A Case Study

Of
Cesarean Section
(Pre- Eclampsia)

Presented to
the Faculty College of Nursing
Isabela State University

In
Partial Fulfilment
of Requirements of
the Subject NCM 107

Presented by:
Arceo, Rio Lei D.
Derilo, Jocelyn V.
Gabayno, Kathlene G.
Foo, Milagros B.
Kinilo, May Anne F.
Pontalba, Regin G.
Quilang, Sherimay A.
Ragasa, James M.
Singh, Mardew Kaur J.
I. Introduction

II. Objectives

III. Client’s Profile

IV. History

V. Case Discussion
I. Cesarean Section
II. Pre-eclampsia
- Definition
- Purpose
- Complications
- Course of the Procedure

VI. Anatomy

VII. Physiology

VIII. Management

IX. Diagnostic Procedure

X. Drug Study

XI. Nursing Care Plan

XII. Methods
I-Introduction

OVERVIEW OF THE DISEASE

Intoduction
Pre-eclampsia
 also referred to as toxemia, is a medical condition where hypertension arises in pregnancy
(pregnancy-induced hypertension) in association with significant amounts of protein in the urine.
 Pre-eclampsia may develop from 20 weeks gestation. Its progress differs among patients. Most
cases are diagnosed pre-term. Pre-eclampsia may also occur up to six weeks post-partum. It is the
most common of the dangerous pregnancy complications; it may affect both the mother and the
unborn child.
Risk Factors
cause: UNKNOWN

 Primiparity (giving birth for the first time)

 Preeclampsia during a previous pregnancy

 Chronic hypertension, chronic renal (kidney) disease, or both

 A history of thrombophilia (an abnormal condition that increases risk of blood clots in blood
vessels)

 Multiple babies in one pregnancy (e.g., twins, triplets)

 In vitro fertilization

 A family history of preeclampsia

 Type I or type II diabetes

 Obesity

 Lupus (an autoimmune disease)

 Advanced maternal age (older than 40 years)

Signs and Symptoms

 Swelling in the feet, legs, and hands.
 rapid weight gain caused by a significant increase in bodily fluid
 Abdominal pain
 Severe headaches
 A change in reflexes
 Reduced output of urine or no urine
 Dizziness
 Excessive vomiting and nausea
Classifications
Mild Preeclampsia
 Blood pressure ≥ 140/90—2 occasions 6 h apart (not more than 1 week apart)
 Proteinuria— ≥ 300mg/24-h sample
Severe Preeclampsia
 Blood Pressure ≥ 160/110—2 occasion at least 6 h apart (not more than 1 week apart)
 Proteinuria— ≥ 5g/24-h sample

Treatments
  abortion or delivery
 either by labor induction or Caesarean section (and therefore delivery of the placenta)

Pharmacological Management
 Magnesium sulfate-is the first-line treatment of prevention of primary and recurrent eclamptic
seizures (it reduces transmission of nerve impulses from brain to muscles).

Nursing Management
 The mother and her family deserve careful teaching regarding the problem, its observation, and its
treatment.
 Regular, adequate prenatal care is the best insurance for control of the complication.

According to The Scientific World Journal Volume (2018), pre-eclampsia and eclampsia rank
second or third in the world ranking of maternal morbidity and mortality causes. In an analysis
implemented by the World Health Organization, which evaluated the causes of maternal death occurred
between 2003 and 2009, the hypertensive causes appear in the second place, occurring in 14% of the cases,
preceded only by hemorrhagic causes, responsible for 27.1% of the maternal deaths.
https://www.hindawi.com/journals/tswj/2018/6268276/

In the Philippines, according to Department of Health, Maternal Mortality Rate (MMR) is 162 out
of 10,000live births (Family Planning Survey 2006). 3 Maternal deaths account for 14% of deaths among
women. For the past five years all of the causes of maternal deaths exhibited an upward trend. Preeclampsia
showed an increasing trend of 6.89%; 20%; 40%; and 100%. Ten women die every day in the Philippines
from pregnancy and childbirth related causes but for every mother who dies, roughly 20 more suffer serious
disease and disability. The UNFPA office in the Philippines declared that family planning can help prevent
maternal deaths by 35%. (http://hb4110.net/wpcontent/uploads/KIT_MATERNAL%20HEALTH_BASIC
%20STATS.doc.)
 I. OBJECTIVES

General Objectives

This study aimed to improve the student’s knowledge for Cesarean Section (Pre- Eclampsia) by
obtaining sufficient information that could serve as a guide for us student nurses who will be focusing
on the same case and it is also designed to enhance skills and attitudes in the application of nursing
process and management of the procedure.

Specific Objectives
To gain enough knowledge on disease process
To understand the entire course of the procedure.
To know the client’s personal data, her family profile, past health history, current medical history,
and physical assessment.
To review the anatomy and physiology of the female reproductive system.
To discuss the purpose of the procedure and its possible complication.
To correlate the results of the diagnostic procedures to its normal values.
To formulate the drug study
To develop an effective nursing care plan in which the client may benefit.
 II. PATIENT’S PROFILE

Name : Patient KVA

Age : 19 years old

Gender : Female

Civil Status : Married

Nationality : Filipino

Address : Purok 5, General Aguinaldo, Ramon, Isabela

Religion : Roman Catholic

Date of Birth : July 5, 1999

Birthplace : San Mateo, Isabela

Attending Physician : Dr. PC

Date of Admission : May 2, 2019 (1:00 am)

Final Diagnosis : G1P0 Pregnancy Uterine 39 2/7 weeks of Gestation

Cephalic in Beginning Labor Pre Eclampsia with Severe Feature

Chief complaint : elevated blood pressure with lumbosacral pains

 PATIENT HISTORY

History of Present Illness

T h e c l i e n t i s o n h e r 3 9 th w e e k A O G . F e w h o u r s b e f o r e h e r c o n f i n e m e n t ,
t h e c l i e n t experienced headache, positive contraction, lumbar pains while washing dishes . She
immediately called her h u s b a n d w h o w a s i n s i d e t h e h o u s e a t t h a t t i m e a n d s h e w a s
r u s h e d t o t h e e m e r g e n c y department of the Southern Isabela Medical City on the 2nd day of May two
thousand nineteen and decided to admitted.

Past Medical History

According to the patient, she received two shots of Tetanus Toxoid. When she was not
pregnant her mother u s u a l l y t r e a t s h e r c o m m o n c o l d s a n d c o u g h u s i n g o v e r- t h e -
c o u n t e r d r u g s a n d w i t h h e r b a l medicines. She denies any history of allergies and injuries in the past.

Social and Environmental History

The patient no vices like smoking and drinking alcohol. Her mother doesn’t allowed her to do household
chores.
Family History
The patient stated she does not have any history of diseases. The structure of their family was extended
family her husband lives with her. The father of the patient is the head of the family and he is the one who decides
when there is problem.
ANATOMYAND 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 canal (approximately 10 cm long) that serves as the entrance to the reproductive
tract. It also serves as the exit from the uterus during menses and childbirth.
The Cervix
The cervix is the narrow inferior portion of the uterus that projects into the vagina. The cervix produces
mucus secretions that become thin and stringy under the influence of high systemic plasma estrogen
concentrations, and these secretions can facilitate sperm movement through the reproductive tract.
Uterus
The uterus is the muscular organ that nourishes and supports the growing embryo. Its average size is
approximately 5 cm wide by 7 cm long (approximately 2 in by 3 in) when a female is not pregnant. It has three
sections. The portion of the uterus superior to the opening of the uterine tubes is called the fundus. The middle
section of the uterus is called the body of uterus (or corpus). The wall of the uterus is made up of three layers. The
most superficial layer is the serous membrane, or perimetrium, which consists of epithelial tissue that covers the
exterior portion of the uterus. The middle layer, or myometrium, is a thick layer of smooth muscle responsible for
uterine contractions. The innermost layer of the uterus is called the endometrium. The endometrium contains a
connective tissue lining, the lamina propria, which is covered by epithelial tissue that lines the lumen

Oviducts
The uterine tubes (also called fallopian tubes or oviducts) serve as the conduit of the oocyte from the ovary
to the uterus. Each of the two uterine tubes is close to, but not directly connected to, the ovary and divided into
sections. The isthmus is the narrow medial end of each uterine tube that is connected to the uterus. The wide distal
infundibulum flares out with slender, finger-like projections called fimbriae. The middle region of the tube, called
the ampulla, is where fertilization often occurs.
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.
CESAREAN SECTION

A Caesarean 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.

Caesarian section (CS) is recommended when vaginal delivery might pose a risk to the mother or
baby. Reasons for CS include:

 Precious (high risk) fetus

 Prolonged labor or failure to 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
 Breech Presentation
 PATHOPHYSIOLOGY

Non Modifiable
 Age (<20 ,>35 years old)
Modifiable  primipara
 High Sodium and fat
intake
 lack of activities during
pregnancy

Activation of symphathetic Nervous

System

 Increase HR
 Increase cardiac contractility
 Produces widespread
vasoconstriction in the
peripheral arterioles

ASFdi
Endothelial cell damage

Vasospasms

Vascular effect Kidney effect Instertisial effect

Decreased glomeruli Diffusion of fluid from blood stream

Vasoconstriction filtration rate and increased into interstitial tissue
permeability of glomeruli
membranes
Poor organ perfusion Edema

Increased blood serum urea,

Increased blood pressure nitrogen, uric acid, and
creatinine

Decreased urine output and

proteinuria
 LABORATORY RESULTS

Actual
Procedure / Date Normal Findings Implications
Findings
1. CBC

Hemoglobin 14.3 13.0-18 g/dL Normal

Hematocrit 43.7 40-54 g/dL Normal

WBC 8.0 5 - 10 Normal

Segmenters 0.60 0.36 - 0.66 Normal
Lymphocytes 0.22 0.22 - 0.40 Normal

Eosinophils 3.1 3.0-5.0% Normal

Basophils 0.5 0.1-1.0 Normal
Stab Cells 0.04 0.02 - 0.05 Normal
Platelets 320 150 – 400x9/L Normal

Clinical Chemistry Report

May 2. 2019

TEST Result Range

AST 48 U/ L 14-59
ALTV 27 U/L 0-35
LDH 229 U/L 313-618

TEST Method Result

HBsAg Immunochromatography Non reactive
May 1, 2019

ULTRASOUND FINDINGS

Live m single, intrauterine pregnancy in cephalic presentation with good cardiac and somatic
activities, amnionic fluid index is 4.52 cm. Placenta is postero-fundal high lying grade III AOG is 37 weeks
and 6 days by fetal biometry. EDD is on 5/16/2019. Fetal gender is probably female BPS-fetal breathing-2
fetal tone-2, fetal movement-2, AFI-2 Total BPS-6/8 consider chronic fetal hypoxia.
DRUG STUDY
 DISCHARGE PLANNING

Medications

Environment
 Instructed patient to stay calm quiet environment
 Home environment must free from slipping or accidental hazards
Treatment
 Wound cleaning and dressing
Health Teaching
 Informed patient avoid lifting heavy objects
 Stressed the importance of perineal cleanliness
 Instructed patient to promote breastfeeding
Out patient
 Informed patient to have follow up checkup after 1 week
Diet
 Encouraged patient to increase fruits and vegetables for faster wound healing
 Instructed patient to promote adequate fluid intake
Spiritual
 Encouraged patient to always pray and attend mass.