PAL

\ETTE 1 – ESTABLISHING RAPPORT

-Good day Ma’am, I am _______, student nurse ko nimu karong adlawa and ako
ang mag asikaso nimu for today from 7am to 3pm, and also for the next 2 days.

- So before ko magstart sa akong assessment maam pwede ba nako mahibal an

imung pangalan , edad and birthday ma’am? Tan-awon lang sad nako imohang
wrist band maam ha for verification (acting chuhcu nga gitan-aw ang wristband)
- So maam, Unsa may gusto nimo nga itawag nako sa imuha maam?
- ( So before ta mag start maam mangutana lang ko kung komportable baka sa
temperature diri sa room? )
- E-close nalang sad nako ang kurtina maam ha para sa imuhang privacy.
- Unsa man nga language imong prefer maam para dali ta magkasinabtanay?
-Right now maam I just have some questions so that I can assess you properly, is that
okay maam?
-Do you have any allergies that you would like me to know?
-First pregnancy ba ni nimo maam? –dili
-So kamusta man imong mga previous pregnancy maam? Mas naglisod baka ron?
-Ay okay maam.

PALETTE 2 – ANSWERING PT QUIRES

- So karon Ma’am, magkuha ko sa imong vital signs maam ha, kay mao ni gi
require sa doctor para pud ma monitor imong condition sa pagka karon .
- Palihog ko sa imong kamot ma’am para makakuha nako sa imung VS.
- check nakog una imong bp maam ha, so imong bp 100/70
- imong temperature na sad maam, so magbutang ra kog thermometer sa imong
armpit maam ha –normal ra sad maam 37.5
- Check pud nako imong pulse rate ug oxygen saturation gamit ning pulse oximeter
maam, so mag indicate ni siya kung normal ra ba and beat saimong pulso ug ang
oxygen sa blood nga naga circulate saimong lawas. (incase mag ask si px para
asa ng SPO2) so kani maam gina measure imung oxygen level, kung
oxygenated ba imung dugo or kung well delivered bani sa imung tibook lawas.
- so imong pulse rate maam kay 90bpm ug ang SPO2 nimo kay 96% which is normal
po. imong respiratory rate sad maam kay 20cpm ug normal sad na siya.
- So e aware taka daan maam nga e monitor nako imung VS every after 15 mins sulod
sa duha ka oras (2 hours). Then after ana, every 30 mins nasad sulod gihapon sa duha
ka oras (2 hours). Then kada oras nasad maam until ma stable imung condition then
every after 4 hours nasad dayun. Okey ba maam? CONTINUATION PRESENT IV
So karon maam, e check lang nako imung dextrose kung okey pa ba ang patak, so
okay ra man imong IV maam, iwasi lang po ang pagbutang saimong kamot sa taas
saimong ulo para maiwasan sad ang backflow (magbalik and dugo sa tubo)
- mag continue ko ug med nga e insert sa dextrose , so mao ni ang oxytocin.
( IVF #3 D5LR 500ml +5 units @120 cc/hour) – just incase lang ni
- Continuation sa oxytocin (#4 PLR 1L + 10 UNITS Oxytocin @120 cc/hour)
 Check pud nako imong urine bag maam ha. Okay ra man imong urine maam,
20mL/hr po ang volume.
 Maam okay ra icheck nako imong private area? Para ma assess nako imong
perineum maam.
-So upon checking, na repair na imong 2 nd degree laceration ug moderate ra sad
imong lochia maam ug type rubra which is normal saimong state ron

QUESTION & ANSWER!!

POSSIBLE QUESTIONS
 Unsa diay ng GTPAL maam?
-shortcut ra na siya nga ginagamit namo na term maam about saimong
pregnancy, like ikapila na nimo nga pregnancy para mas ma assess po namo ug
tarong imong pregnancy.
 How do I know if my lochia is NORMAL? –lochia is vaginal discharge
- i-asses po ang color saimong lochia maam, kung red po meaning rubra ag type
saimong lochia, usually mao jud na siya ang lochia sa first 3 days maam, then mga 4-
10days mahimo na na siyag pinkish-brown ug mao na siya ang serosa nga type sa
lochia maam ug if whitish-yellow na o siya, alba nan a siya maam then after 10-14 days
or 6 weeks after na siya maam. Iassess sad ang kadghan saimong lochia maam ug if
naa bay blood clots, check lang din po ang consistency and ang odor. Dapat ang Lochia
kay dili excessive amount, dili offensive ang iyahang odor ug no large blood clots then
dapat mag proceed sya gikan rubra to alba after pila ka weeks.
Pag naay offensive odor pwede sya ma indicate as postpartal infection

 Ngano sakit kaayong akong tiyan maam? Normal pa ba ni?mga naa sa 5/10 ang
kasakit maam.
 When mag start ug sex usab? -wait for the lochia to stop (prob 3-6 weeks). Kay
ang wound sa left uterus (womb) kay still healing pa. If makig sex sya before
mag stop ang bleeding basig ma infection.
 When mag start ug sex usab?
 -wait for the lochia to stop (prob 3-6 weeks). Kay ang wound sa left uterus
(womb) kay still healing pa. If makig sex sya before mag stop ang bleeding basig
ma infection.
 FEEDING PROCESS IS DIFFICULT
- If tungod sa inverted or flat iyang nipple ngano sya nag lisod sya breastfeed kay
ang himuon is mag gamit ug breast shells para maka help sa nipples na
mugawas. Then roll the nipples between sa thums ang forefingers para mugahi
ang nipple. Use breast pump sad before magpa feed para ma draw out ang
inverted nipples. Then ibutang dayon ang baby after mag pump
- Breasftfeed every 2-3 hours, 8-10 times daily.
- How to get good attachment (make sure baby sucks the areola, not just the
nipple. Baby’s top and bottom lip should be turned out. Baby’s chin should be
pressed into the breast.)
- Enhance the flow of milk. Teach the mother to massage breast or burp infant and
switch to other breast when infant's swallowing slows down.

OCTOBER 20 1:00 pm

 Occasional pain on the calf

If positive sya sa homan's sign/pain sa calf habang gina dorsiflex and naka slightly flex
ang tiil ma indicate sya as thrombophlebitis (ang tambal ani kay Arixtra pero maka
prevent ra sya). Naga occur ni sya during postpartum kay tungod fibrinogen level is
elevated/clotting factor is elevated during sa pregnancy.
Do not massage the area kay if ang blood clot kay mag break free and travel through
the bloodstream, mahimo na syang embolus (ang embolus kay ang blood clot, air
bubble or unsa pa ba na maka dala sa bloodstream to lodge in a vessel kay maka
cause ug blockage and organ damage)
Homan's sign Patient Teaching:
-Don’t cross legs - Encourage to ambulate and exercise
-Avoid prolonged sitting - Never massage the leg
-Avoid constrictive clotting
PALETTE 3 – ADMINISTRATION OF MEDICINE
-Right now maam I am going to administer your medication that is being prescribed by
your physician.
1. METHYLERGONOVINE (0.2mg/ml 1ml IM) –STAT

 Kani nga tambal maam kay makatabang ug stop sa bleeding saimong uterus.Dili
kayo daghan ang blood na mawala saimoha.
SIDE EFFECTS:
 Hypertension associated in several cases with seizure and/or headache.
  Hypotension
 Abdominal pain (caused by uterine contractions), nausea and vomiting.
2. Methergine (0.2 mg/tab PO) - Every 6 hours

 Kani nga tambal maam kay makatabang sad ug stop sa bleeding saimong uterus
pero tablet form ni siya sa methylergonovine.
Side Effects:
 Nausea, Vomiting, stomach pain, diarrhea, headache and dizziness
3. Ampicillin (1g IV) – every 6 hours
 Kani nga tambal maam kay antibiotic ni maam para ma treat ang GI Infections
and sa lain pa, genitourinary infections caused bacteria.
SIDE EFFECTS:
CNS: Chills, fatigue, fever, headache, malaise
CV: Chest pain, edema, thrombophlebitis
SKIN: Erythema multiforme; erythematous, mildly pruritic maculopapular rash or
other types of rash; exfoliative dermatitis; pruritus; urticaria
Other: Anaphylaxis, angioedema, injection-site pain

4. Mefenamic Acid (500mg 1tab PO) –every 6 hours

 relief of acute to moderate severe pain

SIDE EFFECTS:
HEADACHE, DIZZINESS, INSOMNIA, DIAPHORESIS (EXCESSIVE SWEATING),
NAUSEA, GI PAIN, DIARRHEA, CONSTIPATION, BLEEDING

5. OMEPRAZOLE (40 mg 1 capsule PO) TWICE A DAY

INDICATIONS: used to treat certain stomach and esophagus problems (such as acid
reflux, ulcers). Common ni sya after sa pregnancy maam kay gina push pataas imohang
mga organs mao na magka acid reflux.
SIDE EFFECTS: Headache or abdominal pain may occur.
6. NALBUPHINE (5mg IVTT) –EVRY 8HRS PRN
Through IV ni sya so mas paspas iyang effect.

INDICATIONS: used to treat pain, for pre and postoperative analgesia, and for
analgesia in labor and delivery.
Makatabang sa sakit na na feel nimo ron maam especially kay bag o raka nahuman ug
labor ug deliver sa baby.
SIDE EFFECTS:
 CNS: Confusion, depression, dizziness, euphoria, fatigue, hallucinations,
headache, nervousness, restlessness, seizures, syncope, tiredness, weakness
 EENT: Blurred vision, diplopia, dry mouth
 GI: Abdominal cramps, anorexia, constipation, nausea, vomiting
 SKIN: Diaphoresis, flushing, pruritus, rash, sensation of warmth, urticaria
 Injection-site burning, pain, redness, swelling, and warmth
7. PLASIL (10mg IVTT) –EVRY 6 HRS (METOCLOPRAMIDE) PRN
As need pero since naga reklamo naman ka na kasukaon naka ihatag na nako ni na
tambal.
INDICATIONS: Prevent/Treat nausea, vomiting
SIDE EFFECTS: Drowsiness, restlessness, fatigue and lethargy

8. FONDAPARINUX SODIUM (ARIXTRA) (2.5mg SQ.) Once a day

Para sa blood clot nimo which is naga cause ug sakit saimong bagtak
- used to prevent deep vein thrombosis (DVT – blood clot, usually in the leg.) which may
lead to pulmonary embolism in patients undergoing abdominal surgery.
SIDE EFFECTS:
 CNS: Confusion, dizziness, fever, headache, insomnia
 GI: Constipation, diarrhea, elevated liver enzymes, indigestion, nausea, vomiting

9. PARACETAMOL (500mg/tab PO) - Every 4hrs.

INDICATION: Reduction of fever, temporary reduction of minor aches caused by
influenza, and common cold.
SIDE EFFECTS: Headache, chest pain, dyspnea (shortness of breath)

HOME MEDS:

1. Mefenamic acid 500mg 1tab PO x 2days

RELIEF OF ACUTE TO MODERATE SEVERE PAIN
SIDE EFFECTS:
HEADACHE, DIZZINESS, INSOMNIA, DIAPHORESIS (EXCESSIVE SWEATING),
NAUSEA, GI PAIN, DIARRHEA, CONSTIPATION, BLEEDING
 2. Cefuroxime 500mg 1tab PO BID x 7days
 For treatment of many different types of bacterial infections such as
bronchitis, sinusitis, tonsillitis, ear infection, skin infections, gonorrhea,
and urinary tract infection. For treatment of many different types of
bacterial infections such as bronchitis, sinusitis, tonsillitis, ear infection,
skin infections, Gonorrhea, and urinary tract infection. For treatment of
many different types of bacterial infections such as
bronchitis, sinusitis, tonsillitis, ear infection, skin infections, gonorrhea,
and urinary tract infection.
Side Effects: 
Diarrhea, nausea, vomiting, Mucus rush, rash. Difficulty in breathing, unusual redness,
fatigue, itching or irritation 

3. Ascorbid acid (1cap OD PO) x 1 month

INDICATIONS: This medication is an iron supplement used to treat or prevent low blood
levels of iron (such as those caused by anemia or pregnancy).
SIDE EFFECTS: Constipation, Diarrhea, stomach, cramps, upset stomach

4. Multivitamins +Ferous sulfate tab, 1tab x 1month

Indications: to treat/prevent vitamin deficiency due to poor diet, certain illnesses, or
during pregnancy.
Side Effects: constipation, diarrhea, upset stomach
Nursing Responsibilities:
 Advise patient that it is best to take on an empty stomach 1 hour before or 2
hours after meals.
 Advise patient to take the drug with a full glass of water (8 ounces or 240
milliliters).
 Tell patient to take medication with food if there is an occurrence of stomach
upset.
 Advise patient to avoid taking antacids, diary products, tea, or coffee within 2
hours before or after taking the drug as it can decrease its effectivity.
 Advise patient not to lie down for at least 10 minutes after taking the tablet.
PALETTE 4 – ENDING THE SHIFT

-So right now maam, mag hatag kog advise ug health teachings nga makatabang saimo
for the next following days.

 POSTPARTUM BLUES- A maternal adjustment reaction

- So possible nga mag occur ni siya maam during sa 2nd ug 3rd day after nimo
manganak. So maka feel ka ug kalit na sadness ug kanang kahilakon, irritable ka
maam pero normal ran a siya maam since daghan ug changes sa levels saimong
hormones maong dili pa stable imomg emotions.
- Characterized by mood swings, anorexia, and sleeping problems
 Ang lochia sad maam, or kanang vaginal discharge kay need sa imonitor kay isa
pud na siya sa indication kung naa kay postpartal infection. Check for any signs
of odor and ang color din po.
 Importante sad nga mag perform ug perinial care after each void maam and
frequent change sad ug perinial pad is highly encouraged to avoid infection
 (Nursing care BLADDER) Mas better sad maam if maka ihi ka every 4-6 hours
para dili distended im ong bladder
 So hydration is very important po since we encourage you to void every 4-6 Hrs.
Remember to drink 6-8 glasses of water every day.
 So ang oder ni doc maam is diet as tolerated meaning you can eat foods nga ma
tolerate nimo pero mas advisable jud ang mga healthy foods kay maka promote
sad na saimong healing process. Increase po ang pagkaon sa mga fruits,
vegetables, whole grains and protein. Since naga breastfeed ka po maam, fluid
intake and food nutrition is important po talaga.
 Importante sad maam nga maka rest ka ug tarong para mas dali nimo ma regain
imong strength. Mas beter po if may support kayo sap ag alaga kay baby para di
kayo ka malisdan ug makapoy maam. Having enough sleep maam is very
important sad. And avoid sa ang mga heavy works.
 About sad sa sex maam, wait sap o na mag stop ang vaginal discharge or ang
lochia kay ang wound sa imong womb kay healing pa po. If makig sex sya before
mag stop ang bleeding basig ma infection.
 If not breastfeeding mom; after 6-10 weeks after birth mubalik ang PERIOD. If
breastfeeding mom 3-4 months
ENDING CHURVA
-So before we end, do have any questions or clarifications ma’am?
*wala na nurse (hopefully)
Maam human naman ko saakng shift karun so ayaw kalimti to akong mga gipang
ingon saimoha kanina. Iendorse na tika sa next shift nga nurse. Ayaw balaka maam
kay mubalik man ghapon ko ugma same ghapon na oras. Anytime maam mag
rounds si doc, so andam lng ta daan and if naa kay mga pangutana or mga gipati
ayaw pagduha duha na ipahibalo dayun kay doc.Thank you so much for your time
and cooperation maam. I’ll go ahead so you can take some rest and have a good
day!
ENDORSEMENT SCRIPT: Good Day, I am student nurse //// under recovery room. I
would like to refer to you room 204, Pt. Dee,Dana a 28 year old female
(G4T3P1A0L4),came in due post (NORMAL SPONTANEOUS VAGINAL DELIVERY )
NSVD to live baby girl under the service of Dr. Valdez

October 19 @8:00am – Patient complain abdominal pain, pain scale 5/10

(+) lethargic
(+) soaked perineal pad in 30 minutes
(-) blood clots
(+) intact episiorrhaphy
(+) uterus 2 cm above umbilicus, boggy
(+) distended bladder (+) 10 ml/hr urine output
(+) 400 ml estimated blood loss Walay allegy ni sya

VITAL SIGNS:
Last vital signs nako ganina around 7am Iyahang BP: 100/70 mmHg tas karon gi BP
nasad nako , iyang BP: 85/55 mmHG tas iyang PR ganina around 7 kay 90bpm, then
karon mejo nitaas naana sa 110 bpm …tapos iyang RR ganina sad pagcheck nako kay
20cpm tapos karon naana sa 23cpm ,
Then iyang temperature ganina around 7 kay 37.5 then karon naa sa 37.9 C .
Postpartum Orders: DONE INSTRUTED PX TO Increase Oral Fluid Intake Continue
monitor vs every 15min. Watch out for hypotension, tachycardia and tachypnea
Medications:
-Na administered na ang Methylergonovine 0.2mg/ml, 1 ml IM now
- Methergine 0.2mg/tablet, 1 tablet PO q6 hours
- Ampicillin 1g IVTT q6 hours - Mefenamic Acid 500mg 1 tablet PO q 6 hrs
- Omeprazole 40 mg 1 Capsule PO, BID
- Nalbuphine 5mg IVTT every 8 hrs. PRN - Plasil 10mg IVTT every 6 hours PRN
- Watch out untoward effects of medications
Refer accordingly
LABS:
Repeat CBC
Blood GS/CS x 2 sites
Repeat U/A MSCC WITH GSCS
Follow up CXR result
Medications:
- Fondaparinux (Arixtra) 2.5mg SQ, once a day
-Paracetamol 500mg/tab, 1 tablet P.O every q4 hours for fever
-Continue present medications
Refer accordingly
WALA NA GURO NI APIL
Good Day, I am student nurse ANA GRACE LOZADA under the OB ward (not sure). I
would like to refer to you room 204, Pt. Dee,Dana a 28 year old female
(G4T3P1A0L4),came in due post NSVD to live baby girl under the service of Dr.
Valdez
October 19 @7:00am
(+) asleep
(+) moderate lochia rubra
(+) repaired 2nd degree laceration
(+) Urine output 20ml/hr, Foley Catheter
Not in cardio respiratory distress
VITAL SIGNS:
BP- 100/70mmgh
T- 37.3
RR- 20
PR- 90 bpm
SPO2-96%
-On DAT
- Please monitor vital signs q 15 minutes x 2 hours, 30minutes x 2 hours hourly until
stable then q 4hrs
-Monitor intake and output cc/cc
- IVF: #3 d5lr 500 ml + 5 units oxytocin at 120 cc/hr
-IVF TF: #4 PLR 1L +10 Units Oxytocin at 120cc/hr
- Watch out for any unusuality’s and danger signs
- Please Refer and facilitate lab works
Good Day, I am student nurse ANA GRACE LOZADA under the OB ward (not sure). I
would like to refer to you room 204, Pt. Dee,Dana a 28 year old female
(G4T3P1A0L4),came in due Abdominal Pain, Pain Scale 5/10 under the service of
Dr. Valdez
October 19 @8:00am
(+) lethargic
(+) soaked perineal pad in 30 minutes
(-) blood clots
(+) intact episiorrhaphy
(+) uterus 2 cm above umbilicus, boggy
(+) distended bladder
(+) 10 ml/hr urine output
(+) 400 ml EBL
VITAL SIGNS:
BP: 85/55 mmHG
PR: 110 cpm
RR: 23 cpm
T: 37.9 C
O2Sat: 95%
Cont. Postpartum Orders:
- Increase Oral Fluid Intake
- Continue vital signs monitoring every 15 minutes
- Watch out for hypotension, tachycardia and tachypnea
Medications:
- Methylergonovine 0.2mg/ml, 1 ml IM now
- Methergine 0.2mg/tablet, 1 tablet PO q6 hours
- Ampicillin 1g IVTT q6 hours
- Mefenamic Acid 500mg 1 tablet PO q 6 hrs
- Omeprazole 40 mg 1 Capsule PO, BID
- Nalbuphine 5mg IVTT every 8 hrs. PRN
- Plasil 10mg IVTT every 6 hours PRN
- Watch out untoward effects of medications
Refer accordingly
Good Day, I am student nurse ANA GRACE LOZADA under the OB ward (not sure). I
would like to refer to you room 204, Pt. Dee,Dana a 28 year old female ,came in due
Occasional pain on calf under the service of Dr. Valdez
October 20 @1:00pm
(+) awake, coherent, on bed
(+) minimal lochia
(-) blood clots
(+) intact episiorrhaphy, nontender
(+) uterus 1 cm below umbilicus, contracted, round, firm, nontender
(+) voiding freely
(+) warm to touch back of the knee
(+)lactating, engorged breast, minimal crack, redness noted
VITAL SIGNS:
BP: 85/55 mmHG
PR: 110 cpm
RR: 23 cpm
T: 37.9 C
O2Sat: 95%
LABS:
Repeat CBC
Blood GS/CS x 2 sites
Repeat U/A MSCC WITH GSCS
Follow up CXR result
Medications:
- Fondaparinux (Arixtra) 2.5mg SQ, once a day
-Paracetamol 500mg/tab, 1 tablet P.O every q4 hours for fever
-Continue present medications
Refer accordingly