Nabarun Debnath, Roll no.

48 , 6 th semester
FAMILY CARDS
1. Satarupa chakraborty, 34 year old lady, primi gravida came to madhupur PHC at
34 weeks of gestation for the first time with bleeding per vagina. On examination
her blood pressure was 100/60 mmhg.

What is your provisional diagnosis?

Ante-partum hemorrhage.

What is your plan for management for this lady?

 Advice to report all vaginal bleeding to the antenatal care provider.

 Admission to hospital for clinical assessment and management.
 May need resuscitation if in shock or severe bleeding.
 Airway, breathing and circulation to be ensured
 Take blood for blood grouping, complete blood count, hb, liver and renal
function
 Volume should be replaced by colloid/ crystalloids until blood is available
 Severe bleeding or fetal distress: if urgent delivery is anticipated irrespective of
the gestational age.

Who are high risk mothers?

“High Risk” mothers form a large group of antenatal mothers. These cases comprise
the following:
 elderly primi (30 years and over)
 -short statured primi (140cm and below)
 -malpresentations: breech, transverse, lie
 -antepartum hemorrhage, threatened abortion
 -Pre eclampsia and eclampsia
 -anemia
 -twins, hydramnios
 -previous still birth, intrauterine death, manual removal of placenta
 -elderly grand multiparas
  -prolonged pregnancy (14 days after expected date)
 -history of previous cesarean or instrumental delivery
 -pregnancy associated with general systemic diseases
 -treatment for infertility
 -3 or more spontaneous consecutive abortions

2. You have surveyed one family in dukli on 06/07/17. There were one couple
named shibaprada banerjee, 40 yrs old and mousumi banerjee 36 yrs old and
they had one daughter named sreetama banerjee, 6 yrs old.

How will you assess their nutritional status?

Assessment of nutritional status involves the following techniques :-
 Clinical examination
 Anthropometry
 Biochemical evaluation
 Functional assessment
 Assessment of dietary intake
 Vital and health statistics
 Ecological studies

What is the best family planning method for this couple?

The best family planning method for this couple would be use of intrauterine
devices.
Cu-T-380 A can be used.
These devices are significantly more effective in preventing pregnancy and offers
the further advantage of having an effective life of at least 5 years.

3. Enumerate nutritional assessment methods for a family

The assessment methods include the following:
- Clinical examination
- Anthropometry
- Biochemical evaluation
- Functional assessment
- Assessment of dietary intake
 - Vital and health statistics
- Ecological studies
Write in brief assessment of dietary intake of family
Household inquiry is to be done. A diet survey may be done by the following
methods:
•Weightment of raw foods: commonly 7 days ‘one dietary cycle’ method is done.
Raw foods are weighed before cooking as well as all that is wasted or discarded.
•Weightment of cooked foods: foods should be ideally weighed in the state they
are consumed but this method is not much accepted.
•\Oral questionnaire method: this is useful for a family that has large number of
people and can be done in a very short period of time. Nature and quantity of
foods eaten during the last 24 or 48 hours are inquired. If done properly, it gives
reliable results.

4. Mamoni is 20 months old. Her mother has bought her to immunization clinic. She
was born on 14/01/2012 in a govt. hospital. Her immunization card
BCG & OPV0 – 04/03/12
DPT1 & OPV1 - 18/04/12
DPT2 & OPV2 – 10/07/12
DPT3 & OPV3 – 24/08/12

Comment on the schedule.

MISSED VACCINES WHEN IT WAS TO BE GIVEN

1. Hepatitis b (birth dose) At birth or within 24 hrs
2. Rota virus vaccine 6, 10, 14 weeks (within 1 year of age)
3. IPV 6 and 14 weeks (within 1 year of age)
4. Pneumococcal conjugate vaccine 6 and 14 weeks (within 1 year of age)

What the health worker should do now?

The health worker shouldn’t administer any kind of missed vaccine to the infant now.
Especially Hepatitis B vaccines (first dose)shouldn’t be administered as it is supposed
to be administered within 24 hours of birth.
However, he or she can administer the remaining vaccines to the infant .
Vaccines to be given When to give
1. Measles (first dose) Immediately
2. Vitamin a (first dose) Immediately along with measles

3. Measles (2nd dose) One month after the first dose

4. Vitamin a (2nd dose) 7-12 months after the first dose

5. Vitamin a (3rd – 9th dose) One dose after every 6 months

5. Structure of the family

NAME AGE SEX BODY WT. C.U

Gopal sarkar 60 M 65 1.6
Ganga sarkar 55 F 60 1.2
Kamal sarkar 25 M 55 1.6
Kajal sarkar 19 M 45 1.0
Tulsi sarkar 16 F 46 1.0
Calculate the standard total requirement of protein and energy for the family.
- Protein requirement = 0.83g for adults and 0.86g for girls aged 11-18yrs,
protein/kg weight/day
So protein requirement of the family= 65+60+55+45(adults) (adolescent)
= 225kg * 0.83 = 46kg * 0.86
= 186.75g/day = 39.56g/day
Total protein requirement/day= 186.75 + 39.56
= 226.31g/day
- Energy requirement
Adult men (moderate active) = 46kcal/kg/day
Adult women (moderate active) = 41 kcal/kg/day
Adolescent girl = 47kcal/kg/day
So energy requirement of family = 65+55+45(adult men) 60kg (adult women)
= 165 * 46 = 60 * 41
 = 7590 kcal/day = 2460 kcal/day
46kg (female adolescent)
= 46* 47
= 2162kcal/day
Total energy requirement = 7590 + 2460 + 2162
= 12,212 kcal/day

Write the characteristics of an Indian reference man and Indian reference woman
 REFERENCE MAN: -He is aged between 18-29 years and weighs 60kg with a
height of 1.73M and a BMI of 20.3, is free from disease and is physically fit for
active work.
-On each working day, he is engaged in 8 hours of occupation which usually
involves moderate activity.
- While when not at work he spends 8hrs in bed, 4-6 hours in sitting and
moving about, 2 hrs in walking, active recreation or household duties
 REFERENCE WOMAN: -She is aged between 18-29 years, non pregnant non
lactating (NPNL) and weighs about 55kg with a height of 1.61M and a BMI of
21.2, is free from disease and is physically fit for active work.
-On each working day, he is engaged in 8 hours of occupation which usually
involves moderate activity.
- While when not at work he spends 8hrs in bed, 4-6 hours in sitting and
moving about, 2 hrs in walking, active recreation or household duties

6. A 10 month old child has come to the immunization clinic who was delivered in a
hospital and received BCG and OPV zero doses. After that no vaccine taken.

Comment on immunization status of the child

MISSED VACCINE WHEN IT IS TO BE GIVEN

1. Hepatitis B birth dose At birth (or within 24 hours)
2. OPV 1,2,3 At 6, 10, 14 weeks
3. Rota virus vaccine At 6, 10, 14 weeks
4. IPV At 14 weeks
5. Pentavalent 1,2,3 At 6, 10, 14 weeks
 6. PCV At 6, 14 weeks
7. Measles -1st dose At 9-12 completed months
8. Vitamin A 1 st dose At 9 completed months
with measles

Mention the vaccine dose of vit.a in oil to be given to the child at this visit
DOSE: 100000 IU (30mg RE) vitamin A.
ROUTE OF ADMINISTRATION: Oil based preparation of retinyl palmitate or retinyl
acetate

What vaccines are to be given at this age to the child?

VACCINES WHEN TO BE GIVEN

1. OPV 1,2,3 At 6,10,14 weeks (till 1 yr)
2. Rota virus vaccine At 6,10, 14 weeks (till 1yr)
3. IPV At 14 weeks (till 1yr)
4. Pentavalent 1, 2 ,3 6,10,14 weeks (till 1yr)
5. Measles 9.12 onths ( till 5yrs)

6.Vitamin a 1st dose 9 months (till 5yrs)

7.PCV At 6, 14 weeks (till 1yr)

7. Lata has come to the sub centre for family planning advice. She, 24 yrs of age has
a son of 7 months. Her menstrual history is normal. Her husband is alcoholic and
has refused to come there. Lata has suffered from jaundice 2 months back

Which method of contraception will not be suitable for the couple?

OCP (oral contraceptive pill). OCPs are contraindicated in acute liver diseases like
jaundice. So it shouldn’t be given as it can increase hepatotoxicity

Which contraceptive method is ideal?

 Intra uterine device (copper-T 380 Ag). It has low expulsion rate and can be
effectively kept for atleast 5 years unless specific reasons or conditions call for
earlier removal. It has increased contraceptive effectiveness too.

Mention 2 important complications of this suggested method

- The commonest complaint of women fitted with IUD is increased vaginal bleeding.
- Pelvic Inflammatory disease

8. Pritesh biswas 25 yrs old and priyanka biswas 24 yrs old of dukli are married for
last 7 months. They don’t want to have baby for next 2 years.

What family planning methods will you advice for them?

Oral contraceptive pill (OCP) and barrier methods like Condoms and female
condoms can be used.
Give reason for advising this method
OCP:It is the most effective and reversible method of contraception, with a failure
rate of only 0.1%. A simple regime of ‘3 weeks and 1 week off’ can be followed.
Condoms :-easily available , easy to use and no sid effects. Provides not only
protection from Pregnancy but also against STDs.

Advantages and disadvantages of this method

ADVANTAGES
- Convenient to use
- Reversibility
- Improved maternal and child health care
- Improvement against menstrual abnormalities like dysmenorrhea, menorrhagia,etc
- Protection against health disorders like Iron deficiency anemia, ectopic pregnancy
and pelvic inflammatory disease, hirsutism, acne, fibroid, etc
DISADVANTAGES
Minor complications include:
- Nausea, vomiting, headache, leg cramps
- Mastalgia
- Weight gain
 - Chloasma
- Libido
- Leucorrhea
Major complications include:
- Depression
- Hypertension
- Vascular complications
- Cholestatic jaundice
- Neoplasia

And for condoms : may slip off or tear during coitus due to incorrect use
Interferes with sex sensation locally

9. Pratima biswas 35 yrs old lady, primigravida came to madhupur RHTC at 32

weeks of gestation for the first time with swelling of feet. On examination her BP
was 150/100mmhg.

What is your provisional diagnosis?

PRE-ECLAMPSIA. It is a multisystem unknown etiology characterized by
development of hypertension to the extent of 140/100 mmhg or more with
proteinuria after the 20th week normotensive and nonproteinuric mother.

What are the danger signs during pregnancy?

If the following signs occur, the woman should be taken immediately to the
hospital or health care centre
- Vaginal bleeding
-
- Convulsions
- Severe headache with blurred vision
- Fever and too weak to get up from bed
- Severe abdominal pain
- Fast or difficult breathing
- Swelling of face, fingers and legs

How will you manage this patient?

•Rest and diet control: diet should contain adequate amount of daily protein about
100g. total calorie approx 1600 cal/day
•Diuretics: the diuretics shouldn’t be used injudiciously as they cause harm to the
baby by diminishing placental perfusion.
Furosemide (LASIX) 40 mg given orally after meal for 5days in a week .
- Anti hypertensives :Methyldopa,Labetalol ,Nifedipine ,Hydralazine can be
given.
- Sedatives :- to cut down emotional factors. Phenobarbitome 60 mg or
Diazepam 5 my at bed time.

10. The family has an insanitary latrine

Write the health hazards due to improper excreta disposal?
- Soil pollution
- Water pollution
- Contamination of foods, and
- Propagation of flies
Draw the sanitation barrier to transmission of fecal borne diseases.
11. There is a 70 yrs old lady. Write the health problems she may face?
- Diabetes
- Breast cancer
- Osteoporosis
 - Arthritis
- Heart disease
- Dementia
- Depression

12. Baby chakma, 2 months old girl from adarsha colony of madhupur came to
RHTC with her mother for the first time. She did not receive any vaccine till
now.

What are the vaccines you will give her now?

•BCG : can be given till one year of age

•OPV 1 : since it is given at 8th week, OPV 2 and 3 will be given each 4 weeks apart
•Rota virus vaccine: since it is given at 8th week, remaining 2 doses will be given
each 4 weeks apart
•Pentavalent 1: since it is given at 8th week, Pentavalent 2 and 3 will be given each
4 weeks apart
•Pneumococcal conjugate vaccine (PCV) : since it is given at 8 th week, the other
dose will be given after 8 weeks

Write her immunization schedule till 2 years of age

VACCINE WHEN TO GIVE

1. BCG at birth or within 1 yr
2. Hepatitis B At birth or within 24 hrs
3. OPV 0 At birth or within 15days
4. OPV 1,2,3 At 6,10, 14 weeks (max 5yrs)
5. Rota virus vaccine At 6,10, 14 weeks (max 1yr)
6. IPV At 14 weeks (max 1yr)
7. Pentavalent 1,2,3 At 6,10, 14 weeks (max 1yr)
8. PCV At 6 and 14 weeks (max 1yr)
9. Measles 1st dose 9-12 months (max 5yrs)
10.Japanese encephalitis 1st dose 9-12 months (max 15yrs)
11.vitamin A first dose 9 months (max 5yrs)
12.DPT booster 1 16-24 months (max 7yrs)
 13. Measles 2nd dose 16-24 months (max 5yrs)
14. OPV booster 16-24 months (max 5yrs)
15. Japanese encephalitis 2nd dose
16.Vitamin A (2nd-9th dose) 16months. Then once every 6 months

13. You have visited a family in dukli on 01/12/2017. You found there were one
couple and one 3 yrs old son in the family.

How will you assess their nutritional status?

Assessment of dietary intake by oral questionnaire by (24 hour) recall method.
This method is very useful in carrying out a diet survey in a short amount of time.
Inquiries are made about the nature and quantity of food taken in the last 24
hours. The data that is collected is converted into:
- Mean intake: grams of food in terms of cereals, pulses, vegetables, meat, fish, eggs
- Mean intake of nutrients per adult man value or ‘consumption unit’

What are the other methods of nutritional assessment?

- Clinical examination
- Anthropometry
- Biochemical tests
- Functional assessment
- Vital and health statistics
- Ecological studies

14. There is an eligible couple with 2 children in the family. The age of the
younger child is 3 yrs. What contraceptive advice will you give to them?
Sterilisation will be the correct choice of contraception in this couple as their
family is complete. It is a permanent method of contraception for people who do
not want to bear any more children.
Sterilization offers many advantages over other contraception methods-
- it is a one time method.
-It doesn’t require sustained motivation of the user for its effectiveness
-provides the most effective protection against pregnancy
- risk of complication is small of procedure is performed according to accepted
medical standards
- cost effective.

•Male sterilisation also called vasectomy, which is done by removing a piece of

vas at least 1 cm after clamping . The ends are ligated and then folded back on
themswlves and sutured into position, so that the cut ends face away from each
other.

•Female Sterilization also called tubectomy or tubal occlusion, which is done by

two procedures – Laparoscopy and Minilap operation.

In case of malw sterilisation, Contraceptive should be used until aspermia has

been established.

Thank You.