CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)

BSN 2-3|SECOND SEM|BATCH 2023

Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

Framework for Maternal and Child Nursing Focusing Philosophies of MCN

on At- Risk, High Risk and Sick Clients
1. MCN is Family Centered; assessment must include
Obstetric both family and individual assessment.

• Branch of medicine that specializes in the 2. MCN is Community Centered; health of families
care of women during pregnancy and depends on & influences the health of
childbirth. communities.
• Derived from the Greek word “obstare” (to
3. MCN is Evidence Based because critical knowledge
keep watch)
increases
Pediatrics
4. MCN includes independent nursing functions
• Branch of medicine with children and their because teaching & counselling are
diseases. major interventions.
• Derived from the Greek word “pais” (child)
5. MCN Nurse Advocate (protects the rights of family
Maternal & Child Nursing (MCN) members, including fetus)

• Focus: Care of childbearing and childrearing 6. Health Promotion and Disease Prevention to
families. protect health of new generation
• Primary Goal of MCN: Promotion and 7. MCN is a challenging role for nurses
maintenance of optimal health.
Framework for MCN
Range of Practice of MCN Includes:
1. Preconceptual 4. Care of Infants during 1. Nursing Process (ADPIE)
Care perintal period (6 weeks
2. Evidence – Based Practice
before conception and 6
weeks after birth) 3. Nursing Research
2. Care of woman 5. Care of children from
during the 3 birth and adolescence: 4. Nursing Theory
trimesters of • Neonatal period (1st
Four Phases of Health Care
pregnancy: 28 days of life)
• 1st trimester • Infancy (1-12 1. Health Promotion
(1-3 months)
months) • Toddler (1-3 years) • Educating clients to be aware of good health
• 2nd trimester • Preschool Age (3-4 through teaching and role modelling
(4-6 years)
Example:
months) • School Age (4-17
• 3rd trimester years old) Family planning, teach the importance
( 7-9 ❖ Adolescence of safe sex practice, importance of
months) (10-19 immunizations.
years)
3. Care of woman 6. Care of setting as varied
during puerperium as the birthing room, PICU,
or 4th trimester (6 and at home.
weeks after
childbirth)
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

2. Health Maintenance Trends in MCN Population

• Intervening to maintain health when risk Trends Nursing Implications
of illness is present. Families are smaller size • Fewer family
member is
Example: present as
support people
Encourage prenatal care, importance in time of crisis.
of safeguarding homes by childproofing • Role of Nurses:
it against poisoning. fulfill the role.
3. Health Restoration
Increased Single Parents • Fewer financial
• Diagnosing and treating illness using (most common type of resource
interventions that will return client to parent in US) especially
wellness fast. woman.
• Role of Nurse:
Example: Inform parents
of care options
Care of child during illness, care of woman during
and back – up
pregnancy complications opinion
4. Health Rehabilitation Increased mothers • Healthcare must
working outside home be scheduled at
• Preventing further complications from an at east Part- Time (90%) times a working
illness. parent can care
• Bringing client back to an optimal state of for her own self
wellness or bring a child
• Helping client accept inevitable death. for care.
• Role of Nurse:
Example: Discuss
selection of
Encourage continuous therapies and medications. childcare
centers
Families are more • Good
NOTE: mobile; Increased no. of interviewing &
homeless women & health
Client Advocacy children monitoring are
necessary so
• safeguarding and advancing the health database
interests of clients and their can be
families established and
continuity of
care.
Child and Intimate • Screening for
Partner Abuse child or intimate
partner abuse;
Nurses must be
aware of legal
responsibilities
for reporting
abuse.
Families are more • Provide Health
health conscious Education
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

Philippine Health Picture

Health Care should ➢ Comprehensive Estimated Population

respect cost care is Increased from
containment necessary is 74,745,756 to 107, 288,
primary care 150. 43.5% Increase
settings because
referral to
specialist may
no longer be an
option; Health Crude Birth Rate
insurance is not Decreased from21.6 to
available in all 15.6.
families. 27.8% Decrease

Statistics In MCN Crude Death Rate

Measuring Maternal and Child Health / Statistical Increased from 4.7 to
Terms Used to Report Maternal and Child Health 5.8.
23.4% Increase
1. Birth Rate – no. of births per 1000 population
2. Fertility Rate – no. of pregnancies per 1000
women of childbearing age Infant Death Threat
3. Fetal Death Rate –no. of fetal deaths weighing Declined from 15.6 to
more than 500 g or more per 1000 live births. 13.0.
4. Neonatal Death Rate 16.7% Decrease
➢ Neonatal Period – 1st 28 days of life;
Infant is called Neonate.
Maternal Death Rate
➢ No. of deaths per 1000 live births
Increased from 0.8 to
occurring in the 1st 28 days of life.
0.9
5. Perinatal Death Rate 12.5% increase
➢ Perinatal Period – 6 weeks before
conception and 6 weeks after
childbirth Fetal Death Ration
➢ No. of deaths of fetuses weighing > Decreased from 6.1 to
500g and within the first 28 days of 5.4
life per 1000 birth. 11.5% Decrease
6. Infant Mortality Rate – no. of deaths per 1000
live births in the first 12 months of life.
7. Childhood Mortality rate – no. of deaths per
1000 population in children; 1 – 14 y/.
8. Maternal Mortality Rate – no. of maternal
deaths per 100,000 live births that occur as
direct result of reproductive process.
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

6. Increasing the Use of Alternative Treatment

Modalities
Latest Unicef – Data Philippines
➢ alternative method of therapies such
as
➢ acupuncture and therapeutic touch;
herbal remedies
7. Increasing Reliance on Home Care
➢ decreased hospital stay.
8. Increasing Use of Technology
➢ use of internet, charting in computer,
using Doppler
9. Free birthing
➢ women giving birth without health
care provider supervision; unassisted
Trends In Health Care Environment
birth.
1. Cost containment 10. LAMAZE
➢ reducing the cost of health by closely ➢ breathing techniques
monitoring the cost of personnel, use
Use of Technology: Doppler Ultrasound
and brands of supplies, length of
hospital stays, no. of procedures 6 Tips from LAMAZE Techniques
carried out, and no. of referrals while
1. Let the Labor Begin on its Own
maintaining quality care.
2. Increasing Alternative Settings and Styles for 2. Walk, move around and change positions
Health Care throughout labor
➢ LDRP Rooms (Labor – Delivery –
Recovery – Postpartum) a more 3. Bring a loved one, Friends or doula for continuous
natural childbirth environment as a support
birthing room. Family members are 4. Avoid interventions that are not medically
invited to stay to be a part of necessary
childbirth.
➢ Retail Clinics or Emergent Care Clinics 5. Avoid giving birth on your back and follow your
located in shopping malls. body’s urge to push
➢ Ambulatory Clinics or at home to 6. Keep your baby with you. It’s best for you, Your
avoid long hospital stays for women baby and breastfeeding.
and children.
3. Including Family in Health Care Legal Considerations of MCN Practice
4. Increasing Intensive Care Units
1. Identifying and Reporting Child Abuse
➢ ICU (Neonatal Intensive Care Unit) or
2. Child can bring a lawsuit when they reach
ICN (Intensive Care Nursery)
legal age .
➢ PICU (Pediatric Intensive Care Unit)
3. Informed Consent for invasive procedure and
5. Regionalizing Intensive Care
any risk that may harm the fetus
➢ ex. Premature infant transferred to
4. In divorced or blended families, nurse has the
regional hospital.
right to give consent.
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

Genetics
NOTE: • The scientific study of genes and heredity – of
Nurses legally responsible to protect the certain qualities or traits are passed from
rights of their client and documentation is parents to offspring as a result of changes in
essential to protect nurse and justify his or DNA sequence.
her actions. Genetic Counselling

• Gives information about how genetic

Ethical Considerations of Practice
conditions might affect an individual or their
1. Conception Issues family.
➢ In Vitro Fertilization
➢ Embryo Transfer
➢ Cloning
➢ Stem Cell Research
➢ Surrogate Mothers
2. Abortion
3. Fetal Rights vs Rights of the Mother
4. Use of Fetal Tissue for Research
5. Resuscitation
6. No. of Procedures or Degree of Pain that a
Child should be asked to Achieve Better
Health
7. Balance Between Modern Technology and
Quality of Life

In Vitro Fertilization Process

Reasons for Genetic Counselling

1. Planning for Pregnancy

➢ Address concerns about factors that
might affect the baby during infancy
or childhood or the patient’s ability to
become pregnant, including:
a. Genetic condition that run in
the patient’s family or
Surrogacy Process partner’s family
b. History of infertility, multiple
miscarriages, or stillbirth
c. Previous pregnancy or child
affected by a birth defect or
genetic condition
d. Assisted Reproductive
Technology (ART) options.
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

Most Common Birth Defects 3. Caring of Children

➢ Address concerns if the child is
showing signs and symptoms of a
disorder that might be genetic,
including:
a. Abnormal newborn screening
results
b. Intellectual disability or
developmental disabilities
c. Autism Spectrum Disorder
(ASD)
2. During Pregnancy d. Vision or hearing problems
➢ Address certain tests that may be Newborn Screening Tests (Philippines)
done during patient’s pregnancy, any
detected problems, or conditions that
might affect the baby during infancy
or childhood, including :
a. History of infertility, multiple
miscarriages, or stillbirth
b. Abnormal test result, such a
blood test, ultrasound,
chronic villus sampling (CVS),
or amniocentesis
c. Maternal infections, such as
Cytomegalovirus (CMV) and
other exposures such as
medicines, drugs , chemical,
and x-rays
d. Genetic screening that is
recommended for all
pregnant woman, which
includes cystic fibrosis, sickle
cell disease, and any
conditions that run the
patient’s family or her
partner’s family.
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

✓ Helping couples arrange for further

assessment measures.
4. Managing Patient’s Health
✓ Guide couple to concentrate om short
➢ Genetic counselling for adults includes
– term goals and actions or help them
specialty areas such as cardiovascular,
look at the immediate needs of the
psychiatric, and cancer. Genetic
family, fetus, and the newborn and
counseling can be helpful if the
later on what type of continued
patient has symptoms of a condition
follow- up will be necessary.
or have a family history of a condition
4. Implementation
that makes her more likely to be
✓ Parents of children with genetic
affected with that condition,
disorder disorders go through stages
including:
of grief.
a. Hereditary breast and ovarian
✓ Reaction occurs at later point of
cancer (HBOC) syndrome
diagnosis.
b. Lynch Syndrome (hereditary
✓ Support couple in whatever stage
colorectal and other cancers)
they have reached when you care for
c. Familial Hypercholesterolemia
them and help them work through
d. Muscular Dystrophy and other
and adjust to their child’s diagnosis.
muscle disease
5. Outcome Evaluation
e. Inherited movement disorders
✓ Couple states the feel capable of
such as Huntington’s disease
coping no matter what the outcome
f. Inherited blood disorder such as
of genetic testing.
sickle cell disease
✓ Patient accurately states the chances
Nursing Process in Genetic Counselling of genetic disorder occurring in her
next child.
1. Assessment ✓ Couple states they have resolved their
✓ Detailed family history (preferably 3 feelings of low self- esteem related to
generations) birth of child with a genetic disorder.
✓ Physical examination of both parents
and any affected children Stages of Grief
✓ Series of laboratory assays of blood, I. Denial II. Depression
amniotic fluid, and maternal and fetal III. Anger IV. Acceptance
cells V. Bargaining
2. Diagnosis
✓ Fear related to outcome of genetic Inherited or Genetic Disorder
screening tests
✓ Altered sexuality pattern related to I. Disorders that can be passed from one
fear of conceiving a child with genetic generation to the next because they result
disorder. from some disorder in the gene or
✓ Deficient knowledge related to chromosome structure
inheritance pattern of family’s II. Occur in some ethnic groups more than
inherited disorder. others because people tend to marry within
3. Outcome Identification and Planning their own cultural group
✓ Determining what information the III. May occur due to occupational hazards, such
couple needs to know before testing as toxic substances in the environment of
can proceed workplaces.
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

Mendelian Inheritance

Common Genetic Disorders in the

Philippines
Down Syndrome Autism Care of at – risk / High Risk and Sick Mother and Child
Cerebral Palsy Diabetes Mellitus What is a High-Risk Pregnancy?
Hyperthyroidism
✓ A pregnancy that threatens the health or life
of the mother or her fetus
Down Syndrome ✓ Often requires specialized care from specially
➢ TRISOMY 21 (47XY21+ OR 47XX21+) trained providers.
➢ Occurs in about 1 in 800 pregnancies. ✓ Risk Factors:
➢ In women who are older than 35 1. Existing Health Conditions
years of age, the incidence is as high ➢ Example: High Blood
as 1 in 100 live births. Pressure, Diabetes, or being
HIV- Positive
2. Overweight and Obesity
➢ Increases risks of
complications
3. Multiple Births
➢ Risks increases when mother
is carrying more than 1 fetus.
4. Young or Old Maternal Age
➢ Pregnancy in teens and
women with age 35 or older
increases risk for
preeclampsia and gestational
high blood pressure.
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

High – Risk Pregnancy: ✓ 3Ps = polydipsia (thirst), polysuria

(increased urination), polyphagia
➢ Increased Risk of
(ingestion of increased amount of
Complications “Management”
food)
is a Vital Factor & Here’s
✓ May have signs of ketosis and may
What You Have to Do:
lead to ketoacidosis.
✓ Uncontrolled DM may lead to damage
to small blood vessels throughout the
body and may lead to serious
impairment esp. in the kidneys , eyes,
and heart
✓ 3 Types
a. DM Type 1 (Insulin –
deficient)
b. DM Type 2 (Insulin-
resistance)
c c. Gestational DM
o Onset of glucose
Complications of Pregnancy intolerance during
Conditions That Occur Conditions Related to pregnancy
Concurrent to Pregnancy o (ADA) Diabetes
Pregnancy diagnosed in the
1. Diabetes Mellitus 1. Hemorrhagic second and third
Conditions that occur in
trimester of
early pregnancy
pregnancy that was
2. Cardiac Arrest 2. Hemorrhagic
not clearly overt
Complications of the
Placenta in Late diabetes before
Pregnancy gestation.
3. Obesity 3. Hyperemesis
Gravidarum (HEG)
4. Anemias 4. Hypertensive Disorder
of Pregnancy
5. Immune Complex 5. Blood
Disorder Incompatibilities
6. Neurologic Disorder
7. Infections

Concurrent Conditions That Occur in Pregnancy

1. Diabetes Mellitus
✓ Common medical condition that
affects pregnancy
✓ Disorder of carbohydrates
metabolism caused by partial or
complete lack of insulin secretion by
the beta cells of the pancreas
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

✓ Fasting glucose more than 126mg/dL

or post meal glucose more than
Blood Sugar Chart
200mg/dL

Effects of Diabetes Mellitus In Pregnancy

Maternal Effects Fetal and Neonatal
Effects
• Spontaneous • Congenital
Abortion Abnormalities
• Gestational • Complications of
Hypertension Large Fetal Size
(macrosomia)
• Preterm Labor • Intrauterine
and Premature Growth
Rupture of Restriction
Comparison of Hypoglycemia and Hyperglycemia in Membranes
the Diabetic Woman • Hydramnios • Birth Injury
(excessive
amniotic fluid;
also called
polyhydramnios
)
• Infections • Delayed Lung
✓ Vaginiti Maturation;
s Respiratory
✓ Urinary Disease
Tract Syndrome
Infectio
ns
• Complications • Neonatal
of Large Fetal Hypoglycemia
Gestational Diabetes (GDM) Size:
✓ Birth
➢ Common
Canal
➢ Resolves quickly after childbirth.
Injuries
➢ Women might develop DM Type 2 ✓ Cesarea
➢ Women who are high risk for GDM: n Birth
✓ Maternal Obesity (greater than 90kg • Ketoacidosis • Neonatal
or 198lbs) Hypocalcemia
✓ Large infant (greater than 400g or • Neonatal
9lbs, macrosomia) Hyperbilirubine
✓ Maternal Age Older Than 25 years mia and Jaundice
✓ Previous unexplained stillbirth or • Neonatal
infant having congenital Polycythemia
abnormalities. (excess
✓ History of GDM In previous pregnancy erythrocytes)
✓ Family History of DM caused by
hypoxia
• Perinatal Death
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

Nursing Care for Patient with Risk for DM or with ➢ 3rd trimester: Maternal assessment of
Complications of DM fetal movements, via UTZ - BPPs, NSTs
and contraction tests, series of
Assessment at Preconception & During Pregnancy
sonograms to monitor growth of the
1. Preconception fetus.
➢ Get the medical history (onset and
Normal Values – Oral Glucose Challenge Test
management if there is pre-existing
DM), medications, infections,
vaccinations etc.
➢ Physical examination: routine pre-
natal examination, baseline ECG,
retinopathy, weight, and blood
pressure
➢ Lab tests: 24-hour urine collection for
total protein excretion and creatinine
clearance, urine sample to check for
UTIs, dipstick test for presence of Target Blood Sugar Levels for Pregnant Woman
glucose, ketones, and protein, thyroid
function test, HbA1c (test for glycemic
control)
➢ Genetic Testing
2. During Pregnancy
➢ Get the medical history (onset and
management if there is pre-existing
DM), medications, infections,
vaccinations etc.
➢ Physical examination: routine pre-
natal examination, baseline ECG,
retinopathy, weight and blood
pressure, fundal height (via UTZ)
➢ Lab tests: 24-hour urine collection for Safety Check
total protein excretion and creatinine
clearance, urine sample to check for Signs and Symptoms of Maternal Hypoglycemia
UTIs, dipstick test for presence of Include the following:
glucose, ketones, and protein, thyroid ➢ Shakiness ➢ Sweating
function test, HbA1c (test for glycemic (tremors)
control), Oral Glucose Challenge Test ➢ Pallor; cold, ➢ Disorientation,
clammy skin irritably
between 24-28 weeks of gestation if
➢ Headache ➢ Hunger
they are at risk of GDM.
➢ Blurred Vision
➢ Fetal surveillance: multiple-marker
screening, ultrasound at 18-20 weeks
of gestation and fetal Diagnoses at Preconception and During Pregnancy
echocardiography at 20-22 weeks of
➢ Risk for ineffective tissue perfusion related to
gestation to determine integrity of
reduced vascular flow.
fetal body and cardiac structure.
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

➢ Imbalanced nutrition, less than body Management During Labor and Childbirth
requirements, related to inability to use
✓ Monitoring of labor (vital signs, stages)
glucose
✓ Intravenous infusion of dextrose solution plus
➢ Risk for ineffective coping related to required
regular insulin as needed.
change in lifestyle.
✓ Glucose control via infusion
➢ Risk for infection related to impaired healing
✓ Glucose monitoring
accompanying condition.
✓ Close monitoring of fetus
➢ Deficient fluid volume related to polyuria
✓ Assessments for impending childbirth
accompanying the disorder.
✓ Care during the birthing process (normal
➢ Deficient knowledge related to complex
delivery or caesarian)
health problem.
✓ Care of neonate as with normal (cleaning,
➢ Health- seeking behaviors related to voiced
suction of fluids, keeping child warm, giving of
need to learn home glucose monitoring.
vitamin K etc.)
Planning, Implementation, and Evaluation at
Preconception and During Pregnancy
Management During Post -partum period
1. Diet and Activities
✓ Encourage breastfeeding.
➢ Patient Education: Teach proper
✓ Patient Education: Care of neonate,
nutrition and hygiene, explaining
management of wounds, health, hygiene etc.
allowed/ restricted activities
✓ Adherence to checkups
(exercises, vitamins and other
✓ Glucose monitoring for DM patients
substances etc.)
✓ Adherence to medications
2. Provide Normal Pregnancy Care
✓ Postpartum Contraception
3. Provide Emotional Support for Results of Tests
and Clinical Diagnosis Concurrent Conditions That Occur in Pregnancy
4. Maintenance of Glucose Levels
➢ Laboratory tests esp. screening for 2. Cardiac Diseases
GDM ✓ Complicates 1-4% of pregnancies.
➢ Education on self-monitoring of ✓ One of the leading causes of maternal
glucose levels i.e. use of glucometers death
➢ Use of diabetic medications, insulin ✓ 2 Categories
therapy I. Acquired – develops after
5. Fetal Surveillance birth.
➢ Adherence to checkups II. Congenital – present at birth
➢ Ultrasonography and other tests ✓ Common Causes:
needed. I. Valve deformities caused by
6. Referrals to Specialists (Ophthalmologists, rheumatic fever or Kawasaki’s
Nutritionists, Perinatologists etc.) disease.
7. Timing and Type of Delivery II. Congenital anomalies such as
➢ Timing: Ideally > 39 weeks AOG Atrial septal defect (ASD) or
➢ Normal birthing vs Caesarian delivery uncorrected coarctation of
(benefits vs risks ratio, timing, other aorta
preparations) III. Diseases such as Marfan
syndrome which can cause
aortic dilatation.
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

IV. Peripartum diseases – Normal Heart Vs Coarctation

Cardiomyopathy which
happen in pregnancy for
women with no history of
cardiac disease (Cause is
unknown, but stress could be
a factor

Rheumatic Fever
Signs and Risk Factors Complications
Symptoms
Fever Family History Valve Stenosis
Marfan Syndrome
Painful and Certain Strains Valve
tender joints of Strep Regurgitation
Bacteria
Red, hot, and Environmental Damage to
swollen joints Factors Heart Muscles
Small, painless
bumps beneath
the skin
Chest Pain
Heart Murmur
Fatigue
Outburst of
unusual
behavior

Kawasaki Disease
Classification of Heart Disease

1. Uncompromised, Ordinary Physical

Activities causes no discomfort, No
symptoms of cardiac insufficiency and no
anginal pain
2. Slightly compromised, Ordinary physical
activity causes excessive fatigue,
palpitation, and dyspnea or anginal pain
3. Markedly compromised. During less than
ordinary activity, woman experiences
excessive fatigue, palpitations, dyspnea, or
Normal Heart vs ASD anginal pain
4. Severely compromised. Woman is unable to
carry out any physical activity without
experiencing discomfort. Even at rest,
symptoms of cardiac insufficiency or
anginal pain are present
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

pulmonary
artery
2 Types of Heart Failure pressure
Left – Sided Heart Failure Right – Sided Heart ➢ ➢ Close
Failure monitoring
➢ Mitral stenosis, ➢ Unrepaired when given
mitral congenital epidural
insufficiency, heart defect anesthesia →
coarctation of such as might develop
aorta pulmonary hypotension
valve stenosis,
Eisenmenger
syndrome Congestive Heart Failure (CHF)
➢ High risk for ➢ Jugular
spontaneous distention and Signs of Congestive Heart Failure During Pregnancy
miscarriage, increase ➢ Orthopnea (having to sit upright to breath
preterm labor, or portal more easily)
even maternal circulation is
➢ Persistent cough, often with expectoration of
death present
mucus that may be blood-tinged.
➢ Symptoms: ➢ Liver and
Paroxysmal spleen ➢ Moist lung sounds because of fluids within
Nocturnal become lungs.
Dyspnea (PND), distended → ➢ Difficulty breathing on exertion.
Orthopnea, blood liver ➢ Palpitations
speckled sputum enlargement ➢ Fatigue or fainting on exertion.
→ dyspnea ➢ Severe pitting edema of the lower extremities
➢ Thrombus ➢ Distention of or generalized edema.
formation if mitral abdomen -- ➢ Changes in fetal heart rate indicating hypoxia
stenosis is present .Peripheral or growth restriction if placental blood in flow
(anticoagulants edema is reduced.
are prescribed)
➢ Antihypertensives, ➢ Not advised to Nursing Care for Patient with Risk of Cardiac Disease
diuretics, and beta get pregnant or with Complications of Cardiac Disease
blockers will be until anomaly
given is corrected Assessment at Preconception and During Pregnancy
➢ Serial ultrasounds ➢ If pregnant or 1. Take thorough medical history.
and NSTs are planning to 2. Document pre-pregnancy or pregnancy status
done after 30-32 get pregnant,
(Baseline blood pressure, pulse rate,
weeks of monitor ABGs
respiratory rate in sitting or lying position, nail
pregnancy to to ensure fetal
assess fetal health growth bed filling -capillary refill test, jugular vein
and rule out poor distention, measure liver size in 1st visit)
placental 3. Document patient’s level of exercise
perfusion performance
➢ ➢ During labor, 4. Ask if she has normally cough or edema.
pulmonary 5. Vaccinations, medications, etc.
artery 6. Review laboratory results and prescriptions if
catheter is any
inserted to 7. Make fetal assessments
monitor
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

Capillary Refill Test (N= <5 seconds)

Jugular Vein Distention

Possible Diagnosis at Preconception and During

Pregnancy

➢ Deficient knowledge regarding steps to take

to reduce the effects of maternal
cardiovascular disease on pregnancy and
fetus.

Planning, Implementation, and Evaluation at

Preconception and During Pregnancy

1. Monitor and document blood pressure, pulse

rate, respiratory rate in sitting or lying
position, nail bed filling -capillary refill test,
jugular vein distention in every visit. Measure
liver size.
2. Advise adherence to prenatal checkups.
3. Request laboratory tests, if necessary
4. Cardiac assessments such as ECG
5. Fetal assessments in every visit (ultrasounds,
NSTs)
6. Referrals to Specialists (OB-Gyne,
cardiologists)
7. Discuss and plan types of delivery.
➢ Normal vs caesarian
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

➢ Assisted vaginal birth (Use of forceps or ✓ Tell her to assume side-lying position (left
vacuum extractor) lateral recumbent) during labor to prevent
8. Promote rest supine hypotension syndrome
➢ 2 rest periods a day and a full night’s ✓ If mother has edema, elevate head and
sleep chest (semi-Fowler’s position) to ease the
➢ Plan activities work of breathing You can also put a towel
➢ Sleeping position: Left lateral under her right hip to shift the uterus off
recumbent. the vena cava.
9. Promote healthy nutrition ✓ Monitor and evaluate mother’s fatigue if
➢ Use of prenatal vitamins related to heart condition or if labor
➢ Foods rich in iron and folic acid related.
➢ Salt-restricted diet ✓ Oxygen may be needed on women with
10. Educate regarding medications extreme heart disease.
➢ Use of anticoagulants (such as ✓ Continuous hemodynamic monitoring such
heparin), antibiotics (penicillin, as by a Swan-Ganz catheter to monitor
amoxicillin, ampicillin etc.), and heart heart function.
medications such as digoxin, ✓ Mother should not push with contractions;
antihypertensive and antiarrhythmic epidural anesthesia is given to help mother
drugs during labor.
11. Educate about avoiding infections ✓ Low forceps or vacuum extractor may be
➢ UTI, STDs, etc used for birth.

Sleep Sideways for Healthy Pregnancy

Fetal Heart Monitoring

Management During Labor and Childbirth

✓ Frequently assess blood pressure, pulse

(Abnormal if > 100 beats/min means mother’s
heart is trying to compensate) , respirations
(Abnormal if > 25 breaths/min, and if there is
signs of dyspnea i.e. coughing and abnormal
breath sounds), and uterine contractions. For
abnormal signs, record and inform physician
right away.
✓ Monitor fetal heart rate.
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

Care of At-Risk/ High Risk and Sick Mother and Child

(Part 3- Infections)
Swan-Ganz Hemodynamic Monitoring
Concurrent Conditions that Occur in Pregnancy

Infection

✓ TORCH infections
➢ Toxoplasmosis
➢ Other: Syphilis, UTIs, Group B
Streptococcus etc.
➢ Rubella
➢ Cytomegalovirus (CMV)
➢ Herpes Virus (HSV)/ Hepatitis B
✓ Used to describe infections that can be
devastating to the fetus or newborn

Management During Post-Partum Period Background

✓ Decrease activity. • Infection of developing fetus or newborn that

✓ Oxytocin (Pitocin) is given to encourage can occur in utero during delivery, or after birth
uterine involution (You should monitor • Complications Include:
patient because it can increase heart rate.) ➢ Preterm Birth
✓ Prophylactic antibiotics should be given ➢ Delayed Development of fetus
immediately (if not started prior to childbirth) ➢ Physical Malformations
to prevent subacute endocarditis and prevent ➢ Loss of Pregnancy
microorganisms infecting placental site Symptoms
✓ Use of anticoagulants and digoxin therapy
until mother’s circulation stabilizes. • Vary depending on specific underlying
✓ Anti-embolic stockings or intermittent infections but share non- specific signs and
pneumatic compression (IPC) boots may be symptoms:
prescribed to increase venous return. ➢ Fever
✓ Breastfeeding is encouraged. ➢ Lethargy
✓ Stool softener is also given to prevent ➢ Cataracts
straining with bowel movements. ➢ Jaundice
✓ Kegel exercises for perineal strengthening. ➢ Reddish – Brown Spots on Skin
Postpartum abdominal exercises only with the ➢ Hepatosplenomegaly
approval of physician. ➢ Congenital Heart Disease
✓ Rest at home ➢ Microcephaly
✓ Checkups with OB-Gynae and Cardiologist ➢ Decreases Birth Weight
➢ Hearing Loss
Kegel Exercises ➢ “Blueberry Muffin” Rash

Transmission

• Transmitted to Fetus through Placenta

• Infant may catch infection while passing
through birth canal.
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

• Mother can pass infection to infection • If a woman receives a rubella vaccine prior to
through breastmilk pregnancy, she should not get pregnant for at
least 1 month.
Toxoplasmosis
• Not given during pregnancy because vaccine is
• Caused by a protozoan Toxoplasma gondii. from a live virus.
• Transmitted in raw and undercooked meat, • Effects on embryo or fetus:
through cat feces or soil, and across the ➢ Microcephaly (small head size)
placental barrier to the fetus ➢ Congenital cataracts
• Newborn Symptoms: ➢ Deafness
✓ Low birth weight ➢ Cardiac effects
✓ Enlarged liver and spleen ➢ Intrauterine Growth Restriction (IGR)
✓ Jaundice
Rubella Infection Routes
✓ Anemia
✓ Inflammation of eye structures
✓ Neurological damage

Management of Mothers at Risk or with

Toxoplasmosis

• Patient education about toxoplasmosis during

prenatal and during pregnancy:
✓ Cook meat thoroughly.
✓ Wash hands and all kitchen surfaces after
handling raw meat.
✓ Avoid touching mucous membranes of
eyes and mouth when handling raw meat.
✓ Avoid uncooked eggs and unpasteurized
milk.
✓ Wash fresh fruits and vegetables well.
✓ Avoid materials contaminated with cat
feces such as litter boxes, sand boxes,
garden soil.
• 1st trimester of pregnancy: Treatment of the
mother if she has the infection with
pyrimethamine and sulfadiazine; Leucovorin
after 18 weeks of gestation.
Management of Mothers at risk or with Rubella
• For infected neonates: Treatment with
pyrimethamine, sulfadiazine, and leucovorin • Women of child-bearing age should get a
for 1 year, which may reduce severity of vaccine if planning to get pregnant; she
congenital effects of the disease. should not get pregnant for at least 1 month
after immunization.
Rubella (German Measles)
• Vaccine is offered postpartum to non-
• Mild viral infection to the mother immune women.
• SYMPTOMS: Low-grade fever and rash • VACCINE NOT GIVEN DURING PREGNANCY
• Destructive to the developing fetus because it is a live (attenuated or weakened)
form of the virus.
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

✓ Antivirals given to newborns: Ganciclovir and

valganciclovir.
Cytomegalovirus (CMV)
Prevention of CMV
• Herpes infection that is sexually transmitted
• Mother may be asymptomatic. The 5 Steps to Reduce your Risk of Infection
• Infected infants may have: 1. Wash your 4. Carefully
✓ Intellectual disability hands activities dispose of
✓ Seizures like changing nappies, used
✓ Blindness nappies wipes and
tissues
✓ Deafness
2. Don’t share 5. Clean toys that
✓ Dental abnormalities
food, drinks, children have
✓ Petechiae
utensils, and had contact
• Treatment avoid putting a
✓ No effective treatment is known. child’s dummy
✓ Therapeutic abortion may be offered or toothbrush in
if infection is discovered early in the your mouth
pregnancy. 3. Avoid contact
with saliva, kiss
children on their
W forehead
instead of the
lips.

Hepatitis and Getting Pregnant

• More than 325 million people worldwide

suffer from a liver infection called hepatitis.
• Hepatitis B and C might cause pregnancy
complications and put babies at risk of viral
transmission.
Congenital Effects of CMV to the Fetus/Baby • Women with hepatitis can go through safe
pregnancies but need special care during
1. Permanent Visual Impairment labor and delivery.
2. Brain abnormalities, Microcephaly, Mental
Retardation Hepatitis B
3. Permanent Hearing Impairment
• Blood, saliva, vaginal secretions, semen, and
4. Epilepsy
breast milk can transmit the virus.
5. Liver, Lung, and Spleen Tissues
• Infection can cross the placenta.
6. Premature birth, Low birth weight
• Woman may be asymptomatic or acutely ill
7. Coordination Disorders
with:
Management of Mothers at risk or with CMV ✓ Chronic low-grade fever
✓ Anorexia
✓ CMV immunoglobulin to symptomatic mother
✓ Nausea and vomiting
✓ Hand hygiene is essential.
• Some mothers become chronic carriers of the
✓ Therapeutic pregnancy termination is offered
virus.
if discovered during early pregnancy.
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

• Fetus is infected trans placentally or by • Neonatal herpes infection can either be

contact at birth; child may also be chronic localized or disseminated (widespread);
carrier. Disseminated neonatal infection has high
mortality rate and can cause neurological
Persons at High Risk for Hepatitis B Infection
disorders.
✓ Intravenous Drug Users
✓ Persons with multiple sexual partners
✓ Person with repeated infection with sexually
transmitted infections
✓ Health Care Workers with occupational
exposure to blood products and needle sticks
✓ Hemodialysis patients
✓ Recipients of multiple blood transfusion or
other blood products
✓ Household contact with hepatitis carrier or
hemodialysis patient
✓ Persons arriving from the countries where
there is a higher incidence of the disease.

Management of Mothers at risk or with Hepatitis B

✓ Preconception & During Pregnancy: Screening

for hepatitis infection; should be repeated in
the third trimester for women at high-risk
groups; Immunization during pregnancy is not
contraindicated Management of Mothers at risk or with HSV
✓ At childbirth: Infants should receive a single ✓ Patient education: Sexual abstinence -both
dose of hepatitis B immune globulin (for partners need to be screened and tested.
temporary immunity after birth, if their ✓ Serological/ lab tests
mother is hepatitis B positive); Followed by ✓ Delay pregnancy if positive
hepatitis B vaccine (for long-term immunity) ✓ Avoiding contact with lesions to prevent
✓ Staff who will be managing the birthing neonatal herpes infection.
process should be vaccinated as well. ✓ If woman has an active genital herpes
Herpes Virus (HSV) lesions when membranes rupture or labor
begins, caesarian delivery mat be required
Two Types to prevent fetal contact.
1. Type 1 ✓ Breast feeding is safe as long as there are no
lesions on the breasts.
• Cause fever blisters or cold sores ✓ Antiviral therapy of both partners; acyclovir
may be given orally during pregnancy
2. Type 2
✓ Infected infants can be given acyclovir at birth
• Cause genital herpes. and should be monitored closely.
• Can lie dormant in the nerves (primary
Group B Streptococcus (GBS)
infection) and reactivated (secondary
infection) • Leading cause of perinatal infections and
• Initial infection in 1st half of pregnancy can result in high neonatal mortality rate
cause spontaneous abortion.
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

• Microorganism can be found in the woman's

vagina, rectum, cervix, throat, or skin
GBS TESTING
• Woman can be asymptomatic, but infant can
be infected through contact at birth and
vaginal secretions; deadly for infant; may be
early onset or late onset (after 7 days)
• Significant cause of maternal postpartum
infection (endometritis) especially after
caesarian birth
• Symptoms: Elevated temperature within 12
hours after delivery, rapid heart rate and
abdominal distention

GBS Early- Onset GBS Late – Onset

Disease (EOD) Disease (LOD)
Onset in first week of Usually occurs 1-4
life weeks after birth, but
may occur up to 3
months of life
Leading cause of sepsis Wilder Clinical Spectrum Urinary Tract Infection (UTI)
in neonates
Can also cause: May cause: • Common in women because of short urethra
✓ Pneumonia ✓ Meningitis and the ease of contamination of the urethra
✓ Meningitis ✓ Sepsis from the rectum; also because of
✓ Septic Arthritis contamination from the vagina during sexual
✓ Osteomyelitis activity
✓ Pneumonia • Cystitis (bladder infection) symptoms:
Acquired by fetus in
✓ Burning with urination
utero or during birth
✓ Increased frequency and urgency of
urination
Management of Mothers at risk or with Group B ✓ A normal or slightly elevated
Streptococcus temperature
• If cystitis is not treated may lead to
✓ Urine culture is done preconception and
pyelonephritis (kidney infection). Symptoms:
during pregnancy. If positive, she is given
✓ High fever (Dangerous for fetus)
antibiotics.
✓ Chills
✓ Bacterial culture of woman’s rectum and
✓ Flank pain or tenderness
lower vagina for presence of GBS at 35-37
✓ Nausea and vomiting
weeks of gestation. Can be done prenatally or
• Complications of pyelonephritis:
during labor.
✓ Maternal hypertension
✓ During labor if patient has a history of GBS,
✓ Chronic renal disease
prolonged rupture of membranes, fever
✓ Preterm birth
greater than 37.7 deg C, patient is given
antibiotics. Management of Mothers at risk or with UTI
✓ Infant is given antibiotics at birth.
✓ Urinalysis is requested.
 CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (LECTURE)
BSN 2-3|SECOND SEM|BATCH 2023
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite
Student: Nizalyn Jane A. Destor
Lecturer:
Reference/Source:

✓ Patient education on how to reduce

introduction of rectal microorganisms into the
bladder.
✓ Adequate fluid intake
✓ Drinking cranberry juice
✓ Urinating before and after sexual intercourse
✓ Drug Therapy
• Asymptomatic bacteriuria: Oral antibiotics
for 10 days
• Pyelonephritis: Multiple antibiotics, initially
via IV
• Cystitis: Full 7 days of antibiotic therapy

Vaccination Schedules

Routine Prenatal Tests – Diagnostic & Labs Requested