CLINICAL

TEACHING
SUBJECT

OBSTETRIC AND GYNAECOLOGICAL

NUSRING

TOPIC

BREAST CARE

SUBMITTED TO

MISS MONIKA MAM

SUBMITTED ON

18-3-16
SUBMITTED BY
RITIKA
Msc Nsg 1st year

LESSON PLAN
Name of Evaluator

Miss Monika mam

Name of Student

Ritika

Class

Msc Nsg 1st year

Subject

Obstetrics & gynecological nsg

Topic

Breast care

Date
Venue
Method of teaching

9-3-16
Maternity ward
lecture cum discussion

GENERAL OBJECTIVES
At the end of teaching group will be able to answer
the question and complete knowledge about Breast Care.

SPECIFIC OBJECTIVES
At the end of the teaching the group will be able
explain about to define the the term Breast care
explain the Purposes of Breast care.
explain the techniques of . Breast care
explain the Articles used in . Breast care
explain the Procedure of Breast care

Sr.no

Specific
objectives

Time

To
Introduce
My self.

min

To
Announce
the topic .

min

To check
the
previous
knowledg
e.

Min

To
introduce
the topic .

min

To define
the topic

Min

Content

matter

Learning and
teaching
method

INTRODUCTION
My self Ritika I am student of Msc
Nsg 1st year of LLR CON .
L
E
C
ANNOUNCEMENT
T
Today I am going to represent the U
topic antenatal examination.
R
E

PREVIOUS KNOWLEDGE
C
What do you mean by Antenatal U
M
examination?
What are the steps for antenatal
D
examination ?
I
S
C
U
INTRODUCTION TO TOPICS
clinical assessment of mother and
S
fetus during pregnancy . it includes
I
examination & advices .
O
DEFINITION OF ANTENATAL N
EXAMINATIONSystematic supervision ( Examination
and advice) of women during
pregnancy
is
called
antenatal
examination.

7)

To explain 2 min
the aims
of
antenatal
examinati
on.

To explain 3 min
the
principles
of
antenatal
examinati
on.

AIMS
To screen high risk cases.
To provide continued medical
surveillance and prophylaxis.
To ensure the mother about
physiology of pregnancy.
To educate the mother about
physiology of pregnancy and
labor by demonstration , charts
and diagrams.
To explain the couple about the
time , place , mode of delivery
and care of newborn.
To motivate the couple about
time , place, mode of delivery
and care of new born.
To motivate the couple about
the need of family planning give
appropriate advice regarding
medical
termination
of
pregnancy.
PRINCIPLES TO BE FOLLOWED
Ensure the mother is physically
and mentally comfortable and
relaxed.
Wash
the
hands
before
examination.
Always stand to right of the
patient.
Provide privacy .
Empty the bladder prior to
examination
Be good listener to what patient

L
E
C
T
U
R
E

C
U
M

D
I
S
C
U
S
S
I
O
N

says.
Examine patient says.
Examine patient systematically
head to foot.
Expose only the needed part.
Be kind and sympathetic to
mother to give cooperation.
Explain clearly about procedure
and
in
simple
and
understandable manner.

Articles required
8)

To explain
the articles 3 min
of
antenatal
examinati
on.

Sr.
no
1.

Articles

Rational

A
tray
containing
Fetoscope

To listen the
fetal heart
sound.

Weighing
machine

To
check
the weight.

Measuring
tape

To
check
the
abdominal
girth.

Screen

To maintain
the privacy.

L
E
C
T
U
R
E
C
C
U
M
D
I
S
C

 TPR Tray

2.

To
check
the
temperature
, pulse
and
respiration.

Savlon
solution

To
disinfection
the
thermomete
r.

Plain water

To clean the
thermomete
r.

U
S
S
I
O
N

Bowel
cotton

with To clean
the
thermomete
r.

L
E
C
T
U
R
E

Thermometer To
check
the
temperature
.

BP apparatus

To

check

C
U
M

the
blood
pressure.
Stethoscope

To
check
the
blood
pressure

Recording
To record
and reporting the findings.
chart.

D
I
S
C
U
S
S
I
O
N

9)

To explain 7 min
the
procedure
of
antenatal
examinati
on.

L
E
C
T
U
R
E
Procedure
General examination
Obstetrical examination
General
examination C
U
M

D
I
S
C
It includes appearance of health , U
built check ht=cm, wt in kg , TPR, S
routine urine and blood examination to S
be done.
I
O
N
Head to foot examination .
Head- check the scalp of any
dandruff, pediculosis, scalp infection ,
injury in the scalp.
Face- check facial expression pallor
skin , skin changes , mask pregnancy,
swelling on the face , eyes , nose , lips
mouth for dental carries and bleeding
gums .
Neck - symmetry , shape lymph
adenopathy.
Upper extremities check for any
bony deformity , capillary refill in
nails for pallor.
Legs human sign, edema ,
varicosities, bony deformity.

L
E
C
T
U

R
Back normalcy of spine and E
symmetry.
Bowel and bladder.-Constipation ,
incontinence
C
U
Vagina bleeding discharge , M
infection and boils etc.

Obstetrical examination

Breast examination
It is the technique by which a through
inspection and palpation of the breast
is made during antenatal and postnatal
period to collect data about the breast
condition of mother.
To assess primary areola,
secondary areola.
To assess secretion
from
nipple, breast size ,shape and
symmetry.
Abdominal Examination

D
I
S
C
U
S
S
I
O
N

Preparation
of
woman
abdominal examination

for

Ask woman to empty the

bladder before examination.
Assist her for dorsal or supine
position on the examination
couch with legs flexed.
Provide emotional support.
Steps of abdominal examination
Inspection
Uterus
Shape and size of abdominal
contour.
Fetal movements.
Skin changes.
Linea nigra, presence of any
scar.
Check fundal height
Take fundal height in cms and
in weeks . place ulna border of
hand at the highest point of the
uterine fundus and compare it
with accepted levels for
different period of gestation .
each 4 weeks period of
gestation is equal to middle 3
fingers width.
Check abdominal girth .
Palpation in sequence :

L
E
C
T
U
R
E
C
U
M
D
I
S
C
U
S
S
I
O
N

L
E
C
T
U
Fundal palpation- to determine R
E
if it is a breech or the head i.e
presentation .
Lateral palpation- to deermine C
position of foetal back and U
limbs i.e to determine position M
of foetus in uterus.
Pelvic palpation : to determine
presentation , flexion of head D
I
and ballottement of head
S
.
C
Pawliks grip to see size , U
flexion and mobility of head / S
breech
and
to
know S
engagement of presenting parts. I
O
Auscultation fetal heart N
sounds can be hear by
stethoscope from 18-20 weeks
onward. It states whether fetus
is alive or not . normally foetal
rate
ranges
from
120140beats/minute. With average

of 140beats/mints.
Vaginal examination- vaginal
examination is generally done
by doctor when needed
especially towards the end
pregnancy to ensure normalcy
and adequacy towards of pelvis
to deliver the baby.

L
E
C
T
U
Laboratory investigation it R
is necessary to take laboratory E
investigation for abdominal
examination .following are the
laboratory
investigations.
Hemoglobin
Urinalysis ( albumin, sugar and C
U
pus cells)
Blood grouping and rhesus M
typing
VDRL and HIV testing.
Pap smear
Blood Sugar
Calculating expected date of
deliveryThis
is
done D
according to naegels formula I
i.e expected date of delivery S
=last menstrual period +9 C
month and 7 days eg if last U
S
menstrual period (LMP)
S
I
ADVICES
TO
PREGNANT O
WOMAN
IN
ANTENATAL N
10)

To explain 5 min

the
advices
for
antenatal
mother.

PERIOD
1) Nutrition Well balanced diet.
It should include meat, fish ,
cheese , peas , lentils , milk
eggs fresh fruit and vegetables.
Avoid stale and spicy food and
excess of fat. Take short
frequent meals. The total calorie
requirement in antenatal period
is 2,500kcal/day. Meals should
be light , nutritious and easily
digestatible. Woman should take
iron and folic supplement .
L
E
2) Follow up regular follow up C
as the dates are given by health T
personnel.
U
R
3) Rest take rest when necessary E
and in the afternoon . Avoid
remaining in one position for
long time . elevate legs while C
taking rest to relieve edema in U
M
legs.
4) Exercise and work exercises
and work to be continued till
D
woman
can
do
them
I
comfortably.
S
C
U
5) Comfort measures wear
S
comfortable clothes . make
S

modification as per need . wear I

well fitting bra, shoes and O
panties. Avoid travel in 1st and N
3rd trimester . avoid long hours
of standing or sitting in one
positions.
6) Warning signs of pregnancy
woman should know warning
signs of pregnancy . report to
doctors as soon as possible
when these signs are present .
following are the warning signs
of pregnancy . bleeding or
leaking of amniotic fluid per
vagina.
Loss of excessive fetal
movements.
Sever
continuous
headache
Dimness or blurring of
vision .
Flashes of light or dots
before eyes.
Pain in epigastric region
Persistent vomiting.
Chills and fever
Dysuria
edema of face and
abdomen
7) Minor disorder of pregnancy
Manage them with home
remedies . if severity increases
consult the doctor.

8) Sex avoid sexual intercourse

in 1st and 3rd trimester . assume
alternate position and methods
which are comfortable for the
couple
.
9) Preparation for confinement
collect articles for mother and
baby . mother should know
signs of true labor and be ready
with articles in the last 6 weeks
of gestation . arrange transport
in time.
SUMMARIZATION
11)

To
summariz
e the
topic.

2 min

Today I had discussed

Definition of antenatal
examination ?
Aims and objectives
Principles of antenatal
examination
Steps
of
antenatal
examination
Advices for antenatal
mother
RECAPTUALIZATION

12)

To
1 min
recapitaliz
e the topic

What do you mean by antenatal

examination ?
What are the steps for antenatal
examination ?
What are the advices of

antenatal mother ?

BIBLIOGRAPHY
D.C. Dutta, textbook of
Obstetrics,7th
edition,
new
central book agency pg 79-80
Annamma Jacob , Manual Of
Midwifery pg 300-314
www.wikipedia.com
www.nursingcrib.com