Immunization and postnatal examination

Immunization

Immunization can be defined as a process of introducing
a substance or antigen in form of vaccine into the body to stimulate (help) the
production of antibodies against specific invading organism.

The immunity of an individual can be built up
against many of the common infection disease by administering the appropriate vaccine;
the incidence of that disease in the community will depend upon the number of
susceptible person in the community. The larger the immunized people in the
community the less easy are the spread of the disease from one person to
another.

Mobilization and public awareness

The public can be informed through any of the
following medium, radio, television, national and local newspaper, village
head, village development commute (VDC), district development committee (DDC)
in various school, churches, mosque and market places.

Objective of (NPI)

1.
To immunize all children below 0-2 years, given tetanus toxoid to all
pregnant woman and of child bearing age (14 years – 40 years).

2.
To reduce the child morbidity and mortality resulting from the six
deadly diseases.

3.
To administer potent vaccines to children, pregnant women and immunity to
resist infections.

4.
To ensure stability and happy home

5.
To foster inter-sectoral co-operation in the communities, thus ensuring
participation in NPI activities at all levels will enhance the ability of the
program to sustain itself effectively.

National immunization day (NID)

Objectives

i.
To boost NPI performance

ii.
To increase awareness and mobilize Nigerian for immunization

iii.
To increase access to NPI

This day was introduced because the aims and
federal ministry of health invited some voluntary organization such as the
rotary club, Red Cross, Lion and Lioness, Scout etc. planed with them and set
aside three day days-a month for three consecutive months, the first NID was held in 1988, in order to achieve the target
percentage.

Year Month Days

1988 March 8th,
9th, 10th

1988 April 12th,
13th, 14th

1988 May 24th,
25th, 26th

Before the commencement of NID the communities were
mobilized in order to understand and accept the programme. There was much
publicity, the radio, television, VDC, DPC, churches.

Baby trackers went from house to house to bring
mothers and babies to the health facilities. This was possible by the provision
of transport by voluntary organization and the creation of the catchments centre
at strategic places for immunization

Immunizable diseases

1.
Tuberculosis

2.
Diphtheria

3.
Measles

4.
Hepatitis B

5.
pertusis

6.
Yellow fever

7.
Poliomyelitis

Tuberculosis

This is a disease caused by a bacterium called
mycobacterium tuberculosis. The bacteria usually attack the lungs, but it can
attack any part of the body such as kidney, spine and brain, if not treated
properly.

Signs and symptoms of tuberculosis

i.
A bad cough that last 3 week or longer

ii.
Pain in the chest

iii.
Weakness or fatigue

iv.
Weight loss

v.
Sweating at night

How tuberculosis is spread

Tuberculosis is spread through the air from one
person to another. The TB bacteria are put into the air when a person with TB
disease of the lung or throat coughs, sneezes, speaks or sings people nearly
any breathe in these bacteria and become infected.

Testing for tuberculosis

There are two kinds of test are used to detect TB
bacteria in the body. The TB skin test (TST) and TB Blood test (TBT). These
tests can be given by health care provider or local health department.

Prevention of tuberculosis

TB disease can be treated by taking several drugs,
usually for 6 to 9 months. It is very important to finish the medicine, and
take drug exactly as prescribed if you stop taking the drugs too soon, you can
become sick again.

Diphtheria

This is a disease caused by corynebacterium diphtheriae
bacterium. Its most commonly spread through person to person contact to items
that have the bacteria on them.

Signs and symptoms of diphtheria

i.
Difficulty breathing

ii.
Swollen lymph nodes in the neck

iii.
Chills

iv.
Fever

v.
A sore throat

vi.
Bluish skin

vii.
A loud barking cough

Prevention of diphtheria

With the use of antibiotics and vaccines,
diphtheria is not only treated, but preventable as well. The vaccine for
diphtheria is given in a single shot that is called DTaP vaccine is
administered in a series at 2,4 and 6 months of age.

Diagnosing diphtheria

Your doctor will likely perform a physical exam to
chick for swollen lymph nodes. He or she should ask you about your medical
history and the symptoms you have been having.

Treatment for diphtheria

Because diphtheria is a serious illness, your
doctor will likely want to treat you quickly. The first step is an antitoxin
injection, if you are allergic to the antitoxin inform your doctor and he can
give you small doses of the antitoxin and gradually build up to higher amount.

After the diphtheria antitoxin, your doctor will
prescribe antibiotics like erythromycin and penicillin. Antibiotics help clear
up the infection.

Measles

Measles is caused by a virus in the paramyxovirus
family and it is normally passed through direct contact and through the air.
The virus infects the mucous membranes, than spreads throughout the baby.

Signs and symptoms of measles

1.
High fever

2.
A runny nose

3.
Cough

4.
Red and watery eyes

A small white spots outside the cheek can develop
in the initial stage after several days; a rash erupts usually on the face and
upper neck over about 3 days rashes spread.

Who is at risk of measles?

Unvaccinated young children are at highest risk of
measles, unvaccinated pregnant woman are also at risk.

Transmission of measles

1.
Through coughing

2.
Sneezing

3.
Close personal contact or direct contact with infection nasal or throat
secretions

Treatment for measles

No specified antivirus treatment exists for measles
virus. Measles can be avoided through supportive care that ensures good
nutrition, adequate fluid, intake and treatment of dehydration with WHO
recommendation oral rehydration solution.

Prevention of measles

Routine measles vaccination for children combined
with mass immunization campaigns in countries with high case and death rates
are key public health strategies to reduce global measles death.

Hepatitis B

Hepatitis B is a virus that infects the liver; it
is caused by the hepatitis B virus. It is spread through contact with the blood
and body fluid of an infected person.

Transmission of hepatitis B

1.
Have sex with an infected person without using a condom

2.
Share needles used for injecting drugs with an infected person

3.
Get a tattoo or piercing with tool that were not sterilized

4.
Share personal items like razors or toothbrushes with an infected
person.

Symptoms of hepatitis B

i.
Feeling very tired

ii.
Mild fever

iii.
Headache

iv.
Yellowish eyes and skin

v.
Skin rash

Treatment for hepatitis B

If your doctor thinks you may have liver damage
from hepatitis B, he or she may use a needle to take a tiny sample of your
liver for testing this is called a liver biopsy.

Pertusis

Pertusis is also known as whooping cough, is a
highly contagious respiratory disease caused by the bacterium Bordetella
pertusis . Pertusis is known for uncountable, violent coughing which often
makes it hard to breath.

Transmission of pertusis

i.
Through cough

ii.
Sneeze of an infected person

Diagnosis of pertusis

By collecting a sample from the back of the nose
and throat. This sample can then be tested by either culture or by polymerase
chain reaction

Prevention of pertusis

1.
Is mainly vaccination with the pertusis vaccine

2.
Initial immunization is recommended between six in the first two years
of life.

Symptoms of pertusis

i.
Paroxysmal cough

ii.
Inspiratory whooping

iii.
Fainting

iv.
Vomiting

Yellow fever

Yellow
fever is an acute viral haemorrhagic disease transmitted by infection
mosquitoes.

Signs and symptoms of yellow fever

1.
Fever

2.
Muscle pain with prominent backache

3.
Headache

4.
Shivers

5.
Loss of appetite

6.
Nausea or vomiting

Transmission of yellow fever

The yellow fever virus is an arbovirus of the
flavivirus genus, and the mosquito is the primary vector. It carries the virus
from one host to another, primarily between monkeys, from monkeys to humans and
from person to person.

Treatment for yellow fever

There is no specific treatment for yellow fever,
only supportive care to treat dehydration, respiratory failure and fever
bacteria’s infection can be treated with antibiotics.

Prevention of yellow fever

1.
Vaccination

2.
Immunization

3.
Using of insecticide mosquito treated net

Conditions at which a child cannot be immunized

i.
When the child is sick

ii.
When the child is born prematurely

iii.
When the child’s parents are ignorant

iv.
When the child is underweight

v.
When there is no vaccine of the health centre

The materials for immunization

1.
Sterile needle and syringes or auto disable syringe and needle

2.
Sterile kidney dish with cover

3.
Sterile galipot with cover for cotton wool

4.
Safety box for used needle and syringes

5.
Vaccine box

6.
Vaccine with their correct diluents

7.
Patients cards

8.
Immunization register

9.
Pen

10.
Artery forceps

11.
Ice packs

12.
Immunization card.

Immunization song

Get your children vaccinated (x2)

To prevent all deadly disease,

Get your children vaccinated

Better complete your entire dose (x2)

Five (5) doses for absolute protection

Let success grow all your effort

Freely, freely we give to you (x2)

The expensive immunization

Freely, freely we give to you

Postnatal examination

First what is postnatal?

Postnatal means after child birth

Postnatal examination

Postnatal examination is conducted six-eight weeks
after delivery to ensure that :

i.
The organ effected by pregnancy and labour have returned to their pre-pregnant
state

ii.
Lactation is successful with sufficient milk for the baby, and that
there are no beast complications.

iii.
The patient is in good condition and if there are any medical and gynaecological
complications, the patient is referred to the treatment.

iv.
The baby is thriving well and is directed to the infant welfare clinic
for subsequent care and immunization

Common postnatal complications

The common postnatal complications are

1.
Vaginal discharge which may be due to infection or cervitis with or
without cervical erosion.

2.
Backache is often due to over work and poor feeding, as commonly seen amongst
poor grade multipaval

3.
Headache, dizziness and tiredness are often complained of by anaemic
patients.

Prolapsed of the uterus is often associated with
cystocele and rectocele. The women complains of pelvic discomfort with dragging
or bearing down sensation, she should be referred to a gynaecologist

Postnatal exercise

Since patients are discharged early in the pueperium,
the midwife should teach or write out some postnatal exercise which the patient
can practiced at home. It should be done daily in the three months follow up
her confinement.

The exercises are as follows:

i.
Lying on the back with knee bent, feet resting on the floor

a.
Then breathe in, letting your abdomen go up and down as you breathe in and
down as you breathe out.

b.
Breathe in, expand your ribs sideways, breath out as deeply as you can.

ii.
Lying on the back with knees bent feet resting on the floor: tighten
your seat muscles and pull your abdomen in so that your back is pressed flat
against the floor then relax , hollow your back, then relax; practice this
exercise also sitting and standing

iii.
Lying on the back legs straight, angles crossed: tighten your seat
muscle, press your thighs against each other, draw in the muscle of your back
passage and pull your abdomen in; hold it all tight for a moment, then let it
relax slowly

iv.
Lying with one leg straight, the other leg bent and foot resting on the
floor.

a.
Make the straight leg shorter by drawing it up from your waist then
longer by stretching down repeat with the other legs.

b.
Roll bent knee over straight legs, repeat the other knee

v.
Sitting with hands resting on top of the head turn as far to the right
as possible, then to the left.

vi.
Sitting with legs straight in front

a.
Bend and stretch ankles

b.
Bend and stretch toes

c.
Turn feet in and out (ankles bent up)

Health education at promoting good health

1
Rest and Sleep: These are very important in the management of
puerperal patient. Rest should be encouraged by restricting visitors during the
day (to some extent) and when the patient can sleep at night the doctor may
order sedative for her.

2
Ambulation: Patient are encouraged to get up 6-12 hours after
delivery, that is if there is no complication recorded, this gives a feeling of
well-being, promote good circulation and drainage of lochia. It also enables the patient to participate in
the care management of her baby

3
Diet:

·
The food of a mother that just put to birth should be rich protein,
vitamins and minerals in order to promote lactation.

·
Adequate fluid in the form milk and beverages are also given.

·
Supplicating vitamins and iron in order to prevent anaemia and malaria.

·
Should be encourage to take plenty bowel, the care of bladder and bowel.

·
Patient is encouraged to empty her bladder regularly because and over
distended bladder predisposes to P.PH, subinvolution of the uterus.

·
Constipation should be avoided as it may contribute to subinvolution of
the uterus.

·
N.B.: eat and drink fruit and plenty of fluids to avoid this.

4
Personal Hygiene: Vulva toilet which is carried out twice daily with
the antiseptic and aseptic precaution when the patient is confined to bed.

5
Aiding Involution: This can be successful by encouraging on the
following

i.
Promoting good health habit

ii.
Early ambulation