INSTRUCTIONAL PLAN FOR A HEALTHY PREGNANCY ( WHAT TO EXPECT WHEN YOU’RE EXPECTING? ) A. ASSESSMENT I. SETTING The health teaching site constitutes an important dimension of health education and promotion programs towards meeting learning needs, efficacy, and effectiveness. The health education setting will take place at Benguet State University Gymnasium at Kilometer 6, La Trinidad, Benguet. Specifically, the learners and health educators will gather at the gymnasium distant the last gate. The said setting can be described as conducive to learning because it expresses concern for the health, convenience, and comfort for both the learners and health educators. The gymnasiums’ structure expresses a cheering setting for the learners and health educators. The construction, equipment, and facilities will add to enlightening ideas for the
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INSTRUCTIONAL PLAN FOR A HEALTHY PREGNANCY
( WHAT TO EXPECT WHEN YOU’RE EXPECTING? )
A. ASSESSMENT
I. SETTING
The health teaching site constitutes an important dimension
of health education and promotion programs towards meeting
learning needs, efficacy, and effectiveness.
The health education setting will take place at Benguet State
University Gymnasium at Kilometer 6, La Trinidad, Benguet.
Specifically, the learners and health educators will gather at the
gymnasium distant the last gate.
The said setting can be described as conducive to learning
because it expresses concern for the health, convenience, and
comfort for both the learners and health educators.
The gymnasiums’ structure expresses a cheering setting for
the learners and health educators. The construction, equipment,
and facilities will add to enlightening ideas for the health teaching
process. The light-painted walls of the gymnasium will be suitable
for learning since it will reduce confrontation and anxiety, thus it
promotes a sense of well being.
Comfortable seats and spacious work place will also be
recognized. Learners will have an adequate working space and will
have a good environment with the wooden floor. Cleanliness will
also be practiced through out the learning practice with the
availability of trash cans inside the learning area.
The setting will also consider practical lighting. Natural
sunlight will provide a balance view that is optimal for the learning.
The windows, doors, and the main entrance will be kept open for
the sunlight and also for ventilation. Fresh air will be able to pass
through the corners of the learning area.
The gymnasium will be conducive to learning. The said setting will be
enlightening and idea generating. It allows sharing between the learners and the
health educators that draws to excitement, happiness, and learning for both
II.POPULATION
a. Type
The health teaching will be directed to expectant mothers.
Specifically, they will be mothers who are expected to be on their first child
pregnancy. These expectant mothers will be coming from nearby
Barangays of La Trinidad. Barangays near the setting will be preferred.
Expectant mothers will be coming from Barangay Balili, Betag, and
Poblacion, La Trinidad, Benguet. The health educators presumed the
learners to be at least high school graduates thus, they could be able to
comprehend with the discussion.
b. Health Status
The learners would be coming from semi-modernized community
therefore presumed that they have knowledge in proper hygiene. Proper
sanitation is also being monitored in the learner’s community which
contributes to cleanliness of their environment. The learners have easy
access to Rural Health Units(RHU’s) and hospitals for them to have a
regular monitor of their health.
c. Population Number
Since the learners would be coming from three barangay’s, the health
educators anticipates fourty(40)-fifty(50) participants for the said health
education.
III. PLAN
a. General Objective
The learners will be able to know appropriate ways on how
to deal with proper and healthy pregnancy.
b. Specific Objectives
1. The learners will be able to state what to expect at their
first prenatal visit.
2. The learners will be able to know what to expect during
the first, second and third trimester of pregnancy.
3. The learners will be able to state some of the common
symptoms during pregnancy and can give
solutions to it.
4. The learners will be able to know the importance of
nutrition during pregnancy and enumerate some of
the nutrients needed by the mother.
B. DIAGNOSIS
a. Knowledge deficit: foods to avoid during pregnancy related to lack of
information.
b. Knowledge deficit: possible effects or complications during pregnancy
related to lack of exposure.
c. Knowledge deficit: proper ways of cooping with unusual signs and
symptoms of pregnancy related to misinformation.
d. Knowledge deficit: proper nutrition or nutrients needed to take during
pregnancy related to lack of information.
` C. PLANNING
a. Materials and Equipment
Guide card
Ball pen
Pencil with eraser
Coupon bond
Marker
Manila paper
Posters
Video clips
CD
Universal Serial Bus (USB)
White Screen
Liquid-Crystal Display (LCD)
Adhesive Tape
b. Funding/ Budget
The health teaching activity requires a total of 500.00 Php
(approximation). The proceedings will be foe the snacks, probably
water and banana-que, and also for some materials needed for the
health education practice. The fund will be sourced out from
contributions of the health teaching team. Voluntary donations and
assistance from supporters and other entities will be gladly and
greatly appreciated.
c. Scheduling / Time Frame
The health education will be scheduled on the 6th of April,
2009 (Monday). Registration will start at 8:30 in the morning. The
activity proper will begin at exactly 9:00 AM and will conclude at
12:00 noon. The health education will be a three-hour learning
session.
Since that the learners will be expectant mothers, proper
choice of time will be recognized. The health educators will
consider the preferences of the learners on the suitable time for
their learning. For expectant mothers who are morning learners will
be able to perform well, concentrate, and focus on the learning,
thus this learning practice will be a benefit for them.
d. Language Spoken
The primary medium of instruction to be employed during the
health education will be English. Supplementary languages to be used
are Filipino and Ilocano.
e. Instructional Strategies
i. Lecture
For the purpose of instruction, the health educator will
verbally transmit information about the topic what to expect when
you’re expecting directly to the learners. The educator can easily
highlight the main ideas and can present unique ways of viewing
information through lecture.
The ideas and information can be imparted across the large
number learners at the same time as well as within e relatively
reasonable time frame.
ii. Power Point Presentation
The use of the Computer Assisted Instruction will allow the
educators to systematically present and discuss the topic.
Graphics and pictures about the topic may be flashed via the
projector. On the part of the learners, they will be able to easily
follow and thus facilitate spontaneous delivery of the topic.
iii. Other instructional for short-term learning
Group discussion sessions will be incorporated during the
learning process. The learners will have time for exposure and
time for sharing. It will be a short-term acquaintance for the
learners with the health educators.
Definition and clarification of medical and scientific terms will be
considered.
Several options will be suggested for the learners to choose on
what courses of action they will prefer.
A rationale will be given for all that is said and done to help
learners sustain ideas and information and to insure
understanding and fulfillment.
Negative reactions from the learners shall be expected
considering they are expectant mothers that they have a sudden
change in mood.
Summary or rundown of all the activities and discussions will be
done at the end of the session to freshen up the learners on the
topics tackled.
D. INTERVENTIONS
a. Activities
i. Group Discussion
The use of group discussion would foster interest in the topic and
learning in general are increased. A modified sample that would possibly
be done is group sharing. The learners will be divided into groups. In each
group, there will be discussion and sharing about pregnancy experiences.
ii. Ice-breaker
An ice breaker will interfere during the health education to break the
monotony for example. Jokes could be presented to stimulate the
learners’ alertness. Brain-teasers could also be introduced to stimulate the
learners’ interest and thinking skills. The jokes and brain-teasers to be
presented would still be related and based on the topic discussed.
iii. Work-out / Exercise
A work-out or an exercise would also be introduced during the
health education. Yoga will be introduced to the learners. This will help the
learners relax and gain more balance state of mind and body. Yoga will
also help lessen the learners’ anxiety. The learners would easily grasp
information and ideas with a relaxed mind and body.
iv. Discussion
Pregnancy is the carrying of one or more offspring, known as a fetus or
embryo, inside the uterus of a female.
I. What to expect at the first prenatal visit?
A complete medical history will be taken, and certain tests and
procedures will be performed.
Confirmation of Your Pregnancy
The practitioner will want to check the following: the pregnancy symptoms;
the date of the last normal menstrual period, to determine the estimated date of
delivery (EDD); the cervix and uterus, for signs and approximate age of the
pregnancy.
A Complete History
To give the best care, the practitioner will want to know a great deal about
the mother. Come prepared by checking home records and refreshing her
memory, as necessary, on the following: personal medical history (chronic
illness, previous major illness or surgery, medications presently taking or have
taken since conception, known allergies, including drug allergies); your family
medical history (genetic disorders and chronic illnesses); your social history (age,
occupation, and habits, such as smoking, drinking, exercising, diet; and factors in
your personal life that might affect your pregnancy.
A Complete Physical Examination
This may include: assessment of the mother’s general health through
examination of heart, lungs, breasts, abdomen; measurement of the blood
pressure to serve as a baseline reading for comparison at subsequent visits;
notation the height and weight, usual and present; inspection of extremities for
Stay away from stimulant laxatives. They might work in the short run, but
they may make you very uncomfortable.
Schedule your bathroom time carefully so you're in the vicinity and won't
feel rushed when the mood strikes.
Nasal Congestion and Nosebleeds
It is the annoying stuffiness in the nose and the nosebleeds that can
accompany it, especially when blowing often.
It is caused by high levels of estrogen and progesterone that increase
blood flow to all the body's mucous membranes, including the nose, causing
them to swell and soften.
Things to do about Nasal Congestion and Nosebleeds
Use the right blowing technique. Use your thumb to close one nostril, and
blow gently out the other side. Repeat with the other nostril until you can
breathe again.
Try to put a warm-mist humidifier in your room to add some nose-soothing
moisture to the air.
Dab a little petroleum jelly in each nostril using a cotton swab to combat
the dryness of the nose.
Round Ligament Pain
It is also called abdominal achiness.
It is the experience of “growing pains" around the middle as the uterus
expands during pregnancy. It is typically felt as achy or sharp sensations on one
or both sides of the abdomen.
Things to do about Round Ligament Pain
Get off your feet, get comfy, and stay there for a while. If that doesn't bring
relief, or if the achiness crosses the line into severe abdominal pain,
contact the practitioner and let him or her know what you're feeling.
Contractions (Braxton-Hicks)
It is like a like a dress rehearsal —the uterine muscles are flexing in
preparation for the big job they'll have to do in the near future.
The cause is that pregnancy hormones are hard at work, sending
messages to the body to start the process of childbirth.
Things to do about Contractions
Change position during a painful contraction —after sitting, stand (and
vice versa).
Use these contractions as a chance to practice breathing and visualization
techniques.
If contractions are quite frequent (more than four in an hour) and/or in a lot
of pain or see any kind of vaginal discharge, call a practitioner.
Varicose Veins
It is the large, swollen blood vessels found predominantly in the legs, but
that can show up almost anywhere in the lower half of the body.
The extra volume of blood that is produce during pregnancy is essential
to support two growing bodies. It does, however, put extra pressure on the blood
vessels, especially the veins in the legs, which have to work against gravity to
push all that extra blood back up to the heart. Add to that, the pressure the
burgeoning uterus puts on your pelvic blood vessels, and the vessel-relaxing
effects of the extra progesterone your body is producing.
Things to do about Varicose Veins
Keep the blood circulating. Keep legs elevated when sitting. When
standing, put one foot on a low stool and alternate legs. Flex ankles every
so often, and break the habit of sitting with legs crossed.
(Take a walk (or even better still, several walks) each day, or do some
other form of low-key, circulation-increasing exercises.
Wear clothes — including underwear — that fit well and don't bind.
Sleep on the left side to avoid pressure on your main blood vessels, and
keep circulation going strong.
Don’t strain. Heavy lifting or straining on the toilet can add to vein visibility.
Use pantyhose.
Stretch Marks
These are red, pink, or purplish streaks that appear across the belly, hips,
thighs, and breasts during pregnancy. They're more pronounced on fair-skinned
women.
Things to do about Stretch Marks
Moisturizers, such as cocoa butter. They'll help with the dryness and
itching associated with pregnancy-stretched skin.
Eating the best diet possible may also help keep the skin toned.
Consult a dermatologist.
Snoring
It is caused by nasal congestion and excess weight gain (both common
among the pregnant women).
Things to do about Snoring
Stick on a nasal strip at bedtime (they're completely drug-free).
Try using a warm-mist humidifier in the bedroom at night.
Plump up the pillows and try sleeping with head slightly elevated.
Keep an eye on calories to make sure extra weight doesn't contribute to
snoring.
Ask your practitioner about your snoring and sleep apnea.
Gums (bleeding/ sore)
It is the tender, red, swollen, extra-sensitive condition of the gums in the
mouth during pregnancy.
Hormones cause the gums to swell, become inflamed, and bleed more
easily. These same hormones also leave the mouth more vulnerable to bacteria
and plaque, both of which make the gums even more tender.
Things to do about Bleeding Gums
Always brush and floss.
Get to the dentist frequently for checkup and cleaning.
Skip the sweets, particularly the chewy kind.
Fulfill the calcium requirement every day for stronger teeth.
Try chewing a piece of sugarless gum or grabbing (unless you're allergic)
a handful of nuts or a small chunk of cheese. All have antibacterial
properties.
IV. Other things to be expected during pregnancy
Fetal Movement during Pregnancy
Feeling the baby twist, wriggle, punch, kick, and hiccup is simply one of
pregnancy's biggest thrills.
Fetal Movement in the First Trimester
From the first few days and weeks of pregnancy until the end of the third
month, the first trimester is a time of astoundingly fast development. But fetal
movement is not yet felt in this trimester except the queasiness, the fatigue, and
the headaches.
Fetal Movement in the Second Trimester
Pregnant women will start to feel the movement of the baby.
By the fifth month, most women are feeling the fidgets and squirms of their
active little tenant. The baby's routines will grow increasingly acrobatic and the
punches more powerful as those little muscles get stronger and those fledgling
motor skills develop.
In the sixth month, the baby picks up the pace. Leg movements will seem
more choreographed. The baby is more active when the mother will settle down
especially at night because the motion of the body during daily routine can lull the
baby to sleep. When relaxed, the movement of the baby is greatly felt.
Fetal Movement in the Third Trimester
By the seventh month, it starts to get a little cramp in the womb but the
baby has still enough room to toss and turn for a little longer. Moreover, babies’
rhythms and patterns of their activity will vary.
Sleep Problems during Pregnancy
Sleep Problems during the First Trimester
Sleep problems during pregnancy start in this trimester, when frequent
trips to the bathroom during the night, to pee, to powder, ruin the night. The
mother’s rest starts facing a whole other cast of interrupting characters such as,
heartburn, hunger, vivid dreams, nightmares, leg cramps, restless leg syndrome
and anxieties.
Sleep Problems in the Third Trimester
In the third trimester, just when enough sleep is needed, slumber
becomes even more elusive. It is hard to sleep because of frequent urination.
This is because; as the uterus flattens the bladder storing an entire night’s worth
of urine. Moreover, the kidneys which have to filter up to 50percent more blood
than usual, are putting out more urine.
Tips for getting a Good Night’s Sleep
Avoid caffeine in all its forms after noon.
Get your eight glasses of water but taper off at night.
Exercise regularly during the day or early evening. A daily workout will
help to sleep better, but if it comes too close to bedtime, it could
actually sabotage sleep.
Take a warm bath just before bed.
Leave a night-light on in the bathroom. Switching on the overhead is
way too much of a wakeup call and will make it much harder to fall
back asleep.
Some Pregnancy Complications
Pregnancy complications can be rather rare or relatively common, only mildly concerning significant risks. For many conditions, early detection and good prenatal care can reduce the risks to both the mother and the baby, leading to a perfectly outcome.
Abdominal Pain (Severe)
Mild abdominal pain during pregnancy (from implantation cramping, ligament stretching in early pregnancy, or uncomfortable Braxton Hicks contractions later on) is considered normal. But when in labor, severe abdominal pain is not normal. Nor is it normal to experience abdominal pain that’s accompanied by spotting, bleeding, fever, chills, nausea, vomiting, fainting, or even pain when urinating.
The pain is such that it forces the mother to stop breathing. She may also experience bleeding, fever, high blood pressure and contractions.
What to do:
Take abdominal pain seriously, especially if it goes beyond the normal comfort level. If the pain is accompanied by any other symptoms, or if it doesn't go away when lying or resting, call a practitioner.
Chicken Pox
It is a viral infection (the varicella virus) that causes red, itchy, fluid-filled blisters to erupt on the skin.
Chicken pox usually starts on the torso, appearing on the abdomen or back first and then spreading to the rest of the body. The rash begins as small, red bumps that then develop into fluid-filled blisters which break and eventually crust over and scab.
What to do:
If the mother is not immune, she should avoid exposure to the virus during pregnancy. Pregnant women cannot be vaccinated because the vaccine contains live virus.
If not immune and was exposed, the practitioner may recommend an injection of varicella-zoster immune globulin (VZIG), to protect the mother.
Ectopic Pregnancy
It occurs when a fertilized egg implants outside the uterus, most commonly in a fallopian tube. This usually occurs because something (such as scarring in the fallopian tube) slows the movement of the fertilized egg into the uterus.
The symptoms of ectopic pregnancy includes pain on one side of the abdomen (usually beginning as a dull ache that progresses to spasms and cramps) and abnormal bleeding.
What to do:
Occasional cramping and even slight spotting early in pregnancy is not cause for alarm, but let the practitioner know if crampy pain in the lower abdomen, heavy bleeding, or any of the other symptoms of an ectopic pregnancy is experienced. If one is diagnosed (usually through blood tests, pelvic exam, and
ultrasound), the mother will undergo surgery (laparoscopically) to remove the tubal pregnancy or be given drugs (methotrexate or misoprostol), which will destroy the developing cells.
Miscarriage
It is also called a spontaneous abortion.
It is the unplanned end of a pregnancy before 20 weeks gestation. (After week 20, the loss of the developing baby is called a stillbirth.) Eighty percent of miscarriages occur in the first trimester and are usually related to a chromosomal or genetic defect in the embryo, though they can also be caused by an inadequate supply of pregnancy hormones or an immune reaction to the embryo. A miscarriage that occurs between the end of the first trimester and week 20 is considered a late miscarriage. Late miscarriage is usually due to the mother's health, the condition of her cervix or uterus, or to problems with the placenta.
The symptoms of a miscarriage can include cramping or pain in the center of the lower abdomen, heavy bleeding (possibly with clots and/or tissue), or light staining continuing for more than three days, as well as a decrease in the usual signs of early pregnancy, such as nausea and breast tenderness.
What to do:
Not all bleeding or spotting means it is a miscarriage. In fact there are many reasons (other than miscarriage) that could account for the bleeding. If there is spotting, call a practitioner, who will probably perform an ultrasound. If the pregnancy still appears to be viable (i.e., a heartbeat is detected on the ultrasound), the practitioner will likely impose bed rest, your hormone levels will be monitored (rising hCG levels are a good sign), and the bleeding will most likely stop on its own. If the practitioner determines that a miscarriage is inevitable, there's unfortunately little you can do.
A miscarriage isn't complete and parts of the pregnancy remain in the uterus or a heartbeat is no longer detected yet. In such cases the practitioner might recommend the mother to undergo a dilation and curettage (D&C) to remove all fetal and placental tissue. Or he/ she might give medications to trigger uterine contractions to expel the pregnancy. A third approach is to wait until the uterus naturally expels the pregnancy.
Gestational Diabetes
It is a form of diabetes that appears only during pregnancy. It occurs when the body does not produce adequate amounts of insulin (the hormone that lets the body turn blood sugar into energy) to deal with the increased blood sugar of pregnancy. Gestational diabetes usually begins between weeks 24 and 28 of pregnancy .
Most women with gestational diabetes have no symptoms, though a few may experience extreme thirst, very frequent and very copious urination, or fatigue. The practitioner will probably screen the mother for gestational diabetes around week 28 of pregnancy. She'll drink a sugary liquid and then take a blood test an hour later. If the blood sugar level is high, she'll take a three-hour glucose tolerance test to determine whether she has gestational diabetes.
What to do:
Keeping an eye on the weight gain (both before and during pregnancy) can help prevent gestational diabetes.
If the mother is diagnosed with gestational diabetes, scrupulous control of blood sugar levels will mitigate the potential risks associated with the condition. The practitioner will likely put a special diet and will suggest simple exercises to keep the mother’s gestational diabetes under control.
NUTRITION DURING PREGNANCY
Proper nutrition during pregnancy has been shown to reduce the risk of birth defects in babies and chronic diseases in adulthood such as heart disease, type 2 diabetes, high blood pressure, and high cholesterol. Likewise, babies born to mothers who gain excessive amounts of pregnancy weight are at increased risk for childhood obesity.
A healthy diet helps mothers avoid pregnancy complications such as anemia, high blood pressure, and gestational diabetes. Good nutrition may also minimize morning sickness, fatigue, and constipation. And mothers who eat sensibly during pregnancy are more likely to return to their pre-pregnancy weight sooner.
These guidelines will help all mothers make healthy choices for their growing little ones:
Eating for Two
Although it is said that pregnant women are “eating for two”, the truth is they are only eating for about one and an eighth. The second one is much smaller and does not have the same calorie needs. The average pregnant woman requires approximately 300 additional calories per day during the second and third trimesters.
Variety is the Spice of Life
Eating a variety of food each day will ensure that the mother will get all the vitamins, minerals, and other nutrients needed for her and the baby. Avoid eating the same meals every day. Have fun with the food and try new recipes. Select assorted fruits and vegetables daily. Also, choose products in various colors to provide different nutrients. Vary the proteins by alternating meats, fish, poultry, pork, eggs, beans, and nuts in the diet. And find new whole grains to enjoy beyond the basic bread, rice, and pasta.
Following the Pyramid
Like the rest of the non-pregnant world, expecting mothers should look to the Food Guide Pyramid to determine what and how much to eat. It is recommended that pregnant women consume a minimum of 9 servings of breads, cereals, grains, and/or pastas, 4 servings of vegetables, 3 servings of fruit, 2-3 servings of low fat milk, cheese, and/or yogurt, and 2 servings (6oz) of lean meat, poultry, fish, beans, eggs, and/or nuts per day. Each food group provides different nutrients, so eating from all the food groups daily will help ensure a complete diet.
Fresh is Best
Select whole foods rather than processed foods when available. Packaged foods often lose many of the nutrients they contain during processing. On the other hand, whole foods are loaded with nutrients and are usually free of preservatives, additives, and sweeteners.
Foods to Avoid
Although most foods are perfectly safe for expecting women, certain foods can be harmful to a growing baby. Avoid following foods during pregnancy:
Alcohol Sushi containing raw fish
Shark, swordfish, king mackerel, & tilefish (limit intake of other fish to no more than 12 ounces/week)
Raw or undercooked meat, poultry, eggs, fish, & shellfish
Smoked seafood & cured ham
Soft cheeses such as Brie, blue, feta, & goat cheeses
Hot dogs, sausages, & other processed meats containing nitrates
Alfalfa sprouts
Unpasteurized milk & juices
Think about Your Drink
During pregnancy, the amount of fluid in the body increases; thus, increasing the fluid needs. The baby needs fluids as well. Aim for at least eight 8 oz. glasses of fluid per day. This includes water, low fat or fat free milk, 100% fruit and vegetable juices, decaffeinated coffee and tea, and soup. While juices are a nutritious alternative to soda, they still contain a large amount of sugar, so avoid consuming excessive amounts. Also, limit caffeinated beverages to no more than two per day.
Forget Fad Diets
Many women worry about having difficulty losing the weight postpartum and will consider dieting or restricting food intake. Pregnancy is not an appropriate time to diet. Dieting will decrease the amount of nutrients your baby receives and will affect the baby’s growth and development. Your baby needs to be nourished consistently throughout the day. Keep in mind, the majority of the weight you gain is not additional body fat.
Where does the weight go? Baby 7-1/2 lbs Your breasts — 2 lbs Your protein & fat stores — 7 lbs Placenta — 1-1/2 lbs Uterus — 2 lbs Amniotic fluid — 2 lbs Your blood — 4 lbs Your body fluids — 4 lbs
Prenatal Vitamins
Pregnant women have an increased need for folic acid, iron, and calcium. Therefore, it is recommended that expectant women take a prenatal vitamin to supplement a balanced diet. However, too much of certain vitamins and minerals can be harmful to your baby. Talk with your doctor about an appropriate supplement and avoid supplements providing more than 100% of the daily value for any vitamin or mineral.
Treat Yourself
Try to eat a sensible diet. An occasional treat is appropriate and well deserved. When indulge, avoid skipping meals. Continue to eat normal diet.
Recommended nutrients during pregnancy
NutrientRecommendation (Extra = Above RDA)
Maximum/Total amount recommended per day
EnergyIncrease by 200 kcal (840 kJ) per day in last trimester only.
RDA
Proteins Extra 6 g per day 51 g per day
ThiaminIncrease in line with energy; increase by 0.1 mg per day
0.9 mg per day
RiboflavinNeeded for tissue growth; extra 0.3 mg per day
1.4 mg per day
NiacinRegular supplementation/diet of substance. No increase required.
RDA
FolateMaintain plasma levels; extra 100 µg per day