INTRODUCTION

Cesarean Section A cesarean birth, also known as C-section, happens through an incision in the abdominal wall and uterus rather than through the vagina. Some Csections are planned due to pregnancy complications or because you've had a previous C-section. But, in many cases, the need for a first-time C-section doesn't become obvious until labor has already started. Knowing what to expect during the procedure and recovery can help the mother prepare. Base on the studies conducted by the Department of Obstetrics and Gynecology, College of Medicine, University of the Philippines Manila, that out of 9550 women undergone cesarean section, 2592 (27%) women and their 2645(27%) babies were born by caesarean. Actual rates varied from 12% to 39% between hospitals. Overall 27% of women had a caesarean section, with rates varying from 12% to 39% between hospitals within the Philippines. The most common indications for caesarean were previous caesarean (7.0%), cephalo- pelvic disproportion (6.3%), mal-presentation (4.7%) and fetal distress (3.3%). Neonatal resuscitation rates ranged from 7% to 60% between countries. Prophylactic antibiotics were almost universally given but variations in timing occurred between countries and between hospitals within countries. Types 1. The ''classical Caesarean section'' involves a midline longitudinal incision which allows a larger space to deliver the baby. However, it is rarely performed today as it is more prone to complications. 2. The lower uterine segment section is the procedure most commonly used today; it involves a transverse cut just above the edge of the bladder and results in less blood loss and is easier to repair. Patient x undergone cesarean section for the reason that she failed to progressed her labor and the OB gyne found out for cephalo- pelvic disproportion thus surgery performed to save life of the mother as well as the baby. After the operation the patient was cared for and monitored closely for her early recovery. Health teachings address to the mother such as the significant of early ambulation, good personal hygiene and the importance of breast feeding were accurately discussed by the health team.

PATIENT PROFILE

I. Demographic data: Patient X is 32 years of age born on april 11, 1979. A religious Roman Catholic by her faith and a bonafide resident of purok 3C Ampyon Butuan City. Her height estimated as 5 feet and 9 inches tall and she weighs approximately 69 kilograms. She happily married by a neurosurgeon currently working at Butuan Doctors Hospital and affiliated to other hospitals here in Butuan City. During her admission she accompanied by her eldest sister as her source of moral support. Patient X is a Certified Public Accountant and finished her Bachelor of Science in Accountancy in Iligan Institute of Technology in the year 2000. As patient X goes along to her life she discovered interests when it comes to health related courses. Patient X took her Bachelor of Science in Nursing at Butuan Doctors College. She enjoyed her school days and she graduated on 2007 at the same year she earned her Licensure examination in Nursing. Currently, she happily committed to her loving husband as plain housewife enjoying her interests in life such as cooking and reading magazines. II. Health Status Patient X eats three times a day with noon and midnight snacks. She preferred to eat rice, vegetables, meats and sea foods and other latest menu. She love fruits also and she used to drink 5-6 glasses of water a day and 1 glass of milk every night. Patient X was very Health Conscious during her pregnancy she comply all the pre natal check up and she limit her sugar intake to prepare for her expected date of delivery. Patient X doesnt have any food allergies and problem in chewing and swallowing ability. Patient X doesnt have allergies to medications also and she had current home medications prescribed by her physician. Co-Amoxiclav (Augmentin) 625 mg 1 tablet three times a day an anti-infective drug help to prevent entry of

micro organisms and Eterocoxib 120 mg 1 tablet once a day an analgesic drug to treat pain. III. History of present illness Prior to admission it was January 21, 2012 in the morning when patient X developed unbearable pain started at the lower back that radiates to the abdomen. Her complaint prompted her significant others to referred in the hospital. Thorough assessment was conducted and revealed patient last menstrual period was on April 23,2011, age of gestation was 38-39 weeks and her expected date of confinement will be on January 30,2012.Vital signs was taken and recorded as within normal results internal examination done and revealed 2-3 cm dilatation she undergone laboratory examination such CBC-all were in normal range except for the significant decrease of the hematocrit . Patients admission was processed and she transferred to OB ward for labor monitoring. Labor pain lasted for longer period of time without progression caused alarmed to the physician and decide for STAT CS with pre-diagnosis of PUFT CPD in labor. Pre-op care done, informed consent signed already and health conditioned assessed completely by the anesthesiologist and the surgeon. It was January 22,2012 at 7:30 pm cesarean section was started under epidural anesthesia. Extracted alive baby girl; crying at 8:05pm and the operation ended at 9pm with final diagnosis of PUFT delivered by primary CS secondary to CPD.

IV. Patient Past Medical History Patient X hospitalized due to fever and cough at Butuan Medical Center when she was 9 years old. She does not undergone any previous surgery . her cesarean delivery was her first surgery. She doesnt have any other medical condition and a history of childhood diseases. V. Family history of Disease -----NONE---VI. Environment health history Their house situated 6 kilometers away from the proper City of Butuan but nevertheless Patient X considered their house as conducive for living. She smelled fresh air and she like the environmental views that surrounds in

their house. They had planted domestic flowers and they had two house workers to maintain the cleanliness of their house/home. VII. Psychosocial and Cultural history According to patient X their house was near apart their families and relatives and they had their family gathering most of the time. They improved their relationship by showing respect to each other and they maintain the standard behavior as professionals. VIII. Functional health pattern Health Perception: Patient X is able to maintain healthy living. Before hospitalization she adhers to pre natal check up and limits her caloric intake and during hospitalization she obeyed to instructions for her delivery that is why patient x adapts normally. Nutrition/Elimination/Bowel/Bladder and Skin: Patient ate meals on time with enough fluid intake and had her regular elimination and it altered during hospitalization. Patient x also maintain her pear skin complexion and its cleanliness. Activity/Exercise and Cognitive Perceptual: Patient X was able to performed activities during her labor and she was able to manage her emotions. She comply her early ambulation that is why patient x had recovered earlier. Sleep/Rest and Self concept: patient x had enough rest periods and she maintains herself as to conserved energy. She had good self disciplined as she carried herself. Role Relationship and Sexuality: before and after the hospitalization patient x maintained her role as a mother and as a wife. She prepares herself for her baby and for her husband to better mold their relationships. Coping and Value/Belief: though she had hospitalized shes doing good to her health. Doing ambulation and personal care. Still she had strong faith the man above on earth who gave us what we need and pray.

IX. Head to Toe assessment

Pateint X was responsive and coherent upon interactions. She was very nice to talk for because she could gave me more information when it comes to health. According to her, she doesnt feel any dizziness and body weakness only what she wanted to do was to transferred to NICU to watched her cute baby. Her head was in normal size and shape proportionate to her body. her eyes looks so good and her ears and nose were in good condition without any obstruction or presence of drainage. Her teeths were completely formed without cavity and her breath sounds were cleared. She had post-op dressing supported with abdominal binder it was dried and intact without the presence of drainage nor swelling and redness in the area. She doesnt have complained for abdominal distention and a sense of nausea and vomiting. She had her regular urination, urine with minimal lochial discharges pinkish in color and she had bowel movement and her feces were in normal consistency without the presence of blood. She had pear skin complexion at normal warmth to touch. She doesnt complain for pain in the body just for sometimes aggravated by movements in ambulation she felt slight pain in the operative site but it was tolerable.

ANATOMY AND PHYSIOLOGY

A pair of ovaries

which

release an egg/ova alternately every cycle(28days) into the fallopian tube(oviduct)

A fallopian tube or oviduct

leading from each ovary in the uterus

The

uterus-

muscular

structure in which the fetus develops

The vagina(birth canal) The vulva or external opening The ovaries are the female sex organs. They occur in the lower part of

the abdominal cavity and are held in place by ligaments . Each ovary is

made up of a covering of germinal epithelium tissue with a large number of follicles within them.

The germinal epithelium cells produce the follicles which in turn

produce the ova during the process of oogenesis. The breast is an apocrine gland that produces milk to feed an infant child; for which the nipple of the breast is centred in (surrounded by) an areola (nipple-areola complex,), the skin color of which varies from pink to dark brown, and has many sebaceous glands. The basic units of the breast are the terminal duct lobular units , which produce the fatty breast milk. They give the breast its offspring-feeding functions as a mammary gland. They are distributed throughout the body of the breast; approximately two-thirds of the lactiferous tissue is within 30-mm of the base of the nipple. The terminal lactiferous ducts drain the milk from 418 lactiferous ducts, which drain to the nipple; the milk-glands-to-fat ratio is 2:1 in a lactating woman, and 1:1 in a nonlactating woman.In addition to the milk glands, the breast also is composed of connective tissues (collagen, elastin), white fat, and the suspensory Cooper's ligaments. Sensation in the breast is provided by the peripheral nervous system innervation, by means of the front (anterior) and side (lateral) cutaneous branches of the fourth-, the fifth-, and the sixth intercostal nerves, while the T-4 nerve (Thoracic spinal nerve 4), which innervates the dermatomic area, supplies sensation to the nipple-areola complex. A womans breasts overlay the pectoralis major muscles and usually extend from the level of the second rib to the level of the sixth rib in the front of the human rib cage; thus, the breasts cover much of the chest area and the chest walls. At the front of the chest, the breast tissue can extend from the clavicle (collarbone) to the middle of the sternum (breastbone). At the sides of the chest, the breast tissue can extend into the axilla (armpit), and can reach as far to the back as the latissimus dorsi muscle, extending from the lower back to the humerus bone (the longest bone of the upper arm). As a mammary gland, the breast is an inhomogeneous anatomic structure composed of layers of different types of tissue, among which

predominate two types: (i) adipose tissue and (ii) glandular tissue, which effects the lactation functions of the breasts.Morphologically, the breast is a cone with the base at the chest wall, and the apex at the nipple, the center of the NAC (nipple-areola complex). The supercial tissue layer (superficial fascia) is separated from the skin by 0.52.5 cm of subcutaneous fat (adipose tissue). The suspensory Coopers ligaments are fibrous-tissue prolongations that radiate from the superficial fascia to the skin envelope. The adult breast contains 1418 irregular lactiferous lobes that converge to the nipple, to ducts 2.04.5 mm in diameter; the milk ducts (lactiferous ducts) are immediately surrounded with dense connective tissue that functions as a support framework. The glandular tissue of the breast is biochemically supported with estrogen; thus, when a woman reaches menopause (cessation of menstruation) and her body estrogen levels decrease, the milk gland tissue then atrophies, withers, and disappears, resulting in a breast composed of adipose tissue, supercial fascia, suspensory ligaments, and the skin envelope.

PATHOPHYSIOLOGY 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 Ripening of the cervix

(Descent of the fetal (Goodells sign wherein head to the pelvis) the cervix feels softer the consistency

Braxton hicks Contraction

(False Labor) > Begin and remain irregular like of

>1st felt abdominally >Pain disappears with ambulation the earlobe. >Do not increased in duration and intensity >Do not achieve cervical dilatation

TRUE LABOR

Uterine contractions Rupture of the membranes >Increased in duration and intensity (rupture of the amniotic sac) >1St felt to the back and radiates to the Abdomen >Pains does not relieve no matter what the activity >Achieve cervical dilatation

Show

(Pink tinged of blood a mixture of blood and fluids)

Failed to progress labor (due to Cephalo- pelvic disproportion)

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)

Removal of the fetus

Removal of the placenta


Post op Management

-Monitoring patients vital signs -Encouraged patient for early ambulation -Encouraged to comply medication - Emphasized the importance of good personal hygiene and Breast Feeding -Patient recovered after 3 days Patients chart Processed for Discharge

DIAGNOSTIC TESTS

January 21, 2012 CBC Hemoglobin Result 14.7 % Normal values 11.0 -16.0 Interpretatio n Normal Significance Encourage to eat nutritious foods and fruits high in vit.C. Advise to increase fluid intake.

Hematocrit

14.3 %

37 - 47

Below normal

White Blood Cell Platelet Count

10.63 % 159 %

4.5 - 11 150 - 450

Normal Normal Emphasize the importance of good personal hygiene. Advise to clean environment.

Segmenters

75 %

50 - 70

Above normal

Lymphocytes Eosinophils Monocytes Band Basophils

18 % 0 % 6 % 0% 0%

20 - 40 1-5 1-6 2-3 0-1

Normal Normal Normal Normal Normal

DRUG STUDY Generic/ Brand name/ Date ordered CoAmixocla v (Augmen tin) Jan.25,20 12 Classific ation/ Dose and frequenc y Antiinfective 625 mg TID Mechani sm of action Indicati ons Contraindic ation Adverse reaction s Nursing Responsibilitie s

Infectio It works n in by upper interferin and g with lower GI the tract. ability of Skin and bacteria childbirt to form h. cell walls. It blocks the release of Prostagla ndin/Bloc ks pain Receptors . Relieve acute and chronic pain/dys menorrh ea.

Hypersensiti vity or allergy to cephalosporin.

Diarrhea, Nausea and Vomiting Indigesti on.

Give Drug with full Stomach. Observe the 11 golden rights in administering medication.

Eterocoxi b (Arcoxia) Jan. 25, 2012

Analgesic 120 mg 1 tab. Once a day.

Advanced renal disease, heart failure and liver dysfunction.

Dizziness , palpitatio ns and skin irritation s.

Give drug with full stomach. Maintain golden rule of giving medication.

DISCHARDE PLAN

MEDICATION Co- Amoxiclav (Augmentin) 625 mg TID Eterocoxib (Arcoxia) 120 mg OD

EXERCISE Gradual ambulation as tolerated.

Flexion and Extension of the lower and upper extremities.

TREATMENT Increase oral fluid intake.

Maintain a conducive environment for early recovery.

HEALTH TEACHINGS Instructed to to have regular hygiene. Encouraged breast feeding.

Encouraged to eat nutritious foods and fruits.

FOLLOW-UP / CHECH UP To come back on February 2, 2012 at Dra. Gambes clinic.

DIET Diet as tolerated without any restrictions.

LEARNING OUTCOME

Within 3 days of exposure in clinical area floor 2A, with extensive processed of learning to developed/improved my knowledge in medicalsurgical ward. I found myself tensed but tolerable and I was able to improve

my weaknesses such as proper time management and prioritization. Though in a short period of duty it maximized my learning as to comply all the requirements given by our SHN and CI.

All in all it adds my knowledge and skills , I encountered new clients with different health problems. I believe that what I learned in the area will be apply to different situation wherever I am and for the rest of my life. Finally, learning could be like as an acute illness well never no at span of time learning accumulate learning reach into expertise.

GOD BLESS ALL..

JANAURY 27, 2012

INDIVIDUAL..

CASE...
S TUDY.

PUFT DELIVERED PRIMARY CS SECONDARY TO CPD

RANDY J. AMOR SN IV SHAHANY C. CAF SHN IV MARIVIC M. SUGUITAN RN, MN