I.

INTRODUCTION

A Caesarian section (or Cesarean section), also known as C-section or Caesar, is a surgical procedure in which incisions are made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies. It is usually performed when a vaginal delivery would put the baby's or mother's life or health at risk. There are several types of Caesarean section (CS). An important distinction lies in the type of incision (longitudinal or latitudinal) made on the uterus, apart from the incision on the skin. In this case study, the subject underwent a low segment transverse caesarian section. This is a type of CS which is also called lower uterine segment section. It is the procedure most commonly used today; it involves a transverse cut just above the edge of the bladder and results in less blood loss and is easier to repair. A woman can only undergo caesarean section when vaginal delivery might pose a risk to the mother or baby. In this case, the subject of the study underwent this kind of surgical operation due to persistent variable deceleration exhibited by the fetus. The fetal heart tone pattern was non-recessing. The researcher selected this case to further explain the factors causing this complication. The researcher would also like to determine how it affects both the mother and the fetus. Moreover, the researcher would like to come across with the appropriate interventions that would aid in preventing this complication from occurring.

II. GENERAL DATA

Name of Patient Age Sex Race Place of birth Marital Status Occupation Religion Date of Admission Room/Bed No. Hospital No. Diagnosis

: Ms. X : 26 : Female : Filipino : Mangagoy, Bislig City, Surigao del Sur : Single : Sales Specialist : Roman Catholic : January 26, 2010 : 225-3 : 309795 : Pregnancy Uterine Full Term Delivered via Primary Low Segment Transverse Caesarian Section a live baby boy cephalic secondary to Non-recessing Fetal Heart Tone Pattern (Persisten Variable Deceleration)

Diet Referring Physician Chief Complaints

: Soft diet : Dr. Susan C. Mancelita : watery vaginal discharge

III. HEALTH ASSESSMENT

A. HEALTH HISTORY

A.1 Biological Data Name of Patient: Ms. X Age: 26 Sex: Female Race: Filipino Place of birth: Mangagoy, Bislig City, Surigao del Sur Marital Status: Single Occupation: Sales Specialist Religion: Roman Catholic

A.2 Reason for seeking consultation First prenatal check up started at 1 month AOG with irregular visits thereafter. No illness occurred during the pregnancy. Blood pressure within normal limit as claimed. Multivitamins were taken for supplement. Ultrasound taken at 1 month AOG with subchorionic hemorrhage, advised for bed rests and given with unrecalled medicines. Another ultrasound taken at 8 months AOG with premature placental aging as claimed. Morning PTA, noted watery vaginal discharge associated with irregular uterine contractions and low back pain. Consult done, thus advised admission.

A.3 Current Health Status Patient verbalized pain on the incision site. Patient also shows guarding movements with a grimaced face when moving. Patient also expressed that she dont get a straight sleep due to vital signs taking during her sleep. Patient also shared her inability to defecate for how many days already. Patient also expressed that her SO was not usually around when she needed to have her incision be applied with antiseptic.

A.4 Past Health History Patient was conscious, coherent and oriented to time and place. Patient was calm, cooperative and responds appropriately. During childhood years, patient experienced mumps with no other known illnesses. Patient had childhood immunizations, but had no tetanus and hepatitis vaccines. Patient denies adult illnesses experience. Patient had good psychiatric condition and never experienced any problems with it. At age 10, patient had minor operation with a carbuncle on the upper part of the posterior left leg. Patient experienced burn on the right elbow due to an accidental contact with a warm metal plate. Patient was admitted once due to an unrecalled reason. Patient denies allergies on drugs but not on alcoholic drinks. Patient usually sleeps 8-10 hours per night. Patient does not smoke but drinks occasionally and claims usual drinking is only up to the limited extent.

A.5 Family History

DM
82

HT N
81

79

HT N
79

HTN 59

A& W 56

D M 53

A& W 51

A& W

49

RA 47

52

A& W

HT N 50

A& W 49

HTN 46

A& W

29

A& W 28

A& W

26

A& W 24

A& W 21

19

A& W

Legend: Living Male Living Female Deceased Male Deceased Female Points to patient HTN - Hypertension DM Diabetes Mellitus RA Rheumatoid Arthritis A & W Alive and well

On each side, both grandparents already passed away due to serious diseases. On the patients paternal side, the grandfather and grandmother died due to Diabetes mellitus and hypertension, respectively. On the mothers side, only the grandmother died due to a serious disease which was hypertension. Some of their children acquired the same condition, just like the 59-year-old with HTN and 53-year-old with DM, and the other

sides 50-year-old and 46-year-old both with HTN. Only the paternal sides 47-year-old with Rheumatoid Arthritis developed a new disease in their family. The rest and the younger generation were staying alive and well, with no perceivable heredofamilial diseases.

A.6 Review of Systems

General: Patient is conscious, coherent, logical, and oriented to time and place. Patient was calm and responds appropriately. Skin: Skin is uniform brown in color with no areas of increased vascularity or bleeding. The skin surface temperature is warm and equal bilaterally. It feels smooth, firm and even. Head: The hair is black in color with terminal hairs distributed in the eyebrows, eyelashes and scalp. The scalp is light brown in color. Eyes: The patients eyelids appears symmetrical with no drooping, infections, or tumors of the lids. There were also no enlargement, swelling, or any tenderness, and no redness that is visible. Ears: The ears match the flesh color of the rest of the patients skin and is positioned centrally and in proportion to the blood. The top of the ear crossed an imaginary line drawn from outer canthus of the eye to the occiput. Nose: The shape of the external nose is located symmetrically in the midline of the face and is without swelling, bleeding, lesions and masses. Throat: The ventral surface of the tongue has prominent blood vessels. The number of teeth is less than the normal with minimal dental caries. Palates are concave and pink. Respiratory: Patient exhibits normal respiration. There is no exaggerated chest expansion.

Gastrointestinal: Patient is having constipation. Patient complains abdominal pain due to incision brought by operation. Genitourinary: Patient is attached with catheter. Urine is of less amount. It is yellow in color. Endocrine: No changes in hair distribution, no intolerance of heat and cold, no fatigue noted. Musculoskeletal: Movement is limited due to pain of incision, with muscle weakness and stiffness. Psychiatric: No mood swings, anxiety and suicidal thoughts or attempts.

GORDONS LEVEL OF FUNCTIONING Health Perception and Health Management Patient started having irregular prenatal check-ups during her first pregnancy. Walking a few meters away from home to the road serves as her daily exercise. In addition, she does her household chores everyday and does the general cleaning once a month. If she feels ill, she takes medicines in order to give remedy for her and her family. She denies allergies on drugs but not on alcoholic drinks. She does not smoke but drinks occasionally and claims usual drinking is only up to the limited extent. Her family has history of hypertension, diabetes mellitus and rheumatoid arthritis. Nutrition and Metabolism Patient eats whatever she likes since she doesnt have any food allergies. However, she avoids fatty foods which she knows are risk factors for heart diseases. She loves to eat fruits but less on vegetables. She drinks occasionally but only up to the limited extent. Elimination

Patient defecates once a day without experiencing discomforts, usually morning before she heads to her duty. Stool is brown in color and is well-formed. Patient voids usually 5-7 times a day. Urine is yellow in color. There is no pain when voiding. She easily releases sweat while doing household chores. Activity and Exercise Everyday, patient usually walks a few meters away from home in going to work. Her job in the company is mostly standing. She presents and sells company products and services to current and potential clients and coordinates company staff to accomplish the work required to close sales. At home, she loves to watch primetime shows on TV. Cognition and Perception Patient finished her college course, Sales Marketing, at the University of San Carlos Main. Basically, she knows how to read and write. Moreover, she can use code-switching when communicating with her co-workers. Sleep and Rest Patient usually sleeps 8-10 hours per night. She loves to read pocket books until she falls asleep. She feels regainment of energy if she gets long hours of sleep after an intense days work. She usually does deep inhalation and exhalation when stress comes her way. Self-Perception and Self-Concept Patient has many friends due to her extrovert personality. It is easy for her to get along with others since she knows how to handle people. Her job fits her socializing skills. She

considers herself as a holistic human being as long as she is healthy and her family is always there for her. She wants to maintain a good health and live his life to the fullest. Roles and Relationships Patient can speak and understand English, Tagalog and Cebuano. She can clearly express whatever she wants to voice out. She has 5 siblings and they were all close to each other. Patient is very active and extrovert. She usually socializes with her neighbors. She and the father of her baby were not yet married. Sexuality and Reproduction Patient is still single but is living under the same roof with her partner. She is sexually active with her live-in partner for almost a year and a half. She denies using contraceptives. Coping and Stress Tolerance Whenever the patient meets problems, she immediately examines it and searches for an effective solution in no time. This would somehow stop it from getting worse. She follows the rule of 8 as a means of reducing stress. An example is deep inhalation and exhalation whenever stress comes her way. Values and Belief Patient is a Roman Catholic, usually attending Sunday masses with her partner. She has a strong faith in God that she asks faithfully healing of any perceived illnesses. Patient inculcated honesty and integrity in their relationship and outlook in life.

A.7 Psychosocial Profile

Patient wakes up at 6AM and makes breakfast with live-in partner. Walking a few meters away from home to the road serves as her daily exercise. She goes to work from 8AM to 6PM. Patient is living with her live-in partner and is well-supported by her immediate family. Patient finished her college course, Sales Marketing, at University of San Carlos Main. She is now working as a Sales Specialist at Sanitary Care Company. Patient is a Roman Catholic, usually attending Sunday masses with her partner. Patient usually commutes via jeepney in going to work and other local places. Patient is residing in a rented house at Basak, Pardo with a good drainage and water supply. Patient is just an occasional drinker and claims drinking is up to the limited extent only. She denies abuse and binging. She also denies smoking and use of prohibited drugs. Patient is heterosexual and is sexually active with her live-in partner for almost a year and a half. She denies using contraceptives.

B. PHYSICAL EXAMINATION

Vital Signs:

T: R:

37.6oC 24 cpm

P: BP:

66 bpm 90/60 mmHg .

General Observations: Received patient conscious, coherent and mentally-oriented to time, people and place. Patient has fair skin with stitches on the incision site of the lower abdomen. Overall, patient is in a normal appearance. Skin: (Color, Moisture, Temperature, Texture, Mobility, and Turgor) Patient has fair, moist warm and smooth skin. Its turgor is within 1 to 2 seconds.

Hair: (Color, distribution, texture, oiliness, and infestation) Patient has long, black hair. It is distributed evenly. It is smooth and silky. Scalp: (Scaliness, lumps, and tenderness) The scalp is free from lesions. Tenderness and masses are not noted. Nails: (Color, shape, texture, capillary refill, and lesions) Nails of patient are pinkish in color. It is a bit square. It is smooth. Capillary refill is 2 to 3 seconds. No lesions found. Skull: (Shape, symmetry, contour, and masses) Patient has a normocephalic head, symmetrical and no masses were found. Face: (Expression, shape, symmetry, edema, and masses) The face is able to do any impressions or expressions. It is oblong-shaped, symmetrical and free from edema and/or masses. Eyes: (Visual acuity, EOM, Oculomotor nerve, eyelids, lacrimal glands, conjuctiva, sclera, cornea, lens, PERRLA, confrontation test, and fundus) Eyes are functioning properly. No inflammation on the eyelids, lacrimal glands and other surrounding the eyes. The eyes are wet and moist. Sclera on both sides is dirty white. Conjuctiva has small blood vessels. Ears: (Symmetry, color, discharge, swelling, otoscopic assessment, whispered voice test, Webers test, and Rinnes test) Ears are symmetrical, fair, and no noted discharge and swelling. The ears can hear perfectly. Nose and Sinuses: (Symmetry, flaring, inflammation, discharges, patency, nasal cavities, palpation, and percussion) Nose is symmetrical with no inflammation and discharges noted. Airway patency is present. Sinuses are palpable and resonant when percussed. Mouth and Pharynx: (Odor, lips, buccal mucosa, gums, teeth, tongue, hard palate, soft palate, and pharynx) Patient has good breathe. Lips are pinkish and smooth with moist. Buccal mucosa, gums and tongue are pinkish in color, teeth are dirty white, and the hard and soft palate are pinkish in color as well.

Neck: (Symmetry, musculature, lymph nodes, trachea, and thyroid) The neck is symmetrical. Lymph nodes are palpable. Bruit sounds are heard on the trachea. It isfelt and palpable. Thyroid gland is palpable. No inflammation or lesions noted. Posterior Chest: (Shape, symmetry, anteroposterior diameter, lateral diameter, tenderness, thoracic expansion, tactile fremitus, percussion, and auscultation) The posterior chest is symmetrical with the anteroposterior diameter at a ratio of 2:1. Tenderness and masses are not found. Thoracic expansion is 2 to 3 cm. vibrations were felt during tactile fremitus. Resonance upon percussion, and no wheezing or crackling sounds upon auscultation. Anterior Chest: (Precordium area inspection, cardiac landmarks, epigastric region pulsations, auscultation) Pulsations are felt. No wheezing or crackle sounds are heard upon auscultation. Heart: (Inspect anterior thorax, precordium area, palpate cardiac landmarks, palpate epigastric region, auscultate cardiac landmarks, auscultate aortic pulsations) Heart is positioned right and correctly with the cardiac landmarks. Heartbeats are heard during auscultation. Vascular System: (Carotid artery inspection, palpation, and auscultation: bilateral external and internal vein, blood pressure, bilateral peripheral pulses, Allens test, enlargement of legs, and Homans sign) Carotid arteries are present with pulsations felt. It is palpable and no lumps are felt. Blood pressure is within normal range. Lymphatic system: (epitochlear nodes, superficial inguinal nodes) Epitochlear nodes are palpable, as well as, the superficial inguinal nodes. No tenderness noted. Breast: (size, contour, dimpling, nipple discharge, tenderness, and presence of lumps, and health teachings on breast self-examination) The breasts are big due to lactation. There are no dimplings, nipple discharges, tenderness nor lumps noted. Patient is aware of breast self-examination and learned it.

Abdomen: (Inspect abdomen, inspect umbilicus, respiration movement, surface motion, pulsations, auscultation, percussion, and light palpation) Abdomen is round. The umbilicus is inverted. Respiration and surface motion are present. Pulsations on the abdomen are felt. The abdomen is palpable. Female External Genitalia and Anus: (Mons pubis, vulva, clitoris, urethral meatus, vaginal introitus, perineum, and anus) Patient has stitches on her perineum. Musculoskeletal System: (Temporomandibular joint, neck, hands, wrist, grip strength, elbow, shoulders, hip, spine, knees, feet, and ankles) Patient has grip strength. Temporomandibular joint is felt. The neck, shoulder, hip, spine, knees, feet, ankles, hands, elbow and wrists can do the different ranges of motion easily. Deep Tendon Reflexes: (biceps, triceps, Brachioradialis, patellar, Achilles, and plantar) Biceps, triceps, Brachioradialis, patellar, Achilles and plantar reflexes are present. Neurologic Screening Assessment: (level of consciousness, appearance, affect, speech content, memory, logic, judgment, speech patterns, gait, heel-to-toe walk, shallow knee bends, and Rombergs test) Patient is conscious, coherent and alert. She has good memory and is mentally-oriented with people, place and time. She has goos speech patterns and walks properly. Cranial nerve assessment: (Olfactory, gustatory, hypoglossal, tactile, gag reflex, and shoulder shrug test; exclude optic, oculomotor, trochlear, auditory, and abducens) All cranial nerves function correctly and properly.

IV. REPRODUCTIVE ANATOMY AND PHYSIOLOGY

A. External Structures:
1. Mons Veneris/Pubis Pad of fat which lies over the symphysis pubis where dark and

curly hair grow in triangular shape that begins 1-2 years before the onset of menstruation. It protects the surrounding delicate tissues from trauma.
2. Labia Majora Two (2) lengthwise fatty folds of skin extending from mons veneris to the

perineum that protect the labia minora, urinary meatus and vaginal orifice.
3. Labia Minora 2 thinner, lenghtwise folds of hairless skin extending from clitoris to

fourchette.

Glands in the labia minora lubricates the vulva Very sensitive because of rich nerve supply Space between the labia is called the Vestibule

4. Clitoris small, erectile structure at the anterior junction of the labia minora that contains

more nerve endings. It is very sensitive to temperature and touch, and secretes a fatty substance called Smegma. It is comparable to the penis in its being extremely sensitive.
5. Vestibule the flattened smooth surface inside the labia. It encloses the openings of the

urethra and vagina.

6. Skenes Glands/Paraurethral Glands located just lateral to the urinary meatus on both

sides. Secretion helps lubricate the external genital during coitus.

7. Bartholins Gland/Vulvovaginal Glands located lateral to the vaginal opening on both

sides. It lubricates the external vulva during coitus and the alkaline pH of their secretion helps to improve sperm survival in the vagina.
8. Fourchette thin fold of tissue formed by the merging of the labia majora and labia

minora below the vaginal orifice.

9. Perineum muscular, skin-covered space between the vaginal opening and the anus. It is

easily stretched during childbirth to allow enlargement of vagina and passage of the fetal head. It contains the muscles (pubococcygeal and levator ani) which support the pelvic organs, the arteries that supply blood and the pudendal nerves which are important during delivery under anesthesia.
10. Urethral meatus external opening of the urethra. It contains the openings of the Skenes

glands which are often involved in the infections of the external genitalia.
11. Vaginal Orifice/Introitus external opening of the vagina, covered by a thin membrane

called Hymen.

B. Internal Structures:
12. Fallopian tube/Oviduct 4 inches long from each side of the uterus (fundus). It transports

the mature ova form the ovaries to the uterus and provide a place for fertilization of the ova by the sperm in its outer 3rd or outer half. Parts:

Interstitial lies within the uterine wall Isthmus portion that is cut or sealed in a tubal ligation. Ampulla widest, longest portion that spreads into fingerlike projections/fimbriae and it is where fertilization usually occurs.

Infundibulum - rim of the funnel covered by fimbriated cells (hair covered fingerlike projections) that help to guide the ova into the fallopian tube.

13. Ovaries Oval, almond sized, dull white sex glands on either side of the uterus that

measures 4 by 2 cm in diameter and 1.5 cm thick. It is responsible for the production, maturation and discharge of ova and secretion of estrogen and progesterone.

14. Uterus hollow, pear-shaped muscular organ, 3 inches long, 2 inches wide, weighing 50-

60 grams held in place by broad and round ligaments, and abundant blood supply from the uterine and ovarian arteries. It is located in the lower pelvis, posterior to the bladder and anterior to the rectum. Organ of menstruation, site of implantation and provide nourishment to the products of conception. Layers: 1. Perimetrium outermost layer of the uterus comprised of connective tissue, it offers added strenght and support to the structure. 2. Myometrium middle layer, comprised of smooth muscles running in 3 directions; expels fetus during birth process then contracts around blood vessels to prevent hemorrhage. 3. Endometrium Inner layer which is visibly vascular and is shed during menstruation and following delivery. Divisions of the Uterus: 1. Fundus upper rounded, dome-shaped portion that can be palpated to determine uterine growth during pregnancy and the force of contractions and for the assessment that the uterus is returning to its non-pregnant state following child birth. 2. Corpus body of the uterus.

3. Isthmus area between corpus and cervix which forms part of the lower uterine segment. It enlarges greatly to aid in accommodating the fetus. The portion that is cut when a fetus is delivered by a caesarian section. 4. Cervix lower cylindrical portion that represents 1/3 of the total uterus. Half of it lies above the vagina; half of it extends to the vagina. The cavity is termed the cervical canal. It has 2 openings/Os: internal os that open to the uterine cavity and the external os that opens to the vagina. 5. Vagina a 3-4 inch long dilatable canal located between the bladder and the rectum, it contains rugnae which permit considerable stretching without tearing. It acts as a organ of intercourse/copulation and passageway for menstrual discharges and fetus. Doderleins bacillus is the normal flora of the vagina which makes the pH of vagina acidic, detrimental to the growth of pathologic bacteria.

V. CONCEPTUAL FRAMEWORK OF THE PATHOPHYSIOLOGY OF

PREGNANCY Release of FSH by the anterior Pituitary Gland

Development of the graafian follicle

Production of estrogen
(thickening of the endometrium)

Release of the Luteinizing Hormone

Ovulation
(release of mature ovum from the graafian follicle)

Ovum travels into the graafa tube

Fertilization
(union of the ovum and sperm in the ampulla)

Zygote travels from the fallopian tube to the uterus

Implantation

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

Preliminary signs of labor

Lightening
(descent of the fetal wherein head into the pelvis softer like earlobe)

Braxton Hicks Contraction

(or false labour or practice contractions)

Ripening of the cervix

(the softened, effaced and dilated condition of the cervix just prior to labor)

True labor

Uterine contractions
(at regular intervals that begin before the fetus is mature, usually before the due date of delivery)

Show
(After the discharge of the mucous plug that has filled the cervical canal during pregnancy, the pressure of the descending presenting part of the fetus causes the minute capillaries in the cervix to rupture. )

Rupture of the membranes

(rupture of the amniotic sac at the onset of, or during, labor.)

Non-Recessing Fetal Heart Tone

(when the baby exhibits persistent variable deceleration in which there is cord compression in relation to uterine contractions)

Caesarean Section
(The baby is taken out through the mother's abdomen and uterus.)

VI. THEORETICAL FRAMEWORK OF THE PHYSIOLOGY OF PREGNANCY or PATHOPHYSIOLOGY OF PREGNANCY

Variable decelerations are characterized by slowing of the FHR with an abrupt onset and return. They are frequently followed by small accelerations of the FHR. They vary in depth, duration, and shape. Variable decelerations coincide with cord compression, and they usually coincide with the timing of the uterine contractions. Variable decelerations are the most common decelerations seen in labor, and they are caused by umbilical cord compression. They are generally associated with a favorable outcome. Persistent, deep, and long lasting variable decelerations are nonreassuring. Persistent variable decelerations to less than 70 bpm, lasting more than 60 seconds are concerning. Variable decelerations with persistently slow return to baseline are considered nonreassuring, as these reflect persistent hypoxia. Nonreassuring variable decelerations are associated with tachycardia, absence of accelerations, and loss of variability. Variable decelerations are transitory decreases in fetal heart rate caused by umbilical cord compression.

A variable deceleration is unrelated to contractions. They mean umbilical cord compression. They may appear V-shaped or U-shaped. If a woman could be monitored throughout the 9 months of her pregnancy, it would be apparent that variable decelerations occur transiently as the baby grabs the umbilical cord or the cord gets compressed between the baby and the uterine wall during fetal movement. As many as fifty percent of all monitored babies experience variable decelerations during labor. If the baseline fetal heart rate remains stable and the variability remains good, variable decelerations are not associated with poor fetal outcome. They indicate possible compromise if they become prolonged or are persistent.

VII.

CLINICAL MANAGEMENT

A. MEDICAL MANAGEMENT

A.1 Laboratory And Diagnostic Examinations

HEMATOLOGY SECTION Test Name WBC Segmenters Lymphocytes Monocytes Eosinophils Basophils RBC Hemoglobin Hematocrit Platelet Result 13.96 H 76.50 15.30 6.70 1.40 0.10 4.08 12.60 36.70 288.00 URINALYSIS Macroscopic Color Appearance pH Specific Gravity Protein Glucose Microscopic RBC WBC Epithelial Cells Amorphous Material Bacteria A.2 Treatment and Procedures Before the cesarean section procedure, the patient was given anesthesia to numb the pain. The doctor then made horizontal incision in the abdomen and uterus. After the incision was made, Result Yellow Slightly cloudy 6.5 1.020 NEG ( - ) NEG ( - ) 3-6 0-2 RARE RARE RARE Units Units R/uL % % % % % M/L g/dL % K/L Ref. Range 4.1-10.9 47.0-80.0 13.0-40.0 2.0-11.0 0-5.0 0-2.0 4.0-5.2 12.0-16.0 36.0-46.0 140.0-440.0

/hpf /hpf

the baby was delivered through it, and the placenta was removed. After the cesarean section procedure, the incision was closed with stitches. After receiving cesarean section anesthesia, a catheter (plastic tube) was placed in the bladder for urine drainage during the surgery. The lower abdomen was then washed with a special disinfectant cleanser, and the patient was covered with sterile sheets to help protect the patient against infections. When the cesarean section was started, the doctor made a 6- to 8-inch incision in the abdomen directly over the uterus. The incision was horizontal, which was side to side. The baby was then delivered through this opening. The umbilical cord was cut, and the baby was handed to the healthcare provider, who took him to a small, warmly lit plastic crib called a warmer. Then the baby was cleaned and dried and eventually checked by the pediatrician. After the baby had been delivered, the placenta was carefully removed from the uterus. At that time, the patient received oxytocin, a drug that causes the uterus to contract and helps prevent serious bleeding. The doctor then closed the incision on the uterus, and the incisions in the skin were closed with stitches that would dissolve on their own.

A.3 Medications See Appendix B

A.4 Diet According to the Centers for Disease Control and Prevention, more than 30 percent of births take place by cesarean section surgery. This means that each year over one million women deal with recovering from major surgery. Diet and nutrition play a vital role in the health of a

cesarean mother. Getting adequate rest, healthy food, and keeping the immune system strong are important in the months following a cesarean. It is important to eat a healthy, well-balanced diet which includes all four food groups. Particularly important to post-cesarean health are fresh fruits and vegetables, dairy foods and protein. Since a woman who delivered via C-section will probably experience increased gas after the procedure, limiting foods which produce gas, such as fried foods and carbonated drinks, is highly recommended. Women who have undergone a cesarean section should take care to get adequate vitamins from food and supplements, especially vitamins E and C as these promote health and healing and help the body resist infection.

B. NURSING MANAGEMENT

B.1 Nursing Care Plan See Appendix C

B.2 Discharge Plan DISCHARGE PLAN Patients Name: Ms. X Hospital No.: 309795 Age: 26 Room No.: 225-3 Impression/Diagnosis: PUFT delivered a live Physician: Dr. Susan C. Mancelita baby boy via 1o low Nurses Signature: segment transverse C/S 2o to persistent variable deceleration KLARK KEVIN A. TROCIO, S.N

PATIENTS OUTCOME CRITERIA

NURSING ORDER

As soon as the patient is discharged from the hospital, the patient will be able to acquire basic knowledge develop skills and positive attitude towards the caesarean operation.

Specifically the patient will be able to:

ASSESSMENT -Assess level of understanding on how to perform perineal care. Encourage patient to do perineal care. The proper to do this is: To clean from the least contaminated to the most. from front to back

PLANNING -Plan ahead the return visit to the doctors hospital Remind the patient to schedule a return visit for monitoring.

IMPLEMENTATION 1.Medication Comply with the medication regimen 2.Exercise Perform simple exercise gradually 3.Treatment Comply with the medication regimen, follow up check-ups and dietary instructions. 4.Health Teaching Explain the patient the importance of compliance of therapies. Encourage the patient to exercise. Discuss to the patient the importance of completing ones medication. Encourage the patient to follow the medication regimen religiously.

Know proper way of perineal care.

Demonstrate the patient the correct way of perineal care.

5.Out-patient Referrals/Observable S/S Coordinate with social services, physical therapy and occupational therapy. 6.Diet Adhere to prescribed dietary regimen. Encourage patient to eat nutritious foods rich in protein which facilitates tissue repair. Encourage patient to follow dietary regimen as given by the dietitian. 7.Spiritual Allocate a time for reflection, Praying and reading the bible. EVALUATION Discuss to the patient the importance of evaluating self-compliance in order to monitor the patients condition. Emphasize to the patient the need for spiritual guidance. Discuss to the patient that such services enhance adequate discharge planning for home treatments after discharge.

1.Evaluate self compliance of all treatment regimens.

2.Evaluate progress of the patients health condition.

Encourage the patient and the S.O to evaluate any progress on patients health.

IX. CONCLUSION AND RECOMMENDATION

Conclusion The main purpose of the study was successfully met. The major reason why the patient underwent a surgical procedure called LSTCS was due to persistent variable decelerations. The baby exhibited non-recessing fetal heart tone as uterine contractions occur. The operation was done to resolve the risk of pregnancy and eventually save the babys life. Further run through of the study showed that there are many other complications that would pose a risk to pregnant women. These were more complicated and rare. Unlike those, variable decelerations are seen most commonly in pregnant women experiencing labor.

Recommendation

As a nursing student, it is a responsibility to give a pregnant patient the proper recommendation so she can make herself ready if any problem will arise. She should be monitored frequentlyher blood pressure, medical history and also check the baby inside if he/she is doing well or in the proper position. The most important one is the mothers health. The mother should be given the proper care for herself and for the baby. There is a possibility that a caesarean delivery might be planned advance if a medical reason is needed or it might be unplanned and take place during the labor if some problems occur. The mother must be given the proper knowledge regarding a vaginal or caesarean delivery right from her first pregnancy. For caesarean section, it is

very complicated operation which can have some risks like death for the mother, sometimes have some initial trouble breathing for the newborn babies and will make them drowsy from the pain medication administered to the mother. Breastfeeding maybe difficult due to the limited mobility of the mother after the operation. A pregnant woman must be well cared by a nurse with her personal attending obstetrician.

X. IMPLICATIONS OF THE STUDY TO

A. Nursing Education

This study helps in enriching the knowledge base of the nurses regarding the concepts of this kind of complication. This would greatly help in determining the risk factors that would possibly be prevented from occurring once there is an application of this study. This can cater all the questions regarding how and why this certain kind of operation is performed. The best thing about this study is that there is a comprehensive explanation of the relationship between the surgery performed and the cause of this high-risk pregnancy. The cause is highly fatal if not given attention so this gave motivation to performing CS. This broad information would really enhance the previously learned concepts of the nurse so as to help him/her in becoming a competent nurse.

B. Nursing Practice

This study helps in giving care to a woman experiencing high-risk pregnancy. Appropriate measures and interventions can be taken which are very useful in promoting the health

status of the client. The nurses skills are further guided as to how he/she manages the implementation of nursing procedures in order to meet the varying needs of his/her patient. This study alarms the nurses when to act immediately in cases of unexpected or unusual situations which might pose a risk to the mother or the baby or maybe both. Having competency in performing the procedures is the most effective way of responding the needs of the client. That is why this study is equipped with numerous appropriate and effective interventions that would somehow guide and develop the nurse in his/her nursing practice.

C. Nursing Research

As it is a comprehensive compilation, this study greatly helps in the development of nursing profession. It typically shows how an individual was able to cope up with this kind of complication. As we all know, each individual has a unique adaptive mechanism. This study gives relevant contribution to modern studies at it is of a high-technologically based study. Modern facilities are used in the performance of care to the patient, monitoring and as well as the operation. Moreover, there is a good complementation since the patient is at high risk. It shows the beneficial relationship of our technological advances to science nowadays. This study will further be a basis of improving the nursing approach to high-risk pregnancies.