Identify 3 current trends (Philippine setting) in
Maternal Health care that affect the pregnant woman. Explain how these will
affect the Maternal care to women.
·
Maternal Malnutrition
The nutrition of women before conception, during pregnancy
and lactation has profound effects on reproductive outcome and infant
development. Thus, nutrition before conception is not only related to fertility
but in fact can affect early embryogenesis and determine life long health.
Nutrition during pregnancy clearly affects fetal growth and infant development.
The physiological stress of added nutrient demands makes pregnancy and
lactation high risk periods in the life of a woman. The womans tissues become
depleted of essential nutrients as she enters the vicious cycle of too many
closedly spaced pregnancies and prolonged breastfeeding. They become vulnerable
to disease and infections which ultimately take their life. The cause of
maternal malnutrition is of course, less food and not enough food of the right
kind. A woman who is well fed and healthy can complete pregnancy successfully
giving birth to a healthy normal child. In poorly nourished women 30-40% of
their children have low birth weights ( less than 2.5kg ). The possibility of
nutritional status may be significant in the higher incidence of toxemia of
pregnancy according to research. Iron deficiency anemia is the most alarming of
the micronutrient deficiences affecting a pregnant women. Severe anaemia leads
to premature births, also anaemic women will not be able to do normal physical
work.
·
Poor delivery of health services
Maternal mortality remains high in the philippines, for such reasons as inqualities in wealth, residence,
and gender. Access to prenatal and ante natal health clinics are poor and
sometimes very far to the rural area that is why women seeks the help of a
village healer or arbulario(hilot). Mothers who receive late or no prenatal
care are more likely to have birth defects, low birth weight and prematurity.
Prematurity is responsible for half of all congenital neurological disability
in children. LBW are at increased risk for chronic pulmonary disease, visual
and hearing impairment, neurodevelopmental handicaps, learning difficulties
resulting in school failures, abuse and neglect and recurring illness. The
advantages of Prenatal care provides a wonderful opportunity to promote healthy
behaviors, counseling, and education to help pregnant women stop or reduce
risky behaviors. In addition, It also prepares parents for parenting.
·
Obstructed labor
Obstructed labor is among the leading causes of maternal
deaths in the Philippines. Neglected obstructed failure is a major cause of
both maternal and newborn morbidity and mortality. The obstruction can only be
alleviated by means of an operative delivery, either caesarian section or other
instrumental delivery (forceps, vacuum extraction). Maternal complications
include include intrauterine infectionsfollowing prolonged rupture of
membranes, trauma to the bladder and /or rectum due to pressure from the fetal
head or damage during delivery and ruptured uterus with consequent hemorrhage,
shock or even death. Trauma to the bladder during vaginal or instrumental
delivery may lead to stress incontinence. And the most severe condition is
obstetric fistula, a hole which forms in the vaginal wall communicating into
the bladder or the rectum or both.
Describe the nursing implications of current trends in
Womens health care.
The currents trends in Maternal health care offers
oppurtunities for nurses to alter nursing practice and improve the way care is
being deliverd through managed care, integrated delivery sytem and redefined
roles. Nurses have been critically important in developing strategies to
improve the well being of woman and their infants and have led the efforts to
implement clinical practice guidelines and to practice using an evidence based
approach. Through professional association nurses can have a voice in setting
standards and in influencing health policy by actively participating in the
education of the public. Changes in the health care are infuencing the way
healthcare providers can care for their patients.
Discuss your role as a Maternal child nurse in throughout
the life cycle continuum.
Lifecycle of women from cradle to grave , in other words,
different stages of life, such as childhood, adolescent, adulthood and
reproductive life including old age may have indication of the human rights
situation around them and their ability to have access to the basic needs and
services. As a Maternal Child Nurse I believed that all women should have
access to reproductive health choices and care during pregnancy and childbirth,
and all babies should be able to grow into children who survive and thrive. It
is vital that we pay attention to the reproductive health continuum within the
life cycle approach: birth, breastfeeding and birth spacing. There are lots of
program and services that the goverment implement and my role first of all is
to educate women and families to be aware of good health through teaching. for
example, teaching men and women the importnace of safer sex practices. An age appropiate
reproductive health education that promotes correct sexual values. My role is
to help ensure patients have a seamless continuum of care and provide support
and knowledge during their journey.
I am a pro life and believe in the protection of all life
and the quality of life. My belief concerning ethical decision making is
whatever is good for others and not harm to self or good for self and no harm
to others.
Identify the Goals ans Philosophy of MCN and its
significance.
Goals
·
Pre conceptual healthcare
·
Care of women during three trimesters of
pregnancy and the puerperium (the 6 weeks after childbirth, sometimes termed
the fourth trimester of pregnancy)
·
Care of children from birth through adolescence
·
Care in settings as varied as the birthing room,
the pediatric intensive care unit, and the home.
Philosophy
·
Maternal and child health nursing is family
centered; assessment data must include a family and individual assessment.
·
Maternal and child health nursing is community
centerd; the health of families depends onand influences the health of
communities
·
Maternal and child health nursing is research
oriented, because research is the means whereby critical knowledge increases.
·
Both nursing theory and evidenced based parctice
provide a foundation for nursing care.
·
A maternal and child health nurse serves as an
advocate to protect the rights of all family members, including the fetus.
·
Maternal and child health care includes a high
degree of independent nursing functions, because teaching and counselling are
so frequently required.
·
Promoting health is an important nursing role,
because this protects the health of the next generation.
·
Pregnancy and childhood illness can be stressful
and can alter family life in both subtle and extensive ways.
·
Personal, cultural, and religious attitudes and
beliefs influence the meaning of illness and its impact on the family .
circumstance such as illness or pregnancy are meaningful only in a context of a
total life.
·
Maternal and child health nursing is a challenging
role for a nurse and its major factor in promoting high level wellness in
families.
Maternity
nursing focuses on the care of child bearing women and their families through
all stages of pregnancy and childbirth as well as the first 4 weeks after birth.
Througout the prenatal period nurses teach classes to help families prepare for
childbirth. Maternity nurses teach about pregnancy, the process of labor, birth
and recovery and parenting skills. They provide continuity of care throughout
the childbearing cycle.
Mrs. Berna a 32 year old client, G1P0, is pregnant but
has not gone for pre natal check up. She tells the nurse that before the pre
natal consultation, she wants to visit a “Hilot” who will predict the sex and
guarantee safe birth.
Would recommending that she must undergo a sonogram be
likely as satisfying for her?
Sonogram (Ultrasound) the diagnostic or therapeutic use of
ultrasound and especially a non invasive technique involving the formation of a
two dimensional image used for the examination and measurement of internal body
structures and the detection of bodily abnormalities (Webster).
Yes I would recommend Mrs. Berna to undergo Sonogram. With
the case of Mrs. Berna being a primigravid, not taken any prenatal care and 32 years old. As a nurse, its is
important for Mrs Berna to ascertain whether she understand why the ultrasound
is being suggested. We should act provide an opportunity for them to ask
questions and act as an advocate. We can reassure her that early
ultrasound will not harm her baby in
either the short or long term. Cultural attitudes of Mrs. Berna lead her to
believe that care isnt needed. She should be assisted and educated in a manner
that she will understand. Ultrasound testing can benifit Mrs Berna in the
following way but I dont recommend ultrasound simply to find out the sex of the
baby.
- Early identification of pregnancy. Pregnancy may be detected as early as the 5th or 6th week after the last menstrual period.
- Observation of fetal heart beat and fetal breathing movement. FBM have been observed as early as week 11 gestation.
- Identification of more than one embryo or fetus
- Measurement of the biparietal diameter of the fetal head or the fetal femur length
- Clinical estimations of birth wieght. This assessment helps to identify macrosomia.
- Detection of fetal anomalies such as hydroceplalus and anencephaly
- Location of placenta and placental grading
- Identification of amniotic fluid
- Detection of fetal death
- Examination of fetal cardiac structures
- Examination of nuchal translucency in the 1rst sem to assess Doen syndrome
Identify the advantages and disadvantages of Prenatal
care
Having a baby without having had a prenatal care is a risky
venture. Those woman who do not receive prenatal care are three times more
likely to give birth to a low weight baby and their baby is five times more
likely to die. Pregnancy and childbirth are natural process and most of the
time they go well. But its still best to be prepared in case something goes
wrong. Proper care before and during pregnancy can help reduce health risk to
mother and baby. it can also help provide emotional support to mother (and
famil) and develop a relationship with a physician. Prenatal care also can
detect many problems with the baby that will require immidiate care at birth,
such as heart defect. With these a proper referral can be given to medical
facility by a maternal nurse or a physician at an earlier time. Another
advantage of prenatal care is getting answers to your questions and developing
a relationshipwith your doctor and other health care worker. This support makes
for a more enjoyable pregnancy and when its time for the birth, pregnant women
feels confident knowing they are in the care of someone they know and trust.
Prenatal care involves a series of doctor’s visits
throughout the pregnancy to check the health of the women and her fetus to make
sure the pregnancy is progressing normally. So the total cost is high if a
woman does’nt have maternal insurance. Community health centers provide free or
low cost health care. But due to some complicated procedure and time consuming
process, women are ambivalent to used it. In addition the quality of prenatal
care services are compromised due to the quantity of women seeking prenatal
care. The result is differences between the prenatal care and the pregnancy
outcome.
Mr. And Mrs. Blanco from the province want to have a
better life in Metro Manila. They are brought with them their 4 year and 2 year
old children. Mr. Blanco is a messenger of the Realty property while Mrs. Blanco
is a housewife and takes care of children. They are renting a 2 bedroom place
approximately 15 square meter. Mr. Blanco receives P 10,000.00 per month. After
6 months. Mrs. Blanco is pregnant and looks for a health center where she can
seek consultation.
·
Formulate a nursing care plan for Mr. and
Mrs. Blanco. Identify 3 nursing Diagnosis. Please follow format: Assessment /
Cues Nursing Diagnosis Goal Nursing Interventions Evaluation
Assessment:
Check height and weight as well as her weight gain during
pregnancy
Take pertinent laboratory values espaecially hemoglobin and
hematocrit
Watch for clinical signs that have possible nutritional
implications such as constipation, anorexia and heartburn
Obtain a dietary History to eavaluate the Mrs Blanco’s views
on nutrition as well as her specific nutrient intake
Watch for symptoms associated with anemia such as weakness,
fatigue, pallor and general malaise, dizziness, headache and loss of apetite
Nursing Diagnosis:
Imbalanced Nutrition less than body requirement related to
intake insufficient to meet metabolic demands and replace losses as evidenced
by closedly spaced pregnancies and low socio economic status
Goal:
To maintain appropiate weight gain according to her weeks of
gestation.
Nursing Intervention:
1. Assess
Mrs. Blanco’s nutritional status, condition of hair and nails, and height and
pregravid weight.
2. Monitor
laboratory values that indicate nutritional status: albumin, transferrin, RBC
and WBC counts, electrolytes
3. Provide
information about normal weight gain in pregnancy, modifying it to meet Mrs.
Blanco’s needs.
4. Instruct
the patient to have frequent rest periods.
5. Provide
her with high protein, high calorie, iron in the diet (organ meat, egg yolk)
and consult with nutritionist to calculate energy demand by using indirect
calometry.
6. Administer
oral iron and folic supplements.
7. Provide
oral and written information about action and uses of protein and its role in
development of PIH.
8. Determine
food preferences with cosideration of cultural and religious preferences.
Evaluation:
Display appropiate weight gain.
Verbalize understanding of individual dietary needs .
Demonstrate knowledge of proper diet as evidenced by
developing a dietary plan with own financial resources.
