THE COLLEGE OF MAASIN

College of Nursing
NCM 104/ 105 RLE

ANTEPARTAL CARE CASE STUDY

Schedule: April 21, 26-28, & May 3, 2021 (6am-4pm)

Name: NANETH B. CADISAL Section: BSN-II LEVINE

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.

Answer:
• First day of last menstrual period: January 15, 2021
• Add 9 months: October 15, 2021
• Add 7 days: October 22, 2021
• Estimated date of delivery: October 22, 2021

2. Define gravida, para, primigravida, and multipara.

Answer:
• 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?
Answer:
• (G) Gravidity- 6
• (T) Term Births- 2
• (P) Preterm Births- 0
• (A) Abortions- 3
• (L) Living Children- 2
4. List four factors that place Mrs. Cruz in a high risk pregnancy category and identify why they are
risks.
Answer:
• Obesity- having a high BMI during pregnancy increases the risk of various complications,
including the risk of miscarriage, still birth, and recurrent miscarriage that may place Mrs. Cruz in a
high risk pregnancy.
• Smoking- smoking while pregnant doubles the risk of abnormal bleeding during pregnancy and
delivery. This can put both Mrs. Cruz and her unborn baby in danger. Smoking raises baby’s risk for
birth defects, including cleft lip, cleft palate or both.
• Multiple Pregnancy - women having five or more pregnancies increases the risk of labor and
excessive bleeding after delivery. This condition can increase the risk of preeclampsia and of
developing diabetes mellitus later in life.
• Old-Maternal age- women who are older than 25 are at a greater risk for developing
gestational diabetes than younger women.
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- during pregnancy, as the baby grows the woman’s uterus increases in size till
the 38 weeks after that the funds level starts to descend preparing for delivery. And it
stretches to accommodate the fetus size and associated with an increase in the
thickness and length of the fundus.
ii. Urinary System- it increased blood volume and cardiac output during pregnancy cause
a 50-60% increase in renal blood flow and glomerular filtration rate (GFR). 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.
iii. Heart and Circulatory System- the blood flow to various organs increases during
pregnancy to meet the increased metabolic needs of tissues. Thus, venous return and
cardiac output increases dramatically during pregnancy. Cardiac output gradually
increases during the first 2 trimesters with the largest increase occurring by 16 weeks
of gestation. A variety of changes in the cardiovascular system occur during normal
pregnancy, including increases in cardiac output, arterial compliance, and extracellular
fluid volume and decreases in blood pressure (BP) and total peripheral resistance.
iv. 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.
v. Respiratory System- increased vascularity and edema of upper respiratory mucosa.
The chest increases in size. The diaphragm, the large flat muscle used in breathing,
moves upward toward the chest. Increase in the amount of air breathed in and out.
 vi. Breast- the breasts will enlarge in size because of the hormones are preparing the
breasts milk production. These changes are caused by an increase in hormones, and
may include the following: Tenderness or a change in sensation of the nipple and
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.
Answer:
• Nausea and vomiting- is also called morning sickness because symptoms most severe in
the morning. Some women may have nausea and vomiting throughout the pregnancy.
Morning sickness may be due to the changes in hormone levels during pregnancy. For
morning nausea, eat toast, cereal, crackers, or other dry foods before getting out of
bed. Eat cheese, lean meat, or other high-protein snack before bedtime. Sip fluids, such
as clear fruit juices, water, or ice chips, throughout day. Don't drink lots of fluid at one
time. If morning sickness symptoms persist, call a health care provider.
• Fatigue- causes of tiredness in early pregnancy may be: hormonal changes, due to
increased levels of the hormone progesterone. Emotional changes - anxiety is common
in early stages and will usually pass as the weeks go by. No matter how tired you get,
you should avoid taking any over-the-counter medicines as a sleeping aid. Most
pregnant women should spend at least 8 hours in bed, aiming for at least 7 hours of
sleep every night. If possible, try going to sleep a little earlier than usual.
• Heartburn and indigestion- indigestion, also called heartburn or acid reflux, is common
in pregnancy. It can be caused by hormonal changes and the growing baby pressing
against your stomach. You can help ease indigestion and heartburn by making changes
to your diet and lifestyle and there are medicines that are safe to take in pregnancy.
Changes to your diet and lifestyle may be enough to control your symptoms,
particularly if they are mild, including eat healthily, change your eating and drinking
habits, keep upright and avoid alcohol. Heartburn and indigestion is caused by pressure
on the intestines and stomach (which, in turn, pushes stomach contents back up into
the esophagus). It can be prevented or reduced by eating smaller meals throughout the
day and by not lying down shortly after eating.
• Headaches- hormonal changes may be the cause of headaches during pregnancy,
especially during the first trimester. In order to prevent or relieve headaches during
pregnancy without taking medication, try to avoid headache triggers, manage stress,
include physical activity in you daily routine, practice relaxation techniques, eat
regularly and follow a regular sleep schedule. Rest, proper nutrition, and adequate fluid
intake may help ease headache symptoms. Always talk with your healthcare provider or
midwife before taking any medicine for this condition. If you have a severe headache or
a headache that does not go away, call your healthcare provider.
• Constipation- hormone changes may also slow down the food being processed by the
body. Pregnancy constipation can often be prevented with lifestyle changes for
example, drink plenty of fluids, include physical activity in your daily routine and include
more fiber in your diet. Increased pressure from the pregnancy on the rectum and
intestines can interfere with digestion and bowel movements. Always check with your
healthcare provider or midwife before taking any medicine for this condition.
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?
Answer:
Mrs.Cruz hematocrit is normal, because the normal values of hematocrit are determined from
36 to 48 percent for women in childbearing age. The cause of its decrease in adults during pregnancy
is pseudoanemia, where the blood volume expands during pregnancy slightly ahead of the red cell
count, and most women have pseudoanemia in early pregnancy. This condition is normal and should
not be confused with true types of anemia that occur as complications of pregnancy. True anemia is
typically considered to be present when a woman’s hemoglobin concentration is less than 11g/dl
(hematocrit <33%) in the first or third trimester of pregnancy or when the hemoglobin concentration
is less than 10.5g/dl (hematocrit <32%) in the second trimester.

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

adjusts to pregnancy.
Answer:
FIRST TRIMESTER (WEEK 1 TO WEEK 12)
 Morning sickness
 Weight Gain/ Loss gain
 Cravings
 Headache
 Mood changes
SECOND TRIMESTER (WEEK 13 – WEEK 18)
 Stretch marks (thighs, breasts ,abdomen)
 Line on the skin running from belly button to public hairline
 Body aches
 Numbness
 Swelling on the ankles, fingers and face/edema
THIRD TRIMESTER (WEEK 29- WEEK 40)
 Contractions, which can be a sign for labor
 Trouble sleeping
 Shortness of breath
 Breast Tenderness
 Heartburn
 8. Make at least five (5) NURSING CARE PLAN for Mrs. Cruz.

Patient’s Name: Mrs. Cruz
NCP NO.1
ASSESSMENT
Subjective:
“I am smoking daily but I
don’t feel something is
wrong’’, as verbalized by
the client.
Objective:
G- 6, T- 2, P- 0, A-3, L- 2
- Grandmultigravida (6th
pregnancy)
- Multiparous woman (5th
birth)
- Obese (BMI of 34.7 with
height of 5’2’’)
NURSING DIAGNOSIS
Risk for ineffective
peripheral tissue
perfusion related to
increased peripheral
vascular resistance
secondary to chronic
smoking and obesity as
evidenced by chronic
smoker with 1 ½ packs
per day and BMI of 34.7
with height of 5’2’’).
Age: 37 yrs. Old Marital Status: Married
NURSING CARE PLAN
GOALS/ DESIRED
INTERVENTION RATIONALE VALUATION
OUTCOMES
After 8 hours of nursing Independent: At the end of my
1. To place client at care, the patient
interventions, the 1. Identify presence was able to:
patient will be able to: a greater risk for
of high-risk facts and
-Demonstrate
developing
conditions (e.g. increased perfusion
-Demonstrate some
peripheral vascular as evidenced by
smoking and
measures to increased absence of edema.
disease with
obesity).
perfusion. - Verbalize
associated
understanding of
complication.
-Verbalize risk factors or
condition, therapy
understanding of risk
regimens and when
2. Assess presence, 2. Useful in
factors or condition, to contact
location, and degree identifying or healthcare provider
therapy regimens and
as evidenced by,
of swelling or edema quantifying edema
when to contact “Now I know what
formation. in involved are the necessary
lifestyle changes I
- Old maternal extremity. will do and factors
Scientific basis: healthcare provider. that could improve
age(37yrs.old)
peripheral
-Height: 5’2’’ 3. Note current 3. Can affect circulation and the
Chronic smoking and
situation or presence systemic potential effects
- Weight: 190 lbs. (86.18
obesity during pregnancy during my
kg.) of conditions (e.g., circulation/perfusio pregnancy and my
increased in coronary
CHF, lung disorders, n. future baby due to
-Chronic smoker with 1 ½
vascular resistance and . my condition.” as
packs per day major trauma, septic verbalized by the
have an increased risk of
or hypovolemic client.
- History of cervical
pregnancy loss
insufficiency or premature (miscarriage) which can shock,

dilation of cervix. coagulopathies,

lead to a decrease in
V/S taken as follows: sickle cell anemia).
oxygen resulting in the
T- 36.8°C
failure to nourish the 4. Determine
P- 88 bpm 4. Measure capillary
tissues at the capillary adequacy of
R- 22cpm refill.
level or risk for ineffective systemic circulation.
Bp- 130/90mmHg peripheral tissue
perfusion. 5. Malnutrition can
5. Note client’s
nutritional and fluid cause ischemic

status. tissues to be more

prone to breakdown
and dehydration
 reduces blood
REFERENCE:
volume and
compromises
• Doenges, M. E.,
peripheral
Moorhouse, M. F., & amp;
circulation.
Murr, A. C. (2008).
Nurse’s pocket guide: 6.Inspect lower
6. Often a sign of
Diagnoses, prioritized extremities for skin
diminished
interventions, and texture (e.g.,
peripheral
rationales. Philadelphia, atrophic, shiny
circulation.
Pensylvennia: F.A. Davis appearance, lack of
Company. hair, dry/scaly,
reddened skin), and
• Matt Vera, B. R. (2001).
skin breaks or
Nurselabs. Retrieved from
ulcerations
Nurselabs.com:
https://nurseslabs.com/.
7. Check for calf 7. Indicators of deep
tenderness or pain vein thrombosis
on dorsiflexion of (DVT), although DVT
foot (homan’s sign), is often present
swelling and redness. without a positive
 Homan’s sign.

8. Review laboratory 8. To determine

studies such as lipid probability, location,
profile, coagulation, and degree of
hct., and impairment.
renal/cardiac
function test.

9. Collaborate in 9. To maximize
treatment of systemic circulation
underlying conditions and organ perfusion.
such as diabetes,
hypertension,
cardiopulmonary
conditions, blood
disorders, traumatic
injury, hypovolemia
and hypoxemia.

10. Necessary for

10. Discuss to
 patient about client to make
relevant risk factors. informed choices
(e.g., family history, about remediating
smoking, obesity, risk factors and
hypertension, committing to
diabetes and clotting lifestyle changes.
factors).

11. Provide 11. Smoking

education about contributes to the
relationship between progression and
smoking and development of
peripheral vascular peripheral vascular
circulation. disease.

NCP NO.2
GOALS/ DESIRED
ASSESSMENT NURSING DIAGNOSIS INTERVENTION RATIONALE VALUATION
OUTCOMES
Subjective:
“I am smoking daily but I
don’t feel something is
wrong’’, as verbalized by
the client.
“I am afraid that my child
might die again before
being born.” as verbalized
by the client.
Objective:
G- 6, T- 2, P- 0, A-3, L- 2
th
- Grandmultigravida (6
pregnancy)
- Multiparous woman (5
birth)
- Obese (BMI of 34.7 with
height of 5’2’’)
- Old maternal
age(37yrs.old)
Ineffective childbearing After 8 hours of nursing Independent: At the end of my
1. Has correlation care, the patient
process related to interventions, the 1. Determine was able to:
maternal factors of patient will be able to: maternal/nutritional for increased
status, usual gravid, - Acknowledge an
maternal age (more than perinatal morbidity
weight,and dietary address individual
- Acknowledge an
35yrs old), multiparity, rates, preterm births risk factor as
pattern.
address individual risk evidenced by
grandmultigravidity, and macrosomia.
understand and
factor.
obese and frequent restate her current
2. Evaluate current condition about
smoker as evidenced by 2. Provides
- Verbalize knowledge regarding what is happening
previous spontaneous information to assist to her.
understanding of care physiological and
abortions and psychological in identifying needs
requirements to - Verbalize
changes associated and creating an
development of understanding of
promote health of self with pregnancy.
gestational diabetes in. individual plan of
and infant. care requirements
care.
to promote health
of self and infant as
th
3. Identify 3. To identify if the
evidenced by client
involvement/respons father is supportive
states the
e to child’s father. or has potential of
importance of
posing a threat to
Scientific Basis: engaging in
the safety and well-
activities to prepare
Maternal age of 37 yrs. being of
for birth process
-Height: 5’2’’ mother/fetus.
old with previous and care of
- Weight: 190 lbs. (86.18 - Ensures quality and
spontaneous abortions newborn.
kg.) continuity of care.
and development of
-Chronic smoker with 1 ½
gestational diabetes in 4. Determine client’s
packs per day 4. Lack of
cultural
the last pregnancy are at
- History of cervical beliefs/expectations knowledge,
greater risk of about childbearing,
insufficiency or premature misconceptions, or
complications including self-care and so on.
dilation of cervix. unrealistic
miscarriage, premature
expectations can
delivery and stillbirth,
V/S taken as follows: have a negative
gestational diabetes,
T- 36.8°C impact on coping
chromosomal
P- 88 bpm capabilities.
5. Ascertain the
abnormalities, and fetus
R- 22cpm client’s
growth retardation, which understanding and 5. Facilitate
Bp- 130/90mmHg
can be due to inability to expectations of the
discharge and
labor process.
prepare for and/or ensure client/infant
maintain a healthy needs will be met.
pregnancy or ineffective 6. Determine plan of
childbearing process. discharge after
6. To ensure
delivery and home
care support needs. nutritional needs
are met and delivery
 without major
REFERENCE:
complication.

• Doenges, M. E., 7. Review nutrient

requirements and 7. Reduces risk for
Moorhouse, M. F., & amp;
encourage moderate premature birth,
Murr, A. C. (2008).
non-intense exercises
stillbirth, low birth
Nurse’s pocket guide: such as walking or
any non-weight weight, congenital
Diagnoses, prioritized
bearing exercises. defects, drug
interventions, and
withdrawal of
rationales. Philadelphia,
newborn, and fetal
Pensylvennia: F.A. Davis
alcohol syndrome.
Company. 8. Encourage
participation in
• Matt Vera, B. R. (2001). smoke cessation, 8. Client has
Nurselabs. Retrieved from alcohol and drugs increased risk for
cessation programs.
Nurselabs.com: anxiety and/or loss
https://nurseslabs.com/. of control when left
9. Monitor labor unattended.
progress and
maternal-fetal well-
9.Ensures that
being per protocol.
mother knows and
will do what is
 appropriate in the
respective processes
that she will
undergo and go
through each
process with little or
if possible, no
complications.

10. Assess and

provide teaching to 10. Reduces risk for
the client about the premature birth,
processes and
changes in stillbirth, low birth
pregnancy, weight, congenital
intrapartum and defects, drug
postpartum.
withdrawal of
newborn, and fetal
alcohol syndrome.
 NCP NO.3
GOALS/ DESIRED
ASSESSMENT NURSING DIAGNOSIS INTERVENTION RATIONALE VALUATION
OUTCOMES
Subjective: Mild anxiety related to After 8 hours of nursing Independent: At the end of my
1. To gain care, the patient
“I am smoking daily but I previous hx of fetal death interventions, the 1. Established was able to:
don’t feel something is as evidenced by patient will be able to: rapport. cooperation and
wrong’’, as verbalized by trembling. trust from the
- Verbalize the healthy - Verbalize the
the client. patient.
ways to deal with, healthy ways to
2.Monitor vital signs
express and awareness deal with, express
“I am afraid that my child 2. To determine
Scientific Basis:
of feelings of anxiety. and awareness of
might die again before patient’s physiologic
Fetal death refers to the feelings of anxiety
being born.” as verbalized status with regards
spontaneous intrauterine as evidenced by
by the client. to the health process
death of a fetus at any using positive self-
Objective: she is undergoing.
time during pregnancy talk, appear relaxed
G- 6
can be due to a traumatic and report that
T- 2 3. Can heighten
3. Determine
situation or event sudden anxiety is reduced
P- 0 current prescribed feelings and sense of
that are usually beyond medications and to a manageable
A-3 anxiety.
the individual’s control recent drug history level.
L- 2
of prescribed or
- Grandmultigravida (6th that leads to your body's
over-the-counter
pregnancy) natural response to stress medications.
- Multiparous woman (5th or anxiety.
4. Distorted
birth)
REFERENCE: 4. Identify the
perceptions of the
- Obese (BMI of 34.7 with client’s perception
of the threat situation may
height of 5’2’’) • Doenges, M. E.,
represented by the magnify anxiety.
- Old maternal Moorhouse, M. F., & amp;
age(37yrs.old) situation.
Murr, A. C. (2008).
-Height: 5’2’’
Nurse’s pocket guide: 5. Individual
- Weight: 190 lbs. (86.18
Diagnoses, prioritized responses are
kg.)
interventions, and 5. Note cultural
-Chronic smoker with 1 ½ influenced by cultural
factors that may
rationales. Philadelphia, values and beliefs.
packs per day influence anxiety.
Pensylvennia: F.A. Davis
- History of cervical
Company. 6. May interfere with
insufficiency or premature
dilation of cervix. the ability to deal
• Matt Vera, B. R. (2001).
6. Be aware of the with the problem.
Nurselabs. Retrieved from defense
V/S taken as follows: mechanisms being
Nurselabs.com:
T- 36.8°C used.
https://nurseslabs.com/.
P- 88 bpm
R- 22cpm
7. To ensure proper
Bp- 130/90mmHg
compliance of the

7. Establish a client to the nurse

therapeutic and prevent
relationship,
transmission of
conveying empathy
and unconditional anxiety to other
members of family.
positive regard.
8. This helps the
client identify what is
reality based.

8. Provide accurate
information about
9. To aid in meeting
the situation.
basic human need,
decrease sense of
9. Provide comfort isolation, and
measures. ( e.g.
assisting client to feel
calm/quiet
environment, soft less anxious.
music, a warm bath, 10. To deal with
back rub)
chronic anxiety
states.
9. Refer to individual
and/or group
therapy, as
appropriate.
 NCP NO.4
GOALS/ DESIRED
ASSESSMENT NURSING DIAGNOSIS INTERVENTION RATIONALE VALUATION
OUTCOMES
Subjective: Risk for infection related After 8 hours of nursing Independent: At the end of my
1. To determine care, the patient
“I am smoking daily but I to tissue destruction and interventions, the 1. Monitor vital signs was able to:
don’t feel something is inadequate secondary patient will be able to: patient’s physiologic
wrong’’, as verbalized by defenses secondary to every 30 minutes for status with regards
- Remain free of - Remain free of
the client. labor and birth process, 2 hours until stable. to the health
infection. infection, as
maternal age (37yrs. old), process she is
evidenced by
“I am afraid that my child multigravidity, undergoing.
normal vital signs
might die again before grandmultiparity, obese
and absence of
being born.” as verbalized and frequen smoker. 2. To prevent/
signs and
by the client. 2. Note signs of reduce risk for
localized infection at symptoms of
Objective: infection.
insertion sites of infection.
G- 6
invasive lines,
T- 2 sutures, surgical
P- 0 Scientific Basis: incisions and
wounds.
A-3
Tissue destruction and 3. To know and
L- 2
inadequate secondary monitor health
- Grandmultigravida (6th 3. Let the client
defenses due to labor and status with regards
pregnancy) undergo laboratory
birth process are at tests. (e.g. CBC) to infection.
- Multiparous woman (5th
increased risk for being
birth)
invaded by pathogenic 4. To identify client’s
- Obese (BMI of 34.7 with
organisms which can lead health state and
height of 5’2’’) 4. Note signs and
to risk for infection. appropriate
- Old maternal symptoms of sepsis.
(e.g. fever, chills, countermeasures to
age(37yrs.old) diaphoresis, altered be used.
REFERENCE: level of
-Height: 5’2’’
consciousness,
- Weight: 190 lbs. (86.18 • Doenges, M. E., positive blood
kg.) cultures)
Moorhouse, M. F., & amp;
-Chronic smoker with 1 ½ 5. To identify the
Murr, A. C. (2008).
packs per day presence, manner
Nurse’s pocket guide: 5. Obtain appropriate
- History of cervical and type of
Diagnoses, prioritized tissue/fluid
insufficiency or premature specimens for infection.
interventions, and
dilation of cervix. observation and
rationales. Philadelphia, culture/sensitivities
V/S taken as follows: testing.
Pensylvennia: F.A. Davis
T- 36.8°C Company. 6. Friction and
P- 88 bpm
6. Wash hands or running water
R- 22cpm • Matt Vera, B. R. (2001).
perform hand effectively remove
Bp- 130/90mmHg Nurselabs. Retrieved from hygiene before
microorganisms
Nurselabs.com: having contact with
the patient. Also from hands.
https://nurseslabs.com/.
impart these duties Washing between
to the patient and procedures reduces
their significant
others. Know the the risk of
instances when to transmitting
perform hand pathogens from one
hygiene or “5 area of the body to
moments for hand another. Wash
hygiene”:
hands with
antiseptic soap and
- Before touching a water for at least 15
patient.
seconds followed by
- Before clean or alcohol-based hand
aseptic procedure
rub. If hands were
(wound dressing,
starting an IV, etc.). not in contact with
anyone or anything
- After body fluid
exposure risk in the room, use an
alcohol-based hand
- After touching a
patient rub and rub until
dry. Plain soap is
- After touching the
patient’s good at reducing
surroundings. bacterial counts but
antimicrobial soap is
better, and alcohol-
based hand rubs are
the best.
 7. To limit
exposures, thus
reducing cross-
7. Monitor client’s
contamination.
visitors/caregivers.
8. Knowledge of
ways to reduce or
eliminate germs
8. Educate clients reduces the
and SO about
likelihood of
appropriate methods
for cleaning, transmission.
disinfecting, and
sterilizing items.

NCP NO.5
GOALS/ DESIRED
ASSESSMENT NURSING DIAGNOSIS INTERVENTION RATIONALE VALUATION
OUTCOMES
Subjective: Readiness for enhanced After 8 hours of nursing Independent: At the end of my
1. To determine care, the patient
“I am smoking daily but I parenting related to interventions, the 1. Ascertain was able to:
don’t feel something is childcare. patient will be able to: motivation/ need/motivation for
expectation for - Verbalize realistic
wrong’’, as verbalized by improvement.
the client. change.
- Verbalize realistic information and
information and 2. Expectations may expectations of
“I am afraid that my child Scientific Basis: 2. Note
expectations of vary with different parenting role as
might die again before cultural/religious
A pattern of providing an parenting role. cultures. These evidenced by client
being born.” as verbalized influences on
by the client. environment for children parenting, beliefs may interfere states the
expectations of responsibility for
Objective: or other dependent with desire to
self/child, sense of
person(s) that is sufficient improve parenting emotional and
G- 6 success and failure.
to nurture growth and skills when there is physical care and
T- 2
P- 0 development and can be conflict between the well-being of the
strengthened. two. new family
A-3
member.
L- 2
- Grandmultigravida (6th 3. Make time in 3. Promotes sense
listening to the
pregnancy) of importance and
REFERENCE: concerns of the
- Multiparous woman (5th parent(s). being heard.

birth) • Doenges, M. E., Identifies accurate

- Obese (BMI of 34.7 with Moorhouse, M. F., & amp; information

height of 5’2’’) Murr, A. C. (2008). regarding needs of

- Old maternal Nurse’s pocket guide: the family for

age(37yrs.old) Diagnoses, prioritized enhancing

interventions, and
-Height: 5’2’’ relationships.
rationales. Philadelphia,
- Weight: 190 lbs. (86.18
Pensylvennia: F.A. Davis
kg.)
Company. 4. To enable them to
-Chronic smoker with 1 ½
4. Emphasize
packs per day be notified that
• Matt Vera, B. R. (2001). parenting functions
- History of cervical rather than parenting tasks can
Nurselabs. Retrieved from
insufficiency or premature Nurselabs.com: mothering/fathering both be done,
skills.
dilation of cervix. regardless of
https://nurseslabs.com/.
V/S taken as follows: gender.

T- 36.8°C
P- 88 bpm 5. Assists in

R- 22cpm developing
5. Encourage
Bp- 130/90mmHg attendance at skill parenting skills.
classes, such as
parent/family
effectiveness
training.

6. To promote
6. Involve all the optimal wellness.
family members in
learning.
 7. To ensure that

7. Discuss long-term proper parenting

plans with the family and guidance is
observed
throughout the
stages in life.

Dependent:

8. To learn positive

8. Provide parenting skills and

information about adapt to change in
time management situations.
and stress-reduction
techniques.

9. Provide your Health Teaching Plan for Mrs. Cruz.

Patient’s Name: Mrs. Cruz Age: 37 yrs. Old Marital Status: Married

HEALTH TEACHING PLAN

TOPIC: The importance of maintaining a Healthy Pregnancy.
LEARNING LEARNING PROCESSING
LEARNING OUTCOME CONTENTS TIME ALLOTMENT
METHODOLOGY MATERIALS QUESTIONS
After 20 mins. of Nutrition: The entire process 1. What are the
teaching-learning should last in the -Graphic important things to
experience, the Eating a nutritious diet during whole 1 hour of illustrations consider in maintaining
patient will be able to: pregnancy is linked to good allotted time. -Laptop a healthy pregnancy?
brain development and a -Visual aids
-Gain knowledge and healthy birth weight, and can 2. Why is it important
-Introduction of -Specific time:
verbalize the reduce the risk of many birth to eat a balanced diet?
self. 5 minutes
importance of defects. A balanced diet will
maintaining a healthy also reduce the risks of 3. Define the
pregnancy. anemia, as well as other effectiveness of the
-Lecture -Specific time:
unpleasant pregnancy lesson given?
discussion 40 minutes
-Identify how to symptoms such as fatigue and
maintain a healthy morning sickness. 4. What are the
pregnancy through comments or opinions
-Proper -Specific time:
nutrition, vitamins, A well-balanced pregnancy about the procedure
conversation with 15 minutes
good habits, and when diet includes: being taught?
the S.O.
to contact healthcare
provider.  protein 5. Why is it very
 vitamin C important for the
 calcium mothers of having
 fruits and vegetables regular prenatal care
 whole grains and the risk factor for
 iron-rich foods not having any
 adequate fat prenatal care?
 folic acid
 other nutrients like
choline

Weight gain:
A simple way to satisfy your
nutritional needs during
pregnancy is to eat a variety of
foods from each of the food
groups every day.

Gaining weight while pregnant

is completely natural and
expected. If your weight was
in a normal range before you
got pregnant, The American
College of Obstetrics and
Gynecology (ACOG)
recommends a weight gain of
about 25 to 35 pounds.

It’s important to discuss and

monitor your weight and
nutritional needs with your
doctor throughout your
pregnancy.

Weight gain recommendations

will vary for people who are
underweight before
conceiving, for people who
have obesity, and for those
with a multiple gestation
pregnancy, such as twins.

What not to eat:

To protect you and baby from

a bacterial or parasitic
infection, such as listeriosis,
make sure that all milk,
cheese, and juice are
pasteurized.

Don’t eat meat from the deli

counter or hot dogs unless
they are thoroughly heated.
Also avoid refrigerated
smoked seafood and
undercooked meat and
seafood.

If you or someone in your

family has had a history of
allergies, speak to your doctor
about other foods to avoid.

Exercise:

Aerobic exercises, such as

walking, light jogging, and
swimming, stimulates the
heart and lungs as well as
muscle and joint activity,
which help to process and
utilize oxygen.

There are many exercise

classes designed specifically
for pregnant women that help
to build strength, improve
posture and alignment, and
promote better circulation and
respiration. Plus, you can meet
other parents for support!

Squatting and Kegel exercises

should be added to the
exercise routine. Kegel
exercises focus on the perineal
muscles. This exercise is done
in the same way you stop and
start the flow of urine.

The perineal muscles are

tightened for a count of three,
and then they’re slowly
relaxed. The period of time
the muscles are contracted
can be increased over time as
muscle control becomes
easier.

Relaxing the perineal muscles

can help during the birth of
the baby. Kegel exercises are
thought to help maintain good
muscle tone and control in the
perineal area, which can aid in
delivery and recovery after
birth.

Changing habits:

Making good lifestyle choices

will directly impact the health
of your baby. It’s important to
stop any tobacco smoking,
drug misuse, and alcohol
consumption. These have
been linked to serious
complications and risks for
both you and your baby.

Drinking alcohol during

pregnancy is linked with a
wide range of problems in the
developing baby. Any alcohol
that is consumed enters the
fetal bloodstream from the
mother’s bloodstream.

Tobacco smoking before

pregnancy has started is a risk
for serious harm Trusted
Source to a developing baby.
There is also plenty of proof
Trusted Source that smoking
during pregnancy is
hazardous.

Smoking affects blood flow

and oxygen delivery to a baby,
and therefore their growth.

Prenatal care:

Attending all prenatal care

checkups will help your doctor
carefully monitor you and your
growing baby throughout your
pregnancy.

It will also give you a

scheduled time to ask your
doctor about any concerns
you’re having about your
pregnancy. Set up a schedule
with your healthcare providers
to manage all of your
 symptoms and questions.

Smoin

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

Patient’s Name: Mrs. Cruz Age: 37 yrs. Old Marital Status: Married
 DRUG STUDY
MODE OF SIDE EFFECTS/ ADVSERSE
DRUG NAME INDICATIONS CONTRAINDICATIONS NURSING INTERVENTIONS
ACTION EFFECTS
Generic Name: Decreases This medication is to Hypersensitivity, Side Effects: Baseline Assessment:
 metformin hepatic treat diabetes. It is chronic heart failure,  Weight loss Questions for history
production of used to decrease metabolic acidosis with allergies, especially to this
Brand Name: glucose. hepatic (liver) glucose or without coma, GI Tract: medication.
 Apo- Decreases production, to diabetic ketoacidosis  Nausea and vomiting
Metformin intestinal decrease GI glucose (DKA), severe renal  Anorexia Intervention/ Evaluation:
 Glucophage absorption of absorption and to disease, abnormal  Diarrhea  Monitor urine or
 Glucophage glucose, increase target cell creatinine clearance  Bloating/ abdominal serum levels
XR improves insulin insulin sensitivity. This resulting from shock, distention frequently to
 Fortamet sensitivity. medication is a myocardial infarction  Constipation determine
 Glumetza treatment indicated and actation. effectiveness of drug
 Riomet Therapeutic as an adjunct to diet, CNS: and dosage.
Effect: Improves exercise, and lifestyle Cautions: HF, hepatic  Chills, dizziness  Arrange for transfer
Therapeutic Class: glycemic changes such as impairment, excessive  Headache insulin therapy
 Biguanides control, weight loss to acute/chronic alcohol during periods of
stabilizes/decrea improve glycemic intake, elderly. Adverse Effects: high stress
Pharmacological ses body weight, (blood sugar) controls Recommend  Heartburn (infections, surgery)
Class: improves lipid in adults with type 2 temporary  Stomach  Use IV if severe
 Antidiabetic profile. diabetes. discontinuation at time pain/cramping hypoglycemia occurs
of or before iodinated  Muscle pain as a result of
contrast imaging  Indigestion overdose.
procedures in pts with  Be alert for
CrCl of 30–60 mL/min, superinfection: fever,
Actual dose, or with history of vomiting, diarrhea,
timing and route: hepatic disease, etc.
alcoholism, HF.
Adults : Patient/Family Health
PO: 500 mg orally Teaching:
once daily with  Tell patient to take
evening meal every this medicine with
12 hours or 850mg meals to avoid
orally once/day gestational problems.
meals; increase  Prescribed diet is
dose in increments principal part of
of 500mg/week or treatment, do not
850mg ever 2 skip and delay meals.
weeks on the basis  Diabetes requires
of glycemic control lifelong control.
and tolerability.  Avoid alcohol.
 Report persistent
Give extended- headache, nausea,
release tablets vomiting, diarrhea or
whole. Do not if skin rash, unusual
break, crush, bruising/bleeding,
dissolve / divide. change in color of
urine or stool occurs.
Pregnancy /
Lactation:
Insulin is drug of
choice during
pregnancy.
Distributed in
breastmilk in
animals

REFERENCE:
  Saunders Nursing Drug Handbook 1st Edition 2019.pdf

MODE OF SIDE EFFECTS/ ADVSERSE

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

REFERENCE:
 Saunders Nursing Drug Handbook 1st Edition 2019.pdf

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.

Patient’s Name: Mrs. Cruz Age: 37 yrs. Old Marital Status: Married

FDAR
DATE/TIME FOCUS DATA ACTION and RESPONSE
04/27/2021 Anxiety D: Received client sitting on chair and seems to be restless
8:00 AM - With voice quivering
- With physical discomfort
- Hand tremors and facial flushing are noted
- Vital signs taken as follows:
 T=36.8°C
 P=88 bpm
 R=22 cpm
 BP=130/90 mmHg
A - Established rapport and introduced self
- Vital signs taken and recorded
- Encouraged the client to have sufficient rest
- Health teaching imparted to S.O. on:
 Proper nutrition, adequate rest and sleep
R: Client appeared relaxed with less anxious
- Anxiety was reduced as evidenced by decreased voice
quivering, decreased hand tremors and facial flushing and no
claim of physical discomfort has seen.

04/28/2021 Elevated Blood Pressure D: Received client lying on bed and seems to be lethargic
8:00 AM - With flushed skin and irritable
- Acute pain headache as evidenced by reluctance to move head,
avoidance of bright lights and noise.
- With pain scale of 8/10
- V/S taken as follows:
 T= 37.2 °C
 P= 90 bpm
 R= 22 cpm
 BP=180/110 mmhg
A - Established rapport and introduced self
 - Vital signs taken and recorded
- Advised the client to have adequate rest and sleep
- Encouraged the client to have healthy diet
- Advised to monitor blood pressure at home
R: Client seen relaxed lying on bed
- Verbalized pain decreased from a scale of 8/10-5/10 as
evidenced by decreased flushed skin, irritability and appeared
relieved with lesser pain.
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.

A. 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?
Answer:
It is important to do these tests every time she visit a clinic and to see a doctor so that the
doctor can check if her pregnancy is normal or there might be complications or life threatening
health issue. Early in pregnancy, performing a limited physical exam and obtaining a Blood Pressure,
Weight, and Urine dipstick is essential for a pregnant women. . At times, it may be important to
determine fetal orientation. In weight, before getting pregnant, get as close to a healthy weight as
possible to help spare complications for the mother and child. The extra weight you gain during
pregnancy provides nourishment to your developing baby and is also stored for breastfeeding your
baby after delivery. Weight gain during pregnancy helps your baby grow. In blood pressure,
preeclampsia is easily diagnosed during the routine checks you have while you're pregnant. That’s
why it is important to regularly check for signs of high blood pressure and a urine sample is tested to
see if it contains protein. In urine dipstick, that's why at each prenatal visit, you'll be asked to give a
urine sample as part of your regular exam. This sample is used to help determine if you have
diabetes, kidney disease, or a bladder infection by measuring the levels of sugar, protein, bacteria, or
other substances in your urine to make sure you don't have a condition such as a UTI, gestational
diabetes, or preeclampsia. Urine dipstick screening tests includes acidity (pH), concentration,
protein, sugar, ketones, bilirubin, evidence of infection and blood.

B. Assuming Mary Lou has a uncomplicated pregnancy, what will be the routine schedule for
her prenatal visits to the health care provider?
Answer:
For uncomplicated pregnancies, she should expect to see a health care provider every four
weeks through 28 weeks. Between 28 and 36 weeks, every two weeks and from 36 weeks to
delivery, expect to see a health care provider weekly. Be sure to stick to the schedule that your
doctor suggests, even if life gets hectic. Prenatal care is important for both mother’s health and
baby's health. So, when your doctor checks you regularly, they can spot problems early and treat
them so that you can have the healthiest pregnancy possible.

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- all pregnant women get a blood test at their first prenatal visit
during early pregnancy. This test will show if she has Rh-negative blood but are not
sensitized: The blood test may be repeated between 24 and 28 weeks of pregnancy. This will
identify whether her blood cells carry the Rh factor protein. It is documented because blood
may have to be made available if a woman has bleeding during pregnancy and to detect the
possibility of ABO and Rh isoimmunization. Women who want to have children, and those
already pregnant, should know their blood types for another important reason: blood type
or Rh factor incompatibility. If an expectant mother has Rh-negative blood and her baby has
Rh-positive blood, it can lead to something called Rh incompatibility; complications may
include brain damage due to high levels of bilirubin, fluid buildup and swelling in the baby
(hydrops fetalis), problems with mental function, movement, hearing, speech and seizures.
 ii. Antibody Screen- this is performed early in pregnancy as part of every woman’s pregnancy
workup. This screening used to screen for antibodies in the blood of the mother that might
cross the placenta and attack the baby’s red cells, causing hemolytic disease of the newborn.
Red blood cell antibodies may cause harm after a transfusion or, if you are pregnant, to your
baby. An RBC antibody screen can find these antibodies before they cause health problems.
iii. Hct/ Hgb- most women experience a lowering of hemoglobin and hematocrit in the second
trimester and a rise in the third. Early in the third trimester, at 26 to 28 weeks, the
hemoglobin and hematocrit level should be measured again. This test should again be
repeated at 32 to 36 weeks gestation. This is to determine the presence of anemia, a white
blood cells count to determine any infection and a platelet count to estimate clotting ability.
It measures how much of your blood is made up of red blood cells. Red blood cells contain a
protein called hemoglobin that carries oxygen from your lungs to the rest of your body.
Hematocrit levels that are too high or too low can indicate a blood disorder, dehydration, or
other medical conditions.
iv. Hepatitis B- screening for hepatitis B infection is usually done by blood tests. Different blood
tests can detect current infection as opposed to past infection or immunization. For
pregnant women, the best test to detect current infection is the hepatitis B surface antigen
(HBsAg) test. Screening all HBsAg-positive pregnant women for HBV DNA to guide the use of
maternal antiviral therapy during pregnancy.
v. Pap Smear-- this procedure is safe to perform during pregnancy, but any further procedures
are typically delayed until after the baby is born. Physicians perform Pap tests during
pregnancy up until 24 weeks. After that, your cervix will be too sensitive in preparation for
birth, as a result of increased blood flow to your cervix. Most doctors recommend getting a
Pap smear (also known as a Pap test) in early pregnancy as a part of routine prenatal care.
The test results are sent to a lab that checks for abnormal cervical cells, the presence of
which could mean cervical cancer. This is also a good time to check for vaginal infection or
STIs.
vi. Urinalysis/Urine culture- a urine specimen should be carefully collected for urinalysis and
culturing at 12-16 weeks gestation, or the first prenatal appointment, whichever comes first.
These tests help to identify patients with asymptomatic bacteriuria, as well as those with
other concerning findings such as glucosuria. A urine test is used to assess bladder or kidney
infections, diabetes, dehydration, and Preeclampsia by screening for high levels of sugars,
proteins, ketones, and bacteria. High levels of sugars may suggest Gestational Diabetes,
which may develop around the 20th week of pregnancy.
vii. HIV screen- women should receive one HIV screening test as early as possible during
pregnancy to establish baseline HIV status and a second HIV screening test during the third
trimester. HIV antibody testing during pregnancy, with patient consent, is a routine part of
prenatal care. An HIV test is recommended for all people who are pregnant, or planning a
pregnancy regardless of their risk factors or the prevalence rates where they live.
viii. Biophysical Profile (BPP)- it is commonly done in the last trimester of pregnancy. If there is a
chance that the baby may have problems during pregnancy (high-risk pregnancy), a BPP may
done by 32 to 34 weeks or earlier. Some women with high-risk pregnancies may have a BPP
test every week or twice a week in the third trimester. A BPP test may include a nonstress
test with electronic fetal heart monitoring and a fetal ultrasound. The BPP measures your
baby's heart rate, muscle tone, movement, breathing, and the amount of amniotic fluid
around your baby. It is used to evaluate and monitor a baby's health.
 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?
Answer:
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 are 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.

E. What are the recommended guidelines for weight gain during each trimester?
Answer:
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. About 1,800 calories per day during first trimester,
2,200 calories per day during second trimester and about 2,400 calories per day during third
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.

F. What will you teach her about risks of medications, alcohol, and smoking during pregnancy?
Answer:
I will tell her that the risks of medications, alcohol, and smoking can affect her pregnancy and
her child’s health which can lead to long-term harm to the baby. The effect of medication on
pregnancy, drugs or medication taken by the mother may cross the placenta and reach the
developing fetus. The possible effects may include developmental delay, intellectual disability, birth
defects miscarriage and stillbirth. Drinking while pregnant effects on baby, a woman who drinks
alcohol while she is pregnant may harm her developing baby (fetus). Alcohol can pass from the
mother's blood into the baby's blood. It can damage and affect the growth of the baby's cells. Brain
and spinal cord cells are most likely to have damage. In smoking, during pregnancy increases the risk
of health problems for developing babies, including preterm birth, low birth weight, and birth
defects of the mouth and lip. Smoking during and after pregnancy also increases the risk of sudden
infant death syndrome (SIDS).

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?
Answer:
Healthy pregnant women need at least 2½ hours of aerobic activity, such as walking or
swimming, each week. Having regular physical activity can help reduce the risk of pregnancy
complications and ease pregnancy discomforts, such as back pain. Regular exercise can keep the
mind and body healthy, can help to feel good and give extra energy. It also makes heart, lungs, and
blood vessels strong, helps to stay fit to gain the right amount of weight during pregnancy, help to
manage stress, sleep better and can reduce your risk of pregnancy complications, such as gestational
diabetes and preeclampsia and prepare Mary Lou’s body for her labor and delivery. Babies whose
mothers had exercised tended to perform better on tests of motor skills. Newborns whose mothers
exercise during pregnancy may become physically coordinated a little earlier than other babies.
 H. Make five (5) possible NURSING CARE PLAN for Mrs. Sanchez.

Patient’s Name: Mrs. Sanchez Age: N/A Marital Status: Married

NURSING CARE PLAN

NCP NO.1
GOALS/ DESIRED
ASSESSMENT NURSING DIAGNOSIS INTERVENTION RATIONALE VALUATION
OUTCOMES
Subjective: Deficient knowledge After 4 hours of nursing Independent: At the end of my
regarding laboratory tests interventions, the 1. To gain care, the patient
1. Establish rapport.
“Wala ko kahibaw ug
during prenatal visits patient will be able to: cooperation and was able to:
kasabot ngano ig kada
related to lack of source trust from the
prenatal care/prenatal -Verbalize the -Verbalize the
of information as patient.
visit kuhaan man kog ihi, understanding and understanding and
evidenced by patient is
BP, ug pati akong weight importance of importance of
pregnant for the first time 2. Monitor vital signs. 2. To have baseline
e measure sad nila” as information regarding data. information
or primigravida.
verbalized by the patient. laboratory tests during regarding
3. Explain to the
prenatal visits. 3. To know or laboratory tests
Objective: patient about the
tests. understand why is it during prenatal
Scientific Basis:
tested. visits as evidenced
 Lack of source of
The patient has a by “kahibaw nako
information
4. Assess ability to
knowledge deficit or no 4. Cognitive ug unsa ka
 Confusion learn or perform
impairments need importane ag mga
  Primigravida
awareness of necessary
information about
V/S taken as follows: laboratory tests during
T- 36.8°C prenatal visits due to lack
P- 88 bpm of source of information.
R- 22cpm
Bp- 120/80mmHg
REFERENCE:
• Doenges, M. E.,
Moorhouse, M. F., & amp;
Murr, A. C. (2008).
Nurse’s pocket guide:
Diagnoses, prioritized
interventions, and
rationales. Philadelphia,
Pensylvennia: F.A. Davis
Company.
• Matt Vera, B. R. (2001).
desired health to be identified to
related care. laboratory tests
an appropriate
kada pa prenatal
teaching plan.
check-up ko ”, as
verbalized by the
5. To know what
5. Determine priority
patient.
of learning needs needs to be
within the overall discussed and what
care plan.
to prioritize in
teaching.
6. Able to ask
6.Provide clear, and
understandable questions and
explanation about understand of these
the tests during each
tests during prenatal
prenatal visit.
visit.
7.Learners often
7. Encourage to ask embarrasses/shy
questions. about asking
questions.
 Nurselabs. Retrieved from
8. To check if there
Nurselabs.com:
might be a health
8. Discuss to patient
https://nurseslabs.com/.
why weight, BP and problems for both
urine were taken or patient and baby.
tested during each
prenatal.

9. This allows
9. Document additional teaching
progress of teaching based on what
and learning.
learners have
understood and
completed.

10. To give
answers/enlighten
10. Provide contact
numbers for health the client with
care team members. problems being
dealt every day.

NCP NO.2
ASSESSMENT NURSING DIAGNOSIS GOALS/ DESIRED INTERVENTION RATIONALE VALUATION
 OUTCOMES
Subjective: Mild anxiety related to After 4 hours of nursing Independent: At the end of my
lack of knowledge about interventions, the 1. Identify area of care, the patient
1. Assess patient
“ Nabalaka ug naay patient will be able to:
pregnancy process as level of anxiety concerns of process was able to:
kahadlok ug kaya raba through verbal and
evidenced by poor eye - Verbalize the of pregnancy.
kaha ni naho nya wala nonverbal cues. - Verbalize the
contact, trembling and understanding and
pud ko kahibaw unsay 2. Monitor vital signs. 2. To obtain baseline understanding and
patient is primigravida. confidence in herself.
dapat ug angay buhaton data. confidence in
aron healthy ako -Maintain blood herself as
pagbuntis” as verbalized pressure at normal level 3. Enhances nurse evidenced by using
Scientific Basis: 3. Interact with a
by the patient. of range. client relationship positive self-talk,
calm, confident and a
Lacks of knowledge due peaceful manner. and pts feeling of appear relaxed and
Objective:
to the process of stability. report that anxiety

pregnancy which result is reduced to a

 Lack of source of
fear that leads to your manageable level.
information
body's natural response 4.Acknowledgement
 Confusion
4. Recognize -Maintain blood
to stress or anxiety. of pts feelings
 Primigravida
awareness of anxiety. pressure at normal
validates the
 Observed worried level of range as
REFERENCE: feelings and
expressions evidenced by
acceptance of their
 Poor eye contact • Doenges, M. E., normalize blood
  Trembling concerns.
Moorhouse, M. F., & amp; pressure from
5. Allow expressing
V/S taken as follows: Murr, A. C. (2008). 130/90 mmHg to
patient concerns. 5. To validate
T- 36.8°C Nurse’s pocket guide: 120/80 mmHg.
patient concerns.
P- 88 bpm Diagnoses, prioritized
6. Acknowledgement
R- 22cpm interventions, and 6. It helps reduce
of normality of
Bp- 130/90mmHg rationales. Philadelphia, feeling’s anxiety anxiety and
Pensylvennia: F.A. Davis about first time understand about
Company. experience of
feelings of anxiety.
pregnancy.

• Matt Vera, B. R. (2001).

Nurselabs. Retrieved from 7. Offer support by 7. Provides feeling
Nurselabs.com: staying with the
of sense of security
https://nurseslabs.com/. patient, and be active
listeners. and trust between
nurse and patient.
8.Provide accurate
information about 8. Helps client to
situation identify what is
reality based.
NCP NO.3
GOALS/ DESIRED
ASSESSMENT NURSING DIAGNOSIS INTERVENTION RATIONALE VALUATION
OUTCOMES
Subjective: Imbalanced nutrition
related to knowledge
“unsa kahay mga
deficit about nutritional
nutritional food nga
needs during process of
pwedi e intake ug
pregnancy as evidenced
prenatal vitamins nga
by patient is primigravida.
kailangan pud nahu, aron
healthy akoa pagbuntis?” Risk for imbalance require
as verbalized by the
If nay risk di ma
patient.
evidenced
Scientific Basis:
Objective:
Deficient knowledge
 Lack of source of about nutritional needs
information during process of
 Confusion pregnancy and not able to
 Primigravida have adequate nutrition
 Observed worried to meet the body’s
expressions demands can lead to
inability of an individual's
After 4 hours of nursing Independent: At the end of my
interventions, the 1. For the nurse to care, the patient
1. Assess knowledge
patient will be able to:
of nutritional needs. know what was able to:
-verbalize knowledge that the
-verbalize
understanding about patient has already
understanding
the importance of about the
about the
having enough nutritional needs
importance of
nutritional intake and during pregnancy.
having enough
vitamin supplements
2. Metabolism and nutritional intake
during pregnancy. 2. Encourage light
exercises such as utilization of and vitamin
walking, stretching. nutrients are supplements during
improved by pregnancy as
evidenced by “
activity.
karon, kahibaw
3. Eating enough nako nga ug adunay
3. Educate patient
healthy nutritional igo nga nutritional
about adequate
food provide intake ug mga
enough nutritional
intake. everything and vitamins
baby’s need supplements
Important part of importante kaayo
V/S taken as follows: pregnancy nutrition.
body to take in and para sa ahung
T- 36.8°C
absorb specific nutrients pagbuntis” as
P- 88 bpm 4. Important part of
4. Tell to drink
or it may even result from verbalized by the
R- 22cpm enough fluid intakes. pregnancy nutrition.
a poor diet plan. patient.
Bp- 120/80mmHg
5. Beneficial to
5. Help develop a
patient’s health and
plan about the ideal
foods to eat during fetal development
pregnancy. during patient
pregnancy.

6. Folic acid helps

6. Advise to have
reduce the risk of
vitamins
supplements such as neural tube defects.
folic acid.

REFERENCE:
7. Validation lets the
7. Validate the
• Doenges, M. E., patient know that
patient feelings
Moorhouse, M. F., & amp; regarding the impact the nurse has heard
Murr, A. C. (2008). on ability to obtain
and understand
nutrition intake.
Nurse’s pocket guide:
 what was taught.
Diagnoses, prioritized
interventions, and
8. Several factors
8. Assess patient’s
rationales. Philadelphia,
ability to obtain and may affect the
Pensylvennia: F.A. Davis use essential patient’s nutritional
Company. nutrients.
intake, so it is
necessary to assess
• Matt Vera, B. R. (2001).
accurately.
Nurselabs. Retrieved from
Nurselabs.com:
https://nurseslabs.com/.

NCP NO.4
ASSESSMENT NURSING DIAGNOSIS GOALS/ DESIRED INTERVENTION RATIONALE VALUATION
 OUTCOMES
Subjective: Fear related to invasive After 4 hours of nursing Independent: At the end of my
procedure during interventions, the 1. Assess the 1. This information care, the patient
“First time ni nahung patient will be able to:
hospitalization of behavioral and verbal provides a was able to:
pagbuntis ron ug
upcoming labor and -Use breathing and expression of fear. foundation for
mahadlok ko ig labor ug ig -Use breathing and
delivery process as relaxation techniques planning
panganak nahu puhon” as relaxation
evidenced by patient is effectively to reduce interventions to
verbalized by the patient. techniques
primigravida. fear. support patient
effectively to
coping strategies.
Fear rerdin labore process Knowledge , reduce fear as

Objective: verbalization 2. Evaluate the 2. Helps determine evidenced by

Scientific Basis:
measures the pt the effectiveness of absence of worried
• Lack of source of practices to cope expressions and
Hospitalization of coping strategies
information with fear. vital signs are
upcoming labor and used by patient.
stable within
• Confusion delivery process for the
3. Open up 3. Validates the normal range.
first time can lead to an
• Primigravida awareness about feelings the patient
unpleasant emotion or
fear. is holding and
fear.
• Observed worried
demonstrate
expressions
recognition of those
 feelings.
V/S taken as follows: REFERENCE:
4. Tell patient that
fears is normal 4. This reassurance
T- 36.8°C • Doenges, M. E.,
appropriate response places fear within
Moorhouse, M. F., & amp;
P- 88 bpm for her situation. the field of normal
Murr, A. C. (2008).
human experience.
Nurse’s pocket guide:
R- 22cpm
Diagnoses, prioritized
5. Maintain a relaxed 5. Patient feeling of
Bp- 130/90mmHg interventions, and
and accepting stability increases in
rationales. Philadelphia,
demeanor while a peaceful
Pensylvennia: F.A. Davis
communicating. environment.
Company.

• Matt Vera, B. R. (2001). 6. Provide accurate 6. Replacing

Nurselabs. Retrieved from information if inaccurate beliefs

Nurselabs.com: irrational fears based into accurate

https://nurseslabs.com/. on incorrect information reduces

information. anxiety/fear.

7. Discuss the 7. Anticipation of a

process of thinking
future reaction
about their feared
allows client to deal
 situation. with physical
manifestations of
fear.

8. This approach
8. Discuss the helps the patient
situation with the
deal with fear.
patient and help
differentiate
between real and
imagined threats to
well-being.

NCP NO.5
GOALS/ DESIRED
ASSESSMENT NURSING DIAGNOSIS INTERVENTION RATIONALE VALUATION
OUTCOMES
Subjective: Readiness for enhanced After 8 hours of nursing Independent: At the end of my
 parenting related to
“Unsa imong mahatag
childcare.
nga advice para sa akong
pag alaga puhon sa bata?”
as verbalized by the
Scientific Basis:
patient.
A pattern of providing an
environment for children
Objective: or other dependent
person(s) that is sufficient
•Shows manifestations of
to nurture growth and
eagerness and willingness
development and can be
to cooperate
strengthened.
•Lack of source of
information
REFERENCE:
• Confusion
• Doenges, M. E.,
• Primigravida
Moorhouse, M. F., & amp;
Murr, A. C. (2008).
• Observed worried
Nurse’s pocket guide:
interventions, the 1. Perform physical 1. To promote care, the patient
assessment with was able to:
patient will be able to: parent’s knowledge
parents present and
of infant physical - Verbalize realistic
show typical
- Verbalize realistic
newborn characteristics and information and
information and characteristics. Point
behavior. expectations of
expectations of out state such as
parenting role as
quiet awake and cues
parenting role.
to feeing readiness. evidenced by client
states the
responsibility for
2. Encourage parent 2. To promote
emotional and
participation in care
familiarity with
behaviors such as physical care and
behaviors and
diapering, formula well-being of the
feeding and bathing. decrease parental
new family
anxiety and to
member.
enhance parental
feeling of
contribution as
newborn’s primary
caretakers.
3. Make time in 3. Promotes sense
 listening to the of importance and
expressions Diagnoses, prioritized concerns of the being heard.
interventions, and parent(s).
Identifies accurate
V/S taken as follows:
rationales. Philadelphia,
information
Pensylvennia: F.A. Davis
T- 36.8°C regarding needs of
Company.
the family for
P- 88 bpm
enhancing
• Matt Vera, B. R. (2001).
R- 22cpm relationships.
Nurselabs. Retrieved from
Nurselabs.com:
Bp- 130/90mmHg 4. To enable them to
https://nurseslabs.com/.
4. Emphasize be notified that
parenting functions
parenting tasks can
rather than
mothering/fathering both be done,
skills. regardless of
gender.

5. Assists in
5. Encourage
attendance at skill developing
classes, such as parenting skills.
parent/family
effectiveness
training.

6. To promote
6. Involve all the
optimal wellness.
family members in
learning.

7. To ensure that
7. Discuss long-term
proper parenting
plans with the family
and guidance is
observed
throughout the
stages in life.

Dependent:

8. Provide 8. To learn positive

information about
parenting skills and
time management
and stress-reduction adapt to change in
techniques. situations.
 I. Provide your Health Teaching Plan for Mrs. Sanchez.

Patient’s Name: Mrs. Sanchez Age: N/A Marital Status: Married

HEALTH TEACHING PLAN

TOPIC: The importance of having regular prenatal check-ups.
LEARNING LEARNING PROCESSING
LEARNING OUTCOME CONTENTS TIME ALLOTMENT
METHODOLOGY MATERIALS QUESTIONS
After 1 hour of What is prenatal care and The entire process 1. What are the
teaching-learning why is it important? should last in the -Graphic important things to
experience, the whole 1 hour of illustrations consider of having
patient will be able to: Prenatal care is medical care allotted time. -Laptop regular prenatal check-
you get during pregnancy. At -Visual aids ups?
-Gain knowledge and each visit, your health care
-Introduction of -Specific time:
verbalize the provider checks on you and 2. Why is it important
self. 5 minutes
importance of having your growing baby. Call your to have prenatal care?
regular prenatal provider and go for your first
check-ups. prenatal care checkup as soon 3. Define the
-Lecture -Specific time:
as you know you’re pregnant. effectiveness of the
discussion 40 minutes
And go to all your prenatal lesson given?
care checkups, even if you’re
feeling fine. 4. What are the
-Proper -Specific time: comments or opinions
conversation with 15 minutes
Getting early and regular about the procedure
the S.O.
prenatal care can help you being taught?
have a healthy pregnancy and
a full-term baby. Full term 5. Why is it very
means your baby is born important for the
between 39 weeks (1 week mothers of having
before your due date) and 40 regular prenatal care
weeks, 6 days (1 week after and the risk factor for
your due date). Being born full not having any
term gives your baby the right prenatal care?
amount of time he needs in
the womb to grow and
develop.

How often do you go for

prenatal care checkups?

Most pregnant women can

follow a schedule like this:

 Weeks 4 to 28 of
pregnancy. Go for one
checkup every 4 weeks
(once a month).
 Weeks 28 to 36 of
pregnancy. Go for one
checkup every 2 weeks
(twice a month).
 Weeks 36 to 41 of
pregnancy. Go for one
checkup every week
(once a week).

If you have complications

during pregnancy, your
provider may want to see you
more often.

What happens at later

prenatal care checkups?

Later prenatal care checkups

usually are shorter than the
first one. At your checkups,
tell your provider how you’re
feeling. There’s a lot going on
inside your body during
pregnancy. Your provider can
help you understand what’s
happening and help you feel
better if you’re not feeling
well. Between visits, write
down questions you have and
ask them at your next
checkup.

At later prenatal care

checkups, your health care
provider:

 Checks your weight

and blood pressure.
You also may get urine
and blood tests.
 Checks your baby’s
heartbeat. This
happens after about 10
to 12 weeks of
pregnancy. You can
listen, too!
 Measures your belly to
check your baby’s
growth. Your provider
 starts doing this at
about 20 weeks of
pregnancy. Later in
pregnancy, she also
feels your belly to
check your baby’s
position in the womb.
 Gives you certain
prenatal tests to check
you and your baby. For
example, most women
get an ultrasound at 18
to 20 weeks of
pregnancy. You may be
able to tell if your
baby’s a boy or a girl
from this ultrasound,
so be sure to tell your
provider if you don’t
want to know! Later in
pregnancy, your
provider may use
ultrasound to check
the amount of amniotic
fluid around your baby
in the womb. Between
24 and 28 weeks, you
get a glucose screening
test to see if you may
have gestational
 diabetes. This is a kind
of diabetes that some
women get during
pregnancy. And at 35
to 37 weeks, you get a
test to check for group
B strep. This is an
infection you can pass
to your baby.
 Asks you about your
baby’s movement in
the womb. If it’s your
first pregnancy, you
may feel your baby
move by about 20
weeks. If you’ve been
pregnant before, you
may feel your baby
move sooner. Your
provider may ask you
to do kick counts to
keep track of how
often your baby
moves.
 Gives you a Tdap
vaccination at 27 to 36
weeks of pregnancy.
This vaccination
protects both you and
your baby against
 pertussis (also called
whooping cough).
Pertussis spreads easily
and is dangerous for a
baby.
 Does a pelvic exam.
Your provider may
check for changes in
your cervix as you get
close to your due date.

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

Patient’s Name: Mrs. Sanchez Age: N/A Marital Status: Married

DRUG STUDY
SIDE EFFECTS/ ADVSERSE
DRUG NAME MODE OF ACTION INDICATIONS CONTRAINDICATIONS NURSING INTERVENTIONS
EFFECTS
Generic Name: Stimulates Treatment of Hypersensitivity to folic Side Effects: Baseline Assessment:
 folic acid production of megaloblastic acid. None known Pernicious anemia should be
platelets, RBCs, and macrocytic ruled out with Schilling test
Brand Name: WBCs in folate anemias due to Cautions: anemias Adverse Effects: and vitamin B12, blood level
 Apo-Folic deficiency anemia. folate deficiency. ( aplastic, normocytic, Allergic hypersensitivity before initiating therapy.
Treatment of pernicious, refractory) occurs rarely with parenteral Resistant to treatment may
Therapeutic Class: Therapeutic anemias due to form. Oral folic acid is occur if decreased
when anemia present win
 Vitamin, Effect: Essential folate deficiency hepatopoiesis, alcoholism,
vitamin B12 nontoxic
water for nucleoprotein in pregnant antimetabolic drugs,
soluble synthesis, women. Folate deficiency of vit. B6, B12, C,
maintenance of supplementation E is evident.
Pharmacological normal during
Class: erythropoiesis. pericoceptual Intervention/ Evaluation:
 Nutritional period decreases Assess for therapeutic
supplement risk of neural improvement: improved
tube defects. sense of well-being, relief
Actual dose, timing
and route: from iron deficiency
Durin prenancy
symptoms ( fatigue, SOB,
to prevent /fetal
PO: may give neural tube headache).
without regard to defefects
food. Patient/Family Health
Teaching:
IM/IV/SQ/PO:  Eat foods rich in folic
ADULTS, ELDERLY,
acid, including fruits,
CHOLDREN 4YRS TO
OLDER: 0.4 mg/day. vegetables , organic
meats.
Children younger
than 4yrs: up to 0.3
mg/day.
Infants: 0.1mg/day
Pregnant /Lactating
Women: 0.8mg/day
IV: may give 5mg or
less undiluted over
at least 1min , or
dilute with 50mL.

Prevention of
Neural Tube
Defects:
PO: Women of
Childbearing Age:
400-800mcg/day
(microgram per
day).

REFERENCE:
 Saunders Nursing Drug Handbook 1st Edition 2019.pdf multivitamin ,suplemntary
K. Formulate two (2) FDAR for Mrs. Sanchez.

Patient’s Name: Mrs. Sanchez Age: N/A Marital Status: Married

FDAR
DATE/TIME FOCUS DATA ACTION and RESPONSE
04/27/2021 Readiness for enhanced knowledge D: Received client sitting on chair, responsive and coherent
8:00 AM - Appropriateness of facial expression
Ealt teanin bout labor process or prenatal - Expresses an interest in learning
care - No claim of physical discomfort are noted
- Good hygiene
- Vital signs taken as follows:
 T= 36.5 °C
 P= 80 bpm
 R= 22 cpm
 BP=120/80 mmhg
A - Established rapport and introduced self
- Vital signs taken and recorded
- Provided with comfortable environment
- Performed documenting the data
- Encourage the client to have sufficient rest and
adequate sleep
R; Client appeared focus content to be learned
- Behaviors congruent with expressed knowledge as
evidenced by exhibit responsibility for own learning
and seek answers to questions, verify accuracy of
informational resources and verbalized
understanding of information gained.
02/28/2021 Readiness for enhanced nutrition D: Received client sitting on chair, responsive and coherent
8:00 AM - Expresses an interest in learning
- Expresses willingness to enhance nutrition
- Appropriateness of facial
- No claim of physical discomfort are noted
- Good hygiene
- Vital signs taken as follows:
 T= 36.5 °C
 P= 80 bpm
 R= 22 cpm
 BP=120/80 mmhg
A - Established rapport and introduced self
- Vital signs taken and recorded
- Provided with comfortable environment
- Encouraged the client to have proper nutrition and
adequate sleep
- Performed documenting the data
- Encouraged the client to have eating patterns and
food/fluid choices in relation to any health-risk
factors and health goals.
- Advised the client about the safe separation and
storage for foods and fluids.
R; Client appeared focus content to be learned
- Attitude toward eating and drinking is congruent
with expressed knowledge as evidenced by
demonstrate behaviors to attain/maintain
appropriate weight, be free of signs of malnutrition
and able to safely prepare and store foods.