Republic of the Philippines

City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

College of Allied Health Studies

Detailed Learning Module

Program: Graduate in Midwifery

Course Code: CP 102 -CLINICAL PRACTICUM 2(MDW 101)

Title: Expanded Function of the Midwife (Insertion of Intravenous fluid in case of Obstetrical Emergencies)
Computation of drugs used in Normal Spontaneous Delivery

Module No. 1

I.Introduction: Midwives are expected to perform a variety of procedures in the course of caring for a patient
during intrapartum and postpartum period. One of the expanded functions of the midwives is to insert
intravenous fluid in case of obstetrical emergencies such as postpartum bleeding or any emergencies while
referral to the nearest hospital is arranged. This module focuses in developing skills in inserting the
intravenous fluid, assessment of client if intravenous fluid is indicated to the client.

II. Learning Outcomes: After studying this module the student should be able to:

o Analyze the expanded functions of the midwives as per RA 7392 or Midwifery Law
o Describe the considerations in the selection of insertion sites of IV fluid.
o Differentiate the needed competency in starting, regulation and discontinuing of IV fluid using the
case scenario.
o Correlate the step by step procedures when the learners encountered intravenous complications
o Describe infection control guidelines pertaining to IV fluid insertion during obstetrical emergencies.

III. Topics and Key Concepts

Philippine midwifery practice is guided by the Midwifery Act of 1992 (RA 7392)
Aside from providing care to the woman during normal pregnancy and childbirth, the law has
provided added skills that the midwife must learn to do her task competently. These include:
1. Repair of first and second degree perineal lacerations to control bleeding
2. Internal examination except when the woman has antepartum bleeding
3. Intravenous fluid infusion during obstetrical emergencies
4. Giving oxytocic drugs after delivery of placenta
5. Giving Vitamin K to the newborn

-It is stated in the Midwifery law that expanded functions of the midwives, but bear in mind that there is a
limitation in performing such procedures:

o When a midwives is trained to do so

o Those midwives graduate under the Midwifery curriculum of 1992
o Midwives are not allowed to do episiotomy. But they allowed suturing the perineal laceration up to
2nd degree laceration to control bleeding. But the midwives must exert effort in delivering the baby
to support the perieum by applying the Ritgen's manuever to prevent laceration.
 Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

o Internal examination during labor except when the woman has a history of bleeding during her
pregnancy. Evaluate first the age of gestation based on LMP or measure the fundic height to
determine if pregnancy is premature.
o Observe aseptic technique in conducting internal examination
o Limit your internal examination every four hours or as needed
o The cervix dilated 1cm per hour in Primigravida and 1.5 -2 cm per hour in multigravida client.
o Check the status of vagina, fetal presentation, position, presenting part, the status of bag of
water and check if there is prolapse of the umbilical cord.

o Oxytocin is given after the placenta was delivered but according to Essential Intrapartum Newborn
Care (EINC) or Active Management of Third Stage of Labor (AMSTL) oxytocin must be given after
delivery of the NB within 1 minute and after excluding the second baby. Proper training is required
before following the AMTSL and EINC.

o Giving Vitamin K to all NB to control bleeding from the umbilical cord

 1mg in term NB and 0.5 mg in the premature NB, intramuscular at the upper outer
part of the legs.

o Giving intravenous fluid in case of obstetrical emergencies such as bleeding secondary to uterine
atony. Immediately insert IV fluid and give additional oxytocin incorporate in the fluid.

The students should complete the needed cases before they are allowed to graduate:
o 20 actual handled normal spontaneous delivery
o 20 assisted normal spontaneous delivery
o 20 Internal Examination
o 5 perineal suturing
o 5 IV fluid insertion
o 20 cord care
The students should complete the needed cases before they are allowed to graduate:
o 20 actual handled normal spontaneous delivery
Ex :
 Student No. 1:
 Corazon Padua, 22 years old, Apitong St, Old Cabalan Olongapo City
 G1P1 PU 37 weeks AOG, cephalic presentation, delivered spontaneously to
alive baby girl weighing 2.8 kgs ,AS of 9,10 with 2nd degree laceration
repaired.
 Jan 3, 2022, 6:05pm, James L. Gordon Memorial Hospital
 CI: Ms. Renavil Fernande, RM, BSM-Clinical Instructor

 Student No. 3:
 G3P3 PU 38 weeks AOG, cephalic presentation, delivered spontaneously via
perineal support to a live baby boy weighing 3.1 kgs, AS of 8-9
 Jan 3, 2022 ,9:00pm James L. Gordon Memorial Hospital
 CI: Ms. Renavil Fernandez, RM, BSM

o 20 Internal Examination
 Student No. 2
 Corazon Padua, 22 years old, Apitong St, Old Cabalan Olongapo City
 G1P0 PU 37 weeks AOG, cephalic in labor , 7cm cervical dilatation
 Jan 3, 2021, 2pm , James L. Gordon Memorial Hospital
 Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

 CI: Ms. Renavil Fernandez, RM, BSM

o 5 perineal suturing
 Student No. 1:
 Corazon Padua, 22 years old, Apitomg St, Old Cabalan Olongapo City
 G1P1 PU 37 weeks AOG, cephalic presentation, delivered spontaneously to
alive baby girl weighing 2.8 kgs ,AS of 9-10 with 2nd degree laceration
repaired.
 Jan 3, 2021, 6:35pm, James L. Gordon Memorial Hospital
 CI: Ms. Renavil Fernandez, RM, BSM

o 5 IV fluid insertion
 Student No. 4:
 Katrina Suero, 23 yo, Mabayuan, Olongapo City
 G1P0 PU 32 weeks AOG, cephalic preterm in labor
 Jan 3, 2021, 10:05pm, James L. Gordon Memorial Hospital
 CI: Ms. Renavil Fernandez, RM, BSM

Intravenous fluids (usually shortened to 'IV' fluids) are liquids given to replace water, sugar and salt that you
might need if you are ill or having an operation, and can't eat or drink as you would normally. IV fluids are
given straight into a vein through a drip.
o Direct IV, IV push, IV infusion
o Most rapid route of absorption of medication
o Larger doses of medications can be administered by this route

TYPES OF IV FLUID

ISOTONIC – has the same HYPOTONIC – has lower HYPERTONIC – has higher concentration
concentration as the body fluids. concentration than the body than the body fluids
fluids
0.9% Nacl 0.45% Nacl 3% Nacl
Lactated Ringers 0.33% Nacl 5% Nacl
Ringer's Solution .2% Nacl 3% Nacl or 5% Nacl +D/W
5% Dextrose in water 2.5% Dextrose water >5% D/W example, D10 W

Intravenous Fluid Comparison

Type Solution Uses Special Considerations

Isotonic Dextrose 5% in • Fluid loss • Use cautiously in renal and cardiac patients
water • Dehydration • Can cause fluid overload
(D5W) • Hypernatremia
Isotonic 0.9% sodium • Shock • Can lead to overload
chloride • Hyponatremia • Use with caution in patients with heart failure
(Normal Saline) • Blood transfusions or edema
(NaCl) • Resuscitation
• Fluid challenges
• DKA
 Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

Isotonic Lactated Ringer’s • Dehydration • Contains potassium, don’t use with renal failure
(LR) • Burns patients
• Lower GI fluid loss • Don’t use with liver disease, can’t metabolize
• Acute blood loss lactate
• Hypovolemia due to third
spacing
Hypotonic 0.45% sodium • Water replacement • Use with caution
chloride • DKA • May cause cardiovascular collapse or increased
(1/2 normal • Gastric fluid loss from NG intracranial pressure
saline) or vomiting • Don’t use with liver disease, trauma, or burns
Hypertonic Dextrose 5% in ½ • Later in DKA treatment • Use only when blood sugar falls below 250
normal saline mg/dL
Hypertonic Dextrose 5% in • Temporary treatment for • Don’t use n cardiac or renal patients
normal saline shock if plasma expanders
aren’t available
• ’s crisis
Hypertonic Dextrose 10% in • Water replacement • Monitor blood sugar levels
water • Conditions where some
nutrition with glucose is
required

INDICATIONS FOR I.V. THERAPY

1. To establish or maintain fluid and electrolyte balance.
2. To administer continuous or intermittent medication.
3. To administer a bolus injection.
4. To administer blood and/or blood component therapy.
5. To administer intravenous anesthetics.
6. To maintain or correct a patient’s nutritional state.
7. To administer diagnostic substances.

SITE SELECTIONS FOR I.V. THERAPY

Factors to Consider
A. Patient’s medical history
B. Patient’s age, size, general condition
C. Condition of patient’s veins
D. Type and rate of I.V. fluid or medication to be infused
E. Expected duration of I.V. therapy II.

Options in Adults:
A. Veins in the hand: Metacarpal and digital veins.
B. Veins in the lower arm: Cephalic and basilica veins – larger arm veins do not become phlebotic as quickly as
hand veins.
C. Veins in upper arm (above antecubital fossa) – these are deeper veins; good choice for infusing irritating
solutions because they are less prone to phlebitis than lower veins.
D. Veins of the inner aspect of the arm and wrist – use only if absolutely necessary. They are thin walled, and
are often associated with bruising, phlebitis, and infiltration.
E. Veins of legs, feet and ankles – generally used only with doctor’s approval. Using them may compromise
circulation in the legs and cause thrombophlebitis or embolism.
F. Avoid using the following sites:
o Veins below a previous I.V. infiltration
o Areas of skin inflammation, disease, bruising or breakdown
 Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

EQUIPMENTS

IV pole INTRAVENOUS CATHETER/ABBOCATH

INFUSION SET/VENOSET ADHESIVE OR NON ALLERGIC TAPE

CLEAN GLOVES COTTON BALLS AND ALCOHOL

Bottle or bag of Intravenous fluid Splint

 Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

Tourniguet

CHOOSING THE SITE OF INSERTION

PREFERRED: HAND SITE, LARGER VEINS
ALTERNATIVE: FOREARM VEINS
LAST RESORT:LEG ,FOOT, ANKLE
1. AVOID
- Areas of joint flexion
- Veins close to arteries and deep lying vessels
- Small, visible but impalpable superficial veins
Veins irritated by previous use
2. Use distal veins first
3. Use vein on opposite side to the site of intended procedure
 Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

COMPLICATIONS OF IV INFUSION

1. INFILTRATION- The needle is out of vein, and fluids accumulate in the

subcutaneous tissues.
- PAIN, SWELLING, PALLOR OF SITE, iv FLOW RATE DECREASES OR STOPS,
ABSENCE OF BACKFLOW OF BLOOD INTO TUBING
INFILTRATION
ASSESSMENT: Pain, Swelling, Skin is cold at needle site, Pallor at the site,
Flow of IV rate decreases or stops, Absence of backflow of blood into the
tubing as the IV fluid is put down, or the IV tubing is kinked
NURSING INTERVENTIONS
1. Change the side of needle.
2. Apply cold compress. This will reabsorb edema fluids and reduce swelling.

2. CIRCULATORY OVERLOAD- It results from administration of

excessive volume of iv FLUIDS.
ASSESSMENT: Headache, Flushed skin, .Rapid pulse,
Increased BP, Weight gain.,Coughing, Shortness of
breath, Tachypnea, Shock
NURSING INTERVENTION
1. Slow infusion to KVO (10 gtts/min)
2. Place patient in high fowler's position. To ease
breathing.
3. Administer diuretic, bronchodilator as ordered.

3. DRUG OVERLOAD-The patient receives an excessive amount of fluid containing drugs

ASSESSMENT: Dizziness, Shock, fainting
NURSING INTERVENTION:
1. Slow infusion to KVO. Notify the physician.

4. SUPERFICIAL THROMBOPHLEBITIS- It is due to overuse of a vein, irritating

solutions or drugs, clot formation, large bore catheter.
 Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

PHLEBITIS- inflammation of the blood vessel. Occurs commonly after the insertion of IV
The inflammation causes localized redness & warmth at the IV insertion site and at a short distance
along the course of the vein in which the IV has been placed.
ASSESSMENT: Pain along the course of vein, Vein may feel hard and cordlike, Edema & redness at
needle insertion site, Arm feels warmer than the other arm
NURSING INTERVENTION
1. Change IV site every 72 hours.
2. Use large veins for irritating fluids
3. Stabilize venipuncture at area of flexion
4. Apply warm compress immedaitely to relieve pain & inflammation
5. AIR EMBOLISM-Air manages to get into the circulatory system 5 ml of air or more causes air embolism
ASSESSMENT: Chest, shoulder, or back pain, Hypotension, Dyspnea, Cyanosis, Tachycardia, Increase
venous pressure, Loss of consciousness
NURSING INTERVENTION
1. Do not allow IV bottle to “run dry”
2. “Prime” IV tubing before starting infusion
3. Turn patient to left side in the T-burg position, to allow air to rise in the right side of the
heart, prevent pulmonary embolism

6. NERVE DAMAGE- It may result from tying the arm too tightly to the splint.
ASSESSMENT: Numbness of fingers and hands
NURSING INTERVENTION
1. Massage area.
2. Instruct the patient to open & close hand several times each hour
3. Physical therapy may be required.

INTERVENTION(step by step procedures(Demonstration please see attached video/illustration of

the procedures)
Equipment:
Infusion set Tourniquet Adhesive or non allergic tape Container of sterile parenteral
solution Arm spint
IV pole Intravenous catheter Clean gloves Alcohol swab

Intervention (Step by step procedures)

1. Prepare the client & articles completely.
2. Open & prepare the infusion set.
3. Spike the solution container.
4. Hang the solution container on the pole.
5. Partially fill the drip chamber w/ solution.
6. Prime the tubing.
7. Apply appropriate label on the solution container.
8. Include the client’s name, date, and note time of infusion.
9. Apply a timing label on the solution container.
10. wash hands. Wear clean gloves (optional).
11. Except for the scalp area, use of tourniquet or BP cuff to produce venous enlargement.
12. Request the patient to make a fist.
13. Tap the vein gently until it becomes engorged or place the part in a dependent position for several
minutes.
14. Cleanse the area with antiseptic.
15. Grasp the site.
16. Rest the thumb on the skin approximately two inches below the selected site of insertion.
17. Exert pressure downward toward the patient’s hand.
 Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

18. hold the needle approximately 45 degrees & insert w/ the bevel facing upward about ½ inch below the
target vein.
19. Carefully push the needle into the vein in an upward direction for approximately ¾ inch & observe the
backflow of blood.
20. Release the tourniquet.
21. Anchor the needle w/ tape.
22. apply a splint or an arm board.
23. Regulate the flow rate as indicated or prescribed.
24. Mark on the infusion bottle the time started, time to consume, medicines added & rate of flow per
minute.

1. Prepare the client & articles completely 2. Open & prepare the infusion set

3. Spike the solution container. 4. Hang the solution container on the pole
 Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

5. Partially fill the drip chamber w/ solution. 6. Prime the tubing.

7. Apply appropriate label on the solution container. 10. Wash hands. Wear clean gloves
Include the client’s name, date, and note time of (optional).
infusion.
Apply a timing label on the solution container

11. Except for the scalp area, use of tourniquet or BP 12. Request the patient to make a fist.
cuff to produce venous enlargement.

13. Tap the vein gently until it becomes engorged or
place the part in a dependent position for several
minutes.
14. Cleanse the area with antiseptic.
15. Rest the thumb on the skin
approximately two inches below the
selected site of insertion.
16. Exert pressure downward to ward the
patient’s hand.
17. hold the needle approximately 45
 Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

degrees & insert w/ the bevel facing

upward about ½ inch below the target
vein.
18. hold the needle approximately 45
degrees & insert w/ the bevel facing
upward about ½ inch below the target
vein.
19. Carefully push the needle into the vein in
an upward direction for approximately ¾
inch & observe the backflow of blood.

Anchor the needle w/ tape.

IV REGULATIONS -Calculating IV Drip Rates

o When calculating the flow rate, determine which IV tubing you will be using, microdrip or
macrodrip, so you can use the proper drop factor in your calculations.
o The drop factor is the number of drops in one mL of solution, and is printed on the IV tubing
package.
 Macrodrip and microdrip - refers to the diameter of the needle where the drop enters the
drip chamber.
 Macrodrip tubing delivers 10 to 20 gtts/mL(15 gtts) and is used to infuse large volumes or to
infuse fluids quickly.
 Microdrip tubing delivers 60 gtts/mL and is used for small or very precise amounts of fluid, as
with neonates or pediatric patients.

o To figure out the mL per hour to infuse, take the total volume in mL, divided by the
total time in hours, to equal the mL per hour.

For example, if you have 1000 mL NS to infuse over 8 hours, take 1000 divided by 8,
to equal 125 mL/hr.
1000 cc/8 hrs= 125 cc per hour

o To calculate the drops per minute, the drop factor is needed:

o The formula for calculating the IV flow rate (drip rate) is… total volume (in mL)
divided by time (in min), multiplied by the drop factor (in gtts/mL), which equals the
IV flow rate in gtts/min.
 Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

For example: The provider has ordered 1,000 mL Lactated Ringers to infuse over 8
hours. You have a macrodrip tubing with a drop factor of 15 gtts/mL. Calculate how
many gtts/min to set as the IV flow rate. Using the formula, 1,000 mL divided by 8 x
60 (since we have 8 hours times 60min/hr), then multiply by 15 gtts/min to equal
31.2, rounded to 31 gtts/min.
1000 cc x 15 gtts/min
8 hr x 60 min/hr

15,000/480 = 31.25 Final Answer 31-32 gtts/min

How to label the IV fluid: If 1 liter of IV fluid to consumed in 8 hrs. The IV fluid starts to
infuse at 8 am. It is expected that the IV fluid is already consumed at 4pm. Divide the
total volume of IV fluid to time in hours

1000 cc/10 hrs= 100 cc

1000 cc
8am start of infusion
Since 125 cc/hr

9am-875 125 cc consumed

10am 750 cc remaining 250 cc consumed
11am625 cc 375 cc consumed

IV. Teaching and Learning Materials and Resources

- Reference book
-Equipment and materials used in insertion of IV fluid
-Equipment and materials used in insertion of IV fluid
 Supplies/materials need to purchase on the nearest pharmacy/drug
outlet
o IV catheter/abbocath g 20
o Macroset/venoset
o Plaster
o tourniquet
o cotton balls
o alcohol
 Suggested improvised materials
o IV tray: Any container that suitable for the content of
materials/equipment for IV insertion
o cotton balls container: any plastic small container (1- clean/dry
cotton balls, 1-cotton balls with alcohol
o waste container: any plastic container
o IVF: empty bottle of soft drinks
 Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

-Midwifery Skills Procedure Checklist

-White pad and pen

V. Learning Task

1. Analyze the given scenario and identify the possible complication of IV fluid, the assessment and
intervention.
2. Identify what type, sizes of needle suitable in the given scenario.
3. Watch the video (during synchoronous discussion) about insertion of IV fluid and interpret if it is properly
followed the step-by step procedures.
4. Analyze the given scenario on how to regulate the IV fluid and label the IV fluid properly.
5. Write your answers legibly.
6. Watch the attached video(illustration) on how to insert the intravenous fluid. Return demonstration would
conduct via online on scheduled rotation.
6. Queries relevant to the topic will be entertained thru online discussion via facebook messenger or any
online application.(please follow office hour or scheduled CP rotation)

Guidelines:
1. Please refer to the General Guidelines/ CP policy during flexible learning.
2. Additional Guidelines:
A. Modules: - All learning tasks in the modules are expected to be answered completely and to be passed a
week after the discussion. All modules that are passed beyond the due date set will automatically be
deducted 10 points each week it has lapsed the due date.
B. Return Demonstrations:
o Students are expected to accomplish ALL return demonstrations discussed. Failure to do so will
automatically mean a grade of 60% for that specific demonstration. But still, the student will be
required to accomplish the demonstration before moving on to the next level and before clinical
exposure when face to face mode of learning is permitted.
o The student will not be allowed to enroll on the next semester until he/she has complied with all the
demos required.
o All return demonstration (synchronous or recorded video) should be done in their own home using
the suggested improvised materials/ equipment available in the home. However, selected hospital
instruments, materials such as sterile gloves, cord clamp, cotton balls etc as stated in a specific
module should be purchased in the nearest pharmacy or hospital equipment outlet.
o Upon performing the return demonstration, the students must be seen in the video doing the
procedure wearing proper attire and hair neatly tied, NO voice over or voice recording and reading
the step by step procedures is allowed. It is expected to be performed with confidence.
o All recorded return demonstration should be passed on due date as specified in the modules. It is
expected to be turned-in in your respective clinical instructors email, google classroom or via
messenger using the student GC domain with proper label of the Module Title, module no and
Midwifery Procedures title. It is also advised to have a back -up file for proper documentation.
o Strict compliance to the procedure is a must. Any errors or failures encountered during the
demonstration as a result of the student's disobedience or neglect, the student will be held
accountable.

C. Attendance: - A student with 50% accumulated non-attendance on the required synchronous sessions of
clinical practicum subjects within the semester will be marked Failed due to Absences (FDA).

Name: ________________________________________________________Module No:______1_______

Course Code: CP 102 -CLINICAL PRACTICUM 2
Module Title: Expanded Function of the Midwives: Inravenous Insertion
 Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

Activity 1: Analyze the given scenario and identify what type of complication of IV fluid and identify the
nursing intervention:

Case Scenario Complication of IV fluid insertion Nursing Interventions

and definition
1. Midwife Marina while inserting
the intravenous fluid observes the
inability to advance the cannula
all the way into the vein during
insertion
2. Patient Rowena develops a
fever, body malaise and the
infusion set of her IV fluid is
inability to flush
3. Patient Cruz feels coolness of
the skin around site
4. Patient Andrea complained of
numbness of fingers and hands
5 .It is usually happen when the
needle size is too large for the
vein size
6. Patient Marie complains of
chest, shoulder, and back pain.
Her blood pressure is 80/60 and
looks cyanotic

Activity 2: Identify what type of IV fluid:

Types of IV fluid
7. This type of fluid has higher concentration than
the body fluids
8. The type of IV fluidhas the same concentration as
the body fluids.
9. The type of IV fluid has lower concentration than
the body
10. Dextrose 5% in water
11. 0.9% sodium chloride
12. Lactated Ringer’s (LR)
13. 0.45% sodium chloride

Activity No. 3: Calculate the amount of fluid per hour and the number of drops per minute:
Answer (show your computation)
14. The provider has ordered 1,000 mL Lactated
Ringers to infuse over 8 hours to a G2P1 PU 37
weeks AOG cephalic in labor. You have a macrodrip
tubing with a drop factor of 20 gtts/mL. Calculate
how many gtts/min to set as the IV flow rate.
15. The provider has ordered 1,000 mL Lactated
Ringers to infuse over 12 hours. You have a
macrodrip tubing with a drop factor of 15 gtts/mL.
 Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

Calculate how many gtts/min to set as the IV flow

rate.
16. Draw and label IV fluid solution on how many cc
of fluid per hour if the provider ordered 1 liter to be
consumed in 8 hrs. The infusion starts at 2 pm
17. Draw and label the different sites of intravenous
insertion. Identify the preferred and last sort of
insertion.
18. Draw and label the infusion set.

Activity No. 4: Analyze the following scenario and analyze if the midwife follows the expanded/scope of
functions according the RA 7392. Support your answer:
19. Case No. 1: Katrina ,25 years old G2P1 (1-0-0-1) PU 37 5/7 weeks AOG, admitted at Orario Birthing Clinic.
Katrina is conscious coherent, having a regular uterine contraction of 2/10 minutes. Internal examination of
6 cm dilated. Midwife Cristina inserted intravenous fluid with 1 unit of oxytocin regulated at 15 gtts per
minute.

Guide Questions:
1. When is the best time to give the oxytocin following the RA 7392? Support your answer.

2. Did Midwife Cristina follow the RA 7392 in inserting the intravenous fluid? Support your answer.

20. Case No. 2: Margarita, 22 years old, G3P2(2-0-0-2) PU 33 weeks AOG consulted at De Castro Birthing
Clinic because of slight vaginal bleeding without uterine contraction. After assessment Midwife Liza
conducted internal examination and revealed as 4 cm dilated , intact bag of water and cephalic presentation.

Guide Question:
1. Did Midwife Liza follow the RA 7392 in conducting internal examination? Support your answer

2. When is the best time to conduct internal examination following the RA 7392?

21. Case No. 3: Patient Rosiel, 56 years old, which she is not able to drink and eat. Her relative requests
Midwife Cristina to insert intravenous fluid to opt the health condition of Patient Rosiel. Is Midwife Cristina
could insert the IV fluid following teh RA 7392? Support your answer.

22. Case No. 4: Midwife Monica failed to inject Vitamin K to a newly born Baby Rodriquez resulting to
umbilical cord bleeding two (2) hours after birth. Is Midwife Monica liable of what happen to Baby
Rodriquez? Support your answer following the RA 7392.

23. Case No. 5: Patient Rosita, G1P1 who had just given birth to a live baby girl weighing 3.1 kgs with 2nd
degree laceration resulting to postpartum bleeding secondary to laceration of soft parts. Midwife Liza as her
attending midwife failed to suture the perineal laceration. Is Midwife Liza liable in the condition or what
happening to Patient Rosita? Support your answer following the RA 7392.
 Republic of the Philippines
City of Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo City
Tel. No. (047) 224-2089 loc. 314

Activity No 4: Return demonstration of intravenous fluid insertion. (synchronous demonstration, please

check your scheduled rotation). Prepare the needed supplies, materials etc.)

Recorded video of your return demonstration and accomplished module should be passed next week after
the scheduled rotation in email(rivera,mariasandra@gordoncollege.edu.ph), Fb messenger(screen shot
only) and googleclassroom

VI. References:

World Health Organization(2006) Integrated Management of Pregnancy and Childbirth, Pregnancy, Childbirth,
Postpartum and Newborn Care: A Guide for Essential Practice
World Health Organization(1998). Care of the Umbilical Cord: A Review of the Evidence.
Williams Obstetrics 24th Edition
Essentials of Obstetric Nursing by Cagayan 2018
BEMONC Module for Midwives
Case Files in Obstetrics and Gynecology, Lance
Textbook for Midwives, Myles 17th edition 2020

Prepared by:

Maria Sandra C. Rivera, RM MCHS, BSM

Clinical Instructor