Njekwa-Ma-Scrubs

24/06/2026

Njekwa-Ma-Scrub
💚💙♥️

24/06/2026

15/02/2026

NJEKWA-MA-SCRUB
Kitwe

14/09/2025

17/06/2025

PUERPERAL SEPSIS

A. (i) Diagnosis puerperal sepsis 3%
(ii) Organisms -
Staphylococcus aureus
Escherichia coli
Clostridium welchi
Gonococcus
Pneumococcus
Proteus
Pseudomonas

B. Predisposing factors 20%

- Lowering of general resistance due to Anaemia malnutrition, Diabetes, haemorrhage.

- Lowering of local resistance due to bruising lacerations, v***a oedema, catheterization, premature rupture of membranes.

- Interferance
From procedures like many va**nal examinations, manual removal of the placenta, instrumental delivery.

- Retained products of conception

- Untreated local infections

C. Management until discharge 42%

- Admission
- Isolation
- Rest, prop up in bed to allow for drainage of va**nal discharge
- Hygiene baths to lower temperature
- V***a toilet twice per day
- Breastfeeding to continue unless mother is very sick
- Encourage exercises e.g walking, breathing
- Nutrition encourage to take a balanced light diet which is rich in calories and vitamins.

- Observations
- TPR
- Lochia for color, amount, smell, content
- Fundal height checked daily and PRN
- Mothers metal state
- Fluid intake
- Elimination - bowel movement
- Fluids monitor urine output

- Medication

Med. Management - Uterine evacuation D&C
MVA or manually. Blood transfusion

- Investigations - blood for Hb, M/C/S, G&X match
- HVS
- Urine
- Antibiotics

Frist broad spectrum
Later when culture is done use specific treatment

- Intravenous therapy
- NG aspiration PRN
- Analgesics, iron supplements, multi vitamins
- Other examinations done to rule out typhoid malaria, viral hepatitis, appendicitis
- Psychological care:-

Nurse baby next/near the mother
Breastfeed as soon as condition allows
Explain everything being done and her condition

- I.E.C.

D. Prevention 25%

- During pregnancy

IEC on personal hygiene
Treatment of infections and any minor disorder

17/06/2025

POSTPARTUM HAEMORRHAGE
Mrs. Masiye Para 7 gravida 8 progressed well to a spontaneous va**nal delivery of a live mature infant with Apgar score 9/10. She starts bleeding profusely per va**na and a diagnosis of primary postpartum haemorrhage is made.
Define primary postpartum haemorrhage. 5%
i) Outline five (5) causes of postpartum haemorrhage. 20% ii) List five (5) signs and symptoms that Mrs. Masiye will
present with. 5%
Describe in detail the immediate management that you would give
to Mrs. Masiye. 50%
Explain five (5) complications that Mrs. Masiye is likely to develop. 20%
MARKING KEY
Define primary postpartum haemorrhage (5%)
Primary postpartum haemorrhage is bleeding from the ge***al tract within the first 24 hours after delivery of the baby.

i) Outline five (5) causes of postpartum haemorrhage. (20%)
Vaginal tears /lacerations: These may be related to trauma to the birth canal during delivery.
Uterine atony: The myometrium fail to contract and retract and to compress the torn blood vessels and control blood loss by a living ligature action. This may be due to prolonged labour, retained products of conception or a full bladder.
Retained cotyledon, placental fragments or membrane: These will impede efficient uterine action.
Previous history of postpartum haemorrhage or retained placenta: There is a risk of recurrence in subsequent pregnancies. Proper history needs to be taken antenatally to identif

17/06/2025

ABORTIONS MARKING KEY
SECTION A 15% THE FEMALE INTERNAL REPRODUCTIVE SYSTEM IN THE ANTERIOR VIEW

SECTION B
Abortion is classified under two major classification, spontaneous and induced 2%
Spontaneous abortion: may progress to threatened abortion.Threatened abortion may progress to : Term, Hydatidform mole, missed abortion and inevitable abortion
Missed abortion: may progress to
Blood mole
Carneous mole
Inevitable abortion may progress to
A complete or incomplete abortion.
Complete abortion may result in habitual abortion.
Incomplete abortion can become septic abortion
INDUCED ABORTION:This subdivided into; Therapeutic abortion and Criminal abortion.
These two can become septic abortion.
1. Threatened abortion: This refers to bleeding from the placental site which is not yet severe enough to terminate the pregnancy. 2%
The cervix is not open.
Bloody va**nal discharge occurs during the first half of pregnancy.
2. Inevitable abortion: In this type of abortion bleeding is also slight and the cervix is open. 2%
Membranes rupture and the cervix dilates.
There is usually pain.
Clinically the patient presents as a threatened abortion but bleeding is retro placental and the embryo is already dead
Ultra sound shows no foetal heart beat and the pregnancy test may still be positive as Hcg is produced by the chorion and not the placenta.
With time, the uterus expels the products of conception.
Incomplete abortion 2%
The foetus and membranes are expelled but the chorionic tissue remains attached and bleeding continues.
This is a gynaecological emmergency that needs prompt treatment
Because part of the placenta may adhere to the uterine wall, bleeding continues.
Haemorrhage occurs because the uterus does not contract and seal the large vessels that fed the placenta.
Complete abortion 2%
Uterus passes all the products of conception, the pain stops and signs of pregnancy regress.
The uterus is firmly contracted on palpation and an empty cavity is seen on ultra soun

17/06/2025

MARKING KEY 1ST STAGE LABOUR
A. Define the term established labour 5%
- This is the active stage of labour when the cervix under goes more rapid rhythmic dilatation. It begins when the cervix is 3-4cm till fully dilated (1ocm)
B. State four (4) signs of true labour
i. Show due to the separation of the membranes
ii. Painful regular contractions becoming longer stronger
and more frequent.
iii. Effacement of the cervix and progressive dilation of
the OS as the contractions progress
iv Rupture of the membranes with uterine contractions
and dilatation of OS
v. Backache with regular contractions
C. Management of first stage of labour
Objectives
To ensure the safe delivery of a live health baby to the mother
To enable the mother have a pleasurable, fulfilling experience of child birth
To detect and correct quickly any deviations from normal labour.
Drugs
Pain relief
Pethidine- to allow mother to relax and even sleep between contractions
Dose 50-100mg
Route IM
Action-pain relief and euphoria, side effects-restlessness, dry mouth and blurred, vision, respiratory depression, nausea and vomiting,pupil constriction
Nursing implications
Naloxone administered to reverse respiratory depression in the baby
Not to be give too close to delivery to prevent ineffective pushing and diminished memory of event. Given between 6-8cm cervical OS dilation

Nitrous oxide and oxygen (ENTONOX)
Usually offered towards the end of the first stage of labour.
Short term temporaly relief of pain and discomfort
PMTC REGIME
PREGNANCE
Triple ARVs after 14 weeks
Labour
Triple ARVs
After birth:mother
Triple ARVs until 1 week after breast feeding
After birth: (Infant)
Nevirapine and Zidovudine for seven days
Investigations
Blood grouping and cross match
Haemoglobin
Urinalysis
NURSING CARE
The first stage of labour is divided into two (2) phase’s inactive and active phase
ADMISSION
Get comprehensive history
0-3cm admits in antenatal ward and encou