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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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Introduction:

Cesarean section is very common in our society especially in


Palestinian community due to early marriage, malnutrition
gestational diabetes and other problems. 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
.pregnancy that may cause C/S

Demographic data :
- Client name: A.M.K
.Age: 33years-
.Address: halhoul-
-
.Hospital: AL-Makased hospital-

:Chief complain
The pt refereed from out pt clinic due to decrease fetal
movement , then did ultrasound and the fetal in breech
.presentation

History of present pregnancy


G3P2A1 , on 29/6/2007 was the first day of last menstrual
cycle, and 6/4/2008 was the day of delivery for my pt . and now
she delivered male baby on 3/3/2008. my pt was complete 38
weeks, as my pt describe her pregnancy it was easy without
stress during it's period , it was little time when she suffered
. from morning sickness .the baby's wt is 3.235 gm

Past history
Medical history: pt has hepatitis B , no hypertension , no
.diabetes , and no tuberculosis
Surgical history: previous cesarean , abortion at 2005 , then did
.DNC
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Allergic : as my pt said she has allergy from ,and unknown
allergy to the medication ,she never experience allergy for odor
or dust , and didn't suffer from any abnormalities for any plant
.or trees
.Medications: she didn't take any regular medication
.Gynecological disorder: she did DNC

Obstetric history
Data of all previous pregnancy: the first birth was in 31/7/2004.
after complete 36 weeks she did elective C/S delivery ,female
baby, unhealthy , she has imperforate anus, thy did colostomy ,
spinal bifida , hips dislocated , enlargement of bladder ,
ABGAR score was 6/9 under general anesthesia , she didn't
remember a lot about prenatal , intrapartum, but she said that
.post partum period was very long & tired
she delivered male baby complete 38 weeks, by , 3/3/2008
C/S delivery due to breech position ,spinal anesthesia , post
partum ,the first 24hr of bed , then she walked 5min, she felt of
dizziness, then back pain , she tokes sedative , the codition of
new born is good , the baby was active & the ABGAR score
.was 9/9

Family history
Her grand other was diabetic pt ,and hypertensive pt , her
husband's relatives have mental problem, down syndrome, heart
disease, two member of them had congenital problem
.abnormality and they died

Nutritional assessment habits


She had good nutritional habits , she take 4 meals every day , no
allergy from medications ,she tokes supplement of multiple
.vitamins & folic acid

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Labor & it's stages
I deal with my pt on post natal word after C/S , so I deal in 4th
.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 = 36.5
R = 17

Weight
.Befor delivery her wt was 96 kg , now her wt is 85 kg

.Height : 168 cm

: Skine
Pink in color , smooth in texture , brown patches at the face,
.vertical lina niagra

Heart
Lub-dub heart sound ,so regular rhythm 71 beat/ min , clear
heart beats and strong . she had no heart abnormalities , no
.murmur or hypotension

Breast
Both are symmetrical, no redness or swelling, the nipple is small
.inverted, soft breast & no congestion , areola patches

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:Abdomen
the fundus is under the umbilicus, the operation site transverse
incision. she has abdominal pain due to the operation , transfer
.incision . the abdomen is distend, she also has bowl movement

Back
Has good postured shape , spinal vertebral is normal shape , she
has lower back pain due to pregnancy & spinal anesthesia , there
.is no disc

Extremities
Both are symmetrical , have good reflexes , no edema , no
.varicose vein or DVT , can walk & eat alone

Pelvic area
.Normal skin ,clean , no discharge , no congenital anomalies

:Path physiology
C/S birth accomplished through on abdominal incision in to the
uterus. The incidence of C/S birth is nearly 18% for the first
mother .70% for repeat procedures. This rate result from the
combination of the increased safety of C/S and the use of fetal
. monitors , which provide for early detection of fetal problems

Indication for c/s ((**


Aids-
Cervical closed-
Hyper tension of pregnancy-
Gestational debates-
Cardiac disease-
Big body-

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Placenta factor ((*
placenta previa-
premature separation of placenta-
umbilical cord prolapsed-

fetal factor ((*


.Extreme low birth wt-
.Major fetal anomalies e.g. hydrocephalous-
. Transfers fetal lie-

The reason for my pt that she was complete breech


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

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Laboratory tests

Prenatal tests
Test Value Normal value Meaning of
abnormal
values
WBC 10.1K/ul K/ul 4.1-10.9 Normal
RBC 4.95M/uL 4.6-6.2M/uL Normal
Hgb g/dl 12.9 12-18g/dl Normal
PLT 121K/UL 140-440K/UL Ubnormal due
to hepatitis B
Glucose 106 70-110 Normal

Postnatal tests
Test Value Normal value Meaning of
abnormal
values
WBC 10.6K/ul K/ul 4.1-10.9 Normal
RBC 4.00M/uL 4.6-6.2M/uL Ubnormal
Due to the
bleeding
during surgery
Hgb g/dl 10.9 12-18g/dl Normal
PLT 121K/UL 140-440K/UL Ubnormal
Due to
hepatitis B
Glucose 106 70-110 Normal

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BLOOD GAS
Ph 7.30 -
Po2 18.4-

Cross match: mother A negative-


Baby A positive
. She toke anti D-

MEDICATION

RUFENAL (diclofen) IV 50 mg ((1


.Action: analgesic, anti-inflammatory and antipyretic
Rational: to reduce pain after cesarean surgery, also to prevent
.inflammation
Contraindication: hyper sensitivity to the active ingredient,
.peptic ulcer
Side effect: nausea, vomiting, headache, dizziness, skin rashes
and diarrhea

Nursing consideration : teach the mother how to take this drug


and source of this drugs, also to monitor side effect for drugs.

Zinacef (cefuroxime) (500mg) (IV) 1*2((2


Action : antibiotic which is resistant to most B-
lactamasses and active against awide range of
.gram positive and gram negative Organisms
Rational : to treat urinary tract infection. And to
.prevent infection because of the surgery
.Side effect: GI disturbance, rashes
Contraindication: hyper sensitivity to
.cephalosporin antibiotic
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Nursing concederation : I explain the action
for this antibiotics, also to monitor side effects for
.drugs

Iron Supplements: 1*2 oral iron.

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

.Side effects. Constipation, change of the color of the feces


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:NURSING CARE PLANE

Nursing Diagnosis : alteration in bowel elimination((1


.constipation related to sluggish peristalsis movement
Goal : short term pt will eliminate soft formed stool at aregular
intervals during a hospitalization period, long term pt will
.verbalize an increased in comfortable

:Nursing action
.remove any impaction palpable on digital exam -1
.Rational : to remove constipation causes
administer laxatives of choice , stool softener , bulk agent , -2
.and enemas as prescribed
.Rational: To facilitate & soften stool
.encourge a high fibers diet specially vegetable-3
Rational :Vegetable contains fibers which consider laxative
.that facilitate deification
. Aske pt for food intake -4
. Rational : to determine the case of constipation
. Encourage pt to walk -5
.Rational: to encourage the peristalsis movement

. Evaluation: goal is met , the pt go to path room and defecated

.Nursing diagnosis: pain related to effects of surgery((2


Goals: Short term: suppressing the pain during a
hospitalization period, long term: reliving the pain after
.hospitalization
:Nursing action
.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
.to minimize the pain experience
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provide analgesics as ordered such, pethedine or rufinal -2


.suppository
Rational: Analgesics inhibit brain's pain early ability to
interpret pain early and frequent uses of measures to relive
.pain allow optimal control and facilitate healing

teaching the woman about relaxation technique and deep -3


.breathing
.Rational: Relaxation of the muscle can suppress the pain
consult physician if above measures fail to provide -4
.adequate pain relief
Rational: Notifying the physician allows for modification
.of the treatment plan

. Evaluation : pt become cmfort

Nursing Diagnosis: risk for wound infection related to the ((3


. C/S
.goals :maintain the wound clean and dry the wound

: Nursing action
.Checked the C/S site-1
.Rational: To prevent infection
.Checked the dressing -2
Rational: To reduce the infection
.recourse
Checked the wound if the wound if the.3
wound bleeding or discharge, swelling or
.redness
Rational: To mention the wound clean
.and dry
.Clean the wound -4
.Rational: To prevent infection
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.(Checked the V/S (temp -5


Rational: To mention the V/S of baby
.and to monitoring
Observe the CBC test (WBC) to -6
.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, vagina because of lochia,
.and incision site
Rational: To prevent these areas from
.infection

Evaluation : until the last day , 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


.bed rest
.Goals: maintain the strong of muscle
:Nursing Action
.Changing position-1
Rational: To prevent the stiff of
.muscle
.Advice the pt to walking-2
.Rational: To strength the muscles

.Exercise-3
Rational: To strength the muscluses and
.to prevent the stiff of muscles

Evaluation : goal is met ,because pt


.walked
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Nursing Diagnosis: risk for impaired skin integrity related to((4


.immobility
.Goals: maintain of skin integrity

:Nursing Action
.change position and walks-1
.Assess the temp of skin-2
.wash the skin with warm water and dry it -3
.doingmassage it needed -4
Rational: To prevent bed source and skin ulcer to mention
.the skin as soft

Evaluation : goal is met , because pt is active , and walked


.( ( go out of bed

Analyze briefly how this condition affects the pregnant ((*


.mother physically, psychologically, economically

Physically:- complaining of back pain and abdomen pain due


to cesarean section, and decrease mobility, she was very tired
.because of blood loss due to operation , paleness

Psychological:- she was feard from deliver baby has the same
problem, so when she saw the child she was happy, and about
.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, her husband work and he
get his life by day. The operation cost allot of money which
make allot of problem for them, and he must work allot to
.find money
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-:Conclusion
this case very interesting, I learned from this case many
thinks like the procedure use of the operation, and care the
wound after the operation, I learned how to deal with mother
in post partum, what the benefit from cesarean section and in
.the same time what the disadvantage from it

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-:Refrences
.patient file-1
. From patient-2
Gil Bert and human, manual of high risk pregnancy and delivery,-3
.third edition 2003
Lenin (1995)pharmacology, Philadelphia, Lippincoot Company, -4
.fourth edition
.pillitter, Adel, maternal and child health nursing fourth edition -5
.http:// www.rashaduniversity. Com/poshem.html -6
.http://www.med.umich.edu/1 libr/wha/wha pphem crs.htm -7
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