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Age:- 24
Occupation:- housewife
Address: bolar
GPL:- G1P1L1
IP NO:-11375
Date of admission:-21/09/09
Birth weight:1.9kg
Height: 46cms
Weakness,
HISTORY :-
Menstrual history :- 3-4 days with normal flow
Antenatal history :-
First Trimester :-
- Last date of Menstruation:18/12/08
- Expected date of Delivery:20/09/09
- Unusual tenderness and tingling in breast: slight tenderness was present
since 2nd month of pregnancy
- Nausea and Vomiting: present in all 3 months
- Back pain: there was no history of backpain
- Habits :e / treatment/ medication: pregnancy confirmed with UPT and
scan in 9wks
Second Trimester :-
- Back pain: gradually started from 5th month of pregnancy
- Nausea and vomiting: taken medication so nausea and vomiting symptoms
reduced
- Edema of ankle and feet: slight edema of ankle was present
- Fetal movements: quickening at 5 MA
- Functional status: active
- Special investigation/treatment/medication:
immunisation with 2 doses of T.T.
1st at 16 wk
2nd at 24 wk
Taken folic acid and calcium supplements
Third Trimester :-
- Edema of ankle and feet: increased in 8th month of pregnancy
- Nausea and vomiting: no h/o nausea n vomiting
- Back pain and other joint pain: no h/o back pain
- Bed rest/ Functionally active: active
- History of Incontinence: urinary symptoms- increased frequency of day n
night
Labor History:- On 21/09/09at around 3:30pm she started with labour pain
and at 5:40pm she delivered the baby.
- 1st stage :
- 2nd stage :
- 3rd stage :
- Time /Duration: 2hours (from 3:30pm to 5:30 pm)
Date of delivery:- 21/09/09
Any History of:- no h/o any complications during delivery
- Failure to progress :
- In coordinated uterine activity :
- Placental abruption :
- Labial hematoma :
- Perineal tears :
- Malpresentation like breech/ vertex : vertex
- Mal position :
Assisted delivery:-
- Episiotomy: done
- Forceps delivery:
- Vacuum Extraction:done
- Caesarean section:
Drugs taken during delivery:- oxytocin and methacyn given
Past history :-
Medical History :-
- Posture -
Slightly protracted shoulders
ON PALPATION :-
- Tenderness(pelvic region/ back) :
- Scar : Adherent
Non adherent
- Edema : Pitting
Non pitting- present at both ankles
- Diastasis recti examination : 1finger widthway
ON EXAMINATION :-
Vital signs :
Motor examination :
Trunk
MUSCLE GRADES ( MMT )
- Oblique trunk - 2
- Rectus abdominals - 2
- Back extensors - Not taken
- Transverse abdominals 2
Lower limb
- Girth measurement :
5,8,15 and 23 cms above the base of patella
Ankle
Left-25cms
Right-25cms
Respiratory assessment :
- MOTHER:
Chest expansion:
Nipple level-2cms
Axillary level-3cms
Xiphisternum- 1.5cms
Breathing pattern: thoracoabdominal
- CHILD:
Auscultation:
Chest expansion:
Back pain assessment :
Body chart / location : Constant pain / intermittent pain
- Type of pain :
Sharp and burning, distributed along specific nerves- nerve
Dull aching, poorly localized and referred to other areas-
muscle
Localized but referred pain to other areas- joint
Diffuse, aching especially in one portion- vascular/ischemic
Pins and needles- present on lateral aspect of thigh
Problem
1. weakness n lower limb pain
2. suture pain
2. strengthening of trunk
Management
DAY 2:
Deep breathing exercises with abdominal wall tightening
Ankle foot exercises with elevation to reduce edema of ankles
Strengthening exercises:
Static quadriceps and gluteal contractions,
Hip adductor isometrics
Abdominal strengthening exercises-in crook lying, head lift with
abdominal support
Lower abd leg sliding exercise with posterior pelvic tilt
Correction of posture
- Patient is make to understand about her wrong posture and is
ask to keep shoulder back during her functional activities.
- In supine position patient is ask to try to touch both shoulders to
plinth and stretch it downwards for stretching of pec minor.
- In sitting patient is ask to retract the shoulder while performing
butterfly position during breathing
- In prone position also she is ask to take shoulder back direction,
this will give resistance as against gravity activity will be
performed.
Preventive measures:-
Back care :
1. patient is taught to sit erect
2. while doing household activities like cooking and washing clothes don’t
strain the back with prolonged bending
3. while lifting her baby from the floor or any heavy object bend from the
knees and lift
4. When she gets up from lying position, she has to turn to the one side
and then slowly get up.
Home program :
1. To follow and continue the instructions given for the preventive
measures.
2. Progression of exercise can be done from leg sliding exercise to
alteranate knee flexion and extension in air to cycling movement
in the air.
-post pelvic tilt with both legs raised straight ahead until the range
where she can maintain the posterior pelvic tilt.
Repetitions are kept same for this exercises only resistance is
increased.
3. back strengthening in prone can be done as patient is comfortable
in prone position
4. in prone position from lifting shoulders from plinth to lifting the
arms along it and holding for 5 secs to both arms in 90degree abd
and then shoulders are lifted and 5 secs hold time is given.
5. breathing exercise is taught to patient
diaphragmatic and butterfly position in sitting is taught.