University of Cebu – Lapulapu and Mandaue

A.C. Cortes Avenue, Brgy. Looc, Mandaue City, Cebu

Course Title : Care of Mother and Child: Risk Client

Course Code : NCM 109
Credit Units :

Online Clinical Module

(Credit Contact Hours : 20 )

Module Title : Care of Clients with Postpartum Depression (PPD)

I. Legal Basis (CMO No. 4, S. 2020)

The emergence of the COVID – 19 pandemic brought unprecedented disruptions in the

lives of people all over the world. It came unexpectedly where no one was ready enough to
brace its impact to society.
With an increasing number of cases spreading to various territories and confirmed human-to-
human transmission, the World Health Organization (WHO) declared the outbreak as a Public
Health Emergency of International Concern (PHEIC) last January 30, 2020 (DOH, February 3,
2020).

The Philippines in particular, faced a critical situation due to the rise of said health crisis.
For higher education institutions, avoiding and limiting the risks of infection of the academic
community has become a primordial concern. Hence, with the implementation of community
quarantine, conduct of classes needed to be immediately suspended. The herculean challenge
team was how to continue teaching and learning beyond the usual face-to-face instruction.

Thus, it has become urgent need to explore other innovative learning modalities that
will facilitate migration from traditional to flexible teaching and learning options. As learners
are differently situated in terms of time, pace, and place, those options allow customization of
delivery modes responsive to students’ need for access to quality education. This shall also give
the students the option to choose the delivery mode most convenient to them as early as the
time of their enrollment.

II. Scope and Coverage

Applicable Program Outcomes of the BSN Curriculum with the corresponding

Course/Subject Outcomes and specific Learning Outcomes are herewith presented to provide
directions to student learning.
 A clinical scenario is supplied as source of case databases for the student to do the
health assessment and the phases of the nursing process, namely: Nursing Diagnosis
Outcomes/Objectives of Care, Nursing Interventions, and Evaluation of Care as the end of the
learning activity, the student is requested to respond to random questions requiring candied
answers aimed to assess his/her level of reflective learning.

Quick guides provided for students’ use in coming up with the module tasks together
with performance rubrics for assessment of outcomes.

Upon completing this online module, the student will earn 20 contact hours.

III. Program Outcomes:

1. Apply knowledge of physical, social, natural and health sciences, and humanities in the
practice of nursing.
2. Provide safe, appropriate, and holistic care to individuals, families, population group and
community utilizing the nursing process.
3. Practice nursing in accordance with existing laws, legal, ethical, and moral principles.
4. Communicate effectively in speaking, writing and presenting using culturally appropriate
language.
5. Document to include reporting up-to-date client care accurately and comprehensively.
6. Work effectively in collaboration with inter, intra, and multi-disciplinary and multi-cultural
teams.
7. Practice beginning management and leadership skills in the delivery of client care using a
systems approach.
8. Demonstrate responsible citizenship and pride of being a Filipino.
9. Apply techno-intelligent care systems and processes in health care delivery.
10. Adapt the nursing core values in the practice of the profession.

IV. Course/ Subject Outcomes:

1. Apply knowledge of physical, social, natural and health sciences and humanities in the
2. Provide safe, appropriate, and holistic care to mother, child, family, and population
group at risk or with problems utilizing the nursing process.
3. Report and document accurately and comprehensively the care provided to mother and
child at risk or with problems.
4. Demonstrate compassion, respect, empathy, and unconditional positive regard during
the care of mother and child at risk or with problems.

V. Learning Outcomes
Given a hypothetical care of a client with Post-Partum Depression, the BSN II student will:
1. Obtain comprehensive and relevant health assessment data.
2. Formulate patient problem-based nursing diagnosis considering his/her responses to actual or
potential health problem.
3. Formulate measurable, patient focused on long-term goals that are described from the patients
nursing diagnosis.
4. Select one or more nursing interventions to achieve each of the expected outcome identified for the
patient.
5. Assess the effectiveness of the care plan in terms of the patients’ progress against the projected
outcomes.
6. Formulate a comprehensive Nursing Care Plan that:
6.1 Utilizes nursing interventions based on social, natural, and health sciences and humanities
that are consistent with the Philippine Nursing Act and the Code of Ethics for Filipino Nurses.
6.2 Adheres to Filipino family and cultural values and respect for human dignity and worth.
6.3 Collaborates with other members of the health team in providing holistic patient care.

VI. Quick Guides, Worksheets, and Performance Assessment Rubric for Health Assessment, Nursing
Care Plan, Pharmacologic Nursing Care Plan, and Nursing Documentation. (Refer to subsequent
presentation)

VII. Reflections
Based on Gibbs’ model of reflection, please candidly answer the following questions:
1. Describe briefly your experience in doing this module.
- When doing this module my comprehensive and analytic skills were used in order to
fully understand the case and the problem involved. It would really used up your
cognitive skills to formulate a good nursing care plan that would suit the situation and
that could hopefully resolve the problem the patient is experiencing.
2. What were you thinking and feeling?
- While reading through the case I was thinking, that anything could happen to you even
if you were healthy before giving birth and during pregnancy. I feel a sense of pity to the
mothers out there who has the same problem with the patient in the case scenario.
3. What was good and bad about the experience?
- The good thing about these case scenarios is that it provides and reveals real case
scenarios that mothers and infants experience in the real world. Another good thing is
that it enhances our skills in making Nursing diagnosis and making NCPs. The bad thing
for me is that we cannot share our opinions animatedly in a real setting, watching our
reactions and expressions.
4. What sense can you make of the situation?
- I learned that in answering these case scenario, one must be familiar and
knowledgeable with the different types of nursing diagnosis in NANDA, could it be,
actual, risk, health promotion and syndrome diagnosis. One must also be familiar with
the normal physical assessment findings from the different systems of our body and one
must also be familiar the normal values in laboratory findings.
 5. What else could you have done?
- I could have work harder and discuss with my groupmates about the case, and share our
opinions and analysis about the case so we could have different conclusions and from these
conclusion we could have formulate the best nursing care plan that would help the client,
relieve from her health problems.
6. If it arose again, what would you do?
- I would encourage and push my self to work harder and learn from the corrections that was given to
us.
More importantly, I would not limit myself to explore all the possible nursing diagnosis and care plans
that would best suit and would be appropriate base on the given situation.

Clinical Case Scenario 1

Maya is a 32-year-old computer programmer who presents to the clinic with a four-week history of
irritable anxious mood, broken sleep, fatigue, crying episodes, poor concentration, headaches and
diminished appetite. She has been finding it increasingly difficult to cope with her emotional changes
and is presenting to the clinic requesting time off from work. During interview she was quite tearful and
felt she was a "failure as a mom." Her baby cried incessantly and she could barely get sleep. She
struggled with getting the baby to latch during nursing and didn’t want to have to give him formula.

There is no significant past medical history, she is unable to identify any acute stressors. There is no
misuse of alcohol, medication or illicit drugs.

She was mostly active, upbeat and cheerful during her pregnancy. She gave birth to a healthy 7.3-pound
baby boy. After the delivery, she started to feel sad, overwhelmed and consistently tearful. She
frequently felt irritable and on edge. This feeling persisted for the first 12 weeks after the baby was
born. She had limited support—her parents were divorced and her mother was living in another state
and helping her sister’s family as a full-time babysitter. Her in-laws were much older with numerous
health complications and couldn’t help regularly.

Maya felt utterly incapable of soothing her baby and would get frustrated and tearful. She was so afraid
of what she had learned about sudden infant death (SIDS), that she would barely allow herself to sleep.
She felt that it was a constant race against the clock—with nursing, pumping and changing. She was
always cleaning bottles and diapers. She felt horrified with how she looked. She had expected to wear
pre-pregnancy clothes immediately after childbirth. She hadn't had a meal in peace or gotten her hair or
nails done and couldn't even think about having sex with her husband. He tried to be supportive, but
also felt overwhelmed by it all. He felt she was inconsolable and they both felt at a loss.

She denies any suicidal ideation or symptoms of mania. She does express feelings of guilt, and fears that
she is jeopardizing the health of her baby. She is in a very stable relationship. She has a strong family
history of depression. Both her mother and sister have been treated with antidepressant therapy. Maya
herself has had one episode of depression in her early 20s, which was treated successfully with
antidepressants and supportive therapy
 Client Profile
Last Name: Lopez First Name: Maya
Gender: Female Age: 32 Ht: 5’2’’ Wt: 85 lbs

Spiritual Catholic Ethnicity: Filipino Language spoken: English, Tagalog

Practice:
A. History of Present Illness:

Maya Lopez, is a 32 years old, Filipino female, married and is 12 weeks post partum. She presents to o
the out-patient psych clinic due to 4 week history of irritable anxious mood, broken sleep, fatigue,
crying episodes, poor concentration, headaches and diminished appetite, and ineffective
coping.
Primary Medical Diagnosis: PPD or Postpartum Depression
Final Remarks: Post Natal Depression

B. Review of Systems

Normal Assessment Significant Findings

CNS  Discomfort and fatigue are Patient was irritable and anxious, experiences
common headache, has poor concentration and crying
 After pains and discomfort from episodes.
the delivery, lacerations,
episiotomy and muscle aches are
common
 Frontal and bilateral headaches
are common and are caused by
fluid shifts in the first two week
postpartum
 Non-rapid eye movement (REM)
sleep is absent after birth and
increases during the next 2 weeks.
 REM sleep decreases as non-REM
sleep increases.
Cardiovascular  Increase in stroke volume and
heart rate leading to a 60 to 80%
rise in cardiac output, which
rapidly declines to pre-labor
values in 1 to 2 hours following
delivery and to pre-pregnancy
values in two weeks postpartum.
 Progressive decrease in systemic
vascular resistance (SVR). SVR
decreases by 35 to 40% during
pregnancy and increases to pre-
pregnant levels in 2 weeks
postpartum. 
 There is also a decrease in
systemic blood pressure by 5 to
 10 mm Hg during pregnancy.
Diastolic blood pressure decreases
more than systolic blood
pressure. 

Pulmonary  Remain within the normal range

of 12- 20 breaths per minute
 Returns to normal by 6 to 8 weeks
postpartum
 Basal metabolic rate increases for
7 to 14 days postpartum,
secondary to mild anemia,
laceration, and psychological
changes.
Renal/ Hepatic  The bladder wall may become
edematous, hyperemic, and the
bladder might be overdistended
without the urge to pass urine.
 The retention of urine in the first
few days after labor may be due
to the laxity of the abdominal
musculature, tone of pelvic floor
muscles, atony of bladder,
compression of urethra by edema
or hematoma, reflex inhibition of
micturition due to genitourinary
trauma.
 Normal bowel function returns
approximately 2 to 3 days
postpartum.
 Liver function returns to normal
app 10 to 14 days postpartum.
 Gallbladder contractility increases
to normal, allowing for expulsion
of small gallstones
Gastrointestinal  The mother may develop Patient’s appetite deminished
flatulence or constipation due to
intestinal ileus (induced by pain or
presence of placental hormone
relaxin in the circulation), loss of
body fluids, laxity of abdominal
wall, and hemorrhoids.
 The postpartum constipation is
due to the progesterone-
induced decrease in
gastrointestinal transit time.
 After delivery, the levels of
progesterone and gastrin drop
within 24 hours, and the acid
reflux and associated symptoms
resolve in the next three to four
days.
 Endocrine  The level of human chorionic
gonadotropin that mimics
stimulating thyroid hormone falls
dramatically after delivery.
 Consequently, the thyroid gland
volume regresses to the pre-
pregnant state by 12 weeks, and
the thyroid function returns to
normal by four weeks
postpartum.
 The insulin sensitivity begins to
increase after delivery and
becomes restored within 2 to 3
days following delivery.
 However, in obese females,
postpartum normalization of
insulin sensitivity may take 15 to
16 weeks.
 Prolactin levels increase after
birth, oxytocin released from
posterior pituitary in response to
suckling infant, Estrogen and
Progesterone decrease markedly
with expulsion of the placenta.
Musculoskeletal  There is generalized physical Patient experiences fatigue
fatigue immediately after
delivery. 
 Decreased abdominal tone
 Diastasis recti heals and resolves
by the 4th to 6th week
postpartum. Until healing is
complete, abdominal exercises
are contraindicated.
integumentary  The nails undergo symmetrical,
uniform hyperpigmentation
during pregnancy that fades away
in the postpartum period.
 Striae lighten and melasma is
usually gone by 6 weeks
postpartum
 Hair loss can increase for the first
4 to 20 weeks postpartum and
regrowth will occur, although the
hair may not be as thick as it was
before pregnancy.

Baseline Laboratory:
Complete Blood Count
WBC count 9.0 × 109/L
RBC Count 4.5 ml/mm3
Hemoglobin level 14 g/dl
 Hematocrit 40 %
Platelet Count 170,000/mm3

Medications: Sertraline( Zoloft) 25 mg OD

Questions?
1. What are the risk factors for this patient developing PDD?
- The risk factors for patient Maya Lopez developing PPD are depression episode she
experienced during her early 20’s and strong family history of depression and anxiety,
stressful coping and thinking like when she felt utterly incapable of soothing her baby
and would get frustrated and tearful, she was so afraid of sudden infant death
syndrome (SIDS), that she would barely allow herself to sleep, lack of social/family
support due to divorced parents and mother living in a different state, She struggled
with getting the baby to latch during nursing and didn’t want to give him formula, and
low self-esteem as to why she verbalized that she was a “failure as a mom”, as well as,
feeling horrified with how she looked and had expected to wear pre-pregnancy clothes
immediately after childbirth, She also expressed feelings of guilt, and fears that she is
jeopardizing the health of her baby.
2. What is the primary screening tool for PPD? Explain how it is done.
- Post partum depression assessment or the Edinburgh Postnatal Depression Scale
(EPDS) test. The Edinburgh Postnatal Depression Scale (EPDS) is a set of 10
screening questions that can indicate whether a parent has symptoms that are
common in women with depression and anxiety during pregnancy and in the year
following the birth of a child. This is not intended to provide a diagnosis – only trained
health professionals should do this. It is strongly recommended that this set of
questions is completed with a health professional. To complete this set of questions,
the parent would select the number next to the response that comes closest to how
they have felt in the past seven days. The total score is calculated by adding the
numbers selected for each of the 10 items. If the parent’s score is 10 points or
above, they should speak to a health professional about those symptoms.
3. Aside from the routine bloodwork, the patient suspected of PPD is also ordered a thyroid
function test or thyroid panel? Why is this ordered?
- A thyroid panel can help diagnose and monitor the treatment of thyroid disorders. Thyroid
problems, can contribute to psychiatric disorders ranging from depression, anxiety and even
psychosis that’s why thyroid panel was ordered for the Maya, because they would check if she
has thyroid problems that contributes to her developing PDD.
4. Identify 5 Nursing Problems and prioritize them
Anxiety related to perceived death threat
Insomnia r/t interrupted sleeping pattern
Impaired mood regulation related to anxiety
Fatigue r/t sleep deprivation
Ineffective coping r/t Inadequate confidence in ability to deal with a situation
 5. Out of the 5 identified Nursing Problems, make a Nursing Care Plan which includes 3 top-priority
Nursing Diagnoses. Observe NCP Format

Cues/ Nursing Scientific basis Goals and Nursing Evaluation

Evidences Diagnosis Outcome Intervention
Criteria
identification
Subjective: Anxiety related Anxiety is a Patient will Monitor Patient
Patient to perceived physiological verbalize patient’s mood, verbalized
verbalizes fear death threat as state awareness of behavior, crying awareness of
for her baby evidenced by characterized feeling anxiety. episodes, anxiety.
when she fear of SIDS as by cognitive, concentration,
learned about verbalized by somatic, Patient will headache and Patient relaxed
the SIDS, the patient. emotional, and relax and appetite that and anxiety was
behavioral anxiety will be can point out to reduced to
components. reduced to a patient’s manageable
Objective: manageable anxiety. levels.
These
Irritable anxious level.
components
mood Encourage the Patient learned
combine to
Frustrated Patient will client to more about
create the
Restlessness learn about acknowledge SIDS.
feelings that we
SIDS. and express
typically
feelings. Patient has
recognize as
fear, Patient will acknowledged
acknowledge Provide comfort and expressed
apprehension,
and express measures (calm her feelings.
or worry.
feelings. or quiet
Anxiety is often environment, Patient
accompanied by Patient will be soft music, complied with
physical provided with warm bath, treatment plan.
sensations such comfort back rub,
as heart measures. Therapeutic
palpitations, Touch)
nausea, chest Patient will
pain, shortness identify coping Administer
of breath, skills that works medication
stomach aches, best for her prescribed by
or headache. situation. the doctor

6. Create a Drug Study for the Medication ordered

Gener Dose Indicatio Adverse side effects Nursing Rationale Client

ic/ strength n/ drug interaction responsibiliti teaching
Brand and mechani es
name formulati sm of
& on drug
classi action
ficatio
n
Generi Tablets Sertraline Monitor mood To assess for Instruct
c 25 mg OD is used to CV: Palpitations, chest changes and manic patient to:
name: 50mg treat pain, hypertension, behavior in behaviors,
sertrali 100mg depressio patient. suicidal Report
ne n, hypotension, edema, ideations, diarrhea,
hydroc Oral obsessive- syncope, and nausea,
hloride concentrati compulsiv patient’s
dyspepsia,
on e tachycardia. CNS: Agitati feelings.
disorder, insomnia,
Brand 20mg/dL Administer
on, insomnia, headache, drowsiness,
name: anxiety For client
right dose as dizziness, or
Zoloft disorders dizziness, somnolence, safety.
prescribed.
(including persistent
panic fatigue, ataxia, headache to
Drug Monitor the
disorder
class: incoordination, vertigo, signs and To measure physician
CNS and social how well
symptoms
agent; anxiety abnormal dreams, the patient’s Report signs
antide disorder), body is
aggressive behavior, of bleeding
pressa post- adapting to
traumatic
promptly to
nt delusions, the
stress physician
medication.
disorder hallucinations, Note for any when taking
(PTSD), adverse concomitant
emotional lability, To
and reactions
immediately
warfarin.
premenstr paranoia, suicidal
give
ual Do not
ideation, intervention
dysphoric breast feed
s
disorder depersonalization. while taking
(PMDD).
this drug
 Endocrine: Gynecomasti without
Sertraline
is known consulting
a, male sexual physician
as a
selective dysfunction. GI: Nausea,
serotonin
reuptake vomiting, diarrhea,
inhibitor constipation,
(SSRI). It
works by indigestion, anorexia,
helping to flatulence, abdominal
restore
the pain, dry mouth. 
balance of
a certain
natural Special
substance Senses: Exophthalmos,
(serotonin
 ) in
the brain.
blurred vision, dry eyes,
diplopia, photophobia,
tearing, conjunctivitis,
mydriasis. 

Skin: Rash, urticaria,
acne, alopecia. 

Respiratory: Rhinitis,
pharyngitis, cough,
dyspnea, bronchospasm

Body as a
Whole: Myalgia,
arthralgia, muscle
weakness. 

Metabolic: Hyponatremi
a in older adults.

7. Identify one of the treatment modalities for PPD. Describe and explain the rationale for this treatment.
- Interpersonal Psychotherapy is a time-limited, dynamically informed psychotherapy that aims to
alleviate patients’ symptoms and improve their interpersonal functioning. IPT for postpartum
women often includes specific ‘themes’ in the interpersonal problem areas. Interpersonal
disputes typically involve the woman's partner or immediate family. With partners, the dispute
nearly always involves a lack of instrumental support in childcare or a perceived lack of
emotional support. It should be made clear to the patient at the outset of treatment that IPT is a
way to assist patients in their own recovery and a method through which patients can be taught
skills that facilitate recovery and reduce the likelihood of relapse.