GPA

Delivery Room Rotation:  GRAVIDA – the number of the mother got

pregnant including the present pregnancy
Skills Laboratory  PARA – the number of pregnancies that has
reached the age of viability (age of viability: 28
weeks and above): dead or alive
I. Admission Care Routine: Procedure  ABORTION – the number of pregnancies below
the age of viability.
1. Receive the patient and introduce yourself. TPAL
2. Don’t allow patient to walk (SOP wheelchair) if:
RBOW, LBOW, severe vaginal bleeding, increase  TERM BIRTHS – number of times the mother has
BP, preterm labor, severely in pain, with bearing carries a pregnancy to at least 38-42 weeks
down sensation, etc. (placenta previa; painless) gestation and delivered.
3. Change with DR slippers prior to entering the area  PRETERM BIRTHS – number of times the
4. Change street clothes to hospital gown. Remove mother has carried a pregnancy from 28-37
underwear and jewelries, provide privacy. If not weeks gestation and delivered.
contraindicated; let patient void/urinate at CR or  ABORTION – number of pregnancies below the
offer bedpan. age of viability (< 28 weeks)
5. Bring patient to receiving area (IE room).  LIVING CHILDREN – number of live births
6. Assist in lithotomy position on IE table.
7. Do perineal/flushing shave.
8. If patient is ready, call on ROD (resident on duty). Example
9. Assist in attachment of EFM (electric fetal
Scenario 1
monitor).
10. Assist patient to labor room. A 35-year-old woman presents one week post laparoscopy
after a confirmed ectopic pregnancy was discovered. The
ectopic contents were successfully removed. History
reveals recurrent ectopic pregnancies – 4 additional –
II. History Taking/ Data Gathering which were noted in the chart. She has 3 living children,
one birth at 35 weeks and twins born at 38 weeks.
Demographic Data
 Complete name GPA: G = 7, P = 2, A = 5
 Age TPAL: T = 2, P = 1, A = 5, L = 3
 Address
Scenario 2
 Reason/complaint on admission
 Time uterine contraction started Xyla with twins born at 32 weeks, her eldest child was born
(Duration, Frequency, Interval, Intensity) at 38 weeks, she had miscarriage at 12th week of her 2nd
 Passage of watery stool/ bloody mucoid vaginal pregnancy and is currently pregnant.
discharge GPA: G = 4, P = 2, A = 2
 Included are the Vital Signs TPAL: T = 1, P = 2, A = 1, L = 3

Example

Name: Maria Clara

Age: 27
Address: Davao city
III. Obstetrics Computation
Reason/complaint on admission: “Sigig padayon ra
ang sakit sa akong tiyan.” What to Compute?
Time uterine contraction started: 1. AOG – Age of Gestation
 Duration – 60s
 Frequency – 4min 3 methods:
 Interval – 3min  Computation in weeks based on LMP
 Intensity – moderate  Using McDonald’s rule (months)
 With clear vaginal discharge
 Using Bartholomew’s rule (landmarks)

2. EDC/EDD – Expected Date of Confinement/

Obstetrical Data
Delivery; Naegele’s rule
 GRAVIDA PARA ABORTION (GPA) 3. EFW – Estimated Fetal Weight; Johnson’s rule
– Number of pregnancies 4. EFL – Estimated Fetal Length; Haases’s rule
 TERM PRETERM ABORTION LIVING (TPAL)
– Number of births
Bartholomew’s Rule
IV. Medical History
 Calculated the estimated AOG depending on
the height of the fundus. Medical Data
 Does not use numerical height values to  Hypertension (Gestational hypertension)
compute gestational age but landmarks  Gestational diabetes mellitus
 Laboratories – CBC (hct, hgb: 12-16 gm/dL),
UA (sugar, ketones, bacteria, proteins), blood
type, RH factor
History of Previous Pregnancies
 Method of delivery – CS, NSVD, VBAC
 Place of delivery – helps indicate if the woman
underwent precipitous labor
 Risk involved/complications

Obstetrical (OB History) – Example:

Gravida Year AOG Type of Place of Sex Weight
Delivery Delivery
G1 2016 FT NSVD Home M 8 lbs.

G2 2017 FT NSVD Home M 7.5 lbs.

12 wks. – At symphysis pubis
16 wks. – Between symphysis pubis and umbilicus G3 2018 Abortus
20 wks. – Umbilicus
G4 2019 FT CS Hospital M 6 lbs.
24 wks. – 2cm above umbilicus
28 wks. – Between umbilicus and xiphoid process G5 2020 Present Pregnancy
32 wks. – Below xiphoid process
36 wks. – Xiphoid Process
40 wks. – Below xiphoid process
V. Present Pregnancy (Danger Signs)
Naegele’s Rule (EDC/EDD)
 NAUSEA/VOMITING – Hyperemesis gravidarum is
Formula: (-3, +7, +1) – Months, Days, Year the medical term for severe nausea and vomiting
Caution! If LMP is between January and March, do during pregnancy. The symptoms can be severely
NOT add 1 year. uncomfortable (may lead to dehydration).
 VAGINAL BLEEDING – bleeding during pregnancy
Johnson’s Rule (EFW) is common, especially during the first trimester, and
usually it’s no cause for alarm. But because bleeding
Formula: EFW= Fundic Height – N x 155 can sometimes be a sign of something serious, it’s
Given: if engaged (12), if not (11) important to know the possible causes, and get
Grams to Kg – divide by 1000 checked out by your doctor to make sure you and
Convert to pounds – Kg x 2.2 your baby are healthy.
 ABSENCE OF FHR/FHT – BPM. Moderate = 6 to 25
Note: Round off to at least 2 decimal points bpm. Marked => 25 BPM. The tracing to the right
shows an amplitude range of -10 BPM (moderate
Birth Weight Classifications variability).
LOW BIRTH WEIGHT = less than 2500g
 SWELLING OF FACE AND LOWER EXTREMITIES
VERY LOW BIRTH WEIGHT = less than 1500g – as pregnancy progresses, fluid may accumulate in
EXTREMELY LOW BIRTH WEIGHT = less than 1000g tissues, usually in the feet, ankles, and legs, causing
them to swell and appear puffy. This condition is
called edema. Occasionally, the face and hands also
Haases’s Rule (Estimation of Fetal Length) swell. Some fluid accumulation during pregnancy is
normal, particularly during the 3rd trimester. It is
called physiologic edema.
Formula:
1st half of pregnancy (1-4 months) squared by month  SEVERE CONTINUOUS HEADACHE – tension
2nd half of pregnancy (5-9 months) squared by 5 headaches are common in the first trimester of your
pregnancy. This may happen because your body is
11 = 1cm 55 = 25cm 95 = 45cm undergoing several changes at this time. These
22 = 4cm 65 = 30cm changes may trigger headache pain: (a) hormonal
33 = 9cm 75 = 35cm
44 = 16cm 85 = 40cm changes, (b) higher blood volume, (c) weight
changes.
 PALENESS/PALLOR DURING PREGNANCY –
one of the most common causes of paleness is
VII. Leopold’s Maneuvers
anemia, a condition in which your body doesn’t
 Four specific steps in palpating the uterus through
have enough red blood cells to transport and
the abdomen
circulate oxygen. You are particularly susceptible
 Low cost, easy to perform, and non-invasive
during pregnancy since your blood flow has
 Used to determine position, presentation, and
increased and you need extra iron and folate to
engagement of the fetus in the utero
produce enough healthy red blood cells. Paleness
could also be a result of general fatigue, inadequate  Named after the German obstetrician and
sleep, or vomiting, all common symptoms of gynecologist Christian Gerhard Leopold (1846-1911)
pregnancy.  Part of the physical examination of pregnant women
 SUDDEN ESCAPE OF FLUID – preterm premature  Preferably performed after 24 weeks gestation
rupture of membrane (PPROM) when fetal outline can be already palpated.
(Swelling and headache may indicate PIH –
Preparation
Pregnancy Induced Hypertension)
1. Instruct woman to empty her bladder first.
2. Place woman in dorsal recumbent position, supine
with knees flexed to relax abdominal muscles.
Place a small pillow under the head for comfort.
3. Drape properly to maintain privacy.
4. Explain procedure to the patient.
5. Warm hands by rubbing together. (Cold hands can
stimulate uterine contractions)
6. Use the palm for palpation not the fingers.

Maneuvers

TYPES INDICATIONS

FUNDAL GRIP Presentation

 Determines which
part of the baby is in
the fundus, either the
head or the buttocks.
 Head are firm and
move independently,
Fig.1 Image result for absence of FHR. Absent variability = buttocks are soft and
amplitude range undetectable. Minimal = <5 Intrapartum fetal move with the body
heart rate monitoring.

VI. Baseline Maternal and Fetal Status

Maternal Health History
 Name and age
Fetal lie
 Prenatal record data – Longitudinal, Oblique,
UMBILICAL GRIP
 Estimated date of birth Transverse
 History of current pregnancy
 Lab results (e.g. blood type, Rh status)  Clinician’s hands are
 Past pregnancy and OB history placed flat and
parallel to each other
Maternal Generalized Assessment along the abdominal
- Fundal ht. measurement wall at the level of the
umbilicus.
- Uterine activity (contraction frequency,
duration, and intensity)  Determines the
location of the back
- Cervical dilatation and degree of effacement
- Fetal status, including heart rate, position, and  The back feels firm
and smooth,
station extremities are small
- Pain level and bent.
PAWLICK’S GRIP Internal EFM
 The doctor will attach an electrode to the part of
Engagement
the baby’s body that is closest to the cervical
Determines the part in opening. This is usually the baby’s scalp.
the pelvic outlet. Head
may or may not be
engage. IX. Pelvic Examination
Internal Examination in the Delivery Room
- Helps determine cervical dilatation, effacement,
BOW (bag of water, fetal presentation, and station.
- To monitor the progress of labor.
Preparation:
1. Let the patient void and explain the procedure
2. Place patient in a lithotomy position
3. Shave half-moon
4. Do perineal flushing
PELVIC GRIP 5. Call the OB resident/obstetrician
Fetal attitude
6. Assist the doctor
7. Get sterile gloves from patient’s basket
 This maneuver 8. Serve KY jelly
involves the examiner
9. Prepare jotdown notebook and pen
placing the palms of
both hands on either
side of the lower
What will be checked during an IE?
abdomen, with the tips DILATATION – opening of the cervical OS from 1cm to
of the fingers facing 10cm due to uterine contraction and amniotic fluid.
downward toward the
pelvic inlet.
 Determines cephalic
prominence, and the
brow should be on the
opposite side of the
back

1st maneuver- V shape (identify head or buttocks)

2nd maneuver- locate fetal back (hands on sides)
3rd maneuver- L shape (for engagement)
4th maneuver- face mother’s feet (bottom to top)

VIII. FHT/EFM
Fetal Heart Monitoring- process of checking the Fig 2. Measurement of dilatation
condition of the fetus during labor and delivery by
monitoring your fetus’ heart rate.

- TOCO Transducer- placed where contractions

are most felt/active
- Ultrasound Transducer- for the fetal heart rate
- Event Marker- clicked every time contractions are
Fig 3. Cervical dilatation chart
felt
EFFACEMENT – gradual thinning of the cervical canal First Stage of Labor
expressed in percentage (100% is fully effaced)
CRITERIA LATENT ACTIVE TRANSITIONAL
Dilatation 0-3 cm 4-7 cm 8-10 cm
Intensity mild moderate strong
Duration 15-30 secs 30-60 secs 60-90 secs
Interval 15-30 mins 3-5 mins 2-3 mins
Length 8-12 hrs. 2-3 hrs. 1 hr.
Emotion excited fear Irritable
Diet DAT-soft NPO NPO
BOW IBOW RBOW ARM

Fig. 4 Cervical Effacement

X. Uterine Contraction Monitoring
BOW (Bag of Water)  EARLY CONTRACTIONS
 IBOW- Intact Bag of Water - Stretching of the ligaments around the uterus
 RBOW- Ruptured Bag of Water (dehydration, constipation, and gas pains)
 LBOW- Leaking Bag of Water - Spotting, bleeding, and/or abdominal pain →
report to the doctor
STATION – Relationship of the fetal presenting part to  BRAXTON HICKS CONTRACTIONS
the level of the ischial spine. (Ischial spine= Station 0) - Second trimester
- False contraction
PRESENTATION – Fetal body part that is in contact - Generally, not painful last anywhere from 30
with the cervix. seconds to 2 minutes and happen randomly
- Can be triggered by things like
exercise/intercourse
 PRETERM CONTRACTIONS
- Before 37 weeks of pregnancy
- Contractions that come regularly (every 10
minutes or less) may signal preterm labor
 LABOR CONTRACTIONS
- True labor contractions might start out as an
occasional uncomfortable twinge of the stomach
- They’ll slowly build to something more like really
bas cramps/gas pains
- As labor progresses, these contractions will
become stronger, more intense, and closer
together

False Labor True Labor

Irregular interval contractions Regular interval contractions
Pain in abdomen Starts at back to abdomen
Intensity remains the same Contractions are intensified
Intervals remain long Intervals gradually shorten
Walking gives relief Intensified by walking
No bloody show With bloody show
No cervical changes Cervical dilatation and
effacement
Contractions stop with Does not stop with sedation
sedation

Example of Uterine Contractions Documentation

TIME DURATION INTERVAL INTENSITY
8:53 50 secs 5 minutes Mod
8:58 60 secs 6 minutes Strong
9:05 55 seconds 4 minutes Mod
9:09 50 seconds 4 minutes Strong
9:12 60 seconds Strong

Fig. 5 & 6 Variations in Presentation

Interpretation: Ć Mod – Strong UC @ 50-60 seconds
q 4-6 mins interval
Do aftercare and assist the patient to the labor room
TOCO Transducer – a pressure sensitive device called  MAYO SCISSORS
a tocodynamometer is placed on the mother’s abdomen o STRAIGHT SCISSORS – are used for
over the area of strongest contractions to measure the cutting sutures and ligatures or
length frequency and strength of uterine contractions. trimming the skin around the wound,
hence it is also known as ‘suture
Electronic Fetal Monitoring – a method in which scissors’.
electronic instruments are used to record the heartbeat o CURVE BLADES – ideal to cut tough
of the fetus and contractions of the mother’s uterus. tissue like fascia, tendons, and
ligaments
 Frequency- Beginning of one contraction to
the beginning of another contraction.
 Duration- Beginning and end of the same
contraction.
 Interval- End of one contraction to the
beginning of another.
 Intensity- Strength of contraction at its peak.
Mild-nose, Moderate-chin, Strong-forehead
Duration and Intensity increases as labor progresses.
Frequency and Interval decreases as labor progress.

XI. Different Tools in the Delivery

Room
 FORCEPS – their primary purpose is to grasp,
ALLIS FORCEPS - the allis clamp is a surgical retract, or stabilize tissue
instrument that has a ratchet locking system; the
terminal end of the blades bears short teeth,
 Used to hold or grasp heavy tissue

 BLADE HOLDER AND BLADE – are intended to

be use with surgical blades for tissue separation
and other procedure that require a sharp surgical
blade to puncture or cut.  NEEDLE HOLDER – are designed to hold a
suture needle for episiorrhaphy.
 TISSUE FORCEPS – are used in surgical
procedures for grasping tissue

 PLACENTAL CURRETE – Dilation and curettage

(D&C) is a surgical procedure in which the cervix is
opened (dilated) and a thin instrument is inserted
into the uterus. The instrument is used to remove
tissue from the inside of the uterus (curettage).

 SUTURE NEEDLE
o CUTTINGS NEEDLE – used to suture
perineal skin
o ROUND NEEDLE – used to suture
perineal tissues

 OVUM FORCEPS – used to grasp, hold,

manipulate and remove tissue from inside the
uterus including the ovum and placenta.
 Used to clean the uterus with OS

 CONTENTS OF THE OB PACK

o BIG BASIN
o 3 TOWELS
o 1 PAIR OF LEGGINGS
o 1 FLANNEL
o 1 BONNET
 2 OVUM FORCEPS
 3 CLAMPS
 NEEDLE HOLDER

Procedure
1. Do medical hand washing
2. Obtain the pack and check its sterility and
expiration and open it aseptically

2.1 Place the OB Pack at the center of the table

ARRANGEMENT OF THE INSRUMENTS 2.2 Open first wrap with hands
2.3 Open second wrap with pick up forceps
 CONTENTS OF OB PACK 2.4 Take out the items inside the OB pack
 PAIR OF LEGGINGS
 FLANELLE Arrange in order (from bottom to top)
 BONNET  2 towels
 1 TOWEL  Bonnet
 Flanelle
 Towel
 Leggings

3. Open the instrument set and cautiously drop

the contents on the sterile field and open it
aseptically
4. Place all sterile supplies on the sterile field
5. Using pick up forceps, arrange all equipment
according to its use
6. Perform surgical hand scrubbing
7. Don sterile gloves
8. With assistance, aspirate 5 cc of local
anesthesia
9. Prepare the suture and mount the surgical
blade into blade holder
XII. Essential Intrapartum Care 10. Disinfect the vulva with betadine solution and
drape the client’s legs aseptically
EQUIPMENT: 11. Place 1 hypotowel under patient’s buttocks
 STERILE CORD CLAMP 12. Coach the patient the proper breathing and
 STERILE BONNET pushing technique
 SURGICAL BLADE 13. Give to the doctor the allis forceps
 DISPOSABLE SYRINGE 5cc 14. Open syringe and offer it to doctor
 SUTURE 15. Offer scalpel
16. Do Ritgen’s maneuver during crowning
 STERILE FLUSHING BOWL/ KIDNEY BASIN
17. Assist the baby’s head in external rotation
WITH COTTON BALLS SOAKED IN
18. Anchor the baby’s neck, pull the head
BETADINE SOLUTION
downwards and upward
 OS
19. Slide your hands on baby’s back and grasp
 LOCAL ANESTHESIA
both legs
 OXYTOCIN DRUGS
20. Immediately place the baby on the mother’s
 STERILE GLOVES abdomen for essential newborn care
21. Cord care
STERILE OB PACK CONTAINING: 22. Wait for pulsation to stop the place cord clamp
 BASIN 1-1.5 inches
 2 BIG DRAPES (LAYETTE) 23. Milk cord up to 2 inches then lock using
 3 SMALL DRAPES (HYPOTOWELS) straight forceps
 1 PAIR OF LEGGINGS 24. Cut below the cord clamp using mayo scissors
25. Do Brandt Andrews maneuver and Crede’s
STERILE INSTRUMENT SET CONTAINING: maneuver
 BLADE HOLDER 26. Inspect and dispose the placenta appropriately
 TISSUE FORCEPS 27. Replace another hypotowel under the buttocks
 MAYO SCISSORS 28. Assist in the episiorrhaphy or repair of
 PLACENTAL CURRETTE laceration
 BANDAGE SCISSORS 29. Do perineal cleaning
30. Remove all drapes from the patient Ritgen Maneuver
31. Apply adult diaper
32. Straighten the legs of the patient
33. Change patient’s gown and make patient
comfortable
34. Remove all sharps and dispose properly
35. Wash the instrument according to hospital
protocol
36. Place all soiled linens into the hamper
37. Clean the area
38. Remove gloves
39. Wash hands
40. Document the procedure

1. As soon as the head of a fetus is prominent at

the vaginal opening, the physician or nurse
XIII. Maneuvers during Delivery midwife may place a sterile towel over the
rectum and press toward the fetal chin while the
Episiotomy other hand is pressed downward on the occiput
(back of the head or skull)
2. It controls the delivery of the fetal head. It
involves applying an upward pressure from the
coccygeal region to extend the head during
actual delivery, thereby protecting the
musculature of the perineum.
3. This helps a fetus achieve extension, so that the
head is born with the smallest diameter
presenting.
4. This also controls the rate at which the head is
born. Pressure should never be applied to the
fundus of the uterus to effect birth, because
uterine rupture could occur
5. A woman is asked to continue pushing until the
occiput of the fetal head is firmly at the pubic
arch. Then the head is born between
contractions.
1) An episiotomy is a surgical incision of the
perineum that is made both to prevent tearing 6. The woman may be asked to pant deliberately,
so that she does not push during a contraction.
of the perineum and to release pressure on the
fetal head with birth. Instructions should be repeated as necessary,
because often a woman is so involved with the
2) An episiotomy incision is made with blunt- coming birth that she does not hear.
tipped scissors in the midline of the perineum 7. Immediately after birth of the baby’s head, the
physician or nurse-midwife suctions the infant’s
(midline episiotomy) or is begun in the midline
but directed laterally away from the rectum mouth with a bulb syringe.
(mediolateral episiotomy). 8. Doctors or nurse midwife will pass his or her
fingers along the occiput to the newborn’s neck,
3) Mediolateral episiotomies have the advantage to determine whether a loop of umbilical cord is
encircling the neck.
over midline cuts in that, if tearing occurs
beyond the incision, it will be away from the 9. If such a loop is felt, it is gently loosened and
rectum. drawn down over the fetal head. If it is too tightly
coiled to allow this, it is clamped and cut before
4) The advantage of an episiotomy is that it the shoulders are born. Otherwise, it could tear
and interfere with the fetal oxygen supply.
substitutes a clean cut for a ragged tear,
minimizes pressure on the fetal head, and may 10. After expulsion of the fetal head, external
rotation occurs.
shorten the last portion of the second stage of
labor 11. Gentle pressure is exerted downward on the
side of the infant’s head, and the anterior
shoulder is born. Slight upward pressure on the
side of the head allows the anterior shoulder to
nestle against the symphysis as the posterior
shoulder is born.
12. Subsequent upward pressure in the opposite 4. Take note of time and placental separation
direction facilitates delivery of the posterior (Schultz or Duncan) and take BP
shoulder. 5. In checking for the completeness of the
13. The remainder of the body then slides free cotyledons, student nurse will palpate if there
without any difficulty. is a hollow portion, tell the doctor there is
14. This is the time that should be noted and something missing
recorded as the time of birth. Make sure to also
- Retained placental tissue is associated with
note the gender.
postpartum hemorrhage and infection. The
15. With the birth of the infant, the second stage of
labor is complete. maternal surface of the placenta should be
16. The baby is vigorously stimulated and dried, inspected to be certain that all cotyledons are
and placed on the mother’s abdomen using the present.
“Unang Yakap” for 90 minutes.
17. The cord is clamped with two Kelly hemostats
placed 2 to 5 cm from the infant’s umbilicus
and then is cut between them.
a) Feel pulsation
b) Clamp an inch from the baby’s abdomen
c) Milk cord about 2cm
d) Hold, then clamp using scissor clamp
e) Cut near the plastic clamp

XIV. Placental Delivery

 Delivery of the placenta is also known as the
third stage of labor 6. Promote uterine contraction
a. Massage the hypogastric area (done by the
student)
Signs of Placental Separation
b. Administer medication oxyticine, maleate (by
1. Lengthening of the cord
2. Sudden gush of blood registered nurse)
3. Rising of the fundus (Calkin’s sign) c. If not contracted aside from massaging and
4. Globular shape of the abdomen (Calkin’s sign) giving of medication, apply ice pack the
hypogastric and allow the patient to stimulate
Placental Delivery the nipple by tickling the nipple
1. Schultz Delivery (Shiny, fetal side) 7. Inspect perineum for lacerations
2. Duncan Delivery (Dirty, Raw, Red, Irregular, 8. Assist in episiorrhaphy
Cotyledon showing maternal side) - Surgical repair of injury to the vulva by
suturing to help prevent more extensive
vaginal tears during childbirth and heal better
than a natural tear
9. Do perineal care
a. Flushing using sterile water
b. Drying perineal area to thigh, buttocks using
leggings. If in the perineal, apply OS
c. Apply diaper or contour brief
10. Make patient comfortable
To Help Deliver Placenta: a. Straightening the legs
1. Perform Crede’s maneuver b. Changing gowns and blanket
- Involves placing one hand on the top of the 11. Monitoring vital signs q15 minutes for the first
uterus (uttering fundus) and squeezing it hour, q30 for second hour, q hourly until
between the thumb and other fingers to help stable then q4.
placental separation and delivery
2. Grab basin above the anus and catch the XV. Post-Partum Assessment
placenta
 Post-Partum Assessment – is a process of
3. Coil cord using Brandt Andrews maneuver
thorough examination and evaluation of the
- Method of expressing the placenta by woman’s physical, physiological functioning
grasping the umbilical cord with one hand during a certain period after giving birth; normal,
and placing the other hand on the abdomen. caesarian section, or by instrumentation
PURPOSES: B – BLADDER
1. To examine the physical, psychological, and Voiding should occur 4-6 hours, post-partum (6-8 hrs.):
physiological status of post-partum patient a. Ask patient her last voiding time. Ask for the color,
2. To determine the involution process of post- amount, and presence of tenderness while
partum, voiding.
3. To evaluate the normal postpartum adaptation b. Inspect for bladder distention. Patient may hold
level, urine due to pain during urination. Full bladder will
4. To assess for possible postpartum impede uterine contraction.
complications. c. If patient is on indwelling catheter, take note of the
patency of the tubing, amount and color of urine.
4th Stage of Labor
 Puerperium/Postpartum Period – 6 week B – BOWEL
period after childbirth  More active soon after birth
 Involution – reproductive organs return to its  Peptide hormone relaxing (high circulating levels
non-pregnant state during pregnancy) depresses bowel motility
 Subinvolution – failure of the reproductive  Continued effects of progesterone on the smooth
organ to return to its non-pregnant state muscles
 Exfoliation – placental site heals by scaling off  Bowel movement typically delayed until 2nd or
dead tissue 3rd puerperal date
 Atony – uterus does not have good muscle  Bowel is slowed
tone and consequently relaxes  During of labor, restriction of food
 Fear of tearing the stitches
Principles of Puerperium
 Promotion of healing and prevention of illness L – LOCHIA
 Prevent postpartal complications  Discharges of the uterus:
 Establish successful lactation  Lochia Rubra – 1-3 days bloody red in color
 Motivate use of family planning method  Lochia Serosa – 4-10 days pink or brown color
 Provide emotional and psychological support  Lochia Alba – creamy, yellowish color
 Pattern should not be reverse
AV BUBBLEHER  Increase in activity
 Decrease in breastfeeding
A – APPEARANCE  Not offensive in odor
 observe for patient’s general appearance,  Without large clots
body built, activities, hygiene, mood, color, and  Present in CS
communication

V - VITAL SIGNS E – EPISIOTOMY

 Temperature – increase on the 1st 24hrs, Midline or Mediolateral Lacerations:
dehydration effort in labor,after 24 hrs 1st degree – skin, mucus membrane
infection, after 3-4 days, milk production 2nd degree – skin, mucus membrane, fascia
 Pulse – decrease due to decreased cardiac 3rd degree – skin, mucus, membrane, muscles, rectal
output sphincter
 Blood pressure – slightly decrease 4th degree – involve all these structures plus anal wall
 Respiratory Rate – no changes
R – Redness
B – BREAST E – Edema
 Drop in estrogen and progesterone E – Ecchymosis
 Lactating D – Discharges
 Colostrum is present A – Approximation
 Let-down reflex
 Warm and Tender H – HOMAN’S SIGN
 Engorged
 Used in assessment of Deep Venous Thrombosis
 Milk is produced by the 3rd – 4th day (DVT) in the leg.
 Veins are apparent  Varicosities and signs of thrombophlebitis
U – UTERUS - Inflammatory process that causes blood clot
to form and block one or more veins.
 Size is reduced
- Pedal pulses may be obstructed by
 Placental site is sealed off
thrombophlebitis and should be palpated
 Cervical os are narrowed
with each assessment.
 Painful during contraction
 Contracted
E - EMOTIONAL STATUS Step 2: Initiate immediate uninterrupted skin to
 Sense of elation immediately after birth skin contact
 Mother wanted to talk about her labor and  For 60-90 minutes even when transferring
delivery  Or until baby completes 1st breastfeed
 Exhausted, need rest and sleep to restore her  Prone on the mother’s abdomen or between
body to health breasts
 Normally during the 1st 24 hours, passive,  R: promotes bonding, overall success of
preoccupied with own needs, talkative if
breastfeeding, and prevents hypoglycemia
unable to sleep
 Put linen and bonnet on baby
 1-2 days beginning to assume responsibility
 Note: Time initiated and stopped
R - RH INCOMPATIBILITY Step 3: Properly timed cord clamping
 Possible when specific circumstances exist:
 Wait for pulsations to stop
 Mother is Rh (-), fetus is Rh (+)
 R: prevents anemia and intraventricular
RHOGAM – Rh immune globulin, unsensitized hemorrhage in preterm
 28/7 AOG
 72 hours PP-IM Icterus Gravis – RBC are Step 4: Initiate early breastfeeding
destroyed  Watch for feeding cues at 20-90 minutes
 Fetal bilirubin increases  Feeding cues: rooting – head turns to look for
 KERNICTERUS (bilirubin encephalopathy) nipple, smacking lips, sucking hands
 Note: time initiated and completed

Breastfeeding:
XVI. Essential Newborn Care  Encourage breastfeed per demand
 Observe at least one breastfeed for proper
Equipment: 2 blankets/linens, Bonnet, Cord Care Set
positioning and attachment
 Proper positioning: head and lower body of baby
must be aligned, tummy to tummy
 Proper attachment: baby grasps not only the
nipple but also the areola, lower lip turned outward,
chin of baby touches the mother’s breast.

Things to Note:
 Minimize handling of newborn
 Do not bathe the baby for at least the 1-6 hours;
R: May cause hyperthermia or infection
 Do not give sugar water, formula or other liquids
 Do not use pacifiers or bottles
 Strict breastfeeding until 6 months

APGAR Scoring System

Indicator 0 point 1 point 2 points
Activity absent Flexed arms active
(muscle tone) and legs

Pulse absent Below 100 Over 100

bpm bpm

Grimace floppy Minimal Prompt

Step 1: Drying with rapid assessment of the (reflex irritability) response to response to
baby’s breathing stimulation stimulation
 Dry off newborn with a linen Appearance Blue; Pink body, pink
(skin color) pale blue
 Do not rub off vernix as it provide natural
extremities
protection
Respiration absent Slow and Vigorous cry
 Simultaneously, stimulate the baby to cry by irregular
rubbing or patting
 Carry out a rapid assessment
Anthropomorphic Measurements
a. Head Circumference: 33-35 cm
b. Chest Circumference: 31-33 cm
c. Abdominal Circumference: 28-30 cm
d. Length: 48-53 cm
e. Weight: 2.35-4 kls.

Medication
 Hepatitis B Injection- To prevent hepatitis B
infection (0.5cc): Vastus Lateralis
 Vitamin K- to prevent bleeding (0.1cc)
 Erythromycin (Terramycin) Eye Ointment- to
avoid the chance of a serious eye infection

XVII. Principles of Aseptic Technique

Asepsis – free from contamination caused by
harmful bacteria, viruses, or other microorganism

Aseptic technique – using practices and

procedures to prevent contamination from pathogens

 Only Sterile items touches the sterile field

 Gowns of the surgical team are considered
sterile from chest to the level of the sterile field.
The sleeves are also considered sterile from 2
inches above the elbow stockinette cuff
 Sterile drapes are used to create a sterile field.
Only the top surface of a drape table is
considered sterile.
 Once sterile field is set up, the border of one
inch at the edge of the sterile drape is
considered unsterile.
 Sterile persons or objects may only contact
sterile areas; non-sterile persons or items
contact only non-sterile areas.
 Items of doubtful sterility are considered
unsterile. Sterile fields should be prepared as
close as possible to the time of use.

“Success is not final, failure is not fatal:

It is the courage to continue that counts.”

- Pachar char na quote para inspired daw kuno

DELIVERY ROOM OBSTETRICAL DATA

OUTLINE • GRAVIDA PARA ABORTION (GPA) – number of

pregnancies
I. Admission Care Routine • TERM PRETERM ABORTION LIVING (TPAL) – number
II. History taking/Data gathering of births
III. Obstetrics Computation
IV. Medical history
V. Present pregnancy (danger signs) GPA
VI. Leopold’s maneuvers
VII. Pelvic examination
VIII. Uterine contraction monitoring
• GRAVIDA – the number of the mother got pregnant
including the present pregnancy
• PARA – the number of pregnancies that has reached the
ADMISSION CARE ROUTINE: PROCEDURE age of viability (age of viability: 28 weeks and above)
• ABORTION – the number of pregnancies below the age of
1. Receive the patient and introduce yourself. viability
2. Don’t allow patient to walk (SOP wheelchair) if: RBOW,
LBOW, severe vaginal bleeding, increase BP, preterm TPAL
labor, severely in pain, with bearing down sensation, etc.
3. Change street clothes to hospital gown. Remove
underwear and jewelries, provide privacy, if not • TERM BIRTHS – number of times the mother has carries
contraindicated let patient void/urinate at CR or offer a pregnancy to at least 38-42 weeks gestation and
bedpan. delivered.
4. Bring patient to receiving area (IE room). • PRETERM BIRTHS – number of times the mother has
5. Assist in lithotomy position on IE table. carried a pregnancy from 28-37 weeks gestation and
6. Do perineal/flushing shave. delivered.
7. If patient is ready, call on ROD (resident on duty).
8. Assist in attachment of EFM (electric fetal monitor).
• ABORTION – number of pregnancies below the age of
viability (< 28 weeks)
9. Assist patient to labor room.
• LIVING CHILDREN – number of live births
HISTORY TAKING/DATA GATHERING
Example

• Complete name Scenario 1

• Age
A 35-year-old woman presents one week post laparoscopy
• Address after a confirmed ectopic pregnancy was discovered. The
• Reason/complaint on admission ectopic contents were successfully removed. History
• Time uterine contraction started reveals recurrent ectopic pregnancies – 4 additional –
which were noted in the chart. She has 3 living children,
• Passage of watery stool/bloody mucoid vaginal discharge one birth at 35 weeks and twins born at 38 weeks.

Example GPA: G = 7, P = 2, A = 5
TPAL: T = 2, P = 1, A = 5, L = 3
Name: Maria Clara
Age: 27 Scenario 2
Address: Davao city
Reason/complaint on admission: “Sigig padayon ra ang Xyla with twins born at 32 weeks, her eldest child was born
sakit sa akong tiyan.” at 38 weeks, she had miscarriage at 12th week of her 2nd
Time uterine contraction started: pregnancy and is currently pregnant.
• Duration – 60s
• Frequency – 4min GPA: G = 4, P = 2, A = 2
• Interval – 3min TPAL: T = 1, P = 2, A = 1, L = 3
• Intensity – moderate
• With clear vaginal discharge

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 20

OBSTETRICS COMPUTATION: WHAT TO possible causes, and get checked out by your doctor to
COMPUTE? make sure you and your baby are healthy.
• ABSENCE OF FHR/FHT – BPM. Moderate = 6 to 25 bpm.
Marked => 25 BPM. The tracing to the right shows an
• AOG – age of gestation amplitude range of -10 BPM (moderate variability).
• SWELLING OF FACE AND LOWER EXTREMITIES – as
3 methods: pregnancy progresses, fluid may accumulate in tissues,
usually in the feet, ankles, and legs, causing them to swell
Computation in weeks based on LMP and appear puffy. This condition is called edema.
Using McDonald’s rule (months) Occasionally, the face and hands also swell. Some fluid
accumulation during pregnancy is normal, particularly
Using Bartholomew’s rule (landmarks)
during the 3rd trimester. It is called physiologic edema.
• SEVERE CONTINUOUS HEADACHE – tension
• EDC/EDD – expected date of confinement/delivery using headaches are common in the first trimester of your
Naegele’s rule pregnancy. This may happen because your body is
• EFW – estimated fetal weight using Johnson’s rule undergoing several changes at this time. These changes
• EFL – estimated fetal length using Haases’s rule may trigger headache pain: (a) hormonal changes, (b)
higher blood volume, (c) weight changes

Birth Weight Classifications • PALENESS/PALLOR DURING PREGNANCY – one of the

most common causes of paleness is anemia, a condition in
which your body doesn’t have enough red blood cells to
LOW BIRTH WEIGHT = less than 2500g
transport and circulate oxygen. You are particularly
VERY LOW BIRTH WEIGHT = less than 1500g
susceptible during pregnancy since your blood flow has
EXTREMELY LOW BIRTH WEIGHT = less than 1000g
increased and you need extra iron and folate to produce
enough healthy red blood cells. Paleness could also be a
result of general fatigue, inadequate sleep, or vomiting, all
Haases’s Rule common symptoms of pregnancy.

Formula: • SUDDEN ESCAPE OF FLUID – preterm premature rupture

1st ½ of pregnancy (1-4 months) squared by month of membrane (PPROM)
2nd ½ of pregnancy (5-9 months) squared by 5

11 = 1cm 55 = 25cm 95 = 45cm

22 = 4cm 65 = 30cm
33 = 9cm 75 = 35cm
44 = 16cm 85 = 40cm

MEDICAL HISTORY

• Hypertension
• Gestational diabetes mellitus
• Laboratories – CBC (hct, hgb: 12-16 gm/dL), UA (sugar,
ketones, bacteria, proteins), blood type, RH factor

HISTORY OF PREVIOUS PREGNANCIES

• Method of delivery – CS, NSVD, VBAC

• Place of delivery
• Risk involved/complications

PRESENT PREGNANCY (DANGER SIGNS)

• NAUSEA/VOMITING – Hyperemesis gravidarum is the

medical term for severe nausea and vomiting during
pregnancy. The symptoms can be severely uncomfortable.
• VAGINAL BLEEDING – bleeding during pregnancy is
common, especially during the first trimester, and usually it’s Fig.1 Image result for absence of FHR. Absent variability =
no cause for alarm. But because bleeding can sometimes amplitude range undetectable. Minimal = <5 Intrapartum fetal
be a sign of something serious, it’s important to know the heart rate monitoring.

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 21

LEOPOLD’S MANEUVER PELVIC GRIP • This maneuver
involves the examiner
• Four specific steps in palpating the uterus through the placing the palms of
abdomen both hands on either
side of the lower
• Low cost, easy to perform, and non-invasive abdomen, with the
• Used to determine position, presentation, and engagement tips of the fingers
of the fetus in the utero facing downward
toward the pelvic inlet.
• Named after the German obstetrician and gynecologist
Christian Gerhard Leopold (1846-1911) • Determines cephalic
prominence, and the
• Part of the physical examination of pregnant women brow should be on the
• Preferably performed after 24 weeks gestation when fetal opposite side of the
outline can be already palpated. back

PAWLICK’S GRIP • Determines the part in

Preparation the pelvic outlet. Head
may or may not be
1. Instruct woman to empty her bladder first. engage.
2. Place woman in dorsal recumbent position,
supine with knees flexed to relax abdominal
muscles. Place a small pillow under the head for
comfort.
3. Drape properly to maintain privacy.
4. Explain procedure to the patient.
5. Warm hands by rubbing together. (Cold hands
can stimulate uterine contractions)
6. Use the palm for palpation not the fingers.

Maneuvers

TYPES INDICATIONS
• Determines which
part of the baby is in PELVIC EXAMINATION
FUNDAL GRIP the fundus, either the
head or the buttocks.
• Head are firm and
• DILATATION – opening of the cervical OS from 1cm to
10cm due to uterine contraction and amniotic fluid
move independently,
buttocks are soft and
move with the body

UMBILICAL GRIP • Clinician’s hands are

placed flat and
parallel to each other
along the abdominal
wall at the level of the
umbilicus.
• Determines the
location of the back
• The back feels firm
and smooth,
extremities are small
and bent.
Fig 2. Measurement of dilatation

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 22

Fig. 5 & 6 Variations in Presentation

First stage of labor

CRITERIA LATENT ACTIVE TRANSITIONAL
0-3 cms 4-7 cms 8-10 cms
Fig 3. Cervical dilatation chart
DILATATION
• EFFACEMENT – gradual thinning of the cervical canal
expressed in percentage (100% is a fully effaced cervix)
INTENSITY Mild Moderate Strong

DURATION 15-30 30-60 60-90 secs

secs secs

INTERVAL 15-30 3-5 mins 2-3 mins

mins

LENGTH 8-12 hrs 2-3 hrs 1 hr

EMOTION Excited Fear Irritable
Fig. 4 Cervical Effacement DIET DAT-soft NPO NPO
BOW IBOW RBOW ARM

UTERINE CONTRACTION MONITORING

• EARLY CONTRACTIONS

- Stretching of the ligaments around the uterus

(dehydration, constipation, and gas pains)
- Spotting, bleeding, and/or abdominal pain → report to
the doctor

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 23

• BRAXTON HICKS CONTRACTIONS REFERENCES

- Second trimester I. Mr. Abello, Bernal, Canton, Carido, Cuanan,

Dapitanon’s PPT
- False contraction
II. Ms. Abad and Abellon’s PPT
- Generally, not painful last anywhere from 30 seconds
to 2 minutes and happen randomly
- Can be triggered by things like exercise/intercourse

• PRETERM CONTRACTIONS

- Before 37 weeks of pregnancy

- Contractions that come regularly (every 10 minutes or
less) may signal preterm labor

• LABOR CONTRACTIONS

- True labor contractions might start out as an

occasional uncomfortable twinge of the stomach
- They’ll slowly build to something more like really bas
cramps/gas pains
- As labor progresses, these contractions will become
stronger, more intense, and closer together

Example of Uterine Contractions Documentation

TIME DURATION INTERVAL INTENSITY

8:53 50 secs 5 minutes Mod

8:58 60 secs 6 minutes Strong

9:05 55 seconds 4 minutes Mod

9:09 50 seconds 4 minutes Strong

9:12 60 seconds Strong

Interpretation: Ć Mod – Strong UC @ 50-60 seconds q 4-6

mins interval

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 24

DELIVERY ROOM
 MAYO SCISSORS
OUTLINE o STRAIGHT SCISSORS – are used
for cutting sutures and ligatures or
I. Different tools in Delivery Room trimming the skin around the
II. Essential Intrapartum Care wound, hence it is also known as
III. Placental Delivery ‘suture scissors’.
IV. Post Partum Assessment o CURVE BLADES – ideal to cut
V. Definition of Post-Partum tough tissue like fascia, tendons,
Assessment and ligaments
VI. Purposes
VII. 4th stage of labor
VIII. Principle of Puerperium
IX. AV BUBBLEHER
X. APGAR SCORE
XI. Principles of Aseptic Technique

DIFFERENT TOOLS IN DELIVERY ROOM

 ALLIS FORCEPS - the allis clamp is a
surgical instrument that has a ratchet locking  FORCEPS – their primary purpose is to
system; the terminal end of the blades bears grasp, retract, or stabilize tissue
short teeth,
 Used to hold or grasp heavy tissue

 BLADE HOLDER AND BLADE – are  NEEDLE HOLDER – are designed to hold a
intended to be use with surgical blades for suture needle for episiorrhaphy.
tissue separation and other procedure that
require a sharp surgical blade to puncture or
cut.

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2-D Page 25

 TISSUE FORCEPS – are used in surgical
procedures for grasping tissue

 PLACENTAL CURRETE – Dilation and

curettage (D&C) is a surgical procedure in
which the cervix is opened (dilated) and a
thin instrument is inserted into the uterus.
The instrument is used to remove tissue from
the inside of the uterus (curettage).

 SUTURE NEEDLE
o CUTTINGS NEEDLE – used to
suture perineal skin
o ROUND NEEDLE – used to suture
perineal tissues

 OVUM FORCEPS – used to grasp, hold,

manipulate and remove tissue from inside
the uterus including the ovum and placenta.
 Used to clean the uterus with OS

 CONTENTS OF THE OB PACK

o BIG BASIN
o 3 TOWELS
o 1 PAIR OF LEGGINGS
o 1 FLANNEL
o 1 BONNET

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2-D Page 26

 OS
 LOCAL ANESTHESIA
 OXYTOCIN DRUGS
 STERILE GLOVES

STERILE OB PACK CONTAINING:

 BASIN
 2 BIG DRAPES (LAYETTE)
 3 SMALL DRAPES (HYPOTOWELS)
 1 PAIR OF LEGGINGS

STERILE INSTRUMENT SET CONTAINING:

 BLADE HOLDER
 TISSUE FORCEPS
 MAYO SCISSORS
 PLACENTAL CURRETTE
 BANDAGE SCISSORS
 2 OVUM FORCEPS
 3 CLAMPS
ARRANGEMENT OF THE INSTRUMENT
 NEDDLE HOLDER
 CONTENTS OF OB PACK
 PAIR OF LEGGINGS PROCEDURE
 FLANELlE 1. Do medical hand washing
 BONNET 2. Obtain the pack and check its sterility
 1 TOWEL and expiration and open it aseptically
2.1 Place the OB Pack at the center of the
table
2.2 Open first wrap with hands
2.3 Open second wrap with pick up
forceps
2.4 Take out the items inside the OB pack
and arrange it in order (from bottom
to top)
 2 towels
 Bonnet
 Flanelle
 Towel
 Leggings
ESSENTIAL INTRAPARTUM CARE 3. Open the instrument set and cautiously
drop the contents on the sterile field and
EQUIPMENT:
open it aseptically
 STERILE CORD CLAMP
4. Place all sterile supplies on the sterile
 STERULE BONNET field
 SURGICAL BLADE 5. Using pick up forceps, arrange all
 DISPOSABLE SYRING 5cc equipment according to its use
 SUTURE 6. Perform surgical hand scrubbing
 STERILE FLUSHING BOWL/ KIDNEY 7. Don sterile gloves
BASIN WITH COTTON BALLS 8. With assistance, aspirate 5 cc of local
SOAKED IN BETADINE SOLUTION anesthesia

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2-D Page 27

9. Prepare the suture and mount the  Delivery of the placenta is also known as
surgical blade into blade holder the third stage of labor
10. Disinfect the vulva with betadine solution
SIGNS OF PLACENTAL SEPARATION
and drape the client’s legs aseptically
11. Place 1 hypotowel under patient’s 1. Lengthening of the cord
buttocks 2. Sudden gush of blood
12. Coach the patient the proper breathing 3. Rising of the fundus (Calkin’s sign)
and pushing technique 4. Globular shape of the abdomen (Calkin’s
13. Give to the doctor the allis forceps sign)
14. Open syringe and offer it to doctor
15. Offer scalpel PLACENTAL DELIVERY
16. Do Ritgen’s maneuver during crowning 1. Schultz Delivery (shiny, fetal side)
17. Assist the baby’s head in external 2. Duncan Delivery (Dirty, Raw, Red,
rotation Irregular, Cotyledon showing maternal
18. Anchor the baby’s neck, pull the head side)
downwards and upward
19. Slide your hands on baby’s back and
grasp both legs
20. Immediately place the baby on the
mother’s abdomen for essential newborn
care
21. Cord care
22. Wait for pulsation to stop the place cord
clamp 1-1.5 inches
TO HELP DELIVER PLACENTA:
23. Milk cord up to 2 inches then lock using
straight forceps 1. Perform Crede’s maneuver
24. Cut below the cord clamp using mayo - Involves placing one hand on the top of
scissors the uterus (uttering fundus) and
25. Do Brandt Andrews maneuver and squeezing it between the thumb and
Crede’s maneuver other fingers to help placental
26. Inspect and dispose the placenta separation and delivery
appropriately 2. Grab basin above the anus and catch the
27. Replace another hypotowel under the placenta
buttocks 3. Coil cord using Brandt Andrews
28. Assist in the episiorrhaphy or repair of maneuver
laceration - Method of expressing the placenta by
29. Do perineal cleaning grasping the umbilical cord with one
30. Remove all drapes from the patient hand and placing the other hand on the
31. Apply adult diaper abdomen
32. Straighten the legs of the patient 4. Take note of time and placental
33. Change patient’s gown and make patient separation (Schultz or Duncan) and take
comfortable BP
34. Remove all sharps and dispose properly 5. In checking for the completeness of the
35. Wash the instrument according to cotyledons, student nurse will palpate if
hospital protocol there is a hollow portion, tell the doctor
36. Place all soiled linens into the hamper there is something missing
37. Clean the area - Retained placental tissue is associated
38. Remove gloves with postpartum hemorrhage and
39. Wash hands infection. The maternal surface of the
40. Document the procedure placenta should be inspected to be
certain that all cotyledons are present.
PLACENTAL DELIVERY

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2-D Page 28

- Surgical repair of injury to the vulva by
suturing to help prevent more extensive
vaginal tears during childbirth and heal
better than a natural tear
9. Do perineal care
a. Flushing using sterile water
b. Drying perineal area to thigh, buttocks
using leggings. If in the perineal, apply
OS
c. Apply diaper or contour brief
10. Make patient comfortable
a. Straightening the legs
b. Changing gowns and blanket
11. Monitoring vital signs q15 minutes for the
first hour, q30 for second hour, q hourly
until stable then q4.

POST PARTUM ASSESSMENT

 Post-Partum Assessment – is a process

of thorough examination and evaluation of
the woman’s physical, physiological
functioning during a certain period after
giving birth; normal, caesarian section, or
by instrumentation

PURPOSES:

1. To examine the physical, psychological,

and physiological status of post-partum
patient
2. To determine the involution process of
post-partum,
3. To evaluate the normal postpartum
adaptation level,
4. To assess for possible postpartum
complicaions.

4th STAGE OF LABOR

4TH STAGE OF LABOR

 Puerperium/Postparrtum Period – 6
6. Promote uterine contraction week period after childbirth
a. Massage the hypogastric area (done by  Involution – reproductive organs return to
the student) its non-pregnant state
b. Administer medication oxyticine, maleate  Subinvolution – failure of the reproductive
(by registered nurse) organ to return to its non-pregnant state
c. If not contracted aside from massaging  Exfoliation – placental site heals by
and giving of medication, apply ice pack scaling off dead tissue
the hypogastric and allow the patient to  Atony – uterus does not have good muscle
stimulate the nipple by tickling the nipple tone and consequently relaxes
7. Inspect perineum for lacerations
8. Assist in episiorrhaphy

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2-D Page 29

PRINCIPLES OF PUERPERIUM c. If patient is on indwelling catheter, take note
of the patency of the tubing, amount and
 Promotion of healing and prevention of color of urine.
illness B - BOWEL
 Prevent postpartal complications  More active soon after birth
 Establish successful lactation  Peptide hormone relaxing (high
circulating levels during pregnancy)
AV BUBBLEHER depresses bowel motility
 Continued effects of progesterone on
the smooth muscles
A - APPEARANCE  Bowel movement typically delayed until
- observe for patient’s general appearance, body 2nd or 3rd puerperal date
built, activities, hygiene, mood, color, and  Bowel is slowed
communication  During of labor, restriction of food
-  Fear of tearing the stitches
V – VITAL SIGNS
L – LOCHIA
 Temperature – increase on the 1st 24hrs,
dehydration effort in labor,after 24 hrs – discharges of the uterus
infection, after 3-4 days, milk production  Lochia Rubra – 1-3 days bloody red in
 Pulse – decrease due to decreased cardiac color
output  Lochia Serosa – 4-10 days pink or
 Blood pressure – slightly decrease brown color
 Respiratory Rate – no changes  Lochia Alba – creamy, yellowish color
 Pattern should not be reverse
B - BREAST
 Increase in activity
 Drop in estrogen and progesterone  Decrease in breastfeeding
 Lactating  Not offensive in odor
 Colostrum is present  Without large clots
 Let-down reflex  Present in CS
 Warm and Tender  E - EPISIOTOMY
 Engorged Lacerations
 Milk is produced by the 3rd – 4th day  1st degree – skin, mucus
 Veins are apparent membrane
 2nd degree – skin, mucus
U - UTERUS membrane, fascia
 Size is reduced  3rd degree – skin, mucus,
 Placental site is sealed off membrane, muscles, rectal
 Cervical os are narrowed sphincter
 Painful during contraction  4th degree – involve all these
 Contracted structures plus anal wall

B - BLADDER R – Redness
E – Edema
– voiding should occur 4-6 hours, post-partum (6-8
E – Ecchymosis
hrs)
D – Discharges
a. Ask patient her last voiding time. Ask for the
A – Approximation
color, amount, and presence of tenderness
while voiding.
b. Inspect for bladder distention. Patient may E – EMOTIONAL STATUS
hold urine due to pain during urination. Full  Sense of elation
bladder will impede uterine contraction.  Mother wanted to talk about her labor
and delivery

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2-D Page 30

 Exhausted, need rest and sleep to
restore her body to health Step 2: Initiate immediate uninterrupted skin
 Normally during the 1st 24 hours, passive, to skin contact
preoccupied with own needs, talkative if  For 60-90 minutes even when transferring
unable to sleep  Or until baby completes 1st breastfeed
 1-2 days beginning to assume responsibility  Prone on the mother’s abdomen or between
breasts
R – RH ICOMPATIBILITY
 R: promotes bonding, overall success of
– possible when specific circumstances exist: breastfeeding, and prevents hypoglycemia
 Monitoring through wearables  Put linen and bonnet on baby
 RHOGAM – Rh immune globulin,  Note: Time initiated and stopped
unsensitized Step 3: Properly timed cord clamping
 28/7 AOG  Wait for pulsations to stop
 72 hours PP-IM Icterus Gravis – RBC are  R: prevents anemia and intraventricular
destroyed hemorrhage in preterm
 Fetal bilirubin increases Step 4: Initiate early breastfeeding
 KERNICTERUS ( bilirubin  Watch for feeding cues at 20-90 minutes
encephalopathy)  Feeding cues: rooting – head turns to look
for nipple, smacking lips, sucking hands
ESSENTIAL NEW BORN CARE  Note: time initiated and completed
Equipments: 2 blankets/linens Breastfeeding:
Bonnet  Encourage breastfeed per demand
Cord Care Set  Observe at least one breastfeed for proper
positioning and attachment
 Proper positioning: head and lower body
of baby must be aligned, tummy to tummy
 Proper attachment: baby grasps not only
the nipple but also the areola, lower lip
turned outward, chin of baby touches the
mother’s breast.
Things to Note:
 Minimize handling of newborn
 Do not bathe the baby for at least the 1-6
hours; R: May cause hyperthermia or
infection
 Do not give sugar water, formula or other
liquids
 Do not use pacifiers or bottles
 Strict breastfeeding until 6 months

Step 1: Drying with rapid assessment of the

baby’s breathing
 Dry off newborn with a linen
 Do not rub off vernix as it provide natural
protection
 Simultaneously, stimulate the baby to cry by
rubbing or patting
 Carry out a rapid assessment

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2-D Page 31

should be prepared as close as
APGAR SCORING SYSTEM possible to the time of use.

Indicator 0 point 1 point 2 points

Activity absent Flexed active

arms and
legs
Pulse absent Below 100 Over 100
bpm bpm
Grimace floppy Minimal Prompt
response to response to
stimulation stimulation
Appearance Blue;pale Pink body, pink
blue
extremities
Respiration absent Slow and Vigorous
irregular cry

PRINCIPLES OF ASEPTIC TECHNIQUE

Asepsis – free from contamination caused by

harmful bacteria, viruses, or other
microorganism

Aseptic technique – using practices and

procedures to prevent contamination from
pathogens

 Only Sterile items touches the sterile

field
 Gowns of the surgical team are
considered sterile from chest to the
level of the sterile field. The sleeves are
also considered sterile from 2 inches
above the elbow stockinette cuff
 Sterile drapes are used to create a
sterile field. Only the top surface of a
drape table is considered sterile.
 Once sterile field is set up, the border
of one inch at the edge of the sterile
drape is considered unsterile.
 Sterile persons or objects may only
contact sterile areas; non-sterile
persons or items contact only non-
sterile areas.
 Items of doubtful sterility are
considered unsterile. Sterile fields

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2-D Page 32

NATIONAL SAFE MOTHERHOOD PROGRAM with integrity and accountability using proven
and innovative approaches.
OUTLINE OBJECTIVES
• The Program contributes to the national goal
I. Introduction of improving women’s health and well-being
II. National Safe Motherhood Program by:
III. Component A: Local Delivery Of The ✓ Collaborating with Local Government
Maternal-Newborn Service Package Units in establishing sustainable, cost-
IV. Component B: National Capacity To
effective approach of delivering health
Sustain Maternal-Newborn
V. Unang Yakap services that ensure access of
VI. Newborn Screening disadvantaged women to acceptable
VII. Expanded Program on Immunization and high quality maternal and newborn
VIII. Infancy and Young Child Feeding health services and enable them to
IX. Integrated Management of Childhood safely give birth in health facilities near
Illness their homes
✓ Establishing core knowledge base and
INTRODUCTION support systems that facilitate the
• The health of women, their infants, and their delivery of quality maternal and newborn
children is intricately linked. health services in the country
• In the Philippines, the Department of Health COMPONENT A: LOCAL DELIVERY OF THE
(DOH) is stepping up the implementation of MATERNAL-NEWBORN SERVICE PACKAGE
Maternal and Child Health programs for women
in order to increase their access to maternity
and newborn health care. • This component supports LGUs in
establishing and mobilizing the service
delivery network of public and private
NATIONAL SAFE MOTHERHOOD PROGRAM
providers.
VISION
• In each province and city, the following
• For Filipino women to have full access to shall continue to be undertaken;
health services towards making their • Establishment of critical capacities to
pregnancy and delivery safer. AL SAFE MOTH provide quality maternal-newborn services
MISSION through the organization and operation of a
network of Service Delivery Teams
• Guided by the Department of Health
consisting of:
FOURmula One Plus thrust and the Universal
✓ Barangay Health Workers
Health Care Frame, the National Safe
✓ Basic Emergency Obstetric and
Motherhood Program is committed to provide
Newborn Care (BEmONC) Teams
rational and responsive policy direction to its
composed of Doctors, Nurses and
local government partners in the delivery of
Midwives
quality maternal and newborn health services

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN-2D 33

• Annual Program Implementation Reviews
With Provincial Health Officers and
Regional Coordinators
• In collaboration with the Centers for health
Development and relevant national offices: PARTNER INSTITUTIONS
Establishing of Reliable Sustainable Support • Local Government Units
Systems for Maternal-Newborn Service • Development Partners
Delivery through such initiatives as:
POLICIES AND LAWS
✓ Establishment of Safe Blood Supply • Republic Act No. 1035: Responsible
Network with support from the National parenthood and reproductive health law
Voluntary Blood Program (RPRH Act of 2012)
✓ Behavior Change Interventions in 1. Administrative Order 2008-0029:
collaboration with the Health Promotion Implementing Health Reforms to Rapidly
and Communication Service Reduce Maternal and Neonatal Mortality
✓ Sustainable financing of maternal – 2. Department Order 2009-0084: Guidelines
newborn services and commodities Governing the Payment of Training Fees
through locally initiated revenue relative to the Attendance Of Health Workers
generation and retention activities to Basic Emergency Obstetric and Newborns
including PhilHealth accreditation and Care Skills Training Course at Duly
enrolment. Designated Training Centers
3. Administrative Order 2011-0011:
COMPONENT B: NATIONAL CAPACITY TO Establishment of Basic Emergency Obstetric
SUSTAIN MATERNAL-NEWBORN
and Newborn Care Training Centers in
1. Operational and Regulatory Guidelines
Regional Hospitals And Medical Centers
• Identification and profiling of current FP
4. Administrative Order 2015-0020: Guidelines
users and identification of potential FP
in the Administration of Life Savings Drugs
clients (permanent or temporary methods)
During Maternal Care Emergencies by Nurses
• Mainstreaming FP in the regions with high
and Midwives in Birthing Centers
unmet need for FP
5. Administrative Order 2016-0035: Guidelines
• Development and dissemination of on the Provisions of Quality Antenatal Care in
Information, Education Communication
All Birthing Centers and Health Facilities
materials
Providing Maternity Care Services
• Advocacy and social mobilization for FP 6. Administrative Order 2018-0003: National
2. Network Of Training Providers Policy on the Prevention of Illegal and Unsafe
• 31 training centers that provide being more Abortion and Management of Post Abortion
skills training Complications.
3. Monitoring, Evaluation Research and UNANG YAKAP
Dissemination with support from the ESSENTIAL NEWBORN CARE: PROTOCOL
Epidemiology Bureau and Health Policy FOR NEW LIFE
Development and Planning Bureau • Essential Newborn Care (ENC)
• Monitoring and Supervision of Private - Giving appropriate and immediate support
Midwife Clinics in cooperation with PRC on the health and nutrition of a newborn is
Board Of Midwifery and Professional significant in avoiding newborn
Midwifery Organizations complications that may result to death.
• Maternal Death Reporting and Review • It is an evidence based intervention that
Systems In Collaboration With Provincial ✓ Emphasizes a core sequence of
And City Review Team actions, performed methodically (step
by step)

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN-2D 34

✓ Is organized so that essential time
bound interventions are not
interrupted; and • A newborn baby must also be given with
✓ Fills a gap for a package of bundled vitamin K injection and antibiotic eye drops
interventions in a guideline format • Complete physical assessment to identify
• On December 2009, Francis Duke, a medical conditions and abnormalities
secretary of Department of Health, signed • It is also important that they should be given
administrative order 2009-0025. with birth dose of BCG and hepatitis B
• This administrative order mandates the vaccination.
implementation of the Essential Intrapartum • A newborn baby should also undergo newborn
Newborn Care (EINC) Protocol and create screening (NBS) within 24 hours from birth.
the Unang Yakap Campaign. • All newborns should undergo to universal
• This campaign aims to promote ways to take hearing screening on their first day of life in
care of newborn children and their mother. accordance with the international clinical
• Unang Yakap is a simple and evidence- practice guidelines and provision in Republic
based interventions that may help in Act 9709 Universal Hearing Screening Act.
ensuring the survival of all newborns and
young infant.
• Within 48 hours of delivery until the first week
of baby, series of measures are performed in
order to give safe and quality care.
✓ First, the newborn baby must be
immediately and thoroughly dried
✓ Second, skin to skin contact between
the newborn and mother must be
done
✓ Third, appropriately time clumping and
cutting of the umbilical cord
✓ Lastly, early breastfeeding is
implemented to the newborn

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN-2D 35

• DOH Health Facilities and Services Regulatory
Bureau ( HFSRB)
NEWBORN SCREENING PROGRAM (NBS) • DOH Health Facility Development Bureau
• Is an essential public health strategy that
(HFDB)
enables the early detection and management
• DOH National Center for Health Promotion
of cyber several congenital disorders.
(NCHP)
• Early diagnosis at the initiation of treatment,
• NIH – Institute of Human Genetics (NIH – IHG)
along with appropriate Long-term care help
• Department of the Interior and Local
ensure normal growth and development of the
Government (DILG)
affected individual
• Council for the Welfare of Children (CWC)
• In the Philippines, it is a service available since
• Philippine Health Insurance Corporation
1996.
(PhilHealth)
• In 2004, the country implemented the Newborn
• D. Policies and Laws: RA 9288 or the Newborn
Screening Act (Republic Act No. 9288)
Screening Act of 2004 and DOH AO No. 2014 –
IMPORTANCE OF NEWBORN SCREENING
0045 or the Guidelines on the Implementation
• This allows for early detection of disorders. If
of the Expanded Newborn Screening Program
detected, treatment may be done immediately.
The goal of newborn screening is to give all EXPANDED PROGRAM ON IMMUNIZATION
• The Expanded Program on Immunization (EPI)
newborns a chance to live in normal lives and
was established in 1976
safeguard them to reach their full potential.
• Ensure that infants/ children and mothers have
PROGRAM OBJECTIVES access to routinely recommended
• By 2030, all Filipino newborns are screened; infant/childhood vaccines
Strengthen quality of service and intensify • Six vaccine - preventable diseases were initially
monitoring and evaluation of NBS included in the EPI tuberculosis poliomyelitis
implementation; Sustainable financial scheme; diphtheria, tetanus, pertussis, and measles
Strengthen patient management. • Vaccines under the EPI are BCG birth dose,
Hepatitis B birth dose, Oral Polio Virus Vaccine
TARGET POPULATION Pentavalent Vaccine, Measles Containing
• Filipino newborns
Vaccines (Antimeasles vaccines, Measles,
AREA OF COVERAGE Mumps, Rubella) and Tetanus toxoid
• Nationwide
• In 2014, Pneumococcal Conjugate Vaccine 13
STRATEGIES was included in the routine immunization of the
1. Ensuring Efficient Operations, Systems and EPI.
Networks Management • In 2016, the Expanded Program on
2. Expanding Package of Services and Delivery Immunization transmission to become the
Network National Immunization Program.
3. Enhancing Health Promotion and Advocacy PROGRAM OBJECTIVES/GOALS
4. Optimizing Health Information Management Over-all Goal:
Systems for Expanded Newborn Screening • To reduce the morbidity and mortality among
5. Strengthen Monitoring and Evaluation children against the most common vaccine
6. Establishing Sustainable Financing Scheme preventable disease.
PARTNER INSTITUTIONS Specific Goals:
• National Technical Working Group on Newborn 1. To immunize all infants/children against the
Screening Program (NTWG-NBS) most common vaccine - preventable
• National Institutes of Health (NIH) disease.
• NIH-Newborn Screening Reference Center 2. To sustain the polio-free status of the
(NIH-NSRC) Philippines
• DOH Epidemiology Bureau (EB) 3. To eliminate measles infection

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN-2D 36

4. To eliminate maternal and neonatal tetanus 4. Procurement of adequate and potent
5. to control diphtheria, pertussis, hepatitis B vaccines and needles and syringe to all
and German measles health facilities nationwide.
6. To prevent extra pulmonary tuberculosis INFANCY AND YOUNG CHILD FEEDING
among children. • A global strategy for Infant and Young Child
SCENARIO Feeding (IYCF) was issued jointly by the World
• Global Situation (The burden) Health Organization (WHO) and the United
- In 2002, WHO estimated that 1.4 million of Nations Children's Fund (UNICEF) in 2002.
deaths among children under 5 years due • This global strategy was endorsed by the 55th
to disease that could have been prevented World Health Assembly in May 2002 and by the
by routine vaccination. This represents UNICEF Executive Board in September 2002
14% of global total mortality in children respectively.
under 5 years of age. • In 2004, infant and young child feeding
• Burden of Disease practices were assessed using the WHO
- The immunization coverage of all assessment protocol and rated poor to fair.
individual vaccines have improved. Fully • To address these problems on infant and young
Immunized Child (FIC) coverage improved child, feeding practices the first National IYCF
by 10% and the Child Protect at Birth Plan of Action was formulated.
(CPAB) against Tetanus improved by 13% • It aimed to improve the nutritional status and
compared to any prior period. Thus, the health of children especially the under-three,
Philippines has now historically the highest and consequently reduce infant and under-five
coverage of these two major indicators mortality.
PROGRAM TARGET • Its objectives were to improve, protect and
• Achieve 95% Fully Immunized Child Coverage promote infant and young child feeding
MANDATES practices, increase political commitment at all
• Republic Act No. 10152 “Mandatory Infants and levels, provide a supportive environment and
Children Health Immunization Act of 2011 ensure its sustainability.
signed by President Benigno Aquino III in July, • On May 23, 2005, Administrative Order (AO)
16 2010. The mandatory includes basic 2005-0014: National Policies on IYCF was
immunization for children under 5, including signed and endorsed by the Secretary of
other types that will be determined by the Health.
Secretary of Health • The policy was intended to guide health
TRAINING SUPPORT workers and other concerned parties in
1. The Immunization in Practice. ensuring the protection, promotion and support
2. The Cold Chain and Logistics Management of exclusive breastfeeding and adequate and
Training. appropriate complimentary feeding with
3. The Reaching Every Barangay Strategy continued breastfeeding.
4. The Adverse Events Following GUIDING PRINCIPLES
Immunization Training under the The IYCF strategic plan of action upholds
Epidemiology and Surveillance Unit. the following guiding principles:
INTERVENTIONS/STRATEGIES 1. Children have the right to adequate nutrition
1. Conduct of Routine Immunization for and access to safe and nutritious food, and
Infants/Children/ Women through The both are essential for fulfilling their right to
Reaching Every Barangay (REB) strategy. the highest attainable standard of health.
2. Supplemental Immunization Activity (SIA) 2. Mothers and Infants form a biological and
3. Strengthening Vaccine - Preventable social unit and improve IYCF begins with
Diseases Surveillance ensuring the health and nutritional status of
women.

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN-2D 37

3. Almost every woman can breastfeed • 100% of IYCF related emergency/disaster
provided they have accurate information response and evacuation are compliant to
and support from their families, communities the IFE guidelines
and responsible health and non-health B. Target beneficiaries of the program are;
related institutions during critical setting and • Infants ( 0-11 months) and young children,
various circumstances including special and (12 to 36, months years old are 1 to 3 years
emergency situations. old)
4. The national and local government PARTNER ORGANIZATIONS/AGENCIES
development partners, non-government Local:
organizations, business sectors, • Employers Confederation of the
professional groups, academe and other Philippines
stakeholders acknowledges their • Trade Union Congress of the Philippines
responsibilities and form alliances and • Beauty, Brains and Breastfeeding
partnerships for improving IYCF with no • ARUGAAN
conflict of interest. • Action for Economic Reforms
5. Strengthened communication approaches • Save Baby e-group
focusing on behavioral and social change is • Philippine Obstetric and Gynecology
essential for demand generation and Society
community empowerment. • Philippine Academy of Family Physicians
OUTCOMES Inc.
By 2016:
• Philippine Society of Newborn Medicine
• 90% of newborns are initiated dead to
• Philippine Society of Pediatric
breastfeed within one hour after birth;
Gastroenterology
• 70% of infants are excluded exclusively
• Philippine Neonatology Society
breastfeed for the first 6 months of life; and
• Philippine Society of Obstetric
• 95% of infants are given timely adequate
Anesthesiologist
and safe complimentary food starting at 6
• Philippine Academy of Lactation
months of age.
Consultant
TARGETS
A. By 2016: • Perinatal Association of the Philippines
• 50% of hospitals providing maternity and • Philippine Medical Association
child health care services are certified • Integrated Midwives Association of the
MBFHI; Philippines
• 60% of municipalities/ cities have at least • Maternal and Child Nurses Association of
one functional ICYF supportive group; the Philippines
• 50% of workplace have lactation units, • Philippine Nurses Association
and or implementation, nursing, lactation • National League of Philippine Government
breaks. Nurses Inc.
• 100% of reported legged Milk Code • Malls: SM, NCCC
violations are acted upon and sanctions • Union of Local Authorities of the
are implemented as appropriate; Philippines
• 100% of elementary, high school and • CODHEND
tertiary schools are using the updated Government Partners:
IYCF curricula including the inclusion of • Department of Labor and Employment
IYCF into the prescribed textbooks and • Department of Social Welfare and
teaching materials, and; Development
• Department of Justice
• Department of Trade and Industry

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN-2D 38

• Department of Local Government 5. Start at 6 months with small amount of
• Food and Drug Administration food and increase gradually as the child
• National Nutrition Council gets older
• Council for the Welfare of Children 6. Gradually increase food consistency and
• Department of Education variety
• Commission on Higher Education 7. Increase the number of items that the
• Commission on Higher Education child is fed, 2-3 meals per day for
infants 6-8 months of age and 3-4
• Nutrition Council of the Philippines
meals per day for infants 9-23 months
International Organizations:
of age, with 1-2 additional snacks as
• Worlf Health Organization
required.
• UNICEF
8. Feed a variety of nutrients – rich foods
• PLAN International
9. Use fortified complementary food or
• Helen Keller International
vitamin – mineral supplements as
• Save the Children – US needed
• World Vision 10. Increase fluid intake during illness
APPROPRIATE INFANT YOUNG CHILD including more breastfeeding and offer
FEEDING
soft, favorite foods.
1. Breastfeeding
• Feeding in Exceptionally Difficult
• Is the most ideal way of providing food for
Circumstances
the healthy growth and development of
1. Malnourished infants: Continue
infants
breastfeeding frequently and relactate
• Is an important source of energy and
2. Preterm or low birth weight infants:
nutrients in children 6-23 months of age
Feed every 2 hours during day and
• Early initiations if breastfeeding should be
night; keep the baby close to mother’s
initiated to breastfeeding within 1 hour after
breast
birth
3. Feeding during emergencies:
• Infants should be exclusively breastfed for
a. Continue breastfeeding is possible
the first 6 months of life to achieve optimum
b. If breastfeeding is not possible,
growth and development
provide breast milk from milk bank.
2. Complementary Feeding
Provide properly prepared breast
• Provide nutritionally adequate and safe milk substitute. Practice
complementary foods to meet the infants complementary feeding – prepare
evolving nutritional requirements after 6 food properly and use safe drinking
months of age. water
• Guiding Principles for appropriate INTEGRATED MANAGEMENT OF CHILDHOOD
complementary feeding ILLNESS
1. Continue frequent, on demand • One million children under five years old die
breastfeeding until 2 years old and each year in less developed countries.
beyond • Just five diseases (pneumonia, diarrhea,
2. Practice responsive feeding (e.g. feed malaria, measles and dengue hemorrhagic
infants directly and assist older fever) account for nearly half of these deaths
children) and malnutrition is often the underlying
3. Feed slowly and patiently; encourage condition.
them to eat but not force them; talk to • The Integrated Management of Childhood
the child and maintain eye contact Illness strategy has been introduced in an
4. Practice good hygiene and proper food increasing number of countries in the region
handling since 1995.

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN-2D 39

• IMCI is a major strategy for child survival, months are examined for VERY SEVERE
healthy growth and development and is DISEASE AND LOCAL BACTERIAL
based on the combined delivery of essential INFECTION. These signs indicate immediate
interventions at community, health facility and referral or admission to hospital
health systems levels. 2. The children and infants are then assessed for
• The strategy was developed by the World main symptoms. For sick children, the main
Health Organization (WHO) and United symptoms include: cough or difficulty
Nations Children’s Fund (UNICEF). breathing, diarrhea and jaundice. All sick
• In the Philippines, IMCI was started on a pilot children are routinely assessed for nutritional,
basis in 1996, thereafter more health workers immunization and deworming status and for
and hospital staffs were capacitated to other problems.
implement the strategy at the frontline level. 3. Only a limited number of clinical signs are
OBJECTIVES OF IMCI used
• Reduce death and frequency and severity of 4. A combination of individual signs leads to a
illness and disability, and child’s classification within one or more
• Contribute to improved growth and symptom groups rather than a diagnosis
development 5. IMCI management procedures use limited
COMPONENTS OF IMCI number of essential drugs and encourage
• Improving case management skills of health active participation of caretakers in the
workers treatment of children
✓ 11 – day Basic Course for RHMs, 6. Counseling of caretakers on home care,
PHNs and MOHs correct feeding and giving of fluids, and when
✓ 5 – day Facilitators course to return to clinic is an essential component of
✓ 5 – day Follow-up course for IMCI IMCI
Supervisors BASIS FOR CLASSIFYING THE CHILD’S
• Improving over-all health systems ILLNESS: The child’s illness is classified
based on color-coded triage system
• Improving family and community health
• PINK – indicates urgent hospital referral or
practices
admission
RATIONALE FOR AN INTEGRATED APPROACH
IN THE MANAGEMENT OF SICK CHILDREN • YELLOW – indicates initiation of specific
• Majority of these deaths are caused by 5 Outpatient Treatment
preventable and treatable conditions namely: • GREEN – indicates supportive home care
pneumonia, diarrhea, malaria, measles and STEPS OF THE IMCI CASE MANAGEMENT
malnutrition. Three (3) out of four (4) PROCESS
The following is the flow of the IMCI process.
episodes of childhood illness are caused by
• At the out-patient health facility, the health
these 5 conditions.
worker should routinely do basic
• Most children have more than one illness at
demographic data collection, vital signs
one time. This overlap means that a single
taking, and asking the mother about the
diagnosis may not be possible or appropriate.
child’s problems. Determine whether this is
WHO ARE THE CHILDREN COVERED BY THE
IMCI PROTOCOL? an initial or a follow-up visit. The health
• Sick children birth up to 2 months (Sick Young worker then proceeds with the IMCI process
Infant) by checking for general danger signs,
• Sick children 2 months up to 5 years old (Sick assessing the main symptoms and other
Child) processes indicated in the chart below/
STRATEGIES/PRINCIPLES OF IMCI • Take note that for the pink box, referral
1. All sick children aged 2 months and up to 5 facility includes district, provincial and
years are examined for GENERAL DANGER tertiary hospitals. Once admitted, the
signs and all Sick Young Infants Birth up to 2

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN-2D 40

hospital is used in the management of the
sick child.
SYNTHESIS
The Maternal, Infant, and Child Health subject
area’s objectives cover a wide variety of conditions,
health behaviors, and health system indicators that
influence women’s, children’s, and families’ health,
well-being, and quality of life. Improving the health
of mothers, babies, and children is a major public
health priority. Their well—being influences the

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN-2D 41

FETAL CIRCULATION PATHWAY

Outline

I. FETAL CIRCULATION
II. UMBILICAL CORD
III. PATHWAY

INTRODUCTION
 The fetal circulation is the circulatory
system of a human fetus, often
encompassing the entire
fetoplacental circulation which
includes the umbilical cord and the
blood vessels within the placenta
that carry fetal blood

UMBILICAL CORD

 2 Umbilical arteries: return non-

oxygenated blood, fecal waste, CO2
to placenta Cardiac output:
 1 umbilical vein: brings oxygenated
blood and nutrients to the fetus  During fetal life: 350ml
Three shunts are present in fetal life: per kg per min
 Ductus venosus: connects the  Following birth: 500ml per
umbilical vein to the inferior vena cava min
 Ductus arteriosus: connects the main Heart rate: 120-140 per min
pulmonary artery to the aorta
 Foramen ovale: anatomic opening
between the right and left atrium AT BIRTH

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN2D Page 1

 Clamping the cord shuts down low-
pressure system
 Increased atmospheric pressure
(increased systemic vascular
resistance) causes lungs to inflate
with oxygen
 Lungs now become a low-pressure
system

NEONATAL CIRCULATION

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN2D Page 2

PRE-NATAL CARE
REGISTRATION

Booking visit: to be at 6th week of Gestation

OUTLINE a. 6th – 28th week: to be every 4 weeks
b. 29th- 36th week: to be every 2
I. Antenatal Care weeks
II. Providers of Antenatal Care c. 36th up to delivery: to be weekly
III. Components of Antenatal Care
IV. Danger Signs The World Health Organization (WHO)
recommends a minimum of four antenatal
visits:

 1st visit: before 4 months

ANTENATAL CARE  2nd visit: 6 months
 3rd visit: 8 months
 4th visit: 9 months
 Prenatal care/ANC is the care of the woman
during pregnancy to achieve a healthy baby
DURING REGISTRATION

PROVIDERS OF ANTENATAL CARE  Make the woman comfortable

 Greet her, make sure she is comfortable
 Doctor and ask how she is feeling.
 Nurse  If first visit, register the woman and issue
 Midwife a Mother and Child Book (antenatal
record form)
COMPONENTS OF ANTENATAL
CARE
HISTORY TAKING

A. Registration
1. General Information:
B. History taking
 Name
C. Obstetric Examination
 Age
D. Clinical Service
 Gravidity
E. Health Education
 Parity
F. Immunization
 LMP (Last menstrual Period)

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN-2D Page 1

2. Current Problem/ Complaint
3. History of current complain
4. History of current pregnancy details of the 1st, OBSTETRIC EXAMINATIONS
2nd and 3rd trimester lab tests and U/S scan pattern
5. Menstrual and Gynecological history  Drug History
LMP details (timing, volume, appearance)  Family History
Regular or irregular cycle, length of the cycle  Hereditary illnesses – DM, thalassemia,
Surgical procedures, Hx of infertility sickle cell disease, hemophilia
Sexually transmitted diseases
 Congenital defects eg. Neural tube defects,
down syndrome
PAST OBSTETRIC HISTORY
 Social history – Cigarette smoking, illegal
drug abuse, domestic violence, housing
 Outcome of previous pregnancies in details
conditions
including abortions
 Height, weight, BMI
 Any significant antenatal, intrapartum or
 Blood pressure
postpartum events
 Pulse
 Previous maternal complications
 Diffuse enlargement – head, eyes, ears,
 Mode of delivery
nose, throat, thyroid
 Baby weight
 Skin – pigmentation of the face
 Life and health of the baby
(choloasma), abdomen (linea negra)
Some medical conditions may have impact on the
 Stretch marks on the abdomen, thighs and
course of the pregnancy or the pregnancy may have
breast
an impact on the medical condition examples:
 Heart disease
INSPECTION
 Hypertension
 Dm  Shape and size
 Epilepsy  Asymmetry
 Thyroid disease  Fetal movement
 Bronchial asthma  Surgical scars
 Any previous surgery Cutaneous Signs of pregnancy
 Kidney diseases - linea negra
 UTI - striae gravidarum
 Autoimmune disease - Umbilicus (flat or everted)
 Psychiatric disorders - Superficial veins
 Hepatitis
 Venereal diseases PALPATION
 Blood transfusion
 Fundal grip
 Lateral grip
 Pelvis
 Deep pelvic grip

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN-2D Page 2

 Check for pallor or anemia
AUSCULTATION
On subsequent visits:

Fetal Heart at 13-14 weeks  Look for conjunctival pallor

 Look for palmar pallor, count number of
breaths in one minute

PERCUSSION
CHECK FOR HYPERTENSION/
PREECLAMPSIA
Polyhyramnios - is where there is too much
amniotic fluid around the baby during  Measure Bp in sitting position
pregnancy  If diastolic BP is mm HG or higher, repeat
 Measurement after hour rest
VULVAL AND VAGINAL EXAM  If diastolic bp is still higher ask the woman if
 Hyper pigmentation
she has: Severe headache, blurred vision,
 Look for abnormalities varicose veins/ epigastric pain,
hemorrhoids, warts or herpes vaginal
 Check urine for protein
secretions
 Uterus enlarged
IMMUNIZATION
PROVISION OF AN VISITS
Tetanus vaccination
 Check Duration of pregnancy
 Ask for bleeding danger signs during the  TT-1: During First pregnancy
pregnancy
 TT-2: 1 month after first dose
 Check record for previous treatments
 TT-3: 6 months after second dose
received during this pregnancy
 TT-4: 1 year after third dose
 Prepare birth and emergency plan
 TT-5: 1 year after fourth dose
 Ask patient if she has other concerns
 Give education and counseling on family
planning and breastfeeding

CLINICAL SERVICES
 Get baseline laboratory information of HEALTH INFORMATION
1. Nutrition
the woman on the first or following the
2. Self- care during pregnancy
first visit
3. Effect of tobacco, alcohol, and drugs
 Hemoglobin, blood group
4. Breastfeeding
 Urinalysis
5. Birth and emergency situations
 VDRL or RPR to screen syphilis
6. Schedule of appointment

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN-2D Page 3

DANGER SIGNS

1. Vaginal Bleeding
2. Convulsions
3. Severe headache
4. Severe abdominal pain
5. Fast or difficult breathing
6. Fever or burning urination

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN-2D Page 4

DELIVERY ROOM DRUGS the uterus. Increased calcium increases contraction of
the uterus.

OUTLINE INDICATIONS
Induction of labor, Control of postpartum bleeding,
I. Oxytocin Added in management of abortion.
II. Methylergonovine maleate
III. Methyldopa CONTRAINDICATIONS
IV. Misoprostol Hypersensitivity, cephalopelvic disproportion, fetal
V. Methotrexate distress, prolapsed umbilical cord, Hypertonic uterine
VI. Ritodrine contractions, placenta previa, placental abruption, cord
VII. Dexamethasone prolapse.
VIII. Promethazine
SIDE EFFECTS
IX. Ropivacaine
X. Lidocaine OCCASIONAL
XI. Isoxsuprine Hydrochloride Tachycardia, premature ventricular contractions,
XII. Meperidine hypotension, nausea, vomiting.
XIII. Butorphanol
XIV. Hepatitis B Vaccine RARE
XV. Desaminooxytocin Lacrimation /tearing, nasal irritation, rhinorrhea,
XVI. Aminophylline unexpected uterine bleeding/contractions.
XVII. Heparin
ADVERSE REACTIONS
XVIII. Nalbuphine
OCCASIONAL
Bradycardia, brain damage, trauma due to rapid
OXYTOCIN propulsion, low Apgar score at 5 min, retinal
Julliane Audrey Lino hemorrhage occurs rarely. Prolonged IV infusion of
oxytocin with excessive fluid volume has caused severe
Generic Name: Oxytocin water intoxication with
Brand Names: Pitocin, Evatocin, Syntocinon
Drug Classification: Oxytocic Hormone MATERNAL
Pregnancy Category: Category X Hypertonicity may occur with tearing of uterus,
increased bleeding, placental abruption,
SUGGESTED DOSE cervical/vaginal lacerations, seizures, coma, death.
INTRAVENOUS ROUTE DRUG INTERACTION
LABOR: 0.5 – 2 milliunit/min.
• Caudal block anesthetics, Vasopressors may
INTRAVENOUS ROUTE increase pressor effects.
POSTPARTUM BLEEDING: 10 – 40 units in 1,000 ml
• Increase: hypertension due to ephedra and
IV fluid at rate sufficient to control uterine atony
vasopressors
• Other oxytocic may cause cervical lacerations,
INTRAVENOUS ROUTE
uterine hypertonus, and uterine rupture.
ABORTION: 10 – 20 milliunits/min. Maximum: 30
units/12-hr dose.
NURSING RESPONSIBILITIES
1. Assess for fetal presentation and pelvic
INTRAMASCULAR ROUTE
dimensions before administration
POSTPARTUM BLEEDING: 3 – 10 units after delivery
2. Before administration, an IV infusion of NS
of placenta
should be already running for use in case of
adverse reactions
MODE OF ACTION
3. Administer using an infusion pump to ensure
Oxytocin works by increasing the concentration of
accurate dosing
calcium inside muscle cells that control contraction of

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 48

4. Magnesium sulfate should be readily available CONTRAINDATIONS
if relaxation of the myometrium is needed • Hypertension
5. After administration, check and monitor the vital • Toxemia
signs of both mother and baby to watch for any • Pregnancy
changes and abnormalities that may cause • Hypersensitivity
complications
6. Monitor the length, intensity and duration of
contraction SIDE EFFECTS
7. Monitor fetal heart tone and fetal distress and • Nausea, uterine cramping, and vomiting
watch for acceleration and deceleration • Abdominal pain, diarrhea, dizzinesss,
8. If contractions last for 1 min or more or there is diaphoresis, tinnitus, bradycardia, chest pain
absence of contractions, discontinue oxytocin • Allergic reaction i.e rash, pruritis; dyspnea,
9. After placental delivery, inject oxytocin into a and severe or sudden hypertension
large muscle mass
10. Maintain careful intake and output and be alert ADVERSE REACTIONS
for potential water intoxication;
• Severe hypertensive episodes
11. After childbirth, continue to monitor the mother
• CVA (cerebrovascular accident)
and baby for sides effects of the drug
12. Teach patient/family to report increased blood • Arrythmia
loss, abdominal cramps, fever, foul- smelling • Seizures
lochia, nausea, blurred vision, itching, swelling,
and that contractions will be similar to DRUG INTERACTION
menstrual cramps, gradually increasing in • Drug to drug interaction:
intensity Vasoconstrictors, vasopressors may increase
effects.
METHYLERGONOVINE MALEATE • Drug to herb interaction: Unknown.
Trishia Jo Aira Santos
NURSING RESPONSIBILITIES
Generic Name: Methylergonovine maleate 1. Determine baseline serum calcium level, blood
Brand Name: Methergine pressure and pulse rate.
Drug classification: Ergot alkoid, oxytoxic agent, uterine 2. Assess for any evidence of bleeding before
stimulant administration.
3. Monitor uterine tone, bleeding, blood pressure,
MODE OF ACTION pulse rate every 15 minutes, until stable for the
• Post delivery first 1-2 hours.
• Uterus muscle tone (smooth muscle) 4. Assess extremities for color, warmth,
• Uterine contraction movement and pain.
5. Report chest pain immediately.
• Sustain Ecbolic
6. Provide support with ambulation if dizziness
• Control bleeding
has occurred.
7. To educate the patient to avoid smoking during
ROUTE AND DOSAGE
treatment as it increases vasoconstriction.
For IV, IM
8. Report for increased cramping, bleeding, foul-
Adult and Elderly: 1ml, 0.2 mg methyleronovine
smelling lochia
maleate, q2-4hrs
9. Report for pale, cold hands/feet for possibility of
diminished circulation.
For PO
10. Document necessary data obtained.
Adult and Elderly: 1 tab, 0.2 mg methyleronovine
maleate, for seven days
METHYLDOPA
Ellen Anne Bugnos
INDICATIONS
• Uterine hemorrhage Generic Name: Methyldopa
• Uterine atony management Brand Name: Aldomet, Apo-methyldopa, Dopamet
• Subinvolution of uterus Drug Classification: Antihypertensive
• Delivery placenta

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 49

MODE OF ACTION NURSING RESPONSIBILITIES
Methyl norepinephrine is centrally used to decrease the 1. Observe the 10 rights when administering
adrenergic outflow by alpha-2 agonistic action from the medications.
central nervous system, leading to reduced total 2. Monitor blood pressure regularly during therapy
peripheral resistance and decreased systemic blood 3. Advise patient to change position from time to
pressure. time slowly to minimize orthostatic hypotension
4. Be aware that hypertension may return within
ROUTE AND DOSAGE 48 hours after stopping drug.
• To manage hypertension, to treat hypertensive 5. Ask to notify the physician if patient has signs
crisis of heart failure (dyspnea, edema, hyper
tension) or involuntary, rapid, jerky movements
For PO 6. Assess for weight gain and edema. If they
Adults, elderly: initially, 250-500 mg bid or tid, then develop, give a diuretic, as prescribed by the
adjusted q2days as needed. 0.5-2 g/day in 2-4 divided attending physician.
doses (maintenance), max 3 g/day 7. Use cautiously in pregnancy. In breastfeeding it
has been used for pregnancy-induced
Children: initially, 10 mg/kg/day in 2-4 divided doses, hypertension.
max 65 mg/kg or 3 g/day, whichever is less 8. Suggest the patient to take the medication at
bedtime to reduce daytime drowsiness.
INDICATIONS 9. Ask the patient to weigh herself daily and report
Treatment for high blood pressure. Methyldopa is in a immediately if there is a weight gain of 5lb (2.3
class of medications called antihypertensives. It works kg) within 2 days.
by relaxing the blood vessels so that blood can flow 10. Inform the patient not to stop drug abruptly;
more easily through the body. doing so may cause withdrawal symptoms,
such as headache, hypertension, increased
CONTRAINDICATIONS sweating, nausea, and tremor.
Active hepatic disease, hypersensitivity, and maoi
therapy. Precaution for pregnancy, geriatric patients, MISOPROSTOL
cardiac disease, autoimmune disease, depression, Anne Karen Abelo
dialysis, hemolytic anemia, Parkinson’s disease,
pheochromocytoma, sulfite hypersensitivity Generic Name: Misoprostol
Brand Name: Cytotec, Arthrotec, Mifegymiso
SIDE EFFECTS Drug Classification: Prostaglandin, Antisecretory
Expected side effect during pregnancy is that it crosses
the placenta, and may cause mild hypotension in MODE OF ACTION
neonates of treated mothers. Misoprostol is a synthetic prostaglandin E1 analog that
stimulates prostaglandin E1 receptors on parietal cells
ADVERSE REACTIONS in the stomach to reduce gastric acid secretion. Mucus
Expected adverse reactions from the drug is headache, and bicarbonate secretion are also increased along with
muscle weakness, swollen ankles or feet, upset thickening of the mucosal bilayer so the mucosa can
stomach, vomiting, diarrhea, gas, dry mouth, and rash. generate new cells. Misoprostol binds to smooth muscle
There are also some serious reactions like unexplained cells in the uterine lining to increase the strength and
fever, extreme tiredness, and yellowing of the skin or frequency of contractions as well as degrade collagen
eyes. and reduce cervical tone.

DRUG INTERACTIONS ROUTE AND DOSAGE

• Diuretics and other antihypertensives may • Prevention of NSAID-Induced Gastric Ulcer
increase risk for hypotension. ADULTS (For PO)
• Methyldopa absorption can decrease iron to the 200 mcg 4 times/day with food (last dose at bedtime).
patient’s body Continue for duration of NSAID therapy. May reduce
• Phenothiazines, amphetamines, and other dosage to 100 mcg 4 times/day or 200 mcg 2 times/day
specific drugs can increase blood pressures with food
ELDERLY
100–200 mcg 4 times/day with food

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 50

INDICATIONS 3. Inform patient to take the medicine with or after
meals.
Misoprostol is indicated as a tablet to reduce the risk of R: To lessen incidence of diarrhea
NSAID induced gastric ulcers but not duodenal ulcers in 4. Advise patient to avoid alcohol, coffee, acidic
high-risk patients. Misoprostol is also formulated in food, fruit juices, fatty food, fried food,
combination with diclofenac to treat symptoms of carbonated drink and spicy food.
osteoarthritis or rheumatoid arthritis in patients with a R: To prevent increase in GI irritation.
high risk of developing gastric ulcers. Misoprostol is 5. Inform patient that misoprostol will cause
used off label for the management of miscarriages, spontaneous abortion.
prevention of post-partum hemorrhage, and is also used R: Women of childbearing age must be
alone or in combination with mifepristone in other informed of this effect through verbal and
countries for first trimester abortions written information and must use contraception
throughout drug treatment. If pregnancy is
suspected, the woman should stop taking
CONTRAINDICATIONS misoprostol and notify her health care
professional immediately.
Pregnancy Category X. Use during pregnancy can 6. Inform patient on the possible side effects and
cause abortion, premature birth, birth defects. Not adverse reactions of the medication. R: Patient
recommended in women of childbearing potential should also know what to do and not do if they
unless patient is capable of complying with effective experience any side effects, including stopping
contraception. a medication or taking other medications.
7. Instruct patient to report any severe or unusual
SIDE EFFECTS cramping, bleeding, or pelvic pain that extends
Frequent side effect are abdominal pain, and diarrhea. beyond the expected time periods.
Occasional side effect are nausea, flatulence, R: Call immediately health care provider who
dyspepsia, and headache. Rare are vomiting, can advise on any treatment that may be
constipation. needed
8. Instruct patient to report bothersome side
ADVERSE REACTIONS effects, including severe or prolonged
Overdosage may produce sedation, tremor, seizures, headache, menstrual irregularities, or GI
dyspnea, palpitations, hypotension, bradycardia. problems (nausea, diarrhea, vomiting,
constipation, heartburn, flatulence, abdominal
DRUG INTERACTIONS pain).
• Antacids may increase concentration. R: Healthcare professional will tell you if you
• The risk or severity of adverse effects can be need any medical care. They will also consider
increased when Misoprostol is combined with if you need to change your treatment or if you
Carbetocin, Hydrotalcite, Magaldrate, Magnesium, need a different treatment.
Magnesium carbonate, Magnesium chloride,
Magnesium citrate, Magnesium gluconate and METHOTREXATE
Magnesium hydroxide Renzo Miguel Alcordo
• Carboprost tromethamine may increase the
uterotonic activities of Misoprostol. Generic Name: Methotrexate
Brand Name: OtrexupTM (other Trexall and Rasuvo)
NURSING RESPONSIBILITIES Classification: Anti-metabolites
1. Question for possibility of pregnancy before
initiating therapy. SUGGESTED DOSE
R: It is a medicine that pregnancy category X.
Avoid magnesium-containing antacids. R: To For Otrexup - 7.5 mg/0.4ml per week (subcutaneous
minimizes potential for diarrhea. autoinjector)
2. Women of childbearing potential must not be (most range from 7.5 mg – 25 mg)
pregnant before or during medication therapy.
R: It may result in hospitalization, surgery, MODE OF ACTION
infertility, fetal death Methotrexate inhibits DNA synthesis as it is a antagonist
folic acid. Dihydrofolate reductase is irreversibly bind in

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 51

which forms reduced folates and also thymidylate. This intestine of methotrexate or enterohepatic
causes purine and thymidylic acid synthesis to be circulation is interfered.
inhibited. • Penicillin – reduce methotrexate renal
clearance, increased methotrexate concentration
INDICATIONS with concomitant hematologic and gastrointestinal
• Non-Hodgkin’s lymphoma toxicity.
• Brain tumors • Folic Acid decreases administered
• Solid tumors methotrexate response.
• Uveitis • Theophylline: decrease clearance of
• Vasculitis theophylline by methotrexate.
• Leukemia
• Juvenile idiopathic arthritis NURSING RESPONSIBILITIES
• Dermatomyositis 1. Arrange for test: evaluate CBC, renal and liver
• Ectopic pregnancy test, urinalysis, Chest X-ray on and before
therapy.
CONTRAINDICATIONS 2. Checking if the mother’s not pregnant before
For patients who have rheumatoid arthritis or psoriasis giving the medication as this can cause birth
with alcoholism, overt immunodeficiency syndromes, defects and abnormalities, tell it to mother to be
liver disease, blood marrow hypoplasia, informed of the risk
thrombocytopenia, leukopenia or anemia and patients 3. If there is signs and symptoms of renal failure,
with hypersensitivity to the medication. reduce dosage or discontinue completely.
4. When using for intrathecal, reconstitute first
with preservative-free sterile sodium chloride
SIDE EFFECTS while discarding remainder for this is only for 1
• Drowsiness dose.
5. Antidote of methotrexate is leucovorin should
• Dizziness
be prepared in case of large doses and
• Headache
overdose. The dosage should be higher or
• Tender or swollen gums equal to methotrexate and given the first hour.
• Reddened eyes 6. Following medications that contains alcohol
• Decreased appetite should not be administered.
• Hair loss 7. Hydration therapy should be arranged to
• Confusion prevent and reduce risk for hyperuricemia.
• Seizures 8. If there are signs of severe nausea and
• Blurred vision vomiting antiemetic should be arranged.
• Loss of consciousness
• Weakened body RITODRINE
Camille Quimno
ADVERSE EFFECT
Known are abdominal distress, leukopenia, ulcerative Generic Name: Ritodrine
stomatitis, arachnoiditis, leukopenia, glossitis, anorexia, Brand Name: Yutopar
gingivitis, diarrhea, fatigue, chills and fever, decreased Therapeutic class: Tocolytic agents
resistance to infection, neuropathy, azotemia, Pharmacologic class: Beta-2 Adrenergic Agonist
hepatotoxicity, osteopenia and nausea. Pregnancy Category: B

DRUG INTERACTIONS Capsules

• NSAID’s: Due to elevated and prolonged serum For oral dosage form (extended-release capsules):
methotrexate levels it results in death from severe • Adults: In the first twenty-four hours after the
hematologic and gastrointestinal toxicity. doctor stops your intravenous ritodrine, your dose
• Salicylates, phenytoin, phenylbutazone and may be as high as 40 milligrams (mg) every eight
sulfonamides: increased toxicity due to hours. After that, the dose is usually 40 mg every
displacement of drugs eight to twelve hours. Your doctor may want you to
• Chloramphenicol, tetracycline and non- take oral ritodrine up until it is time for you to deliver
absorbable antibiotics decreases absorption in the your baby or until your 37th week of pregnancy.

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 52

Tablets INDICATIONS
For oral dosage form (tablets): Management of Preterm Labor
• Adults: In the first twenty-four hours after the
doctor stops your intravenous ritodrine, your dose CONTRAINDICATIONS
may be as high as 10 milligrams (mg) every two • Prior to the 20th week of pregnancy
hours. After that, the dose is usually 10 to 20 mg
every four to six hours. Your doctor may want you In conditions where the continuation of the pregnancy
to take oral ritodrine up until it is time for you to may be harmful to mother or fetus, such as :
deliver your baby or until your 37th week of • Antepartum hemorrhage that demands
pregnancy. immediate delivery Eclampsia
• Severe preeclampsia
Injection • Interuterine fetal death Chorioamnionitis
For injection dosage form: • Maternal cardiac disease
• Adults: 50 to 350 micrograms per minute, • Pulmonary hypertension
injected into a vein. • Maternal hyperthyroidism
• Uncontrolled maternal diabetes mellitus
MODE OF ACTION
A selective β2-adrenoceptor agonist with its main action Maternal conditions that would be adversely affected by
on the uterus, causing relaxation. It reduces the ritodrine pharmacology, such as:
intensity and frequency of contractions. Heart rate is • Hypovolemia
also increased while diastolic pressure is reduced. May
• Cardiac arrhythmias associated with
cause bronchial relaxation but this is not clinically
tachycardia or digitalis intoxication
significant in its usage.
• Uncontrolled hypertension
PHARMACOKINETICS • Pheochromocytoma
• Bronchial asthma is already being treated with
• ABSORPTION beta-agonists or steroids
Rapid absorption from the GI tract (oral).
Bioavailability: about 30% of an oral dose. SIDE EFFECTS
• DISTRIBUTION • More common Blurred vision
Crosses the placenta. • Chest pain or tightness
• ELIMINATION • dizziness or lightheadedness drowsiness
70-90% of a dose is excreted in the urine within 10- • dry mouth
12 hr. • fast or irregular heartbeat—rare with oral form
• flushed and dry skin
SUGGESTED DOSE • fruit-like breath odor
Applies to the following strengths: 10 mg/mL; 15 mg/mL; • increased urination
5%-30 mg/100 mL • loss of appetite
• nausea
Usual Adult Dose for Premature Labor • severe pounding or racing heartbeat —rare with
• Initial dose: 50 to 100 mcg IV per minute, oral form
increased every ten minutes as needed in • shortness of breath—rare with oral form
increments of 50 mcg to the effective dose that • sleepiness
balances uterine response and unwanted effects • stomachache
(increased maternal heart rate and decreased • tiredness
blood pressure and increased fetal heart rate), or • troubled breathing (rapid and deep) unusual
until the maternal heart rate reaches 130 beats per thirst vomiting
minute.
• Maintenance dose: 150 to 350 mcg IV per Rare
minute at the lowest dose that maintains a relaxed • Sore throat or fever yellow eyes or skin
uterus. If labor is irreversible or the maximum dose • Get emergency help immediately if any of the
of 350 mcg per minute is reached and labor following symptoms of overdose occur:
persists, ritodrine should be discontinued.

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 53

Fast or irregular heartbeat (severe) nausea or Dexamethasone is a potent glucocorticoid with minimal
vomiting (severe) nervousness or trembling to no mineralocorticoid activity (Sodium-Retaining
(severe) shortness of breath (severe) Activity)

DRUG INTERACTIONS INDICATIONS

Using ritodrine with any of the following medicines is • Used to treat many inflammatory conditions
usually not recommended but may be required in some such as allergic disorders and skin
cases. If both medicines are prescribed together, your conditions.
doctor may change the dose or how often you use one • Also used to treat ulcerative colitis, arthritis,
or both medicines. lupus, psoriasis and breathing disorders.
• Methacholine • Multiple Sclerosis, Cerebral Edema, and
• Sotalol Shock
• Can be also used as a test for an adrenal
NURSING RESPONSIBILITIES gland disorder
1. Observe the rights of drug administration
2. Assess for contraindications, allergies, and CONTRAINDICATIONS
precautions. • Avoid chronic use during lactation; may affect
3. Monitor and assess uterine activity and FHR child’s growth
4. Monitor IV infusion flow rate • Systemic Fungal Infection, Documented
5. Maintain client in left lateral position as much as hypersensitivity, Cerebral Malaria
possible • Administration of live or live, attenuated
6. Monitor maternal and fetal vital signs every 15 vaccines is contraindicated in patients receiving
min when the client is receiving IV dose immunosuppressive doses of corticosteroids
7. Monitor plasma glucose and Potassium • Use with caution in cirrhosis, diverticulitis,
8. Monitor daily weight myasthenia gravis, peptic ulcer disease,
9. Monitor electrolyte, fluid, and cardiac functions ulcerative colitis, renal insufficiency, pregnancy
10. Advise patient/watcher to not take any
medicines unless discussed with doctor. This SIDE EFFECT
especially includes over the counter • CNS- a seizure (convulsions) blurred vision,
(nonprescription) medicines for appetite tunnel vision, eye pain, or seeing halos around
control, asthma, colds, cough, hay fever, or lights
sinus problems
• GI- Nausea, Vomiting
• INTEGUMENTARY: pancreatitis intestinal
DEXAMETHASONE
bleeding
Paul Christian Abenoja
• MUSCULO-SKELETAL: muscle tightness,
Generic Name: Dexamethasone weakness, or limp feeling bone/joint pain
Brand Name: Decadron, Baycadrol, Dexamenthasone
Intensol ADVERSE REACTIONS
Drug Classification: Glucocorticoids, Anti- • GI- ulcerative esophagitis
Inflammatory Agents • Abdominal distention
• perforation of the small and large intestine
SUGGESTED DOSE • CNS- depression
• Headache
Tablet- 0.5-0.75mg (Decadron) • increased intracranial pressure with
Elixir/Oral Solution- 0.5-5ml(Baycadron) papilledema
Injectable Suspension- 4mg/ml; 10mg/ml • METABOLISM- increased appetite
Oral Concentrate- 1mg/ml (Dexamenthasone Intensol)
DRUG INTERACTIONS
MODE OF ACTION • A total of 678 drugs are known to interact with
Decreases inflammation by suppressing migration of dexamethasone categorized as 120 major, 507
polymorphonuclear leukocytes (PMNs) and reducing moderate, and 51 minor interactions.
capillary permeability. Has numerous intense metabolic • May interact with drugs that include aldesleukin
effects. that can cause bleeding/bruising.

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 54

• May speed up the removal of other medications • CHILDREN: 0.5 mg/ kg 30–60 min before
of certain cancer drugs such as dasatinib, departure; may repeat in 8–12 hrs.,
lapatinib, and rilpivirine among others.
• May also interfere with certain lab tests For IV, IM, Rectal
including skin tests with a possibility of causing • ADULTS, ELDERLY: 12.5–25 mg q4–6h as
false test results. needed
• CHILDREN: 0.25–1 mg/kg q4–6h as needed
NURSING RESPONSIBILITIES Maximum: 25 mg/dose.
1. This medication is used to treat a variety of
ailments. INDICATIONS
2. Monitor intake and output of patients. Take into Treatment and prevention of nausea, vomiting and
account the weight of the patient whether it motion sickness
increases or decreases.
3. Monitor blood pressure and other vital signs of CONTRAINDICATIONS
the patient periodically. • Children 2 yrs. and younger (may cause fatal
4. Watch for insomnia and depression in patients. respiratory depression)
• hypersensitivity to phenothiazines, - severe
PATIENT AND FAMILY EDUCATION CNS depression,
5. Advise lactating women not to breastfeed • not suitable to patient with epilepsy and asthma
during treatment and for 2 weeks after the last
dose. SIDE EFFECTS
6. Notify patient of adverse effects; symptoms are Frequent: Drowsiness, dry mouth, nose, throat; urinary
usually controlled by dosage reduction or slow retention, thickening of bronchial secretions.
discontinuation of drug as sudden
discontinuation could have unpleasant Occasional: Epigastric distress, flushing, visual
withdrawal symptoms. disturbances, hearing disturbances, wheezing,
7. Vaccines may not work as well while using a paresthesia, diaphoresis, chills, disorientation,
steroid medication. hypotension, confusion, syncope in elderly.

PROMETHAZINE Rare: Dizziness, urticaria, photosensitivity, nightmares.

Leslie Kaye Princess Latip
ADVERSE REACTIONS
Generic Name: Promethazine Paradoxical reaction particularly in children, manifested
Brand Name: Phenergan, Phenadoz, as excitation, anxiety, tremor, hyperactive reflexes,
Drug Classification: Antihistamines, 1st Generation; seizures. Long-term therapy may produce
Antiemetic Agents extrapyramidal symptoms (EPS) noted as dystonia
(abnormal movements), pronounced motor
MODE OF ACTION restlessness (most frequently in children), parkinsonism
Promethazine is an antagonist of histamine H1, post- (esp. noted in elderly). Blood dyscrasias, particularly
synaptic mesolimbic dopamine, alpha adrenergic, agranulocytosis, occur rarely.
muscarinic, and NMDA receptors. The antihistamine
action is used to treat allergic reactions. Antagonism of DRUG INTERACTION
muscarinic and NMDA receptors contribute to its use as • Alcohol, CNS depressants may increase CNS
a sleep aid, as well as for anxiety and tension. depressant effects.
Antagonism of histamine H1, muscarinic, and dopamine • may increase anticholinergic effects. MAOIs
receptors in the medullary vomiting center make may prolong, intensify anticholinergic, CNS
promethazine useful in the treatment of nausea and depressant effects.
vomiting.
NURSING RESPONSIBILITIES
ROUTE AND DOSAGE 1. Medication must be stored at room
12.5– 25 mg PO/IV/IO/IM/Rectal For PO temperature, and not directly from sunlight.
Don’t freeze.
• ADULTS, ELDERLY: 25 mg 30–60 min before 2. Determine the history of hypersensitivity
departure; may repeat in 8–12 hrs., reactions to the drug before therapy is started.

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 55

3. Assess allergy symptoms INDICATIONS
4. Assess dizziness and drowsiness that might Parenteral: AcAdult: 0.2 soln: Lumbar epidurial block:
affect gait, balance, and other functional 20-4- mg (10-20 mL) as an initial bolus followed by 20-
activities. 30 mg (10-15 ml) at intervals of not less than 30 min.
5. Assess skin turgor, mucous membranes for Alternatively, 12-20 mg/hr (6-10 mL/hr) as a continuous
hydration status; observe for edema. epidurial infusion. Doses up to 28 mg/hr (4 mL/hr) may
6. Check and monitor vital signs, especially blood be used if additional pain relief is required.
pressure, pulse, for hypotension before Thoracic epidurial block: 12-28 mg/hr (6-14 mL/hr) as a
administration. continuous infusion.
7. Monitor serum electrolytes in patient with Infiltration anaesth: 0.2% soln: 2-200mg (1-100 mL); or
severe vomiting. 0.5% soln: 5-200 mg (1-40)
8. Assess motor function, and be alert for
extrapyramidal reactions. Report these Surgical Anesthesia
symptoms immediately, especially tardive Adult: Lumbar epidurial block: 0.5% soln: 75-150mg
dyskinesia, because this problem may be (15-30 mL); 0.75% soln: 112.5-187.5 mg (15-25ml); 1%
irreversible. soln: 150-200mg (15-20 mL).
9. Tell patient to expect Drowsiness, dry mouth
may occur as response to drug. Caesarean section: 0.5% soln: 100-150 mg (20-30mL);
10. Encourage patient and family teaching: 0.75% soln: 112.5-150 mg (15-20 mL).
To sips water as it may relieve dry mouth.
Avoid other CNS depressants CONTRAINDICATIONS
Avoid prolonged exposure to sunlight. Hypovolemia. Not intended for IV regional anesthesia
and obstetric paracervical block.
ROPIVACAINE
Amelodin Abubakar DRUG INTERACTIONS
systemic toxic effects w/ other local anesthesia or
Generic Name: Ropivacaine agents structurally related to amid-type local
Brand Name: Naropin anesthesia. (e.g. certain antiarrhythmics, lidocaine and
Therapeutic Class: Anesthetics mexiletine). May potentiate the adverse effects of
Pharmacologic Class: Anesthetic, Amide general anesthesia or opioids.
Pregnancy Category: B
Available forms: Injection SIDE EFFECTS
• Anxiety
MODE OF ACTION • Headache
Ropivacaine blocks both initiation and conduction of • Paresthesia
nerve impulses resulting in blockade of conduction. • Dizziness
• Symptoms of CNS toxicity
Route: El • Bradycardia
Onset: 3-15 mins • Tachycardia
Duration: 3-15 hrs. (dose and route dependent)
• Cardiac arrhythmias
• Hypotension
Distribution: Crosses the placenta. Plasma proteins
binding: Approx. 94% • HTN, Syncope, Dyspnea, Nausea, Vomiting,
Urinary retention, Back pain , Hyperthermia,
Elimination: Mainly via urine (approx.. 1% as Rigors, Hypothermia, Allergic reaction
unchanges drug). Terminal elimination half-life: 1.8 hr.
NURSING RESPONSIBILITIES
1. Assess for the mentioned cautions and
SUGGESTED DOSE contraindications.
Individualized dosage. Adult & children >12yr 150-2— 2. Perform a thorough physical assessment (e.g.
mg (15-20 ml) for 10-20 min 4-6 hr. weight, neurological status, vital signs, heart
sounds, skin color and lesions, bowel sounds,
etc.)
3. Inspect site for local anesthetic application to
ensure integrity of the skin.

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 56

4. Monitor laboratory test results (e.g. liver and maximum dosage for use as a topical or local anesthetic
renal function tests, plasma esterase). is dependent on the indication, route, and formulation
5. Prepare emergency equipment. used.
6. Ensure that patients receiving spinal
anesthesia or epidural anesthesia are well INDICATIONS
hydrated and remain. lying down for up to 12 Controls acute ventricular arrhythmias following
hours after the anesthesia. myocardial infarction, cardiac surgery, cardiac
7. Provide skin care to site of administration. catheterization, digitalis-induced ventricular
8. Provide comfort measures. arrhythmias; used as a local anesthetic such as
9. Provide safety measures. infiltration/ nerve blocking for dental/surgical
10. Educate client on drug therapy. procedures, childbirth; topical anesthetic such as local
skin disorders (abrasions, prickly heat, minor burns,
LIDOCAINE skin manifestations of chickenpox,insect bites); local
Julianne Mey Alabastro anesthesia for mucous membranes such as oral, nasal,
laryngeal mucous membranes; local anesthesia of
Generic Name: Lidocaine respiratory, urinary tracts; relief of discomfort of pruritus
Brand Name: Lidocaine CV, Lidopen Drug ani, hemorrhoids, pruritus vulvae; dermal patch - painful
Classification: Amide anesthetic hypersensitivity

MODE OF ACTION CONTRAINDICATIONS

Lidocaine works suppressing the depolarization of the Hypersensitivity to amide-type local anesthetics, Wolff-
ventricles during diastole. Through that, it alters the flux Parkinson-White syndrome, Adams-Stokes syndrome,
of sodium ions across the cell membrane with no effect supraventricular arrhythmias, Severe degree of SA, AV,
on the heart. It then inhibits the transport of ions across or intraventricular heart block
the neural membranes required for the initiation and (except in pts with functioning pacemaker)
conduction of impulses, therefore effecting local
anesthetic action. SIDE EFFECTS
Occasional pain at the injection site for intramuscular
ROUTE AND DOSAGE injections. Topical medications
For preventing and treating pain, anesthesia include burning, stinging, tenderness at application site.
For Spinal/Epidural Anesthesia (Vaginal Delivery High doses of medication include nausea, blurred or
/Caesarean Section) doubled vision, drowsiness, dizziness, euphoria,
sensation of heat, cold, numbness, disorientation, light-
ADULTS, ELDERLY: headedness and tinnitus
For vaginal delivery, 1 mL (50 mg) of 5% solution.
ADVERSE REACTIONS
For caesarean section or those requiring intrauterine Usually uncommon, however if administered in high
manipulations, 1.5 mL (75 mg) of 5% solution doses by any route may produce bradycardia,
arrhythmias, heart block, cardiovascular collapse,
For intracutaneous, SE and IM infiltration Anesthesia cardiovascular depression, hypotension, cardiac arrest.
(episiotomy) Potential for malignant hyperthermia, CNS toxicity may
occur, especially with regional anesthesia use,
ADULTS, ELDERLY: 5ml -10ml of lidocaine 1% (50mg) progressing rapidly from mild side effects to seizures,
for infiltration prior to episiotomy followed by 10-15ml of drowsiness, tremors, vomiting,
lidocaine 1% (150mg) for the subsequent repair respiratory depression. Methemoglobinemia has
occurred following topical application of lidocaine for
Maximum volume of 20ml of lidocaine1% (200mg) teething discomfort and laryngeal anesthetic spray.
between the episiotomy and repair or maximum of 20ml
of lidocaine1% (200mg) for repair of spontaneous DRUG INTERACTIONS
perineal trauma, divided between sites to be repaired • Class 1 antiarrhythmics may increase cardiac
effects
For Topical Anesthesia • Should not be taken with axitinib oral,
ADULTS, ELDERLY, CHILDREN, NEONATES: bosutinib cobimetinib, eliglustat, fentanyl,
fentanyl intranasal, iontophoretic transdermal

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 57

system, transdermal, transmucosal, SUGGESTED DOSE
fluvoxamine, fosamprenavir, ivabradine oral, IV INFUSION
ivacaftor, mefloquine, naloxegol, Olaparib, 100mg isoxsuprine in 500 mL infusion fluid (normal
pefloxacin, phenytoin, pimozide and saline or dextrose solution)
pomalidomide as they may cause serious IM INJECTION
effects If IV infusion is not feasible: Isoxsuprine 10 mg (2mL
ampule) every 3 hours for 24 hours, then every 4-6
Drug to Herbal Interaction: hours for a further 48 hours
• St. John’s Wort may potentially decrease ORAL
concentration Patients may be maintained on oral isoxsuprine 20 mg
(2 tablets) 3-4 times daily when uterine contractions
NURSING RESPONSIBILITIES have ceased for at least 12 hours with parenteral
1. Obtain complete health history which includes isoxsuprine.
allergies, drug history and possible drug
interactions MODE OF ACTION
2. Assess for presence/history of Adam-Stokes • Isoxsuprine hydrochloride is a β2-adrenoceptor
syndrome, severe cardiac problems, and/or agonist that causes vasodilation by direct
decreased liver function. Lidocaine is relaxation of vascular smooth muscle.
contraindicated for those with this disorder • Decreases peripheral vascular resistance
3. Check for the presence of broken skin, • May also have positive inotropic and
infection, burns and wounds where medication chronotropic effects on the heart and may
is to be used. increase cardiac output
4. Monitor Vital signs and oxygen levels for both • Relaxes uterine smooth muscle and is valuable
maternal and fetal before, during and after in arresting contractions in threatened abortion
administering lidocaine to acquire baseline and premature labor.
data. (Look out for signs of allergies, toxicity)
5. Double check for drug name, expiration date as INDICATIONS
well as the drug concentration; many drugs in • Uterine hypermotility disorders such as
different concentrations are available threatened abortion and uncomplicated
6. The numbed part should be assessed to premature labor.
determine if the dosage of the lidocaine worked • An adjunct therapy in the treatment of
7. Monitor EKG closely during and following drug peripheral vascular disease such as
administration for cardiac performance. If EKG arteriosclerosis obliterans, thromboangiitis
shows arrhythmias, prolongation of PR interval obliterans (Buerger's disease), and Raynaud's
or QRS complex, inform physician immediately disease.
8. Assess neurological frequently for signs of • For the relief of symptoms associated with
maternal and fetal toxicity cerebrovascular insufficiency.
9. Keep life-support equipment readily available in
case severe adverse reactions occur CONTRAINDICATIONS
10. Have patients who have received lidocaine as • Presence of arterial bleeding; parenteral use in
a spinal anesthetic remain lying flat for 6–12 presence of hypotension, fetal distress;
hrs. afterward, and ensure that they are intrauterine fetal death; vaginal bleeding;
adequately hydrated to minimize risk of tachycardia.
headache
• Parenteral use of isoxsuprine hydrochloride is
also contraindicated in the following
ISOXSUPRINE HYDROCHLORIDE
conditions:
Lei Villamon
Premature detachment of the placenta;
Immediately postpartum; Premature labor if
Generic Name: Isoxsuprine Hydrochloride
there is infection.
Brand Name: Isoxilan, Duvadilan
Classification: Vasodilator
SIDE EFFECTS
• Chest pain, Dizziness or faintness , Fast
heartbeat , Shortness of breath, Skin rash,
Nausea or vomiting

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 58

ADVERSE EFFECTS been observed in babies born of mothers taking
• Isoxsuprine adverse effects may include isoxsuprine.
trembling, nervousness, weakness, dizziness, 8. Notify prescriber of adverse reactions (skin
flushing, transient palpitation, tachycardia, rash, palpitation, flushing) promptly; symptoms
chest pain, hypotension, abdominal distress, are usually effectively controlled by dosage
nausea, vomiting, intestinal distention, and reduction or discontinuation of drug.
severe rash. 9. Prevent orthostatic hypotension by making
• Isoxsuprine may also cause slight increase in position changes slowly and in stages,
fetal heart rate if used as IV infusion in particularly from lying down to sitting upright
premature labor. and avoid standing still.
Note: For treatment of menstrual cramps,
DRUG INTERACTIONS isoxsuprine is usually started 1–3 days before
Isoxsuprine may cause severe hypotension when onset of menstruation and continued until pain
administered with other vasodilators and anti- is relieved or menstrual flow stops
hypertensive drugs.
MEPERIDINE
Chester Jan Alingasa
ADDITIONAL NOTES
• Observe for Vaginal bleeding Generic name: Meperidine
• Check for preterm labor Brand name: Demerol and pethidine
• Advice Patient to avoid stressors Drug classification: Synthetic, Opioids, Opioid
• Patient should be in CBR Without BRP. If Analgesics
patient insists to ambulate, explain the risks of MODE OF ACTION
the action • Meperidine works by binding to opioid receptors
blocks transmission of nociceptive signals, signals
NURSING RESPONSIBILITIES pain-modulating neurons in the spinal cord, and
1. Immediately discontinue isoxsuprine treatment inhibits primary afferent nociceptors to the dorsal horn
if rash develops. sensory projection cells. It also acts as an agonist to
2. To avoid pulmonary edema in women being the mu-opioid receptor. The anti-shivering effect may
treated for premature labor, very carefully involve the stimulation of k- opioid receptors.
monitor the patient's state of hydration, and • Meperidine also has some local anesthetic
cardiac and respiratory function. Keep fluid effects because of interactions with sodium ion
infusion volume to the minimum. For infusion, channels. Also, meperidine has stimulant effects by
hypotonic dextrose is preferred over isotonic inhibition of the dopamine transporter (DAT) and
saline solution norepinephrine transporter (NET).
3. Discontinue isoxsuprine immediately and
institute diuretic therapy when signs of ROUTE AND DOSAGE
pulmonary edema develop. Available forms: Tablets—50, 100 mg; syrup—50 mg/5
4. Maintain patients in preterm labor in the lateral mL; injection—25, 50, 75, 100 mg/mL
position during infusion.
5. Monitor blood pressure (maternal) and heart
rate (maternal and fetal) regularly during ADULTS
infusion and reduce the rate of infusion or • Relief of pain: Individualize dosage; 50–150 mg
discontinue infusion if prolonged fall in blood IM, subcutaneously, or PO q 3–4 hr as needed.
pressure occurs. Diluted solution may be given by slow IV
6. Monitor for therapeutic effectiveness: injection. IM route is preferred for repeated
Response to treatment of peripheral vascular injections.
disorders may take several weeks. Evaluate • Preoperative medication: 50–100 mg IM or
clinical manifestations of arterial insufficiency. subcutaneously, 30–90 min before beginning
7. Observe both mother and baby for hypotension anesthesia.
and irregular and rapid heartbeat if isoxsuprine • Support of anesthesia: Dilute to 10 mg/mL, and
is used to delay premature labor. give repeated doses by slow IV injection, or
Hypocalcemia, hypoglycemia, and ileus have dilute to 1 mg/mL and infuse continuously.
Individualize dosage.

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 59

• Obstetric analgesia: When contractions disorientation, drowsiness, lethargy, impaired
become regular, 50–100 mg IM or mental and physical performance, coma, mood
subcutaneously; repeat q 1–3 hr. changes, weakness, headache, tremor,
seizures, miosis, visual disturbances,
PEDIATRIC PATIENTS suppression of cough reflex
• Contraindicated in premature infants. • CV: Facial flushing, peripheral circulatory
• Relief of pain: 1.1–1.75 mg/kg IM, collapse, tachycardia, bradycardia, arrhythmia,
subcutaneously, or PO up to adult dose q 3–4 palpitations, chest wall rigidity, hypertension,
hr as needed. hypotension, orthostatic hypotension, syncope
• Preoperative medication: 1.1–2.2 mg/kg IM or • Dermatologic: Pruritus, urticaria,
subcutaneously, up to adult dose, 30– 90 min laryngospasm, bronchospasm, edema
before beginning anesthesia. • GI: Nausea, vomiting, dry mouth, anorexia,
constipation, biliary tract spasm, increased
GERIATRIC PATIENTS OR IMPAIRED ADULTS colonic motility in patients with chronic
• Use caution; respiratory depression may occur ulcerative colitis
in elderly, the very ill, those with respiratory • GU: Ureteral spasm, spasm of vesical
problems. Reduced dosage may be needed. sphincters, urine retention or hesitancy,
oliguria, antidiuretic effect, reduced libido or
INDICATIONS potency
• Oral, parenteral: Relief of moderate to severe • Local: Tissue irritation and induration
acute pain (subcutaneous injection)
• Parenteral: Preoperative medication, support of • Major hazards: Respiratory depression, apnea,
anesthesia, and obstetric analgesia circulatory depression, respiratory arrest,
shock, cardiac arrest
CONTRAINDICATIONS • Other: Sweating, physical tolerance and
• Contraindicated with hypersensitivity to opioids, dependence, psychological dependence
bronchial asthma, COPD, cor pulmonale,
respiratory depression, anoxia, kyphoscoliosis, DRUG INTERACTIONS
acute alcoholism, increased intracranial • MAO inhibitors (isoisocarboxazid, linezolid,
pressure, pregnancy, seizure disorder, renal methylene blue, moclobemide, phenelzine,
impairment. Contraindicated in premature procarbazine, rasagiline, safinamide,
infants. selegiline, tranylcypromine). May caused
• Use cautiously with acute abdominal drowsiness or breathing problems and serious
conditions, CV disease, supraventricular (possibly fatal) drug interaction
tachycardias, myxedema, delirium tremens, • Drugs that increase serotonin may cause
cerebral arteriosclerosis, ulcerative colitis, serotonin syndrome/toxicity.
fever, Addison’s disease, prostatic hypertrophy, • Other medications can affect the removal of
urethral stricture, recent GI or GU surgery, toxic meperidine from your body, which include azole
psychosis, labor or delivery (opioids given to antifungals (such as ketoconazole), macrolide
the mother can cause respiratory depression of antibiotics (such as erythromycin),
neonate; premature infants are especially at mifepristone, rifamycins (such as rifabutin),
risk), renal or hepatic impairment, lactation. ritonavir, drugs used to treat seizures (such as
carbamazepine, phenytoin).
SIDE EFFECTS
• Possible side effects are lightheadedness, NURSING RESPONSIBILITIES
dizziness, weakness, headache, extreme calm, mood 1. Check the patient's medical record for an
changes, nausea, vomiting, stomach pain or cramps, allergy or contraindication to the prescribed
constipation, dry mouth, flushing, sweating, and medication. If an allergy or contraindications
changes in vision. exist, don't administer the medication and notify
the practitioner.
ADVERSE REACTIONS 2. Get the baseline vital signs before
• CNS: Light-headedness, dizziness, sedation, administering the medications
euphoria, dysphoria, delirium, insomnia,
agitation, anxiety, fear, hallucinations,

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 60

3. When meperidine is administered to lactating Route: PO, IV
woman 4 – 6 hours before the next feeding to Onset: 1 minute
minimize the amount in milk Peak: 4-5 minutes
4. Keep opioid antagonist and facilities for Duration: 3-4 hours
assisted or controlled respiration readily • Absorption: Rapidly and well absorbed.
available during parenteral administration. Bioavailability: 60-70% (nasal). Time to
5. Use caution when injecting subcutaneously into peakplasma concentration: 0.5-1 hr (IM, IV); 1-
chilled areas of the body or in patients with 2 hr (nasal).
hypotension or in shock; impaired perfusion • Distribution: Crosses the placenta and enters
may delay absorption; with repeated doses, an breast milk. Volume of distribution: 305- 901 L.
excessive amount may be absorbed when Plasma protein binding: Approx 80%.
circulation is restored. • Elimination: Via urine (approx 70-80%, 5% as
6. Reduce dosage of meperidine by 25%–50% in unchanged); faeces (approx 15%). Elimination
patients receiving phenothiazines or other half-life: Approx 2-9 hr (IV, nasal).
tranquilizers
7. Give each dose of the oral syrup in half glass of SUGGESTED DOSE
water. If taken undiluted, it may exert a slight Nasal (Moderate to severe pain)
local anesthetic effect on mucous membranes. • Adult: As metered-dose spray: Initially, 1 mg (1
8. Reassure patient that addiction is unlikely; most spray in 1 nostril), repeated after 60-90 min if
patients who receive opiates for medical needed; sequence may be repeated after 3-4 hr
reasons do not develop dependence when necessary. Severe pain: 2 mg (1 spray
syndromes into each nostril), may only be repeated after 3-
9. Tell the client that she/he make experience side 4 hr.
effects and make the actions to lessen the • Elderly: Initially, 1 mg, repeated after 90-120
effect of nausea, loss of appetite (take with food min if needed. Subsequent doses may be given
and lie quietly, eat frequent small meals); if necessary at intervals of ≥6 hr.
constipation (request a laxative); dizziness,
sedation, drowsiness, impaired visual acuity Parenteral (Moderate to severe pain)
(avoid performing other tasks that require • Adult: 1-4 mg via IM inj or 0.5-2 mg via IV inj,
alertness and visual acuity. repeated after 3-4 hr if necessary.
10. Ask the client to report signs of severe nausea, • Elderly: Initiate at half the usual dose. Adjust
constipation, shortness of breath, or difficulty in subsequent doses according to response at
breathing and any unusualities. intervals of ≥6 hr
BUTORPHANOL Parenteral (Anaesthesia)
Joren John Pascual
• Adult: As premedication: 2 mg via IM inj 60-90
min prior to surgery. As balanced anaesth: 2 mg
Generic Name: Butorphanol
via IV inj before induction and/or 0.5-1 mg in
Brand Name: Orfadol, Zinol, Ziphanol
increments during anaesth
Therapeutic Class: Analgesics (Opioid)
Parenteral (Obstetric analgesia)
Pharmacologic Class: Morphinan Derivative Opioids
• Adult: 1-2 mg via IM or IV inj during early labour,
Pregnancy Category: C
may be repeated after 4 hr, if necessary
Available forms
Capsules: N/A
Renal Impairment (Moderate to severe pain)
Injection: Yes
Tablets: N/A • Parenteral: Initiate at half the usual dose. Adjust
subsequent doses according to response at
MODE OF ACTION intervals of ≥6 hr.
Butorphanol is a phenanthrene derivative w/ mixed • Nasal: Initially, 1 mg, repeated after 90-120 min
opioid agonist and antagonist effect. It causes inhibition if needed. Subsequent doses may be given if
of ascending pain pathways, thus alters the perception necessary at intervals of ≥6 hr.
of and response to pain. It also produces respiratory
depression and sedation similar to opioids.
Pharmacokinetics

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 61

Hepatic Impairment (Moderate to severe pain) 4. Observe neonate for signs of respiratory
• Parenteral: Initiate at half the usual dose. Adjust depression when used in labor or delivery.
subsequent doses according to response at 5. Schedule gradual withdrawal following chronic
intervals of ≥6 hr. administration. Withdrawal symptoms peak 48
• Nasal: Initially, 1 mg, repeated after 90-120 min h after discontinuation of drug.
if needed. Subsequent doses may be given if 6. Instruct patient to lie down to control drug-
necessary at intervals of ≥6 hr. induced nausea.
7. Instruct patient not to take alcohol or other CNS
INDICATIONS depressants with this drug without consulting
This medication is an opioid analgesic, prescribed to physician.
alleviate pain post operatively, migraine, balanced 8. Instruct patient not to breast feed while taking
general anesthesia, and used to relieve pain during this drug without consulting physician.
labor. It blocks the pain sensations. 9. Assess for clinical improvement; record onset
of pain relief.
CONTRAINDICATIONS
Significant resp depression, unmonitored acute or HEPATITIS B VACCINE
severe bronchial asthma. Althea Marie Abonado

SIDE EFFECTS Generic Name: Hepatitis B Vaccine

Brand Name: Engerix-B, Recombivax HB, Heplisav-B
Asthenia/lethargy, headache, heat sensation, Classification: Hepatitis Vaccines, Inactivated
vasodilation, palpitations, anorexia, constipation, dry Vaccines, Viral Vaccines
mouth, nausea and vomiting, stomach pain, anxiety, Pregnancy category: C
confusion, dizziness, euphoria, floating feeling,
insomnia, nervousness, paraesthesia, somnolence, RA. 7846
tremor, bronchitis, cough, dyspnoea, epistaxis, nasal An act requiring compulsory immunization against
congestion, nasal irritation, pharyngitis, rhinitis, Hepatitis-B for infants and children below (8) years old
sweating, pruritus, blurred vision, ear pain, tinnitus,
unpleasant taste, hypotension, syncope, abnormal SUGGESTED DOSE
dreams, agitation, dysphoria, hallucinations, hostility, • Persons from birth through 19 years of age: A
rash, impaired urination, oedema, chest pain, HTN, series of 3 doses (0.5 mL each) on a 0, 1, 6
tachycardia, depression, shallow breathing. month schedule
• Persons 20 years of age and older: A series of
Potentially Fatal: Resp depression. 3 doses (1 mL each) on a 0, 1, 6 month
schedule
DRUG INTERACTIONS • Usually 1 dose only in the health centers
Additive effect w/ other CNS depressants (e.g. general
anaesth, phenothiazines or other tranquilizers, MODE OF ACTION
sedatives, hypnotics, antihistamines). May increase Hepatitis B vaccine recombinant is used to prevent
risk of transient high BP when used w/ sumatriptan severe liver disease infection by the hepatitis B virus.
nasal spray. Increased conjunctival changes when The vaccine works by causing your body to produce its
used w/ pancuronium. Decreased rate of absorption own protection (antibodies) against the disease.
when used w/ oxymetazoline (nasal).
INDICATIONS
NURSING RESPONSIBILITIES • INFANTS All infants within 24 hours of birth
1. Assess type, location, and intensity of pain prior • ANYONE (Anyone who wants protection
to 4-5 minutes (peak) following IV against hepatitis B)
administration
2. Monitor for respiratory depression. Do not CONTRAINDICATIONS
administer drug if respiratory rate is <12 • Has had an allergic reaction after a previous
breaths/min. dose or any component of a hepatitis B vaccine
3. Assess level of consciousness and monitor vital • Has had an allergic reaction to yeast
signs. Report marked changes in BP or • Has had an allergic reaction to neomycin
bradycardia.

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 62

grams (2 kg), or preterm < 2000 grams (2 kg)
SIDE EFFECTS for the timing and administer dosage at right
• diarrhea, loss of appetite, feeling weak or tired, thigh.
mild fussiness or crying, low fever; or runny R: This is to ensure if the baby should be
nose and injection site reactions (pain, vaccinated right after birth. The American
soreness, redness, swelling). Academy of Pediatrics recommends that all
medically stable preterm babies with a
ADVERSE REACTIONS minimum birth weight of 2000 grams be treated
• Central nervous system: like full-term babies and receive the first dose of
Dizziness, fatigue, fever, headache, irritability, the hepatitis B immunization according to the
malaise Gastrointestinal: Appetite decreased, recommended childhood immunization
diarrhea, nausea schedule. If birth weight is less than 2000 g, the
• Local: Injection site reactions: Ecchymosis, AAP recommends temporarily delay
erythema, induration, nodule formation, administering the hepatitis B vaccine at one
pruritis, soreness, swelling month of age or at the time of discharge from
• Neuromuscular & skeletal: Weakness the hospital – whichever comes first
• Respiratory: Apnea (premature neonate),
pharyngitis, rhinitis, upper respiratory tract 3. Identify is the mother is infected with hepatitis B
infection virus by checking the laboratory results on
• Miscellaneous: Anaphylaxis, hypersensitivity hepatitis B viral load blood test (HBV DNA) if
reactions applicable
R: Infants born to HBsAg-positive mothers
DRUG INTERACTIONS should receive vaccine and hepatitis B immune
• Cancer medications(e.g., carboplatin, globulin (HBIG) within 12 hours after birth
cyclophosphamide, doxorubicin, ifosfamide, because they are at immediate risk of hepatitis
vincristine) B infection. HBIG is an additional medicine that
gives extra help to your baby’s body to fight the
• Corticosteroids (e.g., budesonide,
virus. Infants born to HBsAg-negative mothers
dexamethasone, hydrocortisone, fluticasone,
should receive hepatitis B vaccine within 24
prednisone)
hours after birth. Dosage is still the same
• Hepatitis B Immune Globulin, HBIG,
regardless if the mother is infected or not
Ocrelizumab, Siponimod, Abatacept,
Azathioprine, Baricitinib, Belimumab,
4. Always take note of the precautions in using
cyclosporine, eculizumab, etanercept,
different forms of the vaccine
fingolimod, golimumab, hydroxyurea,
R: For glass vials, do not mix them with any
infliximab, ixekizumab, leflunomide,
other vaccines or products. For pre-filled
mycophenolate, rituximab, romidepsin,
syringes, the tip caps contain natural rubber
secukinumab, siltuximab, sirolimus,
latex, which may cause allergic reactions.
tacrolimus, teriflumomide, tocilizumab,
Always observe and follow the precautions to
tofacitinib, vedolizumab, vaccines, and
prevent adverse effects or injury to the patient
warfarin
5. Monitor for allergic response
NURSING RESPONSIBILITIES
R: Symptoms of severe allergic reactions can
1. Identify potential contraindications to needed
happen, and they can be life- threatening. It is
vaccine
essential to look out for the patient because
R: The condition of the client must be
they might require immediate medical attention
thoroughly assessed before administration.
(Centers for Disease Control and Prevention,
This is to diminish the risk of an adverse event.
2020).
According to a study, babies can acquire
allergies from their mothers in the womb and
6. Look out for physical manifestation of side
can last for a short time after birth, but these
effects on injection site
allergen-specific sensitivities fade with time
R: There could be redness, swelling or itching,
purple spot, or lump that might lead to the
2. Using the anthropometric measurements,
classify if the newborn is a term, preterm > 2000

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 63

development of signs and symptoms of membrane, increasing the content of calcium ions in
injection-site inflammation smooth muscle cells, thereby increasing its contraction.
The drug stimulates the contraction of smooth muscles
7. Monitor temperature and respiratory rate of the uterus, as well as stimulating the contraction of
R: Some patients develop a temperature myoepithelial cells of the mammary gland, enhances
elevation after vaccination. One of the most the secretion of milk.
common side effects is fever. We have to
monitor the temperature so that we can plan PHARMACOKINETICS
interventions for the patient. For infants born • Absorption: Rapidly and completely absorbed
prematurely, there are conditions such as through the mucous membrane of the oral
apnea observed after vaccination. cavity and enters the bloodstream. With buccal
administration of 1 tablet of 50 IU,\
8. Increase patient comfort and safety after demoxytocin is absorbed within 15-30 minutes.
administering the Hepatitis B vaccine • Distribution: Saliva enzymes do not destroy the
R: The vaccine can produce side effects that drug because it is resistant to oxytocinase.
might be uncomfortable and upsetting. It is vital • Elimination: Carried out within 30-60 minutes.
to promote comfort and safety to lessen the
distress. You can do the swaddle for newborns, SUGGESTED DOSE
properly position them, or offer the mother’s • 25 to 50 units buccal tablet every 30 minutes or
breastmilk or formula more often because some as necessary.
babies may eat less after 24 hours of getting the • LABOUR INDUCTION ADULT: 50 units (1
vaccine tablet) every 30 minutes, reduce to 25 units
every 30 minutes when normal contraction
9. Administer anti-inflammatory medications for rhythm is established. Max: 500 units (10
pain as ordered by the physician tablets).
R: This is to relieve pain if they exhibit post- • LABOUR AUGMENTATION ADULT: 25 or 50
vaccination symptoms. Always consult a units, if necessary, every 1⁄2 hr.
physician if it will be allowed to administer such • LACTATION: Desaminooxytocin should be
medications administered from the 2nd to the 6th
postpartum day, 25–50 IU (1⁄2 – 1 tablet) 5
10. Observe proper storage and handling minutes before the baby is fed 2–4 times a day.
R: Storage of Hepatitis B vaccine is safe and
• CHILDREN: Do not prescribe to children.
effective when maintained in ambient
temperatures (2–8 °C). According to a study, if
INDICATIONS
there is a risk of freezing the vaccine, it will
Desaminooxytocin is used for the treatment of
render ineffective to the potentially critical post-
postpartum hemorrhage, to induce and augment labor
exposure birth dose of Hepatitis B vaccine
and promote lactation.
amongst infants whose mothers are carrier of
hepatitis
CONTRAINDICATIONS
Desaminooxytocin is contraindicated in the presence of
DESAMINOOXYTOCIN
fetal distress, excess uterine distensions, unfavorable
Cheriz Jea Alonzo
presentation of the fetus, obstructed labor, more than
four previous birth or previous surgery on the uterus, or
Generic name: Desaminooxytocin
other conditions that could increase the risk of uterine
Brand name: Buctocin, Sandopart, Odeax, Sandopral
rupture, elderly woman, severe toxemia of pregnancy,
Available forms: Tablets
amniotic fluid embolism, and placenta previa.
Therapeutic class: Oxytocin and analogues, uterine
stimulants
SIDE EFFECTS
Pharmacological class: Oxytocic drugs
• Mother: uterine cramps, uterine hypertonicity,
Pregnancy category: Unknown
tetanic contractions, uterine hyperactivity with
uterine and vaginal tissue ruptures; nausea,
MODE OF ACTION
vomiting, hypersalivation, increased blood
Desaminooxytocin, also known as Demoxytocin,
pressure, tachycardia, arrhythmia; death is
Deaminooxytocin, affects the permeability of the cell
possible.

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 64

• Fetus: bradycardia, arrhythmia, asphyxia, intensity of contractions frequently during and
acute fetal hypoxia, staining of amniotic fluid after administration.
with meconium; death is possible 6. Watch for uterine tone and involution and
• Newborns: there may be jaundice, retinal amount of bleeding.
hemorrhage. 7. Ensure fetal position (if appropriate) and
• Immune system: rarely - hypersensitivity cephalopelvic proportions.
reactions, including anaphylactic reactions 8. 8.Observe for postpartum hemorrhage.
(with difficulty breathing, hypotension, or 9. Provide comfort measures.
shock). 10. Obtain laboratory test results (e.g. coagulation
• Nervous system: often - headache. studies, complete blood count, etc.)
• Cardiovascular system: often - tachycardia,
bradycardia; infrequently - arrhythmia. AMINOPHYLLINE
• Digestive system: often - nausea, vomiting. Kristine Boquel
• Skin and subcutaneous tissues: rarely - rashes.
Generic name: Amenophylline (theophylline
ADVERSE EFFECTS ethylenediamine)
Brand name: Phyllocontin, truphylline
• Postpartum bleeding
Therapeutic Class: Bronchodilators
• Neonatal jaundice
Pharmacologic Class: Xanthines
• Water retention
• Acute transient hypotension with flushing and MODE OF ACTION
reflex tachycardia Inhibit phosphodiesterase, producing increased tissue
Potentially Fatal: Death; anaphylactic reactions; fatal concentrations of cyclic adenosine monophosphate
afibrinogenemia; maternal deaths from severe (cAMP). Increased levels of cAMP result in
hypertension and subarachnoid hemorrhage. Bronchodilation, CNS stimulation, Positive inotropic and
chronotropic effects, Diuresis, Gastric acid secretion.
DRUG INTERACTIONS Aminophylline is a salt of theophylline and releases free
• Inhalation of drugs used for anesthesia, theophylline after administration. Therapeutic Effects:
possibly reduces the effect of Bronchodilation.
Desaminooxytocin. With caudal anesthesia,
Desaminooxytocin can increase the severity of ROUTE AND DOSAGE
sympathomimetic vasoconstrictor pressor • Adults (non-smokers): 0.7 mg/kg/hour i.v. for
action. first 12 hours. Maintenance dosage is 0.5
• Due to the fact that prostaglandins increase the • Children ages 9 to 16: 1 mg/kg/hour i.v. for first
uterotonic effect of Desaminooxytocin, the latter 12 hours.
is not used within 6 hours after vaginal • Maintenance dosage
administration of prostaglandins.
• Children ages 6 months to 9 years: 1.2
• Desaminooxytocin is incompatible with other mg/kg/hour i.v. for first 12 hours. Maintenance
drugs with the effect of oxytocin. β-adrenergic dosage is 0.8 mg/kg/ IV
agonists reduce the effectiveness of
• Children ages 6 months to 9 years: 1.2
demoxytocin.
mg/kg/hr IV for first 12 hours. Maintenance
dosage is mg/kg/hour IV
NURSING RESPONSIBILITES
• Adults and children: dosage is highly
1. Educate client on drug therapy.
individualized. Common initial dosage is 16
2. Assess for the mentioned cautions and
mg/kg/24 Hours i.v. or 400 mg/24 hours i.v. in
contraindications. (e.g. drug allergies, current
divided at 6 or 8 hours intervals. If needed,
status of lactation, uterine atony, hypertension,
dosage may be increased 25% at 3-day
etc.)
intervals.
3. Make sure the patient doesn't mistakenly
swallow a tablet intended for delivery by the
INDICATIONS
buccal route.
4. Monitor fetal heart rate. • Symptomatic treatment or prevention of
5. Monitor maternal status including blood bronchial asthma and reversible bronchospasm
pressure, pulse, and frequency, duration, and associated with chronic bronchitis and
emphysema

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 65

• Unlabeled uses: Respiratory stimulant in serum levels exceed therapeutic range of 10–
Cheyne-Stokes respiration; treatment of apnea 20 mcg/mL.
and bradycardia in premature babies 7. To determine peak serum theophylline level,
draw blood sample 15 to 30 minutes after
CONTRAINDICATIONS administering I.V. loading dose.
• Peptic ulcer disease, hypersensitivity to any 8. Monitor for clinical signs of adverse effects,
xanthine or to ethylenediamine, active gastritis; particularly if serum theophylline levels are not
rectal or colonic irritation or infection. available.
• Cautions: cardiac arrhythmias, acute 9. Ensure that diazepam is readily available to
myocardial injury, CHF, cor pulmonale, severe treat seizures.
hypertension, severe hypoxemia, renal or
hepatic disease, hyperthyroidism, alcoholism, HEPARIN
labor, lactation, pregnancy. Mikaella Castillo

SIDE EFFECTS Generic Name: Heparin

The common side effects of aminophylline are usually Brand Name: Heparin Lock Flush, Monoject Prefill
upset stomach, stomach pain, diarrhea, headache, Advanced, PosiFlush
restlessness, insomnia and irritability Drug Classification: Anticoagulants
MODE OF ACTION
ADVERSE REACTIONS Heparin is a diverse group of glycosaminoglycans,
The reactions that require immediate medical attention which are straight-chain anionic mucopolysaccharides
includes vomiting, increased or rapid heart rate, with anticoagulant properties that are utilized to slow
irregular heartbeat, seizures, and skin rash down blood clotting or “thins” the blood to prevent clot
formation. It acts mainly by accelerating the rate of the
DRUG INTERACTIONS neutralization of certain activated coagulation factors by
• Calcium channel blockers, cimetidine, antithrombin
ciprofloxacin, disulfiram, erythromycin,
hormonal contraceptives, influenza vaccine, ROUTE AND DOSAGE
interferon, methotrexate eliminates i.v. infusion or injection
aminophylline blood level • Adults. Loading: 35 to 70 units/kg or 5,000 units
• Drug-herbs: Cayenne: increased risk of by injection. Then 20,000 to 40,000 units
aminophylline toxicity infused over 24 hr.
• Drug-diagnostic Test: Aspartate • Children. Loading: 50 units/kg by injection.
aminotransferase, glucose: increased levels Then 100 units/kg infused every 4 hr or
• Drug-behaviors: Smoking: increased 20,000 units/m2 infused over 24 hr.
aminophylline elimination i.v. injection
• Adults. Initial: 10,000 units. Maintenance: 5,000
NURSING RESPONSIBILITIES to 10,000 units every 4 to 6 hr.
1. Administer to pregnant patients only when • Children. Initial: 50 units/kg. Maintenance: 100
absolutely necessary—neonatal tachycardia, units/kg/dose every 4 hr
jitteriness, and withdrawal apnea observed i.v. or subcutaneous injection
when mothers received xanthines up until • Adults. Loading: 5,000 units I.V. Then 10,000 to
delivery. 20,000 units subcutaneously.
2. Caution patient not to chew or crush enteric- • Maintenance: 8,000 to 10,000 units
coated timed-release forms. subcutaneously every 8 hr or 15,000 to 20,000
3. Give immediate-release, liquid dosage forms units subcutaneously every 12 hr
with food if GI effects occur.
4. Do not give timed-release forms with food; INDICATIONS
these should be given on an empty stomach 1 Indicated in pregnancy for the treatment of acute
hr before or 2 hr after meals. Food can alter venous thromboembolism (VTE) and pulmonary
drug absorption embolism, valvular heart disease, as well as for the
5. Maintain adequate hydration. prevention of pregnancy-related complications in
6. Monitor results of serum theophylline levels women with antithrombin deficiency or thrombosis.
carefully, and arrange for reduced dosage if

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 66

CONTRAINDICATIONS NALBUPHINE
Bleeding, Hypersensitivity to heparin or its components. Paul Dominique Reyes
Heparin-induced thrombocytopenia (HIT), hemophilia,
severe thrombocytopenic purpura Generic Name: Nalbuphine

SIDE EFFECTS Brand Name: Nubain

Expected side effects are bruising in the injected site, Drug Classification: Opioid analgesic, narcotic agonist,
Increase tendency of bleeding, Increase risk of bruising antagonist, anesthesia adjunct
if cesarian birth is performed, may result to bone
thinning , headache, hemorrhage, thrombocytopenia, MODE OF ACTION
anemia, heparin-induced thrombocytopenia (HIT)
Depresses pain impulse transmission at the spinal cord
ADVERSE REACTIONS binding and stimulating mu and kappa opioid receptors
May lead to headache, Chest pain, Abdominal pain and within the CNS, altering pain perception and emotional
distention, hematemesis, melena, nausea, vomiting, response to pain.
easy bruising, excessive bleeding from wounds,
ROUTE AND DOSAGE
thrombocytopenia, back pain and dyspnea.
FOR IV, IM, Subcutaneous (Moderate to severe pain)
DRUG INTERACTION
• Aspirin, NSAIDs, platelet aggregation, ADULTS, ELDERLY: 10 mg q3-6h prn for adults
inhibitors, sulfinpyrazone cefamandole, weighing70 kg. Dosage depends on patients’
cefoperazone, cefotetan, methimazole, weight. Maximum single dose of 20 mg/dose and daily
plicamycin, propylthiouracil, valproic acid, dose of 160 mg/day.
ethacrynic acid, glucocorticoids, salicylate may
increase risk of bleeding CHILDREN 1YR AND OLDER: 0.1-0.2 mg/kg, q3-4h
• Antihistamines, digoxin, nicotine, tetracyclines prn. Maximum single dose of 20 mg/dose and daily
decrease anticoagulant effect of heparin. dose of 160 mg/day
As adjunct to anesthesia
NURSING RESPONSIBILITIES
1. Always check compatibilities with other IV
solutions.
2. Mix well when adding heparin to IV infusion. For IV
3. Provide for safety measures to prevent injury
ADULTS: 0.3 to 3 mg/kg over 10 to 15 min followed by
from bleeding.
0.25 to 0/5 mg/kg prn
4. Alternate injection sites, and watch for signs of
bleeding and hematoma. Dosage Adjustment
5. Make sure all healthcare providers know that
patient is receiving heparin. Initial dosage reduction of 25% of usual is received for
6. Give deep subcutaneous injections, do not give patients who have repeatedly received opioid agonist.
IM injections to patients on heparin therapy
7. Watch closely if patient is receiving heparin INDICATIONS
therapy Depresses moderate to severe pain impulse. Nubain is
also utilized for, preoperative and postoperative
Patient Teachings analgesia, obstetrical analgesia during labor and
8. Explain that heparin cannot be taken orally delivery, and supplement to balanced anesthesia
9. Patient may experience hair loss
10. Inform patient taking heparin increases signs of CONTRAINDICATIONS
bleeding
Hypersensitivity with drug and addiction. Precautions
include pregnancy, breastfeeding, person with addictive
personality, increased intracranial pressure, acute
myocardial infarction and severe heart disease,
respiratory depression, renal/hepatic disease, bowel
impaction, abrupt discontinuation.

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 67

SIDE EFFECTS adverse effects is mainly associated with the
CNS.
Side effects in the Central Nervous System is the most 7. Monitor Respiratory Dysfunctions. Respiratory
expected specifically, sedation. Occasional side effects depression, character, rate, rhythm should be
include diaphoresis, cold/clammy skin, nausea, reported when rate is <10 cpm less the normal
vomiting, dizziness, vertigo, dry mouth, and headache. range.
Occurrence of restlessness, emotional liability, 8. Monitor Bowel Status. Since constipation is
paresthesia, flushing, and paradoxical reactions are common, laxative or stool softener may be
rare. necessary.
ADVERSE REACTIONS 9. Evaluate the decrease in pain without
respiratory depression.
Abrupt withdrawal after chronic use may induce 10. Encourage patient to report any symptoms of
abdominal cramping, rhinorrhea, lacrimation, anxiety, CNS changes and allergic reactions to avoid
fever, piloerection, as well as physical dependence or possible life-threatening incidence and
addiction. Severe respiratory depression, flaccidity in irritability.
muscles, cyanosis, stupor, coma, and seizures 11. Inform the patient that the drug causes
preceding from severe drowsiness are usually found in withdrawal symptoms, such as abdominal
patients overdosing from this drug. cramps, vascular occlusion: abscesses,
ulcerations, nausea, vomiting, seizures, opioid
DRUG INTERACTIONS craving, and dependence.
12. Encourage patient to avoid consumption of
Difenoxin, atropine, loperamide, paregoric,
CNS depressants and alcohol.
hydroxyzine, MAO inhibitors, and neuromuscular
blockers generally impose a threat to the Central
Nervous System. Sufentanil, antihypertensives, and
hydroxyzine increases the risk of hypotension. ADDITIONAL DRUGS
Additionally, alfentanil, sufentanil, antidiarrheals,
buprenorphine, hydroxyzine, MAO inhibitors, and
Protamine sulfate
neuromuscular blockers increases the risk of CNS and • antidote for heparin
Respiratory depression. Lastly, anticholinergics
increases the risk of severe constipation and urine
retention, buprenorphine decreases therapeutic effects Magnesium sulfate (MgSO4)
of nalbuphine, metoclopramide antagonizes effects of • anti-convulsant
metoclopramide, and naloxone and naltrexone • prevent seizures
decrease the pharmacologic effects of nalbuphine • for hypertension
• increase maternal circulation
NURSING RESPONSIBILITIES Magnesium toxicity:
1. Determine the past health history of the patient • monitor I&O (< 30 cc/hr)
especially, allergies or hypersensitivity prior to • check RR < 12 cpm
drug administration to ensure that the patient is • deep tendon reflexes (DTR)
not allergic to drugs to be administered. • monitor ECG
2. Respect and observe the 10 rights when Calcium gluconate
administering medications. • antidote for MgSO4 toxicity
3. Obtain the vital signs of the patient to gather
baseline data for essential for contraindications
in administering medication.
4. Ready resuscitation equipment and naloxone to
reverse nalbuphine’s effect if needed.
5. Assess onset, type, location, and duration of REFERENCES
the pain to obtain and determine accurate data
regarding the patient’s condition. I. Individual PPT of DR Group 3
6. Monitor CNS changes such as sedation, II. Maam Atillo’s Discussion
dizziness, drowsiness, hallucinations, III. PCI’s Discussion
euphoria, Level of Consciousness, and
pupillary reaction as the drug’s side and

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN 2D 68

Newborn Care Prepare the (sterile) hypo tray- the inner side is considered sterile, the outside
is contaminated.
 Separate NICU and Delivery Room- Procedure is performed inside the NICU.
Equipment:
 There is an infant warmer system where the baby is placed, along with a small
- Tuberculin syringe: for injection
table placed with the equipment.
- Medications: Ampule for Vitamin K injection, (Terramycin) Crede’s
 Before performing the procedure, make sure to wear closed cap and a mask.
Prophylaxis
- Tape Measure
What is immediate newborn care? - 2 thermometers
- These are activities that will prevent the occurrence of untoward effect - Alcohol swab
in the newborn. Including hypothermia, infection, and bleeding.
Also prepare:
Purposes: - Kidney basin as a waste receptacle
 To prevent bleeding from the cord - The baby’s comb/ brush
 To prevent infection of the cord and eyes - For the VS, prepare stethoscope (pediatric)
 To prevent hypothermia - Working gloves
- CBs in a jar
Before starting the procedure: - Sharps container
1. When the mother is about 7cms dilated, the doctor would usually order - Alcohol
the transfer of the mother from the labor room to the DR. During that
time, the nurse must prepare the crib. After assembling all the equipment, prepare the jot down notebook.
2. Disinfect the crib. Cleaning it in and out including the frame. Information:
3. Also clean the mattress and apply new linens.  Name of Institution:
4. Prepare 2 droplights beside the crib.  Name of Patient: Baby (gender), (family name)
 Name of Mother:
In preparation:  Date of delivery:
1. Assemble needed equipment.  Time of delivery:
2. Perform medical handwashing.
3. Set up the working table/ area in preparation for the coming the baby. Medications given:
 Name of ophthalmic ointment and time given.
Put all the necessary equipment  Vitamin K/ dosage/ route/ time given
(Left Handed; Equipment at left side, working area at right)
- Layette: lay down over the infant warmer Vital Signs:
 Time:
Arrange equipment in order of use (Starting from topmost)
 CR: (Normal: 120-160bpm)
1) Baby’s dress
 RR: (Normal: 40-60 cpm)
2) Bonnet
3) Diaper  Temp: (Normal: 36.5-37.5oC- Appropriate for Gestational Age;
4) Mittens and Booties 35.5-36.5oC- Premature)
5) 2nd layette
- Binder (Optional)- used to restrain the newborn’s knee during
administration of medications
Anthropometric Measurements and Normal Values: III. Hepatitis B Vaccine
 Weight: 2.5-3.5 kg - 0.5cc/ IM at right thigh (Vastus lateralis)
 Head circumference: 33-35 cm
 Chest circumference: 31-33 cm When the patient is about to be delivered, we are now ready to receive the
 Abdominal circumference: 30-32 cm baby.
 Length: 48.5-53.75 cm 1. Do medical handwashing and apply alcohol or sanitizer to disinfect hands.
2. Don working gloves: To protect the nurse from the newborn.
3. Receive the baby: The baby will be brought to the NICU well-wrapped,
Next, prepare the medications. These should not be prepared very early before endorsed, the pediatrician will be taking the weight. As the receiving
because it is important to maintain the drug’s patency nurse, take note of the result and record on the jot down notebook

1. Terramycin- Ophthalmic Ointment Once the baby is received:

2. Vitamin K- Phytomenadione
- Start by disinfecting the neck of the ampule using a cotton ball and 1. Remove the wrap since a layette has been prepared.
alcohol. 2. Turn baby to sides carefully when removing the wrap.
- Get another CB again, wrap the neck, and break with the mark
facing away from you. 3. Make sure the surroundings are warm.
- Discard neck on the sharps container. 4. Identify the baby (Check name band)
- Aspirate the medication. Lock the syringe needle and remove cap
with one hand, aspirate, and then fishhook to return. 5. Perform a quick head-to-toe assessment: check for unusualities,
deformities, and confirm if gender matches what is written on the name
Reminders: band.
- Check medication by reading the name of the drug before preparing it, 6. Take the vital signs;
just before administration and after preparation.  Rectal Temperature (initial), - hold the baby’s legs to support
- Check for the manufacturing date, expiration date, dosage and and gently fold to have access to the anus. Insert in a circular
characteristics of the medication. twisting motion slowly, only up to the tip/ bulb to avoid injuring
- No need to prepare medication ticket for Vitamin K and Crede’s the newborn. Place the thermometer on the waste receptacle
Prophylaxis after.
 CR- using pediatric stethoscope; RR- place hand over chest or
I. Crede’s Prophylaxis abdomen and count rise and fall.
- Application of ophthalmic ointment to newborn’s eyes to prevent
neonatal blindness or Ophthalmia Neonatorum caused by 7. Administer medications. Vitamin K and Crede’s Prophylaxis.
gonorrheal infection as the newborn passes through the - Restrain the baby first; Lock the arms and tuck layette under the
mother’s birth canal. buttocks. For the knees, the centerfold of the binder will be placed
- Name of medication- Terramycin Ophthalmic Ointment, or on top, bring to the back crisscross, back to the front, and knot.
depending on what the institution uses. - Start with Crede’s Prophylaxis. Double check medication. Open
then discard the first drop in the waste receptacle.
II. Vitamin K - Expose the lower lid of the baby by pulling the cheek downward.
- Generic name: Phytomenadione - Squeeze a little medicine out and apply within the lid from inner to
- Full-term Neonates: 0.1cc/ IM at left thigh (Vastus lateralis) outer canthus.
- Preterm Neonates: 0.05cc/ IM at left thigh (Vastus lateralis) - Next, administer the Vitamin K injection.
- Locate the site. (Left thigh- middle third of the anterolateral site 90o - Once done with the anthropometric measurements, place tape
IM) measure on the waste receptacle.
- Disinfect the site with an alcohol swab starting from inner to outer
portion. 9. Clean the baby
- Grab a CB and secure between fingers. - Usually, washing of the baby is done 6 hours after birth. So in this
- Using the heel of the palm over the knee to lock gently. case, we are not washing the baby, but only trying to remove excess
- Do cushion fashion to grasp the muscle and inject. blood and secretions which are commonly found on the vertex,
- Support the hub, aspirate to check if there is blood. If none, then especially when there is episiotomy.
slowly introduce the medication. - Using the baby’s comb, remove the excess blood from the head.
- After injecting, remove needle, lock the cap, and dispose on the - Support the baby’s head and neck, then use the brush to remove
waste receptacle and press only the site until there is no more blood the blood. Do it gently as not to cause injury to the baby.
coming out. - Once cleaned, place comb on the waste receptacle and slowly lower
- Remove the restraints. down the baby’s head.
- After cleaning, put on the baby’s sterile dress.
8. Take the anthropomorphic measurements - Insert the arms first, one side at a time. Making sure that the hands
- Weight is already taken previously. Proceed with the others. are curled into a fist as not to injure the fingers when accidentally
- Use tape measure for measurements pulled backwards.
- Check the head circumference. Use the lower border and it must be - Slowly turn the baby to the side and insert the excess. Make sure
in lined with the baby’s eyebrow and the tip of the ears. that the tie is also inserted well.
- Gently support the baby’s head and position the tape measure. - Insert on the other side as well, making sure that the fist is closed.
- Measure and read. - Tie the cords and make a knot/ ribbon.
- Next, check the chest circumference. - Put on the baby’s bonnet to prevent hypothermia. Support the head
- Place the tape measure in lined with the nipples. with both hands, slowly insert, and lay the baby’s head down after.
- Do not pull the measuring tape, instead, gently turn the baby to the - Fold the bottom part of the baby’s gown for aesthetic reasons, to
sides and gradually lower the tape measure and position. make it look nice. Ensure that it is sterile and the cord is placed on
- Measure and read. top.
- Following the cephalocaudal pattern of growth and development; - Apply the diaper. Making sure that the diaper should not be placed
(The head is bigger than the chest, and the chest is bigger than the on top of the cord.
abdomen) - Slowly lift the buttocks, supporting both feet. Insert the diaper below.
- Next, check the abdominal circumference. - Again, make sure that the diaper is placed a little lower than the
- Slowly turn the baby to the sides and gently lowering the tape cord. Rationale: When the diaper is filled with urine, the cord should
measure in the level positioned just next to the umbilical cord. not be contaminated.
- Mark and read. Then remove the tape measure. - Apply the mittens from the back and tie to lock. But before inserting,
- Take the baby’s length. try to invert and check underneath for excess thread to avoid cutting
- Turn the baby to the side. Try to gently extend the extremities a little the baby’s skin. If there are any excess, try to remove them.
and position the tape measure - Put on the baby’s booties. Note to be careful on the toes.
- Starting with the heel, the tip of the tape measure must be in lined
with the heel and measured up to the vertex of the head. 10. Change the layette. Lift the baby carefully, and with one hand
- Position the thumb on the mark of the measurement because we supporting the baby, the other is maneuvering the new layette.
need to take the measurement quickly as to avoid prolonging the - Spread the layette in a diamond form and fold the top part
baby in the side position. downwards.
- Return the baby in a supine position and read.
- Lay the baby’s neck in lined with the folded part and insert both arms Documentation of Medication:
on the inside spaces.
- Bring one side of the layette across and tuck excess at the back. Where to document?
- Fold the lower portion next, then insert the other arm of the baby on A. Patient’s chart
the other side as well. 1. Medication Sheet
- Tuck the excess and the baby is now swaddled. 2. Vital Sign Sheet
B. Medication Notebook provided in the NICU
11. After dressing up and cleaning, we may now put the baby in the crib.
Position with the head elevated to prevent increase in pressure. Medication:
- Slowly put down the buttocks first, then transfer the hand to support What and where to write:
the head. Slowly lower down the baby.  Medication sheet- single order/ stat medication portion
 Date, name of drug, dosage, route or site, time, and nurse’s initial
12. Once the baby is placed, prepare all the labels and other needed things.
13. Before doing aftercare, we may recheck the vital signs. But this time, the Example:
temperature can be taken axillary.  3/16/2021 Terramycin Ophthalmic ointment applied O.U 7:50 am JG
 3/16/2021 Vitamin K 0.1cc given IM at left thigh 7:55 am JG
14. Check vital signs every 30 minutes.
 3/16/2021 Hepatitis B vaccine 0.5cc given IM at right thigh 8:00 am JG

After care:

1. Begin with the sharps such as the needle and ampule. Dispose them in
the sharps container.

2. Wrappers and other discarded materials are disposed in the infectious

(yellow) bin.

3. Equipment such as comb and tape measure are cleaned and dried.
Thermometer is disinfected from stem to bulb before returning.

4. Return all the equipment after.

5. Remove the gloves (in the proper manner). Discard in the yellow bin.

6. Perform handwashing

7. Document
 Arrange the contents of the OB
DELIVERY AND POSTPARTUM
pack according to its use:
CARE
 Drape
 Bonnet

 Check for the tape, check for the  Layette

date and check if it is autoclaved.  2nd drape

When opening, observe aseptic  3rd drape

technique. Position yourself  Leggings

away from the table, make sure  Move along the basin on top of

your uniform do not touch the the table so you have a free

edge of the table. Do proper working space.

medical handwashing and  Put back the working forceps

remove jewelries. When and take one instrument at a

working on your table, remember time. Start with the biggest one:

that 1 inch from the edge of the instrument set. Turn to the side

table is considered unsterile. No and open the sterile pack.

coughing, talking and over- Position your hand over the

reaching over the sterile field. handle and open the edge of the

Wet surface is considered wrapper. Open in a banana peel

unsterile. manner and then drop the

 When opening the pack, open it instruments on the sterile table.

according to the cover direction. Make sure that the instruments

Open the first cover you can do not fall away from the table.

touch then drop. If you see the  Open the sterile bowl in the

calf over the first layer, touch same manner (turn to the side,

only the calf and make sure you banana peel manner), make

do not contaminate the inner sure that you do not touch the

layer. Start opening the calf bowl. Then drop.

away from you, then drop.  Next, open the placental curette

 On the 2nd layer, use the working in the same manner. Then drop.

forceps. Make sure that it is  Next is the allis forceps and then

sterile. Open according to its the mayo scissors.

direction then drop.  Next is the suction bulb. Drop

the suction bulb over the basin.
This is to prevent the bulb from  Sterile bowl with cotton balls
bouncing and dropping to the is placed on top of the
floor from the table. syringe
 Next, open the sterile cotton ball  Tissue holder beside the
then drop on the sterile bowl. forceps
 Next is the sterile OS. Then the  Needle holder
5cc syringe for the lidocaine.  Placental curette
 Next is the Chronic 2O (di ko  Ovum forceps
sure sa term basta katong gold  Place the blade on top of the
na murag ticket). blade holder
 Open the umbilical cord clamp  Suture over the basin
according to its arrow.  Cord clamp beside the mayo
 Lastly, open the blade and drop scissors - positioned teeth
over the sterile table. down
 After opening all the equipment,  Allis forceps is optional. It is
open all the sterile gloves. There used if the BOW is still intact.
should be 3 sterile gloves: 1 for Place beside the syringe.
the OB/GYN, 1 for the resident,  Position the gloves
and 1 for you. Open in a banana according to its use. OB →
peel manner then drop over the Resident → Nurse
sterile table.  For the OS, arrange in
 Once the equipment are cascading manner. One OS
complete on the table, arrange it after the other.
one at a time. Place your hand
at your back and use your
working forceps when arranging.
 Arrange the equipment
according to its use:
 5cc syringe
 Blade holder
 Mayo scissors
USES OF THE INSTRUMENTS
 3 forceps - combination of a
1. ALLIS FORCEPS - used to
straight and curved forceps
rupture the intact BOW.
2. 5cc SYRINGE - it is where  Do the surgical hand scrubbing.
your lidocaine will be placed. Keep hands above the waist.
3. BLADE HOLDER AND Then don sterile gloves (open
BLADE - if the blade is gloving technique).
connected to the blade holder, it  Place the wrapper of the sterile
will now become a knife. gloves underneath the sterile
4. MAYO SCISSOR - used for basin.
episiotomy and cutting of the  After donning the sterile gloves,
umbilical cord. prepare the lidocaine. There are
5. UMBILICAL CORD CLAMP 2 ways in aspirating the
6. FIRST FORCEPS - will be lidocaine. 1st is making use of
used to clamp the umbilical cord. the needle, 2nd is removing the
7. OTHER 2 FORCEPS - will be needle and using the luer-lock of
used for the bleeders. Bleeders the lidocaine. Ask for assistance
are the arteries and veins that when doing the 2nd way of
has been cut during the aspirating. Then put back the
episiotomy. needle, twist and lock then
8. TISSUE FORCEPS - used to remove the air.
hold the tissue after the  Proceed with the blade and
episiotomy is done and when blade holder. Use the forceps to
you will perform the episiorraphy. secure the blade. Make sure that
9. NEEDLE HOLDER - used to the oblique end of the blade
hold the needle. Needle holder is matches the oblique part of the
more blunt than the forceps. blade holder.
10. OVUM FORCEPS - used to  Followed by the suture, usually it
clean the uterus. is open after the delivery of the
11. PLACENTAL CURETTE - placenta. Cutting needle is used
used for cleaning and scraping to suture the skin. Round needle
the uterine lining. is used to suture the inner
muscles and tissues. Open over
 Make sure that the equipment the basin because the suture
have 1inch allowance from the wrapper has a solution inside
edge of the sterile table. that keeps the suture moist.
 Open the suture and take the While waiting, place your hand
needle. Identify the round from over the table to also avoid
the cutting needle. The cutting getting unsterile. When the
needle is flat while the round patient is already fully dilated
needle is round. Cut them 1/3, and fully effaced, inform the
2/3. 1/3 for the cutting and 2/3 NICU that we are about to
for the round. How? Have it deliver the baby.
halfway then get the other end of  Do the final preparation. Clean
the needle and place it over the the perineal area using the
left hand, use the pinky finger to perineal flushing technique and
anchor over the suture thread. betadine spray. This is also the
Do not rush this process, just time where we place the
enough to have equal parts. leggings and drape.
 Secure the round needle using  When starting the draping, begin
the needle holder by placing the with the leggings. Position the
needle holder at the edge of the open part of the leggings away
needle. Tip of the needle facing from you and the folded part
downward. near you. Insert your palm under
 Secure the cutting needle using the calf of the leggings and open
the OS. like a book. Take a step
 Place your OS over the ovum. backward and open the leggings
Make sure that the entire hole of away from the patient and away
the ovum is covered. Make a from the table.
triangular shape out of the OS  Start with the far leg.
and clip using the ovum at the  Proceed with the second
edge and wrap around then lock. leggings, do the same procedure.
 Finally, ask for assistance to  Next, use the 1st drape. It is
pour over water and betadine usually folded with a triangle fold
over the sterile bowl and cotton on top for easy access. Cover
balls. the back of your palm to keep
 Position the OB table near the your hands sterile when inserting
client. under the buttocks of the client.
 Wait for the doctor to say that we  Next thing to do is to wait for the
are about to deliver the baby. contractions.
 When there is already crowning  For the episiotomy, the doctor
and the BOW is still intact, you will do median episiotomy or mid-
will perform rupturing of the lateral episiotomy.
BOW. Make use of the allis  Give more OS for the preparation
forceps, then do ARM (Artificial for Ritgen’s maneuver.
Rupture of the Membrane).  Give the “Mayo” to cut the
assist the vaginal opening then perineal tissue and
cut. Observe with the water that muscles.
goes off, it should be clear with a  Support the perineal area
little white particles with no for prevention of perineal
unusual smell. If it is greenish, it tear “laceration”
is called the MECONIUM STAIN.  The baby will be push or
Report the time the ARM was called station for crowning.
done.  If the baby’s head is out, wipe
 While the client is keep pushing, the mouth and nose. If there
prepare the perineal area for is secretion, use the suction
episiotomy (prepare injection for bulb and suction first the nose,
perineal area of the lidocaine) discard and suction the other
ROLE OF ST. N: give the side then the mouth (to
instrument to doctor and the facilitate airway)
doctor will do the procedure  In delivering the head, review
 When handling instrument to OB- the mechanism of labor and
GYNE, touch the tip of the delivery
instrument and the handle will be  Fetal descend
handled by the doctor. (rupture  Flexion
the bag of water)  Internal rotation
 Take hold of syringe/anesthesia  Extension
then give it to the doctor as well
 External rotation
as the OS (will be inserted in the
 expulsion
perineal area in preparation for
 Assist the biggest part (head),
episiotomy)
do the scissor like using finger
 Give the blade (hold the neck
in the neck of the baby and
part) and give OS also.
1. Pull the baby down to let cord over the forceps towards
the upper shoulder out and the perineal area of the
pull the baby up to let the mother)
lower shoulder out.  To perform crede’s maneuver,
2. Externally rotate the baby put the dominant hand over
supporting with non-dominant pubis to push the placenta out
hand, while the dominant while pulling using non-
hand supports the back and dominant hand.
facilitate the delivery of the  Prepare and position
fetal body parts and catches the basin under the
the feet. buttocks just above
 Check for the time and anus and slowly pull
gender of the baby and put in the placenta out.
the mother’s abdomen  Remove the forceps and
 Place the layette over place in the table
the mother’s abdomen  While the doctor is checking
 Place layette over the for placental fragments, make
baby (for drying) and use of placenta and flip it.
bonette  Break the membrane,
 Wait for the position of the count of numbers of
cord to stop (in prone position) cotyledon 15-20
 Offer to the doctor the (normal size of
umbilical cord clamp (1inch placenta)
from the base)  After, tell the doctor if it
 Offer the scissor to the doctor is complete or not.
and put on the drape the  Get 1 OS and wipe it on your
scissor attached with the cord gloves.
in the mother.  Offer the doctor the forceps
 Put the 3rd drape under the (to clamp the arteries and
buttocks of the mother and vein) with the needle
put the old one in the floor. (preparation of suturing)
 Perform the Brandt-Andrews  To assist make use of the
maneuver (role the umbilical Mayo scissor with OS.
Position your self at the back  Offer ovum forceps
of the doctor and side of the with the OS to clean
mother’s hips and legs. the lining of uterus
 Put the OS on the which is the
drape endometrium, if it is still
 Support the needle bloody do it repeatedly
making the sutures  Do the post-partum care
straight and easy for  Remove the cover first
doctors. 1. Get a bowl with cb and
 If the doctor position betadine (perineal
their hand you have to cleaning) 1:02:08
cut the knot (position 2. A. Zigzag manner in
between fingers and synthesis pubis
cut on top of the knots) (discarb cb) (upper part
 Support end of the of vagina)
suture B. Near leg from the
 When the doctor is done groin zigzag manner
suturing the deep tissues and (singit)
muscle using round needle, C. Labia (1 direction)
you need to anchor the use another cb per
cutting needle to suture the direction – 2 cb
skin. D. From the clitoris to
 Will be needing cotton the vaginal opening to
ball with betadine and perineum
squeeze over the site e. from the clitoris to vo
to clean the suture site to perineum to the
 Offer the placental curette- anus
will clean the placental F. suture line
fragments left in the uterus 3. Flush the perineal area
either the placenta is 4. Spray the
complete or incomplete episiorrhaphy side
(perform placental curettage)
5. Put the diaper with the  Release the air of the
help of classmate cellophane that has urine,
(lifting the hips) stool etc and close. Bring it at
6. Position the leg of the the back of DR
client to supine position  MOP THE FLOOR – 3 types
from lithotomy position of mop
7. Change the gown and 1. Yellow- infectious, hep b
provide blanket or hiv
8. Make the patient 2. Red- blood
comfortable and ask 3. White- rinsing the blood
for any discomfort Then the disinfectant
9. Regulate the IV  Go to the back of DR rinse
10. Palpate the fundus the mop and go back
 Instrument  Clean the table, spray it with
1. For the sharps, separate it. disinfectant then wipe
2. Separate the needle
3. Separate the blade
4. All sharps go to yellow  After 2hrs the mother will go
bin/sharps container out on the delivery room
5. Syringes to pail  Remove the cover of the bed
6. Count the “scissors” -10 and spray then cover
pcs with sterile bowl  Ask CI if ready to remove na
7. Brush the teeth of “scissor” ang gloves
8. Rinse and dry the  Remove gloves
instruments  Proper handwashing
 Throw the placenta on the
placental pail
 Clean the placental bowl and
place the instruments in it and
go to the sink in DR
 Go to back of DR and get a
mop
 Place all the used drape etc
and put in a hamper