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    perinatal nursing: day 1 online discussion

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    Althea P
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    Re: perinatal nursing: day 1 online discussion

    Post  Althea P on Mon 10 Aug 2009, 10:20 pm

    What should have been done?

    The doctor or health care provider, like what angel said, could have used their critical thinking skills. They should have GUIDED Amrapali and her husband on what appropriate medical interventions must be given. Considering that they couldn't afford the treatment, they should also offer other alternatives.

    ara_portillo

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    summary for question 2-case 1

    Post  ara_portillo on Mon 10 Aug 2009, 10:19 pm

    i think we are all arriving with the same recommendations on how the case of amparali should have been handled.. again it needs to correct the delays of care that have occurred at all levels. also, the same way that most of you answered it, much should have been done to improve the health care delivery system. like training of our health care professionals..

    railibo-
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    Re: perinatal nursing: day 1 online discussion

    Post  railibo- on Mon 10 Aug 2009, 10:17 pm

    i agree with you tina. the government should give time in reviewing the health care systems. they are the ones that should know what is the best for people living in rural areas.

    And as much as possible it would also be better if the husband is also involved in their wife's prenatal check-ups. Atleast they will gain informations about safe pregnancy.

    anlorrai
    Guest

    perinatal care

    Post  anlorrai on Mon 10 Aug 2009, 10:16 pm

    1. Yes I do I agree with Ms. Arroyo,the risk factors that we can clearly see from this scenario are: poverty, (lack of finance to support or pay for the hospital bills, medications etc.,Lack of facilities and equipments as well, that will aid in the thorough assessment of the patient and this is due to the lack of support from the government and lack of awareness about the institutions/organizations from which they can ask for financial assistance like PCSO.
    2. I think the best thing that can be done from this situation of Amrapali is that the husband must have brought her wife to the hospital and he should ask for assistance from the other institutions/organizations to help them to pay for their expenses in the hospital. ( PCSO Very Happy )

    ara_portillo

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    to all..

    Post  ara_portillo on Mon 10 Aug 2009, 10:14 pm

    i appreciate everyone's opinion on how the case should have been handled.. you are all looking into the bigger picture of improving the health care delivery system.. but can we enumerate interventions/measures specific to the case..just like that of angel.. but others' answers are also correct. thanks!

    Angel Ve
    Guest

    Answer 2

    Post  Angel Ve on Mon 10 Aug 2009, 10:12 pm

    2. What should have been done differently in this case?

    There should have been comprehensive assessment done during the pregnancy of Amparali. Also, the health care provider should have increased the awareness of Amparali and his husband regarding the risk factors during pregnancy and delivery and the signs and symptoms to watch out for should there be any health problem that might occur. With regards to the doctors, they should have used their critical thinking, knowledge and skills in deciding as to when will be the proper time to refer a patient to other health care facility.

    ma. cristina arroyo

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    Re: perinatal nursing: day 1 online discussion

    Post  ma. cristina arroyo on Mon 10 Aug 2009, 10:12 pm

    i agree ara about the HBMR. but as what thea said, are the health care providers at this level can interpret and implement the said HBMR as it is supposed to be implemented?

    ma. cristina arroyo

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    Join date : 2009-06-24

    Re: perinatal nursing: day 1 online discussion

    Post  ma. cristina arroyo on Mon 10 Aug 2009, 10:10 pm

    What should be done?

    The system at the level of the barrio/barangay or where prenatal check ups is provided should be reviewed and modified. Trainings and seminars on teh proper and adequate assessment must be done to pinpoint who is at risk.

    Health Education involving teh family especially the husband about pregnancy must be provided and strengthened.

    It will be costly as some point, but health care delivery system should review its system to be able to provide health care at a lower cost. Literature will always support that one of the factors that affects decision-making re:health care delivery acquisition is money matters (poverty).

    ara_portillo

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    for thea's post..

    Post  ara_portillo on Mon 10 Aug 2009, 10:08 pm

    yes thea, tina and rai.. if many cases like this are happening, it is rooted on the quality of services being given by the health care systems (esp. those at the level 1 and 2) with regards to prenatal care and other reproductive services. Part of this quality services is the existing referral system..

    railibo-
    Guest

    Re: perinatal nursing: day 1 online discussion

    Post  railibo- on Mon 10 Aug 2009, 10:04 pm

    Yes thea, poverty plays an important role in the outcome of Amparali's case. The fact that her husband opted to bring her to a clinic some 8 kilometers away from their home instead of bringing her to the hospital that was only 5 kilometers away, just because he wasn't sure if he can shoulder the hospitalization fee.

    And I guess those who were providing the prenatal check-ups were not that trained properly. The government should have provided proper training for these health workers before so as to make sure that they can provide proper care to their patients.

    Althea P
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    Re: perinatal nursing: day 1 online discussion

    Post  Althea P on Mon 10 Aug 2009, 10:03 pm

    I definitely agree with Tina and Thea, because the doctor also plays a role in terms of the appropriate care to be given. He could have referred Amrapali's case as soon as it was detected.

    ma. cristina arroyo

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    Re: perinatal nursing: day 1 online discussion

    Post  ma. cristina arroyo on Mon 10 Aug 2009, 10:02 pm

    yes indeed. the competency of the health care professionals at the prenatal clinic should be questioned because again, the reason for prenatal check up is to promote safe pregnancy, both for the mother and infant, which is the opposite of what happened to Amparali.

    ara_portillo

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    for the question 1-case 1

    Post  ara_portillo on Mon 10 Aug 2009, 10:01 pm

    common themes that occur in your responses in question 1 are as follows:
    -economic status of the family (lack of adequate funds for emergency health needs) is a factor since the husband brought his wife to the less equipped, farther health facility
    -social and medical factors: delays in the care given which occur in the decision making of the husband as to where to bring amparali, delays in arrival at health facility and delays in providing quality care and immediate referral; social factors is the patriarchal decision making of the husband..

    let us answer the second question.. or do u want to add anything?..


    Last edited by ara_portillo on Mon 10 Aug 2009, 10:02 pm; edited 1 time in total

    Angel Ve
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    Re: perinatal nursing: day 1 online discussion

    Post  Angel Ve on Mon 10 Aug 2009, 9:59 pm

    Yes Tina, I agree with you. In addition, there was also a delay in the decision of the doctor to refer Amparali to the other hospital. If only proper assessment and decision making was done, appropriate interventions should have been given to Amparali.

    ma. cristina arroyo

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    Join date : 2009-06-24

    Re: perinatal nursing: day 1 online discussion

    Post  ma. cristina arroyo on Mon 10 Aug 2009, 9:59 pm

    i agree with thea to question why is the high BP not diagnosed in the prenatal care. maybe it's in the system and the facilities. agree thea?

    Althea P
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    Re: perinatal nursing: day 1 online discussion

    Post  Althea P on Mon 10 Aug 2009, 9:59 pm

    I agree with ara, but even if they have WHO prototype of the HBMR, the question is, are the health care providers in their community skilled or competent to even perform such kind of pre-natal assessment?

    Althea P
    Guest

    Re: perinatal nursing: day 1 online discussion

    Post  Althea P on Mon 10 Aug 2009, 9:55 pm

    I think, the main reason why all of this happened may be related to poverty. The lack of health care resources, both the family as well as the community they lived in. They cant afford to rush her to the hospital nearest to them, but instead, they went to the 8km affordable hospital, meaningless health facilities.

    I just wondered why the BP of Amrapali wasnt diagnosed during pregnancy. Lack of facilities? Or was it because lack of skilled workers to be able to determine even the simplest test?

    What should have happen? The health workers, even in far-flung areas must be trained appropriately. Government fundings are important also for people who cannot afford to go to decent hospitals and receive quality care. Early detection of potentially health risk factors during the ante-natal period.

    Angel Ve
    Guest

    Answer 1

    Post  Angel Ve on Mon 10 Aug 2009, 9:54 pm

    I think the case is Eclampsia..

    Eclampsia, defined as the occurrence of one or more convulsions (fits) in association with the syndrome of pre-eclampsia, is a rare but serious complication" (Duley, Gulmezoglu & Henderson-Smart, 2000:1). Eclampsia is a condition peculiar to pregnant or newly delivered patients. It is characterised by convulsions, which occur as a result of raised blood pressure associated with pregnancy (WHO, 1996:14)

    Reference:
    C. Mudokwenuy-Rawdon, M.C. Bezuidenhout, V.J. Ehlers, 2003 Factors influencing pre-eclampsia/eclampsia outcomes in high-risk patients in Zimbabwe Available at: http://findarticles.com/p/articles/mi_6820/is_1_8/ai_n28173305/

    ara_portillo

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    with regards to that ate rai..

    Post  ara_portillo on Mon 10 Aug 2009, 9:54 pm

    yes. if the woman has pre-existing undiagnosed HTN during the pregnancy, and this condition is not known during the duration of pregnancy, the woman can just suddenly suffer from worsening condition like eclampsia... close monitoring and persistent prenatal should be done and should have been instituted in her case.

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    answer for case1

    Post  ma. cristina arroyo on Mon 10 Aug 2009, 9:51 pm

    yes ara, i absolutely remember. i must say that it is a delay on the decision of the patient's family. although i must point out that the husband made the decision but it's on the weight of the decision that matters, the husband chose to go to a small clinic than a hospital which made the delay of care longer. Two of the factors that influence the husband to make such decision is 1st, poverty, in which the husband considered the expenses in making a decision; and the 2nd is, maybe on the health education for the husband. If the husband just knew that sign such as labor pain should be consulted to the nearest hospital, then Amparali should have been saved.

    railibo-
    Guest

    Re: perinatal nursing: day 1 online discussion

    Post  railibo- on Mon 10 Aug 2009, 9:49 pm

    I agree with you ara. It's really a big question if she has been regularly attending prenatal check-ups and then they weren't able to detect her high blood pressure... I guess, they are not that keen in providing proper antenatal care.

    railibo-
    Guest

    answer for case 1

    Post  railibo- on Mon 10 Aug 2009, 9:46 pm

    hmm..delays in decision making? I guess it's because maybe her husband was not sure if he can shoulder the hospital fees.

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    for rai's post...

    Post  ara_portillo on Mon 10 Aug 2009, 9:44 pm

    yes.. ate rai. just as what tina mentioned also, we can trace it back on the adequacy or quality of the prenatal care given.. however, if they are using the same HBMR prototype of the WHO, somehow, the danger signs of pregnancy can be assessed by using that tool...


    Last edited by ara_portillo on Mon 10 Aug 2009, 9:48 pm; edited 1 time in total

    Angel Ve
    Guest

    Answer Case 1

    Post  Angel Ve on Mon 10 Aug 2009, 9:43 pm

    1. What were the social, economic, and medical factors that contributed to Amrapalis death?

    Preeclampsia is a frequent disease with an incidence of 5 to 7% among the general population; however, geographic, social, economic and racial differences are responsible for an incidence that is up to three times higher in some populations Lopez-Mayorga & Lpez-Jaramillo P (1993)

    he decision of the husband to bring Amparali in a small clinic that is 8 km away rather than in hospital that is only 5 km away, indicates that they have financial constraint. This factor caused not just a delay on the management that should have been provided to Amparali, but also on the quality of services that she should have received if she was brought to the hospital.

    Another factor that should be considered is the antenatal check-up of Amparali. Why is it that the health care provider was not able to determine and assessed the increase in blood pressure of Amparali considering the fact that she visits regularly for the antenatal care? There must be a problem with the health facility and the performance of the health care providers in diagnosing the disease.

    Last consideration would be the timing for the referral to the hospital. Immediate intervention should have been provided if only she was transferred earlier into the hospital where complete medical services are available.

    Reference:
    J.P. Casas Brazilian Journal of Medical and Biological Research October 2001, Volume 34(10) 1227-1235 Available at: (Review

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    for tina's post..

    Post  ara_portillo on Mon 10 Aug 2009, 9:38 pm

    yes.. i agree with what tina posted... remember the discussion we have in women's health? One of the causes of maternal mortality is delayed care which occurs in the household, community and hospital facility (Thadeus, 1994). Ref: Thaddeus S, Maine D. 1994. Too far to walk: maternal mortality in context. Social Science Medicine 38:1091-110.
    >>In amparalis case, where are the delays of care occurred?


    Last edited by ara_portillo on Mon 10 Aug 2009, 10:41 pm; edited 1 time in total

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