nat Examination (Question and Anwsers) ves in theit Professio « 7 7 XAMINATION (0.S.C.E) FO SAMPLE OF ORJECTIVE STRUCTURED CLINICAL STUDENT MIDWIVE (BASIC, POST BASIC AND UNIVERSITY MIDWIFERY STUDENTS) Rk PROCEDURE STATION 1 using this phantom INSTRUCTIONS TO CANDIDATE FO! ‘go along, Demonstrate vulva swabbing ‘Report the procedure as You CHECKLIST FOR PROCEDURE STATION 1 % [* [! [2 [2%] Tom TITLE: VULVA SWABBING. st or {3 Explains produoe to cent and gins er consent 3] Provides privacy <7 Ensure that all the requirement forthe procedure are well set out ona trolley. Protects bed linen from soiling using drapes or slipping a bedpan under client's buttocks Lifts up client gently and positions her correctly with assistance [7 Washes hand thoroughly | Puts on gloves without contaminating the outside of the | slovesto prevent spread of micro organisms ‘Meation that swabbing is dane using swabs soaked in antiseptic lotion 10 | Caries out the procedure by using the 5 sterile balls oF swabs thus: ~ Uses right hand to pick the wet swab and asses tothe left hand Swabs each labia majora in an upward/down ward manner once Repeats same for the labia minora ‘Swabs the vestibule clitoris and introitus with the right hands using that last ball of swabs ~ Dries excess lotion using sterile dry swab ~ Removes drapes or bedpan ~ Applies a clean perineal pad, Tidies and make client comfortable Discards used items Washes handsc-4 (+ sembie the requirement Ed ‘Lies baby on. the back and exposes the abdomen _7-Gieans the base thoroughly with sterile water ron wt the cord of topo Report the procedure a FOR PROC “ashes and dries hand PT 7 {sng the Tet hand, the ip ofthe cord is grasped with werle como wool soaked in sterile water - Geans the tip ofthe cord as well as the Hollister clamp (s_4 5 Fiigaure was used applies a fresh one if previous one is Toose without removing old one [peas te cord open to dry g ‘Wraps baby and makes it comfortable Opserves the cord for - Bleeding - Offensive odour - Loose ligature - — Infection/redness = Discolouration - Hemiation ~_ Discharge Records and reports any abnormality if detectedid Anwsers) ion Land Midwives in their Professional Examination (QUESTION EA 5 INSTRUCTIONS TO CANDIDATE FOR PROCEDURE STATION "a tower limbs for dedema (2) Examine this pregnant worna ee (b) Report your findings EO nia 2. ayTest the specimen of wrine toe Yo biel ot (b)Report your findings 48 Yo (CHECKLIST FOR PROCEDURE STATION 5 ting For Albumin rms: amination Of The Lower Limbs Of 4 Pregnant Woman Far Oedema And ns 3p *Trotat 1] Greet the cet tetroduces herself - Explains procedre to client Provides privacy [7 Reston te cca 3_| Exposes the Tower limbs by folding the upwards neatly 4 “| Examines and reports on the following | ~ Assesses the sate ofhygiene ofthe fost v * Sie 2 Shape ‘ 2 Skin = _ Observes any reddened area ofthe calf 3 | Feels gently the lower limbs to = Asses normal warmth ~ Exclude irregularity = _ Observes areas that appear white excluding any tendemess ‘6 | Tests for pitting ocdema by = Asking the client whether she has notices any swelling in the ‘moming or during the day which worsens at night = Applying fingertips pressure for 10 seconds over the tibia bone = Asking the client whether she has experienced any pain or cramps in the knee or foot URINE TESTING FOR ALBUMIN 7 | Bramine urine specimen - Colour - Odour = Deposits ‘| Tests for reaction — (Acid or Alkaline) Uses litmus paper Acidities urine if Alkaline 9] Obiains specific Gravity Uses Urinometer Reads off value T0_| Filters urine if cloudy j T1_| Removes one Albustix strip quickly and replaces cap Dips reagent strip into urine and shakes off excess moisture | from strip } = Compares strip with colour chart and reads up value = __Discards stip _| Tz] Tidies up the trolley 13_| Washes and dries hand. pa fr (+(CHECKLIST FOR PROCEDURE STATION 7 TITLE: THE USE OF VACUUM EXTRACTION ACTIVITIES OMK | “mk Timak_| Wm er nad troduees seh Fain procedure t0 patient and gain consent 9) the equipment in addition to the routine delivery instrument 1 Fis connects and tests the vacuum client's bladder — Fron the cet to ie in dorsal poston with Tage bent eri vaginal examination to determine baby's station and position — cae sistant ta help Keep client buttock atthe edge ofthe bed and suppor eas —Fesure fetal scalp is visible then wipes clean with dry gauze hooses the right sizeof vacuum cup 7 Fils he cup with her fingers and separate the abia with fingers ofthe other Rand — rer the cups gently into the vaginal orifice pressing the cup down wards and inwards into the vaginal until cup touches the baby’s scalp atthe flexion point or neat it Passes a finger gently around the edge of the cup to ensure maternal tissue is grasped “fais assistant to pump the pressure and carefully watches the gauge Make sure the pressure reaches 0.2 —0.8kg/em™ Ensure chignon is formed Applies traction in backwards and downward direction and encourage patient to push with contraction then in a forwards and upwards manner Pulls upward to lift head and with contraction until head begins to crown “alls assistant to release pressure and detached the cup from baby’s head at crowing Encourage patient to push for the final part ofthe birth Ensure fetal heart is recorded regularly ~ Explains that she completes third stage of labour Tides the work field and makes it ready for the next candidateFOR PROCEDURE STATION 9 . STO CANDIDAT INSTRUCTIONS TO CANDIDATE FORE terior pos ace the al inthe mene ere as you fo ONE FOR PROCEDURE STATION 9 CHECKLIST demonstrate the mechanism of labour, OMK Yamk | Yarak[iae) TITLE: MECHANISM OF LAROUR (LEFT OCCIPITO — ANTERIOR) HT Hands the pei and dol Cary the rede Fy menonng he Rowing points Lietongudinal Ait - eon Preematon— Cephalic Devoranator-Osipt Presenting part ~ posterior part of the anterior parietal bone Presenting diameter ~ Sub ~ ocecipito frontal of 11.5cm Eneaing carter ~Sub ocipitebregatic of 9.Sem ‘Demonstrates and explains the following movement in sequence Continuing. Flesoe of Head: Descent occiput lies under the symphysis pubis 7 imernal Rotation of Head: with descent occiput lies under the symphysis | Crewing: occiput escapes under the symphysis pubis and head crowns © | Extension: snciput, face and chin sweeps the perineum and head is born By a | movement of extension of the underlined points 17 Restntion: occiput tum 178 a cirele to undue the twist on the neck or for the head |__| tw align ist with te shoulders ofthe underlined point _ © | Internal Rotation of the shoulders: shoulders enter the pelvis in right oblique | | diameter, anterior shoulder leading, rotates 1/8 a circle to lie under the |__| symphysis pubis ofthe underlined points [9] Lateral Fesioncanterior shoulder under the symphysis pubis the posterior |_| shoulder sweeps the perineum and baby is bom by movement of lateral flexion of the underlined points ‘Tidies wp and makes the work field ready for the next candidate Candidate was able to explain each step correctly and sequentiallywe Bet 10 Success, for Studen eo Sune ako Soe, fot Student ind Midwives in Oe ad Mid INSTRUCTIONS : : Toc yrs Okechukwu delivered a live female baby with ny UATE FOR PROCEDURE STATION 11 cee no visible sign of respira Aeveett wh sett ofaeano poole eer eee one art as you go along HECKLIST FOR PROCEDURE STATION 11 TLE: RESUSCITATION OF THE NEWBORN py p, 7 ACTIVRN BY FACE MASK VENTILATION Ensures adequate lighting and warm in the birthing rooms a Sart the clock timer immediately after delivery Assess the AGPAR score at one minute and five minutes Clear the baby’s upper airways by gentle suctior le suction ofthe oropharynx Dress baby quickly from head fo toe using dry towel loth Transfer baby 0 a well it resuscitaire ata comfortable working height ~ Extend baby's neck by placing small towel under the baby’s shoulder to Keep His airways opened (sniffing position) [Do not insert more than 2-3cm of the tube into the nostril and not more than Sem while suctioning the mouth their Professional Examination (Question and Anvsers) T Sucks the mouth first before the nose [Choose an appropriately sized mask, size 00 or O71 Position the mask on the face using a rolling from chin to nose bridge so that it covers the nose and the mouth [Ensure a good seal over the nose and mouth — Care taken not to apply pressure on the soft tissue under the jaw so as not to obstruct the airway —Deliver five (5) sustained inflations using air or oxygen for 2-3 seconds with @ pressure of 30 cm Ho Repeat process of inflation five times —Check the movement of the chest wall and the heart rate "Stimulate breathing by rubbing palms up and down the bay's —Tidies the work field and makes it ready for the next candidateere Be te Succes, for Sd ures end Midwives in thee Profesional Examination (Question and AMWSEr) pIDATE FOR PROCEDURE STATION 1 "insertion of copper-releasing intra-uterine device. less as you demonstrate. INSTRUCTIONS TO CAN! Demonstrate the procedure for ‘Narrate the proc CHECKLIST FOR PROCEDURE STATION 1 TITLE: INSERTION OF INTRAUTERINE DEVICE (COPPER-RELEASING) OMK | mk _| “mk [Tr ACTIVITIE Pre-Insertion process Ec Pais on examination surgical gloves on both hands Performs vulva swabbing correctly Thsers clean Cuseo"eraves speculum in the vagina ‘leans the cervix with normal saline or povidon iodine solution Toading the CuT3&0A Tarecty load device while in its package ‘ents tat po-ouch technique is observed in Randling CuT380A and part ofthe insertion tb tat will enter the uterus |-S-Tinig he other hand pushes and rotates inserifon tube against arms ofthe CuT3B0A to tend the arms to push them securely into the inserter the tubes ‘Chess to be sure the folded arms and depth gauge (lange) are lying lat against the cord “Adjuss the flange on the inserter depth ofthe uterus by aligning it withthe uterine sound tothe level of the clamp (wile still in inserter) |e flnge shouldbe aligned with TUD arms and set at the distance the werus was [sounded I Tntra- uterine placement of pre-loaded CuT360A | Grasp passes the uterine lip ofthe cervix gently with a tenaculum at 10 o°elock and 2 | o'clock position we passes the uterine sound into the uterine cavity until contact is made with the jus ~ Can the uterine sound at point of external ben dadperioamiiata (Os with sponge holding forceps and draw = Clean the cervix with antiseptic solution ‘Measure the length of the loader and ensure it corresponds tothe uterine depth = Gently nivoduce the Toader with uterus until the flange is against the cervical Os ~ ull back the clear inserter tube on the ins aa ertion rod approximately 2om so that the arms = Advance the tube slowly to ensure a correct position of the TUD ~ Removed the insertion rod by holding the insertion tube in place = Remove the insertion tube and the tenaculumir Profesional Examination (Question and Anvsery) Sure Bet to Success, for Student Nurves and Midwives in Se a rs an Midwives i INSTRUCTIONS TO CANDIDATE FOR PROCEDURE STATION dentify these instruments following these guidelines Identification Use(s) Care after use (CHECKLIST FOR PROCEDURE STATION 4 TITLE: INSTRUMENTS USED IV MIDWIFERY [rive ARTERY FORCEPS Proper ienitexion —| ~“adiate Tor as Ton Heating ss i, For holding dressing gauze | | ii, For clamping blood vessels. | it Forlanpingubla cod iv, Forging ee + Care after use | i Decontamination i JK salto or 10 ites i Wah ssp and water (wth us paying atesion he seated ges Rinse under unig water iv.Sterilize/autoclaves/soak in solution of Glutaradehyde 1-4% for 10 ‘hours/boil for 20- 30 mies Cards ape ton Tadeation ore iar ofthe ubilil cod Care arse i Decomamiation nT solution fr 10 mints i,Wash in soup and water wth brash iRise under ening nate iv Autoclave in Slaton of 1-4 for 10 house 2030 mints CUSCOS VAGINAL SPECULUM pepe iderieaton Indication for we Vaginal examination i.Visulation eric when inserting IUD To obtain pep ner ivhen hoes ling ‘Dunn postnatal tamraton Care after {Decontamination in JIK solution for 10 minutes \Wash in soapy water with brush {ii.Rinse under running water iv. Autoctaves/soak in solution in Glutaraldehyde 1-4% for 10 hours/boil for 20-30 minutes KOCHER’S TISSUE FORCEPS ‘proper identification (1/2 mk) Tadication for use [Rupture of forewater (Clamping umbilical cord at birth Care after use: {Decontamination in jik solution for 10 minutes, i, Wash in soapy water with brush ii Rinse under running water iv. Autoclavelsoak in solution in glutaraldehyde I~ for 10 hours/ boil for 20-30 minutesExamination (Question and Anvsers) a Te FOR PROCEDURE STATION 5 INSTRUCTIONS TO CANDID Ae id demonstrate the mechanism of labour. ‘Place the doll it vito-anterior pos! ee he ih once m3 ANE CHECKLIST FOR PROCEDURE STATION 5 % 7) 1% [2 [tome rTLls MECHANISM OF LABOUR (RIGHT OCCIPITO-ANTERIOR) a ee Hanes the pets Bone properly and correctly 1+ Restons the dal correct + Teves the bead property Tames out the procedure By mentioning the following points: Le longital Atitode — flexion Presentation ~ cephalic Deenoeminator isthe occiput Presenting part posterior part of the anterior parietal bone Presenting diameter - sub occpito frontal of 10.5em Engaging diameter ~ sub occpito bregmatic -9.5cm Ensure movement of doll on pelvis and reporting are coordinated ‘Denoastaies and explains the following movements in sequence Continuous flexion- Decent takes place with inreased flexion =~ roation of head- with decent Brings the occiput to be behind the symphysis abi 7] Groming: the accipat under the symphisis pubis and the head is crowned ‘| Exiension- the sinciput, face and chin sweep the perineum and the head is — | bor by a movement of extension [710 Resttcion- the occiput turns 178° ofa circle and the head rights itself with | the shoulders [TT] Internal rotation of shoulders- the shoulder entire the pelvis in left oblique ‘diameter, anterior shoulder leads and rotates 1/8* ofa circle to lie under the sympbiss pubis 12 Lateral flexion-the anterior shoulder escapes under the symphisis pubis, the rove ea el teeSee eee ft aden Naren Mies i tht iT: sure Bet to Success, for Student Nurses and Midwives in their Professional Examination (Question and 4 INSTRUCTIONS TO CANDIDATE FOR PROCEDURE STATION 7 Describe the pelvic floor using the model in front of you Narrate the description as you go along CHECKLIST FOR PROCEDURE STATION 7 THE PELVIC FLOOR ‘Handles and position the pelvis correctly for the procedure using a pointed object TA ‘Mentions the type of pelvis she is handling Mentions that the pelvic floor is formed by soft tissues which fill the pelvic outlet Mentions that the pelvic floor is a strong diaphragm of muscle slung like a hammock from the walls of the pelvis ‘Mentions that the urethra, vagina and the anal canal pass through these muscles Points out the position of these three openings ‘Mentions the superficial layers of the pelvic floor muscles as follows pointing out their locations - The external anal sphincter — encircles the anus, is attached to the coceyx ~The transverse perinan! muscles from ischial tuberosity to the centre of perineum ~The bulbocavemosus muscles from the perineum around vaginal to corpora venosa of clitoris under the pubie arch ~The ischiocavernosus muscles from the ischial tuberosities along, the public arch to the corpora cavernosa - The membranous sphincter of the urethra composed of muscle fibers passing above and below the urethra and attached to the public bones Mentions the deep layer, its composition and location as follows = Composed of three pairs of muscles together known as the levator ani muscles Mentions that levator ani museles consist of i:The pubococcygous muscles from pubis to coceyx ii:The illococeygous muscles from the obturator internus muscle to the coceyx ili, The ischlococeygeus muscle from the ischial spine to the coccyxSure Bet to Se Student Nurses and Midwives in thet ea Se Ben Sec, for Seder Nur INSTRUCTIONS TO CANDIDATE 108 une Demonstrate the process of performing a” Warnare the process a JOH TT) FOR PROCE ‘EDURE STA TION 9 (CHECKLIST. Professional Examination (Question and Auwsers) ROCEDURE STATION 9 in second stage using the phantom, ‘out the procedure 10 TITLE: GIVING OF EPISIOTOMY MK. }-—Garet The Women And Inivaduces Self encourage her 10 ask questions Explain what is to be done and cotton woll, episitoromy See tay with nevescary requirement eg antiseptic lotion, scxssors lignocaine 0.5% 10m syring, + Ramumisterng Local Anaesthetic ‘Clean perineum with antiseptic lotion Draw 10ml of 0.5% lignocaine into the syringe Place two fingers into the vagina along proposed incision line Insert needle beneath skin for 4-Sem following same line (about 3-4em) Draw back the plunger of syrings to make sure the needle is not in a blood | vessel Inject lignocaine into vaginal mucosa beneath skin of perineum and deeply into perineal muscle Wai for 2 minutes and then pinch incision site with forceps ~ Giving the Episiotomy Wait to perform episiotomy when 1. Perineum is thinned out 2. 3-4em of baby's head is visible during a contraction "Plc tv ag betwen te by heal andthe perne episiotomy scissors between perineum and two fingers and cut medio- tary perineum and posterior vagina ‘ot follow immediately apply pressure to episiotomy site between comsracions ings ee of gage mininize ith of head, shoulder or buttocks to avoid extension of the episiotomyina Sure Bet to Success, for Student Nurses and Midwives in their Professional E INSTRUCTIONS TO CANDIDATE FOR PROCEDURE STATION 11 Describe the pelvic brim using the model in front of you. Narrate the description as you go along. CHECKLIST FOR PROCEDURE STATION 11 TL: ANATOMY OF THE PELVIC BRIM = Student introduces his/herself 0 mik Th mk ‘mk — Pick the model, holds it properly and using the pointer Definition | Defines the pelvic as the basin like structure that articulates with the 5 lumber vertebra above with the head of the Right and left femur of the acetabulum = Ithouses the pelvic organ Description ~The brim is divided into two (2) parts 1. False pelvis — lies above the brim 2. True pelvis — the pelvic brim and all the area below it ~ Shape ~ the brim is almost round in shapes and eight (8) points ean be demonstrated on it = Promontory of the sacrum — the first sacral bone that join into the cavity Sacral ala or wing fanned out region by the sacro- iliac joint = Sacro ~ iliac joint where the sacral and liac bone meet = Illiopectineal line which is the edge formed at the inward aspect of the ilium. = Illiopectineal eminence which is the roughened area formed where the superior ramus of the pubic bone meets the ilium = Superior ramus of the pubic bone, a bony projection on the upper border of the pubic bone - Upper inner border of the body of the pubic bone-inner surface of the pubic bone = Upper inner border of the symphysis pubis-inner surface of the cartilaginous pad joining the two pubic bonesProfessional Examination (Question an 7 TE FOR PROCEDURE STATION 1 sTRECTIONS TOC AN mination 10 ajuniorwsing the dummy. Demonstrate the Reper CHECKLIST FOR vr you carry ont the procedure. PROCEDURE STATION 1 10MK MK pres th BSE is best performed afer menses "Mentions the three (3) methods: 5s inspection method nae ee re ands ve bind the head check for asymmetry cree dawn, place your hands by yur sides ina relaxed manner ook for changes sche sox, coour of kn ofthe breast, enlarge glands, nipple changes “cHand onthe hips ~ while standing place hands on hips, press down and bend forwards: note anything unusual or abnormal | Biplan and teach palpation method |e Teact the student to use the right hand to palpate the left breast and vice versa. ‘b Support the back of the head with the other hand «Staring from the outer edge of the breast to the nipple using the plamer of the fingertips move easly over the skin in a clockwise movement all - round the | breast | aPaipate the beast tissue against the chest wall to feel for lump «Palpat areola and nipple using a similar circular technique as with breast ‘Palpate the axillary region. Identify any inflamed axillary nodes s-Repeat steps A - F on the left breast gon lin ad each pressing iquezng mi es the nipple to see if there is discharge that is watery, blood or pulse 1 Repeat procedure onthe other breast including armpitSure Bet to Success, for Student Nurses and Midwives inthe INSTRUCTIONS TO CANDIDATE FOR PROCEDURE STATION 3 Demonstrate the use of the Manual Vacuum Aipiration (MVA) apparatus using 4 phantom: Report as you carry out the procedure. (CHECKLIST FoR PROC TITLE: MANUAL VACUUM ASPIRATION EDURE STATION 3 rofessional Examination (Quest = _ Greet and explain procedure to the examiner ToMK ZMK ~— Before the procedure Before beginning the MVA procedure, the candidate must make sure the following aspects of patient care are addressed ‘a The duration of gestation Is 12 weeks LMP or less ‘.Obtain voluntary informed consent from the patent -Ascertain the necessary equipment are available (Candidates should be able to name the parts of the apparatus, for at least should be able to name 3 parts correctly Procedure preparation = Provide privacy = Perform physical and pelvie examination = __Ascertain the gestation age one more ime Use the appropriate cannula size » _Atuterine size of 4 to 6 weeks — 4-7mm cannulae ~ _Atuterine size of 7 to 9 weeks ~ 5 to 10mm cannulae = _Atuterine size of 9 to 12 weeks ~ 8 to 12mm cannulae = Charge the aspirator ~__Check the aspirator for vacuum retention before use = Access the dilatation of the cervix = Insert the speculum correctly = Clean the cervical os with antiseptic ~ Ensure that all instrument that entire the uterus are sterilized or high level disinfected = Give paracervieal block for pain control, necessary = Using traction, dilate the cervix gently with progressively larger cannulae = Evacuation = Using the tenaculum to gently apply traction to the cervix = __Insert a cannula ofthe correct size through the cervical os = Move the cannula slowly into the uterine eavity until it touches the fundus = Attach the charge MVA aspirator to the cannula holding the tenaculum and the fend of the cannula in one hand and aspirator in the other = Release the buttons, suction start immediately — Evacuate the uterine content by gently rotating the cannula 180 degree in each direction — Ifthe aspirator becomes fll, depress the buttons and disconnect it rom the cannula Post-Evacuation = Ensure the uterus is empty —— Disconnect the cannula from the aspirator or withdraw the cannula and aspirator together ~ Empty the contents ofthe aspirator and inspect the tissue Clean up patient ‘Decontaminate used instrument in 05% chlorine solutionSA Sr Sta nt New our ine mechanism of 40" INSTRUCTIO URE STATION INS TO CANDIDATE FOR PROCED! *esciplto-antertor position (long internal rotation) and demonstrate Report the procedure as you go alone. ‘Place the doll in th CHECKLIST FOR PROCEDURE STATION 7 TON —— TITLE: OCCIPITO POSTERIOR POSITION (LONG INTERNAL ROTA’ 10N a] - | 4 ml | greets and introduces self | _— Handles the doll and pelvis correctly | Revites the preamble 1 Lie~ Longitudinal ii Attitude ~ Deflexed head \ iii Presentation - Cephalic | iv Position ~ Right Occipito Posterior ‘Dominator ~ Occipito vy.Presenting part~ Anterior or middle area ofthe left parietal bone vii Presenting diameter- Occipito frontal diameter 11.5em ii. At onset of labour, Oceipito points fo right sacroiliac joint while the sineiput points to the lef illiopectneal eminence. FLEXION ~ With contraction, decent takes place with increasing flexion |= cvciput becomes the leading part INTERNAL ROTATION | - occiput reaches pelvic Noor frst ~ Rotates 3/8 ofa circle forward along the right side ofthe pelvis to lie under the symphysis pubis ~_Wit 2/8 turing of the shoulders from left to right oblique diameter GROWING ~ With contraction, occiput escapes under the symphysis pubis = __And the head is crowed EXTENSION ~ _Sincipat, face and chin sweep the perineum ~_ And the head is born by a movement of extension. RESTITUTION = _Occiput tums 1/8 ofa circle to the right for the head to realign itself with the shoulders INTERNAL ROTATION OF THE SHOULDERS ~ Shoulder enter the pelvis in the right oblique diameter ~ The anterior shoulder becomes the leading part, reaches the pelvic floor muscle first, rotates 118 ofa circle forward to lie under the symphysis pubis, ~ With contraction, the anterior shoulder escapes under the symphysis pubis ~ _With the posterior shoulder sweeps the perineum and the shoulders are born EXTERNAL ROTATION OF THE HEAD = __ The occiput tums further 1/8 of a circle to the right. TATERAL FLEXION ~ The anterior shoulder escapes under the symphysis pubis The posterior shoulder sweeps the perineum and | The body is bom by a movement of lateral flexion Towards the mothers abdomen - Candidate replaces the doll and pelvis well Ty TTsure Bet to Success, for Student Nurses and Midwi in their Professional Examination (Question and Anvxe INSTRUC’ ri Using the model TTeptne OCANDIDATE. FOR PROCEDURE STATION 9 Played before you, demonstrate active management of third stage of labour. Report as you go along CHECKLIST FOR PROCEDURE STATIONS TITLE: ACTIVE MANAG ENT OF THIRD STAGE OF LABOUR andite wrets and explains procedure wo waniner pan tha ative manageryent of tye helps to reduce The ow hs Hage of about By oer the Wier empty tags of eb oy A. —t —}— Give oxytocin 5 unit IM 1 + +Gamp and cut the umbilical cord after pulsation has ceases or 2-3 minutes after birh | [-__ecrd about Som ‘and Sem from the umbilicus and cut the cord between the ties Face the newborn on the mother’s chest, helps initiate lactation Place the other hand just above the pubic bone and gently apply counter traction (push upwards on | the uterus to stabilize the uterus and prevent uterine inversion ‘Keep light tension on the cord and wait for strong uterine contraction (wo oF three minutes) TI “When the uterus becomes rounded or the lengthens, apply gentle pull downward on the cord 19 | deliver the placenta Continue to apply counter traction with the other hand | fe placenta does not decent in 30-40 seconds of controlled traction, release the tension and repeat | with the next contraction. “As te placenta delivers, hold it with both hands, and twist slowly so that membranes are expelled ] intact | Slowly pull to complete delivery T “Massage uterus if it is not well contracted T = Note time of delivery of placenta. Gently clean the perineum with warm water and clean cotton wool | ‘Apply a clean pad to the vulva {11 Replaces phantom well "Tidy the work field and makes it ready for the next candidate" INSTRUCTIONS TO CANDIDATE FOR PROCEDURE STATION Educate the junior student midwife on the uterine fibro CHECKLIST FOR PROCEDURE STATION 11 s TITLE: HEALTH EDUCATION ON UTERINE FIBROID: ae fo [4 — ‘Candidate greets the examiner and introduce self” rap Explains the procedure briefly hat we Rods ‘Muscular tumours that grow in the wall of the uterus. | | ‘Mostly benign: | Wihe gets fibroids? (predisposing factors)” | ~ Age women during the 30s and 40s through menopause Family history: having a family member with fibroids increase the risk Obesity: overweight women are at higher risk Eating habits: eating a lot red meat is linked with a higher risk of fibroids Causes of Fibroids Unknown, ~ Hormonal (affected by estrogen and progesterone levels), = _ Genetic (runs in famities) : | ‘Symptoms of Fibroids |. Heavy bleeding | - Painful periods | Enlargement of the lower abdomen ~ Frequent urination. - Pain during sex ~ Lower back pain ~ Complication during pregnaney and labour ~_ Reproductive problems e.g. infertility (very rare) ‘Types of Fibroids : ~ Sub mucosa: fibroids grow into the uterine cavity ~ _ Intramural: fibroids grow within the wall ofthe uterus ~ _ Subserosal: fibroids grow on the outside of the uterus, -_Pedunculated” + on PACE “un We vheruds Surgical Treatment for Fibroids ~ _ Mymectomy: surgery to remove fibroids without taking out the healthy tissue of the uterus ~ Hysterectomy: surgery to remove the uterus. ~ Endomertrial ablation: the lining of the uterus ~ Uterine Fibroid Embolization or Uterine Artery Embolization ‘Conclusion * Candidate is able to summarize the teaching —_Obvains clarity from ensures junior midwife understands the teaching‘sure Bet to Success, for Student Nurses and Midwives in their Professio INSTRUCTIONS TO CANDIDATE FOR PROCEDURE STAY Demonstrate ante-natal booking using the pregnant woma! Report as you go along. STATION CHECKLIST FOR PROCEDURE STATION 1 fore you. sal Examination (Question and Annsers) = _ Greets the women with courtesy [Introduces self oo Explain procedure to client =__ Tells her what is going to happen, listen to her and encourage her to ask question — Historytaking - Social history: Ask the client about the following - Name - Age ~ Marital status - Religion - Address = Occupation = Age and occupation of partner - Smoking = Activities of daily living = Living situation- house or bunglow? Stairs? Who does she live with? Etc. Menstrual History ~ Ask the age at first period (menarche) - First day of last normal menstrual period ~ LMP. = Duration of menses - Regularity of menses. - _ EDD- (LMP + Smonths + 7 days) = Contraceptive use? ~ COCP, Depot, Implant. ‘Symptoms of pregnancy - _ Nausea/voriting- if severe may suggest hyperemesis gravidarum - Tiredness = Urinary frequency — rule out UTI ~ Breast changes Fetal movements etc ‘Obstetric history (present and past) ~ Present — present LMP and EDD - Gravidarity - Pavity - Details of each pregnancy = __ Baby sex/weight/current healthINSTRUCTIONS TO CANDIDATE FOR PROCEDURE STATION 3 Using the moe! and instrument provides, Report as you go along nl LIST FOR PROCEDURE STATION 3 AL INSP F THE CERVIX WITH ACETIC ACID TITLE: VISUAL INSPECTION Of Sure Bet to Swocess, for Student Nurves and Midwives in their Professional Examination (Question and Anwser ‘demonstrate the visual inspection of cervix with acetic acid 0 [% inins the procedure, the merit and demerit of the procedure ‘explained. Obtain inform Candidate exp consent ‘Sinn the reasons forthe examination and when to perform: within 20 weeks of pregnancy, 6 weeks pox - partum, when a woman is suspected of having an STL “able should be set which contain, bivalve vaginal speculum, sterile glove, normal saline veewne kidney dish war water, acetic aci, sterile cotton wool, sponge holding forceps, gallipots, oan client in dorsal or Tithotomy position with patients heel on the stir ups and have the patient ste her hips until she contact your hands atthe edge of the table ‘Wea gloves on both hands pick and warm speculum by holding it in hand and lubricate with clean water or normal saline ‘Expose the introitus by spreading the labia from below using the index and middle fingers of the non- dominant gloved hand Tnsex the speculum with bills horizontal, pointing and pressing slightly doward 1 Avoid pressure on the anterior structures, catching the skin or pulling hairs which can cause discomfort (Oper the bills ofthe speculum slightly to keep the vagina walls in sight and continue the insertion tum the cervix is seen Position the speculum’s bill so that cervix falls in between (Open the bills of the speculum 2 or 3cm using the thumb lever = Secure the speculum by turning the thumb nut VAGINAL SPECULUM EXAMINATION Pecform VIA by cleaning the cervix with clean water or normal saline Carefully observe the cervix and the vaginal walls for lesions or discharge Damp the cervix with 3-5% acetic, wait for I minute and read the result with white after the ‘pplication of acetic acid, this is called ACETOWHITE reaction and it is a positive result for cancer recusor cells ~ Ifthere is no change in color result is negative. Withdraw the speculum slightly, loosen the screw on the speculum and allow the bills to fall together ~ Explain result to client and give her appointment or refer based on result ~_Tidy the work field and make it ready for the next candidatern _ Sure Beto Succes, for Student Nurses and Midwives in thet Profesional Examination Aer 5 INSTRUCTIONS TO CANDIDATE FOR PROCEDURE STATIONS ‘Using the model and equipment provided, demonstrate the steps in positioning the baby for Kawearee mater cary Tens yen gece "1 STATION 5 CHECKLIST FOR PROCEDURE ST/ SMOTHER CARE TITLE: STEPS IN POSITIONING THE BABY FOR KANGARO - o T% TA ‘STEPS. “Great the client and introduce yourself ~ Explain procedure and gain permission to proceed = Dress the ayn diapers, sock and cap on the ead instruct client to put ona font open toprblouse = Place the baby between the mother's breast in an upright position, chest with the baby feet below the mother's breast = Secure baby on the client chest with a cloth firmly or the binder ~ Support baby’s head by pulling the top ofthe wrap upto just under the baby's ear to allow for breastfeeding = Thehead tured to one side ina slightly extended position ~The slightly extended head position keeps the airway open and allows eye-to-eye contact between the mother and the baby = Avoid both forward flexion and hyperextension of the head = The baby’s hip should be flexed and extended in a frog or fetal position = The arms should also be flexed = Tiethe cloth firmly enough so that when mother stand up, the baby does not slide out ~ Make sure the tight part ofthe cloth is over the bay's chest ~ Baby's abdomen should not be constricted and should be somewhere atthe level of the mother's epigastriim Tdicate for Kangaroo Mother Care: = Preterm infants weighing less than 1.Skg = And breathing independently Use skin to skin contact continuously until baby weighs _2-5kg | INSTRUCTIONS TO CANDIDATE FOR PROCEDURE STATION 7 Using the model and equipments/instruments displayed before you, demonstrate bimanual compression of the wteres, Report as you go along, (CHECKLIST FOR PROCEDURE STATION 7 ‘TITLE: BIMANUAL COMPRESSION OF THE UTERUS(EXTERNAL) ‘STEPS Ce ae a = Candidate explain the procedure and gain permission 10 proceed = Prepare and explain tothe client that because she is bleeding much her uterus needs to rubbed = Place her well on dorsal position = Ensure bladder is empty = Calls for an assistance Provide privacy and wear sterile gloves ‘Stand on the patient right side Place one hand on the abdominal wall and rub the uterus to make it contract Expels blood clots If bleeding does not stop place one hand on the abdomen pressing down the fundus of the weru nd the other hand above the symphysis pubs and press both hands together 10 compress ing vessels a the placenta ste for Sminu observin bleeding at the vulva “es while ial ~ Ask assistant to give 10iu of oxytocin IM = Put baby to breast to enhance oxytocic release = Check and record vital signs - Estimate blood loss and record It bleeding didnot stop continue to hold the contracted bimanual compression ‘Tidy patient and make her comfortable Return used instrument and clean the work field lterus and prepare for internalINSTRUCTIONS TO CANDIDATE FOR PROCEDURE ST) sing the placenta displayed before you, inspect Report as you go along CHECKLIST FOR PROCEDURE STATION? ay) _ dnvesers) inn westion and Al Seba ees form Noe Sden Naren Midi Ml Pres seminan sind A) rATION 9 ___TITLE: INSPECTION OF THE PLACENTA, MEMBRANEAND CORD ie RL Tee procedure is performed immediately after birth Candidate put on gown, apron and glove 'Bxamines the placenta under running water okt placenta by the cont Allow the membranes to hang to ad inspection Avhand is spread outside the membranes to aid inspection Lay placenta on a flat surface xamine fetal surface and report as follows! [Ammnion: should be peeled from the chorion right up to the umbilical cord Disinbution of blood vessels ‘Number of blood vessels in the cord = _ State of membranes ‘Examine maternal surface and report as follows: Broken fragment of cotyledon should be carefully replaced = Completeness of the lobes ~ Attachment of blood vessels (Check for abnormalities of the placenta eg. succenturiate lobe ~ Report any missing lobe ~ Wash and dry hands = _Tidies the work field after the procedure INSTRUCTIONS TO CANDIDATE FOR PROCEDURE STATION 11 Describe birth preparedness and complication readiness to the pregnant woman before you Report as you go along. (CHECK LIST FOR PROCEDURE STATION 11 Tk TILE: BIRTH PREPAREDNESS AND COMPLICATION READINESS mk [mk ‘Steps nodes self professionally to the Client ‘Explain birth preparedness and complication readiness ~ A process of planning for safe delivery and anticipating the actions needed in case of emergency, 3 Goal: reduce matemal mortality and morbidity through effective planning Tor emergencies “4 Discuss with the cient the elements oF a bith plan, which inclode + Skilled provider: Assist the woman in making arrangement fora skilled providerto attend the birt or make sure she reaches the skilled provider (or health facility a the appropriate time) =Place of Delivery: Assists the woman in making arrangement for place of birth or depending ‘on her individual needs, recommend a specific level of healthcare facility += Transportation: Let the woman know the available transportation system within her locality ‘and make necessary arrangement for transportation tothe place of birth = Emergency transportation to an appropriate health care facility if danger signs arises =Funds: Educate her on the important of personal savings or other funds that she can access when needed to pay for care during normal birth and emergency necessary discuss emergency funds within the family, community and so on Decision making: Ask for decision maker in the family or who else ean in the absence of the person, ‘Support: assists the woman in making arrangement for necessary suppor, bith companion and who to stay with other kids if available = Blood donor: Assists the woman and identifies an appropriate donor and make person is available in case of emergency. | Items needed for clean safe birth Educate the woman on items need for birth eg perineal cloths/pads, soap, placenta theamination (Question and Anwrers) INSTRUCTIONS To ©, Poe ane! S TO CANDIDATE FOR the pregnant w ; FOR PROCEDURE STATION 1 Using nm weman before you, demonstrate and deseribe vaginal examinatien lor 8 womee ia lboer Report as you go along CHECK LIST FOE PROCEDURE STATION 1 w STEPS Tk —Tniroduces self properly to the woman ~e a =] ~ Explains she is carrying outa vagina examination on her to gain co- | ‘operation and consent ~ Ensure she empties her bladder = Palpates totally finding with vaginal findings = Seren her to provide privacy = Position her dorsally with knees flexed and = Swabs the vulva using the correct technique = Lubricates the first and index finger = With the woman fully relaxed inset the two finger gently Explores the vagina digitally and quickly assess the pelvic capacity Z = Report's findings as follows or otherwise i.Vulve normal fi. Vagina- warm and moist iii Cervix — soft and thin or soft and thick iv.Os~2 or 3em dilated ‘Presentation: vertex above or below the level ofthe ischial spines vviMembranes- intact, no cord felt - Reports her findings = __Keep her comfortable and appreciate her for her co-operds jon Oe a postion. NS pr ‘ang STRUCTION ‘TO CANDIDATE FOR PROCEDURE STATION 2. ine tbe teand ‘trumentiequipment displayed before you, demonstrate and & mgecmtannation slo sng ald DEC Report as you go along. NB CHECK LIST FOR PROCEDURE STATIO! 5% — (WK) OF P73 ‘TITLE FREPARATION OF DECONTAMINATION SOLUTION USING LIQUID. ae sos 4 Defines decontamination as a process of making inarumenis safe 1o be handled —_| t——| ‘LBrumerate purpose of decontamination, Prevention : of transmission of infections via instrument and surfaces tat ‘have! may come in contact with blood or other body fluids with suit | — ‘Explains formla for preparing a chlorine solution from jk as eblanne in tiauid bleach __No of parts of water_ ‘S chionine desired ‘needed per bleach eg3K = 71-6 L oy | ‘4.Mention the steps for decontamination as, spe (Cleaning in soapy water HLD(igh level Disinfectant) Storage ‘a Explain decontamination step as ~ Soak instruments for 10 minutes I + Open or unlock all jointed instrument e'g forceps | 7 Do not leave instruments for more than 10 minutes ~ Decontamination solution can be used to deconterminate large surfaces ¢.g ‘examination tables, operating tables, laboratory bench tops and other enna ~All instruments should be submerged completely in the decontamination solution | Serta ae +> Wear thick utility gloves before cleaning instruments. ~Glean instruments with detergent rather than soap as it leaves stains. | Clean instruments with brush where necessary. | = Rinse all instruments with clean water ''€ Sep IIE High -level disinfection (HLD) Make 0.5% chlorine solution 7 all instruments in solution for 20 minutes ~ Open al hinged instruments and disassembled those with sling or multiple parts Place bow/ or container upright not upside down and fil with solution + Do not add or remove any instruments once timing has bese ~ Remove instruments from solution using dry, high evel st deifected pickups eg cheatle forceps ~ Rinse thoroughly with boiled water to remove reside that chlorine . leaves which is toxic to tissues and skin _ | 2 SepiV Storage Store only dry items Store in an enclosed cabinet if possible ora HLD tray and cover Instruments remain sterile for up to 7 days = Ifnot use re-process instruments again. S.Discard and tidy the area