IN PARTIAL FULFILLMENT OF THE

MATERNAL AND CHILD NURSING

REQUIREMENTS OF

A CASE STUDY ON
PREECLAMPSI
ABRUPTIO
A
PREMATURI
PLACENTA
PRESENTED BY:

TY CLINICAL GROUP 3
o Overview
o Introduction
o Anatomy and physiology
o General Pathophysiology
o Clinical Health History
o Physical Assessment
o Developmental Task
o Patterns of functioning
o Levels of Competencies
o Specific Pathophysiology
o Diagnostic Examination
o Ongoing appraisal
o Drug Study
o Nursing Care Plan
 GROUP 1
PRESENTORS
A CASE STUDY ON PREECLAMPSIA

RIALYN AILLENNE KIMBERLY HANNAH FAYE PRINCESS

ABOGADO ALAMBRA BULUSAN BALUBAL GANIGAN
 GROUP 1
PRESENTORS
A CASE STUDY ON PREECLAMPSIA

MARIA JELAIKA SAFFERY KYLE CHRISTIAN ROXANNE

LAO LAYUGAN SARANDI RESPICIO TUMALE
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 GENERAL OVERVIEW OF PREECLAMPSIA
In today's world complication during pregnancy are not unheard of. In fact many women are at risk for some
sort of complication during their pregnancy. One of the most common complications during pregnancy is
preeclampsia. Preeclampsia, also known as pregnancy induces hypertension, with its greatest morbidity and
mortality, preeclampsia affects 5% to 7% of all pregnant women but is responsible for over 70, 000 maternal deaths
and 500 000 fetal deaths worldwide every year..
Preeclampsia-eclampsia was not formally classified as a disorder of pregnancy during Ancient times. Despite limited
knowledge and technology, the writings of this period did demonstrate that the concept of eclampsia was recognized.
Hippocrates (400BCE/1950) states that a headache accompanied by heaviness and convulsions during pregnancy is
considered bad. Then, during the Middle Ages, medical and scientific progress came to a standstill. In the
seventeenth century, medicine continued to gain momentum and men began to enter the field of obstetrics.
According to McMillen (2003), Frenchman Mauriceau’s, writings helped to establish obstetrics as a specialty and
was the first to systematically describe eclampsia. Near the end of the Reniassance, the classification of disease
progressed. And it wasn’t until 1619 that the word “eclampsia” first appeared in Varandaeus’ treatise on gynecology.
In addition, According to Chesley (1978), the “pre-eclamptic” state was not included in textbooks until 1903. In the
year 1966, Toxemia of pregnancy was introduced with Diagnostic criteria of preeclampsia: hypertension, proteinuria,
edema after 24 weeks. Lastly, According to Hibbard (1988), preeclampsia, under classification of Hypertensive
disorders of pregnancy was grouped into Pregnancy induced Hypertension that are classified into mild-moderate and
severe preeclampsia.
Moreover, according to Errol R. Norwitz, MD, PhD, MBA, women with preeclampsia develop high blood
pressure (defined as a sustained elevation greater than 140/90 mmHg) and generally have protein in
their urine, although some women develop other features of the disease without proteinuria. This can
occur anytime during the last half of pregnancy (after 20 weeks of gestation) or in the first few days
after delivery. Moreover, preeclampsia occurs in 3 to 4 percent of pregnancies in the United States. It
is not known why some women develop preeclampsia while others do not. Currently, there are no
tests that can reliably predict who will get the disease, and there is no way to completely prevent it.
Taking low-dose aspirin in the late first trimester through the third trimester appears to lower the risk
of developing preeclampsia in women at high risk of developing the disease. In addition, the majority
of women with preeclampsia have no symptoms. The disease can progress quickly, symptoms of this
may include headache, vision problems, shortness of breath, and upper abdominal pain. A pregnant
woman should immediately call her health care provider if any of the signs or symptoms of severe
disease develop, or if she has decreased fetal activity, vaginal bleeding, abdominal pain, or frequent
uterine contractions.
Furthermore, the only cure for preeclampsia is delivery of the fetus and placenta. Reduced physical activity, but
not strict bed rest, and taking high blood pressure medication can lower the blood pressure but will not stop
preeclampsia from worsening or reduce the risk of its complications. If tests monitoring the mother's or fetus's
condition show concerning results, the health care provider may recommend delivery. A vaginal delivery is often
possible. Because women with preeclampsia can develop seizures (called eclampsia), most women are treated
with an anticonvulsant medication during labor and usually for 24 hours after delivery. Intravenous magnesium
sulfate is the drug most commonly used to prevent seizures. It is safe for both mother and fetus. High blood
pressure and protein in the urine resolve after delivery, usually within a few days or weeks. However, some
women require medication to reduce high blood pressure after being discharged from the hospital.
Most women who experience preeclampsia without severe features will not have it again in a future pregnancy.
The risk of recurrence is higher in women with severe features of preeclampsia, especially when they occur in the
second trimester. Women who develop preeclampsia appear to be at increased risk of developing cardiovascular
disease later in life, so regular health care may be particularly important in this group of patients. Women who
had high blood pressure during pregnancy should have their blood pressure checked yearly. They can also reduce
their risk of having high blood pressure later in life by maintaining a healthy weight, limiting their salt intake,
avoiding excess alcohol use, and exercising regularly. A greater risk may be related to inequities in access to
prenatal care and health care in general, as well as social inequities and chronic stressors that affect health and
well-being. Lower income also is associated with a greater risk of preeclampsia likely because of access to health
care and social factors affecting health.
Furthermore, the only cure for preeclampsia is delivery of the fetus and placenta. Reduced physical activity, but not
strict bed rest, and taking high blood pressure medication can lower the blood pressure but will not stop preeclampsia
from worsening or reduce the risk of its complications. If tests monitoring the mother's or fetus's condition show
concerning results, the health care provider may recommend delivery. A vaginal delivery is often possible. Because
women with preeclampsia can develop seizures (called eclampsia), most women are treated with an anticonvulsant
medication during labor and usually for 24 hours after delivery. Intravenous magnesium sulfate is the drug most
commonly used to prevent seizures. It is safe for both mother and fetus. High blood pressure and protein in the urine
resolve after delivery, usually within a few days or weeks. However, some women require medication to reduce high
blood pressure after being discharged from the hospital.
Most women who experience preeclampsia without severe features will not have it again in a future pregnancy. The
risk of recurrence is higher in women with severe features of preeclampsia, especially when they occur in the second
trimester. Women who develop preeclampsia appear to be at increased risk of developing cardiovascular disease later
in life, so regular health care may be particularly important in this group of patients. Women who had high blood
pressure during pregnancy should have their blood pressure checked yearly. They can also reduce their risk of having
high blood pressure later in life by maintaining a healthy weight, limiting their salt intake, avoiding excess alcohol use,
and exercising regularly. A greater risk may be related to inequities in access to prenatal care and health care in
general, as well as social inequities and chronic stressors that affect health and well-being. Lower income also is
associated with a greater risk of preeclampsia likely because of access to health care and social factors affecting health.
A. DEFINITION OF TERMS

According to World Health Organization preeclampsia is a hypertensive disorder that can occurs during
pregnancy and postpartum period and affects the mother and the fetus. Globally, preeclampsia and other
hypertensive disorders of pregnancy are the main cause of maternal and neonatal illness and death. In the
Region, according to data from the World Health Organization, more than 20% of maternal deaths are
caused by hypertensive problems. 

Preeclampsia refers to the new onset of hypertension and evidence of organ injury in a pregnant woman
during the latter half of gestation (after 20 weeks of pregnancy). Many organs can be affected, including the
kidneys (leading to excess protein in the urine, called proteinuria), the liver, and the brain (leading to
headaches and changes in vision and occasionally seizures). Preeclampsia can occur for the first time after
delivery. The organ injury typically resolves within several days to weeks after delivery.

Preeclampsia is a pregnancy specific hypertensive disease with multi-system involvement. It usually occurs
after 20 weeks of gestation and can be superimposed on another hypertensive disorder. While preeclampsia
was historically defined by the new onset of hypertension in combination with proteinuria, some women will
present with hypertension and multisystemic signs in the absence of proteinuria. The presence of
multisystemic signs is an indication of disease severity.
B. TYPES OF PREECLAMPSIA
Preeclampsia can be categorized as:

● Preeclampsia without severe features

You may be diagnosed with mild preeclampsia if you have high blood pressure plus
high levels of protein in your urine.
● Symptoms may include:
● Blood pressure of 140/90mmHg
● Water retention or edema in the face and fingers
● Proteinuria 1+ or 1g/day

Preeclampsia with severe features

You are diagnosed with severe preeclampsia if you have symptoms of mild
preeclampsia plus signs of kidney or liver damage.

Signs and symptoms may include:

● Blood pressure of 160/110 mmHg

● protenuria 3+ to 4+ or 5g/day or more
● Severe swelling of the face
● Excessive weight gain
● Epigastric pain
• Eclampsia
You are diagnosed with eclampsia when cerebral edema is so acute a grand
mal(tonic-clonic) seizure or coma has occurred. Eclampsia associated with
convulsions and coma.

The following are common symptoms of eclampsia:

• Seizures- are periods of disturbed brain activity that can cause by convulsions.
• Loss of consciousness- results in fainting and it happens because your brain
isn’t getting enough oxygen. Sometimes this is due to severe pain.
• Agitation- is a normal emotion experienced by most people. In the majority of
cases, there’s no need for worry or concern. It is cause by stress.
C. GENERAL CAUSE
● Preeclampsia results from abnormalities in the development of the placenta
very early in pregnancy. If the placenta does not invade deeply enough into
the uterus and establish a healthy blood supply from the mother, it may not
be able to supply itself or the fetus with adequate nutrients and oxygen as the
pregnancy continues. This is especially problematic after 20 weeks of
gestation when the fetus is growing rapidly. A cascade of events may occur
that can damage blood vessels throughout the mother's body (in the kidneys,
liver, brain) and cause the clinical syndrome that we call preeclampsia. Why
this happens to some women and not others is not completely understood.
D. INCIDENCE RATE
INTERNATIONAL
D. INCIDENCE
RATE
NATIONAL
 D. INCIDENCE RATE
LOCAL
INCIDENCE RATE OF PREECLAMPSIA IN CAUAYAN MEDICAL SPECIALIST HOSPITAL IN 2021-
PRESENT.

TYPE OF SERVICE NO. OF CASES YEAR

 

OBSTETRICS 329 2021-PRESENT

GYNECOLOGY 98 2021-PRESENT

PEDIATRICIAN 550 2021-PRESENT

CASE NUMBER OF CASES PERCENTAGE YEAR

PREECLAMPSIA 111 36.52% 2021- PRESENT

ECLAMPSIA 34 11.20 2021- PRESENT

E. GENERAL SIGNS AND SYMPTOMS
SEVERE

 Excess protein in urine (proteinuria)

 Decreased levels of platelets in blood (thrombocytopenia)
 Shortness of breath
 Increased liver enzymes that indicate liver problems
 Changes in vision, including temporary loss of vision, blurred vision or light
sensitivity
 Severe headaches
E. SIGNS AND SYMPTOMS
MILD
Nausea or vomiting
Unusual swelling in your hands and face
Pain in the upper belly, usually under the ribs on the right
side
F. RISK FACTORS
Risk factors for preeclampsia includes:

NON-MODIFIABLE RISK FACTORS:

 Nulliparity
 Age older than 40 years
 Family history
 Twin gestation
MODIFIABLE RISK FACTORS:
 Diabetes mellitus
 High body mass index
G. COMPLICATIONS
MATERNAL
 HELLP syndrome. 
 Eclampsia. 
 Cardiovascular disease. 

FETAL
 Fetal growth restriction. 
 Preterm birth. 

BOTH MATERNAL AND FETAL

 Placental abruption. 
H. LABORATORY AND DIAGNOSTIC TEST
Blood tests.
A blood sample analyzed in a lab can show how well the liver and kidneys are working. Blood
tests can also measure the amount of blood platelets, the cells that help blood clot.
Platelets.
The number of platelets in the blood may be measured. Preeclampsia may cause an abnormally
low platelet count.
Uric acid.
Increased uric acid in the blood is often the earliest laboratory finding related to preeclampsia.
Uric acid is a waste product formed from the breakdown of some protein-rich foods and the
breakdown of cells in the body. It is normally filtered from the blood by the kidneys. But if the
kidneys have been damaged by preeclampsia, uric acid levels in the blood may rise.
H. LABORATORY AND DIAGNOSTIC TEST
Fetal ultrasound. 
Close monitoring of your baby's growth, typically through ultrasound. The images
of your baby created during the ultrasound exam allow for estimates of the baby's
weight and the amount of fluid in the uterus (amniotic fluid).
Nonstress test or biophysical profile. 
A nonstress test is a simple procedure that checks how your baby's heart rate reacts
when your baby moves. A biophysical profile uses an ultrasound to measure your
baby's breathing, muscle tone, movement and the volume of amniotic fluid in your
uterus.
Urine analysis
Your health care provider will ask you for a 24-hour urine sample or a single urine
sample to determine how well the kidneys are working.
I. MEDICAL MANAGEMENT
IV THERAPHY

DRUG DOSAGE INDICATION NURSING MANAGEMENT

Infuse loading dose slowly over

Magnesium sulphate
(pregnancy risk category
B)
 
Loading dose: -Muscle relaxant and used to
15-30 minutes.
4-6g prevent seizures. Always administer as piggybank
infusion.
Maintenance dose:
Assess respiratory rate, urine
1-2 g/hr IV output, deep tendon reflexes, and
clonus every hour.
Urine output should be over 30
ml/hr and respiratory rate over 12
breaths/min. serum magnesium
level should remain below 7.5
mEq/l.
Observe for central nervous
system (CNS) depression and
hypotonia in infant at birth and
calcium deficit in the mother.
 I. MEDICAL MANAGEMENT
IV THERAPHY
DRUG
Hydralazine (Apresoline)
(pregnancy risk category C)
 
Diazepam (Valium)
(pregnancy risk category
D)
Calcium  gluconate
(pregnancy risk category
C)
DOSAGE INDICATION NURSING MANAGEMENT
Administer slowly to avoid sudden
5-10 mg IV -antihypertensive (peripheral
fall in blood pressure.
vasodilator used to decreased
Maintain diastolic pressure over
hypertension.
90 mmHg to adequate placental
filling.
Administer slowly. Dose may be
5-10 mg IV -used to halt seizures.
repeated q 5-10 minutes (up to 30
mg/hr)
Have prepared at bedside as the
1g IV (1O ml of a 10% solution) -antidote for magnesium
antidote when administering
intoxication. magnesium sulfate.
Administer at 5 ml/min.
 J. PHARMACOLOGIC MANAGEMENT (DRUG OF
CHOICE)
DRUG   DOSAGE INDICTION
nifedipine The most The starting dose is 30 mg nifedipine is a calcium channel blocker
recommended drug or 60 mg by mouth once in the dihydropyridine subclass. It is
for mild per day. The dosage can be primarily used as an antihypertensive
preeclampsia. increased every 7 to 14 and as an anti-anginal medication.
days until the maximum Nifedipine is an effective drug to treat
dosage of 90–120 mg per severe hypertension in pregnancy and
day is reached preterm labour. Because it is given in a
tablet or capsule by mouth, it is easier to
use than intravenous drugs.

labetalol(Normodyne) Most recommended 100 mg PO for 12hr initially, Labetalol has been used to treat high
increased by 100 mg every 12hr
drug for severe every 2-3 days. blood pressure in pregnant women. It is
preeclampsia. important to control high blood pressure
for the health of the mother and unborn
baby.
 J. PHARMACOLOGIC MANAGEMENT (DRUG OF
DRUG  
CHOICE)DOSAGE INDICTION

Magnesium sulfate Classified as The recommended Magnesium sulfate

cathartic, reduces regimen of therapy is used to
edema by causing a magnesium sulfate is prevent seizures in
shift in fluid from the a loading dose of 4 to women with
extracellular spaces 6 g given over 15 to preeclampsia. It can
into the intestine. 20 minutes. also help prolong a
Also has central pregnancy for up to
nervous system two days. This allows
depressant action drugs that speed up
which lessen the your baby's lung
possibility of development to be
seizures. administered.
• K. SURGICAL MANAGEMENT
Anesthesia Used
• SAB (Subarachnoid (spinal) Block)
Description
• Is a safe and effective alternative to general anesthesia when the surgical site is located on the lower
extremities, perineum or lower body wall.
Nursing Responsibilities
• Secure consent
• Take vital sgins
• Perform hand hygiene
• Use sterile gloves to prevent spread of microorganism
• Preanesthesia preparation
• Assessing laboring woman’s level of pain and desired for pain reliever
• Assessing oral intake of fluids and solid foods
• Catheter placement and insertion, providing preload fluid as ordered.
• Ensuring emergency equipment and drugs
 K. SURGICAL MANAGEMENT
Anesthesia Used
SAB (Subarachnoid (spinal) Block)
Description
Is a safe and effective alternative to general anesthesia when the surgical site is located on the lower
extremities, perineum or lower body wall.
Nursing Responsibilities
Secure consent
Take vital sgins
Perform hand hygiene
Use sterile gloves to prevent spread of microorganism
Preanesthesia preparation
Assessing laboring woman’s level of pain and desired for pain reliever
Assessing oral intake of fluids and solid foods
Catheter placement and insertion, providing preload fluid as ordered.
Ensuring emergency equipment and drugs
Pre-operative nursing management:
 Documentation of nursing care up until the patient leaves the
hospital must be complete and factual.
 Upon transport to surgery, ensure that the patient is lying on her
left side to prevent supine hypotension.
 Ensure that the side rails are up, and the patient is covered with a
blanket.
 A support person may be needed during cesarean birth, and they
also need encouragement to watch the birth live.
Intraoperative nursing responsibilities:
 While anesthesia is being administered, a surgical nurse will assist the patient first to move from
the transport stretcher to the operating table.
 The anesthesia of choice is usually a regional block.
 Encourage the patient to remain on her side or insert a pillow under her right hip to keep her body
slightly tilted to the side to prevent supine hypotension.
 In emergency cases, a spinal anesthesia is administered while the patient is sitting up.
 It would be difficult for a patient in labor to remain in a curved position during administration of
the anesthetic, so talk to her gently and let her lean on you while you gently restrain her.
 For the skin preparation, shaving away abdominal hair and washing the skin over the incision site
with soap and water could reduce the bacteria on the skin.
 The incision area is scrubbed by an antiseptic, and additional drapes are placed around the area so
that only a small area of the skin is exposed.
 A classic incision is made vertically through both the abdominal skin and the uterus. or;
 A low segment incision or low transverse incision is made horizontally across the abdomen just
over the symphysis pubis and also horizontally across the uterus just over the cervix.
Postpartal Care nursing responsibilities:
The postpartal care period of a patient who has undergone emergent cesarean birth is divided into two:
immediate recovery period and extended postpartal period.
 The postpartal care period of a patient who has undergone emergent cesarean birth is divided into two:
immediate recovery period and extended postpartal period.
 After surgery, the patient would be transferred by stretcher to the postanesthesia care unit. .
 Pain control is a major problem after birth because it was so intense that it interfered with the patient’s
ability to move and deep breathe.
 This may lead to complications such as pneumonia or thrombophlebitis.
 Use a pain rating scale to allow a patient to rate her pain.
 Some women may need patient controlled analgesia or continued epidural injections to relieve the pain.
 Supplement the analgesics with comfort measures such as change in position or straightening of bed
linen.
 Instruct the patient to ambulate because this is the most effective method to relieve gas pain.
 Inform the patient that she should not take acetylsalicylic acid or aspirin because this can interfere with
blood clotting and healing.
 Instruct the patient to place a pillow on her lap as she feeds the infant to deflect the weight of the infant
from the suture line and lessen the pain.
 Football hold for breast feeding is a way to keep the infant’s weight off the mother’s incision.
 Postpartal Care nursing responsibilities:
 During the extended postpartal period, the patient most commonly experiences gastrointestinal
function interference.
 Note carefully the patient’s first bowel movement after surgery.
 Teach the patient to eat a diet high in fiber and fluid.
 Caution the patient not to strain to pass stools because this puts pressure on their incision.
 Advice the patient to keep their water pitcher full as a reminder for her to drink fluids.
 Reassure the patient that it is normal not to have bowel movements for 3 to 4 days
postoperatively.
L. NON- PHARMACOLOGIC MANAGEMENT
APPLYING EVENING PRIMROSE
NURSING RESPONSIBILITIES:
Instruct the patient to:
 Follow healthcare provider's instructions about any restrictions on food, beverages, or activity.
 Avoid using evening primrose together with other herbal/health supplements that can also affect blood-
clotting.
 Do not use different formulations (e.g., tablets, liquids, and others) of evening primrose at the same
time, unless specifically directed to do so by a health care professional. Using different formulations
together increases the risk of an overdose of evening primrose.
 Call your doctor if the condition you are treating with evening primrose does not improve, or if it gets
worse while using this product.
NURSING INTERVENTIONS FOR A WOMAN WITH PREECLAMPSIA WITHOUT SEVERE FEATURES
 
 Promote Bed Rest
 Promote Good Nutrition
 Provide Emotional Support
NURSING INTERVENTIONS FOR A WOMAN WITH PREECLAMPSIA WITH SEVERE FEATURES
 Support bed rest
 Monitor maternal well-being
 fetal well-being
 Support a nutritious intake
M. DIET

• Foods high in protein (chicken, tofu, fish, peanut, butter, nuts, steak, pork, turkey, eggs, cheese, hummus) serve 9 ounces.

• Iron-rich protein (meat, poultry, pork, fish, eggs, beans) serve 9 ounces.

• Calcium-rich foods ( milk(cow’s, soya, almond, rice), yogurt, cheese, calcium-fortified orange juice, fortified tofu, sardines w/ bones)

• Vegetables and fruits( apples, bananas, spinach, collard greens, carrots, sweet potatoes, squash)  

• Vitamin C-rich foods (broccoli, tomatoes, peppers, oranges, strawberries

• Water and other fluid (water, diluted juice)

N. OXYGENATION
Nasal cannula- A nasal cannula is a flexible tube with two prongs that go inside the patient's nostrils. Oxygen
therapy is a treatment that provides you with extra oxygen to breathe in. Treatment in which a storage tank of oxygen
or a machine called a compressor is used to give oxygen to people with breathing problems. It may be given through
a nose tube, a mask, or a tent. The extra oxygen is breathed in along with normal air.
O. PROGNOSIS OF PREECLAMPSIA

If left untreated, preeclampsia can be potentially fatal to both you and your baby. Before delivery, the most
common complications are preterm birth, low birth weight or placental abruption. Preeclampsia can cause
HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count). This happens when
preeclampsia damages your liver and red blood cells and interferes with blood clotting. Other signs of
HELLP syndrome are blurry vision, chest pain, headaches and nosebleeds. After you've delivered your baby,
you may be at an increased risk for:
• Kidney disease.
• Heart attack.
• Stroke.
• Developing preeclampsia in future pregnancies.
Signs and symptoms of preeclampsia most often go away within 6 weeks after the delivery. However, high
blood pressure sometimes get worst in the first few days after delivery. You are still at risk for preeclampsia
for up to 6 weeks after delivery. This postpartum preeclampsia carries a higher risk of death. If you had
preeclampsia, you are more likely to develop it again during another pregnancy. In most cases, it is not as
severe as the first time. If you have high blood pressure during more than one pregnancy, you are more
likely to have high blood pressure when you get older.
O. PROGNOSIS OF ECLAMPSIA
a
Once convulsion occur prognosis become uncertain, prognosis depends on many factors and features
that are:

Long interval between onset treatment or late referral

Temperature over 39 degree Celsius with pulse rate above 120/min.
Proteinuria
Non response to treatment
Respiration rate of 40/min
Coma taken 6 hour or more

Left untreated, the seizures can result in coma, brain damage and potentially in maternal or infant
death.
P. NURSING DIAGNOSIS
Decrease cardiac output related to increase systemic vascular resistance secondary to
preeclampsia.
Management:
1. Determine vital signs/hemodynamic parameters including cognitive status. Note vital
sign response to activity or procedures and time required to return to baseline.
2. Observe for worsening signs and symptoms of decreased cardiac output when using
positive pressure ventilation.
3. Emphasize importance of regular medical follow-up care
4. Administer fluids, diuretics, inotropic drugs, antidysrhythmic, steroids, vasopressors,
and dilators as indicated and evaluate response.
P. NURSING DIAGNOSIS
Ineffective tissue perfusion related to vasoconstriction of blood vessels
Management:
1. Submit patient to diagnostic testing as indicated.
2. Check for optimal fluid balance. Administer IV fluids as ordered.
3. Note urine output.
4. maintain optimal cardiac output.
5. Consider the need for potential embolectomy, heparinization, vasodilator therapy, thrombolytic therapy,
and fluid rescue.
P. NURSING DIAGNOSIS
Deficient fluid volume related to fluid loss to subcutaneous tissue.
Management:
1. Urge the patient to drink the prescribed amount of fluid.
2. Aid the patient if they cannot eat without assistance, and encourage the family or SO to assist with
feedings as necessary.
3. Monitor BP for orthostatic changes (changes seen when changing from supine to standing
position). Monitor HR for orthostatic changes.
4. Assess color and amount of urine. Report urine output less than 30 ml/hr for two (2) consecutive
hours.
5. Monitor fluid status in relation to dietary intake
6. Monitor and document temperature
7. Note the presence of nausea, vomiting, and fever.
8. Identify the possible cause of the fluid disturbance or imbalance.
9. Monitor for the existence of factors causing deficient fluid volume (e.g., gastrointestinal losses,
difficulty maintaining oral intake, fever, uncontrolled type II diabetes mellitus, diuretic therapy).
10. Ascertain whether the patient has any related heart problem before initiating parenteral therapy.
P. NURSING DIAGNOSIS
Social isolation related to bed rest.
Management:
1. Demonstrate unwavering supportive behavior.
2. Maintain a kind and welcoming behavior by establishing frequent, quick encounters.
3. Maintain integrity, keep all commitments, and be truthful with the patient.
4. Administer sedatives as prescribed and keep an eye out for any negative side effects
5. Be careful when it comes to physical contact. Enough space and an exit for the client should be
provided if she becomes anxious.
6. Assist the patient by being there for her during any group activities that she finds challenging or
frightening.
7. If there is noticeable signs that the patient is becoming anxious, talk to her about the indications of
anxiety and ways to break or counteract the cycle, such as suggesting breathing exercises,
relaxation, and even meditation
8. Recognize and encourage the patient's willingness to socialize with others by expressing
appreciation and providing praise.
OVERVIEW OF
ABRUPTIO
PLACENTA
 GENERAL OVERVIEW
Placental abruption traditionally is defined as the premature separation of the
implanted placenta before the delivery of the fetus. The existing clinical criteria of severity
rely exclusively on fetal (fetal distress or fetal death) and maternal complications without
consideration of neonatal or preterm delivery-related complications. However, two-thirds of
abruption cases are accompanied by fetal or neonatal complications, including preterm
delivery.
A clinically meaningful classification for abruption therefore should include not only maternal
complications but also adverse fetal and neonatal outcomes that include intrauterine growth
restriction and preterm delivery. Placental abruption (abruptio placentae) is an uncommon yet
serious complication of pregnancy. The placenta develops in the uterus during pregnancy and
it attaches to the wall of the uterus and supplies the baby with nutrients and oxygen.
Definition of terms:
Abruptio placenta is a
complication of late pregnancy or
labor characterize by premature
partial or complete separation of a
normally implanted placenta. Also
termed accidental hemorrhage and
ablatio placenta and the second
leading cause is bleeding in the third
trimester occurs in 1: 300 pregnancy
 Types of abruptio placenta
● Type I: (mild)Concealed, covert or central type:; the classical type
Placenta separates at the center causing blood to accumulate behind the placenta.
External bleeding not evident.
Signs of shock not proportional to the amount of external bleeding.
● Type II: marginal, overt or external bleeding type
Placenta separates at the margins
Bleeding is external, usually proportional to the amount of internal bleeding
May be complete or incomplete depending on the degree of detachment.

Etiology/causes
• Maternal hypertension
• Mulitparity
• Poor nutrition ; folic acid deficency
• Decompression of polyhydramnios
• Short cord
• Tension of uterus
INCIDENCE RATE
INTERNATIONAL
 Signs and symptoms
● Sharp, stabbing pain.
● Heavy bleeding.
● Uterus is tense and rigid.

Risk factors
Non-Modifiable :
● Maternal hypertension
● High parity.
● Short umbilical cord.
● Advanced maternal age
Modifiable
● Cigarette smoking
● Trauma:
● Chorioamnionitis.
 Complication
● Maternal
-Hemorrhagic shock/ hypovolimic shock
-Couvelaire uterus-
-Disseminated intravascular coagulation
-Renal failure
● Fetal
-When the placenta malfunctions, it's unable to supply adequate oxygen
and nutrients to the baby from the mother's bloodstream. Without this vital
support, the baby cannot grow and thrive as well as can cause
-Restricted growth from not getting enough nutrients-
-Not getting enough oxygen
-Premature birth
-Stillbirth
 ASSESSMENT AND DIAGNOSTIC
FINDINGS TEST
● Painful vaginal bleeding in the third trimester
● Rigid, boardlike,and painful abdomen
● Enlarge uterus due to concealed bleeding: signs of shock not proportional to the degree of
external bleeding (classic type)
● If in labor: tetanic contractions with the absence of alternating contraction and relaxation of
the uterus
● Clinical diagnosis- signs and symptoms
● Ultrasound detects the retro placental bleeding
● Clotting studies- reveal DIC, clotting detects clot enters maternal circulation and consumes
maternal free fibrinogen resulting in:
● DIC: small fibrin clots in circulation
● Hypofibrinogemia: decrease normal fibrinogen result in absence of normal blood
coagulation
MEDICAL MANAGEMENT FOR APRUPTIO PLACEN

● The woman is hospitalized and monitored

carefully for signs of increasing separation.
● Ultrasound is necessary to differentiate abruptio
placenta from placenta previa
● Check urine output, hematocrit, platelet counts
and fibrinogen concentration determination
● Cesarean birth delivery
● Fluid and blood replacement
● Oxygen inhalation Analgesic and antibiotic .ex-
morphine vaginal delivery blood loss are
minimal mother condition is stable to give
betamethasone for fetal lung maturity
 PHARMACOLOGIC MANAGEMENT
● Tocolytics
-Tocolytics may allow for the effective administration of glucocorticoids to the preterm fetus to accelerate fetal lung
maturation. In chronic abruption, these drugs may also help to delay delivery to a gestational age when complications
of prematurity are less severe.

● Nifedipine (Adalat, Procardia, Nifediac CC, Nifedical XL)

-Nifedipine is a calcium channel blocker. The theory behind its use as a tocolytic is that by blocking an influx of
calcium into uterine muscle cells, it will decrease contractions, which are dependent on calcium.

● Magnesium sulfate
- This is the drug of choice for tocolysis in patients with placental abruption.
● Corticosteroids
-Corticosteroids are given when preterm delivery (less than 37 weeks) is expected. They are associated with a
decreased risk of neonatal respiratory distress, necrotizing enterocolitis, and intracranial hemorrhage. The two most
used medications are betamethasone and dexamethasone. While they should be considered if the patient is preterm
with an abruption, delivery should not be delayed for their administration.
 Surgical management

Classic uterine incision

● the uterus is incised vertically above the attachment of the bladder. The bladder is
not dissected of the lower uterine segment. This approach is rarely used but may be
necessary for a fetus in transverse presentation or for multiple fetuses. It may be
indicated for a low anterior placenta, varicosities of the lower uterine segment, or
cervical cancer. A major disadvantage is the high incidence of rupture with
subsequent pregnancy
 Nursing management
● Maintain bed rest, LLR
● Careful monitoring
● Maternal VS
● FHT
● Labor onset/ progress
● I&O, oliguria/ anuria
● Uterine pain
● Bleeding (not proportional to degree of shock)
● Administer intravenous fluid, plasma, or blood as ordered
● Prepare for diagnostic examination- explain results.
● Provide psychological support- prepare for all examination, explain what is happening and inform/ explain result
● Prepare for emergency birth either per vagina or CS
● Observe for associated problems
● After delivery
● Poorly contracting uterus (Couvelaire uterus) to post-partal hemorrhage
● DIC to hemorrhage and possibly CVA
● Hypofibrinogenemia to post partal hemorrhage
● Prematurity neonatal distress to neotal morbidity and mortality.
 Prognosis
● If the bleeding continues, fetal and maternal distress may develop.
Fetal and maternal death may occur if appropriate interventions are
not undertaken.
● The severity of fetal distress correlates with the degree of placental
separation. In near-complete or complete abruption, fetal death is
inevitable unless an immediate cesarian delivery is performed.
 Diagnosis &Nursing management
Diagnosis: Risk for deficient fluid volume related to bleeding during pregnancy
● Alert healthcare team of emergency situation
● Place patient on flat in bed on her side
● Begin intravenous such as ringer's lactate with a 16 or 18 gauge angiocath
● Administer oxygen as necessary 6 to10 minute by face mask
● Monitor uterine contractions and fetal heart rate by external monitor.
● Omit vaginal examination Withhold oral fluid Order type and cross-match of 2 units of whole
blood
● Measure Input and out put
● Assess vital sign
● Assist with placement of central venous pressure or pulmonary artery catheter and blood
determinations
● Measure maternal blood loss by weighing perineal pad; save any tissue passed
● Assist with ultrasound examination
● Maintain a positive attitude about fetal outcome
● Support patient selfsteem; provide emotional support and her significant other.
 INTRODUCTION OF PREMATURITY

a. Definition Preterm
A preterm, premature or "preemie" baby is a baby born too early, or about three weeks before the due date. A normal
pregnancy period (fetal development) is about 40 weeks. Preterm birth occurs at 37 weeks or earlier. This premature
or early birth can pose serious health risks to the mother and baby.
About 1 out of every 10 births in the U.S. is premature. The number increases in lower-income countries.
Complications from premature births are the leading cause of death in children younger than 5.
 
 a. Types of Preterm

 Late preterm, - born between 34 and 36 weeks.

 Moderately preterm, - born between 32 and 34
weeks.
 Very preterm, - born before 32 weeks.
 Extremely preterm, - born before 25 weeks.
 

C. General Causes of Preterm

Premature births can happen suddenly, with no known cause. Sometimes providers have to induce (start) labor early for medical reasons. Women can
also go into premature labor due to:

 Your pregnancy history

 Your current pregnancy
 If you became pregnant less than 6 months after your last pregnancy
 If you have placenta previa
 Polyhydramnios (too much amniotic fluid)
 Uterine abnormalities
 If you bleed after 24 weeks
 If there is a problem with your cervix (a weak cervix)
 If you are carrying more than 1 baby
 Twin-to-twin transfusion syndrome (TTTS)
 Gestational diabetes
 Antiphospholipid syndrome (APS)
 Pre-eclampsia
 Waters breaking early (PPROM)
 Fetal growth restriction (FGR)
 Intrahepatic cholestasis of pregnancy (ICP)
 If you have an infection
 Urinary tract infections
 Placental abruption
 Your age
 Race
 Weight
 Psychological or social stress
 Lifestyle choices that affect your risk of premature birth
 Alcohol
 Smoking
 Vaping
 General Incidence Rate of Preterm
International
More than 60% of preterm births occur in Africa and South Asia, but preterm birth is truly a global problem. In the lower-income
countries, on average, 12% of babies are born too early compared with 9% in higher-income countries. Within countries, poorer
families are at higher risk.
The 10 countries with the greatest number of preterm births:
India: 3 519 100
China: 1 172 300
Nigeria: 773 600
Pakistan: 748 100
Indonesia: 675 700
United States of America: 517 400
Bangladesh: 424 100
Philippines: 348 900
Democratic Republic of the Congo: 341 400
Brazil: 279 300
Of 65 countries with reliable trend data, all but three show an increase in preterm birth rates over the past 20 years. Possible reasons
for this include better measurement, increases in maternal age and underlying maternal health problems such as diabetes and high
blood pressure, greater use of infertility treatments leading to increased rates of multiple pregnancies, and changes in obstetric
practices such as more caesarean births before term.

There is a dramatic difference in survival of premature babies depending on where they are born. For example, more than 90% of
extremely preterm babies (less than 28 weeks) born in low-income countries die within the first few days of life; yet less than 10% of
extremely preterm babies die in high-income settings.
 National
13 Preterm birth rate (births <37
weeks per 100 live births)
LEADING CAUSES OF
NEONATAL DEATHS IN
PHILIPPINES (2019)
Source: Estimates for causes of death
2000-2019 generated by the WHO
and Maternal and Child
Epidemiology Estimation Group
(MCEE) 2022 and downloaded from
http://data.unicef.org
a. Signs and symptoms
 
Signs and symptoms of preterm labor include:

 Contractions
 Constant low, dull backache
 A sensation of pelvic or lower abdominal pressure
 Mild abdominal cramps
 Vaginal bleeding
 Preterm rupture of membranes
 A change in type of vaginal discharge
B. Risk Factors

 Maternal infection
 Multiple pregnancy
 Age
 PIH, DM
 PPROM
 Severe isoimmunization
 Trauma
 Incompetent Cervix
PRETERM COMPLICATIONS
 
Short-term complications
In the first weeks, the complications of premature birth may include:
 
• Breathing problems.
• Heart problems.
• Brain problems.
• Heart problems.
• Brain problems.
• Gastrointestinal problems.
• Blood problems.  
• Metabolism problems.
• Immune system problems.
Long-term complications
In the long term, premature birth may lead to the following complications:
 
• Cerebral palsy.
• Impaired learning.
• Vision problems..
• Hearing problems.
• Dental problems.
• Behavioral and psychological problems.
• Chronic health issues.
Assessment Findings
1. Physical Appearance
Old man's faces
Head: disproportionately large Hypermobility of the bone Hematoma and visible angulation Incomplete
Moro reflex
Hair: lanugo, fine, fuzzy
Ears: flat
Thorax: small
f. Breast buds: 5 mm or below
g. Abdomen: relatively large, protruding
h. Testes: commonly undescended Scrotum: pink, fine rugae; labia:
J. Skin: increased lanugo, thin and red and wrinkled, visible capillaries, decreased subcutaneous fats
k. Muscle tone: poor
I. Nails: soft
 Altered Physiology
 Respiratory system
 Poorly developed lungs/respiratory muscles
 Decreased surfactant prone to atelectasis and respiratory distress syndrome (RDS)
 Difficulty breathing with apnea and cyanosis
 Poor/unstable chest walls -› retractions
 Poor gag/cough reflex - aspiration
 Poor thermal control
 Poikilothermia: infant easily takes on the temperature of the environment; can stabilize temperature at a lower
level 35°C- 36°C
 Decreased subcutaneous fats, muscle, fat and glycogen deposit
 Decreased activity; decreased sweat glands
 Digestive system
 Poor sucking and swallowing (before 32 to 34 weeks)
 A Small stomach - decreased gastric capacity
 Poor cardiac sphincter tone-›vomiting/ regurgitation
 Decreased enzymes decreased tolerance
 Decreased bile salts decreased digestion and absorption of fats and fat-soluble vitamins A, D, E, and K
 Decreased ability to release insulin in response to glucose
 Poor glucose to glycogen conversion and vice-versa
 Liver function
 Decreased vitamin K-› bleeding
 Decreased hemoglobin and blood production › anemia
 Poor bilirubin conjugation -› hyperbilirubinemia
 Poor sugar storage and release -› hypoglycemia
Renal system: immature function
 Decreased ability to conserve and excrete urine
 Decreased ability to concentrate urine →→ dehydration
 Decreased ability to acidify urine
 Increased sodium and decreased potassium excretion
 Imbalanced glomerular tubular function: (+) sugar, (+) protein, (+) amino acid and (+)
sodium in the urine
 Medications
Once you're in labor, there are no medications or surgical procedures to stop
labor, other than temporarily. However, your doctor might recommend the
following medications:

• Corticosteroids. 
• Magnesium sulfate.
• Tocolytics.
Surgical procedures
If you are at risk of preterm labor because of a short cervix, your doctor may
suggest a surgical procedure known as cervical cerclage. During this procedure,
the cervix is stitched closed with strong sutures. Typically, the sutures are
removed after 36 completed weeks of pregnancy. If necessary, the sutures can be
removed earlier.

Cervical cerclage might be recommended if you're less than 24 weeks pregnant,

you have a history of early premature birth, and an ultrasound shows your cervix
is opening or your cervical length is less than 25 millimeters.
l. NURSING IMPLEMENTATION

1. Maintain respirations at less than 60/min

a. Monitor pattern of respiration; check every 1 to 2 hours.
b. Suction gently as necessary.
c. Administer oxygen as ordered; frequently check concentration to prevent toxicity and
blindness (retrolental fibroplasia). Observe oxygen precautions.
d. Auscultate lungs to assess expansion; tm every 1-2 hours for better lung expansion and to
prevent exhaustion.
e. Monitor for apnea; encourage breathing with gentle rubbing of back and feet
f. Evaluate ABG results and electrolytes
2. Maintain thermoneutral body temperature; prevent cold stress

a. Maintain in incubator or radiant warmer if temperature is not stable as ordered; maintain

appropriate humidity.
b. Turn gently to increase body heat.
c. Monitor temperature per axilla; maintain axillary temperature between 97 °F and 99.5 °F.
d. Keep dry; change wet diapers and blankets, immediately.
e. Use heat source when bathing the infant. Wash small parts of the body one at a time, then
dry first before proceeding to the next part
3. Meet nutritional, fluid and electrolytes needs: feed according to abilities.

a. Use "preemie" nipple if the baby started bottle-feeding and has good sucking.
b. Use small, rubber-tipped syringe or dropper if sucking is poor or if sucking causes much fatigue and
tachypnea.
c. Use gavage feeding as ordered for poor sucking and swallowing.
d. Feed slowly and carefully as regurgitation and vomiting are more common in these infants.
e. Monitor I & O, weight, passage of stools, signs of dehydration, hypoglycemia and
hyperbilirubinemia.
f. Provide supplementary vitamins (particularly vitamin C to prevent infection) and minerals,
especially iron to prevent anemia, as ordered. g. Implement breastfeeding or use mother's pumped
breast milk whenever appropriate.
4. Prevent bleeding
a. Administer vitamin K injection as ordered.
b. Handle gently and carefully.
c. Monitor potential bleeding sites (umbilicus, injection sites, skin, and urine).
 
5. Prevent infection
a. Implement meticulous handwashing before and after handling the infant. Handwashing is still the best way to prevent sprea
of nosocomial infection (hospital-acquired infection).
b. Provide skin care giving special attention to the: scalp (prevents "cradle cap"/seborrheic dermatitis) periumbilical area
(prevents omphalitis or inflammation of the cord) .creases at the perianal region (prevents "diaper rash"/ammoniacal
dermatitis)
c. Monitor temperature.
d. Administer prophylactic antibiotic as ordered.
e. Maintain high vitamin C, iron and protein formula as ordered to increase resistance to infection and promote growth and
development.
f. Provide meticulous but careful skin care and reposition to prevent breakdown.
6. Provide support to the parents.

a. Encourage verbalization of concerns, fears. and anxiety.

b. Provide complete explanations about treatments, procedures and
plans as appropriate.
c. Encourage involvement in the care of the infant. Encourage
frequent visits. Promote confidence with infant care before
discharge.
d. Refer to self-help groups.
 Diagnosis
The most frequently detected nursing diagnoses were: activity intolerance, impaired spontaneous ventilation,
ineffective breathing pattern, risk for aspiration, delayed growth and development, Ineffective breastfeeding,
Ineffective infant feeding pattern, hyperthermia / hypothermia, risk for infection, impaired tissue integrity,
Interrupted family processes, risk for impaired parenting, risk for impaired attachment, interrupted family
processes.

Prognosis
 Outcome for the baby depends on many factors, not all obvious and including infection and maternal and fetal health.
 A reasonably easy to remember guide is that the survival rate is about 40% for all babies born at 24 weeks' gestation, 50% for those
born at 25 weeks, 60% for those born at 26 weeks, 70% for those born at 27 weeks, and 80% for those born at 28 weeks. 3
 Every baby is an individual, and the parents need to realise that their baby may be different from the average. The table is designed to
share with parents risk factors that need to be understood within the unique context of the child and family.
 Babies born at 25 weeks and less are at high risk of death, a long, tortuous journey through life, and disability. Some babies born at 24
and 25 weeks do, however, seem to be developing normally.
ANATOMY AND
PHYSIOLOGY
 FEMALE REPRODUCTIVE SYSTEM
The female reproductive system is designed to carry out several functions. It produces the female egg cells necessary for
reproduction, called the ova The system is designed to transport the ova to the site of fertilization. Conception, the
fertilization of an egg by a sperm, normally occurs in the fallopian tubes. The next step for the fertilized egg is to implant
into the walls of the uterus, beginning the initial stages of pregnancy. If fertilization and/or implantation does not take
place, the system is designed to menstruate (the monthly shedding of the uterine lining). In addition, the female
reproductive system produces female sex hormones that maintain the reproductive cycle.
The female reproductive system is primarily responsible for the following three functions:

 the development of ova (eggs)

 Fertilization

 the discharge of hormones

 protection of and assistance with the development of the fetus within a pregnant woman pregnant female.
The internal reproductive organ in the female include:

a) Vagina - The vagina is the female organ of copulation; it

receives the penis during intercourse. It also allows
menstrual flow and childbirth.
B) External Genitalia - The external female genitalia, also
called the vulva or pudendum, consist of the vestibule and its
surrounding structures.
Uterus - The uterus (womb) is as big as a medium-sized pear. It is oriented in the pelvic cavity with the larger,
rounded part directed superiorly.
OVARIES -The ovaries are small, oval-shaped glands that are located on either side of the uterus. The ovaries produce eggs
and hormones.
Fallopian tubes - These are narrow tubes that are attached to the upper part of the uterus and serve as tunnels for the ova
(egg cells) to travel from the ovaries to the uterus.
 PHYSIOLOGY OF FEMALE REPRODUCTION

Puberty in Females - The initial change that results in puberty

is most likely maturation of the hypothalamus
Menstrual cycle - The term menstrual cycle refers to the series
of changes that occur in sexually mature, nonpregnant females
and that result in menses. Menses is a period of mild
hemorrhage, during which part of the endometrium is sloughed
and expelled from the uterus.
a) Fertilization - Fertilization is the union of a sperm cell and an oocyte, along with their genetic material
(chromosomes), to produce a new individual.
b) Cell Division - About 18–36 hours after fertilization, the zygote divides by mitosis to form two cells.
c) Implantation - Fertilization will occur after ovulation, usually within the uterine tube. About 7 days after
fertilization, the blastocyst attaches itself to the uterine wall and begins the process of implantation.
The organs of the reproductive system are where you will see
the most noticeable changes in your body during pregnancy.

a) Uterus
Changes in the uterus are phenomenal. By the time the pregnancy has reached term, the uterus will have increased five times its normal size:
 In length from 6.5 to 32 cm.
 In-depth from 2.5 to 22 cm.
 In width from 4 to 24 cm.
 In weight from 50 to 1000 grams.
In the thickness of the walls is from 1 to 0.5 cm.
The capacity of the uterus must expand to normally
accommodate a seven-pound fetus and the placenta, the
umbilical cord, 500 ml to 1000 ml of amniotic fluid, and the
fetal membranes.

The abdominal contents are displaced to the sides as the

uterus grows in size, which allows for ample space for the
uterus within the abdominal cavity.

 Growth of the uterus occurs at a steady, predictable pace.

 Measurement of the fundal height during pregnancy is an
important factor that is noted and recorded.

 Growth that occurs too fast or too slow could be an

indication of problems.
 The size of the uterus usually reaches its peak at 38
weeks gestation. The uterus may drop slightly as the
fetal head settles into the pelvis, preparing for
• Cervix
Cardiovascular System
HEART
 A shaped like a blunt cone, which is the size of our fist.
 Weighs about 325 gm is males and about 275 gm in
females.
 Normally located in the middle and slightly to the left side
of the thoracic cavity on the diaphragm between 3rd and 5th
ribs.
 
 Surrounded by a double-layered membrane, called the
pericardium or pericardial sac.

2 layers:

1. Fibrous pericardium
2. Serous pericardium
THREE LAYERS OF HEART WALL

 Epicardium

• Myocardium

 Endocardium
According to its shape:

 The blunt, rounded point of the heart is the APEX, and the
larger flat part at the opposite end of the heart is the BASE.

Functions:

1. Generating blood pressure.

2. Routing blood.

3. . Ensuring one-way blood flow.

4. Regulating blood supply. -

BLOOD VESSELS

Types:

1. Artery

2. Vein

3. Capillary
HEART CHAMBERS

The heart has four chambers:

The heart has four valves

1. Tricuspid valve

2. Pulmonary valve

3. Mitral valve

4. Aortic valve
CARDIACCIRCULATION

As the heart beats, it pumps blood through a system of blood vessels,

called the circulatory system. The vessels are elastic tubes that carry

blood to every part of the body.

THE PLACENTA

The placenta (Latin for “pancake,” which is descriptive of its size and appearance at term) grows from a few identifiable

trophoblastic cells at the beginning of pregnancy to an organ 15 to 20 cm in diameter and 2 to 3 cm in depth, covering about

half the surface area of the internal uterus at term (Huppertz & Kingdom, 2012).
Placental Circulation
Fetal Circulation

Fetal circulation differs from extrauterine

circulation because the fetus derives oxygen and

excretes carbon dioxide not from gas exchange in

the lungs but from exchange in the placenta.

 
 CLINICAL HEALTH HISTORY
Name: Client R
Age: 29 years old
Gender: Female
Birthday: January 28, 1993
Birthplace: Cauayan District Hospital located in Cauayan City, Isabela
Marital Status: Married
Religion: Born again Christian
Address: Puroc 5, Carabbatan Punta, Cauayan City, Isabela
Telephone number/cellphone 09061943699
number:
Occupation: Banker
Race: Filipino
Ethnic Origin: Ilocano
Educational Attainment: Bachelor of Science in Accountancy- College Graduate
Primary Language Spoken: Tagalog
Secondary Language: Ilocano, English and Gaddang
Attending Physician: Dr. Susan C. Tan
Significant Other or Support Person: Husband, Mr. A and their parents
Date of Admission: May 14, 2022
Time of admission: 8:42 AM
Chief complaint upon admission: Abdominal cramps ~ 8 hrs. PTC
Admission diagnosis: Pregnancy uterine 36 weeks
Preeclampsia; signs of severity
Final diagnosis: Preeclampsia; signs of severity
Abruptio placenta
Date of Discharge: May 17, 2022
Time of Discharge: 1: 40 PM
OB Scoring: G – 2; P – 2
T–0
P–2
A– 0
L–2
Source of Data: All data were given by our patient and husband, first hand.
 FAMILY BACKGROUND
Family Occupation Status Type of Family Sources of Educational Nature and
Member Income Attainment Component of
Living Space

Father N/A Married Nuclear N/A Bachelor of 40 sqm Single

Science in floor Concrete
Criminology- house; under
College construction
Undergraduate - 1 bedroom
  - 1 kitchen
- 1 bathroom
Mother Banker Married Nuclear Monthly salary Bachelor of - 1 living
Science in room
Accountancy-  
College  
Graduate
Child A N/A Single Nuclear N/A  
Child B N/A Single Nuclear N/A  
● Patient R household belongs to a nuclear type of family. She is married for 4 years and they
are bestowed with 2 children. Her firstborn is a 3-year-old boy delivered prematurely via
cesarean section on the year 2018 at Isabela United Doctors Medical Center, and her second
child is a baby boy that was previously born on May 14, 2022 prematurely via cesarean
section as well. Patient R made the decision to withhold information on her sexual history
and her romantic relationships. However, she shared that she was married on April 29, 2018
reaching 4 years of marriage. Also, she added that before marriage, they were in the
relationship for 2 years on the year 2016-2018. According to the patient, she became
pregnant with their first baby prior in their marriage at the age of 24. In addition, she stated
that they indulge in family planning method and we assessed that she is fully aware in
allotting space on giving birth. However, according to the patient they haven’t try or utilize
any contraceptives. More on that, she chooses to disclose any information about their family
relationships.
● Patient R has completed her education and received a Bachelor of Science degree in
Accounting from their previous institution. She earned her degree at Isabela State University's
Cauayan Campus in the year 2013. Patient R is employed at the EastWest Bank branch
located in Maharlika Highway, District II, Cauayan City at the moment as a banker for 5
consecutive years from 2018 up to the present. She narrates that she approaches her work in a
highly professional manner and has a high level of respect for the field. Clients receive
assistance with managing their accounts and funds, as well as advice on a variety of financial
services, from Patient R. The daily routine of a personal banker includes a variety of duties
and responsibilities, some of the most common of which include account opening, the sale of
investment products, the sale of loans, retirement and college planning, skills, as well as pay
and hours. Among these duties and responsibilities are also included retirement and college
planning. As a public worker, Patient R is responsible for a wide variety of tasks which is
why she identifies herself as a "workaholic".
- The daily routine of a personal banker includes a variety of duties and responsibilities, some of
the most common of which include account opening, the sale of investment products, the sale of
loans, retirement and college planning, skills, as well as pay and hours. Among these duties and
responsibilities are also included retirement and college planning. As a public worker, Patient R
is responsible for a wide variety of tasks which is why she identifies herself as a "workaholic".
Moreover, she shares that sometimes she commutes going to work, but most of the time her
husband rides a single-seat motorbike to get her to work on time. And she never works less than
the required amount of time, even when she works overtime. She has mentioned that she has
never had enemies at her workplace since she started working there and she has a positive
connection with her coworkers
Moreover, she shares that sometimes she commutes going to work, but most of the time her husband rides a
single-seat motorbike to get her to work on time. And she never works less than the required amount of time,
even when she works overtime. She has mentioned that she has never had enemies at her workplace since she
started working there and she has a positive connection with her coworkers. Patient R is the primary
breadwinner in their household, along with the interview she requested that her and her partner's income
remain confidential. Her husband is an undergraduate with a degree in Bachelor of Science in Criminology
from the same university as the patient at the Isabela State University's Cauayan Campus. In the year 2015-
2016 her husband worked at the Cauayan City Rescue 922 and in the years 2017-2018 her husband had a full-
time job with the Isabela Anti-Crime Task Force, however, he resigned due to confidential reasons. Then she
added that when their first baby was born her husband helped her in raising and taking care of the child full
time and this continued until the pandemic struck, after which he had trouble finding work. Patient R shared
that her husband is considering submitting an application for a different kind of employment.
● Furthermore, Patient R’s three-year-old son is currently learning his colors, how to count, use scissors,
and play ball thought by his parents. Patient R supplies all the necessities of her son even without the
presence of his Father. She also wishes to guide her kid as he grows up as a teenager with respect,
responsibility, and independence.
● Patient R along with her family members is currently residing in Puroc 5, Carabatan Punta,
Cauayan City, Isabela. According to the patient and her husband, the space occupied by their home and
lot is around 60 square meters, and the structure itself is a single-story concrete building. Due to the fact
that the house is still in the process of being built, they only have one bedroom with a queen-size bed
that is air conditioned, one kitchen, one bathroom, and one living room at the present. All of their rooms
where equipped with normal light bulb as stated by the husband of the patient. On the other hand, they
intend to have a total of four bedrooms. Each and every one of the floors is tiled, and the roofing is
made of galvanized steel. According to the patient, although they have not yet painted their house
because it is still in the process of being constructed, they have the plans of painting it white or any
other shade that is light colored.
● In their home's kitchen, they are utilizing a double burner gas stove and they use the brand
“Solane” for its gas. The customer claims that the household is equipped with the following
appliances: a 7-foot refrigerator with a single door, a flat-screen television measuring 40
inches, one rice cooker, an air conditioner rated at 1 horsepower, 3 smartphones, a laptop,
one portable fan, and two stand fans for the living and dining area. They claim that they
only utilize “Poso” as a source of water and that they do not yet have faucets in their homes.
However, they are buying gallons of distilled water nearby their home for their daily
consumption.
● Furthermore, they have one Honda XRM motorbike, which is used exclusively for transportation by
her spouse. Her husband also has tools set or equipment for mechanical procedure which they
organized in a box as described by the patient and they call it “tool box”. Moreover, they have the
common construction equioments such as shovel, claw bar bareta (nail remover) , digging
bar(“bareta”), an ax and a semicircular sickle blade tool which they call “karit”. In waste managing,
they are burning papers, dried leaves and plastics excluding plastic bottles wherein they are collecting
it in “sako bags” and giving those to their neighborhood. For their kitchen waste they are throwing
those at their backyards until it decomposed such as peelings of fruits or vegetable and food waste.
However, for spoiled or rice waste they are giving those to their chickens. The patient stated that they
have 7 chickens at their backyard other than that they don’t have any pets at home. The patient also
stated that when pandemic strikes where we all became isolated in our own home, she became fond in
planting plants in their front yard.
 Family Health History

Client B’s family is in the average or middle class of the society. On her paternal side, her grandfather
died because of aging and high blood pressure at the age of 83. Her grandmother died at the age of
78 due to aging. The patient stated that she can’t recall the dates when her grandparents died. Her
parental grandparents are blessed with 6 children wherein Client B’s father is the youngest. The
father of Client R is now 53 years old and still alive but has a high blood pressure. As the patient
stated, her father is taking Losartan as her maintenance and have been taking this for 2 years. Her
father is managing their own farm of rice where he regularly visit, however the client doesn’t know
vastness of the area. The five siblings of the patient’s father are still alive and her father is the only
child who is suffering from high blood pressure. Her father has 3 older brother and 2 older sisters.
According to the patient, she barely visits her relatives from parental side due to her busy work but
she still can recall the ages of her aunties and uncle and their appearances.
● On the other hand, regarding the maternal side, she states that her grandfather and grandmother died
also because of old age. She was not sure about the age, but she estimated that her grandfather was
around 87 years old and her grandmother was 84 years old at that time. Her mother has 4 siblings and
she was third among them. She is now 49 years old, a housewife with no serious illnesses. Her 47-
year-old female siblings ha high blood pressure, while the other 55-year-old older sister and 58-year-
old older brother has no serious illness. Client R shared that she haven’t seen her relatives from her
mother side since 2015 for most of them they are residing in Caloocan City, Metro Manila.
● Client R’s father and mother was bestowed with 2 children whereas all of them are via normal vaginal
delivery. She stated that both of them was delivered in Emergency Cauayan Hospital, in Cauayan City,
Isabela. All of them were breastfed and with complete immunizations but she was unable to remember
them. In addition, she stated that all of them already received covid vaccines. Both of her parents
received AstraZeneca Covid Vaccine and Pfizer for her younger brother. According to the patient, her
younger brother is single and currently working at Metro Manila.
● Client R was the first child of the family. She doesn’t have high blood pressure as well as
her sibling as they grew up. She shared that when they were children, they cure their
wounds using Guava leaves that were pulverized as taught by their old neighborhood.
Another when she was freshman in high school and she had chicken pox, her mother said
she had to cover her entire body for perspiration that would eventually dry out her skin
which she eventually discovered when she became adult that it was actually wrong. Just
like any other families, her family is also experiencing common illness such as colds,
toothache, headache and LBM. They usually treat it with home remedies or over-the-
counter drugs such as Biogesic for colds, Bioflu for headache, Dolfenal for toothache, and
Loperamide for LBM. Client B’s family do not use “atang” or “hilot and they do not go to
albularyos because they were raised strict to their religion which is Born Again Christian.
When they are young, they don’t experience to be hospitalized or go to dental clinics. Not
until she was in college wherein, she had the chance to go for check up with her tooth
ache. She stated that she can’t recall the medications that she had for her toothache.
● Moreover, when she got married and got pregnant at the year 2018, they moved at
they’re newly constructed house with her own family. At that time, she goes for regular
prenatal visits at the clinic of Dr. Susan C. Tan who’s her OB-GYN for her 2 children.
In terms of nutrition, as a family, they usually budget 400 pesos daily. But when she
became pregnant, she saves half of her monthly salary for her baby as well as gets a
portion from his husband’s earnings. They say that it was difficult for them to budget
daily expenses and needs during pandemic as they have a toddler and she was pregnant
with her second child during the midst of pandemic. However, she excitedly shares that
due to pandemic and lockdowns they had a full time and attention in taking care with
their 1st born and become extra careful during her pregnancy.
● For their daily bonding, they usually stay at home watching movies, cleaning the house
and teaching their first child primary lessons for development. The patient stated that
through it, they can instill lesson to her child to prepare him in entering kindergarten
when she turned 4 or 5.
● 

Genogram
 PAST HEALTH HISTORY

● Patient R was born on the 28th of January 1993 at Emergency Cauayan Hospital in Cauayan City, Isabela
via normal vaginal delivery. She was breastfed as well as all her siblings. She cannot remember which
vaccines she has taken but declared that it was complete as she also showed her BCG mark on her deltoid.
She was also fully vaccinated for Covid 19 and has received Astrazenica for her 1st and 2nd dose.
● Throughout Patient R’s pregnancy she stated to have a healthy working environment and doesn’t get
involved to any serious fights in their workplace. She stated that her working environment doesn’t cause her
any stress. During Patient R’s pregnancy, she had cravings and requested frequently her favorite foods such
as pata tim, lechon kawali, bulalo, sinigang na baboy, sisig, adobong manok, adobong baboy, Jollibee fried
chicken, fries, ice cream, and many more. Patient R eats about 2 cups of rice almost every meal and 1 to 2
servings of meat dish and sometimes vegetables.
● She shared that she rarely gets sick and doesn’t experience any serious illnesses. Some common illnesses
she had experienced growing up were common colds, fever, cough, and diarrhea which they seek
treatment for through over-the-counter drugs such as Ibuprofen for a pain killer and Neozep for colds and
take rest and drinks more water as advised by her parents. The patient doesn’t have drug maintenance.
However, she takes vitamin c specifically, Enervon when she had the time to take it before going to work.
She stated that she often forgets to take vitamins. Also, she doesn’t have any allergies, accidents or
injuries. She also hasn’t experienced being hospitalized for an illness.
● Client R had her first menstruation when she was 14 years old and it lasted for 5 days. She regularly
changes her menstrual pads, sometimes if the flow was heavy, she would change for about three times a
day. She also has regular menstruation which occurs in a 28-day cycle with an approximately 60-75mL
across the length of her period. She doesn’t experience any discomforts during menstruation such as
dysmenorrhea.
● Client R is married since the year 2018. She discloses any information about her first
sexual contact. Client R’s attending physician is Dr. Susan C. Tan. Client R is gravida 2
para 2. Her first pregnancy was in the year 2018, she was 24 years old back then. It was
confirmed through the missed menstrual period and a positive pregnancy test. She
wasn’t able to carry to term and delivered the baby via a cesarean method of delivery.
The baby was delivered prematurely during its 34th week of gestation, male, with a birth
weight of 4.5lbs. and no serious complications. The patient stated that after giving birth
to her 1st child, she become conscious and cooperative to all the doctor’s orders such as
following a soft diet and not carrying items that are heavy. She can’t recall the
medications given to her but she stated that it took her 3 weeks to recover from the
delivery. She narrates that she limits her activities and gets enough sleep for a day and
conducts a light exercise, specifically walking around their backyard.
● Recently, she had her second pregnancy which was on the year 2021, she was 28 years old that time.
Like her previous pregnancy, she was able to confirm it through missed menstrual period and
positive pregnancy test. For all her previous pregnancies, the patient was unable to mention the date
when she used pregnancy test for confirmation. As she stated, she cannot remember them anymore.
Furthermore, she mentions that she takes vitamins such as calcium and multivitamins because her
doctor told her so and she only adds lactating food such as malunggay, biscuits, and chips containing
lactation. She stated that she takes Enfamom vitamins and mineral supplements. Moreover, during
the 26th week of gestation, the patient is reported to have a high blood pressure. Her physician
ordered her to take Methyldopa 250 mg twice a day. Along with Methyldopa, she takes Asipirin
80mg/day that was given to her on her 1st prenatal visit on 12 weeks of gestation.
● She delivered her second baby last May 14, 2022, at the Cauayan Medical Specialists Hospital via
Cesarean Delivery. The baby was delivered preterm at 36 weeks and needed to stay at the hospital
for antibiotics as stated by the patient.
 PRESENT HEALTH HISTORY

● Patient R is from Puroc 5 Carabbatan Punta, Cauayan City, Isabela, and is currently working as a
banker at EastWest Bank. The patient is a 4 days postoperative from her cesarean delivery. Upon
interview, her facial expression would tell that she genuinely feels happy at the moment.
Through our different topics such as introducing ourselves and the processes we will conduct, her
eyebrows would arch with curiosity, and when we talked about the recent heavy rain happened
from the past days, she fixed her relaxed arms over the bed and grab the pillow behind her back
and talked about how it was relaxing for her and sad at the same time. She narrates that she loves
rain especially when she is in a cozy place and it relaxes her feelings, however, she feels sad since
she was not with her 1st child at those moments for she loves to cuddle with him.
● After our friendly discussions, we let her rest for a few minutes until she was able to
relax. We then proceeded to check her vital signs. First is her temperature which is
36.6 degrees Celsius, next is her blood pressure of 120/80, RR of 20 breaths per
minute, PR of 85 beats per minute. We also checked her weight which is 65kg
compared to her last recorded weight from her last prenatal check-up last May 4,
2022 which is 65.2kg. Her height is 5’3”. In terms of her general state of health, she
is well and healthy. In terms of five senses, no indication that she is deaf, blind, nor
mute. The patient and her baby’s attending physician is Dr. Susan C. Tan. According
to her, she goes to her prenatal check-up every week. However, on the 14th day of
May, she was admitted to Cauayan Medical Specialists Hospital at exactly 8:42 in
the morning.
● According to the patient 1 week prior her admission she had on and off headache but she
sets it aside and rest herself when aches occur. Along with it, she experienced few hours of
blurry vision and severe hypogastric pains. She said that she didn’t notify anyone neither her
physician. She claimed that she was hypertensive starting on the 26th weeks of pregnancy.
In addition, she has a history of preeclampsia with her 1st pregnancy. On May 14, 2022 at 7
in the morning after taking up breakfast she feels abdominal cramps and she described it
“masakit na mabigat”. Her abdominal cramps go along with headache and dizziness at that
time as reported by the patient. Upon admission, she was reported with dry mucous
membrane, abdomen tenderness, with edema and swelling in Bipedal extremities. Also,
reported with FHT Tachycardia, closed cervix and negative discharge. Her physician Dr.
Susan Tan, admission diagnosis was Pregnancy uterine 36 weeks; preeclampsia.
● At the moment, she have delivered her baby via cesarean method and she was also ligated as per
ordered by her physician. The postoperative/ principal diagnosis is pregnancy uterine 36 weeks cesarean
delivered operatively to an alive baby boy 2.320 kg. Other diagnosis is pre-eclampsia and abruptio
placenta. In addition, the Principal operation procedure was Repeat Low Transverse Cesarean Section.
She has Cesarean incision site with 5 inches in length, non-absorbable suture is being used. The incision
was clean, dried and secured with Tegaderm patch to maintain the moist environment for wound healing
and she stated that it will be cleaned and removed on her next checkup on May 26, 2022. As per May
16, her physician orders were self-diet for the patient, wound cleaning, monitoring for vital and she
must continue oral medications. The patient is still lying in the hospital with her baby. On May 18,
2022, at 10 AM when we conducted an interview with the patient, she was discharged and advised for
rest at home on the previous day last May 17, 2022, and follow up checkup May 26, 2022. However, the
patient is breastfeeding her child, therefore, she chooses to stay at the hospital. The patient stated that
she was advised to go for follow-up a check-up for the removal of the Tegaderm patch and wound
cleaning.
● The patient reported on that day that she can walk around the room, go to the
bathroom alone, and plans to go home for a while to check her toddler and
will be back on time of breastfeeding. However, as stated by the patient she
still feels pain over the cesarean incision site and declares the pain 10 over
10. Aside from it she doesn’t have any complications or complaints2Her
vital signs are ranging to normal values and she said that she eats a lot of
fruits and soft foods at the moment of hospitalization.
 PHYSICAL
ASSESSMENT
Date of Admission : May 14, 2022
Date Examined: May 18, 2022
Date Assessed: Day 4 of hospitalization 
Time Started: 10 am

General Appearance
              The patient was 28 years old, gravida 2, para 2, residing in Carabbatan Punta, Cauayan
City, Isabela. She is recovering from Cesarean delivery birth on the 14th day of May at the
Cauayan Medical Specialists Hospital.  She was wearing a white slightly loose blouse, a magenta
cardigan, and a comfortable pajama, clean and well-groomed ambulatory, conscious and coherent.
The patient was alert, active, and cooperative. The fat distribution on her body increases as
observed and stated by the patient. As to her condition, she still manages to walk but her daily
routine activities at home become limited. The patient was discharged last May 17, 2022, but still
lying in the hospital due to her baby’s condition. Her baby was delivered prematurely at 36 weeks
and needed to stay in the hospital for further medical support, specifically for antibiotics as stated
by the patient. Also, the patient was able to speak clearly as well as without slur.  
 APPEARANCE
TECHNIQUES ACTUAL FINDINGS INTERPRETATION
Level of Consciousness Inspection The patient was Normal
receptive; knew how to
maintain eye contact
when conveying
information; she
participated well in
assessment; and aware of
herself and her
surroundings.

Facial Expression Inspection Patient expressed her Normal

ideas and feelings clearly
and confidently. She often
smiles when sharing her
ideas. 
 TECHNIQUES ACTUAL FINDINGS
Posture Inspection The patient was sitting on
her hospital bed and still
limiting her movement since
she's still in pain from the
site of surgery. However,
she still manage to welcome
us
INTERPRETATION
Abnormal
Impaired physical mobility
related to pain in cesarean
incision site as evidenced by
pain scale 7/10

Hygiene and Grooming Inspection The patient was well- Normal 

groomed, and have her
personal hygiene such as
taking a bath, tooth
brushing, fixing her hair and
changing her clothing in her
daily basis. In addition,
the patient is practicing
proper and sterile wound
dressing over her incision
site.
 NORMAL FINDINGS  ACTUAL FINDINGS INTERPRETATION
Temperature
VITAL SIGNS
37 degree Celsius 36.7 degree Celsius Normal
Pulse Rate 60 to 100 beats pm 85 beats pm Normal
Respiratory Rate 16-20 breaths pm 19 breaths pm Normal
Blood Pressure 120/80 mmHg 120/80 mmHg Normal
Pain Pain scale of 7/10 Abnormal 
Acute pain related to post
operative incision site as
evidenced by pain scale level of
7/10

Height  5’3 ft Normal 

Weight Based on 5’3 ft height: 45 kg Pre-pregnancy: 65 kg Abnormal
1st Trimester: 52 kg Increase of weight related to
2nd Trimester: 67 kg increase food intake
3rd Trimester: 70 kg
Total weight gain during
pregnancy: 25 kg
Current weight gain: 65 kg

BMI 18.5-24.9 25    Abnormal

Imbalanced Nutrition related to
excessive dietary intake as
evidenced by overweight
 SKIN ASSESSMENT
TECHNIQUES ACTUAL FINDINGS INTERPRETATION

Color Inspection Light brown but slightly Normal 

fairer to those body parts
that are not oftentimes
exposed to sun.

Texture Palpation Smooth and soft in texture Normal 

but more uneven in the
belly part because of the
presence of stretch marks.
Skin is also moist. No edema
presents.
Stretch Marks or the
presence of Linea Nigra (is
due to fluctuating
hormones) and Striae
Gravidarum (due to
increased uterine size).

Temperature Palpation Skin is warm to touch  Normal 

Skin Turgor Palpation Skin turns back within Normal 
2 seconds
Edema Inspection No presence of edema on Normal 
both hands
 EYE ASSESSMENT 
BODY PARTS TECHNIQUES ACTUAL FINDINGS INTERPRETATION

Eyes Inspection Eyes are curved equally; no Normal

lesions, redness, swelling and
edema present. 

Eyebrows Inspection Eyebrows are evenly distributed; Normal

skin is intact.

Eyelids and Eyelashes Inspection Upper and lower lids close easily Normal
and meet completely when
closed. Eyelashes are evenly
distributed and curve outward
along the lid margins. 

Conjunctiva  Inspection Bulbar Conjunctiva is clear and Normal

moist 
Lower and upper conjunctiva are
clear and free of swelling or
lesions
 EYE ASSESSMENT 
BODY PARTS TECHNIQUES ACTUAL FINDINGS INTERPRETATION

Eyeballs Inspection Symmetrically aligned in Normal

sockets without protruding

Cornea  Inspection Transparent and Shiny. Normal

Iris Inspection Iris is round and evenly colored Normal

Pupil Inspection The pupils are equally round Normal

and react to light (pupil
constrict) accommodation

Sclera Inspection White color  Normal

Lacrimal Apparatus Inspection and palpation No swelling, redness, and Normal

drainage is present
 NOSE ASSESSMENT
BODY PARTS TECHNIQUES ACTUAL FINDINGS INTERPRETATION
Nose Inspection Nasal congestion is not Normal
present in the patient.
Inspection No presence if mucus in the Normal
nose
Inspection Tender or any pain of the Normal
nose is not present.

NAIL ASSESSMENT
BODY PARTS TECHNIQUES ACTUAL FINDINGS INTERPRETATION

Grooming and cleanliness Inspection Nails are clean, short and Normal
well-trimmed
Color Inspection Nail bed is pinkish Normal

On capillary refill test Inspection Pink tone Normal

returns immediately within
2 to 3 seconds. 
 HEAD AND NECK

BODY PARTS TECHNIQUES ACTUAL FINDINGS INTERPRETATION

Hair Inspection Hair is course, evenly Normal
distributed, smooth, no
parasites, and has a dyed
hair which is brown in
color.

Color Inspection Hair is color black Normal

Amount and Distribution Inspection Evenly distributed, no oily Normal
hair is present.

Present of parasites Inspection No presence of parasites Normal

Scalp Inspection Clear white in color Normal

Thickness and texture Palpation Absence of masses, Normal
lumps, scars, nits,
dandruffs. 

Face Inspection Face is symmetric. Normal

 HEAD AND NECK
BODY PARTS TECHNIQUES ACTUAL FINDINGS INTERPRETATION
Eyes  Inspection  Her eyes curved equally; Pupils Normal 
are equal and reactive to light;
Conjunctiva are white and free
from lesions and redness. 

Mouth and Throat  Inspection  No pain or any lesions is present; Normal 

buccal mucosa appears pink and
moist; gums are pink with no
swelling; no decayed teeth;
tonsils are pinkish 

Ears Inspection  Equal in size; no lesions or Normal 

nodules in the auricle; No
discharges present 

Lips  Inspection  Lips are brown to light pink in Normal 

color with no dryness and lesions

Nose Inspection  Symmetric and straight; no Normal 

mucosal discharges are present. 

Neck Palpation Symmetrical and straight; Normal 

proportional to size of head. No
inflammation of lymph nodes;
Nontender and smooth.
 BREAST ASSESSMENT : 
BODY PARTS TECHNIQUES ACTUAL FINDINGS INTERPRETATION
Breast  Inspection Breast is full and heavy; breast Normal 
engorged, nipples are leaking
and become larger

Size and Symmetry Inspection Breasts enlarged or increased Normal 

Increased in breast size in
postpartum stage primarily due
to prolactin hormones, make the
breasts engorged with milk
production.

Color Inspection Breast color varies from light Normal

pink

Shape Inspection Round in shape,  right is larger Normal

than the left and breast are tender

Discharge Inspection There is a thin and watery Normal

colostrum discharge (breast milk)
 CHEST AND ABDOMEN 

BODY PARTS TECHNIQUES ACTUAL FINDINGS INTERPRETATION

Thorax and Lungs Auscultation Clear auscultation of sounds Normal
which are loud.
Heart Auscultation Normal sinus rhythm and no Normal
murmur sound is present.
Abdomen  Inspection Incision site from CS operation in Normal 
a classical cut is present.  Striae Gravidarum: 
Striae Gravidarum and Linea Increased uterine size secondary
Negra are both present to overstretching of the abdomen
due to enlarged uterus. 

C-Section Incision Site  Cesarean incision site is intact; Normal

Inspection length is 5 inches; non absorbable
suture is being used; tegaderm
patch is applied; clean, no
redness around the patch, no
drainage and edema present.
 ARMS AND HANDS
BODY PARTS TECHNIQUES ACTUAL FINDINGS INTERPRETATION
Hands Inspection No edema is present Normal
Fingernails Inspection Her nails are hard, round Normal
and pinkish. Capillary refill
time is 1 second.

LEGS AND FEET

BODY PARTS TECHNIQUES ACTUAL FINDINGS INTERPRETATION

Legs Inspection No edema is present. Normal

Toenails Inspection Her nails are hard, Normal

elongated.
 Developmental Task
●ERIK ERIKSON’S DEVELOPMENTAL TASKS
Erikson theory proposes that life is a sequence of developmental stages or level of achievement. Each stage signals a task
that must be done. The relation of the task can be complete, partial, or unsuccessful. Erikson believed that the more
success an individual has at each developmental stage, the healthier the personality of the individual. Failure to complete
any developmental stages can be viewed as series of crises. Successful resolution of the crises supports healthy ego
developmental. Failure to resolve the crises damage the ego.
Infancy 0-8 months Trust vs. Mistrust Learning to trust others mistrust Withdrawal
Early Childhood 18mos – 3y/o Autonomy vs. Shame and Self-control without loss of self- Compulsive self-restraint,
doubt esteem, ability to cooperate and willfulness, and defiance.
express one self.

Late childhood 3-5 y/o Initiative vs. Guilt Beginning ability to evaluate one’s Lack of self- confidence fear of
own behavior. wrong doing.

School Age 6-12 y/o Industry vs. Inferiority Developing self of competence and Loss of hopes withdrawal from
prevenance. school and peers.

Adolescence 12-20 y/o Identity vs. Role confusion Coherent sense of self plans to Feeling confusion indecisiveness.
actualizes one’s ability.

Young Adulthood 18-25 y/o Intimacy vs. Isolation Intimate relationship with another Avoidance of relationship career of
person commitment to work and lifestyle commitment.
relationship.

Adulthood 25-65 y/o Generatively vs. Creativity productivity concern for Self-indulgence, self-concern, lack
Stagnation others. of interest.

Maturity/ late 65y/o to death Integrity vs. Despair Acceptance of worth and uniqueness Sense of loss contempt for other.
adulthood of one’s own life. Acceptance of death.
 According to Erikson's Theory of development, Patient R belongs to the Generativity vs.
Stagnation stage, in which we can say at the age of 29 years, she is developing generativity. Erikson
believes that generativity encompasses adults' desire to leave a legacy to the next generation. Through
generativity, adults achieve a kind of immortality by leaving their legacy. There are characteristics of
generativity that were seen and presented to Patient R, including developing relationships with family,
making contributions, feeling productive, and taking responsibility.
Patient R has been married to her husband for about three (3) years. They have been gifted with 2
children. The first born is now three (3) years old and her youngest is currently three (3) days old.
Patient R is a job-driven person. She is a "workaholic" person and she works at East West bank. Officer
as a banker, her usual routine as a banker in bank is to assist consumers with their banking and
financial requirements by working at a retail bank. patient R also helps the costumers in their Needs
such as opening bank accounts and investing in certificates of deposit (CDs), money markets, and other
commercial banking products. Patient R has a strong bond and relationship with her parents. They do
not have any conflict despite her current situation. Patient R's relationship with her husband are very
strong and patient R’s husband has a lot of time for her and for their baby. Patient R stated that they
both support the financial of her pregnancy.
Overall, Patient R is developing generativity or making her image by taking care of the people in
her city and helping them on their needs by providing them with the greatest service they can get.
ROBERT HAVIGHURST’S DEVELOPMENTAL THEORY
He promotes concept of developmental task and he said that developmental task is a task which arises at or about a
certain period of life of an individual, successful achievement of which leads to his happiness and to success with later
task while failure leads to unhappiness in the individual disapproval by society and difficulty with later task.
●Stages
●Infancy and early child hood
 Learning to talk
 Learning to take solid foods
 Leaning to control the elimination of body wastes
 Learning sex differences and sexual modesty
 Achieving psychological stability
 Forming simple concepts of social and physical reality
 Learning to relate emotionally to parents, siblings, and other people
 Learning to distinguish right from wrong and developing a conscience
Middle Childhood Adolescence
 Learning physical skills necessary for ordinary games  Achieving new and more mature relations with age-mates
of both sexes
 Building wholesome attitudes toward oneself as a growing
organism  Achieving a masculine or feminine social role
 Learning to get along with age-mates  Accepting one’s physique and using the body effectively
 Learning an appropriate masculine or feminine social role  Achieving emotional independence of parents and other
adults
 Developing fundamental skills in reading, writing and
calculating  Preparing for marriage and family life
 Developing concepts necessary for everyday living  Acquiring a set of ales and an ethical system as a guide to
behavior, developing an ideology
 Developing conscience, morality and a scale of values
 Desiring and achieving socially responsible behavior
 Achieving personal independence
 Developing attitudes toward social groups and institutions
Early Adulthood Middle Age
 Selecting a mate  Performing social responsibility
 Learning to live with a partner  Establishing and maintaining an economic
 Starting a family standard of living

 Rearing children  Assisting teenage children to become

responsible and happy adults
 Managing a home
 Relating oneself to one’s spouse as a person
 Getting started in an occupation
 Accepting and adjusting to the physiologic
 Taking on civic responsibility
changes or middle age
 Finding a congenital social group
 Adjusting to aging parents
Late Maturity
 Adjusting to decreasing physical strength and health
 Adjusting to retirement and reduced income
 Adjusting to death of a spouse
 Establishing an explicit affiliation with one’s age group
 Meeting social and civil obligations
 Establishing satisfactory physical living arrangement.

Patient R belongs to the Middle Age stage. According to Havighurst, developmental task of Middle Age
includes
1. Performing social responsibility

Patient R currently working at East West Bank in Cauayan City, wherein she is a banker. Patient R helps
customers manage their accounts and finances, and advise clients on various financial services. Opening
Accounts, selling investment products, selling loans, retirement and college planning, skills, and pay and
hours are some of the most common duties and responsibilities involved in the daily routine of a
personal banker. Patient R’s scope of work as public servant is wide. That is why Patient R labels herself
as a “workaholic” person.

2. Establishing and maintaining an economic standard of living.

Patient R is a Banker at East West Bank in Cauayan City. Patient R stated that she does not have a hard
time budgeting the expenses for their use, her stay in the hospital, and her second baby since she and her
husband had been planning and budgeting well their finances for her hospitalization and her future
expenses in her first born and her second baby. Patient R is trying her best to maintain a type of living to
sustain the needs of her children and look for more opportunities in the future.
3. Assisting teenage children to become responsible and happy adults

Patient R has a three-year-old son and is currently learning his colors and how to count, use
scissors, and play ball thought by his parents. Patient R supplies all the necessities of her son
even without the presence of his Father. She also wishes to guide her kid as he grows up as a
teenager with respect, responsibility, and independence.

4. Relating oneself to one’s spouse as a person

Patient R has a good relationship with her husband. As patient R stated, her husband has a lot
of time for them and does exert effort to help her provide for their needs financially. That is
why their marriage turns into a strong and happy family. Patient R, a thankful mother because
of her husband's commitment.
5. Accepting and adjusting to the physiologic changes or middle age

Patient R explained that she is mentally and emotionally good for now. Still, she needs to be stronger for her
son and her newborn, she plans to continue her work being a banker in East West Bank Cauayan City, but she
will aim higher and try to raise her children healthy and safe. She hopes that within ten years from now, she
will have an opportunity to work in the bank in a higher position because her and her husband’s income will
not be sufficient to meet the demands of her children. In addition, she worries about her elderly parents
because they are financially supporting her, but she doesn't want to rely on them as they become older.

6. Adjusting to aging parents.

Patient R's mother is currently 52 years old, and her father is currently 53 years old. Patient R's parents are
very supportive of her. Sometimes, Patients R's financial needs are also taken care of financially by them.
While she doesn't want to rely on her parents, the patient nonetheless aspires to raise her children on her own
so that she can provide for them. Lastly, support her parents financially with their needs and health
maintenance.
LAWRENCE KOHLBERG MORAL DEVELOPMENT

Kohlberg first level of development called the pre-conventional level, children are
responsive to cultural rules and labels of good and bad, right and wrong. However, children
interpret these terms of the physical consequences of their actions that are punishment or
reward.

At the second level, the conventional level, the individual concerned about maintaining
the expectations of the family, group nations and the emphasis of this level is conformity and
legally and one’s own expectations as well society’s level three called the post conventional
autonomous or principal level. At this level, people make an effort to define valid values and
principle without regard to outside authority or and the expectation of other stage.
Level 1 Stage Fear of punishment, respect for authority, is the reason for decisions, behavior
Pre-Conventional Morality 1: and conformity.
Punishment Obedience  
Orientation Conformity is based on egocentricity and narcissistic needs. There is no feeling
Stage 2: Instrumental of justice, loyalty, or gratitude. “I’ll do something if I get something for it or
Relativist Orientation because it please”

Level 2 Stage 3: Good boy, nice girl
Conventional Morality Orientation
 
 
Stage 4: Law and order
Orientation
 
Stage 5: Social contract
Orientation
Decisions and behavior are based on concerns about others reaction, the persons
want others approval or reward. An empathetic response, based on understanding
of how another person feels, is a determinant for decision and behavior. “I can
put myself in your shoes”
The person wants established rules from authorities and the reason for
decisions and behavior that is social and sexual roles and traditions demand
the response. “I’ll do something because it’s the law of my duty”
The social rules are not the sole bases for decisions and behavior because the
person believes a higher moral principle applies.

Level 3 Stage 6: Universal ethical Decision and behavior are based on internalized rules on conscience rather than
Post conventional Morality principal Orientation social laws and self-chosen ethical and abstract principles that are universal
comprehensive and consistent
 ● Patient R belongs to Level 2 Stage 4: Law and order Orientation of Kohlberg’s Moral
Development because Patient R believes that rules from authorities are important and
must try to obey the laws. Patient R stated that she is works at East West Bank Cauayan
City as banker. As needed to follow the rules when interacting with the clients within
your community. Patient R stated to respect the client no matter the kind of living of the
client they have and provide the quality care needed for them.

●FREUD’S FIVE STAGES OF DEVELOPMENT

Freud believed that personality developed through a series of childhood stages in which the
pleasure – seeking energies of the id become focused on certain erogenous area. An erogenous
zone is characterized as an area of the body that is particularly sensitive to stimulation. During
the five psychosexual stages, which are the oral, anal, phallic, latent and genital stages, the
erogenous zone associated with each stage serve as a source of pleasure.
 STAGE AGE CHARACTERISTICS IMPLICATIONS

Oral Birth to Mouth is the center of pleasure. Security is primary need. Major Conflict: Feeding produces pleasure and sense of
1½ weaning comfort and safety. Feeding should be
year pleasurable and provided when required.

Anal 1 ½ to 3 Anus and bladder are the sources of pleasure. Major conflict: Toilet Controlling and expelling feces provide
years training pleasure and sense of control. Toilet
training should be a pleasurable
experience.
Phallic 4 to 6 Masturbation offers pleasure. Other activities can include fantasy, The child identifies with the parent of the
years experimentation with peers, and questioning of adults about sexual topics. opposite sex and later takes on a love
Major conflict: The Oedipus or Electra complex, which resolves when the relationship outside the family. Encourage
child identifies with parent of the same sex. (The Oedipus complex refers identity.
to the male child’s attraction for his mother and hostile attitude towards his
father. The Electra complex refers to the female’s attraction for her father
and hostile attitudes toward her mother.)

Latency 6 years Energy is directed to physical and intellectual activities. Sexual impulses Encourage child with physical and
to tend to be repressed. Develop relationships between peers of the same sex. intellectual pursuits. Encourage sports and
puberty other activities with same-sex peers.

Genital Pubert Energy is directed toward full sexual maturity and function and Encourage separation from parents,
y and development of skills needed to cope with the environment. achievement of independence and
after decision making.
● According to Freud’s psychosexual developmental task, Patient R is in the genital stage
(Puberty and after). It is where energy is directed toward full sexual maturity and function
and the development of skills needed to cope with the environment. At this point, Freud
believed that the ego and superego were fully formed and functioning. In this stage, the
person was encouraged to separate from parents, achieve independence, and make
decisions. As mentioned, Patient R, she studied at Isabela State University, wherein she
graduated in 2009. Patient R married her husband, and they are also same religion
(Christian Born Again). The date of their marriage is at April 29, 2018. She was currently
25 years old when they got married, and their relationship was 4 years and counting. So,
their marriage grew, Patient R got pregnant with her second baby with same man who is
responsible and provides her needs and support.
CONCLUSION
S
Mercury is the closest planet to the Sun and
the smallest. The planet’s name has nothing
to do with the liquid metal, it was named
after the Roman messenger god
 REFERENCES

● AUTHOR (YEAR). Title of the publication. Publisher

● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
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