to  accomplish  in  career   (3-­‐6y/o)   Ä The  genitals  are  the  pleasure  of  the   and  family   child     Middle   Generativity  vs.  Stagnation   Ä Oedipus  and  Electra  Complex   Adult   Ä Physical  Changes:  graying  hair,   Ä Masturbation  is  common  during  this   wrinkling  skin,  pain  &  muscle  aches,   phase  and    may  also  show   menopausal  period   exhibitionism   Ä Mature  adult  is  concerned  w/   School-­‐Age   Latent  Stage  /  Latency  Period   establishing  &  guiding  the  new   (6-­‐12  y/o)   Ä Child’s  personality  development   generation  or  else  feels  personal   appears  to  be  nonactive  or  dormant   impoverishment   Adolescent   Genital  Stage   Ä Become  “Pillars  of  the  Community”   (13-­‐20  y/o)   Ä Adolescent  develops  sexual  maturity   Older  Adult   Integrity  vs.  Despair   and  learns  to  establish  satisfactory   Ä Achieves  sense  of  acceptance  of  own   relationships  w/  the  opposite  sex   life     Ä Adapts  to  triumphs  &  disappointment     w/  a  certain  ego  integrity      M.  Erikson’s  Theory       N.  Physical  Growth  and  Development         Erikson’s  Theory  of     Psychosocial  Development   Mo. Gross Fine Motor Development Infants   Trust  vs.  Mistrust   Yr. Motor Development (birth  to  1   Ä Fear:  strangers,  anxiety,  loud  noises,   Ä Largely reflex Ä The eyes is fixated on year)   falls,  sudden  movements  in  the   0-1 the person environment   Ä Keeps hands fisted Ä Play:  Solitary   Ä Holds head up when Ä Development of social Ä Learning  confidence  or  learning  to   prone smile 2 Ä Responds to familiar love   voice   Ä Holds head & chest Ä The baby knows how Toddler   Autonmy  vs.  Shame   up when prone to cry (1-­‐3  y/o)   Ä Psychosocial  Theme:  “hold  on  or  let   3 Ä Laughs aloud go”   Ä Babbles and “coos”POSSIBLE  TOPICS  ON  MATERNAL  AND  CHILD  HEALTH  NURSING  FOR  THE  UPCOMING  JULY  2012  PNLE  *Patterned  on  the  previous  board  exams  from  December  2006  –  December  2011…  the  purpose  of  this  note  is  to  GUIDE  students  on  the  possible  topics  that  might  be  part  of  the  upcoming  July  2012  PNLE  
  • 6. WHAT YOU SHOULD KNOW BEFORE THE PNLE JULY  2012  PNLE  PEARLS  OF  SUCCESS    PART  2:  MATERNAL  AND  CHILD  HEALTH  NURSING     Ä Grasp Ä Can raise head and Ä Stepping chest Ä Tonic neck Ä Reach out to object 4 Ä Reflexes are fading Ä Turns front to back Ä Roll over 5 Ä Has head lag when Ä Hold blocks at each pulled upright hand Ä Turns both ways Ä Doubles birth weight st Ä Moro reflex fading Ä Eruption of 1 tooth Ä Sits w/ minimal support 6 Ä Uses palmar grasp Ä Reaches out in Ä “dada”, “mama” anticipation of being Ä Sleeps on prone picked up position 7 Ä Sits unsteadily Ä Uses fingers to hold objects Ä Transfers objects hand to hand Ä Sits securely w/o Ä Sits alone steadily for support an indefinite period 8 Ä Recognizes strangers Ä Peek-a-boo (to test memory) Ä Creeps or crawls Ä Can hold own bottle Ä Starts to crawl 9 Ä Understands simple gestures Ä Pulls self to standing Ä From crawling to standing 10 Ä Responds when called by his/her name Ä From crawling to Ä Walks with assistance 11 standing Ä Stands alone Ä Triples birth weight st 12 Ä Some infants take 1 Ä Can say 2 syllable step words Ä Can walk w/ help  POSSIBLE  TOPICS  ON  MATERNAL  AND  CHILD  HEALTH  NURSING  FOR  THE  UPCOMING  JULY  2012  PNLE  *Patterned  on  the  previous  board  exams  from  December  2006  –  December  2011…  the  purpose  of  this  note  is  to  GUIDE  students  on  the  possible  topics  that  might  be  part  of  the  upcoming  July  2012  PNLE  

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