Course Number: CHS240A
Course Title: Maternal and Child Health II
STUDENT LEARNING OUTCOMES
General
To develop skills needed for health
assistants to provide basic preventive and curative care to women of
reproductive age and their children in areas where there is no doctor.
Specific
Students will be able to:
-
Explain the 10 principles for health workers in the Code of Conduct of the
International Red Cross as they apply both to disaster
relief and community
health
(see Community Health. Wood,
CH. AMREF, 2nd ed. Nairobi Kenya,
1997.)
-
Define confidentiality and explain why it is important for all health workers to
preserve confidentiality.
- Demonstrate 3 techniques for establishing rapport with a patient.
(text part 1A)
Background Information:
-
List
3 types of advice that are important to deliver during prenatal care
-
List
4 types of treatment that are important to deliver during prenatal care.
-
List
3 types of abnormalities that are important to detect during prenatal care.
-
List
2 ways that prenatal care can prevent pregnancy deaths from bleeding.
-
List
1 way that prenatal care can prevent pregnancy deaths from difficult labor.
-
List
1 way that prenatal care can prevent pregnancy deaths from eclampsia.
-
List
1 way that prenatal care can prevent pregnancy deaths from abortion.
-
List
3 ways that prenatal care can prevent pregnancy deaths from infection.
-
List
1 way that prenatal care can prevent pregnancy deaths from low birth weight.
-
List
2 ways that prenatal care can prevent pregnancy deaths from tetanus.
-
Recognize signs and symptoms to diagnose early pregnancy.
-
Identify location and function of pelvic organs related to pregnancy.
-
Examine abdomen to detect the following:
o
Scar from previous cesarean section,
o
Fundal height of the uterus,
o
Position of the fetus,
o
Fetal heart rate.
-
Determine whether findings of exam are normal or not and what action should be
taken based on findings.
-
Identify growth milestones for the uterus and determine whether rate of growth
is normal, and, if not, what action should be taken.
-
Explain what are the risks of pre-term and post-term labor, how to prevent them
and what to do for a patient who presents with
them.
-
Explain what local and imported foods help to make a pregnancy safer; and which
may do harm to the mother or baby.
(part 1D) Minor Disorders of Pregnancy
-
Explain what measures (including traditional remedies) can be taken to relieve
the following minor problems of pregnancy:
o
Nausea and vomiting of early
pregnancy,
o
Heartburn (burning pains over the
stomach),
o
Constipation,
o
Vaginal discharge,
o
Colds and coughs,
o
Backache.
- Identify situations when it is dangerous to
delay or interrupt modern medical treatments for health problems.
-
Explain why it is dangerous to induce abortion by traditional means (using herbs
and manipulation of the uterus).
-
Estimate the expected date of birth from knowledge of the mother's last
menstrual period.
(part 1E)
Serious Disorders of Pregnancy
-
Identify and explain the causes and what measures can and should not be taken to care for
the woman with the following serious
problems of pregnancy:
o
Bleeding
in early pregnancy,
o
Bleeding
in late pregnancy,
o
Discrepancy between dates and size of the uterus,
o
Abnormal
fetal heart rate,
o
Abnormal
Lie and presentation,
o
Severe abdominal pain,
o
Fever,
o
Weakness,
o
Severe Anemia,
o
Hypertensive disease of pregnancy,
o
Eclampsia and other seizures,
o
Diabetes
in pregnancy,
o
Sexually transmitted diseases,
o
Abnormal
screening tests (including interpretation).
-
Explain
the different types of discharge from the vagina in pregnancy and what they
mean.
(part 2A)
Normal labor & Delivery.
-
Explain what happens during each of the three
stages of normal labor.
-
Explain how to determine which stage of labor a woman is in.
-
Identify the landmarks of the human pelvis and baby's skull.
-
Identify the baby's position, and the position of the baby's head in the pelvis
using pelvic and infant manikins.
-
Identify the structures of the female perineum, and their functions.
-
Identify the structures of the developing fetus and uterus, and their functions.
-
Explain what things to check about each of the following in the woman who
presents with labor, how to recognize abnormalities and
what to do for
abnormalities that are detected:
o
The history of the labor,
o
The prenatal record of the mother,
o
The physical examination of the
mother.
-
Correctly record, report obstetrical vital
statistics (including
timing uterine contractions and fetal heart rate).
-
Recognize abnormalities of obstetrical vital
statistics and select the proper response to these.
-
Make
a list of things that you need to attend to a normal delivery.
-
Explain the use of each of these items.
-
List
the correct advice to give to a woman in the first stage of labor with regard to
what she may take by mouth, what kind of
activity she may engage in.
-
Describe what observations and how often to check to assess the mother's
condition, the baby's condition, and the progress of
labor during the first
stage.
-
Explain how to determine whether each of these observations is normal or not,
and what to do for each abnormal sign.
-
List 3 ways to assess the
state of the membranes.
-
Estimate cervical dilatation by manual exam using a model.
-
Plot
points on a partogram correctly, and decide whether labor progress is normal
using the partogram.
-
Explain what things an attendant can do to help a woman during the second stage
of labor.
-
Determine the position of the head
using pelvic and infant manikins.
-
Demonstrate the proper measures to take during the
delivery of the
head, using pelvic and infant manikins.
-
Demonstrate the proper measures to take during delivery of the shoulders, using
pelvic and infant manikins.
-
Demonstrate the proper immediate measures to take to care for the newly
delivered infant.
- Demonstrate the proper measures to take
to deliver the placenta,
using pelvic and infant manikins.
- Describe the indications for episiotomy.
- Perform an
episiotomy and repair it.
-
Recognize the
indications, common side effects and dangers of medications on the
dispensary essential drug list
which are
given in labor and delivery.
- Select correct dose and dose intervals of meds
based on diagnosis, patient age and weight.
(part 2B) Complications of Labor & Delivery.
-
Explain how to recognize and what measures can be taken to care for the woman
with the following problems of labor:
o
Maternal distress from obstructed
labor, infections of other illness,
o
Arrested
labor,
o
Fetal distress (resuscitation of the baby),
o
Delay in labor,
o
Breech
presentation,
o
Transverse
lie,
o
Prolapsed cord,
o
Multiple pregnancy,
o
Postpartum
hemorrhage,
o
Retained placenta,
o
shoulder distocia,
o
lacerations
and vulvar hematoma,
(part 3A) Post-Partum Care,
Including Lactation and Breast Feeding
-
Explain what happens to the mother and infant during the first 24 hours and the
1st week after delivery.
-
Explain advice that should be given to help keep mothers healthy after delivery.
-
Advise mothers on the proper techniques for breastfeeding, including:
o
when to start,
o
establishing
attachment of baby,
o
what is colostrums, and what good is
it,
o
when to expect the "regular milk" to
come in,
o
how often to feed,
o
how to position the infant,
o
how to assure good latching on,
o
the importance of emptying the
breasts throughout each day.
(part 3B) Postpartum Care, Continued
-
Describe the normal state
of the uterine fundus & lochia
during the first day, week, and month post-partum.
-
Explain to a mother how to care
for perineal repairs.
-
Explain how to recognize and what measures can be taken to care for the woman
with the following postpartum problems:
o
Pyrexia,
o
Infection of the genital tract,
o
Urinary infection,
o
Inability to control the flow of
urine or stool,
o
Too much bleeding,
o
Breast engorgement,
o
Sore nipples,
o
Mastitis,
o
Post partum depression.
(part 3C)
Family Planning.
-
Describe how soon after delivery it is possible for a woman to get pregnant
again.
-
Explain what is the ideal interval between births for the health of mother and
infants.
-
Explain
how the following contraceptive methods work,
and the advantages and disadvantages of each (including
failure rates and
side effects) and which are available in your setting:
o
Condoms,
o
Abstention,
o
Rhythm,
o
Exclusive breast feeding,
o
Oral contraceptive pills,
o
Depo-Provera injection,
o
IUD,
o
Male and female sterilization.
-
Counsel the woman and her partner to inform them of the
importance of
birth spacing, the advantages and disadvantages of
the
various methods and to determine their preferences.
-
Determine whether a couple is eligible for a particular method based on their
risk factors and preferences.
-
Prescribe a contraceptive method to a woman or her partner, based on their
preferences and risk factors; counsel them regarding
proper use of the method,
danger signs to report and scheduled follow-up.
-
Prepare proper records for a family planning client for the dispensary and to
send to the family planning program office.
-
Correctly conduct and chart follow-up visits for
family planning clients.
(part )
Care of the Neonate
-
Explain how to tell whether a new born baby is normal with regard to:
o
Normal vs. abnormal crying,
o
Muscle tone and movement of arms and
legs,
o
Color of lips and tongue,
o
Breathing,
o
Sucking at breast,
o
Amount of sleep per day,
o
Alertness when awake,
o
Weight,
o
Passage of meconium and urine,
o
Appearance of umbilical cord,
o
Infant temperature,
o
Color of skin (and eye schlera).
-
Explain how to recognize and what measures can be taken to care for the
following problems in the infant:
o
Infection of the umbilical cord,
o
Pus spots on the skin,
o
Septicemia,
o
Sore eyes,
o
Pneumonia,
o
Meningitis,
o
Hypothermia,
o
Poor feeding,
o
Vomiting,
o
Convulsions,
o
High-pitched cry,
o
Congenital anomalies.
-
Explain what measures can be taken
to minimize the chance of infection in the newborn.
-
Describe the proper procedure,
including paper work, to take to refer a seriously sick baby or mother for more
advanced care.
-
Using the formulary and reference
materials, determine the proper dose, route, side effects to watch for, side
effects to warn the
patient about, and contraindications for the medications
related to the care of mothers and infants that are on the state essential
medications list.
(WHO New Model ANC
materials) Prenatal Care.
-
Correctly perform and interpret the WHO New Model ANC first visit
risk assessment and correctly fill out the ANC
card.
-
Correctly perform and chart the procedures for each of the five
antenatal and postpartum visits recommended in
the WHO New Model ANC including making observations (BP, weight, fundal height, fetal lie and presentation,
fetal heart rate),
ordering and interpreting appropriate screening tests in
pregnancy.
-
Select correct responses to findings from
procedures for each of the five antenatal and postpartum visits
recommended in
the WHO New Model ANC.
Other Gyn Topics
-
Describe signs and symptoms of abnormal menses.
-
Correctly obtain a Pap Smear.
-
Select correct workup and management of menstrual
abnormalities.
-
Explain the "ABC's" of HIV/STD prevention to
clients.
-
Describe signs, symptoms, complications, clinical
management and management of patient contacts for gonorrhea,
chlamydia, HIV,
hepatitis B,HPV, and syphilis in males and females (per WHO Syndromic
Management of STI
guidelines).
(Community Health, Ch 9) Childhood
Vaccination
-
Describe the effects of the following vaccine-preventable diseases: TB,
Hepatitis B, Polio, Measles, Mumps, Rubella, Diphtheria ,
Pertussis, Tetanus
and Hemophilis B.
-
List
barriers to childhood immunization and how to overcome each one.
-
Define the vaccine "cold chain" and explain why it is important.
-
Decide whether and which vaccines are indicated
based on a child's age, history or reactions to previous vaccines,
current state
of health, contraindications and vaccine record.
-
Decide whether and which vaccines are indicated
based on a child's age, history or reactions to previous vaccines,
current state
of health, contraindications and a vaccine program master list.
-
Select the correct route and site for each vaccine
type.
-
Correctly record vaccinations given on master
list, patient's chart, and "Road to Health" card.
- Counsel
parents about how to care for the child post-vaccination and what side effects
to look for with each vaccine type.
(Community Health, Ch 14) Well Child Care
-
Correctly perform each of the following tasks for
a well child clinic:
o
Registration,
o
Check developmental milestones based on age,
o
Weigh child and plot weight on "Road to Health" chart,
o
Determine whether development and growth are normal and select the correct
actions if abnormal,
o
Examine child and advise parents about child's current growth, development and
physical status,
o
Correctly administer each type of vaccine to a child under supervision,
o
Give standardized key health education messages based on child's age,
o
Record findings correctly on child's clinic chart, MCH registry, and take-home
"Road to Health" card.