GOVERNMENT

COLLEGE OF
NURSING, DAMAN
ANTENATAL CASE STUDY

ON

ANTENATAL ANEMIA

SUBJECT: OBSTETRICS AND GYNECOLOGICAL

NURSING II

SUBMITED TO, SUBMITED BY,

MRS NAJBUNNISHA PATIL RAJESHREE

NURSING TUTOR 1 ST YEAR MSC (N)

G.C.O.N, DAMAN G.C.O.N, DAMAN

DATE OF SUBMISSION
 INDEX
SR NO TOPICS PAGE
NO
1 INTRODUCTION

2 PATIENT HISTORY-PRESENT AND PAST SURGICAL AND

MEDICAL HISTORY
3 FAMILY HISTORY

4 PERSONAL HISTORY

5 PHYSICAL EXAMINATION

6 INVESTIGATION

7 MEDICATION

8 ANATOMY AND PHYSIOLOGY

9 DISEASE CONDITION
 INTRODUCTION
NAME : MS Patil Rajeshree

CLASS :1st Year MSc Nursing

SUBJECT : Obstetrics and Gynaecological Nursing

TOPIC : Antenatal Anaemia

DATE :

As a part of our clinical experience in Nursing education. We were posted in antenatal ward
in Community Health Center, Daman. There I get chance to give care to patient with ANTANATL
ANEMIA
 DEMOGRAPHIC DATA
Name: Mrs. Anitaben Patel

Age: 20 years

Sex: female

Address: Mishal chawk, Nani Daman, Daman & Diu

Religion: Hindu

Marital status: Married

Education: B.Com

Occupation: Teacher

Income: 20,00 per month

Ward: MCH ward (antenatal)

Date of Admission:

Obstetrical score:

Gestational age:

L.M.P:

EDD:

Diagnosis:

II. CHIEF COMPLAINTS (ON THE DAY CARE STARTED):

Patient was admitted in community health centre, Daman on 20/05/2023 at 11:00 am with
the complain of fever, body ache, generalized weakness and pallor and also with diagnosed with the
antenatal anaemia. After that mother is under treatment now

III. PRESENT ILLNESS / PRESENT HEALTH STATUS:

DAY-1
Mrs. Anita came with the complain of fever, body ache, generalized weakness and pallor So she is
advice to get admit in antenatal ward.

Examination findings: P/A- uterus 32 weeks, FHS- 140/min, and relaxed

Investigation advised- HbsAg, HIV, PT,INR,BT,CT,LFT & RFT

- all investigation results are within normal limit.

- Her Hb was 7.2 gm% and blood group was B+ve.

Treatment adviced- FD + HPD

Inj.iron sucrose 5mg Iv in 100ml NS.

INj.cefotaxim 1.gm IV BD

INj.Rantac 50mg IV BD

Tab.folic acid 10mg orally BD

Doctor Advice- Monitor for the vital signs& FHS

DAY – 2

PATIENT’S COMPLAINTS - Back pain ,

Weakness

FINDINGS: P/A – uterus 32 weeks –

FHS – 150/min and regular

TREATMENT

Tab Iron Od

Tab calcium Od

Doctor Advice: Monitor for the vital signs & FHS

DAY – 3

PATIENT’S COMPLAINTS – Back pain ,weakness

TREATMENT – same treatment continued

DAY – 4

PATIENT’S COMPLAINTS – Weakness

TREATMENT – same treatment continued

DAY-5

PATIENT COMPLAINS - Nil

TREATMENT- same treatment continued

IV. PAST HISTORY

Medical: She had no history of any communicable disease like HT, DM or IHD any other

Illness: No allergy to any medication and food

Surgical: No any past surgical history

V. MENSTRUAL HISTORY

Menarche: at the age of 14 yrs

Flow: moderate

Duration: 4-5 days

Frequency: 28-30 days

Other complaints: no any complain

Obstetrical score: G1 P0 L0 A0 D0

VI. MARITAL HISTORY:

She got married at the age of 18 years. Her duration of married life is 1 years. She has
nonconsanguineous type of marriage.

VII. CONTRACEPTIVE HISTORY:

She or her husband has not used any type of contraceptive measures.

VIII. PAST OBSTETRICAL HISTORY

No any past obstetrical history.

IX. PRESENT OBSTETRICAL HISTORY

1st trimester:

Pregnancy was confirmed by urine pregnancy test. She had no complaints of nausea, vomiting or
anorexia. She had complaints of frequency of urine. Lab investigations of ANC profile was done. All
results are within normal limits. First dose of T.T taken. Folic acid and ferrous sulphate supplements
started.

2nd trimester:

She felt quickening at 18 weeks of gestation. In this trimester she is advised for obstetrical USG and
finding was normal. 2nd dose of Inj. T.T. was given to her. Iron folic acid and calcium supplements
started. She was taking it regularly. No any other problem or complaints in this trimester.

3rd trimester:

In this trimester she came for her ANC check up and she finds with HB- 7.2gm So She is admitted in
community health centre, Daman for the treatment.
 ANTENATAL ASSESSMENT
1) HEIGHT: 156 CMS

2) WEIGHT: 46 KGS

3) GENERAL OBSERVATION:

 Constitution: thin body built

 Stature : Normal
 State of Nutrition : Good
 Personal appearance : clean
 Posture : Good
 Emotional stage : Anxious
 Skin : dry, pallor
 Cooperativeness : Cooperative

4) VITAL SIGNS:

Temperature: 100 F

Pulse: 88 beats/min

Respiration: 24 breaths/min

Blood pressure: 100/54 mm of hg

5) HEAD TO TOE ASSESSMENT:

HEAD

 Scalp: clear, no injury scar or dandruff present.

 Hair: Black hair, hair equally distributed.
 Movements of the head: Full range of movement

FACE: Cholasma present, facial puffiness present

EYES:

 Periorbital oedema: present

 Eye lids/Eye lashes: No lesion or infection
 Conjunctiva: pink
  Pupils: PERLA
 Sclera: white
 Abnormal discharge: not present
 Vision: Normal

EARS

 Congenital anomalies: Not present

 Discharge: absent
 Hearing: Normal
 Lesion: Absent

NOSE

 Appearance: No Septal deviation

 Discharge: No
 Polyps: Not evident
 Nasal congestion: Absent

MOUTH AND THROAT:

 Lips: Dry
 Tongue: No glossitis or coated tongue
 Teeth: Dental carries present.
 Gums: Gingivitis absent
 Tonsil: No swelling of redness.

NECK:

 Range of movement: Normal

 Carotid pulse: felt
 Lymph node: No enlargement
 Thyroid gland: Feel smooth and firm
 Cyst and tumor: Absence

CHEST AND RESPIRATORY SYSTEM:

 Inspection: Size and shape normal, chest expansion equal in both side and respirations are
normal
  Auscultation: Breath sounds are normal, normal resonance sound on both sides. Respiratory
rate 20 bpm, S1 and S2 heart normal, HR- 88 bpm

BREAST

Inspection

 Size: enlarged
 Shape: symmetrical
 Skin of breast: no any other changes
 Areola: primary & secondary areola present
 Skin of breast: no any other changes
 Nipple: erect
 Skin: no visible prominent veins or Striae. Montgomery’s tubercles not visible.

Palpation: soft, no any abnormal mass. Colostrums expressed.

ABDOMEN:

Abdominal girth: 86 cm

Fundal Height: 30 cm (Inch tape method) 32 weeks (finger breadth method)

a) Inspection :
 Adequate according to gestational age.
 No any previous scar is visible.
 Muscle tone intact.
 Contour normal flank full.
 Linea nigra visible between symphysis pubis and xyphoid sternum
 Umbilicus flat
 Striae gravida visible at lower abdomen. Bladder empty
 External foetal movement visible.
b) Palpation :
 Fundal palpation- a broad soft mass felt at upper pole of uterus indicates fetal buttocks
 Lateral palpation – ‘C’ shaped continuous curvature is present on Rt. Side indicating
fetal back & irregular mass felt on Lt. Side indicating foetal limbs.
 I st Grip – hard, globular mass felt indicating head of foetus
 IInd Grip – head is ballotable indicating no engaged head.
c) Auscultation:
 FHS heard at Rt. Side and more laterally at the level of umbilicus. It is 145 beats/min
and regular Impression:
 Position – ROA
 Presentation – vertex
 Lie – longitudinal
 FHS – 145 beats/min
GENITALIA:
 No vulval oedema or any bleeding or discharge present.
 No complaints of itching.
UPPER EXTREMITIES:
 Normal movement,
 No deformities,
 No lymph node enlargement
LOWER EXTREMITIES:
 Normal movement.
 Oedema present.
 Homan’s sign negative
 INVESTIGATIONS

SR INVESTIGATIONS PATIENTS NORMAL REMARK

N VALUE VALUE
O
1 CBC:
Haemoglobin 11-16 g/dl
Leukocyte count 4000-11000/cmm
WBC differential count:
Neutrophils 30-70%
Lymphocytes 20-40%
Eosinophils 1-6%
Monocytes 1-8%
Basophils < 2%
Platelets count 150-450 thousand
/cmm

ULTRASONOGRAPHY OF ABDOMEN & PELVIS

Liver:

 No focal mass.
 normal size, contour and parenchymal echotexture

Gall bladder: shows physiological distension

Pancreas, spleen, portal vein, kidneys, pelvis: normal

Uterus: normal in size, both ovaries are normal.

No any mass or lesion found.

DRUG STUDY

Sr no Medication name Dose/Route Frequency Action

1
 ANATOMY AND PHYSIOLOGY THE BLOOD
• Blood is a fluid connective tissue. It circulates continually around the body, allowing constant
communication between tissues distant from each other.

• Blood makes up about 7% of body weight (about 5.6 litters in a 72 Kg man). This proportion is
less in women, while in children is greater (gradually decreasing until the adult level is reached).

FUNCTIONS OF THE BLOOD

1) The main function of the blood is to maintain intracellular homeostasis by:

 Carries O2 and nutrients (glucose, amino acids, lipids, and vitamins) to the cells.
 Carries CO2 and other wastes (nitrates, creatine, nucleic acid) away from the cell.

2) Providing intercellular communication in the body: carries hormones (secreted by endocrine

glands) to the target organs.

3) Production and defence: it allows cells and immunological proteins to transport from place to
place where need them.

4) Self repair mechanism: clotting cascade.

BLOOD COMPONENTS

• Blood is composed from 2 fractions:

1. Plasma: Non living extracellular matrix composes about 55% of total blood volume.

2. Formed elements (living cells) compose about 45% of total blood volume.

• The two frictions of blood can be separated by spinning.

PLASMA

The constituents of plasma are:

1. Water (90-92%)

2. Plasma proteins: make up about 7% of plasma.

 Albumins (about 60% of total plasma protein) they are responsible for maintain normal
plasma osmotic pressure. Albumins also act as carrier molecules for free fatty acids, some
drugs and steroid hormones.
 Globins their main functions are: as antibodies (immunoglobulin’s), transportation of some
hormones and mineral salts (e.g. thymoglobulin carries the hormone thyroxin and
transferring carries the mineral iron.
 Clotting factors. These are responsible for coagulation of blood. And inhibition of some
proteolytic enzymes (e.g. macroglobulin inhibits trypsin) activities)

3. Inorganic salts (electrolytes) like Ca, Na, Po4 which are responsible for muscle contraction,
transmission of nerve impulses, --ECT

4. Nutrients: glucose, amino acid, fatty acids and glycerol.

5. Waste products like urea, creatinine and uric acid they are carried in the blood to the kidney for
excretion.

6. Hormones and gases Formed Element

CELLULAR CONTENT OF BLOOD

• There are three types of blood cell:

1. Erythrocytes (Red Blood Cells =RBC).

2. Platelets (thrombocytes)

3. Leukocytes (white blood cells = WBC) they include monocytes, lymphocytes, neutrophils,
eosinophils, and basophils.

SOURCE OF BLOOD CELLS

• Mature blood cells have a relatively short life spine

• Blood cells are synthesised mainly in the red bone marrow

• Some lymphocytes additionally are produced in lymphoid tissue.

• The organ or system responsible for synthesis blood cells are called hematopoietic system and the
process of blood cell formation is called haematopoiesis.
 DISEASE CONDITION
ANTINATAL ANEMIA
Anaemia is the commonest haematological disorder that may occur in pregnancy, the others being
rhesus is immunization and blood coagulation disorders

DEFINITION

According to the standard laid down by WHO, anaemia in pregnancy is present when the
haemoglobin concentration in the peripheral blood is 11 g/100 ml or less. During pregnancy plasma
volume expands (maximum around 32 weeks) resulting in haemoglobin dilution. For this reason,
haemoglobin level below 10 g/dl at any time during puerperium is considered anaemia (WHO, 1993;
CDC, 1990).

CLASSIFICATION OF THE POSTNATAL ANEMIA

BOOK PICTURE PATIENT PICTURE

• Physiological anaemia of pregnancy Patient have Iron Deficiency
• Pathological Anemia
DEFICIENCY ANEMIA (ISOLATED OR COMBINED)
 Iron deficiency
 Folic acid deficiency
 Vitamin B12deficiency
 Protein deficiency HEMORRHAGIC
 Acute: Following bleeding in early months or APH or
PPH
 Chronic: Hookworm infestation, bleeding piles, etc
HEREDITARY
 Thalassemias
 Sickle cell hemoglobinopathies
 Other hemoglobinopathies
 Hereditary hemolyticanemias (RBC membrane defects,
 spherocytosis)
• BONE MARROW INSUFFICIENCY
hypoplasia or aplasia due to radiation, drugs (aspirin,
indomethacin)
• ANEMIA OF INFECTION (malaria, tuberculosis, kalaazar
• CHRONIC DISEASE (renal) or neoplasm
• HEMATOLOGIC MALIGNANCY (leukemias, lymphomas)
Arbitrary grading of pathological anemiais done according to the
level of hemoglobin:
• mild—between 8 gm% and 10 gm%,
• moderate—less than 8 to 7 gm% and
• severe—less than 7 gm%
 PATHOPHYSIOLOGY
Maternal plasma volume increases by about 40-50%, RBC volume increases by 20%

There is relative fall in the level of haemoglobin and hamatocrit during pregnancy.

In addition, there is marked demand of extra from during pregnancy especially in the second half.
Even an adequate diet cannot provide the extra demand of iron.

Thus, there always remains a physiological iron deficiency state during antenatal period.

As a result, there is not only a fail in haemoglobin concentration and hematocrit value in the second
half of pregnancy but there is also associated low serum iron, increased iron binding capacity and
increased rate of iron absorption as found in iron deficiency

Thus the fall in the haemoglobin concentration during pregnancy is due to combined effect of
hemodilution and negative iron balance.

Antenatal Anaemia
 ETIOLOGY

BOOK PICTURE PARIENTS PICTURE

BEFORE PREGNANCY:
 Faulty dietetic habit:
 Faulty absorption mechanism:
 Iron loss:
 more iron is lost through sweat to the extent of 15 mg
per month
 Repeated pregnancies at short intervals along with a
prolonged Period of lactation
 Excessive blood loss during menstruation which is left
untreated and uncared for
 Hookworm infestation with consequent blood
depletion to the Extent of 0.5–2 mg of iron daily (each
worm extracts up to 0.05 ml of the blood per day).
 Chronic malaria,
DURING PREGNANCY:
• Increased demands of iron:
• Diminished intake of iron:
• Diminished absorption:
• Disturbed metabolism:
• Pre-pregnant health status:
• Excess demand:
i. Multiple pregnancy increases the iron demand by twofold.
ii. Women with rapidly recurring pregnancy, within 2 years
following the last delivery, need more iron to replenish
deficient iron reserve.
iii. The demand of iron which accompanies the natural growth
before the age of 21 should not be underestimated, especially
where teenage pregnancies are quite prevalent.
 CLINICAL MANIFESTATIONS

BOOK PICTURE PATIENT’S PICTURE

SYMPTOMS:
1. Lassitude and fatigue or weakness may be the earliest
manifestations.
2. The other features are
 anorexia and
 indigestion;
 palpitation caused by ectopic beats, dyspnea, giddiness
and
 Swelling of the legs.
ON EXAMINATION:
1. There is pallor of varying degrees; evidences of glossitis
and stomatitis.
2. Oedema of the legs may be due to hypoproteinemia or
associated preeclampsia.
3. A soft systolic murmur may be heard in the mitral area due
to physiological mitral incompetence.
4. Crepitations may be heard at the base of the lungs due to
congestion.
 Disturbed sleep
 Pain in the abdomen or epigastric area (tummy)
 Blurred vision
 Sudden blindness
 DIANGOSTIC FINDINGS

BOOK PICTURE PATIENT’S PICTURE

• History taking
• Physical Examination

TO NOTE THE DEGREE OF ANEMIA:

This requires haematological examination which includes
estimation of:
1. Haemoglobin,
2. total red cell count (The red cell count is not of great value
unless changed to the extreme) and
3. Determination of packed cell volume.

TO ASCERTAIN THE TYPE OF ANEMIA:

Peripheral blood smear:
Haematological indices:
 Calculation of MCHC, MCV and MCH is based on the
values of haemoglobin estimation,
 Total red cells count and PCV. MCV and MCH values
 MCHC is the most sensitive index of iron deficiency
anaemia
A typical iron deficiency anaemia shows the following blood
values:
 Haemoglobin—less than 10 gm%,
 red blood cells —less than 4 million/mm3
 PCV—less than 30%,
 MCHC — less than 30%,
 MCV — less than 75 µ3and
 MCH—less than 25 pg
TO FIND OUT THE CAUSE OF ANEMIA:
 Examination of stool
 The urine is examined for the presence of protein, sugar and
pus cells.
 X-ray of chest
 bone marrow study
 MANAGEMENT

BOOK PICTURE PATIENT’S PICTURE

THE PROPHYLAXIS INCLUDES:

 Avoidance of frequent child-births
 Supplementary iron therapy:
Daily administration of 200 mg of ferrous sulphate
(containing 60 mg of elemental iron) along with 1 mg folic
acid is a quite effective prophylactic procedure. Tea should
be avoided within 1 hour of taking iron tablet.
 Dietary prescription:
The foods rich in iron are liver, meat, egg, green vegetables,
green peas, figs, beans, whole wheat and green plantains,
onion stalks, jaggery, etc. Iron utensils should preferably be
used for cooking and the water used in rice and vegetable
cooking should not be discarded.
 Adequate treatment should be instituted to eradicate
hookworm infestation, dysentery, malaria, bleeding piles,
and urinary tract infection.
 Early detection of falling haemoglobin level is to be made.
Haemoglobin level should be estimated at the first antenatal
visit, at the 30th week and finally at 36th week.
CURATIVE
1. Hospitalization:
2. General treatment:
 Diet: A realistic balanced diet rich in proteins, iron
and vitamins and which is easily assailable is
prescribed.
 To improve the appetite and facilitate digestion,
preparation containing acid pepsin may be given
thrice daily after meals.
 To eradicate even a minimal septic focus by
 appropriate antibiotic therapy.
 Effective therapy to cure the disease contributing to
the cause of anemia.
3. Specific therapy
IRONTHERAPY:
1. Oral therapy
2. Parenteral therapy
ORAL THERAPY
 preparations available are ferrous gluconate, ferrous
fumarate or ferrous succinate
 Fersolate tablet contains 325 mg ferrous sulphate
which contains 60 mg of elemental iron, trace of
copper and manganese. The initial dose is one tablet
to be given thrice daily 30 minutes before meals. If
larger dose is necessary (maximum six tablets a
day), it should be stepped up gradually in 3–4 days.
PARENTERAL THERAPY:
Intravenous route:
 Repeated injections
 Total dose infusion (TDI) The compounds
used are:
 Iron (ferrous) sucrose compound, sodium
ferric gluconateor iron dextran.
 Sodium ferric gluconate complex 12.5
mg/dose usually one dose/day, usually 8
doses needed (12.5 mg elemental iron/ml).
 Iron (ferrous) Sucrose: (20 mg elemental
iron/ml) 100 mg/dose, usually one dose daily
for 10 days.
Intramuscular therapy: The expected rise in haemoglobin
concentration after parenteral therapy is 0.7 to 1 g/100 ml/week.
The compounds used (with elemental iron/ml) are—
 Iron sucrose (20 mg/ml)
  Iron-dextran (Imferon) (50 mg/ml)
 Sodium ferric gluconate complex 12.5
mgelemental iron/ml
To prevent dark staining of the skin over
the injection sites and to minimize pain,
the injections are given with a 2 inch
needle deep into the upper outer quadrant
of the buttock using a ‘Z’ technique
(pulling the skin and subcutaneous
tissues to one side before inserting the
needle)
PLACE OF BLOOD TRANSFUSION
The indication of blood transfusion in anaemia during pregnancy is
very much limited. The indications are :
(1) To correct anaemia due to blood loss and to combat postpartum
haemorrhage.
(2) Patient with severe anaemia seen in later months of pregnancy
(beyond 36 weeks)
(3) Refractory anaemia: Anaemia not responding to either oral or
parenteral therapy in spite of correct typing.
(4) Associated infection Exchange transfusion:

MANAGEMENT DURINGLABOR FIRST STAGE:

The following are the special precautions that are to be taken when
an anaemic patient goes into labour.
 The patient should be in bed and should lie in a position
comfortable to her.
 Arrangements for oxygen inhalations to be kept ready to
increase the oxygenation of the maternal blood and thus
diminish the risk of fetal hypoxia.
 Strictasepsisis to be maintained to minimize puerperal
infection.

SECOND STAGE :
Asepsis is maintained. Prophylactic low forceps or vacuum delivery
may be done to shorten the duration of second stage. Intravenous
methergine 0.2 mg should be given soon following the delivery of
the baby.

THIRD STAGE:
Significant amount of blood loss should be replenished by fresh
packed cell transfusion after taking the usual precautions mentioned
earlier. The danger of postpartum overloading of the heart should
be avoided.

PUERPERIUM:
(1) Prophylactic antibiotics are given to prevent infection.
(2) Pre delivery anti anemic therapy
(3) Patient should be warned of the danger of recurrence in
subsequent pregnancies
 COMPLICATIONS OF ANEMIA IN PREGNANCY

DURING PREGNANCY

1. Preeclampsia may be related to malnutrition and hypoproteinaemia.

2. Intercurrent infection Heart failure at 30–32 weeks of pregnancy.
3. Preterm labour.

DURING LABOR:

1. Uterine inertias
2. Postpartum haemorrhage
3. Cardiac failure
4. Shock

PUERPERIUM:

1. Puerperal sepsis
2. Subinvolution
3. Poor lactation
4. Puerperal venous thrombosis
5. Pulmonary embolism.

RISK PERIODS:

1. At about 30–32 weeks of pregnancy

2. During labour
3. Immediately following delivery
4. Any time in puerperium especially 7–10 days following delivery due to cardiac
failure or pulmonary embolism.

EFFECTS ON BABY:

1. There is increased incidence of low-birth-weight babies with its incidental hazards

2. Intrauterine death
 THEORY APPLICATION
IMOGENE KING'S THEORY OF GOAL ATTAINMENT

ITRODUCTION

BASIC ASSUMPTIONS

 Nursing focus is the care of human being

 Nursing goal is the health care of individuals & groups
 Human beings: are open systems interacting constantly with their environment.
 Basic assumption of goal attainment theory is that nurse and client communicate information,
set goal mutually and then act to attain those goals, is also the basic assumption of nursing
process
 “Each human being perceives the world as a total person in making transactions with
individuals and things in environment”
 “Transaction represents a life situation in which perceiver & thing perceived are encountered
and in which person enters the situation as an active participant and each is changed in the
process of these experiences”

MAJOR CONCEOTS

 Interacting systems: o personal system o Interpersonal system

 Social system Concepts for Personal System
 Perception
 Self
 Growth & development
 Body image
 Space
 Time

Concepts for Interpersonal System

 Interaction

 Communication
  Transaction

 Role

 Stress

Concepts for Social System

 Organization

 Authority

 Power

 Status

 Decision making

PROPOSITONS OF KING’S THEORY

 If perceptual interaction accuracy is present in nurse-client interactions, transaction
will occur If
 nurse and client make transaction, goal will be attained

 IF goal are attained, satisfaction will occur

 If transactions are made in nurse-client interactions, growth & development will be

enhanced
 If role expectations and role performance as perceived by nurse & client are
congruent, transaction will occur
 If role conflict is experienced by nurse or client or both, stress in nurse-client
interaction will occur
 If nurse with special knowledge skill communicate appropriate information to client,
mutual goal setting and goal attainment will occur.

NURSING PARADIGMAS

1. Human being /person

 Human being or person refers to social being who are rational and sentient.

 Person has ability to :

 perceive
  think

 feel

 choose

 set goals

 select means to achieve goals and

 to make decision

 Human being has three fundamental needs:

1. The need for the health information that is unable at the time
when it is needed and can be used
2. The need for care that seek to prevent illness, and
3. The need for care when human beings are unable to help
themselves

2. Health

• Health involves dynamic life experiences of a human being, which implies

continuous adjustment to stressors in the internal and external environment through
optimum use of one’s resources to achieve maximum potential for daily living.

3. Environment

• Environment is the background for human interactions.

• It involves:

i. Internal environment: transforms energy to enable person to adjust to

continuous external environmental changes.

ii. External environment: involves formal and informal organizations. Nurse is

a part of the patient’s environment.

4. Nursing

 Definition: “A process of action, reaction and interaction by which nurse and

client share information about their perception in nursing situation.” and “ a
process of human interactions between nurse and client whereby each perceives
the other and the situation, and through communication, they set goals, explore
means, and agree on means to achieve goals.”
  Action: is defined as a sequence of behaviors involving mental and physical
action.
 Reaction: which is considered as included in the sequence of behaviors
described in action.
 In addition, king discussed:

 goal

 domain and

 functions of professional nurse

 Goal of nurse: “To help individuals to maintain their health so they can function
in their roles.”
 Domain of nurse: “includes promoting, maintaining, and restoring health, and
caring for the sick, injured and dying.
 Function of professional nurse: “To interpret information in nursing process to
plan, implement and evaluate nursing care.

THEORY OF GOAL ALATTAAINMENT AND NURSING PROCESS

Assessment

 Assessment occurs during interaction.

 The nurse brings special knowledge and skills whereas client brings knowledge of self and
perception of problems of concern, to this interaction.
 During assessment nurse collects data regarding client (his/her growth & development,
perception of self and current health status, roles etc.)
 Perception is the base for collection and interpretation of data.

 Communication is required to verify accuracy of perception, for interaction and transaction.

Nursing diagnosis
 The data collected by assessment are used to make nursing diagnosis in nursing process.

 In process of attaining goal the nurse identifies the problems, concerns and disturbances
about which person seek help.

Planning
  After diagnosis, planning for interventions to solve those problems is done.

 In goal attainment planning is represented by setting goals and making decisions about
and being agreed on the means to achieve goals.
 This part of transaction and client’s participation is encouraged in making decision on
the means to achieve the goals. Implementations
 In nursing process implementation involves the actual activities to achieve the goals.

 In goal attainment it is the continuation of transaction.

Evaluation

 It involves to finding out whether goals are achieved or not.

 In king description evaluation speaks about attainment of goal and effectiveness of nursing
care.

Nursing Process and Theory of Goal Attainment

Nursing process method Nursing process theory

A system of oriented actions A system of oriented concepts
Planning Perception, communication and interaction of
nurse and client
Implementation Transaction made
Evaluation Goal attained
 Nursing diagnosis
1. Ineffective Thermoregulation, Hyperthermia related to infection secondary to antenatal
anaemia as evidenced by increased body temperature (100 F) and warm body.
2. Deficit fluid volume related antenatal anaemia as evidenced by dry and pallor skin and low
Hb level.
3. Imbalanced nutrition less than body requirement related to anorexia secondary to antenatal
anaemia as evidenced by input / output chart.
4. Activity intolerance related to weakness secondary to anaemia as evidenced by patient is
verbalization observation.
5. Self-care deficit: dressing, toileting related to generalize weakness secondary to antenatal
anaemia as evidenced by and poor grooming.
6. Deficit knowledge related to management of antenatal anaemia as evidenced by
frequently asking question.
7. Impaired sleeping pattern related to discomfort secondary to antenatal anaemia evidenced
by dark circle around eyes.
ASSESSMEN NURSING GOAL INTERVENTION RATIONAL IMPLIMENTATION EVALUATION

T DIAGNOSIS

Subjective data Ineffective Short Term Assess vital sign of -to check Assess patient’s vitals. Now patient
Patient reported thermoregulation, patient will be the patient temperature of Temperature-100 F maintain body
that “I have fever Hyperthermia relieved from the patient Pulse-102 /min temperature to
and discomfort related to the discomfort -select and apply a to promote Respiration-34 /min normal i.e.98.6
infection related and reduced variety of measures comfort -to provide cold sponge to F
to antenatal body to reduce body reduce the the patient -provide
Objective data anaemia as temperature temperature infection diversional therapy
Temperature100 F evidenced by -reduce factors -to decrease -reduce or eliminate
Warm body skin. increased body that precipitate or discomfort and factor that can
temperature Long Term increase the fever pain precipitate or increase
(100F) and warm patient will be experience the fever experience
body. maintain -control to reduce body - control environmental
normal body environmental temperature factors that may
temperature factors that may influence the patient’s
influence the response to discomfort
patient’s response like room temperature,
to discomfort lighting, noise etc.
-to reduce body
-administered -administered antibiotic
temperature
antipyretic drug like cefotaxim and
antipyretic drug
ASSESSMENT NURSING GOAL INTERVENTION RATIONAL IMPLIMENTATION EVALUATION
DIAGNOSIS
Subjective data Imbalanced Short Term --monitor food - to determine - monitor food /fluid and Now patient
Patient says that nutrition less patient will /fluid ingested adequacy of intake calculate daily calorie maintain normal
“I am not than body be Desire to -for avoidance of intake nutritional
feeling to eat requirement eat and monitor laboratory malnutrition pattern.
and decreased related to loss of increase values -to moisten and - monitor laboratory test
appetite.” appetite related intake of provide mouth clean the mouth of and its value
to antenatal food care sputum taste - provide oral care before
anaemia’s -to provide meals
evidenced by provide patient adequate calorie
pallor body & with nutritious food and protein that do - provide high protein,
I/O chart. Long Term not require much high calorie, nutritious
Objective data patient will energy to consume finger foods and drink that
Patient is not be maintain - to assess can be ready consumed
taking food I/O normal nutritional status -weight patient at
chart nutritional -weight patient at -to ensure appropriate interval
pattern appropriate interval nutritional adequacy provide appropriate
provide appropriate after discharge information about
information about nutritional need and how
nutritional need to meet them
ASSESSMENT NURSING GOAL INTERVENTION RATIONAL IMPLIMENTATION EVALUATION
DIAGNOSIS
Sub. data: - Self-care Short Term -evaluate client’s -establish client’s -Reports of dyspnea, increase Now patient is
Patient reported deficit: dressing, patient will response to activity needs and weakness and change in vital able to do activity

that” I am toileting related be maintain facilitate choice signs during and after and maintain
personal hygiene
having so much to generalize daily activity of interventions activity
weakness and weakness and reduced -assist client to -client may be -assist client to assume
not able to do secondary to foul smell assume take easily breath comfortable position for rest
daily activity” antenatal from body comfortable and sleep
anaemia as position for rest
evidenced by -done the daily -To prevent -done the daily dressing
and poor dressing infection
grooming. -provide comfort -client enhance -provide comfort measures
Obj.data:- measures -instruct sense of well e.g. back rubs, change of
Patient is unable Long Term and assist client in being position, quiet music or
to perform daily patient will self care activity conversation
activity Poor be maintain -to control of -instruct and assist client in
grooming. Bad personal discomfort self care activity
odour. hygiene
ASSESSMENT NURSING GOAL INTERVENTION RATIONAL IMPLIMENTATION EVALUATION
DIAGNOSIS
Objective data: Risk for Short Term -monitor for -to determine if an monitor for systematic and Now patient
-patient HB infection related patient will localized sign and infection is localized sign and WBC count in
level is 6.4g/dl to improper be reduce to symptoms of present symptoms of infection normal and
hygiene related get the infection infection risk
to lack of infection -monitor WBC -to detect - monitor WBC count and also decrease.
knowledge count presence of differential results
regarding infection
antenatal -teach patient and -to prevent -teach patient and family
anaemia family about infection about infection control
infection control measures
Long Term -instruct patient on -to prevent spread -instruct patient on
patient will appropriate hand of infection appropriate hand washing
be getting washing techniques techniques and other aseptic
adequate -use universal -to prevent techniques
knowledge precautions infection among - use universal precautions
about health care and use aseptic technique to
infection member treat patient
HEALTH EDUCATION:
DIET

 Provide 3-4 smaller meals per day

 Avoid gas causing foods such as broccoli, cabbage, beans

 Use less salt and spice in the food

 Fruits and fruit juice to be given to the client, that is a good source of fiber

 Law fat diet like milk, yogurt, and cheese to be included in diet

PSYCHOLOGICAL SUPPORT

 Give psychological support to patient and family

 Describe whole disease condition to family

 Give all the answer of those question which they asking.

REHABILITATIVE ACTIVITY

 Teach regarding high calorie diet

 Teach walking techniques and bending techniques

 Follow up and take all medicine regularly

 SUMMARY
Patient was admitted in Community Health Centre, Daman. On at 11:00 am with the
complain of fever, body ache, generalized weakness and pallor. Then diagnosed with antenatal
anemia. For that she was under treatment by the Dr. Madhuri Patel. After that she is good prognosis.