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Questions and Answers
Which practice is recommended during the dilatation stage of labor?
What is not recommended during the dilatation stage of labor?
Which position is advised for patients during the first stage of labor?
What is a guideline regarding the monitoring of labor progress?
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Which of the following is a suggested limitation for internal examinations (IE) during labor?
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In what situation would it be inappropriate to use a partograph during labor?
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Which of the following conditions does not require the use of a partograph?
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Identify the scenario where a partograph is not utilized in monitoring labor progression.
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Which condition is least likely to warrant the use of a partograph?
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Which of these conditions does not necessitate the employment of a partograph during labor?
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What does the progress of labor section in a partograph primarily record?
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Which of the following is a measure of maternal well-being included in a partograph?
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In the fetal expulsion stage, which practice is specifically recommended?
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Which of these practices is explicitly not recommended during labor?
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Which of the following factors is NOT part of fetal well-being monitoring in a partograph?
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What is the first step recommended in the Active Management of the Third Stage of Labor for placental expulsion?
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Which practice is part of the recommended immediate postpartum monitoring?
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Which practice is NOT included in the recommended steps during the immediate postpartum recovery period?
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What is the purpose of controlled cord traction during the third stage of labor?
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Which of the following actions is not advised immediately after the delivery of the placenta?
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What should be avoided when providing care to a newborn immediately after birth?
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Which of the following practices is integral to supportive care immediately after a baby is born?
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What is a key action to take after the newborn has had its first full breastfeeding?
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Which action is NOT recommended in the immediate care of a newborn?
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Which of the following is part of the recommended care sequence after a newborn's breastfeeding?
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What is the primary purpose of the Comprehensive Newborn Screening Program?
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How many congenital metabolic disorders can be detected with the expanded newborn screening test?
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At what age should the Newborn Screening Test ideally be conducted after delivery?
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What option is available to families regarding the number of disorders included in the screening?
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What is a critical reason for early detection of congenital metabolic disorders through screening?
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What is the purpose of the heel prick method in newborn screening?
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What is the maximum time frame within which positive newborn screening results should be communicated to the health facility?
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What is the drying time required for the blood samples used in newborn screening?
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Which program focuses on the inclusion of screening for congenital disorders in newborns?
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How long does it typically take to receive normal newborn screening results once the samples are at the center?
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What is one of the key services provided by a comprehensive EmONC (CEmONC) facility that distinguishes it from a basic EmONC (BEmONC) facility?
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Which statement accurately describes a BEmONC-capable facility?
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What does the term 'comprehensive EmONC (CEmONC)' implicitly refer to?
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Who typically makes up the itinerant outreach team in EmONC services?
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Which one of the following interventions is part of basic EmONC (BEmONC) services?
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What distinguishes a CEmONC facility in terms of population capacity?
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Which of the following basic emergency obstetric interventions is NOT performed at a BEmONC-capable facility?
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What essential newborn care intervention is included in the services of a BEmONC facility?
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What is the causative agent of tuberculosis in most cases?
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What is the primary mode of transmission for tuberculosis?
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Which symptom is NOT typically associated with tuberculosis?
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What is the recommended procedure for collecting sputum for Direct Sputum Smear Microscopy (DSSM)?
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What is the incubation period for tuberculosis?
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Which of the following is a principal diagnostic tool for tuberculosis adopted by the National Tuberculosis Program?
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What is a recommended step when advising a patient on sputum collection?
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Which of the following is NOT a characteristic of tuberculosis in the Philippines as per the provided data?
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What condition must be noted regarding patients with massive hemoptysis during sputum collection?
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What is the global estimate of people with tuberculosis according to WHO's Global Tuberculosis Report of 2019?
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What is the primary method adopted by the National Tuberculosis Control Program for ensuring treatment adherence in patients?
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Which of the following drugs is administered orally during the initial treatment phase for Tuberculosis?
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What is the duration of the continuation phase in TB treatment according to the outlined regimen?
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What is the effectiveness percentage of BCG vaccination in protecting against tuberculosis in newborns?
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What type of precautions should be taken during the transportation of a sputum cup for TB diagnosis?
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What is the main reason for the inclusion of environmental sanitation in the control of Tuberculosis?
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Which antibiotic is NOT included in the first-line treatment regimen for Tuberculosis?
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Which component is NOT part of the directly observed treatment strategy for TB?
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What is required for TB treatment to prevent the development of drug resistance?
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What action should be taken if a specimen cannot be sent immediately to the microscopy unit?
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What is a potential complication of mumps in post-pubescent males?
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Which laboratory diagnostic method is specific for Rubella virus detection?
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What primary preventive measure is administered for chicken pox?
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Which of the following symptoms is associated with the abortive type of poliomyelitis?
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What is the mode of transmission for the rubella virus?
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What is indicated for the nursing care of a patient with mumps?
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Which component is essential in the nursing care of a patient with poliomyelitis?
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What is the incubation period range for chicken pox?
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Which vaccines are recommended at 9 and 12 months of age?
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What is the primary treatment approach for chicken pox?
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What is the average incubation period for measles?
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Which complication is not commonly associated with mumps?
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Which sign is specific to measles and not typically found in other infections?
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What is the primary mode of transmission for measles?
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What type of diagnostic examination is primarily used to diagnose measles?
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During which period is a person with mumps most contagious?
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Which precaution is essential for preventing measles?
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What symptom is characteristic of mumps?
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Which of the following is not a treatment for measles?
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What is the typical duration of communicability for an individual with mumps?
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What is the primary causative agent of gonorrhea?
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Which of the following symptoms is commonly associated with gonorrhea?
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What is the recommended treatment for gonorrhea?
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Which mode of transmission is common for both gonorrhea and syphilis?
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What is the incubation period for syphilis?
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Which of the following is NOT a form of prevention for gonorrhea?
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Which sign or symptom indicates the secondary stage of syphilis?
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What is the purpose of contact tracing in the management of STIs?
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Which of the following is a common sign of gonorrhea in females?
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What is Crede's prophylaxis used for in the context of STIs?
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What is the primary treatment for Chlamydia infections?
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What is the incubation period for genital herpes caused by the Herpes simplex virus?
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Which diagnostic test is commonly used to confirm a diagnosis of syphilis?
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Which type of HPV vaccine is recommended for young individuals aged 11-12 years?
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What is a common sign of Chlamydia in males?
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Which symptom is commonly associated with genital herpes infections?
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What is the mode of transmission for Chlamydia trachomatis?
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Which treatment is commonly used for managing genital warts?
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What is a recommended preventive measure for genital herpes during late pregnancy?
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Which of the following diagnostic examinations is used for genital warts?
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Study Notes
Essential Intrapartal Newborn Care (EINC) - Dilatation Stage
-
Recommended Practices:
- Admit patients only when they are in the active phase of labor.
- Provide continuous maternal support throughout labor.
- Encourage upright positions during the first stage of labor.
- Use the WHO partograph routinely to monitor labor progress.
- Limit the total number of vaginal examinations to 5 or less.
-
Not Recommended Practices:
- Routine perineal shaving upon admission.
- Routine enema administration.
- Routine nil-by-mouth (NPO) orders.
- Routine intravenous fluid (IVF) infusion.
- Routine vaginal douching.
- Routine amniotomy (artificial rupture of membranes).
- Routine oxytocin augmentation.
Conditions Not Requiring Partograph Use
- Antepartum hemorrhage: Labor may be spontaneous or induced, necessitating prompt management with a focus on maternal and fetal well-being.
- Severe preeclampsia and eclampsia: Labor may be induced or expedited, requiring close monitoring and potential intervention.
- Fetal distress: Immediate intervention and expeditious delivery are priorities.
- Previous cesarean section: The risk of uterine rupture and the potential for vaginal birth after cesarean (VBAC) are considered.
- Multiple pregnancy: Labor management often differs from singleton pregnancies, and the partograph might not be suitable.
- Malpresentation: Cesarean section might be necessary, rendering the partograph less relevant.
- Very premature baby: Management focuses on maternal and fetal well-being, and the partograph may not reflect the specific needs of the situation.
- Obvious obstructed labor: Prompt intervention, likely including surgery, is critical.
Partograph Sections
-
Progress of Labor: Plots Cervical Dilatation against time
- Alert line: Indicates potential deviations from normal labor progress
- Action line: Triggers intervention if labor progress falls below the line
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Maternal and Fetal Well-being: Tracks maternal and fetal health during labor
-
Maternal:
- Blood Pressure
- Respiratory Rate
- Urine Temperature
- Pulse Rate
-
Fetal:
- Fetal Heart Rate
- Amniotic fluid status and color
-
Maternal:
Fetal Expulsion Stage
-
Recommended practices:
- Upright position during delivery
- Double gloving
- Selective episiotomy
-
Not Recommended practices:
- Perineal massage or "plantsa"
- Fundal pressure
Active Management of Third Stage of Labor (AMTSL)
- Administer oxytocin within 1 minute of baby delivery to promote uterine contraction and reduce postpartum hemorrhage risk.
- Apply controlled cord traction while simultaneously supporting the uterus to facilitate placental expulsion.
Immediate Postpartum or Recovery Period
- Utilize a dyad monitoring sheet to track mother and baby's vital signs and recovery progress.
- Conduct a thorough inspection of the birth canal to identify any lacerations.
- Examine the delivered placenta to ensure its completeness.
- Encourages early breastfeeding to promote bonding and facilitate uterine contraction.
- Continue massaging the uterus to encourage its contraction and reduce the risk of bleeding.
Immediate Essential Care of the Newborn
-
Four Core Steps:
- Immediate and thorough drying: Helps stabilize body temperature, prevents heat loss.
- Skin-to-skin contact: Facilitates bonding, maintains body temperature, and promotes breastfeeding.
- Properly timed cord clamping: Delayed clamping allows blood to flow from the placenta to the newborn, boosting iron levels.
- Nonseparation of newborn from mother for early breastfeeding: Encourages successful breastfeeding and strengthens the mother-child bond.
Not Recommended Practices
-
Avoid:
- Ventilation unless the baby demonstrates signs of breathing distress.
- Suctioning the mouth and nose unless there are obstructions.
- Wiping off vernix: It protects the newborn's skin.
- Bathing the newborn: The baby doesn't need to be bathed immediately.
- Taking a footprint: This can wait until after the initial bond and breastfeeding.
- Slapping, hanging upside-down, squeezing the chest, milking the cord, and using abdominal binders: These practices can be harmful to the newborn.
Post-Breastfeeding Care
-
The following actions should be performed after the newborn's first full breastfeeding:
- Eye ointment: Given to prevent infections.
- Stethoscope: Used to assess the newborn's physical condition.
- Vitamin K: Administered to prevent bleeding.
- Hepatitis B Vaccine: Provides protection against Hepatitis B.
- BCG Vaccine: A vaccine against tuberculosis.
Newborn Screening in the Philippines
- The Comprehensive Newborn Screening (NBS) program was established in the Philippines in 2004 through Republic Act no. 9288, also known as the Newborn Screening Act.
- The Department of Health (DOH) leads the implementation of this program, working with other government agencies and stakeholders.
- The goal is to detect and manage several congenital metabolic disorders in newborns, preventing potential mental retardation or death.
- Early diagnosis and treatment allow for normal development in affected individuals.
- Newborn screening is done within 24 hours after initial breastfeeding but ideally no later than 3 days after delivery.
- Premature or critically ill infants in the intensive care unit (ICU) may be tested within 7 days of age.
- Since 2004, the number of disorders covered by the NBS program has expanded from 6 to 28.
- These disorders fall into categories like hemoglobinopathies, amino acid disorders, organic acidurias, fatty acid oxidation disorders, carbohydrate metabolism disorders, biotin metabolism disorders, cystic fibrosis, and endocrine disorders.
- Families can choose to test for 6 disorders covered by PhilHealth (Congenital Hypothyroidism, Congenital Adrenal Hyperplasia, Galactosemia, Phenylketonuria, G6PD Deficiency, and Maple Syrup Disease) or for all 28 disorders.
- The newborn screening test is not a definitive diagnosis, it identifies babies at risk of developing these conditions.
- Early detection is critical because most babies with metabolic disorders appear normal at birth but these conditions are irreversible once symptoms develop.
Newborn Screening Policy and Laws
- Administrative Order No. 2018-0025 (National Policy and Strategic Framework on Expanded Newborn Screening for 2017) outlines the national policy and strategic framework for expanded newborn screening.
- Administrative Order No. 2014-0045 (Guidelines on the Implementation of the Expanded Newborn Screening Program) provides guidelines for implementing the expanded newborn screening program.
Newborn Screening Procedure
- The specimen for NBS is obtained through the heel prick method.
- A few drops of blood are taken from the baby's heel and blotted on a special absorbent filter card.
- Blood is dried for four hours and then sent to an NBS center.
- Normal results are available within 7-14 days from the time samples are received at the NBS centers.
- Positive results should be relayed immediately within 24 hours by the health facility.
- A positive screen means that the newborn should be referred to a specialist for confirmatory testing and further management.
Emergency Obstetric and Newborn Care (EmONC)
- EmONC is a set of life-saving interventions for major obstetric and newborn causes of morbidity and mortality.
- EmONC facilities are classified into two levels: Basic EmONC (BEmONC) and Comprehensive EmONC (CEmONC).
Basic EmONC (BEmONC)
- Provided by Barangay Health Stations, lying-in, or birthing homes.
- Includes parenteral administration of oxytocin, loading anticonvulsant, initial dose of antibiotic.
- Also includes assisted imminent breech deliveries, removal of retained products and placenta.
- Emergency newborn interventions such as resuscitation, sepsis, and oxygen treatment are performed.
- Blood transfusion may be available.
Comprehensive EmONC (CEmONC)
- Provides all services of BEmONC facilities.
- In addition, CEmONC facilities provide cesarean section, blood banking and transfusion.
- Highly specialized obstetric intervention, management of low birth weight and preterm babies, and other newborn specialized services are available.
- Intrauterine device insertion, vasectomy, and bilateral tubal ligation are offered.
- Outreach services are provided by an itinerant team composed of a physician, a nurse, and a midwife.
- One CEmONC facility serves a population of at least 500,000.
Tuberculosis in the Philippines
- Tuberculosis (TB) is a major public health concern in the Philippines, ranking as the eighth leading cause of morbidity and mortality.
- TB is caused by the bacteria Mycobacterium tuberculosis, primarily spread through airborne droplets.
- The incubation period for TB is 4 to 6 weeks.
- Symptoms of TB include fever, loss of appetite, fatigue, night sweats, cough (initially dry, later productive with blood), and chest pain.
- The National Tuberculosis Program (NTP) utilizes Direct Sputum Smear Microscopy (DSSM) for diagnosis.
- The NTP emphasizes the importance of collecting two sputum specimens for accurate diagnosis.
- Treatment for TB is available and involves a directly observed treatment short course (DOTS) strategy.
- DOTS ensures patient adherence to medication by providing supervision.
- Treatment includes a combination of antibiotics, typically Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Ethambutol (E), and Streptomycin (S).
- The initial phase of treatment involves 2 months of HRZE, followed by a continuation phase of HR for 4 months.
- Prevention and control measures for TB include BCG vaccination, health education, environmental sanitation, early diagnosis and treatment, and respiratory isolation.
Measles
- Caused by the Morbili virus, a member of the Paramyxoviridae family
- Transmitted through the air
- Incubation period: 8 to 20 days, with an average of 10 days
- Symptoms:
- Sudden onset of fever
- Runny nose
- Conjunctivitis
- Bronchitis
- Excessive tearing
- Koplik's spots (clustered white lesions) on the buccal mucosa
- Stomatitis
- Maculopapular rash that begins on the face and spreads to the whole body
- Can lead to serious complications like pneumonia, encephalitis, and others
Mumps
- Caused by the Mumps virus, a member of the Paramyxoviridae family
- Transmitted through the air, droplets, or direct contact with saliva from an infected person
- Incubation period: 16 to 18 days, with a range of 14 to 25 days
- Communicability period: 2 days before to 4 days after the onset of parotitis, but can range from 7 days before to 15 days after onset
- Symptoms:
- Sudden onset of fever
- Painful swelling of the salivary or parotid glands
- Headache
- Complications: Meningoencephalitis, permanent hearing impairment, orchitis in post-pubescent males (but rarely sterility)
Rubella (German Measles)
- Caused by the Rubella virus, a member of the Togaviridae family
- Transmitted through droplets and direct contact with nasopharyngeal secretions from an infected person
- Incubation period: 10 to 21 days
- Symptoms:
- Fever
- Headache
- Malaise
- Maculopapular rash
- Enlarged post-auricular, occipital, and posterior cervical lymph nodes
- Sore throat
- Runny nose
- Conjunctivitis
- Bronchitis
- Forchheimer's spots (small red spots) on the soft palate
Chickenpox
- Caused by the Varicella Zoster Virus
- Transmitted through direct and indirect contact with droplets from respiratory passages or vesicle fluid
- Incubation period: 14 to 16 days, with a range of 2 to 3 weeks
- Symptoms:
- Body malaise
- Fever
- Itchy vesiculo-pustular lesions that appear first on the chest and trunk and spread to the extremities
Poliomyelitis (Polio)
- Caused by the poliovirus (Legio debilitans)
- Transmitted through fecal-oral route and droplets
- Incubation period: 7 to 21 days
- Types and symptoms:
- Abortive: Fever, sore throat, low-lumbar backache, cervical stiffness on anteflexion of the spine
- Non-paralytic: Recurrence of fever, "poker spine," tightness and spasm of hamstrings, hypersensitivity of the skin, exaggerated deep reflexes
- Paralytic: Paralysis depending on the affected body part
General Nursing Care
- Administer antipyretics (fever reducers)
- Increase fluid intake
- Bed rest
- Provide strict isolation for contagious diseases
- Encourage handwashing
- Trim fingernails to prevent scratching (especially for Chickenpox)
- Give daily baths
- Passive range of motion exercises for poliomyelitis
Syndromic Case Management for STIs
- 4 Cs: Compliance, Counseling, Contact Tracing, Condom Use
Gonorrhea
- Causative Agent: Neisseria gonorrhoeae
- Transmission: Sexual Contact
- Incubation: 2 to 7 days
- Symptoms: Thick purulent urethral discharge, frequent urination (females), burning urination (males/females)
- Diagnosis: Culture of cervical specimen (females), Gram stain (males)
- Treatment: Ceftriaxone
- Prevention: Avoid contact with secretions, practice monogamous relationships, Crede's prophylaxis for newborns (tetracycline eye ointment)
Syphilis
- Causative Agent: Treponema pallidum
- Transmission: Sexual Contact
- Incubation: 10-90 days
-
Stages:
- Primary: Chancre at site of contact (3 weeks)
- Secondary: Condylomata, sore throat, mouth lesions, maculopapular rash
- Tertiary: Gumma formation, cardiovascular/nervous system involvement
- Diagnosis: Darkfield illumination test, VDRL test, Fluorescent treponemal antibody test
- Treatment: Penicillin, tetracycline, erythromycin
- Prevention: Practice monogamy, sex education
Chlamydia
- Causative Agent: Chlamydia trachomatis
- Transmission: Sexual contact, contact with exudates, childbirth
- Incubation: 7-14 days
- Symptoms: Urethritis with discharge (males), mucopurulent cervicitis (often asymptomatic, females) that may lead to endometritis, salpingitis, pelvic peritonitis
- Diagnosis: Culture, Nucleic acid amplification test (NAAT) of urine or swab samples
- Treatment: Doxycycline, Azithromycin (single dose)
- Prevention: Safe sexual practices, test pregnant women
Genital Herpes
- Causative Agent: Herpes simplex virus (HSV) types 1 and 2
- Transmission: Direct contact with infected skin/mucous membranes, childbirth
- Incubation: 2 to 12 days
- Communicability: During and up to 7 weeks after primary lesions appear
- Symptoms: Localized vesicular lesions at site of contact, may spread to surrounding tissues or disseminate
- Diagnosis: Serological test, virus isolation from lesions/tissues, biopsy
- Treatment: Antiviral agents
- Prevention: Safe sexual practices, cesarean delivery if lesions present during late pregnancy
Genital Warts
- Causative Agent: Human Papilloma Virus (HPV) with 100 types
- Transmission: Direct contact with infected skin/mucous membranes, childbirth
- Incubation: 2 to 3 months (range 1 to 20 months)
- Communicability: As long as lesions persist
- Symptoms: Circumscribed lesions on cervix, vulva, anus, penis, vagina, oropharynx (varying sizes)
- Diagnosis: Visualization of lesion, excision and histological examination
- Treatment: Removal of warts by freezing with liquid nitrogen
- Prevention: HPV vaccine (11-12 years old), safe sexual practices
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Description
This quiz focuses on the recommended and not recommended practices during the dilatation stage of labor. Understand proper admission criteria, maternal support, and monitoring techniques while avoiding unnecessary interventions. Test your knowledge on essential practices for ensuring safe delivery and newborn care.
