A CASE STUDY ON A SECUNDIGRAVIDA PATIENT COMPREHENSIVE

INTRAPARTUM CARE

Alingayao, Angelica S.

Ancheta, Phia Ynara F.

Barrera, Nicole Anne L.

Carama, Muhammad J.

De Jesus, Ariel B.

Toribio, Hanz Joseph O.

Sarapuddin, Shariff Shidjay

Wahab, Ahmed Fa-Ez Nadhir M.

Usman, Rasaifah

S.Y. 2022-2023

1st Semester

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 Approval Sheet

This Case Study paper entitled “A Case Study on a secundigravida patient comprehensive
prenatal experience” prepared and submitted by Angelica Alingayao, Phia Ynara F. Ancheta,
Nicole Anne L. Barrera, Muhammad J. Carama, Eyriel B. De Jesus, Hanz Joseph Toribio, Shariff
Shidjay Sarapuddin, Ahmed Fa-Ez Nadhir Wahab, Rasaifah Usman, in partial fulfillment of the
requirements in Related Learning Experience II (RLE) First Semester A.Y. 2022-2023

_____________________________
Ms. Floribel P. San Luis, RN, MN
Adviser

Approved by the Oral Examination Committee with a grade of ____________.

Ms. Estrellita Mancao

Ms. Raquel De Villa Ms. Gertrudes Maico

Accepted in partial fulfilment of the requirements in Nursing Care Management 107.

Eva R.Relao RN, MN Ms. Araceli S. Pison, RN, MSPH

Level II Coordinator Level II Chairperson

Ms. Maria Lorna B. Paber, RN, MAN

Dean, College of Nursing

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 ACKNOWLEDGEMENT

This case study was completed successfully, thanks to the unending support and guidance

of numerous individuals. The student nurses would like to openly express their sincere gratitude

and appreciation to everyone who gave their time, effort, and support to this noteworthy

accomplishment.

To our parents, family, friends, as well as relatives, for their moral, financial, and

emotional support, which never ceases to give us courage and inspiration when we need it. Such

conduct would not have served as the source of inspiration and desire to pursue this goal.

We are grateful to the Dean of the College of Nursing, and to our Clinical Instructors for

enabling us to perform this case study and for assisting us in developing our expertise as student

nurses. This case study has flourished as a product of your unwavering support, along with your

extra teachings and experiences.

To our case study Adviser, we would like to express our gratitude for her guidance and

encouragement throughout the case study as well as for being a thoughtful instructor. We greatly

appreciate your compliments and helpful criticism. We appreciate you sharing your knowledge

and experience with us; without it, this case study would not have been successful.

To the esteemed Panelists, Ms. Estrellita Mancao, Ms. Raquel De Villa and Ms.

Gertrudes Maico for providing correction and teaching on how to improve the case study better,

and by preparing and educating the researchers to become competent registered nurses towards

our client in the future.

To the client and her family for actively engaging in the case study's process with their

genuine contributions to the study, and welcoming attitude to complete this case study.
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 To the families of the student nurses, for their unwavering love and constant spiritual

support, which never ceased to inspire and motivate the researchers to complete this study.

To our fellow group members, who has consistently given this case study their undivided

attention to detail to perfect the case study, tremendous effort in accomplishing this case study,

and amazing teamwork.

Finally, and most importantly, we want to thank God, The Almighty, for all of his

blessings and for giving us the endurance, bravery, strength, love, inspiration, and knowledge

necessary to finish this case study. Our ability to conclude this case study was fueled by our

resilience and mental clarity. Thank you very much for being an essential part of our journey.

Pro Deo et Patria

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 TABLE OF CONTENTS

Cover Page1
Approval Sheet2
Acknowledgement3
4
Table of Contents5

6
Introduction7
Background of the Study7
8
Significance of the Study9
9
Objectives10
11
Anatomy and Physiology12
13
14
15
Pathophysiology16
16
Nursing Processes17
Assessment 17
A.1 Biographical Information 17
A.2 Comprehensive Health History18
A.3 Marjorie Gordon’s 11 Functional Health Problems 19
20
21
A.4 Physical Assessment 21
5
 22
23
24
25
Diagnostic Test25
26
Laboratory Results26
27
Drug Study28
29
Nursing Care Plans30
37
Health Teaching Plan38
41
Evaluation42
Recommendations43
References44

45

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 I. INTRODUCTION

1.1 Background of the Study

The patient who is assigned to related learning experience (RLE) group 16 will be

referred to as “Jane Doe or J.D.” for patient privacy and confidentiality of records. Jane Doe is

confined at ABC Hospital as she experienced a rupture of her amniotic sac or a pre-labor rupture

of membranes (PROM). She has carried her first pregnancy to Pre-term, this second pregnancy is

expected to be carried at full-term. She has no cases of abortion, and there is currently one living

child as of the moment (1001), Pre-term 1, Abortion 0, Term 0, and 36 weeks pregnant (AOG).

She is currently awaiting labor and delivery.

Jane Doe is a 33 years old female. Her first child was born with a normal delivery

procedure. However, the child was born prematurely at 8 months old because of a urinary tract

infection (UTI). She and her husband had a 12-year pregnancy gap as they wanted to have a

child but could not conceive in utero, and they did not use contraceptives or birth control.

According to her pregnancy experience, while bearing the second child, she underwent the stress

of being a pregnant mother and being a mother to her first child. Her diet consisted of pregnancy

cravings that should not be consumed during pregnancy, such as drinking mountain dew almost

four times a day. Recently, she has developed a sleeping habit of only resting for two hours a

day. According to Harreiter (2014), the risk for maternal depression and abnormal child growth

and development has a direct correlation with unhealthy nutritional consumption and bad habits

and routines during pregnancy. Moreover, complete blood count (CBC), reverse transcription
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polymerase chain reaction (RT-PCR), and Hepatitis-B surface antigen screening test were done

during the stay in ABC Hospital.

As student nurses, the case was chosen because of its convenience and it is appropriate

for the group’s skill level. This case is particularly influential and significant to our experiences

as student nurses as it provides an introduction for us in the maternity specialization of Nursing

itself. Lastly, this case is important for us to become acquainted with the laboratories such as the

delivery, labor room and maternity, it prepares us to become efficient and effective nurses of

Ateneo de Zamboanga University.

The pregnancy Jane Doe is currently having is her second gravida, in which the

pregnancy at 36-week gestational age was verified as having the sex male. She drank her

vitamins as needed and complied with the recommendations of her doctor regarding her

visitation schedule throughout her pregnancy, particularly during the weekly exams she was

required to have attended during the final weeks of her third trimester.

This case study's major goal is to evaluate the client's entire pregnancy experience and

identify any crucial information that could help analyze the results if the client is experiencing

any complications. To be able to achieve that, it is necessary to periodically assess both the

mother's health and that of the child she is carrying. As a nurse, it is essential to employ client-

centered behavior while providing the necessary care.

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1.2 Significance of the study

This component of the case study shows the significance of the case study in terms of

nursing education, nursing practice, and nursing research. Furthermore, this case study is

important to the group as it helps them become better nurses in the future, this case study also

provides an experience and knowledge that would the group become more efficient and effective

healthcare providers.

Nursing Education

This case study can benefit nursing students and other healthcare providers in improving

the skills and broadening the wider aspect of knowledge attained in maternal care of patients.

Furthermore, this case study can provide additional information regarding the ability to properly

administer adequate care towards the patients as it can be used to support a better grasp in

understanding the patient in need, and it can also provide a better standard for the nursing

education, as well as revamping parts of the nursing practice.

Nursing Practice

The information and outcome gathered from this case study can serve as a foundation for

the College of Nursing in Ateneo de Zamboanga University (AdZU) in handling, providing and

administering good quality maternal care. Additionally, this case study can act as a basis for

developing and improving competencies, skills, proficiency, and knowledge for the healthcare

provider. Moreover, the outcome of this case study can present and bring forward the error and
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mistakes that may occur during the administration of care towards the patient, and how to create

better planning to prevent it from happening.

Nursing Research

This case study can serve as a foundation and support for future studies regarding the

care provided for maternal patients. Furthermore, this study can be used as a reference for

conducting related case studies to further widen the knowledge and understanding of the science

of nursing, and improve the skills and competencies of nursing students and healthcare

providers. Lastly, this case study can particularly serve as a way for nursing students and

healthcare providers to think of alternative ways to improve and promote patients' well-being.

Nursing Students

This case study can help nursing students prepare for their future obligations and, most

importantly, for themselves. Furthermore, this study can give appropriate information for nursing

students, particularly female nursing students, to be more educated about their abilities to

effectively care for patients, and therefore this can be utilized for future references.

1.3 Objectives

General objectives

Acquisition and application of knowledge, skills, and attitudes through the utilization of

the nursing process in the care of mothers (well clients) in the delivery and labor room with

emphasis on health promotion, maintenance, disease prevention, and care for the mother (pre-

and post-partum).
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Specific objectives

The case study aims to answer the following objectives:

● Establish a sense of relationship and rapport with the client favorably.

● Check the client's vital signs every four (4) hours as well as the fetal heart rate

(FHT) of the newborn every one (1) hour to maintain a client-centered attitude at

all times.

● Assess the client’s overall health condition, in terms of psychological, emotional,

and physiological well-being respectfully.

● Determine any health problems that may have occurred during the pregnancy and

apply the necessary nursing care appropriately.

● Educate the mother/patient on how different medicine works and how it aids in

labor and delivery appropriately and effectively.

● Periodically assess any changes if the client reported any discomfort, —whether

desirable or undesirable—in her condition as effectively and efficiently as

possible.

● Comprehensively assess and evaluate the client’s overall experience during her

second pregnancy

● Evaluate the overall results of the case study properly.

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1.4 Anatomy and Physiology

The several organs and/or systems that undergo several significant changes anatomically

and physiologically during pregnancy include the following reproductive system and

Gastrointestinal system.

Reproductive System

Figure 1.0: Illustration of Pregnant mother’s Reproductive System.

The state of becoming a mother affects the reproductive system of the patient as she is

carrying a living fetus. Furthermore, when the mother is currently pregnant with her unborn

child, her reproductive system goes through three stages of pregnancy which is the germinal,

embryonic, and fetal stage. During these stages, the mother can experience a lot of changes

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throughout her body including physical changes that may cause discomfort and pain, and

emotional and mental changes that may affect the mother’s self-esteem and body image.

Gastrointestinal System

Figure 2.0: Anatomy of Gastrointestinal during Pregnancy.

The changes in the patient’s gastrointestinal system have substantial changes due to the

nutritional and dietary appetite during the entire 1st to 3rd trimester of pregnancy. According to

Orloff (2014), The changes in the dietary and nutritional demands of the patient are caused by

hormonal changes, nutritional deficits, pharmacologically active ingredients in desired foods,

and cultural and psychological factors. Furthermore, additional changes and adjustments to the

patient may be required to ensure the fetus is healthy and living during the entire pregnancy.

Furthermore, due to the developing fetus inside the uterus of the mother, the changes in the
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placement of the gastrointestinal organs (stomach, small and large intestines, liver, pancreas,

pharynx, and esophagus) affect the mother’s dietary and nutritional habits

Respiratory System

Figure 3.0: Changes in the placement of the diaphragm during Pregnancy.

           The respiratory system is made up of particular organs and structures that work in unison

for gas exchange and aid in the elimination of metabolic waste products and pH regulation both

for the mother and the baby. During pregnancy, due to the enlargement of the uterus, the

diaphragm gets elevated by 4 centimeters, which decreases the functional residual capacity

resorting to minimal or absent gas exchange. Another change that occurs during pregnancy is

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that the lung volume undergoes significant alteration. Expiratory reserve volume and residual

volume gradually decline (reduction of 8–40% at term) throughout the second part of pregnancy,

resulting in a reduction in all air volumes. To maintain a steady total lung capacity, on the other

hand, the tidal volume, or the quantity of breath a person takes, and the one-minute ventilation

increases (TLC).

Placenta

Figure 4.0: Anatomy of the Placenta.

During pregnancy, the placenta develops within the uterus and serves as a temporary organ that

allows nutrition uptake, eliminates carbon dioxide and waste materials from the baby's blood and

provides oxygen and security to the growing fetus during the gestation time period.

1.5 Pathophysiology

The client is 36-week pregnant with her second child. According to her, her diet consists
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of "normal foods", presumably common Filipino dishes, foods that are prohibited for her such as

junk foods, excessive coffee and such, and a notable craving for "Mountain dew" beverage

which she claims to drink roughly four (4) times a day. Looking back at her pregnancy history,

the client had a premature delivery of her first child due to a UTI. With this in mind, it may be

possible she may be at risk of giving premature birth once again with her current pregnancy

because of her unhealthy consumption of "Mountain dew" which could lead to another urinary

tract infection. As of the moment of conducting this study, there are no pertinent findings, signs,

or symptoms for possible UTI. The client is stable based on the data from her periodic vital signs

check-ups. In the 36-week of gestation the baby will start to rotate down to the vaginal opening,

the mother may feel more frequent contractions, and lastly, using the Leopold’s Maneuver the

healthcare provider can assess and palpate for the location of the baby’s head whether it is breech

or cephalic, and they could also assess the position of the baby’s back for acquiring the fetal

heart tone (FHT) using a doppler.

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 II. NURSING PROCESSES

A. Assessment

A.1. Biographical information

The patient is named Jane Doe for privacy and confidentiality reasons, she is currently 33

years old, and has been married for 13 years, and she is practicing Roman Catholicism as her

chosen faith of belief. The patient is 5’2 or 158 cm, weighs 47 kg or 103 lbs, and she is currently

residing in Sta. Maria, Zamboanga City. She is currently working as a senior high school teacher

and librarian.

Name/Alias: Jane Doe (for privacy reasons).

Marital Status: Married.

Religion: Roman Catholic.

Race: Asian.

Age: 33-years old.

Gender: Female.

Height: 5’1 - 5’2/ 155 - 158 cm.

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 Weight 47kg/103 lbs.

Birthplace: Sta. Maria, Zamboanga City.

Occupation: Teacher/ Librarian.

A.2. Comprehensive Nursing Health History

History of present illnesses

J.D. was admitted to the maternal ward of ABC Hospital, due to complaints of

Contraction at 36 weeks’ gestation. During the interview and consultation with the nurses

working in the delivery and labor ward of the ABC Hospital, she stated that for the past few

weeks her diet includes junk foods which are not advisable for pregnant woman to take, as per

advice of the OB, healthy diet should be recommended. She is also experiencing bad sleeping

pattern probably due to her week’s gestation, she’s nearly to her expected date of delivery.

Past Illnesses

According to the patient’s previous pregnancy, she was diagnosed with Urinary Tract

Infection (UTI) during her third trimester. Due to her acquiring UTI, she consequently

experienced contractions that led to her giving birth 4 weeks prematurely at 32 weeks/8 months.

Additionally, after the premature delivery of her first child, the child is currently healthy and

living. Moreover, the patient was able to cure and treat her UTI with antibiotics and was able to

clean her excretory system.

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 A.3. Marjorie Gordon’s 11 Functional Health Problems

1. Health Perception and Health Management Patterns:

The client currently has weekly check-ups and takes the vitamins (B, C, and D), Folic

Acid, Iron, and Calcium minerals that her OB doctor has prescribed. The client engages in mild

exercises such as meditation.

2. Nutrition and Metabolism Pattern:

The client typically eats a moderate amount of meat, eggs, and vegetables on a daily

basis. There were no difficulties with eating certain meals that were stated, nor were there any

problems with food intake such as gastrointestinal pain. The nails are translucent and firm in

texture, the skin is brown in color, the teeth are healthy, the hair is black in color, and no

complications were observed.

3. Elimination Patterns:

The client estimated that she eliminated stool at least twice per day but varied and

urinated often on a daily basis, which she considered to be normal. She also remarked that the

colors of her urine and stool were both normal—yellow for the urine and brown for the stool.

There were no reported difficulties or discomforts with the elimination

a. Urination: She had a hard time urinating due to the UTI (urinary tract infection) caused

by drinking too many soft drinks specifically Mountain dew.

b. Defecation: Twice per day, but varies.

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4. Activity and Exercise patterns:

The patient gets 15-30 minutes of morning exercise twice or three times a week. The

majority of the patient's daily activities include housework, lesson planning, and a specific

exercise for pregnant women. The patient is self-sufficient in performing the aforementioned

activities. She has no breathing difficulties and does not cough. Her heart beats slightly faster

than usual during her morning workout, and she does not get tired easily

5. Cognitive and Perception pattern:

The patient has no difficulty with her senses such as hearing, vision, taste, touch, smell,

and pain indication. She is capable of making decisions on her own, but she occasionally seeks

advice from her husband.

6. Sleep and Rest Pattern:

The patient sleeps for 5-7 hours a day. She usually takes daytime naps for about 15-30

minutes. She usually sleeps at 9-11 PM and wakes up 1-2 times during the night for urinating.

She sometimes has trouble falling asleep but she is not taking any medication for sleeping such

as sleeping pills.

7. Self-perception and Self-concept pattern:

The client claimed that she is physically fit. She is comfortable with her body image

knowing that she is still carrying her soon-to-be-born baby.

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8. Role and Relationship Pattern:

The patient is living with her daughter and husband, along with her mother. Since the

patient and her husband have work from the morning until the afternoon, the patient’s mother is

the one who is looking for her daughter.

9. Reproductive Pattern:

The client is in her second pregnancy, with a 12-year gap in between. No difficulties in

sexual functioning or sexual dissatisfaction were stated. According to the patient, her last

menstrual cycle before bearing her second child was in the 3 rd to 4th week of December 2021.

Furthermore, her first child was prematurely born due to a UTI. As she is now in her third

trimester, the patient visits her doctor once a week for her weekly checkup. The client also

mentioned having her first painful contractions in the 1st trimester and experiencing them

suddenly just a few hours ago at midnight before deciding to visit the hospital for a checkup. She

characterized the discomfort as being extreme, irregular, and comparable to the pressure of

severe menstrual cramps hitting her abdomen. The overall OB score would be G2T1P1A0L2.

10. Coping and Stress Tolerance Pattern:

The client claimed that engaging in recreational activities helped her deal with stress. The

client's family is her support system for enhancing her general mental health state. Her concept

of stress freedom starts with a positive mindset.

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11. Values and Belief Pattern:

The client is a Roman Catholic, and she claims that her family is what matters to her most.

No value beliefs that would endanger her health were stated. Prayers are a part of religious

practices.

A.4. Physical Assessment (Head to Toe).

1. General, Neurologic, and Appearance

The client’s general, neurologic, and appearance were at normal limits. The client was

appearance was in normal condition, no bruising or edema spotted around the extremities, torso,

and head. The client was able to respond with no delay and was able to perform a reflex.

However, the client was slightly fatigued by her recent development of sleeping habits. No signs

of seizures, spasms, cramps, or irritation were observed. Lastly, the client's general appearance

was at normal limits, and no further abnormalities were found.

2. Skin

The skin of the client remained normal; however, slight discoloration of the client’s neck

can be attributed to acanthosis nigricans as a result of a bad diet habit and routine developed by

the client. Nothing further was observed as abnormal.

3. Head and Neck

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 The head and neck of the client were within normal limits, however, slight discoloration

on the skin of the neck was observed. The head of the client had slight hyperpigmentation on the

cheeks and forehead. Moreover, no additional abnormalities in the head, face, or neck were

noted.

4. Eyes

The eyes were within normal limits indicating a normal physical eye appearance, with no

indication of swelling or redness in the palpebral fissure. Moreover, the pupils, iris, cornea, and

sclera had no discoloration, and reflex was shown when a penlight was shined through. The

client has developed eye bags, due to the recent development of unusual sleeping patterns.

Lastly, the client’s visual acuity remains normal.

5. Ears

The ears of the client were within normal limits, no deviation from the normal was

observed, and the external (outer) parts of the ear had no issues to be observed, however, the

auricle had a slightly yellow buildup of dirt. Furthermore, the hearing ability of the client was

tested using a tuning fork and remains in the normal range. Lastly, the equilibrium of the client

remains normal.

6. Nose

The nose of the client remained at normal limits. No bleeding nor nasal flaring or

congestion was observed. The breathing capabilities of the client remained at the normal limit,

moreover, the smelling ability of the client is sensitive to odor and other scents.

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7. Mouth

The mouth of the client remains at normal limits, and no swelling nor sores were

observed around the gingivae (gums). Furthermore, no abnormalities were observed in the

mouth. Lastly. The client’s ability to taste food remained normal.

8. Chest and Lungs

The chest and lungs of the client remain at normal or optimum conditions, The client’s

respirations were at normal limits, not shallow nor deep breathing. No sound of murmurs and

crepitations was observed during the inspection of the lungs and diaphragm.

9. Abdomen

The abdomen of client had a visible appearance of Linea nigra from the fundus of the

uterus down to the symphysis pubis. Furthermore, the client’s abdomen also had

hyperpigmentation in the epigastric region, umbilical region, and hypogastric regions.

10. Genitourinary

The client’s genitourinary tract was observed to be normal; the client was utilizing a

diaper during her stay in the hospital. Furthermore, no deviation from the normal was observed

and no signs of urinary incontinence were observed. The client has a history of UTI during her

first pregnancy that inevitably caused her to deliver prematurely, fortunately, during her second

pregnancy, she did not have a Urinary tract infection.

11. Anus

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 The client was supported or was using a diaper at that time. However, no abnormalities or

deviation from the normal was observed from the client.

12. Extremities/ Hips/ Back

The client’s extremities, hips, and back were at normal limits. While assisting the patient

to the bed, to await labor and delivery, the client had a leaned-back posture to use as a

counterweight for her baby because her center of gravity is thrown off. Furthermore, when

assisting the client toward the bed, she had a waddling gait. Lastly, no abnormalities were further

observed.

13. Infusion

The client was observed to be utilizing Intravenous fluid therapy during her stay in the

hospital, she was prescribed dexamethasone for alleviation and relief of inflammation.

Furthermore, no infection or bruising was observed at the injection site. Lastly, no additional

abnormalities were observed.

B. Diagnostic test

A Diagnostic test is done to determine whether a patient has a specific illness condition

or not. The range of diagnostic tests includes biochemical, pathologic, psychological, and signs

and symptoms discovered during a clinical examination. Diagnostic tests are typically used to

check for, diagnose, and monitor diseases.

Reverse Transcription Polymerase Chain Reaction (RT-PCR)

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RT-PCR is conducted to check and detect the presence of Viruses, i.e., Coronavirus Disease

2019. Furthermore, an RT-PCR test is done before labor and delivery to assess and determine if

the patient is positive for a virus, and to provide additional protection and safety for nurses and

doctors, including mother and child.

Hepatitis-B Surface Antigen Screening (HBsAg)

HBsAg is conducted to detect and evaluate for the presence of the Hepatitis B virus

named Surface Antigen. Moreover, HBsAg is also conducted before labor and delivery to detect

the presence of the virus within the mother and provide post-exposure prophylaxis, on the

possibility that the infant is positive for Hepatitis B.

Complete Blood Count (CBC)

CBC test is done to assess and evaluate overall health conditions and detect and observe

for an extensive range of disorders, diseases, or syndromes, infections, and leukemia.

Additionally, CBC is also conducted during delivery to provide assessment and estimation of

blood loss during labor, and to identify patients/mothers in need of blood transfusion.

C. Laboratory Results

Tests: Results: Normal Range/ Signs: Clinical Significance:

Complete Blood Red Blood Cells RBC: 3.8 to 5.2 x Within Normal Limits.
Count (CBC). (RBC): 10*12/L.

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 4.3 x 10^12/L
Blood Type: O+. WBC:
White Blood Cells
(WBC): 4.0 to 11.0 x 10^9/L

8.4 x 10^9/L
Platelets:

Platelets: 150 - 400 x 10^6/L

343 x 10^6/L

Hepatitis-B Non-Reactive. Normal: Non-Reactive. Within Normal Limits.

Surface Antigen
Screening
(HBsAg).

Reverse Negative. Normal: Negative. Within Normal Limits.

transcription

polymerase chain

reaction (RT-

PCR).

27
 D. Drug Study
Drug 1: Mechanism of Action/ Contra/Indications Nursing Responsibilities/

Considerations
Dexamethasone Side-effects

Brand name: Mechanism of Action: Indication: ● Observe signs of adverse

reactions that the client may

Dexamethasone They enter cells where they mix Dexamethasone accelerates the
experience.
with steroid receptors in the maturation of fetal lungs, decreases the
● Monitor and Assess for Vital
Generic name: cytoplasm to form a large number of neonates with respiratory
signs, particularly blood
molecular complex. This complex distress syndrome, and improves
Cortix
pressure.
then travels to the nucleus where it survival in preterm delivered neonates.
● Assess for changes in the
interacts with the elements of

Classification: affected the area.

chromosomes and changes the
● Monitor the client’s overall
Corticosteroids expression of genes, which has an
wellbeing.
impact on organs and tissues. Contraindication:

Route: Dexamethasone is a type of

Intravenous corticosteroid that readily crosses the

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Injection (IV). placental barrier during pregnancy,

and its prolonged use can have

Side effects:
harmful effects on both the mother and
Dosage:
The side-effects of dexamethasone
the fetus. For women, these effects
5mg/ml include upset stomach, Vomiting,
include an increased risk of
Headache, Insomnia restlessness,
endometritis and chorioamnionitis in
Frequency: Depression, Anxiety, Acne,
patients with preterm labor, an
Increased hair growth, Easy
4 to 20 mg/day increased amino acid concentration,
bruising, Increased appetite and
given in a single and hyperglycemia. Corticosteroid use
Weight gain, and Irregular or
daily dose or in on a regular basis can decrease fetal
absent menstrual periods.
2 to 4 divided body and respiratory movements, and

doses. raise the risk of early-onset newborn

sepsis, low birth weight, fetal

hypoglycemia, and intrauterine growth

restriction.

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30
Drug 2: Mechanism of Action/Side-effects Contra/Indications Nursing Responsibilities/

Considerations
Nobel

Brand name: Mechanism of Action: Indication: ● Monitor signs of

intestinal paralysis
Nobel Dicyclomine non-competitively Dicyclomine Diclofenac is
(paralytic ileus),
inhibits the action of bradykinin and used in the treatment of
Generic name:
including nausea, lack
histamine, resulting in direct action abdominal pain.
Dicyclomine diclofenac. of bowel sounds or
on the smooth muscle, and decreased Dicyclomine + Diclofenac

Classification: movements,
strength of contractions seen in is a combination of two
abdominal
Aanticholinergics/antispasmodics spasms of the ileum. medicines: Dicyclomine
bloating/distention,
and Diclofenac, which
Route: Side effects:
and vomiting. Report
relieves abdominal pain
Intravenous Injection (IV). The side effects of Nobel these signs to the
and cramps. Dicyclomine is
may experience nausea, diarrhea, physician
an anticholinergic which
vomiting, loss of appetite, sleepiness, immediately.
works by relaxing the
dryness in the mouth, weakness,
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Dosage: dizziness, nervousness, heartburn, muscles in the stomach and

blurred vision. Most of these side gut (intestine).

10mg per ml (IV)
effects of diclofenac dicyclomine do ● Assess heart rate,
Frequency:
not require medical attention and ECG, and heart
Contraindications:
10mg to 20 mg four times a day, gradually resolve over time. sounds, especially
to be used only for 1 or 2 days Patients affected with liver during exercise.
when the patient cannot take oral disease, bleeding disorder, Report a rapid heart
medication. myasthenia gravis, asthma, rate (tachycardia) or
gastrointestinal toxicity, signs of other
high blood pressure and arrhythmias, including
alcoholism should not take palpitations, chest
diclofenac dicyclomine as discomfort, shortness
it has severe interaction. of breath, fainting, and

fatigue/weakness.

● Monitor any changes

in irritable bowel

symptoms (decreased

32
abdominal pain,

decreased diarrhea,

improved appetite) to

help document

whether drug therapy

is successful.

33
Drug 3: Mechanism of Action/Side-effects Contra/Indications Nursing Responsibilities/

Considerations
Valium

Brand name: Mechanism of actions Indications: ● Contraindicated in

hepatic dysfunction.
Valium Diazepam is a benzodiazepine with The use of valium is

amnestic, sedative, muscle-relaxant, recommended for the treatment

Generic name:
anxiolytic, and anticonvulsant of anxiety disorders or for the ● Use caution with renal
Diazepam
properties. The majority of these temporary reduction of anxiety impairment.

Classification: effects are assumed to be caused by symptoms. Anxiolytic therapy ● Can cause dizziness,

drowsiness, lethargy,
Antianxiety Agents; gamma aminobutyric acid (GABA), is typically not necessary for
an inhibitory neurotransmitter in the anxiety or tension brought on hypotension, physical
Anxiolytics,
dependence, tolerance.
Benzodiazepines; Skeletal central nervous system, being more by daily stress.
● Instruct patient to take
Muscle Relaxants; easily able to do its job.
as directed.
Anticonvulsants,
● Caution to avoid alcohol
Benzodiazepine
34
 Side effects: use. Flumazenil

(Romazicon) is the
Route: There could be drowsiness, vertigo,
reversal agent.
fatigue, blurred vision, or
Intravenous Injection (IV). Contraindications:
● Change from IV therapy
unsteadiness. Inform your doctor or
Patients with myasthenia to oral therapy as soon
pharmacist as soon as possible if any
gravis, severe respiratory as possible.
Dosage: 10mg of these side effects persist or get
impairment, severe hepatic ● Do not use small veins
Frequency: worse.
impairment, and sleep apnea (dorsum of hand or
2mg, taken 3 times a day, syndrome should not take wrist) for IV injection.
this can be increased to valium. It is contraindicated in ● Reduce dose of opioid
5mg to 10mg, taken 3 acute narrow-angle glaucoma analgesics with IV
times a day. sleep but may be used in open-angle diazepam; dose should
problems (related to glaucoma patients who are be reduced by at least
anxiety) – 5mg to 15mg, getting the proper treatment. one-third or eliminated.
taken once a day at
● Carefully monitor P,
bedtime. muscle spasms in
BP, respiration during
adults – 2mg to 15 mg a

35
day. IV administration.

36
Drug 4: Mechanism of Action/Side- Contra/Indications Nursing Responsibilities/

effects Considerations
Dormicum

Brand name: Mechanism of action Indications: ● Before administering,

have oxygen and

Dormicum Midazolam has a calming effect Intended to induce
resuscitation equipment
on the muscles because it forgetfulness, anesthesia,
available in case of
interacts with glycine receptors. drowsiness, or anxiolysis
Generic name: severe respiratory
The activity of the drug on before to surgery.

Midazolam depression.
GABA receptors can be used to recommended for the treatment

explain almost all of the of adult status epilepticus.

pharmacologic effects, ● Monitor and record

Classification:
including as drowsiness, patient response to
Benzodiazepine drugs Contraindications:
anxiolysis, anterograde medication and level of

amnesia, and anticonvulsant Patients with a known sedation.

impact. hypersensitivity to the

37
Route: medication should not get

injectable midazolam. Patients

Intravenous Injection (IV). Side effects: ● Observe site closely for
with acute narrow-angle
extravasation.
Nausea, vomiting, dizziness, or
glaucoma should not use
● Monitor for adverse
drowsiness may occur. If any
Dosage: benzodiazepines. Only patients
reactions.
of these effects last or get
1 mg/ml who are receiving the proper
● Continuous
worse, notify the doctor
treatment for their open-angle
cardiorespiratory
or pharmacist promptly.
glaucoma may utilize
monitoring.
Frequency:
benzodiazepines.
● Monitor BP and oxygen
The dose range from 0.08-0.2
saturation.
mg/kg body weight has been
● Assess sedated infant
shown to be effective and safe.
for signs of pain
Dormicum should be
(midazolam does not
administered deep into a large
possess analgesic
muscle mass 30-60 min prior to
properties).
the induction of anesthesia.

38
Drug 5: Mechanism of Action/Side- Contra/Indications Nursing Responsibilities/

effects Considerations
Buscopan

Brand name: Mechanism of action: Indications: ● Drug compatibility

should be monitored
Buscopan It works on the muscular Buscopan medicine 20mg/ml
closely in patients
spasm that is the source of the is indicated in cases
requiring adjunctive
pain to relieve it. A of gastrointestinal spasms,
Generic name: therapy
spasmolytic effect is produced biliary tract spasms, renal colic

Hyosin N- butylbromide ● Avoid driving &

on the smooth muscle of the and menstrual pain relief.
operating machinery
gastrointestinal, biliary, and
after parenteral
genito-urinary systems by the
Classification: Contraindications: administration.
drug hyoscine-N-butylbromide
Spasmolytics ● Avoid strict heat
(BUSCOPAN). Hyoscine Myasthenia gravis, mechanical
● Raise side rails as a
butylbromide is a quaternary stenosis of the gastrointestinal
precaution because
ammonium derivative that tract, paralytical or obstructive
some patients become
does not reach the central ileus, megacolon, and patients
39
Route: nervous system. who have previously displayed temporarily excited or

hypersensitivity to hyoscine disoriented and some

Intravenous Injection (IV).
butyl bromide or any other develop amnesia or
Side effects:
component of the products are become drowsy.

Dosage: Some of the common and contraindicated for the use of ● Reorient patient, as

serious side effects of BUSCOPAN and needed, Tolerance may

20mg/ml
Buscopan are: BUSCOPAN FORTE. develop when therapy

Dizziness, Dryness in mouth, is prolonged

Frequency:
Pain in the injection site ● Atropine-like toxicity

Injection 20 mg/ml: clear, Constipation, Difficulty in may cause dose related

colorless solution in glass passing urine, Abnormal adverse reactions.

ampoules. Muscle spasm of sweating, Redness of the face, Individual tolerance

the gastrointestinal tract. Oral: Skin rashes, Itching, Blurry varies greatly

Adults and children over 6 vision, increased Heartbeats, ● Overdose may cause

years: 2 buscopan 10 mg Low blood pressure, curare-like effects, such

tablets (20 mg) four times a Accumulation of Urine, as respiratory paralysis.

day or 1 buscopan forte 20 mg Breathing problem, and Eye Keep emergency

40
tablet four times a day. related problem equipment available.

41
Drug 6: Mechanism of Action/Side- Contra/Indications Nursing Responsibilities/

effects Considerations
Oxytocin

Brand name: Mechanism of action: Indication ● Start a primary line

with 1000 mL IV fluid.

Oxytocin By increasing the uterine Pitocin is indicated to produce
● Start a second line with
myofibrils' sodium permeability, uterine contractions during the
standardized
oxytocin indirectly stimulates the third stage of labor and to
Generic name: concentration of
contraction of the uterine smooth control postpartum bleeding

Gyne -tocin oxytocin in IV fluid

muscle. or hemorrhage.
● Ensure the bags and

tubing are labeled

Classification: Side effects: Contraindications: clearly

Oxytocic hormones Side effects include Slow heart Interventions with oxytocin, ● Insert oxytocin

rate Fast heart rate, especially at high dosages, infusion into mainline

IV by connect to port
42
Route: Premature ventricular complexes may affect fetal heart rhythms nearest to IV insertion

, and other irregular heartbeats and cause uterine site

Intravenous Injection (IV).
(arrhythmias), Permanent central tachysystole, which could be ● Always administer

nervous system (CNS) or brain harmful to the mother and the oxytocin via infusion

damage, and death secondary to fetus 3. This happens as a pump

Dosage: suffocation, Neonatal seizure, result of the blood supply to ● Titrate infusion

Neonatal yellowing of skin or the intervillous space being according to client and
10 iu/ml
eyes (jaundice), Fetal death, reduced or interrupted during fetal response

Low Apgar score (5 minutes), contractions. ● Document the start

Frequency: Uteroplacental hypoperfusion time, end time, dose,

and variable deceleration of fetal and any changes made

1 to 4 milliunits/minute or 2
heart rate, Inadequate fetal during administration
to 8 drops/minute should be
oxygen levels (hypoxia), ● VS and I&O
the first infusion rate. It may
Perinatal hepatic necrosis ● Frequency, duration,
be gradually raised until a
and force of
contraction pattern Fetal hypercapnia, Severe
contractions; resting
resembling that of typical decreases in

labor is developed, with

43
intervals no less than 20 maternal systolic and diastolic  uterine tone

minutes and increments no ● FHR pattern

Blood pressure, increases in heart
greater than 1 to 2 ● Side effects; uterine
rate, systemic venous return
milliunits/minute. hyperstimulation; e.g.,
and cardiac output,
tachysystole
and arrhythmia.
(excessively frequent

uterine contractions),

uterine tetany

(excessively long

contractions), nausea,

hypertension

● Signs / symptoms of

water intoxication; e.g.,

headache, irritability,

confusion, and nausea.

44
Drug 7: Mechanism of Action/Side- Contra/Indications Nursing Responsibilities/

effects Considerations
Evaprost

Brand name: Mechanism of actions: Indication: ● Monitor uterine

contractions and observe

Evaprost A man-made prostaglandin,
and report excessive
carboprost. It binds to the
Used to induce abortion or
vaginal bleeding and
prostaglandin E2 receptor and
augment labor and to minimize
Generic name: cramping pain. Save all
causes myometrial contractions
blood loss from the placental
Carboprost trometamol clots and tissue for
that lead to labor induction or
site.
physician inspection and
placenta expulsion.
laboratory analysis.
Prostaglandins act at numerous
Classification:
locations throughout the body, Contraindications:
Prostaglandins
including the womb, and are Evaprost should be used with ● Check vital signs at

produced naturally by the body caution in individuals who have regular intervals.

(uterus). They have an effect on Arborist-induced febrile

45
Route: the uterine muscles, causing a history of asthma, hypo- or reaction occurs in more

them to contract. hypertension, cardiovascular, than 10% of patients and

Intravenous Injection (IV).
renal, or hepatic disease, must be differentiated
Dosage: 250mcg/ml
anemia, jaundice, diabetes, or from endometritis, which
Side effects:
Frequency: epilepsy. occurs around third day

The body may experience after abortion.

2 mg in intervals of 15-90 min. Evaprost should be administered
lightheadedness, nausea, or
cautiously in patients with
dizziness while the drug takes
compromised (scarred) uterine,
effect. Inform prescribed doctor
just like with oxytocic drugs.
or pharmacist as soon as

possible if any of these side

effects persist or get worse.

46
 E. Nursing Care Plan
NCP 1: Contractions.

Assessment Diagnosis Goal and desired Nursing Implementation Evaluation

outcomes intervention
/Cues

Subjective: Lumbosacral At the end of 30 ● Assess the ● Check and/or ● After the 30

pain as minutes of overall monitor the vital minutes

“May
evidenced by nursing condition signs of the mother nursing
nararamdaman po
uterine interventions, the of the client such as Blood interventions:
akong sakit sa
contraction client will be able pressure,
aking tiyan” as
related to to: Temperature, Heart
verbalized by the ● Assess the ● The mother
Pregnancy. Rate, Oxygen
patient. fetal heart was
Level, and
rate of the adequately
Translation: “I feel ● Be more
Respiration
newborn informed
pain in my belly” knowledge
about the
able about
● Using the doppler, possible pains
Objective: the ● Assess the
assess the heart rate that will
possible level of
47
Patients experience pains that pain for of the newborn, possibly occur

acute pain due to occur uterine check for any during

contractions. during contraction complications, and pregnancy.

pregnancy ensure a smooth

labor and delivery

● Teach the
BP:
as possible.
client the
120/60 mm Hg
proper

Temperature: control ● Check the intensity

36.3 °C measures level of pain, and

related to assess if it is regular

Heart/ Pulse
labor pain or irregular.
Rate:

100 bpm
● Instruct and guide
Oxygen Level:
the mother to walk,

98% teach proper

breathing

48
Respiration: techniques, proper

positioning, and
18 bpm
labor massage.
Pain Intensity:

6 out of 10.

35 out of 50 (using

McGill’s Pain

Index).

Fetal Heart Rate:

135-137

49
NCP 2: Poor Diet and habits.
Assessment/ Cues Nursing Goals And Nursing Implementation Evaluation

Diagnosis Desired Outcome Intervention

Subjective Cues: Prone At the end of 30 ● Assess Consult to the patient’s ● The patient

The patient Health minutes of nursing Readiness to physician and/or nutritionist was able to

verbalized that she Behavior interventions, the change and give her the adjust to the

drinks “Mountain related to client will be able ● Engage in recommended food and the recommended

dew” 4 times a day. unhealthy to: Collaborativ necessary amount to diet assigned

lifestyle e Negotiation maintain healthy. to her.

Objective Cues: choices ● The patient (focus on

BP: has what is Discuss to the patient and ● The patient

120/60 mm Hg progress in allowed) clearly state what is allowed gains

controlling ● Determine to eat and suggest ways to progress in

Temperature: 36.3 her how control her cravings. adapting to

C cravings confident the the

client is to When discussing, encourage recommended

Heart/Pulse Rate: ● Patient can make change the patient to motivate her diet and

50
100 bpm report confidence by affirming controlling

honestly on remarks. her cravings

Oxygen level: 98% her ● Patient was

progress able to

Respiration: 18 modify her

bpm ● And can diet at her

modify her own pace

diet at her with the

own pace nurse’s

with the assistance.

nurse’s ● The patient

assistance was able to

report her

progress

honestly and

does not lie.

51
NCP 3: Inadequate Sleep and poor sleeping patterns.

Assessment/ Cues Nursing Goals and desired Nursing intervention implementation Evaluation

diagnosis outcomes

Subjective Cues: Disturbed After the 30 minutes ● Examine the ● normal sleep After the 15 minutes

sleeping nursing client's sleeping patterns are nursing interventions,

“Nahihirapan akong
pattern interventions, the habits and unique to each goal was met. The
matulog sa gabi
related to patient will be able nighttime rituals. individual, patient was able to:
kamakailan lamang,
quickening. to: data gathered
nararamdaman ko rin
through a full
si baby na ● Achieve ● Examine the
● The client was
and holistic
gumagalaw at optimal client's
able to
examination
sumisipa” as amount of medication, food,
demonstrate a
are required to
verbalized by the sleep as and caffeine
rested look,
establish the
patient. evidenced by consumption.
articulate feeling
etiology of the
rested Look for caffeine
Translation: “I have a rested, and show
problem.
appearance. sources that are
hard time sleeping at improvement in
not immediately
night recently, and I sleep pattern.
evident. For ● Difficulty of
52
fell the baby is ● Achieve example, over- sleeping also

moving and kicking optimal the-counter can be a side ● The client was

around. amount of drugs. effect of able to Achieve

sleep as medications. optimal amount

evidenced by Caffeine can of sleep as

● Provide measures
Objectives Cues:
verbalization also interfere evidenced by
to take before
The Client had visible of feeling with sleep. verbalization of
bedtime to assist
dark circles under the rested and feeling rested
with sleep such
eyes, the client was improvemen and
as considering ● Simple
also restless and t in sleep improvement in
lowering the measures can
yawning during the pattern. sleep pattern.
volume of voices increase
interview.
near and or quality of

BP: around the sleep.

120/60 mm Hg patient; quit time

and back

Temperature: massage.

53
 36.3 C

● Perform as much
Heart/Pulse Rate:
as care as
● To minimize
100 bpm
possible without
sleep
walking the
disruptions
Oxygen level: 98%
client, and do as
and optimize
much care as
the sleeping
Respiration: 18 bpm
possible while
process.
the pregnant

patient is still

awake.

F. Health Teaching Plan

Topic/s: Health Maintenance for a Pregnant Patient.

54
Target Participants: Mrs. Jane Doe.
General Objectives: To give adequate and comprehensive patient education on her medications and health maintenance of a pregnant
patient.

Learning Objectives: Content: Time Teaching Learning Evaluation

Strategies

Medications: Dexamethasone 5 30 mins One-on-one ● Item review

At the end of the 30 minutes - 1 hour
mg/ml, - 1 discussion questions on
of health teaching, the patient will be
hour. what has
able to:
been
Diet: Physical pamphlet
● Know how the medications discussed

work and their side effects. What should be included in her

● Understand the significance of diet:

● Formulating
the prescribed medications to
● Whole Grains and cereals a menu with
the client’s and the
Vegetables and legumes / guidance
developing fetus’ well-being.
beans from the
● Identify cheaper and healthy
● Lean meats and poultry, student
alternatives for preferred food

55
 products fish, eggs, tofu, nuts and nurses

● Recognize food seeds as well as

recommendations of the legumes/beans

student nurses for health ● Fruits

maintenance ● Dairy foods including

● Select nutritious food choices mostly reduced fat milk,

and menu from the presented cheese and yoghurt

options.
What to avoid:
● Create a personal diet plan
● Raw or partially cooked
that is both appropriate and
eggs
suits the client’s personal
● Raw or undercooked meat
preferences
● Raw shellfish

● Liver

products/Supplements

containing vitamin A (too

much vit A is harmful for

56
 the baby)

● Cold cured meats (cold

cooked ready-to-eat

chicken,sliced ready-to-

eat meats)

● Unpasteurised milk

● Alcohol

● Caffeine

● Energy drinks

● Cut off mountain dew

from diet

57
 III. EVALUATION

The nursing interventions developed by the group were successful in achieving the intended

general and specific objectives, which included assessing the client's overall health, the fetal

heart rate, and the pregnant woman's degree of pain during uterine contractions, as well as

educating the mother about potential typical pregnancy pains and discomforts.

The group was able to provide proper and appropriate nursing care to the client/patient Jane

Doe. The group was able to develop a sense of relationship and rapport with the client favorably,

the client’s relationship with the group serves as a benefit and prime motivation for the group to

successfully and efficiently finish the study.

The group was able to determine any health problems that occurred during pregnancy and

was able to provide the appropriate nursing care plan to the patient. The client’s well-being

stands as a primary concern for the group’s case study, thus, any problems that may have

occurred during the entire process of the case study were able to be provided with the utmost

care with an emphasis on health promotion, maintenance, disease prevention, and proper care for

the mother.

The group was able to give the secundigravida mother a suitable nursing care plan and assist

in educating her about the specific pregnancy contractions and discomforts associated with labor

pains. A discussion on management regarding identifying ways to manage labor pains was also

conducted between the student nurses and the mother. Because of this intervention, the expectant

mother was then able to express her comprehension of the potential normal discomforts

associated with pregnancy.

58
 IV. RECOMMENDATIONS

This study can help nurses and nursing students learn more about the various nursing duties

and interventions that they can utilize to provide their patient’s high-quality care. As a result, the

nursing students would like to suggest widening the subject matter to include additional variables

that are not mentioned in the case but could cause stress or anxiety as well as specifying the

contrasts between PROM and UTI. In the meanwhile, patients can utilize this study as a guide to

get better or as a starting point for mental recovery following pregnancy and childbirth. This

could be used as a foundation to protect pregnant mothers from any problems brought on by their

regular activities or routines. This study may be used as a guide for nurses and nursing students

alike in regard to various nursing duties and interventions that can be utilized in providing high-

quality care to their patients.

To the mother, we recommend providing the essentials to her baby, to apply the therapeutic

interventions that were given to alleviate her bad sleeping habits and unhealthy diet to avoid

complications such as PROM during her primigravida due to UTI. We encourage her to eat food

that is recommended by her health provider or lessen the consumption of junk foods, to lessen

the risk of getting a UTI, and to get adequate amounts of sleep to ensure the baby’s growth and

development proceed smoothly. We advise that the mother regularly visits her pediatrician for

the continual care of the offspring through the maintenance of health and early detection of

diseases so that suitable interventions and treatments may be given promptly

59
 V. REFERENCES

Complete blood count (CBC) - Mayo Clinic. (n.d.). Www.mayoclinic.org.

https://www.mayoclinic.org/tests-procedures/complete-blood-count/about/pac-

20384919#:~:text=A%20complete%20blood%20count%20

Complete Blood Count (CBC) | Obstetrics and Gynecology Associates of Hampton. (n.d.).

Retrieved October 10, 2022, from https://www.obgynofhampton.com/complete-blood-

count-cbc/#:~:text=Because%20on%20average%2C%20a%20woman

Laboratory Reporting of Pregnancy Status for Hepatitis B-positive Women | HBV | Division of

Viral Hepatitis | CDC. (2019, November 7). Www.cdc.gov.

https://www.cdc.gov/hepatitis/hbv/pregstatuslabreporting.htm#:~:text=In%201988%2C

%20the%20Advisory%20Committee

Hepatitis B Foundation: Hepatitis B Blood Tests. (n.d.). Www.hepb.org.

https://www.hepb.org/prevention-and-diagnosis/diagnosis/hbv-blood-tests/

#:~:text=HBsAg%20(Hepatitis%20B%20surface%20antigen)

Orloff, N. C., & Hormes, J. M. (2014). Pickles and ice cream! Food cravings in pregnancy:

hypotheses, preliminary evidence, and directions for future research. Frontiers in

Psychology, 5. https://doi.org/10.3389/fpsyg.2014.01076

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Prenatal Panel: MedlinePlus Medical Test. (n.d.). Medlineplus.gov. https://medlineplus.gov/lab-

tests/prenatal-panel/#:~:text=A%20prenatal%20panel%20usually%20includes

Harreiter, J., Dovjak, G., & Kautzky-Willer, A. (2014). Gestational Diabetes Mellitus and

Cardiovascular Risk after Pregnancy. Women’s Health, 10(1), 91–108.

https://doi.org/10.2217/whe.13.69

61