Davao Doctors College Inc.

General Malvar St., Davao City

Nursing Program

Nursing Management of a Patient in

Postpartum Stage

A Case Study Presented to the Nursing Clinical Instructors

of Davao Doctors College, Inc.

In Partial Fulfillment of the Requirements in NRG203: NRG 203: Care of Mother, Child,
And Adolescent (Well Clients) Postpartum Period

Castro, Jonalyn S.
Diadula, Rodel U
Escovilla, Martina Roselle B.
Galigao, Ma. Dianne P.
Garro, Jovy Anne B.
Gentapa, Luis S.
Gesta, Charles Axle M.
Gonzales, Francesca D.
Guinocor, Monica I.
Jorge, Christian Jay A.
Kanda, Fatma Aizah M.

October 27, 2022

 Table of Contents
Objectives(General & Specific)……………………………...……………….. 2
Introduction……………………………………………………… ……………....3-4
Patient’s Profile…………………………………………………………………..5-8
i. BiographicData………………………………………....……………….5
ii. ClinicalData………………………………………………...………….. 5-6
iii. Past Health History - Narrative……………………………………….6
iv. Present Health History - Narrative……………….……………...…...7
v Family History (with Genogram) - Narrative......................................8
Health Assessment……………………………………...……………………... 9-12
Review of Anatomy & Physiology…………………………………………….13-20
Pathophysiology……………………………………….……………………….. 21-30
i. Definition of Diagnosis…………………….…………………………... 21
´ii. Etiology (tabular)........................................................................... 22-26
´iii. Symptomatology (tabular)............................................................ 27-28
´ iv. Schematic Diagram………………….……………………………….. 29-30
´v. Narrative………………………………………………………………. 30
Course in the ward/Treatment/Interventions………………………………. 31-54
i.Medical Management …………...…………………………………….. 36-42
a. Doctors Progress notes...………………………………………. 31-41
b. Laboratory/Diagnostic Examination (tabular)…………………. 41-54
Nursing Management……….…………………………………………………. 55-60
Reference…………….……………...…………………………………………... 61-62
 OBJECTIVES
i. General objectives

The Bachelor of Science in Nursing, Section 12H Group 30, strives to develop a
productive and competent group with the goal of establishing thorough comprehensive
case studies within time constraints. By doing an effective assessment, evaluation, and
documentation, the group will adopt appropriate nursing care to assure the patient's
physical, mental, and emotional health needs. This goal will allow us to improve our
abilities and knowledge in using the nursing process to care for a healthy mother and
fetus during the intrapartum period.

ii. Specific Objectives

Within our 1-week span of nursing care, the following specific objectives will guide
us to achieve our general objectives.

Specifically, the group aims to accomplish the following objectives.

a). Understand the condition of the patient;

b). Establish a strong and working relationship with the patient and family in the
means of therapeutic communication;

c). Create an introduction that contains an overview of the case study;

d). Construct specific, measurable, attainable realistic, and time-bound objectives;

e). Gather important personal and clinical information that will serve as our
baseline data;

f). Present a genogram that contains the client’s maternal and paternal diseases;

g). Present the client’s past health history up to his present health condition status;

h). Perform a thorough physical assessment of the client in a cephalocaudal

manner;

i). Define the diagnosis of the client with different sources;

j). Discuss the anatomy and physiology of the body system affected by the
condition of the client.

k). Illustrate the pathophysiology of the condition of the client with its corresponding
predisposing and precipitating factors and symptomatology;

l). Render high-quality care appropriate for the patient;

m). Provide appropriate health teaching to the patient and family, and

n). List down all the references used for the completion of this case study.
 INTRODUCTION

The postpartum period refers to the period beginning immediately after the birth of
a child continuing until about six weeks. It is a significant phase in the lives of mothers
and babies for the reason that it is a time of adaptation to parenthood, the development
of secure attachment for the neonate and young infant, and a time where bonds can
develop within the family and with the community.

However, maternal mortality data relating to the postpartum period indicates that
there are an estimated 303,000 maternal deaths annually resulting from complications
related to pregnancy, childbirth, or the postnatal period he majority of these deaths occur
postnatally, with post-partum hemorrhage as the most common cause of maternal death.
Neonatal data are more widely available and recent estimates indicate there are almost
three million neonatal deaths (deaths in the first 28 days after birth) each year, most of
which are preventable. The Global Strategy for Women’s, Children’s, and Adolescents’
Health 2016–2030 highlights the importance of postnatal care for mothers and babies in
ending preventable deaths and ensuring health and wellbeing. Strategies designed to
reduce the rates of maternal and neonatal mortality are also endorsed by the World Health
Organization and emphasize the importance of the postnatal period in achieving this goal.

Nationally, the Philppines’ maternal mortality rate (MMR) remains high.

Approximately two-thirds of all maternal deaths occur during the postpartum period and
to overcome the MMR, the efforts in the Philippines have focused on pregnancy and
delivery. Unfortunately, only 13.5% of postpartum women receive their first postpartum
check-up in the 3–41 days after delivery, and 9.0% do not receive any check-ups.
Importantly, Singh et al. show that underutilization of postpartum maternal healthcare
services may reflect why the maternal mortality rate among moms in India remains high.
Furthermore, Romeo et al. suggest that women in the Philippines should receive constant
care and support from professional caregivers throughout the pregnancy, childbirth, and
postpartum periods. As a result, the low level of maternal healthcare services supplied to
postpartum women by health facilities may be to blame for the Philippines' chronically
high MMR. Previous research has found that economic concerns, accessibility to care,
transport difficulties, and authorization from the patient's family are all causes for this
reduced level of care. Additionally, Yamashita et al. found that the majority of postpartum
women have a poor overall knowledge of postpartum health problems, including heavy
bleeding, postpartum depression, and high blood pressure. Furthermore, women who
gave birth at home used fewer postpartum healthcare services than women who gave
birth in medical centers.

In Davao City, Local Government Units (LGU) provide Mother-Baby Handbooks to

pregnant women as a means of ensuring that they will receive sufficient nourishment
securing a healthy postpartum. According to the City Health Office (CHO) Nutrition
Division, during this coronavirus pandemic, there has been a greater emphasis placed on
the value of appropriate nutrition, particularly for children and expectant mothers.

In this case study, the patient is a 29-year-old female, G1 P1, and she delivered a
full-term baby girl via normal spontaneous vaginal delivery (NSVD). Following pregnancy,
the patient is observed to be tired and exhausted. At first, she was dependent and passive
and talked and asked about labor and her delivery experiences, but afterwards, she
initiated action. The patient later on demonstrates independence, is receptive to infant
care, and begins to take an interest in the baby. She assumed the mother role and
accepted the neonate’s real image through grief work and readjustment of relationships.

The purpose of this case study is to analyze the available data, determine actual
and potential nursing diagnoses as well as collaborative problems, describe the
psychological and physiological changes that occur in the postpartum woman, discuss
the commonly used obstetric medications and their nursing implications, and describe
nursing responsibilities regarding discharge teaching for the client. In general, this case
study aims to contribute to the existing case studies on postpartum care. For nursing
students, registered nurses, and researchers, this case study will aid in raising the
standard of nursing practice and research.
 Patient’s Profile

i. Biographic Data

Name: Narda

Age: 29 years old

Birthdate: N/A

Gender: Female

Civil Status: Married

Citizenship: Filipino

Religion: N/A

Educational Attainment: High School Graduate

Occupation: Factory Worker

Family Income: N/A

Socioeconomic Status: Middle Class Family

ii. Clinical Data

Chief Complaint: Contraction with uncomfortable feeling

Date of Admission: October 1, 2022

Time of Admission: 1:00 AM

Manner of Admission: Delivery

Hospital: N/A

Ward/ Room No.: Labor and Delivery Unit

Attending Physician: N/A

Final Diagnosis:
i. Past Health History

Patient N is Gravida 1 Para 1 and was expected to deliver on October 10, 2022.
Her delivery was one week earlier than her estimated date of delivery. The patient has
poor prenatal check-ups and poor compliance with prescribed medicines such as
Ferrous Sulfate. The pregnancy was unplanned; however, the patient is thankful
because no problems or complications arose during labor. No reported no known
foods, drugs, or environmental allergies. The patient had a history of
hospitalization/surgery in 2021. The patient claimed that her gallbladder was removed
because of gallstones. The patient had her menarche at 12 years of age. She had a
regular menstruation 30 days cycle lasting 3-4 days, moderate to heavy flow. She
experienced dysmenorrhea and had no history of bleeding between periods.

ii. Present Health History

Patient is a 29 year old female, G1P1 delivered to a full-term baby girl with an
APGAR score of 9 after 5 minutes via NSVD with a mediolateral episiotomy. The
patient is currently experiencing some postpartum pain. 6 hours after her delivery, the
patient’s pads were saturated in less than an hour, and excessive lochia was noted.
She has a soft and boggy uterus, and a distended bladder. She had an estimated
blood loss of 700 ccs and was then referred to her attending physician. The patient is
also experiencing pain in the incision site, a small amount of seropurulent drainage
and redness of skin around the episiorrhaphy can be observed.

iii. Family/Social History (With Genogram)

Patient has been married for one year. They live in a single unit house, in a
relocation area. Patient is a current factory worker and a high school graduate. The
family is of middle-class status. The patient reports no history of alcohol, cigarette
smoking, or illicit drug use. Family history reveals (+) for diabetes mellitus on her
paternal side and (+) for heart disease on the maternal side.
Genogram
 HEALTH ASSESSMENT

A. PRELIMINARIES
VITAL SIGNS AND ANTHROPOMETRIC MEASUREMENTS

Integument

The patient has a fair-colored complexion. Her skin is warm and dry. Capillary refill
actively returns to its normal color in less than 4 seconds. Mask of pregnancy is visible
on her face. Patient has palmar erythema and diaphoresis.

Head and Face

Head is rounded, normocephalic, and symmetrical. Patient has normal alignment

of the pinna. Pupils of the eyes black and equal in size, the sclera appear white. and the
palpebra conjunctive is pale. The nose is clear and has no presence of discharge or
flaring. No palpable nodules.

Cardiopulmonary

Patient’ s chest is symmetrical. There were no visible pulsations on the aortic and
pulmonic areas and there is no presence of heaves or lifts. Patient’s pulse is palpable,
She has a Cardiac rate of 105 beats per minutes, no signs of crackles, wheezing, or
stridor. The patient is tachycardic. Patients’ lungs have normal breath sounds without
dyspnea and are clear to auscultation in all lobes.

Gastrointestinal

Patient is able to digest foods, but she is constipated, hemorrhoids are present.
Upon inspection, the patient’s abdomen appears reddened, linea nigra and stretch marks
can be noted. Upon palpation, the patient’s abdomen is soft and non-tender, a soft and
boggy uterus can also palpated. The patient’s abdomen also has audible bowel sounds.

Genitourinary and Gynecology

The patient’s perineum is edematous with ecchymosis patches from ruptured

capillaries. An increased steady flow of bright red blood and clots from the vagina can be
noted. Upon palpation, Cervix feels soft and malleable, the vagina feels soft with few
rugae, and diameter is greater than normal. The patient has a foley catheter inserted. The
patient’s urine has no signs of sediment or cloudiness. The patient’s breasts are larger,
hard and more erectile. It is engorged and shiny.

Peripheral and Musculoskeletal

The neck muscles are equal in sizes. Thyroid and nodules are palpable in the neck,
but excessive pigment or Chloasma on the face and neck can be observed. Patient’s
extremities have a good range of motion, no pelvic girdle pain or back pain were noted.
Leg pain and varicosities were not noted. Leg pain and varicosities were not noted.
 G. Review of Anatomy and Physiology

The Breasts

The mammary glands, or breasts, form early in intrauterine life. They then remain
in a halted stage of development until a rise in estrogen at puberty causes them to
increase in size. This increase occurs mainly because of growth of connective tissue plus
deposition of fat.

Breasts are located anterior to the pectoral muscle as shown in Fig. 5.10. In many
women, breast tissue extends well into the axilla.

Milk glands of the breasts are divided by connective tissue partitions into
approximately 20 lobes. All of the glands in each lobe produce milk by acinar cells and
deliver it to the nipple via a lactiferous duct. The nipple has approximately 20 small
openings through which milk is secreted. An ampulla portion of the duct, located just
posterior to the nipple, serves as a reservoir for milk before breastfeeding.
 The nipple, on stimulation, it
transmits sensations to the posterior
pituitary gland to release oxytocin,
which then acts to constrict milk
glands and push milk forward into the
ducts that lead to the nipple (a let-

down reflex). Around the nipples is the areola which appears rough on the surface
because it contains many sebaceous glands, called Montgomery tubercles.

The blood supply to the breasts is profuse because it is supplied by large thoracic
branches of the axillary, internal mammary, and intercostal arteries. This effective blood
supply is necessary so milk glands can be supplied with nutrients and fluid to make
possible a plentiful supply of milk for breastfeeding.
Physiological Changes of The Postpartal Period

Retrogressive physiologic changes that occur during the postpartal period include
those related specifically to the reproductive system as well as other systemic changes
(Box 17.5).
REPRODUCTIVE SYSTEM CHANGES

Involution is the process whereby the reproductive organs return to their

nonpregnant state. A woman is in danger of hemorrhage from the denuded surface of the
uterus until involution is complete (Katz, 2012).

The Uterus

Involution of the uterus involves two processes. First, the area where the placenta
was implanted is sealed off to prevent bleeding. Second, the organ is reduced to its
approximate pregestational size. The sealing of the
placenta site is accomplished by rapid contraction of
the uterus immediately after delivery of the placenta.

Immediately after birth, the uterus weighs about

1,000 g. At the end of the first week, it weighs 500 g.
By the time involution is complete (6 weeks), it weighs
approximately 50 g, similar to its pre-pregnancy
weight. The uterus of a breastfeeding mother may
contract even more quickly because oxytocin, which is released with breastfeeding,
stimulates uterine contractions.

The fundus is normally located in the midline of the abdomen. Occasionally, it can
be felt slightly to the right because the bulk of the sigmoid colon forced it to that side
during pregnancy and it tends to remain in that position.

Lochia

The separation of the placenta and membranes occurs in the spongy layer or outer
portion of the decidua basalis of the uterus. By the second day after birth, the layer of
decidua remaining under the placental site (an area 7 cm wide) and throughout the uterus
differentiates into two distinct layers. The inner layer attached to the muscular wall of the
uterus remains, serving as the foundation from which a new layer of endometrium will be
formed. The layer adjacent to the uterine cavity becomes necrotic and is cast off as a
vaginal discharge similar to a menstrual flow. This flow, consisting of blood, fragments of
decidua, white blood cells, mucus, and some bacteria, is termed lochia.

Characteristics of lochia are summarized in Table 17.1.

The Cervix

Like contraction of the uterus, contraction of the

cervix toward its prepregnant state begins at once. By the
end of 7 days, the external os has narrowed to the size of
a pencil opening; the cervix feels firm and nongravid
again. The cervix does not return exactly to its pre-
pregnancy state, the external os usually remains slightly open and appears slit-like or
stellate (star shaped), whereas previously, it was round.

The Vagina

After a vaginal birth, the vagina feels soft, with few rugae, and its diameter is
considerably greater than normal. It takes the entire postpartal period for the vagina to
involute (by contraction, as with the uterus) until it gradually returns to its approximate
pre-pregnancy state. Thickening of the walls appears to depend on renewed estrogen
stimulation from the ovaries. Because a woman who is breastfeeding may have delayed
ovulation, she may continue to have thin-walled or fragile vaginal cells that cause slight
vaginal bleeding during sexual intercourse until about 6 weeks’ time.
The Perineum

Because of the great amount of pressure experienced during birth, the perineum
is edematous and tender immediately after birth. Ecchymosis patches from ruptured
capillaries may show on the surface. The labia majora and labia minora typically remain
atrophic and softened after birth, never returning to their pre-pregnancy state.

Anatomy of the Infant

The anatomy of newborns is different from that of adults, or even of toddlers. These
anatomical differences make breastfeeding possible.

All babies are born with a small

degree of retrognathia, or physiologic jaw
retraction. This results in a relative
posterior positioning of the base of the
tongue and renders the newborn
predominantly obligate nasal breather.
The tongue is also larger in neonates than
adults relative to the jaw. The base of the
tongue sits far back in the throat over the
epiglottis. The newborn’s larynx is in a higher position relative to an adult and sits near
the soft palate.

This anatomy allows an infant: (1) to breathe even with a teat filling his mouth and
his nose pressed up against the breast; and (2) to swallow milk without worry of having
the liquid spill into the trachea. However, this also means that the newborn has to
coordinate sucking, swallowing, and breathing in a very specific way with little margin of
error (Sanches 2004).
 PATHOPHYSIOLOGY

Definition of Diagnosis

Postpartum has three unique periods. The third stage is the delayed postpartum
period, which can continue for up to six months. The genitourinary system modifications
can take a long time to resolve in some cases, and they might never fully return to their
prepregnant form in others. ( Romano et al., 2010 )

The postpartum period is the initial six weeks following childbirth. This is a
demanding time when you and your baby need a variety of care. Your body will go through
a lot of changes during this period, including hormonal mood swings and postpartum
recovery. All of this on top of the additional strain of dealing with nursing, lack of sleep,
and the general enormous adjustment to parenthood (if this is your first child). (
Rasminsky, 2018 )

Postpartum often referred to as the puerperium and the "fourth trimester," this
period follows delivery and marks the point at which the body returns to its pre-pregnancy
condition physiologically. ( Berens, 2022 )

Etiology

TABLE 1.1

FACTOR PRESENT JUSTIFICATION

Major Blood or Fluid Loss These include:
✔ ● Rapid breathing
● Generalized weakness
● Confusion
● Low blood pressure
The amount of circulating blood in your
body also may drop when you lose too
much body fluid from other causes.
 Losing about one fifth or more of the
normal amount of blood in your body
causes hypovolemic shock. A physical
examination can reveal signs of shock,
such as low blood pressure and a rapid
heart rate which is observed to the
patient as well as there is an estimated
blood loss of 700 ccs. Severe fluid loss
makes it difficult for the heart to pump
enough blood to your body. As the fluid
loss increases, hypovolemic shock can
lead to organ failure.

Uterine Atony Uterine atony (uterine tone) refers to a

✔ soft and weak uterus after childbirth. It
happens when your uterine muscles
don’t contract enough to clamp the
placental blood vessels shut after
childbirth. This can lead to immediate
medical treatment.

Placental Fragments Postpartum retained placental

✔ fragments (RPF) are most often
clinically manifested as delayed
postpartum hemorrhage or prolonged
postpartum spotting. This is a rare
complication of labor, yet can
potentially cause severe morbidity and
discomfort.
 Symptomatology:

Signs & Symptoms Present (place a Justification (discuss how can the
check mark if the sign or symptom appear in the
client has illness being investigated, cite
manifested the references at the end of each
sign/symptom) discussion)

Uterine Contractions ✔ Contractions occur in pregnancy

when you have a certain level of
oxytocin flowing in your blood,
which is normal when in labor.
Contractions start when the
pituitary gland releases the
hormone oxytocin. This stimulates
the muscles in the uterus to start
tightening and relaxing. The
contractions make the top of the
uterus tighten to push the baby
down. They also soften and stretch
the lower part of the uterus and
cervix to allow the baby through.
(Healthdirect, 2020)
Hemorrhoids ✔ Hemorrhoids are swollen veins
inside your rectum or in the skin
surrounding your anus. They’re
usually caused by increased
pressure on your lower rectum.
When you’re pregnant, the baby
puts extra pressure on this area.
As a result, hemorrhoids can
develop both during and after
pregnancy. They’re especially
common after vaginal deliveries.
(Osborne, O. O. 2018)

Sleep Disturbance ✔ Postpartum insomnia can arise for

a few different reasons. One
relates to hormonal shifts that
occur after delivery. Once you give
birth, your levels of estrogen and
progesterone drop precipitously.
These hormones influence
circadian rhythms, your body's
natural sleep-wake cycle. When
your circadian rhythms are
disrupted, you may be sleepier
during the day and more alert at
night. (Phillips, H. 2022)
Fatigue ✔ Pregnancy fatigue is largely due to
ramped-up production of the
hormone progesterone, which
supports your pregnancy and
increases production of milk glands
required for breastfeeding later on.
Hormone changes can also cause
mood upheaval, and riding the
emotional roller coaster of
pregnancy can be tiring.
(Bellefonds, C. D. 2020)

Lochia ✔ Lochia, also known as postpartum

bleeding, is a normal discharge of
blood and mucus from the uterus
after childbirth. It begins right after
delivery and can continue for four
to six weeks postpartum, with the
heaviest flow occurring for the first
10 to 14 days. (Bradley, S. 2022)

Postpartum Pain/Afterpain ✔ The most common reason you

have cramping after your baby is
born is that your uterus contracts to
shrink back down to its original
size. While it contracts, your body
is also working to compress blood
vessels in the uterus to prevent too
much bleeding. The contractions
are like mini versions of labor
contractions and they’re
sometimes called “afterpains”
because, well, you get these pains
after you deliver your little one.
(Marcin, A. 2020)
Constipation ✔ An increase in the pregnancy
hormone progesterone can cause
your gut to work less efficiently and
your food to move more slowly
through your intestines. This is
known as reduced gastric motility.
Another cause of constipation is
the medicines and supplements
that some women take during
pregnancy. Medicines prescribed
for nausea and vomiting, antacids
for heartburn, and some strong
pain medicines can induce
constipation in some women.
Supplements like iron and calcium,
as well as some multivitamins can
also trigger
constipation.(Pregnancybirth&bab
y. 2021)
Schematic Diagram

Narrative

Prior starting care and therapy for the patient during the postpartum period, many
factors must be taken into consideration. It may result in negative consequences if done
incorrectly. There are two categories for the factors: predisposing and precipitating. Her
age (29) and her genetics are risk factors (her parents have a history of diabetes and
heart disease). On the other hand, precipitating variables include physical discomfort,
lifestyle mental health, and social standing.

Moreover, there have been indicators and symptoms of bleeding and baby blues
(the feelings of sadness that you may have in the first few days after having a baby).
During the assessment, it was clear that the patient had mood swings, anxiety, eating
issues, insomnia, uncontrolled bleeding, hypotension, and anemia. This information,
along with a great deal more, was acquired utilizing diagnostic tools like physical
examination, lab findings, and clinical diagnosis. So, it is our responsibility as nurses to
use critical thinking and experience to assess and recognize any risk factors that might
later come into play. This will allow us to properly assess the situation and come up with
a nursing intervention that will assist reduce and treat any dangers we may later
encounter.
COURSE IN THE WARD / TREATMENT / INTERVENTIONS
i. Medical Management

a. Doctor’s Progress Notes

DATE Physician’s Order Rationale

October 1, Please admit under the

2022 service of Dr.

These are the postpartum medications ordered:

Sultamicillin 750 mg tab For the treatment of obstetric and

BID X 7 days PO gynecological bacterial infections

Fe SO4 (Feosol) 300 mg To treat and prevent iron deficiency

BID anemia.

Ranitidine (Zantac) 150 To treat or relieve heartburn, acid

mg tab BID PO indigestion, GERD, and gastric ulcers.

Metoclopramide (Plasil) To help stop you feeling or being sick

10 mg tab PRN for (nausea or vomiting).
vomiting PO

Oxytocin (Syntocinon) To begin or improve contractions during

10 “u” incorporate to labor and used to reduce bleeding after
present IVF childbirth.
Methylgometrine To prevent and control uterine atony and
(Methergin) 1-tab TID X hemorrhage before and after delivery.
3 days PO

Ketorolac (Toradol) 10 To relieve moderately severe pain,

mg q 6 hours PO usually pain that occurs after an
operation or other painful procedure.

The following were also ordered by the pediatrician for the

newborn:

Terramycin Ophthalmic To treats pink eye and other eye

ointment on both eyes infections of the conjunctiva, cornea, or
eyelid.

Phytonadione Indicated for prophylaxis and treatment

(Aquamephyton) 0.1 ml of vitamin Kdeficiency bleeding in
IM @Left vastus lateralis neonate.

Hepa B (Hyper Hep) To prevent a certain serious virus

vaccine 0.5 ml IM right infection such as Hepatitis B.
vastus lateralis

Hence the following were ordered:

Insert IVF of PNSS 1 For fluid and electrolyte replenishment

liter and incorporate 20 for intravenous administration. Indicated
units of oxytocin to run for the initiation or improvement of
@ 40 drops per minutes uterine contractions.
 Secure Packed Red To improve blood oxygen carrying
blood cell, 1 unit and capacity and restore blood volume. The
transfuse after proper purpose of the crossmatch is to detect
cross-matching the presence of antibodies in the
recipient against the red blood cells of the
donor.

Insert Foley catheter and To helps drain urine from the bladder and
attached to Uro-bag connected to a collection bag.

To decrease the risk of postpartum

hemorrhage.

Manual removal of To provide supplemental oxygen therapy

retained placental who have lower oxygen levels.
fragments.

O2 inhalation @ 2LPM To treat severe bleeding after childbirth

via nasal cannula. and used to treat severe bleeding after
childbirth.

October 6, Carboprost To evaluate your overall health and

2022 tromethamine detect a wide range of disorders,
intramuscular STAT. including anemia, infection, and
leukemia.

CBC STAT To check if the blood of two people is

compatible when mixed specially if the
person is pregnant.

ABO and RH/blood type For detecting infection, if Hepatitis B is

present and is contagious.
HBsAg Patient must be always at bed and use
bathroom for the elimination of urine and
stool.

CBR without BRP For the treatment of obstetric and

gynecological bacterial infections.

Included in the “May go home” order is the following:

Take home meds:

Sultamicillin 750 mg cap To relieve mild to moderate pain.

BID X 2 days more

Mefenamic acid 500 mg To treat and prevent iron deficiency

cap q6 PRN for pain anemia

Mefenamic acid 500 mg To check how far your cervix has

cap q6 PRN for pain opened, which will tell them how
advanced your labor is.

Ferrous Sulfate 300 mg Wants another sample to monitor the

tab OD X 1month situation or to recheck the overall health
and to screen for a variety of disorders,
such as anemia or leukemia.

Internal Examination
prior to discharge

To come back after 1

week with CBC
laboratory results at
OPD
Assessment notes by Dr:

• 39 weeks AOG

• Fetal heart rate 120

beats per minute with
adequate variability

• Cephalic in
presentation

• APGAR is score 8 after

1 minute and 9 afer 5
minutes.

• Blood pressure 80/50

• Cardiac Rate 105 bpm

• Temperature 35
degrees Celsius

• Present weight 110 lbs.

• Weight upon admission

127 lbs.
 Laboratory/ Diagnostic Examinations

Procedure Purpose Normal Range Result (Red Nursing

High, Blue low, Management
Black normal
range)

Hematology test To measure the Hemoglobin: BEFORE:

different parts and
CBC (Complete 120-140 g/L 100 g/dL- Low -Explain test
features of your
blood count) procedure.
blood, including RBC count:
red blood cells, -Explain that slight
white blood cells, 4 4.0- Low
discomfort may be
and platelets. A felt when the skin is
WBC count:
CBC can help punctured.
diagnose a variety 5-10 g/L 11.5- High
of health -Encourage to
Hematocrit: avoid stress if
problems, such as
anemia, clotting possible because
0.34-0.45 .27- Low
disorders, and altered physiologic
Platelet count: status influences
infections.
and changes
140-440 g/dL 382
normal hematologic
Differential values.
count:
-Explain that fasting
Segmenters: is not necessary.
67.8- H
However, fatty
Lymphocytes:
20.6- L meals may alter
some test results
as lipidemia. a
 result of lipidemia.

INTRA Apply manual

pressure and dress
over the puncture
site on the removal of
dinner.

POST: Monitor the

puncture site for
oozing or hematoma
formation.

Instruct to resume
normal activities and
diet

To enable safe BLOOD TYPE: A

Immunohematol B O AB Before:
blood transfusion O+
ogy RHESUS
and -Explain the test
FACTOR:
(Blood Typing transplantation of (+) Positive procedure
(-) Negative Hepatitis B
and HBsAg) haematopoietic Surface Antigen:
tissue, as well as Non- Reactive During:

prevent undesired
-Apply direct
immune-related
pressure to the
phenomena after
venipuncture site
transfusion,
until bleeding
transplantation
stops.
and during
pregnancy - If a hematoma
develops at the
venipuncture site,
apply direct
pressure.

POST: Observe for

 redness and swelling
on the site.

It measures VDRL Non-reactive

Miscellaneous BEFORE:
substances
(proteins), called
-Observe proper
antibodies, which
hygiene and wear
your body may
protective gears.
produce if you
have come in DURING:
contact with the -Must ensure that
bacteria that cause the client receives
syphilis. the highest quality
of service during
the VDRL test.

Let the patient

-

know when drawing

the blood, that they
may feel moderate
pain, or only a prick
or stinging
sensation.

-Observe and
follow health
protocols.

AFTER:
-Document any
 important
information.

To make sure you PRE: Ensure the

Urinalysis Color: environment is safe,
don't have a as well as provide
condition such as a CLEAR privacy for the patient
Straw to be comfortable.
UTI, gestational
INTRA:
diabetes, or Appearance: Instruct the patient to
preeclampsia. void into a clean, dry
Clear Clear container.

Glucose: Negative
Instruct the patient to
have a clean-catch
Albumin: Negative specimen if a
microscopes
examination is
Ph: 5.0-8.0 7.0 ordered. Vaginal
secretions, feces,
Specific discharges, and
menstrual blood will
Gravity: contaminate the
1.015 urine specimen.
.001-1.035
POST:
Observe standard
precautions when
handling urine
specimens.
Blood:
Negative
NEGATIVE Do appropriate
preservation to the
specimen if it cannot
Ketones: Negative be delivered
NEGATIVE
 DRUG STUDY

GESTA
JORGE
KANDA
GONZALES
CASTRO
GARRO
GENTAPA
GALIGAO
ESCOVILLA
GUINOCOR
DIADULA
 NCP
CASTRO
DIADULA
ESCOVILLA
GALIGAO
GARRO
GENTAPA
GESTA
GONZALES
GUINOCOR
JORGE
KANDA
 FDAR

CASTRO
DIADULA
ESCOVILLA
GALIGAO
GARRO
GENTAPA
GESTA
GONZALES
GUINOCOR
JORGE
KANDA
 NURSING MANAGEMENT

Clinical Reasoning Questions

Narda was worried that she might never portray the role of being a good mom. She
gave birth to a 39 weeks AOG baby girl but small for gestational age and believed that it
was her doing not complying with the prenatal medical regimen and working in a factory.
Days after delivery, upon learning that her baby’s condition should be monitored in the
NICU, she started to feel sad, overwhelmed, and consistently tearful. She frequently felt
irritable and would never talk to her husband, and just kept blaming herself. Her husband
shows unwavering support by making sure the necessity of the requirement as to the
health care needs of their baby is prioritized. The Pediatrician tells them that the baby
was diagnosed with Sepsis and needs to be administered antibiotics. After knowing her
baby’s condition, Narda felt guilty, and felt inadequate as a mother, stating “I was reckless
when I had her, I should not be a mom”. “Whatever happens to my baby, I should be
responsible”, while weeping with tears. What will be the response of the nurse when
hearing this statement from a postpartum patient? What is the responsibility of the health
caregiver in a situation like this?

C Head Nurse, I AM CONCERNED about the

patient blaming herself for not being a good mom.
She’s always worried that she might never portray
the role of being a good mom. I think you should
hear me out. She started to feel sad,
overwhelmed, and consistently tearful, and she
frequently felt irritable and would never talk to her
husband, and just kept blaming herself.
U Head Nurse, the patient’s husband, shows
unwavering support by making sure the necessity
of the requirement as the health care needs of their
baby is prioritized, but I AM UNCOMFORTABLE
 with seeing Narda feel guilty and inadequate as a
mother, telling herself that she is reckless and
should not be a mom.
S Doctor, Judging by the mother’s situation, THIS IS
A SAFETY ISSUE this may affect her role as a
mother and may impede the care and support that
the infant needs from her. It may also possibly
harm the mother. We must do something.

Clinical Reasoning Questions – Ethico – Moral- Legal

A woman who chooses not to keep her child

Leonor, a 20-year-old single, got pregnant and delivered just recently. “This
pregnancy is unplanned. My partner refused to support my baby and I am not ready to
assume responsibility for parenthood”, she narrated. “Besides, I don't want to raise a child
alone.” “I realized that I have to finish my studies, pursue a career, then settle.”. Leondra
is also afraid of her parents and of what other people may say. During pregnancy and
until labor, she has decided to keep the baby. Not until she gave birth, she had this
ambivalent feeling whether to keep the baby or not. After weighing things, though very
hard to let go of her child, finally she has decided to surrender her child for adoption. Are
you going to attempt to change a woman’s mind about keeping her child or placing the
child for adoption? Why or why not. What would be your nursing action? What ethical
principle is applicable

NURSING MANAGEMENT As a nurse in the maternity ward, we play an

important role in supporting mothers and welcoming
new babies. In this scenario I will attempt to change
the patient’s mind by giving her courage and time to
carefully think about her decisions. Even though the
adoption is a decision she is making voluntarily, it is
also an incredible sacrifice and significant loss. But if
the patient is consistent about her decision. As a
nurse we will support birth mothers by staying flexible
and respecting her wishes. The best thing we can do
 for a patient may be to offer an encouraging word and
let them know we are there to support them.

ETHICO PRINCIPLE UPHELD AUTONOMY:

This principle is described as an agreement to

respect another’s right to self-determine a course of
action and to support another’s independent decision
making. In the scenario wherein, she made a choice
not to keep her child and place it in adoption. The role
of a nurse In adoption process is to remain open,
positive and nonjudgmental at all times. While a
nurse might not agree with a patient's decision, they
must support it.

BENEFICENCE:

An ethical principle that addresses the idea that a

nurse’s actions should promote good. In this
scenario, the nurse will support and assist the patient
in the adoption process as they need it for the
benefits of both mother and baby.
DISCHARGE PLAN

A discharge plan or discharge planning is a process that determines the kind of care the
patient needs after leaving the hospital premises. This system assures a seamless,
thorough, and secure transfer of care from the hospital to the patient's home. The
following are included in this discharge plan, which was created using the METHODS
format: medicine, exercise, treatment, hygiene, outpatient, diet, and spirituality. Some
areas are beyond the nurse’s expertise, and with that, the nurse may choose to consult
or refer the client to professionals who are inclined to the areas mentioned.

MEDICATION As prescribed by the client's attending physician,

instruct the client to take all the medication
religiously until it is already advised by the
physician to stop. The nurse may print hand-outs or
simplified forms of the discharge plan for the client
to know the medication's appropriate administration
time, frequency, and when to stop

EXERCISE In terms of exercises, the nurse may consult an

occupational or physical therapist for modification of
exercises suited for the client's condition. These
recommended exercises by both the therapists and
the doctor may also be included in the simplified
form of the discharge plan.

TREATMENT Treatments related to postpartum care should also

be included in the simplified form of the discharge
plan handed out to the client. Needed treatments,
their importance, and their time-slots may be
consulted by the doctor if there is any need for
them depending on the clients case.
HYGIENE In terms of hygiene, the nurse may advise the
patient to consistently wash their hands and follow
adequate and appropriate cleaning procedures for
their everyday activities. The client must be
reminded of the following:

- Taking a regular bath to maintain breast hygiene

and relief from hot flashes.

- Utilizing disinfecting wipes, antibacterial soap, and

a clean cloth or towel if needed.

- Foods that the mother will serve to both

themselves and their family must be meticulously
prepared. Washing and cooking of raw vegetables,
fruits, and meat must be observed.

- teach patient on how to perform perineal care to

remove discharges that can build up
microorganism.

OUTPATIENT Explain to the patient the importance of follow up

checkups.

- Instruct the patient to attend the follow-up checkup

by their primary care provider.

- Teach patient on how to differentiate minor and

major complications that need medical attention.

DIET Encourage patients to drink fluids (8 or more

glasses a day)

- Instructed the patient to eat more green leafy

vegetables with high regards to foods that are rich
in protein and iron.

- Instructed the patient to engage in a more healthy

and sustainable diet and lifestyle that is free from
any dangerous and harmful vices as possible.
SPIRITUAL The nurse may query the patient about their
spiritual or psychological requirements in terms of
their spiritual needs. The nurse may decide to
recommend the client to a psychologist, counselor,
or their preferred spiritual advisor if professional
involvement is necessary in relation to the client's
difficulties. The wants and will of the client must be
taken into account during spiritual interventions.
STEPPING IN

Review of the Concept of Postpartum

A. Identify the Fetal Presentation

1. Postnatal, Puerperium

2. Newborn

3. Postpartum Hemorrhage

4. Peritonitis

5. Tenderness or Throbbing

6. Uterine Involution

7. Lactation

8. Rooming-in

B. Behavioral Adjustment: Phases of Puerperium

1. A

2. A

3. B

4. D

5. D
Review of Anatomy of Mammary Gland
Structure of Lactating Mammary Glands. Identify each part and write your answer on the
space provided.

a. Skin (cut)

b. Pectoralis major muscle

c. Connective suspensory ligament

d. Adipose tissue

e. Lobe

f. Areola

g. Nipple

h. Opening of the lactiferous duct

i. Lactiferous sinus

j. Lactiferous duct

k. Lobule containing alveoli

1. Lactation

2. Estrogen

3. Progesterone

4. Prolactin

5. Oxytocin

6. Colostrum

Trace It: Maternal breastfeeding reflexes (Milk production and Let Down Reflex)
1. How does breast milk produce?

➢ Stimulation of Tactile Receptors – Mammary gland secretion is triggered when

the infant sucks on the nipple.

➢ Neural Impulse Transmission – Impulses are propagated to the spinal cord and
then to the brain.

➢ Oxytocin Secretion – The stimulation of tactile receptors in the nipple leads to the
stimulation of secretory neurons in the paraventricular nucleus of the maternal
hypothalamus.

➢ Oxytocin Release – The hypothalamic neurons release oxytocin into the posterior
lobe of the pituitary gland. Oxytocin enters the bloodstream and is distributed
throughout the body.

➢ Milk Ejected – Circulating oxytocin reaches the mammary gland, causing the
contraction of myoepithelial cells in the walls of the lactiferous ducts and sinuses.
The result is milk ejection, or milk let-down.

2. Lactogenesis/ Let Down reflex

a. Estrogen, progesterone, prolactin, pituitary

b. Prolactin

c. Increased

d. Oxytocin

e. Alveolar Cells

f. Decreased

g. Oxytocin, mammary gland, oxytocin, milk

h. Prolactin and Oxytocin

1. CONCEPT MAP OF MOTHER DURING POSTPARTUM PERIOD

DESTINATION CHECK

A. Discharge Instruction. List the discharge instructions that should be

included

1. In addition, you will also give instructions on the following area: What are
you going to include on instructions on Work, Rest, Hygiene, Coitus, and
Contraception.

POSTPARTUM DISCHARGE INSTRUCTIONS

AREAS INSTRUCTIONS

MEDICATION • Inform the patient to continue taking prenatal vitamins until she
finishes her current prescription.
• Explain to the patient that if she is breastfeeding, continue to take
the prenatal vitamins until the patient stops breastfeeding.
• Explain to the patient that if she is breastfeeding; do not take any
other medications without contacting her pediatrician, the hospital
lactation nurse, or our office to ensure the medication is safe.
• Explain to the patient that she has home medications to take, she
needs to take sultamicillin, 750 mg twice a day for 2 days or more.
She also needs to take Mefenamic acid, 500 mg, every 6 hours, this
medication will only be taken as needed for pain, and lastly the
patient needs to take Ferrous Sulfate 300 mg, once daily for 1 month.

EXERCISE • Inform the patient that as soon as she feels ready and then gradually
resume her typical activities, starting with light activity such as
walking.
• Explain to the patient that she may begin walking within one to two
weeks after delivery. And should limit the number of stairs she climbs
to one flight/day.
• Explain to the patient that the more time she spends up and out of
bed, the quicker she will recuperate.
• Explain that the patient and her baby will benefit from the fresh air
and sunshine.
 • Instruct the patient to avoid heavy lifting, strenuous exercise and
excessive stair climbing and refer to doctor’s specific activity
restrictions given to her when she leaves the hospital.
• Encourage the patient to begin Kegel exercises as soon as possible
following birth. Stopping the flow of urine is analogous to this
movement. This will aid in the healing process as well as reduce
bladder leaks.
• She should continue with muscle-strengthening exercises, such as
abdominal crunches.

HYGIENE • Inform the patient that stitches will dissolve on its own and encourage
her to use a sitz bath one to three times a day to keep the area clean.
Keep the area dry to promote healing. In addition, inform the patient
that the area will be tender for several weeks.
• Encourage the patient to shower as much as she wants but wait until
her postpartum visit to have a tub bath or go swimming.
• Explain to the patient that there should be nothing placed in the
vagina such as tampons or douching until after her postpartum
checkup.
• Encourage the patient to change her sanitary napkin or pad
frequently to avoid infection.
• Encourage the patient to wear a well-fitting bra. Make sure that her
baby is latched properly to avoid sore or cracked nipples. Inform the
patient that she can express a small amount of breast milk on her
nipples after feeding and let it air dry.
• Encourage the patient to take a warm shower or apply a warm face
cloth to her breasts. The heat may help milk flow.

OUTPATIENT • Instruct the patient to come back after 1 week with CBC laboratory
(CHECK-UP)
results at OPD
• Instruct the patient not to forget to visit her health care provider for
postpartum check-up.
• Instruct the patient to call the clinic within one week to schedule her
6- week postpartum appointment.
 • Instruct the patient to call or visit her doctor if bleeding stays heavy
despite rest
• Instruct the patient to call or visit her doctor if social withdrawal or
persistent baby blues/depression occurs.
• Instruct the patient to call or visit her doctor if she developed breast
redness, significant breast tenderness, cracked or bleeding nipples,
or noticed a mass in the breast or under her arm.
• Instruct the patient to call or visit her doctor if she experiences a hot,
firm, and noticeable red area in the breast.

DIET • Explain to the patient that good nutrition and adequate fluids are
necessary for tissue repair, healing, breastfeeding, and general
health.
• Instruct the patient to refrain from any weight-reducing diets until
after your postpartum checkup.
• Explain to the patient that constipation is common because this is a
side effect of narcotics medication.
• Encourage the patient to eat a well-balanced diet that is high in
protein (meat, fish, legumes), fiber (fruits, vegetables, whole grains),
calcium (milk, yogurt, cheese, green leafy vegetables) and fluids.
• Explain to the patient that if she has a family history of food allergies
or are concerned about food allergies for your baby while
breastfeeding, consult your physician for guidance.

SPIRITUAL/ • Encourage the patient to read holy books when there is free time.
EMOTIONAL
• Encourage the patient to express their religious beliefs.
• Encourage the patients to establish a friendly relationship with
others.
• Explain to the patient that as a new mother you will feel joy, fear,
confusion, exhaustion and love. During the first few days after giving
birth, you may experience the "Baby Blues" which includes
impatience, irritability and crying.
 • Explain to the patient that her emotional and mental health is just as
important as her physical health, tell the patient to know that she is
not alone and seek help.

WORK • Inform the patient that she should avoid heavy work (lifting or
straining) for at least the first 3 weeks after birth. Women differ in
their concept of heavy work, so it is a good idea to explore what the
patient considers heavy work.
• It is usually advised that a woman not return to an outside job for at
least 3 weeks (or better, 6 weeks), not only for her own health but
also for enjoyment of the early weeks with her newborn.

REST • Encourage the patient to get as much rest, because she will be up
frequently during the night with the infant; schedule at least one nap
every day. Explain that sleep deprivation can influence her mood and
cause anxiety.
• Inform the patient that she should plan at least one rest period each
day while her baby sleeps and try to get a good night’s sleep.
• Advise her to explore the possibility of having a neighbor, another
family member, or a person from a community health agency relieve
her so she can rest.

COITUS • Inform her that coitus is safe as soon as her lochia has turned to
alba and, if present, an episiotomy is healed (usually the first week
after birth).
• Inform her that vaginal cells may not be as thick as formerly because
pre-pregnancy hormone balance has not yet completely returned to
supply lubrication.
• And remind her about safer sex precaution such as take it slowly,
use of lubricant or lubricating jelly that will aid comfort.

CONTRACEPTION • Inform her that if it is desired, the patient should begin a

contraception measure with the initiation of coitus.
• Inform her that if she wants an intrauterine device, this may be fitted
immediately after birth or at her first postpartum checkup.
 • Inform her that combination oral contraceptives are begun about 2–
3 weeks after birth due to clotting factor risks and interference with
milk production for women who are breastfeeding (progestin-only
oral contraceptives can be started earlier).
• Inform her that a diaphragm must be refitted at a 6-week checkup.
Until she returns for this checkup, an over-the counter spermicidal
jelly and condoms can provide protection.

FOLLOW-UP • Inform her that she should notify her primary care provider if she
notices an increase, not a decrease, in lochial discharge, or if lochia
serosa or lochia alba becomes lochia rubra; if lochia has a foul odor;
if she has a temperature greater than 101°F; or if symptoms of
sadness last longer than 2 weeks.
• Instruct her that she should schedule a 4- to 6-week checkup so she
can be assured involution is complete.
• Inform her about immunization if not previously immunized against
the virus associated with cervical cancer (human papillomavirus) can
be administered and so reproductive life planning (if desired) can be
discussed.

2. Nursing Care of a Postpartal woman and Family with unique needs

According to Jean Watson Caring is the essence of Nursing. What important Nursing
Care to the following postpartum woman and family with unique needs you will provide.

Situation A: A Woman who is discharged but whose child remains hospitalized

1. Patricia, an obese, multiparous woman at 40 weeks gestation has just given birth to a
male infant who weighed 2 kilograms at birth. His APGAR score is 5 and 7. Her baby
needs monitoring. After 3 days in the hospital, Patricia is ready for discharge. She was
informed that the baby is having difficulty breathing, RR is 70, there is nasal flaring,
expiratory grunting with his breathing. Presently her baby is being gavaged because he
is too lethargic to latch on and suck effectively. Her baby is also receiving oxygen. The
pediatrician decided to place the baby with respiratory distress in the neonatal intensive
care unit. Present nursing care that will help Patricia and her family overcome this
unexpected outcome of pregnancy.

- Some people also find it difficult to cope with the many lifestyle changes that are
expected of you. Encourage the family to keep communicating with each other.
This will serve the family, especially the mother as a support system and will allow
her to express her feelings and insecurities. Feelings are vital to
Patricia's recovery from postpartum depression. Patricia may experience extreme
loneliness that may cause depression if there is no one to talk to. Do not smoke or
allow anyone else to smoke in your house. Smoking increases the chance of
sudden infant death syndrome (SIDS), ear infections, asthma, colds, and
pneumonia. Watch closely for changes in your child's health and be sure to contact
your doctor or nurse for advice.

Situation B: A family who is adopting a child

2. Jia and Joe are married for 10 years. The couple is experiencing issues with infertility
and is childless. The couple consulted different fertility clinics. Jia even tried dancing in
the streets of Obando, Bulacan, dancing to the tune of “Sta. Clara, Pinong Pino”. This is
a fertility dance that serves as a form of prayer for couples who are hoping to conceive a
child or who had struggled for years to have children. The couple hopes for the same for
themselves. Jia wasn’t able to conceive despite their “panata”. Until lately, the couple
realized that it's not wrong to adopt a child. The couple went to DSWD for assessment,
counseling, and evaluation. Finally, the couple was qualified and granted a permit to
adopt. What nursing care applies to these adoptive parents?

- Setting unrealistically high standards for themselves as parents may put

additional strain on adoptive parents. Adoptive families may face challenges such
as ignorance of the child's medical history, difficulty integrating if the child is
adopted from another country, and difficulty selecting whether and how to notify
the child about being adopted. Aside from that, the bulk of challenges confronting
adoptive parents are comparable to those confronting biological parents. Every
parent wishes to be a good parent for their children. Both biological and adoptive
parents require information, support, and guidance in order to be prepared to raise
their child. All of the biological parents or parents' legal rights and obligations are
transferred to the person(s) who become the child's new parents through adoption
(s). Every parent wishes to be a good parent for their children. Both biological and
adoptive parents require information, support, and guidance in order to be
prepared to raise their child.
 Reflection

The postpartum phase is when a mother, her newborn, and her family go through
a crucial transitional period emotionally and physically. After the placenta has been
delivered, a period known as the "postpartum period," or "puerperium," begins and lasts
until all organ systems have fully recovered. The infant receives all of the immediate family
and friends of the mother's immediate attention after she has safely and successfully
coped with the discomfort of pregnancy and the three stages of labor, which are active
labor (stage 1), delivery of the baby (stage 2), and delivery of the placenta (stage 3).

One of our duties as aspiring nurses is to give each patient we need to care for the
appropriate medical attention. A patient's physical condition, mental health condition, and
emotional impairment may all be present. We will devotedly employ skills to recognize
and address postpartum crises for both the mother and her newborn. Support was crucial
as the mother was anxious, dealing with postpartum complications while also taking care
of her newborn while unsure of what to do when it comes to caring for her newborn, such
as breastfeeding, emotional bonding, changing clothes, and so forth. In order to monitor
the mother's postpartum hemorrhage, we will measure the amount of blood lost, check
her vital signs, and give her oxytocin to assist the uterus contract and stop excessive
postpartum bleeding. Since most maternal deaths happen during the first 24 hours
following delivery, oxytocin is administered to the mother as soon as the baby is delivered.

In Conclusion, the postpartum period is a demanding period characterized by

overwhelming changes. It requires significant personal and interpersonal adaptation,
especially in the case of primigravida. Pregnant women and other families have lots of
aspirations from the postpartum period which is colored by the joyful arrival of a new baby.
Perinatal mood and anxiety disorders can be considered major public health problems.
Undiagnosed and untreated disorders can plunge women into despair, rob them of the
joys of motherhood, and turn their pregnancies first month after birth into darkness.
 CASTRO, DIADULA, ESCOVILLA, GARRO
GENTAPA, GESTA, GALIGAO, GONZALES, GUINOCOR, JORGE, KANDA
BSN 2-12H GROUP #30

10/26/2022 DDC

Labor and delivery 29 F N/A

N/A
N/A Avoid heavy act., rest as much as possible

Painful contractions High fiber diet, increase fluid intake

No known allergies. Patient was hospitalized/surgery on 2021 (Gallbladder removed due to

gallstones).

(+) diabetes mellitus on paternal side & (+) heart disease on maternal side.

Poor prenatal check-up & compliance with prescribed medicines such as ferrous sulfate.

Patient is 29-year-old, married, primigravid, 39 weeks AOG. A middle-class family living in a

single unit house in a relocation area. Patient is a factory worker and a high-school graduate.
Reports pregnancy is unplanned, No history of drug use, alcohol, cigarette smoking.

Not indicated
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