BSN 2 01 Grand Case PPROM

A Clinical Case Study
Preterm Premature Rupture of Membranes

Presented to
Manila Doctors College of Nursing
S.Y. 2021-2022
_____________________________________________________________
In Partial Fulfillment of the

Requirements for the Related Learning Experience
NCM 109 CARE OF MOTHER, CHILD AT RISK
OR WITH PROBLEMS (ACUTE AND CHRONIC)
______________________________________________________________
Submitted by
Group 1 BSN II - 01
Agcaoili, Franz Lorenz
Amancio, Aliah Aira
Calanog, Hershe Anne
Derit, Vina Marie
Fortes, Erika
Leviste, Reiarose Linh
Nemis, Dianne
Pornuevo, Therease Antonine
Romulo, Rommel
Roxas, Francheska Lorainne
Vilma Reyes
Clinical Instructor
I. Case Abstract
Premature Rupture of Membranes (PROM) occurs when the fetal membranes rupture before the onset of labor.
When the membranes around the fetus rupture, the amniotic fluid or the fluid within the membranes around the fetus
flows out of the vagina. This occurs in 5% to 10% of all pregnancies. While when the membrane ruptures before 37
weeks of pregnancy, it is known as Preterm Premature Rupture of Membranes (PPROM) and it affects about 3% of
pregnancies and accounts for one-third of all preterm births. According to Stanford Children’s Health (2019), the
cause of PPROM is unknown in the vast majority of patients. Having a preterm birth in a prior pregnancy, having an
infection in the reproductive system, vaginal bleeding during pregnancy, and smoking while pregnant are all factors
that can raise the risk. Some of the symptoms that can occur in each pregnancy include a sudden gush of fluid or
leaking fluid from the vagina, and a sense of wetness in the vagina or underwear. On the other hand, PPROM
increases the risk of prematurity and causes along with other perinatal and neonatal complications, including a 1% to
2% probability of fetal death. A woman who has prematurely ruptured her membranes is at risk for intra-amniotic
infection, postpartum infection, endometritis, and death while respiratory distress syndrome, sepsis, intraventricular
hemorrhage, and mortality are among risks for a neonate born from premature rupture of membranes (Assefa, et al.,
2018).
Patient X, a 32 years old G3P2 at 30th week of pregnancy reported that she had awakened from a deep sleep
feeling wet with a thought of only having urinated on herself. Thus, she went to the bathroom to clean herself and
returned to bed. However, she continued to feel wet, which made her feel concerned, resulting in her going for a
consultation. She reported no contractions, no bleeding, and a good fetal movement. A sterile speculum examination
was then done confirming the diagnosis of “Preterm Premature Rupture of Membranes” (PPROM) resulting in her to
get admitted. Results also showed that the fetal weight is at 1,530 g (47th percentile for 30 weeks) and there is a
decreased amniotic fluid index (AF) at 4.3 cm. According to Lewsey (2019), a fetus at 30 weeks has an average
weight nearly 1,300 g and according to Sissons (2020), AFI measurements has an average score of 5 to 25 cm and a
score lower than 5 cm is too low and is referred to by the doctors as oligohydramnios. Fetal heart rate (FHR) pattern
showed no evidence of compromise, maternal status was reassuring and was not currently at labor. Two weeks later
after admission, she complained abdominal pain and was assessed to have started labor. After several hours, she had
then delivered a 2,030 g infant at 32th week gestation. According to Flagg and Pilliteri (2018), preterm labor refers
to the start of true uterine contractions resulting in the opening of the cervix after 20 weeks and before 37 weeks of
pregnancy and preterm delivery is the birth of a baby after 20 weeks and before 37 weeks of pregnancy. Whereas,
the earlier a premature birth occurred, the greater the health risk for a baby (Mayo Clinic, 2020).
According to Dayal & Hong (2021), patients with preterm rupture of membranes are treated differently
depending on their gestational age, and early detection and treatment are crucial for better patient outcomes. Based
on the patient’s condition, three nursing diagnoses were identified including anxiety, deficient knowledge, and risk
for infection, all of which would be addressed by specialized nursing interventions and patient health education.
These specific nursing interventions for the patient include actions to eliminate anxiety, gain adequate knowledge,
minimize risk, and prevent infections, as well as health teachings about the condition and its associated risk
prevention and management, as well as activities, procedures, and matters involving the patient.
II. Nursing Health History
a. Biographic Data
Client’s Initial: Gender: Age: Date of Birth:

Mrs. X Female 32 years old March 20, 1990
Educational Attainment: Occupation: Status: Place of Birth:
College Graduate Elementary School Teacher Married Pasay City
Date of Admission: No. of days in hospital: Order of Admission: Source of Information:
April 25, 2022 18 days Ambulatory Primary (Patient)
b. Chief Complaint
Leaking fluid or bag of water.
c. History of Present Illness

Patient X, is a G3P2 pregnant mother at 30 weeks of gestational age. Her prior two
pregnancies were delivered vaginally and at term. Her current or third pregnancy had no prior
complications until she experienced leaking fluid or bag of water prior to her admission on April 25,
2022. No contractions, bleeding, and good fetal movement was reported with her leakage of fluid.
Upon admission, a sterile speculum examination result showed and confirmed the diagnosis of
ruptured membranes. An ultrasound showed a single male fetus in cephalic presentation. Other
findings showed that the fetal weight is at 1,530 g (47th percentile for 30 weeks AOG) and a
decreased amniotic fluid index (AFI) at 4.3 cm. Her maternal status was also reassuring with no
fever, no uterine tenderness, and a white blood cell count (WBC) of 10.2 cubic millimeters that
confirmed she is not in labor and does not have an infection. With this, a course of antenatal
corticosteroids or Betamethasone 12 mg IM every 24 hours for a total of 2 doses was started and
given.
In the following weeks, period antenatal testing showed a fetal heart rate baseline between
150 and 155 bpm and an AFI that remained 3 to 7 cm. Patient X’s temperature remained within
normal range and reported continued minimal leakage of fluid that had no significant increase as she
increased her level of activity with bathroom privileges and a biweekly shower. After two weeks
upon admission or on April 30, 2022 (at 32 weeks AOG), she complained of abdominal pain and had
no uterine tenderness but contractions were palpable. An ultrasound showed a cephalic presentation,
AFI 4 cm and estimated fetal weight (EFW) of 1,940g. Contractions were noted every 5 to 8 minutes
and a fetal heart rate pattern consistent with fetal well being.
d. Past History
Mrs. X’s past history, her Childhood Illness(es), and Childhood/Adult Immunization(s) cannot be
recalled. The patient has no history of major/minor accidents. For the patient’s medication prior to
confinement there is no medication given or taken by the patient.
Childhood illness(es) Cannot recall
Childhood/adult immunization(s) Cannot recall
Accidents and Injuries No major/minor accidents
Previous hospitalization/surgery Cannot recall
Medication prior to confinement Cannot recall
e. Family history
General Family Information:
Name Relation Age Gender Occupation Educational Diseases/Disorder

Attainment
F.D. Mother 64 Female Unemployed College Graduate PROM,
Type 2 Diabetes Mellitus

(controlled)
N.D. Father 67 Male Unemployed College Graduate Lung Cancer / Deceased
J.D. Sister 29 Female Working College Graduate N/A
S.D. Sister 27 Female Working College Graduate N/A
M.D. Sister 24 Female Working College Graduate N/A
R.B. Husband 35 Male Farm Manager College Graduate N/A
M.B. Daughter 6 Female N/A N/A N/A
F.B. Daughter 3 Female N/A N/A N/A

Family Genogram:
f. Developmental History
Theory Age Developmental Task Client Description Interpretation
Psychosexual 32 Genital Stage N/A Analysis:

The patient matures sexually and learns
to have satisfying relationships with the
opposite sex (Pillitteri, 2010, 797)
Psychosocial 32 Intimacy vs Isolation N/A Analysis:

The young adult's developmental
dilemma is establishing a sense of
intimacy versus isolation. Intimacy is the
capability to relate effectively to others,
not just members of the opposing sex but
also members of one's own sex, in order
to build long-lasting friendships
(Pillitteri, 2010, p.799).
Cognitive 32 Formal Operational N/A Analysis:

Stage When adolescents reach this stage, they
may consider a variety of
possibilities—what could be (abstract
thought)—rather than being constrained
to thinking about what is actually there
(concrete thought). Adolescents can
utilize scientific thinking or grasp
deductive reasoning, or reasoning that
goes from the general to the specific, as a
result of this (Pillitteri, 2010, p. 802).
Moral 32 Postconventional N/A Analysis:

Morality
An individual follows what is right in
accordance with ethical principles
(Kozier & Erb’s, 2015).
Spiritual 32 Individual-Reflective N/A Analysis:

Faith Religious or spiritual beliefs can become
more complex and have more shades of
nuance. There is a greater sense of
open-mindedness, which can also lead to
conflicts when different beliefs or
traditions come together (Armstrong,
2020).
g. Environmental History
Patient X resides in a subdivision in Pasay City in a 2-bedroom house together with her immediate
family. She does all the household chores including going to the supermarket to buy groceries and essential
needs because they have no housemaid. With this, their house is made up of concrete materials, is
well-ventilated and no presence of any vectors noted.
h. OB/Gyne History
Menarche Age: 13 y/o Amount: 2-3 pads per day Characteristic: Bright Red
Duration: 3-5 days Associated Symptom: None
Obstetric History G3 T2 P0 A0 L2 M0 Type of Delivery: Normal Spontaneous

Vaginal Delivery
Complications: None Exposure to Teratogenic Agents: None
LMP: September 27, 2021 EDC: July 04, 2022 AOG: 30 weeks
III. Physical Assessment

a. General Survey:
Body Built: Grooming/Hygiene: Posture & Gait: Body Odor and Breath Odor:
Ectomorph Well-groomed, neat, Stands erect and Body odorless
and clean posture straight Breath odorless
Signs of Distress: Obvious Signs of Illness(es):

N/A leaking fluid or bag of water
Orientation: Level of Affect: Mood:

Consciousness: Euthymia Anxious,
Time (/) Person (/) Place (/) Alert, oriented, cooperative and
and coherent appropriate
Quantity & Quality of Speech: Organization of thoughts:

Normal quantity, clear moderately paced Organized thoughts and relevant answers
quality of speech
b . Anthropometric measurements
Height: Weight: BMI:

168 cm 68 kg 24.1
c . Vital signs
Temperature: Pulse rate: Respiratory rate: Blood pressure: Oxygen saturation:

37 °C 110 bpm 30 cpm 125/75 mmHg 97%
d. Physical Examination
Body Normal Findings Actual Findings Analysis & Interpretation
Part (IPPA) (IPPA)
Skin Skin color ranges from pale Skin is moist and Analysis:
white with pink, yellow, sweaty. The skin is the largest organ of
brown, or olive tones to dark the body. It is a physical barrier
brown or black. No strong that protects the underlying
odor should be evident, and tissues and organs from
the skin should be lesion free. microorganisms, physical
trauma, ultraviolet radiation, and
There should be no noticeable dehydration (Weber, 2022). A
odor, and there should be no properly functioning stratum
visible lesions on the skin. corneum is essential for healthy
skin. To maintain integrity, the
Skin should be soft, warm, stratum corneum employs a
and slightly moist, with good number of natural systems to
turgor and without edema keep water in or on the skin
(Kelley and Weber, 2014). which allows the skin to be
moist (Spada et al.,
2018).Hormonal changes taking
place in pregnancy will make
skin color may also darken a
little, either in patches or all
over. Birthmarks, moles and
freckles may also darken
(Healthdirect Australia, 2020).
Sweating is one key sign
response for anxiety as the
stimulus of fighting a threat, or
fleeing from it, requires you to
expend energy, which can raise
your body temperature. But
overheating would make it
difficult to escape or keep
fighting, so your body signals
your sweat glands to produce
sweat and keep you cool so that
you can carry on.
Interpretation:
Skin is abnormal.
Hair Hair is normally lustrous, Hair is silky, strong and Analysis:
silky, strong, and elastic. Fine, elastic. Scalp is clean Hair consists of layers of
downy hair covers the body. and free from scars and keratinized cells, found over
Hair is in natural hair color, lesions. much of the body except for the
and fine in texture. However, lips, nipples, soles of the feet,
adolescents may display a palms of the hands, and labia
variety of hairstyles and hair minora (Weber, 2022).
colors to assert independence
and group conformity. Interpretation:
Hair is normal.
Scalp is white, clean, dry and
free from scars, lice, dandruff
and lesions (Kelley and
Weber, 2014).
Nails Nails are clean and Nails are brittle. Analysis:
manicured. Pink tones are Faster nail growth is caused by
seen. Some longitudinal an increase in hormones during
ridging is normal. There is pregnancy, as is the case with
normally a 160-degree angle many other physiological
between the nail base and the changes (Kelly, 2020).
skin. Nails are hard and
basically immobile. Nails are Pregnancy can make nails more
smooth and firm; nail pate brittle and prone to chipping.
should be firmly attached to They can also get stronger in
the nail bed. Pink tone returns some circumstances (Boyles,
immediately to blanched nail 2021).
beds when pressure is released
(Kelley and Weber, 2018). Interpretation:
Nails are abnormal for adult
females in general but are
normal for pregnant women.
Head & Face The head is symmetric, round, Dark patches are visible. Analysis:
erect, and in midline and During pregnancy, some women
appropriately related to body experience dark, blotchy areas
size. No lesions are visible. on their faces, most commonly
Head is still and upright. Head on the bridge of the nose, the
is hard and smooth, without corners of the mouth, and the
lesions. tops of the cheeks and forehead.
This is known as 'chloasma.'
Face is symmetric with a The “mask of pregnancy’’ or
round, oval, elongated, or melasma are other names for
square appearance. No this condition. Chloasma is
abnormal movements. hypothesized to be caused by
Temporal artery is elastic and the production of melanin
not tender. No swelling, pigments (dark-colored
tenderness, or crepitation with pigments) by activating
movement. Mouth opens and pigment-producing cells by
closes fully (3-6 cm between female sex hormones. When
upper and lower teeth). lower women take oral contraceptives,
jaw moves laterally 1-2 cm in they may notice a red, itchy
each direction. (Kelley and patch on their skin (Pregnancy,
Weber, 2018) Birth and Baby, n.d.).
Changes in a pregnant woman's

hair and skin, including stretch
marks and hyperpigmentation
(darker patches), can be
attributed to the estrogen and
progesterone produced (Kelly,
2020).
Interpretation:
Head and face are abnormal for
adult females in general but are
Eyes The upper eyelid margin is Blurry vision is noted. Analysis:

between the upper margin of Pregnancy might cause hazy
the iris and the upper margin vision in some women. An
of the pupil. The lower lid increase in fluid retention may
margin rests on the lower be the cause of blurry vision.
border of the iris. No white According to the American
sclera is seen above or below Pregnancy Association, there is
the iris. Palpebral fissures may a 50% increase in fluid and
be horizontal. blood production in women
during pregnancy. Pregnant
The upper and lower lids close women may benefit from the
easily and meet completely additional fluid, but the opposite
when closed. is true. Swollen ankles are a
frequent sign of pregnancy. The
The lower eyelid is upright increasing corneal thickness
with no inward or outward may also cause your vision to
turning. Eyelashes are evenly become hazy due to water
distributed with curves retention. After a few months,
outward along the lid margins. most women report their vision
returning to normal (Kadrmas
Skin on both eyelids is Eye Care New England, n.d.).
without redness, swelling, or
lesions. Interpretation:
Eyes are abnormal for adult
Eyeballs are symmetrically females in general but are
aligned in sockets without normal for pregnant women.
protruding or sinking.
Bulbar conjunctiva is clear,

moist, and smooth.
Underlying structures are
visible. Sclera is white
The lower and upper palpebral

conjunctiva are clear and free
of swelling or lesions.
Palpebral conjunctiva is free
of swelling, foreign bodies, or
trauma.
No swelling and redness over

the areas of the lacrimal
gland. The puncta is visible
without swelling or redness
and is turned slightly toward
the eye. No drainage should
be noted from the puncta
when palpating the
nasolacrimal duct.
The cornea is transparent,

with no opacities. The oblique
view shows a smooth and
overall moist surface; the lens
is free of opacities.
The iris is round, flat, and

evenly colored. The pupil,
round with a regular border, is
centered in the iris, Pupils are
normally equal in size (3-5
mm).
The optic disc should be

round to oval with sharp,
defined borders. The nasal
edge of the optic disc may be
blurred. The disc is normally
creamy, yellow-orange to
pink, and approximately 1.5
mm wide.
Four sets of arterioles and

venules should pass through
the optic disc. General
background appears consistent
in texture. The red-orange
color of the background is
lighter near the optic disc.
The macula is the darker area,
one disc diameter in size,
located to the temporal side of
the optic disc.
The anterior chamber is

transparent.
No foreign body is observed.

The eye globe is intact with
no indication of blood in the
eye.
There is no swelling of the

eye, no blood anterior
chamber, cornea is clear,
pupils equal and reactive to
light. (Kelley and Weber,
2018)
Ears Ears are equal in size Ears are smooth. No Analysis:

bilaterally (normally 4-10 lesions, lumps, or The size, shape, and color of the
cm). The auricle aligns with nodules noted. Color is ear canal vary from person to
the corner of each eye and consistent with facial person. Normally, the canal is
within 10-degree angle of the color. No discharge skin-colored and covered in fine
vertical position. Earlobes present. hairs. There may be
may be free, attached , or yellowish-brown earwax
soldered. present. The eardrum is either
light gray or pearly white in
The skin is smooth, with no appearance. Light should reflect
lesions, lumps, or nodules. off the surface of the eardrum.
Color is consistent with facial (MedicinePlus, 2021)
color. Darwin’s tubercle,
which is a clinically Interpretation:
insignificant projection, may Ears are normal.
be seen on the auricle. No
discharge should be present.
Normally the auricle, tragus,

and mastoid process are not
tender.
A small amount of odorless

cerumen (earwax) is the only
discharge normally present.
Cerumen color may be yellow,
orange, red, brown, gray, or
black. Consistency may be
soft, moist, dry, flaky, or even
hard.
The canal walls should be

pink and smooth, without
nodules.
The tympanic membrane

should be pearly gray, shiny,
and translucent, with no
bulging or retraction. It is
slightly concave, smooth, and
intact. A cone-shaped
reflection of the otoscope light
is normally seen at 5 o’clock
in the right ear and 7 o’clock
in the left ear. The short
process and handle of the
malleus and the umbo are
clearly visible. (Kelley and
Weber, 2018)
Nose Color is the same as the rest of Swollen nose Analysis:
the face; the nasal structure is Swelling can occur in
smooth and symmetric; the unexpected locations, such as
patient reports no tenderness. the nasal passages, when the
body produces more blood and
The nasal mucosa is dark fluids during pregnancy. A
pink, moist, and free of swollen blood artery in the nose
exudate. The nasal septum is might cause a runny nose as a
intact and free of ulcers or result of the increased volume.
perforations. Turbinates are (Pregnancy Matters, 2020)
dark pink (redder than oral
mucosa), moist, and free of Interpretation:
lesions. Nose is abnormal for adult
females in general but is normal
for pregnant women.
Mouth & Pharynx Lips are smooth and moist Gums are pink, moist Analysis:
without lesions or swelling. and firm with tight
margins to the tooth. No The mouth or oral cavity is
No missing teeth, No decayed lesions or masses.Throat formed by the lips, cheeks, hard
areas. Jaws are aligned with is normally pink, and soft palates, uvula, and the
no deviation seen with biting without exudate or tongue and its muscles. The
down. lesions mouth is the beginning of the
digestive tract and serves as an
Color and consistency of airway for the respiratory tract.
tissues along cheeks and gums The upper and lower lips form
are even. No redness, the entrance to the mouth,
swelling, pain or moistness in serving as a protective gate- way
the area. Fordyce spots or to the digestive and respiratory
granules, yellowish-whitish tracts.
raised spots, are normal
ectopic sebaceous glands. The throat (pharynx), located
behind the mouth and nose,
The tongue’s ventral surface is serves as a muscular passage for
smooth, shiny, pink, or food and air.
slightly pale, with visible
veins. No swelling, redness, or Gingivitis is more likely to
pain. No lesions,ulcer, or develop in pregnant women, a
nodules are apparent. The hormone fluctuation that can
tongue offers strong affect the gum tissue, making it
resistance. The patient can red, inflamed and sore, that can
distinguish between sweet, be made even worse by plaque
and salty. and bacteria that has
accumulated along the gumline
The hard palate is pale or and between the teeth (Weber &
whitish with firm, transverse Kelley, 2014 & Oral Health and
rugae. Palatine tissues are Pregnancy, n.d. ).
intact; the soft palate should
be pinkish, movable, spongy, Interpretation:
and smooth. Mouth/Pharynx is normal.
The uvula is a fleshly, solid

structure that hangs freely in
the midline. No redness of or
exudate from uvula or soft
palate. They are
normally pink and symmetric
and enlarged to +1 in healthy
patients. No exudate,
swelling, lesion present.
Neck Neck is symmetric, with the Slight enlargement of Analysis:

head centered and without the thyroid gland.
bulging masses. There is no Thyroid hormone is critical to
present of enlargement and no the normal development of the
tenderness. baby’s brain and nervous
system. Two pregnancy-related
The thyroid cartilage and hormones, the human chorionic
cricoid cartilage move upward gonadotropin (hCG) and
symmetrically as the patient estrogen cause higher measured
swallows. thyroid hormone levels in your
blood. The thyroid then enlarges
Normally neck movement is slightly in healthy women
smooth and controlled with during pregnancy. According to
45- degree flexion, 55- degree Pillitteri (2018), a slight thyroid
extension, 40- degree lateral hypertrophy is common during
and 70- degree rotation. pregnancy as the thyroid
undergoes physiological
Trachea is midline. changes during pregnancy, such
Landmarks are positioned as moderate enlargement of the
midline. Lobes feel smooth, gland and increasing of
rubbery, and free of nodules. vascularization. However, a
No bruits are auscultated. noticeable enlargement of the
(Weber & Kelley, 2018) thyroid can be a sign of thyroid
disease. Thyroid problems can
be difficult to diagnose in
pregnancy due to higher levels
of thyroid hormone in the blood,
increased thyroid size, fatigue,
and other symptoms common to
both pregnancy and thyroid
disorders (Pregnancy and
Thyroid Disease, 2010).
Interpretation:
Neck is normal
Spine Scapula are symmetric and Tenderness, pain and Analysis:

non-protruding. Shoulders and usual sensation.
scapula are at equal horizontal Back pain during pregnancy is a
positions. The ratio anterior- common complaint and it's no
posterior to transverse wonder. As mothers gain
diameter is 1:2. Spinous weight, their center of gravity
processes appear straight, and changes, and the body makes a
thorax appears symmetric, hormone called relaxin that
with ribs sloping downward at allows ligaments in the pelvic
approximately a 45-degree area to relax and the joints to
angle in relation to the spine. become looser in preparation for
the birth process. The hormone
No tenderness, pain, or can cause ligaments that support
unusual sensations. the spine to loosen, leading to
Temperature is equal instability and pain (WebMD,
bilaterally. The examiner finds 2020; Mayo Clinic, n.d.)
no palpable crepitus.
Interpretation:
Percussion elicits flat tones Spine is abnormal in adults in
over the scapula. Excursion is general but in pregnancy it is
equal bilaterally and measures normal.
3-5 cm in adults. In
well-conditioned patients,
excursion measures up to 7 or
8 cm.
No adventitious sounds, such

as crackle or wheezes are
auscultated. Voice
transmission is soft, muffled,
and indistinct. The sound is
heard but the actual phase
cannot be
distinguished(Weber &
Kelley, 2018).
Thorax/Lungs The anterior- posterior Patients respiratory rate Analysis:

diameter is less than the has increased and the
transverse diameter. The ratio chest increases in size. Pregnancy alters lung function,
of anterior-posterior diameter chest expansion and the natural
to the transverse is 1:2. history of common pulmonary
Sternum is positioned at the disorders. Pregnant women with
midline and straight. respiratory problems pose a
Retractions not observed. Ribs challenge, as the wellbeing of
slope downward with the fetus has to be kept in mind.
symmetric intercostal spaces. The fetus depends on the
Costal angle is within 90 mother's lungs for oxygenation
degrees. and any impairment in the
mother may result in fetal
Respirations are relaxed, distress. Hence, pregnant
effortless,and quiet. They are women with pre-existing lung
of a regular rhythm and disorders should be advised to
normal depth at the rate of 10 have planned pregnancies. They
- 20 per minute in adults. should also be assessed before
Tachypnea and bradypnea are pregnancy by a chest physician
normal in some patient. and should be followed up by
the chest physicians during the
No retractions or bulging of pregnancy. The pediatricians
intercostal spaces are noted. and anesthetists should also be
No tenderness or pain is involved in the care of such high
palpated over the lung area risk patients. (BMJ Journal.
with respirations. (n.d.)
Tymphany is detected over the Interpretation:

muscles and bones. (Weber & Thorax/Lungs are abnormal.
Kelley, 2018)
Cardiovascular/Heart The Apical impulse is The pulse rate of patient Analysis:

palpated in the mitral area and increases and blood
may be the size of a nickel (1 pressure elevated. Mothers have heart conditions
-2 cm). Amplitude is usually during their pregnancy, blood
small- like a gentle tap. The volume increases by 30 to 50
duration is brief, lasting percent to nourish the growing
through the first two-thirds of baby, the heart pumps more
systole and often less. In blood each minute and heart rate
obese patients with large increases. In labor and delivery
breasts, the apical impulse it also adds workloads in their
may not be palpable. heart’s, too. During labor
particularly when mother pushes
No pulsation or vibrations are she has abrupt changes in blood
palpated in the areas of the flow and pressure. It takes
apex, left sternal border, or several weeks after delivery for
base. Rate should be 60- 100 the stresses on the heart to return
beats/min, with regular to the levels they were before
rhythm. A regularly irregular becoming pregnant. (Mayo
rhythm such as sinus Clinic, 2022)
arrhythmia when the HR
increases with inspiration, Interpretation:
may be normal in young Cardiovascular/Heart is
adults. abnormal
Resting Pulse rate (RR) varies

by age, gender, and
ethnnic/racial factors (Ocstega
et.al., 2011). Adult female
RPRs are a few beats faster
than male RPRs. The radial
and apical pulse rates should
be identical.
S1 corresponds with each

carotid pulsation and is
loudest at the apex of the
heart. S2 immediately follows
after S1 and is loudest at the
base of the heart.
A distinct sound is heard in

each area but loudest at the
apex. May become softer with
aspiration. A split S1 is
normally heard in young
adults at the left lateral sternal
border. Distinct sound is
heard in each area but loudest
is in base. A split s2 is normal
and termed physiologic
splitting. It is usually heard
late in inspiration at the
second or third left
interspaces.
Normally no sounds are heard.

A physiologic S3 heart sound
is a benign finding commonly
heard at the beginning of
diastolic pause in children,
adolescents and young adults.
It is rare after age 40. The
physiologic S3 usually
subsides upon standing or
sitting up. A physiologic S4
heart sound heard near the
diastole in well- conditioned
athletes and in adults of older
than age 40 or 50 with no
evidence of heart disease,
especially after exercise.
Normally no murmurs are

heard. However, innocent and
physiologic midsystolic
murmurs are present in a
healthy heart. S1 and S2 heart
sounds are normally present.
(Weber & Kelley, 2018)
Breast & Axilla The breasts are rounded in The breast is firm and Analysis:
shape, can be a variety of tender. There are also
sizes as it can be slightly prominent veins seen During pregnancy, the breasts
unequal in size or generally around the skin of the may feel firm and tender. It also
symmetric. The skin around breast and the areolas tends to become enlarged
the breast is uniform in color, around the nipples are because hormones particularly,
it is smooth and intact with no darker in color. the estrogen are preparing the
presence of edema. The skin breasts for milk production. The
around the breast is also at a glands that produce milk
normal body temperature. gradually increase in number
Moreover, areolas vary from and are able to produce milk
dark pink to dark brown, (Artal, 2021). Moreover, during
depending on the patient’s the last weeks of pregnancy, the
skin tones. They are round breasts may produce a thin,
and may vary in size. There yellowish or milky discharge
are also small Montgomery called colostrum, a fluid which
tubercles present. is rich in minerals and
antibodies. Colostrum is also
Nipples are nearly equal produced during the first few
bilaterally in size and are in days after delivery, before breast
the same location on each milk is produced.
breast. They are usually
everted, but they may also be Blood volume typically
inverted or flat. It may also increases by 50% throughout
become erect and the areola pregnancy. As a result,
may pucker in response to prominent blue veins usually
stimulation. A milky appear on several areas of the
discharge is usually normal skin, including the breasts and
only during pregnancy and stomach. These veins are
lactation. However, some necessary to carry the increasing
women may normally have a volumes of blood and nutrients
clear discharge. around the body to the
developing fetus. In addition,
Linear stretch marks may also during second and third
be seen during and after trimesters, the areolas often
pregnancy. In addition, veins become larger and darker as it is
radiate either horizontally and likely to result from hormonal
toward the axilla (transverse) changes (Leonard, 2021).
or vertically with a lateral
flare (longitudinal). Veins are
more prominent during Interpretation:
pregnancy as the breasts of the The breast and axilla are
women become enlarged. abnormal for adult females in
general but are normal for
In the axilla, there should be pregnant women.
no palpable nodes, rash or
infection noted (Kelley and
Weber, 2013).
Abdomen Abdomen is free of lesions or The patient’s abdomen Analysis:

rashes. There may be flat or is enlarged at 30 weeks
raised brown moles seen. The of gestation with a During pregnancy, the abdomen
umbilical skin tones are fundal height can be seen as protruding as the
similar to surrounding measurement of 30 cm. uterus becomes enlarged
abdominal skin tones or even throughout pregnancy. The
pinkish. Umbilicus is midline The fetal presentation is woman may also have
at the lateral line. cephalic. constipation as the pressure
from the enlarging uterus on the
The skin of the abdomen may rectum and the lower part of the
be paler than the general skin intestine may cause it. It may be
tone because this skin is so worsened because the high level
seldom exposed to the natural of progesterone during
elements. There may be new pregnancy slows the automatic
striae that are pink or bluish in waves of muscular contractions
color or old striae that are in the intestine, which normally
silvery, white, linear, and move food along (Artal, 2021).
uneven stretch marks from
past pregnancies or weight During the second to third
gain. trimester, baby settles into
cephalic position/presentation. It
There are a series of is a position where in the baby is
intermittent, soft clicks and positioned head-down, facing
gurgles are heard at a rate of the mother’s back with the chin
5–30 per minute. Hyperactive tucked to its chest and the back
bowel sounds or loud gurgling of the head ready to enter the
sounds referred to as pelvis (ClevelandClinic, 2020).
“borborygmus” may also be
heard.
Interpretation:
Abdomen is flat or evenly Abdomen is abnormal for adult
rounded. Has symmetric females in general but is normal
movements caused by for pregnant women.
respiration. It is also
nontender and soft. Normal
(mild) tenderness is possible
over the xiphoid, aorta,
cecum, sigmoid colon, and
ovaries with deep palpation
Venous hum is not normally

heard over the epigastric and
umbilical areas. There is no
friction rub over the liver or
spleen.
Moreover, a generalized
tympany predominates over
the abdomen because of air in
the stomach and intestines.
Dullness is heard over the
liver and spleen. There is
dullness may also be elicited
over a nonevacuate
descending colon.
The lower border of liver

dullness is located at the
costal margin to 1 to 2 cm
below and on deep inspiration,
it may descend from 1 to 4 cm
below the costal margin. In
addition, The upper border of
liver dullness is located
between the left fifth and
seventh intercostal spaces.
The normal liver span at the

midclavicular line is 6 to12
cm. The normal liver span at
the midsternal line is 4 to 8
cm. In addition, the liver is
usually not palpable
The spleen is an oval area of

dullness approximately 7 cm
wide near the left tenth rib and
slightly posterior to the mid
axillary line. It is seldom
palpable at the left costal
margin. Rarely, the tip is
palpable in the presence of a
low, flat diaphragm or with
deep diaphragmatic descent
on inspiration. If the edge of
the spleen can be palpated, it
should be soft and nontender
The aorta is approximately 2.5

to 3.0 cm wide with a
moderately strong and regular
pulse. Possibly mild
tenderness may be elicited
once palpated.
The kidneys are usually not

palpable. Sometimes the
lower pole of the right kidney
may be palpable by the
capture method because of its
lower position. If palpated, it
should feel firm, smooth, and
rounded. The kidney may or
may not be slightly tender.
An empty bladder is neither

palpable nor tender. No fluid
wave is transmitted. No
rebound tenderness, rebound
pain is elicited.
Musculoskeletal In muscles, there are no Gait is slightly forward. Analysis:
contractures, tremors and both Waddling gait and
sides of the body are equal in pelvic pain is also noted. As the fetus grows during
size and strength. In bones, pregnancy, the musculoskeletal
there are no deformities, system is challenged by altered
tenderness or swelling. In posture, muscle imbalances, and
joints, it moves smoothly, changes in spinal mobility.
there is no swelling, These changes may cause pain,
tenderness, crepitation, or difficulty with balance, and
nodules. reduced activity
(Musculoskeletal Dysfunction
During Pregnancy and After
Childbirth, 2019).
According to Pillitteri (2018),

during the second trimester of
pregnancy, relaxin is secreted
from the ovaries causing the
cartilage between joints to be
more flexible. This allows the
joints of the pelvis to be able to
open as much as 2 cm in labor to
allow for fetal passage. A wider
pelvis makes labor and delivery
both easier and safer, but it can
also affect the way you walk
(Whelan, 2018). In the later
stages of pregnancy, the
abdomen will start to protrude
significantly, which can throw
off the mother's center of gravity
and make it harder to balance,
especially while walking and
leads to waddling gait. The
spine and pelvis may also start
to curve in to support the
enlargement of the abdomen
causing the mother to lean back
slightly while standing or
walking.
Moreover, this position is called

lumbar lordosis that is
commonly seen in pregnancy.
Lumbar spine curvature
increased by 18% between 12
and 22 weeks and by a total of
41% between 12 and 32 weeks.
Hence, the spinal curvature of
pregnant women increases until
the end of pregnancy (Yoo et al.,
2015).
Interpretation:
Musculoskeletal is abnormal for
adult females in general but is
Genitals External Genitalia: Leakage of clear fluid in Analysis:

the vagina was noted.
Pubic hair is distributed in an During pregnancy, when there is
inverted triangular pattern and a leakage of clear and odorless
there are no signs of fluid in the vagina, it indicates
infestation. There is no that the fetus is about to enter
enlargement or swelling of the the pelvis of the mother. The
lymph nodes. fluid that comes out of the
vagina is the amniotic fluid
The labia majora are equal in which surrounds a fetus in the
size and free of lesions, womb and help them in their
swelling, and excoriation. A development. The amniotic fluid
healed tear or episiotomy scar is a warm, fluid cushion that
may be visible on the protects and supports the baby
perineum if the patient has as they grow in the mother’s
given birth. The perineum womb (Nall, 2016). Moreover,
should be smooth. The labia when the amniotic fluid leaks
of a woman who has not before full term pregnancy
delivered offspring vaginally which is usually 37 to 40 weeks
will meet in the middle. The of gestation, it may indicate that
labia of a woman who has the amniotic sac have been
delivered vaginally will not ruptured and is called as preterm
meet in the middle and may premature rupture of membranes
appear shriveled. (PPROM).
The labia minora appear

symmetric, dark pink, and Interpretation:
moist. The clitoris is a small Genitals are abnormal for adult
mound of erectile tissue, females in general but are
sensitive to touch. The normal normal for pregnant women.
size of the clitoris varies. The
urethral meatus is small and
slit-like. The vaginal opening
is positioned below the
urethral meatus. Its size
depends on sexual activity or
vaginal delivery. A hymen
may cover the vaginal
opening partially or
completely.
Bartholin’s glands are usually

soft, nontender, and drainage
free.
No drainage should be noted

from the urethral meatus. The
area is normally soft and
nontender.
Internal Genitalia:
The normal vaginal opening

varies in size according to the
patient’s age, sexual history,
and whether she has given
birth vaginally. The vagina is
typically tilted posteriorly at a
45-degree angle and should
feel moist.
No bulging and no urinary

discharge.
The surface of the cervix is

normally smooth, pink, and
even. Normally, it is midline
in position and projects 1 to 3
cm into the vagina. In
pregnant patients, the cervix
appears blue (Chadwick’s
sign).
The cervical os normally

appears as a small, round
opening in nulliparous women
and appears slit-like in parous
women.
Cervical secretions are

normally clear or white and
without unpleasant odor.
Secretions may vary
according to timing within the
menstrual cycle.
The vagina should appear

pink, moist, smooth, and free
of lesions and irritation. It
should also be free of any
colored or malodorous
discharge. The vaginal wall
should feel smooth, and no
tenderness.
The cervix should feel firm

and soft (like the tip of your
nose). It is rounded, and can
be moved somewhat from side
to side without eliciting
tenderness.
The fundus, the large, upper

end of the uterus, is normally
round, firm, and smooth. In
most women, it is at the level
of the pubis; the cervix is
aimed posteriorly (anteverted
position). However, several
other positions are considered
normal.
The normal uterus moves

freely and is not tender.
Ovaries are approximately 3 ×

2 × 1 cm (or the size of a
walnut) and almond-shaped.
They are firm, smooth,
mobile, and somewhat tender
on palpation. There is a clear,
minimal amount of drainage
appearing on the glove upon
examination from the vagina
is normal.
The rectovaginal septum is

normally smooth, thin,
movable, and firm. The
posterior uterine wall is
normally smooth, firm, round,
movable, and nontender
(Kelley and Weber, 2013).
Rectum and Anus The anal opening should Slight tenderness in the Analysis:
appear hairless, moist, and rectal mucosa was
tightly closed. The skin noted. During pregnancy, a woman can
around the anal opening is expect to feel some new aches
more coarse and more darkly and pains, due to changes that
pigmented. The surrounding the body is undergoing and pain
perianal area should be free of in the buttocks is common and
redness, lumps, ulcers, normal during pregnancy
lesions, and rashes. There is (Fletcher, 2019). The pain is
no bulging or lesions. usually resulted as the fetus and
uterus grow, it puts pressure on
The sacrococcygeal area is the hips, back, and buttocks that
normally smooth and free of leads to discomfort and pain.
redness and hair.
Interpretation:
Patient’s sphincter relaxes, Rectum and anus is abnormal
permitting entry. for adult females in general but
is normal for pregnant women.
The anus is normally smooth,
nontender, and free of nodules
and hardness.
The rectal mucosa is normally

soft, smooth, nontender, and
free of nodules.
redness and hair.
Interpretation:
and hardness.
free of nodules.
redness and hair.
Interpretation:
and hardness.

free of nodules.
e. Neurologic Status
Cranial Reflexes Sensory Function

Nerves *
I: Intact IX: Intact Biceps Reflex (+2) Touch: 2
II: Intact X: Intact Triceps Reflex (+2) Pain: 2
III,IV,VI: Intact Brachioradialis Reflex (+2) Temperature: 2
V: Intact XI: Intact Patellar Reflex (+2) Position: 2
VII: Intact XII: Intact Achilles Reflex (+2) Tactile Discrimination: 2
VIII: Intact Plantar/Babinski Reflex (+2)
* Scoring (+1, +2…)

IV. Anatomy and Physiology
1. Female Reproductive System
● INTRODUCTION
Figure 1.1: The Female Reproductive System
The female reproductive system serves several purposes. The ovaries produce the egg cells, known as ova or
oocytes. The oocytes are then transported to the fallopian tube, where sperm may fertilize them. Fertilized eggs are
subsequently carried into pregnancy by a woman's own body's uterus, which has thickened due to the average
production of reproductive hormones. The fertilized egg can implant into the thick uterine wall and continue to grow.
If implantation fails, the uterine lining is shed as menstrual flow. Furthermore, the female reproductive system
produces female sex hormones, which help to keep the reproductive cycle going (Cleveland Clinic, 2019).
● INTERNAL STRUCTURE
a. Ovaries
Figure 1.2: Ovaries

The female reproductive system includes the ovaries. Two ovaries are found in every woman. The pelvic
region known as the ovarian fossa is oval, roughly four centimeters long, and located on either side of the uterus
(uterus). In the womb, they are maintained by ligaments, but the remainder of the female reproductive system, e.g.,
the fallopian tubes, are not directly related to them. A female's ovaries serve two purposes for reproduction in the
body. Oocytes (eggs) are produced for fertilization, and estrogen and progesterone are reproductive hormones
produced by the ovaries. GnRH is produced by nerve cells in the hypothalamus and communicates with the pituitary
gland to produce luteinizing hormone and follicle-stimulating hormone, which regulate the functions of the ovaries.
These hormones are injected into the bloodstream to regulate the menstrual cycle. The main hormones secreted by
the ovaries are estrogen and progesterone, which play essential roles in the menstrual cycle. Estrogen production
predominates in the first half of the menstrual cycle, and progesterone production dominates in the second half of
the menstrual cycle after the corpus luteum has formed. Both hormones play an essential role in preparing the womb
lining for pregnancy and the implantation of a fertilized egg or embryo (You and Your Hormones, n.d.).
b. Fallopian Tubes
The fallopian tubes are muscular tubes that sit alongside the other reproductive organs in the lower
abdomen/pelvis. Two tubes extend from near the top of the uterus, run laterally, and then curve over and around the
ovaries, one on each side. Their shape resembles an extended J. The open ends of the fallopian tubes are very close
to the ovaries but are not directly connected. Instead, the fallopian tubes' fimbriae sweep ovulated eggs into the tubes
and towards the uterus. The fallopian tubes are approximately 10 to 12 centimeters long, though this varies
significantly from person to person. They are generally thought to be divided into four sections. The short interstitial
section connects the uterine wall to the uterine interior. The isthmus follows a narrow passage about one-third the
length of the tube. The ampulla follows, with thin walls like the isthmus but a larger circumference. It is
approximately half the length of the tube. Finally, there's the infundibulum, where the tube widens into a fringed
funnel near the ovary. The fimbriae are the fringes, and they are sometimes considered a fifth segment. The ovarian
fimbria is the longest fimbriae and the one closest to the ovary (Boskey, 2020).
c. Uterus
Figure 1.3: Internal parts within the uterus Figure 1.4: 3 Main parts of the uterus
The primary female reproductive organ is the uterus. It is an inverted pear shaped, thick-walled hollow
muscular organ. It's found in the pelvis between the bladder and the rectum. In the normal, non-pregnant state, it
measures around 8 cm in length, 4 cm in width, and 5 cm in depth. It also has muscular walls and an inner lining
known as the endometrium. Moreover, the uterus has a variety of functions during a woman's reproductive years,
despite being mostly stagnant in an individual’s pre-pubertal and post-menopausal years. It reacts to the synthesis of
female hormones, causing modifications that allow for the implantation of a fertilized egg or the onset of
menstruation in the absence of pregnancy. Primarily, the uterus has three main functions such as for menstruation,
pregnancy, and childbirth (Family Planning National Training Center, n.d.).
Throughout the menstrual cycle, the endometrium, or uterine lining, responds to the changing hormone
levels. It thickens to give nutrients for the fertilization and growth of a fertilized egg. If implantation fails, the top
layers of the endometrium shed as monthly bleeding, while the deeper layers rebuild for the following cycle. On the
other hand, when a fertilized egg is received by the uterus, it creates an environment in which the fertilized egg can
develop into a fetus, which can then grow throughout the pregnancy. The uterus is about the size and shape of a pear
before the first pregnancy, with the narrow end pointing down toward the vaginal opening, while it can also enlarge
fast as a pregnancy progresses and has a contractile function for labor and delivery during childbirth. The uterus then
grows larger after childbirth and shrinks again after menopause (Guyer, et al, 2020).
The uterus, on the other hand, is separated into three parts: the fundus, body, and cervix.
● Fundus
The fundus is a broad arched or curved upper portion where the fallopian tubes connect to the uterus.
It is convex like a dome and rests above the entrances to the two uterine tubes. When the bladder is empty,
the fundus is surrounded by peritoneum and directed forward. Moreover, the uterine cavity is not included
and in most cases, the fertilized ovum is implanted in the fundus's posterior wall (Guyer, et al, 2020).
● The Body
The upper enlarged region of the uterus is known as the body. It's the major section of the uterus that
starts just below the fallopian tubes and continues downward until the uterine walls and cavity narrow. The
isthmus, on the other hand, is the narrowest section of the uterus. It refers to the circular constriction between
the body and the cervix that corresponds to the internal os (Britannica, 2022).
● Cervix
The cervix is the lowest cylindrical portion of the uterus that lies beneath the internal os. It descends
from the isthmus until it reaches the vaginal opening. Essentially, it connects to the vaginal canal. The cervix
is 2.5 cm long and tubular in shape. The lower half of the cervix protrudes into the vaginal anterior wall,
dividing it into supravaginal and vaginal sections. During labor, the cervix expands to allow the baby to exit
the uterus. Here, various types of beneficial secretions are created. Throughout the month, these secretions
vary. They are white and sticky at times, and clear and stretchy at other times. Menstrual blood and other
fluids flow from the uterus, into the vagina, and out of the body through the cervix's opening (Family
Planning National Training Center, n.d.).
● EXTERNAL GENITALIA
Figure 1.5: The external part of the female genitalia.

a. Mons veneris
Mons veneris or commonly known as mons pubis, this is where the two labia majora meet anteriorly, it is
also covered with coarse hair. It is also a fat-filled tissue mound found right anterior to the pubic bones. Females
usually have a noticeable mound of tissue that is covered with pubic hair. One of it’s function is during sexual
intercourse, the mons pubis serves as a source of cushioning. Sebaceous glands secrete pheromones to enhance
sexual desire, which is also found in the mons pubis (Palmer, 2021).
b. Labia minora
Labia minora or usually called the ‘small lips’. According to Regan et al. (2018), labia minora is the
vestibule bordered by a pair of thin, longitudinal skin folds. Moreover, the labia minora are a set of thin cutaneous
folds that descend downward from the clitoris. The clitoral hood and frenulum of the clitoris are formed by the
anterior folds of the labia minora around the clitoris. The labia minora then travels obliquely and downward,
creating the vulva vestibule's borders. The posterior ends of the labia minora eventually come to an end when they
are joined together by a skin fold known as the frenulum of the labia minora. The labia minora will surround and
stop between the labia majora and the vulva vestibule. The labia minora get engorged with blood and become
edematous during sexual arousal (Palmer, 2021).
c. Labia Majora
On the other hand labia majora is referred to as the ‘large lips’. As stated by Regan et al. (2018), labia majora
is found lateral to the labia minora, and there are two prominent rounded folds of skin. Furthermore, it is known to
cover the labia minora, clitoris, vulva vestibule, vestibular bulbs, Bartholin's glands, Skene's glands, urethra, and
vaginal entrance. The anterior labial commissure is formed by the anterior section of the labia majora folds merging
together right beneath the mons pubis. While the posterior labial commissure is formed by the posterior part of the
labia majora coming together. Just like in labia minora, during sexual arousal, the labia majora engorges with blood
and appears edematous (Palmer, 2021).
d. Clitoris
The clitoris (which is homologous to the glans penis in males) is a sex organ in females that functions as a
sensory organ. The clitoris can be divided into the glans clitoris and the body of the clitoris. The underlying tissue
that makes the clitoris is the corpus cavernous. The corpus cavernous is a type of erectile tissue that merges together
and protrudes to the exterior of the vulva as the glans clitoris. While proximally, the two separate ends of the tissue
will form the crus of the clitoris (legs of the clitoris) and the body of the clitoris. The glans clitoris is the only visible
part of the clitoris. The glans clitoris is highly innervated by nerves and perfused by many blood vessels. It is
estimated that glans clitoris is innervated by roughly eight thousand nerve endings. Since the glans clitoris is so
highly innervated, it becomes erected and engorged with blood during sexual arousal and stimulation (Palmer,
2021).
e. Vaginal orifice
The vagina orifice or the vagina opening itself, is also called the vaginal vestibule or introitus (Sullivan,
2020). It is an elastic, muscular tube connected to the cervix proximally and extends to the external surface through
the vulva vestibule. The distal opening of the vagina is usually partially covered by a membrane called the hymen.
The vaginal opening is located posterior to the urethra opening. The function of the vagina is for sexual intercourse
and childbirth. During sexual intercourse, the vagina acts as a reservoir for semen to collect before the sperm
ascending into the cervix to travel towards the uterus and fallopian tubes. In addition, it also acts as an outflow tract
for menstrual period (Palmer, 2021).
f. Skene glands (paraurethral glands)
Figure 1.6: The External Genitalia with Skene’s Gland
The Skene's glands, which are also known as the lesser vestibular glands (homologous to the prostate glands
in males), are two glands located on either side of the urethra. These glands are believed to secrete a substance to
lubricate the urethra opening. This substance is also believed to act as an antimicrobial. This antimicrobial is used to
prevent urinary tract infections. The function of Skene's gland is not fully understood but is believed to be the source
of female ejaculation during sexual arousal (Palmer, 2021).
g. Bartholin glands (vulvovaginal glands)
Figure 1.7: Bartholin glands
The primary function of the Bartholin glands is the production of a mucoid secretion that aids in vaginal and
vulvar lubrication, specifically at the distal end of the vagina during intercourse. The glands are located in the vulvar
vestibule, at either side of the external orifice of the vagina. The glands become active after menarche and are
non-palpable. Each gland is oval-shaped and measures, on average, 0.5 cm. A two-centimeter-long efferent duct
connects each gland to the posterolateral aspect of the vaginal orifice (Gregory, 2022).
2. Placenta
Figure 2: The Placenta

The placenta develops in the uterus during pregnancy which is usually attached to the top, side, front or back
of the uterus. It is formed gradually during the first three months of pregnancy, while, after the fourth month, it
grows parallel to the development of the uterus. Once completed, it resembles a spongy disc 20 cm in diameter and 3
cm thick. It is a temporary organ, whose genetic characteristics are identical to those of the developing child. Its
proper development is essential for a successful pregnancy (HO, 2021; Mayo Clinic, 2022).
The placenta has multiple functions, such as endocrine, immune, and physiological as well as a means of
communication between the mother and fetus. The placental membrane is where the exchange of substances
happens between mother and fetus. This exchange is essential for the transfer of gases, electrolytes, hormones,
maternal antibodies, fetal waste, and nutrition such as water, amino acids, glucose, vitamins, and free fatty acids
(HO, 2021).
Furthermore, the placenta is a fetal organ made up of its parenchyma, chorion, amnion, and umbilical cord. It
contains a network of blood vessels that absorb nutrients and oxygen from the mother’s blood and carry them to the
baby. Specifically, the placental membrane is where the mother and fetus exchange gases and nutrients. The
membrane is formed by the syncytiotrophoblast, cytotrophoblast, embryonic connective tissue or Wharton’s jelly,
and the endothelium of fetal blood vessels. On the other hand, the umbilical cord serves to attach the fetus to the
placenta and consists of two umbilical arteries and one umbilical vein. The umbilical vein carries oxygenated,
nutrient-rich blood from the placenta to the fetus, and the umbilical arteries carry deoxygenated, nutrient-depleted
blood from the fetus to the placenta (HO, 2021).
● Amniotic Fluid
Figure 2.2: The Amniotic Fluid
The amniotic fluid, which is contained in the amniotic sac, is a clear, slightly yellowish liquid that surrounds
the fetus during pregnancy. It is where the baby floats while in the womb. Its amount is greatest at about 34 weeks of
gestation, when it averages 800 mL. About 600 mL of amniotic fluid surrounds the baby at full term, which is at 40
weeks gestation. The amniotic fluid helps the developing baby to move in the womb, which allows for proper bone
growth. It also helps the lungs to develop properly as well as it prevents pressure on the umbilical cord. Additionally,
it keeps a constant temperature around the baby which protects him or her from heat loss. It also protects the baby
from outside injury by cushioning sudden blows or movements. However, too much amniotic fluid, which is called
Polyhydramnios, can occur with multiple pregnancies such as in twins or triplets, congenital anomalies which are
problems that exist when the baby is born, or with gestational diabetes. On the other hand, too little amniotic fluid
called oligohydramnios may occur with late pregnancies, ruptured membranes, placental dysfunction, or fetal
abnormalities (Martinez & Johns, 2022).
V. Pathophysiology
VI. Drug Study
Drugs Indication Action Side Effect & Adverse Effect Nursing Considerations/ Health Teachings
a. Brand Name Betamethasone is a Betamethasone binds to Side effects:
- N/A corticosteroid and is specific intracellular ● acne 1. If a patient presents with symptoms such as blurred
b. Generic Name indicated for the glucocorticoid receptors ● blurred vision vision or other visual disturbances, the patient should
- Betamethasone treatment of several and subsequently binds to ● dizziness be considered for referral to an ophthalmologist for
c. Classification inflammatory DNA to modify gene ● dry skin evaluation of possible causes.
- corticosteroids conditions. Its expression. The synthesis ● headache 2. Monitor patient’s blood pressure, serum potassium,
d. Dose injectable suspension of certain injection site reactions and glucose levels.
● itching
- 12 mg and can be used to anti-inflammatory 3. As the drug may cause visual disturbances, avoid
● nausea
e. Frequency manage a range of proteins is induced while driving or operating machinery.
● Insomnia
- q24H, 2 doses inflammatory the synthesis of certain 4. Patients/and or carers should be warned that
● mood swings
conditions including inflammatory mediators potentially severe psychiatric adverse reactions may
Adverse reactions:
endocrine disorders, is inhibited. As a result, occur with systemic steroids.
gastrointestinal there is an overall ● Convulsion 5. Patients receiving corticosteroids should avoid
disorders, and reduction in chronic ● fainting chickenpox or measles-infected persons if
rheumatic disorders inflammation and ● Enlarged heart unvaccinated.
among other autoimmune reactions. ● enlarged liver
conditions ● fluid retention
(DrugBank, 2022). ● potassium loss

● Partial paralysis
● Pancreatitis
● Depression
a. Brand Name Cephalexin is a type Cephalexin is a Side effects:
- N/A of antibiotic beta-lactam antibiotic 1. Instruct the patient to notify the physician
● Diarrhea
b. Generic Name indicated for the which means its structure immediately of signs of superinfection, including
- Cefalexin treatment of certain contains a beta-lactam ● Nausea black, furry overgrowth on the tongue, vaginal
c. Classification infections caused by ring. In a bacterial cell, ● Vomiting itching or discharge, and loose or foul-smelling
- Cephalosporin susceptible bacteria. peptidoglycan provides stools.
● Upset stomach
antibiotics These infections the cell wall with 2. Instruct the patient to report other troublesome side
d. Dose include respiratory mechanical stability. Adverse reactions: effects such as severe or prolonged skin problems
- 500 mg tract infections, otitis Cephalexin as well as (rash, hives) or GI problems (nausea, vomiting,
● Abdominal pain
e. Frequency media, skin and skin other beta-lactam diarrhea, abdominal pain).
● Severe diarrhea
- TID x 7 days structure infections, antibiotics utilize a 3. Instruct the patient to take the medication with food
● Dyspepsia
bone infections, and beta-lactam ring to inhibit and advise to have small, frequent meals if
● Gastritis
genitourinary tract the synthesis of gastrointestinal complications occur.
● Erythema multiforme
infections. It is also peptidoglycan, which is a 4. Advise the patient to report severe diarrhea with
● Genital pruritus
commonly used in critical step in the blood, pus, or mucus; rash or hives; difficulty
● Vaginitis,
treating formation of the bacterial breathing; unusual tiredness, fatigue; unusual
● Vaginal discharge,
streptococcal and cell wall. Specifically, the bleeding or bruising.
● Candidiasis
staphylococcal skin beta-lactam binds to 5. Advise the patient to not drink alcohol while still
● Thrombocytopenia
infections. penicillin-binding taking the medication as mixing with alcohol can
● Neutropenia
Antibiotics are given proteins (PBPs), which result in the delay of clearing the antibiotics which
● Eosinophilia
in postpartum to result in the inhibition of could lead to toxicity and other severe adverse
● Arthralgia
reduce the incidence the last phase of effects.
● Arthropathy
of infections. peptidoglycan synthesis,
● Arthritis
a transpeptidation
reaction required for
bacterial peptidoglycan
cross-linking. This
activity outturns in the
loss of cell viability and
eventually causes
bacterial cell autolysis
which is the
self-digestion of the cell
wall.
a. Brand Name Mefenamic acid Mefenamic Acid is used to Side Effects
- N/A indicates relief of treat mild to moderate ● Abdominal pain 1. Monitor for the patient's allergic reaction to
b. Generic Name acute pain in adults pain. It may also be used ● Constipation mefenamic acid and/or any other medicines that will
- Mefenamic Acid and adolescents ≥ 14 to treat menstrual cramps ● Diarrhea be given.
c. Classification years of age, this is and other conditions as ● Indigestion 2. Instruct the patient to discontinue drug promptly if
- NSAIDs given or dose is 500 determined by a doctor. ● Heartburn diarrhea, dark stools, hematemesis, ecchymoses,
d. Dose mg as an initial dose This medicine is available ● Nausea epistaxis, or rash occur and do not use again.
- 500 mg followed by 250 mg only with a doctor's ● Vomiting 3. Advise patient not to give breastfeed while taking
e. Frequency every 6 hours as prescription. ● Drowsiness this drug without consulting a physician.
- TID, PRN for needed, usually not ● Headache 4. Assess the patient who develops severe diarrhea and
pain to exceed one week. ● Abdominal Renal Function vomiting for dehydration and electrolyte imbalance.
given orally. Clinical ● Dizziness 5. Keep in mind, using mefenamic acid during
studies indicate that pregnancy is not advisable unless prescribed by a
effective treatment Adverse Effects: doctor, especially if you are 30 or more weeks
can be initiated with ● Gross Bleeding/Perforation pregnant. Paracetamol is usually recommended to
the start of menses ● Heartburn control pain or fever during pregnancy.
and should not be ● Swelling - Taking mefenamic acid before week 30 of
necessary for more ● Rashes pregnancy is unlikely to harm a baby in the
than 2 to 3 days. ● Itching womb.
● Ringing in the ears
● Anemia
a. Brand Name Ferrous sulfate is an Ferrous sulfate allows for Side effects: 1. Although iron supplements are best taken on an
- N/A iron supplement a more rapid increase in ● Nausea and vomiting empty stomach (at least 1 hour before or 2 hours
b. Generic Name that is used to treat iron when dietary stores or ● Stomach pain after a meal), they can also be taken after meals to
- Ferrous Sulfate or prevent low supply are insufficient. ● Heartburn avoid gastrointestinal side effects.
c. Classification blood levels of iron Wherein, iron combines or ● Loss of appetite 2. Advise patients that they may experience discolored
- Antianemics/ including after joins with porphyrin and ● Diarrhea or constipation stools particularly green, dark or black stool
Oral iron bivalent pregnancy. globin chains to form ● Green, dark or black stool 3. Contraindicated for those with haemochromatosis,
preparations Wherein, iron is a hemoglobin critical for the ● Black stained teeth other iron overload syndromes, blood disorders like
d. Dose mineral needed by delivery of oxygen from ● Dark urine haemolytic anemia and hemosiderosis, active peptic
- 1 tab the body to produce the lungs to the other parts ulcer, regional enteritis, and ulcerative colitis, patient
e. Frequency red blood cells to of the body or tissues Adverse effects: receiving frequent blood transfusions, and
- OD keep a person (Drug Bank, 2022). ● Anaphylaxis concomitant parenteral iron therapy.
healthy for it carries ● Rash or hives 4. Other iron supplements should be avoided. Ask your
oxygen around the ● Itching doctor or pharmacist before taking any vitamin or
body (Cunha, ● Swelling of the face/tongue/throat mineral supplements.
2021). ● Severe dizziness 5. Tea, coffee, eggs, dairy products, and soybean
● Trouble breathing products should not be consumed with it since they
● Severe and persistent stomach pain might limit the quantity of iron absorbed. Allow 2
hours after taking ferrous sulfate (or eating foods
high in iron) before eating or drinking these meals or
beverages.
VII. Laboratory Findings
Specimen: Blood
Laboratory Normal Values Result Analysis & Interpretation

● White blood cells 4.6 - 10.0 x 10.2 cubic Analysis:
10^9/L millimeters. White blood cells also known as

leukocytes are part of the body’s immune
system that circulate in the blood and
respond to injury or illness. They function
to help in combating infection and other
diseases. As white blood cells travel
through the bloodstream and tissues, they
will locate the site of an infection and
serve as an army general to inform other
white blood cells of their location. In that
way, they can help defend the body from
an attack by an unknown organism. Once
they have reached the site, they will fight
against the invader by producing antibody
proteins to attach to the organism and
destroy it (Cleveland Clinic, 2021).
Interpretation:
White blood cells are slightly elevated.
According to an article published in the
Indian Journal of Hematology and Blood
Transfusion, your white blood cell count
will be higher during pregnancy. This is
because your body is going through a lot
of stress just by being pregnant (Allibone,
2020). As per the healthcare team of the
patient, they reassure that she appears to
have no infection.
Diagnostic Findings
Diagnostic Normal Result Analysis & Interpretation

Examination Findings
● Sterile Speculum Intact amniotic The ruptured Analysis:
Examination membrane membrane is A sterile speculum examination is a visual
confirmed examination of the vagina and cervix

performed during labor to determine the
presence of any amniotic fluid in the vault.
This procedure is done to identify if there
is a premature rupture of membranes.
Here, a small instrument covered inthe gel
is inserted in the vagina. This enabled the
examiner to check if there is any cause for
the bleeding, or to confirm if the bag of
water had ruptured. It is usually not
painful, however, can sometimes cause
discomfort for the patient (Tommy’s,
2021).
Interpretation:
The amniotic membranes have been
ruptured.
● Ultrasound A fetus in cephalic Demonstrates a Analysis:
membrane single male fetus A prenatal ultrasound is a procedure that

in cephalic utilizes high-frequency sound waves,
presentation. inaudible to the human ear, that are

transmitted through the abdomen via a
device called a transducer to look at the
inside of the abdomen. Here, the echoes
are recorded and transformed into video or
photographic images of the baby and
position. Apart from providing
visualization of the fetus, it can also
display images of the amniotic sac,
placenta, and number of fetuses present.
Major anatomical abnormalities or birth
defects may be visible on ultrasound
(Todd, 2020).
Interpretation:
Results show the presence of only one
fetus that is identified as male.
Additionally, it also demonstrated a
cephalic presentation wherein the
presenting part near the birth canal is the
head of the fetus. This type of fetal
position is considered to be the ideal one
for vaginal delivery because it is easiest
for the head to “crown” or come out
smoothly as you give birth (Iftikhar, 2020).
● Amniotic Fluid Analysis:
Index (AFI) 4.3 cm Amniotic fluid is a clear, slightly
5 - 25 cm
yellowish liquid which surrounds the fetus
during pregnancy. It is contained in the
amniotic sac and protects the fetus in the
event the maternal abdomen is the object
of trauma as well as serves as a cushion
between the fetus and the umbilical cord,
thus reducing the risk of compression
between the fetus and the uterine wall.
Amniotic fluid also helps protect the fetus
from infectious agents due to its inherent
antibacterial properties. Additionally, it
serves as a reservoir of fluid and nutrients
for the fetus containing: proteins,
electrolytes, immunoglobulins, and
vitamins from the mother. The amniotic
fluid index (AFI) is an estimate of the
amniotic fluid volume in a pregnant uterus.
It is part of the fetal biophysical profile.
(Fitzsimmons, 2021; Martin, 2020).
Interpretation:
AFI is below normal range.
Low amniotic fluid indicates
oligohydramnios. It can increase the risk
of miscarriage or stillbirth, preterm birth,
severe birth abnormalities, and injury to
the organs including underdeveloped
lungs.
VIII. List of Prioritized problems
Cues Nursing Diagnosis Rank Justification

Subjective: Anxiety related to 1 Anxiety is defined as an emotional response to a diffuse threat in which the individual anticipates nonspecific
“Nag-aalala ako sa perceived threat to self impending danger, catastrophe, or misfortune (NANDA, 2021). This is the first priority nursing problem
pwedeng mangyari sa akin
and fetus secondary to because anxiety has both short-term and long-term effects on maternal pregnancy and fetal outcomes. With
at sa anak ko dahil may
bigla bigla nalang Preterm Premature increased anxiety, the cortisol hormone appears to cross the placenta and affect the fetus, which results in the
tumatagas sa kin na
Rupture of Membranes disruption of an ongoing process, affecting the limbic and prefrontal cortex, and releasing chemicals such as
parang tubig, lalo na at
ngayon lang to nangyari sa (PPROM) as evidenced acetylcholine and adrenaline in the mother’s body. These chemicals pass through the placenta into the fetus
lahat ng pagbubuntis ko”
by anxious appearance and can cause detrimental effects on proper fetal growth. Additionally, anxiety can result in inappropriate
as verbalized by the
patient. and verbalization of maternal responses to the fetus during pregnancy and may decrease the ability to portray a motherly role
concern of leaking fluid (Vera, 2021). Since anxiety is easily discerned from the mother through her expressions or verbalizations of
● Patient states she had
concerns upon check-up, addressing the problem immediately could aid in relaxing the mother’s feelings so
two vaginal term
deliveries effective communication can occur. With that, she will be able to absorb and understand the explanation and
information that will be provided to her, and understand the possible procedure she might undergo. Also, with
Objective: calmed emotions, she will be able to involve and engage in her care which could help her and the fetus
● Restlessness positively to receive a better outcome.
● Tense
● Poor eye contact
● Diaphoresis
● Vital Signs:
➢ PR: 110 bpm
➢ RR: 30 cpm
➢ BP: 125/75 mmHg
Subjective: Deficient knowledge 2 Deficient knowledge is defined as the absence of cognitive information related to a specific topic, or its
related to unfamiliarity acquisition (Herdman et al., 2021). This is prioritized as second among the three nursing diagnosis because
“Madalas ako kumain ng with individual risks and unlike the first nursing diagnosis deficient knowledge doesn’t have an immediate physiological effect on the
mga matatamis, tinapay,
own role in risk patient’s overall condition which requires to be managed like anxiety and at the same time, unlike the third
kanin, pizza at pasta tapos
madalang ako kumain ng prevention and nursing diagnosis it isn’t a risk factor that hasn’t occurred just yet but an already existing condition. According
prutas at gulay” as management aeb to an article among patients, low health literacy has been consistently associated with poor health outcomes,
verbalized by the patient.
insufficient knowledge including poorer health status, lack of knowledge about medical conditions and related care, lack of
“Ako lahat gumagawa ng and statement of engagement with health care providers, decreased comprehension of medical information, mortality, and
gawain bahay at namimili concerns poorer use of preventive health services, poorer self-reported health, and increased hospitalizations
ng mga pangarawaraw na
(Jayasinghe et al., 2016) as a person’s knowledge of their health defines how an individual subjectively
pangangailangan” as
verbalized by the patient. assesses their own well-being and their ability to perform, manage and regulate their physiological,
psychological, and social functions, as good health literacy is foundational to successful management and
“Nagising po ako ng basa prevention of chronic diseases (Poureslami et al., 2016).
yung ibaba ko, kala ko
napaihi lang ako kaya
nagCR at hugas lang ako
tas bumalik lang din sa
tulog, kaso maya maya
basa nanaman kaya
nagtaka na ako kung bakit
ganon?” as verbalized by
the patient.
● Patient states she had

two vaginal term
deliveries
Objective:
N/A
Subjective: Risk for Infection related 3 Risk for infection is defined as being susceptible to invasion and multiplication of pathogenic organisms,
● “Nagising po ako to loss of protective which may compromise health (Herdman, et al., 2021). According to The National Academies (2022)
ng basa yung ibaba barrier secondary to infection happens when viruses, bacteria, or other organisms enter your body and begin to multiply. Bacteria,
ko, kala ko napaihi Preterm Premature viruses, fungi, and other parasites infect vulnerable hosts as a result of injuries and exposures that are
lang ako kaya Rupture of Membrane unavoidable. Natural barriers and the immune system, according to Bush (2020), protect the body against
nagCR at hugas (PPROM) infection-causing organisms and if the patient's immune system is unable to adequately combat the invading
lang ako tas pathogen, an infection develops.
bumalik lang din sa
tulog, kaso maya During pregnancy, a baby is protected while in the womb by the amniotic sac, which is made up of two
maya basa membranes, the amnion and the chorion. The fetus develops and grows within this sac, which is surrounded
nanaman kaya by amniotic fluid. According to March of Dimes (2020) this fluid cushions and protects the baby, maintains a
nagtaka na ako constant temperature surrounding the baby, and includes nutrients, hormones produced by the body, and
kung bakit ganon?” antibodies that fight infection. When the amniotic sac or membranes rupture, the fluid within the membranes
as verbalized by the surrounding the fetus or the amniotic fluid flows out of the vaginal opening, while with Preterm Premature
patient Rupture of Membranes (PPROM), the membrane is ruptured for an extended period of time prior to birth
allowing present microorganisms from the vaginal canal to enter the uterus. It can lead to the development of
Objective: a major infection of the placental tissues termed chorioamnionitis, which can be highly harmful for both
● WBC: 10.2 cubic mother and baby (Children's Hospital of Philadelphia, 2014). However, because this diagnosis is simply a risk
millimeter diagnosis and has yet to surface in comparison to other diagnoses, it is regarded as the least immediate
(Normal) problem. Thus, the infection would not develop if the preterm premature rupture of membranes was properly
● Sterile speculum managed.
examination result:
Ruptured
membranes
● Decreased AFI 4.3
cm
● Vital Sign:
➢ Temp: 37 °C
IX. Nursing Care Plan
Cues Nursing Diagnosis Rationale Goals & Interventions Rationale Evaluation

Objectives
Subjective: Anxiety related to Anxiety is defined as Goal: Eliminate anxiety Independent: Goal is met.
“Nag-aalala ako perceived threat to an emotional response 1. Assess the patient’s 1. To establish a baseline The patient was able to
sa pwedeng
self and fetus to a diffuse threat in Short-term: vital signs and the fetal for intervention eliminate her anxiety.
mangyari sa akin
at sa anak ko secondary to which the individual Within 8 hours of nursing heart rate. effectiveness, determine
dahil may bigla
Preterm Premature anticipates nonspecific interventions: fetal condition, and rule Short-term:
bigla nalang
tumatagas sa kin Rupture of impending danger, out other maternal After 8 hours of nursing
na parang tubig,
Membranes catastrophe, or 1. The patient's vital medical conditions such interventions:
lalo na at ngayon
lang to nangyari (PPROM) as misfortune (NANDA, signs and the fetal heart as hypertension or fever.
sa lahat ng
evidenced by 2021). Premature rate will be monitored 1. The patient's vital signs
pagbubuntis ko”
as verbalized by anxious Rupture of and assessed. 2. Assess the anxiety 2. To establish a baseline and the fetal heart rate were
the patient.
appearance and Membranes (PROM) level of the patient, assessment of the monitored and assessed.
● Patient states verbalization of is defined as the 2. The patient will be anxiety triggers, and patient’s anxiety level.
she had two concern of leaking rupture of the able to express herself symptoms by asking Open-ended questions 2. The patient was able to
vaginal term
fluid membrane or freely while gaining open-ended questions. can help in eliciting the express herself freely and
deliveries
commonly understood understanding of her patient’s thoughts and gained understanding about
Objective: as when the bag of condition. feelings about the her condition.
● Restlessness water breaks before situational crisis.
● Tense labor. Premature 3. The patient’s anxiety 3. The patient’s anxiety
● Poor eye Rupture of level will be assessed and 3. Maintain eye contact 3. A calm voice can help level was assessed and
contact Membranes (PROM) monitored. with the patient and the patient feel secure monitored.
● Diaphoresis occurs before 37 communicate in a calm and comfortable enough
● Vital Signs: weeks of pregnancy, it 4. The patient’s questions and non-threatening to express her concerns 4. The patient’s questions
➢ PR: 110 is referred to as and concerns about her manner. and fears. If the patient and concerns about her
bpm Preterm Premature condition will be perceives the nurse to be condition were answered
➢ RR: 30 Rupture of answered and addressed, calm and in control, she and addressed, respectively.
cpm Membranes respectively. may become more
➢ BP: 125/75 (PPROM). relaxed and open to 5. The patient was able to
mmHg 5. The patient will be discussion. manage her anxiety through
Some of the common able to manage her relaxation techniques.
signs and symptoms anxiety through 4. Provide adequate 4. To make the
of anxiety include relaxation techniques. lighting, good environment more 6. The patient was able to
feeling nervous, ventilation, and low comfortable for the have emotional support
restless, or tense, 6. The patient will have noise levels and respect patient to promote from her family and friends.
having a sense of emotional support from the patient’s personal feelings of being safe
impending danger, her family and friends. space, but don't sit too and relaxed. Long-term:
panic or doom, far from her. After 18 days of nursing
having an increased Long-term: interventions:
heart rate, Within 18 days of 5. Teach the patient 5. To facilitate relaxation
breathing rapidly nursing interventions: relaxation techniques and stress reduction. 1. The patient was able to
(hyperventilation), like guided imagery, Guided imagery, effectively manage her
sweating, 1. The patient will be meditation, and meditation, and anxiety and appeared more
trembling, and able to effectively progressive muscle progressive muscle relaxed before delivery.
feeling weak or tired. manage her anxiety and relaxation. relaxation all contribute
will appear more relaxed to a sense of peace and 2. The patient had no
Situational anxiety is a before delivery. tranquility. manifestations of anxiety.
type of anxiety that
occurs when we are 2. The patient will have 6. Assist the patient in 6. The patient may believe
faced with unfamiliar no manifestations of understanding that mild that all anxiety is
situations or anxiety. anxiety can be a harmful and unhelpful,
occurrences that cause positive force for thus assisting her in
us to lose control of change and should not understanding anxiety
our capacity to remain be avoided. can help initiate change
calm. Since the patient or compliance with
has never experienced interventions.
having some fluid
leaking in her past 7. Inform and explain all 7. Being informed and
pregnancies, it was activities, procedures, knowing what to expect
normal to feel anxious and issues that involve would make the patient
and worry about how the patient in a manner feel less anxious and
it could affect her and that they will less emotional distress,
the baby. understand, slowly and since uncertainty
with the use of usually provides anxiety
nonmedical terms. to the patient.
8. Promote support 8. This is to give

systems to the patient, additional emotional
such as encouraging support to the patient.
the significant other or
the family of the
patient to visit or check
in on her. .
9. Encourage or let the 9. Letting them express

patient express their their feelings could
own feelings towards sometimes reduce their
her current situation anxiety.
and condition.
10. Encourage adequate 10. Acquisition of adequate

rest for the patient. rest provides the patient
reduced stress levels,
improved blood
pressure and less likely
to feel overwhelmed or
on edge.
Dependent:
1. Assist the physician in 1. To monitor her current
speculum vaginal condition which might
examination, for help reduce her anxiety;
checking the cervix of To provide proper
the patient. intervention as
necessary.
Collaborative:
1. Collaborate with the 1. This allows the doctors
ultrasonographer to to know the following
measure the amniotic care for the patient.
fluid index of the
patient from time to
time.

Objectives
Subjective: Deficient Deficient knowledge Goal: Gain adequate Independent: Goal: Patient had
“Madalas ako knowledge related is defined as the knowledge 1. Assess the patient's level 1. To reassess their gained adequate
kumain ng mga to unfamiliarity absence of cognitive of understanding or understanding and make knowledge
matatamis, tinapay,
with individual information related to Short-term: knowledge about it easier to clarify if
kanin, pizza at
pasta tapos risks and own role a specific topic, or its Within 8 hours of pregnancy and her there is any wrong Short-term:
madalang ako in risk prevention acquisition (Herdman nursing intervention: current condition by information acquired by After 8 hours of nursing
kumain ng prutas at
and management as et al., 2021). 1. Patient will asking them to explain the patient regarding her intervention:
gulay” as
verbalized by the evidenced by According to an have the what they know in their condition, help 1. Patient had the
patient. insufficient article among patients, readiness to own words. enlighten them on what readiness to
knowledge and low health literacy has learn. they do not understand. learn.
“Ako lahat
gumagawa ng statement of been consistently 2. Patient's overall 2. Patient's overall
gawaing bahay at concerns associated with poor level of 2. Educate the patient about 2. Patients can be level of
namimili ng mga health outcomes, understanding the importance of having educated on how to understanding
pang-araw-araw na
pangangailangan” including poorer and health adequate knowledge better maintain their and health
as verbalized by the health status, lack of knowledge will about her condition and own health and avoid knowledge was
patient. knowledge about be assessed. its corresponding risk unnecessary assessed.
medical conditions 3. Patient will be prevention and readmissions through 3. Patient was able
“Nagising po ako
ng basa yung ibaba and related care, lack able to express management. patient education. It is to express her
ko, kala ko napaihi of engagement with her concerns important for patients concerns and
lang ako kaya health care providers, and to be educated about experiences.
nagCR at hugas decreased experiences. the proper care setting 4. Patient had a full
lang ako tas
comprehension of 4. Patient will for their ailment so that understanding
bumalik lang din sa
tulog, kaso maya medical information, have a full they avoid unnecessary about her
maya basa mortality, and poorer understanding hospitalizations. condition with
nanaman kaya
use of preventive about her its
nagtaka na ako
kung bakit ganon?” health services, poorer condition with corresponding
as verbalized by the self-reported health, its 3. Educate the patient on 3. To provide further risks.
patient.
and increased corresponding do’s and don’ts of knowledge on what 5. The patient had
● Patient states hospitalizations risks. pregnancy during the should be done and a full
she had two (Jayasinghe et al., 5. The patient will third trimester such as what should not be understanding of
vaginal term 2016) as a person’s have a full eating healthy foods, done during pregnancy the risk
deliveries
knowledge of their understanding doing appropriate specifically during the prevention and
health defines how an of the risk exercises, and having third trimester. This management
Objective: individual subjectively prevention and adequate rest periods. way the patient will applicable to
N/A assesses their own management know the appropriate her.
well-being and their applicable to actions to perform if 6. The patient’s
ability to perform, her. she will plan to have questions and
manage and regulate 6. The patient’s another pregnancy in concerns about
their physiological, questions and the future and will her condition
psychological, and concerns about avoid any were answered
social functions, as her condition complications or risk and addressed,
good health literacy is will be from occurring or respectively.
foundational to answered and reoccurence that might
successful addressed, cause detrimental Long-term:
management and respectively. effects in her future After 18 days of nursing
prevention of chronic pregnancies. intervention:
diseases (Poureslami Long-term: 1. Patient was able
et al., 2016). Within 18 days of 4. Provide a quiet 4. This allows the patient to apply all
nursing intervention: atmosphere without to concentrate more health teachings
1. Patient will be interruption. completely. given to her
able to apply all such as self-care
health teachings needs.
given to her 5. Encourage the patient to 5. To have a better 2. Patient was
such as self-care open up about previous understanding about a more ready and
needs. experience/pregnancies. patient's experience on prepared for her
2. Patient will be her previous delivery and
more ready and pregnancies and assess postpartum care.
prepared for her the parameters or
delivery and evaluate the important
postpartum points that should be
care. included or necessary in
the health teaching that
will be given. In
addition, most patients
often share life
experiences at each
learning session and
they best learn when
teaching builds on
previous knowledge and
experience.
6. Identify the patient's 6. To initiate and maintain
understanding of good communication
common medical with the patient and to
terminology and use make sure that she can
layman's terms in fully understand and
explanation if needed. comprehend the health
Repeat and summarize information better and
as needed. faster making the
educating process more
effective.
7. Educate the patient about 7. To provide information

the positive effects of to the patient that
consuming proper and consuming proper and
healthy foods during healthy foods will yield
pregnancy. her more sustainable
energy, a stronger
immune system, and the
reduced risk of
pregnancy
complications. All foods
that a mother intake will
also have an effect on
her baby, thus
consuming healthy
foods will minimize any
complications and birth
defects to the baby
making him/her more
stronger and healthier.
8. Educate the patient about 8. To provide better

PPROM including signs understanding of her
and symptoms and own condition since
potential risks with clear, knowing the signs and
thorough, and symptoms can help her
understandable know when to call for a
explanation. doctor or medical
assistance. Knowing the
potential risks that
might occur once she
failed to do the
management of PPROM
can encourage her to
adhere in the subsequent
interventions regarding
management of
PPROM.
9. Educate the patient on 9. To increase patient
safety measures in awareness and
managing PPROM such adherence to safety
as complete bed rest w/o management measures
bathroom privileges and in treating PPROM. In
avoiding vigorous and addition, bed rest eases
physical activities uterine contractions and
reduces the effects of
gravity then there is less
pull on the uterus and
less pressure on the
cervix opening
therefore preventing
preterm labor which
most patients with
PPROM are at risk.
While, vigorous
exercises and
exhausting physical
activities can further
worsen the leaking of
bag of water which
might further result in
reduced amniotic fluid
10. Assess the patient's 10. The patient may not be

readiness to learn. ready to learn due to
factors such as
nervousness or a lack of
knowledge of the
importance of learning.
When the patient is
eager and eager to learn,
retention of information
improves. At the time of
preterm labor, the nurse
should assess the
patient’s feelings about
the pregnancy.
11. Educate the patient with 11. Early detection of

the signs and symptoms preterm labor signs and
of early labor. symptoms is critical
because they can be
subtle. Pregnant women
should be given
counseling, education,
and information about
these symptoms and
what to do if they
develop. Pregnant
women should be
educated on the
significance of
obtaining medical
attention at the hospital
as soon as they notice
any signs or symptoms
of preterm labor.
12. Provide textual material 12. It helps the patient learn

or instructions and at his or her own pace
self-learning modules for and reinforces the
the patient to use as learning process.
needed.
Dependent: N/A
Collaborative:
1. Refer to dieticians for 1. To give in depth
further counseling to knowledge about the
individual dietary importance of a healthy
customs. diet in PPROM and
provide an appropriate
diet suitable for the
patient in order to boost
her immune system and
decrease any potential
risks.

Objectives
Subjective: Risk for Infection Risk for infection is Goal: Minimize risk Independent: Goal: Minimize the
“Nagising po ako related to loss of defined as being and prevent infection risk for infection
ng basa yung ibaba protective barrier susceptible to invasion 1. Monitor vital signs, 1. To minimize the risk
ko, kala ko napaihi
secondary to and multiplication of Short-term: especially the temperature of having further Short-term:
lang ako kaya
nagCR at hugas Preterm Premature pathogenic organisms, Within 8 hours of complications and in Within 8 hours of
lang ako tas Rupture of which may compromise nursing intervention: order to provide nursing intervention:
bumalik lang din sa
Membranes health (Herdman, et al., immediate
tulog, kaso maya
maya basa (PPROM) 2021). Infection occurs 1. The patient and her interventions to 1. The patient and her
nanaman kaya when viruses, bacteria, family will be able to address the condition. family was able to
nagtaka na ako
or other organisms enter assess, identify, and Additionally, a fever assess, identify, and
kung bakit ganon?”
as verbalized by the the body and multiply prevent risk factors of usually indicates an prevent risk factors of
patient as a result of infection associated infection. infection associated
unavoidable injuries and with the patient's with the patient's
Objective: exposures, according to condition. 2. Assess for signs and 2. Maternal and fetal condition.
● WBC: 10.2 The National symptoms of infection infection may occur
cubic Academies (2022). 2. The patient and her once membranes have 2. The patient and her
millimeter family will be able to ruptured and must be family was able to
(Normal) During pregnancy, identify and treated quickly to identify and understand
● Sterile according to March of understand methods avoid fetal methods and factors
speculum Dimes (2020), the and factors that may compromise. that may contribute to
examination amniotic fluid cushions contribute to minimize the risk for
result: and protects the fetus, minimize the risk for 3. Inspect and disinfect or 3. To reduce or eliminate infection.
Ruptured maintains a steady infection. sterilize all items during the germs and prevent
membranes temperature surrounding vaginal examination before inducing 3. The patient’s
● Decreased the baby, and contains 3. The patient’s using them to ensure that microorganisms to the environment exhibited
AFI 4.3 cm nutrients, hormones environment will they are free of patient. minimal risk for
● Vital Sign: produced by the body, exhibit minimal risk contaminants. infection.
➢ Temp: 37 and antibodies that fight for infection.
°C infection. This fluid 4. Utilize good hand washing 4. Hand hygiene and 4. The patient and her
leaks out of the vagina 4. The patient and her techniques before and after wearing of gloves family was able to
when the membranes family will be able to handling the patient and reduce the risk of demonstrate clean
rupture, resulting in a demonstrate clean wear gloves as necessary transmitting pathogens techniques and aseptic
decrease in amniotic techniques and when providing from one area of the techniques to prevent
fluid. With Preterm aseptic techniques to interventions. body to another, and infection.
Premature Rupture of prevent infection. reduce opportunities
Membranes (PPROM), for cross-transmission
the amniotic sac or 5. The patient and her of microorganisms 5. The patient and her
membrane is ruptured family will be able to family was able to
for a long period of time identify and verbalize 5. Explain to the patient the 5. Providing information identify and verbalize
prior to birth allowing understanding about treatments she might need about the possible understanding about
the present bacteria the signs and to prevent infection treatments she might the signs and
from the vaginal canal symptoms of undergo to prevent symptoms of infection.
to enter the uterus. It infection. infection will
can cause encourage her
chorioamnionitis, a 6. The patient and her participation in her 6. The patient and her
serious infection of the family will be care. family was oriented
placental tissues that oriented and and verbalized
can be extremely verbalize 6. Inform the patient of the 6. This will provide an understanding about
harmful to both the understanding about signs and symptoms of opportunity for early the hospital’s infection
mother and the baby the hospital’s infection she should watch intervention in the prevention procedures.
(Children's Hospital of infection prevention out for and advise her to event of developing
Philadelphia, 2014). procedures. tell the medical complications. Long-term:
professionals once noticed. After 15 days of
Long-term: nursing interventions:
Within 15 days of 7. Encourage the patient and 7. Proper hand
nursing interventions: family to perform proper sanitization promotes 1. The patient showed
hand sanitization. wellness and no signs and symptoms
1. The patient will sanitization to prevent of infection including
show no signs and possible infection. the absence of an
symptoms of elevated temperature
infection including 8. Encourage intake of 8. Proper nutrition and a and a WBC within
the absence of an protein-rich and balanced diet support normal range.
elevated temperature calorie-rich foods and the immune systems’
and a WBC within encourage a balanced diet. responsiveness and
normal range. enhance the health of
all the body’s tissues.
Adequate nutrition
enables the body to
maintain and rebuild
tissues and helps keep
the immune system
functioning well
(Vera, 2022).
9. Limit patient’s visitors and 9. Restricting visitation

inform the family of the reduces the possible
significance of doing so. sources and
transmission of
pathogens. Informing
family members
allows greater help in
cooperation with
specific precautions to
prevent possible
infection.
10. Encourage adequate fluid 10. Drinking enough

intake if not water each day is
contraindicated. crucial for many
reasons: to regulate
body temperature,
prevent infections,
deliver nutrients to
cells, and keep organs
functioning properly
(Harvard College,
2018).
11. Minimize the frequency of 11. Individuals with ≥8
internal monitoring and cervical exams had 1.7
vaginal examinations. times the risk of
developing clinical
chorioamnionitis
compared with those
with 1 to 3 exams
(Zafra-Tanaka et al.,
2019).
Dependent: N/A
Collaborative:
1. Collaborate with the 1. To allow proper
nutritionist for a catered nutrition and a
diet plan. balanced diet to
support the immune
system function.
2. Collaborate with the 2. Leukocytosis is the

medical technologist to term used for high
monitor the white blood white blood cell count.
cells. It can indicate a range
of conditions, including
infections,
inflammation, injury,
and immune system
disorders. Monitoring
the WBC will aid in
immediate
interventions to prevent
further complications
from occurring.
X. Health Teaching Plan
Topic: Basic information about Preterm Premature Rupture of Membrane (PPROM)
Goal: At the end of the 40 to 60 minutes of interactive discussion, the patient and her family will be able to gain adequate knowledge of basic information about Preterm Premature
Rupture of Membrane (PPROM).
Time Allotment: 40-60 minutes
Learning Objectives Learning Content Methodology Resources Method of Evaluation
At the end of the health
teaching, the patient and
patient’s family shall be able
to:
1. Define the meaning of 1. Definition of 1. Lecture and 1. Relevant informational 1. Able to state the meaning of Preterm
Preterm Premature Preterm Premature Discussion; Question material such as brochure, Premature Rupture of Membrane in
Rupture of Membrane Rupture of and answer flyers, or pamphlet related to their own words (verbal); Learners
in their own words. Membrane the topic; Pictures and videos; were asked what new information they
white board and pen for the have obtained from the discussion
visual explanation; Small (reflection); Learners were encouraged
notebook and pen for note to ask questions or clarifications about
taking of the patient’s family the discussion (question & answer);
Learners were asked to read the notes
they have written (written).
2. State causes of 2. Different possible 2. Lecture and 2. Relevant informational material 2. Able to state possible causes of
Preterm Premature causes of Preterm Discussion; Question such as brochure, flyers, or Preterm Premature Rupture of
Rupture of Premature Rupture and answer pamphlet related to the topic; Membrane (verbal); Learners were
Membrane, in their of Membrane Pictures and videos; white board asked what new information they have
own words. and pen for the visual obtained from the discussion
explanation; Small notebook and (reflection); Learners were encouraged
pen for note taking of the to ask questions or clarifications about
patient’s family the discussion (question & answer);
3. Enumerate the 3. Signs and symptoms 3. Lecture and 3. Relevant informational material 3. Able to enumerate signs and symptoms
possible signs and of Preterm Discussion; Question such as brochure, flyers, or of Preterm Premature Rupture of
symptoms of Preterm Premature Rupture and answer pamphlet related to the topic; Membrane (verbal); Learners were
Premature Rupture of of Membrane Pictures and videos; white board asked what new information they have
Membrane using their and pen for the visual obtained from the discussion
own words. explanation; Small notebook and (reflection); Learners were encouraged
pen for note taking of the to ask questions or clarifications about
patient’s family the discussion (question & answer);
4. Enumerate possible 4. Complications 4. Lecture and 4. Relevant informational material 4. Able to enumerate complications
complications linked to Preterm Discussion; Question such as brochures, flyers, or associated with Preterm Premature
associated with Premature Rupture and answer pamphlets related to the topic; Rupture of Membrane (verbal);
Preterm Premature of Membrane Pictures and videos; whiteboard Learners were asked what new
Rupture of Membrane and pen for the visual information they have obtained from
in their own words. explanation; Small notebook and the discussion (reflection); Learners
pen for note taking of the were encouraged to ask questions or
patient’s family clarifications about the discussion
(question & answer); Learners were
asked to read the notes they have
written (written).
5. Discuss the 5. Importance of 5. Lecture and 5. Relevant informational material 5. Able to discuss the importance of
importance of reducing risk of Discussion; Question such as brochures, flyers, or reducing risk of Preterm Premature
reducing the risk of Preterm Premature and answer pamphlets related to the topic; Rupture of Membrane (verbal);
having Preterm Rupture of Pictures and videos; Small Learners were asked what new
Premature Rupture of Membrane notebook and pen for note-taking information they have obtained from
Membrane of the patient’s family the discussion (reflection); Learners
were encouraged to ask questions or
clarifications about the discussion
asked to read the notes they have
written (written).
6. Enumerate ways to 6. Ways to reduce risk 6. Lecture and 6. Relevant informational material 6. Able to enumerate ways to reduce risk
reduce risk of Preterm of Preterm Discussion; Question such as brochures, flyers, or of Preterm Premature Rupture of
Premature Rupture of Premature Rupture and answer pamphlets related to the topic; Membrane (verbal); Learners were
Membrane using their of Membrane Pictures and videos; Small asked what new information they have
own words. notebook and pen for note-taking obtained from the discussion
of the patient’s family (reflection); Learners were encouraged
to ask questions or clarifications about
the discussion (question & answer);
Topic: Proper management and care for Preterm Premature Rupture of Membrane (PPROM)
Goal: At the end of the 30 to 60 minutes of interactive discussion and activity, the patient and her family will be able to gain adequate knowledge and develop beginning skills about
the proper management and care for Preterm Premature Rupture of Membrane (PPROM).

At the end of heath teaching,
the patient and patient’s family
shall be able to:
1. Discuss the importance 1. Importance of proper 1. Lecture and 1. Relevant informational 1. Able to discuss the importance of
of providing proper management and care discussion; Question material such as brochure, providing proper management and care
management and care to and answer flyers, or pamphlet related to to the patient (verbal); Learners were
the patient. the topic; Pictures and videos; asked what new information they have
Small notebook and pen for obtained from the discussion
note taking of the patient’s (reflection); Learners were encouraged
family to ask questions or clarifications about
they have written (written)
2. State their importance 2. Importance of family 2. Lecture and 2. Relevant informational 2. Able to state their importance as the
as the patient’s family and guardian in the discussion; Question material such as brochure, patient’s family and guardian in the
and guardian in the patient’s health and answer flyers, or pamphlet related to patient’s overall health condition
patient’s overall health condition. the topic; Pictures and videos; (verbal); Learners were asked what new
condition. Small notebook and pen for information they have obtained from the
note taking of the patient’s discussion (reflection); Learners were
family encouraged to ask questions or
asked to read the notes they have written
(written)
3. Discuss and 3. Proper management 3. Lecture and 3. Relevant informational 3. Able to discuss and demonstrate the
demonstrate the proper and care for Preterm discussion with material such as brochures, proper management and care for Preterm
management and care Premature Rupture of demonstration; flyers, or pamphlets related to Premature Rupture of Membrane
for Preterm Premature Membrane with Question and the topic; Pictures, videos, appropriate for the patient (verbal &
Rupture of Membrane demonstration answer return demonstration demonstration); Learners were asked
appropriate for the what new information they have obtained
patient. from the discussion (reflection); Learners
were encouraged to ask questions or
(question & answer)
Topic: Basic Postpartum Care
Goal: At the end of the 30 to 60 minutes of interactive discussion, the patient and her family will be able to gain basic information knowledge and develop beginning skills about
basic postpartum care

the patient and patient’s family
shall be able to:
1. Discuss the basic 1. Postpartum care 1. Lecture and 1. Relevant informational 1. Able to discuss the basic Postpartum
Postpartum Care discussion; Question material such as brochure, Care (verbal); Learners were asked
and answer flyers, or pamphlet related to what new information they have
the topic; Pictures and videos; obtained from the discussion
Small notebook and pen for (reflection); Learners were encouraged
note taking of the patient’s to ask questions or clarifications about
family the discussion (question & answer);
2. State the importance of 2. Importance of 2. Lecture and 2. Relevant informational 2. Able to state the importance of
Postpartum Care postpartum care discussion; Question material such as brochure, Postpartum care (verbal); Learners were
and answer flyers, or pamphlet related to asked what new information they have
the topic; Pictures and videos; obtained from the discussion (reflection);
Small notebook and pen for Learners were encouraged to ask
note taking of the patient’s questions or clarifications about the
family discussion (question & answer); Learners
were asked to read the notes they have
written (written)
3. Discuss and 3. Postpartum wound 3. Lecture and 3. Relevant informational 3. Able to discuss and demonstrate proper
demonstrate postpartum care discussion with material such as brochures, postpartum wound care (demonstration);
wound care properly to demonstration; flyers, or pamphlets related to Learners were asked what new
avoid infection and Question and the topic; Pictures, videos, information they have obtained from the
promote proper healing answer return demonstration discussion (reflection); Learners were
encouraged to ask questions or
(question & answer)
Topic: Guidelines in proper development of the baby at home
Goal: At the end of the 30 to 60 minutes of interactive discussion and activity, the patient’s family will be able to gain adequate knowledge and develop beginning skills about the
guidelines in the proper development of the baby after discharge

the patient’s family shall be
able to:
1. Discuss the importance 1. Importance of 1. Lecture and 1. Relevant informational 1. Able to discuss the importance of
of providing proper nutrition and discussion with material such as brochures, providing proper nutrition to the baby
nutrition to the baby; breastfeeding to demonstration; flyers, or pamphlets related to (verbal) and demonstrate proper
Demonstrate proper newborns Question and the topic; Pictures and videos; breastfeeding (demonstration); Learners
breastfeeding answer Small notebook and pen for were asked what new information they
note-taking of the patient’s have obtained from the discussion
family; return demonstration (reflection); Learners were encouraged
to ask questions or clarifications about
2. Enumerate all the 2. Newborn 2. Lecture and 2. Relevant informational 2. Able to enumerate all the necessary
necessary vaccines of vaccinations and their discussion; Question material such as brochures, vaccines for newborns and discuss their
newborn and discuss importance and answer flyers, or pamphlets related to importance (verbal); Learners were asked
their importance the topic; Pictures and videos; what new information they have obtained
Small notebook and pen for from the discussion (reflection); Learners
note-taking of the patient’s were encouraged to ask questions or
family clarifications about the discussion
asked to read the notes they have written
(written)
3. Discuss the importance 3. Importance of regular 3. Lecture and 3. Relevant informational 3. Able to discuss the importance of regular
of regular check ups of check-ups discussion; Question material such as brochures, checkups of babies (verbal); Learners
babies. and answer flyers, or pamphlets related to were asked what new information they
the topic; Pictures and videos; have obtained from the discussion
Small notebook and pen for (reflection); Learners were encouraged to
note-taking of the patient’s ask questions or clarifications about the
family discussion (question & answer)
XI. Discharge Plan
Medication As ordered by the physician, continue home medications such as:
● Cefalexin
- Dosage: 500 mg
- Frequency: TID x 7 days for infection prophylaxis
● Mefenamic Acid
- Dosage: 500 mg
- Frequency: TID, PRN for pain
● Ferrous sulfate
- Dosage: 1 tab
- Frequency: OD
Exercise The patient can gradually resume her normal activities as regularly as before but vigorous
movements and exercises should be limited.
Recommended exercises for patient includes the following:
● Walking
- This can be done a few days after birth.
- It is beneficial for physical health but also boosts mental health. Walking can
also helps mother to enjoy nature and relax which can aid in reducing the risk
of postpartum depression
● Kegel Exercise
- Can be done at least 1 week after birth
- Strengthen your pelvic floor muscles
● Pelvic tilt exercise
- Can be done at least 1 week after birth
- Strengthen your abdominal muscles
● Diaphragmatic / Deep breathing
- Can be done a few days after birth.
- Helps in relaxation and reducing stress. This is also to improve core stability
and slow your rate of breathing.
● Postnatal Yoga (Happy baby pose and cat-cow stretch)
- Loosen tight pelvic floor muscles
- Support back muscles, strengthens the core, and promotes mobility in the
spine.
However there are few factors to be considered before starting postpartum exercises. These
are waiting for the bleeding to stop, evaluate the pelvic floor, and be mindful of the joints.
Remember to be aware and talk to the physician if there is any vaginal bleeding, abdominal
pain, sudden discomfort in your pelvic region.
Others:
● Short trips are allowed, and if long automobile rides are necessary, it is advised to
have stopovers and get out of the car at frequent intervals.
● Returning to work at six weeks can also be allowed
Treatment ● If there is postpartum swelling, elevate the feet when sitting or lying down and make
sure to drink a lot of fluids/water to help the body get rid of the excess fluid.
● Use only pads (no tampons) for the postpartum bleeding or lochia. Anything in the
vagina increases the risk for infection while your uterus is healing.
● If there is presence of hemorrhoids, use of witch hazel pads can reduce swelling and
are soothing; It can even be stored in the freezer and then placed right onto the
affected area.
● Take stool softeners (Metamucil) as directed or indicated by the physician.
● Wipe from front to back after every bowel movement.
● Getting adequate rest especially during her first weeks at home will do much to
prevent the possibility of delayed postpartum hemorrhage.
● Try to find time for your own needs, including recreation and social activities with
friends, family and your partner to prevent or help with postpartum blues.
● If will be breastfeeding do the following:
➢ Wear a loose bra 24 hours a day
➢ Wash the breasts with water and avoid using any soap for cleaning the breast.
➢ Air dry nipples after each feeding.
➢ If nipples are sore, apply a few drops of breast milk after a feeding and let air
dry.
➢ If breasts are engorged, apply warm packs and express milk
● If will not be breastfeeding do the following:
➢ Don't pump or remove milk from your breasts by hand
➢ Wear a bra that fits well and provides good support.
➢ Apply a cold pack to your breasts for 15 minutes at a time every hour as
needed.
➢ Avoid stimulation to the breast (pumping or hot showers).
➢ (Optional) Take ibuprofen such as Advil or Motrin to reduce pain and
swelling. Be safe with medicines. Read and follow all instructions on the label
Health Education Topics to be taught to the mother are the basic knowledge about Preterm Premature Rupture
of Membrane, postpartum care and lastly, is the proper breastfeeding.
1. Preterm Premature Rupture of Membrane:
a. Signs and Symptoms
■ Premature contractions
■ Sudden gush of fluid from your vagina.
■ Change in vaginal discharge or “bloody show”
■ Low back pain
b. Risk factors
■ Multiple gestation
■ Cervical incompetence
■ Uterine anomaly
■ Age of the mother (below 18 and above 35)
■ Stress
■ Substance abuse
■ Previous preterm birth
■ Exposure to diethylstilbestrol
■ Diabetic
■ Abruptio placenta
■ Placenta previa
■ Pre-eclampsia
■ Infection
■ Poor nutrition
■ Drug abusers
2. Postpartum Care:
a. Wound care
■ Apply ice packs in the first 24 hours.
■ Sit in a sitz bath for 20 minutes, three times a day.
■ Keep wound area clean after you pass urine or move your bowels by
rinsing the area gently with tap water from front to back and pat dry.
■ You can also use soft cotton balls soaked in Chlorhexidine liquid (a
gentle non-stinging antiseptic) to gently clean the area three times a
day for the first week.
■ Keep the area dry by changing your sanitary pads regularly especially
in the first week when the lochia is the heaviest.
3. Proper Development of the Baby:

A. Important Newborn Immunizations
a. Hepatitis B
■ Given immediately after the child is born to prevent hepatits b
infection that may damage the liver (Watson, 2020).
b. HIB (Haemophilus Influenzae type B) vaccine
■ Babies need four doses of HIB vaccine, at 2 months, 4 months, 6
months, and between 12 and 15 months to prevent infection in the
brain and spinal cord that can damage a baby's brain and hearing
(Watson, 2020).
c. Pneumococcal vaccine
■ The pneumococcal vaccine is recommended for all children between 2
and 23 months. The vaccine is administered at 2, 4, 6, and 12 months
and provides protection for 6 to 10 years (Pillitteri p.996, 2010).
d. Diphtheria, tetanus, pertussis (DTaP)
■ Babies need 3 shots of DTaP to build up high levels of protection
against diphtheria, tetanus, and whooping cough. Then, young children
need 2 booster shots to maintain that protection through early
childhood (CDC, 2020).
e. Rotavirus vaccine
■ The 1st dose should be administered at age 6 through 14 weeks to
prevent the infant from severe gastrointestinal disease that causes
diarrhea. Furthermore, vaccine is given at 2, 4 and 6 months. No doses
should be given after children are older than 32 weeks (Pillitteri p.995,
2010).
B. Common Breastfeeding Positions

a. Cradle Position
■ The cradle hold is the most common breastfeeding position.
■ The mum's arm supports the baby at the breast. The baby’s head is
cradled near her elbow, and her arm supports the infant along the back
and neck. The mother and baby should be chest to chest.
b. Cross Cradle Position
■ The cross-cradle position uses the opposite arm (to the cradle position)
to support the infant, with the back of the baby's head and neck being
held in the mother's hand. Her other hand is able to support and shape
the breast if required.
■ In this position the mum can guide the baby easily to the breast when
they are ready to latch on.
c. Clutch Position
■ The baby is positioned at the mother’s side, with their body and feet
tucked under the mum's arm. The baby’s head is held in the mum's
hand. The mum’s arm may also rest on a pillow with this hold.
■ This position may be advantageous for mums who have undergone a
cesarean section, since it places no or limited weight on the mum’s
chest and abdomen area.
■ It may also work for low-birth-weight babies or babies that have
trouble latching, since their head is fully supported.
d. Side lying position
■ The mum lies on her side and faces the baby. The baby's mouth is in
line with the nipple.
■ The mum may also use a pillow for back and neck support.
■ This position may also be advantageous for mums who have
undergone a cesarean section, since it places no or limited weight on
the mum’s chest and abdomen area.
C. The baby is correctly attached when:

■ breastfeeding feels comfortable, not painful.
■ your baby is sucking deeply and regularly (sometimes with short pauses), and
you can hear baby swallowing.
■ your baby takes the whole nipple and a large amount of the areola into their
mouth, more towards their chin than their nose.
■ your baby’s chin is pressed into your breast and their nose is clear or just
touching your breast.
■ your baby’s bottom lip is turned out over your breast (not sucked in).
■ your nipples stay in good condition, and don’t show any signs of damage.
■ your baby is draining your breast properly, so that it feels softer after a feed.
OPD Follow-up ● Encourage to make a postpartum checkup after 1 week.
● Educate the patient about the benefits of attending every follow up check up.
● Encourage the patient in voicing out concerns and questions about possible conditions
that she may be feeling or the baby’s.
● Encourage and educate the patient about the importance of completing the baby’s
immunization.
Diet
1. Foods to be encouraged while breastfeeding:
a. Protein-rich foods
b. Green leafy vegetables
c. Fruits
d. Whole grains
e. Fluids
2. Foods to be avoided while breastfeeding
a. Alcohol
b. Caffeine
c. Fishes that are high in mercury
d. Herbal supplements
e. Highly processed foods
Spiritual Continue as practiced.
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BSN 2 01 Grand Case PPROM

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A Clinical Case Study

Preterm Premature Rupture of Membranes

In Partial Fulfillment of the

Client’s Initial: Gender: Age: Date of Birth:

c. History of Present Illness

Name Relation Age Gender Occupation Educational Diseases/Disorder

F.D. Mother 64 Female Unemployed College Graduate PROM,

Type 2 Diabetes Mellitus

N.D. Father 67 Male Unemployed College Graduate Lung Cancer / Deceased

J.D. Sister 29 Female Working College Graduate N/A

S.D. Sister 27 Female Working College Graduate N/A

M.D. Sister 24 Female Working College Graduate N/A

R.B. Husband 35 Male Farm Manager College Graduate N/A

M.B. Daughter 6 Female N/A N/A N/A

F.B. Daughter 3 Female N/A N/A N/A

Theory Age Developmental Task Client Description Interpretation

Psychosexual 32 Genital Stage N/A Analysis:

Psychosocial 32 Intimacy vs Isolation N/A Analysis:

Cognitive 32 Formal Operational N/A Analysis:

Moral 32 Postconventional N/A Analysis:

Spiritual 32 Individual-Reflective N/A Analysis:

Duration: 3-5 days Associated Symptom: None

Obstetric History G3 T2 P0 A0 L2 M0 Type of Delivery: Normal Spontaneous

III. Physical Assessment

Signs of Distress: Obvious Signs of Illness(es):

Orientation: Level of Affect: Mood:

Quantity & Quality of Speech: Organization of thoughts:

Height: Weight: BMI:

Temperature: Pulse rate: Respiratory rate: Blood pressure: Oxygen saturation:

Changes in a pregnant woman's

Eyes The upper eyelid margin is Blurry vision is noted. Analysis:

Bulbar conjunctiva is clear,

The lower and upper palpebral

No swelling and redness over

The cornea is transparent,

The iris is round, flat, and

The optic disc should be

Four sets of arterioles and

The anterior chamber is

No foreign body is observed.

There is no swelling of the

Ears Ears are equal in size Ears are smooth. No Analysis:

Normally the auricle, tragus,

A small amount of odorless

The canal walls should be

The tympanic membrane

The uvula is a fleshly, solid

Neck Neck is symmetric, with the Slight enlargement of Analysis:

Spine Scapula are symmetric and Tenderness, pain and Analysis:

No adventitious sounds, such

Thorax/Lungs The anterior- posterior Patients respiratory rate Analysis:

Tymphany is detected over the Interpretation:

Cardiovascular/Heart The Apical impulse is The pulse rate of patient Analysis:

Resting Pulse rate (RR) varies

S1 corresponds with each

A distinct sound is heard in

Normally no sounds are heard.

Normally no murmurs are

Abdomen Abdomen is free of lesions or The patient’s abdomen Analysis:

Venous hum is not normally

The lower border of liver

The normal liver span at the