Nueva Ecija University of Science and Technology

College of Nursing

Case Study
Normal Spontaneous Vaginal Delivery

Roberto, Pauline Mae Mangalinao

Rodriguez, Princess Nicole Lapuz

Sabado, Janine Mae Aquino

Salenga, James Conrad Mangahas

BSN 2-D

Kristhine Abegail M. Gamiao, MAN, RN

Clinical Instructor
Chapter 1

General Objectives

This case study aims to broaden our knowledge as a student nurse as well as the reader’s
regarding normal spontaneous vaginal delivery including the management of post-partum
care. In addition, this case study also aims to collect significant information that can
enhance our skills and attitude in providing nursing care to a patient that will undergo or
had undergo normal spontaneous vaginal delivery.

Specific Objectives

 To review the anatomy and physiology of the female reproductive system.

 To differentiate the physical assessment findings from normal to abnormal results.
 To determine the normal values of the laboratory results and the corresponding
problems that can arise on abnormal results.
 To gain extensive knowledge and understands the entire course of the normal
spontaneous vaginal delivery and its possible complications.
 To develop an effective nursing care plan on the common problems faced on
normal spontaneous delivery.
 To formulate drug study.
 To formulate recommendations and plan especially on post-partum discharge.

Introduction

During pregnancy, when gestation has been completed, it goes through a process
called delivery where the developed fetus is expelled from the mother’s womb. There are
two options of delivery, cesarean section and normal spontaneous vaginal delivery. NSVD is
the delivery of the baby through vaginal route with effort and force exertion. It can also be
called as NSD or normal spontaneous delivery, or SVD or spontaneous vaginal delivery.

In the process of delivery, the pregnant woman first experience labor. Normal
labor is defined as the gradual subjugation and dilatation of the uterine cervix as a
result of rhythmic uterine contractions leading to the delivery of the fetus including the
membranes, umbilical cord and placenta. It is composed of four stages where the stage 1
begins with the initiation of true labor contractions and ends when the cervix is fully
dilated. On the other hand, in the second stage, it is the period from full dilatation and
cervical effacement to the birth of the infant. Next on the third stage, it is also called the
placental stage that begins after the birth of the infant and ends with the delivery of the
placenta. And lastly, on the fourth stage or also called as the post-partum juncture, it
begins right after the placental delivery and ends with the recovery of the mother from the
delivery.
 Labor and delivery are not easy as it entails physiological effects on both the mother
and the fetus. The mother’s cardiac output increases because of the increase need in blood
in the uterine area. In addition, blood pressure and respiration also arise due to the effort
exerted and the pain to expel the fetus.

With delivery imminent, the mother is usually placed in supine with her knees bent
or in dorsal lithotomy position. Then, an episiotomy or an incision continuous with the
vaginal introitus may also be performed at this time as it eases the delivery of the fetal head.
However, many providers no longer perform routine episiotomy since it may increase
the risk of rectal injury. As labor and delivery are always accompanied by pain, several
options for pain control are available ranging from intramuscular or intravenous doses to
general anesthesia and regional nerve blocks to manage the pain.

Patient’s Data

Demographic Profile

Family History

History of Past Illness

Admitting History

Status of Present Illness

Physical Assessment

Body Parts Normal Findings Actual findings Result

Skull Normal Or
 Generally round, with prominences in Abnormal
the frontal and occipital area
 No tenderness noted upon palpation
Scalp
 Lighter in color than the complexion
 Can be moist or oily
 No scars noted
 Free from lice, nits, and dandruff
 No lesions should be noted
 No tenderness or masses on palpation

Hair  Can be black, brown, or burgundy

 depending on the race
 Evenly distributed and covers the
whole scalp
 No evidence of Alopecia
 Maybe thick or thin, coarse, or smooth
 Neither brittle nor dry
Face
 Shape may be oval or rounded
 Face is symmetrical
 No involuntary muscle movement
 Can move facial muscles at will
 Mask of pregnancy is can be
encountered
 No edema
Eyes  Evenly placed and in line with each
other
 None protruding
 Equal palpebral fissure
Ears  The earlobes are bean-shaped, parallel,
and symmetrical
 Skin is the same in color as in the
complexion
 No lesions noted on inspection
 The auricles have firm cartilage on
palpation
 The pinna recoils when folded
 There is no pain or tenderness on the
palpation of the auricles and mastoid
process
 The ear canal has normally some
cerumen in inspection
 No discharges or lesions noted at the
ear canal
 On otoscopic examination, the
tympanic membrane appears flat,
translucent, and pearly gray in color
Nose and  Nose in the midline
Paranasal  Nasal congestion due to the stimulation
sinuses of estrogen
 Both nares are patent
 No bone and cartilage deviation noted
on palpation
  No tenderness noted on palpation
 Nasal septum in the midline and not
perforated
 The nasal mucosa is pinkish to red in
color. (Increased redness on turbinate
are typical of allergy)
 No tenderness noted on palpation of
the paranasal sinuses
Mouth  With visible margin
 Symmetrical in appearance and
movement
 Pinkish in color
 Swollen gums or epulis due to the
stimulation of estrogen
Neck  The neck is straight
 No visible mass or lumps
 Symmetrical
 No jugular venous distension
(suggestive of cardiac congestion)
Chest/Breast  No lumps or masses are palpable
 No tenderness upon palpation
 Darker areola
 Prominent veins
 May have discharges from the nipples
or colostrum
Thorax
 Pulsation of the apical impulse may be
visible. (this can give us some
indication of the cardiac size)
 There should be no lift or heaves
Abdomen  Skin color is uniform, no lesions
 Some clients may have striae or scar
 No venous engorgement
 Contour may be flat, rounded or
scaphoid
Extremities  Ankle swelling
 No involuntary movements
 No edema on upper extremities
 Color is even
 Temperature is warm and even
 Has equal contraction and even
 Can perform complete range of motion
 No crepitus must be noted on joints
  Can counteract gravity and resistance
on ROM
Skin  Color varies based on race (black, white
etc.) and environmental effect (tan)
 Few moles and areas of pigmentation
can be encountered
 Fine hair is seen over most of the skin
 Linea nigra
 Palmar erythema
Genital Area  May be light pink to deep violet
(Chadwick’s sign)

Physical Assessment - Nurseslabs. Retrieved October 3, 2020, from Nurseslabs website:

https://nurseslabs.com/ultimate-guide-to-head-to-toe-physical-assessment/?fbclid

Chapter 2

Definition of Case
According to Cirino, 2017 normal spontaneous vaginal delivery is the type of
delivery that occurs when a pregnant woman goes into labor without the use of drugs and
delivers the baby through vaginal route with effort and force exertion. In other words, it is
a complete natural way of delivery without any medical intervention. The primary focus of
the doctor, midwife and the attending nurse is to aid and position the mother at the
most comfortable to deliver the baby while being alert on any kind of emergencies that can
arise as the mother can lead the whole process. Nowadays due to the advent of
technology, normal spontaneous vaginal delivery is now assisted with medical
intervention if the mother prefers. Medications are now used to alleviate the pain and
even speed up the delivery process.
In order to undergo normal childbirth, there are four stages of labor to face and
experience according to Pilletteri, 2010. On stage 1, the mother will feel the initiation of
true labor contraction and the fully dilation of the cervix with the duration of 60-90
seconds every 3-4 minutes. As the labor progresses on the stage 2, the contraction will be
so strong and the attending doctor or midwife may or may not perform episiotomy or
an incision made in the area between the vagina and the rectum to widen the vaginal
opening to promote the smooth delivery of the infant on this stage. Next on the third
stage, or also called the placental stage the mother will deliver the placenta and lastly, on
the fourth stage or also called as the post-partum juncture, the mother’s uterus will
contract again to expel the remaining contents.
NSVD is known as the most common type of delivery and the most recommended
especially for women whose babies have reached full term and with no complications due
to its benefits of quick recovery compared to caesarean thus having short hospital stay
and
 cost to pay, low infection rates, and no surgery needed. However, as risks are always
present, NSVD may cause vaginal tear, postpartum hemorrhage, and even fetal
distress if not executed properly.
Anatomy and Physiology

Anatomy of the Female Reproductive

System
External Genitalia

The structures that form the female external genitalia are termed vulva meaning
covering. It includes the mons pubis, labia majora, labia minora, Bartholin
glands and clitoris. The external genital organs have three main functions namely, it
enables the sperm to enter the vagina, protects the internal genital organs from
infectious organisms and provides sexual pleasure.

The mons pubis is a rounded mound of fatty tissue that covers the pubic bone.
During puberty, it becomes covered with hair. It contains oil-secreting sebaceous
glands that release substances that are involved in sexual attraction which is the
pheromones. The function of mons pubis is to protect the junction of pubic bone
from trauma.

The labia majora are the large, two fleshy folds of adipose tissue covered by loose
connective tissue and epithelium that is covered with pubic hair. It encloses and
protect the other external genital and the distal urethra and vagina. They are
comparable to the scrotum in males. The labia majora contain sweat and sebaceous
glands, which produce lubricating secretions.

The labia minora can be very small or up to 2 inches wide. It lies just inside the
labia majora and surround the openings to the vagina and urethra. A rich supply of
blood vessels gives the labia minora a pink color. During sexual stimulation, these
blood vessels become engorged with blood, causing the labia minora to swell and
become more sensitive to stimulation.

When stimulated, Bartholin glands located beside the vaginal opening secrete a
thick fluid that supplies lubrication for intercourse.
The clitoris, located between the labia minora at their upper end, is a small
protrusion that corresponds to the penis in the male. It is covered by a fold of skin
called prepuce and are very sensitive to sexual stimulation where it is considered
as the center of sexual arousal and orgasm in a woman.

Internal Genitalia

The internal reproductive organs include the vagina, cervix, ovaries, fallopian
tube, and the uterus.

The vagina is a tubelike, muscular but elastic organ about 4 to 5 inches long in an
adult woman. It is also known as the canal that connects the cervix to the outside of
the body. It is the passageway of the sperm to the egg, menstrual blood, and even
the baby outside the body.

The uterus is a hollow, pear-shaped organ that is the home of a developing fetus. It
is divided into two parts: the cervix, which is the lower part that opens into the
vagina, and the main body of the uterus, called the corpus. The corpus can easily
expand to hold a developing baby. A canal through the cervix allows sperm to
enter and menstrual blood to exit.

The ovaries are small, oval-shaped glands that are located on either side of the
uterus that are responsible in producing eggs and hormones.

The fallopian tubes are the narrow tubes that are attached to the upper part of the
uterus and serve as pathways for the ova or egg cells to travel from the ovaries to
the uterus. Fertilization of an egg by a sperm normally occurs in the fallopian tubes.
The fertilized egg then moves to the uterus, where it implants to the uterine lining.

Mammary Glands
 Mammary Glands are the organs of milk production. It is a modified sweat gland that
consist of glandular lobes and adipose tissue. It has lobes that are connected to the
nipple through ducts.

The nipple is a very sensitive smooth muscle that response to stimuli such as touch,
temperature, and sexual arousal.

The nipple is surrounded by the areola or the circular pigmented area in the breast.

Physiology of the Female Reproductive System

Breast Changes
The breasts will increase in size and the areola will darkens due to the increase
levels of estrogen. It will also become flushed, swollen, sore, and engorged with milk
for a day or two after the birth due to the increase level of prolactin. Milk leakage
are also expected to be experience for several weeks, even if not breastfeeding.

Vaginal Pain and Discharge

The vagina may feel stretched and tender after the delivery. A vaginal discharge
mostly of blood are also expected called lochia that can last for several weeks.
 MSD Manuals. (2020). The Vagina. Retrieved October 3, 2020, from MSD Manual
Consumer Version website: https://www.msdmanuals.com/home/women-s-health-
issues/biology-of-the-female-reproductive-system/female-internal-genitalorgans

Pathophysiology (Process of NSVD)

↓ Prostaglandin

Uterine Contraction ↑ Oxytocin Softening of the cervix

Stage 1
Initiation of True Labor of
contraction

↑ Frequency of Contraction ↑ Duration of contraction ↑ Intensity of contraction

Stage 2
Complete cervical dilatation and delivery of the baby

Stage 3
Delivery of the placenta

Stage 4
Postpartum juncture
Clinical Manifestations (Signs and Symptoms)
Signs and Symptoms of Impending Labor
Before labor, a woman often experiences subtle signs that signal labor is imminent
such as lightening due to the descent of the fetus and uterus to the pelvic cavity, cervical
changes or the dilation and effacement of the cervix, Braxton Hick’s contractions or the false
labor which is a painless contraction, rupture of the amniotic membrane or the sudden gush
of amniotic fluid, nesting behavior or the sudden surge of energy and lastly weight loss due
to the increase in body fluid excretion.

Signs and Symptoms of True Labor

Right after the impending labor, the woman will experience the signs and symptoms
of the true labor that includes regular contractions that begins in the back and radiates to
the abdomen with progressive frequency and intensity along with shorter intervals
between contractions. In addition, the contraction will continue no matter what the
woman’s level of activity. And lastly, and the most important signs is the woman will have
bloody show and cervical dilatation.

Signs and Symptoms of Labor and Delivery on NSVD

According to Pillitteri, 2010 the signs and symptoms of the stage 1 of labor is the
contraction that last from 20 to 40 seconds and the rapid cervical dilatation from 0 to 3 cm
on the latent phase up to 60 to 90 seconds contraction and cervical dilatation of 10 cm on
the transition phase. As the labor progresses, on the stage 2 the signs and symptoms is the
complete dilatation of the cervix and a change on contraction characteristic from crescendo-
decrescendo pattern to an overwhelming and uncontrollable urge to push with each
contraction thus gives way to the birth of the baby. On the third stage, the signs and
symptoms is the change in size of the uterus where the fundus becomes globular and rises
which is an early sign of placental separation, lengthening of the cord which is the most
reliable sign, and the sudden gush of blood. And lastly on the stage 4 or the postpartum
juncture, which is an hour or two after the delivery the signs and symptoms is the uterus
tone will be reestablish and contracts again to expel any remaining contents.

Medical Management
In normal spontaneous delivery the medical management are as follows
a. Order the administration of D5LRS – a sterile non pyrogenic solution for
fluid and electrolyte replenishment during delivery, caloric supply, and
route for medication during labor and delivery.
 b. Order the administration of medication such as local anesthesia for pain relief
in episiotomy and perineal repair and on epidural delivery
c. Order the administration of oxytocin for assisted
labor
d. Perform episiotomy - incision made in the area between the vagina and the
rectum to widen the vaginal opening to promote smooth delivery and to
minimize pressure in the fetal head

e. Give instruction for the delivery and clamping of the umbilical

cord f. Remove of leftover pieces of placenta to prevent heavy
bleeding

Medical Care During Pregnancy (for Parents) (2018). Retrieved October 3, 2020,
from
Kidshealth.org website: https://kidshealth.org/en/parents/medical-care-pregnancy

Nursing Management
Nursing Care during 1st Stage of Labor
1. Assess the start of labor

a. Painful contraction with certain regularity

b. Effacement and/or dilatation of the
cervix c. Assessment of amniotic fluid
a. Clear – normal color
b. Yellow stained – blood
incompatibility c. Green – meconium
staining
d. Gray/cloudy – infection
e. Pink/red – bleeding
f. Brown – fetal death
d. Bloody discharge

2. Ambulation: encourage walking to shorten the first stage of labor but not applicable
if the membranes ruptured
3. Bladder care: Encourage every 2 hours
4. Encourage breathing through chest
5. Pain relief measures: relaxation and breathing techniques, therapeutic
massage, peaceful imaging, administer narcotic analgesics such as morphine
sulfate as ordered.

Nursing Care during the 2nd Stage of Labor

1. Prepare the place of birth

2. Position the client in lithotomy position
3. Perineal cleaning
4. Encourage pushing
5. Perineal tear or Episiotomy

Nursing Care during the 3rd Stage of Labor

1. Check the completeness of placenta – 15 to 20

cotyledons
 2. Clamp and cut the cord: when the cord stops pulsating
3. Check the fundus
4. Uterine massage
5. Check blood pressure: administer methergine to prevent hemorrhage (if
the patient has pre-eclampsia administer oxytocin such as Pitocin as
ordered)

Nursing Care during the 4th Stage of Labor

1. Monitor vital signs and watch for possible complications

2. Care for the vagina and perineum

Chapter 3
Laboratory Results

Complete Blood Count (CBC)

Laboratory Test Normal Range ↑ ↓

Red Blood Cell Women: 4.1 to  May be a  Indication of
(RBCs) 5.1 million symptom of a anemia.
cells/mcL disease or
disorder,
although it
doesn’t
always
indicate a
health
problem.
White Blood Cell 4,500 to 10,000  Sign of  The mother is
(WBC) cells/mcL infection prone to
infections.
 Indication of
sickle-cell anemia
or leukemia
Hematocrit (Hct) 36.9% to  Can indicate  The mother may
44.6% dehydration. have anemia.
 Indication of  Sign of iron
Lungs or deficiency
heart disease.
Mean 80 to 96  The mother  Fatigue and
Corpuscular could have a chronic tiredness,
Volume (MCV) type of shortness of
anemia breath, pale skin,
 Indication of easily bruised,
low vitamin dizziness,
B12 or Folic weakness, and
levels loss of stamina.
Platelets 150,000 to  The mother is  Sign of
450,000 susceptible to thrombocytopenia
platelets /mcL sudden  Indication of
 internal blood bleeding
clots and
hemorrhages.

Complete blood count (CBC) - Mayo Clinic. (2018). Retrieved October 3, 2020, from
Mayoclinic.org website: https://www.mayoclinic.org/tests-procedures/complete-
blood- count/about/pac-20384919

Urinalysis

Laboratory Test Normal Range ↑ ↓

pH 4.5-7.2 pH  Indicates  Urine is normally
infection acidic
Specific gravity 1.005-1.025  Indicates  Indicated diabetes
dehydration
and liver
failure
Glucose 141-200  Indicate  Indicates
MG/dL gestational hypoglycemia.
diabetes.
Protein 120 to 160  Signs of  Normal or
ml/min urinary tract possibly indicate a
infection or minor infection.
kidney
disease.
 Signs of
Preeclampsia
Bacteria A count of  Indicate  Normal, a small
100,000 or infection in number of
more bacteria the urinary bacteria may be
per milliliter of tract or found in the urine
urine may be kidneys. of many healthy
caused by an people
infection
Ketones Small: <20  Indicates  Don’t pose a risk
mg/dL ketonuria.
Moderate: 30  Indicate
to 40 mg/dL. diabetic
Large: >80 mg/ ketoacidosis
(DKA).

Laboratory Tests Interpretation. (2020). Retrieved October 3, 2020, from

Nurseslearning.com website:
https://www.nurseslearning.com/courses/nrp/labtest/course/section5/index.htm
Hepatitis B surface Antigen (HBsAg)

Lab test Result

Hepatitis B  Level of less than 1 s/c is considered negative.
surface Antigen  Level of more than 5 s/c is considered positive.
 Any value between 1 and 5 s/c is indeterminate and should
be repeated.

Hepatitis B Foundation: Hepatitis B Blood Tests. (2020). Retrieved October 3, 2020, from
Hepb.org website: https://www.hepb.org/prevention-and-diagnosis/diagnosis/hbv-
blood- tests/

Venereal Disease Research Laboratory (VDRL) or Syphilis

Lab Test Result

VDRL or  A negative test result means normal, no antibodies to
Syphillis syphilis
 A positive test result means you have syphilis
 False positive test includes
o HIV/AIDS
o Lyme disease
o Certain types of pneumonia
o Malaria
o Systemic lupus erythematosus

VDRL. (2019, August 13). Retrieved October 3, 2020, from ucsfhealth.org website:
https://www.ucsfhealth.org/medical-tests/vdrl-test
Chapter 4

Nursing Care Plan

ASSESSMEN NURSING OUTCOME PLANNING INTERVENTION EVALUATIO

T DIAGNOSIS IDENTIFICATION N

Subjective: Acute pain related Within 4 hours of Short term: Independent: Position the client in Goal was met.
“Sobrang to intense uterine nursing intervention, After 1 hour of dorsal recumbent with the shoulder, After four hours
sakit ng tyan contractions as the client will deliver nursing head, and back elevated of nursing
ko humihilab, evidenced by the baby including the intervention Rationale: This position promotes intervention, the
manganganak report of 7/10 placenta and will the client will effective pushing due to the presence client delivered
na ako” as pain scale, demonstrate a relief be able of gravity the baby
verbalized. elevated of pain from the pain achieve Independent: Perform perineal including the
Objective: respiration rate; scale of 7/10 to 4/10 complete cleaning placenta and
Pain scale 24 bpm and blood and will have a change cervical Rationale: Perineal cleaning verbalized a
7/10, pressure; 140/90 in respiration from 24 dilatation reduces the risk for infection relief of pain
respiration; mmHg, ruptured bpm to 19 bpm and Independent: from 7/10 to
24 bpm, amniotic blood pressure from Long term: Instruct deep breathing 4/10 with a
blood membrane and 140/90 to 120/80. After the 3 Rationale: Deep breathing enhance change in
pressure; cervical dilatation hours of relaxation and decrease perception respiration rate
140/90 of 8 cm. continuous of pain from 24 bpm to
mmHg, nursing Independent: 19 bpm and
ruptured intervention, Clean perineal are after delivery blood pressure
amniotic the client will Rationale: Perineal care promotes from 140/90
membrane, deliver the comfort and reduce the risk for mmHg to
cervical baby including infection. It is also a way to assess 120/80 mmHg.
dilatation of 8 the placenta. the perineal for laceration.
cm. Independent:
Check vital signs every 15 minutes
after the delivery
Rationale: Vital signs provide
baseline of data and indicate
underlying problems such as
infection and complications
Dependent: Open an IV line as
 ordered
Rationale: IV line is used during
labor and delivery to maintain
hydration and for emergency
Dependent: Administer oxytocin 10
units/mL IM as ordered after the
expulsion of the placenta
Rationale: Oxytocin prevent
postpartum hemorrhage

Collaborative: Collaborate with the

nutritionist regarding the high-
protein diet applicable for the client
Rationale: High protein intake is
necessary to promote wound healing
and tissue repair.

Chapter 5

Drug Study; Cefuroxime

 DRUG MECHANISM INDICATIONS CONTRAINDICATIONS ADVERSE NURSING RESPONSIBILITIES
OF ACTION REACTIONS
Generic Name Binds to Treatment of CNS: chills, fever, Before
Cefuroxime bacterial cell susceptible Contraindicated in headache, seizure  Consider the 10 rights of
Sodium membranes, infections clients with history of CV: Edema administering medication
inhibits cell caused by GI: nausea,  Determine history of
hypersensitivity/anaphy
vomiting, diarrhea,
Brand Name wall synthesis bacteria lactic reaction, hypersensitivity reactions to
anorexia, abdominal
Zinacef including hypersensitivity to pain, flatulence cephalosporins, penicillin
Therapeutic acute/chronic cephalosporins GU: Renal failure, and history of allergies
Classification effect: bronchitis, nephrotoxicity  Perform sensitivity test
Therapeutic Bactericidal gonorrhea, Caution in client with Hematologic: bone During
class: Antibiotic impetigo, early severe renal marrow, depression  Monitor periodically BUN
Chemical class: Lyme disease, impairment, and history SKIN: erythema, and creatinine clearance
Second otitis media, of penicillin allergy pruritus, rash  Inspect IV injection sites
generation pharyngitis/to OTHERS: frequently for signs of
cephalosporin nsilitis, anaphylaxis,
phlebitis
sinusitis, UTI, injection-site
Pregnancy  Monitor for manifestations
edema, pain, and
category: B skin infection of hypersensitivity
redness
and  Monitor I&O rates pattern
Dosage perioperative especially important in
750 mg diluted prophylaxis severely ill patients receiving
in sterile water high dose
After
Route  Tell the client to report
Parenteral loose stools or diarrhea
promptly
 Tell the client to avoid
alcohol for 3 days after
because severe reaction

Homeworkping4. (2015, September 13). drug-study-final. Retrieved October 3, 2020, from Slideshare.net website:
https://www.slideshare.net/homeworkping4/241603963-drugstudyfinal?from_m_app

Drug Study; Ferrous Sulfate

Generic Name Combines Ferrous sulfate CNS: dizziness, Before
Ferrous Sulfate with is used for the Contraindicated in fever, headache  Consider the 10 rights of
porphyrin prevention and clients with CV: chest pain, administering medication
Brand Name and globin treatment of hypertension,  Assess nutritional status
hemochromatosis, and
hypotension
Feratab, chains to iron deficiency hemolytic anemia and dietary history
EENT: metallic
FeroSul form anemia due to taste, tooth  Alert the client that oral
hemoglobin, inadequate Caution in client with discoloration iron may turn stool to black
Classification which is diet, peptic ulcer, regional GI: abdominal During
Chemical class: critical for malabsorption, enteritis, and ulcerative cramps,  Monitor serum iron, total
Trace element, oxygen pregnancy, and colitis constipation, iron-binding capacity,
mineral delivery from blood loss nausea, vomiting reticulocyte count, Hgb,
Therapeutic the lungs to HEME: ferritin.
class: other tissues. hemochromatosis,  Monitor daily pattern of
Antianemia, hemolysis
bowel activity and stool
Therapeutic SKIN: Pruritus, rash
nutritional consistency
OTHER:
supplement effect: After
anaphylaxis (IV),
Prevents iron angioedema,  Assess for clinical
Dosage deficiency injection site improvement
65-200 mg/day discoloration  Record relief of iron
deficiency symptoms such
Route as fatigue, irritability,
P.O. pallor, paresthesia of
extremities, and headache

Drug study (ferrous sulfate). (2011). Retrieved October 3, 2020, from Scribd website:
https://www.scribd.com/document/250086635/Drug-study-ferrous-sulfate?fbclid

Drug study; Paracetamol

Generic Name Paracetamol Relieve mild pain Hematologic: Before
Paracetamol cause such as Contraindicated in clients Hemolytic anemia,  Consider the 10 rights of
analgesia by headache, with hypersensitivity to leukopenia, administering medication
Brand Name inhibiting muscle and joint acetaminophen or neutropenia,  Determine history of
pain, backache, phenacetin; use with pancytopenia,
Biogesic prostaglandin hypersensitivity reactions
and period pains alcohol. thrombocytopenia
synthesis in as well as fever. Hepatic: Liver to acetaminophen or
Classification the CNS. The damage, jaundice phenacetin
Analgesic drug relieve Metabolic: During
(Non-opiod) fever through Hypoglycemia  Assess allergic reactions:
Antipyretic central action Skin; Rash, urticaria rash, urticarial; if these
in the occur, drug may have to be
Dosage hypothalamic discontinued.
500 mg/tab heat- After
regulating  Tell patient to notify
Route center prescriber for pain or fever
Oral lasting for more than 3
days.

Paracetamol. (2011). Retrieved October 3, 2020, from Scribd website: https://www.scribd.com/doc/154473457/Paracetamol

Chapter 6
Evaluation

Findings

Recommendation

Medications

 Continue to take iron supplements such as ferrous sulfate as it is essential for the body to make new blood cells especially
there’s a lot of blood lost during delivery.
 Take ascorbic acid as it essential in the formation of collagen needed to heal wounds and build tissue. It also acts as an
antioxidant that protects the cells form damage and help absorbs iron that promotes prothrombin formation.
 Take ibuprofen or paracetamol as prescribed as this will help to reduce the pain after the delivery.
 Take zinc supplements as it aids in wound healing and tissue repair.

Exercise

 Recommend ambulation or walking as it is the simplest ways to ease into a fitness routine after giving birth and it
promotes normal functioning and circulation on the cardiovascular and musculoskeletal system.
 Recommend doing Kegels Exercise as this classic exercise will help to tone the bladder and perineal muscles and will help
reduce risks of incontinence associated with childbirth. The more Kegels you do, and the longer you hold them, the better
control you will have over those leaks caused by sneezing, laughing, or picking up your baby.
 Recommend Deep Belly Breathing as this exercise will helps relax muscles, and it starts the process of strengthening and
toning the abs and belly. It also promotes comfort and relaxation.
 Recommend kneeling pelvic tilt as this exercise helps tone the tummy and strengthens the abs that can also relieve back
pain.
 Recommend swiss ball bird dog holds because this exercise helps with stability, posture, and reduces low back pain, which
is common after giving birth.
 Recommend cat-cow in tabletop as this beginner’s yoga move helps to support back muscles, strengthens the core, and
promotes mobility in the spine. Including this move in postpartum workouts can help reduce back pain, promote
relaxation, and improve circulation.
Treatment
  Take the medication as prescribed.
 Perform perineal care to avoid infections.
 Apply prescribed topical medications on episiotomy.
 Have a follow up checkup from your physician after you discharged.

Health Teaching

 Teach the mother how to breastfeed and the importance of breastfeeding.

 Include tips on what to do if the breast is engorged such as applying warm packs and if the nipples are sore such as
applying with breast milk.
 Educate the client that pain is normal due to the delivery as well as the uterine contractions as the uterus is contracting to
return to its non-pregnant state that usually takes five to six weeks.
 Inform the client that vaginal discharge is present after the delivery and will usually last about 10 days to four weeks and
the color will change from bright red to brownish to tan and will become less in amount and finally disappear.
 Instruct the client that her period will resume approximately six to eight weeks unless breastfeeding.
 Instruct the client to rest and don’t do heavy housework and heavy exercise.
 Educate the client that it is normal to get “baby blues” after delivery where she may feel let down, anxious and cry easily.
These feelings can begin two to three days after delivery and usually disappear in about a week or two, but prolonged
sadness may indicate postpartum depression and she should contact her physician.

OPD Instructions

 Start Kegel exercise immediately after delivery to help with healing as well as minimize bladder leakage
 Shower as often as you like but avoid tub baths and swimming as well as applying tampons, and even intercourse
until after the postpartum checkup as there’s should be nothing placed in the vagina.
 Try to get as much rest because lack of sleep can affect the mood and increase anxiety
 Refrain from any weight reducing diets instead eat balanced diet as it is necessary for tissue repair, healing,
breastfeeding, and general health
 Uterine pain, bleeding, and contraction is normal. Use breathing techniques and pain medications prescribed by the doctor
to lessen discomfort
  Continue to use the peri-bottle to clean the perineum from front to back with warm water as well as sitz bath as directed
as this will dissolve any stitches if there’s any and aid in healing the perineum.
 Call the doctor if you experience burning sensation upon urination, elevated temperature, pus drainage on the perineum,
no bowel movement for four days, excessive bleeding with foul smell, severe headache that are not relieved
with acetaminophen, swollen leg, and blurred vision.
 After 6 weeks of getting birth, go back to your doctor for postpartum visit.

Diet

 Recommend eating foods that are high in protein such as milk, cheese, yogurt, meat, fish, and beans. Protein rich foods
are important to help to recover from childbirth as it promotes wound healing and tissue repair.
 Eat fruits and vegetables. Try to make half of the plate with fruits and vegetables as it has vitamins and minerals that keeps
you and the baby healthy when breastfeeding. It also has fiber, which helps prevent constipation which is a problem
after delivery.
 Drink plenty of liquids. The body needs lot of fluid at about 6-10 glasses a day especially if breastfeeding. Drink mostly
water, milk, and fruit juice.
 Eat foods that are high in iron such as red meat, poultry, tofu, and bean as it is essential for the body to make new
blood cells especially there’s a lot of blood lost during delivery.
 Don’t go on a crash diet just to lose the excess weight gained during pregnancy because it can harm you since it will have a
drastic drop of energy in the body.

Spirituality

 Spirituality intervention in pregnancy include prayers during discomfort and after for the blessing of life.