Bulacan State University

College of Nursing
City of Malolos, Bulacan

In partial fulfilment

At NCM 102

Case Study: Cesarean Section

Submitted to:
All 2nd Level Clinical Instructors

Submitted By:

Ducducan, Allen B.
Dalisay, Ria-Dianne E.
David, Leizel Abigael S.
De Belen, Mary Ann D.J
Dela Cruz, Clarice Mae F.
Dela Cruz, Divine Mysterie N.
De Leon, Abigael R.
Eusebio, Ma. Edilaine N.
Eusebio, Ma. Edilyn N.
Jeremias, Monique J.

BSN 2E Group2

pg. 1
 Table of Contents

I. Introduction …………………………………………………………………………………… 1 - 3

II. Nursing Assessment …………………………………………………………………………… 4 - 15

A. Personal history
B. Reasons for visit
C. History of past illness
D. History of present illness
E. Family health history
F. Functional health pattern (Gordon’s)
a. HEALTH PERCEPTION/ HEALTH MANAGEMENT PATTERN
b. NUTRITION METABOLIC PATTERN
c. ELIMINATION PATTERN
d. ACTIVITY AND EXERCISE PATTERN
e. SLEEP-REST PATTERN
f. COGNITIVE –PERCEPTUAL PATTERN
g. SELF-PERCEPTION AND SELF-CONCEPT PATTERN
h. ROLE-RELATIONSHIP PATTERN
i. SEXUALITY-REPRODUCTIVE PATTERN
j. COPING-STRESS TOLERANCE PATTERN
k. VALUE-BELIEF PATTERN
G. Concepts and theories of growth and development

III. Anatomy and physiology……………………………………………………………………… 16 – 27

IV. Patient and his illness ……………………………………………………………………………. 28 - 31

V. Physical assessment ………………………………………………………………………… 32 - 37

VI. Laboratory results……………………………………………………………………………. 38 - 40

VII. Patient and his care……………………………………………………………………………. 41 - 58

pg. 2
 A. Medical Management

B. Surgical Management

C. Nursing Problem Prioritization

D. NCP

VIII. Discharge Planning………………………………………………………………………………. 59

IX. Conclusion…………………………………………………………………………………………… 60

X. Bibliography……………………………………………………………………………………….. 61

pg. 3
INTRODUCTION

This is the case of Ms. HY, 35 years old, from Capalangan, Apalit, Pampanga. She was born on January 31, 1979. She is a high school graduate and her religion is Roman
Catholic. She was married and living with her husband for 6 years now. They already have 2 children. Her first child was delivered via normal spontaneous delivery and her
second child was delivered through cesarean section due to prolonged labor. According to her, her LMP was last April 4,2010. She had cesarean section last January 20, 2011 at
exactly 2:15 am in BMCH with initial diagnosis of G2P1 (1001), PU 41 wks AOG. Her menarche started when she was 15years old and it usually lasts for 3 days. According to
her she can consume 2 to 3 pads per day and sometimes she experiences dysmenorrhea. She usually drink softdrinks and eat sour fruits to relief the pain of her dysmenorrhea. She
is GTPAL and never experience difficulty in conceiving. According to her, she doesn’t have allergy to any food and drug. She told us that whenever she have a typical sickness
like flu, colds and cough, she do not go to see a doctor instead, she will take a drug of her choice which she believes can help her to feel good. She takes herbal supplements which
she believes can help her become healthier. She was brought to the hospital last January 19 due to the labor pains. After 22 hours of prolonged labor, the doctors decided that she
needs to undergo cesarean section.

Cesarean section is a surgery to deliver a baby. The baby is taken out of the mother’s abdomen. Most C-section are done when unexpected problems happen during
delivery. These include health problem, the position of the baby, not enough room for the baby to go through the vagina and signs of distress in the baby. C-sections are most
common among women carrying more than one baby. The surgery is relatively safe for mother and the baby. Still, it is major surgery and carries risks. It also takes longer to
recover to C-section than from vaginal birth. After healing, the incision may leave a weak spot in the wall of the uterus. This could cause problems with an attempted vaginal birth
later. However, more than half of women who have cesarean section can give vaginal birth later.

The World Health Organization (WHO) states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent. A cesarean section poses
documented medical risks to the mother's health, including infections, hemorrhage, transfusion, injury to other organs, anesthesia complications, psychological complications, and
a maternal mortality two to four times greater than that for a vaginal birth. An elective cesarean section increases the risk to the infant of premature birth and respiratory distress
syndrome, both of which are associated with multiple complications, intensive care and burdensome financial costs. Even mature babies, the absences of labor increases the risk of
breathing problems and other complications.

Cesarean section is one of the life saving emergency obstetric care when complications occur during childbirth. According to the survey in 2003, 7% of births were
delivered via C-section in total. C-section rate was higher in urban areas than in rural areas by approximately 2-fold.

pg. 4
GENERAL OBJECTIVE:

The main purpose of this case is for us to understand the process of Cesarean Section Delivery. This may also help us to know the difference of C-section Delivery to Normal
Spontaneous Delivery. Thorough Nursing Health History, Physical Assessment were obtained to render appropriate nursing intervention.

KNOWLEDGE:

1. To know the different kinds of delivery and understand the physiologic changes that a pregnant woman has to go through, from pregnancy to surgical procedures up to the
delivery of the baby.
2. To be able to learn the steps in the care for a post operation mother.
3. To be able to use our critical thinking in assessing the patient’s condition and interpreting the cues and datas gathered with appropriate nursing care management

SKILLS:

1. To apply the knowledge we obtained from our Related Learning Experience to an actual hospital setting with an actual patient.
2. To formulate appropriate nursing care plans applicable to the patient’s condition and render an effective nursing intervention.
3. To be able to establish rapport with the patient and understand the condition she went through and share some of the knowledge that were obtained from academe that will be
beneficial to the patient’s general condition and promote wellness.

ATTITUDE:

1. To be able to appreciate the essence of being a woman.

2. To establish an effective nurse-patient relationship.
3. To show respect to and provide emotional support to the client.

pg. 5
PATIENT’s PROFILE:

NAME: Mrs. H.Y

ADDRESS: Capalangan, Apalit Pampanga
OCCUPATION: House wife
GENDER: Female
RACE: Asian
BIRTHDAY: January 31, 1979
PLACE OF BIRTH: Capalangan, Apalit Pampanga
MARITAL STATUS: Married
RELIGION: Roman Catholic
EDUCATIONAL ATTAINMENT: 4th year High School Graduate
HEALTH CARE FINANCING: Husband
FINAL DIAGNOSIS: G2P1(1001) PU 41 weeks AOG, delivered via CS due to prolonged 2nd stage of labor failure in descent with APGAR SCORE of 8, birth weight of 3.4kg

DATE OF ADMISSION: January 20, 2011 TIME OF ADMISSION: 2:15 am

DATE OF DISCHARGE: January 26, 2011 TIME OF DISCHARGE: 3:00 pm

REASONS FOR VISIT/CHIEF COMPLAINT:

Our client, Ms. H.Y. at 41 weeks gestation was rushed to the hospital because of labor pains. The Labor starts at 10:00 am and was described strong, intense and frequent.

HISTORY OF PAST ILLNESS:

The patient stated that she had vaccination such as BCG, DPT, OPV, MMR and HEPA B. but hasn’t taken immunization of tetanus toxoid because of not consulting in a
clinic for prenatal check-up. When she was still young, she had a bicycle accident. She also experienced having measles, chicken pox, and other common illness like fever, cough,

pg. 6
 colds and flu but easily cured by taking medication and consulting sometimes with her physician. She also said that she experienced having urinary tract infection before the first
and 2nd pregnancy but cured. She stated that she doesn’t have any allergies to drugs, food, or any environmental factors (dust and smoke). She didn’t experience any major injuries
in the past and she had her first hospitalization when she delivered her 1st baby via NSD. During her first childbirth, she had undergone episiotomy.

HISTORY OF PRESENT ILLNESS:

The patient was admitted in the hospital at 2:15 am of January 20, 2011. She is Ms. H.Y. a 34 year old gravida 2 para 1 (1001) and her last menstrual period was on the 4th
of April, year of 2010. Prior to hospitalization, the patient felt that it was the time of her delivery because of painful uterine contractions felt first in lower back & sweep around to
the abdomen in a wave so she immediately asked her husband to bring her to the hospital.

Ms. H.Y. admitted that her present pregnancy was expected. The client told us that she only had 2 instances of prenatal check up at the third trimester of her pregnancy
because of being lazy and because she has no available times to do it. She noticed during her pregnancy that her appetite had change. She also experienced nausea and vomiting
during on the second and third month of her pregnancy, an increased urge to void, mild to severe back ache, fatigue and shortness of breath.

At the time of delivery, she rated the severity of pain on a scale of 1-10 (1 is the lowest and 10 is the highest), as 10. She presumed that the anesthetic given to her will help
in the labor process. During the labor process, the patient is referred to the Operating Room. The patient delivered her baby boy via primary low segment caesarian section due to
prolonged second stage of labor and failure of descent with the APGAR score of 8, birth weight of 3.4 Kg.

After the delivery, the patient experienced pain and discomfort at her lower abdomen due to surgical incision made by her physician. She was referred to her ward for her to
be comfortable and for her fast recovery.

Our patient kept on complaining about the pain. She had difficulty to sit, stand and walk beside her bed. She rated pain at 6. (1 is the lowest and 10 is the highest).

Functional PRIOR TO HOSPITALIZATION DURING HOSPITALIZATION

Health Pattern

pg. 7
Health Perception/
Health Management
Nutritional-Metabolic Pattern
.When she was asked to rate her health on a scale of 1- Our client told us that she felt some changes in her body after
10( 1 is the lowest and 10 is the highest), her rate was 10. giving birth because of her postsurgical incision. We asked her to
“Hindi naman ako sakitin kaya sa tingin ko malusog naman rate the pain from 1 to 10, (1 is the lowest, 10 is the highest) she
ako” as verbalized by the client. When she gets sick, she rated it as 6. She’s following the medication prescribed by her
just takes medicine of her choice and consult a doctor physician (cefalexin, cefazolin, discofunal, mefenamic acid,
sometimes. She takes some herbal medicines which she ferrousulfate, nalbuphine, ascorbic acid & bisacodyl) at the right
believes can make her healthier. She told us that she only time & dose. With that, she can gain strength that helps her to cope
had her prenatal check up twice. “Tinatamad kasi akong with her situation and to be able to do her activities of daily living.
magpablik-balik sa ospital” as verbalized by the client.
She’s not in vices until now. She doesn’t encounter any
problem in her pregnancy, and her child doesn’t have any
abnormalities.
Januray 18, 2011 January 19, 2011
Breakfast 1 piece of bread 1 cup of coffee
(putok) 1 piece of
1 cup of coffee pandesal
2 glass of water 2 rolls of suman
1 glass of water
Lunch 1 piece of fried NPO
galungong
1 bowl of
pinakbet
1 cup of rice
2 glass of water
SNACKS:
1 packed of Mr.
Chips
1 bottle
softdrinks 8 oz
1 glass of water
Dinner 1 piece of NPO
pg. 8
 galunggong
1 bowl of
pinakbet
2 glass of water
2 cup of rice

According to patient, her husband is the one responsible for

cooking and preparing foods for the family. Our patient
stated that she drinks 6-8 glasses of water every day. She
loves to eat sweets and spicy foods before. “hindi ako
nagtatake ng food supplements” as verbalized by the client.
She presumed that she is healthy enough so that she doesn’t
take any supplement.

Elimination Pattern URINE January 18, January 19, 2011

2011 URINE January 20, 2011 January 21, 2011
COLOR Yellow Yellow COLOR None dark yellow
ODOR Aromatic Aromatic ODOR None - -
FREQUENCY 8 times (1,800 5 times (1,000 FREQUENCY None The patient has a
ml) ml) catheter and urine
bag attached to her
TRANSPAREN Clear Clear
(2,250 ml)
CY
TRANSPARENCY None With trace of blood

During hospitalization, the client had a Foley catheter inserted to

She consumes 10 glasses of water daily and urinates about
her urethral orifice and it is attached to a urine bag. She felt
8 times a day. According to client, she perspires not little
uncomfortable because of postsurgical procedure and catheter that
and not too much. She doesn’t experience any voiding
was inserted to her.
difficulties. She just complains of the discomfort of
frequent urination during her pregnancy.
FECES January 20, 2011 January 21, 2011
FECES January 18, 2011 January 19, 2011 COLOR Brown-black Brownish Yellow

pg. 9
 ODOR Foul Foul
COLOR Brown Brown FREQUENCY Use of diaper Once
ODOR Foul Foul CONSISTENCY Not formed Formed
FREQUENCY Once Once
CONSISTENCY Formed Formed As we go in her room, she was defecating; she moves a little and is
dependent to her mother-in-law. “Nahihirapan ako dumumi
ngayon” as verbalized by the client. Because of pain she felt and
Our patient stated that she doesn’t experience any
limited mobility, our client had difficulty in excreting her waste.
defecation difficulties except constipation. She usually
She also used diaper upon interview.
defecates every morning.

Activity – Exercise Pattern
The client’s daily activities are doing household chores “Hindi ako makahakbang” as verbalized by our patient. During the
with her mother-in-law like cleaning the house, cooking first day of hospitalization,the patient was not able to walk. She
meals sometimes and taking care of her daughter. When can’t perform what her daily activities until on the 2nd day.
she has a free time, She watches television and make Standing, lying flat on bed and sitting on a chair is the common
herself happy by joining social groups. She makes sure to activity she did on the 2nd day. When she wants/needs anything, she
finish all activities before going to sleep. According to her, move dependently or ask her mother-in-law in favor. The doctor
she is not exercising every morning. “Madalang lang ako also ordered walking exercise and deep breathing exercise to client.
magexercise” as verbalized by our patient.
-0- Feeding
-0- Feeding -0- Grooming -II- Bathing
-0- Bathing -0- General mobility -II- Toileting
-0- Bed mobility -II- Cooking mobility -II- Dressing
-0-Dressing -II- Home Maintenance -II- Grooming
-II- Shopping -II- General

Level 0 – full self care Level 0 – full self care

Level I – requires use of equipment device

pg. 10
 Level II – requires assistance or supervision from another Level I – requires use of equipment device
person Level II – requires assistance or supervision from another person
Level III – is independent and does not participate Level III – is independent and does not participate
Our patient has no hearing difficulty and any deviations in After giving birth, our patient doesn’t experience any alterations in
Cognitive-Perceptual Pattern
her senses. She also told us that she’s not using devices that her senses. During the interview process, our patient is slightly
help in her senses. She has no difficulty in learning or irritable but responded well to the questions that were asked to her.
absorbing knowledge. She verbalizes and express what she “Sumasakit ang tahi ko kapag nagsasalita” as verbalized by our
feels upon her situation. patient. She keep on complaining about the pain and discomfort she
felt. During hospitalization, she asked “Anu-anu pa ba mga
kailangan kong gawen para alagaan si baby?” She is just confused
so that she frequently questioned us.
Sleep-Rest Pattern Date January 18, 2011 January 19, 2011 Date January 20, 2011 January 21, 2011
Time of Sleep 11:00 pm LABOR Time of Sleep LABOR PROCESS
PROCESS Time of Awakening LABOR PROCESS 6 :00 am
Time of 7 :00 am 7:00 am Total no. of sleep - - - -
Awakening
Total no. of sleep 8 hours - -
The patient doesn’t get enough rest during her hospital stay. She
fell asleep after the surgical procedure. “Paputol-putol ang tulog ko
Nap January 18, 2011 January 19, dito sa Ospital” as verbalized by our patient on the 2nd day. She
2011 doesn’t get enough sleep and rest because she was hungry and the
Total no. of sleep 1 ½ hours 30 mins. nurses that monitor her vital signs. She also stated that the strange
hospital environment added to her sleeping difficulties. However,
she’s contented in time of sleep.
According to the client, she was able to sleep for 8-10
hours sometimes because at times, because of increase
frequency of urination, she usually wake up at 2 pm. She
usually wakes up at 7 am to do household chores and other
activities. She also stated that before going to sleep, she
drinks milk and the lights must always be turned off. She
doesn’t experience any sleeping difficulties.

pg. 11

Self-Perception/
Self Concept Pattern
Role-Relationship Pattern
Sexuality-Reproductive Pattern
Our patient is cheerful but she is not that friendly. “hindi ko When our patient was asked on how she feels after giving birth
kasundo ang iba kong kapitbahay naming dahil mga especially when she undergone surgical procedure, she told us that
chismosa sila” as she verbalized. She told us that she really she’s okay. According to her, when she is pregnant, she gets
felt happy for the 2nd time she knew she is pregnant. She irritable easily. She also told us that her pregnancy may affect her
really felt fulfilled when she gave birth to her first child physical appearance but she doesn’t care about it. What’s important
and those feelings doesn’t change upon giving birth to her is for her to provide the needs of her children and to take good care
next child. She doesn’t have any regrets in having her own of them as well. She told us again that she was very happy to have a
family. When she was asked what she wants to change in new baby.
her body, she told us that as long as she’s healthy, she will
always feel contented.
The patient live with her husband together with her
“Gusto ko na ngang umuwi kasi may anak pa akong naiwan sa
daughter. She belongs to egalitarian type of family, were bahay” as verbalized by the client. She wants to go home even
both of them of her husband decides in the financial needs. without the doctor’s order. Only her older sister is the one who take
She told us that her family is the most important people in good care of her daughter at their home. During her hospitalization,
her life. The closest person to her is her eldest sister who she and her mother-in-law is the one responsible for taking good
lives also nearby. According to her, she is kind to everyone care of the infant.
as well to her family. She plays a very important role as
mother and she will always maintain good relationship to
each member of family.
Our patient menarche is when she was 14 years old. “Gagamit na ako ng contraceptives tulad ng paginom ng pills para
According to her, her mense’s duration is about 3-4 days hindi na mabuntis” as verbalized by our patient. After the 2nd child
and she consumes 3 pads of napkin a day. Her menses were of hers, she doesn’t want to get pregnant again because of fear that
just right, not too heavy and not too little amount of flow she might not give them enough of their needs especially now that
but she experienced pain in her lower abdomen before and the life is too hard to live.
during times of menstruation. For these, she takes medicine
advised to her by her acquaintances. Her last menstrual
period was on April 04, 2010. She doesn’t experienced any
miscarriage or abortion before, Her pregnancy were
planned as she said and when we asked her sexual
satisfaction from 1-10(1 is the lowest, 10 is the highest).
She smiled and her rate was 8.
She is G2P1 patient and doesn’t experience any difficulties
of conceiving. Her eldest is the one she gave birth last 2004
and her 2nd was the one she’s had given birth this January.
pg. 12

Coping / Stress Tolerance Pattern
Value – Belief Pattern
20, 2011. Two of them are normal and reached full term.
No other problem about her sexuality-reproductive
according to the patient.
“Tuwing hapon, nakikipagtong-its ako sa mga kaibigan ko”
“Iniisip ko ngayon ang babayarin dito sa Ospital” as verbalized by
as verbalized by our patient. According to her, she is doing the clientt. According to her, her husband helps them in financial
this for refreshment and sometimes reading pocketbooks needs. She doesn’t see that giving birth is a problem rather, they see
and watching television at afternoon. She doesn’t use any it a blessing from God. She fear of not meeting the needs of her
alcohol and other vices to relieve stress when problem is children and family primarily because of their financial situation.
arise. She and her husband usually resolve problems by She’s relying her problems to God just by striving hard and
talking things out. She also told us that she responded well praying for divine intervention.
to situations because of the help of her husband. God and
her family is the primary source of her strength to
overcome her problems.
“Nagprepray ako lagi kay Lord para sa paggaling ko at sa ikabubuti
She is a roman catholic. She always pray and go to church
ng pamilya ko” as verbalized by our patient. She doesn’t change
together with her family. In times of problem, she believes
her beliefs and she knows God is always there to help.
that God will be a great help. “Bukod sa Diyos, hindi na
ako naniniwala sa iba at anu anu pa” as she verbalized.
pg. 13
FAMILY HEALTH ILLNESS HISTORY

The patient is the 3rd children of Mrs. L, 61 years old and Mr. Z., 65 years old. The client stated that her mother and father-in-law side, most of them had DM and Hypertensive. All
of these are inherited by their daughter and sons. Several of her grandparents are can no longer remember by the patient. On the Mrs. H.Y. side, she had no diseases present cause
of inheritance.

? ? J ?
? ? E ?

? ? ? ? ? ? ? ?
(stroke) (DM) (?) (? ) (oldness) (heart attack) (oldness)
(oldness)
Hypertensive DM hypertensive hypertensive

H A C A ? S E Z G J ? ? ?
P ? N C L
dered

? ? ? ? ? ? ? ? ? 61 ? ? ? ? ? ? 52 61
(?) (heart attack) DM DM (?) smokes/ smokes/ (?) hypertensive (car accident) smokes/ smokes/ (heart attack) (fetal death) A/W A/W smokes/drinks
DM Hypertensive DM drinks drinks hypertensive drinks occasionally drinks occasionally drinks ocassionally
Smokes/ drinks ocassionally ocassionally
Ocassionally

H E
S S C C F H M

35 31 27 22 40 36 31 28 25
Hypertensive Hypertensive Hypertensive Hypertensive A/W A/W A/W smokesdrinks A/W
Smokes and Drinks Occasional

A J
6 years old 2 day old

pg. 14
 A/W A/W

GROWTH AND DEVELOPMENT

PSYCHOSOCIAL PSYCHOSEXUAL COGNITIVE MORAL
STAGE Adulthood GENITAL STAGE Formal Operations Conventional
(25-65 y/o) (puberty onward) (11+ years) (adolescence and adulthood)
Generativity vs stagnation

DEFINITION By this stage, middle aged adults
are productive, performing
meaningful work, and raising a
family, or become stagnant and
inactive.
This stage is energy directed
towards full sexual maturity &
function & development of skills
to cope with the environment.
By this stage, people are able to
see relationships and to reason in
the abstract.
Person is concerned with
maintaining expectations and
rules of the family, group, nation
or society. Sense guilt has
developed and affects behavior.
The person values conformity,
loyalty, active maintenance of
social order and control.
Conformity means good behavior
and is approved.

ANALYSIS The patient is able to seek
attention and satisfying
relationship within her partner and
her family.
Physical sexual changes reawaken
repressed needs.
Direct sexual feelings towards
others lead to sexual gratification.
The patient is capable of
deductive and hypothetical
reasoning
The patient is in the stage where
she gets more mature to handle
situation, making enough
decision about herself and her
family and maintaining right way
among expectation and rules for
the family and society.

pg. 15
pg. 16
pg. 17
ANATOMY AND PHYSIOLOGY:
FEMALE REPRODUCTIVE SYSTEM

FEMALE EXTERNAL STRUCTURES

The structures the female external genitalia are termed the vulva (from the Latin word of covering)

Vulva- is the external genital organs of the female.

Mons Veneris- the mons veneris is a pad of adipose tissue located over the symphysis pubis, the pubic bone joint. It is covered by a triangle of course, curly hairs. The purpose of
the mons veneris is to protect the junction of the pubic bone from trauma.

Labia Minora- Just posterior to the mons veneris spread two hairless folds of connective tissue, the labia minora. Before menarche, these folds are fairly small; after menopause,
they atrophy and again become much smaller. The area is abundant with sebaceous glands, so localized sebaceous cyst may occur here.

Labia Majora- The labia majora are two folds of adipose tissue covered by loose connective tissue and epithelium that are positioned lateral to the labia minora. Covered by pubic
hair, the labia majora serve as protection for the external genitalia and distal urethra and vagina.

Vestibule- is the flattened, smooth surface inside the labia. The openings to the bladder (the urethra) and the uterus (the vagina) both arise from the vestibule.

Clitoris- is a small (approximately 1-2 cm), rounded organ of erectile tissue at the forward junction of the labia minora. It is covered by a fold of skin, the prepuce. The clitoris is
sensitive to touch and temperature and is the center of sexual arousal and orgasm in a woman. Arterial blood supply for the clitoris is plentiful.

2 Skene’s glands (paraurethral glands) - are located just lateral to the urinary meatus, one on each side. There ducts open to the urethra.

Perineum- a region of the body including the perineal body and the surrounding structures.

Bartholin’s glands (vulvovaginal glands) – are located just lateral to the vaginal opening on both sides. There ducts open to the distal vagina. Secretions from both of these
glands help to lubricate the external genitalia during coitus. The alkaline pH of their secretions helps to improve sperm survival into the vagina.

Fourchette- is the ridge of tissue formed by the posterior joining of the two labia minora and the labia majora. This is the structure that is sometimes cut (episiotomy) during
childbirth to allow for enlargement of the vaginal opening.
Perineal muscle/ perineal body- is a muscular area; is easily stretched during childbirth to allow for enlargement of the vagina and passage of the fetal head.

Hymen-is a tough but elastic semicircle of tissue that covers the opening to the vagina in childhood. It is often torn during the first sexual intercourse

pg. 18
FEMALE INTERNAL STRUCTURES

Ovaries- approximately 4 cm long by 2 cm in diameter and approximately 1.5 cm thick, or the size and shape of almonds. They are grayish white and appear pitted or with minute
indentations on the surface. An unruptured, glistening, clear, fluid-filled graafian follicle (an ovum about to be discharged) or a miniature yellow corpus luteum (the structure left
behind after the ovum has been discharged) often can be observed on the surface of the ovary.

Fallopian tubes- arise from each upper corner of the uterine body and extend outward and backward until each opens at its distal end, next to an ovary; approximately 10 cm long
in mature woman. Their function is to convey the ovum from the ovaries to the uterus and to provide a place for fertilization of the ovum by the sperm.

Uterus- is a hollow, muscular, pear-shaped organ located in the lower pelvis, posterior to the bladder and anterior to the rectum; consists of 3 divisions: the body or corpus, the
isthmus and the cervix

Body of the uterus- the uppermost part and forms the bulk of the organ.

Fundus- portion of the uterus between the points of attachment of the fallopian tubes.

Isthmus- is a short segment between the body and the cervix.

Cervix- is lowest portion of the uterus. It represents approximately one third of the total uterus size and is approximately 2-5 cm long. Approximately
half of it lies above the vagina and half extends into the vagina.

Endometrium- layer of the uterus is the one that is important for menstrual function.

Endocervix- membrane lining the cervix; continues with the endometrium, is also affected by hormones; secrete mucus to provide a lubricated surface so that spermatozoa can
readily pass through the cervix.

Myometrium- or muscle layer of the uterus, is composed of 3 interwoven layers of smooth muscle, the fibers of which are arranged in longitudinal, transverse, and oblique
directions; serves an important function of constricting the tubal junctions and preventing regurgitation of menstrual blood into the tubes.

Fimbrae- finger like part or structure, as the opening of the fallopian tubes.

Corpus luteum- “yellow body”; is a temporary endocrine structure in mammals, involved in production of estrogen and progesterone, which is needed to maintain the
endometrium. It is colored as a result of concentrating carotenoids from the diet.

pg. 19
pg. 20
 BREAST

Breast- located anterior to the pectoral muscle and in many women breast tissue extends well into the axilla; is the upper ventral region of the torso of a primate, in left or right
sides, which in a female contain the mammary gland that secretes milk used to feed infants.

Milk glands- are divided by connective tissue partitions into approximately 20 lobes. All of the glands in each lobe produce milk by acinar cells and deliver it to the nipple via a
lactiferous duct.

Areola- the skin surrounding the nipples that are darkly pigmented out to approximately 4 cm

Montgomery’s tubercle- sebaceous glands causing the areola to appear rough.

Milk Ducts- a small, tube-shaped part of the body that carries fluids, such as tears, bile, and breast milk.

pg. 21
GASTROINTESTINAL TRACT

pg. 22
 GASTROINTESTINAL TRACT

Abdomen- The part of the body that lies between the thorax and the pelvis and encloses the stomach, intestines, liver, spleen, and pancreas also called belly.

Mouth- The body opening through which an animal takes in food; the cavity lying at the upper end of the alimentary canal, bounded on the outside by the lips and inside by the
oropharynx and containing in higher vertebrates the tongue, gums, and teeth; this cavity regarded as the source of sounds and speech; the opening to any cavity or canal in an organ
or a bodily part.

Tongue- The fleshy, movable, muscular organ attached in most vertebrates to the floor of the mouth, that is the principal organ of taste, an aid in chewing and swallowing, and, in
humans, an important organ of speech.

Pharynx- The section of the alimentary canal that extends from the mouth and nasal cavities to the larynx, where it becomes continuous with the esophagus.

Esophagus- The muscular membranous tube for the passage of food from the pharynx to the stomach; the gullet.

Pancreas- A long, irregularly shaped gland in vertebrates, lying behind the stomach that secretes pancreatic juice into the duodenum and insulin, glucagon, and somatostatin into
the bloodstream.

Liver- A large, reddish-brown, glandular vertebrate organ located in the upper right portion of the abdominal cavity that secretes bile and is active in the formation of certain
blood proteins and in the metabolism of carbohydrates, fats, and proteins.

Gallbladder- is a hollow system that sits just beneath the liver.[2]In adults, the gallbladder measures approximately 8 cm in length and 4 cm in diameter when fully distended.[3] It is
divided into three sections: fundus, body and neck. The neck tapers and connects to the biliary tree via the cystic duct, which then joins the common hepatic duct to become
the common bile duct.

Duodenum- is the first section of the small intestine. In mammals the duodenum may be the principal site for iron absorption.

Ascending colon- is smaller in caliber than the cecum: It passes upward, from its commencement at the cecum, opposite the colic valve, to the under surface of the right lobe of
the liver, on the right of the gall-bladder, where it is lodged in a shallow depression, the colic impression; here it bends abruptly forward and to the left, forming the right colic
flexure (hepatic).

Appendix- In human anatomy, the appendix (or vermiform appendix; also cecal (or caecal) appendix; also vermix) is a blind-ended tube connected to the cecum (or caecum), from
which it develops embryologically.

Ileum- is the final section of the small intestine.

pg. 23
Transverse colon- the longest and most movable part of the colon, passes with a downward convexity from the right hypochondrium region across the abdomen, opposite the
confines of the epigastric and umbilical zones, into the left hypochondrium region, where it curves sharply on itself beneath the lower end of the spleen, forming the splenic or left
colic flexure. The right colic flexure is adjacent to the liver.

Descending colon- passes downward through the left hypochondrium and lumbar regions, along the lateral border of the left kidney.

Jejunum- lies between the duodenum and the ileum. The change from the duodenum to the jejunum is usually defined as the ligament of Treitz.

Sigmoid colon- is the part of the large intestine that is closest to the rectum and anus. It forms a loop that averages about 40 cm. in length, and normally lies within the pelvis, but
on account of its freedom of movement it is liable to be displaced into the abdominal cavity.

Rectum- (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in
the anus. The human rectum is about 12 cm long. Its caliber is similar to that of the sigmoid colon at its commencement, but it is dilated near its termination, forming the rectal
ampulla.

Anus- is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during
digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest, such as bones; food material after all the nutrients have been
extracted, for example cellulose or lignin; ingested matter which would be toxic if it remained in the digestive tract; and dead or excess gut bacteria and other endosymbionts.

pg. 24
pg. 25
 FEMALE PELVIS

Pubic Symphysis- is the midline cartilaginous joint (secondary cartilaginous) uniting the superior rami of the left and right pubic bones. It is located anterior to the urinary
bladder and superior to the external genitalia; for females it is above the vulva and for males it is above the penis. In males, the suspensory ligament of the penis attaches to the
pubic symphysis. In females, the pubic symphysis is intimately close to the clitoris. In normal adults it can be moved roughly 2 mm and with 1 degree rotation. This increases for
women at the time of child birth.

Ischial Spine- a thin pointed triangular eminence that projects from the dorsal border of the ischium and gives attachment to the gemellus superior on its external surface and to the
coccygeus, levator ani, and pelvic fascia on its internal surface.

Iliopubic eminence- is a broad, shallow groove, over which the iliacus and psoas major muscles pass; marks the point of union of the ilium and pubis.

Sacroiliac joint- sacroiliac joint or SI joint is the joint in the bony pelvis between the sacrum and the ilium of the pelvis, which are joined together by strong ligaments. In humans,
the sacrum supports the spine and is supported in turn by an ilium on each side. The joint is a strong, weight bearing synovial joint with irregular elevations and depressions that
produce interlocking of the two bones. The human body has two sacroiliac joints, one on the left and one on the right that often match each other but are highly variable from
person to person.

Sacral Promontory- sacral promontory is the anatomical term for the superior most portion of the sacrum. It marks part of the border of the pelvic inlet. The rectosigmoid junction is at the level
of the sacral promontory.

Ischial Tuberosity- is a swollen part or broadening of the bone in the frontal portion of the ischium, the lowest of the three major bones that make up each half of the
pelvis.

pg. 26
Anatomy and Physiology

Description:

a. Primary Follicle- an immature ovarian follicle.

b. Growing follicle
1. Egg cell- the female reproductive cell; the female gamete
2. Follicular cells- an epithelial cell lining follicle such as that of the thyroid.
c. Mature Follicle
1. Follicular fluid- is a liquid which fills the follicular antrum and surrounds the ovum in an ovarian follicle
d. Ovulation- the discharge of an ovum from the ovary. The phase of the monthly female cycle when a developed egg is released from ovary in the fallopian tube for possible
fertilization. Ovulation is when an egg released from the ovary and is swept into the fallopian tube toward the uterus.
e. Empty follicle- oocytes are absent from stimulated follicles
f. Corpus Luteum- a yellow grandular mass in the ovary, formed by an ovarian follicle that has matured and discharged its oocytes.
g. Ovarian follicles- are the basic units of the female reproductive biology, each of which is compose of roughly spherical aggregation of cells found in the ovary. They
contain single oocytes. This structure are periodically initiated to grow and develop and culminating in ovulation of usually a single competent oocytes in human.
h. Graafian Follicle- a small sac, embedded in the ovary that encloses an ovum. At sexual maturity each ovary has large numbers of immature follicles, each of which contains
an undeveloped egg cell. This structure is called primodial or primitive follicles.

Breast

a. Mammary Gland- secretes milk for the nourishment of the young

b. Lactiferous ducts- a specialized gland of the female which secretes milk
c. Nipple- the small conical projection in the center of the areola of each breast, which in women contains the outlet of milk ducts
d. Areola- small circular area such as pigmented ring around the nipple.

Uterus

a. Fundus- the part of the uterus above the orifices of the uterine tube
b. Body of the Uterus
c. Isthmus of the Uterus- the constricted part of the uterus between the cervix and the body of the uterus
d. Endometrium- The endometrium function as lining of the uterus preventing adhesion between the opposed walls of the myometrium, hereby maintaining the patency of the
uterine cavity.
e. Myometrium- the smooth muscle forming the wall of the uterus

pg. 27
 f. Broad Ligament of the uterus- is a wide fold of the peritoneum that connects the sides of the uterus to the walls and floor of the pelvis

Types of Ligaments:

Mesometrium- the mesentery of the uterus; the largest portion of the broad ligament

Mesosalpinx- the part tat surrounds the uterine tube

Mesovarium- the part that surrounds the ovary

g. Uterine vessels- Either of two veins on each side that arise from the uterine plexus, pass through a part of broad ligament and through a peritoneal fold and empty to the
hypogastric vein.
h. Uterine tube- a slender tube extending from the uterus toward the ovary on the same side, for passage of oocytes to the cavity of the uterus and the usual site of
fertilization.

pg. 28
 Modifiable Factors
Name: MRS. H.Y
Religion: Roman Catholic
Nationality: Filipino
Status: Married
Address: Capalangan, Apalit, Pathophysiology
Pampanga

Non Modifiable Factors

Birth date: January 31, 1979

Age: 31
Religion: Roman Catholic LMP: April 4, 2010
EDC: January 7, 2011
AOG: 40 wks AOG
Age: 31 Gynecology History: PU 40 wks
Nationality: Filipino G2P1, CIL

LMP: April
4, 2010
Status: Married

EDC:
January 7, 2011
Address: Capalangan, Apalit, Theories
Pampanga • Prostaglandin Theory
• Oxytocin Theory
• Uterine Stretch Theory
• Placental Degredation Theory
• Progesterone Deprivation Theory

pg. 29
 Release of FSH by the anterior pituitary gland

Development of the Graafian follicle

Production of estrogen (thickening of the endometrium)

Release of 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

pg. 30
 Development of the fetus/ embryo and placental structure until full term

Preliminary Signs of Labor

Lightening (descent of the fetal head into the pelvis)
Braxton Hicks Contraction (false labor) Ripening of the Cervix
• Begin and remain irregular
• First felt abdominally
• Pain disappears with ambulation
• Do not increase with duration and intensity
• Do not achieve cervical dilatation

True Labor

Uterine Contraction Show (pink tinge of blood; a mixture of blood and fluid) Rupture of Membranes
• Increase in duration and intensity
• First felt at the back and radiates to the abdomen
• Pain is not relieved no matter what the activity is
• Achieve cervical dilatation

• Latent Phase- contractions:

Average Length of Normal Labor:
20-40 seconds; dilatation: 0 to
Primi Multi Client First Stage of Labor 3 cm
First Stage 12 ½ hr 8 hrs 11 hrs (Stage of Dilatation)
• Active Phase- contractions:
Second Stage 80 mins 30 mins 5 hrs 40- 60 seconds; dilatation: 4-7
cm
Second stage of Labor
Thrid Stage 10 mins 10 mins • Transition Phase-
contractions: 60- 90 seconds;
dilatation: 8- 10 cm pg. 31
Fourth stage 2 hrs 2hrs
 (Stage of Expulsion)

Failed to progress labor

Due to Cephalo Pelvic Disproportion

Increase risk of fetal distress

(Meconium Staining, Hypoxia)

Increase Risk of fetal death

Emergent Cesarean Delivery

(The incision made on the lower part of the abdomen)

Expulsion of the Fetus

Third Stage
Expulsion of the Placenta
(Accompanied by blood loss of approximately 1000-1500 ml)

pg. 32
 Physical assessment
Physical examination follows a methodical head to toe format in the cephalocaudal assessment. This is done systematically using the techniques of inspection, palpation,
percussion and auscultation with the use of materials and investment of such as the penlight, thermometer, sphygmomanometer, tape measure and stetoscope and also the senses.
During the procedure, we made every effort to recognize and respect the patient’s felling as well as to provide comfort measures and follow appropriate safety precautions.

Areas assessed Technique Normal findings Actual findings Remarks

General appearance
1. body built, height and weight Inspection Proportionate Proportionate Normal
2. posture, gait standing,sitting Inspection Relaxed, erect posture,coordinated unrelaxed and not erect Due to her post operative
and walking movement condition
3.overall hygene and grooming Inspection Clean Slightly unkept Due to her labor and
hospitalization
4. note body and breath odor Inspection Minor body odor Slightly has body odor Due to lochia
5. signs of distress in posture or Inspection No distress Signs of distress are present Due to surgery
facial expression
6. obvious signs of health or Inspection No signs of illness Physically ill Due to surgery
illness
7.client’s attitude Inspection Cooperative Cooperative Normal
8. client’s affect/mood; inspection responsive Slightly irritable but responsive Deviation from normal
appropriateness of the clients because of her physical illness
response
9. quantity of speech, quality and Inspection Understandable moderate pace Hard to speak but can deliver Due to post-operative condition
organization organize ideas
10. relevance and organization of Inspection Logical sequence makes sense Makes sense and has sense of Normal
thoughts reality
Skin and nails
1. skin color Inspection Varies from light to deep brown brown Normal

pg. 33
 2. uniformity in color Inspection Uniform in color Generally uniform in areas Normal
exposed to the sun
3. skin moisture Palpation No moisture No moisture in skin folds and Normal
axillae
4. skin temperature Palpation Uniform in normal range Normal range, warm Normal
5. skin turgor Palpation Skin springs back to previous state Springs back to previous state Normal
6. fingernail plate/shape to Inspection Convex curvature, smooth Slightly dirty smooth
determine curvature, angle Due to inadequate time to clean
her nails
7. tissue surrounding nails Inspection Intact nails Intact epidermis Normal
8. blanch test of capillary refill Palpation Prompt return in pink color or usual Prompt return in pink color or Normal
color usual color
Head
1. skull (size, shape) Palpation Round Round Normal
2. masses, nodules Palpation No masses, no nodules No masses, no nodules Normal
3. scalp (color, tenderness) Inspection/palpation White/light in color, no tenderness Light color, no tenderness Normal
Hair
1. growth and texture Inspection Evenly distributed(thinness or Thinness is evenly distributed, Normal
thickness) silky, resilient hair silky, resilient

Presence of white hair

Face
1. facial movements Inspection Coordinated Coordinated Normal
Eyes
1. eyelids for surface Inspection No discharge, no discoloration, lids No discharge, no discoloration, Normal
characteristics close symmetrically lids close symmetrically
2. ability to blink Inspection 15-20 involuntary blinks Dull eyes Due to sedation
3. eyebrows Inspection Hair evenly distributed, skin intact Evenly distributed Normal
4. bulbar conjuctiva for color, Inspection Transparent, capillaries sometimes Transparent, presence of Normal
texture and presence of lesions evident capillaries

Sclera appears white Sclera appears white

No edema No presence of edema

5. inspect lacrimal gland Palpation Tenderness over lacrimal gland Tenderness over lacrimal gland Normal
pg. 34
 6. anterior chamber for Inspection No shadow of light on iris, depth of No shadow of light on iris, depth Normal
transparency and depth iris abot 3mm of iris abot 3mm
7. pupils Inspection Black, equal in size, round, smooth Black, equal in size, round, Normal
border smooth border
8. assess near vision Inspection Able to read newspaper Able to read newspaper Normal

Ears
1. auricle for color, symmetry of Inspection Color same as facial skin Color same as facial skin Normal
size, position

2. auricle for texture elasticity, Inspection Mobile, firm, and not tender Mobile, firm, and not tender Normal
areas of tenderness

Nose
1. shape, size, or color and Inspection Symmetric, straight, no discharge Symmetric, straight, no Normal
flaring/discharge from nares discharge

2. nasal septum Inspection Nasal septum is intact and in the Place in the middle Normal
middle

Mouth
1. outer lips for symmetry of Inspection Uniform in color Uniform pink in color Normal
counter color
2. teeth Inspection 32 adult teeth
3. tounge movement,color Inspection Pink in color, no lesions, moves Pink in color, no lesions, moves Normal
freely freely
Neck and lymph nodes
1. neck muscle, swelling Inspection Muscle equal in size, head centered Muscle equal in size, no swelling Normal
2. head movement Inspection Coordinated Coordinated, smooth movement Normal
with no discomfort
Trachea

pg. 35
 1. placement Inspection Central placement in midline of Central placement in midline of Normal
neck neck
Thyroid gland
1. thyroid gland Inspection Not visible Gland descend during Normal
swallowing but not visible
2. smoothness, note areas of Inspection/palpation Lobes may not be palpated. If Not palpated smooth and it is not Normal
enlargement, masses/nodules palpated,lobes are small and centerally located, painless and
smooth rise freely with swallowing
Carotid arteries
1. carotid arteries Inspection Symmetry pulses volumes Symmetry pulses volumes Normal
Jugular veins
1. jugular veins Inspection Veins not visible Veins not visible Normal
Breast and axilla
1. size, symmetry and shape Inspection Rounded shape, slightly unequal in Rounded shape, slightly unequal Normal
size in size

Unable to excrete milk

2. swelling or edema Inspection With slightly edema No edema Deviation from normal
3. areola ( size, shape, color) Inspection Oval in shape, dark brown color, Oval in shape, dark brown color, Normal
equal in size equal in size
4. nipples (size, shape, position, Inspection Round, equal in size, nipples point Round, equal in size, nipples Normal
discharge) at the same directions, similar in point at the same directions,
color, and normally erect similar in color, and normally
With excretion of milk erect
No excretion of milk Deviation from normal(unable to
excrete milk)
5. breast (masses, tenderness) Palpation with tenderness, No tenderness, Deviation from normal
no masses or nodules No masses or nodules normal
Thorax
1. spinal alignment Inspection Vertically aligned Not able to perform because of
surgical incision in abdomen
2. temperature, tenderness and Palpation No tenderness No tenderness Normal
masses No masses No masses
Abdomen

pg. 36
 1.inspect for contour and Inspection Flat, rounded(convex), scaphoid Rounded, no evidence of Due to surgery
symmetry concave), no evidence of enlargement of liver or spleen,
enlargement of liver or spleen, symmetric
symmetry Sutures were intact
Intact sutures
3-4 inches surgical incision on
lower abdomen (traditional cut)
2. observe abdominal Inspection/auscultation Symmetric movements, visible Slightly symmetric movements, Normal
movements associated with peristalsis,aortic pulsation in thin no visible peristalsis,
respiration, peristalsis, or auto person at epigastric area
pulsations
3. auscultate abdomen for bowel Auscultation Audible bowel sounds, absence of Audible bowel sounds, absence Normal
sounds, vascular sounds, and friction of friction
peritoneal friction
4. tenderness Palpation No tenderness No tenderness Normal
Upper and lower extremities
1. muscle size Inspection Equal in size Equal in size Normal

Scar in left knee due to bicycle

accident when she was young
2. muscle fasciculation and Inspection No fasciculation No fasciculation Normal
tremors
3. involuntary movements, Inspection Normally Normally Normal
tremors, muscle tonocity
4. muscle flaccidity, spasticity, Palpation Smooth Smooth Normal
smoothness
5. muscle strength Inspection Equal strength in both sides Equal strength in both sides Normal
Perineum
1. lesions and swelling inspection No presence of lesions and swelling No presence of lesions and Normal
swelling
bones
1. Normal structure Inspection No deformities No deformities Normal
2. Edema and palpation No edema, no swelling No edema, no swelling Normal
tenderness
Joints

pg. 37
 1.Swelling Inspection No swelling No swelling Normal
2. Presence of tenderness, palpation No tenderness, swelling, No tenderness, swelling, normal
smoothness of movement, crepitating, or nodules crepitating, or nodules
swelling, crepitating and
presence of nodule.
range of motions
1. Upper extremities assessment Varies to some degree in Done different range of motion normal
accordance with person’s genetic in the upper extremities.
makeup and degree of physical Difficulty in parts of abdomen.
activity.
Difficulty in parts of abdomen.
2. Lower extremities assessment Varies to some degree in Uneasy movements done with Due to catheterization
accordance with person’s genetic the parts of lower extremities.
makeup and degree of physical
activity.

pg. 38
 LABORATORY/DIAGNOSTIC TESTS

Diagnostic Normal Values

Laboratory Date Ordered and Indications or Result (unit used in Analysis and Nursing
Procedure Date Result Purpose the Hospital) interpretation of Responsibilities
the results
A
HEMATOLOGY: Gives valuable diagnostic PRIOR:
confirmation about >Verify the doctor’s
hematologic/other body order.
systems, prognosis, >Explain the procedure
response to treatment and to patient
recovery. >Tell the patient that a
blood sample will be
taken.
Hemoglobin 01/20/2011 measures the amount of 104 g/l 110-165 g/l The result is below >Tell the patient slight
01/20/2011 oxygen-carrying protein normal range discomfort may be felt
in the bloods when skin is punctured
Indicates anemia

DURING:
Hematocrit 01/20/2011 Measures the percentage .273 l/l .350-.500 l/l The result is below > Collect a venous
01/20/2011 of red blood cells in a normal range sample according to the
given volume of whole protocol of the
blood Indicates anemia laboratory.
>Transport time for
RBC 01/20/2011 Is used to evaluate any 3.71 x1012/l 3.80-5.80 x1012/l The result is below culture specimen must
01/20/2011 type of decrease or normal range be minimized.
increase in the # of RBCs >Handle specimen
as measured by liter of Indicates anemia carefully.
blood
pg. 39
 AFTER:
WBC Count 01/20/2011 maintained at a stable 18.7 x109/l 5.0-10.0 x109/l The result is above > Apply manual
01/20/2011 number until the immune the normal range pressure/dressing to the
system detects the punctured site in
presence of a foreign Indicates infection removal of needle
invader > Monitor punctured
site for bleeding and
signs of infection
Lymphocytes 01/20/2011 Indicates the amount of 1.4 x /l 1.2 – 3.2 x /l The result is within >Document the time,
01/20/2011 lymphocytes normal range date and the procedure.
participating with >Inform them that the
macrophages at a site of results will be out as
a local injury. soon as the specimen is
interpreted in the
laboratory.
Granulocyte 01/20/2011 Indicates raised in 16.8 x /l 1.2-6.8 x /l The result is above
01/20/2011 infection normal range

Indicates infection

Monocytes 01/20/2011 Indicates raised in 0.5 x /l 0.3-0.8 x /l The result is within

01/20/2011 infection normal range

Platelet 01/20/2011 Measures clotting 295 x109/l 150 – 390 x 109/l The result is within
Count 01/20/2011 potential normal range

PCT 01/20/2011 .186 x /l .100-.500 x /l The result is within

01/20/2011 normal range

MCH 01/20/2011 Is a calculation of the 28.0 pg 26.5 – 33.5 pg The result is within
(mean 01/20/2011 average amount of normal range

pg. 40
 corpuscular oxygen-carrying
hemoglobin) hemoglobin inside a red
blood cell

MCV 01/20/2011 is a measurement of the 74 fl 80 – 97 fl The result is below

(mean 01/20/2011 average size of your normal range
corpuscular RBCs
volume) Together with high
RDW this indicates
iron deficiency
anemia

MCHC 01/20/2011 is a calculation of the 380 g/l 315 – 350 g/l The result is above
(mean 01/20/2011 average concentration of normal range
corpuscular hemoglobin inside a red
hemoglobin cell Indicates
concentration spherocytosis
)

RDW 01/20/2011 Measures the different 15.7 % 10.0 – 15.0 % The result is above
(Red cell 01/20/2011 sizes and shapes of the normal range
distribution width) red cell
Indicates iron
deficiency anemia

MPV 01/20/2011 Reflects the average 6.5 fl 6.5 – 11.0 fl The result is within
(Mean platelet 01/20/2011 volume of platelets normal range
volume)

PDW 01/20/2011 Determine the size of the 9.3 % 10.0 – 18.0 % The result is below
(Platelet 01/20/2011 platelets and may the normal range
distribution width) indicate underlying
disease such as not necessarily
thrombocytopenia indicate disease

pg. 41
Medical Management
A. Intravenous fluid

Medical Management Date ordered/ Date General Description Indications Client’s response to the Nursing
performed/ Date treatment Responsibilities
chnged/ Date
discontinued

D5LR Date ordered: Treatment for persons • Check for doctor’s

January 20,2011 needing extra calories order.
who cannot tolerate fluid • Obtain baseline data.
overload. • Do not administer
unless solution is clear
and container is
undamaged.
• Documentation.

B. Drugs

Generic/ Brand Date ordered/ Route of Action, Indication Client’s response Nursing
name Date taken/Date Administration, classification, responsibilities
changed/ Date Dosage, Frequecy mechanism of
discontinue action

Oxytoxin Date ordered: TIV Acts directly on Initiation or None • Review doctor’s

pg. 42
 Jan. 20,2011 myofibrils, improvement of order.
producing uterine uterine contractions • Obtain baseline
Date discontinue: contractions: to achieve early data.
stimulate milk vaginal delivery for • Monitor and record
ejection by the maternal or fetal uterine cotractions,
heartrate, BP,
breast. reasons. intruterine
pressure,fetal heart
rate and blood loss.
• Monitor adverse
reaction.
Cefazolin Date ordered: 1gram TIV ANST Action: Infections caused by None • Review doctors
Jan. 20,2011 q12 x2 dose staphylococcus, order.
(2:15 am) Inhibits bacterial streptococcus, E. coli, • Assess patient for
cell wall synthesis, D. pneumoniae, infection.
Date discontinue: thus promoting Proteus spp. and • Obtan specimens
Jan. 20,2011 osmotic instability for culture and
other susceptible
which eventually sensitivity before
microorganisms. initiating therapy.
leads to bacterial Respiratory tract
death. • Observe patient for
infections, adverse reaction.
Classification: genitourinary tract • Instruct patient to
infections, notfy healthcare
gynecological professional of the
infections, skin and adverse reaction.
skin structure • Documentatio.
infections, pre-and
post-operative wound
and trauma, biliary
tract infections.

pg. 43
Diclofenac Date ordered: 75mg IM now Inhibits for It is used mainly as • Verify the
Jan. 20,2011 cyclooxygenase, an the sodium salt for doctor’s order.
Then q12 Imx2 enzyme needed for the relief of pain and • Obtain baseline
dose more ANST the biosynthesis of inflammation in data.
prostaglandin, various conditions: • Monitor adverse
reaction.
subsequent decrease musculoskeletal and
• Monitor hepatic
in prostaglandin joint disorders,peri-
status and
result to the articular disorders, function.
analgesic, soft-tissue disorders, • Monitor
antipyretic and anti- and other painful hematologic
inflammatory coditions.Opthalmic status.
effects. solution. • Advise the patient
not to chew, cut,
crush or
dissolvehe
capsule.
• Inform the client
that the drug may
be taken or with
food or milk to
minimize GI
distress.
• Refrain also
alcoholic
beverages.
• Documentation.
Nalbuphine Date ordered: 5mg TIV q6 PRN Binds with opiate Relief of moderate to Relieved pain • Assess
Jan. 20, 2011 for severe pain receptors in the severe pain; for pre- patient’s
CNS: ascending operatively analgesi, underlying
pain pathways in supplement to condition before
therapy obtain
lymbic sysems, balanced anesthesia,
drug history.
thalamus, midbrain, surgical anesthesia, • Monitor vital
hypothalamus, obstretical analgesia. signs after

pg. 44
alteing perception of paranteral route.
and emotional • Monitor
response to pain allergic reaction.
• Monitor for
possible adverse
reactions.
• Assess
patient’s and
family’s
knowledge of
drug therapy.

pg. 45
Cefalexin Date ordered: 500 mg q6 x 1week Inhibits bacterial Cefalexin is used to none • Check for
Jan. 21, 2011 cell wall synthesis, treat urinary tract doctor’s order.
thus promoting infections, respiratory • Assess
Date discontinue: osmotic instability tract infections patient’s for
Jan. 26,2011 which eventually (including sinusitis, previous
sensitivity
leads to bacterial otitis media, reaction to
cell death. pharyngitis, tonsillitis penicillinor other
and pneumonia), skin cephalosporins.
and soft tissue • Obtain baseline
infections. data.
• Assess patient
for any signs of
infection.
• The drug
should be taken
with or without
food.
• Inform the
patient not to
crush the tablets.
• Documentation
.
Mefenamic acid Date ordered: 500mg cap q8 Aspirin- like drug Relief of pain Relieved of pain • Check for
Jan. 21,2011 that has analgesic, including muscular, relaed to doctor’s order.
antipyretic and ani- rheumatic, traumatic, underlying • Obtain baseline
Date discontinue: nflamatory dental, post- condition. data.
Jan. 21, 2011 activities. These operative and • Monitor for
possible drug
activities appear to postpartum pain,
adverse
be due to its ability headache, migrain, reactions.
to inhibit fever, and • Documentation
cyclooxygenase and dysmenorrhea, pain .
also antagonize from rheumatoid
certain effects of arthritis including

pg. 46
 prostaglandins. still’s disease, soft
tissue injuries.
Therapy should not
exceed 7 days.

FeSO4 Date ordered: OD Provides/replaces Prevention and Decrease feeling • Check for
Jan. 21,2011 elemental iron, an treatment of iron- of fatigue and doctor’s order.
essential component defficiency anemia. weakness. • Obtain baseline
Date discontinue: in formation of data.
Jan. 26, 2011 hemoglobin in red • Give between
meals for best
blood cell
absorption
development.

Ascorbic acid Date ordered: BID Needed for wound Enhance body’s Increase vitamin C • Assess
Jan. 21,2011 healing, collagen natural immune nutritional status
synthesis, function. for inclussion of
Date discontinue: antioxidant, foods high in vit.
Jan. 26, 2011 C.
carbohydrate
• Assess for vit.
metabolism, protein, C defficiency
lipid synthesis, before, during
prevention of and after
infection. treatment.
• Monitor input-
output ratio.
• Assess
patient’s and
family’s
knowledge on
drug therapy.
Bisacodyl Date ordered: Suppository Increases peristalsis Constipation, relief of Empty the client’s • Review for
Jan. 21, 2011 and moor activity of evaculation in bladder doctor’s order or
9:00 am 2 bisacodyl the small intestines hemorrhoids, medication
by acting directly on preparation for record.
• Obtain baselne
pg. 47
 Date discontinue: the smooth muscles. barium enema; data: GI status,
May stimulate preparation of colon bowel disorder,
Jan. 21, 2011 colonic intramural for fluid intake.
plexus and promote proctosigmoidoscopy, • Monitor
frequency and
fluid accumulation pre-and-post
characteristics of
in the intestines and operative. stool.
colon. • Monitor for the
adverse reactions.
• Inform the
patient not to

C. DIET
TYPE OF DIET DATE ORDERED, GENERAL INDICATION/ SPECIFIC FOOD CLIENT’S NURSING
DATE CHANGED, DESCRIPTION PURPOSES TAKEN REPSONSE RESPONSIBILITIES
and DATE (prior, during, after)
DISCONTINUED

NPO Date Ordered: NPO dietary state in It is usually on none The client received Before Be able to
pg. 48
 January 19,2011 which patient is force client’s chart who is nothing per orem and explain the general
January 20, 2011 to take nothing by about to undergo did not experience principles of the diet to
mouth over a given surgery or special vomiting. the patient, and obtain
Date discontinue: period diagnostic the patient's
January 21,2011 procedures requiring cooperation
Normally instructed that the digestive
to pre-op patient and tract be empty or Instruct the client to,
patient that have to who is unable to not eat any foods or
undergo a certain tolerate food and drinks.
laboratory fluids by mouth for
examination. some reason.
Ex. FBS, serum During: make sure that
electrolyte patient followed
doctor’s ordered

Help plan for the

patient's continued care

After: Observe for

restoration of GI
function such as
passage of flatus and
presence of bowel
sounds then document
findings.

SOFT DIET Date ordered: soft diet is one where Diet can be used for 1 skyflakes The diet was taking Before: Be able to
January 21, 2011 all the food are clients who have 1 bowl of Lugaw soft type of food and explain the general
January 22,2011 mashed, pureed or difficulty in chewing Mashed potato able to follow the principles of the diet to
placed in a sauce for or swallowing. Banana order. the patient, and obtain
Date discontinue: easy swallowing. Water the patient's
January 23,2011 This type of diet is Help to ease cooperation

pg. 49
 usually difficulty in chewing
recommended after and/or swallowing Instruct client to take
any type of jaw, due to dental easy to digest food like
throat or digestive problems or extreme soft food.
track surgery as well weakness, and it is
as after the sometimes During: make sure that
installation of new recommended to patient followed
dental braces. The relieve mild doctor’s order
patient can eat a intestinal or stomach
wide variety of food discomfort. Help plan for the
groups and types, but patient's continued care
they must all have a
soft texture. After; Assess for GI
upset symptoms.

DAT Date ordered: Diet as tolerated is a Provides immediate Rice The diet was well Before: Be able to
Diet as Tolerated Jan 22,2011 term that indicates replenishment of loss Water tolerated by the explain the general
Jan 23,2011 that the nutrients due to diet Leafy vegetables client, and her GI principles of the diet to
Jan 24,2011 gastrointestinal tracts restrictions or Bread (pandesal) function remains the patient, and obtain
is tolerating food and medical/ surgical Bangus normal and stable all the patient's
Date discontinue: is ready for intervention through Coffee throughout. cooperation
Until discharge of advancement to the oral intake.
the patient. next stage. Inform client she could
Therefore, this eat/drink the food and
statement is most beverages she desires.
applicably in regard
to the diet after
abdominal or During: make sure that
gastrointestinal patient followed
surgery, signifying doctor’s order
the patient's
tolerance of his diet. Help plan for the
patient's continued care

pg. 50
 After: Assess for GI
upset symptoms.

D. ACTIVITY AND EXERCISE

TYPE OF EXERCISE DATE ORDERED, GENERAL INDICATION/PURPOSES CLIENTS RESPONSE NURSING

DATE STARTED, DESCRIPTION RESPONSIBILITIES
DATE CHANGED & (prior, during, after)
DATE
DISCONTINUED

Walking Exercise Date Ordered: A rhythmic, ordered This action is indicated to Clients responded to Prior: none
January 21,2011 movement of the legs, prepare client start walking. regimen with positivism

pg. 51
 knee and feet that lets the
body shift its weight to
each leg alternately to
initiate movement and
travel
It would replenish the
circulation of the periphery
and reoxygenize the leg
muscles in preparation for
walking
and affirmation.
During: Advice client to
walk around the room

Aids in restoring circulation After: Assess for any

in lower extremities. complain or discomfort
Prevents pooling of blood
and createnin of blood clots
Helps in readying the leg
muscles to reaccomodate
body weight after bed rest.

Deep breathing is a Acute or chronic lung

Deep breathing Exercise Date Ordered: relaxation technique that
January 21,2011 can be self-taught. Deep
breathing releases
tension from the body
and clear the mind,
improving both physical
and mental wellness.
We tend to breathe
shallowly or even hold
our hold our breath when
we are feeling anxious.
Sometimes we are not
even aware of it. Shallow
breathing limits your
oxygen intake and adds
further stress to your
body, creating a vicious
cycle. Breathing
exercises can break this
disease.
Chronic obstructive lung
disease.
1. Pneumonia.
2. Atelectasis.
3. Pulmonary
embolism.
4. Acute respiratory
distress.
Pain in the thoracic or
abdominal area because of
surgery or trauma.
Airway obstruction
secondary to bronchospasm
or retained secretions.
Deficit in the central nervous
Clients responded to Prior: none
regimen with positivism
and affirmation.
During: Encourage client
to Inhale slowly through the
nose, distending the
abdomen and exhaling
slowly through pursed lips
Deep breath as often as
possible, preferably 5 to 10
times every hour during the
postoperative, immobilized
period.
After: Asses for any
complain or discomfort.

pg. 52

cycle.
The importance of good
posture cannot be
overstated. While sitting,
we tend to slouch, which
compresses the
diaphragm and other
organs, resulting in
shallow breathing.
Slouching also strains
muscles in the neck and
back. It is helpful to sit in
a chair with good back
support to avoid fatigue
that leads to slouching.
system that lead to muscle
weakness.
High spinal cord injury.
Acute, chronic, or
progressive myopathic or
neuropathy diseases.
Severe orthopedic
abnormalities, such as
scoliosis and kyphosis that
affects respiratory function.
Stress management and
relaxation procedures

SURGICAL MANAGEMENT

A cesarean section is a surgical procedure in which one or more incisions are made through a mother's abdomen (laparotomy) and uterus
(hysterectomy) to deliver one or more babies, or, rarely, to remove a dead fetus. A late-term abortion using Caesarean section procedures is termed a hysterectomy abortion and is
very rarely performed. A Caesarean section 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 request for childbirths that could otherwise have been natural. It is performed whenever abnormal conditions complicate labor and vaginal delivery,
threatening the life or health of the mother or the baby.

pg. 53
 Regional anesthesia, either a spinal or epidural, is the preferred method of pain relief during a c-section. The benefits of regional anesthesia include
allowing the mother to be awake during the surgery, avoiding the risks of general anesthesia, and allowing early contact between mother and child. Spinal anesthesia involves
inserting a needle into a region between the vertebrae of the lower back and injecting numbing medications. An epidural is similar to a spinal except that a catheter is inserted so
that numbing medications may be administered continuously. Some women experience a drop in blood pressure when a regional anesthetic is administered; this can be countered
with fluids and/or medications. Once the patient has received anesthesia, the abdomen is washed with an antibacterial solution and a portion of the pubic hair may be shaved. The
first incision opens the abdomen. Infrequently, it will be vertical from just below the navel to the top of the pubic bone or, more commonly, it will be a horizontal incision across
and above the pubic bone (informally called a "bikini cut").

The second incision opens the uterus. In most cases, a transverse incision is made. The classical incision is vertical. Because it provides a larger
opening than a low transverse incision, it is used in the most critical situations such as placenta previa. However, the classic incision causes more bleeding, a greater risk of
abdominal infection, and a weaker scar.

Once the uterus is opened, the amniotic sac is ruptured and the baby is delivered. The time from the initial incision to birth is typically five minutes.
The umbilical cord is clamped and cut, and the newborn is evaluated. The placenta is removed from the mother, and her uterus and abdomen are stitched closed (surgical staples
may be used instead in closing the outermost layer of the abdominal incision). From birth through suturing may take 30–40 minutes; the entire surgical procedure may be
performed in less than one hour.

NURSING RESPONSIBILITIES

PRIOR

pg. 54
  Inform the patient and the family of the patient for the procedure to be done.

During and after

 Provide instructions on techniques used for cleaning the suture.

 Explain the purpose of cleaning the suture.
 Give pain medications to the patient that do not interfere her breastfeeding.
 Encouraged to get out of bed and walk around 8- 24 hours after surgery to stimulate circulation (thus avoiding the formation of blood clots) and bowel
movement.
 Encourage the patient to breastfeed her baby.

PRIORITIZATION

DATE IDENTIFIED CUES PROBLEM/ NURSING DIAGNOSIS JUSTIFICATION

pg. 55
 January 21, 2011 “ Sumasakit ang tahi ko kapag Acute pain related to actual tissue
nagsasalita,” as verbalized by the client damage secondary to surgical incision
at the lower abdomen as manifested by
verbalization of pain scale of 6/10
January 21, 2011 “ Hindi ako makahakbang,” as Impaired walking related to pain
verbalized by the client secondary to surgical incision as
manifested by facial grimace when
moving and seeing patient always in
bed
January 21, 2011 “ Nahihirapan akong dumumi dahil sa Bowel incontinence related to impaired
tahi ko,” as verbalized by the client cognition as secondary to pain due to
surgical incision at lower abdomen as
manifested by fecal staining at
maternal diaper.
January 21, 2011 “ Walang lumalabas na gatas sa suso Ineffective breastfeeding related to
ko,” as verbalized by the client previous history of breastfeeding
failure as manifested by observable
signs of inadequate infant intake
January 21, 2011 “Paputol-putol ang tulog ko dito sa Sleep deprivation related to sustained
ospital,” as verbalized by the client environmental stimulation and
discomfort as manifested by irritability
ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE
DIAGNOSIS
S: “Hindi ako Impaired mobility related LONG TERM GOAL: -Assist with results of -for differential diagnosis LONG TERM GOAL:
Our client feels pain whenever she
talks, walk and move because of her
operation that’s why during the entire
interview; we took her condition into
consideration.
Our client feels uncomfortable
whenever she ambulates. It is specially
seen during our physical assessment
Because of difficulty in walking and
moving, our client find it hard to
defecate that’s why she defecated once
in her maternity diaper.
Due to failure in breastfeeding to her
first baby, our client becomes
unconfident in breastfeeding her newly
born baby. And also because of her
operation, our client feels pain that she
finds it hard to breastfeed
Because of pain and the nurses who
routinely get her vital signs, our client
find it hard to sleep that is why she is
so irritable and look restless.
EVALUATION
pg. 56
makahakbang kasi to pain secondary to After 2hours of nursing mobility testing. and to guide treatment After 2hours of nursing
sumasakit yung tahi ko.” surgical incision as intervention, the patient interventions. intervention, the patient
as verbalized by my manifested by grimace should learn therapeutic -Consult -for individualized learned therapeutic
patient. face when moving and techniques that may PT/OT/rehabilitation mobility/walking techniques that may
seeing patient always on provide comfort to her. team. program, and provide comfort to her.
O: -seen patient always bed. SHORT TERM GOALS: identify/develop
on bed 30min discuss the factors appropriate devices.
-grimace face when that contribute to the -Schedule -to reduce fatigue. SHORT TERM GOALS:
moving pain she feels. walking/exercise
-holding her abdomen 45min verbalize activities interspersed GOAL MET within
when moving therapeutic techniques or with adequate rest 30min the client was able
-using bedpan when pain management that periods. to discussed the factors
voiding may give her comfort. -Encourage active and -to increase that contribute to the pain
-undergone cesarean 30min demonstrate some passive exercises. stamina/endurance. she feels.
section ROM’s that can help her Advanced levels of
-pain scale: 6/10 recover with her exercise, as able. GOAL MET within
situation. -Instruct client in safety -to enhance safety for 45min the client was able
30min assist the patient measures, as individually client and caregivers. to verbalized therapeutic
to do the ROM’s. indicated. techniques or pain
management that may
give her comfort.

GOAL MET within

30min the client was able
to demonstrated some
ROM’s that can help her
recover with her
situation.
30min assisted the
patient to do the ROM’s.

ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Subjective: Long Term goal: Long Term goal:

pg. 57
 “ Sumasakit ang tahi Acute pain related to  After 4 hours of  Provide comfort - To provide non  After 40 minutes
ko pag nagsasalita” as actual tissue damage as nursing measures. pharmacological of nursing
verbalized by the client.secondary to surgical intervention,the pain intervention, the
incision of the lower client will be able management. client was able to
Objective: abdomen as manifested to minimize minimize
 Pain scale ( 6/10 ) by verbalization of pain verbalization of  Review verbalization of
 Verbalization of ( 6/10 ) pain from procedures/ - To reduce pain from
pain ( 6/ 10 ) expectations and concern of the ( 6/ 10 )
 Facial grimace to ( 2/10 ). tell client when unknown and to ( 2/10 ).
treatment will associated muscle
 Touching of
Short Term goal: hurt. tension. Short Term goal:
abdomen upon
interview and GOAL MET
irritable.  After 30 minutes  Administer  After 1 hour the
the client will be analgesics as client was able to
able to follow - To maintain follow prescribed
indicated to
prescribed acceptable level pharmacological
maternal dosage
pharmacological of pain. regimen.
as needed.
regimen. GOAL MET
 After 30 minutes  After 1 hour the
the client will be  Perform pain client was able to
- To rule out
able to report assessment each report pain is
worsening of
pain is relieved time pain occurs. relieved
underlying
/controlled. /controlled.
condition of
 After 1 hour the GOAL MET
complications.
client will be able  After 1 hour the
to verbalized - To medicate client was able to
methods that  Note when pain verbalized
occurs. prophylactically
provide relief. as appropriate. methods that
 After 1 hour the provide relief.
client will be able GOAL MET
to demonstrate  After 1 hour the
the use of client was able to
relaxation skills demonstrate the
and diversional use of relaxation
activities as skills and
manifested for diversional
pg. 58
 individual activities as
situation. manifested for
individual
situation.

ASSESMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: Bowel Incontinence Long Term Goal: >encouraged client or -to note relationship to Long Term Goal:
“Nahihirapan ako related to impaired SO to record times at meals, activity and
dumumi dahil sa tahi ko cognition as secondary to After 4hours of Nursing which incontinence client’s behavior. After of Nursing

pg. 59
sa tyan” as verbalized by pain due to surgical Intervention, the client
the client. incision at lower will able to return her
abdomen as manifested changed in normal bowel
OBJECTIVE: by fecal staining at habits characterized by
>inability to diapers. difficulty to defecate.
recognize/inattention to
urge to defecate Short Term Goal:
>discomfort because of
pain due to surgical Within 30 min. the
incision @ lower client will able to
abdomen verbalize understanding
>used of diaper of causative/ controlling
>fecal staining at diapers factors.
and at bed
>constant dribbling of Within 30 min. the client
soft tools will able to identify
>fecal odor on diapers individually appropriate
interventions.
Within 1 hour the client
will able to participate in
therapeutic regimens to
control incontinences.
Within 1 hour the client
will able to establish
maintain as regular of
bowel functioning as
possible.
DISCHARGE SUMMARY:
occur. Intervention, the client
was able to return her
>take client to the -to maintain success of changed in normal bowel
bathroom/place on program. habits characterized by
commode a bedpan at difficulty to defecate.
specified intervals taking
into consideration Short Term Goal:
individual needs and
incontinence pattern. GOAL MET the client
wasl able to verbalized
>encourage and instruct understanding of
client/care giver in causative/ controlling
providing diet high in factors.
fiber and adequate fluids
GOAL MET the client
>give stool softener/bulk was able to identified
form as indicate/needed. individually appropriate
Encourage warm fluid interventions.
intake after meals -to avoid perineal
excoriation. GOAL MET the client
>provide pericare with was able to participate in
frequent gentle cleaning therapeutic regimens to
and use of emollients. control incontinences.
-to stimulate timed
>Instruct in use of defecation. GOAL MET the client
suppositories or stool was able to established
softeners if indicated. maintain as regular of
-to enhance coping bowel functioning as
>provide emotional difficult situation. possible.
support to client and SO,
especially when
condition in long term
pg. 60
 A. The General Condition of the client upon discharge is neat, clean and in proper attitude to understand the things that she needs to do upon discharge.

B. METHODS

Medication - Cefalexin, Ferrous Sulfate, Mefenamic Acid, Ascorbic Acid tablet

Exercise – She needs to perform likes ROM, Walking and ADL

Treatment – Continue to take medications, Encourage Breastfeeding, Advice to clean Wound twice a day, Advice to eat healthy Foods.

Hygiene – Can Take a Bath after discharge but should protect her wound so it will not easily get wet and always clean the wound with Betadine , cover it
clean gauze, twice a day and use Binder to easy heal the wound, Advice also Perineal Care.

Out Patient : MGH, complete medications

: Oral meds instructed
: Advice follow up after 1 week

Diet – Prefer to have Regular Diet or DAT

Spirituality – Always go to church and always have a communication with God.

pg. 61
Conclusion:

After we studied the case, we understood the process of cesarean section delivery. It helps us to know the differences of C- Section to normal spontaneous delivery.
Through nursing health history, physical assessment was obtained to render appropriate nursing intervention. We use our critical thinking in assessing the patient’s condition using
the knowledge that we obtained in our Related Learning Experience, which we also apply in the hospital. In formulating appropriate nursing care plans that are applicable to the
patient’s condition and rendering an effective nursing intervention. It is also important to establish rapport. As a woman we need to appreciate the essence of it. We need to respect
our patient and giving them an emotional support in times of need.

Being able to have a case study that is concerned with cesarean section, we learned a lot of things beyond what we already know. We discovered a lot of new informations on how
the C-section happens and the factor that is concerned with it. We learned how to appreciate the effort of the mother just to deliver her baby. Experiences like this help student
nurses like us to grow as a person and to gain more respect to mothers who do their best to deliver their babies alive.

BIBLIOGRAPHY:

Cesarean definition- www.nlm.nih.gov/medlineplus/cesarean section.html

pg. 62
www.childbirth.org/section/CSFact.html
www.babycenter.com.ph/pregnancy/labourandbirth/labourcomplications/cesarean

Growth and development:

Source: http://nursingcrib.com/nursing-notes-reviewer/human-growth-and-development-theories/

Medical and Surgical Management:

http://www.surgeryencyclopedia.com/Ce-Fi/Cesarean-Section.html

PPD’s Nursing Drug Guide, 2nd Edition p.11, p.22, p.27 p.92, p.93, p476, p.450 p456, p.506

DRUGS:

http://www.scribd.com/doc/12250676/Drug-Study
http://www.nursing-nurse.com/drug-study-cefazolin-ancef-172/#more-172
PDD’s Nursing DrugGuide 2nd edition pages: 506, 502,92, 93, 11, 22, 27, 450, 456, 476
IVF
http://www.scribd.com/doc/16349954/D5LR

DIET and EXERCISE

http://www.wisegeek.com/what-is-a-soft-diet.htm

http://books.google.com.ph/books?id=odY9mXicPlYC&pg=PA341&lpg=PA341&dq=indication+of+soft+diet&source=bl&ots=z-
7Ge5YXyT&sig=anvH8kYfkBtQtVNIvXlqRr8BrhE&hl=tl&ei=8AxlTc-tIMKrcZ-
ukN4F&sa=X&oi=book_result&ct=result&resnum=10&ved=0CGYQ6AEwCQ#v=onepage&q=indication%20of%20soft%20diet&f=false

www.answers.com

http://www.tpub.com/content/armymedical/md0915/md09150012.htm

http://www.stress-relief-exercises.com/deep-breathing-exercises.html

pg. 63
pg. 64