The College of Maasin

College of Nursing
NCM 104/ 105 RLE

ANTEPARTAL CARE CASE STUDY

Schedule: April 12-14, 19 & 20 (6am-4pm)

Name: MALDO, MICAH JOYCE P. Section: BSN LEVINE II

Case No. 1

Mrs. Cruz, a 37-year-old Caucasian woman, presented to your OB/GYN office for her first prenatal visit. Mrs. Cruz states her last menstrual period began
January 15th and a positive pregnancy test reveals she is pregnant for the sixth time. Her previous pregnancy history includes three spontaneous abortions because
of cervical insufficiency/premature dilation of the cervix. Her last two pregnancies were carried to term, but Mrs. Cruz had to stay in bed for three months. She
also developed gestational diabetes during her last pregnancy. Mrs. Cruz is 5 foot 2 inches tall, weighs 190 lbs., and smokes 1 ½ packs per day.
Kindly answer the following questions:

1. Use Nagele’s rule to calculate the EDC.

2. Define gravida, para, primigravida, and multipara.
3. What is Mrs. Cruz’ gravida and para, utilizing the GTPAL system?
4. List four factors that place Mrs. Cruz in a high risk pregnancy category and identify why they are risks.
5. Throughout Mrs. Cruz’s pregnancy, many anatomical and physiological changes will occur. As a result of these changes, she will experience various minor discomforts
and complaints.
a) For the following organs or systems, explain the changes that will occur, the trimester in which the changes are expected to occur, and physiological basis for each
change.
i. Uterus
ii. Urinary System
iii. Heart and Circulatory System
iv. Digestive System
v. Respiratory System
vi. Breast
b) Related to these anatomical and physiological changes, discuss five discomforts a woman might experience during pregnancy, and explain the suggestions you
would give her to alleviate or manage each discomfort based on evidence based research or scientific rationale.
6. At the beginning of pregnancy Mrs. Cruz’s hematocrit was 42. At 32 week’s gestation her hematocrit measures 36. Explain the rationale for this drop in her hematocrit.
Is this a tru anemia or a pseudoanemia?

7. Briefly summarize psychological responses or behaviors seen in each trimester as a woman adjusts to pregnancy.

8. Make at least five (5) NURSING CARE PLAN for Mrs. Cruz.
9. Provide your Health Teaching Plan for Mrs. Cruz.
10. Make a drug study of all drugs that Mrs. Cruz should take during her pregnancy.
11. Suppose you are having daily home visits, you are required to document your care for Mrs. Cruz. Documenting care means formulating FDAR. Just make two (2)
FDAR for this case.

Case No. 2

A. Mary Lou Sanchez is pregnant for the first time. After several visits, she realized that her blood pressure, weight, and urine were measured or tested during each
appointment. She asked the nurse why it is important to do these tests every time she visits your clinic. What is the explanation for obtaining a blood pressure, weight,
and urine dipstick at each visit? What screening tests are included in the urine dipstick?

B. Assuming Mary Lou has a uncomplicated pregnancy, what will be the routine schedule for her prenatal visits to the health care provider?

C. At her first prenatal visit and at subsequent visits, laboratory tests will be obtained. Briefly describe each of the following tests, explain what gestational age they will be
performed at, why each is done, and any anticipated interventions.
i. Blood type and Rh factor
ii. Antibody Screen
iii. Hct/ Hgb
iv. Hepatitis B
v. Pap Smear
vi. Urinalysis/Urine culture
vii. HIV screen
viii. Biophysical Profile (BPP)
D. At these prenatal visits, Mary Lou will need some guidance in planning an appropriate diet. What information will you give Mary Lou regarding the number of calories
she should consume during her pregnancy? What additional factors should be considered?

E. What are the recommended guidelines for weight gain during each trimester?

F. What will you teach her about risks of medications, alcohol, and smoking during pregnancy?

G. Mary Lou asks about the physical activity she can engage in during pregnancy. What exercise and safety guidelines would you suggest she follow when engaging in
sports and physical activities? What benefits of exercise would you identify?

H. Make five (5) possible NURSING CARE PLAN for Mrs. Sanchez.

I. Provide your Health Teaching Plan for Mrs. Sanchez.

J. Make a drug study of all drugs that Mrs. Cruz should take during her pregnancy.

K. Formulate two (2) FDAR for Mrs. Sanchez.

CASE I ANSWER:

1. October 22 (-3months, +7days)

2. Gravida- a pregnant woman
Para- Pregnancy to 20 weeks of gestation or more
Primigravida- A woman who is pregnant for the first time
Multipara- A woman who has completed two or more pregnancies to 20 weeks or more
3. G:6 P:2 TPAL:2, 0, 3, 2
4. Smokes 1 ½ packs per day: low birth weight, preterm birth, still birth, sudden infant death syndrome, ectopic pregnancy and
orofacial clefts
Weighs 190lbs and has gestational diabetes: Higher risk for spontaneous abortion and still birth. Higher risk for fetal
congenital abnormalities such as neural tube defects, hydrocephaly, cardiovascular, orofacial and limb reduction anomalties.
Increase incidence of post term pregnancy and longer labor
Age is 37 years old: Pregnancy in women older than 35 years of age is associated with increased risk for miscarriage, still
birth, diabetes, hypertension, placenta previa, placental abruption, caesarean birth and pregnancy related mortality
Previous complications of cervical insufficiency/ premature dilation of cervix: Risk of spontaneous abortion
5. A.
Uterus: During 1st trimester high levels of estrogen and progesterone stimulate uterine growth. Results from increased
vascularity and dilation of blood vessels, hyperplasia and hyperthrophy and development of decidua. After the 3rd month,
uterine enlargement is primarily the result of mechanical pressure of the growing fetus. By 12 weeks it rises out of the pelvis
into the abdominal cavity. After the 4th month, intermittent contractions, known as Braxton Hicks, may be felt through the
abdominal wall. They enhance blood flow through the intervillous spaces.
Urinary System: Changes in renal structure result from the hormonal cavity, Pressure from the enlarging uterus and an
increase in blood volume. As early as the 10th week of pregnancy, the renal pelvis and the ureters dilate. Larger volume of urine
of urine is held in the pelvis and ureters and urine flow rate is slowed causing urinary stasis. Bladder irritability, nocturia, and
urinary frequency and urgency are commonly reported in early pregnancy and third trimester
Heart and circulatory system: Total blood volume increases from 40% to 50%, peaks at 28 to 34 weeks. Increased blood
volume is a protective mechanism. Cardiac output increases 30% to
50% reaching peak by 25 to 30 weeks of gestation. Cardiac output increases as a result of increases stroke volume and heart
rate and occurs in response to increased tissue demands for oxygen. Maternal blood pressure remains the same or decreases due
 to reduced systemic vascular resistance. Compression of the iliac veins and inferior vena cava by the uterus causes increased
venous pressure and reduced blood flow to the veins. Slight cardiac hypertrophy.
Digestive system: Nausea and vomiting of pregnancy appears at approximately 4 to 6 weeks of gestations, peaks by 9 weeks
and usually subsides by the end of first trimester. By the second
trimester, appetite increases in response to increased metabolic needs. Intrabdominal alterations that can cause discomfort
include pelvic heaviness or pressure, rounded ligament tension, flatulence, distention and bowel cramping and uterine
contractions.
Respiratory system: Maternal oxygen consumption increases during pregnancy by 20% to 40%, necessary to support the
needs of the fetus, placenta, and changes in maternal organs. Chest breathing replaces abdominal breathing and it becomes less
possible for the diaphragm to descend with inspiration. Pregnancy-related dyspnea is common beginning with the first or
second trimester. Tidal volume increases by 40% during pregnancy.
Breasts: Fullness, heightened sensitivity, tingling, and heaviness of the breasts begin in the earlyweeks of gestation in response
to increased evels of estrogen and progesterone. Nipples and areola become more pigmented, areola enlarge and nipples
become more erectile. During pregnancy the breasts are being prepared for lactation and show progressive enlargement.
Duringthe second trimester, human placental lactogen stimulates secretion of colostrum.
B.
1. Breast changes: pain, tingling, tenderness, enlargement- Wear supportive maternity bras with pads to absorb discharge, may
be worn at night.
2. Urgency and frequency or urination- Empty bladder regularly, perform Kegel exercises, limit fluid intake before bedtime,
avoid caffeine, wear perineal pad, report pain or burning senation to obstretic care provider.
3. Nausea and vomiting- Avoid empty or overloaded stomach, maintain good posture. Eat dry carbohydrate on awakening.
Remain in bed until feeling subsides.
4. Supine hypotension- Side lying position or semisitting posture with knees slightlyflexed.
5. Flatulence with bloating and belching- Chew foods slowly and thoroughly, avoid gas producing foods, fatty foods, large
meals. Maintain moderate exercise, maintain regular bowel habits.

6. Hematocrit decreases as a result of plasma increase being greater than the increase in RBC. This creates a state of
hemodilution. This is pseudoanemia.
7. First trimester: Accepting the idea of pregnancy and assimilating the pregnant state into the woman’s way of life.
Ambivalence is considered a normal response in people preparing for a new role. “I am pregnant.” Anxiety related to deficient
knowledge about prenatal visits and fear about losing baby
Second trimester: Fetus becomes more real. Body changes are more evident. Possible low self-esteem related to weight
gain. “Trying on” role of motherhood. “I am going to have a baby.”
Third Trimester: Body changes are more dramatic. Minor discomforts become more tiresome. Intense feelings of
ambivalence that persist through the third trimester may indicate an unresolved conflict with the motherhood role. “I am going
to be a mother.” Fear related to inexperienced regarding processes of labor.
CUES/ NURSING NSG GOALS NURSING RATIONALE EVALUATION
DATA DIAGNOSIS AND INTERVENTIONS
OBJECTIVE
Subjective Altered nutritional Short term:  To Weigh client on  Client’s weight Short term:
Data: status less than body -After 30mins each prenatal visit. is 190lbs -After 30mins of
Patient says requirement r/t of health  To Assess calorie  Advised the health teaching
her appetite inability to utilize teaching, intake and dietary patient to eat the patient is bale
has nutrients appropriately patient will be pattern using 24 hour well balanced to verbalized her
increased. (imbalance between able to recall. diet. It should understanding
glucose intake and verbalized her be highly about gestational
Objective glucose utilization) understanding nutritious and diabetes.
Data: about easily digest
Blood Scientific Basis: gestational  To Review importance  Take meals
glucose When blood glucose diabetes. of regularity of meals after 15 minutes
levels: stays too high for too and snacks when of insulin
FBS- long, taking insulin. administration.
155mg/dl serious health problems
PP- can develop. It's  To Discuss  Diet with 2000-
204mg/dl important to control dosage ,schedule,type 2500kcal/day
HbA1c-9.3 your blood glucose of insulin for normal
through diet, exercise, women weight
and medicine. This can and restriction
delay or prevent to 1200-
kidney, eye, nerve, and 1800kcal/day
heart disease, and other for overweight
complications women is
of diabetes. recommended.
High protein
diet
Source:  To Adjust diet or  Avoid foods
ronchester.edu insulin regimen to containing
meet individual needs. excess of
carbohydrate
like sweets,
honey,sugar,
fried foods,
cold drinks
 To Refer to registered  Avoid foods
dietician to rich in fats and
individualize diet calories.
pattern.
 Teaching the  Eating very
importance of frequent small
regularity of meals and meals improves
snacks insulin function
when taking insulin.

 Teach and  insulin needs

demonstrate client to for the day can
monitor sugar using a be adjusted
finger stick method. based on
periodic serum
glucose
readings
 Discuss the type of  Division of
insulin dosage and insulin dosage
schedule (eg. Usually considers basal
4time/day; 7:30am- maternal needs
 NPH; 10:00am- and mealtime
regular; 4:00pm-NPH; insulin to food
6:00pm-regular) ratio and allows
more freedom
in meal-
scheduling
 Refered to a registered  Diet specific
dietician to indi is
individualized diet and necessary to
counsel regarding maintain
dietary questions. normoglycemia
and to obtain
desired weight
gain
CUES/DATA NURSING DIAGNOSIS NSG GOALS AND NURSING RATIONALE EVALUATIO
OBJECTIVES INTERVENTION N
Subjective Data: Knowledge deficit r/t on After 30 minutes of  Establish  To ensure After 30
“wa man koy progress labor nursing rapport. minutes of
mga nahibaw an intervention: compliance of Nursing
Introduce self.
abut aning aho SCIENTIFIC BASIS:  The patient Explain the patient Intervention:
sakit doc wa ko Knowledge will be able purpose.
 client’s/couple
kahibaw sani deficit among pregnant adolesce to verbalize  Assess The patient is
ahong buhaton” nts may include lack of understandin client’s/couple ’s knowledge able
awareness about health benefits g of the ’s knowledge participate in
Objective Data: of ANC, late recognition procedures, of disease the
of disease
 Confusion of pregnancy, poverty, being laboratory process and process and management
 Request single and lack of support tests, and treatment, of diabetes
system throughout pregnancy activities treatment, during
for including
informati involved in relationships including pregnancy as
on Source: controlling between diet, well as
relationships
 Frustratio bmcpregnancychildbirth. diabetes exercise, verbalize
n biomedcentral.com  The patient illness, stress, between diet, understanding
will be able and insulin of the
exercise, procedures,
proficiency requirements.
in self- illness, stress, laboratory
monitoring tests, and
and insulin activities
and insulin
administrati requirements involved in
on controlling
assessed. diabetes and
demonstrate
 Discuss proficiency in
importance of self-
 home serum  importance of monitoring
glucose and insulin
monitoring home serum administration
using glucose
reflectance
meter, and the monitoring
need for using
frequent
readings (at reflectance
least 4 meter, and the
times/day), as
indicated. need for
frequent
readings (at
least 4
times/day), as
indicated
discussed.
 Review
reasons why  reasons
oral
hypoglycemic explained
medications why oral
should be
avoided, to hypoglycemic
control medications
diabetes
 before should be
pregnancy.
avoided,
 Information
 Provide
provided
information
about action about action
and adverse
and adverse
effects of
insulin. effects of
insulin.
 Recommend
client maintain  Recommend
a diary of
client maintain
home
assessment of a diary of
serum glucose
home
levels, insulin
dosage, diet, assessment of
exercise,
serum glucose
reactions,
general levels, insulin
feelings of
dosage, diet,
well-being,
and any other exercise,
pertinent
reactions,
thoughts
general
 feelings of
well-being,
and any other
pertinent
 Assess
client’s/couple thoughts.
s knowledge
 Clients with
of disease
process and preexisting
treatment,
diabetes or
including
relationships GDM are at
between diet,
risk for
exercise,
illness, stress, ineffective
and insulin
glucose uptake
requirements
within the
cells, excess
utilization of
fats/ proteins
for energy,
and cellular
dehydration as
water draws
from the cell
by a
hypertonic
concentration
of glucose
within the
serum.
Pregnancy
alters insulin
requirements
drastically and
necessities
more intense
control,
requiring the
client/couple
to take a very
active role.
Informed
 decisions can
be made only
when there is
clear
 Discuss
importance of understanding
home serum
of both the
glucose
monitoring disease
using
process and
reflectance
meter, and the the rationale
need for
for
frequent
readings (at management.
least 4
 Frequent
times/day). As
indicated. blood glucose
Demonstrate
measurements
procedure,
then observe allow client to
return
recognize the
demonstration
by the client impact of her
diet and
 Review
reasons why exercise on
oral
hypoglycemic serum glucose
medications
levels and
should be
avoided, even promote
though they
tighter control
may have
been used by of glucose
the class A
levels
client, to
control  Although
diabetes
before insulin does
pregnancy cross the
placenta, oral
hypoglycemic
agents do and
are potentially
harmful to the
fetus.
necessitating a
change in
diabetic
management.
 Although
some clinical
 Provide sources report
information use of oral
about action agents in
and adverse clients with
effects of GDM is not
insulin. Assist recommended
client to learn during
administration pregnancy
by injection,  Prenatal
insulin pump, metabolic
or nasal spray changes cause
(experimental insulin
techniques) as requirements
indicated to change. In
the first
trimester,
insulin
requirements
are lower but
they double
and then may
quadruple
during second
and third
trimester
CUES/DATA NURSING NSG GOALS/ NURSING RATIONALE EVALUATION
DIAGNOSIS OBJECTIVES INTERVENTION
Subjective Data: Anxiety r/t outcome After 30 minutes of  To assess  patients level of After 30 minutes of
“Kubaan man ko of pregnancy and nursing intervention patients level of anxiety nursing
ma’am saniy health of unborn patient is able to: anxiety. assessed. intervention:
mahitabo sa ahong child as witnessed  Respond to
bata after naho by mother’s relaxation  To discuss with  To the ways to The patient is
manganak” frequent doubts techniques mother the ways improve relaxed and is no
about pregnancy with a to improve pregnancy longer experiencing
Objective Data: outcome. decreased pregnancy outcome like by anxiety attacks
 Decreased anxiety outcome like by regular
attention SCIENTIFIC level. regular antenatal check-
span BASIS:  Reduce own antenatal up , maintained
 Restlessness Anxiety is more anxiety checkup etc. blood glucose
 Feelings of than feeling anxious level. levels within
discomfort, about a specific  Be free normal range,
apprehension situation; it occurs from consuming
or when feelings of anxiety diabetic diet.
helplessness being anxious and attacks. discussed with
stressed don’t go mother
away, can’t be  To allow  mother allowed
controlled easily, mother to ask to ask questions
and come on questions and and ventilate
without any ventilate her her feelings
particular reason. feelings
Excessive worry
and the stress of  Assess  client’s/couple’s
anxiety can start to client’s/couple’s knowledge of
knowledge of disease process
have a serious disease process and treatment,
impact on your life. and treatment, including
including relationships
Source: relationships between diet,
https://www. between diet, exercise, illness,
pregnancybirthbaby. exercise, illness, stress, and
org.au/ stress, and insulin
insulin requirements
requirements. assessed.

 To involve  family members

family members involved in care
in care of the of the client.
client.
 To educate the  the mother
mother about educated about
maternal as well maternal as well
as fetal hazards as fetal hazards
of gestational of gestational
diabetes and diabetes.
hence educate
her to maintain
her serum
glucose levels
within normal
range.
 Maintain a  Anxiety is
calm, non contagious and
threatening may be
 manner while transferred from
working with health care
the client. provider to
client or vice
versa. Client
develops feeling
of security in
presence of
calm staff
person.

 Establish and  Therapeutic

maintain a skills need to be
trusting directed toward
relationship by putting the
listening to the client at ease,
client; because the
displaying nurse who is a
warmth, stranger may
answering pose a threat to
questions the highly
directly, anxious client.
offering
unconditional
acceptance;
being available
and respecting
the client’s use
 of personal
space.  The client will
 Maintain feel more secure
calmness in if you are calm
your approach and inform the
to the client. client feels you
are in control of
the situation.

 Helps relieve
 Provide anxiety.
reassurance and
comfort
measures.

CUES/DATA NURSING NSG NURSING RATIONALE EVALUATION

DIAGNOSIS GOALS/OBJECTIVES INTERVENTION
SUBJECTIVE: Ineffective peripheral After 1 hour of nursing  Assessed for  Particular Goal was met after
“Doc maglisod lage tissue perfusion intervention the client signs of clusters of signs 1 hour of nursing
kog ginhawa related to will be able to decreased and symptoms intervention as
usahay vasoconstrictive demonstrate: tissue
occur with evidenced by the
like dalia nako effects of nicotine perfusion.
differing causes. patient’s ability to:
pungahon unya taas  Patient
kayo aho BP” SCIENTIFIC BASIS: Evaluation of
identifies  Identify
OBJECTIVE: The chemicals factors that Ineffective
factors that
 Gray Lips in tobacco affect your improve Tissue Perfusion
improve
 Yellowish blood cells and how circulation defining
teeth your heart and blood
VITAL SIGNS: vessels function. This  Patient characteristics circulation
T: 36.7 can increase your risk identifies provides a
P: 110 of developing necessary  Identify the
baseline for need of
R: 21 atherosclerosis, a lifestyle future changing her
BP: 110/60 condition in which changes.
comparison. lifestyle
plaque builds up in  Patient exhibits because of
the arteries. growing  Assessed for  Early detection her
tolerance to probable of the source pregnancy
Source: activity. contributing
azuravascularcare.com facilitates quick,
factors
related to effective
temporarily management.
impaired
arterial
blood flow.
Some
examples
include
compartment
syndrome,
constricting
cast,
embolism,
indwelling
arterial
catheters,
positioning,
thrombus,
 and
vasospasm.

 Checked  Cardiac pump

respirations
malfunction
and absence
of work of and/or ischemic
breathing. pain may result
in respiratory
distress.
Nevertheless,
abrupt or
continuous
dyspnea may
signify
thromboembolic
pulmonary
complications.

 Checked  Electrolyte/acid-
rapid base variations,
changes or hypoxia, and
continued systemic emboli
shifts in
influence
mental
status. cerebral
perfusion. In
addition, it is
 directly related
to cardiac output

 Recorded  Stable BP is
BP readings needed to keep
for sufficient tissue
orthostatic perfusion.
changes Medication
(drop of 20
effects such as
mm Hg
systolic BP altered
or 10 mm autonomic
Hg diastolic control,
BP with decompensated
position heart failure,
changes).
reduced fluid
volume, and
vasodilation are
among many
factors
potentially
jeopardizing
optimal BP.
 Monitored  Indicators of
higher location or
functions, as
degree of
well as
cerebral
 speech, if circulation or
patient is perfusion are
alert. alteration in
cognition and
speech content.
 Submit  A variety of
patient to tests are
diagnostic
available
testing as
indicated. depending on
the cause of the
impaired tissue
perfusion.
Angiograms,
Doppler flow
studies,
segmental limb
pressure
measurement
such as ankle-
brachial index
(ABI), and
vascular stress
testing are
examples of
these tests.
 Checked for  Sufficient fluid
optimal fluid intake maintains
balance. adequate filling
Administer
pressures and
IV fluids as
ordered. optimizes
cardiac output
needed for tissue
perfusion.

 Noted urine  Reduce renal

output. perfusion may
take place due to
vascular
occlusion.

 Maintained  This ensures

optimal adequate
cardiac perfusion of
output. vital organs.
CUES/DATA NURSING NURSING GOAL NURSING RATIONALE EVALUATION
DIAGNOSIS AND OBJECTIVE INTERVENTION

SUBJECTIVE: Risk for infection After 4 hours of  Stated your  To gain trust After 4 hours of
related to inadequate nursing intervention, name to the nursing intervention,
“Doc sge lage kog
glycemic control the patient will be client and call the patient is able to:
kangihi nya kaon unya
able to: her by her name
dalia pajod ko uhawon  Identify and
doc ngano mana  Identify  Teached and  Hand hygiene is perceived
SCIENTIFIC BASIS:
normal rani?” interventions to promote good the single most learning needs
High blood sugar levels prevent/reduce risk hand hygiene. effective way in
 The patient is
can weaken a person's of infection. preventing the
able to know
OBJECTIVE: immune system transmission of
 Demonstrate what to do and
defenses. People who diseases.
 fasting blood have had diabetes for a techniques, not to do in her
Include the
sugar level lifestyle changes to case
long time may have patient’s so in
greater than or prevent
peripheral nerve teaching.
equal to 95 development of
damage and reduced
mg/dL or 105 blood flow to their infection.  Maintained  Increased
mg/dL. asepsis during glucose in the
extremities, which
IV insertion, blood creates an
 one-hour increases
excellent
the chance for infection. administration of
blood sugar medium for
medications, and
level greater immune
providing wound
than or equal dysfunction and
or site care.
to 180 mg/dL Source: for pathogens to
Rotate IV sites
or 190 mg/dL thrive.
apic.org as indicated.
  Provided  Urinary tract
catheter or infections are
VITAL SIGNS:
perineal care. more prevalent
T: 36.5 degrees Teach female in individuals
patients to clean with diabetes.
P: 88 bpm from front to Diabetes is a
R: 17 cpm back after predisposing
elimination. factor for
BP: 120/80 mmHg vaginitis, poor
perineal hygiene
increases the
risk of vaginitis
and can spread
through the
urinary tract
causing
infection.

 Provided  An impairment
meticulous skin or ineffective
care by gently peripheral
massaging bony circulation can
areas, keep skin place the patient
dry. Keep linens at risk for
dry and wrinkle- increased skin
free. breakdown and
 development of
infection.
 Facilitates lung
 Placed in semi-
expansion;
Fowler’s
reduces risk of
position.
aspiration.

 Encouraged
 Increase fluid
coughing or
intake to
deep breathing if
approximately
the patient is
3,000 mL per
alert and
day to increase
cooperative.
urinary flow and
Frequent
prevent stasis of
repositioning is
urine which
also
may increase
recommended.
susceptibility to
infection (i.e.,
urinary tract
infection).
Regular intake
of cranberry
juice can help in
inhibiting the
 adhesion of
pathogens to the
bladder wall and
impairing the
colonization.
 Administered
antibiotics as  Early treatment
indicated. may help
prevent sepsis
as patients with
diabetes are
more prone to
serious
infectious
diseases.
 HEALTH TEACHING PLAN CASE 1
LEARNING CONTENT LEARNING TIME LEARNING PROCESSING
OUTCOME METHODOLOGY ALLOTMENT MATERIAL QUESTION
Within 30 minutes 1.Welcome talk & 40 minutes composed  1 Laptop 1.How is Diabetes
of client/family introduction of the of:  1 Visual Mellitus different
teaching they will host. Host will  5 minutes Aid from any other
be able to: begin with a warm welcome talk types of diabetes?
 Define and  Definition welcome and small and
understand of the introduction about introduction 2. Can you explain
about her Gestational the topic and its  20 minutes on what way can
condition diabetes content. video you help your
which is presentation patient having this
having a 2.Discussion about and kind of condition?
GDM or the topic with discussion
Gestational regards to its  10 minutes of
Diabetes content demonstration
Mellitus  5 minutes for
 Describe the  Different 3.Video questions and
signs and signs and presentation to conclusion
symptoms symptoms present to the
of having of having a audience for better
this kind of Diabetes understanding
condition Mellitus
 Identifies  Steps on 4.Return
different how to demonstration
techniques teach the
and patient
necessary different
techniques
 lifestyle as well as a
changes new
lifestyle for
having a
Diabetes
Mellitus

DRUG STUDY FOR CASE I

NAME OF ROUTE & MODE OF INDICATIONS CONTRAINDICATIONS SIDE GENERAL
DRUG DOSAGES ACTION EFFECTS & NURSING
ADVERSE RESPONSIBILITIES
REACTIONS
Generic Name: Note: Insulin Acts via Diabetes Hypersensitivity to Occasional: Assess for
insulin requirements vary specific Mellitus insulin, use during Localized hypoglycemia (refer
dramatically receptor to episodes of redness, to pharmacokinetics
Brand Name: among pts, regulate hypoglycemia. Afrezza: swelling, table for peak times
Rapid acting requiring dosage metabolism of Chronic lung disease. itching (due to and
adjustment. Type carbohydrates, Cautions: Pts at risk for improper duration): cool, wet
Pharmacologic 1 Diabetes: protein, and hypokalemia; insulin skin, tremors,
Class: Multiple daily fats. Acts on renal/hepatic impairment, injection dizziness, headache,
Exogenous injections, guided liver, skeletal elderly. Afrezza: Must be technique), anxiety, tachycardia,
insulin. by glucose muscle, and used with a allergy to numbness in mouth,
monitoring or adipose tissue. long-acting insulin in type insulin hunger, diplopia.
Therapeutic continuous Liver: 1 diabetes. Not cleansing Assess sleeping pt for
Class: subcutaneous Stimulates recommended for use in solution. restlessness,
Antidiabetic. insulin infusions, hepatic diabetic Infrequent: diaphoresis. Check
is standard of glycogen ketoacidosis or in Somogyi for hyperglycemia:
care. Usual initial synthesis, smokers. Pts with active
dose: 0.2-0.6 synthesis of lung cancer, history of effect (rebound polyuria (excessive
unit/kg/day in fatty acids. lung cancer or hyperglycemia) urine output),
divided doses. Muscle: at risk for lung cancer. with polyphagia
Usual Increases chronically (excessive food
maintenance: 0.5– protein, excessive intake), polydipsia
1.2 units/kg/day glycogen insulin dosages. (excessive thirst),
in divided doses. synthesis. Systemic nausea/vomiting, dim
Type 2 Diabetes: Adipose allergic reaction vision, fatigue, deep
General goal is to tissue: (rash, and rapid breathing
achieve Hgb A1c Stimulates angioedema, (Kussmaul
less than 7% lipoproteins to anaphylaxis), respirations). Be alert
using safe provide free lipodystrophy to conditions altering
medication fatty acids, (depression at glucose
titration. Dual triglyceride injection site requirements: fever,
therapy synthesis. due to trauma,
(metformin and a Therapeutic breakdown of increased
second Effect: adipose tissue), activity/stress,
antihyperglycemic Controls lipohypertrophy surgical procedure.
agent) is serum glucose (accumulation Patient/family
recommended in levels. of subcutaneous teaching
pts who fail to tissue at • Instruct on proper
achieve glycemic injection site technique for drug
goals after 3 mos due to administration,
with lifestyle inadequate site testing of glucose,
interventions and rotation). Rare: signs/symptoms of
metformin Insulin hypoglycemia and
monotherapy. resistance. hyperglycemia.
Afrezza: Dosage • Diet and exercise
based on are essential parts of
metabolic needs,
blood glucose treatment; do not
results, glycemic skip/delay meals.
goal control. • Carry candy, sugar
packets, other sugar
Dosage in Hepatic supplements for
Impairment immediate response
Insulin to
requirement: may hypoglycemia.
be reduced. • Wear or carry
medical alert
identification.
• Check with
physician when
insulin demands are
altered (e.g., fever,
infection,
trauma, stress, heavy
physical activity).
• Do not take other
medication without
consulting physician.
• Weight control,
exercise, hygiene
(including foot care),
not smoking are
integral parts of
therapy.
• Protect skin, limit
sun exposure.
• Inform dentist,
physician, surgeon of
medication before
any treatment is
given
DATE/HOUR FOCUS PROGRESS NOTES

04/15/2021 Change of lifestyle to avoid complications D:

about her pregnancy
1:00 PM Patient verbalize that she is having hard
time to breath due to her smoking habit
VITAL SIGNS:
T: 36.7
P: 110
R: 21
BP: 110/60
A:
– Assessed for signs of
decreased tissue
perfusion.
– Assessed for
probable contributing
factors related to
temporarily impaired
arterial blood flow.
– Encourage the patient
to stop smoking
– Emphasize to the
patient the effects of
not smoking
R:
The client is able to identify factors that
improve circulation as well as the need of
changing her lifestyle due to her pregnancy
MALDO, MICAH JOYCE P. MS. ROSE BERTIA, RN
Student nurse CM-CN Clinical Instructor
DATE/HOUR FOCUS PROGRESS NOTES

16/04/2021 Anxiety r/t outcome of pregnancy and D:

health of unborn child as witnessed by
1 PM
mother’s frequent doubts about pregnancy
outcome.
Patient is anxious about what will happen
to her baby during and after the labor
 Decreased attention span
 Restlessness
 Feelings of discomfort,
apprehension or helplessness
A:
– assessed patients level of anxiety.
– discussed with mother the ways to
improve pregnancy outcome like
by regular antenatal checkup etc.
– Assessed client’s/couple’s
knowledge of disease process and
treatment, including relationships
between diet, exercise, illness,
stress, and insulin requirements.
– Maintained a calm, non-
threatening manner while working
with the client.
– Established and maintain a trusting
relationship by listening to the
client; displaying warmth,
answering questions directly,
 offering unconditional acceptance;
being available and respecting the
client’s use of personal space.
– Provided reassurance and comfort
measures.
R:
The patient is now relaxed and is no
longer experiencing anxiety attacks

MALDO, MICAH JOYCE P. MS. ROSE BERTIA, RN

Student nurse CM-CN Clinical
Instructor
CASE II ANSWER:

A.
1.Blood pressure: to monitor that no increase has taken place; should stay the same or decreased
Dipstick: hydration status (color, specific gravity), nutritional status (glucose), infection status 2(leukocytes), possible complications (protein)
Weight: appropriateness of gestational weight gain evaluated in relationship with BMI Dipstick tests show glycosuria and proteinuria
B.
First visit within first trimester (12 weeks), monthly visits weeks 16-28, every 2 weeks from week 29-36, weekly visits week 36-birth
C.
a. Blood type and Rh factor: blood draw, FIRST visit, identifies a woman whose fetuses are at risk for developing erythroblastosis fetalis or
hyperbilirubinemia in neonatal period
b. Antibody Screen blood draw, FIRST visit, identifies a woman whose fetuses are at risk for developing erythroblastosis fetal is or
hyperbilirubinemia in neonatal period; injection of Rh immune globulins during first trimester
c. Hct/ Hgb: blood draw, FIRST visit, only retest in high-risk or suspected women, detects anemia and infection; intervene with prenatal
vitamins and good nutrition
d. Rubella titer – blood draw, FIRST visit, determines immunity to rubella; give rubella vaccine if necessary
e. VDRL/RPR – blood draw, FIRST visit (repeated in third trimester for high risk
women), identifies women with untreated syphilis, treat syphilis
f. Hepatitis B – blood draw, FIRST visit, screens for specific antigen, whether positive or have definite exposure women should be given
vaccination serious ASAP
g. Pap Smear – physical assessment taking sample from cervix, FIRST visit, screens for cervical intraepithelial neoplasia, (if liquid also does
HPV)
h. Gonorrhea and Chlamydia culture – either from urine or sample from pap, FIRST visit (repeated in third trimester for high risk women),
identifies women with gonorrhea or chlamydia, treat the STI
i. Urinalysis/Urine culture sample of urine, FRIST visit and all subsequent, identifies women with glycosuria, renal disease, hyptertensive
disease of pregnancy, infection, occult hematuria, hCG for confirmation of pregnancy, asymptomatic bacteriuria; change in diet both food and
fluids
j. HIV screen blood draw, FIRST visit (repeated in third trimester for high risk women), screens for specific antigen, if mother is positive
treatment can be taken
k. Triple/Quad screen – State what each test includes and what potential risk condition for the fetus the test identifies. Screen for fetuses with
trisomy 21 and trisomy 18
Triple marker 16-18 weeks measures levels of 3 maternal serum markers: MSAFP, unconjugated estriol, and hCG
Quad screen: 16-18 weeks, all from tripel plus placental hormone inhibin A (increases accuracy of screening for Down syndrome in women less
than 35 years), elevated levels indicate possibility of down syndrome
l. Biophysical Profile (BPP)-noninvasive dynamic assessment of a fetus based on acute and chronic markers of fetal disease; includes AFV,
FBM, fetal movements, and fetal tone; physical examination of fetus; late second and third trimesters for testing, scored 8-10 normal, done after
32 weeks
m. Group Beta Strep (GBS) prenatal rectovaginal culture taken, screened 35-37 weeks
infection is associated with poor pregnancy outcomes; for positive IV antibiotic is given during labor
D.
First trimester no change in caloric intake, second trimester needs +340 kcal , third trimester
+452 kcal; recommendations are for singleton pregnancy (may be adjusted for multi), this is not
a large increase just 2 small servings of fruits or vegetables more
E.
Weight gain varies, recommended range of total weight gain for BMI <18.5 28-40lbs, 18.5-24.925-35lbs, 25-29.9 15-25lbs, >30 11-20lbs
F.
Medications have interactions, it is vital to report all medications taking and carefully read side effects/contraindications; all drugs have potential
to cross placenta and harm fetus.
Maternal alcoholism is associated with high rates of miscarriage and retal alcohol spectrum disorders
Cigarette smoking or secondhand smoke is associated with IUGR and an increase in perintal and infant morbidity and mortality, increased
frequency of preterm labor and low birth weight.
G.
Exercise well within your limit of tolerance, decrease weight-bearing exercises, avoid risky activities, exercise regularly (every day) 30 minutes
of medreate exercise, avoid becoming overheated, warm-up and stretch, cool-down, rest after for 10 minutes lying on your side, drink 2-3
glasses of water after exercise to replenish fluids, replace calories burnt.
 CUES/DATA NURSING NSG NURSING RATIONALE EVALUATION
DIAGNOSIS GOALS/OBJECTIVES INTERVENTION
Subjective Data: Anxiety related to After 30 minutes of  Monitor Vital  To obtain After 30 minutes of
Client verbalized hospitalization and nursing intervention Signs baseline nursing intervention
concern about upcoming delivery within our care, client data. the client was able
upcoming delivery process will manage anxiety  Assess level  Identify to:
and expresses with positive coping of anxiety areas of
worries about her SCIENTIFIC DATA: mechanisms as through verbal concern that  Maintained
child inside her Anxiety in pregnancy is evidenced by: and nonverbal might V/S within
womb. very common. More  V/S within cues. interfere normal
than 1 in normal range with the range
Objective Data: 10 pregnant women normal  Claimed
 Exhibit poor have it. Don't feel like  Acknowledge progress of that she is
eye contact you are a failure and discuss labor. worried
 Facial because you're not fears,  Employ a  Enhances about the
tension coping. Pregnancy can recognizing calm, caring, nurse client condition of
observed be a very emotional healthy vs. confident, and relationship. her baby
 Impaired experience and it can unhealthy fears non-  Verbalized
attention sometimes be difficult  Absence of judgmental that she is
noted to know whether your facial tension approach. capable of
 Appear s feelings are and improved  Allow client  Provides a delivering
preoccupied; manageable or a sign of attention span. to express healthy the baby
decreased something more Verbalizes fears and outlet of  Claimed
perceptual serious. control of the feelings of emotions excited to
field. situation anxiety and relieves see her baby
Source:  Verbalizes desi appropriately anxiety.  She claimed
www.tommys.org re to participate  Acknowledge  Adequate that she
in labor process normalcy of explanation trusts the
as tolerated fear and helps reduce nurses in the
 Expresses provide anxiety, hospital as
confidence in opportunity soothe fears, well as the
herself, her for questions and doctors
support person, and answer provides
and the honestly assurance.
healthcare within client’s
personnel. level of
Acquires understanding.  Provides
knowledge  Offer support feeling or
about childbirth by staying sense of
and is better with the security and
prepared to patient, trust
cope with patting her between the
future births arms, and nurse and
brushing a the patient.
whisp of hair
off her
forehead, and
provide a cool
cloth on her
forehead a s
needed.  Mechanism
 Administer of action is
anti- anxiety to relieve
medication as anxiety.
ordered by the
physician.  Provides
 Refer to ongoing and
support
 groups as timely
needed. support.
 Maintain  The client
calmness in will feel
your approach more secure
to the client. if you are
calm and
inform the
client feels
you are in
control of
the situation
 Provide  Helps
reassurance relieve
and comfort anxiety.
measures.

CUES/DATA NURSING DIAGNOSIS NSG NURSING RATIONALE EVALUATION

GOALS/OBJECTIVES INTERVENTION
SUBJECTIVE Disturbed sleep pattern Within 30 minutes of  Assess vital  Elevated After 30 minutes
DATA: r/t shortness of breath our care, the client will signs blood within our care, the
Patient verbalized and urinary frequency improve sleep pattern especially her pressure is client had improved
that she easily wakes as evidenced by: blood usually sleeping pattern as
up whenever she SCIENTIFIC DATA:  Absence of pressure level observed in evidenced by:
hears noise. Pregnant women may dark circles sleep
Furthermore, she experience more under eyelids disturbed  Absence of
reported frequent noticeable shortness of and frequent  Encourage client dark circles
awakenings during breath in the second yawning, the mother to  Voiding under eyelids
the night to go trimester. The growing before and frequent
bathroom due uterus commonly improved face void before bedtime may yawning as
increased urge to contributes to shortness expression sleeping limit the observed
urinate which of breath in the second  Verbalized sleep  Decrease
happened around trimester. understanding disturbance urinary
5times.She also on the cause of brought frequency
added that she finds it Source: sleep about by from 5 times
difficult to sleep https:// disturbance urinary each night to
sometimes because www.medicalnewstoday  Report frequency 3 times
she felt slight pain on .com/ increased sense  Provide a  A quiet  Report of
the area near her of well – being quiet environment rested and
buttocks due to the and feeling of environment promotes more relaxed
pressure she feels on rested conducive for continuation
her chest which  Report an sleeping of sleep
affects her breathing. increased without
number of disturbances
OBJECTIVE hours of sleep  Promote use  Promotes
DATA: of bedtime relaxation
 Sleepy eyed rituals such and readiness
noted as drinking a for sleep
 Dark circles glass of milk
under eyelid before
observed sleeping,
 Frequent taking a bath,
yawning reading a
noted book
 Teach client  Elevating the
Vital signs: to elevate head
T=37˚C head by promotes
RR=14 cpm using more lung
BP= 138/74 mmHg pillows expansion,
PR= 72 bpm during sleep being in a
or have her side – lying
 on side – position
lying position decrease the
pressure on
the chest wall
and vena
cava by the
 Assess the gravid uterus
patient’s  High
perception of Percentage of
the cause of sleep
sleep disturbances
difficulty and can affect the
possible client
relief
measures to
facilitate
treatment
 Observe and
obtain
feedback  This ensures
regarding the the client’s
usual degree of
sleeping sleep pattern.
pattern,
bedtime
routine, and
the usual
number of
hours of
sleep and
rest.
 Evaluate the
patient’s  The patient
knowledge of may have
the cause of insights
sleep about the
problems and existing
potential problems
relief (e.g., anxiety
measures to or fear about
facilitate a certain
treatment. situation in
life). This
data will
determine
appropriate
 Ensure the therapy
environment  To enhance
is quiet and the ability to
has a fall asleep.
comfortable
temperature
by providing.
 Explore other
sleep aids  This soothes
such as a and relaxes
warm bath or the client.
drinking Milk has an
milk. L-tryptophan
component
that promotes
sleep, as well
as wellness.
CUES/DATA NURSING DIAGNOSIS NSG GOALS/ NURSING RATIONALE EVALUATION
OBJECTIVES INTERVENTION
SUBJECTIVE Altered comfort: pain related Within 30 minutes of  Monitor vital  To obtain After 30 minutes
DATA: to abdominal or lumbar pain our care, client shall signs every 15 baseline data. within our care, the
Client verbalized related to progress of labor experience increased minutes for 2 client was able to:
excruciating pain on and delivery comfort as evidenced hours and 30  Maintained
the abdomen and by: minutes until v/s within
further stated that SCIENTEFIC BASIS: V/S within normal stable. normal range
the intensity of pain Low back pain could present range:  Assess  This is to  Verbalize pain
is increasing. as either a pelvic girdle pain T: 36.5-37.5 contraction monitor the within
between the posterior iliac PR: 60-100bpm patterns, progress of tolerable
OBJECTIVE crest and the gluteal fold or as RR: 12-20cpm bloody show labor and the limits.
DATA: a lumbar pain over and around BP: 110-140/60- and the degree condition of  Verbalize
 Rated pain the lumbar spine. The source 90mmHg of pain and its both the discomfort as
as 9 in a of the pain should be characteristics, mother and controlled
scale of 1 to diagnosed and differentiated  Within location, the baby. with non-
10; 10 being early.The appropriate tolerable severity, Helps to pharmacologic
most painful treatment aims to reduce the limits duration, and identify areas methods
while 1 discomfort and the impact on throughout the frequency. of chief  Rated pain as
being least the pregnant womans quality duration of concern, 8 in a scale of
painful. of life. This article reveals the labor providing 1 – 10
 Facial most common risk factors, as  Verbalize baseline for  Groaning, and
grimacing well as treatment methods, discomfort as future facial
noted which may help to alleviate controlled interventions. grimacing not
Abdominal the pain. with non-  Encourage  Left lateral noted.
guarding pharmacologic comfortable position  Responded to
noted Source: methods positioning increases questions and
 Restlessness https://www.ncbi.nlm.nih.gov/  Rates pain as venous return instructions
noted pmc/articles/PMC3306025/ < 8 in a scale and enhances appropriately.
especially of 1-10, 10 as placental
during the highest circulation.
exacerbation and 1 is the Position
of lowest. changes
contractions.  Absence of promote
expressive comfort ,
behaviors reduce
such as muscle
restlessness, tension,
moaning, relieve
sighing, pressure and
irritability, promote fetal
and facial descent.
grimacing  Teach proper  Proper
 Verbalize breathing breathing
desire to technique technique
participate in can prevent
labor as exhaustion,
tolerated therefore
 Responds to preventing
questions and prolonged
instructions delivery of
appropriately the fetus and
 Identifies need prolonged
for additional pain
pain relief  Inspect the  A full
measures as client’s bladder
tolerated. suprapubic contributes to
area and discomfort
palpate for and impedes
bladder fetal descent.
distention.
 Encourage the
client to void.  Helps
 Provide alleviate any
information anxiety and
and update fears that
client on labor may
progress exacerbate
pain.
 Mechanism
 Administer of action is to
analgesia as reduce pain.
ordered  To provide
 Refer to immediate
physician any medical
abnormalities intervention.
that may be
observed  The client’s
 The use of pain was
noninvasive lessened.
pain relief
measures can
increase the
release of
endorphins
and enhance
the therapeutic
effects of pain
relief me  The client
 Pain is a was able to
subjective verbalize to
experience characterize
and must be
 described by and locate
the client in the pain.
order to plan
effective
treatment
dications.

CUES/DATA NURSING DIAGNOSIS NSG NURSING RATIONALE EVALUATION

GOALS/OBJECTIVES INTERVENTION
SUBJECTIVE Energy Field disturbance Within 30 minutes of  Assessed pain,  Pain assessment After 30 minutes
DATA: related to increase anxiety our care, client will character, can provide clues within of our care,
or pain have improved skin locatin, about diagnosis, client had
Client verbalized, integrity as evidenced severity, and and be used to improved skin
“wa man ko kahibaw SCIENTIFIC BASIS: by: duration; used determine integrity as
if normal raba ning Hormonal changes during  a pain rating treatment required evidenced by:
aho ge pang bati sa pregnancy may affect the scale.
aho lawas ma’am chemicals in your brain.  Accepted  Pain is subjected
tungod raba nis This can cause client’s experience and
ahong hormones?” anxiety. Pregnancy is also description of cannot be felt by
a time of tremendous pain. other
OBJECTIVE change. Acknowledged
DATA: Some of these feelings the pain
 Confusion and sensations are experience and
 Restlessness welcomed, while others are convey
downright acceptance of
uncomfortable and scary. client’s
response to
Source: pain.
https://www.healthline.com  Monitor v/s  Slight increase of
every 4hrs RR could be
 resulted from the
 possibility pf
patient’s reaction
towards pain
 Review  Maybe helpful for
client’s management pain
previous control
experiences
with pain and
methods found
in the past
 Teach client  To maximize
and significant opportunities for
other about the self-control over
non- pain and
pharmacologic manifestation
ways to lessen
the pain
 Teach  Use of guided
patient to imagery has been
visualize or useful for reducing
fantasize about anxiety.
the absence of
anxiety or
pain,
successful
experience of
the situation,
resolution of
conflict, or
outcome of
procedure.
 Educate  If patient and
patient and family can identify
family about anxious responses,
the symptoms they can intervene
of anxiety. earlier than
otherwise.
 Provide  Music is a simple,
massage and inexpensive,
backrubs for esthetically
patient to pleasing means of
reduce alleviating anxiety.
anxiety.
 Tell the patient  Stimulants (e.g.,
to limit use of caffeine, nicotine,
central theophylline,
nervous terbutaline sulfate,
system amphetamines, and
stimulants. cocaine) can
increase physical
symptoms of
anxiety.
 Explain all  With preadmission
activities, patient education,
procedures, patients experience
and issues that less anxiety and
involve the emotional distress
patient; use and have increased
nonmedical coping skills
terms and because they know
calm, slow what to
speech. Do expect. Uncertainty
this in advance and lack of
 of procedures predictability
when possible, contribute to
and validate anxiety.
patient’s
understanding.

CUES/DATA NURSING DIAGNOSIS NSG NURSING RATIONALR EVALUATION

GOALS/OBJECTIVES INTERVENTION
SUBJECTIVE Disturbed Body mage related 30 minutes within our  Assess  Give patient After Within our
DATA: to change of appearance care, client shall accept readiness to sense of care, client had
associated with pregnancy body image as accept control over accepted her body
Client verbalized that manifested by: changes in situation image as evidenced
she feels sad about SCIENTIFIC BASIS: body image by:
the sudden change of a patient's world view or  Express  Employ a  Improves
her appearance body image adversely positive feeling calm, caring, nurse-client  Expressed
impacts the provision of towards self confident, and relationship. positive
health care and others non- feeling
Source:  Verbalize judgmental towards self
https://www.ncbi.nlm.nih.gov acceptance of approach. and others.
/pmc/articles/PMC2911009/ body image  Discuss with  Creates a  Verbalized
 Perceived mother sense of trust acceptance of
pregnancy in a physiologic at the same body image:
positive light changes time educate “Ok na man
during mother about ako pagkita
pregnancy changes sa ako
during kaugalingon”
pregnancy  Perceived
 Allow pt to  To create a pregnancy in
express positive outlet a positive
feelings of emotions light and
 towards her claimed she
pregnancy  Help is excited to
 Teach pt overcome see her baby.
coping maladaptive
strategies: behaviors
Preparing for
upcoming
deliver and
Provide
literary
articles about
pregnancy  Adolescents
 Assess the and young
result of body adults may be
image individually
disturbance in affected by
relation to the changes in the
patient’s structure or
developmental function of
stage. their bodies at
a time when
developmental
changes are
normally
rapid and at a
time when
developing
social and
intimate
relationships
is particularly
important.
  There is a
 Evaluate the broad range of
patient’s behaviors
behavior associated
regarding the with body
actual or image
perceived disturbance,
changed body ranging from
part or totally
function. ignoring the
altered
structure or
function to
preoccupation
with it.
 Negative
 Evaluate the statements
patient’s about the
verbal affected body
remarks about part may
the actual or indicate
perceived limited ability
change in to integrate
body part or the change
function. into the
patient’s self-
concept.
 Acceptance of
 Acknowledge these feelings
and accept as a normal
expression of response to
feelings of what has
 frustration, occurred
dependency, facilitates
anger, grief, resolution. It
and hostility. is not helpful
Note or possible to
withdrawn push patient
behavior and before ready
use of denial. to deal with
situation.
Denial may be
prolonged and
be an adaptive
mechanism
because
patient is not
ready to cope
with personal
problems.
 Experiencing
 Recognize the stages of grief
normalcy of over loss of a
response to body part or
the actual or function is
perceived normal and
change in typically
body structure involves a
or function. period of
denial, the
length of
which varies
among
individuals.
DATE/HOUR FOCUS PROGRESS NOTES

04/15/2021 Disturbed Body mage related to change of D:

appearance associated with pregnancy
1PM Patient verbalize that she is conscious about her
image due to her pregnancy
A:
– Assess readiness to accept changes in
body image
– Discuss with mother physiologic
changes during pregnancy
– Allow pt to express feelings towards
her pregnancy
– Assess the result of body image
disturbance in relation to the patient’s
developmental stage.
R:
The client is able to accept and expressed
positive feelings about herself and others

MALDO, MICAH JOYCE P. MS. ROSE BERTIA, RN

Student nurse CM-CN Clinical Instructor
DATE/HOUR FOCUS PROGRESS NOTES

04/15/2021 Anxiety related to hospitalization and D:

upcoming delivery process
1 PM Patient verbalize concern about upcoming
delivery and expresses worries about her child
inside her womb
A:
– Assess level of anxiety through verbal
and nonverbal cues.
– Allow client to express fears and
feelings of anxiety appropriately
– Administer anti- anxiety medication as
ordered by the physician.
– Maintain calmness in your approach to
the client.
– Provide reassurance and comfort
measures.
R:
Patient is able Verbalized that she is capable of
delivering the baby and claimed excited to see
her baby
MALDO, MICAH JOYCE P. MS. ROSE BERTIA, RN
Student nurse CM-CN Clinical Instructor

LEARNING CONTENT LEARNING TIME ALLOTMENT LEARNING PROCESSING

OUTCOME METHODOLOGY MATERIAL QUESTION
Within 30 minutes of 1.Welcome talk & 30 minutes composed – 1 Laptop – Is it
client/ family introduction of the of: – 1 Speaker necessary to
teaching they will be host and introduction – 5 minutes know the
able to: of the topic welcome talk different
2. Discussion of the and nutrition
1. Know the – Definition of topic regarding with introduction needed to
benefits of all the different its content – 15 minutes have a
the procedures 3. Video presentation for the healthy
procedures that has to be for the audience for discussion of pregnancy as
done during done and its better understanding its topic well as a
the patients benefits – 5 minutes baby?
prenatal care – Instruction video – What kind of
2. Know what are to be presentation exercises are
to do during discussed – 5 minutes for good for the
and after the that need to question and pregnant
pregnancy to be followed conclusion women that
have healthy in order to cannot
baby have a endanger the
3. Know the healthy baby?
proper pregnancy – What are the
healthy diet – A well activities or
balanced diet food that a
during is mandatory pregnant
pregnancy taught to woman
have a good should
brain avoid?
development
and birth
weight
 DRUG STUDY

NAME OF ROUTE & DOSAGES MODE OF INDICATION CONTRAINDICATIO SIDE GENERAL

DRUG ACTION S NS EFFECTS & NURSING
ADVERSE RESPONSIBILITIE
REACTIONS S
Generic Anemia IM/IV/SQ/PO: Stimulates Anemia Contraindications: Side effects Intervention/evaluati
Name: ADULTS, ELDERLY, production of Prevention of Hypersensitivity to folic None known. on Assess for
Folic acid CHILDREN 4 YRS AND platelets, Neural Tube acid. Cautions: Adverse therapeutic
OLDER: 0.4 mg/day. RBCs, Defects Anemias (aplastic, effects/toxic improvement:
Brand Name: CHILDREN YOUNGER WBCs in normocytic, pernicious, reactions improved sense of
Apo-Folic THAN 4 YRS: Up to 0.3 folate refractory) when Allergic well-being, relief
mg/day. INFANTS: 0.1 deficiency anemia present with hypersensitivit from iron deficiency
Pharmacolog mg/day. anemia. vitamin B12 deficiency. y occurs symptoms (fatigue,
ic Class: PREGNANT/LACTATI Therapeutic rarely with shortness of breath,
Vitamin, NG WOMEN: 0.8 Effect: parenteral sore tongue,
water mg/day. Prevention of Essential for form. Oral headache, pallor).
soluble. Neural Tube Defects nucleoprotei folic acid is Patient/family
PO:WOMEN OF n synthesis, nontoxic. teaching • Eat foods
Therapeutic CHILDBEARING AGE: maintenance rich in folic acid,
Class: 400–800 mcg/day. of normal including fruits,
Nutritional WOMEN AT HIGH erythropoiesi vegetables, organ
supplement. RISK OR FAMILY s. meats.
HISTORY OF NEURAL
TUBE DEFECTS: 4
mg/day