JMJ Ch

Marist Brothers
Notre Dame of Kidapawan College
Kidapawan City

NORMAL SPONTANEOUS VAGINAL DELIVERY

In Partial Fulfillment of the Requirements

In NCM 107 RLE OB Ward Rotation.

Presented to:

Dominique E. Cartoneros RN, MN

Clinical Instructress

Presented by:

Anulao, Angel Jhudiel P. Danzalan, Berlei Grace G.

Apostol, Desiery C. Dapal, Karen May C.

Avena, Vince Alexis E. Denaga, Irize

Eding, Kurt Daniel P.
Batilong, Andrea Nina D.
Fabian, Angel Kaye A.
Botaya, Justine P.
 November 2021

GENERAL OBJECTIVES

After two weeks rotation in the Obstetric-Gynecology ward, student nurses

will be able to analyze the data given, assess ob-related problems, create a

nursing care plan and provide health teachings for the mother and her newborn

Specific objectives;

Specifically, student nurses will be able to;

 study and analyze the given data;

 gather information regarding the client’s demographic profile;

 gather information regarding the anatomy and physiology of the

reproductive system

 identify and describe the different etiological factors that causes such

disease;

 explain the process of labor and delivery in terms of;

Mother

3.1 system involved; (anatomy and physiology)

3.2 labor experiences before the delivery of the baby;

3.3 stages of labor and delivery; and

3.4 mechanism of labor and delivery.

Newborn

3.5 fetal development; and

3.6 fetal circulation.

 create a nursing care plan for the identified problems.

 assess the laboratory and diagnostic test;

 identify the drug given to the client and make a drug study that includes its

mechanism of action, dosage, indications, its effects and nursing

considerations

 provide health teachings for the mother and newborn;

 discuss the implication of the case study in terms of nursing education,

nursing practice and research; and

 present the case study.

 INTRODUCTION

Every child has the right to a healthy start in life, and every woman has the

right to appropriate health care during pregnancy and childbirth. The EINC is a

simple and evidence-based strategy that may aid in the survival of all new born

and infants (Rajendrababu, 2015). The basic purpose of mother and child health

nursing care is to promote and maintain optimal family health in order to ensure

cycles of optimal childbearing and childrearing. Health professionals recommend

vaginal delivery for women whose kids have reached full term. When compared

to other techniques of childbirth, such as cesarean delivery and induced labor, it

is the most straightforward type of delivery process. Given the higher morbidity

and mortality associated with surgical cesarean births, vaginal delivery is

preferred (Desai, 2021). A typical spontaneous vaginal delivery occurs when a

woman goes into labor without the use of any labor inducing medicines or

procedures and is able to deliver the baby without the assistance of a doctor via

cesarean section, vacuum extraction, or forceps (NSVD).

The World Health Organization (WHO), the United Nations Children's

Fund, and the United Nations Population Fund estimate that roughly 15% of

planned deliveries are affected by obstetric difficulties. This figure is more than

doubled: nearly 20 million women are affected. Birth difficulties and acute
maternal complications, such as mortality and impairments, are the leading

causes of death and disability among women in underdeveloped nations.

Carrying a developing embryo or fetus within the female body can be indicated

by positive results on an over-the-counter urine test, and confirmed through a

blood test, ultrasound, detection of fetal heartbeat, or an X-ray. Pregnancy lasts

for about nine months, measured from the date of the woman's last menstrual

period (LMP). It is conventionally divided into three trimesters, each roughly three

months long (Davis C.P., 2021).

If the mother or the baby’s safety is endangered, an alternative mode of

delivery can be utilized, instead of having a normal delivery. Approximately 11%

of singleton pregnancies are delivered prematurely, and 10% of all deliveries are

delivered late (Iams, 2003). Thus, approximately 80% of newborns are delivered

at full term, despite the fact that only 3-5% of deliveries occur on the expected

due date. The percentage of patients who go into spontaneous labor has

declined over the last few decades, while the rate of inductions has climbed to

22% of all pregnancies. Complications develop throughout each of the three

stages, which might result in the planned vaginal birth being converted to an

operational cesarean delivery. As of the most recent public data, there were

3,855,500 births in the United States in 2017, with vaginal deliveries accounting

for 68 percent (2,621,010) of them. Preterm births accounted for 9.9 percent of

all births, with the population birth rate being at 11.8 per 1000.
 The case was last November 11, 2021 at around 2:00 in the afternoon,

patient Park came in to emergency room due to labor pain and blood show.

Patient park stated that watery discharges started at around 1: 00 in the morning,

she observes that contractions became frequent more than 5 minutes duration,

and 3 minutes interval. Her vital signs; bp 140/90mmhg, temp :37 degree

Celsius, rr 25 cpm, pr -89 bpm, fht -132 cpm. She was seen and examined by a

physician; internal examination reveals that she is already in 5 cm dilatation.

Thus, the case is about a normal mother giving birth to a normal baby,

which means that there are no complications during the delivery or during

pregnancy. As for the case that was assigned to us, the situation that we

examined, all of the findings, including the laboratory tests and the assessment

offered, are normal. In this case study, the learner will be able to have knowledge

on how to handle a case that has no problems or complications. They will gain

knowledge on taking care of a well mother and baby.

 REVIEW OF RELATED LITERATURE

Vaginal delivery defined by DALE A. PATTERSON; MD (2008 Aug 1), is a

natural occurrence that normally does not need extensive medical intervention.

Management guided by current understanding of relevant screening tests and

the typical labor process can considerably improve the chances of a smooth

delivery and postpartum period. Once a woman is in labor, management should

concentrate on delivering a healthy baby while reducing the mother's suffering

and difficulties. Providing continual emotional support to a patient after she has

been admitted to the hospital can enhance delivery results and the birthing

experience.

Spontaneous vaginal delivery outlined by MARGUERITE WINSLOW, MD,

and CORAL D. MATUS, MD (2010), pregnancy at term has traditionally been

seen to be the best outcome. Lowering the cesarean delivery rate has been a

goal in the United States for more than 25 years, owing to the perceived health,

economic, and social benefits of vaginal deliveries. Despite the fact that some

professionals now advocate for elective primary cesarean delivery, and despite

the fact that the number of surgical births has climbed from 21% in 1996 to 30%

in 2005, the majority of women still give birth vaginally.

 Vaginal delivery according to Ninad M. Desai and Alexander Tsukerman

(2021), is when the infant is full-term, at 37 to 42 weeks gestational age, it is the

safest for the fetus and the mother. Because the morbidity and mortality

associated with operational cesarean deliveries has grown over time, vaginal

delivery is recommended. Approximately 80% of all singleton vaginal births occur

at full term due to spontaneous labor, with 11% being preterm and 10% being

post-term. The number of patients who achieve spontaneous labor has declined

over time as operational and surgical delivery methods have become more

common, while inducement of labor has grown.

Vaginal delivery defined by Debra Rose Wilson, Ph.D., MSN, R.N.,

IBCLC, AHN-BC, CHT (2017), for women whose infants have reached full term,

is the type of delivery that most health professionals suggest. It is the easiest

type of delivery process when compared to other birthing methods such as

cesarean delivery and induced labor.

A spontaneous vaginal delivery according to Erica Cirino, Ph.D., (2019), is

a vaginal birth that occurs naturally rather than requiring doctors to employ

equipment to assist in the delivery. After a pregnant woman has gone through

childbirth, something happens. Her cervix dilates to at least 10 cm during labor.

The duration of labor differs from one woman to the next. Women who are having

their first child usually go through labor for 12 to 24 hours, however women who

have already given birth may just go through labor for 6 to 8 hours.

According to Samantha J. Prosser, Adrian G. Barnett & Yvette D. Miller

(2018), their findings point to a number of controllable factors that might help
increase the likelihood of a normal birth, including movement, monitoring, and

care throughout labor and delivery. Increased knowledge of such links through

patient engagement in informed decision-making and application of this evidence

in care standards is an essential step forward in encouraging normal delivery.

ANATOMY AND PHYSIOLOGY

First Trimester

Right within a week of conception, the fertilized egg cell divides the

development process. By week three, the egg has hundreds of cells. It has now

passed through the fallopian tube and embedded itself in the uterine lining. The

egg develops into an embryo as it grows. The lungs, liver, and digestive system

of the kid will be found in the inner layer of an embryo. The bones, kidneys, sex

organs, and heart of the newborn will be formed in the intermediate layer. The

baby's skin, hair, eyes, and nervous system are all part of the outer layer.

During the first trimester, the spinal cord, brain, heart, and lungs grow and

develop fast. The mouth, nose, eyes, ears, toes, and fingers also start to

develop. Around week 6, the fetus's heart will start to beat. It is sometimes not

heard until the 10th or 12th week. Throughout the first trimester of pregnancy, the

umbilical cord nourishes the fetus and eliminates its waste.

Throughout the first trimester, the fetus' digestive and reproductive

systems are developing. The fetus may begin to move in week nine as the
muscles of the fetus continue to mature, but the mother will not be able to feel it.

By the conclusion of the mother's first trimester, the fetus will be about three

inches long and weigh around 12 ounces.

Second Trimester

The fetus' hair, including eyebrows and eyelashes, begins to develop in

the second trimester. Muscles and bones continue to grow, allowing for more

mobility. If the fetus is a female, her eggs will be deposited in her ovaries early in

the second trimester. The fetus can hear the mother's heartbeat around week 18

and may be scared by loud noises.

The fetus will develop rapidly in the second trimester. Because of the

strain on her lungs, stomach, bladder, and kidneys, the pregnant woman will feel

the baby growth. During the fifth month, the mother will sense the baby's

movement. The mother can tell if her baby is sleeping or awake before the end of

the second trimester. During the second trimester, the fetus can taste and touch

due to the development of taste buds and sensory neurons.

The fetus would weigh roughly a pound by the end of week 23. Babies

born this early may survive with the intervention of professional medical care, but

they are frequently mentally and physically handicapped. The eyes of the fetus

are closed until the second trimester, when the fetus begins to blink. The fetus

will weigh about 2 pounds and be around 1 foot long by the end of the second

trimester. All of the vital organs have developed at this point.

Third Trimester
 The infant may identify the sound of the mother and father's voices in the

beginning phases of the third trimester. During the third trimester, you'll be doing

a lot of movement. Around 10 movements per hour should be felt by the

pregnant mother. During the third trimester, fetuses begin "practicing" breathing

by moving their diaphragm. The expectant mother could notice that her kid has

hiccups now and again.

The baby will acquire a significant amount of weight in the weeks leading

up to birth. The fetus should be in position for birth by week 33, with his or her

head resting on the cervix of the expectant lady. The skin thickens and the bones

grow harder. The kid would be able to live outside the womb by 34 weeks without

the need for major medical care, however oxygen treatment may be required.

Starting around week 35, the fetus will grow fast, gaining 1/2-3/4 pound

every week. By week 37, the fetus has reached "full-term" development. The

baby, on the other hand, will continue to develop and gain weight, and will most

likely be born between weeks 38 and 42. At delivery, the kid will weigh an

average of 7.5 pounds and be 20-22 inches long.

A pregnancy that lasts longer than 42 weeks is called past due. The

doctor may induce labor at this point. If the pregnancy has progressed past 40

weeks, the pregnant woman's doctor should be consulted.

DEVELOPMENT
 ● Pre-embryonic- first 2 weeks

● Embryonic- 3-7 weeks

● Fetal- 8-40 weeks

o Full term: 38-42 weeks

o Preterm: 42 weeks

o Post-term: > 42 weeks

First Trimester

Month 1 (Week 1 - 4)

● A water-tight sac grows around an egg after it is fertilized and implants

into the uterine lining, gradually filling with fluid. The amniotic sac is a

cushion that protects the developing embryo.

● The placenta also grows during this pregnancy. The placenta is a flat,

spherical organ that transports nutrients and wastes from the mother to

the fetus. Throughout the pregnancy, the placenta provides sustenance

for the fetus.

● During the first few weeks, a primitive visage with huge black rings for

eyes will emerge. The lower jaw, mouth, and throat are all growing.
 ● Circulation will begin as blood cells begin to form. By the end of the fourth

week, the little "heart" tube will be beating 65 times per minute.

● The fetus is about 1/4 inch long by the end of the first month, roughly the

size of a grain of rice.

● Vitamin B6 and Folic Acid (Vitamin B9) are essential for early

development and play an important role in the development of both the

mother and the infant.

Month 2 (Week 5 - 9)

● The development of facial characteristics continues.

● Tiny buds are sprouting, which will ultimately expand into arms and legs.

Fingers, toes, and eyeballs are all growing at the same time.

● Each ear originates as a little fold of skin on the head's side.

● Organs including the brain, sensory organs, and the digestive system start

to form.

● In addition, the digestive tract and sensory organs start to mature.

Cartilage is being replaced by bone.

● At this time, the head is disproportionately huge in comparison to the rest

of the body.

● An ultrasound can generally detect a heartbeat at around six weeks.

● Healthcare practitioners refer to it as a fetus rather than an embryo after

the eighth week.

 ● The fetus is about 1-inch long and weighs around 1/30 of an ounce by the

end of the second month.

Month 3 (Week 10-14)

● The fetus is beginning to explore by opening and shutting its fists and lips

at this time.

● The arms, hands, fingers, feet, and toes have completed their formation.

The external ears, as well as the fingernails and toenails, are starting to

form.

● Under the gums, the first teeth are growing.

● The circulatory and urinary systems are both operational, and bile is

produced by the liver. The reproductive organs mature as well, although

gender might still be difficult to discern on ultrasound or sonogram.

● The fetus is fully developed by the end of the third month. All organs and

limbs (extremities) are present and will develop further to become

functional.

● The fetus is around 4 inches long and 1 ounce in weight.

● After three months, the risk of miscarriage has decreased significantly

since the most crucial development has occurred.

Second Trimester

Month 4 (Week 15-19)

● Eyelids, brows, eyelashes, nails, and hair shapes are all examples of

facial features.

● Teeth and bones get denser as we become older.

● The toes and fingers are well delineated.

● The fetus starts sucking its thumb, yawning, stretching, and making funny

faces.

● The nervous system is beginning to work.

● Through the use of a doppler, the fetal heartbeat may now be plainly

heard.

● The reproductive organs and genitalia are now completely grown, and the

doctor can tell whether the fetus is a boy or a girl at birth using

ultrasonography.

● The fetus is around 6 inches long and weighs 4 ounces by the end of the

fourth month.

Month 5 (Week 20-24)

● You may see the fetus moving about at this point. The fetus is growing

and strengthening its muscles. Quickening is the initial movement, which

might feel like a flutter.

● On the head and torso of the newborn, hair continues to develop. Lanugo

is a fine, smooth hair that covers the shoulders, back, and temples. The
 fetus is protected by this hair, which sheds towards the end of the baby's

first week of life.

● The skin is covered with a white layer called vernix caseosa. This

"cheesy" component shields embryonic skin from extended amniotic fluid

contact. Just before birth, this layer is shed.

● The fetus is around 10 inches long and weighs 1/2 to 1 pound by the end

of the fifth month.

● If the baby is born prematurely after the 23rd week, the infant will be

maintained in the NICU for a higher chance of survival.

Month 6 (weeks 25-30)

● The skin of the fetus is reddish, wrinkled, and veins may be seen through

the thin skin.

● The prints on the fingers and toes become well-developed.

● The eyelids begin to separate and the eyes open at this point.

● The fetus moves or increases its pulse in response to noises. If the fetus

hiccups, you may observe jerking gestures.

● If the baby is born preterm, it may survive until the 23rd week if given

intensive care.

● The fetus is around 12 inches long and weighs about 2 pounds by the end

of the sixth month.

Third Trimester (7-9 months or 26 – 40+ weeks)

Month 7 (weeks 26-29)

● During this month, the baby's organs and systems will continue to develop

and expand. Furthermore, a layer of fat will begin to accumulate.

● Hearing is completely developed at this stage.

● The fetus moves about a lot and responds to stimuli such as sound, pain,

and light.

● As the baby becomes bigger, the amniotic fluid starts to disappear.

● If your kid is born early, he or she is likely to survive until the seventh

month.

● The fetus is around 14 inches long and weighs between 2 and 4 pounds at

the end of the seventh month.

Month 8 (weeks 30-34)

● The fetus continues to grow and create body fat stores. More kicking may

be seen by the mother.

● At this stage, the brain is quickly growing, and the fetus can see and hear.

● The majority of the internal systems are fully matured, however the lungs

may still require some maturation.

● The fetus is around 18 inches in length and weighs up to 5 pounds.

Month 9 (weeks 35 – 40+)

● The fetus continues to develop and expand throughout this time.

● At this time, the lungs are almost completely grown.

 ● Blinking, closing eyelids, turning the head, grasping firmly, and responding

to noises, light, and touch are all reflexes that the fetus has.

● The woman might go into labor at any point during the final month.

● Because room is limited, you may find that there is less mobility.

● The fetus' posture may have shifted at this stage to prepare for delivery. It

should be head down in your uterus.

● As the fetus descends into your pelvis and prepares for delivery, you may

feel quite uncomfortable in this final time.

● The infant is around 18 to 20 inches long and weighs approximately 7

pounds.

SYMPTOMATOLOGY

The signs of early pregnancy can include:

● Missed period

Missing a period is often the first sign of possible pregnancy. However,

some women experience light bleeding around the time of their expected period.

● Nausea and vomiting (often called ‘morning’ sickness, but it can

occur at any time)

‘Morning’ sickness is a condition that affects more than half of all pregnant

women. The symptoms include nausea and vomiting, and loss of appetite. Most

women with morning sickness don’t just get symptoms in the morning, but

experience them throughout the whole day.

Morning sickness usually begins around the fourth to sixth week of pregnancy

and may settle by week 12, although it can continue for longer or return at

around 32 weeks.

● Breast tenderness and enlargement

During pregnancy, the breasts become fuller, swollen and tender.

These changes are similar to those you may have noticed in the few days

before your period. During pregnancy, the skin around the nipple becomes

darker and the veins in the breast become more obvious.

● Fatigue

Overwhelming tiredness is common in early pregnancy. This is most likely

caused by the massive increase in the sex hormone progesterone. Progesterone

is needed to maintain the pregnancy and help the baby to grow, but it also slows

your metabolism.

Try to get some more sleep or rest when you can during this early stage. Your

energy levels will probably rise again by around the fourth month of pregnancy

when the placenta is well established.

Tiredness during pregnancy can also be caused by anaemia, which is most

commonly caused by iron deficiency. Eating iron-rich foods is important in the

prevention of iron deficiency anaemia during pregnancy. Medical treatment of

anaemia in pregnancy involves taking iron supplements.

 ● Passing urine more frequently than usual, particularly at night

Pregnancy causes an increase in levels of body fluids and greater kidney

efficiency. The swelling uterus also presses against the bladder. As a result,

most women start experiencing more frequent urination within the first few weeks

of becoming pregnant.

● Cravings for some foods, distaste for foods you usually like, and a

sour or metallic taste that persists even when you’re not eating

(dysgeusia).

Cravings for certain foods are very common in pregnancy, especially for

foods that provide energy and calcium, such as milk and other dairy products.

You may also notice a sudden distaste for foods you previously liked.

Some women even develop an unusual taste for non-food items such as soil or

paper. This is called ‘pica’ and may indicate a nutrient deficiency. Please speak

to your GP or midwife if this develops.

Many of the signs of pregnancy, such as a missed period (amenorrhoea),

nausea(morning sickness), or fatigue, can also be caused by stress or illness, so

if you think you're pregnant, use a home pregnancy test (urine test) or visit your

doctor, who will perform a urine test, blood test, or ultrasound scan.

Other symptoms of pregnancy

Many of these symptoms may also be indicative of other conditions. If in doubt,

see your GP.

● back ache

● breathlessness

● constipation

● haemorrhoids (piles)

● headaches

● heartburn and indigestion

● itchy skin

● leg cramps

● mood changes (such as unexplained crying)

● tingling and numbness in your hands

● vaginal discharge

● vaginitis

● varicose veins and leg oedema (swelling).

 PHYSIOLOGY OF PREGNANCY

The earliest sign of pregnancy and the reason most pregnant women

initially see a physician is missing a menstrual period. For sexually active women

who are of reproductive age and have regular periods, a period that is ≥ 1 week

late is presumptive evidence of pregnancy. Pregnancy is considered to last 266

days from the time of conception. 280 days from the first day of the last

menstrual period if periods occur regularly every 28 days. Delivery date is

estimated based on the last menstrual period. Delivery up to 2 weeks earlier or

later than the estimated date is normal. Delivery before 37 weeks gestation is

considered preterm; delivery after 42 weeks gestation is considered postterm.

Pregnancy causes physiologic changes in all maternal organ systems; most

return to normal after delivery. In general, the changes are more dramatic in

multifetal than in single pregnancies.

Cardiovascular

Beginning at 6 weeks gestation and peaking between 16 and 28 weeks, cardiac

output (CO) increases 30 to 50%. (usually at about 24 weeks). It stays near high

levels over the next 30 weeks. CO becomes sensitive to body posture after that.

CO levels drop the highest in positions where the expanding uterus obstructs the
vena cava the most (e.g., the reclined posture). CO levels normally drop

somewhat between 30 weeks and the start of labor. CO levels rise by another

30% during labor. The uterus contracts after birth, lowering CO to around 15 to

25% above normal, then progressively decreasing (mainly over the next 3 to 4

weeks) until it reaches the pre-pregnancy level at about 6 weeks postpartum.

Hematologic

Total blood volume increases proportionally with cardiac output, but plasma

volume increases more (near to 50%, generally by around 1600 mL for a total of

5200 mL) than red blood cell (RBC) mass (approximately 25%); hence,

hemoglobin (Hb) is diluted from about 13.3 to 12.1 g/dL. Blood viscosity is

reduced as a result of dilutional anemia. With twins, the overall volume of

maternal blood increases even greater (closer to 60 percent ).

The white blood cell count (WBC) rises to 9,000 to 12,000 cells per microliter

(mcL). During labor and the first several days after delivery, significant

leukocytosis (20,000/mcL) develops.

Urinary

Renal function changes are roughly correlated with cardiac function changes.

The glomerular filtration rate (GFR) increases by 30 to 50 percent between 16

and 24 weeks of pregnancy, peaks between 16 and 24 weeks, and stays at that

level until almost term, when it may decline somewhat due to venous stagnation

in the lower extremities caused by uterine strain on the vena cava. Renal plasma
flow rises in lockstep with GFR. As a result, blood urea nitrogen (BUN) levels

drop to around 10 mg/dL (3.6 mmol urea/L), while creatinine levels fall to around

0.5 to 0.7 mg/dL (44 to 62 micromole/L). Hormonal factors (most notably

progesterone) and backup due to presbyopia produce considerable dilatation of

the ureters (hydroureter).

Respiratory

Lung function alters when progesterone levels rise, as well as as the uterus

expands, interfering with lung expansion. The hormone progesterone instructs

the brain to reduce carbon dioxide (CO2) levels. To meet the increased

metabolic needs of the fetus, placenta, and several maternal organs, tidal and

minute volume and respiratory rate increase, resulting in an increase in plasma

pH. Oxygen consumption increases by about 20% to meet the increased

metabolic needs of the fetus, placenta, and several maternal organs. The

residual volume and capacity of the lungs, as well as plasma PCO2, decrease.

The vital capacity and plasma PCO2 levels remain unchanged. The

circumference of the thorax expands by around 10 cm.

Gastrointestinal (GI) and hepatobiliary

Constipation can develop as the uterus grows larger, putting pressure on the

rectum and lower portion of the colon. Because higher progesterone levels relax

smooth muscle, GI motility diminishes. Heartburn and belching are common,

presumably due to delayed stomach emptying and gastroesophageal reflux

caused by lower esophageal sphincter relaxation and the diaphragmatic hiatus.

Peptic ulcer illness is uncommon during pregnancy, and preexisting ulcers

frequently become less severe as hydrochloric acid production reduces.

Endocrine

Most endocrine glands change their activity during pregnancy, partly because the

placenta produces hormones and partly because most hormones circulate in

protein-bound forms, which increases throughout pregnancy.

Human chorionic gonadotropin (beta-hCG) is a trophic hormone produced by the

placenta that, like follicle-stimulating and luteinizing hormones, maintains the

corpus luteum and so prevents ovulation. Because beta-hCG stimulates the

ovaries to generate them continually, estrogen and progesterone levels rise early

in pregnancy. The placenta produces substantial amounts of estrogen and

progesterone after 9 to 10 weeks of pregnancy to help keep the baby healthy.

Dermatologic

Increased levels of estrogens, progesterone, and MSH contribute to pigmentary

changes, although exact pathogenesis is unknown. These changes include

Melasma (mask of pregnancy), which is a blotchy, brownish pigment over the

forehead and malar eminences

Darkening of the mammary areolae, axilla, and genitals

Linea nigra, a dark line that appears down the midabdomen

Melasma due to pregnancy usually regresses within a year.

Because of elevated levels of estrogen (mainly) and progesterone, pregnancy

can produce breast engorgement, which is a continuation of premenstrual breast

engorgement. Beginning 10 days after fertilization, increased release of estrogen

and the beta subunit of human chorionic gonadotropin (beta-hCG) by syncytial

cells of the placenta may cause nausea and vomiting (see Conception and

Prenatal Development). The ovary's corpus luteum, spurred by beta-hCG,

continues to secrete significant levels of estrogen and progesterone in order to

keep the pregnancy going. Many women feel tired at this time, and a few suffer

abdominal bloating early on. Women frequently start to feel this way when they

are pregnant.
 True labor False labor

Contractions Regular intervals; frequency, Irregular intervals; no

duration &intensity increase increase in frequency,
over time duration or intensity; may
dissipate overtime

Discomfort Begins in lower back, Located in lower abdomen

radiates to abdomen and groin

Comfort measures (walking, Contractions increase Contractions may lessen or

position changes, hydration) despite comfort measures dissipate with comfort
measures

Cervical change Increase in cervical dilation No cervical change

and effacement

SIGNS OF LABOR (TRUE LABOR)

TERMINOLOGY

Pre-embryonic: A fertilized ovum up to 14 days old, before it becomes

implanted in the uterus.

Embryonic: In human prenatal development, the roughly 6-week period in

which the three-layered embryo (gastrula) develops.

Amniotic Sac : A thin-walled sac that surrounds the fetus during pregnancy.

Visage: A person's face, with reference to the form or proportions of the

features.

Bile: A fluid that is made and released by the liver and stored in the

gallbladder
 Nursing Care Plan

ASSESSMENT MASLOW’S NURSING EXPECTED NURSING RATIONALE EVALUATION

HIERARCHY DIAGNOSIS OUTCOMES INTERVENTION
OF NEEDS W/
RATIONALE
S/O: risk for Within 8 hours Independent: After 3 days span
- watery Safety needs deficient Fluid span of nursing of nursing care,
discharges Volume / risk care, be free of 1. Assess vital 1. to determine the goal was met
started at around for Bleeding signs of active signs, including if an as evidenced by;
1: 00 in the Rationale: bleeding, such blood pressure, intravascular display of
morning Deficient Fluid Rationale: as hemoptysis, pulse, and fluid deficit laboratory results
Volume (also Susceptible to hematuria, respirations exists. for clotting times
- contractions known as a decrease in hematemesis, and factors are
became frequent Fluid Volume blood volume, or, excessive 2. to determine within normal
more than 5 Deficit (FVD), which may blood loss, as 2. Hema test all possible range; and,
minutes duration hypovolemia) compromise evidenced by secretions and sources of patient can
and 3 minutes is a state or health. stable vital excretions for occult bleeding. identify individual
interval condition signs, skin and blood risks and can
where the fluid Reference: mucous engage in
- came in to output Doenges, M.E., membranes free appropriate
emergency room exceeds the Moorhouse, of pallor, and behaviors or
due to labor pain fluid intake. It M.F., Murr, usual mentation 3. Apply direct lifestyle changes
and blood show occurs when A.C., NANDA-I and urinary pressure and cold to prevent or
the body loses (2018-2020) output. pack to bleeding reduce the
-internal both water Nurse's Pocket site, insert nasal frequency of
examination and Guide, 15e: packing, or perform bleeding
reveals that she electrolytes Diagnoses, fundal massage as episodes.
is already in 5 from the ECF Prioritized appropriate.
cm dilatation in similar Interventions
proportions. and Rationales.
Vital Signs: 4. Restrict activity
and encourage
Mother: bedrest or chair rest
RR: 25 CPM until bleeding
PR: 89 BPM abates.
Temp: 37 C 5. Treatment of
BP: 5. Assist with the underlying
140/90mmhg treatment of conditions may
Fetus: underlying prevent or halt
FHT: 132 CPM conditions causing bleeding
or contributing to complication.
blood loss, such as
medical treatment
of systemic
infections or balloon
tamponade of
esophageal varices
prior to
sclerotherapy

6. Hematest
secretions and
excretions for occult
blood. 6. for early
identification of
7. Maintain direct internal
pressure or bleeding.
pressure dressings
as indicated for a 7. to prevent
longer period of oozing or
time over arterial active bleeding.
puncture sites

8. Be prepared to
administer
hemostatic agents,
if needed 8. to promote
clotting and
diminish
bleeding by
increasing
coagulation
factors
Dependent:

- Consult to the
physician if the
condition may
become severe. - To detect
potentially life-
threatening
Reference: health
conditions or
Doenges, M.E., diseases early.
Moorhouse, M.F.,
Murr, A.C.,
NANDA-I (2018-
2020) Nurse's
Pocket Guide, 15e:
Diagnoses,
Prioritized
Interventions and
Rationales.
ASSESSM Maslow's NURSING DIAGNOSIS WITH EXPECT NURSING RATION EVALUA
ENT Hierarch RATIONALE ED INTERVENT ALE TION
y of OUTCO IONS
Needs MES
Safety Alteration in comfort related to That Independen After
S/O Needs the uterine contractions due to within 12 t: 1. hours of
laboring. hours Provides nursing
span of 1. Assess informati care, the
Rationale Rationale: care pain, noting on to aid goal was
: The contractions of the uterine upon location, in met as
muscles and the pressure on admissio intensity determini evidenced
The labor the cervix can create pain n, there (scale of 0 – ng by;
Vital pain during childbirth. Strong will be 10), duration choice or Patient
Signs: incorpora cramping, as well as an achy some effective
RR: 25 tes safety feeling, can be felt in the belly comfort 2. Monitor ness of verbalized
CPM needs and back. manifest blood interventi
PR: 89 since Reference: ed even pressure of on. comfort
BPM safety ([Link] in the patient
Temp: requirem ts/[Link] contracti and some
ents at on as 2. To
37oC make
BP: 140/90 this stage evidence relief of
are about by. sure your
mmHg high
FHT: 132 keeping a. 3. Provide pain and
us safe Patient's comfort blood
CPM pressure
5 cm from pain will measure like controlled
harm. be back rub, is not
dilatation affecting
Health is bearable helping uterine
one of or position of the
these controlle comfort. growth of contractio
requirem d Suggest use your
ents; if a of relaxation baby and ns
person technique to check
does not and deep for a
feel breathing condition
secure in exercises. called
an 4. Provide pre-
environm calm and eclampsi
ent, they restful a
would surroundings
seek in the 3.
safety environment Promote
before s
relaxatio
5. Maintain n,
activity refocuse
restrictions s
attention,
and may
enhance
Dependent: coping
- Consult to abilities.
the physician
if the 4. Help
condition reduce
may become sympath
severe. etic
Doenges, simulatio
M.E., n,
Moorhouse, promotes
M.F., Murr, relaxatio
A.C., n
NANDA-I
(2018- 5.
Nurse's Reduces
Pocket physical
Guide, 15e: stress
Diagnoses, and
Prioritized tension
Interventions that
and affect
Rationales.2 blood
020) pressure

- To
detect
potentiall
y life-
threateni
ng health
condition
s or
diseases
early.
 ASSESSMENT MASLOW’S NURSING DIAGNOSIS EXPECTED NURSING RATION EVALUATION
HIERARCH W/ RATIONALE OUTCOMES INTERVENTION ALE
Y OF
NEEDS
Subjective: Anxiety related to SHORT Independent: GOAL MET
- N/A Safety situational crisis and TERM: 1. Monitor 1. Vital After 8 hours span of care, the client was able:
Needs perceived or actual threats After 8 hours maternal and fetal signs of -to verbalize and express her feelings
to self and fetus span of care, vital signs. client throughout the entire shift which helped
Objective: Rationale: client will be and her relieve her anxiety.
Observes that Anxiety is a Rationale: able: fetus -Client verbalized,
contractions highly Anxiety can be a result of -to verbalize may be “I feel much better now that
became frequent individualize fear, uncertainty, circular decrease in altered I have someone to talk to about it..”
more than 5 d, normal and racing thoughts, and anxiety 2. Explain the by -Client has appeared to be relaxed
minutes duration, physical and the avoidance of certain -to appear procedures, anxiety. and reported anxiety to be a manageable level;
and 3 minutes psychologic behaviors. It can affect our relaxed and nursing Stabiliza with maternal vital signs within normal limits.
interval. al response ability to function normally. comfortable to interventions, and tion may
to internal or For pregnant mothers, use treatment reflect
Vital Signs taken external life anxiety may be related to communica- regimen. Keep reductio
as follows: events. Vital situational crisis, threat of tion and communication n
BP: 140/90 mmHg signs may death or fetal loss, relaxation open; discuss with anxiety
Temperature: be normal or possibly evidenced by techniques in the client the level.
37 degree Celsius slightly increased tension, order to possible side
RR: 25 CPM elevated. apprehension, feelings of alleviate the effects and 2.
PR -89 BPM The patient inadequacy, sympathetic anxiousness outcomes while Informati
FHT -132 cpm . may report stimulation, and repetitive -Report maintaining an on and
feeling questioning. anxiety is optimistic attitude knowled
tense. reduced 3. Orient client ge of the
Reference: and/or and partner to reasons
Wayne, G. (2019. manageable labor suite of these
Nurse's Pocket Guide, -Patient will environment activities
15e: Diagnoses, appear can
Prioritized, Interventions relaxed; with decreas
and Rationales. F. A. maternal vital e fear of
signs within 4. Encourage use the
Davis Company.
normal limits. of relaxation unknow
Philadelphia, PA 19103
techniques. n.

3. Helps
5. Encourage client
verbalization of and/or
fears or concerns. significa
6. If patient feels nt others
extreme cold, feel at
provide blanket. ease
Dependent: and
- Answer more
questions comforta
honestly, ble in
especially their
information surround
regarding ings.
contraction pattern
and fetal status. 4.
Enables
the
- Administer client to
sedative if other obtain
measures are not maximu
successful. m
benefit
Reference:
from rest
Wayne, G. (2019.
periods;
Nurse's Pocket
prevents
Guide, 15e:
muscle
Diagnoses,
fatigue
Prioritized,
and
Interventions and
improve
Rationales. F. A.
s uterine
Davis Company.
 Philadelphia, PA blood
19103 flow.
5. Can
help
reduce
anxiety
and
stimulat
e
identifica
tion of
coping
behavior
s.

-
Provisio
n of
clear
informati
on can
help the
client or
couple
understa
nd what
is
happeni
ng and
may
reduce
anxiety.
-
Provides
soothing
and
tranquili
zing
effect.

ASSESSMENT MASLOW’S NURSING EXPECTED NURSING RATIONALE

HIERARCHY OF DIAGNOSIS W/ OUTCOMES INTERVENTION
NEEDS RATIONALE

Subjective: Physiological Labor Pain After 8 hours of 1. Provide for a quiet 1. No distracting
needs related to duty, patient will environment that is environment
cervical dilation be able to: adequately provides After 8
ventilated, dimly lit, optimal able to:
and free of opportunity for a. Exhib
a. Exhibit unnecessary rest and b. Dem
Rationale: Rationale: decrease personnel. relaxation and de
Labor pain related Labor pain level of pain. 2. Build rapport between c. Moni
Objective: to cervical dilation related to b. Demonstrate 3. Check and monitor contractions. within t
Observes that is defined as cervical dilation relaxation vitals signs 2. Gain
contractions reccurent pain felt is defined as technique 4. Evaluate degree of cooperation
became by a woman in the reccurent pain and deep discomfort through with the
frequent more abdomen, groin, felt by a woman breathing verbal and patient
than 5 minutes and back during in the abdomen, exercise nonverbal cues; 3. For baseline
duration , and 3 child birth due to groin, and back c. Monitor the note cultural data
minutes uterine during child birth vital signs influences on pain 4. Attitudes
interval. contractions that due to uterine within the response. 5. and reactions
causes the cervix contractions that normal 5. Coach use of to pain are
BP: to dilate. causes the range appropriate individual and
140/90mmhg, cervix to dilate. breathing/relaxation based on past
TEMP: techniques and experiences,
37 degree Citation: abdominal understanding
celsius Herdman, T., & effleurage based of
RR: 25 cpm Kamitsuri, S. on stage of labor. physiological
PR: (2018). NANDA 6. Offer changes, and
89 bpm International, encouragement, 6. familial/cultura
FHT: 132 cpm Inc. nursing provide information l expectations
diagnoses: about labor 7. May block
definition & progress, and pain impulses
classification provide positive within the
reinforcement for cerebral
client’s/couple’s cortex through
efforts. conditioned
7. Assess client`s responses and
pain scale and cutaneous
perception stimulation
and gives
client a means
of coping with
and controlling
the level of
discomfort
8. Provides
emotional
support, which
can reduce
fear, lower
anxiety levels,
and help
minimize pain.
9. To identify the
intensity,
onset,
duration,
quality, and
quality of the
pain.
ASSESS MASLO NURSING EXPECTED NURSING RATIONALE EVALUATI
MENT W’S DIAGNOSIS OUTCOMES INTERVENTIO ON
HIERAR W/ N
CHY OF RATIONALE
NEEDS
Objective Risk for Within 8 Independent: After 8
Physiolo 1. Signs and
Cues: infection hours span 1. Monitor and hours span
gic symptoms of
Needs Rationale: of nursing report any signs infection vary of care.
according to
Vulnerable care the and symptoms Goal met,
the body area
invasion and client will of infection. involved. the client is
Subjectiv
2. A first line
e Cues: multiplication remain free 2. Practice and free of
defense
of pathogenic of infection, emphasize infection as
against
organisms, as evidence constant and evidenced
healthcare
which may by normal proper hygiene. by the
associated
compromise vital signs [Link] in normal vital
infections.
health. and absence color and/or signs of a
3. That could
Reference: of signs and odor of client
Doenges, indicate onset
symptoms of secretions. Bp:110/70
M.E.,
of infection.
Moorhouse, infection. [Link] in Temp: 36.6
M.F., Murr, 4. That could
skin color and Pulse:84.
A.C., (2010).
be signs of
Davis nurse’s warmth at
pocket guide: developing
insertion sites.
diagnosis,
localized
prioritized,
interventions infection.
and rationales.
5. To free from
(ed) 12,
Pennsylvania: infection.
5. Provide clean
F.A Davis
Company and ventilated
Philadelphia. 6. Low-grade
environment.
temperature
6. Observe and
elevation that
report if an older
appears in
client has a low-
older clients
grade fever or
must be
new onset of
reported as it
confusion.
could
Reference: potentially be
Doenges, M.E.,
an infection.
Moorhouse,
M.F., Murr, A.C.,
(2010). Davis
nurse’s pocket
guide:
diagnosis,
prioritized,
interventions
and rationales.
(ed) 12,
Pennsylvania:
F.A Davis
Company
Philadelphia
 DRUG STUDY

DRUG INDICATIO DOSAG SIDE EFFECTS ADVERSE CONTRAIN NURSING

NS E EFFECT DICATION RESPONSIB
S ILITIES
Generic -Infection of 250mg Nausea, vomiting, -Erythema A history of Monitor signs
Name: the 500mg multiforme hypersensit of allergic
or diarrhea may
Ampicillin genitourinar Exfoliative ivity to any reactions and
y tract occur. If any of dermatitis penicillin is anaphylaxis,
 Brand including these effects persist -Rash a including
Name: gonorrhoea -Urticaria contraindic pulmonary
or worsen, notify
Ampi, -Infection of -Fever ations. symptoms
Omnipen, the your doctor -Seizure Infectious (tightness in
Penglobe, -Diarrhea the throat
respiratory or pharmacist promp mononucle
Principen -Nausea and chest,
tract tly Ampicillin can -Stomatitis- osis wheezing,
Drug -Infection of patients
Class: Vomiting cough
the commonly cause a develop
Penicillins, -Anemia dyspnea) or
Amino gastrointest mild rash that is - rash, and skin
inal tract Leukopenia therefore reactions
usually not serious.
-Soft use is (rash,
tissues However, you may avoided. pruritus,
urticaria).
Infection not be able to tell it Renal and
Notify
apart from a rare hepatic physician or
function nursing staff
rash that could be a should be immediately
sign of a severe monitored if these
reactions
allergic reaction.
occur.
Therefore, seek
immediate medical
attention if you
develop any rash

DRUG INDICATION DOSAGE SIDE EFFECTS ADVERSE CONTAINDICATIONS

S EFFECT
Generic Name: -used after 1 AMP IM NOW -nausea -nausea -high blood pressure
Methylergonovine childbirth to -a heart attack
-vomiting -vomiting
help stop Intramuscularly -stroke
bleeding from 0.2mg, 1mL -stomach pain -stomach pain -blockage of the arteries called arteriosclerosis obliterans
Brand Name: after delivery of
the uterus. -diarrhea -diarrhea -liver problems
Methergine the anterior
-works by shoulder, after -leg cramps -leg cramps -serious numbness or pricking or tingling of fingers and toes.
Drug Class: Ergot increasing the delivery of the -coronary artery disease.
rate and -increases sweating -increases -blockage or narrowing of mitral heart valve
Alkaloids placenta, or
strength of during the -skin rash sweating
contractions puerperium.
-headache -skin rash
and the Intravenously
stiffness of 0.2mg, 1mL, -dizziness -headache
administered
the uterus -ringing in the ears. -dizziness
slowly over a
muscles. period of no less -stuffy nose -ringing in the ears
-Effects of this than 60
drug help to -unpleasant tase in -stuffy nose
seconds.
decrease Orally your mouth. -unpleasant taste
bleeding. 0.2mg, 3 or 4
in the mouth.
times daily in the
puerperium
week for 1 week.
Generic -relief of 500mg -diarrhea CNS: headache, - BEFORE:
Name: moderate pain 1 tab for Contrain -Check the doctor’s order.
-constipation dizziness,
Mefenamic when therapy pain dicated -assess pain score
Acid will not exceed -gas or insomnia. with -assess history of allergies to NSAIDs
Availabl -Educate patient regarding desired and
1 week bloating Dermatologic: rash, hyperse
e adverse effects.
nsitivity
Brand dosage: -headache pruritus, sweating -Educate patient that prolonged
Name: -. treatment of 250mg to use of drug may damage the liver.
primary -dizziness GI: nausea, GI mefena
Ponstel capsule DURING:
dysmenorrhea. s -nervousness pain, diarrhea, mic -Give drug with food, milk or antacids.
Drug Class: -Mefenamic Minimu acid, -Do not increase or double the dose,
-ringing in the constipation.
Analgesic, acid is given to m dose: aspirin follow exactly as prescribed and
antipyretic patient for 125mg ears. GU: dysuria, renal allergy, indicated.
relief of acute Maximu and as -Administer drug with full glass of water.
impairment.
to moderately treatme -Do not break, chew or
m dose:
Hematologic: crush the capsule and tablet.
pain 500mg nt of
-Do not administer with anticoagulants
bleeding, platelet perioper and other drug that causes GI upset.
inhibition with ative AFTER:
pain -Document accurately
higher doses,
with -Monitor for adverse effects
neutropenia coronar -Instruct discontinuation of
y artery medication if adverse effects occur.
Respiratory:
bypass -Symptomatic management for non-serio
dyspnea, grafting. -Assess for occurrence
of GI ulcers after taking.
hemoptysis,
pharyngitis. Precauti
on:
Other: peripheral Use
edema, cautious
ly with
anaphylactoid
asthma,
reactions to renal or
anaphylactic shock. hepatic
impairm
ent,
peptic
ulcer
disease,
GI
bleeding
,
hyperte
nsion,
heart
failure,
pregnan
cy,
lactation
.
.
 DRUG INDICATION DOSAGE SIDE ADVERSE CONTAINDIC NURSING
S EFFECTS EFFECT ATIONS RESPONSIBI
LITIES
Generic - Short-term 50 mg ●headache ● pancreatitis - 1. Follow the
Name: treatment of IVTT Contraindicate 10 rights of
● ● deficiency of
Ranitidine active d with allergy drug
Hydrochlorid duodenal abdominal platelets in the to ranitidine, administration.
e Assessment:
ulcer pain blood lactation
1. History:
-Short-term ● agitation ● reduction of all -Use allergy to
Brand treatment of cautiously with ranitidine,
active, ● hair loss blood cells impaired renal
Name: impaired renal
Zantac benign ● confusion ● lowered white or hepatic or hepatic
gastric ulcer function, function,
●constipati blood cells
Drug Class: -Maintenance pregnancy lactation,
Histamine2 therapy for on ● acquired pregnancy.
antagonists 2. Physical:
duodenal ● diarrhea immune hemolytic
Therapeutic skin lesions,
class: ulcer at ● dizziness anemia orientation,
Antiulcer reduced affect, liver
dosage ●hypersens ● joint pain
drug evaluation,
Pregnancy - Short-term i-tivity ● muscle pain abdominal
risk category treatment for examination,
reaction
B GERD. normal output,
-Pathologic ● nausea renal function
tests, CBC
hyper ● vomiting
Interventions:
secretory ● anemia 1. Administer
conditions(Zo oral drug with
llinger-Ellison ●
meals and at
syndrome necrotizing bedtime.
 - Treatment inflammatio 2. Decrease
of erosive doses in renal
n of the
esophagitis and liver
-Treatment of small failure.
3. Provide
heartburn, intestine
concurrent
acid and colon antacid
indigestion, therapy to
sour stomach in fetus or
relieve pain.
newborn 4. Administer
IM dose
undiluted,
deep into large
muscle group.
5. Arrange for
regular follow-
up including
blood test, to
evaluate
effects.

DRUG INDICATIONS DOSAGE SIDE ADVERSE CONTAINDICA NURSING

EFFECTS EFFECT TIONS RESPONSIBI
LITIES
Generic -Disturbances 10 mg ●headache CNS: ● 1. Follow the
Name: of GI motility IVTT Hypersensitivity 10 rights of
Metoclopramid -Relief of ●confusion drowsiness, to drug drug
e symptoms of ● administration.
●trouble restlessness,
acute and Pheochromocyt Assessment:
Brand Name: recurrent sleeping anxiety, oma 1. History:
Maxolon allergy to
diabetic ●dizziness depression, ● Parkinson’s
metoclopramid
Drug Class: gastroparesis ●restlessne irritability, disease e, GI
Antiemetic, GI -Nausea and ● Suspected GI hemorrhage,
vomiting ss fatigue, obstruction,
stimulant mechanical
Pregnancy risk -Metabolic ●sleepines lassitude, perforation, obstruction or
category B diseases or hemorrhage perforation,
s insomnia,
Pharmacologic -Short-term ● History of depression,
class: therapy for ●exhaustio tardive seizure epilepsy,
Dopamine lactation,
adults with n dyskinesia, disorders
antagonist previously
symptomatic parkinsonian- Precautions detected
gastro Use cautiously breast cancer
esophageal like reactions, in: 2. Physical:
reflux who fail extrapyramialr ● diabetes orientation,
to respond to mellitus, renal reflexes,
eactions,
conventional dysfunction affect, bowel
therapy akathisia, ● history of sounds,
normal output,
- Prophylaxis dystonia depression
EEG
of CV: ● elderly Interventions:
postoperative patients 1. Monitor
nausea and hypertension, ● pregnant or blood pressure
vomiting when hypotension, breastfeeding carefully
nasogastric patients during IV
arrhythmias,
suction is children. administration.
undesirable. neuroleptic 2. Monitor
diabetic
malignant
patients,
syndrome arrange for
alterations in
GI: nausea,
insulin dose or
constipation, timing if
diabetic control
diarrhea, dry
is
mouth compromised
by alterations
GU:
in timing of
gynecomastia food
absorption.
 INDICATIONS DOSAGE SIDE ADVERSE CONTAINDI NURSING RESPO
DRUG
EFFECTS EFFECT CATIONS

Name
IV: Induction of  1O Occasional: Hypertonicity may Hypersensiti 1. Fetal matu
labor at term. UNITS vity to and pelvi
Tachycardia, occur with tearing
Oxytocin IV: Facilitation of IU oxytocin. should be
threatened premature of uterus, Adequate to adminis
Induction or uterine oxytocin
abortion. ventricular increased
Stimulation of activity that 2. Monitor B
Brand IV, IM: contractions, bleeding, abruptio fails to
Labor IV: fetal hear
Name Postpartum progress, pressure,
ADULTS: 0.5– hypotension, placentae (i.e.,
control of bleeding cephalopelvi (duration
Pitocin 1 milliunit/min.
after expulsion of nausea, placental c q15min.
May gradually disproportion
the placenta vomiting. abruption), 3. Notify phy
increase in , fetal that last l
Classificat increments of Rare: cervical/vaginal distress occur mor
ion 1–2 without every 2 m
Nasal: lacerations. Fetal:
milliunits/min imminent 4. Maintain c
Uterine q30–60 Lacrimation/t Bradycardia, delivery, be alert to
smooth grand intoxicatio
minutes until earing, nasal CNS/brain
muscle multiparity, 5. Monitor pa
stimulant desired
irritation, damage, trauma hyperactive symptoms
contraction or hypertonic
rhinorrhea, due to rapid care profe
pattern is uterus,
established. unexpected propulsion, low obstetric
Rates greater emergencies
uterine Apgar score at 5
than 9–10 that favor
milliunits/min bleeding/ min, retinal surgical
are rarely intervention,
contractions hemorrhage
prematurity,
required. occur rarely. unengaged
Abortion IV: fetal head,
ADULTS: Prolonged IV
unfavorable
(Midterm infusion of fetal
elective position/pres
oxytocin with
abortion): 10– entation,
20 excessive fluid when vaginal
milliunits/min. delivery is
volume has
contraindicat
Maximum: 30 caused severe ed (e.g.,
units/12-hr active genital
dose. water intoxication
herpes
(Incomplete, with seizures, infection,
inevitable invasive
coma, death.
abortion): 10 cervical
units as IV cancer,
infusion after placenta
previa, cord
suction or a
presentation)
sharp .
curettage.
Control of
Postpartum
Bleeding IV
Infusion:
ADULTS: 10–
40 units in
1,000 mL IV
fluid at rate
sufficient to
sustain uterine
contractions
 and control
uterine atony.
IM: ADULTS:
10 units (total
dose) after
delivery.
Dosage in
Renal/Hepatic
Impairment No
dose
adjustment

DRUG INDICATIO DOSAGE SIDE ADVERSE CONTAINDICATIONS NURSING RESPON

NS EFFECTS EFFECT
Name PO, IM, IV:  300 CAP /1 CNS: CNS: Contraindicated in: Assess for infection
clindamycin Treatment CAP Hypersensitivity;
dizziness, dizziness, appearance of woun
Brand of: Skin and EVERY 6 Regional enteritis or
Name headache, headache, ulcerative colitis urine, and stool; WB
skin HOURS
Cleocin, (topical foam); beginning of and du
structure vertigo. vertigo.
Cleocin T, Previous Clostridium ● Obtain specimens
infections, PO (Adults): Most
Clinda- CV: CV: difficile-associated
Respiratory infections—150– and sensitivity prior
Derm, diarrhea; Severe liver
tract 450 mg every 6 hr. arrhythmias, arrhythmias, therapy. First dose m
Clinda-T, impairment; Diarrhea;
Clindagel, infections, Pneumocystis hypotension. hypotension. Known alcohol before receiving res
Clindesse, Septicemia, jiroveci pneumonia intolerance (topical ● Monitor bowel elim
GI: GI:
Clindets, Intraabdomi —1200– 1800 solution, suspension).
Diarrhea, abdomina
Dalacin C, nal mg/day in divided CLOSTRIDIU CLOSTRIDIU Use Cautiously in:
Dalacin T, OB: Safety not fever, and bloody sto
infections, doses with 15– 30 M DIFFICILE M DIFFICILE
Evoclin mg primaquine/ established for topical be reported to health
Gynecologic ASSOCIATED ASSOCIATED administration;
day (unlabeled). professional prompt
infections, systemic
Classificati DIARRHEA, DIARRHEA, of Clostridium difficil
Osteomyeliti CNS administration during
on
s, toxoplasmosis— diarrhea, bitter diarrhea, bitter 2nd and 3rd trimesters associated diarrhea
Therapeutic:
anti- Endocarditis 1200– 2400 not associated with May begin up to sev
or metallic or metallic
infectives prophylaxis. mg/day in divided risk of congenital following the cessati
doses with taste, nausea, taste, nausea, abnormalities;
Topical: therapy.
pyrimethamine approved for vaginal
Severe vomiting. vomiting. ● Assess patient for
use in 3rd trimester of
acne. 50– 100 mg/day
 Vag: (unlabeled); Derm: DRUG Derm: DRUG pregnancy; injection hypersensitivity (skin
Bacterial Bacterial contains benzyl
REACTION REACTION urticaria).
vaginosis. endocarditis alcohol which can
WITH WITH cross placenta; ● Lab Test Consider
IV: prophylaxis—600
Lactation: Has been Monitor CBC; may c
Treatment of mg 1 hr before EOSINOPHILI EOSINOPHILI
used safely but transientpin leukocy
Pneumocysti procedure. A AND A AND appears in breast milk
s jiroveci PO (Children 1 eosinophils, and pla
and exposes infant to
pneumonia, mo): 10– 30 SYSTEMIC SYSTEMIC ● May causeqalkalin
drug and its side
CNS mg/kg/day divided SYMPTOMS SYMPTOMS effects; phosphatase, bilirub
toxoplasmos every 6– 8 hr; Pedi: Injection AST, and ALT conce
(DRESS), (DRESS),
is, and maximum dose contains
babesiosis. 1.8 g/day. ERYTHEMA ERYTHEMA benzyl alcohol which
can cause gasping
Bacterial MULTIFORME MULTIFORME
syndrome in infants
endocarditis , , and neonates.
prophylaxis—20
mg/kg 1 hr before STEVENS- STEVENS-
procedure. JOHNSON JOHNSON
IM, IV (Adults): SYNDROME, SYNDROME,
Most infections—
300– 600 Mg TOXIC TOXIC
every 6– 8 hr or EPIDERMAL EPIDERMAL
900 mg every 8 hr NECROLYSIS NECROLYSIS
(up to 4.8 g/day IV
has been used; , rash, , rash,
single IM doses of urticaria. urticaria.
600 mg are not Local: local Local: local
recommended). P.
carinii pneumonia irritation irritation
—2400– 2700 (topical (topical
mg/day in divided products), products),
doses with
primaquine phlebitis at IV phlebitis at IV
(unlabeled). site. Misc: site. Misc:
Toxoplasmosis— HYPERSENSI HYPERSENSI
1200– 4800
mg/day in divided TIVITY TIVITY
doses with REACTIONS REACTIONS
pyrimethamine. (including (including
Bacterial
endocarditis anaphylaxis). anaphylaxis).
prophylaxis—600
mg 30 min before
procedure.
IM, IV (Children 1
mo): 25– 40
mg/kg/day divided
every 6– 8 hr;
maximum dose:
4.8 g/day.
Bacterial
endocarditis
prophylaxis—20
mg/kg 30 min
before procedure;
maximum dose:
600 mg.
IM, IV (Infants 1
mo and 2 kg): 5
mg/kg every 8– 12
hr; 2 kg—20– 30
mg/kg/day divided
every 6–8 hr.
Vag (Adults and
Adolescents):
Cleocin,
Clindamax—1
applicatorful (5 g)
at bedtime for 3 or
7 days (7 days in
pregnant patients);
Clindesse—one
applicatorful (5 g)
single dose; or 1
suppository (100
mg)at bedtime for
3 nights.
Topical (Adults
and Adolescents):
Solution—1%
solution/suspensio
n applied twice
daily (range 1– 4
times daily).Foam,
gel—1% foam or
gel applied once
daily.
Availability
(generic
available)
Capsules: 75 mg,
150 mg, 300 mg.
Oral suspension:
75 mg/5 mL.
Injection: 150
mg/mL. Premixed
infusion: 300
mg/50 mL, 600
mg/50 mL, 900
mg/50 mL.
Topical: 1% lotion,
gel, foam,
solution,
suspension,
single-use
applicators.
Vaginal cream:
2%. Vaginal
suppositories
(ovules): 100 mg.
In combination
with: benzoyl
peroxide (Acanya,
BenzaClin, Duac,
Onexton), tretinoin
(Veltin, Ziana);
(see Appendix B)
 LABORATORY TESTS

EXAMINATIO PURPOSE RESULT IMPLICATION

N
A hemoglobin test 143 g/L Hemoglobin level in
is often used to
Hemoglobin (Normal) between 123-163ng/L
check for anemia,
means that the
a condition in
which your body hemoglobin level is
has fewer red normal.
blood cells than
normal. If you
have anemia, your
cells don't get all
the oxygen they

need.
Hematocrit Hematocrit test Hematocrit level
measures how
0.38 between 0.36-0.45
much of your
blood is made (Normal) means that the
up of red blood
hemoglobin level is
cells. Red
blood cells normal.
contain a
protein called
hemoglobin
that carries
oxygen from
your lungs to
the rest of your
 body.
Hematocrit
levels that are
too high or too
low can
indicate a
blood disorder,
dehydration, or
other medical
conditions
HBsAg HbSag normal results
HBsAg (Hepatitis B Nonreactive are negative or
surface nonreactive, meaning
antigen) - A that no hepatitis B
"positive" or surface antigen was
"reactive" found. If your test is
HBsAg test positive or reactive, it
result means may mean you are
that the person actively infected with
is infected with HBV.
hepatitis B.
This test can
detect the
actual
presence of the
hepatitis B
virus (called the
“surface
antigen”) in
your blood.
 URINALYSIS

History:

LAST NOVEMBER 11, 2021 AT AROUND 2:00 IN THE AFTERNOON, patient

park came in to emergency room due to labor pain , and blood show , patient
park stated that watery discharges started at around 1: 00 in the morning . she
observes that contractions became frequent more than 5 minutes duration , and
3 minutes interval. Her vital signs; bp 140/90mmhg, temp :37 degree Celsius, rr
25 cpm, pr -89 bpm, fht -132 cpm . she was seen and examined by a physician ,
internal examination reveals that she is already in 5 cm dilatation .

Macroscopic Urinalysis:
 Characteristic Result
Color Amber
Appearance Hazy
Leukocyte Esterase Neg
Nitrite Neg
pH 5.0
Protein Trace
Blood 2+
Specific Gravity 1.020
Ketones Trace
Glucose Neg
Bilirubin Neg

Microscopic Urinalysis:

Characteristic Result
WBC/hpf <2/hpf
RBC/hpf 10-30/hpf
Occasional hyaline
Casts
casts
Atypical urothelial cells
Other
present
ULTRASOUND
Purpose Ultrasounds week by Results Implications
week
A fetal ultrasound 6-8 weeks (baby The Ultrasound Ultrasound imaging
(sonogram) is an sonogram) result will provide introduces an
imaging procedure This is the first ultrasound an information energy into the
that produces you will get as a pregnant containing the body, and laboratory
pictures of a fetus woman. But not all baby’s growth, studies have shown
in the uterus using woman will get this scan; development, and that diagnostic
sound waves. Your some physicians only the baby’s overall levels of ultrasound
health care conduct it for certain high- health. produce physical
practitioner can risk pregnancy conditions effects in tissue,
use fetal such as bleeding, such as pressure
ultrasound pictures abdominal pain, and oscillations with
to assess your history of miscarriage. subsequent
baby's growth and During six weeks mechanical effects
development as gestation, it is possible to and rise in
well as track your see the baby’s heartbeat. temperature.
pregnancy. During this week, your
practitioner will also
predict your baby’s due
date, track milestones,
determine the number of
babies in the womb, and
see if you have an ectopic
pregnancy.
10-13 weeks (Dating
Ultrasound)
Those who did not had
the sixth to eighth week
ultrasound might have a
“dating ultrasound”
around 10-13 weeks of
pregnancy. This gives the
parents the same
information the first
ultrasound does but with
the inclusion of your
baby’s “crown-rump
length” (measurement
from head to bottom).
14-20 weeks (Nuchal
Translucency
Ultrasound)
Between 14 and 20
weeks, you may also
have a nuchal
translucency test to check
for Down syndrome, heart
defects, or other
chromosomal
abnormalities (Joanne
Stone, MD). Women
should consider getting it
if their screening test
revealed a potential
problem, or if they are 35
or older, or if they have a
 HEALTH TEACHINGS

Encourage patient to get plenty of rest. Get as much sleep as possible to

cope with tiredness and fatigue. Your baby may wake up every two to three
hours for feeding. To make sure you’re getting enough rest, sleep when your
baby sleeps.

Encourage patient to Seek help. Don’t hesitate to accept help from family and
friends during the postpartum period, as well as after this period. Your body
needs to heal, and practical help around the home can help you get much-
needed rest. Friends or family can prepare meals, run errands, or help care for
other children in the home.

Encourage patient to exercise. Your doctor will let you know when it’s OK to
exercise. The activity should not be strenuous. Try taking a walk near your
house. The change of scenery is refreshing and can increase your energy level.
Diet Regimen

 Encourage patient to avoid fish high in mercury.

 Encourage patient to drink plenty of liquids. Your body needs lot of fluid

(about 6-10 glasses a day) especially if you are breastfeeding your baby.

Drink mostly water, milk, and fruit juice.

 Encourage patient to eat foods that have protein such as milk, cheese,

yogurt, meat, fish and beans. Protein rich foods are important to help you

recover from childbirth and keep your body strong. If you are under 18, or

were underweight prior to pregnancy, you need to eat more protein.

 Encourage patient to eat your fruits and vegetables. Try to make half your

plate fruits and vegetables. Fruits and vegetables have vitamins and

minerals that keep you healthy. They also have fiber, which helps prevent

constipation. Make sure to wash fruits and vegetables under running cold

water before eating them.

 Encourage patient to take prenatal vitamins. If you are breastfeeding, it is a

good idea to continue to take your prenatal vitamins. Your doctor can

prescribe these pills so that your health insurance will cover a portion of the

cost.
 NURSING IMPLICATIONS

Nursing Education

This study helps in enriching the knowledge base of the nurses regarding

the concepts of this kind of situation. The student nurses can teach a various

coping strategies skill that may help the patient, deal more effectively with the

illness and may contribute to an improved outcome for the patient. In looking at

Mrs. Park’s case, which has been quite standard in any setting with no extra

issues or complications, we can gain a lot of insight on how to appropriately

handle and care for a mother giving birth to a healthy baby. Because the

scenario is typical, all of the results are normal, and all laboratory tests for the
mother are normal. Tfhe mother and family members will learn how to deal with

the pain the mother is experiencing and how to appropriately care for the baby.

Nursing Practice

This case study would be beneficial in relation to the nursing practice. This

will also help the nursing student to determine the best approach to be delivered

to a particular patient, to render better care to patients, enhance our

understanding. This will also enhance one’s knowledge and understanding

based on the condition and its appropriate intervention for patient and due to the

COVID-19 pandemic we could not handle the patient in physical contact

however, if the situation goes back to normal we can apply all the learnings, we

can assure that we will be able to develop, master our skills and ability to learn,

think critically, analyze, assess, apply the nursing process to care the patient,

ability to accept responsibility and accountability.

Nursing Research

As it is a comprehensive compilation, this study greatly helps in the

development of nursing profession. This study is necessary regarding the

effectiveness of the nursing intervention. It could help patients improve their life

performance and improving their condition. These guides student nurses in

anticipating the results and in promoting practice changes based on results,

enhance what we have learned now so that we may be able to give better care.
Through this study we hope it gives a chance to expound and add information to

improve management of the condition, patients would receive better care and

developed plans of care. Thus, by analyzing our case study, it helps us to learn

more on how to take care of a well mother giving birth to a well-baby. The

information that has been gathered and the test that has been made contributed

in determining the complications that must be avoided.

References

Desai, N., (2021) Vaginal Delivery. Continuing Education Activity. NCBI

Iams J.D., (2003) Prediction and early detection of preterm labor. Obstet

Gynecol. 2003 Feb;101(2):402-12. [PubMed]

Rajendrababu, R. (2015)., Society of Obstetrics and Gynaecologists of Canada.

British Columbia Perinatal Health Program. Fetal health surveillance: antepartum

and intrapartum consensus guideline. J Obstet Gynaecol Can. 2007 Sep;29(9

Suppl 4):S3-56. [PubMed]

U.S National Library of Medicine,(2020), ultrasound, Rockville Pike,Bethesda,MD

20894.

Rxlist Inc.(2020) ,Methergerine (Methylergonovine Maleate);uses,dosage,side

effects, interactions, warning.

Conrad M.(2021), Methylergonovine- oral, [Link].

Spontaneous Vaginal Delivery: [Link]

Vaginal Delivery: [Link]

Normal Delivery of the Infant: [Link]

overview

Normal spontaneous vaginal delivery after transcervical radiofrequency ablation

of uterine fibroids: a case report: [Link]

spontaneous-vaginal-delivery-after-transcervical-radiofrequency-peer-reviewed-

fulltext-article-IJWH

Spontaneous Vaginal Delivery:

[Link]

Association of Planned Natural Childbirth With Spontaneous Vaginal Delivery,

Interventions, and Complications [36E]:

[Link]

ed_Natural_Childbirth_With.[Link]

Factors promoting or inhibiting normal birth:

[Link]

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