CASE SCENARIO NO.

2:
SECOND TRIMESTER PREPARTUM
CLINIC VISIT
BSN 2B GROUP 4

NCM 107 RLE

TABLE OF CONTENTS

01 03 05
INTRODUCTION NURSING HEALTH ANATOMY AND
HISTORY PHYSIOLOGY

02 04 06
OBJECTIVES PHYSICAL DIAGNOSTIC AND
EXAMINATION LABORATORY
TABLE OF CONTENTS

07
NURSING CARE
PLAN

08
DISCHARGE PLAN
AND HEALTH
TEACHING
INTRODUCTION
THE SECOND TRIMESTER OF PREGNANCY IS USUALLY THE MOST
COMFORTABLE FOR PREGNANT WOMEN. YOU WILL START TO NOTICE
YOUR BABY GROWING RAPIDLY IN THE SECOND TRIMESTER. DIFFICULTIES
MIGHT ARISE, AND CERTAIN WOMEN MAY EXPERIENCE SPECIFIC ISSUES.

BACK ACHES AND PAINS DURING PREGNANCY CAN BE BROUGHT ON BY AN

INCREASE IN HORMONE LEVELS, POSTURE CHANGES, WEIGHT GROWTH,
MUSCLE SEPARATION, AND PHYSICAL STRESS. AFTER GIVING BIRTH, BACK
PAIN CAUSED BY PREGNANCY TYPICALLY GOES AWAY ON ITS OWN.
PHYSICAL THERAPY OR MEDICAL ATTENTION MAY BE NECESSARY FOR
SEVERE BACK PAIN THAT PERSISTS FOR MORE THAN TWO WEEKS.

PREGNANCY CONTRACTIONS REFER TO THE TIGHTNESS AND HARDNESS

OF THE UTERINE MUSCLES FOR 30 TO 70 SECONDS. BEFORE YOU START
EXPERIENCING CONTRACTIONS, DISCUSS YOUR EXPECTATIONS WITH
YOUR DOCTOR. FIND OUT THE SYMPTOMS OF LABOR AND THE
DISTINCTION BETWEEN ACTUAL AND BRAXTON HICKS CONTRACTIONS.
CONSTIPATION DURING PREGNANCY IS CAUSED BY AN INCREASE IN
PROGESTERONE HORMONES, WHICH RELAX THE INTESTINAL MUSCLE AND INHIBIT
THE PASSAGE OF FOOD AND WASTE THROUGH YOUR SYSTEM. IRON
SUPPLEMENTS MAY OCCASIONALLY CAUSE CONSTIPATION. IN ADDITION TO
HORMONAL CHANGES, STRAIN ON THE RECTUM BROUGHT ON BY PRESSURE ON
THE LOWER PART OF THE FETUS ALSO CONTRIBUTES TO THE DIFFICULTY IN
DEFECATING THAT PREGNANT WOMEN EXPERIENCE FREQUENTLY. IF YOU ARE
TAKING IRON SUPPLEMENTS, BE SURE YOU ARE GETTING ENOUGH WATER.

ONE OF THE FIRST INDICATIONS OF PREGNANCY MAY BE AN INCREASE IN VAGINAL

DISCHARGE. LEUKORRHEA, THE MEDICAL TERM FOR REGULAR VAGINAL
DISCHARGE, IS A CLEAR OR MILKY-WHITE DISCHARGE WITH A FAINT OR NO ODOR.
BECAUSE OF INCREASED BLOOD FLOW TO THE VAGINAL REGION AND ENHANCED
ESTROGEN LEVELS, VAGINAL DISCHARGE INCREASES DURING PREGNANCY.

YOUR BODY'S HORMONES ARE PRIMARILY TO BLAME FOR YOUR CONTINUED

DIFFICULTY IN BREATHING ALSO KNOWN AS DYSPNEA. BREATHING YOUR LUNGS'
CAPILLARIES WILL ENLARGE WHILE THE MUSCLES AROUND THEM RELAX.
BREATHLESSNESS IS OFTEN NOT A CAUSE FOR CONCERN. BUT SINCE VARIOUS
UNDERLYING CONDITIONS MIGHT CAUSE SHORTNESS OF BREATH, IT IS BEST TO
CONSULT YOUR DOCTOR.
OBJECTIVES
 GENERAL OBJECTIVES

THIS CASE STUDY WILL SERVE AS A GUIDE FOR NURSING

STUDENTS, TO RENDER EFFECTIVE NURSING CARE WITH
RIGHT ATTITUDE TOWARDS THE PATIENT.

SPECIFIC OBJECTIVES

KNOWLEDGE
1. IDENTIFY THE SIGNS AND SYMPTOMS OF THE CONDITION
AND ITS CONTRIBUTING FACTORS.
2. RECOGNIZE THE ROLE OF DRUG THERAPY AND ITS
CONNECTION IN ALLEVIATING THE PATIENT’S CONDITION.
3. DISCUSS THE ANATOMY AND PHYSIOLOGY OF FEMALE
REPRODUCTIVE SYSTEM.
SKILLS
1. IMPLEMENT NURSING CARE TO THE PATIENT.
2. APPLY NURSING INTERVENTIONS TO BE IMPLEMENTED
FOR THE PATIENT’S WELLNESS AND RECOVERY.
3. IDENTIFY THE BEST NURSING DIAGNOSIS REQUIRED IN
THEMANAGEMENT OF THE PATIENT’S CONDITION.
ATTITUDES
1. SHOW EMPATHY TO ASSESS SOCIAL CUES AND VITAL
SIGNS TO BETTER UNDERSTAND THEIR NEEDS.
2. ESTABLISH RAPPORT WITH CLIENT AS WELL AS THEIR
FAMILY TO ELICIT MORE RELEVANT INFORMATION
REGARDING THEIR CONDITION.
3. RECOGNIZE THE CLIENT’S FEELINGS AND WORRIES
REGARDING THE CONDITION AND PROMOTE POSITIVE
RESPONSE TOWARDS IT.
NURSING
HEALTH
HISTORY
A. BIOGRAPHIC DATA

PATIENT’S NAME: A.R.

ADDRESS: N/A
AGE: 22 YEARS OLD
SEX: FEMALE
MARITAL STATUS: SINGLE
OCCUPATION: N/A
RELIGION: N/A
SOURCE OF INFORMATION: PATIENT HERSELF
ATTENDING PHYSICIAN: N/A
DATE OF ADMISSION: N/A
TIME OF ADMISSION: N/A
CHIEF COMPLAINT: LOWER BACKACHES AND
PAINS
B. CHIEF COMPLAINT
LOWER BACK ACHES AND PAINS

C. HISTORY OF PRESENT ILLNESS

SHE COMPLAINED OF HAVING LOWER BACKACHES AND
PAINS. SHE ALSO EXPERIENCED PAINLESS CONTRACTIONS
OVER HER ABDOMEN BUT GOES AWAY AT SOME POINT. SHE
MENTIONED THAT, AT TIMES, SHE IS CONSTIPATED AND HAS
THE DIFFICULTY IN DEFECATING. SHE REPORTED THAT HER
VAGINAL SECTIONS INCREASED WHICH ARE WHITE IN
COLOR. BECAUSE HER ABDOMEN IS SLOWLY GROWING, SHE
FEELS AS IF SHE IS LOSING HER BREATH WHILE MOVING
ABOUT.
D. PAST MEDICAL HISTORY
THE PATIENT HAS A HISTORY OF CHICKENPOX WHEN SHE WAS 12 YEARS
OLD. SHE HAS NO HISTORY OF ADMISSION, ANY RESPIRATORY ILLNESSES,
TB, HEART DISEASE, DM, AND HPN. THE PATIENT ALSO HAS A FAMILY
HISTORY OF ASTHMA (FATHER), HYPERTENSION (MOTHER), AND NO
FAMILY HISTORY OF MENTAL ILLNESSES AND CANCER.
E. OBSTETRIC HISTORY
PATIENT’S MENARCHE STARTED AT 12 YEARS OLD ON A 28 DAYS CYCLE.
5 DAYS DURATION USING 2 MENSTRUAL PADS A DAY. DYSMENORRHEA IS
USUALLY EXPERIENCED DURING MONTHLY MENSTRUAL BLEEDING BUT
IT IS TOLERATED.
F. LIFESTYLE AND HEALTH PRACTICES
FOR THE DIET, THE PATIENT TAKES 3 COMPLETE MEALS A DAY. DIET
CONSISTS OF VEGETABLES, FISH, AND FRUITS LIKE BANANA. EATS
CHICKEN AND MEAT BUT NOT ON A DAILY BASIS. DRINKS 1 CUP OF
COFFEE DURING BREAKFAST. THE PATIENT IS A NON-SMOKER AND DOES
NOT DRINK ALCOHOL.
 PHYSICAL
EXAMINATION
A HEAD-TO-TOE PHYSICAL EXAMINATION OF
CLIENT A.R. WAS CONDUCTED. THE RESULTS
SHOWED NORMAL FINDINGS.
DURING THE PHYSICAL EXAMINATION, THE
CLIENT'S VITAL SIGNS WERE TAKEN AND THE
RESULTS ARE: BLOOD PRESSURE=130/70 MMHG,
PULSE RATE= 87 BPM, RESPIRATORY RATE= 24 CPM
AND TEMPERATURE= 36.5°C.
 ANATOMY
AND
PHYSIOLOGY
 THE SECOND TRIMESTER:
CHANGES TO YOUR BODY

THE SECOND TRIMESTER IS THE MOST

PHYSICALLY ENJOYABLE FOR MOST WOMEN.
MORNING SICKNESS USUALLY LESSENS BY
THIS TIME, AND THE EXTREME TIREDNESS AND
BREAST TENDERNESS USUALLY EASE UP.
THESE CHANGES CAN BE ATTRIBUTED TO A
DECREASE IN LEVELS OF HUMAN CHORIONIC
GONADOTROPIN HORMONE AND AN
ADJUSTMENT TO THE LEVELS OF ESTROGEN
AND PROGESTERONE HORMONES.
YOUR FETUS HAS NOW DEVELOPED ALL ITS
ORGANS AND SYSTEMS AND WILL NOW BEGIN
GROWING IN LENGTH AND WEIGHT.
DURING THE SECOND TRIMESTER, THE UMBILICAL CORD
CONTINUES TO THICKEN AS IT CARRIES NOURISHMENT TO THE
FETUS. HOWEVER, HARMFUL SUBSTANCES ALSO PASS THROUGH
THE UMBILICAL CORD TO THE FETUS, SO CARE SHOULD BE TAKEN
TO AVOID ALCOHOL, TOBACCO AND OTHER KNOWN HAZARDS.

ESTROGEN LEVELS INCREASE STEADILY DURING PREGNANCY AND

REACH THEIR PEAK IN THE THIRD TRIMESTER. THE RAPID
INCREASE IN ESTROGEN LEVELS DURING THE FIRST TRIMESTER
MAY CAUSE SOME OF THE NAUSEA ASSOCIATED WITH
PREGNANCY. DURING THE SECOND TRIMESTER, IT PLAYS A MAJOR
ROLE IN THE MILK DUCT DEVELOPMENT THAT ENLARGES THE
BREASTS.

PROGESTERONE LEVELS ALSO ARE EXTRAORDINARILY HIGH

DURING PREGNANCY. THE CHANGES IN PROGESTERONE CAUSE A
LAXITY OR LOOSENING OF LIGAMENTS AND JOINTS THROUGHOUT
THE BODY.
SIGNS AND SYMPTOMS MENTIONED ON CASE STUDY 2
· ANDREA COMPLAINS ABOUT BACKACHE AND PAINS
(THE UTERUS GROWS TO THE HEIGHT OF THE BELLYBUTTON AROUND 20
WEEKS, MAKING THE PREGNANCY VISIBLE.)
(THE SKIN ON THE BELLY MAY ITCH AS IT GROWS, AND THERE MAY BE PAIN
DOWN THE SIDES OF THE BODY AS THE UTERUS STRETCHES. THE LOWER
STOMACH MAY ACHE AS LIGAMENTS STRETCH TO SUPPORT THE UTERUS.)

· PAINLESS CONTRACTIONS ON ABDOMEN

(THESE IRREGULAR UTERINE CONTRACTIONS ARE PERFECTLY NORMAL ALSO
KNOWN AS BRAXTON HICKS CONTRACTIONS AND MIGHT BEGIN IN YOUR
SECOND OR THIRD TRIMESTER. A CONTRACTION IS WHEN YOUR UTERUS
TIGHTENS AND THEN RELAXES.)
(IF FIRST PREGNANCY CAN BE FELT DURING 16TH WEEK)

· VAGINAL SECRETIONS
(YOU MIGHT NOTICE A STICKY, CLEAR OR WHITE VAGINAL DISCHARGE
ANDTHIS IS NORMAL (LEUKORRHEA). CONTACT YOUR HEALTH CARE
PROVIDER IF THE DISCHARGE BECOMES STRONG SMELLING, UNUSUAL IN
COLOR, OR IF IT'S ACCOMPANIED BY PAIN, SORENESS OR ITCHING IN YOUR
VAGINAL AREA. THIS COULD INDICATE A VAGINAL INFECTION.)
SIGNS AND SYMPTOMS MENTIONED ON CASE STUDY 2
· CONSTIPATED AND DIFFICULTY IN DEFECATING
(HORMONE LEVELS CAN AFFECT DIGESTION BEYOND SLOWING DOWN
BOWEL MOVEMENTS. BOWEL MOVEMENTS MIGHT BE PAINFUL OR
DIFFICULT, AND YOUR BELLY MIGHT SWELL. YOU MAY ALSO HAVE
HIGHER LEVELS OF IRON IF YOU’RE TAKING PRENATAL VITAMINS. HIGH
IRON LEVELS CAN CONTRIBUTE TO CONSTIPATION.)

· SHORTNESS OF BREATH
(THE GROWING UTERUS COMMONLY CONTRIBUTES TO SHORTNESS OF
BREATH IN THE SECOND TRIMESTER. HOWEVER, SOME CHANGES IN THE
WAY THE HEART FUNCTIONS CAN ALSO CAUSE BREATHLESSNESS. THE
AMOUNT OF BLOOD IN A PERSON’S BODY INCREASES SIGNIFICANTLY
DURING PREGNANCY. THE HEART HAS TO PUMP HARDER TO MOVE THIS
BLOOD THROUGH THE BODY AND TO THE PLACENTA. THE INCREASED
WORKLOAD ON THE HEART CAN MAKE A PREGNANT PERSON FEEL
SHORT OF BREATH.)
SIGNS AND SYMPTOMS MENTIONED ON CASE STUDY 2
· AUDIBLE FETAL HEART RATE 145BPM
(ONCE A WOMAN HAS REACHED HER SECOND TRIMESTER, HER BABY'S
HEARTBEAT WILL BE BETWEEN 110 TO 160 BPM AND CAN BE DETECTED
USING A DOPPLER DEVICE. IF THE DOCTOR HAS DISCOVERED AN
IRREGULAR HEARTBEAT, SUCH AS BEATING TOO SLOW OR TOO FAST,
THERE IS A CHANCE THAT THE BABY COULD HAVE A HEART CONDITION.)

· CEPHALIC PRESENTATION ROA

(THE RIGHT OCCIPUT ANTERIOR (ROA) PRESENTATION IS ALSO
COMMON IN LABOR. IN THIS POSITION, THE BACK OF THE BABY IS
SLIGHTLY OFF-CENTER IN THE PELVIS WITH THE BACK OF THE HEAD
TOWARD THE MOTHER'S RIGHT THIGH.)
 MOTHER DURING 2ND TRIMESTER

WHAT HAPPENS TO THE MOTHER'S BODY DURING THE SECOND

TRIMESTER OF PREGNANCY?

YOUR UTERUS — THE PLACE WHERE THE FETUS GROWS DURING

PREGNANCY — CONTINUES TO STRETCH. THIS ORGAN WILL EXPAND
THROUGHOUT YOUR PREGNANCY AS THE FETUS GETS LARGER. AFTER
PREGNANCY, YOUR UTERUS WILL RETURN TO ITS PRE-PREGNANCY
SIZE (PICTURE AN UPSIDE-DOWN PEAR).

HOWEVER, YOUR UTERUS ISN’T THE ONLY THING GROWING DURING

THE SECOND TRIMESTER EITHER. YOU’LL START GAINING WEIGHT
AND MIGHT START DEVELOPING THE TELL-TALE ENLARGED BELLY OF
A PREGNANT PERSON.
 MOTHER DURING 2ND TRIMESTER

WHAT HAPPENS TO THE MOTHER'S BODY DURING THE SECOND

TRIMESTER OF PREGNANCY?

YOU MIGHT ALSO FEEL OR DEVELOP A FEW NEW SYMPTOMS OF

PREGNANCY DURING YOUR SECOND TRIMESTER, INCLUDING:
· AN INCREASED APPETITE.
· AN ACHY BODY.
· SOME SWELLING IN YOUR HANDS, FEET AND ANKLES.
· SOME STRETCH MARKS.

IF YOU EXPERIENCED MORNING SICKNESS DURING YOUR FIRST

TRIMESTER, IT’S LIKELY FADING AWAY NOW. THE UNCOMFORTABLE
SYMPTOMS OF EARLY PREGNANCY (NAUSEA AND EXTREME FATIGUE,
FOR EXAMPLE) DON’T TYPICALLY CONTINUE INTO YOUR SECOND
TRIMESTER. THIS IS ONE REASON WHY MANY PEOPLE CONSIDER THEIR
SECOND TRIMESTER OF PREGNANCY TO BE THE BEST PART OF
PREGNANCY.
 FETUS DEVELOPMENT DURING 2ND TRIMESTER
WEEK 13: URINE FORMS

THIRTEEN WEEKS INTO YOUR PREGNANCY, OR 11 WEEKS AFTER CONCEPTION,

YOUR BABY IS BEGINNING TO MAKE URINE AND RELEASE IT INTO THE
SURROUNDING AMNIOTIC FLUID. YOUR BABY ALSO SWALLOWS SOME
AMNIOTIC FLUID.

BONES ARE BEGINNING TO HARDEN IN YOUR BABY'S SKELETON, ESPECIALLY IN

THE SKULL AND LONG BONES. YOUR BABY'S SKIN IS STILL THIN AND
TRANSPARENT, BUT IT WILL START TO THICKEN SOON.

WEEK 14: BABY'S SEX BECOMING APPARENT

FOURTEEN WEEKS INTO YOUR PREGNANCY, OR 12 WEEKS AFTER CONCEPTION,

YOUR BABY'S NECK HAS BECOME MORE DEFINED. RED BLOOD CELLS ARE
FORMING IN YOUR BABY'S SPLEEN.
YOUR BABY'S SEX WILL BECOME APPARENT THIS WEEK OR IN THE COMING
WEEKS.
BY NOW YOUR BABY MIGHT BE ALMOST 3 1/2 INCHES (87 MILLIMETERS) LONG
FROM CROWN TO RUMP AND WEIGH ABOUT 1 1/2 OUNCES (45 GRAMS).
 FETUS DEVELOPMENT DURING 2ND TRIMESTER
WEEK 15: BABY'S SCALP PATTERN DEVELOPS

FIFTEEN WEEKS INTO YOUR PREGNANCY, OR 13 WEEKS AFTER CONCEPTION,

YOUR BABY IS GROWING RAPIDLY. BONE DEVELOPMENT CONTINUES AND WILL
SOON BECOME VISIBLE ON ULTRASOUND IMAGES. YOUR BABY'S SCALP HAIR
PATTERN ALSO IS FORMING.

WEEK 16: BABY'S EYES MOVE

FETUS 14 WEEKS AFTER CONCEPTION

OPEN POP-UP DIALOG BOX
FETAL DEVELOPMENT 14 WEEKS AFTER CONCEPTION

SIXTEEN WEEKS INTO YOUR PREGNANCY, OR 14 WEEKS AFTER CONCEPTION,

YOUR BABY'S HEAD IS ERECT. HIS OR HER EYES CAN SLOWLY MOVE. THE EARS
ARE CLOSE TO REACHING THEIR FINAL POSITION. YOUR BABY'S SKIN IS
GETTING THICKER.
 FETUS DEVELOPMENT DURING 2ND TRIMESTER
YOUR BABY'S LIMB MOVEMENTS ARE BECOMING COORDINATED AND CAN BE
DETECTED DURING ULTRASOUND EXAMS. HOWEVER, THESE MOVEMENTS ARE
STILL TOO SLIGHT TO BE FELT BY YOU.

BY NOW YOUR BABY MIGHT BE MORE THAN 4 1/2 INCHES (120 MILLIMETERS)
LONG FROM CROWN TO RUMP AND WEIGH CLOSE TO 4 OUNCES (110 GRAMS).

WEEK 17: BABY'S TOENAILS DEVELOP

SEVENTEEN WEEKS INTO YOUR PREGNANCY, OR 15 WEEKS AFTER

CONCEPTION, TOENAILS BEGIN DEVELOPING.

YOUR BABY IS BECOMING MORE ACTIVE IN THE AMNIOTIC SAC, ROLLING AND
FLIPPING. HIS OR HER HEART IS PUMPING ABOUT 100 PINTS OF BLOOD EACH
DAY.
 FETUS DEVELOPMENT DURING 2ND TRIMESTER
WEEK 18: BABY BEGINS TO HEAR

EIGHTEEN WEEKS INTO YOUR PREGNANCY, OR 16 WEEKS AFTER CONCEPTION,

YOUR BABY'S EARS BEGIN TO STAND OUT ON THE SIDES OF HIS OR HER HEAD.
YOUR BABY MIGHT BEGIN TO HEAR SOUNDS. THE EYES ARE BEGINNING TO
FACE FORWARD. YOUR BABY'S DIGESTIVE SYSTEM HAS STARTED WORKING.
BY NOW YOUR BABY MIGHT BE 5 1/2 INCHES (140 MILLIMETERS) LONG FROM
CROWN TO RUMP AND WEIGH 7 OUNCES (200 GRAMS).

WEEK 19: BABY DEVELOPS PROTECTIVE COATING

NINETEEN WEEKS INTO YOUR PREGNANCY, OR 17 WEEKS AFTER CONCEPTION,

GROWTH SLOWS.
A GREASY, CHEESELIKE COATING CALLED VERNIX CASEOSA BEGINS TO COVER
YOUR BABY. THE VERNIX CASEOSA HELPS PROTECT YOUR BABY'S DELICATE
SKIN FROM ABRASIONS, CHAPPING AND HARDENING THAT CAN RESULT FROM
EXPOSURE TO AMNIOTIC FLUID.
FOR GIRLS, THE UTERUS AND VAGINAL CANAL ARE FORMING.
 FETUS DEVELOPMENT DURING 2ND TRIMESTER
WEEK 20: THE HALFWAY POINT

HALFWAY INTO YOUR PREGNANCY, OR 18 WEEKS AFTER CONCEPTION, YOU

MIGHT BE ABLE TO FEEL YOUR BABY'S MOVEMENTS (QUICKENING). YOUR BABY
IS REGULARLY SLEEPING AND WAKING. HE OR SHE MIGHT BE AWAKENED BY
NOISES OR YOUR MOVEMENTS.
BY NOW YOUR BABY MIGHT BE ABOUT 6 1/3 INCHES (160 MILLIMETERS) LONG
FROM CROWN TO RUMP AND WEIGH MORE THAN 11 OUNCES (320 GRAMS).

WEEK 21: BABY CAN SUCK HIS OR HER THUMB

FETUS 19 WEEKS AFTER CONCEPTION

OPEN POP-UP DIALOG BOX
FETAL DEVELOPMENT 19 WEEKS AFTER CONCEPTION
TWENTY-ONE WEEKS INTO YOUR PREGNANCY, OR 19 WEEKS AFTER
CONCEPTION, YOUR BABY IS COMPLETELY COVERED WITH A FINE, DOWNY
HAIR CALLED LANUGO. THE LANUGO HELPS HOLD THE VERNIX CASEOSA ON
THE SKIN.
THE SUCKING REFLEX ALSO IS DEVELOPING, ENABLING YOUR BABY TO SUCK
HIS OR HER THUMB.
 FETUS DEVELOPMENT DURING 2ND TRIMESTER
WEEK 22: BABY'S HAIR BECOMES VISIBLE

TWENTY-TWO WEEKS INTO YOUR PREGNANCY, OR 20 WEEKS AFTER

CONCEPTION, YOUR BABY'S EYEBROWS AND HAIR ARE VISIBLE. BROWN FAT
ALSO IS FORMING, THE SITE OF HEAT PRODUCTION.
FOR BOYS, THE TESTES HAVE BEGUN TO DESCEND.
BY NOW YOUR BABY MIGHT BE 7 1/2 INCHES (190 MILLIMETERS) LONG FROM
CROWN TO RUMP AND WEIGH ABOUT 1 POUND (460 GRAMS).

WEEK 23: FINGERPRINTS AND FOOTPRINTS FORM

TWENTY-THREE WEEKS INTO YOUR PREGNANCY, OR 21 WEEKS AFTER

CONCEPTION, YOUR BABY BEGINS TO HAVE RAPID EYE MOVEMENTS. RIDGES
ALSO FORM IN THE PALMS OF THE HANDS AND SOLES OF THE FEET THAT WILL
LATER CREATE THE FOUNDATION FOR FINGERPRINTS AND FOOTPRINTS.
YOUR BABY MIGHT BEGIN HICCUPING, CAUSING JERKING MOVEMENTS.
 FETUS DEVELOPMENT DURING 2ND TRIMESTER
WEEK 24: BABY'S SKIN IS WRINKLED

TWENTY-FOUR WEEKS INTO YOUR PREGNANCY, OR 22 WEEKS AFTER

CONCEPTION, YOUR BABY'S SKIN IS WRINKLED, TRANSLUCENT AND PINK TO
RED BECAUSE OF VISIBLE BLOOD IN THE CAPILLARIES.
BY NOW YOUR BABY MIGHT BE ABOUT 8 INCHES (210 MILLIMETERS) LONG
FROM CROWN TO RUMP AND WEIGH MORE THAN 1 1/3 POUNDS (630 GRAMS).

WEEK 25: BABY RESPONDS TO YOUR VOICE

FETUS 23 WEEKS AFTER CONCEPTION

OPEN POP-UP DIALOG BOX
FETAL DEVELOPMENT 23 WEEKS AFTER CONCEPTION

TWENTY-FIVE WEEKS INTO YOUR PREGNANCY, OR 23 WEEKS AFTER

CONCEPTION, YOUR BABY MIGHT BE ABLE TO RESPOND TO FAMILIAR SOUNDS,
SUCH AS YOUR VOICE, WITH MOVEMENT.
YOUR BABY IS SPENDING MOST OF HIS OR HER SLEEP TIME IN RAPID EYE
MOVEMENT (REM), WHEN THE EYES MOVE RAPIDLY EVEN THOUGH THE
EYELIDS ARE CLOSED.
 FETUS DEVELOPMENT DURING 2ND TRIMESTER
WEEK 26: BABY'S LUNGS DEVELOP

TWENTY-SIX WEEKS INTO YOUR PREGNANCY, OR 24 WEEKS AFTER

CONCEPTION, YOUR BABY'S LUNGS ARE BEGINNING TO PRODUCE
SURFACTANT, THE SUBSTANCE THAT ALLOWS THE AIR SACS IN THE LUNGS TO
INFLATE — AND KEEPS THEM FROM COLLAPSING AND STICKING TOGETHER
WHEN THEY DEFLATE.

BY NOW YOUR BABY MIGHT BE 9 INCHES (230 MILLIMETERS) LONG FROM

CROWN TO RUMP AND WEIGH NEARLY 2 POUNDS (820 GRAMS).

WEEK 27: 2ND TRIMESTER ENDS

THIS WEEK MARKS THE END OF THE SECOND TRIMESTER. AT 27 WEEKS, OR 25

WEEKS AFTER CONCEPTION, YOUR BABY'S NERVOUS SYSTEM IS CONTINUING
TO MATURE.
 diagnostic
and
laboratory
Sample Submitted: August 27, 2022
Release Date: N/A

nursing
care
plan
discharge plan
and
health teaching
EVALUATION:

THE PATIENT A. R. VISITED THE HEALTH CENTER WITH HER

MOTHER TO HAVE A PRENATAL CHECK-UP. UPON
ASSESSMENT, THE PATIENT STATED THAT SHE HAS NOT
EXPERIENCED ANY OF SIGNS OF VAGINAL BLEEDING SINCE
FIRST TRIMESTER AND HAS EXPERIENCED LOWER
BACKACHES AND PAINS, PAINLESS CONTRACTIONS,
CONSTIPATION, DIFFICULTY IN DEFECATING. SHE ALSO
EXPERIENCED LOSING HER BREATH WHILE MOVING DUE TO
PREGNANCY. PRIOR TO THE GATHERING OF THE PATIENT’S
DATA, PHYSICAL ASSESSMENT (VITAL SIGNS) AND RESULTS
OF LABORATORY TESTS ARE WITHIN THE NORMAL RANGE.
LEOPOLD’S MANEUVER WAS DONE TO VALIDATE THE
ULTRASOUND RESULT AT CEPHALIC PRESENTATION WITH
THE BABY POSITIONED AT RIGHT OCCIPUT ANTERIOR (ROA).

DISCOMFORTS (SECOND TRIMESTER):

BASED ON THE SCENARIO, PATIENT A. R. EXPERIENCED
THE FOLLOWING DISCOMFORTS DURING HER SECOND
TRIMESTER:
LOWER BACKACHES AND PAINS
PAINLESS CONTRACTIONS
CONSTIPATION
INCREASED VAGINAL SECRETIONS (WHITE)
LOSS OF BREATH / SHORTNESS OF BREATH

MANAGEMENT
LOWER BACKACHES AND PAINS
PELVIC ROCKING EXERCISE TO RELIEVE LOWER
BACKACHE.
SIDE LYING WHILE SLEEPING OR RESTING USING A
WEDGE-SHAPED PILLOW TO SUPPORT STOMACH
PAINLESS CONTRACTIONS (BRAXTON HICKS
CONTRACTIONS)
TAKE A WALK OR MOVE IF SITTING FOR A LONG TIME.
DRINK PLENTY OF WATER (AT LEAST 10 TO 12 GLASSES
OF WATER PER DAY).
REST AN RELAX TO EASE DISCOMFORT.
CONSTIPATION
DRINK PLENTY OF FLUIDS.
INCLUDE PHYSICAL ACTIVITY IN DAILY ROUTINE.
INCLUDE MORE FIBER IN DIET (SUCH AS FRUITS,
VEGETABLES, BEANS, AND WHOLE GRAINS).
INCREASED VAGINAL SECRETIONS (WHITE)
PROPER PERINEAL HYGIENE, FLUSH PERINEUM WITH
WATER AFTER EACH VOIDING; NO DOUCHING IS
NECESSARY.
USE OF SANITARY PAD FOR EXCESSIVE VAGINAL
SECRETIONS.

LOSS OF BREATH / SHORTNESS OF BREATH

PROPER POSTURE GIVES THE LUNGS A LITTLE MORE
ROOM TO THEIR FUNCTION.
SLEEPING ON THE LEFT SIDE IS BEST FOR CIRCULATION
DURING PREGNANCY, AND PROPPING UP WITH PILLOWS.
LIGHT EXERCISE SUCH AS WALKING AND YOGA.
HEALTH TEACHING FOR SECOND TRIMESTER PREGNANCY

DURING THE SECOND TRIMESTER, PREGNANT WOMEN SHOULD EAT THE

FOLLOWING FOODS;
1. RICH IN IRON SUCH AS LEAN MEAT, LEAFY GREEN VEGETABLES, WHOLE
GRAINS, AND NUTS
2. RICH IN PROTEIN SUCH AS FISH, EGGS, AND LEAN MEAT
3. RICH IN CALCIUM SUCH AS DAIRY PRODUCTS (MILK, YOGURT,
PASTEURIZED CHEESE), WHITE BEANS, ALMONDS, SARDINES, AND TOFU
4. RICH IN FOLATE (FOLIC ACID) SUCH AS BLACK-EYED PEAS AND OTHER
LEGUMES, DARK GREEN LEAFY VEGETABLES, AND WHOLE GRAINS
5. RICH IN VITAMIN D SUCH AS FATTY FISH (SALMON, FRESH TUNA,
MACKEREL), FISH LIVER OILS, AND EGG YOLKS
6. RICH IN OMEGA-3 FATTY ACIDS SUCH AS FISH OIL, FLAXSEEDS, AND CHIA
SEEDS.
HEALTH TEACHING FOR SECOND TRIMESTER PREGNANCY

EAT ENOUGH CALORIES (ABOUT 300 CALORIES MORE THAN NORMAL).

KEEP THE TEETH AND GUMS HEALTHY AS POOR DENTAL HYGIENE IS LINKED
TO PREMATURE LABOR.
WORK OUT THE PELVIC FLOOR BY DOING KEGEL EXERCISES.
CONTINUE TO TAKE PRENATAL VITAMINS.
AVOID STRENUOUS EXERCISE OR STRENGTH TRAINING THAT COULD CAUSE
AN INJURY TO YOUR STOMACH.
AVOID ALCOHOLIC DRINKS, SMOKING, AND CAFFEINE (NO MORE THAN ONE
CUP OF COFFEE OR TEA PER DAY).
PRACTICE RELAXATION TECHNIQUES DAILY SUCH AS YOGA, STRETCHING,
DEEP BREATHING, AND MASSAGE.
EAT A WELL-BALANCED MEALS EVERY DAY.
TAKE PRENATAL EDUCATION CLASSES THAT ARE OFFERED LOCALLY.
EDUCATE SELF WITH ONLINE RESEARCH.
EMBRACE POSITIVITY DURING THE PREGNANCY PERIOD.
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BSN 2B GROUP 4

NCM 107 RLE