SUBJECT: OBSTETRIC & GYNECOLOGICAL NURSING Procedure on Perineal care SUBMITTED TO: SUBMITTED BY:PERINEAL CARE PROCEDURE Introduction: Perineal injury is the most common maternal morbidity associated with vaginal birth. Anal sphincter injury is a major complication that can significantly affect women's quality of life. Perineal hygiene involves cleaning external genitalia and surrounding area. The perineal area is conductive to growth of pathogenic organisms because so the pathogenic organisms enter into body many orifice in situated in this area is less ventilated. Since Delivery is the physical strengthen, effort done by the mother during their delivery period and suffer from birth canal injuries, episiotomy incision, perineal tear laceration may be occur so staff nurses provided perineal care to the patient in the hospital at least minimum twice a day and try to recover the patient in early healing Definition: Perineal care is an aseptic irrigation of the vulva and perineum after voiding or defecation in specified period following delivery or an operation of birth canal, perineum, urinary meats or anus. cleansing the area between the anus and vulva in female, or the anus and scrotum in male; promotes comfort and prevents odor kin excoriation, and infection. usually given along with a complete bed bath, but may have to do more often (e.g. incontinent of urine or feces) Perineal care is the term applied to the external irrigation or cleansing of the vulva and perineum region as a means of prevent infection, promote healing of the stitched perineum and making the patient comfortable. It cleansing procedure prescribed for the genital and anal areas as part of the daily bath or after various obstetrical and gynecological procedures PURPOSE 1. ‘To.clean the skin and mucous membrane of the vulva and perincum.,To eliminate the bacterial growth by application of antiseptic solution. To increase the healing of perineal tissues. To relieve itching, pain, discomfort of the perineal area. ‘To prevent the infection in to the genital area. To minimize pain, tendemess and edema due to operational trauma after Episiotomy yaya ep ‘To observe the colour, nature and characteristics of lochia. Indication Of Perineal Care: 1) Postpartum patients especially with stitches in the perineum. 2) Persons with surgery of the genitourinary tract, 3) Patients with lesions, ulcer or surgery of the perinea arca or rectum. 4) Patient having indwelling catheter. 5) Patients having excessive vaginal harges. 6) Patients with incontinence of urine or stool 7) Patient should not perform the perineal care by herself General instruction: 1) Maintain strict aseptic technique during the procedure. 2) Provide privacy to the mother. 3) Observe the colour, nature and characteristics of lochia, 4) Don’t touch inner area of the sterile tray. 5) ‘Use the one swab for each stock from upward to downward. 6) If the glove is soil before procedure change it. 7) To observe the patient for discomfort during procedure. 8) Discard all the swabs and pad in the paper bag or dustbin 9) Used mild antiseptic solution or plain warm water for perineal care. Preliminary Assessment: 1) Identify the patient. 2) Cheek the doctor's order for any specific precautions,3) Identify any specific contraindications present. 4) Any cont indic: ns to the applications of perineal care in the patient. 5) General condition of patient and ability to follow instruction. 6) Check the articles available in patient unit. > Preparation Of The Articles :- Srno. | Articles Use. 1, | Soap dish, towel For hand washing before and after procedure 2 | Curtain To maintain privacy 3._| Spot light /torch For focusing the perinea area 4._| Plastic apron To protect her self ‘5__| Bath blanket To cover the patient (6_| Mackintosh draw sheet | To protect the bed linen 7,_| Paper bag and Kidney tray | To receive the waste 8, | Sterile tray: > Gloves * To maintain sterile technique > Artery forcep ¢ Toremove the previous dressing > Sponge holder > Bowl containing savion solution > Cotton swab > Gauze piece * To hold the swab and clean the perineum To clean the perineum © To clean the vulva and perineum * Toclean the perineum with antiseptic solution ‘© apply the antiseptic cream on sutures To apply over the perineum 1) Identify the patient with the name and explain the procedure to the patient to win the confidence and co-operation. 2) Advice the patient to empty the bladder and bowel 3) Provide privacy.4) ¥ 6) 7) 8) 9) Position the patient in dorsal recumbent. Give extra pillows to raise the head. Arrange the articles at the bed side locker Place the mackintosh and towel under the patient to protect the bed. Provide adequate light by placing extra spot light. Drape the patient and open only vaginal area. 10) Use the bed pan if you perform the procedure in bed, > PROCEDURE. STEPS RATIONAL Explain the procedure to the patient. To gain the confidence and co-operation of the| patient. Spread the mackintosh and draw sheet! under the buttocks. Pour lotion into the bowl Hand wash. Wear the gloves Holding the perineal pad or dressing with artery forceps and observe characteristics of the secretion, lochia, amount colour, odour and discard soil pad Hold the swab with swab holder To prevent cross infection To prevent soiling of bed. To clean the perineum To prevent cross infection. To maintain universal precaution To identify any abnormality. To clean the perineum Clean the perineum with sterile wet swab from upward to downward. First clean the stitches and then other area. Clean vulva and perineum using each sponge once only and start from upward to downwards making as little pressure as possible on the tissue work from the midline outward. To prevent Ascending infection To prevent infection as stitches consider more sterile than the other area. To clean the perineum and to prevent infection.‘STEPS RATIONAL “Tum the patient on one side Inspect perinea stitches for infection To give the treatment Clean and dry the buttocks ‘Apply antibiotics ointment the surfice of dressing that comes in contact with vulva and perinew ‘Apply dressing, cotton pad and bandage. To discourage of bacterial growth ‘Apply the dressing and avoid touching To prevent contamination of area this in contact with the perineum. To secure the pad > After Care of The Patient And Articles: 1) Remove the mackintosh and bedpan. 2) Change the linen if necessary. Straighten the bed Arrange the bed linen. y 4) contents into the toilet. Rinse the bedpan with cold water using a brush. Immerse It In lotion to disinfect it. 5) 6) 0) 8) 9%) Boil the forceps. Replace the articles. Wash hands. Give the comfortable position to the patient. Take the bedpan to the sanitary use Remove the cotton swabs If any And empty the Wash and dry well and keep it on the bedpan rack. Ready forthe next use. Take all the articles to the utility room, clean it and replace it. Remove the screen and tidy up the unit. 10) Record the procedure with date and time and the observations made. > Recording and Reporting: Record the procedure in patient's chart.1) Record amount, colour and odours of lochia. 2) Note consistency of uterus. 3) Record if dry heat is applied. 4) Record the condition of stitches. 5) Report any abnormality if observed. BIBLIOGRAPHY:BIBLIOGRAPHY: a) Inamdar Madhuri, Nursing Arts (Principles and Practice) Part-II; I" edition, 1998; Vora Medical Publication, Bombay; Pp: 98-100 b) Sr. Nancy, Principles and Practice of Nursing; Volume-1; 5* edition, reprinted , 2001; N.R. Publication, Indore; Pp: 234-233 c) Spencer May and Tait Katherine M., Introduction to Nursing; 4" edition, 1978; Blackwell scientific publication, oxford London; Pp: 87 4) Thresyamma C. P., Fundamentals of Nursing Procedure Manual for General Nursing And Midwifery Course; 1* edition, reprint 2004; Jaypee Brothers Medical Publishers, New Delhi; Pp: 392-395Case Presewntation - C - SectionSUBMITTED TO: CASE PRESENTATION ON CAESARIAN SECTION SUBMITTED BY:(CASE PRESENTATION sumecr Toric NAME OF SUPERVISOR ‘SPEAKER cLass/GRouP DATE, TIME DURATION PLACE AV AIDS (Obstetric and obstricel Nursing. (Caesarean Section Mrs, Jyoti Bala Jangid Priyanka Gehlot ‘Me. Nursing final year 22 Feb 2005 1AM 30 Min Flash cards‘After the completion of class the students will be able to— Gain knowledge about caesarean section, “To demify factors associatod in patients comparing with literatures. ‘To discus indications and compliINTRODUCTION ADENTIEICATION DATA [Name ofthe Mother - Poonam Husband's Name Vinod Age - 22 MRD No - 71st Sex - Female Religion Hinds ‘Ward & Unit = Ward S/unitat Bed No 2 ‘Monthly Income = 3000. Gceupition of Mother- House Wife Cceupation of Husband — = Unemployed Adress Paota C Read Jodhpur Religion = Hind Grav - 0Para Abortion Living Date of Admission Dae of Ping Diagnosis Typeofdeivery Date of Delivery Dats of Discharge Indication of Operation « ca (6f0472021 a 04:40 PME 7rowz021 ‘Primi with 40 wks with breech with Preeclampsia, Emergency LSCS done under SA on 6404/2021 roar021 1sou2021 Prion with 40 wks Breech History of Preeclampsia‘Subjective Data Addmlsslan history - Poonam was a booked case of 10/1/05 admited at MDM hospital on 14/205 nt 4.40 pm with Eomplins of headache, dizziness and Teaking per vagina since 2 hrs, ‘Borsonal history -She has an average bull fur, good looking. well behaved concern person. She is non-smoker and murricd doe I year. She is non- Alcoholic too, She educated upto 8.4. 1ST year. She is vegetarian. Medical histary- She had no history of major or chronic illness. She had never been admited to hospitals. She had UTI in month of Dec then took: treatment for 5-7 days, She was B>P of 136/96 ut tims of booking and an antihypertensive, -SurgleaL_hltary- She had no history of any surgery in the pas. Eamlly history - Shei living in jot family, She as 2 brother inlaw and are matrial, There ie no history of diabetes, HEN, Twin pregnancy, TB and any other majorilloese inher family or husbands family. There is na history of genetic disorder or hereditary disorder i either of files Menstrualstary - She started menarche at theage of 15, Shelhad in 4 days. Days 28 eyele. She had dysmenorthoes inher period, LMP > 17408 EDD> 18/1405 ‘OstetricaLhlstary > She ina firs Primi gravida, She ishaving no previous history of abortions or lve birth, ‘She is having an high isk seore of Risk actors Primi Pregnancy associated with HTN, ‘Abnormal presentation‘So she was an high risk mother as score was 5. ‘Blsiary aL Present Pregnancy 1" Trimester- She fad a complaint of mild morning sickness, She had a pricking semation on her breast. She had no history of any spotting, fever. Her dose of TT is completed. Her B. P was on higher side and was on Amlodipine. OD and strict B.P monitoring on visits ‘Second Trimester- She relieved from vomiting. She started gaining wt. She felt fetal movement. Appetite improved Breast size improved and colour ‘changed. Her B.P continues tobe om higher side. She was admited for 1 day and Inj Betamethasone 12mg 2 doses was given at 24 bly interval for mg maturity ‘Third Trimester- She gained mow weight Apotte was good. Breech was diagnoned in UCG of 7 months ic on 28/11/04. She was on stret BP ‘monitoring a well a amlodipine $ mg OD. ChicCcomplaints. on admission - Leaking per vaginum since 2 hes, Feeling ofresilesness. ‘Slight abou pains ‘Olsectxedata- (On examination > on 14/2/05 oc «fir “Temperatures febrile Poles 88 Min BP-13090mmofhgPallor - Mild Heart /Lung-NAD Ror Abdamen- 36 wks by palpation Term sire Presentation -breech ‘Uterus relaxed FHS. regular Pec Vagioum- (Carvin — 1 finger loose ie 2-3 em Effacement - 60-7006 Membrane negative “Liquor clear, leaking + ot Pelvie~ -2 sationInvestigation- Blood group oR Hb 104 gris Ros = 75ma%6 ort. - oR Urie albumin Sugar Nd LET> —Seumbilimbin = — 9 soor 2 sorr a) KET > Blood Urea ~— tBngid Creatinine - 05mg Uric aid ~ amg USG-> —142/05-> SingleSar fun 37 whe +3 days Liquor adequate NoGca Placenta a anterior segment Nit 14 gmt 90-110‘Defiaitian. Tei an operative procedure whereby the fetus offer the end of 28 wh are delivered through am incision on the abdominal and trine wall Ancidences Incidence is steadily ising, During last decade there has been to to thee fold rise in incidence fom inital rate of about 10%, Due to increased safety of the operation dus fo improved anesthesia, availabiliy of blood transfusion and antibiotics, increased awareness of fetal well being, ‘identification of at risk mothers, malpresentations et. Andications, Ts broadly divided into 7 categories ‘Absolute Relative [Absolute -> > Severe degree of contracted Pelvis with tra conjugate less than 7.5 em > Cervical or brand ligament fibroid > Vaginal ares > Advanced caranoma cervix Relative => Contmeted pelvis and cephala-pelvie disproportion. > Previous werine scar. > Fetal distress during frst stage of labour. > Abnormal urine contractions > Prolongation of labour dus to in coordinate uterine action, > Antepartum hacmorrhage — Placenta previa or Abruptio placenta > Malpresentation > Uncorrected or persistent transvelse lic, brow ‘or mentoposterior, big breech arn average size breech along ‘ith associated complicating factors specially in primigravidae My patent had] indiewion of rdative ie Malpresenaticn, Hypertensive disordersNewwww Health Edu - On Postnatal ExerciseINRODUCTION «| STUDENT TEACHERNAME —-HEMLATA BHANWARIA SUBJECT OBSTETRIC AND GYNAECOLOGICAL NURSING: I Toric =POST- NATAL EXCERICES nour VENUE DATE AND TIME DURATION -30MINUTE, METHOD OF TEACHING -LECTURECUMDISCUSSION AY. AIDS Name of Supervisor Mr, YOTI BALA JANGID PREVIOUS KNOWLEDGE OF THE GROUP- Some ofthe woman is less aware about POST NATAL EXERCISE.SPECIFIC OBJECTIVE: Afr the completion of health eduction, postnatal mothers will be able to gain the knowledge regarding postnatal exercise GENERAL OBJECTIVE: ‘Atthe end ofthe health eduestion. Introduce about the postnatal exercise. Deine postnatal exercise, post nal period. Explain importance of postnatal exerese. Enumerate benefit of exercise. Describe the principles of exercise Explain the preparation for postnatal exercise. Enlist the general instruction. Enumerate the postnatal exereise. Discuss the warning sign. [Explain the aftercare ofthe patent"Teaching & Learalng Acti INTRODUCTION: Post-Natal Exercises Postnatal exercises are the| reinforcement of ANC exercises and these shoukl be stunted soon after the delivery. (Childbirth and care of the newborn are both physically exhausting tasks, Most new] ‘mother’ Find that they do not have the same ‘energy level, which they had before their baby was born ‘nthe Fir few months, the mothers ‘ight sloop is disturbed and this add o the ‘cthaustion. The pressures of taking care of ‘newborn and managing the house leaves the smother mentally and physically drained. | ‘number of new mothers have found tha finding the time to do few simple exercises jncremes thar energy levels and makes them feel better mentally as well. During} exercie keep your breath smooth work gradually according to your capabilites, ‘SELE ‘aTRonucTiow: Good morning tall of you. Lum HEMLATA BHANWARIA srs nursing) student. Today Iwill be slscussng postnatal Lecture eum diseussion"Teaching & Learning |_Objestives |__| | _ctivity P| DEFINITION: natal “These are the exercises that are performed in period. the postnatal peri, in order to strengshon pelvie floor and abdominal muscles and prevent complications ie. ill sx weeks after the birth of the-baby. Post natal Pertod +l rofereto the time frm termination of pregnancy tll 42 days'6 week. Exercises Exercise is a physica activity thats planned structured and repetitive forthe purpose af ‘conditioning any part ofthe body ‘To strengthen muscles that was during labour or pregnancy ie. awlominal ‘and pelvic floor muses. “The purpose of performing these exercises is 1+ Redaoe excessive ft ‘© Maintain figure, shape of breasts nd secure adequate milk supply. + Promote woman's rid esovere