CASE STUDY

IN
POLYHYDRAMNIOS
Submitted by:
Aliza Savarez
Ma. Loisa Faresa Lim
Peter Lagulos
Ma. Mil Pama
BSN 2A

NTRODUCTION

 Delivery Room Rotation, is all about the

goal of the student nurses to provide a
safe and supportive environment for the
mother and the baby during delivery.
Patient ML admitted
Onset of irreg. abdominal contractions
No pain, bloody and watery vaginal
discharges
37 weeks and 6 days
35 y.o
Edc : dec. 26, 14
polyhydramnios

We chose this client: ( reason )

Show the readers the process;
Causes;
Effects;
s/s;
Probable risk that might happen in
the later course
and for the readers to fully
understand and be reminded on one
of the complications, associated in
pregnancy.

 According to Carlo WA, Polyhydramnios,

Early in the second trimester;
the baby starts to swallow the fluid
and excrete urine which is swallowed
again
Cunningham FG,Polyhydramnios,
Complications are;
prolapsed of the umbilical cord,
increased incidence of malpresentations
increased incidence of postpartum
maternal hemorrhage.

 Gilbert WM stated:

A high-resolution ultrasound is
needed to check for abnormalities
amniocentesisto test for a genetic
defect and infections.
must have regularnon stress tests

 (Statistically,)According to Washingtons
State ,
conducted a population-based casecontrol study
This assess possible association of
maternal smoking with polyhydramnios
which is 70 % Result as of 2014
(Davis M, Am J
Public Health)

 Nationally, in Manila Philippines St.

Lukes Hospital
mild Polyhydramnios, 85 %;
And for the moderate Polyhydramnios is
17 %
( DOH 2013 )
Locally, in Davao city
Davao doctors Hospital
reach a 15% percent incidence rate of
pregnant women diagnosed with
Polyhydramnios.

 Nursing Education;
Enhance the:
reasoning skills as an act of
discovering new diseases and
complications.
NursingPractice;
Enhaced:
excellent communication skills for
counseling and educating clients

 Lastly,
In Nursing Research
Research is becoming more wider in
view;
In Complications of pregnancy
Share some points
On how to deal with complications in
pregnancy.

General Objectives:
At the end of this Case
Study, we the students of
BSN 2A group 3 will enhance
our knowledge, develop our
skills,
and
acquire
the
necessary attitude with the
care of our client.

Specific Objectives:
We would like to achieve the following:

Establish rapport to the patient during Initial

Assessment;
conduct an Interview;
gather pertinent datas of the patient;
describe what is delivery room rotation;
define polyhydramnious;
get the statistical data of polyhydramnious globally,
nationally and locally;
relate the case in the nursing education and
nursing implications;
get our clients demographic data;
obtain clients obstetric data;

calculate clients EDC;

recall the clients obstetric history;
search out the clients past health history;
dig up the clients past health history;
trace the hereditary diseases that are acquired by th
patient;
perform physical assessment;
monitor contractions and fetal heart tone
make a drug study on the clients ordered medicatio

 relate our case to the nursing theories

prioritize our nursing care plans;
formulate a related nursing diagnosis
from the patients health data and to
current problems patient is experiences
and to come out with different nursing
interventions effective for the patient and
to improve and progress on the most
possible time;
set realistic objectives of care
perform and implement the nursing
interventions
evaluate the nursing interventions that
have been done.

Demographic Data
Mirasol Libaton
35 years old
Poblacion Marasugusan Comval Province
Roman Catholic
Married
Self-employed in RTWs Clothing Line
August 27, 1979
Jerry Libaton
Self-employed in RTWs Clothing Line
20-25 thousand monthly
College Graduate in Commerce

Obstetric Data
Menarche: 13 years old
Coitarche: 20 years old
Sexual Partner: 1
LMP: March 19, 2014
EDC: December, 26, 2014
PMP: February 2014
AOG: 37 weeks and 6 days
Menstrual Cycle: regular 5 days*5 pads
Quickening 4 months
USD: May 25, 2014
Adjusted EDC: January 1, 2015
AOG: 37 weeks
G4 P3 A0
T3 P0 A0 L2

LMP calculations
LMP- March 19, 2014
3
19 2014
-3
+7
+1
0
26
2015
+12
-1
12 26 2014

PRESENT HEALTH
HISTORY

Diagnosed with UTI 3

months prior to
admission
Measles after 2 months
Irregular abdominal
contractions 2 days prior
to admission

PAST HEALTH HISTORY

11 years of age, surgery due
to strabismus or cross eyed
2 years ago. Cholecystectomy;
contraceptive pills without
approval,
fatty foods and,
eating peanuts.
asymptomatic
rupture of gallbladder through
USD

Family History

On the first generation, paternal side, both

grandparents were deceased already. Wherein,
paternal
grandfather
was
asthmatic
and
hypertensive. On its second generation, they are
all 7 in the siblings these are, Rosalinda the
eldest, followed by Rudy,then Sam which is
hypertensive, Estrella which is also hypertensive as
well, and then followed by Roland, Carla, and
lastly Ernes.
On the first generation, maternal side,
both grandparents were deceased already, wherein
only maternal Grandfather was ill because of
leukemia. On its second generation,maternal side,
they are all 5 in the siblings these are Ferdinand
the eldest, followed by Edwin, then Rosy, Felly,

Physical Assessment

General Survey

receive the patient sitting down on the bed

wearing her delivery room slippers,
delivery room gown
with an IVF of D5LR 1L @120cc/hr infused
Right metacarpal vein,
awake
and conscious,
and is experiencing labor pain.
Signs of distress present,
grimaced face
and was in labor breathing.
height of 52 inches
weight of 75.4 kg

 Temperature- 35.8 degree Celsius

Pulse rate -79 bpm
Cardiac rate- 81 bpm
Respiratory rate- 20 cpm
Blood pressure -100/ 70 mmhg

Head and Scalp

Oily hair
dandruff noted.
some tangled hair from the bottom
part
head is normocephalic,
there are no deformities of the head
noted.

Nails
Capillary Refill- blanch test- of 2
seconds (< 3 sec); may indicate
circulatory or respiratory problem.
nails are not properly trimmed
some dirt in each sides of it.
There are no clubbing of fingers

Skin
brown which is even to other parts of
the body,
There is an absence of lesions

Eyes
The conjunctiva is pink,.
Has a good vision of 20/20 ,
the eyelids are blinking normally .

Nose
Normal nasal congestion noted,
no signs of tenderness
and swelling

Ears
no discharges noted
no tenderness
pinna is level at the outer canthus of the
eye ,
no lesions noted.
some dirt at the back of the ear as
observed.
no Nasal painfulness/swelling/tenderness

Mouth and Teeth

cracked lips not noted,
moist lips noted.
There are Dental carries

Neck
There are no tenderness,
there are no any enlarged or painful
nodes.

Thorax
respiratory rate, it is 20 cpm
Pt. in labored breathing at the
time of contraction
clear breath sounds all
through lung fields.

Heart
cardiac rate in supine which
is 81 bpm.
heard the two basic normal
sounds which lub dub.

Breast
enlargement of the breast
wider and darker areola
Colostrum,
a thin watery fluid, can be expressed
from the nipple as verbalized by our
client.

Skin in the abdomen

Purple striae is present
linea nigra as inspected.
Fetal heart tone of 140 bpm

Back
a lumbar curve

Extremities
feet edema ;
both ankles and
Waddling walk is observed

Genitals
Small amount of Vaginal discharge
IE: 3cm dilatation
No lumps,
no rashes,
no tenderness noted.
Bloody smell
She can also feel that there is a
discharge coming out from her rectum
during contraction as verbalized.

Medical Management/ medical

orders
December 9,2014
-Fleet enema
December 9,2014
-D5LR 120cc/hr
December 10, 2014
-Multivitamins and ferrous sulfate

Generic name

Ferrous Sulfate

Classification

Antianemic Iron

Pregnancy

Category
OTC

Feosol, Fer-Gen-Sol, Fer-in-Sol, FeroSul

DOSAGE

Dose: 2-3mg/kg
Frequency: Once a day
Route: PO.

USES

Prophylaxis and treatment of iron deficiency and iron-deficiency anemias.

Dietary supplement for iron. Optimum therapeutic responses are usually noted within
2-4 weeks.

MOA

Ferrous Sulfate is an essential component in the formation of hemoglobin, myoglobin

and enzymes. It is necessary for effective erythropoiesis and transport or utilization
of oxygen.

CONTRAINDICATIO Hemosiderosis, hemochromatosis, peptic ulcer, regional enteritis, and ulcerative

NS

colitis.Hemolytic anemia, pyridoxine-responsive anemia, and cirrhosis of the liver. Uses in

those with normal iron balance.

prenatal multivitamin (pree-NATE-al muhl-tee-VYE-ta-min

Brand Name

Prenate AM and Vitafol-Ultra

Classification

A 22.1 Multivitamins with minerals

Dosage

One to two tablets daily.

Side Effect

Constipation; darkened or green stools; diarrhea; loss of appetite; nausea; stomach cramps, pain, or upset;
vomiting.

Adverse Effect

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth,
face, lips, or tongue); black, tarry stools; blood or streaks of blood in the stools; fever; severe or persistent
nausea, stomach pain, or vomiting; vomit that looks like blood or coffee grounds.

Mode of Action:

Prenatal multivitamin is a vitamin and other supplement combination. It works by providing vitamins and
minerals to the body to help meet nutritional requirements

Drug Interaction

Multivitamins can interact with certain medications, or affect how medications work in your body. Ask a doctor or
pharmacist if it is safe for you to use multivitamins if you are also using any of the following drugs:

tretinoin or isotretinoin;

an antacid;

an antibiotic;

a diuretic or "water pill";

heart or blood pressure medications;

a sulfa drug; or

NSAIDs (nonsteroidal anti-inflammatory drugs)--ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib,

diclofenac, indomethacin, meloxicam, and others.

Nursing Responsibility:

Do not take large doses of vitamins (megadoses

or megavitamin therapy) while you use prenatal
multivitamin unless your doctor tells you to.

Prenatal multivitamin may cause darkened or

green stools. This is normal and not a cause for
concern.

Prenatal multivitamin may interfere with certain

lab tests. Be sure the doctor and lab personnel
know

your

patient

are

taking

prenatal

multivitamin.

Tell the patient do not take an antacid within 2

hours of prenatal multivitamin.

Advices the patients do not take dairy products

with this drug. Dairy products may make this
drug not work as well.

Generic Name

Sodium Phosphate

Brand Name

Fleet Enema Extra

Classification

Laxative

DOSAGE

Adults: Enema/Enema Extra: 1 bottle (133mL or 230mL)/24 hrs.

Rectal route

MOA

Saline laxative; induces complete emptying of the left colon, usually within 1-5 min, without pain
or spasm.

Side Effects

Adverse
Effects

Abdominal or stomach pain

Bloating

Nausea

Vomiting

Hypersensitivity, Pruritus, Dehydration, Hyperphosphatemia, hypocalcemia, hypokalemia,

hypernatremia, metabolic acidosis

Drug

Do not coadminister with other sodium phosphate preparations. Electrolyte disturbances and

Interaction

hypovolemia from purgation may be exacerbated by concomitant use of diuretics, ACE

inhibitors, ARBs, NSAIDs, and lithium or other medications that may affect electrolyte levels.
May lower lithium levels, causing reduced effectiveness. Caution with medications that affect
renal perfusion/function or hydration status, or known to prolong the QT interval.

Generic Name

dextrose monohydrate

sodium chloride

sodium lactate

Brand Name

5% Dextrose in Lactated Ringer's

Classification

Hypertonic

Nonpyrogenic

Parenteral fluid

Electrolyte

Nutrient replenisher

D5LRs is supplied in single-dose 500 and 1000 mL flexible plastic containers.

1000 mL @ 30 gtts/min or as prescribed by the physician.

Hypertonic solutions are those that have an effective osmolarity greater than the body fluids.

DOSAGE
MOA

This pulls the fluid into the vascular by osmosis resulting in an increase vascular volume. It
raises intravascular osmotic pressure and provides fluid, electrolytes and calories for
Side Effects

energy.
ncreasedserumosmolality

Hypernatremia

Hypokalemia

Alteredthermoregulation

Pulmonaryedema

Cardiovascularoverload

Adverse Effects

Immune System Disorders: Hypersensitivity/infusion reactions, including

anaphylactic/anaphylactoid

reactions,

and

the

following

manifestations:

angioedema, chest pain, chest discomfort, bronchospasm, dyspnea, cough,

urticaria, rash, pruritus, erythema, nausea and pyrexia

Drug Interaction
Nursing Responsibility

Do not administer unless solution is clear and container is undamaged.

Caution must be exercised in the administration of parenteral fluids, especially

those

containing

sodium

ions

to

patients

receiving

corticosteroids

or

corticotrophin.

Solution containing acetate should be used with caution as excess administration

may result in metabolic alkalosis.

Solution containing dextrose should be used with caution in patients with known
subclinical or overt diabetes mellitus.

Discard unused portion.

In very low birth weight infants, excessive or rapid administration of dextrose

injection may result in increased serum osmolality and possible intracerebral
hemorrhage.

Properly label the IV Fluid

Observe aseptic technique when changing IV fluid

Date

Result

Rationale

October 10 2014

Bilateral cleft lip and

Defects caused by congenital infections result when a mother gets an

palate

infection before or during the pregnancy. Infections that can cause

Diagnostic Test

birth defectsinclude rubella (German measles),

cytomegalovirus (CMV), syphilis, toxoplasmosis, Venezuelan equine
encephalitis, parvovirus, and, rarely, chickenpox. If the mother is
infected during early pregnancy, rubella carries the highest risk for
birth defects.

October 20, 2014

Fetal 2Decho

done around 20 weeks provide general information on different parts

of the fetus including the head, chest, abdomen, and extremities. The
regular ultrasound checks the fetus' heart to make sure it has all four
chambers.

December 5,2014

Polyhydamios

a baby will have a medical problem or birth defect that causes him to
stop swallowing fluid while his kidneys continue to produce more. This
may include any condition that makes it hard for him to swallow, such
as pyloric stenosis, a cleft lip or palate, or some kind of blockage in
the gastrointestinal tract. Certain neurological problems, such as with
a neural tube defect or hydrocephaly, can keep the baby from
swallowing as well

Date Ordered

Medical Order

Rationale

December 9,2014

Fleet enema

A fleet enema is a saline-based enema, which pulls water from your

body, into the bowels, so that your stools are softened, making it easier
for you to have a bowel movement. People all over the world use fleet
enema as a measure for constipation. Since constipation is one of the
signs of pregnancy, many women check with their doctors if it is safe for
them to use a fleet enema during pregnancy.

December 9,2014

D5LR 120cc/hr

Lactated Ringer's maintains fluid volumes in balance between the space

Medical Orders

inside and outside the blood vessels. It contains electrolytes, substances

necessary for cell functioning, such as sodium, chloride, potassium and
calcium, but not in the same proportion as the human body. It is used
when intravascular volume is low or to maintain fluid volume during
surgery or labor. Dehydration, burns, gastrointestinal fluid loss and acute
blood loss may all dictate Lactated Ringer's administration to replace
large fluid losses quickly.

December 10, 2014

Multivitamins

Ferrous sulfate is given during pregnancy when the potential benefits

and ferrous

outweigh the potential risks also it is given on both anemic and non-

sulfate

anemic patient. Ferrous sulfate administration during lactation is

generally considered safe for the infant. Pregnancy multivitamins give
you 100 per cent of the recommended daily allowance of all the essential
vitamins and most minerals.

Diagnostic test
October 10 2014
- Bilateral cleft lip and palate
October 20, 2014
-Fetal 2Decho
December 5,2014
-Polyhydamios

Nursing Theories
1. Maternal Role Attainment Theory
Theorist: Ramona Mercer
head nurse in pediatric
staff nurse in intrapartum, postpartum
and newborn
experience in nursing care of mother
and infants

The Theory Contain 4 Stages of

Acquisition

Anticipatory Stage
Formal Stage
Informal Stage
Personal Stage
development of mother-child relationship

 Theorist : Virginia Henderson

First Lady of Nursing & First Truly
International Nurse
health as a quality of life

14 Basic needs of the theory

1.
2.
3.
4.
5.
6.
7.

Breathing Normally
Eating and drinking
Elimination of wastes
Moving and maintaining a desirable position
Sleeping and resting
Selecting suitable clothes
Maintaining normal body temperature by
adjusting clothing

8.Clean body and well groomed

9.Avoiding dangers and injuries
10. Communicating
11. Worshipping
12. Working for accomplishment
13. Planning or participating
14. Learning, discovering ,satisfying the
curiosity

Hendersons theory
Patient and Family as a single unit
support system (emotional needs)

THANKYO
U