BROKENSHIRE COLLEGE

MADAPO, DAVAO CITY

Normal Spontaneous Vaginal Delivery

A Case Study Presented to the Faculty of the School of Brokenshire College

Davao City

In Partial Fulfillment of the Requirements for the

Related Learning Experience NCM 107

Submitted by:
Abing, Hannah Mae A. Ayaon, Amerah B.
Abuloc, Cristine Mae C. Andres, Maybelyn G. Banudan, Julia.
Barcena, Jonah Mae C. Alvarado, Reden D. Acob, Jamil C.

December 15, 2022

ACKNOWLEDGEMENT
 The group would like to express our heartfelt and deepest appreciation to the
people involved with making our case presentation possible. We are ever so grateful for
the guidance and encouragement offered. We would also like to thank our family, friends
and others who in one way or another shared their support, either morally, financially and
physically, thank you.

To our Dean of Nursing Deborah Hannah T. Razon, RN, LPT, MAN we are ever
so grateful for the advice, recommendations, assistance and encouragement offered.

Special thanks to our clinical instructors, Rejoice G. Liberato, RN, MN, Maria
Zita Garcia, RN, MN, and Lourie T. Rionda, RN, MN for her guidance and support with
our case presentation throughout our class. We also appreciate the patience shown even
in stressful situations and mistakes were made.

Above all, to the Great Almighty. The author of knowledge and wisdom, for His
countless love.

We thank you.

TABLE OF CONTENTS
Title Page

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Approval Sheet
Acknowledgement
Table of Contents

THE PROBLEM

Introduction ……………………………………………………………… 5

Background of the Case …………………………………………………. 8

Significance of the Case Study …………………………………………...9

Definition of Terms ………………………………………………………1

REVIEW OF RELATED LITERATURE

Related Literatures ……………………………………………………….12

Evidence-Based Practice …………………………………………………14

Anatomy and Physiology of Systems Involved ………………………….16

Labor Process: ………………………………………………………….23

Symptomatology

Etiology

Process of Labor

Developmental Theories …………………………………………………28

DATA GATHERING

Patient’s Profile…………………………………………………………...35

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Health Assessment ……………………………………………………….36

Physician’s Finding and Medical Diagnosis……………………...37

Nursing Assessment ……………………………………………...38

Health History…………………………………………………………….41

MEDICAL MANAGEMENT

Doctor’s Order …………………………………………………………...42

Laboratory Examinations ………………………………………………..43

Drugs and Treatments …………………………………………...45

Medical Prognosis ……………………………………………….57

NURSING CARE MANAGEMENT

A. Assessment data interpretation…………………………………60

B. Identifying nursing problems ………………………………….60

Problem List.…………………………………………………...60

Nursing priorities………………………………………………61

Nursing diagnosis………………………………………………61

C. Plan

Setting goals/ objectives……………………………………….62

NCP……………………………………………………………63

D. Implementation

Application of nursing intervention

Progress notes during the course of care

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 and nursing interventions

Health education: instructions on……………………………..77

prevention and health promotion

Discharge plan………………………………………………..80

E. Evaluation and modification

Evaluation……………………………………………………82

F. Nursing Conclusions and Recommendation …………………83

REFERENCES………………………………………………….85

Chapter 1

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 THE PROBLEM

Introduction

NSVD stands for Normal Spontaneous Vaginal Delivery. It is the condition of a

woman having a growing embryo or fetus inside her body called pregnancy. Positive
results on an over-the-counter urine test can serve as a warning sign for this ailment,
which can then be validated by a blood test, ultrasound, fetal heartbeat detection, or X-
ray. From the date of the woman's last menstrual period, the duration of pregnancy is
approximately nine months (LMP). Typically, it is split into three trimesters that last
around three months each (Sara, P., Whittington, J. & Lack, N. 2022)

The gradual subjection and dilation of the uterine cervix brought on by regular
uterine contractions that result in the delivery of the fetus, membranes, umbilical cord,
and placenta are known as normal labor. The fact that laboring cannot be simple implies
that there are steps and processes to be followed in order to attain spontaneous delivery.
Through which, Obstetrics have divided labor into four (4) stages thereby explaining this
continuous process (Lothian, J. 2022)

STAGE 1: Usually, it takes up the most time during labor. Regular uterine
contractions start it off, and at 10 cm, the cervical dilation is finished. This stage is
divided into three (3) phases: the Early phase, during which contractions are typically
light and spaced out by 20 minutes or more at first, before gradually getting closer and
lasting up to five minutes; the Active phase, during which contractions are spaced out by
four or five times and may last up to 60 seconds; and the Post-Active phase. Cervix
enlarges by 4–7 cm and starts to enlarge more quickly. It is well established that moving
around and relaxing help to speed up contractions during active labor; and the Transition
phase, which is unquestionably the shortest period but the hardest, with contractions that
may occur two or three times apart and last up to a minute and a half, causing a cervical
dilation of 8 to 10 cm. It's considered common for some women to shake at this time and
possibly vomit. Women would typically find a comfortable position to obtain full
dilation.

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 STAGE II: This phase lasts three hours or longer. However, depending on the
mother's position, this period can last for a while (e.g.; upright position yields faster
delivery). The second stage started once the cervix had fully dilated. The fetus is expelled
at the conclusion of this period.

STAGE III: The placenta's removal from the mother is the main focus of this
stage. The infant is placed on top of the mother's womb during this stage, making
placenta exclusion simpler than childbirth because it has no bones.

STAGE IV: Since this is considered to be the POSTPARTUM juncture, no more

expulsions of conception products are permitted at this point. This stage spans the
placental birth and the mother's complete recovery ( Hutchison, J. & Mahdy, H. 2022)

According to Pascual and Langaker (2021) both the mother and the fetus have
physiological repercussions as a result of labor and delivery. Because more blood is
required in the uterine area, the mother's cardiac output rises in her cardiovascular
system. The mother's endeavor to evacuate the fetus may cause her blood pressure to
increase. As a result of stress and strenuous activity, there may also be a formation of
leukocytes or a significant rise in the number of circulating white blood cells. Also
possible is an increase in respiratory rate. This occurs as a reaction to the increased blood
flow in order to boost oxygen consumption

OBJECTIVES

General Objectives

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 This study aims to produce a comprehensive case study that would help student
nurses who conduct this study as well as the readers to have a deeper understanding and
insight about Normal Spontaneous Vaginal Delivery and to be used for future references.

Specific Objectives

After completion of all case presentation requirements, the presenters aim to

achieve the following:

1. To identify our patient

2. To establish rapport with the patient, family, and significant others.
3. To gather enough information regarding the patient
4. To present significance of the study for the students, and more emphasis on the
nursing education to the patient and family.
5. To present selected terms related to the study
6. To gather review of related literature that would address and emphasize the
importance of the case to be tackled with evidence-based practice.
7. To discuss the anatomy and physiology of the organ and systems involved in the
condition.
8. To determine etiology, symptomatology, and physiology.
9. To identify the drugs prescribed for the patient’s condition.
10. To present the laboratory results and discussed its significance
11. To provide good medical prognosis with justification as evidence by computation
12. To present the nursing theories applicable to the patient’s condition.
13. To formulate an effective nursing care plan to address the identified problem.
14. To provide health teaching as well as discharge plan for the patient’s progress and
recovery.
15. To provide conclusion and recommendation regarding the client’s condition

Background of the Case

7
Name: Mrs J.N

Attending Physician: Dr. Cabling

Room No.:226

Date and Time of Admission: 11/16/2022 6:30 pm

Age: 28

Sex: Female

Civil Status: Married

Weight: 65 kgs

Height: 5’3

Admitting Diagnosis: Gravida 1 Parity 0 Pregnancy Uterine 37 5/7 weeks of Gestation,

cephalic in latent phase of labor; Gestational Diabetes Mellitus on medical nutrition
therapy.

Significance of the Case

Our group was assigned to this study in order to obtain further knowledge and
better understanding about Normal Spontaneous Vaginal Delivery (NSVD).
This study hopes to establish an additional understanding of NSVD. It is also a
thorough study about the patient’s condition and status on natural birth. Furthermore, the
study could also be important to the following:

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 To the Students: The information gathered and presented in the study will give the
students a thorough understanding about NSVD, and will also serve as reference or guide
in creating our further case study in-lined with the case.
To the Nursing Clinical Instructors: The outcome of this study will facilitate them
to formulate efficient strategies and approaches to make learning more comprehensive
and retentive.
To the Nurses: The information gathered in the study will give nurses more
knowledge about NSVD in order to help them improve their nursing care and to
formulate interventions that can facilitate a faster recovery for their patients.
To the Community: The information presented will give the community better
understanding and awareness about NSVD.
To the Individuals: The information presented in the study will give the
individuals knowledge and understanding about NSVD.

Definition of Terms

AOG (Age of Gestation) - Gestation is a term that describes the time between conception
and birth, during which a baby grows and develops in the pregnant parent's uterus.
Gestational age refers to how far along the pregnancy is and is generally expressed as a
combination of weeks and days.
Bag of Water - The amniotic fluid, or bag of waters, surrounds and protects the baby in
the uterus and provides a protective barrier from the outside environment.
Dilation - is the opening of the cervix. Both dilation and effacement happen during labor,
and are necessary to allow your baby to pass through the birth canal.
Episiotomy - is a cut (incision) through the area between the vaginal opening and anus.
This area is called the perineum. This procedure is done to make the vaginal opening
larger for childbirth.
GDM (Gestational Diabetes Mellitus) - is a condition in which a hormone made by the
placenta prevents the body from using insulin effectively. Glucose builds up in the blood
instead of being absorbed by the cells.

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Gravida - is defined as the number of times that a woman has been pregnant.
Labor - is a series of continuous, progressive contractions of the uterus that help the
cervix dilate and efface (thin out). This lets the fetus move through the birth canal.
LMP (Last Menstrual Period) - is the first day (onset of bleeding) of the last menstrual
period before falling pregnant.
NSVD (Normal Spontaneous Vaginal Delivery) - is a natural birth process which does
not usually require significant medical intervention.
Parity - is the number of times that the mother has given birth to a fetus with a gestational
age of 24 weeks or more.
Placenta - is an organ that develops in the uterus during pregnancy. This structure
provides oxygen and nutrients to a growing baby. It also removes waste products from
the baby's blood.
Postpartum - it begins after the delivery of the baby and ends when the body of the
mother has nearly returned to its pre-pregnant state.
Progress of Labor - The first stage starts when labor begins and ends with full cervical
dilation and effacement. The second stage commences with complete cervical dilation
and ends with the delivery of the fetus. The third stage initiates after the fetus is delivered
and ends when the placenta is delivered.
Uterine Contractions - is when the muscles of the mother's uterus tighten up like a fist
and then relax. Contractions help push the baby out. They're so strong that mothers can't
walk or talk during contractions.

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 Review of Related Literature

Normal spontaneous vaginal delivery (NSVD) is the delivery of a baby through

the vaginal route. Normal labor is defined as the gradual subjugation and dilatation of the
uterine cervix as a result of rhythmic uterine contractions leading to the expulsion of the
products of conception: the delivery of the fetus, membranes, umbilical cord, and
placenta. Laboring cannot be that simple, implying that there are processes and stages to
be followed in order to achieve spontaneous delivery (Sara, P., Whittington, J., & Lack,
N. 2022)
Vaginal delivery is safest for the fetus and the mother when the newborn is full-
term at the gestational age of 37 to 42 weeks. Vaginal delivery is preferred considering
the morbidity and the mortality associated with operative cesarean births has increased
over time.Approximately 80% of all singleton vaginal deliveries are at full-term via
spontaneous labor, whereas 11% are preterm, and 10% are post-term. Of note, with the
advent of operative delivery modalities and surgical delivery modalities, the number of
patients who reach spontaneous labor has decreased over time, and the induction of labor
has increased.According to the latest published data, in the USA, in 2017, there were
3,855,500 births, and 68% (2,621,010) of those were vaginal deliveries. The preterm birth
rate was 9.9%, and the population’s birth rate was 11.8 per 1000.(Desai NM, Tsukerman
A., 2022)

Gestational diabetes mellitus (GDM) develops during the severe metabolic stress
of pregnancy when the body is unable to maintain adequate glucose tolerance levels. In
this condition, a hormone released by the placenta prevents the body from properly
utilizing insulin. As a result, glucose accumulates in the blood instead of being absorbed
by the cells. According to the most recent International Diabetes Federation (IDF)
estimates, GDM affects more than 14% of pregnancies worldwide, resulting in
approximately 18 million newborns each year. Globally, the number of cases of GDM is
increasing. Obesity, advanced maternal age, and migratory issues are some of the reasons
for this.

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 According to Hewage, Audimulam, Sullivan, Chi, Yew & Yoong, (2020)
qualitative results, working women reported facing obstacles such as a lack of blood
glucose self-monitoring, difficulty with food control, and a lack of time for prescribed
exercise. Despite the fact that physical activity has been shown to help women with
GDM control their blood glucose levels, pregnant women in Singapore are less likely to
be active, especially in the late stages of pregnancy. Other responsibilities, such as work-
related activities, may aggravate this lack of behavioral change. GDM treatment gaps
have been identified, emphasizing the need for appropriate interventions that can fit into
busy schedules.

Pregnancy-related gestational diabetes, which affects between 1% and 45% of

pregnancies depending on the population and diagnostic criteria, is the most frequent
medical pregnancy complication. Counseling, food modification, and increasing physical
activity are the three main goals of treatment. Involving mothers in self-monitoring blood
glucose levels is essential for optimal control. These women can receive the behavioral
support and instruction they need from digital health interventions including websites,
SMS messages, and smartphone apps. As evaluated the use of digital health interventions
to help manage mothers with gestational diabetes and their effects on glycemic control
and discovered that using digital health interventions was linked to better glucose
management and less weight gain during pregnancy, which lowers the likelihood of
difficulties for the mother and baby after delivery. Additionally, mothers with gestational
diabetes were less likely to require a cesarean section, and their newborns were more
likely to be delivered within the normal weight range. Digital health should only be used
as a complement to routine clinic follow-up, though, until more reliable evidence is
produced.( Leblalta B, Kebaili H, Sim R, Lee SWH, 2022)

The ADA recommends nutritional counseling by a registered dietitian and development

of a personalized plan based on the patient's BMI. In some settings, in which dietitians
are not able, the physician can provide recommendations based on the three major
nutritional concepts: caloric allotment, caloric distribution, and carbohydrate intake. The
amount of exercise recommended in GDM is 30 minutes of moderate-intensity aerobic

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exercise at least five days a week or a minimum of 150 minutes per week.However, ADA
first line of treatment for GDM is insulin. The therapy with insulin has been considered
the standard therapy for gestational diabetes management when adequate glucose levels
are unachievable with diet and exercise. Insulin can help achieve an appropriate
metabolic control, and it is added to the management if fasting blood glucose is greater or
equal to 95 mg/dL, if 1-hour glucose level is greater or equal to 140 mg/dL, or if 2-hour
glucose level is greater than 120 mg/dL.(Quintanilla Rodriguez BS, Mahdy H., 2022)

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 Evidence-based Practice Care for Mother

Gestational Diabetes Mellitus in NSVD

According to (Vaginal Delivery - StatPearls - NCBI Bookshelf, 2022) labor and birth

appear to be the conclusion of a pregnancy. When gestation is completed, it goes through

a process which is called delivery, where the fetus is out of the womb. Normal

Spontaneous Delivery is one of the options of delivery where the newborn is being

delivered through a vaginal route. Vaginal birth is advised for full-term pregnancies when

spontaneous labor starts or if the amniotic and chorionic membranes burst. In addition,

for complicated gestations or for post-term pregnancies, induction of labor is indicated,

which is also an indication for vaginal delivery. The study shows that if the woman

experiences a consistent contraction that requires her focus and attention combined with

effacement, 4-5 cm of cervical dilation, we can say that the woman is in spontaneous

labor and should be admitted to the hospital for a normal spontaneous delivery. Another

sign of a vaginal birth is the rupture of the membranes. A mother may have seen a quick

flow of watery fluid, which could have been caused by a uterine contraction.

According to (RETIRED: Screening for Gestational Diabetes Mellitus. - Abstract,

n.d.) gestational diabetes mellitus (GDM) is one of the known complications during
pregnancy. Usually it happens during their 24th-28th gestation. Gestational diabetes
mellitus is defined as glucose intolerance that begins, or is first recognized, during
pregnancy. According to the Academy of Nutrition and Dietetics Gestational Diabetes
Evidence-Based Nutrition Practice Guideline, a wide range of complications is associated
with the disorder. For the mother, gestational diabetes increases the risk of preeclampsia,
cesarean delivery, and future type 2 diabetes. In the fetus or neonate, the disorder is
associated with higher rates of perinatal mortality, macrosomia, birth trauma,
hyperbilirubinemia, and neonatal hypoglycemia. Some studies have found an association

14
between gestational diabetes and increased perinatal mortality rates. Treatment of GDM
aims to reverse hyperglycemia and reduce the risk of the associated adverse pregnancy
outcomes. Treatment of GDM aims to reverse hyperglycemia and reduce the risk of the
associated adverse pregnancy outcomes. Recent studies show that diagnosis and
management of this disorder have beneficial effects on maternal and neonatal outcomes,
including reduced rates of shoulder dystocia, fractures, nerve palsies, and neonatal
hypoglycemia. Treatment consists of glucose monitoring, dietary modification, exercise,
and, when necessary, pharmacotherapy to maintain euglycemia. Insulin therapy is the
mainstay of treatment, although glyburide and metformin may become more widely used.

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 Anatomy and Physiology of the Systems Involved

Female and Male reproductive system

Female Internal Reproductive system

Ovaries

The ovaries are the ultimate life-maker for the females.

· For its physical structure, it has an estimated length of 4 cm and width of 2 cm

and is 1.5 cm thick. It appears to be shaped like an almond. It looks pitted, like
a raisin, but is grayish white in color.

· It is located proximal to both sides of the uterus at the lower abdomen.

· For its function, the ovaries produce, mature, and discharge the egg cells or ova.

· Ovarian function is for the maturation and maintenance of the secondary sex
characteristics in females.

· It also has three divisions: the protective layer of epithelium, the cortex, and the
central medulla.

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Fallopian Tubes

· The fallopian tubes serve as the pathway of the egg cells towards the uterus.

· It is a smooth, hollow tunnel that is divided into four parts: the interstitial, which
is 1 cm in length; the isthmus, which is2 cm in length; the ampulla, which is 5
cm in length; and the infundibular, which is 2 cm long and shaped like a
funnel.

· The funnel has small hairs called the fimbria that propel the ovum into the
fallopian tube.

· The fallopian tube is lined with mucous membrane, and underneath is the
connective tissue and the muscle layer.

· The muscle layer is responsible for the peristaltic movements that propel the
ovum forward.

· The distal ends of the fallopian tubes are open, making a pathway for conception
to occur.

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 An overview of the external reproductive system, The mons pubis is a rounded
mound of fatty tissue that covers the pubic bone. During puberty, it becomes covered
with hair. The mons pubis contains oil-secreting (sebaceous) glands that release
substances that are involved in sexual attraction (pheromones). The labia majora
(literally, large lips) are relatively large, fleshy folds of tissue that enclose and protect the
other external genital organs. They are comparable to the scrotum in males. ---The labia
majora contains sweat and sebaceous glands, which produce lubricating secretions. -
During puberty, hair appears on the labia majora.

The labia minora (literally, small lips) can be very small or up to 2 inches wide.
The labia minora lie just inside the labia majora and surround the openings to the vagina
and urethra. A rich supply of blood vessels gives the labia minora a pink color. During
sexual stimulation, these blood vessels become engorged with blood, causing the labia
minora to swell and become more sensitive to stimulation. The area between the opening
of the vagina and the anus, below the labia majora, is called the perineum. It varies in
length from almost 1 to more than 2 inches (2 to 5 centimeters). The labia majora and the
perineum are covered with skin similar to that on the rest of the body. In contrast, the
labia minora are lined with a mucous membrane, whose surface is kept moist by fluid
secreted by specialized cells. The opening to the vagina is called the introitus. The

18
vaginal opening is the entryway for the penis during sexual intercourse and the exit for
blood during menstruation and for the baby during birth.

Perineum

Perineum is the tiny patch of sensitive skin between your genitals (vaginal
opening or scrotum) and anus, and it’s also the bottom region of your pelvic cavity. The
perineum may refer to just the part of your body you can see (the skin in between your
genitals and your anus). Perineum may also refer to the underlying structures inside your
body beneath your pelvic floor.

Your perineum is between your genitals and your anus. This part of your
perineum that you can see corresponds with structures inside your body that you can’t
see. Internally, your perineum is located below the primary muscle of your pelvic floor
(levator ani), and it stretches across your pelvic bones.

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Episiotomy

Episiotomy is a minor surgery that widens the opening of the vagina during
childbirth. It is the cut to the perineum- the skin and muscle between the vaginal opening
and anus. There are some risks in having an episiotomy. Because of risks, episiotomies
are not as common as they used to be. The risks include:

● The cut may tear and become larger during the delivery.
● The tear may reach into the muscle around the rectum, or even into the
rectum itself
● · There may be more blood loss
● The cut and the stitches may get infected
● Sex may be painful for the first few months after birth.

Sometimes, an episiotomy can be helpful even with the risks.

Times when an episiotomy is often performed include:

● If you are pushing as the baby’s head is dose to coming out, and
you tear up toward the urethral area
● If labor is stressful for the baby and the pushing phase needs to be
shortened to decrease problems for the baby

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 ● If the baby’s head or shoulders are too big for the mother’s vaginal
opening
● · If the baby in a breech position (feet or buttocks coming first) and
there is a problem during delivery
● If instruments ( forcep or vacuum extractor) are needed to help the
baby out·

Not every woman will need an episiotomy during childbirth. Many women get
through childbirth without tearing on their own, and without needing a cut.

Episiotomies don’t heal better than tears. They often take longer to heal since the
cut is usually deeper than a natural tear. In both cases, the cut or tear must be stitched and
properly cared for after childbirth.

Just before your baby is born, and as the head is about to crown, your doctor or midwife
will give you a shot to numb the area(if you haven’t had an epidural).

Next, a small incision (cut) is made. There are two types of cuts: median and
medio-lateral.

● · The median incision is the most common type. It is a straight cut

in the middle of the perineum.
● · The medio-lateral incision is made at an angle . it is less likely to
tear through the anus, but it takes longer to heal than a median cut.

Your Doctor will then deliver the baby through the enlarged opening.

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Frenulum

Also known as fourchette, frenulum is the convergence of the labia minora behind the
vagina, in front of the anus. It is part of the vulva (external genital organs – including
mons, clitoris, urethra/vaginal orifices, labia majora/minora), itself part of the perineum
(the pelvic outlet, a surface area, roughly diamond-shaped, between pubic symphysis and
coccyx). The frenulum stretches out during childbirth to aid the passage of the baby.

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 LABOR PROCESS

Physiology:

Concept of labor:

Labor is a series of continuous, progressive contractions of the uterus that help the
cervix dilate (open) and efface (thin). This allows the fetus to move through the birth
canal. Labor usually starts two weeks before or after the estimated date of delivery.
However, the exact trigger for the onset of labor is unknown. While the signs of labor
may vary, the most common are contractions, rupture of the amniotic sac (“breaking your
water”) and bloody show. Labor is typically divided into three stages: dilation and
effacement of the cervix, pushing and the delivery of the placenta.

Stage of Labor
First Stage: This stage begins when the cervix starts to soften and to open. First
stage is complete when the cervix has opened to around 10 centimeters. In the very early
stages of labor, the cervix softens and becomes quite thin. This can go on for hours, even
days. During this early stage the pregnant woman may feel nothing at all for some time.
Eventually, you might feel some pain and discomfort but there is no pattern and the
contractions are irregular. In early labor they may have: a blood show, lower back pain,
period-like pain that comes and goes, loose bowel motions, sudden gush or slow leak of
fluid from the vagina when your waters break or your membrane ruptures,
Second Stage: this stage describes the period of time from when the cervix is fully
dilated to when the baby is ben. In the second stage they may have longer and stronger
contractions, with a one to two minute break between, increased pressure in your bottom,
the desire or urge to push, shaky cramps, nausea, and vomiting, stretching and burning
feelings in your vagina.
Third Stage: the third stage begins after your baby is born and finishes when the
placenta and membranes have been delivered. In the third stage they may have more
contractions to expel the placenta, a feeling of fullness in their vagina.

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Signs and Symptoms of NSVD (Normal Spontaneous Vaginal Delivery)
● Pressure in the uterus ● Bloody show
● Pressure in the bladder ● Water breaks

Etiology

Labor is a series of continuous, progressive contractions of the uterus that help the
cervix dilate (open) and efface (thin). This allows the fetus to move through the birth
canal.

Signs of Labor:

● Bloody show.A bloody show is a common symptom during late pregnancy when
a small amount of blood and mucus is released from the vagina. A bloody show
occurs because the cervix starts to soften and thin (efface) and widen (dilate) in
preparation for labor. When your cervix dilates, it's making room for your baby to
pass through. Because it's filled with blood vessels, it can bleed easily when
dilation occurs. What you see in a bloody show is blood from your cervix, mixed
with mucus from the mucus plug.
● Contractions. Contractions start when the pituitary gland releases the hormone
oxytocin. This stimulates the muscles in the uterus to start tightening and relaxing.
The contractions make the top of the uterus tighten to push the baby down. They
also soften and stretch the lower part of the uterus and cervix (the opening to the
uterus) to allow the baby through. Uterine muscle spasms that occur at intervals of
less than 10 minutes may signify that labor has started. These may become more
frequent and severe as labor progresses.
● Rupture of the amniotic sac (bag of water). If you experience amniotic fluid
gushing or leaking from your vagina, go to the hospital immediately and contact
your healthcare provider. Most women go into labor within hours of the amniotic
sac breaking. If labor does not begin soon after rupturing your amniotic sac, you
will be given medications to induce your labor. This step is often taken to prevent
infection and other delivery complications.

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 These are the three stages of labor that signal a spontaneous vaginal delivery is
about to occur:
● Contractions soften and dilate the cervix until it’s flexible and wide enough for
the baby to exit the mother’s uterus.
● The mother must push to move her baby down her birth canal until it’s born.
● Within an hour, the mother pushes out her placenta, the organ connecting the
mother and the baby through the umbilical cord and providing nutrition and
oxygen.

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 Process of Labor (Stages and Phases)

Pre-Labor (1-4 weeks before

labor)
Abdominal Pain
Joints feel loser
Diarrhea
Baby’s head is dropping down
Cervix effacement and Dilatation

Latent Phase
Stage 1: Early Labor
Variable Duration
Bloody Show
Starts at onset of Labor
Water breaks
Complete when the rate of
Uterine contraction every 2
cervical dilation increases
minutes
(3cm

Active Phase
Dilate from 6cm to 10 cm
Stronger contractions
Stage 2: Delivery of the
Baby Last up to 4 to 8 hours
Four cardinal of Immediate
Newborn Care Last up to 20 minutes Cervix
to 5 will dilate at
approximately 1 cm an hour
Immediate Drying hours
Delivery of the Fetus
Skin-to-Skin Contact
Full dilation of the cervix
Immediate Breastfeed
Episiotomy
Non-Separation of the baby as neededTransitional
for Phase
Operation Last up to 15 - 60 mins
Preparation of the body for
giving birth

Stage 3: Delivery of the Placenta

17-21 Cotyledons 26
Last up to 60 minutes after delivery
of the fetus
Stage 4: Postpartum
First 4 hours of post partum
24 hours post birth monitoring of
the baby

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 Developmental Theories
This portion of review of Related Literature will discuss the different developmental
theories.

Florence Nightingale’s Environmental Theory

Florence Nightingale’s Environmental Theory defined Nursing as “the act of

utilizing the patient’s environment to assist him in his recovery.” It involves the nurse’s
initiative to configure environmental settings appropriate for the gradual restoration of
the patient’s health and that external factors associated with the patient’s surroundings
affect the life or biologic and physiologic processes and his development. This theory is
very amicable not only in this case, but to all cases that we are going to phase inside or
outside the hospital. We should make sure that our clients will reserve the best care as
well as a hospital environment that can give comfort and security to our clients.

With Florence Nightingale's theory, the nursing staff shifts the hospital setting
into a more welcoming environment as postpartum women may feel uncomfortable in the
hospital setting. As in this case, the primigravida mother might have her needs neglected
because she provides for the newborn’s needs. The neglected needs of a mother may pose
a negative impact on her restorative process. That said, it is important to implement
actions that positively affect the internal environment of these high-risk postpartum
women, from the mobilization of the external environment

Dorothea Orem’s Self Care Deficit Theory

The Self-Care Deficit Nursing Theory's basic tenet is that all patients want to take
care of themselves and can heal more rapidly and completely if they take care of
themselves as much as they can. This notion is most frequently applied in contexts where
patients are urged to be independent, such as primary care and rehabilitation. Dorothea
Orem identified three areas in which the self-care requirements fit. The first are universal
self-care requirements, or universal needs. These consist of elements like air, water, food,
exercise, rest, and hazard mitigation. The second category is developmental self-care
requirements, which is further divided into two subcategories: maturational, which

28
advances the patient to a higher level of maturation, and situational, which guards against
detrimental development-related impacts. Health deviation requirements, or needs that
arise because of the patient's condition, make up the third group. A "self-care deficit"
develops when a patient is unable to fulfill their self-care obligations. In this situation, the
patient's nurse intervenes with a support modality, such as full or partial compensation,
education and support, or total compensation.

Pregnancy and childbirth place a woman in a position where she experiences

drastic changes in the different aspects of her life. The application of Dorothea Orem’s
Self-Care Deficit Theory is reflected in how a mother can embody self-care physically
and emotionally. This will allow positive developmental, physical, emotional, and
cognitive benefits for both the mother and the newborn. Further, self-care can also allow
mothers to adopt positive behaviors that may lead to positive outcomes. In this case, Mrs.
J.N. is a self-care agent with special needs. With the nurses’ assistance, Mrs. J.N
increases her self-care abilities which enhances her health and well-being in her
rehabilitation process.

Ramona Mercer’s Maternal Attainment Theory

A mid-range theory called the Maternal Role Attainment Theory was created to
give nurses a framework for offering the right medical care to atypical mothers so that
they may successfully build a strong maternal identity. This notion can help moms
connect with their newborns before, during, and after childbirth, but it can also be helpful
for adoptive mothers, foster mothers, or other people who have unexpectedly become
atypical mothers, such as caring for a relative's or friend's child as a result of a loss.The
procedure aids in the development of the mother's attachment to the child, which in turn
aids in the development of the child's attachment to the mother. As the baby grows, this
aids in the development of the mother-child bond.

It is imperative for mothers to establish a maternal identity with the aid of Ramona
Mercer’s Maternal Attainment Theory. Here, Mrs. J.N. goes through a developmental and
interactional process. As she gives birth, she obtains confidence and competence in
caretaking tasks and forms a bond with the newborn. She goes through the four stages of

29
acquisition namely; anticipatory, formal, informal, and personal. In the beginning, she
learns about expectations in her pregnancy. Mrs. J.N. acquires the formal stage in her
assumption of the maternal role as she gave birth. She acquires the informal stage by the
time she can come up with her own methods of mothering. Finally, she can experience
the personal stage as she finds harmony, joy, competence, and confidence in her new
role.

Katherine Kolcaba’s Comfort Theory

According to the Theory of Comfort, patients might be single people, families,

groups of people, organizations, or entire communities. Any element of the patient's,
family's, or institution's surroundings that can be changed by a nurse or family member to
improve comfort is referred to as the environment. According to the patient, group,
family, or community, health is understood to be the patient's ability to operate at their
best. The model defines nursing as the process of determining the patient's level of
comfort, creating and implementing the best nursing care plans, and assessing the
patient's level of comfort following the implementation of the care plans. Nursing
comprises the deliberate assessment of comfort needs, the creation of comfort
interventions to meet those needs, and the subsequent evaluation of comfort levels.
Assessments can be either objective as in watching a wound heal or subjective as in
asking the patient if they are comfortable.

Mrs. J.N. arrived at the hospital with the chief complaint of labor pain. To attain
relief, nurses assisted her and relieved her pain by providing her with relaxation
techniques which included massaging her lower back, teaching her deep breathing
exercises, and proper positioning. Nurses reassured Mrs. J.N. and effectively
communicated with her and were actively listening to Mrs. JN whenever she was anxious
to achieve ease. In order to achieve transcendence, nurses ask Mrs. JN's family and
significant others to support and divert her mind by engaging her in conversations. The
job of the nurses and family is to help Mrs. J.N. “rise above” those persistent comfort
needs. Transcendence is important for motivation and inspiration to achieve a new and
stable normal relative to any particular need or set of needs. Transcendence is the type of

30
comfort that signals to Mrs. J.N. and the nurses to never give up on meeting her many
needs for comfort.

Lydia E. Hall’s Care Cure Core Nursing Theory

The Care, Cure, Core Theory of Lydia Hall emphasizes the significance of the
total patient instead of just an aspect. The central concepts of this theory are care, cure,
and core functions together. The Core is identified as the patient directed with nursing
care. In communicating with the patient, the core involves the therapeutic use of self.
The Cure is identified as the given attention by the nurse to the patient. It includes
interventions such as administration of medications and treatments intended to treat the
patient of whatever illness or disease he or she’s suffering from. The Care, According to
the theory, is focused on performing the task of nurturing patients. It is where a
comforting and nurturing relationship is reflected in the intimate bodily care aspect of
nursing the patient.

In the application of Lydia Hall’s Theory, the mother is the core where nursing
care is being directed into. The Core decides and behaves based on her feelings and
values where she has also set goals by herself. Care involves the applied tasks that
nurture the well-being of the mother. It also involves addressing any comfort issues of the
mother in her maternal role. Here, the nurse educates the mother, and helps in meeting
any needs that she is unable to meet alone. Finally, the Cure are the nursing interventions
exerted on the mother by the nurses and other health care professionals .

Developmental Tasks

Pregnancy entails significant changes and major psychosocial adjustment for both
the expectant mother and father. In this stage, the pregnant woman prepares and faces her
new role through accomplishing developmental tasks to inculcate the maternal identity in
her. Each of these tasks are approached and accomplished uniquely by individuals.
Discussed below are the developmental tasks of a pregnant woman from existing
theories.

31
Four Major Developmental Tasks of a pregnant woman According to Rubin (1984)

1. Safe Passage

The goal of this task is to have a healthy pregnancy and an intact newborn with
no detrimental effects on the mother. The mother seeks safe passage for herself and her
child through pregnancy, labor and delivery. It is done deliberately in every semester of
the pregnancy. During the first trimester, the pregnant woman is conscious of what intake
she’s going to have as she concentrates on her well-being and the growing fetus inside
her. For the second trimester, fear about the baby and the delivery starts to escalate. It is
for this reason that the mother religiously adheres to every part of her prenatal care. For
the third trimester, the mother attempts to look for role models that may give her advice
on the best approach to her pregnancy and parenthood.

2. Acceptance by others

The acknowledgement of the significant others in the life of the mother and the
baby is crucial. The mother shapes her new identity in motherhood through the
motivational force of her partner and family. An adjustment must be made as this new
stage of the family’s life comes. In order to do this, the mother should be aware and
assertive about the sacrifices that should be made. The other members of the family
should significantly assist her to adapt to the new phase of their life as a new member
comes.

3. Binding in to the Child

The formation and establishment of the bond between the mother and the baby is
the next developmental task (Rubin 1984 as cited in Welch et al.,2008). In the beginning,
this is done as the mother enriches herself to maintain the pregnancy. In the coming
months, as the mother starts to feel fetal movement, the mother’s attention is focused on
the newborn’s safe arrival.

32
4. Giving of oneself

This is a time of nourishment for a mother’s behavior towards her child. She
learns to give of herself knowing that pregnancy will put her through physical, emotional,
and lifestyle changes. At this stage, the mother prioritizes, above all, the needs of her
growing infant. This is done successfully with enough support systems to help her adapt
and endure the discomforts of the physical changes in her pregnancy.

Developmental Tasks - Psychological Adaptation to Pregnancy (White, 2004)

1st trimester: Pregnancy Validation

Pregnancy validation is about the acceptance of pregnancy. Planned or not,

ambivalence and surprise could be felt by the mother. This is the initial reaction to the
validation of pregnancy and it may be due to various reasons. Ambivalence is recognized
as normal and it is repeated occasionally throughout the pregnancy. In addition, in this
stage mood swings often occur and it is caused by hormone fluctuations. Ambivalence is
associated particularly with the speculation about the immensity of the step into
motherhood.

2nd trimester - Fetal Embodiment & Distinction

Fetal Embodiment is about the acceptance of the baby. This takes place as the
mother recognizes the growing fetus as part of her body image. To meet this task, she
acknowledges the physical changes that she is going through. A sign of successfully
doing this developmental task is showing a positive attitude toward the changes.
However, difficulty in meeting the task may result in depression or regressive disorder.

Fetal Distinction means the acceptance of the baby as a separate individual

despite the fact of being connected to the mother. The mother can meet this task as fetal
movement occurs giving her the cues that the baby is a separate being. It also comes with
how the mother envisions what the baby will be like.

33
3rd trimester - Role transition

Role transition means enacting the ways of parenthood. Both couples explore the
meaning of parenthood in various ways. First-time parents learn parenting skills that are
going to guide the growing child. This is also an adjustment period as the baby finally
comes out and is together with them. Skills in interacting with the baby are also learned
to go through with the physical and behavioral maturing in the first 12 months of life.
The act of “nesting” is also seen as parents, especially mothers, feel the need to prepare
and organize the household.

34
 DATA GATHERING

PATIENT PROFILE

Patient’s Code Name: Mrs. J.N

Address: 233-A Sto. Nino San Gabriel Street Buhangin, Davao City

Age: 28

Birthdate: September 28, 1994

Birthplace: Davao City

Sex: Female

Nationality: Filipino

Father: No data provided

Mother: No data provided

Religion: Roman Catholic

Civil Status: Married

Occupation: Teacher

Date and Time of Admission: November 16, 2022 7:30 PM

35
 HEALTH ASSESSMENT

PHYSICIAN’S FINDINGS

DATE: November 16, 2022

General Appearance:

Awake, Alert, Coherent and Responsive, Afebrile, Not in respiratory distress

Vital signs:

Blood pressure: 100/70 mmHg

Pulse rate: 84 bpm

Respiratory rate: 20 cpm

Temperature: 37 ‘C

Skin: Warm, Moist, Color is Normal and Turgor is Elastic

Neck: Movable, soft, non-tender

Chest and Lungs: Symmetrical chest expansion, with clear breath sounds on both lung
fields

Heart: Normal S1 & S2, no adventitious sound noted

Abdomen: Soft with active bowel sounds

Extremities: Bounding pulses, no edema noted

Genitalia: Not assessed

Neurological exam: Cooperative behavior, eyes are spontaneous, oriented verbally

CHIEF COMPLAINT: Labor Pains

36
 Physician’s Finding and Medical Diagnosis

MEDICAL DIAGNOSIS

Admitting Diagnosis: Gravida 1, Para 0, Pregnancy Uterine 37 weeks of gestation.

Cephalic in the latent phase of labor. Gestational Diabetes mellitus for medical nutritional
therapy.

Final Diagnosis: Gravida 1 Para 1, Pregnancy Uterine 37 weeks Age of Gestation,

Cephalic delivered via NSVD, 37 weeks live baby girl.

37
 NURSING ASSESSMENT TOOL

DATE: November 17, 2022

PHYSICAL EXAMINATION

I. General Appearance and Mental Status

Mrs. J. N is a 28 years old female. The patient was alert, responsive and cooperative to
the care given to her. The vital sign is recorded as follows: Temp. 37°C, Pulse rate:84
bpm, respiratory rate: 20 cpm, and BP 100/70 mmHg.

II. Integumentary

A. Skin

The skin is warm to touch and moist with good skin turgor and normal skin color. Brown
in color; presence of marks of wounds in the legs and arms.

B. Hair

Hair is long, thin and coarse, curly and evenly distributed.

C. Nails

Firm bed nails, not brittle, and smooth nail texture.

III. Head

Head is round in shape. Scalp is smooth and there is no presence of any masses or
lesions. Presence of Dandruff and Hair falls were noted.

IV. Eyes

Pupils are equally round and reactive to light. Her eyes are symmetrical, black in color.

38
V. Ears

Ears are clean, no ear wax was noted and approximately of the same size and shape.
Patients can hear normally when spoken softly.

VI. Nose

With a narrow nose bridge, no discharges, no swelling of the mucous membrane and
presence of nasal hairs were seen.

VII. Mouth/Teeth/Tongue

She has a complete set of teeth with minimal dental caries noted. Oral mucosa and
gingival are pink in color, moist and there were no lesions nor inflammation noted.
Tongue is pinkish and is free of swelling and lesions. Lips are symmetrical, appearing
pale without bits noted upon observation.

VIII. Speech

No signs of difficulty in speaking. No hoarseness of voice. Able to respond to commands.

IX. Neck

Lymph nodes noted. Neck has strength that allows movement back and forth, left and
right. Patient is able to freely move her neck.

X. Respiratory

Deep, and non-labored. Client appears to be not in any form of respiratory distress. With
symmetric chest expansion. With no abnormal breath sounds.

XI. Breast

Not assessed

39
XII. Circulatory

With capillary refill of 3 seconds. With 84 bpm pulse rate. Blood pressure 100/70mmHG.

XIII. Abdomen

Abdominal movement as with respiration.

XIV. Genitourinary

Not assessed

XV. Elimination

Not assessed

XVI. Neurological

Able to speak spontaneously, obey commands and be well oriented.

40
 HEALTH HISTORY

HISTORY OF PRESENT ILLNESS

1 day prior to admission the patient experienced mild contractions (RS 2/10)
lasting for 5 minutes. no associated symptoms of headache, abdominal pain, and nausea,
no consultation was done. Hours prior to admission, the patient noted vaginal discharge
(minimal) and sought prenatal consultation. Upon internal examination, the patient was
found to be 3 cm dilated, 30% effaced, S-3 with an intact bag of water. Patient was then
advised for admission. For the past few months, the patient was known to have diabetes
during her 37th week of gestation. The patient has no symptoms of hypertension. No
asthma and allergies. The patient’s Last Menstrual Period was on February 7, 2022.

PAST ILLNESS/ HOSPITALIZATION

The Patient had no serious illnesses other than gestational diabetes treatable by
nutritional modification or to institute insulin therapy.

PERSONAL HISTORY:

No personal history data of the patient’s provided case.

GENOGRAM: No data provided

41
 Medical Management

Doctor’s Order

11/16/22 Please admit the patient under the services of Dr. Cabling
Secure consent to care
Vs q4
DAT, NPO once in active labor
Labs:
Monitor progress of labor
FHT & UC monitoring
Baseline EFM then q4
Refer
Will aware AP of this admission

11/17/22
Referred w/ Dr. Cabling
6: 20 am
CBG 2 hours post meal
4cnm, 50, -3, IBow

8: 40am Refer to IM-endo Dr. Ho for co-mgt

Last meal 7: 30 am Hook to EMP now
CbC - 270
4cm, 50%, -3, IBow

42
 LABORATORY EXAMINATIONS

OGTT 100 GMS

Examination Result Normal Value

FBS (Fasting Blood Sugar) 9.6 4.1-5.9 mmol/L

1ST HOUR 10.0 9.0-10.0 mmol/L

2ND HOUR 8.1 7.8-8.6 mmol/L

3RD HOUR 5.9 7.8 mmol/L

CBC WITH PLATELET (CBC, PLT)

EXAMINATION RESULT NORMAL VALUE

WBC COUNT 8.5 4.0 - 10.0 X 0^g/L

RBC COUNT 4.8 3.69 - 5.13 X10^12/L

HEMOGLOBIN 13.4 11.7 - 14.5 g/dL

HEMATOCRIT 0.41 0.34- 0.44

PLATELET COUNT 282 150 - 400 X10^8/L

MEAN PIT VOLUME 9.9 8.0-12.0 fL

MCV 85.1 79.0 - 100.0 fL

MCH 27.5 27.0 - 34.0 pg

MCHC 324 320 - 360 g/L

SEGMENTERS H 0.68 0.55 - 0.65

LYMPHOCYTES L 0.24 0.35 - 0.55

43
MONOCYTES 0.06 0.02 - 0.09

EOSINOPHILS L 0.01 0.02 - 0.04

BASOPHILS 0.01 0.00 - 0.02

44
 BROKENSHIRE COLLEGE
MADAPO, DAVAO CITY
DRUG STUDY

Generi Bra General Mechanis Rout Indicati Contraindication Adverse Reaction/s Nursing Responsibility
c nd Classific m of e of ons
Name Na ation Action Dosa
me ge
Oxyto Pico oxytocic Uterine Side for Contraindicated Maternal Start flow charts to record
cin tin , motility Drip labor in patients maternal BP and other
lactation depends inducti hypersensitive to • CNS: vital signs, I&O ratio,
stimulan on the on, drugs and in subarachnoid weight, strength, duration,
t formation augmen those with severe hemorrhage (from and frequency of
of the tation toxemia, hypertension), contractions, as well as
contractil of hypertonic seizures or coma fetal heart tone and rate,
e protein labor, uterine patterns, (from water before instituting
actomyos postpart total placenta intoxication). treatment.
in under um previa, and • CV:
the abbrevi vasoprevia. Also hypertension; Monitor fetal heart rate

45
influence ation of contraindicated increased heart and maternal BP and
of the third when rate, systemic pulse at least q15min
Ca2+- stage of cephalopelvic venous return, and during infusion period;
dependen labor, disproportion is cardiac output; evaluate tonus of
t postpart present; when arrhythmias. myometrium during and
phosphor um delivery requires • GI: nausea, between contractions and
ylating control conversion, as in vomiting. record on flow chart.
enzyme of transverse lie; in • GU: tetanic Report change in rate and
myosin uterine fetal distress uterine rhythm immediately.
light- bleedin when delivery contractions,
chain g, isn’t imminent; abruptio placentae, Stop infusion to prevent
kinase. termina and in impaired uterine fetal anoxia, turn the
Oxytocin tion of prematurity and blood flow, pelvic patient on her side, and
promotes pregnan other obstetric hematoma, notify the physician if
contractio cy and emergencies. increased uterine contractions are
ns by for the Use cautiously motility, uterine prolonged (occurring at
increasin evaluati during first and rupture, postpartum less than 2-min intervals)
g the on of second stages of hemorrhage. and if monitor records
intracellul fetal labor and in • Hematologic: contractions about 50 mm
ar Ca2+, respirat patients with afibrinogenemia Hg or if contractions last
which in ory history of (may be related to 90 seconds or longer.
turn capabili cervical or postpartum Stimulation will wane

46
activates ty. uterine surgery bleeding). rapidly within 2–3 min.
myosin's Oxytoci (including • Other: Oxygen administration
light n cesarean hypersensitivity may be necessary.
chain cannot section), grand reactions
kinase.. be used multiparity, (anaphylaxis), If local or regional
Oxytocin for uterine sepsis, water retention. (caudal, spinal) anesthesia
has elective traumatic is being given to the
specific inducti delivery, Fetal patient receiving
receptors on of overdistended oxytocin, be alert to the
in the labor, uterus, or • CNS: infant brain possibility of
muscle there invasive cervical damage. hypertensive crisis
lining of must be cancer. • EENT: retinal (sudden intense occipital
the uterus a clear hemorrhage. headache, palpitation,
and the medical • CV: marked hypertension, stiff
receptor require bradycardia, PVCs, neck, nausea, vomiting,
concentra ment. arrhythmias. sweating, fever,
tion • Hepatic: photophobia, dilated
increases jaundice. pupils, bradycardia or
greatly • Respiratory: tachycardia, constricting
during anoxia, asphyxia. chest pain).
pregnanc • Other: low Apgar
y, scores.

47
reaching
a
maximum
in early
labor at
term.

48
 BROKENSHIRE COLLEGE
MADAPO, DAVAO CITY
DRUG STUDY
Gene Bra Gene Mechanism of Route of Indications Contraindication Adverse Nursing Responsibility
ric nd ral Action Dosage Reaction/s
Name Na Class
me ificat
ion
Insuli Lev Antid Insulin lowers Subcutane • Treatment of Contraindicated Hypoglyc Assessment
ous
n emir iabeti blood glucose type 1 in patients emia History:
injection
Insu c levels. It diabetes hypersensitive to Allergy to pork
lins regulates mellitus drug and in those products; pregnancy;
carbohydrate, with severe lactation
protein and • Treatment of toxemia, Physical: Skin color,
fat type 2 hypertonic lesions; eyeball turgor;
metabolism diabetes uterine patterns, orientation, reflexes,
by inhibiting mellitus that total placenta peripheral sensation; P,

49
hepatic cannot be previa, and BP, adventitious
glucose controlled by vasoprevia. Also sounds; R; urinalysis,
production diet or oral contraindicated blood glucose
and lipolysis, drugs when Interventions
and • Regular cephalopelvic Ensure uniform
enhancing insulin disproportion is dispersion of insulin
peripheral injection: present; when suspensions by rolling
glucose Treatment of delivery requires the vial gently between
disposal. The severe conversion, as in hands; avoid vigorous
various ketoacidosis transverse lie; in shaking.
insulin or diabetic fetal distress
formulations coma when delivery - Give maintenance
are classified isn’t imminent; doses subcutaneously,
according to • Treatment of and in rotating injection sites
their hyperkalemia prematurity and regularly to decrease
durations of with infusion other obstetric incidence of
action after of glucose to emergencies. lipodystrophy; give
SC Inj. They produce a shift Use cautiously regular insulin IV or IM
are divided of potassium during first and in severe ketoacidosis
into short-, into the cells second stages of or diabetic coma.
intermediate-, labor and in - Obtain baseline and
or long-acting • Highly patients with periodic PFTs for

50
insulin. purified and history of patient using inhaled
Soluble human cervical or insulin; carefully
insulin (also insulins uterine surgery monitor glucose levels
known as promoted for (including when converting from
‘neutral short courses cesarean subcutaneous to inhaled
insulin’ or of therapy section), grand insulin
‘regular (surgery, multiparity,
insulin’) is a intercurrent uterine sepsis, - Monitor patients
short-acting disease), traumatic receiving insulin IV
preparation. newly delivery, carefully; plastic IV
To extend the diagnosed overdistended infusion sets have been
duration of patients, uterus, or reported to remove
action of patients with invasive cervical 20%–80% of the
insulin, poor cancer. insulin; dosage
preparations metabolic delivered to the patient
are control, and will vary.
formulated as patients with
suspensions gestational - Do not give insulin
in 2 methods. diabetes injection concentrated
The 1st IV; severe anaphylactic
method • Insulin reactions can occur.
involves injection

51
complexing concentrated: - Use caution when
insulin with a Treatment of mixing two types of
protein so that diabetic insulin; always draw
it is slowly patients with the regular insulin into
released, e.g. marked insulin the syringe first; if
protamine resistance mixing with insulin
zinc insulin (requirements lispro, draw the lispro
(contains an of > 200 first; use mixtures of
excess of units/day) regular and NPH or
protamine) regular and Lente
and isophane • Glargine insulins within 5–15
insulin (or (Lantus): min of combining them;
NPH insulin Treatment of Lantus insulin (insulin
which adult patients glargine) and Levemir
contains equal with type 2 (insulin detemir) cannot
amounts of diabetes be mixed in solution
protamine and mellitus who with any other drug,
insulin). An require basal including other insulins.
alternative insulin control .
method is of - Carefully monitor
particle size hyperglycemia patients being switched
modification from one type of insulin

52
e.g. insulin • Treatment of to another; dosage
zinc adults and adjustments are often
suspensions. children > 6 yr needed. Human insulins
While all the who require often require smaller
formulations baseline doses than beef or pork
can be insulin control insulin; monitor
administered cautiously if patients
by SC inj, • Detemir are switched; lispro
most by IM (Levemir): insulin is given 15 min
inj, only Treatment of before a meal. Levemir
soluble adults with is given in the evening.
insulin can be diabetes who
administered require basal - Store insulin in a cool
by IV. insulin for the place away from direct
Compared to control of sunlight. Refrigeration
SC inj, IM hyperglycemia is preferred. Do not
admin usually freeze insulin. Insulin
has a faster prefilled in glass or
onset of plastic syringes is stable
action, with a for 1 wk refrigerated;
shorter this is a safe way of
duration of ensuring proper dosage

53
action. for patients with limited
vision or who have
problems with drawing
up insulin.
- Monitor urine or
serum glucose levels
frequently to determine
effectiveness of drug
and dosage. Patients
can learn to adjust
insulin dosage on a
sliding scale based on
test results.

- Monitor insulin needs

during times of trauma
or severe stress; dosage
adjustments may be
needed.

- Monitor fetal heart

rate and maternal BP

54
and pulse at least
q15min during infusion
period; evaluate tonus
of myometrium during
and between
contractions and record
on flow chart. Report
change in rate and
rhythm immediately.
- Stop infusion to
prevent fetal anoxia,
turn the patient on her
side, and notify the
physician if
contractions are
prolonged (occurring at
less than 2-min
intervals) and if
monitor records
contractions about 50
mm Hg or if
contractions last 90

55
seconds or longer.
Stimulation will wane
rapidly within 2–3 min.
Oxygen administration
may be necessary.
- If local or regional
(caudal, spinal)
anesthesia is being
given to the patient
receiving oxytocin, be
alert to the possibility
of hypertensive crisis
(sudden intense
occipital headache,
palpitation, marked
hypertension, stiff neck,
nausea, vomiting,
sweating, fever,
photophobia, dilated
pupils, bradycardia or
tachycardia,
constricting chest pain).

56
 Medical Prognosis

Criteria Poor Fair Good Justification

Onset of the illness ✔

1 day prior to
admission the patient
experienced mild
contractions (RS 2/10)
lasting for 5 minutes.
Hours prior to
admission, the patient
noted vaginal discharge
(minimal) and sought
prenatal consultation.
Upon internal
examination, the patient
was found to be 3 cm
dilated, 30% effaced, S-
3 with an intact bag of
water. Good fetal heart
rate pattern.

Duration of the illness ✔ Occurrence of the

symptoms has been
observed by the patient
1 day prior to
admission.

age ✔ The patient is 28 years

old. We rated it as good
since being pregnant at

57
 20s will not make the
pregnant woman at high
risk, unless they have
other illnesses.

Precipitating and ✔ We rated it fair because

predisposing factors she has gestational
diabetes mellitus. GDM
usually happens to
pregnant women even
though they were not
diagnosed with diabetes
mellitus.

Environment ✔ The room has good

ventilation, not crowded
and quiet.

Family Support ✔ Family support is fair.

The husband shows
love and support to her
wife.

Qualitative Evaluation:

Good 5/6= 0.29 x 100%=83%

Fair 1/6= 0.57 x 100% = 17%
100%

58
Qualitative Analysis:

In determining the prognosis of patient Mrs. J.N. We have evaluated 6 criteria

which include Onset of illness, Duration of illness, Precipitating factors, Age,
Environment and family support. 83% good prognosis, 17% fair prognosis and 0% poor
prognosis which means that Mrs. J.N’s condition is good in the possibility of getting
better if the said criteria are met accordingly.

59
 NURSING CARE MANAGEMENT/ PROBLEM SOLVING

A. Assessment Data Interpretation

The data collected in the study interprets the assessment to determine the
problems according to priority. To implement nursing interventions, the study determines
the nursing problems and then the nursing diagnosis. As stated by the physician, the
patient NSVD. The surgery started around 1:00 PM and ended around 6:00 PM. The
patient was received by the nurse on duty on November 16, 2022 at 7:00 AM lying in
bed. The blood pressure of the patient was 110/70, temperature was 37 C, cardiac rate
was 84, and respiratory rate was 20 cpm. The nurse on duty focused on elevating pain of
the client, providing comfort, encouraging an adequate amount of fluids, and monitoring
the client's psychological state.

B. Identifying Nursing Problems

Problem List

>Labor

Nursing Priorities

60
 Maslow's hierarchy of needs is a diagram that shows the human needs that
must be met for a person to reach full growth and self-actualization. Abraham
Maslow, a psychologist, developed the notion of the hierarchy of needs. The
hierarchy is represented as a pyramid, with the basic requirements at the base
that must be met before an individual can move on to handle more secondary
wants. It is accepted that a person who must battle to exist does not consider or
achieve self-actualization to the same extent as a person whose survival is more
or less assured. The hierarchy of needs illustrates the general evolution of
human activities into the spiritual, the creative, and/or the intellectual after
survival and comfort are guaranteed. Moreover, Maslow was able to understand
both complicated and very fundamental requirements since he examined both
human and animal behavior. He believed that not being able to meet the
demands at the base of the pyramid, which are more basic, would have the
greatest detrimental effect on our psychological health. (Hungtinton, 2021)

Nursing Diagnosis

● Altered Nutrition: More than daily required intake of sugar and glucose.
The client has a high fasted blood sugar in OGTT examination (9.6) FBS.
Having a high sugar level could lead to several complications of the fetus
like; macrosomia, hyperglycemia, and prolonged age of gestation.
● Risk for High Risk Pregnancy. The reason for this is the patient has a
GDM. It could lead to high risk pregnancy since it is dangerous for both
baby and the mother. Immense care and intervention are needed if the
pregnancy leads to severe conditions.
● Knowledge deficit related to disease and insulin use and interaction. The
patient is primigravida, aside from deficient knowledge about caring for
an infant, the mother needs to know the drug interaction and use of the
insulin since the patient has GDM. Lacking knowledge about the
medication could lead to anxiety and complicate the operation.

61
 ● Labor Pains. The patient’s chief complaint is determined to be labor pain
due to mild contractions (RS 2/10) lasting for 5 minutes. As per internal
examination, the patient was found out to be 3 cm dilated, 30% effaced.
This requires the need to make the patient comfortable, keeping her from
pain and stress and the baby from the difficulties.

C. Plan
Setting Goals/ Objectives
This case study aims to develop a nursing care plan and set interventions
in-lined with the nursing diagnosis made. Based on Maslow’s Hierarchy of
needs, Altered Nutrition is placed as physiological needs as it is the cause why
the patient has GDM. Moreover, it could lead to more complicated conditions of
pregnancy. Second is the Risk for High Risk Pregnancy as it is placed in safety
and security. It needs to be intervened since it’s also related to the GDM of the
patient in which the mother and fetus are both at risk. Then we have the
knowledge deficit related to disease and insulin use and interaction. The mother
needs to know the information and have the right education about the disease
and medication to lessen the anxiety and provide sufficient knowledge. Lastly,
labor pains is under physiological needs for the reason that the nursing
interventions will provide the need for rest as part of the physiological needs

62
 NURSING CARE PLAN

Name of Patient:Mrs. Nazareno J. Age: 28 years old Civil Status: Married

Religion: Roman Catholic

Address: 233- A Sto. Nino San Gabriel Stret Buhangin, Davao City Informant: No data Given Relationship: No data
given

Chief Complaint: Labor Pain Medical Diagnosis: _________________________________________

Dat Problem Assessm Nursing Planning Implementation Evaluation

e List ent Diagnosis
Nursing Rationale Reference
Interven
tions

High Risk for After 8 - -Between 24 Goal Partially met. After

Objectiv The nursing 8 hours of nursing
risk high risk hours of Perform and 28 weeks
e Cues: diagnosis intervention, the patient
N pregnan pregnancy nursing a of pregnancy
(ND), Risk was able to:
O cy The related to interventi prenatal is the typical
for high risk Determines what could
V patient gestational on, the screenin time for
pregnancy change blood glucose
E is diabetes patient g test to diabetes
levels.

63
M mellitus as will be identify screening - Verbalized knowledge
diagnos related to of balancing physical
B evidenced able to: gestatio tests, though
ed with gestational and energy requirements.
E by high -Gain nal they can be
GDM diabetes - Verbalized plan of
R fasting Knowled diabetes done earlier if changing risk factors to
mellitus as prevent changes in
blood ge on mellitus. risk factors
evidenced by glucose level.
1 sugar Gestation -monitor are present.
high fasting - Manage their blood
6, al vital After sugar levels at or around
blood sugar
Diabetes signs consuming the normal range.
calls for
2 Mellitus -Provide 50g of an oral
high-risk
0 informat glucose
pregnancy
2 - ion solution, the
Understa care due to
2 regardin woman has a
nd the the
individua g any blood sample
l complication
required drawn for
treatment s that may
regimen changes analysis an
and the arise during
in hour later. A
need for pregnancy
regular diabetic more
glucose and
manage involved,
self- childbirth.
monitorin ment three-hour
g. Mothers with
e.g., use glucose
GDM are
of tolerance test
susceptible
human is performed

64
insulin if the blood
to the
only, glucose level
increased
changin is 130 to 140
risk of pre-
g from mg/dL or
eclampsia,
oral higher.
C-section,
diabetic - Monitor the
and future
drugs to client's
diabetes.
insulin, development,
and self- perform a McIntyre,
monitori physical H.D.,
ng of examination, Catalano, P.,
serum and alert her Zhang, C. et
blood to the first al.
glucose signs of Gestational
levels at labor. An diabetes
least elevated FHR mellitus. Nat
twice a may indicate Rev Dis
day fetal Primers 5,
discomfort. 47 (2019).
Preterm labor
could start as
a result of

65
uterine
contractions.
- A pregnant
diabetic
woman may
monitor her
blood glucose
levels several
times a day
as directed by
a healthcare
provider. The
client not
only must be
skilled in the
techniques
but also
understand
the results
and how to
incorporate
them into the

66
daily
regimen. To
ensure a
successful
pregnancy,
the client
must keep
her blood
sugar levels
as close to
normal as
possible.
- Metabolism
and
maternal/fetal
needs
fluctuate
during
gestation,
requiring
close
monitoring

67
and
adaptation.
The dose and
frequency of
insulin
injections are
tailored to a
woman's
individual
needs. Two-
thirds of
daily insulin
needs are
given before
breakfast and
one-third
before
dinner.

68
 NURSING CARE PLAN

Name of Patient:Mrs. Nazareno J. Age: 28 years old Civil Status: Married

Religion: Roman Catholic

Address: 233- A Sto. Nino San Gabriel Stret Buhangin, Davao City Informant: No data Given Relationship: No data
given

Chief Complaint: Labor Pain Medical Diagnosis: _________________________________________

D Problem Assessme Nursing Planning Implementation Evaluation

at List nt Diagnosis
Nursing Rational Reference
e
Interventions e

Altered Altered
Subjectiv After 8 Establish To gain “The nursing After 8 hours of nursing
Nutritio Nutrition:
e data: hours Rapport the diagnosis (ND), intervention, the patient
N n More
of patient's imbalanced was able to:
O “Sukad than daily Encourage
nursing trust. nutrition: more than
V tong required moderate -Verbalize desire to
interve body requirements
E nabuntis intake of intensity Exercise achieve appropriate
ntion, consists of the intake
M ko sige ra sugar and exercise is an weight
the of nutrients that

69
B glucose.
ko ug patient suitable for integral exceeds metabolic Goal Partially met.
E
kaon will be pregnant part of needs. Excessive
R
tapos able to: mothers. weight weight gain can
wala ko reductio increase postpartum
1 - Assess the
ga- n weight retention, and
6, verbali timing and
exercise” program has a greater
ze content of
as s. association with
2 desire meals
verbalize Moderat gestational diabetes
0 to
d by Instruct on the e- mellitus and
2 achieve
patient importance of a intensity hypertensive
2 appropr
well-balanced physical disorders of
iate
diet activity pregnancy” (Moura,
weight
Objective is safe E. R. F., Valente, M.

data: during M. Q. P., Lopes, M.

pregnanc V. D. O., Damaseno,
Height: - y. A. K. D. C., &
5’3 verbali Evangelista, D. R.,
ze 2012).
Weight:
measur
65 Intention
es
kilograms al eating
necessa
with
ry to

70
BMI: achieve mindful
25.4 and attention
maintai to the
Fasting
n timing
Blood
appropr and
sugar of
iate frequenc
9.6
weight y of
mmol/L
eating
occasion
s could
lead to a
healthier
lifestyle.

A
balanced
diet
supplies
the fuel
your

71
body
needs to
work
effective
ly.
Without
balanced
nutrition,
your
body is
more
prone to
illnesses
such as
heart
disease,
diabetes,
and
cancer.

72
 NURSING CARE PLAN

Name of Patient:Mrs. Nazareno J. Age: 28 years old Civil Status: Married

Religion: Roman Catholic

Address: 233- A Sto. Nino San Gabriel Street Buhangin, Davao City Informant: No data Given Relationship: No
data given

Chief Complaint: Labor Pain Medical Diagnosis: _________________________________________

D Proble Assessme Nursing Planning Implementation Evaluation

at m List nt Diagnosis
Nursing Rationale Reference
e
Interventions

Lack
Subjecti Knowledg After 8 Establish To gain the The nursing After 8 hours of
of
ve data: e deficit hours of Rapport patient's diagnosis (ND), nursing
N Knowl
related to nursing trust. Knowledge deficit intervention, the
O edge Explain that
labor interventio related to disease patient was able
V labor mood
mood and n, the and insulin use, to:
E or

73
M
insulin patient postpartum Monitoring and interaction -Verbalize her
B
use and will be blues are weight takes into account understanding
E Objectiv
interaction able to: normal after changes are the need for proper when clarifying
R e data:
giving birth. important education. Further, about the health
-
BP: to ensure Jasper et. al (2014) teaching.
1 Understan Educate the
108/66 dietary stated that
6, d about client - felt confident in
HR: 91 therapy Insufficient
the health regarding the her ability to leave
RR:19 adequacy knowledge of
2 teaching use and the hospital and
Temp: and insulin use can lead
0 that is action of care for the new
36.1 maintain a to preventable
2 related to insulin. baby
O2 stat weight gain complications,
2 Labor
98 Educate the within the adverse patient Goal Partially
mood.
client on how recommend outcomes, poor met.
Height:
-State to perform ed rates. adherence to
5’3 therapy and
confidence serum
The use of
in her glucose invariably poor
Weight: an insulin
ability to monitoring at glycemic control.
65 pump has
manage home using a Hence, It needs to
kilogra proved of
situations glucometer be addressed.
ms great value
and and the need
for glucose Doenges,
BMI: remain in to record
control in Moorhouse, &

74
25.4 control of readings. pregnant Murr (Eds.).
life before and (2019). Nurse’s
Fasting Instruct the
she is nonpregnan Pocket Guide (15th
Blood client on how
discharged t clients ed.). iGroup press
sugar of to
. with Co., Ltd.
9.6 incorporate
diabetes
mmol/L exercise into
mellitus
her regimen.
and reduces
hypoglyce
mic events.

Self-
monitoring
of blood
glucose
should
initially be
performed
at least four
times daily.

75
Exercise is
another
mechanism
that lowers
serum
glucose
levels and
the need for
insulin

76
D Probl Assessmen Nursing Planning Implementation Evaluation
at em t Diagnosis
Nursing Rationale Reference
e List
Interventions

Labor Labor The nursing

Subjectiv After 5 Establish To gain the After 5 hours of
Pain pain diagnosis (ND),
e data: hours of rapport patient's nursing
N related to Labor pain RT
nursing trust. intervention, the
O Client uterine Monitor uterine contractions
interventi patient was able
V Verbalize contractio Vital signs of Serves as and cervical
on, the to:
E d “ Sakit ns and both Mother the baseline dilation as
client
M akong cervical and Fetus. foundation evidenced by facial report reduced
must be
B tiyan na dilation as of expression of pain, pain at a
able to Encourage
E murag evidenced knowledge distraction manageable level
report the use of
R naga by facial for any behavior, and
that pain comfort Goal Partially
hilab sa expression possible alteration in
is at a measures met.
1 kasakit of pain, changes on respiratory rate
managea such as back
distraction calls for the need to

77
6, behavior. relieve the
apil na sa ble level. leg rub, the
discomfort of the
may likod sacral condition
2 patient. Nurses
banda” pressure, of the
0 have the role of
back rest, client.
2 making the patient
repositioning
2 Promote comfortable,
Objective and or
relaxation keeping her from
data: shower or
and pain and stress and
hot tub.
hygiene the baby from the
Client
periodical which will difficulties.
enhance Ninidze, N. N.,
ly
caresses feelings of Chelidze, G. D.,
wellbeing Davarashvili, D. I.,
the
abdomen and may & Nikolaishvili, T.

when reduce the G. (2006).

contractio need of Georgian medical

ns occur. analgesia or news, (138), 89–93.

anesthesia.
Position
changes
can also
enhance

78
circulation
and reduce
muscle
tension.

79
 NURSING CONCLUSIONS

Health Education

- Patient Assessment:

- The FIRST STEP in patient education is to review the Admission

Assessment for learning needs.

- Then meet with the patient to determine what are specific needs for
that patient.

- Health/Patient Education Should Cover:

- Safe and Effective Use of Medications:

Patients need to know:

● How much to take, when to take it and for how long

● Possible food and drug interactions
● Expected action of the medication and possible side
effects
● What to do if a dose is missed
● Special directions for mixing and administering the
medications
● Proper storage and expiration and disposal.
- Medical Equipment and Supplies:

Patient and/or family member(s) should know how to use any supplies and
equipment that will be needed at home.

- Diet and Nutrition:

Patient/family may need to know:

80
 ● What foods to avoid, especially to prevent food and drug
interactions.
● Special diet instructions
● How to read food labels.
- Rehabilitation:

Patient/family may need to know, depending on patient's physical needs:

● Rehabilitation techniques (example: special exercises, low

sugar diet, and sitz bath)
● Safe and effective use of equipment.
- Pain Management:

Understanding pain and the risk of pain

● How to describe pain

● How pain will be managed
- Personal Hygiene:
● Instructions for bathing and toileting may be needed.
● Perform sitz bath
● Self-care of Perineal area
- Psychosocial:

-Information about possible emotional reactions, interpersonal functioning

or normal feelings secondary to diagnosis or treatment.

-Awareness of Postpartum blues

- Community Resources:

The patient/family may need helpful local resources:

● Health clinic(s)
● Home health care agency
● Support Health Groups from Barangay/LGU

81
- Patient Rights:

All patients or a family member must be informed of their rights with

regard to:

● Informed consent
● Privacy
● Treatment options
● Respect

- Patient Responsibilities:

Patient/family members must be informed of their responsibility to

communicate:

● present complaints
● present illnesses
● prior hospitalizations
● types of medications/alternative treatments that the patient
is using or has used
● other health related issues/concerns
● questions about the diagnosis or care plan.

82
 Discharge Planning for Normal Spontaneous Vaginal Delivery (NSVD)

Exercise

● Instruct clients to balance activities with adequate rest periods.

● Teach the client on proper body mechanics to avoid muscle strain.
● Encourage deep breathing exercise.
● Tell the client to avoid strenuous activities in the early postpartum and take plenty
of rest for the first 2-3 weeks and slowly start with non-impact activities such as
walking and a gradual return to previous activities.

Nutrition

● Advise clients to take a variety of healthy balanced diets.

● Advise clients to take hydrating food such as soup, juicy fruits.
● Tell clients the need to take sufficient caloric intake.

Breastfeeding engorgement

● Encourage clients to breastfeed on both breasts to avoid engorgement.

● Advise women to use warm washcloths or warm showers or place cold
washcloths between feedings to relieve the pain.

Medication

● Instruct clients to follow and take medications prescribed by the physician.

Vaginl pain

● Advise clients to take over the counter medication such as ibuprofen or

acetaminophen for pain.
● Inform the client about the signs of infection such as fever and encourage them to
seek medical attention for persistent, severe pain.

Vaginal bleeding/discharge

83
 ● Advise women to seek medical attention if heavy vaginal bleeding persists.

Hygiene

● Advise clients to do proper perineal care regularly.

● Take showers instead of tub baths. This helps prevent infection.

Call the doctor/health care provider fi:

● You have a fever greater than 100.4°F (38°c) or chills.

● Vaginal bleeding or a smelly discharge
● Vaginal bleeding that soaks more than one menstrual pad per hour.
● Belly pain that is severe or getting worse.
● You have extreme sadness, grief, or feel unable to cope with what has happened
● You have questions or concerns about your condition or care.

84
 Evaluation and Modification

The group was able to come up with understanding with the case presented about
a patient who experienced Normal Spontaneous Vaginal Delivery.

After the case study objectives were met. We are able to:

1. Identify our patient

2. Establish rapport with the patient, family, and significant others.
3. Gather enough information regarding the patient
4. Present significance of the study for the students, and more emphasis on the
nursing education to the patient and family.
5. Present selected terms related to the study
6. Gather review of related literature that would address and emphasize the
importance of the case to be tackled with evidence-based practice.
7. Discuss the anatomy and physiology of the organ and systems involved in the
condition.
8. Determine the etiology, symptomatology, and physiology.
9. Identify the drugs prescribed for the patient’s condition.
10. Present the laboratory results and discussed its significance
11. Provide good medical prognosis with justification as evidence by computation
12. Present the nursing theories applicable to the patient’s condition.
13. Formulate an effective nursing care plan to address the identified problem.
14. Provide health teaching as well as discharge plan for the patient’s progress and
recovery.
15. Provide conclusion and recommendation regarding the client’s condition

85
RECOMMENDATION

PROPOSED OUTCOME AND RECOMMENDATIONS

1. Advise family planning such as long-acting reversible contraceptives, hormonal

contraceptives, or barrier methods.

2. Breastfeed the infant per demand, refrain from bottle fleeting as per advised.

3. Teach the mother the proper way of burping the infant. If the mother is not
knowledgeable enough, advise the mother to attend seminars at barangay health centers.

4. Encourage proper hygienic practices, especially perineal hygiene to the mother.

5. Instruct patient to drink a lot of water

6. Advise to have well balanced diet and adequate rest

To our client’s family:

For the client’s family, teach them to be better equipped in the knowledge of these kinds
of cases, as for them not to be scared. As they say, preparation and learning is the key.
Also this case study aims to stimulate the bonding and importance of the family in
helping someone cope with a current or lingering illness.

To the vulnerable groups:

To serve as a guide to the vulnerable groups in the community and in the public. In
supplying the accurate information and the correct value and also the problems in-line
with NSVD ( Normal Spontaneous Vaginal Delivery). This case study aims to answer the
questions asked by the vulnerable groups within the community.

To the Student Nurses:

Our aim in this case study is to provide information and knowledge to our fellow student
nurses, in the hopes of improving more on our skills and our mindset in situations like

86
this in the future. Also we aim to help further research studies of these diseases, for us to
be better equipped in these kinds of situations in the future.

To the Healthcare Community:

As we all know, in the everyday life routine of nurses and other members of the medical
team they are always on the front lines, responsible for providing their best holistic care
to all their patients. Given that nurses and physicians play an important role in the
healthcare system. We want to motivate and encourage each healthcare professional to be
more involved and compassionate in their chosen profession. Their roles in patient care
include providing essential care during emergencies, providing holistic nursing practices
that manage multiple infections and diseases, playing critical roles in expanding care
services.

87
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