INDEX NUMBER: 4622190146

FAMILY CENTERED MATERNITY STUDY

ON

MADAM D.N

AT

EFFIDUASI GOVERNMENT HOSPITAL

WRITTEN BY:

WINIFRED HEWTON

(STUDENT MIDWIFE)

N URSING AND MIDWIFERY TRAINING COLLEGE

ASANTE -MAMPONG

OCTOBER, 2022
CONTENTS

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 LIST OF TABLES

TABLES PAGE

TABLE I: NURSING CARE PLAN DURING ANTENATAL 22

TABLE II: DURATION OF LABOUR 45

TABLE III: NURSING CARE PLAN DURING LABOUR 49

TABLE IV: NURSING CARE PLAN DURING PUERPERIUM 71

TABLE V: PHARMACOLOGY OF DRUG USED 80

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 INTRODUCTION

The family centered maternity care study is a comprehensive care given to the expectant

mother and family using the necessary midwifery measures to ensure that the client gets

quality care through the later part of pregnancy, labour and first seven days of puerperium.

Through interactions with her, the family and her community, adequate preparations are

made to welcome the new member of the family and any information concerning the

progress of the later part of pregnancy, labour and the first seven days of puerperium made

known to them.

The study is based on midwifery measures and guidelines for the midwife to identify and

help the pregnant woman in solving any problem identified during the period of care.

This family centered maternity care study was conducted on Madam D.N. at 24 year old

expectant mother of 36weeks with an obstetric profile of Gravida 2 Para 1 alive (G 2P1A).

My interactions with her started on the 1 st October, 2021 at 10:00am during my district

practical. When she was 36 weeks pregnant during her eighth visit to the antenatal clinic at

Effiduasi Government hospital (maternity wing) and ended on 15th October2021. She had

spontaneous vaginal delivery on 19th October 2021. She delivered a live healthy female

infant at 4:30pm with birth weight of 3.0 kilograms without any abnormality. Client was

handed over to the community health nurse 26th October 2021 for continuity of care. The

condition of the mother and baby was good. Family Centered Maternity care study

contains four chapters.

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Chapter one deals with assessment of client and family which consist of clients personal

and social history, daily lifestyle and hobbies, family medical and socio-economic history,

medical history, surgical history, menstrual history, past obstetric and present obstetric

history and summary of subsequent antenatal visits.

Chapter two consists of antenatal care rendered to client which involves first contact with

client, first antenatal home visit, client subsequent visit to the clinic, second home visit,

client last visit to the clinic.

Chapter three talks about admission, history taking and initial assessment of client in

labour, active management of the first, second, third and the fourth stages of labour.

Chapter four emphasis on the management of client and baby during puerperium from the

day of delivery to the seventh day.

Finally, the care study also has a summary of the care plan, conclusion and pharmacology

of drugs, bibliography as well as various signatories.

Why I Chose My Client

On 1st October 2021, when she was 36weeks pregnant. I chose her for my family centered

maternity care study to help educate and manage her on some minor disorders,I then

introduced myself as a final year student of Mampong Nursing and Midwifery Training

College and with her permission I looked through her antenatal record book and she was

within the criteria for the study to help her throughout pregnancy, labour and puerperium.

She accepted and promised to co-operate and gave me the necessary information to make

the study a success. I thanked her for her time and promised to render a comprehensive

care.

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 LITERATURE REVIEW

Literature review gives detail information about various authors and editors ideas about

pregnancy, labour and puerperium.

Pregnancy

According to Marshall&Raynor (2020) a human pregnancy is considered to last

approximately 40weeks,with labour usually occurring between 37 and 42weeks”gestation.

Williams &Wilkins (2017) defines pregnancy as the time during which one or more

offspring develops in a woman. It typically occurs around 40 weeks from the start of the

last menstrual period which is just over 9 months. Pregnancy is divided into 3 trimesters,

each lasting for approximately 3 months.

Pregnancy According to Spong(2017) pregnancy is the term used to describe the period in

which the foetus develops inside a woman’s womb or uterus .It usually lasts about

40weeks ,just over 9months ,as measured from the last menstrual period to delivery.

Although pregnancy is normal during this period certain physiological and psychological

changes exist this affect the entire system as result of hormonal influence .Some women

suffer minor disorders like vomiting ,heart burns, constipation, and waist pain.

Labour

According to Marshall &Ranynor(2020), labour, purely in the physical sense ,may be

described as the process by which the fetus, placenta and membranes are expelled through

the birth canal; however, labour is much more than a purely physical event.

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According to Shiel (2018), labour is the process of delivering a baby and the placenta,

membranes and the umbilical cord from the uterus to the vagina to the outside world.

Labour is defined by Williams & Wilkins (2017) as the ending of pregnancy where one or

more babies leaves the uterus by passing through the vagina or birth canal with its placenta

and membranes.

Labour is divided into four stages. The first stages starts from the onset of labour dilatation

of the cervical os. This stage is divided into two, active phase and latent phase. The latent

phase may last for 4-6hours primigravida. Here contractions are short and mild but

becomes more frequent in duration and intensive overtime. This stage is monitored by the

use of observational chart.

The active phase begins when the contractions become regular and more frequent lasting

longer and more intense with moderately hardened palpable fundus. Dilation also

progresses from 4-10cm. This stage is monitored by the use of partograph.

Partograph is a graphical record of observation carried out during active phase of the first

stage of labour maternal and foetal data during progress of labour entered against time on

a single paper sheet (WHO, 2018). The second stage starts from 10cm to complete

expulsion of the foetus. The third stage starts from complete expulsion of the foetus to

complete expulsion of the placenta and membranes and control of hemorrhage. The fourth

stage comprises with the first six hours after the third stage where the mother and baby re

closely observed for any deviation.

Puerperium

According to Marshall&Ranynor (2020), Puerperium start immediately after child birth

and placenta and membranes are expelled and continue for approximately 6-8weeks.

Puerperium is a period of six weeks following childbirth during which the reproductive

organs return to their pre-pregnant state both anatomically.

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Puerperium is also defined as the time from the delivery of the placenta through the first

few weeks after the delivery. This period is usually considered to be 6 weeks in duration.

By 6 weeks after delivery, most of the changes of pregnancy, labour and delivery have

resolved and the body has reverted to the non-pregnant state. (Kansky, 2016)

Puerperium is also defined by WHO (2021) as the period which begins immediately after

childbirth as the mother’s body including hormone levels and the uterus size returns to a

non-pregnant state. The period is commonly used to refer to the first 6 six weeks following

childbirth.

Involution involves the gradual return and reduction in size of the uterus to a pelvic organ

until it is no longer palpable above the symphysis pubis.

Nursing process

Nursing process is an organized approach to the identification of a patient’s nursing care

problem and the utilization of nursing actions that effectively alleviates, minimize or

prevent the problems being presented from developing (Weller 2018).

The nursing care plan is a systematic method by which nurses plan and provide care for

client. It involves data gathering, analyzing and identification of problem, plan care to

meet set goals, intervention and evaluation of set objectives. It comprises of five phases

namely; assessment, nursing diagnoses, planning, implantation and evaluation

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 CHAPTER ONE

ASSESSMENT OF THE CLIENT'S PROFILE

According to Ead (2019) assessment is the act of gathering key information in order to

determine the direction of care and judging how client is responding to treatment. This

chapter deals with the information about the client personal and social history, family

history, medical history, past obstetric history and present history.

Personal and Social History

Madam D.N. G2 P1A is 24years old and she lives in Effiduase. She is fair in complexion

with 158cm in height and weights 44kg. She is fashion designer and a University graduate

and she speaks English and Twi only.

Madam D.N. is a Christian and she attends St. Joseph Catholic church of Ghana. She is

married to Mr. P.A.D for four (4) years and he works as a Pharmacist. They are blessed

with one child being a boy. Client’s next of kin is her husband because he is the person

available in terms of need as well as his source of support during pregnancy. Her favorite

food is banku and okro stew and her hobby is listening to music.

Client’s Habit of Daily Living

Madam D.N. wakes up early in the morning around 5:30am, prays and leaves her room,

brushes her teeth and performs her household chores. She takes her breakfast with her

family and prepares her son for school whilst she also leaves to work.

She usually takes her lunch at 12:30pm. She closes from work around 3:00pm and gets

home by 3:30pm. After work she prepares supper for her family, listen to news when its

6:00-7:00pm does devotion with her family before leaving for bed around 9:00pm.

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Family Medical and Socio-Economic History

Madam D.N is the third born of her parents and they are from the Agona clan. Her parents

and her two sister`s reside at Effiduase in the Ashanti Region. According to Madam D.N

there are no known hereditary conditions such as hypertension, diabetes mellitus or mental

illness in her family.

There are no congenital abnormalities as well as infectious diseases like asthma,

tuberculosis, leprosy and measles in her family.

There are no multiple pregnancies in both her maternal and paternal lineages. Occasionally

when any of the family member suffer a minor ailment, they seek medical care from the

hospital and no member of her family has passed away for the pass 2years. She has no

family allergies to drugs, substance such as copper and lead. Most of her siblings belongs

to blood group O with rhesus factor being positive. She chose her two brothers to her

blood donors in case of any emergency.

Medical History

According to Madam D.N she has never been admitted into any hospital before neither has

she been diagnosed of having any disease like hypertension, sickle cell disease, chronic

cough, epilepsy, diabetes, mental disorders, STIs such as human immune deficiency

(HIV),gonohorea, congenital abnormalities like hare lip, extra digits or cleft palate. She

has never been transfused before and she uses the National Health Insurance (NHIS) to

seek medical care when sick. She has no known allergy to any food, drugs or substances

like copper or lead. She belongs to blood group O with rhesus factor positive (O +). Client

did not suffer from childhood preventable infection like measles, polio. Client is not on

any other medication. Diphtheria injection for the prevention of maternal tetanus with a

month interval and five doses of sulphadoxine pyrimethamine (SP) with a month interval

without any adverse reaction

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Surgical History

She has never had any surgical operation involving the reproductive organs such caesarean

section, laporatomy or myomectomy. She has not experienced any road traffic accident

which could cause injury to the pelvis or affects its adequacy. She has also not diagnosed

of any secondary infertility by her.

Menstrual History

According to my client, she had her menarche at the age of 17. She has a regular menstrual

cycle of 28days.she has about 100ml of blood flow for 5 days during each cycle. Mrs D.N

last menstrual period was 15th January 2021 and her expected date of delivery was

calculated to be 22ndOctober, 2021 using her last menstrual period. According to the first

ultrasound scan taken on 16th April, 2021, her expected date of delivery was given as 25 th

October, 2021.

Client was on oral contraceptive (Microgynon) as a family planning and stopped when she

wanted to get pregnant.

Past Obstetric History

Pregnancy

Madam D.N, gravida two Para one G2P1A became pregnant for the first time in 5th January

2019 and carried her pregnancy to term without any complication such as antepartum

haemorrahage or pre- eclampsia or eclampsia .She has never had any form of abortion

before .Again she had minor disorders such as heart burns, backache, vomiting and was

managed and treated at the hospital. According to her, she started antenatal visit when she

was 10th weeks at Asangman S.D.A Government Hospital and since then she became

regular attendant, she visited at least six[6] before delivery. She completed intermittent

preventive treatment for malaria; that is the Sulphadoxinepyrimethamine doses which was

given as directly observational therapy as a malaria prophylaxis to prevent malaria and

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two doses for the prevention of tetanus diphtheria before delivery to prevent neonatal

tetanus.

Labour

Client had spontaneous vaginal delivery which lasted within seventeen hours. She gave

birth to a live male baby weighing 3.2kg (kilogram) on 12th October 2019 at Asangman

S.D.A Government Hospital maternity wing around 3:30pm who cried after birth. Placenta

and membranes were completely expelled within five minutes after delivery. Blood lost

was approximately 150milliters and baby's condition was. Client had no tear and was not

given episiotomy. She said her baby cried immediately after the birth and had no

congenital abnormalities like hydrocephalus and cleft palate.

Puerperium

According to client after delivery she did not encounter any complication and her baby's

condition was satisfactory and was discharged 24hours after delivery. Her baby was

immunized against the preventable diseases. According her, she breastfed her baby and

completely weaned baby of breast at 1 year six months. According to her, she has been

practicing family planning method with the use of oral contraceptive (Microgynon) and

stopped when she wanted to get pregnant. She gets her support from her mother after

delivery.

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Present Obstetric History

Madam D. N she attended her first antenatal on 16 th April 2021 and she was 12 weeks

pregnant. According to my client, her last menstrual period was 15 th January, 2021 and her

expected date of delivery was 25th October 2021 calculated by her last menstrual period.

According to the first ultrasound scan taken on 16 th April 2021, her expected date of

delivery was given as 25th October, 2021. She took her third dose of tetanus diphtheria to

prevent maternal and neonatal tetanus.

General examination was carried out and findings were communicated to her. First foetal

moment was felt at 16 weeks of gestation. Madam D.N has the appetite for sugary foods

and she is not on any medication and she also experience minor disorders like leg cramps,

constipation, and sleeplessness which she has been managing.

Laboratory investigations and ultra sound scan examination were also done and recorded

as well as her vital signs to serve as a baseline information for comparison and they are as

follows

Temperature 36.2 degree Celsius (0 C)

Pulse 80beat per minute (bpm)

Respiration 20 cycle per minute (cpm)

Blood pressure 110/70 millimeters per mercury(mmHg)

Weight 44 kilograms(kg)

Height 158 centimeters(cm)

Various laboratory investigations were carried out and the results came as

Urine R\E Negative/negative

Stool R/E Negative

Hemoglobin 11.0g/dl

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Blood group O

Rhesus factor +

Hepatitis B Negative

Blood film for malaria parasite Not seen

HIV status Negative

Venereal disease research laboratory (VDRL) Non-reactive

Glucose-6-phosphate Dehydrogenase deficiency (G6PD) No defect

Urine Routine Examination Macroscopy

Appearance Clear

Colour Amber

Protein Negative

Ketones Negative

Glucose Negative

PH 6.0

Nitrite Negative

Leucocyte Negative

Blood Negative

Microscopy

Red Blood Cells 0/1

Pus cells 1/1

Epithelia 1/1

Sedimentation No abnormalities seen

Stool Routing Examination

Macroscopy Semi formed specimen

Microscopy No ova, larvae or protozoa

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Other investigations

First Ultrasound scan reveals the following results;

Gestational age 12weeks

Liquor volume Adequate

Expected date of delivery 25/10/2021

Number of foetuses Single viable foetus

Placenta location Posterior upper

No abnormalities were detected when physical examination was performed on her from

head to toe. Client was given long lasting insecticide treated net to prevent malaria

infection

Tablet Folic Acid 5mg daily for 30 days

Tablet Multivitamin 200mg daily for 30 days

Tablet Fersolate 200mg daily for 30days

There was no complaint reported by my client.

Client was educated to follow a good nutritional diet which includes; kontomire, agushie,

fruit and vegetables and also the importance of taking in more fluid. She was given the

third dose of injection tetanus diphtheria on 16th April, 2021 and also her records

indicated that, she attended antenatal clinic as scheduled. All investigations conducted

shows that no abnormalities were detected till I met her when she was 36 weeks pregnant.

Summary of Previous Antenatal Clinic Visits (Second To Seventh)

On the 14th of May 2021, client visited Effiduase District Hospital (maternity wing) for the

second time and her gestational age was 16weeeks, she was examined and all findings

were recorded. Health education was given on diet and nutrition ,Anaemia and Iron,folic

acid supplement refer to appendix IIC(Topic for client counseling). She complained of leg

cramps and was managed by the midwife. Vital signs were checked and recorded as

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temperature 36.2degree Celsius(0 C),pulse 82beat per minutes(bpm) ,respiration18cycle

per minutes(cpm),bloodpressure110/60millimeter per mercury(mmHg),weight

46kilogram(kg). She was given the first dose of sulphadoxine pyrimethamine(SP) for

prevention of malaria under direct observational therapy.

On the 11st June, 2021 she visited the hospital for the third time and her symphysio fundal

height was18centimeters(cm) with a gestational age was 20weeks, vital signs were

checked and recorded as temperature 36.5degree Celsius(0 C),Pulse 72beat per

minutes(bpm),respiration18cycle per minutes(cpm),blood pressure120/70millimeter per

mercury(mmHg),weight 48kilogram(kg), client had no complain but was given prenatal

vitamins as well as the second dose of sulphadoxine pyrimethamine (SP ) under direct

observational therapy to prevent malaria plus dewormer which is Tablet Albendazole

400mg and used for treatment of infection caused by worms.

On 9th July, 2021 client visited the Effiduase Government hospital (maternity wing) for the

fourth time and her symphysio fundal height was 22 centimeters(cm)with gestational age

was 24weeks. Vital signs were checked and recorded as temperature 36.0degree Celsius(0

C),Pulse 77beat per minutes(bpm) ,respiration 22cycle per minutes(cpm),blood

pressure110/70millimeter per mercury(mmhg),Weight 50kilogram(kg). She complained of

sleeplessness, and constipation and was managed by the midwife, urine was checked for

protein and acetone and was negative, third dose of sulphadoxinepyrimethamine (SP) was

given under direct observational therapy to prevent malaria. Health education was given

on sexual activity and safe sex, refer to appendix IIC(Topic for client counseling).

On 6th August, 2021 client came to the hospital for the fifth visit and her symphysio fundal

height was 27centimeter(cm) with a gestational age of 28weeks. Vital signs were checked

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and recorded as temperature 36.5degree Celsius(0 C),Pulse 68beat per

minutes(bpm) ,respiration 20cycle per minutes(cpm),blood pressure101/68millimeter per

mercury(mmHg),weight 52kilogram(kg). She had no complains. Health education was

given, refer to appendix IIC(Topic for client counseling).Hemoglobin level was 11.4g/dl.

She was given her fourth dose of Sulphadoxine pyrimethamine was given under direct

observational therapy to prevent malaria.

On 3rd September, 2021 client came to the hospital for the sixth visit and her symphysio

fundal height 31centimeters (cm) with a gestational age of 32 weeks. Vital signs were

checked and recorded as temperature 36.0degree Celsius(0 C),pulse 70beat per

minutes(bpm) ,respiration 20cycle per minutes(cpm),blood pressure101/60millimeter per

mercury(mmHg),weight 54kilogram(kg). She had no complains. Health education was

given on diet and nutrition/anaemia/Iron,folic acid supplement refer to appendix IIC(Topic

for client counseling) Urine was checked for protein and glucose, both were negative She

was given her fifth dose of Sulphadoxine pyrimethamine was given under direct

observational therapy to prevent malaria.

On 17th September, 2021 Madam D.N came to the hospital for the seventh visit which she

had her vital signs checked and recorded as temperature 36.4degree Celsius(0 C),pulse

70beat per minutes(bpm),respiration 20cycle per minutes(cpm),blood

pressure100/60millimeter per mercury(mmhg),weight 55kilogram(kg), urine was also

checked for protein and acetone and abdominal examination were performed. Iron and

folic acid were served and recorded in Antenatal Records Book in Appendix II. Health

education was given on neonatal care and dangers signs in newborn and recorded in

Appendix IIC (Topics for client counseling).Repeated Human immune deficiency virus

was done and result was 280 refer to appendix I(Record of current pregnancy).

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 CHAPTER TWO

ANTENATAL CARE

Antenatal care is a care provided by midwives and obstetrician during pregnancy to ensure

that the fetal and maternal health is satisfactory (Weller, 2014).

This chapter talks about focused antenatal care including first contact with the pregnant

woman, first antenatal home visits, client’s subsequent clinic visits and subsequent home

visits. How her problems were identified and solved using the nursing care plan.

First contact with my client

My first contact with Madam D.N was on the 1 stof 0ctober, 2021 around 9:30am at the

antenatal clinic (OPD) at Effiduase Hospital (Maternity Wing) on her eighth visit to the

Hospital. She was welcomed and made comfortable. I introduced myself to her by

mentioning my name to her and also as a student of Nursing and Midwifery Training

College, Mampong Ashanti, I took her antenatal maternal record book and glanced

through for her previous record with her permission, by then Madam D. N. was 36weeks

pregnant , at 10:00am I explained to her the reason why I chose her as a client and that

was to help educate her on the heart burns she complained during the education on minor

disorders. She was reassured to allay fear and anxiety, client was encouraged to eat small

meals at frequent time. Client was educated to take warm milk to relieve pain. Client was

encouraged to sit on chair and avoid bending down when carrying out household chores

such as scrubbing and washing. Client was encouraged not to eat spicy food like fried rice.

10
,her reason for visit was asked and she said she was coming for her schedule antenatal

clinic.

At 10:30am during history taking, client complained of headache, Client was

reassured.physiological changes were explained to her. Client was encouraged to have

enough rest and sleep. Client was advised to avoid strenuous exercises. Client was advised

to apply cold compresses on the forehead .Client was advised to ask family to assist in

household chores. Client was instructed to take her prescribed analgesic.

All procedures to be carried out were explained to her in clear and simple language

provided privacy and her vital signs were checked and recorded as follows

Temperature 36.2 degree Celsius (0C)

Pulse rate 60 beat per minutes (bpm)

Respiration 22 cycle per minutes (cpm)

Blood Pressure 110/70millimeters per mercury (mmHg)

Weight 56 kilogram (kg)

Symphysiofundal Height 35 Centimeters (cm)

Laboratory investigations recorded as the following results;

Hemoglobin level 12.0 grams per deciliter (g/dl)

Second Ultrasound scan revealed the following;

Gestational Age 36 weeks

Placenta position posterior upper

Liquor volume Adequate

Presentation Cephalic

Expected date of delivery 29/10/2021

Number of fetus’s Single viable fetus

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Fetal heart rate Present

Physical examination

I sorted permission from her to examine her from head to toe. The procedure was

explained to her and she was asked to empty her bladder. I assisted her to undress and

wear a gown. She was assisted to lie on the couch and asked her to lie on the left side to

prevent inferior vena cava occlusion, privacy was fully ensured by screening, closing of

windows and reassured her of confidentiality. I washed my hands with soap and under

running water and dried with a clean neat hand towel, a tray was set and hands were

properly washed and cleaned for the second time, she was assisted to assume a dorsal

position, and then she was examined from head to toe .

On inspection, the hair was examined for perdiculosis and dandruff but none was seen,

hair was nicely styled, there was no cholasama found on the face, her eyes were white and

clear from discharge and conjunctiva was pink. The lips were soft and moist, her mouth

was cleaned and smells good, she had a white teeth and a clean tongue, her ears were

patent and free from discharges, and her neck was of a normal size.

On examination of the upper limbs, they were of equal sizes and length. I inspected the

nails they were well trimmed and her palms were pink in colour with palmar creases. I

gently squeezed the tip of her fingers for capillary refill and was present.

On breast examination, the breasts were normally situated on the chest with the left breast

a little bigger than the right one. The skin was healthy with dark pigment areola and

Montgomery’s tubercular. I palpated the left breast first after she was asked to put the

right hand under her head and no abnormalities were seen. I gently squeezed the areolar

and colostrum was seen, I swabbed it with cotton wool swab and discarded. The same

procedure was carried out for the right breast and no abnormalities were detected. I taught

her how to perform self-breast examination at home after menstruation and after delivery.

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On abdominal inspection, I explained to her that I was going to examine her abdomen. I

prepared her for abdominal examination by informing her what will be done. She had

already emptied her bladder, so I made her comfortable on the couch assuming dorsal

position with her hands resting by her side. I asked her permission and exposed her

abdomen. I draped her down part from the symphysis pubis to the legs exposing her

abdomen and I stood by her right side.

On inspection, the size of the abdomen corresponded with the gestational age and the

shape was globular. There were no striaegravidarum but lineanigra was present with

visible fetal movement. The skin was elastic and healthy with no scars. I palpated the

abdomen for tenderness, masses, enlarged spleen and liver but none was detected.

On measurement of the symphysiofundal height, I placed my ulnar border of my palm on

either side of the fundus and located the upper border of the symphysis pubis and extend

the tape measure along the middle of the abdomen to the fundus and it measured 35cm

with the gestational age of 36 weeks.

On fundal palpation, I curved my fingers on the top of the fundus to palpate and what was

occupying the upper pole of the uterus was buttocks as a soft irregular mass was felt and

lie was longitudinal.

On lateral palpation, I placed my palm of both hands on each side of the uterus midway

between symphysis pubis and the fundus. I then stabilized the uterus with one hand and

palpated the entire area from the abdominal midline to the lateral side from the symphysis

pubis to the fundus in a rotary manner. I changed hand and repeated palpation for the other

half of the abdomen. The fetal back was located at the left side of the mother’s abdomen

as a smooth curve was felt and the limbs were palpated at the right side of the abdomen as

movement was felt.

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On pelvic palpation, I turned and faced her feet, I asked her to bend her knees slightly. I

helped her to relax by guiding her to breathe out slowly, I then placed the palm of my

hands side of the uterus with my palm just below the level of the umbilicus and my fingers

were directed towards the symphysis pubis with thumbs almost meeting. A hard rounded

mass was felt indicating the head was presenting (cephalic presentation) and the position

was left occipito anterior (LOA).

I then palpated to know the descent of the head by locating the anterior shoulder which

was 2.5cm from the linea nigra where the limbs were located below the umbilicus. I then

kept my two fingers of my left hand over the anterior shoulder and placed my right ulna

just above the symphysis pubis and spread towards the location of the anterior shoulder

which accommodated five fingers therefore indicating a descent of 5/5 th above the pelvic

brim.

On auscultation, the fetal stethoscope was warmed by rubbing it in my palm before

placing it on the mother’s abdomen of the left side where the back was located. I then

placed my ears against the fetoscope and while I was listening to the fetal heart rate, I

placed my two fingers on her radial artery just below her thumb to feel for the maternal

pulse rate and compare with the fetal heart beat. The fetal heart sound was counted for one

full minute and it was 140 beat per minute(bpm) with regular rhythm, full and bouncing

volume.

On vulva inspection, I washed my hands with soap under running water and dried them

after I have helped her to lie on her side and sought her permission to inspect her vulva. I

helped her into a dorsal position and assisted her to bend her knees. I draped her for

minimal exposure. I put on examination gloves an inspected the labia majora and the labia

minora, the perineum for presence of sore, lesion, wart, varicosity, pubis lice, reddening,

or any abnormal discharge were inspected but it was a clean and neatly shaved vulva. I

14
told her to lie on her side as I removed my gloves, I washed my hands with soap under

running water.

I assisted her to lie on her side for me to palpate her back. I run my two fingers gently

through the spine for pains and scoliosis but none was detected. The spine was of normal

curvature.

I assisted her to lie on her back again for examination of the lower extremities and on

examination they were of equal size and length. The toe nails were pink in color and well-

trimmed with no edema at the feet. I helped her out of the couch and assisted her to change

from the hospital gown to her own dress and offered her a seat. I cleaned up the

examination couch and washed my hands again with soap under running water and dried

with a clean towel. All findings were communicated to her and recorded in her hospital

maternal record book. Client was given the sixth dose of sulphadoxine prymethamine

under direct observed therapy to prevent malaria.

Health education on was given diet and nutrition and IFA Supplement refer to Appendix

IIC(Topics for client counseling). I discussed my plans of visiting her at home and I took

her mobile phone number and direction to her house.

The following Iron, folic acid supplement as follows;

Tablet fersolate 200mg daily for 7 days

Tablet folic acid 5mg daily for 7days

Tablet Multivitamin 200mg daily for 7 days

Tablet Paracetamol 1g tds for 5 days

She was encouraged to take her drugs as prescribed and i saw her off. At 10:00am on 2 nd

October 2021, client was called to enquire about the headache and she verbalized that she

is relieve of the headache with a little conversation I also asked about the heart burns, that

was 10:30pm she verbalized that she was also relieve of it.

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First Antenatal Home Visit (Home Environment)

I visited Mrs. D.N. at Effiduase on 4th October, 2021 at 2:30pm.I met her together with

the husband and her mother in law in the house and they warmly welcomed me. I was

introduced to them, they were happy to see me.

Psychosocial environment

Her relationship with her mother in law was good. According to her she had a very

cordial relationship with members of her family. According to her she is the women

fellowship leader and attends funerals, wedding and any other programs of the church. The

purpose of my visit was to educate of danger signs of pregnancy and also find out whether

there was any condition that could impede their health and to familiarize myself with the

family.

Physical environment

Mrs. D.N and her family live in their own apartment with three bedrooms and hall. The

house was built with cement blocks and roofed with aluminum sheets. Their windows

were all filled with mosquito prove nets and they were large enough to improved

ventilation. They have their own washroom and kitchen. Source of water for the house is a

pipe borne and the house was connected to national electricity grid. She has a well-fitting

barrel for storing water; there was a well-covered dustbin and dispose of refuse at the

town's refuse dump. In her room at 3:00pm, she had a treated mosquito net which was

given to her at her first antenatal clinic visit but does not use because she feels hot when

and uncomfortable whenever she sleeps under it .She was educated on how to use and the

need of sleeping under the treated mosquito net in simple terms for her. At 3:30pm client

promised to sleep under the treated mosquito net I realized that the weeds were grown

around the house. The family was encouraged to ensure their surroundings are cleared to

16
prevent the breed of mosquitoes. When we settled down; she was asked to bring her

antenatal card together with the husband and mother. I discussed with them the true signs

of labour. I also explained all the danger signs at the card one by one and told them the

need to quickly go to the nearest hospital when they see any of the signs .we also

discussed birth preparedness and complication readiness. A sign of the onset of true labour

was also discussed. I stressed on how to use and the need to sleep under the treated net,

and why they should keep their surroundings clean to prevent breed of mosquitoes. I asked

client questions on the topics discussed. All the question asked were answered in simple

terms that they could understand.

Her husband promised to observe and report any danger sign of pregnancy. My client's

husband together with her mother, were encouraged to help with the house hold chores so

she could have enough rest. I then reminded her of her next visit to the clinic on 8 th

October 2021 and asked permission to leave.I then thanked them and promised them of

another visit again.

Subsequent Antenatal Clinic Visit (9th And 10th Visit)

On the 8th October, 2021 at 8:00 am client came for her ninth visit at Effiduase

Government Hospital (Maternity Wing). Vital signs were checked and recorded as

Temperature 36.40C

Pulse 80bpm,

Respiration 18cpm

Blood pressure 110/70mmHg

Her urine was checked for protein and acetone and it was negative. Physical examination

from head to toe was done. On abdominal observation, fetal movement was observed. On

measurement of the symphysio fundal height was 36cm and a gestational age of 37 weeks.

On fundal palpation, the buttock was occupying the fundus. The lie of the fetus was

longitudinal and was in the left occipito anterior position when palpated laterally. On

17
pelvic palpation, presentation was cephalic and descent was 5/5th above pelvic brim. On

auscultation the fetal heart beat rate was 136 beat per minutes with good volume and

regular rhythm. I communicated all findings to her and documented them in her Maternal

Health Record Book .Refer to Appendix II (Antenatal Records).Health education was

given on importance of postnatal care refer to appendix IIC (Topic for client counseling).

During history taking, at 10:00am, she complained of frequent micturition. She was

reassured that she will be fine to allay anxiety; the physiology was explained to her that it

was due the pressure on the bladder by the gravid uterus. She was educated on good

perineal care after each urination to prevent infection. She was encouraged to urinate as

soon as she feels the urge to do so and also eat her super early. I encouraged her to reduce

the intake of fluid before going to bed and keep a chamber pot close to her bed to avoid

walking out at night. On 9th October, 2021 at 10:00am client was called to enquire about

the frequency micturition and she verbalized that she is able to cope with it.

On the 15th October, 2021, Client came for her tenth visit at Effiduasi Government

Hospital (Maternity Wing) and during history taking she had no complains Vital signs

were checked and recorded as

Temperature 36.20C

Pulse 80bpm

Respiration 20cpm

Blood pressure 100/60mmHg

her urine was checked for protein and acetone and it was negative. Iron and folic acid

were served and recorded in Antenatal Records Book in Appendix II. Physical

examination from head to toe was done. On abdominal observation, fetal movement was

observed. On measurement of the symphysio fundal height was 37cm and a gestational

age of 38 weeks. On fundal palpation, the buttock was occupying the fundus. The lie of

the fetus was longitudinal and was in the left occipito anterior position when palpated

laterally. On pelvic palpation, presentation was cephalic and descent was 5/5th above

18
pelvic brim. On auscultation the fetal heart beat rate was 142 beat per minutes with good

volume and regular rhythm. I communicated all findings to her and documented them in

her Maternal Health Record Book Refer to Appendix II (Antenatal Records).She received

her sixth dose of sulphadoxine pyrimethamine to prevent malaria under direct

observational therapy. Health education was given on breastfeeding and breast care and

recorded in Appendix IIC (Topics for client counsel).

Second Antenatal Home Visit

On the 13th of October 2021,I got to her house around 3:00pm, I met her mother and the

daughter. They gave me a warm reception and asked about how they were doing. They

said they were doing well. We discussed issues about health education on birth

preparedness and complications readiness plan. She brought their things for conferment

which was neatly packed in a bag .I congratulated her and encouraged her to keep her

antenatal card together with the health insurance Scheme [NHIS] card in the bag so that

when labour sets in, she will just pick her things without forgetting anything. I asked if she

has someone who can donate blood for her when the need arises and she said her brothers

are ready to donate for her. She told me she has saved enough money for her birth and her

mother will be her birth companion whiles her sister in-law will be around to take care of

her first born in the house. She also told me that her husband is already using a car but has

arranged for a taxi that will convey her to the hospital incase her husband is at work and

labour has set in .I educated them on true signs of labour and the breathing techniques and

reminded not to forget to call me when labour sets in .Client was encouraged with her Iron

and folic acid supplement drugs and all the education she had received from me till labour

begins.

This time at 3:30pm, client complained of severe lower abdominal pains. The physiology

behind and the lower abdominal pain was explained to her in simple terms and I reassure

19
her that it will stop after delivery, at 4:00 after the education client was able to cope with

the lower abdominal by verbalizing it. I encouraged her to continue complying to the

education given to her .I thanked her and asked permission to leave. Mrs. D.N and her

family saw me off. I reminded her of her next visit to the clinic which was on 22th

October 2021.

NURSING CARE PLAN DURING THE ANTENATAL CARE

Nursing process is an organized approach to the identification of a patient’s nursing care

problem and the utilization of nursing actions that effectively alleviates, minimize or

prevent the problems being presented from developing (Weller 2014).

The nursing care plan is a systematic method by which nurses plan and provide care for

client. It involves data gathering, analyzing and identification of problem, plan care to

meet set goals, intervention and evaluation of set objectives. It comprises of five phases

namely; assessment, nursing diagnoses, planning, implantation and evaluation.

Actual Problems Identified During Pregnancy

1. On 1st October, 2021 at 10:00 am, client complained of heartburns

2. On 1st October, 2021 at 10:30 am, client complained of headache.

3. On 4th October, 2021 at 3:00 pm, client had no knowledge on the use mosquito treated net.

4. On 8th October, 2021at 8:30 am, client complained of frequency of micturition.

5. On 13th October, 2021 at 3:30 pm, client complains of lower abdominal pain.

Short Term Objectives

1. Client will be relieved of heart burns within 24 hours

2. Client will be relieved of headache within 24hours.

3. Client will gain knowledge on the importance of sleeping in a mosquito treated net .

20
4. .Client will be able to cope with frequency of micturition throughout the latter part of

pregnancy.

5. Client will be able to cope with reduced lower abdominal pain throughout the latter

part of pregnancy.

Long Term Objectives

Client will go through pregnancy successful and without any complications to both the

mother and baby.

21
 TABLE I: NURSING CARE PLAN DURING ANTENATAL

DATE NURSING NURSING NURSING ORDERS NURSING INTERVENTION DATE EVALUATION

AND DIAGNOSIS OBJECTIVES AND TIME
TIME
1 October
st
Impaired body Client will be 1. Reassure client that she will 1Client was reassured of the relieve of the 2nd October Goal fully
be relieved of heart burns. heart burns.
2021 at comfort relieved of heart 2021 at met as client
2 .Encourage client to eat
10:00am (Heart burns) burns within 10:00am verbalized on
small meals at frequent 2. Client was encouraged to eat small
related to back 24hours as intervals. meals at frequent time. phone that she
3.Educate client to take warm
flow of gastric evidenced by has been
milk 3. Client was educated to take warm milk to
acid to the client relieved of
relieve the pain.
oesophagus. verbalizing that 4. Encourage client to sit on a heartburns
chair and avoid bending 4. Client was encouraged to sit on a chair
she has been
down. and avoid bending down when carrying
relieved
out household chores such as scrubbing
5.Encourage client not to eat and washing.
spicy foods 5.Client was encouraged not to eat spicy
food like fried rice

DATE/ NURSING NURSING NURSING ORDERS NURSING INTERVENTION DATE EVALUATION

TIME DIAGNOSIS OBJECTIVES

22
 AND TIME

1st Impaired body Client will 1. Reassure client. 1. Client was reassured was reassured to 2ndOctober,2 Goal fully met as
2. Explain the physiological allay fear and anxiety..
October,20 discomfort[head relieve of 021 at client verbalized
changes to her. 2. physiological changes were explained to
21 at ache] related to headache within 10:30am on phone that
3. Encourage client to have her.
10:30am. stress of 24hours as enough rest and sleep. 3. Client was encouraged to have enough she was relieved
4. Advise client to avoid rest and sleep.
pregnancy evidence by of the headache.
strenuous exercises. 4. Client was advised to avoid strenuous
client
5. Ask client to apply cold exercises.
verbalizing that compresses on her forehead. 5. Client was advised to apply cold
6. Advise client to ask family compresses on the forehead.
she is being
to assist in house hold 6. Client was advised to ask family to assist
relieved of
chores. in household chores.
headache within 7. Client was served with
prescribed analgesic 1g 7. Client was instructed to take her
hours.
PRN prescribed analgesics.

DATE NURSING NURSING NURSING ORDERS NURSING INTERVENTION DATE EVALUATION

AND DIAGNOSIS OBJECTIVES AND TIME

23
 TIME
4th October, Knowledge Client will 1. Reassure client that she will 1. Client was reassured that she will have Goal fully met as
have knowledge on the adequate knowledge on important of
2021 deficit on the verbalize of 4th October client verbalized
important of sleeping under sleeping under mosquito treated net.
At 3:00 importance of gaining of 2021 at she has gained
the mosquito net. 2. Client was asked what she knows about
pm. sleeping under adequate 2. Ask client what she knows the treated mosquito net. 3:30pm. adequate
about sleeping under the
the treated knowledge on knowledge on
treated mosquito net. 3. Pictures in ANC book were used to make
mosquito net the importance the importance
3. Use the pictures in ANC the discussion clear and easy to
related to of sleeping book to make discussion understand. of sleeping under
clear and easy to 4. Client was taught how to use the treated
inadequate under the mosquito net.
understand. mosquito net.
information. treated
4. Teach client how to use the 5. Client was encouraged to ask questions
mosquito net treated mosquito net. bothering her.
5. Encourage client to ask any 6. Client questions were asked answered in
within an hour
questions bothering her. a simple language.
6Answer questions that client
asks in a simple language
that she understands.

24
 DATE NURSING NURSING NURSING ORDERS NURSING INTERVENTION DATE EVALUATION
AND DIAGNOSIS OBJECTIVES AND TIME
TIME
8th Functional Client will be 1. Reassure client that she 1. Client was reassured that she will be able 9th Goal fully met as
will be able to cope with to cope with frequency of micturition.
October, urinary able to cope october,202 client verbalized
frequency of micturition.
2021 . incontinence with frequency 1 that she was
2. Explain to client that it is
(Frequency of of micturition due to the effect of foetal 2. It was explained to her that it is due to the at able to cope with
head pressing on the effect of foetal head pressing on the
At micturition) within 24 hours reduced
bladder. bladder.
10;00am related to foetal as evidenced by 10:00am. frequency of

head pressing client 3. Educate client on good micturition

perineal care after each 3. Client was educated on good perineal
on the bladder. verbalizing that
urination to prevent care after each urination to prevent
she was able to
infection. infection.
cope. 4. Encourage client to urinate
whenever she has the urge 4. Client was encouraged to urinate
to whenever she has the urge to.
5. Advice client to empty her
bladder before returning to 5. Client was advised to empty her bladder
bed at night. before returning to bed at night.

25
 DATE NURSING NURSING NURSING ORDERS NURSING INTERVENTION DATE EVALUATION
AND DIAGNOSIS OBJECTIVES AND TIME
TIME
13th Impaired Client will be 1. Reassure client that she will 1. Client was reassured that she will be able 13th Goal fully met as

October, body comfort able to cope be able to cope with lower to cope with the lower abdominal pain. October,202 client verbalize

2021 (severe lower with a reduced abdominal pain. 1 at that she was able

at 3:30pm abdominal pain) lower 2. Assess the intensity of pain 4:00pm to cope with the

related to abdominal pain and cause of pain. 2. The intensity of pain and cause of pain a reduced lower

descent of the as evidence by 3. Educate client on the was assessed. abdominal pain

fetal head. client physiology behind the 3.Client was educated on the physiology throughout the

verbalizing that lower abdominal pain. behind the lower abdominal pain latter part of

she can cope 4. Encourage client to avoid pregnancy.

with the lower vigorous exercise. 4. Client was encouraged to avoid vigorous

abdominal 5. Advise client to have enough exercise.

pains. rest. 5. Client was advised to have enough rest.

26
27
 CHAPTER THREE

INTRAPARTAL CARE

According to Marshall&Raynor (2020), labour, purely in the physical sense, may be

described as the process by which the foetus, placenta and membranes are expelled

through the birth canal. This chapter includes admission and management of the stages of

labour, care of the baby at birth, examination of the placenta and summary of labour.

notes.

Management of First Stage of Labour

On 19th October, 2021, I was on duty when my client called at 9:50am that she was in

labour and I told them I was on duty, so they arrived at the facility at 11:00 am with their

nose mask on. I went to receive her at the entrance of the hospital with her husband and I

showed them the tap where hand washing is done so I told them to wash their hands under

running water with soap using their elbow to open the tap. After the hand washing, they

were warmly welcomed and her husband was offered a seat at the waiting room after they

were done with the hand washing. Client’s maternal health record book was collected and

quickly glanced through and her last Hemoglobin level taken was on 1 st October, 2021at

36 weeks and was 12.0g/dl and Repeated Human immune deficiency virus was done on

17th September 2021 at 34weeks and result was 280 . Labour history was taken and I

reassured them that they are in competent hands and we will help her deliver safely. Client

was admitted into the first stage room after changing into a light clothing and was given a

prepared comfortable bed, her items for delivery were inspected and it was neatly packed

with everything needed for delivery and were available and the midwife on duty was

informed for assistance and supervision.

28
All procedures were explained to her to gain her cooperation and encouraged her to ask

questions. Vital signs checked and recorded as;

Temperature 36.8oC

Pulse 80bpm

Respiration 22cpm

Blood pressure 120/70 mmHg

I provided privacy and her midstream urine was tested for protein and acetone, both were

negative. I measured the amount of urine passed and it was 150mls and the colour was

amber. I discarded used items, washed my hands and recorded findings. Client was sent to

the examination room to be examined.

Physical Examination

I sorted permission from her to examine her from head to toe. The procedure was

explained to her and she was asked to empty her bladder. I assisted her to undress and

wear a gown. She was assisted to lie on the couch and asked her to lie on the left side to

prevent inferior vena cava occlusion, privacy was fully ensured by screening, closing of

windows and reassured her of confidentiality. I washed my hands with soap and under

running water and dried with a clean neat hand towel, a tray was set and hands were

properly washed and cleaned for the second time, she was assisted to assume a dorsal

position, and then she was examined from head to toe .

On inspection, the hair was examined for perdiculosis and dandruff but none was seen,

hair was nicely styled, there was no cholasama found on the face, her eyes were white and

clear from discharge and conjunctiva was pink. The lips were soft and moist, her mouth

was cleaned and smells good, she had a white teeth and a clean tongue, her ears were

patent and free from discharges, and her neck was of a normal size.

29
On examination of the upper limbs, they were of equal sizes and length. I inspected the

nails they were well trimmed and her palms were pink in colour with palmar creases. I

gently squeezed the tip of her fingers for capillary refill and was present.

On breast examination, the breasts were normally situated on the chest with the left breast

a little bigger than the right one. The skin was healthy with dark pigment areola and

Montgomery’s tubercular. I palpated the left breast first after she was asked to put the

right hand under her head and no abnormalities were seen. I gently squeezed the nipple

and colostrum was seen, I swabbed it with cotton wool swab and discarded. The same

procedure was carried out for the right breast and no abnormalities were detected. I taught

her how to perform self-breast examination at home after menstruation and after delivery.

On abdominal inspection, I explained to her that I was going to examine her abdomen. I

prepared her for abdominal examination by informing her what will be done. She had

already emptied her bladder, so I made her comfortable on the couch assuming dorsal

position with her hands resting by her side. I asked her permission and exposed her

abdomen. I draped her down part from the symphysis pubis to the legs exposing her

abdomen and I stood by her right side.

On inspection, the size of the abdomen corresponded with the gestational age and the

shape was globular. There were no striaegravidarum but lineanigra was present withvisible

fetal movement. The skin was elastic and healthy with no scars. I palpated the abdomen

for tenderness, masses, enlarged spleen and liver but none was detected.

On measurement of the symphysiofundal height, I placed my ulnar border of my palm on

either side of the fundus and located the upper border of the symphysis pubis and extend

the tape measure along the middle of the abdomen to the fundus and it measured 37cm

with the gestational age of 38weeks plus 4days.

30
On fundal palpation, I curved my fingers on the top of the fundus to palpate and what was

occupying the upper pole of the uterus was buttocks as a soft irregular mass was felt and

lie was longitudinal.

On lateral palpation, I placed my palm of both hands on each side of the uterus midway

between symphysis pubis and the fundus. I then stabilized the uterus with one hand and

palpated the entire area from the abdominal midline to the lateral side from the symphysis

pubis to the fundus in a rotary manner. I changed hand and repeated palpation for the other

half of the abdomen. The fetal back was located at the left side of the abdomen as a

smooth curve was felt and the limbs were palpated at the right side of the abdomen as

movement was felt.

On pelvic palpation, I turned and faced her feet, I asked her to bend her knees slightly. I

helped her to relax by guiding her to breathe out slowly, I then placed the palm of my

hands side of the uterus with my palm just below the level of the umbilicus and my fingers

were directed towards the symphysis pubis with thumbs almost meeting. A hard rounded

mass was felt indicating the head was presenting (cephalic presentation) and the position

was left occipito anterior (LOA).

I then palpated to know the descent of the head by locating the anterior shoulder which

was 2.5cm from the lineanigra where the limbs were located below the umbilicus. I then

kept my two fingers of my left hand over the anterior shoulder and placed my right ulna

just above the symphysis pubis and spread towards the location of the anterior shoulder

which accommodated five fingers therefore indicating a descent of 5/5 th above the pelvic

brim.

On auscultation, the fetal stethoscope was warmed by rubbing it in my palm before

placing it on the mother’s abdomen of the left side where the back was located. I then

placed my ears against the fetoscope and while I was listening to the fetal heart rate, I

placed my two fingers on her radial artery just below her thumb to feel for the maternal

pulse rate and compare with the fetal heart beat. The fetal heart sound was counted for one

31
full minute and it was 138 beat per minute(bpm) with regular rhythm, full and bouncing

volume.

On vulva inspection, I washed my hands with soap under running water and dried them

after I have helped her to lie on her side and sought her permission to inspect her vulva. I

helped her into a dorsal position and assisted her to bend her knees. I draped her for

minimal exposure. I put on examination gloves an inspected the labia majora and the labia

minora, the perineum for presence of sore, lesion, wart, varicosity, pubis lice, reddening,

or any abnormal discharge were inspected but it was a clean and neatly shaved vulva. I

told her to lie on her side as I removed my gloves, I washed my hands with soap under

running water.

I assisted her to lie on her side for me to palpate her back. I run my two fingers gently

through the spine for pains and scoliosis but none was detected. The spine was of normal

curvature.

I assisted her to lie on her back again for examination of the lower extremities and on

examination they were of equal size and length. The toe nails were pink in color and well-

trimmed with no edema at the feet. I helped her out of the couch and assisted her to change

from the hospital gown to her own dress and offered her a seat. I cleaned up the

examination couch and washed my hands again with soap under running water and dried

with a clean towel. All findings were communicated to her and recorded in her hospital

maternal record book.

Vagina examination

A tray was set and vaginal examination was done. Hand washing was done after which I

put on my sterile pair of gloves and conducted the vaginal examination. I inspected the

vulva and no abnormalities were detected. I then swabbed the vulva with cotton wool

swab and a weak antiseptic solution (savlon). I gently inserted my middle finger into the

vagina and pressed it down and then added the index finger. The vagina was moist and

warm and the walls were distensible. The cervix was central, soft and thin, fully effaced

32
and the presenting part was well applied to the cervix, the membranes were intact. The

cervical dilatation was 5cm as at 11:15am. Pubic arch accommodated the two examining

fingers comfortably.

Vaginal fluid was clear and odorless. I tidied her vulva and applied clean perineal pad and

then thanked her. I washed hands and findings were communicated to her and she was

admitted and made comfortable on a well laid bed. Findings were recorded and plotted on

a partograph (refer appendix III).

Timing of Uterine Contractions

I sat on a chair near her bed, exposed her abdomen, placed my warmed palm on the fundus

and checked the time and started the procedure. I checked the number of action in 10

minutes and duration of each in seconds. I maintained my hand on the fundus and started

counting when the fundus harden and ended when the fundus softened till 10 minutes. I

had 3 contractions in 10 minutes lasting 20 -40 seconds. I wrote her name into the

Admission and Discharge Book and daily ward state and recorded all findings on the

partograph.

Preparation for Birth

After assessment, I was to be assisted by both skilled and unskilled personals in the care of

the mother and baby in case of emergency. The delivery room was clean, windows were

closed to keep the room warm and well- lightened. Proper hand washing was done to

prevent contaminating the area prepared. A dry flat and safe surface was prepared for

resuscitation of the baby. I also set a sterile tray, two sterile cot sheet, a sterile cord clamp,

a sterile artery forceps, two pairs of sterile penguin suction device, cord cutting scissors

solely for cord cutting and a receiver, a sterile episiotomy set (containing episiotomy

scissors, needle holder, and plain dissecting forceps). I covered the items with a sterile

33
drape. I then pick the baby’s cap, perianal pad and stethoscope and placed at the bottom

shelf of the trolley. I added syringes, sutures and needed drugs.

Fetal heart rate, uterine contractions and maternal pulse were checked every 30minutes,

her temperature and urine passed every 2 hours and vaginal examination with head

descent, moulding, blood pressure and membranes were checked every 4 hours and plotted

on the partograph accurately, refer appendix III.

Client complains during labour.

At 11:30 am, Client complained of feeling anxious so she was reassured to allay fear and

anxiety. All procedures were explained to her and all findings were communicated and

discussed with her. She was also educated on the various stages of labour and what she

was expected to do at each stage. I also introduced her to other clients in the ward who had

delivered safely. She was oriented to the labour room to relieve anxiety and tension. At

12:00pm client verbalized that she is relieved of the anxiousness.

She was encouraged to empty her bladder frequently whenever the need aroused to

enhance the descent of fetal head. She was also advised to adopt the left lateral position to

aid in placental perfusion to the fetus. I also educated her on the positions for delivery and

she selected lithotomy as her choice. I communicated and updated her on the process of

labour like delivering her baby onto her abdomen during second stage of labour and also

progress of labour was communicated to her by showing her the dilatation board.

At 2:15 pm, client complained of severe lower abdominal pain and waist pain, for the

severe lower abdominal pain, I gave her emotional support and reassured client that she to

do deep breathing exercise whenever there is contraction to help minimize the pain and

told her she will be relieve of the pain after labour. I also encouraged her to adopt a

comfortable position. will be comfortable after delivery and physiology was also

explained to her that it was due to the strong uterine contractions and she was encouraged

34
to cope with it. She was reminded I also encouraged her to empty her bladder frequently to

aid in descent of the fetal head. At 2:45 client was able to cope lower abdominal pain.

With the waist pain, I reassured client that she will be comfortable after delivery and

physiology was of the waist pain was explained to her that it was due to pressure on the

sacroiliac joint by the fetal head. I encouraged and assisted her to adopt a comfortable

position to relieve pain in the waist. I also engaged her in diversional therapy in the form

of conversation for the relieve of pains and gave her a sacral massage with the partner to

help relieve pain

At 3:00pm, she complained of backache. I reassured client that she will be comfortable

after delivery. The physiology was explained to that it due to due the pressure from the

fetus head applied to the mother’s sacrum. I massaged her sacral area to help relieve the

pain and she took a warm bath in order to help relieve the strains on the pelvis. I

encouraged her to continuously change position to help relieve the pain. I encouraged her

to practice deep breathing exercise to help relieve the pain. At 3:15pm client was able to

cope with the waist pain.

At 4:05pm she complained of fatigue. I reassured client to make her calm. I explained to

client that the fatigue was due to the stress of labour. Client was provided with nourishing

diet to replenish lost energy and encouraged to frequently empty her bladder to aid descent

of the fetal head into the pelvis brim and she will be fine after labour, she was provided

with a bed pan. At 4:10pm client verbalized that she has regain energy to be able to push.

Interpretations of partograph

At 11:15am vaginal examination was done and cervical dilatation was 5cm with no

moulding meaning the two parietal bones are touching each other but not overlapping,

membranes were intact. On pelvic palpation, presentation was cephalic and descent was

35
4/5thabove pelvic brim meaning 1/5th of the fetal head is below the pelvic brim and

stationing was -2 meaning the fetal head was above the ischial spines. On auscultation the

fetal heart beat rate was 138 beat per minutes with good volume and regular rhythm, pulse

was 80beat per minute. Uterine contraction was 3 in 10 minutes lasting between 20 and 40

seconds. Temperature was 36.8 degreeCelsius(0C), Blood Pressure was 120/70mellimeter

per mercury(mmhg). Urine passed and was 150mls and tested negative for both protein

and glucose.

At 11:45am uterine contractions were 3 in 10 minutes lasting between 20 and 40 seconds,

maternal pulse was 72 beat per minute(bpm), fetal heart rate was 132 beat per

minute(bpm)

12:15pm, uterine contractions were 3 in 10 minutes lasting between 20 and 40seconds,

maternal pulse was 72 beat per minute (bpm). Fetal heart rate was 134 beat per minute

(bpm).

From 12:45pm uterine contraction was 3 in 10 minutes lasting 20 and 40seconds, fetal

heart rate was 142 beat per minute (bpm) and maternal pulse was 80 beat per minute

(bpm)

1:15pm, uterine contraction was 3 in 10 minutes lasting between 20 and 40 seconds, fetal

heart rate was 138 beat per minute(bpm) 78 beat per minute(bpm) for maternal pulse,

Temperature was 36.80C, Urine passed and was 100mls and it tested negative for both

protein and glucose.

At 1:45pm, uterine contractions were 4 in 10 minutes lasting between 20 and 40seconds,

fetal heart rate was 132 beat per minute(bpm), maternal pulse was 73 beat per

minute(bpm).

From 2:15pm uterine contractions were 4 in 10 minutes lasting 42seconds, fetal heart rate

was 138 beat per minute and maternal pulse was 76 beat per minute.

36
2:45pm, uterine contractions were 4 in 10 minutes lasting between 44seconds. fetal heart

rate was 142beat per minutes(bpm)and maternal pulse was 78 beat per minutes(bpm)

At 3:15pm there was spontaneous rupture of membranes, vaginal examination was

conducted to rule out cord prolapse and none was detected. Cervical dilatation was 9cm

dilated with descent of 1/5th above the pelvic brim and one plus (+) moulding meaning the

two parietal bones are touching each other but not overlapping and station of two pluses

+2 meaning the presenting part has entered the pelvis two finger breath below the ischial

spine. Fetal heart rate was 130 beat per minute and maternal pulse was 72 beat per minute.

Uterine contractions were 5 in 10 minutes lasting for 48 seconds. Blood Pressure was

100/60 millimeter per mercury, Temperature was 36.20C with a urine of 50mls. Urine

specimen was collected for acetone and protein analysis of which protein was negative and

glucose was negative.

At 3:45pm uterine contractions were 5 in 10 minutes lasting between 50 seconds, fetal

heart rate was 136 beat per minute and maternal pulse was 80 beat per minute.

At 4:15pm, she screamed and shouted of having the strong urge to bear down and to

move her bowel. Uterine contractions were 5 in 10 minutes lasting between 52 seconds

Vaginal examination was done and the cervix was fully dilated at 10cm, descent of the

head was 0/5thabove the pelvic brim with moulding of two pluses (++) meaning the two

parietal bones are overlapping but can be separable when touched with station of three

pluses +3 meaning the fetal head is within the birth canal. Liquor was clear fetal heart rate

was 130 beat per minute and maternal pulse was 78 beat per minute. The anus was gaped,

perineum looked thin and shiny with fetal head almost visible. Findings were

communicated to client, and she was transferred into the delivery room 4:15pm.

37
Management of Second Stage Of Labour

I explained what to expect during the process to her and assured her of emotional support.

I assisted her onto the couch to lie on her left side and encouraged her to continue with

deep breathing exercise .I asked my assistant to be with her and provide emotional

support. Hand washing was done and I put on protective clothing. I washed my hands

again and dried it with sterile towel. The midwife on duty was there to supervise and assist

the delivery. She was asked to assume lithotomy position and I reassured her that her baby

will come out soon and what will be expected of her at that stage. I wore sterile gloves,

swabbed the vulva with cotton wool soaked with savlon (1 in 40) and performed vaginal

examination to confirm full dilatation of the cervical os and the cervix was 10cm dilated. I

then draped her abdomen, thigh and buttocks with a sterile towel and covered her anus

with a pad to absorb faeces or fluids. The assistant was instructed to check fetal heart rate

and maternal pulse after each contraction.

I placed my lightly on the head as it advances to maintain good flexion and to prevent

rapid crowning and to allow the bi-parietal diameter (9.5cm) and sub-occipitobregmatic

diameter (9.5cm) of the fetal head to distend the perineum to prevent perineal tears. As

soon as the head was visible, I told the mother to stop pushing and breathe through her

mouth. I delivered the head by extension where the sinciput, face and mentum (chin)

swept the perineum. Baby’s face was wiped with sterile gauze and the eyes were clean

with sterile cotton wool swab from inner canthus outward immediately the head was

delivered. I felt for cord around the neck but there was none. I waited for restitution and

external rotation of the head confirming internal rotation of the shoulder. The anterior

shoulder was delivered by downward traction and the posterior shoulder by upward

traction and the rest of the body delivered by lateral flexion onto the mother’s abdomen

following the curve of carus at 4:30pm, a live female infant was delivered on 19 th October,

38
2021. Baby cried immediately after delivery and I congratulated the mother for her

cooperation.

Immediate Care of the Baby at Birth

After the head was born, baby’s face was wipe with sterile gauze and eyes were cleaned

with dry sterile cotton wool swab from the inner cantus outwards to prevent infection. I

suctioned the baby’s mouth and nose with mucus extractor (bulb syringe), first the mouth

and then the nose. I felt for cord around neck and there was no cord so I waited for

restitution and delivered the rest of the body onto the mother’s abdomen skin to skin

contact following the curve of carus. At 4:30 pm a live female baby was born. Baby was

shown to mother to identify the sex. I assessed the APGAR score for the first minute and it

was 8/10. I dried the baby with clean towel to stimulate baby to breath and cry, soiled

linen were changed and baby was kept in skin to skin contact with the mother during the

first hour after delivery to prevent hypothermia since the warm from the mother is the best

warm for the baby and also promote breastfeeding. Hair cap and socks applied to keep

baby warm. I assessed for fifth minute APGAR score and it was 9/10. I removed my first

glove and first clamped with a cord clamp and an artery forceps and cut the cord with

umbilical cord scissors after pulsating has ceased preferably after 1-3 minutes, sterile

gauze was used to prevent splash of blood and cut in between to separate the baby from

the mother.

Active Management of third Stage Of Labour

This stage deals with expulsion of the placenta and its membranes and also controlling of

haemorrhage. The procedure was explained to Madam D.N her abdomen was palpated to

rule out any undiagnosed twin. I asked my assistant to give an injection oxytocin 10

international unit intramuscularly on the thigh within one minute at 4:31pm to aid

contraction and control bleeding. A sterile receiver was placed near the perineum to

39
receive the placenta, membranes and blood clot and I placed the clamped end of the cord

into the receiver. The bladder was not full, so with the next contraction felt, I held unto the

clamp on the cord and the left hand placed above her pubic bone with my palm facing the

abdomen supporting back the uterus to prevent inversion of the uterus. With gentle

downward and outward pull, the placenta was delivered by controlled cord traction and

placenta was received into my cupped gloved hands. A gentle twisting was done to deliver

the membranes and all were completely expelled at 4:35pm. The placenta was examined

immediately for missing lobes and membranes and all were intact and I then placed the

placenta in a receiver for thorough examination. The uterus was massaged to contract and

to expel blood clots.

Examination of Placenta

The placenta was examined immediately after delivery for completeness. On examination

of the maternal surface, the lobes were fitted together and separated by sulci. The surface

was roughly dark red in colour. The fetal surface was smooth, bluish-grey in colour with a

shiny surface and blood vessels radiating through it. I held the cord with one hand

allowing the two (2) membranes to hang freely and they were intact. I identified the hole

through which the baby was delivered and spread out my other hand inside the membranes

to aid the inspection. The amnion was peeled up to the umbilical cord and the chorion was

inspected but no abnormality was detected. The cord was centrally situated at the fetal

surface, blood vessels were radiating to the circumference of the placenta and there were

two arteries and one vein in the cord. The fetal surface was covered with amnion. I

weighed the placenta and it was 0.5kg. I measured estimated blood loss and it was 150mls.

I enquired from the mother how to dispose off the placenta and she said it should be

disposed according to hospital’s protocol.

40
Examination of the genital tract

I explained the procedure to be performed on the genital tract to client. I massaged the

uterus for it to contract and asked my assistant to direct a light source on the perineum. I

cleaned the perineum with a weak antiseptic solution, examined the vulva for tears,

lacerations and haematoma. I wrapped a gauze swab around my finger and gently parted

the vaginal walls, I inspected the anterior, posterior and lateral walls. There were no tears

or lacerations, I cleaned the perineum and applied a fresh pad. All her soiled clothes were

changed. She was dressed into new ones and was made comfortable in bed together with

the baby. She was then congratulated. All instrument and equipment used for the delivery

were decontaminated in 0.5% chlorine solution for 10 minutes, washed them with utility

gloves, sterilized and stored for next use. The delivery room and couch were

decontaminated, cleaned and reset for next delivery. I completed the partograph and all the

findings were recorded and documented in the delivery book.

Management Of Fourth Stage Of Labour

Fourth stage is a period of six hours observation of the mother and baby after placental

delivery to rule out any abnormality.

Client was sent to the lying-in ward after one hour of delivery at 5:30 pm on 19 th October

2021, which was one hour after the delivery of the placenta. Vital signs were checked

every 15minutes for the first hour, 30minutes for the second two hours, then hourly for 3

hours and four hourly till discharge and recorded on post-delivery observational form as in

appendix (V). I enquire about the lower abdominal pains, waist pains and backache and

she verbalized that she is relieved of it.

41
Care of the Mother

The uterus was palpated and massaged frequently just like the vital signs to be sure blood

clots are expelled and it remains well contracted at all times. Symphysio-fundal height was

measured and it was 15cm. The perineal pad was observed and lochia was moderate rubra.

Client was advised to urinate frequently to prevent post-partum hemorrhage and aid

uterine contraction. She was encouraged to change perineal pad frequently and wash hands

before and after applying the pad to prevent infection. Client was served with food (millet

porridge) after which she was assisted to breastfeed baby. Mother was encouraged to take

in more fluid. Mother and baby made comfortable on the same bed to promote bonding

and also provide baby with warmth. All procedures carried out including vital signs of

both mother and baby were recorded on the observational chart as in appendix (V)

Post Delivery Vital signs

Temperature 36.2oC

Pulse rate 82 bpm

Respiration 24cpm

Blood pressure 110/60mmHg

Post Delivery Medications Served

Tablet Paracetamol 1g tds for 5 days

Capsule Amoxicillin 500mg tds for 7 days

Tablet Fesolate 200mg tds for 30 days

Tablet Folic Acid 5mg daily for 30 days

Tablet Multivitamin 200mg tds for 30 days

Tablet Flagyl 400mg tds for 7 days

42
Essential Care of the Baby

Skin to skin contact was maintained for one hour to provide warmth to baby and help to

promote bonding as well. Baby’s head was covered to prevent heat loss. During skin to

skin I monitored the breathing of the baby every 15minutes by looking at the upward and

downward movement of the chest, I assisted the mother to initiate breastfeeding within 30

minutes after delivery to aid in the involution of the uterus. Baby’s temperature was

assessed every 15 minutes with the dorsum of my palm at the baby’s soles of the feet and

forehead; however at 60th minute baby’s temperature was measured with a thermometer

and recorded as 36.4 degree Celsius. Baby’s temperature was estimated to be normal and

breathing was also quiet and regular. Baby’s weight was checked and it was 3.0kg. I

checked the expiry date and Chloramphenicol eye drop 0.5 was instilled on baby's eyes to

prevent eye infection. Cord was inspected for bleeding and the presence of two arteries

and one vain and allow to dry before dressing the baby to prevent wiping away the gel

causing reddish skin around the umbilical cord. I checked the expiry date and Injection of

vitamin k1one milligram was given intramuscularly mid anteriolateral thigh to prevent

baby from bleeding. The baby was examined from head to toe. Vital signs were checked

every 15minutes and recorded as

Temperature 36.4 oC -36.8 oC

Pulse 136bpm-14bpm

Respiration 38cpm-46cpm

Examination of the Baby

Finally, I examined the baby. On observation, baby’s skin colour was pink and was

covered with vernixcaseosa. Head was palpated, sutures and fontanels were normal. The

anterior fontanel admitted two fingers and the posterior fontanel also admitted a fingertip.

43
Hair was curly and black. The conjunctiva was pink and cantus of the eyes was in line

with the upper border of the ears. The pinna of the ear was normally positioned, patent and

well formed. The nose was medially positioned and patent. Suckling, swallowing and

rooting reflexes were established and mouth have intact palate.

On neck examination, the neck was normal, free to turn, flexed and extend. The arms were

equal in size and length. Five fingers with nails well developed, palmar creases and

grasping reflex were present. The chest was barrel shaped with respiration corresponding

to the chest movement, nipples were normally situated.

On abdominal inspection, the abdomen was round in shape with normal tone. Bowel

sound was present on auscultation. Baby was turned back and inspected for spinal bifida

and occult bifida but none was detected. The lower limbs were normal and flexible, five

toes with plantar creases in the foot. The vagina was patent and the urethra was patent and

centrally placed. The baby’s anus was patent and baby was able to pass urine twice and

meconium three times. Meconium was dark green in colour. The head circumference

was34cm, chest circumference was 32cm, and full length was 45cm. Baby was classified

as normal baby. All procedures carried out were record as follows

Condition of Baby after Delivery

Condition of baby Good

Sex of baby Female

Apgar score First minute 8/10 and fifth 9/10

Abnormalities None detected

Weight 3.0kg

Baby’s full length 45cm

Head circumference 34cm

Chest circumference 32cm

44
Meconium Passed

Urine Passed

SUMMARY OF LABOUR NOTES

Date and time of delivery 19thOctober at 4:30pm

Mode of delivery Spontaneous vaginal delivery (SVD)

Estimated blood loss 150mls

Time placenta was delivered 4:35pm

Condition of the mother Good

Condition of perineum Intact (no tears)

Condition of the Placenta and the Cord

Cord vessels Two arteries and one vein

Maternal surface Dark red in colour

Fetal surface Bluish grey

Placenta condition Healthy

Cord length 50centimeters

Placenta and membranes Intact

Cord insertion centrally situated

Placenta circumference 51centimeters

TABLE II: DURATION OF LABOUR

STAGES START END DURATION

First stage 11:15am 4:15pm 5hours

45
 Second stage 4:15am 4:30pm 35minutes

Third stage 4:30pm 4:35pm 5minutes

Total duration 11:15am 4:35pm 5hours: 20minutes

Apgar Score

First minute fifth minute

Appearance 2 2

Pulse 2 2

Grimace 1 1

Activity/muscle tone 1 2

Respiration 2 2

Total 8/10 9/10

Findings were communicated to mother and recorded.

46
 NURSING CARE PLAN DURING LABOUR

ACTUAL PROBLEMS IDENTIFIED DURING LABOUR

1. On 19th October, 2021 at 11:30am, client complained of feeling anxious.

2. On 19thOctober 2021 at 2:15pm, client complained of severe lower abdominal pain.

3. On 19th October 20201 at 2:15pm, client complained of waist pain.

4. On 19th October 2021 at 3:00pm, client complained of backache.

5. On 19th October 2021at 4:05pm, client complained of fatigue,

SHORT TERM OBJECTIVES

1. Client will be relieved of anxiety within 30 minutes.

2. Client’s severe lower abdominal pains will be relieved after delivery.

3. Client’s waist pain will be relieved after delivery.

4. Client will be relived of backache after delivery.

5. Client will be relieved of fatigue within one throughout

LONG TERM OBJECTIVES

To ensure client have normal delivery without any complication to both mother and baby.

47
48
 TABLE III: NURSING CARE PLAN DURING LABOUR

DATE NURSING NURSING NURSING ORDERS NURSING INTERVENTIONS DATE EVALUATION

AND DIAGNOIS OBJECTIVES AND
TIME TIME
19th/ Emotional Client will be 1. Reassure client. 1. Client was reassured to allay fear 19th/ Goal fully m
2. Encourage client her to express and anxiety.
11/2021 disturbances(Anxi relived of 10/2021 et as client
concerns and feelings.
At ety) related to anxiety within At verbalized
3. Communication progress of 2. Client was encouraged to express
11:45am. unknown 30 minutes as labour to client and family concern and feelings 12;00pm that she is
from time to time. 3. Progress of labour was
outcome of labour evidenced by relieve.
4. Spend time with the client communicated to client and
. client verbalizing
throughout labour to allay family from time to time
that she is anxiety. 4. Time was spent with client
5.Introduce client to all staff on throughout labour to alley
relieved
duty anxiety
6. Encourage client to ask 5. Client was introduced to the staff
questions and answer them in on duty
simple terms. 6. Client was encouraged to ask
questions.

DATE NURSING NURSING NURSING ORDERS NURSING INTERVENTIONS DATE EVALUATION

49
 AND DIAGNOIS OBJECTIVES AND
TIME TIME
19th/ Impaired body Client will be 1. Reassure Client that she will be 1. Client was reassured. 19th/ Goal fully met as

10/2021 comfort(lower able to cope with able to cope with pain. 2. Client was assisted to Adapt 10/2020 client was able

At 2;15pm abdominal pain)| lower abdominal 2. Assist Client to Adapt a suitable position to ensure At to cope lower

related to throughout suitable position to ensure comfort. 2:45pm abdominal pain.

increased labour as comfort. 3 .Diversional therapy was provided

intensity of evidenced by 3. Provide diversional therapy to client by engaging in a

uterine Client by engaging Client in a conversation.

contractions verbalizing the conversation.

ability to cope. 4. Perform sacral massage to 4. Client was educated to wear low

relieve pains. heeled shoes or slippers.

5. Encourage Client to relax 5. Client was encouraged to relax

between contractions. between contractions.

DATE NURSING NURSING NURSING ORDERS NURSING INTERVENTIONS DATE EVALUATION

50
 AND DIAGNOIS OBJECTIVES AND
TIME TIME
19/10/2021 Impaired body Client will be 1. Reassure client that the waist 1. client was reassured client that the 19/10/21 Goal fully met as
pain will be relieved after waist pain will be relieved after
comfort |(waist relieved of waist at evidenced as
At 2:15pm delivery. delivery
pain) related the pain after 6:00pm client verbalized
2. Explain to client the cause of 2. The cause of the waist pain was
pressure related delivery as that she is
the waist pain. explained to client the cause of
the pressure of evidence by the waist pain. relieved of waist
3. Massage the sacral region to
the fetal head client verbalizing pain after
relieve waist pain. 3. Sacral massage was given to
pressing on the that she is relieve waist pain. delivery.
4. Advise client to assume a
bladder. relieved of the comfortable position such as 4. Client was advised to assume a

waist pains left lateral position. comfortable position such as left

lateral position.
5. Provide diversional therapy by
engaging client in conversation 5. Diversional therapy was provided
to take her attention off pain. by engaging client in conversation
to take her attention off pain.

DATE NURSING NURSING NURSING ORDERS NURSING INTERVENTIONS DATE EVALUATION

AND AND

51
 TIME DIAGNOIS OBJECTIVES TIME
19th/ Impaired body Client will be 1. Reassure client that she will 1. Client was reassured that she will 19th/ Goal fully met as

10/2021 comfort| able to cope with able to cope with backache be able to cope with the backache. 10/2021 clients is able to

At 3:00pm (backache related backache 2. Perform sacral massage to At 3:15 cope with the

to painful uterine throughout reduce pain. 2. Sacral massage was performed to pm backache

contraction and labour as 3. stay with client and engage her reduce pain.

descent of head. evidenced by in conversation 3. Client was stayed with and

client verbalizing 4. Allow Client to assume a engaged conversation.

ability to cope comfortable position. 4 Client was allowed to assume a

with backache 5 Encourage Client to use aback comfortable position.

rest or prop herself with 5. Client was encouraged to relax

pillows when sitting or lying. between uterine contraction

DATE NURSING NURSING NURSING ORDERS NURSING INTERVENTIONS DATE EVALUATION

AND DIAGNOIS OBJECTIVES AND

52
 TIME TIME
19/10/2021 Impaired body Client will be 1.Reassure client that she will be 1. client was reassured client that 19/10/20 Goal fully met

at 4:05pm discomfort(fatigu relieved of relieved of anxiety after she will be relieved of anxiety 21 at evidence by as

e) related to anxiety within delivery after delivery. 4:10pm client verbalizing

painful regular one(1)hour as 2.Explain procedure to client 2. Procedure was explained to client. that she has

uterine evidence by regained energy

3. Client was communicated and
contractions client that she is to push.
discuss findings.
3. Communicate and discuss
relieved of
findings. 4. client was educated client on the
relaxed facial
various stages.
4.Educate client on the various
expression.
stages of labour 5.client was orientated client to the

ward and other client who have

5.Orientate client to the ward and
delivered safely
other client who have

delivered safely

53
 CHAPTER FOUR

MANAGEMENT OF PUERPERIUM

Puerperium starts immediately after birth of the placenta and membrane and continues for

six week (Marshall&Raynor 2020). This chapter consists of care rendered at the day of

delivery, continued through the first seven days at the clinic and home, nursing care plan,

a summary and conclusion of the study, pharmacology of drugs used, bibliography,

appendices and signatories.

Subsequent Care of the Mother

On 19th October, 2021 mother was still monitored in the lying-in after six hours at

10:30pm and will be discharged home after 24 hours. Client was encouraged to empty her

bladder frequently to aid in involution of the uterus and also prevent postpartum

hemorrhage. The perineal pad was inspected for bleeding and lochia was rubra (red) in

colour and she was encouraged to always wash hands before and after changing of pads

and whenever she’s about to breastfeed her baby. I served mother with rice and stew with

boiled egg.

Subsequent Care of the Baby

On 19th October, 2021 0f 10:30pm baby was monitored six hours of fourth stage. Baby

was assessed before classifying as a normal baby. Her breathing pattern was observed for

chest movement to rule out in drawing chest and fast breathing. Cord was examined to

rule out for bleeding but there was none. Baby was able to pass meconium three times

which was dark green in colour. Baby was then cleaned up and a new diaper was applied.

Baby was then classified as a normal baby with no complains. Baby suckled well during

breastfeeding and all other reflexes such as rooting reflex were also present.

54
Baby First Bath and Umbilical Cord Dressing

On 19thOctober, 2021 after six hours of rest at 10:35pm. A tray was set for baby’s first

bath and cord dressing. The bath was done in the evening in the presence of the mother so

she can observe the procedure. The procedure was explained to the client and items for

baby bath were made ready for use on a trolley. I then mixed both warm and cold water

and tested for the temperature using my elbow. I then put on my apron, washed my hands

with soap under running water and dried my hands with a clean dry towel. I then put on

my gloves and took baby from mother. The baby was placed on a protected flat surface

and undressed and wrapped baby in a big towel. Baby’s eyes were cleaned gently with

sterile cotton wool swab soaked with sterile water from the inner canthus to the outer

canthus.

The baby’s face was then cleaned with a wet clean towel and dried. The head was held in

the palm and ears plugged with the middle finger and the thumb, the nape of the neck was

supported with the hands. With mild soap and sponge soak in water, the head, neck and

folds behind the ears were washed thoroughly, rinsed and dried. The body was then bathed

thoroughly, paying much attention to the skin folds, from neck to toes, taking care of the

places where vernixcaseosa had been hidden especially the axillae, groin, in between

fingers, palm and foot. Baby passed meconium thrice and urinated twice during bathing.

The back was turned with one arm supporting the chest and the back was washed to the

feet, she was held and supported firmly and immersed into the warm water with the head

supported above the water and rinsed thoroughly. She was placed on the protected flat

surface and dried with a towel and was wrapped nicely. The procedure was carried out

aseptically by dressing the umbilical cord with chlorhexidine gel and sterile cotton wool

swab. I observed cord clamp for looseness but it was firm. I dipped swabs into the

chlorhexidine gel. I held the stem of the cord with one swab and cleaned around the base

55
of the cord. The stem of the cord was swabbed, pressed to check if it was bleeding. The

cord was also swabbed and the cord was left to dry and uncovered to heal by dry

gangrene. The baby was dressed and wrapped nicely and neatly gave her to her mother.

The work area was tidied and waste materials disposed off according to infection

prevention precaution. Baby was given to mother to breastfeed. Plastic apron and gloves

removed and hands washed and dried. Findings were communicated to the mother and

documented. I therefore informed mother to top and tail baby till the cord falls off and I

thanked her for her cooperation.

First Day of Puerperium and preparation of client discharge

On the 20th October, 2021, at 8:00am, I served mother with warm water for bathing after

she had emptied her bowel and bladder. My client’s husband brought her rice and soup.

Care of mother

The morning medication of the post-delivery drug was served. I talked to them about the

impending discharge. Examination of both mother and baby were carried out to ascertain

their health before discharge. Observations made were:

Vital signs checked and recorded were as follows:

Temperature 36.4 oC

Pulse 78bpm

Respiration 21cpm

Blood pressure 110/70mmHg

I washed my hands with soap under running water, dried them and examined the mother

from head to toe and no abnormalities were detected. The breasts were heavy with

colostrum flow. On abdominal examination, the uterus was well contracted and firm on

palpation. On vulva examination, lochia was red in colour (rubra) with moderate flow.

56
At 9:00am Madam D.N. complained of lower abdominal pain (After pain). I reassured her.

I explained the cause of the after pain to her. She was also encouraged to continue

breastfeeding the baby on demand, have enough rest and sleep, empty bladder frequently

to aid involution of the uterus and I administered Tab paracetamol 1g three times a day for

5 days was prescribed to relieved the after pain. I encouraged client on early

ambulation .Client passed stool once and urine three times.

Care of the Baby

I explained procedure and sought permission from mother to examine baby from head to

toe. General appearance of baby was good with pink skin. Conjunctiva was pink and clear.

The nose and ears were patent and reflexes were present. The neck was flexible, breast and

nipples were normal. Cord was well secured with clamp. The upper and lower limbs were

normal as well as the back. The genital was patent because baby has pass urine three times

and anus was patent and baby has passed meconium three. I dressed cord with

chlorhexidine, wrapped baby in a warm cot sheet and handed him over to mother to

breastfeed. Findings were communicated to mother. I tidied up the examination table with

0.5% chlorine solution. Baby’s vital signs and observations checked and recorded as

follows;

Temperature 36.4 oC

Apex heart beat 140 bpm

Respiration 46cpm

Weight 3.0kg

Skin colour Pink all over

Baby was first immunized by a community health nurse injection Bacillus Calmette

Guerin (BCG) 0.05ml intradermal on the baby’s right arm for the prevention of

tuberculosis and two drops of oral polio O vaccine was also given to prevent poliomyelitis.

57
Mother was advised not apply anything on the injection site to prevent infection. Findings

were communicated to the mother and mother and baby were reviewed by the doctor on

duty. Their conditions were found to be satisfactory.

At 3:30pm I again went to the ward to check up on Madam D.N and the baby. She was

breastfeeding her baby and baby was properly attached to breast and was suckling well. I

asked about their health and she said everyone was fine but complained of loss of appetite.

Client was encourage to eat at least 3times a day, client was encouraged to eat a bit

frequent interval, serve client favorite in different varieties, serve client food in an

attractive manner, I encouraged her to take her iron and folic acid supplement

appropriately and I sought her permission to examine the baby in the presence of her

mother. Client and baby`s general condition was satisfactory. On abdominal examination,

the uterus was well contracted and firm on palpation, on fundal palpation, fundal height

was 16cm refer to appendix VA (Report on mother). She was informed of her discharge.

Her mother and husband visited her at the hospital where they were also informed about

client and baby’s discharged.

Temperature 36.6 oC

Pulse 80bpm

Respiration 20cpm

Blood pressure 100/60mmhg

Preparationof Client and Relatives for Discharge

Madam D.N. and her husband were informed of her discharge on 20th October, 2021.

Before the discharge, client and husband were educated on the need for follow up visits

for effective care of both mother and baby. Client had NHIS card so her additional bills

were submitted to her husband for early settlement and I ensured that her discharged

papers were signed by the doctor.

58
Madam D.N’s husband submitted the receipts for the settled bills and I entered it into the

admission and discharge book and also in the daily ward state and handed over the receipt

to him. Her drugs were collected from the pharmacy by her husband and I educated them

on the indication, dosage, side effects and compliance of drugs. Client was educated to

perform kegel exercise at home to improve uterine and pelvic floor muscle tone to aid in

drainage of the lochia.

Client was educated on good personal hygiene, that is change of perineal pad frequently to

prevent ascending infection and also to wash, dry and iron soiled linen regularly. She was

advised to take in more fluids, fruits and vegetables to prevent constipation. Mother was

educated not to apply herbs or hot water on the fontanelles and that the anterior will take at

least one and half years to close whilst the posterior takes six weeks.

Client was helped to pack her items and I stressed on the importance of reviews to the

hospital and reminded them on the dates. I told her to come for the first postnatal visit to

the hospital on the third day which was 22nd October, 2021 on Friday for assessment and

report any abnormality noticed. I finally encouraged her to register her baby with the birth

and death registry and promised to visit them every morning and evening for the first three

days and then once daily from the fourth to the seventh day and hand them over to a

community health nurse to continue with the care. I ensured that bed linen was removed

and decontaminated according to the hospital protocol. Client was discharged on 20 th

October, 2021 at 4:30pm.

Second To Third Day Postnatal Home Visit

On 21st October, 2021 Thursday, was my client’s second day of puerperium and I visited

and the family in the morning and in the evening at 8:00 am 5:00pm respectively to

enquire about their health. I was warmly welcomed on both occasions and was offered a

seat. Consent was sorted to examine both mother and baby from head to toe. I enquired

59
about the after pain at 9:00am and she verbalized that she has been relieved of the after

pain and I observed her with a cheerful facial expression.

Head to toe examination was done. Client’s abdomen was soft; uterus was contracted..

Lochia rubra (red) and flow was moderate. Lactation was established, colostrum flow and

baby suckled well. Client has passed stool twice and urine two times. She was encouraged

to eat nourishing diet and also have enough rest and sleep. She complained of insomnia at

9:30am after the examination because baby cried a lot. I reassured her to allay fear and

anxiety and advised her to breastfeed baby on demand, proper attachment of baby to

breast, making sure baby suck one breast completely before being put on the other breast,

changing soiled clothing or diaper, I advised client to sleep when baby is sleeping during

the day and encouraged the husband to assist and cuddle baby when crying.

During my evening visit which was 4:30 pm, I visited client for the second time and I

asked about their wellbeing and she said they were doing well. I enquired about the loss of

appetite and she verbalized that her appetite has improved and she can eat about 60% of

meal served. I asked if client had complains but there was none. Client said she has passed

stool once and urine one. So I asked for permission to carry out physical examination and

it was granted. The fundal height was 15cm refer to appendix VA (Report on

mother).After the examination I asked for permission and bid them goodbye and left home

On 22nd October, 2021 at 9:00 am, my client came to the hospital which was her third day

of Puerperium as scheduled.

At 9:30am I enquired about the insomnia and she said she was able to sleep for 6 hours

during the night as she verbalized and the midwife observed with a relaxed facial

expression. Procedure for physical examination was explained to her and the baby and

mother was examined from head to toe. I asked if she had any complains but there was

none. She has passed stool once and urine twice.

60
During my evening visit at 5:00 pm, she complained of baby’s weight loss after the

physical examination, on measurement of the fundal height was 14cm and all findings

were communicated to her and recorded in her maternal record book at the postnatal

record. and she was reassured to allay all anxiousness. The physiologybehind baby’s

weight loss was explained to her that it was normal for the newborn to lose about 10% of

their weight as they eliminate amniotic fluid and meconium in the first three (3) days and

regains her normal weight from fifth to sixth day. Mother was encouraged to breastfeed

baby at least 12-16 times within the day and night to help baby regain her weight. Mother

was encouraged to breastfeed baby on demand to help in regaining of baby’s weight. She

was also educated on the complete emptying of one breast before switching to the other

breast to help weight gain in the baby Client has passed stools twice and urine once.

Mother’s vital signs from first to third day postnatal home visit were checked and

recorded as follows;

Date 20/10/2021 21/10/2021 22/10/2021

Vital signs Morning Evening Morning Evening Morning Evening

Temperature 36.4oC 36.6oC 36.5 36.4oC 36.2 36.3oC

Pulse 80bpm 79bpm 85bpm 80bpm 78bpm 81bpm

Respiration 20cpm 21cpm 20cpm 23cpm 22cpm 22cpm

Blood pressure 111/60 100/60 120/70 100/70 110/60 110/70mmHg

Care of the Baby

On 21st October, 2021, I visited client and family at 5:00 pm and was baby’s second day of

puerperium; head to toe examination was done on baby with the permission from the

mother and no abnormality seen. Baby’s breathing pattern was normal. The cord was

getting dry and healthy and client verbalized that baby passed urine four times and passed

61
within the day refer to appendix VB (Report on baby) and moved her bowel four times

which was dark green in colour refer to appendix VB (Report on baby).

On 22nd October, 2021 was baby’s third day of puerperium. I examined baby from head to

toe on a warm flat surface and everything was in good condition. The baby was top and

tailed and the cord dressed with chlorhexidine. The baby had also passed urine three times

within the day refer to appendix VB (Report on baby) and moved her bowel two times a

within the day which was yellowish brown in colour refer to appendix VB (Report on

baby) which was said by the mother. The cord was exposed to heal by dry gangrene. The

baby was dressed, wrapped with cot sheet, washed hands afterward and gave baby to

mother to breastfeed. I supervised mother to breastfeed baby and on observation,

swallowing reflex was good

Baby’s vital signs from the first to third day of postnatal home visit were checked and

recorded as follows;

Date 20/10/2021 21/10/2021 22/10/2021

Vital signs Evening Morning Evening Evening

Temperature 36.8oC 36.9oC 36.8oC 37.0oC

Respiration 48cpm 40cpm 44cpm 50cpm

Apex heartbeat 134bpm 132bpm 134bpm 144bpm

Fourth To Seventh Day Postnatal Home Visits

On 23rd October, 2021was my client’s fourth day of puerperium. I went to client’s home at

4:00 pm.

Care of mother

I was warmly welcomed and I asked about their well-being and she said they doing well. I

asked for permission to be able to perform physical examination and the permission was

granted so she was examined from head to toe. The fundal height was 13cm on

measurement refer to appendix VA (Report on mother) and the lochia was pink (serosa).

After the examination, client complained of headache 4:00 pm and was reassured to allay

62
fear and anxiety. The physiology of the headache was explained to her and she was

encouraged to enough rest and sleep. Client’s support person was encouraged to help in

the house chores and she was advised to take prescribed analgesics.

On 24th October 2021 was her fifth day of puerperium, I went to the house at 4:00 pm. I

enquired about the head ache and she verbalized that she been relieved of the headache

and had a relaxed facial expression and their well-being and she said they were doing well

at.

She was examined from head to toe and no abnormality was seen. She looked cheerful and

healthy. The fundal height was 12cm and lochia was serosa(pink). I enquired about the

backache and she verbalized that the backache has subsided and had relaxed facial

expression. All findings were communicated to her and recorded in appendix VA (Report

on mother)

On 25th October 2021 was my client’s six day of puerperium and I went there at 5:00pm.

The mother and baby were in a good condition. The fundal height was 11cm and lochia

was pink (serosa)

I examined her from head to toe and everything was good. I enquire about the baby’s

weight loss and client verbalized that the baby has gained weight and the midwife

observed an increase in baby’s weight. I asked her if she had any complains but there

wasn’t any complain. I reinforced that, eating adequate nutritious diet with lots of fruits,

fluids and roughages helps boost immunity and prevent constipation. Findings were

communicated to her and recorded in her maternal record book at the postnatal progress

record and I educated her on perineal hygiene, safe sex, and postnatal exercises to help

strengthen the pelvic floor muscles. I told her that, I will visit her on 26 th October 2021

with a community health nurse.

63
I encouraged her to continue to take good care of herself and the family and I bid them

good bye and left.

On the 26th October, 2021 I visited her at 4:00pm Tuesday. It was the seventh day of

Puerperium and also care was terminated on the same day in the evening so I went with a

community health nurse. We exchanged greetings and I enquired about their well-being

and everything was well with them. We were warmly welcomed and were offered a seat. I

then introduced the community health nurse to my client and family and made it known to

them the reason why I came with a community health nurse and that was she will be

taking over since that day was my last visit and also for the continuity of care. With my

client’s concern, I examined her from head to toe and everything was normal. I measured

the fundal height and it was 10cm and on inspection of client’s pad, lochia was serosa. She

had no complains

Mother’s vital signs from fourth to seventh day of puerperium were checked and recorded

as follows;

Date 23/10/2021 24/10/ 2021 25/12/ 2021 26/10/2021

Vital signs Evening Evening Evening Evening

Temperature 36.4oC 36.4oC 36.4oC 36.2oC

Pulse 80bpm 83bpm 84bpm 80bpm

Respiration 21cpm 24cpm 22cpm 23cpm

Blood pressure 120/70mmhg 115/60mmhg 100/60mmhg 110/70mmHg

Care of the baby

On 23rd October, 2021, was baby’s fourth day of Puerperium. At 4:30 pm, baby was

examined from head to toe on a flat warm surface. Head was normal, the sclera was white

and conjutiva was pink in colour and no abnormalities were seen. Baby passed two times

stool was observe and had changed in colour from dark-green to yellowish-green refer to

64
appendix VB (Report on baby) and she had passed urine which was four times within the

day refer to appendix VB (Report on baby). I topped and tailed baby and dressed the cord

with chlorhexidine and left to dry by gangrene.

On 24th October 2021 was baby’s fifth day of puerperium. At 4:30pm in the evening, a

head to toe examination was done on baby and no abnormalities were detected. According

to my client, baby had passed two stools and was yellow in colourrefer to appendix VB

(Report on baby). Urine was passed three times but was odourless refer to appendix VB

(Report on baby).I topped and tailed baby, dressed the cord with chlorhexidine and left it

to dry by gangrene.

On 25th, October 2021 was baby’s sixth of puerperium. At 5:30 pm, permission was

sought from the mother for a quick head to toe examination on baby and no abnormalities

were seen. Baby had passed three stools and colour was yellow refer to appendix VB

(Report on baby). Urine was passed four times and was odourless refer to appendix VB

(Report on baby). The cord had fallen off and the cord looked healthy and there was no

discharge.There was no abnormality detected during inspection so I dressed baby with cot

sheet and handed her over to the mother. Findings were communicated to mother and the

family.

On 26th October 2021 was baby’s seventh day of puerperium, which was on Tuesday, I

visited client in the evening which was (4:00pm) respectively. On general examination of

baby from head to toe, the anterior fontanelles were levelled, the sclera was clear with

pink conjunctiva. Skin was pink with no rashes. On inspection, abdomen was soft and

baby was looking cheerful and healthy. Baby’s diaper was soiled with yellow stool. Urine

was passed three times within the day. I then bathed baby and applied new diaper and

cloths were changed and I wrapped baby with a cot sheet and I handed baby over to her

mother. I also handed baby over to the community health nurse, thanked them and asked

permission to leave. I bid them fare well and left.

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Baby’s vital signs checked and recorded from fourth to seventh day postnatal are as

follows;

Date 23/10/2021 24/10/2021 25/10/2021 26/10/2021

Vital signs Evening Evening Evening Evening

Temperature 37.2oC 36.7oC 37.1oC 36.8oC

Respiration 42cpm 50cpm 49cpm 44cpm

Apex heartbeat 138bpm. 130bpm 134bpm 134bpm

First Postnatal Visit to the Clinic

On 22nd October, 2021, Madam D.N. and her baby came to the hospital at 9:00am and that

was the third day of puerperium. Mother and baby were neatly dressed and looked healthy.

Examination of mother

On history taking at 9:30am, she had no complains. Both mother and baby were exam

I explained all procedures to be done to her. Vital signs and observations checked and

recorded in appendix VIA (Postnatal records for mother);

Temperature 36.2oC

Pulse 78bpm

Respiration 22cpm

Blood pressure 110/60mmHg

Weight 51kg

I provided privacy, assisted her to lie on the couch and washed and dried my hands, I

performed physical examination on client from head to toe and no abnormality was found.

On palpation, uterus was well contracted and fundal height measured14cm. I draped client

to inspect vulva, removed perineal pad and inspected for colour, odour and amount of

flow. Lochia was red (rubra) and none offensive, perineum was intact and clean. I applied

new pad at the perineum and disposed soiled pad appropriately, helped client out of couch,

66
assisted to dress and offered a seat. Blood and urine sample were taken to the laboratory

for investigations and the Haemoglobin level was 11.4g/dl. I washed and dried my hands,

discussed findings with her and documented. I congratulated her for the support and

cooperation and reminded her of my visit to the house in the evening. I thanked and

advised her to take her prescribed drugs. I educated her on the danger signs in Puerperium

such as; excessive lower abdominal pain, profuse and offensive lochia among others and

encouraged her to report immediately if they occur.

Examination of baby

All procedures were explained to mother and with her consent baby was examined from

head to toe. On general examination, baby skin was pink in colour with good muscle tone.

Head was normal with fontanelles and sutures present. Eyes were clear with pink

conjunctiva. Abdomen was soft and the umbilical cord was healing by dry gangrene. The

baby weighed 2.9kg. Baby’s vital signs was checked as follows;

Temperature 36.9oC

Respiration 51cpm

Apex heart beat 144bpm

Second Postnatal Visit To The Clinic

On 26th October, 2021 was my client’s seveenth day of puerperium so she was told to

come to the hospital on Friday at 9:00am as scheduled. Madam D. N visited the hospital

accompanied by her husband. I welcomed them and offered them a seat. I enquired about

their health and they said everyone is doing well.

Examination of mother

67
 I asked of any complaints but she made none. All procedures were explained to the

mother to gain her cooperation. Hand washing was done before carrying on the

examination. A head to toe examination was done and no abnormalities were detected. Her

fundal height was 10cm. Blood and urine sample of the mother were taken to the

laboratory for investigation and the haemoglobin level was 11.7g/dl. Her perineal pad was

inspected and lochia was pink in colour (serosa) with no offensive odour. Client’s weight

was 54kg. Vital signs for mother were checked and recorded as follows;

Temperature 36.4oC

Pulse 79bpm

Respiration 24cpm

Blood pressure 110/70mmHg

Examination of Baby

A head to toe examination was also carried out on baby with no abnormalities detected.

Baby weighed 3.1kg. Baby’s vital signs were checked and recorded as follows;

Temperature 36.4oC

Respiration 49cpm

Apex heart beat 134bpm

Mother was congratulated and reminded on the need to have enough rest. I then

accompanied them to the family planning unit and handed her over to the community

Health Nurse in charge to continue with immunization schedule for the day and for the

continuity of care. She was reminded to breastfeed baby exclusively and to report any

abnormality seen on the baby to the clinic. She was counseled on family planning services

and directed to try to visit the unit for more information. I also encouraged her to continue

the postnatal exercise; that is abdominal and pelvic floor exercise to maintain good pelvic

68
and abdominal muscle tone. I reminded her of her 6th week postnatal visit which will fall

on 30th November, 2021.

I congratulated them for the visit and their cooperation throughout our interactions and bid

them farewell.

NURSING CARE PLAN DURING PUERPERIUM

ACTUAL PROBLEMS IDENTIFIED DURING PUERPERIUM

1. On 20th October, 2021 at 9:00am, client complained of lower abdominal pain (after

pain)

2. On 20th October, 2021 at 4:30pm, client complained of loss of appetite

3. On 21st October, 2021at 9:30am, client complained of insomnia

4. On 22nd October, 2021 at 5:00pm, client complained of baby’s weight loss

69
5. On 22nd October, 2021 at 4:00pm, client complained of headache

SHORT TERM OBJECTIVES

1. Client will be relieved of after pain within 24 hours as evidenced by client verbalizing

that pain has been relieved.

2. Client will improve within 24hours as evidence by client verbalizing that her appetite

has improved and can eat about 60% of meal served.

3. Client will have at least 6 hours in the night and 2 hours sleep in the day within 48

hours.

4. Client baby’s will regain weight within 72hours as evidence by client verbalizing that

body has gained weight.

5. Client will be relieved from breast engorgement within 48 hours as evidenced by

client.

6. Client will be relieved of fatigue within 24 hour.

LONG TERM OBJECTIVE

Client and baby will go through puerperium successfully without complication.

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 TABLE 4: NURSING CARE PLAN DURING PUERPERIUM

DATE/ NURSING NURSING NURSING ORDERS NURSING INTERVENTION DATE/ EVALUATION

TIME DIAGNOSIS OBJECTIVES TIME

20/10/21 Impaired body Client will be 1. Reassure client that she will be 1.Client was reassured of the relieve of 21/10/2020 Goal fully met as

At comfort(After relieved of after relieved of after pain. the after pain. at client verbalized

9 :00am pain) related to pain within 24 2. Explain physiology of after 9: 00am that the pain has

involution of hours as pain to client 2. Physiology of after pain was explained relieved.

the uterus. evidenced by to client that it is due to involution of

client 3. Advice client to do warm sitz the uterus.

verbalizing that bath. 3. Client was advised to do warm sitz

pain has been 4. Encourage client to apply bath to relieve the pain.

relieved. warm compression to the supra 4. Client was encouraged to apply warm

pubic region. compression to the supra pubic region

5. Serve prescribed analgesic. to relieved the pain..

5. Prescribed analgesic was served such

as paracetamol 1g stat.

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 DATE/ NURSING NURSING NURSING ORDERS NURSING INTERVENTION DATE/ EVALUATION

TIME DIAGNOSIS OBJECTIVES TIME

20/10/20 Nutritional Client will 1. Reassure and encourage client 1. Client was encouraged to eat at least 21/10/2021 Goal fully met as

21 imbalance (less improve within to eat at least three times a day. three times a day. at 4:30pm evidenced by

At than the body 24hours as 2. Encourage client to eat in bit at 2. Client was encouraged to eat in a bit client verbalizing

4:30pm requirement) evidence bt frequent intervals. frequent intervals to help boost her that her appetite

related to loss client nutritional status. has been

of appetite verbalizing 3.Serve clients food in an 3. Client was served with food in an improved and

that,her appetite attractive manner. attractive manner to help boost the can eat 60% of

has improved nutritional status. meal

and can eat 4.Encourage client to take 4.Client was encouraged to take favorite

about 60% of favorite food with different food with different varieties to help

meal served. varieties. boost the nutritional status.

5.Encourage client to take 5.Client was encouraged to take

prescribed Iron folic acid prescribed Iron ,folic acid supplement.

72
 supplement

DATE/ NURSING NURSING NURSING ORDERS NURSING INTERVENTION DATE/ EVALUATION

TIME DIAGNOSIS OBJECTIVES TIME

21st/ Sleep pattern Client will be 1. Reassure client and advice 1. Client was reassured and advised to 22nd Goal fully met

10/2021 disturbance(ins able to have client to change baby’s change baby’s soiled clothing and /10/2021 by client
enough sleep clothing and diapers. diapers to prevent baby crying and
At omnia ) related At 9:30am verbalized that
during night interrupting her sleeping.
9:30am to baby’s 2. Advice client to sleep when 2. Client was advised to sleep when baby she was able to
within 24hours
crying baby is sleeping during the is sleeping during the day. sleep well for
as evidenced by
day. 6hours during
client
3. Encourage client to breastfeed 3.Client was encouraged to breastfeed
verbalizing that the night and the
baby on demand. baby on demand to help her have
she can sleep midwife
enough time to rest and sleep
well for 6hours
4. Encourage client to breastfeed 4. Client was encouraged to breastfeed observed client
at night
baby sufficiently making sure baby sufficiently making sure both with a relaxed
midwife
both breast are empty. breast are empty to enhance sleep so
observed client facial
that she can rest.
with relaxed 5. Advice support person to assist 5 Client support person was advised to expression.

facial and cuddle baby when crying. assist and cuddle baby when crying to
expression.

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 enable her to have enough rest.
DATE/ NURSING NURSING NURSING ORDERS NURSING INTERVENTION DATE/ EVALUATION

TIME DIAGNOSIS OBJECTIVES TIME

22/10/20 Emotional 1.Clients baby 1. Reassure mother to allay all 1. Client was reassured. To allay fear and 25th/ Goal fully met as

21 disturbance(An will regain fear and anxiety. anxiety. 10/2021 at client verbalized

at xiety) related weight within 5:00pm that the body has

5:00pm to loss of 72hours as 2.Explain the physiology behind 2. The physiology behind the weight loss gained weight.

baby’s weight evidenced by weight loss of a newborn to the of the new born was explained to

client mother. client.

verbalizing that 3. Encourage client to breastfeed

baby has gained baby at least12-16 times 3. Client was encouraged to breastfeed
within the day and night. baby at least12-16 times within a day
weight and the
4. Encourage client to breastfeed and night.
midwife also
baby on demand. 4.Client was encouraged to breastfeed on
observing an
the baby’s demand
increase in the 5.Educate mother on the need of 5. Client was advised to empty one breast
babys weight complete emptying of one before putting baby to other breast to
breast before switching to the

74
 other breast relieve the engorgement.

DATE/ NURSING NURSING NURSING ORDERS NURSING INTERVENTION DATE/ EVALUATION

TIME DIAGNOSIS OBJECTIVES TIME

23/10/20 Impaired body Client will be 1. Reassure client that she will be 1. Client was reassured that she will be 24/10/ Goal fully met as
relieved of headache. relieved of the headache.
21 comfort(heada relieved of 2021 client verbalized
2. Explain the physiology to the 2. Physiology behind it was explained to
At che) related to headache within At 4:00pm that she has been
client. client.
4:00pm stress. 24 hours as 3. Encourage client to have relieved from
adequate rest and sleepat least 3. Client was encouraged to have
evidenced by headache
to one (1) to two(2) during the adequate rest and sleep at least 1-
the client
night. 2hours a day a in the night.
verbalizing that 4. Encourage client support
person to assist her in the 4. Client support person was
she was
household chores. encouraged to assist her in the
relieved of
household chores to enable her to
headache with have enough time to sleep and rest
sleep when baby sleep and rest
relaxed facial
5.Advice client to take prescribed 5.Client was advised to take prescribed
expression.
analgesics such as tablet analgesics such tablet paracetamol 1g

75
paracetamol 1g when when necessary to help relieve the
necessary headache chores

76
 TERMINATION OF CARE

This is the period when the therapeutic relationship between the student midwife and

client comes to an end. This usually starts from first encounter with client which was on

the 16th May 2021 and ended on the 26 th October 2021 on the seventh day of puerperium.

I visited client in the evening around 4:00pm together with a community health nurse and

introduced them to the community health nurse and provided her with all the necessary

information for continuity of care. I showed client the family planning unit and told her to

make time to visit the facility to enquire more about family planning and also register her

baby at the birth and death registry within 21 days and immunization of baby was also

stressed. I educated her on exclusive breastfeeding for six months and the need to attend

child welfare clinic. Client was also reminded of the next visit to the postnatal clinic and

report to the clinic anytime she had a problem. She was congratulated for taking good care

of herself and the baby and thanked them for allowing me to use her for my Family

Centered Maternity care study. The family also expressed their gratitude for the love and

care given to them.

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 SUMMARY AND CONCLUSION

This family centered maternity care study was offered to Madam D.N, a 24 years old

gravida two para one all alive (G2P1A) whom I met during my district midwifery practical

at the Effiduase Government Hospital.

She started her antenatal clinic when she was 12weeks pregnant on the 12th April, 2021

but was chosen for the study on 1st October, 2021 when she was 36 weeks pregnant. She

was cared during pregnancy, labour and puerperium without any complication. During this

period, data was accurately collected, needs and problems of client identified and nursing

care plan used to solve them.

She delivered spontaneously per vagina to a live female infant on 19 th October, 2021 Baby

weighed 3.0kg at birth. There were no complications to the mother and baby during and

after delivery. The baby had her first immunization of BCG and polio O the following day.

Post natal care and home visit was given to client for the first 7 days after delivery. During

this period, importance of birth registration, care of the baby and child welfare clinic were

stressed.

She attended the seventh day post- delivery clinic visit on 26 th October, 2021 no

abnormality was detected on both mother and baby. She was handed over to community

health nurse and public health nurse for continuity of care on that day. The midwife in-

charge will also discharge her to the public health nurse and community health nurse for

78
the continuation of care. The public health nurse will ensure that her baby is immunized

and weighed. In conclusion, the care study has given me a broad understanding of

individualized maternity care. I believe there will be reduced maternal and neonatal

mortality if all midwives in Ghana practice the family centered maternity care. This

experience will also help me manage efficiently any expectant mother that comes under

my care by giving her a better and quality care after completion of the programmed

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 APPENDIX VII

TABLE IV: PHARMACOLOGY OF DRUG USED

DRUGS CLASSIFICATION DOSAGE ROUTE ACTIONS AND EFFECTS SIDE EFFECTS REMARKS

Tablet Iron preparation 200mg tid x Oral Supplement the iron requirement 1.Darkstools Passage of dark stools
fersolate 30 days of the body. Help in the formation 2.Diarhoea
of red blood cels 3.Nausea and vomiting
Tablet Folic Vitamin 5mg daily Oral Maintenance of normal red blood Nausea and vomiting Help improve
acid Preparation x30 days cell. haemoglobin
Prevention of neural tube defects
Tablet Anti 400 mg tid x Oral Treatment and prevention of Nausea vomiting Help prevent
Metronidazole Protozoan 7 days infections Gastro intestinal upset infections
Tablet Analgesic and 1000 mg tid Oral Relieve pain,reduce high body Dizziness, prolonged usage Relieved her from
Paracetamol antipyretic x 5 days temperature or overdose may lead to pain.
liver damage
Capsule Antibiotic 500 mg tid x Oral Act against wide range of gram Anorexia It prevent infection
Amoxicillin 7 days positive or negative organism. Nausea and Vomiting and promotes healing.
Tablet Anti 6 tablets Oral Destruction of Malaria Parasite Nausea Malaria was prevented
Sulphadoxine Malaria
Pyrimethamine

80
DRUGS CLASSIFICATION DOSAGE ROUTE ACTIONS AND EFFECTS SIDE EFFECTS REMARKS

Injection Oyxtocic Drug 10 Intramus Act on the uterine muscles to Overdose will lead to Bleeding was
oxytocin internatinal cularly produce and improve uterine uterine rapture controlled
Units on the contractions. It ensures active
thigh management of the third stage and
labour and prevent excessive
bleeding
Bacillus Vaccine 0,05ml Intrader Stimulate production of antibiotics Slight increase in Baby was not infected
Calmette mal against tuberculosis temperature. Blister by tuberculosis.
Guerin formation. Inflammation at
the injection site
Oral Polio O Vaccine 2 drops Oral Production of antibiotics against Slight increase in Baby did not have
poliomyelitis and transfer of temperature. Inflammation polio infection.
immunity to fetus at the injection site
Injection Vaccine Intramus Stimulates production of anti- Slight increase in Prevented mother
Tetanus cular bodies against tetanus and transfer temperature. Inflammation from infection.
Diptheria of immunity of fetus at the injection site
Tetracycline Antibiotic Grain of rice Instillati Prevent infection of the eye Burning Sensation, Infection was
eye ointment on Headache and confusion prevented.

81
 BIBLIOGRAPHY

Client’s Maternal Health Record Booklet, registration number (000291/21) Effiduase

Government Hospital.

Ead,H.(2019 september,16th )Application of the nursing process in a complex care

Edwin, A.M.(2015), Pharmacology and Therapeutic (Revised Ed.). Sunyani: Excel Print

Ltd.

Kansky, C. (2016, July, 22) Normal and Abnormal Puerperium. Retrieved from

Medicine.medscape.com

Marshall, J. and Raynor, M. (2020).Myles’ Textbook for Midwives.17thEd.Great Britain

Churchill Livingstone Elsevier.

Ministry of Health resources for development division.(2000).Reproductive health

Classroom and Clinical Activity Guide for training Midwives. Accra s,Ghana:

Ministry Of Health

Spong, C. Y. (2013, October, 28). Medical definition of pregnancy.Retrieved

http//jama.Jamanetwork.com/article.

Sheil, W. C. (2018, December, 27). Medical Definition of labour. Retrieved from

http//www. Medicinenet.com.

Weller, F. B. (2014). Baillieres Nurses Dictionary for nurses and health care worhers,

(26th Ed).

Williams, L. and Wilkins. P. (2017, September, 10) “Manual for Gynecology and

Obstetrics” Retrieved from https://en.m.wikipedia.com

World Health Organization (2021). “Recommendations on postnatal care of the mother

and newborn”Retrieved from http//www.Medicine.medscape.com

82
World Health Organization (2018), Managing prolong and obstructed labour. Retrieved

from http//whqlibdoc.who.int/publication/20089789241566694.eng.pdf.

SIGNATORIES

NAME OF CANDIDATE :. WINIFRED HEWTON

SIGNATURE : …………………………………

DATE : …………………………………

NAME OF SUPERVISING TUTOR: MS. HAGGAR BOAHEMAA

SIGNATURE : …………………………………

DATE : …………………………………

NAME OF PRINCIPAL: MRS. HELENA GIFTY DWAMENA AMOAH

SIGNATURE : …………………………………

DATE : …………………………………

……………….………

83
 (COLLEGE STAMP)

84