PLANA: MANAGEMENT PROTOCOL FOR INITIAL PRE-NATAL CHECK-UP (Flowchart No. 28) 1. o Dcternune patient's knowledge on bow to take care of herself during pregnancy. 2. 0 Based on 1. 0, teach the patient about proper nutrition. 2. 1-Importan ce of well-balanced, good and nutritious meals (e. g., food sources of iron and p.-otein for hemoglobin production). 2. 2 Stress the inclusion of proper nutrition in pregnam.-y (e. g., inci:eased intake of food sources of minerals like calcium for fetal bone developm ent; avoid high intake of sugar and salt). 3. 0 Based on 1. 0, advise tl,e patient to have enough rest and s1eep and to perform prenatal exercises to prevent or n1inimize discomforts like low back pain and to learn the proper breathing and "bearing down" techniques (start at last trimester for "bearing dowu" exer~-:ises). 4. 0 Advise the patient to take a bath daily and to have daily bowel movement. 5. 0 Advise her to stop smol<lng, drinking alcoholic beverage, and not to take just any over-the-counter me<licine or herbal medicine unless prescribed by the doctor. 6. o Advise the patient to use proper clothing: 6. 1 Use comfortab le, loose titting clothes. 6. 2 Avoid usin?;tig ht brassieres, garter belts or "bigkis". 6. 3 Use low-hee1e d comfortab le shoes. 7. 0 Advise the patient to do the following to relieve minor discomforts in pregnancy. 7. 1 Por nausen nnd vomiting (morning sickness): 7. 1. 1. 1 fave a light bre;,kfast (crackers, unbuttered toasted bread, etc. ) 7. _1. 2. Eat sm:ill frequent meals (around five to six times a day) instead of three full meals, if tl1e symptom occurs later in the day. 7. 1. 3. Avoid fatty or oily foods. 7. 2 For ''he:u·thum.. : 7. 2. 1. Hove small frequent mca1s. 7. 2. 2-. no not lie do"''" immedia tely after eating. 7. 3 For co11stipatio11: 7. 3. 1 Increase fluid intake preferably in the form of milk, soup or juice. 7. :;. 2 Eat plenty ofvcgetables and raw fruits especially ripe p:apaya. 7-4 For varicosit;i es and hemorrhoids: 7. 4.-1. Raise or elevate the legs at least twice a day. 7. 4. 2. When lying down. lie sideways (either left or right side) with the top leg forw;u·d thus placi_ng the weight of the baby on the bed. 7. 4. 3. Do leg raising exercises. 7. 4-4. Do not stny in one position for a long time. 7. 4. 5. Use support or eh1s Hc stocking5, if necessary, for varicose veins. 7-4. 6. Do knee-chest position if there are hemorrhoids. 7. 5 For incre<1sed non-fo U-1 smelling mucoid vaginal discharge: 7. 5. 1. Take a bath daily. 7. 5. 2. Wash genital area frequently using mild soap and water or with 251 