Republic of the Philippines

BATAAN PENINSULA STATE UNIVERSITY

Main Campus
City of Balanga, Bataan
COLLEGE OF NURSING AND MIDWIFERY

CASE STUDY

Submitted to:
Mrs. Ma. Florenda Sy
Submitted by:
Kim Trishia Barbarra Cruz
BSN IIA
I. Introduction

Umbilical cords in pregnancy are accountable for channelizing oxygen, blood and
nutrients in a fetus's body along with removing away the waste disposal. The moment a
baby starts moving around, it creates tension on the umbilical cord thus promoting
positive growth and leading to lengthening of the umbilical cord. The case of my patient
is short umbilical cord. When the umbilical cord is too short, this could be a clear sign
that the baby is not moving around satisfactorily, thus hinting at the deteriorating health
of the fetus. Short umbilical cord also signals risks impending delivery complications and
birth injuries. Among all probable Umbilical Cord abnormalities, Short Umbilical Cord is
a major one, as it may squeeze the baby's neck by wrapping around it. Turning into a
prolapsed cord, Umbilical Cord may develop knots and dangle before the baby. Through
ultrasound specialists can conduct detailed assessment and position of the umbilical
cord.

Signs and Symptoms:

The signs and symptoms of short umbilical cord may include decreased blood flow to the fetus
resulting in fetal distress and non-reassuring fetal heart rates.
Prevention and Management:
Currently, there are no modifiable risks or definitive methods available to prevent short umbilical
cord. However, the following factors may be considered: Some studies indicate that not smoking
and not consuming alcohol during pregnancy can be beneficial. If the woman is a known diabetic
before pregnancy, then a good control of diabetes using suitable treatment measures may help. If
the ultrasound scan indicates an umbilical cord of short length, then careful monitoring of the
pregnancy (including the fetal heart rate) is necessary and vital for a successful outcome.
Possible Complications:
Complications due to Short Umbilical Cord affect both the mother and child. These include:

 In the mother: An increased incidence of retained placenta, prolonged labor, inversion of the
uterus, abruption of placenta causing severe bleeding (during late pregnancy) affecting the
health of both the mother and fetus

 In the baby: Cerebral palsy, hypoxic ischemic encephalopathy (HIE), intrauterine growth
retardation (IUGR), placental disruption, affecting the nutrition of the developing fetus,
umbilical cord rupture, increased incidence of breech presentation, miscarriages and
stillbirths.

Risk Factors

The risk factors for short umbilical cord include: low body mass index (BMI) of mother, history
of smoking during pregnancy, history of alcohol consumption during pregnancy, gestational
diabetes, chromosomal abnormalities such as Down syndrome, first pregnancy, female fetus,
performing early amniocentesis procedures in pregnant women, oligohydramnios (decreased
fluid in amniotic sac) and polyhydramnios (excess fluid in amniotic sac).

It is important to note that having a risk factor does not mean that one will get the condition. A
risk factor increases ones chances of getting a condition compared to an individual without the
risk factors. Some risk factors are more important than others.
 II. Personal Data

1. Client’s Initial: E.G.M

2. Gender: Female
3. Age: 22 years old
4. Birthdate: October 14, 1995
5. Birthplace: Makati City
6. Civil Status: Married
7. Religion: Iglesia Ni Cristo
8. Occupation: Factory Worker
9. Address: Alas-Asin, Mariveles, Bataan
10. Chief complaint: Painful suture
11. Date of admission: April 30, 2018
12. Time of admission: 10:00PM
13. Admitting Diagnosis: G1P0, 41 3/7 weeks AOG
14. Final Diagnosis: G1P1 (1001), pregnancy uterine delivered by LTCS (Low
Transverse Cesarean Section) for arrest in cervical dilation, live term cephalic baby boy
3150g at 8.9 AGA

III. Past Medical History:

Past Illness:
Eight months prior to admission, the client had coughs and colds. E.G.M. is a housewife and
also a factory worker who considers daily household chores to be her exercise. As a child,
she did not experience any serious illnesses, just had simple cough and colds. She also did
not experience any injuries or accidents in the past and this is her first hospitalization and
operation.

Past Surgery: N/A

 Genogram:

On the maternal side of patient, her grandmother who is 64 years old, still alive and is known
to have a heart problem. On the other hand, patient’s grandfather died due to liver cirrhosis
when he was 55 years old. Her mother is the only one child, who is currently 42 years old
and is all well and healthy.

On the paternal side of patient, her grandmother, 58 years old, is the eldest among 4 siblings.
She is currently experiencing osteoarthritis and doesn’t have any other known disease
condition. On the other hand, the patient’s grandfather who is 62 years old, is healthy as well
and doesn’t have any other known disease except that he is a smoker. Her father is 43 years
old is also a smoker and had an appendectomy in 2010.

The patient’s parents were blessed with 2 children; the eldest who is at 23 years of age and
had a history of hospitalization due to bronchopneumonia of unrecalled year. The patient is
the second child and hasn’t had any major illness except for history of cough, cold and
pneumonia.
 Nursing Theory

I chose the theory of Faye Glenn Abdellah because I think that it suits perfectly with the
condition of my patient.

Patient-Centered Approaches to Nursing

Health, or the achieving of it, is the purpose of nursing services. Although Abdellah does not
give a definition of health, she speaks to “total health needs” and “a healthy state of mind and
body.” (Abdellah et al., 1960) Health may be defined as the dynamic pattern of functioning
whereby there is a continued interaction with internal and external forces that results in the
optimal use of necessary resources to minimize vulnerabilities. (Abdellah & Levine, 1986;
Torres & Samton, 1982). The client’s health needs can be viewed as problems, which may
be overt as an apparent condition, or covert as a hidden or concealed one. Because covert
problems can be emotional, sociological, and interpersonal in nature, they are often missed or
perceived incorrectly. Yet, in many instances, solving the covert problems may solve the
overt problems as well. (Abdellah, et al., 1960)

Twenty-one Nursing Problems (Abdellah, 1960)

1. To maintain good hygiene and physical 12. To identify and accept positive and negative
comfort. expressions, feelings, and reactions.

2. To promote optimal activity: exercise, rest,

and sleep.
3. To promote safety through the prevention of
accidents, injury, or other trauma and through
the prevention of the spread of infection.
13. To identify and accept the interrelatedness of
emotions and organic illness.
14. To facilitate the maintenance of effective
verbal and nonverbal communication.

4. To maintain good body mechanics and 15. To promote the development of productive
prevent and correct deformities. interpersonal relationships.

5. To facilitate the maintenance of a supply of 16. To facilitate progress toward achievement of

oxygen to all body cells. personal spiritual goals.

6. To facilitate the maintenance of nutrition of 17. To create and/or maintain a therapeutic

all body cells. environment.

7. To facilitate the maintenance of elimination. 18. To facilitate awareness of self as an

8. To facilitate the maintenance of fluid and
electrolyte balance.
9. To recognize the physiological responses of
the body to disease conditions – pathological,
physiological, and compensatory.
10. To facilitate the maintenance of regulatory
mechanisms and functions.
11. To facilitate the maintenance of sensory
functions.
individual with varying physical, emotional, and
developmental needs.
19. To accept the optimum possible goals in the
light of limitations, physical and emotional.
20. To use community resources as an aid in
resolving problems arising from illness.
21. To understand the role of social problems as
influencing factors in the case of illness.
 LABORATORY FINDINGS

Hematology Findings Normal Value

Hemoglobin 122.0 110.0-150.0

Hematocrit 0.367 0.370-0.470

RBC Count 4.14 3.50-5.00

WBC Count 9.74 4.00-10.00

Neutrophils 0.749 0.500-0.700

Lymphocytes 0.174 0.200-0.400

Monocytes 0.059 0.030-0.120

Eosinophils 0.014 0.005-0.050

Basophils 0.004 0.000-0.010

MCV 88.6 80.0-100.0

MCH 29.4 27.0-34.0

MCHC 331.0 320.0-360.0

RDW-CV 0.129 0.100-0.160

RDW-SD 48.0 35.0-56.0

Platelet Count 245.0 100.0-300.0

MPV 9.0 6.5-12.0

PDW 16.4 12.0-17.0

PCT 0.221 0.108-0.282

As presented, the patient has high neutrophils and low lymphocytes. Neutrophils are type of white blood
cell, which fight infections. Neutrophils circulate through the blood and are normally detected on routine
complete blood count (CBC) tests as part of the white blood cell count. White blood cell count is
increased in pregnancy with the lower limit of the reference range being typically 6,000/cumm.
Leucocytosis, occurring during pregnancy is due to the physiologic stress induced by the pregnant state.
Neutrophils are the major type of leucocytes on differential counts. This is likely due to impaired
neutrophilic apoptosis in pregnancy. The neutrophil cytoplasm shows toxic granulation. Neutrophil
chemotaxis and phagocytic activity are depressed, especially due to inhibitory factors present in the serum
of a pregnant female.
Lymphocyte count decreases during pregnancy through the first and second trimesters and increases
during the third trimester. There is an absolute monocytosis during pregnancy, especially in the first
trimester, but decreases as gestation advances. Monocytes help in preventing fetal allograft rejection by
infiltrating the decidual tissue (7th–20th week of gestation) possibly, through PGE2 mediated
immunosuppression. The monocyte to lymphocyte ratio is markedly increased in pregnancy. Eosinophil
and basophil counts, however, do not change significantly during pregnancy.