INTRODUCTION

Nursing process is a patient centered, goal oriented method of caring that provides a frame
work to the nursing care. The nursing process exists for every problem that the patient has, and
for every element of patient care, rather than once for each patient. The nurse's evaluation of
care will lead to changes in the implementation of the care and the patient's needs are likely to
change during their stay in hospital as their health either improves or deteriorates. Nursing
process was used in this case study for a more systematic to care for a client who have
undergone a cesarean section birth.

A cesarean birth, also known as C-section, happens through an incision in the abdominal
wall and uterus rather than through the vagina. Some C-sections are planned due to pregnancy
complications or because you've had a previous C-section. But, in many cases, the need for a
first-time C-section doesn't become obvious until labor has already started. Knowing what to
expect during the procedure and recovery can help the mother prepare.

There has been a gradual increase in cesarean births over the past 30 years. In November
of 2009, the Centers for Disease Control and Prevention (CDC) reported the national cesarean
birth rate was the highest ever at 29.1%, which is over a quarter of all deliveries. This means
that over 1 in 4 women will experience a cesarean birth.

Objectives

Objectives of this case study were based on 11 competency standards of nursing practice.

General Objectives

 This case study aims to develop the application of critical and analytical thinking in the

nursing practice.

Specific Objectives

 To practice safe and quality nursing care by formulating Nursing Care Plans

 To give health education by performing health teaching with the patient and his family

 To practice legal and ethico-moral responsibility by documenting care rendered to the

patient
  For personal and professional development.

 Promotion of quality nursing service.

 To apply research findings in nursing practice

 To improve record management by maintaining accurate and updated documentation of

patient care

 To practice therapeutic communication with the client.

 To establish collaborative relationship with colleagues and other members of the health

team for the health plan

Significance of the study

To Nursing Students, It will help develop analytical and critical thinking by understand the

disease through anatomy and pathophysiology, analyzing the proper care to the patient by

formulating nursing care plans, drug study and recording the condition of the client by physical

examination, patient’s profile and activities in daily living.

To Nursing Educators, it will aid in identifying vital competencies to be developed in nursing

students, particularly proficiency of roles and functions in patient care and supervision.

To Hospital Management, It will contribute in improving quality of care to the patients by

applying nursing interventions mentioned in the case study.

To the Readers, It will serve as a guide in understanding more about peptic ulcer and its proper

nursing ,medical and collaborative management.

 Scope and delimitations
The study was conducted in pay ward of RPH last November 19, 2010. The study
focused on patient with Post Cesarian Section. The topics to be discussed are: Introduction,
Theoretical Framework, Pathophysiology, Anatomy & Physiology, and Patient’s History,
Physical Assessment, Hematology, Drug study, Discharge Plan and the Nursing Care Plan. All
subjects discussed, nursing interventions and recorded data were limited and based on the
patient’s condition.

Theoretical Framework

14 Functions of Nursing Care

By
Virginia Henderson
(1897 – 1996)

Virginia Henderson graduated from the Army School of Nursing, Washington, D.C., in
1921.Virginia Henderson defined nursing as "assisting individuals to gain independence in
relation to the performance of activities contributing to health or its recovery".  Her famous
definition of nursing was one of the first statements clearly delineating nursing from
medicine:"The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or its recovery (or to peaceful death) that
he would perform unaided if he had the necessary strength, will or knowledge and to do this in
such a way as to help him gain independence as rapidly as possible" (Henderson, 1966). She was
one of the first nurses to point out that nursing does not consist of merely following physician's
orders. Henderson enumerated the 14 functions she believed to be part of basic nursing care. The
nurse should help the patient to perform the following functions:

The 14 components

 Breathe normally.
 Eat and drink adequately.
 Eliminate body wastes.
  Move and maintain desirable postures.
 Sleep and rest.
 Select suitable clothes-dress and undress.
 Maintain body temperature within normal range by adjusting clothing and modifying
environment
 Keep the body clean and well groomed and protect the integument
 Avoid dangers in the environment and avoid injuring others.
 Communicate with others in expressing emotions, needs, fears, or opinions.
 Worship according to one’s faith.
 Work in such a way that there is a sense of accomplishment.
 Play or participate in various forms of recreation.
 Learn, discover, or satisfy the curiosity that leads to normal development and health and
use the available health facilities.
Breathe normally. Eliminate body wastes.Move and maintain desirable postures.

Eat and drink adequately. Sleep and rest

Learn, discover, or satisfy the curiosity that leads to normal development Select suitable clothes-dress and undress

Play or participate in various forms of recreation

HUMAN Maintain body temperature within normal range

Work in such a way that there is a sense of accomplishment Keep the body well groomed and protect the integument

WorshipCommunicate
according to one’s
with others
faith in expressing
Avoid
emotions,
dangersneeds,
in thefears,
environment
or opinions
and avoid injuring others
 NURSING ASSESSMENT

Demographic Profile:
Name : Patient EL
Age : 42 years old
Birthday : February 29, 1991
Address : Morong Rizal
Name of Spouse : M lobarbio
Nationality : Filipino
Occupation : Housewife
Educational Attainment: High School Graduate
Admission Date : November 25, 2010
Surgery Performed : ‘E’ LTCS + BTL

HISTORY OF PAST AND PRESENT ILLNESS

The patient stands 153 centimeters and weighs about 83 kilograms. Her AOG is 43
weeks, LMP was last November 1, 2008, and her EDC was on April 8, 2009. Her OB score is
G2P1 (2,0,0,2). She was already married at the age of 16 years old. She was only 17 years old
when she gave birth to her first child through Cesarean Section (Low Segment Transverse),
because she had a difficulty in delivering the child due to her age and the lack of knowledge.

It was on April 22, 2008 at around 8:00am when Patient Sik Ret Bontes was admitted at
the Ob-ward of Porac District Hospital and was sent to the OR/DR for an internal examination
and was told that her pregnancy was already over due. The patient opted for another cesarean
section for this pregnancy.
 PHYSICAL ASSESSMENT

Gordon’s Level of Functioning

Pattern Before Present Interpretation

1.Health Perception- Patient goes to the Patient is concern Patient cannot
Health Management health center once about her second function normally
upon when she got cesarean section anymore like before
pregnant. All in all, thinking that it may be because of her
she thinks she is in a detrimental to her hospital confinement
healthy state. health. and condition. Her
body image changed
after the surgical
procedure done.
2. Nutritional- Prior to confinement, During hospitalization, Patient’s nutritional
Metabolic patient loves eating the patient is on diet and metabolic status
Management instant foods and fatty as tolerated. She eats has been changed
foods like fries and fruits like apples and due to her
burgers. She also oranges. She eats confinement.
loves condiments like bread instead of rice.
“patis”, vinegar, and She said she loss her
soy sauce. She appetite since her
basically loves eating onset of labor.
whatever she likes.
3.Elimination Pattern Bowel: Bowel: Bowel:
Patient defecates 1-2 Patient defecates There was a change
times a day, usually once a day but not on in the frequency and
morning and in the a regular basis. Stool amount.
afternoon. Stool is is soft, minimal in
brown in color and amount and brown in
well-formed. color.

Bladder:
Patient voids usually Bladder: Bladder:
6-8 times a day. Urine Patient voids 3-4 There was a change
is yellow in color. No times a day without in the frequency and
pain when voiding. pain and discomfort. amount.
4.Activity, Leisure, Patient is a housewife Patient’s activities in During patient’s
and Recreation so she is always in the hospital are confinement in the
Pattern charge of the ambulation, deep hospital, there is a
household chores. breathing and limitation in her
Her leisure time would coughing exercise, activities of daily living
include playing with taking a bath or and a disruption in her
her firstborn and personal hygiene. leisure and recreation
watching television. pattern.
5.Sleep and Rest Patient puts herself to Due to her Patient’s sleep and
Pattern sleep by watching uncomfortable rest pattern changed
television programs. condition and pain, when she was
She usually sleeps at patient complains of admitted. She cannot
 around 11pm to 6am. difficulty of sleeping put himself to sleep
She feels rested when and short period of anymore due to
sleeping and thinks sleeps. present condition and
that her energy is pain plays a big factor
sufficient for her for her sleep
activities. disturbances.
6.Cognitive – Patient is a high Patient’s present No changes/
Perceptual Pattern school graduate. She condition is not a alterations.
can read and write. hindrance to her
She can speak and cognitive- perceptual
be understood by pattern.
others.
7. Self-Perception / Patient is a friendly During the times of There is a slight
Self-Concept Pattern person; she loves to her confinement, she change in her self-
socialize with his doesn’t think that she perception due to
friends in their is a holistic person present condition.
neighborhoods. She anymore. However,
considers himself as she is positive that
holistic human being she will be ok after
as long as she is confinement.
healthy, complete,
and his family is
always there.
8. Role Relationship Patient can The patient’s family is Normal/ No
understand English, supportive to the alterations.
Tagalog, and patient. She is happy
Kapampangan. She with their presence
has 5 siblings. She is and support.
married with 1 child.
9. Sexuality/ Patient has been Patient reserved her Patient reserved her
Reproductive Pattern married for 3 years. right to privacy. right to privacy.
10.Coping and Stress When patient is The recent Patient accepts
Tolerance stressed, she sings in hospitalization of the present condition with
the karaoke and eats patient was stressful a positive attitude.
comfort foods like and source of anxiety.
burgers, fries, and her However, she is
favorite sizzling sisig. positive that she will
When it comes to be able to cope up
problems, she lets with current condition.
herself think
immediately for a
solution.
11.Values- Belief Patient is a Roman She follows a Due to her
Pattern Catholic. She has a therapeutic regimen confinement, patient
strong faith to God and her strong faith to is trusting God that
and goes to mass God accounts for her she will be discharge
every Sunday with her fast recovery. soon and will recover
family. without any
complications.
 ANATOMY AND PHYSIOLOGY

Vagina

The vagina is a muscular, hollow tube that extends from the vaginal opening to the cervix of the
uterus. It is situated between the urinary bladder and the rectum. It is about three to five inches
long in a grown woman. The muscular wall allows the vagina to expand and contract. The
muscular walls are lined with mucous membranes, which keep it protected and moist. A thin
sheet of tissue with one or more holes in it, called the hymen, partially covers the opening of the
vagina. The vagina receives sperm during sexual intercourse from the penis. The sperm that
survive the acidic condition of the vagina continue on through to the fallopian tubes where
fertilization may occur.

The vagina is made up of three layers, an inner mucosal layer, a middle muscularis layer, and
an outer fibrous layer. The inner layer is made of vaginal rugae that stretch and allow
penetration to occur. These also help with stimulation of the penis. The middle layer has glands
that secrete an acidic mucus (pH of around 4.0.) that keeps bacterial growth down. The outer
muscular layer is especially important with delivery of a fetus and placenta.

Purposes of the Vagina

 Receives a males erect penis and semen during sexual intercourse.

 Pathway through a woman's body for the baby to take during childbirth.
 Provides the route for the menstrual blood (menses) from the uterus, to leave the body.
  May hold forms of birth control, such as a diaphragm, FemCap, Nuva Ring, or female
condom.

The cervix (from Latin "neck") is the lower, narrow portion of the uterus where it joins with the
top end of the vagina. Where they join together forms an almost 90 degree curve. It is cylindrical
or conical in shape and protrudes through the upper anterior vaginal wall. Approximately half its
length is visible with appropriate medical equipment; the remainder lies above the vagina
beyond view. It is occasionally called "cervix uteri", or "neck of the uterus".

During menstruation, the cervix stretches open slightly to allow the endometrium to be shed.
This stretching is believed to be part of the cramping pain that many women experience.
Evidence for this is given by the fact that some women's cramps subside or disappear after their
first vaginal birth because the cervical opening has widened.

The portion projecting into the vagina is referred to as the portio vaginalis or ectocervix. On
average, the ectocervix is three cm long and two and a half cm wide. It has a convex, elliptical
surface and is divided into anterior and posterior lips. The ectocervix's opening is called the
external os. The size and shape of the external os and the ectocervix varies widely with age,
hormonal state, and whether the woman has had a vaginal birth. In women who have not had a
vaginal birth the external os appears as a small, circular opening. In women who have had a
vaginal birth, the ectocervix appears bulkier and the external os appears wider, more slit-like
and gaping.

The passageway between the external os and the uterine cavity is referred to as the
endocervical canal. It varies widely in length and width, along with the cervix overall. Flattened
anterior to posterior, the endocervical canal measures seven to eight mm at its widest in
reproductive-aged women. The endocervical canal terminates at the internal os which is the
opening of the cervix inside the uterine cavity.

During childbirth, contractions of the uterus will dilate the cervix up to 10 cm in diameter to allow
the child to pass through. During orgasm, the cervix convulses and the external os dilates.

The uterus is shaped like an upside-down pear, with a thick lining and muscular walls. Located
near the floor of the pelvic cavity, it is hollow to allow a blastocyte, or fertilized egg, to implant
and grow. It also allows for the inner lining of the uterus to build up until a fertilized egg is
implanted, or it is sloughed off during menses.
The uterus contains some of the strongest muscles in the female body. These muscles are able
to expand and contract to accommodate a growing fetus and then help push the baby out during
labor. These muscles also contract rhythmically during an orgasm in a wave like action. It is
thought that this is to help push or guide the sperm up the uterus to the fallopian tubes where
fertilization may be possible.

The uterus is only about three inches long and two inches wide, but during pregnancy it
changes rapidly and dramatically. The top rim of the uterus is called the fundus and is a
landmark for many doctors to track the progress of a pregnancy. The uterine cavity refers to the
fundus of the uterus and the body of the uterus.

Helping support the uterus are ligaments that attach from the body of the uterus to the pelvic
wall and abdominal wall. During pregnancy the ligaments prolapse due to the growing uterus,
but retract after childbirth. In some cases after menopause, they may lose elasticity and uterine
prolapse may occur. This can be fixed with surgery.

Some problems of the uterus include uterine fibroids, pelvic pain (including endometriosis,
adenomyosis), pelvic relaxation (or prolapse), heavy or abnormal menstrual bleeding, and
cancer. It is only after all alternative options have been considered that surgery is recommended
in these cases. This surgery is called hysterectomy. Hysterectomy is the removal of the uterus,
and may include the removal of one or both of the ovaries. Once performed it is irreversible.
After a hysterectomy, many women begin a form of alternate hormone therapy due to the lack of
ovaries and hormone production.

At the upper corners of the uterus are the fallopian tubes. There are two fallopian tubes, also
called the uterine tubes or the oviducts. Each fallopian tube attaches to a side of the uterus and
connects to an ovary. They are positioned between the ligaments that support the uterus. The
fallopian tubes are about four inches long and about as wide as a piece of spaghetti. Within
each tube is a tiny passageway no wider than a sewing needle. At the other end of each
fallopian tube is a fringed area that looks like a funnel. This fringed area, called the
infundibulum, lies close to the ovary, but is not attached. The ovaries alternately release an egg.
When an ovary does ovulate, or release an egg, it is swept into the lumen of the fallopian tube
by the frimbriae.
PATHOPHYSIOLOGY

Release of FSH by
the anterior pituitary gland

Development of the graafian follicle

Production of estrogen (thickening

of the endometrium)

Release of the luteinizing hormone

Ovulation (release of mature ovum from

the graafian follicle)

Ovum travels into the fallopian tube

Fertilization (union of the ovum

and sperm in the ampulla)

Zygote travels from the fallopian tube

to the uterus

Implantation

Development of the fetus/embryo &

placental structure until full term

PRELIMINARY SIGNS OF LABOR

Lightening Braxton Hicks Contraction Ripening of the cervix

(descent of the fetal (false labor)
head into the pelvis) >begin and remain irregular
>1st felt abdominally
>pain disappears with
ambulation
(Goodell’s Sign wherein
the cervix feels softer like
consistency of the earlobe
 >do not increase in duration
and intensity
>do not achieve cervical
dilatation

TRUE LABOR

Uterine Contractions SHOW Rupture of

Membranes
>increase in duration (pink-tinge of blood, (rupture of the
and intensity a mixture of blood and fluid) amniotic sac)
>1st felt at the back &
radiates to the abdomen
>pain is not relieved no
matter what the activity
>achieve cervical dila-
tation

Failed to progress labor

(due to previous cesarean birth, cervical arrest,
cervical atrophy)

increase risk for fetal distress

(meconium staining, hypoxia)

Increase risk of fetal death

Emergent cesarean delivery

(the incision made on the lower part of the abdomen)

Expulsion of the fetus

Expulsion of the placenta

(accompanied by blood approximately
500-1000 mL)
 I. NURSING CARE PLAN

Post-operative NCP

ASSESSMENT DIAGNOSIS ANALYSIS OF PLANNING INTERVENTION RATIONALE EVALUATION

THE PROBLEM
Subjective: Risk for Due to an STG: Independent Patient is
- none infection related elective After 4 hours of -Monitor vital -To establish a expected to be
inadequate cesarean nursing signs baseline data free of
Objective: primary section, intervention, infection, as
- dressing dry defenses patient’s skin patient will be -Inspect dressing -Moist from evidenced by
and intact secondary to and tissue were able to and perform drainage can be a normal vital
-V/S taken as surgical incision mechanically understand wound care source of infection signs and
follows: interrupted. causative absence of
T: 37.3 Thus, the factors, identify - Monitor white - Rising WBC purulent
P: 80 wound is at risk signs of blood count (WB indicates body’s drainage from
R: 19 of developing infection and efforts to combat wounds,
BP: 120/80 infection. report them to pathogens; incisions, and
health care normal values: tubes.
provider 4000 to 11,000
accordingly. mm3
- Monitor
LTG: Elevated -these are signs
After 2-3 days temperature, of infection
of nursing Redness,
intervention, swelling,
patient will increased pain,
achieve timely or purulent
wound healing, drainage at
be free of incisions
purulent
drainage or - Wash hands -Friction and
erythema, be and teach other running water
afebrile and be caregivers to effectively remove
free of infection. wash hands microorganisms
before contact from hands.
with patient and Washing between
between procedures
procedures with reduces the risk of
patient. transmitting
pathogens from
one area of the
body to another

- Encourage fluid - Fluids promote

intake of 2000 ml diluted urine and
to 3000 ml of frequent emptying
water per day of bladder;
(unless reducing stasis of
contraindicated). urine, in turn,
reduces risk of
bladder infection
or urinary tract
infection (UTI).

- Encourage - These measures

coughing and reduce stasis of
deep breathing; secretions in the
consider use of lungs and
incentive bronchial tree.
spirometer. When stasis
occurs, pathogens
can cause upper
respiratory
infections,
including
pneumonia.
Independent:
-Administer -Antibiotics have
antibiotics bactericidal effect
that combats
pathogens
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION
Objective Cues:
 Patient has Risk for Short Term Goal: INDEPENDENT After 8º of
not yet constipation r/t INTERVENTIONS: nursing
eliminated post pregnancy Within 8º of  Ascertain normal  This is to interventions, the
since 2° cesarean nursing bowel functioning of determine the patient was able
delivery the patient, about normal bowel
section interventions, the to identify
 Absence of how many times a pattern
bruit patient will be measures to
day does she
sounds able to prevent infection
defecate  To increase
 Normal demonstrate  Encourage intake of as manifested by
the bulk of the
pattern of behaviors or foods rich in fiber stool and client’s
bowel has lifestyle changes such as fruits facilitate the verbalization of:
not yet to prevent passage “Iinom ako ng
returned developing through the maraming tubig
problem colon at kakain ng
 Promote adequate  To promote prutas para
fluid intake. moist soft makadumi ako.”
Suggest drinking of stool
Long Term Goal: warm fluids,
especially in the
morning to
Within 3 days of stimulate peristalsis
nursing  Encourage  To stimulate
interventions, the ambulation such as contractions of
patient will be walking within the intestines
able to maintain individual limits and prevent
usual pattern of post operative
bowel functioning  However, since she complications
has had cesarean,  To avoid
 also encourage stress on the
adequate rest cesarean
periods incision/
wound
COLLABORATIVE:

 Administer bulk-
forming agents or
stool softeners such  To promote
as laxatives as defecation
indicated or
prescribed by the
physician

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Acute pain r/t STG: Independent: Goal met. After
“Sobrang sakit,” as disruption of skin After 1-2hr of 2hrs of nursing
verbalized by the and tissue nursing - Established rapport. -To have a good intervention, the
patient. secondary to intervention, nurse-client patient verbalized
cesarean patient will relationship pain decreased
Objective: section. verbalize - Monitored vital signs. from a scale of 8/10
-Pain scale= 8/10 decrease intensity -To establish a – 3/20 as
-Teary eyed of pain from 8/10 - Assessed quality, baseline data evidenced by
-(+) guarding to 3/10. characteristics, (-) facial grimace
behavior severity of pain. -To establish (-) guarding
-(+) facial grimace baseline data for behavior.
-Irritable comparison in Frequent small
-Pale palpebral making evaluation talks with significant
conjunctiva and to assess for others
-Skin warm to - Provided comfortable possible internal
touch environment – bleeding.
-V/S taken as changed bed linens
follows: and turned on the -Calm environment
BP= 110/80 fan. helps to decrease the
PR= 80 anxiety of the patient
RR= 22 and promote
T= 37.6 - Instructed to put pillow likelihood of
on the abdomen decreasing pain.
when coughing or
moving. - To check for
diastasis recti and
protect the area of
the incision to
improve comfort. And
to initiate
nonstressful muscle-
setting techniques
and progress as
tolerated, based on
- Instructed patient to the degree of
do deep breathing separation.
and coughing
exercise. - For pulmonary
ventilation, especially
when exercising, and
to relieve stress and
- Provided diversionary promote relaxation.
activities. Initiate
ankle pumping, - To promote
active lower circulation, prevent
extremity ROM, and venous stasis,
walking prevent pressure on
the operative site.
Collaborative:
- Administer analgesic
as per doctor’s
order. -Relieves pain felt by
the patient
 DISCHARGE PLANNING

M – Medication

 Methylgonometrine 1 tab TID

 Mefenamic Acid 250mg 1 tab q4 hrs

 Ferrous sulfate 1 tab once a day

E – Environment

 Instructed patient to stay in calm, quiet environment

 Home environment must be free from slipping or accident hazards

T – Treatment

 Informed patient to have a follow-up check up after 1- 2 weeks

H – Health Teachings

 Informed patient to avoid lifting heavy objects for 1-2 weeks

 Stressed the importance of perineal cleanliness

 Encouraged client to have hot sitz bath

 Instructed patient to increase intake of protein-rich foods to promote faster wound

healing

 Instructed to promote adequate fluid intake

 Discouraged patient to participate in strenuous activities that might precipitate

stress and trauma to the wound

 Instructed patient to promote breastfeeding

O – Observable Signs and Symptoms

 Observe for dehiscence and evisceration

 Instructed patient to report to physician any signs of infection

  Instructed patient to report any case of hemorrhage or abnormal bleeding

D – Diet

 Encouraged client to increase intake of fiber to avoid constipation

 Instructed to increase fluid intake

 Instructed to increase intake of nutritious foods such as fruits and vegetables

 DRUG NAME ACTION AND INDICATION SIDE EFFECTS AND NURSING
ADVERSE EFFECT CONSIDERATION

KETOROLAC Anti inflammatory and -headache 1. be aware that patient may

analgesics activity; inhibits be at increase risk for CV
30 MG TIV Q6 -dizzziness
prostaglandins and events, GI bleeding, renal
leukotriene synthesis. -somnolence toxicity.

Shorterm management of -Insomia 2. do not use during labor,

pain up to 5 days delivery or while nusing;
-fatigue
serious drug effect to th fetus
-tinnitus or baby possible

3. protects drug vials from

light

4. every effort will be made

to administer the drug on
time to control pain,
dizziness drowsiness can
occur

DRUG NAME ACTION AND INDICATION SIDE EFFECTS AND NURSING

 ADVERSE EFFECT CONSIDERATION

NALBUPHINE Nalbuphine act as an It can cause sedation 1. taper dosage when

HYDROCHLORIDE antagonist at specific opiod clamminess, sweating, discontinuing after prolonged

receptors in the CNS to headache, dizziness vertigo, use to avoid withdrawal

NUBAIN syndrome
produce analgesia and drymouth and tachycardia
10 MG TIV Q4, 4 DOSES sedation but also acts to 2. reassure patient about
cause hallucination and is an addiction liability most patients
antagonist at mu receptors who receive opiates for medical
reason do not develop
For post operative analgesia dependence syndrome
as a supplement to surgical
3. keep opiod antagonist and
anesthesia and for obstetric
facilities for assisted or
analgesia during labor and
controlled respiration available
delivery.
in case of respiratory
depression
 CASE STUDY:
POST CESARIAN
BIRTH

KARLO G. BARTOLOME
BSN 4B
GROUP B1