COMMUNITY AS A CLIENT CLIENT ASSESSMENT.pptx

This is a presentation describes how a community can be assessed

1. CLIENT ASSESSMENT IN FAMILY PLANNING

2. Objective By the end of this presentation, students should be able to: Perform client assessment including , physical examination and laboratory investigations for family planning clients.

3. PURPOSE OF CLIENT ASSESSMENT The primary objectives of this assessment, or screening are to determine whether the family planning client: Is pregnant Has any conditions that affect the clients medical eligibility to start or continue using a particular method. Has any special problems that require further assessment, treatment or regular follow up.

4. SETTING Make the atmosphere friendly, provide privacy and ensure interview area is out of hearing range of other clients and personnel. Get clients record card and writing materials. Greet client cordially. Introduce self and offer seat and make her feel welcome. Explain why questions being asked are important, particularly those the patient might consider private.

5. DEMOGRAPHIC DATA Name Age Sex Marital status Address Occupation Religion

6. SOCIAL HABIT HISTORY Tobacco Alcohol Drugs Type amount taken and for how long should be investigated in a non-judgemental manner in order to help clients discuss freely with the provider.

7. MEDICAL HISTORY(PAST AND PRESENT) Details of any diseases, medical/surgical conditions, or allergies Medications being taken now Diabetes mellitus Hypertension Active tuberculosis Surgical operations which left a scar in the uterus Significant weight loss STI Recurrent headache Thrombosis Pain in the calf Liver diseases or jaundice Epilepsy Mental illness

8. GYNAECOLOGICAL/OBSTETRIC HISTORY MENSTRUAL HISTORY Age at menarche Date of last menstrual period Amount of flow-heavy, moderate, light Interval between two periods dysmenorrhoea

9. REPRODUCTIVE DISORDERS Breast cancer Endometrial cancer Ovarian cancer STI Vaginal infections (bacterial vaginosis )

10. SEXUAL HISTORY Age at first intercourse How often do you have sexual intercourse? Painful intercourse Post coital bleeding Number of sexual partners Abnormal vaginal discharge, itching, smelly, too much

11. OBSTETRIC HISTORY Number of pregnancies outcomes,-live birth, still birth, abortions Complications of pregnancy and history Breastfeeding status Reproductive health plan- number of children

12. CONTRACEPTIVE HISTORY Type of method Satisfaction with methods Duration of usage Side effects experienced Reasons for discontinuation

13. FOLLOW-UP VISIT STEPS Recheck the name and address of client

14. MEDICAL HISTORY Any medical problems since last visit? If yes, what was the problem, if was treated, what treatment, where and by who?

15. GYNE AND CONTRACEPTIVE HISTORY Regularity of periods Changes in periods- heavy or painful.

16. PHYSICAL EXAMINATIONS EQUIPMENT AND MATERIALS Bp machine Stethoscope Weighing scale Laboratory forms Bin Trolley Bowl for water Bowl for cotton/gauze Bi-valve sims / cuscos speculum Kidney dish Wooden spatula for cervical smear

17. PREPARATION OF CLIENT Ensure clients comfort and privacy Explain every procedure to the client Ask client to empty bladder Wash hands before and after touching the woman

18. GENERAL EXAMINATION Gait (walking)- shuffling, limping Facial expressions Obvious ill- health Check vital signs, weight and record

19. Systemic examinations HEAD Tinea captis Ear: behind and infront palpate for inflamed lymph nodes Sub mandibular nodes, palpate FACE Pimples/acne Chloasma EYES Jaundice anaemia

20. MOUTH Colour of tongue and mucous membrane Ulcers and fissure NECK Lumps- thyroid enlargement Distended jugular vein

21. EXTREMITIES Vericose veins Deep vein thrombosis

22. BREAST EXAMINATION Done when standing, seated or lying down. Teach them on how to do self breast examination. STANDING : preferably before a mirror with client standing with breasts exposed.

23. INSPECTION AND PALPATION The breast for size, shape, symmetry, scars, thickening of the skin, visible lumps, peau d’ orange ( skin looking like orange peel with little dimples) Engorgement; redness, colour of nipples, the size and shape, the direction of the nipples, ulceration. Dimpling and drawing in of the nipples. Ask client to lift both arms over the head and check if both breasts rise equally. Lean forward letting breasts hang loosely from the chest.

24. Lying down: flat on the back with head on one pillow. Assist client to lie on her back Position clients arm over her head and make imaginary line, divide it into four quadrants Repeat with the other breast. Palpate from the breast tail and for enlarged nodes. If lump present, ask client if is aware of it Ask if it is increasing in size and whether it hurts

25. Instruct client on self breast examination of breast, have her perform the examination while you observe and correct. Encourage the client to examine the breast every month 2-3 days after her menstrual period, and report the findings to the provider.

26. ABDOMINAL EXAMINATION This is used to identify deeper lying tenderness and enlargement of organs to obtain information on the size, consistency, tenderness and mobility of a mass and the position of organs such as liver and spleen.

27. Inspect for Previous scars Distension Any abnormality Linea nigra

28. Palpate for Lumps and hernia Light palpation Using palmar surface of fingers, palpate lightly the entire abdominal wall. Observe the clients facial expression, which may indicate pain.

29. Deep palpation With one hand behind the right lower chest region, place one hand on the right lower abdomen with fingers pointed upwards. With each deep breath, move the hand on the abdomen towards the edge of the rib to feel the edge of the liver. Repeat the left side to feel the spleen. Deeply palpate the rest of the abdomen including the inguinal area feeling for masses. Rebound tenderness test on the lower abdomen and pregnancy.

30. PERCUSSION If any enlargement is detected, should be percussed for resonance or dullness.

31. Pelvic examination Inspection of the genitalia Bimanual examination Speculum examination Pelvic examination can be done if the client raised a problem and for IUD insertion. Also if the clinic offers pap smear (to collect sample) and VIA (visual inspection with Acetic acid).

32. LABORATORY TESTS TYPES OF LABORATORY TESTS IN FP CLINIC Urinalysis- albumin, sugar, acetone Blood for Hb , malaria, sickling Pregnancy test Pap smear, VDRL, HIV screening

33. After everything offer method and or refer for further management .

34. REFERENCE Family planning Training for Physicians and Nurses/Midwives, federal min of health Nigeria