Davao Doctors College, Inc.

College of Allied Health Sciences

Nursing Program

NRG 203: CARE OF MOTHER, CHILD, AND ADOLESCENT (WELL CLIENTS);

ANTEPARTUM PERIOD

Getting to Know the Course Instructor

Hello! I am PRINCESS FABRIENNE T. PANGANIBAN,
RN, I will be your instructor for NRG 203: CARE OF
MOTHER, CHILD, AND ADOLESCENT (WELL
CLIENTS), ANTEPARTUM PERIOD.

Before we begin, let me to introduce myself. I am

Ma’am Cess, a faculty member of the Nursing Program
of Davao Doctors College, Inc. I am a Part-time
Clinical Instructor and a proud alumna of DMMA
College of Southern Philippines, with a degree of
Bachelor of Science in NURSING. I finished BS in
Secondary Education at Rizal Memorial College and
my master’s degree in Nursing at Davao Doctors
College, Inc with
Master of Arts in Nursing Major in Clinical Management. I teach subject: Maternal
Child Nursing and Pharmacology.

I have Professional Nursing Experience in Davao Medical School Foundation Hospital, 5 years
Human Resource experience and 2 years Teaching Experience and these honed my patience
and understanding of the diverse culture and learners. I am exposed in the Respi ward, Medical-
Surgical area, OB wards, and Pediatric Ward.

For this semester, I will be your instructor for NRG 203: CARE OF MOTHER, CHILD, AND
ADOLESCENT (WELL CLIENTS); ANTEPARTUM PERIOD. I am looking forward to guiding you
in learning this course well. If you want to reach me for any academic-related concerns, you can
reach me through the following:

Contact No: (per request)

Facebook account: Cess Panganiban
E-mail address: [email protected]
Consultation hours: Thurs 8 – 10AM

Introduction to the Course

The course NRG 203: CARE OF MOTHER, CHILD, AND ADOLESCENT (WELL CLIENTS),
ANTEPARTUM PERIOD deals with concepts, principles, theories and techniques of nursing care
management of a well mother and fetus during antepartum period. In this course, you are
expected to provide nursing care to a well mother utilizing the nursing process. Presented below
are the specific details of this course:
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Course
NRG 203
Number:

Course Credits

No of Hours
(Lab):

Placement: 2nd year, First Semester

Prerequisite: NRG 201

Schedule: MTW / ThFS 7-1/1-7

GOOGLE CLASSROOM:
Classroom: CLASS CODE:

Requirements in Completing the RLE Activities

Since most of our sessions for this semester will be delivered through distance/blended learning
activities, the submissions will also be done online. To do this, you need to have access to the
following applications:

1. Microsoft Office/Google Docs

2. Google Classroom
3. Google Meet (or any other teleconferencing app, duly agreed by the whole class)
4. Internet connectivity

Please expect that you might need to print some parts of the worksheets in this module (i.e.,
documentation and transcribing parts). If any difficulties in participating in synchronous classes
are encountered, inform your instructor right away! For absences, secure an excuse slip from
your RLE supervisor.

Submissions must be submitted through the Learning Management System (LMS) so that it will
be traced and secured easily.

Daily Activities
Every week, you are expected to follow through the following deliverables:

Day 1 (Monday/Thursday) Day 2 (Tuesday/Friday) Day 3 (Wednesday/Saturday)

Virtual Circle Virtual Circle
Completion of Module, to be
submitted within the day Receiving of Handover Case Presentation (cont.)
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MODULE 1:
CARE OF WELL MOTHER AND FETUS; ANTEPARTUM PERIOD

Preparation of PPT Case Presentation Weekly Quiz and Discussion of

Presentation Module and Quiz Answers

Orientation of Next Week’s

Activity

Now that you are done acquainting yourself with the instructor and the course itself, please
proceed to Module 1: Care of Well mother and fetus; Antepartum Period

Term: First Semester S.Y. 2021-2022

Dates: Week 7- September 15 - 17, 2022
Class Schedule: 7 - 1 PM
No. of Hours: 6 hours/day

Instructions
The case analysis manuscript may be handwritten or computer written. Observe pagination.
Once done, send the compilation of your group’s answers to your clinical instructor.

After the submission, prepare a PPT presentation for your case presentation slated for Days 2 and
3 of your RLE classes. Each member of the group is expected to present during the case
presentations.

Learning Outcomes
At the end of this module, you are expected to:
1. Utilize the nursing process in the care of well mother and fetus during antepartum period.
2. Perform a holistic health assessment based on the case scenario presented.
3. Utilize assessment information to formulate a patient-centered plan of care.
4. Explain appropriate nursing interventions per problems identified.
5. Apply bioethical concepts/principles, core values, and nursing standards in the care of
clients.
6. Document the care rendered to assigned patient in the simulated health care record
accurately.
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As you start with this module, you are free to consult and coordinate with your assigned
clinical instructor. Be sure to get his/her email address and contact number for collaboration
and assistance. Just keep going! You can do it! 😊

STEPPING IN

Hello, future nurse! 😊

Welcome to your first module. You had your discussion on Fertilization and Fetal growth and
development from your concepts in Maternal and Child Nursing, and to nursing procedures
addressing care of mother during antepartum period. And just recently, you started knowing the
physiology, diagnostics, medical and nursing management of these patients with these concerns.
Let us have a review of these concepts and see how much you recall.

A. Review on the Process of Fertilization and Fetal Growth and Development:

To kick things off, let us start by answering the following questions.

Part 1: ANATOMY OF THE FEMALE REPRODUCTIVE SYSTEM. Label the external female
reproductive system. Write your answers on the spaces provided.

1. Mons Pubis

2. Clitoris

3. Labia Majora

4. Labia Minora

5. Vaginal Opening
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6. Fallopian Tubes

7. Ovary

8. Cervix

9. Uterus

10. Vagina

Part 2: FETAL DEVELOPMENT. Match the definition in column A with the related terms involved
in fetal growth in column B. Write the letter of your BEST answer on the spaces provided before
each number.
COLUMN A COLUMN B
C 1. From implantation to 5–8 weeks A. Ovum
A 2. From ovulation to fertilization B. Fetus
E 3. From fertilization to implantation C. Embryo
B 4. From 5–8 weeks until term D. Age of viability
D 5. The earliest age at which fetuses survive if they are E. Zygote
born is generally accepted as 24 weeks or at the point a fetus
weighs
more than 500–600 g.
J 6. It is the union of an ovum and a spermatozoon. F. Decidua
H 7. It is the attachment of the fertilized egg or blastocyst to G. Chorionic villi
the wall of the uterus at the start of pregnancy.
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G 8. It is a membrane full of blood vessels that surrounds H. Implantation

the embryo.
F 9. It is a term refers to the uterine endometrium that I. Placenta
continues to grow in thickness and vascularity during pregnancy.
I 10. It is a temporary organ which plays critical roles in J. Fertilization
facilitating nutrients, gas and waste exchange between mother
and the fetus.

Part 3: MATERNAL HORMONES. Write the words TRUE if the statement is correct. However, if
the statement is incorrect, change the underlined word by writing the correct word or term on the
spaces before each number in order to make the statement correct.

TRUE 1. Estrogen is the hormone that maintains pregnancy.

Prolactin 2. Human Placental Lactogen promotes mammary gland
growth in preparation for lactation in the mother.
TRUE 3. Progesterone reduce the contractility of the uterus during
pregnancy, thus preventing premature labor.
TRUE 4. The first placental hormone produced, Human Chorionic
Gonadotropin, can be found in maternal blood and urine as
early as the first missed menstrual period (shortly after
implantation has occurred).
TRUE 5. Relaxin inhibits uterine contractility and softens the collagen
in body joints which helps in the enlargement 0f birth canal.
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STEPPING IN

B. CONCEPT MAP OF WELL MOTHER AND FETUS DURING ANTEPARTUM

PERIOD Instruction: Trace the milestones of fetal growth and development
from the first to the last trimester; maternal physiologic changes; and indicate
the nursing management on these periods to achieve the optimum well-being
of the fetus and the mother. Follow the diagram below: Note: Please base
your answer on the case scenario.

Patient Information: Signs and Symptoms of Pregnancy

Name: Daisy Mercedes Presumptive Probable Positive
Age: 19 y/o
 Amenorrhea  Abdominal  (+) fetal heart
EDD: 40 weeks
AOG: 40 weeks  Fatigue Enlargeme tone
LMP: October 25, 2021  Voiding nt  Fetal movement
Present Complaint: Extreme  Frequency  Goodell’s sign felt by the
abdominal pain and leaking on  Breast  Hegar’s sign examiner
her vagina  Tenderness  Braxton hicks  Visualization of
 Skin changes  Ballottement the fetus by
 Quickening  (+) Pregnancy ultrasound
 Chadwick’s Test
sign
Milestone of Fetal Growth and
Development

1st Trimester Milestone

-Nail beds are forming on 1. Tylenol may be given;
fingers and toes 1. Breast advise to wear a more
-Some reflexes, such as Tenderness supportive bra.
Babinski reflex are present 2. Palmar 2. Use calamine lotion
-Spontaneous movements are Erythema 3. Vitamin B6 supplements and
possible 3. Nausea, doxylamine; advise to eat
-Bone ossification centers Vomiting, crackers, avoid oily food
begin to form Constipation 4. Advise to increase sleep, rest,
-Tooth buds are present , Pyrosis eating a balanced meal, increase
-Uterine secretions begins but 4. Fatigue water intake
may not yet be evident in the 5. Muscle 5. Calcium supplemtnes and
Cramps magnesium lactate may be
amniotic fluid
6. Frequent advised
- Sex is distinguishable on
Urination
outward appearance 6. Advise to do Kegel exercises to
The heartbeat is audible relax muscles
through Doppler technology
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2nd Trimester Milestones

1. Muscular /  Tylenol may be used;
-Meconium is present as far as the Skeletal advised to squat rather
rectum 2. Ankle Edema than bend, encourage
3. Headache to walk with pelvis
-Active production of lung 4. Dyspnea tilted forward
surfactant begins 5. Braxton hicks  Advise to rest in a left
-Eyelid, previously fused since 12th Contractions side lying position and
week, now open; pupils react to light 6. Emotional avoid constricting
Changes clothes
Hearing can be demonstrated by  May take Tylenol;
response to sudden sound avoid activities
causing
eyestrain/tension
1. Muscular /  Teach breathing
3rd Trimester Milestones
Skeletal exercises, good
-Fetus kicks actively, sometimes 2. Ankle Edema posture
hard enough to cause the mother 3. Headache  Advise to relax
considerable discomfort 4. Dyspnea  Encourage to establish
5. Braxton hicks good communication
-Fetal hemoglobin begin its Contractions with loved ones
conversion to adult hemoglobin 6. Emotional
Changes

ONSET OF LABOR
-Vernix caseosa starts to decrease
after infant reaches 37 weeks
gestation and may be more
apparent in the creases than the
covering of the body as the infant
approaches 40 weeks or more
-Fingernails extend over fingertips.
-Creases on the soles of the feet
cover at least 2/3 of the surface
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You are now ready to meet your patient for this clinical experience.

DEEP DIVE

A Case Study on the Mother and Child (Well Client);

ANTEPARTUM STAGE

Case Scenario:

Patient Daisy Mercedes was born on April 9, 2003. She was born in Mati, Davao
Oriental. Her parents died on her young age, so she was technically an orphan now and
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her distant relatives, but they could not essentially foster her due to
sometimes lives with
lack of financial stability.

She stayed at one of the government facilities in their area and spent most of her
15 years of existence. Her education was funded mainly by volunteers and charitable
foundations. At the same time, she compensated for it by means of helping in chores and
accomplishing tasks in the said foundation.

She grew up with other orphan children with questions in her mind. But to that, she
never completely disclosed herself. Patient Daisy is a victim of sexual abuse. She was
raped and was unable to resist because of her innocence and because fear to be killed.
sideinthe ward, sit silently on
She doesn’t talk that much. Often times, she paces back and forth
her bed and someti mes quietly stares outside the window. When tried to ask about what
she knows of her family, she could only turn silent, and somehow implies to ask the next
question to her.
Unfortunately, hesitancy was felt from the kind of thing that was wanted to be
discussed. The issue was not forced until her watcher, which has no relation to her,
revealed the reason behind her pregnancy.

According to Patient Daisy’s watcher, it was on a cold night in November 13, 2021,
when Miranda came home from school. Not far from the center, a man, which she can’t
identified-wearing a mask, blocked and harassed her brutally. She struggled to let go from
the ruthless hands of the unaccustomed man. Patient Miranda was threatened that if she’d
make any noise, she’d get killed. Ill-fatedly, she was held powerless to the man, and the
crime had happened. Fortunate enough that she wasn’t killed, she thanked the Lord for
sparing her life. Although alive, she felt very much unfair about her situation. She could
only tell, “Kabata pa kaayo nako nahimong inahan, nganong nahitabo man pud ni,dili pa
ko ready ug dili pa ko kabalo” .

Daisy conceived the baby. For the first trimester, she couldn’t believe and accept
her fate, could not look herself into the mirror and sometimes thought of slight curses to
the person who did the crime. But somehow, she felt some feeling of excitement of having
a baby unexpectedly. She even verbalized, “Wa naman koy mabuhat. Nahitabo nato.
Basin makasala pa ko kung ipalaglag nako ang bata.. Wala man siya’y sala.”

As the nurse was completing the health history for documentation and monitoring,
further information revealed that her LMP was October 25, 2021. No report of infection
and medications taken such Folic acid, iron supplements, and vitamins was provided by
the health care center near her place. She eats whatever that is provided in the orphanage
facility, usually she consumed vegetables and fruits, and approximately she drinks 6-8
glasses of water in a day. She sometimes experiences nightmare at sleep, during 1st
trimester and worries about her health and the growing baby.
She was a smoker and occasionally drinks alcohol since she was 14 years old but stopped
when she had known of her first pregnancy. Since then she never had a smoke or a drink.

The doctor continued the interview for patient Daisy, and she participated.
“Any history of previous hospitalization”?,doctor asks her but Miranda seems shy and too
hesitant to answer, so her watcher initiated to provide some details. “Opo doc, kapila na
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siya na hospital katong 1st and 2nd month niya na buntis kay wala kaayo naga kaon. unya
nag sige pud siya suka2x katong duha-tulo kabulan na iyang tiyan.”

“Do you have family history of hypertension? “dili ko kabalo doc”, Daisy stated.

“Do you have family History of Diabetes Mellitus? “dili ko kabalo doc”

“Do you smoke and drink alcoholic beverages? Mercedes replied, “Sa una doc, pero
katong nabal-an nako na buntis ko, ako na giundangan doc. “

“Did you try any of the following: IUD, Oral Contraceptives? “ Wala po doc.”
“Is this your first pregnancy? “Opo Doc.”

“Did you have pre-natal check-ups? “Oo doc naga regular prenatal visit ko sa dool na
health center sa among area.”

“Did you have immunization for tetanus toxoid? “Opo doc”

“What are the symptoms that you experienced while pregnant?” Mercedes claimed, “Oo
Doc katong nag sige ko suka2 tong mga 2-3 months akong tiyan, cge pud kog ihi-ihi lalo na sa
gabii, usahay magmata ra gyud ko arun mangihi. Naka experience pud ko doc ug constipation, na
medyo magsakit na akong anal area, ingon sa midwife naa daw koy haemorrhoids. Unya katong
pag 5-6 months nagalihok ug sipa na ang baby sa akong tiyan, nahadlok ko ug nalipay pud na
akong anak diay nag moved. Pag abot pud na 8 months na kapin sa bulan, gasakit na akong
breast area kay midako na siya; magsakit npud akong bat-ang lalo na kung magdugay kog
tindog, ug nagapula akong duha ka kamot na medyo katol pud.”

Past Medical History: She don’t have idea if she has had heredo-familial disease because she
was an orphan at the age of 3-4 years old, both of her parents died in vehicular accident. No other
reported diseases except for allergy to shrimps and eggs. She was only taking Cetirizine 10mg
whenever needed as per doctor’s order. She reported that she was able to complete the two
doses of her immunization given at their health care center. During the 5th months of her
pregnancy, she was diagnosed of having anemia, since then she has been taking Iron
supplement.

Gynecological History: She had her first menstruation at 12 years old. She has a regular
menstruation ever since. Usually it lasts around 4-5 days, with heavy flow. She usually changes
her pads 5-6 times a day and are really soaked in the first 3 days and moderate to light flow in the
succeeding days. She experiences menstrual cramps in the 1st 2 days of menstruation but not all
the time. Whenever she experiences the discomfort, she applied warmth compress at lower
abdomen to relieved the pain.

COMPREHENSIVE PHYSCAL ASSESSMENTS:

Vital Signs:
BP: 110/70 mmHg
Temp: 36.9°C
PR: 82-90 bpm
RR: 18- 23 bpm
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Weight: 150 lbs

Height: 5’4 inches
Blood type: A+
Fundic height: 32cms
FHT: 125 BPM via Doppler in Left upper quadrant

Inspection: Pallor noted. Neck veins are visible and no enlargement noted. A faint linea nigra and
stretch marks are still visibly noted. Breasts are asymmetric, no dimpling and discoloration noted,
nipples and areolas are dark in color, according to the patient her breast seem to appear larger
and firmer. Abdomen is globular. Lower extremities were checked and no edema was noted.
Palmar erythema noted.

Palpation: Thyroid is non-palpable; Breasts are full and tender; Outline of the fetus is identified;
Ballottement noted and fetal outline is identified.

Pelvic Examination: (+) Goodell’s sign, (+) Chadwick’s sign, (+) Hegar’s sign; patient reported
increased frequency in urination.

A. She is conscious and coherent upon interaction but answers only the questions she is
comfortable with. Most of the time, she is pacing inside the ward and appears withdrawn.

B. 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, minimal lesions were noted. Dandruff and lice were seen.

C. Assessment of the Eyes

Her eyes are symmetrical, black in color, almond shape. Pupils constricts when diverted 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.

D. Assessment of the Ears

Ears are clean, no ear wax was noted and approximately of the same size and shape. Patient
can hear normally when spoken softly.

E. 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.

F. 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.

G. Assessment of the Neck Lymph nodes noted. Neck has strength that allows movement
back and forth, left and right. Patient is able to freely move her neck. Melasma was noticeably
observed all over the neck and the cheeks.
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H. Assessment of the Lungs and Thoracic Region

No reports of pain during the inhalation and exhalation. Absence of adventitious sounds upon
auscultation. Respiratory rate 23 breathes per minute from the normal range of 16-20 breaths
per minute. Patient Miranda also stated that difficulty of breathing was experienced during
the 3rd trimester especially when lying flat on bed.

I. Assessment of the Heart

Patient has an audible heart sound. PMI is heard between 4th - 5th intercostals space. Heart
is pumping well with a pulse rate of 87 bpm from the normal rate of 60-100 beats per minute.

J. Assessment of the Abdomen

Abdominal movement as with respiration, presence of peristalsis during auscultation. Skin
pigmentation like linea nigra and striae gravidarum is noted.

K. Assessment of the Upper Extremities

Skin: brown in color; presence of small scars of wounds in the arms noted. Skin is smooth,
moist and soft to touch.
Hands: Medium in size with 5 fingernails in each side. Nails are short, clean and trimmed.
Arms: Able to move through active ROM. Able to extend arms in front or push them out to the
side.

L. Assessment to the Lower Extremities

Patient is ambulatory with wide stance when walking. Toenails are clean and trimmed. No
edema noted.

M. Assessment of the Genitourinary

Frequency of urination was observed on 1st trimester and the 3rd trimester as stated. Light
yellow colored urine in moderate amount. Sometimes she experienced constipation which
make her defecation irregular in alternate basis.

On August 4, 2022 at late evening Daisy was awaken by tense and rigid feeling of uterine
contraction that last for 3-5 minutes in irregular interval. She counted and check if it
becomes intense and regular. By early morning of August 5, 2022, Daisy complained of
extreme abdominal pain and some water leaking on her vagina. The age of gestation by
this time is 40 weeks by LMP. She cried out loud when the pain intensified, and was
brought to the nearest facility and was admitted at Mati Medical Center around 2:40 am
with blood pressure of 120/90mmHg. She was examined by Dr. Casteel and found out that
her cervix 3cm Dilated, 50% Effaced, Leaking Bag of water and the baby is on Station: -3
cephalic in presentation, with FHT of 142 beats per minute.

By 2:45am, 5 minutes after further assessment and history taking, doctor’s orders were
carried out:

Daisy is transported to Labor room to further monitor her progress of labor, by 2:55am she
was endorsed to Delivery room NOD.
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Laboratory Tests:
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Patient Name: Daisy Mercedes

Patient Name: Daisy Mercedes

TEST
“A” Rh Positive
BLOOD TYPING
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Doctors order:

DDC-0003 DAISY MERCEDES 04/09/2005 OPD DR. CASTEEL None

August 5, 2022 Order: Start IVF D5LR and regulate to 30cc/hr

@ 2:00AM VS q4
I & O qs
NPO
Hook to EFM and monitor progress of labor, watch out for
any unusualities and refer

Laboratories:
CBC, Urinalysis
Blood typing, RAT, HBsAg
Ultrasound

Medications and Vaccines:

Folic Acid 400 mcg
OD Vitamin D 400IU
OD Fe SO4 60 mg
OD
Vitamin C 70 mg OD
Tetanus toxoid vaccine 1 dose given; 2nd dose to be given
1 month after; 3rd dose 2 weeks before EDD.

DR. CASTEEL
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To immerse yourself in the care management of your patient, let us do some detailed description
of your patient care tasks. Using the Case Scenario assigned to you, you are expected to perform
the following:

1. Fill-up the needed data based on the given scenario/case. Note: Assessment findings of
all other areas must be filled up using fictional data BUT should be within the scope of the
case scenario given.
2. Conduct a history taking and physical assessment of your patient. Use BLUE pen for
normal findings and RED for abnormal findings under Review of Systems (ROS).
3. Develop a Concept Map of your patient’s condition using the Concept Map Format.
4. Present your drug study.
5. Prior to administering a patient’s medications, you are required to make a drug study of
all medications required by your patient in oral or parenteral form and document it. Select
one drug. No duplications of selected drugs for study should be made.
6. Formulate a patient-centered care plan for your patient.
7. Clinical Reasoning Questions - Collaboration: A 33-year-old female client who plans to
get pregnant was having second thoughts about getting the Sinovac vaccine. Taking into
consideration that receiving the vax has great significance in lowering down the number of
COVID-19 transmission and cases. She expressed her concern about wanting to get
pregnant but at the same time has thoughts of getting vaccinated because of fears of
being infected. Feeling uncertain about what to do and decide, she approached the nurse
vaccinator and clarify her concern. Knowing that this is a safety concern, how would you
tell this female to intervene and help her out to come up with impartiality and desired
resolution? Follow the CUS method.

CUS method: CUS a communication tool to gives interprofessional team members a

constructive approach to openly discuss an identified safety concern. (Please refer
to the link provided for your guidance on how to do CUS:
https://youtu.be/4VFPfgbk0z8 )

8. Clinical Reasoning Questions - Ethico-Moral-Legal: Patient Miranda was uncertain the

first time she learned of her pregnancy. At an early age, a pregnancy not intended and
wanted, and made out of sexual assault and actions will likely complicate things. These
made it difficult for her to decide. She’s an orphan and her relatives were not supportive of
her condition, and treat her like no one else. She had a hard time contemplating if she will
continue the pregnancy and keep the baby, give it up and do abortion or maybe after
delivery give up the baby for adoption. If she asks you, what will I do with my baby? I am
not yet ready to embrace motherhood. No one will help me with this!
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What would be your nursing action in this situation? What ethical principle is applicable in this
scenario? Justify

DESTINATION CHECK

You are nearly done with your module!

Before we end, let us check what you have learned so far and touch the topics which have been
discussed earlier but may not have been covered in the questions asked so far [Answer in a
separate sheet].

Ideally, assessment for pregnancy begins before the pregnancy with preconception counseling.
During a preconception assessment, evaluate a woman’s overall health status, nutritional intake,
and lifestyle; identify any potential problems; and identify a woman’s understanding and
expectations of conception, pregnancy, and parenthood. The following questions:
1. What are the presumptive, probable and positive signs of pregnancy?

Presumptive Probable Positive

 Period absent  Positive pregnancy test  Fetal movements
(amenorrhea)  Returning of the fetus (ex: bouncing felt by doctor or
 Really Tired / Fatigue back of the fetus) against the fingers nurse
 Urination Increased when the uterus is pushed during  Electronic device
(Voiding Frequency) palpation. This is termed as detects fetal heart
 Movement perceived “external ballottement”. sounds (Doppler)
(Quickening)  Outline of fetus can be palpated  The delivery of the
 Skin changes  Braxton Hicks Contractions: false baby
 Chadwick’s Sign labor contractions that are not  Ultrasound detects
regular and won’t result in cervical the fetus
dilation  See visible
 A softening of the cervix “Goodell’s movement of the
Sign” …. happens around the 6-8th baby by the doctor
week of gestation or nurse
 Bluish color to the vulva, cervix, and
vagina due to increased blood
flow…. happens around 4 weeks
gestation “Chadwick’s Sign”
 Lower uterine segment (LUS)
becomes soft “Hegar’s Sign” …
happens around 6-12 week of
gestation
 Enlarged uterus
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2. What are musculoskeletal changes that occur in pregnancy? Why it happens?
- A woman's body goes through a lot of changes during pregnancy. These changes
affect the cardiovascular, endocrine, and renal systems, as well as the
musculoskeletal system. Even though this can happen at any time during pregnancy,
it may be most noticeable in the third trimester. The results of this study showed that
pain in the hands, wrists, neck, back, low back, hips, knees, and ankles and feet is
significantly worse in the third trimester than in the other two trimesters. People have
said that changes in posture and hormones, weight gain, and fluid retention may be to
be held responsible for more musculoskeletal pain in the third trimester. Pregnancy-
induced biomechanical, hormonal, and vascular changes are likely to give rise to a
wide variety of musculoskeletal problems. The enlarging uterus alters body’s center of
gravity and applies mechanical stress on the body. Joint laxity develops secondary to
hormone level fluctuations.
3. Calculate of the EED (Nagel’s Rule) and AOG of patient Xena based on the details given:
LMP- December 17, 2020. Examination date is September 3, 2021.
 EDD: SEPTEMBER 24, 2021
 AOG: 37 WEEKS AND 1 DAY

4. What is the significance of assessing a pregnant woman for the presence of Edema?
- Edema is common during late pregnancy. It typically involves the lower extremities but
occasionally appears as swelling or puffiness in the face or hands. The significance of
assessing a pregnant woman for the presence of edema is to examine with a review
of vital signs, particularly blood pressure to notice the sign and symptoms to avoid the
worst complications.

5. Leopold’s maneuver is done to assess the fetal lie, position and presentation, enumerate
the steps and rationalization in doing the Leopold’s maneuver?
These are the steps and rationale of Leopold’s maneuver
Step 1: Washes Hands
Rationale: To prevent the spreading of the microorganisms

Step 2:  Explains the procedure to the patient.

Rationale: This is done so that the client would be aware what kind of procedure
the nurses are doing

Step 3:  Let the patient empty her bladder before the procedure.
Rationale: To be able to make the assessment and procedure go smoothly and for
it to palpate better

Step 4. Positions the patient on supine with one pillow under her head and with knees
slightly flexed
Rationale: This position is appropriate to execute the procedure well to locate
better the baby’s position and presentation

Step 5. If right-handed, stands at woman's right, facing the patient and in contrary, if it is
left-handed then, stand at the left side
Rationale: Proper body position is highly needed to follow body mechanics

Step 6. Faces the patient and palpates the uterine fundus to determine what part of the
fetus lies in the upper part of the uterus. (Fundal Grip)
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Rationale: To distinguish which fetal pole engages whether podalic or cephalic
while doing the assessment in uterine fundus.

Step 7. Palpates in a downward direction on the sides of the abdomen applying gently
but deep pressure to determine the position of the fetal extremities, the fetal back and
the anterior shoulder.
Rationale: If the fetal extremities were updated instead of the back, the fetal
extremities would feel nodular and would reflect the sections of the extremities

Step 8. Place one hand over the symphysis pubis and grasp the lower uterine segment
between the thumb and fingers to feel the presenting part.
Rationale: Distinguish the presentation and position of the fetus as well as if it is
engaged or floated

Step 9. Turns and faces the women's feet to confirm the findings of the third maneuver
and determine the flexion of the vertex.
Rationale: It regulates the appropriate site in respect to the true pelvis

Step 10. Locates again for the back of the fetus and places the stethoscope over it and
listens for the fetal heart tone for one full minute.
Rationale: To determine the heartbeat of the baby is in normal condition or at
high risk

Step 11. Notes the location, rate and character of the FHT.
Rationale: To discover the condition if it is at low or high risk

Step 12. Makes the patient comfortable.

Rationale: This provides comfort to the patient after experiencing the procedure

Step 13. Documents the observation made, the fetal presentation position, attitude and
whether engaged or floating.
Rationale: This is done because serves as a reference of the health care
professionals
Have you answered all of the questions above? Great! You are now ready for to proceed to
the next part of the module

REFLECTION TIME

Reflection Time: Make a reading on personal experience of either a patient/family member/nurse

caring for a patient during antepartum period. Please do not forget the link of the article. Provide a
5 paragraph handwritten reflection. 1sT paragraph will be the introduction of your article. 2nd
paragraph will be your reflection as a Person, 3rd paragraph will be your reflection as a Student
nurse. 4th paragraph will be your reflection as a Future Health professional. Lastly the 5th
paragraph will be you conclusion about your reflections.
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Congratulations! You have completed this module. You may now proceed to the weekly quiz.
Please wait for further instructions from you instructor

References:
Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier & Erb’s fundamentals of nursing: Concepts,
process, and practice (10th ed.). Pearson Education, Inc.

Silbert-Flagg,J. & Pillitteri, A. (2018). Maternal & Child Health Nursing, Care of the childbearing &
Childrearing Family, 8th Edition. Wolter Kluwer Health

Doenges, M., Moorhouse, M. & Murr, Alice (2016). Nurse’s Pocket Guide Diagnoses, Prioritized
Interventions, and Rationales(15th Edition). F.A. Davis Company

Quigley, B., Palm, M.L., & Bickley, L. (2012). Bates’ nursing guide to physical examination and
history taking (1st ed.). Wolters Kluwer Health
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LEARNER’S WORKSHEET
Name of Student:
Section/Group:
Date: Institution:
Area:
A. Application of the nursing process
FILL-UP data completely (Put N/A if not applicable) while receiving endorsement from staff

In compliance with the Data Privacy Act, Personal Data are NOT ALLOWED in this worksheet.

Patient's Case: Labor pain Age: 19 years old Sex: Female Room/Bed#: OPD
Doctor/s: Dr. Casteel
Diagnosis: N/A Activity Restriction: N/A
Chief complaint: Abdominal pain and water leaking from vagina
Diet: Has allergies to shrimps and eggs.
Brief History (Part of #2: Assessment)
Present Illness: Patient is experiencing extreme abdominal pain with 3-5 minutes in irregular
interval and watery vaginal discharge.
Past Med/Sur: Patient experienced anemia during the 5th months of her pregnancy. She is also
allergic to shrimps and eggs.
Family: Patient does not know if she has had heredo-familial disease because she was an orphan at
the age of 3-4 years old.
OB-Gyne: Patient has a regular menstruation and duration of 4-5 days with heavy flow. LMP was
October 25, 2021. Primigravida.
Personal/Social: Patient is conscious and coherent upon interaction but answers only the questions
she is comfortable with. Most of the time, she is pacing inside the ward and appears withdrawn.
Previous Nursing Diagnoses: N/A
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Drug Study

CEDENO, JASMINE M.
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CORVERA, ROSE GRACE

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DE LEON, MIKKA YNA R.

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DELIGENCIA, ELIETA C.
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DIMA, AMELYN KIM V.

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FACTO, MICHELLE O.
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GARCIA, RUTH ANGELA I.
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GUMIRAN, KATE
SAMANTHA S.
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INFIESTO, ALHYSSA
SHANNEN M.
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KAMAD, NUR-HAIMEEN
SHAKUR A.
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Nursing Care Plan

CEDENO, JASMINE M.
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CORVERA, ROSE GRACE J.

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DE LEON, MIKKA YNA R.
 Davao Doctors College, Inc.
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DELIGENCIA, ELIETA C.
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DIMA, AMELYN KIM V.
 Davao Doctors College, Inc.
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FACTO, MICHELLE O.
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GARCIA, RUTH ANGELA I.

 Davao Doctors College, Inc.
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GUMIRAN, KATE SAMANTHA S.

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INFIESTO, ALHYSSA SHANNEN M.
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KAMAD, NUR-HAIMEEN SHAKUR A.
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Clinical Reasoning Questions

Collaboration:
C I am concerned with you wanting to get pregnant but fear
yourself to get a vaccination for COVID-19
I am uncomfortable with her being worried about getting a shot
U and wanting to have a baby at the same time. Without a
vaccine, getting pregnant could hurt you and your baby.
Still, it makes me uncomfortable that she wants to get pregnant
without getting the Sinovac vaccines. It would be bad for her
S health. I want you to talk to her about the facts and benefits of
vaccines in all situations, especially during pregnancy. Before
letting her decide whether to get vaccinated or not. The Sinovac
vaccine helps protect you and your baby. This is a safety issue

Ethico-Moral-Legal:
Nursing First, hear what she has to say. Ask her what she thinks, feels,
Action believes, values, and wants. The most essential thing is to let the
patient tell his or her story. When the patient is done telling her
whole story, the nurse's job is to give the patient correct
information about abortion and life in a compassionate and caring
way.   To help her see that there is life after pregnancy, to cheer
her on and help her grow, completing goals that take longer than
the due date. Patients have their own rights, so a doctor or nurse
should respect whatever decision the patient makes.
Ethical Autonomy is the best ethical principle in this situation. Miranda,
Principle the patient, has the freedom to choose her own path and control
Upheld her own life. Patients should be informed and provided access to
all the information they need to make medical care decisions. The
nurses have no impact on the decision of the patient. The desires
of the patient must always be considered by nurses.