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I. Introduction
Pregnancy is the carrying of one or more offspring, known as a fetus or
embryo, inside the uterus of a female human came from Latin word graviditas. In
a pregnancy, there can be multiple gestations, as in the case of twins or triplets.
Human pregnancy is the most studied of all mammalian pregnancies. Obstetrics
is the surgical field that studies and treats pregnancy. Midwifery is the non-
surgical field that cares for pregnant women. Childbirth usually occurs about 38
weeks from conception approximately 40 weeks from the last menstrual period.
Pregnancy is divided into three periods and every period has three months each.
The first trimester is from conception to partial fetal development. The second
trimester is from 4 to 6 months this is the period when the first fetal movement is
observed. The third and last trimester is from 7 to 9 months and it is
characterized by popping out of abdomen, fetus can now move regularly.
After nine months of pregnancy it is now time to face the most crucial and
complicated stage of labor. It is the time when the woman faces chances
between life and death wherein a new form of life is to be given a chance to live.
Every woman undergoes pregnancy unless they dont want to have children.
Childbirth is the process whereby an infant is born. It is considered by many to be
the beginning of a persons life and age is defined relative to this event in most
cultures. A woman is considered to be in labor when she begins experiencing
regular uterine contractions, accompanied by changes of her cervix primarily
effacement and dilation. While childbirth is widely experienced as painful, some
women do report painless labors, while others find that concentrating on the birth
helps to quicken labor and lessen the sensations. Most births are successful
vaginal births, but sometimes complications arise and a woman may undergo a
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caesarean section. A Primi-gravida woman fears what will happen during and
after delivery thinking about the pain, the deformities and life threats. A woman
undergoes many changes before reaching up delivery stage. This changes starts
from conception to full fetal formation. Physiological changes in pregnancy
include hormonal, musculoskeletal, cardiovascular, respiratory, physical,
metabolic, and renal.
Management on nutrition, weight gain, Immunological tolerance, and
psychological changes should be given focus.
During the time immediately after birth, both the mother and the baby are
hormonally cued to bond, the mother through the release of oxytocin, a hormone
also released during breastfeeding The first breast secretions contain colostrums
which can enhance anti-bodies of the baby for stronger immunity. Doing so can
maximize the purpose not only for the babies immune system but also for
bonding with the mother.
Upon this stage of pregnancy many questions will be raised not only by the
client but also from the family. Some of these questions may affect the view of
individuals upon labor. There is a need of giving right information to client so that
no misconception will happen. No matter what questions will be asked by the
relatives of client still only one thing is dearly shown and that is how much they
love the client.
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Theory of Aging Placenta
As the placenta mature more and more pressure is exerted on the
fundal portion, the usual placenta site and the most contractile portion of
the uterus, it is believed that the resultant diminished blood supply to the
area causes contraction.
Uterine Myometrial irritability/ Uterine Stretched Theory
The most acceptable theory) as the uterine muscle get stretched
with fetal growth and increasing amniotic fluids, irritability and contractions
to empty the contents of the uterus are likely to result.
Components of Labor
A. Passage
Is the shape and measurement of maternal pelvis and dispensability of
birth canal.
Fetal Presentation and Position
Attitude - describes the degree of flexion a fetus assumes during
labor the relation of the fetal parts to each other.
Good attitude: is in complete flexion: the spinal column is bowed
forward, the head is flexed forward so much that the chin touches
the sternum, the arms are flexed and folded on the chest, the thighs
are flexed onto the abdomen, and the calves are pressed against
the posterior aspect of the thighs.
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Moderate flexion: if the chin is not touching the chest but is in
alert or military position.
Engagement - refers to the settling of the presenting part of a fetus
enough into the pelvis to be at the level of the ischial spines, midpoint of the
pelvis.
Station refers to the relationship of the presenting part of a fetus to if
level of the ischial spines.
Station 0: when the presenting part is at the level of ischial spin
(Synonymous with engagement)
Minusstations (-1 to -4): if the presenting part is above the spines.
Plusstation (+1 to +4): at 3 to +4 station, the presenting part
at the perineum and can be seen if the vulva is separated (crowning)
Fetal Lie - is the relationship between the long (cephalocaudal) axis the
fetal body and the long (cephalocaudal) axis of a womans body.
B. Passenger
Is the fetus the body part of the fetus that has the widest diameter is the
head, so this is the part least likely to be able to pass through the pelvic ring.
Fetal Head - usually the largest part of the body, it has found effect
on the birthing process.
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Bones of the Skull - are joined by membranous sutures, which
allow for overlapping or molding of cranial bones during birth
process.
Anterior and Posterior Fontanels are the pints of intersection
for the sutures and are important landmarks.
Fontanels are used as landmarks for internal examinations
during labor to determine position of fetus.
Fetal shoulders may be manipulated during delivery to allow
passage of one shoulder at a time.
Molding is the change in shape of the fetal skull produced by
the force of uterine contractions pressing the vertex of the head
against the not-yelled- dilated cervix.
Types of presentation
Cephalic
Head is presenting part, usually the vertex (occiput), which is
the most favorable for birth. Head is flexed with chin on chest.
o Vertex Presentation
When the head is well flexed the
suboccipitobregmatic diameter and the parietal
diameter present. When the head is not flexed but
erect, the presenting diameters are occipitofrontal
and biparietal.
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o Brow Presentation
When the head is partial flexed, the brow or sinciput
becomes the presenting part.
o Face Presentation
When the head is extended to make the face the
presenting part.
o Mentum Presentation
The head is completely hyperextend the head to
present the chin.
Breech
Buttocks or lower extremities present first.
o Frank
Thighs flexed, legs extended on anterior body
surface, buttocks presenting.
o Full or Complete
Thighs and legs are flexed. Buttocks and feet (baby
is squatting position).
o Footling
One or both feet are presenting.
Shoulder
Presenting part is the scapula and baby is in horizontal or
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Transverse position. Cesarean birth indicated.
C. Power (uterine factors)
a. Uterine contractions (involuntary)
Frequency timed from the beginning of one contraction to the
beginning of the next.
Regularity discernable pattern: better established as pregnancy
progresses.
Intensity Strength of contraction; May be determined by the
depressability of the uterus during a contraction. Describe as
mild, moderate or strong.
Duration length of contractions. Contraction lasting more than
90 seconds without a subsequent period of uterine relaxation may
have severe implications for the fetus and should be reported.
Phases of contractions
o the increment, when the intensity of the contraction
increases
o acme, when the is at its strongest
o decrement, when the intensity decreases
Cervical Changes
o Effacement- shortening and thinning of the cervical canal.
Canal is approximately 1-2cm long.
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Primiparas effacement is accomplished before
dilatation begins.
Multiparas dilatation may proceed before
effacement is complete.
Dilatation- refers to the enlargement or widening of
the cervical canal from an opening a few millimeters
wide to one large enough (approximately 10cm) to
permit passage of the fetus.
b. Voluntary Bearing Down Efforts
After full dilatation of the cervix, the mother can use her abdominal
muscles to help expel fetus.
These efforts are similar to those for defecation, but the mother is
pushing out the fetus from the birth canal.
Contraction of levator and muscle
Premonitory Signs of Labor
Lightening- descent of the fetal presenting part into the pelvis
approximately 10-14 days before labor begins.
Signs of Lightening:
o Relief of Dyspnea.
o Relief of abdominal tightness
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o Increase frequency of urination, varicosities, and pedal
edema because of pressure on the bladder and pelvic
girdle.
o Shooting pain down the legs because of the pressure on
the sciatic nerve
o Increase amount of vaginal discharge
Increase Maternal energy- nesting behavior because of increase
level of epinephrine.
Braxton Hicks Contraction- extremely strong which may interpret
as true labor contractions.
Ripening of the cervix (Goodells Sign) - becomes soft as butter
that is seen only on pelvic examination.
Differentiation between True and False Labor Contractions
True Contractions False Contractions
Begin irregular but
become regular and
predictable.
Felt first from lower back
groin to abdomen in a
wave
Continue no mailer what
Begin and remain
irregular
Fell first abdominally
and remain confined to
the abdomen and groin
Often disappear with
ambulation and sleep.
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Mechanism of Labor
Passage of fetus through the birth canal involves a number of
different position changes to keep the smallest diameter of the fetal head (in
cephalic presentation) always presenting to the smallest diameter of the birth
canal. These position changes are termed the cardinal movements of labor:
descent, flexion, internal rotation, extension, external rotation and expulsion.
DESCENT - Is the downward movement of the biparietal diameter
of the fetal head to within the pelvic inlet. Full descent occurs when
the fetal head extrudes beyond the dilated cervix and touches the
posterior vaginal floor. Descent occurs because of pressure on the
fetus by the uterine fundus. The pressure of the fetal head on the
sacral nerves at the pelvic floor causes the mother to experience a
the womans activity
Increase in duration,
frequency and intensity
Achieve cervical
dilatation
Do not increase in
duration, frequency, or
intensity
Do not achieve cervical
dilatation
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pushing sensation. Full descent may be aided by abdominal muscle
contraction as the woman pushes.
FLEXION as the descent occurs and the fetal head reaches the
pelvic floor, the head bends forward onto the chest, making the
smallest anteroposterior diameter (the suboccipitobregmatic
diameter) the one presented to the birth canal. Flexion is also aided
by abdominal muscle contraction during pushing.
INTERNAL ROTATION The head flexes as it touches the pelvic
floor, and occiput rotates until it is superior, or just below the
symphysis pubis, bringing head into the best relationship to the
outlet of the pelvis. This movement brings the shoulders, coming
next, into the optimal position to enter the inlet. Putting widest
diameter of the shoulders in line with the wide transverse diameter
of inlet.
EXTENSION As the occiput is born, the back of the neck stops
beneath pubic arch and acts as a pivot for the rest of the head. The
head extends the foremost parts of the head, the face and chin, are
born.
EXTERNAL ROTATION almost immediately after the head of
the infant is the head rotates back to the diagonal or transverse
position of the early part labor. This brings the after coming
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shoulders into an anteroposterior position which is best for entering
the outlet. The anterior shoulder is born first. Assisted perhaps by
downward flexion of the infants head.
EXPULSION once the shoulders are born, the rest of the baby s
born easily and smoothly because of its smaller size. This
movement is the end of the pelvic division of labor.
Stages of Labor
A. First Stage
A first stage of dilatation, which begins with the initiation of true
labor contract and ends when the cervix is fully dilated. The first stage of
labor is divided into If phases: the latent, the active, and the transition
phase.
PRIMI: 12 1/2 hours
MULTI: 8 hours
a) Latent Phase
The latent or preparatory phase begins at the onset of
regularly perceived uterine contractions and ends when rapid
cervical dilatation begins. Contractions during this phase are
mild and short, lasting 20-40 second cervical effacement
occurs, and the cervix dilates from 0-3cm. the ph lasts
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approximately 6 hours in a nullipara and 4.5 hours in a
multipara. Maternal behavior: talkative, less anxious, alert,
excited and the woman. This stage is excited with some
degree of apprehension but still with the ability to
communicate.
Assessment:
i. Contractions: frequency, intensity, duration
ii. Membranes: intact, ruptured, color of fluid
iii. Bloody show, time of onset, cervical changes
iv. Time of last ingestion of food
v. FHR every l5mirts. Immediately after rupture of
membranes
vi. Maternal vital signs: temperature every 2 hours
membranes ruptured every 4 hours if intact
vii. Pulse and respirations every hour or when necessary
viii. Progress of descent
b) Active Phase
During the active phase of labor, cervical dilatation
occurs more rapidly. Increasing from 4-7 cm. contraction
grow stronger, lasting 40-60 seconds. and occur
approximately every 3-5 minutes. This phase lasts
approximately 3 hours in a nullipara and 2 hours in a
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multipara. Show (increased vaginal secretions) and perhaps
spontaneous rupture of membranes may occur during this
time. Maternal behavior: less talkative. More anxious; may
not want to be alone, fears of losing control, restless.
Increase anxiety. Maternal problem may hyper ventilate.
Assessment:
i. Cervical changes and increase bloody show
ii. Progress of descent
iii. Maternal and fetal vital sign
c) Transition Phase
During the transition phase, contractions reach their
peak of intensity. Occurring every 2-3 minutes with a
duration of 60-90 seconds and causing maximum dilatation
of 8-10 cm. by the end of this phase, both full
Dilatation (10 cm) and complete cervical
effacement(obliteration of the cervix) have occurred. If cervix
is intact, this period is marked by a sudden gush of amniotic
fluid as the fetus is pushed into the birth canal. Shows
become prominent. There is an uncontrollable urge to push
with contractions. The woman may experience intense
discomfort that may be accompanied by nausea and
vomiting. Maternal behavior: feeling of loss of control,
anxiety, panic and irritability.
Assessment:
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i. Progress of labor and cervical changes
ii. Mood changes: if irritable or aggressive may be tiring or
unable to cope
iii. Signs of nausea, vomiting, trembling, crying, irritability
iv. Maternal and fetal vital signs
v. Breathing patterns, may be hyperventilating
vi. Urge to bear down with contractions
B. Second Stage
The second stage of labor is the period from full dilatation and
cervical effacement to birth of the infant; with uncomplicated birth, this
stage about 1 hour. Contractions change from the characteristic
crescendo-decrescendo pattern to an overwhelming, uncontrollable urge
to push or bear down with each contraction as if to move her bowels.
Perineum bulges; grunting sounds. Increase bloody show with leg cramps
and bag of water ruptures. Maternal behavior: progresses from irritability
to participation, eagerness and excitement with need to bear down so she
pushes with uterine contraction spontaneously.
PRIMI: 80 mm.
MULTI: 30 mm
Assessment
i. Signs of imminent delivery
ii. Progress of descent
iii. Maternal and fetal vital signs
iv. Increase maternal pushing efforts
v. Vaginal distension
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vi. Crowning
vii. Birth of baby
C. Third stage
The third stage of labor, the placental stage, begins with the birth of
the infant and ends with the delivery of the placental separation and
placental expulsion.
PRIMI: 10 mm
MULTI: 10 mm
Signs of placental Separation:
Lengthening of the umbilical cord.
Sudden gush of vaginal blood
Change in shape of the uterus
Firm contraction of the uterus
Appearance of the placenta at the vaginal opening
Types of Placental Delivery:
Schultz Mechanism: 80% of the cases; fetal side, shiny clean and
inverted umbrella.
Duncans Mechanism: 20% cases. maternal side. rough dirty and
umbrella shape.
Assessment
i. Signs of placental separation
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ii. Mechanisms of placental separation
iii. Completeness of the placenta
iv. Status of mother and baby: babys apgar scores, blood
pressure, pulse, respirations, lochia and fundal status of the
mother.
C. Fourth Stage (recovery stage)
The first 1- 4 hours after birth of the placenta is sometimes termed
the fourth stage to emphasize the importance of the close observation
needed at this time. First two hours is the most crucial stage of the mother
due to unstable vital signs.
Assessment
i. Fundus: every 15 mm. for one hour and every 30 mm. for
the next four hours.
ii. Lochia: should be moderate in amount
iii. Bladder: full bladder is evidenced by the shifting of the
uterus to the right.
iv. Normally tender, discolored, edematous and intact
sutures
v. BP and HR: monitored closely 15 mm. during the 1 hour,
every 30 mm. for 2 hours.
vi. Rooming- in concept: the mother and the baby stays in
the same room in the hospital to promote the bonding and
encourage breastfeeding.
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vii. Firmness of the fundus and its position
viii. Lochia color and amount
Lochia Rubra Dark red 1-3 days
Blood and cellular
debris from
decidua
Lochia Serosa
Pinkish 4-10 days
Mostly serum,
some blood,
tissue debris
Lochia Alba Yellowish 11-21 days
Mostly, white
leukocytes with
deciduas,
epithelial cells,
ix. Perineum condition
x. Vital signs and medications and IV if any
xi. Infants pulse rate, respiration, appearance, reflexes and
vital measurements
xii. Palpate fundus every 15 mm. for the first 1-2 hours or
until stable
xiii. Monitor Mothers vital signs
xiv. Check vaginal discharges every 15 mm. for the first 1-2
hours
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III. Profile
Name : Dona P. Villlegas
Address : Flores Compound, Calaanan, Canitoan, CDOC
Civil Status : Married
Sex : Female
Age : 24 yrs. old
Height : 162.6 cm
Occupation : Teacher
Educational status : College Graduate
Income : N/A
Religion : Roman Catholic
Nationality : Filipino
LMP : December 10, 2008
EDC : September 17, 2009
Time of delivery : 2:38 pm
Type of delivery : Normal spontaneous delivery
Gravida : 1
Parity : 1
Term : full term
Premature : 0
Abortion : 0
Living : 1
Name of Hospital : J.R Borja General Hospital
Name Physician : Dr. John Paul L. Oliveros, M.D.
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Assessment
Assessment
1st Visit
(July 28, 09)
2nd Visit
(Aug. 28,09)
3rd Visit
(Sept.26,09)
4th Visit
(Oct. 2,09)
Temperature 36.5 C 36.3C 37.5C 37.4C
Pulse rate 76bpm 80bpm 82bpm 81bpm
Respiration rate 21cpm 19cpm 21cpm 21cpm
Blood pressure 120/90mmHg 100/60mmHg 120/80mmHg 110/90mmHg
Height 162.6 162.6cm 162.6cm 162.6cm
Weight 58.9kg 58.5kg 58.9kg 57.5kg
Age of gestation 26weeks 30weeks 34weeks Weeks
Fetal heart beat 128bpm 130bpm 135bpm 134bpm
Fundal height 26cm 30cm 34cm cm
Immunization:
Type of
immunization
dose date Place of
immunization
Tetanus toxoid 1 dose March 29,2009 Canitoan
Health Center
Tetanus toxoid 1 dose April 26,2009 Canitoan
Health Center
Food or drug allergy: No known food and drug allergies
Heredo-Familial Disease: No known Heredo-Familial Disease
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Received Blood in the past: she havent received blood in the past
IV. Ideal Nursing Intervention
A. Antepartum
Nursing Diagnosis
o Fatigue related to effects of physiologic changes of
pregnancy.
Nursing Interventions:
1. Explain to patient physiologic changes responsible for increased
feeling of fatigue during pregnancy.
Information provides knowledge that can
motivate an individual to make lifestyle
changes that will enhance energy level by
promoting adequate rest.
2. Assist patient in developing a plan to increase amount of rest
and sleep.
Mutually deciding on a plan increases the
likelihood that the patient will follow through
with the actions needed to successfully
implement the plan.
3. Instruct patient to limit fluid intake during the evening.
To prevent frequent awakenings from nocturia.
4. Instruct patient to position self in bed for maximum comfort.
Comfort promotes rest.
5. Assist patient in eliminating nonessential tasks from schedule.
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To prevent fatigue from excessive demands
and to allow time for additional rest periods.
Nursing Diagnosis
o Pain related to urinary tract infection.
Nursing Interventions:
1. Assess pain, noting location, intensity (scale of 0-10), and
urination
Provides information to aid in determining
choice/effectiveness of interventions.
2. Recommend bed rest as indicated.
Bed rest may be needed initially during acute
retention phase.
3. Suggest comfort measures, like backrub, deep-breathing
exercises, diversional activities and helping patient assume position
of comfort.
Promotes relaxation, refocuses attention, and
may enhance coping abilities
4. Encourage use of sitz baths, warm soaks to perineum.
Promotes muscle relaxation.
5. Administer medication as indicated:
Narcotics like meperidine (Demerol)
o Given to relieve severe pain, provide
physical and ental relaxation.
Antibacterial like methenamine hippurate
(hiprex)
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o Reduces bacteria present in urinary
tract as well as those introduced by
drainage system.
Antiplasmodics and bladder sedatives like
flavorate (urispas), Oxybutynin (ditropan).
o Relieves bladder irritability.
Nursing Diagnosis
Risk for ineffective breathing pattern related to respiratory
changes during pregnancy..
Nursing Intervention:
1. Investigate etiology of respiratory failure.
Understanding the underlying cause of the
patient particular ventilatory problem is
essential to the care of the patient.
2. Observe overall breathing pattern.
To identify if patient is experiencing
hyperventilation or hypoventilation.
3. Count patients respirations for one full minute and compare to
desired ventilator set rate.
Respirations vary, depending on problem
requiring ventilator assistance.
4. Elevate head of bed or place in orthopedic chair if possible.
Elevation of head is both physically and
psychologically beneficial.
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5. Keep resuscitation bag at bedside and ventilate manually
whenever indicated.
Provides adequate ventilation when patient
problems require that the patient be
temporarily removed from the ventilation.
Nursing Diagnosis
o Imbalanced nutrition, less than body requirements related to
nausea, vomiting and knowledge deficit of nutritional needs
during pregnancy.
Nursing Interventions:
1. Review 24-hour dietary intake and ask if this is typical of the normal
diet.
To provide baseline information of patients
nutritional habits.
2. Determine current knowledge of nutritional needs during
pregnancy.
To provide information needed to develop an
individualized teaching plan.
3. Use of food pyramid to teach patients to eat a nutritional diet;
provide them with a copy of the food pyramid.
A healthy diet should consists of that can be
adapted to accommodate cultural preferences.
4. Teach patient to report excessive nausea and vomiting to health
care provider.
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To allow for early intervention of alternative
forms of nutritional delivery if an oral diet
cannot be tolerated.
5. Avoid beverages with meals and foods that are spicy and greasy.
These have noxious odors can increase
episodes of nausea and vomiting.
Nursing Diagnosis
o Knowledge deficit related to normal changes of pregnancy
versus illness complications.
Nursing Interventions
1. Review avoidance of environmental risk factors.
Reduces potential for acquired infection.
2. Identify specific activity limitations.
Prevents undue strain on operative site.
3. Recommend planned progressive exercise.
Promotes return of normal function and
enhances feeling of general well.
4. Schedule adequate rest periods.
Prevents fatigue and conserves energy for
healing.
5. Review importance of nutritious diet and adequate fluid intake.
Provides elements necessary for tissue
regeneration.
6. Identify signs and symptoms requiring medical evaluation.
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Early recognition and treatment of developing
complications.
B. Intrapartum
Nursing Diagnosis:
o Anxiety: mild related to excitement, of onset of labor and fear
of the birth.
Nursing Interventions:
1. Support womans knowledge of labor.
To provide comfort measures to the mother
during labor and delivery process.
2. Explain all procedures performed or the process of labor.
Explaining the process of labor or childbirth to
the patient minimizes patients apprehensions.
3. Answer all questions and provide information as needed.
To provide reassurance to the mother and help
her to relax during childbirth.
4. Monitor VS, FHR and progress of labor.
Monitoring mothers VS and fetal heart rate is
needed to take baseline data and to take note
for any patients reactions during labor process.
5. Support womans preference for breathing and relaxation
techniques to be used at this time.
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Supporting the mothers preference for
breathing and relaxation techniques helps us to
implement or provide comfort measures and
help the mother to expel the newborn properly.
6. Administer anti-anxiety or anxiolytic medications as ordered.
Anxiolytic drugs or medications lowers level of
anxiety with the proper use of pharmacology.
Nursing Diagnosis:
o Fluid volume deficit related to decreased intake and
increased loss of fluid with the work of labor.
Nursing Interventions
1. Explain to woman and support person why oral fluids are
restricted or stopped at this time.
Explaining the necessary information
concerning fluid intake of the client was
necessary in order to gain cooperation from the
mother and to decrease urination during the 2nd
stage of labor (delivery stage).
2. Start and maintain IV infusion.
Intravenous infusion is necessary to maintain
adequate hydration during the labor process of
the client.
3. Provide ice chips or sips of clear fluids if allowed.
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To prevent dry mouth during labor process and also to
increase mothers energy in doing the bearing down
technique during contractions.
Nursing Diagnosis:
o Pain related to increasing frequency and intensity of uterine
contraction
Nursing Interventions:
1. Provide comfort measures (eg. back rub, change of position)
Back rubbing could provide non-pharmacologic pain
management, thus reducing the pain felt by the mother
during her labor stage.
2. Encourage diversional activities (e.g. TV, radio, socialization
with others )
Diversional activities are a mean of diverting patients
attention on others things, thus reducing the pain felt
by the mother during the labor process.
3. Eliminate additional stressors or sources of discomfort whenever
possible.
Patients may experience an exaggeration in pain or
decreased ability to tolerate painful stimuli if
environmental, interpersonal factors are further
stressing them.
4. Instruct or encourage the mother to use of relaxation exercises,
such as focused breathing, or listening to music.
Relaxation eases the painful sensation.
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5. Administer analgesics as ordered.
Analgesics provide pain relief to the patient during
delivery stage of labor.
Nursing Diagnosis
o Ineffective individual coping, related to anxiety, fear and
decreased problem-solving capability.
Nursing Intervention
1. Assess anxiety level.
To identify appropriate comfort measures to be given
to the client during her labor process.
2. Assess behavior of support person and its effect on the woman.
To help woman cope with increasing pain and anxiety
of active labor.
3. Provide information
Information concerning labor process reduces
mothers feeling of fear or anxiety during labor
process.
4. Assist woman and support person in focusing on breathing and
relaxation techniques to maintain control.
To Relieve from muscular aches
3. Give episiotomy Care
To relieve discomfort
To prevent further infection
4. Promote Perineal Exercises
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Aids comfort by providing circulation to the area and
decreasing edema.
To help regain her Pre-pregnant stage.
To reduce episiotomy discomfort
5. Administer Hot and Cold Therapy
To reduce perineal edema and possibility of
Hematoma formation.
To increase circulation to the perineum, provide
comfort and promote healing.
6. Administer Sitz Baths
To decrease inflammation by causing vasodilatation
in the area, and thereby effectively reduces
discomfort and promotes healing.
7. Provide pain management
To reduce incision line pain
To promote extra encouragement to try the pain
medications
To relieve perineal pain
Nursing Diagnosis
o Risk for infection (uterine) related to lochia and episiotomy
Nursing Intervention
1. Provide Perineal Care
To remove transient microorganisms in the perineum
To avoid further infection
To promote hygiene
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2. Promote perineal self-Care
To teach the patient how to carry out own perineal care
Nursing Diagnosis
o Disturbed sleep pattern related to exhaustion and excitement
from and excitement of childbirth
Nursing Intervention
1. Promote rest in the early postpartal period.
To encourage a period of rest to regain energy.
2. Listen to subjective reports of sleep quality.
To evaluate pattern of sleep and dysfunction.
3. Assist individual to develop schedules that take advantage. of
peak performance times as identified in chronological order.
To promote wellness.
Nursing Diagnosis
o Risk for bathing hygiene self-care deficit related to
exhaustion from childbirth.
Nursing Intervention:
1. Determine current capabilities and barriers to participation in
care.
Identifies need for/level of interventions required
2. Involve patient in formulation of plan of care at level of activity
Enhances sense of control and aids in cooperation and
development of independence.
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3. Encourage self-care. Work with present abilities: do not
pressure patient beyond capabilities. Provide adequate time for
patient to complete task.
Doing for one self enhances feeling of self-worth. Failure
can produce discouragement and depression.
Nursing Diagnosis
o Imbalanced nutrition, less than body requirements,
related to lack knowledge about postpartal needs
Nursing Intervention:
1. Promote Adequate Fluid Intake
Prevent dehydration
2. Emphasize importance of well-balanced, nutritious intake.
Provide information regarding individual nutritional needs and ways
to these needs within financial constraints.
To promote wellness and knowledge about own
nutritional needs
3. Ascertain understanding of individual nutritional needs
To determine what information to provide client.
4. Provide diet modification
To establish nutritional plan that meets individual needs
Nursing Diagnosis
o Risk for impaired urinary elimination or constipation
related to of bladder and bowel sensation after
childbirth.
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Nursing Intervention:
1. Promote Urinary Elimination
To achieve normal elimination pattern
2. Adequate fluids and roughage
To prevent constipation
3. Palpate bladder for retention
To assess the degree of interference
Nursing Diagnosis
o Risk for ineffective peripheral tissue perfusion related
to immobility and increased estrogen
Nursing Intervention:
1. Observe skin for pallor, redness. Manage with lotion, change
position frequently.
Compromised peripheral circulation increases risk of skin
breakdown
2. Assess skin for coolness, pallor, diaphoresis, delayed capillary
refill, and weak, thread peripheral pulses.
Vasoconstriction is a sympathetic response to lowered
circulating volume and/or may occur as a side effect of
vasopressin administration.
Nursing Diagnosis
o Pain related to primary breast engorgement
Nursing Intervention:
1. Promote Breastfeeding
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Prevent tenderness and soreness of primary breast
engorgement.
2. Promote Breast Hygiene
To prevent possible infection when breastfeeding
Nursing Diagnosis
o Health-seeking behaviors related to clients desire to
return to pre- pregnant weight and appearance
Nursing Intervention:
1. Teach methods to promote uterine involution.
To promote fast return to pre-pregnant state
2. Promote using proper body mechanics, getting adequate rest,
and performing prescribed exercises.
To help clients abdominal wall to return to good tone.
Nursing Diagnosis
o Attachment risk for impaired parent/infant! child
Nursing Intervention:
1. Interview parents, noting their perception of situation. Individual
concerns
2. Evaluate parents ability to provide protective environment,
participate in reciprocal relationship.
To provide a good environment to infant/child
3. Educate parents regarding child growth and development,
addressing parental perception. Helps clarify realistic expectations
To enhance behavioral of infant/child
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4. Involve parents in activities with the infant/child that they can
accomplish successfully. Enhance self-concept.
To enhance best functioning of parents
D. Immediate Newborn Care
Nursing Diagnosis
o Imbalance nutrition less than body requirement related
to poor sucking reflex
Nursing Interventions:
1. Assess nutritional status continually during nursing care noting
energy level, condition of the skin, nails, hair and oral cavity.
provides the opportunity to observe deviations from
normal
2. Weigh daily and compare with the admission date.
Establish baseline, aids in monitoring effectiveness of
therapeutic regimen and alerts the nurse to inappropriate
trends in weight loss or gain
3. Always hold the infant when feeding and propping the bottle when
feeding.
To promote bonding and gain trust of the infant
4. Feeding only breast milk or formula milk for the first year.
Feeding only breast milk for the first year is given since it
is theft main source of nutrition consumption because
ingestion of solid foods is not appropriate for infants
aging 0-4 mos.
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5. Avoiding use of honey and corn syrup.
Use of honey and corn syrup can make the infant
dependent on it with out taking new food preference that
contains more nutrition
Nursing Diagnosis
o Risk for ineffective airway clearance related to difficulty
establishing respirations and rapid respiratory rate
Nursing Interventions:
1. Assess respiratory rate every 15 mm. for about 1 hr. report any
increase in rate, retractions or development of nasal flaring or
grunting
Assessment provides a baseline foe evaluating changes.
Increase in respiratory rate and a retraction accompanied
by nasal flaring and grunting indicates respiratory
distress.
2. Position the newborn on his side with his head slightly lower
than the rest of the body
Positioning in this manner facilitates drainage of
secretions from airway
3. Change the position of the newborn frequently
Changing position frequently facilitates drainage of
secretions and thus promotes lung expansion
4. Suction mouth and nose with a suction bulb as indicated
Suctioning removes secretions and suctioning from
mouth to nose prevents aspiration of oral secretions
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5. Monitor newborn temperature and keep him warm via radiant
warmer. Wrap the newborn loosely with a blanket and place a cap
on head
Newborns have difficulty conserving body heat. Exposure
to cold environment increase metabolic rate, increasing
the need of oxygen and further increasing respiratory
rate.
Nursing diagnosis
o Risk for impaired parenting related to concerns about
skin color.
Nursing Interventions:
1. Allow parents to verbalize their concerns about the
discoloration.
Verbalization allows safe outlet for emotion and helps to
increase the parents awareness
2. Explain that Mongolian spats are normal variation to skin color
of the newborn. Inform them that the area usually disappears by
school age.
Explanation as normal provides information to help allay
parents fears and concerns
3. Point out other positive normal attributes of the newborn
Pointing out other positive areas helps the parents focus
on the uniqueness and special qualities of their child.
4. Encourage the parents to hold, talk and explore the newborn
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Nursing Interventions:
1. Assess environmental temperature (78 80F) and modify if
needed example providing warm and cooling blankets and increasing
room temperature.
Assessing would maintain and stabilizes newborns
temperature
2. Monitor newborn temperature and keep him warm via radiant
warmer. Wrap the newborn loosely with a blanket and place a cap
on head
Newborns have difficulty conserving body heat. Exposure
to cold environment increase metabolic rate.
3. Close doors and windows and regulate the cooling facility
To provide warm environment for the newborn thus
preventing him from chilling
4. Prevent exposing the newborns body for a long span of time
Preventing sudden and long exposure of newborns body
to the environment reduces chance of chilling
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Actual Nursing Intervention
A. Antepartum
During antepartal period, a pregnant woman may able to experience many
things related to her health such as headache, nausea, vomiting, and cramps
over the extremities. Due to this complication a pregnant woman may feel
depressed or may form a negative feeling towards her pregnancy. To solve
this complication or to prevent a pregnant woman to have further
complication, it is better for them to consult their physician or by visiting the
nearest health center in their town. The reason for visiting and consulting their
physician and health center is that they can monitor her condition. And so she
can understand why shes experiencing this condition.
During our assessment to our client, we were able to identify different
problems.
We were able to identify the following problems:
y Improper breathing pattern while sleeping
y Back pain
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EENT:
[ ] Impaired vision [ ] blind[ ] pain redden [ ] drainage[ ] gums [] hard of hearing [ ] deaf[ ] burning [ ] edema [ ] lesion teeth[ ] assess eyes ears nose[ ] throat for abnormality[x] no problem
RESP:[ ] Asymmetric [ ] tachypnea [ ] barrel chest[ ] apnea [ ] rales [ ] cough[ ] bradypnea [ ] shallow [ ] rhonchi[ ] sputum [ ] diminished [x] dyspnea[ ] orthopnea [ ] labored [ ] wheezing
[ ] pain [ ] cyanotic[ ] assess resp. rate, rhythm, pulse blood[ ] breath sounds, comfort [ ] no problem
CARDIOVASCULAR:[ ] arrhythmia [ ] tachycardia [ ] numbness[ ] diminished pulses [ ] edema [ ] fatigue[ ] irregular[ ] bradycardia [ ] mur mur[ ] tingling [ ] absent pulses [ ] painAssess heart sounds, rate rhythm, pulse, bloodPressure, circ., fluid retention, comfort[x] no problem
GASTROINTESTINAL TRACT:[ ] obese [ ] distention [ ] mass[ ] dysphagia [ ] rigidity [ ] pain[ ] assess abdomen, bowel habits, swallowing[ ] bowel sounds, comfort [x] no problem
GENITO U
RINA
RYAND
GY
NE[ ] pain [ ] urine [ ] color [ ] vaginal bleeding[ ] hematuria [ ] discharge [x ] nocturia[x] assess urine frequency, control, color, odor, comfort[ ] gyne bleeding [ ] discharge [ ] no problem
NEURO:[ ] paralysis [ ] stuporous [ ] unsteady [ ] seizure[ ] lethargic [ ] comatose [ ] vertigo [ ] tremors[ ] confused [ ] vision [ ] grip[ ] assess motor, function, sensation, LOC, strength[ ] grip, gait, coordination, speech [x ] no problem
MUSCULOSKELETAL and SKIN:
[ ] appliance [ ] stiffness [ ] itching [ ] petechiae[ ] hot [ ] drainage [ ] prosthesis [ ] swelling[ ] lesion [ ] poor turgor [ ] cool [ ] flushed[ ] atrophy [ ] pain [ ] ecchymosis [ ] diaphoretic moist[ ] assess mobility, motion gait, alignment, joint function
[ ] skin color, texture, turgor, integrity [x] no problem
Nursing Assessment (System Review and Nursing Assessment)
Name: Donna P. VillegasBP: 100/60 mmHg T: 36.5 C PR: 80 bpm RR: 19 cpm
Weight: 58.9kgs Height: 162.6cm
No problem
Linea nigra
Strae gravidarum
Back pain
Varicosity
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SUBJECTIVE OBJECTIVE
COMMUNICATION Comments[ ]Hearing Loss[ ]Visual changes[x]Denied
[ ]glasses [ ]languages[ ]contact lens [ ]hearing aideR 3-4mm L 3-4mm
Pupil size: 3-4mm [ ]speech difficultiesReaction: PERRLA
OXYGINATION Comments[x ]Dyspnea[ ]Smoking History________________
[ ]Cough[ ]Sputum[ ]Denied
Respiraatory: [] Regular []irregularDescription: RR is within normal range
R: right lung is symmetric to the left lungL: left lung is symmetric to the right lung
CIRCULATION Comments[x]Back Pain[x]Leg Pain[x]Numbness of the
Extremities[ ]Denied
Heart Rhythm: [] regular [] irregularAnkle Edema NONE
Pulse Car Rad DP FemR + + + N.OL + + + N.OComments: All pulse sites are palpable
NUTRITION CommentsDiet:DAT[x]N [x]VCharacter[ ]Recent change in
Weight, appetite[ ]Swallowing
Difficulty
[]dentures []none
Full partial with patientUpper [] [] []Lower [] [] []
ELIMINATIONUsual bowel pattern [x]urinary frequencyOnce in every two days 6 times per day
[ ]Constipation [ ]urgency
Remedy [ ]dysuria[ ]hematuria
Date of last BM: [ ]incontinenceSept. 25, 2009 [ ]polyuria[ ]diarrhea [ ]foly in place
Character [ ]denied
Comments: Bowel sounds:
Abdominal DistensionPresent []yes[]noUrine (color, consistency, odor)
If they are in place?
MGT. OF HEALTH & ILLNESS[ ]alcohol [ ]denied
[x]SBELMP: Dec.01, 2009
Briefly describe the patients ability to follow treatments
(diet, meds., etc.) for chroni9c health problems ( if present)
The patient did not experience any chronic problem.
Wala man koproblem sa akopanan-an asverbalized by thepatient.
Pag-maghigdako, galisod koug ginhawa.As verbalizedby the patient
Magbinhod
akong tiil ug sakitakong likod inighapon asverbalized by thepatient
Gasuka ko uggakalipong tagabuntag asverbalized by the
patient.
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Skin Integrity Comments[ ]Dry[ ]itching[ ]other[x]denied
[ ]dry [ ]cold [ ]pale[ ]flushed [ ]warm[ ]moist [] cyanotic
Rashes, ulcers, decubitus (describe size, location,drainage) No found any impaired skin integrity.
Activity/Safety Comments[ ]convulsion[ ]dizziness[ ]limited motion of joints[ ]ambulate[ ]Bathe self[ ]Other[x]denied
[ ] LOC and orientation: patient is well
oriented with time and date.Gait: [ ]Walker [ ]cane [ ]other
[ ]steady [ ]unsteady_______[ ]sensory and motor losses in face or extremities: NONE
[ ] ROM limitationsComfort/Sleep/Awake:[ ] pain (location, Comments
frequencyremedies)
[ ] nocturia[x]sleep difficulties[ ]denied
[ ]facial grimace[ ]guarding[ ]other signs of pain[ ]side rail release form signed (60+ tears)
Coping:Occupation: mother
Members of household: 5Most supportive person: mother and father
Observed non-verbal behavior:
The person and her phone number that can be reached anytime:
SPECIAL PATIENT INFORMATION N/A Daily weight N/A PT/OT
N/A BP q shift N/A Irradiation
N/A Nero vs N/A Urine Test N/A CVP/SG. Reading N/A 24 hours Urine Collection
Date Ordered Diagnostic/Laboratory
Exam
Date Done Date Ordered I.V Fluids/Blood Date Done
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HEALTH TEACHINGS
Medication Instruct the patient ordered by the doctor such as
to take ferrous sulfate a day after breakfast
Exercise y Advice to do antepartal exercise inpreparation for labor and delivery. It will
strengthen her muscle over perineum,abdomen, legs, and reduce backache and
numbness over the extremities.
y Demonstrate the antepartal exercise inher front and if possible she will follow
it afterwards. Demonstrate the following exercise:
Pelvic tilting or pelvic rocking Knee chest twist Leg raising Tailor setting Ribcage lifting Shoulder circling Knee bending Calf stretching
Treatment Instruct patient to increase fluid intake so thatthere would be increased in the amount of
amniotic fluid.
Out-patient Regular check-up to their health center
Check-ups Every Tuesday of the week Once a month before EDC
Diet Instruct patient to increase food intake such as:
Foods high in protein Food that has high iron such as chicken
liver and malungay.
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EENT:[ ] Impaired vision [ ] blind
[ ] pain redden [ ] drainage[ ] gums [] hard of hearing [ ] deaf[ ] burning [ ] edema [ ] lesion teeth[ ] assess eyes ears nose[ ] throat for abnormality[x] no problem
RESP:[ ] Asymmetric [ ] tachypnea [ ] barrel chest[ ] apnea [ ] rales [ ] cough[ ] bradypnea [ ] shallow [ ] rhonchi[ ] sputum [ ] diminished [ ] dyspnea[ ] orthopnea [ ] labored [ ] wheezing[ ] pain [ ] cyanotic[ ] assess resp. rate, rhythm, pulse blood[ ] breath sounds, comfort [ ] no problem
CARDIOVASCULAR:[ ] arrhythmia [ ] tachycardia [ ] numbness[ ] diminished pulses [ ] edema [ ] fatigue
[ ] irregular[ ] bradycardia [ ] mur mur[ ] tingling [ ] absent pulses [ ] painAssess heart sounds, rate rhythm, pulse, bloodPressure, circ., fluid retention, comfort[x] no problem
GASTROINTESTINAL TRACT:[ ] obese [ ] distention [ ] mass[ ] dysphagia [ ] rigidity [ ] pain[ ] assess abdomen, bowel habits, swallowing[ ] bowel sounds, comfort [x] no problem
GENITO URINARY ANDGYNE
[ ] pain [ ] urine [ ] color [ ] vaginal bleeding[ ] hematuria [ ] discharge [ ] nocturia[ ] assess urine frequency, control, color, odor, comfort[ x ] gyne bleeding [ ] discharge [ ] no problem
NEURO:
[ ] paralysis [ ] stuporous [ ] unsteady [ ] seizure[ ] lethargic [ ] comatose [ ] vertigo [ ] tremors[ ] confused [ ] vision [ ] grip[ ] assess motor, function, sensation, LOC, strength[ ] grip, gait, coordination, speech [x ] no problem
MUSCULOSKELETAL and SKIN:[ ] appliance [ ] stiffness [ ] itching [ ] petechiae[ ] hot [ ] drainage [ ] prosthesis [ ] swelling[ ] lesion [ ] poor turgor [ ] cool [ ] flushed[ ] atrophy [x ] pain [ ] ecchymosis [ ] diaphoretic moist[ ] assess mobility, motion gait, alignment, joint function[ ] skin color, texture, turgor, integrity [ ] no problem
Nursing Assessment (System Review and Nursing Assessment)
Name: Donna P. VillegasBP: 110/90 mmHg T: 37.4 C PR: 81 bpm RR: 21cpm
Weight: 58.5kg Height: 162.6cm
No problem
Lochia serosa
Itching
Back pain
No problem
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SUBJECTIVE OBJECTIVE
COMMUNICATION Comments[ ]Hearing Loss[ ]Visual changes[x]Denied
[ ]glasses [ ]languages[ ]contact lens [ ]hearing aideR 3-4mm L 3 -4mm
Pupil size: 3-4mm [ ]speech difficultiesReaction: PERRLA
OXYGINATION Comments[ ]Dyspnea[ ]Smoking History
________________
[ ]Cough[ ]Sputum[ ]Denied
Respiratory: [] Regular []irregularDescription: RR is within normal range
R: right lung is symmetric to the left lungL: left lung is symmetric to the right lung
CIRCULATION Comments[x]Back Pain[ ]Leg Pain[ ]Numbness of the
Extremities[ ]Denied
Heart Rhythm: [] regular [] irregularAnkle Edema NONE
Pulse Car Rad DP FemR + + + N.OL + + + N.OComments: All pulse sites are palpable
NUTRITION CommentsDiet: DAT[ ]N [ ]VCharacter[ ]Recent change in
Weight, appetite[ ]Swallowing
Difficulty
[]dentures []none
Full partial with patientUpper [] [] []Lower [] [] []
ELIMINATIONUsual bowel pattern [ ]urinary frequencyOnce adays 3 4 times a day
[ ]Constipation [ ]urgencyRemedy [ ]dysuria
[ ]hematuriaDate of last BM: [ ]incontinenceSept. 24, 2009 [ ]polyuria[ ]diarrhea [ ]foly in place
Character [ ]denied
Comments: Bowel sounds:No noted presence of abdominal sounds
Abdominal Distension
Present []yes[]noUrine (color, consistency, odor)
If they are in place?
MGT. OF HEALTH & ILLNESS[ ]alcohol [x ]denied
Dili ko gainom ug makahubog nga ilimnon[x]SBE Last Pap Smear: NONELMP: Dec.01, 2009
Briefly describe the patients ability to follow treatments(diet, meds., etc.) for chroni9c health problems ( if present)
The patient did not experience any chronic problem.
Wala man koproblem sa akopanan-aw asverbalized by the
patient.
wala man koproblema sa
akongpaginhawa.As verbalized
by the patient
Magbinhod
akong tiil ug sakitakong likod inighapon asverbalized by the
patient
wala man koproblema sa akongpagkaun asverbalized by the
patient.
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Skin integrity Comments[ ]Dry
[x ]itching[ ]other
[ ]denied
[ ]dry [ ]cold [ ]pale
[ ]flushed [ x]warm[ ]moist [] cyanotic
Rashes, ulcers, decubitus (describe size, location,
drainage) No found any impaired skin integrity.
Activity/safety Comments[ ]convulsion
[ ]dizziness[ ]limited motion of joints
[ ]ambulate[ ]Bathe self[ ]Other
[x]denied
[ ] LOC and orientation: patient is well
oriented with time and date.
Gait: [ ]Walker [ ]cane [ ]other[ ]steady [ ]unsteady_______
[ ]sensory and motor losses in face or extremities: NONE
[ ] ROM limitations Comfort/sleep/awake:[ ] pain (location, Comm ents
frequencyremedies)
[ ] nocturia[ ]sleep difficulties[ x]denied
[ ]facial grimace[ ]guarding[ ]other signs of pain
[ ]side rail release form signed (60+ tears)
Coping:
Occupation: teacher
Members of household: 6
Most supportive person: husband
Observed non-verbal behavior: the patient was conscious and
coherent
The person and her phone number that can be reached anytime:
SPECIAL PATIENT INFORMATION N/A Daily weight N/A PT/OT
N/A BP q shift N/A Irradiation N/A Nero vs N/A Urine Test
N/A CVP/SG. Reading N/A 24 hours Urine Collection
Date Ordered Diagnostic/Laboratory
Exam
Date Done Date Ordered I.V Fluids/Blood Date Done
gakatol angakongtinahian as
verbalized by
the patient
ok raman ako
pag-tulog asverbalized by
the patient
makalihok-lihok pamanko asverbalized by
the patient
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Immediate Newborn Care
Donna Villegas, a postpartum client, del ivered a healthy baby girl in a
normal spontaneous vaginal delivery. Last October 2, 2009 , we went to their
home and conducted our last assessment. When we arri ved to their home, we
found her feeding her baby through a milk bottle. She told us that her baby
has a good sucking reflex.
The mother is anxious about the red spot locate d at the lower
Right arm of the infant and we told her that the spot is n ormal for an infant. As
nursing intervention we advised the mother not to place pow der ointment or
baby oil on the babys skin if rashes occur. Vital signs were taken during the
assessment and it was in normal range. We noted little diaper rashes on the
infants inguinal area.
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HealthTeaching
Remind parents to hold infant properly when feeding and never
propping bottle when feeding.
Instruct parents to limit infants water intake to oz. 1 oz.
Instruct the mother not to leave infant unattended on bed, tables, or
other surfaces without side rails.
Encourage to sit comfortably and hold baby in a semi upright position :
hold bottle so that fluids fills the nipples and the air in the bottle does
not enter the nipple.
Encourage the parents to change position of the in fant alternately
during feeding; feed for half of feeding hold ing in 1 hour, and then
switch to the other arm.
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VII. Summary and Evaluation
Pregnancy represents a maturation crisis that requires an open
outlook, a pessimistic attitude that involves self awareness of the situation,
sense of preparedness and readiness. This event requires the involvement of
all family members.
The case studies itself was a great experience for everybody, for us, on
how to actually care and monitor childbearing woman until towards her post
partum care. It was a four months monitoring and studying. It gave way for all
of us the opportunity to incorporate the knowledge that we have learned in
school including the theories and principles behind the phenomenon called
pregnancy to the actual life experience in the persona of our client,
Mrs.Donna. In this way, the group was able to relate ideal nursing intervention
into actual nursing intervention during the said studies. Though along the
way there were undesirable moments that occurred, yet it did not stop the
group from this case studies.
As an overview, Ms. Donna Villegas was experiencing common
discomfort such as dyspnea in supine position, backache, fatigue and
frequent urination. She had a regular prenatal check up with her OB Gyne.
This is one advantage for pregnant women to be guided and be aware of their
conditions for the entire pregnancy months
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During our visit with Ms Donna Villegas, the group made sure that
we gave her health teachings related to her condit ion, such as antepartal
exercise and nutritional requirement to meet her day to day requirement
during the period of pregnancy. We also shared to her the importance of
prenatal check up and advised to have complete immunization to her children
and the group also discussed about family planning method, so that they will
know how they going to plan their family in the future. The group also
discusses or sites an example of danger sign of pregnancy if she will not be
careful.
With this case study, the group learned so much, we gained and
learned a lot from this, we get to have understanding and a good picture of
our goal and sticking to our objective on how to care, provide efficient and
effective care during antepartal period of pregnancy, but also the group
learned so much about themselves as individual person. A lot of drama
happened prior to the completion of this case study, we bonded together, we
laugh together, and we unite as one, agreed on one thing th ough there were
arguments that took place, some misunderstandings that leads to silent
moments.
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