CALAMBA DOCTORS’ COLLEGE

Virborough Subdivision, Parian, Calamba City, Laguna

Case Study of Patient with Substance Abuse During Pregnancy

CASE INTRODUCTION (DIMAPILIS)

Case Scenario : Andrea Drew is an 18-year-old, G3P2, 36-week pregnant woman admitted to the
maternity service because of vaginal bleeding. She broke her leg in a fall last month so uses a wheelchair
for ambulation. She had two previous pregnancies. This preg­nancy was planned and wanted. Client
signed up for prenatal care at the hospital clinic but only kept two appointments.

OBJECTIVES
This case presentation aims to help students acquire related learning experience on various health
situations of Nursing Care of a Pregnant Family with special needs in online distance learning through
analysis of a given scenario.

Specific Objectives:
1. Identify the characteristics and the risks of pregnancy of a pregnant woman who has special needs
such as one who has been injured, an adolescent, a woman over age 40, one who is physically or
cognitively challenged, or a woman who is drug dependent.
2. Assess a woman with special needs during pregnancy.
3. Formulate nursing diagnoses related to pregnancy for a woman with special needs.
4. Identify expected outcomes for a pregnant woman with special needs.
5. Plan nursing care to address the special needs of women at the extremes of the childbearing
spectrum, have a physical or cognitive challenge, have been injured, or are substance dependent.
6. Implement nursing care for a woman with special needs such as encouraging her to remain
ambulatory during pregnancy.
7. Evaluate outcomes for effectiveness and achievement of care.

DEFINITION OF CASES
● Substance abuse
○ is defined as the inability to meet major role obligations, an increase in legal problems or
risk-taking behavior, or exposure to hazardous situations because of an addicting
substance.

● Substance dependent
 ○ A person is substance dependent when he or she has withdrawal symptoms following
discontinuation of the substance, combined with abandonment of important activities,
spending increased time in activities related to substance use, using substances for a
longer time than planned, or continued use despite worsening problems because of
substance use.
● Cocaine
○ is derived from Erythroxylum coca, a plant grown almost exclusively in South America.
When sniffed into the nose or smoked in a pipe, cocaine is absorbed across the mucous
membranes to affect the central nervous system.
● Alkaloidal cocaine (crack)
○ a concentrated mixture, produces an even more rapid and intense “high” when inhaled.
● Marijuana
○ is a green, brown, or gray mix of dried, crumbled parts from the marijuana plant. The
plant contains chemicals which act on your brain and can change your mood or
consciousness.

CURRENT TRENDS AND UPDATE RELATED TOPICS

● 31 January 2020 – WORLD HEALTH ORGANIZATION (WHO)

Title: Adolescent Pregnancy
● Approximately 12 million girls aged 15–19 years and at least 777,000 girls under 15 years give
birth each year in developing regions. At least 10 million unintended pregnancies occur each
year among adolescent girls aged 15–19 years in the developing world. Complications during
pregnancy and childbirth are the leading cause of death for 15–19-year-old girls globally. Of the
estimated 5.6 million abortions that occur each year among adolescent girls aged 15–19 years,
3.9 million are unsafe, contributing to maternal mortality, morbidity and lasting health problems.
Adolescent mothers (ages 10–19 years) face higher risks of eclampsia, puerperal endometritis,
and systemic infections than women aged 20 to 24 years, and babies of adolescent mothers face
higher risks of low birth weight, preterm delivery and severe neonatal conditions.

● Title: Evidence for the Effectiveness and Acceptability of e-SBI or e-SBIRT in the Management of
Alcohol and Illicit Substance Use in Pregnant and Postpartum Women
Source: Trecia A. Wouldes, Andi Crawford, Suzanne Stevens and Karolina Stasiak (Front.
Psychiatry, 05 May 2021)
● Cannabis is still considered illegal in most countries and worldwide, is the most commonly used
illicit substance in general and pregnant populations. In 2018, 192 million people used cannabis.
Regional trends in people aged 15–64 indicate high rates in West and Central Africa (12.4%),
North America (12.1%), Columbia (15.2%), and Oceania (10.8%). Approximately 13.1 million
people are cannabis-dependent globally (49). Males have a higher rate of cannabis dependence
(0.20–0.27%) than females (0.12–0.16%). However, women exhibit an accelerated progression to
a cannabis use disorder. A scoping review of cannabis use in high-income countries including the
United States (US), Australia, the United Kingdom, Canada, France, and the Netherlands found
the prevalence of prenatal cannabis use ranged from 0.24 to 22.6%.
● Prenatal cannabis users across studies appeared to be younger than 25 years of age, of low
parity, and single compared to non-users. Also, cannabis users were more likely to have a lower
income and be less well-educated. Consistent with the rise in the prevalence of cannabis use in
the general population, and regardless of legalization, the prevalence of prenatal cannabis use
appears to be rising during pregnancy.
Assessment (ENERA)
● Nursing Related Theory
Theory: Science of Unitary Human Beings
Theorist: Martha Rogers

The theory views nursing as both a science and art as it provides a way to view the
unitary human being, who is integral with the universe. the unitary human being and
his or her environment are one. Nursing focuses on people and the manifestations
that emerge from the mutual human-environmental field process.

Major concept of unitary Human Beings:

1. Human-unitary human beings
2. Health - An expression of the life process.
3. Nursing
4. Scope of Nursing
5. Environmental Field
6. Energy Field

Concept of Theory of Unitary Human Beings

Patient Andrea with a present chief complaint had a sharp pain in stomach for over
an hour. Paula has a history of chief concern and she was smoking crack when she felt
hard fundal pain followed by dark red vaginal bleeding. Her boyfriend immediately
transported her to hospital.

She was smoking crack when she felt hard fundal pain followed by dark red vaginal
bleeding - Health

Goal: To show how a person is achieving his or her maximum health potential. In this
situation, it expresses from greatest health to those incompatible with maintaining life
processes.

● Biographical Data
Name: Andrea Drew
Age: 18 years old
Gender: Female

● Reasons for Seeking Health Care

“I’ve had sharp pain in my stomach for over an hour.”

● History of Present Health Concern Using COLDSPA

Characteristics - hard fundal pain
 Onset - an hour ago
Location - fundal
Duration - not stated
Severity - followed by dark red vaginal bleeding
Pattern - not stated
Associated Factors - not stated

● Personal Health History

She had chickenpox at 6 years old and scarlet fever at 8 years old. She had viral
pneumonia treated on an ambulatory basis 2 years ago. She was “tripped” over a rug
1 month ago. She was seen in the ER for broken tibia.

● Family History
Maternal Grandmother has severe osteoporosis.

● Lifestyle and Health Practices

She smokes 1 pack of cigarettes daily, she had no alcohol since pregnancy began, she
admits using cocaine at least weekly and marijuana daily.

● Physical Exam Findings:

Review of System Finding and interpretation

Skin, hair, and nails: Edema present on face; otherwise negative

Head and neck negative

Ears, Eyes negative

Mouth, throat, nose, and sinuses negative

Thorax and lungs: faint systolic heart murmur heard at left sternal
border; heart rate 82bpm, clear to auscultation.

Breasts and regional lymphatic

Heart and neck vessels

Peripheral vascular

Abdomen Fundal height: 34cm and rigid; very tender to

touch; abdominal contractions present on external
monitor about every 6 minutes; fetus palpated to
 be in breech position at -1 station; no fetal heart
rate discernible by Doppler.

Female/Male genitalia

Anus, rectum, and prostate

Musculoskeletal

Neurologic

Coarse in the ward – In chronological order/Event timeline (DORIA)

a) Assessment
Subjective:
- Patient stated "I've sharp pain in my stomach for over an hour"
- Patient felt hard fundal pain followed by dark red vagina bleeding
Objective:
- patient admitted to the maternity service because of vaginal bleeding.
- She smokes 1 pack of cigarettes daily
- She admits to using cocaine at least weekly and marijuana daily.
- Client signed up for prenatal care at hospital clinic but only kept two
appointments
- Client drinks 1 cup of coffee for breakfast

b) Diagnostic/Laboratory
- BP: 160/100 mmHg
- abdominal contractions present on external monitor about every 6 minutes
- no fetal heart rate discernible by Doppler
- dark red blood observed flowing from cervix
- Hemoglobin: 9 g/dl

c) Medical/Surgical Intervention
1. Hard fundal pain
-Planning: After 10 hours of nursing intervention, the client will report a pain rating
score of 0 out of 10 on the pain rating scale.
Intervention:: Instruct client to lay on a left side-lying position.
-Rationale: Client’s position may aggravate pain felt. Positioning
properly may promote comfort and ensure good circulation
-Intervention: Teach relaxation techniques, such as deep breathing exercise,
meditation, and guided imagery.
-Rationale: These help client refocus, attention decreases muscle tension, reduces
 perception of discomfort
2. High blood pressure (160/100 mmHg)
-Planning: After 8 hours of nursing intervention, the patient will participate in
activities that reduce blood pressure or cardiac workload
-Intervention: Assess blood pressure and pulse every one (1) hour or as indicated.
-Rationale: Accurate measurement of blood pressure is essential for the early
detection of hypertensive disorders.
-Intervention: Encourage client to sleep at least 8 hours
-Rationale: Improves venous return, cardiac output, and renal-placental perfusion.
3. No fetal heart rate discernible by Doppler
-Intervention: schedule for a fetal ultrasound (sonogram)
-Rationale: to determine whether there is cause for concern through the use of
imaging
4. Dark red blood observed flowing from cervix
-Intervention: schedule for vaginal or pelvic examination, an ultrasound scan or
blood tests
-Rationale: to determine what is the cause of bleeding
5. Low hemoglobin level (9 g/dl)
-Intervention: assess iron and folate stores, and reticulocyte counts; complete
screening for hemolysis; provide dietary counseling and folic acid supplements; and
observe for signs of infection
-Rationale: Provide support and management for clients with hemoglobinopathies

d) Medications/Treatment
1. Administer low-dose aspirin as indicated.
-Rationale: When initiated before 16 weeks gestation, low-dose aspirin effectively
prevents preeclampsia, severe preeclampsia, preterm birth, and intrauterine growth
restriction in patients with high-risk pregnancies
2. Administer antihypertensive medications as ordered.
-Rationale: Antihypertensive drugs work directly on arterioles to promote relaxation
of cardiovascular smooth muscles and help increase blood supply to the cerebrum,
kidneys, uterus, and placenta.
3. Folic acid supplement
-Rationale: to reduce pain and prevent complications.

e) Referral
- Obstetrician
- Smoking cessation therapist
 a) Anatomy/Physiology of related case (GALUTAN)

ANATOMY AND PHYSIOLOGY

WHAT IS BLOOD?

· Blood is essential to life. Blood circulates through our body and delivers essential substances
like oxygen and nutrients to the body’s cells.

· It also transports metabolic waste products away from those same cells.

· It is conducted through blood vessels (arteries and veins)

· Blood is composed of 55% plasma and 45% “formed elements,” including red blood cells,
white blood cells, and platelets.

DESCRIPTION

· Blood is a fluid that is technically considered a connective tissue.

· It normally has a pH of about 7.4 and is slightly denser and more viscous than water.

· Albumin is the main protein found in plasma, and it functions to regulate the
colloidal osmotic pressure of blood.

· Blood appears red because of the high amount of hemoglobin, a molecule found
on RBCs.

· In oxygenated blood found in arterial circulation, hemoglobin-bound oxygen creates a

distinctive red color.

· Deoxygenated blood is a darker shade of red.

TWO MAJOR COMPONENTS OF BLOOD

PLASMA

· It, makes up more than half (about 55%) of its overall content. When separated from the
rest of the blood, plasma is a light-yellow liquid.

· Plasma carries water, salts and enzymes.

· The main role of plasma is to take nutrients, hormones, and proteins to the parts of the
body that need it.

· Blood plasma also carries all parts of the blood through your circulatory system.

BLOOD CELLS

RED BLOOD CELL

· Also called erythrocytes or RBCs

· Known for their bright red color, red cells are the most abundant cell in the blood,
accounting for about 40 to 45 percent of its volume.

· The shape of a red blood cell is a biconcave disk with a flattened center

· Production of red blood cells is controlled by erythropoietin

· no nucleus

· The red blood cell survives on average only 120 days.

· Red cells contain a special protein called hemoglobin

· The percentage of whole blood volume that is made up of red blood cells is called the
hematocrit

WHITE BLOOD CELLS

· Also called leukocytes

· White blood cells protect the body from infection.

· They are much fewer in number than red blood cells, accounting for about 1 percent of

your blood.
· The most common type of white blood cell is the neutrophil

· The other major type of white blood cell is a lymphocyte.

· 2 components: T lymphocytes and B lymphocytes

PLATELETS

· also called thrombocytes

· not cells

· Platelets help the blood clotting process (or coagulation)

· Fibrin also forms the initial scaffolding upon which new tissue forms, thus

promoting healing.

· A higher-than-normal number of platelets can cause unnecessary clotting

FUNCTIONS OF BLOOD

● -supplying oxygen to cells and tissues

● providing essential nutrients to cells, such as amino acids, fatty acids, and glucose

● removing waste materials, such as carbon dioxide, urea, and lactic acid

● protecting the body from diseases, infections, and foreign bodies through the action of

white blood cells

● regulating body temperature

VAGINA
· The vagina is a muscular canal that extends from the vulva to the neck of the uterus
(cervix).

DESCRIPTION

· A large study of women found that the average length of the vagina is 3.77 inches (9.6
centimeters), and the average vaginal opening is 1.14 inches (2.9 centimeters) in width.

· Imaging studies reveal that most vaginas are narrower toward the vaginal opening and
wider toward the cervix. This usually forms a “V” shape, although the width at the widest point
can vary. Their vagina can seem wider or looser following childbirth.

· It is located in front of the rectum and behind the bladder. The upper region of the vagina
connects to the cervix of the uterus. The vaginal channel is narrowest at the upper and lower
ends.

PURPOSES OF VAGINA

1. It's where penetration can occur during sexual intercourse.

2. It's the pathway (the birth canal) through which a baby leaves a woman's body during
childbirth.

3. It's the route through which menstrual blood leaves the body during periods.

PARTS OF VAGINA

VULVA

- the outside parts of the female reproductive system. It includes the mons, clitoris, labia,
hymen and the opening of the urethra

Ø Mons - the fatty pad of skin over the pubic bone

Ø Clitoris - a small, round knob of tissue located on the upper part of the vulva that
has thousands of nerve endings

Ø Labia - the folds of skin on each side of the vagina

Ø Hymen - a thin fold of skin that partly covers the opening of the vagina
VAGINA

- the inside passageway to the cervix and uterus. It receives the penis during sex and serves as
the birth canal during childbirth. It is where babies come out.

Ø Cervix - the organ that surrounds the opening from the vagina to the uterus

Ø Uterus (womb) - the hollow organ where a baby develops.

Ø Endometrium - the lining of the uterus.

Ø Ovaries - Eggs mature here and are released from these paired (2) organs. They
also produce female hormones.

Ø Fallopian tubes - Paired passageways for eggs to go from the ovaries to the uterus.

b. Integrated Pathophysiology

CAUSES OF VAGINAL BLEEDING IN PREGNANCY

· Bleeding in the first trimester happens in 15 to 25 in 100 pregnancies. Light bleeding or

spotting can occur 1 to 2 weeks after fertilization when the fertilized egg implants in the lining

of the uterus. The cervix may bleed more easily during pregnancy

· Problems that can cause bleeding in early pregnancy include infection, early pregnancy
loss, and ectopic.

Ø EARLY PREGNANCY LOSS

ü Loss of a pregnancy during the first 13 weeks of pregnancy

ü Bleeding and cramping are signs of early pregnancy loss.

ü If you have had an early pregnancy loss, some of the pregnancy tissue may be left in the

uterus.

Ø ECTOPIC PREGNANCY
ü An ectopic pregnancy occurs when the fertilized egg does not implant in the uterus but

instead implants somewhere else

ü Blood loss may cause weakness, fainting, pain, shock, or even death.

ü Sometimes vaginal bleeding is the only sign of an ectopic pregnancy. Other symptoms may

include abdominal, pelvic, or shoulder pain.

SEVERAL PROBLEMS WITH THE PLACENTA LATER IN PREGNANCY CAN CAUSE BLEEDING

ü Common problems that may cause light bleeding later in pregnancy include inflammation of
or growths on the cervix. Heavy bleeding is a more serious sign. Heavy bleeding may be caused
by a problem with the placenta, includes:

§ Placental abruption—In placental abruption, the placenta detaches

from the wall of the uterus before or during birth. The most common
signs and symptoms are vaginal bleeding and abdominal or back pain.
The fetus may not get enough oxygen, and the pregnant woman can lose
a large amount of blood.

§ Placenta previa—When the placenta lies low in the uterus, it may

partly or completely cover the cervix. This is called placenta previa. It may
cause vaginal bleeding. Some types of placenta previa resolve on their
own by 32 to 35 weeks of pregnancy. Labor and delivery then can happen
normally. If placenta previa does not resolve, you may need to have a
cesarean birth.

§ Placenta accreta—When the placenta (or part of the placenta) invades

and is inseparable from the uterine wall, it is called placenta accreta.
Placenta accreta can cause bleeding during the third trimester and severe
blood loss during delivery. If you have placenta accreta, you are at risk of
life-threatening blood loss during delivery. Hysterectomy often needs to
be done right after delivery to prevent life-threatening blood loss.
 b) Diagnostic and Laboratory Studies (DELFINADO)
● Result with interpretation (base on client condition)

Test Result Normal Range Interpretation

Hemoglobin 9 g/dl 11.5-13.0 g/dl - Pregnant women with

hemoglobin that has 8 - 10
g/dl are considered to
have a mild anemia.
Clients can have an
increased risk of a
low-birthweight baby.
Having a low hemoglobin
can increase the problem
of tissue perfusion in the
placenta.

Hematocrit 33.5% 36% to 48% - A lower than normal

hematocrit can indicate an
insufficient supply of
healthy red blood cells
(anemia)

Urinalysis Negative for glucose; Protein : Negative - Urinary tract infection

2+ for protein; Glucose : Negative can cause proteinuria
positive for blood Blood : Negative (protein leak into the
urine). While a small
amount is normal, a large
amount of protein in urine
may indicate kidney
disease. Blood in the sign
can also indicate urinary
tract infection.
 c) Drug Study

Drug Action Indication Contraindication Side Nursing

effect/Adverse considerations
reaction

Furosemide - Acts on the - Indicated for - Contraindicated ● headache - Observe 10 rights in

descending loop the treatment in patients ● vertigo giving medication
of henle in the of Edema on hypersensitive to ● dizziness - Test if the patient is
kidney: inhibiting congestive drug and those ● orthostatic allergic to the drug.
reabsorption of heart failure with anuria. hypotensio - To prevent nocturia,
electrolytes n give PO and IM
sodium and - Use cautiously ● abdominal preparations in the
chloride, causing in patients with discomfort morning. Give a
excretion of hepatic cirrhosis and pain second dose in the
sodium, calcium, and in those ● diarrhea early afternoon.
magnesium , allergic to - Monitor weight,
chloride water and sulfonamides. blood pressure, and
some potassium. Use during pulse rate routinely
pregnancy only if with long term use and
potential benefits during rapid
to the mother dieresis.Use can lead
clearly outweigh to profound water and
risks to the fetus. electrolyte depletion.
- If oliguria or azotemia
develops or increases,
drugs may need to be
stopped.
- Monitor fluid intake
and output and
electrolyte, BUN, and
carbon dioxide levels.
- Watch for signs of
hypokalemia, such as
muscle weakness and
cramps.
 Drug Action Indication Contraindication Side Nursing considerations
effect/Adverse
reaction

Tranexamic - Tranexamic acid - It is taken - Hypersensitivity. Side effects : Before:

Acid is a synthetic orally, Active ● Diarrhea - Check the doctor’s
derivative of the tranexamic acid Thromboembolic ● Nausea order before giving the
amino acid lysine is indicated for Disease ● Vomiting medication.
and binds the 5 the treatment (e.g.pulmonary ● Abdominal - Observe the 25 rights
lysine binding of hereditary embolism, DVT), Pain in drug administration.
sites on angioedema,cy history of venous ● Headache - Assess vital signs.
plasminogen. clic heavy or arterial ● Migraine - Assess for other
Tranexamic acid menstrual thrombosis ● Fatigue complications.
competitively and bleeding in (including retinal
reversibly inhibits premenopausal vein or artery During:
the activation of females, and occlusion),dissem Adverse reaction : - Monitor patient vital
plasminogen via other instances inated signs.
binding at several of significant intravascular Blood and
distinct sites, bleeding in the coagulation,fibrin lymphatic system After:
including four or context of olytic conditions disorders: Anemia - Inform the patient to
five low-affinity hyperfibrinolysi after inform the physician to
sites and one s consumption Musculoskeletal inform if severe side
high-affinity site, coagulopathy, and connective effects occur.
the latter of which history of tissue disorders: - Instruct the patient to
is involved in its convulsions. Musculoskeletal take the drug only as
binding to fibrin. Concomitant use pain, muscle prescribed. If a dose is
The binding of with hormonal cramps. missed, advise patient
plasminogen to contraceptives.Se not to double the next
fibrin induced vere renal Respiratory, one
fibrinolysis - by impairment. thoracic and
occupying the mediastinal
necessary binding disorders: Nasal
sites tranexamic and sinus
acid prevents this symptoms.
dissolution of
fibrin, thereby Potentially Fatal:
stabilizing the clot Severe
and preventing hypersensitivity
hemorrhage. reactions including
anaphylaxis
 Drug Action Indication Contraindication Side Nursing considerations
effect/Adverse
reaction

Maalox - Maalox is a balanced Symptomatic - High calcium ● loss of - Observe ’10 rights’ in
mixture of 2 antacids: relief of levels appetite drug administration to
Aluminum hydroxide hyperacidity (hypercalcemia) ● nausea/vo avoid medication
is a slow-acting -Stomach/intesti miting errors.
antacid and nal blockage ● unusual - Monitor and record
magnesium hydroxide - Kidney disease weight loss pain scales to serve as
is fast-acting. The 2 (e.g., kidney ● bone/musc baseline data and to
are frequently stones) le pain determine the
combined in antacid - Severe loss of ● mental/mo effectiveness of the
mixtures. Aluminum body water od changes drug.
hydroxide on its own (dehydration) (e.g., - Give the drug 20 min-
is astringent and may confusion) 1 hour after meal to
cause constipation. ● headache counteract the
This effect is balanced ● increased hydrochloric acid
by the effect of thirst/urina production by
magnesium hydroxide, tion neutralizing the acidity.
which, in common ● unusual - Administer with at
with other magnesium weakness/t least 8 ounces of water
salts, may cause iredness to enhance absorption
diarrhea. Aluminum - Monitor stool
Hydroxide dissolves in consistency to
acidic gastric
secretions releasing
anions that partially
neutralize
gastric hydrochloric
acid. Also elevates
gastric pH, inhibiting
the action of pepsin
(an effect important in
peptic ulcer disease).
 d) Discharge Planning/Health Teaching for Patient and Family (DESTAJO)
● Medication
Furosemide (Lasix)
● Belongs to a group of medicines called loop diuretics (also known as water pills).
Furosemide is given to help treat fluid retention (edema) and swelling that is caused by
congestive heart failure, liver disease, kidney disease, or other medical conditions.
Tranexamic acid
● Is a medication used to treat or prevent excessive blood loss from major trauma,
postpartum bleeding, surgery, tooth removal, nosebleeds, and heavy menstruation. It is
also used for hereditary angioedema. It is taken either orally or by injection into a vein.
Side effects are rare.
Maalox
● This medication is used to treat the symptoms of too much stomach acid such as
stomach upset, heartburn, and acid indigestion. It is also used to relieve symptoms of
extra gas such as belching, bloating, and feelings of pressure/discomfort in the
stomach/gut.

Gaviscon Advance

● Is suitable for pregnancy. It starts working in minutes and provides long-lasting

protection (up to 4 hours). It's the lowest in sodium of all our ranges and its
extra-strength formula helps you get on with your day.

Environmental management
● It is important to create an environment for you and your growing baby to be safe and
healthy. Exposure to toxic substances in the environment and working in unsafe areas
can affect the development of your baby and have life-long impacts on their health.
● Toxic substances in the environment like lead or solvents create health risks for your
developing baby. These and other toxic substances can occur at very high levels at your
place of work or at your home. Exposure to toxic chemicals can affect the development
of your baby's brain and have life-long impacts on their health.
● Cigarette smoking during pregnancy has been the leading environmental factor for
adverse pregnancy outcome. Maternal smoking during pregnancy has been associated
with low birth weight.

Treatment

● Monitor Bleeding
● Prevent Further Bleeding
 ● Get Help
● Rest until you feel better
● Take a warm bath
● Think about what you drink and eat: Drink plenty of fluids
● Think about how you move if you are having brief pains from stretching of the round
ligaments.
● Try gentle stretching.

Health Education

● Take up your prenatal check-up.

● Visit the clinic regularly throughout your pregnancy.
● Avoid smoking
● Avoid illegal drugs
● Avoid coffee

Activity and rest

● 8 hours of sleep
● Plenty of rest
● Avoid heavy activities
● Meditate

Exercise
● Stretching

Spiritual Care
● During pregnancy, women intensify their prayers to God for protection, safe delivery and
blessings. Some women panic at the mention of cesarean section for fear of death
during surgery and others who undergo cesarean section are stigmatized. Therefore,
pregnant women would explore all spiritual and traditional options to ensure that they
deliver spontaneously. Women commune with their God either individually or in a
group. The prayer offered by pregnant women increases their faith and hope in God and
it affords them the confidence of going through a safe delivery.

Emotional care

● Encourage and reassure her.

 ● Ask her what she needs from you.
● Show affection.
● Hold hands and give hugs.
● Talk about what role you want during labour and delivery. Most moms want their
partners to be there, but some may not. And some partners may feel anxious and not
want to be there. You can decide together what's best for both of you.
● Talk a lot with your partner about how you're both feeling. Share what you need, just as
she shares what she needs. For example, let her know if you want to go to all the doctor
visits.

Out-patient referral and follow-up appointments

● Regularly go to prenatal check up appointments.

Diet/Nutrition

● Minimize the salt intake, avoid adding extra salt in meals, and limit the intake of salty
foods such as papad, pickles, fried food, processed food, and dry fish. -Add
potassium-rich foods in your diet like bananas, greens, sweet potatoes etc., to lessen the
swelling.
● Eat foods that are high in iron and vitamin C. Foods high in iron include red meat,
shellfish, eggs, beans, and leafy green vegetables. Foods high in vitamin C include citrus
fruits, tomatoes, and broccoli.
Formulating Nursing Care Plan (CORONEJO)