1

University of Southern Philippines

Foundation Salinas Drive, Lahug, Cebu City
College of Health Sciences
Nursing Department

Case Analysis
On
Normal Pregnancy

Group 1 Members

Aytona, Jamaica
Casia, Ashley
Casiao, Patricia
Ebillo, John
Gomez, Bhea
Josol, Kirstin
Magayanes, Jessica
Mondragon, Prince
Peralta, Anthony
Zozobrado, Aliyah

Clinical Instructor:
Mr. Rolando de Guzman II
 2

TABLE OF CONTENTS

Title Page

Introduction 3

Patient Profile 4-5

Developmental Task 6

Health Assessment & Physical Exam 7-12

Laboratory and Diagnostics 13-24

Summary of Findings 23-25

Anatomy and Physiology 25-29

Pathophysiology 30

Nursing Care Plan 29-34

Drug Study 35-55

Health Teaching 56-78

Discharge Planning 79
 3

INTRODUCTION

Pregnancy is the state of carrying a developing embryo or fetus within the female body. This condition can be indicated by positive results on an
over-the-counter urine test, and confirmed through a blood test, ultrasound, detection of fetal heartbeat, or an X-ray. Pregnancy lasts for about
nine months, measured from the date of the woman's last menstrual period (LMP). It is conventionally divided into three trimesters.

 First trimester

The first trimester occurs during the week 1 and week 12 of pregnancy, pregnancy begins with conception, in which a sperm penetrates an egg.
The fertilized egg (called a zygote) then travels through the woman's fallopian tube to the uterus, where it implants itself in the uterine wall. The
zygote is made up of a cluster of cells that later form the fetus and the placenta. The placenta connects the mother to the fetus and provides
nutrients and oxygen to the fetus.

 Second trimester

During the second trimester starting week 13 to week 28,the physical parts of the fetus become fully distinct and at least somewhat operational.
Between 18 and 20 weeks, the typical timing for ultrasound to look for birth defects, you can often find out the sex of your baby. At 20 weeks,
the mother may begin to feel movement of the fetus. According to research from the NICHD Neonatal Research Network, the survival rate for
babies born at 28 weeks was 92%, although those born at this time will likely still experience serious health complications, including respiratory
and neurologic problems

 Third trimester

During the third trimester starting week 29 to week 40, at 32 weeks, the bones are soft and yet almost fully formed, and the eyes can open and
close. As the end of the pregnancy nears, there may be discomfort as the fetus moves into position in the woman's lower abdomen. Edema
(swelling as the end of the pregnancy nears, there may be discomfort as the fetus moves into position in the woman's lower abdomen. Edema
(swelling of the ankles), back pain, and balance problems are sometimes experienced during this time period.of the ankles), back pain, and
balance problems are sometimes experienced during this time period.

Maternal health refers to the health of women during pregnancy, childbirth and the postnatal period. Each stage should be a positive experience,
ensuring women and their babies reach their full potential for health and well-being.
The most common direct causes of maternal injury and death are excessive blood loss, infection, high blood pressure, unsafe abortion, and
obstructed labour, as well as indirect causes such as anemia, malaria, and heart disease.
Most maternal deaths are preventable with timely management by a skilled health professional working in a supportive environment.
Ending preventable maternal death must remain at the top of the global agenda. At the same time, simply surviving pregnancy and childbirth can
never be the marker of successful maternal health care. It is critical to expand efforts reducing maternal injury and disability to promote health
and well-being.
 4

Every pregnancy and birth is unique. Addressing inequalities that affect health outcomes, especially sexual and reproductive health and rights
and gender, is fundamental to ensuring all women have access to respectful and high-quality maternity care.

PATIENT PROFILE

Demographic Data

I. Personal Patient Profile

Name Marrynell C.B. Age 22
Date of birth November 25, 1998 Gender Female
Address Iligan City Blood Type A+
Nationality Filipino Status Married
Religion Roman Catholic Occupation None
Contact Number -

II. Profile of spouse

Name Jonathan, B Age 31

height 5’7 weight 70 kg

Desired Family Size 5

 5
Health History

Weight 70 kg. BMI 21.3 kg/m2

Height 5’5 ☐ Underweight (<18.5)
☒ Normal (18.5 – 24.9)
☐ Overweight (25-29.9)
☐ Obese (>30)
Medical (Check all that applies) Maternal Family History
☐ Diabetes Millitus ☐ High Blood Pressure
☐ High Blood Pressure ☐ Heart Disease
☐ Heart disease ☐ Asthma
☐ Respiratory Disease ☐ Diabetes Mellitus
☐ Gastrointestinal Disease ☐ Genetic Disorder
☐ Genetic Disorders ☐ Depression/Bipolar Disorder
☐ Mental Issues ☐ Obesity
☐ Allergies: ☒ Others: NONE
☒ Others: NONE
Vaccination (Check all that applies) Smoking/ Alcohol/ Drugs
☒ DPT ☒ Smoking # per day:
☐ Hepatitis A ☐ Alcohol # per day:
☒ Hepatitis B ☐ Drugs type:
☐ MMR
☒ Pneumococcal
☐ Others:
 6

DEVELOPMENTAL TASK

In Erik Erikson's theory of psychosocial development includes the sixth stage of intimacy versus isolation, which occurs after the fifth stage of
identity vs. role confusion. This stage occurs between the ages of 19 and 40 in young adulthood. Erikson thought that it was essential to cultivate
intimate, committed connections with others. As people reach maturity, these emotionally close interactions become increasing ly important in a
person's emotional well-being. In this period of life, romantic and sexual connections might be essential, but intimacy is more about having close,
caring relationships. It might involve romantic partners, but it can also include deep, long-lasting friendships with people other than your family.

The main source of tension at this period of life is the desire to create deep, loving connections with other people. At this level, success leads to
satisfying relationships. Struggling throughout this time, on the other hand, might lead to feelings of loneliness and isolat ion. People at this stage
become worried about finding the right partner or spending the rest of their lives alone.

Close romantic relationships, deep, meaningful connections, durable connections with other people, great relationships with family and friends,
and strong relationships are characteristics of persons who are successful in resolving the intimacy versus isolation stage conflict.

Intimacy involves the ability to share aspects of oneself with others, as well as the ability to listen to and support others. These are reciprocal
partnerships in which you share pieces of yourself with others.

Struggling in this stage of life can result in loneliness and isolation. Adults who struggle with this stage might never share deep intimacy with
their partners or might even struggle to develop any relationships at all. This can be particularly difficult as these individuals watch friends and
acquaintances fall in love, get married, and start families. Loneliness can affect overall health in other ways. For example, socially isolated people
tend to have unhealthier diets, exercise less, experience greater daytime fatigue, and have poorer sleep.

Things learned in early stages of development also contribute to the ability to form effective adult relationships. People who have a low sense of
self are more prone to have uncommitted relationships and to suffer from emotional isolation, loneliness, and despair.

Healthy connections are beneficial to your physical and mental health. Erikson's psychosocial theory of development focuses on how these
essential relationships are formed in the sixth stage. Those who succeed at this stage are able to form strong social bonds and meaningful
relationships with others.

The patient is newly wedded and is building a strong foundation with love and affection. She shared that she ideally wanted one to three children,
which shows how big she wants for a family. In the meantime, she is pregnant, her husband is the one who provides for their humble family,
even so they still find time for each other, and her husband takes care of her like joining her for hiking which is part of her exercise to stay
healthy. By these little efforts they‟ve shown their affection and bond for each other.
 7

Health Assessment & Physical Exam

General Survey

Appearance  Fair dark skin

 Well groom

Mental status Client is alert and oriented. Also responds to questions and interact appropriately.

Behavioral/Mood Cooperative and purposeful in her interaction

Speech Moderate tone, clear, w/ moderate pace.

Mobility Limited ROM

Body Type Ectomorph

 8
Integumentary System

Skin  Linea nigra

 Striae gravidarum

Hair  Increase growth

Nail  Translucent

 Firm in texture

Head and neck  looks smooth

Eyes  pupils are equal and round

Ears  landmarks are visible

Mouth  normal

Nose  Nasal mucosal swelling

Thorax & Lungs  Thoracic breathing

 Shortness of breath

Psychosocial
Assessment
 9
Psychosocial Status  Client is cooperative

 Has a little amount of fear in delivering the baby

 Healthy relationship with both sides of the family

Neurologic Assessment

 Cranial Nerve

Olfactory Was able to smell

Optic Pupils are equal and reactive to light

Ocular Eyes were able to move equally

Trigeminal Can feel any sensation in the face or orally

facial Was able to make facial movements

Acoustic Was able to hear normally

Glossopharyngeal No difficulty in swallowing food and water

Vagus Gag reflex is okay

Spinal Accessory

Hypoglossal
 10
Cardiovascular Assessment

Mucous Membrane Pinkish gingiva and conjunctiva

Pulses & Heart Rhythm Right & left pedal are palpable

Radial and Carotid pulses are palpable

Has regular hear rhythm

Capillary Refill Less than 2 seconds

Respiratory Assessment

Neck Vessels Arteries are elastic and no thrills are noted

Lungs Clear lungs sound bilaterally, No whizzes and No cough

Nails Nailbed of the client is in pink tones at 160-degree angle (normal) between the nail base and the
skin

Gastrointestinal Assessment

Mouth No tooth cavities and gingivitis noted No dentures No dysphagia Mucous membranes are intact

and moist

Abdomen Abdomen is tender without distinctions with the presence of pregnancy

 11
Umbilicus Noticeable Linea Nigra

Genitourinary Assessment

Urine Urine is yellow and clear

Genitals  Chadwick’s sign

 Hegar’s sign

 Goodells’s sign

Musculoskeletal Assessment

Gait Waddling gait as the patient is in third trimester.

ROM Limited ROM

Bones No visible bony overgrowth, no swelling Joints are non-tender

1. History of Present illness: NONE

2. Functional Health Patterns:

2.1 Health Perception and Health Maintenance Folic Acid, Vit C, Iron, Food supplement (usana), calcium

2.3 Elimination 1 or 2x a day 7am – 4pm

 12
2.4 Activity and exercise Hiking 30 mins, 3-4x a week, 7-8 am

2.5 Cognition Perception

2.6 Sleeping pattern 3 hours a night if not disturbed

2.7 Sexually and Reproduction Before 1x a week (before pregnancy and assuming before third trimester)

2.8 Self-perceptiion and Self concept Positive plans were set aside

2.9 Roles and Relationship Family and friends were supportive

2.10 Stress tolerance and coping Was able to cope up by thinking positively

2.11 values and belief

POSTPARTUM ASSESSMENT

Type of delivery: ☒ NSVD ☐CESAREAN SECTION Vital Signs: T 37 C P 80 bpm R 20 15bpm _

BP 95/130 mmHg
Pain Status: Type of Pain: Dull & Sharp Location: Lower Belly_ Severity: Moderate Pain Scale: 6 Pain Relief Needs:
Acetaminophen Breast: Tender( / ) Non- Tender ( )
Color: brown Condition: Tender Secretion: Milk
Nipples: ☒ Erect ☐Flat
Condition: brown Care: breastfeeding Others: _
Uterus: ☒Tender ☐Non Tender ☐ Boggy: ☐Firm ☐Firm with Massage Height: 38 cm Position: _Palpable
Midline: /
Displaced: ☐L ☒R Bladder: Nondistended, voids adequate amounts 100ml
Voiding Pattern: 1x a day Color: brown Amount: little
Characteristic: Mushy consistency with ragged edges Signs of Infection: None
 13
LABORATORY AND DIAGNOSTIC RESULTS

TEST DATE TRIMESTER NORMAL VALUES PATIENT’S INTERPRETATION

RESULT
Beta hCG March 21, 2021 25,700 – 255,000 mlU/ml Normal
Level First 288,000 mlU/ml

June 21, 2021 Second 4,060 – 165,400 145,435 mlU/ml Normal

mlU/ml

September 21, Third 3,640 – 117,000 93, 112 Normal

2021 mlU/ml mlU/ml

TEST DATE RESULTS IMPRESSION

Ultrasound September BPD (Biparietal 9.5cm = 40 wks Single alive intrauterine pregnancy (Cephalic) 40
7, 2021 Diameter): wks by BPD & 39 6/7 wks by FL with good
OFD (Occipitofrontal 11.5cm cardiac (151 bpm) and somatic activities.
Diameter): Placenta Previa Totalis Grade 1,
CI (Cephalic Index): 100% Normohydramnios
HC (Head 35cm = 39 6/7
Circumference): wks
AC (Abdominal 24.5cm = 41
Circumference): wks
FL (Femoral Length): 7.9cm = 39 6/7
wks
AFI (Single Vertical 13.7
Pocket):
Placenta Posterior 2.25
cm passing
internal Grade 1
Estimated fetal weight: 4.3 kg
 14

Cervix measures: 3.2 x 3.2 x

3.6cm, long
unaffected,
negative
funneling
Fetal Cardiac 151 bpm
AOG:

LMP: December 21, 2020

Latest Assessment: September 26, 2021

December (31-21) 10
January 31
February 28
March 31
April 30
May 31
June 30
July 31
August 31
September 26
Total days: 279 ÷ 7 = 39 weeks, 6 days
 15

TEST DATE TRISONOMY FINDINGS INTERPRETATION

Amniocentesis May 21, 2021 21 (Down Syndrome) Negative Based on findings, the fetus does
not have the specific genetic
13 (Patau Syndrome) Negative disease tested.
18 (Edward Syndrome) Negative

TEST DATE DEFECTS FINDINGS INTERPRETATION

Chorionic villus March 21, Down Syndrome Negative Based on findings, the fetus does
sampling 2021 not have the specific genetic
Sickle cell anemia Negative disease tested.
Thalassemia Negative
Other genetic disorder Negative

TEST DATE TRIMESTER NORMAL PATIENT’S INTERPRETATION

VALUES RESULT
Fetal heart March 21, 2021 120 – 160 bmp 145 bpm Normal
monitoring First

June 21, 2021 Second 149 bpm Normal

September 21, Third 153 bpm Normal

2021
 16

TEST DATE Prenatal PATIENT’S NORMAL INTERPRETATION

RESULT VALUES
Blood 1st Trimester 1hr after meal: Before a meal: Normal
glucose March 21, 2021 1 st 139mg/dl 95 mg/dL or
monitoring less.

An hour after a
April 21, 2021 a.c.:83 mg/dl meal: 140 Normal
2nd mg/dL or less.

Two hours after

May 21, 2021 3 rd 1hr after meal: a meal: 120 Slightly above normal
141mg/dl mg/dL or less.

2nd Trimester 4th 2hr after meal: 115 Normal

April 14, 2021

April 21, 2021 5th a.c.:98 mg/dl Slightly above normal

May 14, 2021 6th a.c.:92 mg/dl Normal

May 21, 2021 7th a.c.:91 mg/dl Normal

June 14, 2021 8th 1hr after meal: Normal

132mg/dl

June 21, 2021 9th 2hr after meal: 122 Slightly above normal
 17

3rd Trimester 10th 1hr after meal: Normal

July 1, 2021 138mg/dl

July 7, 2021 11th 1hr after meal: Slightly above normal

143mg/dl

July 14, 2021 13th 1hr after meal: Normal

135mg/dl

July 21, 2021 14th 1hr after meal: Normal

137mg/dl

August 1, 2021 15th 2hr after meal: 119 Normal

mg/dl

August 7, 2021 16th 1hr after meal: Normal

139mg/dl

August 14, 2021 17th a.c.:87 mg/dl Normal

August 21, 2021 18th 1hr after meal: Above normal

146mg/dl

September 1, 2021 19th a.c.:83 mg/dl Normal

September 7, 2021 20th 2hr after meal: 115 Normal

 18

September 14, 21st a.c.:86 mg/dl Normal

2021

September 21, 22nd 1hr after meal: Slightly above normal

2021 142mg/dl

September 26,2021 23rd 2hr after meal: 115 Normal

TEST DATE TRIMESTER PATIENT’S RESULT INTERPRETATION

Fundal height March 21, 2021 Normal

measurement First 12cm

June 21, 2021 Second Normal

24 cm

September 21, Third Normal

2021 38 cm
 19

Date Test Result Interpretation

September 14, Urinalysis Physical Characteristics
Color: Light Yellow
2020
Transparency: Slightly clear
6:19 pm
Chemical Parameters
Specific Gravity: 1.005
PH: 7. 0
Glucose: 95mg/dl
Protein: Negative
Ketone (Quali): .01
mmol/L

Nitrites: Negative
Leukocytes: 0/hpf

Blood: Negative
Microscopic Findings
RBC: 0/hpf
WBC: 0/hpf
 20

Squamous Epithelial Cells:3/hpf

Bacteria: 0/hpf
Mucus Threads: 0/hpf

EDC COMPUTATION

LMP: December 21, 2020

12 21 2020

-3 +7 +1

9 28 2021

EDC: September 28, 2021

 21

TEST DATE TRIMESTER FTR UTERINE Contraction

CTG Tracing March 21, 2021 145 bpm Length: 25 - 30 sec

First Intensity: Moderate
Frequency:
15 -20min

June 21, 2021 Second 149 bpm Length: 27 - 30 sec

Intensity: Moderate
Frequency:
15 -20min
September 21, Third 153 bpm Length: 30 - 40 sec
2021 Intensity: Moderate
Frequency:
13 -20min

Date Test Result Normal Values Interpretation

August 21, 2021 Hematologic section Complete Blood Count

9:10 am Blood Type: A+

WBC Count: 5.6 4.4– 11.0 Normal

X10^9/L

RBC Count: 4.72 4.5 – 5.1 Normal

X10^12/L
 22

Hemoglobin:140.00 123 – 153 Normal

g/L

Hematocrit: 35.70 35.9 – 44.6 Normal

MCV: 85.20 80 – 96 Normal

fl

MCH: 29.60 27.5 – 33.2 pg/cell Normal

MCHC: 34.70 33.4 – 35.5 Normal

RDW-CV: 12.80 11.50 – 14.50 Normal

%
Platelet Count: 195.00 150 – 450 X10^9/L Normal
MPV: 7.2 8.6-15.5 fL Normal
PDW: 19.8 8.3-25 fL Normal
PDW: 45.7 8.3-56.6 % Normal
PCT: 0.23 0.22-0.24 % Normal
IPF: 4.1 1.1-6.1 % Normal
P-LCR: 28 15-35 % Normal
Differential Count

Neutrophil: 59.30 55 – 66 % Normal

Lymphocytes: 30.70 25 -35 % Normal

Monocytes: 5.80 3 – 11 % Normal

Eosinophil: 3 2–4% Normal

Basophil: 0.20 0–1% Normal

 23
SUMMARY OF SIGNIFICANT FINDINGS
Gordon’s Health Laboratory Therapeutic Key
Functional Assessment and management Nursin
Health or Physical Diagnostic g
Pattern Examination Labs Proble
ms
Acute
Health Pain score of 7 TRIMESTER FTR UTERINE Contracti Provide Comfort to the pain
Perception patient through related
and Health encouraging her to change to
145 bpm Length: 25 - 30 sec position from time to time.
maintenance uterine
First Intensity: Moderate contrac
Frequency:
Patient Position Client to side lying tions
15 -20min
experiences position.
contraction
Second 149 bpm Length: 27 - 30 sec
always Put pillow to support the
Intensity: Moderate
“ naa na sha back of the patient.
Frequency:
pero mawala 15 -20min
usahay “ as
Third 153 bpm Length: 30 - 40 sec
verbalized by
Intensity: Moderate
the patient.
Frequency:
13 -20min
Elimination

“ dili ra kaayu, Assist client to go the

wala rako bathroom.
galisod sa ako
pagpangihi” as
verbalized by Tell the Significant Other
the patient. not to leave the client
alone when going to the
The patient bathroom.
defecates once
or twice a day
usually 7 am in
 24
the morning
and 4 in the
afternoon.

Sleep and . Provide safe environment. Disturb

Rest Drowsy , ed
“akong tulog Yawning Sleepin
kay putol putol g
sha jam, three Pattern
hours ra ako related
tulog “ as to
verbalized by freque
the patient . nt
changi
ng
sleep
schedu
le
Self-
Perception
and Self-
Concept

“after
manganak naa
koy plano mag
work , Positive
outlook but
there are plans
na na set aside
pero okay ra as Maintain health by:
verbalized by - Talk therapy Anxiety
the patient. Anxiety - Self-meditation related
- Listening to to
“ Makulbaan ko calm music stress
 25
ig labor” as .
verbalized by
the patient. \

ANATOMY AND PHYSIOLOGY

Female Reproductive System

The female reproductive system, its structures and functions gives the ability to a woman to give birth or produce a baby. While females are
producing eggs during the monthly cycle, it needs to be fertilised by a sperm from a man in order to develop a baby.

Vagina

Vagina is an elastic, muscular canal about 8–10 cm (3–4 inches) long. This is the tube between the vulva and the cervix. The vagina is where
babies exit during birth, exit of blood during the monthly cycle and is used during sexual intercorse. The vagina have an outer muscular layer which
is the smooth muscle and contains many elastic fibers and an inner mucous membrane that is moist and stratified squamous epithelium that forms a
protective surface layer. The vagina wall consists of three coats; the outer fibroelastic adventitia, a smooth muscle muscularis and inner mucosa.
The vaginal opening is covered by a thin mucous membrane which is the hymen (usually in young females). The hymen is very vascular and may
bleed
 26
when it stretches or ruptures during the first coitus however, in some females the cause of their rupture is by sports, pelvic examinations or
tampons.

External Genitalia

External genitalia are the structures that lie external to the vagina or also called as the vulva or pudendum; these include the mons
pubis, labia, clitoris, and structures associated with the vestibule.

 Vestibule- the space into which the vagina and urethra open.
 Labia Minora- thin, longitudinal skin which borders the vestibule.
 Clitoris- a small, erectile structure that is located in the anterior margin of the vestibule.
 Labia Majora- lateral to labia minora are two prominent, rounded folds of skin. Covered with numerous sebaceous and sweat
glands.
 Mons Pubis- the two labia majora unite anteriorly at an elevation of tissue over the pubic symphisis.

Ovaries

The paired ovaries flank the uterus on each side. Shaped like an almond and about twice as large, each ovary is held in place by several
ligaments in the fork of the iliac blood vessels within the peritoneal cavity. The suspensory ligament extends from each ovary to the lateral body wall
and the ovarian ligament attaches the ovary to the superior margin of the uterus. The outer part of the ovary is composed of dense connective tissue
and contains ovaries follicles. Each follicle consists of an immature egg, called an oocyte.

Fallopian Tube

Fallopian tubes are also known as uterine tubes or ovarian ducts. Uterine tubes extend from the area of the ovaries to the uterus. They receive
the ovulated oocyte and are the site where fertilization generally occurs. The tube is about 10 cm (4 inches) long. Medially from the region of an
ovary to empty into the superolateral region of the uterus via a constricted region called the isthmus . The distal end of each uterine tube expands as
it curves around the ovary, forming the ampulla. The ampulla ends in the infundibulum , an open, funnel-shaped structure bearing ciliated, fingerlike
projection also known as fimbriae. Fertilization usually occurs in the uterine tube near the ovary which is the ampulla, then the fertilized oocyte will
travel to the uterus, where it embeds in the uterine wall and will be in the process of implantation.
 27
Uterus

The uterus, which is also known as a woman's womb, measures 3 to 4 inches by 2.5 inches. It has the shape and dimensions of an upside-
down pear, a hollow, thick-walled, muscular organ that receives, retains, and nourishes a fertilized ovum. The uterus is divided into 3 parts; fundus
superior to the entrance of the uterine tubes, body the main part of the uterus, cervix the narrower part and directed inferiorly. Cavity of the cervix
also called as cervical canal, communicates

Uterine wall is also composed of 3 layers; The endometrium is the inner layer that lines the uterus. It is made up of glandular cells that make
secretions. The myometrium is the middle and thickest layer of the uterus wall, made up mostly of smooth muscle. The perimetrium is the outer
serous layer of the uterus.

FETUS IN UTERO
 28

Decidua

Decidua the part of the endometrium that in higher placental mammals undergoes special modifications in preparation for and during
pregnancy and is cast off at parturition. Decidua is a latin word that means “falling off”; it will be discarded after the birth of the child. The decidua
has three separate areas:

1. Decidua basalis, the part of the endometrium that lies directly under the embryo

2. Decidua capsularis, the portion of the endometrium that stretches or encapsulates the surface of the trophoblast

3. Decidua vera, the remaining portion of the uterine lining

Amniotic Fluid

Amniotic fluid is constantly being newly formed and reabsorbed by the amniotic membrane, so it never becomes stagnant. In the fetal
intestine, it is absorbed into the fetal bloodstream. From there, it goes to the umbilical arteries and to the placenta, and it is exchanged across the
placenta. At term, the amount of amniotic fluid has increased so much it ranges from 800 to 1200 mL.

Hydramnios, a condition that occurs when too much amniotic fluid builds up during pregnancy. A disturbance of kidney function may cause
oligohydramnios, or a reduction in the amount of amniotic fluid.

Amniotic Fluid is to shield the fetus against pressure to the mother’s abdomen, it also aids in muscular development and allows the fetus to
move freely. Amniotic Fluid protects the umbilical cord from pressure, protecting the fetal oxygen supply.

Placenta

Placenta is developed and is a temporary endocrine organ. It is in charge to sustain the fetus during the pregnancy; it secretes several protein
hormones and steroids that influence the course of pregnancy. The placenta detaches off after the infant is born.

By 7 or 8 days after ovulation, the endometrium of the uterus is prepared for implantation. After a week of fertilization, the blastocyst attaches
itself to the uterine wall and begins the process of implantation. The blastocyst burrows into the uterine wall. During the first few days of
development each cell has enough yolk to supply its own energy needs and requires few external nutrients.
 29
As the blastocyst burrows into the uterine wall; the chorion forms the embryonic portion of the placenta. Chorionic villi is a fingerlike
projection, protruding into cavities formed within the maternal endometrium. Lacunae the cavities; are filled with maternal blood. Once the placenta
is mature, the maternal blood is separated from the embryonic blood supply. The nutrients and waste products must cross this semipermeable
barrier between two circulations.

When the embryo matures the umbilical cord elongates.

Umbilical Cord

The umbilical cord is formed from the fetal membranes (amnion and chorion) and provides a circulatory pathway that connects the embryo to
the chorionic villi of the placenta. It is assigned to transport oxygen and nutrients to the fetus from the placenta and to return waste products from
the fetus back to the placenta. The cord wharton’s jelly prevents pressure on the vein and arteries that pass through.

The umbilical cord contains only one vein but two arteries carrying blood from the placental villi to the fetus. It is about 53 cm or 21 inches in
length and .75 in radius. The rate of the blood flow through the cord is 350 mL/ min. The walls of the umbilical cord arteries are lined with smooth
muscle. Umbilical cord contains no nerve supply, it can be cut at birth without discomfort to either the child or woman.
 30

PATHOPHYSIOLOGY
31
 32

NURSING CARE PLAN

Nursing Diagnosis: Disturb sleep pattern R/T physical and hormonal changes as evidenced by patient‟s verbal report of discomfort during sleep.

DEFINING SCIENTIFIC BASIS EXPECTED NURSING RATIONALE

CHARACTERISTICS OUTCOME INTERVENTION

During pregnancy and the postpartum period, women are Short Term:  Encourage  stress
Subjective data:”Dili at particular risk for sleep restriction because of the  Within 1 daytime may be
straight ako tulog, physical changes of pregnancy and the need to hour of physical reduced
putol putol ako provide frequent infant care. Pregnancy and the adequate activities by
tulog. Na gyud postpartum period are also times when women are at health but instruct therapeu
usahay wala koy a heightened risk of depression. Maternal depression teaching the patient tic
tulog.” as verbalized has been well documented to adversely impact the to avoid activities
by the patient. maternal-child relationships, parenting practices, patient strenuous and may
family functioning, and children's development and will be activities promote
general well-being. able to before sleep.
verbalize bedtime.
Chang, J. J., Pien, G. W., Duntley, S. P., & Macones, G. A. understan
Objective data: (2010, April). Sleep deprivation during pregnancy and ding of
maternal and fetal outcomes: Is there a relationship? sleep  Introduce
 Dark circles Sleep medicine reviews. Retrieved September 28, 2021, disturbanc relaxing
underneath from e. activities
the eyes are https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824023/.  Within 1 such as  These
noted hour of warm bath, activities
 Drowsiness is adequate calm music, provide
noted health and reading relaxatio
 Vital signs teaching a book n and
taken: the distractio
T- 37.5°C patient n to
PR- 89bpm will able to prepare
RR- 26cpm understan  Teach the mind and
BP – 140/90 d and patient the body for
mm Hg verbalize proper sleep.
home position
remedies, when
 33

just like sleeping.  This is

different done in
sleeping order to
position to  Instruct to provide
improve avoid heavy comfort
sleeping meals, to the
pattern. alcohol, mother
caffeine, or while
smoking sleeping.
Long term: before
After 1 to 2 sleeping.
days, the  Though
patient will be hunger
able to report can also
improvement keep one
in sleep awake,
pattern and gastric
increase digestion
feeling of and
rest. stimulati
on from
caffeine
and
nicotine
can
disturb
sleep.
 34

Nursing Diagnosis: Activity intolerance R/T generalized weakness as evidenced by patient‟s verbal report of fatigue and weakness.

DEFINING SCIENTIFIC BASIS EXPECTED NURSING RATIONALE

CHARACTERISTICS OUTCOME INTERVENTION

During pregnancy, women may Short Term:  Establish  Motivation and

Subjective data:”2 experience one or more of a wide  With in 1 hour guidelines cooperation are
times a week nalang variety of discomforts. Every of adequate and goals of enhanced if the
ko mag hike kay pregnancy is different; discomforts health activity with patient
kapoy na gyud og felt during one pregnancy may not teaching the the patient participates in
wana sad koy trabaho appear in another. Most discomforts patient will be goal setting.
sa balay kay dali rako experienced during pregnancy are able to
kapoyon.” as thought to be the result of abundant verbalize
verbalized by the hormonal changes. As pregnancy understanding  Have the  Helps in
patient. progresses, other discomforts are on energy patient increasing the
attributed to physical changes conservation perform the tolerance for
associated with the enlarging uterus. technique. activity more the activity.
Selected discomforts of pregnancy slowly, in a
are presented with suggestions for  With in 1 hour longer time  These activities
Objective data: clinical management. Nurses can do of adequate with more provide relaxation
something to decrease discomforts health rest or and distraction to
 Heavy breathing associated with pregnancy. teaching the pauses, or prepare mind and
is noted Activity intolerance can be described patient will with body for sleep.
 Slow pace as insufficient physiological or able to assistance if
movement is psychological energy to complete understand necessary.
noted required or desired daily activities. and verbalize
 Pain in lower Activity intolerance can be related to home
extremities generalized weakness and difficulty remedies, just  Tell the  Patient with
noted resting and sleeping. like foods to patient to limited activity
 Vital signs eat to refrain from tolerance need
taken: The Discomforts of Pregnancy. improve performing to prioritize
T- 37.5°C Define_me. (n.d.). Retrieved generalized nonessential important taks
PR- 89bpm September 28, 2021, from weakness. activities or first.
RR- 26 cpm https://www.jognn.org/article/S procedures.
BP – 140/90 0884-2175(15)33319-0/fulltext.  Coordinated
mm Hg  Evaluate the efforts are more
 35

need for meaningful and

Long term: additional effective in
 After 1 to 2 help at assisting the
days of home.\ patient in
nursing conserving
intervention energy.
, the
patient will  Encourage  Exercise
be able to active ROM maintains
report exercises. muscle
increases in Encourage strength, joint
exercise the patient ROM, and
gradually to exercise
 After 1 to 2 participate tolerance.
days in planning
patients activities
report‟s that
decrease in gradually
physiologic build
al signs of endurance.
intolerance
 36

Nursing Diagnosis: Risk for situational low self-esteem R/T changes in body image as evidence by pregnancy.

DEFINING SCIENTIFIC BASIS EXPECTED NURSING RATIONALE

CHARACTERISTICS OUTCOME INTERVENTION

Situational low self-esteem refers to Short Term:  Help client  Identification is

Subjective having a negative perception of self,  Within 1 to identify early stage of
data:”Daghan kayg owing to situation changes such as loss hour of environment problem solving
ng gawas na of body parts or functional abilities. Low nursing al factors process.
stretchmark sa ako self-esteem is often a result of real or education, which
lawas and ning dako anticipated lifestyle changes, fear, the patient increase risk
gyud ko.” as negative feelings, relationship issues, will be able for low self-  Allowing the
verbalized by the low resilience, or rejection by others. to esteem. client to clarify
patient. Stretch marks are narrow, streak-like understand thoughts and
lines that can develop on the surface of that this are  Encourage feelings
the skin. They usually appear on your normal client to promotes self-
tummy, or sometimes on your upper changes in verbalize acceptance
thighs and breasts, as your pregnancy pregnancy thoughts
Objective data: progresses and your bump starts to and feelings  To help the
grow.  Within 1 about the patient to be
 Striae noted in NHS. (n.d.). Stretch marks in hour of current more determine
the abdomen, pregnancy. NHS choices. Retrieved adequate situation.
axilla, and September 29, 2021, from health
buttocks. teaching the  Don’t give  This will help
https://www.nhs.uk/pregnancy/related-
 Weight gain of patient will false hope to the client to
conditions/common-symptoms/stretch- able to the client regain her self
13 kilos
 Vital signs marks/. express her esteem.
taken: anxieties.  Encourage
T- 37.5°C the use of
PR- 89bpm Long term: cream after
RR- 26 cpm  After 2 to childbirth to
BP – 140/90 3 days of lighten the
mm Hg nursing striae.
interventi
 37

on, the
patient
will be
able to
verbalize
acceptanc
e to
changes
in her
body.

REFERENCES: Chang, J. J., Pien, G. W., Duntley, S. P., & Macones, G. A. (2010, April). NANDA
 38

DRUG STUDY

Prenatal Medications

Name of Classification Mechanism of Indication Contraindica Adverse Nursing Responsibilities

Drug Action tion Reactions

Generic General Vitamin C The following Adverse BEFORE:

Name: Classification: It acts as (ascorbic are effects  Obtain a
coenzymes to acid) contraindicati primarily nutritional
Vitamin C Vitamins and
activate a variety are indicated ons and associated assessment.
(ascorbic minerals
of proteins on for the cautions for with Vitamin C  Ensure that the
acid)
enzymes that following: the use of are related to patient has an
Functional catalyze -Treatment Vitamin C gastrointestin actual vitamin
Classification: biochemical of vitamin (ascorbic al upset and deficiency.
Trade Antioxidants activity. deficiencies acid): irritation,  Assess for any
Name: , as dietary which is known allergies and
-Patient‟s with
supplement caused by medical conditions
Acerola, known allergy
s when direct and drugs being
Ascocid, to the drug or
needed. gastrointestin taken.
Ascor L 500, the colorants,
-As specific al contact with  Evaluate skin and
Asco-Tabs, additives, or
therapy the drugs. mucous membrane
C-Caps, preservatives
related to condition.
Cemill, used in the
the activity  Advise patient to
Chew-C, drug
of the avoid the use of
Halls Defense
vitamin. over-the-counter
Vitamin C
-RDA preparations that
Drops
-Frank and contain the same
subclinical vitamins to reduce
Patient’s
scurvy risk of overdose.
Dose:
-Extensive
burns, DURING:
Maximum  Assure that the
Dose: 70 mg delayed
fracture or route of
wound administration is
Minimum healing, appropriate.
 39

Dose: 45 mg postoperati  Assess the patient

ve wound carefully for
healing, potential drug-drug
severe interactions.
febrile or
chronic  Urge patient to
disease report persistent or
states serious adverse
reactions promptly.

 Provide comfort and

safety measures.

AFTER:

 Monitor patient‟s
response to drug.

 Evaluate
effectiveness of the
vitamin.

SOURCES:
BOOK

Amy M. Karch, R. M. (2017). Focus on Nursing Pharmacology, Seventh Edition. Philadelphia: Julie K. Stegman.
Kluwer, W. (2017). Nursing 2017 DRUG HANDBOOK. China: Jay Abramovitz.
 40

Name of Classification Mechanism of Indication Contraindica Adverse Nursing Responsibilities

Drug Action tion Reactions

Generic General Folic Acid are The following Adverse BEFORE:

Name: Classification: It acts as indicated for are effects  Obtain a
coenzymes to the contraindicati primarily nutritional
Folic Acid Vitamins and
activate a variety following: ons and associated assessment.
(Vitamin B9) minerals
of proteins on -RDA cautions for with Folic Acid  Ensure that the
enzymes that - the use of are related to patient has an
Functional catalyze Megaloblast Folic Acid: gastrointestin actual vitamin
Trade Classification: biochemical ic or al upset and deficiency.
-Patient‟s with
Name: Antioxidants activity. macrolytic irritation,  Assess for any
known allergy
anemia which is known allergies and
FA-8 to the drug or
from folic caused by medical conditions
the colorants,
acid or direct and drugs being
Patient’s additives, or
other gastrointestin taken.
Dose: preservatives
nutritional al contact with  Evaluate skin and
used in the
deficiency, the drugs. mucous membrane
Maximum drug
hepatic condition.
Dose: 1 mg disease,  Advise patient to
alcoholism, avoid the use of
Minimum intestinal over-the-counter
Dose: 0.8 obstruction preparations that
mg , or contain the same
excessive vitamins to reduce
hemolysis. risk of overdose.
-To prevent
fetal neural DURING:
tube  Assure that the
defects route of
during administration is
pregnancy. appropriate.
-
Methotrexa  Assess the patient
 41
carefully for
 42

te-induced potential drug-drug

toxicity interactions.

 Urge patient to
report persistent or
serious adverse
reactions promptly.

 Provide comfort and

safety measures.

AFTER:

 Monitor patient‟s
response to drug.

 Evaluate
effectiveness of the
vitamin.

SOURCES:
BOOK

Amy M. Karch, R. M. (2017). Focus on Nursing Pharmacology, Seventh Edition. Philadelphia: Julie K. Stegman.
Kluwer, W. (2017). Nursing 2017 DRUG HANDBOOK. China: Jay Abramovitz.
 43

Name of Classification Mechanism of Indication Contraindic Adverse Nursing

Drug Action ation Reactions Responsibilities

Generic General Ferrous The following Adverse BEFORE:

Name: Classification It acts as gluconate are effects  Obtain a
: coenzymes to is indicated contraindicati primarily nutritional
Ferrous
activate a for the ons and associated assessment.
gluconate Hematinics
variety of following: cautions for with Ferrous  Ensure that the
proteins on -Iron the use of gluconate patient has an
Functional enzymes that deficiency Ferrous Is related to actual vitamin
Trade Classification catalyze gluconate: gastrointestin deficiency.
Name: : biochemical -As al upset and  Assess for any
-Patient‟s
Iron activity. supplemen irritation, known allergies
Fergon, with known
supplements t during which is and medical
Novo- allergy to the
pregnancy caused by conditions and
ferrogluc drug or the
Women: 15- direct drugs being taken.
colorants,
30 mg gastrointestin  Evaluate skin and
Patient’s additives, or
elemental al contact mucous membrane
Dose: preservatives
iron P.O. with the condition.
used in the
daily during drugs.  Advise patient to
Maximum drug
last two avoid the use of
Dose: 30 trimesters. over-the-counter
mg preparations that
contain the same
Minimum vitamins to reduce
Dose: 15 risk of overdose.
mg
DURING:
 Assure that the
route of
administration is
appropriate.

 Assess the patient

carefully for
potential drug-
 44
drug
 45

interactions.

 Urge patient to
report persistent or
serious adverse
reactions promptly.

 Provide comfort
and safety
measures.

AFTER:

 Monitor patient‟s
response to drug.

 Evaluate
effectiveness of the
vitamin.

SOURCES:
BOOK

Amy M. Karch, R. M. (2017). Focus on Nursing Pharmacology, Seventh Edition. Philadelphia: Julie K. Stegman.
Kluwer, W. (2017). Nursing 2017 DRUG HANDBOOK. China: Jay Abramovitz.
 46

Antenatal Medications

Name of Classification Mechanism of Indication Contraindica Adverse Nursing Responsibilities

Drug Action tion Reactions
Generic General Binds with opioid Meperidine The following Adverse BEFORE:
Name: Classification: receptors in the hydrochlorid are effects from  Assess for possible
CNS, altering e are contraindicati the use of contraindications or
Meperidine Opioids
perception of and indicated for ons and Meperidine cautions.
hydrochloride
emotional the cautions for hydrochloride  Perform a physical
(pethidine
Functional response to pain. following: the use of include: examination to
hydrochloride
Classification: -Obstetric Meperidine CNS: establish baseline
)
Opioid Route: P.O. analgesia hydrochloride agitation, data.
analgesics Onset:15 min Adults: 50- : incoordination  Assess the
Peak: 60-90 min 100 mg I.M -Patients , clouded neurologic status of
Trade Duration: 2-4 hr or hypersensitiv sensorium, the patient.
Name: subcutaneou e to drug and dizziness,  Assess the patient‟s
Demerol Route: I.V. sly when in those who euphoria, cardiopulmonary
Onset: 1 min pain have received light- status including the
Peak: 5-7 min becomes MAO headedness, pulse rate and blood
Patient‟s
Duration: 2-4 hr regular inhibitors sedations, pressure to establish
Dose:
; may repeat within past 14 somnolence, data and for
Route: I.M., at 1-to3- days. seizures, comparisons before
Maximum subcut. hour hallucinations, and after effect of
Dose: 100 -Patients with
Onset: 10-15 intervals. headache, drug.
mg (IM or ESRD
mins paradoxical  Examine abdomen,
SC when Peak: 30-50 mins -Moderate -Use anxiety, including liver and
pain Duration: 2-4 hr to severe cautiously in physical auscultate bowel
becomes pain elderly or dependence, sounds to evaluate
regular) Half-life:2 ½ - 4 - debilitated syncope, GI motility and liver
hours Preoperativ patients and tremor function.
e analgesia in those with CV:
Minimum  Assess complaints of
increased ICP, bradychardia
Dose: nausea to determine
-Adjunct to head injury, , cardiac
50 mg (IM the need for
anesthesia asthma and arrest,
or SC when therapy.
other shock,  Monitor laboratory
pain respiratory
-Obstetric hypotension, results to monitor
 47

becomes analgesia conditions, tachycardia, for potential

regular) supraventricul palpitations problem associated
ar GI: biliary with metabolism and
tachycardias, tract spasms, excretion.
seizures, constipation,  Instruct patient that
acute dry mouth, the drug is used
abdominal ileus, nausea, during pregnancy
conditions, vomiting only if needed.
hepatic or GU: urine  Always monitor fetal
renal disease, retention responses and
hypothyroidis Musculoskel mother response to
m, Addison‟s etal: muscle drug.
disease, twitching
urethral Respiratory:
stricture, and respiratory DURING:
prostatic arrest,  Assure that the
hyperplasia. respiratory route of
depression administration is
PREGNANCY Skin: appropriate.
- diaphoresis,
pruritus,  Assess the patient
LACTATION-
urticarial carefully for
REPRODUCT
Other: potential drug-
ION
induration, drug interactions.
- Don‟t use in
local tissue
pregnant  Urge patient to
irritation, pain
women before report persistent or
at injection
labor unless serious adverse
site, phlebitis
physician reactions promptly.
after I.V.
determines
potential delivery
 Provide comfort and
benefits safety measures.
outweigh
possible risks;
safe use in
pregnancy AFTER:
before labor
 48

hasn‟t been  Monitor the patient

established response to the
relative to drug.
possible
adverse  Monitor for adverse
effects on effects.
fetal
development.  Monitor for
effectiveness of
- Drug
comfort measures
appears in
and compliance with
breast milk.
regimen.
Patient should
discontinue
 Evaluate the
breast-
effectiveness of
feeding or
health teaching.
discontinue
drug.
SOURCES:
BOOK

Amy M. Karch, R. M. (2017). Focus on Nursing Pharmacology, Seventh Edition. Philadelphia: Julie K. Stegman.
Kluwer, W. (2017). Nursing 2017 DRUG HANDBOOK. China: Jay Abramovitz.

Name of Classification Mechanism of Indication Contraindica Adverse Nursing Responsibilities

Drug Action tion Reactions
Generic General Oxytocin The following Adverse BEFORE:
Name: Classification: It causes potent (synthetic are effects from  Explain use and
and selective injection) contraindicati the use of administration of
Oxytocin Exogenous
stimulation of are ons and Oxytocin drug to patient and
(synthetic hormones
uterine and indicated for cautions for include: significant others.
injection)
mammary gland the the use of Maternal  Assess for possible
 49

Functional smooth muscle. following: Oxytocin: CNS: contraindications or

/Therapeutic -To induce -Patients with subarachnoi cautions.
Classification: Route: I.V. or hypersensitiv d  Perform a physical
Trade Onset: Immediate stimulate hemorrhage, examination to
Oxytocics e to drug.
Name: Peak: Unknown labor. seizures, establish baseline
-When
Pitocin Duration: 1 hour Adults: coma data.
vaginal
Initially, 10 delivery isn‟t CV:  Assess the
Patient’s Route: I.M. units in 1000 arrhythmias, neurologic status of
advised, when
Dose: Onset: 3-5 mL of D4W hypertension, the patient.
cephalopelvic
mins Peak: injection, disproportion PVCs  Assess the patient‟s
Maximum Unknown lactated is present, or GI: nausea, cardiopulmonary
Dose: Duration: 2-3 ringer, or when delivery vomiting status including the
40 units hours NSS I.V. requires GU: abruptio pulse rate and blood
infused at conversions, placentae, pressure to establish
Half-life: 3-5 0.5 to 3 as in tetanic uterine data and for
Minimum mins. milliunits/mi contractions, comparisons before
transverse lie.
Dose: 10 n. Increase postpartum and after effect of
units -Fetal distress
rate by 1-2 hemorrhage, drug.
when delivery
milliunits//mi uterine  Examine and
isn‟t
n at 30-to rupture, evaluate GI motility
imminent, in
60-minute impaired and liver function.
prematurity,
intervals uterine blood  Monitor laboratory
in other
until normal flow, pelvic results to monitor
obstetric
contraction hematoma, for potential
emergencies,
patter in increased problem associated
and in
established. uterine with metabolism and
patients with
Decrease motility excretion.
severe
rate when Hematologic:  Instruct patient that
toxemia or
labor is afibrinogene the drug is used
hypertonic
firmly mia, possibly during pregnancy
uterine
established. related to only if needed.
patterns.
Rates postpartum
exceeding to -Use bleeding
9 to 10 cautiously, if Other: DURING:
milliunits/mi at all, in anaphylaxis,  Provide continuous
n are rarely patients with death from observation and
 50

required. invasive oxytocin- monitoring.

-To reduce cervical induced
postpartum cancer and in water  Administer oxygen
bleeding those with intoxication, to mother.
after previous hypersensitivit
expulsion cervical or y reactions  Monitor fluid intake
of placenta uterine and output.
Adults: 10 surgery, Fetal
units to 40 grand CNS: infant  Monitor and record
units in 1000 multiparity, brain uterine contractions,
mL of D5W uterine damage, heart rate, BP,
injection, sepsis, seizures intrauterine
lactated traumatic CV: pressure, fetal heart
ringer, or delivery, or bradycardia, rate, and character
NSS I.V. overdistended arrhythmias, of blood loss at least
infused at uterus. PVCs every 15 minutes.
rare needed EENT:
to control neonatal
bleeding, retinal AFTER:
which is hemorrhage
usually 20- Hepatic:  Provide comfort to
40 neonatal patient.
milliunits/mi jaundice
n. Also, 10 Other: low  Advise patient to
units may be Apgar scores promptly report
given I.M. at 5 minutes, adverse reactions
after delivery death like site irritation,
of placenta. nausea, bleeding,
vision changes,
- difficulty in
Incomplete speaking, and
or swelling.
inevitable
abortion
Adults: 10
units I.V. in
 51

500 mL of
NSS,
lactated
Ringer, or
dextrose 5%
in NSS.
Infuse at 10-
20 milliunits
(20-40
drops)/min.
Don‟t exceed
30 units in
12 hours.
SOURCES:
BOOK

Amy M. Karch, R. M. (2017). Focus on Nursing Pharmacology, Seventh Edition. Philadelphia: Julie K. Stegman.
Kluwer, W. (2017). Nursing 2017 DRUG HANDBOOK. China: Jay Abramovitz.

Name of Classification Mechanism of Indication Contraindica Adverse Nursing Responsibilities

Drug Action tion Reactions

Generic General 5% Dextrose The following Adverse BEFORE:

Name: Classification: Solutions are effects  Assess for possible
Parenteral is indicated contraindicati primarily contraindications or
5% Dextrose Parenteral
dextrose is for the ons and associated cautions.
Solutions Agents
oxidized to following: cautions for with  Perform a physical
carbon dioxide -To provide the use of examination to
5% Dextrose
Trade Functional and water, and replacement 5% Dextrose establish baseline
Solutions are
Name: Classification: provides 3.4 cal/g fluids, Solutions: data.
the following:
D50W, Hypertonic of d-glucose. sugars,  Evaluate insertion
-Anyone with -Irritation,
DGlucose solution electrolytes, site and skin
known extravasation
and nutrients hydration.
 52

Patient’s to patients allergies to of the fluid  Assess patient‟s

Dose: -To provide any into the general physical
ready access component of tissue, condition.
Maximum for the solution infection of  Follow
Dose: 30 mg administratio -Patient‟s with the insertion administration
n of drugs in unstable site, fluid guidelines.
an cardiovascular volume
Minimum emergency overload,  Check contents
status
Dose: 15 mg situations vascular of the solution.
-Patient‟s with
-To provide problems
unstable fluid DURING:
rehydration related to fluid
and  Assure that the
-To restore shifts, and
electrolyte
electrolyte potential route of
status
balance electrolyte administration is
imbalance appropriate.
related to
dilution of the  Assess the patient
blood. carefully for
potential drug-
drug interactions.

 Monitor IV insertion
site or central line
and regularly
consult to the
physician.

 Provide comfort and

safety measures.

AFTER:

 Provide comfort and

safety measures.

 Discontinue only
after an alternative
 53

source of drug is
established.

SOURCES:
BOOK

Amy M. Karch, R. M. (2017). Focus on Nursing Pharmacology, Seventh Edition. Philadelphia: Julie K. Stegman.
Kluwer, W. (2017). Nursing 2017 DRUG HANDBOOK. China: Jay Abramovitz.

Postnatal Medications

Name of Classifications Mechanism of Indication Contraindica Adverse Nursing Responsibilities

Drug Action tion Reactions

Generic General Used in the Docusate The following Adverse BEFORE:

Name: Classification: postpartal period Sodium is are effects from  Assess for possible
to prevent indicated for contraindicati the use of contraindications or
Docusate Surfactants
constipation. It the ons and Docusate cautions.
Sodium
works by lowering following: cautions for Sodium  Perform a physical
(dioctyl
Functional the surface - the use of include: examination to
sodium
Classification: tension of feces, Constipatio Docusate -Occasional establish baseline
sulfosuccinat
Laxatives allowing water n (stool Sodium: abdominal data.
e)
and lipids to softener) -Allergy to pain and  Assess the
penetrate the any diarrhea neurologic status of
stool and soften -Prevention component of CNS: the patient.
Trade it. of drug and dizziness,  Assess the patient‟s
Name: constipatio acute headache, cardiopulmonary
Colace, n and abdominal weakness and status including the
Correctol straining disorders may relate to pulse rate and blood
Extra Gentle, after GI including loss of fluid pressure to establish
 54

Diocto, surgery, LI,appendicitis, and data and for

DocQLace, obstetrical diverticulitis electrolyte comparisons before
Docuprene, delivery and ulcerative imbalances and after effect of
Docusoft-S, colitis GI: cathartic drug.
DocuSol Kids -Short-term -Patient with dependence,  Assess bowel
Enema, DOK, treatment heart block, constipation elimination patterns
D.O.S., for coronary and drying of that includes
Dosolax, constipatio artery disease stool, patient‟s perception
DSS, n (CAD), or impaction of normal and actual
Dulcocomfort debilitation frequency and
, Dulcolax -Patient who characteristics of
Stool is currently stool.
Softener, pregnant and  Assess patients
Enemeez lactating. nutritional status
Mini, Pedia- including fluid and
Lax, Phillips fiber intake.
Stool  Assesspatient‟s
Softener, level of
Promolaxin, activity.
Selax, Silace,  Evaluate laboratory
Sof-Lax results including
serum electrolyte
Patient‟s levels.
Dose:  Inform patient that
intake of drug is
Maximum only temporary
Dose: 100 measure.
mg
DURING:
 Assure that the
Minimum route of
Dose: 100 administration is
mg appropriate.

 Assess the patient

carefully for
 55
potential drug-drug
 56

interactions.

 Urge patient to
report persistent or
serious adverse
reactions promptly.

 Let the patient drink

plenty of water
during
administration of
drug.

 Monitor bowel
functions.

 Provide comfort and

safety measures.

AFTER:

 Offer support and

encouragement to
patient.

 Provide health
teaching.

 Monitor patient
response to drug.

 Monitor for adverse

effects.

 Evaluate
 57

effectiveness of
comfort measures
provided.

 Monitor compliance
of prescribed
regimen.

SOURCES:
BOOK

Amy M. Karch, R. M. (2017). Focus on Nursing Pharmacology, Seventh Edition. Philadelphia: Julie K. Stegman.
Kluwer, W. (2017). Nursing 2017 DRUG HANDBOOK. China: Jay Abramovitz.

Name of Classification Mechanism of Indication Contraindica Adverse Nursing Responsibilities

Drug Action tion Reactions
Generic General Thought to Acetaminoph The following Adverse BEFORE:
Name: Classification: produce analgesia en is are effects from  Assess for
by inhibiting indicated for contraindicati the use of contraindications.
Acetaminoph Para-
prostaglandin and the ons and Acetaminophe  Perform a physical
en (APAP, aminophenol
other substances following: cautions for n include: examination to
paracetamol) derivatives
that sensitize pain -Mild pain the use of CNS: agitation establish a baseline
receptors. Drug or fever Acetaminophe (I.V.), data.
Functional may relieve fever n: anxiety,  Assess laboratory
Trade Classification: through central -Mild to -Drug can fatigue, examination such as
Name: Analgesics action in the moderate cause acute headache, createnine clearance
Abenol, hypothalamic pain; mild liver failure, insomnia, and liver function
Acephen, heat-regulating to which may pyrexia test.
ACET, center. moderate require a liver GI: nausea,  Assess vital signs to
Aminofen, pain with transplant or vomiting, establish baseline
APAP, Aphen, Route: P.O. adjunctive cause death. abdominal data.
Onset: Unknown opioid pain, diarrhea,
 58

Atasol, Novo- Peak: ½-1 hour analgesics; Most cases of constipation

Gesic, Duration: 3-4 fever liver injury (I.V.) DURING:
Nortemp, hour are associated GU: oliguria  Assure that the
Triaminic, -Prevention with drug (I.V.) route of
Tylenol‟ Route: I.V. of adverse doses Hematologic: administration is
Onset: Unknown reactions exceeding hemolytic appropriate.
Patient’s Peak: 15 mins. (including 4,000 mg/day anemia,
Dose: Duration: in children and often leukopenia,  Establish safety
Unknown at high risk involve more neutropenia, precautions.
Maximum for than one pancytopeni
Route: P.R. seizures) acetaminophe a, anemia  Assess the patient
Dose: 650
Onset: Unknown with n-containing Metabolic: carefully for
mg
Peak: 1 ½-5 diphtheria, product. hypoalbumine potential drug-
hours tetanus - mia (I.V.), drug interactions.
Minimum Duration: toxoids, hypoglycemi
Contraindicat
Dose: 325 Unknown and a,  Urge patient to
ed in patients
mg pertussis hypokalemia report persistent or
with
Half-life: P.O., 2 vaccination , serious adverse
hypersensitiv
to 3 hours; I.V., hypervolemia, reactions promptly.
e to drug. I.V.
2.4-7 hours; P.R., form is hypomagnes
 Provide comfort and
2-3 hours contraindicate emia,
safety measures.
d in patients hypophosphat
with severe emia (I.V.)
hepatic Musculoskel
impairment or etal: muscle AFTER:
severe active spasms,
liver disease. extremity pain  Monitor patient
-Patients with (I.V.) response to the
any type of Respiratory: drug.
liver disease, abnormal
chronic breath  Always monitor for
malnutrition, sounds, adverse reactions.
severe dyspnea,
hypovolemia hypoxia,  Provide thorough
(dehydration, atelectasis, patient teaching
blood loss), or pleural such as safety
 59

severe renal effusion, precautions when

impairment. pulmonary administering the
-Use catiously edema, drug.
in patients stridor,
with long- wheezing  Evaluate
term alcohol (I.V.) effectiveness of
use because Skin: rash, health teaching.
therapeutic urticarial;
doses cause infusion-
hepatotoxicity site pain
in these (I.V.),
patients. pruritus
-Carefully
weigh the
risks and
benefits of
using drug
during
pregnancy.
SOURCES:
BOOK

Amy M. Karch, R. M. (2017). Focus on Nursing Pharmacology, Seventh Edition. Philadelphia: Julie K. Stegman.
Kluwer, W. (2017). Nursing 2017 DRUG HANDBOOK. China: Jay Abramovitz.
 60

Name of Classification Mechanism of Indication Contraindica Adverse Nursing Responsibilities

Drug Action tion Reactions

Generic General Hamamelis The following Adverse BEFORE:

Name: Classification: Topical agents water is are effects  Assess for presence
are used to treat indicated for contraindicati primarily of any known
Hamamelis Topical Agents
a variety of the ons and associated allergies which
water
disorders in following: cautions for with would be a
localized are. -relieves the use of Hamamelis contraindication to
Trade Because these itching and Hamamelis water: its use.
Name: drugs are irritation of water:  Assess the condition
Functional -Local
Witch Hazel, Classification: designed for vaginal of area to be treated
-Patient‟s with irritation
A.E.R. topical infection, which is the
Lotions and known -Stinging
application, they hemorrhoids, perineum.
Solutions allergies to
are minimally postepisiot -burning  Assess for any open
the vehicle of
absorbed omy -dermatitis wounds or broken
preparations.
Patient’s systemically and, discomfort, -inadvertent skin.
if used properly, -Patient‟s with  Provide proper
Dose: posthemorrh systemic
should have presence of patient health
oidectomy absorption
minimal systemic open wounds teaching about the
Maximum care
effects. or abrasions usage of the drug.
Dose:
6 times per DURING:
day  Assure that the
route of
Minimum administration is
Dose: appropriate.

 Apply sparingly.
Observe proper
sterile technique.

 Avoid contact with

eyes.

 Caution the patient

 61

that transient
stinging or burning
may occur.

 Assess the patient

carefully for
potential drug-drug
interactions.

 Urge patient to
report persistent or
serious adverse
reactions promptly.

 Provide comfort and

safety measures.

AFTER:

 Monitor patient‟s
response to drug.

 Evaluate
effectiveness of
medication.

 Monitor the area

being treated.

 Provide comfort
measures.

SOURCES: BOOK
Amy M. Karch, R. M. (2017). Focus on Nursing Pharmacology, Seventh Edition. Philadelphia: Julie K. Stegman.
Kluwer, W. (2017). Nursing 2017 DRUG HANDBOOK. China: Jay Abramovitz.
 62

HEALTH TEACHING

Topic: Different positions used During Labor and Delivery

General Objectives: After 20 minutes of nurse-client interaction at patient‟s residence, the patient will be able to understand the Different
positions used During Labor and Birth

LEARNING LEARNING LEARNING TIME TEACHING EVALUATION

CONTENT STYLE
OBJECTIVES ACTIVITY ALLOTED

After 20 minutes of
After 20 minutes of
nurse-client I. Interactive one on one
interaction the patient Introduction discussion,
Demonstration and
will be able to: What is your interactive
perspecti-ve on activities at Vicente
Sotto Memorial Medical
1. Explain the the different
Center were able to:
importance of positions during Patient will be able to
5 minutes Thought and understand the Different
Different positions Changing positions labor? What are
Perspective positions used During
used during labor and not only helps women your insights on Labor and Birth
Sharing,
Birth. cope with the pain of this?
introductory
labor; upright
Discussion
positions use gravity
to bring the baby
down, whereas
changing position
frequently moves the
 63

bones of the pelvis,

helping the baby find
the best fit (Simkin &
Ancheta, 2011;
Storton, 2007)

The different positions

during labor and Birth
are:

FLEXIBLE
SACRUM
2. Demonstrate the POSITIONS- aims at II-Lecture
different positions expanding the pelvic proper
during labor and outlet and taking off Lecture
Birth. the woman‟s sacrum; Proper

SITTING POSITION- Demonstratio

allows the woman‟s 15 minutes n

pelvis to open and the Video

baby to move down Showing

into the mother‟s birth

canal.
SQUATTING
POSITION- allows
 64

the pelvis to open up

which gives the baby
more rooms to move
down.
KNEELING AND
LEANING
POSITION-it
encourages the baby
to move forward,
taking the pressure off
the mother‟s back.
SITTING POSITION-
helps to ease the pain
in contractions and
allow the gravity to
assist in bringing the
baby down into the
birth canal.
HANDS AND KNEES
POSITION- allows
the woman to do
pelvic tilts for
comfort. SIDE-
LYING
 65
POSITION- this
 66

position does not

compress the major
veins in the body.
Also, it promotes rest
and relaxation
between pushing
contractions.

NON-FLEXIBLE
SACRUM POSITION-
These are positions
that rest the mother‟s
weight on her
tailbone:

SEMI-SITTING
POSITION- the bed
is raised to at least 30
degrees or greater
and the mother has a
pillow placed under
one of her hips.
SUPINE POSITION-
provides flexibility for
 67

health workers to
monitor the progress
of labor and assist
delivery in the most
efficient way.

LITHOTOMY
POSITION-a woman
lies on her back with
her legs up in stirrups
and her
buttocks are close to
the edge of the table.
 68

Topic: Proper Breastfeeding and its importance

General Objectives: After 45 minutes of nurse-client interaction at patient‟s residence, the patient will be able to understand the proper
breastfeeding and its importance and demonstrate the proper techniques of breastfeeding that contribute to the well-being of both mother and
child.

LEARNING LEARNING CONTENT LEARNING TIME TEACHING EVALUATION

OBJECTIVES ACTIVITY ALLOTED STYLE
After 1 hour of nurse- After 1 hour of
client interaction the Interactive one
patient will be able to: on one
discussion,
demonstration
1. Define breast and
feeding without interactive
difficulty Definition of Terms: II. Introduct 5 minutes One on one activities at
Breastfeeding, is the ion discussion North General
feeding of babies and young Hospital the
children with milk from a What are the patient were able
woman's breast. Health problems you to: Understand
professionals recommend encountereed the process of
breastfeeding within the first upon breast feeding the baby;
few hours of delivery, by feeding your and identified the
allowing the baby to rest or baby? importance and
nurse, skin-to-skin, on the the benefits of
 69

mother's chest. During this breastfeeding;

time, most infants are alert discovered the
and interested in nursing. best position and
25minutes Demostration, comfortable for
Interactive the mother and
One on one the baby; and
discussion, identified the
Showing of proper
Pictures and positioning and
Breast milk is widely III. Lecture giving techniques of
2. Identify and know recognized as the optimal proper booklet/ breastfeeding.
the importance of source of nutrition for all brochures
breastfeeding and its infants. It promotes about
benefits for the infant development of the infant's breastfeeding
and for the mother immune system and meets techniques.
the nutritional needs of a
full-term infant until Video
approximately six months of Showing
age, when complementary
foods and fluids are usually 5 minutes
added to the diet. Why is
breastfeeding important to
you baby?
 70

Breast milk helps keep

the baby healthy. Demonstra
IV. Video tion,
 It supplies all the Showing Questionin
necessary nutrients in g, and
the proper 10 minutes Sharing.
proportions.
 It protects against
allergies, sickness,
and obesity.
 It protects against
diseases, like diabetes V. Learning
and cancer. Assessment
 It protects against
infections, like ear
infections.
 It is easily digested –
no constipation,
diarrhea or upset
stomach.
 Babies have healthier
weights as they grow.
 Breastfed babies score
higher on IQ tests.
 71

Breast milk changes

constantly to meet babies'
needs.
The milk changes in volume
and composition according to
the time of day, nursing
frequency, and age of baby
to promote healthy growth.
Breast milk is the perfect
food for your baby.

Breast milk is always

ready and good for the
environment.
 It is available wherever
and whenever your
baby needs it.
 It is always at the right
temperature, clean and
free.
 No bottles to clean.
 Breastfeeding has no
 72

waste, so it is good for

the environment.

Why is Breastfeeding
Important for Mothers?
Mothers who breastfeed:
 Have a reduced risk of
Type 2 Diabetes and
certain cancers such as
breast cancer
 May find it easier to
return to what they
weighed before they
got pregnant
 Strengthen the bond
with their children
3. Identify the
importance of good A woman may use one of
attachment, proper several positions to hold her
positioning and the infant while breastfeeding.
techniques of There is no one "best"
breastfeeding position for every infant and
woman; the best position is
one that is comfortable for
 73

the woman and allows the

infant to latch-on, suckle,
and swallow easily. In all
positions, the baby should
not have to turn his or her
head to nurse; the baby's
nose should be aligned with
the mother's nipple. Turning
the head in any direction
makes it more difficult to
coordinate suckling and
swallowing, and can
potentially make it more
difficult for the baby to latch
correctly.

Discover 11 different
breastfeeding positions
and find out what is best
for you and your baby:
1. Laid-back
breastfeeding or
reclined position
The laid-back
 74

breastfeeding position,
also known as biological
nurturing, is often the
first mums try. If the
baby is placed on the
mother‟s chest or tummy
as soon as he‟s born, all
being well he‟ll
instinctively work his way
towards one of the
mother‟s breasts and
attempt to latch on – this
is known as the „breast
crawl‟.
2. Cradle hold
4. Redemonstrate It involves the mother sitting
proper positioning and upright, with the baby
techniques of positioned on his side, his
breastfeeding head and neck laying along
the mother‟s forearm and his
body against the stomach, in
a tummy-to-mummy
position.
 75
3. Cross-cradle hold
 76

This looks similar to the

cradle hold but the mother‟s
arms switch roles so the
baby‟s body lies along the
opposite forearm.
4. Rugby ball hold
In this position (also known
as the underarm or clutch),
the mother sits with the baby
resting along her forearm.
His body tucks alongside the
side, with his feet towards
the back of the chair, or
whatever the mother is
sitting on.
5. Side-lying position
The mother and the
baby need to lie on their
sides next to one
another, belly-to-belly.
6. Laid-back
breastfeeding after
a c-section
If the mother had a
 77

caesarean delivery and can‟t

find a comfortable
breastfeeding position, this
may help. Reclining with the
baby‟s body across the
mother‟s shoulder will let her
nurse comfortably without
any weight or pressure on
her wound, or she could also
try side-lying.
7. Upright
breastfeeding or
koala hold
The baby sits straddling in
the mother‟s thigh, or on the
hip, with his spine and head
upright as he feeds.
8. Dangle feeding
This breastfeeding
position involves the baby
lying on his back, while
the mother
crouch over him on all fours
and dangle the nipple in his
 78
mouth.
 79

9. Nursing in a sling
This method usually works
best if the baby is an
experienced breast feeder
and can hold his head up by
himself. The mother can
breastfeed in all sorts of
slings, including stretchy
wraps, ring slings and front
carriers.
10. Double
rugby ball hold
a great breastfeeding
position for twins, as the
mother can feed them in
tandem while having her
hands relatively free.
11. Dancer hand
nursing position
Starts by cupping the
mother‟s breast with her
hand underneath, fingers on
one side and thumb on the
other. Then edge the
 80

mother‟s hand forwards so

the thumb and index finger
form a „U‟ shape just in front
of the breast. The three
remaining fingers should
continue to support the
breast underneath. Rest the
baby‟s jaw on the thumb
and index finger as he feeds,
with his chin at the bottom
of the
„U‟, the mother‟s thumb
gently holding one of his
cheeks and the index finger
on the other.

Topic: Proper Cord Care

General Objectives: After 45 minutes of nurse-client interaction, the patient will be able perform proper cord care for the baby. Also, after
the discussion, the mother will be able to verbalize understanding with regards to the importance of cord care and its beneficial effects to the
baby.
 81
LEARNING LEARNING CONTENT LEARNING TIME TEACHING EVALUATION
OBJECTIVES ACTIVITY ALLOTED STYLE

After 1 hour of I. 5 minutes One on one After 45

nurse-client Introduction/ discussion, minutes of
interaction, the Discussion Questioning interactive one on
mother will be one
able to: What are your discussion,
knowledge about discussion,
1. Define what Definition of terms: Cord cord care? And; demonstration
cord care is with care is the care provided to What are the and questioning,
her own words a newborn. It is a misinformation you the
without difficulty. specialized care of the have patient was
remnants previously
of a acquired about
newborn‟s umbilical cord
until it falls off. The
 82

procedure consists of performing cord able to:

cleaning and prevention of care? Understand and
infection. identify the
Umbilical cord can also be II. Lecture 20 One on one importance of
referred to as the baby‟s proper minutes discussion, performing cord
“supply line” since it carries showing care. The mother
the baby‟s blood back and of was also
forth between the baby and pictures and able to
the placenta. providing verbalize in her
brochures/ own words the
pamphlet about meaning and
2. Know the Importance of newborn cord significance of
importance and newborn care: care the cord care
benefits of cord  It encourages procedure.
care. separation of the cord After
stump from the demonstrating to
attachment site. the mother the
 It reduces the procedure,
risk of infection. she was able to
properly
Perform it.
 83
 It keeps the area 15 Demonstration,
clean. minutes Questioning, and
III.
3. Know and Sharing
Demonstration
perform the Cord Care procedure:
of procedure
cord care  Wash your
procedure. hands.
In order to prevent
transfer of
microorganisms and
IV. Learning 5 minutes
prevent infections.
Assessment
 Clean the cord
stump,
Gently wash the cord
stump.
Remember to clean
from the base and
then outwards in order
to prevent infection in
the attachment site. It
 84

Is also recommended to
use mild soap and water
instead alcohol to avoid
irritating the baby‟s
umbilical cord.
 Clean urine or bowel
movement off the
stump.
If the baby‟s stump gets
dirt from urine or bowel
movement, wash it off
right away with water
and gently pat it dry
after cleaning.
 Let the cord air dry.
After cleaning the
 85

umbilical cord and

changing diapers, fold
the front of the diaper
down below the cord
stump to let it air dry.
 Dress the baby
in loose clothing.
Loose-fitting
clothes will help
the stump dry out
faster.
 Do not pull or tug at
the cord stump.
The stump will fall off
on its own.
 Avoid covering
the cord stump. This
helps the cord
stump become
 86

clean dry.

Contact the baby’s

healthcare provider if:
 The skin around the
4. Identify base of the baby‟s cord
signs stump looks red or
of swollen.
umbilical cord  There are presence of
infections. yellow or green
discharge around the
base of the cord stump.
 The umbilical cord
stump has a foul odor
even after you clean it.
 The cord stump has not
yet fallen off after 21
days.
 87

 There is presence of
fluid leaking from a pink
or red scar on the
baby‟s belly button after
the stump comes off.
 The baby shows signs of
poor feeding.
 The baby has
temperature of 38°C or
higher.
 The baby shows signs of
lethargy.
 The baby has floppy or
poor muscle tone.

5. Execute the proper

procedure of cord care.
 88

DISCHARGE PLANNING

Food/diet  Eat a variety of healthy foods.

o Fruits and vegetables
o Avoid Avocado, jackfruit and durian.
 Limit caffeine intake to less than 200 mg per day
 Limit intake of fish 2 servings per week. do not eat fish high in
mercury (swordfish, tilefish, king mackerel, and shark).
 Drink liquids as directed. (10 -12 glasses of water)
 Do not eat too much sugary food such as donuts.
Medication  Take supplements and vitamins as directed
 Talk to your health care provider before taking any medication
Hygiene  Avoid vaginal douching
 Use anti slip mat to avoid the risk for fall when bathing
Rest  Rest as needed.
 Put your feet up if you have swelling in your ankles and feet.
Exercise  Moderate exercise.
 Talk to your healthcare provider about the exercise needed and safe for
your pregnancy.
Prohibitions (Do not’s)  Do not smoke
 Do not drink alcohol
 Do not use illegal or street drugs (marijuana or cocaine)
 Avoid hot tubs and saunas
 Avoid coitus for a year for proper healing and rest
Concerns:  Experienced nausea in the morning after a week of childbirth
 Trouble with breastfeeding
 Vaginal discharge
 Vaccination for your baby

Call your obstetrician if you have any concerns or questions about your condition or care
8