Case Presentation on Antenatal care.pptx

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Here, Case Presentation on Antenatal care.pptx covers the area of definition, aims, objectives, visits, nursing assessment, investigations, diagnosis, nursing management , health education, advice and counseling etc. Thanks to all.

1. Clinical conference o n A ntenatal care (ANC) Presented by Rabeya sultana Reta MSN (WHMN) 2 nd semester, BSMMU Date: 16.05.24 1

2. Welcome to Antenatal care Systemic supervision (examination and advice) of a women during pregnancy is called ANC. 2

3. Objectives of Antenatal Care To ensure a normal pregnancy with delivery of a healthy baby from a healthy mother. 3

4. Demographic Data Name of Patient : Mrs. T. Age: 20 years. Occupation : Housewife Name of Husband: Ta. Hasan , 29 yrs. Religion: Islam Name of Hospital: BSMMU Hospital. Reg. No. : 2176/40931 Address : Green Road, Dhaka. Contact number: 017*****003 Date of booking: 29/10/23 Date of visiting: 01/04/24 4

5. Chief complain H/O amenorrhea since 8 months. Came for routine examination. Feels tired and weak with her usual work for 1 month. Sudden blurring of vision which is relived on rest . Aspiration and sleepiness at rest time. 5

6. History of present illness Amenorrhea for 8 months with easy fatigability since 1 month. Previously, she was able to do her household work, but for the past 1 months, she gets tired even with minimal work. She complains of fatigability, giddiness, sometimes blurred of vision which relieved by rest. No other complains. 6

7. History of present pregnancy ANC Registration- Registered at BSMMU at 12 wks. after confirmation of pregnancy by Urine test at 5 th wks. with Kit at home. Now she is at 34 wks. No . of ANC visits- she had 3 antenatal visits till now and and this is no. 4 . Investigations- Routine Blood and urine test were done and 2 times USG till now. No H/O Trauma, bleeding P/V, leaking P/V and decreased fetal movements. 7

8. Obstetric history Menarche at 12 yrs. 5/30 days regular cycle. Non Consanguineous marriage. Active Marital Life- 2 years. H/O contraceptive used- (Condom) Gravida: 1 st , Para- 0. LMP : 03/08/23. EDD : 10/05/24 (±7 days) Tetanus Toxoid Immunization- completed 5d. 8

9. Personal history Mixed diet. Bladder & bowel habits normal & regular . Appetite: good Sleep: sound Well hygienic. No H/O exposure to STD's No H/O drug allergy. 9

10. Family & Social history No family history of congenital anomalies, multiple pregnancy, DM, HTN. No history of any chronic illness. Lives in Dhaka with her husband. Nobody for helping with her. Husband- non smoker, had small business and Monthly income-30,000 tk. 10

11. Past medical & surgical history No history of any chronic illness like diabetes, hypertension, Asthma. No history of Tuberculosis. No history of hospitalization, blood transfusion etc. No H/O any surgical intervention. 11

12. History of 1 st ANC visit Complain of increased frequency of micturition. Complain of nausea, vomiting and vertigo . Vital signs were normal in value. Routine blood & urine tests were done & were found in normal range . Advised for IF, setting birth plan, diet, rest, slight regular exercises and personal hygiene. Taught about cope with normal physiology of pregnancy and aware on danger signs. 12

13. History of antenatal visit 2nd Visit- She was prescribed Iron, folic acid and calcium, but had non compliance. Experienced quickening at 18th week. There after she could appreciate fetal movements regularly . 3 rd visit- Subsided nausea, vomiting or weakness. No urinary symptoms Weight gained normally & Normal vital signs. 13

14. General examination Patient is conscious and co-operative. Height: 148 cm, Weight : 67 kg. Build : Moderate, Pallor : Present Pedal edema: absent. Vital Signs:- B.P: 110/70 mmHg Pulse: 96 b/min Temperature : 98⁰F Respiration: 20 breath/min 14

15. Abdominal Examination Inspection : Abdomen uniformly distended, globular in shape. Umbilicus Stretched & centrally placed Linea Nigra and Striae gravidarum present No Scar marks seen . Palpation: Abdominal circumference - 76 cm Symphysio-fundal height - 28 cm (corresponds to 32 weeks) 15

16. Abdominal Examination cont’d . Fundal grip- Smooth, hard, ballotable mass suggestive of head Lateral grip- ➤ Knob like structures, irregular parts on the right side suggestive of limb. buds ➤ Uniform resistance, curve like on the left side suggestive of spine 16

17. Abdominal Examination cont’d. 1 st Pelvic grip - Soft, broad & non- ballotable , suggestive of buttock . 2 nd Pelvic grip - Fingers converge, head floating, not engaged . Uterus is relaxed . Fetal movements felt . 17

18. Abdominal Examination cont’d. Auscultation: Normal bowel sounds heard. FHS present.(140/min) Heard on left sided apart to umbilicus. Findings : a single alive fetus with breech presentation in transverse lie. 18

19. Breast Examination No inverted or cracked nipples. Areola- pigmented. No distended veins visible. Nipples- enlarged, erectile and pigmented Secretions- absent No tenderness. Breasts are normal. 19

20. Lab Findings Urine Albumin-absent Sugar-absent Blood Hb-9.2 gm./ dl (normal 12-16 gm /dl) Grouping-B +(ve) VDRL-non reactive HBSAG-negative RBS-126mg\dl Rubella- Nil. 20

21. USG of pregnancy profile USG OF Pregnancy profile: Single alive fetus in breech presentation in longitudinal lie. Fetal movement , tone, breathing is in normal. liquor volume  is in 800 ml (average). Fetal age = 33 weeks Fetal weight =2280 gm. 21

22. Nursing Diagnosis Imbalanced nutrition less than body requirements related to inadequate food intake as evidence by easy fatigue and weakness. Ineffective breathing pattern related to failure of nutrients absorption necessary for formation of red blood cells. 22

23. Nursing Diagnosis cont’d. Activity level reduced related to imbalance between demand and intake as evidence by tired with usual activities. Risk for infection related to inadequate secondary defenses due to decrease in hemoglobin level leucopenia. 23

24. Health education and counseling Dietary counseling, advised for frequent and nutritious diet specially rich in iron with vit.-C like lemon, guava for better absorption of iron. After assessment of blood hemoglobin, parental (ferric forms) should be advised. Motivation for institutional delivery. Suggested to keep somebody with her who concerned about her diet and health needs. 24

25. Health education and counseling cont’d. Advised for personal hygiene and cleanliness. Review on Birth plan which was set/taken at 1 st visit. Recorded and tell all assessment findings on her ANC card with date of next visit. Diet Menu planning . Aware on danger signs issues. Folic acid, Iron & calcium supplements continued unto 40 days after giving birth. 25

26. References At 34 wks .,www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/anemia-during-pregnancy/art-20114455 A M Hoque , Afr Health Sci. 2022 Sep; 22(3): 81–92.doi :  10.4314/ahs.v22i3.10 ANC care, www.nhs.uk/pregnancy/your-pregnancy-care/your-antenatal-appointments /#:~: text=34%20weeks,tests%20from%20the%20last%20appointment J Hum Nutr Diet. 2023 Jun;36(3):763-771. doi : 10.1111/jhn.13089. Epub 2022 Sep 26. 26

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