ANTENATAL CARE

BY NURSE HADIZA SHEHU S.NURSE RASHIDA LAWAL O
TO DEPT OF NURSING SERVICES CONTINUE EDUCATIONS PRESENTATION FMC BIRNIN KEBBI

1. ANTENATAL CARE   PRESENTED   BY   NURSE HADIZA SHEHU S. NURSE RASHIDA LAWAL O   ON 13 TH SEPTEMBER, 2018   DEPARTMENT OF NURSING, CONTINUING EDUCATION MONTHLY PRESENTATION   FEDERAL MEDICAL CENTRE, BIRNIN KEBBI

2. INTRODUCTION AIMS AND OBJECTIVES EPIDEMIOLOGY OF ANTENATAL CARE RECOMMENDED EIGHT ANTENAL VISIT STATISTICS FOR ANTENATAL PATIENT TYPES OF ANTENATAL CARE INITIAL ASSESSMENT INVESTIGATION PROPHYLAXIS IMMUNIZATION HEALTH EDUCATION NURSING DIAGNOSIS/ CARE PLAN SUMMARY REFERENCE OUTLINE

3. OPENING AND CLOSING PRAYER Oh God of creation,  Direct our noble cause  Guide our leaders right  Help our youths the truth to know  In love and honesty to grow And living just and true  Great lofty heights attain  To build a nation where peace  And justice shall reign.

4. Anetenal care is care given to a pregnant women from the period pregnancy is confirm to the onset of labour , which includes the basic antenatal services recommended for all pregnant women, plus the care for their own health and intervention to prevent mother to child transmission (MTCT) of HIV to there babies. INTRODUCTION

5. To monitor the progress of pregnancy to optimize maternal and fetal health by facilitating the woman and her family in preparing to meet the demand of birth and making a birth plan. Facilitating the women to make an informed choice about methods of infant feeding and giving appropriate and sensitive advice to support her decision especially in HIV positive mother. AIMS AND OBJECTIVES

6. WHO (2016) recommended Eight antenatal visit for a healthy woman with a normal pregnancy, scheduled at specific times in the pregnancy to deliver the essential intervention during antenatal care. But HIV positive pregnant woman usually require more visit than HIV negative pregnant women. EPIDEMIOLOGY OF ANTENATAL CARE

7. 1 ST 2 ND 3 RD 4 TH 5 TH 6 TH 7 TH 8 TH 12weeks 20weeks 26weeks 30weeks 34weeks 36weeks 38wees 40weeks RECOMMENDED EIGHT (8) ANTENATAL VISIT

8. Months No of patient New Revisit January  468 97 371 February 507 132 375 March 552 90 462 April 295 77 218 May June 385 113 272 STATISTICS FOR ANTENATAL PATIENT ATTENDING ANTENATAL CLINIC IN THE FIRST HALF OF (2018) JANUARY – JUNE IN FMC BIRNIN KEBBI

9. General (Routine) antenatal care Focused antenatal care Initial assessment (First booking) Physical assessment TYPES OF ANTENATAL CARE TYPES OF ASSESMENT

10. PERSONAL DATA Name Age Date of birth Religion Ethnic group Occupation Family data Husband's name Husband's occupation Date of booking Next of kin INITIAL ASSESSMENT CONSIST OF THE FOLLOWING:

11. Heart disease Chest disease Blood transfusion Kidney disease Others e.g : surgery PREVIOUS MEDICAL HISTORY

12. Multiple pregnancy Tuberculosis Hypertension Heart disease Others e.g : Diabetics, Epilepsy III. FAMILY HISTORY

13. e.g : Previous C/Section, previous reproductive tract infection, Fibroids and infertility. Year Duration of pregnancy Remark on pregnancy labour & pueperium Remark on each child (sex, weight, status and method of feeding) Abortion should be indicated in red (+) IV. PAST /GYNEA COLOGICAL HISTORY V. PAST OBSTETRICS HISTORY

14. Date of last menstrual period Expected date of delivery( EDD) Estimated weeks of gestation at booking VI. PRESENT OBSTETRIC HISTORY

15. I. MEASUREMENTS Height Weight Temperature Pulse Respiration Blood Pressure PHYSICAL EXAMINATION

16. Head Eye Ear Face Nose Mouth Neck GENERAL EXAMINATION (HEAD TO TOE)

17. Axilla Upper extremities Breast Abdomen Vulva Lower extremities Back GENERAL EXAMINATION (HEAD TO TOE) CONTINUAITON

18. EXAMINATION OF BREAST & AXILLA Inspection Palpation Advice ABDOMINAL EXAMINAITON Inspection Palpation Auscultation

19. AT BOOKING Height and previous delivery are usually considered At 36weeks Pelvic assessment will be done in primigravida and woman with second delivery with previous C/section or malpresentation . PELVIC ASSESMENT AT BOOKING

20. Urinalysis Genotype Blood group Hepatitis Venereal diseases research laboratory test (VDRL) Haemoglobin /PCV Rhesus factor Monteux Test HIV/AIDS Test Pelvic ultrasound INVESTIGATION

21. Intermittent preventive treatment of malaria (every 4 weeks from 16 – 20 weeks) Heamatenic PROPHYLAXIS/DRUGS

22. Types of Immunization Dosage Next appointment Coverage TT1 0.5mils   Nil TT2 0.5mils 4weeks 3years TT3 0.5mils 6months 5years T4 0.5mils 1year 10years T5 0.5mils 1year For life IMMUNIZATION Mother ’ s Immunization

23. The pregnant mother will be advice on the importance of coming to the clinic on time and they will have health education on the following: Nutrition: Eating of well balanced diet, using locally available food substance such as beans, rice, vegetable palm oil, fruit, fish and for the growth and development of her baby and her nourishment. Personal Hygiene: The importance of personal hygiene will be addressed e.g bathing daily, care of hair, perineal and underwear’s. SUMMARY OF MOTHERCRAFT AND OTHER CLASSES ATTENDED

24. Environmental Hygiene: The important of proper hygiene will be over emphasis which will help to prevent breeding of mosquitoes and hence prevent malaria infection and also prevent breeding of other microorganism to prevent infection. Rest & Sleep: The important of rest and sleep will be explain to the them so as to conserved energy and good health. Clothing: Health education on wearing free clothing and low shoes not high for easy movement and to prevent accident, backache and maintain body posture. SUMMARY OF MOTHERCRAFT AND OTHER CLASSES ATTENDED COTN

25. Medication: They will be advice on taken their routine drugs, avoid self medication and taking of harmful traditional medicine. Care of breast: Important of wearing of firm brassieres and cleaning of nipples, inform them about the present of colostrum at 16 – 20weeks of pregnancy. Exclusive Breast feeding/ breastfeeding option: They will be encourage on exclusive breastfeeding and the important of exclusive breast feeding and how to breast feed exclusively but in HIV positive mother it is optional. SUMMARY OF MOTHERCRAFT AND OTHER CLASSES ATTENDED COTN

26. Immunization: Health education on immunization on both mothers and their babies will be explain both prenatal and postnatal. Birth preparedness : They will be informed the important of hospital delivery, preparation for delivery and its importance, which include material and financial, at 32weeks of pregnancy and items to bring to the hospital for delivery. Labour /Danger sign: Danger Signs of pregnancy and signs of true labour will be explain in details especially primigravida and HIV positive mothers. SUMMARY OF MOTHERCRAFT AND OTHER CLASSES ATTENDED COTN

27. Family planning: Health education on need for them to rest after delivery will be emphasize in order for them to breast feed their babies for at least 1-2years and that system affected by pregnancy will go back to pre-pregnant state e.g reproductive system, cardio vascular & urinary system and to prevent unintended pregnancy. SUMMARY OF MOTHERCRAFT AND OTHER CLASSES ATTENDED COTN

28. NURSING DIAGNOSIS Pain (back and leg) related to progress of pregnancy evidence by verbalization. Sleeping disturbance related to frequent micturition evidence by verbalization. Anxiety related to the unknown outcome of pregnancy evidence by changed of mood. NURSING DIAGNOSIS AND NURSING CARE PLAN

29. Date/ Time S/N Nursing Diagnosis Nursing Outcome Nursing Action Rationale Evaluation 13/9/18   Pain (back and leg) related to progress of pregnancy evidence by verbalization Patient verbalized less pain within the period of pregnancy Avoid using high hill shoes Encourage using of sitting toilet Encourage sleeping on flat surface Served prescribed analgesic Prevent twist of muscles It promote comfort It relax the muscles thus preventing pain. It blocked the pain receptors Patient complain less of pain with in the period of intervention NURSING CARE PLAN

30. PREGNANCY RELATED COMPLICATION Aneamia V.V.F Rupture uterus Maternal and fetal death Antepartum haemorrhage Pre -eclampsia and eclampsia

31. PREVENTION OF PREGNANCY RELATED COMPLICATION Health education Early detection Identified patient at risk Prompt management/intervention Changed in life style Drugs Immunization Early referral

32. CONCLUSION Antenatal care for pregnant woman includes basic antenatal services recommended for both HIV and non HIV pregnant woman for their own health and intervention to prevent pregnancy complication. All pregnant woman need to be supported in order for them to engage in healthy behaviour maintain their own health and that of their unborn baby. Doing this will reduce some of the risk of maternal and perinatal problems.

33. REFERENCES ADESOKAN , F.O.O (2011) Reproductive health of all ages, revised edition Ijigbo junction printers Ado Ekiti , Ekiti State. Ajayi , F.T (2004). A guide to primary healthcare practice in developing countries 4 th eduction Government Printers, Ekiti State. AKINLEYE , F. et al (2009). Perceptions of care and services by the clients and families. DIANE, M.F et al (2012), Myles text book for midwives 14 th edition Edinburg London New York. National PMTCT Training manual April, (2018).