I.

INTRODUCTION

Pregnancy is the gestational process, comprising the growth and

development within a woman of a new individual from conception through the

embryonic and fetal periods to birth. It lasts approximately 266 days (38 weeks)

from the day of fertilization but it is clinically considered to last 280 days (40

weeks; 10 lunar months;91/3 calendar months) from the first day of the last

menstrual period. Because pregnancy changes a woman’s normal hormone

patterns, one of the first signs of pregnancy is a missed menstrual period.

The first few months of pregnancy are the most critical for the developing

infant, because during this period the infant’s brain, arms, legs, and internal

organs are form. For this reason, a pregnant woman should be especially careful

about taking any kind of medication except on the advice of a physician who

knows that she is pregnant. Pregnant women should avoid x rays, smoking and

alcohol consumption.

Delivery, the process by which the baby is expelled from the uterus

through the birth canal and into the world, begins with irregular contractions of

the uterus that occur every 20 to 30 minutes. As labor progresses, the

contractions increase in frequency and severity. The usual length of labor for a

first-time mother is about 13 to 14 hours, and about 8 or 9 hours in a woman who

has given birth previously. Wide variations exist, however, in the duration of

labor.

[1]
II.GENERAL DATA

Name : L.B.P.

Age : 36 y.o.

Sex : Female

Citizenship : Filipino

Address : Bateria, Daanbantayan, Cebu

Birthplace : Daanbantayan, Cebu

Birthday : July 21, 1972

Status : Married

Religion : Roman Catholic

Occupation : Fish vendor

Date of Admission : August 8, 2008

Educational Attainment: High School Graduate

III.HISTORY OF PRESENT ILLNESS

Prior to admission, the patient was doing household chores when

suddenly felt lower abdominal pain and strong frequent uterine contractions. She

then decided to go to the hospital accompanied by her husband.

Upon admission, the patient noted to be on her active labor. Her vital

signs were taken as soon as she arrived in the hospital with the following results:

pulse rate was 80 beats per minute, respiratory rate was 22 cycles per minute,

body temperature was 36.6 0C, and blood pressure was 100/70 mmHg.

[2]
 Patient had her menarche at the age of 12 years old with regular monthly

cycle lasting for 5 days consuming 2-3 pads per day. She was negative for

dysmenorrheal and amenorrhea. Her first sexual contact was at the age of 24

years old with her husband as her sole sexual partner.

LMP : November 1, 2007

EDC : August 8, 2008

AOG : 40 weeks and 1 day

OBSCORE :G5T4P0A0L4M0

IV.PAST HEALTH HISTORY

Patient’s general state of health is good. On her early childhood, she had

chickenpox and measles. When she had a fever, her mother wiped her whole

body to relieve the heat. She ate more oranges and a well balanced diet. She

sometimes had headache and diarrhea but she will just take a medicine for it. At

the age of seven, she had a severe fever and her parents brought her to the

hospital for a checkup. She had a diagnosis of a dengue fever. She remembers

that, she feels so tired at that time. She received a complete immunization. She

was not able to undergone any operation and was never experienced to be

injured. She does not have any allergies to foods or drugs.

[3]
V. GORDON’S HEALTH PATTERN

Health Perception- Health Management Pattern

The patient perceived her health in a state of wellness. She said that in

woman, being pregnant is just normal and natural. During her pregnancy, she

easily coped up with the signs and symptoms she felt because she already had

an idea on how it is going to be. She makes sure not to miss any scheduled

prenatal checkup. She followed what the physician advised her to do like eating

nutritious food and doing simple exercise.

Nutritional Metabolic Pattern

The patient usually eats rice and egg during breakfast; rice, fish and

vegetables for lunch; and, for suppertime, she eats rice and meat. She eats

snacks in between breakfast and lunch around 10 am, in between lunch and

supper around 3 pm, and before going to sleep around 10 pm. Her snacks

usually composed of bread, biscuit, and juice. Water is the fluid she usually

intakes. She has no problem with her appetite. She takes iron supplements and

vitamin C as what her physician prescribed her. Her weight changed in last six

months because she ate too much.

Elimination Pattern

The patient does not have any problem with her urination and defecation.

She defecates every other day usually in the evening. Her stools vary depending

upon the food she has eaten.

[4]
Activity - Exercise Pattern

The patient is a fish vendor in the market. She spends her leisure time

watching television shows, listening to the radio, and sleeping. Walking from her

house to the market was her usual exercise. When she became pregnant, she

does simple stretching exercises. She can take care of herself without any help

from others.

Sleep – Rest Pattern

The patient’s usual sleeping time is between 9 pm to 10 pm. Her rising

time is 5 am. She usually gains 7-8 hours of sleep excluding naptime. She takes

an afternoon nap, from 1 pm to 3 pm to feel relax.

Cognitive Perceptual Pattern

The patient was conscious, responsive and coherent. She can see clearly

without an aid of an eyeglass. She can hear clearly and her other senses are

functioning well. She does not have any skin allergy. She knows how to read and

write. She was well oriented of the time and place.

Self - Perception Pattern

The patient does not have any interest in make-ups or putting any art in

her body unlike when she was still in her adolescence stage. She is contented of

what she looks. Her concern focuses more on to her children especially to the

newest member of their family. She felt happy upon delivering a normal and

healthy baby girl.

[5]
Role- Relationship Pattern

The patient can speak Tagalong, a little bit of English and a Visayan

language but she speaks Visayan language every day. Her speech is clear and

relevant to the situation. She can easily express herself verbally. She lived

together with her husband and children. Whenever she had problem, she will ask

for help to her friends, mother and husband. Praying rosary every night together

with her family is their daily activity. She is the one who usually disciplines her

children. In terms of making decisions, she and her husband will have to decide

for it. She has a good relationship with her family and can communicate well.

Sexuality- Sexual Functioning

The patient is sexually active. Her husband sometimes use condom

whenever they had coitus. During pregnancy, she experienced altered sexual

relations and she does not want to have coitus with her husband. She said that

her husband would just try to understand her

Coping- Stress Management Pattern

The patient analyzes first the situation before making decisions. She

always makes decisions together with her husband. If she were stress, she

would just find ways to make herself enjoy like watching television shows and

bonding with her children and a way to relax through sleeping.

[6]
Value - Belief System

The patient’s source of strength is her family and God. For her, God is

very important to her life. She prays rosary, visits churches and hear masses

together with her family. Before she delivered her baby, she prayed to her God to

have a safe delivery and after delivery, she was very thankful to Him for she had

a safe, normal delivery and a new healthy baby girl. In addition, she always

praise and thank God for all the blessings she had.

VI.FAMILY, PERSONAL, SOCIAL AND ENVIRONMENTAL HISTORY

A. MEMBERS OF IMMEDIATE FAMILY

MEMBERS RELATIONSHIP AGE SEX EDUCATIONAL

OF FAMILY ATTAINMENT
J.R.P. Husband 38 years Male High school
old graduate
S.B.P. Daughter 11 years Female Grade six
old

E.B.P. Son 9 years Male Grade four

old
B.B.P. Son 7 years Male Grade two
old
M.B.P. Son 4 years Male
old

B. PERSONAL AND SOCIAL HISTORY

Patient is a non-smoker and non-alcoholic. She describes herself as

simple and approachable. She might have a slow voice but she said she is

[7]
talkative. During her high school years, she loves to be with her friends. She may

look strict but deep inside she is friendly especially if she first gets a smile. She

works hard especially when she became a mother and wife. She spends her free

time in watching television shows or listening to radio. She spent her vacant

periods sleeping to relax herself. She eats three times a day excluding snacks.

She usually sleeps at between 9 pm to 10 pm. Her rising time is 5 am. Whenever

she had problem, she will ask for help to her friends, mother and husband. She

does simple exercise every morning like stretching and considers her household

chores as an exercise. She is religious and attends masses every Sunday.

C. ENVIRONMENTAL HISTORY

Patient and her family are renting a house at Bateria, Daanbantayan

Cebu. They live in that place for almost seven years. On their rented house, she

said that they are fine and comfortable with the place even though sometimes it

is noisy, but they already used to it. The space of their house is just enough for

them. They have their own comfort room, water and electrical supply. Their

neighbors are good and so approachable. They maintain cleanliness of their

environment by having proper disposal of waste and drainage system.

D. HEREDO – FAMILIAL HISTORY

Patient states in his father’s side, there is no a genetic factor or illness

inherited. In contrary, hypertension is in the bloodline of his mother’s side.

[8]
VII. PHYSICAL ASSESSMENT

A case of L.B.P., 36 years old, female, married, Roman Catholic, Filipino

from Bateria, Daanbantayan Cebu was admitted due to lower abdominal pain

and strong frequent uterine contractions in Severo Verallo Memorial Hospital.

Patient was seen transferred from a stretcher to her bed, conscious, coherent

and appropriately responds to questions when asked.

Vital Signs taken during the first contact with the patient:

Blood Pressure : 110/70 mmHg

Heart Rate : 75 beats per minute

Respiratory Rate : 20 breaths per minute

Temperature : 36.5 0C

Skin: brown in color; has lesions on lower extremities; warm and dry; has

moderate pitting in upper extremities; skin turgor springs back to its

previous state in 2-3 seconds

Hair: wavy; black in color; shoulder length; not extremely oily; evenly distributed;

negative for lice

Scalp: shiny; smooth; no dandruff; white in color; negative for lesions

[9]
Head: normocephalic; with smooth contour; without masses; symmetrical;

proportion to body

Face: symmetrical facial features; elongated in shape; has no pimples; no

masses

Eyes: eyelids appear symmetrical with no drooping; eyelashes are black in color

and well curved; lacrimal apparatus has no discharges upon palpation and

no pain felt; with 20/20 vision; pupils are equally round and reactive to light

and accommodation with a size of 3mm; conjunctiva is clear and pale pink;

iris is round

Ears: symmetrical and at level of eyes outer cantus; brown in color; smooth; can

hear normally; no inflammation or lesion noted

Nose: symmetrical to the midline of the face; no lesions or swelling noted; no

discharges; airways are patent and free from obstructions; sinuses are

negative for congestion and no pain felt upon palpation; nasal Mucosa is

free from inflammation or any indication of an infection or infestation of

certain microorganisms

Mouth: teeth are complete, no dentures, slightly yellow in color with no indication

of any tooth decay or other tooth related problems; gums are pinkish with

[10]
 no bleeding; tongue is red in color, symmetrical to the midline of the mouth,

moves freely; lips are pale pink in color, closes symmetrically and negative

for lesions

Neck: free from any aberration or injury; chloasma noted; no inflammation noted

on the thyroid glands; lymph nodes are not inflamed; no masses of any

type were noted in the general area of the neck; no bounding of jugular

vein.

Chest: slightly dark pigmented; no lesions noted; equal chest expansion and

registers a clear breath sound; no cough of any condition was present;

absence of adventitious sounds upon auscultation; respiratory rate is 20

cycles per minute from the normal range of 16-20 cycles per minute.

Heart: with normal heart sounds; has a regular rhythm with 75 beats per minute

from the normal rate of 60-100 beats per minute; no visible pulsations

Breasts: both left and right breast are engorged; have smooth contour; no

redness; no dimpling; lymph nodes are not bulged; with symmetrical

nipples; no swellings noted; with a discharges of breast milk

Abdomen: slightly protruded due to still ongoing involution (1 hour post partum);

linea nigra and striae gravidarum noted; with 3 bowel sound per minute

[11]
 upon auscultation; no masses were noted on the general area; warm to

touch;

Upper Extremities: equally grip; low strength; warm to touch; good skin turgor;

both hands have five fingers; nails are short slightly pinkish; slightly dark

pigmented underarm noted

Lower Extremities: equal strength; negative for edema formation; lesions are

noted; nails are clean and short; warm to touch; good skin turgor

VIII.DEVELOPMENTAL DATA

STAGE DEVELOPMENTA PATIENT’S BEHAVIOR &

L TASK DEVELOPMENTAL EXPLANATION

Infancy Trust “Ambot oi kung nag-unsa ko ani,

Birth to one year vs. basta kahinumdum ko nga niingon

Mistrust akong mama na dili daw ko pabiya

mao na akong mama magsige lang

daw ug kugos nako. Dili pud daw

kuno ko muduol sa lain kay muhilak

man pud daw ko. Kung madunggan

gani ko niya nga naghilak, magdali-

dali intawon siya ug duol nako bahala

na lang daw mabiyaan niya ang iyang

[12]
 gibuhat.”

Infants trust in familiar and natural

person who are responsible in its

needs and provide satisfying

experience as nourishments and

warmth. Through continuity of

experience with adults, infants learn

to rely on them and trust them. When

infants’ needs which are not granted

immediately, they may develop

mistrust to the parents.

Toddlers Autonomy “Ingon si mama nako, dili man

vs.
1-3 years old Shame/Doubt. daw ko lihukan pagkabata. Kung

magdula akong mga igsoon, magtan-

aw lang daw ko. Dili daw ko hingduol

ug mga tawo. Unya ingon sad siya,

nga kung naa daw koy makit-an na

ilang pambuhaton, musunod-sunod

kuno ko nila. Unya, ganahan jud kuno

ko nga masunod ang akong

[13]
 gusto.Peru, dili man daw siya

maglisod ug badlong nako kay dali ra

man daw ko mupatoo.”

A child learns what is expected of

it, what its obligation and privileges

are and what limitations are place

upon it. A sense of self – control

provides a child with lasting feelings

of good will and pride. The child

begins to judge it and others and to

differentiate between right or wrong.

Preschooler Initiative “Ang nahinumduman nako ana

3-6 years old vs. day kay ganahan dyud ko nga

Guilt magsunod-sunod sa unsa man ang

akong makit-an. Ingon akong mama

nga magkatawa daw kuno na siya

nako sa uban nakong pambuhaton.

Unya niingon pud siya nako na

daghan kuno kayo ko ug mga

pangutana niya na wla diri wala didto.

[14]
 Maglisod kuno siya ug tubag sa uban

nako nga mga pangutana kay dili siya

kahibalo unsaon pagtubag ug pag-

esplikar.”

The child during this stage

presents itself as being decisively

more and advanced and more

together both physically and mentally

period. The child is eager to learn and

learn well at this stage, it strives to

grow in a sense of obligation and

performance and in this stage; the

child is fond of imitating a person. A

feeling of guilt may haunt the child

over goals unmet.

School age Industry “Ni eskuwela na ko anang idara.

6-12 years old vs. Inig human sa akong klase mouli ko

Inferiority kay motabang ko sa akong mama sa

mga buluhaton sa balay. Dili man gud

ko ganahan maglakwatsa igkahuman

[15]
 sa klase day. Pangtagaan naman mi

mag-igsoon ug mga buluhaton na

kinahanglan atumanon jud kay kasab-

an man mi kung dili matuman.

Kadtong akoa kay ako may maglung-

ag mao sayo jud ko mauli.”

The child learns to have a formal

education and develop a sense of

industry and learned to reward of

perseverance and diligence, the child

may develop inferiority if he is unable

to master the task which undertaken

for him by parents and teachers.

Adolescence Identity “Aning mga edara, conscious na

13-18 years old vs. kaayo ko sa akong kaugalingon.

Role Confusion Dugay dyud kayo ko mahuman sa

atubangan sa samin kay e sure pa

man gyud nako na gwapa ko inig

gawas nako sa amuang balay.

Magsige lang dyud ko ug kuyog sa

[16]
 akong mga amiga manlaag. Malingaw

man gud ko. Unya kasagaran sa

akong mga amiga kay naa nay mga

uyab. Ako pud uyab uyab sad pero

walay klaro.”

Individual begins to sense a

feeling of his own idea that he is

being unique person and prepared to

fit into some meaningful role in the

society. They become aware of his

likes, dislikes, and have a strength

and purpose to control his destiny. If

the person is unable to make a

decision, he may feel he is regressing

rather than progressing and thus

identity confusion results.

[17]
 Intimacy

Young Adulthood vs. “Okay ra man ang among

19-40 years old Isolation pagpuyo karon day bisan ug pobre

mi. Nakuntento naman ko karon sa

akong bana ug mga anak. Kahibalo

naman ko unsaon pagdala sa akong

pamilya hilabi na sa pagdisiplina sa

akong mga anak.”

In this stage, young adults are

prepared and willing to unite their

identity with others. They seek

relationship of intimacy partnership

and affiliations and are prepared to

develop the necessary strength to

fulfill his commitments despite the

sacrifice they may have to make. The

hazard of this stage is isolation which

is the avoidance of the relationship

because one is unwilling to commit

oneself into

IX. A.ANATOMY AND PHYSIOLOGY OF THE SYSTEM INVOLVED

[18]
 • FEMALE REPRODUCTIVE SYSTEM

EXTERNAL FEMALE GENITALIA

Mons pubis

It is the most visible part of the woman's external genitalia, which is the

pad of fatty tissue that covers the pubic bone and is commonly covered by pubic

hair.

Labia majora

The labia majora are two thick folds of skin running from the mons pubis to

the anus. The outer sides of the labia are covered with pigmented skin,

sebaceous (oil-secreting) glands, and after puberty, coarse hair. The inner sides

are smooth and hairless, with some sweat glands. Beneath the skin layer, there

is mostly fatty tissue with some ligaments, smooth muscle fibers, nerves, and

[19]
blood and lymphatic vessels. The labia majora correspond to the scrotum in the

male.

Labia minora

The labia minora, two smaller folds of skin between the labia majora,

surround the vestibule of the vagina; they have neither fat nor hairs. The skin is

smooth, moist, and pink and has sebaceous and sweat glands.

Urethra

It is the tubular vessel through which urine passes, is located midway

between the clitoris and the vaginal opening.

Clitoris

The two labia minora meet at the clitoris, a small, sensitive protrusion that

is comparable to the penis in males. The clitoris is covered by a fold of skin,

called the prepuce, which is similar to the foreskin at the end of the penis. Like

the penis, it is very sensitive to stimulation and become react.

Perineum

The perineum is the area of skin between the vaginal opening and the

anus.

[20]
Hymen

A thin membrane partially covers the vaginal opening.

Bartolin’s gland

Are located besides the vaginal opening and produce a fluid (mucus)

secretion.

INTERNAL FEMALE GENITALIA

Vagina

The vagina is a muscular and ridged sheath connecting the external

genitals to the uterus. In the reproductive process, the vagina functions as a two

way street, accepting the penis and sperm during intercourse and roughly nine

months later, serving as the avenue of birth through which the new baby enters

the world.

[21]
Uterus

The uterus is a hollow, pear – shaped organ that functions to receive a

fertilized egg and to protect a fetus during development. It is divided into two

parts: the cervix, which is the lower part that opens into the vagina, and the main

body of the uterus corpus. The corpus is highly muscular so that it can enlarge to

hold a developing baby. A chemical through cervix allows sperm to enter and

menstrual blood to exit.

Ovaries

These small, oval – shaped glands are located on either side of the

uterus. The ovaries produce ova, the female cell of reproduction, and produce

hormones.

Fallopian tube

These narrow, muscular tubes are attach to the upper part of the uterus

and serve as tunnels for the ova to travel from the ovaries to the uterus, where it

implants to the uterine wall.

Cervix

The cervix is an opening to the uterus. It varies in diameter from 1 – 3

millimeters, depending upon the time in the cycle the measurement to which

taken. The cervix is sometimes plug with cervical mucus to protect the cervix

[22]
from infection, during ovulation, this mucous becomes a thin fluid to permit the

passage of sperm.

MALE
FEMALE
(XY
Chromosomes) (XX
Chromosomes)
SPERMATOGENESIS PRODUCTION OF OOCYTES

SPERMATOZOA OVULATION

OVA

INTERCOUSRE
OVULATION OR
INSEMINATION OF THE EXPULSION OF MATURE
SEMINAL FLUID FROM OVUM FROM THE
THE MALE URETHRA GRAFIAN FOLLICLE INTO
INTO THE FEMALE THE PELVIS
VAGINA
SPERM MEET THE
EGG
FERTILIZATION

ZYGOTE FORMATION

MORUALA BECOMES A BLASTOCYST

BLASTOCYST TURNS INTO EMBRYO

EMBRYO NOW TERMED AS FETUS

LABOR

[23]
 UTERINE CONTRACTIONS

NSVD

BIRTH OF THE

C. DISCUSSION ON THE CONDITION

The birth of a baby starts from within the body of a mother. At conception,

the gametes unite to form cell that eventually becomes the developing fetus. The

emergence of menstrual cycle defines, as the episodic uterine bleeding in

response to cyclic hormonal changes, the woman is already capable of

conception and implantation of a new life. Human development is an ongoing

process that begins now of fertilization and continues even after birth.

Fertilization occurs when the sperm penetrates the ovum. The ovum is

receptive to fertilization for approximately 24-48 hours, after release from the

ovary, and the sperm are viable for 24-72 hours after ejaculation into the female

reproductive system. During the act of intercourse, the man ejaculates

approximately 300-600 million sperm. However, only one sperm will fertilize the

mature ovum. Prostaglandins in the semen increase smooth muscle contractions

of the uterus, thus facilitating the transport of sperm. Conception usually occurs

when the ovum is in the ampulla (the outermost half) of the fallopian tube.

[24]
 Once fertilization is complete, the zygote migrates toward the body of the

uterus. It takes 3-4 days for the zygote to reach the body of the uterus. During

this time the mitotic cell division or cleavage occurs. By the time the zygote

reaches the body of the uterus, it consists of 16-50 cells and is already termed as

the morula. Once implanted, the zygote is now called the embryo. The placenta

arises out of the trophoblast tissue, a group of cells found in the outer ring of the

zygote.

This placenta serves as the fetal lung, kidneys, gastrointestinal tract, and

as a separate endocrine organ throughout the pregnancy. The cord is composed

of two arteries and one vein. The function of the cord is to transport oxygen and

nutrients to the fetus from the placenta and to return waste products from the

fetus to the placenta. The development of organs and organ systems proceeds in

a cephalocaudal direction. The cardiovascular is one of the first systems to

become functional in the uterine life. After 28th week of pregnancy, the heart rate

begins to show a baseline variability of 5 bpm on a FHR rhythm strip. Both

respiratory and digestive tracts exist as a single tube during the 3rd week of the

intrauterine life. The nervous system develops as early as the 3rd-4th week of

pregnancy. Digestive tract separates from the respiratory tract by the 4th week.

Meconium, the fetal waste forms in about 16th week while the ability of the GI

tract to secrete enzymes for CHO and CHON digestion matures in the 36th week

of pregnancy. For the musculoskeletal system, fetal movements can be felt in the

20th week while bone ossification begins in the 12th week. For the reproductive

system, a child’s sex organ can already be determined as early as 8 weeks of

[25]
chromosomal analysis. For the urinary system, fetal urine is formed by the 12 th

week and is excreted into the amniotic fluid by the 16th week of gestation. In

integumentary system, the skin appears thin and almost translucent. A soft

downy hair called lanugo and a cream cheese-like substance called vernix

caseosa that covers the skin. The average time for gestation is usually about 38

weeks. Within this time, labor can be experience. It is a series of events in which

uterine contractions; abdominal pressure expels the fetus and placenta from the

woman’s body.

D. SYPTOMATOLOGY

PRESUMPTIVE SIGNS OF PREGNANCY

Presumptive signs of pregnancy are those that are least indicative of

pregnancy; taken as single entities, they could easily indicate other conditions.

These findings, discussed in connection with the body system in which they

occur, are largely subjective in that they are experienced by the woman but

cannot be documented by an examiner.

• breast changes

• nausea

• vomiting

• amenorrhea

• frequent urination

[26]
 • fatigue

• uterine enlargement

• quickening

• linea nigra

• melasma

• striae gravidarum

PROBABLE SIGNS OF PREGNANCY

In contrast to presumptive signs, the examiner can document probable

signs of pregnancy. Although they are more reliable than the presumptive signs,

they still are not positive or true diagnostic findings. They are also discussed in

connection with the body system in which they occur.

• Serum Laboratory Tests

• Chadwick’s Sign

• Goodell’s Sign

• Hegar’s Sign

• Sonographic evidence of gestational sac

• Ballottement

• Braxton Hock’s Sign

• Fetal outline felt by the examiner

[27]
POSITIVE SIGNS OF PREGNANCY

Positive signs of pregnancy are those which cannot be mistaken for any

other condition—they are considered absolute evidence that you are, in fact,

pregnant. They rely on the senses: sound, sight and touch, as interpreted by your

caregiver.

There are only three positive signs of pregnancy:

• Demonstration of a fetal heart separate from the mother’s

• Fetal movements felt by the examiner

• Visualizations of the fetus by ultrasound

Signs of Labor

• Preliminary Signs of Labor

• Lightening

• Increase in Level of Activity

• Braxton Hicks Contraction

• Ripening of the Cervix

• Signs of True Labor

• Uterine Contraction

• Begin irregularly but become regular and predictable

[28]
 • Felt first from the lower back and sweep around to the

abdomen in wave

• Continue no matter what the woman’s level of activity

• Increases in duration, intensity and frequency

• Achieve cervical dilatation

• Show / Bloody Show

• Rupture of the Membranes

X. MEDICAL MANAGEMENT

A.TREATMENT AND PROCEDURES

• POSITIONING FOR BIRTH

A variety of positions can be used for giving birth. These positions include

the lithotomy position, which is used frequently by hospitals, in which stirrups are

attached on both sides in foot part to the labor table to facilitate birth in this kind

of position. Alternative birth positions include the dorsal recumbent, semi sitting,

lateral or Sim’s position, and squatting.

• PROMOTING EFFECTIVE SECOND-STAGE PUSHING

The woman must push with contractions and rest between them, is one of

the most effective pushing techniques during second stage of labor; also allow

[29]
her to push using the position she feels best can contribute in promoting effective

pushing.

• PERINEAL CLEANING

Clean the perineum by pouring warmed antiseptic and then rinse with a

designated solution before birth according to agency’s policy or physician’s order.

Clean the vagina from front to back and include a wide area. When cleaning is

done, place sterile drapes around the perineum.

• BIRTH

During the second stage, the woman is encouraged to use her abdominal

muscles to bear down during contractions while the fetus continues to descend

and rotate to the anterior position. Fetal descent is usually slow but steady for the

primipara. Frequently, the fetus of a multipara, after not making significant

downward progress for several hours during active labor, will suddenly descend

and be born with one push. When he fetus is at the station +4, he proceeds to

move through the cardinal movements of extension and external rotation,

followed by delivery of the shoulders and expulsion of the rest of the body.

• CUTTING AND CLAMPING THE CORD

After the infant is born, the infant is then laid on the abdominal drape of

the mother while the cord is cut. The cord is clamped using two Kelly forceps

[30]
placed 8-10 inches from the infant’s umbilicus is cut between them. Cord clamp

is then applied & vessels are then counted to check if they are present.

• PLACENTAL DELIVERY

Signs that indicate the placenta is separating from the uterine will consist

of a gush blood, lengthening of the umbilical cord, and a globular shape to the

fundus. The placenta usually delivers spontaneously by one of two mechanisms.

Expulsion by Schultze’s indicates that the fetal or shiny side of the placenta

delivers first. Duncan’s mechanism specifies that the maternal or rough side of

the placenta present first.

B. MEDICATIONS

• Ferrous sulfate (Sorbifer) 1 tab OD P.O.

• Mefenamic acid (Ponstan) 1 cap 500 mg every 6 hours P.O

• Cefalexin (Panixine) 1 cap 500 mg TID P.O.

• IVF of D5LR 1000ml@20gtts/min

C. DIAGNOSTIC PROCEDURES

• Urinalysis

• Complete blood count

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 URINALYSIS

TEST RESULT NORMAL VALUES

Color Yellow Straw/Amber

Appearance Clear Clear

pH 7.0 4.6 – 8.0

Specific gravity 1.010 1.005 – 1.030

Protein Negative Negative

Glucose Negative Negative

RBC 0-1 <2

WBC 0-3 0-4

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 COMPLETE BLOOD COUNT

TEST RESULT NORMAL VALUES

WBC 9,300/mm3 5,000 – 10,000/mm3

Segmenters 63.3% 47-80%

Lymphocytes 25.5% 20-40%

Monocytes 6.2% 2-8%

Eosinophils 4.7% 1-4%

Basophils 0.3% 0.5-1%

RBC 4.35 x 106/µL 4.2 – 5.4 x 106/µL

Hemoglobin 12.9 g/dl 12.0 – 16.0 g/dl

Hematocrit 38.3% 37% - 47%

MCV 88 mm3 80 – 95 mm3

MCH 29.7 pg 27 – 31 pg

MCHC 33.7 g/dl 32 – 36 g/dl

Platelet 269,000/mm3 150,000 – 400,000/mm3

D.DIET

The physician advised the patient to take a regular or full diet. The regular

or full diet contains essential requirements. The diet follows the principles of food

meal planning and permits the use of all foods.

XI. NURSING MANAGEMENT

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 A. ACTUAL CARE GIVEN

One primary nursing care given to the patient was taking vital signs.

These were done to monitor patient’s condition for signs of infection, abnormal

increase in temperature, irregularity in respiratory rate, and sudden abnormal

increase in blood pressure. Vital signs taking were done every after 15 minutes

for 1 hour prior to delivery, then every hour until vital signs are stable, then

continued monitoring vital signs every after 4 hours. Monitoring and measuring

patient’s intake and output. Giving medications were done as ordered by the

physician. I encouraged patient to have adequate rest and sleep, and do self-

perineal care to prevent infection. A health teaching was done such as muscle

strengthening exercise and proper care for the newborn.

B. PROBLEMS ENCOUNTERED DURING THE IMPLEMENTATION OF

NURSING CARE

There were no major tribulations encountered in the implementation of

quality nursing care. The patient was very obliging as well as cooperative and

was very aware of her health needs and status. I was able to perform the needed

skills with no problems at all.

C. RESTORATIVE MEASURES USED

The patient was encouraged to ambulate as early as she can to promote

good and stable blood circulation throughout the system for faster recovery and

do independent movement to facilitate return of performing activities of daily

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living. She was advice to take adequate rest period to relieve fatigue and to eat

nutritious food for her health as well as for her lactating infant. I encouraged

patient to verbalize any personal discomforts felt. Moreover, I discussed the

importance of therapeutic regimen compliance.

D. EVALUATION

Patient was very cooperative and showed willingness to learn to avoid

different problems in the future in relation to health. She shared on what she felt

especially during her labor and delivery experience. She was very open in talking

about her life. She was so nice. When I asked her some questions, she merely

answered it.

E. PATIENT TEACHING

Health teachings were directed toward resulting the patient’s individual

needs for knowledge of self-care and health maintenance activities. Student

nurse discussed to the patient the importance breastfeeding and immunization

for the infant. I taught her the proper way of cleaning her nipples and self-

perineal care, and techniques on how to massage fundus until it becomes firm. I

reminded her to have a regular check up to know her and her infant’s health

status, not to forget the medications prescribed by the physician like taking

Multivitamins, and continue doing perineal hygiene techniques. I encouraged her

to have adequate rest, deep breathing exercise and not to lift heavy objects, to

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have a plain breastfeeding to the infant, and eat a well balanced diet for her to

give adequate nourishment to her lactating infant.

XII. A. CONCLUSION

As a conclusion of this study, nursing mothers should be aware of the dos

and don’ts of pregnancy, especially the first timers or the primigravida mothers.

Techniques should be taught and explain to them through conducting proper

heath teachings. Understanding and valuing life is one of the important aspects

for both the mothers and the health care providers.

Inorder for a health care provider to render enough and quality care. Basic

knowledge and concept on pregnancy must be obtained and well understand.

Pregnancy is a stage where in a characteristics of a mother change and there for

needs further understanding on the part of the health care providers. The primary

goals of nursing care are to deliver the baby safely with put further problems and

complications during delivery. Pregnancy does not only deal with physical

factors, but also social, emotional and psychological.

The significance of this study is to learn on how to care for the new born and post

– partum mothers. It is to ensure a satisfying and proper growth of the newborn

and to her family. An outcome of care is determined through the response of the

patient in terms of the nursing care they receive and fell which given by the

nurse.

B. RECOMMENDATION

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 This study promotes the growth and interest both on the parents and as

well as the nurses. This also recommends on the scope of maternal and prenatal

care. Current trends and issues should be examined and next should undergo

specific observations to enlighten the mind of the student in understanding and

regards that they can appreciate and incorporate in giving care to this kind of

people. The concept on maternal and child nursing is a dynamic and a never

static concept. It changes as time goes by. As society changes, people change

and evolve their concept, attitudes, beliefs and values.

XIII. IMPLICATION OF THE STUDY TO:

A. NURSING EDUCATION

The implication of this study to nursing education is to broaden, upgrade,

and maximize the knowledge and skills of the nurses (especially the student

nurses) in terms of post – partum care. Nursing is a never-ending educational

challenge to nurses and to the other health care team members. Changes and

evolution of care concerning pregnancy was brought about by the rapid change

of technology nowadays. The health of the mother and the child involves a

preventive and restorative care in order to prevent complications, to nourish the

newly born baby, and to keep and prevent in from further complications and

infections brought about by the environment itself. Maternal and child health in

terms of nursing area is in an expanding scope of nursing profession. Nursing

care does not only deal with rendering care to the sick and disabled but also with

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the care of pregnancy and childbirth which are considered the important aspect

in the areas of child’s care and development.

B. NURSING PRACTICE

The implication of this study in regards with nursing practice is the

utilization of nursing concepts, which includes nursing care plan, nursing process

etc. This is important in nursing practice because in this stage where nursing

interventions are implemented and done in order to promote wellness in the

patient and also to broaden the concept of the student nurse in rendering care. In

this way, the student nurse will be able to prioritize his or her focus of care and

apply the principles in the clinical setting, which he or she learns. Nursing is

planning. It is essential because it aids the student in critical thinking skills.

Prioritizing care, which learned, developed and evolved in this phase. The ever-

changing role of the nurses in terms of giving care plays an important role not

just to the sick and disabled but also to the community. Its role is to broaden the

knowledge of the people in terms of the importance of maternal and child health

is. As a conclusion, the student nurses can emphasize their skills in terms of

giving care. The importance to serve and give care even in the evolution of

trends and technology of new care settings and the changes and acceptance of

roles of the nurses in the nursing field of care.

C. NURSING RESEARCH

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 The implication of this study to nursing research is that, it helps broaden

the knowledge of the student in terms of maternal and child health. It helps

develop the student to be more responsible and to be more participative in caring

for nursing mothers. The care of the mother and its newborn child does not end

once the baby was delivered and was exposed to the real world. It follows the

pattern of care from pregnancy, labor and delivery and post – partum period of

the life of the mother and to her baby. The goal of nursing research is to promote

primary, undefeated and effective care to both the mother and to her newborn

baby. Rendering the effective care helps the post – partum mother gain and be

relieve from post – partum discomfort in fast and easy manner. Health promotion

and health restoration of mothers must carried out to improve their self – esteem

and a feeling of control and give them assurance that delivery is normal to make

this a positive experience for them as well.

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