SPOT MAP

A. Personal Data

Mrs. R is a 27 year-old woman who is 7 months pregnant. She is happily

married to Mr. J, 27 years old, and they are currently residing at Brgy. 2 San Roque,
Paoay, Ilocos Norte, with daughter F, Mr. J’s sister, and Mr. J’s parents. Their type of
family is patrilocal as to residence and extended as to composition since they live
with the husband’s parents and one sister.

Mrs. R is a former crew at a fast food but now a housewife. On the other
hand, Mr. J is an “all around worker” – construction worker-electrician, and farmer.
Daughter F is 3 years old.

1. Socio-Economic Data

Mrs. R is a plain housewife. She used to work as a crew in a fast food chain
but as requested by her husband, she resigned to devote more time caring for their
first child and to her husband as well. Mrs. R’s husband is a fulltime construction
worker-electrician and earns P1680/week and approximately P7000 four times in a
year as a pig raiser. The 7000 is considered as incentive or salary from the parents.
Also, he is a part time farmer and usually grows corn and garlic. They earn 3000
from corn every season for 3 seasons and 2000 for the garlic once a year. All
income earned from being a farmer are incentives from the husband’s parents who
really own the business. They have a total income of P9970 in a month. It is the
husband’s parents who shoulder the expenses on the farm and piggery inputs and
they only help in the overall management and monitoring.

Mrs. R’s family spends P1000 in a week (4000/month) for food. Since theirs is
considered extended, the nuclear family shares food with the paternal parents and
they eat together as verbalized by the patient “agkakabanga kami ken ages-share
kami ti makan nukwa.” They allot P200 for the electric bill, P200 for medical check-
up, P100 weekly for cell phone load, P200 for transportation, 1500 as total
allowance of their daughter monthly and P500 for medications. Their monthly
expenditures cost approximately P7000. The rest of their income serves as their
savings for emergency purposes and in preparation for her delivery.

B. Pregnancy History

1. Current Pregnancy

Mrs. R’s last menstrual period was last December 4, 2008. She is now on her
31st week of gestation. According to Naegele’s rule, Mrs. R’s expected date of
confinement will be on September 11, 2009. She experienced her first quickening
during her 5th month of pregnancy which was in May 2009. Mrs. R has an obstetrical
scoring of G2P1 and T1P0A0L1.

According to Mrs. R, during her first trimester, she experienced morning

sickness approximately 2 tbsp, bearable headache with a rank of 4 in a 0-10 pain-
scale which occurs simultaneously and craving for food such as “isaw”. During her
second trimester, she experienced easy fatigability and abdominal pain with a rank
of 7 in a 0-10 pain-scale at the epigastric area as verbalized, “Haan nak makaanges
nu agsakit ti buksit ko ken alisto nak lang nga mabannog.” She also experiences
frequent urination 4 times during daytime and 3 times at night as verbalized
“normal met ti panagisbuk ken saan nak met maproblemaan”. She received the first
dose of Tetanus Toxoid for her present pregnancy last May 2009. She already
received 2 during her first pregnancy in 2006 but was not able to continue it so she
was required to repeat the vaccination.

Mrs. R had her first check up last April 17, 2009 in MMMH and MC and was
diagnosed as verbalized “Nababa ti matres ko kuna ni doctor isu nga inresetaan nak
iti pagpakapet ti ubing.” She did not buy the prescribed medication instead she
went to a manhihihilot as stated “Haan ko malagip dijay nagan ti agas kasi haan ko
met nga ginatang. Napan nak latta nagpailot idtoy ayan min. Adu pay ngamin ti
gastos ko kadigijay agas jay anak ko kasi adda angkit na.”

When asked about Mrs. R’s chief concern, she answered “nu tumakderak
kasla maregreg ta pus-on ko ken nasakit patong ko.”

Mrs. R admitted that she has low blood pressure last month (June 2009) and
experienced headache, as she said, “nababa darak ken nasakit ulok.” Moreover, she
feels constipated because she only defecates every after two days as she stated,
“natangken ti takkik isu nga kada maikadwa nga aldaw nak lang a tumakki.”

With regards to the medications Mrs. R has received since beginning of

pregnancy, she takes in OB-min and ferrous sulfate alternately once a day but
originally, the prescription was to take OB-min and ferrous sulfate every day. The
OB-min was prescribed by a doctor in MMMH & MC while the ferrous sulfate was
prescribed in the RHU during his check up also in the 5 th month. The reason why
Mrs. R takes these drugs alternately every other day is that she presumes that she
might get overdosed and also, according to her, the OB-min drug makes her
abdomen grow bigger. The student nurses encouraged then the patient to adhere
strictly to the doctor’s order to prevent complications and for better results. Also, as
to the ferrous sulfate, the student nurses informed the patient that it is usually
prescribed to prevent or treat anemia, increasing the iron stores of the body and
replace blood loss during delivery and that it is normal to expect or notice dark
stools and sometimes it causes constipation.

Mrs. R is not exposed to any communicable diseases and did not have any
illnesses from the beginning of her pregnancy.
 Mrs. R admitted that her current pregnancy was unplanned and she really did
not expect getting pregnant. She had to resign from her work in a fast food chain as
requested by her husband in order to have more time to take care of their first child
and to be ready for her labor.

Despite the unpredicted pregnancy, Mrs. R and her family were happy to
have another child and they hope that the next baby would be a boy. They also plan
that Mrs. R would have her ligation after the delivery.

2. Past Obstetrical History

Mrs. R gave birth to her first child on January 2, 2006. She was at 36th week of
gestation when she gave birth. She had undergone a normal delivery at MMMH
Batac. Unfortunately, she experienced pregnancy induced hypertension and was
transfused with 1000 cc of blood because of postpartum bleeding related to uterine
relaxation to compensate the loss of blood. Mrs. R also experienced edema on her
lower extremities specifically on both thighs down to her feet.

3. Menstrual History

Mrs. R had her menarche when she was 12 years old. According to her, she
has a regular 28 day cycle and usually menstruates for 4 days. The heaviest flow
usually occurs from day 1-3 and changes fully soaked sanitary napkin three times a
day. She has spotting for the last day. She also experiences dysmenorrhea and
treats it by using hot compress and claims relief from it as she verbalized
“mabangbangaran nak met nukwa”. Usually, she notices one small clot on her flow.

C. History

1. Genogram
 2. Family History

According to Mrs. R there are certain diseases that are present in their family.
Her father died of lung tumor because of smoking, consuming 1 pack within a day.
He also used to be an occasional drinker of alcoholic beverages and could drink 1-2
glasses of ginebra san Miguel. On the other hand, her mother has a heart disease
and with hypertension that Mrs. R inherited but did not know what her mother does
her heart disease attacks as well as hypertension.

They are 8 siblings in the family. Her second brother was diagnosed with
enlargement of the kidney because of stress and vices such as drinking liquor. The
third one had experienced motor accident and got an injury in the head. While her
other siblings have no major illnesses.

On Mr. J’s side, his father, as verbalized by Mrs. R “adda bara ti ulo na ken
agsaksakit siket na.” Furthermore, he has also vices like drinking liquor and
smoking.

Mr. J had slight attacks of asthma during his childhood days. And according to
Mrs. R, her husband drinks liquor occasionally. Daughter F has asthma which she
inherited from her father.

Common illnesses were experienced by the members of the family which

includes fever, cough, colds, stomach ache, diarrhea, and headache. To manage
such illnesses, they usually take in over-the-counter drugs such as paracetamol for
fever, carboscisteine for cough, neozep for colds, and pain reliever for headache.
 According to Mrs. R, they consult “manghihilot” whenever they experience
body pains. If both “hilot” and over-the-counter drugs don’t relieve the symptoms ,
they immediately consult a doctor.

3. Personal Health History:

Mrs. R does not have any vices, but according to her, she occasionally drinks
liquor during her high-school days when she was still a teen-ager. She considers
doing household chores such as washing the laundry as her form of exercise. Also,
she said that she walks for 5-10 minutes with a distance of 5-10 meters daily and
usually relaxes by watching TV every afternoon as she verbalized “maayatan nak
agbuya nukwa ti wowowee nu aldaw.” The student nurses inform the patient that
doing household chores are not forms of exercise and that it is a physical activity
that someone does regularly to become healthy or to promote wellbeing.

4. Past Medical History

Mrs. R experienced common illnesses such as chicken pox, measles, influenza

or flu, stomach ache, colds, cough, diarrhea and mumps. Decoction from guava
leaves were used in bathing, as well as, smoke from burning skin of onion and
“akot-akot” were used to manage measles, chicken pox and mumps.

She cannot recall whether she received her complete immunization but she
has a scar on her left deltoid implying that she has received a BCG vaccine.

She has no allergy on foods and drugs but she has allergy to dust which leads
to nose irritation and colds. She once had an allergy with a particular detergent
powder which led to roughness and thickening of her palms.

Mrs. R claimed that she accidentally got shot by an “escupeta” on her upper
lip and was operated and hospitalized for 1 week.

5. Nutritional History

July 22, 2009

Amount Caloric Value (kcal)
Canned tuna 1 serving 80
Rice 2 cups 200
Milk ½ glass 95
Water 1 glass -
Inabraw 2 servings 64
Rice 2-3 cups 250
Water 1 glass -
Bread 4 slices 600
Biscuit 1 pack 130
Juice 1 glass 37
Sardines 1 serving 310
Noodles 1 serving 290
 Rice 2 cups 200
Water 2 glasses -
2256

July 23, 2009

Amount Caloric Value (kcal)
Pancit canton 1 pack 290
Rice 2 cups 200
Milk 1 glass 170
Water 1 glass -
Softdrinks 12 ounces 140
Bread 4 slices 600
Fried chicken (leg) 1 piece 350
Adobo 1 serving 122
Pinakbet 2 servings 64
Rice 2-3 cups 250
Water 1 glass -
Papaya with soup 1 serving 16
Sardines 1 serving 310
Pinakbet 2 servings 64
Rice 2 cups 200
Water 1 glass -
2776

July 24, 2009

Amount Caloric Value (kcal)
Pancit bihon 2 servings 580
Softdrinks 12 ounces 140
Tinola 1 serving 350
Rice 2-3 cups 250
Water 1 glass -
Ginisang monggo 1 serving 700
Rice 2-3 cups 250
Water 1 glass -
2270

Total: 7302 kcal

The table shows the dietary intake of Mrs. R for the past three days.

Mrs. R eats meals three times a day. Rice is always present every meal and
she claimed that she eats more than her usual meals. Sometimes she drinks milk
and eats her snacks if she likes to. She has healthy meal preferences.

Her actual body weight is 68 kilograms and her height is 152.4 centimeters.
At present she has a BMI of 29.44 which means that she is overweight. Her actual
body weight prior to her pregnancy is 58kgs. Her desirable body weight for her
pregnancy is 64kg. The total recommended energy for her pregnancy is 2180 kcal.
 Based from the data gathered, the client is in high-carbohydrate-diet because
of the amount of rice and noodles she is taking in and most probably the reason
why she is overweight.

Being an overweight could lead to possible diseases such as hypertension

and diabetes which may be dangerous because the client is pregnant.

6. Sexual History

Mrs. R’s first sexual intercourse with her husband happened on April 2004. At
first, according to Mrs. R, there is fear in her as well as excitement towards having a
sexual intercourse, but in the succeeding sexual contact through several years she
gets along with it, and considers it as part of their marriage. The attitude of Mrs. R
depends upon the time were in they would have their sexual intercourse even if she
does not have the desire she just considers it as a need of her husband and also
Mrs. R is less aggressive than her husband.

According to her, they do sexual intercourse two times a week, most of the
time at night. They usually practice withdrawal and sometimes use of condom as
their form of contraception and according to her the pleasure they get (both of
them) is the same according to her. Since her pregnancy, they just do it usually only
once a week. Her last sexual intercourse with her husband happened last week (3 rd
week of July).

7. Data About Husband

Mrs. R’s husband stands 5’5’’ and weighs 55kg. According to Mrs. R as of her
husband’s health status as verbalized by “healthy nga saan” because he is capable
of getting sick. When he knew about her wife’s pregnancy, he did not expect it but
still was happy because they were longing for a baby. He was the one who initiated
and decided for her wife to resign from her job as a service crew concerning the
risks that may occur to her pregnancy and that for Mrs. R to take care of and look
for their first child. With regards to his relationship with her, he is very supportive,
understanding, and loving as verbalized by Mrs. R, “mayat met ti pinagdendenna
mi, haan kam met unay agap-apa ken masolsolbar mi met dagitoy problema mi”.
He is also a responsible husband and father to their child. He makes sure that he
sustains well the needs of the family.

D. Physical Assessment

Mrs. R is a middle-aged woman who stands 5’ and weighs 68 kgs. She has an
endomorphic body built. The client has a good posture, wears no make-up, her hair
is neatly fixed and neatly groomed. She walks and moves freely and shows a joyful
disposition. She was wearing a loosely-fit maternity dress.
 1. Vital Signs

- Body Temperature: 36.50C per - Respiratory rate: 20 per minute,

axilla regular

- Pulse Rate: 79 beats per - Blood pressure: 100/60 mmHg

minute, regular

2. Head-to-Toe Assessment:

Head

- normocephalic

- able to do ROM exercises

Hair and Scalp

- scalp lighter in color than complexion

- free from lice, nits and/or dandruff

- with evenly distributed black, smooth, and oily hair

Face

- with symmetrical facial features

- able to move facial muscles at will

- no melasma noted

Eyes

- External and internal eyes structures:

o with evenly distributed black eyebrows

o with upper eyelid partially covering the iris

o with white sclera and black iris

o with pinkish and upper and lower conjunctiva

o with symmetrically aligned eyes

o with intact nerve III, IV and VI

o PERRLA

- Visual field and acuity:

 o able to see objects at 1800 angle while looking at a fixed point

o pupils equally round reactive to light and accommodation

o able to read a font-size 12 article at a distance of two feet

Ears

- with symmetrical earlobes

- the upper connection of the earlobes are in line with the outer canthus of the
eye

- with minimal cerumen on both ears canal upon inspection

- with good hearing acuity – able to hear whisper at a distance of two feet

Nose

- nose in the midline, high bridge, with patent nares

- nasal septum in the midline

Oral Cavity

- Lips:

o pinkish in color

- Tongue:

o pinkish and moist

o midline in position

- Teeth

o 29 teeth present

o with dental carries at lower left 2nd molar

- Gums

o pinkish

Neck

- able to do ROM exercises

- trachea in midline
Chest

- moves symmetrically when breathing

- with cardiac rate of 80 beats per minute

Breast

- soft, no tenderness noted

- with dark areola and nipples

Abdomen

- protuberant

- fundic height is 22 cm

- fundus is in halfway between umbilicus and xyphoid process

- presence of linea nigra and striae gravidarum

Upper Extremities

- able to do ROM without any assistance

- with short nails and capillary refill of 1-2 seconds

Lower Extremities

- able to flex and extend legs

- no signs of edema

- with short nails and capillary refill of 1-2 seconds

3. Leopold’s Maneuver

The results of Leopold’s maneuver are the following:

First, we performed the fundal grip and we palpated a cephalic presentation

in relation to the fundus but the general presentation is breech.

In the second maneuver, we palpated the fetal back at the right lower
quadrant of the abdomen and at the same time auscultated and counted the fetal
heart tone with the aid of a stethoscope which was 135 beats per minute.

During the Pawlik’s grip, we found out that the fetus is not yet engaged, still
movable. The 4th maneuver was not applied anymore.
 4. Roll Over Test

The results of the roll over test are as follows:

During the first reading for left lateral position it is 90/50; for supine position
it is 90/70 and after resting for 5 minutes the result for the second reading for the
left lateral is 90/50 and for the supine position it is 100/70, and we also get the BP
on sitting position which is 110/50.

Despite the normal result of Mrs. R’s blood pressure, she is still at risk to having
pregnancy induced hypertension because of her history in her first pregnancy.

Nursing Diagnosis:

Constipation related to inadequate fiber and fluid intake as manifested by passage

of hard stools and verbalization of ““natangken ti takkik isu nga kada maikadwa nga
aldaw nak lang a tumakki.”

Nursing Goal:

After 4-5 hours of nursing intervention, the patient will be able to establish normal
pattern of bowel functioning as will be manifested by defecating everyday and
verbalization of “haan nga natangken ti takki kon ken .”
Nursing Interventions with Rationale:

Nursing Intervention Rationale

• Instruct client to have adequate fluid To promote passage of soft stool
intake (at least 2-3 liters of water
daily within cardiac tolerance),
including high-fiber fruit juices
• Recommend a glass of warm water to This may act as stimulus to bowel
be taken 30 minutes before breakfast evacuation
• Encourage her to evacuate her To avoid fecal impaction
bowels regularly
• Encourage activity/exercise within To stimulate contractions of the
limits of individual ability intestines
• Instruct the client to avoid gas- Decreases gastric distress and
forming foods like rootcrops like abdominal distention
camote

Nursing Evaluation:

After 4 hours of nursing intervention, the patient was able to establish normal
pattern of bowel functioning as manifested by defecating everyday and
verbalization of “haan nga natangken ti takki kon.”
Nursing Diagnosis:

Noncompliance related to barriers to access secondary to financial issues as

manifested by verbalization of “Haan ko malagip diay nagan ti agas kasi haan ko
met nga ginatang. Napan nak latta nagpailoten ditoy ayan min. Adu pay ngamin ti
gastos ko kadagidiay agas diay maysa nga anak ko kasi adda angkit na.”

Nursing Goal:

After 1-2 days of nursing intervention, the patient will be able to understand the
importance of compliance to prescribed regimen and be encouraged to adhere to
the prescribed regimen.

Nursing Interventions with Rationale:

Nursing Intervention Rationale

• Discuss with the patient the Letting the patient know and understand
importance of the drug regimen. the importance of the drug regimen to
encourage the patient to comply.
• Discuss with the patient the danger Letting the patient know the danger or
or risks of noncompliance to regimen. risks of noncompliance can cause fear on
her part. She cannot recover from the
abnormal condition if she does not
comply.
• Help the patient establish a support Support from relatives or friends can
system. minimize/lessen the burden of buying
such medications.
• Help the patient set proper What weighs greater would help the
prioritizations. patient prioritize.

Nursing Evaluation:

After 2 days of nursing intervention, the patient was able to understand the
importance of compliance to prescribed regimen and was encouraged to adhere to
the prescribed regimen.
Nursing Diagnosis:

Risk for injury related to cultural factors secondary to health beliefs (hilot).

Nursing Goal:

After 20-30 minutes of nursing intervention, the patient will be able to prevent the
occurrence of injury to mother and fetus as will be manifested by doubts toward
consulting serious abnormal conditions to ordinary hilots.

Nursing Interventions with Rationale:

Nursing Intervention Rationale

• Discuss with the patient If a person who performs procedures
the
disadvantage of attending risky who has insufficient knowledge of the
clinical condition can bring about
procedures especially to people with
inadequate knowledge. erroneous outcomes, worse injuring the
patient and the fetus.
• Encourage the patient to adhere or The physician knows the most
comply with doctor’s order or appropriate thing to do for her clinical
prescriptions. condition.

Nursing Evaluation:

After 30 minutes of nursing intervention, the patient was able to prevent the
occurrence of injury to mother and fetus as manifested by doubts toward consulting
serious abnormal conditions to ordinary hilots.
Nursing Diagnosis:

Imbalanced nutrition more than body requirements related to excessive intake in

relationship to metabolic need as manifested by patients BMI of 29.44

Nursing Goal:

After 2-3 days of nursing intervention, the patient will be able to go back or execute
normal eating pattern.

Nursing Interventions with Rationale:

Nursing Intervention Rationale

• Discuss client’s motivation for weight Helps client determine realistic
loss. motivating factors, individual situations.

• Calculate calorie requirements based This will limit the intake of calories within
on physical factors and activity. the normal range that should be given to
her.
• Work with dietician to assist in Dietician knows the normal intake a
creating or evaluating nutritional pregnant woman should have.
program.
• Provide positive reinforcement or Enhance commitment to program.
encouragement for efforts as well as
act of weight loss.
• Encourage the patient do a light To burn excess fats and calories.
exercise.

Nursing Evaluation:

After 3 days of nursing intervention, the patient was able to go back or execute
normal eating pattern.
Nursing Diagnosis:

Knowledge deficit related to cognitive limitation as manifested by verbalization of

“pagsinsinublatek lattan tay pinagtumar ko ngamin maamak nak nga baka ma-
overdose ak”.

Nursing Goal:

After 2-3 hours of nursing intervention, the client will be able to understand the
importance of adhering to the prescribed medication as will be manifested by
following the treatment regimen as ordered by the physician.

Nursing Intervention:

Nursing Intervention Rationale

• Provide information about the The client will be aware about the
mechanism of action ferrous sulfate importance of both medications.
and obimin.
• Discuss with the patient the danger Letting the patient know the danger or
or risks of noncompliance to regimen. risks of noncompliance can cause fear on
her part. She cannot recover from the
abnormal condition if she does not
comply.
• Discuss with the patient the Letting the patient know and understand
importance of the drug regimen. the importance of the drug regimen to
encourage the patient to comply.
• Advise the client to seek consultation. The patient will be able to clear things
out on the drug regimen.

Nursing Evaluation:

After 3 hours of nursing intervention, the client was able to understand the
importance of adhering to the prescribed medication as manifested by following the
treatment regimen as ordered by the physician.
 COMPUTATIONS

Fundic Height: 22 cm

Naegele’s Rule

*LMP = December 4, 2008

Expected Date of Delivery (EDD)=

12/4/2008

-3+7+1

9/11/2009

*September 11,
2009

McDonald’s Rule

Age of Gestation (AOG)

in months = fundic height x 2/7

22 x 2/7

6.28 or 6-7 months

In weeks = fundic height x 8/7

22 x 8/7

25.14 or 25-26 weeks

Bartholomew’s Rule

31 weeks – halfway between umbilicus and xiphoid process

Obstetrical Data

LMP = December 4,2008

First clinic visit = april 17,2009

Month # of Days
Decembe 27
r 31
January 28
February 31
March 16
April
Total 133 days

AOG (in weeks) = 133/7 = 19 weeks

Johnson’s Rule

Estimated total weight = fundic height – n x k

=22-11x155

=1705 grams

Haese’s Rule

Estimated fetal length = (# of months)2

(7)2

49 cm

Body Mass Index

Weight
BMI =
(Height)2

68 kg.
=
(1.52m)2

=
29.44
(overweig
ht)
Height= 5ft

5ft x 12 = 60 in x 2.54 cm = 152.4 cm

Weight= 58kgs (prior to pregnancy)

DBW = height – 100; x-10%

152.4 – 100 = 52.4 – 10% of 52.4 = 47.16 or 47

*Range: 42.4 kgs to 51.9 kgs

Physical Activity = 40 kcal (moderate)

TER = DBW x PA = 47 x 40 = 1880 kcal

During Pregnancy,

58 kg

+ 1.35 kg (1st trimester)

+ 2.7 kg (2nd trimester)

+ 1.8 kg (3rd trimester, 1st month)

63.85 kg or 64 kg

Recommended Energy Intake

1880 kcal

+ 300 kcal

2180 kcal