NCM 109 CARE OF MOTHER AND CHILD AT RISK (ACUTE AND CHRONIC)

 According to World Health Organization, Maternal health refers to the health of women
during pregnancy, childbirth and postnatal period. The most common direct causes of
maternal injury and death are excessive blood loss, infection, high blood pressure, unsafe
abortion, obstructed labor, as well as indirect causes such as anemia, malaria and heart
disease.

MATERNAL HEALTH STATUS IN THE PHILIPPINES

MATERNAL MORTALITY: BY MAIN CAUSE

Number, Rate/1000 Livebirths & Percent Distribution

Philippines, 2010

CAUSE Number Rate

TOTAL 1,719 1.0

1. Complications related to pregnancy occurring

660 0.4
in the course of labor, delivery and puerperium

2. Hypertension complicating pregnancy,

605 0.3
childbirth and puerperium

3. Postpartum hemorrhage 298 0.2

4. Pregnancy with abortive outcome 156 0.1

*Percent share to total number of maternal deaths

MATERNAL HEALTH STATUS

 More women and their children are surviving today than ever before

 Women and newborns are most vulnerable during and immediately after childbirth

 Estimated 2.8 million pregnant women and newborns die every year mostly of preventable
causes

MATERNAL HEALTH STATUS IN THE PHILIPPINES

 Complications related to pregnancy occurring
in the course of labor, delivery and puerperium is the number 1 cause of maternal mortality
according to DOH.

 Pneumonia is the leading cause of infant mortality.

 13 mothers die every day from pregnancy related complications.

 9% of Filipino women ages 15-19 have begun childbearing.

 Mother are bearer of the future. They should have given enough attention during their
pregnancy. One goal was to provide a quality maternal health service to every woman
for it’s their own right. Also the equality in providing services in the
mountainous/rural areas.
 GENETICS AND GENETIC COUNSELING
What is Genetics?

 Branch of science that studies genes and pattern of inheritance of a particular disease from
parents to offspring's. From the Greek word “gene” which means to become or to grow into.

What is counseling?

 Counseling is consultation, mutual interchange of opinions, deliberating together.

GENETIC COUNSELING

Genetic Counseling
 The process of checking family medical history and medical record, ordering genetic tests,
evaluating the results of these test and record, helping parents understand and reach decisions
about what to do next.

INDICATIONS OF GENETIC COUNSELING

1. Hereditary disease in a patient or family

2. Birth defects
3. Mental retardation
4. Advanced maternal age
5. Early onset of cancer in the family
6. Miscarriages
7. Malformations
8. Tendency to develop an neurologic conditions

FUNCTIONS OF GENETIC COUNSELING SESSION

1. Provide information
2. Available solution
3. Hel person to understand and cope with his condition
 4. Testing the risk of recurrence

GENETIC COUNSELING ETHICS

1. Respect the right of the individual

2. Non directive approach
3. Keep privacy of individual and family
4. Maintain the communication of the counselor and his client

ROLES OR GENETIC NURSES

1. Taking family history

2. Attend patients concerns
3. Explaining genetic test
4. Obtaining informed consent
5. Collecting blood samples for genetic testing
6. Psychological support and follow up

CARE OF AT RISK/HIGH RISK AND SICK MOTHER AND CHILD

Nursing care of the high risk pregnant client
 A High risk pregnancy is one in which a concurrent disorder, pregnancy related
complications, or external factor jeopardizes the health of the other, the fetus or both
A. Assessment of risk factors
 Begins with the 1st prenatal visit and continues through the puerperium
 Vulnerable groups pregnant women with
 Malnutrition
 Mothers are too young, too old, pregnant too frequently
 Presence of physical deformity
 Psychological/mental illness/mental retardation
 Marginalized because of: poverty, unemployment, lack of education, single or separated
mother, victims of abuse.
B. Factors that categorize a pregnancy at high risk
PSYCHOLOGICAL
 PREPREGNANCY
 History of drug dependence (including alcohol)
 History of intimate partner abuse
 History of mental illness
 Survivor of childhood sexual abuse
 PREGNACY
 Loss of support person
 Illness of family members that decrease in self esteem
 Drug abuse (including alcohol and smoking)
 Poor acceptance of pregnancy
 LABOR AND DELIVERY
 Severely frightened by labor and delivery experience
 Inability to participate due to anesthesia
 Separation of infant at birth
 Lack of preparation for labor
 Illness in newborn
 Birth of infant who is disappointing in some way(e.g sex, appearance, or congenital
anomalies)
 PREPREGNANCY
 Occupation involving handling of toxic substances (radiation and anesthesia gases)
 Environmental contaminants at home
 Isolated
 Poor access to transportation for care
 Highly mobile lifestyle
 Poor housing
SOCIAL
 PREGNANCY
 Refusal or neglected prenatal care
 Disruptive family incident
 Decrease economic support
 Under 1 year from last pregnancy
 LABOR AND DELIVERY
 Lack of support person
 Inadequate home for infant care
 Unplanned cesarean birth
 Lack of access to continued heath care
 Lack of access to emergency or equipment
PHYSICAL
 PREPREGNACY
 Visual or hearing challenge
 Pelvic inadequacy
 Uterine incompetence
 Secondary major disease (heart disease, diabetes, kidney disease, hpn
 History of miscarriage, stillbirth
 History of child with congenital disease
 Obesity
 Cigarette smoker, younger tan age 18 years old or older than 35 years
 PREGNANCY
 Multiple gestation
 Gestational diabetes
 Poor weight gain
 Infection
 Fluid and electrolyte imbalance
 Nutritional deficiency of iron, folic acid or protein
 LABOR AND DELIVERY

 Hemorrhage

 Dystocia

 Precipitous labor

 Laceration of cervix or vagina

 Retained placenta

C. SREENING PROCEDURES,DIAGNOSTIC TEST AND LABORATORY EXAMS

 https://prezi.com/p/gvhjjvvzkdrx/screening-and-testing-during-pregnancy/
 https://www.slideshare.net/SanthoshAntony/screening-32451717
 Screening tests, which will let you know if your baby has a higher risk of having a
problem, but can’t confirm the problem for sure?
 Diagnostic tests, which show whether your baby has a problem, with a much greater level
of certainty.
 First visit
 confirmation that you are pregnant
 Calculating how many weeks your pregnancy is and when your due date will be. You
may be offered an ultrasound scan if the date is not clear.
 blood pressure, height and weight
 medical and family history
 a blood test, including checking your blood group and test for anemia, rubella immunity,
hepatitis B, hepatitis C, syphilis, chlamydia and HIV
 urine test, to see if you have a bladder or urinary tract infection
 screening for Down syndrome
 cervical screening to check for human papillomavirus (HPV) and/or any signs of cervical
cancer
 if at risk of vitamin D deficiency, a test for this may be offered
1. Chorionic villus sampling (CVS), where a small amount of the baby’s placenta is
collected to test for chromosome problems such as Down syndrome or other abnormality.
This is usually done between 11 and 13 weeks of pregnancy, or at another time if a
problem is suspected.
2. Non-invasive pre-natal testing (NIPT), which is a very accurate test to detect Down
syndrome and certain other abnormalities. It can be performed from 10 weeks into the
pregnancy.
3. A nuchal translucency scan, which looks at the back of your baby’s neck to assess the
risk of your baby having Down syndrome. This test is done between 11 and 14 weeks of
pregnancy, and may be conducted at the same time as the dating ultrasound.
4. Amniocentesis, where a small amount of amniotic fluid (fluid around the baby) is
collected to test if the baby has a chromosome problem or other abnormality. This is
usually done at 15 to 20 weeks or at another time if a problem is detected.

D. PRE GESTATIONAL CONDITIONS AFFECTING PREGNANCY OUTCOMES

 https://www.rhdaustralia.org.au/about-disease
 Rheumatic Heart Diseases
 Diabetes Mellitus
 Substance Abuse
 HIV/AIDS
 Anemia
 RHEUMATOID HEART DISEASE
https://prezi.com/p/9vzcgtvrj_uc/rheumatic-heart-disease/
https://drive.google.com/file/d/1ldcqwnSxcJhutsElWSbAUciBb8rLHojV/view?usp=sharing

NURSING DIAGNOSIS AND INTERVENTIONS

1. Nursing Diagnosis
 Altered thermoregulation (hyperthermia) related to microorganisms invasions as manifested
by high temperature of 38 degrees Celsius.
2. Planning
 To decrease clients temperature after interventions
3. Intervention
 Provide tepid sponge bath
 Administer prescribed drugs
 Assess and record patients comfort level


NURSING CARE OF A PREGNANT WITH HEART DISEASE

 Begins with thorough health history to document her pre pregnancy cardiac status
 Every woman with cardiac disease should be instructed to report coughing during pregnancy
 Record a baseline bp, pulse rate and RR for sitting or lying position
 Check for capillary refill
 Advice for laboratory assessment such as ECG, chest x-ray
 Promote rest
 Promote health nutrition
  Educate regarding medication

DIABETES MELLITUS
https://prezi.com/px6byvum2sf8/gestational-diabetes/

https://www.youtube.com/watch?v=T09oiyoy6ek

1. Diabetes: A group of metabolic diseases in which there are high blood sugars levels over a
prolonged period. Two types Diabetes Mellitus Type I (autoimmune destruction of beta cells
in the pancreas) and Type II (insulin resistance followed by beta cell atrohpy)
2. Gestational Diabetes: diabetes diagnosed during the second half of pregnancy with no prior
existing diabetes.

NURSING DIAGNOSIS AND INTERVENTIONS

1. Nursing Diagnosis

 Deficient knowledge related to therapeutic regimen necessary during pregnancy

2. Planning
 The client will demonstrate knowledge about effects of pregnancy on diabetic condition
3. Intervention
 Educate regarding nutrition and exercise during pregnancy
 Teach client to do blood glucose monitoring
4. Evaluation
 Women states importance of careful attention to nutrition, exercise, and home monitoring of
glucose levels during pregnancy.

NURSING CARE WITH PREGNANT WOMAN WITH ENDOCRINE DISORDERS

 Education regarding nutrition and exercise during pregnancy

 Educate women more frequent prenatal visits to ensure close monitoring

SUBSTANCE ABUSE
https://prezi.com/p/f9hun8_jo98d/drugs-and-alcohol-presentation/
https://www.youtube.com/watch?v=EjTxM_lkBQA

 https://prezi.com/p/lyx-xm6qs14w/substance-abuse-in-pregnancy/
 Prenatal substance dependence involves phase of group of behavioral, cognitive, and
physiological symptoms such as inability to control over drug abuse and repetitive use of the
substance in spite of adverse maternal and fetal effects.

NURSING DIAGNOSIS AND INTERVENTIONS

1. Nursing Diagnosis
 Imbalanced Nutrition: Less Than Body Requirements related to Inadequate dietary
consumption in fulfilling metabolic needs for physiological, psychological, or economic
purposes possibly evidenced by decreased subcutaneous fat/muscle mass.
2. Planning
 To educate client the effects of substance dependence and insufficient dietary intake on the
nutritional status and pregnancy.
3. Interventions
  Review and discuss prenatal nutritional needs and develop a dietary plan.
4. Evaluation
 Client will verbalize understanding of effects of substance dependence and demonstrate
progressive weight gain.

NURSING CARE WITH PREGNANT WOMEN OF SUBSTANCE ABUSE

 Develop a trusting relationship with patients

 Maintain a non-judgmental attitude
 Determine a woman's readiness for change
 Provide information on health risks and effects of substance abuse for a fetus
 Enlist the support of family members and friends
 Refers to clinic and community sources for assistance
 Promote maternal bonding with the newborn after birth
HIV ON PREGNANCY
https://prezi.com/p/smay74bdmtrl/hiv-and-maternal-health/

ANEMIA
https://www.webmd.com/baby/guide/anemia-in-pregnancy
https://prezi.com/p/2fkl9wvqhz0e/anemia/

NURSING CARE TO PREGNANT MOTHER WIH ANEMIA

1. To manage fatigue:
 Prioritize activities. Assist the patient in prioritizing activities and establishing balance
between activity and rest that would be acceptable to the patient.
 Exercise and physical activity. Patients with chronic anemia need to maintain some physical
activity and exercise to prevent the deconditioning that results from inactivity.
2. To maintain adequate nutrition:
 Diet. The nurse should encourage a healthy diet that is packed with essential nutrients.
 Alcohol intake. The nurse should inform the patient that alcohol interferes with the
utilization of essential nutrients and should advise the patient to avoid or limit his or her
intake of alcoholic beverages.
 Dietary teaching. Sessions should be individualized and involve the family members and
include cultural aspects related to food preference and preparation.
3. To maintain adequate perfusion:
 Blood transfusion monitoring. The nurse should monitor the patient’s vital signs and pulse
oximeter readings closely.
4. To promote compliance with prescribed therapy:
 Enhance compliance. The nurse should assist the patient to develop ways to incorporate the
therapeutic plan into everyday activities.
 Medication intake. Patients receiving high-dose corticosteroids may need assistance to
obtain needed insurance coverage or to explore alternative ways to obtain these medications.