VI.

OBSTETRICAL MANAGEMENT

A. Ideal Nursing Management

In handling patients in the OB ward, these are the following ideal

measures to take in order to achieve an ideal nursing management. The
first thing to take into account and always maintain is hand hygiene. The
process of hand washing and hand sanitation must be applied in order to
avoid nosocomial infections and cross contamination between patient and
nurse, and patient to patient. Second, it is ideal to check the mother and
child’s vital signs every two hours, and proceed to charting in order to see
progress and any changes. Whenever there are abnormal results, it is
subjected to re-checking and verification.
Third, every item involved in the patient’s care must be prepared,
sorted out, and kept dry and clean. There must be no re-usage of
contaminated items, and re-usable equipment such as thermometers
must be cleaned with alcohol-moistened cotton in order to avoid cross
contamination. Fourth, in medication administration always verify if the
drug is to be given to the right patient by checking the patient ID and
verbalizing verification with the patient. Lastly, make the moment of care a
venue of health teaching, whenever possible. This will not only benefit the
patient in the current situation, but help the patient remember what to do
for health prevention, management, and restoration.

B. Ideal Medical Management

First, the patient and/or the watcher must not forget to submit the child
to newborn screening, and the mother for family planning methods (such
as IUD) in order to ensure their health and well-being. Once the patient
has been cleared and discharged from the hospital facility, the patient and
the watcher must be told to return to the barangay health center a few
days later in order to avail of the necessary vaccinations for the child, as
well as to get a check-up in order to monitor the health of the child and its
growth.
The mother should also submit herself to a check-up to avoid any
optimal maternal health hindrances such as exhaustion, fatigue, and
infections. The mother must also be instructed about the proper
positioning and technique to apply when breastfeeding for us to make
sure that optimal care is continued at home. The mother is also told to not
forsake self care such as maintaining hygiene, nutrition, and getting
enough rest. In cases of medication continuances in the home, check on
the patient’s ability to remember and maintain drug compliance by
providing health teaching and assess through enumeration afterwards.

C. Actual Nursing Management

In the first day and occurrence of thee OB ward rotation and duty, the
patient was greeted by the nurse, rapport was being founded and
established between the patient and the nurse. By then, vital signs were
obtained from the mother. The pain and discomfort was also assessed by
asking question if there are still any existing pain from the recent NSD
procedure undergone by the patient, or the engorgement of her breasts.
According to the patient, she felt pain in her breasts, which was a sign of
engorgement. The patient verbalized that she had rubra lochia, and no
GU irritation or abnormal bleeding.

The patient was also receiving mefenamic acid for pain management,
cephalexin in order to avoid further infections, and ferrous sulfate in order
to treat and avoid worsening of anemia due to pregnancy and recent
childbirth. The patient’s vital signs were also monitored every two hours
and the data is always updated in the patient’s charts. Whenever possible
the nurse provides health teaching especially that the patient is of young
parental age and maturity. The patient’s hygiene, certain scars, and
outlook in the midst of her condition were also assessed. With what were
assessed, the nurse made some important health teachings especially
about nutrition and maintaining hygiene.

D. Actual Medical Management

In the duty proper, patient LM’s vital signs were monitored, verified,
and charted every two hours. Her breastfeeding technique and efficacy
was also checked. Medications were also given by the registered nurses
and compliance was later on verified and confirmed by the student nurse.
In the span of one duty shift, there were no observed abnormalities and
anomalies to the health of the patient. Constant monitoring were
performed in order to assure that patient is fit for discharge and is well-
equipped with learning in order to manage her health even when outside
the hospital facility. Health teachings were given regarding her drug
compliance, nutrition, and breastfeeding.