Lesson Notes: Postnatal Integrated Health Assessment
Course: Reproductive health GNS312
Topic: Integrated Health Intervention/immunization
Target Audience: Students, College of Nursing Sciences, Lafia, Nasarawa State.
SESSION OBJECTIVES:
Upon completion of this lesson, the student nurse will be able to:
Conduct a systematic assessment of a child's immunization status according to the Nigerian
National Program on Immunization (NPI) schedule for birth and 6 weeks.
Assess a mother's Tetanus immunization status and understand its clinical significance.
Identify the need for and provide client-centered counseling on postpartum family planning.
Conduct basic counseling on STIs and HIV, with emphasis on Prevention of Mother-to-Child
Transmission (PMTCT).
Accurately identify infant danger signs requiring urgent referral, based on the Integrated
Management of Childhood Illness (IMCI) guidelines.
Differentiate between conditions requiring urgent referral and minor ailments manageable with
health education.
1. Assessment of Child's Immunization Status
1.1. Introduction
The death rate for children under 5 years in Nigeria is considered to be very high.
childhood killer disease
a. Tuberculosis
b. Poliomyelitis
c. Diphtheria
d. Whooping cough
e. Measles
f. Tetanus
g. Malaria
h. Diarrhea etc
Immunization is the process whereby a person is made resistant, typically by administration of
vaccine.
The postnatal period is a critical window for immunization. Your role is to verify, administer, and
document vaccines accurately, and to educate the mother on their importance. Always begin by
asking for the Child Health Card.
How immunization works
When vaccines are injected into the body, such vaccines allow the body to produce immunity
against certain diseases. This protects a person against the killer diseases.
1.2. The Nigerian Immunization Schedule:
At Birth (up to 2 weeks)
- BCG: Bacille Calmette-Guérin
- OPV 0: Oral Polio Vaccine, Zero Dose
- HBV 1: Hepatitis B Vaccine, Birth Dose
- BCG: Intradermal injection, left upper arm. Inform mother a scar will form.
- OPV 0: Oral drops.
- HBV 1: Intramuscular injection, anterolateral thigh. Crucial for preventing vertical transmission
of Hepatitis B.
Second Visit
At 6 Weeks
- PENTA 1: Pentavalent Vaccine
- OPV 1: Oral Polio Vaccine
- PCV 1: Pneumococcal Conjugate Vaccine
- ROTA 1: Rotavirus Vaccine
- IPV 1:
- PENTA 1: A 5-in-1 vaccine (Diphtheria, Pertussis, Tetanus, Hep B, Hib). Intramuscular injection.
- PCV 1: Intramuscular injection, opposite thigh from PENTA.
- ROTA 1: Oral drops. Counsel mother on potential for mild stool changes.
1.3. Nursing Actions:
Verify: Check the child's health card against the schedule. Note any missed doses.
Counsel: Explain to the mother which vaccines are being given and what diseases they prevent.
Inform her about potential mild side effects (e.g., fever, local swelling) and how to manage them
(e.g., paracetamol, cool compress).
Administer: Follow the "Five Rights" of medication administration. Use correct sites and
techniques.ight
Right patient
Right Route
Right medication
Right dosage
Right time
Document: Record the vaccines given, date, and batch number on the child's card and in the
facility register.
Schedule: Clearly state the date for the next appointment (at 10 weeks).
2. Assessment of Mother's Immunization Status
2.1. Clinical Rationale
A mother's immunization status, particularly against Tetanus, is vital for preventing Neonatal
Tetanus, a highly fatal disease often contracted through unhygienic cord care. Maternal
antibodies are passed to the fetus, providing passive immunity.
2.2. Assessment of Tetanus Toxoid (TT) Status
Procedure: Ask the mother and review her antenatal care (ANC) card.
Key Questions:
How many injections for tetanus did you receive during your last pregnancy?
Have you ever received tetanus injections before this pregnancy?
A woman is considered fully immunized if she has received:
At least two doses during the most recent pregnancy.
A total of five doses in her lifetime for lifelong protection.
Nursing Action: If the mother is not fully immunized, administer a dose of TT vaccine and
schedule her for the next dose according to the national schedule.
3. Integrated Counseling: Family Planning & STIs
3.1. Needs for Family Planning Services
Rationale: Postpartum family planning (PPFP) is a high-impact intervention. It reduces maternal
and infant mortality by allowing for healthy birth spacing (at least 24 months between birth and
next conception).
Counseling Approach:
Initiate the conversation respectfully. Link it to her and her baby's health.
Mama, allowing your body to rest fully before the next pregnancy will help you stay strong and
give this baby the best care. Have you thought about a method you might like to use to space
your children?
Discuss methods suitable for the postpartum period, especially for breastfeeding mothers (e.g.,
Progestin-only methods, implants, condoms, IUDs).
Explain the Lactational Amenorrhea Method (LAM) but emphasize its strict criteria (exclusive
breastfeeding day and night, no return of menses, baby <6 months old) and its limitations.
3.2. Counseling Needs for STIs, HIV/AIDS
Rationale: Protect the mother's health and prevent mother-to-child transmission (PMTCT) of HIV
and other infections like Syphilis and Hepatitis B.
Nursing Actions:
Review ANC Records: Check her HIV status from her ANC testing.
If HIV-Positive: This is a critical follow-up.
Assess adherence to her Antiretroviral Therapy (ART).
Verify the baby has been initiated on Nevirapine prophylaxis.
Counsel on exclusive breastfeeding for 6 months followed by safe transition to complementary
feeds. Mixed feeding is highly discouraged.
Schedule her for Early Infant Diagnosis (EID) testing for the baby at 6 weeks.
If HIV-Negative: Counsel on staying negative. Discuss condom use for dual protection against STIs
and pregnancy.
4. Infant Health: Identification of Urgent Referral Conditions
4.1. The IMCI Framework: Identifying Danger Signs
Your most critical role is to differentiate a well baby from a sick baby who needs immediate
hospital care. For any infant under 2 months, the presence of ANY ONE of the following danger
signs constitutes a medical emergency.
Ask the Mother:
Has the baby had convulsions (fits)?
Is the baby feeding poorly or stopped feeding?
Has the baby vomited everything?
Look, Listen, and Feel:
Lethargy/Unconsciousness: Is the baby abnormally sleepy or difficult to rouse?
Temperature: Feels hot (fever >37.5°C) or cold (hypothermia <35.5°C).
Respiratory Distress:
Fast breathing (≥ 60 breaths/minute).
Severe chest in-drawing.
Nasal flaring or grunting.
Severe Dehydration: Sunken fontanelle, sunken eyes, skin pinch goes back very slowly.
Severe Jaundice: Yellow discoloration of the skin, especially on the palms and soles.
Umbilical Infection: Redness extending to the abdominal wall, or pus draining from the stump.
Dysentery: Blood in the stool.
4.2. Identification of Appropriate Treatment: Counsel vs. Refer
Condition Requiring URGENT REFERRAL
Condition Manageable with Counseling/Home Care
Severe Bacterial Infection (Sepsis): Presents with fever, lethargy, poor feeding.
Oral Thrush: White patches in the mouth. Counsel on oral hygiene, may need antifungal drops.
Severe Dehydration: From diarrhea/vomiting. Requires IV fluids.
Mild Diarrhea (no dehydration): Counsel on continued breastfeeding, giving ORS.
Dysentery: Requires antibiotic treatment.
Blocked Nose: Counsel on clearing with saline drops.
ANY of the IMCI danger signs listed above.
Uncomplicated Umbilical Cord: Counsel on keeping the cord clean and dry (air drying).
Nursing Action for Referral:
Explain: Calmly but clearly explain to the mother why the baby needs to go to the hospital
immediately.
Pre-referral Treatment: Provide urgent care. For example, give the first dose of an appropriate
antibiotic (if per protocol), and manage hypothermia by placing the baby in skin-to-skin contact
with the mother (Kangaroo Mother Care).
Document: Write a clear referral note detailing your findings.
