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BREAKDOWN The first pregnancy way term with 40 weeks gestation by f n!a" height# The baby was !e"i$ere!

at N!iran!e %ea"th &entre an! she !e"i$ere! by 'pontaneo s (erte) De"i$ery b t s staine! a tear which was s t re! an! hea"e! witho t any comp"ications# The baby was *400g at birth an! was born witho t any congenita" nor ! ring birth comp"ication# +abo r ha! taken abo t ,4 ho rs th s from - pm to .am# /rs# Nkhata has no history of ante0part m or intra0part m haemorrhage as we"" as 1re0ec"ampsia or ec"ampsia#

1'2&%O+O34&A+ %4'TOR2 /rs# Nkhata sai! that the pregnancy that she has now was a p"anne! one an! a"so that the !ecision to ha$e the pregnancy was ma!e by both her an! her h sban! s ch that they both were $ery happy for the pregnancy# 'he a"so sai! that she !i! not ha$e any psycho"ogica" prob"ems ! e to both pre$io s pregnancy as we"" as the c rrent one e)cept for the fear of "abo r pains# 4//5N4'AT4ON' /rs# NKhata e)p"aine! that she ha! recei$e! two !oss of Tetan s To)oi! (accine with the first pregnancy an! two !oses with the c rrent pregnancy# %owe$er6 she e)presse! "ack of know"e!ge on the fre7 ency an! n mber of !oses of tetan s To)oi! (accine she is e)pecte! to recei$e !espite knowing the importance of the imm ni8ations# EN(4RON/ENTA+ %4'TOR2 On en$ironmenta" history6 /rs# NKhata sai! that she has a two be!room ho se with a seat room which is occ pie! by three members of thee fami"y6 the h sban!6 the first born chi"! an! herse"f# The ho se is iron sheet roofe!6 cement f"oore! an! e"ectrifie!# 'he sai! that she gets water from a &omm na" Water 1oint which is abo t 90 metres from her ho se b t she makes s re she has eno gh water a"" the time by keeping some in b ckets knowing that there is a prob"em of water scarcity in her area at times#

On waste !isposa"6 she sai! that there is a r bbish pit behin! the ho se which is se! for waste !isposa" an! she keeps b rning the waste in the pit to pre$ent it from being b"own back to the ho se by win! when it:s f ""# 'O&4O0E&ONO/4& %4'TOR2 /rs# Nkhata is a ;orm fo r +ea$er c rrent"y working with K5K5 /atches &ompany as a 1acker# %er h sban! is an e"ectrician who is se"f emp"oye!# 'he sai! that her fami"y is ab"e to get their nee!s an! necessities from the combine! income that they get from their ! ties an! they "i$e happi"y# /rs# Nkhata reporte! no e)pos re to increase! work"oa! for she is c rrent"y gi$en "ight work by her bosses ha$ing n!erstoo! her con!ition# /rs# Nkhata !oes not smoke any kin! of cigar nor !rinks any kin! of a"coho" a"tho gh the h sban! takes a"coho" b t in a reasonab"e manner# 1RE'ENT OB'TETR4& %4'TOR2 /rs# Nkhata is gra$i!a < 1ara , mother +ast norma" menstr a" perio! = E)pecte! !ate of !e"i$ery = 3estation by !ates %4( 'tat s (DR+ = = = ,9th > "y6 <0,0 <<n! Apri"6 <0,, *0 weeks6 !ays Non0reacti$e Non0reacti$e

'he is c rrent"y not on any me!ications e)cept for the ;erro s ' "phate she is gi$en when se $isits antenata" c"inic meant to he"p in the form "ation of haemog"obin# E+4/4NAT4ON

/rs# Nkhata has no any prob"em with either bowe" mo$ement or rination# %owe$er6 she sai! that she ha! in the ear"y !ays of pregnancy a prob"em of fre7 ency mict ration#

OB>E&T4(E DATA Vital Signs Temperat re B"oo! 1ress re 1 "se Rate Respiration Rate = = = = *?#-@& ,<0A-0mm%g -0 beats peer min te << breaths per min te

3ENERA+ A11EEARAN&E /rs Nkhata is a ,?< cm ta"" woman6 s"im an! "ight brown in comp"e)ion# 'he was wearing a re! b"o se an! a b"ack skirt with a pair of b"ack s"ip0ons BshoesC# On this !ay she weighe! 9D ki"ograms6 gaining < ki"ograms from the weight ! ring her booking $isit which was 9? ki"ograms# %EAD %er hea! is o$oi! in shape with "ong chemica" ma!e hair an! there was neither !an!r ff nor presence of scars or masses on the sca"p# ;A&E There were no signs of facia" oe!ema on both inspection an! pa"pation# The face a"so !i! not ha$e scars on inspection# E2E' The eyes are symmetrica" an! o$oi! in shape with no signs of peri0orbita" oe!ema an! ha! a pink conE ncti$a#

EAR' The ears are symmetrica" with the pper ears in "ine with the o ter bor!ers of the eyes# There were no sore6 no ear !ischarge6 no "esions an! no signs of inf"ammation on pa"pating the pre an! post a ric "ar "ymph no!es# NO'E %er nostri"s are symmetrica" with no any !ischarge# 'he has no history of epista)is an! !i! not ha$e any po"yps in the nostri"s# /O5T% %er "ips were smooth with no sores or cracks# %er tong e an! ora" m cosa were pink with no sore6 no korp"iks spots or signs of can!i!iasis# There were neither !ecaye! teeth nor gingi$itis# 'he has neither c"eft "ip nor c"eft pa"ate# The tonsi"or6 s b0 man!ib "ar an! s b menta" "ymph no!es were not en"arge!# NE&K 'he has no prob"ems with neck f"e)ion as we"" as forwar! an! backwar! neck ben!ing# On inspection6 there were no ob$io s signs of !isten!e! E g "ar $eins6 no sores6 no ob$io s "esions# On pa"pation6 there were neither signs of en"arge! thyroi! g"an! nor en"arge! !eep cer$ica"6 s b0c"a$ic"e an! infra 0c"a$ic"e "ymph no!es# &%E'T On inspection6 the chest !i! not ha$e scars6 "esions or signs of a pigeon chest with norma" respiratory mo$ements# On a sc "tation6 there were norma" " ng an! heart so n!s# BREA'T' The breasts are symmetrica" in both si8e an! shape an! they both are "ight brown in co"o r with !ark a""eorae# The breasts ha$e no scars6 sca"es6 "esions6 no sores6 rashes6 re!ness an! no !imp"ing# On breast pa"pation6 no masses were fe"t e)cept for the norma" mammary g"an!# The nipp"es are !ark in co"o r6 c"ean an! not in$erte!#

511ER EFTRE/4T4E' The arms are symmetrica" with no signs of oe!ema on both inspection an! pa"pation# 'he has a capi""ary refi"" of "ess than * secon!s an! has pink pa"ms# %owe$er6 /rs# Nkhata reporte! ha$ing ting"ing sensation of the pper e)tremities# ABDO/EN On inspection of the ab!omen6 there was a !ark "inea nigra6 some striae gra$i!a" m with no sores or scars# The ab!omen was o$oi! in shape with a me!i m si8e# ;oeta" mo$ements were a"so obser$e! me!ia""y on inspection# +i$er an! sp"een were not pa"pab"e in!icating absence of organomega""y# The ca"c "ate! gestation by !ates was *0 weeks an! Fundal height Pelvic, Lateral and Fundal Palpation ; n!a" height ;oeta" 1resentation = ;oeta" +ie ;oeta" 1osition ;oeta" %eart Rate = = = = <. weeks

&epha"ic +ongit !ina" Right Occipita" Anterior ,4< beats per min te

+OWER EFTRE/4T4E' The "ower e)tremities are symmetrica" with no scars6 $aricose $eins as we"" as signs of oe!ema on inspection# On pa"pation6 no tibia"6 ank"e or pe!a" oe!ema was !etecte!# No signs of (aricose (eins or Deep (ein Thrombosis were !etecte! on pa"pation of the c ff m sc"es# Howmans sign was not obser$e! on f"e)ion on the feet# 3EN4TA+4A 5pon inspection of the genita"ia6 no oe!ema6 sores6 warts6 genita" "cers6 abnorma" $agina" !ischarge or signs of hematoma were obser$e!# There were no signs of

$aricose $eins or genita" m ti"ation or circ mcision seen# The $agina" !ischarge was mi"!6 whitish an! o!o r"ess#

1ROB+E/' ANEED' 4DENT4;4ED# Know"e!ge !eficit on se) a"ity ! ring intra an! post part m perio!s re"ate! to inabi"ity set times on when to stop an! res me se)# +ack of a!e7 ate information on imm nisations re"ate! to "imite! information gi$en on imm nisations as e$i!ence! by inabi"ity to o t"ine the norma" sche! "e for Tetan s To)oi! (accine# Know"e!ge !eficit on ;oc sse! Antenata" &are an! its importance re"ate! to "imite! information gi$en abo t foc sse! antenata" care as e$i!ence! by "ate coming for initia" $isit# 1ossibi"y of not sing fami"y p"anning metho!s re"ate! to ntr e spec "ations that Depo0 1ro$era is phasing o t#

&ARE 1RO(4DED ;oc s Antenata" &are "ooks at comprehensi$e care gi$en to a pregnant woman with specifie! type of care per each $isit of the fo r e)pecte! $isits that the woman atten!s antenata" c"inic# 4t "ooks at 7 a"ity of care an! not 7 antity of the n mber of $isits# ;oc se! Antenata" &are emphasises on treating e$ery mother as an in!i$i! a" or ni7 e person with in!i$i! a" prob"ems an! nee!s# The care that was gi$en to /rs# Nkhata was base! on the prob"ems an! nee!s that she ha! as we"" as specific care accor!ing to hergestation age# On this !ay6 /rs# Nkhata was treate! comprehensi$e"y starting with history taking to fi"" in gaps fo""owe! by %4( an! 'yphi"is tests then f "" physica" assessment which in$o"$e! sing a"" the fo r mo!a"ities of inspection6 pa"pation6 a sc "tation an! perc ssion#

4 ma!e s re that the c"ient:s care was pro$i!e! in a $ery con! ci$e en$ironment6 th s ens ring pri$acy as we"" as c"ean"iness# 4 ma!e s re that she fe"t we"" taken care of an! we"come to the c"inic by being respectf "6 accommo!ati$e an! "etting her ask 7 estions an! e)press fears than "ooking at the care as a b r!en thro gho t the proce! res# EN(4RON/ENT D ring the fi""ing in of gaps6 co""ection of important information that was misse! o t on the booking !ay6 an en$ironment that ens re! pri$acy an! comfort was ens re!# The !ata was co""ecte! at an enc"ose! p"ace where no one e"se co "! "isten to what was being !isc sse! an! this ma!e the c"ient to be more open an! to gi$e the information that was re7 ire!# +ikewise6 ! ring the physica" e)amination6 a c bica" was se! to promote pri$acy consi!ering that proce! res in$o"$e! this time inc" !e e)pos re of sensiti$e areas "ike the chest6 ab!omen an! genita"ia# ;4++4N3 4N O; 3A1' 5pon re$iew of the Antenata" car!Apage for /rs# Nkhata se$era" areas that re7 ire! to be fi""e! in were rea"ise!# 4n a!!ition to that6 some more areas in the hea"th passport were i!entifie! which a"so nee!e! fi""ing in# The hea"th !i! not ha$e information on her fami"y me!ica" history an! her me!ica" an! s rgica" history which is s ppose! to be fi""e! o the first an! secon! pages of the hea"th passport an! this is a"so where some important persona" !ata is !oc mente!# 'ee Appen!i)###### showing the pages after fi""ing in# Not on"y that b t a"so b"oo! gro p an! rhes s factor were not teste! b t sti"" more being an important information especia""y when it comes to emergencies "ike anaemia6 4 sti"" referre! her go a"so go for the tests when she goes for the other tests# On the antenata" page as we""6 gra$i!ity an! parity of the mother were not in!icate! ! ring the first $isit b t got !oc mente! on this $isit# TESTS

;oc se! Antenata" recommen!s mothers n!ergoing se$era" !ifferent tests at !ifferent $isits an! !ifferent gestation ages# ' ch tests are "ike %4(6 'yphi"is6 haemog"obin "e$e"6 rine protein an! &D4 co nt in case of those who are %4( positi$e b t not on antiretro$ira" therapy# %4(6 (DR+ an! %aemog"obin "e$e" are the tests that are e)pecte! to be !one on booking so as to ha$e a base"ine !ata for some of them "ike %4( an! haemog"obin are teste! again after sometime i#e# %4( is teste! again after * months whi"e haemog"obin "e$e" is reteste! at *? weeks# 5rine protein is e)pecte! to be teste! e$ery $isit from first to fo rth $isit b t nfort nate"y none of these were !one on the first $isit On this $isit 4 p"aye! a ro"e of he"ping /rs# Nkhata get teste! for %4( an! 'yphi"is whose res "ts came o t negati$e as in!icate! on the antenata" car! BAppen!i)#####C after fi""ing in the gaps# %owe$er6 4 referre! the c"ient to G een E"i8abeth &entra" %ospita" for the tests which co "! not be !one at N!iran!e Antenata" &"inic ! e to "ack of materia"s "ike the haemac e kits an! protein !ipsticks# The referra" was !one after N!iran!e %ea"th &entre a"so reporte! not ha$ing the materia"s 1%2'4&A+ EFA/4NAT4ON As in!icate! in thee obEecti$e !ata6 ! ring physica" assessment6 no specific prob"ems were presente! or !etecte! from /rs# Nkhata an! a"" the fin!ings were !oc mente! on the antenata" car! an! were a"so comm nicate! to the c"ient# 'ee Appen!i)###### showing the antenata" car! with fin!ings of the ab!omina" assessment# /ED4&AT4ON' /ost of me!ications at the Antenata" &"inic are gi$en accor!ing to gestation ages of the mothers an! most of them are gi$en for prophy"actic p rposes i#e# '1 is gi$en to pre$ent a mother from ma"aria6 ;erro s ' "phate is gi$en to pre$ent anaemia whi"st Aben!a8o"e is gi$en to combat worms infestation# '1 is gi$en e$ery fo r weeks between the gestations of ,? to *? weeksH ;erro s ' "phate is gi$en at e$ery $isit thro gho t pregnancy whi"st Aben!a8o"e is gi$en E st once an! at first $isit# '1 is gi$en

in s ch a way to pre$ent the tetratonegic effects that the s "ph r may ha$e on the foet s# On this $isit6 /rs# Nkhata6 ha$ing the gestation age of *0 weeks6 she was gi$en both '1 tab"ets B*C as we"" as ;erro s ' "phate B*0 tab"etsC# '1 was gi$en after confirming that 4 weeks ha! passe! since the "ast !ose was taken# /4DW4;ER2 &ARE

ANA+2'4' O; &ARE A "ot of things an! care were !one ! ring /rs# Nkhata:s booking antenata" $isit# 4 sho "! sincere"y gi$e cre!it to the care pro$i!er who han!"e! /rs# Nkhata on the first $isit for the goo! Eob for most things e)pecte! to be !one on booking especia""y !ata nee!e! to be fi""e! on the antenata" car! was fi""e!# %owe$er6 not e$ery bit of information was co""ecte! an! !oc mente!H for e)amp"e6 no information was !oc mente! in!icating gra$i!ity an! parity on the antenata" car!# This information is $ery important to e$ery mi!wife who wo "! come into contact with the c"ient for it gi$es a pict re of the kin! of c"ient one is !ea"ing with i#e# prim0gra$i!a6 m "tigra$i!a or gran! m "tipara# These a"so !etermine the kin! of care that a c"ient wi"" get# 'econ!"y6 the !ata !oc mente! on the antenata" car! for ab!omina" assessment seem to ha$e been taken for grante! by the care pro$i!er ! ring the pre$io s $isit# %a$ing been gi$en the !ate for the "ast norma" menstr a" perio!6 there was no reason heAshe co "! not ca"c "ate the gestation by !ates for this !ay knowing its importance# The ca"c "ate! gestation by !ates is $ery important to a mi!wife for it gi$es a base comparison with the f n!a" height !one by tape meas re or finger brea!ths# 4t a"so seems that the mi!wife who care! for /rs# Nkhata ! ring the first $isit !oes not know what it means when we say presentation by ab!omina" assessment for sheAhe in!icate! that it was a $erte) presentation of which $erte) can not be !etermine! by pe"$ic pa"pation b t $agina""y# 'heAhe wo "! rather in!icate cepha"ic for presentation an! a position i#e# Right Occipita" Anterior6 +eft Occipita" Anterior or other positions#

B"oo! 1ress re is on of the important $ita" signs in pregnant women an! nfort nate"y6 it was not !one on the booking !ay# 2es its tr e there co "! be no a sphygmomanometer b t sti"" more a referra" to N!iran!e on"y for a b"oo! press re check wo "! be he"pf "# 1regnant women are at a risk of !e$e"oping pre0ec"ampsia which is high b"oo! press re in pregnancy an! can on"y be !iagnose! if b"oo! press re if checke! at e$ery $isit# 5rine protein test is a"so $ita" in the way that presence of protein in rine is in!icati$e of pre0ec"ampsia /rs# Nkhata ha! come for booking at a gestation age of <? weeks by f n!a" height an! this c"ear"y shows "ack of know"e!ge on foc se! antenata" care as we"" as its importance# /rs# Nkhata being a 1ara one with birth of first born in <00- when foc se! antenata" was a"rea!y n!er imp"ementation6 it was e)pecte! she m st ha$e a"rea!y been e)pose! to s ch type of care# 5nfort nate"y6 the mother came at <? weeks gestation fo""owing the o"! ro tine antenata" system# When i aske! her6 she sai! coming at <0 weeks an! abo$e was what she knew# This mother "acke! information on foc se! antenata" an! its importance which ref"ects that she was not gi$en eno gh information abo t it ! ring her first pregnancy# EF1E&TED ;4ND4N3' ;OR T%E NEFT (4'4T /rs# Nkhata ha! come for her secon! antenata" $isit at a gestation age of <. weeks6 howe$er6 accor!ing to foc se! antenata"6 by this time she was s ppose! to becoming for her thir! $isit which is s ppose! to bee between <D weeks an! *< weeks# 4n this case /rs# Nkhata wi"" ha$e her thir! an! fina" norma" $isit at *? weeks tho gh at this time a mother is norma""y e)pecte! to be coming for a fo rth $isit# When /rs# Nkhata comes at *? weeks which wo "! be on #############6 she wi"" n!ergo se$era" assessments some that are ro tine "ike $ita"s signs whi"st some wi"" base on her con!ition as being in thir! trimester or ha$ing a *? weeks gestation# 'ome of thee care wi"" a"so base of the gaps that the mi!wife wi"" i!entify as being "eft o t ! ring the pre$io s $isit# On the ne)t $isit the mi!wife wi"" ha$e to check on the care gi$en on the pre$io s $isit6 e$a" ate an! then ha$e a basing for p"anning hisAher care an! this wi"" a"so !epen! on the c rrent prob"ems an! the nmet nee!s of the c"ient#

The mi!wife wi"" co""ect some information from the c"ient to fi"" in the gaps that are not fi""e! ! ring this $isit# 'he wi"" a"so check on the progress of pregnancy by asking /rs# Nkhata on how she fairing with her pregnancy# 'ome of the 7 estions she may ask are the presence of foeta" mo$ements an! minor !isor!ers of pregnancy for this wi"" he"p the mi!wife to iso"ate the prob"ems that the c"ient has at present# /rs# Nkhata wi"" a"so ha$e to n!ergo se$era" tests which wi"" be ! e by this time i#e# haemog"obin "e$e" an! rine protein# %aemog"obin "e$e" is checke! on booking an! in thir! trimester6 at *? weeks to be specific whi"st for rine protein is checke! at e$ery $isit to the antenata" c"inic# (ita" signs are another aspect that wi"" ha$e to be checke! by the mi!wife as part of monitoring progress of pregnancy# Any abnorma"ity in the $ita" signs is in!icati$e of a prob"em in the pregnant woman# ;or e)amp"eH high b"oo! press re co "! be in!icati$e of pre0ec"ampsia6 fe$er co "! in!icate a systemic infection an! increase! respiratory rate co "! mean !iffic "ty breathing6 tho gh6 it is tho ght to be norma" at *? weeks# 1hysica" assessment wi"" a"so be !one inc" !ing genera" assessment as we"" as ab!omina" assessment# 3enera" assessment wi"" in$o"$e a hea! to assessment an! no abnorma"ity is e)pecte! from it# The ab!omina" assessment wi"" in$o"$e inspection6 pa"pation an! a sc "tation of the ab!omen to check si8e an! shape of ab!omen6 f n!a" height6 "ie6 presentation an! position of foet s as we"" as foeta" heart rate# The ab!omen is inspecte! for scars6 "inea nigra6 striae gra$i!a" m6 si8e an! shape6 foeta" mo$ements6 b"a!!er f ""ness an! $isib"e organomega""y# Thee f n!a" height wi"" be meas re! sing a tape meas re of finger brea!ths so as to !etermine the age of pregnancy# Then the pe"$is wi"" be pa"pate! for presentation which is norma""y6 "atera" pa"pation wi"" be !one to note the "ie an! position of the foet s# ; n!a" pa"pation wi"" a"so be !one to r "e o t m "tip"e gestation or presentation in a sit ation where the hea! is not "ocate! in the pe"$ic# ;oeta" heart rate wi"" a"so ha$e to bee a sc "tate! sing a feta"scope to confirm we""being of the foet s#

EF1E&TEED ;4ND4N3' ; n!a" height ;oeta" 1resentation = ;oeta" +ie ;oeta" 1osition ;oeta" %eart Rate = = = = *? weeks

&epha"ic +ongit !ina" Right Occipita" AnteriorA+eft Occipita" Anterior ,40 I ,?0 beats per min te

The abo$e e)pecte! fin!ings are thee norma" e)pecte! fin!ing in the absence of possibi"ity of ha$ing abnorma" fin!ings DR53' On this $isit /rs# Nkhata wi"" on"y be pro$i!e! with ;erro s ' "phate as a !r g to s pp"ement iron for haemog"obin formation# '1 wi"" not be gi$en beca se it is be"ie$e! to ha$e a teratonic effect on the fet s when gi$en at the gestation of *? weeks an! abo$e# EF1E&TED D4'ORDER' By this time the e)pecte! !isor!ers that /rs# Nkhata may ha$e are !iffic "ty breathing6 fre7 ent mict ration6 hea!ache6 constipation6 backache6 oe!ema $aricosities6 haemorrhoi!s an! cramps for these are the common !isor!ers that s a""y come in thir! trimester# MANAGEMENT OF THE E PE!TE" M#N#$ "#SO$"E$S HEA$T%&$N This is a b rning6 irritating sensation in the oesophag s a"so known as gastric ref" ) B;raser6 &ooper an! No"te6 <00?C# 3astric ref" ) common"y occ rs as a res "t of

!e"aye! gastric emptying6 !ecrease! intestina" moti"ity6 an! !ecrease! "ower oesophagea" sphincter tone# 4f it happens that /rs# Nkhata !e$e"ops heartb rn6 e! cation an! co nse"ing on li'est(le
)odi'ication wi"" be pro$i!e! an! wi"" inc" !e awareness of post re i#e# /aintaining pright positions Bespecia""y after mea"sC6 s"eeping in a proppe! p position an! dietar( )odi'ications Be#g# sma"" fre7 ent mea"s6 eating s"ow"y6 re! ction of high0fat foo!s an! caffeineC#

S*ELL#NG+E"EMA As the growing ter s p ts press re on the $eins that ret rn b"oo! from feet an! "egs6 swo""en feet an! ank"es may become an iss e# At the same time6 swe""ing in "egs6 arms or han!s may p"ace press re on ner$es6 ca sing ting"ing or n mbness# ;" i! retention an! !i"ate! b"oo! $esse"s may "ea$e the face an! eye"i!s p ffy6 especia""y in the morning# To re! ce swe""ing6 the c"ient wi"" be a!$ise! to se co"! compresses on the affecte! areas# +ying !own or sing a footrest may re"ie$e ank"e swe""ing# 'he might e$en e"e$ate her feet an! "egs whi"e she s"eeps which wi"" a"so minimise the swe""ing by gra$ity# ",SPNEA This is a common symptom between the gestation of *4 an! *? weeks# 4t is as a res "t of the press re by the growing ter s on the !iaphragm B;raser6 &ooper an! No"te6 <00?C# 4f /rs# Nkhata happens to !e$e"op !yspnoea6 she wi"" be e! cate! of the physio"ogy of the prob"em for her to n!erstan! what:s happening# 'he wi"" a"so be a!$ise! on s"eeping in semi0fow"ers position so as to be increasing the area for " ng e)pansion hence impro$e! respiratory con!ition# 'he wi"" a"so be enco rage! to ha$e perio!s an! resting to re! ce the bo!y nee! for o)ygen# !ONST#PAT#ON &onstipation in pregnancy especia""y thir! trimester is s a""y ca se! by re! ce! moti"ity of "arge intestine which comes ! e to the m sc"e "a)ati$e effect of the hormone

progesterone which is pro! ce! in "arge amo nts this perio!6 4ncrease! water re0 absorption from "arge intestine ! e to hormone a"!osterone effect6 1ress re on the pe"$ic co"on by the pregnant ter s an! se!entary "ife ! ring pregnancy # if the c"ient wi"" come with the prob"em of constipation6 she wi"" a!$ise! on !rinking p"enty of f" i!s6 high fibre foo!s an! get p"enty of e)ercise# These he"p in softening the bowe"s hence re! ce! risk of constipation# %A!-A!HE D ring pregnancy6 "igaments become softer an! stretch to prepare for "abo r# This can p t a strain on the Eoints of the "ower back an! pe"$is6 which can res "t in backache# To o$ercome this prob"em /rs# Nkhata wi"" be a!$ise! to a$oi! hea$y "ifting6 ben! her knees an! keep her back straight when "ifting or picking p things from the gro n!6 mo$e her feet when t rning an! a$oi! s !!en twisting mo$ements6 Work at a s rface high eno gh to pre$ent her from stooping an! to sit with her back straight an! we""0 s pporte!# Another a!$ice wi"" be that she sho "! make s re she gets eno gh rest6 partic "ar"y "ater in pregnancy#

F$E.&ENT M#!T&$AT#ON As the baby mo$es !eeper into yo r pe"$is towar!s term of pregnancy6 a woman fee" more press re on yo r b"a!!er an! may fin! herse"f rinating more often6 e$en ! ring the night# This e)tra press re may a"so ca se her to "eak rine J especia""y when she "a ghs6 co ghs or snee8es# 4n this case the c"ient wi"" E st ha$e to be ass re! that this is norma" with a goo! e)p"anation of the ca se# 'he wi"" a"so ha$e to be a!$ise! on perinea" care to pre$ent ascen!ing infections# !$AMPS &ramp is a s !!en6 sharp pain6 s a""y in ca"f m sc"es or feet# 4t is most common at night6 b t nobo!y rea""y knows what ca ses it# The woman wi"" be oriente! to ski""s she wi"" ha$e practice to combat the prob"em for e)amp"eH p ""ing p of toes har! p towar!s the ank"e6 or r b the m sc"e har!# 3ent"e e)ercise in pregnancy6 partic "ar"y ank"e an!

"eg mo$ements6 which can impro$e b"oo! circ "ation an! may he"p to pre$ent cramp occ rring an! p"enty of ca"ci m rich foo!s B"eafy green $egetab"es6 !airy pro! cts6 s nf"ower see!s6 sa"mon an! !rie! beansC an! magnesi m rich foo!s Bn ts6 !ates an! figs6 ye""ow corn6 green $egetab"es an! app"esC in her !iet# FEA$ As the pregnancy !raws near term most women become afrai! of the "abo r pains6 fears abo t chi"!birth may become more persistent# %ow m ch wi"" it h rtK %ow "ong wi"" it "astK %ow wi"" they copeK 4f /rs# Nkhata happens to come with s ch a prob"em6 she wi"" be a!$ise! on the importance of hospita" !e"i$ery where pain re"ief mechanisms are a$ai"ab"e# 'he wi"" a"so be aske! to ha$e time with other women who ha$e ha! positi$e e)perience of "abo r an! this wi"" he"p in re"ie$ing her fears#

ED5&AT4ON AND &O5N'E++4N3 D ring the assessment6 se$era" areas were i!entifie! that nee!e! e! cation an! co nse""ing to /rs# Nkhata# ;A/4+2 1+ANN4N3 /rs# Nkhata in!ee! knows what fami"y p"anning is as we"" as the a$ai"ab"e fami"y p"anning metho!s in /a"awi b t has prob"ems with choice of fami"y p"anning metho! accor!ing to her repro! cti$e goa"s# /rs# Nkhata e)presse! that she wants to se inEectab"e contracepti$es BDepo01ro$eraC as her fami"y p"anning metho!s of choice# %owe$er6 she a"so e)presse! fears that she ha! hear! that the metho! is phasing o t soon# +ooking at her repro! cti$e goa"s6 4 fe"t that /rs# Nkhata co "! a"so benefit from other fami"y metho!s that are "ong term "ike 4ntra terine &ontracepti$e De$ice an! >a!e""e than the metho!s she ha! chosen 4 !isc sse! with her of a"" the metho!s on the positi$es6 negati$es an! a$ai"abi"ity of the metho!s with m ch emphasis on >a!e""e which is the best metho! for her basing on her

goa"s as she wants to ha$e a space of fi$e years before gets pregnant again so the same with the metho! as it is ma!e to "ast for 9 years# 4 a"so commente! on the spec "ation that inEectab"e contracepti$es are phasing o t by te""ing her that it is not tr e# 4 a"so e)p"aine! to her that the best time to start fami"y p"anning is si) weeks after !e"i$ery for it is be"ie$e! that by this time a woman:s ferti"ity has ret rne! an! a"so her bo!y has ret rne! to her pre0pregnant state an! can res me se) B;ami"y 1"anning %an!book6 <00.C 4//5N4'AT4ON' Base! on the information that she ha! recei$e! on"y two !oses of Tetan s To)oi! (accine with the first pregnancy an! two with the c rrent one6 4 fe"t she nee!e! more information on the right e)pecte! sche! "e the mothers are nee! to fo""ow to comp"ete a"" the fi$e !oses for TT(# On this !ay6 an e)p"anation on the norma" $accination sche! "e was gi$en to /rs# Nkhata so that as she has a"rea!y starte! with the two !oses6 sho "! finish the remaining three !oses# ;inishing the !oses wi"" he"p in re! cing the risk of the baby from getting tetan s# We together p"anne! on how she was going to get the other !oses# The thir! !ose wi"" be gi$en on -ADA,,6 the fo rth !ose wi"" be gi$en on -ADA,< an! the "ast !ose wi"" !e gi$en on -ADA,*# 'EF5A+4T2 /rs# Nkhata !i! not ha$e know"e!ge on when to stop se) before !e"i$ery an! when res me after !e"i$ery# On this !ay6 oriente! her to the right time as to when she can stop se) as we"" as when to res me# 4 to"! her that there is no "imitation as to when they can stop se) th s they can ha$e se) nti" term of pregnancy as far as they are comfortab"e# 4 a"so e)p"aine! to her that they can res me se) as ear"y as ? weeks as far as she fee"s that her bo!y is rea!y for se)# B4RT%% 1+AN AND &O/1+4&AT4ON 1RE1AREDNE'' Rea"ising that /rs# Nkhata was afrai! of "abo r pains6 4 took sometime co nse""ing her on norma" processes of pregnancy nti" "abo r an! !e"i$ery so as to a""ey her an)iety# 4i p t emphasis on the nee! an! importance of !e"i$ering at the hospita" where meas res

of managing "abo r pains are se!# 4 a"so a!$ise! her on the nee! to associate an! "earn from mothers who ha! n!ergone the same e)perience se$era" times who can he"p her prepare for her "abo r an! !e"i$ery# ;O&5'ED ANTENATA+ &ARE Basing on the time that she ha! starte! antenata" $isits6 it showe! that she !i! not ha$e eno gh or no know"e!ge on foc se! antenata" care an! its importance# 4 therefore p"anne! to e! cate her on what foc se! antenata" is6 an! its importance# /rs# Nkhata was to"! what is !one at the c"inic where foc se! antenata" system is fo""owe! an! a"so what if e)pecte! of women n!ergoing foc se! antenata" care especia""y when to start atten!ing antenata" an! how fre7 ent# We a"so !isc sse! on the importance of atten!ing a"" the e)pecte! norma" fo r $isits of antenata" care# /4NOR D4'ODER' O; 1RE3NAN&2 4n a!!ition to these e! cation an! co nse""ing sessions6 /rs# Nkhata was a"so prepare! for the e)pecte! minor !isor!ers that may !e$e"op as the pregnancy progresses especia""y in the thir! trimester# /inor !isor!ers "ike !yspnoea6 heartb rn6 constipation an! backache are some of the common !isor!ers that occ r to mother in their thir! trimesters# 'o she was to"! of the !isor!ers so as when they happen she sho "! not be an)io s b t accept them as things that happen norma""y#

Date for the ne)t $isit#