CENTRO ESCOLAR UNIVERSITY

Manila*Makati*Malolos

COMPREHENSIVE NURSING
PROCESS
BSN-2A
Mary Angel Casaclang

Ariel Abejar

Alecsandra Mae Cendana

Nicanor Aldron M. Bermas

Matthieu Alec Roche Bernardo

Stefhanie De Mesa

Bendel Gabriel Garcia

Maxter Jones Manalo

Mark Lauren Mempin

John Mervin Oliveros

Kevin Riego

Margaret P. Ruivivar

NCM 107: Care of Mother, Child, and Adolescents

Mrs. Luningning Marcelino

 CHAPTER 1 ASSESSMENT

A. Nursing Health History

Patient’s Biographical Information

Name: J. A.

Address: Malolos City

Age: 21

Status: Married

Religion: Roman Catholic

Date of Consultation: May 10, 2020

Chief Complaint: Missed three menstrual periods. Nauseated, and a positive self pregnancy test

Final Diagnosis: Pregnancy Uterine Full Term via NSD baby boy at 39 weeks AOG

Nursing Health History

Chief Complaint: The patient, Mrs. J. A., primigravida, complains of a Missed three menstrual
periods, nausea and vomiting. She states that she performed a self pregnancy test and was
positive.

History of Present Illness: Mrs. J A., primigravida, who has no history of illnesses and
hospitalization in the past six months complains about feeling nauseated and wanted to vomit
this morning. The client verbalized “napapadalas yata akong mahilo nitong mga nakaraan”, but
she cannot remember when it actually started. “Kapag matagal na ko nakatayo or naglalakad,
lalo ako nahihilo”, the client added. According to the patient, 3 days prior to initial check-up
when she realized she missed three menstrual periods already and decided to take a pregnancy
test. The pregnancy test was positive and described her anxious and worried feeling about her
first-time pregnancy.

Associated with the presumptive signs of pregnancy are the cravings for sour foods.

The patient stated that “wala akong maalalang gamot na iniinom na makakasama sa
pagbubuntis”
Past Medical History: In accordance to the patient’s knowledge about her recent immunization
or vaccination, what she clearly remembers is having taken a flu vaccine shot, and no other
vaccinations the patient can recall taking. The patient also told the nurse that as far as she can
remember, the only hospitalization she had was when she was in elementary when she had a
dengue, and was confined 5days at the hospital. She described that it never happened or has
been a cause for other illness.

Familial History: The patient also told the nurse that as far as she can remember, no occurrence
of hereditary diseases in their family. Her father, who is a smoker, shows no signs of disease
positive to hereditary diseases

Social History: The patient denies an active history of alcohol, smoke, and drug intake. She has
a solid relationship with her family and a friendly neighborhood.

PERSON GORDON’S

Psychosocial

Patient J A., consulted the OB clinic for missing three menstrual periods. She is alarmed by the
signs and symptoms that she is experiencing and that it might be a pregnancy. She also stated
that she is not depressed and has no experience of violence or drug abuse. However, she is
feeling anxious and worried that she might not be able to take care of her newborn baby
because it is her first pregnancy. Her husband and their families are in full support of her
pregnancy. They are happy and excited because after years of waiting, finally J.A and her
husband will have a baby.

Elimination

Patient J A’s verbalizes that her urination increased far from her usual frequency of urine when
she is not pregnant. Also, she mentioned that she experienced constipation as part of
pregnancy.

Rest.

Patient J A. claims that she maintains her rest and wellness at home having 8 hours of sleep
everyday. Having a complete 8 hours of sleep and relaxation a day, she also mentions that she
visits spa. She usually scheduled this every end of the month to relieve all the tension and
anxiety she’s feeling because of her first pregnancy.
Safe Environment

Patient Julia A described their house as “good for the family”, as it is free from hazards and
accidents such as unrailed staircases and slippery areas. She also mentioned that her
neighborhood is calm and peaceful as they interact when she is doing outdoor activities.

Oxygenation

Patient J A. verbalizes that she experiences fatigue after doing household chores but has no
difficulty in breathing

Nutrition

Patient J A. claims that she maintains her food intake but sometimes eats junk foods and
chocolates whenever she is hungry. She follows a diet that her doctor recommended for her
that is appropriate for her condition. As she went along with the process, she also mentioned
that she always craves for ripe mango and calamansi juice. The Doctor instructed Julia A to
take 2400kcal per day diet as tolerated consisted of variety of food choices as sources for
nutrients such as calcium, protein and DHA, especially iron, to prevent anemia. Doctor also
instructed to avoid alcohol or caffeine intake.

BEFORE DURING ANALYSIS AND

(ANTEPARTUM) (INTRAPARTUM) INTERPRETATION

PSYCHOLOGICAL anxious and worried Shows restlessness, Anxiety is normal

about first time and feeling of especially during the first
pregnancy worriedness before pregnancy of a woman.
the delivery
has been given full The patient was able to
support from family Upon newborn’s perceive her new role by
and partner delivery, patient showing excitement for
shows relief and the baby.
excitement for the
baby

ELIMINATION Verbalizes an urge to Normal signs of

urination increases defecate elimination and
and experiences discharge during
constipation Amniotic discharge pregnancy and upon
were Colorless and delivery was observed.
non-odorous upon
labor Patient should expect
normal bowel movement
Presence of Lochia after 3 days.
Rubra during First Pain during urination
hours of postpartum happens during the first
 six weeks after delivery.

REST AND SLEEP Verbalizes “too Rest and sleep

Maintains 8 hours of exhausted” and requirement for a
sleep everyday. wanted to rest pregnant mother has
been met during the
Visits the spa at least antepartum period
every end of the
month Verbalizations of
exhaustion during the
postpartum is more likely
a result of exhaustion
from continuous labor.
Though normal,
continuous monitoring
and assessment should
be done to determine
risks and success of care

SAFETY AND Patient shows facial The patient lives in a

SECURITY Free from hazards grimace and cold house free from risk and
and accidents such sweating. hazards that may cause
as unrailed staircases injury which is good for
and slippery areas. Observable anxiety. both the mother and the
Tremors and tensions baby
are also noted
Mother verbalizes
No complications and feelings of anxiety which
accident was alters her feeling of
recorded upon safety and security
delivery because of the
experience of first time
pregnancy which is later
overcomed after a series
of nursing intervention
and health teaching

OXYGENATION STAGE 2 Experience of easy

experiences fatigue BP: 120/90, fatigability is normal
after doing household RR: 22, during pregnancies.
chores but has no PR: 98, Constant monitoring
difficulty in breathing Temperature: 37.5C, should be considered to
FHR is 150bpm assess difficulty in
breathing

An increase in Blood
pressure and pulse
respiration rate is
observed caused by
 continuous labor.
COnstant monitoring
should be done to
assess the need for
oxygenation

NUTRITION 2400 kcal per day as Instructed with Diet Patient was able to
per doctor’s order as Tolerated when maintain her diet all
fully awake throughout her
Claims to maintain pregnancy.
food intake though
sometimes eats junk After delivery, the patient
foods was given a D5LRS as
treatment of shock.

As per doctor’s order the

patient must maintain
2000- to 2,500 cal.
Additional intake for Iron
for the blood lost during
deliver and fluids to
increase milk for
breastfeeding

B. Physical Examination

INITIAL CHECK UP
Patient J A. is 5’4” in height. Has a weight of 82kg. The mother’s vital signs were taken with
110/80 blood pressure, 16 RR, 98 PR, and 37 C temperature.  Breasts are symmetrical with
noticeable inversion of nipples and tenderness. No discharge was reported. Presence of non-
odorous, clear, jelly-like discharge. This is Julia A’s first pregnancy and no perineal scar or
history of episiotomy is present. Julia A also verbalized that she experiences frequent urination
and described, “Madaling mapagod”. EDC is November 15, 2020

PRENATAL
Upon Physical examination, J A. exhibited the presence of Melasma, Linea Nigra and Striaeum 
Gravidorum. Her fundal height is at 25cm. Presence of Hegar, Goodell, Chadwick and fetal
outline was also observed. Julia A verbalized about occasional quickenings especially after
meals.

INTRAPARTUM
Stage1
Positive Reddish discharge prior to labor. Positive contractions occurring 45seconds with 3-
5minutes intervals. Amniotic fluid was clear and no odor. Further examination revealed Julia A’s
cervix to be 80%effaced and 5cm dilated. Julia A verbalizes “lalo atang sumasakit mga hilab ko”
and shows facial grimace, poor eye contact, irritability and cold sweating. Vital signs are BP:
110/80, RR: 24, PR: 96, Temperature: 37C.

Stage 2
Verbalizations of restlessness, worried, and anxious. J A. reported pain had become more
manageable than before and the delivery of the baby lasted longer than expected upon
administration of the epidural block. An increase in perspiration and observable tremors and
tension are noted. J A. verbalizes feelings of contraction and urge to defecate. Vital signs are
BP: 120/90, RR: 22, PR: 98, Temperature: 37.5C, FHR is 150bpm. Upon child delivery, the
baby boy weighs 6lbs 5oz delivered in ROA position.

Stage 3
Mother shows signs of relief, and excitement for the baby. The nurse observed a raised fundus
with globular and firm upon palpation. Umbilical cord was noted to have lengthened. Placenta
was delivered in a schultze method of separation with 20cotyledons. Presence of first degree
mediolateral laceration.

POSTPARTUM
J A. complains of pain and discomfort in the suture site. Vital signs were 99F temperature,
120bpm PR, 110/70 BP, 16cpm RR, and a pain scale of 8/10. Poor attachment was observed.
Uterus at midline and contracted with reddish discharges. J A.is constipated and the presence
of erythema and edema was observed. The breast was full and feeling of heaviness with
notable inverted nipples. Uterus have risen to the level of umbilicus and are still palpable.
Mother has not had any bowel movement and has an increased urination. Mother describes
weakened lower extremities and she wanted to rest. Mediolateral episiotomy was performed,
and presence of lochia rubra was noted.

C. Diagnostic Procedure

Name: Complete Blood Count (CBC) Test

Definition: Evaluates cells that circulate the blood.
Indication: Results in the following areas above or below the normal ranges
on a complete blood count may indicate a problem.
• Red blood cell count, hemoglobin and hematocrit. If the measures in
these three areas are lower than normal, you have anemia. A red blood cell
count that's higher than normal (erythrocytosis), or high hemoglobin or
hematocrit levels, could point to an underlying medical condition, such as
polycythemia vera or heart disease.
• White blood cell count. A low white blood cell count (leukopenia) may
be caused by a medical condition, such as an autoimmune disorder that
destroys white blood cells, bone marrow problems or cancer. If your white
blood cell count is higher than normal, you may have an infection or
inflammation. Or, it could indicate that you have an immune system
disorder or a bone marrow disease.
 • Platelet count. A platelet count that's lower than normal
(thrombocytopenia) or higher than normal (thrombocytosis) is often a sign
of an underlying medical condition, or it may be a side effect from
medication.

Nursing Responsibilities:
• Verify physician’s order
• Verify Client
• Explain procedure to the client.
• Monitor puncture site for risks of bleeding or infection.

Normal Value Values

Name of Date (standards of Obtained Interpretation
Procedure Ordered the hospital) (Results of
the test)
Complete May 10, Hemoglobin: 11.0-14.3 Hemoglobin: 14 with normal level
BloodC 2020 g/dl
RBC: 3.52-4.52 RBC: 4*10^6/ul with normal level
HCT: 31-41% HCT: 35% with normal level
MCV: 81-96 fl MCV: 81-82 fl with normal level
MCH: 27-32 MCH: 26 pg The MCH is below
normal but not
significant. Below
normal MCH
might indicate a
deficiency in folic
Acid, since folic
acid is utilized in
the development
of the brain of the
fetus

Platelets: 150-400 Platelets: with normal level

160*10^/ul
WBC: 5000-13000 WBC: with normal level
6000*10^3/ul

Name: Urinalysis
 Definition: Used to detect and manage a wide range of disorders such as
UTI, kidney disease and diabetes. It involves checking the appearance,
concentration and content of urine.
Indication:
• Urine specific gravity is the measure of urine and overall
concentration.
• The higher the number of the gravity, the more the person is
dehydrated.
• Abnormal specific gravity results could indicate: excess substance
in blood, kidney disease and infection or brain disease.

Nursing Responsibilities:
• Verify physician’s order
• Verify Client
• Explain procedure to the client and instruct the client to clean the
perineum before collecting urine.
• Instructs patients to catch midstream urine.
• Instructs patients to void directly into a clean dry specimen
container.
• Cover specimens tightly, label properly and send into the
laboratory.

Normal Value Values

Name of Date (standards of Obtained Interpretation
Procedure Ordered the hospital) (Results of
the test)
Urinalysis November Appearance: Clear Appearance: Clear with normal level
10, 2020 Color: Pale Yellow- Color: Pale Yellow with normal level
Yellow
Reaction (pH): 5-6 Reaction (pH): 5 with normal level
Specific gravity: 1010- Specific gravity: with normal level
1030 1010
Protein: Negative- Protein: Negative with normal level
Traces (less than
30mg/dl) 
Glucose: Negative Glucose: Negative with normal level
Ketones: Negative Ketones: Negative with normal level
Epithelial Cells: 0-4 Epithelial Cells: 1  with normal level
p.v.f p.v.f
Erythrocytes: 0-4 p.v.f Erythrocytes: 2 with normal level
p.v.f
Pus Cells: 0-4 p.v.f Pus Cells: 4 p.v.f with normal level
 Name: Blood typing
Definition: This test checks her blood type and Rh factor. And done
before a person gets a blood transfusion and to check a pregnant
woman's blood type\
Indication:
• Blood typing is a method to tell what type of blood you have.
• Blood typing is done so you can safely donate your blood or receive a
blood transfusion.
• It is also done to see if you have a substance called Rh factor on the
surface of your red blood cells.

Nursing Responsibilities:
• Verify physician’s order
• Verify Client
• Explain procedure to the client.

Normal Value Values

Name of Date (standards of Obtained Interpretation
Procedure Ordered the hospital) (Results of
the test)
Blood November AB+ Patient blood type
typing 10, 2020 is AB+

Name: Ultrasound
Definition: An ultrasound scan is a medical test that uses high-frequency
sound waves to capture live images from the inside of your body. It’s also
known as sonography.
Indication:
•Vaginal bleeding, pelvic pain, or any concern for an ectopic pregnancy.
•To confirm intrauterine gestation and cardiac activity and to estimate
gestational age
•To evaluate pelvic or uterine masses

Nursing Responsibilities:
•Explain to the patient the procedure and its purpose.
•Instruct the mother not to void before the procedure.
•Ask the patient to relax while the procedure is going on.

Normal Value Values

Name of Date (standards of Obtained Interpretation
Procedure Ordered the hospital) (Results of
the test)
Ultrasound 25cm Fundal
Height
Baby Boy

D. Anatomy and Physiology

Labia majora- The labia majora enclose and protect the other external reproductive
organs. During puberty, hair growth occurs on the skin of the labia majora, which also
contains sweat and oil-secreting glands.
Labia minora- The labia minora (“small lips”) can have a variety of sizes and shapes.
They lie just inside the labia majora, and surround the openings to the vagina and
urethra. This skin is very delicate and can become easily irritated and swollen.
Symphysis Pubis- Cartilaginous joint in the hips. Takes part as the passage in labor
Mons Pubis- Surrounds the symphysis pubis and other structure of the vulval vestibule
Vagina- The vagina is a canal that joins the cervix (the lower part of uterus) to the
outside of the body. It also is known as the birth canal.
Uterus (womb)- The uterus is a hollow, pear-shaped organ that is the home to a
developing fetus. The uterus is divided into two parts: the cervix, which is the lower part
that opens into the vagina, and the main body of the uterus, called the corpus. The
corpus can easily expand to hold a developing baby. A canal through the cervix allows
sperm to enter and menstrual blood to exit.
Vagina/Vaginal Opening- A canal that joins the lower part of the uterus to the outside of
the body. part takes as a passage of the baby during delivery.
Placenta- allows transport of selected nutrients and substances between mother and
the fetus
Amniotic Sac- Contains amniotic sac which Protects the fetus during pregnancy against
pressure or blow to the mother’s abdomen
Umbilical Cord - carries blood back and forth between the baby and the placenta. It
delivers nutrients and oxygen and removes waste products from the baby
Cervix- Acts as an opening into the uterus. Thins and dilates when the baby is being
delivered
E. Pathophysiology / Disease Process
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
CHAPTER II PLANNING

A. List of Prioritized Nursing Diagnosis

CUES NURSING DX JUSTIFICATION

ANTEPARTUM
Subjective –
- She verbalized that she
is quite anxious about
the pregnancy, she’s
worried that she might
not be able to take care
of her newborn
Objective –
- Insufficient confidence,
self-management, and
skills
INTRAPARTUM
Subjective Data
verbalizes feelings of
contraction and an urge to
defecate and restlessness
Objective Data
Observable trembling
shows facial grimace,
nervousness, worried
Increased tension.
restlessness
irritable
Poor eye contact
Increase in perspiration
Positive contractions
occurring 45seconds with 3-
5minutes intervals each.
Active stage of labor at
80%effaced and 5cm dilated
Ineffective role Based on Maslow’s Hierarchy of
performance related to needs this falls under Esteem,
insufficient role since the mother should reach a
sense of confidence and positive
preparation as
outlook within her own body and
evidenced by first capabilities in order to perform
pregnancy her roles and responsibilities
with her newborn.
“Anxiety related to Safety, every individual needs
active labor as assurance of them being safe
evidenced by during the labor. Giving
contraction and assurance makes us sure that
verbalizations of we are in good hands. Also,
nervousness, worried, receiving enough assistance
and restless feelings. makes it easier for us and it
should be a priority.
Doenges, M.,
Moorhouse, M., & Murr,
A. Labor Pain. Nurse’s
Pocket Guide:
Diagnoses, Prioritized
Interventions, and
Rationales, (15th Ed.),
Page 648-652
 cervix.

VS:

-PR: 120
-Pain scale of 8/10

POSTPARTUM

Subjective – Acute pain related to According to Maslow's hierarchy

episiotomy as of needs, this falls under the
Verbalization of feeling of evidenced by  pain category of Safety where every
soreness. person needs assurance of
score of 8/10
security. One must feel secure
Objective – and safe from all harm and the
-Shows facial grimace threat that is occurring to one
https://nurseslabs.com/ person should and must be
-Restlessness eliminated thus giving comfort to
acute-pain/
the patient.
-guarding behavior in her
perineum area

-shows irritability

-Diaphoretic

-Mediolateral episiotomy

-Erythema and edema are

present on the perineum.

-Moderately soaked
perineal pad with brownish
discharge

Measurable cues:

-120bpm PR

-pain scale of 8/10

Subjective:
“Hindi makadede ng maayos
ang baby ko” verbalized by the
mother
Ineffective
breastfeeding related to This falls under the Physiologic
poor attachment needs since latching is a way to
breastfeed the baby and get
evidenced by  poor
enough breast milk to gain
infant sucking reflex weight and the primary food of
 She verbalized that her baby
has difficulty in latching
Verbalized feeling of heaviness
and tenderness on the breast
and breast anomaly the newborn is the mother’s
evidenced by flat nipple breast milk which is necessary
for the baby’s satisfaction and
ensure proper nutrients

Objective
Observable signs of inadequate
infant intake

notable nipple inversion

fullness of the breast

warm to touch

manifest slight fever as

evidenced by 38.2 C

Subjective – Impaired skin integrity Based on Maslow’s Theory of

“Mahapdi po yung tahi ko.
Medyo naiiyak pa rin po ako
sa sakit.”
Objective –
-Shows facial grimace
related to surgical Needs, this falls under Safety.
incision as evidenced The mother must be free of
danger and pain. She must feel
by first degree
secured with her own body in
laceration on the order to return to its normal
perineum function and be able to perform
her role as a mother.

-limited movement

-1st degree laceration

-Erythema and edema are

present on the perineum.

-No purulent drainage

-Moderately soaked
perineal pad with brownish
discharge

Measurable cues:

-120bpm PR

-pain scale of 8/10

 B. Nursing Care Plan

ANTEPARTUM 

CUES NURSING SCIENTIFIC PLANNING IMPLEMENTATION SCIENTIFIC EVALUATION

DIAGNOSIS EXPLANATION RATIONALE

Subjective Data – Ineffective Independent:

- She role A pattern of After the nursing *After the nursing
verbalized performance behavior and self intervention, the - Encourage the - Enhances self- intervention, the
that she is -expression that patient will be mother to exercise concept and patient was able to
related to
quite does not match able to: control over as many promotes verbalize
anxious insufficient the environmental understanding of
decisions as possible commitment to
about the role context, norms, -Verbalize role expectations or
such as choosing goals
pregnancy, preparation and experiences. understanding of preferred childbirth obligations.
she’s as evidenced role expectations methods.
worried by first and decrease in
*The patient was
that she pregnancy anxiety
- Assist the patient to able to verbalize
might not - Changes in role
express her feelings realistic perception
be able to References:  -Apply necessitated by
(worries and and acceptance of
take care NANDA Nurse’s communication changes in family
anxieties) freely self in a changed
of her Pocket Guide 15th and relaxation structure due to
about role changes role.
newborn edition, page 743 techniques in having a new
order to alleviate by discussing and
baby results in
the anxiousness also encourage
the need to deal *Patient was able to
Objective Data – celebration of
with the feelings identify how to adapt
- Insufficient -Develop positive aspects of
that accompany to the new role.
confidence, sufficient change and
change (bringing
self- knowledge on expressions of
a new baby *The patient
manageme skills that is feelings.
home). exhibited a positive
nt, and necessary for
attitude towards
skills giving newborn
health personnel
care
and people after
- Introduce joining support
- Role rehearsal
techniques for role groups.
Outcome Criteria: helps in coping
rehearsal like using
up with role
dolls as tools to help *The patient
-The patient will changes.
the client develop expresses reliance
identify new ways skills necessary for in herself.
for possible giving newborn care.
adaptation to
new role / role
- Provide a pamphlet
changes.
for health teaching - Provides
on how to take care knowledge that
-The patient will
of a newborn to learn gives opportunity
express a
about role for the patient to
positive attitude,
expectations. be proactive in
confidence and
dealing with
reliance towards
changes.
her support
group, and the
healthcare - Encourage the
workforce. mother to attend
support groups,
parent effectiveness
training, and mother
classes to gain more
knowledge to plan
ahead for her birth
with confidence.
- Support groups
 Collaborative: provide ongoing
support and
- Upon agreement, coping strategies
refer the patient to to sustain
support groups, progress.
parent effectiveness
classes, and mother NANDA Nurse’s
classes. Pocket Guide
15th Edition,
NANDA Nurse’s pages 743-747
Pocket Guide 15th
Edition, pages 743-
747

INTRAPARTUM

Cues Nursing Scientific Explanation Planning Implementation Scientific rationale Evaluation

Diagnosis
Subjective Independen
Data Vague uneasy feeling t
“Anxiety of discomfort or dread after a series To determine appropriate after a series of
verbalizes related to accompanied by an of nursing -Assess level of intervention and patient nursing
feelings of active labor as autonomic response intervention anxiety, taking perception of the intervention
evidenced by
contraction from active labor during labor note of cultural situation during labor
contraction
and an urge during the period, The preferences and period, The client
and
to defecate verbalizations intrapartum stage of client will be physical reaction will be able to:
and of labor; a feeling of able to: to stimuli as to:
restlessness nervousness, apprehension caused
worried, and by anticipation of -discuss Client was able
restless danger. It is an feelings of to express
a. Mild,
Objective feelings. alerting sign that anxiety to be feelings of
warns of impending reduced and b. moderate anxiety at a
Data c. severe
danger and enables at a - Aids in decreasing sense manageable
the individual to take manageable d. panic level
Observable NANDA 15th of isolation, and assists
edition pg.36-37 measures to deal with level the client to feel less
trembling
that threat. anxious
-appear -Provide Comfort The nurse
shows facial measures such
relaxed as observed the
grimace, as calm
Reference: evidenced by client to have
nervousness, environment,
reduced appeared
worried back rub, and
trembling and -understanding clients relaxed
https://kidshealth.org therapeutic
facial tension perception of anxiety appropriate to
Increased /en/parents/childbirth touch
provides more accurate the labor
tension. -
plan of care situations
pain.html#:~:text=Pai
-identify clients evidenced by
restlessness n%20During%20Labor
-use of perception of reduced
%20and
available anxiety -Helps to reduce trembling and
irritable %20Delivery,well
support represented by anxiety and enables facial tension
%20as%20an%20achy
Poor eye %20feeling. systems first pregnancy client to participate
effectively actively Client was able
contact
such as health -demonstrate to utilize the
  presence of
Increase in practitioners the different
relaxation support systems
perspiration
https://www.marchof techniques such as health
-respond
dimes.org/pregnancy/ including muscle practitioners
Positive positively to
stages-of-labor.aspx# relaxation, efficiently
contractions relaxation
  breathing, and -Enables the client to
occurring techniques
mindfulness independently perform
45seconds including
breathing relaxation
with 3- muscle
-Encourage the techniques for herself
5minutes relaxation, Client was able
use or appropriate to the labor
intervals breathing, and to respond and
continuation of situation
each. mindfulness perform
breathing
 positively to
Active stage techniques and relaxation
of labor at relaxation techniques
80%effaced https://nurses exercises
and 5cm labs.com/anxi
dilated ety-panic- - Establish a
cervix. disorders- therapeutic
nursing-care- relationship,
VS: plans/ conveying -To avoid transmission of
empathy and anxiety, establishes
-PR: 120 unconditional rapport and to provide
-Pain scale positive regard ongoing and timely
of 8/10 such as: support

a. Positive
reassurance and
recognition

b. update client
regarding
progress of labor

c. Be available to
the client for
listening and
talking

https://extranet.
who.int/rhl/topic
s/preconceptio
n-pregnancy-
childbirth-and-
postpartum-
care/care-
during-
childbirth/care- NANDA Nurse’s Pocket
during-labour- Guide 15th edition, page 36-
1st-stage/who- 41
recommendatio
n-relaxation-
techniques-
pain-
management-
during-labour

 Early labor
For most first-time moms, early labor lasts about 6 to 12 hours. You can spend this time at home or wherever
you’re most comfortable. During early labor:

-    You may feel mild contractions that come every 5 to 15 minutes and last 60 to 90 seconds.  

-   You may have a bloody show. This is a pink, red or bloody vaginal discharge. If you have heavy bleeding or
bleeding like your period, call your provider right away.  

Active labor
Active labor usually lasts about 4 to 8 hours. It starts when your contractions are regular and your cervix has
dilated to 6 centimeters. In active labor:

-      Your contractions get stronger, longer and more painful. Each lasts about 45 seconds and they can be as
close as 3 minutes apart.
 -  You may feel pressure in your lower back, and your legs may cramp.

-  You may feel the urge to push.

your cervix will dilate up to 10 centimeters. if your water hasn’t broken, it may break now.

-You may feel sick to your stomach.

POSTPARTUM

Cues Nursing Scientific Planning Implementation Scientific rationale Evaluation

Diagnosi Explanation
s
Subjective Acute pain Breakdown of Independent OUTCOME
Data– related to skin on the After 30 to
episiotomy perineum area 1hour of - To determine -Client able to
Verbalization of wound as caused by the nursing -Assess level of the intensity, verbalize pain
feeling of evidenced mediolateral intervention pain location, at a tolerable
soreness. by  pain episiotomy the client duration and level and
score of will be able description. reduce the
Objective Data – 8/10 to; pain 2/10
-shows facial Unpleasant
grimace sensory  -Assess client’s
experience -Verbalized potential type and -To aid in
associated reduced pain perception of pain understanding
-Restlessness from 8/10 to reason for severity
with actual
tissue damage 2/10 of pain
-guarding -Demonstrate
from surgical client’s attitude - Client may have
behavior in her incision
perineum area toward pain and health beliefs
secondary to use of non restricting use of
episiotomy pharmacological medication and
-shows irritability wound upon and non other
NSD pharmacological interventions
-diaphoretic intervention

-mediolateral
episiotomy
-To prevent the
-Encourage client spread of
-Erythema and in doing the microorganism
edema are proper hygiene and to avert
present on the and handwashing infection
perineum.

-Moderately
soaked -Provide a sitz
perineal pad bath -To alleviate
with brownish urinary retention
discharge and to hasten
the healing
 -Identify ways process.
Measurable cues: to avoid or
minimize pain
-120bpm PR in a form of: - To alleviate
pain using
-pain scale of 8/10 Diversional therapeutic and
activity psychological
through approaches.
watching
television, - To maintain
listening to acceptable levels
music, of pain.
  socialization
  with
significant
others, and
other prefered
activity

-Observe
client for
possible sign
and
symptoms of
infection in -To assess
the perineum possible infection
area that could
aggravate the
pain
-Assess lochia
frequently to
maintain normal
amount of
discharge

-Administer cold
compress using
ice pack to -To recognize
reduce swelling risk for
between the legs postpartum
hemorrhage
- Promote
personal perineal
hygiene and self-
care -practices
-To decrease
Collaborative: pain and
promote healing
 -Administering
analgesics as
indicated by the
Doctor’s order. -To avoid
possible infection
on the incision or
suture site

-Act as a last
resort to relieve
pain
  NANDA Nurses
Pocket Guide 15th
Edition, page
633-638

Doenges, M., et. al., 2019. NANDA Nursing Pocket Guide Book: Acute Pain, pp. 633-638.

CHAPTER III IMPLEMENTATION

A. Medical Management
1. Drug Study

10 Rights of Drug Administration

Right Drug- The first right of drug administration is to check and verify if it’s the
right name and form. Beware of look-alike and sound-alike medication names.
Misreading medication names that look similar is a common mistake. These look-
alike medication names may also sound-alike and can lead to errors associated
with verbal prescriptions.
Right Patient- Ask the name of the client and check his/her ID band before giving
the medication. Even if you know that patient’s name, you still need to ask just to
verify.
Right Dose- Check the medication sheet and the doctor’s order before medicating.
Be aware of the difference between an adult and a pediatric dose.
Right Route- Check the order if it’s oral, IV, SQ, IM, etc.
Right Time and Frequency- Check the order for when it would be given and when
was the last time it was given.
Right Documentation- Make sure to write the time and any remarks on the chart
correctly.
Right History and Assessment- Secure a copy of client’s history to drug
interactions and allergies.
Drug approach and Right to Refuse- Give the client enough autonomy to refuse
the medication after thoroughly explaining the effects.
Right Drug-Drug Interaction and Evaluation- Review any medications previously
given or the diet of the patient that can yield a bad interaction to the drug to be
given. Check also the expiry date of the medication being given.
Right Education and Information- Provide enough knowledge to the patient of
what drug he/she would be taking and what are the expected therapeutic and side
effects.
 Drug Classificatio Dose Mechanism Contraindication Side Effects Nursing
n& Route & of Action Responsib
Indication Frequenc ilities
y

1.Generic Therapeutic 50mg Binds with Avoid for patients CNS:

Meperidine class: IV opioid with ESRD agitation, Carefully
hydrochlori   Opioid receptors in dizziness, monitor vital
de analgesics the CNS, Use cautiously in euphoria, signs, pain
altering elderly or debilitated sedation, tremor, level,
2.Brandna Pharmacologic perception of pt and in those with headaches respiratory
me: class: and increased ICP, head status and
DEMEROL    Opioids emotional injury, asthma, and CV: sedation
Adults: response to other respiratory bradycardia, level
repeated slow pain conditions cardiac arrest,
IV injection or shock,
continuous IV Not advisable in hypotension,
infusion pregnant women tachycardia,
Have child
according to before labor unless palpitations
resuscitation
patient’s needs indicated by
equipment
physician and GI:
and
determines potential biliary tract
naloxone
benefits outweigh spasms,
available
possible risks constipation, dry
when used
mouth, ileus,
during labor
Patient should nausea, vomiting
discontinue breast-
feeding or GU: urine  
discontinue drug retention
use because drug Monitor
appears in breast MS: bladder
milk muscle twitching function after
delivery
OVERDOSE signs RESPIRATORY:
and symptoms: arrest, Monitor
depression bowel
Respiratory function.
depression, SKIN: Patient may
somnolence diaphoresis, need a
progressing to pruritus, urticarial stimulant
stupor, coma, laxative and
bradycardia, OTHER: stool
hypotension, induration, local softener
hypothermia, tissue irritation,
delirium, skeletal pain at injection Monitor
muscle flaccidity, site, phlebitis client for
circulatory collapse, after IV delivery possible fall
death
DRUG Classificati Dose, Mechanism Contraindic Side Effects Nursing
on and Route, and of Action ation Responsibilities
Indication Frequency
1. Cephalexin Therapeutic 750 mg Cephalexin is a Does not treat Common: Report severe
Class: PO bactericidal viral infection Diarrhea diarrhea with blood,
anti-toxins Every 8 hrs. agent that acts pus, or mucus; rash
called by the inhibition Patients should CNS: or hives; difficulty
cephalosporins. of bacterial cell- be told to Headache, dizziness, breathing; unusual
2. Brand Name wall synthesis. complete the lethargy, tiredness, fatigue;
CEPOREX Adults: full course of paresthesias unusual bleeding or
Guidelines treatment, even bruising.
recommend a if they feel GI:
beta-lactam for better earlier. Nausea, vomiting, Avoid alcohol while
3 to 7 days as diarrhea, anorexia, taking cephalexin.
alternative Cephalexin abdominal pain,
therapy for should be used flatulence, Take the medication
cystitis when with caution in pseudomembranous with food.
other agents patients with colitis,
cannot be used. renal hepatotoxicity Complete the full
Beta-lactams impairment or course of this drug
generally have renal failure GU: even if you feel
inferior efficacy since the drug Nephrotoxicity better.
than other is eliminated
agents. via renal Hematologic: Bone Assess the client if
mechanisms. marrow depression he/she has allergies
https://www.pdr with the medication.
.net/drug- Prolonged use Hypersensitivity:
summary/Kefle of cephalexin Ranging from rash to Monitor for possible
x-cephalexin- may result in fever to anaphylaxis; allergic reaction.
1565 overgrowth of serum sickness
non susceptible reaction https://www.rnpedia.
organisms. com/nursing-
Other: notes/pharmacology-
Symptoms of Superinfections drug-study-
overdose may notes/cephalexin/
include:
● nausea
● vomiting
● diarrhea
● pink, red,
or dark
brown urine
● stomach
pain
DRUG Classificati Dose, Mechanism Contraindic Side Effects Nursing
on and Route, and of Action ation Responsibilities
Indication Frequency
1. Ferrous - Oral - 1 tab QD - Description: - Gastrointestinal - May cause
Sulfate Prevention and Ferrous sulfate Haemochrom disorders: seizures,
treatment of - PO facilitates atosis, other Gastrointestinal hypotension,
Iron- oxygen iron overload irritation, nausea, constipation,
2. Brand name deficiency - 30 min before transport via syndromes. vomiting, epigastric epigastric pain,
Fersulfate Iron anaemia breakfast Hb. It is used Blood pain, diarrhoea, diarrhea, skin
as iron source disorders (e.g. constipation, staining,
- Antianemics as it replaces paroxysmal blackening of stool, anaphylaxis
iron found in nocturnal tooth discolouration,
- Iron Hb, myoglobin haemoglobinu abdominal discomfort. - Assess nutritional
supplement and other ria, status, bowel
enzymes. haemolytic Immune system function
anaemia, disorders:
- Onset: haemosiderosi Hypersensitivity. - Monitor
Haematologic s, other hemoglobin,
response: anaemias); hematocrit, iron
Approx 3-10 active peptic levels
days (oral). ulcer, regional
Peak effect: enteritis and - May cause
Reticulocytosis ulcerative elevated liver
: 5-10 days; colitis. Patient enzymes
increased Hb: receiving
Within 2-4 frequent blood - Take on an empty
weeks. transfusions. stomach to increase
Concomitant absorption/vitamin c
- Absorption: parenteral iron helps with
Absorbed therapy. absorption
mainly in the
duodenum and Special Inform client for
upper jejunum. Precautions possible darkening of
Food and Patient with the stool.
achlorhydria haemoglobino
may decrease pathies, iron https://nursing.com/
absorption. storage or iron blog/ferrous-sulfate-
absorption feosol-antianemics/
- Distribution: diseases,
Majority binds existing
to transferrin gastrointestina
and transported l disease,
to the bone history of
marrow. peptic ulcer,
intestinal
- Excretion: strictures or
Via urine, diverticula.
sweat, Children and
sloughing of elderly.
the intestinal Pregnancy
mucosa, and and lactation.
menses.

https://www.mi
ms.com/philipp
ines/drug/info/f
errous
%20sulfate?
 mtype=generic

DRUG Classificatio Dose, route, Mechanism Contradiction Side Effects Nursing

n and and of Action Responsibility
Indication Frequency

METHERG Therapeutic 500 mg Acts directly The uterotonic Side effects Monitor vital
INE Class: TID on the effect of of signs
ergot Oral smooth Methergine is Methergine (particularly
Brand alkaloids. muscle of utilized after include: BP) and
name: the uterus delivery to nausea, uterine
Ergon, and assist involution vomiting, response
Mergo and It works by increases the and decrease stomach during and
Ergojen increasing tone, rate, hemorrhage, pain, after parenteral
the rate and and shortening the diarrhea, administration
strength of amplitude of third stage of leg cramps, of
contractions rhythmic labor. increased methylergonov
and the contractions. sweating, ine until
stiffness of skin rash, partum period
the uterus headache, is stabilized
muscles. (about 1–2 h).
These Notify
effects help physician if BP
to decrease suddenly
bleeding. increases or if
there are
frequent
periods of
uterine
relaxation.

Drug Classification and Dose, route, Mechanism Contradiction Side Effects Nursing
Indication and of Action Responsibility
Frequency

Mefenamic Class: Oral Mefenamic Administration: Significant: Patient counseling

Acid Nonsteroidal 500 mg acid, an Should be taken Anaphylactoid information
Anti- TID anthranilic with foods reactions, fluid
Brand Name: inflammatory acid retention, Monitoring
Arthran Drugs (NSIDs) derivative, is Hypersensitivity. anaemia, parameters:
an NSAID. It Patients with hyperkalaemia Blood pressure
Adult : PO Mild reversibly active or history of should be
to moderate pain; inhibits recurrent peptic Lymphatic monitored during
 Postoperative cyclooxygena ulcer/haemorrhage system initiation of
pain. se-1 and -2 , history of Eosinophilia, treatment and
(COX-1 and gastrointestinal leukopenia, throughout the
-2). It bleeding or thrombocytopeni course of therapy.
exhibits perforation a, purpura,
analgesic, (related to agranulocytosis. Should be given in
anti- previous NSAID a shot time use.
inflammatory therapy),
and inflammatory CV: Instruct to take it
antipyretic bowel disease, Dyspnoea. with meals.
properties. severe heart Ear and labyrinth
failure, history of disorders:
asthma, Tinnitus.
bronchospasm,
rhinitis, GI:
angioedema, Diarrhoea,
urticaria, or nausea, vomiting,
allergic-type abdominal pain,
reactions after flatulence,
taking aspirin or constipation,
other NSAIDs. dyspepsia,
heartburn,
gastritis.

Integumentary:
Pruritus,
urticaria, rash,
erythema
multiforme.

Vascular:
Hypertension.

Drug Classification Dose, route, Mechanism of Contradiction Side Effects Nursing

and Indication and Frequency Action Responsibility

D5RLS Indicated as a IV Hypertonic Hypersensitivit ● itching,

source of 1L to run for 8 solutions are y to any of the ● hives, ● Do not
water hours those that have components. ● swelling of the administer
an effective face, unless the
Treatment for osmolarity ● puffy eyes, solution is clear
persons greater than ● coughing, and the container
needing extra the body ● sneezing, is undamaged.
calories who fluids. This ● sore throat, ● In very low birth
cannot tolerate pulls the fluid ● difficulty weight infants,
fluid overload. into the breathing, excessive or
Treatment of vascular by ● fever, and rapid
shock. osmosis ● injection site administration of
resulting in an reactions dextrose
increase (infection, injection may
 vascular swelling, result in
volume. It redness). increased serum
raises osmolality and
intravascular possible
osmotic intracerebral
pressure and https://www.rxlist. hemorrhage.
provides fluid, com/lactated- ● Properly label
electrolytes ringers-in-5- the IV Fluid
and calories dextrose- ● Observe aseptic
for energy. drug.htm#warning technique when
s changing IV
fluid
● Discard unused
portion.

https://www.rnpedia
.com/nursing-
notes/fundamentals-
in-nursing-
notes/d5lrs-lactated-
ringers-solution-iv-
fluid/

1. Treatment
1. Name of treatment  
INTRAVENOUS FLUIDS
D5LRS 1L to run for 8 hours
2. Indication / Purposes 
**-to reduce pain and increase comfortability all throughout the labor process
3. Nursing Responsibilities

**-Carefully monitor vital signs, pain level, respiratory status and

sedation level

-Have child resuscitation equipment and naloxone available when

used during labor

-Monitor bladder function after delivery

-Monitor bowel function. Patient may need a stimulant laxative and

stool softener

● Diet
DIET AS TOLERATED
Postpartum mothers, especially those who undergo normal spontaneous
deliveries, should eat a variety of foods and drink plenty of liquids to help
 replenish energy lost and help in recovery as well as production of breastmilk
and gaining nutrients necessary for breastfeeding.
Nursing Responsibility:
Independent
- Provide a nutrition screening and appropriate nutrition advice to the pt.
- Instruct the client to eat food rich in …
- Encourage the mother not to eat foods such as ...
Collaborative
- Consult the Registered Dietician about the appropriateness of the diet.

● Activity / Exercise
WALKING
Walking is a great way to exercise as it puts less stress over the body specially
for mothers who undergone NSD and episiotomy
Nursing Responsibility:
- Assess the tolerance of the pt on walking
- If assistance is needed, walk beside to support the pt.

BREATHING EXERCISES
Breathing exercises such as Yoga may help in alleviating stress and as a form
of methods of relaxation for postpartum mothers
Nursing Responsibility:
- Encourage the mother to practice proper and appropriate relaxation
techniques

● Surgical Management (if any)

Medio lateral episiorrhaphy
Done to reduce the risk for anal muscle tears during child expulsion of normal
spontaneous delivery
Nursing Responsibility:
- Assess for possible signs and symptoms of infection on the perineal area.

B. Nursing Management
PROCESS OF LABOR

Encourage use of comfort measures such as repositioning, perineal care, linen  

changes, and rubs
-Promotes relaxation and hygiene will enhance feeling of well-being 

Instruct use of appropriate breathing/relaxation techniques (Pant-blow)

--This may block impulses within the cerebral cortex through conditioned responses
and cutaneous stimulation, giving client a means to cope and control level of discomfort

Provide a quiet and ventilated environment

--Undistracting environment provides optimal opportunity for rest and relaxation

CHAPTER IV EVALUATION
 A. Narrative Evaluation of Actual Nursing Problems:

During the Antepartum Period: she expressed her anxiety about pregnancy and
additionally stressed that she probably would not be able to take care of her newborn;
Insufficient confidence, self-management, and skills was also observed in our client. After
nursing interventions, the basis for concluding that the goals were met are, able to
verbalize understanding of role obligations, realistic perception and acceptance of self in a
changed role, identify how to adapt to the new role by exhibiting a positive attitude towards
health personnel and people after joining support groups, and also expressing reliance in
herself.
During the Intrapartum Period: Assessment revealed the patient having
observable trembling, showing grimace, nervousness, worriedness, increased tension,
restlessness, irritability, increased perspiration, poor eye contact, a positive contractions
occurring 45 seconds with 3-5 minutes interval consistently, 80% effacement and 5 cm
dilation of the cervix, pulse rate of 120 bpm and scored 8/10 for the pain scale. After a
series of nursing interventions during the labor period the patient was able to respond
and perform positively to relaxation techniques and express feelings of anxiety at a
manageable level. the client also exhibited relaxed appropriateness to the labor
situations evidenced by reduced trembling and facial tension. And lastly, utilizatilizing the
presence of support systems such as health practitioners efficiently.

During the Postpartum Period, assessment revealed 120 bpm for the pulse rate
and scored 8 out of 10 in the Pain Scale. Patient also revealed having observable facial
grimace, restlessness, guarding behavior in her perineum area, irritability, diaphoresis,
mediolateral episiotomy, erythema and edema present on the perineum, moderately
soaked perineal pad with brownish. discharge.Also the patient verbalized the feeling of
being sore. After 30 minutes to 1 hour of nursing intervention when the patient was able
to verbalize pain at a tolerable level and reduced pain that scored 2 out of 10 in the pain
scale which means the goal was met.

B. Discharge Summary Instructions:

Patient Julia A. was advised to remain at strict pelvic rest and nothing to be
inserted into the vagina for 6 weeks which includes no tampons, douching or sexual
intercourse. The doctor advised her to call immediately if there are signs and symptoms
of infections including increased pain, fever, heavy discharge, and increased use of
pad/hour. Medication at discharge includes Cephalexin 750mg/capsule every 8 hours
orally (8am, 4pm,12mn), Ferrous sulfate 1 tab once a day orally 30 mins before
breakfast, Methergine 1 tab three times a day orally (8 am, 1 pm, 6 pm), and Mefenamic
acid 500mg three times a day orally (8 am, 1 pm, 6 pm) and continue her Postnatal
vitamins. Follow an advanced diet as tolerated. The doctor asked for a follow-up routine
postpartum check up in 6 weeks and if the patient would like to ask for contraception that
will be further discussed at the postpartum visit.

MEDICATION
Data given from case study are insufficient. Over the counter Pain relievers may be applicable
for pain management of suture sight. To reduce the incidence of infections, antibiotics are often
administered to patients after childbirth.

● Cephalexin 750mg/capsule every 8 hours orally (8am, 4pm,12mn)

● Ferrous sulfate 1 tab once a day orally 30 mins before breakfast
● Methergine 1 tab three times a day orally (8 am, 1 pm, 6 pm)
● Mefenamic acid 500mg three times a day orally (8 am, 1 pm, 6 pm)

EXERCISE

Walking and breathing exercises may be appropriate as it is the most suitable because it has
less stress for the body who recently undergone episiotomy and NSD. Breathing exercises will
promote relaxation and stress management. Assisting the patient in activities of daily living in
dire need of assistance and allowing patient independence in activity for as long as safety and
tolerance is considered will also enhance integrity and self’s sense of control

● Walking for 15-30 mins every day

● Kegel exercises
● Sit backs
● Ankle circles
● Leg stretches
● Arm and upper back stretches

TREATMENT

● Monitor vital signs, as a precautionary measure for assessing risk and complications
such as infection.
● Promote perineal care as part of preventing infection and postoperative management for
episiotomy.
● Monitoring of signs and symptoms of pain and appearance of suture sight and perineal
area for assessment and modification of pain management plan for the client can also
be necessary.
● Taking of medication religiously as ordered
● Hot sitz bath

HEALTH TEACHING

● Discuss health teaching about methods of breastfeeding for mothers with inverted
nipples.
● Demonstrate different non-pharmacological and non-surgical methods such as proper
holding of breast for proper attachment such as C-holds, V-holds, and stimulation of
nipples prior to breastfeeding.
● Demonstration of breast-feeding positions such as:
○ Cradle hold
○ Cross-cradle hold
○ Clutch or football hold
○ Reclining or Side-lying
● Practice of using breast pumps or manual expression of milk may help if the newborn is
still unable to latch to the mother.
 ● Compare good and poor attachment of the infant during breastfeeding and identify the
importance of good attachment, proper positioning and technique of breast feeding and
its benefits and advantages.
● Educate patient about doctor or medical expert referral if solutions do not intervene the
problem of breastfeeding

OUTPATIENT DEPARTMENT
● Make a follow up postnatal checkup as per doctor's order
● Keep all medical appointments

DIET

The following are nutritional requirement for lactating mother

1. Calories - total of 2,000 to 2,500 calories per Energy giving foods are good
sources of calories.

2. Protein - two to three servings, or at least 65 grams, of protein such as

3. Calcium and phosphorus = an increase of 0.5 mg to the normal allowance is

needed to prevent severe depletion of maternal calcium

4. Iron – an additional intake is recommended for blood lost in parturition, for milk
iron and basal

5. Vitamin A – an additional 2,000 IU to the normal allowance is needed to provide

the amount of Vitamin A

6. Vitamin B1 – an additional allowance is needed for thiamine secreted in milk.

7. Riboflavin, vitamin C.- an additional allowance is needed for milk secretion.

8. Fluids = an intake of 8 glasses or more is recommended to increase milk

production.

Reference/s:
Chapter 1

Mayo Clinic.(2018, December 19).Complete Blood Count. https://www.mayoclinic.org/tests-

procedures/complete-blood-count/about/pac-20384919

 
Lab Tests Online.(2020, August 12).Complete Blood Count (CBC).
https://labtestsonline.org/tests/complete-blood-count-cbc

Lab Tests Online..(2020, August 12).Urinalysis. https://labtestsonline.org/tests/urinalysis

https://medlineplus.gov/ency/article/003345.htm l 

Chapter 2

William,L.,Wilkins.(2010).Brunner & Suddarth’s textbook of medical – surgical nursing.

zu.edu.jo/UploadFile/Library/E_Books/Files/LibraryFile_9134_13.pdf

Chapter 3

Kluwer,W.(2018).Drug handbook. Philadelphia: Jay Abramovitz

William,L.,Wilkins.(2010).Brunner & Suddarth’s textbook of medical – surgical nursing.

zu.edu.jo/UploadFile/Library/E_Books/Files/LibraryFile_9134_13.pdf

Doenges, Moorhouse, Murr,. (2018).Nurse’s pocket guide. Philadelphia: F.A Davis Company

Chapter 4

Kubala, J. (2020, July 30). Postpartum Diet Plan: Tips for Healthy Eating After Giving Birth

https://www.healthline.com/health/postpartum-diet#milk-supply

Kubala, J. (2020, July 30). Postpartum Diet Plan: Tips for Healthy Eating After Giving Birth 

https://www.healthline.com/health/postpartum-diet#guidelines