Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
NURSING PROGRAM
Requirements in NCM101
A Written Report in
Submitted to:
Clinical Instructor
Submitted by:
BSN 3B
Table of Contents
I. Introduction………………………………………………………………….
A. Theories of Labor……………………………………………..
D. Stages of Labor……………………………………………….
E. Components of Labor………………………………………...
• Antepartum……………………………………………………………..
• Intrapartum……………………………………………………………..
• Postpartum……………………………………………………………..
• Antepartum………………………………………………………….....
• Intrapartum…………………………………………………………….
• Postpartum…………………………………………………………….
VII. Bibliography……………………………………………………………....
VIII. Appendix
• Assessment Tool……………………………………………………..
Patient’s full name is Eva Liona, 38 years old and a resident of 31-22 nd St.
Brgy. Nazareth, Cagayan de Oro City. She is originally here at Cagayan de Oro
City. She is presently not employed. She is the first daughter of four children of
This is her 3rd pregnancy. Her first child is already 15 years old and the
second is 9 years old. On her first husband, she has two children, the first and
the second child. The second husband was the father of her third child. Her first
Rena Liona is the name of second husband of Eva. 26 years old. and a
resident of 31-22nd st. Brgy. Nazareth, Cagayan de Oro City. They are living their
Based on my first visit at Brgy. Nazareth my patient vital signs were: RR-
19 beats per minute; Pulse Pressure- 69 bpm; heart Rate 76 cpm with regular
the assessment.
A. Prenatal Assessment
Mrs. Eva Liona is a 38 years old, was born on December 6, 1970. She is
Filipino Roman Catholic. She did not expect any date on her delivery. I get the
information from the patient. Date of assessment was on January 5, 2008 in the
afternoon.
Activity/ Rest
Mrs. Eva is a plan housewife. She stays at home to work the daily house
chores and take good care of their children. Her hobbies include talking with the
neighbor, watching television and sometime if she is tried she sleep for a while.
She usually sleeps on 7-8 hours. Sometimes she experienced abdominal pain
during her pregnancy related to movement of the baby inside the mother womb.
”Usahay sakit ang tiyan katong pagburos nako”, the client verbalized. The right
and left upper extremity was normal since resistance was noted. Her muscle tone
is normal. The client both hand can flex, extend and hyperextend her elbow.
Circulation
The client has no history of hypertension and diabetes in the family, but
the side of the mother has the history of asthma. During on her pregnancy there
is no any change on her body part. She did not experience everything on her
pregnancy stage. “wala man ko kaagi og ingana sukad sa una katong pag-anak
sa akong 1st baby” the client verbalized. During her pregnancy her BP upon lying
down is 110/80 mmHg, while in sitting is 110/70mmHg, her pulse pressure was
regular with a rate of 68 bpm, no auscultatory gap was noted. Her Heart Rate -78
cpm with regular rhythm and Temperature- 36.8 degree Celsius. The color was
uniform. Her capillary refill on both fingernails of hands replenish at 1-2 seconds
with no nail abnormalities. She has no edema and varicosities in the ankle down
to the feet. Hair was thin, slightly dry and evenly distributed. Her lips are slightly
dark brown “lagom” because she uses cigarettes last year. Nail beds were
normal and pale pink in color. Conjunctiva and sclera were pinkish.
Ego Integrity
Her way on handling it is though when watching television and talking with
the neighbor. She has no financial problem so far. She is living with his husband.
Her religion was Roman Catholic. She was cooperative during assessment.
Elimination
The client moves her bowel twice a day. She doesn’t use any laxative. Her
stool is brown and well formed. She is not experienced any diarrhea and
constipation. Her urine is pale yellow. They have no history of kidney or bladder
disease.
Food/fluids
The client usual diet includes vegetable, bread and meat. She did not take
any vitamins and food supplement. She takes only 3 meals daily. She has no
pregnancy her weight is increased. Her weight is 60 kg. Her height is 5’2” and in
regular build. She has normal skin turgor and moist mucous membrane. Her
Hygiene
She can perform activity of daily living independent. She has personal
bath any time in the morning. She doesn’t use any prosthesis device. She
prepared neat and clean with appropriate dress. No body odor was noted and
Neurosensory
doesn’t experience vision loss, hear loss. She was oriented to time, place,
She is alert and cooperative. She can remember recent and remote memory.
The client doesn’t feel any pain and discomfort as she said.
Respiration
The client is not experience dypnea and cough. Their family has history of
asthma, but she has no history of that. She smoke 3 packs per day but now
when she got pregnant she stop smoking for seek of her baby. Respiratory Rate
Safety
The client has no allergies. She has no STD or no history of any disease.
She doesn’t experience blood transfusion. She admits because of vomiting and
diarrhea, last April 2007 when she was not pregnant. She has done on his
chickenpox when she was still young. Her temperature is normal in 36.6 degree
Sexuality
The client has no sexual concern at that moment. Her menarche started
age of 12 with 30 days of cycle. It usually lasts 4 to 5 days. The first day of her
last menstrual period was May 5, 2007. She estimated date of delivery is on
January 28, 2008, she did not use contraception like IUD. The client was use
Social Interactions
The client has engaged in an 15 years relationship with the first father of
her 1st and 2nd child and she engaged again in an 1 year relationship with the
second father of her 3rd child. On her first husband they are already separated.
She is not married to his second husband in almost 1 year. They support on their
own financial. Her 1st and 2nd child is living with her together with the second
husband. Client’s can speak clear and they are friendly with their neighbor. She
Teaching/Learning
grade school, she did not finish on her study because of financial problem and
B. Intrapartum Assessment
Filipino Roman Catholic. She did not expect any date on her delivery. However
moment of my OB patient Mrs. Eva Liona delivered health baby boy at their
C. Postpartum
Mrs. Eva Liona is a 38 years old. She is a Filipino Roman Catholic. She
did not expect any date on her delivery. Source of information came form the
patient herself with the rate of 4 for reliability. Date of assessment January 27,
2008 in the morning. She did not expect any date on her delivery.
Activity/Rest
Mrs. Eva is a plan housewife. She stays at home to work the daily house
chores and take good care of their children. Her hobbies include talking with the
neighbor, watching television and sometime if she is tried she sleep for a while.
She usually sleeps on 7-8 hours and naps when the baby sleeps as well. She
does not experience excessive grogginess. She was alert and coherent. The
right and left upper extremities was normal since resistance was noted. Her
Circulation
neither in father side nor mother side. During on her pregnancy there is no
change on her body parts and also after giving birth to the 3rd child. During her
auscultatory gap was noted. Her Heart Rate -76 cpm with regular rhythm and
Temperature- 36.5 degree Celsius. The color was uniform. Her capillary refill on
both fingernails of hands replenish at 1-2 seconds with no nail abnormalities. She
has no edema and varicosities in the ankle down to the feet. Hair was thin,
slightly dry and evenly distributed. Her lips are slightly dark brown “lagom”
because she uses cigarettes last year. Nail beds were normal and pale pink in
Her way on handling it is though when watching television and talking with
the neighbor. She has no financial problem so far. She is living with his husband.
Her religion was Roman Catholic. She was cooperative during assessment.
Elimination
The client moves her bowel twice a day. She doesn’t use any laxative. Her
stool is brown and well formed. She is not experienced any diarrhea and
constipation. Her urine is pale yellow. They have no history of kidney or bladder
disease.
A. Theories of Labor
theories have been formulated to give us the idea on how it possibly happens.
physiologic changes that initiate labor. It is said that any hollow viscose tends to
2. Oxytocin Theory
As pregnancy progresses, there is a gradual rise in the amount of
contractions.
5. Prostaglandin Theory
Lightening
It is also known as descent of the fetal presenting part into the pelvis. It
gives the woman relief from diaphragmatic pressure and shortness of breath she
her feelings during the previous month. This increase in activity is due to an
In the last week or days before labor begins, the woman usually notices
extremely strong Braxton Hicks contractions, which may interpret as true labor
and predictable
Felt first abdominally and remain Felt first in lower back and sweep
or intensity intensity
Do not achieve cervical dilatation Achieve cervical dilatation
pregnancy, the cervix feels softer than normal like the consistency of an earlobe
(Goodell’s sign). At term, the cervix becomes still softer and can be described as
“butter soft”, and it tips forward. Ripening is an internal announcement that labor
is close at hand.
Signs of true labor involve uterine and cervical changes. The more women
know about true labor sings, the better because then they will be better able to
recognize them. This is helpful both in preventing preterm birth and being able to
feel secure during labor. The following are namely the uterine contractions, show
C. Stage of Labor
There are three stages of labor. The first stage occurs from the time true
labor begins until the cervix is completely dilated and effaced. During the second
stage is the baby is delivered. The third stages follow the birth of the baby
First stage
The first stage of the labor is the longest. There are three phases within
. Active Phase
. Transition Phase
Latent Phase
‘It begins at the onset of regularly perceived uterine contractions and ends
when rapid cervical dilatation begins. Contractions during this phase are mild and
Active Phase
Tryansition Phase
Second Stage
During the second stage the baby is born. This stage of labor it contract
from 1 to up to 2 hours. The baby’s head stretch the mother’s vagina and
perineum. This may cause a burning sensation. Some women may feel as if they
have a bowel movement, and feel the urge to push or bear down. The physician
doctor or the midwife will tell you if it is the time to push. It is important during the
delivery. “Crowing” occurs as the widest part of the head appears at the vaginal
opening. The secretion must be out to the baby’s mouth and nose by using the
bulb syringe. The baby will take his/her first breath, and begin to cry. The baby I
still connecting to the placenta by the umbilical cord and Give immediately new
Third Stage
Also known as placental stage refers or begins from the time the infant is
born until the delivery of the placenta. Two separate phases are involved namely
contractions. Active bleeding on the maternal surface of the placenta begins with
segment or at the upper vagina. These are the following signs that the placenta
sudden gush of vaginal blood, and change in the shape of the uterus.
placenta, it is delivered either by the natural bearing down effort of the mother or
complication of birth where maternal blood sinuses are open and gross
hemorrhage occurs.
D. Mechanism of Labor
There are five classical steps in the normal mechanism of labor. They are:
. Engagement
. Descent
. Flexion
. Internal Rotation
. Extension
. External Rotation
. Expulsion
Passage of the fetus through the birth canal involves a number of different
position changes to keep the smallest diameter of the fetal head always
presenting to the smallest diameter of the birth canal. These position changes
• Engagement - is when the biparietal diameter of the pelvic inlet, the head is
said to be engaged in the pelvic inlet. In most nulliparous women this occurs
before the onset of active labor because the firmer abdominal muscles direct
the presenting part into the pelvis. In multiparous woman with more relaxed
musculature, the head often remains freely movable above the pelvic brim
(floating) until labor is established. In the majority of cases the sagittal suture
head to within the pelvic inlet. Full descent occurs when the fetal head
extrudes beyond the dilated cervix and touches the posterior vaginal floor.
The pressure of the fetus on the sacral nerves causes the mother to
fetus by the uterine fundus. Full descent may be aided by abdominal muscle
contraction.
• Flexion – while descending through the pelvis, the fetal head flexes so that
the fetal chin is touching thue fetal chest. This functionally creates a smaller
structure to pass through the maternal pelvis. When the flexion occurs, the
occipital (posterior) fontanel slides into the center of the birth canal and the
anterior fontanel becomes more remote and difficult o feel. The fetal position
• Internal rotation - during descent, the head enters the pelvis with the fetal
flexes as it touches the pelvic floor, and the occiput rotates until it is superior,
or just below the symphysis pubis, bringing the head into the best diameter
for the outlet of the pelvis. This movement brings the shoulder, coming next,
into the optimal position to enter the inlet or puts the widest diameter of the
• Extension - as the occiput is born, the back of the neck stops beneath the
pubic arch and acts as a pivot for the rest of the head. The head thus
extends, and the foremost parts of the head, the face and chin, are born.
• External rotation - almost immediately after the head of the infant is born; the
head rotates back to the diagonal or transverse position of the early part of
labor. The after coming shoulders arc thus brought into an anteroposterior
position which is best for entering the outlet. The anterior shoulder is born
• Expulsion - once the shoulders are born, the rest of the baby is born easily
and smoothly because of its smaller size. This is expulsion and is the end of
A. Antepartum
during this stage. They became hesitant because as much as they wanted the
baby, they also want to maintain their usual state as non-pregnant women like
having their usual figure and doing the usual things those non-pregnant women
can do since they are convinced that everything will change once the fetus inside
Pregnancy for them would mean cessation of night outs, smoking and drinking.
They couldn’t wear skimpy outfits anymore because their tummies would start
increasing in size. This is usually felt by women whose pregnancy is not
planned.
doubtfulness of the mother. The most common are nausea and vomiting, back
and most importantly the spiritual status of the pregnant woman at this stage so
we can identify the problems that are most likely to occur and give appropriate
a must for it helps encourage women to do the best they can to protect their
Listed are the discomforts that the pregnant women normally experience
FIRST TRIMESTER
eat small, frequent meals. Instruct the woman to avoid brushing her
teeth after eating. Instruct the woman to get out of bed slowly.
avoid stomach distention. Tell the woman to limit the use of caffeine.
smoking.
2. Fatigue
3. Varicose veins
4. Urinary frequency/UTI
Instruct the woman to limit fluid intake in the evening. Instruct the
5. Breast Tenderness
Encourage the woman to wear a bra with a wide shoulder strap for
soothing
SECOND TRIMESTER
1. Backache
Maintain good posture. Pelvic rocking exercise, tailor sitting and back
2. Pedal Edema
3. Dyspnea
Sitting upright, allowing the weight of the uterus to fall away from the
important to check and monitor the health of the mother and to the baby
THIRD TRIMESTER
1. Upon admission
pressure. Check fetal heart rate. Give prep (perinea shave) and
2. Dilatation
Asses contractions: mild, well-established, 5-15 minutes apart, lasting
fetal heart rate every 15 minutes and check blood pressure every 30
progress. Observe for ruptured membranes and take fetal heart rate
contractions begins, have the client focused her attention on your face.
The client takes a relaxing sigh. She breathes in and out through her
perceive herself. The contraction ends. The clients take another big
sigh. Don’t strain. Let go and flow with the contraction. Relax the pelvic
floor throughout second stage. Don’t tense the muscle when you feel
rectal pressure, the vaginal stretching. Relax all sphincters and the
mouth, too with your lips and jaws parted. Always take one or two deep
breaths to refuse at the start and the end of the contraction. Exhale
slowly as you bear down. Push slowly as long and hard as you feel the
urge to do so. Avoid prolonged pushes, which affects your breathing,
circulation, and also the baby’s heart rate. Check vital signs:
rate. Give prep (perinea shave) and enema. Encourage client to void
B. Intrapartum
Intrapartum is the time when the pregnant women area in their active
phase of labor. They usually have mixed emotion felt during this stage:
Pregnant women tent to be happy because finally, they will be free from
the burden of the heavy weight that they have been carrying for the past nine
months; excited to see their offspring and know if it’s a male or a female
especially for those who have not undergone ultrasound check-up; fear specially
for some pregnant women who doesn’t know yet how it is going to be during the
progress of labor and what will be done to them in case complications arise and
lastly pain. It cannot be denied that pregnancy and delivery entail pain, intense
pain to be exact.
the client for her to understand the whole process of delivery. Strategies in
lessening the problems and discomfort felt during this stage must also be
demonstrated as earlier as possible to make the woman active during labor and
delivery.
As the contraction begins; have the woman focus her attention on your face.
The woman takes a big relaxing sigh. She breathes in and out through her
“conduct” her breathing with her rhythmic hand signals to help her perceive
herself. The contraction ends. The woman takes another big sigh. Reinforced
patient has no classes. Don’t strain. Let go and flow with the contraction.
Relax the pelvic floor throughout second stage. Don’t tense the muscle when
you feel rectal pressure, the vaginal stretching. Relax all sphincters and the
mouth, too with your lips and jaws parted. Direct to push low down and in
front-increase the pressure in your abdomen, not in your face. Don’t strain so
that you screw your eyes- you might miss the moment of birth. Always take
one or two deep breaths to refuse at the start and the end of the contraction.
Exhale slowly as you bear down. Push slowly as long and hard as you feel
the urge to do so. Avoid prolonged pushes, which affects your breathing,
circulation, and also the baby’s heart rate. Check contractions every 2 -3
delivery table and place in lithotomy position. Gently raise both legs
simultaneously into stirrups and drape client. Provide client with handles to
pull on as she pushes. Cleanse vulva and perineum, using sterile technique,
commonly referred. Auscultate fetal heart tone every 5 minutes or after each
push; transient fetal bradychardia not usual due to head compression. Check
blood pressure and pulse every 15 minutes p.r.n. Encourage mother of keep
her informed of advancement baby. Encourage mother to take a deep breath
before beginning to push with each contraction and to sustain push as long as
C. Postpartum
Just like the previous stages, the post partum stage also entails
discomforts and problems that concern the mother. It is the most implicated
mental disorders.
As what was stated earlier, the post partum period is most likely when the
mothers become depressed. This is called post partum depression. They tend
to think negative things like their husbands will not like them anymore after
they’ve given birth and that they were just meant to bear and deliver a child
especially that at this moment, the attention of everyone is already diverted to the
During this stage, mothers should also be taught on ways that could help
her regain her pre pregnancy figure. That is through exercise and appropriate
diet. Family members, most importantly the husband must also be taught how to
comfort the mother. They must be informed about this stage of labor and how
important it is for them to show concern to the woman who have just given birth.
With this the mother will be aware how she means a lot to them and would be
very willing to play her role once again as a wife, a mother and a woman.
Check for gall bladder distention. Maintain intake and output first 24 hours or
until voiding is sufficient. Palpate fundus every 15 minutes and p.r.n. Massage
Encourage voiding and measure amounts. Check lochia for color consistency
and amount. Inspect perineum and for signs of bleeding, unusual redness or
amount of fluids may cause nausea). Change mother’s gown, (gown worn
during labor is soiled and wet from perspiration). Allow mother to rest. Provide
A. Prenatal Assessment
Explain to the mother that it is normal for pregnant woman who are in the
fetal movement. It is natural that the baby will move in the mother’s womb. Tell
the mother to drink milk before going to sleep. The baby will also get more
nutrients during in the mother’s womb. Tell the mother to take a warm shower
B. Postpartum Assessment
Encourage adequate intake of fluids (maximum intake of 2000 ml/day).
Direct to prevent the perineal discomfort to the mother. Encourage diet high in
fiber and roughage. They much eat more fiber to replace their energy after
delivery.
meaning that it is unlikely that you will be having the baby rapidly. Labor and birth
is the culmination of pregnancy, but the beginning of parenting. Labor and birth
can be a very exciting time in your life. It is definitely one of the most memorable.
In line with this some factors are needed to be taught not only to the
woman on labor but to her partner as well. Coping with psychological and
physical factors may include on this part. It is during this time that a woman
to care for and rear a child is not anymore a question. However, there are still
things that need to direct the mother like the proper ways of coping stress
because being pregnant is not easy. Thus, it needs a lot of perseverance and
hard work.
VII. Bibliography
1. Pillitteri, Adele (2007). Maternal and Child Health Nursing (5th edition).
2. www.yahoo.com
3. www.google.com
VIII. Appendix