Davao Doctors College, Inc.

College of Allied Health Sciences

Nursing Program

NRG203: CARE OF MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS),

POSTPARTUM PERIOD.
All a Nurse Needs to Know about Maternal -Child Nursing

1. Getting to Know the Course Instructor

Hello! I am Roldan V. Redoble, and I will be your

Instructor for NRG203: CARE OF MOTHER, CHILD AND
ADOLESCENT (WELL CLIENTS), POSTPARTUM
PERIOD.
Before we begin, allow me to introduce myself. I am Sir
Dan, a faculty member of the Nursing Program of Davao
Doctors College, Inc. I am a Part-time Clinical Instructor of
Davao Doctors College. I earned my degree of BS in
NURSING at Cotabato Medical Foundation College, Inc. and
I finished BS in Secondary Education at St. John Paul
College of Davao, Davao City. I also gained my Master of
Arts in Science Teaching major in Biology degree from
University of Southeastern Philippines, Obrero, Davao City.
Currently studying Doctor of Philosophy in Science
Education major in Biology at Bukinon State University. In Philippine Womens College, Inc. I teach
the following subjects: Ecology, Astronomy and Geo and Natural Sciences. In Davao Doctors College,
Inc. I teach subject: Maternal and Child Nursing and Pharmacology. I handled Learners with Special
Educational Needs (LSENs) at Anchorage School, Inc. for 7 years experienced. It developed my
patience and understanding of different learners. I was a former College Instructor at Philippine
Womens College, Davao City. I am currently working at Catalunan Pequeño National High School as
a Secondary High School Teacher. I am exposed in the Emergency Room at Cainglet Medical
Hospital, Panabo City. It is a great opportunity to practice my nursing career and manifested
genuine enthusiasm and pride in nursing profession.

For this semester, I will be your instructor for NRG203: Care of Postpartum Clients. I am looking
forward to guiding you in learning this course. If you want to reach me for any academic-
related concerns, you can contact me through the following:

Contact No: 0909-481-3189

Facebook account: Roldan Redoble
E-mail address: roldanredoble@davaodoctors.edu.ph
Consultation hours: Wednesday (11:30am-1:00pm/4:30pm-5:30pm) or
Saturday(11:30am-1:00pm/4:30pm-5:30pm)

Introduction to the Course

The course NRG203: The course deals with concepts, principles, theories, and techniques in the
nursing care of individuals and families during childbearing years toward health promotion,
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disease prevention, restoration, and maintenance and rehabilitation. In this course, you are
expected to provide safe, appropriate, and holistic nursing care to clients utilizing the nursing
process. Presented below are the specific details of this course:

Course NRG 203

Number:
Course Credits 9 units (4 units Lecture, 5 units RLE)

255 hours (43 hours/week for 6 weeks)

No of Hours
(Lab):
Placement: Second-year, First Semester
: NRG 105 Health Assessment
Prerequisite:
NRG 106 Fundamentals in Nursing

Schedule: Monday-Wednesdas 7am-1pm/1:00pm-7:00pm,

Thursday-Saturday 7am-1pm/1:00pm-7:00pm
Classroom: Google Classroom Code: _________
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Requirements in Completing the RLE Activities

Since most of our sessions for this semester will be delivered through distance/blended learning
activities, the submissions will also be done online. To do this, you need to have access to the
following applications:

1. Microsoft Office/Google Docs

2. Google Classroom (or Quipper; will depend on the instructor in-charge)
3. Google Meet (or any other teleconferencing app, duly agreed by the whole class)
4. Internet connectivity

Access to a printer and/or scanner is also a plus, but not a requirement.

Daily Activities
Every week, you are expected to follow through with the following deliverables:

October 10 / 13 October 11 / 14 October 12 / 15

(Monday/Thursday) (Tuesday/Friday) (Wednesday/Saturday)
Completion of Module, including Discussion of Stepping In; Discussion of Deep Dive:
Assignment of Reflection Time Review of systems and History Taking, Destination
(Readings) Concept Map. Check

Submission of Stepping In, Review

of Systems, Concept Map, Deep
Dive, History taking, Destination
check
Submission of NCP, Drug study,
and Related readings
Submission of NCP, Drug Quiz
study, and Related readings
Preparation for next week’s
activity
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Now that you are done acquainting yourself with the instructor and the course itself, please
proceed to Module 5: Care of Postpartum Client.

MODULE 5:
CARE OF POSTPARTUM CLIENT

Term: Third Term, First Semester S.Y. 2022-2023

Dates: Week 11 - October 10-15, 2022
Class Schedule:
7am-1:00pm/1:00pm-7:00pm
No. of Hours: 6

Instructions
Print this worksheet to answer or write your answers on clean white bond papers. Answers must
be handwritten. Do not forget to write your name, year level, and section, and course name
on the upper part of all your submissions. Observe pagination. Once done, take clear pictures of
your written outputs, compile them (in WORD or PDF), and send the compilation to your
instructor.

Learning Outcomes
At the end of this module, you are expected to:

1. Utilize the nursing process in the care of postpartum clients.

2. Perform a holistic health assessment based on the case scenario presented.
3. Utilize assessment information to formulate a patient-centered plan of care.
4. Explain appropriate nursing interventions per problem identified.
5. Apply bioethical concepts/principles, core values, and nursing standards in the care of
clients.
6. Document the care rendered to the assigned patient in the simulated health care record
accurately.

As you start with this module, you are free to consult and coordinate with your assigned clinical
instructor. Be sure to get his/her email address and contact number for collaboration and
assistance. Just keep going, you can do it!
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STEPPING IN

Hello, future nurse!

Welcome to your third module. Topics cover concepts on Postpartum. You had your discussion on
immediate care of the newborn, nursing care of a newborn and family health education and
nutritional needs of a newborn, drug therapy during the postpartum period, physiological and
psychological changes, and possible complications. And just recently, you started knowing the
physiology, diagnostics, medical and nursing management of these patients with these concerns.
The basis for including the concept was the expected utilization for clinical competence in patient
care. You are encouraged to study beyond this module. Let us have a review of these concepts and
see how much you recall.

Review on the Concept of Postpartum

A. Let us start by answering the following. Fill in the blank with the correct term.

1. ________(from the Latin puer, for “child,” and parere, for “to bring forth”), refers to the 6
weeks after childbirth. It is a time of maternal changes that are both retrogressive (involution
of the uterus and vagina) and progressive (production of milk for lactation, restoration of the
normal menstrual cycle, and beginning of a parenting role). The period is popularly termed
the fourth trimester of pregnancy.

2. __________ immediate nursing care essential to the needs of neonate provided at the time
of birth

3. __________uterine blood loss in excess of 500ml may be due to atony, incomplete

placental separation, or retained fragments.

4. ___________postpartum infection of the uterus and higher structures. (fever, chills,

increased WBC)

5. ____________feeling of tension in the breast or progressive changes occur that prepares the
breasts for lactation.

6. ___________ is the process whereby the uterus returns to its prepregnant state.

7. ___________ is the production of breast milk.

8. ___________is the preferred healthcare agency arrangement for postpartum families

because it allows a new family the best chance for quality interaction and promotes
breastfeeding
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B. Behavioral Adjustment: Phases of Puerperium
Multiple Choice (ENCIRCLE THE LETTER OF THE CORRECT ANSWER)

1. The client is complaining that she feels very tired. She also began to suspend involvement in that
day’s responsibilities and activities. She relies on others to satisfy needs for comfort, rest,
nourishment. She verbalized her experience of birth and pregnancy. The nurse is aware that the
client is in which phase of the puerperium?

a. Taking-In Phase
b. Taking-Hold phase
c. Holding-on phase
d. letting- go phase

2. Which of the following behaviors characterizes the postpartum mother in the Taking phase?

a. Passive and dependent

b. Desires to review birth experience
c. Striving for independence and autonomy
d. Excited and talkative

3. In response to the nurse's question about how Monica is doing, she states that she is fine. You
notice that her focus is on the care of baby and competent mothering. She desires to take
charge and has the eagerness to learn and practice. The nurse determines that Monica is in
which postpartum phase of psychological adaptation?

a. Taking-in phase
b. taking-hold phase
c. Holding-on phase
d. Letting go-phase

4. On the 4th or 5th postpartum day, the newly developed mother may be unexplainably irritable
and upset. All of the following may be helpful except:

a. This may be a symptom of postpartum psychosis

b. this may be a normal phenomenon, often seen during the puerperium.
c. The patient will need help in understanding her feelings
d. it is helpful to hypnotize the patient.

5. In this phase, a woman finally redefines her new role. She gives up the fantasized image of her
child and accepts the real one; she gives up her old role of being childless or the mother of only
one or two.

a. Taking-in phase
b. Taking-hold phase
c. Holding-on phase
d. Letting go phase
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Review on the anatomy of Mammary Gland (8points)

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Structure of Lactating Mammary Glands. Identify each part and write your answer on
the space provided. (11 points)

a_______________ e____________ i_____________

b._______________ f____________ j _____________
c________________ g____________ k_____________
d________________ h___________
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Trace It: Maternal breastfeeding reflexes(Milk production and Let Down Reflex)
Answer the questions below:
1. How does breast milk produced?

2. Lactogenesis/ Let Down reflex (Fill in the blanks)15 pts.

a. After the mother gives birth, a precipitate decrease in ____________and

____________levels triggers the release of ___________ from the
___________________gland.

b. During pregnancy, ___________prepares the breast to secrete milk and during lactation to
synthesize and secrete milk.

c. Prolactin levels are _______ during the first 10 days after birth, gradually declining over
time but remaining above baseline levels for the duration of lactation.

d. _________ is produced in response to infant suckling and emptying of the breast

e. Milk is constantly produced by the _______as the infant feeds

f. Milk production is a supply meets-demand system, as milk is removed from the breast, more
is produced. Incomplete emptying of the breasts with feedings can lead to a ______milk
supply.

g. ___________is the other hormone essential to lactation. As the nipple is stimulated by the
suckling infant, the posterior pituitary is prompted by the _________ to produce
_______.This hormone is responsible for the _____ ejection reflex or let down reflex.

h. ______and ____ have been referred to as the “mothering hormone” because they are
known to affect the woman’s emotion as well as her physical state.
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1. CONCEPT MAP OF MOTHER DURING POSTPARTUM PERIOD

Instruction: On a separate sheet of paper write the signs and symptoms of Postpartum Maternal
changes and indicate the management. Follow the diagram below:
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DEEP DIVE

A Case Study on the Mother and Child (Well Client);

POSTPARTAL STAGE

On October 1, 2022 (1:00 am), a primigravida with 39 weeks AOG presents at the labor and delivery
unit. Initial assessment of vital signs such as temperature, pulse, respiration, and blood pressure
were normal. Laboratory such as Complete Blood Count and Urinalysis was done as an outpatient
were within normal limits.

Family Profile
This 29-year-old patient is married to Brian for one year. They live in a single unit house, in a
relocation area. Narda is a factory worker and a high school graduate. They belong to a middle-class
family. The patient reports no history of alcohol, cigarette smoking, or illicit drug use. Family history
reveals (+) for diabetes mellitus on her paternal side and (+) for heart disease on the maternal side.

Pregnancy History.
This is her first pregnancy. The patient is Gravida 1 Para 1 and was expecting to deliver on October
10, 2022. Her delivery was one week earlier than her estimated date of delivery. The patient has
poor prenatal check-up and poor compliance with prescribed medicines such as Ferrous Sulfate. The
pregnancy was unplanned; however, the patient is thankful because there were no problems or
complications arise during labor.

Labor and birth history

She reports that there is no fluid leaking from her vagina. She was having contractions for the past 6
hours. “My contractions are coming every 2 minutes and last for about 60 seconds.”” They don’t
change when I lie down or walk, I think I saw some blood leaking”. She is becoming quite
uncomfortable and moaning during contractions. She was in active labor. Her cervix is dilated to 9
cm, and almost completely effaced. She is experiencing a great deal of anxiety and pain and is
unable to stay in control and breathe through her contractions. She does not want epidural
anesthesia, so her physician prescribed Meperidine (Demerol) and Promethazine (Phenergan)The
fetal heart rate and contractions are being monitored by an electronic fetal monitor (EFM). The
nurse notes a fetal heart rate of 120 beats per minute with adequate variability. There are no
decelerations, but there are occasional accelerations. The presentation is in Cephalic. She gave birth
at 6:00 am via NSVD with mediolateral episiotomy. APGAR score is 8 after 1 minute and 9 after 5
minutes. Skin to skin contact was initiated. Latching on was done. The placenta was delivered in the
Schultz mechanism after 10 minutes.

Infant Profile
Narda delivered a 2,200 grams baby boy with an APGAR score of 8 after 1 minute and 9 after 5
minutes. No difficulties at birth were noted and no resuscitation was needed. No Congenital
anomalies were noted. The patient was overwhelmed upon seeing her baby for the first time. She is
glad to be through with the pregnancy but still longing to have another baby soon.
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After staying in the recovery room for two hours and after a thorough physical examination, the
patient was transported to the Postpartum Unit via a stretcher in stable condition. Vital signs such as
RR, PR, BP, and temperature were normal. The uterus is well contracted and globular. The fundus is
at the level of the umbilicus and there is a moderate lochia.

You are now ready to meet your patient for this clinical experience
Case Scenario:
Patient on Postpartum period

Narda, a 29 years old female, G1P1 delivered to a full-term baby girl via NSVD. She is
experiencing some postpartum pain (afterpain). She is tired and exhausted following
childbirth. She began narrating about the beginning of her pregnancy, her experiences
during labor and birth. You observed that Narda was passive. She prefers having a Nurse to
attend her needs and make decisions for her. She is also pondering as she holds her baby
and asking, “Is birth over?”,” Could this child have been inside me?”. This time all she
wanted is to rest to regain her physical strength and experience a calm atmosphere around
her to quiet and contain her swirling thoughts.” After sharing her stories, she said “Please
take care of my baby for a while.” I am exhausted. I was in labor for more than 10 hours
and “I had no sleep at all last night.” I need sleep” After some time of being dependent,
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Narda begins to initiate action. She prefers now to get her washcloth and make her own
decisions. Greater independence can be seen because she can perform self-care. Her
husband said Narda has a stronger interest in her baby and begins her role as a mother.
She cuddles her baby while breastfeeding though not confident in holding her baby. She
feels insecure about her ability to take care of her child, but she tries her best. A brief
demonstration of infant care was demonstrated by the nurse. She appreciated it very much.
To boost her confidence, she was praised for the things she does well and some positive
reinforcement was done. Finally, Narda redefines her role. She gave up her role of being
childless.

A very special moment happened when they begin interacting with their newborn, they said that”
it is priceless” being a first-time mom and dad. Narda holds her child more and begins to express
more warmth. She feels comfortable enough to press her cheek against the baby or kiss the
infant’s nose. She is a mother tending to her child. You notice also that she is looking directly at
her newborn’s face with direct eye contact. You observed also that her husband is staring at the
baby for a long period.

These are the postpartum medications ordered:

 Sultamicillin 750 mg tab BID X 7 days PO

 Fe SO4 (Feosol) 300 mg BID
 Ascorbic Acid (Cecon) 500mg OD
 Ranitidine (Zantac) 150 mg tab BID PO
 Metoclopramide (Plasil) 10 mg tab PRN for vomiting PO
 Oxytocin (Syntocinon) 10 “u” incorporate to present IVF
 Methylgometrine (Methergin) 1-tab TID X 3 days PO
 Ketorolac (Toradol) 10 mg q 6 hours PO

The following were also ordered by the pediatrician for the newborn:

 Terramycin Ophthalmic ointment on both eyes

 Phytonadione (Aquamephyton) 0.1 ml IM @Left vastus lateralis
 Hepa B (Hyper Hep) vaccine 0.5 ml IM right vastus lateralis

Six hours after delivery you noticed that her pad was saturated in less than an hour. There is an
excessive amount of lochia. Immediately you checked the fundus and noticed that it is boggy
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and relaxed and feels poorly contracted and is located above the level of the umbilicus and
deviated to the right. The bladder is distended. Despite the fundal massage done to the patient
and application of an ice pack over the abdomen blood flow remain the same. There is an
estimated blood loss of 700 ccs. The patient was then referred to her attending physician.
Hence the following were ordered:

1. Insert IVF of PNSS 1 liter and incorporate 20 units of oxytocin to run @ 40 drops per
minute
2. Secure Packed Red blood cell, 1 unit and transfuse after proper cross-matching
3. Insert Foley catheter and attached to Uro-bag
4. Manual removal of retained placental fragments.
5. O2 inhalation @ 2LPM via nasal cannula.
6. Carboprost tromethamine intramuscular STAT.
7. CBC STAT, ABO and RH/blood type,HBsAg
8. CBR without BRP

The above doctor’s order was carried out except for blood transfusion. IVF was inserted
immediately at 2:00 pm at 40 drops per minute. Foley catheter was inserted because of blood
loss to evaluate tissue perfusion. The Urine output is a good indicator of kidney perfusion and
fluid balance. The frequency of assessment of fundus, lochia, vital signs skin color, and voiding
was increased. The postpartum complication was addressed. Narda is conscious though weak to
get out of bed to go to the bathroom and verbalized that she had difficulty in moving.
Result of STAT CBC, ABO, and RH/blood type, HBsAg,

Hematology test

CBC RESULT NORMAL

VALUES
Hemoglobin 100 g/dL Low 120-140 g/L
RBC count 4.0 Low 4
WBC count 11.5 High 5-10g/L
Hematocrit .27 Low 0.34-0.45
Platelet count 382 140-440 g/dL
Differential Count
Segmenters 67.8 H
Lymphocytes 20.6 L
Monocytes

LABORATORY TEST

IMMUNOHEMATOLOGY
ABO and RH/blood type O+
HBsAg (Qualitative) Non-Reactive
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Miscellaneous
VDRL Non-Reactive

URINALYSIS

Color Straw Pus Cells 1-2 / hpF Hyaline / lpF

Appearance Clear Red blood Cells 1-2 / hpF Fine Grandular/ lpF
Glucose Negative Epithelial cells + Coarse grandular
Albumin Negative Mucuos threads Red cell cast
Ph 7.0 Bacteria Few WBC cast
Specific Gravity 1.015 Renal tubular /hpF
cells
Blood Negative Cells / uL
Ketones Negative Mmol/L

Assessment and history taking was done and this is the additional information gathered:

Past Medical History:

There are no known foods, drugs, or environmental allergies. The patient had a history of
hospitalization/surgery in 2021. Patient claimed that her gallbladder was removed because of
gallstones.

Menstrual History
Patient had her menarche @ 12 years of age. She had a regular menstruation30 days cycle lasting
3-4 days, moderate to heavy flow. She experienced dysmenorrhea, no history of bleeding between
periods

Physical Examination
Generally, the patient looks pale, tired, and sleepy. Patient is hypotensive, hypothermic, and
tachycardic. Her vital signs are as follows: BP 80/50, pulse-105 bpm, CR-105 bpm, temperature 35.3
degrees Celsius. Present weight:110 lbs. Weight Upon admission 127 lbs.

Inspection:
The patient has a fair-colored complexion. The head is rounded; normocephalic and symmetrical.
The palpebral conjunctiva is pale. The sclera appeared white. The pupils of the eyes are black and
equal in size. The nose has no presence of discharge or flaring, it's clear. Has normal alignment of
the pinna. The neck muscles are equal in size. No palpable nodules. The skin is warm and dry. Mask
of pregnancy is visible on the face. The abdomen has striae gravidarum and appears reddened and
linea Negra. There is excessive pigment on the face and neck (Chloasma)There is also palmar
erythema. With diaphoresis. Breast is hard, larger, and more erectile. It is engorged and shiny. The
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chest is symmetrical. There were no visible pulsations on the aortic and pulmonic areas. There is no
presence of heaves or lifts. Able to digest food. The patient is constipated. The patient has a foley
catheter inserted draining to a yellow-colored. Hemorrhoids are present
Urine.no sign of sediment or cloudiness. The perineum is edematous with ecchymosis patches from
ruptured capillaries. There is an increased steady flow of bright red blood and clots from the vagina.
There is also a saturation period. Leg pain and varicosities were not noted. On musculoskeletal, no
pelvic girdle pain or back pain. Extremities have a good range of motion.

Palpation
Skull has no nodules or masses and depressions fundus 1 cm above the umbilicus and right. Breasts
are hard. There is a soft and boggy uterus. Pulse is palpable. Capillary refill actively returns to its
normal color in less than 4 seconds. Abdomen is soft and non-tender. Thyroid is not palpable in the
neck. Cervix feels soft and malleable, vagina, feels soft with few rugae. Diameter is greater than
normal.

Auscultation
Lungs have normal breath sounds without dyspnea. Clear to auscultation in all lobes. Cardiac rate of
105 beats per minute, no signs of crackles, wheezing, stridor. Abdomen has audible bowel sounds.

Laboratory:
There is a low level of Hemoglobin and Red blood cell count;

After what had happened, her husband noticed that Narda has this overwhelming sadness, burst
into tears, and feeling down, there is also a feeling of inadequacy, anorexia, and sleep
disturbance. She is also worried about the weight of her baby. With the help of her husband,
mother, and health care professional’s anticipatory guidance and individualized support, this
complication was explained to her as an unexpected response, which is normal. She was given a
chance to verbalize her feelings and make as many decisions as she wants to help her gain a
sense of control and move past this strange postpartum emotion.

On the second day of your duty, the patient complained of pain on the incision site. You observe
that the skin around the episiorrhaphy is red and draining a small amount of seropurulent
drainage. A moderate lochia rubra was observed. A hot sitz bath was done and an order to
continue the anti-infective drug was carried out and analgesic was prescribed. The use of stool
softener was prescribed, and a high fiber diet was encouraged. Another problem was also
relayed about breastfeeding. She said, “something is wrong with my breast”. Upon further
questioning, she says that she has a hard, tender, and shiny over the entire breast not just in
one spot. There is no redness, fever, and cracked nipples. You tell her to continue breastfeeding
because it will not harm the baby and weaning during engorgement may cause engorgement
and stasis, leading to abscess formation. Other advice was given to increase oral fluid intake and
use a warm compress to promote comfort.
After 5 days, Narda’s doctor ordered that she may go home but her baby will stay in the hospital
for monitoring and treatment of neonatal sepsis. Included in the “May go home” order is the
following:
1. Take home meds:
Sultamicillin 750 mg cap BID X 2 days more
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Mefenamic acid 500 mg cap q6 PRN for pain
Ferrous Sulfate 300 mg tab OD X 1month
2. Internal Examination prior to discharge.
3. To come back after 1 week with CBC laboratory results at OPD

In preparation for the patient's discharge. Instructions on Take home medicine, Postpartum
exercises, Treatment, Health Education, Outpatient department schedule, Diet, and Spiritual will be
discussed. Other instructions on Work, Rest, Hygiene, Coitus, and Contraception will also be given.

To immerse yourself in the care management of your patient, let us do some detailed description
of your patient care tasks. Using the Case Scenario assigned to you, you are expected to perform
the following:

1. Fill-up the needed data based on the given scenario/case. Note: Assessment findings of
all other areas must be filled up using fictional data BUT should be within the scope of the
case scenario given.
2. Conduct a history taking and physical assessment of your patient. using BLUE pen
for normal findings and RED for abnormal findings under Review of Systems (ROS).
3. Develop a Concept Map of your patient’s condition using the Concept Map Form.
4. Present your drug study and IVF data.
5. Before administering a patient’s medications, you are required to make a drug study of
all medications required by your patient in oral or parenteral form and document it.
6. Formulate a patient-centered care plan for your patient based on his top 3 prioritized
problems. Integrate into your care intervention significant bioethical and legal standards
of patient care.
7. Document the care given by making a nurse documentation following the FDAR format.
8. Clinical Reasoning Questions

Communication: Using ISBAR as a model for structured clinical communication and ensure
accurate handover of information between health care professionals, write down your physician
referral report for the estimated blood loss of 700 ccs, six hours after delivery and be guided by
the following questions:

 Identify: Identify yourself, who you are talking to, and who you are talking about
 Situation: What is the current situation, concerns, observations, etc.
 Background: What is the relevant background information? This helps to set the scenario
to interpret the situation accurately
 Assessment: What do you think the problem is? This requires the interpretation of the
situation and background information to make an educated conclusion about what is going
on
 Recommendation: What do you need them to do? What do you recommend should be
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done to correct the current situation?

Reference: http://www.inmo.ie/tempDocs/ISBAR

Collaboration: Narda was worried that she might never portray the role of being a good mom. She
gave birth to a 39 weeks AOG baby girl but small for gestational age and believed that it was her
doing of not complying with the prenatal medical regimen and working in a factory. Days after
delivery, upon learning that her baby’s condition should be monitored in the NICU, she started to
feel sad, overwhelmed, and consistently tearful. She frequently felt irritable and would never talk to
her husband, and just kept blaming herself. Her husband shows unwavering support by making sure
the necessity of the requirement as to the health care needs of their baby is prioritized. the
Pediatrician tells them that the baby was diagnosed with Sepsis and needs to be administered
antibiotics. After knowing her baby’s condition, Narda felt guilty, and feels inadequate as a mother,
stating“I was reckless when I had her, I should not be a mom”. “Whatever happens to my baby, I
should be responsible”, while weeping with tears. What will be the response of the nurse when
hearing this statement from a postpartum patient? What is the responsibility of the health caregiver
in a situation like this?

Ethico-Moral-Legal: Decision making in the field of bioethics has become increasingly complex.
Faced with complexity, it is generally accepted that many issues are far too many important to
be left to individual preference. In different situations, a particular principle may assume a
greater or lesser priority.

A woman who chooses not to keep her child

Leonor, a 20-year-old single got pregnant and delivered just recently. “This pregnancy is unplanned.
My partner refused to support my baby and I am not ready to assume responsibility of parenthood”,
she narrated. “Besides I don’t want to raise a child alone.” “I realized that I have to finish my studies,
pursue a career, then settle.”.Leondra is also afraid of her parents and of what other people may say.
During pregnancy and until labor, she has decided to keep the baby. Not until she gave birth, she
had this ambivalent feeling whether to keep the baby or not. After weighing things, though very
hard to let go of her child, finally she has decided to surrender her child for adoption.
Are you going to attempt to change a woman’s mind about keeping her child or placing the child for
adoption? Why or why not. What would be your nursing action? What ethical principle is applicable
in this scenario? Justify?

DESTINATION CHECK

You are nearly done with your module! Before we end, let us check what you have learned so far
and touch on the topics which have been discussed before but may not have been covered in
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program
the questions asked so far. [Answer in a separate sheet]
A. Discharge Instruction. List the discharge instructions that should be included.
1. In addition, you will also give instructions on the following area: What are you
going to include on instructions on Work, Rest, Hygiene, Coitus, and
Contraception.

2. Nursing Care of a Postpartal woman and Family with unique needs

According to Jean Watson Caring is the essence of Nursing. What important Nursing Care
to the following postpartum woman and family with unique needs you will provide.

Situation A: A Woman who is discharged but whose child remains hospitalized

1. Patricia, an obese, multiparous woman at 40 weeks gestation has just given birth to a
male infant who weighed 2 kilograms at birth. His APGAR score is 5 and 7. Her baby
needs monitoring. After 3 days in the hospital, Patricia is ready for discharge. She
was informed that the baby is having difficulty breathing, RR is 70, there is nasal
flaring, expiratory grunting with his breathing. Presently her baby is being gavaged
because he is too lethargic to latch on and suck effectively. Her baby is also receiving
oxygen. The pediatrician decided to place the baby with respiratory distress in the
neonatal intensive care unit. Present nursing care that will help Patricia and her family
overcome this unexpected outcome of pregnancy.

Situation B: A family who is adopting a child

2. Jia and Joe are married for 10 years. The couple is experiencing issues with infertility
and is childless. The couple consulted different fertility clinics. Jia even tried dancing
in the streets of Obando, Bulacan, dancing to the tune of “Sta. Clara, Pinong Pino”.
This is a fertility dance that serves as a form of prayer for couples who are hoping to
conceive a child or who had struggled for years to have children. The couple hopes
for the same for themselves. Jia wasn’t able to conceive despite their “panata”. Until
lately, the couple realized that it's not wrong to adopt a child. The couple went to
DSWD for assessment, counseling, and evaluation. Finally, the couple was qualified
and granted a permit to adopt. What nursing care applies to these adoptive parents?

Have you answered all of the questions above? Great! You are now ready for the
weekly quiz.
 Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

REFLECTION TIME

Reflection Time: You were given a normal postpartum patient but eventually develop
postpartum complications such as postpartum hemorrhage, puerperal infection, and exhibit
symptoms of “postpartum blues”. What then is your realization of this scenario as a future nurse?
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Congratulations! You have completed this module. You may now proceed to the next module.
Please wait for further instructions from you instructor

References:
Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier & Erb’s fundamentals of nursing: Concepts,
process, and practice (10th ed.). Pearson Education, Inc.

Silbert-Flagg, J., & Pillitteri, A. (2017). Maternal and child health nursing: Care of the childbearing
and childrearing family (8th ed.). Retrieved from https://b-ok.asia/book/5009747/63990c

Marieb, E., & Keller, S. (2017). Essentials of human anatomy & physiology (12th ed.). Retrieved
from https://bok.asia/book/5010929/ac07d2

Quigley, B., Palm, M.L., & Bickley, L. (2012). Bates’ nursing guide to physical examination and
history taking (1st ed.). Wolters Kluwer Health
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

Concept Mapping
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

 Use the DDC form for drug studies. Drugs will be assigned by the clinical instructor
according to the concept of the rotation
 Must contain the following:
o Generic Name
o Brand Name
o Classification
o Mode of Action
o Indications
o Contraindications
o Side Effects (organized per system; cephalocaudal)
o Adverse Effects (per system; cephalocaudal)
o Dosage
o Nursing considerations
o Reference(s) – Follow APA 7e format
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program