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CHAPTER ONE

1.0 INTRODUCTION
This chapter gives information about client and it includes personal and social history,
family history, medical history, surgical history, menstrual history, past obstetric history,
present obstetric history, and client life style or allow hobbies.

1.1 PERSONAL AND SOCIAL HISTORY


Madam Serwaa Boateng Josephine, gravida three [3] para two [2] alive, is a 28 years old
woman who hails from Ashanti Mampong –krobo in the Ashanti Region but resides at
Adukuma kurom, house number GCA0025 a suburb of Asutifi North in the Brong Ahafo
Region. She is dark in complexion, 5.3 feet tall and weighs 55kg.
she is an SHS graduate who completed Garden City Commercial at Kumasi. She added that
she couldn’t continue her education due to some financial problems faced by her parents.
Madam Josephine is married to Mr. Abudu Kadri Alhasan a 31 Years old man who is a moto
driver and a rice farmer as well which serve as a source of income to support home. Madam
Josephine speaks Asante Twi but her husband speaks Asante twi and Mamprusi.
They have two sons, namely, Magid Kadri and Saddick Kadri who are 6 years and 3 years old
respectively. Madam Josephine is a Christian and worship at Methodist Church of Ghana at
Owusu kurom which is about 60 Kilometers away from Adukuma kurom. Her next of kin is
her mother, Madam Charity Gyima Yeboah.

1.2 FAMILY HISTORY


Mr. Kwabena Dapaa and Mrs. Charity Gyima Yeboah are the parents of Madam
Josephine. She has one other sibling who is a female and alive.
Her parents are farmers and resides at Adukuma kurom which is a small village with
a single mud building where Madam Josephine with her mother, husband, children
and 4 other guys who are the laborers of her husband.
Madam Josephine said her family has a known diabetis medical history which even
killed her grandfather but she doesn’t know any other medical history like
hypertension, sickle cell disease, heart disease, epilepsy, mental illness ect. in the
family.
she also added that most of the deaths in her family are natural, meaning they grow
very old before death take them away. She also said multiples pregnancies run in the
family.

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1.3 MEDICAL HISTORY
According to Madam Josephine, she has ever been admitted at the hospital with the
condition of anemia.
She also said she has a medical history of jaundice which she said has treated for many
years but is still not going. She said she has no history of heart disease, sickle cell,
hypertension and even diabetis that is running through her family.
According to her, she has ever experienced signs and symptoms of sexually
transmitted disease, that is gonorrhea. She said she was experiencing pruritus vulvae,
offensive whitish discharges from the vagina.
She is allergic to okro and peniclline. She also said she donated 4 pant of blood when
she was in senior high school.

1.4 SURGICAL HISTORY


Madam Josephine said she has never undergone any surgical operation like
salpingectomy, laparotomy ect since childhood and have not been involved in any
accident or injury to the head or pelvic bone.
She also added that she was transfused with blood when she was anemic and was
admitted at the hospital.

1.5 MENSTRAL HISTORY


According to Madam Josephine, she does not remember the age of her menarch but
she has 28days menstrual cycle with regular and moderate flow of blood for 6-7 days
without dysmenorrhea.
She added that she uses sanitary pad and change it when it is soaked and bath twice
daily. She also said she can’t remember her last menstrual period.

1.6 HABBIT OF DAILY LIVING


Client said she sleeps at 8pm and wakes up at 6am to do her household chores before
she lives the house to sell bread at the nearby village. She often empties her bowel
once daily and also bath twice daily and rest during her leisure time. She said she
usually goes to the farm for foodstuffs and fire wood. She does not drink or smoke.

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1.7 PAST OBDSTERIC HISTORY
Madam Josephine, gravida 3 para 2, all alive. Fist born named Magid Kadri who is 6
years old and second born is Sadat Kadri who is 3 years old. Pregnancy reach 36 weeks and
40 weeks of gestation before labour was due. During pregnancy, client experienced some
minor disorders such as edematos feet and loss of appetite which was treated.
Client added that she attended Antenatal during all her pregnancies till labour was due. Client
had never received tetanus injections during her pregnancies.
Client said she has never suffered pregnancy induce hypertension and diabetes but anemia
during her first pregnancy. According to her, all her babies were delivered at the hospital with
no complication or retained placenta. Client said during her first pregnancy onset of labour
started at night but during her second pregnancy, labour started on Wednesday 6pm till
Friday 3:30pm.
Client also experienced minor disorders like waist pain and lower abdominal pain durin labor
in both pregnancies. Babies cry immediately they are born and there was moderate blood
loss. Weight of babies were 3.1kg and 3.9kg respectively. Client also said she exclusively
breastfed all her babies till for two years then supplementary feeds were introduced and stop
feeding.
Client added that her babies were immunized against childhood disease at Blessed Family
Maternity Home/Clinic. Madame never used any of the family planning method. Client went
through puerperium successfully without any complication with the support of her family.

1.8 PRESENT OBSTERIC HISTORY


Having glanced through her antenatal records book, client attended her first antenatal clinic
visit on the 13/01/2018 at Blessed Family Maternity Home/Clinic where she was 16 weeks of
gestation and felt fetal movement. Madam Josephine could not remember her last menstrual
period but the scan gave the expected date of delivery as 4/07/2018.
Client had no complains during the first Antenatal visit but complained of general body
weakness when she was 24 weeks of gestation. She weighed 68kg and her height was 162cm
at booking. Vital signs and laboratory investigations were conducted and recorded as follows;
Hemoglobin 14.1 gram per deciliter
Hepatitis B Negative
Blood Group O
Rhesus Factor Positive

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VDRL Non
HIV Status Negative
G6PD Nonreactive
Urine for protein and sugar Negative
Sickling status Negative
Vital signs recorded as;
Temperature 36.6 degree celcious
Blood pressure 120/70mmHg.
Weight 68 kilograms
Height 162 centimeter
Symphysio fundal height 16 centimeters
Pulse
Respiration
Head to toe examination was done with no abnormality detected. She was 16week gestation,
fundal height was 16cm, fetal heart rate was present, there was no descent and no presenting
part by then. She had no complications. she has not taken any dose of Tetanus Dipheteria
[TD] but have taken all five doses of sulphadoxine pyrimethamin on 13/01/18, 13/02/18,
13/03/18, 13/04/18 and 12/05/18 respectively. She was counselled on malaria prevention,
hygiene, good nutritious food, exercise, rest and sleep. She was given treated mosquito net.
She was also given routine drugs as follows;

Tablet multivitamin 200mg Tid for 30 days


Tablet folic acid 5mg once daily for 30 days
Tablet ferrous

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CHAPTER TWO

ANTENATAL CARE
2.0 INTRODUCTION
Antenatal care is the health care and education given to pregnant women from the time of

conception is confirmed until labour begins. This chapter gives information about the antenatal

visits of the client and the care that was rendered to the client from the first encounter with the

client and subsequent visits by the client to the clinic. It also talks about the number of visits

made by the student midwife to the client’s home till labour set in.

2.1 FIRST CONTACT WITH CLIENT

On Wednesday 27th June, 2018, Madam Josephine was encountered when she came to the

clinic for her antenatal care. She was experiencing frequency of micturition since she was in

her 36th week of gestation. She was worried because she had less knowledge about what was

happening to her so an opportunity was taken to educate her about the physiological changes

that occurs during pregnancy. A review was done in her antenatal care record and it was

realized that she sometimes complained of headache and tablet paracetamol was given as

treatment. Explanation on the procedures to be carried out was done to seek her consent of

which she accepted after attending to her, her weight and hemoglobin level was checked and

recorded as 58 kilograms and 11.5gram per deciliter respectively.

Her vital signs and other investigations were recorded as follows;

Temperature - 36.2 degree Celsius

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Pulse - 78 beat per minute

Respiration - 20 cycles per minute

Blood pressure - 110/80 millimeter of mercury

After checking and recording of vital signs, head to toe examination was to be done so she was

kindly asked to empty her bladder and sample of her urine was taken and tested for sugar and

protein which tested negative. The amount of urine voided was also measured as 150 mls after

which she was helped to assume a lateral position on the examination bed. Hands were washed

and dried and all equipment needed for the examination were gathered.

She was asked to assume a supine position before the commencement of the examination. The

hair was first examined for softness, brittle and neatness, followed by the scalp to rule out any

dandruff. The eyes were examined for pallor, jaundice, Sclera for discoloration, the ears for

discharges, followed by the nose for discharges and congestions. The lips were examined for

cracks and the gums for bleeding. She was engaged in a conversation to rule out any halitosis,

dental caries and teeth distribution. The neck was examined for any distended neck veins,

enlarged lymph nodes and thyroid gland. The upper limbs were also examined for pallor and

the nail bed for neatness and to rule out any anemia followed by the axilla for any palpable

nodules. The breasts were to be examined but before that, she was asked to place her hand

under the head of the part of breast to be examined followed by the other. The breasts were

examined for equality, lumps and discharges and were also thought how to do self -breast

examination. The lower limbs were also examined for neatness, edema, varicose vein and the

nail bed for anemia. The back was examined for any spinal or vertebrae abnormalities, sacral

edema as well as the general wellbeing of client. After the examination, she was congratulated

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and taught how to examine her breast and report to the Hospital if any lump or other

abnormality is seen.

ABDOMINAL EXAMININATION.

Hands were washed and dried; permission was sought from client. The abdominal examination

includes inspection, palpation and auscultation.

On Inspection;

On examination, the shape of the abdomen was ovoid and the size corresponds to her

gestational weeks. Linea nigra and striae gravidarum were present and fetal movement was

felt. No scars or rashes were seen on the abdomen. Hands were warmed by rubbing them

together to avoid inducing contractions. The abdomen was palpated for masses, tenderness as

well as enlarged spleen and liver but no abnormalities were detected.

Measuring of symphysiofundal height;


The abdomen was palpated with palms and fundus located. zero mark of the measuring tape
was placed on the fundus and extended along the contours of the abdomen along the midline
to the upper border of the symphysis pubis and it measured 38cm with 39 weeks of gestation.

Fundal palpation
Facing Madam Josephine, hands were rubbed together to warm the hands and the palms were

placed on either side of the fundus and fingers curved around the fundus, a soft mass was felt

indicating the buttocks.

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Lateral palpation

The palms of the hands were placed on both sides of the uterus, midway between symphysis

pubis and fundus. The uterus was stabilized with one and examined with the other hand. The

entire area from the abdominal midline to the fundus was palpated in a rotatory manner. The

other hand was also used to stabilize the uterus and the procedure was repeated. The left lateral

palpation done at the left side of the mother felt rough which indicated the fetal limbs and the

right lateral palpation done at the right side of the mother, a smooth curve was felt which

indicated the back of the fetus. The position of the fetus therefore was right occipito anterior.

Pelvic palpation

Facing the feet of Madam Josephine, the palms were placed on either side of the uterus, with

the palms just below the level of the umbilicus and fingers directed towards the symphysis

pubis, thumbs almost meeting. A hard mass was felt indicating the fetal head. Therefore, from

the above, it was deduced that, lie was longitudinal and the presentation was cephalic.

Descent of fetal head

Location of the anterior shoulder was made using two fingers. The upper border of the

symphysis pubis was located. None of the fingers covered the head indicating no descent. Commented [M1]:

Auscultation

On auscultation, the fetoscope was warmed and placed at the area where the back was located,

the ear was placed against the fetoscope to listen to the fetal heartbeat. One hand was placed at

the maternal radius to differentiate between maternal and fetal pulse. The fetal heart rate was

checked for one minute and recorded as 140 beat per minute with good rhythm and volume.

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Vulva examination

Permission was sought to inspect her vulva and perineum and she agreed, her underpants were

removed and was assisted to assume a lithotomy position and was draped. Soap and water were

used in washing hands and cleaned with a dry clean towel. A sterile glove was worn. The labia

were inspected, the skin was smooth, clean and pubic hair free of lice. The labia tissue was

soft, there were no swelling, redness or tenderness, rashes, sore, scars, warts, edema, varicose

veins, no discharges and no sign of fistula. Clitoris and perineum were inspected and no

abnormalities were found. There was no sign of female genital mutilation. The vagina was

swabbed using sterile cotton and savlon solution aseptically. The vagina was moist with no

offensive smell. Madam Josephine was congratulated for her co-operation. Gloved hands were

dipped in 0.5% chlorine solution and gloves were discarded. Hands were washed with soap and

water and dried with towel. Findings were communicated to her. Permission was then sought

from Madam Josephine for a home visit on Thursday 28th July, 2018 and she was happy and

gave the direction to her house as well as her mobile phone number. She was educated on

nutritious foods to help in the development of the fetus and regular mild exercise. The following

drugs were prescribed for her.

Tab folic acid 5mg daily for 10 days

Tab ferrous sulphate 200mg daily for 10 days

Tab Multivite 200mg daily for 10 days

She was scheduled for next antenatal visit and review date communicated to her or visit the

clinic any time she encounters any problem.

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HOME VISITS

2.2 FIRST ANTENATAL HOME VISIT

On Thursday, 28th June, 2018, a visit was made to Madam Josephine’s house around 4:00pm

as scheduled. The aim of the visit was to observe her surrounding, prepare her towards delivery

and also to inspect her items for labour and find out how she was coping with pregnancy.

Madam Josephine lives in a mud building with six bed rooms and roofed with aluminum sheet

and there is a toilet, a bathroom and a kitchen. Client lives in the second room among the six

rooms in the house. Before entering the house, a stroll was taken around the house. The

surrounding of the house was clean and there is a farm behind it which makes the surrounding

bushy but no stagnant water was available. The house has four main entrances. There is no

electricity available and their source of water is a well which is a walking distance away from

their house. Client cooks in a mud kitchen structure. The kitchen was neat and the items were

nicely arranged to prevent accident. She had a small dustbin which was well covered for

keeping their rubbish and it was emptied whenever it was full. The refuse was emptied at the

refuse dump which is quite far from their house. She shares the same toilet and bathroom with

the other members of the house.

On arrival Madam Josephine was sitting outside with family members chatting. A seat was

offered in her room. The mission of the visit was asked as tradition demands and was stated

accordingly. The whereabouts of her husband and sons were inquired and she said her husband

had gone to work at his rice farm and her kids were outside playing. The room was divided

with curtains with one half of the room serving as a bedroom and the other half as a living

room. Client room was well ventilated with windows made up of wooden louvers. Her room

was neatly arranged and was congratulated on that. In order to know how prepared she was for

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labour, she was kindly asked to bring her bag containing the items for labour and it was

encouraging because items like cot sheets, baby dresses, antiseptic disinfectant, parazone,

perinea pad, pampers and others were seen. Everything needed for labour were seen. She sleeps

under insecticide treated net every day. The entire house was neat and client had a cordial

relationship with the other family members.

Client complained of finding it difficult to sleep at night and also complained of anorexia. She

was advised to take a warm bath before going to bed and educated on the need to practice good

oral hygiene. She was also educated on birth preparedness such as getting her cloth, layette

NHI card, accompanied relative, a moto driver when her husband is not around, a blood donor

in case of emergency etc ready. Client was congratulated on how neat and clean she had kept

the house and was educated on regular exercise and was reminded on the intake of nutritious

diet. She was also educated to report to the clinic immediately when she experienced any of

the true labour signs like the presence of show and painful rhythmic uterine action. Madam

Josephine was thanked for her hospitality and permission was sought to leave. A day was

scheduled for the next visit to the clinic, thus 5th July, 2018.

2.3 SUBSEQUENT HOME VISIT

The next home visit was made on the 4th of July, 2018 at 3:00pm. The aim of this visit was to

know how the family was doing and also educate her on birth preparedness and complications

readiness, since she had not yet delivered. She was educated on the need to deliver at the health

facility to prevent complications like retained placenta, postpartum hemorrhage and importance

of breathing exercise during labour. She was also educated on complication readiness as to who

will donate blood in times of need, a relative to accompany her to the hospital during labour

and transportation to the clinic when in labour.

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Education was made on intake of nutritious diet, fruit and vegetables and intake of more fluids

and also to continue taken her medications. Emphasis was laid on signs of true labour, thus

show and painful uterine contractions and was encouraged to report to the clinic if she

experiences these signs. She was also reminded to report to the clinic if she feels anything

unusual.

She was reminded on the next visit to the clinic and permission was sought to live.

2.4 SUBSEQUENCE VISIT TO THE CLINIC

on 5th July, 2018, was the day scheduled for Madam Josephine’s next visit to the clinic. She

arrived at 9:30am, she was offered a seat and welcome warmly. Her vital signs were checked

and recorded

Temperature 37.2 degree Celsius

Blood Pressure 110/80mmhg

Pulse 88bpm

Respiration 19cpm

She granted permission to perform head to toe examination after it was explained to her. The

purpose was to detect any abnormalities. She was asked to empty her bladder to promote

comfort during which midstream sample was collected and tested for sugar and protein and

results for both were negative. In the examination room, she was assisted to position herself in

a supine position on the examination bed. Hand washing with soap and water was done and

well dried with a clean towel, head to toe examination was done and no abnormality was

detected. On palpation, the gestation was 39 weeks, Symphysio-fundal height was 38cm, lie

longitudinal, and presentation cephalic, descent 4/5th, and fetal heart rate was 140bpm on

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auscultation. Her hemoglobin level was checked and recorded as 12gramme per deciliter. She

was thanked and helped into a comfortable position on a chair, hand washing was done and

dried. Finding were communicated to her. She was encouraged to report to the clinic if there

are signs of true labour or if she encounters any problem. She was also encouraged to keep

taking the routine drugs that were given to her previously.

2.5 CARE PLAN DURING ANTENATAL

PROBLEMS IDENTIFIED

1. Frequency of micturition

2. Insomnia

3. Anorexia

4. Lower abdominal pain

5. Constipation

SHORT TERM OBJECTIVES

1. Client will be able to cope with frequency of micturition within 48 hours during pregnancy.

2. Madam Josephine will be able to sleep for at least four hours during the night and two hours

during the day within 48 hours.

3. Client will be able to regain her eating pattern within 48 hours.

4. Client will be able to cope with lower abdominal pains within 72 hours

5. Client’s will regain her normal bowel habit(1daily) within 48 hours.

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LONG TERM OBJECTIVE

Madam Josephine will have a successful pregnancy, labour and puerperium outcome without any

complications to her and her baby.

DATE/ NURSING OBJECTIVE/OUTCOME NURSING NURSING DATE/ NURSING SIGN


TIME CRITERIA TIME
DIAGNOSIS ORDERS INTERVENTIONS EVALUATION

27/6/18 Frequency Client will be able to 1. Reassure 1. Client was 29/7/18 Goal fully
cope with frequency of client reassured
of met as client
9:30am micturition within 48 2. Explain the 2. The 9:30am
micturition verbalized
hours during pregnancy physiology of physiology of
related to as evidenced by; frequency of frequency of that she no
micturition to micturition was
descent of more urinates
a. Client verbalizing that her. explained to the
the frequently
increase in the 3. Encourage client.
presenting frequency of micturition client on the 3. Client was
has been reduced. need to keep encouraged on
part.
vulva clean the need to keep
b. Midwife witnessing
and wear vulva clean and
that client is no more cotton under wearing of
wears. cotton under
urinating frequently.
4. Encourage wears.
client to void 4. Client was
every 1 – 2 encouraged to
hours. void whenever
she feels the urge
5. Encourage to.
5. Client was
her to have a
encouraged to
pail close to
use a pail at night
her bedside
rather than

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when walking a

sleeping. distance to

urinate

DATE/ NURSING OBJECTIVE/OUTCOME NURSING NURSING DATE/ NURSING SIGN


TIME CRITERIA TIME
DIAGNOSIS ORDERS INTERVENTIONS EVALUATION

27/6/18 Alteration in Client will be able to 1. Reassure 1. Client was 29/6/18 Goal fully
have at least six hours client. reassured.
9:30am sleeping 9:30am met as client
sleep during the night 2. Explain the 2. Physiology of
pattern reported that
and two hours during the physiology of micturition was
(insomnia) day within 48 hours frequency of explained to the she can now
during pregnancy as micturition to client.
related to have enough
evidenced by client the client.
frequency of sleep.
verbalizing that she now 3. Encourage 3. She was
micturition. has enough sleep. client to take encouraged to
a warm bath take a warm bath
before before sleeping.
sleeping.
4. Encourage
her on the 4. She was
need to encouraged to
ensure good ensure good
ventilation in ventilation in her
her room to room.
help her
sleep. 5. She was

encouraged to
5. Encourage
have some sleep
her to have at
during the day.
least 2 hours

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rest and sleep

in the

afternoon.

DATE/ NURSING OBJECTIVE/OUTCOME NURSING NURSING DATE/ NURSING SIGN


TIME CRITERIA TIME
DIAGNOSIS ORDERS INTERVENTIONS EVALUATION

27/6/18 Altered Client will be able to 1. Reassure 1. Client was 29/6/18 Goal fully
the client reassured that she
nutritional regain her normal met as
9:30am that she will will regain her 9:30am
pattern eating pattern within 48 evidence by
regain her

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(anorexia hours as evidence by normal normal eating client
eating pattern.
) related to client verbalizing that verbalizing
pattern.
hormonal she can eat half plate of that she can
2. Educate 2. Client was
changes food served. client to educated to now eat half
practice practice good oral
during plate of food
good oral hygiene.
pregnancy. served.
hygiene.
3. Encourage 3. Client was
client to eat encouraged to eat
food in bits food in bits but
but frequently.
frequently.
4. Encourage 4. Client was
client to eat a encouraged to eat
preferred a preferred food.
food. 5. Client was
5. Encourage
encouraged to
client to
remove all
remove all
nauseating
nauseating
articles around
articles
her when she is
around her
about to eat.
when she is

about to eat.

DATE/ NURSING OBJECTIVE/OUTCOME NURSING NURSING DATE/ NURSING SIGN


TIME CRITERIA TIME
DIAGNOSIS ORDERS INTERVENTIONS EVALUATION

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5/7/18 Lower Client will be able to 1. Reassure 1. Client was 8/7/18 Goal partially
cope with lower client. reassured.
abdominal met as client
10:00am abdominal pains within 2. Explain the 2. The 10:00am
pain related verbalized
72 hours during physiology physiology of
to descent of pregnancy as evidenced associated with lower abdominal that pain was
by; lower pain was
the fetal a bit subside.
abdominal explained to
head.
a. Client verbalizing that pain at the client.
pain has been relieved. latter part of
pregnancy.
b. Midwife observing
3. Conversation
that client is comfortable. 3. Use and watching of
diversional television were
therapy to the therapies
divert client’s used to divert
mind from the client’s mind
pain. from the pain.
4. Client was
4. Encourage encouraged on
client on the enough rest and
need for rest sleep.
and sleep. 5.Tablet
5. Administer
paracetamol
prescribed
1gram
analgesics
administered.

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DATE/ NURSING OBJECTIVE/OUTCOME NURSING NURSING DATE/ NURSING SIGN
TIME CRITERIA TIME
DIAGNOSIS ORDERS INTERVENTIONS EVALUATION

5/7/18 Altered Client will be able to 1 Reassure 1. Client was 7/7/18 Goal fully
client. reassured.
bowel empty her bowel once 2. The achieved as
10:00am 2. Explain the 10:am
physiology of
movement daily within 48 hours constipation was client said she
physiology of
explained to
(constipation) during pregnancy as constipation client. was able to
during
related to evidenced by client empty the
pregnancy to 3. Client was
hormonal verbalizing that she is encouraged on bowel once
the client.
effects of able to empty her bowel 3. Encourage the intake of daily.
client on fruits and
pregnancy once daily.
intake of vegetables to
fruits, prevent
roughages and constipation.
vegetables. 4. Client was
encouraged on
the need to
4. Encourage exercise.
client on mild
exercises like
walking.
5. Client was
5. Educate educated on the

client on the intake of more

intake of more fluids.

fluids

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CHAPTER THREE

LABOUR

3.0 INTRODUCTION

This chapter talks about the care that was rendered from the time labour sets in till complete

expulsion of the fetus, placenta and its membranes, control of hemorrhage and proper

monitoring of mother and baby.

3.1 ADMISSION AND MANAGEMENT OF FIRST STAGE OF LABOUR

First stage of labour starts from the onset of labour till full dilatation of the cervix. Madam

Josephine came to Blessed Family Maternity Home/ Clinic accompanied by her husband and

mother. They were welcomed and offered a seat. Madam Josephine complained of lower

abdominal pains and painful uterine contractions. They arrived at the clinic at 12:15am but

according to the client, labour started on the 12th July, 2018 around 5pm.

Enquires made indicated that client had seen blood stained mucus(show). Client’s antenatal

book was glanced through for previous history and also to confirm expected date of delivery.

At the first stage room, client was offered a bed, Madam Josephine was reassured and

procedures to be done were explained to her and consent was sort. Client’s vital signs were

checked and recorded as follows;

Temperature 36.2 degree Celsius

Pulse 89 beats per minute

Respiration 20 cycles per minute

Blood pressure 110/86 mm/hg

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Client was served with a bedpan to empty her bladder and specimen taken, which tested

negative for protein, and glucose. A total amount of 100mls of urine was emptied. Client was

then helped into a bed, hands were washed and dried with a clean towel, and she was examined

from head to toe and no abnormalities was detected. On abdominal examination, the shape was

ovoid with normal size and there was linea nigra and striae gravidarum presence. The

gestational age was 40weeks while the symphysiofundal height was 39cm.Upon palpation, the

lie was longitudinal, presentation was cephalic, descent was 4/5th, fetal heart rate on

auscultation was 140bpm. After palpation, hands were warmed by rubbing in order to check

for contractions. There were 2 contractions in 10 minutes lasting 25 seconds. Consent was

sought to perform vaginal examination to help know the dilatation of the cervix and she agreed.

A tray was set containing a sterile glove, a gallipot with sterile cotton wool swabs and another

gallipot with savlon, a sanitary pad and a receiver. Client was helped to assume a lithotomy

position and was draped. Hands were washed thoroughly with soap under running water, hands

were dried and sterile gloves were worn. The vulva was inspected and nothing abnormal was

detected. The vulva was then swabbed with five sterile cotton wool swabs soaked in savlon

solution.

The vulva was swabbed from labia majora to minora, and then the vestibule using a different

swab each time, the index and middle finger were then inserted gently into the vagina. The

condition of the vagina was warm, roomy and moist, cervix was soft and slippery with

dilatation of two (2) centimeters with membranes intact. Ischial spines were blunt with a well

curved sacrum, and a wide pubic arch. A fresh perennial pad was placed on the vulva and client

was asked to lie on side (lateral position) to prevent supine hypotension. Gloved hands were

dipped into 0.5% chlorine solution before removing. All findings and progress of labour was

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communicated to the client and recorded on a monitoring sheet. She was cleaned nicely and a

sanitary pad was applied to the vulva. Client was thanked for her co-operation. On arrival it

was observed client was anxious and was going through pains. Madam Josephine was

approached and asked whether there were any other complaints which she complained of

fatigue, backache and lower abdominal pains. Client was reassured of normal labour with a

healthy baby without complications after delivery Client was encouraged to breathe through

her mouth when there was contraction and also avoid pushing during contraction since the

cervix was not fully dilated and to prevent edematous cervix. Bedpan was provided for her to

empty the bladder frequently to enhance effective contraction and descent of the fetal head

since full bladder could slow down progress of labour.

Client was educated on the importance of changing the pad when soiled and not to be touching

the perineal area.

Labour was monitored till 4:00am where vaginal examination was repeated. Cervical os was

4cm with membranes intact. Palm was warm by rubbing hands together, then placed on the

level of the fundus to time for contractions. Within 10 minute, contractions were 3 lasting 25,

30 and 34 seconds respectively. Fetal heart rate was 140bpm, maternal pulse was 89bpm, Blood

Pressure was 110/60mmHg, Temperature was 35.1Oc.

The fetal heart rate, contraction and maternal pulse were monitored every thirty (30) minutes

while temperature, blood pressure, dilation of the cervix and descent of the fetal head were

checked every four (4) hours and recorded on the partograph.

At 11:00am, membranes ruptured spontaneously, vagina examination was done to rule out cord

prolapse. On vaginal examination the vagina was warm and moist, the cervix was eight (8)

centimeters dilated and well applied to the presenting part, bones were separated and sutures

22
were easily felt, liquor was clear with descent 2/5and fetal heart rate was 142 beats per minutes,

Contractions were four (4) in ten (10) minutes lasting for fort five (45) seconds. Vital signs

were checked and recorded as below

Temperature 35.9 degree Celsius

Pulse 88 beat per minute

Respiration 22 cycles per minute

Blood Pressure 130/80 millimeter of mercury

The amount of urine emptied was hundred (100) milliliters. Client was made comfortable in

bed by cleaning all discharges and a new perineal pad applied. All findings were documented

on a partograph sheet.

At exactly 11:30am, client complained of bearing down sensation so another vaginal

examination was done and the cervix was fully dilated (ten centimeters) and there was no cord

prolapse, descent was 0/5, bonds were separated and sutures were easily felt, contractions were

five (5) in ten (10) minutes lasting fifty (50) seconds, fetal heart rate was 138 beats per minute

and urine output was 100 milliliters. Findings were recorded on the partograph sheet and client

was informed of the full dilatation of the cervix. Client was informed that the baby would be

delivered onto the abdomen to establish bonding. Delivery trolley was made ready with the top

shelf containing sterile delivery pack, sterile bulb syringe and 4 clean towels for draping the

client. The down shelf also contained a pair of sterile glove, a jug for measuring blood loss, a

receiver for placenta, fetal stethoscope, a

23
container with syringes and needles, oxytocin drug, extra perineal pad and antiseptic lotion.

3.2 PREPARATION FOR BIRTH.

The midwife in charge who would supervise labour and delivery was identified as a skilled

helper and she would also help in both care of the baby and mother. The unskilled helper that

was identified was Madam Charity, Madam Josephine’s mother who will assist in time of need.

A taxi was made available and the driver was informed that he would be called in case of

emergency. Contact number of referral point was reviewed.

The area was prepared for delivery. Madam Josephine was assisted to wash her hands, her

chest and abdomen and was then prepared for skin-to-skin care. Hands were washed with soap

under running water. A dry, flat and safe space was prepared for baby to receive ventilation if

needed. All equipment and supplies used for ventilation like the ventilation bag were tested if

they were functioning properly. All doors and windows were closed and a rechargeable lamp

on standby.

3.3 MANAGEMENT OF SECOND STAGE OF LABOUR

Second stage of labour is full dilatation of cervix to the birth of the baby.

Madam Josephine was assisted to assume the lithotomy position with her legs well supported

on the bed. Protective clothes were worn and hands were washed with soap and water then

dried with a clean towel. Sterile gloves were put on and delivery pack was opened. The vulva

was cleaned with savlon solution as well as the upper thighs. Clean towel was used to drape

the abdomen, thighs and buttocks. A sheet was placed on the abdomen and another was placed

under the buttocks. Fetal heart rate was also checked and recorded as 135beats per minutes.

She was encouraged to bear down in expulsive stage and rest in between contraction.

24
A fresh pad was applied to the perineum and the index and middle finger were placed on

advancing head to aid flexion. Flexion of the head was maintained to allow the smallest

diameter to distend the vulva. After the head crowned, she was asked to pant while the head

was delivered by extension as the sinciput, face and the chin swept the perineum. The eyes,

nose and mouth were cleaned and airway was cleared with a bulb syringe. The neck was felt

for cord around neck but there was none. Restitution and external rotation of the head took

place allowing the shoulder ready to be born. The head of the fetus was held in both palms on

each side of the bi-parietal bones and a downward traction was applied to allow the anterior

shoulder slipped under the pubic bone. The head was flexed towards the mother’s abdomen

and the posterior shoulder was delivered. The baby was delivered by lateral flexion onto the

mother’s abdomen as explained. Baby was dried, the wet cloth was removed from mother’s

abdomen, she was dried before baby was placed on mother’s bare abdomen in between the

breast and covered with dry warm cloths. This is to help in skin-to-skin contact as well as

providing warmth and bonding between the mother and the baby. A healthy baby girl was

delivered and sex confirmed by the mother. The breathing pattern of the baby was assessed

while drying her and the APGAR score within the first minute was 9/10, and the fifth minute

10/10. The woman was congratulated for her cooperation.

3.4 IMMEDIATE CARE OF THE BABY

Immediately the head was born, the baby's face was wiped with a sterile gauze swab and

eyes were cleaned with a sterile gauze from the inner canthus outwards. A piece of sterile gauze

was wrapped around the little finger and was used to clean the baby’s mouth to remove any

thick mucus. Cord around neck was felt and none was detected while waiting for restitution.

As soon as the rest of the body was delivered onto the mother’s abdomen, the liquor was wiped

off quickly from his body with a warm towel and place skin to skin with the mother to prevent

hypothermia. The baby cried shortly after birth. The cord was clamped with two artery forceps.

25
It was re-clamped with a plastic cord clamp 3cm away from the baby’s abdomen and 2cm from

the first clamp. The cord was cut in between the two cord clamp with a sterile scissors whiles

covering it with a sterile gauze to prevent the splashing of blood. The First and fifth minute

Apgar score was assessed and recorded as 9/10 and 10/10 respectively. Wet towels were

replaced with warm dry towels. An identification band with mother's name, baby’s sex, time

and date of delivery was tied on the baby’s wrist and he was put to breast.

3.5 MANAGEMENT OF THIRD STAGE OF LABOUR

Third stage of labour is the period from the delivery of the baby to the complete explosion of

the placenta, it membranes and control of bleeding

Madam Josephine was in the lithotomy position and a receiver placed near the vulva in

between the thighs. Procedure was explained to her. After the delivery of the baby, the uterus

was palpated to rule out the presence of an undiagnosed twin and ten (10) units of oxytocin

was injected intramuscularly on the mother’s thigh to aid in the contraction of the uterus and

separation of the placenta. Non dominant hand was placed on the fundus to feel for

contraction of the uterus. The cord was re-clamped nearer to the perineum with one artery

forceps. The cord and artery forceps was held with the dominant hand. As soon as the uterus

contracted, the non-dominant hand was removed and placed just above the symphysis pubis

with the palm facing the abdomen of the mother to provide counter traction to prevent uterine

inversion during removal of the placenta. At the same time, the dominant hand that held the

clamped cord was pulled gently in a downwards traction. With steady controlled cord

traction, the process was repeated until the placenta was visible at the vulva and cupped with

the two hands, and was rolled round to gently tease the membranes. The placenta was

completely delivered at 11:55am. A quick examination of the placenta was made where both

the maternal and fetal surfaces were intact. The placenta was placed in a receiver for

26
thorough examination later. The uterus was rubbed for a contraction and clots were expelled.

The client was taught how to massage the uterus. The vulva was cleaned with savlon, the

labia were patted and cleaned. Two sterile gauzes were wrapped on the middle and index

finger for inspection and there were no lacerations on the perineum. The vaginal walls and

cervix were inspected but there were no tears. The total blood loss was 200 milliliters. Client

was cleaned and a new perineal pad was applied to the vulva to absorb any lochia and client

was congratulated.

3.6 EXAMINATION OF THE PLACENTA AND MEMBRANES

In the sluice room, the placenta was immersed in 0.5% chlorine solution to make it safer for

examination. Firstly, the umbilical cord had two arteries and a vein with no knot, the umbilical

cord was situated at the center of the fetal surface and blood vessels were radiating outward.

The fetal surface was bluish grey in color. The umbilical cord was held upward to bring the

membranes down the placenta was placed on a flat surface for further examination. The amnion

was peeled from the chorion up to the umbilical cord and was fully viewed. The maternal

surface was examined by cupping the placenta in the hand, there was no infarct, the color was

reddish brown and the lobes were intact. Hand was spread inside the membranes to examine it

for completeness and it was intact. After the examination, hands were dipped in chlorine

solution before discarding the gloves. The instruments were also decontaminated in 0.5%

chlorine solution for 10 minutes. The instruments were removed, washed, rinsed, dried and

made ready for sterilization. She was encouraged to urinate frequently for the uterus to contract

and was told that if she should feel any changes, she should not hesitate to report. She was told

that she would be taken to the lying in and observed for the next six hours. All findings were

recorded on the partograph.

3.7 MANAGEMENT OF FOURTH STAGE OF LABOUR

27
During the fourth stage of labour, close observation of the mother and baby is made for about

six hours following the expulsion of the placenta, membranes and the subsequent arrest of

hemorrhage. The mother and baby were assessed every 15 minutes for two hours and 30

minutes for the next one hour. Vital signs for the baby was checked and recorded as follows;

Temperature - 36.1oC

Apex beat - 130bpm

Respiration - 34cpm

The mother's vital signs for every 15 minutes for the first 2 hours ranged from:

Temperature 35.6 - 36.30c

Pulse 79 – 94 beats per minute

Respiration 18 – 20 cycles per minute

Blood pressure 120/60 - 130/80 millimeter of mercury

The uterus was massaged to ensure that it was well contracted and client was encouraged to

massage her uterus. She was encouraged to report any unusual bleeding. Symphysio fundal

height was 19 centimeters. Client was given vitamin A 200,000IU capsule. The Lochia was

also checked, with its color being red (rubra) and not offensive. She was again encouraged to

empty her bladder frequently to prevent postpartum hemorrhage and also to change soiled pads

frequently to prevent infections. She was educated to wash her hands with soap and water after

changing her pad and also before and after attending to the baby. She was also educated on

how to fix baby to breast, the importance of exclusive breastfeeding for the first six months.

Madam Josephine and her baby were sent to the lying in after delivery for further monitoring

of both mother and baby.

28
Client husband was allowed to see her and she was served with warm porridge and bread to

restore energy. General condition of client and baby was satisfactory and all labour notes

were recorded on the partograph sheet.

3.8 PREVENTION OF INFECTION

Immediately the baby was born, the eyes were cleaned from inner cantus outwards. Hands

were washed and dried before handling the baby. Gentamycin eye drop was instilled on the eye

as prophylaxis against eye infection and was injected with 1.0mg of vitamin K intramuscularly

on the thigh to aid in clotting. Attention was paid to the cord by cleaning it with sterile cotton

soaked with methylated spirit and kept dry to prevent infections. She was reminded to wash

her hands under running water before and after handling the baby.

3.9 SUMMARY OF LABOUR

On 14thJuly 2018; at 11:49am, Madam Josephine had a spontaneous vaginal delivery to a live

female child. At 11:50am, injection oxytocin 10 units were given. Apgar score first minute was

9/10, fifth minute 10/10. At 11:55am the placenta and membranes were completely delivered.

Baby weighed 3.5kg. Perineum was intact, blood loss was 200 milliliters.

3.10 CONDITION OF MOTHER

Blood pressure 120/60millimetres per mercury

Pulse 94 beat per minute

Temperature 36.2 degree Celsius

Fundal height 18centimetres

29
Uterus Contracted

Lochia Red(rubra)

Perineum Intact

Estimated blood loss 200mls

Condition Satisfactory

3.11 CONDITION OF BABY

Apgar score

First minute 9/10

Fifth minute 10/10

Sex Female

Temperature 36.1 degree Celsius

Birth weight 3.5kilograms

Apex heart beat 130 beats per minute

Respiration 34 cycles per minute

Length of the baby 53 centimeters

Head circumference 32centimeters

Meconium Passed

Urine Passed

Abnormalities No abnormalities detected

30
Condition Satisfactory

3.12 CARE PLAN DURING LABOUR

14th July, 2018

Madam Josephine complained of

1. Lower abdominal pain

2. Fatigue

3. Painful uterine contractions

4. Anxiety

5. Frequency micturition

SHORT TERM OBJECTIVES

1. Madam Josephine will cope with lower abdominal pains within 1 hour.

2. Client will be relieved of fatigue within 2 hours.

3. Client will cope with painful uterine contractions within 1 hour.

4. Client will be relived of anxiety within 30 minute.

5. Client will understand the physiology of frequency micturition and cope within 8

hours.

LONG TERM OBJECTIVES

Madam Josephine will go through all the stages of labour successfully without any form of

complications.

31
DATE/ NURSING OBJECTIVE/ NURSING NURSING DATE/
TIME OUTCOME TIME EVALUATION SIGN
DIAGNOSIS ORDERS INTERVENTION Commented [M2]:
CRITERIA

14/7/ Lower Client will 1. Reassure 1. Client was told 14/7/ Goal fully met as
18 abdominal cope with client that the her condition is 18 client reported
pain related to lower pain will be temporal and the pains has reduced
12:15 physiological abdominal 1:15a and midwife
reduced pains will reduce.
am process pains within m witnessing client
involving first an hour as was able to cope
stage of evidence by 2. Educate 2.Client was told with pain
labour. client client on the lower
verbalizing physiology abdominal pain
that she is of lower was as a result of
able to cope abdominal descent of the
with pain and
pain. presenting part
midwife
witnessing
client coping 3. Massage 3.Sacral region
with pain. the sacral was massaged
region during during contraction
contraction to reduce pain

4. Engage 4. Client was


client in engaged in
diversional conversation
therapy to during the whole
relieve the period of labour to
mind of pain. relieve her mind of
pain.
5.
Encourage 5.Client assumed
client to left lateral position
assume left during the first
lateral stage to help
position reduce pain and to
during first aid in descent of
stage of the presenting
labour.

32
DATE/ NURSING NURSING NURSING ORDERS NURSING DATE/ EVALUATION SIGN
TIME DIAGNOSIS OBJECTIVES/ INTERVENTION TIME
OUTCOME
CRITERIA
14/7/18 Fatigue Client will be 1. Encourage client to 1. Oral fluid (fruit 14/7/18 Goal fully met
take oral fluids to juice) was
12:15am related to relieved of hydrate her. given to the 2:15am as client said
client to client
increased fatigue within 2 that she was no
2. Encourage deep to hydrate her.
energy hours as breathing exercise 2. Deep breathing longer
when in pain. exercise was
requirements evidence by done during exhausted and
3. Encourage her to contractions
during labour client adopt a more midwife
comfortable position 3.Client was
verbalizing that observed no
that is harmless like encouraged to
she is no more left lateral position assumed the lateral signs of fatigue.
position during 1st
tired and the stage of labour
4. Encourage client to
midwife pant and relax in 4. She panted and
between relaxed in-
visualizing that
contractions. between
client is relaxed contractions.
Give emotional and
and not showing 5.Client was given
physical support
signs of fatigue. emotional and
throughout labour
physical support

throughout labour

33
Commented [M3]:

DATE/ NURSING NURSING NURSING NURSING DATE/ EVALUATION SIGN


TIME DIAGNOSIS OBJECTIVES/ ORDERS INTERVENTION TIME
OUTCOME
CRITERIA
14/7/18 Painful Client will cope 1.Reassure 1. Client was told 14/7/18 Goal fully met
client that that the pains will as client
12;15am uterine with painful the pain is help her baby to be 1:15am reported she
temporal delivered was coping and
contractions uterine 2. Encourage 2. She coped by midwife
her to cope carrying out all she observing the
related to contractions with the pain was told to do client
since it is 3. Client performed deep
physiological within 2hours as physiological performed deep breathing
3. Perform breathing exercise exercise during
involvement evidenced by deep during uterine contractions
breathing contractions
of labour client exercise with 4. Client walked
client
verbalizing she 4. Encourage around the ward
client to
is coping and ambulate

midwife

visualizing

client abiding

the education

given

34
DATE/ NURSING NURSING NURSING NURSING DATE/ EVALUATIO SIGN
TIME DIAGNOSIS OBJECTIVES/ ORDERS INTERVENTI TIME N
OUTCOME ON
CRITERIA
14/7/18 Anxiety Madam 1. Reassure 1.Client was told 14/7/18 Goal
related to Josephine will client about the of the caliber of achieved as
12:15a 12:45a
unknown be relieved of competency of the staff on duty midwife
m m
outcome of anxiety within the staff and the and they were reported that
labour 30minutes of outcome of introduced to her client was
labour as labour. relaxed in
evidence by 2.Before timing bed.
midwife 2. Explain every contractions or Client said
she was no
observing client procedure to be listening to fetal
more
with relaxed carried to her to heart rate, client anxious.
looks. allay her was told
Client anxiety and
verbalizing that fear. 3.Client was told
she is no more the finding of
anxious. 3. Educate her each
on the outcome examination
of labour to 4.Client
make her feel performed deep
less anxious. breathing
exercise during
4. Encourage uterine
deep breathing contractions
exercise to
make client feel 5.Client asked
comfortable and
questions on the
relieve her of
outcome of
anxiety.
contraction and
5.Encourage
client to ask

35
questions and answers was
answer them.
given tactfully

DATE/ NURSING NURSING NURSING NURSING DATE/ EVALUATION SIGN


TIME DIAGNOSIS OBJECTIVES/ ORDERS INTERVENTION TIME
OUTCOME
CRITERIA
14/7/18 Frequency of Client will 1. Reassure 1. Client was 14/7/18 Goals fully met
client that reassured that
12:15am micturition understand the 8:15am as evidence by
she is in the she was in the
related to the physiology of client
hands of hands of
descent of the frequent competent competent verbalizing that
midwives. midwives.
foetal head micturition and she now

exerting cope with it understands the


2. Explain 2. Physiology of
pressure on within 8 hours the frequent physiology of
physiology micturition was
the bladder. as evidence by frequent
of frequent explained to her.
client micturition and
micturition 3. Bedpan was
verbalizing that to her. served whenever is coping with
client needed it.
she understand it.
3. Serve
and is coping
bedpan 4. Client was
with the whenever encouraged to
client needs. urinate when she
situation.
has the urge.

4.Encourage
client to

36
urinate 5 Client was
when she
educated to change
has the
urge.

5 Educate

client to

change

37
CHAPTER FOUR

PUERPERIUM

4.0 INTRODUCTION

Puerperium is a period of six weeks following the complete expulsion of the placenta and

membranes from the uterus and control of hemorrhage.

This chapter describes the management of both mother and baby from day one to six weeks
postpartum. It is during this stage that the various organs with exception of the breast, return
to their non-pregnant stage.

4.1 DAY OF DELIVERY

On 14th July 2018 at 8:10am Madam Josephine and baby were sent to the lying-in-ward where

baby was wrapped nicely and put beside her. Client was educated on the need to ensure proper

personal hygiene and empty the bladder frequently so that the uterus could contract and prevent

bleeding. The need to change perineal pad when soiled and applying of new pad to prevent

perineal sepsis was also emphasized. The baby was then put to breast. A capsule of 200,000 I.

U vitamins ‘A’ was served and recorded. Client was educated to feed the baby frequently and

on demand, also, exclusive breastfeeding and fixing of the baby to breast were well explained

to mother. Emphasis was also made on hand washing after visiting the toilet, removing baby’s

soiled napkins to help prevent infection. Client vital signs were checked and recorded every 15

38
minutes for two hours, 30 minutes for one hour and hourly for the next three hours. The first

three hour vital signs that were the blood pressure and pulse were also recorded on the

partograph. The first reading was however recorded as below;

Temperature 36.2 degree Celsius

Pulse 88 beats per minute

Respiration 20 cycles per minute

Blood pressure 130/80 millimeters of mercury

Symphysiofundal height 17 centimeters

Madam Josephine complained of lower abdominal pains, she was reassured that the pain would

resolved with time. She was however given analgesic (tab paracetamol 1g tid for 5days). Her

husband and mother were allowed to visit her and the baby of whom they were very happy.

Client was congratulated on her effort of delivery and was allowed to rest.

4.2 SUBSEQUENT CARE OF THE BABY

After six hours of birth, the baby was examined from head to toe with the consent of the mother

but no abnormality was detected. The baby was given first bath before the cord was cleaned

with sterile cotton wool swabs and methylated spirit. No bleeding was noticed. Baby passed

urine and meconium during the bath. Baby’s vital signs checked and recorded were as follows;

Temperature 37.0 degree Celsius

Apex beat 130 beats per minute

Respiration 32 cycles per minute

39
Weight 4.0kilogram

PROCEDURE FOR BABY BATH

The baby was bathed after the sixth hour observation. Head to toe examination was done and

no abnormality was detected. Madam Josephine was informed about the procedure to seek her

consent and she accepted. She was asked to observe closely how her baby was going to bathed

in order to practice it at home. Requirements needed for the procedure were gathered as

follows;

Soap, sponge, baby oil, powder, basin, towel, cot sheet, apron, sterile gloves, baby dress, cap

and socks, mackintosh, Jug containing hot and cold water each, two receptacles for used water

and dirty cot sheet, pair of scissors sterile cord clamp, brush, comb, methylated spirit, sterile

gallipot containing sterile water for the eye, sterile cotton wool swabs. Plastic apron was worn

after water was mixed and temperature checked with elbow. Hands were washed with soap

under running water. Gloves were worn. Baby was placed on a protected flat surface and

undressed after which he was wrapped with a cot sheet this was done to prevent heat loss. Eyes

were cleaned with wet towel from inner cantus to outer cantus. Baby’s face was also clean with

damp face towel and dried. The nape of the baby’s neck was supported with one hand and ears

were plugged with two fingers (the middle finger and thumb) of the hands supporting the

baby’s head. Head was washed with soapy sponged after which the baby was lifted off the flat

surface. Madam Josephine was educated that, the ears had to be covered with the fingers to

prevent water from entering. Still supporting the nape of the neck and the body resting on the

elbow to the edge of the bowl, hair was rinsed and dried. Baby was placed back on the protected
40
flat surface. His arms and front of trunk were washed paying attention to the skin folds. The

baby’s back was turned with the arm supporting the chest and with the hands holding the distal

arm. The back was washed down to the feet paying attention to the skin folds. Baby was

supported firmly and immersed in the bath of warm water with head above the water and rinsed

thoroughly. Baby was placed on a flat surface and covered with a clean sheet. Small towel was

used to dry the baby, paying attention to the skin folds. His cord was dressed. He was smeared

with baby oil. The baby was dressed in his welcome baby dress with socks and cap.

PROCEDURE FOR CORD DRESSING

This procedure was explained to the mother to gain her consent. Hands were washed

thoroughly with soap under running water and were dried with clean towel. Surgical gloves

were worn and the cord was inspected for bleeding but no bleeding was seen. All the

instruments necessary for the procedure were gathered on a tray. Six cotton wool swabs were

soaked in methylated spirit. One of the swabs was used to hold the cord clamp. The base of the

cord was cleaned with one cotton wool swab. The anterior, posterior and lateral portion of the

cord was cleaned starting with the base to the upper part using swabs of each stroke. The tip of

the cord was cleaned with a cotton wool swab. The swab that was used to hold the cord clamp

was then used to clean the whole of cord clamp. The cord was then left exposed. Both gloves

hands were immersed in a 0.5%chlorine solution. The baby was wrapped in a clean cot sheet

and was handed over to the mother to breastfeed. All findings were documented and

communicated to Madam Josephine.

The baby was examined from head to toe and no abnormality was detected.

41
EXAMINATION OF THE NEW BORN

After the fourth stage, every procedure carried on baby was explained to mother. Hands were

washed and dried with a clean towel. The baby was put on a clean warm and flat surface. Baby

was then exposed systematically as it was examined from head to toe. Baby’s color was pink

on observation; the head was examined for shape and size, widened sutures, bulging/depressed

fontanelles, any edematous swelling, caput succedaneum, microcephaly, anencephaly, and

hydrocephaly. A tape measure was used to encircle its head starting from the occipital

protuberance to the supraorbital ridges to measure the head circumference. The ears were

examined for size, shape, patency, softness of the cartilage, alignment and the eyeballs were

examined for its presence, color, pallor, jaundice and deformities. The nose was examined for

shape, size, patency, deviated septum and discharges. The buccal cavity was inspected for false

teeth, tongue tie, color of tongue and gum, cleft lip and palate by using the little finger to feel

for palate, sub mucous cleft. The neck was also palpated for nodules, rigidity and congenital

goiter. On the chest, respiratory movement was normal, nipples were in alignment, and breast

had no mass. The upper extremities were inspected for equality, number of palmer creases

clubbed fingers, extra/loss digits. Baby’s ability to perform moro and grasp reflexes were also

checked. The abdomen was examined for shape and size, with no bleeding from the umbilical

site and abnormalities such as omphalocele, gastrochiehis were absent. The extremities were

inspected for equality, clubbed feet, extra or loss digits. Congenital hip dislocation was also

checked. The back of the baby was examined for abnormalities like spinal bifida, meningocele,

all these were absent. The genitalia were developed with testis descended into the scrotum and

urethral and anal orifices were patent as it passed urine and meconium respectively. Gloves

were removed and disposed aseptically before washing and drying hands.

42
4.3 EDUCATION TO THE MOTHER ON BABY

Madam Josephine was educated to wash her hands before and after breastfeeding the baby.

She was educated on how to properly fix the baby to the breast to prevent breast engorgement,

cracked, sore nipple and also to promote and maintain adequate breast milk supply to the baby.

Madam Josephine was educated on the needs of exclusive breastfeeding for the first six months

and she was encouraged to practice it. She was educated and encouraged to allow the baby to

completely empty one breast before giving the other breast to the baby. She was educated to

avoid the use of herbs and other medications in dressing the cord to prevent infection. She was

told to use only the methylated spirit given to her to dress the cord. She was encouraged to

always keep the cord dry. Madam Josephine was told not to apply any hot water to the baby’s

fontanelles since they will close by themselves when the time is due. Mother was also educated

and encouraged to eat a well-balanced diet and also to take her routine medications given as

well, in order to help in lactation.

4.3 FIRST DAY POST DELIVERY

On 15th July 2018, was Madam Josephine’s first day post-delivery. Client woke up healthy

and cheerfully looking. All procedure to be carried out on both mother and baby were

explained. Perineal pad was inspected for the flow of lochia which was small and red

(rubra) in color with no odor. Mother then took a warm bath and was served with porridge

and bread. Permission was sought from client and head to toe examination was done with

no abnormalities detected. The uterus was well contracted and the symphysiofundal height

was 14 centimeters. Client vital signs were checked and recorded as,

Temperature 36.8 degree Celsius,

Pulse 99 beats per minute

Respiration 24circles per minute

43
The baby was then wrapped in a clean and warm cot sheet and handed over to the mother for

breastfeeding with which Madam Josephine properly positioned and attached the baby to

breast. Mother was then served with her second dose of 200,000 I. U of vitamin A supplement.

Client was reminded on the intake of nutritious diet, fruit and frequent breastfeeding of the

baby. Education was given on the change of perineal pad when soiled and the need to wash

her hands after removal and before breastfeeding the baby to prevent infections. Client was

also educated on postnatal exercises such as Kegel, ambulation and family planning as well as

exclusive breastfeeding, change of napkins frequently, wash and dry them in sun and keeping

the baby warm always. The baby was given oral polio vaccine and Bacillus Chalmette Guerin

(BCG) vaccine intra-dermally at the right upper arm at the child welfare clinic. Madam

Josephine was educated not to apply anything on the injection site, she was also told that the

baby may have slight fever and swelling at the site of injection which would subside.

Madam Josephine was given the following drugs;

Tablet folic acid 5mg tablet daily for 10 days

Tablet ferrous sulphate 200mg tablet daily for 10days

Tablet multivitamin 200mg tablet daily for 10 days

Tablet paracetamol 1g tids for 5days

Client was discharged and was helped to pack belongings after serving medications. Her

hospital bills were settled by the National Health Insurance Scheme. Client was accompanied

home and a day was scheduled to visit them. Client was congratulated and bade farewell.

4.4 FIRST HOME VISIT EVENING OF DISCHARGE

On the 15th of July 2018, a visit was made in the evening to Madam Josephine’s house. They

were found in good health. All procedures to be carried out on both mother and baby were

explained. Perineal pad was inspected for the flow of lochia which was small and red (rubra)

44
in colour with no odour. Permission was sought from client and head to toe examination was

done with no abnormalities detected. The uterus was well contracted on palpation. Symphysio

fundal height was 13cm. Client’s vital signs was checked and recorded as follows;

Temperature 36.3 degree Celsius

Pulse 94 beat per minute

Respiration 21 cycles per minute

Blood pressure 120/80 millimetres of mercury

The values recorded for the baby were;

Temperature 36.1 degree Celsius

Apex heart beat 130 beat per minute

Respiration 30 cycles per minutes

They were very happy after a little interaction where they were informed of the next visit and

thanked me for the visit as they escorted me outside the house.

4.5 SECOND POSTNATAL HOME VISIT

On the 16th July 2018 at 4:15pm, Madam Josephine and family were visited as promised. Client

was at home with husband and children on arrival. General health condition of mother and baby

was good. Client was examined from head to toe and nothing abnormal was detected. Breast

was lactating well; lochia was red and the flow was small with no offensive odor. On palpation,

the uterus was well contracted and the symphysiofundal height was 12 centimeters. Vital signs

checked and recorded were;

Temperature 36.8degree Celsius

45
Pulse 88 beats per minute

Respiration 22 cycles per minute

Blood pressure 120/60 millimeters of mercury

The baby was toped and tailed the cord was dressed with cotton wool swab and methylated

spirit. Head to toe examination was performed with no abnormalities detected. The baby was

wrapped and breastfed. Client lower abdominal pain had subsided when enquired but

complained of fatigue and back ache. She was reassured and advised to have warm bath before

bed and rest in a noise free environment and also limit time spent with visitors during the day.

The baby’s vital signs were checked and recorded as,

Temperature 36.8degree Celsius

Pulse 128 beats per minute

Respiration 33 cycles per minute

The mother was educated to avoid applying hot compresses on the fontanels with the intentions

of healing a wound. It was explained to her family that the fontanelles will naturally close.

Client was also advised to keep the baby warm always and not to expose the baby to cold

weather. The baby’s weight was checked and recorded as 3.6kg. The surrounding was neat and

she was congratulated and encouraged to keep it up. She was thanked for cooperation and

permission was sought to leave and return the following day.

4.6 THIRD DAY POST NATAL HOME VISIT

On 17th July 2018, the second visit was made to Madam Josephine’s house around 4:00pm in

the evening. Madam Josephine said her condition had improved, lower waits pain and fatigue

46
has subsided and baby was also breastfeeding well. Permission was sought to examine both

mother and baby. Head to toe examination was carried out on her and no abnormalities were

detected. The perineal pad was inspected and the flow of lochia was small and red in color

(rubra) which was not offensive. The symphysio fundal height was 10 centimeters. Her vital

signs were checked and recorded as follows;

Temperature 36.6 degrees Celsius

Pulse 78 beats per minute

Respiration 20 cycles per minute

Blood pressure 110/70millimeters of mercury

The baby was examined from head to toe and there was no abnormality, the mother complained

of fullness of the breast and also inadequate sleep due to frequent breastfeeding in the night.

Mother was reassured and encouraged to sleep during the day time and also the need to take

nutritious diet. Mother was educated to continue breastfeeding. The cord was dressed with

cotton wool swab and spirit and the mother was educated not to apply any herbs on the cord.

The baby was examined again and cord dressed after bathing. The baby’s weight was checked

and recorded as 3.6kg, vital signs was recorded as:

Temperature 36.4 degrees Celsius

Apex heart beat 136 beat per minute

Respiration 30 cycles per minute

47
Permission was sought to leave and Client said she was very grateful and appreciated the care

that was given to them.

4.7 FOURTH DAY POSTNATAL HOME VISIT

Madam Josephine was visited at home on the 18th July 2018 to know how she is faring at

4:10pm. Greetings were exchanged and permission was sought to inspect client’s perineal pad

and it was pink, moderate in flow without any offensive smell. Her breasts were lactating well.

Symphisio Fundal height 8 centimeters. Her vital signs were checked and recorded as follows;

Temperature 36.2degrees Celsius

Pulse 80 beats per minute

Respiration 24 cycles per minute

Blood pressure 120/70 millimeters of mercury

The baby was bathed and general examination was carried out and no abnormality was present.

The cord was neatly dressed with no abnormality detected. The baby also passed stool and

urine. Baby’s weight was checked and recorded as 3.8kg. Baby’s vital signs were taken and

recorded as follows;

Temperature 36.5degrees Celsius

Apex heart beat 130 beat per minute

Respiration 36cycles per minute

48
4.8 FIFTH DAY POSTNATAL HOME VISIT

On the 19th of July 2018, the next home visit was made to the client’s house. They were found

in good health and the family was congratulated for taking good care of the baby. Client said

fullness of breast was better and had no complaints. Client was encouraged to continue sleeping

during the day time and also the need to take in nutritious diet. Baby was given warm bath and

the cord however went off on this day. Vital signs recorded on this day were as follows;

Temperature 36.5 degree Celsius

Pulse 80 beat per minute

Respiration 23 cycles per minute

Blood pressure 120/80 millimetres of mercury

Symphysio-fundal height 7centimeters

The values recorded for the baby were;

Temperature 36.6 degree Celsius

Apex heart beat 128 beat per minute

Respiration 30 cycles per minute

Weight 3.7 kilograms

They were very happy after a little interaction and thanked me for the visit as they escorted me

outside the house.

49
4.9 SIXTH DAY POSTNATAL VISITS

Madam Josephine and baby were visited again on the sixth day postnatal, 20th July, 2018. Their

general health was good, head to toe examination was done and there were no abnormalities

detected. Client lochia was pink in color (serosa) with moderate flow and not offensive. Client

was asked if she was able to sleep for six hours within the two days which madam Josephine

answered positively. The symphysio-fundal height was measured to be 5 centimeters and the

vital signs checked and recorded on the sixth day were as follows;

Temperature 36.2 degree Celsius

Pulse 89beat per minute

Respiration 21cycles per minute

Blood pressure 120/80millimeter of mercury

The baby was also free from any abnormality and the cord stump when dressed was dry and

clean. The baby's vital signs were checked and recorded

Temperature 36.7 degree Celsius

Apex heart beat 130 beat per minute

Respiration 30 cycles per minute

Weight 3.8 kilogram

Client said the fullness of breast had relieved. she was encouraged to continue applying cold

compresses on the breast and put on a well-fitting brazier. She was again encouraged to breast

feed the baby frequently. Madam Josephine was thanked and told of the last home visit.

4.10 SEVENTH DAY HOME VISIT

The seventh day postnatal home visit was done on 21st July 2018 at 4:30pm. Greetings were

exchanged with client and her family and a seat was offered in client’s room. Mother and baby

were both in a healthy condition. On head to toe examination, no abnormalities were detected.

50
Her breast was lactating well. The Fundal was not palpable. Inspection of the lochia was done

and the color was pink (serosa) without any bad odor. The baby was examined after bathing

and dressing of the umbilical stump was done. The wound had healed.

Client’s vital signs were checked and recorded as follow

Temperature 36.5degrees Celsius

Pulse 88beats per minute

Respiration 22cycles per minute

Blood pressure 110/60 millimeters of mercury

Baby’s vital signs were taken and recorded as follows:

Temperature 36.1degrees Celsius

Apex heart beat 134 beats per minute

Respiration 40cycles per minute

Weight 3.8 kilogram

The baby was dressed and handed over to the mother for breastfeeding. Emphasis was made

on her perineal care and the intake of nutritious diets as well as avoiding the use of hot

application on the fontanelles. Client was encouraged to continue exclusive breastfeeding for

6 months. It was further explained that the exclusive breastfeeding could serve as a family

planning method. Mother was reminded of the 1st postnatal visit to the clinic and its

importance and also the need to immunize the baby at the child welfare clinic against the

childhood preventable disease. Client was told to report to the hospital when there was any

problem as soon as possible and also made her aware that, the day was my last visit to her

51
house, Madam Josephine was thanked with the entire family for their cooperation and I

departed.

4.11 FIRST DAY POST NATAL VISIT TO THE CLINIC

On the 22nd July 2018, Madam Josephine came to the clinic for the first postnatal visit. Both

mother and baby were fine and neatly dressed. Every procedure to be carried on client was

explained to her; vital signs were checked and recorded as follows;

Temperature 36.2 degree Celsius

Pulse 86 beat per minute

Respiration 24 cycles per minute

Blood pressure 120/80 millimeters mercury

Weight 60kg

The client was given a specimen bottle to collect midstream urine to test for protein and glucose

and they tested negative. Client was asked to lie on a bed for head to toe examination. On the

head, the hair was neatly dressed. The eyes were free from discharges and the conjunctiva was

not pale and no jaundice noted. The ears were also free from discharges.

The breast was examined and there was no mass, engorgement or sore nipple. There was no

tenderness, enlarged liver or spleen when the abdomen was palpated and the uterus was no

more palpable. The extremities were inspected and no abnormalities were detected. The vulva

was examined for infections, scars and lochia but none was present. The baby was taken from

the mother with permission and examined from head to toe and nothing abnormal was detected.

The baby's vital signs were taken and recorded as follows;

Temperature 36.8 degree Celsius

Pulse 120beats per minute

Respiration 32 cycles per minute

52
Weight 4.0 kilogram

After the examination, client was educated on the need to wash hands before attending to the

baby and was also reminded on various types of family planning methods and emphasized on

the need to feed the baby exclusively. They were reminded on the second postnatal visit to the

clinic on the 6th week or 40 days post-delivery. Madam Josephine was also encouraged to

register the baby at the birth and deaths registry. Client and her baby were handed over to the

midwife in -charge for continuity of care and was thanked for her co-operation throughout the

care.

4.12 SIXTH WEEK POSTNATAL VISIT TO THE CLINIC

According to the midwife in charge on the 25thof August 2018, Madam Josephine came to the

clinic for sixth week postnatal visit. She was warmly welcomed. Both mother and baby were

all looking very healthy. General examination was conducted from head to toe on both mother

and baby. Their vital signs were checked and recorded as follows:

Temperature 36.6 degree Celsius

Pulse 82 beat per minute

Respiration 20 cycles per minute

Blood pressure 100/70 millimeters mercury

Weight 60kg

The client was given a specimen bottle to collect midstream urine to test for protein and glucose

and they tested negative. Client hemoglobin level was 11.5gram per deciliter. Client was asked

to lie on the couch for head to toe examination. On the head, the hair was neatly dressed. The

eyes were free from discharges and the conjunctiva was not pale and no jaundice noted. The

ears were also free from discharges. The breast was examined and there was no mass,

53
engorgement or sore nipple. There was no tenderness, enlarged liver or spleen when the

abdomen was palpated and the uterus was no more palpable. The extremities were inspected

and no abnormalities were detected. The vulva was examined for infections, scars and lochia

but none was present. The baby was taken from the mother with permission and examined from

head to toe and nothing abnormal was detected. The baby's vital signs were taken and recorded

as follows;

Temperature 36.7 degree Celsius

Pulse 120beats per minute

Respiration 26 cycles per minute

Weight 4.7 kilogram

After the examination, client was thanked for her co-operation throughout the care and also

educated on the need to bring the baby to clinic for immunization on the appointed date.

4.2 CARE PLAN DURING POST PARTUM PERIOD

PROBLEM IDENTIFIED

1. Client complained of after pains

2. Client complained of fatigue

3. Client complained of back ache.

4. Client complained of fullness of breast (Potential for breast engorgement)

5. Client complained of inadequate sleep

SHORT TERM OBJECTIVES

54
1. After pains will be reduced within 72hours

2. Client will be relieved of fatigue within 48 hours.

3. Client’s back ache will be reduced within 48 hours.

4. Client will empty the breast completely at each feed within 48hours

5. Client will sleep at least 1 hours in the day and 6hours in the night within 72 hours.

LONG TERM OBJECTIVE

Client will go through puerperium successfully without any complication to both mother

and baby.

DATE/ NURSING NURSING NURSING NURSING DATE/ EVALUATI SIGN


TIME DIAGNOSIS OBJECTIVE/ ORDERS INTERVENTION TIME ON
OUTCOME
CRITERIA
14/07/18 Altered body After pains 1. Reassure 1. Client was 17/07/18 Goal fully
4:00pm comfort (after will be client the reassured by 4:00pm met as client
pains) related reduced within pain she explaining the said that the
to uterine 72 hours as temporal. Physiology of after pain has
involution evidenced by 2. Encourage pains. reduced and
client client to void 2. Client voided midwife
verbalizing frequently. frequently to witnessing
that the pain 3 Encourage prevent the growth client with
has subsided client to of microorganisms relaxed facial
and midwife breastfeed and the spread of expression
witnessing that frequently infection.
client is and on 3. Client breastfed
feeling demand. frequently and on
comfortable. demand and
4. Encourage completely
client to emptied one breast

55
gently before giving the
massage the other.
lower 4. Client gently
abdomen. massaged the
5.Encourage lower abdomen
client to lie during pain.
with her face 5.Client slept with
down and her face down with
with pillow pillow under her
under her abdomen to
abdomen minimize pain

6. Give 6. Client took


client paracetamol 1g
paracetamol before
1g 30 breastfeeding
minutes
before
breastfeeding
to reduce
pain.

56
DATE/ NURSING OBJECTIVE/ NURSING NURSING DATE/ EVALUA SIGN
TIME OUTCOME ORDERS INTERVENTION TIME TION
DIAG CRITERIA
NOSIS

16/7/18 Backache Client 1.Reassure 1.Client was 18/7/18 Goals


related to backache will client she reassured she will 4:15pm fully met
4:15pm
poor posture reduce within will be be relieved of as
during 48 hours as relieve of backache evidence
breastfeeding. evidence by backache by client
client 2.Client was verbalizin
verbalizing 2.Encourage encouraged to g that
that her client to assume good backache
backache has assume posture when has
subsided good breastfeeding subsided
posture
when 3. Client was
breastfeedin encouraged to
g apply cold pack at
the area
3.Encouage
client to 4.Client was
apply cold encouraged to
pack at the massage the area
area gently

57
4.Encourage 5.Client was
client to encouraged to
gently place pillow at the
massage the back when sleeping
area

5.Encourage
client to
place pillow
at the back
when
sleeping

58
DATE/ NURSING NURSING NURSING NURSING DATE/ EVALU SIG
TIME DIAGNOSIS OBJECTIVE/ ORDERS INTERVENTION TIME ATION N
OUTCOME
CRITERIA
16/07/18 Fatigue Client’s fatigue 1. Reassure 1. Client was told to 18/07/18 Goal
4:15pm related to will be resolved client about rest when baby is 4:15pm fully met
stresses of within 48 hours recovery of asleep. as client
labour. as evidenced by her condition. 2. The client rested verbalize
the client 2. Explain the during the day in d she was
verbalizing that, need to have between activities relieved
she is relieved of enough rest. 3. She rested of stress
body discomfort 3. Encourage whenever baby was and
and midwife client to rest asleep. midwife
witnessing client when her witnessin
has no signs of baby is 4. Client slept in a g client
fatigue. asleep. noise free showed
4. Encourage environment and no signs
client to visitors were of
ensure noise restricted tiredness
free
environment 5.Madam Josephine
had a warm bath
5.Educate the before resting since
client to have it will induce sleep
a warm bath and make her feel
before resting comfortable
6.Support person
6.Encourage did most of the
client support house hold chores
person to help to enable client
with the house have enough rest
hold chores

59
DATE/ NURSING NURSING NURSING NURSING DATE/ EVALUA SIGN
TIME DIAGNOSIS OBJECTIVES/ ORDERS INTERVENTION TIME TION
OUTCOME
CRITERIA
17/7/18 Breast Client will empty 1.Reassure 1.Client was told 19/7/18 Goal fully
4:00pm engorgement the client that her condition is 4:00pm met as
related to breast she will be temporal client
inability to completely at relieved of verbalized
empty breast each feed within her 2. Client ensured the breast
completely. 48hours as condition the baby emptied was
evidenced by one breast before completely
1. Client 2.Educate breastfeeding with emptied
verbalizing client to the other breast. and
that she feels ensure the midwife
comfortable baby 3.Client positioned witnessing
in her breast complete baby well when the client
and emptying breastfeeding showed no
2. Midwife one breast signs and
visualizing that 4.Client had good symptoms
client has no 3.Educate brassier on to of
signs and client on support the breast engorged
symptoms of how to breast
breast position 5. Client expressed
engorgement. baby well the breast milk after
when feeding when breast
breastfeedi was not emptied.
ng
4.Encourag
e the client
to support
the breast
with good
brazier or

60
breast
binder
5.
Encourage
client to do
gentle
manual
expression
of the
breast if
breast is not
emptied
after
feeding.

61
DATE/ NURSING OBJECTIVE/ NURSING NURSING DATE/ EVALUATION SIGN
TIME DIAGNOSI OUTCOME ORDERS INTERVENTIO TIME
S CRITERIA N

22/7/18 Sleeping Client sleeping 1. Encourage 1.Client was 24/7/18 Goal fully met
client to have
patterns pattern will be encouraged to as client
8:00am enough rest 8:00am
disturbances restored during the have enough rest verbalizes that
day when the
(inadequate (8hours) within during the day she is able to
baby is
sleep) related 48 hours as asleep. when baby is sleep.
to night evidenced by asleep.
2. Educate
breastfeeding client client to 2.Client was
breastfeed
verbalizing educated to
baby to her
that she is able satisfaction. breastfeed baby to
to sleep. her satisfactory.
3. Encourage
her relatives 3.Client relatives
to help her
were encouraged
with the
house hold to help her in the
chores.
house chores
4. Encourage 4.Client was
the client to
encouraged to
have warm
bath in the have a warm bath
evening
in the evening
before going
to bed. before going to
bed.
5. Serve
prescribed 5.Prescribed
medication.
medication was
served.

62
SUMMARY AND CONCLUSION

This family and client centered maternity care study was conducted on Madam Serwaa Boateng

Josephine, a 28 years old woman, who is gravida 3 para 2 all alive. She was met at Blessed Family

Maternity Home/Clinic, Twabidi no1 in the Brong Ahafo Region. The client was 39week gestation

when she was met on 27th June 2018. Client hails from Ashanti-Mampong, krobo, in the Ashante

Region but resides at Adukuma kurom.

Various observations and examination including laboratory investigations were carried out to aid

in the progress of normal pregnancy, labour and puerperium. She went through some minor

disorders during pregnancy which were managed successfully. Madam Josephine’s labour and

delivery were carefully managed without any complications and she delivered an alive female

child on the 14th of July 2018 at Blessed Family Maternity Home/Clinic, Twabidi no1.

After delivery, she experienced backache, fullness of breast and after pain among others as some

disorders associated with puerperium. She was managed accordingly and they resolved within the

shortest possible time. Our interaction at the postnatal clinic ended on the 22nd of July, 2018 and

She was handed over to the midwife in charge of the facility.

All postnatal visits to the house and subsequent visit to the clinic by the client were done and all

examinations were conducted on both mother and baby. Client, her baby and the entire family

were handed over to the public health nurse in her community for continuity of care.

This client /family centered maternity care given has enabled me gain much experience about the

importance of proper client management during pregnancy, labour and puerperium.

63
It has also helped me to improve my skills as a student midwife in planning, interviewing,

implementing, setting objectives and evaluating them to solve client’s problems identified.

I end it all by saying that, the care study is an important and managerial tool in which theoretical

knowledge could be put into practice and deal with maternity problem as midwifery professionals.

BIBLIOGRAPHY

Antenatal Records Book

Dutta, D.C. (2011). Textbooks for obstetric (7th ed). London: New central Books Agency

Limited.

Myles, M. (2016). Textbook for midwives. london: elsevier limited.

Ghana Health Service (2008). National Safe Motherhood Service Protocol. Accra: Ministry of

health.

Henderson, C.& Macdonald, S. (2011). Mayes Midwifery a textbook for midwives.

London: Elservier limited.

Marshall, J. & Raynor, M. (2014). Myles textbook for midwives. london: elsevier limited

Ojo, O.A (1982). Textbook for midwives in the tropics. New Delhi: Hodder Arnold Medical

Publishers limited

64
Tiran, D. (2008). Baillieres Midwives Dictionary (11thed, pg 183) London: International Book

Manufacturing limited.

Verrals, S. (2008). Anatomy and physiology applied to obstetric (3rd ed). Pitman publishing
limited.

APPENDIX I
COMPLETE DIAGNOSTIC INVESTIGATION
DATE SPECIMEN INVESTIGATION NORMAL VALUE FINDING REMARKS

13/1/18 Urine Sugar Negative Negative Normal


protein Negative Negative Normal
Blood Hemoglobin level 11-16g/dl 14.1g/dl Normal
Sickling Negative Negative Normal
Grouping A, B, AB, O O Normal
Rhesus factor Positive/negative Positive Normal
HIV/AIDS Negative Negative Normal
Hepatitis Negative Negative Normal
Syphilis(VDRL) Negative Negative Normal
G6PD Normal Normal Normal

13/2/18 Urine Sugar Negative Negative Normal


protein Negative Negative Normal
Blood Hemoglobin level 11-16g/dl 13.3g/dl

13/3/18 Urine Sugar Negative Negative Normal


protein Negative Negative Normal
Blood Hemoglobin level 11-16g/dl 13.3g/dl Normal

12 /4/18 Urine Sugar Negative Negative Normal


protein Negative Negative Normal
Blood Hemoglobin level 11-16g/dl 13.3g/dl normal

65
12/5/18 Urine Sugar Negative Negative Normal
protein Negative Negative Normal
Blood Hemoglobin level 11-16g/dl 11.2g/dl Normal

12/6/18 Urine Sugar Negative Negative Normal


protein Negative Trace Normal
Blood Hemoglobin level 11-16g/dl 12.2g/dl Normal

27/6/18 Urine Sugar Negative Negative Normal


protein Negative Negative Normal
Blood
Hemoglobin level 11-16g/dl 13.2 Normal

5/7/18 Urine Sugar Negative Negative Normal


protein Negative Negative Normal
Blood Hemoglobin level 11-16g/dl
13.3g/dl Normal

66
APPENDIX II
PHARMACOLOGICAL DRUGS FOR MOTHER

NAME OF CLASSIFICATION ROUTE DOSAGE ACTUAL SIDE SIDE EFFECT


DRUG EFFECT EFFECT EXPERIENCED
Tablet folic acid Vitamin preparation Oral 5mg daily Maturation of Nausea None
for 30days red blood and
cells vomiting
Tablet Vitamin preparation Oral 200mg Increased Gastroint None
Multivitamin daily for appetite estinal
30days irritation
Tablet ferrous Iron preparation Oral 200mg Formation of Abdomin None
sulphate daily for red blood al
30days cells discomfo
rt,
diarrhea
dark stool
Tablet Anti-malaria and Orally 3 tablet stat Prevent Itching, None
Sulphadoxine prophylaxis from 16 malaria in vomiting,
pyrimethamine weeks pregnancy nausea
intervals/qui
ckening and
the 2nd and
3rd doses in
4 weeks
interval but
not after 36
weeks
Tetanus toxoid Anti-tetanus Subcutan 0.5miligram Prevention of Slight None
injection eous tetanus fever and
chills
Oxytocin Oxytocic drug Intramusc 10units Increase Hypotens None
ular contractions ion and
hyper
stimulati
on
Vitamin A Group A vitamin Oral 200000unit Growth Vomiting None
supplement once daily development,
prevent
infection and
blindness

67
Tablet Analgesic Oral 500mg Relieve pain Liver None
paracetamol damage
with
prolong
use

APPENDIX III
PHARMACOLOGICAL DRUGS FOR BABY
NAME OF CLASSIFICATION DOSAGE ROUTE ACTUAL SIDE SIDE EFFECT
DRUG EFFECT EFFECT EXPERIENCED
Vitamin K Group K vitamins 1milliliter Intramuscular Production Hypersensiti None
of ve reaction
prothrombin
that aids in
clotting
Gentamycin Antibiotics 2 drops Instillation To prevent None None
eye drop eye infection
Oral Antigen vaccine 2 drops Orally Gives Diarrhea, None
Poliomyelitis immunity fever
against
poliomyelitis
Injection Antigen vaccine 0.5 ml Intradermal Production Blister Blister was
Bacillus of antibodies formation formed
Chalmette and and slight
Guerin prevention fever
of
tuberculosis

68
NAME OF CLASSIFI- DOSAGE ROUTE ACTION/ ACTUAL SIDE SIDE
DRUG CATION USES EFFECT EFFECT EFFECT
EXPERIENC
ED

Pneumo Antigen 0.5 Intramuscularly Vaccinates Pneumonia Redness None


coccal neonates prevention at the observed
milligram against side of
pneumonia injection
and fever
5 in 1 Antigen 0.5 Intramuscula- Vaccinates Prevention Low None
vaccine milligram rly neonates of grade observed
(Pentavalent) against childhood fever
diphtheria, preventable
pertussis diseases
(whooping
cough),
tetanus,
hepatitis B,
heamophilu
s influenza
type B
Rota virus Antigen 1.5 Orally Prevention Gastroenter None None
millligra of itis observed
ms gastroenterit prevention
(2 drops) is

69
APPENDIX IV
ANTENATAL CHART
Date Weigh Blood Urine Gestat Fundal Presentation Descent Fetal Complains Treatment Name
t pressure Protein ional height heart rate and
(kg) (mmHg) Sugar age (cm) signature
13/1/ 68 120/70 Negative/ 16 16 - 5/5 Mild No Tablet
18 Negative movement complain (Multivit, folic
acid, ferrous
sulphate
13/2/ 69.5 100/60 Negative/ 20 20 - 5/5 positive No Tablet
18 Negative complain (Multivit, folic
acid, ferrous
sulphate,
Sulphadoxine
Pyrimethamine)
13/3/ 71 110/60 Negative 24 25 cephalic 5/5 positive General Tablet
18 /negative body (Multivite, folic
weakness acid, ferrous
sulphate,
Sulphadoxine
Pyrimethamine)
12/4/ 69 110/60 Negative/ 28 28 Cephalic 5/5 146beat General Tablet
18 negative per minute body (Multivite, folic
weakness acid, ferrous
sulphate,
Sulphadoxine
Pyrimethamine)
12/5/ 69 120/60 Trace 32 31 Cephalic 5/5 138 Nil Tablet
18 /Negative (Multivite, folic
acid, ferrous
sulphate,
Sulphadoxine
Pyrimethamine)
12/6/ 73 110/60 Negative 36 34 Cephalic 5/5 132 Nill Tablet(Multivit,
18 folic acid,
ferrous
sulphate,
Sulphadoxine
Pyrimethamine)

70
27/6/ 75 120/60 Negative 38 37 Cephalic 4/5 140 Insomnia ,
18 anorexia, Tablet(Multivit
frequency e, folic acid
of ferrous
micturition sulphate,)

5/7/1 77 110/80 Negative/ 39 38 Cephalic 4/5 142 Lower Tablet

8 negative abdominal (Multivit, folic

pains , acid, ferrous

constipatio sulphate

71
72
73
74
75
76
77
78
79
80
81
82
83
84
85