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Group Leader: Grace Vania Perfas

Group Members:
Kaye Antoc
Revelyn Olubia
Myra Lyn Mejia
Jela Dulva
Mary Rose Fairbanks
Jhecy Vidal
I. Frank Breech Presentation
II. Table of Contents

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-
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.

Causes of Cesarean Birth:

1. Maternal Factors
Active Genital Herpes or Papilloma
AIDS/ HIV positive status
Cephalopelvic disproportion
Cervical Cerclage
Disabling condition e.g.severe PIH
Failed Induction / failure to progress
Obstructive Benign / Malignant Tumor
Previous Classic Cesarian Section

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:

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.

 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:

a. Name : Patient “Churvaclez”

b. Addres : 878 San Jose St. Ilaya, Las Pinas City
c. Age : 34 years old
d. Sex : Female
e. Religion : Born Again
f. Occupation : House wife
g. Marital Status : Married
h. Room & Bed Number : Saint Elizabeth #10
i. Chief Complaint : Labor Pain and Vaginal Discharged
j. Provisional diagnosis : Cesarean Section
k. Anesthesia to be used : RASAB
l. Attending Physician/Surgeon : Dra. Amurao
and Anesthesiologist
m. Hospital : Our Lady of Peace Hospital
n. Date & Time of Admission : September 13, 2010 / 11:00 P.M
o. Date & Time of Discharge : September 16, 2010 / 5:00 P.M

VI. Nursing History:

a. Past Health History

 Childhood Illness : Chicken Pox, Fever, Flu and Cough
 Immunization : BCG, DPT, Hepa B, TT 1-5, Measles
 Allergies : Baby oil
 Accidents : None
 Hospitalization : None
 Medication Used or Currently Taken: Iron During Pregnancy
 Foreign Travel : In Dubai last 2005, she stays their for 5

b. History of Present Illness

 none

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
-Gravida - 1
- Term - 1
- Para - 1
- Abortion - 0
- Living - 1
_Multipara - 1

 Personal and Pregnancy Detail

- 34 years old
- LMP - December 9, 2009
- EDD - September 16, 2010
- Date pregnancy was confirmed – 8 weeks after LMP by pregnancy test followed
by ultrasound
- Fetal movement by 20 weeks of gestation – the fetal movement is spontaneous
as sensed by the mother.

 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

VII. Patterns of Functioning

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

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.

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.

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.

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.

The patient used facial expression in comes with her emotional patterns. She also
managed her emotion in her own way.

 Sexuality Psychosocial Theory

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

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.

 Family Coping Patterns

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.

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.

 Psychosocial Theory – Generativity VS. Stagnation

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.

b. Socio Cultural Patterns

 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.

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.

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

 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.

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.

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

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

 Religious Beliefs and Practices

The client stated that they are Born Again Christian but they merely none-active.

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

Her Values and Valuing Pattern was bible based belief.

She always relates all her doing in their bible so that she will always avoid to do evil
things and to do good things.

VIII. Gordon's Pattern of Healthcare / Activities of Daily Living

ADL Before During Interpretation &

Hospitalization Hospitalization Analysis
1. Nutrition The client eats all kind She cannot eat food Before hospitalization
of foods. She loves to because she was NPO patient Churvaclez has
eat vegetables, fruits after labor and have a good food and fluid
and sweet foods. an IV hooked as her intake while when she
Water intake increase food and fluid intake. was hospitalized she
2 glasses a day from cannot eat food that's
8-10 glasses a day why she was irritated
while she was and unapproachable
pregnant. after her labor.
2. Elimination The client experienced Before labor she was She has difficulty of
defecation once a day, administered feet defecating during
with out the use of enema. And hospitalization
lavative or other aid constipated after because of exhaustion
for elimination. labor. and straining during
Urination is once in 1 Her voiding is below
hour about 30-50ml. Urination is below because of her
normal. position and not
moving time to time.
3. Exercise Patient don't have any After her labor the The clients activity
physical activity client was advised to tolerance was limited
except for her work rest but advised to due to body weakness
and some times going move time to time. and labor pain also to
to mountain climbing her incision sight.
with her friends.
4. Hygiene Patients takes a bath Patients did not takes After labor she can't
every morning. a bath after labor. take a bath due to
incision sight pain and
5. Substance Use Patients drinks coffee She stop drinking The patient think the
every morning. coffee due to breast health of her baby and
feeding. the risk of substance
to her little girl.
6. Sleep & Rest Patient was able to Patient is always It is normal for the
acquire 6-8 hours of asleep because of patient to be asleep
sleep. pain and her baby is because she always
always asleep. experiencing pain due
to her labor incision
and also she was
worried of her baby to
be asleep.
7. Sexual Activity On her 6th month of Patient don't have any Patient advised nor to
pregnancy she stop sexual activity after have coitus after labor
her sexual intercourse labor. until 6 weeks to avoid
with her husband incision sight damage
because they think and risk for infection.
that it will affect the
growth of the fetus.

IX. Physical Assessment

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
(+) striae
Hair Short, thick, Normal
silky, & evenly Findings
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
Eyebrows Terminal hair Normal
is evenly Findings
aligned, equal
Eyelashes Equally Normal
distributed Findings
Eyelids (-) presence of Normal
discharges Findings
Bulbar Transparent Normal
conjunctiv sclera appears Findings
Palpebral Shiny, smooth Normal
conjunctiv Findings
Lacriminal Swollen Due to Tender to Due to
glands drain pressure drain
tears tears
Pupil (Light test) Normal
reaction Illuminated Findings
to light pupils
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
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
newsprint at
the distance
of 6 inches.
Distant (News print) Normal
Vision client able to Findings
newsprint at
the distance
of 24 inches.
Visual (Snelling Normal
Acquity chart) client Findings
able to read
the snelling
chart of 20-20
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
Gross Normal voice Normal
Hearing acquity Findings
Acquity audible.
Weber (Tunning Fork) Normal
Test the client hear Findings
the tone by
through the
skull; sound
equally loud in
both ears.
Rinne Test (Tunning Fork) Normal
the client hear Findings
the sound
External Symmetrically Normal No Normal
nose and straight, Findings tenderness, Findings
no discharges, no lesions.
uniform in
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
and low
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.
Gums Pink in color, Normal Pink in Normal
moist, firm Findings color, Findings
texture to moist, firm
gum texture to
Tongue Central Due to Moist Normal
position, light inadequ slightly Findings
pale color ate rough, thin
oxygen whitish
supply coating
Moves freely, Normal
no tenderness Findings
Palate Slightly pale, Due to
hard palate inadequ
Uvula Position in mid Normal
line of soft Findings
Oropharyn Light pale and Decreas
x smooth ed
Tonsils Pinkish, Normal
smooth & no Findings
Neck Muscle equal Normal Lymp Normal
muscle in size, head Findings nodes are Findings
(sternoclei centered not
domastoid palpable
Head Normal
movement is Findings
smooth with
no discomfort.
Trachea Central Normal
placement in Findings
middle of the
Thyroid Not visible Normal Not Normal
glands Findings palpable Findings
Posterior Symmetric Normal
thorax chest, Findings
when client
takes a deep
Spinal Unable to Patient
alignment perform due refuse
to pain in to
client's perform
abdomen due to
pain in
n from
Respirator Refuse to Due to
y perform client's
excursion pain in
n from
Tactile Refuse to Due to
fermitus perform client's
pain in
n from
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
Jugular Veins visible Normal
veins in suppine Findings
Peripheral Symmetric Normal
pulse pulse volume Findings
Peripheral Distended Normal
veins vein /elevated Findings
Peripheral Limb not Normal
veins (leg) tender and Findings
symmetric in
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.
Abdomen Client refuse Stated
to perform that she
due to
in her
Cranial (cotton ball Normal
nerve I soaked in Findings
(olfactory alcohol)
nerve) patient able to
correctly the
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.

nerve VI
Cranial (Temporal & Normal
nerve V Masseter Findings
(trigemina Muscle
l nerve) Strenght)
patient able to
become taut
the muscles in
temporal and
masseter by
his/her teeth
Cranial (Test muscles Normal
nerve VII of facial Findings
(facial expression)
nerve) patient able to
smile, frown
and there is
no facial
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
Cranial (Gag Reflex Normal
nerve IX Test) patient Findings
(glosophar able to elicit
yngeal) the gag reflex.
afferent arm
Cranial CN X –
nerve X efferent arm
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
Cranial (Tongue Normal
nerve XII Muscle Findings
(hypoglos Strength)
sal) patient able to
his/her tongue
moving it in
and out, side
to side, &
upward and
Slowly and
rapidly and
the tongue
can't be
Legend: I.A. = Interpretation & Analysis

X. Diagnostic Studies

Date Procedure Norms Result Interpretation &

Pre Natal Analysis
09-09-10 HbsAg Non-reactive Non-reactive Normal

XI. Laboratory Studies

Date Procedure Norms Result Interpretation &
Sept 11, 2010 WBC Count 4.91-12.3 8.6 Normal Range
Granulocyte 55-75 73 Normal Range
Eosinophils 2-4 0.00 Low within
normal range
Lymphocyte 20-35 23 Normal Range
Monocyte 2-6 4 Normal Range
RBC Distribution 12.38-14.6 14.6 Slightly elevated
RBC Count 3.8-5.05 3.97 Normal Range
Hemoglobin 11.93-14.30 11.6 Normal Range
Hematocrit 36.81-43.71 34.4 Low within
normal range
MCV 83.89-100.66 87 Normal Range
MCH 27.21-33.27 29.2 Normal Range
MCHC 31.85-33.87 33.7 Normal Range
Platelet 150-450 281 Normal Range


Test Result Interpretation

Color Yellow Normal Findings
Transparency Hazy Normal Findings
Sugar Negative Normal Findings
Protein Negative Normal Findings
RBC None Normal Findings
Epithelial Cells Few Normal Findings
Mucus Threads Moderate Normal Findings
Reaction Acidic Normal Findings
Specific Gravity 1.020 Normal Findings
Bacteria Occasional Normal Findings

XII. Medications / Treatment Given

XIII. Intravenous Fluids (Central Line & Peripheral Lines)/TPN/Blood Transfusion


09-13- RUN for 41.6gtts/8 Hypertonic -Use to treat - - Monitor V/S
10 hrs hypovolemia. Infiltration carefully -
D5Lr> Time started: - fluid Monitor the
1L 8PM -For overload rate of fluid
Time ended: replacement or - Sepsis flow -
4AM maintenanceof - Phlebitis Assess
fluids and - Air catheter
electrolytes. embolism site daily -
- Check the
Thrombus rate
accuracy -
Pinch off
catheter or
system to
entry of air
- Check the
infusion site
times per
shift for


09-14- RUN for 41.6gtts/8 hrs Hypertonic -Use to treat - - Monitor V/S
10 Time started: hypovolemia. Infiltration carefully
D5Lr> 4AM - fluid - Monitor the
1L Time ended: -For overload rate of fluid
12NN replacement - Sepsis flow -
or - Phlebitis Assess
maintenance - Air catheter
of fluids and embolism site daily
electrolytes. - Thrombus - Check the
- Pinch off
catheter or
system to
entry of air
- Check the
times per
shift for


09-14- 41.6 gtts/ Hypertonic -indicated for - - Do not
10 Min x 8 hours parenteral drowsiness administer
D5NM Time started: 12NN maintenance , dizziness, unless
>1L Time ended:8PM of routine or solution is
daily fluid lightheade clear and
and dness container is
electrolyte undamaged
- Caution
s with
must be
es calories
in the
may help to
in atrogenic
deficiency in
prolonged patients
parenteral receiving
therapy. corticosteroi
should be
used with
caution as
on may
result in


09-14- RUN for 41.6gtts/8 hrs Hypertonic -Use to treat - - Monitor V/S
10 Time started: hypovolemia. Infiltration carefully
D5Lr> 8PM - fluid - Monitor the
1L Time ended: -For overload rate of fluid
4AM replacement - Sepsis flow -
or - Phlebitis Assess
maintenance - Air catheter
of fluids and embolism site daily
electrolytes. - Thrombus - Check the
- Pinch off
catheter or
system to
entry of air
- Check the
times per
shift for


09-15- 41.6 gtts/ Isotonic -Replenish - - Monitor V/S
10 Min x 8 hours fluid and Infiltration carefully
PNSS> Time started: 4AM electrolytes. - fluid - Monitor the
1L Time ended:12 NN of overload rate of
09-15-10 -For patients - Sepsis fluid flow
who have - Phlebitis - Assess
developed - Air catheter
dehydration embolism site daily
or - Thrombus - Check the
hypovolemia rate
- Pinch off
catheter or
system to
entry of air
- Check the
times per
shift for

XIV. Anatomy & Physiology

Anatomy and physiology

•Introduction of female reproductive

>Female reproductive structure include the external genitalia, internal genitalia and
mammary gland. Hormonal influences determine the development and function of these
structures and effect fertility, chilbearing and the ability to experience sexual pleasure.

>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 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 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

>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.

•End of 4th Gestational week

>At the end of the 4th week of gestational the human embryo is a rapidly growing
formation of cells but does not yet resemble of human being.
>Length: 0.75 cm
>Weigth: 400 mg
>The spinal cord is formed and fused at the midpoint.
>Lateral wings that will form the body are folded forward to fuse at the midline.
>Heads folds forward and become prominent, representing about one third of the
entire structures.
>The back is bent so that the head almost touches the tip of the tail.
>The rudimentary heart appears as a rpominent bulge on the anterior surface.
>Arms and leg are budlike structures.
>Rudimentary eyes, ears and nose discernible.
• End of 8th Gestational week
>Length: 2.5 mg (1 inch)
>Weigth: 20 g
>Organogenesis is complete.
>The heart with a septum and valves is beating rhythmically.
>Facial features are difinitely discrenible.
>Arms and legs have developed.
>External genitalia are present, but sex are not distinguishable y a simple
>The primitive tail is regressing.
>Abdomen appears large because the fetal intestine is growing rapidly.
>Sonogram shows a gestational sac, diagnostic of the pregnacy.

End of 12th Gestational Week

>length: 7 to 8 cm
>Weigth: 45 g
>Nail bed are forming on fingers and tails.
>Spontaneous movements are possible, althougth they are usually too faint to be
felty by the mother.
>Some reflexes,such as the Babinski reflex are present.
>Bone ossification centers are forming.
>Tooth buds are present.
>Sex is distinguishable by outward appearance.
>Kidney secretion has begun, although urine may not yet be evident in amniotic
>Heartbeat is audible through doppler technology.

End of 16th Gestational Week

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.

End of 20th Gestational Week

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.

End of 24th Gestational Week

(Second trimester)

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.

End of 28th Gestational Week

Length: 35 to 38 cm
Weight:1,200 grams
Lung aveoli begin to mature and surfactant can be demonstrated in amniotic
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.

End of 36th Gestational Week

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.

End of 40th Gestational Week

(Third trimester)

Length: 48 to 52 cm (crown to rump, 35 to 37 cm)

Weight: 3,000 grams (7 to 7.5 lb)
Fetus kick actively hard enough to cause the mother considerable
Fetal hemoglobin begins its conversion to adult hemoglobin. The
conversion is so rapid thtah at birth about 20% of hemoglobin adult in
Vernix caseosa is fully formed.
Fingernails extend over the fingertips.
Creases on the soles of the feet cover at least two thirds of the surface.

Reason for the increasing rate of C-section

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-
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
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
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
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

XVI. Path Physiology

XVII. Instrumentation

XVIII. Anesthesia Study

XXIX. Procedure

Preparing for the Room


Getting ready

Incission Sight Was Opened

Cutting the Skin

Cesarean Section Surgery Begins

Multiple Layers of Incisions for a Cesarean Section

The Uterine Incision

Suctioning Amniotic Fluids

Disengaging Baby from the Pelvis

Baby's Head is Born

Suctioning the Baby

Baby's Shoulders Born

Baby's Body Born

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.

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
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.

XXII. Incision Site

XXIII. Prioritized List of Nursing Problems

Date Nursing Problems Cues Justification

3rd Priority Knowledge Deficit “Ganito ba ang Lack of Knowledge
Related to tamang paglilinis ng and misconception
unfamiliarity with aking tahi” as about wound healing
information resources. verbalized by the and dressing and
patient. necessary lifestyle
may lead to infection
and further

2nd Priority Activity Intolerance Most activity

related to Pain at the “Nahihirapan akong intolerance may be
incision site. mkabangon at caused by generalized
makalakad as weakness, acute or
verbalized by the chronic pain or
patient” diseases.

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

XXV. Recommendations / Clinical Pathways

XXVI. Discharged Planning

 Medication

The client is advised to take the following:

-Antibiotics to avoid for any infection
Ampicillin 500mg every 6 hours
-Pain reliever and anti-inflammatory for her wound
Celecoxib 200mg every 12 hours

 Exercise

-Encourage patient to move inside the house

-Perform light exercise daily that will be interested for her to do
-Set a time for her daily exercise

 Treatment

With regards to the treatment of the client was advised:

-To continue her medications
-To continue her wound dressing every after bath to avoid enforcing of microorganism
-To continue self medication by slight rubbing her incision sight when she feels pain

 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
-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
-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

 Spiritual and Sexual Activity

-The client was encouraged to be active to her religion and constantly communicate to
-Inform client that sexual activity is restricted until 6weeks after labor

XXVII. Evaluation of Case Presentation


XXIX. Bibliography, to include website if being utilized