ARELLANO UNIVERSITY

Jose Abad Santos Campus

College of Nursing

NCM 1O4-C RLE Community Health Nursing

Alternative Learning Activity
CHN Activity No.: 1

GUINOMMA, Rhica H. BSN 2-2

Submitted to: Prof. Rosechelle Elarco
Date: 8/19/2023

Case Scenario

Marian 25 years old G1P0 was brought and admitted at Poblacion Lying in. She delivered
a baby boy via spontaneous delivery at term. After the delivery, the baby was placed belly
down directly on her mother’s chest for skin-to-skin contact. Three minutes after, the cord
was clamped and cut, and the infant was dried. The infant cries well and appears normal.
The nurse gave the necessary vaccine and attended the newborn care.

The nurse in charge scheduled when will Marian and her baby visits the Health Center for
follow up check-up.

On a prenatal clinic day, as an assigned community health nurse you were going over the
record files of your patients. You crossed check the file with the appointment booked and
realized that Marian failed to attend her scheduled appointment in your Health Center.
You took her family enveloped and went over her record of previous follow up.

You decided to do a home visit follow up on Marian and her baby.

Answer the following:

PURPOSE of the HOME VISIT:

a. To provide the needed support of the new mother and infant to recover, as well as give
assistance to the family in terms of;
i. health promotion,
ii. progress of recovery,
iii. providing resources,
iv. awareness to child immunization,
v. mood and emotional well-being
vi. infant care and feeding,
 vii. birth spacing and;
viii. disease prevention.

b. To teach a responsible family member to give a subsequent care to the mother with a
postpartum issue she might experience, such as; postpartum depression, backaches,
sore nipples, breast discomfort, and other breastfeeding issues, hemorrhoids, painful
intercourse, frequent headaches, depressive sensations, physical tiredness, and sleep
loss.

PLANNING:
1. What information should you know first before going to the family or particular client?
a. Before scheduling a visit, gather clinical information such as;
i. Client’s home address and contact information,
ii. Health history,
iii. Family health background;
iv. Delivery date,
v. Weeks passed after delivery, and;
vi. Infant immunization records.

2. What tools/resources would you gather?

a. I would bring the following paraphernalia:

Tools/Resources Rationale
1. Thermometer To measure temperature.
2. Tape measure To measure the height of the infant.
3. Baby scale To measure the weight of the infant
4. Medicine dropper For administering medications
5. Rubber suction If there will be any secretions on the
infant’s ears and nose
6. Liquid soap and hand For my handwashing
towel
7. Waste receptacle A container for waste materials
8. Medical gloves To protect myself as a nurse.

3. What logistics should be in place?

a. Prior to home visit these logistics must be prepared:
i. Transportation (good working condition and gas)
ii. Approved schedule of visit (daylight hours only)
 iii. Map of patient’s location and familiarize the route.
iv. When visiting crime-prone areas, visit with another person.

4. What safety issues should be considered?

a. Safety precautions in Home Visit are as follows:
i. Low network signal
ii. Getting lost in the location.
iii. Emergency exits of the house.
iv. Intoxicated and hostile patient or family member.
v. Family arguments and abuse.
vi. Cluttered pavements
vii. Potential fire hazards
viii. Air or water pollution
ix. Inadequate sanitation

5. How would you prepare yourself for the visit?

a. I would prepare myself through:

i. Honing my communication skills because it allows me to convey and

get important information during visits with clients, and strong
interpersonal skills aid me in connecting with my patients, earning their
trust, and forming positive relationships with them, which enhances
my capacity to deliver high-quality care.

ii. Equipping myself with updated and relevant knowledge for the patient,
but at the same time empathetic of their situation to build rapport and
trust.

iii. Desiring to help and reach people outside the hospital setting.

iv. Remaining calm in stressful situations.

v. Being attentive to detail.

vi. Before visiting, check family folders or personal health records for
information.

vii. Know what procedures or health education your family needs to

receive.

viii. Keep everything you'll need in your backpack to take care of your family
members.
 ix. Know any health-related services that are offered close to the family
you are visiting.

IMPLEMENTATION:

a. SOCIALIZATION PHASE - Establish rapport with the client and family.

• “Magandang araw po Ma’am Marian, ako po si Rhica Guinomma, ang inyo pong
student nurse na mula pa po sa Arellano University. Ngayon po ay magsasagawa
po ako ng home visit sainyo mommy saka na rin po kay baby, isasagawa po natin
ito para siguraduhing maayos po ang kalagayan ninyo ni baby. Okay lang po ba
na magproceed tayo?”

• “Kamusta naman po kayo ni baby? Ano po ang pangalan ni baby?”

• “Bago po tayo magsimula ay matanong ko lang po kung meron po kayong concern

o problema nang sa ganon ay maagapan po natin.”

b. WORKING/ PROFESSIONAL PHASE - problem solving techniques to situation found

in the home, purpose of visit, planning with the family to resolve health problem
situations.
COMMON PROBLEMS SOLUTION
• Analyze the mother's behavior, emotions, and mental
1. Postpartum health.
depression • The mother should receive postpartum depression
education.
• Promote a balanced diet.
• Support the individual and promote self-care.
• Get a social worker involved who can organize support
groups.
• Encourage the patient to ask for aid by speaking up.
• Promote social interaction with the patient.
• Make sure the postpartum nurse monitors the patient
closely.
• suggest a psychiatrist or a therapist to the patient.
• Encourage the patient to frequently take a break from infant
care.
• Teach the mother how to latch the infant properly.
2. Breast • Teach different breastfeeding positions.
discomforts such • Advise the mother to leave some milk on nipples and let it
as sore nipples, air-dry.
swollen breast, • Use water only to wash nipples.
and mastitis • Apply warm compress.
• Refer to professional help
 • Give the patient a "donut cushion" to sit on.
3. Hemorrhoids and • Apply topical medicine as directed.
Hemorrhage • Apply stool softeners as directed.
• Inform the patient and/or family on how to stop the mothers
prolapse-causing straining and hard lifting.
• By keeping soft stools, increasing volume, fiber, and fluid
intake, as well as consuming fruits and vegetables, it is
possible to prevent straining during bowel movements.
• Warm sitz baths or suppositories with anesthetic
ingredients can assist to temporarily reduce pain.
• scheduled periods for sleeping and resting.
4. Fatigue and sleep • Help the mother create a timetable for her daily activities
deprivation and rest. Stress the value of taking regular breaks.
• Teach energy-saving techniques. As required, work with an
occupational therapist.
• Help the patient define priority for their chosen activities and
job duties.
• To supply energy, the patient will require a properly
balanced meal of lipids, carbs, proteins, vitamins, and
minerals.
• Encourage a proper workout and conditioning regimen.
• Offer calming diversionary activities.
• Inform the patient and their family about time management
and task organization techniques.
• Energy restoration can be aided by encouraging relaxation
before bed and allowing for several hours of uninterrupted
sleep.
• Lifestyle changes such as including more fiber in your diet.
5. Fecal • Medication to slow down your large bowel and increase
incontinence water absorption.
• Obtain the proper nutrients. Eat well and keep taking your
6. Hair loss prenatal vitamin supplement to maintain healthy hair.
• To avoid excessive hair loss after pregnancy, exercise extra
caution. Use a good conditioner, a wide-toothed comb, and
only shampoo when absolutely required to prevent tangling.
• Pick the appropriate accessories. Instead of using elastic
bands to hold hair up, use scrunchies or barrettes, and
avoid pulling hair into tight ponytails.
• Try to avoid using flat irons, curling irons, and blow dryers.
• Stop using therapies that are based on chemicals.
Postpone getting your hair straightened, permed, or
highlighted until the shedding stops.
• Hair loss after pregnancy may be a sign of postpartum
thyroiditis; consult a doctor if it is along with other
symptoms.
• Cleaning the vaginal area properly.
7. Perineal pain
 • Use ice on your perineum for the first 24 hours after giving
birth to lessen pain and edema. At home, you can keep
using ice as needed.
• Tighten the muscles in your perineum, buttocks, and thighs
when you sit upright on the bed or on the chair.
• Cleanse your stitches by squirting warm water from the top
of the stitches back toward the rectum after urinating or
going to the bathroom.
• Clean sanitary pads should be applied from front to back.
• The mother can begin taking hot sitz baths twelve hours
after giving birth to her child.

c. SUMMARY PHASE - documentation of significant findings

8/19/2023
2:30 PM
R.H.G., Student Nurse

SUMMARY OF FINDINGS
Mother Baby (Boy)
o o
T: 36 C T (axillary): 37 C
HR: 80 bpm HR: 100 bpm
RR: 19 breaths RR: 35 breaths
Spo2: 98% Spo2: 98%
BP: 120/80 mmHg BP: 90/60 mmHg

Subjective Cue: Anthropometric Measurements

Weight: 10 lbs.
“Mahapdi ang utong ko at namamaga ang Height: 22 in.
dibdib ko. Madalas din ang pagsakit ng Chest Circum.: 16 in.
puwerta ko at di ako makatulog kakabantay sa Head Circum.: 16 in.
anak ko kaya palagi akong pagod”
Subjective Cue from mother:

“Hindi po nagrereact ang baby ko sa

Objective Cues: malalakas na tunog”

Mild alertness and disoriented.

PERRLA. Objective Cues:

Mother’s airways are patent and can speak full Sclera and conjunctiva are clear, free of
sentences. discharge and lesions.

Equal rise and fall of chest wall. Eyes have transient edema.

Pain score in the nipple and breast – 7 PERRLA.

With adequate intake of fluids. Baby airways are patent.

 Sufficient urine output. Gums appear pink and moist.

Capillary refill 2 seconds. No reaction to noise, might indicate hearing

impairment.
Poor appetite.
Barrel-chested.
Needs assistance to some of activities of daily
living. Umbilicus is pink. No discharge, odor,
redness, or herniation.
Pain score in vaginal area – 6
Penis is normal size for age and no lesions.

Diaper rush.

Positive Babinski reflex.

d. EVALUATION - evaluate the family situation. Write a summary of your visit include
your recommendations based on the present problems and situation.

Marian is a first-time mother, and she will need a lot of support in the coming weeks and
months. Having a doula or the help of a family member can be very helpful, especially during
the postpartum period. A doula is a trained professional who can provide physical, emotional,
and informational support to mothers during pregnancy, childbirth, and the postpartum period.
They can help with things like breastfeeding, bathing the baby, and managing pain. Having a
doula can also help to reduce stress and anxiety, which can be common in new mothers.

I also think it is important for Marian to see a healthcare professional in person. They can
assess her vaginal and breast tenderness and rule out any underlying medical conditions.

Here are some additional things that Marian can do to get support:

• Join a new mothers' group. This is a great way to meet other mothers who are going
through the same things as you. You can share experiences, get advice, and make
friends.

• Read books and articles about motherhood. This can help you to learn more about what
to expect and how to care for your baby.

• Talk to your friends and family about your experiences. They can offer you support and
understanding.

Being a new mother can be challenging, but it is also an amazing experience. Marian should be
sure to take care of herself and to ask for help when she needs it.