INTRODUCTION

Definition of condition
Pregnancy, also known as gravidity or gestation, is the time during which one or
more offspring develops inside a woman. Pregnancy can occur by sexual intercourse or assisted
reproductive technology. It usually lasts around 40 weeks from the last menstrual period (LMP)
and ends in childbirth. This is just over nine lunar months, where each month is about 29
days. When measured from conception it is about 38 weeks. An embryo is the developing
offspring during the first eight weeks following conception, after which, the term fetus is used
until birth. Symptoms of early pregnancy may include missed periods, tender breasts, nausea and
vomiting, hunger, and frequent urination. Pregnancy may be confirmed with a pregnancy test.
Pregnancy is typically divided into three trimesters. The first trimester is from week one
through 12 and includes conception. Conception is when the sperm fertilizes the egg.
The fertilized egg then travels down the fallopian tube and attaches to the inside of the uterus,
where it begins to form the fetus and placenta. The first trimester carries the highest risk
of miscarriage (natural death of embryo or fetus). The second trimester is from week 13 through
28. Around the middle of the second trimester, movement of the fetus may be felt. At 28 weeks,
more than 90% of babies can survive outside of the uterus if provided high-quality medical care.
The third trimester is from 29 weeks through 40 weeks.
Spontaneous Vaginal Delivery- It involves the birth of a baby and delivery of the placenta
from the uterus and through the cervix and the birth canal (vagina). This process results from
contractions of the uterus during labor. Most women deliver 38 to 40 weeks after becoming
pregnant (conception). In some vaginal deliveries, additional assistance is used to assist vaginal
delivery by using forceps or vacuum extraction applied to the baby's head.
In combination with hormonal changes, the regular muscular contractions of the uterus in
labor cause the cervix to soften, thin out, and open (dilate) so that the baby may travel from the
uterus through the bony pelvis to the vaginal opening. The average labor lasts 12 to 14 hours for
a woman having her first baby (nulliparous) and about 6 to 8 hours for subsequent babies
(Beers).

Diagnostic or Laboratory Procedure

The beginning of pregnancy may be detected either based on symptoms by the pregnant
woman herself, or by using a medical test(s). 1/475 women at 20 weeks and 1/2500 women at
delivery, refuse to acknowledge that they are pregnant (denial of pregnancy). Some non-pregnant
women have a very strong belief that they are pregnant along with some of the physical changes.
This condition is known as pseudocyesis or false pregnancy.
Physical signs
Linea nigra in a woman at 22 weeks pregnant
Most pregnant women experience a number of symptoms, which can signify pregnancy. A
number of early medical signs are associated with pregnancy. These signs include:

the presence of human chorionic gonadotropin (hCG) in the blood and urine

missed menstrual period

implantation bleeding that occurs at implantation of the embryo in the uterus during the
third or fourth week after last menstrual period

increased basal body temperature sustained for over 2 weeks after ovulation

Chadwick's sign (darkening of the cervix, vagina, and vulva)

Goodell's sign (softening of the vaginal portion of the cervix)

Hegar's sign (softening of the uterus isthmus)

Pigmentation of linea alba Linea nigra, (darkening of the skin in a midline of

the abdomen, caused by hyperpigmentation resulting from hormonal changes, usually
appearing around the middle of pregnancy).
Darkening of the nipples and areolas due to an increase in hormones.
Biomarkers

Pregnancy detection can be accomplished using one or more various pregnancy

tests, which detect hormones generated by the newly formed placenta, serving as biomarkersof
pregnancy. Blood and urine tests can detect pregnancy 12 days after implantation. Blood
pregnancy tests are more sensitive than urine tests (giving fewer false
negatives). Home pregnancy tests are urine tests, and normally detect a pregnancy 12 to 15 days
after fertilization. A quantitative blood test can determine approximately the date the embryo was
conceived because HCG doubles every 36 to 48 hours. A single test of progesterone levels can
also help determine how likely a fetus will survive in those with a threatened
miscarriage (bleeding in early pregnancy).
Ultrasound
Obstetric ultrasonography can detect some congenital diseases at an early stage, estimate
the due date, and detect multiple pregnancies. The resultant estimated gestational age and due
date of the fetus are slightly more accurate than methods based on last menstrual period.
Ultrasound is used to measure the nuchal fold in order to screen for Downs syndrome.

Drugs

Drugs given to mother:

Oxytocin

Therapeutic Action:
Oxytocin is a hormone that helps relax and reduce blood pressure and
cortisol levels. Oxytocin increases pain thresholds, has anti-anxiety effects,
and stimulates various types of positive social interaction. In addition,
oxytocin promotes growth and healing.

Methergine

is used to treat bleeding during and after delivery of a baby. It may also be
used for other conditions as determined by your doctor. Methergine is an
ergot alkaloid uterine stimulant. It works by increasing uterine contractions,
which helps reduce blood loss after the baby is delivered.
Lidocaine hydrochloride
injection is a local anesthetic (numbing medication). It works by blocking
nerve signals in your body. It is used to numb an area of your body to help
reduce pain or discomfort caused by invasive medical procedures such as
surgery, needle punctures, or insertion of a catheter or breathing tube. Also,
this injection is sometimes used to treat irregular heart rhythms that may
signal a possible heart attack. Lidocaine injection is also given in an epidural
(spinal block) to reduce the discomfort of contractions during labor.
Drugs given to the Neonate:
Therapeutic Action:
Phytomenadione
(Vitamin K)

Phytomenadione (Vitamin K) is used to treat bleeding problems caused by

low vitamin K blood levels or decreased vitamin K activity (eg, caused by
certain anticoagulants, antibiotics, salicylates, other medicines, certain
diseases that decrease absorption or production of vitamin K). It may also be
used to treat or prevent certain bleeding problems (hemorrhagic disease) in
newborns. Phytonadione is a vitamin K. It works by helping the liver to
produce blood clotting factors. Vitamin K is given to neonate.

CIPROFLOXACIN

An antibiotic ciprofloxacin (for the eyes) is used to treat bacterial infections

of the eyes. It may also be used for purposes other than those listed in this
medication guide.

The hepatitis B vaccine

The hepatitis B vaccine is used to help prevent this disease in children and
teenagers. This vaccine works by exposing your child to a small amount of
the virus, which causes the body to develop immunity to the disease. This
vaccine will not treat an active infection that has already developed in the
body. Vaccination with hepatitis B pediatric vaccine is recommended for all
children beginning at birth, especially children and adolescents who are at
risk of getting hepatitis B. Like any vaccine, the hepatitis B vaccine may not
provide protection from disease in every person.

Reasons for choosing the case

On January 25, 2016, I received Patient G at 8:28 for Caesarean Section. I was the cord
care for her baby when I decided to choose the client for my individual case study. She was my
first patient at that day. This is her second baby which gave me an initiative that she needs our
help thats why I chose her. This event is her second time and as a Student Nurse who has an
overview and knowledge about this; its my obligation to help my patient get through this. By
giving her health teachings, what are the procedures to be done together with monitoring her and
her babys conditioned. I also wanted to check her during the postpartum. To examine and
evaluate her after the operation and how she feels physically and emotionally after giving birth.
OBSTETRIC HISTORY AND ASSESSMENT

Last January 25, 2016, I were able to handle patient. I have chosen a patient, interview
was conducted after the delivery and assessments were followed. In accordance with the
principle of confidentiality and maintain patients dignity, I therefore to withhold the real name
of my patient and address her as Patient G.

Case number 23-72-48, Patient G. A 29 years old female stands 5 feet and 3 inches and
weighs 50 kg. Lives with her family at P-2 San Agustin Carmen, ADN. Roman Catholic by faith
and Filipino by blood. She graduated college. Shes living with her 31 years old partner. Her
husband is a konsehal with 5-8 thousand pesos income per month. They are both happy and feel
blessed about the outcome of pregnancy.

Patient G was admitted at Agusan del Norte Provincial Hospital at the OB Ward on
January 24, 2016 at around 10 pm due to labor pain. She is gravida 2and para 2. Her last
menstrual period was on April 18, 2015 and she was expected to give birth on January 24, 2016.
She and her husband used natural method of family planning and wasnt able to use any
contraceptives or condoms. She has visited the clinic for prenatal check-up 5 times throughout
her pregnancy. She was given 1 dose of Tetanus Toxoid and was taking Ferous Sulfate. She
gained a total weight of 12 kilograms during her pregnancy. Her risk status is low and hasnt
experienced antenatal problems.

Her first menstruation was when shes 12 years old. She menstruates regularly every
month and has an interval of within 28-30 days. Her menstruation last for 3 days and utilizes 6
perinal pads every day. She doesnt feel any pain during menses. Patient G doesnt have any
breast disorders, lumps or discharges and hasnt undergone operations or breast surgery before.

On January 25, 2016, I received Patient G at 8:28 am. At 09:15 am she gave birth to a
Baby Boy thu Caesarean Section. During the interview and assessment, shes now 4 hours
postpartum with breast positive for milk production, nipples are round and are able to be sucked
by the baby, fundus at the level of umbilicus, moderate rubra lochia discharges and incision site
are intact without swelling or signs of infection.

ANATOMY AND PHYSIOLOGY OF THE 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 or oocytes. 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.

1. Internal Organs
a) Uterus
The uterus is a hollow organ about the size and shape of a pear. It serves two important
functions: it is the organ of menstruation and during pregnancy it receives the fertilized ovum,
retains and nourishes it until it expels the fetus during labor. The uterus is located between the
urinary bladder and the rectum. It is suspended in the pelvis by broad ligaments.
Divisions of the uterus. The uterus consists of the body or corpus, fundus, cervix, and the
isthmus. The major portion of the uterus is called the body or corpus. The fundus is the superior,
rounded region above the entrance of the fallopian tubes. The cervix is the narrow, inferior outlet
that protrudes into the vagina. The isthmus is the slightly constricted portion that joins the corpus
to the cervix.

Walls of the uterus. The walls are thick and are composed of three layers: the endometrium, the
myometrium, and the perimetrium. The endometrium is the inner layer or mucosa. A fertilized
egg burrows into the endometrium (implantation) and resides there for the rest of its
development. When the female is not pregnant, the endometrial lining sloughs off about every 28
days in response to changes in levels of hormones in the blood. This process is called menses.
The myometrium is the smooth muscle component of the wall. These smooth muscle fibers are
arranged. In longitudinal, circular, and spiral patterns, and are interlaced with connective tissues.
During the monthly female cycles and during pregnancy, these layers undergo extensive changes.
The perimetrium is a strong, serous membrane that coats the entire uterine corpus except the
lower one fourth and anterior surface where the bladder is attached.
b) Vagina
The vagina is the thin in walled muscular tube about 6 inches long leading from the uterus to the
external genitalia. It is located between the bladder and the rectum. The vagina provides the
passageway for childbirth and menstrual flow; it receives the penis and semen during sexual
intercourse.
c) Fallopian Tubes (Two)
Each tube is about 4 inches long and extends medially from each ovary to empty into the
superior region of the uterus. The fallopian tubes transport ovum from the ovaries to the uterus.
There is no contact of fallopian tubes with the ovaries.
The distal end of each fallopian tube is expanded and has finger-like projections called fimbriae,
which partially surround each ovary. When an oocyte is expelled from the ovary, fimbriae create
fluid currents that act to carry the oocyte into the fallopian tube. Oocyte is carried toward the
uterus by combination of tube peristalsis and cilia, which propel the oocyte forward. The most
desirable place for fertilization is the fallopian tube.
d.) Ovaries
The ovaries are for oogenesis-the production of eggs (female sex cells) and for hormone
production (estrogen and progesterone). The ovaries are about the size and shape of almonds.
They lie against the lateral walls of the pelvis, one on each side. They are enclosed and held in
place by the broad ligament. There are compact like tissues on the ovaries, which are called
ovarian follicles. The follicles are tiny sac-like structures that consist of an immature egg
surrounded by one or more layers of follicle cells. As the developing egg begins to ripen or
mature, follicle enlarges and develops a fluid filled central region. When the egg is matured, it is
called a graafian follicle, and is ready to be ejected from the ovary.
2. External Female Organs
The external organs of the female reproductive system include the mons pubis, labia majora,
labia minora, vestibule, perineum, and the Bartholins glands. As a group, these structures that
surround the openings of the urethra and vagina compose the vulva, from the Latin word
meaning covering.
a) Mons Pubis -This is the fatty rounded area overlying the symphysis pubis and covered with
thick coarse hair.
b) Labia Majora -The labia majora run posteriorly from the mons pubis. They are the 2
elongated hair covered skin folds. They enclose and protect other external reproductive organs.
c) Labia Minora -The labia minora are 2 smaller folds enclosed by the labia majora. They
protect the opening of the vagina and urethra.
d) Vestibule -The vestibule consists of the clitoris, urethral meatus, and the vaginal introitus.
The clitoris is a short erectile organ at the top of the vaginal vestibule whose function is sexual
excitation.
The urethral meatus is the mouth or opening of the urethra. The urethra is a small tubular
structure that drains urine from the bladder.

The vaginal introitus is the vaginal entrance.

e) Perineum -This is the skin covered muscular area between the vaginal opening (introitus) and
the anus. It aids in constricting the urinary, vaginal, and anal opening. It also helps support the
pelvic contents.
f) Bartholins Glands (Vulvovaginal or Vestibular Glands) -The Bartholins glands lie on
either side of the vaginal opening. They produce a mucoid substance, which provides
lubrication for intercourse.
Labor and Birth Process

Signs of Labor

A common concern of women as they near the end of pregnancy and how they will know
if they are beginning a labor
Premonitory Signs of Labor
a) Cervical Changes
b) Softening and dilation with descent of the presenting part into the pelvic
c) Cervix becomes shortened and thinned sequent
d) Ripening of Cervix -is an internal sign seen only on pelvic examination. Throughout
pregnancy, the cervix feels softer than normal palpation, similar to the consistency of an
earlobe (Goodells sign). At term, the cervix becomes still softer (described as Buttersoft), and it tips forward. Cervical ripening this way is an internal announcement that

labor is very close at hand.

Preliminary Signs of Labor

Before labor, a woman often experiences subtle signs that signal labor is imminent. It is
important to review these with women during the last trimester of pregnancy so they can more
easily recognize beginning signs.
a) Lightening -lightening or descent of the fetal presenting part into the pelvis, occurs
approximately 10 to 14 days before labor begins. This fetal descent changes a womans
abdominal contour, because it positions the uterus lower and more anterior in the abdomen.
Lightening gives a woman relief from the diaphragmatic pressure and shortness of breaths
that she has been experiencing and in this way lightens her load.
b) Increase in Level of Activity -a woman may awaken on the morning of labor full of energy,
in contrast to the feeling of chronic fatigue she felt during the previous month. The increase
in activity is related to an increase in epinephrine release initiated by a decrease in
progesterone produced by the placenta.
c) Slight loss of weight -as progesterone level falls, body fluid is more easily excreted from the
body. This increase in urine production can lead to a weight loss between 1 and 3 pounds.
d) Braxton Hicks Contractions -in the last week or days before labor begins, a woman usually
notices extremely strong Braxton Hicks contractions. Women having their first child may
great difficulty distinguishing between these and true contractions.
Signs of True Labor
a) Spontaneous Rupture of Membrane - this reduces the capacity of the uterus, thickens the
uterine wall, and increases uterine irritability, labor usually follows.

b) Bloody show - the mucus plug of the cervical softening and increased pressure of the
presenting part. The exposed cervical capillaries release a small amount of blood that mix
with the mucus, resulting in bloody show.
c) Uterine Contraction - surest sign that labor has began. Contractions are involuntary and come
without warning.
d) Difference between True and False Labor

Factors
Contraction timing

Contraction strength

Contraction discomfort

Position Changes

Effect of analgesia

Cervical change

True Labor
Regular intervals, becoming
close together usually 4-6
mins. apart, lasting 30-60
secs.
Becomes stronger with time,
vaginal pressure is usually
felt.
Start in the back and radiates
around toward the front of the
abdomen.
Contractions continue no
matter what position changes
is made.
Not terminated by sedation
Progressive effacement and
dilation

False Labor
Irregular intervals, not
occurring close together.

Frequently weak, not getting

strong with time.
Usually felt in the front of the
abdomen.
Contractions may stop or slow
down with walking or
changing position.
Frequently abolished by
sedation.
No changes

Stages of Labor

Labor is traditionally divided into three stages: a first stage of dilatation, which begins
with the initiation of true labor contraction and ends when the cervix is fully dilated; a second
stage, extending from the time of full dilation until the infant is born; and a third or placental
stage, lasting from the time the infant is born until after the delivery of the placenta.
First Stage
The process of reaching full cervical dilation. This begins with the onset of uterine labor
contractions, and it is the longest phase of labor. The first stage of labor is divided into three
phases:

Latent Phase -the contractions become more frequent, stranger, and gain regularity and
most of the change of the cervix involves thinning, or effacement. The latent phase is the

most variable from woman to woman, and labor to labor

Active Phase -which is the rapid phase of cervical dilation increasing 4 to 7 cm.
contractions grow stronger, lasting 40 to 60 seconds and occur approximately 3 to 5
minutes.

Transition Phase -contractions reach their peak of intensity, occurring every 2 to 3

minutes with duration of 60 to 90 seconds and causing maximum cervical dilation of 8 to
10 cm.

Second Stage
The second stage is the delivery of the infant. It is the period from full dilation and
cerviacal effacement to the birth of the infant. During the second stage, mother actively pushes
out the baby.
As the fetal head touches the internal side of the perineum, the perineum begins to bulge
and appears tense. The anus may become everted , and stool may be expelled.
As the fetal head pushes against the perineum, the vaginal introitus opens and the fetal
scalp appears the opening to the vagina. At first, the opening is slitlike, then becomes oval, and
then circular. The circle enlarges from size of a dime, than a quarter, then a half-dollar. This is
called crowning.
Third Satage of Labor
The third stage of labor, the placental stage, begins with the birth of an infant and ends
with the delivery of the placenta. Two separate phases are involved: Placental Separation and
Placental Expulsion.
After the birth of an infant, a uterus can be palpated as a firm, round mass just inferior to the
level of umbilicus. After a few minutes of rest, uterine contractions begin again, and the organ
assumes discoid shape. It retains this new shape until the placenta has separated, approximately 5
minutes after the birth of the infant.

Placental Separation

As the uterus contracts down on an almost empty interior, there is such a disproportion
between the placenta and the contracting wall of the uterus that folding and separation of the
placenta occur. Active bleeding on the maternal surface of the placenta begins with separation;
this bleeding helps to attach site. As separation is completed, the placenta sinks to the lower
uterus segment or the upper vagina.
The following sign indicates that the placenta has loosened and is ready to deliver:
a)
b)
c)
d)
e)

Lengthening of the umbilical cord

Sudden gush of vaginal blood
Change in the shape of the uterus
Firm contraction of the uterus
Appearance of the placenta at the vaginal opening

Placental Expulsion

After separation, the placenta is delivered either by the natural bearing-down effort of the
mother or by genetic pressure on the contracted uterine fundus by a physician or nurse-midwife
(Credes Maneuver).

ASSESSMENT FOR NEWBORNS

Assessments for Newborn Babies

Each new-born baby is carefully checked at birth for signs of problems or complications.
A complete physical assessment will be done that includes every body system. Throughout the
hospital stay, doctors, nurses, and other health care providers continually assess the health of the
baby, observing for signs of problems or illness. Assessment may include:

Apgar scoring

The Apgar score is one of the first checks of your new baby's health. The Apgar score is
assigned in the first few minutes after birth to help identify babies that have difficulty breathing
or have a problem that needs further care. The baby is checked at 1 minute and 5 minutes after
birth for heart and respiratory rates, muscle tone, reflexes, and colour. Each area can have a score
of 0, 1, or 2, with 10 points as the maximum. A total score of 10 means a baby is in the best
possible condition.
Sign
Heart rate

Score= 0
Absent

Score= 1
Below 100 per minute

Respiratory rate
Muscle tone

Absent
Flaccid

Weak, irregular, or gasping

Some flexion of arms and
legs

Reflex or
irritability
Color

No response

Grimace or weak cry

Blue all over, or

pale

Body pink, hands and feet

blue

Score= 2
Above 100 per
minute
Good crying
Well-flexed, or active
movements of
extremities
Good cry
Pink all over

When Baby Boy R was born her first Apgar score taken within the 1st minute she was
born was 8 and after 5 minutes, Apgar score was rechecked with the score of 9.

Birth weight

A baby's birth weight is an important indicator of health. The average weight for term
babies (born between 37 and 41 weeks gestation) is about 7 lbs. (3.2 kg). In general, small babies
and very large babies are at greater risk for problems. Babies are weighed daily in the nursery to
assess growth, fluid, and nutrition needs.
Baby Boy Rs birth weight is 3.3 kg. Base on the statement above, Baby Girl R is within
40 weeks and is 3.3 kg, this means that she is in an average weight.

Measurements
Other measurements are also taken of each baby. These include the following:
Head circumference. The distance around the baby's head. (32-37 cm)
Chest Circumference. The distance around the chest. (30-35 cm)
Abdominal circumference. The distance around the abdomen.
Length. The measurement from crown of head to the heel. (46-56 cm)
The vital statistics of the baby indicates normal measurements.
HC: 36 cm

AC: 33 cm

CC: 35 cm

L: 55 cm

Vital signs:
Temperature (able to maintain stable body temperature in normal room environment)
(36.5-37.5C)
Pulse (normally 120 to 160 beats per minute in the newborn period)
Breathing rate (normally 40 to 60 breaths per minute in the newborn period
The vital signs of the baby indicate normal findings.
T: 36.7C

P: 122 bpm

R: 55cpm

Physical exam
A complete physical exam is an important part of newborn care. Each body system is

carefully examined for signs of health and normal function. The doctor also looks for any signs
of illness or birth defects. The physical exam was done last January 6, 2016 at 3:30 pm.
Body Parts
1. General appearance (maturity, activity,
tone, cry, color, nutrition, edema)

2. Skin (icterus, rashes, hematoma,

desquamation and wrinkles)

3. Head/.Neck (Caput, molding,

cepahlohematoma)

4. Ears, nose, mouth and throat

5. Eyes (reflex)

6. Thorax (breast hypertrophy)

7. Lungs (air entry, rales and symmetry)

Description
Face is normally proportionate and
symmetric. Pinkish in color. Body
weight appropriate to age of gestation.
Without edema. Has a good and loud
cry. Able to move body, extremities and
head.
Skin in pinkish. Slight Vernix caseosa
present. Without rashes, hematoma,
wrinkles and lesions. Slightly moist
with good turgor. With lanugo in the
extremities.
Caput Succedaneum is present. With
presence of hair in the head. Both neck
and head without cuts, lesions and
bruises. Neck at the midline between
head and chest.
Tip of the pinna is aligned with the
outer canthus of the eyes. Recoils
immediately. No unusual structure or
markings present. With presence of
Epsteins Pearls. Gums are pink and
moist. Nose is midline in face, septum
is straight and nares are patent.
Outer canthus of the eyes aligns with
the tip of the pinna. Sclera and
conjunctiva are clear and free of
discharges, lesions. Redness or
lacerations. The iris is black. Eyelashes
evenly distributed and curled outward.
Chest is circular shaped. Chest
circumference is 2 cm less than the
head circumference. No presence of
breast hypertrophy. Nipples without
presence of discharges.
Respiratory rate within normal range

8. Heart (femoral pulse)

9. Abdomen

10. Trunk and space

11. Genitalia (meatus)

12. Anus

13. Extremities (clavicles, hip joints)

14. Reflexes (moro, sucking and rooting)

for newborns. Lung sounds are clear

and heard with equal volume
bilaterally. Expands symmetrically, no
presence of seesaw.
Pumps blood that circulates throughout
the body as evidence by presence of
Femoral pulse.
Abdominal skin returns immediately
before 2 seconds after pinching the
skin. Umbilical cord still attach to
umbilicus (pink, no discharge, odor,
redness or herniation) Soft to palpation
and without masses or tenderness.
Abdomen is prominent in supine
position.
Trunk connected to neck and hips.
Spinal column aligned at midline.
Labia majora and minora are pink and
moist. Appears prominent and without
bloody discharges. No strong odor,
lesion and injury free. During the
assessment, it was not thoroughly
assessed if the baby was able to urinate
because she was wearing diaper.
Anal opening is visible. Perianal skin is
smooth and free of lesions. During the
assessment baby wasnt able yet to
defecate.
Feet and legs are symmetric in size,
shape and movement. Warm to touch,
mobile with adequate capillary refill.
Pulses are strong and equal bilateral.
Rooting, sucking, palmar grasp, moro
or startle, babinski and tonic neck
reflex are present.

DRUG STUDY
Drugs Given to the Mother:
OXYTOCIN

Classification: Oxytocic drug, lactation stimulant\

Dosage/Preparation: -to induce or stimulate labor: Adults: initially, 1-ml ampule (10
units) IV in 1000 mL of D5W, lactated Ringers, or normal saline solution infused at 0.5
to 2 milliunits/minute.
-to reduce postpartum bleeding after expulsion of placenta: Adults: 10 to 40 units IV in
1000 mL of D5W or Normal Saline Solution infused at rate that controls bleeding,
unusually 20 to 40 milliunits/minute. Give 10 units IM after delivery of placenta

Mechanism of Action: acts on smooth muscle of the uterus to stimulate contractions.

Oxytocin stimulates rhythmic contractions of the uterus, increases the frequency of
existing contractions, and raises the tone of uterine musculature.
Indications: -drug is only indicated for pregnant and postpartum women
-for uterine inertia
-for induction of labor in cases of erythroblastosis fetalis, maternal diabetes mellitus,
preeclampsia, and eclampsia
-for induction of labor after premature rupture of membranes after in the last month of
pregnancy when labor fails to develop within 12 hours
-to hasten uterine involution
-to complete inevitable abortions after the 12th week of pregnancy
Contraindications: contraindicated in patients hypersensitive to the drug or any of its
components. Also contraindicated in cephalopelvic disproportion or delivery that requires
conversion, as in transverse lie; in fetal distress when delivery isnt imminent; in
prematurity; in other obstetric emergencies; and in severe toxaemia, hypertonic uterine
patterns, total placenta previa, or vasa previa
Side effects:
Common side effects of Pitocin include redness or irritation at the injection site, loss of
appetite, nausea, vomiting, cramping, stomach pain, more intense or more frequent
contractions (this is an expected effect of oxytocin), runny nose, sinus pain or irritation,
or memory problems.
Nursing Responsibilities:
- observe the 3 checks and 10 rights
-assess patients condition before starting therapy and regularly thereafter
-provide continuous observation of client checking for dilatation, resting uterine tone,
characteristics of uterine contractions. Record maternal/fetal heart rates
-be alert for adverse reactions and drug interactions
-monitor fluid intake and output. Antidiuretic effect may lead to fluid overload, seizures,
and coma

METHERGINE

Classification: ergat alkaloid

Dosage/Preparation: IM dose: 0.2mg following expulsion of the placenta. The dose
may be repeated every 2 to 4 hours if necessary. Oral dose: 0.2mg every 4 hours (6
doses)
Mechanism of Action: stimulates smooth muscle tissue. Because the smooth muscle
of the uterus is especially sensitive to this drug, it is used postpartally to stimulate
uterus to contract in order to decrease blood loss by clamping off uterine blood
vessels and to promote the involution process. The drug has vasoconstriction effect on
all blood vessels, especially the larger arteries.
Indication: for uterine inertia
Contraindication: pregnancy, hepatic or renal disease, cardiac disease, hypertension,
or preeclampsia contraindicate this drug use
Side effects:
Side effects of Methergine include nausea, vomiting, stomach pain,diarrhea, leg
cramps, sweating, skin rash, headache, dizziness, ringing in your ears, stuffy nose, or
unpleasant taste in your mouth.
Nursing Responsibilities:
- observe the 3 checks and 10 rights
-monitor fundal height, consistency, the amount and the character of the lochia
-assess the blood pressure before and routinely throughout drug administration

-observe for any adverse effects

LIDOCAINE HYDROCHLORIDE

Classification: amide derivative, ventricular antiarrhythmic

Dosage/Preparation: use only 10% solution for IM injection. 300 mg in deltoid muscle
Mechanism of Action: decreases depolarization, automatically and excitability in ventricles
during diastolic phase by direct action on tissues. It abolishes ventricular arrhythmias.
Indication:
-management of acute ventricular arrhythmias during cardiac surgery and MI.
infiltration anaesthesia, peripheral and sympathetic nerve blocks and others
-ventricular arrhythmias resulting from MI, cardiac manipulation, or digoxin
toxicity
-status epilepticus
Contraindications: contraindicated in patients hypersensitive to amide-type local
anaesthetics and in those with Adam-Stokes syndrome, Wolff-Parkinson-White
syndrome, or severe degrees of SA, AV, or intraventricular block in absence of
artificial pacemaker. Hypovolemia, heart block or other conduction disturbances
Side effects:
Less serious side effects include:

mild bruising, redness, itching, or swelling where the medication was

injected;
mild dizziness;

nausea;

numbness in places where the medicine is accidentally applied.

Nursing responsibilities:
- observe the 3 checks and 10 rights
-assess patients condition before starting therapy and regularly thereafter to monitor
drugs effectiveness
-monitor patients response especially ECG, blood pressure, and electrolytes, BUN,
and creatinine levels
-be alert for adverse reactions and drug interactions

Drugs Given to the Newborn:

PHYTOMENODIONE

Classification: Vitamin K derivative, blood coagulation modifier

Dosage/Preparation:
-to prevent hemorrhagic disease of newborns: Neonates 0.5 to 1mg or 0.1mL IM or
subcutaneously
-hemorrhagic disease of newborns: Neonates: 1mg subcutaneously or IM based on
laboratory tests. Higher doses may be needed if mother has been taking
anticoagulants PO
Mechanism of Action: essential for blood clotting, an antihemorrhagic factor that
promotes hepatic formation of active prothrombin, and controls abnormal bleeding.
Indication: this medication is a haemostatic agent, prescribed for blood clottingand
bone formation. It is also used as an antidote.
Contraindications: contraindicated in patients who have severe liver disease and
hypersensitive to drug or any of its components.
Side effects:

Rare - With injection only; Difficulty in swallowing; fast or irregular breathing;

lightheadedness or fainting; shortness of breath; skin rash, hives and/or itching;
swelling of eyelids, face, or lips; tightness in chest; troubled breathing and/or
wheezing
Nursing Responsibilities:
- observe the 3 checks and 10 rights
-monitor PT to determine dosage effectiveness
-be alert for adverse reaction and drug interactions
-assess patients and familys knowledge of drug therapy

CIPROFLOXACIN

Classification: Antibiotic, Macrolide

Dosage/Preparation: Ophthalmic drops: mild to moderate infections (1 drop per eye)
Mechanism of Action: they inhibit protein synthesis of microorganisms by binding
reversibly to a ribosomal unit. Inhibits bacterial protein synthesis by binding to 50S
subunit of ribosomes. It inhibits bacterial growth.
Indication: acute infections
Side effects:
Common side effects of Cipro include diarrhea, dizziness,drowsiness, headache,
stomach upset, abdominal pain,nausea/vomiting, blurred vision, nervousness, anxiety,
agitation, sleep problems (insomnia or nightmares), and rash.
Contraindications:
-contraindicated in patients hypersensitive to drug, any of its components, or other
macrolides. Also contraindicated in patients taking pimozide. It is contraindicated in
patients with hepatic disease
Use other erythromycin salts cautiously in patients with impared liver function.
Nursing Responsibilities:
- observe the 3 checks and 10 rights
-be alert for any adverse effects
-assess patients and familys knowledge of drug therapy

HEPTITIS B VACCINE

Classification: immunoglobulin, hepatitis B prophylaxis

Dosage/Preparation: Adults and children: 0.06 mL/kg IM within 7 days after
exposure. if patient refuses hepatitis B vaccine, repeat dosage 28 days after exposure.
Neonates born to patients who test positive for hepatitis B surface antigen (HBsAg):
0.5mL IM within 12 hours of birth
Mechanism of Action: suspension of inactivated and purified hepatitis B surface
antigen (HBsAg) derived from human plasma of scremd asymptomatic HBsAgpositive carriers of hepatitis B virus. It is against hepatitis B infection by inducing
protective antibody. Provides passive immunity to hepatitis B. It also prevents
hepatitis B.
Indication:
-to promote active immunity in individuals at high reisk of potential exposure to
hepatitis B virus or HBsAg-positive materials
-hepatitis B exposure in high-risk patients
Side effects:
Recombivax [hepatitis b vaccine (recombinant)] is a viral vaccine used to help
prevent the disease Hepatitis B. Common side effects of Recombivax

include irritability (especially in children), pain/soreness/redness/swelling at the

injection site, fever, headache,tiredness, sore throat, runny or stuffy nose, nausea,
Contraindications:
-contraindicated in patients with a history of anaphylactic reactions to immune serum
-use cautiously in patients with severe thrombocytopenia or any coagulation disorder
that would contraindicate IM injections
Nursing Responsibilities:
- observe the 3 checks and 10 rights
-assess patients allergies and reaction to immunizations before starting therapy
-monitor effectiveness by checking patients antibody titers
-be alert for anaphylaxis
-assess patients and familys knowledge of drug therapy

LEARNING OUTCOMES

Within the 2-week duty at Agusan del Norte Provincial Hospital (ADNPH), Delivery
Room, I can say that it was we are not very productive and felt unsatisfied at the same time. We,
student nurses help bring people into the world every day. We cared for women during labor and
childbirth, monitored the baby and the mother, coached and provided health teachings to the
mothers and assisted doctors and staff nurses in the hospital. Yes, it was challenging but when we
get through it every day, we havent felt serious anxiety.
In two weeks of our duty, I felt unsatisfied with my performance because we dont have
many cases in DR. I only had 2 cases in two weeks of our duty DR. thats why I felt unsatisfied
because its our last duty together with our clinical instructor Maam Lumasag in Delivery Room
and yet we missed the chance to give health teachings to the mother, and also to help the mothers
to give birth to the child and assess them and take good care of them.
What I learned in this duty were very significant and helpful to me especially during the
consecutive days of duty in the DR. I improved my communication skills by listening and
interacting with the mother. Our nursing skills, critical thinking skills, analysis and procedural
skills were tested and have levelled up as well. Teamwork was highly developed by having
leadership skills and also, our experiences as student nurses in duties helped a lot in manifesting
cooperation within our group.
When I see mothers going to have birth, I feel putting myself into their shoes. As a
student nurse it is our responsibility to be present in the patients side and render care not just
physically but also emotionally by conducting therapeutic communication and showing
sympathy. During our postpartum visit to the patient we even recognized and gained more

information about her. At the time of interview I discovered that she had 2 abortions and one of
her child died. We did not further more asked her about what happened. We gave health
teachings and reminded her to watch her sanitary pad for any excess bleeding. I was glad to see
she has company because a moral support from significant others is highly needed throughout
pregnancy and specially during labor. Because the pain felt by the mother can be relieve through
encouragement, reassurance and simply by touch.