5 hours PTA, Patient noted sudden onset of watery vaginal discharges, clear associated with intermittent hypogastric pain every 5-10 minutes thus consult • Patient History • General Objectives • Specific Objectives • Anatomy and Physiology • Laboratory and Diagnostics • Nursing Care Plan • Drug Study • Discharge Summary

1. Prepared by: Beldas C.J, Benolirao A.N, Berong R.
BSN 2-B
CARE OF
MOTHER,
CHILD, and
ADOLESCENT
RELATED LEARNING EXPERIENCE CASE 5 PRESENTATION

2. NAME:
G.M.R
AGE: 26
GENDER: Female
BIRTH DATE:
01-08-1994
ADDRESS:
Talisay
MARITAL STATUS:
Married
NATIONALITY: Filipino
RELIGION:
Catholic
BP: 130/80
HR: 92
RR: 24
TEMP: 37.1
WEIGHT: 117 lbs
CHIEF COMPLAINT(S):
Watery
Vaginal Discharge
G₁P₀ Pregnancy Uterine
39 ⁴/₇ weeks AOG,
cephalic, in labor
GDM – diet controlled
Epilepsy
FH – 20 cm
FHT- 140
EFW – 2, 945 grams
6 cm dilated. 80% eff.
PATIENT DATA
SUMMARY
ADMITTING IMPRESSION
BACKGROUND
5 hours PTA, Patient noted sudden onset of watery vaginal discharges,
clear associated with intermittent hypogastric pain every 5-10 minutes
thus consult
Date of Admission: 6-17-20 (5:09 AM)
Attending Physician: DR. Ubal

3. GENERAL
OBJECTIVES
Students will gain understanding of the role of the
midwife in normal midwifery within a multidisciplinary
team, acquire insight to provision of holistic care to the
mother, child and family throughout pregnancy, labor
and puerperium, and able to show appropriate attitude
towards the clinical instructor, staff nurses, patient and
significant others.

4. SPECIFIC
OBJECTIVES
 Define the problem;
 Review the anatomy and physiology of the case
presented;
 Identify etiology of the underlying problem;
 Provide effective care for patient during hospital stay;
 Be knowledgeable about hospital’s protocols and
nurse’s roles;
 Increase the level of awareness and understanding
regarding the patient’s case;
 Able to render nursing skills applicable to the case of
the patient.
 Efficiently create FDAR and NCP.

5. ANATOMY and PHYSIOLOGY
PLACENTA
is an organ that develops in your uterus
during pregnancy. This structure
provides oxygen and nutrients to your
growing baby and removes waste
products from your baby's blood.
AMNIOTIC FLUID
is the protective liquid contained by the
amniotic sac of a gravid amniote. This fluid
serves as a cushion for the growing fetus, but
also serves to facilitate the exchange of
nutrients, water, and biochemical products
between mother and fetus.
UMBILICAL CORD
is the tube-like structure that carries food and
oxygen from a mother to their baby while
pregnant. It also carries waste products away
from the baby so the mother's body can get
rid of them.
VAGINA
it serves three purposes: organ of intercourse,
birth canal, and exit of blood during
menstruation.
CERVIX
is the lower part of the uterus that opens into
the vagina. During childbirth, the cervix
expands about 4 inches (10 centimeters) so
the baby can travel from the uterus through
the vagina and into the world.

6. PATHOPHYSIOLOGY
Before a baby is born, the amniotic sac breaks open, causing amniotic fluid to gush out or, less commonly, to slowly leak. When this
happens before contractions start, it is called prelabor rupture of membranes (PROM). PROM can occur at any time during pregnancy.that
your body is preparing to go into labor. Premature rupture of the membranes (PROM) creates a dilemma for the practicing obstetrician,
because once the membranes have broken the risk of fetal or maternal infection, or both, increases.
Rupture of the membranes near the end of pregnancy (term) may be caused by a natural weakening of the membranes or from the
force of contractions. Before term, PPROM is often due to an infection in the uterus. Other factors that may be linked to PROM include the
following: Low socioeconomic conditions (as women in lower socioeconomic conditions are less likely to receive proper prenatal care),
sexually transmitted infections, such as chlamydia and gonorrhea, previous preterm birth, vaginal bleeding, cigarette smoking during
pregnancy

7. PATHOPHYSIOLOGY
● PROM is associated with malpresentation, possible weak areas in the amnion and chorion, subclinical infection, and, possibly,
incompetent cervix.
● Basic and effective defense against the fetus contracting an infection is lost and the risk of ascending intrauterine infection, known as
chorioamnionitis, is increased.
● The leading cause of death associated with PROM is infection.
● When the latent period (time between rupture of membranes and onset of labor) is less than 24 hours, the risk of infection is low.

8. PATHOPHYSIOLOGY
Complications associated with premature rupture of the membranes are:
● Chorioamnionitis causing premature labour and preterm birth.
● Chorioamnionitis causing fetal distress and perinatal death.
● Cord injury secondary to severe oligohydramnios (low amniotic fluid) or cord prolapse
● Placental detachment causing premature labour.
● Pulmonary hypertension and pulmonary hypoplasia, which cause severe breathing difficulties in preterm infants if membrane rupture
occurs during the 2nd trimester of pregnancy.
These complications are avoided by close medical supervision and by the administration of treatments specific to these conditions.

9. LABORATORY TESTS
NORMAL
RANGE
PATIENT’S RANGE SIGNIFICANCE/ INTERPRETATION
06-17-2020
COMPLETE
BLOOD COUNT
4.4-11
37.0-80.0
10.0-50.0
0.0-12.0
0.0-7.0
0.0-2.5
4.5-5.1
12.3-15.3
35.9-44.6
80-96
27.5-33.2
32.0-36.0
11.6-14.8
150-450
6.0-11.0
11.0-22.0
0.15-0.40
44.0-140.0
18.0-50
WBC: 11.24
10/mm3
NEU: 81.30%
LYM: 11.80%
MON: 6.10%
EOS: 0.50%
BAS: 0.30%
RBC: 3.62
10/mm3
HGB: 11.50g/dL
HCT: 34.0%
MCV: 93.90 um
MCH: 31.70 pg
MCHC: 33.80g/dL
RDW: 14.30%
PLT: 132.0
10/mm3
MPV: 10.0 um3
PDW: 17.3 um3
PCT: 0.13%
P-LCC: 41.0
10/mm3
P-LCR: 31.40%
• Most components are within normal range. However,
WBC and NEU are high, while the RBC, HGB, HCT, PLT,
PCT, and P-LCC are low.
• Low RBC indicates a vitamin B6 or B12 deficiency. For
pregnant women, it occurs due to loss of blood.
• Low HGB & HCT are caused by few RBCs indicating
Anemia
• Low PLT indicates gestational thrombocytopenia. It
affects 1 in 10 pregnant women and develops in mid-
late gestation.
• Low PCT & P-LCC indicate symptoms of a bacterial
infection, such as a viral infection.
• High WBC indicates an infection the body is trying to
fight off. For maternal women, it indicates the body
going through a lot of stress during gestation.
• High NEU indicates the bone marrow's response to
the increased production of red blood cells. It’s not
dangerous to the body nor to the fetus.

10. LABORATORY TESTS
NORMAL
RANGE
PATIENT’S RANGE SIGNIFICANCE/ INTERPRETATION
URINALYSIS
CHEMICAL
EXAMINATION
MICROSCOPIC
EXAMINATION
Yellowish color
clear/slightly cloudy -
1.005-1.030
Albumin – N
pH - 4.5 - 7.2
Ketone – N
Blood – N
Glucose – N
Nitrate:- N
Bilirubin – N
Urobilinogen: N -2-4
WBC’s -4
RBC -1-5 squamous
(EC)
• Small amounts
• Rarely Seen in
microscopic exam
Yellow -30 ML
Hazy -1.010
Albumin: Trace
pH: 6.5
Ketone: 2+
Blood: 1+
Glucose: N
Nitrate: N
Bilirubin: N
Urobilinogen: N
WBC: 1-4/ HPF
RBC: 1-3/HPF
Epithelial cells: FEW Mucus
threads: RARE Bacteria:
MODERATE
• Normal
• Hazy/Cloudy indicates mild dehydration.
• Normal
• Normal.
• Most results are within the normal range. However,
presence of ketones and blood are detected which
are indicative of diabetes ketoacidosis and urinary
tract infection.
• Normal.
• The results are within the normal range, and no signs
of bladder or kidney infections, neither any bacterial
urinary infections.

11. LABORATORY TESTS
NORMAL
RANGE
PATIENT’S RANGE SIGNIFICANCE/ INTERPRETATION
IMMUNOLOGY
HEMATOLOGY:
BLOOD TYPING
NONREACTIVE
NONREACTIVE
NONREACTIVE
RBC Transfusion: O
negative
HIV ½: NONREACTIVE
SYPHILIS: NONREACTIVE
HBsAg(QUALITA TIVE):
NONREACTIVE
-BLOOD TYPE: O -RH:
NEGATIVE
• Normal
• These result in terms for her Immunology
Examination (HIV, SYPHILIS, HBsAg) are within the
normal range, and no complications are seen prior to
the procedure.
• Normal.
• These results will determine if a person is type A, B,
AB, or O and if he or she is Rh negative or positive. The
results will tell the healthcare provider what blood or
blood components will be safe for the person to
receive

12. DIAGNOSTIC TESTS
PATIENT’S RESULTS SIGNIFICANCE/ INTERPRETATION
ULTRASOUND:
19W0D
ULTRASOUND:
34W5D
1.) PLACENTA: ANTERIOR, HIGH
LYING
2.) GRADE: 2
3.) PRESENTATION: CEPHALIC 4.)
FHB: 141 BPM
5.) AMNIOTIC FL: 5.12 CM
1.) PLACENTA: ANTERIOR, HIGH
LYING
2.) GRADE: 2
3.) PRESENTATION: CEPHALIC 4.)
FHB: 152 BPM
5.) AMNIOTIC FL: 10.3 CM
• Normal placental positioning. Occurs when the placenta grows in the
front of the uterine wall, which is not typically a cause for concern and
does not affect the outcome of a pregnancy.
• Normal amniotic fluid index is 5 cm - 25 cm. Less than 5 cm indicates
oligohydramnios, and greater than 2cm is considered polyhydramnios.
• Normal placental positioning. Occurs when the placenta grows in the
front of the uterine wall, which is not typically a cause for concern and
does not affect the outcome of a pregnancy.
• Normal amniotic fluid index is 5 cm - 25 cm. Less than 5 cm indicates
oligohydramnios, and greater than 2cm is considered polyhydramnios.

13. PROBLEM PRIORITIZATION
02
01 03
Hypogastric pain related to uterine
contractions
Patient must be capable of doing things
without alteration or pain. Pain causes
changes to client’s homeostasis and can
affect treatment and cooperation of client.
Risk for trauma or suffocation
related to cognitive limitations or
altered consciousness
Patient’s cognitive limitations or altered
consciousness could slow down her
recovery. It could also cause trauma or
injury to both the patient and her
newborn.
Risk for infection related to
pregnancy as evidenced by
inadequate secondary defenses
Inadequate secondary defenses increases
risk of patient in developing infection
which can lead to a life-threatening
condition called sepsis and will hinder
patient recovery.
04
Risk for maternal infection related to
rupture of amniotic membranes. as
evidenced by onset watery vaginal
discharges
Patient must be free of any signs of infection
as infection may hinder patient’s recovery
and may lead to more serious complications

14. NURSING CARE PLAN
DEFINING
CHARACTERISTICS
NURSING
DIAGNOSIS
SCIENTIFIC
ANALYSIS
PLAN OF CARE
NURSING
INTERVENTION
RATIONALE
Subjective
• Patient noted soaked
underwear.
• Onset watery vaginal
discharge.
• Hypogastric pain
radiating to
lumbosacral area.
• Uterine contractions
every 30 minutes.
• Patient reported
minimal whitish
discharges at fornix
area, foul smell.
Objective:
BP: 90/60
HR: 96
RR: 19
T: 36.5
O2: 98%
Weight: 63kg
Risk for maternal
infection related
to rupture of
amniotic
membranes. as
evidenced by
onset watery
vaginal discharges
Premature Rupture of
the Membranes
(PROM) is a
complication occurring
during pregnancy in
which the mother’s
membranes rupture
(this is commonly
referred to as the
“water breaking”)
more than an hour
before labor begins.
PROM puts unborn
babies at risk of not
getting enough oxygen
because their
umbilical cord
becomes compressed,
as well as becoming
infected and
experiencing other
dangerous
consequences.
Short term:
Within 8 hours patient will:
• Gain knowledge about
the infections.
• Report problems about
the matter, if there is
any.
• Demonstrate a
meticulous hand
washing technique.
Long term:
At the end of
hospitalization,
• To be free to the signs
of infection
Independent:
1. Monitor vital signs,
and white blood cell
(WBC) count, as
indicated.
2. Demonstrate good
hand washing
techniques.
3. Monitor and describe
the character of
amniotic fluid.
4. Encourage perineal
care after elimination
and prn as indicated;
change underpad/
linen when wet.
1. The incidence of
chorioamnionitis (intra-
amniotic infection)
increases within 4 hours
after rupture of
membranes, as
evidenced by elevations
of WBC count and
abnormal vital signs.
2. Reduces risk of
acquiring/spreading
infective agents.
3. The amniotic fluid during
an infection becomes
thicker and yellow-
tinged and has a foul-
smelling odor.
4. Reduces risk of
ascending tract infection.

15. One complication
associated with PROM
is the maternal
infection: Without the
protection of the
amniotic sac, maternal
infections can be easily
transmitted to the
baby, potential leading
to sepsis, meningitis,
and permanent brain
damage.
Reference:
https://nurseslabs.com/
acute-pain/
Collaborative:
1. Provide oral and
parenteral fluids, as
indicated.
2. Obtain blood cultures if
symptoms of sepsis are
present.
Reference:
36 Labor Stages, Induced and
Augmented Labor Nursing
Care Plans Paul Martin- By-
Paul Martin
https://nurseslabs.com/labor-
stages-labor-induced-
nursing-care-plan/#a4
Collaborative:
1. Maintains hydration and a
general sense of well-
being.Relief of pain
facilitated by other
therapeutic intervention.
2. Detects and identifies
causative organism(s).
Reference:
36 Labor Stages, Induced and
Augmented Labor Nursing Care
Plans Paul Martin- By-Paul
Martin
https://nurseslabs.com/labor-
stages-labor-induced-nursing-
care-plan/#a4

16. NURSING CARE PLAN
DEFINING
CHARACTERISTICS
NURSING
DIAGNOSIS
SCIENTIFIC
ANALYSIS
PLAN OF CARE
NURSING
INTERVENTION
RATIONALE
Patient noted to trace
intermittent leaking
hypogastric pain
radiating at the back
Hypogastric pain
r/t uterine
contractions
Acute pain is an
unpleasant sensory
and emotional
experience arising
from actual or
potential tissue
damage or described
in terms of such
damage; sudden or
slow onset of any
intensity from mild to
severe with
anticipated or
predictable end and a
duration of <6 months.
Reference:
https://nurseslabs.co
m/acute-pain/
Short term:
Within 8 hours patient will:
• Verbalize sense of
comfort
• Reports that pain
subsides
• Appear relaxed, able to
sleep or rest
appropriately
Long term:
At the end of
hospitalization,
• SO(s) will be able to
learn ways in assisting
pt.
• Pt. demonstrate use of
relaxation activities and
skills.
Independent:
1. Monitor V/S
2. Perform pain
assessment each time
pain occurs
3. Provide or promote
nonpharmacological
pain management.
e.g. quiet
environment, calm
activities, comfort
measures, relaxation
techniques
4. Encourage adequate
rest periods
5. Encourage presence of
parents/SO(s), during
painful procedures
1. To have a baseline data,
identify pt. status and to
monitor for any
irregularities
2. To demonstrate
improvement in status or
to identify
condition/developing
conditions
3. To lessen pt.
discomfort/pain
4. Prevent fatigue that can
impair ability to manage
or cope with pain
5. Provide comfort to pt.

17. Collaborative:
1. Collaborate treatment
of underlying condition
or diseases processes
during pain and
proactive management
of pain.
2. Give medication
ordered by physician.
3. Discuss with family or
SO(s) ways in which
they can assist pt. with
pain management.
4. Provide accurate and
honest information to
pt. and SO
Reference:
Doenges, Moorhouse, C:
Diagnoses, prioritized
interventions, and relations
15th edition.Philadelphia,
Pennsylvania.F.A.Davis
Company
1. Allow health professionals
to integrate collaborative
plan, which will enhance
patient's condition.
2. Relief of pain facilitated
by other therapeutic
intervention.
3. Family or SO(s) may
provide assistance when
demonstrating or using
relaxation techniques, or
by taking on patient's
strenuous activities,
supporting timely pain
control.
4. Provides emotional
support and lessens
anxiety.

18. DEFINING
CHARACTERISTICS
NURSING
DIAGNOSIS
SCIENTIFIC
ANALYSIS
PLAN OF CARE
NURSING
INTERVENTION
RATIONALE
• G₁P₀ Pregnancy
Uterine 39 ⁴/₇ weeks
AOG, Cephalic, in
labor, PROM
• 6cm - dilated
• Epilepsy
Risk for trauma or
suffocation
related to
cognitive
limitations or
altered
consciousness
Epilepsy is a central
nervous system
(neurological) disorder
in which brain activity
becomes abnormal,
causing seizures or
periods of unusual
behavior, sensations,
and sometimes loss of
awareness. Epilepsy
affects both males and
females of all races,
ethnic backgrounds
and ages.
Short term:
• Pt will verbalize
understanding of
factors that contribute
to the possibility of
trauma and or
suffocation and take
steps to correct the
situation.
• Pt will demonstrate
their understanding of
individual risks and
reasons for specific
interventions.
• Pt will demonstrate
behaviors & lifestyle
changes to reduce risk
factors & protect self
and fetus from injury.
Long term:
• Pt will maintain
treatment regimen to
control or eliminate
seizure activity.
• Pt will be free of
preventable injury or
complications.
Independent:
1. Explore with the
patient the various
stimuli that may
precipitate seizure
activity.
2. Discuss seizure
warning signs and
usual seizure
patterns.
3. Keep padded side
rails up with the bed
in the lowest
position.
4. Evaluate need for
protective gear
5. Maintain strict bed
rest if prodromal
signs or aura
experienced.
6. Turn head side to
side or suction
airways as
indicated.
7. Cradle head, place
on soft area, or
assist to floor if out
of bed.
Independent:
1. Influences the scope and
intensity of interventions to
manage the threat to
safety.
2. Enables patient to protect
self from injury and
recognize changes that
require notification of
physician and further
intervention. Knowing what
to do when a seizure occurs
can prevent injury or
complications and
decreases SO’s feelings of
helplessness.
3. Minimizes injury should
seizure occur while patient
is in bed.
4. Use of helmet may provide
added protection for
individuals during aura or
seizure activity.
5. Patient may feel restless to
ambulate or even defecate
during aura phase, that
inadvertently removing self

19. 8. Reorient patient
following seizure
activity.
Collaborative:
1. Administer
medication as
indicated.
2. Monitor CBC,
electrolytes, and
glucose levels.
References:
https://nurseslabs.com/s
eizure-disorders-nursing-
care-plans/
from safe environment and
easy observation.
6. Help maintain airway.
7. Gentle guiding of
extremities reduces risk of
physical injury.
8. Patient may be confused,
disoriented after seizure
and needed help to regain
control and alleviate
anxiety.
Collaborative:
1. AEDs raise the seizure
threshold by stabilizing
nerve cell membranes,
reducing the excitability of
the neurons, or through
direct action on the limbic
system, thalamus, and
hypothalamus, which is to
suppress seizures with the
lowest dose of a drug &
with few side effects.
2. Identifies factors that
aggravate or decrease the
seizure threshold.
References:
https://nurseslabs.com/seizure-
disorders-nursing-care-plans/

20. DRUG STUDY
NAME OF THE
DRUG
MECHANISM OF
ACTION
INDICATION/S
SIDE EFFECTS/
ADVERSE
REACTION
NURSING
RESPONSIBILITIES
GENERIC NAME:
Levetiracetam
BRAND NAME:
Keppra
Keppra XR
Spritam
CLASSIFICATION:
Anticonvulsant
ACTUAL DOSAGE,
ROUTE, FREQUENCY:
500mg/tab 1 tab BID PO
Levetiracetam’s novel
mechanism of action is
modulation of synaptic
neurotransmitter release
through binding to the synaptic
vesicle protein SV2A in the
brain.
REFERENCE:
https://www.ncbi.nlm.nih.gov/p
mc/articles/PMC2526377/#:~:tex
t=Levetiracetam%20is%20an%20
antiepileptic%20drug,protein%20
SV2A%20in%20the%20brain.
• Partial-Onset Seizures
• Myoclonic Seizures in Patients
with Juvenile Myoclonic
Epilepsy
• Primary Generalized Tonic-
Clonic Seizures
CONTRAINDICATION/S:
• Hypersensitivity to
Levetiracetam
• Immunocompromised
• Poor renal function
• CNS: asthenia,
headache,
somnolence, dizziness,
depression, vertigo,
paresthesia,
nervousness, hostility,
emotional lability,
ataxia, amnesia,
anxiety.
• EENT: diplopia,
sinusitis, pharyngitis,
rhinitis.
• GI: anorexia.
• Hematologic:
leukopenia,
neutropenia.
• Musculoskeletal: pain.
• Respiratory: cough,
infection.
BEFORE:
• Ensure patient is not allergic to
levetiracetam or other
anticonvulsants.
DURING:
• Observe for signs of adverse
effects.
• Monitor fluid balance closely.
• Reduce dosage or discontinue if
renal failure occurs.
• Do not administer the injection
undiluted via the intravenous
route
• Do not administer any other
medications containing alcohol.
AFTER:
• Assess and document any signs of
seizure activity
• Instruct client to avoid alcohol
• Do not discontinue abruptly after
long-term use - withdrawal
symptoms may occur.

21. DRUG STUDY
NAME OF THE
DRUG
MECHANISM OF
ACTION
INDICATION/S
SIDE EFFECTS/
ADVERSE
REACTION
NURSING
RESPONSIBILITIES
GENERIC NAME:
Cefuroxime
BRAND NAME:
Altoxime
CLASSIFICATION:
Cephalosphorins
ACTUAL DOSAGE,
ROUTE, FREQUENCY:
500mg 1 tab BID x 6
days PO
Cefuroxime, like the penicillins,
is a beta-lactam antibiotic. By
binding to specific penicillin-
binding proteins (PBPs) located
inside the bacterial cell wall, it
inhibits the third and last stage
of bacterial cell wall synthesis.
Cell lysis is then mediated by
bacterial cell wall autolytic
enzymes such as autolysins; it
is possible that cefuroxime
interferes with an autolysin
inhibitor.
REFERENCE:
https://go.drugbank.com/drugs/
DB01112
• Lower Respiratory Tract
Infections
• Urinary Tract Infections
• Skin and Skin-Structure
Infections
• Septicemia
• Meningitis
• Gonorrhea
• Bone and Joint Infections
CONTRAINDICATION/S:
Patients with known allergy to
the cephalosphorin group of
antibiotics
• Nausea
• Vomiting
• Diarrhea
• Strange taste in the
mouth
• Stomach pain
• Dizziness
• Drowsiness
BEFORE:
• Assess history of hepatic and renal
impairment, lactation, pregnancy
• Assess skin status, LFTs, renal
function tests, and sensitivity tests
• Culture infection, and arrange for
sensitivity tests before and during
therapy if expected response is
not seen
DURING:
• Give oral drug with food to
decrease GI upset and enhance
absorption.
• Have vitamin K available in case
hypoprothrombinemia occurs.
• Discontinue if hypersensitivity
reaction occurs.
AFTER:
• Avoid alcohol while taking this
drug and for 3 days after because
severe reactions often occur.

22. • You may experience these
side effects: Stomach upset
or diarrhea.
• Report severe diarrhea,
difficulty breathing, unusual
tiredness or fatigue, pain at
injection site.

23. DRUG STUDY
NAME OF THE
DRUG
MECHANISM OF
ACTION
INDICATION/S
SIDE EFFECTS/
ADVERSE
REACTION
NURSING
RESPONSIBILITIES
GENERIC NAME:
Multivitamins with Iron
BRAND NAME:
Stresstabs
CLASSIFICATION:
Multivitamins with
minerals
ACTUAL DOSAGE,
ROUTE, FREQUENCY:
1 cap OD x 3 months
Multivitamins and minerals is a
combination of many different
vitamins and minerals that are
normally found in foods and
other natural sources.
Multivitamins and minerals are
used to provide substances
that are not taken in through
the diet. Multivitamins and
minerals are also used to treat
vitamin or mineral deficiencies
caused by illness, pregnancy,
poor nutrition, digestive
disorders, certain medications,
and many other conditions.
REFERENCE:
https://www.drugs.com/mtm/m
ultivitamins-and-
minerals.html/DB01112
Multivitamins + Iron (Stresstabs)
is indicated for the prevention
and treatment of Vitamin B-
complex, Vitamin C, Vitamin E
and Iron deficiencies during
periods of stress.
CONTRAINDICATION/S:
Patients with known allergy to its
active ingredients or other
components of the product.
• Signs of an allergic
reaction, like rash;
hives; itching; red,
swollen, blistered, or
peeling skin with or
without fever;
wheezing; tightness in
the chest or throat;
trouble breathing,
swallowing, or talking;
unusual hoarseness; or
swelling of the mouth,
face, lips, tongue, or
throat.
• Very upset stomach or
throwing up.
• Severe diarrhea.
• Very bad constipation.
• Muscle weakness.
• Numbness and tingling.
BEFORE:
• Assess patient for signs of
nutrition deficiency prior to and
throughout therapy.
DURING:
• Instruct to notify side effects of
medications to physician.
AFTER:
• Encourage to comply on
medications.
• Encourage patient to comply with
physicians’ recommendations.
• Explain that the best source of
vitamins is a well balanced diet
with foods from the 4 basic food
groups.
• Advise parents not to refer to
chewable multivitamins for
children as candy

24. DISCHARGE
SUMMARY
Patient G.M.T, 26, female, noted sudden onset
of watery vaginal discharges, clear associated
with intermittent hypogastric pain, every 5-10
minutes thus consult.
OBJECTIVE DATA
MGH by Doctor’s order June 18, 2020
ASSESSMENT/NURSING DIAGNOSIS
Hypogastric pain related to uterine contractions
PLANNING
Provide health teachings, drug therapy education, and
encourage adequate rest.
DATE OF ADMISSION:
06/17/2020
DEPARTMENT:
OB-Gyne
ATTENDING PHYSICIAN:
Dr. Ubal

25. OUTPUT REFERRAL
FF-up via call/viber to OB Department phone after 1 week
DIET
Soft diet; Balanced and healthy meal: Transition to regular
DAT
EVALUATION
Patient able to perform self-care activities.
ACTIVITY
Avoid strenuous activities and have adequate rest.
MEDICATION
Cefuroxime (Altoxine) 500mg 1 tab OD x3 months
Tramadol + Paracetamol (Altotram) 37.5mg/3.25mg tab 1 tab
TID as needed for pain
Multivitamins + Iron (OB CARE) 1 cap OD x 3 months
Calcium (OSTEA-D) 1 tab OD x 3 months
Lactulose 30 ml OD HS x 2 weeks
ENVIRONMENT
Clean and stress free
HEALTH TEACHINGS
Instruct necessity of take-home medications. Monitor for
signs of infection. Instruct for bed rest and importance of
breastfeeding. Temperature monitoring and healthy diet.

26. Does anyone have any questions?
THANK
YOU