LYCEUM‌‌NORTHWESTERN‌‌UNIVERSITY‌ 

‌
College‌‌of‌‌Nursing‌ ‌
Dagupan‌‌City‌ ‌
‌
‌
DELIVERY‌‌ROOM‌ ‌
CASE‌‌NUMBER‌‌3 ‌‌
Labour‌‌and‌‌Delivery‌ ‌ ‌
 ‌
You‌‌are‌‌assigned‌‌to‌‌Divina,‌‌who‌‌is‌‌experiencing‌‌preterm‌‌labor‌‌at‌‌28‌‌weeks‌‌gestation.‌‌She‌
‌has‌‌a ‌‌2-year‌‌old‌‌son‌‌at‌‌home.‌‌This‌‌is‌‌her‌‌third‌‌admission‌‌for‌‌preterm‌‌labor‌‌during‌t‌his‌
‌pregnancy.‌‌Her‌ ‌primary‌‌health‌‌care‌‌provider‌‌had‌‌told‌‌her‌‌she‌‌must‌‌remain‌‌hospitalized‌‌on‌
‌bed‌‌rest‌‌until‌‌she‌ r‌ eaches‌‌37‌‌weeks‌‌of‌‌gestation‌‌or‌‌until‌‌birth‌‌of‌‌the‌‌baby‌,‌‌‌whichever‌‌comes‌
‌first.‌‌She‌‌was‌‌given‌ ‌initially‌‌IV‌‌infusion‌‌of‌‌D5W‌‌1‌‌Liter,‌‌Ritodrine‌(‌ Yutopar)‌‌150‌m‌ g‌‌in‌‌500‌‌ml‌
‌isotonic‌I‌V‌‌solution‌ as‌‌piggyback‌‌to‌‌primary‌‌infusion‌‌at‌‌0.05‌‌–0.1‌‌mg/min‌‌q‌‌10-20‌‌minutes.‌I‌n‌
‌case‌‌of‌‌worsening‌ ‌situation,‌‌Betamethasone‌‌12‌‌mg‌I‌M‌‌x‌‌2‌‌doses‌‌24‌‌hours‌‌apart‌‌is‌t‌o‌‌be‌
‌given‌.‌‌‌Divina‌‌tearfully‌ ‌asks‌‌you‌‌why‌‌she‌‌can’t‌‌be‌‌at‌‌home‌‌on‌‌bed‌‌rest,‌‌who‌‌will‌‌help‌‌her‌
‌care‌f‌or‌‌her‌‌son‌‌and‌‌how‌‌she‌ ‌will‌‌manage‌‌to‌‌keep‌f‌rom‌‌going‌‌crazy‌‌staying‌‌in‌‌bed‌t‌hat‌‌long.‌
‌How‌‌will‌‌you‌‌respond‌‌to‌‌her‌ ‌concerns?‌ ‌
A.‌Q‌ uestions‌ ‌
1.Is‌‌there‌‌sufficient‌‌evidence‌‌to‌‌draw‌‌conclusions‌‌about‌‌the‌‌benefits‌‌of‌‌bed‌‌rest‌‌to‌‌prevent‌ ‌
preterm‌‌birth?‌ ‌
2.What‌‌assumptions‌‌can‌‌be‌‌made‌‌about‌t‌he‌‌following‌‌issues?‌ ‌
a. The‌‌impact‌‌her‌‌history‌‌might‌‌have‌‌on‌‌the‌m ‌ edical‌‌and‌‌nursing‌‌care‌‌she‌‌receives‌ ‌
during‌t‌his‌‌pregnancy.‌ ‌
b. The‌‌pros‌‌and‌‌cons‌‌of‌‌home‌‌management‌‌vs.‌‌hospital‌‌management‌f‌or‌t‌he‌‌prevention‌ ‌
of‌‌preterm‌‌birth‌f‌or‌t‌his‌‌woman‌ ‌
c.Ways‌‌to‌r‌ educe‌f‌rustration‌‌and‌‌boredom‌‌that‌‌the‌‌woman‌‌will‌‌experience‌‌if‌‌she‌‌is‌ ‌
restricted‌‌to‌‌bed‌r‌ est‌f‌or‌t‌he‌‌next‌‌several‌‌weeks‌ ‌
resources‌‌available‌t‌o‌‌assist‌‌with‌‌care‌‌of‌‌her‌‌2-year‌‌old‌‌son‌ ‌
3.What‌‌implications‌‌and‌‌priorities‌f‌or‌‌nursing‌‌care‌‌can‌‌be‌‌drawn‌‌at‌‌this‌t‌ime‌? ‌
4.Does‌‌the‌‌evidence‌‌objectively‌‌support‌‌your‌‌conclusion?‌ ‌
5.Are‌t‌here‌‌alternative‌‌perspectives‌‌to‌‌your‌‌conclusion?‌ ‌
6.What‌‌Biochemical‌‌markers‌‌can‌‌predict‌‌imminent‌‌preterm‌‌labor?‌ ‌
 ‌
B.‌M‌ ake‌‌a‌‌Nursing‌‌Care‌‌Plan‌‌(NCP)‌‌and‌‌Drug‌‌Study‌‌for‌‌this‌‌patient‌ ‌
 ‌
 LYCEUM-NORTHWESTERN UNIVERSITY
COLLEGE OF NURSING

Related Learning Experience Plan

1st Semester 2020-2021

Course Title: NCM 109- Care of Mother, Child at Risk or with Problems (Acute & Chronic)
NURSING CARE PLAN
Assessment Planning Implementation Rationale Evaluation
Nursing Short-term Independent Nursing
Problem: Goal: Intervention:
Anxiety After 3 days  Explain the  Information and  Patient will
the mother will procedures, knowledge of the verbalize
accept and nursing reasons of these understanding
Data: understand interventions, activities can of individual
the healthcare and treatment decrease fear of the situation and
Subjective: providers regimen. Keep unknown. possible
The mother ‌asks‌ advise for her communication  Provision of clear outcomes.
‌why‌‌she‌‌can’t‌‌be‌ condition. open; discuss information can help  Patient will
‌at‌‌home‌‌on‌‌bed‌ with the client the client, or couple report anxiety
‌rest,‌‌who‌‌will‌ the possible understand what is is reduced
‌help‌‌her‌‌care‌‌for‌ Long-term side effects happening and may and/or
‌her‌‌son‌‌and‌‌how‌ Goal: and outcomes reduce anxiety. manageable.
‌she‌ ‌will‌m ‌ anage‌ The mother while  Vital signs of client  Patient will
‌to‌‌keep‌f‌rom‌ will establish maintaining an and fetus may be appear
‌going‌‌crazy‌ trust optimistic altered by relaxed, with
‌staying‌‌in‌‌bed‌ relationship to attitude. anxiety. Stabilization maternal vital
‌that‌‌long.‌ the health  Answer may reflect signs within
care provider questions reduction anxiety normal limits.
Objective: cooperating honestly, level.  Patient is
‌Preterm‌‌labor‌‌at‌ with the especially cooperative.
‌28‌‌weeks‌ process until information  Goal met.
‌gestation 37 weeks. regarding
contraction
pattern and
Nursing fetal status.
Diagnosis:  Monitor
Anxiety related to maternal and
situational crisis fetal vital
signs.

Dependent Nursing
Intervention:
 Administer  Provides soothing
sedative if and tranquilizing
other effect.
measures are
not successful.

Collaborative
Management:
 Psychological  Provides further
 counselling emotional support
that will help her
understand her
situation and the
need for
cooperation.

LYCEUM-NORTHWESTERN UNIVERSITY
COLLEGE OF NURSING

DRUG STUDY

Name of the Classification Indications Side Effects Nursing Implications

drug:
Betamethasone Corticosteroids Systemic Sodium and Assessment
administration fluid retention  History (systemic
 Hypercalcem potassium and administration):
Brand Name: Mechanism of ia associated calcium infections, fungal
Betnesol (CAN), Action: with cancer depletion, infections, vaccinia,
Celestone Antenatal betamet  Short term muscle wasting, varicella and
Phosphate hasone is primarily management weakness, antibiotic resistant
used to speed up of osteoporosis, GI infections, kidney or
Dosage: lung development inflammatory disturbances liver disease,
12‌m‌ g‌‌IM‌‌x‌‌2‌ in preterm fetuses. and allergic and bleeding. hypothyroidism,
‌doses‌‌24‌‌hours‌‌ It stimulates the disorders, Increases ulcerative colitis with
synthesis and such as appetite and impending
release of rheumatoid delayed wound perforation,
surfactant, which arthritis, healing, diverticulitis, active
lubricates the collagen bruising, striae, or latent peptic
lungs, allowing the diseases acne, raised ulcer, inflammatory
air sacs to slide (SLE), intracranial bowel disease, CHF,
against one dermatologic pressure, hypertension
another without diseases headache, thromboembolic
sticking when the (Pemphigus), depression, disorders, diabetes
infant breathes. stats psychosis, mellitus, lactation.
asthmatics menstrual  Physical: Baseline
and irregularities. weight, T, reflexes
autoimmune Hyperglycemia, and grip strength
disorders. DM, and orientation, P,
 Hematologic suppression of BP, peripheral
disorders: pituitary perfusion,
Thrombocyto adrenocortical prominence of
penia axis. Growth superficial veins, R
purpura, retardation in and adventitious
 erythroblasto children sounds, serum
penia (prolonged electrolytes, blood
 Ulcerative therapy). glucose.
colitis, acute Increased
exacerbation susceptibility for Interventions
s of MS, and infections. Systemic use
palliation in Topical use,  Give daily dose
some dermal atrophy, before 9 AM to
leukemias local irritation, mimic normal peak
and folliculitis. corticosteroid blood
lymphomas. levels.
Dermatologic  Increase dosage
preparation: when patient is
 Relief of subject to stress.
inflammatory  Taper doses when
and pruritic Adverse discontinuing high
manifestation Effects dose or long-term
s of steroid- Potentially fatal: therapy.
responsive Abrupt  Do not give live virus
dermatoses withdrawal vaccines with
Contraindications leading to acute immunosuppressive
Hypersensitivity; adrenal doses of
systemic fungal or insufficiency corticosteroids.
acute infections manifesting as
malaise,
weakness,
mental changes,
muscle and joint
pains, dystonia,
hypoglycaemia,
hypotension,
dehydration,
and death.
Rapid IV
infusion injection
may cause CV
collapse.
 LYCEUM-NORTHWESTERN UNIVERSITY
COLLEGE OF NURSING

DRUG STUDY

Name of the Classification Indications Side Effects Nursing Implications

drug
Ritodrine Beta2- Adrenergic  Uncomplicated Blurred vision,  Advise the mother
Agonist premature labor chest pain or not to take other
tightness, medicines unless
Brand Name Mechanism of Contraindications dizziness or they have been
Yutopar Action light- discussed with the
Ritodrine is beta-2  Overactive headedness, doctor. This
Dosage adrenergic agonist. thyroid gland, drowsiness, dry especially includes
‌150‌‌mg It binds to beta-2 dehydration, a mouth, fast or over-the-counter
‌ adrenergic migraine irregular (non-prescription)
receptors on outer headache, high heartbeat—rare medicines for
membrane of blood pressure, with oral form, appetite control,
myometrial cell, significant flushed and dry asthma, colds,
activates adenyl uncontrolled high skin, fruit-like cough, hay fever,
cyclase to increase blood pressure, breath odor, or sinus problems
the level of cAMP pulmonary increased since they may
which decreases hypertension, urination, loss of increase the
intracellular abnormal heart appetite, unwanted effects
calcium and leads rhythm, nausea, severe of this medicine.
to a decrease of hemorrhage pounding, or
uterine during racing heartbeat Assessment & Drug
contractions. pregnancy and —rare with oral Effects
before birth of form, shortness
child, mildly of breath—rare  Monitor
increased blood with oral form, continuously for
pressure and sleepiness, pronounced dose-
edema during
pregnancy, stomachache, related adverse
severe increased tiredness, effects to maternal
blood pressure troubled and fetal heart
and edema breathing (rapid rates and maternal
during and deep), BP while infusion is
pregnancy, unusual thirst, running.
seizures with vomiting  Be alert to S&S of
pregnancy, and monitor for
diabetes during hydration to avoid
pregnancy, risk of pulmonary
infection of the Adverse Effect
edema.
amniotic sac, Tachycardia,
fetal death within palpitation,
headache, Patient & Family
the uterus,
nervousness, Education
decreased blood
volume anxiety, nausea,
vomiting. Rarely  Report immediately
anaphylaxis, any of the
arrhythmia, following:
pulmonary palpitations, chest
edema, pain, dizziness,
hypokalaemia respiratory
distress,
weakness,
tremors, sweating
or chills.