Reference no: EM133275219

Assignment:

CASE SCENARIO

On October 1, 2022 (1:00 am), a primigravida with 39 weeks AOG presents at the labor and delivery unit. Initial assessment of vital signs such as temperature, pulse, respiration, and blood pressure were normal. Laboratory such as Complete Blood Count and Urinalysis was done as an outpatient were within normal limits.

This is her first pregnancy. The patient is Gravida 1 Para 1 and was expecting to deliver on October 10, 2022. Her delivery was one week earlier than her estimated date of delivery. The patient has poor prenatal check-up and poor compliance with prescribed medicines such as Ferrous Sulfate. The pregnancy was unplanned; however, the patient is thankful because there were no problems or complications arise during labor.

She reports that there is no fluid leaking from her vagina. She was having contractions for the past 6 hours. "My contractions are coming every 2 minutes and last for about 60 seconds."" They don't change when I lie down or walk, I think I saw some blood leaking". She is becoming quite uncomfortable and moaning during contractions. She was in active labor. Her cervix is dilated to 9 cm, and almost completely effaced. She is experiencing a great deal of anxiety and pain and is unable to stay in control and breathe through her contractions. She does not want epidural anesthesia, so her physician prescribed Meperidine (Demerol) and Promethazine (Phenergan) The fetal heart rate and contractions are being monitored by an electronic fetal monitor (EFM).

The nurse notes a fetal heart rate of 120 beats per minute with adequate variability. There are no decelerations, but there are occasional accelerations. The presentation is in Cephalic. She gave birth at 6:00 am via NSVD with mediolateral episiotomy. APGAR score is 8 after 1 minute and 9 after 5 minutes. Skin to skin contact was initiated. Latching on was done. The placenta was delivered in the Schultz mechanism after 10 minutes.

Narda delivered a 2,200 grams baby boy with an APGAR score of 8 after 1 minute and 9 after 5 minutes. No difficulties at birth were noted and no resuscitation was needed. No Congenital anomalies were noted. The patient was overwhelmed upon seeing her baby for the first time. She is glad to be through with the pregnancy but still longing to have another baby soon.

After staying in the recovery room for two hours and after a thorough physical examination, the patient was transported to the Postpartum Unit via a stretcher in stable condition. Vital signs such as RR, PR, BP, and temperature were normal. The uterus is well contracted and globular. The fundus is at the level of the umbilicus and there is a moderate lochia.

Narda, a 29 years old female, G1P1 delivered to a full-term baby girl via NSVD. She is experiencing some postpartum pain (afterpain). She is tired and exhausted following childbirth. She began narrating about the beginning of her pregnancy, her experiences during labor and birth. You observed that Narda was passive. She prefers having a Nurse to attend her needs and make decisions for her. She is also pondering as she holds her baby and asking, "Is birth over?"," Could this child have been inside me?". This time all she wanted is to rest to regain her physical strength and experience a calm atmosphere around her to quiet and contain her swirling thoughts." After sharing her stories, she said "Please take care of my baby for a while."

I am exhausted. I was in labor for more than 10 hours and "I had no sleep at all last night." I need sleep" After some time of being dependent, Narda begins to initiate action. She prefers now to get her washcloth and make her own decisions. Greater independence can be seen because she can perform self-care. Her husband said Monaliza has a stronger interest in her baby and begins her role as a mother. She cuddles her baby while breastfeeding though not confident in holding her baby. She feels insecure about her ability to take care of her child, but she tries her best. A brief demonstration of infant care was demonstrated by the nurse. She appreciated it very much. To boost her confidence, she was praised for the things she does well and some positive reinforcement was done. Finally, Monaliza redefines her role. She gave up her role of being childless.

A very special moment happened when they begin interacting with their newborn, they said that" it is priceless" being a first-time mom and dad. Narda holds her child more and begins to express more warmth. She feels comfortable enough to press her cheek against the baby or kiss the infant's nose. She is a mother tending to her child. You notice also that she is looking directly at her newborn's face with direct eye contact. You observed also that her husband is staring at the baby for a long period.

On her laboratory test There is a low level of Hemoglobin and Red blood cell count;

After what had happened, her husband noticed that Narda has this overwhelming sadness, burst into tears, and feeling down, there is also a feeling of inadequacy, anorexia, and sleep disturbance. She is also worried about the weight of her baby. With the help of her husband, mother, and health care professional's anticipatory guidance and individualized support, this complication was explained to her as an unexpected response, which is normal. She was given a chance to verbalize her feelings and make as many decisions as she wants to help her gain a sense of control and move past this strange postpartum emotion.

On the second day of your duty, the patient complained of pain on the incision site. You observe that the skin around the episiorrhaphy is red and draining a small amount of seropurulent drainage. A moderate lochia rubra was observed. A hot sitz bath was done and an order to continue the anti-infective drug was carried out and analgesic was prescribed. The use of stool softener was prescribed, and a high fiber diet was encouraged. Another problem was also relayed about breastfeeding. She said, "something is wrong with my breast". Upon further questioning, she says that she has a hard, tender, and shiny over the entire breast not just in one spot. There is no redness, fever, and cracked nipples. You tell her to continue breastfeeding because it will not harm the baby and weaning during engorgement may cause engorgement and stasis, leading to abscess formation. Other advice was given to increase oral fluid intake and use a warm compress to promote comfort.

After 5 days, Narda's doctor ordered that she may go home but her baby will stay in the hospital for monitoring and treatment of neonatal sepsis. Included in the "May go home" order is the following:

Take home meds:

• Sultamicillin 750 mg cap BID X 2 days more
• Mefenamic acid 500 mg cap q6 PRN for pain
• Ferrous Sulfate 300 mg tab OD X 1month

1. Internal Examination prior to discharge.

2. To come back after 1 week with CBC laboratory results at OPD

QUESTION: Can you make a Introduction about the patient?