NCM 107 Learning Plan Intrapartal Third Rotation

NCM 107
CARE OF MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS)
RELATED LEARNING EXPERIENCE
LEARNING PLAN
RLE Focus: INTRAPARTAL CARE
Course Code: NCM 107

Course Title: Care of Mother, Child and Adolescent (Well Clients)
Placement: Level II, S.Y. 2022 – 2023, First Semester
Clinical Area of Skills Laboratory, Community and Hospital (Labor
Assignment: Room / Delivery Room / Birthing Clinics)
Date of Clinical Exposure: October 21, 22, 28, 29, 2022 (II – C)
October 22, 23, 29, 30, 2022 (II – D)
Number of Hours: 30 hours
Overview
This course deals with principles and techniques of caring for the normal mothers,
infants, children and family and the application of principles and concepts on family and
family health nursing process.
The students are expected to utilize the nursing process in the management of
individuals, families and community in varied settings. Students are likewise expected to
observe core values and nursing standards in the care of clients. Learning
Activities
PRE-CONFERENCE
For this two – week clinical rotation, you will be providing nursing
care to a childbearing woman during the labor and delivery
process. Having gone through with the theoretical inputs, the
next step is the application of these principles and techniques in
the nursing care of these clients through a case analysis and
performance of nursing skills needed during the intrapartal
period.
School of Nursing | NCM 107 - Related Learning Experience | Intrapartal Care | Prof. AJ Cabulagan
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LEARNING MAP
At the end of this three – week related learning exposure, you are
expected to:
1) Understand the clinical picture of a childbearing woman

during the labor and delivery process;
2) Perform comprehensive maternal and fetal assessment
basing from the case scenario provided;
3) Utilize the nursing process in the care of a childbearing
woman during the labor and delivery process;
4) Explain diagnostic and laboratory procedures and other
related medical management during the labor and delivery
process;
5) Familiarize pharmacological agents and/or treatments
during intrapartal period;
6) Formulate, together with the client and family, nursing care

plans that address the identified priority needs or
problems;
7) Use critical thinking in the delivery of quality nursing care
for culturally diverse intrapartal clients;
8) Effectively recognize and intervene when complications
arise;
9) Evaluate expected outcomes of nursing care for intrapartal
clients.
through accurate nursing documentation.
CLINICAL ENGAGEMENT REMINDERS
In your provision of nursing care, you are reminded of the

following activities:
Professional Behaviors – engage appropriate legal and

ethical behaviors;
Communication – communicate effectively with your
patient, significant other and the health team;
Critical Thinking Skills – develop clinical decision-making
skills in client care;
Caring Interventions – provide culturally competent and
sensitive care;
Teaching and Learning – provide health education to
patient and significant other;
Collaboration – plan care in partnership with the patient
and family.
As you start for this clinical rotation, you are reminded to consult
and coordinate with your assigned Clinical Instructor. Just keep
going!!! You can do it!!!
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RECAPITULATION
Before we proceed, let’s have a review of the following basic

concepts and see how much do you recall. Check on the
following patients and identify whether their concerns are
intrapartal-related or not. Put a check if the following complaints
of the patients are involved during the intrapartal period and
cross
(x) if it is not.
_________ Patient A: amenorrhea for two consecutive months

_________ Patient B: moderate, foul lochia rubra
_________ Patient C: schedule for second dose of tetanus toxoid
_________ Patient D: tolerable labor pains
_________ Patient E: fully dilated and effaced cervix
EXPLORE
For the next 30 hours of this related learning experience, you are
assigned at the Labor and Delivery Rooms of Mariano Marcos
Memorial Hospital and Medical Center with the following foci:
Utilization of the Nursing Process in Care of a Childbearing

Woman during the Labor and Delivery Process
(Assessment, Diagnosis, Planning, Implementation and
Evaluation)
Holistic Nursing Care (through history taking, assessment,

and health teaching)
- Routine Admission Care
- Familiarization of Nursing Functions in the Labor
and Delivery Rooms
Documentation of Care
Prepare yourself as you meet your patient in this clinical rotation.

Please don’t forget to establish rapport with her.
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You are having your clinical exposure at the Mariano Marcos Memorial Hospital and
Medical Center for the intrapartal concept, 7:00 AM to 2:30 PM. You are assigned to
care for Mrs. Santos, G2P1, who has just been admitted this morning. Accompanied
by her husband, she came in to the Emergency Room complaining of labor pains
which she further characterized as contractions occurring at regular intervals, but the
interval between each contraction gradually becomes shorter, duration of each
contraction gradually increases and the intensity of contractions becomes stronger
and stronger.
Based on your interview, her last menstrual period is January 8, 2022. With this, the
OB-Gyne on Duty asked you to compute for the following: EDC and AOG (in weeks).
She had previous prenatal visits at the OPD of MMMH-MC and was given Ferrous
Fumarate + Folic Acid as her prenatal vitamin taken once a day. No significant familial
disease was traced. No co-morbidities noted.
Facial grimaces, guarding behavior and positioning of comfort were noted. She further
verbalized,
“kastaunay sakit toy panagpasikal iti buksit ko; panay-panay iti panagpatangken nan.”
She was immediately placed in the IE Room for assessment. The following
assessment findings were noted:
Initial Vital Signs:

BP = 130/90 mmHg, PR = 98 beats per minute, RR=20 breaths per minute,
Temp = 36.8 o C
Fundic Height: 30 centimeters
FHT: 138 beats per minute located in the left lower quadrant (LLQ)
IE revealed: 5 cm cervical dilatation, 50% effaced, cephalic in presentation,
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NCM 107
intact bag of water (BOW)
She was directly admitted to the Labor Room at 9:00 AM with the following doctor’s
orders:
ADMISSION ORDERS
Admitting Diagnosis: G2P1 (1001) PU 38 4/7 weeks AOG CIL
October 6, 2022 @ 9:00 AM
➢ Admit to LR - DR
➢ Secure consent for admission and management
➢ DAT the NPO once with active labor ➢ TPR q shift
➢ Diagnostics:
- Complete Blood Count (CBC)
- ABO Typing
- Urinalysis (U/A)
- HbSAg with RPR ➢ Therapeutics:
- Hook D5LR 1L x 12 hours
- HNBB 10mg – 1 amp IV q 1o for 6 doses
➢ Hook to CTG, refer tracing STAT
➢ Monitor V/S, POL and FHT
➢ Refer accordingly
CJ CRUZ, MD, FPOGS, FPSMS

Obstetrician – Gynecologist
License No. 012345
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NCM 107
At 1:00 PM, she was re-examined with the following findings:
Vital Signs:
BP = 140/80 mmHg, PR = 95 beats per minute, RR=25 breaths per minute,
Temp = 36.8 o C
FHT: 155 beats per minute located in the left lower quadrant (LLQ)
IE revealed: 7 cm cervical dilatation, 70% effaced, cephalic in presentation,
leaking bag of water
(BOW)
At 3:30 PM, the patient shouted due to severe pain, “saan ko kaya iti sakit nan”. The
Resident on-Duty performed an internal examination and revealed fully dilated and
fully effaced cervix. Leaking bag of water was also noted. She ordered for an
immediate transfer of the patient to the Delivery Room.
You placed the patient on the delivery table and assisted to lithotomy position. You
prepared the needed instruments, materials and supplies for the delivery. You
instructed the mother to push effectively to facilitate easier expulsion of the baby. The
doctor applied perineal support and subsequently did right mediolateral episiotomy
(RMLE) to the patient’s perineum. While waiting for the complete delivery of the baby,
the doctor is teaching you evidence-based nursing practices in the area and at the
same time you asking some questions related to labor and delivery.
After few minutes, a baby boy has been delivered followed by the delivery of the
placenta. Oxytocin 10 units was given intramuscularly at the right deltoid of the
mother. Another 10 units of oxytocin was incorporated to the ongoing intravenous
fluid of the patient as ordered by the physician. Repair (suturing) of the RMLE was
done. Perineal care rendered. Estimated blood loss during the procedure is
approximately 100-200 cc. Latest assessment findings were taken at 4:30 PM as
follows:
Vital Signs:
BP = 120/80 mmHg, PR = 95 beats per minute, RR= 19 breaths per minute,
Temp = 37 o C With well-contracted uterus
Minimal vaginal bleeding
The procedure was well – tolerated by the patient and now ready for transport to the
recovery room.
For you to be able to immerse yourself in the simulation, watch the following video
presentations:
▪ The Birth: Labor, Delivery & Early Postpartum - Childbirth Series (by Global
Health Media Project):
https://www.youtube.com/watch?v=VHcej771Afg
▪ Unang Yakap (Essential Newborn Care) – by the Department of Health
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NCM 107
DESTINATION CHECK
To immerse yourself in the nursing care management of your

patient in this virtual related learning experience, here are the
detailed description of your tasks in this clinical rotation.
1) Based from the case scenario provided, you will have a

simulation exercise in the accomplishment of clinical
forms.
▪ Labor Record
▪ Partograph
▪ Summary of Parturition
▪ Doctors Order Sheet
▪ Intravenous Fluid Flow Sheet
▪ Medication Sheet (Oral and Parenteral)
▪ Template of Medication Cards
▪ Vital Signs Graphic Sheet
▪ Record of Intake and Output (Hypothetical)
▪ Nurses Progress Notes (FDAR)
✓ Admission Charting
✓ Delivery Room Charting
▪ Laboratory Request Form
2) Basing from the doctor’s order in the case scenario, make

a detailed written output on the following:
▪ Diagnostic and Laboratory Procedures (CBC, ABO
Typing, Urinalysis, HbSAg, RPR)
▪ Drug Study (oxytocin and HNBB)
3) Formulate a patient-centered care plan for the patient

based on his three
(3) prioritized problems. Use the prescribed format.
Prepared by:
ARIEL JAMES C. CABULAGAN, RN, MAN

Clinical Instructor
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NCM 107
DIAGNOSTIC AND LABORATORY PROCEDURES

TEMPLATE
Diagnostic or Laboratory Procedure:

Description:
Date Ordered:
Indication: (why is it being ordered to the patient?)
Nursing Responsibilities Rationale
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DRUG STUDY TEMPLATE
Name: __________________________________ Course / Year / Section / RLE Group:

__________
Generic Name:
Brand Name:
Dosage / Route /
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NCM 107
Frequency:
Pharmacologic
Classification:
Physiologic
Classification:
Mechanism of Action:
Indication:
Desired Effect:
Contraindication:
Side Effects:
Adverse Effects:
Nursing Responsibilities Rationale
NURSING CARE PLAN TEMPLATE
Name: __________________________________ Course / Year / Section / RLE Group:

__________
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NCM 107
Nursing Assessment:
▪ Subjective:
______________________________________________________________
______________
▪ Objective:
______________________________________________________________
______________
______________________________________________________________
______________
List of Nursing Diagnosis: (at least 3)
1) ______________________________________________________________
______________
2) ______________________________________________________________
______________ 3)
_________________________________________________________________
___________
Nursing Diagnosis (PES Format):

▪ Problem:
▪ Etiology:
▪ Signs and Symptoms:
Nursing Inference:
Nursing Goal (Outcome):
Nursing Interventions Rationale
Nursing Evaluation:
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DOCTOR’S ORDER SHEET

Patient’s Name: Hospital Number:
Age: Sex: Civil Status: Ward/Room:
PROGRES ACTIO TIME /

ORDER
S NOTES N SIG
October 6, 2021 @ 8:30 AM
(+) labor
➢ Admit to LR - DR
pains
➢ Secure consent for admission and management
4 cm cervical ➢ DAT the NPO once with active labor
dilatation
➢ TPR q shift
50% effaced ➢ Diagnostics:
BP 130/90 - Complete Blood Count (CBC)
- ABO Typing
Cephalic in
labor - Urinalysis (U/A)
- HbSAg with RPR
(+) BOW
➢ Therapeutics:
- Hook D5LR 1L x 12 hours
- HNBB 10mg – 1 amp IV q 1o for 6 doses
➢ Hook to CTG, refer tracing STAT
➢ Monitor V/S, POL and FHT
➢ Refer accordingly
CJ CRUZ, MD, FPOGS, FPSMS

Obstetrician – Gynecologist
License No. 012345
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NCM 107
INTRAVENOUS FLUID FLOW SHEET

Patient’s Name: Hospital Number:
Age: Sex: Civil Status: Ward/Room:
I.V. Type of Flow

Fluid Cannula Rate and
Bottle Date Type of or Infusion
Date and
No. and Nurse’s I.V. Drug Needle Device Nurse’s
Time Remarks
Time Signature Fluid & Additives and Signature
Consumed
Started Volume Location
of
Insertion
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NCM 107
MEDICATION SHEET (ORAL)
Surname: Age: Hospital Number:

Given Name: MI: Sex: Ward/Room:
Date
Date/Time Medication
Ordered Dosage/Route/Frequency Shift Time Sig Tim Sig Time Sig
e
7-3
3-11
11-7
7-3
3-11
11-7
7-3
3-11
11-7
7-3
3-11
11-7
7-3
3-11
11-7
7-3
3-11
11-7
7-3
3-11
11-7
7-3
3-11
11-7
7-3
3-11
11-7
7-3
3-11
11-7
7-3
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NCM 107
3-11
Treatment 11-7
7-3
3-11
11-7
Breakfast
Diet Lunch
Dinner
MEDICATION SHEET (IV)

Date
Date/Time Medication
Ordered Dosage/Route/Frequency Shift Time Sig Tim Sig Time Sig
e
7-3
3-11
11-7
7-3
3-11
11-7
7-3
3-11
11-7
7-3
3-11
11-7
7-3
3-11
11-7
7-3
3-11
11-7
7-3
3-11
11-7
7-3
3-11
11-7
7-3
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NCM 107
3-11
11-7
7-3
3-11
11-7
7-3
3-11
Treatment
11-7
7-3
3-11
11-7
Breakfast
Diet Lunch
Dinner
VITAL SIGNS GRAPHIC SHEET

(TPR SHEET)

Days of the Month

No. of Days in Hospital
Height / Weight
RESP PULSE TEMP
42
41
180 40
39
160 38
37
140 36
35
120
100
60
50 80
40
30 60
20
10
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SHIFT BP U S BP U S BP U S BP U S
7-3
3-11
11-7
RECORD FLUID INTAKE AND OUTPUT

SECR
DAT SHIF CLYSI BLOO ORA TOTA URIN VOMITOU OTHER TOTA
E S
E T S D L L E S L
TIONS
TOTA
L
TOTA
L
TOTA
L
TOTA
L
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TOTA
L
TOTA
L
TOTA
L
TOTA
L
TOTA
L
TOTA
L
TOTA
L
NURSES PROGRESS NOTES

DATE &
FOCUS DATA ACTION RESPONSE
TIME
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LABORATORY REQUEST FORM

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HEMATOLOGY Total Cell Count PANCREATIC PROFILE HEPATITIS C
Complete Blood Count Differential Count Amylase Anti-HCV Screening
Hemoglobin Glucose Lipase Anti-HCV ECLIA/EIA
Hematocrit Protein LIPID PROFILE THYROID FUNCTION TEST
Platelet count LDH Total Cholesterol T3
Clotting Time CLINICAL CHEMISTRY Triglyceride T4
Bleeding Time BONE/ JOINT ARTHRITIS TEST HDL- Cholesterol FT3
Clot Retraction Time Blood Uric Acid LDL – Cholesterol FT4
ABO-Rh Typing Rheumatoid Factor LIVER FUNCTION PROFILE TSH
COAGULATION STUDIES CARDIAC MARKERS Total Protein TUMOR MARKERS
Prothrombin Time AST/SGOT Albumin AFP
APTT CK-MB Direct Bilirubin Beta-HCG
Fibrinogen Trop-T quantitative Total Bilirubin CEA
ANEMIA WORK UP Trop-I quantitative TEST FOR LIVER INJURY CA 19-9
Iron DIABETIC PROFILE AST/SGOT PSA
Total Iron Binding Capacity Fasting Blood Sugar/ FBS ALT/ SGPT CA 125
Unsaturated Iron Binding Random Blood Sugar/ RBS Alkaline Phosphatase/ALP SLE WORK-UP
Capacity
Folate OGTT _____75 g LDH Anti-Nuclear Antibody
_____100 g
Ferritin OGCT _____ 50g _____75 SEROLOGY/ IMMUNOLOGY SYPHILIS WORK UP
g
BLOOD BANKING HbA1C DENGUE WORK UP Anti T. pallidum rapid test
Direct Coomb’s test 2-HR Post-Prandial Blood Sugar DENGUE NS1 Antigen TPHA
Indirect Coob’s test Insulin Dengue IgG/IgM
DRUG TESTING Urine Ketone HIV TESTING OTHER TEST AVAILABLE

LABORATORY
Cannabinoids ELECTROLYTES Anti-HIV-1/ HIV-2 Complement3 (C3)
Screening/Rapid
Methamphetamine Sodium Anti-HIV-1/ HIV-2 EIA C-Reactive Protein
A.U.B.F./ PARASITOLOGY Potassium HEPATITIS VIRUS INFECTION Anti-streptolysin O (ASO)
MARKERS
24-h Urine HCG Titer ___Ionized/ ____Total Calcium HEPATITIS A Salmonella IgG/IgM
Pregnancy test Chloride
Routine stool examination Magnesium
Routine Urinalysis Phosphorous
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NCM 107 Learning Plan Intrapartal Third Rotation

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NCM 107

CARE OF MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS)

RELATED LEARNING EXPERIENCE

Course Code: NCM 107

RELATED LEARNING EXPERIENCE

1) Understand the clinical picture of a childbearing woman

6) Formulate, together with the client and family, nursing care

CLINICAL ENGAGEMENT REMINDERS

In your provision of nursing care, you are reminded of the

Professional Behaviors – engage appropriate legal and

RELATED LEARNING EXPERIENCE

Before we proceed, let’s have a review of the following basic

_________ Patient A: amenorrhea for two consecutive months

Utilization of the Nursing Process in Care of a Childbearing

Holistic Nursing Care (through history taking, assessment,

Prepare yourself as you meet your patient in this clinical rotation.

RELATED LEARNING EXPERIENCE

Initial Vital Signs:

RELATED LEARNING EXPERIENCE

intact bag of water (BOW)

October 6, 2022 @ 9:00 AM

CJ CRUZ, MD, FPOGS, FPSMS

RELATED LEARNING EXPERIENCE

At 1:00 PM, she was re-examined with the following findings:

▪ Unang Yakap (Essential Newborn Care) – by the Department of Health

RELATED LEARNING EXPERIENCE

To immerse yourself in the nursing care management of your

1) Based from the case scenario provided, you will have a

2) Basing from the doctor’s order in the case scenario, make

3) Formulate a patient-centered care plan for the patient

ARIEL JAMES C. CABULAGAN, RN, MAN

RELATED LEARNING EXPERIENCE

DIAGNOSTIC AND LABORATORY PROCEDURES

Diagnostic or Laboratory Procedure:

Nursing Responsibilities Rationale

RELATED LEARNING EXPERIENCE

DRUG STUDY TEMPLATE

Name: __________________________________ Course / Year / Section / RLE Group:

RELATED LEARNING EXPERIENCE

Nursing Responsibilities Rationale

NURSING CARE PLAN TEMPLATE

Name: __________________________________ Course / Year / Section / RLE Group:

RELATED LEARNING EXPERIENCE

List of Nursing Diagnosis: (at least 3)

Nursing Diagnosis (PES Format):

Nursing Goal (Outcome):

Nursing Interventions Rationale

RELATED LEARNING EXPERIENCE

RELATED LEARNING EXPERIENCE

RELATED LEARNING EXPERIENCE

RELATED LEARNING EXPERIENCE

RELATED LEARNING EXPERIENCE

RELATED LEARNING EXPERIENCE

RELATED LEARNING EXPERIENCE

DOCTOR’S ORDER SHEET

PROGRES ACTIO TIME /

CJ CRUZ, MD, FPOGS, FPSMS

RELATED LEARNING EXPERIENCE

INTRAVENOUS FLUID FLOW SHEET

I.V. Type of Flow

RELATED LEARNING EXPERIENCE

MEDICATION SHEET (ORAL)