CHAPTER 1 Introduction

Pregnancy is a condition by which a woman carries a life inside her body. It usually begins after the union of the egg cell and sperm cell which will then be developed from a fertilized egg into a fetus after a period of time. A woman will carry the fetus for approximately 38 to 42 weeks until the fetus is born. After 9 months of waiting, a woman can now witness the beginning of her infants life which can be done in different ways. There are 2 ways on how to deliver an infant from the uterus of a mother. Aside from the most common method which is the vaginal delivery, Cesarean delivery is another way to give birth to an infant. Cesarean birth is a surgical procedure by which an infant is delivered through an abdominal and uterine incision. It is a procedure more slightly hazardous than vaginal birth thus the decision of using this procedure must be made only after a very careful consideration. The word cesarean is derived from the Latin caedore which means to cut (Pilliteri, 2007). It was believed that Julius Caesar was born by a cesarean section but since there wasnt any anesthesia or sterile procedures during his time, it was not considered as factual. Cesarean birth has two types: Scheduled and Emergency. Scheduled cesarean birth was popular during the 1950s when actresses did not want to experience the pain during vaginal delivery (Pilliteri, 2007). During that time, scheduling cesarean birth resulted to preterm births which increased the risk of mortality of infants. The second type is the emergency cesarean birth. It is usually done when vaginal birth can jeopardize

the safety of fetus as well as the mother. There are some indications on why emergency cesarean birth must be performed: (1) Cephalopelvic Disproportion occurs when the presenting part of the fetus does not fit through the pelvis of the mother, (2) Placenta previa takes place when the placenta covers the cervix thus cesarean delivery must be performed to prevent the baby of having hypoxia, (3) The abnormal position of the baby may indicate the utilization of cesarean birth especially if the presentation of the baby is breech or transverse, (4) If there is a prolapsed cord, immediate cesarean birth should be done in order to prevent the presenting part of the fetus from compressing the cord and cutting of the oxygen supply to the fetus, (5) Abruptio Placentae happens when the placenta separates from the uterine wall thus an emergency cesarean birth is necessary to prevent the mother from excessive bleeding. The surgery itself also shows some effects to the woman. There will be an interference with the body defenses of a woman since an incision will be done in her skin. The circulatory function of the woman can be also interfered because loss of blood during cesarean birth is higher than during vaginal birth. Because the uterus is handled during the procedure, interference with the body organ function may arise thus increasing the chance of having postpartum hemorrhage. There are different types of cesarean incision. The first type is the classical cesarean incision by which the incision is made vertically in order to provide a larger space for the delivery of the baby however, it has not been practiced lately because it is more prone to complications. Another disadvantage of this incision is that it leaves a large scar over the abdominal area. A woman who has this type of incision may not have a subsequent vaginal birth because it can rupture during labor. The most common

incision that has been used currently is the low- segment transverse incision. This type of incision is made horizontally over the symphysis pubis and also horizontally across the uterus over the cervix (Pilliteri, 2007). This incision is commonly known as bikini cut because it can still be hidden even if the woman wears low-cut bathing suit. There are also some complications or risks after cesarean section have been conducted. Some risks for the baby are: (1) premature birth, (2) breathing problems, (3) Low Apgar score, and (4) Fetal injury. There are also some risks for the mother, these are: (1) Infection the uterus or nearby organs can become infected, (2) increased blood loss, (3) decreased bowel movement the bowel sometimes slows down for several days after surgery, resulting in distention, and (4) longer hospital stay and recovery time the common length of stay for mothers who underwent cesarean section is three to five days. (www. Pregnancychildbirth.com) Overall, cesarean birth or delivery is one of the safest procedures that can be performed.

PURPOSE AND OBJECTIVES This case history aims to analyze the factors contributing to the development of the problem through the utilization of the nursing process on the care of the client who underwent Cesarean delivery. Specifically, this case history seeks to achieve the following: 1. Identify factors that led to the development of the problem 2. Analyze the relationship of the factors leading to the development of the problem 3. Discuss the relevant interventions that were utilized to resolve problems 4. Explain the patients response toward the intervention

SIGNIFICANCE OF THE STUDY The case history was conducted for the benefits of the following: To the client, as the recipient of care, this case history will provide knowledge regarding her condition therefore, helping her improve her health. To the significant others, this case history will provide them knowledge regarding the status of the client thus encouraging them to carry out nursing interventions for the client which is a part of their family. It will also give them sufficient data regarding the procedures being performed for the client and its underlying principle for doing it. To the student nurses, this case history will further assist them in rendering care for the client with the same condition thus carrying out accurate nursing interventions for the betterment of the client. To the clinical instructors, this case history will aid them in evaluating their students. It will also provide them an additional knowledge regarding the diagnosis thus, keeping them updated about the actions done in the clinical area. To the future researchers, this case history will serve as a reference for their future paper works. It will also assist them in making an efficient case history for future purposes.

SCOPE AND LIMITATION

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This study is centered on the care of a well post-partum mother, Ms. S.DT.L who underwent a low transverse Caesarian section. The study was conducted at the Makati Medical Center particularly in the 6 th floor by which they render care to OB and pediatric patients. The patient was occupying one of the semi private rooms specifically, room 610B. The observation was made last July 24, 2009 from 0600 1400H. The researcher utilized the OB history form and conducted an interview with the patient for aid in getting information necessary for the completion of the case history. The patients chart was also used for additional information about the condition of the patient. There were problems that were encountered during the information gathering. The answers of the patient were only short due to her present condition. There was only a little time of exposure to the client thus; the researcher wasnt able to ask the patient some other things about her condition.

BACKGROUND OF THE STUDY

The study was conducted at the Makati Medical center, a private institution that offers a wide array of services for treatment and specialization. The hospital has a vision to be a world class hospital of everyones choice. Likewise, the nursing service division has its own vision also which is to be a world class nursing services division of everyones choice. The study was done in the 6th floor front of MMC particularly. Embodied be nurses station, pantry, and 29 semi-private rooms which are rooms 609 A-E, 612 A-C. Most likely the patients occupying there are availing the health service package of MMC. The nurses in 6th floor front are headed by the standard unit manager Ms. Cecil Pangan, Unit manager Ms. Hira Patricio and Charge nurse Ms Riza Lagarico. Other Medical staff, Obstetrician, Gynecologist residents and interns, some doctors from other areas, senior staff nurses, nursing aide, ward clerks and orderlies. The patients are entitled to have one television and a call light. Each room has a single comfort room for all the patients and their visitors. Services are inclusive with care for the well and sick mother, newborn, infant and gynecological patients with or without special cases. Post operative patients are also admitted in this are. Nurses on duty have the primary responsibility to monitor, to administer prescribed medications and to do routine daily care. The patient Ms. S.DT.L was handled by the researcher who, on that time, was occupying room 609B. Her case provides the researchers a room for maximizing their exposure and learning experience regarding Low transverse Cesarean Section.

CHAPTER II

PRESENTATION OF THE CLIENT

This is the case of Ms. S.DT.L., a 30 year old married woman who is residing at Tahanan village, Paraaque City. She was admitted last July 23, 2009 with a chief complaint of irregular contractions. The patients OB score is G1P1 (T1P0A0L1M0), 40 weeks gestational age under the supervision of Dr. Buenconsejo. Her last menstruation period was on October 16, 2008 and the expected date of delivery is on July 23, 2009. On the date of admission, ultrasonography revealed that the patient has oligohydramnios which indicated that there was insufficient amniotic fluid in the uterus. Prior to the procedure, the patient was given a spinal anesthesia. At 2254H the patient underwent a Low Transverse Cesarean section to a live boy, with a cephalic presentation, a weight of 7lbs 8oz and an Apgar score of 9/10 within the first and fifth minute correspondingly. Suctioning of the babys nose and throat was done upon the delivery. The baby was given O2 and was placed under a radiant warmer. The baby cried spontaneously with a good skin color and good body movement. After the procedure, the patient was transferred from the delivery room to the 6 th floor. She arrived with IV line; incision site covered with scultetus binder and was experiencing minimal bleeding. At 0630H, the staff nurse endorsed Ms S.DT.L to the researcher with a Foley catheter and with a diet of NPO. The researcher received the patient conscious and coherent. At 0700H, the researcher was ordered to drain the urine from the urine bag and reported the amount of 7 ml. At 0800H, vital signs were taken and documented; temperature - 37 C, PR 82 bpm, RR 18 cpm, BP 100/70 mmHg. The researcher also

drained the urine from the urine bag and reported the amount of 26 ml from which the attending medical doctor was aware of. Therefore, Risk for imbalanced fluid volume r/t decrease in normal urine output was noted. The patient had a lower abdominal incision and was in limited range of motion thus, impaired tissue integrity r/t surgical procedure aeb presence of abdominal incision was recorded. The patient was given a bed bath at 0800H and the researcher noted the lochia discharge which is negative of foul odor with a reddish color. The skin of the patient was rarely moist and there is a presence of scultetus binder covering the incision site. The patient was also inserted an IV fluid, a side drip and a Foley catheter by which the researcher noted the diagnosis; risk for infection r/t post surgical procedure secondary to presence of contraptions. At 0900H, the attending medical doctor administered a hydrate in response to the decreased in urine output of the patient. When the researcher drained the urine from the urine bag, the amount recorded was 57 ml which indicated that urine output went back to normal range. At 1200H, vital signs were taken: temperature 37 C, PR 78 bpm, RR 20 cpm, BP 120/80. The patient was in an NPO diet and had a total urine output of 160ml, negative of bowel movement and positive of flatus. The patient was also in limited ROM therefore; risk for constipation r/t insufficient physical activity was noted. The researcher made use of OB history form in obtaining information about the patient. The researcher was also able to conduct an interview with the patient. The patients diagnostic examinations revealed that all were in normal condition except for the ultrasonography result of positive in oligohydramnios.

There were no discomforts noted during the first and second trimester of pregnancy. During the third trimester, the patient had experienced ankle edema and dyspnea. She had a past history of chicken pox by which the treatment was unrecalled by the patient. Vital signs were normal and urine output was 160 ml. The researcher had conducted health teaching to the client before the end of her shift.

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