Case Study On Preterm Labor

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CRITERIA
Content:
I. Introduction 5%
II. Assessment 30%
A. Data
1. Demographic
2. OB
B. History
1. Past
2. Family
3. Present
C. Physical Assessment
III. Management
A. Medical Management 20%

B. Nursing Theory 5%
C. Nursing Care Plan 30%
IV. Reference 5%
V. Format 5%
_____________
TOTAL = 100%
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TABLE OF CONTENTS
CRITERIA.....................................................................................................................................2
TABLE OF CONTENTS..............................................................................................................3
I. INTRODUCTION......................................................................................................................4
II. OBJECTIVE.............................................................................................................................5
General Objective:...................................................................................................................5
Specific Objectives:.................................................................................................................6
III. ASSESSMENT.......................................................................................................................6
A.) Data.....................................................................................................................................6
Demographic Data...............................................................................................................6
B.) History.................................................................................................................................9
III MANAGEMENT.....................................................................................................................24
I. INTRODUCTION
Delivery room nursing is the branch of medicine that deals with the care of
women and infants before, during, and after birth. In delivery room nursing,
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mothers and children are monitored, provided with the intrapartum and
postpartum care as well as being educated about the care towards newborns.
Among the cases that we encountered, we chose JMP, a 30-year old
female to be the subject of this case study since her case is related to Delivery
Room cases, primarily preterm labor.
The length of a normal, full-term pregnancy is 40 weeks. Preterm labor
develops when the uterus begins having contractions prior to 37 weeks
gestation. The period of gestation is one of the most important predictors of an
infant’s subsequent health and survival. Preterm delivery, defined as delivery
before 37 weeks of completed gestation (259 days), it is a major cause of
neonatal morbidity and mortality. Despite extensive research, preterm birth still
accounts for 5–10% of all deliveries in developed countries and rates are on the
increase.
According to WHO (2019), More than 60% of preterm labor and preterm
births occur in Africa and South Asia, but preterm birth is truly a global problem.
In the lower-income countries, on average, 12% of babies are born too early
compared with 9% in higher-income countries. Within countries, poorer families
are at higher risk. There are 10 countries with the greatest number of preterm
labor leading to preterm births which includes India and China as the highest.
According to Maternal and Newborn Health Disparities – UNICEF, in the
Philippines, the main causes of the 30 % of neonatal deaths in 2015 were due to
early onset of labor by the mother wherein it lead to premature birth. The
Philippines Ranks at Number 8 with a number of 348 900 (2·3% of the global
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total), preterm birth rate of (14·9% of livebirths) and a number of 2 344 154 live
births (1·7% of global total).
As mentioned above, we chose patient JMP, a 30-year old from Labor
room Ward on room 253-5 to be the subject of our case study because we found
her case interesting and we believe that we could learn a lot from her condition
given that we could relate it to our current concept.
This case study involves the implications to nursing education, practice,
and research. In nursing education, this case study will help us stretch our
knowledge on the said condition of the mother and how the condition will be
treated and attended. In relation to the nursing practice, studying this case will
enhance our skills as we provide care and assistance to the patient. In nursing
research, this case study will serve as a guide in conducting research about
preterm labor which can be very helpful to others by providing necessary
information about the condition.
II. OBJECTIVE
General Objective:
At the end of this four-week rotation of delivery room nursing in San Pedro
Hospital, the students will learn about the concepts of delivery room nursing
specifically maternal and fetal complications by providing proper management to
be rendered in delivery room patients.
Specific Objectives:
Specifically, the student nurses aim to:
a) Choose a pregnant patient with a present complication;
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b) Collect and record clients’ demographic and obstetrical data;

c) Conduct an interview and ask client’s past, present and family health
history;
d) Assess client base on Gordon’s functional health pattern;
e) Conduct a cephalocaudal physical assessment;
f) Rationalize the etiology and relevance of the diagnostic tests that the
client will has;
g) Present the medications given and formulate a drug study each of the
medications;
h) Identify and prioritize the appropriate nursing care plans that should be
done to the client;
III. ASSESSMENT
A.) Data
Demographic Data
Patient name: JMP
Home address: Unit 1916 Tower 2, Avida Condominium
Birthday: April 24, 1990
Age: 30
Birthplace: North Cotabato
Religion: Roman Catholic
Gender: Female
Civil status: Married
Ordinal rank: Eldest
Nationality: Filipino
Mother: Freddie Munoz

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Father: Leonila Munoz
B. Clinical Data
Reason for Admission: for Neuroprotection
Date & Time of Admission: March 01, 2020 at 1:50 pm
Admitting Impression: G1P0, 32 3/7 weeks in AOG via USD, Small for
Gestational Age (SGA) fetus, Gestational Diabetes Mellitus (GDM)
Ward/Room/Bed number: St. Mary 262-1
Attending Physician: Dr. Palabyab
Date of Discharge: N/A
C. Obstetrical Data
Menarche: 13 years old
Menstrual Cycle: Irregular (2 to 3 months x 7days) consumes 7 pads per
day
GPA: G1 P0
LMP: June 25, 2019
EDC: April 01, 2020
06 25 19
-3 +7 +1 Naegels Rule
1(whole month)
03 32 20
-31(days for march)
__________________
04 1 20
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FUNDIC HEIGHT: 28 cm
McDonald’s Rule: FH / 4
28/4
= 7 months
Johnson’s Rule: (FH-11) x155
(28-11)X 155
= 2635 grams
AOG: 34 weeks and 3/7 days @
I.E: closed cervix
FHT: 130 Bpm
Speculum Exam: whitish cup-like adherent to side walls.
The last menstrual period (LMP) was on June 25, 2019, age of gestation (AOG)
of 34 3/7 weeks, estimated date of confinement (EDC) on April 1, 2020 and a
fundic height of 28 centimeters. With Gravida 1, Parity 0 and Abortion 0 or prim
gravida.Patient was not able to have the tetanus toxoid during her pregnancy but
had her prenatal visits less than 5.
B.) History
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Family Health History
Our patient is J.M.P., she is diagnosed with preterm labor and gestational
diabetes. She is married to J.P. and has no children yet. The both parents of
J.M.P. has no known illness and is still alive.
On her maternal side, she has an aunt that died due to diabetes mellitus.
All the other siblings of her mother have no known illnesses as well as her
grandparents.
On her paternal side, her father has 6 siblings one of his siblings has
breast cancer and died. Her grandmother was diagnosed of kidney failure and
died. All the other family members has no known illnesses
Past Health History
Mrs. JMP was born via normal spontaneous vaginal delivery. She was
born at term at a hospital somewhere in North Cotabato. She was fully

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immunized child receiving 3 doses of DPT, 3 doses of OPV, 3 doses of Hepatitis
vaccine and 1 dose of measles vaccine. Mrs. JSM does not have any history of
hospital admissions nor past surgical procedures. With regards to the patient’s
health history, she had mumps, chickenpox and urinary tract infection when she
was a child. She also experienced common illnesses such as fever, colds, and
cough once or twice a year and was treated at home. She was given with
paracetamol for fever and Neozep for colds. She had no allergies. She had her
menarche when she was 13 years old with a regular menstrual cycle, a
frequency of 4 to 5 days and can consume 3 to 4 pads but not fully soaked with
blood. She usually experiences dysmenorrhea during every second day of her
menstruation. She did not indulge in drinking alcoholic beverages nor smoking
cigarettes as well as any form of drugs.
Present Health History
Last February 26, 2020, three days prior to admission, Mrs. JMP went for
a routine check-up with her attending physician which ultrasound was done
revealing fetus that is small for gestational age and fetal cardiac anomalies as
verbalized. She was then referred to a specialist and was advised for an
admission for neuroprotection and monitoring. With this, it prompted her
admission at San Pedro Hospital last February 28, 2020 and was then noted to
have premature uterine contraction with an AOG of 34 weeks. EFM monitoring
done with good variability and mild to moderate contraction. Upon IE the cervix is
still closed.
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Obstetrical History
Patient JMP had her first menarche when she was 13 years old. She had
a regular menstrual cycle lasting for 4-5 days consuming 3-4 pads per day. She
is using calendar method as a birth control. This is her first pregnancy, G1P0 and
her last menstrual period was June 25, 2019. As computed, her Expected date of
confinement would be on April 1, 2020. Her Age of gestation is 34 weeks and 3/7
weeks via ultrasound. She stated that she undergone
C.) Physical Assessment
General Survey
This physical assessment was conducted last march 2, 2020 to a 30 year
old woman, at Labor Room high risk, bed 1. Patient was lying on bed, awake,
conscious and coherent; not in respiratory distress and was wearing clean
hospital gown. With an intravenous fluid of PNSS 1 Liter to run at KVO rate
infusing well at Left metacarpal vein. She has and mesomorph body built and is
well groomed. She is cooperative and purposeful in her interaction with others.
Patient established good eye contact when conversing with the group. Speech is
clear and culturally appropriate. She also gives appropriate responses both
verbally and non-verbally to the questions.
 Vital Signs
Vital Signs Normal Range Actual

Temperature 36.5-37.5 36.4
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Pulse Rate 60-100beats per minute 84 beats per minute

Cardiac Rate 60-100beats per minute 85 beats per minute
Respiratory Rate 16 – 20 cycles per minute 25 cycles per minute
Blood Pressure 110/70 – 130/90 mmHg 112/65mmHg
 Fetal heart Beat

With an FHT of 146 found on left lower quadrant; regular and strong.
 Uterine Contractions
With mild to moderate uterine contractions @ 50 seconds duration at 3-4
min interval
 Skin
The patient has a fair complexion. Her skin is warm to touch, slightly moist
and smooth. Generally, uniform in color except for the areas exposed to sunlight.
No lesions, skin abrasions, and scars noted. She has a good skin turgor.
 Nails
Nails are well trimmed and no nail polish. Fingernails have convex
curvature and a diamond shape was seen when the fingernails of both right and
left thumbs were joined together (Schamroth’s technique). The patient’s nails on
both hands and feet are smooth with vascular and pinkish nail beds and intact
epidermis. The patient has a capillary refill time of less than 2 seconds.
 Head
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The patient’s head is normocephalic. Skull is symmetrical and nodules or
masses and depressions are not noted. She has long, black, evenly distributed
wavy hair below armpit level with no infestations (like lice, dandruff) and infection
noted. Facial features are symmetrical upon asking the patient to raise eyebrows,
frown, lower eyebrows, close eyes tightly, puff cheeks, smile, and clench teeth.
Muscle strength of jaw was also normal.
 Eye structures and visual acuity
The patient's eyebrows are both aligned, evenly distributed and move
uniformly. Eyelashes are well distributed and are curled outward. Eyelids are
intact with no discharges and discoloration noted. Lids close symmetrically.
Palpebral conjunctiva appears to be pale in color. Lacrimal ducts are evident.
The sclera appears to be white. The eyes constrict; with a constriction of two
millimeters when stimulated with a penlight and when the penlight was drawn
near to the patient’s nose. Iris are dark brown in color. Cornea appears shiny and
smooth. Pupils are equally round and are reactive to light and accommodation.
Edema and tenderness are not palpated. When looking straight ahead, client
can see objects in the periphery. When checking for the six ocular movements,
the eyes move smoothly and are able to follow the hand movements. Both eyes
are coordinated; with parallel alignment. Client was asked to read the writings on
a notebook held at a distance of 14 inches, the patient can read the words
written.
 Ears and hearing

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Auricles are symmetrical, aligned with the outer canthus of the eye, and
are in the same color as facial skin. Auricles are mobile, firm, and not tender.
Pinna recoils after it is folded. External canal is clear with minimal dry cerumen.
Inflammation, masses and foreign bodies are absent. Normal voice tones are
audible to the patient.
 Nose and sinuses
Nose is uniform with skin color without any lesions and is symmetrical
without any signs of discharges and lesions. There is no nasal flaring noted.
Nasal septum is intact at midline. When palpated, the patient did not display any
signs of pain. Air moves freely as the patient breathes. The nasal mucosa is pink
in color. When the facial sinuses were palpated, the patient did not complain of
pain. Upon palpation of the maxillary and frontal sinuses, no tenderness was
noted. Cilia was noted upon assessment.
 Mouth
Outer lips are pale in color, with symmetrical contour. Inner lips and buccal
mucosa are moist and no ulcerations are noted. The oral cavity is pink in color.
The gums are intact and the teeth are milky white in color. The soft and hard
palate is pinkings. Tonsils are pinkinsh in color, no inflammation was noted. The
patient has good alignment of teeth and no dental carries are noted. The client 2
missing 3rd lower molar. The tongue is pink, located at the midline, able to move
freely and as commanded such as sticking out of the tongue and moving it from
side to side. The uvula is positioned midline of the soft palate. There were no
signs of inflammation and redness. Gag reflex is present upon assessment.

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 Neck
The neck is symmetric with head centered and without bulging masses.
Neck movements are smooth. As the patient swallows, the thyroid gland and
thyroid cartilage moves upward. Trachea is in the midline. The lymph nodes are
not enlarged and not tender upon palpation. The neck muscles are proportional
in size. The patient is able to move her head sideward, extend and flex with
smoothness and without any signs of discomfort. The trachea is located at
midline. Thyroid gland is not palpable. Lymph nodes are not palpable. On
auscultation, no signs of bruit, which is a gushing sound caused by blood flow, is
noted.
 Chest and Lungs
Chest is symmetric and spine is vertically aligned. The client has quiet,
rhythmic and effortless respirations. Skin is intact with uniform temperature.. The
client also has bilateral symmetry of vocal fremitus. When palpated, no
tenderness noted with full symmetric chest expansion (when the client takes a
deep breath), with respiratory excursion of 3cm, there are no signs of nodules
and the patient did not complain of any pain. Clear breath sounds are noted upon
auscultation and the 3 lung sounds are evidently noted.
 Heart and central vessels
No murmurs or adventitious sounds were audible upon auscultation.
Palpitations are absent. The peripheral pulses were weak when palpated. The
Peripheral veins in the legs and arms showed no signs of phlebitis when the legs
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were inspected for swelling and when the calves were palpated, the patient did
not complain for any pain.
 Breast and axillae
The breasts of the patient have no signs of hyper pigmentation or any
discoloration and lacerations, breasts were symmetrical in size. The areolas are
dark brown with nipples that are round, pointing in an outward direction and are
equal in size. Discharges, lesions, tenderness, nodules, and masses were not
noted. Moisture was felt at the axillary area with few hair growths. The axillae is
dark brown in color. Lymph nodes were not noted upon palpation.
 Abdomen
Upon inspection in the abdomen striae gravidarum are evident on her
abdomen. Symmetric movements were seen when the patient inhales and
exhales, with positive tenderness on hypogastric area, linea negra noted but light
in color. With 10 bowel sounds per minute upon auscultation. Umbilicus is
located in the umbilical region. With fetal movement upon Leopold's maneuver
and fetal heart tone noted via stethoscope. With AP diameter of 2:1.
 Musculoskeletal
Upon comparison, the patient’s muscles have good tonicity. There were
no signs of contracture or any fasciculation or tremors seen. Upon palpation, the
muscles are firm at active state with smooth movements. Muscle strength is
equal at both left and right side. The patient’s both legs have the same length.
When the patient was allowed to move her legs up she moved it slowly because
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she feels pain in her abdominal area. When the patient was asked to push the
student nurse’s hand with her foot she moved her foot slowly. The bones were
palpated especially at the joint areas; there were no deformities.
 Arms, Legs
Arms have equal length. With fair complexion, edema is not noted. With
some hair noted. Legs have also equal length, edema not noted. With some hair.
Color of the knee is darker than the other part.
 Genitourinary
The skin of the vagina has dark skin pigmentation noted. Her pubic
hair is evenly distributed on mons pubis. She also verbalized that she does not
feel any pain during urination. There are no bladder distensions upon palpation.
There are no herniations on inguinal area. She also verbalized that there is a
white scanty discharge with no odor.
III MANAGEMENT
Date Order Rationale
February Please admit JMP MgSO4 is used as a tocolytic to stop preterm

28, 2019 for administration of labor. Do not exceed 5-7 days of continuous
MgSO4 and treatment; longer treatment duration may lead
bethametazone to hypocalcemia in developing fetus resulting
in neonates with skeletal abnormalities related
to osteopenia
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Antenatal betamethasone is primarily used to

speed up lung development in preterm fetuses.
It stimulates the synthesis and release of
surfactant, which lubricates the lungs, allowing
the air sacs to slide against one another
without sticking when the infant breathes.
Please carry out Importance of Physician Orders. Physician's

attending orders provide directions to the healthcare
physician’s order team regarding medications, procedures,
treatments, therapy, diagnostic tests,
laboratory tests, and nutrition.
Secure consent for By giving a informed consent the patient learns

care about and understands the purpose, benefits,
and potential risks of a medical or surgical
intervention, including clinical trials, and then
agrees to receive the treatment or participate
in the trial.
VS q4hrs and record Vital signs are an important component

of monitoring the adult or child patient's
progress during hospitalisation, as they allow
for the prompt detection of delayed recovery or
adverse events.
Full diabetic diet The plan helps you control your blood sugar
(glucose), manage your weight and control
heart disease risk factors, such as high blood
pressure and high blood fats. When you eat
extra calories and fat, your body creates an
undesirable rise in blood glucose.
PNSS 1L @KVO Normal Saline is used to clean out an

rate intravenous (IV) catheter, which helps prevent
blockage and removes any medicine left in the
catheter area after you have received an IV
infusion
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Stat MgSO4 4gm MgSO4 is used as a tocolytic to stop preterm

very slow IVTT now labor. Do not exceed 5-7 days of continuous
then MgSO4 drip: treatment; longer treatment duration may lead
PNSS 500cc 20gms to hypocalcemia in developing fetus resulting
MgSO4 @ 1gm/hr in neonates with skeletal abnormalities related
to osteopenia
Meds: Antenatal betamethasone is primarily used to

Bethamethasone speed up lung development in preterm fetuses.
12gm now then q24 It stimulates the synthesis and release of
hrs. IM for a total of surfactant, which lubricates the lungs, allowing
2 dosage the air sacs to slide against one another
without sticking when the infant breathes.
HGT now: 108 mg/dl Taking a blood sugar test can help determine
your blood sugar level to see if you need to
adjust your diet, exercise, or diabetes
medications.
Plan For BPS On A biophysical profile is used to evaluate and

Wednesday monitor a baby's health. The goal of a
(03/14/2020) biophysical profile is to prevent pregnancy loss
and detect a low oxygen supply in the baby
(fetal hypoxia) early enough so that the baby
can be delivered and not sustain permanent
damage.
Baseline EFM then EFM can help to determine the well-being of

per meals your baby during the labor and delivery
process. EFM essentially tells healthcare
providers the oxygenation status of the baby
during labor. We all know that oxygen
is important to our well being. It is the same
with babies still in the womb
FHT q2 hrs Why might I need fetal heart monitoring? Fetal

heart rate monitoring is especially helpful if you
have a high-risk pregnancy. Your pregnancy is
high risk if you have diabetes or high blood
pressure. It is also high risk if your baby is not
developing or growing as it should.
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MgSO4 toxicity Magnesium sulfate has CNS and

precaution respiratory depressant effects. It acts
peripherally, causing vasodilation; moderate
doses cause flushing and sweating, whereas
high doses cause hypotension. It prevents or
controls seizures by blocking neuromuscular
transmission.
March 3, Humulin 70/30 14 Humulin 70/30 contains a combination

2020 units SQ pre- of insulin isophane and insulin regular. Insulin is
breakfast a hormone that works by lowering levels of glucose
(sugar) in the blood. Humulin 70/30 is used to
improve blood sugar control in adults with diabetes
mellitus.
RI 2 units SQ Regular insulin is used to improve blood sugar

@11am control in adults and children
11pm 1L 1 unit with diabetes mellitus. Insulin regular may be
@>120 mg mg/dl used for type 1 or type 2 diabetes
RI @ 6am-6pm
CBG q6 6-11-6 Taking a blood sugar test can help determine

your blood sugar level to see if you need to
medications.
Continue CBG Taking a blood sugar test can help determine

2:45 pm your blood sugar level to see if you need to
medications.
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Laboratory Tests
Complete Blood Count (CBC)
Date Component Def. & Normal Rationale Result Interpretation Nsg. Responsibilities
Range
3/01/ Hemoglobin Hemoglobin or A hemoglobin test 111 L Pretest:

20 haemoglobin, measures the g/L If a disease or 1.Orient the patient about the test and
abbreviated Hb amount of condition affects its purpose which would specifically
or Hgb, is the hemoglobin in the body's assist in evaluating the amount of
iron-containing your blood. production of hemoglobin in the blood to support in
oxygen- Hemoglobin is a red blood cells, diagnosis and monitor therapy..
transport protein in your red the hemoglobin 2. Obtain and record a history of the
metalloprotein in blood cells that levels may drop. patient's complaints, including a list of
the red blood carries oxygen to Fewer red blood known allergens, especially allergies or
cells of almost your body's organs cells and lower sensitivities to latex.
all vertebrates and tissues and hemoglobin 3. Note any recent procedures that can
as well as the transports carbon levels may interfere with test results.
tissues of some dioxide from your cause the 4. Obtain a list of the patient's current
invertebrates. organs and tissues person to therapeutic medications; alternative
Hemoglobin in back to your lungs. develop anemia. medications or ordered medications.
blood carries 5. Review the procedure with the
oxygen from the patient. Inform the patient about the
lungs or gills to given schedule for the collection of
the rest of the specimens. (collection takes
body. approximately 5 to 10 min.) Address
(N: 120-160g/L) concerns about pain and explain that
there may be some discomfort during
the venipuncture.
Intratest:
MCH MCH stands for An MCH value 23.3 L 1. Providing support to the patient and
“mean refers to the 10^12/L A low MCH
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Range
corpuscular average quantity of value typically monitoring the patient’s response during
hemoglobin.” An hemoglobin indicates the the procedure.
MCH value present in a single presence of iron
refers to the red blood cell. deficiency 2. Orient patient that medical
average quantity anemia.In more technologists would take over and
of hemoglobin rare cases, low perform the test.
present in a MCH can be
single red blood caused by a Post test:
cell. genetic 1. Reporting the results to the appropriate
(N: 28-33 condition called members of the health care team.
10^12/L) thalassemia. In 2. Place the client in a comfortable
this condition, position right after the procedure.
production of 3. Record the results into the patient's
hemoglobin is medical record.
limited. This 4. Compare previous and current test
means there results and endorse attending physician.
aren’t as many 5. Do the aftercare within the area to give
red blood cells courtesy to the next client.
circulating in
your
bloodstream.
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Range
RBC A red blood cell 4.75 pg Within Normal

Red blood cells
count is a blood Range
(RBCs), also
test that your
called
doctor uses to find
erythrocytes, are
out how many red
cells that
blood cells (RBCs)
circulate in the
you have. It’s also
blood and carry
known as an
oxygen
erythrocyte count.
throughout the
The test is
body.
important because
RBCs contain
(N: 4.0-5.0 pg) hemoglobin, which
carries oxygen to
your body’s
tissues. The
number of RBCs
you have can affect
how much oxygen
your tissues
receive.
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Range
MCV Mean An MCV blood test 74.0 fl L

corpuscular measures the Low in MCV test
volume (MCV), average size of may indicate
also known as your red blood Iron-deficiency
mean cell cells, also known anemia or other
volume, is an as erythrocytes. If types of anemia
important your red blood cells Anemia is a
number listed on are too small or too condition in
a complete large, it could be a which your
blood count sign of a blood blood has a
(CBC) that can disorder such as lower than
help diagnose anemia, a vitamin normal amount
different types of deficiency, or other of red blood
anemia as well medical condition. cells.
as other health
conditions. The
MCV is a value
that describes
the average size
of red blood
cells
(erythrocytes) in
a blood sample.
(N: 82-98 fl)
MCHC MCHC stands The mean 31.5 g/l L

for mean corpuscular A low mean
corpuscular hemoglobin corpuscular
hemoglobin concentration is a hemoglobin
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Range
concentration. measure of the concentration

It's a measure of concentration of (MCHC) shows
the average haemoglobin in a that someone’s
concentration of given volume of red blood cells
hemoglobin packed red blood do not have
inside a single cells. It is enough
red blood cell. calculated by hemoglobin.
(N: 33-36 g/l) dividing the Hemoglobin is
haemoglobin by the an iron-rich
haematocrit. protein, and a
lack of it may
indicate anemia.
WBC WBCs, also A WBC count can 9.4 Within Normal

called detect hidden 10^9/L Range
leukocytes, are infections within
an important your body and alert
part of the doctors to
immune system. undiagnosed
These cells help medical conditions,
fight infections such as
by attacking autoimmune
bacteria, diseases, immune
viruses, and deficiencies, and
germs that blood disorders.
invade the
body.
(N: 4.8-10.8
10^9/L)
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Hemo Glucose Test (HGT)
Date Component Def. & Normal Range Rationale Result Interpretation Nsg. Responsibilities
3/01/20 2:05pm A blood glucose test A blood glucose 108 Within Normal Range Pretest:
measures the glucose test is used to mg/dL
levels in your blood. find out if your 1. Identify the patient
6:45pm blood sugar 136 Hyperglycemic 2. Explain the procedure
Glucose is a type of levels are in the mg/dL refers to high levels of to the patient
sugar. healthy range. It sugar, or glucose, in the 3. Collect together all the
It is your body's main is often used to blood. Several factors can equipment including: test
source of energy. help diagnose contribute to hyperglycemia meter, test strips, finger
and monitor in people with diabetes, pricking device/lancet,
A hormone called diabetes. including food and physical clean gauze and the
insulin helps move activity choices, illness, non patient’s records.
glucose from your diabetes medications, or
bloodstream into your skipping or not taking Intratest:
cells. enough glucose-lowering 1. Wash and dry your
medication hands thoroughly.
Too much or too little Wash and dry your
glucose in the blood hands thoroughly.
can be a sign of a 2. Apply gloves and don
serious medical apron.
condition. 3. If possible, ask the
patient to wash and dry
High blood glucose her or his hands (Fig 1).
levels (hyperglycemia) If not, wash finger with
may be a sign of soap and water and
diabetes, a disorder allow to dry.
that can cause heart 4. Ensure that the
disease, blindness, patient is sitting or lying
kidney failure and other comfortably before the
complications. procedure. If possible,
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Low blood glucose ask the patient to wash

levels (hypoglycemia) and dry her or his hands
can also lead to major (Fig 1). If not, wash your
health problems, fingers with soap and
including brain water and allow them to
damage, if not treated. dry.

5. Use lancet device to
(N: 80-120 mg/dL) pierce the skin at the side
of the finger and
encourage bleeding by
use of gravity (Fig 2).
Avoid squeezing your
finger as this may affect
the result.
6. Wipe first drop of blood
with sterile gauze.
7. Encourage bleeding to
obtain a drop large
enough to cover the test
strip
8. Apply this drop of blood
to the test strip (Fig 5).
9. Apply gauze to prevent
further bleeding.

Post test:
1. Promptly dispose of
lancet into sharps bin.
2. Record the result clearly
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in nursing notes
3. Report abnormal
results, having taken any
corrective action within
your sphere of
competence.
11:35pm - -
6:00am 101 Within Normal Range

mg/dL
11:00am 136 Hyperglycemic

mg/dL refers to high levels of
sugar, or glucose, in the
blood. Several factors can
contribute to hyperglycemia
in people with diabetes,
including food and physical
activity choices, illness, non
diabetes medications, or
skipping or not taking
enough glucose-lowering
medication
29
5:00pm 107 Within Normal Range

mg/dL
30
Diagnostic Exams
Date Test Rationale Result Normal Interpretation Nsg.
Values & Responsibilities
Significance
3/01/2 Electrocardiogram An ECG is a 61bpm 60-100 bpm Sinus Rhythm Procedure

0 (ECG) simple,
noninvasive 1.Verify the order for
procedure. the ECG in the
Electrodes are SR Wave - Proceeding If the deflection client's chart.
placed on the skin Biphasic from V1 to V6, or change of
of the chest and the R waves the sign 2.Verify the order for
connected in a get taller while changes twice the ECG in the
specific order to a the S waves (go up to client's chart.
machine that, get smaller. At positive, then
when turned on, V3 or V4, down to 3.Provide privacy and
measures these waves negative and explain the procedure
electrical activity are usually then back to to the client. Explain
all over the heart. equal. This is zero) it is that the test records
Output usually called the biphasic. the heart's electrical
appears on a long transitional activity and that it
scroll of paper zone. may be repeated at
that displays a certain intervals.
printed graph of Normal Emphasize that no
activity on a T Waves V1- Normally electrical current will
computer screen. V4 : Good rounded and enter the body. Tell
An ECG can Wave asymmetrical, the client that the test
detect areas of Progression with a more typically takes about 5
muscle deprived gradual ascent minutes.
of oxygen and/or than descent
31

Significance
dead tissue in the Normal 4.Wash your hands.

heart.
3/02/2 ≤ 0.44 5.Have the client lie
0 seconds for supine in the center of
LQT : 0.32 females Sinus the bed with arms at
Tachycardia his sides. You may
raise the head of the
(N: 60-100 bed to promote
107 bpm bpm) comfort. Expose the
arms and legs and
cover the client
appropriately. The
arms and legs should
be relaxed to
minimize muscle
trembling, which can
cause electrical
interference.
6. Select flat, fleshy

areas to place the
limb lead electrodes.
Avoid muscular and
bony areas. If the
client has an
amputated limb,
32

Significance
choose a site on the

stump.
7.Apply disposable
electrodes to the
client's wrists and to
the medial aspects of
the ankles. (See
Positioning Chest
Electrodes.) Apply the
pre-gelled electrode
directly to the
prepared site, as
recommended by the
manufacturer's
instructions. To
guarantee the best
connection to the lead
wire, position
disposable electrodes
on the legs with the
lead connection
pointing superiorly.
8. Ask the client to

relax and breathe
33

Significance
normally. Tell the

client to lie still and
not to talk when you
record the ECG.
9. Assist the client to

a comfortable
position. Ensure the
bed is in a low
position
10.Document in your
notes the test's date
and time and
significant responses
by the client. Verify
the date, time, client's
name, and assigned
ID number on the
ECG itself. Note any
appropriate clinical
information on the
ECG.
3/03/2 2D An Left Normal Normal Before the procedure

0 Echocardiogram echocardiogram ventricular
34

Significance
is an ultrasound dimension 1. Explain the

test that can with procedure to the
evaluate the adequate patient. Inform the
structures of the wall motion patient that
heart, as well as and echocardiography is
the direction of contractility used to evaluate the
blood flow within fraction 72% size, shape, and
it. motion of various
Normal Left cardiac structures.
It is is a test in Atrium Tell who will perform
which ultrasound the test, where it will
technique is used Normal Right take place, and that
to take pictures of Ventricular it’s safe, painless, and
the heart. It and Right is noninvasive.
displays a cross Atrium
sectional ‘slice’ of 2.No special
the beating heart, Normal Aortic preparation is
showing Valve and needed. Advise the
chambers, valves Mitral Valve patient that he doesn’t
and the major leaflets need to restrict food
blood vessels of without and fluids for the test.
the heart. restriction of
motion 3.Ensure to empty the
bladder. Instruct
Normal patient to void prior
Tricuspid and to change into a
35

Significance
Valve and gown.

Pulmonic
Valve leaflets 4.Encourage the
with good patient to cooperate.
opening and Advise the patient to
closing remain still during the
motion test because
movement may distort
Normal main results. He may also
Pulmonary be asked to breathe
Artery and in or out or to briefly
Aortic Root hold his breath during
dimensions the exam.
Minimal 5.Explain the need to

Pericardial darkened the
effusion examination field. The
room may be
Color: darkened slightly to
moderate aid visualization on
mitral the monitor screen,
regurgitation, and that other
mild tricuspid procedure (ECG and
regurgitation, phonocardiography)
mild aortic may be performed
regurgitation simultaneously to
36

Significance
time events in the

cardiac cycles.
6.Explain that a
vasodilator (amyl
nitrate) may be given.
The patient may be
asked to inhale a gas
with a slightly sweet
odor while changes in
heart functions are
recorded.
During the procedure
1.Inform that a
conductive gel is
applied to the chest
area. A conductive
gel will be applied to
his chest and that a
quarter-sized
transducer will be
placed over it. Warn
him that he may feel
minor discomfort
37

Significance
because pressure is
exerted to keep the
transducer in contact
with the skin.
2.Position the patient

on his left side.
Explain that the
transducer is angled
to observe different
areas of the heart and
that he may be
repositioned on his
left side during the
procedure.
After the procedure
1.Remove the
conductive gel from
the patient’s skin.
When the procedure
is completed, remove
the gel from the
38

Significance
patient’s chest wall.
2.Inform the patient

that the study will be
interpreted by the
physician. An official
report will be sent to
the requesting
physician, who will
discuss the findings
with the patient.
3.Instruct the patient

to resume regular diet
and activities. There
is no special type of
care given following
the test.
Normal results
39
Urinalysis
Dat Component Def. & Normal Range Rationale Result Interpretation Nsg.
e Responsibilities
Color Urine can be a variety of Normal urine color is pale Pale yellow Pre:
colors, most often shades due to the presence Yellow urine means
of yellow, from very pale of a pigment called you are more - Instruct the patient
or colorless to very dark urochrome. Urine hydrated catch the midstream
or amber. Unusual or color varies based on urine by urinating in
abnormal urine colors can the urine the toilet and
be the result of a disease concentration and continue to void and
process, several chemical composition. interrupt the stream
medications (e.g., Normal urine can vary to collect into the
multivitamins can turn from pale light yellow supplied container.
urine bright yellow), or the to a dark amber color.
result of eating certain Highly concentrated Post:
foods. urine has a darker
- Label the container
yellow appearance.
with the name and
Color – Yellow (light/pale This may be seen in
room number and
to dark/deep amber) patients who are
send to laboratory.
volume depleted. In
contrast, dilute urine
has a lighter yellow
appearance.
Transparency Urine clarity refers to how Clear Clear urine

clear the urine is. Usually, Clear urine tends to tends to
laboratorians report the indicate that a person indicate that a
clarity of the urine using is well hydrated. It person is well
40
e Responsibilities
one of the following hydrated

terms: clear, slightly could also suggest
cloudy, cloudy, or turbid. that they are too
"Normal" urine can be hydrated. If a person
clear or cloudy. has consumed a lot of
Substances that cause liquids during the day,
cloudiness but that are they may have too
not considered unhealthy much water in their
include mucus, sperm system. When this
and prostatic fluid, cells occurs, they can
from the skin, normal inadvertently dilute
urine crystals, and their blood and lower
contaminants such as their essential salt
body lotions and and electrolyte levels.
powders. Other
substances that can
make urine cloudy, like
red blood cells, white
blood cells, or bacteria,
indicate a condition that
requires attention.
Clarity/turbidity – Clear or
cloudy
41
e Responsibilities
RXN According to the 6.0 normal

American Association for The acidity or
Clinical Chemistry, the alkalinity of urine can
average value for urine help a doctor
pH is 6.0, but it can range diagnose medical
from 4.5 to conditions. Doctors
8.0. Urine under 5.0 is can test urine pH
acidic, and urine higher using a litmus paper
than 8.0 is alkaline, or test.
basic. Different
laboratories may have
different ranges for A doctor can perform
“normal” pH levels. a urine pH test as part
of a larger urinalysis
-normal 6.0 test, or a they can
specifically test urine
pH.
High and low pH

levels can indicate
problems with a
person’s kidneys,
such as an
environment that
could help kidney
stones develop.
42
e Responsibilities
Specific specific gravity is a Specific gravity 1.020 normal

Gravity measure of urine measurements are a
concentration. This test comparison of the
simply indicates how amount of substances
concentrated the urine is. dissolved in urine as
present, the Specific compared to pure
gravity – 1.005-1.025 water. If there were
no substances
present, the specific
gravity of the urine
would be 1.000 (the
same as pure water).
Since all urine has
some substances in it,
a urine SG of 1.000 is
not possible. If a
person drinks
excessive quantities
of water in a short
period of time or gets
an intravenous (IV)
infusion of large
volumes of fluid, then
the urine specific
gravity may be very
close to that of water.
The upper limit of the
43
e Responsibilities
test pad, a specific

gravity of 1.035,
indicates
concentrated urine,
one with many
substances in a
limited amount of
water.
WBC The number of WBCs in An increased number 8 normal

urine sediment is of WBCs seen in the
normally low (0-5 WBCs urine under a
per high power field, microscope and/or
HPF). WBCs can be a positive test for
contaminant, such as leukocyte esterase
those from vaginal may indicate an
secretions. infection or
inflammation
somewhere in the
(N: 0-17) urinary tract. If also
seen with bacteria
(see below), they
indicate a likely
urinary tract infection.
RBC Normally, a few RBCs are Blood in the urine is 3 normal

44
e Responsibilities
present in urine sediment not a normal finding,

(0-5 RBCs per high but it is not
power field, HPF). A uncommon and is not
positive chemical test for necessarily a cause
hemoglobin and an for alarm. Hematuria
increase in the number of is a sign or an
RBCs seen under the indicator that prompts
microscope indicates that a healthcare
there is blood in the urine. practitioner to
However, this test cannot investigate further to
be used to identify where try to determine the
the blood is coming from. underlying cause of
For instance, the blood. As part of
contamination of urine the investigation, a
with blood from healthcare practitioner
hemorrhoids or vaginal will evaluate an
bleeding cannot be individual's medical
distinguished from a history, physical
bleed in the urinary tract. examination, and
This is why it is important accompanying signs
to collect a urine and symptoms.
specimen correctly and Additional urine and
for women to tell their blood tests may be
healthcare provider that done to help
they are menstruating determine the source.
when asked to collect a
urine specimen. Some of the
45
e Responsibilities
underlying causes of
hematuria are benign,
temporary states that
(N: 0-11) do no lasting harm
and resolve with little
or no specific
treatment. If there is
blood in the urine
along with white blood
cells and bacteria, it
may be caused by a
urinary tract infection
that can be easily
treated with
antibiotics. Some
causes of hematuria,
however, may be
critical conditions or
represent a chronic
condition that requires
treatment and
monitoring.
Epithelial Epithelial cells are usually Normally, in men and 12 moderate

Cells reported as "few," women, a few
"moderate," or "many" epithelial cells can be
46
e Responsibilities
present per low power found in the urine

field (LPF). sediment. In urinary
(N: 0-17) tract conditions such
as infections,
inflammation, and
malignancies, an
increased number of
epithelial cells are
present. Determining
the kinds of cells
present may
sometimes help to
identify certain
conditions. For
example, epithelial
cells containing large
amounts of broken-
down hemoglobin
(called hemosiderin)
may indicate that
there were red blood
cells or hemoglobin in
the urine recently,
even if there are none
now.
Casts Casts are cylindrical Normally, healthy 0 normal

47
e Responsibilities
particles sometimes people may have a

found in urine that are few (0–5) hyaline
formed from coagulated casts per low power
protein released by field (LPF). After
kidney cells. strenuous exercise,
(N: 0-1) more hyaline casts
may be detected.
Bacteria Bacteria from the Bacteriuria can be 44 normal

surrounding skin can confirmed if a single
enter the urinary tract at bacterial species is
the urethra and move up isolated in a
to the bladder, causing a concentration greater
urinary tract infection than 100,000 colony
(UTI). (N: 0-278) forming units per
millilitre of urine in
clean-catch
midstream urine
specimens (one for
men, two consecutive
specimens with the
same bacterium for
women).
Glucose Glucose is normally not An excessively high Neg negative

present in urine. When glucose level in the
glucose is present, the blood, such as may
48
e Responsibilities
condition is called be seen with people

glucosuria. It results from who have
either: uncontrolled diabetes
A reduction in the
Glucose - negative "renal threshold;"
when blood glucose
levels reach a certain
concentration, the
kidneys begin to
eliminate glucose into
the urine to decrease
blood concentrations.
Sometimes the
threshold
concentration is
reduced and glucose
enters the urine
sooner, at a lower
blood glucose
concentration.
Protein The protein test pad Proteinuria may Neg nevative

provides a rough estimate occasionally be seen
of the amount of albumin in healthy individuals.
in the urine. Albumin Healthy people can
makes up about 60% of have temporary or
49
e Responsibilities
the total protein in the persistent proteinuria

blood. Normally, there will due to stress,
be no protein or a small exercise, fever,
amount of protein in the aspirin therapy, or
urine. When urine protein exposure to cold, for
is elevated, a person has example. Repeat
a condition called testing may be done
proteinuria. once these conditions
have resolved to
Protein - negative determine whether
the proteinuria is
persistent
50
Serum electrolytes
Dat Component Def. & Normal Rationale Result Interpretation Nsg.
e Range Responsibilities
Potassium Potassium is A potassium blood test 3.90 normal

an electrolyte that' is often included in a
s essential for series of routine blood 1. Explain the
proper muscle and tests called an
procedure to the
nerve function. electrolyte panel. The
Even minor test may also be used patient.
increases or to monitor or diagnose
2. Tell the patient that
decreases in the conditions related to
amount abnormal potassium food or fluid is not
of potassium in levels. These
restricted.
your blood can conditions
result in serious include kidney Assess the
health problems. disease, high blood venipuncture site for
(N: 3.5- 5.1) pressure, and heart bleeding.
disease.
Sodium Sodium. Sodium, Once your body takes 141 normal 1. Explain the
or Na, is one of the in enough sodium, the
procedure to the
most kidneys get rid of the
important electrolyt rest in your urine. If patient.
es in the body and your sodium blood leve
is responsible for a ls are too high or too
number of low, it may mean that no special diet or
important functions, you have a problem
fasting is required.
mostly related to with your kidneys,
51

fluid and water dehydration, or another 3. Assess the

regulation. medical condition.
venipuncture site
normal 136-145 for bleeding.
mEq/L
4. Evaluate the
patient with
increased or
decreased
potassium
potassium levels
for cardiac
arrhythmias.
Monitor patients taking
digoxin and diuretics
for hypokalemia
Total Calcium is the most Hypercalcemia, which 2.37 normal 1. Explain the
calcium abundant mineral is a calcium level of
procedure to the
element in the more than 10.6 mg/dL,
body. About 98% of is most often patient.
the 1200 g of associated with the
calcium in the adult endocrine disorder of
is in the form of hyperparathyroidism, no special diet or
52

hydroxyapatite in but it is also associated

the skeleton. with some medications
Hydroxyapatite is a such as thiazide
lattice-like crystal diuretics and lithium,
composed of some forms of cancer
calcium, such as breast cancer fasting is required.
phosphorus, and and cancer of the
3. Assess the
hydroxide. The lungs, with multiple
remaining calcium myeloma, Paget's venipuncture site for
is in the disease, non weight
bleeding.
extracellular fluid bearing activity and
(50%) and in elevated levels of
various tissues, calcitriol as can occur
especially skeletal with sarcoidosis and
muscle. tuberculosis.
-normal (2.12-2.52)
53
Betamethasone
Generic Name
Betaderm, Beta-Val,
Betnovate, Celestoderm A,
Brand Name Ectosone Lotion, Luxiq,
Metaderm, Novobetamet,
Valnac
Adrenal Corticosteroid;
Classification Glucocorticoid; Anti-
Inflammatory
Pregnancy C
Category
Controls rate of protein synthesis, depresses migration of

polymorphonuclear leukocytes/fibroblasts, reverses capillary
permeability, prevents or controls inflammation. Decreases
Mechanism of tissue response to inflammatory process.Synthetic, long-acting
Action glucocorticoid with minor mineralocorticoid properties but strong
immunosuppressive, anti-inflammatory, and metabolic actions.
Relieves anti-inflammatory manifestations and is an
immunosuppressive agent.
Dosage & Route Intramuscular:

Allergic and inflammatory disorders
Adult: As betamethasone Na phosphate and betamethasone

acetate: 0.25-9 mg daily.
Nasal:
Adult: Instill 2-3 drops into each nostril bid as required.

Child: Same as adult dose.
54
Ophthalmic:
Adult: Initially, 1-2 drops instilled into affected eye(s) 2 hrly,

reduce frequency once the condition is under control.
Oral:
Allergic and inflammatory disorders, Congenital adrenal
hyperplasia
Adult: As betamethasone Na phosphate: 0-5-5 mg daily in

divided doses, depending on the severity of the disease and
clinical response. Recommended regimen: Short-term
treatment: 2-3 mg daily for the first few days, then gradually
decrease by 0.25 or 0.5 mg every 2-5 days, depending on
response. Rheumatoid arthritis: 0.5-2 mg daily. Other
conditions: 1.5-5 mg daily for 1-3 wk, then gradually reduce to
Min effective dose.
Child: Dose is proportional to adult dose (e.g. 1 yr 25% of adult
dose; 7 yr 50% of adult dose; 12 yr 75% of adult dose).
Treatment is limited to the Min dosage for the shortest possible
time.
Otic/Aural:
Adult: Initially, 2-3 drops instilled into affected ear(s) 3-4 hrly,

reduce frequency once the condition is under control.
Parenteral:
55
Adult: As betamethasone Na phosphate: 4-20 mg via deep IM

inj, IV inj over 0.5-1 min, or IV infusion, repeated 3-4 times in 24
hr, as necessary.
Child: As betamethasone Na phosphate: ≤1 yr 1 mg; >1-5 yr 2
mg; 6-12 yr 4 mg. Doses are given via IV inj or infusion,
repeated 3-4 times in 24 hr as necessary.
Topical/Cutaneous:
Corticosteroid-responsive dermatoses
Adult: As 0.05% betamethasone dipropionate oint, cream, gel,

or lotion: Apply to affected area 1-2 times daily for up to 2 wk.
As 0.025 or 0.1% betamethasone valerate cream, oint, or lotion:
Apply thinly into affected area 1-3 times daily for up to 4 wk or
until improvement occurs. As 0.1% betamethasone valerate
soln: Rub gently into affected area bid. As 0.12%
betamethasone valerate foam: Massage gently into scalp bid.
Topical/Cutaneou:
Mild to moderate plaque psoriasis
Adult: As 0.05% betamethasone dipropionate spray: Apply to

affected area bid for up to 4 wk.
Indications Systemic: Anti-inflammatory, immunosuppressant in the

treatment of diseases, including those of allergic, dermatologic,
endocrine, GI, hematologic, respiratory, or rheumatoid origin.
Topical: Relief of inflammatory and pruritic dermatoses.
Foam: Relief of inflammation, itching associated with

dermatosis of the scalp.
56
Sernivo: Treatment of mild to moderate plaque psoriasis.
OFF-LABEL: Accelerate fetal lung maturation in pts with

preterm labor.
Hypersensitivity to betamethasone. IM administration in

idiopathic thrombocytopenia purpura.
Contraindications
In patients with systemic fungal infections; acne vulgaris; acne
rosacea; Cushing’s syndrome; periorbital dermatitis; vaccines.
Frequent:
Systemic: Increased appetite, abdominal distention,

nervousness, insomnia, false sense of well-being.
Topical: Burning, stinging, pruritus.
Side Effects
Occasional:
Systemic: Dizziness, facial flushing, diaphoresis, decreased or

blurred vision, mood swings.
Topical: Allergic contact dermatitis, purpura or blood-containing

blisters, thinning of skin with easy bruising, telangiectases,
raised dark red spots on skin, angiomas.
Overdose may cause systemic hypercorticism, adrenal

Adverse Reactions
suppression
Drug Interactions DRUG: Amphotericin may increase risk of hypokalemia. May

decrease effects of insulin, oral hypoglycemics (e.g.,
glimepiride, metFORMIN, SITagliptin), potassium supplements.
May increase digoxin toxicity (due to hypokalemia). Hepatic
enzyme inducers (e.g., carBAMazepine, PHENobarbital,
rifAMPin) may decrease effect. Live virus vaccines may
potentiate virus replication, increase vaccine side effects,
insulin, regular
Generic Name
(injection, concentrated)
57
Novolin geToronto,
Brand Name NovoLIN R, HumuLIN R
decrease pt’s antibody response to vaccine.
U-500 (Concentrated)
Antidiabetics, Hormones
Classification
HERBAL: Cat’s claw, echinacea possess immunostimulant
B
Pregnancy effects. FOOD: None known.
Category
Promotes glucose transport, which stimulates carbohydrate

LAB VALUES:
metabolism in skeletal May decrease
and cardiac serum
muscle and calcium, potassium,
adipose tissue.
Mechanism of Also thyroxine. May increase serum
promotes phosphorylation cholesterol,
of glucose lipids, itglucose,
in liver, where is
Action sodium, amylase.
converted to glycogen. Directly affects fat and protein
Question
metabolism, for hypersensitivity
stimulates to any corticosteroid,
protein synthesis, sulfite.
inhibits release of free
fatty acids, and indirectly decreases phosphate and potassium
Obtain baseline values for height, weight, B/P, serum glucose,
Adultselectrolytes.
and children: In newly diagnosed diabetes, total of 0.5 to
1 unit/ kg/day subcutaneously as part of multidose regimen of
short-Monitor B/P, blood
and longacting insulin.glucose, electrolytes. based
Dosage individualized Apply on
topical
preparation
patient’s glucosesparingly.
level, adjusted to premeal and bedtime
glucose levels. Reserve concentrated insulin (500 units/ml) for
For topical; Do not use on broken skin or in areas of infection.
patients requiring more than 200 units/day.
Nursing Do not apply to wet skin, face, inguinal areas.
Dosage & Route
Responsibilities
Take with food, milk.
Diabetic ketoacidosis Adults and children: Loading dose of 0.15

Take single daily dose in the morning.
units/kg (nonconcentrated regular insulin) I.V. bolus, followed by
Do notinfusion
continuous stop abruptly.
of 0.1 unit/kg/hour until glucose level drops.
Then administer subcutaneously, adjusting dosage according to
Apply topical preparations in a thin layer.
glucose level.
Do of
nothyperglycemia
receive smallpoxin vaccination during or immediately
Control patients with diabetes mellitus. after
therapy. regular insulin U-500: Only for use in patients with
Indications Concentrated
insulin requirements 200 units/ day
Hypoglycemia; Allergy or hypersensitivity to a particular type of

Contraindications
insulin, preservatives, or other additives.
Endo: HYPOGLYCEMIA.
Side Effects
Local: pruritus, erythema, swelling. Misc: allergic reactions
Metabolic: hypokalemia, sodium retention, hypoglycemia,

rebound hyperglycemia (Somogyi effect) Skin: urticaria, rash,
Adverse pruritus
Reactions
58
Insulin Isophane and Insulin Regular

Generic Name
HumuLIN 70/30, HumuLIN

Brand Name 70/30 KwikPen, NovoLIN
70/30, ReliOn/NovoLIN 70/30
Antidiabetic; Short-Acting
Classification
Insulin
Pregnancy B
Category
Humulin 70/30 contains a combination of insulin isophane and

insulin regular. Insulin is a hormone that works by lowering
levels of glucose (sugar) in the blood. Insulin isophane is a
Mechanism of
intermediate-acting insulin. Insulin regular is an short-acting
Action
insulin. This combination insulin starts to work within 10 to 20
minutes after injection, peaks in 2 hours, and keeps working for
up to 24 hours.
Administration: Given by SC injection only.

Dosage & Route
Treatment of patients with diabetes mellitus for the control of

Indications
hyperglycemia.
Protamine zinc and isophane insulin, and insulin zinc

Contraindications suspensions should never be given IV and are not indicated for
hyperglycemic coma.Hypoglycemia.
Fluid Retention - weight gain, swelling in your hands or feet,

feeling short of breath;
Low Potassium - leg cramps, constipation, irregular heartbeats,

fluttering in your chest, increased thirst or urination, numbness
Side Effects or tingling, muscle weakness or limp feeling.
Signs of an allergic reaction, like rash; hives; itching; red, swollen,

blistered, or peeling skin with or without fever; wheezing; tightness in the
chest or throat; trouble breathing, swallowing, or talking; unusual
hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
59
Lipodystrophy, insulin resistance and hypersensitivity reactions

have been associated with insulin therapy, but the incidence
Adverse Reactions
and severity of these unwanted effects is minimal with
monocomponent insulin.
The addition of corticosteroids, diuretics of thiazide, furosemide

or ethacrynic acid type, oral contraceptives or thyroid
replacement therapy to the patient's treatment may lead to an
increase in insulin requirements.
Drug Interactions The addition of MAOI may necessitate an adjustment of insulin

dosage.
Insulin requirements may be reduced in the presence of drugs
with hypoglycemic activity, eg oral hypoglycemics, salicylates
(eg, aspirin), sulfa antibiotics and certain antidepressants.
Nursing Do not use Humulin 70/30 if you are having an episode of

Responsibilities hypoglycemia (low blood sugar).
Humulin 70/30 is not approved for use by anyone younger than

18 years old.
Humulin 70/30 must not be given with an insulin pump, or

mixed with other insulins. Do not inject Humulin 70/30 into a
vein or a muscle.
After using Humulin 70/30, you should eat a meal within 30 to

45 minutes.
If you use an injection pen, use only the injection pen that
comes with Humulin 70/30.
Attach a new needle before each use. Do not transfer the

insulin from the pen into a syringe.
Never share a Humulin 70/30 injection pen or syringe with

another person, even if the needle has been changed.
Use a disposable needle or syringe only once.

60
Store the injection pen at room temperature (do not refrigerate)

and use within 10 days. Do not store the injection pen with a
needle attached.
Wear a diabetes medical alert tag in case of emergency. Any

medical care provider who treats you should know that you
have diabetes.
Metronidazole +
Generic Name
Miconazole Nitrate
Trimic
Brand Name
Antiinfectives
Classification
Pregnancy C
Category
TRIMIC (Metronidazole + Miconazole Nitrate) vaginal

suppository contains metronidazole for antibacterial and
antitrichomonal effects and miconazole for antifungal action.
Miconazole nitrate has a wide spectrum of activity. It is
Mechanism of particularly effective against pathogen fungi including Candida
Action albicans, in addition to Gram (+) bacteria. Metronidazole is an
antibacterial and antiprotozoal agent that is effective against
several infections caused by anaerobic bacteria and protozoa
such as Gardenerella vaginalis, Trichomonas vaginalis and
anaerobic bacteria including anaerobic Streptococci.
Dosage & Route In treatment of Vaginitis: Adults and Elderly (>65 years): Usual

dose: Insert 1 vaginal suppository at night and in the morning for
7 days or insert 1 vaginal suppository at night for 14 days.
Vaginitis resistant to other treatments or recurrent
61
vaginitis: Insert 1 vaginal suppository at night and in the morning

for 14 days.
Treatment of vaginitis Adult & elderly (>65 yr) Insert vag supp at

night & in the morning for 7 days, or insert 1 vag supp at night
Indications
for 14 days. Vaginitis resistant to other treatments or recurrent
vaginitis Insert 1 vag supp at night & in the morning for 14 days.
Hypersensitivity. Severe liver problems, nervous system

Contraindications
diseases, disturbances in hematopoiesis.
Abdominal pain or cramp, metallic taste, constipation, dry

mouth, seldom diarrhea, lack of appetite, vomiting, nausea;
decrease of WBC; cramps; headache, movement disorders,
Side Effects
dizziness, mental changes, peripheral neuropathy after
overdose or long period of usage; vaginal irritation (burning,
itching); rash.
Gastrointestinal: Abdominal pain or cramp, metallic taste,

constipation, dry mouth, seldom diarrhea, lack of appetite,
vomiting, nausea
Haematopoietic: Decrease of white blood cell
Adverse Musculoskeletal: Cramps
Reactions Nervous: Headache, movement disorders, dizziness, mental

changes, peripheral neuropathy after overdose or long period of
usage
Reproductive: Vaginal irritation (burning, itching)
Integumentary: Rash
Drug Interactions Metronidazole Disulfiram-like reaction w/ alcohol. Increase risk

of cardiotoxicity (QT prolongation, Torsade de pointes, cardiac
arrest) w/ amiodaron. Increases plasma conc of astemizole &
terfenadine. CNS related effects (eg, psychotic reactions) w/
disulfiram. Increased blood levels of phenytoin. Decreased
blood levels w/ phenobarb. Increased blood levels & toxicity of
62
fluorouracil & lithium. Increased blood conc of carbamazepine.

Increased effect of anticoagulants. Increased risk of
cyclosporine toxicity. Increased blood levels & risk of neurologic
side effects w/ cimetidine.
Miconazole Increased bleeding risk w/ acenocoumarol,

anisindione, dicumarol, phenindione, phenprocoumon, warfarin.
Increases plasma conc of astemizole, cisapride & terfenadine.
Increases phenytoin toxicity risk (ataxy, hyperlexia, nystagmus,
tremor). Increase or prolonged opioid effects (CNS depression,
resp depression) w/ fentanyl. Increased hypoglycemic action of
glimepiride. Decreased metabolism of carbamazepine.
Increased plasma conc or exposure to oxybutinin. Increased
plasma conc & reduction clearance of oxycodone. Increased
cardiotoxicity risk (QT prolongation, torsades de pointes, cardiac
arrest) w/ pimozide. Increased risk of cyclosporine toxicity (renal
dysfunction, cholestasis, parasthesias).
Nursing Assess for infection (vital signs; appearance of wound, sputum,

Responsibilities urine, and stool; WBC) at beginning of and throughout therapy.
Obtain specimens for culture and sensitivity before initiating

therapy. First dose may be given before receiving results.
Monitor neurologic status during and after IV infusions. Inform

health care professional if numbness, paresthesia, weakness,
ataxia, or seizures occur.
Monitor intake and output and daily weight, especially for

patients on sodium restriction. Each 500 mg of premixed
injectionfor dilution contains 14 mEq of sodium.
Assess for rash periodically during therapy. May cause Stevens-

Johnson syndrome. Discontinue therapy if severe or if
accompanied with fever, general malaise, fatigue, muscle or
joint aches, blisters, oral lesions, conjunctivitis, hepatitis and/or
eosinophilia.
63
Instruct patient to take medication as directed with evenly

spaced times between doses, even if feeling better. Do not skip
doses or double up on missed doses. Take missed doses as
soon as remembered if not almost time for next dose.
Advise patients treated for trichomoniasis that sexual partners

may be asymptomatic sources of reinfection and should be
treated concurrently. Patient should also refrain from intercourse
or use a condom to prevent reinfection.
Caution patient to avoid intake of alcoholic beverages or

preparations containing alcohol during and for at least 3 days
after treatment with metronidazole, including vaginal gel. May
cause a disulfiram-like reaction (flushing, nausea, vomiting,
headache, abdominal cramps).
May cause dizziness or light-headedness. Caution patient to

avoid driving or other activities requiring alertness until response
to medication is known.
Instruct patient to notify health care professional promptly if rash

occurs.
Inform patient that medication may cause an unpleasant metallic

taste.
Advise patient to notify health care professional of all Rx or OTC

medications, vitamins, or herbal products being taken and to
consult with health care professional before taking other
medications.
Advise patient that frequent mouth rinses, good oral hygiene,

and sugarless gum or candy may minimize dry mouth. Notify
health care professional if dry mouth persists for more than 2
wk.
Inform patient that medication may cause urine to turn dark

64
Magnesium Sulfate
Generic Name
Epsom Salt, Magnesium

Brand Name
Sulfate Injectio
Antacid, Anticonvulsant,
Classification
Electrolyte, Laxative
Pregnancy D
Category
Treatment/prevention of hypomagnesemia; prevention and

treatment of seizures in severe preeclampsia or eclampsia;
pediatric acute nephritis, treatment of arrhythmias due to
Mechanism of
hypomagnesemia (ventricular fibrillation, ventricular
Action
tachycardia, or torsades de points [a typical ventricular
tachycardia]). OFF-LABEL: Magnesium sulfate: Asthma
exacerbation unresponsive to conventional treatment
Dosage & Route Eclampsia IV: ADULTS: 4–5 g infusion, then 1–2 g/ hr
continuous infusion. Maximum: 40 g/24 hrs
Hypertension, Seizures IV, IM (Magnesium Sulfate): ADULTS,

ELDERLY: 1 g q6h for 4 doses as needed.
CHILDREN: 20–100 mg/kg/dose q4–6h as needed.
Arrhythmias, Torsade de Pointes IV (Magnesium Sulfate):

ADULTS, ELDERLY: Initially, 1–2 g over 15 min. CHILDREN:
25–50 mg/kg/dose.
Bronchodilation IV (Magnesium Sulfate): ADULTS, ELDERLY:

2 g as a single dose. CHILDREN: 25–75 mg/kg/dose as a
single dose.
65
Constipation PO (Magnesium Hydroxide): ADULTS,

ELDERLY, CHILDREN 12 YRS AND OLDER: 6–8 tablets or
30–60 ml/day (400 mg/5 ml). CHILDREN 6–11 YRS: 3–4
tablets or 15–30 ml/day (400 mg/5 ml). CHILDREN 2–5 YRS:
1–2 tablets or 5–15 ml/day (400 mg/5 ml).
Hyperacidity PO (Magnesium Hydroxide): ADULTS,

ELDERLY, CHILDREN 12 YRS AND OLDER: 2–4 tablets or
5–15 ml as needed up to 4 times/day.
Convulsions (treatment) - Intravenous magnesium sulfate (magnesium

sulfate (magnesium sulfate injection) injection) is indicated for immediate
control of life-threatening convulsions in the treatment of severe toxemias
(pre-eclampsia and eclampsia) of pregnancy and in the treatment of
acute nephritis in children.
Hypomagnesemia (prophylaxis and treatment) - Magnesium sulfate

(magnesium sulfate (magnesium sulfate injection) injection) is indicated for
replacement therapy in magnesium deficiency, especially in
Indications acute hypomagnesemia accompanied by signs of tetany similar to
those of hypocalcemia.
Magnesium sulfate (magnesium sulfate (magnesium sulfate injection)

injection) is also used to prevent or treat magnesium deficiency in patients
receiving total parenteral nutrition.
Tetany, uterine (treatment) - Magnesium sulfate (magnesium sulfate

(magnesium sulfate injection) injection) is indicated in uterine tetany as a
myometrial relaxant.
Contraindications Contraindications
● Hypermagnesemia
● Heart block
● Myocardial damage
66
● Active labor or within 2 hours of
delivery
Frequent:
Antacid: Chalky taste, diarrhea, laxative effect.
Occasional:
Antacid: Nausea, vomiting, stomach cramps.
Antacid, laxative: Prolonged use or large doses in renal

Side Effects
impairment may cause hypermagnesemia (dizziness,
palpitations, altered mental status, fatigue, weakness).
Laxative: Cramping, diarrhea, increased thirst, flatulence.
Systemic (dietary supplement, electrolyte replacement):

Reduced respiratory rate, decreased reflexes, flushing,
hypotension, decreased heart rate
Adverse Reactions CNS (with I.V. use): confusion, decreased reflexes, dizziness,
syncope, sedation, hypothermia, paralysis
CV (with I.V. use): hypotension, arrhythmias, circulatory

collapse
GI: nausea, vomiting, cramps, flatulence, anorexia
Metabolic: hypermagnesemia, hypocalcemia
Musculoskeletal (with I.V. use): muscle weakness, flaccidity
Respiratory: respiratory paralysis
Skin: diaphoresis
Other: allergic reaction, injection site reaction, laxative

67
dependence (with
repeated or prolonged use)
May decrease absorption of quinolones, tetracycline,

Drug Interactions
bisphosphonates. May increase effects of antihypertensives
Assess sensitivity to magnesium
Assess for relief of gastric distress. Monitor renal function (esp.

if dosing is long term or frequent)
Report any signs of hypermagnesemia (dizziness, palpitations,

altered mental status, fatigue, weakness).
When giving prolonged or repeated I.V. infusions, assess

patellar reflex and monitor for respiratory rate of 16
Nursing
breaths/minute or more.
Responsibilities
Monitor urine output, which should measure 100 ml or more
every 4 hours.
Teach patient about adverse reactions. Instruct him to report

symptoms that occur during I.V. administration.
Advise patient to consult prescriber before using magnesium if

he’s taking other drugs. Magnesium may delay orenhance
absorption of other drugs.
Nursing Theories
Dorothea Orem “Self-Care Deficit Theory of Nursing”
68
Orem's self-care deficit theory suggests patients are better able to recover when
they maintain some independence over their own self-care. “Self-care” is
practiced when it enhances the health and well-being of an individual.Orem’s
theory of self-care deficits explains how nurses can and should intervene to help
patients maintain autonomy.
We chose this theory because the theory suggests that one should gain
independence to be able to recover. In pregnancy, both the mother and the fetus
are put into a very vulnerable situation wherein the nurse is responsible to
provide the therapeutic self-care that is demanded depending on what care is
needed. Likewise, with our client, we are able to support and aid in the healing
process whoever, it is up to her and as proven by Orem to gain autonomy
through “self-care.” Especially that our client is recovering from the incisions she
had post-op.
Self-care Deficit Theory of Nursing serves as a foundation to provide a

humanistic approach to achieve the goals of nursing through managing patients
no matter what culture or boundary there may be.
Katharine Kolcaba “Comfort Theory”

69
Kolcaba described comfort as existing in 3 forms: relief, ease, and

transcendence. Comfort is the product of holistic nursing. Also, Kolcaba
described 4 contexts in which patient comfort can occur: physical,
psychospiritual, environmental, and sociocultural.If specific comfort needs of a
patient are met, the patient experiences comfort in the sense of relief.
We have chosen the “comfort theory” for the reasons that our client is
experiencing pain after the cesarean section delivery. This theory can help us
assess the state of comfort the client is currently in and reassess the comfort
levels after being addressed. For our client, pain medication is given because of
her incision in which she will feel relief due to the effects of the drug. It is only
when the comfortable state of contentment or sense of ease are met that we can
say that comfort is achieved.
70
Ncp
Date Cues Ne Nursing Diagnosis Nursing outcome Nursing interventions interpr evaluation
and ed etatio
time s n
March Subjective: S Sleep pattern Within my 8-hour 1. Establish rapport. March 2, 2020
2, disturbance related span of care, my  Allays fear, gain trust, and
“Di ko katulog L to anxiety as
2020 patient will be able cooperation.
kay sigi kog evidenced by
@ E to: @
isip sa bata” preoccupation
4pm E 2. Identify presence of

P a. Identify factors that contribute 10 pm
“first time man Anxiety causes slee
individually to disturbance in
3-11 gud nako ma ping problems, and
- appropriate sleeping (e.g. night-
shift ani mao sigi new research
intervention shift working hours,
R suggests sleep depri Goal met
kog isip” s to noise, pain, current
vation can cause
E promote illness).
an anxiety disorder.
sleep.  Such factors disturb the
Research also
S shows that some b. Report and sleeping pattern especially in Patient was able to:
form verbalize elderly.
Objective: T improveme
of sleep disruption is a. Identify individual
present in nearly all nt in
- Restless sleep/rest appropriate
- Drowsy psychiatric 3. Observe and obtain intervention to
P disorders. Studies pattern.
Eyes feedback from patient promote sleep by
also show that c. Take a
- Irritated A regarding usual transferring to
people with short nap
- Tired bedtime, another bed with
chronic insomnia are for at least
- Eyebags T rituals/routines, no “kutchon”
at high risk of 2-3 hours.
- Expressio number of hours of (foam bedding).
T developing d. Verbalize
nless face sleep, time of arising,
an anxiety disorder. understandi
- Frequent and environmental
E ng of sleep
yawning needs. b. Reported
disturbance
 To determine usual sleep improvement of
71
and ed etatio
time s n
R Bibliography: pattern and provide rest but tells
Sleep Disorders. comparative baseline. needs more rest
N (2018, July). Anxiety and verbalized
and Depression “Arang-arang
Association of napud akong
4. Listen to subjective
America, tulog tong
reports of sleep
ADAA. https://adaa. nagbalhin nako
quality.
diri (bed with no
org/understanding-  To be aware of patient’s
kutchon”), alimu-
anxiety/related- problem and able to help in ot man gud ng
illnesses/sleep- such ways. kutchon”.
disorders
5. Observe physical signs

of fatigue (e.g., c. Take a short nap
restlessness, hand from 9:99-11:00
tremors, thick speech). am.
 Such indicate lack of
rest/sleep. The patient may
be unaware of fatigue and d. Verbalized “wala
ignore the need to rest. man pud koy
mabuhat kung
cgeg hilak mga
bata, sabton
6. Explain necessity of nalang, bata man
disturbances for pud na sila”, also
monitoring vital signs “kasabot man ko
and/or other care when na kinahinanglan
patient is hospitalized. jud mi kwa-an ug
 To let the patient be VS, kadali lang
72
and ed etatio
time s n
aware of the importance in man pud na”.
caring patients.
7. Assist patient to
develop individual
program of relaxation.
 Let patient identify ways
to solve the problem, so the
patient would be comfortable
in his own decision.
Health Teachings
8. Limit fluid intake in
evening if nocturia is a
problem.
 To reduce need for
nighttime elimination.
9. Recommend limiting
intake of chocolates
and caffeine and
alcoholic beverages.
 Overindulgence interferes
73
and ed etatio
time s n
with REM sleep.
10. Recommend inclusion

of bedtime snack (e.g.,
milk or mild juice,
crackers, protein
source such as
cheese/peanut butter)
in dietary program.
 To reduce sleep
interference from
hunger/hypoglycemia.
11. Not to take a long nap

in the afternoon
especially if the patient
finds it hard to sleep at
night.
 Long naps could interfere
sleep at night.
Bibliography:
Marilynn E. Doenges, Mary
74
and ed etatio
time s n
Frances Moorhouse, Alice
C. Geissler-Murr. Nurse’s
Pocket Guide; Copyright 
2016 Eight Edition; F.A.
Davis Company; 2220/31
Ramkhamhaeng 36/1
Huamark Bangkok 10240
Thailand; Pages 452-456.
DAT CUES NEED NURSING DIAGNOSIS PATIENT OUTCOME NURSING IMPLE EVALUATION
E INTERVENTIONS MENT
ATION
TIM
E
Subjective: Self Fear related to potential After 6 hours of nursing October 16, 2019 @ 10 PM
-percepti preterm birth as intervention, the patient will be
on and evidenced by sleep able to: 1. Check and 1 “PARTIALLY MET”
Self- disturbance monitor vital
M “Katungnagacontr signs of the
concept
actakoatiyan kay patient.
A nakulbaanko. a. verbalizedecrease in R: To identify At the end of my 6 hours of
Mahadlokko basin the level of fear. physical nursing interventions, the
R patient was able to:
makaanakkoaniug responses
Rationale: b. verbalized that she associated with
C sayo.”As
was able to have a
verbalized by the both medical and
comfortable sleep and
H mother. rest. emotional A. “Walanamankokaayoma
75
In clinical settings, fear conditions. hadlok. Ay

of the unknown, mahadlokgudperokanan
4, “Dugaykomakatulo unexpected news about c. demonstrate g di nakaayo.” As
giniggabii kay one’s health, and any relaxation techniques verbalized by the patient.
usahaymakathinkl in order to alleviate 2. Identify the
impairment of bodily
angko about the fear such as client’s B. “Nakatulog man
2 functions engender perception of the
saakoa situation breathing techniques. kokadalilangkagainalabin
anxiety. Anxiety that threat
karon.” as awala man koybuhaton
0 escalates to a near panic represented by 2
verbalized when sab” as verbalized by the
state can be the situation. patient when she was
2 asked during the incapacitating. Different R: To know the ask if she was able to
interview. patients manifest appropriate rest and sleep.
0
physiologic, emotional, health teachings
and behavioral signs and for the client.
symptoms of anxiety in C. “pagmakulbaanko or
@ different ways. 3. Use presence or muandarakokahadlok kay
verbalization to kailangannaku mag take ug
encourage deep breath gamitang nose
expressions or pagginhawa.
4p clarifications of Taposmagabasa sab
m needs, koglibrokadtunggihatagsaak
Reference:
concerns, oa husband para sab
OBJECTIVE: Hinkle, J.L., unknowns, and
3 marelaxko.” As she
&Cheever,K.H. questions
- Eagerness to demonstrated the relaxation
(2018)Brunner R:Being
be in good techniques.
&Suddarths textbook of supportive and
condition and medical-surgical nursing approachable
to go home (Vol.1).Philadelphia:Wolt
- Sleep encourages
ers Kluwer. communication.
disturbance
4. Establish a
therapeutic
relationship,
conveying
76
empathy and
unconditional
positive regard.
R:To assist
client to identify
feelings and
begin to deal
with problems.
5. Encourage
verbalization of
fears and
concerns.
R: It can help 5
reduce anxiety
and stimulate
identificationof
coping
behaviors.
6. Encourage use
of relaxation
techniques such
as deep
breathing
exercises and
music therapy.
R: It enables to
obtain
maximum
benefit fromrest
periods;
prevents
77
muscle fatigue 4
and
improvesuterine
blood flow.
7. Explain the
procedures,
nursing
interventions,
and treatment
regimen. Keep
communication
open and
explain possible 9
outcomes while
explaining an
optimistic
attitude.
R: information
and knowledge
of the reasons of
these activities
can decrease
fear of the
unknown.
8. Assess support
systems
available to the
client which
would include all
significant
78
others.
R: the
assistance of the
significant
others, including
caregivers, are 6
extremely
important during
this time of
uncertainty and
stress. If the
client is to return
home, additional
support will be
required to meet
self-care needs.
9. Promote bed
rest for the
mother.
R: this will help
relax the patient
7
and lowers risk
of preterm birth
and pregnancy
complications.
10. Provide
alternative
relaxation tools
or things to the
8
patients like
books or novels
79
which are not

restricted inside
the labor room
and delivery
room.
R: This will help
distract the
patient from
focusing with the
situational crisis.
10
80
References:
(1) https://www.who.int/news-room/fact-sheets/detail/preterm-birth
(2) Blencowe H, Cousens S, Oestergaard M, Chou D, Moller AB, Narwal R, Adler
A, Garcia CV, Rohde S, Say L, Lawn JE. National, regional and worldwide
estimates of preterm birth. The Lancet, June 2012. 9;379(9832):2162-72.
Estimates from 2010.
(3) Blencowe H, Cousens S, Oestergaard M, Chou D, Moller AB, Narwal R, Adler
A, Garcia CV, Rohde S,
(4) Maternal and Newborn Health Disparities – UNICEF. Data from UNICEF
reanalysis of Philippines Demographic and Health Survey 2013
https://www.webmd.com/drugs/2/drug-163871/zenatane-oral/details
June 9 2012, 379(9832): 2162-72.
Kizior & Hodgson 2019. Saunders NURSING DRUG HANDBOOK 2019. St. Louis,
Missouri. Elsevier Inc.,
Magnesium Sulfate. Retrieved March 8, 2020 from https://www.rxlist.com/magnesium-

sulfate-drug.htm#indications
Patricia Dwyer Schull 2015. McGraw-Hill NURSE’S DRUG Handbook. New York.
McGraw-Hill Education, LLC
Say L, Lawn JE. National, regional and worldwide estimates of preterm birth
rates in the year 2010 with
time trends since 1990 for selected countries: a systematic analysis and
implications. The Lancet,
Vallerand & Sanoski 2017. Davis’s DRUG GUIDE FOR NURSESSIXTEENTH EDITION.
Philadelphia, PA. F. A. Davis Company.
81
Wilson, Shannon, & Shields (2015). Pearson Nurse’s Drug Guide 2015. Hoboken, NJ.
Pearson Education, Inc.,
Zenatane. Retrieved March 8, 2020 from
Zenatane. Retrieved March 8, 2020 from https://www.walgreens.com/rx-

druginfo/pharmacy/finddrug/druginfodrugdetails?drugId=677483s
82
Preterm Labor
____________________
A Case Study Presented to

The faculty of Nursing Department
Karen Sol I. Operario, RN.,MN.
____________________
In Partial fulfilment of the

Requirements in NCM-209
Delivery Room Rotation
By:
Keyna Juliet Dizon , Stn

Reca Nicole Lucero, Stn
Karl Angelo Montano,Stn
BSN 2A
Group 2 Subgroup 3
March 9, 2020

Case Study On Preterm Labor

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2

II. Assessment 30%

A. Medical Management 20%

Among the cases that we encountered, we chose JMP, a 30-year old

Room cases, primarily preterm labor.

The length of a normal, full-term pregnancy is 40 weeks. Preterm labor

develops when the uterus begins having contractions prior to 37 weeks

gestation. The period of gestation is one of the most important predictors of an

infant’s subsequent health and survival. Preterm delivery, defined as delivery

before 37 weeks of completed gestation (259 days), it is a major cause of

compared with 9% in higher-income countries. Within countries, poorer families

According to Maternal and Newborn Health Disparities – UNICEF, in the

births (1·7% of global total).

As mentioned above, we chose patient JMP, a 30-year old from Labor

given that we could relate it to our current concept.

This case study involves the implications to nursing education, practice,

preterm labor which can be very helpful to others by providing necessary

information about the condition.

specifically maternal and fetal complications by providing proper management to

be rendered in delivery room patients.

b) Collect and record clients’ demographic and obstetrical data;

Patient name: JMP

Home address: Unit 1916 Tower 2, Avida Condominium

Birthday: April 24, 1990

Birthplace: North Cotabato

Religion: Roman Catholic

Civil status: Married

Ordinal rank: Eldest

Mother: Freddie Munoz

Father: Leonila Munoz

Reason for Admission: for Neuroprotection

Date & Time of Admission: March 01, 2020 at 1:50 pm

Gestational Age (SGA) fetus, Gestational Diabetes Mellitus (GDM)

Ward/Room/Bed number: St. Mary 262-1

Attending Physician: Dr. Palabyab

Date of Discharge: N/A

Menarche: 13 years old

Menstrual Cycle: Irregular (2 to 3 months x 7days) consumes 7 pads per

LMP: June 25, 2019

EDC: April 01, 2020

-31(days for march)

I.E: closed cervix

FHT: 130 Bpm

Speculum Exam: whitish cup-like adherent to side walls.

Family Health History

J.M.P. has no known illness and is still alive.

died. All the other family members has no known illnesses

Past Health History

born at term at a hospital somewhere in North Cotabato. She was fully

immunized child receiving 3 doses of DPT, 3 doses of OPV, 3 doses of Hepatitis

cigarettes as well as any form of drugs.

Present Health History

admission for neuroprotection and monitoring. With this, it prompted her

have premature uterine contraction with an AOG of 34 weeks. EFM monitoring

weeks via ultrasound. She stated that she undergone

C.) Physical Assessment

This physical assessment was conducted last march 2, 2020 to a 30 year

verbally and non-verbally to the questions.

Vital Signs Normal Range Actual

Pulse Rate 60-100beats per minute 84 beats per minute

 Fetal heart Beat

The patient’s head is normocephalic. Skull is symmetrical and nodules or

Muscle strength of jaw was also normal.