FATHER SATURNINO URIOS UNIVERSITY

San Francisco St. Butuan City 8600, Region XIII

Caraga, Philippines Tel. Number 085-34130001 local 4853

Nursing Program

A GROUP CASE STUDY

PRESENTATION ON PROLONGED
LABOUR AND THE DECISION FOR
CESAREAN SECTION DELIVERY

Guimba, Jamel N.

Havana, Hezekiah M.

Hidalgo, Ruben Gin B.

Inchoco, Fria Jane D.

Jadumas, Xylhex B.

Jastillana, Stella Mae C.

Justalero, Krishane B.

Labrador, Erl Jen R.

Lacson, Joshua S.

Layo, Ivy L.

Level II Students

MR. JEBOR S. ORTIGAS, RN

Supervising Clinical Instructor

1
 TABLE OF CONTENTS

Pages Content Reporter

2…………………………….….Table of Contents…………………………………………………

3………………………...………Introduction…………………………….…….Fria Jane Inchoco

4…………………………......Definition of Terms………………….....……. Fria Jane Inchoco

5-6……………………………..Nursing Health History…………………….... Xylhex Jadumas

7-11………………………..…..Physical Assessment………………………….Stella Mae Jastillana

12-15…………………………..Anatomy and Physiology…………….……….Hezekiah Havana

16-17…………………………..Pathophysiology……………………………....Krishane Justalero

18-20…………………………..Lab Results………………………….……......Ivy Layo

21-23…………………………..Drug Study……………………………..……..Jamel Guimba

24-54…………………………..Nursing Care Plan………………………….…Erl Labrador & Joshua

Lacson

55-56…………………………..Discharge Plan……………………….……….Ruben Hidalgo

57……………………………...Learning Outcomes…………………..………. Fria Jane Inchoco

58…………………………...…References……………………………………. Fria Jane Inchoco

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 I. INTRODUCTION

The management of the latent phase of labor is still debatable and usually leads to problems
with definition and recognition. The latent phases of nulliparas tended to be longer than those of
multiparas, according to Friedman, who described the latent phase of labor in detail (Friedman
1955, 1978; Kilpatrick and (1989, Laros). In Southern Africa, Philpott and Castle (1972) believed
that a latent phase was prolonged if it lasted more than eight hours. The extended latent phase of
labor and the difficulties that go along with it have not been well studied up until now.

The conventional wisdom holds that the extended latent phase is a safe state in which there
are no mother and complications throughout pregnancy (Friedman, 1972). Gestational issues
resulting from the extended latent phase have nonetheless been reported, including an increase in
frequency of cesarean sections and neonatal asphyxia (1993, Chelmow et al.). Most South African
protocols Currently, intervention after eight hours is advised. (Health Department, 2000). Usually,
this requires the prostaglandin, oxytocin infusion, or amniotomy delivery, along with electronic
fetal monitoring if necessary accessible. Certain obstetricians distinguish between women who are
nulliparous and multiparous, and they will advise involvement after six and twelve hours,
respectively (1993, Chelmow et al.).

Longer labors produced more primiparae, lower labor outcomes, and less satisfying birth
experiences for the women involved. The prevalence of prolonged labor was found to be 35.6% among
primiparous women and 10.2% among multiparaous women. This prevalence is comparable to that of
Kjaergaard's (2009) study, which found that 37% of first-time mothers were diagnosed with prolonged
labor, and Selin's (2009) study, which found that the prevalence was 33% among first-time mothers and
7% among women who had previously given birth. Based on data from hospital births, this study shows
that prolonged labor is rarely life-threatening, despite poor diagnosis. But it should be mentioned that 8%
of maternal deaths globally are caused by obstructed labor.

Furthermore, the national statistics show that a prolonged labor affects about 8% of all women
giving birth, and the hospital birth rates were roughly 1500, 600, and 300 every year. Maternal risk factors
that raise the possibility of an extended labor include high body mass index or total maternal weight gain.
Primiparity is another risk factor. High birth weight, a broad head circumference, and occiput posterior
presentation are examples of fetal risk factors. Additionally, a longer labor is linked to more intense labor
pain than anticipated, increasing the need for epidural analgesia and raising the possibility of surgical
procedures. In Butuan City, there is no available statistical data and the student nurse’s patient, Patient N,
is a 20-year-old female who was admitted to Butuan Medical Center, Butuan City, who undergone cesarean
section delivery due to prolonged labor on November 20, 2023.

3
 II. DEFINITION OF TERMS

Amniotic fluid - the liquid that envelops the baby in pregnancy which is very critical to the growth
of the child.

Amniotic sac - A thin-walled sac that surrounds the fetus during pregnancy. The sac is filled with
liquid made by the fetus (amniotic fluid) and is also called as the “bag of water.”

Antepartum - the period of time before the onset of labor and childbirth.

Braxton Hicks Contraction - irregular uterine muscular contractions and relaxations and also
known as prodromal or "false labor" pains at times.

Bleeding - the loss of blood from the circulatory system.

Cervix - a little channel that permits fluids to enter and exit the uterus and connects it to the vagina.

Chadwick’s Sign - a vague, early pregnancy indicator that is usually identified by bluish staining
of the vulva, vagina, and cervix.

Compression - a mechanical pressure exerted from the outside onto skin and tissue.

Contractions - when the uterine muscles contract, then release, assisting in the release of the baby.

Effacement - the cervix stretches and gets thinner.

Incision - a cut created during surgery, such as an abdominal incision made by a surgeon
performing a cesarean-section.

Intrapartum - the time during labor and childbirth.

Meconium - is the newborn’s first poop that is sticky, thick, dark and green poop that is made up
of cells, proteins, fats, and intestinal secretions.

Postpartum - the period of time after childbirth.

Suture - a stitch or a series of stitches used to close a cut or wound.

Umbilical Cord - a tube that connects you to your baby during pregnancy.

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 III. NURSING HEALTH HISTORY

Level 2 student nurses of Father Saturnino Urios University were assigned to the Delivery
Room at Butuan Medical Center, dated from November, 13, 14, 15, 20, 21, and 22 2023. The
student Nurses made sure to attain substantial information on the chosen case with analytic and
systematic thought assessment.

Recording a patient's medical history is a vital aspect of patient assessment, as it facilitates

more effective treatment. By comprehending the intricacies and methods involved in obtaining a
patient's history, nurses can gain a better understanding of their patients' challenges. This nursing
health history will include data provided by the patient and their close contacts, as well as
information gathered by student nurses through a comprehensive interview, all following Gordon's
11 Functional Patterns. The team has decided and chosen to focus on the case of Patient N, who
presented with a primary concern of labor pain, ultimately resulting in Cesarean Delivery due to
Prolonged Labor on November 20, 2023.

I. Patient’s Demographic Profile

A 20-year-old patient N, was born on August 28, 2003, in Butuan City. and also raised in
Brgy. Obrero Butuan City, current address, Brgy. Obrero Butuan City Agusan del Norte. currently
living with his live-in partner. She weighs 132 lbs (60kg) with a height of 155 cm (5’1) and a total
BMI (body mass index) of 24.9 which indicates healthy. Patient N is a first-time mother who
delivered via Cesarean section delivery

II. Family History

Patient N has a notable family history that includes a predisposition to hypertension on

both her mother's and father's side, and her mother has been diagnosed with kidney failure and
Diabetes.

III. Past Health History

Patient N has a history of significant health events. She experienced a motor vehicle
accident during her childhood, resulting in severe wounds on her extremities. Patient N was prone
to fever during her childhood and adulthood. a pattern that has persisted into their current state of
health.

IV. Onset of Illness

On November 19, 2023, Patient N was admitted to Butuan Medical Center with the chief
complaint of labor pain. Patient G was anxious the day she was admitted because she experienced
severe bleeding during her first trimester of pregnancy.

11 GORDON’S FUNCTIONAL PATTERN

I. Health Perception - Health Management Pattern

Patient N takes good care of her health by always taking the medicines the Doctor
prescribed. She thinks it's really important because she knows that being healthy is crucial for
being able to take care of her family.

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II. Nutritional - Metabolic Pattern

Patient N in a Day Treatment, program with a "Soft Diet" for recovering from surgery from
a Cesarean section delivery.

III. Elimination Pattern

Patient N hasn't eliminated stool yet but only urine through a catheter and had a level of
1000 on a Foley bag catheter on the night after the surgery then a level of 300 in the morning.

IV. Activity Exercise Pattern

Patient N considers her house chores as her daily exercise.

V. Cognitive - Perceptual Pattern

Patient N understood and responded clearly to the questions that were given and asked by
the student nurse.

VI. Sleep - Rest Pattern

Patient N experienced frequent awakening due to post-surgery discomfort and pain from a
Cesarean Delivery.

VII. Self-perception Self-concept

Pattern Patient N reports having physical limitations and is in the process of recovering
from the stress caused by surgery.

VIII. Role - Relationship Pattern

Patient N and his live-in partner often take care of their daily needs, providing emotional
support to each other, and managing their finances and decision-making.

IX. Sexuality - Reproductive Pattern

Her sexual relationship is marked by a low degree of satisfaction, her decision to manage
her reproductive choices actively reflects her commitment to her family and relationship goals.

X. Coping - Stress Pattern

Patient N typically copes by openly expressing her emotions, often turning to eating as a
way to deal with stressors.

XI. Value - Belief Pattern

Patient N grew up exposed to a Born Again religion but since her live-in partner is a Roman
Catholic, there are occasional conflicts in terms of their core values and beliefs and scheduling
practices, but it also reflects commitment for the sake of their relationship.

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 IV. PHYSICAL ASSESSMENT

Physical assessment is a planned, methodical procedure for gathering factual information based on
a person’s medical history and comprehensive physical examination. The nursing procedure begins with a
physical evaluation. Your observations are a key component of the nursing care plan’s assessment,
intervention, and evaluation stages since it serves as its framework. Regarding the client’s complaints, the
nurse’s personal observations of issues, the client’s presenting issue, the nursing treatments offered, and
the medical therapy are all thoroughly assessed.

A physical assessment was carried out on November 21, 2023, 10:00 AM in order to build a
systematic process for gathering the necessary objective data about the particular body systems related to
the presenting issue or the current concern. It establishes the foundation for the nursing care plan, which
incorporates observations into the assessment, intervention, and phases of evaluation. A physical
assessment, intervention, and phases of evaluation. Physical assessment is conducted to examine the
patient’s overall health and identify any abnormalities that might be related to the underlying disease
process.

Techniques used: Inspection, Palpation, Percussion, Auscultation

Name: Patient N Date: November 21 ,2023

Age: 20 years old Time: 10:00 AM

LEGEND

BLACK - NORMAL

RED – ABNORMAL

Instruments used:

● Tape measure

● Pen light

● Thermometer

● Pulse Oximeter

● Wristwatch

● Stethoscope

● Blood Pressure Apparatus

● Physical Assessment Tool Guide

The following data are based on a thorough physical examination that was conducted last November
21, 2023 10:00 AM.

GENERAL SURVEY

Upon the assessment, the patient stands 155 cm, 5 ft and 5 inches tall and weighs 60 kg, with a
BMI of 24.9 which is interpreted to be normal weight. The patient is received on bed in a semi fowler

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position,awake, responsive, and coherent .With ongoing IV fluid of 30 cc D5LR 1L Infusing well at right
metacarpal; with baseline vital signs of Temperature: 38.2 °C ,Pulse rate: 110 bpm ,Respiratory rate:
19 cpm,Blood Pressure: 120/90 mmHg,and O2sat 98% .Patient N complains of pain in the surgical site
with pain scale of 7 out of 10 and has fever. She can sit and get up in bed. The student nurse observed that
she likes to stay in bed to ease the pain. Despite her situation, she is cooperative and responsive and was
able to answer the questions of the student nurses.

STATISTICS

ASSESSMENT MEASUREMENT

Head circumference 53 cm

Chest circumference 91 cm

Abdominal circumference 96 cm

Mid arm Left 12 cm Right 12 cm

Calf Left 15 cm Right 15 cm

GENERAL SURVEY

ASSESSMENT OBSERVATION

Body build Proportionate (endomorph)

Posture Relaxed

Hygiene and grooming Clean and neat

Attitude Cooperative

Quality and quantity of speech Understandable

Relevance of thoughts Logical

BODY PART INSPECTION PALPATION PERCUSSION AUSCULTATION

SKIN Dry intact without Skin is warm to Not applicable Not applicable
rashes or lesions. touch

HAIR Hair is normal Not applicable Not applicable Not applicable

texture and evenly
distributed

SCALP Skin intact;no No masses or Not applicable Not applicable

lesion and no tenderness.
presence of
dandruff.

SKULL Rounded The head is in a Not applicable Not applicable

,smooth,symmetri normal condition
c features and has and without lumps
symmetric or bumps and
movement. tenderness.

EYES

EYEBROWS Hair is evenly The eyebrows are Not applicable Not applicable
distributed,symme Smooth.
trical and has
equal movement.

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EYELASH Equally Fine line hair Not applicable Not applicable
distributed and
curled out.

EYELIDS Intact skin,no No discharge Not applicable Not applicable

discharge,

BULBAR Transparent ,white Not applicable Not applicable Not applicable

CONJUNCTIVA clear and some
capillaries.

PALPEBRAL Shiny and smooth. Not applicable Not applicable Not applicable
CONJUNCTIVA

LACRIMAL No observable No edema and Not applicable Not applicable

GLAND discharge upon tenderness .
inspection.

CORNEA Transparent and Not applicable Not applicable Not applicable

shiny.

PUPILS Black, equal in Not applicable Not applicable Not applicable

size,round,pupils
constrict to light
and pupil constrict
at close distance.

VISUAL FIELD Can see sides Not applicable Not applicable Not applicable
when looking
straight.

EXTRAOCULA Move in Not applicable Not applicable Not applicable

R MUSCLE unison,coordinate
d and parallel
alignment.

VISUAL Able to read Not applicable Not applicable Not applicable

ACUITY newsprint and able
to count fingers 1
feet away.

EARS AND HEARING

AURICLES Color same as No lesion or Not applicable Not applicable

facial discharge and
skin,symmetric pinna immediately
auricle with outer recoils.
canthus of eye 10
degrees vertical.

EXTERNAL Has hair follicles Not applicable Not applicable Not applicable
EAR with cerumen
upon assessment.

TYMPANIC Pearly gray color Not applicable Not applicable Not applicable
MEMBRANE and
semitransparent

GROSS Able to hear in Not applicable Not applicable Not applicable

HEARING normal voice
tones audible.

MOUTH AND OROPHARYNX

LIPS AND Uniform pink Not applicable Not applicable Not applicable
BUCCAL color,able to purse

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MUSCOSA lips and dry and
crusted lips.

TONGUE Patient refused to Patient refused to Patient refused to Patient refused to

do the procedure do the procedure do the procedure do the procedure

PALATES Patient refused to Patient refused to Patient refused to Patient refused to

UVULA do the procedure do the procedure do the procedure do the procedure

OROPHARYNX Patient refused to Patient refused to Patient refused to Patient refused to

do the procedure do the procedure do the procedure do the procedure

NECK

NECK Muscles equals in No tenderness Not applicable Not applicable

MUSCLES size,head
centred,coordinate
d,coordinated
movement and no
discomfort.

LYMPH NODES The neck is Not palpable Not applicable Not applicable
moving without
any enlarged and
swollen lymph
nodes.

TRACHEA Trachea is in At central Not applicable Not applicable

midline placement

THYROID Not visible upon Thyroid gland is Not applicable Not applicable
GLAND inspection and normal without
gland ascend masses.
when swallowing

CAROTID No jugular vein Both arteries are Not applicable Not applicable
ARTERIES distension palpable

THORAX AND Patient refused to Patient refused to Patient refused to Patient refused to
LUNGS do the procedure. do the procedure. do the procedure. do the procedure.

BREAST AND Patient refused to Patient refused to Patient refused to Patient refused to
AXILLAE do the procedure. do the procedure. do the procedure. do the procedure.

HEART AND The external chest Heart rate and Patient refused to Patient refused to
CENTRAL is normal in rhythm are normal do the procedure. do the procedure.
VESSELS appearance
without
lifts,heaves,or
thrills.

UPPER Symmetric pulse No tenderness and Not applicable Not applicable

EXTREMITIES volumes,equal no edema.
size,no tremors
,no
contractures,and
full pulsations.

LOWER Symmetric pulse No tenderness and Not applicable Not applicable

EXTREMITIES volumes,full edema noted.
pulsations,capillar
y refill immediate
return less than 4
seconds,and
convex nail curve
160°.

ABDOMEN Abdominal Patient refused to Patient refused to Patient refused to

contour is bloated do the procedure. do the procedure. do the procedure.
with 6.7 inches

10
 abdominal wound
incision below
umbilicus.

INGUINAL Patient refused to Patient refused to Not applicable Not applicable

AREA AND do the procedure do the procedure
GENITALIA

GLASGOW COMA SCALE

Patient N is awake and alert, displaying full responsiveness,and her Glasgow Coma Scale score is 15.

EYE OPENING 4 Spontaneous

VERBAL RESPONSE 5 Oriented

MOTOR RESPONSE 6 Obeys commands

TOTAL: 15

NEUROLOGIC ASSESSMENT

ASSESSMENT OBSERVATION

BEHAVIOR Cooperative but irritable and Guarding behavior

MENTAL STATUS Logical and oriented

MOTOR FUNCTIONING Unable to stand slow and limited movements

COORDINATION Coordinated

FINE MOTOR SKILLS Can grip pen etc.

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 V. ANATOMY AND PHYSIOLOGY

PREGNANT WOMEN AND CESAREAN SECTION

Pregnancy and the changes that accompany it are a normal physiological reaction to the
development of the fetus. These changes occur as a result of a variety of variables, including
hormonal changes, an increase in total blood volume, weight growth, and an increase in foetal size
as the pregnancy proceeds. All of these elements have an effect on the pregnant woman’s
physiological systems, including the musculoskeletal, endocrine, reproductive, cardiovascular,
respiratory, neurological, urinary, gastrointestinal, and immune systems, as well as changes to the
skin and breasts.

UTERUS

During pregnancy, your uterus occasionally tightens in preparation for labour. These
‘practice contractions’ are commonly referred to as Braxton Hicks contractions. During active
labour, the muscles of your uterus contract purposefully, to help:

● Open your cervix

● Help your baby move down into the birth canal.

Each labour contraction may start like a wave and build in intensity, moving from the top
of your uterus right down to your cervix. Your uterus will feel tight during the contraction. But
between contractions, the pain intensity may ease off and allow you to rest before the next one
builds.

CERVIX

The cervix is a muscular canal or aperture that connects your uterus (also known as the
womb) to your vagina. During pregnancy, your cervix is extremely important. It protects your
growing kid from conception until shortly before birth. The mucus on the surface of your cervix
grows sticky and thick from the start of your pregnancy. This creates a mucus ‘plug,’ which aids
in the prevention of microbes, germs, such as bacteria and viruses, from entering your uterus and
potentially hurting your baby. During labor, your cervix experiences tremendous changes. This is
referred to as ‘effacement’ or ‘ripening’. Your cervix transforms from lengthy and stiff to soft,

12
thin, and stretchy. Your cervix begins to dilate (open). The time it takes your cervix to open (or
dilate) during the initial stage of labour varies from person to person.

VAGINA

The Chadwicks sign occurs when the vagina turns bluish due to increased blood flow down
below. Because it causes no discomfort, you may not even be aware that it has occurred unless
you are actively seeking for it. Regardless, the blue or purple color should fade soon after you give
birth. People frequently refer to the vagina as a “birth canal” when discussing its role during
birthing. To be born, your baby goes from your uterus through your vagina. Your baby’s last stop
on its journey from your body to the outside world is through your vaginal opening.

PLACENTA

During pregnancy, the placenta develops into a temporary organ in your uterus. It adheres
to the uterine wall and delivers nourishment and oxygen to your baby via the umbilical cord.
Certain placental abnormalities m placenta ight lead to pregnancy problems. Around seven to ten
days after conception, a fertilized egg implants in your uterus and begins to form the placenta. It
grows to support your baby during your pregnancy.

AMNIOTIC FLUID AND AMNIOTIC SAC

Your baby develops inside the amniotic sac (bag) inside your uterus (womb) throughout
pregnancy. The sac contains amniotic fluid. This sac arises about 12 days after conception. What
the fluid does is as follows:

● Protects and cushions your infant

● Maintains a constant temperature around your infant because your kid breathes
in the fluid, it helps your baby’s lungs expand and develop because your baby consumes
the fluid

● It aids in the development of his or her digestive system because your baby may
move about in the fluid, it aids in the development of his or her muscles and bones.

● Avoids squeezing the umbilical cord (the cord that transports food and oxygen
from the placenta to your baby).

UMBILICAL CORD

During pregnancy, the umbilical cord is a tube that links you to your baby. It has three
blood vessels: one vein that transports food and oxygen from the placenta to your baby and two
arteries that transport waste back to the placenta.

A C-section is a frequent surgical operation that involves delivering a baby through an

incision in the mother’s abdomen and uterus. A breech or transverse position of the baby, concern
for fetal distress during or prior to labor, serious health difficulties of the mother, or failure of labor
and or unsuccessful inducement are all grounds for a C-section.

13
A doctor makes an incision through seven separate layers of tissue during a C-section.

1. Skin

2. Fat beneath the skin

3. Fascia

4. Muscle

5. Peritoneum

6. Uterus

7. Sac Amniotic

Procedure :

● A solution is applied to the skin to lessen the risk of wound infection.

●A catheter is inserted into the bladder.

●Shave the hair surrounding the incision.

●An incision in the skin is created and carried through the abdominal wall to the pelvis. The
incision in the skin might be vertical (up and down) or transverse (from side to side). Many factors
influence the decision, including the speed of entry, the amount of exposure required, the expected
weight of the baby, and the risk of wound infection. The most typical incision is a transverse skin
incision made 2-3 centimeters (one inch) above the pubic bone.

● The uterus is then located. The vesicouterine peritoneum is a thin layer of tissue that drapes over
the front aspect of the uterus and subsequently onto the bladder. This layer is incised to allow the
bladder to be withdrawn away from the uterus in order for the uterine incision to be made.

14
● The uterine incision is then made all the way down to the amniotic sack (fetal membranes or
water bag).

● Transverse or vertical uterine incisions are possible. A transverse uterine incision is present in
90% of women. A pre-term pregnancy, a fetus that is not head down, and emergency C-sections
are all reasons for a vertical uterine incision. Even in these cases, a transverse incision may be
necessary. A lady who has had a previous C-section with a vertical uterine incision is unlikely to
have a vaginal birth.

● Following that, the fetal head or buttocks are delivered through the uterine incision, followed by
the remainder of the body.

● Some obstetricians repair the uterus after it has been delivered through the abdominal incision,
while others repair it while it is still in the abdomen. One or two layers of suture are used to seal
the uterus.

● The abdominal wall layers are sutured, and the skin is closed with suture or staples.

15
VI. PATHOPHYSIOLOGY

16
17
 VII. LABORATORY RESULTS

Legend: RED values indicate abnormalities.

Urinalysis

Date: November 20, 2023

Macroscopic Examination Result

Color Yellow

Transparency Hazy

Chemical Analysis (Strip

Test)

pH 6.5

Specific Gravity 1.020

Protein TRACE

Glucose NEGATIVE

Blood +1

Leukocytes +1

Nitrite NEGATIVE

Ketones NEGATIVE

Bilirubin NEGATIVE

Urobilinogen NEGATIVE

Microscopic Examination

Pus cells 21-30

RBC 11-20

Epithelial Cells FEW

Bacteria MODERATE

HEMATOLOGY

Date: November 19, 2023

Test Result Unit Reference Remarks

Range

WBC 32.69 10/L 5.0-10.0 Increased The white

blood cell
count is
32.69, which
is higher than
the reference
range of 5.0 -
10.0. An
elevated
WBC count
can be a sign

18
 of infection
or
inflammation.

RBC 4.12 10/L M: 4.5 - 5.2 Normal

F: 3.4 - 5.6

Hemoglobin 133 g/L M: 135 - 175 Normal

F: 125 - 155

Hematocrit 0.39 M: 0.40 - Normal

0.52
F: 0.36 - 0.48

MCV 95.0 fL 82 - 92 Increased The MCV

count is 95.0,
which is
higher than
the reference
range of 82 -
92. An
increased
MCV (mean
corpuscular
volume) in
hematology
results
typically
indicates
larger-than-
normal red
blood cells,
suggesting
conditions
such as
macrocytic
anemias or
certain
nutrient
deficiencies.

MCH 32.4 pg 27 - 32 Increased The MCH

count is 32.4,
which is
higher than
the normal
range of 27 -
32. An
increased
mean
corpuscular
hemoglobin
(MCH) in
hematology
results may
indicate
larger and
potentially
more
saturated red
blood cells,
suggesting
conditions
such as
macrocytic

19
 anemias or
vitamin
B12/folate
deficiencies.

MCHC 341 g/L 320 - 380 Normal

Platelet 218 10/L 150 - 400 Normal

Differential
Count

NEUTROPHI 0.86 0.50 - 0.70 Increased The

LS neutrophils
count is 0.86,
which is
higher than
the normal
range of 0.50
- 0.70.
Increased
neutrophils
suggest an
active
immune
response,
commonly
due to
infections,
inflammation,
or tissue
injury.

LYMPHOCY 0.10 0.20 - 0.40 Decreased The

TE lymphocyte
count is 0.10,
which is
lower than
the normal
range of 0.20
- 0.40. A
decreased
lymphocyte
has a higher
risk for
infection.

MONOCYTE 0.04 0.02 - 0.06 Normal

Blood Type “O”

POSITIVE

SEROLOGY

Released Date: November 19, 2023

Result (CU) Unit (CU) Reference Range

(CU)

Examinations

HBsAG (Hepa B) Non Reactive

20
 VIII. DRUG STUDY

1. Name of Drug: Omeprazole

Date Ordered: November 20, 2023

Classification: Proton pump inhibitors

Dosage/ Frequency:40mg IV for one dose only every 6 hours

Mechanism of Action: Inhibits proton pump activity by binding to hydrogen-potassium adenosine

triphosphate, located at the secretory surface of gastric parietal cells, to suppress gastric acid secretion.

Specification: use to treat to reduce the acid in your stomach or to reduce the risk of acid
aspiration.

Contraindication: use cautiously in patients with respiratory alkalosis, hypokalemia, low sodium
diet, and a patient hypersensitive to drug or its components and in patients receiving rilpivirine-
containing products.

Side effects: nausea, vomiting, flatulence, diarrhoea

Nursing consideration:

· Report any changes in urinary elimination such as pain or discomfort associated with

urination or blood in urine.

· Report severe diarrhea; the drug may need to be discontinued.

· Do not breastfeed while taking this drug.

2. Drug Name: Paracetamol

Classification: Acetaminophen

Date Ordered: November 20, 2023

Dosage/ Frequency: 300 mg IV for one dose via slow IV push. Then after 6hours

Mechanism of action: to produce analgesia by inhibiting prostaglandin and other substances that
sensitive pain receptors. Drug may relieve fever through central action in the hypothalamic heat
regulating center

Specification: use for mild pain, pain reliever, inflammatory and fever

Contraindication: contraindicated in patients hypersensitive to drug IV form is contraindicated

in patients with severe hepatic impairment (hepatotoxicity) or acute liver disease.

Side effects: nausea, vomiting, and constipation

Nursing consideration:

· Be aware of this drug when calculating total daily dose

21
 · Be sure to base dose on in patient weight less than 50 kg to properly program infusion
pump

· Ensure total daily dosage total daily dose of acetaminophen from all sources doesn’t exceed
maximum daily limit.

3. Name of Drug: Tramadol

Date Ordered: November 20, 2023

Classification: Analgesic

Dosage/ Frequency: 50 mg for one dose via slow IV push, every 6 hours

Mechanism of Action: to bind to opioid receptors and inhibit reuptake of norepinephrine

Specification: Tramadol is used for the short-term relief of severe pain. It should only be used
when other forms of non-opioid pain relief have not been successful in managing pain or are not
tolerated.

Contraindication: contraindicated in patients hypersensitive to drugs or opioids in patients

hepatic impairment

Side effects: dizziness, chest pain, headache, weakness

Nursing consideration:

· Reassess patients level of pain at least 30 minutes

· Monitor vital sign

· For better analgesic effects, give drug before onset intense pain

· Monitor bowel and bladder function. Anticipate need for stimulant laxative.

4.Drug name: Cefuroxime

Date ordered: November 20, 2023

Classification: Cephalosporin antibiotic

Dose/Frequency: 750 mg IV every 8 hours x 72 hours then shift to cefuroxime 500 mg per cap
twice a day per oral

Mechanism of action: Cefuroxime is a bactericidal agent that acts by inhibition of bacterial cell
wall synthesis.

Specification: treatment of a variety of infections including acute bacterial otitis media, several
upper respiratory tract infections, skin infections, urinary tract infections, gonorrhea, early Lyme
disease, and impetigo.

Contraindication: patients with known hypersensitivity to ceftriaxone.

Side effects: chest pain, shortness of breath, swelling, redness or pain at the injection site.

Nursing consideration:

· monitor of pseudomembranous colitis

· monitor for rashes

22
· Encourage the patient to increase fluid intake unless contraindicated

5. Name of Drug: Ketarolac

Date Ordered: November 20, 2023

Classification: non-steroidal anti-inflammatory drug

Dosage/ Frequency: 30mg IV for one dose then after 8 hours.

Mechanism of Action: may inhibit prostaglandin synthesis to produce anti-inflammatory, analgesics,

and antipyretic effects.

Specification: short term management of moderately severe, acute pain for single dose treatment,
and shor- term management of moderately severe, acute pain for multiple dose treatment.

Contraindications: drugs in contraindicated in patients who have a previously of hypersensitivity

to ketorolac allergic manifestations to aspirin.

Side effects: nausea, dizziness, headache, flatulence

Nursing consideration:

· Correct hypovolemia before giving drug

· Monitor for signs and symptoms of heart attack (chest pain shortness of breath)

· Observe patients taking anti- coagulants drug.

6.Drug name: Metronidazole

Date ordered: 11/20/23

Classification: Nitroimidazole antibiotic

Dose/Frequency: 500 mg IV every 12 hours x 6 dose then shift to metronidazole 500 mg per cap
thrice day per oral

Mechanism of action: diffuses into the organism, inhibits protein synthesis by interacting with
DNA, and causes a loss of helical DNA structure and strand breakage. Therefore, it causes cell
death in susceptible organisms.

Specification: Metronidazole is indicated for the treatment of confirmed trichomoniasis caused

by Trichomonas vaginalis, endometritis, bacterial vaginosis, intra-abdominal infections, lower
respiratory tract infections, skin structure infections.

Contraindication: patients with a prior history of hypersensitivity to metronidazole or other

nitroimidazole derivatives and during the first trimester of pregnancy.

Side effects: Dizziness, Stomach cramps, Heat burn, Sensation of spinning, trouble sleeping,
weight loss

Nursing consideration:

· Monitor IV injection site for pain, swelling, and irritation. Report prolonged or excessive
injection site reactions to the physician.

· Assess dizziness that might affect gait, balance, and other functional activities

· Monitor signs of allergic reaction.

23
 VIII. NURSING CARE PLAN

ANTEPARTUM:

Impaired comfort may be related to hormonal influences, physical changes, possibly

evidenced by verbal reports as nausea and vomiting, alteration in muscle tone, inability to relax.

Ineffective breathing patterns may be related to impingement of the diaphragm by

enlarging the uterus, possibly evidenced by reports of shortness of breath.

Impaired urinary elimination may be related to uterine enlargement, increased abdominal

pressure, fluctuation of renal blood flow, and possibly evidenced by urinary incontinence.

INTRAPARTUM:

Risk for labor pain as evidence by prolonged contractions

Deficient knowledge related to underlying procedure as evidence by verbalization of

concerns

Anxiety related to perceived threat for fetus as evidenced by restlessness

POSTPARTUM:

Acute pain related to post-operative procedure as evidenced by surgical incision

Constipation related to impaired physical mobility as evidenced by a post-operative

procedure

Self-care deficit related to surgical procedure as evidenced by difficulty accessing the

bathroom

24
Nursing Care Plan: 1

Cues Nursing Desired Intervention Rationale Evaluation

Diagnosis Outcome
Within 8 1. Staying After 8
Subjective- Impaired hours of 1. Advice the hydrated can hours of
comfort may nursing patient to drink help prevent nursing
“ Kato buros be related to intervention, dehydration intervention
the patient will
a lot of water.
pa ko cge ra hormonal caused by the patients
ko suka og influences, no longer
experience
vomiting. is no longer
kalipungon” physical Clear fluids experiencing
nausea and
changes, vomiting. such as nausea and
possibly water, ginger vomiting as
evidenced by tea, or verbalised
Objectives- verbal reports electrolyte by the
as nausea and solutions can patient
-Guarding
behaviour
vomiting, be easier on “nawala na
alteration in the stomach. akong
-Irritable muscle tone, kalipungon
inability to 2.Consuming 2. Eating nya di napud
-Alert and relax. smaller, ko gasuka”
Small,
Oriented more
Frequent frequent
Meals. meals helps
maintain a
With the steady blood
following sugar level
vital signs: and prevents
the stomach
TR-38 C from
becoming
PR- 110 bpm overly full,
reducing the
RR- 19 cpm
likelihood of
BP- nausea.
120/mmHg
3.Identify
3. Avoiding and avoid
Trigger Foods. foods that
trigger
nausea.
Common
triggers
include
strong
odours, spicy
or fatty
foods, and
those known
to cause
indigestion.

4. Ginger
Supplements 4.Ginger has
antiemetic
or Ginger Tea.
properties
and can help
alleviate

25
 nausea.
Ginger
supplements
or ginger tea
are
convenient
ways to
5.Acupressure incorporate
(Wristbands or this natural
Pressure remedy.
Points)
5. Applying
pressure to
specific
points on the
wrist or
using
acupressure
bands may
help reduce
nausea. This
is a non-
invasive
technique
that
individuals
can perform
6. Deep
on their own.
Breathing and
Relaxation 6. Deep
Techniques. breathing
exercises and
relaxation
techniques
can help
manage
stress and
anxiety,
7. common
Aromatherapy contributors
(Peppermint or to nausea.
Lem8.on):
7. Inhaling
pleasant
scents, such
as
peppermint
or lemon,
through
aromatherap
y can have
antiemetic
effects and
may provide
8. Cold relief from
Compress to nausea.
Forehead or
Back of Neck. 8. Applying
a cold
compress to
the forehead
or the back
of the neck
can have a

26
 soothing
effect and
help alleviate
nausea,
particularly
in cases
where
sensory
stimuli
9.Over-the- contribute to
Counter symptoms.
Antacids.

9. Antacids
can
neutralize
stomach acid
and provide
relief from
10. Rest and indigestion,
reducing the
Sleep
likelihood of
nausea.

10. Fatigue
can
exacerbate
nausea.
Ensuring
adequate
rest and
sleep can
contribute to
overall well-
being and
may help
alleviate
nausea.

Nursing Care Plan: 2

Cues Nursing Desired Intervention Rationale Evaluation

Diagnosis Ouotcome

Within 8 1. Encourage After 8

Subjective- Ineffective hours of 1. Deep slow and hours of
breathing nursing Breathing deep nursing
“ kadtong pattern may intervention, Exercises. breathing intervention
medyo dako be related to the patient exercises to the patient
na akong impingement will be able promote will be able
tiyan medyo of the to breathe relaxation to breathe
maglisud jog diaphragm by comfortably. and improve comfortably
ginhawa ato enlarging lung as verbalized
na time” uterus, capacity. by the
possibly This can patient
Objectives evidenced by alleviate “wala nako
reports of feelings of naglisud og
-Crusty lip shortness of breathlessne ginhawa”.
breath. ss and
-Limited
enhance

27
Movements overall
respiratory
-Warm to function.
touch
2. Engaging
With the 2.Prenatal in gentle
following Yoga or Gentle prenatal
vital signs: yoga or
Exercise.
appropriate
TR-38 C exercises can
improve
PR- 110 bpm
respiratory
RR- 19 cpm muscle
strength and
BP- flexibility,
120/mmHg contributing
to more
effective
breathing.

3. Encourage
3. Body pregnant
individuals
Positioning
to find
(Sitting or comfortable
Standing). positions,
such as
sitting or
standing, to
optimize
lung
expansion
and reduce
the feeling of
breathlessne
ss.

4.
Emphasize
4.Maintaining proper
Good Posture. posture to
prevent
compression
of the
diaphragm.
Maintaining
an upright
posture
allows for
optimal lung
expansion
and may
alleviate
breathing
difficulties.

5. Suggest
using extra
5. Using Extra pillows to
Pillows for support
various
Support sleeping
During Sleep. positions,
promoting

28
 better
comfort and
reducing
pressure on
the
diaphragm
during sleep.

6. Staying
6. Hydration well-
and hydrated
Moistening the helps
Air. maintain
respiratory
secretions,
making
breathing
more
comfortable.
Using a
humidifier
can add
moisture to
the air,
easing
breathing in
dry
environment
s.

7. Identify
7. Avoiding and
Triggers (e.g., minimise
Irritants or exposure to
Allergens). potential
respiratory
irritants or
allergens
that may
contribute to
an
ineffective
breathing
pattern.
8. Breathing
Techniques for 8. Anxiety
Anxiety can
exacerbate
Management. breathing
difficulties.
Teaching
relaxation
techniques,
such as
mindful
breathing or
paced
breathing,
can help
manage
anxiety and
improve
breathing
patterns.

29
 9. Wearing
Loose and 9. Loose and
Comfortable comfortable
Clothing. clothing
reduces
pressure on
the
diaphragm,
allowing for
easier and
more
effective
breathing.
10. Regular
10. Engaging
Physical in regular,
Activity. moderate
physical
activity helps
maintain
overall
health and
can enhance
respiratory
function.
Consultation
with
healthcare
providers is
recommende
d to ensure
activities are
safe during
pregnancy.

Nursing Care Plan: 3

Cues Nursing Desired Intervention Rationale Evaluation

Diagnosis Ouotcome

Within 8 After 8
Subjective- Impaired hours of 1. Pelvic floor 1. Kegel hours of
Urinary nursing exercise. exercises nursing
“Katong elimination intervention, intervention
strengthen the
gahapon na may be the patient the patient is
kaanakon pelvic floor
related to will be able able urinate
nako uterine muscles,
to urinate without any
maglisud kog enlargement without any promoting diffiulties as
ihi medyu and increased difficulties. better bladder evidence
sakit” abdominal control and verbalize by
pressure , reducing the patient “
Bp: 120/90 possibly Dile nako
mmHg risk of urinary
evidenced by maglisud og
incontinence.
urinary ihi nya dile
Temp: 38.2 incontinene. 2. Frequent 2. Although it na sab sya
c
bathroom sakit.”
may seem

30
 RR: 19 breaks. counterintuitiv
CPM e, maintaining
adequate
PR- 110 bpm
hydration is
essential.
Dehydration
can
concentrate
urine and
irritate the
bladder,
contributing to
urinary
discomfort.

3. Avoid
caffeine and 3.Caffeine and
bladder certain bladder
irritants. irritants can
exacerbate
urinary
frequency and
urgency.
Recommendin
g the
avoidance of
these
substances can
help manage
impaired
urinary
elimination.
4.Pelvic tilt
4.Pelvic tilts
exercise.
may help
relieve
pressure on the
bladder and
improve the
efficiency of
urine
elimination.
These
exercises can
be performed
easily and are
beneficial for
promoting.

5.Maintaining
adequate 5.Although it
hydration. may seem
counterintuitiv
e, maintaining
adequate

31
 hydration is
essential.
Dehydration
can
concentrate
urine and
irritate the
bladder,
contributing to
urinary
6. Avoid
discomfort.
prolonged
standing or 6. Prolonged
sitting. periods of
standing or
sitting can
increase
pressure on the
bladder.
Encourage
changing
positions
regularly to
alleviate this
pressure and
promote
optimal
urinary
function.
7. Wearing
loose and
comfortable
clothing. 7. Tight
clothing can
contribute to
increased
pressure on the
bladder.
Advising loose
and
comfortable
clothing can
help reduce
this pressure
and improve
urinary
8. Practising elimination.
double
voiding. 8. Double
voiding
involves
urinating,
waiting a few
minutes, and
then trying to
urinate again
to ensure the

32
 bladder is
emptied fully.
This can be
helpful in
managing
residual urine
and preventing
urinary
9.Implementin retention.
g relaxation
technique.

9. Stress and
anxiety can
contribute to
urinary issues.
Encourage the
practice of
relaxation
techniques,
such as deep
breathing or
meditation, to
reduce stress
and promote
optimal
10. Using a urinary
supportive function.
pillow for
sleep position. 10.For
nighttime
comfort,
suggest using a
supportive
pillow to
alleviate
pressure on the
bladder and
allow for better
sleep quality
without
frequent
disruptions for
bathroom
visits.

33
 Nursing Care Plan:4

Cues Nursing Desired Intervention Rationale Evaluation

Diagnosis Ouotcome

Within 8
Subj- Risk for labor hours of 1. 1. This Goat met! The patient
pain as nursing Continuous fetal intervention is verbalize that her pain
Sakit akong evidenced by intervention, monitoring to crucial for scale is 4 out of 10 and
tiyan sa may pus prolonged the patient
on dapit assess the baby's monitoring the ensure the patient’s
contractions will be able
well-being and baby's heart comfort. She is able to
to, participate
Pain scale of in changing ensure timely rate and manage her pain
7/10 and moving identification of detecting signs effectively and cope
contributing any distress. of distress, with pain using
to increased allowing for pharmacological
Objective: comfort and prompt method. The patient is
potentially intervention to also engage in
Bp: 120/90 aiding in the
ensure fetal breathing exercises
mmHg progression of
labor well-being and uses her phone to
Temp: 38.2 c during labor. divert her attention
away from the pain.
RR: 19 CPM 2. Regular
2. Conduct pain
PR- 110 bpm regular pain assessments
assessments to provide
understand the valuable
intensity, information to
location, and guide
characteristics appropriate
of the woman's pain
pain. management
interventions,
ensuring
individualized
care for the
woman's
comfort.

3. Changing
3. Encourage positions can
the woman to promote
change positions optimal fetal
regularly to positioning,
optimize fetal relieve
descent and pressure on
reduce certain areas,
discomfort. and enhance
comfort,
contributing to
the progress of
labor.

4. Proper
4. Teach and breathing
encourage the techniques
use of effective help the

34
breathing woman cope
techniques to with pain by
manage pain and promoting
enhance relaxation,
relaxation. reducing
anxiety, and
improving
oxygenation,
contributing to
overall well-
being.

5. Adequate
5. Administer hydration is
intravenous essential
fluids to ensure during labor to
hydration and maintain
support maternal maternal well-
well-being. being, prevent
dehydration,
and support the
physiological
demands of
labor.

6.
Emotional
support from a
trusted person
6. Encourage can alleviate
the presence of a anxiety,
support person enhance
to provide coping
emotional mechanisms,
support and and positively
reassurance. impact the
woman's
emotional
well-being
during labor.

7.
Positioning
aids contribute
7. Provide to the woman's
pillows and comfort,
other potentially
positioning aids easing the
to help the intensity of
woman find contractions
comfortable and facilitating
positions during labor
contractions. progression.

8.
Distraction
techniques

35
 help shift the
8. Offer woman's focus
distraction away from
techniques such pain,
as music, guided promoting
imagery, or relaxation and
conversation to enhancing the
divert attention overall labor
from pain. experience.

9. Cool
compresses
and fans
9. Apply cool provide
compresses or physical
provide a fan to comfort,
offer relief helping to
during reduce
contractions. discomfort and
manage the
heat associated
with
contractions.

10.
Continuous
reassurance
promotes a
sense of
10. control,
Continuously reduces
reassure the anxiety, and
woman about enhances the
the progress of woman's
labor and the confidence in
effectiveness of the labor
interventions. process and the
effectiveness
of
interventions.

36
 Nursing Care Plan:5

Cues Nursing Desired Intervention Rationale Evaluation

Diagnosis Ouotcome

Subjective Deficient Within 8 hours 1. Conduct 1. Within 8 hours of

knowledge of nursing an information Providing a nursing intervention,
Unsa nang cs? related to intervention, session detailed the patient is able to
Nganu I cs man underlying
ko? the patient will explaining the explanation demonstate an
procedure as
evidence by be able to, procedure, helps the understanding of
verbalization participates in including its patient available options and
of concerns decision- purpose, understand the
making informed
Objective
making benefits, and necessity of choices based on her
Bp: 120/90 regarding the potential risks. the procedure,
preferences and
mmHg procedure, its potentialvalues. By conducting
demonstrating benefits, andinformation and
Temp: 38.2 c an the associated
explaining the
RR: 19 CPM understanding risks, fostering
procedure to the
of available an informed patient including it’s
PR- 110 bpm options and decision- risk respecting her
making making cultural preferences
informed process. and values that may
choices based 2. Present influence decision-
on her available 2. Offering making.
preferences options, if information
and values. applicable, and about
discuss the pros alternative
and cons of options allows
each, ensuring the patient to
the patient is make choices
informed about aligned with
alternative their
approaches. preferences
and values,
contributing to
shared
decision-
making.

3. Utilize 3. Visual
visual aids, such aids enhance
as diagrams or comprehension
educational by providing a
videos, to visual
enhance the representation
patient's of the
understanding of procedure,
the procedure. making
complex
information
more
accessible and
promoting
better
understanding.

37
4. Review the 4. A
informed thorough
consent review of the
document with informed
the patient, consent
explaining each ensures the
section and patient is
ensuring aware of the
comprehension. procedure's
details, risks,
and benefits,
promoting
autonomy and
informed
decision-
making.

5. Supply 5. Written
written materials materials serve
outlining key as a reference
information for the patient,
about the allowing them
procedure, to revisit
possible essential
outcomes, and information,
aftercare discuss it with
instructions. family, and
make well-
informed
decisions at
their own pace.

6. Involving
6. Include the support
patient's family persons helps
or support create a
persons in the supportive
education environment,
process to encourages
provide open
additional communicatio
perspectives and n, and provides
support. additional
perspectives
that may
influence the
decision-
making
process
positively.

7.
Understanding
7. Discuss cultural
and explore the preferences
patient's cultural and values is

38
preferences and crucial for
values that may providing
influence culturally
decision- sensitive care
making. and ensuring
that decisions
align with the
patient's
beliefs and
preferences.

8. Clear
communicatio
8. n in plain
Communicate language
using plain and enhances the
simple language, patient's
avoiding understanding
medical jargon of complex
to enhance the medical
patient's information,
understanding. reducing
confusion and
facilitating
meaningful
participation in
decision-
making.

9.
9. Recognizing
Acknowledge and addressing
and address emotional
emotional concerns
concerns related validates the
to the procedure, patient's
providing feelings,
emotional fosters trust,
support. and creates an
environment
conducive to
informed
decision-
making.

10. Reassure 10. Offering

the patient of the ongoing
ongoing support
availability of reassures the
information and patient that
support as their questions
needed. and concerns
will be
addressed
throughout the
decision-
making

39
process,
promoting a
sense of
security and
trust in the
healthcare
team.

40
41
 Nursing Care Plan: 7

Cues Nursing Desired Intervention Rationale Evaluation

Diagnosis Ouotcome

“ sakit akong Within 8 hours Within 8 hours of

1.It helps
tiyan tungod sa of nursing nursing intervention,
samad nako sa Acute pain intervention, in tailoring
1. the patient is able to
tiyan’ related to the client will the care
Regularly demonstate an
post- plan to the
Pain scale 7 verbalize the assess the understanding of
operative patient's
out of 10 reduction of patient's available options and
procedure as pain intensity. unique
pain using making informed
Objective evidenced by needs.
a pain scale choices based on her
surgical preferences and
Bp: 120/90
incision values. By conducting
mmHg
information and
Temp: 38.2 c 2. Offer 2.Creating explaining the
comfort a soothing procedure to the
RR: 19 CPM measures environme patient including it’s
PR- 110 bpm such as nt reduces risk respecting her
warm anxiety, cultural preferences
blankets, which can and values that may
soothing exacerbate influence decision-
music, pain making.
dimmed perception.
lighting,
and a calm
environme
nt to reduce
anxiety and
promote
relaxation.

3. Apply
3. Provide
cold or
localized
warm
relief by
compresses
reducing
to the
inflammati
surgical
on and
site, per
improving
physician's
blood flow
orders or
to the area.
patient
preference.

4.Distracti
4. Offer on
activities or techniques
diversional divert the
therapy to patient's
help divert attention
from pain,

42
 helping
the
them cope
patient's
with
attention
discomfort
away from
more
the pain,
effectively
such as
.
reading,
watching
TV, or
engaging in
hobbies. 5.
Prop
5. Ensure er wound
proper care care is
of the crucial for
surgical preventing
incision complicati
site to ons,
prevent reducing
infection or the risk of
complicatio infection,
ns. Provide and
guidance ensuring
on dressing the
changes surgical
and signs incision
of heals
infection. properly.

6.Regular
6. evaluation
Regularly helps
assess the determine
effectivene the
ss of the effectivene
interventio ss of
ns and interventio
make ns,
necessary allowing
adjustment adjustment
s to the s to the
pain pain
manageme manageme
nt plan nt plan to
based on achieve
the better pain
patient's relief and
response overall
patient
comfort.

7.
7. Administer
Administer ing pain
medication

43
 s as
prescribed
prescribed
pain
by the
medication
physician
s as
is essential
ordered by
for pain
the
control
physician
and
and ensure
promoting
the patient
the
receives
patient's
them on
comfort.
time to
maintain -
pain
control.

-
Paracetam
ol 500mg
for 1 dose
via low as
IV push
then after
6 hours

-Tramadol
50 mg 1
dose via
low as IV
push

8.Patient
education
ensures
that the
8. Educate
patient
the patient
understand
on the
s their pain
importance
manageme
of adhering
nt plan.
to the pain
Helping
manageme
the patient
nt plan,
cope with
including
pain more
the timing
effectively
and
.
dosages of
pain
medication
s
9.instructi
ng patients
in deep
9. Instruct breathing
the patient exercises
in deep and

44
 relaxation
breathing
techniques
exercises
aimed at
and
addressing
relaxation
both the
techniques
physiologi
to reduce
cal and
muscle
psychologi
tension and
cal aspects
improve
of stress,
oxygenatio
promoting
n.
muscle
relaxation,
and
enhancing
overall
oxygenatio
n for
improved
health
outcomes.

10.
Effective
communic
ation with
the
healthcare
team
ensures
that any
changes in
the
patient's
condition
or adverse
effects of
medication
s are
addressed
promptly.

10.
Communicate
any changes in
the patient's pain
status or adverse
effects of pain
medications to
the healthcare
team for
appropriate
adjustments.

45
 Nursing Care Plan: 8

Cues Nursing Desired Intervention Rationale Evaluation

Diagnosis Ouotcome

Subjective: Constipation Within 8 hours

1.Provide 1.A Goal met! After 8
related to of nursing
“ Wala pako information balanced hours of nursing
impaired intervention,
kalibang sukad on how to diet and intervention, the
nanganak ko” physical the patient will
maintain a regular patient have a
mobility as be able to have
healthy diet, exercise successful bowel
Objective : evidenced by a successful
stay promote movement,
a post- bowel
- Bloated hydrated, bowel alleviate
operative movement and
and engage regularity, constipation with
- Post- procedure. alleviate
in regular and rich in fiber
operative constipation
exercise hydration foods, drinking
patient with
softens water, and
surgical site
incision . stool. promote
gastrointestinal
- With 2.Smaller, comfort while
2.Suggest
surgical maintaining
smaller, frequent
dressing on surgical recovery
below the more meals are
easier to and physical
umbilicus. frequent
digest and mobility.
meals and
snacks to can help
support maintain
Objective
caloric energy and
Bp: 120/90 intake, caloric
mmHg especially if intake even
the patient's when the
Temp: 38.2 c
appetite is appetite is
RR: 19 CPM reduced. reduced.

PR- 110 bpm

3. Ensure 3. This
that the intervention
patient has a helps create
private and a relaxed
comfortable atmosphere
environment for
for toileting, toileting.
which can
help reduce
stress and
anxiety that
might
exacerbate
constipation
.
4.Patient
education
4. Educate
on the
the patient
significance

46
about the of regular
importance bowel
of regular movements
bowel encourages
movements them to
and the actively
factors participate
contributing in relieving
to constipatio
constipation n.
.

5.Regular
monitoring
for signs of
5. Monitor discomfort,
for signs of abdominal
discomfort, distension,
abdominal or other
distension, symptoms
or other is crucial to
symptoms identify
related to constipatio
constipation n promptly
. and initiate
intervention
s.

6.
Educating
the patient
6. Provide
about the
education
benefits of
on the
a high-fiber
benefits of a
diet
high-fiber
reinforces
diet for
the
preventing
importance
constipation
of dietary
.
choices that
prevent
constipatio
n.

7.
7. If Administeri
prescribed ng
by the prescribed
healthcare stool

47
provider, softeners or
administer laxatives,
stool under the
softeners or direction of
laxatives to a healthcare
relieve provider, is
constipation necessary
and to provide
encourage symptomati
regular c relief
bowel from
movements. constipatio
n and
facilitate
regular
bowel
movements
.

8.
Continuous
assessment
8. of the
Continuousl patient's
y assess the progress is
patient's essential to
progress in determine
relieving the
constipation effectivenes
and s of
achieving a intervention
regular s and make
bowel necessary
pattern. adjustments
Adjust the to the care
plan as plan.
needed
based on the
patient's
response.

9. It is
important
9.
to consider
Encourage
safety and
gentle
patient
physical
comfort in
activity,
post-
such as
cesarean
walking, as
care.
soon as it is
safe and
comfortable

48
for the
patient post-
cesarean
section.

10. This
10. Work in coordinatio
collaboratio n of care
n with other provides a
healthcare holistic
professional approach to
s, including the patient's
obstetricians well-being.
, to ensure
that
intervention
s do not
interfere
with the
patient's
postoperativ
e care.

49
 Nursing Care Plan: 9

Cues Nursing Desired Intervention Rationale Evaluation

Diagnosis Ouotcome

Subjective Self-care
Within 8 1. The Goal met! After 8
deficit related
“Pag mag cr hours of initial hours of nursing
to surgical 1. Conduct an initial pain assessment to determine
ko naa dapat nursing pain intervention, the the level of
akong bana or procedure as by the patient.
interventio assessme patient is be able
akong evidenced by
n, the nt is to improve her
manghud para difficulty
patient will crucial to independence in
ubanan ko inig accessing the
be able to understa performing self-
mag cr ko” bathroom
improve nding the care activities,
independen patient's including safety
ce in pain accessing the
Objective performing level and bathroom with
Bp: 120/90 self- care tailoring minimal or no
mmHg activities pain assistance ,
manage enhancing overall
Temp: 38.2 c ment self- care and
interventi physical mobility.
RR: 19 CPM
ons to
PR- 110 bpm their
needs.

2. Educate the patient and caregivers on the correct usage of th

2. Proper
safety and educatio
n on the
comfort during
use of
Toileting. assistive
devices
ensures
the
patient
and
caregiver
s can use
these
devices
safely
and
effectivel
y,
reducing
the risk
of
accidents
and
promotin
g

50
 comfort.

3. Develop and adhere

3. Ato a toileting schedule for the patient wi
ensure timely toileting
schedule
and consistent
ensures
assistance. that the
patient
receives
timely
assistanc
e,
reducing
discomfo
rt and the
risk of
accidents
.

4.
4. Assess the patient's environment for potential safety hazards
Assessin
minimize the
g the
risk of falls or patient's
environm
accidents. ent for
safety
hazards
helps
create a
safer
toileting
environm
ent,
minimizi
ng the
risk of
falls and
accidents
.

5.
Continuo
5. Continuously reassess the patient's comfort, pain levels, and
us
throughout the
reassess
Shift ment of
the
patient's
comfort,
and
toileting
needs

51
 allows
for real-
time
adjustme
nts to
interventi
ons,
ensuring
the
patient's
well-
being.

6.Effecti
ve
communi
6. Encourage cation
and
the patient to
responsiv
communicate eness to
the
any discomfort patient's
needs
or need for contribut
e to a
Assistance
positive
promptly nurse-
patient
relations
hip. It
fosters
trust and
a sense
of
partnersh
ip in
care.

7.Providi
ng and
assisting
the
7. Provide and assist the patient in using appropriate assistive d
patient
as a raised toilet
with the
seat, commode use of
assistive
chair, or grab devices
enhances
bars. safety
and
comfort

52
 during
toileting.

8.
Assisting
the
patient to
8. Ensure that the patient
the is assisted to the bathroom or commo
based on their bathroom
or
needs and the commod
e at
healthcare
regular
provider's intervals,
based on
Recommendation their
needs
s. and
recomme
ndations,
ensures
that their
toileting
needs are
met
promptly
.

9.
Educatio
n with
caregiver
9.Educate the patient and
s on thecaregivers on the correct usage of the
safety and c correct
usage of
omfort during assistive
devices
toileting.
ensures
that the
patient
receives
consisten
t support
and
maintain
s safety
during
toileting.

53
 10.
Educatio
n on
proper
body
mechanic
s reduces
the risk
of injury
and pain
during
toileting,
promotin
g safety
and
comfort.

10. Provide brief

education to the
patient and
caregivers on the
importance of
proper body
mechanics during
toileting to reduce
pain and ensure
safety.

54
 IX. DISCHARGE PLAN

A patient needs discharge planning on an interdisciplinary approach to continuity of care in order

to go from level care to another without any problems. By taking the patient’s requirements in the
community into account, the procedure seeks to improve the coordination of services after hospital
discharge.

METHODS

MEDICATIONS

● Take prescribed pain medication as directed by you physician to manage post-operative

discomfort.

● Discuss the importance of avoiding self-medication.

ENVIRONMENT

● Ensure a clean and comfortable environment at home for your recovery.

● Minimize trip hazards to prevent accidents and falls.

● Maintain good ventilation and a moderate room temperature.

● Create a calm and comfortable space at home conducive to rest and recovery

TREATMENT

● Encourage adequate rest and gentle physical activity, such as walking, to aid recovery.

● Monitor the surgical site for any signs of infection or unusual symptoms.

● Suggest warm sitz baths or cold compresses to alleviate any perineal discomfort

HEALTH TEACHING

● Educate on signs of postpartum complication (fever, excessive bleeding) and when to seek
medical help.

● Understand the importance of proper wound care and medication management.

● Discuss any specific concerns of questions you may have about your recovery with your
healthcare provider.

OUTPATIENT FOLLOW-UP

● Schedule a postpartum check-up with a healthcare provider within a specified timeframe

● Use these appointments to discuss any concerns, complication, or questions about your recovery.

● Be prepared with a list of topics or questions to address during your follow-up visits.

DIET

55
 ● Maintain a balanced and nutritious diet, focusing on fruits, vegetables, and lean proteins to
support healing.

● Stay adequately hydrated by drinking an appropriate amount of water.

● To prevent constipation, consider including fiber-rich foods in your diet and discuss over the
counter options with your healthcare provider if needed.

SPIRITUAL

● Engage in spiritual practices or activities that provide you with comfort and solace during your
recovery.

● Seek support and community from your spiritual or religious group if that is a source of comfort
for you.

● Recommend relaxation techniques or mindfulness practice for emotional and spiritual well-being

56
 XI. LEARNING OUTCOMES

We can see that we've learnt a lot during the course of our actual hospital work at the

Butuan Medical Center in Delivery Room clinical rotation, focusing not only on what to work on

improving our own development and growth as individuals, but also how to deliver the greatest

nursing care and possibly save lives in the future. Patient care proficiency, clinical expertise,

communication, teamwork, professionalism, critical thinking, cultural competence, time

management, patient safety, quality improvement, professional growth, thorough documentation,

legal and ethical awareness, leadership skills, and an understanding of the implications for public

health are among the key learning outcomes. Students are required to deliver thorough care,

collaborate successfully, uphold moral and legal obligations, and consistently evaluate and

improve their performance while adjusting to a range of patient demands and healthcare

environments. Being a nursing student has not been a simple one because we constantly need to

learn, develop, and gain new skills.

However still, our clinical instructor, Mr. Jebor S, Ortigas, RN, educated and disciplined

us on most of the practices and abilities essential to our profession, boosting our self-assurance,

commitment, and desire to pursue the profession wholeheartedly. We would like to thank you for

all of your helpful advice and assistance all throughout our clinical rotation in the delivery room.

The learning process we had has been greatly enhanced by your knowledge and desire to share it.

We value the chance you've given us to put our academic understanding to use in a real-world

situation as your mentor. Your encouraging words and helpful criticism have really helped us to

work through the many areas of patient care and clinical processes. We especially appreciate the

knowledge you provided on Obstetrics and Gynecology in the Delivery Room.

57
 XII. REFERENCES

Aude Girault, Camille Le Ray. (2022). Understanding the association between first and second
stages of labour duration and its impact on mode of delivery, Paediatric and Perinatal
Epidemiology, 36, 3, (368-369).
https://doi.org/10.1111/ppe.12848

Gaudernack, L.C., Michelsen, T.M., Egeland, T. et al. Does prolonged labor affect the birth
experience and subsequent wish for cesarean section among first-time mothers? A quantitative and
qualitative analysis of a survey from Norway. BMC Pregnancy Childbirth 20, 605 (2020).
https://doi.org/10.1186/s12884-020-03196-0

G. Rizzo, A. Dall'Asta, A. Capponi, S. Resta, P. Bontempo, M. Salluce, I. Mappa, T. Ghi. (2023).

OP01.02: Does fetal occiput position affect the ultrasonographic prediction of vaginal delivery in
prolonged second stage of labour? Ultrasound in Obstetrics & Gynecology, 62 (1), 47.
https://doi.org/10.1002/uog.26455

Mkangi, Sospeter, Seif, Saada A., Bakari, Rehema, Tambwe, Aisha. (2023). Determining the
effects of maternal upright birth position on maternal and foetal outcome among pregnant women
delivering in government hospitals in Dar es Salaam: A randomized controlled trial study protocol.
Medicine Case Reports and Study Protocols 4(7):p e285.
DOI: 10.1097/MD9.0000000000000285

Nyfløt LT, Stray-Pedersen B, Forsén L, Vangen S (2017) Duration of labor and the risk of severe
postpartum hemorrhage: A case-control study. PLoS ONE 12(4): e0175306.
https://doi.org/10.1371/journal.pone.0175306

Nystedt, A., Hildingsson, I. Diverse definitions of prolonged labour and its consequences with
sometimes subsequent inappropriate treatment. BMC Pregnancy Childbirth 14, 233 (2014).
https://doi.org/10.1186/1471-2393-14-233

Rebecka Dalbye, Ellen Blix, Kathrine Frey Frøslie, Jun Zhang, Torbjørn Moe Eggebø, Inge
Christoffer Olsen, Daniella Rozsa, Pål Øian, Stine Bernitz. (2020). The Labour Progression Study
(LaPS): Duration of labour following Zhang's guideline and the WHO partograph – A cluster
randomised trial, Midwifery, Volume 81, 102578.
https://doi.org/10.1016/j.midw.2019.102578.\

58