Sanaani, Nur-Fatima M. (Rle) Week

Ateneo de Zamboanga University
College of Nursing
School Year 2020-2021
Learning Packet in Level 2 RLE - BLUE

Care of Pregnant Woman with conditions affecting pregnancy
Name:SANAANI, NUR-FATIMA, M. Date:__________________

Level and Section:BSN-2(H) Learning Packet No:___#3___
Topic: Care of Pregnant Woman Semester: First

with conditions affecting pregnancy -
week 6
Learning Materials:
 Laptop, computer desktop or android phone
 Ballpen
 Paper
 Video clips
I. INTRODUCTION
What is this about ?
This packet is about Care of family and client during Pregnancy with conditions
affecting pregnancy particularly Gestational Bleeding disorders
What will you learn?
A. First Trimester Bleeding:

• Abortion • Ectopic Pregnancy
B. Second Trimester Bleeding
• Gestational Trophoblastic Disease (H-Mole) • Incompetent Cervix
C. Third Trimester Bleeding
This learning packet is a property of ADZU- College of Nursing 2020. Unauthorized reproduction, distribution and selling is strictly prohibited. Page | 1
Learning Competencies and Objectives
At the end of the 24 hour RLE student will be able to:
1. Describe the common conditions affecting pregnancy

such as:Gestational Bleeding Conditions:
A. First Trimester Bleeding:
 Abortion
 Ectopic Pregnancy
 Gestational Trophoblastic Disease (H-Mole)
 Incompetent Cervix
2. Assess a woman for physiologic, pathologic and psychological changes during
pregnancy.
3. Formulate a nursing diagnoses related to conditions affecting pregnancy.
4. Identify expected outcomes for a pregnant woman with conditions affecting
pregnancy.
5. Plan nursing care for a pregnant client with conditions affecting her pregnancy.
6. Implement nursing care, such as health teaching related to relief of pregnancy

discomforts (e.g. Bleeding, abdominal pain) and methods to prevent
complications in pregnancy.
7. Evaluate outcome criteria for the achievement and effectiveness of care.
II.LEARNING EXPERIENCE
A. Can you do this?
Activity 1: experience wise
Directions: Interview a mother you know thru social media/ in your household
with experience of being pregnant or is pregnant with any of the following
conditions:
1. A. First Trimester Bleeding:
• Abortion
• Ectopic Pregnancy
• Gestational Trophoblastic Disease (H-Mole)
• Incompetent Cervix
Guide Questions:
1. With the Interview can you make your Learning Objectives?
General Objectives:
-nurses will be able to build a rapport with the client during interview.
-nurses will build trust and confidentiality during interview
-nurses will be able to make heath history during session of interview
Specific objectives:
-nurses will be able to make a nursing care plan during session
-nurses will be able to manifest intervention and alleviate psychological and
physiological burden
-nurses will be able to manifest health care teaching during the session
2. on the case scenario #1 (your interview) Can you write the mother’s OB
History?
Biographic Data:
Name: N/A Gender:Female
Age:45 Status:Marriaged
Religion:islam
Address: Patalon, Z,C
Chief Complaint:Fear during pregnancy
OB Score:G(6)/P(5)
History of Present Illness:N/A
History of Past Illness:N/A
Family History:N/A
Social History:N/A
3. Can you make a Cephalocaudal Assessment?
Vital Signs:
 T-37.1
 PR-78
 RR-20
 BP-100/70
General Appearance”
Skin: Morena
HEENT:
Chest and Lungs:Normal

Abdomen: Stretch marks are present
Extremities: various veins are present
4. Can you make Gordon’s 11 functional Pattern?
I client stated that she was never hospitalized; she also described herself as an
healthy individual person until she became pregnant again. She started to felt like
nauseated, and feels like vomiting during first to 6 weeks of pregnancy. when
asked if client has a session of pre-natal check up, she said just before 1 month of
her pregnancy she begin to have a session of pre-natal, she applied any
perception of heath teaching from pre-natal doctor
II she usually have 5 session of food intake during the day
 Breakfast
 Lunch
 Snacks
 Dinner
 Snacks
-Fluid intake only a minimum of 1 litre a day
-coffee only 1 cup a day
-follicle acid supplement, and iron
III Bladder
-usually every morning as i wake up, multiple times of urination occurred, 6-10
times, yellow color
Bowel movement
-every after meal at about 3 hours later, one a day, brown, semi-solid
IV usual Daily activity, watch television with the kids, limited activity due to
nauseated every time,
V usual sleep patterns: bedtime(12am), hours sleep(9), with pillows about 2 one
for my head and one for my feet, between my legs ,afternoon session of
sleep(1hours, and a half).
VI patient has no cognitive dysfunction, but prior to dizziness and feeling fatigue,
nauseated she described her pain during pregnancy as 7-out of 10(1-10), scale
pain.
VII She wanted to finish her pregnancy and to performed her duty, session she
has a hard time to find self-worth during pregnancy,
VIII language spoken, speaks in Filipino, chavacanos, bisaya, islam, living with her
family (6 children, and her husband)
IX patient is aware of her sexual functioning as a women
Xpatient is at the age of 45, she is mentally capable on making a decision making,
and she is able to manage stress by communicating with her family, and give
insight for any stresses her.
XI the patient has a stronger relationship with god is very essential and with her
presence of blessing from god, she often as for what direction she must go ofter
her decision making. She is a Christian religious.
Don’t Forget Putting it All Together

Assessment: The first step in determining a patient’s health status.
 Gather information, put pieces of the health puzzle together.
 Entire plan is based on the data you collect, data needs to be
complete and accurate
 Collect, verify, and organize data, identify patterns, report and
record the data.
 Vaginal bleeding during pregnancy is always a deviation from
the normal, may occur at any point during pregnancy, and is
always frightening. It must always be carefully investigated
because if it occurs in sufficient amount or for sufficient cause,
it can impair both the outcome of the pregnancy and a woman’s
life or health
Let’s start!
1. Based on Scenario 1, What could be a possible nursing diagnosis for this case?
2. What are some of the measures that she can take to relieve pregnancy
discomforts ?
CUES Nursing Diagnosis
Subjective: “Maam, mahadluk ko Anxiety related to uncertainty during
maam, baka dili ko makaya mangaak pregnancy
maam AAaHHHH” verbalized by client
Objective:
T-37.1
PR-78
RR-20
BP-100/70
3. Can you formulate a health teaching plan?
CUES OBJECTIVES CONTENT STRATE TIME EVALU
GY Allot ATION
ment
Subjec At the end of - General Demons 45mi At the
tive: the session of informatio tration ns end of
health care n the
Subjec
teaching, - Methods session
tive:
learners will be of non- ,
“Maa
able to: pharmacol learner
m,
ogical will
maha  Ho
measure begin
dluk w
to  Such as: to
ko
ma  Relaxati initiate
maam
na on relief
, baka  Focusin
ge during
dili ko g
pai the
makay  Imagery
n session
a  Effleura
du of labor
mang rin ge
and the
aak g  Distrac
tion progres
maam lab
 lamaze sion
AAaH ou
HHH” r Breathi
verbal du ng
rin techniq
ized
g ues
by
pr 
client
og
res
sio
n
of
lab
ou
r
Objec
tive:
T-37.1
PR-78
RR-20
BP-
100/7
0
Activity 2: Video Clip Viewing

1. Bleeding during the first trimester: https://www.youtube.com/watch?v=7fDiT39Kwp0
One Minute Paper: You will be given exactly ‘one minute’ to write down all you
learned or would like to know about the video clip.
3-2-1 reflect
3- What was the most important

or useful piece of information you
learned from these video clips?
2- What two questions do you still

have?
1-What would you like to know

more about?
Activity 3: D and C Suction Curettage (Refer to Checklist)
B. Think about these
Activity 4: Think, Pair and Share

Scenario #2: Beverly Muzuki tells you, “I had a miscarriage when I
was younger, but my doctor called it an abortion.
What is the difference?”
What would be the best advice to give a woman who tells you she
is miscarrying?
Client Assessment ✽ Gravida 2, para 0, A 1 30 week pregnancy. Heart rate 88
bpm; respirations 22; blood pressure 120/78. Fetal heart rate 120 bpm; reports
positive fetal movements. Uterine contractions none, With bleeding.
Betamethasone (Celestone) prescribed
Suppose Beverly Muzuki develops a placenta previa. What

would be an important assessment to make with her after her
baby’s birth?
.
Guide Questions:
1. What methods will you discuss to prevent complications in pregnancy?
2. What criteria will you be using to evaluate patient progress?
3. How will you encourage the mother to promote a healthy lifestyle during
pregnancy?
Then, you may share and discuss your answer with your partner.
( a predetermined classmate assigned to you)
4. Can you formulate a health teaching plan?
CUES OBJECTIVES CONTE STRATE TIME EVALUATI
NT GY Allotm ON
ent
Subjective: At the end -Terms Discuss 45mins At the
“I had a miscarriage when I of the and ion end of
was younger, but my session definiti (45min the
doctor called it an client will on of s) session
abortion.What is the be able to miscar clint will
difference?” differentiat riage be able to
e the vs identify
difference abortio and
between n differenti
Objective: miscarriage, ate the
HR- 88 bpm and -Factor different
RR- 22 abortion s that categorie
BP- 120/78. relate s of the
FHR- 120 bpm from miscarria
miscar ge vs
riage abortion
vs
abortio
n
-
sympt
oms
and
sign
for
miscar
riage
vs
abortio
n
-
preven
tive
measu
re
during
the
pregna
ncy
-
therap
eutic
manag
ement
5. What is your nursing Diagnosis?
6. What would be your plan and intervention for this stage?
Direction: 1. Formulate a Nursing Care Plan based on scenario #2
Evaluation Plan
Cues Nursing Objective of Plan of
Outcome Meth
Diagnosis Nursing Intervention
Criteria/ od/
Care
Indicators, Tool
standards
Subjective Deficient -Client will -Assess client’s At the end
: knowledge verbalize baseline of the
“I had a related to understandi knowledge and session of
miscarriag information ng of expectations nursing
e when I misinterpret psychologic during pregnancy. interventi
was ation al on, client
younger, evidence by and physiol -Provide and will be
but my statement ogical discuss options for able to
doctor of changes. care during the manifest a
called it misconcepti -Client will labor process. good,
an on participate Provide verbalizati
abortion. in decision- information about on of
What is making birthing proper
the process. alternatives, if understan
difference -Client will available and ding,
?” demonstrat appropriate. during
e labour
appropriate -Provide understan
breathing information about ding
Objective: and procedures
HR- 88 relaxation (especially fetal
bpm techniques. monitor and
RR- 22 telemetry) and
BP- normal
120/78. progression of
FHR- 120 labor.
bpm
-Review
appropriate
activity levels and
safety
precautions,
whether client
remains in
hospital or returns
home
-Review roles of
staff members.
-Obtain informed
consent for
procedures, e.g.,
forceps
delivery, episioto
my. Explain
the procedures
and the possible
risks associated
with labor and
delivery.
-Educate the client

about breathing
and relaxation tec
hniques
appropriate to
each phase of
labor; teach and
review pushing
positions for stage
II.
7. Can You make a Drug Study?

DRUG ACTION INDICATION/ NURSING
RESPONSIBILITIES
CONTRAINDICATION
Generic In Management of Monitor signs of
Name: pharmacol adrenocortical thrombophlebitis
Betaject, ogic doses, insufficiency; chronic use (lower extremity
Celestone suppresses in other situations is swelling, warmth,
limited because of erythema,
Brand Name: inflammati mineralocorticoid tenderness) and
betamethason on and the activity. Used thromboembolism
e (systemic) normal systemically and locally in (shortness of breath,
immune a wide variety of chronic chest pain, cough,
Classification: diseases, including bloody sputum).
response.
anti- Has Inflammatory; Allergic; Notify physician
inflammatorie numerous Hematologic; Neoplastic; immediately, and
Autoimmune disorders. request objective
s (steroidal) intense
Replacement therapy in tests (Doppler
Frequency: metabolic adrenal ultrasound, lung scan,
Route: effects (see insufficiency. Unlabeled others) if thrombosis
Adverse Use: Short-term is suspected.
Dose: Reactions administration to high- Monitor and report
and Side risk mothers before signs of peptic ulcer,
Effects). delivery to prevent including heartburn,
Suppresses respiratory distress nausea, vomiting
adrenal syndrome in the blood, tarry stools,
function at newborn. and loss of appetite.
chronic Assess any muscle or
joint pain. Report
doses of
persistent or
0.6
increased
mg/day.
musculoskeletal pain
Has to determine
negligible presence of bone or
mineraloco joint pathology
rticoid (aseptic necrosis,
activity. fracture).
Therapeuti Assess muscle
c Effects: strength periodically
Suppressio to document the
n of degree of muscle
inflammati wasting during long-
term use.
on and
Measure blood
modificatio
pressure periodically
n of the and compare to
normal normal values
immune (See Appendix F).
response. Report a sustained
Replaceme
nt therapy increase in blood
in adrenal pressure
insufficienc (hypertension) to the
y. physician.
Assess peripheral
edema using girth
measurements,
volume displacement,
and measurement of
pitting edema
(See Appendix N).
Report increased
swelling in feet and
ankles or a sudden
increase in body
weight due to fluid
retention.
Monitor personality
changes, including
depression, euphoria,
restlessness,
hallucinations, and
psychosis. Notify
physician if these
changes become
problematic.
Assess signs of
increased intracranial
pressure in children,
including changes in
mood and behavior,
decreased
consciousness,
headache, lethargy,
seizures, and
vomiting. Notify
physician of these
signs immediately.
Be alert for signs of
low potassium levels
(hypokalemia) and
metabolic acidosis,
including
hyperventilation,
cardiac arrhythmias,
dizziness, and
confusion. Notify
physician immediately
...
Feedback
Now , let’s check how you are doing so far in the Think, Pair and Share activity
4- Outstanding
3- Very Satisfactory
2- Satisfactory
1- Unsatisfactory
C. Do you know?
Therapy for hypovolemic shock is aimed at restoring blood volume and halting the
source of hemorrhage
Monitoring urine output is a good gauge of blood loss because kidneys need sufficient
arterial
blood flow and pressure to function. If they are not producing urine, it suggests that they
are not obtaining adequate blood. If the blood deficit continues so blood cannot reach
other major organs, multiorgan failure can result (Dambro, 2008).
Obtaining hemoglobin and hematocrit levels and securing a blood sample for typing or
cross-matching are essential to help not only predict the extent of blood loss but prepare
for blood replacement. A woman may have a central venous pressure catheter
(measurement of right atrial pressure or the pressure of blood within the vena cava) or a
pulmonary capillary wedge catheter (measures the pressure in the left atrium or the filling
pressure in the left
ventricle) inserted During pregnancy, usual values of these measures differ from the
average, so they need to be evaluated in light of the pregnancy.
Central venous pressure normally is 4 to 10 mm Hg during pregnancy it is 1 to 6 mm Hg;
pulmonary capillary wedge pressure is normally 4 to 12 mm Hg; it is 6 to 12 mm Hg with
pregnancy (Cansino & Lipsett, 2007).
A woman suspected of having serious bleeding will need intravenous fluid replacement
such as Ringer’s lactate as an early intervention. Use a large-gauge angiocath (16 or 18) for
rapid fluid expansion as this will allow a blood transfusion to be administered
through the same site as soon as blood is available. If respirations are rapid, administer
oxygen by mask and monitor oxygen saturation levels by pulse oximetry. Obtain arterial
blood gases as ordered.
A woman needs frequent assessments of vital signs and continuous fetal monitoring by
an external monitoring device should be started.
Urge the woman to lie in a lateral position. If this is not possible, position her on her
back, with a wedge under one hip to minimize uterine pressure on the vena cava and
prevent blood from being trapped in the lower extremities (supine hypotension syndrome).
III. LEARNING VALUES
During the time of pandemic. We are facing an invisible enemy. To keep our
self, our family and others safe. We are bound to follow quarantine rules.
Just like in our lessons of taking care of mothers and their family during
Pregnancy and experience hemorrahge . We too are doing certain actions.
Sometimes, we can’t do things on our own. We also ask and need help from
others. Whatever actions we make, these actions will always have outcomes
and consequences. Therefore we need to be responsible with our actions.
Guide Questions: What are the quarantine rules that may be applied when taking
care of the pregnant with hemorrhage ?
What do you think are the rules as a student in our class , in the
hospital or in the community that you need to follow?
What do you think will happen if we will not follow these rules?
Activity 5: Thought shapes
Directions: Write down inside each shape: what you learned, what you enjoyed,
what you felt and what were your thoughts .
The most important thing I have learned… What I enjoyed most……….
How I feel about using the skills and The thoughts still going around
ideas I have learned… in my head are …
IV.EVALUATION
I. Multiple choice: Write the letter of your choice on the space provided before
the number.
__________1 Beverly Muzuki, the woman you met at scenario 2
had a miscarriage when she was younger. What
would be the best advice to give a woman who tells you she
is miscarrying?
a. Lie down and do not move for 24 hours to stop the
bleeding.
b. Do not do anything special; early miscarriages happen all
the time.
c. Save any clots or material passed for your health care
provider.
d. Use a tight tampon to put pressure on your cervix and stop
the bleeding
________2. Suppose Beverly Muzuki was discovered to have an ectopic
pregnancy. What advice would you give her?
a. Most ectopic pregnancies go to completion, although the
newborn is small.
b. If she must have a fallopian tube removed, she will be sterile afterward.
c. She will have a continuous nagging pain through the rest of
pregnancy.
d. Ectopic pregnancy can be either medically or surgically
treated.
_________3. Suppose Beverly Muzuki develops a placenta previa. What
would be an important assessment to make with her after her
baby’s birth?
a. Whether she recognizes that this is inherited and will probably happen again.
b. Assessment of vaginal bleeding, as she is prone to have
more than usual.
c. Whether she appears “jittery” or nervous from the prebirth
drugs she received.
d. Whether she understands that her uterus has a scar and so
will be always weakened.
You are done! Congratulations for actively participating and answering all the
activities in the learning packet, see you on your next packet. Enjoy Learning!
Do you have questions? Concerns?
Do you need help about the topic?
I am available at our e-class chat room or I am just a text away.
Sources:
Pillitteri, Adele, Maternal and Child Nursing: Care of Child bearing and Child rearing,
Edition 6, 2010 ( Pg 568, 585)
Retreived from:
1. Bleeding during the first trimester: https://www.youtube.com/watch?v=7fDiT39Kwp0
Prepared By:
Maria Rosario M. Romero

Clinical Instructor,
Level 2- RLE-Blue
Ateneo de Zamboanga University, 2020

Sanaani, Nur-Fatima M. (Rle) Week

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Ateneo de Zamboanga University

Learning Packet in Level 2 RLE - BLUE

Name:SANAANI, NUR-FATIMA, M. Date:__________________

Topic: Care of Pregnant Woman Semester: First

What will you learn?

A. First Trimester Bleeding:

At the end of the 24 hour RLE student will be able to:

1. Describe the common conditions affecting pregnancy

6. Implement nursing care, such as health teaching related to relief of pregnancy

3. Can you make a Cephalocaudal Assessment?

Chest and Lungs:Normal

Don’t Forget Putting it All Together

3. Can you formulate a health teaching plan?

Activity 2: Video Clip Viewing

3- What was the most important

2- What two questions do you still

1-What would you like to know

Activity 3: D and C Suction Curettage (Refer to Checklist)

Activity 4: Think, Pair and Share

Suppose Beverly Muzuki develops a placenta previa. What

2. What criteria will you be using to evaluate patient progress?

5. What is your nursing Diagnosis?

6. What would be your plan and intervention for this stage?

-Educate the client

7. Can You make a Drug Study?

III. LEARNING VALUES

The most important thing I have learned… What I enjoyed most……….

Do you have questions? Concerns?

Do you need help about the topic?

I am available at our e-class chat room or I am just a text away.

1. Bleeding during the first trimester: https://www.youtube.com/watch?v=7fDiT39Kwp0

Maria Rosario M. Romero

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