2012 Midwifery Licensure ExamsFUNDAMENTALS OF HEALTH CARE

Weight: 20 %

Subject Coverage and Competencies Based on Board of Midwifery CMO No. 33

1. PRENATALa. Assessment of major discomforts and

relief measuresb. Performs Leopold's maneuversc. Performs auscultationd. Compute for EDC and AOGe. Administer tetanus toxoidf. Conducts health education/counselling in

relation to: hygiene, diet, exercise, and preparation for delivery

2. LABOR AND DELIVERYa. Monitor the progress of laborb. Recognize early detection of abnormalityc. Performs

a) Catheterizationb) Hand washing c) Gloving and drapingd) Internal examinatione) Suturing f) IVF insertion

d. Administers oxytocin in labor e. Early detection of minor and serious

complications during delivery a) Monitor and evaluate outcome of

pregnancyb) Refers urgently any complication

identified3. POSTPARTUM

a. Monitor and evaluate mother’s conditionb. Perform postpartum carec. Conduct health teaching and counselling

on:a) Breastfeeding, family planning, diet,

exercise, and hygieneb) Plans and conducts home visits

following proper protocol 4. MIDWIFERY PROCEDURES

a. Health Care Process a) Collect datab) Take OB history and medical history c) Asses patient’s conditiond) Refer for laboratory examination

b. Vital Signs a) Take temperature b) Take pulsesc) Observe and count respirationd) Take blood pressure

e) Observe level of consciousness c. Drug Administration

a) Discuss classification of drugs b) Identify names and uses of drugsc) Follow types of medication ordersd) Administer drugs through proper

routese) Discuss actions/effects of drugsf) Identify proper abbreviationg) Identify commonly used drugs during

pregnancy d. Preventive and comfort measures

a) Give appropriate bed bathb) Prepare bed for the patientc) Perform perineal cared) Give health teaching on rest, sleep,

personal hygiene, and position. e) Conduct health education on proper

nutrition and elimination f) Perform hot and cold application g) Perform cord careh) Perform aseptic technique

e. Common Emergency Measures a) Manage minor bleeding/hemorrhage b) Give comfort measures to

fracture/sprainc) Give first aid to wounds and burnsd) Manage shock and unconsciousnesse) Give first aid during convulsion during

laborf. Principles of Bacteriology

a) Defines vocabulary wordb) Identify principal group of

microorganismc) Identify diseases caused by

microorganism _____________________________________________________

Focused Antenatal Care• Is based on the premise that every

pregnancy is at risk for complications• All women should receive the same basic

care including identifying complications• Involves a minimum of 4 visits in normal

or uncomplicated pregnancies• It stresses quality rather than number of

visit & has essential goal-directed elements including screening for diseases that complicate pregnancy (pre-eclampsia & anemia)

• It also reduces cost, lessens workload & provides more time to interact with patients thereby improving quality of care

pg. 1

Focused Antenatal Care Components 1. General Assessment of the Pregnant

Woman2. Screening for diseases that complicate

pregnancy: hypertension, anemia, syphilis3. Preventive measures: tetanus

immunization, iron, folic acid supplementation

4. Health Education: self-care, nutrition & danger signs of pregnancy

5. Birth Plan

Objectives:1. Detection of diseases which may

complicate pregnancy.2. Education of women on danger &

emergency signs & symptoms3. Preparation of the woman & her family for

childbirth

Steps to follow:I. IMMEDIATE ASSESSMENT for emergency

signs (QUICK CHECK): Unconscious/Convulsing Vaginal bleeding Severe abdominal pain Looks very ill Severe headache with visual

disturbance Severe difficulty in breathing Fever Severe vomiting

II. Make the woman comfortable Greet her, make sure she is

comfortable & ask how she is feeling If first visit, register the woman &

issue a Mother & Child Book/Home Based Maternal Record

III. Assess the pregnant woman First Visit: How old is patient? Past medical

history? Obstetrical history: Gravidity? LMP?

AOG? Ask about or check record for prior

pregnancies: convulsion, stillbirth or death in the first day, heavy bleeding during or after delivery, prior cesarean section, forceps or abortion

ON ALL VISITS: Check duration of pregnancy (AOG)

Ask for bleeding/danger signs during this pregnancy

Check record for previous treatments received during this pregnancy

Prepare birth & emergency plan Ask patient if she has other concern Give education & counseling on family

planning THIRD TRIMESTER Leopold’s exam, fetal heart beat Give education & counseling on family

planning Remember:

• Do not perform vaginal exam as a routine prenatal care procedure.

• Always record findings.• All pregnancies are at risk. Encourage

all pregnant women to deliver in the facility.

• Refer patients with abnormal findings to the doctor or to higher facility.

IV. Get the baseline laboratory information of the woman on the first or following the first visit.• Hemoglobin, blood type• Urinalysis

V. Screen for diseases that may complicate pregnancy: check for pallor or anemia

• Ask about getting tired easily or shortness of breath during routine work, drowsiness, palpitations, headaches – these may indicate anemia

First visit: o Check hemoglobin & blood type [normal

Hb cut-off level for pregnant woman is 11g/dl.

o if <8g/dl, refer to doctor for work-up & treatment for anemia

Subsequent visit:• Look for conjunctival pallor• Look for palmar pallor. If pallor: Is it

severe pallor? Some pallor?• Count number of breaths in one minute

VI. Check for hypertension/pre-eclampsia Measure BP in sitting position. If BP is

above 140/90 early in pregnancy, she is suffering from chronic hypertension & should be referred to the doctor

pg. 2

If diastolic BP is 90mmHg or higher repeat measurement after 1 hour rest

If diastolic BP is still 90mmHg or higher ask the woman if she has:

1. Severe headache2. Blurred vision3. Epigastric pain

Check urine for protein Diastolic BP >90mmHg, especially if with

severe headache, blurred vision & epigastric pain & urine protein – signs of severe pre-eclampsia – REFER IMMEDIATELY!

VII. Screen for diseases that may complicate pregnancy: Check for gestational diabetes

ASK ABOUT:• Family history (1st degree) of diabetes

& history of obesity• Past pregnancy for difficult labor, large

babies, congenital malformation & unexplained fetal death

LOOK FOR:• Signs of maternal overweight or

obesity• Polyhydramnios • Signs of large baby or fetal

abnormality• Vaginal infection

REFER FOR GLUCOSE TEST AT 24-28 WEEEKS FOR LOW RISKS OR IMMEDIATELY IF HIGH RISK.

VIII. Check for fever, burning sensation on urination & abnormal vaginal discharge:• Ask about episodes of fever or chills &

take temperature• Ask about pain or burning sensation

on urination• Ask about presence of abnormal

vaginal discharge, itching at the vulva if partner has a urinary problem

IX. Give preventive measures: IMMUNIZE AGAINST TETANUS

• To be protected, a pregnant mother must receive at least 2 doses of TT. The last dose should be given at least 2 weeks before delivery.

X. Give preventive measures: Give MEBENDAZOLE: to treat intestinal

parasites;

500 mg single dose once in 6 months after 1st trimester

XI. Give iron & folate supplementation to prevent anemia & neural tube defects:

Ferrous sulfate 320 mg (60 mg elemental iron) & 250 mcg folate

If Hgb <80 gm/dl – double the dose of iron. Refer to doctor for work-up of anemia

XII. Give preventive intermittent for falciparum malaria (if area is endemic)

XIII. Provide health information, advice & counsel on danger signals.

a. Health Informationa. Nutrition b. Self-care during pregnancyc. Effect of tobacco, alcohol and drugsd. Breastfeedinge. Birth and emergency situationsf. Schedule of appointment

b. Danger Signs a. Vaginal bleedingb. Convulsionsc. Severe headached. Severe abdominal paine. Fast or difficult breathingf. Fever g. Burning feeling during urination

XIV. Encourage the woman to come back for return visits.

At least 4 routine antenatal visits: 1st visit: before 4 months 2nd visit: 6 months 3rd visit: 8 months 4th visit: 9 months – return if

undelivered within 2 weeks after EDC. Pregnant women who do not come for

prenatal care should be visited at home.

The Birth • A written document prepared during the

first prenatal consultation. Plan may change anytime during pregnancy if abnormality develops.

• Discussed by the patient with the skilled birth attendant

• Contains information on:• Woman’s condition during pregnancy• Preferences for her place of delivery &

choice of birth attendant. Discuss why facility delivery vs. home delivery with skilled attendant is recommended

pg. 3

• Available resources (transportation, companion, money) for her childbirth & newborn baby

• Preparation needed (blood donor, referral center) should an emergency situation arise during pregnancy, childbirth & postpartum

The Emergency Plan Discuss how to prepare for an emergency in

pregnancy: Advise on danger signs, signs of labor Where to go? How to go? What to bring? With whom will you go? How much will it cost? Who will pay? How

will you pay? Start saving for these possible cost now Who will care for your home & other

children when you are away?

PRENATAL CARE ASSESSMENT

• Past Medical History – Disease experienced in the past– Childhood illnesses– Immunizations– Drug sensitivities– Past surgical procedures– Smoking and alcohol consumption

history– Intake of over-the-counter drugs

• Gyneologic History – Shows the woman’s past

experiences with childbearing, labor, and delivery

– Menstrual Hx• Age of menarche. Frequency

and duration of menstruation, amount of menstrual flow, discomforts (dysmenorrhea), premenstrual syndrome

– Reproductive Tract Health Hx• Vaginal discharges

(characteristics), vaginal pruritus, odor, or any surgery

– Sexual Hx• STD; if currently sexually

active, discomforts during coitus; concerns about sexual intercourse

– Contraception Hx

• Contraceptive presently being used; types in the past

– Breast Health • Any abnormality; any breast

surgery; if she has breastfed a child

• Obstetric History – Past pregnancies (number, sex of

the child, date and place of birth, whether all pregnancies were planned, any complications, surgery, medications, prenatal care, duration of pregnancy or labor, type of delivery, infant’s birth weight, infant’s condition at birth, any abortions.

– Determine the gravida and para– Obstetrical scoring: T-P-A-L

T-P-A-L• T – the number of full term infants born

(37 weeks or after) • P – the number of preterm infants born

(before 37 weeks)• A – the number of spontaneous or induced

abortions• L – the number of living children

Present pregnancy• LMP (last menstrual period); duration of

pregnancy or age of gestation. The Weeks of gestation is the clinically appropriate unit of measure for the duration of pregnancy.

• Early signs of pregnancy; minor discomforts; her feelings about her present pregnancy; any medications prescribed or OTC; danger signs of pregnancy.

• Compute for the EDC using Naegele’s rule: Determine the LMP, count back 3 d months and add 7 days

Physical Examination• Techniques: Inspection, Percussion,

Palpation, Auscultation • Provide privacy; examining room

temperature must be comfortable.• Ask to empty bladder (except with UTZ)• Initial data of VS must be taken especially

BP and weight • Include general appearance first, then each

body parts must be examined (head to foot)

pg. 4

• During PE, observe the normal physiologic changes or other abnormalities.

• Important: PE must be focused on the reproductive tract.

• Cervix is visualized using a speculum in order to identify cytological abnormalities (Pap smear).

• Vaginal secretions:• Normal – moderate amount of

white mucoid discharge• Trichomonas – foamy yellow liquid• Candida – presence of curdl-ike

discharge • For digital pelvic examination, special

attention is given to the consistency, length, and dilatation of the cervix;

• Note the presenting part, bony architecture of the pelvis, and any abnormalities of the vagina and perineum.

• The vulva and other nearby structures are also carefully inspected.

• Pelvic or cervical examination must be done with caution especially if there is history of bleeding because this might aggravate the problem.

• Between 18 to 32 weeks, there is a good correlation between the gestational age of the fetus in weeks and the height of the uterine fundus in centimetres.

• Fundic height is measured as the distance over the abdominal wall from the top of the symphysis pubis.

Ultrasound:• Can be prescribed as early as 5 to 6 weeks

after LMP• Shows fetal heartbeat at 9-10 weeks

gestation• 12 -13 weeks can show the biparietal

diameter of the fetal skullFetal heartbeat

• Generally heard by 10-12 weeks with Doppler device

• Heard using a stethoscope at 18-20 weeks Quickening

• Fetal movement usually felt by the mother at 20 weeks gestation

• Usually detected in 2nd pregnancy than with a first

Leopold’s maneuvers• Purpose: Systematically observing and

palpating the abdomen to determine fetal presentation and position.

1 st Maneuver : determine whether fetal head or breech is in the fundus.

• The midwife stands at the foot of the client, facing her, and place both hands flat on the abdomen.

• A head is round and hard; the breech is less well defined.

2 nd Maneuver : To locate the back of the fetus• The health worker faces the client and

places the palms of each hand on either side of the abdomen.

• The back is the smooth, hard, resistant surface

• On the opposite, a number of angular nodulations (the knees and the elbows) will be felt, indicating the front side of the fetus.

3 rd Maneuver : Determine the part of the fetus at the inlet and its mobility.

• Grasp the lower portion of the abdomen just above the symphysis pubis between the thumb and the index finger together.

• Determine any movement and whether the part is firm or soft.

• If the presenting part moves upward, the presenting part is not yet engaged.

• If the part is firm, it is the head; if soft, then it is breech.

4 th Maneuver: • Determines the fetal attitude and degree of

fetal extension into the pelvis. Done only if the fetus is in cephalic presentation.

Summary of PE• Measure client’s height and weight • Vital signs• Head-to-toe examination• Special attention to the heart, lungs, pelvis,

breasts, and nipples• Pelvic exam is performed last• External genitalia are examined for scars,

lesions, or infection• Pap smear for cervical cancer and

gonorrhea is usually obtained• Leopold’s maneuvers• Pelvic size for adequacy

After taking the Hx, PE, and lab tests, analysis is done in order to estimate whether the pregnancy will continue with a good outcome or if is one that has the potential to end before term or with an unfavorable fetal or maternal outcome.

Danger Signals/Signs of Pregnancy• Any vaginal bleeding• Swelling of the face and fingers• Severe or continuous headache

pg. 5

• Dimness or blurring of vision• Abdominal pain• Marked change in intensity or frequency of

fetal movement• Persistent vomiting• Chills or fever• Dysuria• Escape of fluid from vagina

Tetanus Toxoid• Basis: Number of Pregnancies that will

terminate in live births (3% of total population) plus number of other pregnancies that may not terminate in live births

• (0.5% of the total population) = 3.5% of the total population.

• Formula: Population x 3.5%• Wastage allowance: TT 25%• Annual Dose: TT 2/year • Number of dose in every ampule or vial:

TT 20

Nutrition during Pregnancy• Nutritional status of the mother is likely to

be compromised in any of the following circumstances:– Under 16 years of age– Economically deprived– Pregnant for the 3rd time in 2 years– Past reproductive performance has been

poor– Consumes a therapeutic diet in the

course of management of some pre-existing diseases

– Food faddist – Smokes, drinks, or uses hard drugs– Appreciably underweight at the outset– Hematocrit drops much below 11gm/dl– Weight for any month during the 2nd and

3rd trimester is less than 2 pounds

General Instructions for Pregnant Mothers Exercise

o It is not necessary for a pregnant woman to limit exercise, provided she does not become excessively fatigued or risk injuring herself or the fetus.

o Contraindication: women who have pregnancy complications like PIH; multiple gestation; or suspected of having growth retarded fetus

Recommended Exercise During Pregnancyo Stretching Exercises for Pregnancy

Neck rotation Shoulder rotation Swim thigh shift Leg shake Ankle rotation

Kegel’s Exercise• Strengthen the muscles that support the

bladder, uterus, and bowels.• By strengthening these muscles, the

pregnant woman can develop the ability to relax and control the muscles in preparation for labor and birth.

• Also recommended during the postpartum period to promote healing of the perineal tissues, increase the strength of the pelvic floor muscles, and also increase urinary control.

Coitus• For healthy pregnant women, sexual

intercourse usually does no harm before the last four weeks or so of pregnancy.

• Should be avoided whenever abortion or preterm labor threatens.

• Position: Woman on top or side lying.

Care of the Breast and the Abdomen• Pregnant women should wear a brassiere

that is well-fitted to support the breast in a normal uplift position.

• This is conducive to good posture and helps prevent backache.

• Flat or inverted nipple: special care is needed.

• Abdominal Support• A properly fitted maternity girdle

gives the needed support to keep the mother from becoming fatigued. The purpose of the garment is support and comfort (prevents backache)

• Care of the teeth • Good dental care is necessary because

the teeth are important for mastication of food. Dental carries should be treated during pregnancy and oral hygiene must be emphasized.

• Smoking • Contraindicated during pregnancy.

Will result in LBW infants. • Alcohol

• Excessive ingestion or chronic alcoholism can lead to fetal maldevelopment. Can result to growth restriction, facial abnormalities, and CNS dysfunction.

pg. 6

Advise woman not to consume alcohol.

• Caffeine • Decreases uterine blood flow by 5 to

10 %. Advise woman to limit caffeine intake.

• Hard drugs/Addicting drugs • Opium derivatives, barbiturates,

amphetamine in large doses are harmful to the fetus. This causes intrauterine distress, LBW, and serious compromise. The infant will have symptoms of drug withdrawal. Addicting drugs must be avoided.

• Medication• With rare exceptions, any drug that

exerts a systemic effect in the mother will cross the placenta to reach the embryo and fetus. Medication must always be prescribed.

• Immunization • The following vaccines are

contraindicated during pregnancy:• Measles• Mumps• Poliomyelitis• Rubella• Yellow fever

ENSURING BOWEL ELIMINATION

Bowel Elimination - basic needs to remove solid wastes from the body usually through defecation

Defecation - The expulsion of the feces from the rectum.

Factors Hindering Normal Bowel Elimination Accumulation of flatus (gas) Accumulation of fluid or feces d/t

decreased peristalsis Surgical procedures (colostomy) Head or spinal cord injury Immobility Change in diet Environment

Signs of Interference in Bowel Elimination Decreased bowel sounds Flatulence/adbominal distention -

accumulation of gas in the stomach/intestines

Vomiting - expulsion of gastric contents

Constipation - Difficulty in passage of hard stools

Diarrhea - Passage of 3 or more soft, watery stools

Fecal impaction

Normal Characteristics of Stools Color - yellow or golden brown (d/t

stercobilin) Odor - aromatic upon defecation (d/t

skatole & indole) Amount - depends on bulk of food intake

Alterations in Characteristic of Stools Melena -passage of black tarry stools d/t

upper GI bleeding Acolic - gray, pale or clay colored stools

d/t biliary obstruction Hematochezia - stool with bright red blood

d/t lower GI bleeding Steatorrhea - greasy, bulky, foul smelling

stools d/t hepato-pancreatic obstruction

Independent Measures to Promote Normal Defecation

Positioning - thighs flexed while sitting to increase intra-abdominal pressure

Assist client to bed pan High fiber diet Adequate fluid intake (8-10 glasses/day) Provide client privacy Exercise

Dependent Nursing Measures Inserting a rectal tube Enema

Administering Enema The introduction of a solution into the GIT

through the rectum for various purposes• Relieve constipation• Relieve flatulence• Administer medication• Lower body temperature• Evacuate feces in preparation for

surgery or diagnostic procedures

Types of Enema Non-retention Enemas (to be expelled)

• Cleansing - cleanses bowel prior to surgery or diagnostic procedure. Solution used: tap water, soap suds, NSS (500-1000 mL)

pg. 7

• Antihelminthic - to expel worms. Quassia solution

• Astringent - control or check bleeding

• Carminative Expel flatus or gas Milk and molasses solution Introduce 60-180 mL Fleet enema: 100-130 mL

Enema to be Retained (retention enema)

Diagnostic• Outline colon for x-ray• Barium sulfate

Emollient• Coat membranes to relieve

irritation• Starch solution

Lubricating • To soften stools• Olive oil, mineral oil, or cottonseed

oil• Introduce 90-120 mL of solution

Nutrient• To give nourishment• Dextrose solution

Sedative • Induce sleep• Paraldehyde solution

Stimulating • Stimulate body processes• Black coffee

Special Considerations Retention enemas

• Hang solution 12 inches from buttocks

• Solution temperature: 105-110 F• Hold solution for 1-3 hours

Non-retention enemas• Hang solution 12 inches from

buttocks • Solution temperature: 115-125 F• Retain solution for 1-3 hours

- Position adult patient in sims/left lateral- Infants and children on dorsal recumbent- Use Fr # 22-30 catheter for adults- Use Fr # 12-18 catheter for children - Allow solution to flow through tube first to

expel air

- Lubricate tip and insert 3-4 inches, with tip towards the umbilicus in rotating motion.

- Instruct patient to breath through mouth- Do not administer more than three times

at one time- If abdominal cramps occur, clamp tubing &

temporarily stop solution until peristalsis relaxes. Lower level of solution

- Not to be given to patient suspected having bowel obstruction and appendicitis

Stool Examination Routine fecalysis Stool c/s

• Stool specimen in a sterile test tube

Guaiac Test• Test for occult/hidden blood• Hemoglobin free diet x 3 days• No meat, avoid dark colored foods• Discontinue Iron• Positive result: gastric cancer,

peptic ulcer, colon cancer

Insertion of Rectal Tube Purpose - remove flatus and relieve

abdominal distention Position - left side lying Length of tube to be inserted - 4-6 “ Duration - 15-20 minutes Indicator of effectiveness - bubbling in

kidney basin

Common Problems in Bowel Elimination Constipation – passage of hard, dry stools

• Fluids• High fiber diet• Regular bowel elimination• Exercise• Reduce stress• Administration of laxatives

Fecal Impaction - mass or collection of hardened stools in folds of rectum

• S/Sx: - Hardened fecal mass- Anorexia- Nausea and vomiting- Abdominal distention

• Interventions - Digital (manual) extraction- Increase oral fluids- High fiber diet- Activity and exercise

pg. 8

Diarrhea - increased frequency and passage of soft to liquid stools

• Rest• Oral rehydration• Low fiber diet• BAR diet – banana, apple, rice AM• Avoid excessive hot or cold drinks• Anti-diarrheals, absorbents,

astringents Flatulence - excessive gas in the intestines

• Avoid gas forming food• Knee-chest position

ENSURING URINARY ELIMINATION

Urination - Also termed “Voiding” or “Micturition”- Occurs when the bladder contains 250-300

mL (adults) and 50-200 mL (children) of urine.

- The pair of kidneys normally produces 30 mL/hour of urine.

Characteristics of Normal Urine• CLEAR - amber/straw colored• ODOR -aromatic upon voiding• pH - slightly acidic (4.6-8/average: 6)• SPECIFIC GRAVITY - 1.015 – 1.025• AMOUNT - 1500 – 2000 mL/day

Abnormal Characteristics & Alterations in Patterns of Voiding

Turbid, cloudy Abnormal color – tea colored or bloody Hematuria – blood or RBC in the urine Albuminuria – albumin in the urine Glycosuria – sugar in the urine Pyuria – pus in the urine Bacteuria – bacteria in urine Proteinuria – protein in the urine Clinduria – presence of casts Ketonuria – ketones in the urine Dysuria – painful urination Polyuria – voiding of abnormally large

amounts of urine (more than 2000 ml/day)

Oliguria – voiding of less than 500 mL per day

Anuria – absence of urine or voiding of less than 200 mL per day

Incontinence – involuntary emptying of the bladder, loss of control in voiding.

Stress incontinence – leakage of less than 50 mL of urine as a result of sudden

increase in intra-abdominal pressure as when one coughs, sneezes, laughs, or exerts physically.

Urge incontinence - feels strong desire to urinate and leads to involuntary detrusor contraction.

Functional incontinence – involuntary unpredictable passage of urine.

Reflex incontinence – involuntary loss of urine occuring at somewhat predictable intervals.

Retention – accumulation of urine in the bladder caused by inability to urinate.

Dribbling (retention with overflow) – frequent voiding of small amounts of urine while the bladder remains distended.

Nocturia – increased frequency of voiding at night.

Frequency – voiding at frequent intervals Urgency – strong feeling or desire to void Hesitancy – difficulty in initiating voiding Enuresis – repeated involuntary voiding

beyond 4-5 years of age (bedwetting) Pollakuria – frequent, scanty urination.

Measures to Promote Urinary Elimination Independent Functions

- Encouraging fluid intake- Running tap water within the client’s

hearing- Pouring water over the patient’s

perineum- Alternate warm and cold compress over

hypogastrium- Assist to toilet or bed pan

Dependent Funtions- Obtaining urine specimens for laboratory

examination- Catheterization

Fluid Monitoring Measuring fluid intake and output (I & O)

refers to measuring all fluid that enters and exits from the body.

Intake - All food and fluids that liquify at room

temperature (ice cream, gelatin)- Parenteral fluids (IVF)- Fluids introduced through tubes (NGT)

Output- Urine- Vomitus- Diarrhea- Drainage from suctioning- Fluid in feces

pg. 9

Purpose of Fluid Monitoring Monitor client’s fluid intake and output Monitor renal function.

Urine Specimen Collection Clean Cath, Midstream urine specimen (for

routine Urinalysis (U/A), C & S- Catch first voided specimen- Perineal care prior to collection- Discard first flow and catch 30-50 mL

midstream- Discard the last flow

24 Hour Specimen- Discard first voided specimen- Collect all specimen thereafter until

the same time the following day- Soak specimen container in ice or put

in refrigerator Sterile Urine Specimen

- Obtained through catheterization

Urinalysis Benedict’s Test – to determine prescence

of sugar in the urine. - Collect specimen before meals - Put 5 mL of Benedict’s Solution into

the test tube- Add 8 – 10 drops of urine- Heat Benedict’s Solution with urine- Blue (-)- Green (+)- Yellow (++)- Orange (+++)- Red (++++)

Clinitest – to determine sugar in the urine- Put one clinitest tablet in test tube- Add 5 drops of urine- Add 10 drops of water- Wait for reaction to occur and compare

with standard chart

Heat and Acetic Acid Test- Collect urine specimen before meals- Imaginary divide test tube into three parts- Put 2/3 parts of acetic acid in test tube- Add 1/3 part urine- Heat and observe for CLOUDINESS which

indicates Albuminuria

Catheterization - insertion of a catheter into the urethra and bladderPurposes:

- Relieve retention- Obtain a sterile urine specimen

- Measure residual urine- Instill medications in the bladder- Irrigate the bladder (treat infections)- Measure hourly urine output- Maintain continence

Special Considerations- Provide privacy- Practice strict asepsis- Catheter size:

French # 8-10 (Children) French # 14-16 (adult female) French # 18 – 20 (adult male)

- Types of catheter Foley – for indwelling catheters,

balloon tipped Straight – for intermittent

catheterization - Position patient in DORSAL RECUMBENT- Perineal care before catheterization- Drape DIAGONALLY- Insert catheter 2-3 inches in females and

7-9 inches in males in gently rotating motion.

- Let patient take deep breaths to relax sphincter.

- Inflate with sterile water of PNSS (0.9 NaCl) (Check label for quantity required).

- Limit emptying of bladder to 700-1000 mL only to allow for gradual decompression and prevent shock

- Anchor indwelling catheter in inner aspect of thigh.

PROMOTING HYGIENE AND COMFORT- Measures to promote personal cleanliness

and grooming- Maintain client’s well-being and self-

esteem.- Infection control.

Determining Factors- Culture- Socioeconomic status- Religion- Developmental level- Health status- Personal preference

Bathinga. Cleansing Bath

- Complete bath – washes the entire body

- Partial bath – cleanses some body parts only

- Tub/Shower bath – entire body

pg. 10

b. Therapeutic Bath - Sitz – reduce inflammation and clean

perineal and perianal area. - Tepid Sponge Bath – reduce

fever/temperature- Medicated tub bath – relieve skin irritation

Cleansing Bed Bath- Cleanse the skin- Comfort and relaxation- Stimulate circulation- Remove secretion and excretions- Assessment of client- Inspection for skin breakdown

Special Considerations- Water temperature – 109 F – 115 F (43-45

degree Celsius)- Fold washcloth into a mitt- Wipe eyes from inner to outer canthus- Use S-motion when wiping face- Use long strokes from fingers to axilla

(distal to proximal), ankle to knee and knee to thigh.

- Wash perineum last (“finishing the bath”).

Perineal care- Promote comfort and cleanliness- Prevent infection- Promote healing- Remove perineal secretions and odor

Special Considerations- Water temperature – 109 F – 115 F (43-45

degree Celsius)- Position patient in dorsal recumbent

position- Apply diagonal draping- Clean from labia majora, labia minora,

vagina to pubis to rectum- Grasp cotton ball with forceps using one

downward stroke with each cotton ball- Drape patient diagonally with one

tip/corner if blanket in between the patient’s thighs to cover perineum

Back rub - Consists of massaging the back, shoulder,

and lower neck- Done after a bath or bedtime- Relaxation- Relieve muscle tension- Stimulate circulation- Assessment of client skin

Techniques- Effleurage - Stroking skin with the use of

the palms in long or circular strokes.

- Petrissage - kneading, lifts up portion of the skin

- Tapotement - quick hacking motion using the side of the hand

Special Considerations- Rub in circular motion over sacral and

scapular area- In effleurage, use long strokes upward

along center of patient’s back from buttocks to shoulder

- Move downward alongside of back of iliac crest

- Repeat strokes for 3-5 minutes

Bed Making- Types of Bed

o Closed/Unoccupied – bed with no patient in it and is covered to the top.

o Open – bed with top sheet fan folded or folded diagonally ready for a newly admitted client

o Post – op or surgical bed – bed ready to admit a client recovering from anesthesia

o Occupied – bed made with the client on it.

Purposes- Provide a clean and neat environment- Promote client comfort- Reduce the transmission of organisms

Special Considerations- Practice good body mechanics- Strip one bed linen/sheet at a time and do

not shake soiled linens.- Apply bed sheets from bottom to top in the

following order: bottom sheet, rubber sheet, draw sheet, top sheet and blanket, pillowcase

- Fold bottom sheet wrong side out and top sheet right side out.

- Place hem of bottom sheet even with the bottom of the mattress and pull towards the head part. Miter corner and tuck in at head part.

- Place hem of top sheet even at the top of bed and pull towards bottom (foot part) of the bed. Miter corner and tuck in at foot part.

- Place draw sheets about 15 – 18” from top to bed.

- Place pillow case on head part of the bed with open end facing away from the door.

- For close beds, draw top sheet and fold about 12-15” from top of bed. Place pillow and then draw over pillow to cover.

pg. 11

- Fanfold or fold top sheet diagonally when making an open bed.

- Finish one side of bed at a time to save time and conserve energy.

Post–operative/Surgical Bed- Top linens are folded a quarter from head

and bottom of bed- Fanfold top sheets towards the center of

bed- Place pillow against head board- Keep bed in high position to facilitate

transfer- Prepare at the bed side: IV pole, emesis

basin, BP and suction apparatus, Oxygen device.

Medication Administration

• Medications administered to clients are used, almost exclusively, to prevent, diagnose, or treat disease.

Types of medication action• Therapeutic effects:

▫ The expected or predictable physiological response a medication causes.

▫ Each medication has a desired therapeutic effect for which it is prescribed.

Side effects• Are the unintended, secondary effects a

medication predictably will cause. • Side effects may be harmless or injurious.• If the side effects are serious enough to

negate the beneficial effects of a medication’s therapeutic action, the prescriber may discontinue the medication.

• Clients usually stop taking medications because of the side effects.

Adverse effects• Generally considered severe responses to

medication.• For example: a client may become

comatose when a drug is ingested.• When adverse responses to medications

occur, the prescriber must discontinue the medication immediately.

• Some adverse effects are unexpected effects that were not discovered during drug testing.

Routes of administration• Depends on the medication’s properties

and desired effect and on the client’s mental and physical condition.

• Oral routes ▫ Easiest and most commonly used ▫ Given by mouth and swallowed

with fluid▫ Have slower onset of action and a

more prolonged effect than parenteral medications.

▫ Most preferred route. • Sublingual

▫ Readily absorbed after being placed under the tongue to dissolve

▫ Should not be swallowed, or the desired effect will not be achieved.

▫ Nitroglycerine is an example • Buccal

▫ Placing the solid medication in the mouth and against the mucous membranes of the cheek until the medication dissolves

▫ Client must alternate between cheeks to prevent irritation

▫ Do not chew or swallow medication or take any liquids with it.

Parenteral routes• Involves injecting a medication into body

tissues.• Intradermal – into the dermis just under

the epidermis• Subcutaneous – into tissues just below the

dermis of the skin• Intramuscular – into a muscle• Intravenous – into a vein

Topical administration• Medications applied to the skin and

mucous membranes and generally have local effects

• Systemic effects may occur if the skin of the client is broken down

▫ Includes ointments, eye drops, gargles, suppository

Inhalation• Medications administered through the

nasal passages, oral passages, or endotracheal or tracheostomy tubes.

• Readily absorbed and work rapidly because of the rich vascular alveolar capillary network available

pg. 12

• Can either have local or systemic effects

Ways to prevent medication errors• Read medication labels carefully• Question administration of multiple

tablets or vials for single dose• Be aware of medications with similar

names• Check decimal point• Question abrupt and excessive increase in

dosages• When new or unfamiliar medication is

ordered, check a reference• Do not administer medication ordered by

nickname or unofficial abbreviation • Do not attempt to decipher illegible

handwriting• Know clients with the same last names.

Also, have clients fully state their names and check bands carefully.

• Do not confuse equivalents

Avoiding Medication Errors1. RIGHT DRUG - ensure that the medication

order is properly composed and includes;- Patient’s full name- Drug name- Dosage form- Dose amount- Administration route- Time schedule- Practitioner’s signature- Date and Time of order

Check the medication order against drug label THREE TIMES (3X)

Know why the patient is receiving the specific drug at this time.

Do not administer a medication someone else has prepared

If using a unit dose system, do not open the packaging until you are at the client's bedside

Never leave a medication unattended2.) RIGHT ROUTE

Check the order and medication supplied Oral (by mouth or gastric tube) Parenteral ( ID, Subcutaneous, IM, IV) Topical Otical Opthalmic Mucous membrane ( sublingual, buccal,

vaginal, rectal, intranasal, transdermal, inhalation)

3.) RIGHT DOSE- perform dosage calculation

always use the appropriate measuring device and read it correctly ( measure liquid for oral administration at the meniscus)

shake all suspensions and emulsions when measuring drops of medication with

a dropper, always hold the dropper vertically and close the medication cup

when removing a drug from a multiple dose vial, inject an amount of air equal to the amount of fluid to be withdrawn

do not attempt to divide unscored tablets and do not administer tablets that have been broken unevenly along the scoring

4.) RIGHT TIME verify the frequency of dosage with the

medication order

5.) RIGHT PATIENT check the tag on the client's bed check the client's identification band ask the client to state his name ask the parents to state the name of their

child always check a prescription that the client

questions

6.) RIGHT DOCUMENTATION Make sure that the practitioner’s order is

clear and complete Compare the original order with the

medication label to ensure accuracy Record the medication in the patient’s

chart immediately after administering it If the patient doesn’t take the

medication, document that the drug was not given, why; notify the practitioner if appropriate.

7.) RIGHT EDUCATION Teach your patient about the drug he is

receiving8.) RIGHT DRUG HISTORY

take a complete patient drug history (there is a risk of adverse drug reactions when a number of drugs are taken or when patient is taking alcohol drinks)

9.) RIGHT TO REFUSE be sure to assess the client's reason for

refusing the medication document if client refuses medication,

client's reason and reporting of refusal to healthcare provider

pg. 13

Do not forget to assert client education as to why is the medication prescribed, what the medication does, and importance of medication for treatment of client's health alteration.

VITAL SIGNS - A.k.a “cardinal signs”- Includes temperature, pulse, respiration,

blood pressure and pain- Measurement provides data to determine

the client’s usual state of health- Change in v/s can indicate change in

physiologic function- Assessment of v/s will enable the HW to:

Identify the problem precisely Plan for the right intervention

- Techniques:a. Inspectionb. Palpation c. auscultation

BODY TEMPERATURE- The balance between the heat produced and

the lost from the body- Measured in “degrees”KINDS:

a. CORE TEMPERATURE - Temperature of the deep tissues of the

body (abdominal & pelvic cavity)- Remains relatively constant within the

range of 36.0°C to 37.5°Cb. SURFACE TEMPERATURE- Temperature of the skin, subcutaneous

tissue & fat- Rises & fails in response to the

environment

FACTORS OF HEAT PRODUCTION- Basal metabolic rate- Muscle activity- Shivering - Thyroxin output- Sympathetic stimulation

Four Processes of Heat Loss- Radiation - Convection - Evaporation - Conduction

ALTERATIONS IN BODY TEMPERATURE- Pyrexia or hyperthermia- Hyperpyrexia - Hypothermia - Febrile - Afebrile

TYPES OF FEVER- Intermittent- Remittent- Relapsing- Constant

SITES OF TEMPERATURE TAKING- Oral - Rectal - Axilla - Tympanic membrane

An elevation of body temperature above normal is labelled FEVER or HYPERTHERMIA

A patient who has a temperature of 36.5°C is known to be AFEBRILE

A condition wherein the body temperature falls below 35°C is called HYPOTHERMIA

Cooling the body with the use of an electric fan is an example of heat loss by CONVECTION

Your patient’s temperature records 40°C. This condition is called HYPERPYREXIA

PULSE- Palpable bounding of blood flow noted at

various points on the body- Serves as indicator of circulatory status- Can be assessed by:

a. Palpationb. Auscultation

SITES FOR ASSESSING PULSE- Temporal - Carotid - Apical - Brachial - Radial - Femoral - Popliteal - Posterior tibia- Dorsalis pedis

RATE- Tachycardia – excessively fast heart rate- Bradycardia – heart rate lower than

normal

- TACHYCARDIA a pulse rate of 120 bpm in an adult female

- BRACHIAL used in cases of cardiac arrest for infants

- BRADYCARDIA a pulse rate of 70 bpm in a newborn

- FEMORAL used to determine circulation to the lower extremities

pg. 14

- BOUNDING PULSE a forceful blood volume that is obliterated only with difficulty

RESPIRATIONS- The act of breathing- Involves several physiologic events:

Pulmonary ventilation External respiration Internal respiration

ASSESSING RESPIRATIONS- Normally, breathing is carried out

automatically and effortlessly- Respirations are assessed while the client is

relaxed- Before assessing a client’s respiration, check

for:a. The client’s normal breathing patternb. Influence of client’s health problems

on respirationsc. Medications or therapies that might

affect respirationsd. The relationship of the client’s

respiration to cardiovascular function RESPIRATORY RATE

- Normally described in breaths per minute or cycles per minute

Described as: Eupnea – normal breathing Bradypnea Tachypnea

BREATH SOUNDS: Wheeze – continuous high-pitched musical

squeak or whistling sound occurring on expiration & sometimes on inspiration when air moves through a narrowed or partially obstructed airway

Stridor – a shrill, harsh sound heard during inspiration with laryngeal obstruction

Stertor – snoring respiration due to partial obstruction of the upper airway

Bubbling – gurgling sounds heard as air passes through moist secretions in RT

12 – 20 cpm normal respiratory rate in adults.

- EUPNEA normal respiratory rate & depth.- ORTHOPNEA ability to breathe only in

upright sitting or standing position.- HEMOPTYSIS presence of blood in sputum.

APNEA cessation of respiration for several seconds

BLOOD PRESSURERefers to the force of blood against arterial walls

BP measures:- SYSTOLIC PRESSURE

The pressure of the blood as a result of contraction of the ventricles

- DIASTOLIC PRESSUREThe pressure when the ventricles are at rest.

- PULSE PRESSURE Difference between the systolic & diastolic pressure

BP - measured in millimeters of mercury (mmHg)- Recorded as a fraction- Numerator: systolic pressure- Denominator: diastolic pressure

HYPERTENSION- A BP that is persistently above normal- Usually asymptomatic; predisposing factor

to myocardial infarction- Types:

a. Essential HPNb. Secondary HPN

HYPOTENSION- A BP that is below normal - Causes:

Analgesics Bleeding Severe burns Dehydration

- Orthostatic hypotension – pressure falls when the client changes position; results from peripheral vasodilatation

CONSIDERATIONS IN TAKING THE BP- BP reading should be made with the eye at

the level of the rounded curve (meniscus) of the manometer

- BP cuff should be of accurate size:Width of cuff = 40% of arm circumference2/3 of the arm’s length

- Patient’s arm should be supported and positioned at the level of the heart

Bladder cuff that is too narrow – false high BPBladder cuff that is too wide – false low BP

Family Planning

How to determine that a woman is NOT pregnant?• Has not had intercourse since last normal

menses, or

pg. 15

• Has been correctly and consistently using another reliable method, or

• Is within the first 7 days after normal menses, or

• Is within 4 weeks postpartum (for nonlactating women), or

• Is within the first 7 days post abortion, or • Is fully breastfeeding, amenorrheic, and less

than 6 months postpartum

If the client answered NO to all of the questions, pregnancy cannot be ruled out. The client should await menses or use a pregnancy test.

If the client answered YES to at least one of the questions and she is free of signs or symptoms of pregnancy, provide client with desired method.

FERTILITY AWARENESS-BASED METHODS (FAB) & LAM

• FAB Methods- are family planning methods that focus on the awareness of the beginning & end of the fertile time of a woman’s menstrual cycle.

• Effectiveness depends on the couple’s ability to identify fertile & infertile periods & motivation to practice abstinence when required.

Signs of Fertility1. Changes in the cervical mucus: cervical

mucus can be used to determine the beginning & end of the fertile period.

2. Changes in the basal body temperature: BBT can be used to determine when ovulation has passed & the fertile days have ended.

Billing’s ovulation method (BOM)- Based on the daily observation of what a

woman sees & feels at the vaginal area throughout the day.

- Cervical mucus changes indicate whether days are fertile or infertile & can be used to avoid or achieved pregnancy.

- With perfect use, this method is 97% effective.

- Typical use: 80% effectiveness

Basal Body Temperature (BBT)- It is based on a woman’s resting body

temperature (body temp. after 3 hours of continuous sleep) which is lower before

ovulation until it rises to a higher level beginning around the time of ovulation.

- Her infertile days begin from the fourth day of the high temperature reading to the last day of the cycle

- All days from the start of the menstrual cycle up to 3rd high temp.reading are considered FERTILE DAYS.

- Perfect use:99%- Typical use: 80%

Symptothermal Method (STM)- Combined technology of the BBT & BOM

which indicate that the woman is fertile or infertile.

- 98% effective as correctly used.

Standard Days Method (SDM)- Is based on a calculated fertile & infertile

period for menstrual cycle lengths that are 26-32 days.

- Women who are qualified to use this method are counseled to abstain from sexual intercourse on days 8-19 to avoid pregnancy.

- Couples use the device called the color coded “cycle beads”.

Women with special consideration- Contraceptive shifters may also use SDM

provided the following criteria are met;- Menstrual cycles were within 26-32 days

before pill use- Expect current cycle to be within 26-32 days

Advantage of FABM (Fertility Awareness Based Methods)• Effective when used correctly &

consistently• No physical SE• No prescription required• Inexpensive; no medication involve• No follow-up medical appointments

required• Better understanding of the couple about

their sexual physiology & reproductive function.

• Encouraged shared responsibility for FP• Foster better communication between

partners.Disadvantage• May inhibit sexual spontaneity• Except for SDM, need extensive training-

takes about 2-3 cycles to accurately identify the fertile period & how to effectively use it.

pg. 16

• Requires consistent & accurate record keeping & close attention to body changes.

• Required periods of abstinence from sexual intercourse, which may be difficult for some couples.

• Required rigid adherence to daily routine of awakening at a fixed time, without enduring any disturbances before taking the temp.

• Can be used only by women whose cycles are within 26-32 days (SDM).

• Offer no protection against STI, HIV & AIDS.

Lactational Amenorrhea Methods (LAM)• LAM is a method that relies on the condition

of infertility that results from specific BF patterns.

• Use of BF as a temporary FP method.• Lactational means breastfeeding• Amenorrhea means not having a menstrual

bleeding.

3 criteria that must be met to use LAM1. Woman fully or nearly fully breastfeeds her

infants. Fully/ Nearly Fully maybe interpreted as;- Fully (exclusive) means no supplements

of any sort are given. Infants receive no other liquid or food, not even water in addition to breast milk.

- Nearly fully means very small amount of water, vitamins or ritual foods are given not more than once per day. For LAM to remain effective, 85% or more of feedings must be breastfeeds.

- Simply put, the woman should use both breasts to breastfeed her baby on demand with no more than a 4 hour interval between any 2 daytime feeds & no more than a 6 hour interval between any two night time feeds.

2. Amenorrhea- mothers monthly bleeding has not returned. In the first 6-8 weeks PP.

3. 3. Infant is less than 6 months old.

IF ANY OF THE CRITERIA IS NOT MET, LAM IS NOT APPLICABLE

Mechanisms of Action (LAM)• Works primarily by preventing the release of

eggs from the ovaries. Frequent BF temporarily prevents the release of the natural hormones that cause ovulation.

Effectiveness

• 99.5% effectiveness if the 3 criteria are consistently followed.

• 98% typically use• Mothers should initiate BF as soon as

possible after birth, & avoid separation from the baby as much as possible.

• BF on demand day & night, with no more than a 4 hour interval between any 2 daytime feeds & no more than a 6 hour interval between any 2 night time feeds.

Advantages of LAM• It can be started immediately after

delivery• It is recommended & easily available• It does not require an Rx.• No action is required at the time of

intercourse• There are no SE or precautions to its use• No commodities/supplies are required for

clients or for the FPP.• Fosters mother-child bonding• It serves as a bridge to using other

methods because LAM is used for a limited time only

• It is consistent with religious & cultural practices.

Disadvantages of LAM Effectiveness after 6 months is not certain. Frequent breastfeeding may be

inconvenient or difficult for some women, especially working mothers.

No protection against sexually transmitted diseases (STDs) including HIV/AIDS.

If the mother has HIV (the virus that causes AIDS), there is a small chance that breast milk will pass HIV to the baby.

Categories of Choice of FP methods for Postpartum and Breastfeeding women

1st choice; Non-hormonal methods other than LAM- IUD, condom, BTL, NFP, vasectomy

2nd choice: Progestin-only pills- DMPA & POI ( can be initiated after 6 weeks

PP)3rd choice: Methods containing estrogen (only after 6 months)

KEY POINTS FOR PROVIDERS AND CLIENTS• Take one pill every day. For greatest

effectiveness a woman must take pills daily and start each new pack of pills on time.

• Bleeding changes are common but not harmful. Typically, irregular bleeding for

pg. 17

the first few months and then lighter and more regular bleeding.

• Take any missed pill as soon as possible. Missing pills risks pregnancy and may make some side effects worse.

• Can be given to women at any time to start later. If pregnancy cannot be ruled out, a provider can give her pills to take later, when her monthly bleeding begins.

How Effective?• Effectiveness depends on the user: Risk of

pregnancy is greatest when a woman starts a new pill pack 3 or more days late, or misses 3 or more pills near the beginning or end of a pill pack.

Who Can and Cannot Use Combined Oral Contraceptives?- Safe and Suitable for Nearly All Women- Nearly all women can use COCs safely and

effectively, including women who:• Have or have not had children• Are not married• Are of any age, including adolescents and

women over 40 years old• Have just had an abortion or miscarriage• Smoke cigarettes—if under 35 years old• Have anemia now or had in the past• Have varicose veins• Are infected with HIV, whether or not on

antiretroviral therapy, unless that therapy includes ritonavir (see Combined Oral Contraceptives for Women With HIV, p. 9)

2 types of pills packets• 28 pills- 21 active pills containing hormones- 7 inactive or reminder (does not contain

hormones)Mechanism of Action

• Low dose COC prevents ovulation by suppressing FSH & LH.

• It also causes thickening of the cervical mucus, which makes it difficult for sperm to pass through.

• Perfect use: 99.7 %Factors affecting effectiveness

• Correct & consistent use• Low dose COC must be taken daily,

preferably at the same time of the day or night.

• Low dose COC should be started within the 1st seven days of the menstrual cycle.

• Proper storage, observance of shelf life & expiration date

• Vomiting/diarrhea• If vomits within 2 hours after taking

a pill, she should take another pill from her pack as soon as possible, then keep taking pills as usual.

• Drug interaction• Effectiveness lowered when taken

with certain drugs: rifampicin, anticonvulsants

Advantage of COC• Safe as proven by extensive studies• Reversible, rapid return of fertility• Convenient, easy to use, no need to do

anything at the time of sexual intercourse• Has significant non-contraceptive benefits;- Monthly periods regular & predictable- Reduce symptoms of gyne conditions- Decrease risk of iron-deficiency anemia- Can be used at any age from adolescence

to menopause- Will not affect a woman’s lactation after it

is well-established.Disadvantage

• Requires regular & dependence supply• Client- dependent• Offers no protection against STI/HIV• Not most appropriate choice for lactating

women as it can suppress lactation• Effectiveness maybe lowered when taken

with certain drugs Possible Side Effects & Management

• Possible SE which are common during the first 3 months of use of the COC- Spotting- Amenorrhea- Nausea- Breast tenderness- Headaches- Depression

Warning Signso J-jaundiceo abdominal pain (severe)o chest paino H- headaches (severe)o E- eye problems such as acute loss of

vision in one eye, seeing flasheso S- severe leg pains

When is the best time to start low-dose COC?• It is best for the woman to start taking

low-dose COC within the first 5 days of the menstrual period.

When can low dose COC be started Postpartum?• Be sure a client is not pregnant”• If not BF =start at 3 weeks after deliver

pg. 18

May low dose COC be started immediately post-abortion?

• Begin immediately• No back up contraceptives is needed if she

begins within the first 5 days following abortion.

Progestin Only Pills (POP)• Contain a small amount of progestin which

is similar to the woman’s hormone, progesterone. They do not contain estrogen.

• 0.5mg lynestrenol (exluton, daphne)• 75ug desogestrel

Mechanism of Action• Prevents ovulation in about half of

menstrual cycles • Causes thickening of the cervical mucus,

which it make more difficult for sperm to pass through.

Effectiveness• Perfect use 99%• Typical use 99.5%

Family Planning Counseling: PrinciplesFocuses on individual client’s needs and situation by assuring:

– Confidentiality– Voluntary choice– Informed consent– Client’s rights– Empowerment

In serving clients, it is important to remember that they have:– The right to decide whether or not to practice

family planning,– The freedom to choose which method to use,– The right to privacy and confidentiality, – The right to complete and accurate

information,– The right to form/express their own

opinions, and – The right to refuse any type of examination.

Counseling can be divided into three major phases:– initial counseling or education at reception,– individual counseling prior to and

immediately following service provision, and – Follow-up counseling.

An effective counselor:– Understands and respects the client’s rights– Earns the client’s trust

– Understands the benefits and limitations of all contraceptive methods

– Understands the cultural and emotional factors that affect a woman’s (or a couple’s) decision to use a particular contraceptive method

– Encourages the client to ask questions– Be brief (most important information only)– First things first– Use simple words and short sentences– Repeat most important information– Organize information– Be specific

Counseling should be part of every interaction with the client.

MYTHS AND MISCONCEPTIONS• THE MORAL – Contraception is EVIL!• THE LEGAL – Emergency contraception is

allowed in the Philippines.• THE SEXUAL – Contraception makes one a

“sex maniac”• THE PERSONAL – Contraception cannot be

used by single or unmarried women or even by adolescents.

• THE MEDICAL – Contraception has no health benefits.

• THE SOCIAL – Contraception promotes promiscuity and rise in STIs.

• THE RIDICULOUS – IUD can travel and reach the brain.

• THE MORBID – Contraception can cause illnesses (e.g. Cancers) and can KILL!

Most popular and most effective method is through COUNSELING!

Adherence to the Principle of Informed Choice

pg. 19