Lesson Plan On Antenatal Care

INDEX: SR.NO

CONTENT

PAGE. NO.

1

Identification data

02

2

Central objectives

03

3

Specific objectives

03

4

Introduction of antenatal care

04

5

Aims of antenatal care

05

6

Objectives of antenatal care

06

7

Components of antenatal care

06

8

Antenatal examination

09

9

Antenatal advice

13

10

Values of antenatal care

19

11

Summary

20

12

Assignments

20

13

Abstract

21

14

Bibliography

23

1

LESSON PLAN ON ANTENATAL CARE:  Student name: Miss Ravina patel  Name of the course: MSc Nursing  Name of the subject: Obstetrics and midwifery  Name of the unit:  Name of the topic: Antenatal care  Class:  Size of the class:  Date and time: / /2019  Vanue:  Previous knowledge of level: student had some knowledge regarding antenatal  Method of teching: Lecture cum discussion  Media of teaching: Blackboard, Powerpoint, chart  Name of evaluator:  Designation:

2

 Central objective: At the end of the class, the student will be able to gain in depth knowledge regarding the meaning of antenatal care, its objectives, aims, its components, antenatal examination, antenatal advice and value of antenatal care.

 Specific objective: At the end of the class, the student will be able to:  Introduction of antenatal care  Aims and objectives  Discuss history collection and Antenatal examination  Discuss about Antenatal advices  Describe Values of antenatal care  Explain antenatal counseling

 Introduction: Introduced my self and the discuss the topic related to the presentation and asked some question and checked the previous knowledge regarding the antenatal care.

3

SR.NO TIME OBJECTIVES

CONTENT

TEACHER’S STUDENT’S EVALUATION ACTIVITY

1

5

Explain

Discuss

INTRODUCTION:

minute antenatal care?

ACTIVITY

the Listens to the Explain

the

explaination. antenatal care. Antenatal care is a systematic supervision of introduction the Interact with the pregnant women. The supervision should about be regular and periodical in nature according to antenatal the need of the individual. Actually prenatal care

the teacher.

care is the care in continue that start before pregnancy and end at the delivery and the postpartum period.

2

3

Define

the DEFINITION:

minute antenatal care

Write the key Student listen What

is

the

antenatal care? and point on the the explaination. advice) of a women during pregnancy is called blackboard. Review the Antenatal Nursing Care (ANC). definition Interact with Systematic

supervision

(examination

using

the teacher.

blackboard question the Given

the

student what answer

the

4

is

the question.

antenatal care?

Takes

down

the notes.

3

3

Aims of the AIMS:

minute antenatal care?

Asked

to Student listen What is the aims

 To screen the “high risk” cases

students

 To prevent or to detect and treat at the

what is the explaination.

earliest any complication,  To ensure continued risk assessment and to

the

of the antenatal

aims of the antenatal

Interact with

provide ongoing primary preventive health

care? Then to the teacher.

care,

discuss

 To educate the mother about the physiology of pregnancy and labor by demonstrations, charts and diagrams (mothercraft classes),

care?

aims students.

the with Given

the

answer

the

question.

so that fear is removed and psychology is improved,  To discuss with the couple about the place,

Takes

down

the notes.

time and mode of delivery, provisionally and care of the newborn,  To motivate the couple about the need of family planning and also appropriate advice 5

to couple seeking medical termination of pregnancy.

4

2

Discuss

the OBJECTIVES:

Explain

the Listen

the What

Minute objectives of The objective is to ensure a normal pregnancy objectives to explaination. antenatal care with delivery of a healthy baby from a healthy student with the help of mother.

is

the

objectives of the antenatal care?

powerpoint.

5

2

List down the COMPONENT:

Minute component of antenatal care.

Asked

to Answer

the Which are the

 Registration of pregnancy

student about teacher

component

 History taking

the

consist in the

 Antenatal examinations obstetrical]

which question.

[general and component consist in

 Laboratory investigations

antenatal

 Health education

care? Explain

anenatal care?

the component of antenatal care.

6

3

Describe

the REGISTRATION OF PREGNANCY:

Explain

the Carefully

minute registration of Registered the pregnancy as soon as possible to registration pregnancy. the near PHC. After the confirmation of the of pregnancy

listen

Explain

the

the registration

of

explaination.

the pregnancy. 6

pregnancy to registered the pregnancy and to do first antenatal visit.

7

10

Describe

minute history collection

HISTORY COOLECTION:

Asked

to Student listen Which

At the first visit to taken the history of the student about the of preganant women. History taking are as follow: which type of explaination.

pregnant

 Name

history

women.

 Age

should

 Date of first examination

taken during the teacher.

 Address

antenatal

 GPAL

visit?

 Duration of marriage

Discuss with answer

 Religious

student about question.

 Occupation of women and her husband

the

 Period of gestation

type

 Complain: ask to women for any history should complain and to be noted.

should

history be

collected during antenatal care?

be Interact with

Given

the the

which of Takes

down

the notes. be

 History of present illness: elaborate taken. the chief complain as regard their onset, duration, severity, use of medication  History of present pregnancy: The important complication in different 7

trimester of the present pregnancy are to be noted. Number of previous antenatal visit, immunization status, has to be noted. 

Obstetric history: This is only related with multigravidae. The previous obstetric events are to be recorded chronologically like pregnancy event, labor event, method of delivery, puerperium, baby

 Menstrual history: Cycle, duration, amount of blood flow and first day of the last normal menstrual period (LNMP) are to be noted (spontaneous). From the LNMP, the expected date of delivery (EDD) has to be calculated. Calculation of the expected date of delivery (EDD): This is done according to Naegele’s formula (1812) by adding 9 calendar months and 7 days to the first day of the last normal 8

(28 days cycle) period.  Past medical history: Relevant history of past medical illnesses (urinary tract infections, tuberculosis) is to be elicited.  Past surgical history: Previous surgery—general or gynecological, if any, is to be enquired.  Family history: Family history of hypertension, diabetes, tuberculosis, blood dyscrasia, known hereditary disease, if any, or twinning is to be enquired.  Personal history: Contraceptive practice prior to pregnancy, smoking or alcohol habits are to be enquired. LMP may be a withdrawal bleed following pill usage.

8

5

Describe

the ANTENATAL EXAMINATION:

minute antenatal examination.

Explain

the Student listen Explain

 General physical examination:

antenatal

the

antenatal

 Built

examination

explaination.

examination.

the

which include 9

 Height

the

 Weight

examination,

 Pulse

abdominal

 Respiration rate

examination,

Given

the

 Blood pressure

vaginal

answer

the

 Pallor

examination

question.

 Jaundice  Tongue, teeth, gum  Edema

physical Interact with the teacher.

with the use of chart and Takes powerpoint.

down

the notes.

 Systematic head to toe examination 9

5

Explain

the EXAMINATION OF THE BREASTS helps

Minute breast examination.

10

5

Discuss

the Student listen Explain

to note the presence of pregnancy changes but

breast

the

breast

also to note the nipples (cracked or depressed)

examination.

explaination.

examination.

and skin condition of the areola. The purpose is

Interact with

to correct the abnormality; if any, so that there

the teacher.

will be no difficulty in breastfeeding

Takes

immediately following delivery.

the notes.

the VAGINAL EXAMINATION: Examination is

minute vaginal examination.

discuss

explain

the

down

how Student listen Explain

done in the antenatal clinic when the patient

to do vaginal the

vaginal

attends the clinic for the first time before 12

examination.

examination.

explaination.

the

10

weeks. It is done: (1) to diagnose the

Given

the

pregnancy, (2) to corroborate the size of the

answer

the

uterus with the period of amenorrhea and (3)

question.

to exclude any pelvic pathology. Internal examination is, however, omitted in cases with

Takes

down

previous history of miscarriage, occasional

the notes.

vaginal bleeding in present pregnancy. Ultrasound examination has replaced routine internal examination. It is more informative and without any known adverse effect.

Steps of vaginal examination: Vaginal examination is done in the antenatal clinic. The patient must empty her bladder prior to examination and is placed in the dorsal position with the thighs flexed along with the buttocks placed on the foot-end of the table. Hands are washed with soap and a sterile glove is put on the examining hand (usually right).

Inspection: By separating the labia—using the left two fingers (thumb and index), the character of the vaginal discharge, if any, is 11

noted. Presence of cystocele or uterine prolapse or rectocele is to be elicited.

Bimanual: Two fingers (index and middle) of the right hand are introduced deep into the vagina while separating the labia by left hand. The left hand is now placed suprapubically. Gentle and systematic examinations are to be done to note: (1) Cervix: consistency, direction and any pathology. (2) Uterus: size, shape, position and consistency. Early pregnancy is the best time to correlate accurately uterine size and duration of gestation. (3) Adnexa: any mass felt through the fornix. If the introitus is narrow, one finger may be introduced for examination. No attempt should be made to assess the pelvis at this stage.

11

10

Discuss

the ABDOMINAL EXAMINATION:

minute abdominal examination.

Inspection: Abdominal enlargement, pregnancy marks—linea nigra,

Discuss about Student listen How to do the the

the

abdominal

abdominal

explaination.

examination?

examination 12

striae, surgical scars (midline or suprapubic).

to

the Interact with

Palpation: (a) To note the height of the

students with the teacher.

fundus above the symphysis pubis. (b) In the

the help of

second trimester, to identify the fetus by

the chart.

Given

the

external ballottement, fetal movements,

Asked

answer

the

palpation of fetal parts and auscultation of fetal

question

heart sounds. (c) In the third trimester,

the

abdominal palpation will help to identify fetal

about

lie, presentation, position, growth pattern,

How

volume of liquor and also any abnormality.

abdominal

Examination also helps to detect whether the

examination?

to question.

student the Takes to

down

do the notes.

presenting part is engaged or not. Girth of abdomen is measured at the level of umbilicus. The girth increases by about 2.5 cm per week beyond 30 weeks and at term, measures about 95–100 cm. (d) Others—any uterine mass (fibroid) or tenderness. Fetal activity (movements) is also recorded.

12

5

Discuss

minute antenatal advice.

the ANTENATAL ADVICE:

Asked

Student listen List down the

providing antenatal advice to pregnant question to the the student explaination.

antenatal advise given

to

the 13

women and her family are as followed:

about

the

pregnant

PRINCIPLES: (1) To counsel the women

which type of Interact with women?

about the importance of regular checkup. (2)

health advice the teacher.

To maintain or improve the health status of

you have to

the woman to the optimum till delivery by

given to the Given

the

judicious advice regarding diet, drugs and

pregnant

answer

the

hygiene. (3) To improve the psychology and to

women?

question.

remove the fear of the unknown by counseling the woman.

Takes

down

the notes.

DIET: The diet during pregnancy should be adequate to provide: (a) good maternal health, (b) optimum fetal growth, (c) the strength and vitality required during labor and (d) successful lactation. During pregnancy, there is increased calorie requirement due to increased growth of the maternal tissues, fetus, placenta and increased basal metabolic rate.

Supplementary nutritional therapy: 14

As previously mentioned, there is negative iron balance during pregnancy and the dietetic iron is not enough to meet the daily requirement especially in the second half of the pregnancy. Thus, supplementary iron therapy is needed for all pregnant mothers from 16 weeks onwards. Above 10 g% of hemoglobin, 1 tablet of ferrous sulfate (Fersolate) containing 60 mg of elemental iron is enough. The dose should be proportionately increased with lower hemoglobin level to 2–3 tablets a day. Three tablets provide 45 mg of absorbable iron.

ANTENATAL HYGIENE: In otherwise uncomplicated cases, the following advices are to be given:

Rest and sleep: The patient may continue her usual activities throughout pregnancy. However, excessive and strenuous work should be avoided especially in the first trimester and the last 4 weeks. 15

Recreational exercise (prenatal exercise class) is permitted as long as she feels comfortable. There is individual variation of the amount of sleep required. However, on an average, the patient should be in bed for about 10 hours (8 hours at night and 2 hours at noon), especially in the last 6 weeks. In late pregnancy, lateral posture is more comfortable.

Bowel: Constipation is common. It may cause backache and abdominal discomfort. Regular bowel movement may be facilitated by regulation of diet taking plenty of fluids, vegetables and milk or prescribing stool softeners at bedtime. There may be rectal bleeding, painful fissures or hemorrhoids due to hard stool.

Bathing: The patient should take daily bath but be careful against slipping in the bathroom due to imbalance.

Clothing, shoes and belt: The patient

16

should wear loose but comfortable garments. High heel shoes should better be avoided in advanced pregnancy when the center of balance alters. Constricting belt should be avoided.

Dental care: Good dental and oral hygiene should be maintained. The dentist should be consulted, if necessary. This will facilitate extraction or filling of the caries tooth, if required, comfortably in the second trimester.

Care of the breasts: Breast engorgement may cause discomfort during late pregnancy. A well-fitting brassiere can give relief.

Coitus: Generally, coitus is not restricted during pregnancy. Release of prostaglandins and oxytocin with coitus may cause uterine contractions. Women with increased risk of miscarriage or preterm labor should avoid coitus if they feel such increased uterine activity.

17

Travel: Travel by vehicles having jerks is better to be avoided, especially in first trimester and the last 6 weeks. The long journey is preferably to be limited to the second trimester. Rail route is preferable to bus route. Travel in pressurized aircraft is safe up to 36 weeks. Air travel is contraindicated in cases with placenta previa, preeclampsia, severe anemia and sickle cell disease. Prolonged sitting in a car or aeroplane should be avoided due to the risk of venous stasis and thromboembolism. Seat belt should be under the abdomen.

Smoking and alcohol: In view of the fact that smoking is injurious to health, it is better to stop smoking not only during pregnancy but even thereafter. Heavy smokers have smaller babies and there is also more chance of abortion. Similarly, alcohol consumption is to be drastically curtailed or avoided, so as to prevent fetal maldevelopment or growth 18

restriction.

IMMUNIZATION: Fortunately, most of lifethreatening epidemics are rare. In the developing countries, immunization in pregnancy is a routine for tetanus; others are given when epidemic occurs or traveling to an endemic zone or for traveling overseas.

13

2

Explain

value VALUES OF ANTENATAL CARE:

antenatal Minute of care.

Describe the Student listen What

is

the

 To screen the high risk cases

values

of

the

 Detection of high risk factors

antenatal

 Pregnancy

should

be

regularly care

supervised

of the

values

explaination.

antenatal care?

Interact with the teacher.

 Acceptance of advise

Takes

down

 Reduction of maternal mortality and

the notes.

morbidity  Optimize the health level

19

SUMMARY: Antenatal care is the systematic examination and supervision of the pregnant women. The supervision should be regular and periodical in nature according to the need of the individual. Actually prenatal care is the care in continue that start before pregnancy and end at the delivery and the postpartum period. Antenatal care consist of the antenatal examination its include physical, breast, vaginal, abdominal examination etc, and antenatal advices. During the antenatal care provide the antenatal advice to the pregnant women and her family. Antenatal care should be provided for the optimum health of the women and fetus, early detection of high risk, prevent for complication etc.

ASSIGNMENT:

1. Define the antenatal care. Explain the antenatal advices. 2. Write down about the abdominal examination of the pregnant women.

20

ABSTRACT:  BACKGROUND Antenatal care (ANC) is one of the evidence based interventions to decrease the probability of bad health outcomes for mothers and their newborns. Effectiveness of antenatal care, however, relies on the quality of care provided during each antenatal care visit. Hence this study attempted to assess the quality of antenatal care services at public health facilities of Bahir-Dar special zone, North Western Ethiopia.

 METHODS A facility based cross-sectional study employing both quantitative and qualitative methods was conducted from March to April 2010 in Bahir-Dar special zone, North Western Ethiopia. Quality of care was measured as a proportion of patients receiving recommended components of care. To measure the indicators, data was collected from 369 pregnant women who attended ANC clinics in eight public health facilities, during the data collection period. Data were collected through exit interviews with ANC attendees, observation during consultation, and in-depth interviews with health care providers.

 RESULTS Pregnant mothers attending ANC clinics were found to receive only part of recommended care components. Venereal Disease Research Laboratory (VDRL) test, blood group and Rhesus factor tests were done only for 73 (19.8%) and 133 (36.0%) of the women, respectively. Moreover 236 (64.0%) of the mothers missed the opportunity of receiving iron/folic acid supplement during their ANC visit. Three hundred fifty five (96.2%) of the women received tetanus toxoid vaccine. And only 226 (61.2%) of the women had their conjunctiva checked for anemia. Lack of reagents partly explained the problems observed in the provision of recommended care components.

21

 CONCLUSION Almost half, 175 (47.7%) of the study women were not satisfied and a large proportion of mothers are missing opportunities to receive screening (like blood pressure and weight measurements) and preventive components of antenatal care (iron/folic acid supplementation). Therefore, efforts should be targeted to avoid missed opportunities by taking quality improvement measures including the fulfillment of all necessary resource.

22

BIBLIOGRAPHY: 1. Annamma Jocob. A Comprehensive Textbook Of Midwifery And Gynecological Nursing: antenatal care. Fourth Edition. New Delhi: Jaypee Brother Medical Publisher (P) Ltd; 2015. Pp (112-119) 2. D.C. Dutta’s. Text Book Of Obstetrics: Antenatal care. Seventh Edition. New Delhi: New Central Book Agency (P) Ltd; 2010. Pp (94-102) 3. Dr. Shally Magon. Sanju Sira. Textbook Of Midwifery And Obstetrical Nursing: Antenatal examination. Third Edition. New Delhi: Lotus Publisher; 2013. Pp (5363) 4. Myles. Text Book For Midwives: Abdominal examination. Fifth Edition. UK: Churchill Livingstone Elsevier; 1964. Pp (263-268) 5. Nima Baskar. Midwifery And Obstetrical Nursing: Antenatal care. Seventh Edition. Bangalore: EMMESS Medical Publisher; 2015. Pp (134-141)

23