Antepartum Case Study

THE COLLEGE OF MAASIN
“Nisi Dominus Frustra”

College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
LEARNING ACTIVITIES (Clinical Simulation/ Exploration and Application)

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.

Formula: Answer:
1) Add 7 days to last LMP. Last Menstrual Period: December 15 th, 2020
• Jan 15th + 7 days= Jan 22nd
2) Subtract 3 months • January 22nd – 3months = September 22nd 2021

3) Add a year
2. Define gravida, para, primigravida, and multipara.
• Gravida- the number of times a woman is or has been pregnant
• Para- number of pregnancy or pregnancies
• Primigravida- first pregnancy of a woman
• Multipara- a woman that who has given birth two or more times
3. What is Mrs. Cruz’ gravida and para, utilizing the GTPAL system?
Gravidity- 6
Term Births- 2
Preterm Births- 0
Abortions- 3
Living Children- 2
4. List four factors that place Mrs. Cruz in a high risk pregnancy category and identify why they are risks.
 Overweight or Obese- Obesity and excessive gestational weight gain may cause gestational diabetes mellitus. Also overweight can
cause complications such as high blood , preeclampsia problems that may place Mrs. Cruz in a high risk pregnancy.
 Cigarette use- smoking while pregnant puts both Mrs. Cruz and her unborn baby at risks. Cigarettes contains dangerous chemicals
and it may increases the risk of pregnancy complications which can be fatal for Mrs.Cruz or the baby. It also can cause a miscarriage
or stillbirth
 Multiple Pregnancies- Having five or more pregnancies increases the risk of labor and excessive bleeding after delivery
 Old- Maternal age- in maternal age, older than 25 years old is an established risk factor for preeclampsia and gestational diabetes.
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.
5.1. 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.
5.1.1. Uterus- During pregnancy, as the baby grows, the woman size of the uterus will increase. Uterus increases in size until the 38weeks of
pregnancy after the funds level starts to decend and prepare for delivery
5.1.2. Urinary System- The smooth muscle of the renal pelvis and ureter become relaxed and dilated, residual urine volume will increase and
also kidneys increase in length and ureters become longer. It also increase the water retention causes reduction of plasma osmolality
5.1.3. Heart and Circulatory System- increases heart rate, increases renal and uterine blood flow and increases blood volume, capillary
hydrostatic pressure
5.1.4. Digestive System- increases in gastric pH and reduced gastrointestinal motility. Nausea and vomiting in the morning are symptoms of
pregnancy. As pregnancy progresses, pressure from enlarging uterus on the rectum and the lower part of the intestine may cause
constipation
5.1.5. Respiratory System- increased vascularity and edema of upper respiratory mucosa.
5.1.6. Breast- the breasts will enlarge in size because of the hormones are preparing the breasts milk production
5.2. 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.
 Nausea and vomiting- is also called morning sickness because symptoms most severe in the morning. Nausea and vomiting may be due
to the changes in hormone level during pregnancy. Eating small meals several times a day may help lessen the symptoms and a diet high
in protein and carbohydrates may help reduce severity of nausea
 Headaches- hormonal changes may cause of headaches during pregnancy. To manage this discomfort is to take rest, proper nutrition and
adequate fluid intake may help ease headache symptoms
 Breast tenderness- breasts enlarge in size, can be quite tender and may feel uncomfortable
 Heartburn and indigestion- it is caused by pressure on the stomach and intestines. It cab be reduced by eating small meals throughout
the day and not lying down right after eating
 Stretch marks- stretch marks are generally caused by a rapid increase in weight during pregnancy and it will usually fade after having a
baby.
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 true anemia or a pseudoanemia?
Mrs.Cruz hematocrit is normal because normal values of hematocrit is determined from 36 to 48 percent for women in childbearing age.
7. Briefly summarize psychological responses or behaviors seen in each trimester as a woman adjusts to pregnancy.
The psychological changes during pregnancy is associated with changes in psychological functioning or behavior changes of pregnant women.
During in each trimester there are different kinds of symptoms that pregnant women will be having or experience. Body undergoes many
changes
FIRST TRIMESTER (WEEK 1 TO WEEK 12)
 Morning sickness
 Cravings
 Headache
 Weight Gain/ Loss gain
 Mood changes
SECOND TRIMESTER (WEEK 13 – WEEK 18)
 Stretch marks (thighs, breasts ,abdomen)
 Swelling on the ankles, fingers and face
 Body aches
 Numb
 A line on the skin running from belly button to public hairline

THIRD TRIMESTER (WEEK 29- WEEK 40)
 Heartburn
 Breast Tenderness
 Contractions, which can be a sign for labor
 Trouble sleeping
 Shortness of breath
8. Make at least five (5) NURSING CARE PLAN for Mrs. Cruz.
PATIENT’S NAME: Mrs. Cruz AGE: 37y/o MARITAL STATUS: Married

DIAGNOSIS: RISK FOR MATERNAL INJURY RELATED TO MATERNAL AGE AS EVIDENCED BY MRS. CRUS IS 37 YEARS OF
AGE
CUES/DATA NURSING NSG GOAL AND INTERVENTIONS RATIONALE EVALUATION
DIAGNOSIS OJECTIVES
Subjective Data: : Risk for maternal After 4 hours of  Establish  To promote After 4 hours pf
Nahadlok ko ug injury related to nursing intervention, rapport cooperation nursing care, the goal
nabalaka if delikado maternal age as the patient will be  Assess  To determine was met as evidenced
napud akong evidenced by Mrs. able to: general status patient’s by:
pagbuntis karon Cruz is 37 years of of the patient condition
tungod sa akong edad age a) Patient  Review  To check for Patient was able to
na guwang-guwang identifies history of preference of identified and
na” as verbalized by factors that previous complications understood the risk
the patient increases the pregnancies factors that may
risk for injury  Monitor vital  To establish contribute injury
Scientific Basis: b) Explains signs baseline data
Objective Data: methods on  Assess  To determine
 37y/o Individuals are preventing environmental that may
 Fatigue vulnerable for injury from injury factors that causes injury
 Restlessness of health conditions, may lead to
health problems due injury
Vital Signs: to the individual risks  Validate  To let the
T- 37.3c of pregnancy patient’s patient know
P- 80bpm feeling and the nurse has
R- 18cpm SOURCE: concerns understand

BP- 110/70 mmHg Nurse’s Pocket Guide related the her concerns
10th edition risks of her
pregnancy
 Note maternal  Maternal age
age above 30yrs
old is
associated
with
increased
risks in
pregnant
adolescents
 Inform  Being aware

accurate and about their
honest condition
information
about their
condition
DIAGNOSIS: ANXIETY RELATED TO HEALTH COMPLICATIONS ABOUT THE CONDITION OF HER PREGNANCY
DIAGNOSIS OJECTIVES
Subjective Data: Anxiety related to After 8 hours of  Interact with  The patients After 8 hours of
Patient stated “ dili health complications nursing intervention, patient in a feeling of nursing care, the goal
mawala akong about the condition the patient will be peaceful stability was met, the patient
kabalaka ug akong of her pregnancy able to report anxiety manner increases in was relaxed and
nerbyos about sa diminished and have calm anxiety reduced
akong condition managed as  Assess patient  Different level
karon naa gamay Scientific Basis: manifested by a level of of anxiety will
complictions ug dili Individual relax appearance anxiety affect the
sab mawa sa aho experience anxiety coping
huna-huna sa can be a result of mechanism of
nahitabo sa akong fear, uncertainty client
mga previous circular and the  Instruct to do  This may help
pregnancy” avoidance of certain deep client to relax
behavior due to breathing
individual condition  Avoid  Reassurance is
necessary not helpful for
Objective Data: SOURCE: assurance anxious
 Restlessness Nurse’s Pocket individual
 Trembling Guide 10th edition  Provide  It may can
 Voice patient with a alleviate
Quivering means to anxiety
listen music
Vital Signs: or use of
T- 37.3c gadgets
P- 80bpm  Encourage  It can help

R- 18cpm patient to talk perceive the
BP- 110/70 mmHg about what situation
she’s feeling realistically
 Assist patient  Using anxiety
in developing reduction
anxiety- strategies
reducing enhances
skills patient sense of
confidence
 Accept  If defenses are
patient’s not threatened,
defenses; do the patient may
not dare, feel secure and
argue or protected
debate
 Establish a  An ongoing
working relationship
relationship establishes a
with the basis for
patient comfort in
through communicating
continuity of anxious
care feelings
 Provide  Helps client to
accurate identify what
information is reality based
about the
situation
DIAGNOSIS: IMBALANCED NUTRITION RELATED TO MORE THAN BODY REQUIREMENTS SECONDARY TO GESTATIONAL
DIABETES
DIAGNOSIS OJECTIVES
Subjective Data: Imbalanced nutrition After 8 hours of  Weigh patient  Weight gain After 8 hours of
Wala ko maka related to more than nursing intervention, each prenatal is the key nursing care the goal
control sa akong diet body requirements the patient will be visit index for was met
karong pagbuntis kay secondary to able to: deciding
overweight ko sa gestational diabetes calorie Patient has a progress
akong timbang as evidenced by a) Attain adjustment toward desired
karon” as verbalized overweight desirable  Assess  Stress can outcome and
by the patient body weight understanding elevate serum verbalized
with optimal of the effect glucose understanding about
Scientific Basis: maintenance of stress on levels, the importance body
Objective Data: of health diabetes creating weight self-
 Overweight The prevalence of b) Verbalize during fluctuations in monitoring
(190lbs) overweight and understanding pregnancy insulin needs
 5’2 height obesity may develop of individual
 BMI-34.7 conditions such as needs for self-  Set  Patient may
diabetes mellitus, monitoring appropriate lose interest
Vital Signs: cardiovascular short-term & in the whole
T- 37.3c disease. It may put long term process w/o
P- 80bpm individuals at a high goals short-term
R- 18cpm risk of diseases. goals
BP- 120/60 mmHg  Encourage  Water helps
water intake in the
elimination of
SOURCE: byproducts of
Nurse’s Pocket Guide fat breakdown
10th edition  Provide  Obese
information individual
regarding may be
specific deficient in
nutritional needed
needs nutrients
 Discuss  To support
eating continuation
behavior. of behavioral
Develop changes
appetite-
reduction plan
 Adjust diet or  Prenatal
insulin metabolic
regimen to needs change
meet throughout
individual the trimesters,
needs and
adjustment is
determined by
weight gain
 Identify ways  Promotes

to manage relaxation o
permit focus
tension during on act of

meals eating and
awareness of
satiety
 Educate  Permanent
patient about lifestyle
adequate changes must
nutritional occur for
intake weight loss to
be long
lasting
 Allow and  It helps
encourage reduce weight
patient to and light
adopt an exercise is
exercise such important for
as walking pregnant
five times a women
week
DIAGNOSIS: RISK FOR FETAL INJURY RELATED TO FETAL-MATERNAL OXYGEN TRANSFER SECONDARY TO SMOKING
CESSATION
CUES/DATA NURSING NSG GOAL AND NURSING RATIONALE EVALUATION
DIAGNOSIS OBJECTIVES INTERVENTIONS
SUBJECTIVE Risk for fetal injury After 8 hours of  Assess and  Alternation of After nursing care
DATA: related to fetal- nursing interventions, monitor the vital signs of interventions, the
maternal oxygen the patient will be vital signs of the mother goal was met
“ Mo smoke ko ug transfer secondary to able to: the mother and the fetus
makahurot ko about 1 smoking cessation and the fetus from normal
½ cigarettes karon sa a) Verbalize values may
akong pagbuntis” as understanding indicate that
verbalized by the Scientific Basis: the risk there is
patient Individuals that factors of something
involve cigarette use smoking wrong of the
may develop risk of during mother
OBJECTIVE DATA: health problems and pregnancy  Assess  To check or
 Smokes 1 ½ other health disease b) Demonstrate electronic continuously
pack per day such as cancer, lung techniques on fetal assess FHR
 Bad breath disease, heart disease quitting monitoring
 Yellowish and may cause smoking  Provide  Facilitates
teeth problems of the information understanding
immune system due truthfully and retention
Vital Signs: to the use of to information
T- 37.3c cigarettes.
P- 80bpm  Educate  Smoking
R- 18cpm patient about during
BP- 120/60 mmHg the risk of pregnancy
smoking for increases the

SOURCE: both mother risk of health
Nurse’s Pocket Guide and the baby problems for
10th edition developing
babies
 Encourage the  Smoking

patient to harms the
avoid the use fetus and it
of cigarettes can cause
health
problems for
both mother
and the baby
 Assist patient  It helps

in stopping patient on
and help them planning how
plan on how to slowly quit
to slowly stop and
the use of understand
cigarettes why it’s
important to
quit
 Advise about  It will reduce

the benefits of the risk of
quitting complications
smoking in pregnancy
& to have
healthier
pregnancy
and healthier
baby
 Educate  To have a
patient about healthy
adequate pregnancy
enough and a healthy
nutritional baby
intake
DIAGNOSIS: RISK FOR INFECTION RELATED TO CIGARETTE USE DURING PREGNANCY

CUES/DATA NURSING NURSING GOAL INTERVENTIONS RATIONALE EVALUATION
DIAGNOSIS AND
OBJECTIVES
Subjective Data: Risk for infection After 8 hours of  Assess  To know After nursing care
relate to cigarette use nursing interventions, patient’s patient’s interventions, the
“Mo smoke ko ug during pregnancy the patient will be motivation to eagerness and goal was met as
makahurot ko about 1 able to: stop willingness to evidenced by:
½ cigarettes” as stop smoking
verbalized by the Scientific Basis: Identify interventions Patient was able to
patient An individual is at to prevent or reduce  Advise to quit  Quitting identified
increased risk for risk for infections smoking interventions that
Objective Data: invaded by an reduce their may reduce the risk
 Smokes 1 ½ opportunistic agent Stable vital signs risk for of infections
pack such as bacteria , within normal range infection
 Yellowing of various infectious cardiovascular Vital signs are
teeth from endogenous or disease and stabled
 Bad breath, exogenous sources reduces the
dark lips risk of
pregnancy
Vital signs: complications
T-37.0c SOURCE:
P- 70bpm Nurse’s Pocket  Discuss  To have
R- 15cpm Guide 10th edition patient about awareness
BP- 110/70mmHg the main risk about the
factors for effects of
smoking and
infection of risk for

smoking infection
 Discuss the  Smoking can

role of cause
respiratory infections in
infections respiratory
tract, digestive
and other
system in
human
 Involve in  To increase
appropriate awareness of
community prevention of
education infections
programs
 Assist patient  Quitting

and help smoking
motivate in improves the
slowly health and
quitting increases
respiratory
capacity
 Encourage  Help support

intake of immune
protein-rich system
and calorie- responsiveness
rich foods
DRUG STUDY
DRUG NAME ROUTE AND MODE OF INDICATIONS CONTRA- SIDE NURSING
DOSAGES ACTION INDICATIONS EFFECTS/ADVERSE INTERVENTIONS
EFFECTS
Generic Name: Adults : Acts as a This medication Hypersensitivity, Side Effects: Baseline Assessment:
metformin PO: 500 mg metabolic is to treat chronic heart  Weight loss  Questions for
orally once daily inhibitor and diabetes. It is failure, metabolic history
with evening alters both used to decrease acidosis with or GI Tract: allergies,
Brand Name: meal every 12 whole-body hepatic (liver) without coma,  Nausea and especially to
Glucophage hours or 850mg and cellular glucose diabetic vomiting this medication
Glucophage XR orally once/day energy production, to ketoacidosis  Anorexia
Fortamet meals; increase metabolism. It decrease GI (DKA), severe  Diarrhea Intervention/
Glumetza dose in is primarily glucose renal disease,  Bloating/ Evaluation:
Riomet increments of used in absorption and to abnormal abdominal  Monitor urine
500mg/week or patients with increase target creatinine distention or serum levels
850mg ever 2 diabetes cell insulin clearance resulting  Constipation frequently to
Therapeutic weeks on the mellitus and its sensitivity. This from shock, determine
Class: basis of main medication is a myocardial CNS: effectiveness
Biguanides glycemic control mechanism of treatment infarction and of drug and
 Chills, dizziness
and tolerability action in this indicated as an lactation dosage
 Headache
disease setting adjunct to diet,  Arrange for
Pharmacological Give extended- is inhibition of exercise, and transfer insulin
Class: release tablets hepatic lifestyle changes therapy during
Adverse Effects:
Antidiabetic whole. Do not gluconeogenes such as weight periods of high
 Heartburn
break, crush, is loss to improve stress
dissolve / divide glycemic (blood  Stomach
(infections,
sugar) controls in pain/cramping
surgery)
Pregnancy / adults with type 2  Muscle pain  Use IV if

Lactation: diabetes.  Indigestion severe
Insulin is drug hypoglycemia
of choice during occurs as a
pregnancy. result of
Distributed in overdose
breastmilk in  Be alert for
animals superinfection:
fever,
vomiting,
diarrhea, etc
Patient/Family
Health Teaching:
 Tell patient to
take this
medicine with
meals to avoid
gestational
problems
 Prescribed diet
is principal
part of
treatment, do
not skip, delay
meals
 Diabetes
requires
lifelong
control
 Avoid alcohol

EFFECTS
Generic Name: Adults : Blocks alpha1- Management of Hypersensitivity to Side Effects: Baseline Assessment:
labetalol PO: beta2- (large hypertension. IV labetalol. Bronchial  Questions for
Give w/o regard dose) fore sever asthma, history of history
to food adrenergic hypertension. obstructive airway GI Tract: allergies,
Brand Name: Tablets may be receptor sites. disease,  Nausea and especially to
Apo-Labetalol crushed OFF-LABEL: cardiogenic shock, vomiting this medication
Trandate Therapeutic Management of uncompensated  Diarrhea  Assess BP,
100mg twice Effect: slows preeclampsia, HR, second- or  Abdominal apical pulse
daily. Adjust in sinus heart; severe third degree heart discomfort before drug
Therapeutic increments of decrease hypertension in block, severe  Constipation administration
Class: 100mg twice peripheral pregnancy, bradycardia,  Question
Beta-andrenergic daily q2-3 days. vascular hypertension condition CNS: history of
blocked, alpha- Usual dose: resistance, B/P during acute associated with  Chills, dizziness bradycardia,
adrenergic 100-300mg ischemic stroke, severe prolonged  Headache HF, 2nd or 3rd
blocker twice daily. May pediatric hypertension  Anxiety degree heart
require up 2,400 hypertension block
 Insomnia
mg/day
MUSC: Intervention/
Pharmacological Evaluation:
 Weakness
Class:  Monitor BP
Antihypertensive for
RESPI:
 Dyspnea hypotension
 Assess pulse
quality,
irregular rate,
bradycardia
Adverse Effects:  Assist with
may precipitate, ambulation if
aggravate HR due to dizziness
decreased myocardial occurs.
stimulation, chest pain,  Assess for
diaphoresis, evidence of
palpitations, headache, HF: dyspnea
tremor, tachycardia,  Monitor I&O
optic nerve infarction
Patient/Family
Health Teaching:
 Do not
discontinue
drug except
upon advice of
physician
 Compliance
with therapy
regimen is
essential to
control
hypertension,
arrhythmias
 Report SOB,
excessive
fatigue, weight
gain,
prolonged
dizziness,
headache
 Limit alcohol
HEALTH TEACHING PLAN

TOPIC
Learning Outcome Content Learning Time Allotment Learning Material Processing Question
Methodology
After 1 hour of health Introduce self and the April 16, 2021 Visual aids such as 1) Ask the
teaching the patient, purpose for this 9:00am – 10:00am marker, cartolina, and patient about
the patient will be health teaching plan scotch tape their prior
able to: learnings
about the
safety and
healthy
pregnancy
Knowledge: Audio and visual
Gain awareness and  Discuss the Discussion 30 minutes presentation
knowledge about the importance of
safety and healthy having 2) Have you
pregnancy regular gain more
prenatal care knowledge
or prenatal about the
check-ups safety
 Safety practices
practices for a during
healthy pregnancy?
pregnancy;
perform light
exercises such
as walking /
stretching 3) Why is it very

during important for
process of the mothers of
pregnancy having
 The health regular
needs for prenatal care
pregnancy and the risk
such as intake factor for not
of essential having any
and nutritious prenatal care?
food with
emphasis of
fruits and
vegetables 4) Give some
examples or
reasons why
the cigarette
Understand and  Discussion Discussion and cite 30 minutes use,
identify the high risk about the realistic common overweight
pregnancy and risks factor of situation to better and multiple
understand why they cigarette use understand the pregnancies
are risk during lecture or lesson are high risks
pregnancy in pregnancy?
 The risk for
mother’s
who’s
overweight
and risk for 5) What are your

multiple opinions
pregnancies about the
 Discuss why lecture that
they are risk are being
for taught?
pregnancies
and for their
baby’s health
Case No. 2
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.
1. 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?
It is important to do these tests every time you visits your clinic and see your doctor so the doctor can check if your pregnancy is normal or there
might be complications or life threatening health issue. Also, it monitors health issue of the mother and the unborn baby. Early in pregnancy,
performing a limited physical exam and obtaining a Blood Pressure, Weight, and Urine dipstick is essential for a pregnant women. It determines
fetal orientation. In weight, typical weight gain during pregnancy provides nourishment to your developing baby and also is stored for
breastfeeding after delivery. Too much gain weight leads to weight concerns during pregnancy. Obtaining urine dipstick helps to know bladder
infections, dehydration, diabetes and preeclampsia by screening for high levels of sugars, proteins, ketones, bilirubin, evidence of infection and
blood. In blood pressure, it is important to pregnant women to regularly check for signs and symptoms of high blood pressure. Screening tests
are included in the urine dipsticks are:
 Acidity
 Concentration
 Protein
 Sugar
 Ketones
 Bilirubin
 Evidence of infection and blood.
2. Assuming Mary Lou has an uncomplicated pregnancy, what will be the routine schedule for her prenatal visits to the health care
provider?
For uncomplicated pregnancy, Mary Lou should see a health care provider for her prenatal visits every four weeks through her 28 weeks
pregnancy. Between 28 weeks to 36 weeks, she should expect to her health care provider every two weeks for prenatal care checkups and
weekly visit from
36 weeks to her delivery. Prenatal care visits is important for both the mother and the baby’s health.
3. 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.
3.1. Blood type and Rh factor- this will identify whether the blood cells carries the Rh factor protein. Rh testing is performed because
the difference Rh blood group types between a Rh negative and Rh positive.
3.2. Antibody Screen- antibody screening is done to detect antibodies directed against red blood cells antigens. Also, identifies a woman
whose fetuses are at risk for developing complications in neonatal period
3.3. Hct/ Hgb- this test is most often done between the 24th and 28th weeks of pregnancy. This tests is to determine the presence of
anemia, a white blood cells count to determine any infection and a platelet count to estimate clotting ability
3.4. Hepatitis B- this is to determine whether a woman is protected against these diseases that may lead into complications during
pregnancy.
3.5. Pap Smear- pap smears identifies vaginal infections and inflammation. It is mainly used to screen for cervical cancer
3.6. Urinalysis/Urine culture
3.7. HIV screen- Human immunodeficiency virus testing determines whether if you are infected with HIV virus. HIV testing is
important for pregnant women because they can pass the disease to their babies during pregnancy or delivery or through breast
feeding
3. 8. Biophysical Profile (BPP) - this test is to measure the health of the baby or fetus during pregnancy. A BPP tests may include a non-
stress test with electronic fetal heart monitoring. It also measures the baby’s heart rate, muscle tone, breathing, movement and the amount
of amniotic fluid around the baby
4. 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?
Eating a balance and healthy diet can prevent gaining too much weight and can prevent getting any complications during pregnancy.
Consuming the right number of calories, about 1,800 calories per day during the first trimester of pregnancy and about 2,200 calories per day
during the second trimester and 2,400 calories per day during the third trimester. Pregnant women is obliged to eat nutritious food such as
vegetables, fruits, dairy products and other food that has proteins. Also consume fats and sweets sparingly. So mothers will be healthy during
her pregnancy and for her baby to be healthy too.
5. What are the recommended guidelines for weight gain during each trimester?
The amount of weight you gain during pregnancy is important for the health of your pregnancy and for the long-term health of you and for the
baby. For women of average weight before pregnancy, with a BMI of 18.5 to 24.9, the recommended weight gain is 25 to 35 pounds. For
underweight, should gain 28-40 pounds. And for overweight, need to gain 15 to 25 pounds during pregnancy.
First Trimester- about 1,800 calories per day
Second Trimester- about 2,200 calories per day
Third Trimester- about 2,400 calories per day
6. What will you teach her about risks of medications, alcohol, and smoking during pregnancy?
• I will teach her about the risks of medications, alcohol and smoking cigarettes during pregnancy can affect her child’ health and drinking
in pregnancy can lead to long-term harm to the baby. And the more the mother drinks, the greater the risk. Also drinking alcohol can
passes through the placenta and can affect the baby’s development that can lead to premature birth, low birth weight and impact on the
physical and mental development of the child. Smoking or using of cigarettes while your pregnant can damage both of your health and
baby’s health, it can cause miscarriage, premature birth, or other complications defects for both mother and the baby. It is important to
avoid this risks It is important for pregnant women to avoid this risks for them to be healthy and minimize any complications during
pregnancy.
7. 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?
There are some activities or physical exercises that are safe for pregnant women such as walking, yoga, water workouts, low- impact
aerobics. These exercises can help reduce backaches, risk of getting pregnancy complications such as preeclampsia and gestational diabetes.
Also it can prevent gaining excess weight, manage stress and it can promote muscle tone and strength. I would engage Mary Lou in doing
some exercises 5 times a week so her pregnancy will be healthy and lower the risks of pregnancy. Also it benefits both for her and her baby
and prepare Mary Lou’s body for her labor and delivery.
LEARNING EXTENSION:
Suppose you are having daily home visits to the 2 clients. In your 3-day duty, you are required to document your care for Mrs. Cruz and
Ms. Sanchez. Formulate FDAR (Focus-Data-Action-Response) per day for each of the cases. Be sure to indicate vital signs and comprehensive
data using your own clinical judgment.
PATIENT’S NAME: SANCHEZ, MARY LOU AGE: N/A MARITAL STATUS: MARRIED
DIAGNOSIS: DEFICIENT KNOWLEDGE RELATED TO LABORATORY TESTS DURING PRENATAL VISITS AS EVIDENCED BY
SHE REALIZED THAT HER WEIGHT, BP AND URINE WERE TESTED DURING EACH APPOINTMENT
DIAGNOSIS OBJECTIVES
SUBJECTIVE Deficient After 4 hours of  Establish  To promote After 4 hours of
DATA: knowledge related nursing interventions, rapport cooperation nursing care, the
“Wala ko kahibalo to laboratory tests the patient will be goal was met as
og kasabot ngano during prenatal able to:  Explain to the  To know or evidenced by:
everytime sa akong visits as evidenced patient about understand why
prenatal care or by she realized that a) Verbalize the tests is it tested Patient had
prenatal visit kuhaan her weight, BP, and understanding understand about the
man kog ihi, BP, ug urine were tested about the tests  Assess ability  Cognitive tests during prenatal
e measure sab nila during each taken during to learn or impairments visits
ako weight” as appointment each prenatal perform need to be
verbalized by the visits desired health identified to an
patient related care appropriate
teaching plan
Scientific basis:
OBJECTIVE A deficit in  Determine  To know what
DATA: knowledge is priority of needs to be
 Confusion commonly learning needs discussed and
 Lack of experienced by the within the what to
source of individuals coping overall care prioritize in
information with unfamiliar plan teaching
information,
Vital signs: treatment, condition  Provide clear,  Able to ask

T-37.0c and often complex and questions and
P- 80bpm problems due to understandable understand of
R- 18cpm lack of knowledge explanation these tests
BP-130/90mmHg about their about the tests during prenatal
condition during each visit
prenatal visit
SOURCE:
Nurse’s Pocket  Encourage to  Learners often
Guide 10th edition ask questions embarrasses/shy
about asking
questions
 Discuss to  To check if
patient why there might be a
weight, BP health problems
and urine were for both patient
taken or tested and baby
during each
prenatal
 Document
progress of  This allows
teaching and additional
learning teaching based
on what
learners have
understand and
completed
DIAGNOSIS: ANXIETY RELATED TO LACK OF KNOWLEDGE ABOUT PREGNANCY AS EVIDENCED BY PATIENT IS

PRIMIGRAVIDA
Subjective Data: Anxiety related After 4 hours of  Assess pts level of  Identify area of After nursing care
“ nahadlok kog to lack of nursing anxiety through concerns of interventions, the
nabalaka if kaya knowledge about interventions, the verbal and process of goal was met as
raba kaha ni naho ug pregnancy as patient will be able nonverbal cues pregnancy evidenced by:
wala ko kahibaw evidenced by pts to:
unsay dapat nakong is primigravida  Monitor vital  To obtain baseline Patient was
buhaton or e a) Verbalize signs data relaxed and able
maintain para reduce of  Interact with a  Enhances nurse to reduced
healthy ako Scientific Basis: anxiety calm, confident client relationship anxiety.
pgbuntis” as Individual b) Expresses and a peaceful and pts feeling of Maintained stable
verbalized by the pt experience understanding manner stability vital signs:
anxiety and fear and  Acknowledgement T-37.0c
of the process of confidence in  Recognize of pts feelings P- 78 bpm
Objective Data: pregnancy herself awareness of validates the R- 18cpm
 Observed condition due to c) Maintain vital anxiety feelings and BP-130/90mmHg
worried primigravida signs at acceptance of their
expressions lack of normal level concerns
 Poor eye knowledge about of range
contact pregnancy  Allow to express  To validate pts
 Trembling processes. pts concerns concerns
 Primigravida
Vital Signs:  Acknowledgement  It helps reduce

T-37.0c of normality of anxiety and
P- 80bpm feeling’s anxiety understand about
R- 18cpm about first time feelings of anxiety
BP-130/90mmHg experience of
pregnancy
 Provides feeling
 Offer support by of sense of
staying with the security and trust
patient, and be between nurse and
active listeners patient
 Helps client to
 Provide accurate identify what is
information about reality based
situation
DIAGNOSIS: FEAR RELATED TO INVASIVE PROCEDURE DURING HOSPITALIZATION OF UPCOMING LABOR

Subjective Data: Fear related to After 8 hours of  Assess the  This After nursing care
invasive procedure nursing care behavioral and information interventions, the
“ mahadlok ko puhon during interventions, the verbal provides a goal was met as
sa akong paglabor ug hospitalization of patient will be able expression of foundation for evidenced by:
pagpanganak samot upcoming labor to: fear planning
kay first time ni interventions Diminished fear, pt
nako,” as verbalized Used relaxation to support pts able to relax.
by the patient techniques to reduce coping Vital signs are stable
fear strategies within normal range
Objective Data: Scientific Basis: Stable vital signs  Evaluate the  Helps
 Sweat Fear is distressing within normal range: measures the determine the
 Pale emotion caused by T- 37.0c pt practices to effectiveness
 Primigravida impending of danger P- 80bpm cope with fear of coping
or pain. Most R- 18cpm strategies
Vital signs: common fears of BP- 130/90 used by
T-37.3c individuals are pain patient
P- 95bpm and bodily injury due
R-21cpm to their conditions or  Open up  Validates the
BP- 120/70mmHg problems. awareness feelings the
about fear patient is
holding and
demonstrate
SOURCE: recognition of
Nurse’s Pocket those feelings
Guide 10th edition
 Tell patient  This
that fear is reassurance
normal places fear
appropriate within the
response for field of
her situation normal human
experience
 Maintain a  Pts feeling of

relaxed and stability
accepting increases in a
demeanor peaceful
while environment
communicating
 Provide  Replacing
accurate inaccurate
information if beliefs into
irrational fears accurate
based on information
incorrect reduces
information anxiety/fear
 Discuss the  Anticipation

process of of a future
thinking about reaction
their feared allows client
situation to deal with
physical
manifestations
of fear
DIAGNOSIS: IMBALANCED NUTRITION RELATED TO DEFICIENT KNOWLEDGE ABOUD NUTRITIONAL NEEDS DURING
PROCESS OF PREGNANCY AS EVIDENCED BY PT IS PRIMIGRAVIDA
Subjective Data: Imbalanced nutrition After 8 hours of  Assess  For the nurse After nursing care
r/t deficient nursing care knowledge of to know what interventions, the
Patient stated “ unsa knowledge about interventions, the nutritional knowledge goal was met
may proper diet, nutritional needs patient will be able needs that the pt has
nutritional food during process of to: already about
intake ug prenatal pregnancy as the nutritional
vitamins na ako evidenced by patient Will able to verbalize needs during
kailangan e take? is primigravida understanding about pregnancy
Ganahan ko og the importance of
healthy akoa having enough  Encourage  Metabolism
pagbuntis nutritional intake and light exercises and utilization
vitamin supplements such as of nutrients
Objective Data: Scientific Basis: during pregnncy walking, are improved
 Primigravida Intake of nutrients stretching by activity
 Expressing insufficient to meet
frustration or metabolic needs.  Educate  Eating
confusion Adequate nutrition is patient about enough
essential to meet the adequate healthy
Vital signs: body demand during enough nutritional
T-37.3c process of pregnancy nutritional food provide
P- 85bpm intake everything
R- 18cpm and baby’s
BP- 110/70mmHg need
SOURCE:
Nurse’s Pocket Guide  Tell to drink  Important part
10th edition enough fluid of pregnancy
intake nutrition
 Help develop
a plan about  Beneficial to
the ideal pt.’s health
foods to eat and fetal
during development
pregnancy during pts
pregnancy
 Advise to
have vitamins  Folic acid
supplements helps reduce
such as folic the risk of
acid neural tube
defects
 Validate the
pts feelings  Validation
regarding the lets the pts
impact on know that the
ability to nurse has
obtain heard and
nutrition understand
intake what was
taught
DRUG STUDY
EFFECTS
Generic Name: PO: may give Stimulates Treatment of Hypersensitivity to Side Effects: Baseline Assessment:
folic acid without regard production of megaloblastic and folic acid. None known Pernicious anemia
to food platelets, macrocytic should be ruled out
RBCs, WBCs anemias due to Cautions: anemias with Schilling test and
Brand Name: IM/IV/SQ/PO: in folate folate deficiency. ( aplastic, vitamin B12, blood
Apo-Folic ADULTS, deficiency Treatment of normocytic, level before initiating
ELDERLY, anemia. anemias due to pernicious, Adverse Effects: therapy.
CHOLDREN folate deficiency refractory) when Allergic Resistant to treatment
Therapeutic 4YRS TO Therapeutic in pregnant anemia present win hypersensitivity occurs may occur if
Class: OLDER: 0.4 effect: women. Folate vitamin B12 rarely with parenteral decreased
Vitamin, water mg/day essential for supplementation deficiency form. Oral folic acid is hepatopoiesis,
soluble nucleoprotein during nontoxic alcoholism,
Children synthesis, pericoceptual antimetabolic drugs,
younger than maintenance of period decreases deficiency of vit. B6,
Pharmacological 4yrs: up to 0.3 normal risk of neural tube B12, C, E is evident
Class: mg/day erythropoiesis defects
Nutritional Infants: Intervention/
supplement 0.1mg/day Evaluation:
Pregnant
/Lactating Assess for therapeutic
Women: improvement:
0.8mg/day improved sense of
well-being, relief from
iron deficiency
IV: may give symptoms ( fatigue,
5mg or less SOB, headache)
undiluted over at
least 1min , or Patient/Family
dilute with Health Teaching:
50mL
Eat foods rich in folic
Prevention of acid, including fruits,
Neural Tube vegetables , organic
Defects: meats
PO: Women of
Childbearing
Age: 400-
800mcg/day
(microgram per
day)
HEALTH TEACHING PLAN

TOPIC
Learning Outcome Content Learning Time allotment Learning Material Processing
Methodology Questions
After 1 hour of health Introduce self and the April 19, 2021 Audio and visual 1. Why pregnant
teaching the patient, purpose for this 8:00am-9:00am presentations women do
the patient will be health teaching needs to have
able to: a regular
Handouts prenatal care/
prenatal
visits?
Time and effort
Benefits of having
Understand the regular prenatal visits
importance of having or having regular Discussion and 2. Give some
regular prenatal prenatal care provide common 30 minutes sample safety
check-ups and situation to better tips for a
identify why understand the healthy
laboratory test are Importance and the lectures being taught pregnancy?
tested during each purpose of several
prenatal care laboratory tests early
in pregnancy 3. Why the
laboratory
Discuss the risks tests are taken
associated with the during each
lack of adequate prenatal visit?
prenatal care?
4. How to
maintain a
Health education and healthy
health promotion in lifestyle and
maintaining a healthy why is it
pregnancy Discussion and cite 30 minutes Audio and visual important of
Gain awareness and realistic common presentation staying
knowledge about situations or healthy
healthy processes Discuss or give tips examples during
during pregnancy on how to stay pregnancy?
healthy during
pregnancy( light
exercises, food
nutrients and 5. What are your
vitamins intake, etc) comments,
opinions or
concerns
about the
lecture being
taught?
NURSES’S NOTES
Mrs. Cruz
Date Time Focus Data Action Response
04/14/2021 8:00am Risk for maternal injury related to maternal D: Nahadlok ko ug nabalaka if delikado napud akong
age pagbuntis karon tungod sa akong edad na guwang-
guwang na
- 37 years old
- Patient is worried
- Restlessness
Vital signs:
10:00am T- 37.3c
P- 80bpm
R- 18cpm
BP- 110/70mmHg
A:
 Introduced self and establish rapport
 Assessed general status
 Monitored vital signs
 Assessed environmental factors that
12:00pm may lead to injury
 Reviewed history of previous
pregnancies
 Noted maternal age
 Validated patient feelings and concerns
R:
 Patient have understood the risk factors that
may contribute injury
 Maintained vital signs w/in normal range

04/15/2021 8:00am Imbalanced nutrition related to more than D: Wala ko maka control sa akong diet karong
body requirements secondary to gestational pagbuntis kay overweight ko sa akong timbang karon
diabetes
- 37 years old
- 190lbs
- 5’2 height
- BMI- 34.7
Vital signs:
10:00am T- 37.3c
P- 80bpm
R- 18cpm
BP- 110/70mmHg
A:
 Weighed patient during prenatal visit
 Discussed earing behavior and
developed appetite-reduction plan
 Assessed understanding of the effect
on diabetes during pregnancy
 Educated patient about more
1:00am nutritional and water intake and limit
eating foods
 Allowed patient to adopt an exercise
such as walking

R:
 Patient has a progress toward desired outcome

 Verbalized understanding about body weight
self- monitoring and developed appetite
reduction plan

04/16/2021 7:00am Anxiety related to fear about the condition D: Dili mawala akong kabalaka ug akong nerbyos
of her pregnancy about sa akong condition karon naa gamay
complictions ug dili sab mawa sa aho huna-huna sa
nahitabo sa akong mga previous pregnancy
- Restlessness
- Trembling
- Increased vital signs
T- 37.3c
P- 98bpm
R- 21cpm
BP- 125/80mmHg
9:00am A:
 Established rapport
 Assessed patient level of anxiety
 Acknowledged awareness of patient anxiety
 Instructed to do deep breathing exercise
 Assisted patient in developing anxiety
reducing skills
 Encouraged patient to talk about what she’s
feeling and her concerns
12:00pm R:
 Reported anxiety diminished and have
managed as manifested by a relax appearance
 Vital signs are stable
T- 37.0c
P- 80bpm
R- 18cpm
BP-120/80mmHg
Mrs. Sanchez
04/14/2021 8:00am Knowledge deficit related to laboratory D: Wala ko kahibalo og kasabot ngano everytime sa
tests during each prenatal visit akong prenatal care or prenatal visit kuhaan man kog
ihi, BP, ug e measure sab nila ako weight
Vital signs:
T-37.0c
P- 80bpm
R- 18cpm
10:00am BP-130/90mmHg
A:
 Introduced self and establish rapport
 Evaluated desire or readiness of patient
to learn
 Determined priority learning needs
within the overall health
 Encouraged ask questions
12:00pm  Discussed patient about laboratory
tests during each prenatal visit
 Educated patient about the importance
of regular prenatal
R:
 Patient understood and gained awareness why
those tests are taken during each prenatal visit

04/15/2021 8:00am Anxiety related to lack of knowledge about D: Nahadlok kog nabalaka if kaya raba kaha ni naho
pregnancy as evidenced by pts is ug wala ko kahibaw unsay dapat nakong buhaton or e
primigravida maintain para healthy ako pgbuntis
Vital signs:
T-37.0c
P- 80bpm
R- 18cpm
10:00am BP-130/90mmHg
A:
 A: Established rapport
 Assessed patient level of anxiety
 Acknowledged awareness of patient anxiety
 Allowed to expressed patients concerns
 Assisted patient in developing anxiety
reducing skills
12:00pm
 Encouraged patient to talk about what she’s
feeling and her concerns
R:
 Reported anxiety diminished and have
managed as manifested by a relax appearance
 Maintained vital signs within normal range

04/16/2021 8:00am Fear related to invasive procedure during D:
hospitalization of upcoming labor Mahadlok ko puhon sa akong paglabor ug
pagpanganak samot first time ni nako
 Primigravida
Vital signs:
T-37.3c
10:00am P- 95bpm
R-21cpm
BP- 120/70mmHg
A:
 A: Established rapport
 Assessed the behavioral and verbal expression
of fear
 Opened awareness about fear
12:00pm  Allowed to expressed patients concerns of her
pregnancy
 Provided accurate information
R:
 Reported fear diminished and have managed
as manifested by a relax appearance
 Stabled vital signs within normal range
Vital signs:
T-37.2c
P- 80bpm
R-18cpm
BP- 110/70mmHg

Antepartum Case Study

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THE COLLEGE OF MAASIN

“Nisi Dominus Frustra”

LEARNING ACTIVITIES (Clinical Simulation/ Exploration and Application)

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

• Jan 15th + 7 days= Jan 22nd

2) Subtract 3 months • January 22nd – 3months = September 22nd 2021

 A line on the skin running from belly button to public hairline

PATIENT’S NAME: Mrs. Cruz AGE: 37y/o MARITAL STATUS: Married

R- 18cpm SOURCE: concerns understand

 Inform  Being aware

P- 80bpm  Encourage  It can help

 Identify ways  Promotes

tension during on act of

smoking for increases the

 Encourage the  Smoking

 Assist patient  It helps

 Advise about  It will reduce

DIAGNOSIS: RISK FOR INFECTION RELATED TO CIGARETTE USE DURING PREGNANCY

infection of risk for

 Discuss the  Smoking can

 Assist patient  Quitting

 Encourage  Help support

Pregnancy / adults with type 2  Muscle pain  Use IV if

DRUG NAME ROUTE AND MODE OF INDICATIONS CONTRA- SIDE NURSING

HEALTH TEACHING PLAN

stretching 3) Why is it very

and risk for 5) What are your

Vital signs: treatment, condition  Provide clear,  Able to ask

DIAGNOSIS: ANXIETY RELATED TO LACK OF KNOWLEDGE ABOUT PREGNANCY AS EVIDENCED BY PATIENT IS

Vital Signs:  Acknowledgement  It helps reduce

DIAGNOSIS: FEAR RELATED TO INVASIVE PROCEDURE DURING HOSPITALIZATION OF UPCOMING LABOR

 Maintain a  Pts feeling of

 Discuss the  Anticipation

HEALTH TEACHING PLAN

Date Time Focus Data Action Response

 Patient has a progress toward desired outcome

Date Time Focus Data Action Response

Date Time Focus Data Action Response

Date Time Focus Data Action Response

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