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Case Study

INTRODUCTION
Edema is the accumulation of fluid in the intestinal cell. A person
with edema manifested swelling in different parts of the body. In
pregnant woman, edema usually occurs between the second and third
trimester. Clinically, it is divided into three degrees namely:

a. Mild Case → obvious edema appears on the legs and feet but
can disappear after rest.
b. Moderate Case → edema extends to thighs and vulva or even
in the abdomen.
c. General Edema → accumulation of fluids in the abdomen

Swelling or normal edema during pregnancy is not really


dangerous, however, if a pregnant woman suddenly swell in the hands
and face, there is a possibility that she might be developing pre
-eclampsia. This is a serious condition that can be life threatening for
the mother and baby. Pre-eclampsia typically results in high blood
pressure during pregnancy, putting the life of both the mother and the
baby at stake. This is the reason why even a simple normal edema
should still be monitored.

OBJECTIVES
General:
This study aims to deepen our knowledge and
understanding about edema.
Specific:
After this, we should be able to:
1. Define what edema is.
2. Identify its cause.
3. Discuss it’s effect in the mother and baby.
4. Determine the appropriate interventions to be done.
5. Know what is/are the possible complication.

THEORETICAL FRAMEWORK
Mommy X just like any mother- to be have experienced
pregnancy discomfort like morning sickness, dizziness and tiredness.
Among all those discomfort, edema in her lower extremities is what

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bothers her the most. Even though people around her keep on telling
her that it is fine and need not to worry about she still can’t help but
think if it was really alright. Edema on her first and her second
pregnancy disappeared on their own. What she was worried about was
if it can possibly have any effect on her baby’s health.

COMPONENT OF NURSING HEALTH


HISTORY

I.BIOGRAPHICAL DATA

Name: Mommy X

Address: 426 Barangka Ibaba, Mandaluyong City

Age: 33 years old

Gender: Female

Religious Affiliation: Roman Catholic

Marital Status: Married

Occupation: Plain Housewife

Place: Mauway, Lying-in

Chief Complaint: 37 weeks, AOG G2 p1 (T1P0A0L1)

Midwives: Marieta Reyes and Milagros Naïve

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II. NURSING HISTORY


A. History of Present Illness

The baby was planned together with the place of delivery, the
Mauway-Lying-In Clinic. The baby according to the mother will be
breastfeed just like their first born baby.

B. Past Health History

Mommy X has also experienced edema during her first


pregnancy. Aside from it, she had no other complaint regarding her
pregnancy. She also hasn’t experienced any serious illnesses like
hypertension, diabetes and the like.

C. Family History

There are no history of diabetes, allergies and mental


disorder in the family. The only one that they identify was hypertension
in her husband’s family.

D. Maternal and Obstetrical History

Mommy X have 2 beautiful daughters including the


newborn, both were born normally. She has no multiple pregnancies
and no history of abortion.

August 19, 2008 / 11:04 am


Mommy X gives birth to a healthy baby girl with the following
measurements:
Weight: 2.4 kg
Height: 31 cm
Head Circumference: 33 cm
Chest Circumference: 32 cm

III. PATTERN OF FUNCTIONING


Psychological Health
1. Coping Patterns:

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Whenever she has a problem she always pray to God to give her
strength to be able to cope up and solve no matter what problem it
was.

2. Interaction Patterns:
Mommy X is the type of person one can easily get along with for
she was very friendly and approachable.

3. Cognitive Patterns:
There are no sign of mental disturbances in Mommy X. She
seems to cope up well with the hardship of pregnancy and pain of
labor.

4. Self Concept:
She views herself as a woman, a wife to her husband and a
mother to her two beautiful daughters.

5. Emotional Pattern:
She is a positive type of person. She deals effectively with her
emotions.
6. Sexuality:
For Mommy X, being a woman is being responsible enough to
take good care of your family and keeping it intact no matter what
happen.

7. Family Coping Pattern:


If there is /are problems in the family they discuss it together
(she and her husband) and solve it together.

Socio-Cultural Health

1. Cultural Pattern:
They celebrate fiesta, Christmas and New Year and other
significant event or occasions.

2. Significant Relationship:
She does not have any complain with regards to her relationship
with her husband. She cited her husband as a responsible and loving
one.

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3. Recreational Pattern:
The Family goes to church every Sunday and their favorite past
time is watching television specifically the noon time show,
Wowawee…

4. Environment:
According to Mommy X, Their place was a very quiet place to live
in although sometimes, there are quarrellings in the neighborhood
which is inevitable of course, all in all, their place was ideal for her.

5. Economic
In the family, all finances are shouldered by her husband who is
a bodyguard with a salary of P 33 per day.

Spiritual Health

1. Religious Belief

They are Roman Catholic who believed in God and the only
savior, His son Jesus Christ.

2. Values and Valuing

They practice kissing the hands of elders and value respect and
good attitude at all times.

IV. ACTIVITIES OF DAILY LIVING

Before After
Activities Hospitalizatio Hospitalizatio Analysis
n n

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1. Nutrition
Mostly Vegetables and The mother
vegetables and soups also prefers nutritious
soups and soupy foods
for the sake of
her baby that
was
breastfeeding on
her.
2. Elimination
Every morning Every morning The mother still
has her normal
elimination
pattern even
after delivery.
3. Exercise
No exercise Do some Because of the
walking in the new born baby,
morning the mother now
together with lends time to do
the baby little exercises
together with
her baby.
4. Hygiene
Practice good The same The mother still
grooming maintains good
grooming.
5. Rest and
Sleep 8 hours of sleep 3-4 hours The mother
1 hour nap 30 minutes nap usually lack in
sleep at night
due to the
supervision she
was doing on her
newborn baby
6. Sexual
activities 3x a week No sex Sexual
intercourse was
not practice after
delivery because
the wound was
still new and not
yet completely

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healed.

V. PHYSICAL ASSESSMENT
Day: Wednesday Date: August 20, 2008 Time: 10:43 am BMI:
19.4(normal)

A.
Interpretation/
Measurement Findings Normal
Analysis
s
Weight M= 78.5 7.7†,
Normal
43 kilograms F=58.8 4.1†
Height M=163.5 cm
(5' 4.4") F=151.8 Normal
5 ft. tall cm (4' 11.8")

Interpretation/
B. Vital signs Findings Normal
Analysis
Temperature
37◦ 36.5◦C-37.2◦C normal
Pulse Rate
69bpm 60-100bpm Normal
Respiratory
Rate 24bpm 6-20bpm normal
Blood pressure H
110/80mmgh 120/90mmgh hypotensive

HEAD TO TOE PHYSICAL ASSESSMENT

Body Parts Actual Normal Interpretat


/ Findings Findings ion
Technique

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Head
Proportion to
the size of the
1.Skull
body, round,
Palpation
Normal with Normal
Size, shape
prominences in
or contour,
the frontal area
symmetry
interior and the
and
occipital are
curvature.
posterior,
symmetrical in
all planes,
gently curved.

Normal Normal
2.Scalp
Inspection White, clean,
Carefully free from
separate the masses, lumps,
hair at scars, lice, nits,
various dandruff, and
locations. lesions.
Inspect for
color,
appearance, Normal Normal
and presence
of masses,
lice nits, and
dandruff.

Palpation No areas of
Areas for Normal tenderness. Normal
tenderness

3.Hair
Inspection Black evenly
Inspect for distributed and
the color, Normal covers the Normal
distribution, whole scalp,

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thickness, thick, shiny and


and free from split
lubrication or ends.
appearance.
Normal Normal

Palpation
Palpate for Coarse of fine
texture

4.Face
Inspection Oblong or oval
Observe for or round or
the square or heart-
symmetry, shape,
shape, facial symmetrical,
expression, facial
movement expression that
and is dependent on
appearance. Normal the mood or Normal
true feelings,
smooth and free
from wrinkles
and no
involuntary
Normal muscle Normal
movements.

5.Eyes
Inspection
Observe for
placement, Parallel and
symmetry, evenly placed,
protrusion, Normal symmetrical, Normal
clarity, and non protruding,
lacrimations. with scant
amount of
*Eyebrows secretions, both
Inspection eyes bright and
Observe for clear.
color,
symmetry, Normal Black, Normal
and quantity symmetrical,
of hair, thick, raise and

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distribution lower
and symmetrically,
placement evenly
unparallel. distributed and
parallel with
each other.
*Eyelashes
Inspection Tenderness and Abnormal
Observe for pain
the color,
distribution
Black evenly
and direction distributed and
tuned outward.
*Eyelids
Inspection
Ask the client
to close
eyes. Upper lid covers
a small portion Abnormal
Observe for Pale of the iris and
position and the cornea and
symmetry sclera when the
and then ask eyes are open.
him to open When the eyes
eyes again. are closed---the
symmetrical
Palpation
Using the tip
of the index Normal
finger, Normal
palpate the Non-palpable,
lacrimal non tender.
gland. Normal
Normal

Normal
Normal

*Lower
palpebral
conjunctiva Salmon pink,
Inspection shiny, moist.

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Ask the client


to look up
and pull the
lower lid
down, Normal
Observe for Normal
color and
appearance.
White and clear,
*Sclera no visible blood
Inspection vessels.
Color and
clarity Normal
Normal Transparent,
*Cornea shiny, smooth.
Inspection
Clarity and
texture Round, equal
constrict when
*Pupils light is pointed
Inspection to the eyes and
Size, shape, dilated when
symmetry, light is Normal
reaction to Normal removed,
light and constrict when
accommodati object is close
on. to the eyes and
dilated when
object is
removed away.

Iris
Inspection Proportional to Normal
Size, color, Normal the size of the
shape eyes, round,
black brown,
symmetrical.

*Testing for
eye
movement
Inspection Able to move Normal
Stand Normal eyes in full

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directly in ranges of
front of the motion or able
client and to move in all
hold the direction.
finger at
about one
foot in front
of the Normal
client’s eyes. Normal

Able to see 60
Ask the client degrees
to refrain superiority.
from moving
his head and Normal
follow the Normal
direction of
the
examiner’s
fingers with
his eyes only.
Move the
finger in a
slow manner Midline, Normal
though the Normal symmetrical
cardinal and patent.
fields of
gaze.

*Testing for
visual fields
Inspection Normal
Stand 2-3 ft. Normal
from the Able to repeat
client. Ask the words
(one ear at a
time and
then at the Normal
back of the Normal
client for
both ears).

Instruct the In the correct


client not to placement,
move his Patent and

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head and to symmetrical Normal


repeat the Normal
words that
you will say.

Clean, pinkish,
with few cilia. Normal
6.Nose Normal
Inspection
Placement,
symmetry
and patency.

*Internal
nares Straight. Normal
Inspection Normal
Appearance,
color of
mucus
membrane, Normal
presence of Normal
cilia.
Pinkish,
symmetrical
with lip margin
well defined,
*Septum smooth and
Inspection moist. Normal
Appearance Normal

Pinkish, smooth,
7.Mouth moist, no
reseeding, no Normal
*Lips Normal swelling and no
Inspection discharge
Observe for
color, shape,
symmetry,
lip margin
and 32 permanent Normal
appearance Normal teeth, well-
aligned, free
from caries or
*Gums filling and no Normal
Inspection Normal halitosis.

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Observe for
color,
appearance, Large, medium,
discharge red or pink,
and swelling slightly rough in
or top, smooth Normal
contraction. Normal along the lateral
margins, moist
*Teeth shiny and freely
Inspection movable.
Number,
color,
alignment, Midline, straight Normal
general Normal end thin
condition,
breath

*Tongue Pinkish, moist


Inspection and smooth Normal
Inspect for Normal
size, color,
surface,

appearance
and
movement Pinkish, moist,
smooth Normal
*Frenulum Normal
Inspection
Position and
appearance
Slightly pinkish Normal
*Checks Normal
(buccal
mucosa)
Inspection
Color and
appearance At the center Normal
Symmetrical
8.Palate Normal and freely
movable
*Soft palate
Inspection
Color and Pinkish, non-
appearance inflamed

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*Hard
palate Normal
Inspection Normal
Color and
appearance.
Proportional to
*Uvula the size of the
Inspection body and head,
Position, symmetrical
color, size, and straight.
symmetry,
And mobility
No palpable
*Tonsils lumps, masses
Inspection or areas of
Detect if tenderness Normal
there is
hoarseness
of voice

9.*Neck Palpable
Inspection
Size,
symmetry,
position

*Palpation Freely movable Normal


Palpate for Normal without
lumps, difficulty
masses or
areas of
tenderness
Symmetrical
and able to
resist applied
Palpates the force(both
Adam’s apple muscle)
(for male)

Able to resist
applied force

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symmetrical in
structure of size
Range of motion and muscular
Chin to chest strength
Ear to shoulder

Muscular
strength
Inspection
Symmetry and The chest
strength of the contour is
sternocleidomas symmetrical Normal
toid muscle Normal and the chest is
twice as wide as
deep
Force/strength (anteriposterior
of the trapezius diameter in a
muscle 1:2 ratio) the
spine is straight
posteriorly, the
10. Thorax ribs tend to
slope across
(Anterior and and down the
posterior) ribs are
Inspection prominent in a
Have the client thin person
all comfortably. there is no
Inspect for the bulging or
shape, position retraction of
of the spine, breathing.
slope of the
ribs, retraction
of the The chest wall
intercostals moves
spaces (ICS) on symmetrically
the inspiration, during
and bulging of respiration
the ICS on
experimentation
.

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Observe for
symmetry of the Normal
chest wall Normal No lumps,
during masses, areas
respiration of tenderness
sides of the
thorax expand
symmetrically.
the examiners
thumb separate
approximately 2
inches during
breathing

Palpation
Palpate for Normal
lumps, masses, Normal
areas of
tenderness.

Normal
Normal

Measure chest
excursion (to
determine the
depth of
breathing).
Place hands on
the lower The vibrations
portion of the are feeling most
rib cage with strongly
the thumbs 2 between the
inches apart first and second
pointing toward ribs along the
the spine so a sternum
small fold of the interiorly and
skin appears between the
between the scapulae
thumbs. posteriorly. Normal
Normal

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Ask the client to


take a few deep
breaths.

Elicit lacille
fromitus (a thrill
felt by the hand
on the chest
wall while the
client is
speaking). Place
the palms of the
hands
bilaterally
symmetrical on
the chest. Start Normal
from the top of Normal
the chest wall
going down
.each time the
hands move
down, ask the
client to say
ninety-nine or Normal
one-one –one Normal
with the same
intensity of Vesicular
voice. sounds are
heard over lung
periphery
particularly at
the base of the
lungs, they are
Percussion: soft intensity,
low pitched
Anterior thorax. gentle sighing
The client is sounds created
preferably in a by hair moving Normal
lying position. Normal through smaller
airways
Posterior thorax. bronchovessicul
The client is ar so this are
sitting position heard at the 1st
with the arms and 2nd IC at the
folded forward sternum

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across the interiorly and


chest. This between the
position will scapulae
separate posteriorly
scapulae further
to expose more
lung to
assessment.
No pulsations. Normal
Normal
Using the direct
percussion,
percuss in the
ICS over
symmetrical
areas of the
chest starting
from the
supraclavicular
area. Compare
one side of the
chest with the Normal
other. Normal

Pulsations
visible and
palpable
Auscultation:

Use the flat-disc


diaphragm. Use
the systematic
zigzag
procedure used
in percussion.
Ask the client to
take slow deep
breaths through Abdominal
the mouth. aortic pulsation
Listen at each visible and

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point to the palpable.


breath sounds
during a
complete
respiration. The 2 heart
Compare sounds are
findings at each audible in all
point on the areas but
opposite side of loudest at apical
the chest. area.. Normal
Normal

*Heart
CR ranges from
Inspection and 60-100 beats
palpation: per minute. Normal
Place the client Normal
in supine
position. Stand
in the client’s
right side. Ask
client not to
talk. Inspect
and palpate the
valve areas of
the heart. Females:
variable in size
depending on
*Aortic areas body build,
Around at the rounded shape,
2nd ICS on the symmetrical
right angle of
Louis as a
dominance on Males: Flat,
the Sternum symmytrical, if
obese, may be
*Pulmonic Area- slightly
at the 2nd ICS on rounded. Normal
the left of Louis. Normal
Note: Observe
these areas at
an angle to the
side to improve

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the chance of
seeing Normal
pulsations. Normal

*Tricusspid Area
– move the
fingers along
the client’s left
sternal border
to the 5th ICS.

*Apical Area –
moves the
fingers laterally
to the left mid-
clavicular line
(LMCL), which is
slightly below
the nipple. This
point where the
apex touches
the anterior
chest wall is
known as the
point of
maximal
impulse (PMA)

*Epigastric Area
– at the tip of
the sternum.

Auscultation:
Auscultate the
hearth in all 4
anatomic sites:
aortic,

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pulmonic,
tricuspid and
apical (mitral)
Eliminate all
sources of room Skin is the same
noise. Heart in color in the
sounds are of abdomen, no
low intensity retractional
and other noise dimpling.
hinders the
nurse’s ability
to hear them.

Identify the first


sounds No masses or Normal
described and lumps,
“lub”. Then, Normal tenderness,
identify the 2nd breast tissues
sound. This is are firm and
higher – pitched elastic.
that SI,
described as
“dub”

Use the bell-


shaped
diaphragm.
Once SI and S2
are identified,
count the heart
rate for one
minute. Each
combination of
S1 and S2
counts as one Normal
heart beat.

11.Breast
Round or oval,
Inspection color darker
Ask the client to that
remove the top surrounding
gown or drape skin,
to allow symmetrical
simultaneous

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visualization of
the breast.
Have the client No masses and
sit comfortably tenderness.
with arms at the
sides. Inspect
the breast for
size, symmetry
and contour or
shape.

Inspect the skin


of breast for Round, averted,
color, retraction, equal in size,
or dimpling. similar in color.
Both nipple
points in one
direction, no
Palpation discharge, no
Assist the client lesion
in supine
position. This No masses,
position allows tenderness and
the breast discharge.
tissues to
flatten evenly
against the Normal
chest wall Normal
facilitating
palpation. Ask
client to false
his/her hand
and place it
under the head
palpate the
breast for lumps
or masses,
tenderness, and
consistency of
breast tissues.
The palmar
surface of the
first three

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fingers is used
to compress
breast tissues
against the
chest wall.
Perform
palpation in a
clockwise rotary
motion from the Normal
borders going Normal
inward.

*Areola
Inspection
Inspect for size,
shape, color and
summetry.

Skin is
unblemished,
Palpation no scars, color Normal
Palpate for Normal is uniform, flat,
masses and rounded or
tenderness scapoid,
symmetrical
movement
caused by
respiration,
Normal nortic pulsation
at epigastric are
*Nipples visible thin
persons,
Inspection umbilicus is flat
Inspect for size, or concave
shape, position, positioned
discharge and midway
lesions. between the
xipoid process
Normal and the
symphisisd
Palpation pubis, color is
Use thumb and the same as the
index finger to surrounding
compress the skin.

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nipple to
determine any
discharge.
Normal
12.Abdomen Rough

Divide the
abdomen into 4
imaginary
quadrants.
Draw a vertical Normal
line from the
xipoid process
to the
symphysis pubis
and a horizontal
line across the
umbilicus.
These
quadrants are Abnormal
labeled right Has edema
upper
quadrants
(RUQ).left lower
quadrants
(LLQ), and right
lower quadrant Abnormal
(RLQ) Has edema
Ask the client if
he/she needs to
void. Drape the
upper chest and Abnormal
legs. Explore Has edema
the abdomen
from the xipoid
process to the
symphisis pubis.
The client lies in Abnormal
supine position Has edema
with arms down
at the sides. A
small pillow
may be placed
under the head. Liver’s edge
feels firm and

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non-tender

Inspection
Inspect the
abdomen for
skin integrity,
color, contour,
symmetry,
movement or
pulsations and
color and
placement of
umbilicus.

Tympanic
Auscultation ground
Warm the predominated
diaphragm of because of the
the air in the
sytethoscope. stomach and
Cold int4estines.
stethoscope Percussion
may cause the sound is dull at
client to contact the liver’s lower
the abdominal portion.
muscles and the
contractions
may be heard
during
auscultation.
Diaphram is
used because Perform with
intestinal ease
sounds are

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highpitched
sounds. Place
the diaphragm
in each of the 4
quadrants over
all auscultation Perform with
sites. It may ease
take minute to
hear bowel
sounds.

Palpation
Perform light
palpation first to
detect areas of
tenderness, Symmetrical in
muscle size and length,
guarding no
(voluntary abnormalities,
tightening of fine hair equally
muscles), lumps distributed, no
or masses, visible varicose
constancy, and vein
organomegaly.

Depress the
abdominal wall
lightly, about 1
cm with the
pads of your Warm and
fingers. Move smooth
the finger pads
in a sight
circular motion.
Palpate all 4
quadrants.
Clean no
Palpate the liver lesions, 5 toes
using deep on each foot.
palpation. Stand
on the client’s
right side. Place
your left hand
on the posterior
thorax at about

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the 11th and 12th


rib and then
apply upward Performs with
pressure. This ease
maneur makes
it easier to feel
the liver
anteriorly. With
the fingers of
the right hand
pointing Performs with
upward, place ease
the hand on the
RUQ well below
the liver’s lower
border, then
press gently Performs with
until you reach ease
a depth of 1 ½ -
2 inches. Ask
the client to
take a deep
breath using the
abdominal Performs with
muscles. As he ease
inhales, try to
palpate the
liver’s edge as it
descends.

Percussion
Percuss each of
the 4 quadrants
starting from
the RUQ going
clockwise.

*Wrist

Ask the client to


flex and extend

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hands at the
wrist and then
perform radial
and ulnar
flexion.

*Hands and
fingers

Ask the client to


do flexion,
extension,
abduction of
fingers,

13.Lower
Extremities

Inspection
Inspect for
symmetry of
size and length
and the
presence of
abnormalities.
Note the pattern
of hair
distribution,
color and
presence of
varicose veins.

Palpation
Palpate from
thighs to logs
for temperature,
and texture.

*Feet and Toes

Inspection
Inspect for
cleanliness, skin
lesion and

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number of toes

*Hips

*Range of
Motion
Ask the client to
do flexion,
extension,
abduction,
adduction, and
internal external
rotation of the
legs

*Knees
Ask the client to
flex and extend
each leg

*Ankle
Ask the client to
do flexion,
extension,
aversion, and
inversion of
each foot.

*Foot and Toes


Ask the client to
flex, extend,
abduct and
adduct toes

VI. ANATOMY AND PYSIOLOGY

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The Human Circulatory System

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BLOOD
• Blood contains the fluid part called Plasma, and many blood cells
• Plasma is a yellowish, slightly alkaline liquid that comprises 55%
of blood, and is a mixture of nutrients (amino acids, sugars, fatty
acids, glycerol, salts), hormones, antibodies, enzymes and some
dissolved gases in water
• Red Blood Cells (Erythrocytes) are made in the bone marrow in
the centre of certain long bones. Red blood cells have nuclei
when first formed, but lose their nuclei when mature. They live
only about 4 months before being destroyed by the spleen and
the liver. Red blood cells contain red chemical called
haemoglobin that attaches either to oxygen or carbon dioxide
molecules to transport them around the body.
• White Blood Cells (Leukocytes) are made in bone marrow and the
spleen. They live only 2 to 4 days, because their purpose is to
fight infection. They either surround or ingest foreign particles or
bacteria (macrophages that perform phagocytosis), or produce
chemicals such as antibodies and antitoxins to neutralise the
invading particles or bacteria.

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• Platelets are small disc-shaped blood cells without a nucleus.


They are formed in bone marrow, and play an important role in
the clotting of blood.

BLOOD VESSELS
• Arteries take blood away from the heart. They usually contain
blood rich in oxygen. Arteries have elastic muscular walls that
can dilate and constrict as each pulse of blood goes through.
• Veins take blood back to the heart. They contain valves that
allow a one-way flow of blood. Veins are less muscular than
arteries.
• Capillaries are the smallest and most numerous of blood vessels.
The capillary diameter is only the width of one red blood cell, so
blood travels slowly through capillaries. The capillary wall is only
one cell thick to allow exchange of nutrients and oxygen into,
and wastes such as carbon dioxide out of the body cells.

STRUCTURE OF THE HEART

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• The heart is a strong muscular organ used to pump blood.


• It has 4 blood-collecting chambers - 2 atria and 2 ventricles.
• Valves between the chambers allow one-way blood flow.
• The wall of the left ventricle is the thickest and strongest
because blood from here is pumped all around the body.
• The heart has its own blood supply via the coronary artery. If
this is blocked, a 'heart attack' may occur.

BLOOD FLOW THROUGH THE HEART


• Oxygenated Blood - contains a lot of oxygen but very little
carbon dioxide
• Deoxygenated blood - contains very little oxygen bit a lot of
carbon dioxide
• Direction of Blood Flow - Blood from body - Vena Cava - Right
Atrium - Right Ventricle - Pulmonary Artery - Lungs - Pulmonary
Veins - Left Atrium - Left Ventricle - Aorta - All body cells

VII. PATHOPYSIOLOGY

Growing uterus puts Uterus enlarges, it presses


pressure on pelvic and vena cava. down on main veins to the legs.
(Pressure slows down circulation ( the reduces the flow of blood
and causes blood to pool in legs returning to heart which pushes
and forcing fluid from veins into water into the tissues into the legs
the tissues of feet and ankles) and feet)

Mild
Case

Swelling or puffiness Stretch skin or shiny Paleness


of tissue on skin

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SUBCUTANEOUS EDEMA
→ commonly occurs in the legs and ankles due to the influence of
gravity in woman.

EDEMA
→excessive accumulation of fluid in body tissues popularly known as
dropsy. The resultant swelling may be local or with an injuring or
inflammation.

VIII. DIAGNOSIS, LABORATORY RESULTS


AND PROCEDURE

Date: May 19, 2008


HEMATOLOGY

Examination Results Reference Value

Hemoglobin 128 (M) 130 – 180


(mass concentration) (F) 120 -160

Erythrocytes 0.39 (M) 0.40 – 0.54


(volume fraction) (F) 0.37 – 0.47

Leucocytes 8.7 5-10x10 9/l


(no. concentration)

Erythrocytes(no. 4.2 (M) 4.5 – 6.0


concentration) (F) 4.0 -5.5x10 12/l

Thrombocytes

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Neutrophil 0.75 (F) 0.51 – 0.67

Lymphocytes 0.20 (N) 0.21 – 0.35

Monocytes 0.03 0.02 – 0.08

Eosinophil 0.02 0.01 – 0.04

URINALYSIS

Result Analysis Nursing Care

Physical
Examination: Light Yellow Normal Health Teaching
1.Color Hazy Normal Health Teaching
2.Character /
Transparency

Chemical Negative Normal Health Teaching


Examination: Negative Normal Health Teaching
1.Albumin
2.Sugar

Microscopic Few Normal Health Teaching


Examination:
1.Epithelial Cells Few Normal Health Teaching

2.Mucus Few Normal Health Teaching


Threads
1-2/hpf Compromised Hygiene

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3.Amorphous for infection Teaching


Urates
0-1hpf Normal
4.Pus Cells Health Teaching
7.1 Normal
Health Teaching
5.RBC 1.015 Normal
Health Teaching
6.PH

7.Specific
Gravity

Diagnostic X-Ray / Ultrasound Report

Name : Libot, Nemia


Age : 33 years old
Sex : Female
Civil Status : Married
O.R Number : 99661
Physician : Luz Uy
Date : May 19, 2008
Case Number : 08-2563

Fetal and Obstetrical Report

Number of Fetus : Single


Presentation : Cephalic
Biparietal Diameter : 6.21 cm 25 weeks, 2d

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Femoral Length : 4.82 cm 25 weeks, 6d


Abdominal Circumference : 20.4 cm 24 weeks, 6d
FHR : 139 beats/min.
Placental Location : Anterior highying
Amniotic Fluid : 11.7cm AFI
Gender : Female
Maturity grade : 1
Average Gestational Age : 25 weeks, 2d
Estimated Fetal Body Weight : 815 grams

Impression:

Single, Live, Intrauterine Pregnancy in Cephalic presentation of


about 25 weeks and 2 days based on bpd, FL and Ac.
GR. 1, Anterior Placenta
Normohydraminios
EDC : August 30, 2008

M.J.M. Alba MD,


DPBR
Radiologist /
Sonologist

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