RAD RLE Guide -Written Requirements

Name of Student : Nicole Zschech C Leyson Section : BSNA9

Concept : Maternal RLE 1 Name ofClinical Instructor : Gil Platon Soriano

Patient’s Data:
Name: Grace Marie Torres Renegado Occupation: Buisnesswoman
Gender: Female Nationality: Filipino
Birth Date: January 08,1994 Religion: Roman Catholic
Birth Place: Source of Data: Eugene Renegado(husband)
Age: 26 years old Date & Time of Admission: 06/17/2020 05:09 AM
Address: : Pook, Talisay City, Cebu Attending Physician: Dr. Ubal
Educational Level:College graduate Diagnosis: Cephalic in labor, PROM
Marital Status: Married

Chief Complaint: Watery Vaginal Discharge

LMP : 09/13/2019
AOG : 39 ⁴/₇ weeks (LMP)
EDC : 06/20/2020
VITAL SIGNS: BP 130/80 mmHg Temp 37.1°C Pulse Rate 92 bpm Resting Rate 24 bpm O2 Sat: 98% Weight:
117 lbs.

Brief History Upon Admission:

S: 5 hours PTA, Patient noted sudden onset of watery vaginal discharges, clear associated with intermittent hypogastric pain,
every 5-10 minutes thus consult.
Abdomen: FH: 20 cm
FHT: 140 bpm
EFW – 2, 945 grams IE:
6 cm dilated. 80% eff.

Admitting Diagnosis: G₁P₁ PU 39 ⁴/₇ weeks AOG, Cephalic in labor, PROM, 6 cm -dilated associated with history of Epilepsy.

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 Anatomy & Physiology

Embrayonic structure
 PLACENTA- A placenta is a female organ that develops during pregnancy stage which provides
oxygen, removes waste products from the baby’s blood and gives nutrients to the fetus.
 UMBILICAL CORD- The umbilical cord connects a fetus to the mother's placenta, supplying
oxygen and nutrient-rich blood while also eliminating waste.
 AMNIOTIC SAC (BAG OF WATER)- The double-walled fluid-filled sac that encloses and protects
the fetus in the womb splits during the birth process, releasing its fluid.
 AMNIOTIC FLUID- The protecting liquid retained by the amniotic sac of a gravid amniote is called
amniotic fluid. This fluid not only acts as a cushion for the growing fetus, but it also helps the mother
and fetus exchange nutrients, water, and metabolic products.
 UTERUS- The uterus, commonly known as the womb, is an inverted pear-shaped muscle organ
positioned between the bladder and the rectum in the female reproductive system. Its purpose is to
feed and house a fertilized egg until the fetus, or child, is ready to be born.
 CERVIX- The uterus's lowest portion, the cervix, connects the uterus to the vagina and creates a
pathway between the vaginal and uterine cavities.
 VAGINA-The vagina serves three purposes: It's where the penis is inserted during sexual intercourse.
It's the pathway (the birth canal) through which a baby leaves a woman's body during childbirth. It's
the route through which menstrual blood leaves the body during periods.

Definition of the disease

PREMATURE RUPTURE MEMBRANE

The rupture of the fetal membranes before the commencement of labor is known as premature rupture of membranes (PROM).
The majority of the time, this happens near term, however preterm PROM occurs when the membrane ruptures before 37
weeks of pregnancy. Preterm PROM causes one-third of preterm deliveries and complicates around 3% of pregnancies. 1It
raises the risk of preterm and causes a slew of other perinatal and neonatal issues, including a 1% to 2% chance of fetal death.
2 Physicians caringfor pregnant patients should be familiar with the treatment of preterm PROM because early detection and
treatment can enhance results.

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Parts of the organ and functions:

• The cervix is a narrow, tubular passage that comprises the inferior end of the uterus. The uterus is a pear-shaped organ
with the narrower part, the cervix, facing downwards and protruding slightly into the vagina in pre-menopausal
women. As such, the cervix serves as a passageway between the endometrial cavity and the vagina and is
physiologically important in reproduction and childbirth.
• The cervix divides into the endocervix, the endocervical canal, and the ectocervix. The endocervix is the portion of
the cervix that meets the corpus of the uterus. The ectocervix is the most inferior portion of the cervix that protrudes
into the vagina. The internal os of the cervix is the opening of the cervix that joins the uterus, while the external os of
the cervix is the junction between the cervix and the vagina. During labor, the internal os will undergo effacement,
while the external os will undergo dilation.
• The cervix serves as a barrier between the endometrial cavity and the vagina, the latter essentially being the external
world. Depending on the phase a female is in during her menstrual cycle, the cervix will produce mucus of different
consistencies to either facilitate or hinder sperm entry into the endometrial cavity. Furthermore, during pregnancy, the
cervix produces a thick mucus plug that keeps pathogens out of the endometrial cavity to protect the developing fetus
and to maintain a sterile environment in the uterus.
• Towards the end of pregnancy, as the time of labor approaches, the cervix must thin and open wider to facilitate and
accommodate the passage of the fetus during delivery. This process is known as cervical effacement and dilation. The
determining factor for the first stage of labor is cervical progression; when the cervix has become completely effaced
and dilated, it marks the beginning of the second stage of labor. Should this process become impaired or proceed too
slowly, the obstetrician can augment cervical effacement and dilation.

Pathophysiology

A Premature Rupture Membranes(PROM) is the breakage of membranes before the onset of labor and if occurs before
labor or before 37 weeks of gestation then it is called as Preterm Rupture membrane(PPROM). There are symptoms such as
gradual leakage of watery fluid from the vagina and damp underwear/pad, or a change in the color or nature of vaginal discharge
can be more non-specific. The PROM occurs due to Membrane rupture that is caused by a multitude of circumstances that
eventually contribute to increased membrane deterioration. Increased intrauterine pressure is generated by an increase in local
cytokines, an imbalance in the interaction between matrix metalloproteinases and tissue inhibitors of matrixmetalloproteinases,

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increased collagenase and protease activity, and other variables. After this, the amniotic fluid that surrounds the baby inside the
womb in which there are layers of tissue that hold this, known as the amniotic sac willl eventually rupture which then expose
client for high risk infections and complications.Such as, Chorioamnionitis an infection-related inflammation of the fetal
membranes and the longer the membranes are torn and the baby is not delivered, the higher the risk. Oligohydramnios this is
especially important if the gestational age is less than 24 weeks, since it increases the risk of lung hypoplasia significantly.
Neonatal death due to prematurity-related problems, sepsis, and pulmonary hypoplasia. Abruption of the placenta and Prolapse
of the umbilical chord.
The patient also had a history of Epilepsy. This is a type of nervous system condition that referred to as a seizure disorder.
Normally, electrical and chemical signals are used by the body's nerves to transmit information. Epilepsy is characterized by
aberrant electrical signals in the brain. This may result in a seizure. Muscle tremors are a common symptom of seizures. They
could also be quite minor, with no symptoms at all. Epilepsy is not caused by pregnancy. A pregnant woman with epilepsy, on
the other hand, may experience more seizures. This could be due to the fact that epilepsy medications work differently during
pregnancy. They might not be as well absorbed. Alternatively, they could not operate as well. Women who have nausea and
vomiting early in pregnancy may also vomit the drug before it takes action.
Therefore, the patient needs an immediate clinical attention and it is the nurse responsibility to keep on monitoring the
patient, educating client on what are the possible outcomes of her case, teaching hand hygiene and avoiding sexual intercourse
for a couple of months after the delivery.

 Active Labor starts when the contractions become regular and the cervix has dilated to 6 centimeters. The mother
will get stronger, longer and more painful contractions as it dilates toward 10 cm. Each contraction lasts about
45 seconds and they can be as close as 3 minutes apart. The duration of this stage can last from about 4 to 8
hours.

Pathological pathway

PRO EPILEPSY
Premature Rupture Membranes(PROM) type of nervous system condition that referred
is the breakage of membranes before the to as a seizure disorder. Normally, electrical
onset of labor. and chemical signals are used by the body's
nerves to transmit information.

SYMPTOMS
 Temporary confusion MANAGEMENT
-Increase in the fetal
MANAGEMENT -Surgeries
heart rate
Hospitalization  A staring spell -Therapies
-Contractions of the
- -Anti seizure
uterus (womb)  Uncontrollable jerking
Antibiotic(prescri medicine prescribed
-Tenderness of the movements of the arms
bed by doctors) by doctors
uterus and legs

 Loss of consciousness or
awareness

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Laboratory Tests:

Date Type of Exam Patient’s Result Normal Significance/Interpretation

Values
06/17/2020 HEMATOLOGY WBC= 11.24 10³/mm³ 4.4-11.0 Above Normal
(CBC)
NEU= 81.30 % 37.0-80.0 Above Normal

LYM= 11.80 % 10.0-50.0 Normal

MON= 6.10 % 0.0-12.0 Normal

EOS= 0.50 % 0.0-7.0 Normal

BAS= 0.30 % 0.0-2.5 Normal

RBC= 3.62 10⁶/mm³ 4.5-5.1 Below Normal

HGB=11.50 g/dL 12.3-15.3 Below Normal

HCT= 34.00 % 35.9-44.6 Below Normal

PTC= 132.00 10³uL 150.00-400.00 Below Normal

MCV= 93.90 fL 80-96 Normal

MCH= 31.70 pg 27.5-33.2 Normal

MCHC= 33.80 g/dL 32.0-36.0 Normal

RDW= 14.30 % 11.6-14.8 Normal

PLT= 292 10³/mm³ 150-450 Normal

MPV= 10.00 um³ 6.0-11.0 Normal

PDW= 17.30 um³ 11.00-22.00 Normal

PCT= 0.13 % 0.15-0.40 Below Normal

P-LCC= 41.00 10³uL 44.00-140.00 Below Normal

P-LCR= 31.40 % 18.00-50.00 Normal

*A complete blood count (CBC) is a blood test

used to evaluate your overall health and detect a
wide range of disorders, including anemia,
infection and leukemia. A complete blood count
test measures several components and features of
your blood, including: Red blood cells, which carry
BLOOD TYPING oxygen.

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 Blood Type: *This is done so that the client can safely donate
Rh: blood or receive a blood transfusion. It is also done
TYPE O NEGATIVE to see if the clienthave a substance called Rh factor
on the surface of their red blood cells.

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 04/17/2020 URINALYSIS *A urinalysis is a test of your urine. A urinalysis is
used to detect and manage a wide range of
•Macroscopic Exam: YELLOW STRAW disorders, such as urinary tract infections, kidney
Color: 30 mL disease and diabetes. A urinalysis involves
Volume: checking the appearance, concentration and content
HAZY CLEAR
Transparency: of urine. Abnormal urinalysis results may point to
1.010 1.003-1.030
Specific Gravity: a disease or illness.

• Chemical Exam:
Albumin: TRACE
pH: 6.5 4.5-8.0
Ketone: Blood: 2+
Glucose: 1+
Nitrite: NEGATIVE
Bilirubin: NEGATIVE
Urobilinogen: NEGATIVE
NORMAL
• Microscopic Exam:
WBC:
RBC: 1-4/HPF
Epithelial Cell: 1-3/HPF
Mucus Threads: FEW
Bacteria: RARE
MODERATE
• Crystals:
Coarse Granular:
Fine Granular:
Hyaline:
Waxy:
Amorphous Urates:
Uric Acid: MODERATE
Calcium Oxalates:
Amorphous Phosphates:
Triple Phosphates:
Ammonium Phosphates:

06/17/2020 IMMUNOLOGY *Quantification of serum hepatitis B antigen

(HBsAg) is an important test that marks active
HIV ½: NONREACTIVE
infection with hepatitis B and helps in the prediction
Syphilis: NONREACTIVE of the clinical outcome and management of hepatitis
HbsAg (Qualitative) NONREACTIVE B virus (HBV) infection.

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 Diagnostic Test:

Date Type of Test Patient’s Result Significance/Interpretation

06/17/2020 ULTRASOUND 8.72 cm AOG: 25W4D *Single, live, intrauterine pregnancy in cephalic
(Sonogram) 31.3 cm AOG: 26W0D presentation with average ultrasound age of 34
BPD: 29.9 cm AOG: 25W2D weeks and 6 days age of gestation. Placenta
HC: 6.85 cm AOG: posterior, high lying grade 2 and the amniotic
AC: 26W3D 34 weeks volume is adequate. Incidentally, the fetus is
FL: 6 days AOG female.
Avera Posterior, High Lying
Grade 2
ge:
10.3
Placen
cm
ta:
09/13/
Amniotic Fluid Index
19 152
(AFI): LMP:
bpm
FHB:
06/20/
EDD
20
(LMP): 2450 grams
EFW:

Problem Lists:

Number of Focus / Nursing Diagnosis

Priority
1 Pain associated with intermittent hypogastric pain radiating at the back, every 5-10 mins
due to cervical dilation.

2 Risk for trauma or suffocation related to epilepsy.

3 Risk for infection as evidenced by watery vaginal discharge.

 Drug Study:

Drug Name Classification Mechanism of Indication Contraindication Adverse reaction Nursing responsibilities
Action
Generic name: Pyrrolidine May inhibit Adjunctive Hypersensitivity Acute psychosis, Before:
Levetiracetam derivative voltage-dependent therapy, to levetiracetam. agitation, delirium, Review history of seizure disorder (intensity,
Brand name: calcium channels, partial Renal impulsivity have been frequency, duration, LOC).
Keppra facilitate GABA seizures, impairments, pts reported. Sudden Initiate seizure precautions.
inhibitory primary tonic- with depression at discontinuance Question hypersensitivity reaction.
Actual Dosage: transmission, clonic high risk for increases risk of Obtain renal function test.
500 mg reduce potassium seizures, suicide. seizure activity. During:
current, or bind to myoclonic Serious dermatological Continue antibiotic therapy for full length treatment.
Route: synaptic proteins seizures. reactions, including Space doses evenly.
PO that modulate Stevens-Johnson After:
neurotransmitter syndrome and toxic Observe for reoccurrence of seizures.
Frequency: release. epidermal necrolysis, Assess for clinical improvement (decreased
BID have been reported. intensity/ frequency).
Observe for suicidal ideation, depression,
THERAPEUTIC behavioural changes.
EFFECT: Assist with ambulation if dizziness occurs.
Prevents seizure
activity.
 Drug Name Classification Mechanism of Indication Contraindication Adverse reaction Nursing responsibilities
Action
Generic name: Vitamin Stimulates Treatment of Hypersensitivit y Allergic Before:
Folic Acid Water Soluble production of anemia due to for folic acid. hypersensitivity occurs Pernicious anemia should be ruled out with schilling
platelets, WBCs in folate Anemias (aplastic, rarely with parenteral test and vitamin B12
Brand name: folatedeficiency deficiency in normocytic, form. blood level before initiating therapy.
Folvite anemia. Necessary pregnant pernicious, Eat in foods rich in folic acid, including fruits,
for formation of co- women. refractory) when vegetables, and organs meats.
Actual dosage: 500 enzymes in many anemia present
mg metabolic pathways with vitamin b12 During:
and erythropoiesis. deficiency. Continue antibiotic therapy for full length treatment.
Route: Space doses evenly.
PO
After:
Frequency: THERAPEUTIC 1. Assess for therapeutic improvement: improved
1 tab OD EFFECT: sense of well-being, relief from iron deficiency
Essential for symptoms (fatigue, shortness of breath, sore tongue,
nucleoprotein headache, pallor)
synthesis,
maintenance of
normal
erythropoiesis.
 Drug Name Classification Mechanism of Indication Contraindication Adverse reaction Nursing responsibilities
Action
Generic name: Second Binds to bacterial Treatment for History of Antibiotic-associated Before:
Cefuroxime generation cell membranes, many hypersensitivit colitis, other
cephalospori inhibits cell wall different types y/anaphylactic superinfections Obtain CBC, renal function tests.
Brand name: n synthesis. of bacterial reaction to (abdominal cramps, Question for history of allergies, esp. penicillins,
Altoxime infections cefuroxime, severe watery cephalosporins.
such as cephalosporins. diarrhea, and fever)
Actual dosage: THERAPEUTIC bronchitis, may result from altered During:
500 mg EFFECT: sinusitis, Cautions: Severe bacterial balance in GI Continue antibiotic therapy for full length treatment.
Bactericidal tonsillitis, ear renal impairment, tract. Nephrotoxicity Space doses evenly.
Route: PO infections, history of may occur, esp. in pts May cause GI upset (may take with food, milk).
skin penicillin allergy. with pre-existing renal
Frequency: infections, Pts with hx of disease. Pts with
1 tab OD gonorrhea, colitis, GI history of penicillin After:
and urinary malabsorption, allergy are at increased Assess oral cavity for white patches on mucous
tract and seizures. risk for developing a membranes, tongue (thrush).
infections. severe hypersensitivity Monitor daily pattern of bowel activity, stool
reaction (severe consistency.
pruritus, angioedema, Monitor I/O renal function tests for nephrotoxicity. 4.
bronchospasm Be alert for superinfection: fever, vomiting, diarrhea,
anaphylaxis). and anal/genital pruritus, oral mucosa changes
(ulceration, pain, and erythema).
 Drug Name Classification Mechanism of Indication Contraindication Adverse reaction Nursing responsibilities
Action
Generic name: Non-narcotic Inhibits the Immediate Chronic active Nausea, dizziness, Before:
Tramadol HCl, Analgesic binding of parent Release: alcoholism, somnolence,
Para cetamol 1. Assess onset, type, location, duration of pain.
and M1 metabolite Manageme increased asthenia, fatigue,
to μopioid nt of sensitivity to hot flushes, 2. Assess drug history, esp. carbamazepine,
receptors and moderate Dolcet, marked headache, and analgesic, CNS depressants. MAOIs.
Brand name: weak inhibition of to disturbances of tremors. 3. Review past medical history, eps. Epilepsy,
Altotram
reuptake of moderatel liver function
y severe seizures.
norepinephrine and / or kidney
pain. 4. Monitor pulse, B/P, renal/hepatic function.
and serotonin. disease,
Actual dosage: anemia,
7.5mg/325 mg
pregnancy (I
ExtendedRel term). During:
ease: 1. Assist in the intake of tablets with adequate
Route: Around- amount of liquid.
PO thecock
management 2. Palpate bladder to urinary retention.
of moderate
Frequency: to
1 tab BID moderately After:
severe pain 1. Monitor vital signs.
for
extended 2. Report symptoms such as headache, fatigue,
period. and etc.
 Drug Name Classification Mechanism of Indication Contraindication Adverse reaction Nursing responsibilities
Action
Generic name: Multivita Water-soluble Essential Prevention Contraindicate Seizures, dizziness, Before:
mins + FESO4 vitamins; iron component in and d in headache, syncope,
supplements 1. Monitor blood studies of pt.
formation of Hgb, treatment of hemochromato hypotension,
myogobin, iron-vitamin sis, hypertension, nausea, 2. Assess for intakes of other
enzymes. and dietary hemosiderosis, constipation, diarrhea, multivitamin products within 2 hours,
Brand name: OB Care Promotes effective deficiency or other may result to vitamin overdose.
epigastric pain, GI
erythropoiesis and anemias. evidence of bleeding, and 3. Assess for colostomy or
transport, Used in iron overload;
Actual dosage: 500 mg utilization of anemia due vomiting. ileostomy.
Anemias not
oxygen. to blood loss due to iron
during deficiency; During:
Route: menstruation some products
PO THERAPEUTIC , infections, contain alcohol, 1. Administer orally 1-2 hours
EFFECT: surgery, tartrazine or after meal.
Prevents iron delivery, sulfites and
2. Take tablets and capsules with
deficiency. intoxications should be
Frequency: a full glass of water.
, parasitosis avoided in
1 tab OD patients with
or other 3. Avoid using antacids, coffee,
cause, and known tea, dairy products, and eggs within 1
anemias intolerance or hour of administration.
during hypersensitivit
y
pregnancy. After:

1. Monitor pt. blood studies

periodically thereafter to determine the
level of effectiveness.

2. Assess bowel function for

constipation or diarrhea.

3. Monitor for adverse effects that

would arise for prompt intervention.
 Nursing Care Plan:

Defining Nursing Scientific Analysis Goal of Care Intervention Rationale

Characteristics Diagnosis
Subjective Data: Pain Pain generally is Short-Term Independent: - Provides
associated defined as having two goal: - Assess pain information to aid in
Water vaginal
with basic components, a noting its location, determining choice or
discharge
intermittent primary phenomenon intensity (pain score), effectiveness of
Onset of hypogastric consisting of afferent • At the and location. intervention.
intermittent pain to the output from sensory end of 8 hours, - Provide the - Promotes
hypogastric pains
lumbosacral receptors and the patient will use of comfort relaxation and
every 5-10 mins
area every 5- secondary have a measures hygiene enhancing
with a pain score of lessened or (back/leg rubs, sacral felling of wellbeing
10 mins due phenomenon
severe pain. controlled pain pressure, back rest, and may reduce the
to cervical involving processing
score. repositioning, need for analgesic or
dilation. and reaction. The
perineal care, and anesthesia.
primary phenomenon
etc.) - Narcotics can
is of psychologic • At the - Monitor have a depressant
Objective Data: origin, results from end of 8 hours, effect on fetus,
maternal vital signs
the stimulation and the patient will particularly when
As the patient and fetal heart rate
response of sensory demonstrate variability after dug administered 2-3
arrived in the
receptors, and is relaxation administration. hours before delivery.
hospital, she was
presumably the same technique. - Reduces
suffering with an
intermittent for a given stimulus in bladder distention
- Assist the
hypogastric pain al psychological intact which can increase
client to void every
every 5-10 mins people. This primary 12 hours. discomfort and
with a pain score of component overlaps prolong labor.
severe pain. with and leads to the Long-Term - Provides
secondary Dependent: relief once active
Alterations blood goal:
phenomenon, when - Assist with labor is established.
pressure from epidural anesthesia
110/60 mmHg to the afferent stimulus - Administering
• The using an indwelling IV drug during uterine
130/80 mmHg. erupts into
patient will catheter as approved contraction decreases
consciousness. This with the doctor.
incudes the have a stable amount of medication
physical and - Administer that immediately
recognition of, medication as
processing of, and emotional reaches fetus.
ordered. - Physical
reaction to the status before
sensation. delivery. examination results
determine the status
Collaborative: of the patient.
Source: The Pain and - Collaborate
Discomfort of Labor with other
and Birth, Lowe, N., department for the
vol. 25, Retrieved examinations
from: requested.
https://bit.ly/2XSs5RB
Source: Nurse’s
Pocket Guide,
Doenges, M., p.531,
14th ed.

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FDARS

Date Focus Time DAR

06/17/2020 Pain associated with 05:00 AM D: Onset of intermittent hypogastric pains every 5-10 mins
intermittent with a pain score of severe pain alterations blood pressure
hypogastric pain to from110/60 mmHg to 130/80 mmHg.
the lumbosacral
area every 5-10
A: Administered epidural anesthesia
mins due to cervical
dilation.
R: The patient feels relieved and a lessen pain score from
severe to moderate.

06/17/2020 Risk for trauma or 7:50 AM D: The patient has a history epilepsy with a last attack H.S
suffocation related
to epilepsy.
A: Administered medication (Levetiracetam 500 mg and Folic
Acid 500 mg)

R: The patient has a monitored seizure attack.

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Discharge Plan:

Date Focus Time DAR

06/17/2020 Discharge 12:00 NN D: With discharge order from attending physician Dr. Ubal.
Instructions
A: Monitor the patient’s vital signs and laboratory results before
discharge. The nurse verbalizes the doctors order to the patient to do the
following: exclusive breastfeeding, keep uterus we contracted, may go
home once with COVID PCR negative result.
M: The client knows the name, action, purpose, dose, route of
administration and side effects of each drug he or she is taking.
1. Cefuroxime (Altoxime) 500 mg /cap/ 1 cap BID x 6 days
2. Tramadol HCl, Paracetamol (Altotram) 37.5mg/ 325 mg tab 1
tab TID as needed for pain.
3. Multivitamins + Iron (OB CARE) 1 cap OD x 3 months
4.Calcium + Vitamin D (OSTEO-D) 1 tab OD x 3 months
5. Lactulose 30ml OD HS x 2 weeks
E: The patient and her family were reminded to have a clean,
comfortable and healthy environment to reduce risk of infections due to
microorganism and bacteria. Also, to provide support to lessen the
severity for postpartum depression.
T: The client and family will know the purpose and action of any
treatment.
1. Cefuroxime- Antibiotic for bacterial infections.
2. Tramadol HCl, Paracetamol- Management of moderate to
moderately severe pain.
3. Multivitamins + Iron- Prevention and treatment of iron-vitamin
and dietary deficiency anemias.
4. Calcium + Vitamin D - Treat conditions causes by low calcium
levels.
5. Lactulose- treatment for constipation.
H: The drugs are administered orally and the client will undergo with
postpartum changes.
O: The patient is instructed to do a follow up check up through
call/viber to OB Department Phone after 1 week. Follow up Dr. Ubal at
the clinic after 1 week with the result for ECG and all labs with
photocopy of the results.
D: Follows a high potassium diet including 1 banana per meal.

R: Done vital signs to the patient prior to discharge.

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BIBLIOGRAPHY:

Ali, R. & Nagalli, S. (2021, August 11). Hyperammonemia. NCBI. Retrieved on August 28, 2021
from https://www.ncbi.nlm.nih.gov/books/NBK557504/#_NBK557504_pubdet_
Doenges, M. Nurse’s Pocket Guide. p.531, 14th ed.
Gestational Diabetes Mellitus. (n.d). Hopkinsmedicine. Retrieved on August 28, 2021 from
shorturl.at/erJTW
Jewett BE, Sharma S. Physiology, GABA. [Updated 2021 Jul 26]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
Levine, M. & Padayatty S. (2016, April 14). Vitamin C physiology: the known and the unknown
and Goldilocks. NCBI. Retrieved on August 27, 2021 from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4959991/# ffn_sectitle
Lowe, N. (n.d.). The Pain and Discomfort of Labor and Birth, vol. 25. Retrieved on August 28,
2021 from https://bit.ly/2XSs5RB
Pradeep, A. (2021, July 21). Chronic Kidney Disease (CKD) Medication. Medscape. Retrieved on
August 28, 2021 from https://emedicine.medscape.com/article/238798-medication
Saunders Nursing Drug Handbook. (2021). Elsevier. Retrieved on August 27, 2021 from
https://books.google.com.ph/books
Seizure Disorder Nursing Care Plan and Management. RNpedia. Retrieved on August 28, 2021
from https://bit.ly/3zIOHb6

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