25905003-Nursing-Case-Study-C-section

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NURSING CASE STUDY:

CAESARIAN SECTION

I. DEMOGRAPHIC DATA

Name: A.G.M Name: A.G.M Gender: Female Gender: Female Civil

Civil Status: Status: MarriedMarried Address:

Address: Bacoor, Bacoor, CaviteCavite Age:

Age: 40 40 years years oldold Bi

Birtrthdhdatate:e: SeSeptptemembeber 2r 26, 6, 11996969 Bi

Birtrthphplalacece:: ImImusus, , CaCavivitete Religion:

Religion: Roman Roman CatholicCatholic Oc

Occucupapatitionon:: HoHoususewewififee Di

Diagagnonosisis:s: ElElderderly ly GrGravavidida, a, PU PU 3939-4-40 0 wkwks s AOAOGG (Low Lying Placenta Frank Breech) (Low Lying Placenta Frank Breech)

Operation Performed: Low Transverse Caesarian Section Operation Performed: Low Transverse Caesarian Section

II. HEALTH HISTORY

Patient A.G.M is a 40 year old female, who is preganant for 40 Patient A.G.M is a 40 year old female, who is preganant for 40 we

weekeks, s, mamarrrrieied d anand d a a momothther er of of twtwo. o. ShShe e is is a a cacaththololic ic wiwith th fafairir co

compmplelexixionon, , ststanands ds 15153 3 cm cm anand d weweigighs hs 76 76 kgkgs. s. ShShe e wawas s boborn rn atat Dasmarinas, Cavite and second among three siblings.

Dasmarinas, Cavite and second among three siblings.

Her AOG is 40 weeks. Patient had a previous CS delivery because Her AOG is 40 weeks. Patient had a previous CS delivery because she had difficulty on delivering her child.

she had difficulty on delivering her child.

Patient had no history of asthma, no seizure, no diabetes mellitus Patient had no history of asthma, no seizure, no diabetes mellitus and

and no no hyphypertertensiension. on. PatPatient had ient had cocomplmplete ete immimmuniunizatzation ion and and had had nono allergies to either food or medications.

allergies to either food or medications.

III. LABORATORY / DIAGNOSTICS

Procedure / Date

Procedure / Date ActualActual Findings Findings

Normal Normal Findings

Findings ImplicationsImplications

Nursing Nursing Responsibilities Responsibilities 1. CBC 1. CBC Pre:Pre:

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Procedure / Date

Nursing Nursing Responsibilities Responsibilities Hemoglobin Hemoglobin Hematocrit Hematocrit WBC WBC Segmenters Segmenters Lymphocytes Lymphocytes Eosinophils Eosinophils Stab Cells Stab Cells Platelets Platelets 116 116 0.35 0.35 8.0 8.0 0.60 0.60 0.14 0.14 0.02 0.02 0.04 0.04 320 320 120 – 140 120 – 140 g/dL g/dL 0.30 0.30 5 - 10 5 - 10 0.36 - 0.66 0.36 - 0.66 0.22 - 0.40 0.22 - 0.40 0.01 - 0.04 0.01 - 0.04 0.02 - 0.05 0.02 - 0.05 150 – 150 – 400x9/L 400x9/L Decrease Decrease - Indicates - Indicates occurrence of occurrence of anemia anemia Increase Increase - Indicates - Indicates hypercoagulatio hypercoagulatio n n Normal Normal Normal Normal Decrease Decrease - Indicates high - Indicates high risk for risk for acquiring acquiring infection infection Normal Normal Normal Normal Normal Normal Order. Order.

 Inform client andInform client and explain the

explain the procedure. procedure.

 No need for NPO.No need for NPO.

Intra: Intra:

 Perform bloodPerform blood extraction extraction (venipuncture (venipuncture technique) using technique) using aseptic aseptic technique. technique.

 Put extractedPut extracted blood in blood in ethyldiamino-tetracetate tetracetate (EDTA) or the (EDTA) or the lavender top lavender top vacuum tube. vacuum tube. Post: Post:

 Label theLabel the container container properly and properly and correctly. correctly.

 Send specimen toSend specimen to the lab

the lab

immediately. immediately.

 Document theDocument the result to the result to the chart and inform chart and inform

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Procedure / Date

Nursing Nursing Responsibilities Responsibilities physician that physician that the result is out. the result is out.

URINE ANALYSIS

M

Miiccrroossccooppiic c EExxaamm CChheemmiiccaal l EExxaamm C

Coolloorr: : YYeellllooww AAllbbuummiinn: : NNeeggaattiivvee T

Trraannssppaarreennccyy: : HHaazzeell SSuuggaarr: : NNeeggaattiivvee pH: 6.0 (7.35 – 7.45)

pH: 6.0 (7.35 – 7.45)

Specific Gravity: 1.010 (1.010 – 1.025) Specific Gravity: 1.010 (1.010 – 1.025) Epithelial Cells: Moderate

Epithelial Cells: Moderate

IV. INDICATIONS FOR THE PROCEDURE

CAESARIAN SECTION CAESARIAN SECTION

A Caesarian section is a form of childbirth in which a surgical A Caesarian section is a form of childbirth in which a surgical incision is made through a mother’s abdomen and uterus to deliver one 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 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 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 times it has been also performed upon requests for births that would otherwise have been normal.

otherwise have been normal. Cae

Caesarisarian an secsectiotion n (CS(CS) ) is is recrecommommendeended d whewhen n vagvaginainal l deldeliveiveryry might pose a risk to the mother or baby. Reasons for CS include:

might pose a risk to the mother or baby. Reasons for CS include:

 Precious (high risk) fetusPrecious (high risk) fetus

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 Apparent fetal distressApparent fetal distress

 Apparent maternal distressApparent maternal distress

 Complications (pre-eclampsia, active herpes)Complications (pre-eclampsia, active herpes)

 Catastrophes such as cord prolapse or uterine ruptureCatastrophes such as cord prolapse or uterine rupture

 Multiple birthsMultiple births

 Abnormal presentation (breech or transverse positions)Abnormal presentation (breech or transverse positions)

 Failed induction of laborFailed induction of labor

 Failed instrumental deliveryFailed instrumental delivery

 The baby is too The baby is too large (macrosomia)large (macrosomia)

 Placental problems (placenta previa, placental abruption/Placental problems (placenta previa, placental abruption/ placenta accrete)

placenta accrete)

 Umbilical cord abnormalitiesUmbilical cord abnormalities

 Contracted pelvisContracted pelvis

 Sexually transmitted infections such as genital herpesSexually transmitted infections such as genital herpes

 Previous caesarian sectionPrevious caesarian section

 Old ageOld age

V. PREPARATION



 POSITIONINGPOSITIONING

Patient that would undergo caesarian delivery should be Patient that would undergo caesarian delivery should be re

reququirired ed to to be be in in SUSUPIPINE NE POPOSISITITION ON in in ththe e enentitire re cocoururse se of of del

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

for procedures of the anterior body such as: abdominal, thoracic,racic, facial and anterior upper and lower extremity procedures.

facial and anterior upper and lower extremity procedures.



 CATHETER INSERTIONCATHETER INSERTION

The patient is placed in a lithotomy position. The nurse The patient is placed in a lithotomy position. The nurse mus

must t weawear r stesterile rile glogloves ves whewhen n perfperformorming ing thithis s proprocedcedure. ure. TheThe genital area is exposed. The area is cleansed with the use of genital area is exposed. The area is cleansed with the use of antiseptic solution (3 times). Cleaning of the genital area starts at antiseptic solution (3 times). Cleaning of the genital area starts at the top of the genitalia to the bottom using a pattern-7 motion on the top of the genitalia to the bottom using a pattern-7 motion on bo

both th sidsideses. . ThThenen, , the the cacathetheter ter is is ininseserterted. d. To To fafacicililitatate te thethe insertion, the catheter is lubricated. Urine will flow when the insertion, the catheter is lubricated. Urine will flow when the catheter passed the bladder. Then, the catheter is secured by catheter passed the bladder. Then, the catheter is secured by injecting 10ml of sterile water on the Y-port. The urune bag is injecting 10ml of sterile water on the Y-port. The urune bag is then attached to the catheter.

then attached to the catheter.



 APPLICATION OF DRAPESAPPLICATION OF DRAPES

Dr

Draapiping ng ininccluludedes s ththe e ususe e oof f totowewells, s, eyeye e shsheeeets ts aandnd la

lapapararatotomy my shsheeeet t to to mamainintatain in ththe e acaccecessssibibililitity y aandnd maximize the area to be examined and repaired and also maximize the area to be examined and repaired and also provide a continuous sterile field.

provide a continuous sterile field.

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 ANESTHESIAANESTHESIA

Sp

Spininal al anand d epepididuraural l ananestesthehesia sia arare e waways ys to to numnumb b susurgrgicicalal patienst from the chest on down the legs. Both spinal and epidural patienst from the chest on down the legs. Both spinal and epidural

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anesthe

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

expected.



 INDUCTION OF ANESTHETIC AGENTINDUCTION OF ANESTHETIC AGENT

Th

The e papatitienent t is is plplacaced ed on on a a lalateteraral l poposisitition on wiwith th babackck exposed. The nurse must wear sterile gloves before performing exposed. The nurse must wear sterile gloves before performing the procedure. The area where the anesthesia is to be inducted is the procedure. The area where the anesthesia is to be inducted is cl

cleaeansnsed ed wiwith th alalcocohohol l anand d fofollllowowed ed by by anantitiseseptiptic c sosolulutition on (3(3 tim

times)es). . The The clecleanianing ng stastarts rts on on the the inseinsertirtion on sitsite e witwith h circirculcularar motion using firm strokes.

motion using firm strokes.

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The patient is placed on a supine position exposing the The patient is placed on a supine position exposing the abdominal area. Sterile gloves are donned using the open glove abdominal area. Sterile gloves are donned using the open glove method before performing the procedure. The operative site is method before performing the procedure. The operative site is cleansed with the use of cleanser (3 times), wet OS (3 times) and cleansed with the use of cleanser (3 times), wet OS (3 times) and then changed the gloves before applying the antiseptic (3 times). then changed the gloves before applying the antiseptic (3 times). Beg

Beginniinning ng at at the the incincisiision on sitsite, e, the the arearea a wilwill l incinclude postelude posterioriorr breast as the upper margin, the axillary line as lateral margins breast as the upper margin, the axillary line as lateral margins and to the anterior two thirds of the legs as posterior margin. and to the anterior two thirds of the legs as posterior margin. Cleaning would always include use of firm circular motion leaving Cleaning would always include use of firm circular motion leaving no spaces unwiped.

no spaces unwiped.

VI. INSTRUMENTS (C/S set)

 Small kellies (6)Small kellies (6)

 Towel clips (4)Towel clips (4)

 Straight kellies (2)Straight kellies (2)

 Needle holder (2)Needle holder (2)

 Mayo Collins (2)Mayo Collins (2)

 Tissue forceps (2)Tissue forceps (2)

 Ovum forcep (1)Ovum forcep (1)

 Metzenbaum (1)Metzenbaum (1)

 OchsnersOchsners

 Richarson retractorRicharson retractor

 Medium Kellies (6)Medium Kellies (6)

 Allises (8)Allises (8)

 Bobcock (2)Bobcock (2)

 Army navy (2)Army navy (2)

 Thumb forceps (2)Thumb forceps (2)

 Blade handle #3 and #4Blade handle #3 and #4

 Mayo scissor (1)Mayo scissor (1)

 Bladder retractorBladder retractor

 DeaverDeaver

 Self-retaining retractorSelf-retaining retractor

VII. PROCEDURES

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•

• Client was place in supine position with contraptions noted andClient was place in supine position with contraptions noted and

checked by anesthesiologist. checked by anesthesiologist.

•

• Skin preparation of the induction site of anesthetic agentsSkin preparation of the induction site of anesthetic agents •

• Induction of anesthesia, either spinal or epidurInduction of anesthesia, either spinal or epidural and sometimesal and sometimes

general anesthesia general anesthesia

•

• Abdominal skin preparation to be doneAbdominal skin preparation to be done •

• Application of drapes, eye sheet, laparotomy sheetApplication of drapes, eye sheet, laparotomy sheet •

• Sequential incision begins: the skin, subcutaneous, peritoneumSequential incision begins: the skin, subcutaneous, peritoneum

penetrating to the uterus penetrating to the uterus

•

• Delivery of the babyDelivery of the baby •

• Delivery of the placentaDelivery of the placenta •

• Sequential closing using appropriate absorbable suturesSequential closing using appropriate absorbable sutures •

• Hemostasis secured, peritoneal wash doneHemostasis secured, peritoneal wash done •

• Initials OS, instruments and needles completedInitials OS, instruments and needles completed

VIII. ANATOMY AND PHYSIOLOGY

ANATOMY AND PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM ANATOMY AND PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM

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EXTERNAL GENITALIA EXTERNAL GENITALIA

Our overview of the reproductive system begins at the external genital area Our overview of the reproductive system begins at the external genital area — or

— or vulva—which runs from the pubic area downward to the rectum. Two folds of 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: fatty, fleshy tissue surround the entrance to the vagina and the urinary opening: the

the labia majoralabia majora, or outer folds, and the, or outer folds, and the labia minoralabia minora, or inner folds, located, or inner folds, located under the labia majora. The

under the labia majora. The clitoris, is a relatively short organ (less than one inchclitoris, is a relatively short organ (less than one inch long), shielded by a hood of flesh. When stimulated sexually, the clitoris can long), shielded by a hood of flesh. When stimulated sexually, the clitoris can become erect like a man's penis. The

become erect like a man's penis. The hymen, a thin membrane protecting thehymen, a thin membrane protecting the entrance of the vagina, stretches when you insert a tampon or have intercourse. entrance of the vagina, stretches when you insert a tampon or have intercourse.

INTERNAL REPRODUCTIVE STRUCTURE INTERNAL REPRODUCTIVE STRUCTURE

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The Vagina The Vagina

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

the avenue of birth through which the new baby enters the world .

The Cervix The Cervix

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

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Aft

After er intintercercourourse, se, spesperm rm ejaejaculculateated d in in the the vagvagina ina paspass s thrthrougough h thethe cervix, then proceed through the uterus to the

cervix, then proceed through the uterus to the fallopian tubesfallopian tubes where, if awhere, if a sperm encounters an ovum (egg), conception occurs. The cervix is lined with sperm encounters an ovum (egg), conception occurs. The cervix is lined with mucus, the quality and quantity of which is

mucus, the quality and quantity of which is governed by monthly fluctuations ingoverned by monthly fluctuations in the levels of the two principle sex hormones, estrogen and progesterone.

the levels of the two principle sex hormones, estrogen and progesterone.

When estrogen levels are low, the mucus tends to be thick and sparse, When estrogen levels are low, the mucus tends to be thick and sparse, which makes it difficult for sperm to reach the fallopian tubes. But when an which makes it difficult for sperm to reach the fallopian tubes. But when an egg is ready for fertilization and estrogen levels are high the mucus then egg is ready for fertilization and estrogen levels are high the mucus then bec

becomeomes s thithin n and and slislipperppery, y, ofofferfering ing a a mucmuch h mormore e frifriendlendly y envienvironmronment ent toto sperm as they struggle towards their goal. (This phenomenon is employed by sperm as they struggle towards their goal. (This phenomenon is employed by bi

birtrth h cocontntrorol l pipilllls, s, shshoots ts anand d imimplplanantsts. . OnOne e of of ththe e waways ys ththey ey prprevevenentt conception is to render the

conception is to render the cervical mucus thick, sparse, and hostile to sperm.)cervical mucus thick, sparse, and hostile to sperm.)

Uterus Uterus

The uterus or womb is the major female reproductive

The uterus or womb is the major female reproductive organorgan of of humanshumans.. One end, the

One end, the cervixcervix, opens into the, opens into the vaginavagina; the other is connected on both; the other is connected on both sides to the

sides to the fallopian tubesfallopian tubes..

The uterus mostly consists of

The uterus mostly consists of musclemuscle, known as myometrium. Its major, known as myometrium. Its major function is to accept a fertilized

function is to accept a fertilized ovumovum which becomes implanted into thewhich becomes implanted into the endometrium, and derives nourishment from blood vessels which develop endometrium, and derives nourishment from blood vessels which develop exclusively for this purpose. The fertilized ovum becomes an

exclusively for this purpose. The fertilized ovum becomes an embryoembryo, develops, develops into a

into a fetusfetus and gestates untiland gestates until childbirthchildbirth..

Oviducts Oviducts

The Fallopian tubes or oviducts are two very fine tubes leading from the The Fallopian tubes or oviducts are two very fine tubes leading from the ovaries

ovaries of femaleof female mammalsmammals into theinto the uterusuterus.. On

On mamatuturitrity y of of an an ovovumum, , the the fofollllicicle le and and the the ovovarary'y's s wawall ll ruprupturture,e, allowing the ovum to escape and enter the Fallopian tube. There it travels allowing the ovum to escape and enter the Fallopian tube. There it travels

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toward the uterus, pushed along by movements of

toward the uterus, pushed along by movements of ciliacilia on the inner lining of on the inner lining of the tubes. This trip takes hours or days. If the ovum is

the tubes. This trip takes hours or days. If the ovum is fertilizedfertilized while in thewhile in the Fallopian tube, then it normally implants in the

Fallopian tube, then it normally implants in the endometriumendometrium when it reacheswhen it reaches the uterus, which signals the beginning of

the uterus, which signals the beginning of pregnancypregnancy..

Ovaries Ovaries

The ovaries are the

The ovaries are the place inside the female body whereplace inside the female body where ovaova oror eggseggs areare produced. The process by which the ovum is released is called

produced. The process by which the ovum is released is called ovulationovulation. The. The speed of ovulation is

speed of ovulation is periodicperiodic and impacts directly to the length of aand impacts directly to the length of a menstrualmenstrual cycle

cycle..

After ovulat

After ovulation, the ovum is ion, the ovum is capturecaptured by d by thethe oviductoviduct, where it travelled, where it travelled down the oviduct to the uterus, occasionally being

down the oviduct to the uterus, occasionally being fertilisedfertilised on its way by anon its way by an incoming

incoming spermsperm, leading to, leading to pregnancypregnancy and the eventual birth of a new humanand the eventual birth of a new human being.

being.

The Fallopian tubes are often called the oviducts and they have small The Fallopian tubes are often called the oviducts and they have small hairs (