Charisse Arriane C.

Belasoto BSN 2-E

CASE STUDY 5 – QUESTIONS

1. Why is it important to breastfeed immediately after birth? Does breastfeeding help with
postpartum?

Breastfeeding should be started as soon as possible to ensure that infants obtain

colostrum, or "first breastmilk," which includes antibodies that protect the child from
disease. Breastfeeding in the first hour of life reduces the risk of sepsis, pneumonia,
diarrhea, and hypothermia in newborns. Breastmilk delivers just the right amount of
nourishment for a baby's growth and development. Colostrum, or breastmilk generated
within the first few days after delivery, is high in nutrients and immunological
components that help protect the baby from infection.

When your baby nurses, oxytocin is released, which helps your uterus contract
and reduces post-delivery blood loss. Breastfeeding also aids the mother's uterus in
returning to normal size sooner, at roughly six weeks postpartum, versus ten weeks if she
does not. Breastfeeding mothers also have less cases of postpartum depression, according
to studies. Breastfeeding mothers had a lower chance of having PPD, and the effects
lasted for the first four months after delivery. PPD may reduce breastfeeding rates,
implying a reciprocal link between these variables.

2. What is breast engorgement? What caused breasts engorgement after delivery?

Breast engorgement is a condition in which the breasts swell and become

uncomfortable and tender. It happens in the initial days after childbirth and is caused by
an increase in blood flow and milk supply in the mother's breasts. Your breasts may grow
stiff and puffy, making breastfeeding difficult for your kid. Breast enlargement can be
addressed at home. Breast engorgement is the result of increased blood flow in the
breasts in the days after the delivery of a baby. The increased blood flow helps the breasts
make ample milk, but it can also cause pain and discomfort. It's possible that milk
production won't start until three to five days after the baby is born. If you continue to
breastfeed, it may recur at any time. Mastitis (blocked milk ducts and infection of the
breast) can result from severe engorgement. Antibiotics are required to treat mastitis.

3. What are your management for breast engorgement?

For those who are breastfeeding, treatments for breast engorgement include:

 To encourage milk let down, apply a warm compress or take a warm shower.
Charisse Arriane C. Belasoto BSN 2-E

 Feedings should be more frequent, at least every one to three hours.

 For as long as the infant is hungry, continue breastfeeding.
 massaging the breasts while nursing
 To alleviate pain and swelling, apply a cold compress or ice pack.
 alternating feeding positions to drain milk from all areas of the breast
 alternate breasts at feedings until the baby's supply is depleted
 When a woman is unable to nurse, she can express her milk by hand or with
the use of a pump.
 Using pain relievers prescribed by a doctor

For those who don’t breastfeed:

 reducing swelling and inflammation with a cold compress or ice packs

 taking pain medicine that has been prescribed by a doctor
 wearing a supportive bra that keeps your breasts from sliding around too
much

4. What is the level of the fundus after delivery? How do you check fundus after delivery?

The top section of the uterus, known as the fundus, is midline and palpable
halfway between the symphysis pubis and the umbilicus immediately after delivery. The
fundus is solid and at the level of the umbilicus by one hour after delivery. Palpate the
uterine fundus after birth to determine the uterine size, hardness, and rate of descent,
which is measured in fingerbreadths above or below the umbilicus. The uterus should feel
firm and should feel about the size of a grapefruit for the first few days. The uterus
shrinks at a rate of one centimeter every month. Each day It can no longer be felt above
the pubic bone by day ten. These can be fairly painful, but providing a hot compress will
typically help. After-pains are common after nursing, especially in moms who have
previously given birth. By the third day, they are generally over. You will most likely
need to pass urine if your fundus is positioned above your navel.

5. Determine the amount and characteristic of lochial discharges. Is it scanty, moderate or

heavy? Explain the 3 stages of postpartum bleeding:
a. Lochia Rubra
b. Lochia Serosa
c. Lochia Alba

Lochia has a dark red color for the first three days following delivery, which we
call Lochia Rubra. A few tiny blood clots, about the size of a plum, are common. The
lochia will be waterier and more pinkish to brownish in hue from the fourth through tenth
Charisse Arriane C. Belasoto BSN 2-E

day following delivery, which is known as lochia serosa. The Lochia Alba is the lochia
that is creamy or yellowish in color from approximately the seventh to tenth day after
delivery until the fourteenth day after delivery. When a woman gets up in the morning, is
physically active, or is breastfeeding, she may notice an increase in lochia. Cesarean
section mothers may have less lochia after 24 hours than vaginal delivery mothers.
Within 4 to 6 weeks following delivery, the bleeding usually ceases. The first few days
after the baby is born, postpartum bleeding is the most intense. As time goes by the blood
flow will lighten and eventually one will experience occasional spotting of blood. As
time passes, the blood flow will become lighter, and spotting of blood will become more
common.

6. What are the types of episiotomy? What is the reasons/rationale of performing

episiotomy? What are possible complications of episiotomy?

During labor, an episiotomy was thought to help prevent more extensive vaginal
tears and heal faster than a natural tear. The technique was also supposed to assist protect
the pelvic floor's muscular and connective tissue support. The midline (median) incision
and the mediolateral incision are the two forms of episiotomies. A vertical midline
incision is made. Although a midline incision is easier to repair, it runs the danger of
spreading into the anal area, whereas a mediolateral incision is made at an angle.
Episiotomy is used to shorten labor, aid in vaginal delivery, and the delivery of a large
baby, minimize tearing, relieve pressure on the fetal head, enlarge the route, and replace a
zigzag cut with a clean cut. The main disadvantage of a midline episiotomy is the
increased risk for tears that extend into or through the anal muscles. Painful future sexual
intercourse, infection, swelling, hematoma (blood accumulation at the site), spilling of
gas or feces owing to tearing of rectal tissue, and bleeding are all possible risks of
episiotomy. Episiotomy recovery is uncomfortable, and sometimes the surgical incision is
more extensive than a natural tear would have been. Infection is possible. For some
women, an episiotomy causes pain during sex in the months after delivery. Fourth-degree
vaginal tearing, which spreads beyond the anal sphincter and into the mucous membrane
that lines the rectum, is a concern with a midline episiotomy. Fecal incontinence is a
potential side effect.

7. What are some common postpartum complications? Enumerate and discuss briefly.
a. Infection or sepsis - After a woman delivers birth, bacteria invade the uterus and
surrounding tissues, causing a puerperal infection.
Charisse Arriane C. Belasoto BSN 2-E

b. Cardiomyopathy - Peripartum cardiomyopathy is a heart muscle weakness that

develops during the last month of pregnancy and lasts for about five months after
delivery, with no other known cause. It usually happens shortly after delivery.
c. Thrombotic pulmonary embolism - Blood clots that migrate to the lungs from the
legs often cause a blockage in one of the pulmonary arteries in the lungs. Women
who have had blood clots, varicose veins, or deep vein thrombosis are at a higher
risk of pulmonary embolism when pregnant than the general population.
d. Hemorrhage - When a woman has severe bleeding after giving birth, it is known
as postpartum hemorrhage (also known as PPH). When more than 1000 mL of
blood is lost during or after a vaginal or cesarean delivery, a PPH occurs.
e. Preeclampsia - Preeclampsia is a hypertensive condition of pregnancy marked by
high blood pressure (Systolic blood pressure greater than or equal to 140mmHg
OR Diastolic blood pressure greater than or equal to 90mmHg) and proteinuria.
f. Mastitis - Mastitis is a condition in which an infection develops in the breast
tissue. One breast becomes enlarged, red, and inflamed as a result of the
uncomfortable disease. It can affect both breasts in rare situations. Mastitis is a
noncancerous (benign) breast condition.

8. Assess emotional state of the patient after delivery. Discuss & explain the following
a. What is post-partum depression and ‘baby blues”? How long does it last?
b. What are the causes of post-partum depression and how can it be prevented?

The patient was accommodating and attentive, and she was confident in her
ability to care for the newborn. She also follows directions, as indicated by her
willingness to provide perinatal care as directed and her eagerness to care for her
newborn.

In the days following childbirth, up to 70% of women experience the "baby

blues." The mother's mood fluctuations could be extreme, with her feeling extremely
joyful and then extremely sad. She may cry for no apparent cause and experience
feelings of impatience, irritability, restlessness, anxiety, loneliness, and sadness. The
newborn blues can persist anywhere from a few hours to up to two weeks following
delivery. Postpartum depression (PPD) can strike days, weeks, or even months after a
baby is born. PPD can strike at any time following the birth of a child, not just the
first. The mother may experience sentiments comparable to those experienced by the
baby, such as melancholy, despair, anxiety, and crankiness, but she does so much
more intensely. PPD frequently prevents a woman from accomplishing the things she
needs to do on a daily basis. When one's capacity to function is harmed, she should
see a doctor, such as her OB/GYN or primary care physician.

Some things that can raise the chances of postpartum depression include:
Charisse Arriane C. Belasoto BSN 2-E

 Prior to getting pregnant, or throughout pregnancy, you may have

had a history of depression.
 Age at the time of conception (the younger you are, the higher the
chances)
 Uncertainty about the pregnancy
 Children are the future (the more you have, the more likely you are
to be depressed in a later pregnancy)
 Mood disorders run in the family
 Going through a traumatic incident, such as a job loss or a health
issue
 Having a child with special needs or who suffers from health
issues
 Having twins or triplets
 Having a history of depression or premenstrual dysphoric disorder
(PMDD)
 Limited social support
 Living alone
 Marital conflict
 Hormones. After you give birth, your estrogen and progesterone
levels drop dramatically, which could have an impact. Other
thyroid hormones may also drop dramatically, leaving you feeling
weary, sluggish, and sad.
 Lack of sleep. When you're sleep deprived and overloaded, even
simple issues can be difficult to handle.
 Anxiety. You might be worried about being able to care for a
newborn.
 Self-image. You might be less beautiful, have identity issues, or
feel like you've lost control over your life. Postpartum depression
can be caused by any of these factors.

9. What are the physiologic changes during post-partum?

The uterus undergoes two stages of involution. To prevent hemorrhage, the region
where the placenta was inserted is first sealed off. Second, the organ is shrunk down to its
pre-pregnancy size. A uterine cervix feels soft and flexible to the touch shortly after birth.
Both the internal and external operating systems are accessible. Contraction of the cervix
toward its prepregnant state begins at the same time as contraction of the uterus. The
vagina feels velvety and has few rugae after a vaginal birth, and its diameter is much
larger than typical. The hymen is permanently damaged and heals in little, distinct tissue
tags. The vagina takes the entire postpartum period to involute (by contraction, just like
the uterus) and eventually return to its pre-pregnancy state. The ovaries' fresh estrogen
Charisse Arriane C. Belasoto BSN 2-E

stimulation appears to be necessary for wall thickening. The perineum is edematous and
painful immediately after birth due to the high amount of pressure experienced during
birth. As soon as the placenta is no longer present, pregnancy hormones begin to decline.
Because the body collects as much as 2,000 to 3,000 ml of surplus fluid
throughout pregnancy, diaphoresis (excessive sweating) and diuresis (excess urine
production) occur practically immediately after birth to rid the body of this fluid. During
the second to fifth days after delivery, this readily boosts a postpartal woman's daily urine
production from a typical level of 1,500 ml to as much as 3,000 ml/day. The bladder fills
up quickly as a result of this significant increase in pee production. Hemorrhoids
(distended rectal veins) that have been pushed out of the rectum due to pelvic-stage
pushing are frequently found. Because the influence of relaxin (a hormone that softens
and lengthens the cervix and pubic symphysis in preparation for the infant's delivery
during pregnancy) on the bowel is still present, stool movement through the intestine may
be delayed.
Stretch marks on a woman's abdomen (striae gravidarum) remain reddish after
birth and may be much more noticeable than they were during pregnancy, when they
were stretched taut. These will often fade to a pale white in a White woman during the
next 3 to 6 months; in a Black woman, they may stay as patches of slightly deeper
pigment. By 6 weeks, excess pigment on the face and neck (chloasma) and the abdomen
(linea nigra) will be hardly visible. If diastasis recti (abdominal musculature
overstretching and separation) has occurred, the area will look as a slightly indented
bluish streak in the midline of the abdomen. Modified sit-ups help to build abdominal
muscles and restore pre-pregnancy abdominal support. Diastasis recti, on the other hand,
may necessitate surgery to rectify.
Charisse Arriane C. Belasoto BSN 2-E

Drug Name Classification Mechanism Indication Contraindication Adverse Nursing

of action Reaction responsibility

Co- Amoxiclav Amoxiclav -It destroys  -is -Is -side effects -Check doctor’s
Generic name: is an bacteria by indicated contraindicated of co- order
AMOXICILLIN antibiotic disrupting for short - in patients amoxiclav Assess for
and works their ability term with a history of are diarrhoea allergy to any
Trade name: by killing to form cell treatment hypersensitivity , thrush and ingredient.
Augmentin bacteria that walls. - of bacterial to beta-lactams, feeling or
cause Clavulanic infections at e.g. penicillin’s being sick. -Educating the
Dosage: infection acid blocks the and Co-amoxiclav Client about the
625 mg the following cephalosporin’s liquid can Medications
mg 1 tablet BID for chemical sites when - in patients stain teeth. Self-
7days defence, caused by with a previous Administration
known as amoxicillin- history of Procedures
Route: beta- clavulanate amoxicillin-
Oral lactamase sensitive clavulanate-
that some organisms associated
Frequency: bacteria jaundice/hepatic
1 tablet a day for 7 have dysfunction.
days against
penicillin’s.

10. Make a Drug Study

 Charisse Arriane C. Belasoto BSN 2-E

Drug name: Classification Mechanism of Indication Contraindicati Adverse Nursing

action on Reaction responsibility

Generic Mefenamic It works by To prevent -Increased risk NSAIDs- -Check

Name: acid is in a stopping the painful of bleeding ulcers, doctor’s order
Mefenamic class of body's conditions due to clotting bleeding, or assess for
Acid medications production of such as disorder. holes in the allergy to any
called NSAIDs a substance arthritis, stomach or ingredient.
Trade name: that causes pain -High blood intestine.
Ponstel pain, fever, associated pressure.
and with heavy
Dosage: inflammation. menstrual Chronic heart
500 mg/1 bleeding failure.
capsule every and pain
6 hours. after
surgical
per orem operations.
 Charisse Arriane C. Belasoto BSN 2-E

Drug Classification Mechanism of Indication Contraindication Adverse Reaction Nursing

Name action responsibility

Obimin Vitamins & This product Calcium If the patient is -Omega-3 Fatty -Educating the
Plus Minerals for pregnant Supplement allergic to any Acids: Rare minor Client About
(Pre & Post and component of side effects that Medications
Natal) / lactating women A pre- and the product. have been reported
Generic Antianemics has vitamins, postnatal after consumption of -Review pertinent
name: 1 to 3 grams per day data prior to
minerals and supplement
of omega-3 fatty medication
N/A the omega-3 to help acids include mild administration
fatty acids, DHA provide gastrointestinal (contraindications),
Trade and EPA to help adequate upset such as nausea lab results,
provide supply of and diarrhea, allergies, potential
name:
adequate supply vitamins, halitosis (bad interactions)
N/A of nutrients minerals breath), eructation
essential during and omega- (belching) and
Dosage pregnancy and 3 fatty "fishy" smelling
lactation: Folic acids, DHA breath, skin and
:
urine.
1 tablet acid, vitamins and EPA
B6 and B12:
OD for -Zinc: Gastrointestin
Folic acid is al side effects such
1 necessary for as nausea and
month the prevention vomiting are seen
of neural tube with doses of
-Per defects (NTDs) elemental zinc
Orem greater than 30 mg.

Iron: Doses of
elemental iron
greater than 120 mg
per day may cause
gastrointestinal side
effects such as
nausea, vomiting,
bloating, and upper
abdominal
discomfort. Other
undesirable effects
may include black
stools, diarrhea or
constipation.
 Charisse Arriane C. Belasoto BSN 2-E

Drug Name Classification Mechanism Indication Contraindication Adverse Nursing responsibility

of action Reaction

Generic name: Iron  Iron This If the patient - -Educate client about
Ferrous sulfate supplement combines medication cannot tolerate Constipation medications
with is an iron the
Trade name: porphyrin supplemen gastrointestinal - Diarrhea. - Educate client on
Femiron, and globin t used to side effects, - Dark medication self-
Hemocyte, Iron chains to treat or they may take it stools. administration
form prevent with small procedures
hemoglobin, low blood amounts of -Feeling or
Dosage: which is levels of food. Avoid being sick
1 tablet OD for 1 critical for iron (such taking it (nausea or
month oxygen as those with milk, vomiting),
delivery caused by calcium, and stomach
from the anemia or antacids, high pain or
Route: lungs to pregnancy). fiber foods, or heartburn.
Per orem other Iron is an caffeine.
tissues. Iron important
deficiency mineral
causes a that the
microcytic body needs
anemia due to produce
to the red blood
formation of cells and
small keep you in
erythrocytes good
with health.
insufficient
hemoglobin.
 Charisse Arriane C. Belasoto BSN 2-E

Drug Name Classification Mechanism of Indication Contraindicati Adverse Nursing

action on Reaction responsibility

Generic name: - - -Following -Should not -Blood in -Educate client

methylergonovine Methylergono Methylergono delivery of use the urine. on medication
vine belongs vine is used to the methylergono self-
Trade name: Methergine to a class of prevent or placenta, vine if you - Change administration
drugs treat bleeding for routine are allergic to in skin procedures
Dosage: called ergot from the manageme it, or if you color.
1 tablet 3 times a day alkaloids. uterus that can nt of have high - Difficult -Administer and
for 9 days happen after uterine blood or labored document
childbirth or atony, pressure; breathing. medications
Per orem an abortion. hemorrhag toxemia of given by
e, and pregnancy; or. - Fast, parenteral routes
subinvoluti If your baby pounding,
on of the has not yet or - Evaluate
uterus. For been born. irregular appropriateness
control of heartbeat and accuracy of
uterine -Ergot alkaloid or pulse. medication order
hemorrhag hypersensitivit for client
e in the y -
second Methylergono Lighthead
stage of vine is edness,
labor contraindicate dizziness,
following d in those with or
delivery of known ergot fainting.
the alkaloid
anterior hypersensitivit
shoulder. y.
Hypertension,
hypertensive
crisis,
intraarterial
administration
stroke
Methylergono
vine use is
contraindicate
d in patients
with
hypertension. 
 Charisse Arriane C. Belasoto BSN 2-E

11. Identify at least 2 nursing problem and make Nursing Care Plan.

NURSING CARE PLAN

Name of Patient: Belle Impression/Diagnosis:

Age & Sex: 21, Female Ward/Bed:

DEFINING NURSING OUTCOME NURSING RATIONALE EVALUATION

CHARACTERISTIC DIAGNOSIS IDENTIFICATION/ INTERVENTION
S OBJECTIVE

SUBJECTIVE: LONG TERM: INDEPENDENT:

Discomfort claimed Impaired After nursing Encourage Prevents Goals were met
by the client that comfort intervention, the continuation of discomfort of after nursing
strengthens during related to patient will identify breastfeeding as engorgement; intervention.
breastfeeding due to uterine appropriate methods client’s condition promotes Patient was able
uterine contraction. contraction as to provide relief permits. Otherwise adequacy of to verbalize
evidenced by from pain. suggest and provide milk supply relief from pain
occasional instruction in the use in and discomfort.
cramping of manual or electric breastfeeding
breast pump. client.

OBJECTIVE: RATIONALE: Provide instruction

SHORT TERM: regarding, and assist Promotes
T = 37.2°C Cramping After an hour of with, maintenance of sense of
PR = 79 bpm after the baby nursing cleanliness and general well-
RR = 19 bpm is born due to intervention, the warmth. being and
BP = 110/70 mmHg uterine patient will enhances
contractions verbalize relief from healing.
occur because pain and discomfort Alleviates
uterus shrinks and understands the discomfort
back down to reasons for the associated
its original discomfort. with chills.
size. Change client’s
Breastfeeding position frequently.
strengthens Provide comfort Reduces
discomfort measures; e.g., back muscle
due to the rubs, linen changes. fatigue,
oxytocin promotes
released that relaxation and
initiates Encourage the comfort.
uterine woman to ask for
contractions. pain medications
before the pain
Charisse Arriane C. Belasoto BSN 2-E

becomes Pain is a lot

severe/intolerable. easier to
NOTE: control before
Nursing it becomes
Diagnosis Apply local heat severe.
should be using heat lamp or
based on the sitz bath as indicated.
(NANDA –
Approved
Nursing Heat
Diagnosis) promotes
vasodilation,
increasing
DEPENDENT: circulation to
the affected
Administer pain area and
medication as promoting
prescribed. localized
comfort.
COLLABORATIVE
:
Labs:
Hematology,
CBC, Urinalysis Decreases
pain and
anxiety;
Helps
promote
relaxation.
 Charisse Arriane C. Belasoto BSN 2-E

NURSING CARE PLAN

Name of Patient: Belle Impression/Diagnosis:

Age & Sex: 21, Female Ward/Bed:

DEFINING NURSING OUTCOME NURSING RATIONAL EVALUATIO

CHARACTERISTIC DIAGNOSIS IDENTIFICATION INTERVENTION E N
S /
OBJECTIVE

SUBJECTIVE: LONG TERM: INDEPENDENT:

Patient complaining Pain related to After nursing Assess Emergency Goals were met
of moderate pain at a mediolateral intervention, the psychological causes situations after nursing
scale of 6/10 pain episiotomy as patient will identify of pain and may intervention.
scale on episiotomy. evidenced by appropriate discomfort. precipitate Patient was
slightly methods to provide fear, anxiety able to
bruised and relief from pain. which can verbalize relief
swollen raise from pain and
perineum and perception of discomfort.
a 6/10 pain pain and
scale as discomfort.
OBJECTIVE: claimed by Perform pain
the patient assessment by This will help
T = 37.2°C SHORT TERM: identifying the type, in differential
PR = 79 bpm After an hour of location, diagnosis and
RR = 19 bpm nursing characteristic, in
BP = 110/70 mmHg intervention, the severity, and determining
RATIONALE patient will duration of the pain. the applicable
: verbalize relief Use a pain scale of treatment
An from pain and 0-10; method.
episiotomy is discomfort.
an incision Encourage the use of
made in the relaxation To assist the
perineum — techniques (e.g., client in
the tissue deep breathing exploring
between the exercise) methods for
vaginal the control of
opening and pain.
the anus — Provide comfort
during measures such as Ice compress
childbirth. application of ice decreases
The stitches pack into the edema and
may make it perineum, use of sitz minimizes
painful to sit bath or heat lamp to hematoma
or walk for a episiotomy and pain
Charisse Arriane C. Belasoto BSN 2-E

little while extension. sensation

during while heat
healing. It promotes
also can be vasodilation
painful when which
one coughs or facilitates
sneezes DEPENDENT: resorption of
during the hematoma.
Administer pain
healing time.
medication as
NOTE: prescribed.
Nursing Decreases
Diagnosis pain and
should be anxiety;
based on the Helps
(NANDA – COLLABORATIVE promote
Approved : relaxation.
Nursing Labs:
Diagnosis) Hematology,
CBC, Urinalysis