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

Dayrit, Gil Matthew B.

Escobar, Myrna

Ganaban, Andrew

Gomez, Kadelyn

Oliver, Verheugen

Submitted to:

Prof, Jerald Mendoza, RN

Clinical Instructor, NCM 109 -RLE

May 14, 2024

Date
 Case Scenario:

An Eight-year-old pediatric patient named Nunez, John Patrick Canlas was admitted to the

pediatric unit in Jose B. Lingad Memorial General Hospital with a history of chronic liver disease,

likely secondary to autoimmune hepatitis type 1 or Wilson disease, presenting with massive

ascites and hypoalbuminemia. The admitting diagnosis indicates the complexity of his condition,

which requires close monitoring and specialized care. Upon admission, John underwent a series

of tests, including hematological, biochemical assessments, and chemistry test to better

understand the extent of his liver disease and its impact on her overall health.

I. INTRODUCTION

Brief description of the diseases:

Autoimmune hepatitis type 1 is a chronic inflammatory liver disease characterized by

the body's immune system mistakenly attacking liver cells, leading to inflammation and

damage. Wilson disease, on the other hand, is a genetic disorder that causes copper to

accumulate in various organs, particularly the liver and brain, resulting in liver damage and

neurological symptoms. The presence of massive ascites, the accumulation of fluid in the

abdominal cavity, suggests advanced liver disease and portal hypertension, a common

complication of chronic liver conditions. Hypoalbuminemia, indicated by low levels of serum

albumin, highlights malnutrition and impaired liver function, as albumin is produced by the liver

and plays a crucial role in maintaining fluid balance in the body. Further diagnostic tests,

including hematological, biochemical, and chemistry assessments, were conducted to evaluate

the extent of John's liver disease and its impact on his overall health. These tests provide

valuable information about coagulation function, blood cell counts, and liver enzyme levels,

aiding in the management and treatment of his condition.

Current trends about the disease condition:

Medical advancements have led to more precise diagnostic tools for chronic liver

diseases like autoimmune hepatitis type 1 or Wilson disease. Techniques such as genetic

testing, imaging modalities like MRI or CT scans, and advanced biochemical assays help in

accurate diagnosis and understanding disease progression. Moreover, tailoring treatment

 plans based on individual patient characteristics and disease severity is a growing trend. With

advancements in pharmacogenomics and precision medicine, healthcare providers can select

therapies that are most effective and least toxic for pediatric patients like John, taking into

account factors such as age, weight, genetic predisposition, and comorbidities. Furthermore,

an ongoing research effort focus on understanding the underlying mechanisms of chronic liver

diseases in pediatric patients and developing novel therapeutic interventions. Clinical trials

investigating new drugs, immunomodulatory therapies, and gene therapies offer hope for

improved outcomes and quality of life for children like John with complex liver conditions.

These current trends about this condition reflect the developing field of pediatric hepatology

and highlight the importance of comprehensive, patient-centered care in managing chronic

liver diseases in children.

Reasons for choosing such case presentation:

The reason for selecting John's case involves different reasons of complication due to

his chronic liver disease, likely secondary to autoimmune hepatitis type 1 or Wilson disease.

This complexity provides an opportunity for healthcare professionals, medical students, and

researchers to further explore into the intricacies of diagnosing, managing, and treating such

challenging cases. Furthermore, by highlighting a pediatric patient like John emphasizes the

unique considerations and challenges in managing liver diseases in children. Pediatric liver

diseases often present differently from adult cases and require specialized care encouraged to

the developmental stage, nutritional needs, and psychosocial aspects of young patients.

Objectives:

1. Nurse-Centered

To provide comprehensive and compassionate care to John Patrick Canlas Nunez, an

eight-year-old pediatric patient admitted with chronic liver disease, ensuring optimal

management of symptoms, monitoring for complications, and supporting his overall well-being

throughout his hospitalization:

 Conduct thorough assessments of John's vital signs, fluid status, nutritional intake,

and pain levels to identify any changes or deterioration in his condition.

  Implement appropriate interventions to alleviate John's symptoms, such as

administering medications for pain relief, addressing discomfort associated with

ascites, and implementing measures to manage hypoalbuminemia-related

complications like edema and fatigue

 Monitor John's fluid intake and output meticulously, taking into account his massive

ascites and risk of fluid overload or dehydration.

 Administer medications prescribed for John's liver disease management, such as

immunosuppressants or chelating agents, ensuring accurate dosing, timing, and

monitoring for adverse effects.

 Recognize and address John's emotional needs and psychological well-being,

offering age-appropriate explanations, reassurance, and distraction techniques to

alleviate anxiety or fear related to his condition and hospitalization.

2. Client-Centered

 Provide age-appropriate explanations to John or to his parents/significant other

about his liver disease, including its causes, symptoms, and treatment options, using

language and materials that he or his significant other can comprehend.

 Teach John’s parents/significant other or John age-appropriate self-care skills and

strategies to manage his condition, such as adhering to medication schedules,

monitoring symptoms, and recognizing signs of potential complications.

 Provide a supportive and empathetic environment for John to express his feelings,

fears, and worries about his health and hospitalization.

 Involve John's family as partners in his care, providing support, guidance, and

resources to help them navigate the challenges of managing his chronic liver

disease. Offer opportunities for family members to participate in decision-making

processes, learn about John's condition, and acquire skills to support his ongoing

care and recovery at home.

 Develop a comprehensive discharge plan in collaboration with John, his family, and

the healthcare team, ensuring seamless transitions between the hospital and home

settings.
II. NURSING ASSESSMENT

NAME: NUNEZ, JOHN PATRICK CANLAS

AGE: 8 YEARS OLD

SEX: MALE

RELIGION: ROMAN CATHOLIC

NAME OF MOTHER: CANLAS, JULIE ANN

NAME OF FATHER: UNKNOWN

ADDRESS: 1077 SAN FRANCISCO ST. SANTA TERESITA

DATE OF BIRTH: MAY 23, 2015

PLACE OF BIRTH: Angeles City, Pampanga

NATIONALITY: FILIPINO

DATE OF ADMISSION: APRIL 29, 2024

FAMILY HISTORY

- John’s Chronic Liver Disease Secondary to Autoimmune Hepatitis Type 1 and

Wilson Disease massive ascites secondary to consider Hypoalbuminemia was inherited to

his father

HISTORY OF PAST ILLNESS

- Unknown

HISTORY OF PRESENT ILLNESS

- Chronic Liver Disease Secondary to Autoimmune Hepatitis Type 1 and Wilson

Disease massive ascites secondary to consider Hypoalbuminemia

PHYSICAL EXAMINATION
- Blood Pressure: 100/50 mmHg

- Heart Rate: 89 bpm

- Respiratory Rate: 26 breaths per minute

- Temp: 36.5 °C

CLINICAL FINDINGS:

Telmatology Test Normal Values

 Hemoglobin: 85g/h 115 - 148 g/dl

 LTCT: 0.27 (89) (0.27) 0.38 - 0.44

 RBC: 2.8 (2.9) mcL 3.8 – 5.4 mcL

 WBC: 3.0 (3.9) mm3 4.0 – 11.0 mm3

 Neutrophils: 66.5 (76.2) x10^9/L 45.0 – 55.0 x10^9/L

 Lymphocytes: 21.8 (14.3) x10^9/L 38.0 – 45.0 x10^9/L

 Amniocytes: 6.1 (7.6) x10^9/L 3.0 – 6.0 x10^9/L

 Eosinophils: 3.0 (1.4) x10^9/L 2.0 – 5.0 x10^9/L

 Basophils: 2.6 (0.5) x10^9/L 0.0 – 1.0

 Platelet: 80 (81) 3x10^11/unit 250 – 510 3x10^11/unit

 MCV: 97.3 (91.8) fl 80.0 – 100.0 fl

 MCHC: 316 (335) g/dl 310 – 370 g/dl

 RDW – W: 0.228 (0.81) fl 0.110 – 0.160 fl

 RDW – SD: 74.9 (67.8) fl 35.0 – 56.0 fl

 MPW: 10.3 (11.5) n/mm2 6.5 – 12.0 n/mm2

Chemistry Test

April 29, 2024

 Protein: 63.10 g/L 66.87 g/L

  Albumin: 16.90 g/L 35 – 52 g/dl

 Globulin 46.20 g/L 29 -31 g/L

 A/G Ratio: 3.66 g/dl 12 – 17 g/dl

 SGOT / AST: 82.30 IV/L 0.40 IV/L

 Sodium: 129.00 mmol/L 136 – 145 mmol/L

 Potassium 2.40 mEq/L 3.5 – 5.1 mEq/L

 Ionized calcium: 1.08 mg/dL 1.12 – 1.33 md/Dl

 ABOTYPING A

 PH TYPING POSITIVE (+)

May 1, 2024

 Sodium: 133.00 mmol/L 136 – 145 mmol/L

 Potassium: 2.90 mEq/L 3.5 – 5.1 mEq/L

 Ionized Calcium: 1.10 mg/dL 1.12 – 1.33 mg/dL

May 6, 2024 #4

 Protein: 64.90 g/dL 66 – 87 g/dL

 Albumin: 20.10 g/dL 35 – 52 g/dL

 Globulin: 44.80 g/dL 29 – 31 g/dL

 A/G Ratio: 4.49 g/dL 12 -17 g/dL

May 6, 2024 #5

 Albumin: 20.40 g/dL 35 – 52 g/dL

 Globulin: 45.60 g/dL 29 – 31 g/dL

 A/G Ratio: 4.49 g/dL 12 – 17 g/dL

III. ANATOMY AND PHYSIOLOGY

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 - Verify patient

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

Date Results carries it throughout capacity to carry

- Ensure patient
In: the body, oxygen all
comfort during blood
facilitating throughout the
sample collection and
March 18, 2024 tissues/ body since
oxygen delivery to educate the patient
tissues and organs. an abnormally
(9:56 am) that there will be
low HgB can be an
 indication of
anemia.

discomfort during the

Date Ordered: Hematocrit is the Measuring 37.00 - 47.00 procedure.
Hematocrit 39.4 Within normal range
March 18, 2024 ratio of hematocrit levels
%
With the collaboration
identifies the
(7:17 am) Red Blood Cells of other healthcare
percentage volume
(RBC) to the total providers, collecting
of RBC in the
Date Results blood of the body blood samples from
In: overall blood of the the patient is done.
body which
March 18, 2024
indicates levels of

(9:56 am) blood- oxygen

carrying capacity.
- Label
samples accurately
and send them for
 Date Ordered: In order to monitor 4.00 - 6.00 x analysis promptly.
RBC Count Red Blood Cell 4.50 Within normal range
March 18, 2024 and early diagnose
(RBC) Count 10^12/L - Monitor for
any abnormalities
(7:17 am) measures the level signs of bleeding or
in levels which
of RBC in the blood hematoma
could be an
Date Results which delivers formation post-
In: oxygen in the body. procedure.
indication of
conditions affecting
March 18, 2024 - Educate
RBC like anemias.
patient on potential
(9:56 am)
discomfort or bruising
at the puncture site
Mean 80.00 -
MCV To assess the 87.6 Within normal range
Date Ordered: Corpuscular - Review CBC
average size of red 100.00 fl
March 18, 2024 Volume, or results and report
blood cells, aiding
in the diagnosis of abnormalities in the
(7:17 am) MCV, is a CBC-
various types of healthcare teams.
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
 (7:17 am)
Corpuscular complications like
Date Results Hemoglobin, or deficiency that

In: MCH, measures the leads to anemia

average amount of that endanger the
March 18, 2024 HgB per RBC. maternal and fetal
well-being.
(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
The WBC 10^9/L
number of white
(7:17 am) count in pregnancy
blood cells in a
is important for
Date Results blood sample,
monitoring
reflecting the
In: maternal immune
body's immune
function and
March 18, 2024 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
The eosinophil test Range
type of white blood
in pregnancy helps
cell involved in the
monitor immune
immune response,
function and detect
particularly in
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 Platelet count in 10 Range
number of pregnancy is ^9/L
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 and identification.
 Date Results - Explain the
function by detect any potential procedure clearly.
In:
measuring waste complications
- Assist with
March 18, product levels in the during pregnancy. specimen collection.
2024 blood.
- 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 - Monitor
indicate are monitored to mmol/L
electrolyte patient response.
ensure
(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 results.

In:
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

DATE STARTED DATE
MEDICAL GENERAL DESCRIPTION PURPOSE CLIENTS RESPONSE RESPONSIBILITIES
CHANGED
MANAGEMENT
#1 D5LRS DATE STARTED In response to D5LRS - Verify
3/25/24 infusion, the client physician's orders for
exhibited stable vital signs D5LRS administration.
6:40 am
and reported feeling
adequately hydrated with
5% Dextrose in no adverse reactions noted. - Assess the
DATE CHANGED Lactated Ringer’s patient's fluid and
5% Dextrose in
3/25/24 Solution is a solution specifically an electrolyte status.
Lactated Ringer's Solution may be
9:30 am electrolyte solution such as sodium,
indicated for pregnant women or those
potassium, calcium, and lactate,
post-delivery to address dehydration, - Prime IV
#2 D5LRS DATE STARTED designed to replenish fluids and
maintain electrolyte balance, and tubing with D5LRS
3/25/24 electrolytes in patients. It is
support fluid volume during
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 D5LRS with 10 units of oxytocin is an D5LRS with 10 units of oxytocin is In response to the - Assess
units 3/25/24 4pm intravenous solution containing administered to pregnant women or administration of D5LRS patients for signs of
dextrose, electrolytes, and oxytocin, those post-delivery to induce or with 10 units of oxytocin, fluid overload or
OXYTOCIN
commonly administered during augment labor, promoting uterine the client experienced
dehydration.
pregnancy to support hydration, contractions and preventing uterine contractions
DATE CHANGED
maintain electrolyte balance, and postpartum hemorrhage. intensifying, leading to
3/25/24 promote uterine contractions during progress in labor. - Monitor blood
12am labor. glucose levels in
diabetic patients
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

Generic and Brand Classifications Indication / Specific Dosage, frequency Side

Yellowing of the
effect and  Do not give any
Nursing
Generic
name Name: Histamine2 Antagonist suppresses
action / Mechanism the release of and Dosage:
preparation skin or the
Adverse reactions new medication
consideration
Ranitidine of gastric
action acid by 50mg selera during therapy
Generic and Brand Classifications blocking histamine
Indication / Specific at Dosage, frequency Side effect and Nursing
without
Brand
nameName: the H2
action receptor siteof
/ Mechanism Frequency:
and preparation  Indigestion
Adverse reactions
Tirediness  Monitor forthe
consideration
consulting
Zantac
Generic Name: Analgesic which isaction
mainly found
Prostaglandin Q8hrs
Dosage: physician
therapeutic
Generic
Generic and Brand
and
DiclofenacBrand Classifications
Classifications inIndication
gastric
synthesis
Indication // Specific
parietal
is reduced cells.
Specific by Dosage, frequency
75mg
Dosage, frequency Side Side effect
effect
Dark and
and
Urine Nursing
Nursing
stomach pain effectiveness.
name
name action / Mechanism
the drug's
action / Mechanism strong of of and preparation
Preparation:
and preparation 
Adverse
Adverse reactions reactions
Sweating consideration
Instruct
consideration the
to take
Generic Name:
Brand Name: Opioid Analgesic Binds action
to mu-opioid of
Short-termtreatment
cyclooxygenase
action Dosage:
I.V
Frequency:  Stomach Pain patient
medication to
Tramadol
Voltaren receptors.
activeduodenalulcers Inhibits
inhibitory action. 50mg
Q3hrs 3doses  nausea Dizziness and  Observe
exactly asand
increase fluid
Generic and Brand Classifications Indication /
reuptake of serotonin
andbenigngastriculcers Specific Dosage, frequency Side effect
Nausea and
vomiting Nursing
 Monitor
report
intake for
signs
to and of
prevent
name action
Treatment / Mechanism of and preparation  Nausea
Adverse
vomiting
Confusion and
reactions
Administer
directed
consideration
with
not
Generic
Brand
Generic Name:
Name:
Name: Dopamine receptor
Opioid analgesic andAnalgesic
Tramadol . diabetic
of
norepinephrine and in Dosage:
Frequency:
Dosage:
Preparation:  Vomiting Nausea and anxiety
dry mouth
bleeding
to increase
food and
or milk toand
Metoclopramide
Ultram
Tramadol + antagonist paracetamol action
gastroparesis
the CNS. has faster 10mg
Q6hrs
50mg constipation
antipyretic effects in I.V  Restlessness
vomiting
Agitation
diarrhea restlessness
dose.
prevent And GI upset
Paracetamol symptoms,
onst of action
symptomatic treatment  Headache instruct
during
 Administer IVthat
Monitor for the it
signs
Brand Name: Reliefimplantation
of moderate of Frequency: Anorexia
compared
of postpartum painto
to tramadol Preparation:
Frequency:  Dry mouth  For
may a better
take days
Generic
Reglan
Brand
Name:
Name:
Non-opioid Analgesic selectively
intestinal
moderately
alone and
inhibits
feeding
severe
longerpain
Dosage:
Q8hrs
I.Vq8hrs
1 tablet  Depression
Drowsiness
constipation  administration.
and
drug
Assesssymptoms
with
analgesic food or
patient
Celecoxib cyclooxygenase 2 200mg bedofre effect
Ultracet duration ofand
tubes, action Dizziness
 Convulsion of
BP GI
after
give irritation
meals
and
drugs
noticeable if GI
RRrelief
(COX-2)
chemotherapyan enzyme  Fatigue
Hallucination
compared to or Preparation:
Preparation:  Fatigue
headache  Monitor
upset
beforeoccurs
periodically renal
the onset
Brand Name: required for
postoperative Frequency:
I.V
paracetamol P.O Stroke
 Seizure
Constipation function,B/P,
of intense
 during
Advice thepain
Celebrex biosynthesis
treatment fortonausea prevent BID capsule Blurry vision
the synthesis of  Insomnia heart
 Establish rate
patient to safety
administration
and vomiting dizziness
Postparative pain  consult
Reassess the or if
prostaglandins. Preparation:  Hypertension
Tachycardia
Hypotension measurements
management treatment monitor
physician
 Monitor the level
first
daily
P.O  Dystonia CNS or visual
Administer drug
for a patient having a drowsiness of pain at least
before
Management of acute Dyspnea patternin ofbowel
disturbances
caesarean delivery.  Edema
Respiratory early
30mins the
afterday
breastfeeding
pain activity, stool
 Myoclounu
arrest
itching occur
so increase
administration
 Abdominal pain consistency
urination will not
 Dizziness
Bradycardia
increased  Monitor
disturb sleeppatient's
 Diarrhea
sweating vital signs
Anxiety
 Dyspnea
Nausea and
 increased blood
Diarrhea pain
 Vomiting
Abdominal
pressure
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, constipation, atelectasis, precautions. Assess the patient's ability to

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

immediate postoperative promoting circulation, consider the use of pain medication or analgesia

period. It includes assisting improving lung expansion, as needed.

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

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

distances to promote transfers, and mobility exercises. Offer

circulation, prevent ● Ambulation supports the encouragement, reassurance, and guidance to

complications, and facilitate recovery process by promote confidence and independence in

recovery following surgery. 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

pt. will identify at baby’s health.

BP: 120/80 mmHg least foods that Glucose screening is

PR: 95 bpm should be avoided to done on the 24th or

RR: 20 breaths per maintain stable 28th week of

minute blood glucose levels. gestation to detect

O2 – 98% 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
Evaluate the client’s active participation in
Temp – 36°C symptoms of fatigue. outlook for fatigue planning,

BP: 120/80 mmHg relief, eagerness to implementing, and

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

decrease fatigue.

Long term:
Recognizing
Collaborate with the
Encourage the client relationships
patient to set
to maintain a 24- between specific
realistic daily activity
hour fatigue or activities and levels
goals that balance
activity log for at of fatigue can aid the
activity with rest.
least one week. client in recognizing

Encourage gradual unnecessary energy

increase in light
outflow.
physical activities

(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

RR: 20 breaths per Blood Glucose balanced diet rich in RR: 20 breaths per
minute Monitoring Initiation nutrients and fiber. minute

O2 – 98% to establish a O2 – 98%

baseline of blood

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
pregnancy
postpartum follow-
blood glucose in the
outcomes.
up.
longer term,

reducing the risk of

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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