1. MATERNAL AND INFANT HEALTH CARE IN PRIMARY HEALTH CARE SETTING Lecture 5 1 1 Clinical Application for Community Health Nursing (NUR 417)

2. Objectives of maternal –infant and child health care program:  Ensure that every expected and nursing mother maintains good health, has a normal delivery, bears healthy children and learns the art of child care  Conduct activities for the health promotion of children from 0 to 6 years of age 2 2

3. Services offered by primary health center to mothers and infant: 1.Pre-marital care and counseling 2.Maternity care 3.Infant and preschool child care 4.Family planning 5.Health education 6.Social care 3 3

4. PRE-MARTIAL CARE Importance of pre-marital care: 1.Early detection of health problems, better chance to treatment 2.Providing guidance, preparation for marriage, family education, training in the art of children rearing and family planning 3.Prevention of health problems for the couple and their future children 4 4

5. 1.Promote the health of the future parents 2.Prevent health hazards and to have healthy future generations. 3.Give education about health care before marriage 4.Implement medical consultation for those who are not of a legal age to marry, or who have severe genetic diseases, psychiatric diseases and certain infectious diseases 5.Perform physical exams, including radiological exams, screening for diseases of the renal, reproductive, and metabolic systems, and screening for sexually transmitted diseases. 5 5 The goal of the premarital care is to:

6. Components of Premarital Care A.Premarital Counseling B.Premarital examination C.Premarital immunization D.Genetic counseling E.Premarital education 6 6

7. A.Premarital Counseling  Is a communication process in which the counselor (nurse) tries to provide a couple with complete and accurate information about the responsibilities of marriage  The counselor encourages the couple to explore and communicate their individual’s needs, goals, values and deficiencies. It is a chance for couple to verbalize their expectations of marriage including any fears and anxieties they may have  Topics in counseling includes sexuality, sexual health and sexual problems, the family planning concept, the befits of different methods of family planning 7 7

8. The benefits of premarital counseling: 1.It can reduce the risk of divorce by up to thirty percent 2.It can lead to a significantly happier marriage 3.It can help reduce the stress of planning a wedding 8 8 A.Premarital Counseling

9. The role of the nurse premarital counseling 1.Prepare a proper atmosphere for counseling 2.Ensures privacy of the client 3.Assess the health needs of the couple 4.Take a complete history of the couple 5.Helps them to understand several topics including family planning, conception, etc. 6.Help the future couple to make decisions about their future lives and their marriage 9 9 A.Premarital Counseling

10. 10 1.History taking should include:  Personal history ;as name, age, occupation, education & address, religion  Menstrual history : menarche, dysmenorrheal, menstrual disturbances and last menstrual cycles  Medical history: cardiovascular disease, renal disease, infectious disease, hypertension, tumors, surgical procedure and trauma, venereal diseases, DM and TB B. Premarital Examination 2. Premarital examination (physical examination):  Complete physical examination including: heart and chest examination, pelvic measurement to detect contracted of deformed pelvis

11. 11 3. Laboratory examination:  Complete blood counts, hematocrit, hemoglobin and platelet counts.  Antibody test to detect Human Immunodeficiency Virus (HIV).  Urine analysis for sugar and albumin to exclude D.M or kidney diseases.  Analysis of the man's seminal fluid to determine its speed, morphology, volume and number of sperms for early detection and intervention in case of infertility.  Chest x-ray to exclude pulmonary T.B. B. Premarital Examination

12. Such as:  MMR  Tetanus  Hepatitis 12 C. Premarital Immunization

13. Genetic counseling is the process of:  Evaluating family history and medical records  Ordering genetic tests  Evaluating the results of this investigation  Helping parents understand and reach decisions about what to do next 13 D. Genetic Counseling

14. Premarital education used to guide and prepare couples for marriage The following areas of health education should emphasize on: Parent’s health Nutrition Safe environment Role of father Role of mother Child rearing Sex education Family planning 14 E. Premarital education

15. Antenatal care is the care giving to pregnant women in primary health centers to maintain their mental and physical fitness Objectives of antenatal care:  To maintain the mother and her fetus health  To prepare the mother for labor and subsequent care of her child  To early detect and appropriate treatment of high risk conditions  To reduce of maternal and infant mortality, stillbirths and prematurely  Increase the number of breast fed babies 15 2.Antenatal Care in Primary Health Care Centers

16. Schedule of antenatal visits: The total visits during pregnancy are 12 to 15 visits in normal as follows:  One visit every month until the 6 th months of pregnancy  One visit every two weeks during 7 th and 8 th months of pregnancy  One visit every week during the 9 th month of pregnancy 16 2.Antenatal Care in Primary Health Care Centers

17. Anti natal care during initial visit: A. History taken including  Social history : family members  Family history: any genetic diseases, hypertension DM TB, heart disease  Medical history : past illness HD, DM, TB venereal diseases  Menstrual history :LMP,EDD, Menarche, any disorders or irregularities  Obstetric history : gravidity, parity, and complications for mother of baby 17 2.Antenatal Care in Primary Health Care Centers

18. B. General physical examination concentrated on  Extremities are examined for varicose veins and edema  Blood pressure: should be 120/80 or less and not above 140/90  Body weight and height: weight should be recorded in the first visit  Obstetric examination: For breast and abdomen (fundal height, fetal lie, presentation and fetal heart sound should be assessed accurately) 18 2.Antenatal Care in Primary Health Care Centers

19. C. Laboratory investigation : Urine analysis for glucoses and albumin Blood group is determined because of the risk of hemorrhage Hemoglobin: if HB is below 12.9g: iron, folic acid and vitamins B&C are prescribed. Screening for AID’s and Hepatitis C 19 2.Antenatal Care in Primary Health Care Centers

20.  The first six weeks after birth – is critical to the health and survival of a mother and her newborn.  Lack of care in this time period may result in death or disability as well as missed opportunities to promote healthy behaviors, affecting women and newborn 20 3. Post Partum Care

21. Schedule of home visits for post partum care by nurse or midwife or community health nurse:  1 st day of post partum,  3 rd day of postpartum,  7 th day of post partum,  40 th day of post partum 21 3. Post Partum Care

22. Objectives of post partum care: 1.To help women to resume physical and mental health 2.Detect and arrange proper management and follow up obstetric injuries, heath problems, and pregnancy associated complication, as well as treat reproductive tract infection 3.Examine the newborn for early detection of congenital malformation, handicapping condition and jaundice. 4.Provide health education and guidance for the mother regarding hygiene, nutrition, child-care, breast feeding, immunization, birth spacing and family planning methods. 22 3. Post Partum Care