CENTRAL LUZON DOCTOR’S HOSPITAL

EDUCATIONAL INSTITUTION

San Pablo, Tarlac City

TITLE

GROUP MEMBER:

BUMATAY, Nicole Q.

CORTES, Kyle Michael C.

DOMAGAS, Jhona May T.

FAUSTINO, Gilliane Franzel B.

GERVACIO, Trine Nichole A.

HABON, Kate Audrey

INIGO, Kean Kate P.

LIBUNAO, Joshua L.

MENDOZA, Apple E.

PANGILINAN, Kia G.

STAPLES, Charles Nico M.

TUAZON, Jay Martin S.

VALIX, Elena A.

Maria Glenda Q. Cura RN, MSN

CLINICAL INSTRUCTOR
TABLE OF CONTENTS

I. Introduction

II. Objectives

A.Student Nurse Centered

III. Nursing Process

A.Data Base

a. Nursing Health History A

1. Demographic data

2. Chief complaint

3. History of present illness

4. Past medical history

5. Genogram

6. Review of system

b. Nursing Health History B.

1. General Description Of Client

2. Health Perception-Health Management Pattern

3. Nutritional-Metabolic Pattern

4. Elimination Pattern

5. Activity-Exercise Pattern

6. Sleep-Rest Pattern

7. Cognitive-Perceptual Pattern
 8. Self-Perception — Self-Concept Pattern

9. Role-Relationship Pattern

10. Sexuality-Reproductive Pattern

11. Coping-Stress Tolerance Pattern

12. Value-Belief Pattern

c. Physical Examination (Heading of the table - Body Parts, Normal Findings,

Actual Findings, and Analysis and Interpretation)

d. Laboratory Findings (Heading of the table - Date, Findings, Normal Values

and Analysis and Interpretation)

Sequence of laboratory tests: WBC, RBC, Hemoglobin Hematocrit Platelet

Count

e. Review of anatomy and physiology

f. Pathophysiology

B.NCP (Prioritization of problems)

A - irway

B - reathing

C - irculation

P - hysiologic needs

E - limination

R - est

S - exual

S - ocial

N - utrition

C.Drug Study

D.Medical Management
 E. Discharge Plan

IV. Evaluation

a. Narrative evaluation of the objectives

b. Patient Condition upon discharge

V. Recommendation

VI. References/Bibliography

TABLE OF CONTENTS

I. Introduction

“Birth is not only about making babies. Birth is about making

mothers...strong, competent, capable mothers who trust themselves and know

their inner strength." -Barbara Katz Rothman. From the start of pregnancy, a

woman is designed to be a mother who provides essential care to the offspring.

This includes proper nutrition, prenatal visit, and preparation for birth. A

woman needs to eat enough throughout pregnancy to support both her own

nutrition and to provide enough nutrients for the developing fetus. It is the

mother's responsibility to take care of herself and the baby all throughout the

pregnancy with the guidance of health care providers. Maternal care is

important to reduce risks and complications that may arise during labor and

delivery. As much as possible, physicians aim to deliver a safe and healthy

baby.
 Fertilization is the union of the sperm and the egg cell which takes

place in a woman's fallopian tube. After fertilization is completed, the zygote

moves toward the body of the uterus. The diploid zygote divides through

mitosis to become an embryo, which then grows into a fetus. Gestation is the

period of time between conception (fertilization) and birth. The baby develops

and grows during this time inside the mother's womb. Gestational age is the

common term used during pregnancy to describe how far along the pregnancy

is. From the start day of the woman's most recent normal menstrual cycle or

last menstrual period (LMP) to the present time, it is measured in completed

days or completed weeks. Usually, conception happens two weeks following

the last menstrual period.

On the other hand, pregnancy is the process in which a woman's body

and tissues go through a number of changes as a result of carrying or

producing a fetus. It consists of three trimesters. Each of the three trimesters of

pregnancy lasts for three months. A normal pregnancy lasts between 38 and

42 weeks. Premature birth refers to births that occur before 37 weeks.

Postmature babies are those born after 42 weeks of gestation. A urine

pregnancy test is used to confirm pregnancy. It is testing the human chorionic

gonadotropin (hCG) hormone in the blood and the urine. Babies can be born

naturally through a vaginal birth or surgically through a cesarean section. Both

approaches ultimately aim to protect the mother and child's health.

In certain situations, such as those involving a medical condition like

diabetes or high blood pressure, issues with the placenta, multiple pregnancies,

and cephalopelvic disproportion, a cesarean section can save the lives of both
 the mother and the infant. However, it might have negative effects on the

mother and the fetus. In the year 2021, the number of births registered in the

United States is 3, 664, 292 and 2, 486, 856 of those births occurred through

vaginal delivery and 1, 174, 545 occurred through CS delivery. According to

the National Center for Health Statistics, about 2-3 babies in the United States

are born via vaginal delivery which is the preferred method of delivery for

first pregnancies.

According to the National Nutrition Council 2023, in the Philippines,

vaginal birth is preferred by the majority of women. Aside from being less

expensive than a cesarean birth, it also has a variety of advantages for the

mother and the baby. It has several advantages, including a shorter hospital

stay and a quicker recovery. Newborns born through the birth canal are

exposed to good bacteria thus, the baby will receive beneficial bacteria that

will improve their immune system. Moreover, it leads to fewer complications

in future pregnancies. According to the Philippine Statistics Office, 19.5 % of

births in the Philippines 2022 are delivered via cesarean

II. Objectives

B.Student Nurse Centered

After the antenatal visit, the nurse student will able be:

1. Establish rapport with the patient to gain trust and cooperation that is vital for

the therapeutic nurse-patient interaction.

2. Gain knowledge and develop skills regarding patients’ health condition, the

procedure done and its treatment.

3. To identify the existing and potential health risks that might manifest during
 the process, will provide the basis for imparting a sustainable, reliable, and

certain nursing care plan.

4. Impart useful health teachings that are appropriate for the patient’s condition.

5. To evaluate the patient’s progress and maintenance of her health.

III. Nursing Process

A. Data Base

a. NURSING HEALTH HISTORY A

a. Introduction

Patient name: X

Age: 28

Gender: Female

Address: Tibagan

b. Chief Complaint:

The patient denied any pain while doing the interview.

c. History of present illness

The patient denied any presenting illnesses.

d. Past medical history

A. Pediatric and Adult Illness

Patient X is 28 years old and has experienced Chicken Pox in her childhood.

She added that in her current pregnancy she experienced measles at 3rd month

gestation.

B. Immunizations/ Tests

She denied any immunization and testing for Flu and Pneumonia but she

has completed the BCG, Pentavalent, OPV, IPV, Hepa B, MMR, Measles,
 PVC, and Tetanus.

C. Hospitalizations

She was admitted to the hospital when she was 7 years old because of a

Bacteria skin test.

D. Injuries and Transfusion

She denied a history of injuries and blood transfusion.

E. Obstetrics/ gynecologic History- GTPALM, G3, T2, P0, A0, L2, M0

Her first menstrual period was when she was grade 6 at the age of 12 years old and

she denied having irregular menstruation. When the patient was asked if she thinks

that her husband only does sexual intercourse with her, the patient said “May tiwala

ako sa asawa ko. Wala akong ibang katalik.” She has a G3T2P0A0L2M0, AOG of 28

weeks and a EDC of December 30, 2024. She denied having any pain in the body.

G. Medication

The patient said that she self medicated a biogesic last night (October 4, 2023)

because of her headache. She is currently taking medication for her pregnancy which

are the Calcium Ambical, 500mg taken per oral 2x a day and Multivitamins with iron.

H. Allergies
She has no history of any allergies.

7. Genogram

8. Review of system

General Description:

Weight loss: 67.5 kg

Night Sweats: (-)

Fatigue: (+)

Weakness: (-)

Anorexia: (-)

Skin:

Itch: (+)

Rash: (+)

Lesions: (-)

Bruising: (+)

Bleeding: (-)

Color Change: (-)

Eyes:

Pain: (-)

Diplopia: (-)

Glasses/Contact Lenses: (-)

Itch: (-)

Blurring: (-)

Vision Loss: (-)

 Excessive Tearing: (-)

Ears:

Earaches: (-)

Discharge: (-)

Tinnitus: (-)

Hearing Loss: (-)

Nose:

Obstruction: (-)

Epistaxis: (-)

Discharges: (-)

Note! *Cold last month (September)*

Throat and Mouth:

Sore Throats: (-)

Bleeding Gums: (+) (Hard bristled toothbrush)

Tooth Aches: (-) (Had one pulled tooth, 2015/2016)

Decay: (-)

Neck:

Swelling: (-)

Dysphagia: (-)

Hoarseness: (-)

Chest:

Cough: (-) (Last month, the patient drank lukewarm water, and

calamansi juice)

Wheeze: (-)

Breast: (-)
 Sputum: (-) (Last month, the patient has a minimal sputum)

Pain on respiration: (-)

Lumps: (-)

Pain: (-)

Bleeding: (-)

Hemoptysis: (-)

Dyspnea: Rest/Exertion: (+)

Discharge: (-)

CVS:

Chest pain: (-)

PND: (+) (When patient does house chores)

Palpitation: (-)

Orthopnea: (-)

Dyspnea on exertion: (+)

Edema: (-)

GIT:

Food tolerance: 10:00 am breakfast, 2:00 pm lunch, 8:00 pm snacks

Vomiting: (+) (Labor)

Constipation: (+) (Labor)

Heartburn: (-)

Pain: (-)

Change in BM: (-)

Nausea: (-)

Bloating: (-)

Melena: (-)
 Jaundice: (-)

Excessive Gas: (-)

GU:

Dysuria: (-)

Hematuria: (-)

Nocturia: (-) (Once, about 2 or 3 am)

Retention: (-)

Polyuria: (-)

Dribbling: (-)

Female: / Menarche: 12 year old LMP: March 23, 2023 Cycle: Normal

Extremities:

Joint pains: (-)

Edema: (-)

Varicose veins: (-)

Stiffness: (-)

Claudication: (-)

Deformities: (-)

Neuro:

Headaches Dizziness: (-)

Numbness Tingling: (-)

Memory Loss: (-)

Fainting: (-)

Paralysis: (-)

Paresis: (-)

Seizures: (-)
Mental Health Status:

Anxiety: (+)

Sexual Problems: (-)

Depression: (-)

Fears: (-)

Insomnia: (-)

g. Nursing Health History B.

13. General Description Of Client - The client

14. Health Perception-Health Management Pattern

15. Nutritional-Metabolic Pattern

16. Elimination Pattern

17. Activity-Exercise Pattern

18. Sleep-Rest Pattern

19. Cognitive-Perceptual Pattern

20. Self-Perception — Self-Concept Pattern

21. Role-Relationship Pattern

22. Sexuality-Reproductive Pattern

23. Coping-Stress Tolerance Pattern

24. Value-Belief Pattern

h. Physical Examination (Heading of the table - Body Parts, Normal

Findings, Actual Findings, and Analysis and Interpretation)

i. Laboratory Findings (Heading of the table - Date, Findings, Normal

Values and Analysis and Interpretation)

Sequence of laboratory tests: WBC, RBC, Hemoglobin Hematocrit Platelet

Count
j. Review of anatomy and physiology

Anatomy

The female reproductive system consists of the primary as well as accessory

sex organs. It is framed to perform different functions. Aside from allowing a person

to have sexual intercourse, it creates egg cells that are essential for reproduction

known as ova. The system is organized to deliver the ova to the region of fertilization.

Apart from the above-mentioned functions, the female reproductive system is

also involved in the production of female sex hormones to maintain the reproductive

cycle. The ovaries produce hormones predominantly estrogen, progesterone and

prostaglandin.

The female reproductive system is composed of a pair of ovaries along with

oviducts, vagina, cervix, uterus, and the external genitalia that are located in the

pelvic region. These parts along with a pair of mammary glands that are integrated

both functionally and structurally also support the process of ovulation, fertilization,

birth and finally the child care.

The main parts of the vulva or external genitals are the labia majora, which

enclose and protect the other external reproductive organs, the labia minora that

surround the opening to the vagina and urethra, the clitoris, which is the pleasure

center of the vulva, the vaginal opening that allows menstrual blood and babies to exit

the body, hymen which is a piece of tissue covering or surrounding part of the vaginal

opening, and the opening to the urethra.

The internal parts includes:

The vagina is a muscular and elastic tube (approximately 10 cm long) that

connects the cervix to the external body. It functions as the receptacle for the penis in
sexual intercourse and delivers sperm to the fallopian tubes and uterus. It also acts as

a birth canal by expanding to allow delivery of the fetus during childbirth.

The cervix is a small canal that connects the uterus and vagina. It allows fluids

to leave and enter your uterus. It's also a powerful gatekeeper that can open and close

in ways that make pregnancy and childbirth possible

The endometrium is the tissue that lines the uterus, or womb—the pear-shaped

organ that houses a fetus. This mucous membrane thickens in anticipation of a

possible pregnancy.

The ovaries are small, oval-shaped glands that are located on either side of

your uterus. Your ovaries produce eggs and hormones.

The fimbriae of the uterine tube, also known as fimbriae tubae, are small,

fingerlike projections connected to the end of the fallopian tubes, closest to the

ovaries through which eggs move from the ovaries to the uterus.

The fallopian tubes are a pair of muscular tubes and funnel-shaped structures,

extending from the right and left of the superior corners of the uterus to the edge of

the ovaries.

The uterus is also called the womb. It is a muscular, inverted pear-shaped

organ of the female reproductive system. The walls of the uterus consist of three

layers- the inner glandular layer, the middle thick layer, and the outer thin layer.

Physiology

Fertilization

Fertilization occurs when a sperm fuses with the female during intercourse and

further forms an egg that gets implanted in the uterus of the female. The sperm travels

through the fallopian tube and penetrates the zona pellucida layer of the ovum (female
egg) and fuses with it which forms zygote (fertilized egg). Thousands of sperms are

produced in male body to compensate for the ones unfit and non-motile ones. Once

the zygote is formed, it gets implanted in the uterus and further growth takes place

when cells start dividing and forming tissues and tissues form organs which results in

information of an organ system, ultimately turning into an organism.

There are many steps involved in the whole process of fertilization, right from

the capacitation of sperm to zona reaction and post-fertilization events.

● Sperm Capacitation – it literally translates to the preparation of sperm for

fertilization. The sperm becomes hyperactive, and its motility increases.

● Sperm-Zona Pellucida Binding– this is the next step if the sperm finds an

ovum. Sperm binds with the zona pellucida layer of an ovum and a receptor-

ligand reaction occurs.

● Penetration of Zona Pellucida– the shape of sperm’s head helps in cutting

through the layers of ovum. It further activates growth of ovum which is

arrested at one stage of meiosis which only resumes after the egg gets

fertilized.

● Acrosome Reaction– the head of sperm (acrosome) contains various zona

pellucida digesting enzymes which help it in deeper penetration into the layers

of ovum. The head of sperm diminishes with deeper penetration. It is crucial

for sperm to retain its acrosomal content before it fertilizes the ovum.

● Cortical Reaction– egg activation takes place at this stage as the egg is

previously frozen at metaphase stage in meiotic division II. A rapid

development of the ovum takes place and cortical granules fuse with zona

pellucida along with exocytosis.

● Zona Reaction – the zona pellucida layer hardens, and this completes the
 process of fertilization.

1. Pre-embryonic

The pre-embryonic period, known as the germinal phase, is the first and

shortest phase of embryonic development. It lasts from fertilization to the second

week of the embryo’s life.

First Week

Immediately after penetration of the ovum, the chromosomal material of the

ovum and spermatozoon fuse to form a zygote. After fertilization (around 24 hours

after fertilization), zygote migrates towards the body of the uterus and begins a

process of dividing by mitosis in a process called cleavage.

It divides until it reaches 16 cells. It is now referred to as a morula. As the

morula floats freely within the uterus, it starts to bring nutrients into the cells.

The morula fills with fluid and the cells inside start to form two separate

groups. At this stage it is now a blastocyst. The inner layer of cells is called the

embryoblast, and will become the fetus. The outer layer is called a trophoblast, which

will develop into part of the placenta.

The trophoblast attaches to the endometrial epithelium and begins the process

of implantation. The attached portion of the trophoblast develops into two layers: the

internal cellular layer is called the cytotrophoblast and the outer layer is called the

syncytiotrophoblast, which invades the endometrial epithelium by the end of the 7th

day.

Second Week

The blastocyst preserves itself by secreting Human chorionic gonadotropin

(hCG), a hormone that indirectly stops menstruation. The trophoblast cells secrete
hCG hormones that help maintain the corpus luteum, which would normally regress.

The fetal life support system and the placenta begin to form, and eventually the

placenta will take over the job of producing progesterone.

The inner cell mass differentiates into two cell layers; the endoderm (the

inside of the embryo) and the ectoderm (the outside of the embryo).

The amniotic cavity appears as a space between the inner cell mass and the

trophoblast. When the embryo becomes a cylinder, the amnion surrounds it and forms

the amniotic sac.

By the end of the second week, the embryonic cells and the amniotic and yolk

sacs are attached to the chorionic sac by a slender band, which becomes the umbilical

cord.

2. Embryonic

The beginning of the third week after conception marks the start of the

embryonic period, a time when the mass of cells becomes distinct as a human.

As the third week of development begins, the two-layered disc of cells

becomes a three-layered disc through the process of gastrulation. The embryo, which

takes the shape of an oval-shaped disc, forms an indentation called the primitive

streak along the dorsal surface of the epiblast. A node at the caudal or “tail” end of the

primitive streak emits growth factors that direct cells to multiply and migrate.

The first layer is the endoderm, a sheet of cells that displaces the hypoblast

and lies adjacent to the yolk sac. The second layer of cells fills in as the middle layer,

or mesoderm. The cells of the epiblast that remain (not having migrated through the

primitive streak) become the ectoderm. Lastly, the ectoderm gives rise to cell lineages

that differentiate to become the central and peripheral nervous systems, sensory

organs, epidermis, hair, and nails. Mesodermal cells ultimately become the skeleton,
muscles, connective tissue, heart, blood vessels, and kidneys. The endoderm goes on

to form the epithelial lining of the gastrointestinal tract, liver, and pancreas, as well as

the lungs.

3. Fetal

Once cell differentiation is mostly complete, the embryo enters the next stage

and becomes known as a fetus. The fetal period of prenatal development marks more

important changes in the brain. This period of development begins during the eighth

week and lasts until birth.

The early body systems and structures established in the embryonic stage

continue to develop. The neural tube develops into the brain and spinal cord and

neurons continue to form. Once these neurons have formed, they begin to migrate to

their correct locations. Synapses, or the connections between neurons, also begin to

develop.

k. Pathophysiology
k.1 Ovarian Changes
 The developing syncytiotrophoblast cells of the placenta release beta human

chorionic gonadotropin (beta-hCG) hormone which stimulates the corpus luteum of

the ovaries to release estrogen and progesterone. The corpus luteum releases these

hormones until 12 weeks of pregnancy. The increased estrogen and progesterone

stimulates the pituitary gland which inhibits the follicle stimulating hormone (FSH)

and luteinizing hormone (LH) which inhibits ovulation of the mother.

F. NCP (Prioritization of problems)

CUES

Subjective Risk for

cues: nutritional Short Independent: Independent
imbalanced term: :
as
evidenced
“Hindi po by the -Emphasize
ako verbalizatio -After 1 importance of - For
kumakain n of the hour of the well-balanced Comprehens
ng tatlong patient nursing nutritious ive
beses sa interventio intake. improvemen
isang araw n the ts in the
dahil takot patient will nutritional
po ako nab be able to -Develop and health
aka lumaki verbalized consistent, status of
o tumaba the realistic women
yung bata” importance weight goal before and
as of nutrition with client. during
verbalized to their pregnancy
by the body.
patient.
-Weight at
regular -Reduce the
Long term: intervals and risk of
Objective document pregnancy
cues: results. and birth
complication
Vital signs -After 1-2 s as well as
days of the to minimise
BP:110/70 nursing Dependent:
the risk of
interventio obesity
TEMP: n, the development
35.5 patient will and
-Consult with
be able to dietitian or metabolic
PR:108 demonstrat nutritional diseases such
BPM e lifestyle support as as type 2
changes to necessary diabetes in
RR:24 regain and
BPM the long
maintain term
adequate
WEIGHT:
nutritional
67.5 KG
status.
HEIGHT: 154 -To monitor
CM the
improvemen
As t of the
evidenced patient’s
by weight.
increased
body
weight.
-To provide
extensive
support to
pregnant
women and
to promote a
healthy
dietary
 intake

G. Drug Study

H. Medical Management

I. Discharge Plan

VII. Evaluation

c. Narrative evaluation of the objectives

d. Patient Condition upon discharge

VIII. Recommendation

IX. References/Bibliography
F. PATHOPHYSIOLOGY

PICTURE NG BUONG PATHO

 Figure 2

Decrease in Estrogen will trigger menstruation then the Hypothalamus will

release GnRH to the Anterior Pituitary Gland so that Follicle Stimulating Hormone

and Luteinizing Hormone will take place. For the first phase or the proliferative

phase, the negative feedback mechanism will work so that the estrogen will increase

and beyond its normal level. Then, the FSH will increase the follicular fluid which

will initiate the rupture of Graafian Follicles, therefore the ovum will then travel to

the fallopian tube. After the first phase, the secretory phase will now proceed, where

the Luteinizing hormone will produce Corpus Luteum which will release the

Progesterone. Progesterone will maintain the endometrial lining. The corpus luteum

will become a corpus albicans after 10 days if the ovum is not fertilized, but if it is

fertilized, it will remain until the 16th week.

 Figure 3.

One of the effects of Progesterone is it relaxes the muscles, therefore if the

muscles are relaxed, vasodilation is possible. There will also be an increase in

estrogen, which is a hormone responsible for our secondary characteristics. And if

there is an increased level of estrogen, reproductive organs of the pregnant woman

will increase in size, specifically the uterus so that the fetus can be accomodated.
 Figure 4.

Due to increase in Progesterone, the muscles will be relaxed, including the

gastroesophageal sphincter. Therefore, if gastric juices in the stomach activates, the

spinchter will not be able to completely hold it which will result in reflux, and this is

the reason why vomiting is present in pregnant women.

 NURSING CARE PLAN

CUES NURSING PROBLEM NURSING EVALUATION/

DIAGNOSIS STATEMENT INTERVENTION RATIONALE EXPECTED

(GOAL) OUTCOME

Subjective: Short term: Independent: Short term:

After 4 hours - Provide

“Hindi ako Disturbed the patient will information at the To assess a After 4 hours the

satisfied (sa body image be able to client’s level of client's current patient was able

katawan ko)” related to verbalized or acceptance and in level of to verbalized or

as verbalized obesity as express feelings small segments to adaptation and express feelings

by the patient. evidenced by about self and allow easier progress. about self and

perceived acknowledged assimilation. acknowledged

change in changes in the Clarify changes in the

body body misconceptions. To evaluate the body

Objective: appearance need for
Reinforce

explanations given counseling

Vital Signs Long term:
Long term: by other health and/or
BP: 110/70 After 3 days the
After 3 days the team members. medications.
mmHg patient was able
patient will
Temp: 35.5 °C to demonstrate
demonstrate - Assist the client in
enhanced body
PR: 108 bpm enhanced body incorporating the image and self-

RR: 24 cpm image and self- therapeutic regimen esteem

esteem into activities of

Height: 154 daily living.

cm as evidenced by as evidenced by

Weight: 67.5 ability to talk Collaborative: ability to talk

kg about and care Begin counseling about and care for

BMI: 28.46 for actual or or other therapies actual or

perceived (specific exercises) perceived altered

altered body body appearance

appearance

CUES NURSING PROBLEM NURSING EVALUATION/

DIAGNOSIS STATEMEN INTERVENTION RATIONALE EXPECTED

T OUTCOME

(GOAL)

Subjective Risk for short term: Independent: Independent: Short term:

cues: nutritional
imbalanced as
evidenced by
-After 1 hour -Emphasize - For -After 1 hour of
the
“Hindi po of the nursing importance of well- Comprehensive the nursing
verbalization
ako intervention balanced nutritious improvements intervention the
of the patient
kumakain ng the patient intake. in the patient was able to
tatlong beses will be able to nutritional and verbalized the
sa isang araw verbalized the health status of importance of
dahil takot po importance of women before nutrition to their
nutrition to -Develop consistent, and during body.
ako nab aka
lumaki o their body. realistic weight goal pregnancy
tumaba yung with client.
bata” as Long term:
verbalized by
the patient. Long term: -Reduce the risk
-Weight at regular of pregnancy
intervals and and birth -After 1-2 days of
document results. complications the nursing
Objective -After 1-2 as well as to intervention, the
cues: days of the minimize the patient was able to
nursing risk of obesity demonstrate
Vital signs intervention, Dependent: development lifestyle changes
the patient and metabolic to regain and
BP:110/70 will be able to diseases such as maintain adequate
mmHg demonstrate type 2 diabetes nutritional status.
lifestyle -Consult with
dietitian or in the long term
TEMP: 35.5 changes to
regain and nutritional support
-To monitor the
PR:108 BPM maintain as necessary As evidenced by
improvement of
adequate the patient’s increased body
RR:24 BPM nutritional weight.
weight.
status.
WEIGHT:
67.5 KG As evidenced
by increased -To provide
HEIGHT:
body weight. extensive
154 CM
support to
pregnant
women and to
promote a
healthy dietary
intake

Medical Management

Calcium Ambical (500g) is taken every morning and evening, as verbalized

by the patient. Calcium is essential for bone formation, muscle contraction, and
enzyme and hormone functioning. Getting enough calcium included in the diet is
especially important during the last three months of pregnancy, when the baby is
overgrowing and has the greatest need for calcium as it helps in the development of
bones and teeth, and boosts muscles, heart, and nerve development as well. Calcium
is regulated to meet the demands of the developing fetus for skeletal mineralization
and growth.

● Recommended Dietary Intake (WHO)

- 1200mg a day for pregnant women.
- For people who are pregnant and over the age of 18 years, the RDA is
1000mg a day.
- For people who are pregnant and are ages 14 to 18 years old, the RDA
of Calcium Intake is 1300mg a day.

● Duration
- From 20 weeks gestation until the end of pregnancy.

When taken by mouth: Calcium is likely safe when used in recommended amounts of
about 1000-1200 mg daily. Calcium can cause some minor side effects such as
belching or gas. However, calcium is possibly unsafe when taken in doses above the
daily tolerable upper intake level (UL). The UL is 2500 mg for adults ages 19-50
years and 2000 mg for adults over 50 years. Taking more than this daily can increase
the chance of having serious side effects.

Pregnancy and breastfeeding: Calcium is likely safe when taken by mouth in

recommended amounts. However, calcium is possibly unsafe when taken by mouth in
doses above the daily tolerable upper intake level (UL). Higher doses might increase
the risk of seizures in the infant. Be sure to consider total calcium intake from both
dietary and supplemental sources of calcium. Avoid taking more than 1000-1200 mg
of calcium from supplements daily unless prescribed by your doctor.