BETHLEHEM UNIVERSITY

Faculty of Nursing and Health Science Department of Nursing Maternity 335 Case study: cesarean suction (Breech Elective presentation ) Done By: Adnan Ta'amra Presented to : Dina Isma'ael Spring2008

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no . then did ultrasound and the fetal in breech .K . as my pt describe her pregnancy it was easy without stress during it's period .DNC (2) .Address: halhoul. abortion at 2005 .presentation History of present pregnancy G3P2A1 . so I have chosen this case to improve my knowledge in this course and to tell the mother to avoid many problems and complications during the .M.diabetes .Age: 33years.the baby's wt is 3.235 gm Past history Medical history: pt has hepatitis B .Hospital: AL-Makased hospital- :Chief complain The pt refereed from out pt clinic due to decrease fetal movement . it was little time when she suffered .Client name: A. and 6/4/2008 was the day of delivery for my pt . from morning sickness .Introduction: Cesarean section is very common in our society especially in Palestinian community due to early marriage. on 29/6/2007 was the first day of last menstrual cycle. then did .pregnancy that may cause C/S Demographic data : . no hypertension . and now she delivered male baby on 3/3/2008. and no tuberculosis Surgical history: previous cesarean . malnutrition gestational diabetes and other problems. my pt was complete 38 weeks.

or trees . ABGAR score was 6/9 under general anesthesia .vitamins & folic acid (3) .abnormality and they died Nutritional assessment habits She had good nutritional habits . she take 4 meals every day . but she said that .female baby. she didn't remember a lot about prenatal .Medications: she didn't take any regular medication . no allergy from medications .post partum period was very long & tired she delivered male baby complete 38 weeks.spinal anesthesia . post partum . down syndrome.and unknown allergy to the medication . heart disease. thy did colostomy . intrapartum. spinal bifida . enlargement of bladder . she tokes sedative .Allergic : as my pt said she has allergy from .Gynecological disorder: she did DNC Obstetric history Data of all previous pregnancy: the first birth was in 31/7/2004. she felt of dizziness. she has imperforate anus. 3/3/2008 C/S delivery due to breech position .and hypertensive pt . the codition of new born is good . two member of them had congenital problem .she tokes supplement of multiple . then she walked 5min. then back pain .she never experience allergy for odor or dust . her husband's relatives have mental problem. after complete 36 weeks she did elective C/S delivery .the first 24hr of bed .was 9/9 Family history Her grand other was diabetic pt . the baby was active & the ABGAR score . hips dislocated . unhealthy . and didn't suffer from any abnormalities for any plant . by .

areola patches (4) . clear heart beats and strong . . smooth in texture . she had no heart abnormalities . no .Befor delivery her wt was 96 kg . soft breast & no congestion .inverted.Height : 168 cm : Skine Pink in color .Labor & it's stages I deal with my pt on post natal word after C/S .stage of labor :Post natal condition of the mother Sever pain at the surgical site & dizziness with hypotension and .back pain due to spinal anesthesia Physical assessment Vital signs : BP = 110/60 P = 71 T = 36.vertical lina niagra Heart Lub-dub heart sound .murmur or hypotension Breast Both are symmetrical.so regular rhythm 71 beat/ min . no redness or swelling. so I deal in 4th . the nipple is small . now her wt is 85 kg . brown patches at the face.5 R = 17 Weight .

:Abdomen the fundus is under the umbilicus. no edema .clean . transfer . have good reflexes . she also has bowl movement Back Has good postured shape . the abdomen is distend.70% for repeat procedures. can walk & eat alone Pelvic area . which provide for early detection of fetal problems Indication for c/s ((** AidsCervical closedHyper tension of pregnancyGestational debatesCardiac diseaseBig body(5) . monitors .incision . the operation site transverse incision. she has lower back pain due to pregnancy & spinal anesthesia .Normal skin . she has abdominal pain due to the operation .varicose vein or DVT . This rate result from the combination of the increased safety of C/S and the use of fetal .is no disc Extremities Both are symmetrical . spinal vertebral is normal shape . there . The incidence of C/S birth is nearly 18% for the first mother . no . no congenital anomalies :Path physiology C/S birth accomplished through on abdominal incision in to the uterus. no discharge .

mother may not be aware much earlier than 36-37 weeks that their baby remaining in breech position is a problem . there is a danger that the baby may deliver easily leaving the head trapped behind an incompletely dilated cervix .Major fetal anomalies e. doctors can turn the fetus to present head first by pressing on the woman's abdomen before labor begins . Transfers fetal lieThe reason for my pt that she was complete breech presentation and previous C/S .Placenta factor ((* placenta previapremature separation of placentaumbilical cord prolapsedfetal factor ((* .presentations The main fears surrounding vaginal breech delivery are birth trauma & shoulder asphyxia . the prevalence of breech presentation decrease from about 15% at 29-32 weeks gestation .to between 3-4% at term Sometimes . cord prolapse with breech. the complete breech presentation means : the buttock is down with the legs folded at the knee and the feet near the buttock . many hospitals have a policy of elective C/S at 38 weeks gestation for all breech . the after coming head doesn't have an opportunity to mould before passing through the birth canal. hydrocephalous.g. usually at the 37th or 38th week of pregnancy .or an inadequate pelvis (6) . If the baby is small or premature.Extreme low birth wt.

2M/uL Ubnormal Due to the bleeding during surgery 12-18g/dl Normal 140-440K/UL Ubnormal Due to hepatitis B 70-110 Normal (7) BLOOD GAS .9 Normal 4.00M/uL Normal value Hgb PLT Glucose g/dl 10.9 121K/UL 106 Normal value Meaning of abnormal values K/ul 4.6-6.1-10.9 Normal 4.Laboratory tests Prenatal tests Test WBC RBC Hgb PLT Glucose Value 10.6K/ul 4.2M/uL Normal 12-18g/dl Normal 140-440K/UL Ubnormal due to hepatitis B 70-110 Normal Postnatal tests Test Value WBC RBC 10.9 121K/UL 106 Meaning of abnormal values K/ul 4.1-10.1K/ul 4.6-6.95M/uL g/dl 12.

She toke anti D- MEDICATION RUFENAL (diclofen) IV 50 mg ((1 .Ph Po2 7. headache.Action: analgesic. Zinacef (cefuroxime) (500mg) (IV) 1*2((2 Action : antibiotic which is resistant to most Blactamasses and active against awide range of .peptic ulcer Side effect: nausea. vomiting.30 18. . rashes Contraindication: hyper sensitivity to .Side effect: GI disturbance.4- Cross match: mother A negativeBaby A positive .prevent infection because of the surgery .gram positive and gram negative Organisms Rational : to treat urinary tract infection. dizziness. And to . also to monitor side effect for drugs.inflammation Contraindication: hyper sensitivity to the active ingredient. also to prevent .cephalosporin antibiotic (8) . anti-inflammatory and antipyretic Rational: to reduce pain after cesarean surgery. skin rashes and diarrhea Nursing consideration : teach the mother how to take this drug and source of this drugs.

but separate iron vitamin supplements are also available in varying dosages to fit your particular needs . :Action Iron.drugs Iron Supplements: 1*2 oral iron. Constipation.Nursing concederation : I explain the action for this antibiotics. who have a greater need for iron to support enlarged blood volume. If you're not getting enough of these foods. prunes and raisins. change of the color of the feces . Many multi-vitamins contain iron. which helps builds and replace blood cells that deliver oxygen throughout the body. who may be at risk for iron deficiency due to blood loss. and fetal and placental needs. also to monitor side effects for . liver. is an important part of a healthy diet. as well as pregnant women. Iron dietary supplements are particularly important for menstruating woman. Iron can be found in foods such as red meat. kidney beans. an iron supplement is recommended. whole wheat.Side effects.

long term pt will .Rational: to encourage the peristalsis movement . Aske pt for food intake -4 . Encourage pt to walk -5 . stool softener .determine how the client usually responds to pain -1 Rational: An awareness of the client usual response to painful stimuli enables the nurse to better evaluate the level of pain and facilitates the development of effective strategies .Nursing diagnosis: pain related to effects of surgery((2 Goals: Short term: suppressing the pain during a hospitalization period.remove any impaction palpable on digital exam -1 .Rational : to remove constipation causes administer laxatives of choice .that facilitate deification .Rational: To facilitate & soften stool .to minimize the pain experience .(9) :NURSING CARE PLANE Nursing Diagnosis : alteration in bowel elimination((1 .and enemas as prescribed .verbalize an increased in comfortable :Nursing action . the pt go to path room and defecated . long term: reliving the pain after . Rational : to determine the case of constipation . Evaluation: goal is met .constipation related to sluggish peristalsis movement Goal : short term pt will eliminate soft formed stool at aregular intervals during a hospitalization period.encourge a high fibers diet specially vegetable-3 Rational :Vegetable contains fibers which consider laxative .hospitalization :Nursing action . bulk agent . -2 .

Rational: Relaxation of the muscle can suppress the pain consult physician if above measures fail to provide -4 .of the treatment plan .and dry .adequate pain relief Rational: Notifying the physician allows for modification .suppository Rational: Analgesics inhibit brain's pain early ability to interpret pain early and frequent uses of measures to relive .Rational: To prevent infection .Rational: To prevent infection .Clean the wound -4 .recourse Checked the wound if the wound if the.goals :maintain the wound clean and dry the wound : Nursing action .redness Rational: To mention the wound clean . C/S . pethedine or rufinal -2 . Evaluation : pt become cmfort Nursing Diagnosis: risk for wound infection related to the ((3 .pain allow optimal control and facilitate healing teaching the woman about relaxation technique and deep -3 .Checked the C/S site-1 .Checked the dressing -2 Rational: To reduce the infection .(10) provide analgesics as ordered such. swelling or .breathing .3 wound bleeding or discharge.

Goals: maintain the strong of muscle :Nursing Action .Changing position-1 Rational: To prevent the stiff of .infection Evaluation : until the last day .(Checked the V/S (temp -5 Rational: To mention the V/S of baby .to prevent the stiff of muscles Evaluation : goal is met .Rational: To strength the muscles .and incision site Rational: To prevent these areas from .and to monitoring Observe the CBC test (WBC) to -6 .Advice the pt to walking-2 .muscle .because pt .(11) .bed rest .discover if the baby has any problem Rational: To discover if the body has any problem Maintain a good hygiene for the folly's -7 catheter site.walked . vagina because of lochia. I saw her fine & hadn't any sign of infection or any . .change in WBC count Nursing Diagnosis: fatigue and muscle weakness related to((4 .Exercise-3 Rational: To strength the muscluses and .

(12) Nursing Diagnosis: risk for impaired skin integrity related to((4 . psychologically. and walked . so when she saw the child she was happy.doingmassage it needed -4 Rational: To prevent bed source and skin ulcer to mention .the skin as soft Evaluation : goal is met .Goals: maintain of skin integrity :Nursing Action . and he must work allot to . paleness Psychological:.the operation she don`t care because she did it befor Economically: the operation cost more money than normal delivery and she take anti D needle.find money . and decrease mobility. economically Physically:.she was feard from deliver baby has the same problem.( ( go out of bed Analyze briefly how this condition affects the pregnant ((* .mother physically.immobility .wash the skin with warm water and dry it -3 .complaining of back pain and abdomen pain due to cesarean section. because pt is active .Assess the temp of skin-2 .change position and walks-1 . The operation cost allot of money which make allot of problem for them.because of blood loss due to operation . her husband work and he get his life by day. she was very tired . and about .

Com/poshem.htm -7 .-3 . what the benefit from cesarean section and in . Lippincoot Company.third edition 2003 Lenin (1995)pharmacology. Adel.med.html -6 . and care the wound after the operation.pillitter. Philadelphia.(13) -:Conclusion this case very interesting.rashaduniversity. maternal and child health nursing fourth edition -5 .patient file-1 . I learned from this case many thinks like the procedure use of the operation.http://www. I learned how to deal with mother in post partum.fourth edition . -4 . From patient-2 Gil Bert and human.edu/1 libr/wha/wha pphem crs.umich. manual of high risk pregnancy and delivery.http:// www.the same time what the disadvantage from it ---------------------------------------------------------------------:Refrences .

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