Maternal and Child Nursing

Signs of pregnancy
Presumptive – changes felt by woman
 Morning sickness
 Amenorrhea
 Changes in breast size
 Fatigue
 Lassitude
 Urinary frequency
 Quickening (18-20 weeks)

Probable – changes observed by the

examiner
 Chadwick’s sign – bluish discoloration of the vaginal
wall.
 Hegar’s sign – softening of the lower uterine
segment.
 Uterine enlargement – at 12 weeks gestation felt just
above the symphysis pubis
 Positive pregnancy test – presence of gonadotropin
in the urine.
 Ballottement – sinking and rebounding of the fetus.
 Outlining of the fetal body
 Goodell’s sign – softening of the cervix
 Soufflé, contraction and Braxton-Hick’s
Positive – definitive signs of pregnancy
 Heartbeat
o 12 weeks by Doppler
o 18-20 weeks by auscultation.
 Movement – felt by examiner usually 20 weeks.
 Skeleton – by sonography or x-ray

Danger – should be taken immediately to

the hospital
 Vaginal bleeding – Placental problems (previa,
ubruptio, premature separation)
 Convulsions
 Severe headaches with blurred vision –
Hypertension of pregnancy
 Fever and too week to get out of bed - Infection
 Severe abdominal pain – Ectopic pregnancy,
Uterine rupture
 Fast or difficult breathing – pulmonary edema
 Swelling of fingers, face and legs – Hypertension
of pregnancy, thrombophlebitis (swelling legs)
 Escape of vaginal fluids – premature rupture of
membranes.
 Abortion
It is the termination if pregnancy before the age of
viability.
 Threatened abortion – bleeding, cramping and
softening of uterus with CLOSED CERVIX.
o Bed rest, no intercourse, monitor bleeding.
 Inevitable abortion – unpreventable cervical
dilation with persistent hemorrhage, and severe
cramping.
o Save and count pads, monitor.
o Emotional support.
 Incomplete abortion – expulsion of some part
of conception.
o D&C, Oxytocin, IV/Blood transfusion
 Complete abortion – expulsion of all parts of
conception
o Observe; may be given oxytocin
 Missed abortion – fetus dies in the utero and
has not been expelled as cervix may be closed.
o D&C, monitor for infection, Disseminate
intravascular coagulation (DIC)
 Habitual abortion – with history of three or more
abortions, commonly due to incompetent cervix.
o Ceriage – encircling cervix with a suture
 Important Trimesters of Pregnancy
First trimester
 Lasts for 12 weeks of the pregnancy and is crucial for
the baby’s development.
 The fetus’s heart rate can be heard as early as 8
weeks on a Doppler in the doctor’s office. But more
likely closer to 12 weeks.
 External genitalia will have formed and may be visible
during an ultrasound
Second trimester
 Lasts between weeks 13 to 26 of pregnancy.
 Fetal height: 4-5 inches in length; 12 inches in width
 Fetal weight: from 3 ounces to 1 lb. or more.
 Male: testes begins to drop into the scrotum; female:
ovaries begin to form eggs.
 Quickening – feeling that the baby is moving.
 Braxton-Hicks – contraction of the uterus (False labor)
Third trimester
 Lasts form week 27 until delivery.
  Fetal height and weight: around 12 inches long and 1.5
lbs. in weight to about 18-20 inches long and 7-8 lbs.
in weight.
Postpartum (Fourth trimester)
 Keeping the baby calm means replicating life in the
womb as closely as possible which can be
accomplished by:
o Holding the baby close
o Gently swaying or rocking the baby
o Making swishing or shushing noises
o Swaddling
o Giving the baby opportunity to suck, either during
breastfeeding or by using pacifier.
 A woman will experience lochia, or bleeding and
vaginal discharge, that continues for4-6 weeks
after birth.
 Breast may be sore and leak as she adjusts to
breastfeeding.
 Some women may experience postpartum
depression after childbirth. This includes feeling of
intense sadness, fatigue, anxiety, and
hopelessness that can affect her ability to care for
herself and the baby.
 Computation of AOG and EDC
 Naegele’s rule
o (April-December) Count back 3 months from the
LMP (1st day of the last menstrual cycle) and add 7
days and 1 year.
o (January-March) Add 7 days from LMP and add 1
year.

 Ultrasonography – estimates fetal age from head

circumference

 Fundal height – gross estimate of expected date of

confinement
o If above symphysis – between 12-14 weeks AOG
o If at the level of the umbilicus – approximately 20
weeks AOG
o McDonald’s rule – adding 1 cm per week until 36
weeks of pregnancy (at xyphoid).

 McDonald’s rule
o Height of fundus X 2/7 = Gestation in lunar months
o Height of fundus X 8/7 = Gestation in weeks
o For women weighing over 200 lbs., subtract 1cm from
the measurement obtained.
 GTPALM – OB scoring
 G – Gravida: number of times the woman has been
pregnant. This includes current pregnancy, miscarriages,
abortions and twins/triplets counted as one.
 T – Term births: number born (alive/still birth) at 37
weeks gestation onward (multiple births are counted as
one)
 P – Preterm births: Number born 20-37 weeks,
alive or still birth (multiple births are counted as one).
 A – Abortion: pregnancy loses before 20 weeks.
Counted as pregnancy (Gravidity). If the baby died after
20 weeks it is added under preterm or term not abortion.
 L – Living children: Number of children living.
Note twin or triplets count individually.
 M – Multiple birth: counted as “1” regardless of the
number in one birth.

GP Scoring
 Gravida – the number of times a woman get
pregnant.
 Parity/Para – Number of times a fetus has reached
the age of viability
 Leopold’s Maneuver
Systematic method of observation and palpation to
determine fetal position, FHT, and fetal size.
First maneuver (A)
 Facing mother, palpate the fundus with both hands –
assess for shape, size, consistency and mobility.
 Fetal head: firm, hard, and round.
o Moves independently of the rest
o Detectable by ballottement
 Breech/buttocks: softer and has bony
prominences.
Second maneuver (B) - “Where is the back?”
 Place both palms on the abdomen
o Hold right hand still and with deep but gentle
pressure, use left hand to feel for the firm, smooth
back
o Repeat using opposite hands.
 Confirm your findings by palpating the fetal extremities
on the opposite side.
o Small protrusions, “lumpy”
Third maneuver (C) – “What is at the inlet of the
pelvis?”
  Gently grasp the lower portion of the abdomen (just
above symphysis) with the thumb and fingers of the
right hand.
 Confirm presenting part
o Head will feel firm
o Buttocks will feel softer, and irregular
 If not engaged, it may be gently pushed back and
forth.
Fourth maneuver (D) – “What is the fetal attitude?”
 Locate the brow
 Assess descent of the presenting part.
o Turn to face the woman’s feet
o Move fingers of both hands gently down the sides
of the abdomen towards the pubis
 Palpate for the cephalic prominence (vertex)
o Prominence on the same side as the small parts
suggests that the head is flexed (Optimum).
o Prominence as the same side as the back suggest
that the head is extended.
 Factors affecting labor and delivery
CLAPPS
 Contraction
o Frequency – beginning of one to beginning of next.
Report if less than 2 minutes!
o Duration – beginning to end of one contraction.
Report if more than 90 seconds!
 Increment – contraction increases
 Acme – contraction is at strongest
 Decrement – when intensity decreases
o Intensity – strength of ache.
 Lie – relationship of fetal spine to maternal spine
o Parallel – longitudinal
o Right angle – transverse
o Angle off – oblique
 Attitude – relationship of fetal parts to each other.
Common flexion of head & extremities.
o Vertex – full flexion (good attitude; presents the
smallest part - anteroposterior diameter of skull.)
o Sinciput – moderate flexion; military attitude
o Brow – partial extension
o Face – poor flexion, complete extension (presents
wide diameter – occipitomental diameter)
 Presentation – Part of fetus that enters maternal
pelvis.
o Cephalic/vertex head – most common
 o Breech/Buttocks
 Complete – flexed hips and knees.
 Footling – extended hips
o Shoulder – Transverse lie
 Position
o Positions identified based on presentation:
 Vertex
 Occiput – (O)
 Mentum/Chin (full extension) - (M)
 Brow (Moderate extension) – (B)
 Breech
 Sacrum (S)
 Shoulder/Scapula – (Sc)
o Position based on 4 quadrants of abdomen
 LOA – left occiput anterior (vertex with fetal
occiput on mother towards front)
 LOP – left occiput posterior
 ROA – right occiput anterior
 ROP – right occiput posterior
 LSA – left sacrum anterior
 RSA – right sacrum anterior
 Station –
relationship of the
presenting part of a
fetus to the level of
the ischial spines.
True Labor vs. False Labor
Progress of Labor
ED FIRE ERE
 Pregnancy Induced Hypertension
Pathophysiologic basis is vascular spasm that leads to
hypertension (HPN) (vascular effect), Edema (Interstitial
effect) and proteinuria (renal effect).
Occurs after 20th week of gestation. Diabetes occurred
before the 20th week gestation is not pregnancy induced
hypertension.

 Preeclampsia
o BP 140/90 (mild); 160/110 (severe)
o 1+ to 4+ proteinuria on random
o Cerebral or visual disturbances
o Epigastric pain
o Pulmonary edema
o Peripheral edema
o Liver dysfunction.
 Eclampsia
o Hypertension
o Proteinuria
o CONVULSION
o COMA

Magnesium Sulfate
 Drug of choice for treatment of convulsion
 Given on IV or IM on Z-tract method
 Antidote is Calcium gluconate
 Nursing Interventions for
Preeclampsia and Eclampsia
 Preeclampsia
o Assess:
 BP in sitting and left lateral position
 Protein level in urine
 Changes in LOC
 Weight
 FHT
 Vaginal bleeding
o Bedrest – aid in sodium excretion (where sodium
goes, water follows.)
o Left lateral recumbent position – avoids uterine
pressure on vena cava.
o High protein diet
o Seizure precautions – note headaches, visual
changes, dizziness and epigastric pain.
 Eclampsia
o Maintain IV line
o Keep O2 and airway equipment available at
bedside; padded tongue depressor.
o Minimize stimuli
o Medication ordered (Magnesium sulfate, valium,
apressoline)
o Side rails up and padded
o Aspiration precaution, post ictal phase
 Essential Intrapartum and Newborn
Care (EINC)
 Immediate drying
o Drying using a clean, dry cloth.
o Thoroughly dry the baby, wiping the face, eyes,
head, front and back, arms, and legs.
 Skin-to-skin contact
o If baby is crying or breathing normally, avoid any
manipulation, such as routine suctioning, that may
cause trauma or introduce infection.
o Place the newborn prone on the mother’s abdomen
or chest skin-to-skin.
o Cover newborn’s back with a blanket and head with
a bonnet.
o Place identification band on ankle.
 Proper cord clamping and cutting
o Clamp and cut the cord after cord pulsations have
stopped (typically 1-3 minutes).
o Put ties tightly around the cord at 2 centimeters and
5 centimeters from the newborns abdomen.
o Cut between ties with sterile instrument.
o Observe for oozing of blood.
o Do not milk the cord towards the newborn.
 o After cord clamping, ensure oxytocin 10 IU IM is
given to the mother.
 Non separation of the baby from mother
and breastfeeding initiation
o Observe the newborn. Only when the newborn
shows feeding cues (opening mouth, tonguing,
licking, rooting), making any verbal suggestions to
the mother to encourage her newborn to move
toward the breast (e.g., nudging).
o Counsel on positioning and attachment.
o When the baby is ready, advise the mother to:
a. Make sure the newborn’s neck is neither flexed
nor twisted.
b. Make sure the newborn is facing the breast, with
the newborn’s nose opposite her nipple and chin
touching the breast.
c. Hold the newborn’s body close to her body.
d. Support the newborn’s whole body, not just the
neck and shoulders.
e. Wait until her newborn’s mouth is opened wide.
f. Move her newborn onto her breast, aiming the
infant’s lower lip well below the nipple.
g. Look for good signs of good attachment and
suckling:
(1) Mouth wide open, (2) Lower lip turned outward, (3)
Baby’s chin touching the breast, (4) Suckling is slow, deep
with some pauses, (5) If the attachment or suckling is not
good, try again and reassess.
 NOTES
o Health workers should not touch the
newborn unless there is a medical
indication.
o Do not give sugar water, formula or other
prelateals.
o Do not give bottles or pacifiers.
o Do not throw away colostrum.
NOTES:
 Health Education (BUBBLESHE)
This method enhances the standard physical
assessment process. For stable patients, VS is taken
every 15 minutes during the first hour following delivery
and then gradually less frequently.
 Breast: assessment include evaluating the breast in
the postpartum period
o Breast evaluation
 Size
 Shape
 Firmness
 Redness
 Symmetry
o Bottle-Feeding Mom: Lactation Suppression
 Breast will be tender with feeling of heaviness
 Breast enlargement that occurs usually about 72
hours after birth.
 Firm, snug-fitting bra is ideal for the woman
whose not breastfeeding.
 Ice and cabbage leaves can provide relief
 Any warmth over the breast and stimulation of
the nipples will create faucet-like effect
 Uterus
o Fundus: firm or boggy- make a “C-shape” with your
hand and push up on the lower fundus; if it’s not
 stabilized, the uterus can prolapse, or fall into the
vagina.
o Fundal height
o Midline or Deviated to the Left or Right
o Nursing considerations – boggy fundus may be a
sign of uterine atony, which places the patient at risk
for developing a postpartum hemorrhage and other
complications.
 Bladder
o Bladder assessment
 Ask mom when she last voided
 Establish a voiding schedule to prevent bladder
distension and urinary stasis
 Encourage mom to urinate every time before she
feed baby.
 Bowels
o Bowel assessment
 Bowel in shock- just move into some strange
positions
 Take a stool softener- don’t want ripping or
episiotomy or trauma to the C-section incision.
 Lochia
o Lochia assessment
 Assess the color, odor, and amount
 The lochia color should forward in the
progression of lightness, never go backward
o Lochia color
  Lochia rubra: bright red, may have small clots,
usually lasts 3 days.
 Lochia serosa: pink, serous, other tissues.
 Lochia alba: tissue, whitish
o Lochia odor
o Lochia should have “no odor” or “no foul odor”
o Real world: virtually all lochia has unpleasant or
at least a neutral odor associated with it and
moms may be quick to describe it as “foul”
o It’s important for the nurse to assess the odor to
eliminate subjective patient description of the
scent
o A truly foul odor or a change in odor may be a
sign of infection.
o Lochia amount
 Scant: 2.5 cm saturation
 Light: < 10 cm saturation
 Moderate: > 10 cm saturation
 Heavy: pad is completely saturated within 2
hours
 Episiotomy and perineum
o REEDA Assessment
 Redness
 Edema
 Ecchymosis
 Discharge
 Approximation
o Perineal assessment
 Pull the labia from front to back
Check the episiotomy or areas of vaginal tearing
Look for hematoma formation
Look for hemorrhoids
Always help mom to get up and ambulate the first
two times after birth to assess for mobility, reduce
risk of falling, and prevent trauma to the perineum
and C-section incision.
o Hematoma care
 Start with cold to stop the bleeding, once it stops,
begin to warm
 Continue to monitor
 If it gets worse, that active area of bleeding is not
healing, and it will need to be opened and the
active area is discovered and cauterized.
 May not appear so much of an out pouching as
much as a disfigurement.
o Hemorrhoids
 Vasculature that forms pouch
 Color can match the skin in the rectal area and
may look more like a blood blister when irritated.
 Severe hemorrhoids appear as grape clusters.
 Intervention:
 Seitz Bath – a rotating fluid that moves the
water. May fit over the commode or one can
be performed with no special equipment
using the bathtub other than a bathtub ring.
Turn tub on and allow drain to open and use
 a ring for circulating water. It is very shallow
and only bathes the perineal area.
 Homan’s Sign
o Assess for signs of Deep Vein Thrombosis (DVT)
by the Homan’s sign.
 A positive Homan’s sign is indicative of DVT,
although it is not the most reliable indicator.
 All of the characteristic changes to maternal
clotting factors are higher than any other point as
the body prepares for labor.
 Combine this with being in bed, especially if mom
underwent a C-section, and it’s easy to see why
the postpartum woman is at such a huge risk for
DVT
o Performing Homan’s test
 Most commonly performed with the mom in a
supine position while lying in bed
 The calf is flexed at a 90 degree angle
 The nurse manipulates the foot in a dorsiflexion
movement
 If pain is felt in the calf, the Homan’s sign is said
to be positive.
o Signs of DVT
 Sudden and unexplainable pain, usually in the
back of the leg or calf.
 Tachycardia and shortness of breath or dyspnea.
 Edema, redness, and warmth localized over
the area of the DVT
 Emotional status
o Emotional status and bonding patterns
 Fluctuation in estrogen levels are blamed for
the emotional roller-coaster that many moms
experience after birth.
 High levels of stress, increased responsibility;
and sleep deprivation exacerbates this
 Bonding refers to the interaction between the
mother and the baby.
 Caregiving of self and baby is an indicator of
emotional status.
o Common postpartum assessment findings
 The Taking In Phase – may be considered as
self-focused, re-lives experience. This is different
from maladaptive.
 Taking Hold Place – a little bit about the mother,
a little about the baby. The world appears to be
revolving around the baby and mother as a unit.
 Letting-In Phase – Mother allows other people in.
o Comparing Blues, Depression and Psychosis
 Postpartum Blues – usually occurs within 2-3
weeks. Mother may be sensitive such as crying
during a commercial.
 Postpartum Depression – when the blues
moves to the point where mother can’t care for
herself or the baby.
 Postpartum psychosis – a severe form of
depression that warrants immediate intervention.
 When mother harms herself or the neonate or
considers doing so. Typically predicated by
depressive episodes.

Perineal Care
Perineal care is performed after a patient uses the bedpan,
becomes incontinent, and as a part of daily bathing. Follow
these steps:
1. Ask the patient to open his or her legs if they are able.
If not, you will need to gently separate the legs.
2. Using a washcloth and warm water, gently clean the skin
of the perineal area moving from front to back. Do not
move from back to front due to the risk of introducing
germs from the anal area into the urethra, a primary
source of urinary tract infection.
3. When you are finished washing, dry the area thoroughly
to prevent skin from becoming chapped.
4. Never reuse linens used to clean the perineal area to
clean any other part of the body. Use a clean washcloth
for this area only to minimize the spread of germs.
5. If bed linens are soiled or become wet during the cleaning
process, you will need to replace them as quickly as
possible.
6. Place used linens in the appropriate receptacle. Help
the patient move to a comfortable position. Dispose of
gloves and wash hands.
7. As you work, remember it is important to look for
signs that may indicate infection. This can include pain
 or tenderness in an area, rashes, sores, or boils. If you
notice any of these signs, report them to the nurse
immediately. Proper care can help your patient remain
comfortable as they recover.
Examiners Checklist for This Skill:
(Perineal care cont.)
1. Performed beginning tasks.
2. Filled basin with water at correct temperature to resident
preference, if applicable.
3. Covered the resident appropriately to avoid exposure and
maintain dignity.
4. Placed a waterproof pad under buttocks.
5. Positioned resident appropriately.
6. Wet washcloths and applied cleansing solution.
7. Washed perineal area:
a. Females: Separated the labia, cleaned front to back
using downward strokes. Used a clean area of the
cloth for each downward motion. Repeated using
additional cloths, as needed.
b. Males: Retracted foreskin in uncircumcised male.
Grasped penis, cleaned tip of penis using a circular
motion, washed down shaft of the penis and washed
testicles. Replaced foreskin of uncircumcised male.

8. Rinsed the perineal area, if applicable.

9. Turned the patient on their side facing away. Cleaned
anal area by washing from front to back.
10. Patted area dry, if applicable.
11. Removed waterproof pad and discarded.
12. Performed completion tasks.
 Pregnancy Category of Medicines
A Adequate and wee-controlled studies have failed to
demonstrate the risk to the fetus in the first trimester
of pregnancy and there is no evidence of risk in later
trimesters.
B Animal reproduction studies have failed to
demonstrate a risk to fetus and there are no
adequate and well-controlled studies in pregnant
women.
C Animal reproduction studies have shown an adverse
effect on the fetus and there are no adequate and
well-controlled studies in humans, but potential
benefits may warrant use in pregnant women despite
potential risks.
D There is positive evidence of human fetal risk based
on adverse reaction data from investigational or
marketing experience or studies in humans, but
potential benefits may warrant use in pregnant
women despite potential risks.
X Studies in animals or humans have demonstrated
fetal abnormalities and/or there is positive evidence
of human fetal risk based on adverse reaction data
from investigational or marketing experience, and the
risk involved in use in pregnant women clearly
outweigh potential benefits
N FDA has not classified the drug
 Medications
 Co-amoxiclav – (amoxicillin and
clavulanate)
Action: Amoxicillin inhibits bacterial cell wall
synthesis; Clavulanate inhibits beta-
lactamase – protects amoxicillin from
enzymatic degradation
Uses: Treatment for UTIs, ans S. aureus (not
MRSA) including lower respiratory, skin and
skin structure.
Contraindic Hypersensitivity to penicillin, hepatic
ations: impairment, severe renal impairment
Pregnancy: Crosses placenta, appears in cord blood,
amniotic fluid. Distributed in breast milk. May
cause rashes in infant.
Pregnancy Category B
Administrat Give without regard to meals.
ion Give food to increase absorption, decrease
stomach upset.
Indications/ PO: 250-500 mg q8h or 875 mg q12h
routes/dos
age
Side Diarrhea, loose stools, nausea, skin rashes,
effects urticarial

 Ferrous fumarate
Action: Essential component for formation of hgb,
myoglobin, enzymes
Prevents iron deficiency
Uses: Prevention/treatment of iron deficiency
anemia
Contraindic Hemochromatosis, hemolytic anemia
ations:
Pregnancy: Crosses placenta; distributed in breast milk
Pregnancy Category A
Administrat Do not give with milk products.
ion Given between meals with water; given with
meals id GI discomfort occurs.
Indications/ PO: 60-100 mg/day
routes/dos
age
Side Mild, transient nausea, heartburn, anorexia,
effects constipation, diarrhea

 Magnesium sulfate
Action Anticonvulsant: Blocks neuromuscular
transmission, amount of acetylcholine
released at motor end plate.
Therapeutic effect: seizure control.
Uses: Prevention/treatment of seizures in
eclampsia
Premature labor
Contraindic Heart block, myocardial damage, renal
ations: failure
Pregnancy: Readily crosses placenta; distributed in
breast milk for 24 hrs after magnesium
therapy is d/c
Pregnancy Category B
Administrat IV, slow piggy back
ion: IM, Z-tract method

Indications/ Therapeutic level: 4-7 mg/100ml
routes/dos
age:
Monitor: Suppression of DTR may be a sign of
impending respiratory arrest.
Absence of DTR - means increase in
magnesium level.
Maternal and fetal vital signs
Hypermagnesia – dizziness, palpitations,
altered mental status, fatigue, weakness.
Antidote Calcium gluconate

 Mefenamic acid
Action: First class NSAID
Inhibits prostaglandin synthesis by inhibiting
COX-1 and COX-2; thus decreasing
inflammation and pain
Uses: For acute and chronic arthritis; moderate
pain that does not exceed 1 week
Contraindic History of peptic ulcer
ations:
Pregnancy: Pregnancy Category C (D, in the third
trimester)
Administrat Can cause GI upset so it should be taken
ion with water, milk, or food.
Indications/ PO: initially: 500mg; then 250mg q6h PRN
routes/dos
age
Side Dizziness, tiredness, nausea, dyspepsia,
effects rash, constipation, bleeding, diarrhea.
 Methylergonovine (Methergine)
Action: Increases strength, frequency of uterine
contractions, decreases uterine bleeding
Uses: Prevention/treatment of postpartum or post
abortion hemorrhage due to atony,
involution.
Not for induction, augmentation of labor.
Contraindic HPN, pregnancy, toxemia, concurrent use
ations: with CYP3A4 inhibitors.
Pregnancy: Contraindicated; small amounts distributed
in breast milk
Pregnancy Category C
Administrat Initial dose may be given parenterally,
ion followed by oral regimen
IV use for life-threatening emergencies only.
Indications/ Prevention/treatment of postpartum/post-
routes/dos abortion hemorrhage:
age PO: 0.2 mg 3-4 times a day for up to 7 days.
IV, IM: Initially 0.2 mg after delivery of
anterior shoulder, after delivery of placenta,
 or during puerperium. May repeat q2-4h as
needed
Side Nausea, uterine cramping, vomiting
effects diarrhea, dizziness, abd. pain, diaphoresis,
tinnitus, bradycardia and chest pain.
 Oxytocin
Action: Contracts uterine smooth muscle. Enhances
lactation.
Uses: Induction of labor at term, control of
postpartum bleeding.
Contraindic Adequate uterine activity that fails to
ations: progress, cephalopelvic disproportion, fetal
distress without delivery, grand multiparity,
hyperactive/hypertonic uterus, obstetric
emergencies that favor surgical intervention,
prematurity, unengaged fetal head,
unfavorable fetal presentation/position, when
vaginal delivery is contraindicated.
Pregnancy: Used as indicated; small amounts in breast
milk; breast feeding not recommended
Pregnancy Category X
Administrat Given Intravenously
ion Compatible with heparin, insulin, KCl.
Indications/ Abortion: IV: 10-20 milliunits/min
routes/dos Control of postpartum bleeding: IV
age infusion 10-40 units in 1000 ml IV fluid.
IM: 10 units (total dose) after delivery.
Side Tachycardia, premature ventricular
effects contractions, hypotension, nausea, vomiting.
 Newborn Assessment
Apgar scoring
 The baby is checked at 1 minute and 5 minutes after
birth for heart and respiratory rates, muscle tone,
 reflexes, and color. Apgar scores of 6 or less usually
mean a baby needed immediate attention and care.
The Normal New Born
 Fontanel
o Anterior diamond – Closes at 18 mos.
o Posterior triangle – Closes at 2-3 mos.
 Head Circumference
o 35.5 cm – 36.5 cm
 Weight
o 6-9 lbs.
 Urine and meconium
o Within 12 – 24 hrs.
 Abdominal Circumference
o 1cm less than Head circumference
 Baby length
o 52 – 53.5 cm
 Vital Signs:
o Apical pulse:
 120-140
 Other says 120-160
o RR – Diaphragmatic and abdominal with period of
apnea (< 15 seconds)
 30-60
 Other says 40-60
  Nose breather
o BP
 65/41

Care of the Newborn

 Airway
o Maintain respirations at 30-50 bpm
o Suction secretion by a bulb syringe (M) mouth first,
the (N) nose before the first breath to prevent
aspirations
o Vigorous suctioning causes vasovagal response –
bradycardia.
o Babies born with meconium-stained amniotic fluid
are incubated with endotracheal suctioning.

 Warm
o Rub dry; swaddle & loose blanket; place in warmed
bassinet or unwrapped in radiant heat warmer.
o Take axillary temp. at the end of 1st hour of life, then
every 4 hours for the 1st 24 hours of life, once a day
onwards. If rectal, the purpose is to detect
imperforate anus.
o If normal temperature (37oc), bathe quickly.

 Monitor character of crying

o Vigorous crying blows off extra carbon dioxide,
making all newborns slightly acidotic
 o Note for the time of gasping and crying after birth.

 Umbilical cord care

o Assess umbilical cord pulsation.
o Note for number of vessels of the cord – 2 arteries, 1
vein – immediately after cutting.
o Assess cord for possible bleeding – apply antibiotic
or triple dry to reduce infection.
o Sponge bathing is advised until cord falls off on the
7th – 10th day of life.
o Avoid using creams, lotions or oils near the cord to
fasten drying and prevent infections.
o Dabbing with rubbing alcohol once or twice a day
may help fasten drying.

 Eye care
o Credé prophylaxis – Gonorrheal conjunction
prophylaxis
o Erythromycin ointment is more commonly used
today; (Silver Nitrate was the drug of choice in the
past.
o Penicillin ophthalmic ointment or drops may be
used and is effective against gonorrheal strains (but
was discouraged due to the development of PCN
sensitivity at an early stage).
 o Use individual tube or package per infant. Instill or
squeeze ointment along the lower eyelid from the
inner canthus to the outer canthus.

 Initial feeding
o May breastfeed immediately after birth (E.O. 51)
o For baby who is to be formula-fed, give 1oz of sterile
water first at 4-6 hours of age, then every 4 hours, 3
or 4 subsequent feedings with glucose water then
formula may be started.

 Bathing
o Complete bath within an hour after birth to remove
vernix caseosa.
o Once a day, thereafter limiting to face, diaper area &
skin folds only.
o Room temperature – 24 ⁰C (75⁰F)
o Bath water 98-100⁰F (37-38⁰C)
o Mild soap without hexachlorophene base.
o Bathe prior to, NOT AFTER, a feeding to prevent
spitting, vomiting and/or aspirations.
o Proceed from the cleanest to the dirtiest area of the
body (eyes, face to the trunk & extremities, LAST –
diaper area)
o Wash eyes using clean, clear water from inner
canthus outward using separate clean portion of
washcloth for each eye.
 o DO NOT SOAK THE CORD.
o No tub bath until cord has fallen off.
o Wash skin creases as milk tends to collect in these
areas during spitting.
o Don’t retract forcefully the foreskin of uncircumcised
penis – to prevent constriction of the penis.
o Wash female vulva from front to back – to prevent
contamination of the vaginal/urethral area by rectal
bacteria.
o Avoid powder or lotion to newborn – due to allergies
by some infants.
o Zinc stearate in talcum powders – irritating to
respiratory tract

 Vitamin K Administration
o 1mg of (IM) of phytonadione (water soluble Vitamin
K1) immediately after birth to prevent hemorrhagic
disease.
o Larger IV doses – development of
hyperbilirubinemia and kernicterus.

 Identification
o Foot Stamping
o Name tag
NOTES:
NOTES:
 Formulas for calculating pediatric
dosages
 Fried’s rule – applies to a child younger than 1 year of
age. The rule assumes that an adult dose would be
appropriate for a child who is 12.5 years old

 Surface area calculation – determine the appropriate

dosage that should be used. The child’s surface are
determined with the use of nomogram.
 Reflexes (Newborn)

 Rooting reflex
o This reflex starts when the corner of the baby's
mouth is stroked or touched. The baby will turn his
or her head and open his or her mouth to follow
and root in the direction of the stroking. This
helps the baby find the breast or bottle to start
feeding. This reflex lasts about 4 months.
 Suck reflex
o Rooting helps the baby get ready to suck. When the
roof of the baby's mouth is touched, the baby will
start to suck. This reflex doesn't start until about
the 32nd week of pregnancy and is not fully
developed until about 36 weeks. Premature
babies may have a weak or immature sucking
ability because of this. Because babies also have
a hand-to-mouth reflex that goes with rooting and
sucking, they may suck on their fingers or hands.
 Moro reflex
o The Moro reflex is often called a startle reflex.
That’s because it usually occurs when a baby is
startled by a loud sound or movement. In response
to the sound, the baby throws back his or her
head, extends out his or her arms and legs,
cries, then pulls the arms and legs back in.
  Tonic neck reflex
o When a baby's head is turned to one side, the arm
on that side stretches out and the opposite arm
bends up at the elbow. This is often called the
fencing position. This reflex lasts until the baby is
about 5 to 7 months old.
 Grasp reflex
o Stroking the palm of a baby's hand causes the
baby to close his or her fingers in a grasp. The
grasp reflex lasts until the baby is about 5 to 6
months old. A similar reflex in the toes lasts until 9 to
12 months.
 Stepping reflex
o This reflex is also called the walking or dance reflex
because a baby appears to take steps or dance
when held upright with his or her feet touching a
solid surface. This reflex lasts about 2 months.
NOTES:
 Family Planning Methods
 Fertility awareness
About the method About the use
It means that a woman  May start anytime.
learns how to tell when the Requires 6 cycle record
fertile period of her before starting calendar
menstrual cycle starts and method.
end.  Calendar and BBT are
 Calendar method unreliable immediately
 Cervical secretion method after childbirth.
– sense cervical wetness  Characteristic cervical
to detect fertility. secretion that signal
 Basal Body Temperature fertility: slippery, wet, and
(BBT) – rely on women’s can be stretched
resting body temperature (spinbarkeit)
which goes up slightly  BBT should be taken each
higher at the time of morning before getting out
ovulation. of bed and engaging in
 Sympthothermal activity
technique – combination  Calendar method
of 2-3 methods requires recording of the
 Periodic abstinence – no number of days in each
sex during fertile period. menstrual cycle for at
least 6 months, identifying
the first day of mense as
 day 1. Woman subtracts
18 from the length of her
shortest cycle (telling the
first day of fertile day),
then she subtracts 11 from
the length of her longest
cycle (telling the last day
of her fertile time.

 Lactational amenorrhea method (LAM)

About the method About the use
 Use of breast feeding as  The following condition
a temporary family increase the mother’s
planning method. chance of being
 A woman is naturally pregnant: (A) menstrual
protected from period returns; (B)
pregnancy when: (A) her regularly giving baby
baby gets at least 85% much food other than
of feeding as breast milk, breast milk; and (C)
(B) her menstrual cycle baby is more than 6
has not returned, and months old
(C) her baby is less than  Encourage mothers to:
6 months old. breastfeed often (8-10
 Protection from times a day or at least
pregnancy may be as once at night) with no
long as 9-12 months, daytime feedings
 provided she keeps regularly more than 4
breastfeeding very often, hours apart, no night
day and night. feedings regularly more
than 6 hours apart;
breastfeed properly; and
start other food when
baby is 6 months old;
and start family planning
methods when
necessary.

 Combined oral contraceptives

About the method About the use
 Contains estrogen and  Take one pill each day,
progestin that stop the same time of the day. The
ovulation, and also more pills are missed, the
thickens cervical mucus, greater the risk of
making it difficult for the becoming pregnant.
sperm to pass through.  The best time to start is
 Effective (especially when anytime during the first 5
taken everyday in the first days after her menstrual
year of use), convenient, bleeding starts, or first day
lead to lighter and regular of menses.
menses with milder  If woman missed one or
abdominal cramps, can be more pills, advise to take
stopped anytime, and the pill as soon as she
 fertility returns, and can be remembers, and take the
used by any age group. next pill at the usual time
 In a 28-pill packet contains onwards.
7 reminder pills that  If a woman missed any 5
contain no hormone. If or more active pills in a
women forgets these row (day 1-21), advise to
reminder pills, she is still finish daily all active pills in
protected. the pack, and not to take
the last 7 (inactive pills).
And also start a new pack
and not wait 7 days to start
new 21-pill pack.
 Combined oral
contraceptive is not
preferred if mother is
breastfeeding.
 Not given for patient with
breast cancer.

 Progestin-only oral contraception

About the method About the use
 Contains only 1/2 to 1/10  Most effective when taken
as much progestin as the at about the same time
combined oral everyday.
contraceptives, preventing  Does not affect the
quantity and quality of
 ovulation and thickening breast milk. Hence can be
the cervical mucus. given to breastfeeding
 Contains no estrogen. women as early as 6
Hence, no estrogen side weeks postpartum.

 DMPA (Depot-medroxyprogesterone
acetate)
About the method About the use
 Injectable contraceptives  Breastfeeding mothers
that contains progestin may be given DMPA
that is similar to the beginning 6 weeks
natural hormone that a postpartum.
woman’s body makes.  Not given to those who
Stops ovulation and have breast CA, HPN, and
thickens cervical mucus. other cardiac disorders.
 Depo-Provera and  Should never be given to
megastron are given every pregnant women!
3 months Ascertain first that woman
is not pregnant before
injection.
 May be started anytime
provided that woman is
not pregnant.
 Next injection (3 months
after) may be given 2
 weeks early or late.
Advice to use other
method if next injection is
more than 2 weeks.

 Bilateral tubal ligation (BTL-Sterilization)

About the method About the use
 A safe and simple surgical  No medical; condition
procedure using local prevents a woman from
anesthesia that provides using sterilization. Come
permanent sterilization by factors may delay awaiting
blocking off (tie/cutting) resolution (pregnancy,
the two fallopian tubes. postpartum complications,
 Successful reversal is not STDs), and referral
guaranteed. Hence, only (hernia, endometriosis,
for women who do not breast CA).
want to have children  Best time – immediately
anymore after birth or within 7 days.
 No major changes in NOT between 7 days and
menstrual patterns, unless 6 weeks postpartum.
related to other factors.  Voluntary, informed
consent.
 Post op, should not have
sex for at least 1 week;
avoid heavy lifting; rest for
3 days.
  Vasectomy
About the method About the use
 Simple, safe and quick  First 20 ejaculations after
permanent contraception vasectomy (or 3 months
that cuts off vas deferens after) may still contain
to completely ensure sperm
blockage of the passage  No medical condition
of sperm prevents a man from using
 No-scalpel vasectomy vasectomy. Some factors
involves tiny puncture may delay (active STD,
instead of any incision, inflammation of genitals,
leading to shorter recovery scrotal infection/mass),
time. refer (hernia and
undescended testis.
 Post op – 2 days cold
compress, wearing snug-
fit underwear; sex may
assume 2-3 days after
procedure (but remember,
20 ejaculations may still
contain sperm)

 Condom
About the method About the use
 A sheath or covering (thin  EDUCATE to put on
latex rubber coated with condom before penis
lubricant or spermicides, touches partner.
coming in different sizes,  Do not unroll before use
shapes, color, texture, and (difficult to put on and
TASTES TOO!) weakens the condom)
 Helps to prevent STDs  Use only water-based
 Disadvantage: allergy to lubricant if necessary, as
some latex, decreased oil can damage condoms.
sensation, and availability  After ejaculation, hold the
required; weakened rim of the condom to the
condoms if stored too long base so it will not slip off.
or in too much heat and Pull penis from the vagina
humidity. before completely losing
erection.
 Do not reuse condom;
dispose off properly

 Vaginal methods
About the method About the use
 Spermicides kill sperm or  Store spermicides in a
make sperm unable to cool, dry place so it will
move towards the egg. not melt.
 Diaphragms and cervical  To insert diaphragm, a
caps block sperm from woman squeezes its sides
 entering the uterus and together and pushes it into
tubes. her vagina as far as it will
 May prevent some STDs; go. Then, with her finger,
safe woman-controlled she checks that the
method that offers diaphragm fits snugly
contraception only when behind the pubic bone and
needed; no hormonal side covers the cervix.
effects; no effect on breast  Diaphragm should be kept
milk. Spermicides can be in place after intercourse
inserted one hour before for at least 6 hours! But
to avoid interruption of not more than 24 hours
sexual act. (risk for toxic shock
 Irritation and local reaction syndrome).
and UTI to woman and  Films and suppositories
partner; may be messy; may be inserted at least
diaphragm requires fitting 10 minutes before sex.
and may be difficult to  DO NOT douche for at
remove. least 6 hours after sex
using vaginal methods.

 Intrauterine devices (IUD)

About the method About the use
 Insertion of small, flexible  IUD is best inserted during
plastic that often has menstruation (because it
copper wire or sleeves in is sure that woman is not
pregnant)
 it, into the uterus through but may also be given
the vagina. within first 12 days after
 The strings hang through the start of menstrual
the opening of the cervix, bleed, or any time if it is
which allows the user to reasonable sure that
check if IUD is in place. It woman is not pregnant.
is also what health care  IUD may also be inserted
providers pull gentle with within 10 mins. after the
forceps on removal. delivery of the placenta or
 Possibly prevents up to 48 hours after
pregnancy by preventing childbirth, by specially
fertilization, or making it trained professionals.
hard for sperm to move  Removal is easiest during
through the woman’s menstruation because
reproductive tract, or cervix is dilated.
preventing implantation  Advised to check IUD
 Advantage: long term weekly during the first
prevention of pregnancy; month of insertion and
no hormonal side effect; every after menstrual
immediately reversible; period.
can be inserted after  IUD does not cause
immediately childbirth; no discomfort to partner or
interaction with any woman during sex; if so,
medicine. the strings may be
 Disadvantage: menstrual shortened.
changes in the first 3
 months; Pelvic  Remove IUD if woman got
inflammatory disease pregnant to prevent
(PID) following STD; client severe infection,
cannot stop use of IUD on miscarriage or premature
her own; may come out of birth.
uterus without woman’s
notice.

NOTES:
Erikson’s psychosocial theory of human
development
Stages Developmental task Strength
Oral-sensory TRUST-MISTRUST Drive and hope
(birth – 1
year)
Musculo- AUTONOMY-DOUBT Self-control and will
anal (1-3 AND SHAME power
years)
Locomotor- INITIATIVE-GUILT Direction and
genital (3-5 purpose
years)
Latency (6- INDUSTRY- Methods and
11 years) INFERIORITY competence
Adolescence IDENTITY-ROLE Devotion and fidelity
(12–18 CONFUSION
years)
Young adult INTIMACY- Affiliation and love
(19-35 ISOLATION
years)
Adulthood GENERATIVITY- Production and care
(35-50 STAGNATION
years)
Maturity (50 EGO INTEGRITY-
+ years) DESPAIR
 Piaget’s theory of cognitive
development

Sensorimotor (0-2 Development proceeds from reflex

years) activity to representation and
sensorimotor solutions to problem

Pre-operational (2- Problem solved through

7 years) REPRESENTATION; language
development; (2-4 years); thoughts and
language both EGOCENTRIC; cannot
solve conservation problems.

Concrete operation Reversibility attained; can solve

(7-11 years) conservation problems; LOGICAL
OPERATION developed and applied to
CONCRETE problems; cannot solve
complex verbal problems.
Formal operation LOGICALLY SOLVES all types of
11 years – problems; thinks SCIENTIFICALLY;
adulthood) solves COMPLEX problems;
COGNITIVE structures mature.

NOTES:
Community Health Nursing
 Overview
 Clients of community health nurse
o Individual
o Family
o Population group
o Community
 What is community?
o A group of people with common characteristics or
interest living together within a territory or
geographical boundary.
o The best object or focus of care.
o The patient in CHN is the community.
o Client is active not passive.
 What is health?
o A state of physical, mental and social well-being and
not merely the absence of disease or infirmity
(WHO, 1995).
o Basic Human Right
 What is nursing?
o The diagnosis and treatment of human responses to
actual or potential health problems (ANA, 1980).
o Objective is to achieve, maintain, or recover a high
level of functioning.
o A general practice – deals with all cases.
 Primary focus of CHN
o Health promotion wherein health teaching is the
primary responsibility.
o Promotive-preventive service.
 Public heath
 Objectives of public health
o Preventing disease
o Prolonging life
o Promoting health
 Through…
o Sanitation of the environment.
o Control of communicable infections.
o Education of individual in personal hygiene.
o Organization of medical and nursing services for
the early diagnosis and preventive treatment of
diseases.
o Development of social machinery to ensure
everyone a standard of living adequate for the
maintenance of health.
 Primary Health Care (PHC) – is essential
healthcare made
o Universally accessible to individuals and families
in the community,
o Acceptable to them through their full participation,
o And at cost that the community and country can
afford, in the spirit of self-reliance and self-
determination.
 Four cornerstones of PHC
o Inter- and intra-sectoral linkages (multisectoral
linkages)
  Intersectoral – population control, private
sectors, social welfare, public service,
environmental, etc.
 Intrasectoral – people’s empowerment, within
own system.
o Active community participation
o Use of appropriate technology – method used to
provide a socially and environmentally acceptable
level of service or quality product at the least
economic cost. (ex. 10 medicinal plants, Botika sa
Baryo)
 Safe
 Acceptable
 Feasible
 Effective
 Scope-wise
 Affordable
 Complex.
o Support mechanism made available
Village/grass root Intermediate level Health personnel
(barangay) health of First-line
workers hospitals
Trained community General medical Physicians with
health worker; practitioners specialty area
health auxiliary Public health Nurses
volunteer; nurses Dentists
traditional birth Midwives
attendant/healer
 DOH 2030
Vision by 2030
A global leader for attaining better health outcomes,
competitive and responsive healthcare systems, and
equitable health financing.
Mission
To guarantee equitable, sustainable, and quality health
for all Filipinos, especially the poor and to lead the quest for
excellence in health.
Principles in attaining the vision of DOH
 Equity – equal health services for all
 Quality – Philosophy of DOH: “Quality is above quantity”
 Accessibility
NOTES:
 Basic health services (DOH)

 Education for health – potent methodology that enriches

partnership with people.
 Local endemic disease control
 Expanded program on immunization
 Maternal and child health services
 Essential drugs and herbal plants
 Nutrition – Nutritional Health Services (PD 491): Creation of
Nutrition Council of the Philippines
 Treatment of communicable and non-communicable
diseases
 Safe water and sanitation – Sanitation of the Environment
(PD 856): Sanitary Code of the Philippines

 Dental health promotion

 Access to use of hospitals as Centers of Wellness
 Mental health promotion
 CHN Process
 Rapport
o Initiating contact
o Communicating interest in the client’s welfare
o Showing willingness to help with expressed need of
the client
o Maintaining a two-way communication with the client
 Assessment
o Data gathering: tools or instruments used during
survey:
 Interview
 Observation
 Questionnaires – mostly patronized and used in
CHN
 Records and reports available
o Consolidation and Collation: collecting back the
questionnaires, tabulate and summarize.
o Validation: use statistical approaches.
Statistical Approaches:
1. Central tendencies: 3 M’s
a. Mean – average
b. Median – range (highest to lowest score)
c. Mode – Frequency of occurrence of a variable,
used if there is too many variable occur.
 2. Standard deviation: used if there are too many
variables available to be treated which is seldom
used in CHN

a. - summation
b. − variables available
c. − mean
d. − no. of existing variables
3. Percentile method: most common used in CHN by
adding all scores then multiply by 100
o Presentation of data
 Table/chart
 Graph:
 Pie chart
 Bar graph
 Line graph
 Polygon connecting results
 Histograph – 2 or more variable & appear
adjacent to each other
Typology of Nursing Problems in Family
Nursing Practice

First level assessment: to determine problems of

family
1. Sources of problems using IDB
 2. Family: use of initial data base (IDB)
3. Nature: health deficit, health threat, foreseeable
crisis
Use of initial database
 Family Start Structure:
o Nuclear
o Extended
o Multi-generational extended
o Dyad
o Blended
o Gay
o Matriarchal
o Patriarchal
o Communal
 Socio-economic: poverty level, educational
attainment & nature of occupation of members of
the family.
 Socio-cultural: different nature or religion
 Home environment: assessment according to ES,
treatment of garbage, preparation of food,
availability of toilet, water & food sanitation, sources
of disease.
 Medical history: history of certain disease, family
member with disease.
 Resources: available in the community for use by
the family
Generalized M’s in resources available in
community
 Man/manpower
 Money
 Machine
 Materials
 Methods
Identifying it according to nature
 Presence of Wellness Condition:
o Wellness potential – is a nursing judgment on
wellness state but no explicit expression of client
desire.
o Readiness for enhanced wellness state – is a
judgment on wellness state on wellness state based
on current competencies and performance, clinical
data, and explicit expression of desire to achieve
higher level of functioning or state.
 Presence of Health Threats:
o Health threats – are conditions that are conductive
to disease, accident or failure.
 Presence of Health Deficits:
o Health deficits – are instances of failure in health
maintenance.
 Presence of Stress Points/Foreseeable Crisis
Situation:
 o Stress points/Foreseeable Crisis – are anticipated
periods of unusual demand on the individual or
family in terms of adjustment/family resources.
Second level assessment
 Inability to recognize the presence of the condition of
problem.
 Inability to make decisions with respect to taking
appropriate health action.
 Inability to provide adequate nursing care to the sick,
disabled, dependent or vulnerable/at risk member of the
family.
 Inability to provide a home environment conductive to
health maintenance and personal development.
 Inability to utilize community resources for health
care.

 Planning- four standard steps:

o Prioritization – start if there are multiple identified
problems.
o Formulation of objectives – planning a procedure
will start here if there is only one problem
o Developing strategies of action
o Formulation of evaluation tools – for the identified
strategy developed
Criteria for ranking health conditions and
problem according to priorities:
1. Nature of the condition or problem presented
2. Modifiability of the condition or problem (probability of
success)
3. Preventive potential
4. Salience (perception/evaluation of seriousness and
urgency)

 Intervention
o Capacity to provide management
o The professional phase of nursing process
o The time when PHN executes the standard function
of an RN
o 3 standard functions of RN
 Dependent - giving of medicines
 Independent – monitor, assess, provide,
educate.
 Interdependent – referrals
 Evaluation – 3 things to be evaluated
o Structure of program & activity – what articles,
equipment, supplies are utilized
o Processed utilized – steps used
o Outcome of activity – results can be:
 Desirable to be implemented, advocated,
strengthen
  Undesirable – to be avoided
2 aspects to be evaluated in the outcome
 Quality – characteristic or kind of outcome; no
numerical value, not measured.
 Quantity – with numerical value, measurable.
Elements of community diagnosis
Demographic Size, composition, and geographical
variables distribution.
Socio-economic Socio-economic indicators, environmental
variables indicators, cultural factors
Illness-Health Leading causes of death and illness
pattern
Resources for Human resource and material resource
health
Political- Power structures and people attitude to
leadership authority.
patterns

Major strategies of primary health care:

1. Elevating health to a comprehensive and sustained
national effort.
2. Promoting and supporting community-managed health
care.
3. Increasing efficiencies in the health sector.
4. Advancing essential national health research.
E-L-E-M-E-N-T-S of PHC
 Education for health
 Locally endemic diseases control
 Expanded program on immunization
 Maternal and child health
 Essential drugs
 Nutrition
 Treatment of communicable diseases
 Safe water and sanitation.
 Community Organizing
A process by which people, health service and
agencies of the community are brought together to.
 Learn about the common problems
 Identify these problem as their own
 Plan the kind of action to solve the problems
 Act on this basis
Different phases:
 Preparation phase
o Area selection
o Profiling the community
o Entry and integration
 Organization phase
o Social preparation
o Spotting and developing potential leaders
o Core group formation
o Setting up community organization.
 Training and education phase
o Community diagnosis
o Training health workers
o Health services mobilization
o Leadership formation
 Collaboration phase
o Intersectoral collaboration
o Sourcing out of external resources
 o Coordination with external institutions, agencies
and people
 Phase-out phase
o Gradual preparation for turnover of work
o Planning for monitoring
o Follow-up
Duvall and Miller 8 family tasks
1. Physical maintenance
2. Socialization of family members
3. Allocation of resources
4. Maintenance of order
5. Division of labor
6. Reproduction, recruitment and release of family
members
7. Placement of members into a large society
8. Maintenance of motivation and morale.
Duvall’s Family Cycles
1. Marriage
2. Early childbearing
3. Families with preschool children
4. Families with school-aged children
5. Families with adolescent children
6. Launching center families
7. Families of middle years
8. Family in retirement or old age.
 Rates and Ratio (Vital Statistics)
Rate – shows the relationship between a vital event and
those persons exposed to the occurrence of the said event,
within a given area and during a specified unit of time.
Ratio – describe the relationship between 2 numerical
quantities or measures of events without taking particular
considerations to the time of place.
Crude or General rates – the rates are referred to the
total living population. It must be presumed that the total
population was exposed to the risk of occurrence of the
event.
Specific rate – the relationship for a specific population,
class or group. It limits the occurrence of the event to that
portion of the population definitely exposed to it.

 Crude birth rate – a measure of one characteristic of

the natural growth or increase of a population

 Crude death rate – A measure of one mortality from all

causes which may result in a decrease of population
 Infant mortality rate – measures the risk of dying during
the 1st year of life. It is a good index of the general
health condition of a community since it reflects the
changes in the environmental and medical conditioning
of a community

 Maternal mortality rate – measures the risk of dying

from causes related to pregnancy, child birth, and
puerperium. It is an index of the obstetrical care needed
and received by the women in community.

 Fetal death rate – measures pregnancy wastage. Death

of the product of conception occurs prior to its complete
expulsion, irrespective of duration of pregnancy.
Neonatal death rate – Measures the risk of dying during the
1st month of life. May serve as index of the effects of prenatal
care and obstetrical management on the newborn.
 7 principles and strategies (DOH)
1. Accessibility, availability, and acceptability of Health
services
a. Delivery of health services where the people are
b. Use of indigenous volunteer workers as health care
providers (1:10-20 ratio)
c. Use of traditional medicine together with essential
drugs.
2. Provision of quality basic and essential health
services
a. Competency-based training design and curriculum
based on community needs and priorities.
b. Attitude, knowledge, and skills developed on
promotive, preventive, curative and rehabilitative
health care
c. Regular monitoring and periodic evaluation of CHW
performances by community and health staff
3. Community participation
a. Awareness building and consciousness raising on
health and health related issues
b. Planning, implementation, monitoring and evaluation
done through small group meetings
c. Selection of CHW by the community
d. Community building and organizing
e. Formation of health committees
f. Establishment of community health worker
organization at the municipal level
 g. Mass health campaign and mobilization to combat
health problems
4. Self-reliance
a. Community generates support for the health program
b. Use of local resources
c. Training of community in leadership and management
skills.
d. Incorporation of income generating projects,
cooperatives and businesses.
5. Recognition if interrelationship between health and
government
a. Convergence of health, food, nutrition/water,
sanitation, and population services.
b. Integration of PHC into national, regional, provincial,
municipal, Barangay development plans.
c. Coordination of activities with economic planning,
education, agriculture, industry, housing, public
works, communication and social services.
6. Social mobilization
a. Establishment of an effective health referral
b. Multisectoral and interdisciplinary linkages
c. Information, education, communication, support using
multimedia
d. Collaboration between government and NGO
7. Decentralization
a. Relocation of budget resources
b. Reorientation of health professionals on PHC
c. Advocacy for political will and support from national
leadership down to the barangay level
 Strategies in delivering health services
 Creation of Restructures Health Care Delivery System
(RHCDS) regulated by PD 568 (1976)
o Creation of RHCHS
 RHO (National Health Agency)
 National agencies like PGH
 Specialized agencies such as Heart Center
for Asia
 MHO & PHO (Municipal/Provincial Health Office
 BHS & RHU (barangay Heath Station/Rural
Health Unit
 Management Information Systems regulated by RA
3753: Vital Health Statistics Law
 Primary Health Care regulated by Letter of Instruction
(LOI) 949 (1984): Legalization of implementation of PHC
in the Philippines
Sentrong Sigla Movement (SSM)
Established by DOH with LGUs having a logo of 8 rays and
composed of 4 pillars:
1. Health promotion
2. Granted facilities
3. Technical assistance
4. Awards: cash, plaques, certificates
 3 levels of health care
 Primary – prevention of illness or promotion of health
o Barangay health station.
o Rural health units, community hospitals and health center
 Information dissemination
 Secondary – curative; diagnosis and treatment.
o Emergency district hospital
o Provincial/city hospitals; provincial/city health services
 Screening
 Tertiary – rehabilitative
o Regional health services; regional medical centers and
training hospitals.
o National health services; medical centers; teaching and
training hospitals
 PT/OT

Referral system:
BHS  RHU  MHO  PHO  RHO  National
agencies  Specialized agencies.
 BHS is under the management of Rural health midwives
(RHM)
 RHU is under the management or supervision of PHN
 Public health nurse (PHN) caters 1:10,000 population,
acts as managers in the implementation of the policies
and activities of RHU, directly under the supervision of
MHO.
 Contributions of PHC to DOH &
Economy
 Training of Health Workers
o 3 levels of training:
 Grassroots/village – non-professionals, didn’t
undergo formal training, receive no salary but
are given incentive in a form of honorarium from
the local government since 1993
 Intermediate – professionals including 8
members of the PHW:
 Medical officer – Physician
 Public health nurse – RN
 Rural health midwife – Registered midwife
 Dentist
 Nutritionist
 Medical technologist
 Pharmacist
 Rural sanitary inspector – sanitary engineer
 First line personnel
 Creation of Botika sa Baryo & Botika sa
Health Center – R.A. 6675: Generics Act of 1988
implementing:
o “Oplan Walang Reseta Program” – solution to the
absence of a medical officer who prescribed the
medicines so PHN are given the responsibility to
prescribe generic medicines.
 o “walong Wastong Gamot Program” – available
generics in “Botika sa Baryo: & health center
o Father of Generics Act: Dr. Alfredo Bengzon.
 Herbal Plants – R.A. 8423: Alternative Traditional
Medicine law.
o Program where patient may opt to use herbal plants
especially for drugs that are not available in dosage
form or patients has no financial means to buy the
drug.
 Oresol
Glucose 20g 1⁰ degree significance:
o For reabsorption of Na
o Facilitates assimilation of Na
2⁰ significance:
 Provides heat and energy
NaCl 3.5g For retention of fluid/water
Sodium 2.5g  Buffer content solution
bicarbonate  Neutralizer content of solution.
KCl 1.5g Stimulates smooth muscle
contractility especially the heart
and GI tract

o Preparation of proper homemade Oresol

A volume of 1L homemade Smaller volume or a glass
Oresol homemade Oresol
Water: 1L 250ml
Sugar: 8 teaspoon 2 teaspoon
Salt: 1 teaspoon 1/4 teaspoon or a pinch of
salt
o 10-12 granules of rock
salt
o Iodized salt - tips of
thumb & index finger are
penetrated with salt

NOTES:
8 commonly available generics
 Co-Trimoxazole – combination of Trimethoprim
(TMP) and Sulfamethoxazole (SMZ)
Action: Bacteriostatic (TMP) and Bactericidal (SMZ)
in susceptible organisms
Uses: TMP+SMZ:
 For UTI, GIT, URTI
SMZ:
 For UTI, GIT, URTI, and skin infections.
Contraindic Renal/hepatic impairment, pregnancy (at
ations: term), hypersensitivity to sulfonamides,
infants younger than 2 months,
megaloblastic anemia.
Pregnancy: Contraindicated during pregnancy; readily
crosses placenta; distributed in breast milk.
Pregnancy Category C (D at term)
Administrat Administer on empty stomach with 8 oz.
ion water.
Indications/ PO: Adult - One double-strength tablet q12-
routes/dos 24 hours.
age Mild to moderate infection: PO: Children:
8-12mg/kg/day as trimethoprim in divided
doses q12h
Severe infections: PO: Children:
20mg/kg/day as trimethoprim in divided
doses q6h
Side Anorexia, nausea, vomiting, rash (7-14 days
effects after therapy), urticarial, diarrhea, abdominal
pain,
 Amoxicillin/Ampicillin
 From penicillin family
 Effect is generally bacteriostatic
 These 2 drugs provide the least reaction.
o Amoxicillin
Action: Bactericidal in susceptible microorganisms.
Affects bacteria and produces bacteriostatic
effect when source of infection is bacteria.
Uses: Ear, nose, and throat infection.
LRTI infections
Skin infection
UTI and acute gonorrhea
H. pylori – causes peptic ulcer
Contraindic Hypersensitivity to penicillin.
ations:
Pregnancy: Crosses placenta, appears in cord blood,
amniotic fluid. Distributed in breast milk. May
cause rashes in infant.
Pregnancy Category B
Administrat Give without regard to meals.
ion Give food to increase absorption, decrease
stomach upset.
Indications/ PO: Adult, elderly, children 12 years and
routes/dos older: 250-500 mg q8h or 875 mg q12h
age Children older than 3 months: 20-
50mg/kg/day in divided doses q8-12h.
Children 3 months and younger: 20-
30mg/kg/day in divided doses q12h
Side (GI disturbance) Diarrhea, loose stools,
effects nausea, skin rashes, urticarial
o Ampicillin
Action: Bactericidal in susceptible microorganisms.
Affects bacteria and produces bacteriostatic
effect when source of infection is bacteria.
Uses: GI, GU, respiratory infections
Meningitis, endocarditis prophylaxis
Contraindic Hypersensitivity to penicillin.
ations:
Pregnancy: Crosses placenta, appears in cord blood,
amniotic fluid. Distributed in breast milk. May
cause rashes in infant.
Pregnancy Category B
Administrat Given orally 1-2 hrs. before meal for
ion maximum absorption
Indications/ PO: Adults, Elderly: 250-500 mg q6h
routes/dos Children: 50-1—mg/kg/day in divided doses
age q6h.
Maximum: 2-4g/day
Side (GI disturbance) Diarrhea, loose stools,
effects nausea, skin rashes, urticarial

 TB Drugs
o Rifampin
Action: Bactericidal in susceptible organisms
Interferes with bacterial RNA synthesis.
Uses: In conjunction with at least one other
antitubercular agent for initial treatment. Re-
treatment of clinical tuberculosis.
Contraindic Hypersensitivity to other rifamycins
ations:
Pregnancy: Crosses placenta, distributed in breast milk
Pregnancy Category C
Administrat Give 1 hour before or 2 hours following meal
ion with 8oz. of water
For those unable to swallow capsules,
content may be mixed with applesauce, jelly
Indications/ PO, IV: Adult - 10mg/kg/day
routes/dos Maximum: 600mg/day
age Children - 10-20mg/kg/day in divided doses
q12-24h.
Maximum: 6000mg/day
Side Red-orange or red-brown discoloration of
effects urine, feces, saliva, skin, sputum, sweat,
tears.

o Isoniazid
Action: Inhibits mycolic acid synthesis
Bactericidal against actively growing
intracellular, extracellular susceptible
mybobacteria
Uses: Treatment for mycobacterial infection due to
Mycobacterium tuberculosis.
Drug of choice in tuberculosis prophylaxis.
 Used in combination with other
antitubercular agents.
Contraindic Acute hepatic disease, hx of sensitivity
ations: reactions, severe adverse reaction to
isoniazid therapy.
Pregnancy: Prophylaxis usually postponed until after
delivery; crosses placenta; Distributed in
breast milk
Pregnancy Category C
Administrat Given 1 hour before or 2 hours following
ion meals.
Indications/ Active TB:
routes/dos  IM/PO: Adults, Elderly: 5mg/kg/day as
age a single dose. Usual dose: 300mg/day
 Children: 10-15 mg/kg/day as a single
daily dose
 Maximum: 300mg/day
TB Prophylaxis
 IM/PO: Adults, Elderly: 5mg/kg/day
(Max: 300mg/day) or 15 mg/kg twice
weekly (Max: 900mg)
 Children: 10-20 mg/kg/day as a single
daily dose.
 Maximum: 300mg/day or 20-40mg/kg 2
times/week. Maximum: 900 mg/dose
Side Nausea, vomiting, diarrhea, abdominal pain
effects

o Pyrazinamide
Action: May disrupt mycobacterium tuberculosis
membrane transport.
Bacteriostatic/bactericidal, depending on
drug concentration at infection site,
susceptibility of infecting bacteria
Uses: Treatment of clinical tuberculosis in
conjunction with other antitubercular agents.
Contraindic Acute gout, severe hepatic dysfunction
ations:
Pregnancy: Unknown if drug crosses placenta or is
distributed in breast milk
Pregnancy Category C
Availability 500 mg
Indications/ PO: Adults: Based on lean body weight.
routes/dos 40-55 kg: 1000mg daily
age 56-75 kg: 1500mg daily
76-90 kg: 2000mg daily (Maximum dose
regardless of weight)
Children: 15-30 mg/kg/day in 1 or 2 doses.
Maximum: 2 g/day
Side Arthralgia, myalgia (usually mind, self-
effects limited)

 Paracetamol (Acetaminophen)
 Acetyl Salicylic Acid/Aspirin is never kept in the
“Botika” because of its effects:
 Anticoagulant - highly dangerous to dengue
patients.
Action: Has an analgesic (inhibits prostaglandin
synthesis in the CNS) and antipyretic effect
(produces peripheral vasodilation for heat
loss, skin erythema, diaphoresis)
Uses: Used to treat mild to moderate pain
(headaches, menstrual periods, toothaches,
backaches, osteoarthritis, or cold/flu and
pains) and to reduce fever.
Contraindic Severe hepatic impairment or severe active
ations: liver disease.
Pregnancy: Crosses placenta, distributed in breast milk.
Routinely used in all stages of pregnancy
and appears safe for short-term use
Pregnancy Category B
Interaction Alcohol, hepatic medications, hepatic
s enzyme inducers may increase risk of
hepatotoxicity with prolonged high dose or
single toxic dose.
Administrat Give without regard to meals.
ion Tablets may be crushed.
Don’t crush extended-release tablets.
Indications/ PO: Adults, Elderly, Children 13 years
routes/dos and older: 325-650 mg q4-6h or 1g 3-4
age times a day. Maximum: 4g/day
Children 12 years or younger: 10-
15mg/kg/dose 14-6h as needed. Maximum:
5 doses/24 hours
Neonates: 10-15mg/kg/dose q4-8h as
needed depending on gestational age.
 Maximum daily dose: 20-90mg/kg/day
depending on gestational age
Side Hypersensitivity reaction.
effects

o Oresol
Action: Replaces fluids and minerals due to diarrhea
and vomiting
Helps to prevent or treat dehydration
Uses: For management of diarrhea to prevent
dehydration under the Control of Diarrheal
Disease (CDD) program
Contraindic Allergies to oresol
ations:
Administrat Given orally.
ion
 What oresol contains.
Glucose 20g 1⁰ degree significance:
o For reabsorption of Na
o Facilitates assimilation of Na
2⁰ significance:
 Provides heat and energy
NaCl 3.5g For retention of fluid/water
Sodium 2.5g  Buffer content solution
bicarbonate  Neutralizer content of solution.
KCl 1.5g Stimulates smooth muscle
contractility especially the heart
and GI tract
  Making homemade oresol:
A volume of 1L homemade Smaller volume or a glass
Oresol homemade Oresol
Water: 1L 250ml
Sugar: 8 teaspoon 2 teaspoon
Salt: 1 teaspoon 1/4 teaspoon or a pinch of
salt
o 10-12 granules of rock
salt
o Iodized salt - tips of
thumb & index finger are
penetrated with salt

o Nifedipine
Action: Increases heart rate. Cardiac output.
Decrease systemic vascular resistance.
Inhibits calcium ion movement across cell
membranes, depressing contraction of
cardiac, vascular smooth muscle.
Uses: Treatment of angina, chronic stable angina.
Extended release: treatment of essential
HPN.
Contraindic Cardiogenic shock, concomitant
ations: administration with strong CYP3A4 inducers
(ex. Rifampin), acute MI
Pregnancy: Insignificant amount distributed in breast
milk
Pregnancy Category C
 Administrat PO: Do not crush/break/chew extended
ion release tablets
Give without regard to meals
Grape-fruit juice may alter absorption; avoid
with all products
Indications/ Extended-release
routes/dos PO: Adults, Elderly: Initially, 30-60mg/day.
age May increase at 7- to 14- day intervals
Maximum: 90-120 mg/day
Children 1-17 years: 0.25-0.5 mg/kg/day.
Maximum: 3mg/kg/day or 120 mg/day.
Side Peripheral edema, headaches, flushed skin,
effects dizziness, nausea, shakiness, muscle
cramps/pain, drowsiness, palpitations, nasal
congestion, cough, dyspnea, wheezing.

NOTES:
 Herbal Medicine (RA 8423)
Plant name Uses Preparation
Sambong Anti-edema, Chopped LEAVES are boiled
(Blumea diuretic, anti-in a glass of water for 15
balsamifera) urolithiasis mins. Drink one part 3 times
a day (decoction)
Diarrhea Chopped LEAVES are boiled
in a glass of water for 15
mins. Drink one part 3 times
a day (decoction)
Akapulko Antifungal FRESH MATURED LEAVES
(Cassia alata (Tinea Flava, are pounded. Apply soap to
L.) ringworm, the affected area 1-2 times a
athlete’s food, day (poultice)
& scabies)
Niyug- Anti- The SEED are taken 2 hours
niyogan helminthic after supper. If no worms are
(Quisqualis expelled, the dose may be
indica) repeated after one week.
(decoction/poultice)
Tsaang Stomachache Chopped LEAVES are boiled
gubat Diarrhea in 1 glass of water for 15
(Carmona infantile colic minutes. Cool and filter/strain
retusa) (kabag) (decoction/poultice)
Ampalaya Diabetes Chopped and boiled 6
(Mamordica Mellitus (mild tablespoons (LEAVES) in
charantia) non-insulin two glasses of water for 15
dependent) minutes. Take 1/3 cup 3
 times a day after meals.
(decoction)
Lagundi Asthma, Decoction – boil RAW
(Vitex cough, and FRUITS or LEAVES for 15
negudo) fever mins.
Dysentery, Decoction – boil handful of
colds, and LEAVES AND FLOWER to
pain produce a glass, 3 times a
day.
Skin diseases Wash and clean the
(dermatitis, skin/wound with the prepared
scabies, ulcer, decoction of LEAVES
eczema & (decoction)
wounds)
Headache Crush LEAVES then apply
on forehead. (poultice)
Rheumatism, Pound the LEAVES and
sprain, apply on affected area.
contusion, (poultice)
insect bites
Aromatic bath For sick and newly delivered
patients
Ulasimang Lower uric One and a half cup of
bato acid LEAVES are boiled in 2
(Peperonia (rheumatism glasses of water. Drink one
pellucida) and gout) part 3 times a day.
(decoction)
Bawang HPN (CLOVES/BULB)May be
(Allium fried, roasted, soaked in
sativum) vinegar for 30 minutes, or
 blanched in boiled water for
15 minutes.
Toothache Pound a small piece and
apply to affected area.
Bayabas For washing (LEAVES)May be used twice
(Psidium wounds a day.
guajawa L.) (decoction)
Diarrhea May be taken 3-4 times a
day (decoction)
As gargle and Chopped guava leaves are
for toothache boiled for 15 minutes. Warm
decoction is used for gargle.
Freshly pounded leaves are
used for toothache.
Yerba Pain Chopped leaves are boiled in
(Hierba) (headache/ 2 glasses for 15 minutes.
Buena Stomachache) Drink one part every 3 hours.
(Mentha
cordifelia)
Rheumatism, Crush leaves and squeeze
arthritis, and
sap. Massage sap on painful
headache parts with eucalyptus.
(poultice)
Cough and Soak 10 fresh leaves in glass
colds of water. Drink as tea
(infusion)
Swollen gums Steep 6g of fresh leaves in a
glass of boiling water for 30
minutes. Use solution as
gargle.
 Toothache Soak a piece of cotton in the
squeeze sap and insert this
in aching tooth cavity
Menstrual/ Soak a handful of leaves in a
gastric pain glass of boiling water. Drink
infusion.
Nausea and Crush leaves and apply at
fainting nostrils of patients.
Insect bites Crush leaves and apply juice
on affected are
Pruritus Decoction – boil plant alone
or with eucalyptus in water

 Procedures/preparations
o Decoction – boiling without cover to vaporize/steam
to release toxic substances and undesirable taste.
Use extracts for washing.
o Poultice – done by pounding or chewing leaves used
by herbolario. Treatment of skin diseases.
o Infusion – to prepare a tea (use Lipton bag) keep
standing for 15 minutes in a cup of warm water where
a brown solution is collected, pectin which serves as
an absorbent and astringent.
o Juice/syrup – put inside water and add sugar. Syrup:
add sugar then heat to dissolve sugars) mix it.
o Cream/ointment – start with poultice to turn into
semisolid. Add flour to make it pasty. Ointment: add
oil to the prepared cream to keep it lubricated.