VI.

OBSTETRICAL MANAGEMENT

Ideal Nursing Management

In receiving patient, offer and perform morning care and bedside care. Provide
an environment that is suitable for the patient. Take Patient XYZ's vital signs every 4
hours. In taking vital signs the nurse should wash her hands, gather the equipment,
identify the patient, explain the procedure, and assist the patient in a comfortable
position. Thorough assessment should be performed. Monitor patient XYZ's urine
and stool, intake and output. Administer medications ordered by the physician. When
administering medications, check and select cards for the mediation to be given at
the time they are to be given. Should contain patient name, name of the drug, drug
usage, time and route of administration, and signature of the person writing the
order. Regulate patient's intravenous fluid flow and monitor patient's oxygen
inhalation, and O2 saturation. Monitor patient's lung function carefully throughout
pregnancy to ensure that her growing fetus gets enough oxygen. Monitor fetal
movements daily. Build rapport with the patient and patient's family through
therapeutic communication and nursing care to address their needs and concerns.
Provide and emphasize health teachings to the patient. Patient should be asked
about their emotional well-being, what family and social support they have and their
usual coping strategies for dealing with day-to-day matters. The postpartum patient
and their families/partners should be encouraged to tell their health care professional
about any changes in mood, emotional state and behavior that are outside of the
patient's normal pattern.

Ideal Medical Management

Administer medications as ordered by the physician. Intravenous Antibiotic
treatment should be guided by urine culture and sensitivity reports. Provide
nebulization and O2 inhilation PRN for dyspnea via nasal cannula. Increase fluid
intake (may require intravenous fluids if clinically dehydrated). Monitor urine output to
assess complete emptying of the bladder (assists antimicrobial treatment). Monitor
Patient XYZ's vital signs, O2 saturation, CBC results and FHT; UC and progress of
labor.
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Actual Nursing Management

Upon duty, morning care was offered but was refused by Patient XYZ.
Bedside care was also given by changing the linens into a new one then tacking it in
properly and neatly. Arranging of things on the bedside table and in the bed was also
done in part of bedside care. Thorough assessment was also performed on the day
of duty including general skin pallor, capillary refill and over-all condition of the
patient. Patient XYZ's vital signs were taken every 4 hours, at 7:45 oclock in the
morning and 12 oclock noon which were then plotted on the TPR sheet. Stool and
urine were also monitored and recorded from 8 hours of duty. Medications were
given by the nurse and student nurses on duty as ordered by the physician.
Intravenous fluid (D5Water 500cc + 2 ampule Aminophylline) was monitored and
regulated at 20 drops per minute. Oxygen inhalation 2 LPM via nasal cannula. The
nurses established rapport with the patient and watcher through therapeutic
communication and nursing care. Health teachings were given such as advising the
patient to follow a hypoallergenic diet, informed to stay in environments that are
unpolluted, free from smoke, and dusts in order to lessen the risk of asthma attack,
informed to have adequate rest of atleast 6-8 hrs at night for her overall being,
instruct on the proper usage, importance, and proper cleaning of the nebulizer for
optimum use and decreased risk for contamination. Patient XYZ was encouraged to
discuss her feelings and fears related to her condition and concerns about
complications. Nurses have attended to her concerns, needs and problems like fear,
anxiety and emotional distress that she is feeling or may feel as an antepartum
patient.

Actual Medical Management

Upon duty, Patient XYZ's vital signs were taken and recorded with an interval
of 4 hours. Intake and output were monitored, recorded, and changes were noted.
Specific medications were given to patient XYZ as ordered by the physician. An IVF
of (D5Water 500cc + 2 ampule Aminophylline) was monitored and regulated at 20
drops per minute., Ranitidine 130mg, 1 capsule, Salbutamol, 1 neb., Ampicillin 2
grams IVTT, O2 inhalation PRN for dyspnea, Vitamin C @ 500mg 1 tab. Monitoring
of FHT; UC and progress of labor was done. Modified high back rest to the patient.
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Constant observation of the patient was also done and reported any abnormal
findings such as an increased respiratory rate, increased heart rate, and decreased
blood pressure.

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