PERSONAL HISTORY Name: Rhoda Chimaliro Age: 19 years Address: Makata, Ndilande Home Village: TA Msamala, Balaka.

Religion: Baptist N !: Mai "era, #Mother$ Marital %tat&s: Married 'd&(ational )e*el: +orm , -ate o. Admission: ,/012019. Time o. deli*ery 19:,2am, ,3012019. PRESENT COMPLAINT Mother (omplained that she is .eeling pain on the perine&m d&e to tear, and lo4er a5dominal pains. %he is a5le to pass &rine, 5&t has not yet passed stools. %he *er5ali6ed that she had pain.&l la5or and deli*ery e7perien(e 5e(a&se o. the tear. Ba5y is a5le to 5reast.eed and eliminate. REVIEW OF AND ANALYSIS OF COLLECTED ANTENATAL, LABOUR AND DELIVERY DATA.

The re*ie4 o. antenatal, la5or and deli*ery data is important in the (are o. a 4oman in pe&peri&m, this a(ts as 5aseline in.ormation .or 4hi(h s&5se8&ent assessments, (are and e*al&ati*e meas&res are 5ased on. The (olle(ted data may also help the mid4i.e to pro*ide e..e(ti*e and (lient (entered health ed&(ation. Antenatally, Mrs. RC stated Antenatal Care #ANC$ at ,9 4eeks gestation, she attended three *isits and re(ei*ed t4o doses o. +ansidar .or :ntermittent ;res&mpti*e Treatment #:;T$ and three doses o. :ron ta5lets. %he had normal 5lood press&re ranges and she had a steady 4eight gain. Hemoglo5in le*el and V-R) 4ere not (he(ked, her H:V stat&s 4as negati*e. Mrs. RC re(ei*ed t4o doses o. TTV and the third dose is d&e in %eptem5er, her height 4as 1/1(m, 5stetri( history indi(ated that this 4as her .irst pregnan(y, she had no any pro5lem d&ring antenatal period, her last menstr&al period 4as on the 13th o. %eptem5er 1< and her e7pe(ted date o. deli*ery 4as on ,9th "&ne 2, ,119. Mrs. RC attained menar(he at the age o. 1= years and sin(e then her menstr&al (y(le has 5een reg&lar>,<days (y(le. %he menstr&ates .or 2 days and the nat&re o. her menstr&al .lo4 is moderate. %he said she does not e7perien(e any dysmenorrhoea. Additionally she has ne*er had an a5ortion or e(topi( pregnan(y. Mrs. RC displayed ade8&ate kno4ledge in .amily planning. %he e7plained that she kno4s *ario&s methods like pills, in?e(tion, (ondoms and 5ilateral t&5al ligation, B& has ne*er &sed any .amily planning method, ho4e*er she opts to &se -epo>;ro*era a.ter deli*ery as a .amily planning method. This 4as not a planned pregnan(y, 5oth the (lient and her spo&se a((epted it, that is 4hy they kept this pregnan(y &p to term. Mrs. RC is the .irst and only 4i.e to Mr. Chimaliro. Her h&s5and 4ent to s(hool &p to .orm .o&r. None o. them smokes nor takes al(oholi( 5e*erage. C&rrently, Mrs. RC stays 4ith her mother in>la4 5e(a&se her h&s5and 4ent to %o&th A.ri(a in sear(h o. greener past&res 4hen she 4as 3months pregnant. All the s&pport (omes .rom her mother in>la4, she doesn@t ha*e any in(ome generating a(ti*ity. Mrs. RC said she has ade8&ate kno4ledge o. si7 .ood gro&ps and she said she is pro*ided 4ith the si7 .ood gro&ps 4itho&t any pro5lems .rom her mother in> la4, the pre*io&s day 5e.ore she (ame to the hospital she had tea 4ith 5read in the morning, o@(lo(k, nsima

4ith 5oiled eggs and *egeta5les .or l&n(h and d&ring s&pper she said she had nsima, 5eans and *egeta5les pl&s 5anana. There is nothing signi.i(ant a5o&t .amily history, medi(al and s&rgi(al history A((ording to +ANC g&idelines it ad*isa5le .or a 4oman to start ANC as soon as she noti(es that she is pregnant or 5et4een 1, and 1/4eeks gestation. This is done to dete(t pro5lems related to pregnan(y as early as possi5le in order to pre*ent (ompli(ations. The ANC re(ords also sho4s that Mrs. RC attended = *isits, this sho4s that she had a good n&m5er o. *isits tho&gh she stated ANC late, and 4ithin these three *isits she .inished the re(ommended dose o. +ansidar. The re(ords also sho4 that Hemoglo5in #H5$ le*el and V-R) tests 4ere not done. :t is important to kno4 the le*el o. H5 in a pregnant 4oman 5e(a&se it pro*ides the 5aseline data d&ring la5or and deli*ery and postnatal (are. +&rthermore, it helps r&le o&t anemia in pregnan(y 4hi(h (an 5ring (ompli(ations d&ring la5or and deli*ery and postnatal period. V-R) test is done to esta5lish 4hether the mother has syphilis or not, syphilis is a dangero&s in.e(tion in pregnan(y 5e(a&se it (rosses the pla(enta and in.e(ts the de*eloping .et&s and this (an lead to a5ortion, .etal de.e(ts and premat&re 5irth. There.ore early dete(tion o. the in.e(tion re8&ires prompt treatment to a*oid (ompli(ations. )a5or 4as spontaneo&s, lasting .or 3ho&rs, she had t4o *aginal e7aminations, la5or 4as progressing 4ell, 4ith normal .etal heart rate, the time o. rapt&re o. mem5ranes 4as not indi(ated, there 4as no (ap&t, no molding, maternal (ondition monitoring 4as not done, initial assessment o. the neonate 4as not done, immediate *ital 4ere not done. %he s&stained a se(ond degree tear and it 4as repaired. Monitoring and re(ording o. o5ser*ations, e7aminations and any dr&g treatment on the partograph is important, 5e(a&se this helps to esta5lish normal .rom a5normal 4hen la5or is esta5lished. A((ording to the re(ords on the la5or (hart, it sho4s that maternal (ondition 4as not monitored d&ring and a.ter deli*ery. This is dangero&s 5e(a&se d&ring la5or the mother may de*elop (ompli(ations, and his may lead to mismanagement o. the mother d&ring la5or and a.ter deli*ery.

+etal (ondition 4as 5eing monitored, this is good 5e(a&se it helps to dete(t (ompli(ation as early as possi5le and also to kno4 the response o. the .et&s to la5o&r. :nitial assessment o. the 5a5y 4as not re(orded 4hi(h means it 4as not done. :nitial assessment is important 5e(a&se it helps to identi.y a5normalities .or immediate attention.

INITIAL PHYSICAL EXAMINATION MOTHER A'N'RA) C N-:T: N Health looking, 4ell kempt, energeti(, 4ell hydrated, 4ith an an7io&s .a(e. V:TA) %:AN% B; 1110/1mmHg, RR ,95reaths per min&te, ;R1915eats per min&te, T=3.,degrees Celsi&s. H'A- T T ' 'BAM:NAT: N H'A-: 5la(k (oarse te7t&re, no tinea, no dandr&.., no s(ars seen, no alope(ia. 'C'%: pink (on?&n(ti*a, estimated hemoglo5in o. 9.9g0dl, no eye dis(harge, no lesions no eye dis(harge. M DTH: pink m&(&s mem5ranes, no oral thr&sh, no kaposis sar(oma lesions. 'AR%: no lesions, no eye dis(harge, pre and post a&ri(&lar lymph nodes not palpa5le. N'C!: no distended ?&g&lar *eins no enlarged deep and s&per.i(ial nodes. CH'%T: symeri(al mo*ement 4ith 5reathing, no s4elling, no s(ars seen, n a&s(&ltation, normal air entry, no 4hee6es, normal heart so&nds. BR'A%T: symmetri(ally lo(ated, medi&m si6e, nipples not in*erted, n palpation, nodes not palpa5le, 5reast tiss&e so.t and not tender, no lamps .elt, (olostr&ms e7pressed. AB- M'N: no distention, 5ladder empty no lesions, strea gra*id&l&m present linea

nigra present, 5o4el so&nds present. n palpation, no tenderness, no organomegally, re(t&s diaastasis>, .ingers. DT'RD%: mildline, 4ell (ontra(ted, 5elo4 &m5ili(&s, .&ndal height 12(m. D;;'R 'BTR'M:T:'%: no pallor, (apillary re.ill less than ,se(onds. ) E'R 'BTR'M:T:'%: symmetri(al, 4arm, no (&.. tenderness, no *ari(osities, no edema. A'N'TA):A: no sores, no 4arts, no hemorrhoids, tear, se(ond degree, not 5leeding, :nta(t s&t&res, lo(hia, mild, .resh, not o..ensi*e.

:M;R'%%: N A primi para 9ho&rs post %V- adapting 4ell to pre pregnant state. M:-E:+'RC -:AAN %:% :-'NT:+:'- + R TH:% C):'NT 1. Altered (om.ort pain, related to &terine (ontra(tion and tear. ,. High risk .or hemorrhage related to ra4 pla(ental site. =. High risk .or in.e(tion related to altered skin integrity #tear$. 9. ;otential .or altered sleep and rest pattern related to pain on tear and ne4 attained motherly role. 2. !no4ledge de.i(it on postpart&m, sel. and 5a5y (are, related to inade8&ate in.ormation and e7perien(e. INTIAL PHYSICAL EXAMINATION/BABY Aeneral (ondition Health looking 5a5y, a(ti*e, pink, 4ell .le7ed, no o5*io&s a5normalities seen. V:TA) %:AN%: T=/./degrees Celsi&s, E':AHT 9111g, RR== 5reaths per min&te, HR1=1 5eats per min&te. H'A-: proportion to the 5ody, 4ell distri5&ted hair, 5la(k in (omple7ion, palpa5le anterior and posterior .ontanelles 5&t not 5&lging or s&nken. Cap&t present, head (ir(&m.eren(e =9(m. (ro4n to heal 29(m.

'C'%: symmetri(ally lo(ated, no dis(harge seen, pink (on?&(ti*a, (lear (orneas, 4ell positioned. 'AR%: symmetri(ally lo(ated, 4ell .ormed, no septi( spots N %': 4ell pla(ed, no (le.t, no .laring, no gro4th, no dis(harge seen. M DTH: no (le.t, no oral thr&sh, no teeth, pink m&(&s mem5ranes, 4ell .ormed g&ms , no 5leeding. CH'%T: symmetri(al mo*ements 4ith 5reathing, no (entral (yanosis, no (hest in dra4ing, no masses no gro4th seen, t4o 5reast present, symmetri(ally lo(ated not engorged, 4ith ade8&ate areola. Clear l&ng .ields and normal heart so&nds. Heart rate 1==5eat per min&te. AB- M'N: ro&nd shaped, no distention, 5o4el so&nds present, no organomegally on palpation, (ord (lean and dry, no redness, no p&s and no 5leeding seen. D;;'R 'BTR'M:T:'%: symmetri(al, no .ra(t&res, grasping re.le7 present, no e7tra digit, no 4e55ing seen. ) E'R 'BTR'M:T:'%: symmetri(al, 4arm, plantar and 4alking re.le7 positi*e. no e7tra digit, no 4e55ing seen. A'N'TA):A: 4ell de*eloped la5ia mi?ora and minora, &rethra and *aginal ori.i(e ;resent and patent. Anal ori.i(e present and patent. BAC!: no spinal 5i.ida, no gro4th or de.ormity o5ser*ed. IMPRESSION 9hrs old .emale neonate adapting 4ell to e7tra &terine li.e. MIDWIFERY DIAGNOSIS IDENTIFIED 1. High risk .or hemorrhage related to e7posed 5lood *essels. ,. High risk .or in.e(tion related to open 4o&ld =. High risk .or hypothermia, related to poor 4rapping o. the 5a5y.

M:-E:+'RC CAR' ;)AN + R TH' M TH'R. ,30120,119 M:-E:+'RC A A) :NT'RV'NT: N -:AAN %:% High risk .or Mrs.RC. 4ill 'n(o&rage Mrs. hemorrhage not de*elop RC to .re8&ently related to ra4 hemorrhage empty her 5ladder pla(ental site. the .irst and re(t&m 9<ho&rs.

RAT: NA)' To .a(ilitate &terine in*ol&tion and (ontra(tion there 5y pre*enting &terine atony. This 4ill help in the release o. o7yto(in 4hi(h 4ill enhan(e &terine (ontra(tion there5y red&(ing 5leeding. This 4ill help in the e7p&lsion o. (lots 5y gra*ity, there5y

'VA)DAT: N Che(k the &ter&s .or (ontra(tility 9ho&ry. Che(k .or a .&ll 5ladder 9ho&ry. Che(k the sanitary pad .or amo&nt and (onsisten(y o. lo(hia.

'n(o&rage Mrs. RC to e7(l&si*ely 5reast.eed her 5a5y.

'n(o&rage mo5ili6ation.

.a(ilitating &terine in*ol&tion. High risk .or in.e(tion related to altered skin integrity #tear$. Mrs. RC 4ill not de*elop in.e(tion thro&gho&t her period o. hospitali6ation Ad*ise Mrs. RC to p&t on dry (lean pads and to (hange at least =times a day and 4hene*er they are 4et. -ry and (lean pads 4ill help to pre*ent in.e(tion as 4et pads ha5o&r in.e(tions. Che(k the odor o. lo(hia and inspe(t the tear 1, ho&rly.

'n(o&rage Mrs. C -irty skin and on general 5ody (lothes hygiene. ha5o&r in.e(tions Ad*ise Mrs. RC This 4ill to (lean perine&m pre*ent .e(al .rom .ront to 5a(k matter .rom (ontaminating the s&t&red area. Altered (om.ort, pain related to &terine (ontra(tions and tear. Mrs. RC 4ill *er5ali6e red&(ed pain a.ter =1 min&tes o. mid4i.ery inter*entions. ;romote 5ed rest and sleep, espe(ially 4hen the 5a5y is asleep. Dnne(essary mo*ements e7ert press&re on the tear and 4o&ld irritate ner*e endings there5y (a&sing pain. 5ser*e pain (&es.

'7plain the so&r(e o. pain to Mrs. RC.

This 4ill help the (lient to a*oid a(tions that 4ill (a&se

<

pain. ;ro*ide di*ersion therapy, .or e7ample, (hat 4ith the Mrs.C. This 4ill distra(t the (lient .rom (on(entrating on pain. This 4ill red&(e press&re on the tear. %its 5aths also ha*e a soothing e..e(t. This 4ill inhi5it the prod&(tion o. prostaglandins that (a&se pain. This pro*ides physi(al rela7ation and rest This pre*ents an7iety, physi(al and psy(hologi(al stress. This 4ill pre*ent interr&ption as all inter*entions are done at on(e. 5ser*e .or signs o. .atig&e.

'n(o&rage (lient to do sit6 5aths <ho&rly.

Administer ;ara(etamol 1g e*ery <ho&rs.

;otential .or rest and sleep dist&r5an(e related to perineal tear and ne4 attained motherly role.

Mrs. RC 4ill not e7perien(e sleep dist&r5an(e thro&gho&t the 9<ho&rs o. hospitali6ation

;ro*ide a (om.orta5le 5ed .or sleep. N&rse (lient in a 8&ite and (alm en*ironment

;ro*ide (are in 5lo(k

Ad*ise the mother This 4ill

to take ad*antage o. sleep 4hen the 5a5y is sleeping.

ena5le her to ha*e time to sleep and rest as it is di..i(&lt to sleep 4hen the 5a5y is a4ake.

Ad*ise the mother Ade8&ately to 5reast.eed the 5reast.ed 5a5y e7(l&si*ely. 5a5ies 4o&ld not .re8&ently (ry, there5y pro*iding the mother 4ith time to rest. Ad*ise the mother on 5ladder emptying 5e.ore sleeping. !no4ledge de.i(it on sel. and 5a5y (are related to inade8&ate in.ormation and e7perien(e. Mrs. RC 4ill demonstrate &nderstanding in postpart&m sel. and 5a5y (are. Ai*e thoro&gh health ed&(ation on the .ollo4ingF e7(l&si*e 5reast.eeding, hygiene, e7er(ises, n&trition, rest and sleep, .amily planning, sel. and 5a5y (are, ho4 to keep 5a5y 4arm and ho4 to maintain atta(hment and 5onding. To a*oid 4aking &p d&ring the night. !no4ledge on these areas 4ill help to pre*ent postpart&m (ompli(ations and promote physiologi(al, psy(hologi(al, and emotional ret&rn to pre pregnant state. Mrs. RC 4ill *er5ali6e &nderstanding o. postpart&m sel. and 5a5y (are.

11

M:-E:+'RC CAR' ;)AN + R TH' BABC M:-E:+'RC A A) :NT'RV'NT: N% -:AAN %:% High risk .or There 4ill 5e Tea(h the mother hemorrhage no 5leeding to o5ser*e and related to .rom the (ord report any signs o. e7posed 5lood .or the .irst 9< 5leeding .rom the *essels. ho&rs o. (ord. admission. Ad*ise the mother to a*oid to&(hing the (ord &nne(essarily. High risk .or (ord in.e(tion related to open 4o&nd. The (ord 4ill not de*elop in.e(tion d&ring the period o. hospitali6ation and a.ter dis(harge Tea(h the mother on ho4 to do (ord (are &sing the .i*e s4a5 te(hni8&e at least three times a day &sing spirit or salty 4ater. Ad*i(e the mother to 4rap the 5a5y@s nappy 5elo4 the &m5ili(&s. High risk .or hypothermia, related to poor 4rapping o. the 5a5y. The 5a5y 4ill not de*elop hypothermia, the .irst 9<ho&rs. Tea(h the mother ho4 to 4rap the 5a5y.

RAT: NA)' To dete(t signs o. 5leeding as soon as 5leeding o((&rs. This (an make the (ord loose and ind&(e 5leeding. To pre*ent in.e(tion .rom the (ord.

'VA)DAT: N Che(k the tightness o. the (ord t4i(e a day.

Che(k .or signs o. in.e(tion .or e7ample redness, p&s and .e*er.

To keep &rine a4ay .rom the (ord To pre*ent hypothermia 5y not e7posing the 5a5y. This 4ill enhan(e heat trans.er .rom the mother to the 5a5y there5y pre*enting Che(k temperat&re e*ery 9ho&rs .or the .irst 9<ho&rs.

Ad*ise the mother to keep the 5a5y (lose to her 5ody.

11

hypothermia. Ad*ise the mother on e7(l&si*e 5reast.eeding. Milk .rom the mother is 4arm and it 4ill help to maintain heat. A soiled nappy makes the 5a5y .eel (old and this may ind&(e hypothermia.

Ad*ise the mother on .re8&ent (hange o. nappies 4hene*er they are soiled.

MIDWIFERY CARE RECORDS 27/05/09 9 50 !" Mother admitted .rom )a5o&r 4ard. Bed 4as prepared .or her and patient 4as orientated to the 4ard. Assisted the mother to a (om.orta5le position. Vital signs: Respirations ,, 5reaths0min&te, ;&lse rate 111 5eats0min&te, Temperat&re =3., degrees Celsi&s, Blood press&re 1110/1 mmHg. Dter&s 4as .irm, 4ell (ontra(ted and in midline position. )o(hia 4as red and moderate. ;ara(etamol 1g orally gi*en. Mother e7plained the (a&se o. pain. Mother ad*ised to take some .ood and to (ontin&e 5reast .eeding. Ad*ised the mother to .re8&ently empty the 5ladder and to report any hea*y 5leeding. Mother ad*ised to rest. # $0%" Mother reported that she 4as 5leeding moderately and red&(tion in pain. Mother ad*ised to (hange sanitary pads 4hene*er they are 4et to pre*ent in.e(tion. Ad*ised the mother to do sit6 5ath = times a day.

1,

Mother ed&(ated onF e7(l&si*e 5reast .eeding, positioning, N&trition, perineal (are, (ord (are. &%" 5ser*ed the mother 5reast.eeding the 5a5y. Vital signsF Temp =3 degrees Celsi&s, p&lse rate 111 5eats0min&te, Respirations ,9 5reaths0min&te, Blood press&re 1110/1mmHg. Dter&s 4as 4ell (ontra(tedF )o(hia 4as red #r&5ra$ and moderate.

2'/05/09 ' $0!" S Mrs. RC (omplained a5o&t general 5ody pains, she has passed &rine three times sin(e yesterday, 5&t has not yet passed stools sin(e deli*ery. %he report moderate .lo4 o. lo(hia, 4ith no (lots. %he has (hanged pads 4hi(h 4ere hal. soaked t4o times sin(e /pm yesterday. %he also reported that the 5a5y has 5een (rying at night and she dis not ha*e ade8&ate rest and sleep, 5a5y is 5reast.eeding 4ell, has passed stools t4i(e and &rine three times sin(e yesterday .rom /pm. O Mother Aeneral (ondition: 4ell kempt, happy looking .a(e, 4ell hydrated and 4ell no&rished. Vital signs: B; 1110/1, T=/.3 degrees Celsi&s, RR,95reaths per min&te, ;R1115eats per min&te. 'yes: pink (on?&n(ti*a Mo&th: pink m&(&s mem5ranes Ne(k: no distended ?&g&lar *eins Breast: symmetri(al, so.t, not tender, ere(t nipples, (olostr&ms e7pressed.

1=

A5domen: not distended, &ter&s, midline, 4ell (ontra(ted, +&ndal Height 19(m, 5ladder empty. Dpper '7tremities: no edema, ade8&ate (apillary re.ill. )o4er e7tremities: 4arm, no edema, no (&.. tenderness no *ari(osities. Aenitalia: s&t&res inta(t, no redness, no p&s. )o(hia .resh red, mild .lo4, no odor and no (lots. IMPRESSION 2$ ()*+, %),- SVD !.!%-/01 2344 -) %+3%+310!0- ,-!-3. A Altered (om.ort, pain related .rom &terine (ontra(tions and .ri(tion .rom the tear. High risk .or hemorrhage related to ra4 pla(ental site High risk .or in.e(tion related to open 4o&nd ;otential .or rest and sleep dist&r5an(e related to pain .rom the perineal tear and ne4 attained motherly role. P +353+ -) -(3 6!+3 %4!0 S*7,38*30- A,,3,,"30- )5 -(3 B!79 T=/.2 -egrees Celsi&s. Aeneral appearan(e Health looking, 4ell .le7ed, pink, a(ti*e. Head: .ontanelles .lat and no (alp&t, no hematoma 'yes: pink and (lear (ornea, Nose: no (ongestion, no .laring. Chest: symmetri(al, normal &p and do4n mo*ements 4ith 5reathing, no (hest in dra4ing, no stridor. A5domen: so.t and pink, not distended, (ord not 5leeding, (lean, no signs o. in.e(tion. )o4er e7tremities: 4arm. IMPRESSION 2$ ()*+, )4. 03)0!-3, !.!%-/01 2344 -) 3:-+! *-3+/03 4/53

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A High risk .or hemorrhage related to open 5lood *essels High risk .or in.e(tion related to open 4o&nd on the (ord. High risk .or hypothermia related to poor 4rapping o. the 5a5y. P re.er to (are plan '$0!" I %it6 5ath done Cord (are done Health ed&(ation on the .ollo4ing areas gi*enF (ord (are, perineal (are, .re8&ent (hange o. pads 4hene*er they are soiled and keeping the perine&m dry all the time.

#000!" ;olio 1 and BCA *a((ines gi*en to the 5a5y. 'd&(ated mother on the imm&ni6ation s(hed&le and the importan(e o. ha*ing all the imm&ni6ations gi*en to the 5a5y a((ording to the s(hed&le. Atta(hments o5ser*ed and (olle(tion made on ho4 4ell to position the 5a5y. ##00!" Chrolapheni(ol eye ointment gi*en to the 5a5y. 'n(o&raged mother to (ontin&e 5reast.eeding <>1, or more times a day. 'n(o&raged mother to rest 4hene*er the 5a5y is asleep Vital signs re(he(ked, B;1110/1, RR,=5reaths per min&te, ;R 9<5eats per min&te, T=3.1degrees Celsi&s. )e.t mother and 5a5y sleeping. #2$0%" 5ser*ed mother taking nsima, eggs and *egeta5les. 200%" %it6 5ath done.

12

Cord (are done. 5ser*ed mother 5reast.eeding the 5a5y. 2$0%" Reminded mother to (ontin&e 4ith (ord (are and perineal (are a.ter dis(harge, also reminded her to (ome .or postnatal (he(k &p at 1 and /4eeks, to (ontin&e 4ith e7(l&si*e 5reast.eeding, to take note o. the danger signs 4hene*er they o((&r. To note signs o. in.e(tion on the (ord and to al4ays remem5er to eat a 5alan(ed diet. $00%" )e.t mother and 5a5y to rest. &&5%" E Dter&s (he(ked and it 4as 4ell (ontra(ted Bladder 4as empty No signs o. in.e(tion o5ser*ed on the (ord and perine&m Cord tight and (lean. Vital signs (he(ked B;1110/1mmHg, T=3.1degrees Celsi&s, RR,950m, ;R11150m. Hando*er gi*en to the night d&ty n&rse on the (ondition o. the (lient and the neonate. 29/05/09 ' 00!" S there 4as no (omplaint raised, she said that she spent the night 4ell e7(ept .or the mild pain .rom the perine&m, she has passed &rine three times and stools on(e. %he had nsima 4ith 5ee. and *egeta5les, this morning she had tea 4ith 5read, and 5a5y is 5reast.eeding 4ell, has passed &rine three times and me(oni&m on(e and that there@s no 5leeding .rom the (ord. O mother looks happy, 4ell dehydrated, 4ell no&rished and 4ell kempt. Vital signs: T =/., degrees Celsi&s, B; 1,10/1, RR,= 5reaths per min&te, ;R 9, 5eats per min&te. 'yes: pink (on?&n(ti*a, (lear , no ?a&ndi(e. Mo&th: no oral thr&sh, pink m&(osa

1/

Ne(k: no distended ?&g&lar *ein. Breast: so.t, no sores, not tender, nipples ere(t, milk e7pressed. Dpper '7tremities: no edema, no pallor, (apillary re.ill less than ,se(onds. A5domen: not distended, so.t, not tender, &ter&s .irm, midline position, 4ell (ontra(ted, .&ndal height 1=(m. )o4er e7tremities: 4arm, no (&.. tenderness, no edema, no *ari(osities. Aenitalia: s&t&res inta(t, 5&t some p&s seen aro&nd the s&t&re area, lo(hia r&5ra, mild .lo4, .resh, no odor. A A %+/" P!+! &;()*+, %),- SVD !.!%-/01 2344 -) %+3 %+310!0- ,-!-3. :n.e(tion related to altered skin integrity, #tear$ as mani.ested 5y the presen(e o. p&s on the s&t&red area. S*7,38*30- !,,3,,"30- )5 -(3 7!79 T=3.1 -egrees Celsi&s. Aeneral appearan(e Health looking, 4ell .le7ed, pink and a(ti*e. Head: .ontanelles .lat and p&lsating 'yes: pink, (lear (on?&n(ti*a, Nose: no (ongestion, no .laring. Chest: symmetri(al, *isi5le &p and do4n mo*ements 4ith 5reathing, no (hest indra4ing, no stridor. A5domen: so.t and pink, not distended, (ord not 5leeding, (lean, no signs o. in.e(tion. )o4er e7tremities: 4arm. A &; ()*+, )4. 03)0!-3 !.!%-/01 2344 -) 3:-+! *-3+/03 4/53. P administer 'rythromy(in 211mg tds .or 2days.or the plan o. the 5a5y. Re.er to (are plan . 9 00!" I o5ser*ed mother doing sit6 5ath Mother ed&(ated on perineal (are =times a day. Ad*ised mother to 4ipe perine&m .rom .ront to 5a(k to pre*ent .e(al matter .rom

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Contaminating the s&t&red area. Ad*ised the mother on (hange o. sanitary pads 4hene*er they are 4et and to p&t on dry sanitary to4els. #0 $0!" Reminded mother on 5reast .eeding, hygiene , n&trition, elimination, .amily planning, post natal (he(k &ps at one and si7 4eeks, and a5o&t the danger signs that might o((&r to the 5a5y and hersel.. E mother 4as a5le to *er5ali6e &nderstanding o. e7(l&si*e 5reast .eeding, (ord (are, 5a5y (are, and the importan(e o. eating a 4ell 5alan(e diet and rest Mother 4as a5le to do a ret&rn demonstration o. ho4 to 4rap the 5a5y, (ord (are and 5reast e7amination.

CONSTRAINTS EXPERIENCED IN THE PROVISION OF CARE There 4as only one Blood ;ress&re ma(hine, and one 4eighing s(ale, .or la5or 4ard and postnatal 4ard, this res&lted in .ragmented (are. The hospital does not ha*e 4arm 4ater and it 4as di..i(&lt .or the (lient do sit6 5ath and to 5ath the 5a5y. :t 4as also di..i(&lt to (on*in(e the (lient to stay in the hospital .or 9<ho&rs 5e(a&se it is a ro&tine that postnatal mothers are dis(harged a.ter ,9 ho&rs. DISCHARGE CRITERIA %ome o. the (o&nseling iss&es that 4e dis(&ssed 4ith Mrs. RC in preparation .or dis(harge are as .ollo4s: Ad*i(e on ;erineal (are and not to insert anything in the *agina rest and sleep importan(e o. personal hygiene n&trition #si7 .ood gro&ps$ .or the mother e7(l&si*e 5reast .eeding .amily planning :mm&ni6ations and gro4th monitoring Dm5ili(al (are.

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)a(tation 4as esta5lished, there 4as good atta(hment, and mother demonstrated kno4ledge on 5reast.eeding skills. The &ter&s 4as 4ell (ontra(ted and in*ol&tion had stated taking pla(e. There 4as minimal lo(hia 4hi(h 4as not o..ensi*e it 4as .lo4ing mildly. DISCHARGE PLAN -is(harge plan stated d&ring the time o. admission to the postnatal 4ard thro&gho&t hospitali6ation and d&ring the time o. dis(harge. This in(l&ded the importan(e o. e7(l&si*e 5reast.eeding, danger signs .or the mother and the 5a5y d&ring pe&peri&m, postnatal e7er(ises like !egel e7er(ises to impro*e the m&s(le torn o. the perineal m&s(les. The importan(e o. rest and sleep, Ho4 to 4rap the 5a5y to a*oid hypothermia, .re8&ent (hange o. pads and 5a5y@s nappies 4hene*er they are soiled, .amily planning (o&nseling, the importan(e o. imm&ni6ation .or 5oth the mother and the 5a5y, and postnatal (he(k &ps at 14eek and at /4eeks. RECOMMENDATIONS There is need .or ade8&ate reso&r(es at the hospital, .or e7ample, B; ma(hine, 4eighing s(ale and 4ater heater. There is also need to intensi.y proper monitoring o. 4omen in la5or and those 4ho ha*e ?&st deli*ered. Eomen sho&ld also 5e told that the length o. stay in the hospital depends on indi*id&al o&t(ome o. la5or and deli*ery and its re(ommended that 4omen in postpart&m (are may stay in the hospital .or a minim&m o. ,9 to 9< ho&rs. SUMMARY OF THE CARE GIVEN Mrs. RC 4as (ared .or a period o. 9<ho&rs &sing the mid4i.ery (are pro(esses, health ed&(ation 4as an ongoing a(ti*ity. The (are gi*en 4as also (&lt&ral sensiti*e. By the time she 4as dis(harged she and the 5a5y had met the (riteria .or dis(harge and she had gained kno4ledge on the (are o. the 5a5y and hersel..

19

REFERENCE +ra6er, -.M.F Copper, M.A. G Nolte, A.A.E. #,11/$ M943, T3:-7))< 5)+ M/.2/=3, 19th 'd. Ch&r(hill )i*ingstone. ;hiladelphia. Myles, M. #19<9$. T3:-7))< 5)+ "/.2/=3, )ongman, )ondon. 5stetri(s li.e skills training man&al .or Mala4i #,111$: S!53 M)-(3+()).>H34%/01 -) %+3=30- "!-3+0!4 .3!-(,F Ministry o. health and pop&lation. lds, %.B.F )ondon, M.).F )ade4ig, ;.A. G -a*idson, %.V #,111$. O7,-3-+/6, N*+,/01. Addison>Eesley ;&5lishing Company. Menlo ;ark, Cali.ornia. %ellers, ;.M. ?200#@ M/.2/53+9. Cape To4nF "&ta G Co.

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