Professional Documents
Culture Documents
Submitted by:
Group 3
January, 2010
shows concern for client welfare and acceptance of the client as a person
2. Teacher
3. Counselor
Focuses on helping a client to develop new attitudes, feelings and behaviors rather
than promoting intellectual growth.
Encourages the client to look at alternative behaviors recognize the choices and
develop a sense of control.
4. Client advocate
Promotes what is best for the client, ensuring that the clients needs are met and
protecting the clients right.
5. Manager
Plans, give direction, develop staff, monitors operations, give the rewards fairly
and represents both staff and administrations as needed.
6. Researcher
ACKNOWLEDGEMENTS
This case study would not have been possible without the help of the following:
First, to our Almighty God, without His spiritual guidance we will not be able to
do and finish this study.
We wish to express our warm and sincere appreciation to Mr. and Mrs. CP, for
their trust and cooperation, without them, we wouldnt able to conduct the study.
We would like to express our deep and sincere gratitude to our Clinical Instructor,
Ms. Evangeline V. Fermin. Her wide knowledge and her logical way of thinking have
been of great value for us. Her understanding, encouragement and personal guidance
have provided a good basis for the present case study.
To the midwives and staffs of Esperanza Lying-in Clinic, their assistance,
guidance and accommodation have given us opportunity to do and conduct the study.
To our friends and classmates, for their enthusiasm and upholdment for us to
accomplish the study.
Lastly, we owe our loving gratitude to our family without their encouragement,
understanding and financial support, it would have been impossible for us to finish the
study.
GROUP 3
Terminologies
Bloody show - is the passage of a small amount of blood or blood-tinged mucus through
the vagina near the end of pregnancy
Brant-Andrews maneuver - slowly pulling the cord and wind at the clamp
Childbirth - is the culmination of a human pregnancy or gestation period with birth of
one or more newborn infants from a woman's uterus.
Dilatation an induced, temporary enlargement of an opening or passageway, as to aid
examination.
Effacement - is the shortening, or thinning, of the cervical canal, stretched and dilated by
the fetus during labor.
Gestation pregnancy or maternal condition of having a developing fetus in the body.
Internal Examination - A physical examination in which the health care professional
will feel for lumps or changes in the shape of the vagina, cervix, uterus, fallopian tubes,
ovaries, and rectum.
Involution a process whereby the reproductive organs return to their non-pregnant
state.
Labor is the process by which the fetus & placents are expelled from the uterus and the
vagina into the external environment.
Leopold's Maneuvers - are a common and systematic way to determine the position of a
fetus inside the woman's uterus.
Multiparous - refers to a woman who has given birth two or more times
Newborn Screening -is the process of testing and screening newborn babies for certain
potentially dangerous conditions.
Obstetrics - is the surgical specialty dealing with the care of women and their children
during pregnancy, childbirth and postnatal
Parity - is a technical term that refers to the number of times a woman or female animal
has given birth.
Postnatal - is the period beginning immediately after the birth of a child and extending
for about six weeks
Pregnancy - is the carrying of one or more offspring, known as a fetus or embryo, inside
the uterus of a female.
Prenatal care -refers to the medical and nursing care recommended for women before
and during pregnancy.
Primipara - a woman in her first pregnancy
Puerperium the state of a woman at and immediately following childbirth.
Vaginoplasty surgery on the vagina.
Viability capability of living, usually accepted as 24 weeks, although survival is rare.
Introduction
The care of the childbearing and childrearing families are the major focus of the
practice because to have a heathy adults, you must have a healthy children at first. To
have a healthy children, it is important to promote the childbearing woman and her
family from the time before the children are born until adulthood. Both preconceptual and
prenatal care are essential contribution to the health of the woman and the fetus to a
familys emotional preparation for the and childrearing family.
Maternal health refers to the health of women during pregnancy, childbirth and the
postpartum period. While motherhood is often a positive and fulfilling experience, for too
many women it is associated with suffering, ill-health and even death.
The major direct causes of maternal morbidity and mortality include haemorrhage,
infection, high blood pressure, unsafe abortion, and obstructed labour.
For the past so many years in the past, there has been a huge percentage of
maternal death that dappen during the entire course of pregnancy. This also leads to the
increase of the infant mortality rate. Primary reason of this is the improper management
of the mother and infant during the course of delivery.
Because of this, a very important of role of nurse is needed to be implied, the
study holds a very essential vsion of studying and establishing what are the roles of the
nurse in assessing, caring and evaluating a mother before, during, and after a childbearing
process.
The first step for avoiding maternal deaths is to ensure that women have access to
family planning and proper nursing management during the entire period of pregnancy.
The women who continue pregnancies need care during this critical period for
their health and for the health of the babies they are bearing. Most maternal deaths are
avoidable, as the health care solutions to prevent or manage the complications are well
known. Since complications are not predictable, all women need care from skilled health
professionals, especially at birth, when rapid treatment can make the difference between
life and death.
Given all of these situations and conditions, it is very important that there should
be an established practice about maternal management during the course of prenancy. It is
very important for nurses that they can efficiently assess, mange, and evaluate a normal
maternal pregnancy.
Objectives
General Objective:
To make an established concept on the proper assessment, management, and
evaluation of a normal pregnancy and the period after it.
Specific Objectives:
1. To determine the conditions and measures that the mother has undergone during
pregnancy for the promotion of maternal and infant health.
2. To determine what are the emotional responses by the mother and her family
during the course of acceptance of pregnancy.
3. To determine what are the management done by the mother after delivery of infant
for the promotion of maternal health.
4. To gain knowledge regarding different drugs. Citing its side/adverse effects and
nursing management with patient.
5. To educate appropriate health teaching that will promote wellness of the mother
and the baby. At the same time, equip the patient knowledge that will eliminate
their doubts about health.
Biographical Data
Mothers name: Mrs. C.P.
Age: 27 y/o
Birthday: October 8, 1982
Place of birth: Sta. Mesa, Manila (ELIC)
Address: 4730 Old Sta. Mesa St. Manila
Height: 5 2
Weight: 48 kg
Religion: Roman Catholic
Language: Tagalog, English
Marital status: Single
Occupation: Saleslady
Name of husband : Mr. C.P.
Age: 25 y/o
Occupation: Employee
Religion: Roman Catholic
Usual Source of medical care: Health Center/ Family care/Clinic
No. of children: 1 child
Obstetrics: G1P1
Physical Assessment
(Cephalocaudal)
Mrs. C.P., a twenty-seven years old, was a newly postpartum mother who
delivered her first baby. She was a well-groomed and active mother. She stands 5 ft and
weighs 48 kgs. Her BP-110/70 mmHg, PR-90 bpm, Respiration-25 breaths/min and
temperature-36.8C.
Body Part
Head
Hair
Eyes
Nose/Sinuses
Tool-Technique
Inspection
Palpation
Findings
Skull is well-formed
Rigid w/ no damage
found.
Normal because of
Inspection
visible irregularities
seen and no visual
Palpation
clear conjuctiva
Eyelids show no evidence of
Inspection
swelling or tenderness
Symmetrical, lesion free, no
Normal because no
evidence of foreign
discharge
External nose is free from
structural deviation, no
tenderness and sweelling
Mouth/Throat
Inspection
Palpation
Palpation
Ears
Interpretation
Normal bcause its
blurring.
familiar odors.
Normal because
inflammation, no discharge,
Inspection
no swelling
Pink lips, no dryness and
Palpation
cracking, no lesions
Free from tenderness,
Inspection
Skin/Nails
Inspection
Palpation
inflammation.
pain
Pink color nails, no areas of
is adequate circulating
are intact.
160 or less.
Relatively dry skin, smooth
and warm, quickly returns to
its original shape when
Breast
Inspection
Palpation
gently squeezed.
Slightly asymmetrical, no
tenderness is apparent
Cardiovascular
System
Abdomen
Inspection
Palpation
Auscultation
detectable
No murmurs
Inspection
Palpation
Percussion
Musculoskeletal
Auscultation
Inspection
is no presence of
System
Neurologic
System
Palpation
Inspection
or twitching is detectable
Memory and attention span
infection decreased. Because it is her first time to get pregnant she often have prenatal
check-up.
On Mr. C.P. side, his father had an illness of arthritis, while his mother died
because of cancer in the pancreas. They are both complete in immunization like BCG,
DPT, OPV, Hepa B and measles.
Stages of Labor
(First stage Puerperium)
FIRST STAGE
First Stage: onset of contractions to full dilatation & effacement of the cervix stage of
effacement & dilatation
Latent Phase:
Assessment:
Dilatations: 0-3 cm
Frequency: 5-10 mins
Duration: 20-40 mins
Intensity: mild
Mother is excited, apprehensive but can communicate
Nursing Care:
Encourage walking (shortens the 1st stage of labor)
Encourage to void q2-3 hrs. (full bladder inhibits uterine contraction)
Breathing (chest breathing technique)
Active Phase:
Assessment:
Dilatations: 4-8 cm
Frequency: q 3-5 mins lasting for 30-60 secs
Duration: 30-60 secs
Intensity: moderate
Nursing Care:
M edications (have medication ready)
A ssessment (include: v/s, cervical dilatation & effacement, fetal monitor, etc)
D ry lips (oral care -ointment, dry linens)
Breathing (abdominal breathing)
Transitional Phase:
Assessment:
Dilatations: 8-10cm
Frequency: q 2-3 mins contractions
Duration: 45-90 sec
Intensity: strong
Mood of mother suddenly change accompanied by hyperesthesia (hypersensitivity
of mother to touch) of the skin. Management:sacral pressure, cold compress
Nursing care:
T tires
I inform of progress (to relieve emotional support)
R restless support her breathing technique
E encourage & praise
D discomfort
Duration of Labor:
Primipara 14 hrs but not more than 120 hrs
Multipara 8 hrs but not more than 14 hrs
Pelvic Exams: Effacement & Dilatation
Station relationship of the presenting part to the ischial spine
5 -1 = the presenting part is above the ischial spine
Engagement 1-0 = the presenting part is in line with the ischial spine
(-) fetus is floating
(+) below the ischial spine
Presentation the relationship of the long axis of the fetus to the long axis of themother.
spine relationship of the spine of the mother & the spine of the fetus
Two Types:
Longitudinal Lie (Parallel)/ Vertical
Cephalic when the fetus is completely flexed
o Vertex
o Face
o Brow
o Chin
Breech
o Complete breech thigh rest on abdomen while legs rest on thigh
o Incomplete breech
Frank thigh resting on abdomen while legs extend to the head
Footling
Kneeling
Transverse Lie (Perpendicular)/Horizontal lie
Position relationship of the fetal presenting part to specific quadrant of the mothers
pelvis.
o ROA/LOA
left occipito anterior
most common & favorable position
o ROT/LOT left occipito transverse
o ROP/LOP left occipito posterior
o L/R- side of maternal pelvis
o Middle presenting part
o ROP/ROT most common malposition
Crowning occurs
PRIMI transfer to DR at 10 cm dilatation
MULTI transfer to DR at 7 8 cm dilatation
Position in lithotomy both legs at the same time
Bulging of perineum surest sign of delivery initiation
Pant & Blow Breathing, fetal pushing should be done on an open glottis
Respiratory alkalosis
o Due to incorrect breathing
o Hyperventilation
o S/sx:
RR
Lightheadedness
Tingling sensation
Carpopedal spasm
Circumoral numbness
Episiotomy
o Prevent laceration
o Widen the vaginal canal
o Shortens the 2nd stage of labor
o 2 types:
MEDIAN
Less bleeding
Less pain
Easy repair
Possible urethroanal fistula major disadvantage
MEDIOLATERAL
More bleeding
More pain
Hard to repair and slow healing
o Ironing the Perenium prevent laceration
Mechanism of Labor:
Engagement
Descent
Flexion
Internal Rotation
Extension
External Rotation
Expulsion
PELVIS
3 Parts
o Inlet AP diameter narrow, transverse wider
o Cavity between inner and outer
o Outlet AP diameter wider, transverse narrow
Nursing Care:
Modified Rigens maneuver
o Done by supporting the perenium with a towel during delivery
o Facilitates complete flexion
o Avoids laceration
First intervention: Support the head and suction secretion
Do not milk the cord, wait for pulsation to stop before cutting
o Milking may cause too much blood going to the baby that may cause
cardiac overload
When there is still birth, let the mother see the baby to accept the finality of death
Placement of fundus
o In between umbilicus and pubis symphysis
o Check bladder, assist in voiding, May lead to uterine atony hemorrhage
Lochia
Perineum
o Check REEDA
R edness
E dema
E cchymosis
D ischarge
A pproximation
o Fully saturated 30 40 cc
NURSING CONSIDERATIONS:
Flat on bed to prevent dizziness
If with Chills give blanket due to dehydration
Give nourishment (progression of meal)
o Clear liquids gatorade, ginger juice, gelatins
o Full liquid milk, ice cream
o Soft diet
o Regular diet
Check VS/ Pain
Pychic State
Bonding interaction between mother and newborn
o Strict 24 hours with mother
o Partial morning with mother, night nursery
FIFTH STAGE (Puerperium)
The postpartum period, or puerperium, refers to the 1 to 6 or 8-weeks period after
delivery during which the mothers body returns to its prepregnant state. Some people
refer to this period as the fourth trimester of pregnancy. Many physiologic and
psychological changes occur in the mother during this time. Nursing care should focus on
helping the mother and her family adjust to these changes and on easing the transition to
the parenting role.
Psychological Responses:
Taking in phase dependent phase (1st three days) mom passive, cant make decisions,
activity is to tell child birth experiences. During this time, the womans attention is
focused on her own needs for sleep, rest and she is dependent on others.
Nursing Care: - proper hygiene
Taking hold phase dependent to independent phase (4 to 7 days). Mother is active, can
make decisions. The concern of the mother at this time is focused on her ability to control
body function and her ability to assume the mothering role. She prefers to do things by
herself. As she is not yet completely recovered, she feels impatient that shes not strong
enough to do everything she wishes to accomplish. Because of the tendency of the
woman to overwork herself, fatigue and exhaustion is common at this stage.
- Begins to take a strong interest for her child
- Give the woman brief demonstration of baby care
- Allow her to care for the child herself with watchful guidance
Letting go interdependent phase 7 days & above. Mother redefines new roles, may
extend until child grows. Letting-Go the act of ending old ways of thinking or
believing.
- The woman finally redefines her new role
- Gives up fantasized image of her child and accepts the real one
- Gives up her old role of being childless or the mother of only one or two
- Extended and continues during the childs growing years
Maternal Concerns & Feelings during Postpartum:
ABANDONMENT Only hours before, they were the center of attention, with
everyone asking about their health and well-being. Now suddenly, the baby is the
chief interest. The woman may feel confused by a sensation very close to jealousy.
Father may have much same feelings. Shared responsibility for infant care can
help to make both partners feel equally involved in the babys care and can help
alleviate these feelings.
DISAPPOINTMENT It can be difficult for parents to feel positive immediately
about a child who does not meet their expectations. Handle the child warmly.
Comment on the child good points.
POSTPARTUM BLUES (Baby blues) 50% of women experience some feelings
of overwhelming sadness. The mother burst into tears easily or may feel let down
or be irritable. Maybe due to hormonal changes (decrease estrogen &
progesterone). It maybe a response to dependence and low self-esteem caused by
exhaustion, being away from home, physical discomfort, and the tension
endangered by assuming a new role. A woman needs aasurance that sudden crying
episodes are normal. Allow to Verbalize feelings.
Physiologic Changes:
Blood Components
Hct rises in the first 3 to 7 days due to hemoconcentration caused by excretion of
large amounts of fluids in the urine (diuresis during the first few days after
delivery). Hct level returns to normal on the fourth to fifth postpartum week.
Leukocytosis of 20,000 to 30,000 (normal is 5000 to 10000) during the first 12
days characterized by increased neutrophils and easinophils and decreased
lymphocytes.
Fibrinogen and thromboplastin remains elevated until the 3rd postpartum week.
Increased leukocyte sedimentation rate.
INTEGUMENTARY SYSTEM
Chloasma, palmar erythema, linea nigra and other skin changes during pregnancy
gradually disappear during the postpartum period.
Striae gravidarum do not disappear and assumes a silvery white appearance.
Hyperpigmentation of the areola may not disappear completely. Some women are
left with a wider and darker areola after pregnancy.
Linea nigra will be barely detectable in 6 weeks time
GASTROINTESTINAL SYSTEM
Many women are hungry after delivery because of foods and fluids restriction
during labor, diaphoresis and the strenuous labor they just went through.
Bowel movement maybe delayed for days after delivery resulting in constipation.
This is caused by:
o Decreased muscle tone during labor and puerperium
o Lack of food during labor
o Dehydration
o Perineal pain caused by episiotomy, hemorrhage,laceration
o Bowel sounds are active, but passage of stool through the bowel may be
slow
URINARY SYSTEM
Voiding is difficult because of the pressure on the bladder and urethra
making it edematous.
To prevent permanent damage to the bladder from over distention, assess the
womans abdomen frequently in the immediate postpartum period
Increase daily output from 1500ml/day to 3000ml/day during the second to fifth
day after birth
Diuresis begins 12 hour after delivery and extends up to the 5 th day as the body
gets rid of extracellular fluid accumulated during pregnancy. The woman loses up
to 9 lbs. weight from the excretion of these fluids and electrolytes.
Acetone in the urine right after labor and lactosuria during the first week is
normal.
The bladder and urethra are traumatized by the pressure exerted by the fetal head
as it passes through the birth canal. Trauma to bladder results in loss of bladder
tone, edema and hyperemia. As a result, the woman experiences bladder tone
that results in bladder capacity. Decreased bladder tone causes decreased
sensation to the filling and distention of the bladder, the woman may not
experience the urge to void even if her bladder is already distended with urine w/c
predisposes to infection.
When catheterization of postpartum patient with urinary retention:
o Use straight catheter if one hour catheterization is ordered; use foley for 24
hours catheterization
o Maitain aseptic technique.
o Provide gentle touch as the area is sore.
o When amount of urine reaches 900-1000 cc, clamp catheter to prevent rapid
decompression in the abdomen w/c can cause hypotension
o Check vital signs after catheterization.
o Unclamp after 1 hour to drain urine.
HORMONAL SYSTEM
HCG & HPL almost negligible by 24 hours
Progestin, Estrone & Estradiol are at pre-pregnant level by 7th day
FSH remains low for about 12 days, then begins to rise to initiate a new menstrual
cycle
Pregnancy hormones begin to decrease as soon as the placenta is no longer
present.
REPRODUCTIVE SYSTEM
UTERUS
INVOLUTION a process whereby the reproductive organs return to their non-pregnant
state.
Promotion of Uterine Involution : (well-nourished, ambulates early after
birth,breastfeeding)
24 hours after birth the uterus is at the level of umbilicus.
1 cm or 1 fingerbreadths every postpartum day.
After 9-10 days the fundus is no longer palpable.
a well-contracted fundus should feel firm
Uterine Atony relaxed uterus, woman may loss blood rapidly
After pains intermittent cramping of the uterus
Common in multiparas, and those who have given birth to large babies
Uterus contracts more forcefully
FUNDUS
Height:
Measure the position or height of fundus by using umbilicus as a landmark. Place
fingers on the abdomen of the woman just below the umbilicus and count the
number of fingerbreadths that fit btwn the top of the fundus and umbilicus.
Immediately after delivery, the fundus is located midway btwn the umbilicus and
symphysis pubis or slightly higher. After several hours, it rises to the level of the
umbilicus. It then, descends into the pelvic cavity by one cm or one fingerbreadth
a day.
Palpation:
Place woman supine with small pillow under her head and knees flexed to relaxed
abdominal muscles. Make sure the bed is flat. Palpate the fundus by placing a
hand at the umbilicus and pressing it downward while the other hand is placed just
above the symphysis to support the lower segment of the uterus. Never palpate the
uterus without supporting the lower segment as this can result to uterine inversion.
If on palpation, the uterus feels boggy:
Massage it gently in circular motion, this is the first action to take
Place infant on mothers breast to stimulate uterine contractions by the release of
oxytocin
Administer oxytocin (as ordered) or increase infusion, do not administer ergot
products if BP is above 140/90mmHg.
LOCHIA
The seperation of the placenta and membranes occurs in the spongy layer or outer
portion of the decidua basalis
2nd day after birth, the layer of the deciduas remaining under the placental site and
throughout the uterus differentiates into two distinct layers.
o Inner layer
o Adjacent layer
-Uterine flow, consisting of blood, fragments of deciduas, white blood cells,
mucus and some bacteria
Type of Lochia
Rubra
Serosa
Alba
Color
red
pink
white
Duration
1-3 days
3-10 days
10-14 days
Composition
Blood,fragments of deciduas, mucus
Blood,mucus,invading leukocytes
Largely mucus,leukocyte count high
CERVIX
Immediately after birth, the cervix is soft and malleable
Both the internal and external os are open
By the end of 7 days the external os is narrowed to the size of a pencil opening and
the cervix feels firm and nongravid again
Does not return exactly to its prepregnant state
External will usually remain slightly open
Cervical os appears slitlike or stellate (star shaped)
VAGINA
After a vaginal birth, the vagina is soft with few rugae
Hymen is permanently torn and heals with small separate tags of tissue
Gradually turns to its approximate prepregnant state
Outlet will remain slightly more distended than before.
AMBULATION
Advantages of early ambulation:
o Prevent constipation
o Prevent thrombophlebitis
o Prevent urinary problems
o Promote rapid recovery and return of womans strength
o Hastens drainage of lochia
o Improves GIT & GUT function
o Provides a sense of well-being
REST & SLEEP
The woman should rest & sleep as much as needed during the early postpartum
period to overcome fatigue, excitement, anxiety & discomfort associated with long
& exhausting labor & delivery. Sleep and rest promote healing by reducing BMR
and allowing O2 & nutrients to be utilized for tissue growth, healing &
regeneration.
Instruct the mother to avoid heavy lifting and strenous activity after discharge
The woman may resume light housekeeping on the second week and can go back
to normal activities by 4 to 6 weeks.
Resumption of Sex:
Before leaving, she should be insructed re: schedule of follow-up clinic visit and
to report immediately to the doctor if the ff. signs & symptoms appear:
o Heavy vaginal bleeding or bright red vaginal discharge
o Fever
o Foul smelling lochia
o Swollen, tender, hot area on her leg
o Burning sensation on urination
o Persistent pelvic or perineal pain
Health Teachings
BREASTFEEDING TECHNIQUE
It is a preferred feeding method that provides optimal infant nutrition, easily
digested; it contains antibodies to bolster the immune system as well as nutrients
needed by the infant.
Purposes:
To help mothers body return to prepregnant state faster.
To provide some child spacing.
Through breastfeeding, the infants sucking stimulates production of
prolactin which eventually stimulates milk production.
Physiology:
estrogen, progesterone releases prolactin acts on acinar/alveoli cells
produces foremilk store in lactiferous tubules
Sucking stimulates posterior pituitary gland releases oxytocin causes
contraction of smooth muscles of lactiferous tubules milk ejection reflex letdown reflex
Advantages:
Economical
Promotes bonding
Contains Lactobacillus bifidus interfere the attack of pathogenic bacteria
in the GIT.
Helps in early involution of uterus oxytocin causes contraction
Always available
incidence of breast cancer
Breastfed babies have higher IQ than bottles fed ones
Antibody IgA
Macrophages
Disadvantages:
No iron
Possibility of transfer of Hepa B, HIV, CMV (13-39% possibility)
Father cant bond with the mother and baby instead, father can sing, kiss,
put baby to sleep.
Milk:
o Freezer good for 6 mos. / dont reheat
o Should be stored in a sterile plastic container
Colostrum:
o Present 2 4 days
o Contents: fats, CHO, immunoglobulin, protein, fat soluble vitamin,
minerals
Problems and Interventions:
Engorgement
o More frequent breastfeeding
o Apply warm packs before feeding and ice packs between feeding
Retracted Nipples
o Nipple-rolling before feeding
o Wear breast shield before feeding, which would act as a vacuum
when baby suck and consequently pull nipple out.
Cracked Nipples
o Lubricate nipple with A & D ointment after feeding
o Rotate feeding position
o Expose nipples to air for 10-20 mins every after feeding
o Manually express milk at affected side
o Breastfed using the unaffected side
No milk or inadequate supply
o Increase frequency of feeding and make the interval longer
Contraindications:
Maternal Conditions
o HIV
o Hepa B
o CMV
o Coumadin/Warfarin taking moms give heparin instead
Newborn Conditions
o Erythroblastocis Fetalis
o Inborn errors of metabolism (hydrofetalis, phenylketonuria, galactosemia,
tay-sachs disease)
NEWBORN SCREENING
It is the process of testing newborn babies for treatable genetic, endocrinologic,
metabolic and hematologic diseases.
History:
Robert Guthrie is given much of the credit for pioneering the earliest screening for
phenylketonuria in the late 1960s using blood samples on filter paper obtained by
pricking a newborn baby's heel on the second day of life to get a few drops of blood.
Congenital hypothyroidism was the second disease widely added in the 1970s. The
development of tandem mass spectrometry screening by Edwin Naylor and others in
the early 1990s led to a large expansion of potentially detectable congenital metabolic
diseases that affect blood levels of organic acids. Additional tests have been added to
many screening programs over the last two decades.
Common considerations in determining whether to screen for disorders:
1. A disease that can be missed clinically at birth
2. A high enough frequency in the population
3. A delay in diagnosis will induce irreversible damages to the baby
4. A simple and reasonably reliable test exists
5. A treatment or intervention that makes a difference if the disease is detected early
Mandated in the R.A. 9288 or Newborn Screening program of 2004.
A negative screen mean that the result of the test is normal and the baby is not
suffering from any of the disorders being screened. In case of a positive screen, the
NBS nurse coordinator will immediately inform the coordinator of the institution
where the sample was collected for recall of patients for confirmatory testing.
Babies with positive results should be referred at once to the nearest hospital or
specialist for confirmatory test and further management.
Newborn screening results are available within three weeks after the NBS Lab
receives and tests the samples sent by the institutions. Results are released by NBS
Lab to the institutions and are released to your attending birth attendants or
physicians. Parents may seek the results from the institutions where samples are
collected.
Disorders Screened:
Vaccine
Minimum Age
at 1st Dose
# Dose
Dose
Minimum
Interval
Between
Site
Reason
Doses
Bacillus
Birth or
Calmette
anytime after
Gurin
0.05
Right deltoid
mL
region of the
arm
the possibility of TB
birth
6 weeks
0.5 mL
4 weeks
Upper outer
Pertussis
portion of the
Tetanus
thigh
chance of severe
Vaccine
Oral Polio
pertussis.
6 weeks
Vaccine
2-3
4 weeks
Mouth
drops
The extent of
protection against
polio is increased the
earlier the OPV is
given. Keeps the
Philippines poliofree.
HepatitisB
Vaccine
At birth
0.5 mL
6 weeks
interval from
1st dose to
Upper outer
An early start of
portion of the
Hepatitis B vaccine
thigh
2nd dose,8
weeks
becoming a carrier.
interval from
Prevents liver
2nd dose to
third dose.
9 months
Measles
0.5 mL
Vaccine
Upper outer
At least 85% of
portion of the
measles can be
arms
prevented by
immunization at this
age.
Vaccine
TT1
Minimum
Percent
Age/Interval
Protected
As early as possible
during pregnancy
Duration of Protection
TT2
At least 4 weeks
80%
later
TT3
At least 6 months
95%
later
TT4
99%
TT5
99%
protected
Allowable time frames for the storage of vaccines at different levels are:
6 months Regional level
3 months Provincial level/district level
1 month main Health Centers with refrigerator
Not more than 5 days Health Centers using transport boxes