MATERNAL HEALTH PROGRAM Tasked: to reduce MMR by three quarters by2015 to achieve ( millenniumDevelopment Goal) MDG Maternal Mortality

Rate (2003) CAUSEOther Complications related to pregnancy occurring inthe course of labor, delivery and puerperium 1. Hypertension complicating pregnancy, childbirthand puerperium (25%) 2. Postpartum hemorrhage (20.3%) 3. Pregnancy with abortive outcome (9%)4 . H e m o r r h a g e r e l a t e d t o pregnancy Strategic thrusts for 2005-2010 1.Launch and implement Basic E m e r g e n c y a n d Obstetric Care (BEMOC) strategy in coordinationwith DOH Entails establishment of facilities thatprovide emergency obstetric care forevery 125,000 population and which arelocated strategically2.Improve quality of prenatal and postnatal care Pregnant women should have at leastfour (4) prenatal visit3 . R e d u c e w o m e n s exposure to health risks Institutionalization of responsibleparenthood4 . Stakeholders must advocate for health Resource generation and allocation forhealth services Essential Health Service Packages A.Antenatal Registration B. Tetanus Toxoid Immunization

C. Micronutrient SupplementationD.Treatment of Diseases and Other ConditionsE . C l e a n a n d S a f e d e l i v e r y F.Recommended S c h e d u l e f o r P o s t P a r t u m C a r e Visits G. Importance of BF1. Antenatal Registration2. Tetanus Toxoid Immunization Dose:0.5mlRoute: IntramuscularlySite: Right or Left Deltoid/Buttocks3. Micronutrient Supplementation4. Treatment of Diseases and Other Conditions Types: 1.Difficulty of breathing/ obstruction of airway2 . U n c o n s c i o u s n e s s 3 . P o s t p a r t u m b l e e d i n g 4.Intestinal para site infection5 . m a l a r i a 1.Difficulty of breathing/ obstruction of airway What to do? Clear the airway Place in her best position Refer woman to hospital with EmOCcapabilities.Do not give anything PO 2.Unconsciousness What to do? Keep on her back arms at the side. Tilt head backwards (unless trauma issuspected) Lift chin to open airway Clear secretions from throat. Give IVF to prevent or correct shock. Monitor BP and SOB every 15 Monitor fluid given. If DOB and puffinessdevelops, stop the infusion.

Monitor UO Do not give: ORS for both unconscious or withconvulsions IVF if not trained to do so. 3.Post partum bleeding What to do?: Massage uterine and expel clots.

nd pregnancy 500mg-25mg tab., 3 tabs. At thebeginning of 2 nd to 3 rd tri semesters notless than one month interval.E . C l e a n a n d S a f e d e l i v e r y Presence of skilled birth attendant

If bleeding persist: Place cupped palmed on uterinefundus and feel for state of contraction Massage fundus in a circularmotion Apply bimanual uterinecompression if mem treatmentdone and postpartum bleedingstill persist. Give ergometrine 0.2mg IM andanother dose after 15 Do not give: Mem to woman with eclampsia, pre-eclampsia or HPN 4.Intestinal parasite infection What to do? Give mebendazole 500mg tab. Singledose anytime from 4-9mos. Of pregnancyif none was given in the past 6 mos. Do not give: Mebendazole in the 1 st 1-3mos. Of pregnancy This might cause congenitalproblem in the baby 5 . M a l a r i a What to do? Give sulfadoxin-pyrimethamine towoman from malaria endemic areas whoare in 1 st or 2

Purpose to ensure hygiene during labor anddelivery. Provide non-traumatic delivery recognize complications Referred those complicated deliveries tohigh level of careSteps to follow during labor, childbirth and immediatepostpartum Please refer accordingly 1.Do a quick check upon admission f o r e m e r g e n c y signs: Unconscious/convulsion Vaginal bleeding Severe abdominal pain Looks very ill Severe headache with visual disturbance Severe breathing difficulty Fever Sever vomiting 2. Make the woman comfortable Establish rapport with the client by greeting andinterviewing to make her comfortable 3. Assess the woman in labor

to determine the status during labor LMP Number of pregnancy Start of labor pains Age/height Danger signs of pregnancy

Encourage to do breathing technique to helpenergy in pushing out the vagina. Panting canbe done by breathing with open mouth with 2short breaths followed by long breaths. Thisprevent pushing at the end of the 1 st stage 7. Monitor and manage the different stage of labour -watch out for any danger signs 1.First stage: not in active labor Cervix: 3cms

Taking the history through interview will helpdetermine the clients condition during deliveryof baby 4. Determine the stage of labor

Contraction: weak Frequency: < 2 to 10 What to do? Check Q 1hr. for emergency signs,frequency and duration of contractionsand FHT. Check Q 4hrs. For fever, pulse, BP andcervical dilatation. Record time of ROM and color of amniotic fluid Assess progress of labor Refer STAT to hospital withcomplete facilities for the ff condition: If after 8hrs,contractions arestronger and morefrequent but notprogress in cervicaldilatation, with orwithout membranesruptured It is false labor if after 8hrs there is noincrease in contractions, membranes arenot ruptured and no progress in cervicaldilatation. Not to do: IE more frequently than Q 4hrs. First stage: active labor 4cms cervical dilatationWhat to do? Check Q30 for emergency signs

Uterine contractions Bulging vulva Leaking amniotic fluid Vaginal bleeding IE 5. Decide if the woman can safely deliver By assessing the condition of the client and not finding any indication that couldharm the delivery of the baby 6. Give supportive care throughout labor. Purpose: To deliver clean, safe and free fromfatigue1 . E n c o u r a g e t o t a k e a b a t h at the onset of labor2.Encourage to d r i n k b u t n o t e a t a s t h i s m a y interfere surgery in case needed3 . E n c o u r a g e t o e m p t y b l a d d e r a n d b o w e l s t o facilitate delivery of the baby. Remind to emptythe bladder every 2 hours. 4.

Birth registration Check Q4hrs. For fever, pulse, BP andcervical dilatation Record time of ROM and color of amniotic fluid Record finding in partographs/patientrecord.Not to do: Do not allow woman to push unlessdelivery is imminent. It will just exhaustthe woman Do not give medication to speed of labor. It may cause trauma to motherand the baby Second stage: Cervix: 10 cms. or bulging thin perineumand head visibleWhat to do: Check Q 5 for perineum thinning andbulging, visible descend of the hadduring contraction, emergency signs,FHR and mood and behavior Continue recording in the partograph.Not to do: Do not apply fundal pressure to helpdeliver the baby Third stage: Between birth of the baby and deliveryof the placentaWhat to do: Deliver the placenta Check the completeness of placenta andmembranesNot to do: Do not squeeze or massage the abdomento deliver the placenta8 . M o n i t o r closely within 1hr. After delivery a n d give supportive care.9.Continue care after 1hr. Postpartum. Keep watchclosely for at least 2hrs.10.Educate and counsel on FP and provide FPmethod if available and decision was made by awoman.11.Informs, teach and counsel the woman onimportant MCH messages: Importance of BF Newborn Screening for babies deliveredin RHU or at home within 48hrs up to 2weeks after birth. Scheduled when to return forconsultation for postpartum visit F. Recommended Schedule for Post Partum CareVisitsG . I m p o r t a n c e o f B F BREASTFEEDING Breast milk is best for babies up to 2years old. Exclusive breastfeeding is recommended forthe first six months of life. At about six months, givecarefully selected nutritious foods as supplements.Breastfeeding provides physical andpsychological benefits for children and mothers as wellas economic benefits for families and societies . BENEFITS :For infantsa . P r o v i d e s a nutritional complete food for t h e young infant.b . S t r e n g t h e n s t h e i n f a n t s i m m u n e s y s t e m , preventing many infections.c . S a f e l y r e h y d r a t e s a n d p r o v i d e s e s s e n t i a l nutrients to a sick child, especially to thosesuffering from diarrheal diseases.d . R e d u c e s t h e i n f a n t s exposure to infection. BREASTFEEDING/ LACTATION MANAGEMENT EDUCATIONTRAINING Breastfeeding practices has been proved to be verybeneficial to both mother and baby thus the creation of the following laws support the full implementation of this program: A. Executive Order 51 B. Republic Act 7600C. The Rooming-In and Breastfeeding Actof 1992 A. EO 51 THE MILK CODE protection and promotion of breastfeeding to ensure the safe and adequate nutritionof infants through regulation of marketing of infantfoods

and related products. (e.g. breast milk substitutes, infant formulas, feeding bottles, teats etc. )B. RA 7600 THE ROOMING IN and BREASTFEEDING ACTof 1992=An act providing incentives to government and privatehealth institutions promoting and practicing rooming-inand breastfeeding.=Provision for human milk bank.

3. Side Lying Position BEST FOR BABIESREDUCE INCIDENCE OF ALLERGENSECONOMICALANTIBODIES PRESENTSTOOL INOFFENSIVE (GOLDEN YELLOW)EMPERATURE ALWAYS IDEALFRESH MILK NEVER GOES OFF EMOTIONALLY BONDING EASY ONCE ESTABLISHED

=Information, education and re-education drive=Sanction and RegulationBABY Provides Antibodies Contains Lactoferin (binds with Iron) Leukocytes Contains Bifidus factor-promotes growth of theLactobacillus-inhibits the growth of pathogenicbacilli For the Mothere . R e d u c e s a w o m a n s r i s k o f e x c e s s i v e b l o o d l o s s after birthf . P r o v i d e s a n a t u r a l m e t h o d o f d e l a y i n g pregnancies.g . R e d u ces the risk of ovarian and breast c a n c e r s and osteoporosis. For the Family and Communityh . C o n s e r v e s funds that otherwise would be s p e n t on breast milk substitute, supplies and fuel toprepare them.i . S a v e s m e d i c a l c o s t s t o f a m i l i e s a n d governments by preventing illnesses and byproviding immediate postpartum contraception. POSITIONS IN BF THE BABY:

DIGESTED EASILY IMMEDIATELY AVAILABLE NUTRITIONALLY OPTIMAL GASTROENTERITIS GREATLY REDUCED

Environmental Health Program Environmental Sanitation and Promotion of SafeWater Supply Environmental Sanitation is defined as the study of allfactors in the mans environment, which exercise or mayexercise deleterious effect on his well-being andsurvival.-Water is a basic need for life and one factor inmans environment. Water is necessary for themaintenance of healthy lifestyle.Safe Water and Sanitation is necessary for basicpromotion of health . -One basic need of the family is food. And if food is properly prepared then one may be assuredhealthy family. There are many food resources found inthe communities but because of faulty preparation andlack of knowledge regarding proper food planning,Malnutrition is one of the problems that we have in thecountry. HEALTH AND SANITATION -Environmental Sanitation is still a healthproblem in the country.-Diarrheal diseases ranked second in theleading causes of morbidity among the generalpopulation.-Other sanitation related diseases :tuberculosis,

1. Cradle Hold = head and neck are supported

2. Football Hold

intestinal parasitism, schistossomiasis,malaria, infectious hepatitis, filariasis and denguehemorrhagic fever DOH thru Environmental Health Services (EHS) unit isauthorized to act on all issues and concernsinenvironment and health including theverycomprehensive Sanitation Code of the Philippines(PD 856, 1978). WATER SUPPLY SANITATION PROGRAM EHS sets policies on: Approved types of water facilities Unapproved type of water facility Access to safe and potable drinking water Water quality and monitoring surveillance Waterworks/Water system and well construction Approved type of water facilities Level 1 (Point Source)- a protected well or a developedspring with an outlet but without a distribution system indicated for rural areas; serves 15-25 households; its outreach is notmore than 250 m from the farthest user yields 40-140 L/ min Level II ( Communal Faucet or Stand Posts ) With a source, reservoir, piped distributionnetwork and communal faucets Located at not more than 25 m from the farthesthouse Delivers 40-80 L of water per capital per day toan average of 100 households Fit for rural areas where houses are denselyclusteredLevel III ( Individual House Connections or WaterworksSystem)

With a source, reservoir, piped distributornetwork and household taps Fit for densely populated urban communities Requires minimum treatment or disinfectionENVIRONMENTAL SANITATION- the study of all factors in mansphysical environment, which may exercise a deleteriouseffect on his health, well-being and survival.Includes:1.1 Water sanitation1.2 Food s anitation1.3 Refuse and garbage disposal1.4 Exc reta disposal1.5 Insect vector and rodent contro l1.6 Housing1.7 Air pollution1.8 Noise1.9 Radiological Protection1.10 Institution al sanitation1.11 Stream pollutionPROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM EHS sets policies on: Approved types of toilet facilities : LEVEL II on site toilet facilities of the water carriagetype with water-sealed and flush type with septicvault/tank disposal. LEVEL III water carriage types of toilet facilitiesconnected to septic tanks and/or to sewerage system totreatment plant.FOOD SANITATION PROGRAM-sets policy and practical programs to preventand control food-borne diseases to alleviate the livingconditions of the populationHOSPITAL WASTE MANAGEMENT PROGRAMDisposal of infectious, pathological and otherwastes from hospital which combine them with themunicipal or domestic wastes pose health hazards to thepeople.Hospitals shall dispose their hazardous wastes thruincinerators or disinfectants to prevent transmission of nosocomial diseasesPROGRAM ON HEALTH RISK MINIMIZATION DUE TOENVIRONMENTAL POLLUTIONFoci:1. Prevention of serious environmental hazardsresulting from urban growth and industrialization2. policies on health protection measures3. researches on effects of GLOBAL WARMING to health(depletion of the stratosphere ozone layer whichincreases ultraviolet radiation,

climate change and otherconditions)NURSING RESPONSIBILITIES AND ACTIVITIES Health Education IEC by conducting communityassemblies and bench conferences.

He decided to save it by stretching out his fingerbut the scorpion stung him. The man still tried to get the scorpion out of thewater but the scorpion stung him again. Another man nearby told him to stop saving thescorpion but the man said, Its the nature of the scorpion to sting. Its my nature to love, whyshould I give up my nature to love just becauseits the nature of the scorpion to sting? Dont give up loving, dont give up yourgoodness even if people around you stingTHE ENDSee u next sem.

The Occupational Health Nurse, School HealthNurse and other Nursing staff shall impart theneed for an effective and efficient environmentalsanitation in their places of work and in school. Actively participate in the training component of the service like in Food Handlers Class, andattend training/workshops related toenvironmental health. Assist in the deworming activities for the schoolchildren and targeted groups. Effectively and efficiently coordinateprograms/projects/activities with othergovernment and non-government agencies. Act as an advocate or facilitator to families inthe community in matters of program/projects/activities on environmentalhealth in coordination with other members of Rural Health Unit (RHU) especially the RuralSanitary Inspectors. Actively participate in environmental sanitationcampaigns and projects in the community. Ex.Sanitary toilet campaign drive for propergarbage disposal, beautification of homegarden, parks drainage and other projects. Be a role model for others in the community toemulate terms of cleanliness in the home andsurrounding. There was a man who saw a scorpion flounderingaround in the water.