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NCM 102: CARE OF MOTHER, CHILD, FAMILY AND POPULATION GROUP AT RISK OR WITH PROBLEMS
NCM 102: CARE OF MOTHER, CHILD, FAMILY AND POPULATION GROUP AT RISK OR WITH PROBLEMS

NCM 102:

CARE OF MOTHER, CHILD, FAMILY AND POPULATION GROUP AT RISK OR WITH PROBLEMS

NCM 102: CARE OF MOTHER, CHILD, FAMILY AND POPULATION GROUP AT RISK OR WITH PROBLEMS
Description: This course deals with the concept of disturbances and pre-existing and existing health problems of

Description:

Description: This course deals with the concept of disturbances and pre-existing and existing health problems of

This course deals with the concept of disturbances and pre-existing and existing health problems of the pregnant woman and the pathologic changes during the intrapartum and post-partum periods.

This course further deals with the

common problems occuring duting infancy to the adolescent stage.

PART I Care of the Mother

PART I

Care of the Mother

A. Nursing Care of the High Risk Pregnant Client

A. Nursing Care of the High Risk Pregnant Client

A. Identification of Risk Clients

A. Identification of Risk Clients  Risk factors  Screening Procedures  Diagnostic test and laboratory

Risk factors Screening Procedures

Diagnostic test and laboratory exams

Identifying Risk Factors:

Identifying Risk Factors: As a nurse, it is our responsibility to identify risk factors during our

As a nurse, it is our responsibility to identify risk factors during our interaction with our pregnant clients, during our pre- natal examinations, not only to the

mother but also to the fetus.

Purposes of Initial interview:

Purposes of Initial interview:  Establishing  Gaining information about the woman's physical and psychosocial health

Establishing rapport

Gaining information about the woman's physical and psychosocial health

Obtaining a basis for anticipatory guidance for the pregnancy

Learning a woman’s health history will help you give advice to make this pregnancy and birth as safe as

possible.

The Initial Prenatal Visit: Risk Assessment 1.Woman’s History  Demographic  includes name, age, address, telephone

The Initial Prenatal Visit:

Risk Assessment

1.Woman’s History

Demographic Data includes name, age, address, telephone number, religion, and health insurance information.

Chief Concern

 Chief Concern  To help confirm pregnancy, inquire about the date of her LMP. 

To help confirm pregnancy, inquire about the date of her LMP.

Elicit information about the signs of early pregnancy.

And any danger signs of pregnancy, such as bleeding, continuous headache, visual

disturbances, or swelling of the

hands and face.

Family Profile

 Family Profile  Identify support persons, shape the nature and kind of questions asked, and
 Family Profile  Identify support persons, shape the nature and kind of questions asked, and

Identify support persons, shape the nature and kind of questions asked, and evaluate the possible impact of the client's culture on care.

marital status.

know the size of the

apartment or house

 History of Past Illnesses  a past condition may become active during or immediately following

History of Past Illnesses a past condition may become active during or immediately following pregnancy.

 History of Past Illnesses  a past condition may become active during or immediately following

History of Family Illnesses

 History of Family Illnesses  It helps to identify potential problems in the mother during
 History of Family Illnesses  It helps to identify potential problems in the mother during

It helps to identify potential problems in the mother during pregnancy or in the infant at birth.

Day History/Social Profile woman's current nutrition, elimination, sleep, recreation, and interpersonal interactions

 Day History/Social Profile  woman's current nutrition, elimination, sleep, recreation, and interpersonal interactions
 Day History/Social Profile  woman's current nutrition, elimination, sleep, recreation, and interpersonal interactions
 Gynecologic History  woman's past experience with her reproductive system may have some influence on

Gynecologic History

 Gynecologic History  woman's past experience with her reproductive system may have some influence on

woman's past experience with her reproductive system may have some influence on how well she accepts a pregnancy.

Obtain information about her age of menarche (first menstrual period)

Gynecologic History

 Gynecologic History  Ask her usual cycle, including the interval, duration, amount of menstrual flow,
 Gynecologic History  Ask her usual cycle, including the interval, duration, amount of menstrual flow,

Ask her usual cycle, including the interval, duration, amount of menstrual flow, and any discomfort she feels

Past surgery on the reproductive tract.

Assess for the possibility of stress incontinence (incontinence of urine on laughing, coughing, deep inspiration, jogging, or running).

Obstetric History

 Obstetric History  For each previous pregnancy, document the child's sex and the place and
 Obstetric History  For each previous pregnancy, document the child's sex and the place and

For each previous pregnancy, document the child's sex and the place and date of birth.

Ask about any previous miscarriages or abortions and whether she had any complications during or following them.

Obstetric History

 Obstetric History  Classify pregnancy status that determine the woman's status with respect to GRAVIDA
 Obstetric History  Classify pregnancy status that determine the woman's status with respect to GRAVIDA

Classify pregnancy status that determine the woman's status with respect to GRAVIDA & PARA ( TPALM)

Terms Related to Pregnancy Status

Para The number of pregnancies that reached viability, regardless of whether the infants were born alive
Para
The number of pregnancies that reached viability,
regardless of whether the infants were born alive or
not
Gravida
A woman who is or has been pregnant
Primigravid
A woman who is pregnant for the first time
a
Primipara
-A woman who has given birth to one child past age of
viability
-
Multigravida
A woman who has been pregnant previously
Multipara
A woman who has carried two or more pregnancies to
viability
Nulligravida
A woman who has never been and is not currently pregnant
 Review of Systems  A review of systems completes the subjective information.  Use a

Review of Systems

A review of systems completes the subjective information.

Use a systematic approach. and explain each procedure.

A review of systems helps women recall diseases they forgot to mention earlier.

2. Routine Exams and Laboratory Tests a.Comprehensive physical exam including BP, height and weight fundal height

2. Routine Exams and Laboratory Tests a.Comprehensive physical exam including BP, height and weight fundal height measurement, FHT b. Serum testing:

CBC

ABO and Rh typing, antibody

screen Serology

Rubella screen

Hepatitis screen

Hemoglobin electrophoresis

HIV

2. Routine Exams and Laboratory Tests  Pap smear • Cervical cancer test STI cultures 

2. Routine Exams and Laboratory Tests Pap smear

Cervical cancer test STI cultures Urine testing for asymptomatic bacteruria, glycosuria, protenuria, pyuria, ketonuria Pelvic examination Ultrasound

Types of pelvis

Types of pelvis
Pelvic Measurement  Pelvimitry  a method of obtaining pelvic measurements by X-rays to determine the

Pelvic Measurement Pelvimitry

a method of obtaining pelvic measurements by X-rays to determine the adequacy for vaginal birth.

Utrasound

A scan, currently considered to be safe, non-invasive, accurate and cost effective investigation of the fetus.

ULTRASOUND
ULTRASOUND
B. Pre-gestational Medical conditions that affects pregnancy outcomes:  RHD  DM  Substance Abuse 
  • B. Pre-gestational Medical conditions

B. Pre-gestational Medical conditions that affects pregnancy outcomes:  RHD  DM  Substance Abuse 

that affects pregnancy outcomes:

RHD DM Substance Abuse HIV/AIDS Rh Sensitization

Anemia

CARDIAC disease

CARDIAC

disease

 This involves a variety of heart conditions both congenital and acquired that complicates pregnancy.
 This involves a variety of heart conditions both congenital and acquired that complicates pregnancy.

This involves a variety

of heart conditions both

congenital and acquired

that complicates

pregnancy.

 This involves a variety of heart conditions both congenital and acquired that complicates pregnancy.

Risk factors

Risk factors  Rheumatic fever  Congenital defects of the heart  Arteriosclerosis  Pulmonary diseases
Risk factors  Rheumatic fever  Congenital defects of the heart  Arteriosclerosis  Pulmonary diseases

Rheumatic fever Congenital defects of the heart Arteriosclerosis Pulmonary diseases Renal diseases Heart surgery

Myocardial infarction

Cardiac Disease

Cardiac Disease  The danger of pregnancy in a woman with cardiac disease occurs primarily due
Cardiac Disease  The danger of pregnancy in a woman with cardiac disease occurs primarily due

The danger of pregnancy in a woman with cardiac disease occurs primarily due to the increase in circulatory volume.

Two most common cardiac complications of pregnancy are RHD and CHD

The most dangerous time for a woman is in weeks 28 to 32, just after the blood volume peaks.

PROGNOSIS  A woman with class I or II heart disease can have normal pregnancy and

PROGNOSIS

PROGNOSIS  A woman with class I or II heart disease can have normal pregnancy and

A woman with class I or II heart disease can have normal pregnancy and birth.

Women with class III with complete bed rest can maintain pregnancy

Women with class IV heart disease are poor candidates for pregnancy and are usually advised to avoid pregnancy.

Cardiac Disease classification:

Class I

Asymptomatic with all activity

Asymptomatic @ rest; symptomatic with heavy physical activity (produce

palpitations, fatigue, dyspnea and anginal pains)

Asymptomatic @ rest, symptomatic with ordinary activity

Class IV

Symptomatic with all activity, symptomatic

with rest

Cardiac Disease classification: Class I Asymptomatic with all activity Asymptomatic @ rest ; symptomatic with heavy
Class II Class III
Class II
Class III
Cardiac Disease classification: Class I Asymptomatic with all activity Asymptomatic @ rest ; symptomatic with heavy