NCM 102

CARE OF MOTHER, CHILD, FAMILY AND

POPULATION GROUP
AT-RISK OR WITH PROBLEMS

COURSE DESCRIPTION
This

course deals with the

concept of disturbances & preexisting health problems of
pregnant women and the
pathologic changes during
intrapartum and post partum
periods.
This course further deals with the
common problems occurring
during infancy to adolescence
stage.

COURSE CREDIT
5

units lecture, 6 units RLE

[1unit Skills Lab/5units Clinical]

Contact Hours/Sem
90

lecture hours, 306 RLE hours

Course Objectives:
At the end of the course, given actual
or simulated situations /conditions
involving individual client (mother,
newborn baby, children) and family at
risk/with problem, the student will be
able to:
1. Utilize the nursing process in the
holistic care of client for the
promotion and maintenance of health
in community and hospital settings.

Course Objectives:
1.1 Assess with the client his/her health
condition and risk factors affecting health
1.2 Identify actual/at risk nursing
diagnosis
1.3 Plan with client appropriate
interventions for identified problems
1.4 Implement with client appropriate
interventions for identified problems
1.5 Evaluate with client the progress of
their condition and outcomes of care.

Course Objectives:
2. Ensure a well-organized
recording and reporting system
3. Observe bioethical principles
and the core values (love of God,
caring, love country and of
people)
4. Relate effectively with clients,
members of the health team and
others in work situations related
to nursing and health

Course Outline
I. Mother
A. High-Risk Prenatal Client
a. Identifying Clients at Risk
1. Assessment of risk factors
2. Screening procedures
3. Diagnostic tests and laboratory exams
b. Pre-gestational conditions such as
rheumatic heart disease, diabetes
mellitus, substance abuse, HIV/AIDS, Rh
Sensitization, anemia

Course Outline
c. Gestational condition such as
hyperemesis gravidarum, ectopic
pregnancy, gestational
trophoblastic disease (Hmole),
incompetent cervix, spontaneous
abortion, placenta previa,
abruptio placenta, premature
rupture of membranes,
pregnancy-induced hypertension

Course Outline
B. Nursing Care of the client with high-risk labor &
delivery & her Family
1. High-Risk factors: (may happen at anytime
during the course of labor to a client who has
been otherwise been healthy throughout her
pregnancy & may be related to stress/stressor;
adaptive process):
- passenger or fetus
- passage way or pelvic bones & other pelvic
structure
- powers or uterine contractions
- placenta
- clients' psyche or psychologic state

Course Outline
2. Problems of the Passenger
a. Fetal malposition
1. Types of fetal malposition
2. Nursing care
3. Medical Management
b. Fetal malpresentation
1) Vertex malpresentation
a) brow presentation
b) face presentation
c) sincipital presentation

Course Outline
2)

Breech presentation
a) types
b) maternal risks
c) vaginal evolving of breech
d) external/podalic version
3) Shoulder presentation
a) Compound presentation
4) Nursing care of client with
malpresentation

Course Outline
c. Fetal distress
1) causes
2) signs/symptoms
3) nursing interventions
d. Prolapse umbilical cord
1) cause
2) contributing factors
3) assessment & nursing diagnoses
4) nursing interventions.

Course Outline
3. Problems with the passageway
a. abnormal size or shape of the pelvis
b. cephalopelvic disproportion
c. shoulder dystocia
d. nursing care of client with problems of the
passageway
4. Problems with the Powers
a. dystocia or difficult labor
hypertonic uterine dysfunction
hypotonic uterine dysfunction
abnormal progress in labor
retraction rings

Course Outline
b. premature labor
c. precipitate labor and birth
d. uterine prolapse
e. uterine rupture
5. Placental problems
a. Implantation in the lower uterine
segment
b. Premature detachment of placenta
6. Problems with the psyche factors
a. Inability to bear down properly
b. Fear/anxiety

Course Outline
C. Nursing Care of the High-Risk Postpartal
Client
1. Postpartal hemorrhage
a. Early postpartal hemorrhage
b. Late postpartal hemorrhage subinvolution
2. Postpartal puerperal infection
a. Endometritis
b. Wound infection
c. UTI
3. Thromboembolic disorders
4. Postpartal psychiatric disorder

Course Outline
D. Care of couple with problems of
infertility
1. Causes of infertility in males
and females
2. Diagnostic tests
3. Nursing interventions

Course Outline
II. Child
A. Nursing care of the high-risk newborn
to maturity
1. Problems related to maturity
a. Prematurity
b. Postmaturity
2. Problems related to gestational
weight
a. Small for gestational age (SGA)
b. Large for gestational age (LGA)

Course Outline
3. Acute conditions of the neonates
such as:
a. Respiratory distress syndrome
b. Meconium aspiration syndrome
c. Sepsis
d. Hyperbilirubinemia
e. Sudden death syndrome (SDS)

Course Outline
B. Common health problems that develop during
infancy
example: intussusception, failure to thrive, sudden
infant death
syndrome, colic, trisomy 21, cleft palate,
imperforated anus,
hirchsprung's disease, spina bifida, hydrocephalus,
otitis media,
meningitis, febrile seizures, autism/ADHD
C. Health problems common In toddlers example:
burns, poisoning, child abuse, cerebral palsy
D. Health problems common In preschooler example:
leukemia, wilm's tumor (nephroblastoma), asthma,
urinary tract infection (UTI)

Course Outline
E. Health problems most common in
school aged children example:
diabetes mellitus, rheumatic fever,
rheumatic arthritis, scabies,
pediculosis, impetigo
F. Health problems common in
adolescent example: scoliosis, bone
tumors, accidents (trauma/injury), STD,
amenorrhea, dysmenorrhea, obesity,
anorexia nervosa, substance abuse,
suicide

GOAL

Improve the survival, health

and well being of mothers and
the unborn through a package
of services for the:

pre-pregnancy
prenatal
natal
postnatal stages

2a.2

Where are we now?

Population of over 80 million will

double in 30 years at current growth
rate of 2.36%

2a.3

Where are we now?

The lack of family planning

places a disproportionate
burden on the poor.

It

is the poorest
Filipinos (57.1%)
who are not using
family planning
because of poor
access and
ineffective outreach
20.5% of married
women say they
need family
planning but are not
using any method

The Philippine Situation

3.1 million pregnancies occur each year. Half of these pregnancies are
unintended and one third ends in abortion
About 473,000 abortions annually with induced abortion as 4th
leading cause of maternal deaths

10 mothers die everyday due to childbirth and pregnancy related

complications

Every mom who dies leaves 3 orphans. In effect, 30 children are orphaned
every day

Maternal Mortality Ratio

Note: To show progress of MMR based on MDG, UNFPA estimated MMR based on the
average rate of progress in 2003.

Health
Indicators
Selected Asian Countries
Japan

So.Korea

Malaysia

Thailand

Philippines

Life Expectancy

81

75

73

70

70

Infant Mort.
Rate

24

29

Underfivemortal
ity

28

40

Maternal
Mortality

20

41

44

160

Population
Growth

0.3

0.8

2.2

1.4

2.3

70 %

of births were delivered

in the

home

Only 60 % of births were attended by a

health care professional

Source: MCHS-PNSO, Philippines 2002

Why do women die?

Complications

related to pregnancy occurring in

the course of labor, delivery and puerperium.
( obstructed labor, infection)
Hypertension complicating pregnancy,
childbirth, and puerperium( eclampsia etc.)
Postpartum Hemorrhage due to uterine atony,
placental retention
Pregnancy with abortive outcome
Hemorrhage related to pregnancy ( ectopic
pregnancy, placenta previa etc.)

7 Direct Obstetric
Complications

Hemorrhage (antepartum / postpartum)

Prolonged / Obstructed labor
Postpartum sepsis
Complications of abortion
Pre-eclampsia / Eclampsia
Ectopic pregnancy
Ruptured uterus

National Health Goals

Reduce the rate of fetal deaths to
4.1 per 1000 live births from a
baseline of 6.8 per 1000.
Reduce the rate of maternal deaths
to 3.3 per 100,000 live births from a
baseline of 7.1 per 100,000.
Reduce the rate of maternal illness
and complications during pregnancy
to 24 per 100 births from a baseline
of 31.2 per 100 (http://www.nih.gov).

IDENTIFYING
CLIENT AT
RISK

High Risk Pregnancy

Is

one in which a concurrent disorder,

pregnancy-related complication, or external
factor jeopardizes the health of the mother,
the fetus, or both
Some women enter pregnancy with a chronic
illness that, when superimposed on the
pregnancy, makes it high risk
Other women enter pregnancy in good
health but then develop a complication of
pregnancy that causes it to become high
risk.

Identifying the High-Risk

Pregnancy
High-Risk Pregnancy one in which a
concurrent disorder of pregnancy related to
complication or external factor that
jeopardizes the health of the mother, fetus
or both.
Causes:
1. Chronic
2. Developed complication(s) during
pregnancy
3. Combination of particular circumstances
such as:
a. Poverty

b. Lack of support people

c. Poor coping mechanism
d. Genetic inheritance
e. Past history of pregnancy complications
Categories (Risks):
1. Minimal
2. Moderate
3. Extensive

NURSING CARE OF THE WOMAN WITH HIGH RISK PREGNANCY

Nursing Process Overview (Care of the woman

with a pre-existing or newly acquired
illness)
I. ASSESSMENT
1. Nursing History

Obtaining accurate pre-natal assessment

Interview/observation (past/previous
illnesses or condition)

NURSING CARE OF THE WOMAN WITH HIGH RISK PREGNANCY

2. Physical History
Done through observation and physical
examination
Thorough understanding of the signs and
symptoms of illnesses (e.g. cardiovascular
disease; DM)
3. Diagnostic Assessment
Laboratory
Culture and Sensitivity test
CT scan
X-ray
UTZ

NURSING CARE OF THE WOMAN WITH HIGH RISK PREGNANCY

II. NURSING DIAGNOSIS

Possible nursing diagnosis may include:
1.
Risk for infection transmission related to
lack of knowledge of safer sex practice.
2.
Ineffective tissue perfusion
(cardiopulmonary) related to mitral valve
prolapsed during pregnancy.
3.
Pain related to Pyelonephritis.
4.
Social isolation related to prescribed bed
rest during pregnancy secondary to
concurrent illness.
5.
Ineffective role performance related to
increasing level of daily restrictions
secondary to chronic illness and pregnancy.

NURSING CARE OF THE WOMAN WITH HIGH RISK PREGNANCY

6. Knowledge deficit related to normal changes

of pregnancy versus illness complications.
7. Fear regarding pregnancy outcome related
to chronic illness.
8. Health-seeking behaviors related to the
increasing knowledge of the effects of illness
on pregnancy.
9. Situational low self-esteem related to
diagnosis of HIV infection

NURSING CARE OF THE WOMAN WITH HIGH RISK

PREGNANCY

III. PLANNING FOR HEALTH RESTORATION AND

MAINTENANCE
Major Goal: Maintain health during pregnancy.
IV. INTERVENTION
1.
Focus on teaching new or additional
measures to maintain health for a pregnant
woman with an illness unrelated to her
pregnancy.
2.
Encourage and give opportunity to talk and
verbalize feelings and emotions.
3.
Counseling (feelings of guilt and anger).

NURSING CARE OF THE WOMAN WITH HIGH RISK

PREGNANCY

V. EVALUATION
Make an on-going evaluation to ensure
whether interventions are successful.
Examples:
Clients states she rest for two hours
(morning and afternoon).
Dependent edema remains at 1+ or less at
next pre-natal visit.

Factors that Categorize a Pregnancy as High

Risk
A. Pre-Pregnancy
Psychological

Social

Physical

a. history of drug
dependence
b. History of mental
illness
c. History of poor
coping mechanism
d. Cognitively
challenged
e. Survivor of childhood
sexual abuse

a. Occupation handling
of toxic substances
b. Environmental
contaminants at home
c. Isolated
d. Lower economic
level
e. Poor access to
transportation for care
f. Poor housing
g. Lack of support
people

a. Visual or hearing
challenges
b. Pelvic inadequacy or
misshape
c. Secondary major
illness (heart disease,
DM, kidney disease,
hypertension etc.)
d. Poor gynecologic or
obstetric history

Psychological

Social

Physical
e. History of previous
poor pregnancy
outcome(miscarriage,
stillbirth, intrauterine
fetal death)
f. Pelvic inflammatory
disease
g. Obesity
h. Small stature
i. Younger than age
18 years or older than
35 years
j. Cigarette smoker
k. Substance abuse

B. Pregnancy
Psychological

Social

Physical

a. Loss of support
b. Illness of a family
member
c. Decrease selfesteem
d. Poor acceptance of
pregnancy

a. Refusal of or
neglected prenatal
care
b. Exposure to
environmental
teratogens
c. Decreased
economic support
d. Conception less
than 1 year after last
pregnancy or
pregnancy within 12
months of the first
pregnancy

a. Intake of teratogen
b. Multiple gestation
c. Poor placental
formation or
position
d. Gestational
diabetes
e. Nutritional
deficiency
f. Poor weight gain
g. PIH
h. Infection
i. Amniotic fluid
abnormality
j. post maturity

C. Labor and Delivery

Psychological

Social

Physical

a. Severely
frightened by labor
and delivery
experience
b. Inability to
participate due to
anesthesia
c. Lack of preparation
for labor
d. Birth of infant who
is disappointing in
some way
e. Illness in newborn

a. Lack of support
person
b. Unplanned CS
c. Lack of access to
continued health care
d. Lack of access to
emergency personnel
or equipment
e. Inadequate home
for infant care

a. Hemorrhage
b. Infection
c. Dystocia
d. Precipitous birth
e. Lacerations of
cervix or vagina
f. CPD (Cephalopelvic
disproportion)
h. Retained placenta