GROUP A: Group A2 : Day 8 @ DHO Kubang Pasu

MCH - POST NATAL CARE HOME VISITS

Today, on 17th January 2012, we were brought by JM Hadijah to follow her for post natal home visits in housing areas within the district of Kubang Pasu. First and foremost, we were divided into 3 groups consisting of 3-4 people and each of the group took turns to follow the JM to the houses she was in-charge of today.

During the visit, we were told by JM Hadijah that, they have to conduct at least 8 home visits before asking the baby and the mother to continue their follow up visit in the respective clinics. Usually, all those home visits are done by the community nurses @jururawat masyarakat. It was told that usually they have to conduct about 6-7 house visits per day, which may vary according to weekdays or weekends.

The first thing that they would do is inspection of the house as a whole. They will look at the house condition, cleanliness, and anything particularly, which might be hazardous to the baby. If certain criterias are not satisfactory, advice will be given to the house owner and they will inspect again during their next visit to see if there is any improvement or not. Then, Kak Hadijah checked the red book and also the baby's growth chart. She looked through the mother's antenatal and intranatal progress report so that she could know whether the mother had any history of gestational diabetes, pregnancy-induced hypertension,or any other complications earlier. After that, she started examining the baby.

1) Baby
According to her, normally they weigh the baby only on the 10th and the 20th day. Usually,as i said earlier, they have to do at least 8 home visits(the gap between the visits varies) before they can send the baby to continue the check up in the clinics. Nonetheless, there is an exception for it,as in the case of a G6PD baby, they should visit the baby everyday for 14 days and as usual for 2 weeks. While briefing us, Kak Hadijah starts doing physical examination on the baby according to the order mentioned below:

1) check for the apex beat

2) check the fontanelles (anterior/posterior), eye (for any discharge), mouth, chest(respiratory rate, any abnormalities), nipples(any lumps/mass),fingers ( check for length discrepancies or extra digits / clubbing), genitals(cleanliness,palpate for testes if it's a male baby),toes(same as per the fingers) and finally the back (for any spinal abnormalities).

3) clean the umbilicus(if it's dry, then clean it from bottom to top and vice versa if it's wet)

4) check for jaundice- apply pressure for at least 10 seconds using the thumb on the forehead,chest and abdomen and look for blanching/yellowish discolouration on the skin. This test should be done in bright area and if the baby is found to have jaundice, they will sent him/her to the clinics as soon as possible. Besides that, Kak Hadijah asked the parents regarding the baby's bowel habit. According to her,it's another way to see whether the baby is jaundiced or not. If the baby's stool is yellow in colour,then its normal and if let say,the stool is green in colour, and it still persists for more than 6 days without any improvement,the baby will have to be sent to the clinic immediately to prevent any serious complications like kernicterus.
Then,she continued to examined the mother.

2) Mother
Before starting the examination on the mother, the community nurses will first check whether the mother is psychologically stable or not. According to Kak Hadijah, this is quite important as to see whether the mother is fit mentally to take care of the baby or not. If they are found to be mentally depressed, the mothers usually will be sent for few counselling sessions or treated by the doctors if necessary. Then, she asked the mother if she has any complaints such as breast swelling, wound gaping(for LSCS) and they'll be given advice on how to take care of it.

As usual, she started of with examinations in the following order :

1) General examination- eye(pallor), tongue, hands( pallor,cap.refilling time, abnormalities in the nails e.g spoon shaped),legs(edema) and also the vitals signs (bp,temp,Pulse rate)

2) check for signs of DVT- pain in the calf region

3) palpation of the fundus- measure and compare from the previous reading. If the reading remains the same comparatively, then there are two possibilities,either the mother's bladder is full or there is some retention of blood clots in the uterus after delivery. In that case, if the reading persists( most common cut off point taken here is 20cm) even after the mother have cleared her bladder in comparison to the previous measurement, they'll be immediately referred to the clinic.

4) wound inspection- look for cleanliness, any discharge or wound gaping. If wound gaping is present, they'll be asked immediately to go to the nearby hospitals to prevent infections from setting in. Finally, she briefed the mother regarding perineum care.

Kak Hadijah also told us that if let say the mother had GDM during pregnancy, MGTT will be done again 6 weeks post natally and if her blood sugar level is still high, she will be referred to the doctor to decide on her treatment plan.

This is what is usually done in every post natal home visit by the community nurses. Thanks to JM Hadijah because she was really helpful and patient in teaching us although she had repeated the same things to the other subgroups today.