2AN Group 3 Script/Flow for RLE CHN Duty Rotation

Prepared by: Louwella Ramos

Roles:
Nurse/ Assistant Nurse: Mother: Narrator:
 Perez, Linford ~ Matias, Alyssa ~ Ramos, Louwella
 Ramos, Louwella Doctor:
 Silot, Aila ~ Vinoya, Andrea Gwyneth
 Perpetua, Anne

Role Script
Narrator:  Admitted to east Rembo lying in, Mrs. Matias 22year-old,
(Ramos) G1P0 (woman is pregnant for the first time and has not
yet delivered), at term, in active labour intrauterine
pregnancy (Meaning the patient is now ready to deliver
the baby. The bag of water might already burst or the
frequency of the contraction is now indicating labour and
not false labour) at 39 AOG gestation(AOG= age of
gestation) fatal heart rate, baseline 140's (normal),
With initials vital signs as stated
 BP: 145/95 HR: 110 RR: 30 O2 Sat: 94% Temp: 36.2. FHR:
130 with accelerations. Contraction pattern: q3-5mins for
60-70 seconds. (The mother’s BP is above the normal, BP
is should be 120/80 regardless if pregnant or not. Also,
the Oxygen saturation is below normal of 95-100
percent.)
 First and for most all health care workers must
introduced their selves to the patient. We should
remember that the patient is first time pregnant and she
is already in labour anxiety is so high. It is the health care
worker’s responsibility to make the delivery as easy as
possible and as comfortable as possible. Also, perform
hand washing or hygiene before doing any assessment or
examination to the client to prevent the transfer of
microorganism
Scene 1: Admission
Narrator:  Here is the first line of frontiers of the facility once the
(Ramos) patient is admitted either admission department or via ER
(mostly likely our patient is thru ER department). The
nurse at the admission should get all the information
 required as per facility protocol and admits the patient to
the birthing ward or directly to DR (Delivery Room)
depending on the status of the patient.
Introduction of the scenario
Doctor:  (introduce self to the patient) Ask the full name and
(Vinoya) birthdate.
Mother:  I am Alyssa matias, august 25, 1998,( tapos check ni
(Matias) doctor yung tag habang nagsasalita si mother.)
Doctor:  Miss matias eto po yung mga nurse na mag aasikaso po sa
(Vinoya) inyo
Nurse 1:  ( introduce yourself ) – mommy bali papakilala ko po yung
(Perez) 2 nurse na kasama ko pong mag-aassist po sa inyo
through-out your delivery po.
Assistant Nurse 1:  (Introduce self to the patient)
(Perpetua)
Assistant Nurse 2:
(Silot)
Nurse:
(Ramos)
Doctor:  Mommy may request po ba kayo? Maiwan ko po muna
(Vinoya) kayo para makapagproceed na po tayo sa assessment
with nurse aila.
Doctor have to go but nurse Silot and mother will stay
Narrator:  After identifying the client, the nurse must provide the
(Ramos) privacy needed by the client the nurse will close the
curtain, established rapport to the client in order to
accurately assess the client. Always remember make all
the procedure as comfortable as possible.
 before doing any assessment, PPE may be required to
prevent the transfer of microorganism to the client
Assessment
Nurse:  mommy may mga itatanong lang po ako, okay lang po ba?
(silot) Saan ka po nakatira mommy?
Mother:  (state the address)Brgy. East Rembo…
(Matias)
Nurse:  may kinaksama o asawa po ba kayo? Kasal po ba kayo?
(silot)
Mother:  opo ikaw na magbigay ng name hahahahaa
(Matias)
Nurse:  may trabaho ka ba o ang iyong asawa
(silot)
Mother:  ako po housewife, yung asawa ko naman po pulis
(Matias)
Nurse:  may mga anak ka na po ba kayo?
(silot)
Mother:  wala pa po ito po ang unang beses kong pagbubuntis
(Matias)
Nurse:  may family history po or kasalukuyang sakit tulad po ng
(silot) hypertension or diabetes?
Mother:  wala naman po doc
(Matias)
Nurse:  netong mga nakaraang araw ba ay nakakaramdam ka ng pag
(silot) galaw ni baby?
Mother:  opo, yung kanyang pag sipa po nararamdam ko sya minsan
(Matias)
Nurse:  kamusta po kayo ngayon mommy may nararamdama po ba
(silot) kayo?
Mother:  (you may feel each contraction wrap around your body. They
(Matias) may start at your back and Move around your torso to your
abdomen. Your legs may also cramp and ache.) search
additional info.
Nurse:  yung sakit na nararamdaman ninyo po ngayon, maaari niyo po
(silot) bang i rate from 1- 10, 10 po yung highest
Mother:  7 po
(Matias)
Nurse:  Sige po mommy salamat po.
(silot)
Narrator:  The nurse must be observant with the patient’s emotions,
(Ramos) support system, verbal interaction, body language and posture,
perceptual acuity, and energy level because the one that was
“not spoken” is the most important one. Also, note her cultural
background and language spoken. This psychosocial information
provides cues about the woman’s emotional state, culture, and
communication systems. This will help the nurse how to
approach the patient effectively, and what can we take as
opportunity to educate the patient.
Nurse:  (encourage yung patient na mag relax para maiwasan yung
(silot) stress and inform the mother na nasa stage 1 active phase sya
then explain sa patient yung mga mangyayare sakanya at
 mararamdaman nya inform din si patient na magsasagawa ng
vaginal examination then explain the purpose encourage din
yung family member kung sino man na kasama ni mother na
suportahan si mother)
 Make sure repeat yung mga sagot ni mommy kung tama.
Physical Assessment
Narrator:  The health care worker must perform hand hygiene again if
(Ramos) needed before performing another assessment. Physical
assessment is a generalized assessment wherein nurse Anne
and nurse Perez with gather data such as; hydration status, vital
signs and auscultation of the lungs and heart also the mental
health status of the mother before, during and after delivery.
Assistant Nurse : indicate the mother vital signs
(Perpetua)
Nurse 1: indicate the mother hydration status and lungs and heart sounds
(Perez)
Narrator:  aside from generalized examination the nurse must also assess
(Ramos) the ff:
 fundal height measurement
 uterine activity, including contraction frequency, duration, and
intensity
 status of membranes (intact or ruptured)
 cervical dilatation and degree of effacement
 fetal status, including heart rate, position(Leopold’s), and station
 pain level

Doctor:  ask the mother if she needs to pee or defecate then explain the
(Vinoya) procedure (explain the purpose of assessing fundal height
measurement and leopold’s maneuver) (do not forget hand
gloving!! Need ipakita yon)
 Leopold's maneuver then fundal height measurement (need daw
ipakita itong dalawa e kasi kasama siya sa emphasize ng online
duty so magkakapa kapa ka talaga sa bear mo)
 (may apat to na maneuver diba tapos ano yung mga possible na
 makikita don yung similar sa leopold's maneuver na skill natin
yung ilalagay dito feeling ko in another form to pwede sigurong
checklist?)
 inform the mother in regards to her baby's position parang
ineentertain mo alam ko ganon to diba? (while doing fundal
height measurement and leopold’s maneuver medyo sinasabi
sabi mo narin to para bawas oras)
Narrator:  Any deviation from normal both mother and baby might have
(Ramos) change in original plan of care, or might have serious
complication for the both mother and baby. Mostly frequent of
this is the position or the tolerance of pain of the mother which
might lead to Cesarian Section delivery which have more
complication, and duration of healing is expected to be longer
and more expensive for the patient.
 after assessing the fundal height measurement, check the
uterine activity (includes contraction, frequency, duration, and
intensity) explain the purpose on why hcw's needs to check
uterune activity
Nurse:  indicate “alam ko nakalagay na sa file yung contraction at
(silot) frequency not sure For duration and intensity so research about it
at ano meaning or yun ba nagpapa sakit ng Ganito ni mother or
what
Vaginal Examination
Doctor:  assess status of membranes ano meron pag intact parin or
(Vinoya) ruptured na research ulet (always remember before assessing
ask permission and explain the procedure first)
 Assess cervical dilatation & degree of effacement then research
ulet
 Indicate fetal status at fetal heart rate (fhr: 130 with
accelerations) pati postion and station.
Nurse:  assess pain level ulit since in active labor nga siya, instruct the
(silot) patient na Tawagin yung mga nurse kung nararamdaman nya na
manganganak na sya o pumutok na yung Panubigan nya
Narrator:  The nurse will monitor the v/s of the mother and the condition of
(Ramos) the baby until the mother is ready to deliver. Nurse will also
 prepare the dress of the baby and hygiene kits for baby’s bath,
and the first feeding based of facility’s protocol.
Nurse:  sasabihin sa doctor yung updated v/s ng mother and condition of
(silot) the baby search Ka ng v/s and condition ni baby na pwede
sabihin before manganak
Doctor:  ok mommy ready ka na po manganak lipat na po tayo sa delivery
(Vinoya) room Nurse paki assist naman si mother.
Scene 2: Assist in Actual Delivery
Narrator:  while nurse aila is assiting the mother to transfer to the delivery
(Ramos) room (at this point the mother is now stable for transfer after
monitoring), nurse Anne will assist the nurse anne will prepare
the delivery room for another patient.
Assistant Nurse :  prepare the delivery room (5-13)
(Perpetua)
Narrator:  Clean perineum with the use of antiseptic solution (this is done
(Ramos) right after the mother delivers the placenta this is done to
decrease the risk of infection on the episiotomy or CS wound).
Nurse 1:  clean the perinium (14-15)
(Perez)
Narrator:  At the time of delivery (the time the baby is out)is shouted to the
(Ramos) room including the time it was out other facility they also include
other information such as the gender of the baby.)
Doctor:  At the time of delivery (iiri si mother) (kindly make your own script
(Vinoya) in regards to time of birth as well as don’t forget to inform the
mother).
Narrator:  The patient baby and mother will meet once the baby is stable
(Ramos) we call this rooming in. this is depending per facility and the
condition of the both patient.
Nurse 1:  1-3 minutes
(Perez)
Assistant Nurse :  Apgar scoring (after giving oxytocin, before cutting the cord ).
(Perpetua)
Scene 3: New born Care
The two assistant nurses will explain the rationale sa kanilang part such as:
Assistant Nurse:  Advised mother for breastfeeding cues; support and instruct
(Ramos) regarding position and attachment. Explain the importance of the
collustrum (rich in anti-bodies/ ito yung first milk which in hig in sa
 anti-bodies para sa immune system). and why she need to have
her baby intake it, note: some mothers think that it is a stale
breast milk please tell them why it has different color.
 Applied crede's prophylaxis with terraqmycin opthalmic ointment
to both eyes of the baby for (prohylaxis, to prevent most of the
time neonatal infectious conjunctivitis or other infection that might
lead to complication or worse blindness). Get the antropomertric
measurements this is taken as based line measurement to be
use to the infants growth and development.
Nurse:  iinject na po natin ang vit. K 1mg (it is for ano po ganyan tinurok
(silot) po through im at right thigh because of ganito ganyan) as well as
bcg and hepa b (explain purpose ulit).

Narrator:  after performing the perineal care, the mother was transfer to the
(Ramos) ward and kept the mother watm, kept baby warm with blanket
and drop light (this will help the baby retain their normal
temperature as infants do not have matured termo-regulating
functions) at ward
 for the first hour, check baby’s breathing and color as well as vital
signs of the mother. Massage uterus every 15minutes. Also
follow up the baby’s new born screening which is mandated by
the Philippine constitution.
Nurse 1:  acting na chinecheck v/s nung both baby and mother.
(Perez)
Narrator:  in the second hour, check mother and baby conditions every
(Ramos) 30minutesto 1hr.
Assistant Nurse :  acting ulit na inassess condition.
(Perpetua)
SILOT Advise optional delayed bathing (health teaching)
Narrator:  complete all records because not recorded are considered not
(Ramos) done, after completing all records 24hrs they are good to go.
After Everything
Narrator:  patient is delivered via Normal Spontaneous Delivery (NSD),
(Ramos) G1P1 (1001) TPAL delivery time 8:00 am, an alive healthy baby
boy Matias attended by Dr. Vinoya Pediatrician and NOD (medic
on duty) linford perez. Routine newborn care done and core
dressed by Ms. Ramos assisted by Ms. Silot.