POLYTECHNIC COLLEGE OF DAVAO DEL SUR INC.

8002, McArthur Highway, Brgy. Kiagot, Digos City, Davao del Sur

A CASE STUDY ON NORMAL SPONTANEOUS VAGINAL DELIVERY

In Partial Fulfillment of the Requirement in NCM 109-RLE

Maternal and Child Health Nursing for
The Bachelor of Science in Nursing II

Presented to:
BSN 2 Clinical Instructors

Presented by:
Christian Jhon B. Talingting
Clark Anthony S. Savage
Nathalie Veron A. Sigue
Heither Mae B. Rondina
Jerry Ann N. Sumarinas
Samiel Khair M. Sultan
Crystal Marie P. Puno
Carla Joy M. Serenio
Marie Mae P. Sayta
Wendel S. Villaver
Lorena L. Requina
Wendy Joy Suelto
Samlea L. Sultan

March 2021

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 ACKNOWLEDGMENT

A case presentation is not an easy task to do. It is sacrificing an important event in

your life, giving up some commitment with your family and friends, and submerging yourself
into your work.

For this, the researchers of this nursing case study would like to express their deepest
and heartfelt gratitude to the following contributors in one way or another to help the
researcher in the success of this case presentation and for making this activity possible.

To Mrs. Jennifer P. Ybañez, RN, MAN, Dean of the Nursing Department of the
institution of Polytechnic College of Davao del Sur Inc, for the support and for allowing the
researchers to use the available resources in the department. To Mrs. Marina Lui-Ledesma,
RN, MAN the School Nursing Coordinator, for her attention, wisdom and words of
encouragement. To Mrs. Lesley Ann Miro- Pascual, RN, MAN, for equipping the researchers
with the necessary skills, knowledge, and guidance that helped them be capable in the clinical
field. And also, to the respective clinical instructors Mrs. Irene N. Lopez, RN, MN, Mr.
Jaypee C. Malibiran, RN, and Mrs. Vilma Paramio, RN for guiding the researchers and
sharing their insights and wisdom that helped the researchers to be capable and
knowledgeable for their case study.

To Davao del Sur Provincial Hospital (DSPH), for giving the researchers the
opportunity to get the case of the patient whom was the prospect of the case study.

And most of all, to our Almighty Father for giving them the strength, wisdom,
courage, knowledge and enlightenment to finish this case presentation; to the beloved parents
who have always been supportive all throughout the start of the online blended learning, the
hard work and efforts; to the dear group mates who have been extending all out help and for
being cooperative during the hard times. To the group leader of the case study, Mr. Christian
Jhon B. Talingting, who have always been working in leading to the success of the study, and
the unending efforts in reminding and simplifying the tricky parts of the said case study.

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 TABLE OF CONTENTS

I. Cover Page………………………………………………………………page 1
II. Acknowledgement………………………………………………………page 2
III. Table of Contents………………………………………………………..page 3
IV. Introduction……………………………………………………………..page 4-5
V. Objectives of the Case…………………………………………………...page 6
VI. Identification of the Case ………………………………………………..page 7-9
a.) Personal Data………………………………………………………...page 7
b.) Clinical Data…………………………………………………………page 7
c.) Background History………………………………………………….page 8
d.) Medical History………………………………………………………page 8
e.) History of Present Illness…………………………………………….page 9
VII. Anatomy and Physiology………………………………………………...page 10-24
VIII. Physiology of Pregnancy………………………………………………...page 25-28
IX. Etiology and Symptomatology………………………………………......page 29-30
a.) Predisposing Factors…………………………………………………page 29
b.) Symptomatology……………………………………………………..page 29
X. Medial Management……………………………………………………..page 31-35
a.) Ideal………………………………………………………………….page 31-32
b.) Actual………………………………………………………………...page 32-35
XI. Laboratory Findings……………………………………………………..page 36-39
XII. Nursing Theory…………………………………………………………..page 40-43
XIII. Nursing Assessment……………………………………………………...page 44-47
XIV. Nursing Management…………………………………………………….page 48-69
a.) Nursing Care Plan…………………………………………………....page 48-52
b.) Drug Study…………………………………………………………...page 53-69
XV. Health Teachings…………………………………………………………page 70
XVI. Discharge Plan……………………………………………………………page 71-73
XVII. Prognosis…………………………………………………………………page 74
XVIII. Evaluation………………………………………………………………..page 75
XIX. Implication of the Study………………………………………………….page 76
XX. References………………………………………………………………..page 77-78

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 INTRODUCTION

Labor and delivery are physiological process that begins with the onset of regular
uterine contractions end with the expulsion of the products of conception from uterus.
According to a joint policy, statement on normal childbirth, normal labor is defined as a
spontaneous onset and progress of labor to a spontaneous delivery at 37 to 42 weeks of
gestation with a normal third stage. A normal delivery is defined as spontaneous in onset, is
low risk at the start of labor, and remains so throughout labor and birth. The infant is born
spontaneously between 37 to 42 completed weeks of pregnancy (Wiley Blackwell,
Management of Labor and Delivery, 2nd edition, Published 2019).

Management guided by current knowledge of the relevant screening tests and normal
labor process greatly increases the probability of an uncomplicated delivery and postpartum
course. A woman who is in labor, management should focus on the goal of delivering a
healthy newborn while minimizing discomfort and complications for the mother. Once a
patient has been admitted to the hospital, providing her with continuous emotional support
can improve delivery outcomes and the birthing experience. Research has shown that labor
may not progress as rapidly as historically reported; this should be considered before
intervening for dystocia. Routine episiotomy increases morbidity and should be abandoned.
Once the infant has been delivered, active management of the third stage of labor decreases
the risk of postpartum hemorrhage (Dr. Dale Paterson, American Family Physician Book,
Access 2021).

Among women in United States who are giving birth in 2018, 77.5% began prenatal
care in the first trimester of pregnancy, up from 77.3% in 2017. Late (beginning in the third
trimester) or no prenatal care declined in 2018 to 6.2%, from 6.3% in 2017. By age of
mother, women aged 20–24 and 35–39 were more likely to receive first trimester prenatal
care in 2018 (70.9% and 81.7%, respectively) than in 2017 (70.5% and 81.5%, respectively),
whereas women aged 25–29 and 40 and over were less likely to receive first-trimester care
(77.8% to 77.7% and 78.6% to 78.2%, respectively). Rates for other age groups were
unchanged in 2018. Levels of late or no prenatal care increased for mothers under age 20
(11.4% to 11.7%) and declined for women aged 20–24 (8.2% to 8.1%) and 35–39 (5.0% to
4.9%), but were unchanged for other groups in 2018.Over al, a total of 2, 558, 882 women in

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United States gives a vaginal delivery in year 2018 (National Vital Statistics Online Portal,
2018).

In 2018, PSA claimed that Philippines has a total of 1,668,120 live births were
registered, which is equivalent to a crude birth rate (CBR) of 15.8 or 16 births per thousand
populations. The number of registered live births showed a decreasing trend, noticeably from
2012 to 2018. The decrease in the last six years was 6.8 percent, from 1,790,367 live births in
2012 to 1,668,120 recorded births in 2018. On the average, there were about 4,570 babies
born daily or about 190 babies born per hour or approximately three babies born per minute
(Philippine Statistics Authority, 2019).

Locally, Davao Region has an average of 241 registered babies born daily in the
region. A total of 87,834 live births ware registered in Davao Region in 2018 which is
equivalent to a crude birth rate (CBR) of 17.1 or 17 births per thousand populations. On the
average, there were about 241 registered babies born daily or 10 babies per hour. The number
of registered live births from 2008 to 2016 showed an increasing trend, except in the year
2013. There was a decreasing trend from 2016 to 2018 (Philippine Statistics Authority, 2019)

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 OBJECTIVES

The researchers chose this case to study the importance of normal spontaneous
vaginal delivery since it is very important as future nurses of nation for preparation in the
chosen field. Also, as nursing students, it is required to know the process of labor and
delivery process along with the skills intended for it.

General Goals

The researchers’ general goals are to know the process of pregnancy and normal
spontaneous delivery along with postpartum care and to relate how adolescence years handle
pregnancy or how the young mother responded to a motherhood stage. Also, to know what
are the different factors affecting pregnancy.

Specific Goals

 To know what are the needs of a new mother both physically and emotionally.
 To be efficient in making nursing care plan for a postpartum mother.

Also, to identify what theoretical foundation lies in performing postpartum care.

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 IDENTIFICATION OF THE CASE

A. Personal Data

Name: Patient Marites

Age: 20 years old

Sex: Female

Birthday: December 31, 2000

Birth Place: Sulop, Davao del Sur

Address: Prk.7 Roxas, Sulop Davao del Sur

Religion: Roman Catholic

Nationality: Filipino

Tribe: Cebuano

Civil Status: Single

Occupation: House Wife

B. Clinical Data

Date of Admission: January 26, 2021, @3:50PM

Chief Complaint: Labor Pain

Tentative Diagnosis: G1 P0 Pu 36 1/7 weeks AOG,

premature rupture of membrane to
consider gestational hypertension

Final Diagnosis: G1 P1 via NSVD delivered baby boy

Hospital: Davao del Sur Provincial Hospital

(DSPH)

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 Ward: A4

Attending Physician: Dr. K Zamora Tabanao

Source of Information: Patient Marites’ chart

C. BACKGROUND/HISTORY

Patient Marites, is a 20-year-old female. She is a Filipino, who is a Roman Catholic.

She was born on December 31, 2000. She is a non-smoker and a non-alcoholic person. Her
tribe is Cebuano. She is single and currently not working. Patient already had the Tetanus
Toxoid vaccine x2. It is the first time of patient Marites to be admitted for gravid in the
emergency room. No allergies noted. No history of sexually transmitted infections. No
significance on past medical and surgical history. Her menarche was at age 13 with the length
flow of 7 days for menstrual history. Uncomplicated pregnancy, complied the pre-natal
check-up and laboratories. LMP was on the 15th day of March 2020. The patient and her
family are currently residing at Prk.7 Roxas, Sulop, Davao Del Sur.

D. MEDICAL HISTORY

Patient Marites has no medical history of the following: Allergy, Asthma, Blood
Dyscrasis, Diabetes, Hypertension, Sexually Transmitted Infections, Thyroid Disease,
Cancer, Tuberculosis, Heart Disease, Previous Surgery and Seizure Disorder prior to her
present illness.

E. FAMILY HISTORY

Patient Marites has no family history of the following diseases: Asthma, Cancer,
Diabetes, Medical Disorder, Hypertension and Heart Diseases.

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F. IMMUNIZATION HISTORY

Hepatitis B Tetanus Toxoid

X2

Patient Marites had Tetanus Toxoid x2 for immunization history.

G. HISTORY OF PRESENT ILLNESS

A few hours prior to admission (PTA) on January 26, 2021 at around 3:50pm, there
was a complaint of labor pain with painful contraction with a frequency of every 3-4 minutes.
Thus, prompted the family to bring the client to DSPH. Seen and examined by Dr. Tabanao
with tentative diagnosis of G1 P0 PU 36 1/7 weeks AOG with PROM and to consider
gestational hypertension with BP of 140/90.

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 ANATOMY AND PHYSIOLOGY

Almost all of the human’s organ systems in the body function in an uninterrupted
manner in order to maintain the well-being of an individual. However, there is one system
that differs from the others. The reproductive system appears to “slumber” until puberty,
when reproductive organs become functional (Marieb & Keller, 2019). This means that
among the eleven (11) body systems that humans have; only the reproductive system is
considered inactive and unusable until a certain period where it becomes usable.

The gonads are also considered as the primary sex organs. These are the testes in
males and ovaries in females. These organs produce sex cells, or gametes, and secrete sex
hormones. The remaining reproductive system structures are called the accessory
reproductive organs.

Even though the male and female reproductive systems differ from one another, they
share the common purpose and goal; to continue the existence of mankind by producing

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offspring. The reproductive role of the males is to produce male gametes called sperm or
spermatozoa (singular spermatozoon) and deliver them to the woman’s reproductive tract
through coitus. The females on the other hand, produce female gametes called ova (singular
ovum), or eggs. If the conditions meet, a sperm and an egg fuse to produce fertilized egg,
called zygote. Once fertilization has occurred, the female uterus provides a protective
environment in which the embryo, later called the fetus, develops until birth (Marieb &
Keller, 2019). The sex hormones play an essential role in both the development and function
of the reproductive organs, as well as in sexual behavior and desire or drives. These
hormones also influence the growth and development of many other organs and tissues of the
body.

The reproductive system of the female is much more complex than that of a male. It
does not only produce female gametes, but must also provide nourishment and protection for
the developing fetus all throughout the entire nine-month period called pregnancy. The
bones of the human pelvis form a bowl-shaped cavity that supports the weight of a
developing fetus and encloses the organs of the female reproductive tract (Pillitteri & Flagg,
2017). Two ovaries which are the female gonads produce mature eggs. Leading away from
the ovaries are the fallopian tubes, or oviducts, in which fertilization occurs. The uterus is a
muscular organ with an expandable neck called the cervix. It is where the developing fetus

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houses which leaves the woman’s body through the vagina, or birth canal through a
strenuous process called labor and delivery.

OVARIES

These are seen as oval, almond-shaped organs which are located on either sides of the
uterus. An internal view of an ovary reveals that it consist many sac-like structures called
ovarian follicles. Each follicle consists of an immature egg, called oocyte, which are
surrounded by one or more layers of very different cells called follicle cells. As a developing
egg within a follicle begins to mature, the follicle enlarges and develops a fluid-filled central
region called an antrum. At this stage, the follicle, called a vesicular follicle or Graafian
follicle, is mature and the developing egg is ready to be ejected from the ovary, an event
called ovulation (Marieb & Keller, 2019). Preceding ovulation, the ruptured follicle is
transformed into a very different-looking structure called a corpus luteum which eventually
degenerates. Ovulation generally occurs every 28 days, but in some cases occur more or less
frequently in some women.

Ovaries are composed of cortex (considered as the most functional part, it contains
estrogen and progesterone; medulla (contains nerves and lymphatics); and tunica (the
protective layer). Ovaries secrete estrogen and progesterone varying amounts during a
woman’s reproductive cycle to prepare the uterine lining for pregnancy. Ovarian hormone
secretion gradually decreases to very low levels during the climacteric period.

DUCT SYSTEMS

A. ) UTERINE TUBES

Uterine tubes or the fallopian tubes form the initial part of the duct system.
They are paired tubules responsible for receiving ovulated oocyte and provide a site
where fertilization may occur. Each tube is about ten (10) centimeters long [four (4)
inches] long which extends from an ovary to empty into the superior region of the
uterus. Like the ovaries, the uterine tubes are enclosed and supported by the broad
ligament. Mucosal lining of tubes resemble that of vagina and uterus; therefore

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 infection may extend from the lower organs. There is little or no actual contact
between the uterine tubes and the ovaries (Marieb & Keller, 2019). The distal end of
each uterine tube expands as the funnel-shaped infundibulum, which has finger-like
projections called fimbrae that partially surround the ovary. As an oocyte is expelled
from an ovary during ovulation, the waving fimbriae create fluid currents that carry
the oocyte into the uterine tube, where it begins its journey toward the uterus. The
oocyte then is carried toward the uterus by a combination of peristalsis and the
rhythmic beating of cilia.

FOUR (4) DIVISIONS OF FALLOPIAN TUBES

1. INTERSTITIAL PORTION:
- It runs into the uterine cavity and lies within the uterine wall. It is 1 cm long and
only 1 mm diameter. This is the most dangerous place for an ectopic pregnancy.

2. ISTHMUS
- It is the narrow part of the tube adjacent to the uterus which is 2 cm in length. The
tubal isthmus remains contracted until 3 days after conception to allow the
fertilized ovum to develop within the tube. Isthmus is the one that is clamped in
bilateral tubal ligation (BTL).

3. AMPULLA
- The wider area of the tube lateral to the isthmus where fertilization occurs. It is 5
cm in length and is the most common site of ectopic pregnancy.

4. INFUNDIBULUM
- It is a wide, funnel-shaped terminal end of the tube. It is surrounded by finger-like
processes called fimbrae.

B. UTERUS

It is also known as “the womb”. It is located in the pelvis between the urinary
bladder and rectum. It is a hollow organ that functions to receive, retain, and nourish a

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 fertilized egg. In nulliparous women, its size and shape is the same with that of a pear.
During pregnancy, the uterus grows in size and during the latter part of pregnancy can
be felt well above the umbilicus. The uterus is suspended in the pelvis by the broad
ligament and anchored anteriorly and posteriorly by the round ligaments and
uterosacral ligaments, respectively. Its normal position is anteverted (rotated
forward) and slightly anteflexed (flexed forward) (Pillitteri & Flagg, 2017). Each
month the uterus is prepared for a pregnancy, whether or not conception occurs; that
event is the menstrual cycle.

WALLS OF UTERUS HAS THREE (3) LAYERS

1) ENDOMETRIUM

- The inner layer. It is highly vascular and sheds during menstruation and following
delivery. It is responsive to the cyclic variations of estrogen and progesterone
during the female reproductive cycle.

2) MYOMETRIUM

- The middle layer. It is comprised of smooth muscle fibers running in three

directions. This expels the fetus during birth process, and then contracts around
blood process, which then contracts around blood vessels to prevent hemorrhage.

3) PERIMETRIUM

- (Parietal peritoneum): serous outer layer.

UTERUS HAS 3 DIVISIONS

I. CORPUS:

- It is the upper part of the uterus. The fundus of the uterus is the part of the corpus
above the area where the fallopian tubes enter the uterus.

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 II. ISTHMUS:

- It’s a narrower transition zone, between the corpus of the uterus and the cervix.
During the late pregnancy, the isthmus elongates and is known as the lower
uterine segment.

III. CERVIX:

- It is the tubular neck of the lower uterus and is about 2 to 3 cm long. The os is the
opening in the cervix that runs between the uterus and the vagina. The upper part
of the cervix is marked by the internal os (opens to the isthmus). The external os
of the childless woman is round and smooth. After vaginal birth, the external os
has an irregular, slit like shape and may have tags of scar tissue.

C. VAGINA

The vagina is muscular and membranous thin-walled tube 8 to 10 cm (3 to 4

inches) long. It lies between the bladder and rectum and extends from the cervix to
the body exterior. The vagina connects the uterus above and the vestibule below. The
vaginal lining has multiple folds, or rugae, and a muscular layer that are capable of
marked distention during childbirth. Often called the birth canal, the vagina provides a
passageway for the delivery of an infant and for the menstrual flow to leave the body.
Because of the reason that it receives the penis (and semen) during sexual intercourse,
it is the female organ of copulation. The distal end of the vagina is partially closed by
a thin fold of the mucosa called the hymen. The hymen is very vascular and tends to
bleed when it is ruptured during the first sexual intercourse. However, its durability
varies. In some women, it is torn during a sports activity, tampon insertion, or pelvic
examination. Occasionally, it is so tough that it must be ruptured surgically if
intercourse is to occur. The vagina is lubricated by secretions of the cervix and by of
Bartholin’s glands’.

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 EXTERNAL GENETALIA AND FEMALE PERINEUM

The female reproductive structures that are located external to the vagina are the
external genitalia. The external genitalia, also called the vulva, which includes the mons
pubis, labia, clitoris, urethral and vaginal orifices, and greater vestibular glands.

a. MONS PUBIS (MONS VENERIS):

- Rounded, soft, fatty, and loose connective tissue overlying the symphysis pubis.
Dark, curly pubic hair growths in typical triangular shape begin here one to two
years before the onset of menstruation.

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b. LABIA MAJORA:

- Running posteriorly from the mons pubis are two elongated hair-covered skin
folds, the labia majora, which enclose two dedicate, hair-free folds, the labia
minora.

c. LABIA MINORA:

- Thinner, lengthwise folds of hairless skin, extending from the clitoris to the
fourchette.

d. FOURCHETTE:

- Thin fold of tissue formed by the merging of the labia majora and labia minora,
below the vaginal orifice.

e. VESTIBULE:

- The labia majora enclose a region called the vestibule, which contains the external
openings of the urethra, followed posteriorly by that of the vagina, Skene’s and
Bartholin’s glands; easily irritated by chemicals, discharges, or friction.

a) URETHRA:

- External opening to the urinary bladder.

b) SKENE’S GLANDS:

- Secretes a small amount of mucus; especially susceptible to infections.

c) BARTHOLIN’S GLANDS:

- Located to either side of the vaginal orifice; secretes clear mucus during sexual
arousal; susceptible to infections, as well as cyst and abscess formation.
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 d) VAGINAL ORIFICE AND HYMEN:

- Partial fold of tissue surrounding the opening of the vagina.

f. PERINEUM:

- Muscular, skin covered area between vaginal opening and anus.

i. Underlying the perineum are the paired muscle groups that form the
supportive “sling” for the pelvic organ, capable of great distention during
the birth process.

ii. An episiotomy can be made in the perineum if necessary during the birth
process.

FEMALE REPRODUCTIVE FUNCTIONS AND CYCLES

The production of eggs in women is quite different than that of the production of
sperm in men. The total number or amount of eggs that can be released by a female is already
determined by the time she is born. In addition, the reproductive ability of a female begins
during puberty, heralds at the beginning of her menstrual cycle, and usually ends in her
fifties. The period in which a woman’s reproductive capability ends is called menopause.

 OOGENESIS AND THE OVARIAN CYCLE

Meiosis, the special kind of cell division that occurs in the testes to produce
sperm, also occurs in the ovaries. But in this case, ova or female gametes are
produced, and the process is called oogenesis. In the developing female fetus,
oogonia, the female stem cells, multiply rapidly to increase their number, producing
daughter cells called primary oocytes. These primary oocytes then push into the
ovary connective tissue, where they become surrounded by a single layer of cells to

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ultimately form the primary follicles. By birth, oogonia no longer exist, and a
lifetime supply of primary oocytes by women (approximately 1 million of them) is
already in place in ovarian follicles, awaiting a chance to undergo meiosis in order to
produce functional eggs. Because primary oocytes remain in this state of suspended
animation throughout childhood, their wait is a long one, usually between 10 and 14
years.

At puberty, the anterior pituitary gland begins to release FSH (follicle

stimulating hormone) which stimulates a small number of primary follicles to grow
and mature every month, and ovulation begins every month. These cyclic changes that
occur monthly in the ovary constitute the ovarian cycle. At puberty, perhaps 300,000
oocytes remain; and, beginning at this time, a small number of oocytes are activated
every month. Since the reproductive life of a female is approximately 40 years (from
the age of 11 to approximately 51), and there is usually only one ovulation event per
month, less than 500 ova out of a potential 300,000 ova are released during her
lifetime. Again, nature has provided us with a generous oversupply of sex cells.

As the follicle produced by FSH grows larger, it accumulates fluid in the

central chamber called the antrum, and the primary oocyte contains replicates of its
chromosomes, and meiosis begins. The first meiotic division produces two cells that
are very dissimilar in size. The larger cell is a secondary oocyte and the other, very
tiny cell is a polar body (Marieb & Keller, 2019). When the follicle has matured to a
mature (vesicular follicle) stage, it contains a secondary oocyte and protrudes from
the outer surface of the ovary. The development of the follicle at this stage takes about
14 days, and ovulation (secondary oocyte) occurs at just about the time in response to
the burst-like release of the second anterior pituitary hormone, the luteinizing
hormone (LH). The ovulated secondary oocyte is still surrounded by its follicle-cell
capsule, now called the corona radiata (“radiating crown”).

Some women have a twinge of abdominal pain in the lower abdomen when
ovulation occurs. This phenomenon, called Mittelschmerz (German for "Middle
Pain"), is caused by the intense stretching of the ovarian walls during ovulation.

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 Generally speaking, one of the developing follicles outstrips the others each
month to become the dominant follicle. It is not understood how this follicle is
selected or chosen, but the follicle that is at the proper stage of maturity when the LH
level rises is the one that ovulates its oocyte. Mature follicles that are not ovulated
soon become overripe and deteriorate. In addition to playing a major role in triggering
ovulation, LH also causes the ruptured follicle to change to a very different hormone-
producing structure, the corpus luteum. Both mature follicles and corpus luteum
produce hormones.

If the ovulated secondary oocyte is fertilized by a sperm in one of the uterine

tubes, the oocyte quickly completes the second meiotic division that produces the
ovum and the other polar body. Once the ovum is formed, its 23 chromosomes are
combined with those of the sperm to form the zygote. However, if the sperm does not
penetrate the secondary oocyte, it simply deteriorates without meiosis to form a
functional egg. Although meiosis in males results in four functional sperm, in
females, meiosis yields only one functional ovum and three small polar bodies. Polar
bodies, produced to reduce the number of chromosomes in the developing oocyte, do
not have a cytoplasm, so they die quickly. Another major difference between male
and female gametes is the size and structure of these cells. The sperms are tiny and
equipped with locomotive tails. They have little cytoplasm-containing nutrient;
therefore, the nutrients in seminal fluid are vital to their survival. The egg, on the
other hand, is a large, non-motile cell, well stocked with nutrient reserves that nourish
the developing embryo until it can reside in the uterus.

 HORMONE PRODUCTION BY THE OVARIES

As the ovaries become active at puberty and start to produce oocytes, they also
begin to produce ovarian hormones. The follicle cells of the growing and mature
follicles produce estrogens, which cause the appearance of the secondary sex
characteristics in the young woman (Marieb & Keller, 2019). Such changes include
the following:

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  Enlargement of the accessory organs of the female reproductive system
(uterine tubes, uterus, vagina, external genitals)
 Development of the breasts
 Appearance of the axillary and pubic hair
 Increased deposits of fat beneath the skin in general, and particularly in
the hips and breasts
 Widening and lightening of the pelvis
 Onset of menses, or the menstrual cycle

Estrogen has metabolic effects, too. For example, it helps maintain low overall
blood cholesterol levels (and high HDL levels) and facilitates the uptake of calcium
ion, which maintains bone density.

The second ovarian hormone, progesterone, is produced by the glandular

corpus luteum. After ovulation, the destroyed follicle is converted to the corpus
luteum, which looks and acts completely different from the growing and mature
follicle. Once formed, the corpus luteum produces progesterone (and some estrogen)
as long as LH remains present in the blood. Generally speaking, corpus luteum stops
producing hormones 10 to 14 days after ovulation. Apart from working with estrogens
to establish a menstrual cycle, progesterone does not contribute to the appearance of
secondary sex characteristics, its other major effects are exerted during pregnancy and
the breasts are prepared for milk production. However, the source of progesterone
during pregnancy is the placenta, not the ovaries.

 UTERINE (MENSTRUAL) CYCLE

Although young embryo implants develop in the uterus, the organ is receptive
to implantation only for a very short period of time each month. Not surprisingly, this
brief interval coincides exactly with the time when a fertilized egg would start
implanting, approximately 7 days after ovulation. The uterine cycle, or menstrual

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cycle, is a series of cyclical changes that the endometrium (uterine mucosa)
undergoes every month as it responds to changing blood levels of ovarian hormones.

The cyclic production of ovarian estrogens and progesterone is, in turn,

regulated by the anterior pituitary gonadotropic hormones FSH and LH. It is
important to understand how these “hormonal pieces” fit together (Marieb & Keller,
2019). Generally speaking, both female cycles (the ovarian and uterine cycles) are
approximately 28 days long. Ovulation usually occurs in the middle of a cycle, on or
about day 14.

The three phases of the menstrual cycle are as follows:

 Days 1-5: Menstrual Phase

- During this interval, the superficial functional layer of the thick

endometrial lining of the uterus is sloughed off (detached) from the uterine
wall. Detached tissues and blood pass through the vagina as a menstrual
flow (“period”) for 3 to 5 days. The average blood loss during this period
is between 50 and 150 ml (or about 1⁄4 to 1⁄2 cup). By day 5, growing
ovarian follicles are starting to produce more estrogens.

 Days 6-14: Proliferative Phase

- Stimulated by a rising level of estrogens produced by growing ovarian

follicles, the basal layer of the endometrium regenerates the functional
layer, the glands form and the endometrial blood supply increases. Once
again, the endometrium is velvety, thick, and well vascularized. Ovulation
occurs in the ovary at the end of this stage, in response to the sudden surge
of LH in the blood.

 Days 15-28: Secretory Phase

22
 - Increased levels of progesterone production by corpus luteum affect the
estrogen-primed endometrium and increase its blood supply even more.
Progesterone also causes the endometrium glands to grow and begin to
secrete nutrients into the uterine cavity. These nutrients will support the
development of the embryo (if one is present) until it has been implanted.
If fertilization occurs, the embryo produces a hormone very similar to LH
that causes the corpus luteum to continue producing its hormones.

If there is no fertilization, the corpus luteum begins to degenerate towards the

end of this period as the blood level of LH decreases. The lack of ovarian hormones in
the blood causes the blood vessels that supply the functional layer of the endometrium
to go into spasms and kinks. These endometrial cells begin to die when they are
deprived of oxygen and nutrients, which sets the stage for menses to begin again on
day 28.
Although this explanation assumes a classical 28-day cycle, the length of the
menstrual cycle is quite variable. It could be as short as 21 days or as long as 40 days.
Only at interval is fairly constant in all females-the time from ovulation to the
beginning of menses is almost always 14 or 15 days.

 MAMMARY GLANDS

The mammary glands are present in both sexes, and normally only in
women. Because the biological role of the mammary gland is to produce milk to feed
a newborn baby, it is only important when reproduction has already been achieved.
Stimulation of female sex hormones, in particular estrogens, causes female mammary
glands to increase in size at puberty.

The mammary glands are modified sweat glands that are part of the skin. Each
mammary gland is contained within a rounded skin-covered breast anterior to the
pectoral muscles. A pigmented area, the areola that surrounds the central protruding
nipple, is slightly lower than the center of each breast.

23
 Internally, each mammary gland consists of 15 to 25 lobes that radiate around
the nipple. The lobes are padded and separated from one another by connective tissue
and fat. Within each lobe are smaller chambers called lobules, which contain clusters
of alveolar glands that produce milk when a woman is lactating (producing milk).
Milk produced by the alveolar glands exits each lobule by passing into lactiferous
ducts, which open to the outside at the nipple. Just deep to the areola, each duct has a
dilated region called a lactiferous sinus, where milk accumulates during nursing
(Marieb & Keller, 2019).

24
PHYSIOLOGY OF PREGNANCY

25
26
27
28
29
 ETIOLOGY AND SYMPTOMATOLOGY

A.) ETIOLOGY

Predisposing
Present Absent Justification
Factor

Women can get pregnant and bear children

from puberty when they start getting their
menstrual period to menopause when they stop
getting it. The average woman’s reproductive
Age 
years are between ages 12 and 51.

Watson, S, (2018), When can you get pregnant

and what’s the best age to have a baby

B.) SYMPTOMATOLOGY

Symptoms Present Absent Justification

Lightening  Settling or descent of the fetal presenting

part into the pelvic brim two weeks before
delivery in primigravida.

Increased level of  Increase in activity is due to an increase in

activity epinephrine release initiated by the decrease
in progesterone by the placenta.

Ripening of the  An integral or sure sign seen only in pelvic

cervix

30
 examination.

Bloody show  (Pinkish vaginal discharge) the mucus plug

that filled the cervical canal during
pregnancy is expelled.

Rupture of  Experience as either a sudden gush or scanty,

membranes slow seeping of clear fluid from vagina.

Uterine contraction  The surest sign that labor has begun with the
initiation of effective, productive,
involuntary uterine contraction.

Contraction  Regular increase in frequency, intensity, and

duration

Pain/discomfort  Back the radiates to the abdomen , not

relieved by walking

Dilation  Full cervical dilation with intact bag of

water.

31
 MEDICAL MANAGEMENT

A. Ideal

Pregnancy tests and ultrasounds are the only ways to determine if you’re pregnant,
there are other signs and symptoms you can look out for. Diagnosis of pregnancy can be
achieved within the day of missing a menstrual bleed by identifying a rise of concentration of
urinary chorionic gonadotropin.

Diagnostic Test:

 Pregnancy Test (PT)

A pregnancy test works by measuring the amount of hormone in your urine (pee)
called human chorionic gonadotropin (HCG). HCG levels increase during pregnancy. It is
released when a fertilized egg attaches itself to the lining of the uterus. If the pregnancy test
results are positive, it means you’re pregnant. If the results are negative it means you are not
pregnant.

 Blood Test

Blood test can determine if you are pregnant about six to eight days after ovulation.
There are two types of blood test to check for pregnancy the Doctors use. Quantitative blood
test (beta hCG) measures the exact amount of hCG in your blood. It can find even very low
levels of hCG. Qualitative test detects whether hCG is present or not.

 Ultrasound

Ultrasound scan is a test that uses high-frequency sound waves to make pictures of the
internal organs. Screening ultrasound is done during a pregnancy to check normal fetal
growth and make sure of the due date. This test may be done at various times throughout

32
pregnancy. There are two types of ultrasounds can be done during pregnancy: Abdominal
ultrasound and Transvaginal ultrasound.

 Doppler ultrasound

Doppler ultrasound is a noninvasive test that can be used to estimate the blood flow
through your blood vessels by bouncing high-frequency sound waves (ultrasound) off
circulating red blood cells. Doppler ultrasound may help diagnose many conditions,
including: Blood clots, poorly functioning valves in your leg veins, which can cause blood or
other fluids to pool in your legs (venous insufficiency).

 Amniocentesis

Amniocentesis is a test that takes a small sample of the amniotic fluid. This test is
done to diagnose chromosome problems and open neural tube defects (ONTDs) such as spina
bifida. Amniocentesis can also look for other genetic problems and disorders if you have a
family history of them.

 Fetal Monitoring

During late pregnancy and during labor fetal monitoring can be done, your healthcare
provider may want to watch the fetal heart rate and other functions. Fetal heart rate
monitoring is a way of checking the rate and rhythm of the fetal heartbeat. Average fetal
heart rate is between 110 and 160 beats per minute. It may change as the fetus responds to
conditions in the uterus.

B. Actual

Date and Time Orders Rationale

Ordered
January 26, 2021  Admit patient to Emergency  To monitor closely and to
Room ensure that client’s concern
will be addressed
immediately with proper

33
 interventions.

 Secure consent  To establish rapport between

the healthcare provider and
client by ensuring
understanding and to give
approval to medical
treatment.
 V/S q4
 To have baseline data and to
monitor the client health
status/stability.
 Dx:

- CBC
 To evaluate overall health
and detect a variety of
disease and conditions that
- UA affects blood cells.

 To confirm diagnosis and to

identify the bacteria that
may cause infection.
- HbSAg Particularly in the urine.

 To determine if patient is
- CXR infected or positive with the
hepatitis B virus.

 IVF:  To detect problems with

- No.1 D5LR 1L + 10 your heart and lungs.
units Oxytocin
@15gtts/min.  For Fluid and electrolyte
- No.2 D5LR 1L + 10 replacement and easy IV
units Oxytocin access for medication.
@20gtts/min.
 Oxytocin is used to begin or
improve contractions
during labor and to reduce
bleeding after childbirth.
 Medications:
- HNBB 1 ampule
IVTT now then q6
 To reduce duration of labor
by accelerating cervical
dilatation without major side
effects. It also reduces
spasm of the smooth
- Ampicillin 2gm now muscles.
then q6

34
  An antibiotic to treat or
prevent many different types
- Metronidazole 500mg of infections such as bladder
IVTT now then q12 infection.

 Use for the treatment of

possible bacterial and
parasitic vaginal infection.

- Gentamycin 240mg
IVTT then OD

 Use to prevent and treat

wide variety of bacterial
infections. It works by
stopping the growth of
bacteria.
January 27, 2021  V/S q4  To have baseline data and to
monitor the client health
status/stability.
 IVF:  For Fluid and electrolyte
11:40 - D5LR 1L PPO+ 10 replacement and easy IV
units Oxytocin access for medication.
1:41 pm - D5LR 1L @120cc/hr

 Continue Meds  To reduce duration of labor

- HNBB 1 ampule by accelerating cervical
IVTT q6 dilatation without major side
effects. It also reduces
spasm of the smooth
muscles.

- Ampicillin 1grm
IVTT q6 (-) ANST  An antibiotic to treat or
prevent many different types
of infections such as bladder
infection.
- Metronidazole 500mg
IVTT q12 (6am-6pm)  Use for the treatment of
possible bacterial and
parasitic vaginal infection.
- Gentamicin 240mg
IVTT OD (6am)  Use to prevent and treat
wide variety of bacterial
infections. It works by
stopping the growth of
bacteria.
January 28, 2021  V/S q4  To have baseline data and to
monitor the client health

35
 status/stability.
 Follow up UA
 To check for possible
bacterial infection.
 Postpartum order:
-IVF D5LR @ 120cc/hr  For Fluid and electrolyte
number 1&2 replacement and for easy
access of medication.
 Home Medications ordered:
- Cefuroxime 500 mg  Use to treat the symptoms of
tab BID X 7 days PO bacterial infection.
- Fe SO4 (Fersulfate
Iron) 300 mg BID  To treat or prevent low
blood levels of iron such as
anemia and during
pregnancy.
- Ascorbic Acid (Poten-
Cee) 500mg OD  To treat low levels of
vitamin C and for faster
- Mefenamic Acid 500 absorption of iron.
mg q 8 hrs. PRN for
 For postpartum pain as
pain
needed

LABORATORY FINDINGS

 CHEST X-RAY (PA)

36
FINDINGS: HEART SIZE IS WITHIN NORMAL LIMITS. BOTH LUNGS ARE CLEAR
OFINFILTRATES SULCI ARE INTACT.

IMPRESSIONS: NEGATIVE CHEST

 ULTRASOUND RESULT

EXAMINATION: PELVIS

- Within the gravid uterus is a single fetus in cephalic presentation.

- The following parameters are:

BPD: 8.8 cm= 35 weeks and 5 days

HC: 31.1 cm= 34 weeks and 5 days

AC: 30.7 cm= 34 weeks and 5 days

FL: 6.7 cm= 34 weeks and 4 days

- Average AOG is 35 weeks and 2 days.

- The EDC b ultrasound is on February 22, 2021+/- 2weeks.

- The estimated fetal weight at this time is 2,505 grams.

- Real time scan reveals active fetal movements and cardiac rhythm. The FHT is
144 BPM. The stomach and the urinary bladder are fluid-filled indicating
orogastric patency and functioning kidneys. No definite gross fetal deformities.
No nuchal cord coil seen at this time of scan.

- The placenta is implicated anteriorly and away from the cervical os. It has
maturity echopattern of grade II. Amniotic fluid is adequate. AFI is 12.8 cm.

- Female genital is noted.

37
IMPRESSION:

• SINGLE, LIVE, INTRAUTERINE PREGNANCY IN CEPHALIC

PRESENTATION WITH COMPOSITE AOG OF 35 WEEKS AND 2 DAYS BY BPD,
HC, AC, AND FL MEASUREMENTS.

• NORMOHYDRAMNIOS

 HEMATOLOGY

NORMAL
CBC RESULT FINDINGS JUSTIFICATION
RANGE
The result appears to be
Hemoglobin 127 115-155 N within the normal range.

A high hematocrit t can

indicate dehydration, a
disorder such as
Hematocrit 35.6 0.36-0.48 H polycythemia vera that
causes your body to
produce too many red blood
cells. Lung or heart disease.
Low red blood cell may
RBC 4.09 4.20-6.10 L
result to anemia.
A high WBC count may
signify an infection
somewhere in the body or
WBC 11.02 5.0-10.0 H
less commonly, it may
signify an underlying
malignancy.
Having a high percentage
of neutrophils in your blood
is called neutrophilia. This
is a sign that your body has
an infection. Neutrophilia
55.00-
NEUTROPHIL 7.83 H can point to a number of
75.00
underlying conditions and
factors, including:
infection, most likely
bacterial. Non-infectious
inflammation.
LYMPHOCYTE 2.86 20-35 L The result appears to be
S lower than the normal
range.
When lymphocytes is lower
than the normal range

38
 referred to as lymphopenia.
Low levels
of monocytes tend to
develop as a result of
medical conditions
that lower your overall
MONOCYTES 0.04 2-10 L
white blood cell count or
treatments for cancer and
other serious diseases that
suppress the immune
system.
NORMAL
CBC RESULT FINDINGS JUSTIFICATION
RANGE
Low eosinophil count can
be the result of intoxication
from alcohol or excessive
EOSINOPHIL 0.28 1-8 L
production of cortisol, like
in Cushing's disease.

The result is within the

BASOPHIL 0.01 0-1 N
normal range.
Having a high percentage
of neutrophils in your blood
NEU% 71.1 50.0-70.0 H is called neutrophilia. This
is a sign that your body has
an infection
Result is within the normal
LYM% 26.0 20.0-40.0 N
range.
May indicate the presence
of chronic infection, an
MON% 0.3 3.0-12.0 L
autoimmune or blood
disorder.
The result is within the
EOS% 2.5 0.5-5.0 N
normal range.
The result is within the
BAS% 0.1 0.00-0.10 N
normal range.
PLATELET The result is within the
237 150-400 N
COUNT normal range
25.60- The result is within the
MCH 31.0 N
32.20 normal range.
32.20- The result is within the
MCHC 356 N
35.50 normal range.
79.40- The result is within the
MCV 87.0 N
94.80 normal range.
25.60- The result is within the
MCH 31.0 N
32.20 normal range
RDW-SD 42.7 39-46 -If your score is outside this
range you could have a
nutrient deficiency,
infection other disorder.
39
 Even at normal RDW levels
H you may still have a
medical condition.
The result is within the
RDW-CV 12.7 11.5-15.4 N
normal range

NURSING THEORIES

VIRGINIA HENDERSONS’ “THE NATURE OF NURSING MODEL”

40
 Virginia Henderson took a temporary job caring for World War I wounded and ended
up helping to elevate nursing into a respected and independent profession is a renowned
researcher, teacher and scholar .One of the fundamental provisions of Virginia Henderson is
obtaining Magnet status is that the organization must show evidence of the use of a nursing
conceptual framework or theory of nursing in practice wherever nursing care is provided.
This is not necessarily an easy notion to put into practice, especially for settings such as in
childbirth education, where the “patient” comes to the setting experiencing a normal life
event of pregnancy and birth. Henderson’s definition of nursing lends itself to use in
childbirth education because it acknowledges that help is given to the well person that needs
to gain knowledge to maintain health and function independently.

As part of Henderson’s theory she enumerated 14 components that make up the basic
nursing care (fundamental needs), which are as follows:

1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes; dress and undress
7. Maintain body temperature within a normal range by adjusting clothing and
modifying the environment
8. Keep the body clean and well-groomed and protect the integument
9. Avoid dangers in the environment and avoid injuring others
10. Communicate with others in expressing emotions, needs, fears, or opinions
11. Worship according to one’s faith
12. Work in such a way that there is a sense of accomplishment
13. Play or participate in various forms of recreation
14. Learn, discover, or satisfy the curiosity that leads to normal development and health,
and use the available health facilities

The first 9 components are physiological. The tenth and fourteenth are psychological
aspects of communicating and learning. The eleventh component is spiritual and moral. The
twelfth and thirteenth components are sociologically oriented to occupation and recreation.

41
 For nurses or childbirth educators using this theory, she asserts that the practitioner
must be able to assess the patient’s or client’s needs in these 14 areas, and be able to provide
care (Henderson, 1978; Pokorny, 2010).

The major assumptions of the theory are as follows:

 Nurses care for patients until they can care for themselves once again. Patients desire
to return to health.
 Nurses are willing to serve and that nurses will devote themselves to the patient day
and night.
 Nurses should be educated at the university level in both arts and sciences.

This theory focuses on the importance of increasing the patient's independence to

hasten their progress in the hospital. Henderson's theory emphasizes on the basic human
needs, especially in the case of Ms. Marites as she is in labor and delivery as well as taking
part in postpartum stage and how nurses can assist in meeting those needs.

HELEN C. ERICKSON, EVELYN M. TOMLIN, MARY P. SWAIN’S “THE

MODELING AND ROLE-MODELING THEORY”

The Modeling and Role Modeling Theory (MRM Theory) was concertedly developed
by Helen Cook Erickson, Evelyn M. Tomlin, and Mary Ann P. Swain. The basis of this
theory is always to focus on the person receiving nursing care-not on the nurse, not on the
care, not on the disease. The concept of modeling a person’s world is credited to Milton H.
Erickson, MD who was father in-law of Helen Erickson.

Development and utilization of self-care knowledge and self-care resources is known

as self-care action. “Through the self-care action the individual mobilizes internal resources
and acquires additional resources that will help the individual gain, maintain and promote an

42
optimal level of holistic health”. (Erickson, Tomlin, and Swain, 1983, p.49). The theorists
believe that individuals who have a high level of need satisfaction have a greater ability to
positively cope with life’s stressors and to achieve a state of equilibrium. As patient Marites
is having her first baby, she will have a greater satisfaction to cope up easily the situation she
had. Considering the importance of nurse’s role in regards to postpartum stage as of her age,
she needs a balance of everything that is directly catered in this theory. Taking part her role
as a mother from her situation that basically acknowledge her self-care knowledge and also
her resources that leads to action steps for optimal health and assurance of good parenting.

In summary, the Modeling and Role Modeling Theory suggest an interactive,

interpersonal role for nursing. Modeling is the process used to develop an understanding of
client’s world; role-modeling is the process of facilitating health-promoting behaviors.

RAMONA T. MERCER’S MATERNAL ROLE ATTAINMENT THEORY

The Maternal Role Attainment Theory was developed to serve as a framework for
nurses to provide appropriate health care interventions for non-traditional mothers in order
for them to develop a strong maternal identity. This mid-range theory can be used throughout
pregnancy and post-natal care, but is also beneficial for adoptive or foster mothers, especially
in the case of Ms. Marites who is a 20 year-old pregnant for the first time. She needs
knowledge in terms of labor and delivery process especially in the postpartum stage as a
mother’s will initiate gradual action towards their child and she needs to make transition
phase from teenage mindset to mother’s mindset. The process used in this nursing model
helps the mother develop an attachment to the infant, which in turn helps the infant from a
bond with the mother.

This helps develop the mother-child relationship as the infant grows since the primary
concept of this theory is the developmental and interactional process, which occurs over a
period of time. In the process, the mother bonds with the infant, acquires competence in
general caretaking task, and then comes to express joy and pleasure in her role as a mother.

43
 NURSING ASSESSMENT

Date of Assessment: 01/28/2021

44
Time of Assessment: 8:00am

Location of Assessment: Davao del Sur Provincial Hospital

Vital Signs

Temperature 36.5˚C

Heart Rate 81 bpm

Respiratory Rate 21 cpm

Blood Pressure 100/80 mm/Hg

REVIEW OF SYSTEM:

NEUROLOGICAL

The patient is alert and oriented to person, place, and time with normal speech. No

motor deficits are noted.

EYE/VISION

Both eyes have no discharges and discolorations, eyelids close symmetrically, no

discharges and discoloration. Blinks voluntarily and bilaterally; Eyes are able to move freely.
There was no edema or tenderness noted over her lacrimal glands. Pupils are equal in size
and equally reactive to light and accommodation, with pink conjunctiva. Patient can see
objects clearly with no difficulty.

NOSE

External nose is symmetrical, straight and with the same skin color of the face.No
tenderness, masses or underlying deviation and no discharges. Nasal structures are firm and
stable.

45
 MOUTH/TONGUE/TEETH/SPEECH

There were no lesions and masses noted on the lips. Tongue was located at the mid
line and was able to move her tongue freely. The gums have no signs of bleeding. Patient has
no speech or communication problems.

THROAT/NECK

Neck is symmetrical with head on the center. Her neck movement was coordinated
and no stiffness or difficulty in moving was noted. No neck vein distension noted. The
trachea is in the mid line. No lymph nodes were palpable. No neck masses or lesions
palpated. Neck has some presence of dark discoloration.

RESPIRATORY SYSTEM

The patient has regular breathing pattern and with respiratory rate of 21 cpm. The
chest expansion is symmetrical.

CIRCULATORY/CARDIOVASCULAR

The patient has a cardiac rate of 81 bpm. Presence of abnormal heart sounds were not
noted upon auscultation. The patient’s blood pressure is 100/80 mm/Hg which is in normal
range.

GASTROINTESTINAL

Abdomen is round; no mass or lesions. Uterus is well contracted and globular, the
fundus is firm and at the level of umbilicus. Mild uterine cramping or discomfort noted. No
discomfort during defecation; no feeding difficulties. Normal bowel sound present upon
auscultation.

GENITOURINARY

No difficulty in urinating and has normal bladder sensation; color of the urine is
yellow. There is a moderate lochia rubra with no foul smell. The patient still experiencing

46
perineal pain and there is an absence of discharge from the episiotomy or laceration. Sutures
are intact; no bulging or swelling.

MUSCULOSKELETAL

The patient’s radial and brachial pulses were regular. Reports of postpartum afterpains
were noted. No presence of deformities. Range of Motion (ROM) is limited due to afterpains
and weakness.

INTEGUMENTARY

The patient’s skin has a presence of dark discoloration over the armpits and neck; skin
has good skin turgor. Fine hairs are evenly distributed on both extremities. No skin rashes,
presence of edema, mass, or lesions on the body. There is a presence of striae or stretch
marks over the abdomen and legs.

OBSTETRICAL

G1P1 36 1/7 weeks AOG and patient had a Normal Spontaneous Vaginal Delivery.
There are complains of mild postpartum after-pains noted with no occurrence of any
infections. No bleeding; sutures are intact; no bulging or marked swelling. Breast is soft with
colostrum present, no evidence of cracks or bruising. Feeding techniques for newborn is good
and improving. No current risk for postpartum complications.

PRESENT BEHAVIOR

47
 Patient is overwhelmed because it is her first time to have a baby. She keeps sharing
about her labor and delivery experience. She also feels tired, want more rest and passive and
still needs help in childcare.

NURSING CARE PLAN

48
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DRUG STUDY

53
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HEALTH TEACHING

70
 PRIMARY

 Instructed the patient to increased fluid intake. This is to properly stay hydrated.
 Advised patient for treatment regimen such as some diet restrictions, mild exercise and
proper hygiene for patient’s well-being.
 Encourage the patient to verbalize feeling of discomfort.
 Emphasize to the patient the right timing or taking and the right time intervals of the drug
to maximize its effects and avoid further complications.

SECONDARY
 Emphasized to the significant others the importance of proper hygiene and having a
hygienic environment for the patient.
 Inform significant others the consequences of noncompliance of treatment regimen.
 Encourage the significant others to provide physical and emotional support to the client.
 Advised the significant others to help or attend the patient needs.

TERTIARY

 Prior to patient’s discharge, advise the patient or significant others for strict compliance
of medications and all laboratory exams that are needed.
 Encouraged patient to have a follow up check up to a physician after discharge (if
discharged) to assess general physical condition and progress of involution.
 Advised patient to go to go back to the hospital if there is any complications to seek for
necessary intervention to her needs.

DISCHARGE PLAN

71
Medication

 Educate mother and family the importance of taking the prescribed medicine at the
right time and right frequency.
 Explain the purpose of medication to the mother for further knowledge.
 Emphasize the importance of taking the full course of the medication and for the fast
recovery.
 Encourage the mother to take pain relief and antibiotics medications prescribed by the
doctor to lessen discomfort.
 Explain to the mother the side effects and adverse effects of the drugs the patient is
taking by prescribing its manifestation.

Exercise/Environment

 Encouraged the mother to let the baby adequate rest and sleep.
 Emphasize the importance of ambulation and the gradual resume of the mother’s
normal daily activities.
 Encourage to have regular exercise beginning with mild, like walking, stretching and
other forms of activities that would help maintain joint mobility and enhance
circulation.
 Emphasize the benefits of regular exercise that help improve muscle tone and
mobility.
 Encourage to avoid strenuous activities such as heavy lifting.
 Encourage the mother and the family to have clean environment to avoid acquiring
disease that comes from having contaminated surroundings.
 Advise the significant others to give the mother and child a comfortable and quiet
environment to stay in.

Treatment

 Instruct the mother about patient condition, compliance with the medication and
attend follow up check-up and continue medication at home.

72
 Remind the family to always assess the patient’s needs.
 Advise patient to go to their near RHU if patient feel sick or patient develop
complication in her condition.
 Discussed to the patient’s family the complication of the condition because
knowledge about the condition supports learning that will decrease deficit and
anxiety.

Hygiene

 Encouraged the mother to maintain cleanliness of the house, surrounding and provide
a well ventilated area to prevent risk from infection.
 Encourage mother and family to maintain good hygiene of mother and baby by
having a daily bath, clean clothes and keeping the baby supplies sterilized.
 Perform hand washing before handling the baby to prevent transfer of germs and
infections.
 Encourage mother and family to ensure cleanliness in preparation of food.
 Emphasize to the mother the importance of proper hygiene and clean environment for
the baby.

Outpatient order

 Encourage patient and family to have scheduled follow-up check after discharge to
see and check the postpartum condition of patient.
 Encourage patient to comply with home medication as prescribed by the doctor.
 Advise patient and family to maintain good hygiene and following the “don’ts” such
as strenuous activities for fast recovery.

Diet

 Encouraged the mother to continue breastfeeding.

 Advised the mother to eat nutritious foods that’s could help or can improve breast
milk production, since the patient is breastfeed.
 Instruct patient to avoid junk foods and oily foods.
 Instruct patient to increase oral fluid intake as tolerated.

73
 Encourage patient to eat nutritious foods rich in vitamin C to boost immune system
and protein rich foods to help recover from childbirth and keep the body strong.
 Instruct patient to eat variety of healthy foods such as vegetables, green leafy
vegetables and fruits. Having a balanced diet helps in fast recovery.
 Advised mother to take prenatal vitamins as the doctor prescribed.

Significant others/Spiritual

 Encouraged significant others to comply all the medication given by the physician.
 Advised significant others to assist patient’s needs and proper treatment
 Advised significant others to maintain cleanliness of the environment at all time.
 Encouraged mother and family to have baptism (bunyag) for the baby as soon as
possible.

74
 PROGNOSIS

CRITERIA GOOD FAIR POOR JUSTIFICATION

Patient Marites delivered a
healthy baby boy and there
DURATION ✔ were no difficulties during
the birthing process.

Patient Marites was referred

to DSPH because she is
having a pre term pregnancy

ONSET OF and her blood pressure

✔ increased while in labor.
ILLNESS
Fortunately, it was
addressed and medicated
right away.

According to Stephanie
Watson, women are most
fertile and have the best
chance of getting pregnant
AGE ✔ in their 20s. This is the time
when you have the highest
number of good quality
eggs available and your
pregnancy risks are lowest.
 Summary
 Good - 3/3x100= 100%
 Fair - 0/3x100= 0%
 Poor - 0/3x100= 0%

The patient has a good prognosis of 100%. The patient's condition is good because it
addressed and medicated right away her increasing blood pressure and delivered a normal
baby. The client is now getting better because of the applied nursing interventions by the
health care providers.
75
 EVALUATION

The researchers presented the case study covering all the relevant data to be able to
make the study successful. The data was gathered using the patients chart in accordance with
the standardized patient case scenario. Their delivery room and OB ward simulation at Davao
del Sur Provincial Hospital slightly helped them to understand and study them through the
help of their respective clinical instructor. Also, they learned how to apply or use their
knowledge since prior to their online duty during their first semester they have their theories,
discussion regarding Maternal, Newborn, and Child Health and Nutrition.

The researchers chose this study to relate how adolescence years handle pregnancy,
what factors affecting and adolescent mom, to explore how young women responded to a
motherhood stage, to know what are their needs physically and emotionally, to understand
pregnancy, labor and delivery process of normal spontaneous vaginal delivery along with the
postpartum stage, to be efficient in making nursing care plan for a postpartum adolescent
mother, to identify also, what theoretical foundation lies in performing postpartum care.

Therefore, the researchers' conclude that the patient has delivered her baby
successfully as they rendered nursing interventions that suited the patient's condition. The
researchers also consider the postpartum stage by knowing how important the nurse's role and
the significant others' support. Health teaching was provided to the significant other and the
researcher’s evaluation of goal met leads to the betterment of the patient's situation as she is
ready to face the world of motherhood.

76
 IMPLICATION OF THE STUDY

A.) NURSING PRACTICE

This study subjectively imports a huge help to the nursing practice. Considering the
trend of the blended learning modality, the students have taken part in their standardized
patient case scenario as they gradually adjust to the new normal set-up of education amidst
the pandemic that the world is facing. The student nurses have their simulation in the delivery
room and OB ward that slightly helped them broaden their knowledge and answered many of
their questions about the labor and delivery process. The researchers have contributed to the
study not only focusing on the case but it emphasizes the appropriate nursing intervention for
labor and delivery as well in the postpartum stage.

B.) NURSING PROFESSION

As the researchers continue to explore the different nursing interventions in the labor
and delivery process, the researchers realized the significance of education. This study will
provide knowledge to the nurses as well as to the future nurses and serve as their guide and
references in providing quality care and intervention to the patient before and after giving
birth and also for the significant others.

C.) NURSING RESEARCH

This study mainly benefits the readers, the researchers and the future researchers in
providing information in normal spontaneous vaginal delivery and postpartum stage. This
study also helps and guides them on how the case is medically managed to have considered
that normal spontaneous vaginal delivery is a normal process that usually does not require
significant intervention. This study will serve as a tool in order to improve and enhance the
knowledge regarding labor and delivery process.

77
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