Professional Documents
Culture Documents
PRESENTATION
III. Introduction:
Pregnancy, a state of bearing a developing fetus with in the females womb. It's lasts for
about 36-42 weeks of gestation, it can be measured by getting the last menstrual period of a
woman. This situation can be detected as positive through pregnancy test, ultrasound and X-
ray.
When gestation is fully developed it will enter on a state of labor. Where in there are two
ways of labor. Normal Spontaneous Delivery and Cesarean Section. A NSD is a labor through
vagina. Cesarean Section is a procedure wherein accomplished through an abdominal incision
into the uterus of a pregnant woman.
Cesarean birth is defined as a Latin word caedore means “to out”. One of the oldest
type of surgical procedure where in labor is easy and painless. This procedure is usually done
when fetus and the mother's life/health is at risk; however in recent time the said procedure
has been performed upon the choice and request of the mother even though they can undergo
a vaginal labor. Cesarean birth has two types. Scheduled and emergency cesarean birth.
Scheduled Cesarean Birth is processed by knowing the Last Mens Period (LMP) and compute for
the End of Gestation (EOG) of the mother. While Emergency Cesarean birth is done for reason
such as placenta previa, fetal distress and failure to progress in labor.
Frank Breech Presentation, is in moderate attitude because the hips are flexed but the
knees are extended to rest on the chest. Buttocks is the presenting part of the fetus on the
cervix of a mother.
2. Placenta Factors
Placenta Previa
Abruption Placenta
Umbilical cord prolapse
3. Fetal Factors
Compound condition e.g. Macrosomic Fetus in a Breech Lie
Extreme Low Birth Weight
Fetal Distress
Major Fetal Anomalies e.g. Hydrocephalus
Multigestational / Conjoined Twins
Transveres Fetal Lie
IV. Objectives:
General:
Upon the given time span of preparing this case study, we will able to understand and
gain more knowledge about the concept of Frank Breech Cesarean Birth so that we can perform
the right skills and attitude in caring such patient that undergo the said procedure in terms of
its signs and symptoms, manifestations, diagnostic examinations, physical assessment,
anatomy and physiology to have a right intervention.
Specific:
To be able to practice our learned problem solving skills like identifying problems,
gathering data, and analyzing data then evaluation of data.
To be able to practice our social-interaction with our patient by getting information.
To be able to identify the cause and risk factor of Cesarean Birth.
To be able to describe the process during Cesarean Birth.
To be able to understand the importance of having inclusive assessment to come up
with a good intervention.
To be able to developed our nursing skills and attitudes in handling such problem.
To be able to practice our gained knowledge in Maternal & Child Care subject.
To be able to understand the action, mechanism, contraindications and adverse reaction
of the drug give to the patient.
To be able to provide health teaching and discharge planning to the patient.
V. Biographic Data:
c. Family History
She stated that there is history of Hypertension with in her father's side.
She also stated that in her mother's side there is history of asthma.
d. Obstetric History
GTPALM
-Gravida - 1
- Term - 1
- Para - 1
- Abortion - 0
- Living - 1
_Multipara - 1
Menstrual History
- Menarche - 12 years old
- LMP - December 9, 2009
- Interval between Cycle - 4-7 days
- Amount of menstrual flow - 60-100 ml / menstrual period
- Color of menstrual flow - dark red blood with mucus and
endometrial cells
- Odor - similar to marigolds
- Contraceptive used - none
a. Physiological Health
Coping patterns
Whenever patient Churvaclez has problems especially in financial problem during her
pregnancy, she find ways to overcome her problem with her own way, and about her financial
problem for her labor she and her husband already prepared for all the expenses that they
needed.
I.A:
The client manifest to solve her problem with out the help of others with her labor
expenses they share all the expenses they got with her husband who is working in Inches
Enfixel company as a machine operator. They already saved money for her labor so that they
can't encounter such problem.
Interaction Patterns
She used to be a friendly, sociable and happy person. After her procedure of Cesarean
birth she always hard to talk and approach. She rarely expressed her thoughts and feeling. But
two days after the said procedure she already approach us in a friendly manner and answer all
the questions that we ask.
I.A:
Prior to admission her interaction pattern is good as she interacts with people around
her. After birth she become unfriendly because of the procedure during her labor. But when we
approach her two days after her labor she has a good interaction pattern even though she was
still at hospital.
Cognitive Patterns
Mental ability was tested, during our home visit we ask her if when they were discharge
from the hospital she said that Oct.16, 2010 1 pm. She also stated that they were discharged
the second day we visit her in the hospital.
I.A:
Patient Churvaclez has a low memory. She can't really remember the time if when they
were discharge at the hospital because we visit her 2pm-5pm last Sept.16, 2010.She said that
she was discharge 1pm of that date.
Self Concept
She said that she is a friendly person and a dependent woman. Even though she was
living with her family she always overcome her problems without asking the help of her parent.
Even she have family she always give support her parents.
I.A:
The client has a greater sense of independence and has a good self concept.
Emotional Patterns
She always express her emotion. She has a positive outlook in life you can determined
her emotion in her face. When she is mad or not comfortable she express it with her facial
expression rather than doing action like confronting.
I.A:
The patient used facial expression in comes with her emotional patterns. She also
managed her emotion in her own way.
She always express her affection and love with her husband. She was still sexually
active until she was 6 mos.pregnant. But still thinking for the health of the fetus inside her
womb.
I.A:
Even though patient Churvaclez was pregnant she is sexually active because in
pregnant woman the progesterone level increase. It also increases the pleasure for a pregnant
woman. But she stop because they was thinking the health of their baby will be affected.
When she got problem that she cannot handle she share it with her husband. She
always give support and help her parent in all needs.
I.A:
A typical type of family wherein they help each other to solve their problems and even
though she has her own family she didn't forget to help her parents.
I.A:
According to Erik Erikson at her age he establish her careers, also she settle her
relationship and begin her own families and sense of the bigger picture for her family. She
thinks raising her children to be productive and progressive. When she fails to achieve the all of
this she become stagnant and feel unproductive.
Cultural Patterns
She stated that marriage needed to be prolonged unbroken until death because it is a
matrimonial and legal. She also believes that family should not be broken.
I.A:
She believes that marriage that marriage is for long life. And she want her family to be
better . Unbroken and safe.
Significant relationships
The client has a good relationship with her family especially with her husband. They
share evertttything to each other to get their needs. She also help her parents needs.
I.A:
She has a good relation with her husband and also to her parents. She was always
related with them them helping each other for their family needs and shared obligations for
both.
Recreation Patterns
The client states that she loves mountain climbing with her friends when she got free
time, because she is busy to her works.
I.A:
She loves her work but when she got time she go with her friends to do mountain
climbing because it makes her happy and relaxed in work. Also she can do some bonding with
her friends.
Environment
The environment was not that good, the place was crowded and has a small pathway
going to their house. But inside their house was well organized and clean.
I.A:
Even though they have a disorganized neighborhood they have a pleasant environment
inside their house wherein they were stable to stay in.
Economic
Their in was enough to supply their family needs. Her husband is in the area of
management level and earning a minimum range of salary so they already save money for her
labor.
I.A:
Even though they already overcome the expenses that they have from her labor. Her
husband was doing well to his job to earn more for the growth and development of their baby.
c. Spiritual Patterns
The client stated that they are Born Again Christian but they merely none-active.
I.A:
She was focused and busy to her work so she only went to church during her free time.
But she practice the beliefs of their religion even though they were not active.
Values and Valuing
I.A:
She always relates all her doing in their bible so that she will always avoid to do evil
things and to do good things.
Body Part Inspection I.A Palpation I.A Percussion I.A Ausculta- I.A
System tion
Skin Generally Normal Temperatur Normal
uniform Findings e Findings
37.3°
(+) striae
intact
Hair Short, thick, Normal
silky, & evenly Findings
distributed
No infection & Normal
infestation Findings
Head Round, the Normal Uniform, Normal
size of skull is Findings consistency Findings
normo- to absence
cephalic of nodules
Face Symmetrically Normal
Findings
Eyebrows Terminal hair Normal
is evenly Findings
distributed,
symmetrically
aligned, equal
movement
Eyelashes Equally Normal
distributed Findings
Eyelids (-) presence of Normal
discharges Findings
Bulbar Transparent Normal
conjunctiv sclera appears Findings
a
Palpebral Shiny, smooth Normal
conjunctiv Findings
a
Lacriminal Swollen Due to Tender to Due to
glands drain pressure drain
tears tears
Pupil (Light test) Normal
reaction Illuminated Findings
to light pupils
constrict
PERRLA
Pupil (Accomodatio Normal
reaction n test) pupils Findings
to constrict when
accomo- looking at
dation near object;
dilate when
looking at
near object.
Visual (Cover & Normal
field uncover) Findings
parallel aye
movement
Extra (Six ocular Normal
ocular movement) Findings
muscle eye
movemen movement
t aligned and
move equally.
Near (News print) Normal
Vision client able to Findings
read
newsprint at
the distance
of 6 inches.
Distant (News print) Normal
Vision client able to Findings
read
newsprint at
the distance
of 24 inches.
Visual (Snelling Normal
Acquity chart) client Findings
able to read
the snelling
chart of 20-20
vision.
Ears & Symmetrically Normal Elastic and Normal
Hearing aligned; same Findings no Findings
Auricles level at the tenderness
outer cantus ; pinna
of the eyes. recoils
after it is
folded.
Gross Normal voice Normal
Hearing acquity Findings
Acquity audible.
Weber (Tunning Fork) Normal
Test the client hear Findings
the tone by
bone
conduction
through the
skull; sound
equally loud in
both ears.
Rinne Test (Tunning Fork) Normal
the client hear Findings
the sound
twice
External Symmetrically Normal No Normal
nose and straight, Findings tenderness, Findings
no discharges, no lesions.
uniform in
color.
Nasal Intact in Normal
septum midline Findings
Frontal No tenderness Normal
sinus Findings
Ethmoid No tenderness Normal
sinus Findings
Sphenoid No tenderness Normal
sinus Findings
Maxillary No tenderness Normal
sinus Findings
Lips Uniform, pale Due to
color inadequ
ate
oxygen
supply
and low
hemogl
obin
level.
Buccal Uniform, light Due to Uniform, Due to
mucosa pale color, inadequ light pale inadequa
moist, soft, ate color, te
glistening and oxygen moist, soft, oxygen
elastic supply glistening supply
texture. and low and elastic and low
hemogl texture. hemoglo
obin bin level.
level.
Gums Pink in color, Normal Pink in Normal
moist, firm Findings color, Findings
texture to moist, firm
gum texture to
gum
Tongue Central Due to Moist Normal
position, light inadequ slightly Findings
pale color ate rough, thin
oxygen whitish
supply coating
and
decreas
ed
hemogl
obin
level
Moves freely, Normal
no tenderness Findings
Palate Slightly pale, Due to
hard palate inadequ
ate
oxygen
supply
and
decreas
ed
hemogl
obin
level
Uvula Position in mid Normal
line of soft Findings
palate.
Oropharyn Light pale and Decreas
x smooth ed
hemogl
obin
level
Tonsils Pinkish, Normal
smooth & no Findings
discharges
Neck Muscle equal Normal Lymp Normal
muscle in size, head Findings nodes are Findings
(sternoclei centered not
domastoid palpable
&
trapezius)
Head Normal
movement is Findings
coordinated
smooth with
no discomfort.
Trachea Central Normal
placement in Findings
middle of the
neck
Thyroid Not visible Normal Not Normal
glands Findings palpable Findings
Posterior Symmetric Normal
thorax chest, Findings
expansion
when client
takes a deep
breath
Spinal Unable to Patient
alignment perform due refuse
to pain in to
client's perform
abdomen due to
pain in
the
abdome
n from
her
surgery.
Respirator Refuse to Due to
y perform client's
excursion pain in
abdome
n from
her
surgery.
Tactile Refuse to Due to
fermitus perform client's
pain in
abdome
n from
her
surgery.
Anterior Effortless Normal
thorax respiration Findings
Cardio Symmetric in Normal
vascular volume, Findings
peripheral intensity of
pulse pulse is 2+
Carotid Symmetric Normal
artery pulse volume, Findings
intensity of
2+.
Jugular Veins visible Normal
veins in suppine Findings
position
Peripheral Symmetric Normal
pulse pulse volume Findings
Peripheral Distended Normal
veins vein /elevated Findings
(arm)
Peripheral Limb not Normal
veins (leg) tender and Findings
symmetric in
size
Peripheral Skin slightly Due to Skin Decreased
perfusion pale in color client's temperatur hemoglobi
past e is cold n level due
surgery. and skin is to client's
May moist. pregnancy
indicate and poor
poor physical
oxygen activity.
supply..
Abdomen Client refuse Stated
to perform that she
is
having
pain
and
being
uncomf
ortable
due to
her
surgery
in her
abdome
n
Cranial
Nerves
Cranial (cotton ball Normal
nerve I soaked in Findings
(olfactory alcohol)
nerve) patient able to
identify
correctly the
odor
Cranial (visual acquity Normal
nerve II test) patient Findings
(optic able to read
nerve) snellen chart
30ft. Away
Cranial (six cardinal Normal
nerve III directions “H Findings
(oculomot pattern”)
or) patient able to
perform the
Cranial “H pattern”
nerve IV movement.
(trochlear)
Cranial
nerve VI
(abducens
)
Cranial (Temporal & Normal
nerve V Masseter Findings
(trigemina Muscle
l nerve) Strenght)
patient able to
become taut
the muscles in
temporal and
masseter by
clenching
his/her teeth
Cranial (Test muscles Normal
nerve VII of facial Findings
(facial expression)
nerve) patient able to
raise
eyebrows,
smile, frown
and there is
no facial
weakness.
Cranial (Weber Test) Normal
nerve VIII patient able to Findings
(vestibulo hear the
cochlear) sound equally
in both ears.
(Rinne Test) Normal
patient able to Findings
hear again the
sound
(AC>BC)
Cranial (Gag Reflex Normal
nerve IX Test) patient Findings
(glosophar able to elicit
yngeal) the gag reflex.
CN IX –
afferent arm
Cranial CN X –
nerve X efferent arm
(Vagus)
Cranial (Sternocleido Normal
nerve XI mastoid Findings
(acessory Muscle Test)
nerve) patient able to
tun his/her
head to the
right, the left
SCM will
tighten.
Cranial (Tongue Normal
nerve XII Muscle Findings
(hypoglos Strength)
sal) patient able to
protude
his/her tongue
moving it in
and out, side
to side, &
upward and
downward.
Slowly and
rapidly and
the tongue
can't be
dislodged.
Legend: I.A. = Interpretation & Analysis
X. Diagnostic Studies
URINALYSIS
•Uterus
>Uterus is a small, firm,pear-shaped, muscular organ situated between the bladder
and rectum it usualy lies at almost a 90 degree angle to the vagina. Hollow internal female
reproductive organ in which the fertilized ovum is inplanted and the fetus developed.
•Fallopian tube
>The fallopian tubes attach to the uterus and the upper angle of the fundus.
•Ovaries
>Ovaries is a almond-shaped organs located on either side of the uterus the
approximately measure of the fallopian tube is about 3 to 4cm long, 2 cm wide and the
thickness of the ovaries is 0.6 to 1.25 cm.
•Placenta
>Placenta is organ that connects the developing fetus to the uterine wall to allow nutrient
uptake waste elemination and gas exchange via the mother's blood supply.
•Umbilical cord
> Umbilical cord is the connecting cord from the developing embryo or fetus to the placenta
of the mother. The umbilical cord comes from the same zygote as the fetus and normally
contains two arteries and one vein.
Fetal Membrane
•Fertilization
>The union of a spermatozoa and an ovum, it is usualy occur at the outer third of the
fallopian tube, usualy only one ovum reach the maturity per cycle. A mature ovum is available
and ready to be fertilized for 24 hours only. The men ejaculate is about 50-200 million of
spermatozoa are relaese, they move by the means of their tails. They enter the cervix and the
body of the uterus into the fallopian tube and in the stage only one from millions of sperm cells
can able to penetrate the ovum and when the sperm reach the mature ovum the moment of
conception begin.
•Developing Cell
> Immediately after penetration of the ovum the chromosomal material of the ovum
and apermatozoa fuse the resulting is a zygote . Each carries 23 chromosomes (22
chromosomes outcomes and 1 sex chromosomes)and it results into 46 chromosomes within
fretilized cell. From the fertilized ovum (zygote) the future child needed for support during intra
uterine life. After that fertilizes egg it migrates 3-4 days from the fallopian tube to the body of
the uterus and there the site of fertilizes egg implantation.
Length: 10 to 17 cm
Weight: 55 to 120 grams
Fetal heart sounds are audible with an ordinary stethoscope.
Lanugo (the fine, downy hair on the back and arms of newborns, which
apparently serves as a source of insulation for body heat).
Liver and pancreas are functioning.
Fetus actively swallows amniotic fluid, demonstrating an intact but
uncoordinated in swallowing reflex, urine is present in amniotic fluid.
Sex can be determined by ultrasonography.
Length: 25 cm
Weight: 223 grams
Spontaneous fetal movement can be sensed by the mother.
Antibody production is possible.
Hair forms extend to include eyebrows and hair on the head.
Meconium is present in the upper intestine.
Brown fat, a special fat that will aid in temperature regulation ta birth, begins
too be formed behind the kidney sternum and posterior neck.
Venix caseosa, while is serve as protective skin covering during intrauterine life
begins to form.
Definite sleeping and activity patterns are distinguishable (the fetus has
developed biorhythm that will guide sleep / wake patterns throughout life.
Length: 28 to 36 cm
Weight: 550 grams
Passive antibody transfer from mother to fetus probably begins as early as
20th week of gestational, certainly by the 24th week. Infants born before
antibody transfer has taken place have no natural immunity and need than
the usual protections against infectious disease in the newborn period until
the infant’s own store of immunoglobulin can build up.
Meconium is present as the rectum.
Active production of lung surfactant begins.
Eyebrows and eyelashes are well as defined.
Eyelids, previously fused since the 12th week, are now open.
Pupils are capable of reacting to light.
When fetus reaches the 24th weeks, or 601 g, they have achieved practical
low-end age viability if they are cared for after birth in a modern intensive
care facility.
Hearing can be demonstrated by response to sudden sound.
Length: 35 to 38 cm
Weight:1,200 grams
Lung aveoli begin to mature and surfactant can be demonstrated in amniotic
fluid.
Testis begins to descend into the scrotal sac from the lower abdominal cavity.
The blood vessel of the retina are thin and extremities susceptible to damage
from high oxygen concentrations (an important consideration when caring
for preterm infants who need oxygen).
End of 32th Gestational Week
Length: 38 to 43 cm
Weight: 1,600 grams
Subcutaneous fat begin to be deposited (the former stringly “little old man”
appearance is lost).
Fetus response by the movement to sounds outside the mother’s body.
Active moro reflex is present.
Birth position (vertex and breech) may be assumed.
Iron stores, which provide into for the time during which the neonate ingest
only milk after birth, are bebining to be developed.
Fingernails grow to reach the end of fingertips.
Length: 42 to 28 cm
Weight: 1,800 to 2,700 grams
Body stores of glycogen, iron, carbohydrates, and calcium are deposited.
Additional amounts of subcutaneous fat are deposited.
Sool of the foot has only one or two crisscross creases, compared with the
full crisscross pattern that will be evident at term.
Amount of laguno begins to diminish.
Most babies turn into a vertex or head-down presentation during this month.
Continuous fetal monitoring of heart rate increase the number of C-section for
fetal distress.
Women with prior to a C-sections after choose or are required to have C-
section.
Many obstetricians no longer wish to take the risk of a vaginal breech (bottom
first) delivery.
There has been decrease in the number of forceps deliveries which in turn
increase the number of C-section.
Indication of C-sections
Some indications are controversial and some are accepted as the standards.
>Fetal indication.
1. Abnormal fetal heart rate patterns (no reassuring fetal status)
Making Diagnosis
Electronic fetal monitoring- monitoring of the fetus heart rate tracing.
Repetitive decrease in heart rate may signal a decrease in oxygen to the
fetus.
Fetal scalp pH- monitors the acidity of the scalp tissue an elevated acidic
reading (ph<7.2) indicates a build up dioxide and lactic acid in the blood.
Abdominal ultrasound- ultrasound images of the uterus and its contents are
obtained.
MRI- can be used to determine the position of the fetus.
The procedure
The skin is prepared with a solution that reduces the risk of wound infection.
The hair near in the incision may be shaved.
An incision is made in the skin and is carried through the abdominal wall to
enter the pelvis. The skin incision may be vertical (up and down) or
transverse (from side-to-side). The incision is based on many factors include
speed of entry, exposure needed; anticipated weight of the baby and risk
wound infection. A transverse skin incision is most common and skin is
usually made about 2-3 centimeters (one inch) above the pubic bone (figure
A).
The uterus is then identified and there is a thin layer of tissue, which drapes
over the anterior surface of the uterus and then onto the bladder (the
vesicouterine peirtonium). This layer is incised so that the bladder can be
retracted away from the uterus to allow for the uterine incision (figure b).
The uterine incision is then made to amniotic sac (fetal membranes or bag of
water) (figure C).
The uterine incision can be transverse or vertical ninety percent have a
transverse uterine incision. But some indication for a vertical incision in the
uterus is a preterm fetus, a fetus that is not head down and with emergency
C-section. But in this situation a transverse incision may sometimes be used.
The fetal head or buttocks are then delivered through the uterine incision
followed by the rest of the body (figure d).
Some obstetrician repair the uterus by the first delivery the uterus through the
abdominal incision, some repair it while it is still in the abdomen. The uterus
is closed with one or two layers of structure (figure e). the layers of the
abdominal wall are structured and then the skin is closed.
XV. Pathophysiology
XXIX. Procedure
Gowning
Getting ready
Uterine Repair
XX. Draping
Surgical draping a patient reduces the risk of surgical site infections by forming a barrier between the
surgical area and probable sources of bacteria. Draping isolates the treatment area for surgery and protects it from
contaminants. Sterile drapes, when placed on the patient by surgical assistants, must remain undisturbed; if the sterile
drapes touch an unsterile field, a new sterile drape is used. A member of the surgical team (the circulator), is responsible
for disposing of all contaminated drapes.
Instruction
1. Remove the outer covering of the draping pack ( should be done by an “unscrubbed “ surgical assistant).
Gently pull and release each layer of covering away from the center of the pack. Keep your hands from
touching the inner covering of the sterile pack.
2. Open the inner covering of the sterile draping pack ( should be done by a “scrubbed” surgical assistant).
Remove the fan-folded draping sheets one at a time. Hold the sheets high above the waist to prevent
contamination.
3. Place the folded edge of a sterile draping sheet near the incision site to expose it for surgery ( should be
done by the “scrubbed” assistant or a surgeon). Lay another sheet on the opposite side, in the same manner
to further outline of the incision site. Continue draping with additional sterile sheets to cover the entire
surgical area and secure with surgical clips.
XXI. Position
Supine position
-The position in which the individual is lying down while facing up.
-This position in surgical procedures allows access to the ventral side of the body, such as peritoneal, thoracic, and
pericardial regions.
1st Priority Acute Pain Related to “Masakit yung tahi ko” Relaxation Techniques
Disruption of skin, as verbalized by the and other comfort
tissue. patient. measures can help
alleviate pain and
reduce anxiety and
further complication.
XXIV. Nursing Care Plan
Medication
Exercise
Treatment
Health Teaching
Proper Diet
-Eat high Fiber Foods to avoid constipation
-ingest food that is rich in protein for the regeneration of tissue
-Intake/ drink citrus or juices that is rich in Vit. C for fast wound healing
Proper hygiene
-Grooming
-Dressing
-Bathing
-tooth Brushing
Effective Breastfeeding
-Initiate breastfeeding during the demands of the baby
-Encourage her to have 2000ml fluid intake everyday
-Before initiating breastfeeding always clean the breast with a clean water and without
soap
-Encourage to intake soup especially vegetables soup
-Encourage mother/other members of the family to express feelings/concern, and active
listeningto the needs of the baby
Out Patient
-Patient was advised to comeback to the hospital after a week for her check-up and as
well as her baby.
Diet
-The Patient may have DAT diet after flatulence
XXVIII.Acknowledgements