25905003-Nursing-Case-Study-C-section

NURSING CASE STUDY: CAESARIAN SECTION I. DEMOGRAPHIC DATA Name: Gender: Civil Status: Address: Age: Birt Birthd hdat ate: e: Birt Birthp hpla lace ce:: Religion: Occu Occupa pati tion on:: Diag Diagno nosi sis: s:

A.G.M Female Married Bacoor, Cavite 40 years old Sept Septem embe berr 26, 26, 1969 Imus Imus,, Cavi Cavite te Roman Catholic Hous Housew ewif ife e Elder Elderly ly Grav Gravid ida, a, PU 39-4 39-40 0 wk wkss AOG AOG (Low Lying Placenta Frank Breech) Operation Performed: Low Transverse Caesarian Section

II. HEALTH HISTORY Patient A.G.M is a 40 year old female, who is preganant for 40 week we eks, s, marr marrie ied d and and a moth mother er of two. two. She She is a cath cathol olic ic with with fair fair comp comple lexi xion on,, stan stands ds 153 153 cm and and we weig ighs hs 76 kgs. kgs. She She was was born born at Dasmarinas, Cavite and second among three siblings. Her AOG is 40 weeks. Patient had a previous CS delivery because she had difficulty on delivering her child. Patient had no history of asthma, no seizure, no diabetes mellitus and no hypert hypertensi ension. on. Patient Patient had compl complete ete immuni immunizat zation ion and had no allergies to either food or medications.

III. LABORATORY / DIAGNOSTICS

Procedure / Date 1. CBC

Actual

Normal

Findings

Findings

Implications

Nursing Responsibilities Pre: 

Check Doctor’s

Procedure / Date Hemoglobin

Actual

Normal

Findings 116

Findings 120 – 140 g/dL

Hematocrit

0.35

Nursing

Implications

Responsibilities Order.

Decrease - Indicates



Inform client and

occurrence of 

explain the

anemia

procedure.

Increase

0.30



No need for NPO.

- Indicates hypercoagulatio

Intra:

n



WBC

8.0

5 - 10

Segmenters

0.60

0.36 - 0.66

Normal

extraction

Lymphocytes

0.14

0.22 - 0.40

Normal

(venipuncture

Decrease

Perform blood

technique) using

- Indicates high

aseptic

risk for 

technique.

Eosinophils

0.02

0.01 - 0.04

acquiring

Stab Cells

0.04

0.02 - 0.05

infection

Platelets

320

150 –

Normal

ethyldiamino-

400x9/L

Normal

tetracetate

Normal

(EDTA) or the



Put extracted blood in

lavender top vacuum tube.

Post: 

Label the container properly and correctly.



Send specimen to the lab immediately.



Document the result to the chart and inform

Procedure / Date

Actual

Normal

Findings

Findings

Implications

Nursing Responsibilities physician that the result is out.

URINE ANALYSIS Microscopic Exam

Chemical Exam

Color: Yellow Transparency: Hazel pH: 6.0 (7.35 – 7.45) Specific Gravity: 1.010 (1.010 – 1.025) Epithelial Cells: Moderate

Albumin: Negative Sugar: Negative

IV. INDICATIONS FOR THE PROCEDURE CAESARIAN SECTION

A Caesarian section is a form of childbirth in which a surgical incision is made through a mother’s abdomen and uterus to deliver one or more babies. It is usually performed when a vaginal delivery would put the baby’s or mother’s life or health at risk; although in recent times it has been also performed upon requests for births that would otherwise have been normal. Caesari Caesarian an sectio section n (CS) (CS) is recomm recommende ended d when when vagina vaginall delive delivery ry might pose a risk to the mother or baby. Reasons for CS include:  

Precious (high risk) fetus Prolonged labor or failureto progress (dystocia

         

    

Apparent fetal distress Apparent maternal distress Complications (pre-eclampsia, active herpes) Catastrophes such as cord prolapse or uterine rupture Multiple births Abnormal presentation (breech or transverse positions) Failed induction of labor Failed instrumental delivery The baby is too large (macrosomia) Placental problems (placenta previa, placental abruption/ placenta accrete)

Umbilical cord abnormalities Contracted pelvis Sexually transmitted infections such as genital herpes Previous caesarian section Old age

V. PREPARATION 

POSITIONING

Patient that would undergo caesarian delivery should be requ requir ired ed to be in SUPI SUPINE NE POSI POSITI TION ON in the the en enti tire re cour course se of  deliver delivery. y. This This positi position on provide providess acces accesss to the interna internall organs organs

needed to be repaired in a certain operation. This position is used for procedures of the anterior body such as: abdominal, tho racic, facial and anterior upper and lower extremity procedures.



CATHETER INSERTION The patient is placed in a lithotomy position. The nurse must must wear wear sterile sterile gloves gloves whe when n perform performing ing this this proced procedure. ure. The genital area is exposed. The area is cleansed with the use of  antiseptic solution (3 times). Cleaning of the genital area starts at the top of the genitalia to the bottom using a pattern-7 motion on both both sides sides.. Th Then en,, the cathe catheter ter is inse inserte rted. d. To faci facili lita tate te the insertion, the catheter is lubricated. Urine will flow when the catheter passed the bladder. Then, the catheter is secured by injecting 10ml of sterile water on the Y-port. The urune bag is then attached to the catheter.



APPLICATION OF DRAPES Dra Draping ping inc include ludess the the use use of towe towells, eye eye shee sheets ts and lapa lapara rato tomy my shee sheett to main mainta tain in the the acce access ssib ibil ilit ity y and maximize the area to be examined and repaired and also provide a continuous sterile field.



ANESTHESIA

Spin Spinal al and and epid epidura urall anest anesthe hesia sia are are ways ways to numb numb surg surgic ical al patienst from the chest on down the legs. Both spinal and epidural

anesthesia anesthesia involve placing placing medications medications directly into the spinal area. The patient may be given an injection of local anesthetic diretly over the spot where the spinal or epidural anesthetic will be given, to decrease pain from the needle. Epidural anesthesia may be given as a single injection just outside of the sac of fluid that surrounds the spinal cod. When more than one dose of epidural anesthesia might be required, the anesthetist will leave a tiny, flexible tube or catheter in place outside of the fluid sac surrounding the spinal cord. More anesthetic can be given easily if the operation takes longer than expected.



INDUCTION OF ANESTHETIC AGENT The pati The patien entt is plac placed ed on a late latera rall posi positi tion on with with back back exposed. The nurse must wear sterile gloves before performing the procedure. The area where the anesthesia is to be inducted is clea cleans nsed ed with with alco alcoho holl and and foll follow owed ed by anti antise septi ptic c solu soluti tion on (3 times) times).. The cleani cleaning ng starts starts on the inserti insertion on site site with with circul circular ar motion using firm strokes.



INCISION SITE

The patient is placed on a supine position exposing the abdominal area. Sterile gloves are donned using the open glove method before performing the procedure. The operative site is cleansed with the use of cleanser (3 times), wet OS (3 times) and then changed the gloves before applying the antiseptic (3 times). Beginni Beginning ng at the incisi incision on site, site, the area area will will include include posterio posteriorr breast as the upper margin, the axillary line as lateral margins and to the anterior two thirds of the legs as posterior margin. Cleaning would always include use of firm circular motion leaving no spaces unwiped.

VI. INSTRUMENTS (C/S set)                    

Small kellies (6) Towel clips (4) Straight kellies (2) Needle holder (2) Mayo Collins (2) Tissue forceps (2) Ovum forcep (1) Metzenbaum (1) Ochsners Richarson retractor Medium Kellies (6) Allises (8) Bobcock (2) Army navy (2) Thumb forceps (2) Blade handle #3 and #4 Mayo scissor (1) Bladder retractor Deaver Self-retaining retractor

VII. PROCEDURES

•

• •

• • •

• • • • •

Client was place in supine position with contraptions noted and checked by anesthesiologist. Skin preparation of the induction site of anesthetic agents Induction of anesthesia, either spinal or epidural epidur al and sometimes general anesthesia Abdominal skin preparation to be done Application of drapes, eye sheet, laparotomy sheet Sequential incision begins: the skin, subcutaneous, peritoneum penetrating to the uterus Delivery of the baby Delivery of the placenta Sequential closing using appropriate absorbable sutures Hemostasis secured, peritoneal wash done Initials OS, instruments and needles completed

VIII. ANATOMY AND PHYSIOLOGY  ANATOMY AND PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM

EXTERNAL GENITALIA Our overview of the reproductive system begins at the external genital area — or vulva—which runs from the pubic area downward to the rectum. Two folds of  fatty, fleshy tissue surround the entrance to the vagina and the urinary opening: the labia majora , or outer folds, and the labia minora , or inner folds, located under the labia majora. The clitoris, is a relatively short organ (less than one inch long), shielded by a hood of flesh. When stimulated sexually, the clitoris can become erect like a man's penis. The hymen , a thin membrane protecting the entrance of the vagina, stretches when you insert a tampon or have intercourse. INTERNAL REPRODUCTIVE STRUCTURE 

The Vagina The vagina is a muscular, ridged sheath connecting the external genitals to the uterus, where the embryo grows into a fetus during pregnancy. In the reproductive process, the vagina functions as a two-way street, accepting the penis and sperm during intercourse and roughly nine months later, serving as the avenue of birth through which the new baby enters the world .

The Cervix The vagina ends at the cervix, the lower portion or neck of the uterus. Like the vagina, the cervix has dual reproductive functions.

After After interc intercour ourse, se, sperm sperm ejacul ejaculate ated d in the vagina vagina pass pass throug through h the cervix, then proceed through the uterus to the fallopian tubes where, if a sperm encounters an ovum (egg), conception occurs. The cervix is lined with mucus, the quality and quantity of which is governed by monthly fluctuations in the levels of the two principle sex hormones, estrogen and progesterone. When estrogen levels are low, the mucus tends to be thick and sparse, which makes it difficult for sperm to reach the fallopian tubes. But when an egg is ready for fertilization and estrogen levels are high the mucus then become becomess thin thin and slipper slippery, y, offer offering ing a much much more more friendl friendly y environm environment ent to sperm as they struggle towards their goal. (This phenomenon is employed by birt birth h cont contro roll pill pills, s, sho shots and and impl implan ants ts.. One One of the the ways ways they they prev preven entt conception is to render the cervical mucus thick, sparse, and hostile to sperm.) Uterus

The uterus or womb is the major female reproductive organ of humans of humans.. One end, the cervix, cervix, opens into the vagina; vagina; the other is connected on both sides to the fallopian tubes. tubes. The uterus mostly consists of muscle of muscle,, known as myometrium. Its major function is to accept a fertilized ovum which becomes implanted into the endometrium, and derives nourishment from blood vessels which develop exclusively for this purpose. The fertilized ovum becomes an embryo, embryo, develops into a fetus and gestates until childbirth. childbirth. Oviducts

The Fallopian tubes or oviducts are two very fine tubes leading from the ovaries of female mammals into the uterus. uterus. On matu maturit rity y of an ovum ovum,, the foll follic icle le and the ovar ovary' y'ss wall wall ruptur rupture, e, allowing the ovum to escape and enter the Fallopian tube. There it travels

toward the uterus, pushed along by movements of  cilia on the inner lining of  the tubes. This trip takes hours or days. If the ovum is fertilized while in the Fallopian tube, then it normally implants in the endometrium when it reaches the uterus, which signals the beginning of pregnancy of pregnancy.. Ovaries

The ovaries are the place inside the female body where ova or eggs are produced. The process by which the ovum is released is called ovulation. ovulation. The speed of ovulation is periodic and impacts directly to the length of a menstrual cycle. cycle. After ovulation, ovulation, the ovum is captured captured by the oviduct, oviduct, where it travelled down the oviduct to the uterus, occasionally being fertilised on its way by an incoming sperm, sperm, leading to pregnancy and the eventual birth of a new human being. The Fallopian tubes are often called the oviducts and they have small hairs (cilia (cilia)) to help the egg cell travel.