FOUNDATION UNIVERSITY MISSION, VISION, AND LIFE PURPOSE

LIFE PURPOSE:
To educate and develop individuals to become productive, creative, useful and responsible citizens of the society.

VISION:
Foundation University envisions itself as a dynamic, progressive environment that cultivates effective learning, and
generates creative ideas, responds to societal needs and offers equal opportunity for all.
MISSION:
In its quest for excellence in mind body and character and the pursuit of truth and freedom, Foundation University
commits:
1. to develop in students sound character and broad culture;
2. to prepare individuals for a definite career;
3. to imbue citizens with the spirit of universal brotherhood; and
4. To advocate truth, promote justice and advance knowledge

1
 ACKNOWLEDGEMENT

This case presentation would not be made possible with the help of several people who helped us all along the way
on our journey in completing this case presentation. First and foremost we would like to give thanks to the Lord our God
for always being there for us and giving us blessings and guidance. To our parents, benefactors who have been very
supportive in this endeavour, who supported us not only financially but also emotionally and physically.
We would like also to extend our deepest thanks to our clinical instructor, Ms. Pertha Marie S. Alvarico, MSN, RN
for being so patient, concern, and very supportive to us. We very much appreciate her kindness despite the mistakes we
have committed because in those mistakes we became better individuals as it provided as the way to improve our skills,
knowledge and attitude.
To the very kind staff of Negros oriental Provincial Hospital LR-DR department, thank you for making us feel
comfortable and at home. Thank you for accommodating us and for understanding our capacity to perform procedures.
Thank you for sharing us your profound experiences, and making us see and realize the huge responsibility carried by
health care providers as they provide outmost care and safety to their clients.

To the Dean and faculty of the college of nursing for being there for us in enhancing our knowledge and skills that
may help us become a holistic and caring nurse.
And lastly we would like to thank our patient for giving us an opportunity to further understand how to take care of
patient who is having NSVD.

2
 INTRODUCTION

Pregnancy is the term used to describe the period in which a fetus develops inside a woman's womb or [Link]
condition can be indicated by positive results on an over-the-counter urine test, and confirmed through a blood
test,ultrasound, detection of fetal heartbeat, or an X-ray. Pregnancy usually lasts about 40 weeks, or just over 9 months, as
measured from the last menstrual period to delivery. 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 mother’s womb. There are two options of delivery: Cesarean section and NSVD or
normal spontaneous vaginal delivery. A cesarean section is a surgical incision through the mother’s
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 spontaneous vaginal delivery is the commonest mode of delivery globally, particularly in
remote areas of resource constrained countries where modern healthcare is limited. Conditions that may
prevent natural delivery or make it difficult include cephalopelvic disproportion, fetal distress, abnormal
presentations and other medical conditions.  According to a study here in the Philippines, 85% of Filipino
women prefer normal vaginal delivery while 15% preferred delivery by elective caesarean section (CS).

3
Central Objectives: At the end of our case presentation the learners shall gain deeper knowledge, develop and improve
skills and manifest desirable attitude and values relevant in the care of patient who is having NSVD.

Specific Objectives:

Within 1 hour and 30 minutes of our case presentation, the learners will:

 Explain the importance of gathering demographic data and health history of the patient.

 Obtain knowledge about the medications given and its corresponding nursing responsibilities.

 Identify the different systems in the body that is involved with the pregnancy of the patient.

 Check whether the interventions in the Nursing Care Plan are correct and appropriate for the
patient.

 Appraise the case presentation as a whole.

4
 Demographic Profile

Name: J. R. Educational Attainment:

College Graduate
Age: 21 years old Occupation: Teacher
Gender: Female Civil Status: Single
Address: Santa Cruz Nuevo, Tanjay City, Neg., Or. Nationality: Filipino
LMP: May 4, 2019 Religion: Roman Catholic
Doctor in charge: Maria Josephine Encarnacion
Chief Complain: Labor pains

History of Present Illness: Client is a pregnant female for 38 3/7 weeks complains of labor pains prior to Hospitalization
on January 31, 2020 at 4:15 in the afternoon. The client was confined in Negros Oriental Provincial Hospital.

General Impression: Receive patient in DR lying on the bed with IVF , conscious, cooperative and responsive to
environment stimuli. Patient is experiencing pain during her labor.

5
 Erik Erikson’s Theory on Psychosocial Development

Intimacy vs Isolation

This stage takes place during young adulthood between the ages of approximately 18 to 40 years. During this
period, the major conflict center on forming intimate, loving relationship with other people. During this period we begin to
share ourselves more intimately with others. We explore relationships leading toward longer term commitments with
someone other than a family member. Successful completion of this stage can result in happy relationships and a sense of
commitment, safety, and care within a relationship. Avoiding intimacy, fearing commitment and relationships can lead to
isolation, loneliness, and sometimes depression. Success in this stage will lead to the virtue of love.

Correlation:

Our patient is a 31 year old female, she is not married and currently on the stage of delivering her 1 st child. In
correlation with Erik Erikson’s Intimacy versus Isolation the patient is right now sharing her intimate moment with her
live-in partner thus resulting to their expectation of having their 1 st child. The patient committed herself to her live-in
partner to love and cherish each other for the rest of their life and to take care of their children.

6
 NURSING HISTORY

 Chief complaint: Labor pain

 Admitting Impression/Diagnosis: G1P1 (1001), PU 38 3/7 weeks a live term female neonate, AS, 9:10
cephalic, 3230 grams by NSVD with episiotomy
 HPI: Client is a pregnant female for 38 3/7 weeks complains of labor pains prior to Hospitalization on January
31, 2020 at 4:15 in the afternoon.
 Past health history: The Client is a healthy 31 years old woman who takes a really good care of her health and
her baby’s health as well. Client has not been hospitalized before prior to her admission in the NOPH.

7
Family History with Genogram

E.R
47y/o
HTN

8
 P.R
48y/o
Alc

CLIENT
31y/o
P.R JR. A&W
29y/o
A&W
LEGEND:
M

F
Baby Girl
A&W
A&W - alive and well
HTN – hypertension J.R.
Alc - alcoholic 21y/o
A&W

9
Psychosocial History

- She is in a good mental health. She is stress free and is very happy. She socialize and is very friendly towards
everyone.

Environmental History

- She lives with her boyfriend’s family at Santa Cruz Nuevo, Tanjay City, Negros Oriental, where they live in a

average house made of stone and cement. Their place is peaceful and they can breaths fresh air.

Spiritual History

- The whole family is a Roman Catholic and goes to church sometimes. They believe in God and ask for his guidance

and

Protection.

10
 PHYSICAL ASSESSMENT

Assessment Findings
Client is 31 years old, awake, coherent and responsive to
General Survey environmental stimuli with no signs of distress, having a
good posture, well-groomed and with good mental status.
V/S taken: 37.4˚C within normal limit, PR: 80 bpm normal
Vital Signs and regular, RR: 20 cpm normal, BP: 120/80 mmHg within
normal range.

Integumentary
Upon inspection of the skin there is no alteration in color.
Skin The skin is moist and bilaterally warm and within normal
turgor which snaps back before 3 seconds to its normal
position upon palpation.

Nails Upon inspection of the nails convex and with good capillary
refill time of 2 seconds. Upon inspection of the hair and
scalp, hair is evenly distributed, no infestation noted, no
lesions and no tenderness upon palpation of the scalp.

Upon inspection of the hair and scalp, hair is evenly

Hair and Scalp distributed, no scalines and no infestation noted, no primary
and secondary lesions and no tenderness upon palpation of
the scalp

HEENT

11
 Upon inspection, the head is in the midline, normocephalic
in size and shape, and no deformity.
Head Face is symmetrical, round in shape, brown in color and no
involuntary movement upon inspection.
No redness and scaling upon inspection of the scalp.
No lumps and tenderness noted upon palpation of the scalp.
The hair is equally distributed, no infestation noted upon
inspection.
Fine in texture upon palpation.
Upon inspection of the eyebrow, eyebrows are well
distributed and there’s no scalines noted
Eyes No primary primary and secondary lesions noted, no
swelling and no redness noted upon inspection of the
eyelids.
Upon inspection of the conjunctiva there’s no paleness and
no inflammations noted.
No opacities noted upon inspection of the cornea and the
lens.
The pupil is equally round, react to light and
accommodation upon inspection.
Upon inspection of the pinna, there’s no signs of any
Ears deformities, no lumps, and no primary and secondary
lesions. Position is aligned with the outer canthus of the eye.
No tenderness noted upon palpation of the pinna of the ears.
Upon the inspection of the external canal, there’s no
swelling, cerumen or any discharges noted.
Upon inspection of the nose and sinuses, it is symmetric and
Nose and Sinuses straight, no flaring, uniform in color. Mucosa is pink in
color, no lesions upon inspection.
Upon palpation of the frontal and maxillary sinus, there’s no
tenderness noted.
Upon inspection of the lips, the color is pinkish, moist, no
Mouth and Pharynx lumps, ulcers or any cracking noted.

12
 Upon inspection of the buccal mucosa, the color is pinkish,
moist and no lesions noted.
Upon inspection of the teeth, it is complete, white in color
and no dental caries noted.
Upon inspection of the gums, there’s no inflammation,
swelling, bleeding or any discoloration noted.
There’s no lumps and lesions noted in palate.
Upon inspection of the neck, there’s no presence of redness
Neck and no primary or secondary lesions noted.
No tenderness noted upon palpation of the different lymph
nodes, such as occipital, post auricular, preauricular,
submandibular, submental, anterior and posterior cervical,
deep cervical and supra clavicular. Upon palpation, the
trachea is in the midline.
No tenderness noted upon palpation of the thyroid glands.

Anterior chest Upon inspection, there’s no lesions noted and no use of accessory
and posterior chest muscles.
Upon palpation, there’s no tenderness, masses noted.
Upon percussion, it is resonance on sound.
Upon auscultation, there’s no adventitious sounds noted.
Breast and axilla Upon inspection of the breast, there’s no dimpling and retraction
and no lesions noted. No rashes and discharges of the nipple.
The areola is dark brown in color upon inspection.
Upon inspection, there’s no lesions noted.
Abdomen Linea nigra noted upon inspection starting from xiphoid process
and striae noted.
Visible pulsation noted upon inspection.
Upon auscultation of the bowel sounds, it has 20 clicks per
minutes.
Upon percussion
Upon palpation, there’s no masses, and no tenderness noted.
Female Reproductive System Upon inspecting the color is fair with her skin, no lesions, no

13
 discharges,no redness, and no swelling noted.
Upon palpitang there is no tenderness noted.

14
 Anatomy and Physiology of the Female Reproductive System

The female reproductive system functions to produce gametes and reproductive hormones, just like the male reproductive
system; however, it also has the additional task of supporting the developing fetus and delivering it to the outside world.
Unlike its male counterpart, the female reproductive system is located primarily inside the pelvic cavity. Recall that the
ovaries are the female gonads. The gamete they produce is called an oocyte.

Figure 1. Female Reproductive System. The major organs of the female reproductive system are located inside the pelvic
cavity.

External Female Genitals

The external female reproductive structures are referred to collectively as the vulva. The mons pubis is a pad of fat that is
located at the anterior, over the pubic bone. After puberty, it becomes covered in pubic hair. The labia majora (labia =
“lips”; majora = “larger”) are folds of hair-covered skin that begin just posterior to the mons pubis. The thinner and more
pigmented labia minora (labia = “lips”; minora = “smaller”) extend medial to the labia majora. Although they naturally
vary in shape and size from woman to woman, the labia minora serve to protect the female urethra and the entrance to the
female reproductive tract.

15
The superior, anterior portions of the labia minora come together to encircle the clitoris (or glans clitoris), an organ that
originates from the same cells as the glans penis and has abundant nerves that make it important in sexual sensation and
orgasm. The hymen is a thin membrane that sometimes partially covers the entrance to the vagina. An intact hymen cannot
be used as an indication of “virginity”; even at birth, this is only a partial membrane, as menstrual fluid and other secretions
must be able to exit the body, regardless of penile–vaginal intercourse. The vaginal opening is located between the opening
of the urethra and the anus. It is flanked by outlets to the Bartholin’s glands (or greater vestibular glands).

Figure 2. The Vulva. The external female genitalia are referred to collectively as the vulva.

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Vagina
The vaginais a muscular canal (approximately 10 cm long) that serves as the entrance to the reproductive tract. It also
serves as the exit from the uterus during menses and childbirth. The outer walls of the anterior and posterior vagina are
formed into longitudinal columns, or ridges, and the superior portion of the vagina—called the fornix—meets the
protruding uterine cervix. The walls of the vagina are lined with an outer, fibrous adventitia; a middle layer of smooth
muscle; and an inner mucous membrane with transverse folds called rugae. Together, the middle and inner layers allow the
expansion of the vagina to accommodate intercourse and childbirth. The thin, perforated hymen can partially surround the
opening to the vaginal orifice. The hymen can be ruptured with strenuous physical exercise, penile–vaginal intercourse, and
childbirth. The Bartholin’s glands and the lesser vestibular glands (located near the clitoris) secrete mucus, which keeps the
vestibular area moist.
The vagina is home to a normal population of microorganisms that help to protect against infection by pathogenic bacteria,
yeast, or other organisms that can enter the vagina. In a healthy woman, the most predominant type of vaginal bacteria is
from the genus Lactobacillus. This family of beneficial bacterial flora secretes lactic acid, and thus protects the vagina by
maintaining an acidic pH (below 4.5). Potential pathogens are less likely to survive in these acidic conditions. Lactic acid,
in combination with other vaginal secretions, makes the vagina a self-cleansing organ. However, douching—or washing out
the vagina with fluid—can disrupt the normal balance of healthy microorganisms, and actually increase a woman’s risk for
infections and irritation. Indeed, the American College of Obstetricians and Gynecologists recommend that women do not
douche, and that they allow the vagina to maintain its normal healthy population of protective microbial flora.

Ovaries
The ovaries are the female gonads. Paired ovals, they are each about 2 to 3 cm in length, about the size of an almond. The
ovaries are located within the pelvic cavity, and are supported by the mesovarium, an extension of the peritoneum that
connects the ovaries to the broad ligament. Extending from the mesovarium itself is the suspensory ligament that contains
the ovarian blood and lymph vessels. Finally, the ovary itself is attached to the uterus via the ovarian ligament.
The ovary comprises an outer covering of cuboidal epithelium called the ovarian surface epithelium that is superficial to a
dense connective tissue covering called the tunica albuginea. Beneath the tunica albuginea is the cortex, or outer portion, of
the organ. The cortex is composed of a tissue framework called the ovarian stroma that forms the bulk of the adult ovary.
Oocytes develop within the outer layer of this stroma, each surrounded by supporting cells. This grouping of an oocyte and
its supporting cells is called a follicle. The growth and development of ovarian follicles will be described shortly. Beneath
the cortex lies the inner ovarian medulla, the site of blood vessels, lymph vessels, and the nerves of the ovary. You will
learn more about the overall anatomy of the female reproductive system at the end of this section.

17
The Uterine Tubes
The uterine tubes (also called fallopian tubes or oviducts) serve as the conduit of the oocyte from the ovary to the uterus.
Each of the two uterine tubes is close to, but not directly connected to, the ovary and divided into sections. The isthmus is
the narrow medial end of each uterine tube that is connected to the uterus. The wide distal infundibulum flares out with
slender, finger-like projections called fimbriae. The middle region of the tube, called the ampulla, is where fertilization
often occurs. The uterine tubes also have three layers: an outer serosa, a middle smooth muscle layer, and an inner mucosal
layer. In addition to its mucus-secreting cells, the inner mucosa contains ciliated cells that beat in the direction of the uterus,
producing a current that will be critical to move the oocyte.
Following ovulation, the secondary oocyte surrounded by a few granulosa cells is released into the peritoneal cavity. The
nearby uterine tube, either left or right, receives the oocyte. Unlike sperm, oocytes lack flagella, and therefore cannot move
on their own. So how do they travel into the uterine tube and toward the uterus? High concentrations of estrogen that occur
around the time of ovulation induce contractions of the smooth muscle along the length of the uterine tube. These
contractions occur every 4 to 8 seconds, and the result is a coordinated movement that sweeps the surface of the ovary and
the pelvic cavity. Current flowing toward the uterus is generated by coordinated beating of the cilia that line the outside and
lumen of the length of the uterine tube. These cilia beat more strongly in response to the high estrogen concentrations that
occur around the time of ovulation. As a result of these mechanisms, the oocyte–granulosa cell complex is pulled into the
interior of the tube. Once inside, the muscular contractions and beating cilia move the oocyte slowly toward the uterus.
When fertilization does occur, sperm typically meet the egg while it is still moving through the ampulla.

The Uterus and Cervix

The uterus is the muscular organ that nourishes and supports the growing embryo. Its average size is approximately 5 cm
wide by 7 cm long (approximately 2 in by 3 in) when a female is not pregnant. It has three sections. The portion of the
uterus superior to the opening of the uterine tubes is called the fundus. The middle section of the uterus is called the body
of uterus (or corpus). The cervix is the narrow inferior portion of the uterus that projects into the vagina. The cervix
produces mucus secretions that become thin and stringy under the influence of high systemic plasma estrogen
concentrations, and these secretions can facilitate sperm movement through the reproductive tract.
Several ligaments maintain the position of the uterus within the abdominopelvic cavity. The broad ligament is a fold of
peritoneum that serves as a primary support for the uterus, extending laterally from both sides of the uterus and attaching it
to the pelvic wall. The round ligament attaches to the uterus near the uterine tubes, and extends to the labia majora. Finally,
the uterosacral ligament stabilizes the uterus posteriorly by its connection from the cervix to the pelvic wall.

18
The wall of the uterus is made up of three layers. The most superficial layer is the serous membrane, or perimetrium,
which consists of epithelial tissue that covers the exterior portion of the uterus. The middle layer, or myometrium, is a
thick layer of smooth muscle responsible for uterine contractions. Most of the uterus is myometrial tissue, and the muscle
fibers run horizontally, vertically, and diagonally, allowing the powerful contractions that occur during labor and the less
powerful contractions (or cramps) that help to expel menstrual blood during a woman’s period. Anteriorly directed
myometrial contractions also occur near the time of ovulation, and are thought to possibly facilitate the transport of sperm
through the female reproductive tract.
The innermost layer of the uterus is called the endometrium. The endometrium contains a connective tissue lining, the
lamina propria, which is covered by epithelial tissue that lines the lumen. Structurally, the endometrium consists of two
layers: the stratum basalis and the stratum functionalis (the basal and functional layers). The stratum basalis layer is part of
the lamina propria and is adjacent to the myometrium; this layer does not shed during menses. In contrast, the thicker
stratum functionalis layer contains the glandular portion of the lamina propria and the endothelial tissue that lines the
uterine lumen. It is the stratum functionalis that grows and thickens in response to increased levels of estrogen and
progesterone. In the luteal phase of the menstrual cycle, special branches off of the uterine artery called spiral arteries
supply the thickened stratum functionalis. This inner functional layer provides the proper site of implantation for the
fertilized egg, and—should fertilization not occur—it is only the stratum functionalis layer of the endometrium that sheds
during menstruation.
Recall that during the follicular phase of the ovarian cycle, the tertiary follicles are growing and secreting estrogen. At the
same time, the stratum functionalis of the endometrium is thickening to prepare for a potential implantation. The post-
ovulatory increase in progesterone, which characterizes the luteal phase, is key for maintaining a thick stratum functionalis.
As long as a functional corpus luteum is present in the ovary, the endometrial lining is prepared for implantation. Indeed, if
an embryo implants, signals are sent to the corpus luteum to continue secreting progesterone to maintain the endometrium,
and thus maintain the pregnancy. If an embryo does not implant, no signal is sent to the corpus luteum and it degrades,
ceasing progesterone production and ending the luteal phase. Without progesterone, the endometrium thins and, under the
influence of prostaglandins, the spiral arteries of the endometrium constrict and rupture, preventing oxygenated blood from
reaching the endometrial tissue. As a result, endometrial tissue dies and blood, pieces of the endometrial tissue, and white
blood cells are shed through the vagina during menstruation, or the menses. The first menses after puberty, called
menarche, can occur either before or after the first ovulation.

19
 Review of Related Literature

BACKGROUND:
Since episiotomy was first introduced in the 18th century its popularity has expanded. Today, the majority of first
deliveries in Israel are estimated to include an episiotomy. The benefits traditionally ascribed to episiotomy include
prevention of perineal damage and its sequelae, prevention of pelvic floor relaxation and its sequelae, and protection of the
newborn from either intracranial hemorrhage or intrapartum asphyxia.

METHODS:
We reviewed the English language literature published in the last twenty years concerning this issue. We emphasized
sources that included prospective randomized controlled trials.

RESULTS:
Episiotomy prevents anterior perineal lacerations (which carry minimal morbidity), but fails to accomplish any of the other
fetal or maternal benefits. On the other hand, the incision substantially increases maternal blood loss, the length and depth
of posterior perineal injury and the risk of anal injury.

CONCLUSION:
Based on the currently available information, routine episiotomy is no longer advisable. Its incidence must be gradually
lowered.

20
 PATHOPHYSIOLOGY

(Normal Spontaneous Vaginal Delivery)

HOST Agent
Environment
Female Therapeutic
Environment
31 years old Fertilization
G1P11001 (Union of sperm and ovum)

Zygote - Unicellular
(Intermingling of haploid paternal 23 X or Y and maternal 23 x chromosomes)

Series of Mitotic Cell division- Cleavage

(In 24 hours become two cell organism)

In 72 hours becomes 16 cell organism called Morula

Morula enters the uterus on the 3rd day through peristaltic movement

Separate into two parts by fluid from the uterus on the 4th day

The outer layer gave rise to the placenta The inner layer gave rise to the
embryo
(tromphoblast) (embryoblast)

21
 Blastocytes ataches to endometrium on the 6th day

Implantation

Embryonic development begins during second week continues

through the eighth week

3 Stages Fetal development is from ninth week

to birth

 1st stage- increase in cell number and with

elaboration of cell products New born baby via Vaginal
Delivery
with episiotomy
 2nd stage- morphogenesis/includes mass cell movement

 3rd stage- differentiation of maturation of physiologic processes

22
 MEDICAL INTERVENTIONS

a.) Treatment

After her delivery, she was admitted to the OB ward with repaired episiotomy. Post partum doctor’s orders were as follows
which
carried out:
 T = 37.4 degree celcius
 P = 80bpm
 R = 20cpm
 BP = 120/80 mmHg
 DAT (diet as tolerated)
 Ice pack over hypogastrium
 Perineal care
 Oxytocin 10 U infused to IVF and;
 Methergine i tab TID for 3 days
 Cefuroxime 50 mg BID for 1 week
 Mefenamic acid 500 mg i cap Q6h for 3 days
 Multivitamins 1 cap BID for 1 month

b.) Laboratory Exams

CBC RESULTS LIMITS

WBC 9.6 4.0-11.0
RBC 3.51 3.80-5.50
HGB 11.1 11.5-16.0
HCT 34.0 37.0-47.0
MCV 97 76-96

23
 MCH 31.7 27.0-32.0
MCHC 32.7 30.0-35.0
ROW 13.5 11.0-16.0
PCT 213 150-450
MPV 8.8 8.0-12.0
PCT 0.188 0.100-0.500
PDW 16.0 8.0-18.0

c.) Drug Study

DRUG MECHAN INDICATION CONTRAINDI SIDE/ADVERSE DRUG NURSING

ORDE ISM OF CATION EFFECTS INTERACTION RESPONSIBIL
R ACTION ITIES
Cefurox Semisynth Effectively Hypersensitivity Body as a Drug: Probenecid   Determi
ime etic treats bone and to Whole: Thrombophle decreases renal ne
second- joint cephalosporins bitis (IV site); pain, elimination of history
generation infections, and related burning, cellulitis (IM cefuroxime, thus of
cephalosp bronchitis, antibiotics; site); superinfections, prolonging its hyperse
orin meningitis, pregnancy positive Coombs' action. nsitivity
antibiotic gonorrhea, (category B), test. GI: Diarrhea, na reaction
with otitis media, lactation. usea, antibiotic- s to
structure pharyngitis/ton associated cephalos
similar to sillitis, colitis. Skin: Rash, porins,
that of the sinusitis, lower pruritus, penicilli
penicillins respiratory urticaria. Urogenital:  ns, and
. tract Increased serum history
Resistance infections, creatinine and BUN, of
against skin and soft decreased creatinine allergies
beta- tissue clearance. ,
lactamase- infections, particula
producing urinary tract rly to
strains infections, and drugs,

24
exceeds is used for before
that of surgical therapy
first prophylaxis, is
generation reducing or initiated.
cephalosp eliminating  Lab
orins. infection tests:
Antimicro Perform
bial culture
spectrum and
of activity sensitivi
resembles ty tests
that of before
cefonicid. initiatio
Preferenti n of
ally binds therapy
to one or and
more of periodic
the ally
penicillin- during
binding therapy
proteins if
(PBP) indicate
located on d.
cell walls Therapy
of may be
susceptibl institute
e d
organisms pending
. This test
inhibits results.
third and Monitor
final stage periodic
of ally

25
bacterial BUN
cell wall and
synthesis, creatinin
thus e
killing the clearanc
bacterium. e.
Partial  Inspect
cross- IM and
allergenici IV
ty injection
between sites
other beta- frequent
lactam ly for
antibiotics signs of
and phlebitis
cephalosp .
orins has  Report
been onset of
reported. loose
stools or
diarrhea.
Althoug
h
pseudo
membra
nous
colitis
(see
Signs &
Sympto
ms,
Appendi
x F)

26
 rarely
occurs,
this
potential
ly life-
threateni
ng
complic
ation
should
be ruled
out as
the
cause of
diarrhea
during
and after
antibioti
c
therapy.
 Monitor
for
manifest
ations of
hyperse
nsitivity
(see
Appendi
x F).
Disconti
nue drug
and
report

27
 their
appearan
ce
promptl
y.
 Monitor
I&O
rates and
pattern:
Especial
ly
importa
nt in
severely
ill
patients
receivin
g high
doses.
Report
any
significa
nt
changes

28
DRU MECH INDICA CONTRAIN SIDE/ADVERSE EFFECTS DRUG NURSING
G ANISM TION DICATION INTERACTION RESPONSIBILITIES
ORD OF
ER ACTIO
N
Mefe Anthran Short- Hypersensiti CNS: Drowsiness, Drug: Mefenamic acid may  Assess patients
namic ilic acid term vity to drug; insomnia, dizziness, prolong bleeding time who develop
Acid derivati relief of GI nervousness, confusion, with ORAL severe diarrhea
ve. Like mild to inflammatio headache. GI: Severe ANTICOAGULANTS, hepa and vomiting for
ibuprof moderat n, or diarrhea, ulceration, rin; may dehydration and
en e pain ulceration. and bleeding; nausea, increase lithium toxicity; electrolyte
inhibits includin Safety in vomiting, abdominal increases pharmacologic and imbalance.
prostagl g children <14 cramps, flatus, constipation, toxic activity
 Lab tests: With
andin primary y, during hepatic of phenytoin, SULFONYLU
long-term therapy
synthesi dysmen pregnancy toxicity. Hematologic: Prol REAS, SULFONAMIDES, w
(not
s and orrhea. (category C), onged prothrombin time, arfarin because of protein
recommended)
affects or lactation severe autoimmune binding
obtain periodic
platelet is not hemolytic anemia (long- displacement. Herbal: Fever
complete blood
functio established. term use), leukopenia, few, garlic, ginger, ginkgo in
counts, Hct and
n. No eosinophilia, agranulocytosi crease bleeding potential.
Hgb, and kidney
evidenc s, thrombocytopenic
function tests.
e that it purpura, megaloblastic
is anemia, pancytopenia, bone
superior marrow
to hypoplasia. Urogenital: Ne
aspirin. phrotoxicity, dysuria,
albuminuria, hematuria,
elevation of
BUN. Skin: Urticaria, rash,
facial edema. Special
Senses: Eye irritation, loss
of color vision (reversible),

29
 blurred vision, ear
pain. Body as a
Whole: Perspiration. CV: P
alpitation. Respiratory: Dy
spnea; acute exacerbation of
asthma; bronchoconstriction
(in patients sensitive to
aspirin).

DRUG MECHA INDICATI CONTRAINDI SIDE/ADVERSE DRUG NURSING

ORDE NISM ON CATION EFFECTS INTERACTION RESPONSIBILITIES
R OF
ACTION
Mether Ergot Routine Hypersensitivity GI: Nausea, Drug: PARENTERAL  Monitor vital signs
gin alkaloid manageme to ergot vomiting (especially SYMPATHOMIMETIC (particularly BP) and
that nt after preparations; to with IV S, other ERGOT uterine response
induces delivery of induce labor; doses). CV: Severe ALKALOIDS, TRIPTA during and after
rapid, placenta use prior to hypertensive episodes, NS add to pressor parenteral
sustained and for delivery of bradycardia. Body as effects and carry risk of administration of
tetanic postpartu placenta; a Whole: Allergic hypertension; amprena methylergonovine
uterine m atony, threatened phenomena vir, delavirdine, efavir until partum period
contracti subinvolut spontaneous including shock, enz, indinavir, nelfina is stabilized (about
on that ion, and abortion; ergotism. vir, ritonavir, and saqu 1–2 h).
shortens hemorrhag prolonged use; inavir may decrease
 Notify physician if
third e. With uterine sepsis; metabolism
BP suddenly
stage of full hypertension; of ergot derivatives.
increases or if there
labor and obstetric toxemia;
are frequent periods
reduces supervisio lactation.
of uterine relaxation.
blood n, may be
loss. used
during
second
stage of

30
 labor.

DRUG MECHA INDICATIO CONTRAINDI SIDE/ADVERSE DRUG NURSING

ORDER NISM OF N CATION EFFECTS INTERACTION RESPONSIBILITIES
ACTION
Multivita Essential Vitamin A History of CNS: Irritability, Drug: Mineral  Evaluate dosage with
mins for deficiency sensitivity to headache, oil, cholestyramine  consideration of
normal and as vitamin A or to intracranial may decrease patient's average
growth dietary any ingredient hypertension absorption of daily intake of
and supplement in formulation, (pseudotumor vitamin A. vitamin A. Take
developm during hypervitaminosi cerebri), increased dietary and drug
ent of periods of s A, oral intracranial pressure, history (e.g., intake
bones and increased administration bulging fontanelles, of fortified foods,
teeth, for requirement to patients with papilledema, dietary supplements,
integrity s, such as malabsorption exophthalmos, self-administration
of pregnancy, syndrome. Safe miosis, or prescription drug
epithelial lactation, use in amounts nystagmus. Metabol sources). Women
and infancy, and exceeding 6000 ic: Hypervitaminosis taking oral
mucosal infections. IU during A syndrome contraceptives tend
surfaces, Used as pregnancy (malaise, lethargy, to have significantly
and for replacement [category A abdominal high plasma vitamin
synthesis therapy in (category X if discomfort, anorexia, A levels.
of visual conditions >RDA)] is not vomiting),
 Monitor therapeutic
purple that affect established. hypercalcemia. Mus
effectiveness.
necessary absorption, culoskeletal: Slow
Vitamin A
for visual mobilization growth; deep, tender,
deficiency is often
adaptatio , or storage hard lumps
associated with
n to the of vitamin A (subperiosteal
protein malnutrition
dark. (e.g., thickening) over
as well as other
Synthetic steatorrhea, radius, tibia, occiput;
vitamin deficiencies.
fat- severe migratory arthralgia;
It may manifest as
soluble biliary retarded growth;
night blindness,
vitamin obstruction, premature closure of
restriction of growth

31
available liver epiphyses. Skin: Gin and development,
for cirrhosis, givitis, lip fissures, epithelial alterations,
clinical total excessive sweating, susceptibility to
use as gastrectomy drying or cracking of infection, abnormal
retinol or ). Used in skin, pruritus, dryness of skin,
retinol skin increase in skin mouth, and eyes
esters. disorders pigmentation, (xerophthalmia)
Formulati [e.g., massive progressing to
on folliculosis desquamation, brittle keratomalacia
includes keratosis nails, (ulceration and
vitamin A (Darier's alopecia. Urogenital necrosis of cornea
as well as disease), : Hypomenorrhea, G and conjunctiva),
its psoriasis]; I: Hepatosplenomeg and urinary tract
precursor however, aly, calculi.
s. other jaundice. Endocrine
retinoids are : Polydipsia,
being polyurea. Hematolo
preferentiall gic: Leukopenia,
y selected. hypoplastic anemias,
Also used as vitamin A plasma
a screening levels >1200 IU/dL,
test for fat elevations of
malabsorpti sedimentation rate
on. and prothrombin
time. Body as a
Whole: Anaphylaxis
, death (after IV use).

32
 Nursing Theory Applicable To Care Patient
DOROTHEA OREM’S SELF CARE DEFICIT MODEL

The Orem model of nursing was developed between 1959 and 2001 by Dorothea Orem and is also known as the

'Self Care' Model of Nursing. It is particularly used in rehabilitation and primary care settings where the patient is

encouraged to be as independent as possible.

Central Philosophy

The Orem model is based upon the philosophy that all "patients wish to care for themselves.”

Self Care Requisites

Self-care requisites are groups of needs or requirements that Orem identified. They are classified as; Universal self-

care requisites (those needs that all people have), Developmental self-care requisites (those needs that relate to

development of the individual), Health deviation requisites (those needs that arise as a result of a patient's condition)

Self Care Deficit (This consists of three related theories)

Theory of self-care

The Self -care theory postulates that self-care and the self-care of dependents are learned behaviors that individuals

initiate and perform on their own behalf to maintain life, health, and well-being. The individual's ability to perform self-

33
 care is called self-care agency. Adults care for themselves, whereas infants, the aged, the ill and the disabled require

assistance with self-care activities.

Theory of self-care deficit

Self-care deficit theory teaches that people benefit from nursing because they have health-related limitations in

providing self-care. Limitations may result from illness, injury, or from the effects of medical tests or treatments. Two

variables affect these deficits: self care agency (ability) and therapeutic self-care demands (the measures of care required to

meet existing requisites). Self-care deficit results when self-care agency is not adequate to meet the known self-care

demand.

Theory of nursing system

Nursing system theory suggests that nursing systems form when nurses prescribe, design, and provide nursing that

relates the individual's self-care capabilities and meets therapeutic self-care requirements.

Three nursing systems exist within the model:

Compensatory System-nurse provides total care. Example, Mr X is an elderly bedridden patient who suffered a fall after

an episode of confusion. He has an indwelling foley catheter; continuous tube feeds via gastric tube and O2 running at

2l/min via nasal cannula.

34
Partially compensatory system- nurse & patient share responsibility for care. Example, Mrs Y has been discharged

home after a mastectomy. Her wound has become infected and the District Nurse is visiting daily to change her dressings.

Educative-development system-client has primary responsibility for personal health, with nurse acting as a

consultant. Example, Miss Z has smoked for 20 years, is overweight and is now on anti-hypertensive medication. She

takes her medication as prescribed, has joined a smoking cessation group and is following a healthy, more balanced diet to

aid her weight loss.

35
List of Nursing Diagnosis

1. Disturbed sleeping pattern related to pain and discomfort on perineum secondary to labor and
delivery.
2. Anxiety related to hospitalization and upcoming delivery process.
3. Altered Comfort: Pain related to bearing down efforts and distention of the perineum.

36
 Functional Health Pattern

Usual Functional Health Pattern Initial Appraisal

1. Health-Management-Health Concept Pattern February 01, 2010
√Client verbalized that her health in the past was good. √ Date of admission: January 31, 2020 at 4:15 pm
√ Client verbalized that her health now was the same like before. √ Vital signs:
√ Client verbalized the use of exercise and proper diet to stay T- 37.4°C
health P-80 bpm
and to prevent disorders. R-20 cpm
√ Client verbalized the use of proper breastfeeding to her newborn BP-120/80mmHg
child to stay health. √Attendingphysician:[Link]
√ Client verbalized the use of adequate nutrition both to her √
newborn child and to herself. GeneralImpression:Receivedclientlyingonbed,awake,conscious,c
√ Client verbalized the used of proper diet for weight control oherentandresponsivewithongoingIVFofD5LR1literatthelevelof9
√ Client verbalized the complete immunizations before. 00ml⁺oxytocinregulatedat30-
√ Client verbalized that she used to visit dental clinic for some [Link]
exam. d.
√ Client verbalized the used of BSE before her pregnancy until √ Chief complains:
her delivery. •Client verbalized pain on her genital area.
√ Client verbalized no history of hospitalization before • Client verbalized, “Hapdoskaayuakongtahiugmangihiko”.
√ Client described her pain as normal as it was related to her √ Doctor's order:
delivery. Medications
√ The client was able to received pain reliever and antibiotics as 7:24 am
her treatments. • Cefuroxime 50mg BID x 1 week
√ Client verbalized that she was able to follow instructions given • Mefenamic acid 500 mg 1 cap q6hrs
to her. •Methergin 1 tab TID x 3 days
√ Client verbalized no difficulty in caring for herself, her family, •Multivitamins 1 cap BID x 1 month
their home, and their financial concerns and to her newborn child.
√ Client verbalized that she preferred to lay down that to sit.

37
2. NUTRITIONAL-METABOLIC PATTERN
Typical daily food intake:

√ Client verbalized that she had her soft diet 24 hours after the
Breakfast delivery.
1 cup rice
1 bowl of vegetables √ Client verbalized no difficulty in eating, swallowing liquids,
1 paksiw of fish chewing and feeding self.

Lunch Breakfast
1 cup rice 1 cup rice
1 fried fish 1 bowl of vegetable soup
Half bowl of vegetable soup 1 fried of fish

Dinner
1 cup rice
1 dried fish √ Client verbalized the used of fluid intake after delivery.
1 bowl of vegetable soup √ Skin when touched is smooth and warm
√ Perspiration noted but without odor.
Snacks
Junkfoods
Biscuits
Chocolates √ Client verbalized that she had her breakfast taken without
difficulties.
Usual fluid intake √ Client verbalized no difficulty in eating
Water
Milk Usual fluid intake
Coffee Water
√ Client verbalized that her appetite is good. Milk
√ Client verbalized no indigestion, sore throat, or nausea
√ Client verbalized no food restrictions except for drinking soft
drinks.

38
√ Client verbalized no used of food supplements.
√ Client verbalized an additional kilo of weight during the 6
months pregnancy.
√ Client verbalized no difficulty in eating, swallowing liquids,
chewing and feeding self.

3. ELIMINATION PATTERN
BLADDER
√ Client verbalized no difficulty in urinating
√ Client verbalized no used of any assistive devices when √ Client verbalized that she was able to eliminate urine after
urinating. hours of delivery.
BOWEL √ Client verbalized no difficulty in urination.
Time- morning/afternoon/evening
Frequency- 2/day √ Client verbalized that she had not yet done eliminating feces.
Color- brown √ Client verbalized that she had farted 3 times after hours pf
Consistency-formed delivery.
Pattern- morning/afternoon/evening √ Client verbalized no difficulty in bowel elimination.
√ Client verbalized no used of any assistive devices during bowel
elimination.

4. ACTIVITY-EXERCISE PATTERN
√ Client verbalized the household chores as her usual daily
activities of daily living. √ Client verbalized the used of walking as her exercise after
√ Client verbalized that she is a school teacher. sometime of delivery.
Exercise pattern √ Client verbalized no difficulty in walking as her exercise for
Type: walking some time.
Frequency: everyday
√ Client verbalized that she watches movies during her leisure
time.
√ Client has no complaints of dyspnea or fatigue.

39
 √ Client verbized no difficulty in falling asleep.
5. SLEEP-REST PATTERN √ Client verbalized that she was able to bare the pain and fall
Usual sleep pattern asleep.
Bedtime- 8pm
Hours slept-10 hours √ Client verbalized that she has no problem in sleeping aferbreast
Sleep aids- none feeding of her newborn child.
Sleep routine8pm-6am
√ Client verbalized no problems in falling asleep.

√ Client verbalized no deficits in sensory perception like hearing,

6. COGNITIVE-PERCEPTUAL PATTERN sight, and in touch.
√ Client verbalized no deficits in sensory perception like hearing, √ Client verbalized that she was able to hear clearly.
sight, and in touch. √ Client verbalized that she was able see clearly and nothing has
√ Client verbalized no used of eyeglasses and or hearing aids. changed.
√ Client verbalized no complaints of any pain aside from pain
related to episiotomy.
√ Client was able to read and write as asked and observed.

7. SELF-PERCEPTION PATTERN √ Client verbized that she was more focus on taking care of her
√ Client verbalized that she was most concerned to her family’s new born child
health. √ Client verbalized that she will be more happy seeing her family
√ Client verbalized that her present health goal isto have a good healthy.
health everyday
√ Client described herself as a better mother and a good wife to
her family.
√ Client verbalized that being ill does not feel differently about
herself.

40
8. ROLE-RELATIONSHIP PATTERN √ Client verbalized no difficulty in speaking.
COMMUNICATION √ Client verbalized that she can speak 3 languages.
√ Client was able to speak Cebuano, tagalong, and English. √ Client verbalized no used of any devices when speaking.
√ Client’s speech was clear as observed.
√ Client does not need to assess when speaking, writing, and
gestures as she was speaking normally. √ Client verbalized that she had no problem living problem living
with her mother-in-law and its family members.
RELATIONSHIPS √ Client verbalized that when she had problems, she was ble to
√ As observed, the client’s speech was clear. turn herself to her family in times of need.
√ Client verbalized that she was living with her mother-in-law and √ Client verbalized that she finds safety and comfort living with
its husband and children. her mother-in-law and its family members.
√ Client verbalized that she turn to her family in times of needs.
√ Clients verbalized no complaints in living with her mother-in-
law and its family members.

√ Client verbalized that she had no sexual contact anymore at 4

months of pregnancy until the delivery as her husband was not in
9. SEXUALITY-SSEXUAL PATTERN their home.
√ Client verbalized no changes in her sexual relationship as they √ Client verbalized no plan in taking any contraceptives after her
both have no problems or complaints of any sexual dysfunctions. child was born.
√ Client was able to understand the sexual functioning as
observed.

√ Client verbalized that she preferred to make a decision alone

10. COPING-STRESS MANAGEMENT PATTERN but sometimes she need others in times of need.
√ Client verbalized that she prefers to be alone when making √ Client verbalized that when problem comes, she think
decisions. positively to overcome that problems.
√ Client verbalized no loss in her life for the past year. √ Client verbalized that soft communication from the staffs helps
√ Client verbalized that she liked herself as a positive thinker. her felt safety and comfort.
√ Client verbalized no plan in changing her life.
√ Client verbalized that when she have a problem she solved it by

41
herself alone.
√ Client verbalized that therapeutic approached from the nurses’
gives safety and comfort to her during hospitalization..
√ Client verbalized that her strength becomes stronger when she
11. VALUE-BELIEF PATTERN delivered her new born child.
√ Client verbalized that she found her source of strength from her √ Client verbalized that being faithful to god can help her to
family and friends. become a better mom for her child and a better wife to her live in
√ Client verbalized that God is important to her and so was her partner.
religion. √ Client verbalized that her moral beliefs became more stronger
√ Client verbalized normal religion practices like praying and after experiencing some challenges recently.
attending mass.
√ Client verbalized that her moral beliefs has been challenged
recently.

42
 Nursing Care Plan
Cues/Evidences Nursing Scientific Explanation Objectives Intervention Rationale Evaluation
Diagnosis
Subjective: Altered An episiotomy is a cut Short term: Independent: After 2 hours of
comfort: Acute (incision) through the 1. Encourage the client to 1. To help ease the pain, giving holistic care to
√ Client verbized of pain related to area between your After 2 hours of do sitz bath using warm promote healing, and give the patient, the patient
experiencing pain. surgical vaginal opening and nursing water with the assistance good hygiene to the perineal was able to met the
√ "Sakit akong incision your anus. This area is intervention the of her significant others. area. goals:
kinatawo tungod sa secondary to called the perineum. patient will be able
tahi, dayun hapdos episiotomy This procedure is done to meet the goal: 2. Advice client to do 2. To help the client prevent
pod ug mangihi ko", wound to make your vaginal perineal care every from infection and provides a. Goal met: client's
as verbalized by the opening larger for a. The client will morning. fast healing. pain was subsided.
client. childbirth. verbalized that the
[References pain has subsided. 3. Encourage client to take 3. This will help the client b. Goal met: absence
Episiotomy. (2003, a bath every morning. to have a proper hygiene. of facial grimace
Objective/s: September 4). b. Absence of facial
• Facial grimace Wikipedia, the Free grimacing Dependent: 1. This will serve as an c. Goal met:absence
noted Encyclopedia. 1. Administer Cefuroxime antibacterial that prevent of perspiration.
• Perspiration noted Retrieved March 1, c. Absence of 50mg BIDx1week as client from infection.
2020, from perspiration ordered.
[Link] 2. This will help to relieve
.org/wiki/Episiotomy] [Link] Mefenamic pain experiencing by the
acid 500mg 1cap q6hrs as client.
ordered.
3. To support immunity and
3. Administer energy for moms, and also
Multivitamins 1 cap BID x provide nutrients for babies
1 month as ordered by the who are being breastfed.
doctor.
Health Education:
√ Educate the client about
the importance of sitz

43
 bath, perineal care and
proper hygiene.

Annotated Readings Related To Disease Condition

Normal Spontaneous Vaginal Delivery (NSVD)

What is a NSVD?
Vaginal delivery is the method of childbirth most health experts recommend for women whose babies have reached full
term. Compared to other methods of childbirth, such as a cesarean delivery and induced labor, it’s the simplest kind of
delivery process.
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. Labor opens, or dilates, her cervix to at least 10
centimeters.

These are the three stages of labor that signal a spontaneous vaginal delivery is about to occur:
1. Contractions soften and dilate the cervix until it’s flexible and wide enough for the baby to exit the mother’s uterus.
2. The mother must push to move her baby down her birth canal until it’s born.
3. Within an hour, the mother pushes out her placenta, the organ connecting the mother and the baby through the
umbilical cord and providing nutrition and oxygen.

What are the complications of NSVD?

Some problems (complications) that women develop during pregnancy can cause problems during labor or delivery. For
example, preeclampsia (high blood pressure with protein in the urine) may lead to premature detachment of the placenta
from the uterus (placental abruption) and problems in the newborn.
Some problems develop or become obvious during labor or delivery. Such problems include

 Amniotic fluid embolism (the fluid that surrounds the fetus in the uterus enters the woman’s bloodstream,
sometimes causing a life-threatening reaction in the woman)

44
  Shoulder dystocia (the fetus's shoulder lodges against the woman's pubic bone, and the baby is caught in the birth
canal)
 Labor that starts too early (preterm labor) or too late (postterm pregnancy)
 Labor that progresses too slowly
 Prolapsed umbilical cord (the umbilical cord comes out of the birth canal before the baby)
 Nuchal cord (the umbilical cord is wrapped around the baby's neck)
 A fetus that is too large to pass through the birth canal (pelvis and vagina)—called fetopelvic disproportion

When complications develop, alternatives to spontaneous labor and vaginal delivery may be needed. They include

 Artificial starting of labor (induction of labor)

 Forceps or a vacuum extractor (called operative vaginal delivery) to deliver the baby
 Cesarean delivery
Some problems occur immediately after delivery of the fetus, around the time the placenta is delivered. They include

 Excessive uterine bleeding at delivery

 A uterus that is turned inside out (inverted uterus)
 Uterine rupture
Fetal distress, respiratory distress in the newborn, and uterine rupture are uncommon complications of labor (Erica
Cirino,& Julie S. Moldenhauer , MD 2019).

45
CONCLUSION

This case study has made us better as nursing students. We have learned detailed information about the NSVD. Upon
making this case study, we relied on each other to contribute their best just make it better. Time is one of our biggest issues
because we have little time to do so much.

We would like to mention in this case study that, “God is good”. Despite all the constraints we have to face, we managed to
overcome it. If we just made this study just for the sake of requirement, we couldn’t have gotten to this point.

It is important to know the signs and symptoms of having NSVD to prevent from having any serious complications.
We also therefore conclude that NSVD is a very serious and life threatening condition when not manage properly.

46
 Bibliography
Book/s:

Pillitteri, A. (2013). Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. Lippincott
Williams & Wilkins.

Internet:

Episiotomy. (2003, September 4). Wikipedia, the Free Encyclopedia. Retrieved March 1, 2020, from
[Link]
Pathophysiology of Nsvd. (n.d.). Scribd. [Link]
Ncp Episiotomy Wound. (n.d.). Scribd. [Link]
METHYLERGONOVINE MALEATE. (n.d.). Welcome to [Link] – Rob Holland's Personal Webspace and Online
Notebook. [Link]

47