A Case study on

Cesarean Section Delivery

In Partial Fulfillment of the Course Requirements in

Medical Nursing

Submitted to the Faculty of Cebu Doctors University

College of Nursing

Submitted by:
Perez, Diana U.
BSN IV-D

TABLE OF CONTENTS
I.
II.
III.

Introduction
Objectives
Nursing Assessment
1. Personal History
1.1. Patients profile
1.2. Family and individual information
1.3. Level of growth and development
1.3.1. Normal development at particular stage
1.3.2. The ill person at particular stage of patient
2. Diagnostic Results
3. Present profile of Functional Health Patterns
4. Pathophysiology and Rationale
4.1.Normal anatomy and physiology of female reproductive
system
4.2. Schematic drawing to show pathophysiology of
Cesarean Section Delivery
4.3. Disease process and its effect on different organ/system
4.4. Comparative chart to show the classical signs and
symptoms of the disease and the actual manifestation of the
patient with rationale.
IV. Nursing Intervention
1. Care guide of patient with bipolar I disorder
2. Actual patient care:
2.1. Brunswick lens model
2.2. Nursing care plan
2.3. SOAPIE charting
2.4. Health teaching plan
2.5. Drug therapeutic record
V. Evaluation and recommendation
VI. Evaluation and implication of this case study to:
1. Nursing practice
2. Nursing education
3. Nursing research
VII. Bibliography

I. INTRODUCTION
Pregnancy is the gestational process, comprising the growth and development within
a woman of a new individual from conception through the embryonic and fetal periods to
birth. It lasts approximately 266 days (38 weeks) from the day of fertilization but it is
clinically considered to last 280 days (40 weeks; 10 lunar months;91/3 calendar months)
from the first day of the last menstrual period. Because pregnancy changes a womans
normal hormone patterns, one of the first signs of pregnancy is a missed menstrual
period.
The first few months of pregnancy are the most critical for the developing infant,
because during this period the infants brain, arms, legs, and internal organs are form. For
this reason, a pregnant woman should be especially careful about taking any kind of
medication except on the advice of a physician who knows that she is pregnant. Pregnant
women should avoid x rays, smoking and alcohol consumption.
Delivery, the process by which the baby is expelled from the uterus through the
birth canal and into the world, begins with irregular contractions of the uterus that occur
every 20 to 30 minutes. As labor progresses, the contractions increase in frequency and
severity. The usual length of labor for a first-time mother is about 13 to 14 hours, and
about 8 or 9 hours in a woman who has given birth previously. Wide variations exist,
however, in the duration of labor.
Cesarean delivery is defined as the delivery of a fetus through a surgical
incision through the abdominal wall (laparotomy) and uterine wall (hysterotomy). The
words cesarean and section are both derived from verbs that mean to cut. Cesarean
section is one of the most common procedures done on the OR/DR. everyone seems to be

pretty familiar with it, us included. However, encountering a cesarean section procedure
and participating in it as student nurses is an entirely different experience.

The student nurse chose this for her case study out of curiosity of how or why
many post partum patients would experience complications days after and as to how
closely the patient should be monitored time to time to rule out those possible
complications. It also serves as knowledge experience for her to utilize if she encounters
patients with similar conditions. We all know that fatality is a big possibility if post
partum patients are uncared. Therefore, it is important that student nurse knows exactly
on how much care is to be rendered for such patients. Close monitoring of mothers
should be done in order to rule out possibility for complications to occur for mothers at
this time are more prone to life threatening complications. The care mother receives
during this period influence her health for the rest of her life.

II. OBJECTIVES:

General Objectives:
After 2 days of student-nurse client interaction, the student-nurse will be
able to gain adequate knowledge, attitude and skills in caring for a patient who undergone
Cesarean Section towards optimum level of functioning.
Specific Objectives:
After 8 hours of student- nurse and patient interaction, the student- nurse
will be able to:
1. reinforce a thorough assessment of the patient
2. state the normal level of growth and development of the patient
3. discuss the anatomy and physiology of the organs or systems involved
4. explain the physiology of Cesarean Section delivery
5. formulate a comprehensive nursing care plan for the post partum patient
6. implement the formulated nursing care plan
7. impart health teaching related to the care of the post partum patient
8. evaluate the effectiveness of the nursing care implemented
After 8 hours of student-nurse and patient interaction, the patient and significant
others will be able to:
1. establish a trusting relationship with the student nurse
2. discuss relevant history and information about self
3. get involved in the planning of case management with the student nurse
4. cooperate with the nursing students in the implementation of care measures
5. show skills in the management of post partum
6. verbalize feelings about the student nurse and patient interaction

III. NURSING ASSESSMENT

1. Personal History
1.1 Patients Profile
Name: Mrs. Tagalog, Chanel
Age: 28 years old
Sex: Female
Civil status: Married
Religion: Roman Catholic
Date of Admission: April 12, 2010
Room No. OB 1
Complaints: irregular contractions
Impression/Diagnosis: Pregnancy Uterine Full term, incomplete
breech presentation, delivered via primary cesarean section a live male
neonate
Physician: Dr. Yu
1.2 Family and Individual Information, Social and Health History:
A case of 28-year-old female, Mrs. Tagalog, Chanel, Roman Catholic and
married, was admitted at Cebu Doctors University Hospital for the first time.
One week prior to admission, patient had onset of irregular uterine contractions.
Patient tolerated condition; noted passage of vaginal discharge, consulted at labor room,
internal exam was 1 cm cervical dilatation, 50% effacement, NST reactive. Patient was
sent home advised.
Morning prior to admission, patient came in for prenatal check-up at CDUHOPD, internal exam was 1-2 cm, 50% effacement, -3 station. Patient noted irregular
contractions, negative vaginal discharges, good perception of fetal movement. Patient
was then advised admission.
LMP: July 222009
EDC: April 29 2010
AOG: 38 6/7 weeks

1.3 Level of Growth and Development

1.3.1 Normal Development during Young Adult

A. Physical Development
Young Adult: 20-40 years
Psychosocial
Intimacy vs Isolation
The young adults face a number of new experiences and changes
in lifestyle as they progress toward maturity. Choices must be made about
education and employment, about whether to marry or remain single, about
starting a home, and about rearing children. Social responsibilities include
forming new friendships and assuming some community activities. Many
people choose to remain single, perhaps to pursue an education and then to
have the freedom to pursue their chosen vocation.
is in the genital stage in which energy is directed toward attaining a
mature sexual relationship, according to Freuds theory.
has the following developmental tasks:
-

selecting a mate

learning to live with a partner

managing home

starting a family

rearing children

finding a congenial social group

Physical Development
People in their early 20s are in their prime physical years. The
musculoskeletal system is well developed and coordinated. This is the period
when athletic endeavors reach their peak. All other systems pf the body are
also functioning at peek efficiency. Weight and muscle mass may change as a

result of diet and exercise. In addition, extensive physical and psychosocial

changes occur in pregnant and lactating women.

Cognitive Development
Piaget believes that cognitive structures are complete during the
formal operations period. From that time, formal operations (for example,
generating hypotheses) characterize thinking throughout adulthood and are
applied to more areas. Egocentrism continues to decline; however, these
changes do not involve a change in the structure of thought, only a change in
its content and stability. Researchers in the field pf psychology have
suggested that Piagets formal operational stage is not the last stage of
human development. Some have proposed a concept of post-formal thought,
sometimes called the problem finding stage and is characterized by creative
thought in the form of discovered problems, relativistic thinking, the formation
of generic problems, raising of general

questions

from

ill-defined

problems, use of intuition, insight and hunches, and the development of

significant scientific thought. Post-formal thinkers possess an understanding
of the temporary or relative nature of knowledge and are able to comprehend
and balance arguments created by both logic and emotion.
Moral Development
Young adults who have mastered the previous stages of Kohlbergs
theory. This time, the person is able to separate self from the expectations
and rules of others and to define morality in terms of personal principles.
When individuals perceive a conflict with societys rules or laws, they judge
according to their own principles. Men often use an ethic of justice and
define moral problems in terms of rules and rights. Women, by contrast, often
define moral problems in terms of obligation to care and to avoid hurt.

Spiritual Development
The individual, according to Fowler, enters the individuatingreflective period sometime after 18 years of age. In this period, the individual
focuses on reality. The religious teaching that the young adult had as a child
may now be accepted or redefined.
1.3.2. The ill person at particular stage of patient
Traditionally, it is assumed that the bulk of a womans concern in
the postpartal period center on the care of her new infant. Based on this, classes
in the postpartal period have traditionally focused on teaching how to breast-feed
and bathe infants. Although these acts are concerns for many mothers, they are
not necessarily a new mothers chief concern. She ahs come through a
tremendous psychological experience during pregnancy and the birth of a child.
She is in the middle of a complete role change. It is only to be expected that
some of her attention and interest during this time will be directed inward as she
tries to view herself in this new role. Typical issues identified by postpartal
women include their partner, and their children; coping with emotional tension
and sibling jealousy and fatigue.

2. Diagnostic Results
DATE: April 12, 2010
Complete Blood Count
Diagnostic Tests

Normal Values

Patients Results

Significance

Hemoglobin

12.3 15.3 g/L

12.6g/L

Normal

Hematocrit

35.9 44.6 %

37.3%

Normal
= acute

WBC count

4.4 11.0 10^3/uL

13.38 10^3/uL

infection

Neutrophil

40.0 70 %

82%

= infection

Basophil

0.00 1 %

0%

Normal

Eosinophil

0.00 5%

2%

Normal

20.0 40.0 %

12%

= infection

0-6%

5%

Normal

4.5 5.10 106/uL

4.3 10^6/uL

= after

Lymphocyte
Monocyte
Red Cell count

hemorrhage
MCV

80.0 96.0 fL

93.5 fL

Normal

MCH

27.5 33.2 pg

31.6 pg

Normal

MCHC

33.4 35.5 g/L

35 g/L
9.40 fL

Normal

MPV

5.9 9.90 fL

RDW

14.0 18.0 %

Normal
13.1 %

= hypochromic
anemia

Platelet

140.0 440 103/

199 10^3/uL

Normal

uL

3. PHYSICAL ASSESSMENT (IPPA)

BODY PART

HEAD:
Smooth, evenly
Hair

Oily, shiny

distributed short,
black hair
No presence of

No lesions,

Scalp

dandruff
Presence of

lumps
Warm, no

Forehead

pimples,

tenderness

absence of
wrinkles
EYES:
Hair evenly
Brows

distributed,
symmetrically
aligned
Slightly curved

Lashes

upward

Conjunctiva

Pinkish, moist

Sclerae

White and clear

Iris

Round, black,
uniform
Equally round,
reactive to light
and

Pupils

accommodation,
equal reaction of
both sides
Without

Visual Acuity

eyeglasses, can

Peripheral

read
Can see the

Vision

objects at

NOSE

periphery
Centrally located;

Symmetrical;

nasal septum

firm and not

intact

painful

Not visible

Not tender

Frontal and
maxillary
sinuses
MOUTH:

Lips

dry

Slightly smooth

Gums

Pinkish, moist

tenderness

Teeth

No dentures

Hard

used, 28 ivory

colored
Hard Palate

Whitish

Soft Palate

Pinkish

Uvula
Tonsils

Midline
Not inflamed,

tenderness
tenderness

pink
Tongue

Pinkish

Not tender

Symmetrically
EARS:

aligned with eye

Not painful,

level, presence

free of lumps

of cerumen
NECK:

Midline,

Carotid pulse:

symmetrical

82 bpm

Lymph nodes

Not enlarged

Central
Trachea

placement in the

movable

midline of the
neck
Goes up and
Thyroid Gland

Not enlarged,

down when

not visible

patient
swallows

Rises and falls

CHEST:

Resonant

Broncho-

sound heard

vesicular

and exhalation,

upon

sound heard

20 bpm, equal

percussion

during inhalation

No masses

chest expansion
Chest

Moves the

excursion

thumb
separately
Regular and
normal rate

Heart

and rhythm
= 84 bpm,
no murmurs
Normal
breath

Lungs

Equal lung

Equal chest

Resonant

sound 20

expansion

excursion

sound

bpm, no
crackles /
wheezes

Soft, smooth,
warm to touch,
Abdomen

Bowel

Presence of

kidney and

Resonance

sounds = 15

striae and of

spleen not

to dullness

bowel

linea negra

palpable, liver

sounds per

if not enlarged

minute

EXTREMITIES
Arms
Upper

Brown in color

PR = 88 bpm

reacted

BP = 110/70

Extremities

and able to

Temp = 36.9

when hit by

move

Warm, no

hammer

lesions, strong
Legs
Lower

Brown in color,

Tibial and

reactive to

Extremities

able to walk but

dorsalis pedis

percussion

slowly, pain

pulse are

hammer

upon standing

palpable

and moving
SKIN

Fair in color, dry,

Smooth, warm,

perspiration

good skin

present,

turgor

absence of
lesions

4. Present profile of Functional Health Patterns

Health Perception/Health Management Pattern

Before the delivery, she describes her health as poor. Since being pregnant is
very hard have a lot of changes. One thing that is really difficult to bear is the
pain in the abdominal area upon contractions and also the difficulty in walking
and in getting up. After delivery, she then described her health as fair since there
is already lesser pain. There is no mobility nor sensory defect but shes
complaining about fatigue and sleep disturbance, the pain felt in the perineum.
Good nutrition is required to keep her healthy and also medications &
supplements are given as her treatment for her to take. She expected to feel well
and was able to follow the prescribe instruction by the doctor and nurses.

Nutritional - Metabolic Pattern

She eats meals three times a day at the right time and sometimes eats snacks.
She drinks milk every night before going to sleep. Her usual fluid intake was
around 7-9 glasses of water a day. Before the delivery the patient has a good
appetite. She eats a lot since she knows that it is needed for her health and for
the health of her baby inside. After the delivery, she loosed weight. She is
currently taking some supplements for her health. She does not have any eating
disorders or disability and she even drinks milk every meal. She also doesnt
have any allergies to any food or even medications.

Elimination Pattern

Before the delivery, she has no problems in voiding since there is no pain felt.
After the delivery, she feels pain at times. She said that she has no problems in
voiding but has fear in defecating because of her suture. She is currently using
maternity napkin. Although theres the presence of pain, shes not using any
assistive devices when urinating and defecating.

Activity/Exercise Pattern

Before the delivery, the patient does a lot walking. Her usual activities are
cleaning, cooking, watching television or dvds and sometimes read books or
even listening to music. She does ante-partum exercises since she knows that it
could help in a faster delivery. After the delivery, she feels pain upon standing or
moving and especially when exerting a lot of effort thats why she is being
assisted by her husband in what ever she does. She also said that shell be
doing some exercises in order to regain her body figure.

Cognitive/Perceptual Pattern

She doesnt have deficits in sensory perception before and after

the delivery. Patient is oriented with the time, place and of the persons in the
hospital. She is also aware of her current condition. She doesnt have any
glasses and can read and write very well.

Sleep/Rest Pattern

The patient experiences disturbance in her sleep before and after the delivery.
She used to sleep early that usually ranges 7-8 hours but it has changed. After
the delivery and now with the new baby around she sleeps only 2-3 hours since
the baby always cry which keeps her awake and feel worried and also, she
constantly monitors her baby.

Self-perception Pattern

Before the delivery and even after she has delivered, she is most concerned with
her baby. She is also concerned about getting better and be back at her normal
non-pregnant state. She is also concerned about her supply of breastmilk for
baby. She is aware of her health condition and knows that she needs to rest in
order to recover She is excited to go home together with the baby.

Role-Relationship Pattern

The patient said that her role now has changed. Before her attention centers
towards her common-law husband in taking good care and now a new phase
in her life is to begin and that is to become a good mother. She speaks and
understands English, Filipino and Cebuano dialect. She is communicative and
coherent. She is living together with her common law husband. She doesnt
have any problems dealing with her relatives. In terms of decision-making,
role discipline and finances she and her husband both decide.

Sexual Reproductive Pattern

She and her partner decided to have child spacing. Their ideal no. of children
is 2 or 3 only. For now, she is not sexually active due to the vaginal tears and
that they both have decided to focus on caring about their first baby.

Coping-Stress Tolerance Pattern

She doesnt feel so much stress because she knows that her family and
partner is there to support her all throughout.

Value-Belief System

Patient is a Roman Catholic and her family. They go to church every Sunday
at Punta Princesa and during other special occasions together. God is their
source of strength in all their upcomings and problems in life. They pray
together to God for guidance and safety.

V. PATHOPHYSIOLOGY AND RATIONALE

5.1 NORMAL ANATOMY AND PHYSIOLOGY

EXTERNAL GENITALIA

Our overview of the reproductive system begins at the external

genital area or vulvawhich runs from the pubic area downward to the
rectum. Two folds of fatty, fleshy tissue surround the entrance to the
vagina and the urinary opening: the labia majora, or outer folds, and the
labia minora, or inner folds, located under the labia majora. The clitoris,
is a relatively short organ (less than one inch long), shielded by a hood of
flesh. When stimulated sexually, the clitoris can become erect like a man's

penis. The hymen, a thin membrane protecting the entrance of the

vagina, stretches when you insert a tampon or have intercourse.

INTERNAL REPRODUCTIVE STRUCTURE

Vagina
The vagina is a muscular, ridged sheath connecting the external genitals
to the uterus, where the embryo grows into a fetus during pregnancy. In
the reproductive process, the vagina functions as a two-way street,
accepting the penis and sperm during intercourse and roughly nine

months later, serving as the avenue of birth through which the new baby
enters the world.
The Cervix
The vagina ends at the cervix, the lower portion or neck of the uterus. Like
the vagina, the cervix has dual reproductive functions. After intercourse,
sperm ejaculated in the vagina pass through the cervix, then proceed
through the uterus to the fallopian tubes where, if a sperm encounters
an ovum (egg), conception occurs. The cervix is lined with mucus, the
quality and quantity of which is governed by monthly fluctuations in the
levels of the two principle sex hormones, estrogen and progesterone.
When estrogen levels are low, the mucus tends to be thick and sparse,
which makes it difficult for sperm to reach the fallopian tubes. But when
an egg is ready for fertilization and estrogen levels are high the mucus
then becomes thin and slippery, offering a much friendlier environment to
sperm as they struggle towards their goal. (This phenomenon is employed
by birth control pills, shots and implants. One of the ways they prevent
conception is to render the cervical mucus thick, sparse, and hostile to
sperm.)
Uterus
The uterus or womb is the major female reproductive organ of humans.
One end, the cervix, opens into the vagina; the other is connected on
both sides to the fallopian tubes. The uterus mostly consists of muscle,

known as myometrium. Its major function is to accept a fertilized ovum

which

becomes

implanted

into

the

endometrium,

and

derives

nourishment from blood vessels which develop exclusively for this

purpose. The fertilized ovum becomes an embryo, develops into a fetus
and gestates until childbirth.
Oviducts
The Fallopian tubes or oviducts are two very fine tubes leading from the

ovaries of female mammals into the uterus. On maturity of an ovum, the

follicle and the ovary's wall rupture, allowing the ovum to escape and
enter the Fallopian tube. There it travels toward the uterus, pushed along
by movements of cilia on the inner lining of the tubes. This trip takes
hours or days. If the ovum is fertilized while in the Fallopian tube, then it
normally implants in the endometrium when it reaches the uterus, which
signals the beginning of pregnancy.
Ovaries
The ovaries are the place inside the female body where ova or eggs are
produced. The process by which the ovum is released is called ovulation.
The speed of ovulation is periodic and impacts directly to the length of a

cycle. After ovulation, the ovum is captured by the oviduct, where it

traveled down the oviduct to the uterus, occasionally being fertilized on
its way by an incoming sperm, leading to pregnancy and the eventual

birth of a new human being. The Fallopian tubes are often called the
oviducts and they have small hairs (cilia) to help the egg cell travel.

Mammary Glands
These are the organs for milk production and are located in the breasts. A rise in
estrogen at puberty produces a marked increased in size from increased
connective tissue and deposition of fat in girls and a transient increase in boys.
Its glandular tissue is necessary for successful breast-feeding, remains
undeveloped until a first pregnancy begins. During pregnancy, she experiences a
feeling of fullness, tenderness or tingling in her breasts because of the increased
stimulation of breast tissue high estrogen level in the body. As pregnancy
progresses, breast size increases because of hyperplasia of mammary alveoli
and fat deposits. Early in pregnancy, breast begins readying themselves for the
secretion of milk. And of the 16 th week, colostrum, the thin, watery, high-protein
fluid that is the precursor of breast milk, can be expelled from nipples.
SYSTEMIC CHANGES
Integumentary System
As the uterus increases in size, the abdominal wall must stretch to
accommodate it. This stretching can cause rupture and atrophy of small
segments of the connective layer of the skin. This leads to (striae gravidarum)
pink or reddish streaks appearing on the sides of abdominal wall and
sometimeson thighs. During weeks after birth, striae gravidarum lighten to a
silvery-white color, and, although permanent, become barely noticeable. A
narrow,brown line (linea nigra) may form, running from umbilicus to the
symphysis pubis and separating the abdomen into right and left hemispheres.
Darkened areas may appear on face as well, particularly on the cheeks, and
across nose, known as melasma or mask of pregnancy. Vascular spiders (small,
fiery red branching spots) are sometimes seen on the skin of pregnant women,

particularly on thighs as a result from increased level of estrogen. They may fade
but not completely disappear after pregnancy. The activity of sweat glands
increases and is manifested in an increase in perspiration.
Respiratory System
During pregnancy most women worry about stuffiness of the
nasopharynx or shortness of breath. As the uterus enlarges during pregnancy, a
great deal of pressure is pull on the diaphragm and, ultimately, on the lungs. The
diaphragm may be displaces by as much as 4cm upward. This crowding of chest
cavity causes an acute sensation of shortness of breath late in pregnancy, until
lightening relieves the pressure. Residual volume is decreased up to 20% as the
woman draws in extra volume to increase effectiveness of air exchange. 20% is
increased in total oxygen consumption.
Cardiovascular System
The total circulatory blood volume of the womans body increases by at
least 30% during pregnancy. Blood loss of about 300-400mL in a normal vaginal
birth. The increase in blood volume occurs gradually, beginning at the end of first
trimester. Because plasma volume increases faster than RBC production does,
concentration of hemoglobin and erythrocytes declines, leading to pseudoanemia
in early pregnancy. In order for the body to compensate, there is more production
of RBCs by 2nd trimester. Since fetus requires 350-400mg of iron to grow and
mothers circulatory RBC mass require an additional 400mg of iron, a total of
800mg is in need. And because iron

absorption may be impaired during

pregnancy as a result of decrease gastric acidity, additional iron is often

prescribed during pregnancy to prevent true anemia. During the 3 rd trimester,
blood flow to the lower extremities is impaired by the pressure of the expanding
fetus/uterus on veins and arteries, rectum and legs. Blood pressure doesnt
normally rise because of the increase heart action takes care of the greater
amount of circulating blood. In most women, blood pressure actually decreases

slightly during the 2nd trimester because of the lower peripheral resistance to
circulation as the placenta expands rapidly.

Gastrointestinal System
As the uterus increases in size, it tends to push the stomach and
intestines toward the back and sides of the abdomen. At about the midpoint of
pregnancy, this pressure may be sufficient to slow intestinal peristalsis and the
emptying time of the stomach, leading to heartburn, constipation and flatulence.
Pressure from the uterus on veins returning from the lower extremities can lead
to hemorrhoids. At least 50% women experience some nausea and vomiting
early in pregnancy. More frequent in women who smoke cigarettes. Known as
morning sickness, nausea and vomiting begin to be noticed at the same time
levels of hcg and progesterone begin to rise.

Urinary System
Water is retained during pregnancy to aid the increase in blood volume
and to serve as a ready source of nutrients to the fetus. Because nutrients can
pass to the fetus only when dissolved in or carried by fluid. During pregnancy, a
womans kidneys must excrete not only the waste product of her body but also
those of the growing fetus. Also, must be able to excrete additional fluid and
manage the demands of increased renal blood flow. Urinary output gradually
increases by about 60-80%. The specific gravity decreases. The glomerular
filtration rate and renal plasma flow begin to increase in early pregnancy to meet
the increased needs of the circulatory system. A pregnant woman may

notice

an increase in urinary frequency during the first 3 months of pregnancy,

until

the uterus rises out of the pelvis and relieves pressure on the bladder.
Frequency of urination may return at the end of pregnancy, as lightening
occurs and fetal head exerts renewed pressure on the bladder.

Skeletal System
As pregnancy advance, there is a gradual softening of the womans
pelvic ligaments and joints to created pliability and to facilitate passage of the
baby through the pelvis at birth. This softening is probably caused by the
influence of both the ovarian hormone relaxin and placental progesterone. A wide
separation of the symphysis pubis, as much as 3-4mm by 32 weeks of
pregnancy, may

occur. Making women walk with difficulty because of pain. To

change her center of gravity and make ambulation easier, a pregnant woman
tends to stand straighter and taller than usual. pride of pregnancy, standing this
way, with shoulders back and abdomen forward, creates a lordosis leading to
backache.
Endocrine System

Gland

Changes

Effect

Thyroid

slight enlargement

- basal metabolic rate

thyroid hormone

- oxygen consumption

production

Parathyroid

- slight enlargement

- better utilization of calcium

- parathyroid hormone

and vitamin D

production

Pancreas

- early in pregnancy, insulin

- additional glucose is

production because of heavy

available for fetal growth

fetal demand for glucose

- after 1st trimester, insulin

production because of insulin

antagonist properties of
estrogen, progesterone and
HPL

Pituitary

- FSH & LH decreased

- anovulation

Gland

- Prolactin

-breast prepared for

-melanocyte stimulating

lactation

hormone

- skin pigment

- human growth hormone

Placenta

- estrogen and progesterone

-uterine and breast

produced

engorgement, fat deposits,

- relaxin

blood coagulation, Na&

H20 retention
- softening of cervix and
collagen of joints, glucose
available for fetus,
utilization of protein for
energy, protein

5.2 Schematic Drawing

PHYSIOLOGY OF CESAREAN DELIVERY

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
cervix
(descent of the fetal
Sign wherein
head into the pelvis)
feels softer like

Braxton Hicks Contraction Ripening of the

(false labor)

(Goodells

>begin and remain irregular

>1st felt abdominally

the cervix

consistency of

the earlobe
>pain disappears with ambulation
>do not increase in duration
and intensity
>do not achieve cervical
dilatation

TRUE LABOR

Uterine Contractions
of Membranes

>increase in duration
the amniotic sac)
and intensity
>1st felt at the back &
radiates to the abdomen
>pain is not relieved no
matter what the activity
>achieve cervical dilatation

SHOW

Rupture

(pink-tinge of blood,

(rupture of

a mixture of blood and fluid)

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

5.3 Disease / Condition Process
UTERUS
The most obvious alteration in the womans body during pregnancy is the
increase in size of the uterus to accommodate the growing fetus.
AMENORRHEA
Amenorrhea occurs with pregnancy because of the suppression of follicle
stimulating hormone by rising estrogen levels. In a healthy woman who has
menstruated previously, the absence of menstruation strongly suggests that
impregnation has occurred.
CERVICAL CHANGES
Softening of the cervix in pregnancy is marked. This softening is so marked it is
rated as a probable diagnostic signs of pregnancy.
VAGINA
An increase in the vascularity of the vagina, beginning early in pregnancy,
parallels the vascular changes in the uterus. The resulting increase in circulation
changes the color of the vaginal walls from the normal light pink to violet.
OVARY
Ovulation stops with pregnancy because of the active feedback mechanism of
estrogen and progesterone produced by the corpus luteum early in pregnancy
and by the placents later in pregnancy.
BREASTS
As the pregnancy progresses breast size increases because of hyperplasia of
the mammary alveoli and fat deposits. The vascularity of the breast increases
and the areola of the nipples darkened.

5.4 Comparative Chart

Classical
1. Abdominal pain

Clinical
manifested

Rationale
- sign of uterine contraction

- felt first in lower back and

sweep around the
abdomen in wave

Source: Maternal & Child

Health Ng., 4th ed. by Adele

2. nausea and
vomiting

manifested

Pilliteri p.468
- due to hormonal changes

- morning sickness

- due to intense discomfort

felt during the transition
phase
Source: Maternal & Child
health Ng., 4th ed. by Adele

3. extreme tiredness
(fatigue)

manifested
- patient was fatigue after

Pilliteri p. 485
- a woman is generally tired
from labor processes

giving birth
Source: Maternal & Child
Health Ng., 4th ed. by Adele
4. constipation

manifested

Pilliteri, p.487
- the gastrointestinal system

- pt. not able to void after

becomes fairly inactive

first 24 hours from delivery

during labor. This is probably

due to the shunting of blood
to non life-sustaining organs
and also to pressure on
stomach & intensive from the
contracting uterus

Source: Maternal & Child

Health Ng., 4th ed. Adele
5. diarrhea

not manifested

Pilliteri, p. 487
- some women experience a
loose bowel movement as
contractions grow strong
Source: Maternal & Child
Health Ng., 4th ed. by Adele

6. pain

manifested

Pilliteri p. 487
- uterine contractions cause
pain. Pain also results from
incision in the mid-lower
abdomen
- from sutures, uterine pain
or after pains and breast
tenderness
Source: Maternal & Child
Health Ng., 4th ed, Adele
Pilliteri, pp. 521-522

V. NURSING INTERVENTIONS
1. CARE GUIDE OF PATIENT
A. Provide pain relief
Pain from uterine contractions can be intense, but you can assure the woman
that this type of discomfort is normal and rarely lasts longer than three days. If
necessary, either Ibuprofen, which is anti-inflammatory properties, or a common
analgesics such as acetaminophen is effective for relief. As with any abdominal
pain, heat to the abdomen should be avoided, because if could cause relaxation
of the uterus and subsequent uterine bleeding.

B. Enhance family functioning and bonding

womans self-esteem
and allowingOBJECTIVE
her to view herself
as a new mother
SCIENTIFIC
RATIONALE
NEEDSIncrease
/
NURSING
NURSING
BASIS
/
OF
PROBLEMS
ACTIONS
and her DIAGNOSIS
new infant as partSIGNIFICANCE
of their family. Teaching new mothers
is important, but
CARE
CUES
it is also important to explore what they already know about child care and what
they think would be a sensible solution to a problem.
Measures to
I. Physiologic
Pain is an
After 8 hours
relieve and
Overload
Altered
unpleasant
of holistic
control pain:
muscular
a. Altered C. Relieve
comfort:
pain aches
sensory
nursing care,
Comfort A woman
related
experience
he patient
will
maytoneed a mild
analgesic such
as acetaminophen
for the pain. A
1. provide
(Pain)
bikini line
arising from
be able to:
- promotes
comfort
backrubincision
is effective
for
relieving
an
aching
back
or
shoulders.
Carefully
assess
a
in the
actual or
relaxation,
measures
CUES:
potential
1. report that
refocuses
(back rub,etc.)
womanmid-lower
who states that she
has pain on standing.
- facial
abdomen
tissue
pain is
attention &
grimace
damage. It
relieved and
enhance
- pain occurs
may
be
controlled
by
capabilities
D. Administer Cold and Hot Therapy
every 5-10
incisional, or
verbalization
edema
and
the possibility of hematoma
minutes, Applying an ice or cold
mayreduces
be
of the
patient
2.assist in ROM -reduces
located at formation, thereby reducing
inflammation
pain and promoting healing and
comfort.
and
exercises
& Heat muscle/
mid-lower
or infection.
joint
encourage
cold
have
been
known
as
effective
ways
to
help
relieve
the
pain
of
labor.
women
abdomen,
Because of
stiffness;
early
lasting for 2-3
the
surgical
returns organs
who become warm from exertion of labor find a cool washcloth
to the forehead
ambulation
minutes,
incision
to normal
comforting.
characterized
conducted by
position
as stabbing,
the surgery,
aggravated by
the patient
- pt. may
movement,
may
experience a
3. eliminate
relieved by
experience
decreased
additional
stressor
walking,
pain and
ability to
treated with
discomfort.
tolerate
analgesics
and muscles
painful stimuli
- pain scale of
of the
7/10 where 10
perineum are
is the highest
involved in
- minimizes
4. discourage
many
pt. to wear snug pain
activities.
fitting
Source:
Maternal & Child
Health Nursing.

underwear
5. apply ice
packs wrapped
in towel

- to promote
vasodilation

6. provide a
calm, quiet
environment

- to minimize
stressors

7. administer
analgesics as
prescribed

- to reduce
pain

NEEDS /
PROBLEMS
CUES
II.
Psychological
deficit
a. Disturbed
sleep pattern
CUES:
- restlessness

- change in
activity level
- 2-4 hours of
sleep
- frequent
awakenings
during night
- frequent
yawning
- agitation
- mood
alteration

NURSING
DIAGNOSIS

Disturbed
Sleep pattern:
frequent
awakenings
during night
related to pain
in the incision
site and
attending the
needs of the
baby

SCIENTIFIC
BASIS /
SIGNIFICANCE

After birth, a
woman is a
paradox. She
is excited. She
has a baby and
want to hold
and be with
this new
person in her
life. She wants
to talk to her
support person
about the
experience,
their child, their
future. At the
same time, she
is so
exhausted in
most cases
and falls
asleep

Source:
Maternal & Child
Health Nursing.

OBJECTIVE
OF
CARE

NURSING
ACTIONS

2. achieve
optimal
amounts of
sleep as
evidenced by
rested
appearance,
verbalization of
feeling rested
and
improvement
of sleep
pattern

Measures to
achieve
optimal amount
of sleep:

RATIONALE

1. encourage
period of rest

- helps regain
energy

2. Observe
patient-infant
interaction /
provision of
emotional
support.

- Lack of
knowledge of
infant problem
may create
tension
interfering with
sleep.

3. Evaluate
use of caffeine
and alcoholic
beverages.

- Over
indulgence
interferes with
REM sleep

4. increase day
time physical
activities as
indicated

- To aid in
stress control /
release of
energy.

5. Note
mothers sleep
wake pattern

- Structured
sleep routine
based on adult
schedules may
not meet
childs needs

6. reduce
environmental
distractions
and sleep
interruptions

- awakening
during a sleep
cycle may
cause her to
feel poorly
rested

7. Administer
pain
medications as
ordered

- in order to
relieve pain

NEEDS /
PROBLEMS
CUES
b. Risk for
infection
CUES:
- incision in the
mid-lower
abdomen
- disruption of
skin surface
- wound
exposed to
bacteria
- destruction of
skin layer
- elevated
WBC

NURSING
DIAGNOSIS

Risk for
infection
related to
presence of
incision in the
mid-lower
abdomen

SCIENTIFIC
BASIS /
SIGNIFICANCE

Infection
occurs when
an organism
invades a
susceptible
host. Break in
the
integument,
the bodys first
line of defense
allows invasion
by pathogens,
open wound,
traumatic
surgery can be
sites for
infection either
trauma or
invasive
procedures.
Source:
Maternal &
Child Health
Nursing.

OBJECTIVE
OF
CARE

NURSING
ACTIONS

3. identify and
participated in
behaviors to
reduce risk for
infection

Measures to
reduce the risk
for infection:

RATIONALE

1. perform or
promoted
meticulous
hand washing
by care givers

1. prevents
cross
contamination

2. maintain
strict aseptic
techniques
with wound
care

2.reduce risk
for bacterial
growth

3. inspect
wound site,
noting signs of
local
inflammation

3. early
identification or
treatment may
prevent sepsis

4. review
individuals
nutritional
needs,
appropriate
exercises and
needs for rest

4.self care
activities may
provide
protection

5. administer
antibiotics as
indicated

5.helps
prevent
infection

DRUGS /
DOSE/

CLASSIFICATION /
MECHANISM

INDICATIONS &

FREQUENC

CONTRAINDICATIO

Y/ ROUTE

Amoxicillin
(Novamox)

SIDE EFFECTS/
PRINCIPLE

TREATMENT

EVALUATION

OF CARE

NS
C: Penicillin,
Antibiotic

Side Effects:

- store at a

- check for

- there are

- mild diarrhea,

temperature

rash,diarrhea,

already no

500 mg /

Mechanism:

nausea &

of not

nausea and

signs of

cap TID

- rapidly absorbed by

vomiting,

exceeding

vomiting,and

infection

(8am -1pm

the gastrointestinal

headache,

25 C

other signs of

-6pm)

tract after oral

generalized rash

- give without allergic

p.o.

administration and is

regards to

stable in the

Indications:

presence of gastric

- treatment of

acid; diffuses readily

infections caused by

into most body

pathogenic gram

tissues and fluids

positive and gram

except for the

negative bacteria

cerebrospinal fluids;

that are sensitive to

inhibits bacterial cell

amoxicillin

reaction

meal

wall synthesis
Contraindications:
- hypersensitivity to
any penicillin
Mefenamic
acid
(Revalan)

C: NSAIDs

Side effects:

- use drugs

- administer

- pain was

(Anti- inflammatory)

- CNS: headache,

only as

drug with

reduced

Analgesics

500 g/ cap
q 6h x 4

Therapeutic Action:

doses

- its exact

(8am 2pm

mechanism of

-8pm 2am)

action is not known

p.o

dizziness, insomnia, suggested

food or after

tiredness

- do not

meals if GI

exceed

upset occurs

dosage

- provide

- Dermatologic: rash,
sweating
- GI: nausea &

comfort

vomiting, GI pain,

measures to

dyspepsia

reduce

- Hematologic:
bleeding,leukopenia
- Respiratory:

inflammation
- advise
patient to

dyspnea

report any
discomfort or

Indications:

pain felt

- relief of moderate

- provide

pain when therapy will

frequent small

not exceed 1 week

meals if GI

- treatment of primary

upset is

dysmenorrheal

severe

Contraindications:
- contraindicated to
patients with
hypersensitivity to
mefenamic acid and
aspirin allergy
- use cautiously in
renal/liver dysfunction,
peptic ulcer disease,
GI bleeding, hpn
Multivitamins

C: dietary

Side Effects:

- store at

- report severe

- level of Fe is

( Hemarate)

supplement ; Fe

- GI discomfort,

temperature

GI upset,

back to

cap OD

fumarate; iron

anorexia, diarrhea,

not

lethargy,

normal

8am

preparation

constipation, dark

exceeding

constipations,

p.o

Mechanism:

stools, n&v

30C

rapid

- best taken

respiration

- elevates serum
iron concentration,

Indication:

between

which then helps to

- nutritional & Fe

meals

form Hgb or

deficiency anemia

- may be

trapped in the

due to pregnancy,

taken with

reticuloendothelial

lactation and

meals to

cells for storage

menstrual blood loss

reduce GI

and eventual

upset

conversion to

Contraindications:

usable form of iron

- allergic to any
ingredient
- sulfate allergy,
hemolytic anemias

OBJECTIVES

CONTENT

METHODOLOGY

EVALUATION

General:
After 8 hours of student
nurse-patient and significant
others interaction, patient and
significant others will be able to
acquire adequate knowledge,
attitude and skills about caring
postpartum patient
Specific:
After 45 minutes of student
nurse-patient and significant
others interaction, patient and
significant others will be able
to:
1.1 Define the following terms
1.1 breast feeding

1.2 lactation

Breast feeding nursing and

Informal Discussion

Patient and significant

feeding of baby with breast

others were able to

milk

define breast feeding

and lactation

Lactation process of milk

production results from the

In the patients own level of

interplay of hormones,

understanding

instinctive reflexes and

learned behavior of mother
and newborn

2. Enumerate the importance

Importance:

Informal

Patient and significant

of breastfeeding

essential for the survival of

Discussion

others were able to

infant
promotes self care, mother will
learn the importance of
cleanliness and how to care for
her breast when nursing
superior source of nutrition
provides maternal antibodies to
infection
Prevents infant against

enumerate the
importance of breast
feeding.

hypercholestoramia

3. Cite the advantages of

Advantages:

Informal

Patient and significant

breastfeeding

Best for babies

Discussion

others were able to cite

the different advantages.

Reduce incidence of allergies

Economical
Antibodies
Stool inoffensive
Temperature always idea;
Fresh milk
Emotional bonding b/w child
and mother
Easy once established
Digested easily
Immediately available
Nutritionally optimal
Gastroenteritis greatly reduced
4. Demonstrate the steps on

Steps:

Demonstration

Patient was able to

how to manually express milk

Explain procedure to client

and return

perform it properly.

so she can strengthen her milk Assemble equipments

supply and supply milk for
Wash hands
newborn.
Instruct mother to place right
hand on her right breast at the
outer limit of the areola and her
right fingers underneath the
breast. Tell mother to press
inward toward the chest wall
Help mother in handling and
holding the collecting jar just
under the nipple
Have the mother move her
thumb and fingers forward in a
milking motion, causing the
milk to be expressed from
nipple into an infant bottle
Have the woman move her
thumb and fingers around her

demonstration

breast, repeat the technique

Caution mother not to use
excess force
After the collection, refrigerate
milk which will be used within
24 hours

V. EVALUATION AND RECOMMENDATION

Prognosis
Based on the patients assessment, she is not experiencing any
complications after the obstetrical procedure (Cesarean Delivery);
therefore there is no prognosis or simply she is good. She complies with
the treatment, medications, and management regimen instructed by the
doctors and nurses.
Recommendation
The most important goal for the patient who undergone Cesarean
Delivery is to achieve full recovery and rule out the possible occurrence of
infection and abscess.
Below are listed recommendations for the patient are as follows:
1. Compliance and maintenance of the medications being prescribed by
the physician.
2. Bed rest if the patient feels pain and fatigue.
3. Nutritious foods are provided for the patient to eat.
4. Patient must be restricted to physical activities causing stress.
5. Promoting good personal hygiene and stressing careful hand washing.
6. Abstain from alcohol after recovery.
7. Environmental sanitation.
8. Deep breathing exercise if pain if felt.
9. Heat and cold application on the affected site.

10. Ambulation is encouraged.

11. Encourage adequate rest
12. Follow up consultation or check-up at clinics or hospital
VI. EVALUATION AND IMPLICATION OF THE CASE STUDY
Nursing Practice
Studying the case ofMrs. TagalogJulie gave the student the
opportunity to enhance the students knowledge, attitude, and skills in
rendering therapeutic nursing care for post partum patients. It has
provided new ideas that focus on dedication to study.
This case study though not that perfect can serve as a basis and
reference for the never-ending discovery for better interventions of
students, professionals and family of the affected member.
Nursing Education
This study has been very helpful in making me understand the
extents of this condition. It has aided me to relate the theories, discoveries
and other facts written in textbooks, to the actual situation. Through these
observations, students have gained new set of ideas which will be of great
help in caring for patients with the same cases
Nursing Research
This can be utilized as reference for future research studies. This
will also provide additional knowledge to the students for relating real life
situations.
VII. BIBLIOGRAPHY

Kozier, Barbara et.al. Fundamentals of Nursing Concepts, Process and

Practice, 7th editions, Pearson Education Inc., 2004
Marieb, Elaine N. et.al. Essentials of Human Anatomy and Physiology, 6 th
edition, Addison Wesley Longman Inc., 2000
Pilliteri, Adele. Maternal and Child Health Nursing; 4 th edition, Lippincott
Williams and Wilkins
Potter, Patricia and Perry, Anne Griffin. Fundamentals of Nursing. 6 th ed.
St. Louis, Missouri: Mosby 2005

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