Final Obward CP

TAGUM DOCTORS COLLEGE INC.
Mahogany St., Rabe Subd., Visayan Village Tagum City Davao Del Norte
Bachelor of Science in Nursing
In Fulfilment of the Requirements in

RLE 107:
Case Study: Lower Segment Transverse Cesarean Section via
Joel-Cohen Incision
Submitted to:
Melrose Cubillo-Galido, RN
Submitted by:
Obongen, Marie Kathleen D.
Palma, Jules Earl H. Protacio, Alleya Fybes H.
Pascua, Krizhel Mae M. Puno, Gwyneth V.
Pascual, Decere D. Quintela, Jana Therezsa B.
Peteros, Alyn Kaye D. Rufo, Hannah D.
Pizon, Marc June D. Silutan, Rexie Louella T.
Ponsica, Christine Joy R. Villanueva, Bea T.
December 2023
PAGE \* MERGEFORMAT 2 | Page

TABLE OF CONTENTS
I. Acknowledgement……………………………………………………..2
II. Introduction……………………………………………………………..4
III. Objectives……………………………………………………………....7
IV. Patient’s Data…………………………………………………………..9
V. Developmental Data…………………………………………………..11
VI. Definition of Complete Diagnosis……………………………………31
VII. Comprehensive Physical Assessment……………………………...34
VIII. Anatomy and Physiology……………………………………………..56
IX. Etiology and Symptomatology……………………………………….84
X. Pathophysiology……………………………………………………….92
XI. Doctor’s Order……...………………………………………………….96
XII. Diagnostic Exam……………………………………………………..107
XIII. Drug Study……………………………………………………………110
XIV. Nursing Theories…………………………………………………….177
XV. Nursing Care Plan…………………………………………………...187
XVI. Discharge Plan (M.E.T.H.O.D)……………………………………..204
XVII. Recommendation…………………………………………………….209
XVIII. Bibliography…………………………………………………………..211

I. ACKNOWLEDGEMENT
We, Group 9 student nurses of BSN-2C at Tagum Doctors College, extend
our heartfelt gratitude to the individuals who played a crucial role in the successful
completion of this case presentation. Without their unwavering support and
guidance, this endeavor would not have come to completion.
First and foremost, we humbly express our gratitude to the Almighty Father for
blessing our journey, providing us with this opportunity, and offering guidance
throughout the entire process of conceptualizing and presenting this case.
We extend a special acknowledgment to Ma’am Melrose Cubillo, RN, our
esteemed clinical instructor. Her unwavering dedication and insightful contributions
significantly enriched our learning experience, leaving an indelible mark on the
overall quality of our work. We express our sincere gratitude for her invaluable role in
shaping our academic endeavors.
To our parents, guardians, and loved ones, we express our sincere gratitude
for their unwavering support and strong belief in us. Despite the challenges, flaws,
and shortcomings we have encountered, their enduring encouragement towards our
aspirations has been a constant source of strength.
To our group members, for their wholehearted dedication in conducting
interviews and collecting data, despite overcoming schedule conflicts. The collective
effort and teamwork demonstrated by each member significantly contributed to the
success of the project, underscoring the efficacy of collaboration.
We extend our profound and heartfelt gratitude to the dedicated staff of
Tagum Doctors Hospital Inc, especially the nurses at TDH-5A-Ward. Your

unwavering cooperation and invaluable support have been indispensable pillars that
have significantly contributed to the triumphant realization of this noteworthy
endeavor.
Lastly, we would like to extend our heartfelt gratitude to the client and her
family for their invaluable contribution to our case presentation. Their willingness to
openly share personal experiences and provide detailed medical backgrounds has
been instrumental in shaping the depth and richness of our analysis.

II. INTRODUCTION
Caesarean delivery (C-section) is used to deliver a baby through surgical
incisions made in the abdomen and uterus. Planning for a C-section might be
necessary if there are certain pregnancy complications. Women who have had a C-
section might have another C-section. Health care providers might recommend a C-
section if the labor isn’t progressing normally, the baby or babies are in an unusual
position or if there’s a health concern. Some women request C-sections with their
first babies. They might want to avoid labor or the possible complications of vaginal
birth or they might want to plan the time of delivery. However, according to the
American College of Obstetricians and Gynecologists, this might not be a good
option for women who plan to have several children. The more C-sections a woman
has the greater the risk of problems with future pregnancies. A C-section also
increases the risk of the uterus tearing along the scar line (uterine rupture) for
women who attempt a vaginal delivery in a later pregnancy (Mayo Foundation for
Medical Education and Research, 2022).
According to new research from the World Health Organization (WHO),
caesarean section use continues to rise globally, now accounting for more than 1 in
5 (21%) of all childbirths. While a caesarean section can be an essential and
lifesaving surgery, it can put women and babies at unnecessary risk of short-and
long-term health problems if performed when there is no medical need. In the least
developed countries, about 8% of women gave birth by caesarean section with only
5% in sub-Saharan Africa, indicating a concerning lack of access to this lifesaving
surgery. Conversely, in Latin America and the Caribbean, rates are as high as 4 in

10 (43%) of all births. In five countries (Dominican Republic, Brazil, Cyprus, Egypt
and Turkey), caesarean sections now outnumber vaginal deliveries. Worldwide
caesarean section rates have risen from around 7% in 1990 to 21% today, and are
projected to continue increasing over this current decade. If this trend continues, by
2030 the highest rates are likely to be in Eastern Asia (63%), Latin America and the
Caribbean (54%), Western Asia (50%), Northern Africa (48%) Southern Europe
(47%) and Australia and New Zealand (45%), the research suggests (PubMed,
2021).
The most common indications for caesarean were malpresentation, previous
caesarean section, cephalopelvic disproportion, and fetal distress. In The
Philippines, caesarean in a previous pregnancy was the most common indication for
a caesarean for mothers who gave birth again (10.1%), In one hospital in The
Philippines, mothers were given prophylactic antibiotics pre-operatively almost
universally, while in the other hospital 41% of mothers received antibiotics pre-
operatively and 43% post-operatively, with the remainder given intra-operatively after
umbilical cord clamping. In the Philippines 79% were estimated to have a greater
than 500 ml blood loss (PubMed, 2019).
Another factor for having a cesarean section during the stages of labor is the
abnormality of fetal heart tone. In the study of Embay (2022), non-reassuring heart
fetal patterns is still Southern Philippines Medical Center’s leading indication for
cesarean section, with a sample size of 160 patient records (Embay, 2022).
The client, KJB, is a 22-year-old primigravida with GTPAL Score of G1P1001.
The client delivered a baby at 41 weeks AOG, and the baby was delivered via Lower
Segment Transverse Cesarean Section using Joel-Cohen Incision (C-section).

III. OBJECTIVES
GENERAL OBJECTIVES
This study's primary goal is to compile as much client data as possible and
utilize that knowledge to look for solutions to a variety of questions about the effects
of cesarean delivery (C-section) on an individual. Another goal of this case
presentation is in order to distinguish between a typical pregnancy and a cesarean
delivery (C-section), and how it may impact the client's labor and delivery in the near
future.
Specific Objectives
The student nurses would be able to:
COGNITIVE
 Remembering: To determine the client's state, collect as much information as
you can and remember it all.
 Understanding: Understand the theoretical background of pregnancy related
to Cesarean delivery and describe how it is different from normal pregnancy.
 Applying: Perform the necessary nursing assessments needed for a
cesarean birth and record the results.
 Analyzing: Evaluate and contrast all of the information and data, rank the
data according to significance, and determine the client's absolute needs.
 Evaluating: Evaluate the results of the interventions done.

 Creating: Analyze and provide recommendations that are primarily focused
on the management of cesarean delivery, including how they will achieve and
maintain optimal well-being.
AFFECTIVE:
 Advising: Identify the problems of the client and offer solutions towards the
said problems during the assessment.
 Responding: Observe the client and respond to any inquiries they may have.
and take note of the queries posed and the responses provided.
 Valuing: Provide the best care possible and contact the client to establish
rapport.
 Characterization: As you pay close attention to what the client says, apply
the following information as a component of the client's data collection.
PSYCHOMOTOR:
 Perception: Improve the student nurses’ skillset on both independent and
dependent nursing interventions in a gradual manner.
 Set: Set a standard for the performance of the student nurses in order to track
progress of improvement in terms of skills.
 Articulation: Perform all physical evaluations with timing, coordination, and
assurance

 IV. PATIENT’S DATA
A. Biographical Data
 Patient’s Code Name: BKJ
 Age: 22 Years Old Sex: Female
 Nationality: Filipino Civil Status: Single
 Religion: Catholic
 Educational Attainment: College undergraduate
 Ward or unit room: 506
 Date and Time of Admission: November 29, 2023 @ 8:42 PM
 Vital Signs upon admission:
BP- 120/80 mmHg
T- 36.7 C
RR- 20 cpm
PR- 96 bpm
Sp02- 98 %
B. Chief Complaints:
Rupture bag of water.
 Initial Diagnosis:
G1P0 PU 41 weeks AOG, cephalic, NIL
 Final Diagnosis:
PU delivered term, cephalic, livebirth AGA, Male, primary LSCS, G1P1 (1001)
 Surgical procedure performed if any (date and time performed):
Primary LSCS (NOVEMBER 30, 2023 at 2:29 PM)
 Attending physician:
Chiara Mae O. Lascuña, MD, FPOGS, FPSUOG, FPSMFM

 Source of Information/ Informant’s: Patient’s Chart

V. DEVELOPMENTAL DATA
In this segment, established theories will be employed to recognize the
anticipated phases of physical, cognitive, and psychosocial development. This
provides the mother with a comprehensive understanding of her personal growth.
1. Lawrence Kohlberg’s “Stages of Moral Development”
Kohlberg built on the earlier work of cognitive theorist Jean Piaget to
explain children's moral development, which he believed occurred in stages.
Kohlberg classified moral development into three stages: preconventional,
conventional, and postconventional. Each level is divided into two distinct stages.
A child's sense of morality is externally controlled during the preconventional level.
Children accept and believe the rules of authority figures such as parents and
teachers, and they evaluate an action based on the consequences of that action.
STAGE ACTUAL FINDINGS JUSTIFICATION
PUNISHMENT AND ACHIEVED When she was still
OBEDIENCE young, Patient KJB

Patient believes that
ORIENTATION was afraid of making
individuals consider
a sin because she
(2-4 years old) rules as absolute and
believed in the
fixed. She thinks it is
A person’s sense of good
punishment that
important to obey the
and bad is directly linked to
would be given to
rules because it will
whether or not they are
her by her parents.
protect her from
punished. The individual
punishment.
understands that if an

action results in The patient
punishment it is bad, and if understands that if
it results in reward then it is she does not seek
good.
medical attention for
her pregnancy, the
outcome will be a
deterioration of her
condition.
INDIVIDUALISM AND ACHIEVED Her parents taught
EXCHANGE her to help others,

Patient understands
so when they are
(4-7 years old) that ach person is
playing, she helps
different and will,
The person takes into
her friends if they
therefore, have a
account individual need help because
different outlook
she believes that the
points of view and according to their
reward is more than
interests. The
judges actions based on what she did.
individual considers
how they serve their own benefit Patient KJB
individual needs. before taking recognizes that, for
example, she feels

action.
that it would be okay
if she did not take

her medications, but
she recognizes that
her doctor thinks
otherwise.
INTERPERSONAL ACHIEVED She practices
ACCORD AND having a good

Also known as "good
CONFORMITY attitude, so she has
boy-good girl"
many friends to play
(7-10 years old) orientation. She
with and also
highlights the need to
especially in their
be "nice," among the
Interpersonal accord and classroom, so the
people surrounds her.
conformity will guide a teacher will
person’s moral judgment. recognize her.
In other words, the

By emphasizing her
individual is focused on
duty as a first time
living up to social
parent, the patient
expectations and norms
demonstrate values
and will consider how their
living up to social
choices influence their
expectations and
relationships. Usually
obligations. She
dwells with the question:
doesn’t worry about
What do others think of
her pregnancy
me?

because she has a
helpful husband
also.
AUTHORITY AND ACHIEVED Patient follows the
MAINTAINING SOCIAL instructions of her

Patient starts to see
ORDER parents when it
society as a whole
comes to parenting.
(10-12 years old) while making moral
judgments about
A person at this stage
others. The patient
values authority and wants Patient KJB follows
has no history of
to maintain social order. It rules and proper
crime or
is important to follow the procedures within
imprisonment.
rules, otherwise chaos the hospital such as
breaks out and that it is Physician’s ordered
mankind’s duty to uphold NPO and she
the rules. follows it.
SOCIAL CONTRACT ACHIEVED She is careful when
making a decision
(13-19 years old) At this stage , Rules
because there are
of law play a major
A person understands
rules that are
role in maintaining a
rules as a social contract
prohibited,
society, it is important
as opposed to a strict
especially for her
that the members of
order. Rules make sense

only if they serve the right the society must parents.
purpose. Rules exist for approve these

She believes that
the benefit of the masses standards, Patient
the rules and
but they will work against KJB said that
regulations in
the interest of particular everyone should
existence has a
individuals. obey the law too.
purpose, and that no
one should be
immune from them.
UNIVERSAL ETHICAL NOT ACHIEVED The patient has her
PRINCIPLE own set of personal

Patient KJB obey
ORIENTATION principles that she
internalized
works hard to
Young or early adulthood guidelines of justice,
preserve it she also
(20-39 years old) even if sometimes
said that everyone
she’s against moral
Universal ethical ideals
has their own
aspects of laws and
and only rules that are
perspectives.
rules.
based on justice are
legitimate. This dedication
to justice entails the need
to defy unfair regulations.
Rather than rules,
decisions are founded on
universal morality.

2. Jean Piaget's "Theory of Cognitive Development"
He believed that the incorrect answers revealed significant differences in adult
and child thinking. The intelligence of children differs from that of adults in terms of
quality rather than quantity. This means that children think and reason differently
than adults. Children actively acquire knowledge about the world. They are not
passive beings who wait for someone to fill their heads with information.
Understanding children's reasoning requires viewing things through their eyes. It is
therefore, Piaget's theory of cognitive development explains how a child constructs a
mental model of the world. He disagreed with the idea that intelligence was a fixed
trait, and regarded cognitive development as a process which occurs due to
biological maturation and interaction with the environment.
SENSORIMOTOR STAGE ACHIEVED The patient
recalled her close

(Birth to nearly 2 years
relationship with
old)
Patient learn about her
her parents and
surroundings through
friends ,she
sensory perceptions and
Coordinates senses with revealed that she
motor activity.
was afraid to
motor responses to explore
someone who’s
their sensory curiosity

about the world. unfamiliar to her.
Knowledge of the world is
based on physical
Patient KJB is
interactions and
also capable of
experiences. Intelligence is
using her senses
demonstrated through
to navigate and
motor activity. Object
evaluate her
permanence is developed.
surroundings as
evidenced by her
cognizance that
she is in a
hospital.
PRE- OPERATIONAL ACHIEVED She said
STAGE throughout her
(About 2 to 7 years old) pre-school she

The patient met her
knows
creativity at this stage by
engaging in different how to converse

Children become
activities with experiences. and
increasingly adept at
symbolic thinking by engage with other
developing mental children also
representations of objects playing with their
based on experiences and friends is one of

perceptions. Furthermore, her favorite past
memory and use of time.
language is further
developed.
The patient
showed adept use
of symbolic
thinking by being
able to
understand
symbols used in
signs around the
hospital and by
using hand
gestures to
illustrate her
thoughts
alongside her
verbal responses.

CONCRETE ACHIEVED At his age,helping
OPERATIONAL STAGE her parents with

The patient had learn how
their household
(6 to 11 years old) to converse and act
chores, the
responsibly ,she also
patient had
understands that, although
Characterized by the learned how to
things may change in
development of concrete behave
appearance, certain
logical thought, i.e. literal responsibly.
properties remain the same.
thinking focused on the
physical world, immediate

She comprehends
experiences, and exact
reversibility as
interpretations.
evidenced by her
Understanding of inductive
understanding
reasoning, reversibility,
that she has now
and conservation are
a baby
especially indicative of this
stage.
FORMAL OPERATIONAL In her Adolescene

ACHIEVED
STAGE ,the patient
The patient is aware of what manage

(Adolescence to
is the best for her health, challenges and
Adulthood)

has the capacity
and aware of what she
to think clearly
At this stage, thinking needs to save her baby.
and conceptually
becomes increasingly
such as choosing
abstract and they gain an
where to enroll in
understanding of abstract
college.
concepts such as
metaphors, emotions, and
beliefs. Problem-solving
The patient is able
now also uses
to verbalize
hypothetical-deductive
hypothetical
reasoning to ponder “what-
scenarios and
if” scenarios.
outcomes such as
what could have
happened if she
pushed-through
normal delivery .
She also
understands
abstract concepts
as evidenced by
her verbalization
of how the loss of
her amniotic fluid
affects her

emotionally.
3. Robert Havighurst “Developmental Task Model”
Robert Havighurst “Developmental Task Model” stated that change and
growth are continuous throughout the entire life, from birth through death.The
concept of developmental tasks is based on the assumption that human
development in modern societies is characterized by a long series of tasks. The
main claim of the Havighurst developmental tasks theory is that development occurs
in stages throughout a person's entire lifespan. A person advances from one stage to
the next by successfully resolving problems or completing certain developmental
tasks.
INFANCY AND EARLY ACHIEVED In her 12th month
CHILHOOD the patient was

Patient was able to learn
(From birth to age 5 able to walk and
how to walk, talk and able

years old) to form a basic talk according to
understanding of the world her Aunt.

Humans learn basic
survival skills at this stage.
Babies and young children Patient KJB was
gain control of their bodies, able to
form friendships, and learn acknowledge and
basic language concepts. converse
coherently with
the student
nurse. She is also
literate.
MIDDLE CHILDHOOD ACHIEVED The patient
produced a
(6–12 years old) Patient was able to build a
relationship with her connection to her
friends, and develop her peers and grow

This is the stage at which
social skills. her social skills,
humans learn about
she typically
themselves, their morals,
share her toys
their values, and their
with her friends.
personal independence.
Children learn rules,
various societal functions, The patient is
academic skills, and conscious of

attitudes toward various morals and
groups of people. knows the
difference
between right and
wrong. She can
also function
independently
according to her
social roles(as a
daughter,mother,
wife,etc.) She is
able to get along
well with others
as evidenced by
her close
relationship with
her family.
ADOLESCENCE ACHIEVED When she was 15
years old her

(13–17 years old)
dreams were
The patient gained her
high, and said
maturity, she was able to
Humans learn maturity, she wanted to be
plan her dreams and
emotional independence, a successful
discover her wants and
and future planning during

this stage. Teenagers needs. woman one day.
discover careers, form
personal ideologies, and

The patient has
develop social
her own set of
responsibility.
personal ideals
and ideologies.
EARLY ADULTHOOD ACHIEVED
(18 –35 years old) The patient
demonstrated her
The patient was capable of
ability to make
selecting a spouse, and
Humans learn to be useful independent
starting her own family, as
members of society. Adults decisions.The
well as making
are able to find a mate, Patient proved
independent decisions and
raise a family, manage a her ability to
adapting to changes in her
home, and advance in their make
family and work life.
careers.
independent
decisions,
choosing the right
partner
with whom she
with during

her pregnancy.
She chose not to
work willingly, in
commitment to
prioritizing her
well-being and
navigating the
physiological
changes that may
come.
4. Erik Erickson “Theory of Psychosocial Development”
Erickson’s “Theory of Psychosocial Development” suggested that personality
undergoes various stages of evolution, elucidating how social experiences impact
individuals across their entire lifespan. Erickson focused on the role that social
connections and interactions played in the maturation and development of
individuals.

TRUST VS. MISTRUST ACHIEVED She recalls how her parents
provided for her basic

( infant -18 months)
needs in a stable and
Her need was met so she
nurturing environment,
developed a sense of
The fundamental challenge allowing her to form strong
basic trust.
emotional bonds and lay the
is developing confidence in
groundwork for her future
caretakers. Infants learn to social and emotional
rely on their caregivers for growth.
comfort, and if their basic
needs are provided on a The patient exhibits an
ability o trust the people

continuous basis, they
around her through her
acquire a basic trust in the willingness toanswer
questions throughoutthe
world.
interview and allowing the
student to conduct a
physical examination.
AUTONOMY VS. ACHIEVED At this point in
SHAME/DOUBT development,Patient KJB
are just starting to gain a

(2 - 3 years old)
Focused on developing a
little independence. She
sense of personal control
said according to her
over physical skills and

When children are cultivating a sense of parents she is starting to
encouraged to make independence. perform basic actions on
choices and take charge of her own and making simple
their environment, they start little decisions about what
to establish their she prefers.
independence; when they
are restrained or given

Patient KJB is firm that she
harsh reprimands, they may
has autonomy and that she
feel ashamed and
do many things
mistrusted.
independently such as
moving around, taking care
of herself, and helping with
simple tasks around the
house.
INITIATIVE VS. GUILT ACHIEVED Patient played with her
(3 - 5 years old) school friends and with her
Patient assert herself cousins.She develop a
more frequently through sense of initiative if

Children investigate their
directing play and social encouraged but she feel
surroundings and gain
interaction. She explore guilt if she was criticize.
self-confidence. They her interpersonal skills by
initiating different activities

begin to assume Patient KJB exhibits
initiative by being able to

responsibility and make
verbalize her needs and
goals. They develop a
make requests
sense of purpose if they appropriately.
are encouraged and
supported; otherwise, they
may experience guilt.
INDUSTRY VS. ACHIEVED Patient constantly assists
INFERIORITY her parents with chores at
home and was active in

(6- 11 years old)
school and other
Patient finds the balance extracurricular activties.
Through social interactions, of psychosocial
children begin to develop a development that leads to

She now feels capable and
sense of pride in their her strength known as
accomplished in many
accomplishments and competence, in which
different fields.
abilities. children develop a belief
in their abilities to handle

Children need to cope with
the tasks set before them.
new social and academic
demands. Success leads to
a sense of competence,
while failure results in

feelings of inferiority.
IDENTITY VS. ACHIEVED She is secure in her
CONFUSION (12 - 18 personal identity and
years old) understanding of herself as

Patient develop a sense
can be seen in her
of self and personal
conviction to her beliefs and
Adolescents investigate identity. Her success
values. Particularly, she
leads to an ability to stay
their identities and form a feels strongly connected to
true to herself, while her
her religion.
sense of self. They may
failure leads to role
experiment with various confusion and a weak
sense of self. Patient KJB identifies

roles and jobs.
herself as a woman and
Successfully navigating newly mother to her child.
this period results in a
distinct sense of identity,
but uncertainty about one's
place in life may result in
an identity crisis.
INTIMACY VS. ISOLATION ACHIEVED Successful resolution in the
virtue known as love. She is

(19 - 40 years old)
able to form and commit to

Patient was able to form intimate relationship as
intimate, loving evidenced by her current

Young adults build close,
relationships with other fiancé.Patient KJB
long-lasting bonds with
people this success leads expressed that she feels
others. The task is to form to strong relationships. secure and devoted to her
fiancé .
personal, caring
relationships; failing to do
so may lead to feelings of
loneliness.
VI. DEFINITION OF COMPLETE DIAGNOSIS
G1P1 (1001) Pregnancy Uterine (PU), Male, Cephalic, Rupture of Membranes
(RROM), Lower Segment Transverse Caesarian Section (LSTCS), Joel-Cohen
Incision

The GTPAL system provides a comprehensive overview of a woman’s
reproductive history, including the number of times she has been pregnant and the
outcome of each pregnancy. The first component of GTPAL is Gravida, which refers
to the total number of times a woman has been pregnant, regardless of the outcome
—encompassing both current and previous pregnancies, including live births,
stillbirths, miscarriages, and abortions. The 'T' of GTPAL is Term, indicating the
number of times a woman has given birth to an infant after 37 weeks of gestation,
considered a full-term pregnancy. The 'P' component is Preterm, representing the
number of times a woman has given birth before 37 weeks, considered preterm. The
'A' component is Abortions, signifying the number of times a woman has lost a
pregnancy before the 20th week, including both spontaneous miscarriages and
elective terminations. The 'L' component is Living Children, denoting the number of
currently living children a woman has given birth to. In the case of twins or a multi-
gestation pregnancy, this counts as one para and two living children, as each living
child is considered individually in this component.
Intrauterine pregnancy, commonly known as pregnancy within the uterus,
occurs when a fertilized egg travels through the Fallopian tube and embeds itself in
the lining of the uterus. This is the setting where an embryo transforms into a fetus
and ultimately develops into a baby.
The typical positioning of a baby is termed cephalic presentation, where the
baby is oriented head-down, towards the mother's back, with the chin tucked to the
chest and the back of the head prepared to enter the pelvis. This alignment
commonly occurs between the 32nd and 36th weeks of pregnancy.

The infant's gender is male. In other words, "male" refers to the classification
of sex or gender typically associated with individuals who have reproductive
anatomy, including features like testes and male genitalia.
Rupture of the membranes is commonly described as “the water breaks.”
When the membranes break, the fluid within the membranes around the fetus
(amniotic fluid) flows out from the vagina. The flow varies from a trickle to a gush.
As soon as the membranes have ruptured, a woman should contact her doctor or
midwife.
A Lower Segment Transverse Caesarean Section (LSTCS) is a surgical
technique for delivering a baby through a horizontally positioned incision in the lower
segment of the uterus, commonly in the lower abdomen. This approach, also known
as a low transverse incision, is favored for its association with fewer complications,
especially in subsequent pregnancies. The choice of this method is influenced by
considerations such as the mother's medical condition, the baby's position, and
various clinical factors. LSTCS promotes quicker healing and lowers the risk of
uterine rupture in future pregnancies, making it a preferred option when feasible.
The Joel-Cohen Method, developed by Dr. Joel-Cohen, is an innovative and
formalized approach to abdominal surgery, primarily for hysterectomy. Notable for its
minimalistic instrumentation and strategic incision placement, the method offers
efficiency and adaptability beyond hysterectomy, suitable for various abdominal
surgeries. Its advantages include notably shorter operative times, reduced
intraoperative blood loss, and a diminished need for postoperative analgesics.
Aligned with Enhanced Recovery After Surgery (ERAS) protocols, the Joel-Cohen
Method represents a significant advancement in surgical techniques, showcasing

potential improvements in patient outcomes and streamlined practices within the
medical community's ongoing pursuit of innovation.
VII. PHYSICAL ASSESSMENT
Physical assessment is a systematic and thorough examination of a patient's
body to gather information about their overall health status in an efficient manner
starting at the head and proceeding downward (head- to-toe assessment). The

assessment involves inspecting, palpating, percussing, and auscultating different
parts of the body.
A. Obstetric Sheet
The following are the obstetric data obtained from the patient's chart:
Blood Type: RH: Not Noted OBSTETRIC HISTORY: G 1 P 0

Not Noted
Hbs AG: ANTIBIOTIC: PREGNANCY PREGNANCY

Not Noted Not Noted ORDER: OUTCOME:
Not Noted Not Noted
Desired Contraceptive Educational Profile: Socio-Economic
LMP: February 14, 2023
Family Size: 5 History: None College Profile: Employed
PRESENT PREGNANCY: EDC: November 21, 2023
Undergraduate
PMP: Not Noted
AOG: 41 weeks
PHYSICAL EXAMINATION: Temp: 36.7

DATE: 11/29/23 PR: 96
TIME: 9 PM RR: 20
General Status: Conscious
HEENT: Pink Conjunctiva, No

lymphadenopathy
CHEST
Heart: Dynamic Precordium
LEVEL OF SENTORIUM: Lungs: Clear Breath Sounds
Breast: Not Engorged
ABDOMEN
Fundic Height: 36
Presentation: Cephalic
FHT: 141bpm / RLQ
PELVIC EXAMINATION: Cervical Length:

PAGE 2 cm
\* MERGEFORMAT 2 | Page
Effacement: 90%
B. Vital Signs Monitoring Sheet
DATE/SHIFT TIME BP TEMP PR/CR RR SPO2 OUTPUT
11/29/23 7P 8 PM 120/80 36.7 96 20 98%
11/30/23 12MN 110/80 37 88 20 100%
4 AM 110/80 36.5 86 20 100%
8 AM 120/80 37 92 21
12MN 120/80 36.7 91 20
7a 4 PM 110/90 37.3 96 21
4:15
120/70 36.5 90 21
PM
4:30
120/80 36.5 94 19
PM
4:45
110/90 37 90 20
PM
5 PM 120/7 36.5 89 19

0
5:15
PM 120/80 37.4 91 20
5:30
120/7
PM 36.5 90 21
0
5:45
120/6
PM 36.8 89 20
0
120/7
6 PM 36.5 94 19
0
110/6
8 PM 36.6 81 20 97%
0
12M 120/8
12/01/23 N 0 36.5 76 20 97% BM – (-)
120/8 UO – 800
4 AM 36.4 79 20 97%
0 cc

110/8
12/01/23 8 AM 36.2 89 18 98% BM (-)
0
UO – 300
110/8
7a 12NN 36.5 81 17 95% cc
0
120/8 98%
0 IVF-
4 PM 36.5 85 19
300c
120/8
8 PM 36 79 19 98% BM – (-)
0
12N 110/8
12/02/23 36 81 19 98% UO - 5x
N 0
110/8
4 AM 36.1 83 20 98%
0
110/8
12/02/23 8 AM 36.5 106 20 95% BM - 1
0
12NN 120/80 36.3 97 21 96% UO - 6x

C. COMPREHENSIVE PHYSICAL EXAMINATION
The assessment was done on December 01, 2023 @ 9:00 AM.
System Normal Findings Actual Findings Implications

GENERAL Able to respond to Upon assessing No deviations
APPEARANCE AND stimuli at the same this system, we assessed
MENTAL STATUS lower level of utilized an
strength as most inspection tool
people who are through the
functioning without sense of sight.
neurologic Patient
abnormality. KJB was seen
lying supine on
bed, well-
groomed, with
IVF D5LRS 1L
attached at left
arm and a urinary
catheter attached
to urine bag.
Patient was
awake, coherent,
and conscious,
was able to
communicate and
speak fluently. She
was oriented when
asked about

herself, the current
date and time, and
the place and did
not show any
symptoms of
neurologic defects.
GLASCOW SCALE
BEHAVIOR RESPONSE SCORE PATIENT’S

SCORE
Eye opening - Spontaneously 4 4
response - To speech 3
- To pain 2
- No response 1
Best verbal - Oriented to time, 5 5
response place, and person
- Confused 4
- Inappropriate words 3
- Incompreh 2
ensible sounds
- No response 1
Best motor - Obeys 6 6

response

commands
- Moves to 5
localized pain
- Flexion 4
withdrawal from
pain 3
- Abnormal
flexion
2
(decorticate)
- Abnormal
extension
1
(decerebrate)
- No response
Total score - Best 15 15
response 8 or less
- Comatose 3
client
Totally unresponsive
Head Rounded, smooth, Head is round, No deviations
normocephalic, and normocephalic, assessed
symmetrical. Absence of with no
nodules or masses. abnormalities or
tenderness
detected.

INTEGUMENTARY When skin is pinched it Patient’s skin No deviations
Skin goes back to its previous color is uniform assessed
state immediately (2 from light pink
seconds). No rashes, to light brown,
pallor, jaundice, and and is soft and
cyanosis. With fair smooth. With
complexion and good skin turgor
soft skin. (2 seconds) and
no lesions.
· Hair Evenly distributed hair Hair color is No deviations
(long, black, and shiny). black and has a assessed
fine
texture.
Nails Epidermis is intact and Patient’s nails No deviations
smooth. Fingernails and without assessed
toenails are short, clean, cyanosis and
convex and with good clubbing.
capillary refill time of 1-3 Epidermis is
seconds. No cyanosis, intact and
clubbing, and beau’s fingernails and
lines. toenails were
short, clean,
and convex,
with good

capillary refill
time of 2
seconds.
Face Symmetrical facial Normal head No deviations
movement, palpebral motion and no assessed
fissures equal in size, Involuntary
and symmetric nasolabial Movements
folds.
EYE STRUCTURE Eyelids are intact. Patient’s eyelids No deviations
AND VISUAL Absence of discharges were intact with assessed
ACUITY and no discharge;
Visual Fields discoloration; eyelids eyelids closed
Visual Acuity close symmetrically; symmetrically;
sclera appears white; white sclera; no
absence of edema or edema and
tenderness over lacrimal tenderness
gland; pupils constrict noted. Using a
when looking at near penlight to
objects and dilate when assess the
looking at far objects. patient’s pupils,
it was found
that her pupils

are 4 mm
constricting to 2
mm, equally
round, and
reactive to light
and
accommodation
. The patient is
able to read a
book and can
clearly watch an
illustration.
EARS AND Absence of deformities, Examining the No deviations
HEARING discoloration, patient's ear assessed. No
tenderness, or canal with a conductive
discharge. Hearing is penlight hearing loss
intact bilaterally through revealed the and
whisper test, watch tick absence of sensorineural
test, Weber, and discharge, loss. The
Rinne test. redness, patient
masses, or has a Weber
foreign bodies. negative result
However, a wherein the
small quantity patient
of cerumen was perceives the

observed. With sound as
the whisper being equally
test, the patient distributed
was able to between both
repeat the ears. She also
words has a Rinne
whispered 2 positive test
feet behind her which implies
both ears. that air
Using a watch conduction is
and a tuning more effective
fork, we than bone
assessed the conduction,
patient's since she
hearing with a heard the
watch tick test, tuning fork
Weber test and near the ear
Rinne test. canal more
Patient KJB than near the
verbalized that mastoid bone.
she was able to
hear the
watch’s ticking
and the sound
of the tuning

fork on both
ears.
NOSE AND External nose is Patient nose is No
SINUSES symmetrical with no symmetrical deviations
discoloration, swelling or with no assessed
malformations. Nasal discoloration,
mucosa is pinkish red swelling or
with no lesions. No
discharge/bleeding nasal drainage
, swelling, malformations and congestion.
or foreign bodies. Nasal mucosa
pink, septum
midline, no
sinus
tenderness
Symmetrical
and no
discharge is
seen.
MOUTH AND Lips are normal in color Patient did not Cracked lips
THROAT and have no lesions. complain of sore and dry
Teeth present with one throat; had good mucous
loose tooth, good dental dentition, membrane
hygiene; minimal resulted from
cracking, and cold room

gums and mucous oral mucous temperature
membranes are pink, no membrane lacking
bleeding, lesions, or slightly dry. humidity and
inflammation. No present air moisture
inflammation and from
Absence of decreased
bleeding and oral fluid
lesions. intake due to
NPO order.
OROPHARYNX Moist oral cavity. Pink Patient’s uvula No deviations

AND
TONSILS mucosa with is midline, assessed
no discoloration, lesions, pharynx without
nodules, or swelling. exudate,
Tonsils are visible but not swelling, or
enlarged. ulceration, and
no tonsillar
enlargement.
NECK Positioned at the midline Is in midline No
without tenderness and position, no deviations
flexes easily. No masses tenderness, can assessed
palpated. flex neck easily.
No masses.

THORAX AND Lungs resonant to Lungs expand No deviations
LUNGS
percussion and equally on both assessed
- Anterior
vesicular breath sides. No
Thorax
sounds throughout wheezes; has a
- Posterior
peripheral lung normal vocal and
Thorax
fields. No tactile fremitus.
wheezes, or Thorax - Has a
bronchi; normal good air entry and
vocal and tactile no adventitious
fremitus. sounds across the
Upon palpation of anterior thorax’s
posterior chest lobes. No thorax
wall, client reports deformities or
no pain, masses, spinous
temperature warm process in a
to touch, equal straight line
bilaterally, no
moisture, masses,
swelling, or
deformities, equal
tactile fremitus

HEART AND The jugular vein No swelling No deviations
CENTRAL VESSELS should not be or assessed
distended, bulging, or enlargement
protruding at 45 degrees of the jugular
or greater and carotid
The external chest is veins. The
normal in appearance precordium is
without lifts, heaves, or symmetrical.
thrills. Heart rate and
rhythm are normal.
BREAST AND Breasts are round; Breasts are According to
AXILLA slightly unequal in size; round, slightly the patient,
absence of tenderness, unequal in Patient’s
masses, or nodules. size; absence breasts are
Axilla has no lesions, of mass and slightly tender
and no large lymph nodules. and sore due to
nodes Areolas and rising hormone
nipples are Levels.
dark in color
and round.
Axilla is
smooth and
has no
lesions with
no enlarged

lymph nodes.
ABDOMEN Unblemished skin, Patient’s Presence of
uniform in color, abdomen has striae
symmetric contour, not evident linea gravidarum
distended. nigra, striae (from belly
Normoactive bowel gravidarum, button to pubic
sounds are heard in all and loose area) and linea
four skin around nigra was
quadrants. High-pitched, the navel present due to
gurgling sounds. area. increased
Horizontal hormonal levels.
surgical Loose skin is
incision on present
the lower because as the
abdomen is abdomen
present. expands, the
Using skin also
auscultation, stretches,
normoactive leading to loose
bowel sounds skin around the
were heard stomach after
in all four delivery. The
quadrants. incision was due
to the surgical
procedure

called Low
Segment
Cesarean
Section during
recent
hospitalization
GENITO-URINARY Genitals without lesions; Patient Increased
no inflammation, experienced pressure on the
swelling, discharge, urinary bladder during
enlargement, or incontinence. pregnancy and
tenderness. No urethral the recovery
discharge or foul smell. period after a C-
section may
involve limited
physical activity
which can
contribute to
muscle
weakness,
including the
pelvic floor
muscles leading
to difficulty in
controlling the
bladder. Foley

catheter is
inserted into the
bladder prior to
surgery to aid in
draining urine
during the
procedure and
in the initial
recovery period
due to
involuntary
urination.
NEUROLOGIC The patient is alert and Patient is No deviations
Cranial Nerves oriented to person, conscious assessed
Reflex place, and time with and coherent
Motor Function normal speech. No to person,
Pain Sensation motor place, and
deficits are noted, with time with
muscle strength 5/5 normal
bilaterally. speech.
Sensation is intact Oriented and
bilaterally. has a sense
of reality.
Able to speak
and

understand
clearly.
Symmetrical
reflexes.
Sensation is
intact
bilaterally.

VIII. ANATOMY AND PHYSIOLOGY
The Female Reproductive System
Figure 1. The Female Reproductive System
The female reproductive system is a complex of network of organs that
function together to facilitate reproduction. The primary parts include ovaries,
fallopian tubes, uterus, vagina, external genitalia, and the mammary glands. The
reproductive system in females is responsible for producing gametes (called eggs or
ova), certain sex hormones, and maintaining fertilized eggs as they develop into
mature fetuses and become ready for delivery (Rosner J, Samardzic T, Sarao MS.,
2023). It consists of internal and external organs. The function of external female
reproductive structures (the genital) is twofold: To enable sperm to enter and to
protect the internal genital organs from infectious organisms.
PARTS OF THE FEMALE REPRODUCTIVE SYSTEM

External Parts:
Figure 2. External Parts of the Female Reproductive System
Clitoris: a bulb-shaped sexual organ in the female reproductive system, is a
sensitive protrusion similar to the male penis, crucial for sexual pleasure and an
erogenous organ.
Urethral Opening: Urethral opening: the urethral opening is where the urine leaves
the body
Vaginal Opening: The vaginal opening is the area where your baby exits your body
after delivery, and it is responsible for the flow of blood during your menstrual period.
Labia Majora: Labia majora are large lips, fleshy tissue folds protecting external
genital organs, covered with pigmented skin, sebaceous glands, and coarse hair
after puberty, serving as outer skin folds of the vulva.
Labia Minora: The labia minora, small lips, protect the urethra and vagina openings,
but are sensitive and prone to irritation and swelling. They are located under the
labia majora, which extends downward from the mons pubis

Hymen: Hymen is a thin, unique tissue found at the vaginal opening, formed by fetal
tissue fragments. Its size, shape, and thickness are a result of individual
development and can change over time.
Internal Parts:
Figure 3. Internal Parts of the Female Reproductive System
Vagina: The vagina is a muscular canal connecting the cervix to the external body,
providing lubrication and sensation. Its soft, flexible lining ensures smooth
movement. Vagina receives the penis and semen during intercourse and facilitates
menstrual blood flow.
Uterus: The uterus is a pear-shaped organ that holds a fetus during pregnancy. It is
divided into two parts: the cervix, which opens into the vagina, and the corpus, which
can expand to hold the baby. A canal through the cervix allows sperm to enter and
menstrual blood to exit.

Ovaries: Ovaries are oval-shaped glands on either side of the uterus, responsible
for producing, storing, and releasing eggs into fallopian tubes. During ovulation, one
ovaries releases an egg, which, if fertilized by a sperm, can lead to pregnancy.
Fallopian tubes: Fallopian tubes are muscular ducts between the ovaries and
uterus, serving as channels for fertilized eggs to develop into fetuses. They are
narrow tunnels that allow the egg to reach the uterus, facilitating the process of
fertilization.
Cervix: The cervix, a muscular, tunnel-like organ in the lower part of the uterus,
connects the uterus and vagina. It facilitates fluid flow between the two and allows a
baby to exit the uterus for childbirth through the vagina. It is also known as the "neck
of the uterus."
Male
Reproductive System

Figure 4: Male Reproductive System
The male reproductive system is a complex network of organs intricately
intertwined with both the reproductive and urinary systems in men. Comprising
internal and external components, these crucial organs play a pivotal role in various
physiological functions. Internally housed within the body are organs such as the
testes, epididymis, vas deferens, seminal vesicles, prostate gland, and bulbourethral
glands. Externally, the penis serves as the visible organ, facilitating both urination
and sexual intercourse. This intricate system collaboratively enables men to engage
in essential bodily functions, including urination, sexual activity, and the biological
process of procreation. Together, these interconnected elements harmoniously
contribute to the overall functionality of the male reproductive system.
Anatomy of The Male Reproductive System
 Testes:

The testes (singular: testis) are the primary reproductive organs in males. They are
located in the scrotum, a sac of skin and muscle outside the body, which helps
regulate the temperature of the testes for optimal sperm production.
 Scrotum:
The scrotum is a pouch of skin and muscle that houses the testes. It contracts or
relaxes in response to temperature changes, ensuring that the testes are kept at an
ideal temperature for sperm production.
 Epididymis:
The epididymis is a coiled tube attached to the back of each testis. It serves as a
storage and maturation site for sperm. Sperm produced in the testes move through
the epididymis, gaining the ability to swim and fertilize an egg.
 Vas Deferens:
The vas deferens is a muscular tube that connects the epididymis to the urethra. It
transports mature sperm from the epididymis to the urethra during ejaculation.
 Seminal Vesicles:
The seminal vesicles are two small glands located near the base of the bladder.
They produce a significant portion of the seminal fluid, which nourishes and provides
energy for sperm. This fluid also helps in the transportation of sperm.
 Prostate Gland:
The prostate is a gland located just below the bladder and surrounds the urethra. It
produces a milky fluid that mixes with seminal vesicle fluid and sperm to form
semen. The prostate's fluid also contains enzymes that help activate sperm.

 Bulbourethral Glands (Cowper's Glands):
These small glands are located beneath the prostate. They produce a clear, slippery
fluid that is released just before ejaculation. This fluid lubricates the urethra and
neutralizes any acidic urine residue, creating a better environment for sperm.
 Urethra:
The urethra is a tube that runs through the penis. It serves as a passageway for both
urine and semen. During ejaculation, the urethra carries semen from the
reproductive system to the outside of the body.
 Penis:
The penis is the male external organ involved in sexual intercourse and the passage
of urine. It contains erectile tissue that becomes engorged with blood during sexual
arousal, resulting in an erection.
 Accessory Glands:
Besides the seminal vesicles, prostate, and bulbourethral glands, there are also
accessory glands that contribute to the composition of semen.
The male reproductive system is regulated by hormones such as
testosterone, which is produced by the testes and influences the development of
secondary sexual characteristics and the maintenance of reproductive function. The
coordination of these organs and their functions is essential for successful
reproduction.

ANATOMY OF BREAST
Figure 5. Anatomy of Breast
The breast is located on the anterior thoracic wall. The breast is composed of
mammary glands surrounded by a connective tissue stroma. The mammary glands
are modified sweat glands. They consist of a series of ducts and secretory lobules
(15-20). Each lobule consists of many alveoli drained by a single lactiferous duct.
These ducts converge at the nipple like spokes of a wheel. During pregnancy, high
levels of estrogen and progesterone produced by the placenta inhibit milk secretion.
Estrogen and progesterone levels abruptly alter following placenta ejection. When
the baby sucks, this permits the anterior pituitary gland to release the hormone
called prolactin. Prolactin encourages a baby to suckle and also triggers the 47
posterior pituitary gland to release the hormone oxytocin, which enables the milk to
be expelled from the alveoli and enter the ductal system. At the center of the breast
is the nipple, composed mostly of smooth muscle fibers. Surrounding the nipple is a
pigmented area of skin termed the areolae. There are numerous sebaceous
glands within the areolae – these enlarge during pregnancy, secreting an oily

substance that acts as a protective lubricant for the nipple. Breast development
throughout pregnancy may result in enlargement, tenderness, increased prominence
of veins and striae, areolar enlargement, erectile nipples, and/or nipple sensitivity.
FERTILIZATION
Figure 6: Fertilization
Coitus, or Sexual Intercourse, is the initial stage in reproduction where male genitalia
enter the female reproductive system, potentially leading to fertilization. It begins
when the brain stimulates the corpus cavernosum, allowing blood to flow and the
penis to erect. Females use vaginal glands to protect the vagina. The excitement
phase prepares the body, followed by a plateau phase with increased breathing
patterns and muscular tension. The Orgasmic phase releases sperm and semen,
and the reproductive organs return to their unaroused state.

The process of fertilization involves several steps, including ovulation, ejaculation,
journey through the cervical canal, biochemical changes, branching off, and
fertilization. Ovulation occurs when a mature egg emerges from one of the ovarian
follicles, with a 24-hour window for fertilization. During this time, vaginal discharge
becomes wet and slippery, indicating peak fertility. Semen provides nourishment and
protection for sperm, leaving behind a wall across the vagina to prevent downward
movement.
The cervical canal is a warm and conducive environment that allows sperm to thrive
and move through. It is lined with cervical mucus, which is particularly effective
during the fertile window. The days before ovulation also witness molecular changes,
such as microscopic threads of molecules lining up along the canal.
Sperm entering the canal must change their structural form to survive, triggering
biochemical changes that allow them to travel at breakneck speeds through the
uterus and fallopian tubes. Once in the uterus, they have a critical decision to make:
go right or left, depending on the fallopian tube on either side. Sperm tend to branch
off at this point, some gravitating to the left and others to the right.
Fertilization occurs when only the most resilient sperm reach the egg, which
undergoes chemical changes that block other sperm from entering. The
chromosomes in the egg and sperm combine, giving rise to a zygote.
The egg is alive for about 12-24 hours after its release from the ovary. If it is not
fertilized by this time, it disintegrates and is shed off by the uterine lining. If it is not
fertilized by this time, it disintegrates and is shed off by the uterine lining. The sperm
stays alive for about 72 hours within uterine activity. If the woman is fertile during the
sexual intercourse, fertilization may occur. The sperm will meet the egg cell

produced from the ovary in the fallopian tube. Within 24 hours of fertilization, the
Zygote begins mitotic cell division as it makes its journey into to the uterus, where
fetal development occurs.
In conclusion, the different phases of fertilization include Penetration, where the
sperm releases acrosomal enzymes to penetrate inside the egg; Activation, where
the egg membrane depolarizes; and Fusion of nuclei and formation of zygote. The
human fertilization process ends with the creation of the zygote, which is the
organism's first cell formed when the egg and sperm unite. Karyogamy is the term for
the chromosomal fusion that occurs in male and female gametes. Now fertilized, the
ovum is referred to as a zygote.
IMPLANTATION
Once fertilization happens, the cell starts to divide and multiply within 24 hours in the
fallopian tube. This detached multi-celled structure is called a zygote. Later, after 3-4
days it travels to the uterus and now we call it as an embryo. The embryo undergoes
various stages and attaches to the endometrial layer of the uterus through
implantation. After 72 hours since fertilization, the Zygote then becomes a 16-50 cell
organism called morula which migrates from the fallopian tube right down to the
uterus through a peristaltic movement. The morula becomes hallow and is filled with
a blastocyst, which separates it into two parts: the trophoblast, which allows space
for the placenta and membranes, and the embryoblast, responsible for embryo

formation. The blastocyst usually attaches to the endometrium during the 6th day,
shedding the remaining corona and zona pellucida and sticking to the uterine lining.
To sum up, implantation starts with an initial stage called adaptation, in the first
phase of adaptation, the blastocyst loosely adheres to the endothelium, and in the
second phase, this blastocyst rolls to the site of implantation, and is firmly attached
to the endometrial layer of the uterus, wherein the third phase there is adhesion and
interaction of the blastocyst with uterus takes place.
The implantation should always occur in the body of the uterus, sometimes it does
not happen, it may implant in some loss wrong places like fallopian tubes occur,
which is the abnormal implantation, and sometimes even if implantation is proper but
placenta may not develop properly.
EMBRYO DEVELOPMENT
Figure 7: Embryo Development

The embryonic development then begins and it continues till it reaches the 8th
week. Fertilization forms the zygote, which divides mitotically into 2, 4, 8, or 16-celled
stages called, Blastomeres. An embryo with 8 to 16 blastomeres, is called Morula.
The morula continues to divide mitotically and transforms into a blastocyst. The
blastocyst's outer layer is known as the trophoblast, and it attaches to the uterine
wall known as the endometrium. The implantation process begins in the first week
and is completed by the second week. The blastocyst's inner cell mass develops into
the embryo. Blastocysts differentiate into embryonic and extraembryonic tissues.
The placenta is formed by the interdigitated chronic villi of trophoblast and
uterine cells and serves as the link between the mother and the growing fetus. It
provides nourishment and oxygen to the embryo and helps in removing carbon
dioxide and waste produced by the embryo. It also functions as an endocrine gland,
secreting hormones such as hCG (Human Chorionic Gonadotropin), estrogen,
progestogens, and others to keep the pregnancy going.
Gastrulation begins in the third week, and the embryo differentiates into three
germinal layers: ectoderm, endoderm, and mesoderm. These cells differentiate into
various tissues and organs, including the nervous system, brain, spinal cord,
epidermis, hair, nails, and internal organs.
Weeks after Embryonic Development
Fertilizatio
Week Three Gastrulation and formation of three germinal layers. Neurulation
follows gastrulation. Notochord is formed

Week Four The heart is the first organ to start functioning. The heart starts
beating. Arm buds and optic pits become visible
Week Five Size ~ 4 mm. Starts becoming C-shape, inner ear starts
developing, pharyngeal arches develop, liver, pancreas, spleen and
gall bladder start developing
Week Six Size ~ 8 mm. Development of eyes and nose, leg buds and hand
as flat paddles appear, stomach and kidney precursors start
developing
Week Size ~ 13 mm. Lungs and lymphatic system and primary sex
Seven organs start developing, arms and legs lengthen and digits start
appearing
Week Eight Size ~ 20 mm. External ear starts appearing, nipples and hair
follicles start developing, most of the organs start developing by this
time
Week Three Gastrulation and formation of three germinal layers. Neurulation
follows gastrulation. Notochord is formed
Week Four The heart is the first organ to start functioning. The heart starts
beating. Arm buds and optic pits become visible
To sum up, the heart is the first organ to start working, and it develops after
the first month of pregnancy. In the second month, limbs and digits develop, and by

the end of the first trimester, all major organ systems are visible. The embryo moves
during the fifth month, and hairs start appearing on the head. By the end of the
second trimester, eyelashes form, eyelids separate, and the body is covered with
fine hair. By the end of the ninth month, the fetus is fully developed and ready for
birth.
Stages of Fetal Development
Figure 8:
Stages of Fetal Development

Germinal Stage
The germinal stage is the shortest stage of fetal development. This stage of
pregnancy starts at the time of conception, when the sperm and the egg
combine to form a zygote. During the germinal stage, the zygote begins to
divide in order to implant into the uterine wall. The zygote divides multiple
times, creating two structures: embryo and placenta. Rapid cell division turns zygote
into blastocyst, which implants into uterine lining, producing hormones for
pregnancy.
Embryonic Stage
Once implantation is complete, the embryonic stage begins. The mass of cells
is now known as an “embryo The neural tube, which gives rise to the brain and
spinal cord, as well as the head, eyes, mouth, and limbs, are among the structures
and organs that form. During the sixth week of development, the heart starts to beat
and develop, and buds grow into limbs and legs. The majority of the embryo's
systems and organs begin to take shape by the end of the eighth week. By the end
of the eighth week, most of the embryo's systems and organs take shape, except for
sex organs. The embryo looks like a little tadpole, growing to 1 to 1.5 inches and
weighing 1 gram. By the end of this period, the embryo has all basic organs and
parts.
Fetal Stage
The fetus undergoes a series of stages during its prenatal development. The
fetal stage, lasting from week nine until birth, is crucial for a fetus's brain and spinal
cord development, and sex organ differentiation. Gender can be determined around

18-20 weeks through ultrasound or genetic testing. The second trimester, starting at
week 12, marks the fetus's growth up to 6 inches, with hair, eyelid opening, eyebrow
and eyelash development, fingerprinting, and brain development. The third trimester,
starting at week 27, lasts until birth, with the baby reaching 15 inches and maturing
the lungs and digestive system. The baby is considered full-term at 37 weeks.
SIGNS AND SYMPTOMS OF LABOR
Labor is a physiologic process that includes abdominal pressure and uterine
contractions that expel a fetus and placenta from the uterus. Regular contractions
stimulates progressive dilation of the cervix and generate enough muscular uterine
strength to allow a baby to be pushed out into the extra-uterine world.
A sudden burst of energy (nesting), braxton hicks contraction (false labor), a
feeling that the baby has dropped (lightening), contraction that ranges from mild to
strong, thinning of the cervix (effacement), widening the opening of the cervix
(dilation), water breaking, leg cramping, back pain, and nausea are some of the
common signs of labor. This intricate process can be segmented into distinct stages,
each strategically designed to fulfill a particular function in preparing for and ensuring
the secure delivery of the infant.
Stages of Labor
First Stage of Labor: Cervical
Dilation
The first phase of the first
stage of labor is called the latent

phase, when contractions are becoming more frequent (usually 5 to 20 minutes
apart) and somewhat stronger. However, discomfort is minimal. The cervix dilates
(opens approximately three or four centimeters) and effaces (thins out).
Figure 9: Stage 1 of Labor
This stage is divided into three (3) segments which includes Latent, Active and
Transition Phase.
The latent phase is usually the longest and least intense phase of labor. The
mother-to-be is usually admitted to the hospital during this phase. Pelvic exams are
performed to determine the dilation of the cervix.
The second phase of the first stage (active phase) is signaled by the dilation of the
cervix from 4 to 7 centimeters.
Contractions become longer, more severe, and more frequent (usually 3 to 4
minutes apart).
The third phase is called transition and is the last phase. During transition, the
cervix dilates from 8 to 10 centimeters. Contractions are usually very strong, lasting
60 to 90 seconds and occurring every few minutes. Most women feel the urge to
push during this phase.
Second Stage of Labor: Expulsion of the Fetus
The second stage of labor is the period of time from 10 cm full cervical
dilatation and 100% cervical effacement to the delivery of the baby. The
second stage of labor begins when the cervix 10 cm full dilated with 100%
cervical effacement and ends with the delivery of the baby. The second

stage is often referred to as the "pushing" stage. During the second stage,
the woman becomes actively involved by pushing the baby through the birth
canal to the outside world. When the baby's head is visible at the opening of
the vagina, it is called "crowning." The second stage is shorter than the first
stage, and may take between 30 minutes to two hours for a woman's first
pregnancy
Third Stage of Labor: Placental Delivery
The third stage of labor is the period of time from the delivery of the fetus to
the delivery of the placenta. There are several signs associated with the placental
separation from the wall of the uterus. Including, lengthening of the umbilical cord,
fundus become globular in shape and there is a sudden gush of blood. The signs of
separation of the placenta usually
become evident within 5 to 10 minutes after birth. This stage includes 2 separate
phases: Placental Separation and Placental Expulsion. There are signs indicating
placental separation including lengthening of the cord, the fundus become globular in
shape and there is sudden gushing of blood. This is followed by delivery of the
placenta. Accordingly, placenta is presented in 2 ways. If the placenta appears shiny
and glistening from fetal membranes, this is called Schultze. On the other hand, if
the placenta looks raw, red, and irregular, with the ridges or cotyledons that
separates blood collection spaces evident, it is called Duncan.
Fourth Stage of Labor: Recovery

The fourth stage of labor or the recovery stage mostly starts after the placenta
have been delivered to the first two hours after birth. During this time, the healthcare
provider may have to repair an incision (episiotomy) or tears (lacerations) made
during the delivery. This repair is made by giving stitches with thread that absorbs on
its own. The baby will be sent to the newborn nursery within two hours of delivery,
and the mother will be moved to a postpartum (after childbirth) room where the
patient will spend the remainder of her hospital stay. Once the examination of your
child in the nursery completes and he or she maintains a stable temperature, the
baby is given back to the mother and continue skin-to-skin contact. During this time,
the uterus contracts here and there, pushing out what’s left inside and reestablishing
muscle tone. These contractions are hastened by breastfeeding, which stimulates
the production of the hormone oxytocin.
Anatomy of the Skin in the Abdominal Wall

Figure 12: Anatomy of Skin in the Abdominal Wall
The skin is the body’s largest organ, made of water, protein, fats and
minerals. Your skin protects your body from germs and regulates body temperature.
Nerves in the skin help you feel sensations like hot and cold. The abdominal
muscles, in particular, play a crucial role in maintaining core strength and stability,
and they are involved in various movements, including flexion, rotation, and lateral
bending of the trunk.
Layers of the skin in the abdominal wall:
 Skin
 Subcutaneous fat
 Fascia
 Muscle
 Peritoneum
Cesarean Section
Caesarean section is the most common major abdominal operation performed
on women in birth. A surgical delivery of a baby through a cut (incision) made in the
mother's abdomen and uterus. thus, any useful refinement in the operative technique
is likely to yield substantial benefits. The surgical technique for caesarean delivery

has changed over time, and from surgeon to surgeon, and these changes involve
both uterine and skin incision
Anatomy During a C-Section
Figure 13: Anatomy of a C-section
1. Skin:
The outermost layer that is incised to gain access to the underlying structures.
Subcutaneous Tissue:
Beneath the skin, there is a layer of subcutaneous tissue that may be dissected or
pushed aside during the initial incision. This layer contains blood vessels and nerves.
2. Fascia:
The fascia is a tough, connective tissue layer beneath the subcutaneous tissue. It
provides structural support and is often incised during a C-section.

3. Rectus Abdominis Muscles:
These are the paired, large muscles that run vertically along the anterior (front)
abdominal wall. During a C-section, an incision is typically made between these
muscles in a procedure known as a lower segment Cesarean section (LSCS) or a
Pfannenstiel incision.
4. Rectus Sheath:
The rectus abdominis muscles are surrounded by a sheath formed by the
aponeuroses (flat tendons) of the abdominal muscles. The surgeon may make an
incision through this sheath to access the peritoneal cavity.
5. Peritoneum:
The peritoneum is a thin, transparent membrane that lines the abdominal cavity. It
covers the organs within the abdomen.
During a C-section, an incision is made through the rectus sheath and then through
the peritoneum to access the uterus.
6. Uterus:
The uterus, a muscular organ where the baby is housed during pregnancy, is
accessed through the peritoneum.
A transverse incision (horizontal) or a vertical incision (midline) may be made in the
uterus, depending on various factors.
7. Amniotic Fluid and Placenta:
Once the uterus is incised, the amniotic fluid is released, and the baby is delivered.

The placenta is then carefully removed after the baby.
Cesarean Delivery Techniques
A transverse skin incision is the most used and is preferable in most cases due
to improved wound healing and patient tolerability. Because most clinicians are more
adept at low-transverse cesarean entry, this technique is often utilized even in
emergency scenarios. Unplanned cesarean hysterectomies can take place through a
low transverse incision.
Figure 14: Cesarean Delivery
Techniques
 Pfannenstiel-Kerr method
 Joel-Cohen method
 Maylard method
Pubic incision is a type of
abdominal surgical incision that allows

access to the abdomen. It is used for gynecologic and orthopedics surgeries and it is
the most common method for
Figure 15: Pfannenstiel-Kier Method
performing Caesarian sections today. This incision is also used in Stoppa approach
for orthopedics surgeries to treat pelvic fractures. The Pfannenstiel incision offers a
large view of the central pelvis but limits exposure to the lateral pelvis and upper
abdomen, factors that limit the usefulness of this incision for gynecologic cancer
surgery. This incision is commonly called the "bikini line incision". Some common
reasons for this surgical access are obstetric delivery and hernia repair. It is often
used in preference to other incision types for the sake of aesthetics, because the
scar will be hidden by the pubic hair. The incision does not distort the belly
button and heals faster than the traditional vertical incision.
Joel-Cohen incision is a skin
incision used for Caesarean
section. It is a straight incision
that is 3 cm below the line joining
both
Figure
16: Joel-Cohen Incision
anterior superior iliac spines. The skin incision is made 3 cm above the location of
Pfannenstiel incision. The subcutaneous tissue is incised in three medial
centimetres. The lateral tissue separation is done manually and the fascia is divided

by blunt dissection using both index fingers. This incision is extended laterally by the
fingers. It is similar to the Pfannenstiel incision, another commonly used incision in
obstetric surgery. The Joel-Cohen cesarean section technique relies more heavily on
blunt dissection than the traditional Pfannenstiel technique. Joel-Cohen technique
has lower rates of fever, hospital stay, post-operative pain and blood loss compared
to Pfannenstiel. The operating time and use of analgesia are also reduced.
Additionally, the time needed to get out of bed, walk without support and time for re-
appearance of audible intestinal sounds were shorter in Joel-Cohen group than the
Pfannenstiel group in a study conducted with 153 womenIn the two studies (with 411
participants) that compared the Joel-Cohen incision with the Pfannenstiel incision,
the Joel-Cohen incision was associated with a 65% reduction in postoperative febrile
morbidity.
Maylard Method is a straight
transverse incision somewhat
higher than the Pfannenstiel
incision. The subcutaneous
tissue is left undisturbed apart
from

Figure 17: Maylard Method
the midline. The rectus sheath is separated along its fibres. The rectus muscles are
separated by pulling. The peritoneum is opened by stretching with index fingers. The
uterus is opened with an index finger and the hole enlarged between the index finger
of one hand and the thumb on the other. The uterus is closed with a one-layer
continuous locking stitch. The visceral and parietal peritoneal layers are left open.
The rectus muscle is not stitched. The rectus sheath is stitched with a continuous
non-locking stitch. The skin is closed with two or three mattress sutures. The space
in between is apposed with non-traumatic forceps for 5 minutes.
The method gives quicker recovery, less use of post-operative antibiotics,
antifebrile medicines, and analgesics. There is a shorter anesthetic and shorter
working time for the operative team. It is suitable for both emergency and planned
operations.

IX. ETIOLOGY AND SYMPTOMATOLOGY
ETIOLOGY AND SYMPTOMATOLOGY
A. Etiology
Etiology, as defined by Merriam-Webster, pertains to a subdivision of medical
science focused on understanding the causes and origins of diseases. This area of
study delves into exploring the origins, sets of causes, or the way diseases or
conditions are caused.
PREDISPOSING ACTUAL FINDINGS

IMPLICATIONS
FACTORS
Maternal age Present: 22 years old In the study, 10% of young
women aged 18-25
preferred Cesarean
Section (CS), with rates
varying from 7.6% in
Iceland to 18.4% in
Australia. The main
reasons were fear of labor
pain and physical damage,
but a decrease in these
fears and Cesarean
section preferences
occurred as women gained
confidence in their

knowledge of pregnancy
and birth. (Stoll, K. H., et
al)
Primigravida Present: The patient is Cesarean section is
primigravida sometimes recommended
for primigravida, women
pregnant for the first time,
to mitigate the risks and
complications associated
with prolonged or difficult
labor (Bigalbal,2022).
Sex Present: Female The potential for
pregnancy is exclusive to
individuals of the female
gender due to the
presence of essential
reproductive organs, such
as ovaries and a uterus.
This inherent physiological
configuration uniquely
enables the process of
conception and gestation.
PRECIPITATING ACTUAL FINDINGS IMPLICATIONS

FACTORS
A rupture of the bag of
water is a normal event
that occurs during
Present: The patient bag of pregnancy or labor. It

Ruptured Bag of Water
water ruptured. facilitates the passage of
the fetus from the uterine
cavity to the external
environment.
To allow the baby to

Present: The patient’s
descend, the cervix
cervix dilated as evidenced
changes in response to
by the intravaginal
Cervical Changes hormonal signals,
examination. The dilation
becoming softer, thinner
revealed 2-3cm and 90%
(at 100% effacement), and
effacement.
10cm dilation.
Prolonged Labor Present: The patient’s Prolonged labor,
labor lasted approximately surpassing 18 to 24 hours
24 hours with only 3 cm for primigravida, heightens
cervical dilation. the risk of complications for
both mother and baby,
including infection,
hemorrhage, and fetal

distress. Prolonged first-
time labors may prompt the
consideration of a
cesarean section due to
insufficient progress.
A. SYMPTOMATOLOGY OF CESAREAN DELIVERY

1. Signs of Cesarean Delivery
SYMPTOMS PRESENT/ABSENT RATIONALE JUSTIFICATION
Labour Dystocia Present Prolonged labor, The dilation of the
also known as cervix refers to its
dystocia, typically opening, while
involves slow effacement
progress in the signifies the
dilation and thinning of the
effacement of the cervix—a tandem
cervix. process crucial for
the smooth
passage of the
baby through the
birth canal. In
instances of
prolonged labor,
the anticipated
progression in
these cervical
changes
encounters a
deceleration,
indicating a
significant delay
in the labor

process.
Abnormal Fetal Absent Fetal heart rate A normal fetal
Heart Rate monitoring is a heart rate typically
way to check the ranges between
condition of your 110 and 160
fetus during labor beats per minute.
This range
indicates a
healthy oxygen
supply to the fetus
and is associated
with normal fetal
well-being.
Fetal Absent Fetal This deviation
Malpresentation malpresentation from the typical
refers to a fetus head-first
with a fetal part presentation can
other than the complicate the
head engaging delivery process
the maternal and may
pelvis. necessitate
medical
intervention to
ensure a safe
birth for both the

mother and the
baby.
Multiple Gestation Absent It often happens This phenomenon
when more than 1 can result from
egg is fertilized the release of
and implants in multiple eggs
the uterus. during ovulation
or the division of a
single fertilized
egg into multiple
embryos.
Complications
such as preterm
birth, low birth
weight, and
neonatal health
issues are more
common in
multiple
pregnancies.
Suspected Fetal Absent Suspected fetal This condition is
Macrosomia macrosomia often identified
refers to the through
concern that a ultrasound
fetus may be measurements

larger than estimating the
average during baby’s size,
pregnancy. particularly the
abdominal
circumference.
The potential
complications
associated with
macrosomia
include difficulties
during delivery,
such as shoulder
dystocia, which
can pose risks for
both the baby and
the mother.
X. PATHOPHYSIOLOGY

Legend:
Blue outline: Signs
Red outline: Symptoms
Red text: Transition of

NSVD to CS

XI. DOCTOR’S ORDER
Date/Time Doctor’s Order Rationale Remarks
11/29/2023  Please admit under the -Done
9 PM service of Dr. Lascuna
(PC) to see patient
 Dr. Samoranos -Done
 Secure consent -Done
 DAT; NPO once in active - To avoid aspiration - Done
labor esp. for a pregnant
woman that may
need to undergo
emergency surgery,
like cesarean
section.
 IVF: D5LR 1L @10cc -To provide -Done
nutritional support,
maintaining
hydration,
electrolyte balance,
Labs: and stabilizing blood
glucose levels.
 IGGr: CBC, PC, HBsAg
Bloodtyping , UA -To enable

physicians and -Done
clinicians to gather
the precise
information to aid in
the early detection,
prevention, and
monitoring of
disease or current
condition of the
patient (Forbes
Medications: Diagnostics, 2023).
1. Ampicilin 29mg IV Q6 hour
Now -To prevent passing
an infection to the -Done
baby during birth
 Monitor VS q4 hour
-To assess the well-
being of both the -Done
mother and the
developing fetus,
enabling early
detection of any
complications and

timely intervention
to ensure a healthy
pregnancy outcome.
 Monitor I&O q shift
-Tracking patient’s
hydration status and -Done
fluid balance and
kidney function
 To labor room once for
EFM
 Please relay to Dr. -Done
Samoranas
 Refer accordingly -Done
 Pedia: Dr. Dela Cruz
-Done
-Done
11/30/23  EFM q2hrs -To help detect -Done
6:20 AM changes in the
normal heart rate
pattern of the baby
during labor.
 Dr. Valencia for anesthesia -Done
11/30/23  Schedule for STAT CS -Done

1:57 PM  Secure consent -Ensures that the -Done
patient is aware of
the procedure,
purpose and
potential benefits
and risks.
 Dr. Valencia for anesthesia -Done
 NPO
To avoid aspiration -Done
esp. for a pregnant
woman that may
need to undergo
emergency surgery,
like cesarean
 Cefazolin 1 gram after section.
negative skin test now -Skin testing is done -Done
to assess for
potential allergic
reaction or
hypersensitivity to
specific antibiotics.
 D/C Ampicilin IV
-To prevent newborn -Done
from developing an
infection.

 Insert FBC fr 16 and -A catheter helps to
attach to urobag ensure that the -Done
bladder is empty
and as small as
possible, keeping it
away from the
surgical field
 Give Metoclopramide -Decrease
1amp IVTT PTOR postoperative -Done
nausea and
vomiting associated
with cesarean
section.
 Ranitidine 1 amp IVTT
prior to operation -Reduces the risk of
acid aspiration of -Done
gastric contents.
POST-OP ORDERS
11/30/23  To recovery room -To allow for initial -Done
3:15 PM recovery and
monitoring in the
immediate
postpartum period

 NPO - to prevent -Done
complications
related to the intake
of food or liquids
 V/S Q15 mins x 24, then - To monitor -Done
Q4 patient’s condition
and for immediate
intervention and
referral in case of
unusuality.
- to maintain -Done
 O2 @2 LPM PRN adequate oxygen
saturation levels is
essential for
ensuring proper
oxygen delivery to
meet the body's
metabolic demands
 IVF : PLR 1L + Oxytocin - for maintaining -Done
20 unit @120 cc/hr hydration, stabilizing
 IVF TF : D5LR 1L + blood glucose -Done

Oxytocin 10 unit @120 levels, and restoring
cc/hr electrolyte balance
after childbirth.
Medications:
1. Cefazolin 1gm IV Infusion - To treat or prevent -Done
for 1 hour q8h bacterial infections.
2. Tranexamic oral 1 gm -This controls -Done
@q8h x 3 doses bleeding. It helps
your blood to clot
and is used for
heavy periods
3. Ranitidine 50 mg IVTT q8h - To reduce stomach -Done
acidity, preventing
or treating ulcers
and acid reflux.
-A nonsteroidal anti-
4. Ketorolac 30 mg IVTT Q6h inflammatory drug -Done
(NSAID) for pain
relief and

inflammation control
-An analgesic for
5. Tramadol 50 mg IVTT Q6h moderate to severe -Done
pain management.
-To prevent
hypothermia which
 Keep patient warm can affect recovery -Done
and overall well-
being
-Monitoring intake
and output to
 I & O Q hourly assess fluid balance -Done
and kidney function.
- consult or transfer
the patient as
 Refer accordingly needed based on -Done
their condition or
response to
treatment.
12/1/23  IVF TF: D5LR 1L + 10 - for maintaining -Done
7:30 AM units oxytocin @10 cc hydration, stabilizing

blood glucose
levels, and restoring
electrolyte balance
after childbirth.
 May have general liquids -Provides -Done
and crackers sustenance during
NPO periods.
 Dr. Sarorames -Done
12/1/23  DAT - Patient’s diet is -Done
9 AM back to normal,
denoting that the
patient may eat
solid food again, as
tolerated.
 IVF TF: D5LR 1L + 10 -Done
units @30 gtts/min then
consume and discontinue
 Remove foley bag catheter -minimizes the risk -Done
after 4-6 hrs of urinary tract
infections, enhances
patient comfort, and
supports early
mobility in

postoperative care.
 CID IVTT meds -Done
 PO meds to start at 6 PM -Done
tonight
1. Co-amoxiclav 1 gm q12h - treat infections -Done
caused by a wide
variety of bacteria.
2. Celebrex 200 mg 1 -Nonsteroidal anti- -Done
capsule BID inflammatory drug
(NSAID) for pain
and inflammation.
3. Immunopro (vit) 1 tab once - strengthen your -Done
a day immune system,
provide relief
against common
cold symptoms
4. Ferrous sulfate 1 tablet
once a day - to treat and -Done
prevent iron

deficiency anaemia.
Iron helps the body
to make healthy red
blood cells, which
carry oxygen around
 To secure opsite 20 cms the body.
and dressing kit -Done
 Encourage early
ambulation To facilitate fast -Done
 Refer recovery phase. -Done
XII. DIAGNOSTIC EXAM
DIAGNOSTIC EXAM
HEPATITIS PROFILE

DATE: 11-29-23
TESTS RESULT INDEX VALUE
HBsAg Qualitative NONREACTIVE
INTERPRETATION: The hepatitis profile results suggest nonreactive results

for HBsAg, the absence of reactive marker suggests no current viral
replication or ongoing infections.
HEMATOLOGY REPORT
NORMAL
TEST RESULT UNIT REMARKS IMPLICATION
VALUES
HgB 126 120-150 g/L NORMAL
HEMATOCRIT 0.39 0.36-0.45 NORMAL
RBC 4.38 4.0-4.5 X19^12/L NORMAL
High White blood
cells can
indicate/suggest
inflammation or
WBC 10.32 5.0-10.0 X10^9/L HIGH infection.
SEGMENTERS 0.75 0.55-0.65 HIGH High segmenters
suggest an
inflammatory
response, infection, or
stress.

LYMPHOCYTES 0.17 0.25-0.40 % LOW Low
lymphocyte
levels, which
can be caused by
infections,
autoimmune diseases,
and bone marrow
disorders,
weaken the
body's immune
response,
increasing
vulnerability to
infections.
MONOCYTES 0.07 0.01-0.12 % NORMAL
EOSINOPHILS 0.01 0.01-0.5 % NORMAL
BASOPHILS 0.00 0.00-0.005 % NORMAL
PLATELET 150.00-
COUNT 244 440.00 X10^q/L NORMAL
INTERPRETATION: The lab results indicate high segmenters that may

indicate an inflammatory response, while low lymphocyte levels weaken the
immune response. Other parameters, including hemoglobin, hematocrit, red
blood cells, eosinophils, basophils, and platelet count, fall within normal
ranges.

XIII. DRUG STUDY

XIV. NURSING THEORIES
NURSING NEED THEORY BY VIRGINIA HENDERSON
Virginia Henderson's Nursing Need Theory, developed from her
practical experience and education, emphasizes the unique focus of nursing
practice. It centers on increasing patient independence to prevent delays in
post-hospitalization progress. Henderson's theory, rooted in addressing basic
human needs, has contributed to further understanding patient needs and
nursing's role. Three key assumptions in her model include nurses caring for
patients until self-care is possible, nurses' willingness to serve day and night,
and the necessity for nurses to be educated at the college level in both
sciences and arts.
In this case, Henderson's theory highlights the role of the nurse in
educating patients to take responsibility for their health. For a C-section
patient, this involves providing detailed information on postoperative care,
potential complications to watch for, and guidance on resuming normal
activities, including infant care and breastfeeding. The nurse, following
Henderson's theory, engages in therapeutic communication, acknowledges
the patient's emotional responses, and provides support during this significant
period of physical and emotional adjustment. Henderson's theory provides a
structured and systematic framework that guides nursing practice. By
delineating fundamental needs, it assists the nurse in organizing and
prioritizing care activities for the post-C-section patient, ensuring a
comprehensive approach to their well-being. These are the 14 components of

the Nursing Need Theory by Virginia Henderson and how nurses can address
these needs for a patient who has undergone a Cesarean section.
 Breath normally: Nurses monitor respiratory rate and rhythm, encourage
deep breathing exercises, and administer pain medication to ensure
comfort during breathing efforts.
 Eat and drink adequately: Nurses provide nutritional support, assess
dietary needs, and offer guidance on post-operative nutrition to promote
healing.
 Eliminate body waste: Nurses assist with toileting, monitor bowel and
bladder function, and educate the patient on maintaining regular
elimination.
 Move and maintain desirable Posture: Nurses encourage gradual
mobility, assist with positioning to avoid strain on the incision, and educate
on safe movements.
 Sleep and Rest: Nurses create a conducive environment for rest,
manage pain effectively, and establish a sleep routine that aligns with the
patient's recovery needs.
 Select suitable Clothes and Dress and undress: Nurses assist with
dressing changes, choose appropriate attire for comfort, and ensure the
incision site is kept clean.
 Maintain Body Temperature within a normal range by adjusting
clothing and modifying the environment: Nurses monitor and regulate

the patient's temperature, providing blankets or adjusting the room
temperature as needed.
 Keep the body clean and well groomed and protect the integument:
Nurses assist with personal hygiene, ensuring cleanliness to prevent
infection at the incision site.
 Avoid Dangers in the environment and avoid injuring other: Nurses
assess the environment for potential risks, especially for the newborn, and
educate the patient on safety measures.
 Communicate with others in expressing emotions, need, fears, or
opinions: Nurses establish open communication, addressing concerns
and providing emotional support for the patient and family. This is
particularly relevant for a post-C-section patient who may have questions,
concerns, or emotional needs.
 Worship according to ones faith: Nurses respect and accommodate the
patient's spiritual and emotional needs, fostering a supportive
environment.
 Work in Such a Way That There Is a Sense of Accomplishment
Nursing Application: nurse Encourage the patient to engage in
meaningful activities.
 Play or particiate in various forms of Recreation: Nurses encourage
activities that promote relaxation and joy, considering the patient's
physical and emotional well-being.

 learn, Discover, or Satisfy the Curiosity That Leads to Normal
Development and Health: Nurse Provide opportunities for continuous
learning. This Stimulates intellectual engagement of the patient,
contributes to mental health, and aids in a positive recovery experience.
Henderson's also focus on promoting patient independence aligns with the
principles of patient empowerment and involving them in care decisions, thus
encouraging active participation in their recovery. Henderson's theory
encourages a thorough assessment of patients. For a post-C-section patient,
this involves not only evaluating physical recovery but also assessing
emotional well-being, social support, and any potential barriers to effective
self-care.
In conclusion, applying Virginia Henderson's Nursing Need Theory to a patient
who has undergone a Caesarean section is essential for delivering holistic,
patient-centered care. It serves as a guiding framework for nurses,
emphasizing the promotion of patient independence and addressing the
diverse needs of the individual during the crucial postoperative period. The
theory ensures that nursing care is not only focused on the physical aspects
of recovery but also encompasses the emotional, social, and psychological
dimensions of the patient's well-being.

Maternal Role Attainment Theory
Ramona Mercer, with extensive experience as a head nurse in
pediatrics and a staff nurse in intrapartum, postpartum, and newborn nursery
units, developed the Maternal Role Attainment Theory. This theory serves as
a framework for nurses to provide appropriate health care interventions,
specifically for first time mothers in order to facilitate the development of a
strong maternal identity. The process used in this nursing model helps the
mother develop an attachment to the infant, which in turn helps the infant form
a bond with the mother, facilitating the formation of a strong mother-child
relationship as the infant grows. The central concept of this theory revolves
around the developmental and interactional process, which occurs over time,
where the mother bonds with the infant, gains competence in care taking
tasks, and eventually expresses joy and pleasure in her maternal role. There
four stages of acquisition. They are: anticipatory, formal (role-taking), informal
(role-making), and personal (role identity).

In this context, this theory guides nurses in providing personalized care
interventions, tailoring the approach to the individual needs of the patient. This
ensures that the post-C-section patient receives care that is specific to their
recovery, emotional well-being, and the development of their maternal role.
Application of this theory allows nurses to adapt care strategies based on the
evolving needs of the patient, ensuring that support remains relevant
throughout the postoperative period. Nurses can play a pivotal role in
educating post-C-section patients about self-care, infant care, and emotional
well-being, empowering them to actively participate in their recovery and
maternal role development. During in the anticipatory stage, Nurses can
provide education on cesarean recovery, address concerns, and establish a
supportive environment to alleviate anxiety. In the formal stage (role-taking),
Nurses facilitate early mother-infant interaction, assist with breastfeeding, and
offer guidance on adapting care giving practices to accommodate
postoperative needs. In the informal stage(role-making), nurse provide
ongoing support, encourage self-care practices, and address any challenges
or uncertainties the patient may face during the postoperative period. and
lastly on personal stage, Nurses Reinforce positive self-image to the patient,
offer guidance on long-term recovery, and provide resources for continued
maternal well-being.
Philosophy and Theory of Transpersonal Caring: Jean Watson
Jean Watson, known for her theory “The Human Caring Theory”, could
be applied to the care of a cesarean-section mother. Watson’s theory

highlights the uniqueness of both the client and the nurse which is
fundamental to the relationship. In the case of c-section mother, this theory
could guide the nursing care through providing holistic approach to promote
healing and wholeness of a cesarean-section mother. This approach entails
addressing the mother's physical, emotional, and spiritual well-being, along
with offering assistance and guidance to aid her recovery from the surgery
and adaptation to her newfound motherhood responsibilities. By concentrating
on the overall well-being of the patient rather than merely addressing physical
symptoms, the nurse can contribute to cesarean-section mother attaining a
sense of well-being and wholeness.
Jean Watsons theory highlights the significance of the nurse's presence,
not just as a healthcare provider but as a compassionate and empathetic
companion during the physical and emotional recovery process. Watson
views the “ten carative factors” as a guide for the core of nursing, which is
most of it was relate to this case, cesarean-section patient. Here are the
Carative Factors that applied in cesarean-section patient.
Watson’s Ten Carative Factors

1. Practice of
Loving-
Kindness
10. Creating a
2. Instillation of
Healing
Faith-Hope
Environment
9. Assisting
3. Sensitivity to
with Basic
Self and Others
Needs
PATIENT -
FAMILY
4. Helping-
8. Soul Care for
Trust
Self
Relationship
5. Expression of
7. Teaching- Negative and
Learning. Positive
Feelings
6. Creative
Problem-
Solving
VALUES PAGE \* MERGEFORMAT 2 | Page

GOALS
MISSION STATEMENT:
To provide high quality, customer-

oriented and financially strong
healthcare services that meet the
needs of those we serve.
 Carative factor #1, “Cultivating the practice of the loving-kindness and
equanimity toward self and other as foundational caritas
consciousness” – It involves developing a deep sense of respect and
care for the dignity and worth of others. In the case of cesarean-section
mothers, nurses can embody this factor by recognizing the unique
experience of childbirth through C-section. Understanding the
emotional and psychological aspects of the process fosters a
supportive and respectful environment.
 Carative factor #2, “Being authentically present: enabling, sustaining
and honoring the faith, hope, and deep belief system and the inner-
subjective world of self/other” – The emotional support and positive
outlook provided to cesarean-section mothers, addressing concerns
and uncertainties related to the procedure and postpartum recovery,
helps instill hope and confidence in the mother.
 Carative factor #3, “Cultivation of one’s own spiritual practice and
transpersonal self, going beyond ego-self”– encourages nurses to be
aware of their own feelings and those of the cesarean-section mother,
enhancing the quality of care and promoting a nurturing environment.
Nurses should empathize with the mother's pain, anxiety, and

frustration, providing emotional support and comfort. This fosters a
nurturing environment for both mother and baby.
 Carative Factor #5, “Being present to, and supportive of, the
expression of positive and negative feelings” – This implies that the
nurse should support the mother in openly sharing her feelings and
emotions, whether positive or negative, and acknowledge their validity.
Additionally, the nurse should assist the mother in managing any
feelings of guilt, shame, or anger related to challenges in
breastfeeding. Cesarean-section mothers may undergo a spectrum of
emotions, spanning from happiness to disillusionment or anxiety. In line
with this principle, nurses strive to establish a secure environment
where mothers feel free to articulate these emotions without judgment,
thereby fostering emotional well-being.
 Carative factor #7, “Engaging in genuine teaching- learning experience
that attends to unity of being and meaning, attempting to stay within
others’ frames of reference” – Ensuring cesarean-section mothers
receive education and information is crucial for their comprehension of
the surgical procedure, recuperation, and newborn care. This principle
underscores the significance of clear communication and customized
educational approaches.
 Carative factor #8, “Creating healing environment at all levels (physical
as well as non-physical), subtle environment of energy and
consciousness, whereby wholeness, beauty, comfort, dignity and
peace are potentiated” – This includes taking into account not just the
physical environment but also considering emotional and spiritual

aspects, ensuring a comprehensive approach to care. As part of this
approach, the nurse should ensure the creation of a secure, pleasant,
and private space for the mother to engage in breastfeeding or
pumping.
In summary, Jean Watson's Human Caring Theory offers a complete
approach to nursing care, especially relevant for cesarean-section mother.
The theory highlights the special connection between the nurse and client,
emphasizing empathy and compassion. When applied to cesarean-section
care, the theory guides the nurse in addressing the mother's physical,
emotional, and spiritual needs. The "ten carative factors" act as principles,
fostering a supportive atmosphere and promoting healing. These factors
include respecting the mother's experience, offering emotional support, being
self-aware, acknowledging feelings, facilitating learning, and creating a
healing environment. Overall, Jean Watson's theory emphasizes a caring and
thorough approach to enhance the well-being of cesarean-section mothers
during their recovery.

XV. NURSING CARE PLAN
Date/ Assessment Need Nursing Plan of Care Nursing Intervention and Evaluation
Shift Diagnosis Rationale
11/30/23 S: P Impaired Bed After 5 hours INDEPENDENT: After 5 hours
-  Patient H Mobility related to of nursing 1. Built rapport of nursing
12/02/23 report Y Abdominal intervention, Rationale: For a good nurse-client intervention
TDH 5A difficulty S Incision and the patient will relationship. the patient
WARD of I Postoperative be able to: 2. Assessed mobility by evaluating was able to:
7 AM moving O pain. 1. Show range of motion and pain levels. 1. Show
- on bed. L improved Rationale: This helps understand improved
3 PM  Pain O Scientific basis: mobility by the patient's physical capabilities mobility,
scale of G Post-surgery pain increasing and identify any restrictions or evidenced by
7/10 I and abdominal their range of limitations in movement and pain an increased
C cuts can lead to motion and intensity. active range of
muscle guarding, ability to turn 3. Encouraged and assisted with motion and

O: decreased joint in bed. non-drug pain management the ability to
● On bed N mobility, and 2. Express techniques like positioning, deep turn in bed
● 1 day E inflammation. understanding breathing exercises, and distraction and walk.
post-operative E This physiological of their methods. 2. Effectively
primary LSCS D response, along situation, risk Rationale: Adequate pain control express
● Decreased with surgical factors, enhances the patient's willingness understanding
ability stress hormones therapeutic and ability to participate in mobility of their health
to move and pain regimen, and exercises. situation,
around the medications, can safety 4. Incorporated range of motion identify
bed affect muscle measures. exercises and gradually progressed relevant risk
● Expressions function. to more complex movements as the factors,
of Individual patient became more comfortable. accurately
discomfort differences and Rationale: This enhances describe the
during psychosocial circulation, reduces discomfort, and importance of
movement factors add supports the patient's overall well- the
indicated complexity to the being during recovery. therapeutic

pain. relationship 5. Utilized support aids like pillows regimen such
between pain and and bed features to make it easier as exercises,
mobility for the patient to move into different walking, and
impairment. positions and maintain them medication,
Therefore, it's comfortably. and
crucial to balance Rationale: This prevents demonstrate
effective pain musculoskeletal strain and reduces awareness of
management with the risk of pressure ulcers by safety
early walking distributing pressure evenly, thus measures.
strategies for promoting overall comfort.
optimal 6. Monitored the patient for signs of - GOAL MET -
postoperative dizziness, weakness, or fatigue
recovery. during movement.
Rationale: To ensure patient safety
and prevent falls.
7. Provided and educated the

patient on the use of assistive
devices ensuring that they are
within reach and the patient knows
how to use them safely.
Rationale: This promotes safety,
enhances independence, and
facilitates a smoother recovery
process.
8. Educated the patient about the
importance of early ambulation, the
expected progression of
postoperative pain, and the role of
pain medications in improving
mobility.
Rationale: This encourages patient
engagement, ensures

comprehension, facilitates
adherence to the treatment plan,
and promotes active involvement in
their care.
Date/ Assessment Need Nursing Plan of Nursing Intervention and Evaluation

Shift Diagnosis Care Rationale
11/30/23 8:00 AM S Risk for surgical After 6 hours Independent: After 6 hours of
- O: A site infection of nursing 1. Identified the patient by asking nursing
12/02/23 - Post F related to lower intervention, the name and birthdate. intervention,
TDH 5A operative E segment the patient R: Misidentification can result in the patient was
WARD primary T cesarean section will be able managing a wrong patient, which able to:
7 AM LSCS Y (LSCS) as to: puts patient safety at serious risk.
- -Surgical site manifested by 1. 2. Established rapport. R: To have 1. Understand
3 PM covered A incision of Comprehend a good nurse-client relationship. the risk factors
with N abdomen and and assess 3. Monitored vital signs, most of surgical site
waterproof D uterus. the potential importantly the temperature. infection and
dressing risk factors R: It gives specific information articulate that
- Break in S Scientific Basis: associated that can be used to evaluate the certain
skin integrity E with surgical health of a patient. conditions can
- Site is C A surgical site site 4. Assessed the site for swelling, increase the
raised U infection (SSI) is infections. discharge, tenderness, and pain. risk for

slightly R an infection that 2. R: To determine early signs of infection due to
and pinker I develops in the Recognize infection. impaired
than the T area of a surgical preventive 5. Enlightened both patient and immune
rest of the Y procedure. It can actions watcher about the risk and factors response to
skin range from a against of surgical site infection by surgical stress.
VITAL superficial skin infection, like providing patient-related
SIGNS: infection to a hand information. R: This allows them to
- T - 35.4 more serious washing, make informed decisions about 2. Identify
infection involving maintaining their health and care. preventive
tissues, organs, proper 6. Recommended routine or actions against
or implanted hygiene, and preoperative body shower. R: To infection by
materials. The adhering to reduce bacterial colonization. demonstrating
CDC provides prescribed 7. Encouraged the patient and proper hand
guidelines and medication emphasized constant and proper hygiene and
tools to help schedules. hand hygiene. R: To prevent the taking the
prevent SSIs. spread of microorganisms and antibiotic after

Community infections. meals at the
involvement and 8. Emphasized the necessity of correct time.
public education taking antibiotics as directed and
about these discussed the importance of not GOAL MET
infections and using “leftover” drugs unless
protective specifically instructed by the
measures are physician.
crucial. R: Inappropriate use can lead to
Resources should development of drug-resistant
be accessible to strains or secondary infection.
help the public Collaborative:
understand SSIs 9. Cleansed the incision site per
and take facility protocol by gently washing
necessary it with sterile water and mild soap.
precautions. R: To reduce potential infections
and to prevent the growth of

bacteria.
10. Changed dressing, as
indicated, by using aseptic
technique and 10% betadine
solution. R: To remove bioburden
and prevent infection.
Date/ Assessment Need Nursing Plan of Care Nursing Interventions Evaluation
Shift Diagnosis and Rationale

11/30/23 After 6 hours of Independent: After 6 hours of
- Subjective P Insufficient nursing intervention, 1. Identified the patient by nursing intervention,
12/02/23 cues: H Breastmilk the patient will be asking the name and the patient was able
TDH 5A “walay Y Production able to: birthdate. to:
WARD nagagawas S related to 1. The client can R: Misidentification can
7 AM na gatas sa I insufficient adapt ways to result in managing a wrong 1. There was
- akong totoy O maternal increase milk patient, which puts patient an increased
3 PM ma’am” as L fluid volume production. safety at serious risk. milk
verbalized by O 2. Develop plan production.
the client. G Scientific to correct/ 2. Established rapport. 2. Demonstrated
I Basis: change R: To have a good nurse- and
Objectives C Breast milk contributing client relationship. maintained
cues: A production factors. techniques to
- absence of L and quality 3. Demonstrate 3. Assess the mother’s enhance milk
milk can be techniques to knowledge about production.
production affected by enhance milk breastfeeding and the 3. Had learned

with nipple N fluid intake, production. extent of instruction that about
stimulation E particularly 4. Achieve has been provided. breastfeeding
-delayed milk E in cesarean mutually R: lack of knowledge, and
production D mothers who satisfactory unresolved problems, or confidently
- the baby is S may breastfeeding stories told by others may breastfed her
fed by experience pattern with cause client to doubt baby without
formula milk reduced infant content abilities and chances for doubted her
thru feeding appetite, after feedings success. abilities.
bottle. nausea, and gaining 4. Achieved
vomiting, or weight 4. Identify cultural mutually
pain after appropriately. expectations and conflicts satisfactory
surgery. This about breastfeeding and breastfeeding
can lead to beliefs or practices pattern with
dehydration regarding lactation, let- infant content
and down techniques, and after feedings
decreased maternal food preferences. and gaining

blood R: understanding the weight
volume, impact of culture and appropriately.
affecting the idiosyncrasies of specific 5. Increased her
function of feeding practices is fluid intake.
mammary important to determine the GOAL MET
glands and effect on infant
the release breastfeeding success.
of prolactin
and oxytocin 5. Encourage unrestricted
hormones frequency and duration of
that regulate breastfeeding.
milk R: Provides stimulation of
production breast tissue and may
and ejection. increase milk supply
naturally.

6. Emphasize the
importance of adequate
fluid intake.
R: alternating types of
fluids (e.g., water, juice,
and decaffeinated
tea/coffee, and milk)
enhances intake,
promoting milk production.
Note: beer and wine are
not recommended for
increasing lactation.
7. Instruct client to cleanse
her nipple from inner to
outer (cleanest to dirtiest)
with a warm-sterile water.

R: to prevent the baby
against bacterial infection.
8.Demonstrate the breast
massage technique to
increase milk supply
naturally.
R: gently massaging the
breast while the infant
feeds from it can improve
the release of higher
calorie hindmilk from the
milk glands.
9. Recommend using the
breast pump 8 to 12 times

a day.
R: expressing with a
hospital-grade,
double(automatic) pump is
ideal for stimulating/
reestablishing milk supply.
10. Suggest using a breast
pump or hand expression
after the infant finishes
breastfeeding.
R: continued breast
stimulating cues the
mother’s body that more
milk is needed, increasing
supply.

11. Monitor increased filling
of breasts in response to
nursing and/or pumping
R: to help evaluate the
effectiveness of
interventions.

XVI. DISCHARGE PLAN
M – Medication
Encourage client to follow all the instructions including especially the
medications as by the doctor’s order.
E – Exercise
Patients should be encouraged to focus on improving their personal level of
regular exercise walking. It may help to have a healthy lifestyle
Increase your activities bit by bit. Plan your activities so that you don’t have to
go up or down stairs more than needed. Do postsurgical deep breathing and
coughing exercises. Ask your healthcare provider for instructions.
. Exercise promotes healthy body. Exercise after giving birth can also hasten
recovery, and assist with muscle strength and toning and improves mood.
Instruct the patient to talk to their caregiver before they start exercising.
Together they can plan the best exercise program for them.
T – Treatment
Eat healthy foods as it is advised by physician.
Encourage client to follow all the instructions including especially the
medications as by the doctor’s order.
Instruct the patient to always rely on the physician if complications occur and
to have a regular checkup with their doctor.

Keep it Clean: Instruct the patient to keep the incision clean and dry. Gently
clean the incision site with mild soap and water during showers, and pat it dry
with a clean, soft towel.
A nutrient-dense diet full of complex carbs, fiber, healthy fats and protein, plus
adequate hydration, can help heal your body. A healthy postpartum eating
plan is the way to go to stave off bone loss, replenish your iron stores, head
off hemorrhoids and much, much more. It promotes milk production.
H – Health Teaching
- Breast
- Wash breast daily at bath or shower time.
- Wash the breast daily during bathing time. Instruct the client not to
wash the breast with soap because it may eliminate sebaceous
secretion in the breast.
To clean the breast off dirt and bacteria and prevent gastrointestinal
tract infection to the baby
To prevent complications like breast engorgement and nipple soreness
To ensure hygienic breast feeding
- Wear supportive bra.
Wear a nursing bra for support and to relieve discomfort. Some women
may sleep in a bra at night as well.
- Wash or clean hands when feeding the infant.

- Advise the client to put clean cloth in the bra to absorb the
moisture or breast discharge.
- Lochia
- Instruct client to report any abnormal progression of lochia,
excessive bleeding, foul-smelling lochia or large blood clots to their
physician immediately.
- Lochia should never exceed a moderate amount, such as 4 to 8
saturated perineal pads daily with an average of 6.
- Sexual Activity
- Abstain from intercourse until incision is healed
- Watch for Redness, Swelling, or Discharge: Educate the patient about
signs of infection, such as increased redness, swelling, warmth, or any
unusual discharge from the incision. Promptly report any concerning
symptoms to healthcare providers.
O - Out-patient
Ensure that she will follow the health teachings that you have given especially
the maintenance drugs prescribed. FOLLOW UP CHECKUP

Recognize the medications. What they look like, how frequently the
medication should be taken, and why you should take them. Inform the patient
to never take any medication that was not recommended by a doctor.
Advised the patient’s family to follow up check-up as physician’s order to
prevent further complications and to update the medical team concerning the
progress of the patient’s condition and to promote continuity of care.
D – Diet
Advise patient and family members to eat nutritious foods such as fruits and
vegetables.
Encourage the patient to avoid foods such as processed meat, salty snacks
and sweet drinks.
-The client should eat a balanced diet. eat whole grains, fruits and vegetables
every day and limit sodium in your diet. New moms should also emphasize
sources of protein, calcium, vitamin C and iron. Nutrition plays a role in energy
levels, preventing illness, breast milk quality, and weight control.
having a balanced and healthy diet will help your body to heal and certain
types of foods that are high in protein and rich in iron are encouraged as they
are believed to help provide replenishment to the mother to accelerate her
recovery. AVOCADO
Precautions:

Instruct patients to seek help from other family members to be present during
mealtimes in case if the person has difficulty feeding him or herself, or alert
hospital staff to this need.
Encourage the patient to notify medical staff of any difficulties in chewing or
swallowing and any allergic reactions.
S- Spiritual
-Encourage the patient to always ask for guidance and safety and deepen her
relationship with God.
Encourage patients to have an outing to relax but be careful when doing
activities or doing some fun.
Communicate and talk to someone and feel motivated.

XVII. RECOMMENDATIONS
Reflecting on the case study involving a patient who underwent
Primary Lower Segment Cesarean Section (LSCS), the following
recommendations are imperative for both the optimal growth and
development of the baby and the well-being of the client herself:
Rest and Recovery: During the postpartum period, emphasize the
significance of adequate rest and recovery. Encourage the new mother to
prioritize rest, especially within the initial weeks after childbirth.
Monitoring for Infection: encourage Regular monitoring for signs of infection
at the incision site, including redness, swelling, or discharge. seek immediate
medical attention if any of these symptoms occur.
Wound Care: Emphasize meticulous wound care practices, including
maintaining cleanliness and dryness of the incision. Adherence to healthcare
provider instructions for dressing changes is crucial. Sitz baths or warm water
rinses post-toilet use can enhance comfort and facilitate healing.
Activity and Mobility: advocate for a Gradual return to normal activities such
as walking, with an emphasis on avoiding heavy lifting and strenuous
exercises during the initial recovery period.
Pain Management: Facilitate the appropriate use of over-the-counter pain
relievers, as recommended by the healthcare provider, to manage postpartum
discomfort or pain. Strict adherence to prescribed dosage instructions is
essential.

Nutrition and Hydration: Emphasize the importance of a balanced diet with
ample fluids to support recovery and potential breastfeeding. Monitor and
ensure adequate hydration and consumption of nutritious foods.
Emotional Well-Being: Acknowledge and address the emotional challenges
associated with the postoperative period, recognizing its physical and
emotional demands. Maintain attentiveness to her emotional well-being, as
postpartum mood swings, including baby blues or postpartum depression,
may manifest
Support Network: Surround her with a support network of family and friends
who can aid with daily tasks and childcare, allowing her time to rest and
recover.
Follow-Up Care: Stress the importance of attending all postpartum follow-up
appointments with the healthcare provider. These appointments are critical for
monitoring both physical and emotional well-being and addressing any
emerging concerns.
Breastfeeding Support: If she chooses to breastfeed, offer guidance and
support. Ensure she has access to resources such as lactation consultants or
breastfeeding support groups.
Self-Care: Foster the practice of self-care by encouraging activities such as
short walks, relaxation techniques, and dedicated time for enjoyable pursuits.
These practices contribute to both physical and emotional well-being during
the postoperative recovery period.

XVIII. BIBLIOGRAPHY
BOOKS
Doenges, Marilyn E., Moorhouse, M. F., & Murr, A. C. (2022). Risk for
Surgical Site Infection. In Nurse’s Pocket Guide, Diagnoses, Prioritized
Interventions, and Rationales (16th Edition, pp. 975–979). essay, E.A.
Davis Company.
Doenges, Marilynn E., Moorhouse, M. F., & Murr, A. C. (2022a). Impaired Bed
Mobility. In Nurse’s Pocket Guide, Diagnoses, Prioritized Interventions,
and Rationales (16th Edition, pp. 611–616). essay, E.A. Davis Company.
Doenges, Marilynn E., Moorhouse, M. F., & Murr, A. C. (2022b). Insufficient
Breast Milk Production. In Nurse’s Pocket Guide, Diagnoses, Prioritized
Interventions, and Rationales (16th ed., pp. 103–107). essay, F.A. Davis.
Udan, J. Q. (2020a). Chapter 5 - Jean Watson “Philosophy and Theory of
Transpersonal Caring.” In Theoretical Foundation in Nursing (2nd
Edition, pp. 81–109). essay, APD Educational Publishing House.
Udan, J. Q. (2020b). Chapter 20 - Virginia Henderson "Nursing Need Theory.
In Theoretical Foundation in Nursing (2nd Edition, pp. 489–501). essay,
APD Educational Publication House.
Woods, A., & et al. (2023). Ampicillin. In Nursing 2023 Drug Handbook (43rd
Edition, pp. 131–133). essay, Wolters Kluwer.

Woods, A., & et al. (2023). Cefazolin sodium. In Nursing 2023 Drug
Handbook (43rd Edition, pp. 284–286). essay, Wolters Kluwer.
Woods, A., & et al. (2023). Ranitidine. In Nursing 2023 Drug Handbook (43rd
Edition, pp. 50). essay, Wolters Kluwer.
Woods, A., & et al. (2023). Ketorolac Triomethamine. In Nursing 2023 Drug
Handbook (43rd Edition, pp. 53). essay, Wolters Kluwer.
Woods, A., & et al. (2023). Tramadol Hydrochloride. In Nursing 2023 Drug
Handbook (43rd Edition, pp. 1457-1461). essay, Wolters Kluwer.
Woods, A., & et al. (2023). Ferrous Sulfate. In Nursing 2023 Drug Handbook
(43rd Edition, pp. 1647). essay, Wolters Kluwer.
Woods, A., & et al. (2023). Ferrous Sulfate. In Nursing 2023 Drug Handbook
(43rd Edition, pp. 307-310). essay, Wolters Kluwer.
WEBSITES
Abuelghar, W. M., El-Bishry, G., & Emam, L. H. (2019, December 1).
Caesarean deliveries by Pfannenstiel versus Joel-Cohen incision: A
randomised controlled trial. Journal of the Turkish German
Gynecological Association.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935539/
American College of Obstetricians and Gynecologists. (2018). ACOG Practice
Bulletin No. 107: Induction of labor. Obstetrics and gynecology.
https://pubmed.ncbi.nlm.nih.gov/19623003/

American College of Obstetricians and Gynecologists. (2019a, February).
ACOG Practice Bulletin No. 209: Obstetric Analgesia and anesthesia.
Obstetrics and gynecology. https://pubmed.ncbi.nlm.nih.gov/30801474/
American College of Obstetricians and Gynecologists. (2019b, February).
Approaches to limit intervention during labor and birth. ACOG.
https://www.acog.org/clinical/clinical-guidance/committee-opinion/
articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth
Berghella. (2019). Cesarean birth: Surgical technique. UpToDate.
https://www.uptodate.com/contents/cesarean-birth-surgical-technique
Bhasin, S., & Jameson, J. L. (2019, January). Disorders of the testes and
male reproductive system. McGraw Hill Medical.
https://accessmedicine.mhmedical.com/content.aspx?
bookid=2129&sectionid=192287591
Centers for Disease Control and Prevention. (2020, November 24). Surgical
Site infection (SSI). https://www.cdc.gov/hai/ssi/ssi.html?
fbclid=IwAR3WR_42GdkSAJT1coKDT8mX2ljNEQ6
Cheng YW; Caughey. (2017). Defining and managing normal and abnormal
second stage of Labor. Obstetrics and gynecology clinics of North
America. https://pubmed.ncbi.nlm.nih.gov/29078938/
Cherry, K. (2023, March 11). How a baby develops during the prenatal period.
Verywell Mind. https://www.verywellmind.com/stages-of-prenatal-
development-2795073

DrugBank. (2019). Tranexamic acid. Uses, Interactions, Mechanism of Action
| DrugBank Online. https://go.drugbank.com/drugs/DB00302
Duignan, B. (2023, October 12). Psychoanalysis. Encyclopædia Britannica.
https://www.britannica.com/science/psychoanalysis
Embay, C. J. (2021, June 1). Intraoperative findings and neonatal outcomes
in emergency cesarean section for non-reassuring fetal health rate
pattern among low-risk term pregnancies in a tertiary hospital in Davao
City: A retrospective study. Registry Health Research.
https://registry.healthresearch.ph/index.php/registry?
view=research&layout=details&cid=3216
Emily. (2017, October 1). What are the parts of the male reproductive
anatomy?. Planned Parenthood.
https://www.plannedparenthood.org/blog/what-are-the-parts-of-the-male-
reproductive-anatomy
Fernando, A. (2020, December 3). What is fertilization? how do the sperms
meet the eggs? - process explained: Cloudnine blog. RSS.
https://www.cloudninecare.com/blog/sperm-meet-egg-the-process-of-
fertilisation
Festin, M. R., Laopaiboon, M., Pattanittum, P., Ewens, M. R., Henderson-
Smart, D. J., & Crowther, C. A. (2019, May 9). Caesarean section in four
South East Asian countries: Reasons for, rates, associated care
practices and health outcomes. BMC pregnancy and childbirth.

Friedman, E. (2020). Primigravid Labor; a graphicostatistical analysis.
Obstetrics and gynecology. https://pubmed.ncbi.nlm.nih.gov/13272981/
Gurung, P., Yetiskul, E., & Jialal, I. (2023, May 1). Physiology, male
reproductive system - statpearls - NCBI bookshelf. National Library of
Medicine. https://www.ncbi.nlm.nih.gov/books/NBK538429/
Güngördük, K., Olgaç, Y., Gülseren, V., & Kocaer, M. (2018, September).
Active management of the third stage of Labor: A brief overview of key
issues. Turkish journal of obstetrics and gynecology.
Harris SJ;Janssen PA;Saxell L;Carty EA;MacRae GS;Petersen KL; (2018).
Effect of a collaborative Interdisciplinary Maternity Care Program on
perinatal outcomes. CMAJ : Canadian Medical Association journal =
journal de l’Association medicale canadienne.
Hirsch, I. H. (2023, February). Structure of the male reproductive system -
men’s health issues. Merck Manuals Consumer Version.
https://www.merckmanuals.com/home/men-s-health-issues/biology-of-
the-male-reproductive-system/structure-of-the-male-reproductive-system
Horn, R., & Kramer, J. (2022, September 19). Postoperative pain control -
statpearls - NCBI bookshelf. National Center for Biotechnology
Information. https://www.ncbi.nlm.nih.gov/books/NBK544298/

Johnson, T. (2022, November 11). Sexual response cycle: Sexual arousal,
orgasm, and more. WebMD.
https://www.webmd.com/sex-relationships/sexual-health-your-guide-to-
sexual-response-cycle
Kammath, V. (2022, February 7). The breasts. TeachMeAnatomy.
https://teachmeanatomy.info/thorax/organs/breasts/
Karthik. (2020, September 1). Embryo development - a development process
of fetus - week by Week. BYJUS. https://byjus.com/biology/embryo-
development/
Karthik. (2021, September 15). Fertilization & implantation- an overview of
fertilization in humans. BYJUS. https://byjus.com/biology/fertilization-
and-implantation/
Kaya B, Ozay OE, Ozay AC, Tüten A. (2023). Can the Pfannenstiel skin
incision length be adjusted according to the fetal head during elective
cesarean delivery?. Frontiers in surgery.
Kilpatrick SJ, Laros RK. (2019). Characteristics of normal labor. Obstetrics
and gynecology. https://pubmed.ncbi.nlm.nih.gov/2733947/
Liao, J. B., Buhimschi, C., & Norwitz, E. (2019). Normal labor: Mechanism
and duration. Obstetrics and gynecology clinics of North America.

Mayo Clinic. (2022, June 16). C-section. https://www.mayoclinic.org/tests-
procedures/c-section/about/pac-20393655
McGraw Hill. (2022). Male reproductive system. McGraw Hill Medical.
https://accessmedicine.mhmedical.com/content.aspx?
bookid=3307&sectionid=275922413
Perry, B. (2019). What you should know about the stages of prenatal
development: Jefferson Health. Jefferson Health - Greater Philadelphia
& South Jersey Region.
https://www.jeffersonhealth.org/your-health/living-well/what-you-should-
know-about-the-stages-of-prenatal-development
Petiprin, A. (2023, June 14). Mercer’s Maternal Role Attainment Theory.
Nursing Theory. https://nursing-theory.org/theories-and-models/mercer-
maternal-role-attainment-theory.php?
fbclid=IwAR04H85cgpjcgiuf6sHM52IuaWcyvmfv45nIELYxzasbUs5Nv0D
hQjEGeeQ
Rosner J, Samardzic T, Sarao MS. (2022, July 7). Physiology, female
reproduction - statpearls - NCBI bookshelf. StatPearls.
https://www.ncbi.nlm.nih.gov/books/NBK537132/
Saigo, H. (2023, November 21). Piaget’s theory of cognitive development |
overview & stages. Study.com. https://study.com/learn/lesson/jean-
piaget-stages-cognitive-development-overview-theory-analysis.html

Van Der Ham, D., & et al. (2018, April 8). Methods for the diagnosis of rupture
of the fetal membranes in ... - pubmed. National Library for Medicine.
Vedantu. (2023, August 11). Implantation in human - definition, meaning,
process, duration and symptoms. VEDANTU.
https://www.vedantu.com/biology/implantation-in-human
World Health Organization. (2021, June 16). Caesarean section rates
continue to rise, amid growing inequalities in access.
https://www.who.int/news/item/16-06-2021-caesarean-section-rates-
continue-to-rise-amid-growing-inequalities-in-access
Zhang J;Troendle J;Mikolajczyk R;Sundaram R;Beaver J;Fraser W; (2020,
April). The natural history of the normal first stage of Labor. Obstetrics
and gynecology. https://pubmed.ncbi.nlm.nih.gov/20308828/

Final Obward CP

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Final Obward CP

Uploaded by

Copyright:

Available Formats

TAGUM DOCTORS COLLEGE INC.

In Fulfilment of the Requirements in

Obongen, Marie Kathleen D.

Palma, Jules Earl H. Protacio, Alleya Fybes H.

Pascua, Krizhel Mae M. Puno, Gwyneth V.

Pascual, Decere D. Quintela, Jana Therezsa B.

Peteros, Alyn Kaye D. Rufo, Hannah D.

Pizon, Marc June D. Silutan, Rexie Louella T.

Ponsica, Christine Joy R. Villanueva, Bea T.

PAGE \* MERGEFORMAT 2 | Page

IV. Patient’s Data…………………………………………………………..9

VI. Definition of Complete Diagnosis……………………………………31

VII. Comprehensive Physical Assessment……………………………...34

VIII. Anatomy and Physiology……………………………………………..56

IX. Etiology and Symptomatology……………………………………….84

XI. Doctor’s Order……...………………………………………………….96

XII. Diagnostic Exam……………………………………………………..107

XIII. Drug Study……………………………………………………………110

XIV. Nursing Theories…………………………………………………….177

XV. Nursing Care Plan…………………………………………………...187

XVI. Discharge Plan (M.E.T.H.O.D)……………………………………..204

PAGE \* MERGEFORMAT 2 | Page

We, Group 9 student nurses of BSN-2C at Tagum Doctors College, extend

completion of this case presentation. Without their unwavering support and

guidance, this endeavor would not have come to completion.

throughout the entire process of conceptualizing and presenting this case.

We extend a special acknowledgment to Ma’am Melrose Cubillo, RN, our

esteemed clinical instructor. Her unwavering dedication and insightful contributions

significantly enriched our learning experience, leaving an indelible mark on the

shaping our academic endeavors.

and shortcomings we have encountered, their enduring encouragement towards our

aspirations has been a constant source of strength.

To our group members, for their wholehearted dedication in conducting

effort and teamwork demonstrated by each member significantly contributed to the

success of the project, underscoring the efficacy of collaboration.

We extend our profound and heartfelt gratitude to the dedicated staff of

Tagum Doctors Hospital Inc, especially the nurses at TDH-5A-Ward. Your

PAGE \* MERGEFORMAT 2 | Page

have significantly contributed to the triumphant realization of this noteworthy

been instrumental in shaping the depth and richness of our analysis.

PAGE \* MERGEFORMAT 2 | Page

Caesarean delivery (C-section) is used to deliver a baby through surgical

American College of Obstetricians and Gynecologists, this might not be a good

Medical Education and Research, 2022).

According to new research from the World Health Organization (WHO),

5 (21%) of all childbirths. While a caesarean section can be an essential and

5% in sub-Saharan Africa, indicating a concerning lack of access to this lifesaving

PAGE \* MERGEFORMAT 2 | Page

and Turkey), caesarean sections now outnumber vaginal deliveries. Worldwide

The most common indications for caesarean were malpresentation, previous

caesarean section, cephalopelvic disproportion, and fetal distress. In The

Philippines, mothers were given prophylactic antibiotics pre-operatively almost

than 500 ml blood loss (PubMed, 2019).

The client, KJB, is a 22-year-old primigravida with GTPAL Score of G1P1001.

Segment Transverse Cesarean Section using Joel-Cohen Incision (C-section).

PAGE \* MERGEFORMAT 2 | Page

of cesarean delivery (C-section) on an individual. Another goal of this case

presentation is in order to distinguish between a typical pregnancy and a cesarean

The student nurses would be able to:

 Remembering: To determine the client's state, collect as much information as

you can and remember it all.

 Understanding: Understand the theoretical background of pregnancy related

to Cesarean delivery and describe how it is different from normal pregnancy.