SYSTEMS PLUS COLLEGE FOUNDATION

MacArthur Highway, Balibago, Angeles City

COLLEGE OF NURSING

CASE STUDY

in

MATERNITY WARD

(Institution/ Area)

In partial Fulfillment of the Requirements

In the Nursing Care Management 109 – RLE

Submitted by:

GROUP 4 - NURO4B

Castro, Maruella

Cordero, Julia

Crabajales, Gerylle

Cunan, Nicole Jewel

Cunanan, Frances Andrea

David, Charisse Luigi

Dayrit, Gil Matthew B.

Escobar, Myrna

Ganaban, Andrew

Gomez, Kadelyn

Oliver, Verhuegen

Submitted to:

Prof. Kelvin H. Panganiban, RN

Clinical Instructor, NCM 109 -RLE

April 22, 2024

Date
 Case Scenario:

On March 25, 2024, a 26-year-old female patient, pregnant with a male fetus at 36 weeks and 2

days AOG, was admitted to the maternity unit. The fetus was in a cephalic position, with the

placenta located anteriorly. Due to the patient's medical history, including hypothyroidism,

diabetes, Tourette syndrome, and a history of hypertension, her attending physician

recommended a cesarean delivery over a normal spontaneous delivery (NSD) due to concerns

about her ability to handle the stress of labor.

The patient's laboratory results indicated normal levels for most parameters, including

hemoglobin (HGB), hematocrit (HCT), red blood cell (RBC) count, mean corpuscular volume

(MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration

(MCHC), white blood cell (WBC) count, neutrophils, lymphocytes, eosinophils, and platelet

count. However, her monocyte levels were slightly elevated, suggesting a possible mild infection

or inflammation.

Given the patient's medical history and the recommendation of her physician, the cesarean

delivery proceeded as planned to ensure the safety of both the mother and the baby.

I. INTRODUCTION

Brief description of the diseases:

In this case scenario, the patient's medical history presents an intricate relationship of

various conditions, each of which can influence pregnancy and childbirth. Hypothyroidism, a

condition where the thyroid gland does not produce enough thyroid hormone, can impact fertility

and increase the risk of complications during pregnancy, such as preeclampsia and premature

birth. Diabetes, particularly if uncontrolled, can lead to complications for both the mother and the

fetus, including macrosomia (large birth weight), birth defects, and an increased risk of cesarean

delivery. Tourette syndrome, characterized by involuntary movements and vocalizations (tics),

may not directly affect pregnancy but can add to the overall health challenges the patient faces,

potentially exacerbating stress and complicating management. Hypertension, or high blood

pressure, poses significant risks during pregnancy, including preeclampsia, eclampsia, placental

abruption, and preterm birth, all of which necessitate careful monitoring and management to
safeguard the health of both mother and baby. Together, these conditions create a complex

medical background that requires specialized care and consideration in determining the safest

approach to childbirth. Hypertension, often known as high blood pressure, offers substantial

dangers during pregnancy, including preeclampsia, eclampsia, placental abruption, and

premature delivery, all of which require careful monitoring and control to ensure the health of

both mother and baby. Together, these disorders constitute a complicated medical backdrop

that need expert care and thought while deciding the safest method to birthing.

Current trends about the disease condition

Current illness trends, including hypothyroidism, diabetes, Tourette syndrome, and

hypertension, reflect increased knowledge and understanding of these disorders, as well as

breakthroughs in diagnosis, management, and therapy.

Hypothyroidism, which is defined by an underactive thyroid gland, has become more

common as a result of improved screening technologies and increased awareness of its

symptoms. With more people being diagnosed, there is a greater emphasis on regulating thyroid

hormone levels through medicine and lifestyle changes in order to reduce symptoms and avoid

consequences. Diabetes, both type 1 and type 2, is a global health concern, with growing

incidence rates due to factors such as sedentary lifestyles, poor diets, and obesity. Current

trends emphasize early diagnosis through screening programs and focused therapies that

include lifestyle changes, glucose monitoring, and medication management in order to improve

glycemic control and lower the risk of consequences including cardiovascular disease and

neuropathy. Tourette syndrome, a neurological illness defined by recurrent, involuntary

movements and vocalizations known as tics, has received more attention in recent years.

Advances in study have led to a greater knowledge of its underlying processes, which include

genetic and environmental influences. To enhance persons' quality of life, current management

trends stress a multidisciplinary approach that includes behavioral therapy, pharmaceuticals,

and support services. High blood pressure, often known as hypertension, is still a prominent risk

factor for cardiovascular disease, stroke, and other health consequences across the world.

Recent developments emphasize the need of early diagnosis through frequent blood pressure

monitoring and lifestyle adjustments including diet, exercise, and stress management.
Pharmacological therapies are also used to manage blood pressure and lower the risk of

problems.

Overall, recent trends in these illness conditions highlight the necessity of early

identification, tailored management techniques, and holistic care strategies in improving

outcomes and quality of life for those affected by these disorders.

Reasons for choosing such case presentation

In selecting the disease conditions for this case presentation, several interconnected

factors were considered to provide a comprehensive understanding of the patient's medical

background and the decision-making process regarding her pregnancy. Hypothyroidism, a

condition where the thyroid gland doesn't produce enough thyroid hormone, can complicate

pregnancy by increasing the risk of miscarriage, premature birth, and preeclampsia. Diabetes,

particularly if uncontrolled, poses significant risks during pregnancy, including macrosomia (large

birth weight), birth defects, and complications during delivery. Tourette syndrome, characterized

by involuntary movements and vocalizations, can present challenges during labor due to

potential exacerbation of symptoms under stress. Furthermore, hypertension, a condition of high

blood pressure, can lead to complications such as preeclampsia, eclampsia, and placental

abruption, posing serious threats to both maternal and fetal health. Considering these

interconnected conditions, the decision to opt for a cesarean delivery over a normal spontaneous

delivery (NSD) was prudent, aiming to mitigate potential risks associated with the stress of labor

and ensure the safety of both the mother and the baby.

Objectives:

1. Nurse-Centered

The nurse-centered objective is to offer comprehensive and tailored care to protect the

health of both the mother and the baby during the cesarean delivery procedure:

• Emphasize a full pre-operative examination, taking into account the patient's

complicated medical history, which includes hypothyroidism, diabetes, Tourette

syndrome, and hypertension.

 • Close monitoring of vital signs, including as blood pressure and blood glucose levels,

is critical for detecting and treating any issues early on.

• Work closely with the healthcare team to ensure that the patient's conditions are

optimally managed throughout the perioperative period, such as keeping thyroid

hormone levels within the target range and efficiently regulating blood sugar levels.

• Offer emotional support and information to the patient and her family, addressing any

questions or anxiety they may have about the cesarean birth.

• Following the surgery, post-operative treatment should focus on pain management,

wound healing, and monitoring for symptoms of infection or inflammation, given the

patient's slightly raised monocyte levels in the laboratory results.

2. Client-Centered

• Guarantee the health and safety of the 26-year-old pregnant mother and her unborn

child, who are presently 36 weeks and 2 days gestation. With a focus on the patient's

particular medical history, which includes hypothyroidism, diabetes, Tourette

syndrome, and hypertension, our goal is to provide individualized therapy that is suited

to her specific requirements and circumstances.

• Given her attending physician's advice for a cesarean birth over a normal spontaneous

delivery (NSD) owing to worries about her capacity to bear the stress of labor, our goal

is to assist a smooth and successful delivery. I

• Assumed the patient's slightly elevated monocyte levels in the laboratory results,

which indicate a possible mild infection or inflammation, we intend to closely monitor

her condition and implement appropriate medical interventions to ensure optimal

maternal and fetal health outcomes.

• Prioritize open communication, empathy, and cooperation to meet the patient's

concerns and preferences while ensuring her safety and well-being.

II. NURSING ASSESSMENT

NAME: BELTRAN, REYNALYN ANN PARAS

AGE: 26 YEARS OLD

SEX: FEMALE

RELIGION: ROMAN CATHOLIC

NAME OF MOTHER: N/A

NAME OF FATHER: N/A

ADDRESS: N/A

DATE OF BIRTH: NOVEMBER 18, 1997

PLACE OF BIRTH: Angeles City, Pampanga

NATIONALITY: FILIPINO

CHIEF COMPLAINT: 36 weeks and 2 days AOG, was admitted to the maternity unit. The fetus

was in a cephalic position, with the placenta located anteriorly. Due to the patient's medical history,

including hypothyroidism, diabetes, Tourette syndrome, and a history of hypertension, her

attending physician recommended a cesarean delivery over a normal spontaneous delivery (NSD)

due to concerns about her ability to handle the stress of labor.

DATE OF ADMISSION: March 25, 2024

DISCHARGE DIAGNOSIS: G1P1 (1001) Pregnancy uterine delivered term cephalic live baby

boy AP score 8,9 birth weight 2650g, Due to the patient's medical history, including

hypothyroidism, diabetes, Tourette syndrome, and a history of hypertension, her attending

physician recommended a cesarean delivery over a normal spontaneous delivery (NSD) due to

concerns about her ability to handle the stress of labor.

FAMILY HISTORY

- No history of gestational diabetes in her immediate family

- No family history of diabetes

- No Family History of Tourette syndrome, Hypothyroidism

- With a family history of Hypertension

HISTORY OF PAST ILLNESS

- Hypothyroidism

- Diabetes

- Tourette syndrome

- Hypertension

HISTORY OF PRESENT ILLNESS

- Mrs. Beltran had a maintenance in her hypothyroidism and type 2 diabetes.

PHYSICAL EXAMINATION

- Blood Pressure: 130/90 mmHg

- Heart Rate: 93 bpm

- Respiratory Rate: 20 breaths per minute

- Temp: 36.5

CLINICAL FINDINGS:

Chemistry Test

• Creatine = 50.90 umol/L

• Potassium = 3.50 mmol/L

• Sugar = 5.12 mmool/L

Complete Blood Count (CBC)

• Hemoglobin = 13.8 g/dl

• Hematocrit = 39.4%

• RBC Count = 4.50

• MCV (mean corpuscular volume) = 87.6 fl

• MCH (mean corpuscular hemoglobin) = 30.7 pg

• MCHC (mean corpuscular hemoglobin concentration) = 35.0 g/dl

• WBC Count = 9.08 x 10*9/L

 Prothrombin Time

• Control Plasma: 11.9 secs

• Patient’s Plasma: 10.8 secs

• Percent Activity: 108.0%

• INR: 0.95

III. ANATOMY AND PHYSIOLOGY

a. Diabetes

Diabetes Mellitus primarily affects the Islets of Langerhans of the pancreas, where glucagon (from the

alpha cells) and insulin (from the beta cells) are produced. Glucagon raises the blood glucose level,

while insulin lowers it.

Type 1 DM (Insulin Dependent) characterized by autoimmune destruction of insulin-producing beta

cells in the islets of the pancreas, the loss of function of the beta cells leads to an absolute insulin

deficiency.

Type 2 DM (Non-insulin Dependent) the response to insulin is diminished, and this is defined as

insulin resistance. As such, insulin is ineffective and is initially countered by an increase in insulin

production to maintain glucose homeostasis, but over time, insulin production decreases, resulting in

T2DM.

Gestational Diabetes Mellitus (first detected during pregnancy) can occur anytime during

pregnancy. Generally, affects pregnant women during the second and third trimesters. Women with

GDM and their offspring have an increased risk of developing type 2 diabetes mellitus in the future.
Pancreas

The pancreas is a long, slender organ, most of which is located posterior to the bottom half of the

stomach. Although it is primarily an exocrine gland, secreting a variety of digestive enzymes, the

pancreas also has endocrine cells. Its pancreatic islets—clusters of cells formerly known as the islets

of Langerhans—secrete the hormones glucagon, insulin, somatostatin, and pancreatic polypeptide

(PP).

Pancreas endocrine function involves the secretion of insulin (produced by beta cells) and glucagon

(produced by alpha cells) within the pancreatic islets. These two hormones regulate the rate of

glucose metabolism in the body.

Cells and Secretions of the Pancreatic Islets

The pancreatic islets each contain four varieties of cells:

→ The alpha cell - produces the hormone glucagon and makes up approximately 20 percent of each

islet. Low blood glucose levels stimulate the release of glucagon.

→ The beta cell - produces the hormone insulin and makes up approximately 75 percent of each

islet. Elevated blood glucose levels stimulate the release of insulin.

→ The delta cell - accounts for four percent of the islet cells and secretes the peptide hormone

somatostatin. An inhibiting hormone, pancreatic somatostatin inhibits the release of both glucagon

and insulin.
→ The pancreatic polypeptide cell (PP cell) - accounts for about one percent of islet cells and

secretes the pancreatic polypeptide hormone. It is thought to play a role in appetite, as well as in

the regulation of pancreatic exocrine and endocrine secretions. Pancreatic polypeptide released

following a meal may reduce further food consumption; however, it is also released in response to

fasting.

Regulation of Blood Glucose Levels by Insulin and Glucagon

Glucose is utilized in cellular respiration as a fuel for cells of the body. The body derives glucose from

the breakdown of the carbohydrate-containing foods and drinks we consume. Glucose not

immediately taken up by cells for fuel can be stored by the liver and muscles as glycogen or

converted to triglycerides and stored in the adipose tissue. Hormones regulate both the storage and

the utilization of glucose as required. Receptors located in the pancreas sense blood glucose levels,

and subsequently the pancreatic cells secrete glucagon or insulin to maintain appropriate blood

glucose.

Glucagon

Receptors in the pancreas can sense the decline in blood glucose levels, such as during periods of

fasting or during prolonged labor or exercise. In response, the alpha cells of the pancreas secrete the

hormone glucagon. Glucagon increases your blood sugar level and prevents it from dropping too low.

Insulin

The primary function of insulin is to facilitate the uptake of glucose into body cells. Red blood cells, as

well as cells of the brain, liver, kidneys, and the lining of the small intestine, do not have insulin

receptors on their cell membranes and do not require insulin for glucose uptake. Although all other

body cells do require insulin if they are to take glucose from the bloodstream, skeletal muscle cells

and adipose cells are the primary targets of insulin.

 b. Hypothyroidism

Anatomy

The thyroid gland is a part of human endocrine system. Thyroid gland works together with the

nervous system and the immune system to regulate the body metabolism by secreting hormones and

releasing it into the blood stream.

Thyroid gland is a butterfly shaped organ and is situated at the front of the neck in the lower part of

the throat and consists of two connected lobes on either side of the trachea. The lower end of the

lobes is connected by thyroid isthmus which is a thin band of connective tissue.

The thyroid weighs between 20 and 60 grams on average. With each lobe being about 5 cm long, 3

cm wide, and 2 cm thick. The thyroid gland is comparatively larger in women as compared to men

and also increases in size during pregnancy. The infrahyoid muscles lie in front of the gland and the

sternocleidomastoid muscle to the side. Behind the outer wings of the thyroid lie the two carotid

arteries whereas the trachea, larynx, lower pharynx, and esophagus all lie behind the thyroid. Four

parathyroid glands, two on each side, lie on each side between the two layers of the thyroid capsule,

at the back of the thyroid lobes. There is loose connective tissue between the inner and the outer

capsule, so the thyroid can move and change its position when we swallow.

Physiology

Thyroid gland produces three hormones:

1. Triiodothyronine, also known as T3

2. Tetraiodothyronine, also called thyroxine or T4

3. Calcitonin
Physiology of thyroid hormones:

→ T3 and T4 are the only proper thyroid hormones, they are made in follicular epithelial cells of the

thyroid gland.

→ calcitonin is produced by thyroid gland which is made by c-cells.

→ Iodine is the building block of both T3 & T4. Hence, dietary intake of this trace mineral is vital.

Thyroid hormones affect your:

→ T3 and T4 increase the basal metabolic rate. It promotes physical & mental growth in children.

→ Calcitonin is involved in calcium and bone metabolism.

→ Thyroid hormone affects your: body temperature and circulation, appetite, energy levels, growth

and bone development, muscle tone and suppleness, heart rate, blood sugar levels, central

nervous system and bowel function, cholesterol levels, fat, carbohydrate, and protein metabolism.

→ Higher the amount of T3 and T4 in the body, higher is the body metabolism. If the level of T3 and

T4 drops in the body, so does the rate of metabolism.

Underactive Thyroid Gland

(hypothyroidism) is where the thyroid gland does not produce enough thyroid hormones.

Underactive thyroid (hypothyroidism):

1. Feeling tired and fatigued

2. Feeling cold even on warm days

3. Weight gain

4. Depression

5. Reduced concentration

6. Brain fog

7. Puffy face

8. Hair loss

9. Dry skin

10. Constipation

11. Hoarseness
 12. Elevated blood cholesterol level

13. Muscle aches, tenderness, and stiffness

14. Pain, stiffness or swelling in your joints

15. Heavier than normal or irregular menstrual periods

16. Goiter

IV. PATIENT AND HER ILLNESS

a. Type 2 Diabetes Mellitus

A. Pathophysiology

Type 2 diabetes mellitus is often associated with certain genetic predispositions, environmental factors,

lifestyle choices, and the dynamic interactions between all of these different aspects.

This ailment is a disease state which involves the dysfunction of insulin-producing pancreatic beta cells,

insulin hormone resistance in cells of the body, or a combination of both.

Diabetes mellitus type 2 is a condition that typically begins with a resistance to insulin by cells of the

body, that worsens over time and may eventually lead to pancreatic beta cell failure. When the beta

cells fail, endogenous insulin can no longer be secreted, the individual will be dependent upon

exogenous insulin.

Insulin resistance is the inability of cells to use the insulin hormone, which inhibits the cell’s capability

to absorb and then use glucose in metabolic processes. Since insulin is responsible for the cellular

uptake of glucose, the sugar molecules will remain in the bloodstream.

Whether insulin is not present due to hyposecretion, or if the hormone is rendered useless because of

insulin resistance, the end result will be hyperglycemia. Hyperglycemia, or elevated glucose levels

within the blood, is the hallmark of type 2 diabetes mellitus. Hyperglycemia, and the associated

inflammatory processes, lead to the micro and macro-vascular changes that are seen as complications

of diabetes mellitus.

Complications of diabetes include the following:

• Eyes: Retinopathy and Cataracts.

• Central and Peripheral Nervous System: Neuropathy, and decreased cognition.

• Circulatory: Heart disease, cerebrovascular accident, peripheral vascular disease, and

hypertension.

• Liver: Steatohepatitis and biliary disease.

• Gastrointestinal Tract: Gastroparesis.

• Kidneys: Nephropathy and chronic kidney disease.

• Hematologic System: Oxidative stress, immunosuppression, infection, and cancer.

b. Hypothyroidism

The most common cause of hypothyroidism is the inability of the thyroid gland to produce a sufficient

amount of thyroid hormone; however, less commonly pituitary and hypothalamus may also result in

thyroid dysfunction. The hypothalamus secretes thyrotropin-releasing hormone (TRH) that stimulates
the pituitary gland to produce thyroid-stimulating hormone (TSH). Thyroid-stimulating hormone

stimulates the thyroid gland to produce and secrete mainly T4 and smaller quantities of T3. The half-

life of T4 is 7-10 days, and eventually, T4 is converted to T3 peripherally by 5'-deiodination. Levels of

T3 majorly and T4, to some extent, in turn, exert negative feedback on the production of TRH and

TSH. Alteration in the structure and function of any of these organs or pathways can result in

hypothyroidism.

B. Definition of the Disease

a. Type 2 DM

Type 2 diabetes is a chronic disease. It is characterized by high levels of sugar in the blood. Type 2

diabetes is also called type 2 diabetes mellitus and adult-onset diabetes. That's because it used to

start almost always in middle and late adulthood. Type 2 diabetes affects how your body uses sugar

(glucose) for energy. It stops the body from using insulin properly, which can lead to high levels of

blood sugar if not treated.

b. Hypothyroidism

Hypothyroidism (underactive thyroid) is a common condition where the thyroid doesn’t create and

release enough thyroid hormone into your bloodstream. This makes your metabolism slow down.

C. Synthesis of the Disease

● C.1 Risk Factors (Patient-Based):

● Mrs. Beltran Got cesarean section to her first child at the age of 26 years old. She has

multiple coexisting conditions, including hypothyroidism, diabetes, a history of

hypertension and Tourette syndrome.

● Previous history of hypertension during pregnancy can increase the risk of complication

such as preeclampsia, which can affect both the mother and baby, additionally Tourette

syndrome itself doesn't usually directly impact pregnancy, but managing any associated

symptoms and stress me important.

● C. 2 Signs and Symptoms (Patient-Based)

● Mrs. Beltran verbalized that she experiences the following signs and symptoms due to

her illness fatigue, weight gain, cold intolerance, drying of her skin which is commonly

experience by the patient with hypothyroidism also she increased thirst, frequent

urination, hunger, fatigue blurred vision due to her diabetes, she also has a high blood

pressure motor or vocal tics that can show to the patient with Tourette syndrome and

hypertension.
V. MEDICAL MANAGEMENT

A. DIAGNOSTIC AND LABORATORY PROCEDURES

DIAGNOSTIC/ DATE ORDERED GENERAL INDICATION OR RESULTS NORMAL VALUES ANALYSIS AND NURSING
LABORATORY DESCRIPTION PURPOSE INTERPRETATION RESPONSIBILITIES
PROCEDURES DATE RESULTS IN

Complete Blood Count (CBC) test is done for pregnant individuals to monitor hemoglobin levels, detect anemia, assess platelet

count, and ensure overall health before or during labor and delivery

Date Ordered: Hemoglobin is a To measure the

Hemoglobin 13.8 12.00 - 16.00 g/dL Within normal range - Verify patient
March 18, 2024 protein in red blood amount of
identification
cells that binds to hemoglobin in the
(7:17 am) and explain the
oxygen and blood that has the
procedure.
Date Results carries it throughout capacity to carry

In: the body, oxygen all - Ensure patient

facilitating throughout the comfort during blood
March 18, 2024 tissues/ body since sample collection and
oxygen delivery to
tissues and organs. an abnormally educate the patient
(9:56 am)
low HgB can be an that there will be
 discomfort during the
indication of
procedure.
anemia.
With the collaboration
of other healthcare
providers, collecting
blood samples from
the patient is done.

Date Ordered: Hematocrit is the Measuring 37.00 - 47.00

Hematocrit 39.4 Within normal range - Label
March 18, 2024 ratio of hematocrit levels
%
identifies the samples accurately
(7:17 am) Red Blood Cells and send them for
percentage volume
(RBC) to the total analysis promptly.
of RBC in the
Date Results blood of the body
In: overall blood of the - Monitor for

body which signs of bleeding or

March 18, 2024
indicates levels of hematoma

(9:56 am) blood- oxygen formation post-

carrying capacity. procedure.

- Educate
patient on potential
 Date Ordered: In order to monitor 4.00 - 6.00 x discomfort or bruising
RBC Count Red Blood Cell 4.50 Within normal range
March 18, 2024 and early diagnose at the puncture site
(RBC) Count 10^12/L
any abnormalities
(7:17 am) measures the level - Review CBC
in levels which
of RBC in the blood
could be an results and report
Date Results which delivers
abnormalities in the
In: oxygen in the body. indication of healthcare teams.
conditions affecting
March 18, 2024
RBC like anemias.
(9:56 am)

Mean 80.00 -
MCV To assess the 87.6 Within normal range
Date Ordered: Corpuscular 100.00 fl
average size of red
March 18, 2024 Volume, or blood cells, aiding

MCV, is a CBC- in the diagnosis of

(7:17 am)
various types of
based measure of
Date Results anemia and
the average size
In: ensuring maternal
of red blood cells.
and fetal health.
March 18, 2024

(9:56 am)
 Date Ordered: Mean
MCH To detect early 30.7 27.00 - 31.00 pg Within normal range
March 18, 2024
Corpuscular complications like
Hemoglobin, or deficiency that
(7:17 am)
MCH, measures the leads to anemia
Date Results average amount of that endanger the
In: HgB per RBC. maternal and fetal
well-being.
March 18, 2024

(9:56 am)

Date Ordered: Mean 32.00 - 36.00

MCHC To detect early 35.0 Within normal range
March 18, 2024 Corpuscular
complications like g/dl
Hemoglobin
(7:17 am) deficiency that
Concentration,
leads to anemia
Date Results or MCHC, that endanger the
In: measures the level maternal and fetal
of concentration of well-being.
March 18, 2024 HgB in a given
volume of packed
(9:56 am)
RBC.
 Date Ordered: The WBC 4.30 - 10.00 x
WBC COUNT 9.08 Within normal range
March 18, 2024 count measures the
10^9/L
The WBC
number of white
(7:17 am)
blood cells in a count in pregnancy
blood sample, is important for
Date Results
reflecting the monitoring
In:
body's immune maternal immune

March 18, 2024 function and

response and
detecting
(9:56 am) helping identify infections, ensuring
infections or the health of both
inflammation. the mother and the
developing fetus.
 Testing neutrophils 44.20 - 80.20 Within Normal
Neutrophil Neutrophils are a 61
in pregnancy helps
type of white blood % Range
monitor the
cell that plays a
maternal immune
critical role in the
body's immune response, ensuring
response by the early detection
combating bacterial of infections and
infections and optimal health for
clearing cellular both the mother
debris. and the baby.
 0.00 - 5.00 % Within Normal
Eosinophils Eosinophils are a 01
Range
type of white blood The eosinophil test
cell involved in the in pregnancy helps
immune response, monitor immune
particularly in function and detect
combating parasitic any abnormalities
infections and that could indicate
allergic reactions. parasitic infections
or allergic
reactions, ensuring
the well-being of
both the mother
and the fetus.
 Monocytes are a The monocyte 3.00 - 6.00 % Slightly elevated
Monocytes 07
type of white blood test in pregnancy
cell that plays a key aids in monitoring
role in immune maternal immune
defense by function and
engulfing and identifying any
destroying abnormalities that
pathogens and could affect
maternal and fetal
foreign substances.
health.
 Lymphocytes are a The lymphocyte 28.00 - 48.00 Within Normal
Lymphocytes 31
type of white blood test in pregnancy % Range
cell critical for helps assess
immune maternal immune
function and detect
response, including
any abnormalities
the recognition and
that may impact the
elimination of
health of both the
pathogens and
abnormal cells. mother and the
fetus.
 Platelet count 140.00 440.00 x Within Normal
Platelet Count 229
measures the 10 Range
Platelet count in
number of ^9/L
pregnancy is
platelets in the
crucial for
blood, which are assessing clotting
essential for blood function and
clotting and detecting potential
preventing complications such
excessive bleeding. as
gestational
thrombocytope nia
or preeclampsia,
ensuring maternal
and
fetal well-being.

Chemistry tests are done during pregnancy to monitor metabolic functions, detect abnormalities, and ensure the well-being of both the mother and the fetus.
 Date Ordered: Creatinine levels in - Establish
Creatinine Creatinine in pregnant women 50.90 35.00 124.00 Within Normal Range rapport with the
March 18, 2024
chemistry tests are umol/L patient.
monitored to
(7:17 am) assesses kidney assess kidney - Verify patient
function by function and identification.
Date Results measuring waste detect any potential - Explain the
In: product levels in the procedure clearly.
complications
blood. during pregnancy. - Assist with
March 18,
specimen collection.
2024
- Ensure proper
labeling and
(11:41am)
documentation.

- Follow safety
Date Ordered: Potassium levels in Potassium levels precautions.
Potassium chemistry tests during pregnancy 4.49 3.50 - 5.30 Within Normal Range
March 18, 2024
indicate are monitored to mmol/L - Monitor
electrolyte ensure patient response.
(7:17 am) electrolyte
balance and are Provide follow-up and
Date Results crucial for balance, which is
education on test
monitoring cardiac vital for maintaining
In: results.
function and overall normal

health. physiological
functions and
preventing
complications such
as
 March 18,
hypertension or
2024
preterm labor.
(11:41am)

Sugar Date Ordered: Monitoring sugar

Sugar levels in levels in 5.12 3.50 - 8.00 Within Normal Range
March 18, 2024
(Random) chemistry tests pregnant mmol/L
women helps
(7:17 am) assess blood
detect
glucose levels,
Date Results crucial for gestational

In: monitoring diabetes diabetes and

and ensuring ensures optimal

March 18, maternal and fetal
metabolic health.
2024 health.

(11:41am)
 B. IVF

TYPE OF INDICATION OR NURSING

MEDICAL DATE STARTED DATE GENERAL DESCRIPTION CLIENTS RESPONSE RESPONSIBILITIES
PURPOSE
MANAGEMENT CHANGED

#1 D5LRS In response to D5LRS - Verify

DATE STARTED infusion, the client physician's orders for
3/25/24 exhibited stable vital signs D5LRS administration.
6:40 am and reported feeling
adequately hydrated with
5% Dextrose in no adverse reactions noted. - Assess the
Lactated Ringer’s patient's fluid and
DATE CHANGED 5% Dextrose in
Solution is a solution specifically an electrolyte status.
3/25/24 Lactated Ringer's Solution may be
electrolyte solution such as sodium,
9:30 am indicated for pregnant women or those
potassium, calcium, and lactate,
post-delivery to address dehydration, - Prime IV
designed to replenish fluids and
maintain electrolyte balance, and tubing with D5LRS
#2 D5LRS DATE STARTED electrolytes in patients. It is
support fluid volume during
3/25/24 commonly used in medical settings to solution according to
9:33 am address dehydration, hospital protocol.

- Monitor
infusion rate and
adjust as necessary.

#3 D5LRS + 10 DATE STARTED In response to the - Assess

units 3/25/24 4pm administration of D5LRS patients for signs of
D5LRS with 10 units of oxytocin is an with 10 units of oxytocin,
OXYTOCIN fluid overload or
intravenous solution containing D5LRS with 10 units of oxytocin is the client experienced
dextrose, electrolytes, and oxytocin, administered to pregnant women or uterine contractions dehydration.
DATE CHANGED commonly administered during those post-delivery to induce or intensifying, leading to
3/25/24 pregnancy to support hydration, augment labor, promoting uterine progress in labor. - Monitor blood
12am maintain electrolyte balance, and contractions and preventing glucose levels in
promote uterine contractions during postpartum hemorrhage. diabetic patients
labor.
receiving D5LRS.
 - Educate
patients on potential
side effects and signs
of adverse reactions.

- Document
intake and output
accurately.

Dispose of unused
solution and
equipment properly
after infusion.
PNSS
DATE STARTED Plain Normal Saline
3/25/24 12am Solution (PNSS) includes
PNSS (Plain Normal Saline Solution) is PNSS is administered during pregnancy
adequate hydration to
a sterile intravenous fluid containing or post-delivery to replenish fluids and
support maternal and fetal
sodium chloride in water, commonly maintain electrolyte balance,
well-being during labor or
DATE CHANGED used during pregnancy to restore fluid supporting
to address dehydration-
3/25/24 related complications.

5am

balance and electrolyte levels. maternal hydration and well-being.

C. MEDICATIONS

Generic and Brand Classifications Indication / Specific Dosage, frequency Side effect and Nursing
name action / Mechanism of and preparation Adverse reactions consideration
action

• Yellowing of the • Do not give any

Generic Name: Histamine2 Antagonist suppresses the release Dosage: skin or the new medication
Ranitidine of gastric acid by 50mg selera during therapy
blocking histamine at without
Brand Name: the H2 receptor site Frequency: • Tirediness consulting the
Zantac which is mainly found Q8hrs physician
in gastric parietal cells. • Dark Urine
Preparation: • Instruct to take
Short-termtreatment of I.V • Stomach Pain medication
activeduodenalulcers exactly as
andbenigngastriculcers • Confusion directed and not
. to increase
• Agitation dose. And
instruct that it
• Depression may take days
bedofre
• Hallucination noticeable relief

• Blurry vision • Advice the

patient to
• Tachycardia consult the
physician first
before
• Dyspnea
breastfeeding
Generic and Brand Classifications Indication / Specific Dosage, frequency Side effect and Nursing
name action / Mechanism of and preparation Adverse reactions consideration
action

• Sweating • Instruct the

Generic Name: Opioid Analgesic Binds to mu-opioid Dosage: patient to
Tramadol receptors. Inhibits 50mg • Dizziness increase fluid
reuptake of serotonin intake to prevent
Brand Name: and norepinephrine in Frequency: • Nausea and dry mouth and
Ultram the CNS. Q6hrs vomiting constipation

Relief of moderate to Preparation: • Dry mouth • For a better

moderately severe pain I.V analgesic effect
• Fatigue give drugs
before the onset
• Constipation of intense pain

• Reassess or
monitor the level
of pain at least
30mins after
administration
Generic and Brand Classifications Indication / Specific Dosage, frequency Side effect and Nursing
name action / Mechanism of and preparation Adverse reactions consideration
action

• Nausea vomiting • Monitor for

Generic Name: Dopamine receptor Treatment of diabetic Dosage: anxiety and
Metoclopramide antagonist gastroparesis 10mg • Restlessness restlessness
symptoms,
during IV
Brand Name: implantation of Frequency:
Reglan intestinal feeding Q8hrs • Drowsiness administration.
tubes, and
chemotherapy or Preparation: • Fatigue • Monitor renal
postoperative I.V function,B/P,
treatment for nausea
• Insomnia heart rate
and vomiting

• Dystonia • Monitor daily

pattern ofbowel
• Myoclounu activity, stool
consistency
• Dizziness

• Anxiety

• Diarrhea
Generic and Brand Classifications Indication / Specific Dosage, frequency Side effect and Nursing
name action / Mechanism of and preparation Adverse reactions consideration
action

• Indigestion • Monitor for

Generic Name: Analgesic Prostaglandin Dosage: therapeutic
Diclofenac synthesis is reduced by 75mg • stomach pain effectiveness.
the drug's strong
Brand Name: cyclooxygenase Frequency:
Voltaren inhibitory action. Q3hrs 3doses • nausea and • Observe and
vomiting report signs of
Analgesic and Preparation: bleeding
antipyretic effects in I.V • diarrhea
symptomatic treatment • Monitor for signs
of postpartum pain
• constipation and symptoms
of GI irritation
• headache

• dizziness

• drowsiness

• itching

• increased
sweating

• increased blood
pressure
Generic and Brand Classifications Indication / Specific Dosage, frequency Side effect and Nursing
name action / Mechanism of and preparation Adverse reactions consideration
action

• Nausea and • Administer with

Generic Name: Opioid analgesic Tramadol and Dosage: Vomiting food or milk to
Tramadol + paracetamol has faster 50mg prevent GI upset
Paracetamol onst of action
• Anorexia
compared to tramadol Frequency:
Brand Name: alone and longer 1 tablet q8hrs • Assess patient
Ultracet duration of action • Convulsion BP and RR
compared to Preparation: periodically
paracetamol P.O • Seizure during
administration
Postparative pain
management treatment • Hypotension
for a patient having a • Administer drug
caesarean delivery. • Respiratory early in the day
arrest so increase
urination will not
• Bradycardia disturb sleep

• Dyspnea

• Abdominal pain
Generic and Brand Classifications Indication / Specific Dosage, frequency Side effect and Nursing
name action / Mechanism of and preparation Adverse reactions consideration
action

• Headache • Administer the

Generic Name: Non-opioid Analgesic selectively inhibits Dosage: drug with food or
Celecoxib cyclooxygenase 2 200mg • Dizziness after meals if GI
(COX-2) an enzyme
upset occurs
Brand Name: required for Frequency:
Celebrex biosynthesis to prevent BID capsule • Stroke
the synthesis of • Establish safety
prostaglandins. Preparation: • Hypertension measurements if
P.O CNS or visual
Management of acute
• Edema disturbances
pain
occur
• Abdominal pain
• Monitor patient's
• Diarrhea vital signs

• Nausea and
Vomiting
D. DIET
TYPE OF DIET GENERAL DESCRIPTION
Clear Liquid Diet A clear liquid diet is a temporary eating
plan that consists of liquids that are
transparent and leave little to no residue
in the gastrointestinal tract. This diet is
often prescribed for medical purposes,
such as before certain medical
procedures, surgeries, or when
recovering from gastrointestinal issues.
INDICATION OR PURPOSE
Following a cesarean section, the
digestive system may need time to
recover from the effects of anesthesia
and surgery. A clear liquid diet
provides easily digestible fluids that
are gentle on the digestive system,
helping to prevent nausea, vomiting,
and discomfort during the immediate
postoperative period. Furthermore,
Anesthesia and pain medications used
during and after a cesarean section
can sometimes cause nausea and
vomiting. Clear liquids help prevent
these symptoms by providing
hydration without putting additional
stress on the stomach.
NURSING RESPONSIBILITIES
● Monitor vital signs, hydration
status, and gastrointestinal
function, including bowel
sounds and any signs of
abdominal discomfort or
distention.
● Assess the patient's
understanding of the clear
liquid diet and their ability to
comply with the prescribed
dietary restrictions.
● Monitor the patient's intake
of clear liquids, ensuring that
they are consuming an
adequate amount to
maintain hydration.
 TYPE OF DIET GENERAL DESCRIPTION
Soft Diet A soft diet is a type of eating plan that
consists of foods that are easy to chew,
swallow, and digest. This diet is often
recommended for individuals who have
difficulty with chewing or swallowing, as
well as for those recovering from certain
medical procedures or surgeries,
including cesarean section (CS).
INDICATION OR PURPOSE
After surgery, the gastrointestinal
tract may be sensitive, and the patient
may experience discomfort or
difficulty with digestion. A soft diet
minimizes stress on the digestive
system by providing foods that are
easier to process and absorb. Soft,
easily digestible foods can support
the body's healing process by
providing essential nutrients
necessary for tissue repair and
recovery.
NURSING RESPONSIBILITIES
● Assess the patient's ability
to chew and swallow, any
discomfort or pain
experienced during eating,
and any dietary preferences
or restrictions.
● Explain the purpose of the
soft diet, including its role in
postoperative recovery,
ease of chewing and
swallowing, and promotion
of healing.
● Ensure that the patient has
access to appropriate soft
foods, including options
from different food groups
such as fruits, vegetables,
grains, proteins, and dairy.
● Monitor the patient's intake
of soft foods, ensuring that
they are consuming an
adequate amount to meet
their nutritional requirements
and promote healing.
 E. Activity

TYPE OF ACTIVITY GENERAL DESCRIPTION INDICATION OR PURPOSE NURSING RESPONSIBILITIES

Bed Rest Bed rest is a medical Bed rest allows the body to recover ● Conduct thorough assessments of the CS

intervention that involves from the stress of surgery, patient's vital signs, incision site, pain level,

restricting a patient's including wound healing, tissue urinary output, bowel function, and overall well-

physical activity by requiring repair, and restoration of energy being to monitor for signs of complications and

them to remain in bed for a levels. Also, Bed rest helps ensure timely intervention.

specified period. It is often minimize the risk of complications

prescribed by healthcare such as wound dehiscence (wound ● Monitor the CS incision site for signs of infection,

providers in certain medical opening), infection, bleeding, and hematoma, or dehiscence, and provide

situations to promote deep vein thrombosis (DVT) by appropriate wound care, such as dressing

healing, prevent further limiting physical activity and changes, wound irrigation, and assessment of

complications, or manage allowing the surgical site to heal drainage.

specific conditions. undisturbed.

● Document all assessments, interventions, patient

responses, and vital signs accurately and

promptly in the patient's medical record to ensure

 continuity of care and communication among

healthcare team members.

Ambulation Ambulation for a cesarean ● Ambulation helps prevent ● Conduct a thorough assessment of the CS

section (CS) patient involves complications such as deep patient's readiness for ambulation, including their

the gradual and safe vein thrombosis (DVT), vital signs, pain level, mobility status, incision

movement of the patient urinary retention, healing, and any contraindications or

from bed to walking, typically constipation, atelectasis, precautions. Assess the patient's ability to

initiated in the immediate and pneumonia by tolerate sitting up, standing, and walking, and

postoperative period. It promoting circulation, consider the use of pain medication or analgesia

includes assisting the patient improving lung expansion, as needed.

in sitting up, standing, and and facilitating normal bowel ● Provide physical assistance and support as

walking short distances to and bladder function. needed to help the CS patient with ambulation,

promote circulation, prevent transfers, and mobility exercises. Offer

complications, and facilitate ● Ambulation supports the encouragement, reassurance, and guidance to

recovery following surgery. recovery process by promote confidence and independence in

promoting mobilization, walking. Use appropriate assistive devices such

 restoring normal movement as a walker, cane, or abdominal binder to support

patterns, reducing pain and mobility and protect the incision site.

stiffness, and enhancing ● Ensure a safe ambulation environment by

overall well-being. removing obstacles, providing adequate lighting,

● Ambulation can help and maintaining close supervision during

alleviate discomfort ambulation sessions, especially for CS patients

associated with who may be at risk of falls or balance impairment.

postoperative recovery, Implement fall prevention strategies and use

such as gas pain, bloating, appropriate mobility aids to support stability and

and incisional pain, by prevent injury.

promoting gentle movement Educate the CS patient and their family members about

and circulation. the importance of ambulation, proper walking techniques,

and postoperative care instructions. Provide instructions

on incision care, pain management, and activity

restrictions to promote safe and effective recovery

following surgery.
 F. SURGICAL MANAGEMENT (TUBAL LIGATION AND LOW TRANSVERSE CESAREAN
SECTION)

I. Definition of operation

Tubal Ligation:

Tubal ligation, often known colloquially as "getting your tubes tied," is a highly successful surgical

method for contraception. It entails the severing, blocking, or sealing of the fallopian tubes to impede

the fertilization of eggs by sperm. The term "tubal" pertains to the fallopian tubes, while "ligation"

denotes tying or removing. During this procedure, the fallopian tubes are either severed and tied

using a specialized thread (suture) or obstructed with a clamp, clip, or band. During this surgery, the

fallopian tubes most often are cut and tied to prevent pregnancy for the rest of your life.

SURGICAL MANAGEMENT

Pre-operative Management:

● Patient Education:

Provide comprehensive education to the patient about the cesarean delivery

procedure, including what to expect before, during, and after surgery. Emphasize the

importance of glycemic control and adherence to any pre-operative fasting guidelines.

● Assessment:
 Perform a thorough assessment of the patient's medical history, including their diabetes

management, current blood glucose levels, medication regimen, allergies, and any

other relevant factors.

● Preparation:

Assist in preparing the patient for surgery, which may involve tasks such as starting an

intravenous (IV) line, administering pre-operative medications as ordered (such as

antibiotics or antacids), and ensuring that the patient is in a suitable physical and

emotional state for surgery.

Intraoperative Management:

● Assistance with Anesthesia:

Collaborate with the anesthesia team to prepare the patient for anesthesia

administration. Provide support to the patient during the administration of regional or

general anesthesia, ensuring their comfort and safety.

● Monitoring:

Continuously monitor the patient's vital signs, including blood pressure, heart rate,

respiratory rate, and oxygen saturation, throughout the surgical procedure. Be vigilant

for any signs of complications, such as hypoglycemia, hyperglycemia, or adverse

reactions to anesthesia.

● Assist Midwives:

Assist the surgical team as needed during the cesarean delivery procedure, which may

involve tasks such as positioning the patient, handing instruments to the midwife, and

providing suction or other assistance as required.

Post-operative Management:

● Recovery:

Care for the patient in the immediate post-operative period, ensuring their comfort and

safety as they recover from anesthesia and surgery. Monitor for any signs of post-

operative complications, such as bleeding, infection, or respiratory distress.

● Pain Management:

Administer pain relief medications as ordered and provide non-pharmacological pain

management techniques to help alleviate discomfort. Monitor the patient's response to

pain management interventions and advocate for adjustments as needed.

● Blood Glucose Monitoring:

Continuously monitor the patient's blood glucose levels in the post-operative period, as

directed by the healthcare provider. Administer insulin or other medications as ordered

to maintain glycemic control and prevent complications related to diabetes.

● Support and Education:

Provide emotional support and reassurance to the patient and their family members,

addressing any concerns or questions they may have about the surgery, recovery

process, or diabetes management. Offer education on post-operative care, including

wound care, activity restrictions, and signs of potential complications.

VI. NURSING MANAGEMENT (NURSING CARE PLAN)

A.

Assessment Nursing Diagnosis Scientific Rationale Short-term and Nursing Rationale Expected outcome
Long-term Interventions
Objectives

Subjective Data: Short term: Ensure that the Elevated blood Acknowledge factors
Risk for unstable Susceptible to
“may diabetes din Within the next 2-3 patient knows the glucose levels in that may lead to
Blood Glucose Level variation in serum
kase ako kaya bigla hours, the pt. will be symptoms, causes, patients with unstable glucose
possibly evidenced levels of glucose
ako pinag cs ng able to explain the treatment, and previously-
by pregnancy from the normal
doctor ko” as importance of prevention of diagnosed diabetes Verbalize plan for
range, which may
verbalized by the monitoring blood hyperglycemia. indicate the need to modifying factors to
compromise health
patient. glucose levels, evaluate diabetes prevent or minimize

including how and management. shift in glucose level.

Objective Data: when to test blood

glucose at home. Regular Prenatal Prenatal care is

Vital signs Check up essential to monitor

Temp – 36°C Within 2-3 hours, the both the mother and

BP: 120/80 mmHg pt. will identify at baby’s health.

PR: 95 bpm least foods that Glucose screening is

RR: 20 breaths per should be avoided to done on the 24th or

minute maintain stable 28th week of

O2 – 98% blood glucose levels. gestation to detect

gestational diabetes.

Long term: Prompt diagnosis

Over the next 2-3 will help prevent

days, the pt will maternal and

demonstrate congenital

consistent self- disabilities

monitoring of blood

glucose levels at

least four times a

Consult with the Pregnant women are
day (fasting and
dietitian about the required to eat a
after meals) and
appropriate meals balanced diet with
record the results
for the patient various foods. They
accurately.
need to increase

their calorie intake

Within the next 2-3 by around 300 more

days, the client will calories each day.

follow a diet plan Meal plans should

tailored to her needs focus on stabilizing

by a dietitian, which blood glucose levels

includes appropriate or preventing

portions of episodes of

carbohydrates, hypoglycemia or

proteins, and fats, hyperglycemia.

and demonstrate

understanding by

preparing a daily

meal plan.
B.

Assessment Nursing Diagnosis Scientific Rationale Short-term and Nursing Rationale Expected outcome
Long-term Objectives Interventions

Subjective Data: Fatigue related to Short term: Evaluate the client’s Using an appropriate Report improved
An overwhelming
“Nakakaramdam ako metabolic imbalance Educate the patient description of quantitative scoring sense of energy.
sustained sense of
ng pagod ngayon as evidenced by about the fatigue: severity, scale, 1 to 10 for
exhaustion and
kaya hindi pa ako importance of changes in severity example, can aid the Perform activities of
sluggishness and decreased capacity
makagalaw ng energy conservation over time, client to formulate daily living and
despite adequate for physical and
maayos tsaka techniques and how aggravating factors, the amount of participate in desired
rest. mental work at the
nanghihina pa” as scheduled rest can or alleviating factors. fatigue experienced. activities at level of
usual level
verbalized by the pt. help manage fatigue. Further scoring ability.

scales can be
Assist the patient in
Objective Data: developed by using
developing a Identify the basis of
pictures or
personalized daily fatigue and
Lethargy descriptive
schedule that individual areas of
Body Malaise language.
includes time for rest control.

and relaxation to
Vital signs These will promote
help alleviate
Temp – 36°C symptoms of fatigue. Evaluate the client’s active participation in

BP: 120/80 mmHg outlook for fatigue planning,

Monitor the patient's
PR: 95 bpm relief, eagerness to implementing, and
response to rest
RR: 20 breaths per participate in evaluating
periods, and adjust
minute strategies to reduce therapeutic
the schedule as
O2 – 98% fatigue, and level of management to
needed based on
family and social alleviate fatigue.
their feedback and
support. Social support will
observable energy
be essential to assist
levels.
the client put into

practice changes to

Long term: decrease fatigue.

Collaborate with the

Recognizing
patient to set
Encourage the client relationships
realistic daily activity
to maintain a 24- between specific
goals that balance
hour fatigue or activities and levels
activity with rest.
of fatigue can aid the

Encourage gradual client in recognizing

increase in light activity log for at unnecessary energy

physical activities least one week. outflow.

(as tolerated) to

enhance energy

levels.

Regularly assess

and document the

patient’s energy

levels and fatigue

throughout the day

to fine-tune activity

planning and rest

periods.
C.

Assessment Nursing Diagnosis Scientific Rationale Short-term and Nursing Rationale Expected outcome
Long-term Interventions
Objectives

Subjective Data: Short term: Blood Glucose Regular monitoring Subjective Data:
Risk for Fetal Injury Elevated maternal
the pt. reports Patient Education Monitoring: Teach helps in maintaining the pt. reports
related to elevated serum glucose level
excessive thirst Completion to the patient how to glycemic control and excessive thirst
maternal blood pose a risk for fetal
quickly empower the monitor blood adjusting treatment.
glucose level injury by promoting
Objective Data: patient with the glucose levels and Objective Data:
macrosomia, altering
necessary skills to maintain a log.
circulation, and
Frequent Urination begin self- Proper diet is crucial Frequent Urination
inducing
management of her in managing Type 2
hyperinsulinemia,
blood glucose levels, Dietary Diabetes and
highlighting the
Vital signs which is critical for Management: Refer ensuring maternal Vital signs
significance of tight
Temp – 36°C immediate to a dietitian for a and fetal health. Temp – 36°C
glucose control
BP: 120/80 mmHg stabilization. personalized meal BP: 120/80 mmHg
during pregnancy.
PR: 95 bpm plan. Encourage a PR: 95 bpm

Blood Glucose balanced diet rich in

RR: 20 breaths per Monitoring Initiation nutrients and fiber. RR: 20 breaths per

minute to establish a minute

O2 – 98% baseline of blood O2 – 98%

glucose levels for Exercise Guidance: Exercise helps in

immediate Advise moderate regulating blood

assessment and physical activity as glucose levels.

adjustment of dietary per obstetric

and medication guidelines.

management.

Education and

Support: Educate
Understanding Type
about the
Long term:
2 Diabetes reduces
importance of blood
Consistent Blood
the risk of
glucose control,
Glucose
complications and
potential
Management to
promotes healthy
complications, and
stabilize maternal
postpartum follow-
blood glucose in the
longer term, up. pregnancy

reducing the risk of outcomes.

fetal injury and

complications.

Regular Prenatal

Monitoring to

evaluate the

effectiveness of the

implemented

strategies on both

maternal and fetal

health, and make

necessary

adjustments to the

care plan.
VII. DAILY PATIENT’S RECORD/ EVALUATION

DAYS ADMISSION Day 1 Day 2 DISCHARGE

Nursing Problems Operation Preparation Acute Pain Pain due to Incision

BP – 130/80 BP – 120/80 BP – 130/80 BP – 120/80

Vital Signs T: 36.5 T: 36.4 T: 36.1 T: 36
PR: 93 PR: 89 PR: 87 PR: 88
RR: 20 RR: 20 RR: 20 RR: 20

O2: 97 O2: 98 O2: 96 O2: 97

Laboratory Procedures Ultrasound, Complete Blood

Count (CBC), Prothrombin
Time (PT), Blood Chemistry
Test

@6:40 AM @12:00 am @8:30 am

IVF - 1L D5LRS - 1L D5LRS 8 hrs with 10 - 1L PNSS
@9:33 AM units of Oxytocin @12N
- 1L D5LRS
@4:00 PM - 1L PNSS

- 1L D5LRS 8 hrs with 10

units of Oxytocin

⚫ Ranitidine 50mg IV ⚫ Tramadol 5mg IV q6 4 Doctors Order:

DRUGS ⚫ Tramadol 50mg IV doses Celecoxib 200mg/ PO q12
⚫ Metoclopramide 10mg Iv ⚫ Diclofenac 75mg/ SIVP - May resume thyroid
q8 q12 2 doses maintenance and insulin.

Diclofenac 75mg q8 3 doses Tramadol + Paracetamol 1

cap/PO q8
 NPO
DIET NPO @6pm Soft Diet once with flatus DAT

- may have a clear liquid diet.

ACTIVITY Bed Rest Ambulation

Vlll. DISCHARGE PLANNING

A. A. General Condition of the Client Upon Discharge

During the visit, the patient was found seated upright on the bed, fully awake, and attentively

monitoring her baby's well-being at regular intervals. Despite encountering a degree of unease

caused by her surgical wound whenever she shifted position, she displays determination and

expresses excitement to return home and be with her baby in comfort. She remains optimistic as she

expressed confidence in the ongoing recovery journey for both herself and her baby.

B. Methods

MEDICATIONS

> Advise the patient to continue and take all the medication prescribed by her physician on time, if

there is/are.

> Advise the patient to note any changes or side effects when taking the medication.

EXERCISE

According to American College of Obstetrician and Gynecologist (2023), exercise after a CSD or

cesarean delivery is not recommended unlike in NSD or normal spontaneous delivery. Any exercise

should be done once it was recommended by the OB-GYN of the mother. A mother who has had

CSD can do exercise after a month to months (Promecene, 2023).

It was stated by Promecene (2023) that ab exercises should be avoided for a month to a month and a

half after having cesarean delivery. Yoga, jogging and swimming are the exercises recommended for

a post-C-section delivery. It was also recommended by Promecene (2023) that another good exercise

for developing strength of core is pushing a stroller. Usage of stationary bikes and walking are good

exercises if a post-C-section delivery patient wants to (Colombo, 2023).

Exercise after CSD or Cesarean Section Delivery

These exercises should be done after at least six weeks and with the permission from the doctor

(Fox, 2023).
1. Glute Bridge This exercise helps the muscles of the tummy to be firm. It also

helps to strengthen the lower back and glutes.

Materials/equipment to be used:

1. Yoga mat

Guide on doing the exercise:

1. Bend your knees while lying back.

2. Feet should be placed flat on the floor while hips are feet

apart.

3. Slowly lift your butt and slowly back on the floor.

4. Repeat the steps.

This exercise can be repeated 4-8 times.

2. Kegels This exercise helps to strengthen the pelvic floor. This is an

important exercise after a cesarean section delivery particularly

because the pelvic floor supports the uterus, bladder and bowel.

Guide on doing the exercise:

1. Pinpoint the muscles of your pelvic floor by the interruption of

urine flow. (Note: This step is done to find the pelvic floor muscles. It

is not done during the actual exercise.)

2. If you have identified your pelvic floor muscles, contract and

release the PFM without peeing. Do this at least 25-50 times.

3. Once you are fine in doing the exercise, try to contract and

hold it for a couple of seconds.

This exercise should be done 10 times.

 3. Leg Slides This exercise helps in toning the leg muscles and abs. It is an

effective exercise that targets the core muscles.

Guide on doing the exercise:

1. Bend your knees while lying back and feet should be flat on

the floor.

2. Slide forward your right foot until it is straightened on the floor.

3. Bring back your right foot in a bent position.

4. Do it again with your left foot.

This exercise should be done 4-8 times each leg.

TREATMENT

> Clean with the use of mild soap and clean water. Make sure to dry the wound every day gently. Use

betadine when done and cover the incision with clean gauze. Note for signs of infection. If there is,

make sure to contact your physician for further medical advice and proper medication.

> Make sure to wear loose and comfortable clothing. Example: Cotton women’s dress or bestida

> Take painkillers such as ibuprofen or paracetamol when the wound is sore.

HEALTH TEACHINGS

1. Obtain lots of rest. Rest every time you can.

2. Refrain from too much physical activity like lifting heavy items that can lead to bleeding and

dehiscence of incision.

3. Ask for help if you need to do difficult activities.

4. Little by little, increase daily activities.

5. Refrain from having sex for as long as there are no instructions by your physician.

6. Follow-up check ups are important and make sure to listen to your physician.
 7. Call your physician if you have the following:

→ Fever of 38°C or higher

→ Pain, drainage or redness at your incision site

→ Severe vaginal bleeding

→ Severe belly pain

→ Urination with pain or urgency

→ Urination problem

→ Vaginal discharge with foul odor

→ Absence of bowel movement for a week after cesarean delivery

→ Red, painful and swollen are in the leg

→ Rashes or hives are present

→ Panicking, experiencing anxiety and depression

OUTPATIENT FOLLOW UP

> Follow up checkup must be done as per advice of the physician.

DIET

Soft Diet Foods

Foods Allowed on Soft Diet

Fruits and vegetables

→ Canned fruit

→ Soft, skinless fruits (Bananas, melons, mangoes)

→ Baked fruits (Baked apple)

→ Steamed vegetables → Applesauce

Carbohydrates

→ Mashed potato

→ Rice Porridge (Lugaw)

→ Soft bread
Proteins

→ Soft, tender meat (Poultry and Fish)

→ Poached, scrambled or boiled eggs

→ Soft tofu (Silken tofu)

→ Creamy peanut butter (smooth peanut butter)

→ Baked beans (Canned Pork and beans)

→ Dairy

→ Yoghurt

→ Cottage cheese

→ Thinly sliced cheese

7 DAY MEAL PLAN

DAY 1

Breakfast: Snack: Lunch:

Rice Porridge Mashed Banana Vegetable Broth Soup

Snack: Dinner: Snack:

Mashed Potato Chicken Broth Soup Carrot Juice

DAY 2

Breakfast: Snack: Lunch:

Crackers Apple Juice Boiled Squash

Snack: Dinner: Snack:

Yogurt Avocado Oatmeal

DAY 3

Breakfast: Snack: Lunch:

Rice Porridge Papaya Vegetable Salad (Spinach,

Kale and Broccoli)

Snack: Dinner: Snack:

Carrot Juice Vegetable Broth Soup Mashed Banana

DAY 4
 Breakfast: Snack: Lunch:

Crackers Low Fat Yogurt Chicken Broth Soup

Snack: Dinner: Snack:

Broccoli Juice Avocado Mashed Potato

DAY 5

Breakfast: Snack: Lunch:

Rice Porridge Blueberries Vegetable Broth Soup

Snack: Dinner: Snack:

Carrot Juice Soft Mango Papaya

DAY 6

Snack: Lunch:
Breakfast: Crackers
Oatmeal Boiled Squash

Snack: Yogurt Dinner: Snack:

Avocado Apple Juice

DAY 7

Breakfast: Snack: Lunch:

Rice Porridge Papaya Vegetable Salad (Spinach,

Kale and Broccoli)

Snack: Dinner: Snack:

Apple Juice Vegetable Broth Soup Mashed Banana

Note: Eat foods such as fiber-rich foods, herbs, colorful vegetables and nutritious warm soups as

these are anti-inflammatory, can help improve digestion and aid in quickly healing wounds.

Food items that should be avoided after CSD

1. Spicy Food
2. Carbonated Drinks

3. Caffeinated Drinks

4. Fermented or Junk Food

5. Cold Foods

6. Undercooked Foods

7. Alcoholic Drinks

IX. SUMMARY OF FINDINGS

On March 25, 2026, a 36-year-old patient was brought to the maternity unit, pregnant with a boy

fetus at 36 weeks and 2 days AOG. She was planned to deliver the baby via Caesarean delivery. The

patient was diagnosed with hypothyroidism, a disorder in which the thyroid gland does not produce

sufficient thyroid hormone. This illness is also known as underactive thyroid. In the early stages,

hypothyroidism may not produce any visible symptoms. Untreated hypothyroidism can lead to a variety

of health issues, including excessive cholesterol and cardiac difficulties. Diabetes, a chronic metabolic

condition characterized by increased levels of blood glucose (or blood sugar), can cause catastrophic

damage to the heart, blood vessels, eyes, kidneys, and nerves. The most common is type 2 diabetes,

which mainly affects adults and arises when the body develops insulin resistance or fails to produce

enough insulin. She was also diagnosed with Tourette syndrome, a neurological system disorder. TS

produces "tics" in humans. Tics are quick twitches, gestures, or sounds that people repeat. People with

tics are unable to stop their bodies from performing these functions. For example, a person may blink

repeatedly. The patient has a history of hypertension. Because her pregnancy was considered high-

risk, her attending physician recommended that she have a Caesarean birth. A healthy baby boy was

born safely on March 26, 2024.

To summaries, despite the patient's complex medical history, which included hypothyroidism, diabetes,

Tourette syndrome, and hypertension, the decision to proceed with a Caesarean delivery was taken in
the best interests of her and her baby's health. This strategy reduced the dangers associated with her

high-risk pregnancy, resulting in the safe delivery of a healthy baby boy on March 25, 2024.

X. RECOMENDATION/S AND CONCLUSION

As a student nurse, you must recognize the value of comprehensive care for patients with

extensive medical conditions such as the one presented. In instances like this, it's critical to work closely

with the healthcare team to get the best possible results for both the mother and the child.

Understanding each illness and its implications during pregnancy is critical for delivering appropriate

care and monitoring during the prenatal, birth, and postpartum periods. Also, ongoing education and

updates on evidence-based methods for high-risk pregnancies are required to provide quality treatment

effectively.

XI. LEARNING DERIVED

Escobar, Myrna

Careful management of multiple health condition in this case each of the condition of Mrs. Beltran can

increase the risk of complication during pregnancy labor and delivery by optioning for cesarean section

healthcare provider may have aimed to ensure the safety and well-being of both the mother and the

baby.

Castro, Maruella

Throughout the study I have acquired an in-depth knowledge regarding the diseases of diabetes

mellitus and hypothyroidism in a manner which it affects the human body. Furthermore, I have grasped

some understanding pertaining to the treatment of the diseases in a hospital setting in which I have

appreciated and added more beneficial knowledge to me as a student nurse which I can use to develop

my skills and knowledge to aid people.

Gomez, Kadelyn

The case study of a pregnant patient with hypothyroidism, diabetes, a history of hypertension, and

Tourette syndrome undergoing a cesarean section delivery highlights the complexity of care in

maternal health. It underscores the importance of thorough assessment, continuous monitoring, and

proactive management of multiple comorbidities during pregnancy and childbirth. As nursing

students, we realize the significance of interdisciplinary collaboration, effective communication, and

patient education to provide holistic care tailored to the individual's unique needs and ensure positive

outcomes for both the mother and the newborn.

Crabajales, Gerylle

It is important to continuously monitor the glucose level of the patient, especially when she undergoes

cesarean section, it is important to ensure timely detection and management of any fluctuations in blood

sugar levels, which can impact both the mother's recovery and the baby's wellbeing. Monitor the vital

sign and check for early signs of possible infection as postoperative infections can significantly prolong

recovery time and pose risks to the mother.

Cordero, Julia

Understanding the impact of hypothyroidism and diabetes during pregnancy can be eye-

opening. It highlights how intricate and interconnected our bodies are, especially during such a crucial

time as pregnancy. Learning about the increased risk of complications, such as fertility issues, abortion,

gestational hypertension, anemia, and postpartum hemorrhage for women with hypothyroidism,

underscores the importance of early detection and management of this condition.

Moreover, recognizing that these risks are even higher for those with overt hypothyroidism

versus sub clinical hypothyroidism adds depth to our understanding. It emphasizes the significance of

regular monitoring and treatment to ensure the best outcomes for both mother and baby.

Similarly, discovering the heightened risks associated with diabetes during pregnancy, such as

respiratory problems, low blood sugar, and jaundice in newborns, shines a light on the critical need for

comprehensive prenatal care for women with diabetes. It underscores the importance of proactive

management strategies to mitigate these risks and safeguard the health of both the mother and the

developing child.

Ultimately, these insights serve as a reminder of the intricate balance required for a healthy

pregnancy and the importance of medical intervention and support to navigate potential complications

effectively.

David, Charisse
The whole process of pregnancy encompasses both physical and mental readiness, and nutrition plays

a big role in ensuring the well-being of both the mother and the baby. Before the cesarean delivery,

proper nutrition is essential for the mother's health and the baby's development. A well-balanced diet

provides the necessary nutrients, vitamins, and minerals required for the body to function smoothly

during pregnancy and childbirth.

After having a cesarean delivery, it's still super important for the mom to eat well and for the baby to

stay healthy. Giving the body the right kinds of food help it get back energy it lost during childbirth, fixes

tissues, and helps with breastfeeding if the mom wants to do it.

Cunanan, Frances

This case provides useful information for student nurses handling high-risk pregnancies. It

emphasizes the importance of comprehensive assessments and collaborative care in improving

maternal and fetal health outcomes. Understanding the effects of maternal medical problems such as

hypothyroidism, diabetes, Tourette syndrome, and hypertension on pregnancy allows student nurses

to better appreciate the complexities of delivering care in these settings. Furthermore, it emphasizes

the significance of individualized care plans that are suited to each patient's unique requirements and

circumstances. This event teaches student nurses the value of effective communication among

healthcare team members and patient education in achieving favorable outcomes.

Dayrit, Matthew

This case highlights the importance of personalized medical decision-making in obstetrics, considering

both maternal and fetal well-being. It underscores how a comprehensive understanding of the patient's

medical history, including preexisting conditions and potential complications, informs the choice

between cesarean delivery and normal spontaneous delivery. Moreover, it emphasizes the significance

of interdisciplinary collaboration between obstetricians, endocrinologists, and other specialists to

mitigate risks associated with complex pregnancies. By prioritizing patient safety and optimizing

outcomes through tailored interventions, healthcare providers can navigate challenging scenarios like

this one effectively, ensuring the best possible outcome for both mother and child.
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