Ghana Health Service Nurse Case Study Report (Sample)

PREFACE

Patient and family care study is a report primarily about the care rendered to a pregnant woman through pregnancy, labour and puerperium. The care last for a period of time from the time of meeting the patient on the ward till discharge through home visit till care is terminated. This study helps in broadening the knowledge of the student midwife on the nursing process which serves to provide a systematic methodology of nursing practice. It helps the student midwife to unify, standardize and provide direct nursing practices.

The study also helps the student midwife to be abreast with the necessary care given to patient, emphasizing health promotion, maintenance and restoring patient health. The study again, is an academic exercise that forms part of the requirement for an award of certificate by the Nursing and Midwifery Council of Ghana as a Registered midwife. During the study, a midwife is required to give comprehensive details of a particular patient and family which include assessment of the patient and family to enable the student to set goals and objectives for proper implementation. Due to the comprehensive care plan, the student midwife becomes equipped with information on the patients’ condition. For confidentiality sake my client will be known and addressed by her initials as M.K

ACKNOWLEDGEMENT

This project would not have been possible without the help of the Almighty God, granted me strength, wisdom and knowledge. I wish to express my sincere gratitude first and foremost to God Almighty.

A special note of appreciation goes to Mrs. Cecilia Andoh Boame the principal of the school for her guidance and advice throughout the study period.

I appreciate the support of my supervisor Sister Portia Rockson for the support, guidance, and time spent to make this study successful and very grateful to the entire tutorial staff of the Nursing and Midwifery Training College, Esiama.

I am also grateful to my client Madam M.K and her family for their maximum cooperation, acceptance and time throughout the period.

My greatest pleasure goes to Mr. Benard Kodwo Yankey and my entire family for their financial support and encouragement.

Also, my greatest pleasure goes to my lovely and adorable husband Theophilus Cudjoe for his advice, guidance and time spent throughout my project.

Finally, I thank the various authors and publishers of all books used as source of reference.

 

Contents

PREFACE.. iii

ACKNOWLEDGEMENT.. iv

INTRODUCTION.. vii

LITERATURE REVIEW… viii

THE ROLE OF A MIDWIFE AT ANTENATAL CLINIC.. ix

LABOUR.. ix

ROLE OF THE MIDWIFE DURING LABOUR.. xi

PUERPERIUM… xi

ROLES OF A MIDWIFE DURING PUERPERIUM… xii

WHY I CHOSE MY CLIENT.. xiii

CHAPTER ONE.. xiv

ASSESSMENT OF CLIENT AND FAMILY.. xiv

SOCIAL HISTORY.. xiv

HABITS OF DAILY LIVING /HOBBIES. xiv

MEDICAL HISTORY.. xv

SURGICAL HISTORY.. xv

MENSTRUAL HISTORY.. xv

PAST OBSTERTRIC HISTORY.. xv

PRESENT OBSTERTRIC HISTORY.. xvi

FAMILY SOCIO -ECONOMIC HISTORY AND INHERITED CONDITIONS. xviii

PSYCOSOCIAL ENVIRONMENT.. xviii

PHYSICAL ENVIRONMENT.. xix

CHAPTER TWO.. xx

ANTENATAL CARE.. xx

FIRST CONTACT WITH MY CLIENT.. xx

PHYSICAL EXMINATION.. xxi

FIRST ANTENATAL HOME VISIT.. xxiii

CLIENT’S SUBSEQUENT VISIT TO THE CLINIC.. xxiv

SUBSEQUENT ANTENATAL HOME VISIT.. xxiv

NEXT ANTENATAL VISIT TO THE CLINIC.. xxv

NURSING CARE PLAN DURING   ANTENATAL PERIOD.. xxv

NURSING CARE PLAN DURING ANTENATAL PERIOD.. 27

CHAPTER THREE.. 32

INTRAPARTAL CARE.. 32

ADIMISSION AND MANAGEMENT OF FIRST STAGE OF LABOUR. 32

PHYSICAL EXAMINATION.. 33

PREPARATION OF BIRTH.. 36

MANAGEMENT OF FIRST STAGE OF LABOUR.. 36

MANAGEMENT OF SECOND STAGE OF LABOUR.. 38

IMMEDIATE CARE OF THE BABY.. 39

MANAGEMENT OF THIRD STAGE OF LABOUR.. 39

EXAMINATION OF THE PLACENTA.. 40

MANAGEMENT OF FOURTH STAGE OF LAB OUR.. 41

ESSENTIAL CARE OF THE BABY.. 42

SUMMARY OF LABOUR NOTES. 43

NURSING CARE PLAN DURING LABOUR.. 47

TABLE II: NURSING CARE PLAN DURING LABOUR.. 49

CHAPTER FOUR.. 54

MANAGEMENT OF PUERPERIUM… 54

DAY OF DELIVERY.. 54

MOTHER.. 54

SUBSEQUENT CARE OF THE BABY.. 55

BABY’S FIRST BATH AND CORD DRESSING.. 56

PREPARATION OF CLIENT FOR DISCHARGE.. 57

FIRST TO THIRD DAY PUERPERIUM… 58

FIRST TO THIRD DAY PUERPERIUM… 58

FIRST POSTNATAL VISIT TO THE CLINIC.. 61

FOURTH TO SEVENTH DAY PUERPERIUM… 62

SECOND POSTNATAL VISIT TO THE CLINIC.. 67

NURSING CARE PLAN DURING PUERPERIUM… 68

TABLE III: NURSING CARE PLAN DURING PUERPERIUM… 70

TERMINATION OF CARE.. 75

SUMMARY AND CONCLUSION.. 75

BIBLIOGRAPHY.. 76

APPENDICES. 76

 

INTRODUCTION

Client family centered maternity care study is a specialized form of care rendered for a pregnant woman through pregnancy, labour and puerperium and the family as a whole to create a safe memorable nurtured birth. This is an individualized care which emphasis on fostering family unity while maintaining physical safety.

This family centered maternity care study is about Madam M.K a 22-year-old woman, Gravida two para one (G2P1), who lives in Aiynase with her family.

Madam M.K was a regular antenatal attendant at Aiyinase Health Centre. I chose my client after reading through her antenatal records which she meets the criteria for my client for the care study. I told Madam M.K that I would like to care for her from that time of pregnancy till labour and puerperium. Madam M.K was made to understand that I was going to support her and the family physically, emotionally and spiritually and to help her identify problems and address them. Also discussed with her that after caring for her to the 7^th day postnatal, I will hand over to the Public health nurse and the midwife in charge to continue the care. The information on the care study was gathered from Madam M.K through various interviews from her antenatal card from the literature document on midwifery care.  The family centered maternity care consists of four chapters.

The first chapter talks about the assessment of the client profile or information about the client, habits of daily living, family history, medical and surgical history of the client and family, her menstrual history, past and present obstetrical history and home environment both psychosocial and physical environment.

The second chapter, also talks about her attendants and antenatal services rendered to her at the clinic, antenatal home visit problem identified and care plan.

The third chapter consists of the management of the first, second stages of labour with the help of WHO labour care guide, third stage of labour includes delivery of the placenta and its membranes and examination of the placenta, fourth stage of labour is the continuous observation of both mother and baby during the first six (6) hours after delivery of the placenta and its membranes.

The fourth chapter deals with the postnatal care of the mother and baby and management during puerperium, preparation of the client and family towards her discharge and home visit for the first seven days. There is also summary of the care study and conclusion. It also includes the appendixes (tables and charts, pharmacology of drugs, bibliography and signatories by our supervisor and principal of the college.)

LITERATURE REVIEW

The review talks about pregnancy, labour and puerperium.

Pregnancy is the process that begins with the fertilization of an egg and ends into a woman’s uterus.

According to Nuhu (2023). The period of pregnancy is usually described in trimesters. Each trimester last for three (3) months and are divided into three (3) aspects being first, second and third trimesters. Each comes with it own specific hormonal and physiological changes.

The first trimester is the day of conception to the end of the twelve weeks of gestation where there is formation of the initial organ development of the fetus and its body part.

The second trimester starts from thirteen weeks of gestation to twenty-seven weeks of pregnancy. The signs of pregnancy are amenorrhea, nausea, fatigue, constipation. Feeling the movement of the fetus (quickening) occurs by the 16^th to 20^th weeks of pregnancy.

The third trimester starts from twenty-eight to fourty or fourty-two weeks of pregnancy where there is maturation of the fetus. The woman may experience some physical symptoms during this period like sleeping problems, urinary incontinence due to the increase in the size of the uterus mostly.

Antenatal care is the care, supervision and attention given to pregnant woman till she delivers. Antenatal care begins from the time the woman thinks she is pregnant. Some of the benefits of antenatal care are to give health education on important topics such as nutrition ,danger signs of pregnancy and important of exclusive breastfeeding, and also help build a trusting relationship between their family and their care givers ,identify the baseline recording of the woman physical health, certain complications can be prevented at the antenatal clinic and the woman will be made to understand the physiological changes of pregnancy and thus cope with minor disorders in pregnancy.

In view of this, pregnant woman should be educated on the need to attend focus antenatal clinic early and regularly to detect any deviation from normal for proper management to help go through pregnancy safely.

Focus antenatal care is a special type of antenatal service which emphaszes on individual care, client centered and fewer but comprehensive visit, disease detection and not risk classification and cared for by a skilled personnel.  The care gives the client an opportunity to be cared for by same skilled midwife throughout pregnancy. With this, the care provider ensures confidentiality and gives continuity of care to the client and also birth preparedness and complication readiness are assured.  Focus antenatal care is scheduled as follows;

WHO FANC model	2016 WHO ANC model
First trimester Visit 1:8-12 weeks Second trimester Visit 2: 24-26 weeks Third trimester Visit 3:32 weeks Visit 4:36-38 weeks Return at 41 weeks for delivery if birth has not occurred.	First trimester Contact1:up to 12 weeks Second trimester Contact 2:20 weeks Contact 3:2 weeks Third trimester Contact 4:30 weeks Contact 5:34 weeks Contact 6:36 weeks Contact 7:38 weeks Contact 8:40 weeks

THE ROLE OF A MIDWIFE AT ANTENATAL CLINIC

1. Takes complete history such as medical history example history of hypertension and sickle cell disease, obstetric history such as the number of children she has and sex of the children, surgical history example whether she has had any previous surgery.
2. Performs physical examination from head to toe to rule out any abnormalities such as old surgical scars, skin rashes.
3. Gives immunization e.g. Tetanus diphtheria
4. Performs nutritional assessment and counselling on 4 star diet, more intake of fluid.

LABOUR

Labour is defined as the presence of regular uterine contractions with progressive cervical dilation and effacement which result in the process of spontaneous expulsion of the fetus, placenta and its membranes through the birth canal at the end of the 40weeks.World Health Organization (WHO, 2023) defines labour as a spontaneous in onset, low-risk at the start of labour and remaining so throughout labor and delivery. The infant is born spontaneously in the vertex position, cumulating in the mother and infant in good condition.

According to Radhakrishnan. (2021), labour comprises four stages namely the first, second, third and fourth stages.

During the first stage of labor, contractions help the cervix to thin and begin to open. This is called effacement and dilation. As the cervix dilates, the health care provider will measure the opening in centimeters. One centimeter is a little less than half an inch. During this stage, the cervix will widen to about 10 centimeters. It’s the longest and most tiresome aspect of labor which has three division,

The latent phase last 6-8 hours in the primigravida. The cervix dilates to about 3cm. As the cervix begins to open, a sticky, jelly-like pink or slight blood stain mucus discharge called the ‘show’ is seen from the vagina.

The active phase usually begins at 4 cm of cervical dilation and is characterized by rapid cervical dilation and descent of the presenting fetal part. It’s complete when the cervix is fully dilated at (10cm).

The transitional phase is the final phase of the first stage of labour, following early and active labor. At this point, a woman progresses from 8 to 10 centimeters, which is the diameter needed for the baby to pass through the cervix. The word transition means that the body is making the shift from opening of the cervix to the beginning of the descent of the fetal head. Often during this phase, the client starts to feel the pressure of the baby’s head coming down, sometimes accompanied by an urge to push. (Radhakrishnan, 2021)

During the first and second stage of labour, the WHO labour care guide (2020) is a tool to guide the midwife to monitor the mother and the fetus till delivery when she reaches 5cm by plotting it on the labour care guide and helps the health care provider in identifying slow progress in labour, and may help initiate appropriate intervention to prevent prolonged and obstructed labour. It is divided into seven sections.

Section 1: it helps the midwife in identifying and recording the document on the client’s such as name, onset of labour, time of admission, parity, mode of labour, date of active labour, diagnosis, date and time of rupture of membranes and risk factors.

Section 2: it helps the midwife to practice respectful maternity care throughout the provision and monitoring of supportive care which includes labour companionship, access to pharmacology and non-pharmacology pain relief, ensuring that women are offered oral fluid and techniques to improve women’s comfort such as water, giving sacral massage and others.

Section 3: it consist of the well-being of the baby which is monitored by regular observation of baseline, measurement such as fetal heart and deceleration in fetal heart rate and of amniontic fluid, fetal position, moulding of the fetal head and development of caput succedaneum.

Section 4: the midwife monitors the woman’s health and well-being on the labour care guide by regular checking of the pulse, blood pressure, temperature and urine.

Section 5: it helps the midwife to record the labour progress on the labour care guide by regular observation of the frequency and duration of contractions, cervical dilatation and descent of the fetal head.

Section 6: it aids the midwife to record the type of medication and duration of labour by describing whether the woman is receiving its dose and other medication or intravenous fluids are being administered.

Section 7: It guides the midwife to observe continuous communication with the woman and her companion and to record all assessment and plans agreed.

Second stage of labor begins with complete cervical dilatation and ends with the delivery of the fetus. At this stage the woman feels the urge to expel the fetus.

Third stage of labour is the period between the delivery of the fetus and the delivery of the placenta and fetal membranes. Often this stage involves prophylactic administration of oxytocin to help in contraction of the uterus. Also, cord clamping/cutting, and controlled cord traction of the umbilical cord is done at this stage to deliver the placenta.

Fourth stage of labour is the first six hours following delivery of the placenta where critical observation is done on both the mother and of the baby. Care given at this stage includes initiation of breastfeeding, checking of vital signs and production of warmth and monitoring and detection of complications.

ROLE OF THE MIDWIFE DURING LABOUR

1. The midwife conducts a safe delivery by adhering skillfully to the mechanism of labour.
2. Offers vaginal examination to know the descent and presentation of the fetus.
3. She records any findings of the well-being of the mother and fetus such as fetal heart rate and maternal blood pressure.
4. Conduct laboratory investigations such as haemoglobin, full blood count of the mother and so on.
5. Monitors progress of labour by timing contractions using labour care guide.

PUERPERIUM

“This is the period of adjustment after childbirth during which the mother’s reproductive system returns to its normal pregnant state. It generally last 6 to 8 weeks and ends with the first ovulation and return of normal menstruation.” (Rockson, 2022)

There are important physiological events that occur during the puerperium which includes, the return of the reproductive organs and the levels of the female hormones to approximately their pre-pregnant state. Immediately after the baby is born, the uterus can be palpated at or near the woman’s umbilicus (belly button), as it contracts to expel the placenta and fetal membranes. The uterus normally shrinks to its non-pregnant size during the first six weeks after delivery, but most of the reduction in size and weight occurs in the first two weeks.  Around this time, the uterus involute enough to be located in the woman’s pelvis, below her umbilicus.

The inner lining of the uterus (the endometrium) rapidly heals after delivery, so that by the seventh day, it is restored throughout the uterus, except at the placental site which heals by the sixth to eight weeks after delivery.

The inside of the uterus, where the placenta was attached, undergoes a series of changes which reduce the number of blood capillaries entering that site. The capillaries that remain ‘leak’ blood plasma for a time, which results in a normal vaginal discharge called lochia.

From the 1^st day to 4^th day, the lochia is called lochia Rubra is red in color, initially fresh then staler blood consisting of blood from the placental site mixed with shred of decidua. From the 5^th to 9^th day, the Lochia is called lochia Serosa and is pinkish in colour which is mainly made up of exudates from laceration as well as leukocytes and bacteria. From the 10^th to 14^th day, it becomes creamy or whitish and consists of leukocytes, white blood cells and mucus called lochia Alba

In general, lochia has an odor similar to that of normal menstrual fluid. Any offensive odor or change to a greenish color indicates infection by organisms such as Chlamydia.

 

ROLES OF A MIDWIFE DURING PUERPERIUM

1. Examiness of the pueperal mother and baby from head to toe to rule out abnormalities example edema of the feet from the mother and any spinal bifida from the baby.
2. Checks for initiation of lactation, teaches proper position and attachment of the baby during breastfeeding.
3. Checks the lochia for amount, colour, odour, consistency to assess for involution.
4. Teaches mother how to care for the umbilical cord with chlohexidine gel 7.1%.
5. Educates mother on the importance of post natal exercise example Kegel’s exercise.

WHY I CHOSE MY CLIENT

During the regular antenatal visit, which was 18/08/2023, I met Madam M.K. she was 36 weeks 6 days gestation which was her 6^th visit and also had a good obstetrical history which fall under the requirement needed for choosing a client. I chose her as my client because during the health education section, she was very interactive.

I introduced myself as student from Nursing and Midwifery Training College, and explained to her my intention to take her as my client. I showed her antenatal card to the midwife in-charge and she confirmed that I can use her as my client because she is a regular attendant and falls under the criteria for family centered care study. She was very happy and gave her consent.

I promised her a home visit and she agreed. We exchanged telephone numbers so that I could call her for direction to her house.

CAPTER ONE

ASSESSMENT OF CLIENT AND FAMILY

This chapter provides detailed information about client, her family and the community she lives. Assessment is the process of gathering information about a client and the family in order to indicate the actual and potential health problems and appropriate interventions to put in place during pregnancy, labour and puerperium. Some assessments that were carried out on my client includes social history, family history, medical and surgical history, habit of daily living and hobbies, menstrual history, past and present obstetric history and socioeconomic history through personal interview information from maternal and child health record book, laboratory investigation, ultrasound scan, family members and observation.

 

SOCIAL HISTORY

Madam M.K Gravida 2 Para 1, alive was born on the 1^st August, 2001 in the Western Region by Mr. and Mrs. K all alive. She is dark in complexion. She resides at Aiynase near Christ Apostolic Church in Ellembelle district in the Western Region. She is an Nzema by tribe, speaks Fante. Madam M.K is dark in complexion. Madam M.K is a Senior High School leaver. Her husband Mr. J.B is her next of kin and they are blessed with a child, who is a boy. Madam M.K is a trader (sells soap). She is a Christian who attends Church of Christ.  She does not smoke or drink. Madam M.K is married to Mr. J.B who is a carpenter. They have been married for 2years. Madam M.K had ANC Registration number 93/23 and with serial number 246/23.

 HABITS OF DAILY LIVING /HOBBIES

Madam M.K wakes up at 5:00am brushes her teeth. She then helps her co-tenant to sweep the compound and prepares her child for school. After the child had left for school, she takes her bath and her breakfast around 9:00am. This is mostly Hausa Koko, corn porridge or a cup of tea with bread. She then leaves for work after breakfast.

She takes lunch around 1:00pm, mostly fomfom, waakye or rice with vegetable stew. At about 5:30pm she returns home and prepares supper for the family which is mostly banku and grounded pepper with fried fish or jollof rice and gravy with fried chicken. They eat supper around 6:30pm. She retires to bed around 9:30pm after children had gone to bed. She often empties her bowel at last once a day and anytime she has the urge to do so and also urinate often. Client added that she neither drinks nor smokes. From my observation, she relates well with other family members and neighbors. She takes part in social gathering and also participates well in the community during communal labour. She enjoys watching movies and listening to music.

 

 MEDICAL HISTORY

According to Madam M.K, she has not suffered from any medical condition such as hypertension, diabetes, urinary tract infection, heart disease and anemia that required admission at the hospital or blood transfusion. Only few ailments such as headache, body pain and fever which she uses over-the-counter drugs example paracetamol. She is sickling negative. She also tested negative to human Immune Virus (HIV), Hepatitis B and other sexually transmitted infections. There was no defect when she tested for glucose-6-phosphate dehydrogenase (G6PD). Currently, she is not taking any medication including herbal preparations apart from the routine drugs given to her at the ANC. She does not have any psychiatric condition such as epilepsy. Madam M.K is not allergic to any drug or food.

 

 SURGICAL HISTORY

Madam M.K said she has never undergone any operation involving her reproductive organs or any other organ, neither has she been involved in any serious accident. She has not had any injury that affected her pelvis, legs or spine. She has not undergone any caesarean section neither has she been transfused in her life.

 MENSTRUAL HISTORY

Madam M.K said she had her menarche at the age of thirteen but she does not know the actual date. Her menstrual flows have been regular with a twenty-eight days cycle with an average flow lasting five days and has no dysmenorrhea and her LMP is 1^st December, 2022 and EDD is 8^th September, 2023. She normally has a heavy flow on the first and second day which amidst lower abdominal pain. She does not take any medication but the pain subsides on its own after the second day and there is moderate flow on the rest of the days. She said sanitary pad is what she uses during her menses.

 PAST OBSTERTRIC HISTORY

Madam M.K gravida two para one alive said she attended antenatal clinic during her previous pregnancy. She started her antenatal clinic around 16weeks in the pregnancy. She did not have any medical condition like hypertension or anemia and gestational diabetes in her previous pregnancies. She took two doses of tetanus toxoid injection in her first pregnancy. According to her she had three doses of sulphadoxine pyrimethamine (SP) in her previous pregnancy under direct observation by the midwife. She took her hematinic, vitamin C and folic acid tablets as prescribed. She had no history of abortion with her pregnancy reaching term with no complication.  Madam M.K went through a normal spontaneous vagina delivery without any assisted delivery like episiotomy. Her baby cried after delivery and placenta and membranes were delivered immediately with moderate bleeding of blood 70 mls and monitored for six hours. In her delivery labour lasted for 12 hours and delivered an alive baby boy infant on 21^st November 2019 and with examination, baby was healthy and well. She had no complication like PostPartum Hemorrhage or retained placenta, and was discharged on the second day.

During puerperium client went through it normally without any complication such as engorged breast, PostPartum Hemorrhage, PostPartum depression. The baby weighed 2.7kg for the first postnatal visit. She attended the entire postnatal clinic and all the immunization such as pentavalent vaccine, yellow fever, polio vaccine, Bacillus Calmette Guerin (BCG) was given. She breastfed him for one and half years. Madam M.K first child weaning food included corn dough porridge and mashed kenkey with milk.

Her baby did not suffer any ill health such as minor diarrhea, vomiting or malaria. Her husband and mother with other siblings were the support persons during pregnancy, labour and puerperium. She engaged in the natural method of family planning such as lactational amenorrhoea method.

 PRESENT OBSTERTRIC HISTORY

Madam M.K, Gravida (2) Para (1) alive is a regular attendant to antenatal clinic at Aiyinase Health Centre before I met her. She had already visited the clinic five times. She first reported to the antenatal clinic on 7^th February, 2023 and was first seen by the midwife in charge. Her maturity or gestational age at booking was not detected and her second visit her gestational age was 16 weeks and her expected date of delivery was 8^th September, 2023 as obstetric pelvic scan revealed and fundal height was 18cm.

On arrival at the antenatal clinic, she was healthy and had not received any care from another caregiver such as a Traditional Birth Attendant (TBA).

The following laboratory investigations and vital signs were done to serve as baseline dated with which to compare subsequent ones.

• Height   –   157cm
• Weight –   52kg
• Temperature –   36.5°C
• Blood Pressure   –   99/66mmHg
• Pulse   –   83bpm
• Respiration – 20cpm
• Blood Group –   AB⁺
• Rhesus Factor –   Positive
• Haemoglobin –   10.9g/dl
• Sickling   –    Negative
• Glucose in urine-    Negative
• Protein in urine   –    Negative
• BF   –   No MP’S seen
• HIV Status –   Negative
• Venereal Disease Research Laboratory for Syphilis   –    Negative
• G6PD   –    No Defect
• Hepatitis B    –    Negative

She received her third tetanus toxoid injection on the 7^th   February, 2023. She continued the rest of her doses on monthly basis. She said she felt quickening on her 16th week of gestation. Health education was given on nutrition, she was also encouraged to have enough rest and sleep. Her routine drugs which included Tablet Folic acid 5mg 1 daily x 30 days, Tablet Ferrous sulphate 200mg 1 daily x 30 days, and Tablet Multivite 200mg 1 daily x 30 days. She received her 1^st dose of sulphadoxine pyrimethamine (SP) under direct observation on 17/04/2023, second dose on 21/07/2023, third dose on 18/08/2023.

A general examination was done on her first booking at antenatal clinic. Her general appearance was neat and good looking, there was no swelling on the face, no discharge from the eyes, there was no distended swelling of the neck and no lumps was palpated on the breasts. Her perineum was intact, no foul smell from her vagina. No swelling of the feet or pains detected. These all were recorded in her antenatal book and the clinic register. She said with her current pregnancy, she sometimes experience minor disorders such as vomiting, headache and dizziness. She does not crave for any food but eats whatever that is available at any time. All care given to my client from the first day of visit till I met her was recorded in her antenatal book. She was then encouraged to report to the hospital if she encountered any problem before the scheduled dates. According to her antenatal 5card, she attended clinic regularly and all examination and investigations done on her revealed no abnormalities till I met her.

On the third 23/05/2023, she was 21weeks plus 1 day of gestation, FHR 132bpm, presentation was cephalic and descent 5/5^th. Her vital signs were checked, physical examination was done from head to toe with no abnormalities. She complaints of headache, chills and fever. Rapid diagnostic test done was negative. Client was educated to drink more water, paractamol and her routine drugs was given. She was counselled on rest and sleep, pregnancy induced hypertension, diet and nutrition/anaemia /Iron Folic Acid (IFA) supplement.

On the fourth visit, 20/06/2023, she was 28weeks plus 5days of gestation, FHR 140bpm, presentation cephalic and descent 5/5^th. Her vital signs were checked, physical examination done from head to toe which was recorded with no abnormalities. Her routine drugs were given to her which was all recorded in her antenatal book. Repeat heamogolobin was checked and recorded as 10.2g/dl.

On the fifth visit, 21/07/2023, she was 32weeks plus 2days of gestation, presentation was cephalic and descent was 5/5^th. Her vital signs were checked, physical examination was done from head to toe with no abnormalities. Her routine drugs such as tablet folic acid, multivitamins were given to her. Her second dose of sulphadoxide pyrimethamine was given to her.  She was counselled on signs of labour and progress of delivery. She continues the clinic visit till I met her.

FAMILY SOCIO -ECONOMIC HISTORY AND INHERITED CONDITIONS

Madam M.K is the third born out of four siblings of her parents Mr. and Mrs. K. Madam M.K father is farmer who supports the family financially. The first sibling is a hairdresser, the second sibling is a maison and last sibling is a student at Bonzu Kaku SHS. The interaction with Madam M.K, reveals that there is no unknown hereditary disease such as hypertension or diabetes in the family. She has no history of psychiatric condition like epilepsy, mania or schizophrenia and depression in the family. Client has no history of congenital abnormalities such as spinal bifida, cleft palate, hydrocephalous, club foot in the family with no history of multiple pregnancies from neither paternal nor maternal side

PSYCOSOCIAL ENVIRONMENT

I visited the house of Madam M.K. The purpose of this visit was to assess the condition of the home, environment, and how she interact with her family and neighbours and educated her on any problem that I may identify. I got there at 10am and met Madam M.K together with her husband and son. I was warmly welcomed and she introduced me to her husband and son. The family members were all happy to see me whenever I visited and they engaged themselves in conversation between client and I. The family always misses her whenever she travels because she is a very good cook. Her parents and family were given the maximum moral, physical and financial support.

PHYSICAL ENVIRONMENT

Madam M.K lived with the husband and son in a one room self-contain. Arrangement of furniture and other items were also good. The source of light is electricity. Their source of drinking water is pipe and she stores most of their water in rubber containers with a well- fitting lid. The kitchen was neat and things were well arranged. A well- fitting container was there where they dispose their waste and finally dispose-off in a big container in their locality. The bathroom was inside. The house was neatly kept and well organized. I told them my findings and congratulated them for keeping the house neat.