Cs Crud ue Ut dL) 2018 EditionPREFACE ——_ aN i cl » constantly affecting the kind and quality of care in midwit | egoteee This mana » th the realization of the urgent need to help mee obstetrics, This manual is written with the res | droenhance clinical judgmentand high level of health care delivery. abreast of new trends an i This booklet gives clear direction to the concept and technical steps in skill acquisition, skil) competency and skill efficiency. Itadheres such to the style of clinical checklist which can be used well as competency based assessment tool by students, clinicians, as self-learning materials as consultants and educators on midwifery skills. derived from a variety of standardized competency assessment tools of the nursing and The formatis facts and information used were carefully midwifery council of Nigeria, WHO and JHPIEGO. The dat the end as references. dmirable blend of pictorials on technological surate with research _ researched from credible sources that are liste In addition to the previous manual, there is an a advances, different treatment modalities and nursing concepts commen findings. Similarly the context has been carefully arranged in units and related practical tips are added for easy up take of clinical decision skills. Thope this willbe found useful and user friendly by all health care practitioners. B.N. ASHCROFT ii | tis NTTAL PRACTICAL SKILS GUIDE FO HEALTH GARE PRACTITIONERS & STUDENTSACKNOWLEDGMENT. equally want to since curriculum and procedure manual implementation com asic Midwifery UDUTH Sokoto in ensuring the suc Post They include: Mrs. Biodun Nike Ashcroft Tawa Bello (Mrs) Mrs. Grace Isiyaku Ahmadu Anthonia Ene Solomon (Mrs) Mrs. Temitope F. Adcosun Haj. Shafa'atu Umar Haj. Rabi Muhammad Aisha Dalhatu Usman (Mrs) Farida Ango Ndubuisi ljeoma Charity Haj. Fatima Yusuf Shinkafi Taibat F. Idumah 12 us through writing this piec J Almighty for his infinite mercies, guidance and wisdom in y appreciate the tremendous and tireless effort of all members of tee and academic staff of School of essful completion of this manual. Principal Vice Principal Admin. Vice Principal academic Chief Midwife Tutor Chief Midwife Tutor Principal Midwife Tutor/ Committee secretary Principal Midwife Tutor Principal Midwife Tutor Principal Midwife Tutor/Committee member Principal Midwife Tutor/Committee chairperson Senior Midwife Tutor Asst. Chief Nursing Officer/Committee member Our profound gratitude goes to all the organisations such as WHO, JHPIEGO, CDC, MCSP, etc. and authors whose materials, articles and books we've consulted and used in making this manual a great piece. Finally, we will not forget the effort of Hajiya Nana Isah that began work on this manual before her retirement from active service; You are appreciated ma. ESSENTIAL PRAGTICAL SKILLS GUIDE FOR HEALTH CAREPRAGTITIONERS & STUDENTS LilTABLE OF CONTENTS LE OF CONT ———— ii PREFACE iti ACKNOWLEDGMENT a PTT - VASHING . 4 Saree HANDLING OF HYPODERMIC NEEDLES, SYRINGES AND SHARPS INSTRUMENT PROCESSING 9 NEW IMMUNIZATION SCHEDULE if OUT-OF-HOSPITAL CHAIN OF SURVIVAL 5 CARDIO-PULMONARY RESUSCITATION (CPR) CTT TITLE: ANATOMY OF PELVIS 15 TITLE: ANATOMY OF PELVIC LIGAMENTS AND JOINTS 17 TITLE: PELVIC FLOOR MUSCLES 18 TITLE: CHECKLIST FOR PLACENTA AT TERM. 25 TITLE: ANATOMY OF THE FETAL SKULL 22 TITLE: CHECKLIST FOR DIAMETER FETAL SKULL. 24 CATT TITLE: HEALTH EDUCATION OF CLIENT ON COMMON DISORDERS OF PREGNANCY AND ITS MANAGEMENT 25 TITLE: BIRTH PREPAREDNESS AND COMPLICATION READINESS 27 TITLE: HISTORY TAKING DURING ANTENATAL CARE 28 TITLE: GENERAL EXAMINATION OF A PREGNANT WOMAN 30 TITLE: ANTENATAL HISTORY, PHYSICAL EXAMINATION AND BASIC CARE 32 TITLE: PELVIC EXAMINATION 33 HY SICAL EXAMINATION OF A PREGNANT WOMAN FOR ANAEMIA = 34 BDOMINAL EXAMINATION AND MEASUREMENT OF ABDOMINAL GIRTH 35 TITLE: FUNDAL HEIGHT MEASUREMENT 36 TITLE: EXAMINATION OF THE VULVA 37 TITLE: CLINICAL BREAST EXAMINATION 38 TITLE: BREAST SELF EXAMINATION (BSE) 39 TITLE: HEALTH EDUCATION ON WORKING AND BREASTFEEDING 41 TITLE: EFFECTS OF SMOKING AND ALCOHOL ON PREGNANCY 42 43 TITLE: MANUAL VACUUM ASPIRATION (MVA) iv II ESSENTIAL PRACTICAL SKILLS GUIDE FOR HEALTH CARE PRACTITIONERS & STUDENTSTITLE: BLOOD TRANSFUSION 45 TITLE: URINE TEST FOR GLUCOSE AND PROTEIN 46 1 LECTION 47 IECHANISM OF RIGHT OCCIPITO- AV T 4 SECHANISM OF RIGHT OCCIPITO-POSTERIOR POSITION 50 AECHANISM OF LEFT MENTO ANTERIOR POSITION SL POSITIONS USED IN MIDWIFERY. 53 : VULVA SWABBING . 34 EXAMINATION mae “35 =MBRANES (ANANIOMY) 71 ONDUCT OF NORMAL VERTEX DELIVERY $7 “ONDUCT OF BREECH DELIVERY 38 PISIOTOMY AND REPAIR 59 USE OF VACUUM EXTRACTOR 60 VE MANAGEMENT OF THIRD STAGE OF LABOUR (AMTSL) 61 DELIVERY OF THE PLACENTA AND MEMBRANE BY CONTROLLED CORD TRACTION 62 TITLE: MANUAL REMOVAL OF PLACENTA . 63 AMINATION OF THE PLACENTA : 64 TITLE: EXTERNAL BIMANUAL COMPRESSION OF THE UTERUS 65 TITLE: INTERNAL BIMANUAL COMPRESSION OF THE UTERUS. 66 ‘TITLE: APPLICATION AND REMOVAL OF ANTI-SHOCK GARMENT 67 ZECH PRESENTATIONS 68 GD Tea PITLE: POST NATAL EXAMINATION 69 POST NATAL EXERCISE (KNEE ROLLING) 70 POST NATAL EXERCISE (KEGEL EXERCISE) aT Cau CAI ETT : BALANCED COUNSELLING R 'YCLE BEADS 74 USE OF MALE CONDOM 15 USE OF FEMALE CONDOM 16 IMPLANON CONTRACEPTIVE IMPLANT'S INSERTION TECHNIQUE 78 TITLE: REMOVAL OF JADELLE IMPLANT 79 TITLE: RESUSCITATION OF THE NEWBORN 80 TITLE: IMMEDIATIATE CARE OF THE NEW BORN 81 TITLE: CARE OF BABY'S CORD 83 TITLE: PHYSICAL EXAMINATION OF THE NEWBORN 84 TITLE: MEASUREMENT AND NEUROLOGICAL ASSESSMENT OF THE NEWBORN 86 ESSENTIAL PRACTICAL SKILLS GUIDE FOR HEALTH CARE PRACTITIONERS & Sunes! | Vv88 aS CARE (KMC) 89 'LE: BATHING BABY WITH CORD 0 TITLE: ATTACHMENT OF BABY TO THE BREAST i TITLE: MANUAL EXPRESSION OF BREAST MILK a DING RIC TUBE FEEDING TITLE: NASOGAS Pe TITLE: PREPARATION OF ORAL REHYDRATION SOLUTION (ORS) a THT TSS D BATH oe ITZ BATH 98 (OUND DRESSING 99 EMOVAL OF STITCHES :AR PIERCING 1) TITLE: ORAL HYGIENE te TITLE: CERVICAL CANCER SCREENING USING VISUAL INSPECTION WITH ACETIC ACID (VIA) 102 TITLE: MEASUREMENT OF VITAL SIGNS 108 TITLE: PATELLAR REFLEXES AND CLONUS i TITLE: COSTO- VERTEBRAL ANGEL TENDERNESS 1% TITLE: GIVING OF INTRAVENOUS INJECTION 7 TITLE: GIVING OF INTRAMUSCULAR INJECTION 108 TITLE: ADOLESCENT AND YOUTH FRIENDLY HEALTH SERVICES HISTORY TAKING 109 UNIT IX: INSTRUMENTS AND DRUGS USED IN MIDWIFERY TITLE: INSTRUMENTS USED IN MIDWIFERY ll TITLE: DRUGS USED IN MIDWIFERY U7 CT vi | I ESSENTIAL PRACTICAL SKILLS GUIDE FOR HEAITH CARE PRACTITIONERS & STUDENTSQUICK GUIDES TO PRACTICAL TIPS ——_—_ HAND WASHING aarious element in reducing the spread of infection. known that a lack of time is a Hand hygiene isa prt Hand hygiene is rarely carried out in a satisfactory manner and it is mnajor inhibiting f actitioners miss ou hand surface due to poor technique. eon ‘According to the Health and Social Care Act 2008 Code of Practice for the NHS on the prs sociated infections and related guidance, London; An effective hand id running water t some parts of the or, and that a high proportion of health pr vention and control of healthear ; s, Preparation requires wetting hands under tepi into contact with all of hygiene technique involves 10 s before applying liquid soap. When washing the hands the solution must come i 10-15 the surfaces of the hand which should be rubbed together vigorously for a minimum of 10-15 seconds; paying particular attention to the tips of the fingers, the thumbs and. the areas between the hould be rinsed thoroughly and dried using good quality paper towels. Dispose of fingers. Han paper towels into a foot operated domestic waste pedal bin. Hand washing is indicated: © when examining a client (before and after each client) © whenputting on sterile gloves for surgical procedure © afterany situation that may make hands to be contaminated * afterremoving gloves The types of hand washing include: © Plain soap with running water—routine © Antiseptic with running water © Alcohol scrubs * (Hands should be washed first on arrival at work, in-between attending to clients, and as the last thing when leaving the health facility) ~ Good hand hygiene technique involves the following stages * Wetall surfaces thoroughly with warm water Apply soap or skin cleanser and vigorousl x ‘i sa eae cee igorously rub both hands together with the soap and lather, Palm to palm Palm over back of each hand Palm to palm with interlaced fingers Tips and backs of fingers to each palm Clean thumbs Clean wrists 2 | I ESSENTIAL PRACTICAL SKILLS GUIDE FOR HEALTH CARE PRACTITIONERS & STUDENTSands thoroughly undera stream of clean, running water until all soap is gone, ° sing. disposable paper towel or allow hands to air-dry. Os e yhen running water isnot available, use either: . Ao uwitha tap that can be turned off to lather hands and turned on again for rinsing. © Xpucket and pitcher, ‘with one person pouring the water over the other's hands and allowing it into the bucket. todrain hand rub, which doesnot require water. Analcohol Step 5) Palm to palm with Palm over back Interlaced fingers of each hand Tips and backs of fingers to each palm Coy Soa Rinse your hands Pat dry your hands thoroughly 4 sing a disposable paper towel Titres td) Ma | Saar TON TENT OHNE PRACTITIONERS & STUDENTS |S ESSENTIAL PRACTICAL SKILLSEE TIPS SAFE HANDLING OF HYPODERMIC AND PEDLES, SYRING! SHARPS Use each needleand syringe only one Donotdisassemble the ne Donotrecap, bend, or bi Decontaminate the needle and syringe before dispos Dispose of the ncedieand syringe togeth Place theneedle cap ona firm, flat surt With one hand holding the syringe, Tum thesyringe upright (vertical) Use the forefinger and thumb of other hand to grasp the eap and push firmly dows onto Hie hub ifpossible, ringe ane needles before disposal I, 1a puncture-resistant container se the needle to "scoop" up the cap. HANDLING Usea safe zone for passing sharps Say “pass” or “sharps” when passing sharps Use aneedle driver or holder, not your fingers. Use blunt needles when available. Donotblind suture. Always remove blades with another instrument Use a puncture-proof container for storage and/or disposal Donotrecap a needle before disposal unless using the one-hand technique PROPER DISPOSAL OF SHARPS, Donotrecap the needle or disassemble the needle and syringe. Decontaminate the hypodermic needle and syringe Place the needle and syringe in a puncture-resistant sharps container. When the containeris three-quarters full, dispose of it Wear heavy-duty utility gloves. When the sharps container is three-quarters full, cap, plug, or tape the opening of the container tightly closed. Be sure that no sharp items are sticking out of the container. Dispose of the sharps container by burning, encapsulating, or burying it (see below). Removeutility gloves. ‘Wash hands and dry them with aclean cloth or towel or airdry 4 | FessturiarPancricar suits cuine ron neaira CANE PRACTINIONENS © STUDENTSINSTRUMENT PROCESSING Instrument Processing Sterilize Chemical High-pressure steam Dry heat Dry/Cool and Store Decontaminate High-Level Disinfect Boil Steam Chemical ESSENTIAL PRACTICAL SKILLS GUIDE FOR HEALTH CARE PRACTITIONERS & STUDENTS 11 5MAGNESIUM SULPHATE (MgSO): MANAGEMENT OF SEVERE PRE- ECLAMPSIAAND ECLAMPSIA MECHANISM: The paral HF © postulate The mechanism of action of Magnesium sulphate in eclampsia is not clear. The pi lated mechanisms are: artate) subtype * Central action: Voltage dependent blockade of NMDA (N-methyl D-aspartate) subtype of glutamate (excitatory) channel receptors * Peripheral action: At Neuromuscular Junction (NMJ), itcauses: . as ~ Blockage of calcium entering the cell and blocking calcium at intracellular sites/membranes = Reduction of presynaptic acetylcholine (ACh) release at the endplate - Reduction of motor endplate sensitivity to acetylcholine (Ach) ROLE IN SEVERE PRE-ECLAMPSIAAND ECLAMPSIA: ° Magnesium sulphate is an anticonvulsant. * _Itprevents seizures in pre-eclampsia. . * _Ineclampsia, itis given as soonas the convulsion has ended. * _ Itcauses vasodilation, increases cerebral, uterine and renal blood flow. © Itdecreases cerebral oedema, CALCULATION: + “x"% of Magnesium sulphate contains “x” gm in 100 ml * 1 ampoule contains 50% of 2 ml Magnesium sulphate * Lampoulecontains gm of Magnesium sulphate in 2 ml * 4ampoules provide 4gm of Magnesium sulphate in 8 ml * Toprepare 20% of 4gm Magnesium sulphate, “y” ml of Normal saline (NS) must be added: = 20gm/100 ml =4gm/(8 ml +“y" ml) — 8+¥y"=20 ~ syrai REGIMEN: Pritchard Regimen: a. Loading dose: * Initially: 4gm of 20% MgSO, intravenously (IV) over 10-15 minutes ~ Take one 20ml syringe ~ Draw 4 ampoules of Magnesium sulphate ~ Add 12m1Normal saline Immediately followed by: 10gmof 50% Mggo, intramuscularly (IM) (Sgm in each buttock) | “A 6 I esc ania Ss ara RTT CE PRRCTTOEGS SOOOInject 5g here — Taketwo(2) 10 ml syringes — Draw 5 ampoules of MgSO, in each syringe - Add mlof2% Lignocaine in each syringe — Give deep IM in each buttocks Ifconvulsion persists after 15 minutes: 2gm of 50% MgSO, IV bolus over 5 minutes Takeone 10ml syringe © Draw2ampoules of Magnesium sulphate a. Maintenance dose: © Sgmof50% MgSO, IM 4 hourly in alternate buttocks © Take one 10mlsyringe © Draw 5S ampoules of MgSO, © Add 1 mlof2% Lignocaine in each syringe © Give deep IM4 hourly in alternate buttocks © Continue for 24 hours after the last convulsion or delivery whichever is later. Dhaka regimen © Itcomprises a loading dose of 4 grams intravenous slow infusion with 3gm intramuscular in each buttock along with maintenance dose of 2.5 grams intramuscular in alternate buttock every 4 hours for 24 hours aft last fit or delivery, whichever is later. © Incase of repeat fits, 2gm intravenous as 20% solution is given. Other Magnesium Sulphate regimens: © High dose regimens (Loading dose> 10gm): Pritchard, Lucas © Lowdose regimens (Loading dose < 10gm): Zuspan or Sibai, Suman sardesai — Loading dose: 4-6gm IV over 15-20 minutes Tr eal ESSENTIAL PRACTICAL SKILLS GUIDE FOR HEALTH CARE PRACTITIONERS & STUDENTS 7— Maintenance dose: 1-2gnV/hr1V infusion © Single dose regimen: VIMS regimen — Single dose of 4gm diluted 50% MgSO, intravenously, with simultancous 4gm 50%, MgSO, intramuscularly. MONITORING HOURLY FOR MAGNESIUM SULPHATE TOXICITY: Suspend or postpone use of Magnesium sulphate, ifany of the following is present: © Respiratory rate<16/min (Respiratory depression) Absent patellarreflex (Muscle paresis- is the Ist sign of Magnesium toxicity) © Urine output <30ml/hour in preceding 4 hours (Impaired renal function) The therapeutic level of serum magnesium is 4-7 mEq/l. Serum levels of Magnesium toxicity: = 8-12mEq/l: Loss of patellarreflex, flushing, warmth, somnolence, slurred speech — 15-17mEq/l: Muscular paralysis, Respiratory difficulty = 30-35 mEq/l: Cardiacarrest MANAGEMENT OF MAGNESIUM SULPHATE TOXICITY: © Ifurine output<30mV/hour: — MgSO, withheld — IVRinger's lactate infusion 1 litre over 8hours — Monitor forpulmonary oedema © Ifrespiratory arrest occurs: — Perform assisted ventilation — Antidote: Calcium gluconate 1 gm (10% of 10 ml) IV slowly over 10 minutes CONTRAINDICATIONS OF MAGNESIUM SULPHATEADMINISTRATION: © Myasthenia gravis Impaired renal function 8 | fesseariar america suits coe ron neairn CAE PRACTITIONTNS © STOUENTSNEWIMMUNIZATION SCHEDULE UNDER ONE (1) YEAR IMMUNIZATION VACCINE | NUMBER ] AGE Minimum | Route of Dose Vaccination oF interval | administration Site DOSES between doses Bacillus 1 ‘At birth or as Tntradermal | 0.05ml | Upper left arm Calmette-Guerin soon as (BCG) possible HepatitisBO = | 1 At birth Intramuscular | 0.5ml Outer part of the right thigh Oral Polio 4 Atbirth, at6, [4 weeks | Oral 2drops | Mouth Vaccine (OPV) 1 and 14 weeks Pentavalent [3 At6, 10and 14) 4weeks [Intramuscular [0.Sml | Outer part of vaceine weeks the left thigh (PENTA) Pneumococcal [3 ‘At6, 10and 14] 4 weeks [Intramuscular | 0.5ml | Outer part of conjugate weeks the right thigh vaccine (PCV) Inactivated T ‘At 14 weeks Intramuscular [0.Sml | Outer part of Polio Vaccine the right thigh (Pv) Rotavirus 2 ‘Atéand10 [4 weeks | Oral Mouth vaccine weeks MEASLES | 1 ‘At9 Months of | — Subcutaneous [0.5m | Upperleftarm age YELLOW I ‘At9 months of Subcutaneous | 0.5ml | Upperright FEVER age - arm Vitamin A 2 ‘At6months months | Oral 100,000 | Mouth and 12 months Ww SSEVTAT PRAETIONT SUL COTDEFON NEATH CANE PHNCTTIONENS 2 STUDENTS | 9TETANUS DIPHTHERIA (TD) SCHEDULE FOR PREGNANT WOMEN & WOMEN OF CHILD BEARING AGE Route of site of administration | administration Vaccination Antigen] Schedule | Number] Minimum] Period of | Dosage ose) of doses | Interval | protection between doses TDi At first 3 S No O.5mI | intramuscularly | Muscle of the contact with protection (IM) upper arm woman of childbearing age, OR As early as possible in |_pregnancy TD2 | Atleast 4 Fweeks | Syears weeks after D1 TD3 | Atleast6 months |~ 5 years months after TD 2 or in the next pregnancy TD4 | Atleast 1 Tyear | 10 years year after TD3 orin the next pregnancy TDS | Atleast! Tyear | Childbearing year after age TD 4 orin the next pregnancy 1 O| essen rancTiCAT SKITS Goroe Fon NERLTH CARE PRACTITIONERS & STUDENTS_"_" i... a OUT-OF-HOSPITAL CHAIN OF SURVIVAL of Survival provides a useful metaphor forthe elements ofthe ECC systems concept ult out-of-hospital Chain of Survival are: The term Chain The links inthe a Recognition of cardiac arrest and activation of the emergency response system Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions © Rapid defibrillation ¢ Basic and advanced emergency medical services ¢ Advanced life support and post-cardiac arrest care A strong Chain of Survival can improve chances of survival and recovery for victims of cardiac arrest. The paediatric chains of survival are: © Assess responsiveness and prevent arrest Early high quality bystander CPR © Rapid activation of the emergency response system Effective basic and advanced life support (including rapid stabilization and transport to definitive care and rehabilitation) : Integrated post cardiac arrest care (Reassess after every 5 cycles) ESSENTIAL PRAGTICAT SKILLS GUIDE FON HEALTH CANE PANOTITIONENS a STUDENTS | 11CARDIO-PULMONARY RESUSCITATION (CPR) ‘ ing or heartbeat has CPR- an emergency lifesaving procedure that is done when someones breathing stopped, This may happen afteran electric shock, heart attack, or drowning CPR aimsat preventing sudden & unexpected deaths in life threatening situations INDICATIONS © Sudden loss of consciousness/unresponsiveness- «Sudden loss of effective cardiac output (evidenced by pulselessness) CONTRAINDICATIONS © Absolute: - Only a DO NOT RESUSCITATE (D: © Relative: = ADNRorder by asenior cadre cl — Order is based on findings of brain death. VR) order by the victim. urse of events. ician usually given in the co COMPLICATIONS © Regurgitation and aspiration. © Fractured ribs, frail chest © Laceration of viscera e.g. iver, lungs. © Laceration of vessels e.g. pulmonary artery.# ASSESSMENT OF EFFECTIVENESS OF CPR Presence of carotid and femoral pulses (return of spontaneous cardiac activity —rosc). © Spontancous respiration Reactive pupils Presence of an eyelash reflex (blinking of eyes) © Movement/struggling, coughing by the patient.# INITIALOUTCOME OF CPR © Fullrecovery—close monitoring * Partial recovery: inadequate spontaneous respir © Cardiacarrhythmias * Coma 12 ese RETR Sea ECR RETRORERE THOTif you see someone collapse or find someone lying on the ground: EUHEE OmmrmEEIE Safety; hazard, you can't help| Puce atte CET Eer ( 2 Tata uaa 3 rion 4 eaeia on ne VN 2 ASUS L IS eS | “OTESEReRno kes (rag orSamirrieny 5 the shoulder. ie Pounce apr e Breaker ESSENTIAL PRNGTIONT SHILLS GUIDE FOR HEALTH CARE PRACTITIONERS a STUDENTS II 1 3Mone RE Bioeth acct) 4 Vea (E(-0rekY MMe ey act HERMAN iene eso PT MLe ec sf aul pebicbeuds tsi tend ‘eribts Serre Pere ona bi the victim's chest ERT ITS lehiest compressions int Peau dag ae) uae thee bane ese ens Gstbgcsn eer PEC Pence PS renee Ceca i aa er settle bo eae Wie Bice aaa Gilat uae | Ce | SEusanaeiee uae Puts neh cx ACs tetera CURTIS aeL I) = Beimug After 5-cycles; aF CPR, if help, ‘ isnot available and i @)crr Certified INDIGO MEDICAL TRAININGANATOMY ——_—_——— TITLE: ANATOMY OF PELVIS [sNO_|STEPS T, [Handles and position the pelvis correctly for the proced ointed object e.g. Ruler or biro mana I. [Deseribe the pelvis stating the following: Pelvis is made up of: © 2 Innominate bone 1 Sacrum #1 Coccyx 5, [The innominate bones consist ofthe iium, Ischium and the pubis lwhich join at the acetabulum is. © Ilium is the flared out portion of the pelvis, with iliac crest as border between the anterior and posterior surfaces. Anterior surface is concave - (Iliac fossa) for attachment of iliacus muscle 5. @ Ischium is the lowest of the innominate bone with ischial spines separating the greater and lesser sciatic notches and the ischial tuberosity for attachment of muscle 6. © Pubis is the smallest of the three with a body, upper and lower borders. «The two pubic bones join at the symphysis pubis 7. [Sacrum Is the posterior bone of the pelvic bone ‘© Wedge shaped Formed by 5 fused sacral veterbrae ¢ Upper border of the first sacral vertebral jus forward, known as Sacral Promontory Anterior surface is smooth and concave while the posterior is rough and for attachment of gluteal muscles. 8. Coccyx ‘ Itis otherwise known as vestigial tail + Isatriangular bone with the apex inferiorly and base superiorly Formed by four fused bones «Articulating with the 5* sacral vertebra at the sacro-coccygeal _joint. ETSY FRACTION SHILS GUIDE FOR HEALTH CANE PRACTITIONERS & STUDENTS 115 ESSENTIALPe 9. Identifies the true and false pelvis. «False pelvis is the part above the pelvic brim ¢ True pelvis is the part that consist of th brim, cavity andoutlet a2 10. [Mentions the 4 pelvic joints #2 Sacroiliac joints ale ae Ud. ‘¢ _1 Sacro-coccygeal joint —— + 12. 1 Symphysis pubis 73, [Mentions the 5 pelvic ligaments @ Sacroiliac ligament 14. ‘Sacro coceygeal ligament ale [b. @ Sacro spinous ligament 16. Sacro tuberous ligament 17. Inter pubic ligament I 18. Mentions the functions of the pelvis ‘¢ Serves as passage for the foetus during child birth © Helps for walking and running © Transmit the weight of the body © Protects the pelvic organs 1 6| FessenriatPrncriear Suits Govoe ron WEALTH GARE PRACTITIONERS © STORENTSTITLE: ANATOMY OF PELVIC LIGAM ISINO_ [STEPS 7. Picks up the pelvis &. Mention the three ligam ents and one obturator} foramen, using a pointer. 5 [Deseribes each ligament: ISacro-iliac ligaments ‘e Strongest in the body Extends from lower border of the sacrum to ischial tuberosity Sacrospinous ligaments ‘¢ Found below the sacroiliac ligaments «Extends from lower border of the sacrum to ischial spines Sacrotuberous ligament Itnuns from the sacrum to the ischial tuberosity # Sacro-spinous and sacro tuberous ligament crosses the sciatic notch and forms the posterior wall of the pelvic outlet. 5, [Mentions and describes each of the four pelvic joints 2 Sacroiliac joints ‘© Strongest synovial weight bearing joints found in the body © They articulate the sacrum tot he ilium at the Ist & 2nd sacral vertebrae from each side thereby connecting the spine to the pelvis, @ Allows for slight movement T Sacro coccygeal joint Is found where the base of the coccyx joins with the tip of the Sth sacrum It allows the backward tilting of coccyx during labour Capable of flexion & extension movement In the non-pregnant state there is very little movement in these joints During pregnancy endocrine activity causes the ligaments to soften, which allows the joints to give way © Itmay provide more room for the fetal head as it passes through the pelvis T Symphysis pubis. ‘e Apad of cartilage between the bodies of the pubic bones e_Itis 4om long I4. [States that the major functions of ligament and joints are: © To give support to the pelvic organs Holds them in position Is. |Gently drops the pelvis. ESSENTIN.PURCTIOATSHILS CUTDE FOR HEALTH CANE RAGTITIONENS & STOUT 7 x xDescribes that the pel up the pelvis © Superficial layer *__Deep layer Describes that the perficial T ‘composes of five muscles. * External Anal Sphincter: encircles anus attached behind by a few fibres to the coceyx. Transverse perineal musc of the perineum. * Bulbocavenmsus muscles passes from the perineum for vaginato the corpaa cavernosa of the clitoris under the pubic arch. + Ischiocavemosus muscles: passes from the ischial tuberosity along the pubic arch to the corporal ca vernosa. ‘+ Membranous sphincter of the urethra __: is formed by two bands of muscles that pass above and belo. w the urethra and is attached to the pubic bone. ‘+ _Itis not a true sphincter but can close the urethra when it contracts. tre from ischial tuberosity to the rd around the The Deep Layer ‘* Composes of three pairs of muscles known as Levator Ani muscles because they lift or elevate the anus. © They med to form a gutter. ‘© They are surrounded by the urethra, vagina and anal canal. + The muscles are named according to their site of origin and insertion. ‘© Pubococeygeus- each muscle arises from the inner border of the body of the pubic bone and from the white line of fascia to the coccyx. They then sweep posteriorly in three distinct bands. liococeygeus - arises from the white line of fascia on the inner aspect ‘of each iliac bone and runs posteriorly to the coccyx. * Ischiococeygeus -arises from each ischial spine and passes to the upper art of the coccyx, in-front of the sacro-spinous ligament. BLOOD SUPPLY The two ovarian and two internal iliac arteries VENOUS RETURN The two ovarian and two intemal iliac veins» ® NERVE SUPPLY * _Pudendal and sacral nerves FUNCTIONS © Supports the weight of the abdomino-pelvic organs. * The muscles are responsible for the voluntary control of micturition and defecation, Plays an important part in sexual intercourse. During childbirth, it influences the passive movement of the fetus throug! the birth canal and relaxes to allow its exit from the pelvis. 1 8 | Fessenvint ener sis cone ran nentTa cane FRRGTITONERS = STOTEN| DEEPPELVIC FLOOR MUSCLES RE A TTTree. UNEGKLIST FORPLACENTAAT TERM. SIN [STEPS I 1. | Handles the placenta properly I 2. Describes the placenta as follows: * Iisa round, flat mass about 20em in diameter and 2.5em thick at its center, but becoming thinner towards the edge. | NN adic ‘+ Itweighs approximately one sixth of the baby's weight or 600g. * Proportion is affected by the time at which the cord is clamped ‘owing to the varying amounts of fetal blood retained in the vessels. ‘© Placenta has two surfaces. = Maternal surface + Fetal surface 3. | MATERNAL SURFACE | © Itis dark red in colour | ‘© Consists of about 20 lobes which are separated by sulci. | ‘* The lobes are made up of lobules, each of which contains a single villus ‘* The blood seen between the chorionic villi is maternal blood contained in the intervillous spaces. * Fibrin is deposited on the surface of th e placenta which becomes calcified giving a gritty sensation to the fingers. 4. | FETAL SURFACE © Colour; dull white in appearance | © Branches of the umbilical veins and arteries are visible on its | surface ¢ Umbilical cord is centrally attached to its surface | * Umbilical veins and arteries radiate from the point of umbilical cord | to the periphery. | 5. _ | Consists of two membranes viz: © Chorion which is derived from the trophoblastic tissue * Itis thick, opaque and friable and rough in nature * Continuous with the chorionic plate which forms the base of the placenta * Contains no vessels and nerves * Itis thicker than amnion, ¢ Amnion which is derived from the inner cell mass © Smooth, tough and translucent Takes part in the formation of the amniotic fluid, a 0 ——————6. | Umbilical cord (funisy # Itextends from the fetus to the placenta ‘¢ Ittransmits the umbilical blood vessels which have: two arteries an ‘one vein, These are enclosed and protected by Wharton's jelly , a gelatinous substance formed from mesoderm + The whole cord is covered in a layer of amnion co covering the placenta uous with that} © It's about 50 em in length © The average diameter is 1.Sem. 7, | Funetions of the placenta are ¢ «Respiration function for exchange of O» and CO from the mother | to the baby ‘Nutrition for adequate supply of essential nutrients to the baby «Storage for steady supply of glucose by converting glycogen + Exeretory function to ensure proper elimination of waste product from the b aby to the mother * Protec tive function: against invading micro-organisms * Endocrine: ensuring the production of essential hormones that maintains pregnancy [S| Replaces the placenta well and tiies up FSSENTIAL PRACTICA SHULS GOIDEFOR HEMLIN GARE PRACTITIONERS « STUDENTS | 21.Pret ake MN wreeweeeoree SiN |STEPS T.___ [Picks and handles the bony skull properly 2 ]Usesa pointer and mentions thathe fetal skull is divided into three (3) parts name} © The face «The base The vault 3, [The Face ‘© Extends from the orbital ridge to the junction of the neck and the chin # Itis composed of 12 fused bones. The Base © Comprises of bones that are firmly united to protect vital centers in the medulla Vault © Itisadomeshaped part of the fetal skull © Bounded in front by: i. Two frontal bones anteriorly Behind by the occipital bone Laterally by two parietal bones 4. Mentions the sutures as: | ¢ Lambdoidal suture separates the occipital bones from the two parietal bones Sagittal sutures lies between the two parietabones © Coronal suture separates the frontal from theparietal bones Frontal suturoseparates the two frontalbones 3. Mentions the fontanelles: Posterior fontanelle or lambda Triangular in shape ¢ Situated at the junction of the sagittal arldmbdoidal sutures © Normally closes at 6 weeks [Anterior fontanelle or bregma Found at the junction of the frontaJ coronal and sagittal sutures © Kite or diamond shaped © Measures 3-4cem long, 1.52cm wide © Closes at 18 months old age 22 | esseinimt Paaciion Suis GUMTREEpega andar in the eal sll 6. “e The vertex is the area midway between the anterior fontanel Ie, the two parietal bones and the posterior fontanelle " «The brow is the area of skull which extends from the anterior fontanel le to the upper border of the eye, «The face extends from the upper ridge of the eye to the nose and chin (lower jaw) ‘The occiput is the area between the base of the skull and the posterior fontanelle + Glabella ~ is the bridge of the nose, between the eyebrows, ¢ Bregma — anterior fontanelle «Lambda ~ Posterior fontanelle ¢ Mentum - Chin, 7. [Functions + The skull bones encase and protect the delicate brain that is subjected to pressure during delivery. + Knowledge of correct presentation of the fetal skull diameters is essential to the midwife if delivery is to proceed normally. & [Importance of the knowledge of the fetal skull to a midwife: ‘© Mentions the following reasons why the know ledge of the fetal skull is important to a midwife # Helps the midwife to have a practical understanding of the relationship between the fetal head and maternal pelvis. «Fetal skull is the largest part of the baby that passes through the birth canal «98% of the fetus present with head and are born such 9,___ [Gently drops the bony skull. SENT PUNE TTAT STS TOE TON RTT cE PTONENS a SroDeNTs | 23 ESSENTIAL PRACTICAL SKILLS GUIDE FOR HEALTH CARE PRAGTITLE: CHECKLIST FOR DIAMETERS OF THE FETAL SKULL SIN_| STEPS = 1. | Greets and introduces self. 2. | Holds the skull at an eye Fevel withapointer SS - 3._| Describes the transverse diameters as follows: | + Biparictal diameter- measured from two parietal eminences. © This is9.5cm © Bitemporal diameter. measured between the farthest points of the coronal suture at the temples. This is 8.2em 4. | Mentions that thelongitudinal diameters are measured anteriorly angosteriorly | are as follows: | © Mento vertical - taken from the point of the chin to the highest) | point onthe vertex, measures 13.5em ‘© Submento vertical - taken from the point where the chin join the neck to the highest point on the vertex, measures 11.5cm ‘© ~Submento bregmatic- taken from the point where the chin joit the neckto the centre of the bregma, measures 9.5em, + Sub-occipito frontal _- taken from below the occipital protuberance tothe centre of the frontal suture, measures 10cm * Occipitofrontal - taken from the occipital prominence to the glabella measures 11.Scm © Sub-occipito-bregmatic - taken from below the occipital protuberanceto the centre of the anterior fontanelle or bregma, measures 9.5cm. 5.__ | Gently drops the bony skull 1 Sumscepro begat @Sen 2. Supcecppto-tenta, 105 em 3. Ceepaa-tental, 11:5 em 4 Mertovertisl, 13.50n 5. Submentobrogmatic, 860m 2 4 | ESSENTIAL PRACTICAL SKILLS GUIDE FOR HEALTH CARE PRACTITIONERS & STUDENTSPREGNANCY —<— eT TITLE: HEALTH EDUCATION OF CLIENT ON COMMON DISORDERS OF PREGNANCY AND ITS MANAGEMENT SIN_ [STEPS 1, ___ [Greets the client professionally and introduces self 2. Ensures that the client is comfortable. mx A: ses client’s level of knowledge on the topic. [4. Introduces the topic by mentioning the following: © Minor discomforts of pregnancy are feeling s of discomfort when every system of the body tries to adjust to the event of pregnancy 5. [Mentions the types of minor discomforts of pregnancy such as: © Nausea/vomiting «Frequency of micturition Backache and heartbums. 6. |Nausea/Vomiting |Causes: © Hormones of pregnancy © Smell of food ‘© Unsightly environment © Low blood sugar level Management: Advice on the following © To take carbohydrates (snacks) at bed time and before getting out of bed * Avoid fatty and spicy foods Eat small frequent meals throughout the day Drink fluids between meals rather than with milk. 7, _ [Frequency of Micturition Cause: © Pressure of the growing uterus on the bladder. Management: © Ask about signs of urinary tract infections e.g. pain or burning on urination ¢ Advice on the following: + Void when the urge is felt = Reduce caffeine intake since is a bladder irritant = Increase day time fluid intake and reduce evening fluid intake. FSSENTIAL PRACTICAI SHIILS GUIDE FOR HEALTH GARE PRA STONERS «STUDENTS || 25Backache (Causes: © Due to poor muscle tone common in multiparous mothers with bad| posture ‘© The pregnant uterus tends to grow forward instead of up causing strain on the muscles of the back leading to backache. |Management Advice the mother to wear shoes with low or moderate hecls © Maintain proper posture © Perform exercises to strengthen lower back muscles. © Massage the lower back muscles to relieve backache. . . wards| Sleep on a firm mattress Squat and not bend when picking items from the floor. Heartburns (Cause: # Increased pregnancy hormones leading to gastro intestine morbidity and relaxation of the cardiac sphincters of the stomach. Management: advice on the following: © Eat small frequent meals at interval © Sit upright after eating Avoid fatty and fried food Use antacids as ordéred by health provider. Summarizes points and asks questions to assess client’s level of lcomprehension 26 | Fessenrinr Pancreat SHILS Goine Fon HEALTH GARE PRACTITIONERS a STODEITSTITLE: BIRTH PREPAREDNESS A ND READINESS SomnrtexTIOe IS/N_|STEPS, introduces self professionally to the client Explains birth preparedness and complication readi ; d ation readiness as a process of planning for safe delivery and anticipating the actions needed in case of emergency “ee (Goal: Reduces maternal mortality and morbidity through effective planning for 5. lemergencies I¢ [Discusses with the client the elements ofa birth plan, which include: Skilled provider: Assist the women in making arangement for a ski i \ skilled provider to attend the} birth or make sure she reach es the skilled provi ci ee asian) led provider (health facility at the Is. _ [Place of Deliver Assists the woman in making arrangement for place of birth her individual needs pines of ih o epestink 2 «Recommend a specific level of health care facility. (6. | Transportation: Lets the woman know the available transportation system within her locality and make necessary arrangements for transportation to the place of birth Emergency transportation to an appropriate healthcare facility if danger signs arise 7. |Funds: Educate her on the importance of personal savings or other funds that she can access when needed to pay for care during normal birth and emergency «If necessary discuss emergency funds within the family, community and so on. Decision making: Asks for decision maker in the family or who else can in the absence of that person. 57 ]Support: Assists the woman in making arrangement for necessary support birth companion and who to stay with other kids if available. ‘woman to identify an appropriate donor and make sure 10. [Blood Donor: Assists the Ithe person is available in case of emergency. TI. [Items needed for clean safe birth: ne eded for birth e.g. perineal cloths/pads, Educates the woman on items soap, placenta receptacle, cord clamp, blankets, diapers (nappy, cloths etc) «Advises her that items should be kept for easy retrieval [Summarises talk and asks questions for. clarification 12. RTF ERT RAEN TOT. 7im! TITLE: HISTORY TAKING DURING ANTENATAL CARE “ ISIN STEPS PREPARATION [Welcomes the patient and explains the procedure to her Purpose: To assess the health of the woman and bring to Timelight any defect lwhich would adversely affect child bearing [Obtains informed consent PROCEDURE Bio-data: Name, age, Date of birth, Religion, Marital Status, Age at Marringq |, Occupation, Husband's Occu -xt of kin, Relationship to client, Nationality, State of origin, Local government Area, etc. Family history: Asks if family have a genetic predisposition to: Psychiatric disorders, Diabetes, essential hypertension, multiple pregnancies, sickle cell Janaemia, thalassemia, renal disease, etc. [Medical history: asks for the past and present history of any of the medical conditions affecting pregnancy e.g. urinary tract infection, essential hypertension, asthma, epilepsy, psychiatric disorder, diabetes, cardiac disease and allergies. [Surgical history: asks if client has under gone any surgery/blood transfusion| lor not. |Also, asks for any scarification mark, FGM, ete. Past gynaecological history: asks if client has had any of the conditions such| fas pelvic inflammatory disease, fibroid, candidiasis ete. [Menstrual history: asks for the: © age at menarche, Frequency, duration and amount of menstrual flow, © Premenstrual spotting or dysfunctional uterine bleeding e.g. menorrhagia, metrorrhagia and inter-menstrual bleeding 10. |SObstetric history. Past obstetric history Pregnancy: © Previous abortion and time of occurrence * Major disorders such as: hyperemesis, pyelonephritis and pre eclampsia Rhesus and ABO blood type Labour: © Premature or post-term Spontaneous or induced Date and where delivered. Spontaneous vaginal, assisted vaginal or caesarean delivery If rhesus negative, RhoGAM received? Puerperium: © Post- partum haemorrhage, sepsis, etc. She felt well during this period (1* six weeks after delivery) st 228 FessenviaPancTiCn ons CONDE Fon HEATH CANE PRRETTTONENS © TOTESa i #3272; rs Tprovous Babies Ti, [Previous Beal sized babies ‘Normal s Sex Bom alive and well (cried immediately) History of stil birth, preterm birth, neonatal death Number of living children Cases of severe jaundice «Congenital abnormalities. 12. [Presentol stetric history: ® Date of last menstrual period to establish the gstational age and EDD.| Minor disorders of pregnancy «Her health status, drugs taken and dietary habit 73. |Reassures and thanks the patient 14. [Records findings sauna CANE FuROTITONERS SvonenTs1 | 29 ESSENTIAL PRACTICAL SKILLS GUIDE FOR HITITLE: GENERAL EXAMINATION OF A PREGNANT WOMAN SIN | STEPS = TY PREPARATION OO TY 1_| Greets the client respectfully and introdus E 2__| Offers client seat in a conducive envi |_| 3 | Tells the woman what is going to be 4] Explains the purpose of the procedure to the client thu @ Toassess the level of health by taking a detailed history and to employ screening test as appropriate. who is pregnant. |_| . To identify and treat a high risk patis ible an uni © To ensure as much as pos for the mother and the delivery of alive h ‘Obtains verbal consent from the client Prepares the necessary equipment. Ensures client empties her bladder. PROCEDURE 8 |HEADAND NECK Examines the hair for neatness or lice, s]ayoy = Examines the eye for pallor, discharges and jaundice. > Bars and nostrils for discharges and abnormal growth. @ Gum and teeth for decay and missing teeth @ Checks for oedema of the pre-orbital region. © Palpates the neck for enlargement of the thyroid gland. 9 | AXILLAE: © Checks and palpates if well shaved —, not offensive, nil enlarged lymph node. 10 | CHEST: ‘¢ Assesses the symmetry of the chest wall and degree of expansion. Breasts: ‘¢ Inspects the nipples for normalcy for breast feeding. ¢ Palpates the breasts to determine regularity and for breast nodules. 11_| ABDOMEN: © Inspects abdomen for scars, linea Ingra, striae gravidarum, shape, size and fetal movement, 30] fesseimiatemnerient suits eomnEFOn MEAITH CANE PRACTITIONERS 6 STUDENTSfi | ABDUN® «Inspects abdomen for scars, linea Ingra, striae gravidarum, shape, size and fetal movement. {ee ~ Palpates the fundus to locate the fetal pol [+ Palpates the lateral side of the abdomen to locate the back | and limbs. | © Palpates the pelvis to know what lies lowest in the pelvic | region. e Auscultates the abdomen toward the umbilicus to get the fetal heart rate. 12 | EXTREMITIES: © Notes any deformity or restriction of movement of the legs and arms, also checks for equality of the limbs. Checks for varicosities of the lower extremities. ® Checks for oedema of the feet and internal malleolus. © Checks for deep tendon reflexes. 13, | VULVA: © Inspects the vulva for varicosities, abnormal vaginal discharge, warts, oedema, previous tears and episiotomies, state of perineum and laxity of the introitus. ‘Asks the client to cough to rule out prolapse. 14 | BACK: Examines the spinal column for scoliosis or kyphosis. ‘© Checks for sacral oedema. 15_| Supports the client off the couch gently. 16 | Documents findings 17_| Reassures and thanks patient for her co-operation. 18 | Tells client the date of the next appointment toe —_nsure regular attendance to the clinic. SST PREVENT EON ERO PETE TOT |S L ESSENTIAL PRACTICAL SKILLS GUIDE FOR HEALTH CARE PRACTITIONERS & STU!TITLE: ANTENATAL HISTORY, PHYSICAL EXAMINATION AND BASIC CARE [SIN_[STEPS 7 ee _J-T fT -1 PREPARATION | | | L1 n respectfully and introduces self 2 an I | 3 | Obtains informed consent - | L PROCEDURE 4 | Asks the woman how she is feeling and responds immediately to any urgent problem(s). 4} _] 5 | Calls the woman by her name and asks her age, number of previous pregnancies, number of children. - © | Asks the woman her menstrual history such as LMP, gestational age and calculates the EDD. - 7__| Asks woman whether she has felt fetal movements within the last day | 8 | Obtains prevailing health history in the family suchas history of hypertension, diabetes, etc 9 | Asks the wo man about social history such as daily habits, ifestyle and social support. 10 | obtains previous obstetric and gynaecological history such as number of pregnancies, number of children alive, history of infentlity, fibroid etc. 11 | Asks the woman her contraceptive history 12 | Asks the client about her past medical history which include past history | of hypertension, diabetes, sickle cell anaemia, allergy. ete. | 13 | Obtains the past surgical history, blood transfusion, road traffic accident. Records all pertinent information on the woman's record/antenatal card, [ BASIC CARE it 14 _ | Provides tetanus immunization based on client need, | 15 | Educates about necessary self-care topics e.g. personal hygiene, diet ete 16 | Provides counselling about the use of insecticide-treated bed nets. 17 | Dispenses medication of IPT for malaria according to protocol. 18 | Dispenses other necessary medications such as iron and fersolate. 19 | Develops or reviews individualized birth plan with the woman; her complication readiness plan, including danger signs, 20 _ | Records the relevant details of care on the woman’s record/antenatal card, I 21 | Asks the woman if she has any further questions or concems. 22 | Thanks the woman for coming and encourages her to come for her subsequent antenatal visits. 23 | Reports to the hospital immediately if there is any deviation from normal) 32 | FeSsenmint PaneriGnT SUI GomDEFON NEALTH CARE PRACTITIONERS © STUDENTSTITLE: PELVIC EXAMINATION ‘SIN [STEPS T | PREPARATION Prepares the necessary equipment. Tells the woman what you are going to do, encourage her to ask questions, and listens to what she has to say. 3_| Washes hands thoroughly with soap and water and dries with clean, dry cloth or allow to air dry. 4_| Puts new examination or high-level disinfected gloves on both hands. [Selects speculum and warms Blade. PROCEDURE SPECULUM EXAMINATION 6 | Gently inserts index finger of one hand just inside the vaginal opening and pushes down firmly on perineum towards rectum 7 | Holds closed speculum with other hand so that blades are vertical ard at a slightly oblique angle. [Advances speculum while gently rotating blades into horizontal position, with handle down: 9 _| Gently opens blades until cervix is in full view. 10 | Looks at vaginal walls. 11_[ Looks at cervix and cervical opening. 12 | Unlocks speculum blades. 13 | Places speculum in 0.5% chlorine solution fo 1 10 minutes to decontaminate. BIMANUAL EXAMINATION 14 | Tells the woman what you are going to do. 15 | Lubricates index and middle finger of examining hand with antiseptic lubricant, using sterile technique. 16 | Gently separates the labia with two fingers of the abdominal hand and inserts lubricated tips of indexand middles fingers of pelvic handslowly and gently into vagina. 17 | Palpates the cervix. 18 | Palpates the uterus. 19 | Locates the ovaries, 20 | Checks for tendemess or masses in cul-de-sac. POST-PROCEDURE TASKS 21 | Decontaminates gloves before removing them, then if disposing of them, places in a plastic bag or leak-proof, covered container. 22 | Washes hands thoroughly. 23 | Helps the woman off the examination table. 24 | Offers the woman a tissue or “napkin” to wip ¢ external genitalia and shows her where to dispose of tissue or “napkin”. 25 | Discusses findings of examination with the woman and answers any questions she has. 26 | Records findings. 27 | Wipes rubber sheet on examination table with 0.5% chlorine solution. ESSEUTAT PRRETICNT SUS GOK FON HEMT CAME PRMETITIONENSa sTUBENTST 33ITLE: PHYSICAL EXAMINATION OF A PREGNANT WOMAy FOR ANAEMIA SIN | STE PREPARATION Greets the client and introduces self, | ure to the client Eaplains the proe sent Provides priv PROCEDURE, 5 | Examines the face to check the conjunctiva, lips, gums, tongue and the physical appearance of the face for signs of anaemi Examines th the state of the jugular veins. mines the f ingers by checking the palm and nail beds for -y andl positions the el pdomen and checks whether the spleen and liver the lower limbs and checks the nail beds and sole of -cks for sign of anaemia, he client on the prevention of anaemia by stat ing the 10 | Educate followin; Taking of adequate diet especially the one that is rich in protein and iron. © Prevention of malaria by using insecticide andinsecticide treated net, Religious use of haematinics. Prevention of worm infestation by drinking treated water.TITLE: ABDOMINAL EXAMINATION AND MEAsU ABDOMINAL GIRTH of the following purposes: REMENT oF To observe the signs of pregnancy To assess foetal size and growth To detect any deviation from normal To estimate gestational age To determine the position and presentation Provides privacy Ensures client’s bladder is empty PROCEDURE Positions the patient ale)2 Takes history of last menstrual period (LMP) 10 Inspects the abdomen and reports findings as follows: © Size Shape Linea nigra Striae gravidarum «Previous scars . © Foetal movement Palpates the abdomen and reports on the following a) Fundal © Height of fundus « Estimation of gestational age * Measurement of abdominal girth with tape b) Lateral ° Lie * Position ©) Pelvic ¢ Presentation Engagement Auscultates the fetal heart Tidies up the client and the surrounding Records findings PRACTICAL SKILLS GUIDE FOR HEALTH CARETITLE: FUNDAL HEIGHT MEASUREMENT “SIN | STEPS PREPARATION |__| Explains the procedure to the woman/client [2 [Obtains verbal consent | [3___| Makes sure she empties her bladder | PROCEDURE, 7 Ensures the woman/client is comfortable in a semi-recumbent position. | _| 4 S| Washes hands or wears gloves (depending on the hospital policy) i 7 | Exposes the abdomen to allow a thorough examination | Palpates the abdomen with two hands to determine fundus : is Uses a tape to measure 9 Secures tape with hand at top of fundus 10 | The tape measure should be reversed to avoid the centimetre scale influencing the examiner T_| Measures to top of symphysis pubis Ensures that the measurement is taken along longitudinal axis of the uterus 13 | Records the findings of the measured fundal height 14 | Compares findings with the previous measurements and gestational age 15 _ | Ifmeasurement and gestational age do not align then asks another midwife to repeat measurement 16 _| Washes hands or removes gloves 17_| Covers the area exposed for the fundal height measurement || 18 _| Makes the woman comfortable CL] s 2 i 36) fessenrint pancricat suits GUIDE FOR NEALTH ANE PRACTINIONENG © STOUENISTITLE: EXAMINATION OF THE VULVA STEPS. PREPARATION States the purpose of the procedure. 2 [Explains the procedure to the patient. >| Gains informed consent | 4 Ensures all equipment are ready. PROCEDURE 5 _ | Positions the patient for clear view. 6 __| Washes hands, dries and puts on sterile gloves 7___| Examines the vulva. % | Reports on any six of the under listed abnormalities: Varicose v © Warts Abnormal discharge ‘* Bleeding © Previous scar Polyps 2 Ocdema Skin discolouration 9 Makes patient comfortable 10 | Removes gloves, washes and dries hands 11 __| Documents findings ESSENTIAL PRAGTIONT STILLS GUIDEON NERITH CANE PRACTITIONERS a STUDENTS 7TITLE: CLINICAL BREAST EXAMINATION SIN [STEPS PREPARATION: 1__ |Explains procedure to the patient [Obtains her consent [3 |Steps involved in CBE i. Observation Palpation Squeezing | [4 |States purposes as: © Done if a woman finds a lump or change in her breasts «Part of a woman's regular physical examination PROCEDURE: IS |Step1- Observations (done when a woman is sitting or lying down) ‘* The woman removes her clothing from the waist up © Wears a gown or covers her with a sheet ‘© Asks client to raise her two arms behind her head Checks for the following: Changes or differences inthe shape of the breasts ‘Areas of fullness or thickness in only one breast Differences in skin colour, temperature and texture in the breasts suc! as redness, increased warmth or dimpling of the skin = Rashes ~ Visible lumps or swelling + Nipple discharge = Nipple changes such as pointing inward (inverted) or scaling Tells her to bend down and lean forward + Notes any unusual findings Palpation (done while the woman is ling down which flattens the breast tissue over the chest wall) © The entire breast area is examined using the fingers. + Palpates the breast further away starting from the outer edge of the breast to the nipple using the flat part ofthe finger in a circular movement © Feels for the following; - Lumps, including their size, shape and whether or not they move within the tissue = Tendemess or pain + Hardening or thickening in the breast tissue = The axillary lymph nodes «Performs the same on the other breast 7 [Step 3: Squeezing © Gently squeezes the ni if there is di ° mus sql ipples to see if there is discharge - watery, bloody Ifa breast problem is found, the nex i 8 [Makes client comfortable “step depends on the findings 9 {Summarizes the procedure, asks questions and allows Tor Tesdback 1 ]Records and communicates findings 3.81 essen Fane SS Coe FER CARE RETTOTERS CURTTITLE: BREAST SELF EXAMINATION (BSE) PREPARATION the cli {and the topic, t where she will have a full view of the demonstration. tostop you and ask any question where she does not understand. jon should be carried out monthly (after menses) in front of a mirror. “Mentions methods: © Inspection | © Palpation | © Squeezing’ pressing “PROCEDURE | Demonstrates the procedure thus: 6 | Inspection: + Rai the model to a sitting position. ‘Mentions the client can either sit or stand. | [-} Relaxes both arms of the model at the sides. | [7 # Inspects the two breasts for any changes in size and shape, dimpling or puckering of skin, symmetry. scars, visible lumps, engorgement, redness direction of nipple, and ulceration. Raises both arms over the head and inspect for the same thing above and for| quality of the breast. x Palpation: Lowers the model on to the bed and places a pillow under the left shoulder. Puts the left hand under the head. ‘Holds the right hand flat with fingers together. Uses the right hand to palpate the left breast and vice versa Presses gently but firmly making circular movement from the sternum. towards the nipple. ‘® Mentions that the client will be feeling for lump or thickening of breast tissue. «Feels around the nipple and moves towards the lower inner part of the trast. ‘Mentions that the client will feel a ridge of firm tissue in this area which is normal. © Feels the upper and lower outer quadrants of the left breast in that order going from the outer part of the nipple. © Brings down the left arm to the side and feel under the armpit for lumps and nodes. If lump or node is present, asks client if she is aware of it. «Asks her if the lump is increasing in size and whether it hurts. 8 _ | Squeezing/pressing: : © Gently presses the nipple to see if there is any discharge that is watery, bloody, or pus-like ‘« Repeats the procedure on the other breast, 9 | Encourages the client to examine the breasts every month (23 days) after menstrual period and for amenorrhea, once ina month on a chosen day and to maintain that day for every check. 10_| Enquires to know if the client understands. 11_| Covers up the model for next use. FSSEnTIAL PRACTTONI SUILS COTDEFON EAL CARE PRNETIVIONENS « STUDENTS | 3940) fisseirint PractTcnt SHUILS GUIDEFOR HEALTH CARE PRACTITIONERS a STUDENTSHEALTH EDUCATION ON WORKING AND BREASTFEEDING REPARATION 1 fexplains procedure to the wor 2 JObtains perm PROCEDUR 5 |Letsher know that juggling work and breast feeding is not easy, but with determination and commitment to continuing to breast feed, she will find a way to do it. [7 —Tallays whatever anxiety or worries the woman may have, let her know that they are legitimate concems and are problems that can be solved FS TEncourages her to take a full advantage of matemity leave to establish a supply lof milk, She needs to breast fe ed early and often to encourage the breasts to produce lots of milk ie Tells the wot or electronic). “The pump will enable her to empty her breasts quickly and efficiently. Hand expressing milk usually takes 20-30 minutes. Also to get hands-free nursing bras. {o get an appropriate and effective breast pump (manual Tells the woman to become familiar with the process of breast pumping by simulating (practicing) the pumping schedule to be used at work for at least 2 weeks or at most 4 weeks before returning to work so that she and! the baby will get used to the change gradually, «Pumping is best done carly in the morning 8 @ Gets baby used to the cup and spoon. © Accouple of weeks before she retums to work, begins offering baby the cup and spoon or bottle as a toy and let him be familiar with it, Encourages her to get a nearby eréche or a baby care provider who is breast feeding friendly near her workplace or near her home or a child minder/nanny in her home 10 On resumption to work, she should be advised to breastfeed once in the morning, pump every 2 to 3 hours at work, and then breast feed as soon as possible on returning home, during the evening, and at bedtime. 1 [Encourages her to bo nd together with the other brea stfeeding moms she works with, [12 [Teaches the woman how to store breast milk: ‘© Pumped at work in a refrigerator or cooler or the use of ice pack. © Milk can be kept refrigerated for 72 hours. ‘* _Itcan also be frozen for 6 months when kept in the deep-freeze section o: the freezer with constant power supply Freeze milk in small amounts that thaw more quickly ‘Thaw the amount of milk needed for each day overnight in the refrigerat Milk should be warmed in a bow! of hot water after thawing. ‘Most babies prefer the milk warmed up, just like they get from mom's breast ¢ ¢__Any milk left after 24 hours will have to be discarded. 13 13 |Teaches the woman to keep the following in mind: ‘© Pumping the breasts at work can be easy, fast and painless Always wash the areola and nipples with clean water before pumping ‘© Remind the caregiver not to feed baby within an hour of your anticipated arrival so as to have a happy reunion with the baby + _Breastfeed the baby on demand on weekends ESSEnTn PNEIONT HOLS CODE TON MEAT CONE PAG TTVONENS a Tomes || 41