My anemia case presentation

BSC-NURSING 3rd YEARS INDIVIDUAL ASSIGMENT

MID WIFERY AND OBSTETRICAL NURSING - NUR 312

ANEMIA IN PREGNANCY A CASE OF MUEMBE LADU MATENITY HOSPITAL AT RCH CLINIC

  BYAbdulla Khamis Ngwali DATE – 5th APRIL 2016. ZU/FHS/4674/13

Anemia in Pregnancy

Anemia is defined as a condition in which there is less than the normal hemoglobin (Hb) level in the body, which decreases oxygen carrying capacity of red blood cells to tissues. World Health Organization (WHO) definitions for anemia differ by age, sex and pregnancy status as follows: children 6 months to 5year anemia is defined as a Hb level <11g/dl, children 5–11 years Hb < 11.5 g/dl, adult males Hb < 13 g/dl; non pregnant women Hb <12g/dl and pregnant women Hb < 11g/dl4.Anemia could be classified as mild, moderate and severe

Anemia in pregnancy remains is the one of the most intractable public health problems in developing countries. Globally, anemia contributes to 20% of all maternal deaths. Although not always shown to have a causal link, severe anemia contributes to maternal morbidity and mortality. Anemia in pregnancy may also lead to premature births, low birth weight, fetal impairment and infant deaths

Literature review

Worldwide, anemia affects over two billion people and the World Health Organization (WHO) has estimated that half of these are due to iron deficiency [5, 6]. Iron deficiency is not only the most prevalent but also the most neglected nutrient deficiency in the world, particularly among pregnant women and children in developing countries [7]. Presently, over 40 million pregnant women suffer from iron deficiency (ID) and its consequences in developing countries [8].

The status of patient Demographic data Patient initial: H . S. O. Address: Kilima Hewa Age: 22yrs Occupation: House wife Sex: Female M/ Status: Married Date of attendance: 4/03/2016 Medical history Previous history: The patient was pregnant women G2,

Para 1, and was well until 1 week ago when she started to experience headache of gradual onset off and on, heart palpitation mild to moderate intensity no aggravating factor, relieved with sleeping,

Continue..................associated with dizziness and poor vision

sometime, no history of fever. Also complaining general body weakness for 3days now that make her unable to do her normal activities associated with lower limbs numbness. She has no allergic history no history of blood transfusion.

LMP - 2/7/015, EED 8/4/016, Amenorrhea for 6 months, gestational age 20weeks+ 5 days

Medical historyPrevious history:Gravid 2, Para 1LMP - 2/7/015, EED 8/4/016,

Amenorrhea for 6 months, gestational age 20weeks+ 5 days.

1ST Visit -V/sign. BP -120/60 mmHg , FHR was 122 b/min, Hb level was 8.0 g/dl, Respiration 14b/m, urine albumin =Nil, weight was 52 kg, VDRL = Non reactive, PMTCT = 2 , Blood group B, RH+ve.

Continue.............2ND Visit, V/sign. BP -120/70 mmHg ,

FHR was 123b/min, Hb level was 8.9 g/dl last measured, Respiration 14b/m, urine albumin =Nil, weight was 54 kg, VDRL = Non reactive, PMTCT = 2 , Blood group B, RH+ve.

Present history: Gestational age 31 weeks + 4 days, pale ++,

fatigue, Dysnea, palpitation.

Medical diagnosis : Anemia in pregnancy

Current treatment: syrup ,Haemovit 15mls t.d.s for 7/ thenTab FeSO4 1tab o.d for two weeks, tab mebendazole 500 mg start, T.T 2nd dose,

V/S taken was as follows: T: 36.2 C, P:110 b/min, R: 19 b/min, BP: 120/70 mmHg, FHR 129 b/min.

Nursing Assessment , Diagnosis and Investigations. Mental states of the patient: was good in

term of language pt able to introduce her in good and understandable manner with coherent speech able to identify place, time and date

Orientation: able to be oriented with time, stuff, relative and recognize the services provided

Attention; was totally concentrated with services and able to answer any question requested even by try.

Level of consciousness: full consciousness

 NURSING DIAGNOSIS

GOALS INTERVATION AND RATIONALE

EVALUATION

Imbalanced nutrition

less than body

requirements related

to inadequate food

intake to utilize

nutrients so as meet

metabolic needs as

evidence by :

Loose of appetite

Muscles weakness

After 2 to 3 weeks

patient nutritional

status will be

balanced

Encourage patient to eats balance diet especial high iron diet and CHO2 to maintain body nutrition and energy. Encourage patient to eat more and more and drinking including fruits, water, juice to increase appetite.

Within 5 days

patient appetite

was increased and

muscle weakness

also decreased.

Cont…….

Ineffective breathing

pattern t related to failure

of nutrients absorption

necessary for formation of

red blood cells

Patient’s

breathing pattern

will be effective

Encourage patient to eats high iron diet and protein diet, like green vegetables, soup, beans fruits etc.Encourage to use iron supplements as prescribed. In order to increase Hb level and to correct sign of anemia

fortunately the

sign of anemia is

reduced slowly

so and the pt

become

improved

throughout the

management

Activity intolerance related to imbalance between oxygen supply of her body/fetus and demand (delivery) as evidence by fatigue and inability to maintain self care activities regularly and dyspnea.

Short term:After 8 hours of nursing interventions the patient will:Report an increase in activity tolerance including activities of daily living.Long term:After months the patient:Is free from weakness and risk for complications has been prevented and will deliver safetly

 Assess patient’s ability to perform normal task or activities of daily living.Note changes in balance/ gait disturbance, muscle weakness.Recommend bed rest if indicated.Provide assistance with activities or ambulation as necessary, allowing patient to do as much as possible

 After 4 days patient was revealed an increase in activity tolerance, demonstrating a reduction in physiological signs of intolerance

Cont……Risk for infection related to inadequate secondary defenses due to decrease in hemoglobin level leucopenia.

After a month patient will be prevented from infection/ complications

Encourage patient to eats balance diet and iron supplements to correct anemia and increase body immunity

Body immunity is increased and anemia slowly slowly corrected.

Knowledge deficit regarding disease process, treatment and individual care need related to unfamiliarity with information and misinterpretation as evidence by :Inadequate follow the instruction, eg. balance diet

A patient will be gain knowledge

Educate the patient on how to prepare food.Teach on important of balance diet/ iron supplement .

Patient gained knowledge and able to correct misperceptions about disease and treatment

Critique of the careShe was require pronged dose especially of

ferrous sulphate at list one monthPatent require continuous monitoring for

her Hb during whole period of pregnancyUn usual aspect of careThey not instruct pt as this serious

condition and need close follow upPatient didn’t get enough health education

on disease condition.

Education and lesson learned

There must be a limit for midwifery to treat some obstetric related condition this is because midwife are not deep in physiology so as to alleviate un usually suffering.

Muembe ladu RCH must emphasize availability of doctor such as mnazi mmoja so as midwife and doctor make consultation on some disease condition of the patient.

Also midwife should provide health education on diet and different disease in any single visit of the pregnant mother so as to save the life and provision of good viable health

Recommendation for change of the current care plan

According to the millennium goal number four (4) which is to reduce child mortality and goal number five (5) which is to improve maternal health, the following are my recommendation pertaining my case study in muembe ladu maternity hospital.

All nurse prescriber/midwife must follow the standard guideline on treating different illness and disease condition

Government should provide doctors to every rch so as nurse midwife could work together with

Pregnant women should follow the advice given to the hospital and consult their husband or family on its implementation

University and faculty should provide enough time for clinical rotation if possible practice time and case study must be separately to ensure factual information of case study

Students must commit them self when performing case on behalf of the patient not to consider the remarks of their work and left patient with problems

Thank you for listening