Prelabor Rupture of Membranes

University of Saint Louis
Tuguegarao City, Cagayan 3500
SCHOOL OF HEALTH AND ALLIED SCIENCES

BACHELOR OF SCIENCE IN NURSING – LEVEL III
CASE STUDY ON PRELABOR

RUPTURE OF MEMBRANES
In Partial Fulfillment of the Requirements for the Subject
PNCM 1079: Care of Mother, Child, Adolescent (RLE)
Submitted by:
Banquirig, Cristel M.
Israel, Jansen Christine A.
Pascua, Francess Thea T.
Tambauan, Jaysen L.
Viernes, Caitlin Joy G.
October, 2022
Table of Contents
1

Title Page
Title Page ------------------------------------- 1
Table of Contents ------------------------------------- 2
INTRODUCTION
Disease Definition ------------------------------------ 3
Disease Statistics ------------------------------------ 4
Predisposing and Precipitating Factors ------------------------------------- 6
Signs and Symptoms ------------------------------------- 8
Complications ------------------------------------- 9
Diagnostics ------------------------------------- 10
Treatment and Management ------------------------------------- 12
PATIENT’S PROFILE
Patient Information ------------------------------------- 13
NURSING HISTORY ------------------------------------- 14
GORDON’S 11 FUNCTIONAL PATTERNS ------------------------------------- 15
PHYSICAL ASSESSMENT ------------------------------------- 19
ANATOMY AND PHYSIOLOGY ------------------------------------- 30
PATHOPHYSIOLOGY ------------------------------------- 32
COURSE IN THE WARD ------------------------------------- 33
LABORATORY RESULTS ------------------------------------- 46
DRUG STUDY ------------------------------------- 51
NURSING CARE PLAN ------------------------------------- 78
DISCHARGE PLAN ------------------------------------- 86
REFERENCES ------------------------------------- 88
INTRODUCTION
Definition
2

Prelabor rupture of membrane, previously called premature rupture of membrane, is a

pregnancy complication wherein there is a spontaneous rupture of the fetal membranes before
the onset of labor. The PROM is identified from the typical membrane rupture by the prefix
"pre," which means before, thereby giving a ROM occurring "before labor." Normally, this
happens when labor starts. In this case, the rupturing precedes labor, and the interventions
depend on the fetus's gestational age.
The etiology of PROM is unknown, but several risk factors can predispose or precipitate
a pregnant woman to the disease. The predominant mechanism that arises to PROM is the
stimulation of the host-inflammatory response, resulting in the secretion of proteins that alter the
structural barrier of the fetal membrane. When the amniotic membrane ruptures, there is usually
a sudden gush of fluid from the vagina. But if an intra-amniotic infection is present, the
manifestations vary because fever, abdominal pain, and foul-smelling vaginal discharge are
usually reported.
When PROM occurs at term, particularly >37 weeks of gestation, continuing the
pregnancy is discouraged. Instead, delivery of the baby is recommended because a fetus at this
gestational age is already mature. However, immediate interventions are required as PROM is
considered an emergency. If prolonged, it can develop into complications, both for the mother
and baby, including chorioamnionitis and endometritis, which can further lead to abruptio
placentae, cord prolapse, respiratory distress syndrome, and fetal infection that are more
severe and may result in fetal death.
Statistics
Global Statistics
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Globally, prelabor rupture of membranes (PROM) complicates between 5% and 15% of

pregnancies and is frequently linked to infant infections, respiratory distress syndrome,
intraventricular hemorrhage, and even fatality.
International Statistics
Various studies have presented the percentage of pregnancy complicated by PROM in

different countries. In Ethiopia, 1,828 pregnancies out of the 21,939 sample size were reported
experiencing PROM, giving a prevalence rate of 9.2%. Published by the Open Journal of
Obstetrics and Gynecology, the prevalence of PROM varies from country to country with a rate
of 6.3% in Nigeria, 13.8% in Uganda, and 7.4% in Cameroon. While the studies in Shenzhen
Baoan Maternity and Children’s Hospital, Xibei Women and Children’s Hospital, Chendu
Women and Children’s Hospital in China, from August 1, 2017 to March 31, 2018, there were a
total of 43,543 deliveries from which there were 8,151 cases of PROM, showing of a prevalence
rate of 18.72%. Based on the Global Library of Women’s Medicine’s (GLOWM), PROM
complicates 10% or 400,000 pregnancies in the United States each year.
Prelabor Rupture Of Membrane International Statistics

Uganda
13.8%
China
18.72%
Ethiopia 9.2
USA 10%
Nigeria
6.3%
Cameroon 7.4%
National Statistics
During December 2015 to August 2017, a prospective study was released by the
Philippine Journal of Obstetrics and Gynecology at a tertiary hospital with a sample size of 182,
where they found out that 8% of pregnancy have PROM. The clinicians, however, were
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uncertain with the diagnosis in 47% of patients when based only on examinination and history
because there is currently no ideal noninvasive diagnostic test that can diagnose PROM with
certainty.
Prelabor Rupture Of Membrane Philippine Statistics
Philippines
8%
PREDISPOSING AND PRECIPITATING FACTORS
Predisposing Factors
Ethnicity. Black women have been shown to have an increased risk of PROM because
of the increased likelihood of placental abruption compared to other ethnicities.
5

History of PROM. Women with a history of PROM have a higher risk of recurrent
PROM and preterm birth. The risk of recurrence is 16-32%, compared with approximately 4% in
women with uncomplicated prior delivery.
History of Urinary Tract Infection. Urinary tract infection during pregnancy was
significantly associated with PROM. Although it is treatable, UTI can recur anytime the
treatment is disrupted. This can stimulate the host-inflammatory response by the ascending
movement of the pathogens, from the urinary to the reproductive system, causing the release of
cytokines responsible for matrix breakdown and membrane rupture.
Precipitating Factors
Nutritional Deficiency. Micronutrients, especially vitamin C, affect collagen formation,

in which a deficiency alters collagen structure and increases the risk of PROM.
Socioeconomic status. Pregnant women of lower socioeconomic status with lower

educational levels experienced PROM more frequently because of the inability to access
healthcare during the prenatal period due to lack of financial support or ignorance. The quality
of prenatal assistance may also be poor because of the smaller number of consultations and
fewer laboratory tests, which may result in PROM.
Infections such as intra-amniotic infection, urinary and sexually transmitted

infections (chlamydia, gonorrhea, T. vaginalis, candidiasis, syphilis, bacterial vaginosis,
and Group B Streptococcus). Any infection during pregnancy stimulates the release of
inflammatory mediators, such as proteolytic enzymes and cytokines, which triggers matrix
breakdown responsible for weakening the fetal membranes, resulting in PROM.
Vices such as cigarette smoking and the use of illicit drugs. Heavy cigarette
smoking increases the risk of PROM at early gestational age than at term. Cigarettes induce
oxidative stress and inflammation, mechanisms both implicated in fetal membranes weakening.
On the other hand, illicit drugs, such as cocaine, during pregnancy have been associated with
premature rupture of membranes, preterm birth, placental abruption, low birth weight, and small
gestational age.
Hemorrhage and Placental Abruption. Vaginal bleeding during late pregnancy and
abruptio placentae also cause membrane weakness as they contribute to triggering
inflammatory responses.
Direct abdominal trauma. Blunt and penetrating abdominal trauma can cause fetal
membrane rupture. A trauma, either blunt or penetrating, can stimulate the release of cytokines
responsible for matrix breakdown.
Uterine overdistension (polyhydramnios, multifetal pregnancy). Increased

mechanical stretch of fetal membranes due to an overdistended uterus may also lead to loss of
integrity and membrane rupture.
6

Collagen vascular disorders (Ehlers-Danlos syndrome, systemic lupus

erythematosus). Women with collagen vascular disorders during pregnancy are associated
with an increased risk of preterm birth and PROM. Primarily, defects in fibrillary collagen
synthesis or altered collagen or other extracellular matrix protein structure affect the tensile
strength of fetal membranes, leading to preterm birth from unscheduled rupture.
Sexual intercourse during late pregnancy. Coitus during late pregnancy has been
found to increase the risk of PROM because sexual intercourse could precipitate an infectious
process in the membranes and subsequent rupture.
SIGNS AND SYMPTOMS
The following are the most common symptoms of PROM. However, each woman may
experience symptoms differently. Symptoms may include:
 Sudden gush of fluid or continuous leakage of fluid from the vagina

 Constant wetness in underwear
 Sensation of inability to stop urinating
 Color of fluid may be:
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o Clear
o Straw-colored
o Greenish (Meconium-stained)
o Blood-tinged (associated with placental abruption)
o Purulent (Infection)
COMPLICATIONS
Maternal Complications
Chorioamnionitis. It is an inflammation of the amniochorionic membrane due to a

prolonged rupture of membrane. The occurrence is a result of ascending infection wherein the
bacteria in the vagina or anus moves up into the uterus and cause an inflammation.
Endometritis. This condition usually follows vaginal delivery, especially after prolonged
rupture of membrane or chorioamnionitis. Specifically, the rupture of the amniotic membrane
8

enables the translocation of normal bacterial flora from the cervix and vagina to the usually
aseptic uterus, to the innermost uterine lining- endometrium.
Abruptio placentae. Placental abruption is the separation of the placenta from the
uterus before birth. Because placenta is also developed and attached to the uterine wall during
pregnancy, the loss of amniotic fluid due to prelabor rupture of membrane, causing uterine
decompression, can suck it out resulting in placental abruption.
Fetal Complications
Fetal Infection. An infection of the fetus is associated with chorioamnionitis. Due to

prolonged rupture of membranes, the ascending bacteria in the vagina has an easier
penetration to the uterus, spreading an infection to the chorioamnion, and eventually to the
fetus.
Cord Prolapse. The umbilical cord prolapse occurs when the umbilical cord exits the
cervical opening before the fetal presenting part. This happens after prelabor rupture of
membrane because of the fluid rushing out, causing the umbilical cord to be washed downward
through the cervix as well.
Respiratory distress syndrome. Fetal distress is most frequently brought on by the

baby not getting enough oxygen due to issues with the placenta (placental abruption or
placental insufficiency) or the umbilical cord (the cord gets compressed because it comes out of
the cervix first).
Fetal death. PROM is one of the significant causes of infection, which is the leading
cause of neonatal death. PROM-related fetal death are usually the result of complications,
including infection, cord prolapse, and respiratory distress syndrome if untreated immediately.
DIAGNOSTICS
A doctor will diagnose prelabor rupture of membrane by first obtaining a complete
medical history and physical examination. Afterward, several tests will be ordered to confirm the
diagnosis of PROM including the following:
Diagnostic tests
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Sterile speculum examination. This procedure is performed to confirm PROM, assess

cervical dilation, and collect samples for cervical cultures. However, a digital pelvic examination
should be avoided if delivery is not anticipated because it increases the risk of infection.
Fern Test. This test is utilized with a microscope to detect rupture membranes. Wherein
when the bag of water is broken, the fluid and estrogen will form a "fern-like" pattern due to salt
crystallization.
pH Test. This procedure involves measuring the pH level of a sample vaginal fluid.
Whereas the normal vaginal pH ranges from 4.5 to 6.0 and the amniotic fluid has a higher pH of
7.1 to 7.3. Thus, if the pH of the sample fluid is higher than the normal range, the membranes
have ruptured.
Dye test. During this test, the amniotic sac will receive a dye injection through the
abdomen. Within 30 minutes, if the membranes have ruptured, a colored fluid will be observed
in the vagina.
Nitrazine Test. In this test, a drop of vaginal fluid is applied to paper strips dyed with
nitrazine. The pH of the fluid affects how the color of the strips changes. If the pH is above 6.0,
the strips will turn blue, which most likely indicates a rupture of the membrane. However, there
is a possibility that this test will produce false positive results. Wherein the pH of the vaginal fluid
may be higher than usual if there is blood in the sample or if an infection is present. Moreover,
recent vaginal intercourse can also cause a false reading because the semen has a higher pH.
AmniSure ROM test. It is a newer noninvasive test in which speculum examination is

not necessarily needed. This procedure operates by detecting the placental alpha
microglobulin-1 biomarker in the amniotic fluid.
Ultrasound. Transperineal ultrasonography is a non-invasive procedure that can be

used to evaluate vaginal pooling of amniotic fluid.
Fetal fibronectin Test. It is a diagnostic test of cervical and vaginal secretions to

determine the presence of fetal fibronectin (a glue-like protein that secures the amniotic sac to
the lining of the uterus). A level less than 0.05 mcg/mL (SI, 0.05 mg/L) indicates that birth is
unlikely to occur within the next 14 days. However, if the level is greater than 0.05 mcg/mL (SI,
0.05 mg/L), it indicates that birth will likely occur in 7 to 14 days.
Amniocentesis. It is a procedure in which the amniotic fluid is examined to detect the

presence of infection and the fetal lung's level of development.
Laboratory tests
Complete Blood Count (CBC). It measures the quantity and level of red blood cells
(RBC), white blood cells (WBC), and platelets (PLT) present in the body. It is also use to
10

diagnose health conditions and monitor how the body is affected by different diseases or
medical treatments.
Urinalysis. It evaluates the physical characteristics of urine; determines specific gravity

and pH; detects and measures protein, glucose, and ketone bodies; examines sediment for
blood cells, casts, and crystals; can screen for bilirubin, urobilinogen, and nitrates.
TREATMENT AND MANAGEMENT
Treatment
Oxytocin. This drug given is identical to the natural oxytocin produced by the pituitary
gland. Giving oxytocin intravenously makes the uterus contract frequently and forcefully. The
purpose of oxytocin administration is not only to stimulate contraction after PROM, but also to
promote the progress of labor and reduce bleeding after childbirth.
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Ampicillin. This is used to treat a wide variety of bacterial infections. It is a penicillin-

type antibiotic, and this can be beneficial to the mother and the fetus. When PROM happens,
there is a risk of infection entering the uterus and affecting the mother and the fetus, and the
use of ampicillin for the mother may reduce the risk.
Management
Perineal care. This involves maintaining the perineum area clean when an episiotomy
is made. This procedure is done usually during bath time as this prevents infection, irritation,
and odors.
PATIENT’S PROFILE
PATIENT’S INFORMATION
• Name: M.D.
• Sex: Female
• Age: 25 years old
• Birthdate: November 4, 1996
• Birthplace: Cattaran, Solana, Cagayan
• Address: Purok 4, Cattaran, Solana, Cagayan
• Nationality: Filipino
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• Dialect Itawes
• Religion: Roman Catholic
• Civil Status: Married
• Date Admitted September 19, 2022
• Chief Complaint: Leaking Bag of Water
• Admitting Diagnosis: PU 39 6/7 Weeks AOG G1P0 PROM
• Final Diagnosis: Prelabor Rupture of Membranes
• Admitting Physician: Dr. K.C.
• Attending Physician: Dr. K.C.
Initial Vital Signs (September 19; 11 AM, upon admission)
• Temperature: 36.8 degrees Celsius

• Respiratory Rate: 22 cpm
• Pulse Rate: 92 bpm
• Oxygen Saturation: 97%
• Blood Pressure: 130/90 mmHg
Latest Vital Signs (September 21; 12:00 noon, Day 3 and with may go home order)

NURSING HISTORY
HISTORY OF PRESENT ILLNESS
Patient M.D. is a 25-year-old pregnant female admitted to Divine Mercy Wellness Center
Inc. (OB Unit) on September 19, 2022, with a chief complaint of a leaking bag of water. The
patient’s Last Menstrual Period (LMP) was obtained, which is on December 13, 2021. Her
Expected Date of Delivery (EDD) should be on September 20, 2022. However, the patient’s
amniotic membrane ruptured two days before the EDD, which was on September 18, 2022. A
day before admission, the patient experienced a sudden gush of water and vaginal discharge.
After few hours, patient M.D. verbalized uterine contractions, in which she first sought
13

consultation in their Rural Health Unit and then was referred to DMWC afterward. Upon
admission, she was given an admitting diagnosis of PU 39 6/7 Weeks AOG G1P0 PROM.
On September 19, 2022, patient M.D. underwent physical examination and laboratory
tests, in which she was diagnosed with Prelabor Rupture of Membranes. During hospitalization,
patient M.D. was given medications (Oxytocin drip, Nalbuphine, Hyoscine, Evening Primrose
Oil, Midazolam, Methylergometrine, Dicoflenac, Ampicillin, Sultamicillin, Metronidazole,
Mefenamic Acid, Moringa, Ferrous Fumarate, Senna, and Mupirocin ointment) and IVF therapy
(PLRS, D5LRS). Initial vital signs as of September 19 (11:00 AM) were body temperature of
36.8 °C, respiratory rate of 22, pulse rate of 92, blood pressure of 120/90 mmHg, and oxygen
saturation of 97%.
HISTORY OF PAST ILLNESS
According to the patient, she has no history of PROM as it was her first pregnancy.
However, she stated a history of Urinary Tract Infection (UTI).
The patient also verbalized that she completed the COVID-19 vaccine (Moderna) and
DPT vaccine (Diphtheria, Pertussis, and Tetanus), but does not remember the immunizations
she has received in childhood.
FAMILY HEALTH HISTORY
As stated by the patient, their family has no family history of any serious illnesses,
especially hypertension. In fact, her parents are living until now without any illness, as well as
her siblings.
SOCIAL HEALTH HISTORY
Patient M.D is living with her parents and siblings. She verbalized having good
relationships with her family, and a very well support system. As the first child, she mentioned
being a model to her siblings. She helps in doing household chores.
GORDON’S 11 FUNCTIONAL HEALTH PATTERNS
Functional Health Pattern Before Hospitalization During Hospitalization

1. Health Perception-Health The patient verbalized that Patient M.D is still conscious
Management health should always be of her health because she is
taken care of, especially breastfeeding her child. She
since she is carrying a child. complies with her
She stays active and avoids medications and cooperative
going out because she does with the implemented
not want to acquire any interventions. She also
disease, such as initiating a understood the importance of
balanced diet, particularly the taking rest and regaining her
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serving of her rice intake. strength, which is why she

always grabbed the
opportunity to nap whenever
her child was asleep.
2. Nutritional and Metabolic The patient has a good Before delivery, the patient
Pattern appetite, except in her early was put on a soft diet. After
pregnancy, that she started giving birth, she was put on
disliking what she usually ate diet as tolerated. She
and became sensitive to mentioned not having
foods because of her restrictions on food and that
cravings. After this stage, she she ate only the meals
followed a diet wherein she provided by the hospital,
only ate two meals a day with emphasizing the inclusion of
one snack. She mentioned fruits and vegetables in every
that she was fasting at night. meal. In terms of fluids, the
Specifically, the patient patient drinks two glasses of
stated consuming 1 cup of milk and up to 6 glasses of
rice, 2-3 pieces of fruits and water a day, and was infused
vegetable in every meal, as with a total of 5 bottles of IVF,
prepared by the patient 3 D5LR and 2 PLR.
herself or her mother. The
patient drinks water up to 6
glasses a day and milk twice
a day (morning and night),
and coffee and soft drinks but
only occasionally. Along with
her diet are vitamins,
including Calcium, Ferrous
Fumarate, and Moringa.
3. Elimination Pattern Patient M.D. mentioned The patient urinates four
having a regular urination times a day with a little
and defecation scheme. She discomfort and defecate only
urinates 6-7 times, with light once, particularly on her last
yellow urine, and defecates day. She verbalized having
daily with brown color well- difficulty and feeling
formed stool, not hard and discomfort in urinating and
not watery. According to the defecating because of her
patient, there were no perineal cut.
difficulties with urine
elimination and defecation.
The patient also stated
perspiring quickly and
excessively when exercising
and doing household chores.
4. Activity-Exercise Pattern Patient M.D. has an exercise The patient was on bed rest
routine, including walking and because of feeling weak after
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squatting for 30 minutes delivery, but encouraged with

twice daily. Other activities gradual ambulation. She
involved doing household verbalized being mostly
chores, such as washing assisted by her sister and
clothes and the dishes and husband, especially when
cooking, but for a short breastfeeding, eating, and
period because she quickly going to the bathroom. When
gets tired due to her she was bored and had
pregnancy. In her free time, nothing to do, the patient
she usually watches TV spent time on her phone for
shows or scrolls on her 30 minutes, unless she was
mobile phone for 30 minutes sleepy.
to 1 hour.
5. Sleep-Rest Pattern The patient had a sleeping The patient could not sleep
routine from 10 PM to 6 AM. properly and always felt tired.
She verbalized feeling well- She started having
rested after a night of sleep, interrupted 3-4 hours of sleep
with 6-8 hours duration. She because of being awakened
also mentioned taking naps by the cries of her child and
for 15 minutes every after her the need to breastfeed him.
activities and in the Due to this, she makes up for
afternoon. When she was her sleep by taking naps in
nearing her due date, the the morning, at least three
patient experienced difficulty times a day, for 10-15
sleeping. According to her, minutes.
she usually spends time on
her phone, ranging from 30
minutes to an hour, because
she said that she gets sleepy
when she does this.
6. Self-Perception/ Self- Patient M.D. stated being a The patient verbalized having
Concept positive, responsible and the same perception about
dependable daughter, sibling, herself.
and wife. She also sees
herself as someone fit and
healthy. She is the eldest
child that is why she is
striving well to be a good
model to her siblings.
7. Cognitive-Perceptual Patient M.D. could The patient is oriented to
Pattern understand and follow time, place, and person. She
instructions easily. She is was very cooperative during
responsive and can recall the interview and answered
events from the past. all the questions
independently. She were also
able to narrate her daily
16

activities before and her

previous meals.
8. Role-Relationship Patient M.D. lives with her The patient’s relationship with
Pattern family, and because she is her family is fine and stable.
the eldest, she also acts as She mentioned that her
the pillar at their house. She family at home are excited for
has good relationships with her discharge and her baby.
her family and his husband’s She also stated that her
family too. According to the family calls and talks to her
patient, “Close ako sa family every day to check on her
ko at in good terms naman condition and her baby.
ako sa lahat. Nagbbonding
din kami minsan kapag hindi
busy.”
9. Sexuality-Reproductive Patient M.D is a newly- The patient is still recovering
Pattern wedded woman. She from delivering her baby and
mentioned that right after the her minor incision is being
wedding, they wanted to get treated and observed of its
pregnant that is why she was healing process.
sexually active with her
husband until late pregnancy.
10. Coping-Stress The patient verbalized talking Patient M.D relays all her
Tolerance to her husband or family discomfort or problem to her
whenever there is a problem husband, who helps her deal
or she is stressed. She with it. As verbalized by the
mentioned relieving her patient, “Kapag stressed or
stress by walking, bonding may problema ako,
with her family, watching nagkukwento lang ako sa
television and scrolling asawa ko at tinutulungan niya
through her phone. sa kung ano dapat ang isipin
at gawin.”
11. Value-Belief Pattern Patient M.D. is a Roman The patient’s faith grew
Catholic and verbalized that stronger. She believed that
her faith and her family's faith God guided her and her son
are strong. She mentioned throughout the labor and
praying every day and delivery. She also mentioned
sometimes attend the that God kept them safe
Sunday mass because of the despite the complications.
COVID-19 pandemic. Now,
she is willing to teach her son
to believe and always pray to
God.
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PHYSICAL ASSESSMENT
Date of Assessment: September 21, 2022 (8:00 AM)
Upon receiving patient M.D., her general appearance is clean and well-groomed, with an
ongoing infusion of 1 Liter of D5LRS with oxytocin drip at 10 gtts/min on her left hand. The
patient, however, looks tired and shows a slight difficulty with mobility. She is also in a sitting
position, but is slouching.
Throughout the interview and physical examination, the patient is cooperative and alert
to the questions and instructions. She maintains an eye contact and projects facial expressions
that are appropriate to the topic. She also gives her answers clearly and audibly, and repeat the
questions or instructions if necessary.
Latest Vital Signs (September 21; 12:00 noon, Day 3 and with may go home order)

AREA TECHNIQUE NORMAL ACTUAL

REMARKS
ASSESSED USED FINDINGS FINDINGS
SKIN
Color Inspection Skin color Skin color is Normal
varies with brown.
genetic, race,
and
environmental
factors.
Texture Inspection Soft, smooth, Skin is smooth Normal
and Palpation and even skin. soft and even.
Mobility and Palpation Skin returns to The skin returns Normal

Turgor a normal state to its normal state
within 1-2 in 1 second.
seconds when
pinched.
Lesions Inspection No abrasions No abrasions or Normal
or lesions lesions.
Uniformity Inspection Skin color The skin is not Normal
varies from uniform in all
body areas and areas. The
from exposed patient’s abdomen
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and non- have

exposed to sun stretchmarks, a
areas. striae of brown.
Knees and
elbows has
darker skin.
Skin may have

stretchmarks or
freckles.
Moisture Palpation Minimal Minimal presence Normal
presence of of perspiration or
perspiration or oiliness.
oiliness.
Increased
perspiration on
palms, scalp,
forehead,
axillae.
HEAD
Size and Inspection Normocephalic, Normocephalic Normal
Circumference appropriate
with age and
gender.
Facial Features Inspection No dysmorphic No deformity, Normal

features. lesions, edema,
and inflammation.
No presence of
lesions, edema,
and
inflammation.
Shape Inspection Rounded Rounded Normal

HAIR
Color Inspection Color varies Black hair Normal
with genetics
and race.
Changes with No dyes, rinses,

rinses, dyes, and permanents.
and
permanents.
Distribution Inspection Evenly No generalized Normal
distributed. and localized hair
19

loss, or hirsutism.
Present on
scalp, nares,
ears, chest,
axillae, arms,
legs, pubic
area, around
nipples, and
back.
Texture Palpation Texture varies No brittleness Normal
with genetics,
race, location, Fine and straight
and alteration.
Smooth, shiny,
Curly or and resilient hair.
straight.
Coarse or fine.
Smooth, shiny
and resilient
hair.
Presence of Inspection No presence of No infestation, Normal
parasites infestation, inflammation, and
inflammation, infection.
and infection.
SCALP
Symmetry Inspection Symmetrical Symmetrical Normal
aligned with the
age, gender,
and body
structure.
Appearance Inspection Absence of No presence of Normal

seborrheic seborrheic
dermatitis, dermatitis,
lesions, and lesions, and
inflammations. inflammation.
NAILS
Color (nail bed) Inspection Variation of Pinkish in color Normal
pink in color.
Shape Inspection Convex, Convex curve Normal

curvature, 160
degrees angle.
Texture Palpation Smooth and Smooth and firm Normal
20

firm upon
palpation
Tissue Palpation Intact Epidermis is Normal
Surrounding epidermis intact.
Nails
Capillary refill Palpation Color should Returned to its Normal
test return to normal state
normal state within 1 second.
within 1 to 2
seconds
EYEBROWS
Distribution Inspection Evenly Hair is evenly Normal
distributed hair distributed.
Direction of Curl Inspection Equal in Equal movement Normal
movement
Alignment Inspection Symmetrically Symmetrically Normal
aligned aligned
EYELASHES
Evenness Inspection Equally Equally distributed Normal
distributed
Direction of Curl Inspection Slightly curved Slightly curved Normal
outwards outwards
Appearance Inspection Moisturized, Moisturized, Normal
combined, and combined, and
nourished nourished
EYES
Color Inspection White sclera White sclera Normal
Conjunctiva Inspection Transparent. Conjunctiva is Normal
transparent.
Pink palpebral
conjunctiva. Palpebral
conjunctiva is
pink.
Eyelids Inspection Intact skin The patient’s skin Normal
is intact, has no
No presence of discharge and
discharged and discoloration.
discoloration
The lids close
Can close symmetrically and
symmetrically patient blinks
normally.
Iris Inspection Varies with Black Normal
genetics or
race Flat and round
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Black or dark
brown
Flat and round

PUPILS
Color Inspection Depending on The pupils are Normal
race and black without
genetics. cloudiness.
Shape Inspection Has a smooth Smooth and round Normal
and round border.
border.
Symmetry and Inspection Equal in size Equal in size Normal
Size
PERRLA
Accommodation Inspection Pupils constrict Both pupils Normal
when looking at constrict, dilate,
near object; and converge
pupils dilate accordingly.
when looking at
far object;
pupils converge
when near
object is moved
towards the
nose.
Reaction to light Inspection Pupil constricts Both pupils Normal
when exposed constrict with
to bright light; equal response.
light presented
to the opposite
eye also
constricts
(consensual
response).
Visual Fields Inspection Can be able to Can see objects in Normal

see objects the periphery
within while looking
peripheral view straight ahead.
when looking
straightforward
Extra Ocular Inspection Both eyes Both eyes Normal

Movement coordinated, coordinated, move
move in unison, in unison, with
with parallel parallel alignment.
alignment.
22

EARS
Color Inspection Consistent with Consistent with Normal
the color of the the color of the
facial skin. facial skin.
Size Inspection Bilaterally Bilaterally Normal

symmetrical in symmetrical in
size. size.
Position Inspection Lateral to the Positioned Normal

eyebrows and centrally and in
auricles aligned proportion to the
with the outer head.
canthus of
each eye.
Discharge Inspection No discharge No foreign bodies, Normal
redness,
drainage,
deformities,
nodules, and
lesions.
Texture and Inspection Return to Return to normal Normal
elasticity of and Palpation normal state state within 1
pinna within 1-2 second.
seconds.
NOSE
Tenderness Inspection Absence of Nose is not tender Normal
and masses tenderness and no lesions or
during masses are noted.
palpation
Absence of
masses
Patency Inspection Air can move The patient Normal

and palpation freely from breathes easily
air moves nares during and air moves
freely inhaling and freely.
exhaling
sensation
Flaring Inspection Absence of No nasal flaring Normal
nasal flaring was noted
Discharge Inspection Absence of No presence of Normal

discharge discharge
Position Inspection Centered Symmetrically Normal
23

symmetrically centered
Absence of No deformities
deformities were noted.
MOUTH
Presence of Inspection No presence of No presence of Normal
Lesions lesions. lesions.
Lips Inspection Depends on Pale lips. All are normal
age and except for the pale
genetics. Dried lips with and dried lips with a
slight pealing of slight pealing of the
Uniform pink the skin. skin due to
color dehydration and
Contours are patient is still
Moistened, soft symmetrical. recovering.
and smooth in
texture
Symmetrical
Contours
Ability to pursue Inspection Can purse lips Can purse lips Normal
lips
Buccal Mucosa Inspection Smooth, Dry and slightly Due to dehydration
moistened, and pink. and patient is still
glistering in a recovering.
soft pink color.
Teeth Inspection Smooth, white, Smooth, white, Normal
shiny tooth shiny tooth
enamel enamel
Gums Inspection Pink, moist, Pink, moist, and Normal
and firm. firm, without
tenderness or
bleeding.
Tongue Inspection Centrally Tongue is Normal

positioned and centrally
moves freely. positioned and
moves freely;
Pinkish, Pinkish,
Moist, slightly Moist, slightly
rough. rough, without
lesions and
No presence of tenderness.
lesions and
tenderness
Uvula Inspection Positioned at Uvula is Normal
24

the middle positioned at the

middle, color is
Uniform pink uniformly pink,
color and no presence
of lesions and
No presence of tenderness.
lesions and
tenderness.
Tonsils Inspection Pink, smooth Tonsils are pink, Normal
and Palpation posterior wall, has smooth
and not posterior wall, and
inflamed. not inflamed.
Absence of No presence of
discharge. discharge.
NECK
Mobility Inspection Coordinated, Broad range of Normal
smooth motion.
movements
with no No pain during
discomfort. movement.
Position and Inspection Muscles are Muscles are equal Normal
characteristics symmetrical in in size
size.
Head at the center
Head at center.
THORAX AND LUNGS
Breathing Inspection Quiet, rhythmic, Quiet, rhythmic, Normal
Pattern and effortless and effortless
respirations. respirations.
Symmetry Inspection Chest expands Chest expands Normal

symmetrically symmetrically
during during respiration.
respiration.
Chest wall Inspection Intact, without Chest wall is Normal
and palpation presence of intact without
tenderness and presence of
masses. tenderness and
masses.
Chest Palpation Full and Full and Normal
Expansion symmetric symmetric thorax
thorax expansion .
expansion.
Percussion Percussion Able to note Able to note Normal
sound resonance. resonance.
25

Symmetry in Symmetry in
percussion percussion notes.
notes.
No areas of
No areas of dullness or
dullness or flatness over lung
flatness over tissue
lung tissue
Breath Sounds Auscultation No presence of No presence of Normal
wheezing, adventitious
sighing, breath sounds.
panting, deep
inhalations and
exhalations.
ABDOMEN
Integrity Inspection Unblemished Stretchmarks are Normal
skin present.
Stretchmarks
may be present
Umbilicus Inspection Positioned Positioned midline Normal
midline
No discoloration
Absence of and inflammation.
discoloration
and
inflammation
Abdominal Inspection Flat, convex, or Concave Normal
Contour concave.
No notable No notable
enlargement of enlargement of
liver or spleen. liver or spleen
Contour may Contour is

be asymmetric asymmetric.
due to
pregnancy.
Bowel Sound Auscultation Audible bowel Bowel sounds are Normal
sounds audible and
normal
Tenderness Palpation Absence of No tenderness Normal

tenderness
Relax, with
Relax, with smooth and
smooth and consistent tension
26

consistent
tension
HEART
Heart Rate Auscultation Regular with Regular with a HR Normal
HR within 60- of 79 bpm
100 bpm
UPPER EXTREMITIES
Color Inspection Color varies Brown skin color Normal
and depending on
Observation race and No pallor,
genetics. cyanosis, and
jaundice
Dark to brown
in color
Texture Palpation Smooth Smooth Normal
Temperature Palpation 36.5°C-37.5°C 36.3°C Normal
Mobility and Palpation When pinched, Elastic; the skin Normal

Turgor skin springs goes back to
back to previous state in 1
previous state second.
(is elastic).
Lesions Inspection Absence of No lesions Normal
lesions
Appearance Inspection Symmetrically Symmetrically Normal
aligned aligned
No deformities No deformities
Uniformity Inspection Varies from No Normal
body areas and hyperpigmentation
from exposed and discoloration.
and non-
exposed to sun Elbows and knees
areas have darker skin.
Elbows and
knees have
darker skin.
Moisture Palpation Minimal Minimal presence Normal
presence of of perspiration or
perspiration or oiliness, except in
oiliness. the axilla and
skinfolds.
Increased
27

perspiration on
palms and
axillae
28

ANATOMY AND PHYSIOLOGY

Female Reproductive System
The female reproductive system functions to produce egg cells and reproductive
hormones, support a developing fetus and give birth to it. It is primarily inside the pelvic cavity,
divided into external and internal genital organs. The external female genitalia is referred to as
the vulva, which comprises the mons pubis, labia majora, labia minora, clitoris, hymen, and the
Bartholin's gland. Specifically, the mons pubis is a pad of fat located over the pubic bone and
becomes covered with hair during puberty. The labia majora are folds of hair-covered skin that
begin just posterior to the mons pubis, while the labia minora are the thinner and more
pigmented folds that lie inside the labia majora. Both these folds are responsible for protecting
the female urethra and the entrance to the female reproductive tract. The forward portions of the
labia minora come together to encircle the clitoris (or glans clitoris), an organ that originates
from the same cells as the glans penis and has abundant nerves that make it important in
sexual sensation and orgasm. On the other hand, the hymen is a thin membrane that partially
covers the entrance to the vagina. Lastly, the Bartholin's glands are located on each side of the
vaginal opening, responsible for secreting fluid to lubricate the vagina.
The internal female genitalia include the vagina, ovaries, fallopian tubes, and uterus.
Specifically, the ovaries produce the egg cells, called the ova or oocytes. The oocytes are then
transported to the fallopian tube, where fertilization by sperm takes place. The fertilized egg
then moves to the uterus, where the uterine lining thickens in response to the normal hormones
of the reproductive cycle. Once in the uterus, the fertilized egg will be implanted into the
thickened uterine lining, where it continues to develop until ready for birth through the vagina, a
muscular canal that serves as the entrance to the reproductive tract and exit from the uterus
during menses and childbirth.
The Uterus
29

The uterus comprises three layers: the endometrium, myometrium, and perimetrium.
The inner lining is a thin layer called endometrium, which responds to hormones, and the
shedding of this layer causes menstrual bleeding. The middle layer, myometrium, is composed
of smooth muscle cells, while the outer lining, perimetrium, is a thin layer of cells. During
pregnancy, the lining of the uterus thickens, and its blood vessels enlarge to nourish the fetus.
As pregnancy progresses, it expands to make room for the growing and developing fetus.
Along with the fetus are the placenta and amniotic sac or membrane formed inside the
uterus during pregnancy. The placenta is a temporary endocrine organ that produces
hormones, estrogen and progesterone, responsible for maintaining a healthy pregnancy and
preparing for labor and breastfeeding. Aside from that, it also connects the developing fetus to
the wall of the mother’s uterus, enabling the transmission of nutrients for fetal growth and
development.
The Amniotic Membrane
On the other hand, the amniotic membrane is a thin-walled fluid-filled sac that surrounds
the fetus, serving as a cushion and a layer of protection from any injury. It also regulates fetal
temperature and is a core strength that prevents early delivery. The structure of an amnionic
sac consists of an outer thick cellular membrane called the “chorion” and an inner thin
collagenous membrane with high tensile strength called the “amnion.” Basically, the chorion
acts as an immunologic barrier, while the amnion acts as a structural barrier. However, these
barriers can be disrupted when a woman during pregnancy has a compromised immune system
due to an infection, mechanical trauma, defective collagen synthesis, or underlying disorder. All
these factors can weaken the fetal membrane and reduce its ability to maintain its functions until
birth. When there is an increase in cytokines and a decrease in amniotic collagen content and
function, the tensile strength of the fetal membrane decreases, resulting in a prelabor rupture of
the membrane.
PATHOPHYSIOLOGY
30

31

COURSE IN THE WARD

Date and Doctors Order Rationale Intervention
Time
9/19 – Admit the patient to a Admitting the patient will  Patient was admitted
11:20 AM room of choice under help the doctor to take for resumption of care
Doctor K. C. note of their progress. under the service of
Also, admitting them to Dr. K.C.
their room of choice will  Informed Dr. K..C.
ensure that the patient about the admission.
will be comfortable.
NPO To prepare the patient  Explained to the
for the Ampicillin patient and S/O what
administration because is NPO and its
food reduces its purpose.
absorption.
Monitor vital signs, FHT To provide baseline data  Monitored vital signs
q1 and record it. of the patient’s current every hour as
vital signs. ordered.
Monitor I&O q shift and Intake and output (I&O)  Monitored and
record it. indicate the fluid recorded intake and
balance for a patient. output of the patient.
The goal is to have
equal intake and output.
Too much or too less
intake can lead to fluid
imbalance.
Administer D5LR 800 For daily maintenance of  Ensured that all labels
mL with oxytocin drip x body fluids and nutrition in the IV ticket is
10 gtts/min. and for rehydration. The correct.
Oxytocin helps stimulate  Ensured that the
uterine contraction to correct IV and side
promote labor. drips are correct
before being
administered.
 Ensured correct
dosage of medication
before being
administered.
 Explained to the
patient and their S/O
what the purpose of
the IVF and oxytocin
32

is.
 Administered and
regulated IVF and
side drip as ordered.
Laboratory and  Referred the test to

diagnostic tests: the Laboratory and
Diagnostics.
 CBC A complete blood count  Explained to the
is a common blood test patient and S/O what
used to detect a variety the procedure is all
of disorders including about and what is the
infections, anemia, purpose of the
diseases of the immune laboratory test to the
system, and blood
patient in a language
cancers.
they can understand.
 Prepared the client for
Antigen test, frequently
 RAT the procedure.
referred to as a rapid
test, is performed  Explained to the
to detect protein patient that she may
fragments specific to the experience discomfort
Coronavirus. This is during the blood
done as per the hospital collection procedure.
policy.
It is a kind of test that

 Urinalysis
examines the patient’s
urine, and it is often
done to detect infections
or dehydrations.
Transport to the delivery To check and monitor  Explained to the
room for Electrofetal the fetal heart rate. patient and S/O what
monitoring (EFM). the procedure is all
about and what is the
purpose of the EFM to
the patient and fetus
in a language they
can understand.
 Prepared the client for
the procedure.
Give ampicillin 2g/IVT To prevent or reduce the  Verified the patient’s

now, then 1g/IVT 96 risk of infection. name and explained
ANST ( - ). to the significant other
33

about the medication

in a way that they can
understand.
 Administered the
medication following
the 10 rights of drug
administration.
 Ensured that the
medication was given
on an empty stomach
about ½ hour before
meal or 2 hours after
meal.
 Instructed the patient
to report any
complications after
taking the medicine.
Notify the physician Admitting the patient will  Notified the physician
about the admission. help the doctor to take about the patient’s
note of the progress and admission.
provide the necessary
care and treatment.
WOF fetomaternal Fetomaternal distress  Checked the fetal
distress. indicates the presence heart rate, movement,
of complication, such as muscle tone, and
infections. amniotic fluid volume,
and for s/s of distress.
 Monitored the
patient’s VS and signs
and symptoms of
distress.
1 PM Allow soft diet. To ingest only foods that  Referred to the

are not heavy for the dietician about the
body and are easy to prescribed diet of the
digest. patient.
 Explained the diet to
the patient and why it
is necessary.
Shift IVF to PLR to run It is useful for daily  Ensured that all labels
10 gtts/min x 30 mins maintenance of body in the IV ticket is
then FD 200cc then x40 fluids and nutrition, and
34

gtts. for rehydration. Fast IV correct.

drips are often  Ensured that the
necessary if the patient correct IV fluid is
has already lost a great correct before being
deal of blood volume. infused.
what the purpose of
the IVF is.
regulated IVF as
ordered.
Start hyoscine 1amp IV To reduce the duration  Verified the patient’s

q2 x 3 doses ANST ( ). of labor by accelerating name and explained
cervical dilatation to the significant other
without major side about the medication
effects. in a way that they can
understand.
administration.
 Monitored for any
untoward side effects
from the drug.
 Ensured that the drug
administration is well-
documented.
Insert evening primrose To soften and prepare  Verified the patient’s

oil 1000 mg/cap 6 caps the cervix for labor. name and explained
per vagina now then 4 to the significant other
caps q6 x 24 hrs about the medication
understand.
administration.
from the drug.
35

documented.
WOF fetomaternal Fetomaternal distress  Checked the fetal

distress. indicates the presence heart rate, movement,
of complication, such as muscle tone, and
infections. amniotic fluid volume,
and for s/s of distress.
 Monitored the
patient’s VS and signs
and symptoms of
distress.
Refer. Referring is done to let  Referred accordingly.

the attending doctor
know of the patient’s
current condition.
3:33 PM Resume oxytocin drip at To improve contractions  Verified the patient’s

10 gtts/min. during labor. name and explained
to the significant other
understand.
administration.
from the drug.
documented.
6:31 PM Allow dinner. To gain nutrients and  Provided a meal to the

acquire enough strength patient according to
in preparation to the physician’s
delivery. recommended diet.
Reassess at 8 PM. To provide baseline data  Reassessed and

of the patient’s current recorded patient
status. current status.
 Provided comfort after
36

the monitoring.
8:23 PM Resume oxytocin drip. To improve contractions  Verified the patient’s

during labor. name and explained
understand.
administration.
from the drug.
documented.
Resume PLR at 10 To provide the patient  Ensured that all labels

gtts/min for 30 mins with fluid, electrolytes, in the IV ticket is
then 30 gtts/min. and nutrients, as well as correct.
for rehydration.  Ensured that the
correct IV fluid is
correct before being
infused.
what the purpose of
the IVF is.
regulated IVF as
ordered.
8:42 PM Give Nalbuphine 5 To relieve moderate or  Verified the patient’s

mg/IVT at 10 PM and 2 severe pain. name and explained
AM. to the significant other
understand.
administration.
37

documented.
from the drug.
 Evaluate the patient’s
pain using the
numerical pain rating
scale.
Resume oxytocin drip at To improve contractions  Verified the patient’s

6 AM. during labor. name and explained
understand.
administration.
from the drug.
documented.
9/20 – 1:45 Medications ordered  Verified the patient’s

AM STAT: name and explained
 Midazolam 1 amp To relieve anxiety and about the medication
IV produce a loss of in a way that they can
consciousness before understand.
medical procedures.  Administered the
 Nalbuphine 1 amp To relieve moderate or the 10 rights of drug
IV severe pain. administration.
 Methergine 200mcg To prevent uterine untoward side effects
IM bleeding after childbirth.
from the drug.
documented.
2:20 AM Status post vaginal To designate that  Documented the
38

spontaneous delivery patient had undergone a procedures done to

with right mediolateral surgical procedure. the patient
episiotomy, cervical accordingly.
inspection, repair of  Reported relevant
perineal tear and observations to the
episiorrhaphy under physician.
General IV sedation
and local anesthesia.
Diet as tolerated once To reduce gas in the  Referred to the
fully awake. stomach that may cause dietician about the
abdominal pain and prescribed diet of the
discomfort. patient.
 Explained the diet to
the patient and why it
is necessary.
Monitor vital signs q15 To provide baseline data  Monitored and

mins until stable then of the patient’s current recorded vital signs
q2 hrs and record. vital signs. every 15 minutes then
every 2 hours as
ordered.
Monitor I&O qshift. Intake and output (I&O)  Monitored and

indicate the fluid recorded intake and
balance for a patient. output of the patient.
The goal is to have
equal intake and output.
Too much or too less
intake can lead to fluid
imbalance.
IVF D5LR 1L + 10 CC To stimulate contraction  Verified the patient’s
oxytocin + 1 amp of s for the removal of name and explained
Dicoflenac x 30 gtts/min fragments after delivery to the significant other
ANST (-). To follow PLR and to relieve acute about the medication
1L + 1 amp Dicoflenac postoperative pain. in a way that they can
x 30 gtts/min. understand.
administration.
from the drug.
39

documented.
Give last dose of To stimulate uterine  Verified the patient’s

Ampicillin now (2:30 contractions. name and explained
AM) then shift to: to the significant other
 Sultamicillin 750 To treat infections in a way that they can
mg/tab (SILGRAM) caused by beta- understand.
BID lactamase-producing  Administered the
bacteria. medication following
administration.
 Metronidazole 500 To treat conditions such
mg/tab (PATRYL) as bacterial vaginosis  Monitored for any
TID untoward side effects
and pelvic inflammatory
from the drug.
disease.
 Methylergometrine administration is well-
To prevent bleeding
125 mcg/tab from the uterus. documented.
(ERGONE) TID
 Mefenamic Acid 500 To treat mild to

mg/cap TID after moderate pain.
meals to start dinner
.
 Moringa 500 mg/cap
To protect cells from
(MOMMA LAC) BID
damage and to promote
lactation.
 Ferrous fumarate To prevent iron-

cap (FERONERO- deficiency anemia.
FA) BID
 Senna tab To treat constipation.

(SENOKOT) 2 tabs
OD HS
 Mupirocin ointment
TID on episiotomy To treat impetigo
site (bacterial infection).
Encourage gradual To improve physical  Explained to the
ambulation. function. Gradually patient and S/O the
because sudden effects of gradual
movements may open ambulation to her
40

the suture and disrupt recovery.

the healing process.
For straight To promote voiding and  Explained the
catheterization of prevent damage to procedure and its
bladder of still without muscles of the bladder. purpose to the patient.
vaginal spontaneous  Assessed patient
delivery by 9 AM and response to the
refer. catheterization.
 Documented relevant
observations
accordingly.
Refer once has voided To let the attending  Referred to the

urine. physician know of the physician accordingly.
patient’s current
condition.
WOF profuse vaginal Profuse vaginal bleeding  Explained to the
bleeding. may indicate that there patient the symptoms
are still fragments left of vaginal bleeding.
from delivery in the  Instructed the patient
patient’s uterus, and can to report any s/s of
cause a severe drop in bleeding to the NOD
blood pressure.
or primary care
provider immediately.
Refer. Referring is done to let  Referred the patient

the attending doctor accordingly
current condition.
2:30 AM Give metronidazole 500 To manage and treat  Verified the patient’s
mg/IVT now then shift bacterial infection, such name and explained
to oral. as recurrent urinary tract to the significant other
infection. about the medication
understand.
administration.
from the drug.
41

documented.
3:30 AM Conduct postpartum This is to make sure that  Explained the

examination: the patient is recovering procedure and its
well from the delivery purpose to the patient.
 Genitalia: (-) mass, and that no postpartum  Asked the patient
(-) hematoma, (-) complications have consent.
swelling occurred.
 Prepared the patient
 IE: smooth vaginal for the procedure.
mucosa, (-)
 Provided patient
hematoma, (-)
privacy.
 CD 2-3 cm,
maternal bleeding,  Documented relevant
uterus 16 weeks observations
size, firm and accordingly.
contracted
 DRE: (-) rectal
sutures
Advise on proper To keep the perineal  Educated the patient
perineal hygiene and clean and decreases the about the proper way
breastfeeding. risk of infection. and importance of
perineal hygiene and
breastfeeding.
Advise to intermittently To keep it firm and  Advice the patient to

massage uterus to keep contracted. intermittently massage
it firm and contracted. uterus.
 Demonstrated the
proper way of
massaging and its
importance.
D/C hyoscine and It might increase the  Discontinued the

evening oil. chance of bleeding. drugs as ordered.
Refer once has voided Referring is done to let  Referred to the doctor
urine. the attending doctor accordingly.
current condition.

42

cause a severe drop in bleeding to the NOD

blood pressure. or primary care
provider immediately.
Refer. Referring is done to let  Referred the patient

the attending doctor accordingly to the
know of the patient’s recommended
current condition. physician.
9/21 – May go home. A patient can be  Verified the MGH

10:50 AM discharged when he no order and discharge
longer need to receive instructions from the
inpatient care and can physician.
(+) urine go home.
output To take home To educate the patient  Explained medications
(+) CF3 medications advised. about the medication, its to the patient and S/O.
instructed dosage, time, frequency  Ensured that the
(-) pallor/ and common adverse patient and the S/O
bleeding effects understood how to
take the medications
properly.
 Encouraged the
patient to ask
questions or clarify
any unclear
instructions.
To come back and To continue and ensure  Explained to the

follow-up at Solana positive care patient and S/O why a
clinic on 9/29 at 10 AM; outcomes/recovery. follow-up check-up is
Text M. for necessary.
appointment.
cause a severe drop in bleeding to the
blood pressure.
primary care provider
immediately.
PATIENT WAS DISCHARGED
43

LABORATORY AND DIAGNOSTICS
SEROLOGY/IMMUNOLOGY RESULT
RT-PCR RESULT
Date Released: 9/19/2022
Name of Test: COVID-19 Rapid Antigen

Reagent/Kit Used: Abbott Panbio COVID-19 Ag Rapid Test
Specimen: Nasopharyngeal Swab
Methodology: Lateral Flow Immunoassay
44

RESULT REMARKS TEST LIMITATIONS

Result: NEGATIVE  Normal  The design of the test is
Result Interpretation:  Samples are processed not intended to replace
NEGATIVE FOR SARS-CoV- within the specimen RT-PCR, which remains
2 ANTIGEN viability and on the same to be the gold standard in
day of request unless determining whether the
indicated. person is infected and
infectious with the SARS-
CoV-2 virus.
 A negative result reflects
non-exposure to COVID-
19 Antigen at the time of
testing.
 A negative result does
not eliminate the
possibility of SARS-CoV-
2 infection. Test results
must be evaluated in
conjunction with other
clinical data available to
the physician.
 Positive Test result do
not rule co-infections with
other pathogens.
CREATININE TEST RESULT

Date and Time Released: 9/20/2022 10:30 AM
Result UNIT Reference Range REMARKS
Creatinine 49 µmol/L 53-97 Normal because in

pregnant women, the
blood flow to the kidneys
is normally higher,
resulting in an increased
Glomerular Filtration
Rate (GFR). This further
leads to increased rate
45

of creatinine excretion.
PATIENT M.A.D.’s HEMATOLOGY RESULT

Date Received: 9/19/2022 1:06:54 PM
Date and Time Released: 9/20/2022 10:33:00 AM
Examination UNIT Reference REMARKS
Results Range
WBC count 20.1 X10^9/L 4.50 - 11.00 A high WBC

count is
usually
caused by
the activation
of the host-
inflammatory
response
against an
infection.
RBC count 4.12 X10^12/L 4.50 - 6.00 Normal
HGB 116 g/L 120 -160 Normal
HCT 0.342 % 0.37-0.47 Normal
MCV 83 fL 81-99 Normal
Mean 28.2 pg 27.00 - 31.00 Normal

Corpuscular Hgb
Mean 340 g/L 310 - 360 Normal

Corpuscular Hgb
Conc
RDC Distribution 13.6 % 11.50 - 14.50 Normal

Width
DIFFERENTIAL COUNT
Neutrophils 84 % 35-65 This indicates

presence of
an infection.
Eosinophils 2 % 0-5 Normal
Basophils 0 % 0-1 Normal
46

Lymphocytes 7 % 20 - 40 Normal
Monocytes 7 % 2-6 This indicates

presence of
an infection.
PLT Count 385 X10^9/L 150-450 Normal

MPV 7.0 % 7.80-11.00 Normal
URINALYSIS RESULT
Date Requested: 9/19/2022
Requesting Physician: Dr. Kathy Bautista Izon-Carag
Examination Requested: Urinalysis
TEST Reference Range RESULTS REMARKS
PHYSICAL EXAMINATION
Color Dark Yellow This is a sign of

dehydration or fluid
volume deficit.
Transparency Turbid This indicates

presence of an
infection.
CHEMICAL EXAMINATION
Reaction 7.0 Normal
Specific Gravity 1.025 Normal
Sugar NEGATIVE Normal
Protein NEGATIVE Normal
Ketones ( ++ ) Normal. This

indicates insufficient
calorie intake (from
the NPO order),
resulting in fats
being metabolized
for energy use. The
by-product of fat
metabolism is
ketones, leading to
its elevation and
excretion in the
47

urine.
Blood (+) This indicates

presence of
infection.
Bilirubin NEGATIVE Normal
Urobilinogen Normal Normal
Leukocytes NEGATIVE Normal
Nitrite NEGATIVE Normal
MICROSCOPIC EXAMINATION
Red Blood Cells 3-5 Normal
White Blood Cells 0-1 Normal
Squamous MODERATE This indicates

Epithelial Cells presence of
infection.
Non-Squamous NONE Normal

Epithelial Cells
Bacteria MODERATE This indicates

presence of
infection.
Dysmorphic RBC NONE Normal
Crystals NONE Normal
Casts NONE Normal
Budding Yeast NONE Normal

Cells
48

DRUG STUDY
DRUG STUDY FOR AMPICILLIN

NURSING
CLASSIFICATION ACTION CONTRAINDICATIONS ADVERSE EFFECTS
RESPONSIBILITIES
Generic name: Descriptions: Hypersensitivity or Significant: Seizures  Administer
Ampicillin prevents history of hypersensitivity for rapid infusion; medication
Ampicillin
bacterial cell wall (anaphylaxis) to bacterial or fungal following the 10
synthesis by binding to 1 ampicillin, or other β- superinfection in Rights of drug
or more of the penicillin- lactam antibiotics prolonged use; administration.
Brand name:
binding proteins resulting (penicillins, Stevens-Johnson  Monitor sodium
 Polypen in the inhibition of the cephalosporins, syndrome, toxic levels frequently
final transpeptidation carbapenems, epidermal necrolysis, because each gram
step of peptidoglycan monobasssssctams). erythema multiforme. of ampicillin
Classification: synthesis in the bacterial GI: Nausea, vomiting, sodium injection
cell walls. diarrhea, contains 2.9 mEq of
 Antibacterial sodium.
pseudomembranous
Pharmacokinetics: colitis, stomatitis, black  If large doses are
Absorption: Moderately hairy tongue given or if therapy is
Route: prolonged, bacterial
well absorbed from the GU: Oliguria,
 IV gastrointestinal tract. proteinuria, hematuria, or fungal
Decreased absorption vaginitis, moniliasis, superinfection may
rate with food. glomerulonephritis occur.
Dosage: Distribution: Widely HEMA: Anemia,  Watch for signs and
distributed throughout increased bleeding symptoms of
 2g/IVT stat, the body and can be hypersensitivity,
time, bone marrow
found in ascitic, pleural, such as
1g/IVT q6 hours depression,
erythematous
and joint fluids. Crosses granulocytopenia,
maculopapular
the placenta and enters leukopenia,
rash, urticaria,
breast milk (small eosinophilia, hemolysis
and anaphylaxis
49

 Monitor patients for
BACHELOR OF SCIENCE IN NURSING – LEVEL III CDAD, which can
be fatal and can
amounts). Penetrates INTEG: Rash, occur even more
the CSF with inflamed urticarial, erythema than 2 months after
meninges. multiforme therapy ends.
Metabolism: Metabolize
d into penicilloic acid.
Excretion: Via urine
(approx. 90%, as
unchanged drug within
24 hours) and feces.
Elimination half-life: 1-
1.8 hours.
DRUG STUDY FOR SULTAMICILLIN
50

NURSING
CLASSIFICATION ACTION CONTRAINDICATIONS ADVERSE EFFECTS RESPONSIBILITIES
Generic Name: Description: Hypersensitivity to Significant: Severe  Administer

Sultamicillin is a prodrug ampicillin, sulbactam, or skin reactions, such as medication
Sultamicillin
of ampicillin and penicillins. Stevens-Johnson following the 10
sulbactam linked as a syndrome, toxic Rights of drug
double ester. It helps epidermal necrolysis, administration.
Brand Name:
treat infections caused dermatitis exfoliative,  Monitor for signs of
 Silgram by beta-lactamase- erythema multiforme, anaphylaxis during
producing bacteria in the acute exanthematous 1st dose.
upper and lower pustulosis; cholestatic  Monitor
Classification: respiratory tract, the hepatitis, jaundice; hematologic, renal,
kidneys and urinary tract, fungal or bacterial and hepatic function
 Penicillin skin, and soft tissues, superinfection, periodically during
Antibiotics among other organs. including Clostridium prolonged use.
difficile-associated  May perform culture
Route: and susceptibility
Pharmacokinetics: diarrhea (CDAD) and
 Oral Absorption: Absorbed pseudomembranous tests prior to
from the gastrointestinal colitis (prolonged use). treatment initiation;
tract with a bioavailability GI: Diarrhea, nausea, consult local
Dosage: of 80%. vomiting, abdominal institutional
pain, melena, recommendations
Distribution: Crosses
 750 mg/tab BID before treatment
the placenta, enters stomatitis.
Musculoskeletal and initiation due to
breast milk (small
antibiotic resistance
amounts). Distributed in connective tissue:
risks.
the bile, blister, and Arthralgia.
tissue fluids; penetrates NEURO: Headache,
the CSF with inflamed dizziness.
meninges only. Plasma INTEG: Pruritus, rash.
protein binding: 28% Potentially Fatal:
(ampicillin); 38% Hypersensitivity
(sulbactam). reactions
51

Metabolism: (anaphylaxis).
Metabolized via
hydrolysis to provide a
1:1 molar ratio of
ampicillin and sulbactam.
Excretion: Via urine (50-
75% as unchanged
drug). Elimination half-
life: Approx 0.75 hour
(sulbactam); 1 hour
(ampicillin).
DRUG STUDY FOR MUPORICIN OINTMENT
52

BACHELOR OF SCIENCE IN NURSING – LEVEL III NURSING
RESPONSIBILITIES
ADVERSE EFFECTS
CLASSIFICATION ACTION CONTRAINDICATIONS
Description: Mupirocin Hypersensitivity to any of Significant:  Administer
Generic Name: is an antibacterial the other components, Hypersensitivity, medication
ointment used to treat moderate or severe renal systemic allergic following the 10
Mupirocin ointment impetigo and secondary impairment, reactions, including Rights of drug
skin infections caused by angioedema, urticaria, administration.
Staphylococcus aureus generalized rash;  Monitor any new or
Brand Name: and Streptococcus cutaneous sensitization increased skin
pyogenes. It primarily reaction or severe local reactions, including
 Bactroban works by inhibiting irritation; fungal or localized pain,
bacterial protein bacterial superinfection burning, itching, or
synthesis. Due to its in prolonged use. stinging. Report
Classification: severe or prolonged
unique mode of action of CNS: headache.
inhibiting the activity of EEHT: cough, itching, skin reactions to the
 Antibacterial bacterial isoleucyl-tRNA pharyngitis, rhinitis, physician.
synthetase, mupirocin upper respiratory tract  Re-evaluate drug
does not demonstrate congestion. use if patient does
Route: not show clinical
cross-resistance with GI: altered taste.
other classes of response within 3–5
INTEG: burning,
 Topical antimicrobial agents, days..
itching, pain, stinging.
giving it a therapeutic
Dosage: advantage.
Pharmacokinetics:
Absorption: Systemic
TID
or percutaneous
absorption of mupirocin
following dermal
application is expected
to be minimal in adults
and children. Occlusive
dressings do not
53

significantly enhance
drug absorption, but
damaged skin may allow
enhanced penetration of
the drug across the skin
barrier.
Metabolism: Mupirocin
undergoes rapid hepatic
metabolism to form the
principal metabolite
monic acid, which has no
antibacterial activity.
Excretion: Any
mupirocin reaching the
systemic circulation is
rapidly metabolized to
form the inactive monic
acid, which is eliminated
by renal excretion
54

DRUG STUDY FOR
METRONIDAZOLE
CLASSIFICATION NURSING
ACTION CONTRAINDICATIONS ADVERSE EFFECTS
RESPONSIBILITIES
Generic Name: Description: Hypersensitivity, Significant: Severe  Administer

Metronidazole is an psychotic reaction with neurological medication
Metronidazole
antiprotozoal that is used disulfiram, Interaction disturbances, following the 10
to treat a wide variety of with alcohol, Cockayne peripheral and optic Rights of drug
infections. It works by syndrome neuropathy, administration.
Brand Name:
stopping the growth of paresthesia;
 Monitor patient
 Patryl certain bacteria and superinfection, such as
fungal or bacterial reactions to the
parasites. This antibiotic
treats only certain superinfection, C. drug.
Classification: bacterial and parasitic difficile-associated  Assess signs of
infections. It will not work diarrhea). dizziness.
 Antiprotozoal for viral infections, such CNS: Depression,  Watch out for
as common cold or flu. Irritability, Headache, seizures.
Dizziness, Weakness,  Monitor signs of
Route:
Pharmacokinetics: Lightheadedness, numbness.
 Oral Absorption: Readily Muscle weakness,  Be alert of mental
absorbed following Coordination difficulty, health.
administration by mouth Trouble, speaking or
Dosage: with a bioavailability of understanding, Fever,
90-100%. Peak plasma Seizure
 500mg/tab TID GI: Diarrhea
concentrations occur
after 20 minutes to 3 EENT: Vision problems
hours. INTEG: Blisters, Ulcers
Distribution: in the mouth, Swollen
Metronidazole is widely gums, Trouble
distributed throughout swallowing, Increased
the body and various sensitivity to light.
55

body fluids. They include Others: Pain, Difficulty

the bile, saliva, urinating, Trouble
breastmilk, cerebrospinal sleeping, Numbness,
fluid, and the placenta. Neck stiffness.
Excretion:
Metronidazole and
metabolites are 60 to
80% eliminated in the
urine, and 6-15%
excreted in the feces.
56
SCHOOL OF HEALTH AND ALLIED SCIENCES DRUG STUDY FOR

MEFENAMIC ACID
NURSING
RESPONSIBILITIES
Generic Name: Descriptions: Patients with Significant:  Administer
Mefenamic acid is used inflammatory intestinal Anaphylactoid medication
Mefenamic Acid
as a short-term pain disease, active peptic reactions, fluid following the 10
reliever for a variety of ulcers or chronic retention, anemia, Rights of drug
disorders that cause mild inflammation of the hyperkalaemia. administration.
Brand Name:
to moderate pain. upper/lower Blood and lymphatic  Make sure patient
 Ponstel gastrointestinal tract, system disorders: has eaten before
Pharmacokinetics: hypersensitivity to aspirin Eosinophilia, administering.
Absorption: Mefenamic or other non-steroidal leukopenia,  Monitor patient
Classification: acid is quickly absorbed inflammatory agents, thrombocytopenia, reactions to the
when used orally. The and renal failure. purpura, drug.
 NSAID  Assess the patient
average rate of agranulocytosis.
absorption in two 500 mg CNS: Headache, who develops
single oral doses was Dizziness, Drowsiness severe diarrhea and
Route: vomiting for
30.5 mcg/hr/mL. CV: Heartburn
 Oral Distribution: Following GI: Diarrhea, Nausea, dehydration and
an oral dose of 500 mg Constipation, electrolyte
of mefenamic acid, the Gas/Bloating, Vomiting imbalance.
Dosage: apparent volume of EENT: Ringing in the  Discontinue the
distribution was drug promptly if
ears
 500 mg/cap BID diarrhea, dark
determined to be 1.06
stools,
L/kg.
hematemesis,
Excretion: Most of its
ecchymoses,
conjugates and
epistaxis, or rash
metabolites are occur and do not
eliminated through the use it again.
kidneys. Significant
elimination mechanisms
include renal excretion
57

and liver excretion.
DRUG STUDY FOR DICOFLENAC

CLASSIFICATION ACTION CONTRAINDICATIONS ADVERSE EFFECTS NURSING
58
SCHOOL OF HEALTH AND ALLIED SCIENCES RESPONSIBILITIES

 Administer medication
Description: Contraindicated in Significant: Sodium following the 10 Rights
Generic name: of drug administration.
Diclofenac, an NSAID patients with and fluid retention,
Diclofenac derived from hypersensitivity to drug edema, HTN, liver  Monitor patient and
phenylacetic acid, has and in those with hepatic function abnormalities immediately evaluate
(increased liver, signs and symptoms
analgesic, anti- porphyria or history
of heart attack,
Brand name: inflammatory and of asthma, urticaria, or transaminase,
including chest pain,
antipyretic properties. It other allergic reactions enzyme levels),
 Diclogen shortness of breath,
reversibly inhibits after taking aspirin or anemias, rare severe
and trouble breathing,
cyclooxygenase-1 and other NSAIDs. blood dyscrasias
or stroke, consisting of
2, thereby inhibiting (agranulocytosis,
Classification: weakness in one part
prostaglandin thrombocytopenia, or side of the body and
 NSAIDs (Non- synthesis. aplastic anemia), risk slurred speech.
of hyperkalemia;  Consider periodic CBC
Steroidal Anti-
Pharmacokinetics: keratitis (ophthalmic). and chemistry profile
Inflammatory Absorption: Absorbed CNS: anxiety, monitoring with long-
Drugs) from the dizziness, term NSAID treatment
gastrointestinal tract. drowsiness, headach because serious GI
Decreased absorption e bleeding,
Route: rate with food. CV: HF, edema, fluid hepatotoxicity, and
Bioavailability: 55%. retention, HTN. renal injury can occur
 IV Time to peak plasma EENT: blurred without warning.
concentration (under vision, eye pain, night  Monitor patient closely
fasted conditions): blindness, for adverse effects.
Dosage: approx. 5 minutes (IV). reversible hearing  Advise patient to seek
Distribution: Crosses loss, tinnitus, epistaxi medical attention
 1 ampule
the placenta and enters s immediately if chest
(75mg/3mL) at 30 breastmilk. Volume of GI: abdominal pain, shortness of
gtts/min distribution: Approx distention, abdominal breath or trouble
1.3-1.4 L/kg. Plasma pain or breathing, weakness in
protein binding: >99% cramps, bleeding, con one part or side of the
mainly to albumin. stipation, diarrhea, flat body, or slurred
Metabolism: Undergoe ulence, speech occurs.
59

s first-pass metabolism indigestion, melena, n

in the liver via ausea, peptic
hydroxylation and ulceration, taste
methoxylation into disorder,
metabolites including bloody diarrhea,
4'-hydroxydiclofenac appetite change,
(major), 3'- colitis, vomiting, dysp
hydroxydiclofenac, 5- epsia.
hydroxydiclofenac, 4',5- GU: nephrotic
dihydroxydiclofenac syndrome, acute renal
and 3'-hydroxy-4’ failure, interstitial
methoxydiclofenac; nephritis, oliguria,
further metabolised via papillary necrosis,
glucuronidation. proteinuria.
Excretion: Mainly via Hepatic: jaundice, he
urine (approx. 60% as patitis, hepatotoxicity.
metabolites including Metabolic: hypoglyce
glucuronide mia, hyperglycemia.
conjugates; <1% as Musculoskeletal: bac
unchanged drug); bile k, leg, or joint pain.
(approx. 35%). Respiratory: asthma,
laryngeal edema.
Skin: Stevens-
Johnson
Syndrome, allergic
purpura, alopecia,
bullous eruption,
dermatitis, eczema,
photosensitivity
reactions, pruritus,
rash, urticaria,
increased sweating.
60

Others: anaphylactoi
d
reactions, anaphylaxis
, angioedema.
DRUG STUDY FOR NALBUPHINE

NURSING
RESPONSIBILITIES
Generic Name: Description: Nalbuphine Patients with significant Significant:  Administer
is a kappa-opioid receptor respiratory depression, Abdominal pain, medication
61
SCHOOL OF HEALTH AND ALLIED SCIENCES following the 10

BACHELOR OF SCIENCE IN NURSING – LEVEL III Rights of drug
administration.
agonist and a partial mu- acute or severe pyrexia, depressed  Assess symptoms
Nalbuphine
opioid receptor antagonist. bronchial asthma in an level or loss of of respiratory
Analgesic properties are unmonitored setting or consciousness, depression,
mediated through agonist the absence of somnolence, tremor, including decreased
Brand Name:
activity at the kappa- resuscitative equipment, anxiety, pulmonary respiratory rate,
 Nubain opioid receptor. Because known or suspected edema, agitation, confusion, bluish
of this unique mixed gastrointestinal seizures, and injection color of the skin and
agonist-antagonist opioid obstruction, including site reactions such as mucous
Classification: receptor activity of paralytic ileus, or pain, swelling, membranes
nalbuphine, it provides hypersensitivity to redness, burning, and (cyanosis), and
 Sythetic opioid hot sensations. difficult, labored
analgesia with less nalbuphine to any of the
agonist- nausea, pruritus, and other ingredients in HEMA: Anemia. breathing
respiratory depression Nubain. GI: Abdominal (dyspnea).
antagonist  Monitor pulse
compared to morphine. discomfort, abdominal
Route: distention, abdominal oximetry and
pain lower and upper, perform pulmonary
 IV Pharmacokinetics:
function tests to
Absorption: The onset of anal pruritus,
Dosage: quantify suspected
action of nalbuphine after constipation, diarrhea,
changes in
intravenous injection is 2 fecaloma, flatulence,
1 ampule - 5 mg/mL ventilation and
to 3 minutes. The duration gastrointestinal
respiratory function.
of action of nalbuphine motility disorder,
 Be alert for
ranges from 3 to 6 hours. intestinal obstruction,
excessive sedation
Distribution: Protein irritable bowel
or changes in mood
binding is not significant. syndrome, nausea, and behavior
Metabolism: Nalbuphine esophageal ulcer, (euphoria,
is hepatically metabolized. vomiting. dysphoria,
Excretion: The General disorders confusion,
elimination half-life is and administration hallucinations).
about 5 hours. It is site conditions:  Notify physician
excreted in urine and Chills, fatigue, feeling immediately if
feces. cold, injection site patient is
swelling, pyrexia. unconscious or
62
SCHOOL OF HEALTH AND ALLIED SCIENCES extremely difficult to

BACHELOR OF SCIENCE IN NURSING – LEVEL III wake up.
 Assess blood
Muscu: Myalgia. pressure (BP) and
CNS: Dizziness. compare to normal
GU: Cysitis non- values. Report a
infective, dysuria, sustained increase
urinary retention. in BP
INTEG: Eczema, (hypertension) or a
hyperhidrosis, rash fall in BP when
pruritic, urticaria. patient assumes a
more upright
position (lying to
standing, sitting to
standing, lying to
sitting).
DRUG STUDY FOR OXYTOCIN

NURSING
RESPONSIBILITIES
Generic name: Description: Oxytocin, a Hypertonic uterine Significant: Fetal  Administer
cyclic nonapeptide, contractions, mechanical distress, arrhythmias, medication following
Oxytocin
activates G-protein- obstruction to delivery, hypotension, the 10 Rights of drug
63
SCHOOL OF HEALTH AND ALLIED SCIENCES administration.

BACHELOR OF SCIENCE IN NURSING – LEVEL III  Monitor fluid intake
and output.
coupled receptors at the fetal distress; conditions myocardial ischemia,  Monitor for
uterus, which causes an wherein spontaneous peripheral manifestations of
Brand name: increase in intracellular labor or vaginal delivery vasodilation, fluid overload,
Ca levels in uterine is contraindicated tachycardia, QT seizures, and coma
 Pitocin
myofibrils, thus ( significant prolongation, uterine because of the
promoting uterine cephalopelvic hypertonicity, spasm, antidiuretic effect of
contractions. disproportion, fetal tetanic contraction, the drug.
Classification:
malpresentation, disseminated  Monitor and record
 Exogenous Onset: Uterine placenta previa, vasa intravascular uterine contractions,
contractions: approx 1 previa, placental coagulation (DIC). HR, BP, intrauterine
hormones pressure, fetal HR,
minute. abruption, cord
Route: Duration: 1 hour. presentation or prolapse, MATERNAL and character of fluid
overdistension or CNS: subarachnoid loss at least every 15
 IV minutes
Pharmacokinetics: impaired resistance of hemorrhage, seizures
Distribution: Distributed the uterus to rupture, , coma.  Instruct patient to
throughout the multiple pregnancy, CV: arrhythmias, HTN promptly report
Dosage: adverse reactions,
extracellular fluid. polyhydramnios, grand ,
 5 IU with a FR of Crosses placenta, enters multiparity); presence of including site
PVCs, hypotension, ta
breast milk (small a uterine scar from irritation, nausea,
10 gtts/min chycardia.
amounts). previous surgery bleeding, blurred
GI: nausea, vomiting.
including caesarean vision, difficulty
Metabolism: Metabolize GU: abruptio
section. Prolonged use speaking, wheezing,
d in the liver and placentae, tetanic
in resistant uterine itching, and swelling.
kidneys. uterine
inertia, severe CV  Discontinue
Excretion: Via urine (in contractions, postpart
disease, severe pre- oxytocin infusion
small amounts and as um
eclamptic toxemia. immediately if uterine
unchanged drug). hemorrhage, uterine hyperactivity or fetal
Elimination half-life: 1-6 rupture, impaired distress occurs.
minutes. uterine blood flow,
pelvic hematoma,
increased uterine
motility.
Hematologic: afibrino
64
SCHOOL OF HEALTH AND ALLIED SCIENCES gene

BACHELOR OF SCIENCE IN NURSING – LEVEL III mia,
possi
bly related to
postpartum
bleeding, pelvic
hematoma.
Others: anaphylaxis,
death from oxytocin-
induced water
intoxication, hypersen
sitivity reactions.
FETAL
CNS: infant brain
damage, seizures.
CV: bradycardia, arrh
ythmias, PVCs.
EENT: neonatal
retinal hemorrhage.
Hepatic: neonatal jau
ndice
Others: low Apgar
scores at 5
minutes, death.
DRUG STUDY FOR METHYLERGOMETRINE

NURSING
RESPONSIBILITIES
65
SCHOOL OF HEALTH AND ALLIED SCIENCES  Administer

BACHELOR OF SCIENCE IN NURSING – LEVEL III medication
following the 10
Description: Methergine Contraindicated to Significant: Rights of drug
Generic Name: (methylergonovine patients with Hypertension, administration.
maleate) acts directly on hypertension toxemia, myocardial ischemia,  Assess blood
the smooth muscle of the and hypersensitivity to myocardial infarction; pressure (BP) and
Methylergometrine uterus and increases the ergonovine, ergotism, pleural compare to normal
tone, rate, and amplitude methylergonovine, or fibrosis, retroperitoneal values. Report
Brand Name: of rhythmic contractions. any ingredient in the fibrosis (prolonged increased BP
Thus, it induces a rapid formulation use). (hypertension) to
and sustained tetanic CV: Ventricular the physician
 Methergine, immediately.
uterotonic effect which fibrillation, ventricular
Ergone shortens the third stage tachycardia, angina  Assess heart rate,
of labor and reduces pectoris, ECG, and heart
blood loss. antrioventricular block. sounds, especially
Classification: during exercise.
Pharmacokinetics: NV: Cerebrovascular
Absorption: Rapidly accident, paresthesia. Report any rhythm
 Ergot alkaloids absorbed after IM or oral CNS: Dizziness, disturbances or
administration, with a headache. symptoms of
78% bioavailability. increased
Route: EENT: Tinnitus.
arrhythmias,
Onset: Uterine RES: Dyspnea. including
contractions occur within CV: Hypertension,
 IM, Oral palpitations, chest
2–5 minutes. arrhythmias, chest pain, shortness of
Duration: Uterine pain, palpitations. breath, difficulty
Dosage: contractions persist ≥3 GIT: Nausea, vomiting. breathing, fainting,
hours. GU: Cramps. and
 200 mcg/vial IM; Distribution: It is rapidly INTEG: Diaphoresis. fatigue/weakness.
distributed to tissues with  Assess dizziness
125 mcg/tab TID a volume of 39-73L. that affects gait,
Metabolism: It balance, and other
undergoes extensive functional activities.
first-pass hepatic  Report balance
metabolism. problems and
Excretion: It is excreted functional
66
SCHOOL OF HEALTH AND ALLIED SCIENCES limitations to the

BACHELOR OF SCIENCE IN NURSING – LEVEL III physician, and
caution the patient
in urine and feces, with and
an elimination half-life of family/caregivers to
30-120 minutes. guard against falls
and trauma.
 Assess any
abdominal or pelvic
pain and cramping.
DRUG STUDY FOR SENNA

NURSING
RESPONSIBILITIES
Generic Name: Description: Patients with Significant: Abdominal  Administer
67
SCHOOL OF HEALTH AND ALLIED SCIENCES pain or medication

BACHELOR OF SCIENCE IN NURSING – LEVEL III following the 10
Rights of drug
Sennosides (also known hypersensitivity, discomfort, cramps, administration.
Senna
as senna glycoside or gastrointestinal (GI) diarrhea, electrolyte  Assess patient’s
senna) is a medication obstruction or abnormalities reaction to the drug.
used to treat constipation perforation, ulcerative (hypokalemia),  Monitor patient vital
Brand Name:
and empty the large colitis, symptoms of excessive bowel signs.
 Senokot intestine before surgery. appendicitis or acute activity, and nausea.  Monitor for allergic
surgical abdomen, acute GI: Diarrhea, Excessive reaction.
Pharmacokinetics: intestinal inflammation bowel activity, Cramps,  Conduct abdominal
Classification: Absorption: <10% is (crohn's disease), fecal Nausea assessment for
absorbed from the gut impaction, and GI or GU: Kidney characteristics and
 Laxatives rectal bleeding. functions that
mostly in the form of the inflammation,
Route: active metabolite Others: Electrolyte deviate from
rheinanthrone. abnormalities, including normal.
 Oral
Distribution: It may take low potassium
6 to 12 hours before this (hypokalemia), Finger
medication causes a clubbing (long-term
Dosage:
bowel movement. use), Melanosis Coli,
 500mg/tab BID Excretion: 3-6% of Yellow-brown urine
metabolites are excreted discoloration.
in urine with some in
bile. >90% of sennosides
are excreted in the feces
as polymers with 2-6% of
the parent compounds
excreted unchanged.
DRUG STUDY FOR MIDAZOLAM

68

 Administer
Descriptions: Midazolam Patients with acute Significant: medication
is used to reduce anxiety narrow-angle glaucoma, Anterograde amnesia, following the 10
Generic Name: Rights of drug
and induce tiredness or hypersensitivity to CNS depression,
administration.
drowsiness prior to benzodiazepine, and hypotension,
Midazolam paradoxical reactions  Assess patient’s
surgery or other chronic respiratory
reaction to the drug.
treatments. insufficiency. (hyperactive or
aggressive behavior),  Measure level of
Brand Name: sedation and
Pharmacokinetics: suicidal ideation, and
consciousness
Absorption: Midazolam is withdrawal symptoms.
 Versed throughout and for
quickly absorbed after CNS: headache, seiz
2 - 6 hours following
being administered ures, fever, vertigo, at administration.
Classification: intravenously. The median axia, dizziness, synco
 Continuously
time to attain peak plasma pe,
monitor blood
 Benzodiazepines concentrations is 10.2 to incoordination, confus pressure, pulse rate
12.6 minutes, with a ion, and respiration rate.
bioavailability of 55–57%. irritability, depression,  Prepare equipment
Route: Distribution: Midazolam weakness, insomnia, for CPR and
has a volume of encephalopathy, oxygen to be
 IV distribution (Vd) of 1 to 3.1 peripheral accessed right
L/kg and an elimination neuropathy. away, in cases of
half-life of 1.8 to 6.4 CV: prolonged QT emergency.
Dosage: interval, flattened T
hours.
Excretion: After one IV wave, edema,
 1 amp- 5mg/mL dose, less than 0.5% of flushing, thrombophle
midazolam is eliminated bitis after IV infusion.
unaltered in the urine. EENT: rhinitis,
sinusitis, pharyngitis.
GI: nausea, abdomina
l pain, stomatitis,
epigastric
distress, vomiting, an
orexia, diarrhea, const
69
SCHOOL OF HEALTH AND ALLIED SCIENCES ipation,

proctitis, dry mouth,

metallic taste.
GU: vaginitis,
darkened
urine, polyuria, dysuri
a,
cystitis, dyspareunia,
dryness of vagina and
vulva,
vaginal candidiasis,
genital pruritus, UTI, d
ysmenorrhea,
decreased libido.
Hematologic: transie
nt
leukopenia, neutropen
ia.
Musculoskeletal: tra
nsient joint pains.
Respiratory: URI.
INTEG: rash.
Others: decreased
libido; overgrowth of
non-susceptible
organisms, candidiasi
s; flulike symptoms.
DRUG STUDY FOR EVENING PRIMROSE OIL

70

 Administer medication
Descriptions: Evening Contraindicated to CNS: Dizziness, following the 10 Rights
Generic Name: of drug administration.
primrose oil is a patients with Headache
Evening Primrose Oil popular alternative hypersensitivity to GI: Nausea, Upset  Assess patient’s
therapy and a great vitamin e, allergic reaction to the drug.
Stomach
supply of omega-6 reactions, anemia,  Assess the vital signs
INTEG: Rash
Brand Name: essential fatty acids. bleeding/eye disorder, to determine the
worsening of the
High amounts of liver/kidney disease, and
 Eveprim disease and response
gamma-linoleic acid, a vitamin K deficiency.
to therapy.
potent anti-
 Instruct the patient to
inflammatory
Classification: take the medication as
compound, are found in
ordered.
 Herbal the oil of evening
primrose (GLA). Its
Products/Food anti-inflammatory
Supplement activity can reduce
inflammation by 2-16%
Route:
and aid in wound
 Oral healing, cancer cell
identification, and
cancer cell death.
Dosage:
Pharmacokinetics:
6 caps (6000 mg) per
Absorption:
vagina stats then 4 caps Gamolenic acid, the
(4000 mg) q6 x 24 hrs evening primrose oil’s
active component, is
the focus of the
pharmacokinetics of
this substance.
Gamolenic acid is then
quickly absorbed after
administration and
71

turns into Dihomo-

gamma-linolenic acid
and other precursors.
Excretion: Most of the
metabolites produced
by evening primrose oil
are eliminated in the
urine.
72
SCHOOL OF HEALTH AND ALLIED SCIENCES DRUG STUDY FOR FERROUS

FUMARATE
ACTION NURSING
CLASSIFICATION CONTRAINDICATIONS ADVERSE EFFECTS
RESPONSIBILITIES
Generic Name: Descriptions: Ferrous Patients with primary CV: Heartburn  Administer
fumarate is a type of iron hemochromatosis, GI: Nausea, vomiting, medication
Ferrous Fumarate
used as a medication to hemosiderosis, and constipation, diarrhea following the 10
treat and prevent iron hemolytic anemia (unless Rights of drug
deficiency anemia. an iron deficiency is also administration.
Brand Name:
present).  Assess patient’s
 Fersamal, Galfer Pharmacokinetics: reaction after
Absorption: Ferrous administration.
fumarate is easily  Assess for
Classification: absorbed as source of constipation and
iron for replacement note the color of
 Oral Iron Bivalent the stools.
therapy. The digestive
Preparations tract is less irritated by this  Monitor
ferrous iron salt with an hematocrit,
Route: hemoglobin level
organic acid than by salts
 Oral with inorganic acids. and reticulocyte
Distribution: It first enters count during
Dosage: therapy.
through breast milk. It
 500 mg/cap BID then travels to the Fe
stores in the spleen, liver,
and bone marrow after
binding to serum
transferrin.
Excretion: Mainly
eliminated in the urine.
73

DRUG STUDY FOR HYOSCINE-
N-BUTYLBROMIDE (HNBB)
CLASSIFICATION NURSING
ACTION CONTRAINDICATIONS ADVERSE EFFECTS
RESPONSIBILITIES
Generic Name: Description: Hyoscine Contraindicated to Significant:  Administer

butylbromide is a patients with myasthenia Tachyarrhythmia, medication
Hyoscine N-
peripherally acting gravis, mechanical, hypotension, following the 10
butylbromide antispasmodic, stenosis in the increased intra-ocular Rights of drug
anticholinergic agent. It is gastrointestinal tract, pressure, drowsiness, administration.
used to treat pain and paralytical or obstructive confusional states,  Assess patient’s
Brand Name: discomfort caused by ileus, megacolon, and visual hallucinations, reaction after
abdominal cramps, hypersensitivity. blurred vision, eye administration and
 Buscopan check for allergic
menstrual cramps, or pain, idiosyncratic
other spasmodic activity in reactions (agitation, reaction.
Classification: the digestive system. delusion, acute toxic  Routinely check for
 Antispasmodic psychosis), and vital signs.
Pharmacokinetics: epileptic seizures.  Monitor urine
Route: CV: Tachycardia output.
Absorption: Readily
 IV absorbed from the GIT. EENT: Blurred vision  Assess neurological
Distribution: Hyoscine-N- GI: Constipation status.
Dosage: butylbromide is rapidly INTEG: Dry mouth  Assess abdomen
for discomfort
 1 amp – distributed into the tissues Other: Allergic
after intravenous reaction through palpation
20mg/mL administration. It is and numerical pain
metabolized in the liver via scale.
conjugation.
Excretion: Mainly
eliminated in the feces
(27-37%) and urine (42-
61% as unchanged drug).
74

DRUG STUDY FOR MORINGA OLEIFERA

NURSING
RESPONSIBILITIES
Generic Name: Description: Moringa Allergic reaction Significant:  Obtain patient vital
Moringa oleifera contains proteins, Hypotension, signs before
vitamins, and minerals. interference with administering.
Brand Name: As an antioxidant, it fertility, and diarrhea.  Monitor patient for
 Momma lac helps protect cells from allergic reaction.
damage. Moringa may
Classification: also help decrease
 Antioxidant inflammation and
Route: reduce pain. It also
improves lactation
 Oral
(breastfeeding).
Dosage:
 500 mg/cap BID
75

NURSING CARE PLAN

NURSING CARE PLAN FOR ACUTE PAIN
PLANNING IMPLEMENTATION
ASSESSMENT DIAGNOSIS GOALS AND DESIRED EVALUATION
INTERVENTION RATIONALE
OUTCOMES
Independent: Goal met. After an
Subjective (S) Acute pain r/t After an hour of nursing hour of nursing
Data: Mediolateral interventions, the patient  Established  To encourage interventions, the
Episiotomy. will verbalize an rapport with full participation patient verbalized an
“Pag gising ko alleviated discomfort with the patient. in the plan of alleviated discomfort,
ma’am after ko a numerical pain rating care and as evidenced by a
manganak, dun ko score of 3-4 out of 10. reduces anxiety numerical pain rating
palang towards the score of 4/10.
naramdaman na treatment.
masakit yung sa
private part ko,” as
verbalized by the  Assessed the  To create a
patient’s vital baseline data
patient. for the patient’s
signs,
including pulse possible series
“Medyo masakit
rate, of observations.
yung tahi ko kapag
naglalakad ako,” as respiratory
stated rate, and
blood
pressure.
 Helps in
Objective (O)  Encouraged addressing
Data: verbalization concerns more
of concerns. efficient.
Numerical pain
rating scale =6/10  This provides a
 Determined better
how the understanding
76
SCHOOL OF HEALTH AND ALLIED SCIENCES of the

patient usually measures to

Facial grimace respond to adopt in
pain. lessening the
patient’s pain.
 Evaluating
 Evaluated the patient’s
effectiveness response to
of analgesics medication
as ordered, helps in
using the identifying its
numerical pain effect to the
rating scale, patient’s pain,
as well as whether to
observed for continue,
any signs and intensify, or
symptoms stop.
suggesting of
side effects
and adverse
effects.
 Sudden
 Encouraged movements
gradual after an
ambulation. episiotomy may
open the suture
and disrupt the
healing process.
 To prevent
 Encouraged fatigue that can
adequate rest impair the ability
to manage or
77
SCHOOL OF HEALTH AND ALLIED SCIENCES cope

BACHELOR OF SCIENCE IN NURSING – LEVEL III with
pain.
periods.
 Pain
DEPENDENT medications
reduce the
 Administered severity of pain
pain and help aid in
medication, 1 compliance for
ampule of other nursing
HNBB, interventions.
Diclofenac,
and
Nalbuphine,
via
intravenous
route, as
prescribed by
the physician.
78

BACHELOR OF SCIENCE IN NURSING – LEVEL III NURSING CARE PLAN FOR
FLUID VOLUME DEFICIT
(DEHYDRATION)
ASSESSMENT DIAGNOSIS GOALS AND DESIRED EVALUATION
INTERVENTION RATIONALE
OUTCOMES
Subjective: Fluid Volume At the end of 30 minutes Independent: Goal Met. At the end
“Mga anim na Deficit r/t of health education, the  of 30 minutes of
beses lang ako Prelabor patient will report  Monitored  Low blood health education, the
umiinom ng tubig,” Rupture of understanding of the blood pressure pressure and patient reported an
as verbalized by Membrane. importance of and heart rate tachycardia are understanding of the
the patient rehydration. every 2 hours. evident in importance of
decreased adequate fluid intake.
After 6 hours of nursing blood volume.
Objective: interventions, the patient HR is weak and After 6 hours of
 Pale, dry, and will demonstrate an irregular with nursing interventions,
chapped lips stabilized fluid volume as electrolyte the patient
evidenced by balanced imbalance and demonstrated an
 Dry buccal
intake and output. hypotension stabilized fluid volume
mucosa
with as evidenced by
 Dark yellow
hypovolemia. balanced intake and
urine  Monitored fluid
intake and  To output.
determine
output. the fluid balance
of the patient.
 Encouraged
the patient to  To compensate
increase fluid with the fluid
intake. loss and
improve skin
turgor.
 Asked the
patient about  Concentrated
the color and urine denotes
amount of
79
SCHOOL OF HEALTH AND ALLIED SCIENCES fluid

urine. deficit.
 Educated the
patient about
the benefits  Education
and allows the
importance of patient and
adequate fluid significant other
intake. to understand
the benefits of
adequate fluid
intake and
Dependent: increases
adherence to
 Administered treatments.
intravenous
fluids, as  To recover
ordered by the electrolyte
physician imbalances and
(D5LR 1L at for daily
10 gtts/min maintenance of
and PLR 1L at body fluids and
10 gtts/min for nutrition and for
30 minutes rehydration.
then fast drip
200cc at 40
gtts/min, with
a resume
order at 10
gtts/min then
30 gtts/min).
80
SCHOOL OF HEALTH AND ALLIED SCIENCES NURSING CARE PLAN FOR

BACHELOR OF SCIENCE IN NURSING – LEVEL III RISK FOR INFECTION
ASSESSMENT DIAGNOSIS
GOALS AND DESIRED EVALUATION
OUTCOMES INTERVENTION RATIONALE
Risk for Independent:

Subjective: Infection r/t After 30 minutes of Goal met. After 30
Prelabor nursing interventions, the  Established  To encourage minutes of nursing
“Oo ma’am, may Rupture of patient will be able report rapport with full participation interventions, the
UTI ako dati,” as Membrane. an understanding of the the patient. in the plan of patient reported an
stated by the causative factors of care and understanding of the
patient. infection and its reduces anxiety causative factors of
preventive measures. towards the infection and its
Objective: treatment preventive measures.
High WBC count at

20.1 X10^9/L  Assessed for  These suggest
the presence, that there is a
High Neutophils existence, and break in the
count at 84 % history of the body’s normal
common first line of
Hight Monocytes causes of defense which
count at 7 % infection may indicate an
infection.
 Encouraged  To comprehend
the patient to the situation of
verbalize the patient and
concerns. to properly
address his/her
concerns.
 Monitored
 High WBC
laboratory test
81

results. counts signify
the body's
efforts to
combat
Dependent: pathogens or
fight infection.
 Administered
 To prevent or
antibiotic treat a wide
medication variety of
infections.
prescribed by
the physician
(ampicillin
2g/IVT stat,
then 1g/IVT q6
hours;
Sultamicillin
750 mg/tab
BID; Mupirocin
ointment TID;
Metronidazole
500mg/tab
TID;
Mefenamic
Acid 500
82

mg/cap BID)
Collaborative:
 Monitored  High WBC

laboratory test counts signify
results. the body's
efforts to
combat
pathogens or
fight an
infection.
83

DISCHARGE PLAN
COMPONENTS ACTIONS RATIONALE
 Gave proper instructions about  To provide adequate

the importance of following the awareness and
MEDICATIONS
medication regimen given by understanding towards the
the doctor. benefits of the medication
process to the patient.
 Discussed and reminded the  This is to avoid any mistakes

patient about the correct on the administration and to
medication, the correct time to prevent side effects caused
take, and the right dosage of by non-compliance towards
the medication the medication regimen.
To follow the list of names of

the take home medications of
the patient.
 Reminded the patient of the  To prevent anemia and
importance of eating healthy bleeding.
DIET
foods, such as green leafy
vegetables and foods rich in
Vitamin K.
 Encouraged the patient to  To maintain the balance of

consume at least 8 glasses of body fluids and prevent
water a day. dehydration.
 Explained to the patient the  To encourage adherence of

importance of continuous taking medications.
HEALTH TEACHINGS
adherence to the prescribed
medications.
 To maintain good hygiene
 Demonstrated to the patient and prevent harboring of
the proper handwashing and microorganisms
explained its importance in
preventing infections.
 To prevent opening of the
 Instructed to gradually episiotomy that can disrupt
increase physical activities healing process.
until recovery.
 To prevent infection and
 Educated the patient about the improve healing.
proper way of perineal care.
 Made a follow-up appointment  For health status monitoring.
84

OUT-PATIENT-FOLLOW- as ordered by the physician.

UP CARE
 Encouraged the patient to  It is considered one of the

maintain her faith and best coping mechanism a
SPIRITUAL CARE
connection to God. person should have.
REFERENCES
85

Assefa, N., Berhe, H., Girma, F., Berhe., K., Berhe, YZ., Gebreheat, G., Werid, WM., Berhe, A.,
Rufae, HB., & Welu, G. (2018). Risk factors of premature rupture of membranes in public
hospitals at Mekele city, Tigray, a case control study. BMC Pregnancy Childbirth.
https://doi.org/10.1186/s12884-018-2016-6
Cortez, F. & Ocampo-Tapia, M. (2016). Vaginal fluid creatinine for the detection of pre-labor
rupture of membranes. Philippine Journal of Obstetrics and Gynecology.
http://pjog.org/article-detail.php?id=145
Dayal, S. & Hong, P. (2022). Premature Rupture of Membranes. StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK532888/
Duff, P. (2020). Preterm prelabor rupture of membranes: Clinical manifestations and diagnosis.
In Barss, V. A. (Ed.), UpToDate.
https://www.uptodate.com/contents/preterm-prelabor-rupture-of-membranes-clinical-
manifestations-and-diagnosis
Galan, N. (2016). Premature Rupture of Membranes: First-Level Tests. Healthline.

https://www.healthline.com/health/pregnancy/premature-rupture-tests
HISTOLOGIC, M. A. P. O. Famadico S, Uy ME & Tindoc JA (n.d.). Duration of Preterm

Premature Rupture of Membranes as Predictor of Histologic Chorioamnionitis and Early
Onset Neonatal Sepsis: A Cohort Study
http://www.pidsphil.org/home/wp-content/uploads/2019/09/Vol-20-No-
1_FAMADICO_Histologic-Chorioamnionitis-Revised5.pdf
Lippincott Advisor - View Document. (2013). Lww.com.

https://advisor.lww.com/lna/document.do?bid=5&did=1147927&searchTerm=premature
%20rupture%20of%20the%20membrane&hits=membranes,rupture,premature
Madar, H. (2018). [Management of preterm premature rupture of membranes (except for

antibiotherapy): CNGOF preterm premature rupture of membranes guidelines]. Gynecol
Obstet Fertil Senol.
https://pubmed.ncbi.nlm.nih.gov/30389540/
Mobolaji-Lawal, M. & Jubanyik, K. (2021). Prelabor Rupture of Membranes. Obgyn Key.

https://obgynkey.com/prelabor-rupture-of-membranes/
Moldenhauer, J. S. (2022). Induction of Labor. MSD Manual Consumer Version.

https://www.msdmanuals.com/home/women-s-health-issues/complications-of-labor-and-
delivery/induction-of-labor
Moldenhauer, J. S. (2022b, September 19). Prelabor Rupture of the Membranes (PROM). MSD
Manual Consumer Version.
https://www.msdmanuals.com/home/women-s-health-issues/complications-of-labor-and-
delivery/prelabor-rupture-of-the-membranes-prom
86

Pharm, J. (2022). Ferrous Fumarate. RxList; RxList.

https://www.rxlist.com/feostat_ferro-sequels_hemocyte_ferrous_fumarate/drugs-
condition.htm
Ponstel. (2017). RxList; RxList.

https://www.rxlist.com/ponstel-drug.htm#description
Prelabor Rupture of Membranes. (n.d.). ACOG.

https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/03/prelabor-
rupture-of-membranes
Schmitz, T., Sentilhes, L., Lorthe, E., Gallot, D., Madar, H., Doret-Dion, M., Beucher, G.,
Charlier, C., Cazanave, C., Delorme, P., Garabedian, C., Azria, É., Tessier, V., Senat, M.
V., & Kayem, G. (2018). [Preterm premature rupture of membranes: CNGOF Guidelines
for clinical practice - Short version]. Gynecol Obstet Fertil Senol. 46(12), 998–1003.
https://pubmed.ncbi.nlm.nih.gov/30392986/
Search Drug Information, Interactions, Images, Dosage & Side Effects | MIMS Philippines.
(2022). Mims.com.
https://www.mims.com/
TabletWise.com. (2016). Evening Primrose Oil / Vitamin E - Product - TabletWise.com.

TabletWise.com.
https://www.tabletwise.net/medicine/evening-primrose-oil-vitamin-e
Tiruye, G., Shiferaw, K., Tura, A. K., Debella, A., & Musa, A. (2021). Prevalence of premature
rupture of membrane and its associated factors among pregnant women in Ethiopia: A
systematic review and meta-analysis. SAGE open medicine, 9, 20503121211053912.
https://journals.sagepub.com/doi/full/10.1177/20503121211053912
Zhuang, L. (2022). Latency period of PROM at term and the risk of neonatal infectious diseases.
Nature. https://www.nature.com/articles/s41598-022-
16593-6?error=cookies_not_supported&code=73bc0432-4df0-436b-91b6-
2606b73b3595
Zhuang, L., Li, Z. K., Zhu, Y. F., Ju, R., Hua, S. D., Yu, C. Z., … & Feng, Z. C. (2020). The
correlation between prelabour rupture of the membranes and neonatal infectious
diseases, and the evaluation of guideline implementation in China: a multi-centre
prospective cohort study. The Lancet Regional Health-Western Pacific, 3, 100029.
https://www.sciencedirect.com/science/article/pii/S2666606520300298
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University of Saint Louis

Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES

CASE STUDY ON PRELABOR

In Partial Fulfillment of the Requirements for the Subject

PNCM 1079: Care of Mother, Child, Adolescent (RLE)

SCHOOL OF HEALTH AND ALLIED SCIENCES

NURSING HISTORY ------------------------------------- 14

GORDON’S 11 FUNCTIONAL PATTERNS ------------------------------------- 15

PHYSICAL ASSESSMENT ------------------------------------- 19

ANATOMY AND PHYSIOLOGY ------------------------------------- 30

COURSE IN THE WARD ------------------------------------- 33

LABORATORY RESULTS ------------------------------------- 46

DRUG STUDY ------------------------------------- 51

NURSING CARE PLAN ------------------------------------- 78

DISCHARGE PLAN ------------------------------------- 86

SCHOOL OF HEALTH AND ALLIED SCIENCES

Prelabor rupture of membrane, previously called premature rupture of membrane, is a

SCHOOL OF HEALTH AND ALLIED SCIENCES

Globally, prelabor rupture of membranes (PROM) complicates between 5% and 15% of

Various studies have presented the percentage of pregnancy complicated by PROM in

Prelabor Rupture Of Membrane International Statistics

SCHOOL OF HEALTH AND ALLIED SCIENCES

Prelabor Rupture Of Membrane Philippine Statistics

PREDISPOSING AND PRECIPITATING FACTORS

SCHOOL OF HEALTH AND ALLIED SCIENCES

Nutritional Deficiency. Micronutrients, especially vitamin C, affect collagen formation,

Socioeconomic status. Pregnant women of lower socioeconomic status with lower

Infections such as intra-amniotic infection, urinary and sexually transmitted

Uterine overdistension (polyhydramnios, multifetal pregnancy). Increased

SCHOOL OF HEALTH AND ALLIED SCIENCES

Collagen vascular disorders (Ehlers-Danlos syndrome, systemic lupus

SIGNS AND SYMPTOMS

 Sudden gush of fluid or continuous leakage of fluid from the vagina

SCHOOL OF HEALTH AND ALLIED SCIENCES

Chorioamnionitis. It is an inflammation of the amniochorionic membrane due to a

SCHOOL OF HEALTH AND ALLIED SCIENCES

Fetal Infection. An infection of the fetus is associated with chorioamnionitis. Due to

Respiratory distress syndrome. Fetal distress is most frequently brought on by the

SCHOOL OF HEALTH AND ALLIED SCIENCES

Sterile speculum examination. This procedure is performed to confirm PROM, assess

AmniSure ROM test. It is a newer noninvasive test in which speculum examination is

Ultrasound. Transperineal ultrasonography is a non-invasive procedure that can be

Fetal fibronectin Test. It is a diagnostic test of cervical and vaginal secretions to

Amniocentesis. It is a procedure in which the amniotic fluid is examined to detect the

SCHOOL OF HEALTH AND ALLIED SCIENCES

Urinalysis. It evaluates the physical characteristics of urine; determines specific gravity

TREATMENT AND MANAGEMENT

SCHOOL OF HEALTH AND ALLIED SCIENCES

Ampicillin. This is used to treat a wide variety of bacterial infections. It is a penicillin-

SCHOOL OF HEALTH AND ALLIED SCIENCES

Initial Vital Signs (September 19; 11 AM, upon admission)

• Temperature: 36.8 degrees Celsius

• Temperature: 36.3 degrees Celsius

HISTORY OF PRESENT ILLNESS

SCHOOL OF HEALTH AND ALLIED SCIENCES

HISTORY OF PAST ILLNESS

FAMILY HEALTH HISTORY

SOCIAL HEALTH HISTORY

GORDON’S 11 FUNCTIONAL HEALTH PATTERNS

Functional Health Pattern Before Hospitalization During Hospitalization

SCHOOL OF HEALTH AND ALLIED SCIENCES