Deceased Respiratory MRP46UNRECALL0SP 26 UNRECALL MSP 50 RPUNRECALL SP AgingPRP UNRECALL ARP Problem I.

Patient

Arthritis

Introduction This is the case of Mrs. MRP a 26 years old woman who has a diagnosis of G3P2(2002) from Tuktukan Guiguinto, Bulacan. She was admitted at Ospital ng Guiguinto on February 8, 2012 with a chief complaint of labor pains and positive findings of 8-9cm dilated, cephalic and a positive broke of water bag. She was rushed at 5:00 am to the delivery room to deliver her 3rd baby 38 weeks of gestation via normal spontaneous vaginal delivery. Her baby Girl was delivered at exactly 7:56 am. She was discharged at the hospital last February 9, 2012.

Labor is a physiologic process during which the products of conception (ie, the fetus, membranes, umbilical cord, and placenta) are expelled outside of the uterus. Labor is achieved with changes in the biochemical connective tissue and with gradual effacement and dilatation of the cervix as a result of rhythmic uterine contractions of sufficient frequency, intensity, and duration. Labor is a clinical diagnosis. The onset of labor is defined as regular, painful uterine contractions resulting in progressive cervical effacement and dilatation. Cervical dilatation in the absence of uterine contraction suggests cervical insufficiency, whereas uterine contraction without cervical change does not meet the definition of labor. A spontaneous vaginal delivery is defined as the delivery of a baby through the vagina and a vaginal birth occurring without the mechanical assistance of obstetric forceps or vacuum aspirator. In order for a vaginal delivery to occur, the baby must be in a head down position. Dr. Marjorie Greenfield, MD, notes that breech babies, or those who are in the butt first or feet first position, have a higher risk of complications when born vaginally. The Philippine Birth Center statistics report that there are 3.4 million pregnancies occur every year 95% of them give birth by normal spontaneous vaginal delivery in year 2003. NSD ranked as the 2nd for the most common procedure done for delivery in the Philippines according to the PhilHealth since January to September of 2011 having a number of 159,755 claims.

B. Objectives
Knowledge a. To gather information for the concept, purposes and indication of Normal Spontaneous Delivery b. To know and understand common complications of Normal Spontaneous Delivery and ways they

can be prevented. c. To determine the right nursing actions in rendering care for Normal Spontaneous Delivery.
Skills a. To do a nursing diagnosis related to Normal Spontaneous Delivery. b. To perform preoperative and postoperative care measures for Normal Spontaneous Delivery such

as relieving pain. c. To practice effective communication skills when doing functional health pattern.

Attitude a. To promote a therapeutic nursing relationship to our client b. .To establish outcomes that meets the needs of the woman who underwent Normal Spontaneous

Delivery
c. To impart knowledge and information about the Normal Spontaneous Delivery to the mother and

other significant people.

II. Nursing Assessment

A. Personal History

Demographic Data of the Patient

Our clients name is MRP. She lives in Tuktukan, Guiguinto, Bulacan. She is 26 yrs. old, living in with VG. They are not married. They already have three children (including the newborn). Her parents name are SP and RP. She was born on March 26, 1985. Her birthplace was in Naga City. Her LMP was May 18, 2011; AOG of 38 wks.; EDC should be on February 25, 2012. But according to our client she was rushed to the hospital because of early labor last February 2, 2012 and she also felt pain in her hypogatric area radiating to lumbosacral area. She is catholic, single, Filipino and a sewer. She deliver an alive baby girl at exactly 7:56 am. Her attending physician is Dra. Rica Marie R. Hernaez. B. Reason for visit (Chief Complaint) Labor pains and positive findings of 8-9cm dilated; cephalic and positive broke of water bag. C. History of the Present Illness Mrs. MRP is experiencing labor pains. D. History of the Past Illness She doesnt have any childhood illness, allergies, accidents and injuries or hospitalizations.

E. Family Health History

Gordons 11 Functional Health Pattern

Prior to Hospitalization

During Hospitalization

Health Perception-Health Management Pattern

According to our Siguro ngayon, client her health was good during 8 yung grade ko sa sarili ko, her pregnancy. Ok lang naman maayos naman kasi kong ako pagdating sa pagkain, saging nakapanganak, at hindi na ako ang aking napaglihan noong buntis mahihirapan sa gawaing bahay, as pa ako, as verbalized by the verbalized by the client. She stated client. I asked her to rate her healththat she doesnt have any problems from 1-10 (10 as the highest), 5 in caring for herself. Siguro sa yrs. ago she got pregnant and 5 ngayon, hindi ko masasabi kung yrs. ahead. She have stated that 5 kaagad akong makagagawa ng yrs. ago she would rate her health pang araw-araw na kong gawain, with a score of 9 because she as verbalized by the client. As I doesnt feel any problems that have observed to our client, she
4

Gordons 11 Functional Health Pattern

Prior to Hospitalization

During Hospitalization

Nutritional-Metabolic Pattern

would stop or make her as an looks exhausted and very tired unhealthy person, and she rated may be because of the delivery. her health 5 yrs. ahead with the But during our interview, she score of 9 same reason as she have always smile and make sure that stated her health 5 yrs. ago. her answers will deal with our Siguro 9 lang ibibigay ko at hindi questions. perfect score na 10 kasi syempre hindi rin naman ako sure kung healthy nga talaga ako, as verbalized by the client. And she also rated her health during pregnancy, and her score was 5. Nahihirapan din naman kasi ako minsan, kasi syempre mahirap at maselan kapag buntis ang isang tao, kung minsam medyo sumisikip ang dibdib ko kaya nahihirapan akong huminga, as verbalized by the client. During her pregnancy, she have stated to us that she had fever three times for her whole gestational period. Nung buntis ako tatlong beses akong nilagnat, kasi may UTI ako, as verbalized by the client. She have stated that she is very careful in terms of doing her daily activities. Malaki ang epekto ng pagbubuntis ko sa mga gawain ko, mahirap kasing magkikilos at maingat na maingat ako, mahirap na kasi baka mamaya may mangyari pa sa aking hindi maganda, as verbalized by the client. When the client had fever she was rushed to the hospital and was confined there, the doctor or physician gave her antibiotics to
5

Gordons 11 Functional Health Pattern

Prior to Hospitalization

During Hospitalization

lessen or eradicate the infection, Niresitahan ako ng doktor, Cefuroxime Axetil (pinakita samin ang balutan ng gamut) noong mga unang araw ko sa ospital, pero We have asked nung nagtagal tagal pa, Cefurox na ang binigay sa akin, as verbalized our client to have a 72 hour diet recall and she have stated that on by the client. The client have the 1st day she ate, fried milkfish stated that she cannot recall the w/ rice and milk for breakfast, for exact number of days she was her lunch she ate bopis w/ rice and admitted, but she have stated a water and also drank orange juice range of 5-7 days. During her pregnancy, she visit her ob-gyne and for dinner she ate chopsuey w/ rice, fried milkfish and water. On once a month for her prenatal the 2nd day, she ate lugaw and milk check-up and took all the for lunch and dinner she ate medicines prescribed by her physician. Noong buntis ako menudo w/ rice and water. On the 3rd day she ate lugaw w/ egg for hindi ako umiinom ng alak o naninigarilyo, hindi ko naman kasi breakfast fried chicken w/ rice and water for lunch and dinner. During talaga ginagawa iyon, as verbalized by the client. The client hospitalization, she is eating w/ 3 verbalized she works as a sewer. cups of rice. She also stated that Nagtatrabaho ako sa tahian, pero whatever she is eating when she was pregnant was lessen now (e.g. hindi ako expose sa mga polusyon, as verbalized by the banana). Yung mga kinakain ko nung buntis ako, e hindi ko na client. masyadong kinakain ngayon, as During her verbalized by the client. During pregnancy, she have stated she her hospitalization, she drinks always ensure that she always water 6 times a day & milk one include a healthy food whenever time a day. Ngayong she is eating. Nung buntis ako nakapanganak na ko hindi na nga dalawang takal ng kanin ang madalas sumasakit ang lalamunan kinakain ko, as verbalized by the ko, as verbalized by the client. client. During her 1st month of She is also experiencing pain on pregnancy she experienced food her lower abdominal area, and she cravings mostly banana. All will rate the pain as 2. As I have throughout her pregnancy, she observed our client, she has a pale always drink multivitamins w/ iron
6

Gordons 11 Functional Health Pattern Elimination Pattern

Prior to Hospitalization

During Hospitalization

Activity/ Exercise Pattern

and ferrous sulfate. Iniinom ko color of the skin, her face grimace yung mga gamut na binibigay ng was sometimes sad or like she is doktor ko, as verbalized by the feeling so much pain and tiredness. client. She doesnt drink any May be because of her delivery herbal medicines during her thats why her face grimace is pregnancy. She prefer sweet foods sometimes like that. like brownies and chocolates when she was pregnant. Mahilig ako nun sa matatamis, kagaya ng hersheys chocolate, as verbalized by the client. When she was pregnant, she drinks 4-5 glasses of water a day, 1 glass of juice a day and 2 glasses of milk a day. She Output Frequency Amount doesnt feel any difficulties in terms of swallowing. May Urine 2 500ml dalawang sira sa ngipin ko, parehong nasa taas, as verbalized by the client. There are times she experienced having a sore throat, and she stated that drinking cold Stool ----------water and eating chocolate with caramel make her to experience difficulty in swallowing. When she was on her early stage of pregnancy (1-2 mos.), she Hindi pa ako experience vomiting. Siguro nadudumi as verbalized by the nung 1 buwan palang akong buntis, nagsusuka ako pero hindi client. According to the client she ako nahihilo nun, as verbalized has no difficulty in urination. by the client.

During the 1st

7

Gordons 11 Functional Health Pattern

Prior to Hospitalization

During Hospitalization

Output Urine

Frequenc y 6

day in the hospital, patient was still not able to walk. When she needs anything, she asked her husband. She was able to walk slowly to go to restroom, with Amount assistance of her husband. According to 200ml client even if she was finished in delivering her baby she will not be able to return her 100%effectiveness in doing work. Because she needs to care for her four babies.

Sleep-Rest Pattern

Stool

0-feeding II-bathing Cognitive-Perceptual Pattern II-toileting II-bed mobility II-general mobility

II-dressing II-grooming

Level 0- full self-care Level I- requires use of Usually, the equipment/device patient defecates once a day; it is formed and dark green in color. Level II- requires assistance or She stated that she urinates 6 times supervision from another person a day , with yellowish urine color. According also to the client she has difficulty in urination because She takes a of having urinary tract infection nap less than 1 hour and she (UTI). verbalized hindi ako makatulog dahil hindi ako sanay ng may mga
8

Self Perception-Self Concept Pattern

Gordons 11 Functional Health Pattern

Prior to Hospitalization

During Hospitalization kasama sa kwarto sa katunayan nga wala pa akong masasabing tulog e, paidlip idlip lang.

Role-Relationship Pattern

Lagi akong naglalakad sa umaga hindi pareparehas ang layo ng nalalakad ko, as verbalized by the client.

The client works in week days and on week end she do household chores. Texting is the pastime of the client and watching TV. According to the client her effectiveness in working The client is able to understand her is decrease when she got pregnant current condition. Ayos naman, again, because there is a work that naiintindihan ko naman ang aking she cant give her 100 % . pangkasalukuyang kondisyon. Dahil kapapanganak ko lang 0-feeding 0kailangan ko magpahinga at dressing kumain ng masustansya para sa 0-bathing 0aking pangangatawan at para din grooming sa pag papasuso ko sa aking mga 0-toileting 0-bed anak, as verbalized by the client. The client is able to communicate mobility well. Nauunawaan ko ang aking 0-cooking 0-home pangkasalukuyang kondisyon, minsan kapag hindi ko alam ang 0-shopping binibiyan ng doctor o nurse na 0-general mobility maintenance mga gamot , tinatanong ko kung para saan ang mga ito, as verbalized by the client. And when Sexuality-Reproduction Pattern it comes to decision making the Level 0- full self-care client is also able to decide for herself and her family. Level I- requires use of equipment/device Level II- requires assistance or supervision from another person The patient sees herself now as short-tempered. When I ask the client how she feel now about

Gordons 11 Functional Health Pattern

Prior to Hospitalization

During Hospitalization herself, the client verbalized, Ayos lang naman.

Our client has a continuous 8 hours of sleep at Coping Stress Tolerance Pattern night. According to her, she The client watches television for 4 hours before falling asleep. She is takingdescribe her family, maayos ang a nap for atleast 30 minutes duringaming pamilya at kami ay afternoon. Her form of relaxationnakabukod ng tirahan,sa ngayon is watching TV and caring herna ako ay nanganak, ang aking asawa ang nagdedesisyon sa children. aming pamilya, as verbalized by the client. And the financial Value-Belief Pattern supporter of the family for now is her husband. And the most important person on the clients life, is her family & the newborn infant. The clientis able to understand her condition. And the client was able to communicate well. Nauunawaan ko ang aking kalagayan ngayong ako ay buntis.at nagtatanong din naman ako sa doctor o nurse kung para saan ang binibigay sa aking gamut, as verbalized by the client. And when it comes to decision making, pagdating sa pagdedesisyon minsan ang pakiramdan ko ay nahihirapan ako, lalo na kapag patungkol sa aking pamilya kapag may problema, as verbalized by the client.

The patient described herself as

10

Gordons 11 Functional Health Pattern

Prior to Hospitalization easily irritated by noise. Her weakness is when her family encounters problems and she considers her children as source of strength. She said she wants to gain weight. She feels pity to those people who have disabilities.

During Hospitalization

Ayos naman ang aming pamilya, kami ay nakabukod ng tirahan,kami ay No sexual nagsasama-sama pag lingo upang practice. She has an ob score of magsimba ako at aking asawa ang G3P3 (3003.) nag dedesisyon sa aming pamilya, as verbalized by the client. Kaming mag asawa ay nagtratrabaho, ngunit ang kanyang ate na nasa amerika ay nagbibigay din sa pamilya ng pinansyal na supporta, as verbalized by the client. She is the one who that makes decision on their home, ako ang nagdedesisyon sa aming bahay, as verbalized by the client. During The family deals and solve the hospitalization, the most stressful problem, with her family. There is situation in her is lack of sleep. no any major problem now in their After giving birth, she feels family, Wala naming mabigat na happier now. Her husbands sister problema sa pamilya naming helped them in their expenses. ngayon, as verbalized by the client. Ako at ang aking asawa ay factory worker bilang quality control, at maayos naman ang pakikitungo ng aking mga katrabaho at kung may babaguhin man ako sa aking trabaho? Wala The patients akong babaguhin, sapagkat values and beliefs during marangal naman ang aming hospitalization are still the same. trabaho, ngunit ang tanging
11

Gordons 11 Functional Health Pattern

Prior to Hospitalization nagiging problema sa aming trabaho ay ang kalat, as verbalized by the client. Ang aking pamilya ang pinaka importante sa aking buhay, at maayos naman ang pakikitungo ng aking mga kapitbahay at ang aking mga kabaryo friendly naman sila at ayos naman ang aming community kaya wala na kung gustong baguhin pa, as verbalized by the client. Our client had her 1st menstruation when she was 13 years old and her 1st sexual experience when she was 19 years old with her husband. For her 1st first year of being married, they were having coitus twice a week and later on once a week. She is taking pills as a mean of contraception. She is not approve on having oral neither anal sex with her partner. She has an ob score of G3P2 (2002).

During Hospitalization

The most stressful situation in her life is when her children are sick. There have been no personal or major changes in her life over the last year. When she is facing a problem, she and her husband talk about on how to solve it. To relieve stress and tension, she just take a
12

Gordons 11 Functional Health Pattern

Prior to Hospitalization rest and sleep.

During Hospitalization

Her family is the most important to her life. She hopes her children finish their studies. Her husband influences her in making decisions. Her religion is Catholic. Relationship with God is important for her

G. Growth and Development THEORY STAGE

PSYCHOSOCIAL Intimacy Isolation (Erik Erikson) versus

COGNITIVE Formal Operation (Jean Piaget)

PSYCHO Genital

(Sigmun

13

DEFINITION

Intimacy is the ability relate well with other people not only with members of opposite sex but also with ones own sex to form long lasting friendships. Parents without a sense of intimacy may have more others difficulty accepting than a and

Can solve hypothetical problems with scientific reasoning; understand causality and can deal with the past, present, and future. Adult or mature thought.

Energy toward and

maturity

de

skills n

with the

pregnancy newborn child

beginning to love a

REMARKS/ANALYSIS

(+)

the patient has a possibility of intimacy

(+)

the

patient

is

(+) The higher

higher creating

successfully developing formal operations because she was able to understand her present condition and have a good adjustment into it. Shes enjoying happy being and a

successf because

because she has a good relationship with her husband and her children. She is really grateful because she has a new child.

her psyc

have a

relations

mother and a wife.

H. Theoretical Application THEORY

14

THEORIST DESCRIPTION APPLICATION OF THEORY TO THE PATIENT 14 Components of basic Nursing Care Virginia Henderson

Henderson (1996) conceptualizes the nursing role as assisting sick or healthy individuals to gain independence in meeting 14 fundamentals needs.
1. Breathing normally 2. Eating and drinking adequately 3. Eliminating body wastes 4. Moving and maintaining desirable position 5. Sleeping and resting 6. Selecting suitable clothes 7. Maintaining body temperature within normal range 8. Keeping the body clean and well-groomed 9. Avoiding dangers in the environment 10. Communicating with others 11. Worshipping according to ones faith 12. Working in such a way that one feels a sense of accomplishment 13. Playing/participating in various forms of recreation 14. Learning, discovering or satisfying the curiosity that leads to normal development and health

and using available health facilities.

15

We must know the 14 basic needs to provide a rationale for collecting reliable and valid data about the health status of clients, which are essential for effective decision making and implementation. Also this theory help us for prioritizing the nursing problem Assess the patients for 14 fundamental needs and what is/are lacking. Implementation phase uses the 14 basic needs in answering the factors that contributes to the illness

Concept of Twenty One Nursing Problems Faye Glenn Abdellahs

Nursing is broadly grouped into 21 problem areas to guide care and promote the use of nursing judgement.

We use it as a guide in doing nursing care plan to easily determine the health status of the client.

Maternal Role Attainment Becoming a Mother

Ramona T. Mercer

Maternal role attainment is an interactional and developmental process occurring over time in which the mother becomes attached to her infant, acquires competence in the caretaking tasks involve in the role, expresses pleasure and gratification in the role (mercer,1986a).the movement to the personal state in which the mother experience a sense of harmony, confidence, and competence in how she perform the role is the end point of maternal role attainment _maternal identity(Mercer,1981)

16

We use it to understand and provide a foundation in implementing a nursing action because in this theory it said that a mother should able to had maternal identity, self-esteem, self-concept and flexibility to prevent any problem like anxiety, depression and gratification satisfaction .

III. Anatomy and Physiology

Female Genital Organs

17

18

Mons Pubis In human anatomy or in mammals in general, the mons pubis (Latin for "pubic mound"), also known as the mons veneris (Latin, mound of Venus) or simply the mons, is the adipose tissue lying above the pubic bone of adult females, anterior to the pubic symphysis. The mons pubis forms the anterior portion of the vulva. The size of the mons pubis varies with the general level of hormone and body fat. After puberty it is covered with pubic hair and enlarges. In human females this mound is made of fat and is supposed to be larger. It provides protection of the pubic bone during intercourse. In humans, the mons pubis divides into the labia majora (literally "larger lips") on either side of the furrow, known as the pudendal cleft, that surrounds the labia minora, clitoris, vaginal opening, and other structures of the vulval vestibule. The fatty tissue of the mons pubis is sensitive to estrogen, causing a distinct mound to form with the onset of puberty. This pushes the forward portion of the labia majora out and away from the pubic bone. Prepuce of Clitoris In female human anatomy, the clitoral hood, (also called preputium clitoridis and clitoral prepuce), is a fold of skin that surrounds and protects the clitoral glans. It develops as part of the labia minora and is homologous with the foreskin (equally called prepuce) in male genitals. Women with hoods covering most of the clitoris can often masturbate by stimulating the hood over the clitoral glans, an action which is homologous to masturbation in the male with a foreskin. Those with smaller, or more compact structures tend to rub the clitoral glans and hood together as one item. Normally, the glans clitoris itself is too sensitive to be stimulated directly, such as in cases where the hood is retracted. This increased sensitivity due to their nature as internal structures is also found in younger intact males, particularly before full retraction around puberty has occurred. The clitoral hood also provides protection to the clitoral glans like foreskin on the penile glans. During sexual stimulation, the hood may also prevent the penis from coming into direct contact with the glans clitoris, which is usually stimulated by the pressure of the partners' pubis. Most mammals and primates approach copulation from the rear instead of the common frontal position that humans often assume, so the clitoral stimulation is directly created by glans contact with the scrotum at the base of the penis and the different contractions of its corrugated dartos muscles. The clitoral glans, like the foreskin must be lubricated by the naturally provided sebum. If a woman's clitoral glans is not lubricated the hood may not caress it during sexual stimulation, or the female may experience pain rather than pleasure.

19

Glans of Clitoris The head or glans of the clitoris is roughly the size and shape of a pea, although it can be significantly larger or smaller. The clitoral glans is highly sensitive, containing as many nerve endings as the analogous organ in males, the glans penis, but concentrated in a smaller surface, thus making it particularly well-suited for sexual stimulation. During arousal, the glans becomes engorged with blood and sometimes protrudes outside from the clitoral hood or bulging under it. Labia Majora The labia majora (singular: labium majus) are two prominent longitudinal cutaneous folds that extend downward and backward from the mons pubis to the perineum and form the lateral boundaries of the pudendal cleft, which contains the labia minora, interlabial sulci, clitoral hood, clitoral glans, frenulum clitoridis, the Hart's Line, and the vulval vestibule, which contains the external openings of the urethra and the vagina. Each labium majus has two surfaces, an outer, pigmented and covered with strong, crisp hairs; and an inner, smooth and beset with large sebaceous follicles. Between the two there is a considerable quantity of areolar tissue, fat, and a tissue resembling the dartos tunic of the scrotum, besides vessels, nerves, and glands. The labia majora are thicker in front, where they form by their meeting the anterior commisure of the labia majora. Posteriorly, they are not really joined, but appear to become lost in the neighboring integument, ending close to, and nearly parallel to, each other. Together with the connecting skin between them, they form the posterior commisure of the labia majora or posterior boundary of the pudendum. The interval between the posterior commissure of the labia majora and the anus, from 2.5 to 3 cm. in length, constitutes the perineum. The labia majora correspond to the scrotum in the male. Between the labia majora and the inner thighs are the labiocrural folds. Between the labia majora and labia minora are the interlabial sulci. Labia Minora The labia minora (singular: labium minus), also known as the inner labia, inner lips, or nymphae, are two flaps of skin on either side of the human vaginal opening, situated between the labia majora (outer labia, or outer lips). Inner lips vary widely in size, colour, and shape from woman to woman. The inner lips extend from the clitoris obliquely downward, laterally, and backward on either side of the vulval vestibule, ending between the bottom of the vulval vestibule and the outer lips. The posterior ends (bottom) of the inner lips are usually joined across the middle line by a fold of skin, named the frenulum labiorum pudendi or fourchette. On the front, each lip divides into two portions. The upper part of each lip passes above the clitoris to meet the upper part of the other lipwhich will probably be a little larger or smallerforming a fold which overhangs the glans clitoridis; this fold is named the 20

preputium clitoridis. The lower part passes beneath the glans clitoridis and becomes united to its under surface, forming, with the inner lip of the opposite side, the frenulum clitoridis. On the opposed surfaces of the labia minora are numerous sebaceous glands not associated with hair follicles. Hymen The hymen is a membrane that surrounds or partially covers the external vaginal opening. It forms part of the vulva, or external genitalia. The size of the hymenal opening increases with age. Although an often practiced method, it is not possible to confirm with certainty that a girl or woman is a virgin by examining her hymen. The hymen can break from physical activity, tampons, or from sexual intercourse. In children, although a common appearance of the hymen is crescent-shaped, many variations are possible. After a woman gives birth, she may be left with remnants of the hymen, called carunculae myrtiformes, or the hymen may be completely absent. Vagina/Vaginal Entrance The vagina (from Latin vgna, literally "sheath" or "scabbard") is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the oviduct. The Latinate plural "vaginae" is rarely used in English. The word vagina is often used colloquially to refer to the vulva or to the female genitals in general; technically, the vagina is the specific internal structure. In humans, this passage leads from the opening of the vulva to the uterus (womb), but the vaginal tract ends at the cervix. Unlike men, who have only one genital orifice, women have two, the urethra and the vagina. The vaginal opening is much larger compared to the urethral opening, and both openings are protected by the labia. The inner mould of the vagina has a foldy texture which is meant to provide friction for the penis during sexual intercourse. Anus The human anus (from Latin ans meaning "ring", "circle") is the external opening of the rectum. Like other animals, its closure is controlled by sphincter muscles. Feces are expelled from the body through the anus during the act of defecation, the primary function of the anus. The anus can play a role in sexuality, though attitudes towards anal sex vary and it is illegal in some countries. The anus is often considered a taboo part of the body, and it is known by a large number of usually vulgar slang terms. The anus is also the site of potential infections and other conditions, including cancer. The traditional polite synonym for anus 21

was fundament, though this euphemism is rarely heard now that medical terms are widely acceptable.

Ovary The ovary is an ovum-producing reproductive organ, often found in pairs as part of the vertebrate female reproductive system. Ovaries in anatomically female individuals are analogous to testes in anatomically male individuals, in that they are both gonads and endocrine glands. Cervix The cervix (from the Latin cervix uteri, meaning "neck of the womb") is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall. Approximately half its length is visible with appropriate medical equipment; the remainder lies above the vagina beyond view. The cervix has an opening to allow sperm and menstrual fluid to move through. Female Breast

Breast The breast is the upper ventral region of the torso of a primate, in left and right sides, which in a female contains the mammary gland that secretes milk used to feed infants. Both men and women develop breasts from the same embryological tissues. However, at puberty, female sex hormones, mainly estrogen, promote breast development, which does not occur in men, due to the higher amount of testosterone. As a result, women's breasts become far more prominent than those of men. 22

Functions:

Lactation The primary function of the breasts as mammary glands is the feeding and the nourishing of an infant child with breast milk during the maternal lactation period. The round shape of the breast helps to limit the loss of maternal body heat, because milk production depends upon a higher-temperature environment for the proper, milk-production function of the mammary gland tissues, the lactiferous ducts. Regarding the shape of the breast, the study The Evolution of the Human Beast (2001) proposed that the rounded shape of a woman's breast evolved to prevent the sucking infant offspring from suffocating while feeding at the teat; that is, because of the human infant's small jaw, which did not project from the face to reach the nipple, he or she might block the nostrils against the mother's breast if it were of a flatter form (cf. chimpanzee); theoretically, as the human jaw receded into the face, the woman's body compensated with round breasts.
In a woman, the condition of lactation unrelated to pregnancy can occur as galactorrhea (spontaneous milk flow), and because of the adverse effects of drugs (e.g. antipsychotic medications), of extreme physical stress, and of endocrine disorders. In a newborn infant, the capability of lactation is consequence of the mother's circulating hormones (prolactin, oxytocin, etc.) in his or her blood stream, which were introduced by the shared circulatory system of the placenta; neonatal milk, the milk from a lactating infant, is also known as witch's milk. In men, the mammary glands are also present in the body, but normally remain undeveloped because of the hormone testosterone, however, when male lactation occurs, it is considered a pathological symptom of a disorder of the pituitary gland.

Reproduction
In considering the human animal, zoologists proposed that the human female is the only primate that possesses permanent, full-form breasts when not pregnant. Other mammal females develop full breasts only when pregnant. The zoologist Desmond Morris proposed that the rounded shape of a woman's breasts evolved as frontal, secondary sex characteristic that is a sexual-attraction counterpart to the buttocks, and so encouraged frontal copulation. The reason being that, while other primates mate by means of the rearentry position, the upright, bipedal human being was likelier to successfully copulate face to face. As an ethologist, Morris further proposed that breasts, a secondary sex characteristic located on the woman's chest, encouraged face-to-face sexual intercourse that led to the establishment of an emotional bond between man and woman; social progress from an essentially procreational function of human biology. Furthermore, the symmetry of the breasts, and the general symmetry of the human body, influence what men and women consider physical attractiveness in a mate with whom to reproduce. Bodily beauty, evolutionary psychology proposes that a symmetrical body signals genetical health to a potential mate and so is the product of a morphologically stable line of people who physically developed without interference by disease. Therefore, because the breasts are 23

especially sensitive to developmental interference (genetic and environmental), breast symmetry indicates a woman of good health and thus of good breeding stock, who shall successfully bear more (surviving) children than will a woman with asymmetrical breasts.

Trimesters of Pregnancy

Pregnancy Pregnancy is the fertilization and development of one or more offspring, known as an embryo or fetus, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets. Childbirth usually occurs about 38 weeks after conception; in women who have a menstrual cycle length of four weeks, this is approximately 40 weeks from the start of the last normal menstrual period (LNMP). Human pregnancy is the most studied of all mammalian pregnancies. The term embryo is used to describe the developing offspring during the first 8 weeks following conception, and subsequently the term fetus is used henceforth until birth. 40% of pregnancies in the United States and United Kingdom are unplanned. In many societies medical or legal definitions, human pregnancy is somewhat arbitrarily divided into three trimester periods, as a means to simplify reference to the different stages of prenatal development. The first trimester carries the highest risk of miscarriage (natural death of embryo or fetus). During the second trimester, the development of the fetus can be more easily monitored and diagnosed. The beginning of the third trimester 24

often approximates the point of viability, or the ability of the fetus to survive, with or without medical help, outside of the uterus. First Trimester: Traditionally, medical professionals have measured pregnancy from a number of convenient points, including the day of last menstruation, ovulation, fertilization, implantation and chemical detection. In medicine, pregnancy is often defined as beginning when the developing embryo becomes implanted in the endometrial lining of a woman's uterus. Most pregnant women do not have any specific signs or symptoms of implantation, although it is not uncommon to experience minimal bleeding. After implantation, the uterine endometrium is called the decidua. The placenta, which is formed partly from the decidua and partly from outer layers of the embryo, connects the developing embryo to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. The umbilical cord is the connecting cord from the embryo or fetus to the placenta. The developing embryo undergoes tremendous growth and changes during the process of fetal development. Morning sickness occurs in about seventy percent of all pregnant women, and typically improves after the first trimester. Although described as "morning sickness", women can experience this nausea during afternoon, evening, and throughout the entire day. Shortly after conception, the nipples and areolas begin to darken due to a temporary increase in hormones. This process continues throughout the pregnancy. The first 12 weeks of pregnancy are considered to make up the first trimester. The first two weeks from the first trimester are calculated as the first two weeks of pregnancy even though the pregnancy does not actually exist. These two weeks are the two weeks before conception and include the woman's last period. The third week is the week in which fertilization occurs and the 4th week is the period when implantation takes place. In the 4th week, the fecundated egg reaches the uterus and burrows into its wall which provides it with the nutrients it needs. At this point, the zygote becomes a blastocyst and the placenta starts to form. Moreover, most of the pregnancy tests may detect a pregnancy beginning with this week. The 5th week marks the start of the embryonic period. This is when the embryo's brain, spinal cord, heart and other organs begin to form. At this point the embryo is made up of three layers, of which the top one (called the ectoderm) will give rise to the embryo's outermost layer of skin, central and peripheral nervous systems, eyes, inner ear, and many connective tissues.[35] The heart and the beginning of the circulatory system as well as the bones, muscles and kidneys are made up from the mesoderm (the middle layer). The inner layer of the embryo will serve as the starting point for the development of the lungs, intestine and bladder. This layer is referred to as the endoderm. An embryo at 5 weeks is normally between 116 and 18 inch (1.6 and 3.2 mm) in length. 25

In the 6th week, the embryo will be developing basic facial features and its arms and legs start to grow. At this point, the embryo is usually no longer than 16 to 14 inch (4.2 to 6.3 mm). In the following week, the brain, face and arms and legs quickly develop. In the 8th week, the embryo starts moving and in the next 3 weeks, the embryo's toes, neck and genitals develop as well. According to the American Pregnancy Association, by the end of the first trimester, the fetus will be about 3 inches (76 mm) long and will weigh approximately 1 ounce (28 g). Once pregnancy moves into the second trimester, all the risks of miscarriage and birth defects occurring drop drastically. Second Trimester Weeks 13 to 28 of the pregnancy are called the second trimester. Most women feel more energized in this period, and begin to put on weight as the symptoms of morning sickness subside and eventually fade away. The uterus, the muscular organ that holds the developing fetus, can expand up to 20 times its normal size during pregnancy. Although the fetus begins to move and takes a recognizable human shape during the first trimester, it is not until the second trimester that movement of the fetus, often referred to as "quickening", can be felt. This typically happens in the fourth month, more specifically in the 20th to 21st week, or by the 19th week if the woman has been pregnant before. However, it is not uncommon for some women not to feel the fetus move until much later. The placenta fully functions at this time and the fetus makes insulin and urinates. The reproductive organs distinguish the fetus as male or female. During the second trimester, most women begin to wear maternity clothes. Third Trimester Final weight gain takes place, which is the most weight gain throughout the pregnancy. The fetus will be growing the most rapidly during this stage, gaining up to 28 g per day. The woman's belly will transform in shape as the belly drops due to the fetus turning in a downward position ready for birth. During the second trimester, the woman's belly would have been very upright, whereas in the third trimester it will drop down quite low, and the woman will be able to lift her belly up and down. The fetus begins to move regularly, and is felt by the woman. Fetal movement can become quite strong and be disruptive to the woman. The woman's navel will sometimes become convex, "popping" out, due to her expanding abdomen. This period of her pregnancy can be uncomfortable, causing symptoms like weak bladder control and backache. Movement of the fetus becomes stronger and more frequent and via improved brain, eye, and muscle function the fetus is prepared for ex utero viability. The woman can feel the fetus "rolling" and it may cause pain or discomfort when it is near the woman's ribs and spine. There is head engagement in the third trimester, that is, the fetal head descends into the pelvic cavity so that only a small part (or none) of it can be felt abdominally. The perenium 26

and cervix are further flattened and the head may be felt vaginally. Head engagement is known colloquially as the baby drop, and in natural medicine as the lightening because of the release of pressure on the upper abdomen and renewed ease in breathing. However, it severely reduces bladder capacity, increases pressure on the pelvic floor and the rectum, and the mother may experience the perpetual sensation that the fetus will "fall out" at any moment. It is during this time that a baby born prematurely may survive. The use of modern medical intensive care technology has greatly increased the probability of premature babies surviving, and has pushed back the boundary of viability to much earlier dates than would be possible without assistance. In spite of these developments, premature birth remains a major threat to the fetus, and may result in ill health in later life, even if the baby survives. Stages of Fetal Development

Fetal Development

Month 1 Your first month of pregnancy your baby will accomplish many things, first and foremost, conception, fertilization, and implantation. After a woman ovulates, the egg is normally fertilized within 24-48 hours. The single fertilized cell begins to rapidly divide and at this point in time is called a zygote. Many amazing things happen at fertilization. Your baby's entire physical attributes are determined including gender, hair color, and eye color. Between days 7-10 from fertilization implantation usually occurs. Implantation should occur within the uterus if it does not this is considered an ectopic pregnancy. The amniotic sac, umbilical cord and yolk sac are already beginning to form. By the end of this month your baby is approximately 2mm long and beginning early stages of development. Month 2
27

Your baby is now considered a fetus. Her heart, neural tube, arms and legs, liver and other major organs begin to form. By your 6th week, her heart will be beating and visible via ultrasound. The placenta also begins to form as well as the eyes, ears, mouth, and bones. In this month, your baby's fingers and toes will become present, however, they may still be webbed. Her brain and cranial nerves will also begin to form this month. Baby's sex organs begin to become visible. Your baby is approximately 1/2 inch - 3/4 inch long and weighs about 1-2 grams by the end of this month. Month 3 If given an ultrasound now, you would be able to see your baby's arms and legs moving. Baby's heartbeat can be detected by doppler beginning in your third month. Development of the heart and all major organs is complete by the end of the third month. Baby's sex organs continue to develop, but it is still too difficult to differentiate gender. Baby's muscles in trunk, limbs, and head are developing. Baby's face is well formed and your baby looks like a baby. By the end of your third month, your baby is 3-4 inches long and weighs about 1 ounce. Month 4 During your fourth month your baby's hair and teeth begin to form. Your baby will be moving and active now and you may begin to feel baby's movement this month, however, not feeling movements till next month is perfectly normal as well. Your baby's digestive system is forming and the intestines are present. Meconium, your baby's first stool, is present in the intestines as well. By the end of this month it may be possible to determine baby's gender. Your baby is approximately 5-6 inches long and weigh 5-8 ounces by the end of the month.

Month 5 Your baby is developing a fine hair, called lanugo, which covers the body. Likewise, her eyelashes and eyebrows are developing. Her fingerprints and footprints are now developed. She begins to suck and swallow and may even be found sucking her thumb. Vernix, a white lanolin-like covering, appears on baby to protect her skin. Her ears are developed as well and she may be able to hear you now. Your baby is approximately 7-8 inches long and weighs 3/4-1 pound by the end of this month. Month 6 Your baby's immune system is developing and she is beginning to create her own antibodies. She has developed a hand grip reflex and startle reflex. Her lungs are beginning to develop and alveoli are forming. She is growing and filling out. She looks more and more like the person she will be when she is born. By the end of this month, she is approximately 9-10 inches long and weigh in at about 1 1/2-2 1/4 pounds. Month 7

28

Your baby's eyes are open and she is able to cry. She may be very active now and others may be able to see her movements. She may have hiccups which will feel like a jumpy movement. She is increasing in body fat and her bones are fully developed now. By the end of this month, she is approximately 11 inches long and weighs around 3-3 1/2 pounds. Month 8 At this point of your pregnancy, there is not a whole lot of new development. However, your baby is growing and maturing and preparing for life outside the womb. Your baby sleeps most of the time now and has periods of REM sleep. Baby is becoming increasingly cramped for space, but she is still very active. Your baby is approximately 13 inches long and weighs around 5-6 pounds at the end of this month. Month 9 In your 9th month, which actually extends a little further than 9 calendar months, your baby is preparing for birth. She will spend a lot of time resting, but she should still have plenty of active periods. She should be facing head down in preparation for birth. Babies weight and length vary considerably at birth, but a typical range would be between 7-8 pounds and 19-21 inches in length.

Cervical Effacement and Dilatation

29

Cervical Effacement and Dilatation Cervical Effacement Cervical effacement refers to a thinning of the cervix. Prior to effacement, the cervix is like a long bottleneck, usually about four centimeters in length. Throughout pregnancy, the cervix is tightly closed and protected by a plug of mucus. When the cervix effaces, the mucus plug is loosened and passes out of the vagina. The mucus may be tinged with blood and the passage of the mucus plug is called bloody show (or simply "show"). As effacement takes place, the cervix then shortens, or effaces, pulling up into the uterus and becoming part of the lower uterine wall. Effacement may be measured in percentages, from zero percent (not effaced at all) to 100 percent, which indicates a paper-thin cervix. Effacement is followed by cervical dilation. Cervical Dilatation Cervical dilation (cervical dilatation) is the opening of the cervix, the entrance to the uterus, during childbirth, miscarriage, induced abortion, or gynecological surgery. Cervical dilation may occur naturally, or may be induced by medical means.

30

Stages of Labor

First Stage of Labor Thinning (effacement) and opening (dilation) of the cervix
During the first stage of labor, contractions help your cervix to thin and begin to open. This is called effacement and dilation. As your cervix dilates, your health care provider will measure the opening in centimeters. One centimeter is a little less than half an inch. During this stage, your cervix will widen to about 10 centimeters. This first stage of labor usually lasts about 12 to 13 hours for a first baby, and 7 to 8 hours for a second child. The first stage of labor has three parts:

1. Early labor
Your cervix opens to 4 centimeters. You will probably spend most of early labor at home. Try to keep doing your usual activities. Relax, rest, drink clear fluids, eat light meals if you want to, and keep track of your contractions. Contractions may go away if you change activity, but over time they'll get stronger. When you notice a clear change in how frequent, how strong, and how long your contractions are, and when you can no longer talk during a contraction, you are probably moving into active labor.

2. Active labor
Your cervix opens from 4 to 7 centimeters. This is when you should head to the hospital. When you have contractions every 3 to 4 minutes and they each last about 60 seconds, it often means that your cervix is opening faster (about 1 centimeter per hour). You may not 31

want to talk as you become more involved in dealing with your contractions. As your labor progresses, your bag of waters may break, causing a gush of fluid. After the bag of waters breaks, you can expect your contractions to speed up. Slow, easy breathing is usually helpful at this time. Focusing on positive, relaxing images or music may also be helpful. Changing positions, massage, and hot or cold compresses can help you feel better. Walking, standing, or sitting upright will help labor progress. Relaxing during and between contractions saves your energy and helps the cervix to open. Many hospitals have whirlpool or soaking tubs that may help you relax and ease discomfort.

3. Transition to second stage

Your cervix opens from 7 to 10 centimeters. For most women, this is the hardest or most painful part of labor. This is when your cervix opens to its fullest. Contractions last about 60 to 90 seconds and come every 2 to 3 minutes. There is very little time to rest and you may feel overwhelmed by the strength of the contractions. You may feel tired, frustrated, or irritated, and may not want to be touched. You may feel sweaty, sick to your stomach, shaky, hot, or cold. Although you may find slow, easy breathing to be most effective throughout labor, you may also find an uneven breathing pattern most helpful at this time.

Second Stage of Labor Your baby moves through the birth canal
The second stage of labor begins when the cervix is completely dilated (open), and ends with the birth of your baby. Contractions push the baby down the birth canal, and you may feel intense pressure, similar to an urge to have a bowel movement. Your health care provider may ask you to push with each contraction. The contractions continue to be strong, but they may spread out a bit and give you time to rest. The length of the second stage depends on whether or not you've given birth before and how many times, and the position and size of the baby. The intensity at the end of the first stage of labor will continue in this pushing phase. You may be irritable during a contraction and alternate between wanting to be touched and talked to, and wanting to be left alone. It isn't unusual for a woman to grunt or moan when the contractions reach their peak.

Third Stage of Labor Afterbirth

After the birth of your baby, your uterus continues to contract to push out the placenta (afterbirth). The placenta usually delivers about 5 to 15 minutes after the baby arrives.

Fourth Stage of Labor Recovery

32

Your baby is born, the placenta has delivered, and you and your partner will probably feel joy, relief, and fatigue. Most babies are ready to nurse within a short period after birth. Others wait a little longer. If you are planning to breastfeed, we strongly encourage you to try to nurse as soon as possible after your baby is born. Nursing right after birth will help your uterus to contract and will decrease the amount of bleeding.

Mechanisms of Labor and Delivery

Labor and Delivery

Childbirth (also called labor, birth, partus or parturition) is the culmination of a human pregnancy or gestation period with the expulsion of one or more newborn infants from a woman's uterus. The process of normal human childbirth is categorized in three stages of labour: the shortening and dilation of the cervix, descent and birth of the infant, and birth of the placenta. In many cases, with increasing frequency, childbirth is achieved through caesarean section, the removal of the neonate through a surgical incision in the abdomen, 33

rather than through vaginal birth. In the U.S. and Canada it represents nearly 1 in 3 (31.8%) and 1 in 4 (22.5%) of all childbirths, respectively.

Mechanisms of Labor Engagement The widest diameter of the presenting part (with a well-flexed head, where the largest transverse diameter of the fetal occiput is the biparietal diameter) enters the maternal pelvis to a level below the plane of the pelvic inlet. On the pelvic examination, the presenting part is at 0 station, or at the level of the maternal ischial spines. Descent The downward passage of the presenting part through the pelvis. This occurs intermittently with contractions. The rate is greatest during the second stage of labor. Flexion As the fetal vertex descents, it encounters resistance from the bony pelvis or the soft tissues of the pelvic floor, resulting in passive flexion of the fetal occiput. The chin is brought into contact with the fetal thorax, and the presenting diameter changes from occipitofrontal (11.0 cm) to suboccipitobregmatic (9.5 cm) for optimal passage through the pelvis. Internal Rotation As the head descends, the presenting part, usually in the transverse position, is rotated about 45 to anteroposterior (AP) position under the symphysis. Internal rotation brings the AP diameter of the head in line with the AP diameter of the pelvic outlet. Extension With further descent and full flexion of the head, the base of the occiput comes in contact with the inferior margin of the pubic symphysis. Upward resistance from the pelvic floor and the downward forces from the uterine contractions cause the occiput to extend and rotate around the symphysis. This is followed by the delivery of the fetus' head. External Rotation When the fetus' head is free of resistance, it untwists about 45 left or right, returning to its original anatomic position in relation to the body. Expulsion After the fetus' head is delivered, further descent brings the anterior shoulder to the level of the pubic symphysis. The anterior shoulder is then rotated under the symphysis, followed by the posterior shoulder and the rest of the fetus.
Normal Spontaneous Vaginal Delivery

34

Vaginal Delivery A vaginal delivery is the birth of offspring (babies in humans) in mammals through the vagina. It is the natural method of birth for all mammals except monotremes, which lay eggs into the external environment. Types of Vaginal Delivery:

A spontaneous vaginal delivery (SVD) occurs when a pregnant female goes into labor without the use of drugs or techniques to induce labor, and delivers her baby in the normal manner, without forceps, vacuum extraction, or a cesarean section. An assisted vaginal delivery (AVD) occurs when a pregnant female goes into labor (with or without the use of drugs or techniques to induce labor), and requires the use of special instruments such as forceps or a vacuum extractor to deliver her baby vaginally. An instrumental vaginal delivery (IVD) is another term for an assisted vaginal delivery. An induced vaginal delivery (also IVD) is a term for a delivery involving labor induction, where drugs or manual techniques are used to initiate the process of labor. Use of the term "IVD" in this context is less common than for instrumental vaginal delivery. A normal vaginal delivery (NVD) is a term for a vaginal delivery, whether or not assisted or induced, usually used in statistics or studies to contrast with a delivery by cesarean section.

IV. Patient and her illness . A. Pathophysiology of Normal Spontaneous Delivery

Schematic Diagram

35

ENVIRONMENT HOST Therapeutic Environment Female 26 years old

AGENT

G3P2(2002)

Fertilization ( Union of sperm and ovum )

Zygote - Unicellular ( Intermingling of haploid paternal 23 X or Y and maternal 23 X chromosomes )

Series of Mitotic Cell division - Cleavage ( In 24 hours become two cell organism )

In 72 hours become 16 cell organism called Morula

36

Morula enters the uterus on the 3rd day through peristaltic movement

Separate into two parts by fluid from the uterus on the 4 day
th

The outer layer gave rise to the placenta rise to the embryo ( trophoblast )

The inner layer gave ( embryoblast )

blastocytes ataches to endometrium on the 6th day

Implantation

Embryonic development begins during second week continues through the eighth week 3 Stages

1st stage increase in cell number and with elaboration of cell products

Fetal Development

2ndstage morphogenesis / includes mass cell Impending labor Movement 3rdstage differentiation or maturation of
37

physiologic processes Labor

Stages of

Stage of Dilatation Vaginal Delivery Stage of Expulsion

Newborn baby via

(Mechanisms of Labor ) Placental Stage Recovery Stage Physical Assessment AREA OF ASSESSMENT General Survey Describe body built Inspection Arm span equals height, crown to pubis equal to length from pubis to sole Proportionate, varies with lifestyle Relaxed, erect posture; coordinated movement Clean, neat ASSESSMENT TECHNIQUES NORMAL FINDINGS

ACTUAL

Slightly thin b weight are pro

Observe height and weight in relation to clients age Posture and gait Describe over all hygiene and grooming in relation to the persons activities prior to the assessment. Note for body and breathe odor in relation to the persons activities prior to the assessment. Mental state

Inspection

Height and we proportional ac I have observe

Observation Inspection

Relaxed; erect coordinated m Unkempt hair

Inspection

No body odor or minor body odor relative to work or exercise; no breath odor

No body odor

38

Identify signs of distress

Observation

No distress noted

No signs of dis

Note obvious sign of health or illness Assess clients attitude

Observation

Healthy appearance

Face grimace i maybe because feeling.

Observation

Cooperative, able to follow instructions Appropriate to situation

Answers in ou appropriate; co

Describe clients affect or mood

Observation

Clients mood appropriate to

Assess appropriateness of clients responses Describe quantity of speech (amount and pace), quality (loudness, clarity, inflection) and organization (coherence of thought, over generalization, Listen for the relevance and organization of thoughts. Hair Inspect the evenness of growth over the scalp Inspect hair thickness or thinness Inspect hair texture and oiliness Note presence of infections or infestations Inspect amount of body hair

Observation

Appropriate to situation

Answers of ou questions are a

Observation

Understandable, moderate pace; Speech is soft clear tone and inflection; with clear dict exhibits thought association

Observation

Logical sequence; makes sense; has sense of reality

Clients answe reality.

Inspection

Evenly distributed hair

No presence o

Inspection

Thick hair

Slightly thick

Inspection

Silky, resilient hair

Slightly dull h havent take a admitted to ho

Inspection Inspection
39

No infection or infestation Variable

No observable infection or an Variable; hair distributed all

body. Skull Inspect the skull for size, shaped and symmetry Palpate the skull for nodules or masses and depressions Face Facial features Inspection Symmetric or slightly asymmetric facial features; palpebral fissures equal in size; symmetric nasolabial folds Symmetric facial movements Inspection Rounded, smooth skull contour

Normocephali

Palpation

Smooth, uniform consistency; absence of nodules or masses

No palpable no masses.

Facial features

Symmetry of the facial movements Eyebrows and eyelashes Evenness of distribution, direction of curl and movement

Inspection

Eyebrows elev time; eyes blin the same time

Inspection

Evenly distributed, eyebrows symmetrically aligned; curled slightly upward

Eyebrows rais same times; sy aligned; both e slightly upwar

Eyelids Surface characteristics and ability to blink Inspection Skin intact, no discharge, no discoloration; Lids closed symmetrically Conjunctiva Inspect the bulbar conjunctiva for color, texture and the presence of lesions Inspect the palpebral conjunctiva for color, texture and the presence of lesions Sclera
40

Eyelids skin ar discharge and eyelids blink s

Inspection

Transparent

Bulbar conjun transparent; no lesions; with e

Inspection

Shiny, smooth and pink or red

Palpebral conj but whitish

Color and clarity

Inspection

Sclera appears white

Sclera is white

Cornea Color and clarity Inspection Transparent, shiny and smooth

Corneas surfa transparent and

Iris Shape and color Inspection Round

Round, black i

Pupils Color, shaped and symmetry of size Pupil light reaction and accommodation Inspection Black in color, equal in size Pupil is round and equal

Inspection Asking the client to look first at a distant object and then at a distant object behind the penlight Inspection

Pupils constricts when looking at near objects; pupils dilate when looking at far object; pupil converge when near object is moved towards nose Illuminated pupil constricts (direct response)

PERRLA (pup and react to lig accommodatio

Pupils direct and consensual reaction to light

Pupil constrict

Asking the client to look straight ahead, by using the penlight and Nonilluminated pupil constricts approaching from the side, (consensual response) shining a light on the pupil

Visual acuity Test near vision Asking the client to read the newspaper held at a distance of 36 cm Inspection Able to read newsprint

No difficulty r

Test distance vision

20/20 vision on Snellentype chart

Not examined

Lacrimal gland, lacrimal sac and nasolacrimal duct Presence of edema Inspection and palpation
41

No edema or tenderness

There are no p

tenderness and Extraocular muscles Test each eye for alignment and coordination Visual fields Test for peripheral visual fields Inspection noted Ear auricle Color and symmetry of size and position Inspection Color same as facial skin, symmetrical, auricle aligned with outer canthus of the eye, about 10 from vertical. Mobile, firm, and not tender; pinna recoils after it is folded When looking straight ahead, client can see objects in periphery Inspection Both eyes coordinated, move in unison with parallel alignment

Both eyes are parallel alignm

Client can see peripheral visi

Both ear auric color with the

Texture, elasticity and areas of tenderness External ear canal Cerumen, skin lesions, pus and blood Hearing acuity test Clients response to normal voice tones Perform watch tick test

Palpation

There are no a tenderness; no

Inspection

Dry cerumen, grayish-tan color; or sticky, wet cerumen in various shades of brown

Dry cerumen; pus and blood

Inspection

Normal voices tones audible

Can hear clear us.

Inspection

Able to hear ticking in both ears Able to hear w

Nose Shape, size or color and flaring or discharge from the nares Presence of redness, swelling, growths and discharge of nares, Inspection Symmetric and straight, uniform color, no discharge or flaring Mucosa pink, clear, watery discharge, no lesions

Symmetric uni color; no prese or flaring.

Inspection

Mucosa is pink

42

using the flashlight Position of nasal septum Test patency of both nasal spectrum Tenderness, masses and displacement of bone and cartilage Sinuses Presence of tenderness Lips Symmetry of contour, color and texture Inspection Uniform pink color, soft moist, smooth texture, symmetry of contour, ability to purse lips Palpation Not tender Inspection Inspection Nasal septum intact and in midline Air moves freely as the client breath through the nares No tenderness, masses and displacement of bone and cartilage Nasal septum

Client can brea nasal nares.

Palpation

No presence o masses and dis bone and carti

Sinuses are no

Pale color of li moist and smo

Buccal mucosa Color, moisture, texture and the presence of lesions Teeth Inspect for color, number and condition and presence of dentures Gums Color and condition Inspection No presence of lesions, no retraction of gums, pink gums Inspection 32 adult teeth, smooth, shiny, white tooth enamel Inspection and palpation Moist, firm texture, glistening and elastic texture

Buccal mucosa

No presence o two teeth in th has dental prob

No observable lesions; withou without bleedi

Tongue /floor of the mouth Color and texture of the mouth floor and frenulum Inspection Pink color, slightly rough, thin whitish coating, smooth lateral margins, no lesions Pink in color

43

Position, color and texture, movement and base of the tongue Palates and uvula Color, shape, texture and the presence of bony prominences Position of the uvula and mobility Orpharynx and tonsils Color and texture Size of the tonsils, color and discharge Gag reflex

Inspection

Central position, moves freely, no tenderness

Tongue is in ce freely and with

Inspection

Light pink, smooth, soft palate, lighter pink hard palate, more irregular texture Positioned in midline of soft palate

Palates are pin

Inspection

In midline of s

Inspection Inspection Inspection

Pink and smooth posterior wall Pink and smooth, no discharge, of normal size or not visible Present

Pink posterior

No discharge; has normal siz Not examined

Neck and lymph nodes Symmetry and visible mass of the thyroid gland Presence of tenderness or nodules in the lymph nodes Placement of the trachea Inspection Gland ascends during swallowing but is not visible Not palpable

No visible mas

Palpation

No nodules or

Palpation

Central placement in midline of neck; spaces are equal on both sides Lobes may not be palpable

In midline of n

Smoothness and areas of enlargement, masses or nodules in the thyroid gland Skin

Palpation Asking the client to lower the chin slightly

No areas of en masses or nod

44

Inspect for color and uniformity

Inspection

Varies from light to deep brown, ruddy pink to light pink, yellow overtones to olive; generally uniform except in areas exposed to the sun, areas of lighter pigmentation in darkskinned people No edema

Brown in colo

Inspect for the presence of edema. Inspect and palpate for skin lesions according to location, distribution, color, configuration, size, shape, type or structure. Observe and palpate skin moisture. Palpate skin temperature.

Inspection and palpation

No presence o

Inspection and palpation

Freckles, some birthmarks, some flat and raised nevi; no abrasions or other lesions

No observable and birthmarks

Inspection and palpation Palpation

Moisture in the skin folds and axillae Uniform, within normal range

Moist skin

Skin temperatu normal range Skin turgor is

Note for skin turgor of the client.

Inspection

Skin springs back to previous state; may be slower in elders

Nails Inspect fingernail shape to determine its curvature and angle Inspect fingernail and toenail texture Inspect fingernail and toenail bed color Inspection Convex curvature, angle of nail plate about 1600 Smooth texture

No signs of ea

Inspection

Skin is smooth

Inspection

Highly vascular and pink in Pink in color light skinned clients; dark skinned clients may have brown or black pigmentation in longitudinal streaks Intact epidermis

Inspect tissues surrounding

Inspection
45

No presence o

nails

Perform blanch test of capillary refill Posterior Thorax Shape, symmetry, and compare the diameter of the antero posterior thorax to tranverse diameter. Spinal alignment Breathing pattern Respiratory excursion

Inspection

Prompt return of pink or usual color

Skin return to

Inspection

Anteroposterior to transverse diameter in ratio of 1:2, chest symmetric Spine vertically aligned Proper breathing pattern Full and symmetric chest expansion Uniform temperature, no tenderness, no masses Bilateral symmetry of vocal fremitus, heard most clearly at the apex of the lungs Percussion notes resonate, except over scapula, lowest point of resonance is at the diaphragm Vesicular and bronchovesicular breath sounds

Symmetrically

Observation Inspection Inspection

No observable osteoporosis a

Can breath pro Chest expand

Temperature, tenderness, masses Vocal fremitus

Palpation

With uniform signs of tender

Palpation

Has good voca

Percuss the posterior thorax

Percussion

Not examined

Auscultate the posterior thorax

Auscultation

Breath sounds

Anterior thorax Breathing pattern Temperature, tenderness, masses Inspection Palpation Quiet, rhythmic, and effortless respirations Uniform temperature, no presence of masses and tenderness

No problems w respiration of t

No observable masses

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Respiratory excursion

Inspection

Full symmetric excursion; Has good resp thumbs normally separate 3 to 5 cm Same as posterior vocal fremitus; Fremitus is normally decreased over heart and breast tissue Percussion notes resonate down to the sixth rib at the level of the diaphragm but are flat over areas of heavy muscle and bone, dull on areas over the heart and the liver, tympanic over the underlying stomach Bronchial and tubular breath sounds Bronchial and vesicular breath sounds

Vocal fremitus

Inspection

Has good voca

Percuss the anterior thorax

Percussion

Not examined

Auscultation of the trachea Auscultate the anterior thorax Abdomen Skin integrity

Auscultation Auscultation

Breath sounds

Breath sounds

Inspection

Unblemished skin, uniform color, stretch marks Flat, rounded(convex) or scaphoid (concave) Liver and spleen must not be palpated. Symmetric contour Symmetric movements caused by respiration No visible vascular pattern

Skin color is u

Abdominal contour

Inspection

Symmetrical

Enlarges liver or spleen

Palpation

Without enlarg spleen Symmetrical

Symmetry of contour Abdominal movements

Inspection Inspection

Symmetrical m

Vascular pattern Bowel sounds, vascular sounds and peritoneal friction rubs

Inspection Auscultation

Not visible

Audible bowel sounds, absence Not examined of bruits, absence of friction rub

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Percuss abdominal quadrants

Percussion

Tympany over the stomach and gas-filled bowels; dullness, especially over the liver and spleen, or a full bladder No tenderness; relaxed abdomen with smooth, consistent tension

Not examined

Light palpation of abdominal quadrants Musculoskeletal system Muscle size, compare the muscles on one side of the body (arm, thigh, calf) to the same muscle on the other side Muscle tonicity Muscle strength Bones Normal structure Edema or tenderness

Palpation

Without observ tenderness.

Inspection

Equal on both sides of body

Muscle size ar throughout the

Inspection Inspection Equal strength on each body side

Has good mus

Has equal mus

Inspection Palpation

No deformities No tenderness or swelling

No observable

No observable tenderness or s

Diagnostic Procedures LABORATORY PROCEDURE INDICATION/PURPOSES NORMAL VALUES

ACTUAL VALUE

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Hematology
Hemoglobin

Hematocrit WBC RBC Differential count:

It gives important information about the kinds and numbers of cells in the blood, especially red blood cells, white blood cells , and platelets. It helps your doctor check any symptoms, such as weakness, fatigue, or bruising, you may have. It also helps him or her diagnose conditions, such as anemia, infection, and many other disorders.

123-153 g/L 0.35-0.44 g/L

106 g/L 0.32g/L

4.5-10.0x10 9 /L 3.8-5.8x1012 /L 43-76 17-48 4-10 150,000-

11.9x109 /L 3.64x1012 /L

Segmenters Lymphocytes Monocytes Platelets To determine if the mother is Hepa B positive

66 29 5 146,000/cumm

390,000/cumm

Non-reactive

HBSag

Blood Typing

To determine the blood type of the mother

Varies to client

Urinalysis

A urine test checks different components of urine, a waste product made by the kidneys. A regular urine test may be done to help find the cause of symptoms. The test can give information about your health and problems you may have.

Color: light yell Characteristic: c pH: 6.0 specific gravity: 1.005 Albumin: (-) Sugar: (-)

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V. The Patient and her care A. Medical Management a. IVT, Blood Transfusion, Nebulization, Total Parenteral Nutrition, NGT, Oxygen Therapy etc. LABORATORY PROCEDURES DATE ORDERED, DATE GIVEN/CHANGED/ DISCONTINUED GENERAL DESCRIPTION INDICATION/PURPOSES

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Oxygen Therapy (Nasogastric Tube)

Date Ordered: Feb. 8, 2012

Nasogastric Tube F8

Nasogastric tube is for oxygen therapy, and oxygen therapy is essential for tissue oxygenation for all normal physiological functions.

In ox

N it an

IV Therapy

Date Ordered: Feb. 8, 2012

D5LR 1L

Importance of Intravenous (IV) Fluid Therapy is basically hydration. But it all depends on the situation, it is also indispensable for immediate electrolytes replacement, for instance your potassium or magnesium level is critically low and it needs to be replaced immediately because crtitically low potassium and magnesium may be fatal if not replaced as soon as possible, as it affects the heart's activity. Low potassium and magnesium are causes of tachycardia and premature ventricular contraction(PVC).

C d el re

b. Drugs GENERIC.BRAND NAME/DRUG CLASSIFICATION GENERIC NAME: Cefuroxime Sodium BRAND NAME: Cefuroxime
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DATE ORDERE D Feb 8, 2012

GENERAL DESCRIPTION TAKEN/GIVEN Feb 8, 2012

INDICATION AND PURPOSES Cefuroxime tablet 500mg via IV

CLIENTS RESPONSE

Pain, Burning sensation, Cellulitis (IM site); Superinfections, Positive Coombs'test.

No signs of allergies. Normal vital signs.

CLASSIFICATION:
Anti infective; Antibiotic Second generation Cephalosporins

GI: Diarrhea, Nausea, AntibioticUterine contraction Associated Colitis.

GENERIC NAME:

Methylergonovine maleate BRAND NAME: Methergine CLASSIFICATION: Oxytocic

Feb 8, 2012 Feb 8, 2012

1 Ampule I.M 1 Tablet TAD x 3 Day

Feb 8, 2012 GENERIC NAME: Oxytocin BRAND NAME: Pitocin CLASSIFICATION: Oxytocic; Hormone Feb 8, 2012 AvailableForms: 10 units/ml in1ml ampule, vialor syringe incompatible IVsolution

Hyper- or Hypotension, Nausea and Vomiting, Chest pain, Dyspnea, Headache, Hematuria, Thrombophlebitis ,Water intoxicatio n,Hallucinations, Leg cramps, Dizziness, Tinnitus, Nasalcongestion, Diarrhea, Diaphoresis, Palpitations

Normal Vital Signs

The patient is having u contraction

CV: Hypertension,incr eased heartrate, systemicvenous return,cardiac output GI: Nausea,vomiting

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RESPIRATORY: Anoxia, asphyxia OTHERS: Low APGARscore at 5 mins

c. Diet

53

Type of Diet

Date Ordered Date Changed Date Discontinued

General Description

Indication Purpose

Specific Food Taken

Clients Response

Res

Soft and Nutritional Foods

Eating right after delivery isnt that complex, continue eating a goodquality diet just like during pregnancy.

The client is breastfeeding, and the client is just recovering from giving birth it requires a soft and special nutritional foods. In order for the client to give a complete nutrition to her body and to her baby.

Breakfast: Lugaw with Egg

The Clients Response:

Cho diet clie

Good bowel movement. Lunch and Dinner: Fried Chicken with The food taste good. rice and water The food can relieve my fatigue.

d. Type of Exercise TYPE OF EXERCISE DATE ORDERED, DATE STARTED, DATECHANGED, DATE DISCONTINUED
54

GENERAL DESCRIPTION

INDICATION/PURPOSES

Ambulatory or Walking

----

Ambulatory can promote good blood circulation and this type of exercise is the most common and most convenient.

To promote good blood circulation and prepare the body for more vigorous work.

B. Nursing Care Plan ASSESSMENT DIAGNOSIS PLANNING INTERVENTION

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Subjective cues:

Disturbed sleep pattern r/t external factors as manifested by:

She verbalized hindi ako makatulog dahil hindi ako sanay ng may mga kasama sa kwarto sa katunayan nga wala pa akong masasabing tulog e, paidlip idlip lang.

- She verbalized hindi ako makatulog dahil hindi ako sanay ng may mga kasama sa kwarto sa katunayan nga wala pa akong masasabing tulog e, paidlip idlip lang.

After 30 minutes of nursing intervention, client will express feeling of well rested

Ask patient what changes would promote sleep

Provide patient with normal sleep aids, such as pillow, bath, back rub, food, and drink

Objective cues:

As observed, the patient looks sleepy, having eye bags and no energy in answering during interview.

- As observed, the patient looks sleepy, having eye bags and no energy in answering during interview

Instruct client to avoid caffeine from diet, limit alcohol intake and avoid foods that interfere with sleep (for example spicy foods)

VI.

Discharge Planning A. General condition of the patient upon discharge

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The patient communicates well and is not having postpartum depression. She takes care of her baby. Though she is not very well-groomed she has no unpleasant odor. B. METHODS Medication:
Advice the patient to continue the prescribed medication to obtain her total recovery. Explain the

action of the drug to the patient. Exercise:

Teach different exercises she can perform such as arm raising, chin in chest, and Kegels exercise

to facilitate good blood circulation in the perineal area and strengthen muscle. Treatment:
Advice the patient to have an early ambulation after she gave birth. As with any abdominal pain,

heat to the abdomen should be avoided because it could cause relaxation of the uterus and subsequent uterine bleeding. Hygiene:
Encourage the patient to change perineal pad frequently and teach how to do perineal care.

Out Patient:
Advice the patient to return to hospital for postnatal check up. The patient should notify the

physician if she had increased amount of discharge because postpartum hemorrhage can occur if the patient became extremely fatigue and does heavy work. This visit is important to ensure the recovery of the patient after childbirth.

Diet:
Help the mother and the baby to obtain a healthy body. Teach and advice the patient to eat healthy

foods to provide the body sufficient energy and to help in faster recovery. Encourage the patient to take more fluid to avoid constipation. Sex/Spiritual:
Coitus is safe when there is no more presence of discharge. Respect the patients spiritual belief

that will contribute in maintaining her health. VII. Conclusion

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After our case study, we conclude that we have enhanced our knowledge regarding normal spontaneous delivery, the functions of the different parts . of the womans reproductive system and its changes during pregnancy. We identified the attitude of the mother during labor and delivery. From this case, our group had learned a lot in terms of rendering care to the patient and how to deal with patient who had undergo a normal spontaneous delivery. To be able to ..finish this case study, we share our knowledge and apply our skills that we have learned from our clinical instructors

VIII. BOOKS:

Bibliography

Sparks and Taylors Nursing Diagnosis, Reference Manual 6th Edition, 2005 Doenges Nurses Pocket Guide, 11th Edition, 2008 Kozier & Erbs, Fundamentals of Nursing., 8th edition. Pilliterri Adelle Maternal and child health nursing: Care of the Childbearing and Childrearing

Family: copyright Lippincott Wiliams and Wilkins; 5th edition

Tomey,Ann Marriner ,Nursing Theorists and their Work: 6th Edition, 2002

ARTICLES ON INTERNET:
http://sautuqalbi.blogspot.com/2009_01_01_archive.html http://www.happylife.lk/kb/?q=node/19 58

 http://www.drmalpani.com/book/chapter2a.html http://en.wikipedia.org/wiki/Mons_pubis http://en.wikipedia.org/wiki/Clitoral_hood http://en.wikipedia.org/wiki/Hymen http://en.wikipedia.org/wiki/Labia_minora http://en.wikipedia.org/wiki/Labia_majora http://en.wikipedia.org/wiki/Vagina http://en.wikipedia.org/wiki/Human_anus http://en.wikipedia.org/wiki/Breast#Functions_and_health http://ylb1.bol.ucla.edu/anatomy.htm http://en.wikipedia.org/wiki/Pregnancy#First_trimester http://en.wikipedia.org/wiki/Pregnancy http://en.wikipedia.org/wiki/Pregnancy#Second_trimester http://en.wikipedia.org/wiki/Pregnancy#Third_trimester http://www.maxim-energy.com/the-trimesters-of-pregnancy/ http://www.justmommies.com/articles/fetal_development.shtml http://en.wikipedia.org/wiki/Labor_and_Delivery http://www.brooksidepress.org/Products/Obstetric_and_Newborn_Care_1/lesson_10_Section_1A.

htm
http://www.thirdage.com/hc/p/14790/vaginal-birth-what-to-expect

http://en.wikipedia.org/wiki/Vaginal_delivery
http://embryology.med.unsw.edu.au/Child/birth6.htm

http://emedicine.medscape.com/article/263424-overview
http://www.ihacares.com/index.cfm/HealthAdvisors/WomensHealthAdvisor/crs-wha-art.labor/ http://www.ghc.org/healthAndWellness/index.jhtml?

item=/common/healthAndWellness/pregnancy/birth/laborStages.html
http://en.wikipedia.org/wiki/Stages_of_labor#stages 59

 http://en.wikipedia.org/wiki/Oxygen_therapy http://wiki.answers.com/Q/What_is_the_importance_of_IV_therapy http://www.slideshare.net/twogives/oxygen-therapy-new-2-version-2010

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