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This is the case of a female patient, 25 years of age living at Lake Sebu, South
Cotabato She was admitted at August 21, 2019 at 10:00pm at South Cotabato Provincial
Hospital with the chief complaint of Difficulty of Breathing.
Pregnancy starts when a male’s sperm fertilizes a female ovum (egg), and the
fertilized ovum implants in the lining of the uterus. Because pregnancy changes a
woman’s normal hormone patterns, one of the first sign of pregnancy is a missed
menstrual period. Normal labor is defined as the gradual subjugation and dilation of the
uterine cervix as a result of rhythmic uterine contractions leading to the expulsion of the
products of conception, the delivery of the fetus, membranes, umbilical cord, and
placenta. Labor cannot be that easy; thereby implicating that there are process and stages
to be undertaken to achieve spontaneous delivery.
A spontaneous vaginal delivery is a vaginal delivery that happens on its own,
without requiring doctors to use tools to help pull the baby out. This occurs after a
pregnant woman goes through labor which opens or dilates her cervix to atleast 10
centimeters.
Study shows, 16 million women 15 – 19 years old give birth each year, about
11% of all births worldwide, 95% of these births occur in low and middle-income
countries. The average adolescent birth rate in middle income countries is more than
twice as high as those high-income countries, with the rate in low income countries being
five times as high. The proportion of births that take place during adolescence is about
2% in China, 18% in Latin America and the Caribbean and more than 50% in Africa.
Half of all adolescent births occur in just seven countries; Bangladesh, Brazil, Congo,
Ethiopia India, Nigeria, and United States. US teens are two and a half times as likely as
teens in Germany or Norway and almost 10 times in Switzerland.
In 2017, a total of 1,700,618 live births was registered which is equivalent to a
crude birth rate (CBR) of 16.2 or 16 births per thousand population. The number of
registered live births showed a decreasing trend, noticeably from 2012 to 2017. The
decrease in the last five years was 5.0 percent, from 1,790,367 live births in 2012 to
1,700,618 recorded births in 2017. More males (887,972 or 52.2%) were born than
females (812,646 or 47.8%) which resulted in a sex ratio of 109 males per 100 females.
On the average, there were about 4,659 babies born daily or about 194 babies
born per hour or approximately three babies born per minute. Of the total live births, 57.8
percent were born in Luzon, 19.1 percent in Visayas and 23.1 percent in Mindanao.
Among the regions of the country, the National Capital Region (NCR) recorded the
highest number of birth occurrences of about 14.0 percent. Second in rank was
CALABARZON (13.6%) and the third was Central Luzon (11.2%). Of the total number
of births in the country, 93.3 percent birth deliveries were attended by health
professionals which may either be a physician, a midwife or a nurse. The number of
births by place of occurrence and by usual residence of mother showed a remarkable
proportion on births attended by health professionals in the 16 regions. This is indicative
of improving health services in terms of maternal and child health care. Among regions,
only Autonomous Region in Muslim Mindanao (ARMM) showed a very low proportion
of medically attended births. More than half of the births that occurred in the region were
attended by traditional birth attendants (hilot/unlicensed midwife). More than half
(907,061 or 53.3%) of the total registered live births in 2017 were born out of wedlock.
The three regions that recorded the highest number of illegitimate children born in 2017
by usual residence of mother were CALABARZON (144,622), NCR (141,206), and
Central Luzon (100,956).
The proportion of illegitimate babies in ten regions of the country, as usual
residence of mother were more than half of its total births, including Eastern Visayas
(65.4%), NCR (64.9%), CALABARZON (58.2%), Davao (57.4%), Central Visayas
(56.7%), Bicol (55.7%), Caraga (55.6%), Northern Mindanao (53.6%), Central Luzon
(52.7%), and Ilocos Region (50.6%). Babies born to adolescent mothers (196,478) were
more than those babies sired by adolescent fathers (52,342). Moreover, babies sired by
fathers aged 50 years old and over (27,068) were far more than babies born to mothers of
the same age group (328). The modal age group of childbearing in 2017 was at 20-24
years old. The highest frequency of live births (471,356 or 27.7%) belonged to mothers in
this age group. On the other hand, fathers aged 25-29 were recorded to have sired the
highest frequency of live births (416,168 or 24.5%) The median age of mothers giving
birth was 26 and for fathers was 29 years old.
PERSONAL DATA
Vital Information
Patient’s Name: Mrs. Red
Age: 31
Sex: Female
Birth Date: September 15, 1987
Birth Place: Barangay Cacub, Koronadal City
Address: Santo Niño, South Cotabato
Occupation: Housewife
Tribe: Ilonggo
Citizenship: Filipino
Religion: Convert Muslim
Civil Status: Married
Educational Attainment: High School Graduate
Name of Institution: South Cotabato Provincial Hospital
Date and Time of Admission: July 27, 2019 @ 9:27pm
Chief Complaint: Increased Blood Pressure; vomit this
afternoon, Edematous both feet
Admitting Diagnosis: G5P4 (4004) Pregnancy uterine 40 weeks
Age of Gestation, Cephalic not in Labor TK
Preeclampsia
OB History: LMP: October 21, 2018
EDC: July 28, 2019
Attending Physician: Dr. White
Spouse Name: Mr. Blue
Age: 41 years old
Educational attainment: College Graduate
Occupation: Aircon Technician
Parent’s Name:
Father’s Name: Mr. Green
Age: 55 years old
Occupation: Farmer
Educational Attainment: High School Undergraduate
Mother’s Name: Mrs. Yellow
Age: 54 years old
Occupation: Housewife
Educational Attainment: High School Undergraduate
Siblings:
Name Age Educational Attainment
1. Mrs. Gray 36
2. Mrs. Brown 34
3. Mr. Black 29
4. Mr. Orange 27
Source of Information:
Patient
Patient’s Chart
FAMILY BACKGROUND
Mrs. Red is the seventh among twelve children of Mr. Green and Mrs. Yellow;
she is a T’Boli and a Catholic. She belongs to a nuclear type of family, which is
composed of father, mother and children.
Presently, they are residing at Purok Pioneer Santo Niño, South Cotabato with her
second Husband and her children. Mrs. Red’s mother is a housewife and her father is a
farmer. Mrs. Red has four siblings Mrs. Gray age 36, Mrs. Brown age 34, Mr. Black age
29 and Mr. Orange age 27. Mrs. Red herself is a housewife, she has three children from
her first marriage and one child from her second marriage. According to the patient, her
family has no family history of Asthma, Hypertension, Diabetes and Cancer.
The family experiences common illnesses such as fever, cough, colds and flu.
They utilize over the counter drugs such as paracetamol, decongestant, pain reliever and
sometimes they utilize also herbal medicines such as lagundi for cough. She added that
they don’t have any history of serious or viral diseases in both sides of their family.
PHYSICAL ASSESSMENT
Date: July 31, 2019
Time: 7: 50pm
GENERAL APPEARANCE:
The patient is female adult, hair is not fixed and she wears slight clean and
comfortable clothes. She does not have body odor; she is conscious and well oriented by
the time, place and people around her. She speaks well with clear and audible voice and
was able to understand instructions and health teachings. The patient is sitting on bed
with IVF of D5LR 1 L with 10 units of oxytocin at the level of 1000 cc and regulated @
30gtts/min. hooked @ right cephalic vein. No Facial grimace,
VITAL SIGNS:
BP: 130/90 mmHg
Temp. 36.7 C
PR: 71 Bpm
RR: 20 Cpm
Ears:
Inspection: Ears are symmetrical to the head. No lesions noted, no deformities noted as
well as discharges. Client is able to hear whispered words from 1-3 feet inches. Vibration
was heard equally in both ears.
Nose
Inspection: External nose are symmetrical, uniform in color and no discharges noted.
No lesions noted. The patient can determine the smell good and bad odor; air is felt being
exhaled through opposite nares; noiseless.
Lips/ mouth/ teeth/ throat
Inspection: No Dry lips noted. Complete set of adult teeth. Yellow in color.. The gum is
pink in color, no retraction noted and no gum bleeding noted, the tongue’s position is in
the midline, pink in color and has white pigment and moves freely
Neck
Inspection: Jugular veins are not inflamed and no stiffness noted, neck muscles are equal
in size with head centered. Smooth, controlled movements;
Palpation: Trachea is in midline position, smooth, firm, and non-tender. Cervical Lymph
nodes is not palpable, soft mobile, discrete, and non tender.
Respiratory
Inspection: Intercostals spaces are even and relaxed, chest symmetry are equal, the
position of the trachea is at the level with the ribs, the position of the trachea is at the
midline and the client explanation is 7 inches w/ deep inspiration.
Auscultation: Respiration pattern is even, 12-20/ min. unlabored with a normal breathing
pattern.
Cardiovascular
Inspection: Small apical impulse (< 2.5 cm) at medial to left midclavicular line at fourth
or fifth ICS.
Breast
Inspection: Nipples are symmetrical to each other, black in color and increase in size.
The areolas on both breast are black in color, milk secretion noted.
Abdomen
Inspection: presence of linea nigra noted. Moles were also noted.
Genitalia
Inspection: No Vaginal discharge noted, perineal bulging noted. Perineum is shaved.
Extremities:
Upper:
Inspection: Arms are symmetrical and appropriate to body size, with normal tan skin
color. No swelling noted on both extremities, with IVF of D5LR 1 L at 1000cc regulated
at 30 gtts/min. hooked at right cephalic vein. Fingers are compute and no deformities
noted. Arms, elbows, shoulder are able to move in range of motion.
Palpations: No tenderness as well as lesions noted.
Lower extremities:
Inspection: Bone structure and bony landmarks are bilaterally symmetrical and equal,
joint structures are symmetrical & equal. Limited R.O.M of the hip, knee ankle, and toes.
Nails, skin
Inspection: fair skin complexion, no lesion noted, short nails and a little dirty.
DEVELOPMENTAL DATA
Name: Mrs. Red
Age: 31 years old
According to: Erickson’s Psychosocial Developmental Data
Theory: Psychosocial Development
Stage of the patient: Young Adult
Description of Theory
Erikson’s stages of psychosocial development are based on (and expand upon)
Freud’s psychosexual theory. Erikson proposed that we are motivated by the need to
achieve competence in certain areas of our lives. According to psychosocial theory, we
experience eight stages of development over our lifespan, from infancy through late
adulthood. At each stage there is a crisis or task that we need to resolve. Successful
completion of each developmental task results in a sense of competence and a healthy
personality. Failure to master these tasks leads to feelings of inadequacy.
Stage Task Age Justification Remarks
Intimacy vs Positive: 31 Patient is Separated Partially
Isolation Young Adult During years from first Husband. Achieved
Age: 19 – 40 this period, we begin to old And has a second
years old share ourselves more husband, they are
intimately with others living together. They
are striving to build a
Successful completion strong relationship
of this stage can result within the family.
in happy relationships
and
Negative:
Avoiding intimacy,
fearing commitment
and relationships can
lead to isolation,
loneliness, and
sometimes depression.
SIGMUND FREUD PSYCHOSEXUAL THEORY
Description of theory:
According to Freud’s theory of psychosexual development, the personality develops in
five overlapping stages of birth to adulthood. The libido changes, it’s location of
emphasis within the body from one stage to another. Therefore, a particular stage. The 1st
three stages ( oral, anal, phallic) are called pregenital stages. The culminating stage is the
genital stage. Ideally an individual progress through the task of each stage and balance is
achieved between the id, ego and sub ego. Conflict or stress, however can delay or
prolong progression through a stage or cause a person to regress to a previous stage.
Stage Task Justification Remarks
Complete Diagnosis
SIGNS OF LABOR
Preliminary Signs
Lightening
The descent of fetal presenting part into the pelvis occurs approximately 10 to 14
days before labor begins. These changes the woman’s abdominal contour as the uterus
becomes lower and more anterior.
Increase in Level of Activity
The increase in activity is due to an increase epinephrine release that is initiated by a
decrease in progesterone produced by the placenta.
Braxton Hicks Contraction
This is true labor contractions. Contractions that begin irregularly but become regular and
predictable. Felt first in the lower back and sweep around the abdomen in a wave.
Continue no matter what the woman’s level of activity. Increase in duration, frequency
and intensity and it achieve cervical dilatation.
Ripening of the Cervix
This is seen only on pelvic examination. Throughout pregnancy, the cervix feels softer
than normal, like the consistency of an earlobe. At term the cervix becomes still softer.
Ripening is an internal announcement that labor is close at hand.
COMPONENTS OF LABOR
PASSAGE – route the fetus must travel from the uterus through the cervix and vagina to
the external perineum.
PASSENGER – the fetus
POWERS OF LABOR – supplied by the fundus of the uterus, are implemented by
uterine contractions, a process that causes cervical dilatation and then expulsion of the
fetus from the uterus.
PSYCHE – psychological state or feelings that women bring into labor with them.
STAGES OF LABOR
FIRST STAGE
THREE PHASES
LATENT PHASE
Begins at the onset of regularly perceived uterine contractions and ends when
rapid cervical dilatation begins. The cervical dilatation at this phase is 2-3.
ACTIVE PHASE
Cervical dilatation occurs more rapidly, going from 4cm to 7cm.
TRANSITION PHASE
Maximum cervical dilatation of 8 to 10 cm.
SECOND STAGE
The second stage of labor is the period from full dilatation and cervical effacement to
birth of the infant. Contractions change from the characteristic crescendo-decrescendo
pattern to an overwhelming, uncontrollable urge to push or bear down with contractions
as if she had to move her bowels.
THIRD STAGE
The placental stage begins with the birth of the infant and ends with the delivery of the
placenta. Two separate phases are involved: placenta; separation and placental expulsion.
Normal Delivery
PHYSIOLOGY
The innermost layer of uterine Contains glands that secrete fluids that
Endometrium
wall. bathe the utrine lining.
Myometrium Smooth muscle in uterine wall. Contracts to help expel the baby.