BSN 2Y1-4A

CASE PRESENTATION:

Normal OB
Presentation by Group 1
• Birthing usually lasts for 14 hours for first birth and 8 hours for births after that.
There are three basic stages of birthing: labor, delivery and placental delivery.
• The labor begins with regular contractions of the uterus. True labor has severe
and stronger pressure compare to Braxton Hicks contractions.
o Signs of impending labor: Braxton Hicks Contractions, Lightening and Increased Vaginal
Discharge, Cervical changes, Bloody show, Rupture membranes, Weight loss and increased in

BIRTHING
energy.
• During the process called delivery, the mother can start to push. Actual expulsion of the
baby should take only less than one hour or in some women can take only less than 15
minutes from the end of transition phase.
o In normal spontaneous delivery, expulsion of the baby is through the vaginal route and with the
assistance of mother’s effort and force exertion.
• Placental delivery follows the expulsion of the baby and must be done in less than one
hour. It can be rapidly done within five minutes.
 4 Stages
of Labor

1st stage – Dilatation – starts with onset of regular contractions

and ends with complete dilatation of cervix in order to form
a passageway into the vagina, the birth canal.
Latent – 0-3cm; excited

Mechanism of Labor
Active – 4-6cm; anxious
Transition – 8-10cm; loss of control
2nd stage – Expulsion – starts with complete cervical dilatation and
ends with delivery of fetus
(Mechanism of labor)
3rd stage – Placental – expulsion from the womb of the placenta, to
which the umbilical cord is connected.
Signs: lengthening of umbilical cord, gush of blood, change in
the shape of uterus, firm uterine contractions, appearance of placenta
in the vaginal opening
4th stage –Recovery - first four hours after delivery of the baby.
Assessment, health teaching and interventions are
conducted.
 Day 1
October 9,2020
A 29 years old woman was immediately
transferred at the Delivery room and placed in
lithotomy position. years At 10:20 p.m. Mrs. F.
gave birth to a 7 lbs., 5 oz. (3.317 gm.) live baby
boy. Immediate newborn care was done by the
nurse. The nurse applied medicine in the baby's
eyes, placed an identifying bracelet and
administer vitamin K and hepatitis B vaccine. At
10:25 p.m. the placenta was expelled. She was
monitored at the recovery room and monitored
closely Vs for 15 min 1 hour then another 30min
Vs for 1 hour. After RR she was transferred to
OB ward.
Day 2
October 10, 2020
During rounds, the nurse asked Mrs. F how was
she, she replied “I’m good, I haven’t sleep well
since I breastfeed my baby the whole night.
There’s also discharge that comes out of my
vagina, its color is bright red”.She was examined
by her doctor and ordered diet as tolerated diet,
IVF to consume, start medications as follows:
Cefuroxime 500mg/tab BID for 7 days, Mefenamic
acid 500mg/tab TID after meals for 5 days,
Ferrous sulfate 1 tablet OD, Ascorbic Acid 1 tab
OD. Refer accordingly.
Day 3
October 11, 2020
She was examined by her doctor and ordered
diet as tolerated diet, IVF to consume, start
medications as follows: Cefuroxime 500mg/tab
BID for 7 days, Mefenamic acid 500mg/tab TID
after meals for 5 days, Ferrous sulfate 1 tablet
OD, Ascorbic Acid 1 tab OD. Refer accordingly.
 PATIENT’S PROFILE

Name: Mrs. F Age: 29 years old Attending Physician: Dr.

MD
Gender: Female Nationality: Filipino Address: Valenzuela City
PATIENT’S PROFILE
Admission Date: October 9,2020 Religion: Roman Catholic
Admitting Diagnosis: G3P1T1P0A1L1M0, pregnancy uterine 39 weeks, Vital Signs: BP 120/80, PR
cephalic in labor, normal spontaneous delivery 95bpm, RR 20 cpm and
temperature 36.9 C
Chief complaint: contractions at 7 to 10 minute intervals since 3 p.m lasting for 30 seconds, having "a lot
of false labor".
Menstrual History: LMP: January 10,2020 Past Medical History: (-)

OB History: A multipara mother who had one History of Present Illness: No history of any medical
abortion and currently has one living child, problems and no problems identified during her
normal delivery pregnancy.

Personal and Social History: (-) Family History:(-) hypertension (-) diabetes mellitus (-)
heart disease
 INITIATION OF LABOR

Baby pushes Posterior

Pressoreceptors Oxytocin is Uterine
down into the Hypothalamus Pituitary
send signals released contractions
cervix Gland
External structures

❖ Labia majora - enclose and protect the opposite external reproductive organs

❖ Labia minora - lie just inside the labia majora and surround the openings to the
vagina and urethra

❖ Clitoris - a small, sensitive protrusion that's like the penis in males

❖ Anus - final part of the alimentary canal, and directly continues from the rectum
❖ Mons pubis - rounded mound of adipose tissue that covers the pubis

Internal structures

❖ Vagina – a muscular tube approximately 3 to 4 inches long; extends from the

external genital organs to the cervix

❖ Cervix – lower part of the uterus

❖ Uterus – hollow pear-shaped organ with muscular walls that contract during
childbirth; significant female conceptive organ

❖ Ovaries – responsible for producing ova as well as the female sex hormones
estrogen and progesterone

❖ Fallopian tubes – two cylinders driving from the ovaries into the uterus; where
fertilization usually takes place
 CBC (Complete Blood Count) with Blood Typing
PARAMETER [MICROSCOPIC]
RESULT REFERENCE VALUE INTERPRETATION

Color Yellow Light Yellow to Amber Normal

Transparency Clear Clear or Cloudy Normal

Urinalysis [MACROSCOPIC]
PARAMETER RESULT REFERENCE INTERPRETATION
pH 6.0 5-9 Normal VALUE

Specific Gravity 1.010 1.000 – 1.060 Normal White Blood Cells (WBC) 9.0 x 106/ul 4.8 – 10.8 Normal

Protein Negative <20mg/dl Normal Red Blood Cells (RBC) 4.3 x 106/ul 4.10 – 5.90 Normal

Glucose Negative <20mg/dl Normal

Hemoglobin (Hgb) 13.2 g/L 12.6 – 17.4 Normal

Negative <3mg/dl Normal

Ketone
Hematocrit (Hct) 39% 37.0 – 51.0 Normal
Blood + <0.02mg/dl Indication or sign of
Urinary Tract Infection
(UTI)
Platelet count 200,000/mm3 150,000 – 400, 000 Normal

Leukocytes Negative 15 - 40 Normal

Blood type
Nitrite Negative 0 – 1 mg/dl Normal B positive

VRDL (Venereal Diseases Research

Laboratory) [MICROSCOPIC] HbsAg (Hepatitis B Surface Antigen)
PARAMETER RESULT INTERPRETATION PARAMETER RESULT INTERPRETATION

VDRL Negative Normal HbsAg Negative Normal

DRUG ORDERS MECHANISM OF INDICATIONS ADVERSE CONTRA- NURSING
ACTION EFFECT INDICATIONS RESPONSIBILITIES

Ferrous Sulfate Iron combines Iron deficiency Nausea, Patients with Advice patient to
with porphyrin anemia, blood heartburn, hemochromatosis, take medicine as
Dosage: and globin chains loss related to anorexia, hemosiderosis, prescribed.
1 tablet OD to form pregnancy or GI constipation, hemolytic anemia,
hemoglobin, bleeding diarrhea, peptic ulceration, Advice patient to
Classification: which is critical (NSAIDs), epigastric pain, ulcerative colitis, or consult physician
iron supplement for oxygen hookworm abdominal regional enteritis and if irregular
used to treat or delivery from the infestation, or distress, black in those receiving heartbeat,
prevent low blood lungs to other excess coffee stools. blood transfusions dyspnea, swelling
levels of iron tissues. Use cautiously on of hands and feet
long term basis. and hypotension
Iron deficiency occurs.
causes a
microcytic Inform patient
anemia due to the that angina
formation of small attacks may
erythrocytes with occur 30 min,
insufficient after the
hemoglobin administration
due to reflex
tachycardia.
DRUG ORDER MECHANISM OF INDICATIONS ADVERSE-EFFECT CONTAINDICATION NURSING RESPONSIBILITIES
ACTION
Cefuroxime Interferes with Pharyngitis, CNS: headache, Contraindicated in Ask the patient for history
bacterial cell- Tonsilitis, Acute hyperactivity, patients with history of of allergies, particularly
Dosage: wall synthesis Otitis Media, Acute hypertonia, seizures hypersensitivity/anaphyl cephalosporins and
500mg/tab and division by Bacterial Maxillary actic reaction, penicillin.
Sinusitis, Impetigo, GI: nausea, vomiting,
BID for 7 days binding to cell diarrhea, abdominal
hypersensitivity to
wall, causing Gonorrhea, UTI, cephalosporins. Advice the patient take
pain, dyspepsia,
Classification: cell to die. Perioperative medication as prescribed.
pseudomembranous
Prophylaxis, and
(Antibiotic) Active against colitis Cautions: Severe renal
Renal Impairment.
Second gram-negative impairment, history of Teach patient how to
generation and gram- It works by fighting GU: hematuria, vaginal penicillin allergy recognize signs and
cephalosporin positive bacteria in your candidiasis, renal symptoms of
dysfunction, acute renal
bacteria, with body. superinfection. Instruct her
failure
expanded to report these right away.
activity against Cefuroxime is used Hematologic: hemolytic
gram-negative to treat many kinds anemia, aplastic Advise patient to report
bacteria. of bacterial anemia, hemorrhage CNS changes.
Exhibits infections, including
minimal severe or life- Hepatic: hepatic Instruct patient to take drug
immunosuppre threatening forms. dysfunction with food every 12 hours as
ssant activity. prescribed.
Metabolic:
hyperglycemia

Skin: toxic epidermal

necrolysis, erythema
multiforme, Stevens-
Johnson syndrome

Other: allergic reaction,

drug fever,
superinfection,
anaphylaxis
 Medication
CEFUROXIME 500mg/tab BID for 7
days

Exercise:
● Encourage the patient to perform Kegel’s exercise MEFENAMIC ACID 500mg/tab TID after
meals for 5 days
● Encourage the patient to warm up first before exercising or doing any
heavy activities. FERROUS SULFATE 1 tablet OD

ASCORBIC ACID 1 tab OD

Treatment:
● Advise the patient to continue her medication as prescribed by the doctor.
● Continue breastfeeding.
● Advise family planning
● Advise the patient to follow up at OPD 2 weeks after discharge.

When to call the doctor :
• Frequent urgency or burning upon urination
• Temperature of 100.4°F or above
• Unrelieved pain at the back, side, or incision
• Bloody or pus-like drainage from the incision
• No bowel movement for four days or longer
• Bleeding stays heavy despite rest
• Saturating a pad an hour
• Passing many clots or passing clots larger than
an egg (some clots are normal if you have been
sitting or lying down for long periods of time)
Health Teaching:
● Get as much sleep as possible to cope with tiredness and fatigue.
● Don’t hesitate to accept help from family and friends during the postpartum period, as well
as after this period. Your body needs to heal, and practical help around the home can help
you get much-needed rest.
● Maintain a healthy diet to promote healing. Increase your intake of whole grains, vegetables,
fruits, and protein. You should also increase your fluid intake.
● Avoid heavy task such as lifting heavy objects for at least a month after giving birth
● Have proper hygiene and handwashing to prevent infections
● Have exercise. Start with something low impact and simple such as a daily walk. If you're
looking for camaraderie, see if you can find a postpartum exercise class at a local gym or
community center.
● Remind the patient that the incision should be kept clean and dry to avoid infection.
Frequent sitz baths (soaking the area of the wound in a small amount of warm water for
about 20 minutes several times a day), can help keep the area clean.
Outpatient follow up

Within the first week after leaving the hospital, the patient should schedule a follow-up
appointment with the health provider for 4-6 weeks after delivery.

● General activities
o Tell the client to perform Kegel Exercise
o Remain pelvic rest for 6 weeks. This means no tampons, douching, or intercourse
(sex).
o Take a good sleep- Lack of sleep can affect the mood and can increase anxiety.
● Nutrition
o Tell the client to eat a well-balanced diet that is high in protein (meat, fish,
legumes), fiber (fruits, vegetables, whole grains), calcium (milk, yogurt, cheese,
green leafy vegetables), and fluids.
o Refrain from any weight-reducing diets until after your postpartum checkup.
● Bowel care
o Inform the client that bowel function returns normally three to four days after
delivery.
o Tell the client to take high in fiber and fluids to avoid constipation.
● Uterine changes/bleeding/perineal care
o Inform the client that she may feel contractions (afterbirth pains) after delivery as the uterus works to get back to a non-pregnant
size.
o Educate breastfeeding mothers that she may experience more cramping during and after feeding, especially in the early weeks.
o The first few days after delivery, the bleeding (also called lochia) is bright red; it changes to dark red, then brown, much like a
normal period. This bleeding usually lasts two to four weeks.
● Breast care
o Tell the client to wear a well-fitting bra.
o If the breasts become engorged (very full/firm and tender), use ice packs for 15 to 20 minutes at a time.
o Lie flat while applying ice, if possible

● Spiritual and Psychological Adjustment

o Encourage patients to pray. Tell the client to ask for guidance from above for her fast recovery.
 -SANDRA KAMI CHASSIS
THANK YOU!

Anilao, Marc Espada, Roxanne Orevillo, Catherine

Bangalisan, Shara Gatdula, AJ Pagtaconan, Angelica
Bangkiling, Hannah Maac, Katrina Ponce, Christine
Bunagan, Michelle Manahan, Angela Roque, Shanine
Daguio, Zheene Magbitang, Hazel Salvador, John
De Dios, Jericho Medina, Amillein Silhay, Mark
De Guzman, Diana Mendoza, Roxanne Sombillo, Karla
Montaos, Diana