The patient is a 29-year-old woman who presented for her fifth pregnancy. She has a history of hypertension during her first two pregnancies. She is admitted for mild uterine contractions and is found to be 8 cm dilated. A few hours later she is fully dilated and delivers a baby via normal spontaneous vaginal delivery. She then undergoes a bilateral tubal ligation procedure.
6. CASE SCENARIO
A 29 year old multigravida woman is admitted at ISDH – Sinait on
September 15, 2022 at 12: 22 PM due to mild uterine contractions.
Her obstetrical history revealed that she is a mother of 2 boys and 2
girls. They were all delivered normally in full term. During her first
pregnancy, she was only 17 year old and experienced hypertension and
dizziness. While on her second pregnancy, she was 20 year old and she
experienced the same illnesses just like her first pregnancy on her first
trimester. Furthermore, she was 28 year old during her third pregnancy and
she doesn’t experience any illnesses.
On September 16, 2022, IE is done at 10 AM and the patient’s cervix is
dilated at 8 cm. At 6:45 PM, another IE is done and her cervix is fully dilated.
She delivered her baby via normal spontaneous delivery. After that, she
undergone bilateral tubal ligation.
7. Introduction
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. 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.
The length of the labor process varies from woman to woman. Women giving
birth for the first time tend to go through labor for 12 to 24 hours, while women who
have previously delivered a child may only go through labor for 6 to 8 hours. There are
the three stages of labor that signal a spontaneous vaginal delivery is about to occur.
Contractions soften and dilate the cervix until it’s flexible and wide enough for the baby
to exit the mother’s uterus. The mother push to move her baby down her birth canal
until it’s born. 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.
8. Introduction
In spite of poverty, 95% of the women had spontaneous
vaginal birth; 83% had blood loss less than 500 ml; 85% of the
babies required no resuscitation effort; 67% of the labors were
without fetal distress or meconium staining; and 90% of the
babies were of normal birth weight.
For full-term pregnancies, vaginal delivery is indicated when
spontaneous labor occurs or if amniotic and chorionic
membranes rupture. In addition, for complicated gestations or for
post-term pregnancies, induction of labor is indicated, which is
also an indication for vaginal delivery.
9. GENERAL AND SPECIFIC OBJECTIVES
At the end of the shift, the student midwife should be able to enhance
their knowledge skills and attitudes in caring mother who delivered a baby
via Normal Spontaneous Vaginal Delivery.
Specific Objectives
• To broaden their knowledge for Normal Spontaneous Vaginal Delivery by
obtaining sufficient information.
• To understand the pathophysiology of Normal Spontaneous Delivery.
• To correlate the students of results of diagnostic procedure to its normal
values.
• To gain knowledge and understand the entire course of the procedure.
• To formulate an effective care plan to which the client may benefit..
• To provide patient the health education needed through health teachings.
• To formulate a post-partum discharge plan.
10. Name: Patient X
Age: 28
Sex: F
Address: Sisim, Cabugao Ilocos Sur
Religion: Roman Catholic
Marital Status: Married
Nationality: Filipino
Occupation: Housewife
Patient’s Profile
Obstetrics Score: G4 P4 (4004)
LMP: December 8, 2021
AOG: 40 weeks and 2 days
EDC: September 16, 2022
11. PAST MEDICAL HISTORY:
Patient is G4P4 (4004). No past medical history within six months.
On her first and second pregnancy, she experienced hypertension and
dizziness. While on her fourth pregnancy, she has no medical problem.
HISTORY OF PAST AND
PRESENT MEDICAL HISTORY
PRESENT MEDICAL HISTORY:
Patient undergone bilateral tubal ligation after the birth of her fourth
baby via normal spontaneous delivery.
13. HEAD-TO-TOE ASSESSMENT
Body Parts Normal Findings Abnormal Findings Technique Used Actual Findings Significance/Inter
pretation
Head Normo-cephalic without
scalp lesions.
Sensation intact over
face. No facial
asymmetry, muscles of
facial expression intact.
Hair is evenly distributed
covers the whole scalp.
No evidence of Alopecia.
Maybe thick or thin,
coarse or smooth.
Neither brittle nor dry.
Ears and nose without
deformity, external
tenderness or discharge
Hearing intact bilaterally
by rough testing (or: to
whisper
Sebaceous cysts; local
deformities from trauma;
masses; nodules
Lack of symmetry, increased
skull size with more
prominent nose and
forehead; longer mandible.
Asymmetric facial
movements (e.g., eye cannot
close completely); dropping
of lower eyelid and mouth;
involuntary facial movements
(i.e., tics and tremors)
Increased facial hair; low hair
line; thinning of eyebrows;
asymmetric features;
exophthalmos; myxedema
facies; moon face
Peri-orbital edema; sunken
eyes
Inspection, Palpation •Normo-cephalic with scalp
lesions,lice and some white
hairs.
•long hair and dry
•face uneven skin tone and
present of white spot on
forehead,left and right
cheek.
•Ears and nose without
deformity, external
tenderness or discharge.
•ears
Earwax discharge NEGATIVE
Proper hygiene
14. Body Parts Normal Findings Abnormal Findings Technique Used Actual Findings Significance/Inter
pretation
Eyes Evenly placed and in line with
each other. None protruding.
Equal palpebral fissure.
Eyelashes
Evenly distributed.
Turned outward.
Conjunctivae pink, sclerae
white, without jaundice.
No en- or exophthalmos or
ptosis of lids. External ocular
movements (EOM’s) intact
(or: full), no strabismus or
nystagmus.
Pupils equal round, react to
light and accommodation
(PERRLA).
Visual fields intact to
confrontation.
Unequal alignment and
movement of eyebrows
Eyelashes turned inward
Redness, swelling flaking,
crusting plaques, discharge,
nodules, lesions
Jaundiced sclera (e.g., in liver
disease); excessively pale
sclera (e.g., in anemia);
reddened sclera; lesions or
nodules (may indicate
damage by mechanical,
chemical, allergenic, or
bacterial agents)
Lids close asymmetrically,
incompletely, or painfully.
Rapid, monocular, absent, or
infrequent blinking between
lid
Inspection •PERRLA
•Visual fields intact to
confrontation.
•Evenly placed and in line
with each other. None
protruding. Equal palpebral
fissure.
Normal
15. Body Parts Normal Findings Abnormal Findings Technique Used Actual Findings Significance/Inter
pretation
Mouth and
Throat
Lips normal color,
without lesions.
Teeth present, good
dental hygiene.
Gums (or: gingiva) and
mucous membranes pink
without bleeding, lesions
or inflammation.
Tongue normal size and
papillation, midline
protrusion, symmetrical,
moist, possibly with a
thin, whitish coating.
Tonsils not enlarged (or:
absent),
Palate elevates
symmetrically, gag
intact.
Pallor; cyanosis
Missing teeth; ill-fitting
dentures
Excessively red gums
Blisters; generalized or
localized swelling: fissures,
crusts, or scales (may result
from excessive moisture,
nutritional deficiency, or fluid
deficit
Tongue is abnormal in size.
There is a presence of lumps
and bumps.
Brown or black discoloration
of the enamel (may indicate
staining or the presence of
caries)
Inspection
Palpation
•4 missing teeth up
•2 missing teeth down
•Tongue normal size and
papillation, midline
protrusion, symmetrical,
moist, possibly with a thin,
whitish coating.
•Tonsils not enlarged (or:
absent),
•Palate elevates
symmetrically, gag intact.
Normal
16. Body Parts Normal Findings Abnormal Findings Technique Used Actual Findings Significance/Inter
pretation
Neck Neck supple with full
range of motion (ROM).
No masses or tenderness.
Jugular venous
distension (JVD) normal.
Trachea midline.
Thyroid not palpable (or:
normal size and
consistency).
Carotic pulses full and
equal, without bruits.
Unilateral neck swelling;
head tilted to one side
(indicates presence of masses,
injury, muscle weakness,
shortening of
sternocleidomastoid muscle,
scars) muscle tremor, spasm,
or stiffness
Limited range of motion;
painful movements;
involuntary movements (e.g.,
up-and-down nodding
movements associated with
Parkinson’s disease)
Enlarged, palpable, possibly
tender lymph nodes
(associated with infection and
tumors)
Deviation to one side,
indicating possible neck
tumor; thyroid enlargement;
enlarged lymph nodes
Inspection
Palpation
•Neck supple with full range
of motion (ROM).
•No masses or tenderness.
Jugular venous distension
(JVD) normal.
•Thyroid not
palpable(normal size and
consistency).
Normal
17. Body Parts Normal Findings Abnormal Findings Technique Used Actual Findings Significance/Inter
pretation
Lymph
Nodes
Occipital, pre- and
postauricular,
submandibular, anterior
or posterior cervical, or
supraclavicular nodes.
Not swollen, enlarged or
tender. Mobile, which
means that when pressed
on they move around,
rather than fixed or
"matted".
Diminished or absent hilum,
thickened cortex, not
circumscribed margins,
increased size or interval
change.
Enlarged and tender.
Inspection
Palpation
•Not swollen, enlarged or
tender. Mobile, which
means that when pressed on
they move around, rather
than fixed or “matted”.
Normal
Chest &
back
No abnormal curvature
of spine. Full range of
motion, no muscle spasm
or tenderness.
Breasts (female)
symmetrical, normal
size; no dimpling,
masses, tenderness, or
skin changes. No nipple
deformity or discharge.
Have a spine curvature.
Restricted movement due to
frequent muscle spasm or
tenderness.
A recent increase in the size
of one breast.
Asymmetry venous pattern
There is a dimpling or
retraction that is usually cause
by a malignant tumor.
Inspection
Percussion
Palpation
Auscultation
•Enlargement of the breast
and tenderness.
•Medium white to light
brown skin.
Normal
18. Body Parts Normal Findings Abnormal Findings Technique
Used
Actual Findings Significance/Inter
pretation
Lung and
Heart
Respiratory excursions full
and symmetrical.
Lungs resonant to percussion
& vesicular breath sounds
throughout peripheral lung
fields (an accepted
abbreviation for normal lung
percussion and auscultation:
“Clear to A&P”).
No rales, ronchi, wheezes, or
rubs. Vocal and tactile
fremitus normal.
Increased (louder) breath sounds
often occur when consolidation
or compression results in a
denser lung area that enhances
the transmission of sound.
Adventitious lung sounds, such
as crackles (formerly called
rales) and wheezes (formerly
called rhonchi) are evident.
Inspection
Percussion
Palpation
Auscultation
•No rales, ronchi, wheezes,
or rubs. Vocal and tactile
fremitus normal.
Normal
Abdomen Scaphoid without scars.
General tympany
Normal bowel sounds, no
bruits.
Superficial & deep palpation
without organomegaly or
masses; no direct or rebound
tenderness, rigidity, or
guarding.
Liver edge soft (or: not
palpable), liver span 10 cm.
Spleen normal size (or: not
palpable), kidneys not
palpable
Hard stools in the colon appear
as a localized distention.
Percussion over the area
discloses dullness.
Dullness - distended bladder,
adipose tissue, fluid or a mass
hyperresonance - gaseous
distention
Presence of Bulges, masses or
hernia (enlarged liver or spleen
may show)
Lesions (surgical scars -
significant location) or rashes
present (skin breakdown: older
or obese)
Inspection
Auscultation
Percussion
Palpation
•Normal bowel sounds, no
bruits.
•Superficial & deep
palpation without
organomegaly or masses; no
direct or rebound
tenderness, rigidity, or
guarding.
•surgical OS due to her BTL
operation.
•presents of linea nigra
Proper treatment on her
surgical site.
19. Body Parts Normal Findings Abnormal Findings Technique
Used
Actual Findings Significance/Inte
rpretation
Extremities Equal in size both sides of
the body, smooth
coordinated movements,
100% of normal full
movement against gravity
and full resistance.
No deformities or
swelling, joints move
smoothly.
Normal skin temperature.
No edema, or superficial
varicosities.
No asymmetry or muscle
atrophy
Full range of motion (ROM) of
all joints.
Inguinal lymph nodes not
enlarged.
All distal pulses (or:
femoral, popliteal, PT,
and DP pulses) intact,
full, and equal; no bruits
over femoral artery.
Do not have the same contour
with the prominences of
joints
Involuntary movements,
temperature is abnormal,
color is uneven.
Cannot perform complete
range of motions
Inspection
Percussion
Palpation
•Equal in size both sides
of the body, smooth
coordinated movements,
100% of normal full
movement against gravity
and full resistance.
•No deformities or
swelling, joints move
smoothly.
•ROM
• present of scars on
lower extremities.
•Two dying nails in her
toenails
•skin color (tan color)
Proper hygiene and
grooming
20. LABORATORY AND DIAGNOSTIC PROCEDURES
Laboratory done Normal Result/Value
(Non-Pregnant)
Normal Result/Value
(Pregnant)
Interpretation
Hematology
Hemoglobin 110-150 g/L 1st Tri- 116-139 g/L
2nd Tri- 97-148 g/L
3rd Tri- 95-150 g/L
*Below normal considered
iron deficiency anemia.
*Above normal may result
blood disorder, dehydration,
heart or lung disease.
Hematocrit 37.0-47.0% 1st Tri- 31-41 %
2nd Tri- 30-39 %
3rd Tri- 28-40 %
WBC (x /L) 4.00 - 10.00 1st Tri- 6-16
2nd Tri- 6-16
3rd Tri- 6-16
*Low counts may result to
autoimmune disorders,
lymphoma or conditions that
affect bone marrow function.
RBC (x10 12/µL) 3.50-5.00 3.29 - 4.85 *Below normal may result
severe anemia.
21. Platelets (x/L) 100-300 225 -250 *below normal platelets
during pregnancy, called
thrombocytopenia, it can
cause excessive bleeding,
premature delivery.
*Increased platelet count
can give rise to serious
complications as a result
of unexplained blood
clotting.
HBSAg Negative or Nonreactive Negative or Nonreactive A "positive" or "reactive"
HBsAg test result means
that the person is infected
with hepatitis B
VDRL Non-reactive Non-reactive Indicate that the patient
does not have neurosyphilis.
22. ANATOMY AND PHYSIOLOGY OF THE ORGAN
INVOLVED
Ovaries
Ovaries are where the egg cells (ova) grow and
develop. There are two ovaries, each about the size
and shape of an almond.
The ovaries are located in the pelvis, one on each
side of the uterus. Beginning in puberty, follicle-
stimulating hormone supports the growth of egg cells
each month. The ovaries produce estrogen,
progesterone and androgens.
The fallopian tubes (uterine tubes or oviducts) connect the ovaries and the
uterus. If an egg is fertilized by a sperm cell within about 24 hours after
ovulation, the fertilized egg will travel along the fallopian tube for about seven
days until it reaches the uterus for implantation. If the egg is not fertilized, the
egg will dissolve in the fallopian tube.
These are the tubes that are blocked when female sterilization is performed.
Scar tissue in the fallopian tubes can be caused by chlamydia and gonorrhea
infection. This can lead to infertility or ectopic pregnancy. Ectopic pregnancies
occur when a fertilized egg implants outside of the uterine cavity, most often in
a fallopian tube. This can be life-threatening to a woman if not detected early.
23. ANATOMY AND PHYSIOLOGY OF THE ORGAN
INVOLVED
The uterus (womb) is a hollow organ. A fallopian tube extends from each side of the uterus. The
uterus is made up of muscular walls, an inner lining called the endometrium, and a cervix. It is
located in the pelvis between the bladder and the rectum.
The uterus plays a role in three important functions: menstruation, pregnancy, and childbirth.
If the uterus receives a fertilized egg, it provides an environment for the fertilized egg to develop
into a fetus and then the fetus to grow throughout pregnancy. Before the first pregnancy, the uterus
is about the size and shape of a pear, with the narrow portion directed down toward the vagina. After
childbirth the uterus is usually larger and it regresses after menopause.
The vagina is a muscular tube-like structure that extends from the cervix of the uterus to the
outside of the body. It is located between the rectum and the bladder. The vagina provides sexual
sensation due to its many nerve endings, especially in the outer third. It is three inches long when
not aroused and five to six inches long when aroused.
The vagina produces fluid daily to cleanse and lubricate itself and help sperm travel. The vagina
serves as a passageway for menstrual flow. It is very stretchy and can expand during sexual arousal
to receive the erect penis during intercourse, and during childbirth to allow a baby to leave the
body.
26. Assessment Planning Midwifery Intervention Rationale Evaluation
Subjective data:
“Nagpa-ligate nakon
maam. Nasakit pay laeng
tuy sugat dituy tiyan ko”
as verbalized by the
patient.
Objective data:
V/S taken as follows:
BP: 140/100
PR: 87 bpm
RR: 21 bpm
Sp02: 98%
Temp: 36.1
After 8 hours of midwife
intervention, patient will
verbalized decrease
pain. Patient will
participate in treatment,
maintain physical well
being and has ability to
manage situation.
Independent
-Establish rapport.
-Frequently monitor vital signs.
-Instruct the patient to:
-And inspect skin and observe.
-Keep the incision area clean and
supported. Properly dress the
wound.
-Have adequate rest and 8 glass of
water intake.
-Have a comfortable environment
by cleaning the bed.
-To put a pillow on the abdomen
when moving. And don’t lift heavy
objects.
-To follow good hygiene by washing
thoroughly and pat dry the incision.
-Provide additional comfort
measures like back rub and suggest
reposition from family.
-To gain trust with the patient.
-To have baseline data.
-To determine unusual ties for early intervention.
-This will assist the body’s natural process of
repair.
-Prevents fatigue and is necessary for healing.
-Calm environment helps promote decreasing
pain and discomfort.
-To protect the incision site and improve comfort.
-Clean and dry skin provides a barrier to
infection. Patting skin dry instead of rubbing
reduces fragile skin.
-Back rub improves circulation and anxiety with
pain. Reposition may relieve pain.
Goal met.
After 8 hours of
midwifery
intervention,
the patient
verbalized pain
decreased.
27. Assessment Planning Midwifery Intervention Rationale Evaluation
Subjective Data:
“Agulawak Ma’am
” as verbalized by
the patient.
Objective data:
Agitated behavior
V/S taken as
follows:
BP: 140/100
PR: 87 bpm
RR: 21 bpm
Sp02: 98%
Temp: 36.1
After 8 hours of
midwifery
interventions, the
patient will be able to
verbalize that she will
no longer feel dizzy.
Patient will maintain
Blood pressure within
individually acceptable
range to 120/80.
Independent:
Provide calm, restful surroundings,
and minimize environmental activity
and noise. Limit the number of
visitors and length of stay
Maintain activity restrictions
(bedrest or chair rest); schedule
uninterrupted rest periods; assist
patient with self-care activities as
needed.
Implement dietary sodium, fat, and
cholesterol restrictions as indicated
It helps lessen sympathetic
stimulation, dizziness; promotes
relaxation.
Lessens physical stress and tension
that affect dizziness, blood pressure
and the course of hypertension.
These restrictions can help manage
fluid retention and, with the
associated hypertensive response,
decrease myocardial workload.
Goal met:
After 8 hours of
midwifery
interventions,
the patient will
be able to
verbalize that
she will no
longer feel dizzy.
Patient will
maintain Blood
pressure within
individually
acceptable range
to 120/80.
29. NAME OF DRUG MECHANISM OF
ACTION
INDICATION CONTRAINDICATION DOSAGE ADVERSE REACTION MIDWIFE
RESPONSIBILITY
Generic Name:
KETOROLAC
Brand Name:
TORADOL
Drug Class:
KETOROLAC IS A
NON-STEROIDAL
ANTI-
INFLAMMATORY
DRUG (NSAID)
Ketorolac inhibits key
pathways in
prostaglandin synthesis
which is crucial to its
mechanism of action.
Although ketorolac is
non-selective and
inhibits both COX-1 and
COX-2 enzymes, its
clinical efficacy is
derived from its COX-2
inhibition. The COX-2
enzyme is inducible and
is responsible for
converting arachidonic
acid to prostaglandins
that mediate
inflammation and pain.
By blocking this
pathway, ketorolac
achieves analgesia and
reduces inflammation.
Ketorolac is
administered as a
racemic mixture;
however, the "S"
enantiomer is largely
responsible for its
pharmacological activity.
Ketorolac is indicated for
the short-term (≤ 5 days)
management of
moderately severe acute
pain that requires
analgesia at the opioid
level, usually in a
postoperative setting.
Ketorolac is
contraindicated in
patients with previously
demonstrated
hypersensitivity to
Ketorolac, any of its
excipients, or other
NSAIDs and patients in
whom aspirin or other
prostaglandin synthesis
inhibitors induce allergic
reactions (severe
anaphylactic-like
reactions have been
observed in such
patients). Such reactions
have included asthma,
rhinitis, angioedema, or
urticaria.
Intravenous (IV): 30 mg
as a single dose or 30 mg
every 6 hours; not to
exceed 120 mg/day
Premature closure of the
fetal ductus arteriosus
Fetal renal impairment
Inhibition of platelet
aggregation
Delay labor and delivery
Respiratory: Rhinitis,
hemoptysis, dyspnea
GI:
GI pain, diarrhea,
vomiting, nausea
CNS: Dizziness, fatigue,
insomnia, headache
Hematologic:
Neutropenia, leukopenia,
decreased Hgb or Hct,
bone marrow depression
Dermatologic:
Sweating, dry mucous
membrane, pruritus
>Don’t forget to assess
first the patient before
administering this drug:
know the history (e.g.
allergies)
->Report any signs of
itching, swelling in the
ankles, sore throat, easy
bruising, etc.
30. NAME OF DRUG MECHANISM OF
ACTION
INDICATION CONTRAINDICATION DOSAGE ADVERSE
REACTION
MIDWIFE RESPONSIBILITY
Generic Name:
FERROUS
SULFATE
Brand Name:
FER-IN-SOL/
IRON
Drug Class:
ORAL IRON
BIVALENT
PREPARATIONS
Elevates the serum
iron concentration,
and is then converted
to Hgb or trapped in
the
reticuloendothelial
cells for storage and
eventual conversion
to a usable form of
iron.
Prevention and
treatment of iron
deficiency anemias.
Dietary supplement
for iron.
Contraindicated with
allergy to any
ingredient; sulphite
allergy;
hemochromatosis,
hemosiderosis,
hemolytic anemias.
1 CAP OD CNS: CNS toxicity,
acidosis, coma and
death with overdose
GI: GI upset
anorexia, nausea,
vomiting,
constipation,
diarrhea, dark
stools, temporary
staining of teeth
(liquid preparations)
>Assess nutritional
status and dietary
history to determine
possible cause of anemia
and need for patient
teaching
>Assess bowel
function for constipation or
diarrhea. Notify health care
professional
>Assess patient
For signs and symptoms of
anaphylaxis (rash, pruritus,
laryngeal edema, wheezing).
Notify physician
immediately if these occur.
Keep epinephrine and
resuscitation equipment
close by in the event of an
anaphylactic reaction.
31. NAME OF DRUG MECHANISM OF
ACTION
INDICATION CONTRAINDICATION DOSAGE ADVERSE REACTION MIDWIFE
RESPONSIBILITY
Generic Name:
MEFENAMIC
ACID
Brand Name:
PONSTEL
Drug Class:
NONSTEROIDAL
ANTI-
INFLAMMATORY
DRUGS (NSAIDS)
Mefenamic acid
binds the
prostaglandin
synthetase receptors
COX-1 and COX-2,
inhibiting the action
of prostaglandin
synthetase. As these
receptors have a role
as a major mediator
of inflammation
and/or a role for
prostanoid signaling
in activity-dependent
plasticity, the
symptoms of pain are
temporarily reduced.
Relief of
moderate
pain, when
therapy will
not exceed
one week
Treatment of
primary
dysmenorrhe
a
Contraindicated
with
hypersensitivity
to mefenamic
acid, aspirin
allergy, and as
treatment of
perioperative
pain with
coronary artery
bypass grafting
500 mg CNS:
Drowsiness, insomnia, dizziness, nervousness,
confusion, headache.
GI:
Severe diarrhea, ulceration, and bleeding; nausea,
vomiting, abdominal cramps, flatus, constipation,
hepatic toxicity.
Hematologic:
Prolonged prothrombin time, severe autoimmune
hemolytic anemia (long-term use), leukopenia,
eosinophilia,
agranulocytosis, thrombocytopenic purpura,
megaloblastic anemia, pancytopenia, bone
marrow hypoplasia
Urogenital:
Nephrotoxicity, dysuria, albuminuria, hematuria,
elevation of BUN.
Skin:
Urticaria, rash, facial edema.
Spec Senses:
Eye irritation, loss of (reversible), blurred vision,
ear pain.
Body Whole:
Perspiration.
CV:
Palpitation.
Respiratory:
Dyspnea; acute exacerbation of asthma;
bronchoconstriction (in patients sensitive to
aspirin)
>Assess patients who develop
severe diarrhea and vomiting
for dehydration and
electrolyte imbalance.
>Discontinue drug promptly if
diarrhea, dark stools,
hematemesis, ecchymoses,
epistaxis, or rash occur and do
not use again. Contact
physician.
>Notify physician if persistent
GI discomfort, sore throat,
fever, or malaise occur
>Do not drive or engage in
potentially hazardous
activities until response to
drug is known. It may cause
dizziness and drowsiness.
>Monitor blood glucose for
loss of glycemic control if
diabetic.
>Do not breast feed while
taking this drug without
consulting physician.
32. NAME OF DRUG MECHANISM OF
ACTION
INDICATION CONTRAINDICATION DOSAGE ADVERSE
REACTION
MIDWIFE
RESPONSIBILITY
Generic Name:
CEFALEXIN
Brand Name:
KEFLEX
Drug Class:
CEPHALOS-PORIN
ANTIBIOTICS
Cephalexin is a first-
generation cephalosporin.
Cephalexin is a beta-lactam
antibiotic, meaning its
structure contains a beta-
lactam ring. In a bacterial
cell, peptidoglycan gives the
cell wall mechanical
stability. Cephalexin (and
other beta-lactam
antibiotics) use a beta-
lactam ring to inhibit the
synthesis of peptidoglycan,
which is a critical step in the
formation of the bacterial
cell wall. Specifically, the
beta-lactam binds to
penicillin-binding proteins
(PBPs), resulting in
inhibition of the last phase
of peptidoglycan synthesis,
a transpeptidation reaction
required for bacterial
peptidoglycan cross-linking.
This activity results in the
loss of cell viability and
eventually leads to bacterial
cell autolysis.
Cephalexin is an antibiotic
that is effective against
most gram-positive cocci.
Additionally, cephalexin is
effective against gram-
negative bacteria,
particularly E.
coli, Proteus mirabilis,
and Klebsiella
pneumoniae.
Cephalexin is indicated for
the treatment of acute
and chronic urinary tract
infections, gonorrhea,
upper and lower
respiratory tract
infections, scarlet fever,
beta-lactamase-producing
staphylococcal infections,
and streptococcal
septicemia.
Cephalexin is also
commonly used in
treating streptococcal and
staphylococcal skin
infection.
Cephalexin and other
cephalosporins are
contraindicated in
patients with a penicillin
allergy, as this poses an
increased risk of an
allergic reaction to
cephalexin and other
cephalosporins.
Cephalexin is also
contraindicated in
patients who have known
hypersensitivity to
cephalexin or other
medications of the
cephalosporin class.
500mg/CAP
Three times a
day
CNS: Headache,
dizziness, lethargy,
paresthesias
GI: Nausea, vomiting,
diarrhea, anorexia,
abdominal pain,
flatulence,
pseudomembranous
colitis, hepatotoxicity
GU: Nephrotoxicity
Hematologic: Bone
marrow depression
Hypersensitivity: Rang
ing from rash to fever
to anaphylaxis; serum
sickness reaction
Other: Superinfections
Cephalexin is a first-
generation cephalosporin.
Cephalexin is a beta-lactam
antibiotic, meaning its
structure contains a beta-
lactam ring. In a bacterial cell,
peptidoglycan gives the cell
wall mechanical stability.
Cephalexin (and other beta-
lactam antibiotics) use a beta-
lactam ring to inhibit the
synthesis of peptidoglycan,
which is a critical step in the
formation of the bacterial cell
wall. Specifically, the beta-
lactam binds to penicillin-
binding proteins (PBPs),
resulting in inhibition of the
last phase of peptidoglycan
synthesis, a transpeptidation
reaction required for bacterial
peptidoglycan cross-linking.
This activity results in the loss
of cell viability and eventually
leads to bacterial
cell autolysis.
33. NAME OF DRUG MECHANISM OF ACTION INDICATION CONTRAINDICATION DOSAGE ADVERSE REACTION MIDWIFE
RESPONSIBILITY
Generic Name:
OXYTOCIN
Brand Name:
PITOCIN,
SYNTOCINON
Drug Class: N/A
Oxytocin increases the
amplitude and frequency
of uterine contractions,
which transiently impede
uterine blood flow and
decrease cervical
activity, causing dilation
and effacement of the
cervix.
Oxytocin works by
increasing the
concentration of calcium
inside muscle cells that
control contraction of the
uterus. Increase calcium
increases contraction of
the uterus
If uterine atony is
highly suspected.
It is indicated for
induction of labor in
patients with a medical
indication for the
initiation of labor, such
as Rh problems,
maternal diabetes,
preeclampsia at or near
term, when delivery is
in the best interests of
mother and fetus or
when membranes are
prematurely ruptured,
and delivery is
indicated; Induce or
augment labor.
Control postpartum
bleeding and manage
incomplete or
inevitable abortion.
Except in unusual
circumstances,
oxytocin should not
be administered in
the following
conditions:
fetal distress,
hydramnios, partial
placenta previa,
prematurity,
borderline
cephalopelvic,
disproportion,and
any condition in
which there is a
predisposition for
uterine rupture.
Oxytocin
injection
USP, it is
standardiz
ed to
contain 10
units of
oxytocic
hormone/
mL and
contains
0.5%
intramusc
ularly
(IM) after
delivery
of the
placenta
1 AMP
(IM)
CNS: Maternal:
Coma, seizures Fetal:
Intracranial hemorrhage
Resp: Fetal: Asphyxia,
hypoxia
CV:
Maternal:
hypotension; Fetal:
arrhythmias
F and E: Maternal:
hypochloremia,
hyponatremia, water
intoxication
Misc: Maternal:
increased uterine
motility, painful
contractions, abruptio
placentae, decreased
uterine blood flow,
hypersensitivity.
>Safely administration of
oxytocin as ordered by the
physician
>Before starting the
infusion, make sure to
check the client’s medical
records
>Provide the client
education about how
oxytocin will affect their
contractions
>Monitor Vital Signs and
IO
>Monitor FHR Pattern
34. NAME OF DRUG MECHANISM OF ACTION INDICATION CONTRAINDICATI
ON
DOSAGE ADVERSE REACTION MIDWIFE RESPONSIBILITY
Generic Name:
Folic Acid
Brand Name:
Apo-Folic,
Folvite, Novo-
Folacid
Classification:
Nutritional
Supplement
Vitamin B complex
essential for
nucleoprotein synthesis
and maintenance of
normal erythropoiesis.
Acts against folic acid
deficiency that impairs
thymidylate synthesis
and results in production
of defective DNA that
leads to megaloblast
formation and arrest of
bone marrow
maturation.
Folate deficiency,
macrocytic anemia, and
megaloblastic anemias
associated with
malabsorption
syndromes, alcoholism,
primary liver disease,
inadequate dietary
intake, pregnancy,
infancy, and childhood.
Folic acidalone for
pernicious anemia
or other vitamin
B12 deficiency
states;
normocytic,
refractory,
aplastic, or
undiagnosed
anemia.
Therapeutic
Adult:
PO/IM/SC/I
V<1 mg/d
Child:
PO/IM/SC/I
V<1 mg/d
CV:
Peripheral vascular
thrombosis, heart
failure.
GI:
Transient diarrhea.
Respiratory:
Pulmonary edema.
Skin
itching, transitory
exanthema, urticaria.
Others:
anaphylaxis,
anaphylactoid
reactions with
parenteral
administration, pain
or burning at injection
site.
Assessment & Drug Effects
-Obtain a careful history of
dietary intake and drug
and alcohol usage prior to
start of therapy. Drugs
reported to cause folate
deficiency include oral
Contraceptives, alcohol,
barbiturates,
methotrexate, phenytoin,
primidone, and
trimethoprim. Folate
deficiency may also result
from renal dialysis.
-Keep physician informed
of patient’s response to
therapy.
-Monitor patients on
phenytoin for
subtherapeutic plasma
levels.
35. Medication
Mefenamic acid 500 mg for pain as needed
Micronutrient Supplementation: Iron 60 mg and Folate 400µg once a day for 3 months
Micronutrient Supplementation: Vitamin A 200,000 IU within 4 weeks after delivery
Colace or MiraLAX for constipation
Preparation H for hemorrhoids
For breast cracks: Lanolin ointment, Apply to nipple after breastfeeding
Economic
Medicines are given by the rhu health care worker.
Maintain quiet and pleasant environment to promote relaxation.
Treatment
Tell the client the importance of treatment to be done.
Encourage the client to continue complying with diagnostic examination to ensure that they do not have any
complications.
Monitor blood pressure at home
Instruct the client on how to perform breast self-examination.
Encourage the client to follow the Physician’s advice.
DISCHARGE PLANNING
36. Health Teaching
Uterus
By the 9th or 10th day after delivery, the uterus will no longer palpable.
If fundus is in lateral position, instruct the client to void every 2-3 hours.
If uterus is boggy or soft, instruct the client to massage the fundus in a circular motion.
Lochia
Educate the client regarding the duration of lochia and its characteristics
Lochia Rubra - Bright red in color that last for 1-3 days
Lochia Serosa - Pinkish brown in color that last for 4-10 days
Lochia Alba - Yellow white in color for 10 days to 6 weeks after delivery
• Report any abnormal characteristics of lochia such as spurting of blood in vagina that is not expected, saturated perineal
pad in less than 1 hour, lochia is malodorous or foul smelling, and large blood clot to the primary provider.
Perineum
• Instruct the client to take stool softener if constipation occurs.
• Educate about perineal care
• Advise to put ice packs (non-pharmacological pain reliever) for pain and swelling.
37. Breast
• Wash the breast daily during bathing time.
• Instruct the client not to wash the breast with soap because it may eliminate sebaceous
secretion in the breast.
• Wash or clean hands when feeding the infant.
• Advise the client to put clean cloth in the bra to absorb the moisture or breast
discharge.
Bladder
• Explain to the client that frequent urination may occur due to excess fluid accumulated
in the body during pregnancy.
• Encourage the client to urinate for every 4 to 6 hours.
Cord Care
• Keep the cord dry. Gently pat the cord dry with a towel if it gets wet during a bath.
• Keep the diaper below the cord. This helps keep the cord dry and open to the air. It also
prevents irritation from urine
38. Out-Patient Follow up
Call the primary care provider if any of these persist:
Fever
Dizziness and Fainting
Nausea and Vomiting
Shortness of breath or chest pain
Bleeding
Headache with blurred vision
Calf pain, redness or swelling
Swollen, red or tender breast nipples
Problems in urination or leaking
Increase pain in the perineum
Developing foul smelling discharge in the perineum
Redness, swelling, pain, or pus in the incision site
Severe depression or suicidal behavior
39. Diet
Advise the client to eat a higher quantity and choice of
nutritious foods, such as, meat (lean beef, fish (salmon, tuna,
hito), nuts (pistachio, almond, peanuts), whole wheat oats,
beans (garbanzos, black peas, kidney beans soy beans),
vegetables (spinach, malunggay, broccoli) fruits (orange,
banana, mango), and milk (low fat fresh milk, almond milk, soya
milk) to make her feel strong and well.
Encourage the client to drink 8 glasses of water a day.
Whenever the client sits down to feed the infant, drink a full
glass of water.
40. EVALUATION
At the end of the duty, the midwifery student able to
broaden their knowledge and understood the
pathophysiology of Normal Spontaneous Vaginal Delivery, and
correlated the results of the diagnostic procedure to its
normal values. The midwifery student also formulated an
effective care plan, health teaching, and discharge plan to
which the patient may benefit.
