Case Pres, Final (1)

7/27/2019 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;
http://www.medicinenet.com/script/main/art.asp?articlekey=33915http://www.medicinenet.com/script/main/art.asp?articlekey=33915


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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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Documents

Case Pres, Final (1)