OBSTETRICAL CASE SCENARIOS 1ST SEMESTER A.Y.

2021-2022
Mrs. E, a 30 years old housewife with 56 kilos in weight and lives in Maharlika Hiway, Bitas, Cabanatuan City with
her family. She’s a Seventh Day Adventist since birth, and admitted in ER @ September 9, 2021 8:00 in the morning
initially for herself with complaints of easy fatigability since 2 months PTC. G3P2L2A0 comes with 8 months of
amenorrhea.
HISTORY OF PRESENTING COMPLAINTS:

 Patient presents with 8 months of amenorrhea with easy fatigability since 2 months, Previously, the patient
was able to do her household work, but for the past 2 months, she gets tired even with minimal work. On
walking about 50 m, patient complains of fatigability, dizziness, blurring of vision which is relieved on rest.
 No history of increased bleeding during menses prior to pregnancy.
 No history of exertional dyspnea, palpitation, pedal edema or dizziness.
 No history of bleeding or leaking of BOW
 No history of passing worms in the stools.
 No history of fever with chills and burning micturition.
 No history of cough with expectoration, hemoptysis, evening rise of temperature or contact with a known
case of tuberculosis.
 No history of drug intake (anti-malarial drugs or aspirin).
 No history of any yellowish discoloration of skin and sclera.
 Not a known diabetic or hypertensive.
OBSTETRIC HISTORY:

 Married life 13 years

 Obstetric Index- G3P2L2A0
No. DELIVERY BABY AT BIRTH PRESEN COMMENTS
T AGE
G1 NSVD, Cried soon after birth, 12 years Registered and
ELJMH Male , 3.2 kg, breast immunized (had 3
fed for 3 years ante-natal clinic
visits, TT vaccine, and
Iron –Vitamin A)
Post-partum period-
normal
G2 NSVD, Baby cried soon after 10 years Registered and
ELJMH birth, Female , 3 kg, immunized (had 3
breast fed for 2 1/2 ante-natal clinic
years visits, TT vaccine, and
Iron –Vitamin A )
Post-partum period-
normal

PRESENT PREGNANCY:

 T1
 No history of nausea, vomiting or weakness.
 No urinary symptoms
 No drug intake
 No history of craving for abnormal food (pica)
 T2
 Quickening in 5th month
 1st Ante-partum clinic visit-20 weeks, given TT & Iron –Vitamin A tablets (consumed)
 T3
 Fetal movements present
 No leak or bleed from vagina
 No history of pain in the abdomen
CONTRACEPTIVE HISTORY:
No history of using any contraceptive methods.
MENSTRUAL HISTORY:
Age of Menarche- 13 years
Past Cycles-Regular 30 days’ cycles with flow lasting 5 days, normal quantity, no pain or passing of clots.
LMP- January 2, 2021
FAMILY HISTORY:
No history of congenital anomalies or twinning, DM, HTN
PAST HISTORY:
No history of Tuberculosis, Epilepsy, Asthma
No history suggestive of any cardiac ailments.
No history of previous surgeries, blood transfusions.
PERSONAL HISTORY:
Diet- mixed with fish and vegetables
Appetite-good
Sleep- sound
Bowel and Bladder-Regular
Habits- Nil
DIET HISTORY:
Consumes- 2100 kcal/day
Required- 2400 kcal/day
Deficit- 300 kcal/day
GENERAL PHYSICAL EXAMINATION:
Here is a pregnant lady 30-year-old, moderately built and nourished, conscious, alert and cooperative.
Pulse - 84/min, regular, good volume
BP - 110/68 mmHg
RR - 14/min, regular
Temperature - patient is afebrile 36.5˚C/ax
Pallor - present
Icterus - absent
Cyanosis - absent
Clubbing - absent
Edema - absent
Lymphadenopathy - absent
Thyroid - normal
Breasts - normal
Spine - normal

Height - 146 cm
Weight - 56 kg

OBSTERIC EXAMINATION:
INSPECTION:
 Abdomen is uniformly distended, globular in shape
 Umbilicus everted, hernia orifices normal
 Flanks do not appear to be full
 Striae gravidarum and linea nigra present
 No scars over the abdomen
PALPATION:
 Abdominal circumference – 76 cm
 Symphysio-fundal height - 28 cm (corresponds to 32 weeks)
 FUNDAL GRIP - soft, broad and non- ballotable, suggestive of breech
 LATERAL GRIP- Knob like structures on the right side suggestive of limb buds, uniform resistance on the
left side
 1st PELVIC GRIP- Smooth, hard, ballotable mass suggestive of head
 2nd PELVIC GRIP- Fingers converge, head not engaged.
  Uterus is relaxed
AUSCULTATION:
 Fetal Heart sounds heard along the left spino-umbilical line
 142/min, regular, rhythmic
DIAGNOSIS:
30-year-old G3P2 L2A0 with 32 weeks of gestation, moderate anemia probably due to iron deficiency, not in labor
with no clinical signs of failure

OBSTETRICIAN IN ER TREATMENT ORDER:

 To start IVF of D5W 1L x 8 hrs. then followed with another bottle on same rate- 1st bottle
 Monitor and record v/s and FHB q hourly, and I & O every shift
 For routine CBC, APC, U/A, F/A, and Na, K, Cl – blood specimen was requested and extracted by the Med
Tech in Lab to follow up result.
 2 ampules of Vitamin C 500 mg incorporated to the present IVF and another 2 amps for the IVF to follow
regulated at same rate
 Oral Medication of FeSO4 i cap BID
 Diet: 2700 Kcal/day

CASE SCENARIO -1
Mrs. E, was brought to OB-Gyne Ward from ER per wheel chair at 9:00 am with an IVF of D5W iL + 2 amps. Vitamin C
on @ 900 cc level and regulated for 8 hours. Since she was not in labor, she occupied one of the bed in Gyne Section.
Admission care was rendered by the staff nurse on duty. After giving care, the nurse started to arranged the chart of the
patient and filled up the Nursing Care Plan Form for the Kardex of the patient.

Activity:
Using the NCP form of ELJMH, fill up Mrs. E Kardex.

Reflection:
1. In 250 words, write the learning insights in this activity.
2. What are the care rendered to a newly admitted patient like Mrs. E?
3. Identify difficulties that may delay in rendering this care

CASE SCENARIO -2
From the initial vital signs of Mrs. E in ER, it was taken again in the Ward when she arrives @ 9:00 am that reveals as
follows;
Temperature is 36.8 ˚C/ax; Pulse Rate of 85 beats per minute; Respiration Rate of 18 breaths per minute, and Blood
Pressure of 110/70mmHg. Since it was ordered to monitor and record, after an hour the readings are as follows;
Temperature is 37 ˚C/ax; Pulse Rate of 86 beats per minute; Respiration Rate of 18 breaths per minute, and Blood
Pressure of 110/70mmHg.
Activity:
Using the Vital Signs Record, graph the following vital signs taken.
Reflection:
1. In 250 words, what learning insights have you gain in this activity?
2. What are the special consideration in taking vital signs?
3. Identify the difficulties encountered that may delay in rendering this procedure.

CASE SCENARIO -3
When Mrs. E, arrives in the Ward @ 9:00 am, she has an IVF of 1 liter of D5W + 2 ampules of Vitamin C on @ 900 cc
level to run for 8 hours.

Activity:
Show the computation of the IVF regulation using the drop factor of 20 gtts/cc. What will be the rate of flow in gtts/min
using ratio and proportion?
a. cc/H
b. cc/min
c. gtts/min
 d. mgtts/min

Reflection:
1. In 250 words, state learning insights in this activity.
2. What are the important things that needs to watch closely in the IVF of Mrs. E?
3. What difficulties have you encountered in this procedure.

CASE SCENARIO -4
Patient Mrs. E, Intake and Output was also ordered to monitor and record every shift.
Activity:
Using the Intake and Output Chart, fill up this record of the patient.
Reflection:
1. In 250, words, what learning insights have you gain in this activity?
2. What are the data that needs to be record and how can you perform this?
3. What difficulties encountered while performing this task?

FORMS THAT MAY USE:

NURSING CARE PLAN-KARDEX

NAME OF PATIENT: _______________________________________ AGE/SEX: ____________ PATIENT #: ______________

ADDRESS: __________________________________________________ RELIGION: ___________________________________

DIAGNOSIS: _________________________________________________ DATE/TIME ADMITTED: _____________________

OPERATION: _______________________________________________________________ DATE: _______________________

NURSING CARE PROBLEM APPROACH LABORATORY DATE

Diet

Liquid

Privileges

Date Order Oral Medications Date D/C Date Order Injections/Parenteral Date D/C
 CLINICAL REFERRAL SLIP
(EMERGENCY ROOM)

NAME : ___________________________________________________ AGE: ___________________

ADDRESS : ____________________________________________________________________________
REFERRED TO : ______________________________________________________________________

BRIEF HISTORY:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

MEDICATION GIVEN :
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

LABORATORY:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
REASON FOR REFERRAL:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

______________________________
(REFERRING LEVEL)
INTAKE AND OUTPUT CHART

PATIENT ___________________________ WARD________________ BED NO: ____________ TIME:________ to _________

TIME ORAL IV SIGNATURE GASTRIC URINE STOOL VOMITUS OTHERS SIGNATURE

7-8

8-9
9-10

10-11
11-12

12-1
1-2

2-3

8 hrs.
Total
3-4

4-5
5-6

6-7
7-8

8-9
9-10

10-11

8 hrs.
Total
11-12

12-1
1-2

2-3
3-4

4-5
5-6

6-7

8 hrs.
Total

24
hrs.
 Total

TOTAL INTAKE :______________________________________ TOTAL OUTPUT: ___________________________________

BY: __________________________________________________ TIME: ___________________ DATE: ____________________