MATERNAL AND INFANT HEALTH CARE IN PRIMARY HEALTH CARE SETTING

Lecture 9

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Primary Health Care Nursing (NUR 473)

 

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 birth to 6 years of age

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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

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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

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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.

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The goal of the premarital care is to:

Components of Premarital Care

A. Premarital Counseling

B. Premarital examination

C. Premarital immunization

D. Genetic counseling

E. Premarital education

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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

Topics in counseling includes sexuality, sexual health and sexual problems, the family planning concept, the befits of different methods of family planning

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

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The role of the nurse premarital counseling

•Prepare a proper atmosphere for counseling

•Ensures privacy of the client

•Assess the health needs of the couple

•Take a complete history of the couple

•Helps them to understand several topics including family planning, conception, etc.

•Help the future couple to make decisions about their future lives and their marriage

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A. Premarital Counseling 

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1. History taking should include: Personal history; as name, age, occupation, education & address, religion Menstrual history Medical history

B. Premarital Examination 

2. Physical examination: Complete physical examination including: heart and chest examination, pelvic

measurement to detect contracted of deformed pelvis

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

Such as:MMRTetanusHepatitis

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C. Premarital Immunization 

D. Genetic Counseling 

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

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E. Premarital education 

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

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2. Antenatal Care in Primary Health Care Centers

Schedule of antenatal visits:

The total visits during pregnancy are 12 to 15 visits in normal as follows:

One visit every month until the 6th months of pregnancy

One visit every two weeks during 7th and 8th months of pregnancy

One visit every week during the 9th month of pregnancy

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2. Antenatal Care in Primary Health Care Centers

Anti natal care during initial visit: A. History taken includingSocial 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

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2. Antenatal Care in Primary Health Care Centers

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)

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2. Antenatal Care in Primary Health Care Centers

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

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2. Antenatal Care in Primary Health Care Centers

The first six weeks after birth – is critical to the health and survival of a mother and her newborn.

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3. Post Partum Care

Schedule of home visits for post partum care by nurse or midwife or community health nurse:

1st day of post partum, 3rd day of postpartum, 7th day of post partum, 40th day of post partum

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.  

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3. Post Partum Care