TEST RESULTS NORMAL RANGE CLINICAL SIGNIFICANCE

Red Blood Cell 4.3 10˄12/L 4.0 – 5.5 10˄12/L Within normal limits- This indicates that the

patient does not have erythrocytosis (if the red

blood cell is high) and other conditions such as

anemia, bone marrow failure, malnutrition, etc.

Hemoglobin 137 g/L 120 -160 g/L Within normal limits- This indicates that the

patient is not anemic which is caused by low red

blood cell count. The patient is also not

experiencing any blood disorders like

polycythemia vera, living at a high altitude,

smoking and dehydration.

Hematocrit 0.39 volume % 0.36 – 0.46 volume % Within normal limits- This indicates that the

patient is not anemic; does not have a large number

of white blood cells due to long term illness,

infection or a white blood cell disorder such as

leukemia or lymphoma; does not have vitamin or

mineral deficiencies; did not experience recent or

long-term blood loss. The patient is also not

33
 dehydrated and does not have lung or heart

disease.
MCV 88.9 fL 78 – 102 fL Within normal limits- An MCV blood test

measures the average size of your red blood cells,

also known as erythrocytes. From the results of the

patient’s laboratory test, there are no signs of blood

disorders, vitamin deficiency, or medical condition

which are only a result if the red blood cells are too

small or too large.

MCHC 33.5 g/dL 32.0 – 35.0 g/dL Within normal limits- MCHC stands for mean

corpuscular hemoglobin concentration. It’s a

measure of the average concentration of

hemoglobin inside a single red blood cell. The

patient’s result is within normal limits since she

does not have a condition where red blood cells are

fragile or destroyed, leading to hemoglobin being

present outside of the red blood cells. The patient

is also not anemic.

34
 White Blood Cell 12.9 10˄9/L 5.0 – 10.0 10^9/L High- A high white blood cell count may indicate

that the immune system is working to destroy an

infection. It may also be a sign of physical or

emotional stress. People with particular blood

cancers may also have high white blood cells

counts.
Neutrophils 73 % 40 – 70 % High- The increase in the number of the

neutrophils is due to decrease the activity of their

apoptosis mechanism during pregnancy. During

labor, there is further delayed in the neutrophil

apoptosis which lead to further increase of the

white blood cell count after normal vaginal

delivery.
Lymphocyte 21 % 20 – 45 % Within normal limits- This indicates that the

patient does not have serious conditions such as

lymphocytosis which is a serious condition when

lymphocytes are high, and lymphocytopenia which

is when the patient has low lymphocytes.

35
Monocyte 5% 0 – 10 % Within normal limits- This indicates that the

patient is not experiencing monocytosis, which is

when the monocytes are high, in response to hronic

infections, in autoimmune disorders, in blood

disorders, and in certain cancers. She is also not

experiencing monocytopenia which is low

monocyte level.
Eosinophil 1% 0–6% Within normal limits- This indicates that the

patient does not have eosinophilia, a high level of

eosinophil condition which is due to asthma,

allergies, eczema, etc. The patient is also not

intoxicated by the alcohol so there is no

abnormally low eosinophil count.

Basophil 0% 0–1% Within normal limits- This indicates that the

patient is not experiencing infections, severe

allergies, or an overactive thyroid gland which is

due to basopenia. There is also no sign for chronic

inflammation in the body which is due to a high

36
 basophil count in the body.
Platelet Count 221 10˄3/uL 150 – 350 10^3/uL Within normal limits- This indicates that the

patient does not have conditions such as low

platelet count known as thrombocytopenia and

high platelet count which known as

thrombocytosis.
MPV 10 fL 8 – 12 fL Within normal limits- The results for MPV depend

on the results for platelet count. Since the patient

have shown normal results for platelet count,

therefore the MPV result is also normal.

37
E. DRUG STUDY
MECHANISM OF ACTION / SIDE-
DRUG
EFFECT
MECHANISM OF ACTION
Generic Name: oxytocin Stimulates uterine smooth muscle,
producing uterine contractions similar
Brand Name: Oxymed to those in spontaneous labor.
Stimulates mammary gland smooth
Classification: hormones muscle, facilitating lactation. has
vasopressor and antidiuretic effects.
Route: intramuscular
SIDE EFFECTS
Frequency/Dosage: 10 units after  Coma and seizures;
delivery of the placenta  Hypotension;
 Increased uterine motility; painful
contractions, abruption placentae,
decreased uterine blood flow,
hypersensitivity
INDICATION /
CONTRAINDICATION
INDICATION
Induction of labor at term. Facilitation
of threatened abortion. Postpartum
control of bleeding after expulsion of
the placenta.
CONTRAINDICATION
Contraindicated in patients
hypersensitive and has anticipated
nonvaginal delivery.
Use cautiously in patients who are in
the first and second stage of labor.
NURSING CONSIDERATIONS
 10 rights of the patient;
 This drug occasionally causes water
intoxication. Monitor patients for signs
and symptoms (drowsiness,
listlessness,confusion, headache, anuria)
and notify physician or other health care
professional if they occur;
 Do not administer oxytocin
simultaneously by more than one route;
 Magnesium sulphate should be available
if needed for relaxation of the
myometrium.
38

Generic Name: cefuroxime
Brand Name: Ceftin
Classification: anti-infectives
Route: PO
Dosage: 500 mg/tab
Frequency: BID
MECHANISM OF ACTION
Bind to bacterial cell wall membrane,
causing cell death.
Therapeutic Effects: Batericidal action
against susceptible bacteria.
Spectrum: Active against
Borreliaburgdorferi.
SIDE EFFECTS
 Seizures (high dose);
 Pseudomembranous colitis,
diarrhea, cramps, nausea,
vomiting;
 Rashes; Allergic reactions
including anaphylaxis and serum
sickness.
INDICATION
Treatment of the following infections
caused by susceptible organisms:
miningitis, gynecologic infections,
lyme disease, otitis media, septicemia,
perioperative prophylaxis.
CONTRAINDICATION
Contraindicated in: Hypersensitivity to
cephalosporins; Serious
hypersensitivity to penicillins
 10 rights of the patient;
 Observe patient for signs and symptoms
of anaphylaxis. Discontinue the drug
and notify physician or other health care
professional immediately if these
symptoms occur. Keep epinephrine, an
antihistamine, and resuscitation
equipment close by in the event of an
anaphylactic reaction;
 Instruct patient to notify health care
professional if fever and diarrhea
develop, especially if stool contains
blood, pus, or mucus. Advise patient not
to treat diarrhea without consulting
health care professional.
39
Generic Name: mefenamic acid
Brand Name: Ponstel
Classification: nonsteroidal anti-
inflammatory drugs (NSAIDs)
Route: PO
Frequency: PRN TID
Dosage: 500 mg/tab
MECHANISM OF ACTION INDICATION
It is used to ease pain; used to ease For relief of mild to moderate pain in
painful period (menstrual) cycles; may patients ≥ 14 years of age, when
help reduce swelling by lowering levels therapy will not exceed one week (7
of prostaglandin, a hormone-like days); for treatment of primary
substance that usually causes dysmenorrhea.
inflammation.
CONTRAINDICATION
SIDE EFFECTS  Contraindicated in the following
 Stomach pain; patients:
 Nausea;  Known hypersensitivity (e.g.,
 Vomiting; anaphylactic reactions and serious
 Heartburn; skin reactions) to mefenamic acid
 Constipation; or any components of the drug
 Diarrhea; product ;
 History of asthma, urticaria, or
 Rash;
 Dizziness. other allergic-type reactions after
taking aspirin or other NSAIDs.
Severe, sometimes fatal,
anaphylactic reactions to NSAIDs
have been reported in such patients;
* In the setting of coronary artery
bypass graft (CABG) surgery.
 10 rights of the patient;
 Observe patient for signs and symptoms
of anaphylaxis. Discontinue the drug
and notify physician or other health care
professional immediately if these
symptoms occur. Keep epinephrine, an
antihistamine, and resuscitation
equipment close by in the event of an
anaphylactic reaction;
 Instruct patient to notify health care
professional if fever and diarrhea
develop, especially if stool contains
blood, pus, or mucus. Advise patient not
to treat diarrhea without consulting
health care professional.
40
Brand Name:Ferralet 90 MECHANISM OF ACTION INDICATION  10 rights of the patient;
Multivitamin and iron product used to Multivitamins with iron are used to  This medication is best taken on an
Generic Name: multivitamins with treat or prevent vitamin deficiency due provide vitamins and iron that are not empty stomach 1 hour before or 2 hours
iron to poor diet, certain illnesses, or during taken in through the diet. They are also after meals. Take with a full glass of
pregnancy. Vitamins and iron are used to treat iron or vitamin water (8 ounces or 240 milliliters) unless
Classification: dietary supplement important building blocks of the body deficiencies caused by illness, your doctor directs you otherwise;
and help keep you in good health. pregnancy, poor nutrition, digestive  If stomach upset occurs, you may take
Route: PO disorders, and many other conditions. this medication with food;
SIDE EFFECTS CONTRAINDICATION  Avoid taking antacids, dairy products,
Dosage:1 tab  Constipation, diarrhea; The following conditions are tea, or coffee within 2 hours before or
 Nausea, vomiting, heartburn; contraindicated with this drug; after this medication because they may
Frequency: OD  Stamch pain;  iron metabolism disorder causing decrease its effectiveness;
 Black or dark—colored stools or increased iron storage
urine;  increased bodily iron from high red  Do not lie down for at least 10 minutes
 Temporary staining of teeth. blood cell destruction after taking the tablets or capsules.
 hemolyticanemia
 ulcer from stomach acid
 burning stomach
 ulcerated colon
 several blood transfusions
 Diverticular Disease
 Allergies:
 Ascorbic Acid (Vitamin C)
 Iron Complex
 Folic Acid Containing Drugs
E. NURSING CARE PLAN
CUES NURSING GOALS AND NURSING INTERVENTION IMPLEMENTATION EVALUATION

41
 DESIRED
DIAGNOSIS
OUTCOME
SUBJECTIVE Risk for fluid At the end of 1 1. Assess color, odor, consistency, and - Assessed color, odor, GOAL MET
DATA: volume deficit hour, the patient amount of vaginal bleeding. Weigh consistency, and Within our care, the
“Awn pa din dugo related to will maintain fluid pads to assess amount of bleeding. amount of vaginal client:
magguwa kakuh” maternal balance as - Provides information about active bleeding. Weigh
(There is still blood bleeding evidenced by stable bleeding versus old blood, and to pads to assess Has no further vaginal
coming out from me/ secondary to vital signs, good amount of bleeding. bleeding;
measure amount of blood loss.
my part) as verbalized disrupted uterine contractility Maintained adequate
2. Assess skin color, moisture, turgor, and
by client. placental as well as skin - Assessed skin color, fluid balance as
implantation. turgor. capillary refill. moisture, turgor, and evidenced by stable vital
OBJECTIVE DATA: - Provides information about blood capillary refill. signs.
Vaginal bleeding volume.
Unable to rise on bed 3. Monitor vital signs frequently Has good uterine
- Early recognition of possible adverse - Monitored vital signs contractility; and good
T= 36°C
frequently skin turgor.
RR= 21bpm effects allows for prompt
BP=120/60 mmHg intervention.
4. Massage the uterus to promote
involution. - Massaged the uterus
- To help expel blood clots, check the to promote
tone and ensure contraction of the involution.
uterus to control and prevent
excessive bleeding.
5. Administer oxytocin medication as per - Administered
oxytocin medication
physician’s order
as per physician’s
- to promote contraction and prevent
order
further bleeding.

SUBJECTIVE Risk for Within our 1 hour - Performed perineal care GOAL MET
infection span of care, the 1. Perform perineal care while observing while observing proper Within our 1 hour span of
DATA:
related to client will:

42
Client verbalized: 1. Not exhibit aseptic technique care, the
“byah masakit inadequate any signs and proper aseptic technique client:
hibalun in siki ku… primary symptoms of - to prevent infection to the area and - Noted signs and
ha tungud lawman sin defense infection such inhibit cross contamination symptoms of fever, Did not manifest any
hitaku” (It is painful (broken skin as fever and (Hadwen,2010). signs and symptoms of
pallor and chills
to move my legs… integrity) chilling 2. Note signs and symptoms of fever, infection as evidenced by
somewhere in my 2. Free of pallor and chills
- Monitored vital signs maintained normal vital
inner thighs) purulent - to assess if infection is occurring signs (T = 36C) and
3. Monitor vital signs especially especially the
drainage or absence of purulent
temperature temperature
erythema discharge from incisions.
OBJECTIVE DATA: 3. Identify - unusual elevation in temperature T=36C
Normal Spontaneous interventions might indicate infection. Ex. Acknowledged the
Vaginal Delivery to Hyperthermia/ chillings (Doenges, importance of proper
Episiotomy area is prevent/reduc M. E., Moorhouse, M. F., &Murr, A. - Inspected the drainage at perineal cleaning in
swollen and reddish e risk of C., 2008). the incision site and consideration with
in color. infection 4. Inspect the drainage at the incision site lochia of the client infection prevention
4. Verbalized and lochia of the client
understanding - purulent drainage is a sign of - Imparted knowledge as Was able to verbalize an
of individual infection to why and how understanding of the risk
risk factors 5. Impart knowledge as to why and how infection is likely to factors
infection is likely to happen happen
- give the client the idea on the
causative factors on infections - Taught the mother about
formation the importance of proper
6. Teach the mother about the importance perineal cleaning
of proper perineal cleaning
- perineal area should be cleansed well
to prevent growth of microorganisms
(Hadwen, 2010).
- Administered anti-
infective medication as
7. Administer anti-infective medication as per physician’s order

43
 per physician’s order
- drug therapies for these
complications include anti-infective
agents to treat maternal infection

SUBJECTIVE Altered Within 1 hour span - Assessed the level of GOAL MET
Comfort: of our care, the 1. Assess the level of pain experienced pain experienced by
DATA: Within 1 hour span off
by the client utilizing the pain scale client utilizing the pain our care, the
Client verbalized: Pain related to client will:
- assessing the pain level experienced scale
“Masakit ha tungud tissue trauma 1. Report client:
by the client determines her
tahi ku“ secondary to reduction of Reported reduced pain
capability to comply with other - Monitored vital signs perception as having a
(It’s painful around right normal pain
interventions
my stitches) spontaneous 2. Patient will be especially pulse rate, numeric value of 3
Ex. ability to perform normal task such
vaginal able to cope respiratory rate, and
as eating, breastfeeding and dressing
OBJECTIVE DATA: delivery with pain blood pressure Able to perform
2. Monitor vital signs elevation of pulse
Facial grimacing is 3. Exhibit BP= 120/60 mmHg diversional activities
rate, respiratory rate and blood

44
evident absence of pressure indicates presence of pain; RR= 21 bpm
Eyes are closed as 4. facial - Serves as comparison from previous PR= 90 bpm Able to exhibit minimal
observed grimacing measurements thus determine any pain grimacing
Moaning can be heard 5. Manifest improvement or further deterioration - Provided comfort
from the patient normal RR of the client’s condition measures such as hot sitz Breastfed the newborn
Narrowed focus is ( 12-20 bpm) 3. Provide comfort measures such as hot bath, cold compress, Able to demonstrate
evident (reduced 6. Verbalize and sitz bath, cold compress, backrub, backrub, and therapeutic proper massaging of the
interaction with demonstrate and therapeutic touch touch uterus
people) method - To provide nonpharmacologic pain PR=90bpm
Rated pain as 5 in a that provide management; To cleanse, relax and RR= 21bpm
scale of 1-10, 1 as relief increase circulation to the area; to BP= 120/60mmHg
- Provided diversional
the lowest and 10 assist in healing; and to provide relief
activities such as ankle
as the highest from discomfort.
pumping, active lower Verbalized “gimamgam
4. Provide diversional activities such as
extremity ROM, and na raisab in sakit amun
ankle pumping, active lower extremity
walking. tyabangan mu aku mag
ROM, and walking.
- To promote circulation, prevent napas maraw iban
venous stasis and pressure on the - manaw”
Encouraged the use of
operative site.
relaxation technique (the pain subsided when
such as deep breathing you helped me breathe
5. Encourage the use of relaxation well and walk)
technique such as deep breathing and and imagery.
imagery
- May help decrease pain perception
- Advised mother to
by interrupting the conduction of
breastfeed to promote
nerve pain impulse
involution.
6. Advise mother to breastfeed to
promote involution.
- Demonstrated proper
massaging of uterus
7. Demonstrate proper massaging of the
uterus
45
 - to ensure contraction of the uterus - Administered
8. Administer medications for pain as medications for pain as
per physician’s order per physician’s order
- Treatment approaches to chronic pain
include pharmacological measures,
such as analgesics, antidepressants
and anticonvulsants

46