Download - Case Pres, Final (1)
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Submitted by:
Rubio, Kathleen Ann
Vidal, ArianeCalizar, Carl Lou
Dumaraos, Aaron Rafael
De Guzman, Robertson
Lacerna, Jay- Jay
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INTRODUCTION
Pregnancy, the state of carrying a developing embryo or fetus within the femalebody. This condition can be indicated by positive result son an over-the-counter urine test, and
confirmed through a blood test, ultrasound, detection of fetal heartbeat, or an X-ray. Pregnancy
lasts for about nine months, measured from the date of the woman's last menstrual period (LMP).It is conventionally divided into three trimesters, each roughly three months long.
When gestation has completed, it goes through a process called delivery, where
the developed fetus is expelled from the mothers womb. There are two options of
delivery: Cesarean section and NSVD or normal spontaneous vaginal delivery. A cesareansection is a surgical incision through the mothers abdomen and uterus to deliver one or more
fetuses. NSVD or normal spontaneous vaginal delivery is the delivery of the baby through
vaginal route. It can also be called NSD or normal spontaneous delivery, or SVD or spontaneous
vaginal delivery, where the mother delivers the baby with effort and force exertion.Normal labor is defined as the gradual subjugation and dilatation 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. Laboring cannotthat be easy; thereby implicating that there are processes and stages to be undertaken to achieve
spontaneous delivery. Through which, Obstetrics have divided labor into four (4) stages thereby
explaining this continuous process..FOUR ESSENTIALS COMPONENTS OF LABOR
1. PASSAGEWAYABORPAIN-the birth canal
False pelvis
-Flared upper portion of the bony pelvis
True pelvis
-Portion of the pelvis below the linea terminalis
Four types of pelvis
1. Gynecoid Pelvis
-Most favorable for a vaginal birth
-Categorized as a typical female pelvis
-it is a rounded shape that allows the fetus to negotiate the dimensions of the bonypassageway
2.Anthropoid Pelvis-It is also favorable to labor and delivery-Elongated in dimensions and sometimes referred to apelike.
-The anterior-posterior diameter is roomy, but the transverse diameter is narrow
compared with that of the gynecoid pelvis.
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3. Android pelvis-it is typical male pelvis. The heart shape of the android pelvis is not favorable to avaginal delivery. The fetus often gets stuck in this type of pelvis and must bedelivered by cesarean section.
4. Platypeloid Pelvis-it is flat in its dimensions with a very narrow anterior-posterior diameter and a
wide transverse diameter. This shape makes it extremely difficult for the fetus to
pass through the bony pelvis. Therefore woman with this type of pelvis usuallymust deliver the fetus by cesarean section.
2. PASSENGER-THE FETUSThere are three ways that the fetus presents to the pelvis:
Head (cephalic presentation)
Feet or buttock (breech presentation)
Shoulder (shoulder presentation)
3. POWERS-the uterine contractions and pushing efforts of the laboring woman
There are three phases of involuntary contraction:
Increment
Acme
Decrement
4. PSYCHE
-the emotional component of the woman brings to the birth settings.
Factors that may affect the maternal psyche:
Current pregnancy
Previous birth experience
Expectations for current birth experience
Preparation for birth
Support system
culture
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STAGE OF LABOR
STAGE 1: It is usually the longest part of labor. It begins withregular uterine contractions and ends with complete cervical dilatation at
10 centimeters.
This stage is broken down into three (3) phases:
The Ear ly phase, where the contractions are usually very light and maybeapproximately 20 minutes or more apart from the beginning, gradually becoming closer, possibly
up to five minutes apart;
TheActi ve phase, where contractions are generally four or five times apart, and may lastup to 60 seconds long. Cervix dilates with 4-7 cm and initiates a more rapid dilatation. It
is known that to get through active labor, mobility and relaxations are done to increasecontractions; and
TheTransiti on phase ,where it is definitely known as the shortest phase but the hardest,contractions maybe two or three times apart, lasting up to a minute and a half, about
approximately 8-10 cm of cervical dilatation. Some women will shake and may vomit
during this stage, and this is regarded as normal .Most of the time, women would find acomfortable position to acquire complete dilatation.
Cervical changesMembranesBloody Show
Contraction pattern
Pain Characteristics
Effects of walking
FALSE LABOR PAIN
No change Remain intact Absent; may have pinkish
mucous or may expel mucus
plug Pattern tends to be irregular,
although the contractionsmay seem to have a regularpattern for a time
May be described as atightening sensation: usuallythe discomfort is confined tothe abdomen
May decrease the frequencyor eliminate the contractionsaltogether
TRUE LABOR PAIN
Progressive dilationand effacement
May bulge or rupturespontaneously
Present Regular(may be
irregular at first)pattern develops in
which contractionsbecome increasinglyintense and morefrequently
Often starts in thesmall of the back andradiates to the lowerabdomen :may begin
with a cramping
sensation Contraction continue
and become stronger
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STAGE II: This stage lasts for three or more hours. However,The length of this stage depends upon the mothers position (e.g.; upright position yields faster
delivery). Once the cervix has completely dilated, the second stage had begun. This stage endswith the expulsion of the fetus.
STAGE III: This stage focuses on the expulsion of thePlacenta from the mother. Placenta exclusion is much easier than the delivery of the babybecause it includes no bones, and this is during this stage that the baby is placed on top of the
mothers womb.
STAGE IV: No more expulsions of conception products for thisStage as this is generally accepted as POST PARTUM juncture. This phaseis from the placental delivery to full recovery of the mother.
Principles:
Provide healing and the process of involution
Provide emotional support
Prevent postpartum complications
Establish successful lactation
Promote responsible parenthood(FP)
Labor and delivery of the fetus entails physiological effects both on the mother
and the fetus. In the cardiovascular system, the mothers cardiac output increases because of the
increase in the needed amount of blood in the uterine area. Blood pressure may also rise due to theeffort exerted by the mother in order expel the fetus. There could also be a development of
leukocytes or a sharp increase in the number o circulating white blood cells possibly as a result of
stress and heavy exertion. Increased respiratory may also occur. This happens as a response to theincrease in blood supply in order to increase also the oxygen intake.Braxton Hicks contractions, or also known as false labor orpractice
Contraction. Braxton Hicks are sporadic uterine contractions that
Actually start at about 6 weeks, although one will not feel them that early. Most women startfeeling them during the second or third trimester of pregnancy. True labor is felt in the upper and
mid abdomen and leads to the cervical changes that define true labor.
With delivery imminent, the mother is usually placed supine with her knees bent (ie, thedorsal lithotomy position). An episiotomy (an incision continuous with the vaginal introit us)
may be performed at this time. Episiotomy may ease delivery of the fetal head and allow some
control over what may otherwise be an uncontrolled perineal laceration. However, many
providers no longer perform routine episiotomy, since itmay increase the risk of rectal injury andare larger than the spontaneous laceration.
The labor and birth process is always accompanied by pain. Several options for paincontrol are available, ranging from intramuscular or intravenous doses of narcotics, such as
Meperidine (Demerol), to general anesthesia. Regional nerve blocks, such as a pudendal block or
local infiltration of the perineal area can also be used. Further options include epidural blocks
and spinal anesthetics.
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PATIENTS PROFILE
GENERAL DATA
NAME: PATIENT V
AGE: 26
SEX: Female
DATE OF BIRTH: October 31, 1983
PLACE OF BIRTH: Manaol, Nagcarlan
MARITAL STATUS: Married
RELIGION: Catholic
FATHERS NAME: Cecestino Rubian
MOTHER;S NAME: Casilda Rubian
SPOUSE NAME: Arvin Palma
HISTORY OF PREGNANCY AND DELIVERY
First and second baby were born at home without any laceration and episiotomy, whilethe third baby was born at the hospital without any laceration and episiotomy.
HISTORY OF PRESENT ILLNESS
10 Hrs. PTA-LABOR PAIN-SEVERE
Chief Complain= SEVERE LABOR PAIN
Admission:
Date: 9-15-10
Time: 7:00am
Attending Physician: Dr. Gemma Ardines, M.D.
Admitting Diagnosis: G3 P2
Operation Performed: Spontaneous Delivery to an alive baby girl at 7:40am
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PAST ILLNESS
Chicken Pox
Final Diagnosis- G3 P3, Delivered a live full term baby girl, Cephalic
Discharged:
Date: 9-16-2010
Time: 2 pm
BABYS PROFILE
NAME: Baby Girl
AGE: Newborn (1 day old)
DATE OF BIRTH: September 15, 2010
PLACE OF BIRTH: Nagcarlan District Hospital
SEX: Female
TIME IF BIRTH: 7:40 AM
VITAL STATATISTIC:
WEIGHT: 2.9 Kg
Final Diagnosis: Normal Full term baby girl, Cephalic
GENERAL ASSESSMENT
PHYSICAL ASSEMENT
General physical assessment
Pulse- - 79 beat /min24Rr- 24 breath/min
Temp-35.7
Assessment of the head Head is round in shape. Hair is long, thick and
coarse, straight and evenly distributed. Scalp is
smooth and white in color
Assessment of the eyes Her eyes are symmetrical, black in color,
almond shape. Pupils constricts when diverted
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to light and dilates when she gazes afar,
conjunctivas are pink. Eyelashes are equally
distributed and skin around the eyes is intact.
The eyes involuntarily blink
Assessment of the earsEars are clean, no ear wax was noted and
approximately of the
same size and shape. Patient can hear normally
when spoken softly
Assessment of the nose With narrow nose bridge, there were
discharges noted upon inspection. No swelling
of the mucous membrane and presence of nasal
hairs were seen
Assessment of the mouth She has a complete set of teeth with minimal
dental caries noted. Oral mucosa and gingival
are pink in color, moist and there were no
lesions nor inflammation noted. Tongue is
pinkish and is free of swelling and lesions.
Lips are symmetrical, appears pale without bits
noted upon observation
Assessment of the neckNeck has strength that allows movement back
and forth, left and right. Patient is able to freely
move her neck
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Assessment of the lung and thoracic region No reports of pain during the inhalation and
exhalation. Absence of adventitious sounds
upon auscultation. Respiratory rate 21 breathes
per minute from the normal range of 16-20
breaths per minute
Assessment of the heart Patient has an audible heart sound. PMI is
heard between 4th - 5thintercostals space.
Heart is pumping well with a pulse rate of 82
bpm from the normal rate of 60-100 beats per
minute.
Assessment of the abdomenAbdominal movement as with respiration,
presence of peristalsis
during auscultation. there is a presence of striae
gravidarum.
Assessment of the upper extremities Skin: White in color; Skin is smooth, moist
and soft to touch
Hands: Medium in size with approximately 5
fingernails in each side. Nails are
short, small dusty particles are present
Arms:
Able to move through active ROM. Able to
extend arms
in front or push them out to the side
Assessment to the lower extremities Size of the feet is undefined with lines on the sole. Ten fingers are
present. Nails are clean and short.
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Assessment to GenitourinaryWithout episiotomy, urinates 2-4 times a day
and has
not defecated yet since her deliver.
Assessment of perineum absence of lesions and swellingNeurological Assessment BehaviorPatient is silent but is conscious
and coherent upon
interaction. She sits and walks if she wants to.
Motor Functioning -Able to move extremities
through active
ROM. Able to extend arms front and resist
active
as pushed down/up on his hands.
Reflexes -reflexes were present such as the
blinking reflex and
deep tendon reflex.
Sensory FunctioningPatients sensory
system is intact, she was
able to distinguish touch, pain, hot and cold
ANATOMY AND PHYSILOGY
EXTERNAL GENITALIA
Our overview of the
reproductive system begins at the
external genital area or vulva
which runs from the pubic area
downward to the rectum. Two folds of
fatty, fleshy tissue surround the entrance to the vagina and the urinary opening: the labia
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majora, or outer folds, and the labia minora, or inner folds, located under the labia majora.
The clitoris,
is a relatively short organ (less than one inch long), shielded by a hood of flesh. When stimulated
sexually, the clitoris can become erect like a man'spenis. The hymen, a thin membrane
protecting the entrance of the vagina, stretches when you insert a tampon or have intercourse
INTERNAL GENITALIA
INTERNAL FEMALE ORGANS
The internal organs of the female consists of the uterus, vagina, fallopian tubes, and the ovaries
(see figures 1-1 and 1-2).
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.
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(1) Location. The uterus is located between the urinary bladder and the rectum. It is suspended in
the pelvis by broad ligaments.
(2) 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 outletthat protrudes into the vagina. The isthmus is the slightly constricted portion that joins the corpus
to the cervix.
(3) 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 itsdevelopment. 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 extensivechanges. 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.
(1) Location. 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.
(2) Function. The vagina provides the passageway for childbirth and menstrual flow; it receives
the penis and semen during sexual intercourse.
c. Fallopian Tubes (Two).
(1) Location. Each tube is about 4 inches long and extends medially from each ovary to empty
into the superior region of the uterus.
(2) Function. The fallopian tubes transport ovum from the ovaries to the uterus. There is no
contact of fallopian tubes with the ovaries.
(3) Description. 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 carriedtoward 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 (2)
(1) Functions. The ovaries are for oogenesis-the production of eggs (female sex cells) and for
hormone production (estrogen and progesterone).
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(2) Location and gross anatomy. 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 ovarianfollicles. 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 agraafian follicle, and is ready to be ejected from the ovary.
(3) Process of egg production--oogenesis (see figure 1-5).
(a) The total supply of eggs that a female can release has been determined by the time she is
born. The eggs are referred to as "oogonia" in the developing fetus. At the time the female isborn, oogonia have divided into primary oocytes, which contain 46 chromosomes and are
surrounded by a layer of follicle cells.
(b) Primary oocytes remain in the state of suspended animation through childhood until the
female reaches puberty (ages 10 to 14 years). At puberty, the anterior pituitary gland secretesfollicle-stimulating hormone (FSH), which stimulates a small number of primary follicles to
mature each month.
(c) As a primary oocyte begins dividing, two different cells are produced, each containing 23unpaired chromosomes. One of the cells is called a secondary oocyte and the other is called thefirst polar body. The secondary oocyte is the larger cell and is capable of being fertilized. The
first polar body is very small, is nonfunctional, and incapable of being fertilized.
(d) By the time follicles have matured to the graafian follicle stage, they contain secondary
oocytes and can be seen bulging from the surface of the ovary. Follicle development to this stage
takes about 14 days. Ovulation (ejection of the mature egg from the ovary) occurs at this 14-daypoint in response to the luteinizing hormone (LH), which is released by the anterior pituitary
gland.
(e) The follicle at the proper stage of maturity when the LH is secreted will rupture and release
its oocyte into the peritoneal cavity. The motion of the fimbriae draws the oocyte into the
fallopian tube. The luteinizing hormone also causes the ruptured follicle to change into agranular structure called corpus luteum, which secretes estrogen and progesterone.
(f) If the secondary oocyte is penetrated by a sperm, a secondary division occurs that producesanother polar body and an ovum, which combines its 23 chromosomes with those of the sperm to
form the fertilized egg, which contains 46 chromosomes.
(4) Process of hormone production by the ovaries.
(a) Estrogen is produced by the follicle cells, which are responsible secondary sex characteristics
and for the maintenance of these traits. These secondary sex characteristics include the
enlargement of fallopian tubes, uterus, vagina, and external genitals; breast development;
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increased deposits of fat in hips and breasts; widening of the pelvis; and onset of menses or
menstrual cycle.
(b) Progesterone is produced by the corpus luteum in presence of in the blood. It works with
estrogen to produce a normal menstrual cycle. Progesterone is important during pregnancy and in
preparing the breasts for milk production
EVENTS WEEKS OFPREGNANCY
1ST TRIMESTER
The woman's last period beforefertilization occurs. 0
Fertilization occurs. 2
The fertilized egg (zygote)
begins to develop into a hollow
ball of cells called the blastocyst.
The blastocyst implants in the
wall of uterus.The amniotic sac
begins to form. 3
The area that will become the
brain and spinal cord (neural
tube) begins to develop. 5
The heart and major blood
vessels are developing. The
beating heart can be seen during
ultrasonography. 6
The beginnings of arms and legsappear. 7
Bones and muscles form. Theface and neck develop. 9
Brain waves can be detected.
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The skeleton is formed. Fingersand toes are fully defined.
The kidneys begin to function. 10
Almost all organs are completelyformed.
The fetus can move and respond
to touch (when prodded through
the woman's abdomen).
The woman has gained some
weight, and her abdomen may
be slightly enlarged.
2nd Trimester The fetus's sex can be identified. 14
The fetus can hear.
The fetus's fingers can grasp. 16
The fetus moves more
vigorously, so that the mother
can feel it.
The fetus's body begins to fill out
as fat is deposited beneath the
skin. Hair appears on the head
and skin. Eyebrows and
eyelashes are present.
The placenta is fully formed. 20
The fetus has a chance of
survival outside the uterus. 24
The woman begins to gain
weight more rapidly.
3rd Trimester The fetus is active, changing 25
positions often.
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The lungs continue to mature.
The fetus's head moves intoposition for delivery.
On average, the fetus is about20 inches long and weighs about
7 pounds. The woman's
enlarged abdomen causes the
navel to bulge.
Delivery 37-42
RESULTS
HEMATOLOGY
Date: 09/15/2010
ID:63
SQ #: 43
WBC: 17.8 H 1O 9/1 (5.0-10.0) NCV: 80 f1 (80-97)
RBC: 3.81 10 12/1 (3.80-5.80) MCH: 27.7 pq (80-97)
HGB: 105 L a/1 (110-165) MCHC: 347 g/1 (315-350)
HCT: .304 L 1/1 (.350-.500) RDW: 15.1 H % (10.0-15.0)
PLT: 216 10 9/1 (150-390) MPV: 6.0 L f1 (6.5-11.0)
PCT: .130 10 -2 1/1 (.100-.500) PDW: 11.6 % (10.0-18.0)
WBC Flaos : G1
DIFF:
%LYM: 14.7 L% (17.0-48.0) #LYM: 2.6 10 9/1 (1.2-3.2)
%MON: 4.5 % (4.0-10.0) #MON: O.8 10 9/1 (0.3-0.8)
%GRA: 80.8 H % (43.0-76.0) #GRA: 14.4 H 10 9/1 (1.2-6.8)
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DRUG STUDY
Drug name Function Dosage
and
route
Adverse effect
Ferrous Sulfate
(FeSO4)CLASSIFICATION:
Antianemic, Iron
ACTION:
Males: 12-20mg
Females: 8-15mg
Iron is absorbed from
the
duodenum and upper
jejunum by an active
mechanism through
the
mucosal cells where
it
combines with the
protein transferrin
Ferrous sulfate is used to treat irondeficiency anemia (a lack of red
blood cells caused by having too
little iron in the body).
1 cap/
OD
Constipation, gastricirritation, nausea,
abdominal cramps,
anorexia, diarrhea,dark colored stools
OXYTOCIN -
INJECTABLE (ox-ee-TOE-sin)
BRAND NAME(S):
Pitocin
Oxytocin is a hormone used during
the late stage ofpregnancy toinduce labor (contractions). It isoften used to induce labor in
difficult pregnancies or pregnancies
at risk for complications (e.g.,preeclampsia, eclampsia, diabetes).
1 amp Nausea, vomiting,
cramping, and stomachpain may occur. If any ofthese effects persist or
worsen, notify the doctor
promptly.
Cefuroxine
ANTIINFECTIVE;
ANTIBIOTIC;SECOND-
GENERATIONCEPHALOSPORIN
For the treatment of many different
types of bacterial infections such as
bronchitis, sinusitis, tonsillitis, earinfections, skin infections,
gonorrhea, and urinary tract
infections.
250 mg 1
tab TID
diaper rash;
- diarrhea;
- difficulty breathing orswallowing;
- hives;
- itching;- painful sores in the
mouth or throat;
- severe skin rash;- stomach pain;
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- upset stomach;
- vaginal itching anddischarge;
- vomiting;
- wheezing;
Mefenamic acidMefenamic aciddecreases inflammation (swelling)and uterine contractions by a still
unknown mechanism. However it is
thought to be related to theinhibition
ofprostaglandin synthesis. There is
also evidence that supports the use
of mefenamic acid forperimenstrual migraine
headacheprophylaxis, with
treatment starting 2 days prior tothe onset of flow or 1 day prior tothe expected onset of the headache
and continuing for the duration
ofmenstruation.
500Mg1cap
TID pc
known to cause an upset
stomach, therefore it is
recommended to take
prescribed doses together
with food or milk.
Instances of drowsiness
may also occur. As such,
it is recommended to
avoid driving orconsuming alcohol while
taking this medication.
Other known mild side
effects of mefenamic acid
include headaches,
nervousness
and vomiting. Serious
side effects mayinclude diarrhea, bloody
vomit, haematuria(blood
in urine), blurred vision,
skin rash, itching and
swelling, sore throat
and fever. It is advised to
consult a doctor
immediately if
these symptoms appear
while taking this
medication.
http://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Prostaglandinhttp://en.wikipedia.org/wiki/Migraine_headachehttp://en.wikipedia.org/wiki/Migraine_headachehttp://en.wikipedia.org/wiki/Menstruationhttp://en.wikipedia.org/wiki/Alcoholic_beveragehttp://en.wikipedia.org/wiki/Adverse_drug_reactionhttp://en.wikipedia.org/wiki/Adverse_drug_reactionhttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Vomithttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Haematuriahttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Symptomhttp://en.wikipedia.org/wiki/Symptomhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Haematuriahttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Vomithttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Adverse_drug_reactionhttp://en.wikipedia.org/wiki/Adverse_drug_reactionhttp://en.wikipedia.org/wiki/Alcoholic_beveragehttp://en.wikipedia.org/wiki/Menstruationhttp://en.wikipedia.org/wiki/Migraine_headachehttp://en.wikipedia.org/wiki/Migraine_headachehttp://en.wikipedia.org/wiki/Prostaglandinhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Inflammation -
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Drug name Function Dosage and
route
Adverse effect
Vitamin K Vitamin K is a fat-
soluble vitamin, so it
is stored in the body's
fat tissue and liver. It
is best known for its
role in helping blood
clot (coagulate)
properly (the "K"
comes from its
German name,
Koagulationsvitamin).
Vitamin K also plays
an important role in
bone health.
It is rare to have a
vitamin K deficiency,
because in addition to
being found in leafy
green foods, the
bacteria that are foundin the intestines can
make vitamin K.
0.1cc im Pain, swelling, or soreness atthe injection site may occur.
Temporary flushing, tastechanges, dizziness, rapidheartbeat, sweating, shortness
of breath, or bluish
lips/skin/nails may alsoinfrequently occur.
Hepatitis B vaccine The hepatitis B
vaccine (HBV)
protects your childagainst the hepatitis B
virus, which can lead
to liver damage and
even death
0.5cc im Pain/redness/swelling at the
injection site, fever, headache,
and dizziness may occur. Rareside effects may include
bruising/itching at the
injection site, pain/stiffness in
the arm/shoulder/neck,sweating, tiredness, weakness,
chills, muscle/joint aches, cold
symptoms, nausea, vomiting,
temporary loss of appetite,abdominal
cramps, constipation, diarrhea,
swollen glands (lymph nodes),
http://www.babycenter.com/0_hepatitis_10882.bchttp://www.babycenter.com/0_hepatitis_10882.bchttp://www.medicinenet.com/script/main/art.asp?articlekey=20628http://www.medicinenet.com/script/main/art.asp?articlekey=97800http://www.medicinenet.com/script/main/art.asp?articlekey=331http://www.medicinenet.com/script/main/art.asp?articlekey=1900http://www.medicinenet.com/script/main/art.asp?articlekey=1900http://www.medicinenet.com/script/main/art.asp?articlekey=331http://www.medicinenet.com/script/main/art.asp?articlekey=97800http://www.medicinenet.com/script/main/art.asp?articlekey=20628http://www.babycenter.com/0_hepatitis_10882.bchttp://www.babycenter.com/0_hepatitis_10882.bc -
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irritability, agitation, and
trouble sleeping. If any ofthese effects persist or worsen,
tell your doctor or pharmacist
promptly.
Teramycin withPolymyxin B
Ointment
Treating eye infectionscaused by certain
bacteria. It may beused alone or with
other medicines.
Teramycin with
Polymyxin B Ointment
is an antibioticcombination. It works
by interfering with thebacteria's cell wall and
the production of thebacteria's proteins,
which kills thebacteria.
OU Severe allergic reactions (rash;hives; itching; difficultybreathing; tightness in thechest; swelling of the mouth,
face, lips, or tongue); eyeswelling or redness.
Supplemin C Drops
(MULTIVITAMINS)Supplemin C Drops is amultivitamins for
newborn babies. Sincemy baby is of low birth
weight our pediatricianintroduced thismultivitamins. Its a
good multivitaminssince it stimulates my
babys appetite.Eventually she became
bigger and she has a
very good appetite. I amstill using it on my baby
since I think that it hasso much good benefits.
It is not only an appetitestimulate but also givesessential vitamins and
minerals needed by mybaby for her growingyears. Its just asupplement so its not adrug at all.
0.3ml OD
in your mouth
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NURSING CARE PLAN
Before delivery:
Assessment Diagnosis Planning Intervention Rationale Evaluation
S>Managnaganakna ako
O>Facial grimace>Anxious
>Complains
labor pain>with intact
BOW
>Severelabor pain
related to
uterinecontractions
>To lessenthe pain
>To preventany
complications
>Perform apain
assessment at
least everyhour during
labor include
paindescription,
location,
duration, and
intensity
>Encouragethe use of
relaxation
techniquesthat are
helpful for
her
>Assist her tochange
positionsfrequently
>Reinforcethe use of
breathing
patterned.Encourage
her to switch
>A thoroughassessment
will reveal
the need formore
intensive
interventionsto control the
pain of labor
>The morerelaxed the
patient can
remainduring labor,
the better she
will be ableto cope with
the pain of
labor
>Positionchanges can
help thepatient to
better cope, if
she remainsfrozen in
one position;
she is morelikely to
becometense, which
increases the
perception ofpain.
>Patternedbreathing
techniques
>Afternursing
interventions
the patient isable to
tolerate the
uterinecontraction
and labor
pain.
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to a morecomplex
pattern of
breathingwhen simpler
patterns areno longer
helpful
can facilitaterelaxation
and increase
the patientsability to
cope
>Severe pain
related toprogress of
labor
>To lessen
and alleviatethe pain
>Continue to
perform apain
assessment
every 30
minutes
>Frequent
assessment ofpain will
allow for
rapid
detection ofonset pain
>After
nursingintervention
the patient is
able to
tolerate andcope the
severe laborpain.
After Delivery:
Diagnosis Planning Intervention Rationale
>To promote good
bonding relationship of
the newborn and the
mother
>Skin to skin test
(latching)>To develop good
bonding relationship of
the newborn and the
mother
>Acute pain related totraumatized tissue after
birth
>To alleviate pain dueto giving birth >Giving medications(mefenamic acid) >To alleviate andlessen the pain
>Pain related to uterinecontraction
>To promote andachieve uterine
contraction
>Injection of oxytocinthrough IM
>Breastfeeding
>To achieve uterinecontraction
>To stimulate anterior-pituitary gland to
secrete oxytocin
>To provide rest and
comfort
>providing adequate
rest and comfort to the
patient
>To gain energy and to
be able to provide
proper care to her baby>To provide health
teaching>Health teaching will
be render such as:a. Proper breast
feeding
b. Eating nutritious
>To initiate milk
production
>To sustain energy
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food especially greenleafy vegetable
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MECHANISM OF LABOR:
Descent:
As the fetal head engages and descends, it assumes an occiput transverse position because
that is the widest pelvic diameter available for the widest part of the fetal head.
Flexion:
While descending through the pelvis, the fetal head flexes so that the fetal chin is touching the
fetal chest. This functionally creates a smaller structure to pass through the maternal pelvis.
When flexion occurs, the occipital (posterior) fontanel slides into the center of the birth canal
and the anterior fontanel becomes more remote and difficult to feel. The fetal position remains
occiput transverse
Internal Rotation:
With further descent, the occiput rotates anteriorly and the fetal head assumes an oblique
orientation. In some cases, the head may rotate completely to the occiput anterior position.
Extension:
The curve of the hollow of the sacrum favors extension of the fetal head as further descent
occurs. This means that the fetal chin is no longer touching the fetal chest.
External Rotation:
The shoulders rotate into an oblique or frankly anterior-posterior orientation with further descent. This
encourages the fetal head to return to its transverse position. This is also known as restitution.
ExpulsionIt is the birth of the entire body of the fetus.
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