DON MARIANO MARCOS MEMORIAL STATE UNIVERSITY
SOUTH LA UNION CAMPUS
CONSOLACION, AGOO, LA UNION
COLLEGE OF COMMUNITY HEALTH & ALLIED MEDICAL SCIENCES
NUPC 108
Activity 4 RLE Learning Portfolio
Focus Unit: CARE OF CLIENT DURING LABOR AND DELIVERY
CASE SCENARIO:
You are assigned at the Labor and Delivery Room in your 4th Rotation in Ilocos Training and Regional Medical
Center (ITRMC). Your Clinical Instructor assigned and instructed you to assists and to monitor the vital signs
of the mother especially the blood pressure and the fetal heart tone of the baby.
HISTORY:
Cherry Blossom is a 30-year-old woman who is a G2 P0 has been admitted to labor and delivery at 39 weeks
after her membranes ruptured at home. Her first baby was born vaginally 2 years ago. She was diagnosed
with gestational diabetes at 28 weeks and has been on insulin during the last trimester. Her records indicate
that she is carrying a single pregnancy in vertex presentation via ultra-sound. Her past medical history is
uncomplicated, she has no allergies and she take no medication other than the prenatal vitamins (folic acids
and Iron supplements).
Her most recent vital signs minutes ago were as follows: BP 110/70, Pulse 69 beats per minute, Respiratory
rate of 20 breaths per minute and Temperature of 36.8 C.
In the delivery room the mother has been pushing for 2 ½ hours and is becoming exhausted. (“I am so tired”
I can’t push anymore!”) The doctor ordered IVF of PLR 1 liter with incorporation of 10units oxytocin
(1ampule) due to prolonged labor. Fetal heart tones has been uncomplicated (120 to 140 bpm).
Her contractions occurred every 2 to3 minutes lasting 60 seconds, strong to palpation. Her blood sugars
have all been less than 90 mg/dl, so her insulin drip has been on hold for the last couple of hours.
As the baby crowns, the fetal heart rate accelerates to the 150 bpm with pushing. There is fluctuation of
FHR but within normal limits. The doctor decided to have an episiotomy due to prolonged labor secondary to
large baby and cord loop. The baby was delivered with an initial assessment of the following: acrocyanosis,
RR of 42, HR of 98bpm, cries strongly with active movements and with thin meconium stains. The mother’s
vital signs are as follows: BP 130/80 PR 110bpm, RR 25bpm and Temp 36.6. The mother was ok but tired and
restless.
The newborn care was done and the baby was given erythromycin ointment prophylaxis, Vit.K 0.05ML IM and
Hepatitis B vaccine 0.1ML via intramuscular route and BCG vaccine Intradermal.
description of your patient care tasks. Using the Case Scenario assigned to you, you are expected to perform the following:
Determine the APGAR score of the newborn.
Formulate 1 Nurses Notes (documentation)for your Newborn patient using the FDAR format. Integrate your nursing care interventions sign
Make adrug studyof all medications required by your patient in oral or parenteral form and document it. Use the Drug Study Format for you
Make a leaflet on health teachings regarding proper breastfeeding and benefits of Unang Yakap.(Use short bond paper 8.5x11)
Every student should submit an article report/case journal (in PDF format) using APA format with references. References of journal /article
“Whatever you decide to do, Make sure it will make you happy.” Don’t be afraid…Just believe Mark
5:36
APGAR score of the Newborn
Part 2:
Rationalize the following actions
Action Rationale
DON’Ts
1. Suctioning of newborn A baby is born with amniotic fluid from
the mother. Traditionally, amniotic
fluid that had gotten into the baby's
nose and mouth was suctioned out with
a bulb-like apparatus. However, the
Department of Health claims that this
procedure is no longer appropriate
since it can "create trauma or
introduce infection."
2. Removal of vernix caseosa The thick, white covering that covers
newborn newborns is called the vernix
caseosa. The removal of the vernix
caseosa is not acceptable because this
coating, which has antibacterial
characteristics similar to that of
amniotic fluid and breast milk, is
necessary to protect the infant from
infection.
3. Immediate cutting of cord Immediate cord clamping or cutting of
cord could possibly be linked to brain
hemorrhage, respiratory distress,
autism, cerebral palsy, anemia, brain
injury, learning disorders, and
behavioral disorders.
4. Milking of the cord In preterm newborns delivered less
than 32 weeks of gestation, milking the
umbilical chord, which forces the
contents into the newborn's abdomen
before clamping the cord, may raise
the risk of severe intraventricular
hemorrhage, or bleeding into the
brain's fluid-filled cavities. Also,
umbilical cord milking may cause
neonates to have a high hematocrit
(too many red blood cells), a condition
known as polycythemia.
5. Bathing the newborn immediately Bathing exposes the baby to
hypothermia and removes the vernix
caseosa, or thick, white coating that
protects newborns. Bathing should be
postponed until after 6 hours of life,
according to the WHO. You can even
wait days before bathing your baby for
the first time.
6. Foot printing Newborns' footprints have traditionally
been used to identify them. The DOH,
on the other hand, claims that "this
approach raises the risk of cross-
contamination among babies." Studies
have also indicated that footprints are
insufficient for identifying the babies,
according to the health agency.
Instead, skin-to-skin contact keeps the
infant close to the mother, reducing
the danger of switching births.
DO’s
7. Inner canthus to other canthus By opening eyelids and applying the
application of Erythromycin ointment ointment from the inner canthus to the
outer canthus, this should be
administered by 1 hour of life.
Erythromycin is a drug that is used to
treat infections caused by bacteria. It
protects newborns from gonorrhea-
infected moms from developing
ophthalmia neonatorum. It also
prevents conjunctivitis in children
whose moms have chlamydia.
8. Skin to skin contact It is acceptable because skin to skin
contact can provide warmth, improves
bonding, provides protection from
infection by exposure of the baby to
good bacteria of the mother and it also
increases the blood sugar of the baby.
9. Initiation of breastfeeding Breastfeeding encourages the mother's
uterus to contract, lowering the risk of
postpartum hemorrhage. Breast milk
defends infants against infections and
diseases. Breast milk continues to give
high-quality nutrition and infection
protection until the child is two years
old or older. Breastfeeding can help
you space your children's births.
Breastfeeding helps to strengthen the
emotional tie between mother and
child.
10. Properly timed cord clamping/cutting of Before cutting the umbilical cord,
umbilical cord three minutes should have passed. This
allows placental blood to flow to and
nourish the infant as the baby develops
a correct breathing pattern and begins
to rely on its own internal systems.
11. Rooming- in The WHO recommends that parents
continue rooming-in during their baby's
first six months of life because it is so
helpful to their health and
development. This approach lowers the
risk of SIDS and makes feeding,
comforting, and monitoring your new
baby a lot easier.
12. Exclusive Breastfeeding The baby receives no other food or
drink, including water, unless it is
exclusively breastfed. Breastfeeding
exclusively for the first hour after birth
is recommended. Colostrum benefits
the baby's immune system when fed
early.Breastfeeding protects against
diarrhoea and common childhood
illnesses like pneumonia, as well as
having longer-term health benefits for
both the mother and the child,
including as lowering the risk of
childhood and adolescent overweight
and obesity.
