RLE: MCN

Workplan: June 1-5,2020

June 7-12,2020

CASE STUDY 1: CHILDBIRTH ASSESSMENT AND CARE

DIRECTIONS

Read and analyze this case study individually. Answer the case study questions. Consider the steps in clinical decision-making as you answer the questions.

CLIENT PROFILE

Mrs. B is 25 years of age. Her mother-in-law has brought her to the hospital and reports that she has been in labor for 8 hours and that her membranes ruptured 3 hours ago.
You greet Mrs. B and her mother-in-law respectfully and with kindness. On arrival at the hospital, she had a strong contraction lasting 45 seconds. Because she is showing signs
of labor, you complete the Quick Check to detect signs/symptoms of life-threatening complications and, finding none, quickly proceed to physical examination to determine
whether birth is imminent. Although Mrs. B is not pushing, you find that she has a bulging, thin perineum.

1. What history will you include in your assessment of Mrs. B and why?

2. What physical examination will you include in your assessment of Mrs. B and why?

3. What laboratory tests will you include in your assessment of Mrs. B and why?

You have completed your assessment of Mrs. B and your main findings include the following:

History:

A. Mrs. B is at term.
B. This is her fourth pregnancy.
 C. Her previous pregnancies/deliveries were uncomplicated.
D. All other aspects of her history are normal or without significance.

Physical Examination:

A. Vital signs are as follows: Respirations are 20 per minute, BP is 130/82, Pulse is 88 beats per

minute, Temperature is 37.8°C.

B. On abdominal examination:
C. No scars are noted and uterus is oval-shaped
D. Fundal height is 34 cm
E. One set of fetal parts are palpable
F. Fetus is longitudinal in lie and cephalic presentation
G. Presenting part is not palpable above the symphysis
H. Fetal heart tones are 148 per minute
I. Bladder is not palpable
J. Contractions are 3 per 10 minutes, 40–50 seconds in duration each
K. On genital and cervical examination:
L. Her cervix is 10 cm dilated and fully effaced
M. Presentation is vertex and the fetal head is on the perineum
N. Visible amniotic fluid is clear
O. All other aspects of her physical examination are within normal range.

Testing:

 Test results not yet back at this stage

4. Based on these findings, what is Mrs. X's diagnosis (problem/need) and why?

5. Based on your diagnosis (problem/need identification), what is your plan of care for Mrs. B

and why?
EVALUATION

A. Mrs. B has 3 contractions every 10 minutes, each lasting more than 40 seconds.
B. After 15 minutes, she begins pushing spontaneously with each contraction.
C. After another 15 minutes, she has a spontaneous vertex birth of a baby boy. The baby breathes immediately at birth.
D. The third stage of labor has not yet been completed.

6. Based on these findings, what is your continuing plan of care for Mrs. B and why?
RLE: MCN
Workplan: June 15-19,2020
June 22-26,2020

CASE STUDY 2: CHILDBIRTH ASSESSMENT AND CARE

DIRECTIONS

Read and analyze this case study individually. Answer the case study questions. Consider the steps in clinical decision-making as you answer the questions.

CLIENT PROFILE

Mrs. A is 30 years of age. She attended the antenatal clinic 2 weeks ago and has now come to the hospital with her mother-in-law because labor pains started 3 hours ago. Mrs.
A reports that the pains start in her back and move forward, last 20 seconds, and occur about every 8 minutes. Mrs. A. appears very anxious.

PRE-ASSESSMENT

1. Before beginning your assessment, what should you do for and ask Mrs. A?

2. What history will you include in your assessment of Mrs. A and why?

3. What physical examination will you include in your assessment of Mrs. A and why?

4. What laboratory tests will you include in your assessment of Mrs. A and why?

DIAGNOSIS (interpreting information to identify problems/needs)

You have completed your assessment of Mrs. A and your main findings include the following:
History:

A. Mrs. A is 39 weeks pregnant.

B. This is her second pregnancy.
C. Her first pregnancy and birth were uncomplicated, although she repeatedly states that labor was more painful than she had expected.
D. She confirms that labor started 3 hours ago and that contractions seem to be growing increasingly longer and more frequent.
E. All other aspects of her history are normal or without significance.

Physical Examination:

A. Mrs. A kneels to the floor and cries out with each contraction.
B. On measurement of vital signs: Respirations are 18 per minute, BP is 120/82, Pulse is 88 beats per minute, Temperature is 37.8º C.
C. On abdominal examination:
D. Fundal height is 33 cm
E. Presenting part is four-fifths above the pelvic brim
F. Fetal heart tones are124 beats per minute
G. Contractions are irregular every 8-10 minutes and last 14-18 seconds
H. On cervical examination:
I. Dilation of the cervix is 3 cm
J. Membranes are intact
K. Presentation is vertex and there is no molding
L. Her physical exam reveals no abnormal findings.

Testing:

 Blood group is O Positive, RPR is negative, and blood was taken for HIV testing.

5. Based on these findings, what is Mrs. A's diagnosis (problem/need) and why?
CARE PROVISION (implementing plan of care and interventions)

6. Based on your diagnosis (problem/need identification), what is your plan of care for Mrs. A. and why?

EVALUATION

A. Mrs. A continues to have regular contractions; by 2 hours after admission, she is having 2 contractions in 10 minutes, each lasting 20-40 seconds.
B. Maternal pulse remains between 80 and 88 beats per minute; fetal heart rate remains between 150 and 160 beats per minute.
C. Mrs. A's level of anxiety remains high and she continues to become agitated during contractions.

7. Based on these findings, what is your continuing plan of care for Mrs. A and why?
RLE: MCN
Workplan: June 15-19,2020
June 22-26,2020

CASE STUDY 3: POSTPARTUM ASSESSMENT AND CARE

DIRECTIONS

Read and analyze this case study individually. Answer the case study questions. Consider the steps in clinical decision-making as you answer the questions.

CLIENT PROFILE

Mrs. C gave birth 2 weeks ago. Her pregnancy, labor, and birth were uncomplicated. This is her first postpartum clinic visit. Mrs. C has one other child, who is three years of age.
She does not want to become pregnant again for at least 2 years. Mrs. C left her baby at home with her mother-in-law, but reports that the baby is well and had a routine check-
up by the midwife when the baby was one week old.

PRE-ASSESSMENT

1. Before beginning your assessment, what should you do for and ask Mrs. C?

ASSSESSMENT (information gathering through history, physical examination, and testing)

2. What history will you include in your assessment of Mrs. C and why?

3. What physical examination will you include in your assessment of Mrs. C and why?

4. What laboratory tests will you include in your assessment of Mrs. C and why?
DIAGNOSIS (interpreting information to identify problems/needs)

You have completed your assessment of Mrs. C and your main findings include the following:

History:

A. Mrs. C is feeling well.

B. Mrs. C reports no complications or problems during this pregnancy, labor/childbirth, or postpartum period.
Her medical history is not significant: she is taking no medications, nor does she have any chronic conditions or illnesses.
C. Mrs. C’s first child is well and was breastfed for 6 months.
D. She is exclusively breastfeeding her baby and intends to do so for at least 6 months.
E. She wants to know whether she should start using contraception now, as she does not want to become pregnant again for at least 2 years.
F. All other aspects of her history are normal or without significance.

Physical Examination:

A. Mrs. C’s general appearance is healthy.

B. Vital signs are as follows: BP is 120/76, Pulse is 78 beats per minute, Temperature is 37.6°C.
C. Her breasts appear normal.
D. Her abdominal exam is without significant findings and involution is proceeding normally.
E. Her lochia is a pale, creamy brown in color
F. All other aspects of her physical examination are within normal range.

Testing:

HIV test is negative.

5. Based on these findings, what is Mrs. C's diagnosis (problem/need) and why?

CARE PROVISION (implementing plan of care and interventions)

6. Based on your diagnosis (problem/need identification), what is your plan of care for Mrs. C and why?
EVALUATION

A. Mrs. C returns to the clinic at 6 weeks postpartum.

B. She is well.
C. She tells you that she is still breastfeeding exclusively/on demand and her menses have not returned.
D. She also says she has decided to return to work, on a part-time basis, when her baby is 4 months of age, and will only be partially breastfeeding from then on.
E. She asks whether she should start taking a contraceptive.

7. Based on these findings, what is your continuing plan of care for Mrs. C and why?
RLE: MCN
Workplan: June 29-July 3,2020
July 6-10,2020

CASE STUDY 4: POSTPARTUM ASSESSMENT AND CARE

DIRECTIONS

Read and analyze this case study individually. Answer the case study questions. Consider the steps in clinical decision-making as you answer the questions.

CLIENT PROFILE

Mrs. A is 18 years of age and gave birth to her first baby at home 10 days ago. Her pregnancy, labor, and birth were uncomplicated. The midwife who attended the birth checked
Mrs. A and her baby the day after the birth. She has not seen a healthcare provider since then. This is her first postpartum clinic visit. Mrs. A has come to the clinic because she
has sore, red nipples. Her baby is with her.

PRE-ASSESSMENT

1. Before beginning your assessment, what should you do for and ask Mrs. A?

ASSSESSMENT (information gathering through history, physical examination, and testing)

2. What history will you include in your assessment of Mrs. A and why?

3. What physical examination will you include in your assessment of Mrs. A and why?
4. What laboratory tests will you include in your assessment of Mrs. A and why?

DIAGNOSIS (interpreting information to identify problems/needs)

You have completed your assessment of Mrs. A and your main findings include the following:

History:

• Mrs. A is feeling well but has sore, red nipples.

• She reports that the baby breastfeeds approximately every 2 hours.

• All other aspects of her history are normal or without significance.

Physical Examination:

• Mrs. A generally appears well.

• Vital signs are as follows: BP is 110/72, Pulse is 76 beats per minute; Temperature is 37.6°C.

• There is no redness, tenderness, streaking, or masses palpable in the breast tissue; however, during observation of breastfeeding, it was found that the baby was not attaching
well to the breast.

• All findings on examination of the baby are within normal range and without significance.

• All other aspects of her physical examination are within normal range and without significance.

Testing:

HIV test is negative.

5. Based on these findings, what is Mrs. A's diagnosis (problem/need) and why?

CARE PROVISION (implementing plan of care and interventions)

6. Based on your diagnosis (problem/need identification), what is your plan of care for Mrs. A and why?
EVALUATION

• Mrs. A returns to the clinic in 2 days.

• You find that her nipples are less sore and red, and attachment has improved, although the problem has not fully resolved.

• Mrs. A is very eager to continue breastfeeding

7. Based on these findings, what is your continuing plan of care for Mrs. A and why?
RLE: MCN
Workplan: July 13 - 17,2020

CASE STUDY 5: NEWBORN ASSESSMENT AND CARE

DIRECTIONS

Read and analyze this case study individually. Consider the steps in clinical decision-making as you answer the questions.

CLIENT PROFILE

Mrs. E is 30 years of age and gave birth to her third baby at home 5 days ago. Her pregnancy, labor, and birth were uncomplicated. Mrs. E noticed yesterday that her baby’s cord
stump had an offensive smell. She has brought Baby E to the health center for the first time today because she is concerned that the cord may be infected.

PRE-ASSESSMENT

1. Before beginning your assessment, what should you do for and ask Mrs. E and Baby E?

ASSSESSMENT (information gathering through history, physical examination, and testing)

2. What history will you include in your assessment of Baby E and why?

3. What physical examination will you include in your assessment of Baby E and why?

4. What laboratory tests will you include in your assessment of Baby E and why?
DIAGNOSIS (interpreting information to identify problems/needs)

You have completed your assessment of Baby E and your main findings include the following:

Quick Check:

No danger signs or other significant findings except for foul smelling cord.

RIA:

No significant findings nor need for resuscitation.

History:

 Baby weighed 3 kg at birth

 Mrs. E reports that she had no infection during pregnancy, labor, or birth. There were no

other complications for her or her baby at labor or birth.

 The birth was attended by a doctor in a primary healthcare center.

 Baby E is reportedly breastfeeding well.

 Mrs. E denies covering cord or putting any substance on the cord.

 All other aspects of her history are normal or without significance.

Physical Examination:

 Baby E weighs 3 kg.

 Vital signs are as follows: Respirations are 40 per minute, Temperature is 37.0°C.

 Baby E. has a moist cord stump that has an offensive smell.

 None of the following are observed: draining pus, redness and swelling of the skin

extending more than 1 cm beyond umbilicus, skin lesions, red hard surrounding skin, or

distended abdomen.

 You observe that Baby E is breastfeeding well

 All other aspects of her physical examination are within normal range.

5. Based on these findings, what is Baby E's diagnosis (problem/need) and why?

CARE PROVISION (implementing plan of care and interventions)

6. Based on your diagnosis (problem/need identification), what is your plan of care for

Baby E and why?

EVALUATION

A. Mrs. E and Baby E return to the clinic the next day because her mother-in-law has instructed her to not continue the treatment, not wash the cord, and keep the cord
bound with a piece of cloth.
B. You find that the cord stump and umbilicus have improved only slightly.
C. There are no other significant findings or signs of sepsis. The baby continues to feed well and have normal temperature. There is no draining pus, redness and swelling
of the skin extending more than 1 cm beyond umbilicus, skin lesions, red hard surrounding skin, or distended abdomen.

7. Based on these findings, what is your continuing plan of care for Mrs. E. and why?
CASE STUDY 6: NEWBORN ASSESSMENT AND CARE

DIRECTIONS

Read and analyze this case study individually. When the others in your group have finished

reading it, answer the case study questions. Consider the steps in clinical decision-making as you

answer the questions. The other groups in the room are working on the same or a similar case

study. When all groups have finished, we will discuss the case studies and the answers each

group developed.

CLIENT PROFILE

Mrs. F is 20 years of age and gave birth to her first baby at home 12 days ago. Both she and

Baby F were seen at the health center 6 days after the birth. No problems were detected at that

time. Mrs. F lives in a small hut in a local village and does not have easy access to clean water.

She has come to the health center today because her baby has a skin rash and she is concerned

about this.
PRE-ASSESSMENT

1. Before beginning your assessment, what should you do for and ask Mrs. F and Baby F?

ASSSESSMENT (information gathering through history, physical examination, and testing)

2. What history will you include in your assessment of Baby F and why?

3. What physical examination will you include in your assessment of Baby F and why?

4. What laboratory tests will you include in your assessment of Baby F and why?

DIAGNOSIS (interpreting information to identify problems/needs)

You have completed your assessment of Baby F and your main findings include the following:

History:

 Record review reveals that Mrs. F has no running water in her home and must carry water for

household use from a river that is known to be polluted.

 Mrs. F reports that the rash began 3 days ago.

 She denies putting any substance on the baby’s skin.

 She reports that the baby is feeding well.

 All other aspects of the baby’s history are normal or without significance.

64 Basic Maternal and Newborn Care: Basic Childbirth, Postpartum, and Newborn Care

JHPIEGO/Maternal and Neonatal Health Program

Physical Examination:
 Baby F’s temperature is 37.0°C.

 Baby F has 7–8 skin pustules on her left arm and upper chest. There is no localized swelling

or redness, fluctuant lesions, generalized edema, or rash on palms or soles.

 The baby is wearing soiled clothing and is wrapped in a soiled cloth.

 The baby is breastfeeding well and shows no other signs of systemic sepsis as mentioned

above.

 All other aspects of her physical examination are within normal range.

5. Based on these findings, what is Baby F’s diagnosis (problem/need) and why?

CARE PROVISION (implementing plan of care and interventions)

6. Based on your diagnosis (problem/need identification), what is your plan of care for

Baby F and why?

EVALUATION

 Mrs. F returns to the clinic in 2 days.

 You find that the skin pustules have improved and the baby is wearing clean clothes.

 Mrs. F reports that she is boiling water that is used for drinking and for bathing the baby.

7. Based on these findings, what is your continuing plan of care for Baby F and why?