Care of Mother, Child At-Risk or with Problems 9.
The Doctors to the Barrios included Public-Private
(Acute and Chronic)
I. Framework for Maternal and Child Health Nursing (MCN)
focusing on At-Risk, High Risk, and Sick Clients
A. National Health Situation in MCN
• TOP TEN FACTS ON HEALTHCARE IN THE
PHILIPPINES
1. The WHO refers to the Filipino Healthcare System as
“fragmented.” There is a history of unfair and unequal access
to health services that significantly affects the poor. The
government spends little money on the program which
causes high out of pocket spending and further widens the
gap between rich and poor.
2. Out of the 90 million people living in the Philippines, many
do not get access to basic care. The country has a high
maternal and newborn mortality rate, and a high fertility
rate. This creates problems for those who have especially
limited access to this basic care or for those living in generally
poor health conditions.
3. Many Filipinos face diseases such as Tuberculosis, Dengue,
Malaria and HIV/AIDS. These diseases pair with protein-
energy malnutrition and micronutrient deficiencies that are
becoming increasingly common.
4. The population is affected by a high prevalence of obesity
along with heart disease.
5. Healthcare in the Philippines suffers from a shortage of
human medical resources, especially doctors. This makes the
system run slower and less efficiently.
6. Filipino families who can afford private health facilities
usually choose these as their primary option. Private facilities
provide a better quality of care than the public facilities that
lower income families usually go to. The public facilities tend
to be in rural areas that are more run down. These facilities
have less medical staff and inferior supplies.
7. Only 30 percent of health professionals employed by the
government address the health needs of the
majority. Healthcare in the Philippines suffers because the
remaining 70 percent of health professionals work in the
more expensive privately run sectors.
8. To compensate for the inequality, a program called Doctors
to the Barrios and its private sectors decided to build nine
cancer centers, eight heart centers and seven transplant
centers in regional medical centers.
Partnerships in a plan to modernize the government-owned
hospitals and provide more up to date medical supplies.
10. More than 3,500 public health facilities were updated
across the country.
Maternal and Child Health Nursing- refers to the relationship
of mother and child to one another and consideration of the
entire family, as well as the culture and socio-economic to
environment as framework of the clients
Maternal and Child Health Nursing refers to the care of
pregnant woman, child and family.
B. Statistics on MCN
STATISTICAL TERMS USED TO REPORT MATERNAL AND
CHILD HEALTH
Maternal mortality rate: The number of maternal deaths per
100,000 live births that occur as a direct result of the
reproductive process.
Infant mortality rate: The number of deaths per 1,000 live
births occurring at birth or in the first 12 months of life.
Childhood mortality rate: The number of deaths per 1,000
population in children, 1 to 14 years of age
STATISTICAL TERMS USED TO REPORT MATERNAL AND
CHILD HEALTH
Birth rate: the number of births per 1,000 population
Fertility rate: the number of pregnancies per 1,000 women of
childbearing age (WRA).
Fetal death rate: The number of fetal deaths (over 500 g) per
1,000 live births.
Neonatal death rate: The number of deaths per 1,000 live
births occurring at birth or in the first 28 days of life .
Perinatal death rate: The number of deaths of fetuses more
than 500 g and in the first 28 days of life per 1,000 live births.
Fetal Deaths-measures pregnancy wastage. Death of the
product of conception occurs prior to its complete expulsion,
irrespective of duration of pregnancy.
Maternal Mortality- death of a woman while pregnant within
42 days of termination of pregnancy, irrespective of the
duration and the site of the pregnancy.
II. Care of At-Risk / High Risk and Sick Mother and Child  A serious inflammatory disease that may occur in an
individual 1-4 weeks following an untreated throat
A. Nursing Care of the Pregnant Client infection. (sore throat)

1. Identification of Risk Clients  causative agent, Group A Beta-Hemolytic

streptococcus bacteria.
Assessment of pregnant woman begins with the 1st prenatal
visit and continues through the puerperium  can permanently affect the structure and function
of the heart, especially the heart valves.
a. Risk factors include, but are not limited to, the following:
 Common areas occurrence are the mitral and aortic
 mother is younger than 19 years old or older than 35
valve
 mother is underweight or overweight for height
 Team approach in management
 mother has anemia (low red blood cell count) and
 Prevention is the best strategy in RHD
poor nutrition status
 Early prenatal for detection
 low socioeconomic status
 Accurate assessment for s/s -
 previously given birth more than four times
 Referral and follow-
previous preterm birth (birth before 37 weeks
Effect on the Mother (Depends on the level of Stenosis)
Risk factors…
 Pulmonary congestion leading to dyspnea
 previous birth of a very large or very small baby
 Pulmonary HPN
 previous pregnancy loss
 Dizziness and fatigue due to decreased L ventricular
 family history of genetic disease or previous baby
output
with a birth defect
 Dysrhythmia
 substance use (cigarettes, alcohol, drugs)
 Decreased perfusion of the renal system
 pre-existing medical conditions including diabetes,
high blood pressure, and heart disease Perfusion- the act of spreading or pouring over or through,
specifically the artificial passage of fluid through an organ or
infertility medications or treatments (more likely to result in
tissue by way of the blood vessels.
multiple births)
The process whereby oxygen is carried from the lungs to body
Vulnerable Groups
tissues and carbon dioxide is carried from the tissues to the
 Lack of support people lungs.

 Poor coping mechanisms Pulmonary-means lungs

 Genetic inheritance Deoxygenate-to deprive an organism of oxygen.

 Past history of pregnancy complications Congestion-Hyperemia; abnormal accumulation of blood in a

part or an organ.
 2. Pre-gestational Medical conditions that affects
pregnancy outcomes: Stenosis-abnormal narrowing or stricture of any canal or
orifice.
a. Rheumatic Heart Disease (RHD)
Dysrhytmia- disordered or abnormal rhythm
Effect on the Fetus: Classification:

 Decreased perfusion of the major organs including
the placenta
 Nutritional requirements are not met resulting to
SGA babies
1.TYPE I- formerly known as insulin-dependent DM
 Characterized by the destruction of Beta cells in the
pancreas that usually leads to absolute insulin
insufficiency

 Intrauterine growth restriction  Immune-mediated DM

Management:  Idiopathic Type1

 Elevate head of bed while sleeping to relieve
dyspnea
 Antihypertensives to control hypertension
 Decreased sodium diet
 UTZ and NST-ultrasound and non stress test
2. TYPE II- formerly known as non-insulin dependent DM
 A state that usually arises because of insulin
resistance combined with a relative deficiency in the
production of insulin
 GESTATIONAL DIABETES- a condition of abnormal
glucose metabolism that arises during pregnancy.

 Balloon valve angioplasty  Possible signal of an increased risk for type 2

diabetes later in life.
 Anticoagulants
Impaired Glucose Homeostasis
b. DIABETES MELLITUS (Gestational Diabetes
 A state between “normal” and “diabetes” in which
 An endocrine disorder in which the pancreas cannot
the body is no longer using and/or secreting insulin
produce adequate insulin to regulate body glucose
properly.
levels.
a. Impaired fasting glucose. A state when fasting plasma
 can cause early labor, birth defects, and very large
glucose is 110 but under 126mg/dl
babies.
b. Impaired glucose tolerance. A state when results of oral
 It can disappear after pregnancy but the risk of
glucose tolerance test are at least 140 but under 200mg/dl in
developing type 2 is 50-60%
2 hour sample
Can be caused by inadequate insulin response or excessive
Assessment:
resistance to insulin
 Screening is usually done using a 50-g oral glucose
Risk Factors:
challenge test at week 24-28 of pregnancy
 Obesity
 Done at the first prenatal visit and at 24-28 weeks
 Age over 25 years
 HgbAc-glycosylated hemoglobin-measures the amt
 History of large babies(10 lbs. or more) of glucose attached to Hgb

 Hx of unexplained fetal or perinatal loss  Ophthalmic examination for retinal changes,

increase exudates, dot hemorrhage, macular edema
 Hx of congenital anomaly
SIGNS AND SYMPTOMS
 Family hx of diabetes
1. Polyuria
 Member of a population with a high risk for DM
2. Polydipsia

3. Fatigue and muscle weakness

4. Polyphagia IRON DEFICIENCY ANEMIA

5. Increase rate of infections  Most serious among STI’s, fatal to both mother and
child
Therapeutic Management for DM
 Caused by retrovirus that infects and disables T
COCAINE lymphocytes

 Derived from Erythroxylum coca Risk factors include:

 Taken thru inhalation that affects CNS( central  Multiple sex partners
nervous system) resulting to sudden
vasoconstriction that can cause:  Bisexual partners

 Respiratory and cardiac rates and blood pressure  Intravenous drug use
increases rapidly
Screening
AMPHETAMINES
 ELISA test-enzyme-linked immunosorbent assay or
 Similar effect with cocaine
 Western Blot
 Newborns whose mothers used the drug show
jitteriness and poor feeding at birth and may be  This test detect antibody
growth restricted.
 PCR( polymerase chain reaction) -test to detect
Marijuana and Hashish antigen

 From hemp plant, cannabis Management

 Produces tachycardia  A non pregnant woman is advised not to get

pregnant*
 Associated with loss of short-term memory
 50% chance for newborn- contract the virus and
 Increased incidence of respiratory infection develop AIDS in the first yr of their life.

 Frequent user may not be able to breastfeed  Zidovudine(ZVD) is administered on the 14th wk. of
preg.
Narcotic Agonis
 Newborn receives it for 6 weeks(8-10%)
Effects to the fetus
 Nevirapine, an antiretroviral drug further reduces
 Compromise of placental circulation-leading to the incidence
premature separation of the placenta-results in
preterm labor or fetal death.  Continuous blood exam is done until 2 negative
culture at 4 mo. of age
 Learning difficulties are suspected for long term
among infants born with cocaine dependent mother

 Counselling is important

Alcohol

 Causes fetal alcohol syndrome, a syndrome with

significant facial features and cognitive challenge

 Newborn may have thin upper lip and upturned nose