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Pregnancy, the state of carrying a developing embryo or fetus within the female body. This condition
can be indicated by positive results on an over-the-counter urine test, and confirmed through a blood test,
ultrasound, detection of fetal heartbeat, or an X-ray. Pregnancy lasts for about nine months, measured from
the date of the woman's last menstrual period (LMP). It is conventionally divided into three trimesters, each
roughly three months long.
When gestation has completed, it goes through a process called delivery, where the developed fetus
is expelled from the mother¶s womb. There are two options of delivery: Cesarean section and NSVD or
normal spontaneous vaginal delivery. A cesarean section is a surgical incision through the mother¶s
abdomen and uterus to deliver one or more fetuses. NSVD or normal spontaneous vaginal delivery is the
delivery of the baby through vaginal route. It can also be called NSD or normal spontaneous delivery, or
SVD or spontaneous vaginal delivery, where the mother delivers the baby with effort and force exertion.
Normal labor is defined as the gradual subjugation and dilatation of the uterine cervix as a result of
rhythmic uterine contractions leading to the expulsion of the products of conception: the delivery of the
fetus, membranes, umbilical cord, and placenta. Laboring cannot that be easy; thereby implicating that there
are processes and stages to be undertaken to achieve spontaneous delivery. Through which, Obstetrics have
divided labor into four (4) stages thereby explaining this continuous process.

STAGE 1: It is usually the longest part of labor. It begins with regular uterine contractions and ends with
complete cervical dilatation at 10 centimeters. This stage is broken down into three (3) phases: the Early
phase, where the contractions are usually very light and maybe approximately 20 minutes or more apart
from the beginning, gradually becoming closer, possibly up to five minutes apart; the Active phase, where
contractions are generally four or five times apart, and may last up to 60 seconds long. Cervix dilates with
4-7 cm and initiates a more rapid dilatation. It is known that to get through active labor, mobility and
relaxations are done to increase contractions; and the Transition phase, where it is definitely known as the
shortest phase but the hardest, contractions maybe two or three times apart, lasting up to a minute and a half,
about approximately 8-10 cm of cervical dilatation. Some women will shake and may vomit during this
stage, and this is regarded as normal. Most of the time, women would find a comfortable position to acquire
complete dilatation.

STAGE II: This stage lasts for three or more hours. However, the length of this stage depends upon the
mother¶s position (e.g.; upright position yields faster delivery). Once the cervix has completely dilated, the
second stage had begun. This stage ends with the expulsion of the fetus.

STAGE III: This stage focuses on the expulsion of the placenta from the mother. Placenta exclusion is much
more easier than the delivery of the baby because it includes no bones, and this is during this stage that the
baby is placed on top of the mother¶s womb.

STAGE IV: No more expulsions of conception products for this stage as this is generally accepted as POST
PARTUM juncture. This phase is from the placental delivery to full recovery of the mother.
Labor and delivery of the fetus entails physiological effects both on the mother and the fetus. In the
cardiovascular system, the mother¶s cardiac output increases because of the increase in the needed amount
of blood in the uterine area. Blood pressure may also rise due to the effort exerted by the mother in order
expel the fetus. There could also be a development of leukocytes or a sharp increase in the number of
circulating white blood cells possibly as a result of stress and heavy exertion. Increased respiratory may also
occur. This happens as a response to the increase in blood supply in order to increase also the oxygen intake.

Braxton Hicks contractions, or also known as false labor or practice contractions. Braxton Hicks are
sporadic uterine contractions that actually start at about 6 weeks, although one will not feel them that early.
Most women start feeling them during the second or third trimester of pregnancy. True labor is felt in the
upper and mid abdomen and leads to the cervical changes that define true labor.

With delivery imminent, the mother is usually placed supine with her knees bent (ie, the dorsal
lithotomy position). An episiotomy (an incision continuous with the vaginal introitus) may be performed at
this time. Episiotomy may ease delivery of the fetal head and allow some control over what may otherwise
be an uncontrolled perineal laceration. However, many providers no longer perform routine episiotomy,
since it may increase the risk of rectal injury and are larger than the spontaneous laceration.
The labor and birth process is always accompanied by pain. Several options for pain control are
available, ranging from intramuscular or intravenous doses of narcotics, such as Meperidine (Demerol), to
general anesthesia. Regional nerve blocks, such as a pudendal block or local infiltration of the perineal area
can also be used. Further options include epidural blocks and spinal anesthetics.


Within 1 day of exposure at VCHO DR, I will be able to:

ü To be able to review concept on theories in maternal and child nursing.

ü To be able to describe the development, physiology and nursing care of a client who has undergone
normal spontaneous vaginal delivery (NSVD) and episiotomy procedure.
ü To be able to design a nursing care plan for the patient who has undergone NSVD and episiotomy
ü To be able to provide information and health teaching to the patient of the post-partum period.
ü To be able to establish a good working relationship with the patient and hospital staff.

Nursing health history is the first part and one of the most significant aspects in case studies. It is a
systematic collection of subjective and objective data, ordering and a step-by-step process inculcating
detailed information in determining client¶s history, health status, functional status and coping pattern.
These vital informations provide a conceptual baseline data utilized in developing nursing diagnosis,
subsequent plans for individualized care and for the nursing process application as a whole.

In keeping the private life of my patient and in maintaining confidentiality, let me hide for with the
pseudonym of Patient J.D.

Patient J.D was already 30 years old, a housewife. She was born in Brgy. Tortosa, Manapla, but
she¶s still living with them. His husband¶s name is Mr. J.D. It was her 2 pregnancy. Their first child was
also born at VCHO. Their first child is now already 3 years old.

On March 18, 2010, Patient P complained of extreme abdominal pain. Her EDC or expected date of
confinement will be on April 3, 2010. The age of gestation is 37 weeks and 5 days by LMP. Her LMP was
June 27, 2009. She was admitted direct to delivery room at 8:45 AM, bag of water ruptured already before
they went to the health office. At the DR, we positioned her at the DR table and perineal cleansing done. At
8:51 AM, she delivered spontaneously to an alive baby boy in cephalic presentation. At 8:56 AM, placenta
was expelled completely in schultz mechanism. Blood pressure was checked 120/80 mmHg and Methergine
1 ampule was injected intramuscular at left deltoid region. She had laeration and sutured by staff on duty.
After the episiorrhaphy, we cleaned her perineal area and painted with betadine. Then diaper was applied
and ice pack at hypogastric area. She was then tranferred to the ward and placed comfortably.


Health teachings done. I explained to her the importance of proper hygiene to prevent the occurrence
of infection. She needs to clean her wound properly. Emphasis on eating foods rich high protein to promote
wound healing was imparted. Also, I instructed her to increase fluid intake at least 8 oz per hour to facilitate
increase in milk production, and to eat nutritious foods such as fruits and vegetables to nourish her baby

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Physical examination follows a methodical head to toe format in the Cephalocaudal assessment. This
is done systematically using the techniques of inspection, palpation, percussion and auscultation with the
use of materials and investments such as the penlight, thermometer, sphygmomanometer, tape measure and
stethoscope and also the senses. During the procedure, I made every effort to recognize and respect the
patient¶s feelings as well as to provide comfort measures and follow appropriate safety precautions.

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Patient is a 30 year old female, stands 5¶4, with pulse rate of 82 beats pre minute, respiratory rate
of 21 breaths per minute and a temperature of 37.3 °C. She is conscious and coherent upon interaction.

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Head is round in shape. Hair is long, thick and coarse, straight and evenly distributed. Scalp is
smooth and white in color, minimal lesions were noted. Dandruff and lice were seen.

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Her eyes are symmetrical, black in color, almond shape. Pupils constricts when diverted to light
and dilates when she gazes afar, conjunctivas are pink. Eyelashes are equally distributed and skin around
the eyes is intact. The eyes involuntarily blink.

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Ears are clean, no ear wax was noted and approximately of the same size and shape. Patient can
hear normally when spoken softly.

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With narrow nose bridge, there were discharges noted upon inspection. No swelling of the
mucous membrane and presence of nasal hairs were seen.

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She has a complete set of teeth with minimal dental caries noted. Oral mucosa and gingival are
pink in color, moist and there were no lesions nor inflammation noted. Tongue is pinkish and is free of
swelling and lesions. Lips are symmetrical, appears pale without bits noted upon observation.

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Lymph nodes noted. Neck has strength that allows movement back and forth, left and right.
Patient is able to freely move her neck.

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No reports of pain during the inhalation and exhalation. Absence of adventitious sounds upon
auscultation. Respiratory rate 21 breathes per minute from the normal range of 16-20 breaths per minute.

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Patient has an audible heart sound. PMI is heard between 4th - 5th intercostals space. Heart is
pumping well with a pulse rate of 82 bpm from the normal rate of 60-100 beats per minute.

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Abdominal movement as with respiration, presence of peristalsis during auscultation. Presence

of rashes and lesions. With straie gravidarum and linea nigra at the abdominal area.

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Skin: Fair complexion; no presence of marks/scars of wounds in the arms, neck and legs. Skin is
smooth, moist and soft to touch.
Hands: Medium in size with 5 fingernails in each side. Nails are short, small dusty particles are
Arms: Able to move through active ROM. Able to extend arms in front or push them out to the
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Size of the feet is undefined with lines on the sole, presence of scars and lesions. Ten fingers are
present. Nails are clean and short. Patient is ambulatory.


With episiotomy dry and intact, urinates 2-4 times a day and has not defecated yet since her

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With episiotomy intact, absence of lesions and swelling.

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Behavior ± Patient is conscious and coherent upon interaction. She is still on bed.
Motor Functioning - Able to move extremities through active ROM. Able to extend arms front
and resist active as pushed down/up on his hands.
Reflexes - reflexes were present such as the blinking reflex and deep tendon reflex.
Sensory Functioning ± Patient¶s sensory system is intact, she was able to distinguish touch, pain,
hot and cold.


Labor process = Pain in the abdominal tract -- Pressure uterine contraction -- Increment Decrement -
- Effacement -- Cervical dilatation begins uterine relaxes -- Increase the diameter of the cervical canal --
Fluid filled membranes press against the cervix -- Cervical dilatation occur more rapidly -- Increase vaginal
secretions and perhaps spontaneous rupture of the membrane -- Contractions reach their peak of intensity --
Causing maximum dilatation -- They will rupture as a rule of pull dilatation -- Sensation in change from the
Contractions abdomen maybe so intense characteristics crescendodescrecendo -- Fetal presenting part as its
widest diameter reaches the level of the ischial spine of the pelvis -- Downward movment of the biparietal
diameter of fetal head until it reaches the pelvic inlet -- Shortest head diameter passes through the pelvis --
Fetal head reaches the pelvic floor -- Fetus enter the pelvic inlet to the maternal pelvis -- Fetal head passes
beneath the Shoulder rotate internally to fit the pelvis -- Expulsion occurs first as the anterior -- Then the
posterior shoulder passes under the symphysis pubis -- After the shoulder delivery rest of the body follows -
- Folding the separation of the placenta occur -- Active bleeding on the maternal surface of the placenta
begins and separation -- Separation completed -- The placenta sinks to the lower uterine segment of the
upper vagina -- The placenta is delivered either by the natural bearing down effort of the mother or by
gentle pressure on the contracted uterine fundus by the physician.



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CLASSIFICATION: Anti-Inflammatory, Analgesic

ACTION: Inhibits reuptake of serotonin norepinephrine

CNS INDICATIONS: Moderate to moderately severe pain

CONTRAINDICATIONS: Hypersensitivity with drugs, acute intoxication with alcohol, physical opioid

CNS: dizziness
CV: Vasodilation
EENT: visual disturbances
GI: Nausea and Vomiting
GU: urinary retention
SKIN: pruritus


‡ Tell patient that drug works best when taken before pain becomes severe
‡ Recommend medication
‡ Caution patient that drug can cause dependence abstinence from alcohol when taking the medication


1.? 1 Risk for infection r/t traumatized skin tissue 2º to episiotomy
2.? Interrupted breast feeding r/t infant illness
3.? Situational Low Self-Esteem r/t perceived failure at life events 2º to rape trauma

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M- Medication to take > Amoxicillin > Mefenamic acid > Ferosulfate

Instruct the client about the way of taking her medicines. Explain the proper measurement and time of
E- Exercise Encourage the client to do some exercise every morning such as simple walking.
T- Treatments Advice the client not to engage in any house chores that might jeopardize her health.
H- Health teaching Encourage and explain the importance of breast feeding to the client. Breastfeeding
especially the first milk, ³colostrums´, can reduce postpartum bleeding/hemorrhage in the mother, and to
pass immunities and other benefits to the baby. Advice client to let her child expose to mild sunlight in order
to balance and avoid excess bilirubin in the body. Instruct and teach the client about proper bathing of the
O- Out patient follow up Instruct the client to go back for the follow up check ups.
D- Diet Advice client to eat proper diet. Encourage her to eat more vegetables and frequent intake of liquids.
Advice her to eat food which are rich in protein, iron and vitamin C. protein helps to repair body tissues,
iron provides formation of Red Blood Cells and Ascorbic Acid for helping absorption of iron.