Father Saturnino Urios University

NURSING PROGRAM

Butuan City

INDIVIDUAL CASE STUDY

DELIVERY ROOM EXPOSURE

(Agusan del Norte Provincial Hospital,

Butuan City)

Submitted by:

Kristella Marie C. Desiata

Submitted to:

Mrs. Oliva L. Asendente, RN, MAN

Clinical InstructoR
 INTRODUCTION

Definition of the case

A normal spontaneous vaginal delivery is dependent on the adequacy of the female pelvis.
Through the use of clinical pelvimetry, physicians are able to make an assessment if adequate
space exists for the passage of the fetus during prenatal visits. In theory, the most useful planes to
measure are the pelvic inlet and the midline. Normal spontaneous vaginal delivery is a natural
process that usually does not require significant medical intervention. Management guided by
current knowledge of the relevant screening tests and normal labor process can greatly increase
the probability of an uncomplicated delivery and postpartum course.

All women should be screened for group B streptococcus; women who test positive should
be treated with antibiotics during labor. Routine human immunodeficiency virus screening of all
pregnant women, and treatment with antiretroviral medication for those who test positive, can
reduce perinatal transmission of the infection. Once a woman is in labor, management should focus
on the goal of delivering a healthy newborn while minimizing discomfort and complications for
the mother. In a patient who tests negative for group B streptococcus, delaying admission to the
labor ward until she is in active labor decreases the number of possible medical interventions
during labor and delivery.

Once a patient has been admitted to the hospital, providing her with continuous emotional
support can improve delivery outcomes and the birthing experience. Epidural analgesia is effective
for pain control and should not be discontinued late in labor to reduce the need for operative
vaginal delivery. Epidurals prolong labor, but do not increase the risk of cesarean delivery. Labor
may not progress as rapidly as historically reported this should be considered. Spontaneous
vaginal delivery at term has long been considered the referred outcome for pregnancy. Because of
the perceived health, economic, and societal benefits derived from vaginal deliveries, lowering the
cesarean delivery rate has been a goal.
Fertility birth rates

The average number of children a hypothetical cohort of women would have at the end of
their reproductive period if they were subject during their whole lives to the fertility rates of a
given period and if they were not subject to mortality. Births per 1000 women, categorized
according to a specific composition of mothers in the population, first crude birth rate: number of
live births per 1000 of population. Second, general fertility rate: number of live births per 1000
women between the ages of 15 and 44 years. Third, age-specific fertility rate: number of births to
women of a particular age called cohorts. Fourth, total fertility rate: Average number of children a
woman would bear during her lifetime, assuming her childbearing conforms to her age specific
fertility rate every year of her childbearing years (typically, age 15 to 44).
The fertility rate measures the number of births per 1,000 women of childbearing age (ages 15 to
44) occurring in a particular year; birth rates refer to this measure within particular age groups.

Laboratory or diagnostic procedures/tests drug

Laboratory tests are medical devices that are intended for use on samples of decide
whether other tests or procedures are needed to make a diagnosis. Certain tests and screenings
may be scheduled during the pregnancy of the mother or client. An amniocentesis may be needed
for accurate diagnosis. Multiple on the family history and availability of laboratory testing at the
time of the procedure. First trimester screening is a combination of fetal ultrasound and maternal
blood testing. It can help find out the risk that the fetus has certain birth defects. Screening tests
may be used alone or with other tests. First trimester screening has 3 parts. Ultrasound test for fetal
nuchal translucency (NT) Nuchal translucency screening uses an ultrasound test to check the area
at the back of the fetal neck for extra fluid or thickening. Two maternal serum (blood) tests. These
tests measure 2 substances found in the blood of all pregnant women. Pregnancy-associated
plasma protein screening (PAPP-A). This is a protein made by the placenta in early pregnancy.
Abnormal levels are linked to a higher risk for chromosome problem.
Reason for choosing the case

For choosing this case, this case helps us students to absorbed, internalize and incorporate
the discussion that has given or discussed during lecture. Knowledge, skills and attitude are very
important during the actual setting. By the reason of that, cooperation and being prepared on
handling, assisting and cord care is essential. Through this case, it will enhance the knowledge and
skills by knowing the basic information about the mother and the baby. The goal of this rotation
is to enhance the experience and education of the fellow on the medical knowledge and clinical
skills that will enable the fellow to provide intrapartum care in normal and complicated
pregnancies.

OBSTETRIC HISTORY AND ASSESSMENT

Patient’s name, Annie Adorador-Ceriaco,, 40 years of age, married, living in Purok 2

Lumbocan, Butuan City. Patient Annie Adorador-Ceriaco was admitted last July 2, 2019 at Agusan
Del Norte Provincial Hospital, Butuan City caused by abdominal pain and contraction of the cervix
and conclude that she was on labor. The Age of Gestation is 38 weeks by LMP. The clients LMP
was October 2018 exact date was not mentioned. At 11:30 am she was examined by Mam Rowela
Bequibel, the DR Midwife, at the labor room she found she was 6cm dilated.

The patient, Mrs. Ceriaco, delivered a Baby Boy last July 2, 2019 at 12:33 noon. The baby
was born at a gestational age of 38 weeks. Baby Boys is weighing 2.7 kg and 49 cm in length.

Vital statistics of the Baby are the following:

 Head Circumference 32cm

 Chest Circumference 31cm
 Abdominal Circumference 28cm

The baby cried with the same breathing time 12:33pm, Mrs. Ceriaco’s placenta was
delivered 12:40. The handle student nurse is Ms. Cabellon, the assisted student nurse is
Ms.Ayala and cord care students nurse Ms. Desiata.
REPRRODUCTIVE ANATOMY AND PHYSIOLOGY

The reproductive system of a female produces gametes and allows her body to support a
developing fetus. The ovaries are the primary reproductive organs of a female; they produce the
female gametes and the sex hormones estrogen and progesterone. The vagina, also known as the
birth canal, is a canal that joins the cervix to the uterus. The uterus is the organ that prepares for
and carries a developing fetus. The ovaries produce eggs and hormones, and the fallopian tubes
carry ova from the ovaries to the uterus. The external female reproductive structures are referred
to collectively as the vulva. The mons pubis is a pad of fat that is located at the anterior, over the
pubic bone. After puberty, it becomes covered in pubic hair. The labia majora labia means lips
majora larger are folds of hair-covered skin that begin just posterior to the mons pubis. The thinner
and more pigmented labia minora labia means lips minora shorter extend medial to the labia
majora. Although they naturally vary in shape and size from woman to woman, the labia minora
serve to protect the female urethra and the entrance to the female reproductive tract.

The superior, anterior portions of the labia minora come together to encircle the clitoris (or
glans clitoris), an organ that originates from the same cells as the glans penis and has abundant
nerves that make it important in sexual sensation and orgasm. The hymen is a thin membrane that
sometimes partially covers the entrance to the vagina. The vaginal opening is located between the
opening of the urethra and the anus. It is flanked by outlets to the Bartholin’s glands (or greater
vestibular glands)

6. LABOR AND BIRTH PROCESS

Labor is defined as the onset of regular contractions and cervical change. It is traditionally
divided into three stages. The first stage encompasses the onset of labor to the complete dilatation
of the cervix, and is subdivided into latent and active phases. The active phase begins when the
rate of cervical dilatation accelerates, which occurs at 4 cm on average. The second stage consists
of the time from complete dilatation of the cervix to delivery of the infant. Active labor is when
things really get rolling. Your contractions become increasingly intense more frequent, longer, and
stronger and you'll no longer be able to talk through them. Your cervix dilates more quickly, until
it's fully dilated at 10 centimeters. (The last part of active labor, when the cervix dilates from 8 to
10 centimeters, is called transition, which is described in the next section.) The last part of active
labor when your cervix dilates from 8 to a full 10 centimeters is called the transition period because
it marks the shift to the second stage of labor. Second stage: Pushing

Once your cervix is fully dilated, the work of the second stage of labor begins: the final
descent and birth of your baby. At the beginning of the second stage, your contractions may be a
little further apart, giving you the chance for a much-needed rest between them. Many women find
their contractions in the second stage easier to handle than the contractions in active labor because
bearing down offers some relief. Others don't like the sensation of pushing. Third stage: Delivering
the placenta. Minutes after giving birth, your uterus begins to contract again. The first few
contractions usually separate the placenta from your uterine wall. When your caregiver sees signs
of separation, she may ask you to gently push to help expel the placenta. This is usually one short
push that's not at all difficult or painful.

NEWBOARN ASSESSMENT

Mrs. Ceriaco, delivered a Baby Boy last July 2, 2019 at 12:33 noon. The baby was born at
a gestational age of 38 weeks. Baby Boys is weighing 2.7 kg and 49 cm in length.

Vital statistics of the Baby are the following:

 Head Circumference 32cm

 Chest Circumference 31cm
 Abdominal Circumference 28cm

APGAR Scoring of the Baby Boy after 1minute of birth as scored by the cord care nurse.
 SCORE 0 1 2
Appearance Blue Acrocyanotic Pink All over 1

Pulse Absent Below 100bpm Over 100bpm 1

Grimace Floppy Minimal Prompt response 2

response to to stimulation
stimulation

Activity Absent Flexed arms and Active 2

legs

Respiration Absent Slow and Vigorous cry 2

irregular
Total: 8

APGAR Scoring of the Baby Boy after 5minutes of birth as scored by the cord care nurse.

SCORE 0 1 2
Appearance Blue Acrocyanotic Pink All over 1

Pulse Absent Below 100bpm Over 100bpm 2

Grimace Floppy Minimal Prompt response 2

response to to stimulation
stimulation

Activity Absent Flexed arms and Active 2

legs
 Respiration Absent Slow and Vigorous cry 2
irregular
Total: 9

SCORE:

0-4 _ prognosis of newborn is grave

5-7 I infant need specialized, intensive care

<7 – infant doing well

DRUG STUDY

1. Vitamin K

Uses:

Phytonadione (vitamin K) is used to prevent bleeding in people with blood clotting

problems or too little vitamin K in the body. Phytonadione is in a class of medications called
vitamins. It works by providing vitamin K that is needed for blood to clot normally in the body.

Several forms of vitamin K are used around the world as medicine. Vitamin K1
(phytonadione) and vitamin K2 (menaquinone) are available in North America. Vitamin K1 is
generally the preferred form of vitamin K because it is less toxic, works faster, is stronger.

In the body, vitamin K plays a major role in blood clotting. So it is used to reverse the effects
of “blood thinning” medications when too much is given; to prevent clotting problems in
newborns who don’t have enough vitamin K; and to treat bleeding caused by medications
including salicylates, sulfonamides, quinine, quinidine, or antibiotics. Vitamin K is also given to
treat and prevent vitamin K deficiency, a condition in which the body doesn’t have enough vitamin
K. It is also used to prevent and treat weak bones (osteoporosis) and relieve itching that often
accompanies a liver disease called biliary cirrhosis. People apply vitamin K to the skin to remove
spider veins, bruises, scars, stretch marks, and burns. It is also used topically to treat rosacea, a
skin condition that causes redness and pimples on the face. After surgery, vitamin K is used to
speed up skin healing and reduce bruising and swelling. Healthcare providers also give vitamin K
by injection to treat clotting problems.

An increased understanding of the role of vitamin K in the body beyond blood clotting led some
researchers to suggest that the recommended amounts for dietary intake of vitamin K be increased.
In 2001, the National Institute of Medicine Food and Nutrition Board increased their
recommended amounts of vitamin K slightly, but refused to make larger increases. They explained
there wasn’t enough scientific evidence to make larger increases in the recommended amount of
vitamin K.

2. Erythromycin

Uses:
Erythromycin is used to treat certain infections caused by bacteria, such as infections of
the respiratory tract, including bronchitis, pneumonia, Legionnaires' disease (a type of lung
infection), and pertussis (whooping cough; a serious infection that can cause severe
coughing); diphtheria (a serious infection in the throat); sexually transmitted diseases
(STD), including syphilis; and ear, intestine, gynecological, urinary tract, and skin
infections. It also is used to prevent recurrent rheumatic fever. Erythromycin is in a class
of medications called macrolide antibiotics. It works by stopping the growth of bacteria.

Side effects:

Upset stomach, diarrhea, vomiting. stomach pain and loss of appetite.

 3. HEPA B

Indication of usage:

RECOMBIVAX HB is a vaccine indicated for prevention of infection caused by all known

subtypes of hepatitis B virus. RECOMBIVAX HB is approved for use in individuals of all ages.
RECOMBIVAX HB Dialysis Formulation is approved for use in predialysis and dialysis patients
18 years of age and older. (1)

Dosage:

RECOMBIVAX HB

Persons from birth through 19 years of age: A series of 3 doses (0.5 mL each) given on a 0-, 1-, and
6-month schedule.

Adolescents 11 through 15 years of age: A series of either 3 doses (0.5 mL each) given on a 0-, 1-,
amonth schedule or a series of 2 doses (1.0 mL) on a 0- and 4- to 6-month schedule). (

Persons 20 years of age and older: A series of 3 doses (1.0 mL each) given on a 0-, 1-, and 6-onth
schedule.

RECOMBIVAX HB Dialysis Formulation

Adults on predialysis or dialysis: A series of 3 doses (1.0 mL each) given on a 0-, 1-, and 6-month
schedule.

Dosage forms and strength :

RECOMBIVAX HB is a sterile suspension available in the following presentations:

0.5 mL (5 mcg) Pediatric/Adolescent Formulation single-dose vials and prefilled syringes
(3, 11, 16.1)

1 mL (10 mcg) Adult Formulation single-dose vials and prefilled syringes (3, 11, 16.1)

RECOMBIVAX HB Dialysis Formulation is a sterile suspension available in the following

presentation

1 mL (40 mcg) single-dose vials (3, 11, 16.1)

Contraindicatios:

Severe allergic or hypersensitivity reactions (e.g., anaphylaxis) after a previous dose of any
hepatitis B-containing vaccine, or to any component of RECOMBIVAX HB, including yeast.
(4, 11)

Warning and precaution:

The vial stopper, the syringe plunger stopper, and tip cap contain dry natural latex rubber which
may cause allergic reactions in latex-sensitive individuals. (5.1)

Apnea following intramuscular vaccination has been observed in some infants born prematurely.
Decisions about when to administer an intramuscular vaccine, including RECOMBIVAX HB, to
infants born prematurely should be based on consideration of the individual infant's medical status
and the potential benefits and possible risks of vaccination. (5.2)

4. LIDOCAINE

Lidocaine is used to relieve nerve pain after shingles (infection with the herpes
zoster virus). This type of pain is called post-herpetic neuralgia. Lidocaine helps to
reduce sharp/burning/aching pain as well as discomfort caused by skin areas that are overly
sensitive to touch. Lidocaine belongs to a class of drugs known as local anesthetics. It works by
causing a temporary loss of feeling in the area where you apply the patch.

LEARNING OUTCOME

Demonstrate an ability to perform self-assessment and incorporate feedback into

improving clinical practice. Critically analyze and understand the appropriate use of the measures
of intrapartum fetal assessment and clinical management plans formulated and identify areas for
improvement. Use information technology to locate scientific studies from literature on fetal
assessment and management strategies for malpresentations and obstetric emergencies. . Apply
these technologies to improve practice and patient care. Always apply the principle of sterility st
all times,
REFERENCES:

 http://www.businessdictionary.com/definition/fertility-rate.html
 https://www.aafp.org/afp/2008/0801/p336.pdf
 https://knoema.com/atlas/Philippines/topics/Demographics/Fertility/Fertility-rate
 https://www.acog.org/Patients/FAQs/Routine-Tests-During-
Pregnancy?IsMobileSet=false
 https://www.osmosis.org/learn/Anatomy_and_physiology_of_the_female_reproductive_s
ystem
 https://opentextbc.ca/anatomyandphysiology/chapter/27-2-anatomy-and-physiology-of-
the-female-reproductive-system/
 https://www.glowm.com/resources/glowm/cd/pages/drugs/o020.html
 https://www.babycenter.com/stages-of-labor