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Ovaries
Ovaries are approximately 4cm long by 2cm in diameter and of
approximately 1.5cm thick or the size and shape of almonds. They are grayish-
white and appear pitted on the surface. An unruptured, glistening clear, fluid-
filled graafian follicle or a miniature yellow corpus luteum (the structure left after
the ovum has been discharged often can be observed on the surface of the ovary.
Its function is to produce mature and discharge egg cells. In the process, the
ovaries produce estrogen and progesterone and initiate and regulate menstrual
cycles. With pregnancy, ovulation stops because of the feedback mechanism of
estrogen and progesterone produced by the corpus luteum early in pregnancy and
the placenta later in pregnancy. This feedback causes the pituitary gland to halt
production of FSH and LH without stimulation from these, ovulation will not
occur.
Uterus
It a part of uterus located above the vagina; the narrow part of the uterus.
It becomes more vascular and edematous during pregnancy in response to the
increased level of circulating estrogen from placenta.It softens in consistency due
to increased fluid between cells. It darkens from a pale pink to violet because of
increased vascularity. A tenacious coating of mucus fills the cervical canal, which
acts to seal out bacteria during pregnancy and thus help prevent infection in the
fetus and membranes.
Vagina
It is a hollow musculomembranous canal located posterior to the bladder
and anterior to the rectum. It extends from the cervix of the uterus to the external
vulva. Its function is to act as the organ of intercourse and to convey sperm to the
cervix so sperm can meet with the ovum in the fallopian tube. With child birth, it
expands to serve as the birth canal.
Fourchette
It is the ridge of tissue formed by the posterior joining of the two labia
minora nad the labia majora. This is the structure that is sometime cut
(episiotomy) during childbirth to enlarge the vaginal opening.
The median raphe of the levator ani, which is positioned between the anus
and vagina, is reinforced by the central tendon of the perineum on which canverge
the bulbocavernosus muscles, the superficial transverse perineal muscles and the
external anal sphincter.
Anus
Anal tissues are normally moist and hairless compared with perineal skin.
The tissue is coarser and more darkly pigmented. The anus is held closed by the
voluntary external muscle sphincter. The anus is the passage way of feces during
bowel movement.
Mammary Glands
These are the organs for milk production and are located in the breasts. A
rise in estrogen at puberty produces a marked increased in size from increased
connective tissue and deposition of fat in girls and a transient increase in boys. Its
glandular tissue is necessary for successful breast-feeding, remains undeveloped
until a first pregnancy begins. During pregnancy, she experiences a feeling of
fullness, tenderness or tingling in her breasts because of the increased stimulation
of breast tissue high estrogen level in the body. As pregnancy progresses, breast
size increases because of hyperplasia of mammary alveoli and fat deposits. Early
in pregnancy, breast begins readying themselves for the secretion of milk. And of
the 16th week, colostrum, the thin, watery, high-protein fluid that is the precursor
of breast milk, can be expelled from nipples.
DIAGRAM OF THE ORGAN AFFECTED
4.2 Schematic Drawing
SPERM EGG
Fertilization
Morula
Blastocyst
Implantation
Suppress menstruation
Trophoblast
EMBRYO
FETUS
CONCEPTUS
4.3 Disease Process
start to develop in small fluid-filled cysts called follicles. Normally, one of the
follicle" suppresses the growth of all of the other follicles, which stop growing
and degenerate. The mature follicle ruptures and releases the egg from the ovary
(ovulation). Ovulation generally occurs about two weeks before a woman's next
After ovulation, the ruptured follicle develops into a structure called the
corpus luteum, which secretes two hormones, progesterone and estrogen. The
progesterone helps prepare the endometrium (lining of the uterus) for the embryo
The egg is released and travels into the fallopian tube where it remains
until a single sperm penetrates it during fertilization (the union of egg and sperm;
see below). The egg can be fertilized for about 24 hours after ovulation. On
average, ovulation and fertilization occurs about two weeks after your last
menstrual period.
If sperm does meet and penetrate a mature egg after ovulation, it will
fertilize it. When the sperm penetrates the egg, changes occur in the protein
mother can provide only X chromosomes (she's XX), if a Y sperm fertilizes the
egg, your baby will be a boy (XY); if an X sperm fertilizes the egg, your baby
Within 24-hours after fertilization, the egg begins dividing rapidly into
many cells. It remains in the fallopian tube for about three days. The fertilized egg
(called a zygote) continues to divide as it passes slowly through the fallopian tube
to the uterus where its next job is to attach to the endometrium (a process called
implantation). First the zygote becomes a solid ball of cells, then it becomes a
hollow ball of cells called a blastocyst. Before implantation, the blastocyst breaks
out of its protective covering. When the blastocyst establishes contact with the
notice spotting (or slight bleeding) for one or two days around the time of
plug of mucus.
Within three weeks, the blastocyst cells begin to grow as clumps of cells
within that little ball, and the baby's first nerve cells have already formed. Your
developing baby is called an embryo from the moment of conception to the eighth
week of pregnancy. After the eighth week and until the moment of birth, your
blood from the time of conception and is produced by the cells that form the
placenta. This is the hormone detected in a pregnancy test; but, it usually takes
three to four weeks from the first day of your last period for the levels of hCG to
and levator ani is exerted posterior to the rectum, where their fusion forms the
levator plate, it is evident that a laceration through the anterior rectum, perineal
body, and posterior vagina is not likely to have been due to forces simultaneously
the injury disrupted the anal sphincter many of the patients will, by vigorously
hypertrophy which results in a side-to-side sphincter like action which helps hold
continence.
Pain fro sutured perineum can be intense especially when applying force
(the pulling pain from perineal stitches). Pain intervention should be done to
pain. Warm sitz bath can provide comfort beyond the immediate postpartum care.
Some women find that carrying out perineal exercises three or four times a
and relaxing the muscles of perineum five to ten times in succession as if trying to
top voiding (Kegel’s exercise). This improves circulation to the area and so helps
decrease edema.
Applying an ice bag or cold pack to the perineum during the first 24 hours
reduces perineal edema and the possibility of hematoma formation, and therefore
reduces pain and promotes healing and comfort. After this time, healing increases
best, if circulation to the area is encouraged by the use of heat. Dry heat in the
form of a perineal hot pack or moist heat with a sitz bath is an effective way of
promoting healing.
for the pain. A backrub is effective for relieving aching shoulders or back.
mother and her new infant as a member of their family. Teaching new mothers is
important, but it is also important to explore what they already understand about
child care and what they believe would be a sensible solution to a problem.
Measures to
increase urine
output:
SOAPIE#1
S- “sakit akong tahi day uy, kung mangihi ko. Mawawa raman sad ig human, mura
siyag hapdos.” As verbalized by Mrs. Latoy.
I-
done perilite exposure as ordered; elevated head of bed at intervals and turned
patient from side to side; encouraged use of relaxation techniques;
administered cold & hot therapy; administered sitz bath; made time to listen to
and maintain frequent contact with patient; provided pain relief medication as
ordered by physician.
S- ”wa pa ko ka ihi day, karun pa. Sakit man gud e-ihi.” as verbalized by Mrs.
Latoy.
O- received patient lying on bed; patient was conscious; patient had no IVF; urine
output of the patient was less than normal per shift; patient was hesitant to
void.
I-
encouraged fluid intake upto 3000 or more ml per day; encouraged client to
verbalize concerns/fears; recorded urinary output, investigate sudden
reduction/ cessation of urine flow; established bladder training program.
Promote client participation to level of ability.; stimulated bladder emptying
by running water, pouring warm water over peritoneum; emphasized
E-
importance of keeping area dry; promoted perineal care.
the patient voided at least 240 milliliter of urine at the end of the shift.
NORMAL
OUTCOME:
-Lochia rubra= red (1-
3days)
-Lochia serosa= pin
(3-10 days)
-Lochia alba= white
(10-14 days or 3
weeks).
2. demonstrate the • Ways to hold baby Demonstration and The patient
different ways to during Return showed cooperation
breastfeed a baby and breastfeeding: Demonstration. by repeating what
burping positions. -cradle hold the student nurse
-football hold had done.
-side lying
-tailor’s position or
across lap.
3. state the advantages
of breastfeeding Advantages of Informal Patient listened
breastfeeding: Discussion and looked at the
Best for babies student nurse
Reduce incidence of keenly.
allergies
Economical
Antibodies
Stool inoffensive
Temperature always
idea;
Fresh milk
• Emotional bonding
b/w child and
mother
• Easy once
established
• Digested easily
• Immediately
available
• Nutritionally
optimal
• Gastroenteritis
greatly reduced
4. perform cord
dressing Steps in cord Demonstration and
The patient nod
return
dressing: for sometime and
demonstration
• Cord should be kept tried following the
until it drops off by steps being done by
itself. the student nurse.
• Apply alcohol on
the cord area once/
twice.
• Prepare six cotton
pledgets and a
alcohol.
1st cotton pledget:
- base of the
cord
- clean it with
circular motion
starting from inner to
outer or you can do
the sunrays method
2nd cotton pledget:
- sides of the
cord starting down,
going up.
3rd cotton pledget:
- clean the base
of the clamp.
4th cotton pledget:
- clean the sides
of the clamp.
5th cotton pledget:
- clean the cord
again. This time,
clean it from upper to
base.
Prognosis
Based on the patient’s assessment, the patient was experiencing acute pain related
to her fouth degree perineal laceration. Despite this, she prefers not to remain in bed. She
walks as a form of exercise. She does her own perineal car. The patient complies with
other treatment, medications and management regimen instructed by the doctor and
nurses. All these signs shows that the patient will recover from her condition faster than
expected.
Recommendation
The most important goal for the patient who underwent fourth degree perineal
laceration is to achieve full recovery and rule out the possible occurrence of infection.
4. No rectal temperature.
5. Promote good personal hygiene and giving importance to hand washing and perineal
care.
8. Ambulation is encouraged.
9. Bed rest if the patient feels pain and fatigue.
Nursing Practice
Studying the case of Mrs. Latoy, Catherine gave the student nurse the opportunity
to enhance the student’s knowledge, attitude, and skills in rendering holistic therapeutic
nursing care for postpartum patients with the same complication as Mrs. Latoy’s. It has
This case study though not that perfect can aid as a foundation and reference for
the never-ending discovery for better interventions of students, professionals and family
Nursing Education
This case study has been very useful in making the student understand the scope
of this condition. It facilitated the student nurse to relate the theories, discoveries and
other facts written in textbooks, to the actual situation. Through these observations,
students have attained new set of concepts which will be of great remedy in caring for
Nursing Research
This case study can be utilized as reference for imminent research studies. This
will also furnish additional knowledge to the students for associating real life situations.
VII. REFERRAL AND FOLLOW-UP
After one week of discharge, the patient must see her physician for check-up.
VIII. BIBLIOGRAPHY
Kazier, Barbara et. al. Fundamentals of Nursing Concepts, Process and Practice,
7th edition, Pearson Education Inc., 2004
Marieb, Elaine N. et. al. Essentials of Human Anatomy and Physiology, 6th
edition, Addison Wesley Longman Inc., 2000
Nettina, Sandra. The Lippincott Manual of Nursing Practice; 6th edition, Merrian
& Webster Bookstore, Inc.
Pilliteri, Adele. Maternal and Child Health Nursing; 4th edition, Lippincott
Williams and Wilkins
Potter, Patricia and Perri, Anne Griffin. Fundamentals of Nursing. 5th ed. St. Louis
, Missouri: Mosby 2005
http://www.aafp.org/afp/20031015/1585.html
http://www.proceduresconsult.com/medical-procedures/third-and-fourth-degree-
repair-of-the-perineum-FM-procedure.aspx