NCM 109: Care of Mother, Child at Risk or with Philosophy of Maternal – Child Health Nursing:

Problems (Chronic or Acute)

1. Family centered: Assessment should always include
This course deals with the concept of disturbances and the family and the individual.
pre- existing health problems of pregnant women and
2. Community centered: The health of the family is
the pathologic changes during the intra partum and
both affected by and influences the health of
postpartum periods .This course deals with the
communities.
common problems during infancy and adolescent stage.
3. Evidence- based: this is the means by which critical
Course Objectives: At the end of the course, given
knowledge increases.
actual or simulated situations (conditions involving
mother, newborn baby, children and family at risk), the 4. A challenging role for the nurses and a major factor in
student will be able to: keeping families well and optimally functioning.

1. Utilize the nursing process in the holistic care of

clients for the promotion and maintenance of health in
the community and the hospital setting. Framework for Maternal and Child Health Nursing
Care:
1.1 Assess with the client his or her health conditions
and the risk factors affecting health. 1. Health promotion.

1.2 Identify actual/ at risk nursing diagnosis. 2. Health maintenance.

1.3 Plan with client appropriate interventions for 3. Health restoration.

identified problems. 4. Health rehabilitation.
1.4 Implement with client appropriate interventions QSEN: Quality and Safe Education for Nurses:
for identified problems. Competencies
1.5 Evaluate with the client progress of their 1. Patient centered care.
condition and outcome of care.
2. Teamwork and collaboration.

3. Quality improvement.
2. Ensure a well- organized recording and reporting
system. 4. Informatics: Information and Technology/
Computerization
3. Observe bioethical principles and the core values-
love of God, caring, love of country and of people. 5. Evidence- based practices: use of current best
evidence.
4. Communicate effectively with clients, members of
the health team and others in work situations related to 6. Safety: Minimize risk of harm to patients and health
nursing and health. care providers.
TRENDS IN MATERNAL and CHILD HEALTH: 6. Maternal Mortality Rate: the number of maternal
deaths per 100,000 live births that occur as a result of
1. Families are not as extended as in the previous
the reproductive process.
generations so contain fewer members.
7. Infant Mortality Rate: the number of deaths per
2. The number of single parent families is increasing so
1,000 live births occurring at birth or in the first
rapidly, it now equals the number of nuclear families in
the US. 12 months of life.

3. Women work outside their homes, many women are 8. Childhood Mortality Rate: the number of deaths per
the main wage earners in their families. 1,000 population in children aged 1 to 14 years.

4. Families are more mobile than previously, there is an

increase in the number of homeless women and
IDENTIFYING A HIGH-RISK PREGNANCY:
children.
HIGH RISK PREGNANCY: It is one in which a concurrent
5. Both child and intimate partner violence is increasing
disorder, pregnancy- related complications or external
in incidence.
factors jeopardize the health of the woman, the child,
6. Families are more health conscious than ever before, or both.
the use of websites to monitor their health, or ask
health questions is rapidly increasing.
CAUSES OF HIGH-RISK PREGNANCY:
7. Health care must respect cost containment.
1. Chronic Causes
8. Patient advocacy is necessary as it is easy for families
to feel lost in the health care system. 2. Developmental complications during pregnancy.

3. Conditions of particular circumstances:

a) Poverty

b) Lack of support people

COMMON STATISTICAL TERMS USED TO REPORT c) Genetic inheritance
MATERNAL AND CHILD HEALTH
d) Past history of pregnancy complications
1. Birth Rate: the number of births per 1,000
population. A. ASSESSMENT:

2. Fertility Rate: the number of pregnancies per 1,000 1. Nursing History:

women of childbearing age. -Obtaining accurate prenatal assessment.
3. Fetal Death Rate: the number of fetal deaths (over -Interview/ observation__ past/ previous illness or
500 grams) per 1,000 live births. conditions
4. Neonatal Death Rate: the number of deaths per 2. Physical History:
1,000 live births occurring at birth or in the first 28 days
of life. -Observation/ physical examination

5. Perinatal Death Rate: the number of deaths during -Understanding of the signs and symptoms of the illness
the perinatal time period (beginning when a fetus 3. Diagnostic Assessment: Laboratory exams
reaches 500 grams, about week 20 of pregnancy, and
ending about 4 to 6 weeks after birth). Culture and Sensitivity

CT Scan / X ray

Ultrasound
 FACTORS THAT CATEGORIZE A PREGNANCY AS HIGH
RISK
EXAMPLES OF NURSING DIAGNOSIS IN HIGH-RISK
PREGNANCY

1. Risk for infection transmission related to lack of A) Pre- pregnancy Factors:

knowledge of safe sex practices.
Psychological:
2. Ineffective tissue perfusion (Cardiopulmonary)
- History of Drug dependence
related to mitral valve prolapse during pregnancy.
- History of Mental illness
3. Pain related to pyelonephritis. - History of poor coping mechanism
- Survival of child sexual abuse
4. Social isolation related to prescribed bed rest during
pregnancy secondary to concurrent illness.

5. Ineffective role performance related to increasing Social:

level of daily restrictions secondary to chronic illness
_Occupation: handling of toxic substances
and pregnancy.
_ Environmental contaminants at home
6. Knowledge deficit related to normal changes of
pregnancy vs. complications. _Lower economic level
7. Fear regarding pregnancy outcomes related to _Poor access to transportation for care
chronic illnesses.
_ Poor housing
8. Health seeking behaviors related to the effects of
illness on pregnancy. _ Lack of support people

9. Situational low self- esteem related to diagnosis of _ Isolation

HIV infection.

Physical:

_ History of previous poor pregnancy outcome

NURSING CARE OF WOMEN WITH HIGH RISK (miscarriage, stillbirth, intra uterine fetal death)
PREGNANCY/ INTERVENTIONS: _ Pelvic Inflammatory Disease
The goal is to maintain health during pregnancy. _ Obesity
1. Focus on teaching new or additional measures to _ Small stature
maintain health of a pregnant woman with an illness
unrelated to pregnancy. _ Younger than 18 or older than 35 years of age

2. Encourage and give opportunity to talk or verbalize _Cigarette smoking/ Substance abuse
feelings or emotions. B) Pregnancy Factors:
3. Counselling. Psychological:

_ Loss of support

_ Illness of family member

_ Low self- esteem

_ Poor acceptance of pregnancy

Social: Physical:

_ Refusal or neglected ante natal care. _Hemorrhage

_ Exposure to environmental teratogens _Infection

_ Decreased economic support. _ Dystocia, Precipitous birth

Pregnancy within 12 months of the first pregnancy _ Laceration of the cervix / vagina

Physical: _ Cephalopelvic disproportion

_ Intake of teratogens _ Retained placenta.

_ Multiple gestation

_ Poor placental formation/ position

_ Gestational Diabetes, Pregnancy Induced

Hypertension
DANGER SIGNS OF PREGNANCY:
_ Nutritional Deficiency/ Poor weight gain
SIGNS POSSIBLE CAUSES
_ Infections, Amniotic fluid abnormality
1. Swelling of face, fingers and legs
_ Post maturity Hypertension of Pregnancy

2. Continuous and severe headache

Hypertension of Pregnancy
C) Labor and Delivery:
3. Abdominal/ Chest pain
Psychological:
Pregnancy, Uterine Rupture,
_ Severely frightened by labor and delivery experience

_ Inability to participate during anesthesia. Pulmonary Embolism

_ Lack of preparation for labor 4. Vaginal bleeding

Placental problems, Abortion
_ Birth of an infant who is disappointing in some way
5. Persistent vomiting
_Illness of the newborn Infection, Hyperemesis gravidarum

6. Visual changes
Social: Hypertension of Pregnancy

_ Lack of support person SIGNS POSSIBLE CAUSES

_Unplanned birth 7. Escape of vaginal fluid _

PROM (Premature Rupture of Membranes)
_ Lack of access to continued health care

_Lack of access to emergency personnel/ equipment

_ Inadequate home for infant care

PRE-GESTATIONAL CONDITIONS IN HIGH-RISK it also reflects the average blood glucose levels over the
PREGNANCY: past 3 months. Glucose in the bloodstream attaches to
some of the hemoglobin and stays attached during the
I. DIABETES MELLITUS / GESTATIONAL DIABETES:
120 day life span of the RBC.
Diabetes Mellitus is an endocrine disorder in which the
The upper normal level of HbA1C is 60% of total
pancreas cannot produce adequate insulin to regulate
hemoglobin.
the body’s glucose levels. It is the most frequently seen
medical condition in pregnancy. 2. Oral Glucose Tolerance Test/ Oral Glucose
Challenge: A fasting blood sugar level is drawn, and
Before insulin was synthetically produced in 1921,
women with Type I Diabetes died before reaching 100 grams of glucose is given to the patient. The
childbearing age, were sub fertile, or had miscarriages following times blood sugar levels are taken are:
early in pregnancy. Infants of women with unregulated
blood sugar levels are five times apt to be born large for
gestational age or with birth anomalies. Test Type:
Pregnant Glucose Level (mg/ dl)
Other effects of DM in Pregnancy include
polyhydramnios, cephalopelvic disproportion, 1. Fasting Blood Sugar 95 mg/ dl
Increased risk of shoulder dystocia making it necessary 2. 1 Hour 180 mg/ dl
for infants of women with DM to be borne by
3. 2 Hours 5 mg/ dl
Caesarian Section. Long term effects of DM include
vascular narrowing that leads to kidney, heart, and 4. 3 Hours 140 mg/ dl
retinal dysfunction. Following a 100 grams glucose load. Rate is abnormal if
two values are exceeded.

RISK FACTORS FOR GESTATIONAL DIABETES Normal Blood Sugar level is 80- 120 mg/ dl.

1. Obesity 3. Urine Analysis/ Urine Culture and Sensitivity: A urine

culture may be done as increase in glucose
2. Age over 25 years concentration in urine may lead to increased incidence
of Urinary Tract Infection which may lead to
3. History of large babies (10 lbs. or more)
Pyelonephritis in pregnancy. Infections are treated in
4. History of unexplained fetal or perinatal loss order to prevent the woman from developing other
complications like infective endocarditis.
5. History of congenital anomalies in previous
pregnancies.

6. History of Polycystic Ovarian Syndrome SIGNS AND SYMPTOMS OF DIABETES:

7. Family history of DM 1. Polyuria

8. Member of population with high risk for DM 2. Polydipsia

3 .Polyphagia

TESTS FOR DM/ DM IN PREGNANCY:

1. HbA1C (Glycosylated hemoglobin) It is a measure of

the amount of glucose attached to hemoglobin,

It is used to detect the degree of hyperglycemia

present. Measuring HbA1C is advantageous not just
because it offers a present value of glucose but because
MANAGEMENT OF DIABETES MELLITUS: MEDICATION, ASSESSMENT FOR GESTATIONAL DIABETES:
EXERCISE, DIET
1. 3 P’s: Polyuria, Polydipsia, Polyphagia

2. Dizziness if Hypoglycemic, confusion if hyperglycemic

D- Diet: 50-60% Carbohydrates (CHO), 20-30% Fats, 10-
3. Congenital Anomalies
20% Proteins (CHON)
4. Increased risk for Pregnancy Induced Hypertension
I- Insulin- Type I
5. Macrosomia
A- Anti diabetic Agents- Type II
6. Poor tissue perfusion of fetus
B- Blood Sugar Monitoring
7. Glycosuria
E- Exercise
8. Hyperglycemia
T- Transplant of Pancreas
9. Hydramnios
E- Ensure adequate food intake
10.Possible Monilial Infection
S- Scrupulous Foot Care

DIETARY CONTROL OF DM IN PREGNANCY: An 1,800 to

NURSING DIAGNOSIS IN DIABETES MELLITUS:
2,400 calorie Diabetic Diet (or at least 30kcal/ kg of ideal
1. Risk of ineffective tissue perfusion related to reduced body weight) divided into 3 meals and 3 snacks to try to
vascular flow. keep carbohydrates evenly distributed so the glucose
level remains constant.
2. Imbalance Nutrition: less than body requirements/
inability to use glucose

3. Risk for ineffective coping/ required change in INSULIN THERAPY:

lifestyle

4. Risk for infection/ impaired healing accompanying

INSULIN ONSET PEAK DURATION
the condition,
1. Regular Insulin (Humulin R)
5. Deficient fluid volume/ polyuria
30 min.- 1 hour
6. Deficient knowledge/ complex health problems
2-4 hours 5-7 hours

(Short- acting Insulin)

GDM ADVERSE EFFECTS:

1. Macrosomia: excessive fat deposition on shoulders

and trunk 2. NPH Insulin (Humulin N)
2. Predispose to shoulder dystocia 1-2 hours 4-12 hours 24 hours
3. Maternal hyperglycemia- transfer of excess glucose (Intermediate Acting Insulin)
to fetus which stimulates fetal insulin secretion which is
a potent growth factor.

2. Hypoglycemia at birth.
SIGNS OF HYPOGLYCEMIA
SIGNS OF HYPERGLYCEMIA

CAUSE: Excessive Insulin injection

_Inadequate Insulin injection

Limited food intake

_Excessive food intake

Excessive Exercise
_ Stress from infection, surgery, etc.

SYMPTOMS:

Hunger
_Glycosuria and Ketonuria

Lethargy, sensorial changes

_Polyuria, polydipsia, polyphagia

Sweating
_Kussmaul respirations (rapid, deep

breaths)

Pallor
_ Flushing, dehydration

Seizure
_Sweet acetone breath

Coma
_Lower Na, K+, Bicarb, Chloride and

Phosphate

_Coma

DANGER: Brain cells need glucose for functioning

_Fatty acids used and Ketoacidosis

and survival.
Develops.

MAJOR NSG. INTERVENTION:

-Electrolyte balance, rehydration.

-Education to prevent recurrence.

-Education to prevent recurrence.