LIST OF TABLES

LIST+ OF ABREVIATIONS

FCB/CME : FONDATION CHANTAL BIYA/ Centre Mère et Enfant

FP : Family planning

ANC : Antenatal consuktation

BP : blood pressure

P : pulse

T : Temperature

ESS : Ecole des sciences de la santé

IUD : Intra uterine devise

HIV : Human Immunodeficiency Syndrom

STD : Sexually Transmitted Disease

 APPRECIATION

We cannot begin writing this report without first thanking all the people who, directly or
indirectly, contributed to the success of our internship and to the design of this report. All my
gratitude goes to:

From the Almighty for granting me all his protection throughout my internship.

From the director of the ESS who was able to set up the university system allowing nurses
and midwives to improve their career profile.

To the director of the mother-child center of the Chantal Biya foundation, to the care
coordinator, to the major of the ANC and FP services, and to the entire care team for the
warm welcome in their service and their frank collaboration during our internship.

To my manager and all my UCAC supervisors for their good training.

To all the patients and their families for having accepted to participate in the achievement of
our objectives.

To all my fellow students with whom we were able to exchange ideas and share experiences.

To my family for their prayers, love, protection and moral and financial support.
 CHAPTER I : PRESENTATION OF STRUCTURE
1. History

The Mother and Child Center of the Chantal Biya Foundation is a second category parastatal
institution created in April 1994 following the cries of the poor in urban and rural centers.
This structure only meets the needs of women, especially of childbearing age, and children.

23 years ago, to raise national and international awareness of the fight against poverty,
disease, misery and exclusion of all kinds in urban and rural areas, Mrs. Chantal BIYA
decided to create the center mother children.

2. Geographical Location

The CME/FCB in general is located in the center region, department of Mfoundi, district of
Yaoundé II; the CME/FCB is limited:

- In the East by the National Center for the Fight against HIV;

- To the west by the central hospital;

- - To the North by the Center Pasteur and;

- To the south by the firm Henri Dunan.

With easy accessibility to the center it is located a few meters from the road

Specifically, the family planning (FP) service in which the internship took place is located on
the first level in one of the buildings of the center. Where are the gynecological consultation
offices, and ANC.

Analysis: it is true that the family planning service is part of gynecology, but the target
populations are women wishing, for example, to space births the target population will be
mothers coming for vaccination given the fact that childbirth does not are not done in the
center because postpartum women are also targets for FP. The fact is that at the foundation it
is rather attached to the ANC service, we find that the immediate target woman is the
postpartum one.
 3. Philosophy

FCB's philosophy is Smile - Hope - Solidarity. The main objective pursued by the Chantal
BIYA Foundation is to help disadvantaged social strata and the fight against suffering. As
other objectives we have:

- The prevention and alleviation of human suffering;

- Protection, education and social and health actions for mothers and children;

- Assistance to destitute patients;

- Assistance and supervision of abandoned children;

- Assistance to the elderly;

- The fight against poverty and misery;

- Protection of the family;

-Assistance in materials and medicines to hospitals and health centers in need.

4. The Functioning of the Hospital

FCB operates 24 hours a day, 7 days a week, with permanent and rotating staff. In all, the
Center has 205 hospital beds divided between neonatology, hemato-oncology, infectiology,
intensive care and general paediatrics. Cardiology, Neurology and Nephrology units are under
development. The team has 282 people, including 8 paediatricians, 2 obstetrician-
gynecologists, 1 biologist, 1 temporary radiologist, 8 general practitioners, 72 nurses, 12
medical and health personnel and 53 caregivers.

Speaking of which the functioning of the service in which it carries our internship; the FP
service begins at 7:30 a.m. and ends at 3:00 p.m. every day from Monday to Friday,
consultations are done every day (new and old). When a patient arrives after the reception, the
parameters are taken before going to the consultation or the counseling is done individually
before the choice and the installation or the administration of the planning method requested. ,
then an appointment is given for the follow-up of the undesirable effects and finally the filling
of the register.
 5. Human Resources

• 02 obstetrician/ gynecologists

• 01 State-certified midwife

Analysis: there should be at least two personnel in each unit for the proper functioning of the
service and also for assistance in case of work or even absence.

Material

- 01Table de consultation selon les normes

- 01 bureau
- 01 armoire
- 2 chaises confortables pour les clientes
- Une Source d’eau pour le lavage des mains
 CHAPTER 2 : PRESENTATION OF INTENSHIP AND OBJECTIVES

Family planning was described as an essential component of primary health care in the
declaration of Alma Ata. It is also a vital component in reproductive health, it is one of the
four pillars for the reduction of maternal, neonatal and infant mortality. It also plays a role in
preventing mother-to-child transmission. It is defined as all the means that contribute to birth
control, with the aim of allowing families to choose to have a child. The purpose of our
internship from February 13 to March 11, 2022 in family planning with the aim of promoting
reproductive health and welcoming the notions into practice and combining it with theory, our
academic supervisors from the School of Health Sciences of the Catholic University in order
to offer us the best training combining theory and practice.

I. Initier l’accueil des clients/clientes

On arrival, clients are welcomed into the service and an orientation is made in relation to the
functioning of the planning activities: during a reception of the woman, we welcome her by
giving her a seat, we also reassure them that we can confide without any fear of the presence
of students because we are also bound by professional secrecy. Subsequently, after expressing
the reason for her visit, she was directed to the cash register to obtain the transfer ticket for the
consultation.

II. Maitriser la technique du counseling

Counseling is a conversation between the health care provider and the client aimed at building
the person's confidence in order to find a solution to their problem.

FP counseling helps clients:

• Arrive at an informed choice regarding their reproductive option

• Choose a method of contraception that suits them

• Use the method safely and effectively

Family planning counseling follows a number of steps that help us complete this reproductive
health care process. These steps are in this order:

• Establishment of a relationship consisting of welcoming the client, introducing oneself,

ensuring confidentiality, explaining the need to discuss personal and sensitive subjects.
• Categorization of customers, according to the reasons for the visit

New customers:

- new client with no method in mind.

- new client with a method in mind.

Former customers in control visit:

- former customer on a satisfied control visit.

- former customer on a follow-up visit with concerns or problems.

- former client before the check-up date with concerns or problems.

• Decision making is about

- Identify family planning decisions that the client needs to make or confirm

- Evaluate the dominant options for each decision

- Help the client to examine the advantages, the limits as well as the consequences of each
option (provide the information necessary to fill in the gaps).

- Encourage the client to make her own decisions.

• The implementation of the chosen method we must still:

- Make a specific plan together with the client for the implementation of the decision
including the correct use of the method

- Identify the barriers/difficulties that the client is likely to encounter in applying the decision
taken

- Develop strategies to overcome the problems encountered

- Identify and apply the techniques that the client will need

- Make a follow-up plan and/or provide referrals as desired

The plan above elaborates in some way what the standard of counseling would like each
service provider to apply.
Clinical case :

• Home

When the client arrives, taking the case of one who has never been on a family planning
method, we welcome her and install her in confidentiality, while explaining that everything
that will be discussed remains confidential. and who should not feel embarrassed to answer
certain questions that will affect his privacy because it is a good follow-up.

• Categorize the client

This is done during the interrogation, after the reception we ask him his reason for
consultation of the day. During the interview, we ask her if this is the first time she has sought
family planning services. We first find out what she knows and thinks about the FP, whether
she came on her own or it was referred or sent by another service. After this collection of
information we can therefore categorize it as old or new for the PF.

• Decision-making or choice of method

We present to her all the different methods of family planning, according to their different
categories, presenting the advantages and disadvantages of each of them, leaving her the
possibility of making her choice while reassuring us that she has understood the explanations
given. When the client makes her choice and makes a decision, we reassure ourselves that she
is eligible for the method and that these gaps or misunderstandings have been filled and that
we can therefore implement it.

• Implementation

The prescription is written for the purchase of the material corresponding to the method
chosen while reassuring that it will have no difficulties with the method

III. Maitriser le processus de l’examen physique et gynécologique des clientes

Examen physique

The clinical examination is done in a cephalo-caudal way, after having informed the woman
of the goal and its importance acting to eliminate any factor that could lead to a
contraindication of the installation of the method, namely to have the presence of a ganglion
in the neck or varicose veins on the legs to mention a few. For this we need to maintain the
confidentiality of patience by closing the door and then we ask him to undress and lie down
on the bed. We first examine the conjunctivae to eliminate a possible risk of anemia, we also
evaluate the oral cavity in order to search for candidiasis, then we move on to palpation of the
neck checking for inflammation of the thyroid glands and the presence of a ganglion.
Palpation of the breasts in order to eliminate a possible nodule or a risk of breast cancer,
during abdominal palpation we palpate the different quadrants of the abdomen in order to
look for any pathology such as splenomegaly; hepatomegaly; tenderness or inflammation of
the tubes, also for women six weeks postpartum palpation also allows us to check if the
involution has really and completely taken place. Finally we have the palpation of the lower
limbs where we look for the presence of edema and varicose veins.

Gynecological examination

- Gynecological history

The threats, the duration of the menstrual cycle, the duration of the periods, the date of the last
period, its gravidic formula (the number of pregnancies, the number of children delivered at
term, the number of premature, the number of abortions and the number of children currently
living). The age of the first child and that of the last child, a history of sexually transmitted
disease.

- Gynecological examination

Vaginal examination is done using sterile gloves to check and assess the leucorrhoea of
women in order to eliminate a possible infection; or in case of suspicion, push the research
requesting laboratory tests for confirmation of the presumptive diagnosis and management.

IV. Maitriser la technique du contraceptive

However, before inserting a method, we make sure that the client has understood the
advantages and undesirable effects that the method chosen during the pre-insertion counseling
may have.

 Placing of Jadelle

Procedure ;

- Help the client to get on the table

- Ask if she is allergic to anesthesia

- Check that the client has washed and rinsed her arm well

- Explain the steps to the client and encourage her to ask questions

- Choose and place the client's arm on a clean cloth

- Using the model, score points on the arm for each fan-shaped capsule

- Check the presence of sterile instruments

- Open the sterile or high-level disinfected packaging of the instruments

- Open the Jadelle packaging

- Wash your hands thoroughly with soap and water and dry them with a clean cloth or in the
air

- Wear sterile gloves

- Prepare the insertion site by passing an antiseptic solution

- Place a sterile or high-level disinfected cloth on the arm

- Inject the anesthetic (2% lidocaine) subcutaneously

- Check the anesthetic effect before incising the skin

- Make a superficial 2 mm incision with the scalpel just under the skin, or insert the trocar
directly under the skin

- Insert the trocar and the adapted stylet at a low angle with the beveled end upwards while
lifting the skin evenly advance the trocar and the stylet to the mark of the first line

- Remove the chuck

- Load the first capsule using the gloved thumb and index finger keeping one hand below the
trocar to catch the capsule if it falls

- Reinsert the chuck and advance it until there is resistance

- Hold the stylet firmly with one hand and withdraw the trocar from the incision until it comes
to the shaft of the stylet
- Withdraw the stylet and the trocar together, until the mark near the tip of the trocar appears
in the incision (do not withdraw the trocar from the skin)

- Move the tip of the trocar away from the end of the capsule, keeping it away from the trocar

- Redirect the trocar approximately 15° and advance the trocar and stylet to the mark

- Insert the remaining capsules using the same technique

- Palpate the capsules to check that the 2 capsules have been inserted in the shape of a fan

- Palpate the incision to check that the capsules are 5 mm away from the incision;

- Do not remove the trocar from the incision until the last capsule has been inserted

- Remove the operative field and rub the client's skin with an alcohol swab

- Tighten the edges of the incision and close them with a surgical dressing with the sterile
compress

- Dispose of contaminated waste in an airtight container or plastic bag

- Wash hands thoroughly and dry them after removing gloves

- Fill in the register and the client's file with the drawing of the location of the capsules

Post counselling

- Give the client instructions on the care of the wound and give her the appointment for the
follow-up;

- Discuss what to do if the client has problems or side effects after insertion;

- Tell the client that she can ask for the rods to be removed at any time;

- Remind the client that the Jadelle is effective for 5 years

- Tell the client that she can come back to the service at any time for advice or if she wishes to
remove

- Ask the client to repeat the instructions and answer her questions;

- Observe the client for 10 to 20 minutes before sending her home.

Activity carried out: insertion of the jadelle in the clinic

• List of equipment used

- Jadelle + trocar (01)

- Xylocaine 2% (2ml)

- Syringe (01)

- Distilled water (2ml)

- Compress (5 sheets)

- Sterile glove (01)

- Yellow betadine (1 vial)

- Band-aid

- Chisel

- tray

Procedure: preparation of the material for the procedure and the client, we begin by washing
the arm where the insertion will be done with soap and water, then we proceed with the
installation of the woman on the table, we place a clean cloth under the arm then we put on
the sterile gloves using its packaging as a sterile drape under the client's arm.

Prepare the insertion site by passing an antiseptic solution

Using our hands we estimate the place of insertion placing our hand vertically in relation to
the arm of the client so that the auricular note is at the level of the hollow part of the elbow of
the client then we mark the place of insertion at the level where our thumb is.

Inject the anesthetic subcutaneously after diluting 2ml of lidocaine with 2ml of sterile water in
a syringe.

Check the anesthetic effect before inserting the trocar and matching stylet at a low angle with
the beveled tip upwards while lifting the skin steadily advance the trocar and stylet I to the
mark i.e. - say the second line which is marked on the trocar and then the mandrel is removed
to insert one of the rods; we proceed by loading the first capsule using the gloved thumb and
index finger keeping one hand below the trocar to catch the capsule if it falls then we reinsert
the mandrel and we advance it until there is resistance; then hold the stylet firmly with one
hand and withdraw the trocar from the incision until it comes to the stylet handle; the stylet
and the trocar together are withdrawn, until the mark near the tip of the trocar appears in the
incision (do not withdraw the trocar from the skin); then we move the tip of the trocar away
from the end of the capsule, keeping it away from the trocar; redirect the trocar approximately
15° away from the capsule already inserted and advance the trocar and stylet to the mark then
insert the remaining capsule using the same technique from the start.

Then we remove the trocar and the mandrel completely then we palpate the two rods to be
reassured of the insertion at the end we make a surgical dressing at the level of the opening of
the wound made by the trocar.

After the insertion procedure we do post-insertion counseling i.e. we ask him to keep the
wound clean and dry, avoid any trauma to the insertion arm, we remind him of the duration of
the method also we tell him what she must do in the event of a problem, also that she can
come back at any time if a problem arises or in the event of an undesirable effect, without
forgetting that the withdrawal can be done before the expiration period of the method if she
wishes, for example, to conceive .

Analysis: we can show as analysis that the aseptic methods are maintained and that the steps
of insertion of the jadelle are done according to the standards and recommendations
established by the WHO.

 Placing of IUD

- If bimanual and speculum exams are normal, inform client that she is eligible for IUD
insertion and ask if she has any questions.

- Reinsert the vaginal speculum, visualize the cervix and close the speculum.

- Use a compress and an antiseptic solution to clean the cervix and the vagina wait 2
minutes to let the antiseptic solution act.

- By stopping the speculum with one hand and the tenaculum with the other hand, with the
palm of the hand facing upwards, clip the cervix gently horizontally at the 2 and 10
o'clock positions.
- By gently pulling on the tentacle, pass the utero meter through the cervix to the uterine
fundus without however touching the wall of the vagina and the speculum in place; this
procedure will allow us to determine the position of the uterus if it is anterior or posterior.

- Remove the utero meter and read the depth of the uterine cavity on the utero meter.

- Load the T-380A copper without however removing it from its sterile packaging, then
partially open the packaging afterwards put the white wire in the tube inserted then place
the package on a flat surface, slide the packaging underneath arms of the IUD. Hold the
end of the arms of the IUD and push on the insertion tube to help bend the arms.

When the arms touch the sides of the insertion tube, pull the insertion tube away from the
folded arms of the tube.

Remove the insertion tube and push and rotate it to catch the ends of the arms in the tube.

Push the folded arms into the insertion tube to hold them in the tube.

- With the loaded IUD in the sterile package partially open, place the flange at the
corresponding measurement obtained by sounding the uterus. Depress the flange with one
finger to hold steady, and with the other hold steady, and with the other hand slide the
loaded inserter so that the tip of the tube lines up with the tip in the diagram on the board
of white measure.

- Remove the loaded insertion tube without touching anything that is not sterile.

- Hold the insertion tube with your palms facing up and the flange in a horizontal position.
While gently pulling on the tenaculum, pass the loaded insertion tube through the cervix
until the flange touches the cervix or a slight resistance is felt.

- Hold the tenaculum and white stalk still in the hand.

- Release the arms of the IUD using the withdrawal technique: pull the insertion tube
towards you while holding the white rod steady. This will allow the release of the IUD.

- Remove the white rod

- Gently withdraw the insertion tube upwards from the uterus until slight resistance is felt.

- Partially withdraw the insertion tube from the cervical canal.

- With the strings stabilized inside by the partially removed insertion tube, cut the IUD
strings to a length of 3-4 cm and remove the inserter.

- Carefully remove the tenaculum and examine the cervix. If there is bleeding at the
tenaculum puncture site, place a compress over the bleeding site and apply gentle pressure
for 30 seconds.

Observed activity

The insertion of the IUD is one of the activities that we had just the opportunity to observe
due to the reduced entry of clients for the schedule and the fact that the method was not
very much in demand by those we have received.

Materials needed for the procedure

- Copper IUD

- Vaginal speculum

- Sterile glove

- Forceps (pozzi forceps, hysterometer, longuette forceps)

- Sterile compresses

- Yellow Betadine

- Stainless steel tray

- Scissors sims

- Course of the procedure

After verifying the absence of pregnancy and genital infection, and determining the
position of the uterus, the midwife will introduce the IUD, because the examination only
takes a few minutes and is in principle painless. The midwife places the IUD in the
patient's uterus following the steps described above. The IUD ends with a soft nylon
thread, which is cut very short by the doctor after insertion, so as not to interfere,
especially during sexual intercourse.
Patient follow-up

A follow-up visit is given to him within 4 to 6 weeks following insertion to ensure that the
IUD is in place, that there is no abnormality suggesting a possible complication, infection
or expulsion. .

Critical analysis

The insertion of the IUD respects the insertion protocol but we criticize the asepsis
because the forceps used were not sterile and even the process of decontamination by the
chlorine solution was not prepared according to the standards.

 Injection of sayanapress

Sayanapress is similar to other injectable contraceptives, such as depoprovera, but has a

shorter needle that only goes into the skin, not the muscle.

How to administer sayanapress:

- Carefully open the sachet by tearing it at the notch provided for this purpose. Check the
expiration date

- Mix the medicine

- Hold the injector firmly by the needle holder and shake the injector vigorously for at
least 30 seconds

- Do not bend the injector check that sayanapress is mixed and that no liquid is flowing

- If there is a delay between mixing the medicine and the injection, you must repeat the
mixing procedure

- Firmly hold the injector by the needle holder

- Make sure the needle guard is pointing up

- Be careful not to squeeze the tank

- Push the needle cover firmly towards the needle holder until there is no space

- If the space is not completely closed, you will not be able to squeeze the tank during
injection

- Gently pinch the skin at the injection site

- Keep the skin pinched during all this step. This will create a ‘tent’ which will allow the
needle to be inserted

- Insert the needle pointing vertically downwards

- Hold the injector by the needle holder

- Insert the needle into the skin until the needle holder just touches the skin to ensure the
needle is inserted to the correct depth

- Slowly squeeze the tank to inject the medicine (5 to 7 seconds) without sucking

Practical case:

Materials needed for the procedure

Sayanapress

Cotton

Alcohol

Procedure: the counseling has already been done beforehand, we inform the client about
the different injection sites and then we ask her where she feels comfortable. We prepare
the material; in a bean we put an alcohol swab, dry swab and the product injected. We
proceed by mixing the product by shaking it for a few seconds, then we clean the injection
site, most of which was on the outer side of the arm below the shoulder, we pinch the skin
before administering the product then we keep it pinched during the injection then a few
seconds after pushing the contents of the reservoir before releasing it. Finally we do a post
counseling to remind you of the side effects that can occur while on this contraceptive
method, namely:

Change in the menstrual cycle,

Gradual weight gain,

Skin irritation around the injection site

 V. Participer au suivi des clientes et à la prise en charge des effets secondaires
des différentesméthodes contraceptives

A follow-up of side effects is done to each of the clients after insertion of a family planning
method to ensure that the chosen method corresponds to her. The follow-up is done over a
period of three months in this mother-child hospital center.

For the case of jadelle: the first appointment is given 5 days after insertion for the dressing
and to check that the wound is closed, if no complaints the next appointment is for a period of
one month while reminding him that in the event of a problem, he must return to the center
without however waiting for his appointment.

In the event that she comes back with a complaint such as bleeding during the interrogation,
the quantity is assessed by asking the client how much filling she uses per day, and if they are
refilled at the change. We also inquire about the beginning and the regularity is it continuous
or discontinuous. At the clinical examination we take its parameters, we look at the coloring
of the conjunctivae; the paraclinical examination is asked if we suspect anemia after the
clinical examination. If the bleeding is only spotting, counseling is redone regarding the
undesirable effects of the method while reassuring her that the problem can be resolved. What
to do in case of central spotting, we put the client on combined oral pills (microgynon) to
regularize her cycle. If the bleeding does not stabilize and may become a risk of anemia for
the client, the method is stopped and another is offered.

In the case of IUD (non hormal method)

The follow-up of the side effects after insertion of the IUD, we proceeded by an interrogation
aiming to find out if there is a persistence or the appearance of pain, abnormal bleeding or
abnormal leucorrhoea. The frequency, volume and regularity of the bleeding that has occurred
since the insertion was also asked.

VI. Maitriser le processus de gestion des contraceptifs et médicaments essentiels

Essential drugs and contraceptives at the hospital center are managed by the hospital
pharmacy, i.e. the stocks, orders and different types of products are ordered by the pharmacist
in charge of this service.
 VII. Maitriser le processus de prise en charge syndromique des IST

The management of sexually transmitted infections is done either after a gynecological

examination during the installation of a contraceptive method or during the check-up or
follow-up appointment after being put on a contraceptive. The WHO recommends
management of STIs after an etiological diagnosis and not just according to the patient's
symptomatology in order to avoid making a wrong diagnosis, the risk of recurrence of the
infection, or even the possibility of taking unnecessary treatment to the client.

VIII. Activities observed

During our internship there are activities that we could only observe and did not have the
opportunity to practice due to the rarity of cases.

• Insertion of the IUD

• Demonstration of how to use the female condom

- Check the expiry date of the condom. It is marked on the packaging.

- Have it in your hands before you open the package.

- Put yourself in a comfortable position: lying down, sitting or standing with one foot resting
on a chair.

- At the level of the arrow, tear the packaging downwards and carefully remove the condom
(Femidom) from the package, especially if you wear rings and jewellery. Do not use a scissors
knife which could damage the condom.

- Make sure the inner ring is at the bottom of the condom. Hold it by this ring by pressing it
between thumb and forefinger.

- Without releasing it, insert the ring into the vagina and push it as far as possible.

- You can insert your index or middle finger inside the condom to push it further. When the
condom is in place, the outer ring should be outside the vagina. It covers the external
genitalia.

- During intercourse, make sure that your partner's penis penetrates correctly inside the
condom.
- Fémidon adapts to the walls of the vagina and not to the erect penis: it is therefore not
essential to remove it at the end of intercourse. To remove the condom, twist the outer ring to
prevent fluid from leaking out and gently pull it out.

- Tie a knot, put it back in the packaging and throw it in the trash.

During each counseling after installation of a contraceptive method, counseling is done on the
use of condoms as the only dual protection method and its advantage in the prevention of
sexually transmitted infections and the prevention of pregnancy.

IX. Activities not carried out

• Master the process of training, supervision and communication in the family planning
service

Speaking of training in the planning service, it is done through seminars or training on family
planning in order to get in touch with new recommendations. According to the words of the
midwife in charge of the service. This objective is part of the activities not carried out because
we had no opportunity to attend a training during our internship.

• Participate in putting the health of mothers and children in terms of family planning as an
advanced strategy

• Participate in the implementation of the activities of community relays in the field of

contraception

These objectives have not been achieved because the activities in advanced strategy or the
community relays are not done in the health structure.

X. Case Study

This is Mrs. X, 44 years old, resident of her Catholic bride who received her day in the family
planning service for removal and laying of jadelle. The woman says she does not want any
more children because she has eight living children, having had a death, an abortion, she had
twins twice. She and her husband are farmers in the village, she says it is already very
difficult to meet the needs of those who are already there; these are the reasons leading him to
consult and seek family planning services.

Date of consultation 26/02/2022

Mon: Mrs. X
Age: 44 years old

Residence: sa'a

Marital status: married

occupation: farmer

Catholic religion

Contact: xxxxxxxxxx

Reason for consultation: removal and new installation of the jadelle

Date of last period: amenorrhea

Medical history: no known chronic pathology such as hypertension, diabetes, cancer,

thyroiditis or HIV AIDS.

Family history: no parent with a known chronic pathology.

Gynecological history: menarche at 11 years old, irregular cycle, period 4 to 5 days.

Obstetric history: Gravida=8 parity (term=6 premature=0 abortion=1 living child=8) age of
first child=15 years old age of last child=6 years

Vital parameters: TA= 110/68 mmhg weight= 68.4 kg

Physical examination: before starting the physical examination, the client is counseled to
educate her on the need and the importance of this examination.

The woman undress completely then we install her on the examination table in dorsal
decubitus then we start with:

The conjunctivae: colored sclera.

Oral cavity: moist and clean, non-saburral tongue.

Neck: palpate the lymph nodes in order to exclude lymphadenopathy, we also palpate the
thyroid gland in order to eliminate any thyroiditis.

Breasts: palpation of the breasts looking for a nodule.

Abdomen: we palpate the abdomen looking for inflammation of the spleen or liver with a
view to eliminating splenomegaly and hepatomegaly. We also palpate the iliac fossae to look
for inflammation of the tubes at the end of the hypogastric region where we palpate the uterus.
After this abdominal examination we have no suspected abnormalities.

Lower limbs: absence of edema and varicose veins.

Gynecological examination: vaginal examination; vulva clean and healthy, vagina no vaginal
discharge, no other peculiarities.

Conclusion: method chosen implants

jadelle prescribed method

CAT: pre-insertion counseling

Materials needed for both procedures:

- Jadelle + trocar (01)

- Xylocaine 2% (4ml)

- Syringe (02)

- Distilled water (4ml)

- Compresses (10)

- Sterile glove (02)

- Yellow betadine (1 vial)

- Band-aid

- Chisel

- Two microhalstead clamps with and without curve

- Scalpel blade (1)

- Tray (1)

- A bean

Procedure: we start by washing the arm where the insertion will be done,

We install the woman on the table

The arm is disinfected with yellow Betadine

Injection of local anesthesia

We make an incision a few millimeters from the rods to remove them

Then we make a compression using a compress soaked in Betadine to reduce the bleeding.

For the insertion we shifted about 3-5 cm from the point of withdrawal to insert the next
jadelle. For the insertion we used a new pair of sterile gloves, we inject again the anesthesia
and we insert the rods in the shape of a "V" then we make a compression bandage.

At the end of the procedures, post-insertion counseling is given to the client, the appointment
given after four days for the dressing.

Medical prescription: cloxacillin 500mg 2 capsules twice a day for five days.

Ibuprofen 400mg one tablet three times a day for three days

Cotipred 20mg two tablets a day fasting for five days.

Microgynonun tablets daily for 30 days in case of spotting.

XI. Related activities

In parallel we worked in prenatal consultation where we practiced the following activities:

- reception and installation of pregnant women

- questioning pregnant women coming for CPN1 and follow-up visits

- we did the physical examination of the women,

- measure menstruation

- we made the mass educational talk to pregnant women (themes relating to the importance of
prenatal check-ups, the prevention of mother-to-child transmission, and the plan for
childbirth)
 CHAPTER 3 : ANALYSIS OF DIFFICULTIES AND APPRECIATION

 DifficulTIES faced

During our internship we did not face several difficulties because we were well received
by our internship supervisor who is the midwife in charge of planning. The major
difficulty was the frequency of clients requesting family planning services. also the
different activities carried out in this department, which made it difficult to achieve the
internship objectives. Nevertheless with the cases received we were able to observe and
practice on certain cases.

A limitation to this service is the awareness of the population because a service cannot be
requested if the population is not informed even less informed. This could be due to the
fact that there is only one person in charge of the planning making the service less
dynamic.

 Suggestions

- The hospital could assign other staff, even from the prenatal consultation, being the
service attached to the one in the centre.

- Diversify the themes of educational talks by also emphasizing the family planning
service

- We also suggest that women returning for postpartum consultations can also go through
the planning department for an educational talk

- The service will also be able to organize health campaigns even once a year to make the
planning service lively and dynamic as well known to the population

CONCLUSION

In general, the internship took place in very good condition, we were well received by the
staff who were well supervised during this internship period at the Chantal BIYA
foundation. This internship was edifying because we were able to acquire a lot of
knowledge, especially in the field of practice
 References

1) national health accreditation and evaluation agency, strategies for choosing

contraceptive methods for women. HAS; Dec 2004.

2) Frances E Casey, MD, MPH, Virginia Commonwealth University Medical Center Sept
2018.

3) Power J, French R, Cowan F. Subdermal implantable contraceptives or other implants

as effective methods for preventing pregnancy. Cochrane database of systematic reviews
2007; Issue 3. No.: CD001326; DOI: 10.1002/1465858.CD001326.pub2.

4) WHO Training Modules for Syndromic Management of Sexually Transmitted

Infections 2nd Edition.
 NURSING CARE PLAN

DIAGNOSIS OBJECTIVES INTERVENTIONS EVALUATION

Risk of That the  • Educate Mrs. X about
potential bleeding is not the undesirable effects
bleeding a fatality for of the proposed
Mrs. X method.
 • Explain to Mrs. X
how to assess bleeding,
also how to assess
anemia (weight loss,
intense fatigue, dry
mouth) and we asked
her to come back to the
center if her symptoms
occur.
 • Take the prescribed
pills in case of
prolonged spotting for
more than a month.
Risk of That Mrs. X  • Educate Mrs. X on The insertion
infection at the can keep the hygiene and the site was clean
insertionsite wound clean importance of keeping and the wound
until the day of the site clean and dry. closed.
 • Take medication as
the dressing
prescribed
 • Explain to Mrs. X the
importance of honoring
her follow-up
appointments
 PHARMACOLOGICAL TABLE

FAMIL NAME AND COMME CLASSE INDICATION/ ROUTE D’ posol cout

Y FORM RCIAL THERAPE CONTRE- ADMINIST ogie
NAME UTIQUE INDICATION RATION
Cycline Doryx, doxy100, Doxycycli Anti La syphilis, orale 1cp 200F
vibramycin ne bactérien à chlamydioses, par cf
calcium large spectre gonocoque, jour
des, prevention des penda
Infections infections nt 10
Comprime opportuniste Pendant la jours
sécable 100 et et co- grossesse, en
200mg infections cas d’allergie
au cycline
Anti- Pas de forme Ovumix Antimicrobi Traitement des Intra 1 2876
ifectieux générique en vaginites vaginale ovule Fcf
, specifique et au
antisepti non specifique, couch
ques es trichomonas, er
imidazol leucorrhe de penda
es n’importe quel nt 10
cause jours
Forme Contre
galenique : indication :
comprime premier
vaginal trimestre de
200mg/100mg/10 grossesse,
0 000UI/ 3mg pendant
l’allaitement
Implant Levenorgestrel Jadelle Contraceptif Espacement et Sous- Deux 1150
hormonal control des dermique à bâton Fcf
naissances la face net de
Bâtonnet de 75 Allergie au antérieure de 75mg
mg chacun levenorgestrel, l’avant-bras chacu
saignement n
anormal, cancer
des seins cas
suspecter ou
confirmer,
hypertension
artérielle,
maladies
 thrombotiques
Contrace Microgyn Control et Orale 1 350F
ptif oral on espacement de cp/jo cf
naissance, ur
hemorragies de penda
privation, nt 21
l’ebdometriose jours
Comprime Personne a
pelicule de risque de
0.15mg de developerdes
levenorgestel+0.0 thrombose
3mg de veineuse,
ethinylestradiol
Penicilli Cloxacillin Aclox Beta-lactam
Infection Orale 1g 250F
nA antibacterial
urinaire, x2/j cf
: penicillin
septicemie , les penda
resistant
infections des nt
tissues mou de 5jour
la peau s
Gélule 250 et Les patients
500mg hypersensibles
aux pénicillins
Analgési Ibuprofène Espen- Anti- Douleur sévère Voie orale 1cp
que, anti 400 inflammatoi ou modéré, après le x3/jo 100F
inflamm re non dysménorrhée, repas ur cf
atoire, stéroïdien, lombalgie, penda
anti analgésique douleur post nt 3
pyrétiqu opératoire jours
e Comprimé Dysfonctionne
secable de 400mg ment renale,
hypersensible
aux AINS,
lactation et
grossesse
Contrace Methylparahydro Sayanapre Méthode de Prévention de Sous-cutanée Une 250F
ptif xybenzoate ss contraceptio l’ovulation, dose cf
hormona n féminin a contraceptif a uniqu
le long-terme courte durée, e
Suspension Hypersensible pour
injectable 104 aux composants une
mg/0,65 ml du produit, durée
grossesse, cas de 12
confirmé ou semai
suspect de nes
cancer des seins
ou des organes
génitales,
maladie
thromboembolit
ique