I.

Web Assignment:

A. Healthy People 2020's overarching goals are to:

 Attain high-quality, longer lives free of preventable disease, disability, injury and premature death; 
 Achieve health equity, eliminate disparities and improve the health of all groups; 
 Create social and physical environments that promote good health for all; and
 Promote quality of life, healthy development and healthy behaviors across all life stages. 

Maternal and Child Health-Related Topic Areas of Healthy People 2020

Access to Health Services

Goal: Improve access to comprehensive, quality health care services.
 Increase the proportion of insured persons with coverage for clinical preventive services
 Increase the proportion of persons who have a specific source of ongoing care

Environmental Health
Goal: Promote health for all through a healthy environment.
Toxics and Waste

 Reduce blood lead levels in children

 Increase the proportion of the Nation’s elementary, middle, and high schools that have official school policies and engage in
practices that promote a healthy and safe physical school environment
 (Developmental) Increase the proportion of persons living in pre-1978 housing that has been tested for the presence of lead-
based paint or related hazards
 Reduce the number of U.S. homes that are found to have lead-based paint or related hazards
Infrastructure and Surveillance
  Reduce exposure to selected environmental chemicals in the population, as measured by blood and urine concentrations of
the substances or their metabolites*

Family Planning
Goal: Improve pregnancy planning and spacing, and prevent unintended pregnancy.
 Increase the proportion of pregnancies that are intended
 Reduce the proportion of females experiencing pregnancy despite use of a reversible contraceptive method
 Increase the proportion of publicly funded family planning clinics that offer the full-range of FDA-approved methods of
contraception, including emergency contraception, onsite
 (Developmental) Increase the proportion of health insurance plans that cover contraceptive supplies and services
 Reduce the proportion of pregnancies conceived within 18 months of a previous birth
 Increase the proportion of females or their partners at risk of unintended pregnancy who used contraception at most recent
sexual intercourse
 Increase the proportion of sexually active persons who received reproductive health services
 Reduce pregnancy rates among adolescent females
 Increase the proportion of adolescents aged 17 years and under who have never had sexual intercourse
 Increase the proportion of sexually active persons aged 15 to 19 years who use condoms to both effectively prevent
pregnancy and provide barrier protection against disease
 Increase the proportion of sexually active persons aged 15 to 19 years who use condoms and hormonal or intrauterine
contraception to both effectively prevent pregnancy and provide barrier protection against disease
 Increase the proportion of adolescents who received formal instruction on reproductive health topics before they were 18
years old
 Increase the proportion of adolescents who talked to a parent or guardian about reproductive health topics before they were
18 years old
 Increase the number of states that set the income eligibility level for Medicaid-covered family planning services to at least the
same level used to determine eligibility for Medicaid-covered, pregnancy-related care
 Increase the proportion of females in need of publicly supported contraceptive services and supplies who receive those
services and supplies
Education and Community Based Programs
Goal: Increase the quality, availability, and effectiveness of educational and community-based programs designed to prevent
disease and injury, improve health, and enhance quality of life.
 (Developmental) Increase the proportion of preschool Early Head Start and Head Start programs that provide health education
to prevent health problems in the following areas: unintentional injury; violence; tobacco use and addiction; alcohol and drug
use, unhealthy dietary patterns; and inadequate physical activity, dental health, and safety
 Increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education to
prevent health problems in the following areas: unintentional injury; violence; suicide; tobacco use and addiction; alcohol or
other drug use; unintended pregnancy, HIV/AIDS, and STD infection; unhealthy dietary patterns; and inadequate physical
activity
 Increase the proportion of elementary, middle, and senior high schools that have health education goals or objectives that
address the knowledge and skills articulated in the National Health Education Standards (high school, middle, elementary)
 Increase the proportion of elementary, middle, and senior high schools that provide school health education to promote
personal health and wellness in the following areas: hand washing or hand hygiene; oral health; growth and development; sun
safety and skin cancer prevention; benefits of rest and sleep; ways to prevent vision and hearing loss; and the importance of
health screenings and checkups
 Increase the proportion of the Nation’s elementary, middle, and senior high schools that have a full-time registered school
nurse-to-student ratio of at least 1:750 
 Increase the proportion of college and university students who receive information from their institution on each of the priority
health risk behavior areas (all priority areas; unintentional injury; violence; suicide; tobacco use and addiction; alcohol and
other drug use; unintended pregnancy, HIV/AIDS, and STD infection; unhealthy dietary patterns; and inadequate physical
activity)

Maternal, Infant and Child Health

Goal: Improve the health and well-being of women, infants, children and families.
Morbidity and Mortality
  Reduce the rate of fetal and infant deaths
 Reduce the 1-year mortality rate for infants with Down syndrome
 Reduce the rate of child deaths
 Reduce the rate of adolescent and young adult deaths
 Reduce the rate of maternal mortality
 Reduce maternal illness and complications due to pregnancy (complications during hospitalized labor and delivery)
 Reduce cesarean births among low-risk women
 Reduce low birth weight (LBW) and very low birth weight (VLBW)
 Reduce preterm births
Pregnancy Health and Behaviors

 Increase the proportion of pregnant women who receive early and adequate prenatal care
 Increase abstinence from alcohol, cigarettes, and illicit drugs among pregnant women
 (Developmental) Increase the proportion of pregnant women who attend a series of prepared childbirth classes
 (Developmental) Increase the proportion of mothers who achieve a recommended weight gain during their pregnancies
Preconception Health and Behaviors

 Increase the proportion of women of childbearing potential with intake of at least 400 μg of folic acid from fortified foods or
dietary supplements
 Reduce the proportion of women of childbearing potential who have low red blood cell folate concentrations
 Increase the proportion of women delivering a live birth who received preconception care services and practiced key
recommended preconception health behaviors
 Reduce the proportion of persons aged 18 to 44 years who have impaired fecundity (i.e., a physical barrier preventing
pregnancy or carrying a pregnancy to term)
Postpartum Health and Behavior

 (Developmental) Reduce postpartum relapse of smoking among women who quit smoking during pregnancy
 (Developmental) Increase the proportion of women giving birth who attend a postpartum care visit with a health worker
Infant Care

 Increase the proportion of infants who are put to sleep on their backs
 Increase the proportion of infants who are breastfed
  Increase the proportion of employers that have worksite lactation support programs
 Reduce the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life
 Increase the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their
babies
Disability and Other Impairments

 Reduce the occurrence of fetal alcohol syndrome (FAS)

 Reduce the proportion of children diagnosed with a disorder through newborn blood spot screening who experience
developmental delay requiring special education services
 Reduce the proportion of children with cerebral palsy born as low birth weight infants (less than 2,500 grams)
 Reduce occurrence of neural tube defects
 Increase the proportion of young children with an Autism Spectrum Disorder (ASD) and other developmental delays who are
screened, evaluated, and enrolled in early intervention services in a timely manner
Health Services

 Increase the proportion of children, including those with special health care needs, who have access to a medical home
 Increase the proportion of children with special health care needs who receive their care in family-centered, comprehensive,
coordinated systems
 Increase appropriate newborn blood-spot screening and follow-up testing
 Increase the proportion of very low birth weight (VLBW) infants born at level III hospitals or subspecialty perinatal centers

Nutrition and Weight Status

Goal: Promote health and reduce chronic disease risk through the consumption of healthful diets and achievement and
maintenance of healthy body weights.
Healthier Food Access

 Increase the number of states with nutrition standards for foods and beverages provided to preschool-aged children in child
care
 Increase the proportion of schools that offer nutritious foods and beverages outside of school meals
Weight Status
  Reduce the proportion of children and adolescents who are considered obese
 (Developmental) Prevent inappropriate weight gain in youth and adults
Food Insecurity

 Eliminate very low food security among children

Food and Nutrient Consumption

 Increase the contribution of fruits to the diets of the population aged 2 years and older
 Increase the variety and contribution of vegetables to the diets of the population aged 2 years and older
 Increase the contribution of whole grains to the diets of the population aged 2 years and older
 Reduce consumption of calories from solid fats and added sugars in the population aged 2 years and older
 Reduce consumption of saturated fat in the population aged 2 years and older
 Reduce consumption of sodium in the population aged 2 years and older
 Increase consumption of calcium in the population aged 2 years and older
Iron Deficiency

 Reduce iron deficiency among young children and females of childbearing age
 Reduce iron deficiency among pregnant females

REFERENCE: https://www.ncsl.org/research/health/healthy-people-2020-and-maternal-and-child-health.aspx#nutrition

B.
PATIENT-CENTERED CARE
Definition: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated
care based on respect for patient’s preferences, values, and needs.
Knowledge Skills Attitudes
Integrate understanding of multiple Elicit patient values, preferences and Value seeing health care situations
dimensions of patient centered care: expressed needs as part of clinical “through patients’ eyes”
interview, implementation of care plan and Respect and encourage individual
 patient/family/community evaluation of care expression of patient values, preferences

preferences, values
 coordination and integration of care
 information, communication, and
education
 physical comfort and emotional
support
 involvement of family and friends
 transition and continuity
Describe how diverse cultural, ethnic and
social backgrounds function as sources of
patient, family, and community values
Demonstrate comprehensive
understanding of the concepts of pain and
suffering, including physiologic models of
pain and comfort.
Examine how the safety, quality and cost
effectiveness of health care can be
improved through the active involvement of patient preferences
patients and families
Examine common barriers to active
involvement of patients in their own health
care processes
Describe strategies to empower patients or safety and well-being, and self-care
families in all aspects of the health care management
process
Explore ethical and legal implications of
patient-centered care
Describe the limits and boundaries of
therapeutic patient-centered care
Communicate patient values, preferences
and expressed needs to other members of
health care team
Provide patient-centered care with
sensitivity and respect for the diversity of
human experience
Assess presence and extent of pain and
suffering
Assess levels of physical and emotional
comfort
Elicit expectations of patient & family for
relief of pain, discomfort, or suffering
Initiate effective treatments to relieve pain
and suffering in light of patient values,
preferences and expressed needs
Remove barriers to presence of families
and other designated surrogates based on
Assess level of patient’s decisional conflict
and provide access to resources
Engage patients or designated surrogates
in active partnerships that promote health,
Recognize the boundaries of therapeutic
relationships
Facilitate informed patient consent for care
and expressed needs
Value the patient’s expertise with own
health and symptoms
Seek learning opportunities with patients
who represent all aspects of human
diversity
Recognize personally held attitudes about
working with patients from different ethnic,
cultural and social backgrounds
Willingly support patient-centered care for
individuals and groups whose values differ
from own
Recognize personally held values and
beliefs about the management of pain or
suffering
Appreciate the role of the nurse in relief of
all types and sources of pain or suffering
Recognize that patient expectations
influence outcomes in management of pain
or suffering
Value active partnership with patients or
designated surrogates in planning,
implementation, and evaluation of care
Respect patient preferences for degree of
active engagement in care process
Respect patient’s right to access to
personal health records
Acknowledge the tension that may exist
between patient rights and the
organizational responsibility for
professional, ethical care

Discuss principles of effective
communication
Describe basic principles of consensus
building and conflict resolution
Examine nursing roles in assuring
coordination, integration, and continuity of
care
TEAMWORK AND COLLABORATION
Definition: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and
shared decision-making to achieve quality patient care.
Knowledge
Describe own strengths, limitations, and
values in functioning as a member of a
team
Describe scopes of practice and roles of
health care team members
Describe strategies for identifying and
managing overlaps in team member roles
and accountabilities
Recognize contributions of other
individuals and groups in helping
patient/family achieve health goals
Assess own level of communication skill in
encounters with patients and families
Participate in building consensus or
resolving conflict in the context of patient
care
Communicate care provided and needed
at each transition in care
Skills
Demonstrate awareness of own strengths
and limitations as a team member
Initiate plan for self-development as a
team member
Act with integrity, consistency and respect
for differing views
Function competently within own scope of
practice as a member of the health care
team
Assume role of team member or leader
based on the situation
Initiate requests for help when appropriate
to situation
Clarify roles and accountabilities under
Appreciate shared decision-making with
empowered patients and families, even
when conflicts occur
Value continuous improvement of own
communication and conflict resolution
skills
Attitudes
Acknowledge own potential to contribute to
effective team functioning
Appreciate importance of intra- and inter-
professional collaboration
Value the perspectives and expertise of all
health team members
Respect the centrality of the patient/family
as core members of any health care team
Respect the unique attributes that
members bring to a team, including
variations in professional orientations and
accountabilities

Analyze differences in communication
style preferences among patients and
families, nurses and other members of the
health team
Describe impact of own communication
style on others
Discuss effective strategies for
communicating and resolving conflict
Describe examples of the impact of team
functioning on safety and quality of care
Explain how authority gradients influence
teamwork and patient safety
Identify system barriers and facilitators of
effective team functioning
Examine strategies for improving systems
to support team functioning
EVIDENCE-BASED PRACTICE (EBP)
Definition: Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal
health care.
conditions of potential overlap in team
member functioning
Integrate the contributions of others who
play a role in helping patient/family achieve
health goals
Communicate with team members, Value teamwork and the relationships
adapting own style of communicating to upon which it is based
needs of the team and situation Value different styles of communication
Demonstrate commitment to team goals used by patients, families and health care
providers
Solicit input from other team members to
improve individual, as well as team, Contribute to resolution of conflict and
performance disagreement
Initiate actions to resolve conflict
Follow communication practices that Appreciate the risks associated with
minimize risks associated with handoffs handoffs among providers and across
among providers and across transitions in transitions in care
care
Assert own position/perspective in
discussions about patient care
Choose communication styles that
diminish the risks associated with authority
gradients among team members
Participate in designing systems that Value the influence of system solutions in
support effective teamwork achieving effective team functioning
Knowledge
Demonstrate knowledge of basic scientific
methods and processes
Describe EBP to include the components
of research evidence, clinical expertise
and patient/family values.
Differentiate clinical opinion from research
and evidence summaries
Describe reliable sources for locating
evidence reports and clinical practice
guidelines
Explain the role of evidence in determining
best clinical practice
Describe how the strength and relevance
of available evidence influences the choice
of interventions in provision of patient-
centered care
Discriminate between valid and invalid
reasons for modifying evidence-based
clinical practice based on clinical expertise
or patient/family preferences
Skills
Participate effectively in appropriate data
collection and other research activities
Adhere to Institutional Review Board (IRB)
guidelines
Base individualized care plan on patient
values, clinical expertise and evidence
Read original research and evidence
reports related to area of practice
Locate evidence reports related to clinical
practice topics and guidelines
Participate in structuring the work
environment to facilitate integration of new
evidence into standards of practice
Question rationale for routine approaches
to care that result in less-than-desired
outcomes or adverse events
Consult with clinical experts before
deciding to deviate from evidence-based
protocols
Attitudes
Appreciate strengths and weaknesses of
scientific bases for practice
Value the need for ethical conduct of
research and quality improvement
Value the concept of EBP as integral to
determining best clinical practice
Appreciate the importance of regularly
reading relevant professional journals
Value the need for continuous
improvement in clinical practice based on
new knowledge
Acknowledge own limitations in knowledge
and clinical expertise before determining
when to deviate from evidence-based best
practices

QUALITY IMPROVEMENT (QI)

Definition: Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to
continuously improve the quality and safety of health care systems.
Knowledge Skills Attitudes
Describe strategies for learning about the Seek information about outcomes of care Appreciate that continuous quality
outcomes of care in the setting in which for populations served in care setting improvement is an essential part of the
one is engaged in clinical practice daily work of all health professionals
Seek information about quality
improvement projects in the care setting
Recognize that nursing and other health Use tools (such as flow charts, cause- Value own and others’ contributions to
professions students are parts of systems effect diagrams) to make processes of outcomes of care in local care settings
of care and care processes that affect care explicit
outcomes for patients and families
Give examples of the tension between
professional autonomy and system
functioning
Explain the importance of variation and
measurement in assessing quality of care
Describe approaches for changing
processes of care
SAFETY
Definition: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
Knowledge
Examine human factors and other basic
safety design principles as well as
commonly used unsafe practices (such as, safety and quality
work-arounds and dangerous
abbreviations)
Describe the benefits and limitations of
selected safety-enhancing technologies
(such as, barcodes, Computer Provider
Order Entry, medication pumps, and
automatic alerts/alarms)
Discuss effective strategies to reduce
Participate in a root cause analysis of a
sentinel event
Use quality measures to understand Appreciate how unwanted variation affects
performance care
Use tools (such as control charts and run Value measurement and its role in good
charts) that are helpful for understanding patient care
variation
Identify gaps between local and best
practice
Design a small test of change in daily work Value local change (in individual practice
(using an experiential learning method or team practice on a unit) and its role in
such as Plan-Do-Study-Act) creating joy in work
Practice aligning the aims, measures and Appreciate the value of what individuals
changes involved in improving care and teams can to do to improve care
Use measures to evaluate the effect of
change
Skills Attitudes
Demonstrate effective use of technology Value the contributions of
and standardized practices that support standardization/reliability to safety
Appreciate the cognitive and physical limits
Demonstrate effective use of strategies to of human performance
reduce risk of harm to self or others
Use appropriate strategies to reduce
reliance on memory (such as, forcing
functions, checklists)
reliance on memory
Delineate general categories of errors and
hazards in care
Describe factors that create a culture of
safety (such as, open communication
strategies and organizational error
reporting systems)
Describe processes used in understanding
causes of error and allocation of
responsibility and accountability (such as,
root cause analysis and failure mode
effects analysis)
Discuss potential and actual impact of
national patient safety resources, initiatives
and regulations
Communicate observations or concerns
related to hazards and errors to patients,
families and the health care team
Use organizational error reporting systems
for near miss and error reporting
Participate appropriately in analyzing
errors and designing system
improvements
Engage in root cause analysis rather than
blaming when errors or near misses occur
Use national patient safety resources for
own professional development and to
focus attention on safety in care settings
Value own role in preventing errors
Value vigilance and monitoring (even of
own performance of care activities) by
patients, families, and other members of
the health care team
Value relationship between national safety
campaigns and implementation in local
practices and practice settings

INFORMATICS
Definition: Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.
Knowledge Skills Attitudes
Explain why information and technology Seek education about how information is Appreciate the necessity for all health
skills are essential for safe patient care managed in care settings before providing professionals to seek lifelong, continuous
care learning of information technology skills

Apply technology and information

management tools to support safe
processes of care
Identify essential information that must be Navigate the electronic health record Value technologies that support clinical
available in a common database to support Document and plan patient care in an decision-making, error prevention, and
patient care electronic health record care coordination
Contrast benefits and limitations of Protect confidentiality of protected health
Employ communication technologies to
different communication technologies and information in electronic health records
coordinate care for patients
their impact on safety and quality
Describe examples of how technology and Respond appropriately to clinical decision- Value nurses’ involvement in design,
information management are related to the making supports and alerts selection, implementation, and evaluation
 quality and safety of patient care Use information management tools to of information technologies to support
Recognize the time, effort, and skill monitor outcomes of care processes patient care
required for computers, databases and
Use high quality electronic sources of
other technologies to become reliable and
healthcare information
effective tools for patient care

REFERENCES
1
 Institute of Medicine. Health professions education: A bridge to quality. Washington DC: National Academies Press; 2003.
2
 Cronenwett, L., Sherwood, G., Barnsteiner J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D., Warren, J. (2007). Quality and safety
education for nurses. Nursing Outlook, 55(3)122-131.

Nursing Interventions
 Consider the family as a whole as well as its individual members.
 Encourage families to reach out to their community so that family members are not isolated from their community or from each
other.
Encourage family bonding through rooming-in in both maternal and child health hospital settings.
 Participate in early hospital discharge programs to reunite families as soon as possible.
 Encourage family and sibling visits in the hospital to promote family contacts.
Assess families for strengths as well as specific needs or challenges.
 Respect diversity in families as a unique quality of that family.
Encourage families to give care to a newborn or ill child.
 Include developmental stimulation in nursing care.
Share or initiate information on health planning with family members so that care is family oriented .
II. Written Assignments
A.  My philosophy is that nurses have a responsibility to the public to provide safe, holistic, patient-centered care. I must remember that
my patients are not room numbers or medical conditions, but individuals that require and deserve individualized attention and care.
Nurses should use clinical judgment to help meet the needs of the patient. As advocates, we should empower patients by encouraging
them to become active partners in their own care and engage in mutual goal-setting between ourselves and the patient. Nurses should
maintain patient confidentiality except when we have a duty to report as mandated by law. We must educate patients and their families
on diseases, treatments, and healthy behaviors in order to improve their outcomes. We should also strive to model positive healthy
behaviors in our own lives in the belief that we will provide better care to others if we care for ourselves first.
        Nurses have a commitment to keep current in knowledge and skills and seek self-enhancement through perpetual learning. By
doing this, we will not remain stagnant in our beliefs, but evolve professionally through evidence-based practice and technological
advances. My vision for myself as a nurse is that I will always continue learning, not only from textbooks and journals, but from
interactions with other members of the healthcare team and by being involved in the experiences of the patients and their families. I
want to learn each day, and apply what I’ve learned to improve my skills as a nurse
the care of childbearing and childrearing families is a major focus of nursing practice, because to have healthy adults you must have
healthy children. To have healthy children, it is important to promote the health of the childbearing woman and her family from the time
before children are born until they reach adulthood. Both preconceptual and prenatal care are essential contributions to the health of a
woman and fetus and to a family’s emotional preparation for childbearing and childrearing. As children grow, families need continued
health supervision and support. As children reach maturity and plan for their families, a new cycle begins and new support becomes
necessary. The nurse’s role in all these phases focuses on promoting healthy growth and development of the child and family in health
and in illness. Although the field of nursing typically divides its concerns for families during childbearing and childrearing into two
separate entities, maternity care and child health care, the full scope of nursing practice in this area is not two separate entities, but
one: maternal and child health nursing
The goals of maternal and child health nursing care are necessarily broad because the scope of practice is so broad. The range of
practice includes
• Preconceptual health care
• Care of women during three trimesters of pregnancy and the puerperium (the 6 weeks after childbirth, sometimes termed the fourth
trimester of pregnancy) • Care of children during the perinatal period (6 weeks before conception to 6 weeks after birth)
• Care of children from birth through adolescence
• Care in settings as varied as the birthing room, the pediatric intensive care unit, and the home
In all settings and types of care, keeping the family at the center of care delivery is an essential goal. Maternal and child health nursing
is always family-centered; the family is considered the primary unit of care. The level of family functioning affects the health status of
individuals, because if the family’s level of functioning is low, the emotional, physical, and social health and potential of individuals in
that family can be adversely affected. A healthy family, on the other hand, establishes an environment conducive to growth and health-
promoting behaviors that sustain family members during crises. Similarly, the health of an individual and his or her ability to function
strongly influences the health of family members and overall family functioning. For these reasons, a family-centered approach enables
nurses to better understand individuals and, in turn, to provide holistic care.

B.
Physical Assessment Nursing Diagnosis Plan Care Implementation of the Evaluation of the plan of
plan care
An 8 year old skinny and The child body Provide medicine to -Assessed After 4 hour of nursing
malnutrition child with temperature is higher lowered the fever of the -Provided intervention, the temperature
weak body and pale than 37.8’ C related to child, perform TSB, -Administered of the patient was
face. The mother and disease. The child had a assess the vital sign, decreased from
her children living in the painful throat when provide healthy diet to 37.8’C –36.5’C
abandoned jeepney due swallowing, mild cough, the child and a blanket.
to the lack of shelter and redness in the back of the Assist child to gargle The child temperature
proper hygiene. The mouth, and have a dry, with salt water and avoid has been reduced. The
child acquire the scratchy throat acidic foods and lastly child throat improve,
diseases in the stay hydrated redness in the back of
environment. the mouth become
After 4 hour of nursing lighter. The child
Subjective: intervention patient will condition is better and
be able to report feeling lively
“Mainit ang pakiramdam rested and show
ko” as verbalized by the improvement in
patient manageable level

Objective:

 Flushed skin,
warm to touch
 Powerless
 Feeling
uncomfortable
A 40-year-old mother of two children (ages 8 and 10 years) is living in an abandoned jeepney after she lost her job at a restaurant. She
brings her 8-year-old to your clinic with a sore throat and high fever. The mother confides in you that she “has no money and cannot
afford food for her children let alone medications.”