NCM 102:

CARE OF MOTHER, CHILD,

FAMILY AND POPULATION
GROUP AT RISK OR WITH
PROBLEMS
Description:

This course deals with the concept of

disturbances and pre-existing and
existing health problems of the
pregnant woman and the pathologic
changes during the intrapartum and
post-partum periods.
This course further deals with the
common problems occuring duting
infancy to the adolescent stage.
PART I

Care of the Mother

 A. Nursing
Care
of the
High Risk
Pregnant Client
A. Identification of Risk Clients

Risk factors
Screening Procedures
Diagnostic test and
laboratory exams
Identifying Risk Factors:

As a nurse, it is our
responsibility to identify risk
factors during our interaction
with our pregnant clients,
during our pre- natal
examinations, not only to the
mother but also to the fetus .
Purposes of Initial interview:
Establishing rapport
Gaining information about the
woman's physical and
psychosocial health
Obtaining a basis for anticipatory
guidance for the pregnancy

Learning a womans health

history will help you give advice
to make this pregnancy and birth
as safe as possible.
The Initial Prenatal Visit: Risk
Assessment
1.Womans History

Demographic Data
includes name, age,
address, telephone
number, religion, and
health insurance
information.
Chief Concern
To help confirm pregnancy,
inquire about the date of her LMP.
Elicit information about the signs
of early pregnancy.
And any danger signs of
pregnancy, such as bleeding,
continuous headache, visual
disturbances, or swelling of the
hands and face.
Family Profile
Identify support persons, shape
the nature and kind of questions
asked, and evaluate the
possible impact of the client's
culture on care.
marital status.
know the size of the apartment
or house
History of Past Illnesses
a past condition may become
active during or immediately
following pregnancy.
History of Family Illnesses
It helps to identify potential
problems in the mother during
pregnancy or in the infant at
birth.
Day History/Social Profile
woman's current nutrition,
elimination, sleep, recreation, and
interpersonal interactions
Gynecologic History
woman's past experience with her
reproductive system may have
some influence on how well she
accepts a pregnancy.
Obtain information about her age
of menarche (first menstrual
period)
Gynecologic History
Ask her usual cycle, including the
interval, duration, amount of
menstrual flow, and any discomfort
she feels
Past surgery on the reproductive
tract.
Assess for the possibility of stress
incontinence (incontinence of urine
on laughing, coughing, deep
inspiration, jogging, or running).
Obstetric History
For each previous pregnancy,
document the child's sex and
the place and date of birth.
Ask about any previous
miscarriages or abortions and
whether she had any
complications during or
following them.
Obstetric History
Classify pregnancy status that
determine the woman's status
with respect to GRAVIDA & PARA
( TPALM)
 Terms Related to Pregnancy Status

Para The number of pregnancies that reached viability, regardless

of whether the infants were born alive or not

Gravida A woman who is or has been pregnant

Primigravida A woman who is pregnant for the first time

Primipara -A woman who has given birth to one child past age of
viability
-
Multigravida A woman who has been pregnant previously

Multipara A woman who has carried two or more pregnancies to

viability

Nulligravida A woman who has never been and is not currently pregnant
Review of Systems

A review of systems completes

the subjective information.
Use a systematic approach.
and explain each procedure.
A review of systems helps
women recall diseases they
forgot to mention earlier.
2. Routine Exams and Laboratory Tests
a.Comprehensive physical exam
including BP, height and weight
fundal height measurement, FHT
b. Serum testing:
CBC
ABO and Rh typing, antibody
screen
Serology
Rubella screen
Hepatitis screen
Hemoglobin electrophoresis
HIV
2. Routine Exams and Laboratory Tests
Pap smear
Cervical cancer test
STI cultures
Urine testing for
asymptomatic bacteruria,
glycosuria, protenuria, pyuria,
ketonuria
Pelvic examination
Ultrasound
Types of pelvis
Pelvic Measurement
Pelvimitry
a method of obtaining pelvic
measurements by X-rays to
determine the adequacy for
vaginal birth.
Utrasound
A scan, currently considered to
be safe, non-invasive, accurate
and cost effective investigation
of the fetus.
ULTRASOUND
B. Pre-gestational Medical conditions
that affects pregnancy outcomes:
RHD
DM
Substance Abuse
HIV/AIDS
Rh Sensitization
Anemia
This involves a
variety
of heart conditions
both
congenital and
acquired
that complicates
pregnancy.
 Risk factors

Rheumatic fever
Congenital defects of the heart
Arteriosclerosis
Pulmonary diseases
Renal diseases
Heart surgery
Myocardial infarction
Cardiac Disease

The danger of pregnancy in a woman

with cardiac disease occurs primarily due
to the increase in circulatory volume.
Two most common cardiac
complications of pregnancy are RHD and
CHD
The most dangerous time for a woman is
in weeks 28 to 32, just after the blood
volume peaks.
PROGNOSIS

A woman with class I or II heart disease

can have normal pregnancy and birth.
Women with class III with complete bed
rest can maintain pregnancy
Women with class IV heart disease are
poor candidates for pregnancy and are
usually advised to avoid pregnancy.
 Cardiac Disease classification:

Class I Asymptomatic with all activity

Class II Asymptomatic @ rest; symptomatic with heavy

physical activity (produce palpitations,
fatigue, dyspnea and anginal pains)

Class III Asymptomatic @ rest,

symptomatic with ordinary activity

Class IV Symptomatic with all activity, symptomatic

with rest