A 26-year-old G6P6 Client

ANO1
Prof. Mary Ann Nery

Submitted by:
Alvarez, Joshua
Awayan, Karen
Corpuz, Donn Denrik
Santos, Christel Mae
Sayana, Krizzia Krizzel
Soriano, Randolph
Tatualla, Jospeh Bret

CHAPTER 1 - ASSESSMENT
A. Nursing Health History

Client Profile
I. General Information
Name:C. DC.
Hospital:Lying-in Ward, QuirinoMemorialMedicalCenter
Age: 26 years old
Birthdate:July 17, 1989
Birthplace:BacolodCity
Address:Batasan Hills, Quezon City
Occupation:Housewife
Religion:Roman Catholic
Educational Attainment: Grade 5
Spouses Name: J.DC.
Age: 22 years old
Occupation: sells bottle and metals
Name of child: G1
Age:9 years old
Educational Attainment: GRADE 3
Name of child: G2
Age: 7 years old
Educational Attainment: GRADE 1
Name of child: G3
Age:6years old
Educational Attainment: none
Name of child: G4
Age: 4 years old
Educational Attainment: none
Name of child:G5
Age: 1 years old
Educational Attainment: none
Name of child:G6
Age: 0 years old
Educational Attainment: none
II. Chief Complaint:
Labor Pain

III. OB HISTORY
CHILD
YEAR
G1

2001

MODE OF
DELIVERY
NSD

WHERE

SEX

OUTCOME

LI

(-)EMC

G2
2003
NSD
hilot
F
(-)EMC
G3
2004
NSD
hilot
M
(-)EMC
G4
2006
NSD
hilot
M
(-)EMC
G5
2009
NSD
hilot
F
(-)EMC
G6
2010
NSD
QMMC
M
(-)EMC
INDICATION:This table shows the OB history of the client, her children, year
of birth, mode of delivery, location of birth, sex and outcome of delivery
IV. Current Pregnancy
LMP: January 27, 2010
EDC: 39 4/7 weeks by LMP
Prenatal Course: According to her, she goes to the hospital once a month
during her pregnancy. She stated that she could not follow her scheduled
checkups because of her work.
October 31, 2010: admission to QuirinoMemorialMedicalCenter
V. Admitting Diagnosis

October 31, 2010

39 4/7 weeks AOG by LMP
Pregnancy uterine size:
OB Score: G6P5 (6005)

Physical Exam
BP: 100/80
general survey: conscious, coherent, ambulatory
Heart: AP, NRRR, (-)murmurs
Lungs: ECE, CBS
Extremities: (-)edema
Fundic height: 28 cm
FHT: 140/min location: UQ
Exam
Cervical dilatation 2-3 cm
Presentation: Cephalic in beginning labor
station -2
BOW: +

VI. Labor:
Time

BP

Fundic Height

Fetal Heart
Tone

Internal
Examination

4:25 pm

120/80

28

140s

2-3cm, 60%,
eff, ceph, -2,
(+) BOW

5 :00 pm

130s

6:00 pm

130s

3cm, 60% eff,

-2, (+) Bow

130s

3-4cm, 60%
eff, -2

9:00 pm

140s

3-4cm, -2

10:00 pm

150s

7:00 pm

100/70

8:00 pm

11:00 pm

100/60

140s

5cm, 60% eff,

-2, (+) BOW

12:00 am

140s

5-6cm, 60%
eff, -2, (+)
Bow

1:00 am

140s

2:00 am

100/80

6 cm, 65%
eff, -2, (-)
BOW,
irregular VC

3:00 am

100/80

7-8 cm, (-)

BOW

4:00 am

140 s

9 cm, (-) BOW

INDICATION: This table shows the information about the clients labor
process on her last delivery.
VI. Final Diagnosis
Operation ended:November 1, 2010 @ 4:20 AM
OB Score: G6P6 (6006)
39-40 weeks uterine pregnancy
Delivered spontaneously to a live boy at 4:09 AM

VII. Past Medical History

She stated that she had chickenpox, measles and German measles in
her childhood, though, the exact years of occurrence cannot be recalled. She

has complete immunizations. The client has no allergies. She has been
hospitalized for her past deliveries and has undergone a surgical operation
which is ligation on her last delivery.
VIII. Family Health History
Intis, C.

Intis, B.

Santos, V.

Santos, R.

78 years old,
M

75 years old, F

67 years old,
F

72 years old, M

COD: Tuberculosis

hypertension

COD:
Myocardial
infarction

Intis, A.

Intis, Roberto

50 years old, F

56 years old,
M

COD: Tricycle
accident

Santos C.

Santos, Ma.

Santos , F.

50 years old, F

46 years old.

48 years old, F.

hypertension

Stray bullet

LEGEND:
Married
Offspring

Intis N,

Intis, L.

Intis , H

M Male

24 years old,
M

22 years old,
M

23 years old

hypertension

Female

Deceased
Dela Cruz,
Cyrell

Dela Cruz,
Joel

26 years old,
F

22 years
old, M

COD Cause of Death

VIII. Social History

The client currently lives with her partner and her parents in Batasan,
Quezon City.She stated that she is happy about her pregnancy. According to
her, her family was very supportive to her. She stated that she has good
relationship with her family and neighbors. She is not a member on any
organizations on their community or church.

B. Physical Examination
*Physical Examination was done 3 days post partum

General Appearance
Patient C has a small body frame. She is 142 centimeters tall and
weighs 35 kilograms which indicates disproportion in her body built. She has
a weak appearance, slouched and bent posture, and shows signs of anxiety,
discomfort and distress upon movement, such as grimacing and guarding.
The patient is appropriately dressed with minor body odor but no breath odor.
Patient Cs responses are appropriate to situations. Her speech is
understandable and moderate in pace, she also exhibits association of
thoughts. Her thoughts have a logical sequence and sense of reality.
Mental Status
She has a well organization of her thoughts. She was pleasant and
cooperative during the assessment. The client made use of simple words
when answering upon assessment and interrogation. She has a well
organization of her speech.
Skin
Patient C has a dark skin color. Her skin color is generally uniform
except in areas exposed to the sun. Being dark-skinned, there are areas with
lighter pigmentation such as the palms, lips and nail beds. A patch (birth
mark) which is 3 millimeters in length and 5 millimeters in width, light brown
in color and irregular in shape is located in the upper outer quadrant of her
right breast. She has 2 papules (elevated moles) about 1 millimeter in length
and 1 millimeter in width located in her left mandible area and right maxillary
area. An irregular scar can also be located in the left side of her forehead.
There is a lesion located below the umbilicus. Her skin is warm and sweaty
upon palpation due to the humid environment, with the warmth of her skin
being uniform with all parts of her body. When pinched, her skin springs back
to previous state which indicates normal skin turgor.
Hair
Patient C has a soft, silky, black hair. Her thick hair is evenly distributed
and showed no signs of infection or infestation. The patient has a moderate
body hair.
Nails
The patients fingernail plate shape has a convex curvature with an
angle of about 160. Her fingernail and toenail texture is smooth. There are
no signs of cyanosis or pallor and it has a prompt return of usual color that
lasted about less than 3 seconds when blanch test was performed. The
tissues surrounding her nail is intact and shows no signs of lesions or
infection.
Skull and Face
Patient Cs head is normocephalic and symmetric with smooth skull
contour. There are no nodules or masses noted upon palpation. Her scalp is
light brown in color. She has symmetric facial features. Her eyes showed no

signs of edema or hollowness. Symmetric facial movements are noted when

the patient was asked to elevate and lower her eyebrows, frown and smile,
show teeth, close eyes tightly and puff the cheeks.
Eyes
Patient C has evenly distributed eyebrows. The skin is intact. Her
eyebrows are symmetrically aligned and equal in movement. Her eyelashes
are also equally distributed and curved slightly outward. The patients eyelids
also have intact skin with no discharge and no discoloration observed. Her
lids close symmetrically. She blinks bilaterally, 17 times per minute upon
inspection. When she opens her lids, there are no visible scleras above the
corneas, the upper and lower borders of corneas are slightly covered.
The patients bulbar conjunctiva is transparent. The sclera appears
white with few capillaries evident. The palpebral conjunctiva is shiny, smooth
and pink in color. There is no edema or tenderness noted upon palpation and
inspection of the lacrimal gland, nasolacrimal duct and lacrimal sac. The
cornea is transparent and smooth with the visible details of the iris. The
pupils are black in color, round and have smooth borders. They are equal in
size about 4 millimeters in diameters each.
In the corneal sensitivity test, the patient blinks whenever the cornea
is touched which indicates that the trigeminal nerve (CN V) is intact. During
the pupils light sensitivity test, the illuminated pupil constricted, denoting
direct response, as well as the nonilluminated pupil, indicating consensual
response. This shows normal functioning of the oculomotor (CN III) and the
trochlear (CN IV) cranial nerves. During the assessment of the pupils reaction
to accommodation, pupils constricted when looking at near objects and
dilated when looking at far objects. The pupils converged when an object is
moved toward her nose. The patient has no difficulty, when looking straight
ahead. She can see objects in the periphery. During the extraocular muscle
test, her both eyes moved in unison. Her uncovered eye didnt move during
the cover test. After assessing distance vision, these are the acquired
readings: 20/40 for the right eye, 20/50 for the left eye and 20/30 for both
eyes.
Ears
Patient Cs auricles have same color as the facial skin. They are
symmetrical and aligned with the outer canthus of the eye. They are flexible
and firm, the pinna recoiled after it was folded.
Patient C is able of hearing normal voice tones without difficulty. She is
negative in the Webers test meaning that sound is heard in both ears. Airconducted hearing is greater than bone-conducted hearing which indicates
positive Rinne.
Nose and Sinuses
The external nose of Patient C is symmetric and straight, it has no
discharge or flaring and uniform in color. There are no lesions or tenderness.

Air movement is not restricted in both nares. The mucosa is pink with no
lesions. There is a presence of clear watery discharge. The nasal septum is
intact and located in midline. The maxillary and frontals sinuses are not
tender.

Mouth and Oropharynx

Patient C has symmetrical, soft and moist, dark pink, outer lips. She
can purse her lips. The inner lips are uniform pink in color; it is moist, smooth,
soft and elastic. Patient C has 30 present teeth with the 2 of them having
dental caries, particularly the 2 3 rd molars in the lower set of her teeth. She
no longer has her first molar located in the upper right portion as well as her
second molar in the upper left. Her teeth are light yellow in color. She has
dark pink, moist gums; however, there is presence of redness and tenderness
of gums in the 2 3rd molars in the lower set of her teeth. Patient Cs tongue is
centrally located. It is moist and pink in color with a whitish coating. There
are no lesions or palpable nodules observed and palpated. Patient C is able to
mover her tongue freely. The base of her tongue is smooth with prominent
veins. The soft palate is pink and smooth. Her hard palate is also pink in color
but with irregular texture. Patient Cs uvula is centrally positioned in the soft
palate. Patient Cs oropharynx has a pink and smooth posterior wall. The
tonsils are pink and smooth with no signs of inflammation. They are grade 1
in size. Patient Cs gag reflex is present when elicited.
Neck
Patient Cs neck muscles are equal in size. Head movement is
coordinated and smooth with no discomforts. She is able to flex her head in
45 angle, hyperextend in 60 angle, laterally flex in 40 angle to the right,
and laterally rotate in 70 angle to both left and right. She is able to laterally
flex her head to the right in < 40 angle with presence of pain. The patient
has equal muscle strength assessed when asked to shrug the shoulders
against the resistance of the observers hand. However, there is unequal
muscle strength when asked to turn the head to one side against the
resistance of the observers hand, as there is presence of pain when the head
was turned to the left. Patient C has palpable submental, right
submandibular, right anterior cervical and right posterior cervical lymph
nodes. The trachea is located in the midline of the neck with equal spaces on
both sides. The thyroid gland is not visible upon inspection. It ascends during
swallowing. The lobes of the thyroid gland is palpable, it is small and smooth.
The left lobe is tender.
Thorax and Lungs
The anteroposterior diameter of Patient Cs thorax is half its transverse
diameter. Her chest is symmetric. Her spine is straight and centrally aligned.
The skin in her posterior thorax is intact and uniform in temperature. The
chest wall is intact. There is presence of tenderness in the 11 th left rib along
the left posterior axillary line, as well as in the 9 th rib along the left scapular
line. When the patient took a deep breath, the observers thumbs moved

apart an equal distance at about 1 inches. There is bilateral symmetry of

vocal fremitus which is heard clearly at the apex of the lungs. Percussion
notes resonate except over the scapula. There is dullness in the 10 th ICS.
There is the presence of vesicular and bronchovesicualr breath sounds upon
auscultation.
The patients respirations are quiet and effortless. The coastal angle in
the anterior thorax is < 90, and the ribs inserts into the spine at
approximately 45. Again, after assessing for respiratory excursion, the
observers thumbs moved apart an equal distance at about 1 inches. Same
as the posterior vocal fremitus, it is decreased over heart and breast tissue.
Percussion notes are resonant down to the 6 th rib at the level of the
diaphragm, flat over areas of heavy muscles and bones, dull on areas over
the heart and liver, and tympanic over the underlying stomach. The bronchial
breath sounds are heard upon auscultation in the trachea. Bronchovesicular
and vesicular breath sounds are heard upon auscultation in the anterior
chest.
Heart
There are no pulsations in the aortic, pulmonic and tricuspid and apical
area upon inspection and palpation. The heart rate in all four anatomic sites
are as follows: 71 bpm in the aortic area, 77 in the pulmonic area, 78 in the
tricuspid area and 75 in the mitral area. The loudest is at the base of the
heart. No sound was heard upon auscultation in the carotid arteries. Jugular
veins are not visible upon inspection.
Breasts and Axillae
Patient Cs breasts are sagging and generally symmetric. The skin is
uniform in color with prominent veins. The areolas are black in color, round
and bilaterally the same. The nipples are round, everted and equal in size.
They are soft and smooth with no signs of lesions or sores. There are no
discharges other than breast milk. There is tenderness when palpated.
Masses are also present particularly: along the right midclavicular line just an
inch above the nipple; laterally 2 centimeters from that point in the upper
outer quadrant; laterally an inch from the nipple; from that point, about 1
centimeter downward in the lower outer quadrant; and from that point, 2
centimeters downward also in the lower outer quadrant. Masses are also
palpated in the following areas: 1 centimeter above and laterally 1.5
centimeters from the left nipple; and, an inch away from that point along the
left midaxillary line. The left central, left and right anterior and left posterior
lymph nodes are palpable.
Abdomen
There are presence of linea nigra, striae gravidarum and a lesion just
below the umbilicus of the patient (ligation wound). The abdomen has a
rounded contour. There are 6 bowel sounds per minute heard in the RUQ, 9
bowel sounds per minute in the RLQ, 8 bowel sounds per minute in the LUQ
and 6 bowel sounds per minute in the LLQ upon auscultation. Percussion of
the abdomen and liver, light and deep palpation of the abdomen, palpation

for the liver, spleen and bladder were not performed due to the surgical
incision in the patients abdomen.
Uterus
Palpation for the involution of the uterus was not performed due to the
surgical incision in the patients abdomen.
Musculoskeletal
Muscles are equal in
tremors noted. Muscles are
scale, all muscles and
sternocleidomastoid which is

size on both sides of the body. There are no

firm. Based on the muscle and joint swelling
joints are graded 0 except for the R
grade 2.

The following are the findings for the muscle strength:

R sternocleidomastoid

- 4/5 (with pain)

L sternocleidomastoid

- 4/5

Trapezius

- 5/5

R deltoid

- 4/5

L deltoid

- 4/5

R biceps

- 5/5

L biceps

- 5/5

R triceps

- 5/5

L triceps

- 5/5

Wrist and finger muscles

- 5/5

Grip strength
Muscles of the ankles and feet

- 5/5
- 5/5

The range of motion exercise for hip muscles, hip abduction, hip
adduction, hamstrings and quadriceps were not performed due to Patient Cs
surgical incision in the abdomen and inadequate space.
Reflexes
The biceps, triceps, brachioradialis, patellar, Achilles and plantar are
graded +2.
Genitalia and Inguinal Area

The patient refused to be assessed in the genitalia. The patient

verbalized that she has normal distribution of pubic hair. She has no wounds,
sores, parasites or inflammation in the pubic area; however she has a right
mediolateral episiotomy scar from her first child, as verbalized by the patient.
She stated that she has a discharge. Her lochia is red without blood
fragments and scant in amount. She said that she consumes 2 to 3 pads a
day.
Vital Signs (assessed at November 3, 2010, 8 AM)
Patient Cs temperature was 36.2C. Her blood pressure was 90/50
millimeters of mercury. Her pulse rate was 105 beats per minute and her
respiratory rate was 23 breaths per minute.
Homans Sign
Patient C is negative for Homans sign.
Gordons Functional Pattern
Health Perception-Health Management Pattern
According to Patient C, a healthy person is masigla, di sakitin at
mahilig sa gulay. She maintains her health by eating at the right time, eating
fruits and vegetables, drinking milk and having regular exercise. Patient C has
no allergies. The patient also stated that she didnt have any colds in the past
year. She has no absences from work lasting longer than 1 week. She said
that she is afraid to examine her breasts, that is why she doesnt perform
monthly breast self-examination. She said that she has no vices and hasnt
had any accidents or falls in the past. She stated that she didnt miss any of
her prenatal check-ups for all of her past pregnancies and that she always
find ways to follow the doctors or nurses suggestions about health
management.
Nutritional-Metabolic Pattern
Patient C stated that normally, at home, they only have a maximum of
P100 budget for the day. She said that they usually eat porridge or biscuit for
breakfast, and fish, particularly galunggong, vegetables and rice for lunch
and dinner; however, there are also days in which they only eat rice and salt
as lunch and dinner. She also said that she always takes at least 8 glasses of
water.
3-Day Meal Recall
November 1
Breakfast

None

November 2
None

November 3
1 bowl of lugaw,
500 mL of water

Snack

6 pcs of marie

None

biscuit, 500 mL of

3 pcs of marie
biscuit, 1 cup of

water

chocolate drink, 1
glass of water

Lunch

cup of rice, 1

9 pcs of marie

serving of pork

biscuit, 500 mL of

giniling, 500 mL

water

of water
Dinner

6 pcs of marie

9 pcs of marie

biscuit, 500 mL of

biscuit, 500 mL of

water

water

*assessed at 9 AM, November 3, 2010

After delivery, the client started taking 500 mg of Ferrous Sulfate and
multivitamins once a day. She stated that she does not have any discomfort
in eating, only when chewing due to her dental caries. Patient C has 30
present teeth with the 2 of them having dental caries, particularly the 2 3 rd
molars in the lower set of her teeth. She no longer has her first molar located
in the upper right portion as well as her second molar in the upper left. Her
teeth are light yellow in color. She has dark pink, moist gums; however, there
is presence of redness and tenderness of gums in the 2 3 rd molars in the
lower set of her teeth. She also does not have any diet restrictions. She
mentioned that shes taking at least 8 glasses of water daily. The client has
no skin problems and has normal skin turgor. She has no problems in healing.
She is 142 centimeters tall and weighs 35 kilograms which indicates
disproportion in her body built. Patient Cs BMI is 17.4 kg/m which indicated
her being underweight.
Elimination Pattern
Patient C stated that before pregnancy, she was always sweating
heavily with her clothes soaking wet. She voids at least 7 to 8 times a day.
She described her urine as clear and transparent, it has an ammonia odor.
She defecates twice a day, usually, it is brown in color and formed. She said
that she was not experiencing any discomforts when urinating or defecating.
She also didnt have difficulties in holding urine until getting to the bathroom.
During pregnancy, she stated that she still sweats heavily. She voids at
least 7 to 8 times a day. She described her urine as clear and transparent, it
has an ammonia odor. The same as before,she defecates twice a day, usually,
it is brown in color and formed. She said that she was not experiencing any
discomforts when urinating or defecating.

After pregnancy, she said, she hasnt defecated yet. She voids at least
4 to 5 times a day since that time. She described her urine as transparent to
light yellow in color with ammonia odor. She was not experiencing any
troubles when urinating or defecating.
Activity/Exercise Pattern
Patient C described her activity level for most days of the week which
is very active. She always gets up very early in the morning to sweep outside
and clean the house. She does this 30 minutes everyday. She said that she
has no leisure activities since she is very busy with her work. But after
pregnancy, she experienced difficulty in breathing.
Sleep/Rest Pattern
Before and during pregnancy, Patient C said that she was usually
sleeping from 9 PM to 5 AM. She said that she was comfortable with this and
according to her, the only time she was having disturbance during sleep and
rest was whenever shes sick. She said that she doesnt use any form of
sleeping regimen or medication.
After pregnancy, she said that she only have 1 to 2 hours of sleep. Its
not comfortable for her because of the very small and crowded bed and also
the disturbance whenever her baby cries.
Cognitive-Perceptual Pattern
After assessing distance vision, these are the acquired readings: 20/40
for the right eye, 20/50 for the left eye and 20/30 for both eyes. Patient C is
able of hearing normal voice tones without difficulty. She is negative in the
Webers test meaning that sound is heard in both ears. Air-conducted hearing
is greater than bone-conducted hearing which indicates positive Rinne.
She doesnt go to have her eyes checked-up and she also doesnt
wear any glasses or contact lenses. She stated that she has no difficulties in
hearing. She said that she was dizzy during assessment. She also complained
about her pain in her lower abdomen due to her post-operative incision.
When the patient was asked to rate her pain on a scale from 1 (no pain) to 10
(worst pain), she graded it 7. She said she is not experiencing any changes in
tasting food, smelling, feeling or touch and memory. According to her she is
able to concentrate with work well but is not able to decide effectively on her
own especially when it is for her family. She said she doesnt have any
difficulty in learning. She said, Mas maano (effective) sa akin ung tenga, pati
isip. Pagnakikita ko ginagawa mo, kaya ko na syang gawin. 10 years old ako
nag grade 1, 15 years old ako nag grade 5, she said.
Self Perception-Self Concept Pattern
When asked to describe herself, she answered, Mapayat na masipag,
ganito ako. Mahilig tumulong sa kapwa ko. Kapag gipit, maparaan. She said
that she is generally happy in her life and about who she is, ut as of the
moment she said she is feeling sad. According to her, there has been a great

difference before and now that she has given birth. Before and during
pregnancy, she was able to find easy ways to deal with life; however, after
she gave birth, she seemed not able to do anything. When asked the desire
to do something about them, the patient replied, Gusto ko makuha yung dati
kong lakas. Gusto ko na talaga umuwi , wala lang talaga pera. Aside form
feeling lonely, she said she was also feeling anger for her husband who has a
habit of drinking, he didnt look like she was supporting his wife through this
all.
Role-Relationship Pattern
She said they are 8 in the family. She lives with her mother, husband
and their offsprings. Yung asawa ko, bumibili ng bakal at bote at itinitinda sa
junkshop. Kumikita naman ako sa pamamagitan ng paggupit ng buhok, pag
ahit ng kilay, paggawa ng kalan de uling, lagi lang ako sa bahay, she stated.
When asked how problems are dealt with, she answered, Nagsasama-sama
kami para maiwasan ang problema, maayos naman ang komunikasyon
namin, tapos ako ang nagdedesisiyon kapag walang nagkasundo sa mga
desisyon ng iba. Kapag may problema kami ng asawa ko, pinag uusapan
namin, nagsisisgawan minsan pero nagkakaayos naman sa huli. Even
though, its like this, she said she feels safe in her relationship with her
husband. She said that even though she is not really decisive, when she
needs to be, she is able to come up with solutions to their problems. She
usually asks for the help of her neighbor when she needs someone to talk to.
She stated that she is grateful that when she is not around, her eldest is
always there to take care of the house and the other siblings. She said that
she is not a member of any social groups. They only have P100 budget for
the day, not enough but she always finds way to make the most of it.
Sexuality-Reproductive Pattern
The client had her menarche when she was 13 years old. Her last
menstrual period was on December 17, 2009. The client is a G6P6 (6006)
mother. According to Patient C, she is not always satisfied with her sexual
intercourse with her husband. Usually they have sexual intercourse twice a
week. When she was younger, they did it everyday, they stopped when they
had their first child. She said, she doesnt think she can be this active again.
During the 5th month of pregnancy, they had sexual intercourse. They dont
use any form of medication to enhance sexual performance. Before, they
used condoms and pills, now she is ligated. She said that they didnt have
any problems using these contraceptives.
She is not bothered and attentive during the interview.
Coping Stress-Tolerance Pattern
Patient C does not take drugs for relaxation. According to her, she is
relaxed all the time. Masaya ako sa buhay, di baling mahirap basta masaya.
Basta malusog mga anak ko, ayos na yun, she said. She only feels tension
whenever there is emergency, cases which are sudden that she is not sure of
solving. To alleviate stress, she prays to God. Her children, friends and
siblings are the people often helpful whenever she has problems. When asked

for a big change in her life in the last year or two, she replied, Nung nagbago
yung asawa ko, nag-iiba na ang desisyon niya, mas nakapokus na sya sa
pamilya. Medyo nagbago na sya, happy ako dun.
She is relaxed and concentrated during the interview.
Value-Belief Pattern
She feels satisfied with her life. Her family is the most important thing
for her because she came from a broken family, she said she doesnt want to
have them experience, what she had experienced in the past. For her,
religion is not important, there are various kinds of religion, bur what
important is that God is always inside your heart and soul. For her, God is
very helpful whenever problems arise. She said that she has no religious
practices which were interfering when she was admitted to the hospital.

C. Diagnostic Procedures
Type of test: Urinalysis
Date Ordered:
TESTS

NORMAL
VALUES

VALUES
OBTAINE
D
light
yellow

CLINICAL
INTERPRETATIO
N
Normal

Color:

Reaction:

Pale
yellow to
amber
Clear to
slightly
hazy
4.5-8.0

slight
hazy

Normal

6.0

Normal

Specific
gravity:

1.0151.025

1.005

Increase

WBC:

0-2/HPF

none

Normal

RBC:

0-2/HPF

0-2/HPF

Normal

Epithelial
cells:
Bacteria:

Few

few

Normal

contains
bacteria

many

Transparenc
y:

NURSING
RESPONSIBILI
TY
The fluid
intake and
output must
be accurately
measured
and
monitored
Teach client
how to
perform
clean-catch
method

Albumin:
Sugar:

Negative

(-)

Normal

INDICATION: This test was performed for baseline Urinalysis tests to help
determine the general health status of the client and to detect renal and
metabolic diseases.
Type of test: Complete Blood Count (Hematology)
Date Ordered:
TESTS
Red Blood
Cell Count
Hemoglobin

NORMAL
VALUES
4.20-5.40
x1012L
120.0160.0 g/L
0.36-0.47

Values
Obtained
4.05 x1012L

CLINICAL
INTERPRETATION
decrease

114 g/L

decrease

NURSING
RESPONSIBILITY

Prepare the
client for the
procedure

Hematocrit
0.35
decrease
Level
Monitor VS
MCV
80.0-96.0fL
87.4fL
Normal
MCH
27-31pg
28.6pg
Normal
MCHC
32.0-36.0%
32.8%
Normal
Platelet
150-450
371 x109 L
Normal
Count
x109 L
White Blood
5.0-10.0
9.2 x109 L
Normal
9
Cell Count
x10 L
INDICATION: This test was performed for baseline CBC tests to help
determine their general health status of the client. This will help determine
the clients oxygenation, bleeding tendencies, infection, or anemia.
Type of test: Complete Blood Count (Differential Count)
Date Ordered:
TESTS
Neutrophils
Lymphocytes
Eosinophils
Monocytes
Basophils

NORMAL
VALUES
0.5000.700
0.2000.700
0.0000.060
0.0200.090
0.0000.020

VALUES
OBTAINED
0.672

CLINICL
INTERPRETATION
Normal

0.237

Normal

0.038

Normal

0.050

Normal

0.003

Normal

NURSING
RESPONSIBILITY

Prepare the
client for the
procedure

Monitor VS

INDICATION: This test was performed for baseline purposes and to know if
the client had developed infection cause by microorganisms.

D. Anatomy and Physiology

REPRODUCTIVE ORGANS THAT GOES THROUGH CHANGES DURING
PREGNANCY

REPRODUCTIVE ORGANS THAT GOES THROUGH CHANGES DURING

PREGNANCY

VAGINA- when pregnant, vagina will become swollen, and the lining will
thicken. The walls will become slicker and may produce some discharge.
These changes will make the birth easier.
The secretions caused by the vaginal changes may make you feel sore or
possibly cause unwanted odor. Call your doctor if this occurs. Don't douche to
help control the problem. In fact, you should never douche during pregnancy.
Wash the genital area often and dry carefully. Wear cotton underclothes for
comfort.

UTERUS- it increases to 20 times its original weight, and 1,000 times its
initial capacity. The amount of its muscle, connective and elastic tissue, blood
vessels, and nerves increases. Its shape changes from elongated to oval by
the second month, to round by midge station, then back through oval to
elongate at term (the end of a normal nine-month pregnancy).

The uterus softens beginning at the sixth week. It changes position as it

increases in size, ascending into the abdomen by the fourth month and
eventually reaching to the liver.

CERVIX- the cervical tissue becomes very glandular, producing a mass of

thick mucus that plugs the cervical canal called a mucus plug or 'show'. This
seals the uterus from outside infection.
(1) The cervix undergoes a marked softening which is referred to as the
Goodell's sign.
(2) A mucus plug, which is known as "operculum" is formed in the cervical
canal. This is the result of enlarged and active mucus glands of the cervix. It
serves to seal the uterus and to protect the fetus and fetal membranes from
infection. The mucus plug is expelled at the end of the pregnancy. This may
occur at the onset of labor or precede labor by a few days. When the mucus
is blood-tinged, it is referred to as a "bloody show."
(3) Additional changes and softening of the cervix occur prior to the
beginning of labor.
OVARIES- (1) The follicle-stimulating hormone (FSH) ceases its activity due
to the increased levels of estrogen and progesterone secreted by the ovaries
and corpus luteum. The FSH prevents ovulation and menstruation.
(2) The corpus luteum enlarges during early pregnancy and may even form a
cyst on the ovary. The corpus luteum produces progesterone to help maintain
the lining of the endometrium in early pregnancy. It functions until about the
10th to 12th week of pregnancy when the placenta is capable of producing
adequate amounts of progesterone and estrogen. It slowly decreases in size
and function after the 10th to 12th week.

Fertilization:
Sperm travels through the female's vagina through the cervix and uterus


Sperm meets the mature egg

Only one sperm penetrates the egg

The nuclei of the sperm and egg fuse to form a new cell (the zygote)

Zygote travels to the uterus

Zygote divides then formed a cluster of cells (the morula)

The morula develops a cavity (blastocyst)

Blastocyst floats freely within the uterine cavity for about 48 hours

Blastocyst attach itself to a site in the endometrium (uterine lining)

About 10 days following fertilization, the blastocyst is completely

embedded into the endometrium, and forms the placenta.

10 days mothers menses stop

18 days heart begins to beat

21 days pumps own blood through separate close circulatory system

with own blood type

28 days eye, ear, and respiratory system begin to form

42 days brain waves recorded skeleton complete, reflexes present

8 weeks all body systems present

11 weeks spontaneous breathing movements, has fingernails, all body

systems working

16 weeks genital organs clearly differentiated, grasps with hands,

swims, kicks, turns, somersaults, (still not felt by the mother)

18 weeks vocal cords work

23 weeks 15% chance of viability outside of womb if birth premature

25 weeks 79% of babies survive premature birth

Fallopian tube anatomy

Fallopian Tube Anatomy
The fallopian tube is a narrow
muscular organ arising from the
uterus and ending just next to the
ovary. The inner tubal lining is rich
in cilia, the microscopic hair-like
projections that beat in waves and
move the egg to the uterus.
The fallopian tube is about 10 cm (4
inches) long and consists of several segments. Starting from the uterus and proceeding
toward the ovary, these are the:

Interstitial segment -- passes through the uterine muscle

Isthmic segment -- narrow muscular segment by the uterus

Ampullary segment -- wider middle segment

Infundibular segment -- funnel shaped segment near the ovary

Fimbrial segment -- ciliary lining facing the ovary

Pomeroy Technique
The Pomeroy method involves creating and tying off a loop of the fallopian tube. The
tied off section is then surgically removed. The ligatures are designed to dissolve,
eventually leaving two sealed ends.

Tubal Rings or Clips

Tubal ring ligation is similar to the Pomeroy technique; the main difference is that an
elastic ring is used to bind the loop in the fallopian tube. The constriction of the ring cuts
off the blood supply to the tissue in the loop, and scar tissue forms in its place. The
segments of the fallopian tube eventually separate.

Tubal Ligation and Resection

The tubal ligation and resection method involves the removal of a portion of the fallopian
tube. This form of tubal ligation is most commonly utilized immediately following
delivery (post partum). Ligatures are used to tie off a section of the fallopian tube, then
the section in between is removed. Typically only one to two centimeters of fallopian
tube are taken from the middle of the tube.

Tubal Coagulation
Tubal coagulation is primarily used for laparoscopic tubal ligation procedures. A pair of
forceps that can conduct electricity is used to grasp the fallopian tube at the appropriate
point. An electrical current passes through the forceps and coagulates the blood vessels in
adjoining tissue.

PATHOPSHYSIOLOGY
A woman's fallopian tubes move eggs from the ovary to the uterus about once a month.

If a man's sperm meets up with an egg, pregnancy can result.

If the tubes are closed or tied the sperm cannot fertilized an egg and pregnancy will not
occur.

After ligation, a womans ovaries still releases eggs each month

Eggs has nowhere to go

Eggs disintegrate in the tube

After sexual intercourse, the sperm are blocked at the isthmus of the fallopian
tube

Ligation prevents sperm from getting to the eggs in the ovary

Fertilization is prevented

Pathophysiology/Disease Process
Labor Pain
Theoretical Based
Mechanical, chemical (prostaglandins, histamine, bradykinin and serotonin)
or thermal stimuli

Nociceptors transmit pain along small, unmyelinated C fibers and large

myelinated alpha-delta fibers

Travels to the spinal cord

On the dorsal horn of the spinal cord, somatostatin, cholecystokinin and

substance P serve as neurotransmitters

Pain impulse ascends to the cerebral cortex

Neurons from the somatic sensory cortex

Neurons project to the midbrain, to a region called the periaqueductal gray

matter

Neurons project to neurons in the medulla in the nucleus Raphe magnus and
other nuclei in the rostral ventral medulla, particularly one called the nucleus
reticularis paragigantocellularis

neurons project axons down the spinal cord in the same regions of the dorsal
horn

synapse onto primary sensory nerve terminals in the myometrial muscle cells

begin and remain irregular

In early labor, the uterotubal pacemaker
remain confined in the
abdomen

first felt and

may not work in a synchronous manner

with ambulation or sleep

often disappear

do not increase in
frequency, duration or intensity

begin irregularly but become regular

Becomes more attuned to calcium concentrations
lower back & then the
abdomen

felt first in the

in the myometrium and begins to function smoothly

continue no matter what
activity
increase in frequency,
duration and intensity

Client Based
Fig.2 Client based pathophysiology of Labor Pain
Ms. C (26 years old, G6P6)

Mechanical, chemical (prostaglandins, histamine, bradykinin and serotonin)

or thermal stimuli

Nociceptors transmit pain along small, unmyelinated C fibers and large

myelinated alpha-delta fibers

Travels to the spinal cord

On the dorsal horn of the spinal cord, somatostatin, cholecystokinin and

substance P serve as neurotransmitters

Pain impulse ascends to the cerebral cortex

Neurons from the somatic sensory cortex

Neurons project to the midbrain, to a region called the periaqueductal gray

matter

Neurons project to neurons in the medulla in the nucleus Raphe magnus and
other nuclei in the rostral ventral medulla, particularly one called the nucleus
reticularis paragigantocellularis

neurons project axons down the spinal cord in the same regions of the dorsal
horn

synapse onto primary sensory nerve terminals in the myometrial muscle cells

begin and remain irregular

In early labor, the uterotubal pacemaker
confined in the abdomen

first felt and remain

may not work in a synchronous manner

ambulation or sleep

often disappear with

do not increase in frequency, duration or intensity

begin irregularly but become regular

Becomes more attuned to calcium concentrations
lower back and then the
abdomen
in the myometrium and begins to function smoothly
what activity
inc in frequency, duration and intensity

felt first in the

continue no matter

Pain
Theoretical Based
Stimuli
Skin or tissue damage
Stimulation of Peripheral Nervous System
C-fiber
A-beta fiber
A-delta fiber
Dorsal Root Ganglion
Dorsal Horn
Spinal Cord
Brain
Spinal Cord
Dorsal Horn
Dorsal Root Ganglion
A-delta Fiber
A-beta Fiber

C-fiber
Stimulation of Peripheral Nervous System
Pain

Client Based
Patient C. DC
G6P6(6006)

Mechanical Stimula (incision in the abdomen)

Skin or tissue damage
Stimulation of Peripheral Nervous System
C-fiber
A-beta fiber
A-delta fiber
Dorsal Root Ganglion
Dorsal Horn
Spinal Cord
Brain
Spinal Cord
Dorsal Horn
Dorsal Root Ganglion
A-delta Fiber

A-beta Fiber
C-fiber
Stimulation of Peripheral Nervous System
Pai

Chapter 2-Planning
Concept Map

1.Teach recommended positions (eg. lying down or kneeling with your chest down, etc.) and help position the client in a comfortable position
2. Encourage patient to gradually increase her activities.
3. Explain to the client that the pain is temporary and will eventually disappear.
4. Explain and teach various kinds
of distractions (eg. guided imagery, music, etc.)
5. Explain and teach relaxation
techniques (eg. deep breathing exercises, progressive muscle relaxation, etc.)
6. Provide optimal pain relief with prescribed analgesics, instruct client to request PRN pain medication before the pain is severe.

1.
2.
3.

4.

Discuss 5 importance of
sleep.
Discuss 5 environmental
factors that affect sleep.
Discuss 3 effects of diet
in sleeping.
Discuss on how to do
proper time
management to the
client for effective selfcare and neonatal care.

Prioritization
Ineffective
Breathing
Pattern r/t
decreased
hemoglobin
and hematocrit
level in the
blood
1.

2.

Maintain
previous
relationship
with higher
being
Continue
spiritual
practices
not
detrimental
to health

Acute Pain r/t

suture line in
the abdomen

Impaired
nutrition less
than body
requirements
Disturbed
sleeping
pattern r/t
parental
concern as
manifested by
workload and
parenting roles

1. Explain physiologic
changes and nutritional
needs during pregnancy
and lactation,
2. Discuss the food pyramid
3. Discuss foods items that
are rich in carbohydrates,
proteins, fats, vitamins, and
minerals; oral recitation
4. Inform client about
alternative, affordable
nutritious foods.
5. Provide diet modifications.

It can
significantly affect
the client ability to
breathe, transport
gases and
(1)High
participate in
everyday activity
( Kozier and Erbs,
p1357 )
Based
Patient C. DC
.
It
can
directly
G6P6 (6006)
impair health and
QMMC
prolong recovery
(2)High
from surgery, 1. position the client in a
disease and comfortable position.
2.Instruct deep breathing
trauma. (Kozier
and Erb, 2008.)exercises
3. encourage patient to have
Impaired
Because adequate resting periods
nutrition
less
Nutritional
4. assist client in her daily
than
body
problems mayactivities
5. instruct client to increase
requirements
affect many other
(3)High
r/t of humanintake of iron by taking
areas
supplements and eating
functiuoning.foods rich in iron like dark
leafy vegetables
(Kozier and Erbsgreen
,
p1281)
(4)Medium
In a sleepdeprived client,
the loss of NREM
sleep causes
immunosuppressio
n, slows tissue
repair, lowers pain
tolerance, triggers
profound fatigue,
and increases
susceptibility to

Enhanced
Spirituality

(5)Low

infection. (Lower,
Bonsack & Guion,
2003)
Faith is necessary
for spiritual
growth,
particularly for a
relationship to a
higher beinhg.
Hope is also
critical for spiritual
development and
intergral to the
horizontal and
vertical
processes.

CHAPTER 3
I. Medical Management
A. Drug Study
Drug
Cephalexi
n
Dose:
5mg
Route:
PRM
Frequency
:
TID, 7
days

Drug
Clas
s
Antibioti
c
Cephalo
sporin
(1st
Generat
ion)

Mechanis
m of
Action
Bactiricid
al:
Inhibits
synthesis
of
bacterial
cell wall

Side
Effects

Adverse
Effects

Contrain
dications

CNS:
headache,
dizziness,
lethargy,
paresthesi
as

Hematologic:
Bone marrow
depression

Contrain
dicated
with
allergy to
cephalos
porins or
penicillin
s
Use
cautiousl
y with
renal
failure,
lactation
and
pregnanc
y

GI: nausea,
vomiting,
diarrhea,
anorexia,
abdominal
pain,
flatulence,
pseudome
mbranous
colitis,
hepatotoxi
city

Hypersensitiv
ity: ranging
from rash to
anaphylaxis;
serum
sickness
Other:
superinfectio
ns

Nursing
Responsibiliti
es
Arrange for
culture and
sensitivity
tests of
infection
before and
during
therapy if
infection does
not resolve
Give drug
with meals;
arrange for
small
frequent
meals if GI
complications
occur
Refrigerate
suspension,
discard after
14 days
Report severe
diarrhea with

Ampicillin
Dose:
2gm
Route:
TIV

Antibioti
c
Penicilli
n

Bactiricid
al:
Inhibits
synthesis
of
bacterial
cell wall,
causing
cell death

CNS:
lethargy,
hallucinati
ons,
seizures
GI: sore
mouth,
nausea,
vomiting,
abdominal
pain,
bloody
diarrhea
Hematolog
ic: Anemia,
thrombocy
topenia,
leucopenia
,
neutropeni
a,
prolonged
bleeding
time
Local:pain,
phlebitis,
thrombosis
at injection
site

CV: heart
failure
GU: Nephritis
Hypersensitiv
ity:
anaphylaxis
Other:
superinfectio
ns

Contrain
dicated
with
allergies
to
penicillin
s,
cephlosp
orins, or
other
allergies
Use
cautiousl
y with
renal
disorders

blood, pus, or
mucus; rash
or hives;
difficulty in
breathing;
unusual
tiredness,
fatigue;
unusual
bleeding or
bruising
Avoid alcohol
while taking
this drug
Arrange for
culture and
sensitivity
tests of
infection
before and
during
therapy if
infection does
not resolve
Take drug
around the
clock
Take full
course
therapy
Take oral drug
on an empty
stomach. One
hour of before
2 hours after
meals; do not
take with fuit
juice or
softdrinks
Report pain or
discomfort at
sites, unusual
bleeding or
bruising,
mouth sores,
rash, hives,
fever, itching,

Ferrous
Sulfate
Dose:
500 mg
Route:
PO
Frequenc
y:
OD

Iron
Prepara
tion

Elevates
the serum
iron
concentra
tion,
which
then
helps to
form hgb
or
trapped in
the
reticuloen
dothelial
cells for
storage
and
eventual
conversio
n to a
usable
form of
iron

CNS: CNS
toxicity,
acidosis
GI: GI
upset,
anorexia,
nausea,
nausea,
vomiting,
constipatio
n,
diarrhea,
drak
stools,
temporary
staining of
the teeth

CNS: coma
and death
with
overdose

Contrain
dicated
with
allergy to
any
ingredien
t; sulfite
allergy;
hemachr
omatosis
,
hemosid
erosis,
hemolyti
c
anemias
Use
cautiousl
y with
normal
iron
balance;
peptic
ulcer,
regional
enteritis,
ulcerativ
e colitis

severe
diarrhea,
difficulty
breathing.
Confirm that
patient does
have iron
deficiency
anemia
before
treatment.
Give drug
with meals if
GI discomfort
is severe;
slowly
increase to
build up
tolerance.
Administer
liquid
preparations
in water or
juice to mask
the taste and
prevent
staining of
teeth.
Warn patient
that stool
may be dark
green.
Arrange for
periodic
monitoring of
Hct and Hgb
levels.
Take drug on
an empty
stomach with
water. Take
after meals if
GI upset is
severe.
Take liquid

preparations
diluted in
water or juice,
and sip them
through a
straw to
prevent
staining of
the teeth.
Have periodic
blood tests
during
therapy to
determine the
appropriate
dosage.
Do not take
this
preparation
with antacids
or
tetracycline.

Mefenami
c Acid
Dose:
500mg
Route:
PRM
Frequency
:
Q6

NSAID

Antiinflammat
ory,
analgesic
and
antipyreti
c activites
related to
inhibition
of
prostagla
ndin
synthesis;
exact
mechanis
ms of
action are
not
known

CNS:
headache,
dizziness,
somnolenc
e,
insomnia,
fatigue,
tiredness,
dizziness,
tinnitus,
ophthalmic
effects
GI: nausea,
dyspepsia,
GI pain,
diarrhea,
vomiting,
constipatio

GU: renal
impairment
Other:
anaphylactoi
d reactions to
anaphylactic
shock

Report severe
GI upset,
lethargy,
rapid
respirations
and
constipation.
Evaluate
hematopoieti
c status
before and
frequently
during
therapy
Ensure that
the patient is
well hydrate
before and
during
therapy to
minimize
adverse of
hyperuricemi
a

n,
flatulence

Caution
patient about
the risk of
serious fetal
harm while
taking this
drug; advise
patient to use
barrier
contraceptive
s
Drink
adequate
fluids; drink
at least 8-10
glasses of
fluid each day
Have frequent
regular
medical
follow-up
visits,
including
blood tests to
follow the
drug effects
Report fever,
chills, sore
throat,
unusual
bleeding or
bruising,
yellow
discoloration
of the skin or
eyes,
abdominal
pain, flank
pain, joint
pain, fever,
weakness,diar
rhea

B. Surgical Management

Date of

Type of

Effect of

Side effects

Nursing

Operation

Operation

operation

November 3,
2010

Bilateral Tubal
Ligation

Permanent
sterility

Responsibility

Abnormal
bleeding
after
surgery
Heavy
menstrual
flow
Pelvic pain
Hormonal
Imbalance

Before:
Prepare the
client before
the
procedure
Inform the
client about
the effects
after the
operation
During:
Assist the
doctor in
performing
the operation
After:
Assess client
for any signs
of
complication
Assist client
when moving
Provide
adequate
resting
periods
Inform client
to avoid
coitus as long
as she can
feel a pain in
her abdomen
Inform client
to avoid
strenuous
activities

II. Clients Daily Progress Chart

Date and Time

Focus

Data/ Action/ Response

Oct. 31, 2010

4:09 am

>cervix fully dilated

>placenta out complete
>oxytocin 20 units inc.
to improve postpartum
care

4:50 pm

Labor Pain

>admitted a 26 y/o pt.

ambulatory
accompanied by
relatives
>S/E by ROD orders
made to carried out
>NPO maintained
>v/s checked
>awaits vaginal delivery

November 2, 2010
6:00 am

>Continue needs
>proximal hygiene
>vs q 4 and record

November 3, 2010
6-3pm

Fundus stable vs

-MGH

(-) subj. complains

-ff up @ opd after 1

week
-daily would care
-on bed awake
-vs monitored

CHAPTER 4 EVALUATION
I. Evaluation of Actual Nursing Problem
Patient C.DC is a 26- year old G6P5(5006) admitted to
QuirinoMemorialMedicalCenter on October 31, 2010 due to labor pain. Prior to
admission, the clients uterine size measured 28 cm and her AOG is 39-40
weeks. She delivered spontaneously to a live boy at 4:06 am on November 1,
2010. Her final diagnoses include G6P6(6006). No surgical operation was
done after the operation.
II. DischargePlanning Instruction
DISCHARGE PLAN
Medication

*Encourage patient to take 1 tablet of Ferrous

Sulfate, per orem, twice a day, an iron supplement
to reduce anemia. Take drug with citrus juice to
increase absorption of Iron. Discuss the side
effects of taking this drug, such as black tarry
stool.
*When experiencing pain, take Mefenamic Acid
500mg every 6 hours, orally. Do not take this drug
with empty stomach.

Exercise

*Advise client to perform simple exercises like

Kegels exercise,household chores, abdominal
breathing and walking.

Treatment

*Instruct client to do wound care daily to prevent

infection. The client can use betadine or NSS to
clean the wound.

Health Teaching

*Teach client ways to provide proper hygiene like

taking a bath daily and doing the wound care to
minimize infection.
*Teach client to take proper nutrition with highprotein, sufficient calories, vitamins and mineral
supplements to facilitate healing.
*Teach client that adequate periods of rest and
sleep is important.
*Teach client about proper disposal of soiled
dressings to prevent spread of infection.
*Instruct client to continue breastfeeding because
it promotes bond between mother and baby and
for its nutritious content.

Diet

Breakfast

Lunch

2 serving
Fried dilis,
2 serving
boiled egg,
with 1 cup
of rice, 3
serving
boiled
potatoes
(2) rice
(2) chicken
egg
(boiled)
(2) dilis
(fried)
(1)
vegetable
oil
(3) potato

Sinigang
na tilapia
and fried
chicken
with 1 cup
of rice; 1
slice
mango
(2) rice
(1)
tilapia,
(2) string
beans, (3)
gabi (root)
(1)
serving
chicken
leg (fried)
(1) tsp
vegetable
oil
1 slice
mango

Total KCAL: 2120 kcal

Total KCAL:
762 kcal

Total
KCAL: 821
kcal

vResearch

Paper help

https://www.homeworkping.com/

Afternoon
snack
(2) saba
(ripe)
Total
KCAL: 80
kcal

Dinner
2 Fried
galunggon
g, 1 fried
chicken
leg, 1 cup
of rice,
and 1 slice
mango
(2) rice
(1) tsp
vegetable
oil
(2) Fried
Galunggon
g
(1)
chicken
leg (fried)
1 slice
mango
Total: 489
kcal