STUDENT NAMES: JOY WANJIRU

DISGNATION: D/NURS//2022

TITLE: MIDWIFERY CASE STUDY

COURSE: KENYA REGISTERED COMMUNITY HEALTH NURSING

SCHOOL: CONSOLATA SCHOOL OF NURSING NKUBU

CLASS: MARCH 2022

SUPERVISOR: MADAM KABURU

 OBJECTIVES OF THE CASE STUDY
1. Identify high risk cases and appropriate management
2. Maintenance of health of the mother during antepartum, intrapartum and
postpartum period
3. Decrease maternal and fetal mortality and morbidity
4. Develop birth preparedness to the mother and family
5. Prevention of any development of complications
6. Reassurance of the mother during the intrapartum care

BIOGRAPHICAL DATA OF THE CLIENT

NAME: CAROLINE NCABIRA
AGE: 33YEARS
STATUS: MARRIED
RELIGION: CHRISTIAN
CONTACT: 0718678855
ADRRESS: KARIENE
LAST MENSTRUAL PERIOD: 23/9/22
EXPECTED DATE OF DELIVERY: 30/6/23
Where I used the formula +7/-3/+1 ,adding 23+7 to get 30th, subtracting 9-3
=6[June], 2022+1=2023, thus getting the EDD on 30/6 2023.
GESTATION WEEKS: 28WEEKS + 2 DAYS.

MONTH WEEKS DAYS

SEPTEMBER 1 0
OCTOBER 4 3

NOVEMBER 4 2

DECEMBER 4 3

JANUARY 4 3

FEBRUARY 4 0

MARCH 4 3

APRIL 1 2
 DEMOGRAPHY
We met at the antenatal clinic, created a rapport and she agreed to be my case study client

ANTENATAL HISTORY TAKING

PERSONAL HISTORY
NAME: Caroline
AGE: 33Years
RESIDENCE: Kariene
MARITUAL STATUS: Married
PARITY: 1+0
GRAVIDA: 2
HEIGHT: 166cm
WEIGHT: 84kg
LMP: 23/9/2022
EDD: 30/6/2023

ANTENATAL PROFILE

Hemoglobin: 10.2g/dl

Blood group: B

Rhesus factor: positive

TB screening: No sign

Urinalysis: No abnormalities detected

Blood pressure: 118/68mmHg

 Pulse: 77b/m

Weight: 84kg

Height: 166cm

MEDICAL HISTORY
She has no history of tuberculosis, diabetes, hypertension and mental illness
HIV status is non-reactive and has no syphilis
Has no history of blood transfusion
Has no history of drug allergy or food allergy

SURGICAL HISTORY
Has had a cesarean section on 2017, delivering a term baby boy with 3.1kgs and had a normal peuperium period.
SOCIAL AND ECONOMIC HISTORY
She is a business lady. She is well equipped and is ready to maintain her pregnancy as required.

GYNEOCOLOGICAL HISTORY
She had her last menstrual period was on 23/9/2022.
Has no history of menorrhagia or dysmenorrhea

OBSETRIC HISTORY
A Para 1+0 Gravid 2, she had a cesarean section
RATIONALE; to identify risk factors and act accordingly
 PHYSICAL EXAMINATION
HEAD
On inspection, hair is well distributed, clean, black and with fine texture. Scalp had no scars,
no fungal infestation, and no rash.

EYES
On inspection, eyes are equally in shape, has no scars around the eyes, has no discharge from the lachrymal apparatus,
she can see short distant and not so well for long distance currently wearing medicated spectacles , conjunctiva has not
pale and no jaundice.

EARS
They are clean, no discharge, can hear clearly, has no history of hearing problem and has no pain while palpating

NOSE
On inspection; the nostrils are well separated by the septum, no discharge, no swelling, no scars, no polyps, no history of
nose bleeding and she has a good sense of smell.

MOUTH
The tongue red thus not pale, has no bad breath, teeth well arranged and all present, no bleeding gums and no dental cavities.
She has no inflammation of the tonsils, no dentures, no halitosis and the mucous membranes are moist and pink in color.

NECK
On inspection; has no inflammation, no scars
On palpation; has no swollen lymph nodes, no swollen tonsils, and no thyroid gland enlargement, has a palpable jugular
vein and has a regular rhythm.

BREAST
On inspection; no scars, are of the same alignment, same size and no obvious masses.
Nipples have no discharge noted.
On palpation; there’s no mass, no lumps and no scars, no swollen axillary nodes, no inflammation of
supraclavicular and infraclavicular lymph nodes.
UPPER LIMBS
Forearms are of the same length, has 10 fingers with no finger clubbing. She has no pallor on her palms and nails and has no
edema. Nails are short and clean.

ABDOMEN
The abdomen is gravid.
On inspection; there is linea nigra, strae gravidarum, presence of a scar and it is ovular in shape on palpation; the fundal
height was 27/40 and with cephalic presentation. On auscultation; the fetal heart rate were 142 beats per minutes

LOWER LIMBS
The legs were on symmetry.
On inspection; she had no edema
Has no deep venous thrombosis, no varicose veins and posterior tibia pulses were present

INVESTIGATIONS.
 Hemoglobin levels – used to evaluate physical status and anemia.
 Blood grouping – to know if the blood of the two partners are compatible
 Rhesus factors – may play a role in the conceiving of another pregnancy and prevents one from getting miscarriages
this is if there’s negative rhesus which is not compatible with the fetus and the mother.
 HIV/AIDS test and syphilis –it helps in reducing the maternal and fetal transfer of HIV and also treat a high risk
sexually transmitted infection causing miscarriages and is rarely detected especially in women.
 Ultrasound –helps in knowing the expected dates of delivery, position of the placenta, the presentation and position of
the foetus, any abnormalities and fetal movements and heart rate.

NORMAL PREGNANCY
Are those without medical obstetrical or surgical complications and their gestation range from 20 weeks to term
gestation.

Signs of pregnancy:
1. Presumptive signs
2. Probable signs
3. Positive signs

Presumptive signs and symptoms

• Abrupt cessation of menses
• Breast changes- They enlarge, become tender, visible veins in the breast, nipples become more pigmented, colostrum,
a thin, milky fluid.
• Skin pigmentation changes.
• Linea nigra- A dark vertical line on the abdomen from the sternum to the syphilis pubis.
• Striae gravidarum- Reddish linear marks appearing either on the breasts, abdomen buttocks and thighs.
• Frequency of urination. - Caused by pressure of the expanding uterus on the bladder.
• Fatigue characterized by increase in hormonal levels.
• Nausea and vomiting –morning sickness

Probable signs and symptoms

• There is increase in vaginal discharge
• Changes in the cervix –Chadwick's sign [bluish or purplish discoloration of the cervix and the vaginal wall
• Changes in size, shape and consistency of the uterus. It appears ovular in shape.
• Enlargement of the abdomen at about 12 week’s gestation.
• Hegar’s sign –the uterus softens 6-8weeks after the onset of the last menstrual period
• Goodell's sign –softening of the cervix as early as 4weeks.
• Quickening sensation of the fetal movements

Positive signs and symptoms

• Fetal heart sounds –heard from about 16th and 20th weeks of gestation.
• Fetal movements –felt by mother and may also be felt by the examiner after about 20weeks of gestation.
• Ultrasound –the scan is able to give an image of the foetus, its cardiac activity and can be performed from the 1st
trimester.
• Pregnancy test –Human Chorionic Gonadotropin hormone is secreted by the mother is she is pregnant appearing in
urine.

TREATMENT GIVEN
FERROUS SULPHATE
INDICATION; Prevention of iron deficiency [anemia]
DOSAGE; One tablet, three times a day for 30days.
FOLIC ACID.
INDICATION; Prevention of anemia
; Promote normal fetal development.
DOSAGE; One tablet, once in a day for 30days.

IMMUNISATION
Third tetanus toxoid 0.5mg administered intramuscularly on the deltoid muscle of the left hand
RATIONALE; prevent the foetus and mother from tetanus.
 FOLLOWUP CARE FOR THE FIRST VISIT
OBJECTIVES OF FIRST HOME VISIT
 Provide pregnancy education on individual birth plan
 Survey the environment and the living condition of the mother
 To identify if there is any arising complication of the mother

EXPECTATIONS
 To have good individual birth plan
 To ensure there is variable environment and good living condition
 To ensure there is no complication during pregnancy period

FIRST HOME VISIT LESSON PLAN

HEALTH EDUCATION GIVEN
SPECIFIC CONTENT TEACHING EVALUATION
OBJECTIVE METHOD

Introduced myself to I told the client my name and Lecture Asked the client to introduce me to her
the client and the institution am coming from family and asked her of the topic to be
introduced the topic of and introduced the topic and taught
discussion elaboration

By the end of the Birth preparedness Lecture and Ask my client to define birth plan and
session the client will as well as preparation of explaining birth preparedness
be able to define what receiving the baby in a safe
birth plan is. environment and safe
motherhood

By the end of the  Means of payment Lecture and Ask my client to mention some of ways
session my client will explaining of been prepared for birth
 Available
 t
be able to name  Sanitary pads
components
of birth  Baby’s cloths
 Birth companion
 Emergency contact
 Preferred birth place
 Preferred skilled midwife

By the end of the  Quick access to health care Lecture and Ask my client to mention so of the
session my client  Safety of both the mother and explaining importance of birth plan
will be able to the child
mention importance
 Prevent delays in making
of good birth plan
crucial decisions
 To escalate any risk
antepartum, Intrapartum and
postpartum

Summary Definition of birth plan Lecture

Components of birth plan
Importance of a birth plan
HOME ASSESSMENT
The environment was clean, the room was well ventilated
Refuse disposal was in good condition
The source of water was clean
HEALTH ASSESSMENT
There were no complication arising
The mother was still maintain good nutrition for proper fetal development

OBJECTIVES OF THE SECOND HOME VISIT

1. To identify if there is any arising complications with my client

2. Provide health education to the family concerning good hygiene and proper nutrient foods.

3. To identify birth preparedness

SECOND HOME VISIT

LESSON PLAN.
HEALTH EDUCATION GIVEN
CONTENT EVALUATION
TEACHING
SPECIFIC OBJECTIVE
METHOD
By the end of this session Definition of dietary Explaining Ask my client to define
the client requirements and danger danger signs and dietary
will know definition of signs requirements
danger signs and dietary
requirements

By the end of this session Presence of per vaginal bleeding Explaining Ask my client to mention
the client will know the Severe headache some of the danger signs
danger signs in pregnancy Reduction of fetal
movements
Swelling of the face and
hands
Convulsions
High fevers
Labored breathing
By the end of the session Energy giving foods – Explaining Ask my client to mention
my client will be able to carbohydrates – maize, sorghum some dietary requirement
mention some of the and bread Protein –repair cells
dietary requirements and tissues-eggs, legumes, meat
Vitamin –protect the body- fruits
and vegetables
Iron –prevent anemia – spinach,
liver and iron supplements

Summary Definition of danger signs

and dietary requirements The
danger signs Foods required
especially during pregnancy
HEALTH ASSESMENT
The mother was still maintaining good nutrition
There was no complication arising
Mother has all requirements for birth preparedness