DISCHARGE PLAN M-EDICATIONS Continue taking maintenance medications w/c includes the ff: Cephalexin 500mg/TID/Per Orem Ferrous

Sulfate 1Cap OD/Per Orem Mefenamic Acid 500mg/PRN for pain/Per Orem E-XERCISE Performs Activities of daily living (ADLs) as tolerated T-REATMENT The patient has no further prescribed treatments H-EALTH TEACHINGS The client must be instructed to eat well-balanced diet, drink six to eight glasses of water daily and get plenty of rest. To reduce stress on her pelvic muscles and suture sites, heavily lifting should be avoided or 6 weeks until the wound is healed Proper perineal care is also necessary to prevent infection It is recommended that breast feeding is best for nursing the baby for at least 6 months Instruct the client on proper cord dressing to her baby Advise the client to go on follow-up check-up after two weeks O-PD FOLLOW-UP Instructed the client to go on follow-up check-ups D-IET Diet as Tolerated (DAT) Foods rich in protein LABORATORY RESULT

A. BACKGROUND OF THE STUDY Spontaneous vaginal delivery implies that the birth occurred without the need for forceps, vacuum, or any other instrumentation. This term does not imply that every part of the birth was without medical care or intervention. Lacerations (tearing of the tissues) can occur during spontaneous vaginal delivery and may require repair. A mother may choose different levels of pain relief and still experience a spontaneous vaginal delivery. This is still the most common type of delivery and that to which all other modes of delivery are compared. Premature rupture of membranes (PROM) is an event that occurs during pregnancy when the sacs containing the developing baby (fetus) and the amniotic fluid bursts or develops a hole prior to the start of labor. During pregnancy, the unborn baby (fetus) is surrounded and cushioned by a liquid called amniotic fluid. This fluid, along with the fetus and the placenta, is enclosed within a sac called the amniotic membrane. The amniotic fluid is important for several reasons. It cushions and protects the fetus, allowing the fetus to move freely. The amniotic fluid also allows the umbilical cord to float, preventing it from being compressed and cutting off the fetuss supply of oxygen and nutrients. The amniotic membrane contains the amniotic fluid and protects the fetal environment from the outside world. This barrier protects the fetus from organisms (like bacteria or viruses) that could travel up the vagina and potentially cause infection. Although the fetus is almost always mature at between 3640 weeks and can be born without complication, a normal pregnancy lasts an average of 40 weeks. At the end of 40 weeks, the pregnancy is referred to as being term. At term, labor usually begins. During labor, the muscles of the uterus contract repeatedly. This allows the cervix to begin to grow thinner (called effacement) and more open (dilatation). Eventually, the cervix will become completely effaced and dilated. In the most common sequence of events (about 90% of all deliveries), the amniotic membrane breaks (ruptures) around this time. The baby then leaves the uterus and enters the birth canal. Ultimately, the baby will be delivered out of the mothers vagina. In the 30 minutes after the birth of the baby, the placenta should separate from the wall of the uterus and be delivered out of the vagina. Sometimes the membranes burst before the start of labor, and this is called premature rupture of membranes (PROM). There

are two types of PROM. One occurs at a point in pregnancy before normal labor and delivery should take place. This is called preterm PROM. The other type of PROM occurs at 36-40 weeks of pregnancy. PROM occurs in about 10% of all pregnancies. Only about 20% of these cases are preterm PROM. Preterm PROM is responsible for about 34% of all premature births.

B. RATIONALE OF THE STUDY GENERAL OBJECTIVE This study aims to broaden the knowledge of the researchers and readers and also to come up with a detailed study about normal spontaneous delivery and to identify and as well as to provide an appropriate, accurate and effective nursing measures and intervention and responsibilities to consider while taking care of the patient.

SPECIFIC OBJECTIVE This study aims to: 1.Assess properly to determine the contributing factors regarding to the clients condition and identify any present abnormalities if theres any. 2.Develop an individualized plan considering client characteristics or the situation and setting a specific, measurable, attainable, realistic and time bounded plan that reflect the onset, date of problem identified a.Planning (nursing care plan 3. Provide appropriate interventions for every problem encountered

and monitor the client's response to treatment and therapies through means of physical assessment and communication with the client. 4.Broaden the knowledge of each member through further research about the latest news articles and journals regarding to the client disease.

C. SIGNIFICANCE OF THE STUDY *To have an understanding about the condition and to have a positive outlook towards the ongoing curative phase. *To gain knowledge from the experience and apply. *To be able to interact with the patient and and patient to express feelings about the condition to the nurse and participate appropriately *To upgrade the total well being and to alleviate the discomforts of the patient

D. SCOPE AND LIMITATION Related learning experience on OB ward duty dates were July 14, 15, 16, 21, 22 and 23, 2011 and July 14 was the day I was assigned to bed #4a. I introduced myself and was able to establish good rapport with her. Was fortunate to be able to do my interview in no time because Ms. D was accommodative and she responds well to all my queries despite pain and exhaustion from her normal delivery 12 hours ago.

E. THEORETICAL FRAMEWORK

Rubins Theory of Maternal Role Attainment From onset to its destination, childbearing requires an exchange of a known self in a known world for an unknown self in an unknown world. - Reva Rubin Development of Maternal Identity -The achievement of a firm concept or identity of oneself as a mother, in the sense that she is comfortable in the role, occurs considerably later than the birth of the child -Maternal identity development is the womans efforts aimed at becoming a mother The Process of Maternal Role Taking 1. Mimicry - an active operation in which the woman searches the environment and her memory for other people who are or have been in the role she is working to attain, and then examines their behavior and imitates them 2. Role play - acting out what a person in the sought role actually does in particular situations. - the earliest form of role behavior 3. Fantasy - involves cognitively trying varieties of possible role situations - occurs by way of fears, dreams, and daydreams 4. Introjection-projection-rejection/acceptance (IPR/A) - the mother takes in the behavior of others (introjection), and examines if it fits her own role expectations. Then she imagines herself performing in that way (projection) and makes a judgment about the behavior. If the fit is good, the behavior is accepted. 5. Grief work

- an operation that has to do with giving up elements of the former self which would be in conflict with the new role Maternal Tasks -The totality of a womans psychologic work of pregnancy -Has been grouped into four seeking safe passage for self and baby securing acceptance learning to give of self binding-in to the unknown baby 1. Seeking safe passage for self and baby - seeking safe passage in the first trimester is for pregnancy care, in the second trimester it is for baby care, and in the third it is for delivery care. 2. Securing acceptance - securing acceptance is a condition necessary to produce and sustain the energy for all the other tasks - involves a reworking of psychologic, social and physical space within the family to make a place for the coming child 3. Learning to give of self - giving is an inherent and pervasive part of being a mother, during both childbearing or childrearing - the woman has to learn to give to the child voluntarily on a day-to-day basis in order for the child to survive 4. Binding-in to the unknown baby - maternal binding-in is the dynamic process of attachment and interconnection with the infant that begins in the prenatal period. - has two halves: binding-in to the infant and binding-in to self as mother of the infant

Maternal Tasks During Pregnancy by Psychologic Trimesters Trimester Task Safe passage First Concern about self. Am I sick or am I pregnant? Second Concern about baby. Care of and for baby. Is my baby all right? Third Concern about self and baby. Seeking delivery care. Will my baby and I safely go through labor and delivery?

Securing acceptance Giving

Works on acceptance of Works herself as acceptance pregnant her baby Cost-analysis: What do I have to give up? Can I give up all that I have to? Binds in to the idea of self as pregnant. Baby is not real

on of Works on acceptance of this baby, as it is. Feels given out. Feels she cannot give anymore. Extracts gifts from others. Carries a valuable treasure. Becomes fearful- what one possesses/ treasures can be taken away. Hates being pregnant but wants her baby.

Binding-in

Works on meaning of giving. Learns to give by being given to. Attachment to baby. Secret romantic love between self and baby. Feels good- attributes it to baby. Seeks messages from baby.

Sources: Auvenshine, M. (1990). Comprehensive maternity nursing (pp. 227- 233). Boston: Jones and Bartlett, etc.

SIENA COLLEGE TAYTAY, RIZAL NURSING DEPARTMENT

NSD
(Normal Spontaneous Delivery)

A case study in partial fulfillment Of the requirements for RLE In Rizal Provincial Hospital

Submitted by: Lea M. Cocoba

Submitted to: Ms. Jesmar Espiritu

The New Midwifery: Science and Sensitivity in Practice

A. PATIENTS DEMOGRAPHICAL PROFILE Name: Ms. D Age: 30 years old Gender: Female Residence: San Isidro Antipolo, Rizal Date of Birth: July 4, 1981 Place of Birth: Naboa, Camarines Sur Nationality: Filipino Religion: Roman Catholic Civil Status: Single (but living in with Father of her child) Date of Admission: July 13, 2011 Time of admission: 6:00 pm Physician: Dra. Lat Place of Admission: Rizal Provincial Hospital Ward: OB Ward Bed# 4a

B. HISTORY OF PAST ILLNESS Ms. D has no history of illness and never been hospitalized because of illness except for her 1 st birth delivery on her 1 st born child. Her prenatal check ups has no noted abnormalities or problem.

C.HISTORY OF PRESENT ILLNESS Experiencing pain because of episiotomy wound, fatigue and sleepless due to lack of sleep taking good care of her newborn. No noted illness as Ms. D recalls.

D. FAMILY HEALTH HISTORY

According to Ms. D no history of hypertension, Diabetis, Cancer in their family or any illness she can recall. Anatomy and Physiology

EXTERNAL GENITALIA The Labia Majora The labia (L. large lips) are two symmetrical folds of skin, which provide protection for theurethralandvaginal orifices These open into thevestibule of the vagina. Each labium majus, largely filled with subcutaneous fat, passes posteriorly from the mons pubis to about 2.5 cm from the anus. They are situated on each side of the pudendal cleft, which is the slit between the labiamajora into which the vestibule of the vagina opens.

The labia majora meet anteriorly at the anterior labial commissure. They do not join posteriorly but a transverse bridge of skin called the posterior labial commissure passes between them. The Labia Minora The labia minora (L. small lips) are thin, delicate folds of fat-free hairless skin. They are located between the labia majora. The labia minora contain a core of spongy tissue with many small blood vessels but no fat. The internal surface of each labium minus consists of thin skin and has the typical pink colour of a mucous membrane. It contains many sensory nerve endings. Sebaceous and sweat glands open on both of their surfaces. The labia minora enclose the vestibule of the vagina and lie on each side of the orifices of the urethra and vagina They meet just superior to the clitoris to form a fold of skin called the prepuce (clitoralhood). In young females the labia minora are usually united posteriorly by a small fold of the skin, the frenulum of the labia minora. The Clitoris The clitoris is 2 to 3 cm in length. It is homologous with the penis and is an erectile organ.

Unlike the penis, the clitoris is not traversed by the urethra; therefore it has no corpusspongiosum. The clitoris is located posterior to the anterior labial commissure, where the labia majora meet. It usually hidden by the labia when it is flaccid. The clitoris consists of a root and a body that are composed of two crura, two corpora cavernosa, and a glans. It is suspended by a suspensory ligament. The parts of the labia minora passing anterior to the clitoris form the prepuce of the clitoris (homologous with the male prepuce). The parts of the labia passing posterior to the clitoris form the frenulum of the clitoris,which is homologous with the frenulum of the penile prepuce. It is highly sensitive and very important in the sexual arousal of a female. The Vaginal Orifice This large opening is located inferior and posterior to the much smaller external urethral orifice. The size and appearance of the vaginal orifice varies with the condition of thehymen (G.membrane), a thin fold of mucous membrane that surrounds the vaginal orifice. The External Urethral Orifice This median aperture is located 2 to 3 cm posterior to the clitoris and immediately anterior to the vaginal orifice On each side of this orifice are the openings of the ducts of the paraurethral glands (Skene's glands).

These glands are homologous to the prostate in the male. INTERNAL GENITALIA Vagina The vagina extends from the vaginal opening to the cervix, the opening to the uterus. The vagina serves as the receptacle for the penis during sexual intercourse, and as the birth canal through which the baby passes during labor. The average vaginal canal is three inches long,possibly four in women who have given birth. This may seem short in relation to the penis, but during sexual arousal the cervix will lift upwards and the fornix (see illustration) may extend upwards into the body as long as necessary to receive the penis. After intercourse, the contraction of the vagina will allow the cervix to rest inside the fornix, which in its relaxed state is a bowl-shaped fitting perfect for the pooling of semen. At either side of the vaginal opening are the Bartholin's glands, which produce small amounts of lubricating fluid, apparently to keep the inner labia moist during periods of sexual