Ateneo de Naga University

Naga City
COLLEGE OF NURSING

MRS. X CASE STUDY

In partial fulfillment of the requirements in

Maternal and Child Health Nursing
(Related Learning Experience)

BSN II- RR21

Group 3

Submitted by:
Aguilar, Jamielou Marie M.
Constantino, Gian Dreenil SB.
Rebano, Paul N.
Relayo, Gabriel Andrei C.
Señar, Patricia Gwyneth P.
Sombrero, Vernon Tate Darien V.
Villaverde, Angel Marie A.
Yabut, Anz Cyryll S.

Submitted to:
Ms. Suzette Almahmoudi , RN
 Table of Contents

INTRODUCTION 4

PURPOSE OF THE CASE STUDY 6

OBJECTIVES 6
GENERAL OBJECTIVES 6
SPECIFIC OBJECTIVES 6

DEFINITION OF TERMS 8

NURSING HEALTH HISTORY 11

DEMOGRAPHIC PROFILE 11
CHIEF COMPLAINT 11
HISTORY OF PRESENT ILLNESS 11
FAMILY HISTORY OF ILLNESS 12
OBSTETRIC - GYNECOLOGIC HISTORY 12

GORDON’S FUNCTIONAL HEALTH PATTERN 13

Health Perception and Health Management Pattern 13
Nutrition and Metabolism Pattern 13
Elimination Pattern 14
Activity and Exercise Pattern 14
Cognition and Perception Pattern 14
Sleep and Rest Pattern 14
Self-Perception and Self-Concept Pattern 14
Roles and Relationships Pattern 14
Sexuality and Reproduction Pattern 15
Coping and Stress Tolerance Pattern 15
Values and Belief Pattern 16

ANATOMY AND PHYSIOLOGY 17

Cardiovascular System 17

PATHOPHYSIOLOGY 19

DIAGNOSTIC TESTS 20

DRUG STUDY 23

COURSE IN WARD 27
NURSING CARE PLAN 29

Severe Pain 29
Ineffective Breathing Pattern 31
Anxiety 34

DISCHARGE PLAN 37

REFERENCES 40

CONTRIBUTIONS 45
 I. INTRODUCTION

Pregnancy is a process of holistic care in all women. It is the new beginning of

their motherhood as well the foundation of a family. This process follows a normal path.
However, due to some unprecedented situations, causes, and factors some women
experienced medical problems related to their health as well as to their baby’s health.
Hence, these women experience what is called a high risk pregnancy.
High-risk pregnancy is a complication related to diseases or disorder during
pregnancy that may endanger both the life of the mother and the fetus. According to
UCSF perinatologists, high risk complications occur in only 6% to 8% of all pregnancies
and these complications can pose greater problems that require special care to ensure
the safety of the mother and fetus.
The second year student nurses deals with the application of concepts,
principles, and techniques of caring for high-risk pregnancy. As second year student
nurses, we focus on the care that we will be giving before, during, and after delivery. It
is our responsibility to take care of our pregnant clients and their newborns. Part of our
responsibility is to monitor the client, take the client’s vital signs, attend to their
concerns, and give them necessary medications according to the doctor’s order. The
second year student nurse also needs to educate clients on how to take care of
themselves and how to handle their newborns.
All mothers desire safe motherhood and the ideal result is a full-term pregnancy,
the delivery of a healthy infant, and a healthy postpartum period in a positive
environment that supports the physical and emotional needs of the woman, infant, and
the family. And as your future Ignatian Nurses, we are here to achieve this very goal!
This is the case study of the patient involved in this study. She is Mrs. X, a 23
year old primipara, who was admitted at term. The patient complains about labor pains
and is afraid to give birth due to her heart condition. With stable and normal vital signs
upon check-up, the patient was diagnosed however of having Rheumatic Heart Disease
secondary to Mitral Stenosis, Functional Class II (NYHA) during her second trimester of
pregnancy. Due to her condition, Mrs. X was not advised to push during childbirth,
instead she had vacuum delivery, on L.O.A position.
II. PURPOSE OF THE CASE STUDY

The purpose of this case study is to integrate knowledge from the lessons
of the maternal and child care given a scenario that may be encountered by the
student nurse in their rotation and in the near future. It is given to the student
nurses to plan, provide, and evaluate holistic nursing care provided to a client
selected during this clinical experience. With this, it also promotes and enhances
the problem-solving, decision-making, and critical-thinking abilities of each
student.

OBJECTIVES

The main purpose of this case study is to enable the students to develop
knowledge regarding the needed actions and plans during the visit, skill and
practice in providing appropriate nursing care, provide advice, and health
teaching to the client.

GENERAL OBJECTIVES

This study aimed to broaden the students’ knowledge by obtaining

sufficient information which could serve as a guide for student nurses who will
be focusing on the same case and it is also designed to enhance skills and
attitudes in the application of nursing process and management of the
procedure.

SPECIFIC OBJECTIVES

● To gain enough knowledge and understand the entire course of the

procedure.
● To obtain detailed personal data, past health history, current medical
history, and physical assessment.
● To review the anatomy and physiology of the Cardiovascular system
● To correlate the results of the diagnostic to its normal values
● Formulate drug study.
● To develop an effective nursing care plan in which the client may benefit.
III. DEFINITION OF TERMS

+1 Station - Fetal station where the baby has moved about 1 centimeter.
+2 Station - Fetal station where the baby begins to emerge in the birth canal.
Atrial Fibrillation (AF) - Condition also known as AFib where the heart has
irregular heartbeat that can lead to complications such as blood clot, stroke,
heart failure, and other heart-related problems.
Blood Typing - Method of testing the blood of a patient through a blood sample
to know what blood group she belongs to.
Blood Urea Nitrogen (BUN) - A part of the laboratory data where it measures
the amount of nitrogen in the blood of a patient, which comes from the waste
product urea. This test measures how the kidneys are working.
Cardiac Enzyme - Test to measure the levels of enzyme and proteins that is
related to the heart injury of a patient.
Cardiac Symptoms - Signs that the patient has underlying heart disease,
usually includes chest pain, discomfort, shortness of breath, fatigue, etc.
Capillary Refill - The time taken for the nail bed to return to its normal color
after putting pressure to it. The normal capillary refill time is less than two (2)
seconds.
Coital Bleeding - Spotting or bleeding that is related to sexual activities.
Complete Blood Count (CBC) - Medical laboratory test that checks the cell in
the person’s blood. It includes count of red blood cells, white blood cells, and
platelets.
Contraction - When the muscles of the uterus tightens then relaxes
Creatinine - Waste product that is included in the laboratory data where the
test measures the creatinine levels in the blood and/or in the urine of the
patient.
Demerol - A drug, analgesic agent, used to treat pain.
Digoxin - A drug that is used to treat irregular heartbeat and heart failure by
controlling the amount of calcium that goes into the heart muscles.
Electrocardiogram (ECG) - Process of measuring the electrical and rhythm
activity of the heart using the sensors that are attached to the skin.
Echocardiogram (ECHO) - Procedure that uses the method of ultrasound,
which are sound waves, to create an image of the heart.
Edema - Swelling because of fluid accumulation.
Epidural Anesthesia - The anesthesia, a drug administered to have temporary
loss of sensation, given during childbirth in order to remove sensation below the
waist that can cause any pain or discomfort.
Fetal Heart Tone - Heart rate of the fetus at which normal rates are 110-160
beats per minute.
Functional Class II (NYHA) - Mild limitation to physical activity because it can
lead to certain complications like dyspnea, fatigue, etc.
Heart Murmurs - Abnormal sounds in the heart, such as whooshing, and
swishing because of the turbulence or gush of blood in the heart.
Hepatitis B Surface Antigen (HbsAg) - Test that detects the presence of
hepatitis B virus in the blood. A “positive” and “reactive” result means that the
patient is infected.
Intermenstrual Bleeding - Vaginal bleeding at any time of menstrual cycle
other than normal menstruation.
In Vitro Transcription (IVTT) - A procedure that allows synthesis of RNA
molecules of any sequence from short oligonucleotides.
Kidney Function Test - A test that uses blood or urine samples to check the
substances in the kidneys.
Labor Pain - Physical discomfort due to the contractions of the muscles in the
uterus.
Labor Watch - Monitor the labor of the pregnant woman.
Left Occiput Anterior (L.O.A) - Position of the baby for the labor and birth
where the baby is facing towards the mother’s left thigh.
Methergine - Medication given to stop bleeding of the uterus after childbirth.
Mitral Stenosis - The heart’s mitral valve is narrow, which causes poor blood
flow into the main chamber that pumps the heart for circulation of blood.
Normal Spontaneous Delivery (NSD) - Natural method of giving birth where
the baby passes the birth canal.
Obstetrical Score - Patient’s obstetrics history which includes gravia, parity,
live births, abortion, and ectopic pregnancy.
Placenta - Organ developed in the uterus during pregnancy that is responsible
for giving the baby nutrients and oxygen.
Primipara - A woman who is giving birth for the first time.
Rheumatic Fever - A condition from strep throat or scarlet fever that affects
the heart, joints, brain, and skin if not treated well.
Rheumatic Heart Disease - A complication from rheumatic fever, which
damages the heart’s valves.
Semi-Fowler’s Position - Common position of patient in a hospital setting,
where the head is elevated within 15-45 degrees.
Second (2nd) Trimester - Weeks 13-27 of the pregnancy.
Streptococcal Pharyngitis - Commonly known as strep throat, which is an
infection of the back of the throat because of a bacteria, group A streptococcus
(GAS).
Syntocinon - A drug used to induce labor and can also treat excessive bleeding.
Troponin Test (Trop T) - Test to measure levels of troponin T in the blood to
detect heart injury of the patient.
Uterine Rupture - Tearing of the uterus that occurs when the fetus is slipping
into the peritoneal cavity.
Vacuum Delivery - Also called vacuum extraction, a method in which the baby
is delivered through the help of a vacuum device to promote mobility through
the birth canal.
Vaginal Examination - Inspection of the vagina of the mother, usually done
when there are contractions and the cervix changed in preterm labor.
IV. NURSING HEALTH HISTORY
A. DEMOGRAPHIC PROFILE

Mrs. X is a 23 years old female she was admitted at the hospital last February 5,
2021 with a chief complaint of labor pains and she stated that she was diagnosed
with Rheumatic heart disease secondary to mitral stenosis under the service of Dr.
Alcantara as her attending physician. Her vital signs upon admission are BP of
120/70 mmHg, HR of 87 bpm, RR of 18 cpm, and temperature of 36 celsius.

B. CHIEF COMPLAINT

Mrs. X’s chief complaint is labor pains and she also stated that she is afraid
that she had been having contractions at 7-10 minutes before she got admitted.

C. HISTORY OF PRESENT ILLNESS

During Mrs. X’s 2nd trimester in pregnancy she developed palpation. Mrs. X
immediately sought consultation and was referred by her OB to a cardiologist. On
her electrocardiogram records it was found that she is having atrial fibrillation.
Echocardiogram was done and it was noted that she is having mild mitral stenosis.
With the approval of her OB, she was put on DIGOXIn 250 mcg once a day. Mrs. X
was ordered for routine check-up. She was also advised that she may have a NSD
thru vacuum delivery so as not to cause her any strain in giving birth.

D. PAST MEDICAL HISTORY

The patient had a history of rheumatic fever when she was 12 years old but
since she did not manifest any abnormal cardiac symptoms after that, they did not
seek treatment from a cardiologist. No follow-up check ups were done to the
patient.
 E. FAMILY HISTORY OF ILLNESS

The patient has no family health history of Rheumatic fever or Rheumatic heart
disease.

F. OBSTETRIC - GYNECOLOGIC HISTORY

Mrs. X’s last menstrual period is May 11, 2020 and the estimated date of delivery
is February 15, 2021. She gave birth to a healthy baby. She did experience labor
pains and was diagnosed with Rheumatic heart disease secondary to mitral stenosis.
Her OB scoring is G1 P1 ; gravida (1), para (1), term (1), preterm (0), abortion (0),
live birth (0), and her multiple pregnancy is zero.

Year
Type of Place of Type of
Gravida Gender of Complications
Delivery Delivery Feeding
Birth

NSA with
Vacuum
G1 Female 2021 Hospital Breastfeeding None
delivery
on LOA

G. SOCIAL ASSESSMENT

Mrs. X is married for 1 year, She is a former preschool teacher but after having
experienced the palpitation during her 2nd trimester, her husband made her resign
from her work so that she will not be stressed. She is a non-smoker, an occasional
drinker (prior to pregnancy). She spends most of her time in her garden, and also
watching Korean TV series. She does not have a history of drug allergy. Her sleeping
pattern is normal.
 V. GORDON’S FUNCTIONAL HEALTH PATTERN

Health Perception and Health Management Pattern

Before Pregnancy During and After Pregnancy

She is concerned about her condition and seeks to

have a checkup to maintain her well-being.
Immediately after having palpitations, she
immediately sought the attention of her obstetrician,
The mother is knowledgeable
which then she was referred to a cardiologist. It was
about her condition and takes
noted that she had a rheumatic heart disease
the advice of her physicians.
secondary to a mild mitral stenosis, which then she
She was diagnosed with
was prescribed to take Digoxin. She is on a routine
rheumatic fever when she
checkup since she needs to be monitored because of
was 12 years old but never
her heart condition. While in labor, a medication was
sought treatment since there
given to her: Demerol for the pain. On the other
were no abnormal health
hand, before giving birth, she was administered an
symptoms. She does not also
epidural anesthesia for the childbirth and was advised
have any drug allergy.
to have normal spontaneous delivery because of her
Moreover, there is no stated
conditions. After the childbirth, she was given
information of the family
Syntocinon, and Methergine. It was also noted that
health history.
she has stable vital signs but, there are complications
because has edema on feet and ankle, she is
experiencing atrial fibrillation, and echo showed her
underlying condition, which is mild mitral stenosis.

Nutrition and Metabolism Pattern

Prior to her pregnancy, she was already a non-smoker but an occasional drinker.
Her skin is smooth, moist, and soft to touch, which means that there are no abnormal
findings regarding that part of the body. With regards to her food allergy, there was no
data indicated in the profile. Almost all of her laboratory data results are within normal
limits, signifying that she has proper nutrition and diet, except for the Troponin T levels
because she has a heart condition. Food restrictions are guided because she has a
heart condition. It is noted that she should avoid fatty, and unhealthy foods, such as
dairy, big chunks of meat and fat, junk foods, and others.
 Elimination Pattern
In Mrs. X’s condition, since she has a proper diet and nutrition, is an indication
that her bowel elimination is completely normal wherein she does not complain of any
discomfort, as well as to her urinary voidance. It was not noted that she does not
experience severe perspiration, body cavity drainage, nor odor problems. It signifies
that she has no issues with elimination patterns.

Activity and Exercise Pattern

Based on the data, Mrs. X, a former preschool teacher now full time mom,
usually spends most of her time at her garden and binge watches Korean drama TV
series. However, she experienced palpitation on her second trimester of labor and notes
that she experiences shortness of breath upon doing short activities.

Cognition and Perception Pattern

The patient is alert, self-aware, and understands the diagnosis,
recommendations, and treatments given by her physicians. She is conscious enough to
know her condition and activities during the labor and before the birthing process. She
even noted that she was afraid of proceeding with her pregnancy due to her heart
complications, that signifies her highly cognitive thinking. The good thing is there was
no evidence of difficulties in sentence making and loss of memory of the client.

Sleep and Rest Pattern

According to the data, her sleeping pattern is normal and has no difficulties in
sleeping.

Self-Perception and Self-Concept Pattern

There was no detailed information given to assess the mother’s self-perception
and self-concern pattern.

Roles and Relationships Pattern

The patient is married. Mrs. X was accompanied by both her husband and
mother when she was admitted to the hospital. It is not indicated whether what are the
specific roles that each member of the family does. When it comes to the main decision
maker in the family, it seems like her husband is the one responsible, since there was
an instance that he made the decision for her wife to resign in order for Mrs. X to
reduce stress. Although, it was not clearly stated if the decision is mutual.
 Sexuality and Reproduction Pattern
The patient’s menarche was not stated in the patient’s profile but her menstrual
cycle is regular for 4-5 days. There were no intermenstrual or any coital bleeding. Mrs.
X is a primipara patient, which means this is her first time to give birth to a child. There
was no elaborated data about her sexual relations with her husband but it seems that
she is self-aware about her sexual functioning as a woman although having anxiety
about the whole pregnancy and birth thing. She does not have a history of having
Sexually Transmitted Diseases (STDs) and Human Immunodeficiency Viruses (HIVs) or
other diseases affecting her genitals.

Coping and Stress Tolerance Pattern

Mrs. X has various activities after she quit her job, as stated in the Activities and
Exercise Pattern, in order to reduce her stress. Some of which are spending most of the
time in her garden, and watching Korean TV series to pass the time. It was shown in
the data that she has been in pain, having back aches, and anxiety due to labor and the
fear of giving birth. She also stated that the contractions came every four (4) minutes
that lasted for about 45-55 seconds which was moderately strong, resulting in severe
pain that even led to her back, aching. Referring to the simple numerical rating pain
scale from 0 with no pain to 10 with the worst pain imaginable, the pain would be
described as a “10”.

Figure 5.1 - Numerical Rating Pain Scale

 Values and Belief Pattern
The patient is a college graduate, who is a Roman Catholic, and is also one year
married to her husband, Mr. XY. As Mrs. X approached her delivery, she turned to God,
made the sign of the cross, and asked for guidance throughout the birthing process. All
for the reason that she does not want to further complicate her current health condition
and put her baby’s life at risk.
VI. ANATOMY AND PHYSIOLOGY

Cardiovascular System
Cardiovascular System, it is responsible for delivering oxygen and nutrients to
the body tissues and it also carries away wastes such as carbon dioxide via blood.
Typically when we hear cardiovascular we do always think that it is all about the heart,
but it is much more than that.

The heart is a muscular organ which pumps blood throughout the body in the
blood vessels. It is about a person's closed fist and it weighs less than a pound. It is a
triangular shaped organ that is located between the two lungs, particularly in the lower
portion of the mediastinum. Apex is directed toward the left hip and rests on the
diaphragm, approximately at the level of the fifth intercostal space. Apical heart beat is
located between the fifth and sixth rib along the midline of the left clavicle.
Myocardium, it is the bulk of the heart wall that is composed of cardiac muscle. The
heart has four hollow chambers, the two atria which are the receiving chambers and
the two ventricles that are known as the discharging chambers, this four hollow
chambers is lined with endocardium. Heart functions as a double pump, the right
ventricle is the one known as the pulmonary pump, while the left ventricle is the
systemic pump. The heart also has four valves, the AV valves that have the mitral or
bicuspid and the tricuspid that prevents the backflow into the atria when the ventricles
are contracting. The semilunar valve has the pulmonary and the aortic that is
responsible for preventing backflow into the ventricles when the heart is relaxing. These
valves open and close, because of the pressure changes in the heart. The myocardium
is nourished by the coronary circulation, which branches off the aorta and consists of
the right and left coronary arteries and their branches, and is drained by the cardiac
veins and the coronary sinus. The cardiac muscle is able to initiate its own contraction
in a regular way, but its rate is influenced by both intrinsic and extrinsic factors.
Intrinsic conduction system is the one who is capable of increasing the rate of the heart
contraction that ensures the heartbeat as a unit. The SA node is known as the heart's
pacemaker located at the right upper chamber of the heart. Extrinsic factors include
neural and hormonal stimuli. Cardiac cycle is the time and events occurring from one
heartbeat to the next. When the heart beats, the sounds of it are resulting from the
dosing of the valves which you can hear a sound "lub - dub". If the faulty valves reduce
the efficiency of the heart as it pumps it will have an abnormal heart sound which is
called "murmurs". Cardiac output, it is the amount of blood that is pumped out by each
ventricle in one minute, is the product of heart rate (HR) x stroke volume (SV). The
amount of the blood ejected by a ventricle with each beat is called an SV. When the SV
rises and falls with the volume of venous return. The HR is influenced by the nerves of
the autonomic nervous system, drug, and ion levels in the blood.

Blood vessels are the arterial blood that is pumped through a series of large
distribution vessels. Aorta is the largest artery in the body. When the arteries
progressively becomes smaller as they move away from the heart it becomes
arterioles. Arterioles is a small branch of an artery that leads into capillaries. Blood
enters via capillary sphincter smooth muscle cells. In the capillary beds, when the
exchange of nutrients and gases happens between in the blood and the tissue fluid
around the cells. Venules is the blood that drains from the capillary bed and enters
vessels, it eventually becomes larger and it will form veins. SVC and IVC are known as
the two largest veins that return blood to the RA. The three layers are found in the
arteries and veins, tunica externa is the outermost layer that is made of connective
tissue fibers it is responsible in reinforcing the walls under pressure, tunica media is
smooth and technically the middle layer that is responsible in controlling to maintains
BP and blood distribution, and the tunica intima that lines the arteries and veins it is a
single layer of squamous epithelial cells called endothelium.

Fetal circulation, it is temporary circulation that can only be seen in the fetus. It
has three special vessels, the single umbilical vein that carries nutrient and
oxygen-laden blood to the fetus from the placenta, and two umbilical arteries that
carries carbon dioxide and waste-laden blood from the fetus going through the
placenta. If the congenital heart defects account for half of all infant deaths it may
result or caused by congenital problems. The expected consequence of aging is
arteriosclerosis. When the elasticity of the arteries gradually decreases it may lead into
hypertension and hypertensive disease, and also clogging in the vessels with fatty
substances.
VII. PATHOPHYSIOLOGY

Figure 7.1 - Pathophysiology of Rheumatic Heart Disease

 VIII. DIAGNOSTIC TESTS

S.I Units Conventional Units

Analyte Result Normal range Result Normal range

Clinical Chemistry

Blood Urea 5 mmol/L [ 0.00 - 8.30 ] 14 mg/dL [ 0.00 - 23.25 ]

Chemistry

Creatinine 79.56 umol/L [ 59.00 - 104.00 ] 0.9 mg/dL [ 0.67 - 1.18 ]

Sodium 136 mmol/L [ 135.00 - 145.00 ] 310.53 mg/dL [ 310.50 - 333.50 ]

Potassium 4 mmol/L [ 3.50 - 5.50 ] 16.02 mg/dL [ 13.69 - 21.51 ]

Glucose 5.5 mmol/L [ 2.5 - 5.5 ] 100 mg/dL [ 45.00 - 96.00 ]

Calcium 2.25 mmol/L [ 2.2 - 2.7 ] 8.9 mg/dL [ 8.5 - 10.5 ]

Troponin T H 0.6 ng/mL [ 0.0 - 0.4 ] - -

Figure 8.1 - Clinical Chemistry Table

Parameter Results Flags Normal range

CBC

HGB 14gm/dL [ 12.0 - 15.5 ]

HCT 42% [ 35.5 - 44.9 ]

Figure 8.2 - Hematology Table
 Figure 8.3 - Echocardiography

Figure 8.4 - Electrocardiography

 The data shows that our client shows normal levels in the series of blood works.
Some other tests are not indicated in the case study, but the student nurse will indicate
the normal results of the study since it is assumed that the client has normal test
results. The included diagnostic tests are the blood works of clinical chemistry and
complete blood count of the patient. Included here is the hemoglobin, which is the
oxygen-carrying power of the red blood cells; the client has a normal result and in some
cases a lot of normal pregnant women experience low hemoglobin levels during full
terms. The client has a normal blood glucose level. The organ called placenta gives a
growing baby nutrients and oxygen. The placenta also makes hormones and in late
pregnancy, the hormone estrogen, cortisol, and human placental lactogen can block
insulin. Blocked insulin is called insulin resistance. It was also indicated that the
troponin T of the client has high results. Troponin is found in cells in the heart muscle.
When the muscles are injured, they release troponin and other substances into the
blood. Getting a high result from this test indicates that the client has heart disease.
The clients ecg results also came out that the patient’s has an atrial fibrillation; this
occurs when action potentials fire very rapidly within the pulmonary veins or atrium.
Because the atrial rate is so fast, and the action potentials produced are of such low
amplitude, P waves will not be seen on the ECG in patients with atrial fibrillation. The
echocardiography also indicates that the client has mild mitral stenosis. Mitral stenosis
is an abnormal function of the mitral valve; the client also has a past history of having
rheumatic heart disease that is secondary to his present condition of mitral stenosis.
 IX. DRUG STUDY

Dosage
Drug and Drug Nurses
and Indications Contraindications
Content Interaction Responsibility
Frequency

Generic Name: Dosage: Lactated Ringer's Lactate No information ● Do not administer

sodium chloride, 1L and 5% Dextrose administration is provided. unless the solution is
sodium lactate, Injection, USP is contraindicated in clear and the
potassium Frequency: indicated as a severe metabolic container is
chloride, calcium 20gtts/min source of water, acidosis or alkalosis, undamaged.
chloride, and electrolytes and and in severe liver ● Caution must be
dextrose calories or as an disease or anoxic exercised in the
monohydrate alkalinizing agent. states which affect administration of
lactate metabolism. parenteral fluids,
Brand Name: Solutions containing especially those
"Dextrose 5% in dextrose may be containing sodium
Lactated Ringer's contraindicated in ions to patients
injection" patients with receiving
hypersensitivity to corticosteroids or
Classification: corn products. corticotrophin.
Hypertonic ● Solution containing
Nonpyrogenic acetate should be
Parenteral fluid used with caution as
Electrolyte excess administration
Nutrient may result in
replenisher metabolic alkalosis.
● Solution containing
Forms: dextrose should be
injection, solution used with caution in
patients with known
Route: subclinical or overt
IV Route diabetes mellitus.
● Discard unused
portions.
● In very low birth
weight infants,
excessive or rapid
administration of
dextrose injection
may result in
increased serum
osmolality and
possible intracerebral
hemorrhage.
● Properly label the IV
Fluid
● Observe aseptic
technique when
changing IV fluid
Generic Name: Dosage It is indicated for ● Significant MAO inhibitors: ● Management of
Meperidine 50 mg the relief of respiratory may increase moderate to severe
moderate to depression CNS excitation or pain, pre-op
Brand Name: Frequency severe pain. ● Acute or severe depression that sedation, post-op
Demerol, PRN bronchial asthma in can be fatal or and OB analgesia,
pethidine an unmonitored severe. PO: onset 10-15
setting or in the mins, peak 60-30
Classification: absence of CNS depressants, mins, duration 2-4
Narcotic analgesic resuscitative general hrs (usually 3 hrs)
equipment anesthetics, ● IM: onset 10-15
Forms: ● Concomitant use of hypnotics, other mins, peak 30-50
Syrup, Tablet and monoamine oxidase opioid analgesics, mins, duration 2-4
Injectable inhibitors (MAOIs) phenothiazines, hrs (usually 3 hrs)
Solution or within 14 days of sedatives, ● IV: onset less than 5
having taken an tricyclic mins, peak 5-7 mins,
Route: MAOI. antidepressants: duration 2-4 hrs
Tablet ● Known or may cause (usually 3)
suspected respiratory ● subQ: onset 10-15
gastrointestinal depression, mins, peak 30-50
obstruction, hypotension, mins, duration 2-4
including paralytic profound hrs (usually 3 hrs).
ileus sedation or ● Do not give if
● Hypersensitivity to coma. respirations are less
meperidine or to than 12 per min.
any of other ● Avoid use with
ingredients of the alcohol, CNS
product depressants

Generic Name: Dosage ● Initiation or ● Significant Sympathomimetic Continuously monitor

Oxytocin 10IU/L improvement of cephalopelvic drugs contractions, fetal and
uterine disproportion maternal heart rate
Brand Name: Frequency contractions to ● Unfavorable fetal Drugs such as and maternal blood
Pitocin, q.h. achieve early positions or Halothane, pressure and ECG
Syntocinon vaginal delivery presentations Propranolol or
for maternal or ● Obstetric quinidine can Discontinue infusion if
Classification: fetal reasons emergencies that antagonize uterine hyperactivity
Uterine-active (IV) favor surgery uterotonic action occurs.
agents ● As adjunctive ● Fetal distress where of oxytocin.
therapy in the delivery is not Monitor the patient
Forms: management of imminent Inhaled extremely closely
Injection, USP inevitable or ● Where adequate anaesthetics may during first and second
incomplete uterine activity fails augment stages of labor because
Route: abortion (IV) to achieve hypertensive of risk of cervical
IIV/M ● Stimulation of satisfactory effects of large laceration, uterine
uterine progress doses of rupture and maternal
contractions ● Hyperactive or oxytocin. and fetal death.
during third hypertonic uterus
stage of labor ● Contraindicated Concomitant Access fluid intake and
(IV) vaginal delivery administration of output. Watch for signs
● control of ● Hypersensitivity sympathomimetic and symptoms of water
postpartum s, phenylephrine intoxication.
bleeding or or ephedrine is
 hemorrhage not associated
(IV,IM) with any
incidence of
hypertension as
was believed
earlier.

Careful
assessment of
fluid and
electrolyte status
is necessary in
patients who
have received
prolonged
oxytocin
induction.

I.V. Bolus of
oxytocin may be
avoided until the
placenta is
delivered to avoid
the risk of
retained
placenta.

Generic Name: Dosage ● Prevention Contraindicated in Drug-drug ● You should not use
Methylergonovine 1 ampule and pregnant women and methylergonovine
treatment of patients with Ergot alkaloids, during your
Brand Name: Frequency postpartum hypertension, sympathomimetic pregnancy. This
Methergine q.d. hemorrhage toxemia, or sensitivity amines: medicine is to be
from uterine to ergot preparations. Enhances used only after
Classification: atony or Use cautiously during vasoconstrictor delivery of your
ergot alkaloids subinvolution. the second stage of potential. Use baby.
Adults: 0.2 mg labor and in patients together ● Do not breast-feed
Forms: I.M. or I.V. q 2 with renal or hepatic cautiously. within 12 hours
Injectable to 4 hours for disease, sepsis, or after taking
solution, Tablet maximum five obliterative vascular Local anesthetics methylergonovine.
doses. disease. Also used with Methylergonovine
Route: Following initial cautiously in patients vasoconstrictors may pass into breast
IV route I.M. or I.V. with unstable angina, (lidocaine with milk in small amounts
dose, may give recent myocardial epinephrine): and could affect a
0.2 to 0.4 mg infarction, coronary Enhances nursing baby. In
P.O. q 6 to 12 artery disease, history vasoconstriction. some cases, you will
hours for a of cerebrovascular Use together need to use this
maximum 7 accident, eclampsia cautiously. medication for up to
days. Decrease or preeclampsia, and 1 week after your
dose if severe Raynaud’s disease. Drug-lifestyle baby is born. You
cramping may need to use a
occurs. Smoking breast pump to
(nicotine): establish and
 ● Diagnosis of Enhances maintain your milk
coronary vasoconstriction. flow until your
artery spasm. Discourage methylergonovine
Adults: 0.1 to smoking. treatment is finished.
0.4 mg I.V. If you use a breast
pump during this
time, throw out any
milk you collect. Do
not feed it to your
baby.

Generic Name: Dosage ● Digoxin is used ● Acute myocardial Cardiac patients ● Monitor apical pulse
Digoxin 250 mcg to treat heart infarction. receiving digoxin for 1 min before
failure, usually ● Hypersensitivity to therapy are administering; hold
Brand Name: Frequency along with the drug. particularly prone dose if pulse < 60 in
Digitek, OD other ● Ventricular to interactions adult or < 90 in
Lanoxicaps, medications. It fibrillation. with commonly infant; retake pulse
Lanoxin is also used to ● Myocarditis. co-administered in 1 hr. If adult pulse
treat certain ● Hypomagnesemia. medications such remains < 60 or
Classification: types of ● Hypokalemia. as the infant < 90, hold
Inotropic Agents, irregular ● Wolf-Parkinson-W antiarrhythmics drug and notify
Antiarrhythmic, heartbeat (such hite syndrome. quinidine and prescriber. Note any
Cardiac glycoside as chronic atrial amiodarone, the change from baseline
fibrillation). calcium channel rhythm or rate.
Forms: Treating heart blockers ● Take care to
Oral medication failure may help verapamil and differentiate
maintain your nifedipine, and Lanoxicaps from
Route: ability to walk possibly some Lanoxin; dosage is
Oral medication and exercise vasodilating very different
and may agents. ● Check dosage and
improve the preparation carefully.
strength of your ● Avoid IM injections,
heart. which may be very
painful.
● Follow diluting
instructions carefully,
and use diluted
solutions promptly.
● Avoid giving with
meals; this will delay
absorption.
● Have emergency
equipment ready;
have K+ salts,
lidocaine, phenytoin,
atropine, and cardiac
monitor readily
available in case
toxicity develops.
● Monitor for
therapeutic drug
levels: 0.5–2 ng/mL.
X. COURSE IN WARD

Date/Time Medical Surgical Nursing

Admission:

February 05,
2021
- Admitting order - Checked the
7:05 am
from her OB vital signs
- Labor watch
Ordered by the doctor:
- Epidural anesthesia
- Vacuum delivery
- D5LR 1L started at
20 gtts/min
- TPR q hourly
- NPO
- CBC, blood typing,
HbsAG, Kidney
function test
cardiac enzyme

- Demerol 50mg
7:45 am
IV, PRN

- Vaginal
8:30 am
Examination
- Epidural
- Cardiac monitor anesthesia

- Vacuum delivery - Applied

LOA position medicine in
9:15 am
 the baby’s
eyes
- I.D band

- Syntocinon 10IU - Vital signs

via IVF
9:18 am
- Methergine 1
amp IVTT - Transferred
- Oxygen to ward
 XI. NURSING CARE PLAN

Severe Pain

Nursing Implementati
Assessment Rationale Planning Rationale Evaluation
Diagnosis on

Subjective Short Independent: Short

term: Term:
Attitudes to
“I’m in pain due to Severe pain After 30 Assess degree of After 30
pain and
my contractions related to minutes of discomfort through
reactions to minutes of
by 7-10 minutes tissue dilation nursing verbal and non
pain are nursing
since 6 am and it as interventions verbal cues.
individual. intervention
lasts for 30 manifested the patient
seconds” by the will be able the patient
As stated by the patient's to report Assist in use of May block will report
patient chief that the pain appropriate pain impulses
that the pain
complaints and breathing/relaxatio within the
cerebral and
discomfort is n techniques and
Objective: minimized. in abdominal cortex though discomfort is
effleurage. conditioned minimized.
● BP - 120/70 responses
mmHg and Long term:
cutaneous
● HR - 87 bpm
Long term: stimulation.
● RR - 18 cpm Facilitates After 3 to 4
After 3 to 4
● T- 36.7 celsius. days the progression of days the
● +1 station nursing normal labor. nursing
● 4cm dilation to intervention intervention
the cervix and the patient Assist with comfort Promotes the patient
80% effaced. will express measures. relaxation and can express
relief, hygiene.
obtained the relief
Enhances
from labor obtained
feeling of well
pain by the being. from labor
use of pain.
childbirth
technique
learned and Time and record Monitors
or comfort the frequency, labor
measures intensity, and progress and
given as duration of uterine provides
manifested contractile pattern information
by having per protocol. for patient.
controlled
pain, Assess nature and
appearing amount of vaginal Vaginal show
relaxed and show, cervical increases with
normal dilation, fetal descent.
respiratory effacement, fetal
functions. station, and fetal
descent.

Assess BP and
pulse every 1-2 Maternal
min after regional hypotension,
injection for the the most
first 15 min, then common side
every 10-15 min effect of
for reminder of anesthesia,
labor. Elevate may interfere
head with fetal
approximately 30 oxygenation.
degrees, alternate Elevating the
position by turning head prevents
side to side and the block
use hip roll. from
migrating up
and causing
respiratory
depression.
Lateral
positioning
increases
venous return
and enhances
placental
circulation.

Monitor FHR
Decreased
electronically and
FHR
note decreased
variability is a
variability of
common side
bradycardia.
effect of
many
anesthetics/a
nalgesics.

Dependent:
IV route is
Administer preferred
analgesics such as because it
meperidine ensures more
hydrochloride rapid and
(Demorol) by IV or equal
deep intramuscular absorption of
during contractions analgesic.
Medication
administered
 by IM route
may require
up to 45 min
to reach
adequate
plasma levels,
and maternal
uptake may
be variable,
especially if
the drug is
injected into
subcutaneous
fat instead of
muscle.

Administer oxygen,
Increases
and increase plain
circulating
fluid intake if
fluid volume,
systolic pressure
placental
falls below 100
perfusion,
mmHg or falls
and oxygen
more than 30%
available for
below baseline
fetal uptake.
pressure.

Ineffective Breathing Pattern

Nursing
Assessment Rationale Planning Implementation Rationale Evaluation
Diagnosis

Subjective Short Independent:

shortness of term:
breathing due to To determine Short Term:
severe pain from Ineffective A narrowing After 15 Monitor Vital sign degree of Goal met,
contractions as breathing of the minutes of frequently assistance after 15
verbalized by the pattern heart's mitral nursing needed by
valve. This minutes of
patient related to intervention, the patient
rheumatic abnormal the patient and note Nursing
heart disease valve doesn't will be able response to Intervention,
secondary to open to alleviate activities/interve patient was
Mitral stenosis properly, feelings of ntion. able to
as manifested blocking shortness of breathe
Objective: by shortness blood flow breath.
of breath. into the within normal
Vital Sign: main range.
BP:120/70mmHg pumping Long term: Monitor intake and To decrease
HR: 87 Bpm, chamber of output oxygen
RR: 18 cpm your heart After 3 to 4 consumption and
T: 36.7 C (left days of risk of Long term: Goal
ventricle). continuous decompensation. met,
Fetal heart tone: Mitral valve nursing After 4 days of
128 and regular stenosis can intervention,
Nursing
make you the patient Position the patient in To promote lung
Baby’s head: tired and will be able semi fowler position expansion and Intervention,
At the t1 station short of to decrease decreasing the the patient
breath, episodes of work of demonstrate
Cervix was 4cm among other dyspnea breathing. improved
dilated 80% problems. through
breathing
effaced proper Minimize activities and Rest is vital to
intervention. energy expenditures reduce oxygen pattern.
Dyspnea and energy
demand.
Edema

Capillary refill
seconds

Skin smooth,
moist and soft to THERAPEUTIC:
touch

Keep patient on bed To determine

rest/chair rest alterations on
position of comfort. fluid and
electrolyte
balance.

Administer To increase
oxygen oxygen
supplement. available for
cardiac
function and
tissue
perfusion for
both mother
and the baby.

Assist with or
perform self care
Decrease
activities for the
cardiac
client.
workload/pr
ovide
comfort
Provide fluid and
electrolytes as To minimize
indicated dehydration
and
dysrhythmias.

EDUCATIVE:

Encourage Deep Provide

oxygenation.
breathing
exercise.

Can cause
changes in
Instruct client to cardiac
avoid pressures
stressful and or
activities. impede
blood flow.

To monitor
Reiterate importance condition and
of regular prenatal prevent
check ups. complications
specially on the
fetal side.

To enhance
Instruct to Venous
elevate legs return.
when in sitting
position.

Dependent:
Oxygen
support
Give oxygen as
 prescribed by the alveolar
physician gas
exchange
and
improve
oxygen in
blood and
tissue

Anxiety

Nursing
Assessment Rationale Planning Implementation Rationale Evaluation
Diagnosis

Subjective Short Term: Short Term:

“I am afraid to Risk for Anxiety is After 15 Assess level and Provides After 15
give birth anxiety one of the minutes of causes of anxiety, baseline minutes of
because of my related to risk factors nursing preparedness for information. nursing
heart disease,” situational for adverse intervention, childbirth, and role Anxiety intervention,
as stated by the crisis as outcomes for the patient of significant magnifies pain the patient
patient. manifested mother and will be able other/partner. perception, reported
by her fear child. Anxiety to report interferes with anxiety is at
of giving in pregnancy anxiety is at the use of manageable
birth. is associated manageable coping level, uses
with shorter level, will use techniques, and breathing
Objective: gestation breathing and stimulates the and
and has relaxation release of relaxation
Vital Sign: adverse techniques aldosterone, techniques
BP:120/70mmH implications proficiently, which may proficiently,
g, during labor. and will increase sodium and appears
HR: 87 Bpm, This can appear and water relaxed
RR: 18 cpm, affect the relaxed resorption. appropriate
T: 36.7 C process of appropriate to the labor
delivery of to the labor situation.
Fetal heart the mother, situation. Monitor pattern of A hypertonic or
tone: affecting uterine hypotonic
128 and regular both the contraction. contractile
health, pattern may
Baby’s head: delivery, and develop if stress
At the t1 life of both persists and
station mother and causes
child. prolonged
Cervix was 4cm catecholamine
dilated 80% release.
effaced
Dyspnea Stress activates
Monitor BP and the
Edema pulse as indicated. hypothalamic-pit
(If BP is elevated uitary-adrenocor
Capillary refill on admission, tical system,
seconds repeat the which increases
procedure in 30 retention and
Skin smooth, min to obtain true resorption of
moist and soft reading once the sodium and
to touch client is relaxed.) water and
increases
excretion of
potassium.
Sodium and
water resorption
may contribute
to the
development of
intrapartal
toxemia/hyperte
nsion. Loss of
potassium may
contribute to
the reduction of
myometrial
activity.

Education may
Orient client to reduce stress
environment, staff, and anxiety and
and procedures. promote labor
Provide progress.
information about
psychological and
physiological
changes in labor,
as needed.
Modesty is a
concern in most
Promote privacy cultures.
and respect for Support person
modesty; reduce may or may not
unnecessary desire to be
exposure. Use present while a
draping during a client is
vaginal examined or
examination. cared for.
Encourage the Stress, fear, and
client to verbalize anxiety have a
feelings, concerns, profound effect
and fears. on the labor
process, often
prolonging the
first phase
because of
utilization of
glucose
reserves;
causing excess
epinephrine
release from
adrenal
stimulation,
which inhibits
myometrial
activity; and
increasing
norepinephrine
levels, which
tends to
increase uterine
activity. Such an
imbalance of
epinephrine and
norepinephrine
can create a
dysfunctional
labor pattern.

Demonstrate Reduces
breathing and stressors that
relaxation might contribute
methods. Provide to anxiety;
comfort measures. provides coping
strategies.

Prepare for, and/or The comfort and

assist with, familiarity of the
discharge from home
hospital setting, as environment
indicated. may decrease
anxiety and
allow
opportunity for
a variety of
acceptable
 diversional
activities,
thereby
hastening the
labor process.

XII. DISCHARGE PLAN

Discharge goals:
● Realistically managing the present situation.
● Pain relieved/controlled of the palpitations
● Prevented/minimised risks.
● Maintain an optimal health standard.
● Regular check-ups should be done.

● Medication as prescribed by the Physician pre-delivery was:

○ Demerol 50 mg IV; prn for pain

Medications ○ Digoxin 250 mcg; OD for managing heart complication

● As indicated by the health care provider, report any side
effects and adverse reactions.

● Home environment must be free from any hazards.

● Strengthen the desire to perform things at home. Increase
Exercise
mobility and boost heart function with active ROM exercises.
● Encourage deep breathing exercise.

● If Mrs. X’s mitral stenosis progresses, surgery, by means of

Treatment
repairing/replacing the faulty valve, is the best option she has.

● Breast

Health teaching ○ Wash breast daily at shower time

○ Wear supportive bra
 ○ Wash hands before and after every feeding
○ Insert clean OS squares of cloth in the brassiere to absorb
moisture when there is considerable breast discharge.
● Uterus
○ By 10-14 days postpartum, cannot be palpated
abdominally
○ Breastfeeding hastens involution of the uterus
○ The fundus must be firm, if it is not firm, lightly massage
the abdomen until fundus is firm.
○ Empty bladder frequently, it delays involution of the
uterus.
● Breastfeeding
○ Correct position of breastfeeding the baby
○ Instruct the client to feed the baby 8 to 12 times a day.
○ Instruct the client that the baby should breastfeed from
both breasts equally over the course of a day.
● Lochia
○ Instruct to report any abnormal progression of lochia,
excessive bleeding, foul smelling lochia or large blood
clots call their physician immediately.
○ Lochia should never exceed a moderate amount, such
as 4 to 8 saturated perineal pads daily with an average
of 6.

● Instruct the client to monitor the tear (change in color, odor,

or consistency of drainage; increasing discomfort) for
Out-Patient
indications of infections and report immediately to Physician if
any of these signs are seen and observed.
 ● Instruct the client to monitor and report promptly the signs of
complications (uncontrolled pain, signs of infection, and
bleeding)
● Advise the client to consult with the Physician for any pain or
the pain is unmanageable.

● Instruct the client that there are restrictions in the diet. The
client should be reminded not to eat too much fatty foods,
high in gluten edibles, processed sugar and foods (Bacon,
Diet
etc).
● Advise the client to lean towards plant based-diet, oils and
intake a lot of fruits.

● Ask proper counseling regarding Natural Family Planning

Method in order for Mrs. X not to worry about her health
condition towards pregnancy.
Spirituality/Sexuality
● To advise the significant other of the client to provide the
baby and client with presence and support.

REFERENCES

Adrian, J. (2020, March 22). Bacterial Pharyngitis: Background, Pathophysiology,

Epidemiology. Medscape.com; Medscape.
https://emedicine.medscape.com/article/225243-overview
Anesthesiologist. (2021). What is an Anesthesiologist? - Hospital for Special Surgery.
Hospital for Special Surgery.
https://www.hss.edu/what-is-an-anesthesiologist.asp#:~:text=Anesthesiologists
%20are%20physicians%20specializing%20in,in%20anesthesia%20(three%20ye
ars).
Arteriosclerosis / atherosclerosis - Symptoms and causes. (2018). Mayo Clinic;
https://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis/s
ymptoms-causes/syc-20350569#:~:text=Arteriosclerosis%20occurs%20when%2
0the%20blood,to%20your%20organs%20and%20tissues.
Beckert, B., & Masquida, B. (2010). Synthesis of RNA by In Vitro Transcription. RNA,
29–41. https://doi.org/10.1007/978-1-59745-248-9_3
Blood Urea Nitrogen | Michigan Medicine. (2019). Uofmhealth.org.
https://www.uofmhealth.org/health-library/aa36271#:~:text=A%20blood%20ur
ea%20nitrogen%20(BUN,well%20your%20kidneys%20are%20working.
Cadman, B. (2017, December 16). What to know about jugular vein distention (JVD).
Medicalnewstoday.com; Medical News Today.
https://www.medicalnewstoday.com/articles/320320#:~:text=The%20blood%2
0flow%20from%20the,side%20of%20a%20person’s%20neck.
Cafasso, J. (2017, November 14). The Second Trimester of Pregnancy. Healthline;
Healthline Media.
https://www.healthline.com/health/pregnancy/second-trimester
Dass, C., & Arun Kanmanthareddy. (2020, November 21). Rheumatic Heart Disease.
Nih.gov; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK538286/#_article-28514_s4_
Calcium Blood Test. (2014). Medlineplus.gov.
https://medlineplus.gov/lab-tests/calcium-blood-test/#:~:text=A%20calcium%2
0blood%20test%20measures,is%20stored%20in%20your%20bones.
Cardiac Enzyme Studies | Michigan Medicine. (2015). Uofmhealth.org.
https://www.uofmhealth.org/health-library/hw224485#:~:text=Test%20Overvie
w,called%20creatine%20kinase%20(CK).
Creatinine Test. (2014). Medlineplus.gov.
https://medlineplus.gov/lab-tests/creatinine-test/#:~:text=This%20test%20mea
sures%20creatinine%20levels,the%20body%20in%20your%20urine.
Dealing With Pain During Childbirth (for Parents) - Nemours KidsHealth. (2018).
Kidshealth.org.
https://kidshealth.org/en/parents/childbirth-pain.html#:~:text=Pain%20during%
20labor%20is%20caused,sides%20or%20thighs%20as%20well.
Echocardiogram (Echo). (2015). Www.heart.org.
https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/e
chocardiogram-echo#:~:text=An%20echocardiogram%20(echo)%20is%20a,ech
ocardiography%20or%20diagnostic%20cardiac%20ultrasound.
Elaine N. Marieb and Suzanne M. Keller. (2019). Essentials of Human Anatomy and
Physiology, 12th edition. 382-423. Philippines: PEARSON EDUCATION SOUTH ASIA
PTE. LTD.
Group A Strep. (2021).
https://www.cdc.gov/groupastrep/diseases-public/rheumatic-fever.html#:~:text
=Rheumatic%20fever%20(acute%20rheumatic%20fever,key%20to%20preventi
ng%20rheumatic%20fever.
Hematocrit test - Mayo Clinic. (2019). Mayoclinic.org;
https://www.mayoclinic.org/tests-procedures/hematocrit/about/pac-20384728#:
~:text=A%20hematocrit%20(he%2DMAT%2D,is%20a%20simple%20blood%20
test.
Hepatitis B Foundation: Hepatitis B Blood Tests. (2021). Hepb.org.
https://www.hepb.org/prevention-and-diagnosis/diagnosis/hbv-blood-tests/#:~:t
ext=HBsAg%20(Hepatitis%20B%20surface%20antigen,antigen%E2%80%9D)%
20in%20your%20blood.
Hinderer, S., & Schenke-Layland, K. (2019). Cardiac fibrosis – A short review of causes
and therapeutic strategies. Advanced Drug Delivery Reviews, 146, 77–82.
https://doi.org/10.1016/j.addr.2019.05.011
https://www.facebook.com/verywell. (2021). What to Know About Your Baby’s Position
During Labor and Birth. Verywell Family.
https://www.verywellfamily.com/fetal-positions-for-labor-and-birth-2759020
Jarvis, S. (2020, August 24). Intermenstrual and Postcoital Bleeding. Patient.info.
https://patient.info/doctor/intermenstrual-and-postcoital-bleeding#:~:text=Inter
menstrual%20bleeding%20(IMB)%20refers%20to,other%20than%20during%20
normal%20menstruation.
Maria,Masters. (2020, May 8). Vacuum Extraction During Delivery. What to Expect;
WhattoExpect.
https://www.whattoexpect.com/pregnancy/labor-and-delivery/procedures-and-in
terventions/vacuum-extraction.aspx#:~:text=A%20vacuum%20extraction%2C
%20also%20known,a%20mom’s%20labor%20has%20stalled.
Methergine Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing -
WebMD. (2021). Webmd.com.
https://www.webmd.com/drugs/2/drug-12365/methergine-oral/details#:~:text=
 This%20medication%20is%20used%20after,stiffness%20of%20the%20uterus%
20muscles.
Mitral valve stenosis - Symptoms and causes. (2017). Mayo Clinic;
https://www.mayoclinic.org/diseases-conditions/mitral-valve-stenosis/symptoms-
causes/syc-20353159#:~:text=Mitral%20valve%20stenosis%20%E2%80%94%
20or%20mitral,of%20breath%2C%20among%20other%20problems.
NCI Dictionary of Cancer Terms. (2021a). National Cancer Institute; Cancer.gov.
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/demerol
NCI Dictionary of Cancer Terms. (2021b). National Cancer Institute; Cancer.gov.
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/digoxin
NCI Dictionary of Cancer Terms. (2021c). National Cancer Institute; Cancer.gov.
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/renal-functio
n-test
Neal, J. L., Lowe, N. K., Ahijevych, K. L., Patrick, T. E., Cabbage, L. A., & Corwin, E. J.
(2010). “Active Labor” Duration and Dilation Rates Among Low-Risk, Nulliparous
Women With Spontaneous Labor Onset: A Systematic Review. Journal of
Midwifery & Women’s Health, 55(4), 308–318.
https://doi.org/10.1016/j.jmwh.2009.08.004
NHS Choices. (2021). Electrocardiogram (ECG).
https://www.nhs.uk/conditions/electrocardiogram/#:~:text=An%20electrocardio
gram%20(ECG)%20is%20a,heart%20each%20time%20it%20beats.
Numeric Pain Rating Scale. (n.d.). Retrieved from
https://www.physio-pedia.com/Numeric_Pain_Rating_Scale
Pietrangelo, A. (2020, May 7). Potassium Blood Test. Healthline; Healthline Media.
https://www.healthline.com/health/potassium-test#:~:text=A%20normal%20po
tassium%20level%20is,to%20interpret%20your%20specific%20results.
Participating in Activities You Enjoy. (n.d.). Retrieved from
https://www.nia.nih.gov/health/participating-activities-you-enjoy
Positioning of the heart. (2021). Liverpool.ac.uk.
https://www.liverpool.ac.uk/~trh/local_html/heartdisease/positioning_of_the_he
art.htm
POST RN BSN Resources. (2019, May 9). Gordon’s 11 Functional Health Pattern. POST
RN BSN Nursing Resources.
https://postrnbsn.blogspot.com/2019/05/gordons-11-functional-health-pattern.ht
ml
Problem: Mitral Valve Regurgitation. (2020). Www.heart.org.
https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-
valve-problems-and-causes/problem-mitral-valve-regurgitation‌
Rheumatic fever - Symptoms and causes. (2019). Mayo Clinic;
https://www.mayoclinic.org/diseases-conditions/rheumatic-fever/symptoms-causes/
syc-20354588
Rheumatic Heart Disease. (2021).
https://www.hopkinsmedicine.org/health/conditions-and-diseases/rheumatic-hea
rt-disease#:~:text=Rheumatic%20heart%20disease%20is%20a,strep%20throat
%20or%20scarlet%20fever.
Rupture of the Membranes | Michigan Medicine. (2019). Uofmhealth.org.
https://www.uofmhealth.org/health-library/hw195832#:~:text=When%20a%20
hole%20or%20tear,after%20active%20labor%20has%20started.
Sinoatrial Node - an overview | ScienceDirect Topics. (2018). Sciencedirect.com.
https://www.sciencedirect.com/topics/neuroscience/sinoatrial-node#:~:text=The
%20sinoatrial%20node%20(SA%20node,Heart%20Development%20and%20Re
generation%2C%202010
Syntocinon. (2021). NPS MedicineWise.
https://www.nps.org.au/medicine-finder/syntocinon-solution-for-injection#:~:tex
t=What%20Syntocinon%20is%20used%20for,a%20natural%20hormone%20call
ed%20oxytocin.
Troponin - Understand the Test & Your Results. (2019, January 9). Labtestsonline.org.
https://labtestsonline.org/tests/troponin
Tucker, W. D., Ribesh Shrestha, & Bracken Burns. (2020, July 31). Anatomy, Abdomen
and Pelvis, Inferior Vena Cava. Nih.gov; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK482353/
Tunica media | anatomy | Britannica. (2021). In Encyclopædia Britannica.
https://www.britannica.com/science/tunica-media#:~:text=The%20tunica%20m
edia%2C%20or%20middle%20coat%2C%20is%20thicker%20in%20arteries,co
mposed%20primarily%20of%20elastic%20fibres.%E2%80%A6
Wikipedia Contributors. (2021, January 20). Superior vena cava. Wikipedia; Wikimedia
Foundation.
https://en.wikipedia.org/wiki/Superior_vena_cava#:~:text=The%20superior%20
vena%20cava%20(SVC,the%20body%2C%20above%20the%20diaphragm.
Wikipedia Contributors. (2020, March 9). Endocardium. Wikipedia; Wikimedia
Foundation.
https://en.wikipedia.org/wiki/Endocardium#:~:text=The%20endocardium%20is
%20the%20innermost,the%20valves%20and%20heart%20chambers.
What are the New York Heart Association (NYHA) functional classifications of heart
failure? (2021, January 26). Medscape.com.
https://www.medscape.com/answers/163062-86484/what-are-the-new-york-hea
 rt-association-nyha-functional-classifications-of-heart-failure#:~:text=NYHA%20
heart%20failure%20classes%20are,person%20is%20comfortable%20at%20rest
What is Atrial Fibrillation (AFib or AF)? (2016). Www.heart.org.
https://www.heart.org/en/health-topics/atrial-fibrillation/what-is-atrial-fibrillation-
afib-or-af#:~:text=Atrial%20fibrillation%20(also%20called%20AFib,Americans%
20are%20living%20with%20AFib.
What is obstetric score? - Quora. (2020). Quora.com.
https://www.quora.com/What-is-obstetric-score

‌
CONTRIBUTIONS

Introduction - Paul Rebano

Purpose of the Study - Paul Rebano
Definition of Terms - Jamielou Aguilar
Nursing Health History - Angel Villaverde
Gordon's Functional Health Pattern - Jamielou Aguilar, Gian Constantino, Vernon
Sombrero
Anatomy and Physiology - Gian Constantino, Vernon Sombrero
Diagnostic Tests - Gabriel Relayo
Drug Study - Patricia Señar
Nursing Care Plan - Anz Yabut, Paul Rebano
Discharge Plan - Vernon Sombrero, Angel Villaverde