Normal Vaginal Delivery, NSVD

1. Presented by: Dave Jay S. Manriquez, RN.
Theoretical Background
MATERNAL ROLE ATTAINMENT THEORY
Formulated to serve as a framework for nurses to provide appropriate health care interventions for nontraditional mothers so they could successfully attain a strong maternal identity.
• Provide appropriate health care intervention for nontraditional mothers
• Assist nontraditional mothers to attain a strong maternal identity.
CONCEPTS
Maternal Role Attainment
• Primary Concept-Developmental and interactional process occurs over a period of time
• Mother bonds with infant, acquires competence in caretaking tasks, enjoys and expresses joy and pleasure in the role
• Maternal Identity-Personal state of harmony, confidence and competence. End point of maternal role attainment.
Process follows 4 stages of acquisition
• Anticipatory: Social and psychological adaptation to role; learning expectations. Fantasizes about the role "What to expect when you are expecting."
• Formal: Assumption of role at birth; Behaviors guided by others in social system/ network; "My mother always told me…"
• Informal: Mother develops own ways of mothering; not conveyed by social system
• Personal: Joy of Motherhood; Harmony, confidence, and competence in maternal role.; " I’m ready to have another one…"
CONCEPTUAL FRAMEWORK
Mothers post partally must pass each stage to attain the maximal role attainment. First, they would be anticipating for the coming of the baby and for the changes of her new role. Then
next, formal stage where the mother would begin to act as what her mother should have done and what she must do as her mother have done. Then the third stage is the informal stage where mother
develops her own mothering technique based on her own instinct and the bonding built by the mother and child. Then lastly the mother gains confidence of her own technique and thus experience
fulfillment in her new role.
Personal
Informal
Formal
Anticipatory
Jean Watson Theory of Human Caring
Major Conceptual Elements
 Ten carative factors
 Transpersonal caring relationship

2.  Caring moment/caring occasion
 Caring-healing modalities
This view takes nursing and healing work beyond conventional thinking. The latest orientation is located within nursing at its finest while transcending nursing. Caring science as model for nursing
allows nursing’s caring healing core to become both discipline specific and transdisciplinary. Thus, nursing’s timeless, enduring, and most noble contributions come of age through a caring science
orientations- scientifically, aesthetically, and ethically.

3. ANATOMY AND PHYSIOLOGY
FEMALE REPRODUCTIVE SYSTEM
The Human female reproductive system contains two main parts: the vagina and uterus, which acts as the receptacle for the male’s sperm, and the ovaries, which produce the female’s ova.
All of these parts are always internal; the vagina meets the outside at the vulva, which also includes the labia, clitoris, and urethra. The vagina is attached to the uterus through the cervix, while the
uterus is attached to the ovaries via the fallopian tubes. At certain intervals, the ovaries release an ovum, which passes through the fallopian tube into the uterus.
If, in this transit, it meets with sperm, the sperm penetrate and merge with the egg, fertilizing it. The fertilization usually occurs in the oviducts, but can happen in the uterus itself. The
zygote then implants itself in the wall of the uterus, where it begins the processes of embryogenesis and morphogenesis. When developed enough to survive outside the womb, the cervix dilates and
contractions of the uterus propel the fetus through the birth canal, which is the vagina.
The ova are larger than sperm and are generally all created by birth. Approximately every month, a process of oogenesis matures one ovum to be sent down the fallopian tube attached to its
ovary in anticipation of fertilization. If not fertilized, this egg is flushed out of the system through menstruation. Human pregnancy is somewhat arbitrarily divided into three trimester periods, as a
means to simplify reference to the different stages of fetal development. The first trimester period carries the highest risk of miscarriage (natural death of embryo or fetus). During the second
trimester the development of the fetus can start to be monitored and diagnosed. The third trimester marks the beginning of viability, or the ability of the fetus to survive, with or without medical
help, outside of the mother's womb.

4. Ovaries
The ovaries are the main reproductive organs of a woman. The two ovaries, which are about the size and shape of almonds, produce female hormones (estrogens and progesterone) and eggs (ova).
All the other female reproductive organs are there to transport, nurture and otherwise meet the needs of the egg or developing fetus.
The ovaries are held in place by various ligaments which anchor them to the uterus and the pelvis. The ovary contains ovarian follicles, in which eggs develop. Once a follicle is mature, it ruptures
and the developing egg is ejected from the ovary into the fallopian tubes. This is called ovulation. Ovulation occurs in the middle of the menstrual cycle and usually takes place every 28 days or so
in a mature female. It takes place from either the right or left ovary at random.
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall.
Approximately half its length is visible; the remainder lies above the vagina beyond view.
Fallopian tubes
The fallopian tubes are about 10 cm long and begin as funnel-shaped passages next to the ovary. They have a number of finger-like projections known as fimbriae on the end near the ovary. When
an egg is released by the ovary it is ‘caught’ by one of the fimbriae and transported along the fallopian tube to the uterus. The egg is moved along the fallopian tube by the wafting action of cilia —
hairy projections on the surfaces of cells at the entrance of the fallopian tube — and the contractions made by the tube. It takes the egg about 5 days to reach the uterus and it is on this journey down
the fallopian tube that fertilization may occur if a sperm penetrates and fuses with the egg. The egg, however, is only usually viable for 24 hours after ovulation, so fertilization usually occurs in the
top one-third of the fallopian tube.
Uterus
the uterus is a hollow cavity about the size of a pear (in women who have never been pregnant) that exists to house a developing fertilized egg. The main part of the uterus (which sits in the pelvic
cavity) is called the body of the uterus, while the rounded region above the entrance of the fallopian tubes is the fundus and its narrow outlet, which protrudes into the vagina, is the cervix.
The thick wall of the uterus is composed of 3 layers. The inner layer is known as the endometrium. If an egg has been fertilized it will burrow into the endometrium, where it will stay for the rest of
its growth. The uterus will expand during a pregnancy to make room for the growing fetus. A part of the wall of the fertilized egg, which has burrowed into the endometrium, develops into the
placenta. If an egg has not been fertilized, the endometrial lining is shed at the end of each menstrual cycle.
The myometrium is the large middle layer of the uterus, which is made up of interlocking groups of muscle. It plays an important role during the birth of a baby, contracting rhythmically to move
the baby out of the body via the birth canal (vagina).
Vagina
The vagina is a fibromuscular tube that extends from the cervix to the vestibule of the vulva. The vagina receives the penis and semen during sexual intercourse and also provides a passageway for
menstrual blood flow to leave the body.

5. Oviducts
The Fallopian tubes or oviducts are two very fine tubes leading from the ovaries of female mammals into the uterus. On maturity of an ovum, the follicle and the ovary's wall rupture,
allowing the ovum to escape and enter the Fallopian tube. There it travels toward the uterus, pushed along by movements of cilia on the inner lining of the tubes. This trip takes hours or days. If the
ovum is fertilized while in the Fallopian tube, then it normally implants in the endometrium when it reaches the uterus, which signals the beginning of pregnancy.
FETAL CIRCULATION
Since the long and digestive system are not yet functioning in a fetus, all nutrient, excretory, and gas exchanges occur through the placenta. Nutrients and oxygen move form the mother’s
blood into the fetal blood, and fetal wastes move in the opposite direction. The umbilical cord contains three blood vessels: one large umbilical vein and two smaller umbilical arteries. The umbilical
vein carries blood rich in nutrients and oxygen to the fetus. The umbilical arteries carry carbon dioxide and debris-laden blood from the fetus to the placenta. As the blood flows superiorly toward
the heart of the fetus, most of it bypasses the immature liver through the ductus venosus and enters the inferior vena cava, which carries the blood to the right atrium of the heart.
Since fetal lungs are nonfunctional and collapsed, two shunts see to it that they are almost entirely bypassed. Some of the blood entering the right atrium is shunted directly into the left
atrium through the foramen ovale, a flap like opening in the interatrial septum. Blood that does manage to enter the right ventricle is pumped out the pulmonary trunk, where it meets a second shunt,
the ductus arteriosus, a short vessel that connects to the aorta and the pulmonary trunk. Because the collapsed lungs are a high-pressure area, blood tends to enter the systemic circulation through the
ductus arteriosus. The aorta carries blood to the tissues of the fetal body and ultimately back to the placenta through the umbilical arteries. At birth, or shortly after, the foramen ovale closes, and the

6. ductus arteriosus collapses and is converted to fibrous ligamentum arteriosum. As blood stops flowing through umbilical vessels, they become obliterated, and the circulatory pattern becomes that of
an adult.
Pregnancy
The period from conception to birth. After the egg is fertilized by a sperm and then implanted in the lining of the uterus, it develops into the placenta and embryo, and later into a fetus.
Pregnancy usually lasts 40 weeks, beginning from the first day of the woman's last menstrual period, and is divided into three trimesters, each lasting three months. Pregnancy is a state in which a
woman carries a fertilized egg inside her body.
Causes and symptoms
The first sign of pregnancy is usually a missed menstrual period, although some women bleed in the beginning. A woman's breasts swell and may become tender as the mammary glands
prepare for eventual breastfeeding. Nipples begin to enlarge and the veins over the surface of the breasts become more noticeable. Nausea and vomiting are very common symptoms and are usually
worse in the morning and during the first trimester of pregnancy. They are usually caused by hormonal changes, in particular, increased levels of progesterone. Women may feel worse when their
stomach is empty, so it is a good idea to eat several small meals throughout the day, and to keep things like crackers on hand to eat even before getting out of bed in the morning. Many women also
feel extremely tired during the early weeks. Frequent urination is common, and there may be a creamy white discharge from the vagina. Some women crave certain foods, and an extreme sensitivity
to smell may worsen the nausea. Weight begins to increase. In the second trimester (13–28 weeks) a woman begins to look noticeably pregnant and the enlarged uterus is easy to feel. The nipples
get bigger and darker, skin may darken, and some women may feel flushed and warm. Appetite may increase. By the 22nd week, most women have felt the baby move. During the second trimester,
nausea and vomiting often fade away, and the pregnant woman often feels much better and more energetic. Heart rate increases as does the volume of blood in the body. By the third trimester (29–
40 weeks), many women begin to experience a range of common symptoms. Stretch marks may develop on abdomen, breasts and thighs, and a dark line may appear from the navel to pubic hair. A
thin fluid may be expressed from the nipples. Many women feel hot, sweat easily and often find it hard to get comfortable. Kicks from an active baby may cause sharp pains, and lower backaches
are common. More rest is needed as the woman copes with the added stress of extra weight. Braxton Hicks contractions may get stronger. At about the 36th week in a first pregnancy (later in repeat
pregnancies), the baby's head drops down low into the pelvis. This may relieve pressure on the upper abdomen and the lungs, allowing a woman to breathe more easily. However, the new position
places more pressure on the bladder. A healthy gain for most women is between 25 and 35 pounds. Women who are overweight should gain less; and women who are underweight should gain more.
On average, pregnant women need an additional 300 calories a day. Generally, women will gain three to five pounds in the first three months, adding one to two pounds a week until the baby is
born. An average, healthy full-term baby at birth weighs 7.5 lb (3.4 kg), and the placenta and fluid together weigh another 3.5 lb. The remaining weight that a woman gains during pregnancy is
mostly due to water retention and fat stores. Her breasts, for instance, gain about 2 lb. in weight, and she gains another 4 lb due to the increased blood volume of pregnancy. In addition to the
typical, common symptoms of pregnancy, some women experience other problems that may be annoying, but which usually disappear after delivery. Constipation may develop as a result of food
passing more slowly through the intestine. Hemorrhoids and heartburn are fairly common during late pregnancy. Gums may become more sensitive and bleed more easily; eyes may dry out, making
contact lenses feel painful. Pica (a craving to eat substances other than food) may occur. Swollen ankles and varicose veins may be a problem in the second half of pregnancy, and chloasma may
appear on the face. Chloasma, also known as the "mask of pregnancy" or melasma, is caused by hormonal changes that result in blotches of pale brown skin appearing on the forehead, cheeks, and
nose. These blotches may merge into one dark mask. It usually fades gradually after pregnancy, but it may become permanent or recur with subsequent pregnancies. Some women also find that the
line running from the top to the bottom of their abdomen darkens. This is called the linea nigra.
First month

7. At the end of the first month, the embryo is about a third of an inch long, and its head and trunk—plus the beginnings of arms and legs—have started to develop. The embryo receives nutrients and
eliminates waste through the umbilical cord and placenta. By the end of the first month, the liver and digestive system begin to develop, and the heart starts to beat.
Second month
In this month, the heart starts to pump and the nervous system (including the brain and spinal cord) begins to develop. The 1 in (2.5 cm) long fetus has a complete cartilage skeleton, which is
replaced by bone cells by month's end. Arms, legs and all of the major organs begin to appear. Facial features begin to form.
Third month
By now, the fetus has grown to 4 in (10 cm) and weighs a little more than an ounce (28 g). Now the major blood vessels and the roof of the mouth are almost completed, as the face starts to take on
a more recognizably human appearance. Fingers and toes appear. All the major organs are now beginning to form; the kidneys are now functional and the four chambers of the heart are complete.
Fourth month
The fetus begins to kick and swallow, although most women still can't feel the baby move at this point. Now 4 oz (112 g), the fetus can hear and urinate, and has established sleep-wake cycles. All
organs are now fully formed, although they will continue to grow for the next five months. The fetus has skin, eyebrows, and hair.
Fifth month
Now weighing up to a 1 lb (454 g) and measuring 8–12 in (20–30 cm), the fetus experiences rapid growth as its internal organs continue to grow. At this point, the mother may feel her baby move,
and she can hear the heartbeat with a stethoscope.
Sixth month
Even though its lungs are not fully developed, a fetus born during this month can survive with intensive care. Weighing 1–1.5 lb (454–681 g), the fetus is red, wrinkly, and covered with fine hair all
over its body. The fetus will grow very fast during this month as its organs continue to develop.
Seventh month
There is a better chance that a fetus born during this month will survive. The fetus continues to grow rapidly, and may weigh as much as 3 lb (1.3 kg) by now. Now the fetus can suck its thumb and
look around its watery womb with open eyes.
Eighth month

8. Growth continues but slows down as the baby begins to take up most of the room inside the uterus. Now weighing 4–5 lbs (1.8–2.3 kg) and measuring 16–18 in (40–45 cm) long, the fetus may at
this time prepare for delivery next month by moving into the head-down position.
Ninth month
Adding 0.5 lb (227 g) a week as the due date approaches, the fetus drops lower into the mother's abdomen and prepares for the onset of labor, which may begin any time between the 37th and 42nd
week of gestation. Most healthy babies will weigh 6–9 lbs (2.7–4 kg) at birth, and will be about 20 in long.
Diagnosis
Many women first discover they are pregnant after a positive home pregnancy test. Pregnancy urine tests check for the presence of human chorionic gonadotropin (hCG), which is produced
by a placenta. The newest home tests can detect pregnancy on the day of the missed menstrual period. Home pregnancy tests are more than 97% accurate if the result is positive, and about 80%
accurate if the result is negative. If the result is negative and there is no menstrual period within another week, the pregnancy test should be repeated. While home pregnancy tests are very accurate,
they are less accurate than a pregnancy test conducted at a lab. For this reason, women may want to consider having a second pregnancy test conducted at their doctor's office to be sure of the
accuracy of the result. Blood tests to determine pregnancy are usually used only when a very early diagnosis of pregnancy is needed. This more expensive test, which also looks for hCG, can
produce a result within nine to 12 days after conception. Once pregnancy has been confirmed, there are a range of screening tests that can be done to screen for birth defects, which affect about 3%
of unborn children. Two tests are recommended for all pregnant women: alpha-fetoprotein (AFP) and the triple marker test. Other tests are recommended for women at higher risk for having a child
with a birth defect. This would include women over age 35, who had another child or a close relative with a birth defect, or who have been exposed to certain drugs or high levels of radiation.
Women with any of these risk factors may want to consider amniocentesis, chorionic villus sampling (CVS) or ultrasound.
Other prenatal tests
There are a range of other prenatal tests that are routinely performed, including:
• PAP test
• gestational diabetes screening test at 24–28 weeks
• tests for sexually transmitted diseases
• urinalysis
• blood tests for anemia or blood type
• screening for immunity to various diseases, such as German measles
Treatment
Prenatal care is vitally important for the health of the unborn baby. A pregnant woman should be sure to eat a balanced, nutritious diet of frequent, small meals. Women should begin taking
400 mcg of folic acid several months before becoming pregnant, as folic acid has been shown to reduce the risk of spinal cord defects, such as spina bifida. No medication (not even a

9. nonprescription drug) should be taken except under medical supervision, since it could pass from the mother through the placenta to the developing baby. Some drugs, called teratogens, have been
proven harmful to a fetus, but no drug should be considered completely safe (especially during early pregnancy). Drugs taken during the first three months of a pregnancy may interfere with the
normal formation of the baby's organs, leading to birth defects. Drugs taken later on in pregnancy may slow the baby's growth rate, or they may damage specific fetal tissue (such as the developing
teeth), or cause preterm birth.
To have the best chance of having a healthy baby, a pregnant woman should avoid:
• smoking
• alcohol
• street drugs
• large amounts of caffeine
• artificial sweeteners
Nutrition
Women should begin following a healthy diet even before they become pregnant. This means cutting back on high-calorie, high-fat, high-sugar snacks, and increasing the amount of fruits,
vegetables and whole grains in her diet. Once she becomes pregnant, she should make sure to get at least six to 11 servings of breads and other whole grains, three to five servings of vegetables, two
to four servings of fruits, four to six servings of milk and milk products, three to four servings of meat and protein foods, and six to eight glasses of water. She should limit caffeine to no more than
one soft drink or cup of coffee per day.
Prognosis
Pregnancy is a natural condition that usually causes little discomfort provided the woman takes care of herself and gets adequate prenatal care. Childbirth education classes for the woman
and her partner help prepare the couple for labor and delivery.
Prevention
There are many ways to avoid pregnancy. A woman has a choice of many methods of contraception which will prevent pregnancy, including (in order of least to most effective):
• spermicide alone
• natural (rhythm) method
• diaphragm or cap alone
• condom alone
• diaphragm with spermicide

10. • condom with spermicide
• intrauterine device (IUD)
• contraceptive pill
• sterilization (either a man or woman)
• avoiding intercourse
Relative size of the uterus at the end of (a) the third; (b) the sixth; and (c) the ninth month.
Near the end of pregnancy the head usually sinks down into the pelvis (d) ; this is called 'lightening'.

11. Conclusion
Therefore, the researchers conclude that in order to have reliable information, it is necessary to establish a good communication with the informant and render an open type of questions and
accept answers with an open-mind. An open communication and good rapport is necessary to help yield a good response. These are the strategies that are primordial ingredient to obtain a good
answer. After 3 days of nursing care given based on Ramona Mercer’s Maternal Role Attainment, we have come to know and delved into the patients profile for assessment. We have come to
conclude that information and health teachings rendered to the patient was very helpful in assisting in attaining her new role as a mother. The following necessary health teachings given were the
following: the basics of newborn care, the importance and benefits of breastfeeding, developmental milestones, and other health teachings that would promote her well being and would eventually
return the patient to her optimal level of functioning. The health teachings done proved to be beneficial because it was practiced not only by the patient but also by the other significant others of the
baby.
Recommendations
The researchers would like to recommend this case study to the following:
a.) For the family, significant others, the primary care giver of the client should be present upon admission to provide accurate history of the complaints which serves as basis for the
medical staff to afford appropriate diagnosis, care and nursing management.
b.) For the entire health care team that they should learn to establish rapport with the client to obtain trust and cooperation. Consistency and reliability should be observed especially in
taking the history and assessment since the physicians are relying on their data, thus history and assessment is vital in determining the grade of severity of one’s sickness. They
should also establish rapport with the family, attend to the needs of the client and respond to the complaints of the client to provide comfort and relief. They should also be aware
of their client’s health status to know the suitable management and care
c.) For the members of the faculty, that they will continue to inspire, be a good example and guide the students in being assertive and comprehensive in taking history and assessment
to gather consistent and reliable data from varied sources.
d.) For the student nurses, that they will establish rapport with the client and family to create trust and teamwork. They should learn to accept client’s despite of their status and render
genuine care and treat them holistically. Being firm and confident in dealing with clients is needed for the students to become steadfast and develops the students’ attitude, skills
and learns to be responsible. And lastly, to become efficient nurses in the future, they must gain knowledge of resourcefulness and sincerity.
e.) For the future researchers, that they will dig deeper on the aspects that needs to be explained and improved further.
f.) From our learning’s with the study we recommend to mothers the importance of prenatal care. This is to help in the pregnancy in detecting any problems early on and to assure the

12. health of the fetus inside the womb. Moreover, we also emphasized on the right information and health teachings to be given to the mother to decrease anxiety and guide them in
taking care of their baby’s optimal forming years.
g.) For future students, we recommend applying other nursing theories aside from the Maternal Role Attainment, and be able to integrate it as well that can be applied to the patient.
Learning Insights
 To have a good output for a CAR presentation a student must do his /her own initiative to accomplish the work properly
 It is also important to build good relationship to your patient so that they will trust you also
 Learn to work with your health team so that their will be equal opportunity for learning.
 Be open minded for every suggestions or comment about your work.
Bibliography
Fundamentals of Nursing 5th
edition by Potter and Perry:
Lippincott Manual of Nursing Practice 8th
Medical Surgical Nursing by Joyce Black.6th
ed.
Maternal and Child Health Nursing Care of the childbearing and child rearing family, 5th
edition by Pillitteri
The Merck Manual of Medical Info, 2nd
edition
Maternal and Child Heath Nursing by Adele Pillitteri, 4th
Ed
Pathophysiology Concepts of Altered Health States by Carol Mattson Porth
Medical-Surgical Nursing 6th
ed. Brunner and Suddarth’s
Pediatric Nursing 2002 by Nicki L. Potts and Barbara L. Mandleco
Nursing Care Plans, 7th
ed. Mosby
Fundamental of Nursing by Kozier, 7th
ed
Essentials of Pediatric Nursing by Whaley and Wong, 2nd
Ed
Berhman and Kleigman, Nelson textbook of Pediatrics 17th Ed.

13. Joyce Black, Medical Surgical Nursing 7th Edition
http://ncr.umh.es/bibliography/hydrocephalus/
http://www.choa.org/default.aspx
http://www.ucsf.edu/nreview/11-Pediatrics/Hydrocephalus.html
DISCHARGE PLAN order by Dr. Libre 03/06/2008
HEALTH TEACHING:
• Encourage to increase oral fluids and monitor input and output.
• Advised to avoid smoking and drinking alcohol because these may alter the drug effect.
• Encourage to have regular exercise.
• Encourage to continue breastfeeding.
• Encourage to have frequent hand washing before and after using the toilet and before eating.
• Advised to report any signs of infection such as redness, pain, swelling, and presence of unusual discharges.
• Advised patient to always keep self-healthy by proper hygiene.
• Encouraged to always have adequate rest and sleep periods to prevent fatigue.
• Suggested measures to prevent injuries. (Avoid sharps, corners, and etc.)
ANTICIPATORY GUIDANCE:
• Advised to report to the physician when the ff. occurs: discharges from the incision site, signs of hemorrhage, fever, swelling, signs of infection and distress.
• Reminded to have a follow up check-up at OPD 1 week after discharge (March 14, 2008) in the morning.
SPIRITUALITY:
• Encouraged to continue to trust in the Lord.
• Encouraged to continue praying and asking guidance from the Lord.
• Encouraged to continue attending mass with family on Sundays.
MEDICATIONS:
• Advised SO to give to patient the prescribed medicine and doses to prevent further complications.
• Advised SO not to give any medicines to patient not prescribed by the doctor.
MOTHER

14. 1. Co-amoxiclav (Augmen) 625 mg 1 cap every 12hrs PO x 5 more days
2. Ferrous sulfate (United Home) 1 tab Bid POPC x 1-2 months
3. Senna Concentrate (senokot Forte) 1 tab every every HS x 5 more days
4. Methylgonorvine malaete (Methergin) 125mg 1 tab every 8 hours PO x 2 more dose
BABY
1. Ampicillin (Pentrexyl)125mg IVTT every 12 hrs x 10 doses
2. Amikacin (Amikin) 30mg IVTT every 24hrs x 5 doses
INCISION OF CARE:
• Advised patient to always observe frequent hand washing before and after touching the affected area.
• Encouraged to do daily self-perineal care at home.
• Encouraged to do Perineal Care twice a day
NUTRITION:
• Advised SO to always give to patient foods that are rich in nutrition such as vegetables and fruits.
• Advised SO to increase patient oral fluids intake at least 8 glasses per day.
• Encouraged to include foods rich in protein such as: meat, egg, fish and chicken to promote wound healing.
• Encouraged to eat green leafy vegetables such as “Kamungay”, “ Kangkong” and “petchay”.
• Encouraged to eat high calorie or carbohydrate foods such as rice, bread, and root crops to provide adequate energy and to improve nutrition.
ENVIRONMENT:
• Encouraged to keep environment clean and free from all sorts of microorganisms and pollution.
• Encouraged to stay in a quiet place in order to get enough rest and sleep.
• Instructed to have regular cleaning of environment.
• Advised SO to keep those things that are sharp to avoid accident to patient.
• Advised SO to always arrange things on the house to avoid accident to patient.
• Advised to avoid possibly sick people to prevent infection.
DRUG STUDY
MEDICATIONS:
1. amikacin(Amikin) 30 mg IVTT every 24hrs x 5 doses
Classifications: Anti-infectives
Indications: treatment of serious gram negative bacillary infections and infections due to staphylococci when penicillins or other less toxic drugs are contraindicated.
Actions: Inhibits protein synthesis in bacteria, Bactericidal in action.

15. Adverse reactions and side effects: nephrotoxicity, local stinging, burning
Contraindication: Hypersensitivity to the drug.
Nursing Considerations:
1. Assess for infection (vital signs), monitor intake and output
2. Report for any adverse effects of the drug.
3. Take patient drug history.
4. Take medication as prescribed.
5. Take medication until feeling better.
2. Senna Concentrate (Senokot Forte) 1 tab every HS x 5 more days
Classification: Stimulants
Indication: treatment of constipation, particularly with in associated with slow transmit time, constipating drugs, irritable or plastic bowel syndrome, neurologic constipation.
Actions: Laxative action. Alter water and electrolyte transport in the large intestine , resulting in accumulation of water and increased peristalsis.
Adverse reactions and side effects: diarrhea, cramping, nausea, pink red or blown black discoloration of urine.
Contraindication: Hypersensitivity to the medicine, abdominal pain of unknown cause especially associated with fever.
Nursing Considerations:
1. Assess patient for abdominal distention, presence of bowel sounds.
2. Report for any adverse effects of the medicines.
3. Apply medicine until feeling better.
3.Ferrous Sulfate ( United Home ) 1 tab BID OD POPC x 1-2 months
Classification: Antianemics
Indication: treatment of megaloblastic and macrocytic anemias
Actions: Restoration and maintenance of normal hematopoiesis, protein synthesis and red blood cell formation
Adverse reactions and side effects: constipation, black tarry stool, methergine
Contraindication: Hypersensitivity to the medicine, abdominal pain of unknown cause especially associated with fever.
Nursing Considerations:
1. Informed patient patient that black tarry stool is normal when taking Iron supplements.
2. Advised patient to take Iron supplements with citrus juice for best absorption in acidic solution.
3. Advised patient to use a straw to avoid staining of teeth.