Maternal Health Program PDF

Finals Module 1 Maternal Health Program Pregnancy poses a risk to the life of every woman. Pregnant women may suffer complication or die. Every woman has to visit the nearest health facility for...

Finals Module 1 Maternal Health Program Pregnancy poses a risk to the life of every woman. Pregnant women may suffer complication or die. Every woman has to visit the nearest health facility for antenatal registration and to avail prenatal care service. This is the only way to guide her in pregnancy care to make her prepare for child birth. The standard pre-natal visits that a woman has to receive during pregnancy are as follows: Pre-natal visits Period of pregnancy before 1st visit early As early in pregnancy as possible before four must - as , months or during the first trimester 2nd And - Trimester During the 2nd trimester 3rd visit - 3rd Tri During the 3rd trimester till delivery Every 2 weeks - After 8 muth After 8th month of pregnancy till delivery Tetanus Toxoid Immunization Neonatal Tetanus is one of the public health concerns that we need to address among newborn. To protect them from deadly disease tetanus toxoid immunization important for pregnant women and child bearing age women. Both mother and child are protected against tetanus and neonatal tetanus Minimum Age Percent Vaccine Interval Protected Duration of Protection As early as possible TT1 , 1 - O , more during pregnancy 0% None Infants born to the mother will be protected from neonatal tetanus. Gives 3 years protection for the mother from the TT2 4 , 8 , 3 At least 4 weeks later 80% tetanus. Infants born to the mother will be protected from neonatal tetanus. At least 6 months Gives 5 years protection for the mother. TT3 6 , 90 S , later 90% TT4 7 , 99 , 10 At least 1 year later 99% Gives 10 years protection for the mother Gives lifetime protection for the mothers. All Infants born to TT5 1 , 99 , lifetime At least 1 year later 99% that mother will be protected. Schedule when to return for consultation for post-partum visits Recommended Schedule of Post-Partum Care Visits: 1 st visit - 1st week , 3-5 days 1st week post-partum preferably 3-5 days 2 nd visit - 6 weeks 6 weeks post-partum  Finals Module 1 THE PHILIPPINE FAMILY PLANNING PROGRAM (PFFP) FP is means to prevent high- risk pregnancies brought about by the following conditions. 1. Being too young or too old 2. Having had too many (4 or more) pregnancies 3. Having closely spaced pregnancies 4. Being too ill or unhealthy/ too sick or having an existing disease or disorder FOUR PILLARS OF PFFP The guiding principles of the FP program also called the four pillars of the (PFFP) are as follows. 1. Responsible parenthood 2. Respect for life 3. Birth spacing 4. Informed choice CLIENT COUNSELING AND ASSESSMENT Counseling must be based on client’s needs, the following are essential content of the nurse client interaction regarding the chosen method 1. Effectiveness 2. Advantages and disadvantages 3. Possible side effects, complications and signs that require an immediate visit to the health facility 4. How to use the chosen method 5. Prevention of STIs 6. When to return to the health facility THE FAMILY PLANNING PROGRAM The overall goal family planning is to provide universal access to family planning information and service wherever and whenever these are needed. Family Planning aims to contribute to: Reduce infant deaths Neonatal deaths Under-five death Maternal deaths NATURAL FAMILY PLANNING Involves no introduction of chemical or foreign material into the body. The effectiveness of these methods depending mainly on the couples’ ability to refrain from sexual relations on fertile days. 1. ABSTINENCE Refraining from sexual relations Advantage: most effective way to prevent STI’s, no cost Disadvantage: it has a failure rate of 85%, high motivation needed, highly unreliable 2. CALENDAR (RHYTHM) METHOD 18 days from shortest 11 days , for longest (6 muths) Requires a couple to abstain from coitus on the days of menstrual cycle when the woman is likely conceive (3 or 4 days before ovulation and 3 or 4 days after ovulation) To plan for this, the woman keeps a diary of 6 menstrual cycles. To calculate safe days, subtracts 18 from the shortest cycle documented. This number represents her first fertile day. Then subtracts 11 from the longest cycle. This represents her last fertile days. If she had 6 menstrual cycles ranging from 25 to 29 days, her fertile period would be from 7th day to the 18th day. To avoid pregnancy she would avoid coitus during those days. Advantage: no cost Disadvantage: failure rate of 9-25%, requires motivation and cooperation 3. BASAL BODY TEMPERATURE METHOD measuring temp - a morning after waking , up Just before the day of ovulation, a woman’s BBT or temperature of her body at rest falls about 0.5oF at the time of ovulation, her BBT rise a full degree because of the influence of progesterone. ↑ temp during ovulation (progesteron) g+ = >(k) Lt = ▪ Monitoring, follow-up 38.5oC ▪ Any general danger sign or PNEUMONIA ▪ Give an appropriate ▪ Chest indrawing or antibiotic for 5 days  ▪ Stridor in calm child ▪ Soothe the throat and relieve cough with a safe remedy ▪ Advise mother when to return immediately ▪ Follow up in 2 days ▪ Give Paracetamol for fever > 38.5oC ▪ If coughing more than more than 30 days, refer for assessment ▪ Soothe the throat and relieve the cough with a safe remedy ▪ Advise mother when to NO PNEUMONIA : COUGH OR return immediately COLD ▪ Follow up in 5 days if not ▪ Fast breathing improving ▪ No signs of pneumonia or very severe disease ▪ Assess and classify DIARRHEA A child with diarrhea is assessed for: ▪ How long the child has had diarrhoea ▪ Blood in the stool to determine if the child has dysentery ▪ Signs of dehydration. Classify DYSENTERY ▪ Child with diarrhea and blood in the stool ▪ If child has no other severe classification: ▪ Give fluid for severe dehydration ( Plan C ) OR ▪ If child has another severe Two of the following signs? classification : ▪ Refer URGENTLY ▪ Abnormally to hospital with sleepy or mother giving difficult to frequent sips of awaken ORS on the way ▪ Sunken eyes ▪ Advise the ▪ Not able to mother to drink or continue drinking poorly breastfeeding ▪ Skin pinch goes SEVERE ▪ If child is 2 years or older and back very DEHYDRATION there is cholera in your area, slowly give antibiotic for cholera Two of the following signs : ▪ Give fluid and food for some dehydration ( Plan B ) ▪ Restless, ▪ If child also has a severe irritable diff (candrina classification : ▪ Sunken eyes SOME ▪ Refer URGENTLY ▪ Drinks eagerly, DEHYDRATION to hospital with thirsty mother giving  ▪ Skin pinch goes frequent sips of back slowly ORS on the way ▪ Advise mother when to return immediately ▪ Follow up in 5 days if not improving ▪ Home Care ▪ Give fluid and food to treat ▪ Not enough diarrhea at home ( Plan A ) signs to classify ▪ Advise mother when to return as some or NO immediately severe DEHYDRATION ▪ Follow up in 5 days if not dehydration improving ▪ Treat dehydration before SEVERE referral unless the child has PERSISTENT another severe classification ▪ Dehydration DIARRHEA ▪ Give Vitamin a present ▪ Refer to hospital ▪ Advise the mother on feeding a child who has persistent PERSISTENT diarrhea ▪ No DIARRHEA ▪ Give Vitamin A dehydration ▪ Follow up in 5 days ▪ Treat for 5 days with an oral antibiotic recommended for Shigella in your area ▪ Blood in the DYSENTERY ▪ Follow up in 2 days stool ▪ Give also referral treatment Does the child have fever? **Decide: ▪ Malaria Risk ▪ No Malaria Risk ▪ Measles ▪ Dengue Malaria Risk ▪ Give first dose of quinine ( under medical supervision or if a hospital is not accessible within 4hrs ) ▪ Give first dose of an appropriate antibiotic ▪ Treat the child to prevent low blood sugar ▪ Give one dose of paracetamol in health center for high fever VERY SEVERE (38.5oC) or above ▪ Any general FEBRILE DISEASE ▪ Send a blood smear with the danger sign or / MALARIA patient ▪ Stiff neck ▪ Refer URGENTLY to hospital ▪ Blood smear ( MALARIA ▪ Treat the child with an oral +) antimalarial  If blood smear not done: ▪ Give one dose of paracetamol in health center for high fever ▪ NO runny (38.5oC) or above nose, and ▪ Advise mother when to return ▪ NO measles, immediately and ▪ Follow up in 2 days if fever ▪ NO other persists causes of ▪ If fever is present everyday for fever more than 7 days, refer for assessment ▪ Give one dose of paracetamol in health center for high fever (38.5oC) or above ▪ Blood smear ( ▪ Advise mother when to return – ), or immediately ▪ Runny nose, ▪ Follow up in 2 days if fever or FEVER : persists ▪ Measles, or MALARIA ▪ If fever is present everyday for Other causes UNLIKELY more than 7 days, refer for of fever assessment No Malaria Risk ▪ Give first dose of an appropriate antibiotic ▪ Treat the child to prevent low blood sugar VERY SEVERE ▪ Give one dose of paracetamol ▪ Any general FEBRILE in health center for high fever danger sign or DISEASE (38.5oC) or above ▪ Stiff neck ▪ Refer URGENTLY to hospital ▪ Give one dose of paracetamol in health center for high fever (38.5oC) or above ▪ Advise mother when to return immediately ▪ Follow up in 2 days if fever persists ▪ No signs of very FEVER : NO ▪ If fever is present everyday for severe febrile MALARIA more than 7 days, refer for disease assessment Measles ▪ Give Vitamin A ▪ Give first dose of an appropriate antibiotic ▪ If clouding of the cornea ▪ Clouding of or pus draining from the cornea or eye, apply tetracycline ▪ Deep or SEVERE COMPLICATED eye ointment extensive MEASLES ▪ Refer URGENTLY to mouth ulcers hospital ▪ Pus draining MEASLES WITH EYE ▪ Give Vitamin A from the eye OR MOUTH ▪ If pus draining from the or COMPLICATIONS eye, apply tetracycline ▪ Mouth ulcers eye ointment  ▪ If mouth ulcers, teach the mother to treat with gentian violet ▪ Measles now or within the MEASLES last 3 months ▪ Give Vitamin A Dengue Fever ▪ Bleeding from nose or gums or ▪ Bleeding in stools or vomitus or ▪ If skin petechiae or ▪ Black stools or Tourniquet test,are the vomitus or only positive signs give ▪ Skin petechiae or ORS ▪ Cold clammy ▪ If any other signs are extremities or positive, give fluids ▪ Capillary refill rapidly as in Plan C more than 3 ▪ Treat the child to seconds or prevent low blood ▪ Abdominal pain or SEVERE DENGUE sugar ▪ Vomiting HEMORRHAGIC ▪ DO NOT GIVE ASPIRIN ▪ Tourniquet test ( FEVER ▪ Refer all children +) Urgently to hospital ▪ DO NOT GIVE ASPIRIN ▪ Give one dose of paracetamol in health center for high fever (38.5oC) or above ▪ Follow up in 2 days if FEVER: DENGUE fever persists or child ▪ No signs of severe HEMORRHAGIC shows signs of bleeding dengue UNLIKELY ▪ Advise mother when to hemorrhagic fever return immediately Does the child have an ear problem? ▪ Give first dose of appropriate antibiotic ▪ Give paracetamol ▪ Tender swelling behind the MASTOIDITIS for pain ear ▪ Refer URGENTLY ▪ Give antibiotic for 5 days ▪ Pus seen draining from the ▪ Give paracetamol ear and discharge is for pain reported for less than 14 ACUTE EAR ▪ Dry the ear by days or INFECTION wicking ▪ Ear pain ▪ Follow up in 5 days ▪ Pus seen draining from the ear and discharge is CHRONIC EAR ▪ Dry the ear by reported for less than 14 INFECTION wicking days ▪ Follow up in 5 days  NO EAR ▪ No ear pain and no pus INFECTION ▪ No additional seen draining from the ear treatment Check for Malnutrition and Anemia Give an Appropriate Antibiotic: A. For Pneumonia, Acute ear infection or Very Severe disease COTRIMOXAZOLE AMOXYCILLIN BID FOR 5 DAYS BID FOR 5 DAYS Adult Tablet Syrup Age or Weight tablet Syrup 2 months up to 12 months ( 4 – < 9 kg ) 1/2 5 ml 1/2 5 ml 12 months up to 5 years ( 10 – 19kg ) 1 7.5 ml 1 10 ml B. For Dysentery AMOXYCILLIN COTRIMOXAZOLE BID FOR 5 DAYS BID FOR 5 DAYS SYRUP 250MG/5ML AGE OR WEIGHT TABLET SYRUP 2 – 4 months ( 4 – < 6kg ) ½ 1.25 ml ( ¼ tsp ) 5 ml 4 – 12 months ½ 2.5 ml ( ½ tsp ) ( 6 – < 10 kg ) 5 ml 1 – 5 years old 1 ( 1 tsp ) ( 10 – 19 kg ) 7.5 ml C. For Cholera TETRACYCLINE COTRIMOXAZOLE QID FOR 3 DAYS BID FOR 3 DAYS AGE OR WEIGHT Capsule 250mg Tablet Syrup 2 – 4 months ( 4 – < 6kg ) ¼ 1/2 5ml 4 – 12 months ( 6 – < 10 kg ) ½ 1/2 5 ml 1 – 5 years old ( 10 – 19 kg) 1 1 7.5ml Give an Oral Antimalarial Primaquin e Primaquin Give single e Sulfadoxine + CHOLOROQUINE dose in Pyrimethamin health Give daily e Give for 3 days center for for 14 days P. for P. Give single Falciparum Vivax dose TABLET TABLET TABLET AGE TABLET ( 150MG ) ( 15MG) ( 15MG) ( 15MG) DAY DAY DAY1 2 3 2months – 5months ½ ½ ½ ¼ 5 months – 12 months ½ ½ ½ 1/2 12months – 3 years old 1 1 ½ ½ ¼ ¾ 3 years old – 1½ 1½ 1 3/4 1/2 1  5 years old GIVE VITAMIN A AGE VITAMIN A CAPSULES 200,000 IU 6 months – 12 months 1/2 12 months – 5 years old 1 GIVE IRON Iron Syrup Iron/Folate Tablet FeSo4 150 mg/5ml FeSo4 200mg + 250mcg Folate (60mg (6mg elemental iron AGE or WEIGHT elemental iron) per ml ) 2months-4months (4 –