SlideShare a Scribd company logo
5
Most read
6
Most read
12
Most read
BSC-NURSING 3rd YEARS
INDIVIDUALASSIGMENT
MID WIFERY AND OBSTETRICAL NURSING - NUR 312
ANEMIA IN PREGNANCY A CASE OF MUEMBE LADU MATENITY
HOSPITAL AT RCH CLINIC
BY
Abdulla Khamis Ngwali
DATE – 5th APRIL 2016.
ZU/FHS/4674/13
Anemia in Pregnancy
Anemia is defined as a condition in which there
is less than the normal hemoglobin (Hb) level
in the body, which decreases oxygen carrying
capacity of red blood cells to tissues. World
Health Organization (WHO) definitions for
anemia differ by age, sex and pregnancy status
as follows: children 6 months to 5year anemia
is defined as a Hb level <11g/dl, children 5–11
years Hb < 11.5 g/dl, adult males Hb < 13 g/dl;
non pregnant women Hb <12g/dl and pregnant
women Hb < 11g/dl4.Anemia could be
classified as mild, moderate and severe
Anemia in pregnancy remains is the one of the
most intractable public health problems in
developing countries. Globally, anemia
contributes to 20% of all maternal deaths.
Although not always shown to have a causal
link, severe anemia contributes to maternal
morbidity and mortality. Anemia in
pregnancy may also lead to premature births,
low birth weight, fetal impairment and infant
deaths
Literature review
 Worldwide, anemia affects over two
billion people and the World Health
Organization (WHO) has estimated that
half of these are due to iron deficiency
[5, 6]. Iron deficiency is not only the most
prevalent but also the most neglected
nutrient deficiency in the world,
particularly among pregnant women and
children in developing countries [7].
Presently, over 40 million pregnant
women suffer from iron deficiency (ID)
and its consequences in developing
countries [8].
The status of patient
Demographic data
 Patient initial: H . S. O.
 Address: Kilima Hewa
 Age: 22yrs
 Occupation: House wife
 Sex: Female
 M/ Status: Married
 Date of attendance: 4/03/2016
Medical history
 Previous history: The patient was pregnant women
G2, Para 1, and was well until 1 week ago when she
started to experience headache of gradual onset off and
on, heart palpitation mild to moderate intensity no
aggravating factor, relieved with sleeping,
Continue..................
 associated with dizziness and poor vision
sometime, no history of fever. Also
complaining general body weakness for
3days now that make her unable to do her
normal activities associated with lower
limbs numbness. She has no allergic history
no history of blood transfusion.
 LMP - 2/7/015, EED 8/4/016, Amenorrhea
for 6 months, gestational age 20weeks+ 5
days
Medical history
Previous history:
Gravid 2, Para 1LMP - 2/7/015, EED 8/4/016,
Amenorrhea for 6 months, gestational age
20weeks+ 5 days.
1ST Visit -V/sign. BP -120/60 mmHg , FHR was 122
b/min, Hb level was 8.0 g/dl, Respiration 14b/m,
urine albumin =Nil, weight was 52 kg, VDRL = Non
reactive, PMTCT = 2 , Blood group B, RH+ve.
Continue.............
 2ND Visit, V/sign. BP -120/70 mmHg ,
FHR was 123b/min, Hb level was 8.9 g/dl
last measured, Respiration 14b/m, urine
albumin =Nil, weight was 54 kg, VDRL
= Non reactive, PMTCT = 2 , Blood
group B, RH+ve.
 Present history:
Gestational age 31 weeks + 4 days, pale ++,
fatigue, Dysnea, palpitation.
 Medical diagnosis : Anemia in pregnancy
 Current treatment: syrup ,
Haemovit 15mls t.d.s for 7/ then
Tab FeSO4 1tab o.d for two weeks,
tab mebendazole 500 mg start,
T.T 2nd dose,
 V/S taken was as follows: T: 36.2 C,
P:110 b/min, R: 19 b/min, BP: 120/70
mmHg, FHR 129 b/min.
Nursing Assessment , Diagnosis and Investigations.
 Mental states of the patient: was good in
term of language pt able to introduce her in
good and understandable manner with
coherent speech able to identify place, time
and date
 Orientation: able to be oriented with time,
stuff, relative and recognize the services
provided
 Attention; was totally concentrated with
services and able to answer any question
requested even by try.
 Level of consciousness: full consciousness
NURSING
DIAGNOSIS
GOALS INTERVATION
AND RATIONALE
EVALUATION
Imbalanced nutrition
less than body
requirements related
to inadequate food
intake to utilize
nutrients so as meet
metabolic needs as
evidence by :
Loose of appetite
Muscles weakness
After 2 to 3 weeks
patient nutritional
status will be
balanced
Encourage patient
to eats balance diet
especial high iron
diet and CHO2 to
maintain body
nutrition and
energy.
Encourage patient
to eat more and
more and drinking
including fruits,
water, juice to
increase appetite.
Within 5 days
patient appetite
was increased and
muscle weakness
also decreased.
Cont…….
Ineffective breathing
pattern t related to failure
of nutrients absorption
necessary for formation of
red blood cells
Patient’s
breathing pattern
will be effective
Encourage
patient to eats
high iron diet
and protein diet,
like green
vegetables, soup,
beans fruits etc.
Encourage to
use iron
supplements as
prescribed.
In order to
increase Hb
level and to
correct sign of
anemia
fortunately the
sign of anemia is
reduced slowly
so and the pt
become
improved
throughout the
management
Activity intolerance
related to imbalance
between oxygen
supply of her
body/fetus and
demand (delivery) as
evidence by fatigue
and inability to
maintain self care
activities regularly
and dyspnea.
Short term:
After 8 hours
of nursing
interventions the
patient will:
Report an increase
in activity
tolerance including
activities of daily
living.
Long term:
After months the
patient:
Is free from
weakness and risk
for complications
has been prevented
and will deliver
safetly
Assess patient’s
ability to perform
normal task or
activities of daily
living.
Note changes in
balance/ gait
disturbance,
muscle weakness.
Recommend bed
rest if indicated.
Provide assistance
with activities or
ambulation as
necessary,
allowing patient to
do as much as
possible
After 4 days
patient was
revealed an
increase in activity
tolerance,
demonstrating a
reduction in
physiological signs
of intolerance
Cont……
Risk for infection
related to
inadequate
secondary defenses
due to decrease in
hemoglobin level
leucopenia.
After a month
patient will be
prevented from
infection/
complications
Encourage patient
to eats balance diet
and iron
supplements to
correct anemia and
increase body
immunity
Body immunity is
increased and
anemia slowly
slowly corrected.
Knowledge deficit
regarding disease
process, treatment
and individual care
need related to
unfamiliarity with
information and
misinterpretation
as evidence by :
Inadequate follow
the instruction, eg.
balance diet
A patient will be
gain knowledge
Educate the patient
on how to prepare
food.
Teach on important
of balance diet/
iron supplement .
Patient gained
knowledge and
able to correct
misperceptions
about disease and
treatment
Critique of the care
 She was require pronged dose especially of
ferrous sulphate at list one month
 Patent require continuous monitoring for
her Hb during whole period of pregnancy
Un usual aspect of care
 They not instruct pt as this serious
condition and need close follow up
 Patient didn’t get enough health education
on disease condition.
Education and lesson learned
 There must be a limit for midwifery to treat
some obstetric related condition this is because
midwife are not deep in physiology so as to
alleviate un usually suffering.
 Muembe ladu RCH must emphasize
availability of doctor such as mnazi mmoja so
as midwife and doctor make consultation on
some disease condition of the patient.
 Also midwife should provide health education
on diet and different disease in any single visit
of the pregnant mother so as to save the life and
provision of good viable health
Recommendation for change of the current care plan
According to the millennium goal number four (4)
which is to reduce child mortality and goal
number five (5) which is to improve maternal
health, the following are my recommendation
pertaining my case study in muembe ladu
maternity hospital.
 All nurse prescriber/midwife must follow the
standard guideline on treating different illness and
disease condition
 Government should provide doctors to every rch
so as nurse midwife could work together with
Pregnant women should follow the advice
given to the hospital and consult their
husband or family on its implementation
University and faculty should provide
enough time for clinical rotation if possible
practice time and case study must be
separately to ensure factual information of
case study
Students must commit them self when
performing case on behalf of the patient not
to consider the remarks of their work and left
patient with problems
Thank you for listening

More Related Content

DOCX
Iron Deficiency Anemia in Pregnancy Case study
PPT
Case presntation -Anamia in Pregnancy-Case Review
DOCX
Anaemia in pregnancy
PPTX
Pregnancy Induced Hypertension
PPTX
Malaria in pregnancy case presentation edited
DOCX
case study
DOC
Nursing case study Pre eclampsia
PPTX
Focus antenatal care
Iron Deficiency Anemia in Pregnancy Case study
Case presntation -Anamia in Pregnancy-Case Review
Anaemia in pregnancy
Pregnancy Induced Hypertension
Malaria in pregnancy case presentation edited
case study
Nursing case study Pre eclampsia
Focus antenatal care

What's hot (20)

PPT
Gestational diabetes mellitus
PPTX
HYPEREMESIS GRAVIDARUM
PPTX
Danger signs during pregnancy
PPTX
Postpartum hemorrhage
PPTX
Presentation on pneumonia
PPT
Oxytocin
PPT
Mechanism of labour
PPTX
Cephalopelvic disproportion (CPD) & Contracted pelvis
PPTX
Neonatal Jaundice
PPTX
Neonatal hypothermia
PPTX
Pregnancy Induced Hypertension- Pathophysiology
PPSX
Hypothermia in newborn
PPTX
Essential new born care
PPTX
Physiology of labour
PPT
NEWBORN CARE
PPTX
Puerperal sepsis
PPTX
Intrauterine Fetal Death (IUFD),(Kurdistan)
PPTX
SMALL FOR GESTATIONAL AGE,LARGE FOR GESTATIONAL AGE -SSJ, CALICUT MEDICAL COL...
PPT
Puerperal Pyrexia
Gestational diabetes mellitus
HYPEREMESIS GRAVIDARUM
Danger signs during pregnancy
Postpartum hemorrhage
Presentation on pneumonia
Oxytocin
Mechanism of labour
Cephalopelvic disproportion (CPD) & Contracted pelvis
Neonatal Jaundice
Neonatal hypothermia
Pregnancy Induced Hypertension- Pathophysiology
Hypothermia in newborn
Essential new born care
Physiology of labour
NEWBORN CARE
Puerperal sepsis
Intrauterine Fetal Death (IUFD),(Kurdistan)
SMALL FOR GESTATIONAL AGE,LARGE FOR GESTATIONAL AGE -SSJ, CALICUT MEDICAL COL...
Puerperal Pyrexia
Ad

Viewers also liked (20)

PDF
Anemia: A case based approach: Part-1
PPTX
PPT
Iron deficiency anemia.
PPTX
Anemia in pregnancy by dr shabnam naz
PPTX
Anaemia in pregnancy
DOCX
A case study on cirrhosis of liver
PPSX
Case study hypertension presentation show
PPT
Anemia And Its Classification
PPT
Anemia
PPTX
Anemia ppt
PPTX
Park24
DOC
Deliverable 5.1 Scenario definition, advisory board and legal/ethical review
PPTX
Obstetrics and gynaecology seminar a case of Intrauterine Growth Restriction
PPTX
Pan Masala Sada, Meetha & Zarda - Market Survey cum Detailed Techno Economic ...
PDF
Hepatoprotective and antioxidant effects of Azolla microphylla based gold nan...
PPTX
History taking in obstetrics & Gynecology
PPT
Stemming The Rising Tide Of Iron Deficiency Anemia In India
PPT
Anemia with pregnancy
PDF
automatic car parking investment
PPT
Fabry Disease Research Update - 14 February 2014
Anemia: A case based approach: Part-1
Iron deficiency anemia.
Anemia in pregnancy by dr shabnam naz
Anaemia in pregnancy
A case study on cirrhosis of liver
Case study hypertension presentation show
Anemia And Its Classification
Anemia
Anemia ppt
Park24
Deliverable 5.1 Scenario definition, advisory board and legal/ethical review
Obstetrics and gynaecology seminar a case of Intrauterine Growth Restriction
Pan Masala Sada, Meetha & Zarda - Market Survey cum Detailed Techno Economic ...
Hepatoprotective and antioxidant effects of Azolla microphylla based gold nan...
History taking in obstetrics & Gynecology
Stemming The Rising Tide Of Iron Deficiency Anemia In India
Anemia with pregnancy
automatic car parking investment
Fabry Disease Research Update - 14 February 2014
Ad

Similar to My anemia case presentation (20)

PPTX
Anaemia in pregnancy educational bhor series
PPT
Ccp anemia
PPT
5. Anaemia in Pregnancy.ppt this explain the condition wich is more common to...
PPTX
Anaemia in pregnancy
PPT
Anemia with pregnancy
PPTX
Anemia in pregnancy
PPT
Anemia pregnancy and how to make manage
PDF
anaemiainpregnancy-190208054001.pdf
PPT
Anaemia in pregnancy
PPTX
Case presentation by unit 1B anemia.pptx
PPTX
presentation of Anemia and classification
PPTX
Anaemia in pregnancy and its evaluation ppt
PPT
varsha anemia workup final
PPTX
ANEMIA AND NUTRITIONAL DEFICIENCIES IN PREGNANCY.pptx
PDF
Anemia in pregnancy obstructive gynecology
PPTX
anaemiainpregnancy-190208054001.pptx
PPTX
OB 8 ANAEMIA IN PREGNANCY (6) (2).pptx
PPTX
GROUP_5_RH_1_ASSIGNMENT on TUBERCULOSIS [1].pptx
PPTX
anaemiainpregnancy-190208054001 (1).pptx
PDF
Anaemia in pregnancy educational bhor series
Ccp anemia
5. Anaemia in Pregnancy.ppt this explain the condition wich is more common to...
Anaemia in pregnancy
Anemia with pregnancy
Anemia in pregnancy
Anemia pregnancy and how to make manage
anaemiainpregnancy-190208054001.pdf
Anaemia in pregnancy
Case presentation by unit 1B anemia.pptx
presentation of Anemia and classification
Anaemia in pregnancy and its evaluation ppt
varsha anemia workup final
ANEMIA AND NUTRITIONAL DEFICIENCIES IN PREGNANCY.pptx
Anemia in pregnancy obstructive gynecology
anaemiainpregnancy-190208054001.pptx
OB 8 ANAEMIA IN PREGNANCY (6) (2).pptx
GROUP_5_RH_1_ASSIGNMENT on TUBERCULOSIS [1].pptx
anaemiainpregnancy-190208054001 (1).pptx

More from Mnazi Mmoja National Hospital Zanzibar/abdulla mzee hospital (12)

Recently uploaded (20)

PPTX
1. Basic chemist of Biomolecule (1).pptx
PDF
شيت_عطا_0000000000000000000000000000.pdf
PPTX
Cardiovascular - antihypertensive medical backgrounds
PDF
Oral Aspect of Metabolic Disease_20250717_192438_0000.pdf
PPTX
Electrolyte Disturbance in Paediatric - Nitthi.pptx
PDF
Intl J Gynecology Obste - 2021 - Melamed - FIGO International Federation o...
PPTX
Neuropathic pain.ppt treatment managment
PPTX
Acid Base Disorders educational power point.pptx
PPT
nephrology MRCP - Member of Royal College of Physicians ppt
PDF
SEMEN PREPARATION TECHNIGUES FOR INTRAUTERINE INSEMINATION.pdf
PPTX
NRPchitwan6ab2802f9.pptxnepalindiaindiaindiapakistan
PPT
Copy-Histopathology Practical by CMDA ESUTH CHAPTER(0) - Copy.ppt
PPTX
the psycho-oncology for psychiatrists pptx
PPTX
y4d nutrition and diet in pregnancy and postpartum
PDF
Extended-Expanded-role-of-Nurses.pdf is a key for student Nurses
PPTX
Acute Coronary Syndrome for Cardiology Conference
PPTX
Human Reproduction: Anatomy, Physiology & Clinical Insights.pptx
PDF
focused on the development and application of glycoHILIC, pepHILIC, and comm...
PPTX
antibiotics rational use of antibiotics.pptx
PPT
Obstructive sleep apnea in orthodontics treatment
1. Basic chemist of Biomolecule (1).pptx
شيت_عطا_0000000000000000000000000000.pdf
Cardiovascular - antihypertensive medical backgrounds
Oral Aspect of Metabolic Disease_20250717_192438_0000.pdf
Electrolyte Disturbance in Paediatric - Nitthi.pptx
Intl J Gynecology Obste - 2021 - Melamed - FIGO International Federation o...
Neuropathic pain.ppt treatment managment
Acid Base Disorders educational power point.pptx
nephrology MRCP - Member of Royal College of Physicians ppt
SEMEN PREPARATION TECHNIGUES FOR INTRAUTERINE INSEMINATION.pdf
NRPchitwan6ab2802f9.pptxnepalindiaindiaindiapakistan
Copy-Histopathology Practical by CMDA ESUTH CHAPTER(0) - Copy.ppt
the psycho-oncology for psychiatrists pptx
y4d nutrition and diet in pregnancy and postpartum
Extended-Expanded-role-of-Nurses.pdf is a key for student Nurses
Acute Coronary Syndrome for Cardiology Conference
Human Reproduction: Anatomy, Physiology & Clinical Insights.pptx
focused on the development and application of glycoHILIC, pepHILIC, and comm...
antibiotics rational use of antibiotics.pptx
Obstructive sleep apnea in orthodontics treatment

My anemia case presentation

  • 1. BSC-NURSING 3rd YEARS INDIVIDUALASSIGMENT MID WIFERY AND OBSTETRICAL NURSING - NUR 312 ANEMIA IN PREGNANCY A CASE OF MUEMBE LADU MATENITY HOSPITAL AT RCH CLINIC BY Abdulla Khamis Ngwali DATE – 5th APRIL 2016. ZU/FHS/4674/13
  • 2. Anemia in Pregnancy Anemia is defined as a condition in which there is less than the normal hemoglobin (Hb) level in the body, which decreases oxygen carrying capacity of red blood cells to tissues. World Health Organization (WHO) definitions for anemia differ by age, sex and pregnancy status as follows: children 6 months to 5year anemia is defined as a Hb level <11g/dl, children 5–11 years Hb < 11.5 g/dl, adult males Hb < 13 g/dl; non pregnant women Hb <12g/dl and pregnant women Hb < 11g/dl4.Anemia could be classified as mild, moderate and severe
  • 3. Anemia in pregnancy remains is the one of the most intractable public health problems in developing countries. Globally, anemia contributes to 20% of all maternal deaths. Although not always shown to have a causal link, severe anemia contributes to maternal morbidity and mortality. Anemia in pregnancy may also lead to premature births, low birth weight, fetal impairment and infant deaths
  • 4. Literature review  Worldwide, anemia affects over two billion people and the World Health Organization (WHO) has estimated that half of these are due to iron deficiency [5, 6]. Iron deficiency is not only the most prevalent but also the most neglected nutrient deficiency in the world, particularly among pregnant women and children in developing countries [7]. Presently, over 40 million pregnant women suffer from iron deficiency (ID) and its consequences in developing countries [8].
  • 5. The status of patient Demographic data  Patient initial: H . S. O.  Address: Kilima Hewa  Age: 22yrs  Occupation: House wife  Sex: Female  M/ Status: Married  Date of attendance: 4/03/2016 Medical history  Previous history: The patient was pregnant women G2, Para 1, and was well until 1 week ago when she started to experience headache of gradual onset off and on, heart palpitation mild to moderate intensity no aggravating factor, relieved with sleeping,
  • 6. Continue..................  associated with dizziness and poor vision sometime, no history of fever. Also complaining general body weakness for 3days now that make her unable to do her normal activities associated with lower limbs numbness. She has no allergic history no history of blood transfusion.  LMP - 2/7/015, EED 8/4/016, Amenorrhea for 6 months, gestational age 20weeks+ 5 days
  • 7. Medical history Previous history: Gravid 2, Para 1LMP - 2/7/015, EED 8/4/016, Amenorrhea for 6 months, gestational age 20weeks+ 5 days. 1ST Visit -V/sign. BP -120/60 mmHg , FHR was 122 b/min, Hb level was 8.0 g/dl, Respiration 14b/m, urine albumin =Nil, weight was 52 kg, VDRL = Non reactive, PMTCT = 2 , Blood group B, RH+ve.
  • 8. Continue.............  2ND Visit, V/sign. BP -120/70 mmHg , FHR was 123b/min, Hb level was 8.9 g/dl last measured, Respiration 14b/m, urine albumin =Nil, weight was 54 kg, VDRL = Non reactive, PMTCT = 2 , Blood group B, RH+ve.
  • 9.  Present history: Gestational age 31 weeks + 4 days, pale ++, fatigue, Dysnea, palpitation.  Medical diagnosis : Anemia in pregnancy  Current treatment: syrup , Haemovit 15mls t.d.s for 7/ then Tab FeSO4 1tab o.d for two weeks, tab mebendazole 500 mg start, T.T 2nd dose,
  • 10.  V/S taken was as follows: T: 36.2 C, P:110 b/min, R: 19 b/min, BP: 120/70 mmHg, FHR 129 b/min.
  • 11. Nursing Assessment , Diagnosis and Investigations.  Mental states of the patient: was good in term of language pt able to introduce her in good and understandable manner with coherent speech able to identify place, time and date  Orientation: able to be oriented with time, stuff, relative and recognize the services provided  Attention; was totally concentrated with services and able to answer any question requested even by try.  Level of consciousness: full consciousness
  • 12. NURSING DIAGNOSIS GOALS INTERVATION AND RATIONALE EVALUATION Imbalanced nutrition less than body requirements related to inadequate food intake to utilize nutrients so as meet metabolic needs as evidence by : Loose of appetite Muscles weakness After 2 to 3 weeks patient nutritional status will be balanced Encourage patient to eats balance diet especial high iron diet and CHO2 to maintain body nutrition and energy. Encourage patient to eat more and more and drinking including fruits, water, juice to increase appetite. Within 5 days patient appetite was increased and muscle weakness also decreased.
  • 13. Cont……. Ineffective breathing pattern t related to failure of nutrients absorption necessary for formation of red blood cells Patient’s breathing pattern will be effective Encourage patient to eats high iron diet and protein diet, like green vegetables, soup, beans fruits etc. Encourage to use iron supplements as prescribed. In order to increase Hb level and to correct sign of anemia fortunately the sign of anemia is reduced slowly so and the pt become improved throughout the management
  • 14. Activity intolerance related to imbalance between oxygen supply of her body/fetus and demand (delivery) as evidence by fatigue and inability to maintain self care activities regularly and dyspnea. Short term: After 8 hours of nursing interventions the patient will: Report an increase in activity tolerance including activities of daily living. Long term: After months the patient: Is free from weakness and risk for complications has been prevented and will deliver safetly Assess patient’s ability to perform normal task or activities of daily living. Note changes in balance/ gait disturbance, muscle weakness. Recommend bed rest if indicated. Provide assistance with activities or ambulation as necessary, allowing patient to do as much as possible After 4 days patient was revealed an increase in activity tolerance, demonstrating a reduction in physiological signs of intolerance
  • 15. Cont…… Risk for infection related to inadequate secondary defenses due to decrease in hemoglobin level leucopenia. After a month patient will be prevented from infection/ complications Encourage patient to eats balance diet and iron supplements to correct anemia and increase body immunity Body immunity is increased and anemia slowly slowly corrected.
  • 16. Knowledge deficit regarding disease process, treatment and individual care need related to unfamiliarity with information and misinterpretation as evidence by : Inadequate follow the instruction, eg. balance diet A patient will be gain knowledge Educate the patient on how to prepare food. Teach on important of balance diet/ iron supplement . Patient gained knowledge and able to correct misperceptions about disease and treatment
  • 17. Critique of the care  She was require pronged dose especially of ferrous sulphate at list one month  Patent require continuous monitoring for her Hb during whole period of pregnancy Un usual aspect of care  They not instruct pt as this serious condition and need close follow up  Patient didn’t get enough health education on disease condition.
  • 18. Education and lesson learned  There must be a limit for midwifery to treat some obstetric related condition this is because midwife are not deep in physiology so as to alleviate un usually suffering.  Muembe ladu RCH must emphasize availability of doctor such as mnazi mmoja so as midwife and doctor make consultation on some disease condition of the patient.  Also midwife should provide health education on diet and different disease in any single visit of the pregnant mother so as to save the life and provision of good viable health
  • 19. Recommendation for change of the current care plan According to the millennium goal number four (4) which is to reduce child mortality and goal number five (5) which is to improve maternal health, the following are my recommendation pertaining my case study in muembe ladu maternity hospital.  All nurse prescriber/midwife must follow the standard guideline on treating different illness and disease condition  Government should provide doctors to every rch so as nurse midwife could work together with
  • 20. Pregnant women should follow the advice given to the hospital and consult their husband or family on its implementation University and faculty should provide enough time for clinical rotation if possible practice time and case study must be separately to ensure factual information of case study Students must commit them self when performing case on behalf of the patient not to consider the remarks of their work and left patient with problems
  • 21. Thank you for listening