NURSING CASE STUDY:

CAESARIAN SECTION
I. DEMOGRAPHIC DATA

Name: A.G.M
Gender: Female
Civil Status:
Married
Address: Bacoor, Cavite
Age: 40 years old
Birthdate: September 26, 1969
Birthplace: Imus, Cavite
Religion: Roman Catholic
Occupation: Housewife
Diagnosis: Elderly Gravida, PU 39-40 wks AOG
(Low Lying Placenta Frank Breech)
Operation Performed: Low Transverse Caesarian Section

II. HEALTH HISTORY

Patient A.G.M is a 40 year old female, who is preganant for 40

weeks, married and a mother of two. She is a catholic with fair
complexion, stands 153 cm and weighs 76 kgs. She was born at
Dasmarinas, Cavite and second among three siblings.
Her AOG is 40 weeks. Patient had a previous CS delivery because
she had difficulty on delivering her child.
Patient had no history of asthma, no seizure, no diabetes mellitus
and no hypertension. Patient had complete immunization and had no
allergies to either food or medications.

III. LABORATORY / DIAGNOSTICS

Actual Normal Nursing

Procedure / Date Implications
Findings Findings Responsibilities
1. CBC Pre:
 Check Doctor’s
 Actual Normal Nursing
Procedure / Date Implications
Findings Findings Responsibilities
Hemoglobin 116 120 – 140 Decrease Order.
g/dL - Indicates  Inform client and
occurrence of explain the
anemia procedure.
Hematocrit 0.35 0.30 Increase  No need for NPO.
- Indicates
hypercoagulatio Intra:
WBC 8.0 5 - 10 n  Perform blood
Segmenters 0.60 0.36 - 0.66 Normal extraction
Lymphocytes 0.14 0.22 - 0.40 Normal (venipuncture
Decrease technique) using
- Indicates high aseptic
risk for technique.
Eosinophils 0.02 0.01 - 0.04 acquiring  Put extracted
Stab Cells 0.04 0.02 - 0.05 infection blood in
Platelets 320 150 – Normal ethyldiamino-
400x9/L Normal tetracetate
Normal (EDTA) or the
lavender top
vacuum tube.

Post:
 Label the
container
properly and
correctly.
 Send specimen to
the lab
immediately.
 Document the
result to the
chart and inform
 Actual Normal Nursing
Procedure / Date Implications
Findings Findings Responsibilities
physician that
the result is out.

URINE ANALYSIS
Microscopic Exam Chemical Exam

Color: Yellow Albumin: Negative

Transparency: Hazel Sugar: Negative
pH: 6.0 (7.35 – 7.45)
Specific Gravity: 1.010 (1.010 – 1.025)
Epithelial Cells: Moderate

IV. INDICATIONS FOR THE PROCEDURE

CAESARIAN SECTION

A Caesarian section is a form of childbirth in which a surgical

incision is made through a mother’s abdomen and uterus to deliver one
or more babies. It is usually performed when a vaginal delivery would
put the baby’s or mother’s life or health at risk; although in recent
times it has been also performed upon requests for births that would
otherwise have been normal.

Caesarian section (CS) is recommended when vaginal delivery

might pose a risk to the mother or baby. Reasons for CS include:

 Precious (high risk) fetus

 Prolonged labor or failureto progress (dystocia
  Apparent fetal distress
 Apparent maternal distress
 Complications (pre-eclampsia, active herpes)
 Catastrophes such as cord prolapse or uterine rupture
 Multiple births
 Abnormal presentation (breech or transverse positions)
 Failed induction of labor
 Failed instrumental delivery
 The baby is too large (macrosomia)
 Placental problems (placenta previa, placental abruption/
placenta accrete)

 Umbilical cord abnormalities

 Contracted pelvis
 Sexually transmitted infections such as genital herpes
 Previous caesarian section
 Old age

V. PREPARATION

 POSITIONING

Patient that would undergo caesarian delivery should be

required to be in SUPINE POSITION in the entire course of
delivery. This position provides access to the internal organs
 needed to be repaired in a certain operation. This position is used
for procedures of the anterior body such as: abdominal, thoracic,
facial and anterior upper and lower extremity procedures.

 CATHETER INSERTION

The patient is placed in a lithotomy position. The nurse

must wear sterile gloves when performing this procedure. The
genital area is exposed. The area is cleansed with the use of
antiseptic solution (3 times). Cleaning of the genital area starts at
the top of the genitalia to the bottom using a pattern-7 motion on
both sides. Then, the catheter is inserted. To facilitate the
insertion, the catheter is lubricated. Urine will flow when the
catheter passed the bladder. Then, the catheter is secured by
injecting 10ml of sterile water on the Y-port. The urune bag is
then attached to the catheter.

 APPLICATION OF DRAPES

Draping includes the use of towels, eye sheets and

laparatomy sheet to maintain the accessibility and
maximize the area to be examined and repaired and also
provide a continuous sterile field.

 ANESTHESIA

Spinal and epidural anesthesia are ways to numb surgical

patienst from the chest on down the legs. Both spinal and epidural
anesthesia involve placing medications directly into the spinal area.
The patient may be given an injection of local anesthetic diretly over
the spot where the spinal or epidural anesthetic will be given, to
decrease pain from the needle. Epidural anesthesia may be given as a
single injection just outside of the sac of fluid that surrounds the
spinal cod. When more than one dose of epidural anesthesia might be
required, the anesthetist will leave a tiny, flexible tube or catheter
in place outside of the fluid sac surrounding the spinal cord. More
anesthetic can be given easily if the operation takes longer than
expected.

 INDUCTION OF ANESTHETIC AGENT

The patient is placed on a lateral position with back

exposed. The nurse must wear sterile gloves before performing
the procedure. The area where the anesthesia is to be inducted is
cleansed with alcohol and followed by antiseptic solution (3
times). The cleaning starts on the insertion site with circular
motion using firm strokes.

 INCISION SITE
 The patient is placed on a supine position exposing the
abdominal area. Sterile gloves are donned using the open glove
method before performing the procedure. The operative site is
cleansed with the use of cleanser (3 times), wet OS (3 times) and
then changed the gloves before applying the antiseptic (3 times).
Beginning at the incision site, the area will include posterior
breast as the upper margin, the axillary line as lateral margins
and to the anterior two thirds of the legs as posterior margin.
Cleaning would always include use of firm circular motion leaving
no spaces unwiped.

VI. INSTRUMENTS (C/S set)

 Small kellies (6)

 Towel clips (4)
 Straight kellies (2)
 Needle holder (2)
 Mayo Collins (2)
 Tissue forceps (2)
 Ovum forcep (1)
 Metzenbaum (1)
 Ochsners
 Richarson retractor
 Medium Kellies (6)
 Allises (8)
 Bobcock (2)
 Army navy (2)
 Thumb forceps (2)
 Blade handle #3 and #4
 Mayo scissor (1)
 Bladder retractor
 Deaver
 Self-retaining retractor

VII. PROCEDURES
 • Client was place in supine position with contraptions noted and
checked by anesthesiologist.
• Skin preparation of the induction site of anesthetic agents
• Induction of anesthesia, either spinal or epidural and sometimes
general anesthesia
• Abdominal skin preparation to be done
• Application of drapes, eye sheet, laparotomy sheet
• Sequential incision begins: the skin, subcutaneous, peritoneum
penetrating to the uterus
• Delivery of the baby
• Delivery of the placenta
• Sequential closing using appropriate absorbable sutures
• Hemostasis secured, peritoneal wash done
• Initials OS, instruments and needles completed

VIII. ANATOMY AND PHYSIOLOGY

ANATOMY AND PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM

 EXTERNAL GENITALIA

Our overview of the reproductive system begins at the external genital area
— or vulva—which runs from the pubic area downward to the rectum. Two folds of
fatty, fleshy tissue surround the entrance to the vagina and the urinary opening:
the labia majora, or outer folds, and the labia minora, or inner folds, located
under the labia majora. The clitoris, is a relatively short organ (less than one inch
long), shielded by a hood of flesh. When stimulated sexually, the clitoris can
become erect like a man's penis. The hymen, a thin membrane protecting the
entrance of the vagina, stretches when you insert a tampon or have intercourse.
INTERNAL REPRODUCTIVE STRUCTURE
The Vagina

The vagina is a muscular, ridged sheath connecting the external genitals

to the uterus, where the embryo grows into a fetus during pregnancy. In the
reproductive process, the vagina functions as a two-way street, accepting the
penis and sperm during intercourse and roughly nine months later, serving as
the avenue of birth through which the new baby enters the world .

The Cervix

The vagina ends at the cervix, the lower portion or neck of the uterus.
Like the vagina, the cervix has dual reproductive functions.
 After intercourse, sperm ejaculated in the vagina pass through the
cervix, then proceed through the uterus to the fallopian tubes where, if a
sperm encounters an ovum (egg), conception occurs. The cervix is lined with
mucus, the quality and quantity of which is governed by monthly fluctuations in
the levels of the two principle sex hormones, estrogen and progesterone.

When estrogen levels are low, the mucus tends to be thick and sparse,
which makes it difficult for sperm to reach the fallopian tubes. But when an
egg is ready for fertilization and estrogen levels are high the mucus then
becomes thin and slippery, offering a much more friendly environment to
sperm as they struggle towards their goal. (This phenomenon is employed by
birth control pills, shots and implants. One of the ways they prevent
conception is to render the cervical mucus thick, sparse, and hostile to sperm.)

Uterus

The uterus or womb is the major female reproductive organ of humans.

One end, the cervix, opens into the vagina; the other is connected on both
sides to the fallopian tubes.

The uterus mostly consists of muscle, known as myometrium. Its major

function is to accept a fertilized ovum which becomes implanted into the
endometrium, and derives nourishment from blood vessels which develop
exclusively for this purpose. The fertilized ovum becomes an embryo, develops
into a fetus and gestates until childbirth.

Oviducts

The Fallopian tubes or oviducts are two very fine tubes leading from the
ovaries of female mammals into the uterus.

On maturity of an ovum, the follicle and the ovary's wall rupture,

allowing the ovum to escape and enter the Fallopian tube. There it travels
toward the uterus, pushed along by movements of cilia on the inner lining of
the tubes. This trip takes hours or days. If the ovum is fertilized while in the
Fallopian tube, then it normally implants in the endometrium when it reaches
the uterus, which signals the beginning of pregnancy.

Ovaries

The ovaries are the place inside the female body where ova or eggs are
produced. The process by which the ovum is released is called ovulation. The
speed of ovulation is periodic and impacts directly to the length of a menstrual
cycle.

After ovulation, the ovum is captured by the oviduct, where it travelled

down the oviduct to the uterus, occasionally being fertilised on its way by an
incoming sperm, leading to pregnancy and the eventual birth of a new human
being.

The Fallopian tubes are often called the oviducts and they have small
hairs (cilia) to help the egg cell travel.