Davao Doctors College, Inc.

College of Allied Health Sciences

Nursing Program

NRG203: CARE OF MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS),

INTRAPARTUM PERIOD

Getting to Know the Course Instructor

Hello! I am Mae E. Gonzales, and I will be your
instructor for NRG 203: CARE OF MOTHER,
CHILD, AND ADOLESCENT (WELL CLIENTS),
INTRAPARTUM PERIOD.

For this semester, I will be your instructor for

NRG203: CARE OF MOTHER, CHILD, AND
ADOLESCENT (WELL CLIENTS), INTRAPARTUM
PERIOD. I am looking forward to guiding you in
learning this course well. If you want to reach me for
any academic-related concerns, you can reach me
through the following:

Contact No:
Facebook account:
E-mail address: maegonzales@davaodoctors.edu.ph
Consultation hours: MONDAY0700-1300H

Introduction to the Course

The course NRG203: CARE OF MOTHER, CHILD, AND ADOLESCENT (WELL
CLIENTS), INTRAPARTUM PERIOD deals with concepts, principles, theories,s, and techniques in
the nursing care of individuals and families during childbearing years toward health promotion, disease
prevention, restoration, and maintenance and rehabilitation. The learners are expected to provide safe,
appropriate, and holistic nursing care to clients utilizing the nursing process. Presented below are the
specific details of this course:

Course Number: NRG 203

Course Credits 9 units (4 units lecture; 5 units RLE)

No of Hours (Lab):

Placement: Second year, First Semester

NRG 105 Health Assessment

Prerequisite:
NRG 106 Fundamentals in Nursing
Schedule: MTW / THFS 7:00AM – 1:00PM / 1:00PM – 7:00PM

Classroom: Google Classroom/ Class Code

Requirements in Completing the RLE Activities

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Since most of our sessions for this semester will be delivered through distance/blended
learning activities, the submissions will also be done online. To do this, you need to have
access to the following applications:

1. Microsoft Office/Google Docs

2. Google Classroom
3. Google Meet
4. Internet connectivity

Access to a printer and/or scanner is also a plus, but not a requirement.

Daily Activities
Every week, you are expected to follow through with the following deliverables:

Day 1-Monday / Thursday Day 2-Tuesday / Friday Day 3-Wednesday / Saturday

Sept. 12, 2022 Sept. 13, 2022 Sept. 14, 2022
Virtual Circle(Type your Virtual Circle(Prayer: xxxxx; Virtual Circle(Prayer: xxxxx;
name in our Group Chat on Mission/Vision: xxxxxx; Mission/Vision: xxxxxx; DDC
or before 0700H. This will DDC Hymn: xxxxxx) Hymn: xxxxxx)
serve as your attendance)
Receiving of Handover Case Presentation (cont.)
Completion of Module, to be
submitted within the day Case Presentation Weekly Quiz and Discussion
of Module and Quiz Answers
Preparation of PPT
Presentation Orientation of Next Week’s
Activity

Now that you are done acquainting yourself with the instructor and the course itself, please
proceed to Module 2: INTRAPARTUM PERIOD
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MODULE 4:
CARE OF WELL MOTHER AND FETUS;
INTRAPARTUM PERIOD

Term: Third Term, First Semester S.Y. 2022-2023

Dates: Week
Class Schedule: MTW / THFS7:00AM – 1:00PM / 1:00PM – 7:00PM
No. of Hours: 6 hrs./ meeting

Instructions
Print this worksheet to answer or write your answers on clean white bond paper. Answers
must be handwritten. Do not forget to write your name, year level, and section, and
course name on the upper part of all your submissions. Observe pagination. Once done,
take clear pictures of your written outputs, compile them (in WORD or PDF), and send the
compilation to your instructor.

Learning Outcomes
At the end of this module, you are expected to:
1. Utilize the nursing process in the care of the well mother and fetus during the
intrapartum period.
2. Perform a holistic health assessment based on the case scenario presented.
3. Utilize assessment information to formulate a patient-centered plan of care.
4. Explain appropriate nursing interventions per problems identified.
5. Apply bioethical concepts/principles, core values, and nursing standards in the care
of clients.
6. Document the care rendered to the assigned patient in the simulated health care
record accurately.

As you start with this module, you are free to consult and coordinate with your assigned
clinical instructor. Be sure to get his/her email address and contact number for collaboration
and assistance. Just keep going, you can do it!
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STEPPING IN

Hello, future nurse!😊

Welcome to your second module. You had your discussion on Stages of Labor and
Mechanism of Labor from your concepts in Maternal and Child Nursing, and to nursing,
procedures addressing care of the mother during the intrapartum period. And just recently,
you started knowing the physiology, diagnostics, medical and nursing management of these
patients with these concerns. Let us have a review of these concepts and see how much
you recall.

A. Review of fetal presentation and the cardinal sign of labor:

I. Identify the Fetal Presentation

A. Right occiput anterior B. Left occiput anterior C. Right occiput transverse D. Left occiput transverse

E. Left occiput posterior F.Right occiput posterior G. Right mentum anterior H. Right mentum posterior
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I. Left mentum anterior J. Left sacrum anterior K.Left sacrum posterior

II. Identify the Cardinal Sign of Labor

1. Engagement

2. Decent

3. Flexion

4. Internal Rotation

5. Extension
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6. External Rotation

7. Expulsion

III. Enumerate the following and give brief description/discussion.

a. What are the pelvic types?

1. Gynecoid- This is the most common type of pelvis in
females and is generally considered to be the typical female
pelvis. Its overall shape is round, shallow, and open.
2. Platypelloid- The platypelloid pelvis is also called a flat
pelvis. This is the least common type. It’s wide but
shallow, and it resembles an egg or oval lying on its side.
3. Android- This type of pelvis bears more resemblance to
the male pelvis. It’s narrower than the gynecoid pelvis and
is shaped more like a heart or a wedge.
4. Anthropoid- An anthropoid pelvis is narrow and deep.
Its shape is similar to an upright egg or oval.

b. What are the signs of True Labor?

1. Regular uterine contraction
2. Dilation of cervix
3. Membrane Rupture
c. What are the types of placenta?
1. Schultze- “shiny” side-
This is the “shiny” side from the side of the baby…remember shiny and new which is the baby…this
part comes out first.

2. Duncan- “dirty” side-

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This side is “dull”, red, and rough and is the side from the mother. Also, try to remember the mother
is dirty from labor and is in rough condition, so it is the maternal side

II. Trace the Phases of Uterine Contractions

I.

The interval and duration of uterine contractions.

The frequency of contractions is the time from the beginning of one contraction to the beginning of the next contraction. It consists of t
the duration of the contraction and (b) the period of relaxation.
The broken line indicates an indeterminate period because the relaxation time (b)
is usually of longer duration than the actual contraction (a).

III. Draw and Label the Station of Labor

IV.CONCEPT MAP OF WELL MOTHER AND FETUS DURING INTRAPARTAL PERIOD

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Instruction: Trace the Stages of Labor and indicate the nursing management during
these periods to achieve the optimum well-being of the fetus and the mother.
Follow the diagram below:
 Signs of Labor
Analyn  Labor Progress
 Frequency of
Contractions
Diagnostic Tool (Indicate the
diagnostic tool to identify these
signs

Stages of Labor

1st Stage Maternal and Fetal Management

Responses to Labor
(Alongside the s/sx. state
the management,
medical first, then
nursing management,
that will be performed
vis-a-vis the identified
2nd Stage s/sx)

3rd Stage

4th Stage

You are now ready to meet your patient for thisCare of Mother
clinical and Baby
experience.
(Post Natal Care)
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DEEP DIVE
A Case Study on the Mother and
Child (Well Client);

INTRAPARTAL STAGE

Labor Case Scenario:

You are the staff nurse working in labor and delivery at a nearby local hospital. Analyn, 29
years old, 39 weeks AOG, gravid for the second time, comes to the admitting unit having
contractions and feeling somewhat uncomfortable.

On admission, she appears restless, has a dry mouth, and has a heartbeat of 101 beats per
minute.(NORMAL RANGE: 60-100BPM) You take the assessment and assisted her to change
her street clothes into a patient’s gown and ask her questions to determine your next
action. Upon seeing the facial expression noted on her face and the initial assessment
made, you then inform Dr. Ong the Obstetrics about Analyn’s status. Dr. Ong then informed
Analyn that she needs to check and will do an internal examination to verify the true signs
of labor. The OB then ordered to prepare the patient for vaginal examination. The staff
assigned prepared the patient first by telling her to empty her bladder first before the start
of the procedure.

A few minutes later, prepping, and perineal flushing was done for the physician to initiate
the internal examination. The physician stated that Analyn is 80% effaced and 5 cm dilated,
with an intact bulging bag of water. The patient has regular contractions 4 to 5 minutes
apart and lasting 40 seconds.

While the patient was being transferred to the labor area for contraction and FHT
monitoring, the staff nurse safely secures the patient on her bed and instructed the patient
that she will be attached to an Electronic Fetal machine (EFM) to determine the
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contractions, fetal heart tone, and fetal movement. Making ready for the EFM attachment,
the nurse begins to do Leopold’s maneuver to identify the fetal presentation and position
and to locate the fetal back for placement of the diaphragm of the stethoscope.

The fetal heart tone (FHT) ranges from 133 to 155 beats/minute. An hour had passed, the
patient called the attention of the nurse, stating “naaynigawasmuragtubig, perodili ko
sigurado kung ihiba to”. The nurse then inspects the perineum to determine to what
extent the process takes place, and at the same time assures that fetal structure was not
yet seen in the vaginal opening. A few minutes later, Dr. Ong had her IE again to confirm
that the bag of water has ruptured, which reveals a light yellowish color with little white
specks on it. And has a relevant change with the cervical dilatation to 8cms now, with a
thinner lining of the cervix. While transferring the patient to the delivery table, Analyn is
having frequent, strong palpation contractions that are extremely uncomfortable. She is
trembling, complaining of nausea and an uncontrollable urge to push. A few minutes later
she went in normal labor and delivered a healthy single baby boy with an 8 Apgar score at
birth and 9 Apgar score at 5 min. She sustained a second-degree perineal laceration which
was repaired, and sutures were applied. Oxytocin (Pitocin) 10 IU 1 ampoule incorporated to
present IVF of D5LR@1L and regulated at 120 mL/hr.

Past Medical History:

 Her family history revealed no here do-familial diseases for both of her parents. No
other reported diseases except for allergies to shrimps and chicken. Levocetirizine
dihydrochloride (Allerzet) 5mg OD 1 tab at HS PRNas ordered for her allergy.  She
reported that she was able to complete the two doses of her immunization given at
their health care center

Prenatal Care:
1st trimester: had a regular prenatal check-up every month.
2nd trimester: Quickening was felt on 18 weeks AOG and continued to perceive fetal
movements. 2 doses of tetanus toxoid were administered. An anomaly scan was done at 12
weeks AOG. No history of pedal edema, epigastric pain, blurring of vision and headache, No
leaking or bleeding per vagina.
3rd trimester: She continued to perceive fetal movements. Calcium and Ferrous sulfate
tablets were taken.

1
Obstetric History (Menstrual and Pregnancy Hx)
The patient had her menarche @ 12years of age.She had regular menstruation. She usually
changes her pads 3 to 4 times a day and is soaked in the first 2 days and moderate to light
flow in the succeeding days.
 Last menstrual period 39 weeks ago
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 Uncomplicated pregnancy to date, one prior full-term vaginal deliveries

 IBOW, no bleeding, painful contractions every 4-5 minutes
 No history of sexually transmitted infections
 No significant past medical or surgical history
 Allergic to shrimp and chicken

COMPREHENSIVE PHYSICAL ASSESSMENT:

 Vitals: blood pressure 90/60 mmHg, heart rate 101 bpm, respiratory rate 17 CPM,
temperature 37.6 C°
 FHT: 133 – 155 bpm
 IE upon admission: 80% effaced and 5 cm dilated
 Abdomen: term uterus, fundal height 39 cm, cephalic, otherwise soft, non-tender
 Hemoglobin 12.1 g/dL
 Blood type O+, antibody screen negative

Inspection:
The patient has a brown-colored complexion. The head is rounded, normocephalic, and
symmetrical. Pallor is noted. Neck veins are visible, and no enlargement is noted. The
pupils of the eyes are black and equal in size. The nose has no presence of discharge or
flaring, it is clear. The neck muscles are equal in size, with no palpable nodules. The Mask
of pregnancy is visible on the face. The abdomen is globular and a visible linea nigra and
stretch marks were noted. Breasts are symmetric, no dimpling and discoloration noted, and
nipples and areolas are dark in color. Thechest is symmetrical. She reported that once in a
while, difficulty of breathing is experienced especially when she is lying flat on the bed
during the night. Lower extremities have the presence of +1 edema. On musculoskeletal,
back pain was noted especially during uterine contractions. Extremities have a good range
of motion, sometimes felt leg pain due to prolonged standing at work and some varicosities
were noted. Palmar erythema noted. Capillary refill actively returns to its normal color in
less than 2 seconds.

She seldom eats the food being served. Does not eat a meal on time. Able to digest food
being served. She seldom eats green-leafy vegetables.

Auscultation
Lungs have normal breath sounds without dyspnea. Clear to auscultation in all lobes.
Cardiac rate of 101 beats per minute, no signs of crackles, wheezing, or stridor. The
abdomen has audible bowel sounds.

Routine lab
 HIV, hepatitis B, syphilis, chlamydia, gonorrhea, urine culture: Negative
 Blood type: O+
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 Rh status: Rh (D) Positive

 Complete blood count
 Glucose screening at 24-28 weeks: 100 mg/dl

IM x 1 dose
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Nursing Program

To immerse yourself in the care management of your patient, let us do some detailed
descriptions of your patient care tasks. Using the Case Scenario assigned to you, you are
expected to perform the following:

1. Fill up-up the needed data based on the given scenario/case. Note: Assessment
findings of all other areas must be filled up using fictional data BUT should be within
the scope of the case scenario given.
2. Conduct a history taking and physical assessment of your patient. Use BLUE
pen for normal findings and RED for abnormal findings under Review of Systems
(ROS).
3. Develop a Concept Map of your patient’s condition using the Concept Map Format.
4. Present your drug study.
DRUG STUDY ASSIGNMENT SN (STUDENT NURSE)
Allerzet
Oxytocin
Methergin
Folic Acid
Ferrous Sulfate
Vit D
Ca
Betamethasone (Celestone) 12mg IM injection
OD x 3 days
Aspirin 80 mg po OD
Progesterone (Endometrin) 1 vaginal suppository
OD

5. Prior to administering a patient’s medications, you are required to make a drug

study of all medications required by your patient in oral or parenteral form and
document it. Select one drug. No duplications of selected drugs for study should be
made.
6. Formulate a patient-centered care plan for your patient.NO DUPLICATIONS OF
NSG DIAGNOSIS. USE THE NANDA 2018-2020 AS REFERENCE. FDAR + Nurse’s
Notes should be done individually. Use the DDC Forms. Feel free to message your
CI for a copy of the forms.

7. Clinical Reasoning Questions - Collaboration:

You are taking care of a patient who has been in labor started around 8pm.
Handed over to you by the previous shift with cervix 1 cm, 25% efface, -3, BP
145/ 85 mmhg, HR 85 bpm, RR 20 breaths/min. At around 3am patient
complain of regular painful contractions, you noticed late deceleration on the
strips and FHR is decreasing.
S
Knowing that this is a fetal safety concern, how would you tell the admitting
Resident and Intern Doctor who are new to the service and are on call together
for the 1st time? Follow the CUS method.
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CUS method: CUS is a communication tool to give interprofessional team

members a constructive approach to openly discuss an identified safety
concern. (Please refer to the link provided for your guidance on how to do
CUS: https://youtu.be/4VFPfgbk0z8)

In a situation where a patient has serious urgent issues and if the nurse has been unable to get
a response for urgent review from a Doctor, the nurse might contact that Doctor again, or a
more senior Doctor and express their concern saying
“I am concerned, I’m uncomfortable watching these late decelerations, The baby’s heart rate is
dropping. I just don’t think it’s safe to continue labor.”
If the concerns raised are not addressed adequately, then it may be necessary to escalate them,
bypassing the person with whom the concerns were initially raised.

Referrence: Effective communication and teamwork promotes patient safety

Gluyas, Heather. Nursing Standard (2014+); London Vol. 29, Iss. 49,

8. Clinical Reasoning Questions - Ethico-Moral-Legal:

You were assisting in the delivery room for patient Kelly, a young woman giving
birth to her 1st baby and has no health issues. She had several pushes and the baby
started to crown.
A Doctor is sitting on a stool between Kelly’s legs. While She’s pushing the doctor
stands up and takes big sharp scissors and said to you “I think it’s time for
episiotomy now” Kelly cranes her head up and asks” What’s wrong Doctor?’
The doctor responded, “Listen, Kelly, you are pushing but your baby can’t come out
because there is too little space for him to come out”.
After these words, there is another contraction and you ask Kelly to give a push.
The Doctor takes a medical cloth and approaches her holding the scissors.
Kelly cries desperately “No Doctor, don’t cut me”.

What would be your nursing action in this situation? What ethical principle is applicable in
this scenario? Justify?
Autonomy: Recognizing the individual’s right to self-determination and decision-
making. (Rights to informed consent and refusal)
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In this scenario, the patient was not provided with the opportunity to be
consented. Patient cannot make decisions without information. It requires details
relevant to her decision-making process about whatever to assent to a procedure
or treatment. This includes also alternative options, treatment risks and success
rate. Consent is best obtained before they are in labor because they will be most
competent to make such decisions.

There are also exceptions to obtaining informed consent: Life-threatening

emergency situations, court ordered mandatory treatment, therapeutic privilege
and patient incompetence.

Childbirth Is Not an Emergency: Informed Consent in Labor and Delivery Article in

International Journal of Feminist Approaches to Bioethics · February 2018

DESTINATION CHECK

You are nearly done with your module! Before we end, let us check what you have learned
so far and touch on the topics which have been discussed earlier but may not have been
covered in the questions asked so far. [Answer in a separate sheet]

Normally labor begins when the fetus is sufficiently mature. The Intrapartum period is the
process by which the fetus and placenta are expelled from the uterus and the vagina to the
external environment. What have you learned during this process? Answer the following
questions:

1. What is the definition of the second stage of labor?

The second stage of labor starts when the patient’s cervix is fully dilated
and ends when the infant is completely delivered.
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2. What symptoms and signs indicate that the second stage of labor has begun?

One or more of the following may occur:

1. Uterine contractions increase in both frequency and duration, i.e.

they are more frequent and last longer.
2. The patient becomes restless.
3. Nausea and vomiting often occur.
4. The patient has an uncontrollable urge to bear down (push).
5. The perineum bulges during a contraction as it is stretched by the fetal head.
If the symptoms and signs suggest that the second stage of labour has
begun, an abdominal examination to assess the amount of head
palpable above the pelvic brim, followed by a vaginal examination,
must be done.

3. Is there a difference between primigravida and multigravida at the start of the second
stage of labor?

Yes. In primigravida the head is usually engaged when the cervix reaches
full dilatation. In contrast, multigravida often reach full cervical dilatation
when the fetal head is still 3/5 or more palpable above the pelvic brim (i.e.
the head is still not engaged).

A patient should only start bearing down when the fetal head distends the perineum and she has a
strong urge to bear down.
4. What is the definition of engagement of the fetal head?

The fetal head is engaged when the largest transverse diameter of the head (the
biparietal diameter) has passed through the pelvic inlet. When the fetal head is
engaged, 2/5 or less of the head is palpable above the pelvic brim.

The fetal head is engaged when only 2/5 or less of the head is palpable above the
brim of the pelvis.
Engagement usually starts before the onset of labour. Initially 5/5 of the
head is palpable above the pelvic brim, but when engagement has been
completed, the head is no longer palpable on abdominal examination.
Engagement of the head cannot be determined on vaginal examination.
5. list at least 7 preliminarysigns of labor.

1. lightening (baby drops, less pressure on diaphragm and more on bladder)

2. ncreased vaginal secretions

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3. slight weight loss

4. mucus plug, bloody show

5. thinning and softening of cervix

6. persistent backache

7. increased Braxton-Hicks

8. nesting
6. False vs True Labor: How to tell the difference?

False labor: Contractions don't come regularly and they don't get closer
together, they stop with walking or resting or with changes in position, they
are usually weak and don't get stronger, they start strong and get weaker,
and usually the pain is only felt in the front.

True labor: contractions come and get closer together over time, lasting
about 30-70 seconds each, they continue regardless of movement or
resting, ther progressively get stronger and they usually start in the back and
move in front.

Have you answered all of the questions above? Great! You are now ready for the
weekly quiz.

REFLECTION TIME

Reflection Time: Make a reading of a patient during labor and delivery. Please do not
forget the link of the article. Provide a 5-paragraph handwritten reflection. 1sT paragraph
will be the introduction of your article. 2nd paragraph will be your reflection as a Person,
3rd paragraph will be your reflection as a Student nurse. 4th paragraph will be your
reflection as a Future Health professional. Lastly the 5th paragraph will be your conclusion
about your reflections.
__________________________________________________________________________
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__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

Congratulations! You have completed this module. You may now proceed to the next
module. Please wait for further instructions from your instructor

References:
Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier &Erb’s fundamentals of nursing:
Concepts, process, and practice (10th ed.). Pearson Education, Inc.

Hinkle, J. & Cheever, K. (2018). Brunner and Suddarth’s textbook of medical-surgical

nursing (14th ed.). Wolters Kluwer

Marieb, E., & Keller, S. (2017). Essentials of human anatomy & physiology (12th ed.).
Retrieved from https://bok.asia/book/5010929/ac07d2

Quigley, B., Palm, M.L., & Bickley, L. (2012). Bates’ nursing guide to physical examination
and history taking (1st ed.). Wolters Kluwer Health
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Drug Study
 Use the DDC form for drug studies. Drugs will be assigned by the
clinical instructor according to the concept of the rotation
 Must contain the following:
o Generic Name
o Brand Name
o Classification
o Mode of Action
o Indications
o Contraindications
o Side Effects (organized per system; cephalocaudal)
o Adverse Effects (per system; cephalocaudal)
o Dosage
o Nursing considerations
o Reference(s) – Follow APA 7e format

Nursing Care Plan

For the NCP, please follow the DDC NCP template.

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