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Prenatal medical patronage of pregnant women at home. Derodular patronage

Prenatal patronage

The patronage is particularly widely held in maternity and childhood protection institutions. The patronage is carried out by doctors, precinct (patronage) sisters of children's clinic and rural medical sites, paramedic and obstetrics of female consultations and paramedic-obstetric items.

During pregnancy, a woman should be observed in the female consultation or at the Feldsher-Okushetsky point, with its physiological flow, a woman should visit an obstetrician-gynecologist on average 14 times.

Attending these institutions once a month before the 21st week of pregnancy, then twice a month - until the 33rd week, then every week. When visiting a pregnant women's consultation, the doctor and midwife have the opportunity to assess its condition on the dynamics of body weight gain, the level of blood pressure, urine analyzes, etc.

The state of the fetus is judged according to the data of ultrasound and other special research.

First visit to pregnant

The midwife is usually held in the first half of pregnancy, during the second visit (in the second half of pregnancy) checks the execution of these recommendations, asks pregnant about its health status, explains what needs to be prepared for the newborn.

First target patronage targets: Install the contact of the children's clinic with a future mother, to get acquainted with the living conditions of the future child, to evaluate the social status of the family, its psychological climate, the hygiene state of the apartment, find out the state of the mother's health, pay attention to heredity, the presence of bad habits

When deviating from the norm during pregnancy, visits should be more frequent. The midwife should visit the pregnant woman at home twice in order to familiarize themselves with the terms of her life, talking about the antenatal protection of the fetus, personal hygiene (preparing the nipples of the mammary glands to feed the child, the use of prenatal bandage). In addition, the midwife clarifies some laws and decisions of the government to protect the rights and health of a woman. When identifying somatic or obstetric pathology, the frequency of visits increases. If a woman is in a female consultation irregularly or does not attend a doctor on a designated period, especially in the presence of pregnancy pathology, the midwife carries out patronage, i.e. He visits her at home, finds out the cause of the failure, measures blood pressure and invites you to take a doctor. The patronage also spend when a woman's refusal from hospitalization fails. In this case, the doctor or midwife clarify the woman or her close relatives the danger to which violations in the health of women and the fetus can lead, and also reminds of responsibility for the refusal of hospitalization.

Prenatal patronage of pregnant women also carry out nurses of children's clinic. Information about pregnant women in the children's clinic comes from women's consultation. The nurse visits pregnant twice: the first time within 10 days after receiving information about it from the female consultation, the second time - on the 31-32nd week of pregnancy.

Pregnant, infected Bich, are observed by the doctor with an obstetrician-gynecologist of the female consultation in conjunction with a infectious doctor who appoints courses of relevant therapy in coordination with the territorial center for the prevention and control of AIDS and determines the hospital for the delivery.

Tasks of the first patronage:

1. The declaration of risk factors (collection and evaluation of these genealogical, biological and social history);

2. Forecast of the health and development of the future child (risk groups); conducting the forecast and prevention of hypoglactics;

3. Informing the pregnant woman about the revealed risk at the unborn child;

5. Hygienic learning and education of future parents (propaganda of a healthy lifestyle, positive psychological attitudes for the birth of a child, forming motivation for long-term breastfeeding, visiting classes at the school of future parents);

6. Determination of the term of the second prenatal patronage.

With the first prenatal patronage, all adverse factors that can negatively affect the fetus are revealed, and a plan of measures for the protection of the fetus is drawn up. Pregnant who has revealed risk factors, is recorded to control, observation and assistance.

Conditionally allocate the following risk groups of pregnant women:

1. Women under 18 and primordin over 30 years old;

2. Women having a body weight of less than 45 kg or more than 91 kg;

3. Women having over 5 pregnancies and women with multiple pregnancy;

4. Women, with a threat of abortion (having premature or transferred pregnancy in history);

5. Women with a burdened obstetric history (abortions, miscarriages, stillbirth, narrow pelvis, malformations of the uterus, scars of the uterus.);

6. Women with extragnenital pathology (diabetes, bronchial asthma, chronic pyelonephritis, heart rate malformations);

7. Women with social risk factors.

With the first patronage, the midwife gets acquainted with the living conditions and the sanitary condition of the housing of a pregnant woman, if possible, finds out the nature of the family relationship. During the patronage, it is important to continue the sanitary and educational work, started by the doctor, tell us for pregnant and members of her family about the need to comply with the rules of personal hygiene, rational nutrition, regular visits to the doctor.

The second prenatal patronage is carried out at the 32nd week of pregnancy.

Purpose of second patronage - Check how the data is performed earlier than the appointment and recommendations of the female consultation and pediatrician, as a family prepared for the emergence of a child, whether everything is necessary to care for newborns, as well as preparations for the postpartum period.

Special attention is paid to visiting the pregnant school of young mothers and classes on psychoprophilactic preparation for childbirth. Also in 32 weeks of pregnancy and before childbirth, the patronage of women performs the middle medical staff of children's clinics. The doctor is obliged to trace the timely transfer of information about the participants of pregnant women to the district children's clinic.

The tasks of the second patronage are:

1. Revaluation of the factors and risk orientation (obtaining information on the course of pregnancy, transferred diseases, the use of medicines, changes in working conditions, life, refinement of the alleged date of delivery);

2. Control of the implementation of preceding appointments and their effectiveness;

4. Hygienic training and education of future parents (preparation of the mammary glands for lactation, family preparation for a newborn meeting).

5. Instructing includes issues such as:

Organization of a child service (coverage for dressing and swaddling, clean clothes and linen, swimming, children's first aid kits) and a sleeping zone (baby bed), where the newborn can be safely placed;

Acquisition of dowry for a newborn;

Purchase aid kit for mother and child

Information about philic phones and pediatric emergency care;

Conversations with a future mother and other family members about the needs of the newborn and how to satisfy it.

Third patronage

Another visit may cause a pregnant Pediatrician. This visit is optional and appointed in a strictly individual order. As a rule, the doctor comes in the event that the pregnancy is complicated and there is a risk of a child with developmental pathologies or congenital diseases. Increased attention is paid to both unfavorable families. The need for third patronage is determined when analyzing the information obtained after the previous two visits. According to the results of a visit to the future parent, the doctor raises the question of the need for a family formulation. At the same time, after birth, the baby and his mother will be under the closer attention of the pediatrician and other specialists.

Patronage of newborns

The patronage of the newborn child during the first month of life is carried out by a pediatrician and medical sister of the pediatric site. The first patronage of the newborn is carried out by a pediatrician.

If the kid develops normally, it is healthy and grows in a favorable atmosphere, the visits of children's clinics are carried out in this way:

· First visit - 1-3 days after discharge from the maternity hospital

· Second visit - 10th day after discharge from the hospital

· From 1 to 3 years - 1 time in 3 months

If at the birth of a child there were complications and there are problems with his health, the nurse comes more often.

The purpose of such patronage It is to assist the mother's assistance in organizing and conducting care for the newborn. It is important to teach it to correctly perform the care of child care. During the primary patronage of the newborn, a nurse receives a number of specific instructions on the features of the observation of this child. When a child marks one month, mother and child are invited to visit the Plot pediatrician in the clinic.

The patronage nurse also draws his attention to the conditions in which the child is located:

· The presence of a crib;

· Clean linen;

· Daily wet cleaning in the children's room;

· Road rooming;

· Air temperature in the room;

· living conditions;

· Presence of pets and other potential allergens.

The patronage sister estimates the neuro-mental development (NPR) of the newborn, focusing on a number of indicators:

At ten days: the analyzer is visual - the child holds a moving object in the field of view (stepped tracking);

In 18-20 days: a visual analyzer - the child holds a fixed object in sight; Analyzer hearing - the child calms down with strong sound;

In one month: visual analyzer - the child focuses on fixed objects, observes the moving subject (smooth tracking); Analyzer hearing - a child listens to the sound, voice of an adult; General movements - a child, lying on his stomach, trying to raise and keep his head; Emotions - the first smile on the conversation of an adult; The speech is active - the child publishes individual sounds in response to a conversation with him.

You can highlight three main taskswhich carry out primary patronage of newborns:

1. I saw baby

The nurse examines the tummy of the newborn, the spring, the umbilical wreck, if necessary, processes. The task of the nurse during the patronage traverses is to study the conditions of residence of crumbs, its medical examination, during which the condition of the skin, mucous, reflexes, breathing, sucking activity is estimated. In the course of the examination of the child, the course of pregnancy and childbirth is specified, the epicrosis is studied.

2. Mom inspection kid

After a thorough and detailed inspection of the baby, the nurse (or doctor) district clinic should examine the mother. Nurse examines lactains of a nursing mother, asks questions about her health, well-being, nutrition. Gives recommendations for food, compliance with hygiene, regime. A nursing woman needs to stick to a specific power mode, which must be properly balanced and not include product-allergens. A set of products for mom includes low-fat meat or fish, raw vegetables, fruits, milk or kefir, a small piece of cheese, one egg. Oatmeal and buckwheat porridge are recommended. It is necessary to minimize salt consumption. In the occurrence of edema, the amount of fluid decreases.

The nurse gives recommendations to the child's parents for feeding the child, care for him, teaches mom, how to make a daily toilet child, which consists of arms, processing and cleaning the eyes, ears and nose, bathing. Swimming takes each evening at a water temperature of 36-37 degrees. After bathing, the umbilical wound with hydrogen peroxide is treated. It is also necessary as you need to cut the newborn nails. It is necessary to communicate more often with him, take on the hands, tayp. Tactile sensations are very important for the newborn, it actively reacts to strokes, calms down, smiles. The Medicinsky sister gives recommendations on feeding, physical and nervous education of the child, massage, hardening, the production of hygienic skills, the prevention of rickets. The physical education of the first year of life includes massages, gymnastics, hardening. The landing nurse during a patronage visit at home controls the correctness of the implementation of such procedures. All data obtained during such visits are recorded in the history of the child's development. It is important that gymnastics and massages are carried out systematically with a gradual complication of exercises and massage techniques. After fulfilling all the necessary procedures, the nurse on this finishes the primary patronage of newborns. With the second visit, it checks how correctly all recommendations for care for the newborn are being fulfilled.

The Healthy Child Cabinet (KZR) of the Children's Polyclinic is a methodological center where all materials for the care of it and upbringing are assembled, designed for both health workers and parents. The nurse can participate in preventive inspections at the pediatric site and in the KZR, contributing to an increase in the effectiveness of the trial stage. Evaluating the NPR of the child monthly, the medical sister can give parents recommendations on its stimulation.

Basic requirements for newborn care at home.

1. Daily toilet. Toilet leather, mucous, umbilical wounds, the child's wash is carried out according to the same rules as in the wardroom of the newborn maternity hospital. The oral cavity is processed only in the case of thrush. Nails are cut into small scissors with stupid ends, previously treated with 96 ° alcohol.

2. Warding. At the request of the parents, you can use blouses and sliders from the first days of life. But in case the child decided to swaded, the method of free and wide swaddling is used. The essence of free swaddling lies in the dressing of the child from the first days of life with a thin sprawset, and on top of it - blouses with stitched sleeves. At the same time, the Child's handles remain free, the volume of their movements increases, which has a beneficial effect on neuropsychic development, as well as respiratory functions. Wide swaddling is necessary for the proper formation of hip joints. In this case, the method of hips is divorced to the parties and conditions are created for the proper formation of hip joints.

3. Bathing. Up to 6 months - daily, then you can bathe every other day. The water temperature should be 37-37.5 ° C, the duration of the bath is 5-7 minutes.

The soap for washing the body is used 1-2 times a week, the crotch area is washed with soap daily.

4. Walks in the open air. In the summer begin immediately after discharge from the hospital. The duration of the first walk is 15-20 minutes, then staying on the street increases for 10-20 minutes daily. In the spring and autumn, the duration of the walk is reduced to 10-15 minutes and the duration of staying in the fresh air increases slower. In winter, the outdoor stay mode is established individually taking into account climate, the health of the child's health and features.

Sanitary and hygienic requirements:

Wet cleaning is carried out 1-2 times a day and 3-4 times a day it is necessary to ventilate the kid's room. At the time of cleaning and venting, the child's room must be translated into another room.

Parents need to strictly follow the rules of personal hygiene: to regularly take a shower, wash your hands before contact with the child, often change clothes in which the baby is carved.

The baby's underwear should be stored and stitched separately, after washing it strokes on both sides. For washing used baby soap. If possible, it is necessary to limit the visits to relatives and acquaintances.

Remove carpets and other items from the child's room, in which dust accumulates (heavy curtains, sofa pillows, soft toys, etc.).

Maintaining temperature regime

1. The ambient temperature should be such a kid to be comfortable and warm. It is usually 22-24 ° C. The first sign of cooling is the grinding of the nose, as well as palms and stop.

2. If the child is quickly cooled, additional heating is required when swaddling, baby toilet. The child swaded is needed in warmed diapers, if possible, quickly.

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Page Creation Date: 2017-10-12

Pregnancy and development of fetal organ systems is a very important period in the life of the future mother and her baby. From how pregnancy proceeds, not only the health of the child depends, but also moms.

What is prenatal patronage?

Prenatal patronage of a pregnant woman is a process conducted in the LPU (therapeutic and prophylactic institution), the purpose of which is to preserve the health of the fetus and the future mother.

The first prenatal patronage after the pediatric department receives data from the female consultation of the gynecological department, as a rule, within 7 to 12 days.

First prenatal patronage 8-13 weeks

This event is held by a pediatrician and a medical sister at home of a pregnant woman. And so, the tasks of the patronage of pregnant women:

  1. Inspection of household and sanitary conditions in the house;
  2. Identification, by anamnesis (collection of information) health status and forecasting the development of the future child, that is, to identify the risk of diseases, primarily hereditary;
  3. Informing a pregnant woman about the development of possible kid's pathologies;
  4. Choose a plan for certain recommendations for prevention, namely - diet, sleep mode, physical activity, eliminate bad habits, hygiene tips, etc.;
  5. Training and preparation by the time the child is born, that is, to tell about the "School of Future Parents", to advise the right lifestyle, etc.;
  6. Determine and assign the date of the next patronage of pregnant women;
  7. Fill out medical records.

Sample of the necessary medical records - a precipitation scheme of antenatal patronage:

  • Passport part - includes the last name, first name, patronymic of a pregnant woman (fully), the actual address of residence, date of birth.
  • Education and profession, address of the place of work.
  • The passport part of the Father of the Future Child, here also applies to education and place of work.
  • Accommodations.
  • Listing other relatives.
  • Financial security.
  • The health of parents and other family members for the presence of diseases such as tuberculosis, venereal diseases, allergies, mental disorders, alcoholism and smoking.
  • Description of tips, data at the first patronage of a pregnant woman.

The multiplicity of the prenatal patronage of the medical sister is equal to three visits throughout the process of pregnancy.

The prenatal medical patronage comes after the patronage honey. The sister of the pediatric office. Having collected all the necessary information, honey. The sister transfers the Pocil Pediatrician. Thus, the specialist assesses and thinks out possible factors for the risk of future feminine. By making a conclusion, the doctor enlisters, if necessary, treatment with medicines into the patient's medical card, and if the treatment is not medicated, then in this case it sends a woman.

Second prenatal patronage 30-32 weeks

The second prenatal patronage is carried out on the 30-32 week of pregnancy, just like the first, doctor and medical sister. Tasks and objectives: to control whether everything fulfills the future mother, as a doctor prescribed after the first prenatal patronage, as well as analyze and make any more recommendations. It is worth noting that during this period, close attention is paid to how psychologically ready for a pregnant woman to the appearance of a baby in her life, that is, a visit to a psychologist or school, for future mothers and dads.

Tasks of the second primar patronage:

  1. Analyze the information received, learn about the course of pregnancy at the moment, to establish accurate risk factors, as well as learn about all the suffering diseases, such as chickenpox, etc.
  2. Check how the future mother keeps the appointment of a doctor and nurses.
  3. Conduct hypoglactic, namely to evaluate the functioning of the mammary glands.
  4. If at this stage there was any risk for a future newborn, a certain adjustment should be made.
  5. Prepare a pregnant woman to long breastfeeding and the birth of a child.
  6. Fill the medical blank.

According to plan, it looks equally, that is, the second is filled in the same way as the first. However, there is a difference. In the second letterhead, the risk of perinatal pathology and the hypoglactic forecast is indicated. It is worthwhile that the implications for pregnant with preeclampsia are also indicated in the same form.

Third prenatal patronage 37-38 weeks

The third arrival of a doctor at home to the future mother is carried out only if a woman has a heavy pregnancy, or possible risks that have revealed on previous patrings. Feldscher can go to the house, the multiplicity of the prenatal patronage is the state depends on the state of a pregnant girl.

Main factors and subsequent division of newborns on risk groups

The factors belong:

  • Alcoholism of parents and the presence of other bad habits,
  • Development of acute diseases during pregnancy
  • Pregnant girls before adult age and women older than 35 years old,
  • Bleeding and risk of miscarriage.

Newborn risk groups:

  1. Development of diseases of the central nervous system,
  2. Infection of the fetus infection from the mother,
  3. Development of endocrine deviations,
  4. Development of malfunctions of the system of child organs,
  5. Social instability.

How to prepare for the doctor's arrival

  1. First, as a rule, medical personnel arriving at home to the patient never remove shoes, so the perfect option will prepare clean boots in the corridor.
  2. Secondly, the doctor will definitely be washing his hands, even if he just came to spend a survey. Therefore, it is worth preparing a clean soap and a clean towel. Liquid soap is best, as the dirt may be on the solid soap.
  3. Thirdly, you should remove pets if they are available.
  4. It is worth preparing a place to make a doctor where to sit down and fill in medical documents.
  1. Balanced nutrition - in the diet of the future mother should be vitamins and useful trace elements;
  2. Hygiene and sanitary conditions - that is, there must be purity in the house, the nurse can advise daily, make a wet cleaning, as the microbes and fungi are in large quantities in dust, and ticks are in bed linen;
  3. Getting rid of bad habits - when smoking and drinking alcoholic beverages, the fetus intoxication occurs, which in turn increases the risk of developing pathologies after birth at the kid;
  4. Drug treatment - when identifying any diseases of a pregnant woman, for example, with a thrush, a nurse discharges a drug (usually suppositories - vaginal candles), so that there are no bacteria in the vagina and the birth paths.

Legislative regulation

Basic laws on the rights of pregnant women:

  1. Article 52 FZ N 323 "On the basis of the health of citizens in the Russian Federation"
  2. Decree of the President of the Russian Federation of 05.11.1992 N 1335 (ed. From 05.10.2002) "On additional measures for the social protection of pregnant women and women who have children under three years, dismissed in connection with the liquidation of organizations"
  3. Order of the Ministry of Health of the Russian Federation N 345 \u200b\u200b"On the improvement of measures for the prevention of hospital infections in obstetric hospitals"
  4. Order of the Ministry of Health of the Russian Federation N 242 dated 11.06.96 "On the list of social testimony and approval of instructions for artificial interruption of pregnancy"
  5. Order of the Ministry of Health of the Russian Federation N 302 "On Approval of the List of Medical Indications for Artificial Abortion"
  6. Annex N 1 to the order of the regional goods No. 251 dated 29.04.86 "The principles of the distribution of pregnant women in the degrees of the risk of maternal mortality" (in accordance with the order of the Ministry of Health of the RSFSR No. 83-chipboard of 5.02.86)

When a woman is preparing to become a mom, she needs help medical workers. It does not matter what kind of childbirth - the first or third, the doctor is obliged to constantly be near. He must follow the course of pregnancy, the state of the future mother and her who has not yet born baby. The purpose of the prenatal patronage lies in constant control of the life of a pregnant woman, its social status. Special attention is paid to the living conditions and family relationships. During such visits, the woman also receives advice, and answers to all the questions about the future care of the baby. From this article you will learn the dates of the prenatal patronage, the goals of each, the main points.

What is patronage?

This is a form of work of medical institutions. It is aimed at conducting preventive and wellness procedures on the territory of the patient's residence, training for hygiene rules, improving sanitary and hygienic factors in everyday life. Patronage people with mental disorders, seriously ill, pregnant women and newborns need patronage.

Who holds patrons?

Doctors' visits to the house to pregnant women are especially widespread. After registering to the woman, Feldscher or an obstetrician from the female consultation, a doctor and a nurse from the children's clinic are visible.

Prenatal patrons of pregnant women are directed not only to control over the life and state of future women in labor, but also on her familiarity with doctors, establishing contact with them, since after the appearance of a baby into the world, the family and the medical staff will communicate tightly.

The doctor or nurse at a visit is assessed by the household and social conditions for the residence of a woman and the future kid. If there is a need, gives recommendations on sanitary standards and personal hygiene. In the first visit, the health worker determines whether the family does not belong to any risk group. Let's tell about everything in order further in the article.

Need to control

A woman gathering to become a mother, herself comes to a medical facility to track your health and development of the fetus. In the interval until 21 weeks, visits occur only once a month. At the same time, mandatory procedures are not taken into account, analyzes. After that time and up to 33 weeks, visits increase to two times a month, and they occur every week before delivery. If the patient does not come to the doctor on the designated day, then after two days, the medical worker himself visits at the specified place of residence to establish the cause of the failure and explain the need for a stable inspection. However, this is not considered patronage.

During communication with an obstetrician-gynecologist, the future mother reports in detail about his life, living conditions, material status and family relationships. Of course, you can tell anything, and this is not enough for a doctor. He must know the real and complete picture of the living conditions of a woman and the future kid. The health worker is obliged to know in detail all about the life of a woman, because it affects the baby tooling, so there is a need for "espionage".

Carrying out the prenatal patronage allows you to get all the necessary information, possibly hidden pregnant, this is: bad habits, living conditions, material wealth, sanitary and hygienic factors of life, family relationships, psychological situation. The doctor also gives the future feminine the necessary information. It lies in the advice on the arrangement of the children's room, creating comfortable conditions for the most pregnant, care for the baby after the appearance of the light.

Multiplicity of prenatal patronage

Throughout the pregnancy, a woman is awaiting at least two visits to her doctor at home. Most often there is three visits of the health worker in the housing of the patient. The amount may increase under the following circumstances:

  • unstable visits to a woman obstetrician-gynecologist;
  • suspicion of the pathology of the fetus;
  • severe pregnancy;
  • the age of the future of the manufacture of less than 18 years or more than 30 years at the first birth;
  • unfavorable financial situation;
  • identified sanitary and hygienic deviations;
  • after extracting a pregnant woman from a medical and prophylactic institution;
  • after changing the place of residence.

Anyway, the doctor will know everything about his patient. Therefore, it is better to be honestly to tell everything about your destructive habits if they are, the psychological situation in the family, material condition. This will avoid multiple problems, including an uncomfortable position in front of the health career with antenatal patronage.

Each doctor or nurse's observation when visiting the patient is fixed in a personal patronage sheet. There are also prescribed recommendations issued to the woman. The doctor carefully monitors the implementation of the prescriptions, with the necessary inconsistencies, takes the necessary measures to eliminate them.

First prenatal patronage

It is conducted by a pediatrician and a nurse from the precinct polyclinic or an obstetrician-gynecologist. Medical workers come to a pregnant woman about two weeks after she stood up in women's consultation. The earlier the woman will visit the obstetrician-gynecologist and tell about his position, the desire to give birth, the faster the pediatrician will receive information about the need for visits. Most often, the first precious patrons pass between 7 to 14 weeks.

The initial visit is very important. It is necessary to warmly meet the employee, refer to his visit and inspection of housing calmly, understand that this is part of his work. From what kind of contact will be installed, all relationships will depend on pregnancy. Prenatal patronos allow you to enter the baby with great comfort. A woman at the same time receives useful information, moral support.

Goals of the first visit

Doctors are required to attend pregnant women at home to provide the necessary assistance if necessary. The health workers repeat the tirelessly that the baby will be healthy if his mother is healthy. Previous patrons of pregnant women allow you to identify all adverse women's accommodation factors, give advice to eliminate them. The main tasks of the first visit:

  1. Assessment of the state of development and health of the fetus, prevention of the possibility of premature labor.
  2. Identification of the presence of risk factors.
  3. Issuance of recommendations to eliminate the identified inconsistencies (meals and day mode of pregnant, hygienic and sanitary conditions).
  4. Informing parents about the identified possible pathology of the fetus.
  5. Conversation (preferably) with both parents. It is dealing with the positive aspects of a healthy lifestyle, the dangers of smoking and excessive alcohol use, personal hygiene rules, the need to maintain in the house of normal sanitary conditions. The health worker during the conversation sets up parents for a positive attitude towards the birth of a baby, provides psychological support, is responsible for exciting questions. At the same time, the doctor is given a recommendation to feed the baby in the future in the future, to attend a school for women who are preparing to become mothers during pregnancy.

Prenatal patronos are aimed at acquaintance with a woman, establishing contact with her. At the first visit, the doctor reveals the belonging of the future mother or family to the risk group, if any. In this case, the pregnant women take under special control, all measures are being taken to keep the life of the baby.

Basic risk groups

Most often, future mothers do not belong to such a category of persons, but there is still a risk. Therefore, the health worker must take the data of women for special custody. The following risk groups are distinguished:

  • juvenile woman;
  • expected childbirth Late or the first after the thirty-year-old age;
  • feminine, weighing less than 45 kg or more than 91 kg;
  • the woman had more than five pregnancies;
  • the likelihood of interrupting pregnancy (if a history has transferred, premature children or miscarriages);
  • if a few kids are expected;
  • women with unfavorable history (stillbirth, abortion, miscarriages, vices of uterus, narrow pelvis and other);
  • women with chronic diseases (heart disease, bronchial asthma, diabetes, pyelonephritis);
  • women belonging to socially unfavorable layers (alcohol addiction, drug addiction, unfavorable family financially, a large lonely mother).

Additional meetings are held with women who fell into one of the groups, the elimination is monitored (if possible) identified adverse circumstances. If there are problems with the health of the future mother, prescribed above, the doctor assists at home, gives advice, how to save the life of the baby.

Algorithm of the first patronage

Below is an example of prenatal patronage so that every woman knows what it expects when meeting with a health care job at home, how to behave properly, what questions will have to answer.

First of all, the doctor meets the woman. From a pregnant woman depends on the entire expected conversation, so it is important to tune in positively, hospitably refer to the health worker. The doctor can inspect the housing, but not in detail as an employee of the SanEpidemstation, but to look at it with a look to have an idea of \u200b\u200bhygiene, material position. After that, the questionnaire is filled with words of pregnant. If at this time there was, for example, a drunk spouse was detected, the doctor would mark the fact on the sheet, even if the woman would argue what it happens rarely. What is filled in the questionnaire?

  1. Names and names of parents, date of birth, information about work.
  2. Education, place of residence and regulations.
  3. Data on other family members living together with pregnant women, those who will often communicate with the baby (grandparents, grandfathers, aunt, uncle and others).
  4. Information about chronic diseases of parents, close relatives.
  5. Income, personal hygiene, sanitation at home.
  6. Readiness for the birth of a child and a psychological attitude of the pair.

At the end of the meeting, an approximate period is appointed when the second prenatal patronage is. It is worth remembering that the actual picture of the doctor can only get with a spontaneous visit. That is why the exact dates of the following visits are pregnant can not get.

Second visit

The re-meeting with the medical staff at home occurs in the period from 32 to 34 week, if no risk factors were revealed. It is conducted for control. During the visit, the doctor monitors the fulfillment of his prescriptions, and the conversation is usually dedicated to future childbirth and the baby. The exemplary plan may look like this:

  • the doctor is interested in overall states, learns about the suffering diseases during pregnancy;
  • what is the psychological attitude of the family;
  • are parents for birth (concerns material things);
  • do other family members morally and financially support.

In general, the conversation is easy and pleasant, pregnant can get recommendations for visiting the full-time psychologist for women's consultation.

Third meeting

The need for another visit is regulated individually. It occurs closer to childbirth, if there are problems with the health of the feminine, pathology of pregnancy or fetus. Also special attention is paid to families attributed to the group of disadvantaged. The third patronage is carried out on the basis of information obtained at the first two visits.

Conclusion

The prenatal cartridges are needed by the medical staff not in order to just read and check the oral information from pregnant. Visits are needed to preserve the life of the child, maintaining the health of the mother, issuing valuable advice. Patronics are needed by the most pregnant. That is why it is worth considering the spontaneous visit to the doctor at home benevolently and understandably, adequately respond to the words of the health worker and his recommendations, what areas they concern.

It is carried out when pregnant in the female consultation in terms of 8-13 weeks. The task of the first prenatal patronage is to acquaint the precinct medical sister with a future mother, a conversation with her about importance, happiness and great responsibility to be a mother. When first antenatal patronage, the landed nurse should figure out the state of health pregnant, find out how pregnancy flows, under what conditions the future mother lives and worries. The patronage should differ special scrupulsity, the desire to identify all circumstances as closely as possible, which can have a harmful effect on the health of the future child. Special attention should be addressed to the possibility of toxic effects on the fruit due to the use of nicotine, alcohol and other toxic substances.

Depending on the nature of the filling of documentation in children's polyclinics, cargo cards are created by the prenatal patronage or the history of the development of future patients. In order to make the most complete coverage of all the necessary issues and saving the nurse to perform antenatal patronage, special schemes are used. When using any nurse circuits at first antenatal patronage, the following tips should be given:

· 1. Exercise working harm, if any.

· 2. High work and home, work and rest.

· 3. To avoid conflict situations in the family and apartment.

· 4. Net the right food within the allowable for pregnant women: raw and boiled vegetables, fruits, milk, cottage cheese, boiled meat, vitamins A, D, et al. By appointment of a doctor.

· 5. Repair the room, to purchase all the necessary for the newborn in a timely manner.

· 6.In the presence of TBC-patients in the family of TBC, where the mother and the child will be the first two months after discharge from the maternity hospital.

Second prenatal patronage

The second prenatal patron enclosure nurse performs during the period of maternity leave for pregnant on the 31-32th week.



Plot pediatricians perform prenatal patrons of pregnant women with severe extragenital pathology, toxicosis, as well as with other testimony.

The main purpose of the second prenatal patronage of pregnant woman is to monitor the implementation of the appointment of a doctor of female consultation and recommendations, data of the nurse of children's clinic at first patronage and at the school of future mothers.

With the second prenatal patronage, they find out the well-being of a pregnant woman, whether it was translated if it was necessary, on a light job, timing of maternity leave. During the second prenatal patronage, the concern for the future child is already traced: here is the preparation of the Mother's Mother's Milk Rights to lactation, the organization of a newborn corner, preparation for him linen, clothes, etc. Refine the address for which a mother with a child will live.

Third prenatal patronage

The third prenatal patronage, depending on the circumstances, performs a landed nurse or a plot pediatrician. Indications for the implementation of this patronage are severe somatic pathology of pregnant women, unfavorable obstetric history, severe toxicosis of pregnant women, as well as unfavorable social conditions. About such patients in the children's clinic reports the senior nurse of female consultation. In addition, the testimony for the third prenatal patronage is formed on the basis of the study of previous prenatal patronage, made by a precinent nurse. The third prenatal patronage is purely individual, and therefore is performed according to the individual scheme for each case.

According to the results of the prenatal patronage, the precinct pediatrician determines the risk group among pregnant women, i.e. Reviews the contingent of future mothers whose children will have to be under particularly close attention of the district doctor and doctors of the respective specialties. The risk group undoubtedly include extractive diseases of the future mother, professional harm and alcoholism of parents, acute diseases and operational interventions during pregnancy, mother's age at the birth of a child younger than 18 and over 30 years old (fertile age, according to WHO, from 14 to 49), toxicosis of the first and second half of pregnancy, threat of miscarriage, bleeding, increase or decreased blood pressure during pregnancy, i.e. Factors whose presence will determine the distribution of children by health groups.

The main tasks of the KZR are(Regulation number 8 to the Order of the Ministry of Health of the USSR No. 60 dated 19.01.83):

· Promotion of a healthy lifestyle in the family;

· Parents learning the basic rules for the education of young children (regime, nutrition, physical education, hygienic care);

· Sanitary education of parents on the hygienic education of children, prevention of diseases, preparation for admission to DDD;

· Control over the NDR children.

The duties of nurses KZR comes in:

· Reception of children of the 1st year of life at least 5 times a year, the 2nd year of life - at least 4 times a year, the 3rd year of life - at least 1 time in half, older than 3 years - one once a year;

· In accordance with the appointments of the doctor:

§ a) Mother consultation on education and child health issues,

§ b) Mother's teaching methodology for massage and gymnastics,

§ c) conducting control feeding, fulfilling the calculation of nutrition,

§ d) performing appointments of a doctor for the prevention of rickets,

§ E) Conducting the diagnosis of the NPR of children.

· Training of parents methodology and feeding peculiarities;

· Illumination of issues of preventing harmful habits;

· Training method of hygiene of the oral cavity;

· Ensuring parents by methodological materials;

· Consultation of precinct nurses on the education and development of children, physical education and hardening children, diagnostics of the NDR children;

· Assistance to a precinct doctor in conducting classes for pregnant women, at the school of a young family;

· Participation in the preparation of children to enter DDD;

· Implementation of a permanent connection with the precinct pediatric service;

· Maintaining in the history of the child's development F.112 / y - CRP visits inserts;

· Registration in the expectations room of the CZR stands and exhibitions on the organization of living conditions, development and education of children;

· Dissemination of new methodological materials on sanitation issues.

Medical documentation KZR

1. Accounting form No. 112 / y - liner-card visit to the Cabinet for the upbringing of a healthy child.

2. Accounting form No. 039 / U - the work hours of the doctor's working time.

3. Accounting form No. 038 / U - Tabel working hours Nurse.

Equipment of KZR

Equipment of the Cabinet of a Healthy Child and the necessary Methodological materials:

No. p / p Name of equipment (equipped) Amount
1. Table
2. Chair
3. Electronic scales for children up to year
4. Libra
5. Equipment for infrared therapy
6. Bactericidal air irradiator
7. Benefits for assessing the psychophysical development of the child on demand
8. Stetofonderdoscope
9. Medical thermometer
10. Tonometer for measuring blood pressure with cuff for children up to year
11. Putty knife on demand
12. Changing table
13. Table massage
14. Capacity for collecting household and medical waste
15. Disinfectant Capacity on demand

Inspection of a newborn baby

Period newborn - One of the most important periods of childhood. This is the period of child adaptation to new living conditions. Providing in an neonatal period of optimal adhesion newbornThe improvement of the methods of diagnosis and treatment of already emerged diseases is necessary for the formation of health in all subsequent years.

Common inspection of the newborn It has a large diagnostic value. During inspection The doctor receives a common idea of \u200b\u200bthe state of the child's health, its development, timely reveals possible deviations.

If a child Sleep awakened at the beginning of the inspection should not. The pulse and respiratory frequency data will be the most accurate.

To count the breath, the doctor brings a phonenadoscope to the nose child And records time. The counting of the respiratory frequency is carried out in one minute, due to not regular breathing and periodic stops - apnea. The average respiratory frequency is 40 per minute in a dream and 60 during wakefulness.

Inspection is carried out in a half-rowed changing table, at ambient temperatures at least 22 degrees Celsius.

Newborn Survey no earlier than an hour after feeding, which allows you to create comfortable conditions for the child and make a thorough examination.

Warm hands, careful movements, it is completely stripped.

Until child Candle, inspect the heart area. Painted top push. The auscultation of the heart is carried out according to the generally accepted technique, in typical points. Clear heart tones, rhythmic. Quite often in the region of the heart, a short systolic noise listened due to the formation of hemodynamics.

Heart rate newborn It is approximately 140 shots per minute.

Lungs are listened to symmetric areas on both sides of the front, side surfaces. Breath U. newborn Vesicular, somewhat weakened. Then breathing is heard over the rear surface.

The belly has a rounded shape, actively participates in the act of breathing. During calm wake, palpation of the abdominal organs is carried out. The front abdominal wall is elastic and elastic, the stomach is soft.

The edge of the liver is palpable in the midcurbicular line. Speakers from under the rib arc per 1-1.5 centimeter.

The spleen is determined in the left hypochondrium - it is normal, it is not palpable.

The state of the umbilical wound is estimated, which heals by the end of the second week of life. Underfloor veins and umbilical arteries are not palpable.

Skin covers are examined in detail. Palpation of the skin is carried out in different areas. Skin painting newborn Bright pink due to fine epidermis and a well-pronounced capillary network. The skin is examined sequentially from above - down. Especially thoroughly behind the ears, in the folds of the neck, in the axillary areas, in the inguinal areas - where diameters can develop.

To the touch skin newborn Gentle, elastic, velvety. Physiological erythema by the end of the first week of life disappears.

The elasticity of the skin is checked: when trying to collect it - the fold is instantly straightened.

The development of subcutaneous fatty fiber is checked visually and palpatorically on the limbs, on the stomach and under the blades.

The turgor of soft tissues is checked by a feeling of resistance when the shoulder is squeezed on the inner surface, hips.

Independent work of students:

1. Work in the cabinet of the precinct pediatrician. Rules for registration of a leaflet of the first patronage of the newborn.

Task for independent work:

1. Conducting the first prenatal patronage (joint with a patronage sister)

The patronage of pregnant women is to provide a pregnant woman of general information about pregnancy, possible problems with which it can face, the need to comply with hygiene, nutrition, physical exertion, as well as the need to visit a female consultation in order to receive the consultation of the doctor and make sure that the pregnancy takes place well And the future child is healthy. The patronage of pregnant women in a certain way prepares the future mother for the concerns and problems with which she will face after the birth of a child.

What is the patronage of pregnant women

The main conduct of patronage is provided for pregnant women going first to experience the joys of motherhood and have absolutely no experience in this matter. Responsibility for the patronage of the pregnant woman lies on the shoulders of nurses with female consultation, where to lick the future fever. It is a nurse that calls, bringing the young mother's basic information with which she will need to face in the future, and for this it should take this case with the responsibility and understanding of the importance of this information for an inexperienced mother. The basic recommendations and nurse information gives an obstetrician.

What is part of the nurse conducting the patronage of pregnant women

  • The first thing a nurse conducting a pregnant patronage is obliged to establish contact with the woman itself, which is preparing to become a mother and her family in a short time, because it depends on further communication and execution of recommendations to a young family. The nurse must establish itself as a specialist and the pros in this matter that the family would have had any doubts about her work. Recommendations should not be voiced in an indicable tone, it will be better if they follow as tips.
  • The nurse must inspect the family living space in which replenishment is expected, will be convinced of suitable living conditions and further education of the child. If, according to nurses, some points do not meet the requirements, then it is obliged to convey it to future parents.
  • The main task of the nurse conducting the patronage of a pregnant woman is by attracting all family members to convey to their information about the appropriate conditions of the pregnant woman's stay, about her surroundings, which may affect the health and development of the future child.

The main purpose of the patronage of pregnant women is to reduce the cases of premature births, the birth of children with pathology, minimizing diseases that may appear after the child's birth.

When patronage, a pregnant woman is assumed to establish a registration card, in which the questionnaire, filled with a nurse. This card will accompany the woman throughout the pregnancy, data will be made in it, marks for the flow of pregnancy, and then childbirth.

When a nurse spent the patronage of a pregnant woman and fulfilled the main tasks for preparing it to the process of childbirth, the care and education of the future child, she transmits the patronage to the doctor, who observes pregnant. The doctor is obliged to give the nurse further instructions on the patronage of pregnant and assign the date of the next visit to it. Also, the doctor can remove pregnant with patronage, but only when she regularly visits women's advice, perfectly learned and keeps all the recommendations and tips received during patronage, or the conclusion of surveys say that a woman does not need further patronage.

With a patronage of a pregnant woman, who ignores the recommendations and appointments of the doctor and nurses, does not attend women's advice, it is not appropriate, as practice shows, it is these women to more need help and support. In this case, the first patronage is recommended for a doctor, which will help to lay a solid foundation in the future cooperation of the future mother with a nurse. During the whole pregnancy, patronage can be carried out up to three times, and if necessary.

Consequences of lack of patronage of pregnant women

There are cases when for one reason or another, a pregnant woman did not receive the necessary information and answers to those who have arisen. It could serve as she did not respond to his position, did not consider it necessary to spend time on the inspections of the doctors or simply in that female consultation, where it was listed, the patronage is not provided or was carried out in improperly. In view of these and many other reasons, a woman after the birth of a child is completely unreleased in those issues that they are now worried. Therefore, the patronage of the pants can also be held in the maternity homes, but without a preliminary learned patronage of pregnant women who gave birth will be quite difficult.

After the birth of the child, the patronage is performed for women who suffer from diseases after generic activities that doctors in the hospital did not have time to determine. Also, the patronage applies to the feminine temperature of the body, which exceeds the indicators and the process is not localized. First of all, women who have been discovered by these problems should be at the near future to visit women's advice. The doctor will help a woman who recently become a mother to identify the disease, prescribed the necessary treatment, which contributes to the treatment of chronic diseases, the spread of infection, which has been listed in the process of childbirth, inflammatory processes of sex tract, which under conditions of not proper treatment threatens serious problems associated with female health.

Planning a pregnancy to a young mother, you need to understand what responsibility, it carries for the future child, as well as the fact that the health of the child directly depends on its lifestyle and attentive attitude towards their health. In a timely manner, a pregnant woman will not only be able to make sure of the healthy development of the fetus, but also to get a prepar patronage, which will fully prepare it for future birth and the problems with which it can face in the future. Do not give up the predial patronage, because it is in the interests of the future mother.

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