1.

IDENTIFICATION DATA OF CLIENT

a. Mother’s name –Mrs. Tahira Akhter wife of Aashiq hussain

b. Age in years - 34 years
c. Address - Marhama,Anantanaag
d. Registration number- 3186
e. Educational status- 10th pass
f. Occupation- Home maker
g. Family income- Rs 1000/ month
h. Religion- Islam
i. Duration of marriage- 5 years
j. Obstetric score- G2P1L1
k. LMP-07/09/2020
l. EDD- 14/06/2021
m. Date of admission- 02/06/2021
n. Diagnosis- G2P1L1 with Period of gestation 37/38 weeks with breech presentation.

STUDENT DATA

a. Name of student- Peer Zada Yawar Ashraf

b. Class- B.Sc. Nursing 4th year
c. Date of care started- 02/06/2020
d. Date of care ended- 04/06/2020
e. Number of days care provided- 3 days
CHIEF COMPLAINTS AT THE TIME OF ADMISSION

Mrs. Tahira came to MCCH’s OPD on 2nd june,2021 with the chief complaints of:

 Amenorrhea since 9 months

 Mild headache since 2 days
 Reduced fetal movements since 1 day
 Abdominal pain since 1 day.
 Fatigue since 4 days
 Bleeding per vagina since 4-6 hours
 Contractions and Prelabor Rupture Of Membranes(PROM).

2. HISTORY COLLECTION

History of present illness

 HISTORY OF PRESENT ILLNESS- Client came to Maternity And Child Care Hospital’s outpatient department on 2 ndJune 2021
with the chief complaint of Amenorrhea since 9 months, Mild headache since 2 days, Abdominal pain since 1 day, Reduced fetal
movements since 1 day, bleeding per vagina, Contractions and PROM. After the examination and investigation the patient is
diagnosed as G2P1L1 with Period of gestation 38 weeks with severe IUGR with breech presentation and after that client was shifted to
antenatal ward.
 PAST MEDICAL HISTORY- There is no significant past medical history.
 PAST SURGICAL HISTORY- History of previous LSCS.
 PRESENT SURGICAL HISTORY- Mrs. Tahira has planned for LSCS in present surgical history due to breech presentation.

History of prenatal period

 First trimester- pregnancy confirmed by urine pregnancy kit at home at 45 days overdue. There is history of missed period,
swollen breasts, increased urination, nausea and vomiting, and no history leakage per vagina, or bleeding per vagina.
Ultrasonography was done in third month.
 Second trimester- quickening felt at 4th month. Injection tetanus toxoid covered. History of leakage per vagina, Braxton Hicks
contractions, growing belly and breasts. Ultrasonography done and was normal .History of iron and calcium intake.
  Third trimester- there is history of mild headache, abdominal pain, backaches and Braxton Hicks contractions and no history of
burning micturition, blurring of vision or pedal edema. History of iron and calcium intake and ultrasonography done which shows
mild oligohydramnios.

a) Family history
No significant family history of any illness in family members like hypertension, diabetes mellitus, tuberculosis etc
 No of family members- there are total 5 members in the family.
 Monthly income- Rs 15000/ month
 Income per capita- Rs 3000/ member

S.NO NAME RELATIONSHIP AGE SEX OCCUPATION HEALTH STATUS

WITH PATIENT

1. Aashiq Husband 35 years Male farmer Healthy

hussain

2. Tahira Client 34 years Female House wife G2P1L1 with Period of

Akhter gestation 37 weeks with
breech presentation.

3. Sahil Son 3 years Male _________ Healthy

4. Gh. Nabi Father in law 62 years Male _________ Hypertension and history of
wani respiratory problems

5. Hajira begum Mother in law 60 years Female ___________ HTN

FAMILY TREE:
 Gh Nabi (62 Y) Hajira (60 Y) KEYS

MALE

Aashiq Hussain (35 Y) Tahira (34 Y)

FEMALE

Sahil (3 Years) FEMALE

PATIENT

b) Menstrual history
 Age of menarche- at 14 years
 Regularity- regular
 Cycle- 28-30 days
 Duration- 3-4 days
 Flow- average blood flow
 LMP-07/09/2020

c) Marital history
 Age of marriage- client got married at the age of 30.
 Years of married life- 4 years.
d) Obstetrical history
Obstetrical score: -G2P1L1

S.NO YEAR NATURE OF NATURE OF LABOR NATURE OF SEX REMARKS

PREGNANCY PUERPARIUM
G1
2016 LSCS Full term lower segment Normal and healthy male Baby was
cesarean section. healthy and
cried
immediately
after the birth
and
immunized
till date.

G2
2021 Present pregnancy with POG 38 weeks.

Present pregnancy period

 Date of booking/ registration: booked
 Period of gestation- period of gestation is 38 weeks
 Immunization during pregnancy- T1 and T2 covered in third and fourth month.
 Iron and folic acid supplements- there is history of folic acid intake.

e) Personal history
 Hobbies- NA
 Likes/dislikes- client likes to cook
 Veg/non-veg- Mixed
 Alcoholic/ smoker- None
 Sleeping pattern- Disturbed sleeping pattern due to frequent urination.
 Any allergy- Seasonal flu
 f) Diet pattern

DAY BREAKFAST LUNCH EVENING SNACKS DINNER

Day 1
Roti with tea Rice with sabji Tea with bread Mutton and soup with
roti

Day 2
Roti with tea Rice with mutton Tea with biscuits soup

Day 3
Bread and tea soup Tea with bread Bread and soup

g) Socio-economic status
 Type of house- client lives pucca house.
 No. of rooms- there are total 4 rooms and a kitchen in client’s house.
 Electricity facility- there is proper electricity facility in client’s house e.g. tubes and bulbs.
 Drainage facility- there is closed drainage system.
 Water supply. Water is supplied by tap.

3) PHYSICAL EXAMINATION

a) General examination

Date: 2ndjune 2021

Time: 11:00 am

 Height- 5 feet
 Weight- 55 kg.
 Age- 34 years.
  Race and sex- Asian and female.
 Body type- Mesomorphic
 Body movements- Normal.
 Hygiene and grooming- well groomed and hygiene is maintained.
 Mood and effect- Decreased.
 Speech- Normal speech but there was little slurring or stammering of speech.
 Mental status- Conscious and oriented to time, place and person.

b) Vital signs

 Temperature- normothermic, 96.2o f

 Pulse- 85 beats/ min.
 Respiration- 21 breaths / min.
 Blood pressure- 150/90 mmhg

Head and Foot Examination:

Integumentary

 Skin- client was having little dark skin and no rash or redness present.
 Nails- client was having little purple nails with no clubbing and normal nail capillary refill.
 Hair and scalp- client was having black hair with rough texture with normal distribution of hair and dandruff was present.

Head and face examination

 Head- head was normal in shape and size.

 Face- Round shaped face with little brown patches.
 Eyes
 Vision- Normal vision, and there is no history of double vision or blurring of vision.
 Eyelids- eyelids were symmetrical, and meet completely when eyes are closed.
 Conjunctiva-Both palpable and bulbar conjunctivae are pinkish in color with many minute capillaries. Conjunctiva is moist with no
ulceration or foreign object.
 Sclera- White in color and there is no yellowish discoloration of the sclera.
  Pupils- Round, equal and reactive to light and accommodation.
 Eyebrows and eyelashes- the eyebrows and eyelashes are symmetrical with normal hair distribution.

 Ears- Normal in shape and size, and hearing is normal and there is no discharge, pain or redness.
 Nose- Normal in shape and size, nasal mucosa is moist and no discharge or deviated nasal septum present.

 Mouth and pharynx

 Teeth- White in color and hygiene is maintained, no discoloration present.
 Lips- Dark reddish and dry in texture
 Dentures- client is not having any dentures.

 Neck
 Range of motion- Normal range of motion present as client is able to move her neck.
 Normal position of trachea- trachea is centrally located.
 Normal size, shape and symmetry of thyroid gland, and there is no thyroid or lymph node enlargement or tenderness present.

 Breast
 Inspection- Swollen.
 Palpation- on palpating the breast no lumps were present but nipples were hard and some tenderness was found.
 Milk secretions- Colostrum was present
 Tenderness- Present
 Genitalia- normal in shape and size, the mucosal membrane is moist and there is little discharge present.
 Rectum and anus- the rectum and anus are normal and no hemorrhoids present.
 Extremities- extremities are normal in shape and size and symmetrical and range of motion is present.
 Motor system- Normal and no abnormal findings present.
 Sensory system- Normal as patient is able to feel all the sensations like touch, and differentiate between cold and hot temperature.

D. OBSTETRICAL EXAMINATION-

 Antenatal breast examination:

 Inspection: breast is normal in shape and symmetrical, but little swollen, primary and secondary areola present and no cracked or
inverted nipples are present.

Palpation: breast is soft but tenderness is present. No lymph enlargement.

Discharge: not present.

Milk secretion: colostrum present

 Abdominal examination:
Inspection: abdomen is oval in shape and linea nigra and striae gravidarum present.

Measurements: symphysis fundal height- fundal height was 27 cm

Abdominal girth- abdominal girth was 38 inches

 Obstetric Grips:
 Fundal palpation- head was felt as a smooth,hard,round ballotable mass which is also tender.

 Lateral grip- on the left side irregular parts were felt suggesting extremities whereas on the right side smooth curved surface was felt
indicating presence of back of the fetus.

 Pelvic grip 1 –Soft, broad and irregular mass found and the presenting part is buttocks and is outside the pelvic brim.

 Pelvic grip 2- engagement is not present as hands were conversing or meeting while assessing the foetus.

 Auscultation- the foetal heart rate was 138 beats/ min.

CONCLUSION

 Gestational age- 38 weeks

 Lie- longitudinal lie
 Presentation- breech presentation.
 Presenting part- buttocks.
  Position- left sacroanterior.
 Attitude- flexion
 Engagement- not engaged.


4. INVESTIGATION:

S.NO DATE INVESTIGATION PATIENT VALUE NORMAL VALUE REMARKS

.
LFT
1. 02/06/2021 Total bilirubin 0.72mg/dl 0.00-1.20 mg/dl Normal
Direct bilirubin 0.26 mg/dl 0.00-0.20 mg/dl Normal
Indirect bilirubin 0.46mg/dl 0.00-0.60mg/dl Normal
SGOT 28.20 IU/L 0.00-34 IU/L Normal
SGPT 33.40 IU/L 8-40 IU/L Normal
Alkaline phosphate 215.32 IU/L 54-119 U/L Increased
Total protein 6.94g/dl 6.60-8.70 g/dl Normal
Albumin 4.86g/dl 3.50-5.20 g/dl Normal
Globulin 2.08g/dl 1.20-2.20 Normal

KFT
2. 02/06/2021 Urea 26.54 mg/dl 10-50 mg/dl Normal
Createnine 1.21 mg/dl 0.20-1.20mg/dl Increased
Uric acid 6.89 mg/dl 2.50-6.80mg/dl Elevated

HBsAg Negative - Normal

3. 02/06/2021
HCV Negative - Normal

Hb 12.6g% 12-15g% Normal

 Radiological Investigations USG shows single live fetus with gestational age 37/38 weeks with
mild oligohydramnios and fetal heart rate reactive with breech
USG presentation.

5. MEDICATION:

S. DRUG CHEMICAL DOSE ROUTE FREQUENCY ACTION NURSING RESPONSIBILITY

NO. NAME NAME

 Monitor blood pressure

1. Tablet Amlodipine 10 mg Orally OD Antihypertensive frequently.
Amlog  Advise patient to not to stop the
drug abruptly.
 Monitor the diabetic client’s
Tab glucose level closely as beta
Gravidol 100mg blockers sometimes mask certain
sign and symptoms of
hypoglycaemia.
 Advise patient that drug may
cause dizziness, so avoid any
activities which need full
attention.
2. inj oxytocin 2.5 OD LOBOR
syntocino units IV INDUCTION
n
3. Tablet Capsules of 100mg Orally BD Iron supplement  Explain the purpose of iron
Cofol- Z carbonyl iron therapy.
with zinc and  Encourage patient to comply with
folic acid medication regimen.
 Advise client that stools may
become dark.
 Instruct patient to have diet rich in
iron
 5. Injection Betamethasone 12mg IM Stat Corticosteroid  Caution client to avoid
Betnesol sodium vaccination without first
phosphate consulting health care
professionals.
 Instruct client to inform health
care professional if severe
abdomen pain, unusual swelling,
non healing sore, visual
disturbances occur.
 If you notice new joint pain,
stiffness, or loss of motion in any
joint after receiving this medicine,
contact your healthcare provider
right away
 You may get infections more
easily when you are taking this
medicine. Stay away from people
with measles, chickenpox, or
other infections.

BREECH PRESENTATION:

INTRODUCTION:

It is the commonest malpresentation.in breech presentation the lie is longitudinal, podalic pole present
in pelvic brim, presenting diameter is bitrochantric and the denominator is sacrum. A breech birth
is the birth of a baby from a
breech presentation. In the breech presentation theb a b y e n t e r s t h e b i r t h c a n a l w i t h t h e b u t t o c
k o r f e e t f i r s t a s o p p o s e d t o t h e n o r m a l h e a d f i r s t presentation.

INCIDENCE:

The incidence is about 1 in 5 at 28th week and drops to 5% at 34th week and to3% in term. Thus in 3 out of 4
spontaneous corrections into vertex presentation occur by 34th week because the greater proportion of amniotic
fluid facilitates free movement of fetus. The incidence is expected to be low in hospital where high parity
birth are minimal and routine external cephalic version is done in antenatal period.

TYPES:

• Complete

• Incomplete

Complete

The normal attitude of full flexion is maintained. The thighs are flexed at the hips and the legs at the knee. The
presentating part consists of two buttocks, external genitalia and two feet. It commonly present in multipara
(10%).

Incomplete

This is due to varying degree of extension of thighs or legs at the podalic pole. Three varieties are possible
(25%).

 Breech with extended legs(frank breech)

In this condition, the thighs are flexed on the trunk and legs are extended knee joint. The presenting part
consists of the two buttocks and external genitalia only. It is commonly present in primigravida, about 70%. The
increase prevalence in primigravida is due to a tight uterine tone and early engagement of breech that inhibits
flexion of the legs and free turning of the fetus.

 Footling Breech

Both the thigh and the legs are partially extended bringing the legs to present at the brim. This is rare condition.

 Knee presentation

Thighs are extended but the knees are flexed, bringing the knees down to present at the brim. This is very rare.
In addition to the above, breech births in which the sacrum is the fetal denominator can be classified by the
position of a fetus. Thus sacro-anterior, sacro-transverse and sacro-posterior positions all exist, of which sacro-
anterior indicates an easier delivery.

Clinical varieties:

In an attempt to find out the dangers inherent to breech, breech presentation is clinically classified as:

Uncomplicated

It is defined as one where there is no other associated obstetric apart from the breech, prematurity being
excluded.

Complicated:

When the presentation is associated with condition which adversely influences the prognosis such as
prematurity, twins, contracted pelvis, placenta previa etc. it is called complicated breech. Extended
legs extended arms, cord prolapse or difficulty encountered during breech delivery should not be
called complicated breech but are called complicated or abnormal breech.

Epidemiology:

Mortality/Morbidity:

 Many complications can result from breech presentation. They are generally related to complications of
the fetal abnormalities that may be the primary reason for the breech presentation and those related to
umbilical cord compression resultant from abnormal progression through the maternal pelvis.
  Increased birth trauma: As the duration of umbilical cord compression increases, the practitioner tries to
deliver the infant more rapidly than advisable, thus increasing the incidence of birth trauma.

• Incidence of prolapsed umbilical cord depends on type of breech presentation.

○ Footling, 17% incidence

○ Complete, 5% incidence

○ Frank, 0.5% incidence

• Umbilical cord abnormalities: Cord length may be reduced, and, in footings’, there is an increased risk of the
cord coiling around the legs of the fetus.

Etiology:

1. Prematurity: it is the commonest cause of breech2.Factors preventing spontaneous version:

• Breech with extended legs

• Twins

• Oligohydramnios

• Congenital malformation of the uterus such as septets or bicorunated

• Short cord, relative or absolute

• Intrauterine death of the fetus3.Favorable adaptation:

• Hydrocephalus- big head can be well accommodated in the wide fundus

• Placenta previa

• Contracted pelvis

• Cornufundal attachment of the placenta- minimizes the space of the fudus where the smaller head
can placed comfortably
• Undue mobility of fetus:

• Hydraminos

• Multipara with lax abdominal wall4.Fetal abnormality:

• Trisomies 13, 18 21 and myotonicdystrophy due to alteration of fetal muscular tone

andmobility5.Recuurent or habitual:

• On occasion, the breech presentation recurs in successive pregnancies. When it recurs in three or more
consecutive pregnancy, it is called habitual or recurrent breech. The probable causes are congenital
malformation of the uterus or bicorunated, and repeated cornufundal attachment of the placenta.

Diagnosis

Ultrasonography:

It is most informative

1. It confirms the clinical diagnosis- especially in primigravida with engaged frank breech or with
tense abdominal wall and irritable uterus.

2. It can detect fetal congenital abnormality and also congenital anomalies of the uterus.

3. It measure biparietal diameter, gestational age and approximate weight of the fetus.

4. It also localized the placenta.

5. Assessment of liquor volume (important for ECV)

6. Attitude of the head- flexion or hypertension.

Radiology:

A straight X-ray rarely done

1. To confirm the clinical diagnosis

2. To exclude bony congenital malformation (hydrocephalus)

3. To note the size of the baby

4. To note the position of the limbs and the head

Clinical: the diagnostic feature of a complete breech and a frank breech are given below in the tabulated form.

Clinical diagnosis of breech presentation

COMPLETE BREECH FRANK BREECH

PER ABDOMEN

Fundal grip Head – suggested by hard globular mass Head – irregular small parts of the feet may
Head is ballottable be felt by the side of head
Head is non ballottable due to splitting
action of the legs on the trunk
Irregular parts are less felt on the side

Lateral grip Fetal back is to one side and the irregular Small hard conical mass is felt
limbs to the other The breech is usually engaged
Breech – suggested by soft, broad and
irregular mass

Pelvic grip Breech is usually not engaged during Located at lower level in the midline due to
pregnancy early engagement of breech
Usually located at a higher ;evel round about
the umbilicus
Per vagina

During pregnancy Soft and irregular parts are felt through the Hard feel of the sacrumis felt, often
fronix mistaken for the head

During labor Palpation of ischial tuberosities, sacrum and Palpation of ischial tuberocites, and opening
 the feet by the side of buttocks and sacrum only
The foot is identified by the prominence of
the heel and lesser mobility or the great toe

Position: the sacrum is the denominator of the breech and there are four positions. In anterior position, the sacrum is directed towards
the Iliopubic eminences and in posterior position; the sacrum is directed to the sacro iliac joint. The positions are:

Left sacro anterior (LSA)

Right sacro anterior (RSA)

Left sacro posterior (LSP)

Right sacro posterior (RSP)

6. THERAPEUTIC DIET PLAN:

DIET PLAN

Type of diet: diet plan for hypertensive mother

BREAKFAST LUNCH EVENING SNACKS DINNER

 A glass of plain cow’s milk  Roti with choice of dal,  Milk porridge with  Rice with dal, spinach
vegetable and a bowl of sevaior daliya vegetable, and some green salad
 fresh fruits curd with salad Or Or
 Tea with biscuits
 dry fruits Or Or  Mutton soup
 chapathi with tea  Fresh fruit salad
 Rice, dal and vegetable
with vegetable salad
7. NURSING DIAGNOSIS:

1. Anxiety and fear related to hospital environment as evidenced by perception

2. Altered fluid and electrolyte balance related to loss of body fluids during delivery as evidenced by dry lips.
3. Acute abdominal pain related to contraction of uterus as evidenced by facial expressions of the client.
4. Knowledge deficit and fear related to breech pregnancy and leaking.
5. Risk of infection related to leaking of amniotic fluid.

8. NURSING CARE PLAN:

NURSING NURSING GOAL INTERVENTIONS RATIONALE IMPLEMENTATION EVALUATION

ASSESSMENT DIAGNOSIS S
Subjective data: Anxiety and fear Minimizin  Therapeutic  Compliance  Developed a Level of anxiety
Client said that, she related to g anxiety relationship with increases therapeutic was reduced as
is feeling disturbed. hospital of hospital family and with trust. relationship compared with day
environment as admission. patient was with the patient of admission.
developed. and the family.
evidenced by
 Oriented the
perception.  The patient was patient to the
oriented to the  Orientation hospital, its
hospital rules and and rules and
facilities awareness of facilities
Objective data: available. surroundings available.
It was observed that promotes
client is feeling comfort and  Reassured the
anxious.  The patient was allys anxiety patient that she
reassured the is in safe and
patient that she is  Presence of good hands.
in safe hands and trusted
not alone. person  Assisted in
helpful in anxiety
reducing reducing
 Assisted in anxiety. maneuvers;
anxiety reducing relaxation,
maneuvers, deep  Using deep breathing
breathing and anxiety and oral intake
 oral intake of reducing of warm fluids.
warm fluids. strategies
enhances the
patients
sense of
personal
mastery and
confidence.
NURSING NURSING GOAL INTERVENTIONS RATIONALE IMPLEMENTATIONS EVALUATION
ASSESSMENT DIAGNOSIS
Subjective data: Altered fluid Maintain  Assess the fluid  To know the  Assessed the Fluid and
Client said that” and electrolyte fluid and and electrolyte fluid and fluid and electrolyte balance
I’m having feeling balance related electrolyt status. electrolyte electrolyte was maintained as
lethargic. to loss of body e balance status. status. evidenced by wet
during mucous
fluids during
and after  Monitored vitals membranes.
delivery as surgery.  Monitor vitals,  To maintain and intake/output
evidenced by intake/output. intake/output chart.
dry lips, chart.
 Monitored
 Monitor dryness  Monitor the dryness of
of mucous. mucous for mucous
dryness. membranes.

 Replace i/v fluids  Administered IV

as needed..  Provide IV fluids as needed.
fluids.
Objective data:  Provided oral
It was observed sips as needed.
that the client was
dehydrated and
feeling exhausted  Provide oral  Provide oral
and lethargic. fluids like water, sips
soup
 NURSING NURSING GOAL INTERVENTIONS RATIONALE IMPLEMENTATIONS EVALUATION
ASSESSMENT DIAGNOSIS
Subjective Acute To get rid  Assess the level  To know the  Level of pain is Level of pain was
data: abdominal of the of pain with pain level of pain assessed with the reduced to some
Client said that “ pain related to pain. scale. help of pain scale. extent as
I’m having contraction of Score- 5 evidenced by the
abdominal pain” facial expressions
uterus as
 Advise the patient  To provide  Advised the client of the patient.
evidenced by to lie down in a comfort to the to lie in a
communicatin comfortable client comfortable
g with the position position.
client.
 Provide  To promote  Provided extra
Objective data: comfortable comfort and pillows to the
It was observed devices to the rest. client.
that the client client.
was having
acute abdominal  Advise client to  To relax the  Advised the client
pain related to take deep breaths. body and mind to take deep breaths
uterine
contractions.
 Provide  To divert the  Provided
diversional mind of the diversional therapy
therapy to the client by communicating
client with the client

 Teach the client  To divert and  Taught the client

about relaxation relax mind and about relaxation
techniques and body. techniques and
guided imaginary. guided imaginary
  Provide  To  Provided
psychological psychologically psychological
support to the stabilize the support to the
client. client client.

 Educate client  To impart  Educated the client

that this is a knowledge. that this is a normal
normal process. process.

 Provide sacral  To relieve the  Provided sacral

message and pain. message and
abdominal abdominal
effleurage effleurage

9. PROGRESS NOTES:
DATE DAY GENERAL ANY SPECIFIC MEDICATION VITAL SIGNS CARE PROVIDED/ ADVICES
CONDITION OF COMPLAINTS
CLIENT
02/06/2021 1st day General condition was Client was having Labetalol 100 mg Temperature- 96.2 f  Educated the client about
fair and client was calm, anxiety. Calcium 500 mg Pulse rate- hypertension and its
conscious and oriented Iron 100 mg 60beats/min management.
to time place and Inj syntocin 2.5 Respiration- 18  Educated the client about
person. Hygiene was units breaths/min relaxation techniques.
maintained and client BP- 136/85 mmhg.  Advised the client to
was well groomed. maintain oral rehydration.
Acute lower  Educated the client about
03/06/2021 2nd day General condition was abdomen pain and Labetalol 100 mg Temperature- 98.4 f delivery and postnatal
fair and client was calm, headache Calcium 500 mg Pulse rate- changes.
conscious and oriented Iron 100 mg 47beats/min  Advised the client about
to time place and Respiration- 20 postnatal exercises.
person. Hygiene was breaths/min  Educated the client about
maintained and client BP- 135/88mmhg breastfeeding and its
was well groomed. benefits.
 Educated the client about
04/06/2021 3rd day General condition was Abdominal pain Labetalol 100 mg Temperature- 97.9 f care of newborn.
fair and client was calm, Calcium 500 mg Pulse rate-  Educated the client about
conscious and oriented Iron 100 mg 62beats/min self hygiene
to time place and Respiration- 20  Educated the client about
person. Hygiene was breaths/min salt restricted diet.
maintained and client BP- 130/83 mmhg  Educated the client about
was well groomed breech presentation.

10. ANTENATAL ADVICES:

DO’S DON’Ts WARNING SIGNS
 Sleep sideways with a pillow  Sleep on your back  Bleeding per vaginum
 Prepare yourself for breastfeeding  Don’t slump or slouch  Leakage per vaginum
 Be aware of your baby’s  Don't go more than two to three hours  Increased blood pressure
movements without eating  Pedal edema
 Anaemia (less than 6gm %)
 Learn about the stages of labor  Avoid heavy lifting
 Pre rupture of membrane
 Do kegel exercise  Avoid Heavy household chores  Febrile ailments
 Have positive mind and outlook  Avoid heavy exercising  Bad obstetrical history
 Continue antenatal exercise  Don’t over think things or take stress  History of APH or PPH
 Talk to your health care provider  Avoid travelling.  Uterine size less than period of gestation
 Blurry or impaired vision
 Unusual or severe abdominal pain or
backaches
 Frequent, severe, and/or continuous
headaches
HEALTH EDUCATION-
DIET-
 Mother advised to increase calorie requirement to extent of 300 over non-pregnancy state during 2nd half of pregnancy.
 Mother advised to take light, nutritious, easily digestive diet and rich in protein, minerals and vitamins.
 Mother advised to take at least four meals a day.
HYGIENE-
 Mother advised to avoid the strenuous work and start prenatal exercises as long as she feels comfortable.
 Mother advised to take bed rest 8 hours at night and 2 hours at noon.
 Mother advised to take plenty of fluids, veg, fruits and stool softeners to get relief from constipation.
 Mother advised to take daily bath but be careful against slipping in bathroom.
 Mother advised to wear loose and comfortable garments, avoid high heels.
 Mother advised to wear well fitting brassiere to get relief from breast engorgement.
EXERCISES
 Advised mother for active and passive exercises after demonstrating the exercises.
IMMUNIZATION
 Provided knowledge to the parents regarding active immunization.
MEDICINES:
Explained the justification for taking prescribed medications for the mentioned durations.
FOLLOW UP CARE:
Advised the mother to come for regular follow ups along with her baby.

SUMMARY:
I Peer Zada Yawar was posted in antenatal ward where Mrs Tahira a 34 years old female with diagnosis of G2P1L1 with POG 37 weeks with
breech presentation was assigned as a patient to me by our teacher Mrs. Nadia Mam(tutor SMMCNMT). The client came to the hospital
with the chief complaints of Amenorrhea since 9 months, Mild headache since 2 days, Abdominal pain since 1 day, Reduced fetal
movements since 1 day, bleeding per vagina, Contractions and PROM so I cared her for three days and provided health education to the
client for preparing her for the delivery. Along with nursing care and medical treatment the client was feeling better than before.

BIBLIOGRAPHY

 Dutta’s D.C. Textbook of obstetrics. Seventh edition. Published by New central book agency (P) ltd. Chintamoni das lane, Kolkata
India.2013.
 https://www.scribd.com