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INTRODUCTION
Caesar, is a surgical procedure in which incisions are made through a mother's abdomen
performed when a vaginal delivery would put the baby's or mother's life or health at risk.
There are several types of Caesarean section (CS). An important distinction lies in the
type of incision (longitudinal or latitudinal) made on the uterus, apart from the incision
on the skin.
caesarian section. This is a type of CS which is also called lower uterine segment section.
It is the procedure most commonly used today; it involves a transverse cut just above the
edge of the bladder and results in less blood loss and is easier to repair.
might pose a risk to the mother or baby. In this case, the subject of the study underwent
this kind of surgical operation due to persistent variable deceleration exhibited by the
The researcher selected this case to further explain the factors causing this
complication. The researcher would also like to determine how it affects both the mother
and the fetus. Moreover, the researcher would like to come across with the appropriate
1
II. GENERAL DATA
Age : 26
Sex : Female
Race : Filipino
2
III.HEALTH ASSESSMENT
A. HEALTH HISTORY
Age: 26
Sex: Female
Race: Filipino
thereafter. No illness occurred during the pregnancy. Blood pressure within normal limit
as claimed. Multivitamins were taken for supplement. Ultrasound taken at 1 month AOG
– with subchorionic hemorrhage, advised for bed rests and given with unrecalled
medicines. Another ultrasound taken at 8 months AOG – with premature placental aging
as claimed. Morning PTA, noted watery vaginal discharge associated with irregular
uterine contractions and low back pain. Consult done, thus advised admission.
A.3 Current Health Status
Patient verbalized pain on the incision site. Patient also shows guarding
movements with a grimaced face when moving. Patient also expressed that she don’t get
a straight sleep due to vital signs taking during her sleep. Patient also shared her inability
to defecate for how many days already. Patient also expressed that her SO was not
usually around when she needed to have her incision be applied with antiseptic.
Patient was conscious, coherent and oriented to time and place. Patient
was calm, cooperative and responds appropriately. During childhood years, patient
experienced mumps with no other known illnesses. Patient had childhood immunizations,
but had no tetanus and hepatitis vaccines. Patient denies adult illnesses experience.
Patient had good psychiatric condition and never experienced any problems with it. At
age 10, patient had minor operation with a carbuncle on the upper part of the posterior
left leg. Patient experienced burn on the right elbow due to an accidental contact with a
warm metal plate. Patient was admitted once due to an unrecalled reason. Patient denies
allergies on drugs but not on alcoholic drinks. Patient usually sleeps 8-10 hours per night.
Patient does not smoke but drinks occasionally and claims usual drinking is only up to
DM HT
HT N
82 N 79
81
79
Legend:
- Points to patient
On each side, both grandparents already passed away due to serious diseases. On
the patient’s paternal side, the grandfather and grandmother died due to Diabetes mellitus
and hypertension, respectively. On the mother’s side, only the grandmother died due to a
serious disease which was hypertension. Some of their children acquired the same
condition, just like the 59-year-old with HTN and 53-year-old with DM, and the other
side’s 50-year-old and 46-year-old both with HTN. Only the paternal side’s 47-year-old
The rest and the younger generation were staying alive and well, with no
General: Patient is conscious, coherent, logical, and oriented to time and place. Patient was calm
Skin: Skin is uniform brown in color with no areas of increased vascularity or bleeding. The skin
surface temperature is warm and equal bilaterally. It feels smooth, firm and even.
Head: The hair is black in color with terminal hairs distributed in the eyebrows, eyelashes and
Eyes: The patient’s eyelids appears symmetrical with no drooping, infections, or tumors of the
lids. There were also no enlargement, swelling, or any tenderness, and no redness that is visible.
Ears: The ears match the flesh color of the rest of the patient’s skin and is positioned centrally
and in proportion to the blood. The top of the ear crossed an imaginary line drawn from outer
Nose: The shape of the external nose is located symmetrically in the midline of the face and is
Throat: The ventral surface of the tongue has prominent blood vessels. The number of teeth is
less than the normal with minimal dental caries. Palates are concave and pink.
Genitourinary: Patient is attached with catheter. Urine is of less amount. It is yellow in color.
Endocrine: No changes in hair distribution, no intolerance of heat and cold, no fatigue noted.
Musculoskeletal: Movement is limited due to pain of incision, with muscle weakness and
stiffness.
Patient started having irregular prenatal check-ups during her first pregnancy.
Walking a few meters away from home to the road serves as her daily exercise. In addition, she
does her household chores everyday and does the general cleaning once a month. If she feels ill,
she takes medicines in order to give remedy for her and her family. She denies allergies on
drugs but not on alcoholic drinks. She does not smoke but drinks occasionally and claims usual
drinking is only up to the limited extent. Her family has history of hypertension, diabetes
Patient eats whatever she likes since she doesn’t have any food allergies.
However, she avoids fatty foods which she knows are risk factors for heart diseases. She loves to
eat fruits but less on vegetables. She drinks occasionally but only up to the limited extent.
Elimination
Patient defecates once a day without experiencing discomforts, usually morning
before she heads to her duty. Stool is brown in color and is well-formed. Patient voids usually 5-
7 times a day. Urine is yellow in color. There is no pain when voiding. She easily releases sweat
Everyday, patient usually walks a few meters away from home in going to work.
Her job in the company is mostly standing. She presents and sells company products and services
to current and potential clients and coordinates company staff to accomplish the work required to
Patient finished her college course, Sales Marketing, at the University of San
Carlos – Main. Basically, she knows how to read and write. Moreover, she can use code-
Patient usually sleeps 8-10 hours per night. She loves to read pocket books until
she falls asleep. She feels regainment of energy if she gets long hours of sleep after an intense
day’s work. She usually does deep inhalation and exhalation when stress comes her way.
Patient has many friends due to her extrovert personality. It is easy for her to get
along with others since she knows how to handle people. Her job fits her socializing skills. She
considers herself as a holistic human being as long as she is healthy and her family is always
there for her. She wants to maintain a good health and live his life to the fullest.
Patient can speak and understand English, Tagalog and Cebuano. She can clearly
express whatever she wants to voice out. She has 5 siblings and they were all close to each other.
Patient is very active and extrovert. She usually socializes with her neighbors. She and the father
Patient is still single but is living under the same roof with her partner. She is
sexually active with her live-in partner for almost a year and a half. She denies using
contraceptives.
Whenever the patient meets problems, she immediately examines it and searches
for an effective solution in no time. This would somehow stop it from getting worse. She follows
the rule of 8 as a means of reducing stress. An example is deep inhalation and exhalation
Patient is a Roman Catholic, usually attending Sunday masses with her partner.
She has a strong faith in God that she asks faithfully healing of any perceived illnesses. Patient
Patient wakes up at 6AM and makes breakfast with live-in partner. Walking a few meters
away from home to the road serves as her daily exercise. She goes to work from 8AM to 6PM.
Patient is living with her live-in partner and is well-supported by her immediate family. Patient
finished her college course, Sales Marketing, at University of San Carlos – Main. She is now
working as a Sales Specialist at Sanitary Care Company. Patient is a Roman Catholic, usually
attending Sunday masses with her partner. Patient usually commutes via jeepney in going to
work and other local places. Patient is residing in a rented house at Basak, Pardo with a good
drainage and water supply. Patient is just an occasional drinker and claims drinking is up to the
limited extent only. She denies abuse and binging. She also denies smoking and use of prohibited
drugs. Patient is heterosexual and is sexually active with her live-in partner for almost a year and
B. PHYSICAL EXAMINATION
General Observations:
Received patient conscious, coherent and mentally-oriented to time, people and place.
Patient has fair skin with stitches on the incision site of the lower abdomen. Overall, patient is in
a normal appearance.
Patient has fair, moist warm and smooth skin. Its turgor is within 1 to 2 seconds.
Hair: (Color, distribution, texture, oiliness, and infestation)
Patient has long, black hair. It is distributed evenly. It is smooth and silky.
The scalp is free from lesions. Tenderness and masses are not noted.
Nails of patient are pinkish in color. It is a bit square. It is smooth. Capillary refill is 2 to
3 seconds. No lesions found.
Eyes: (Visual acuity, EOM, Oculomotor nerve, eyelids, lacrimal glands, conjuctiva, sclera,
cornea, lens, PERRLA, confrontation test, and fundus)
Eyes are functioning properly. No inflammation on the eyelids, lacrimal glands and other
surrounding the eyes. The eyes are wet and moist. Sclera on both sides is dirty white. Conjuctiva
has small blood vessels.
Ears: (Symmetry, color, discharge, swelling, otoscopic assessment, whispered voice test,
Weber’s test, and Rinne’s test)
Ears are symmetrical, fair, and no noted discharge and swelling. The ears can hear
perfectly.
Nose and Sinuses: (Symmetry, flaring, inflammation, discharges, patency, nasal cavities,
palpation, and percussion)
Mouth and Pharynx: (Odor, lips, buccal mucosa, gums, teeth, tongue, hard palate, soft
palate, and pharynx)
Patient has good breathe. Lips are pinkish and smooth with moist. Buccal mucosa, gums
and tongue are pinkish in color, teeth are dirty white, and the hard and soft palate are pinkish in
color as well.
Neck: (Symmetry, musculature, lymph nodes, trachea, and thyroid)
The neck is symmetrical. Lymph nodes are palpable. Bruit sounds are heard on the
trachea. It isfelt and palpable. Thyroid gland is palpable. No inflammation or lesions noted.
The posterior chest is symmetrical with the anteroposterior diameter at a ratio of 2:1.
Tenderness and masses are not found. Thoracic expansion is 2 to 3 cm. vibrations were felt
during tactile fremitus. Resonance upon percussion, and no wheezing or crackling sounds upon
auscultation.
Pulsations are felt. No wheezing or crackle sounds are heard upon auscultation.
Heart: (Inspect anterior thorax, precordium area, palpate cardiac landmarks, palpate
epigastric region, auscultate cardiac landmarks, auscultate aortic pulsations)
Heart is positioned right and correctly with the cardiac landmarks. Heartbeats are heard
during auscultation.
Carotid arteries are present with pulsations felt. It is palpable and no lumps are felt.
Blood pressure is within normal range.
Epitochlear nodes are palpable, as well as, the superficial inguinal nodes. No tenderness
noted.
Breast: (size, contour, dimpling, nipple discharge, tenderness, and presence of lumps, and
health teachings on breast self-examination)
The breasts are big due to lactation. There are no dimplings, nipple discharges, tenderness
nor lumps noted. Patient is aware of breast self-examination and learned it.
Abdomen: (Inspect abdomen, inspect umbilicus, respiration movement, surface motion,
pulsations, auscultation, percussion, and light palpation)
Abdomen is round. The umbilicus is inverted. Respiration and surface motion are
present. Pulsations on the abdomen are felt. The abdomen is palpable.
Female External Genitalia and Anus: (Mons pubis, vulva, clitoris, urethral meatus, vaginal
introitus, perineum, and anus)
Patient has grip strength. Temporomandibular joint is felt. The neck, shoulder, hip, spine,
knees, feet, ankles, hands, elbow and wrists can do the different ranges of motion easily.
Deep Tendon Reflexes: (biceps, triceps, Brachioradialis, patellar, Achilles, and plantar)
Biceps, triceps, Brachioradialis, patellar, Achilles and plantar reflexes are present.
Patient is conscious, coherent and alert. She has good memory and is mentally-oriented
with people, place and time. She has goos speech patterns and walks properly.
Cranial nerve assessment: (Olfactory, gustatory, hypoglossal, tactile, gag reflex, and
shoulder shrug test; exclude optic, oculomotor, trochlear, auditory, and abducens)
A. External Structures:
1. Mons Veneris/Pubis – Pad of fat which lies over the symphysis pubis where dark and
curly hair grow in triangular shape that begins 1-2 years before the onset of menstruation.
2. Labia Majora – Two (2) lengthwise fatty folds of skin extending from mons veneris to
the perineum that protect the labia minora, urinary meatus and vaginal orifice.
3. Labia Minora – 2 thinner, lenghtwise folds of hairless skin extending from clitoris to
fourchette.
4. Clitoris – small, erectile structure at the anterior junction of the labia minora that
contains more nerve endings. It is very sensitive to temperature and touch, and secretes a
fatty substance called Smegma. It is comparable to the penis in it’s being extremely
sensitive.
5. Vestibule – the flattened smooth surface inside the labia. It encloses the openings of the
both sides. Secretion helps lubricate the external genital during coitus.
both sides. It lubricates the external vulva during coitus and the alkaline pH of their
8. Fourchette – thin fold of tissue formed by the merging of the labia majora and labia
9. Perineum – muscular, skin-covered space between the vaginal opening and the anus. It is
easily stretched during childbirth to allow enlargement of vagina and passage of the fetal
head. It contains the muscles (pubococcygeal and levator ani) which support the pelvic
organs, the arteries that supply blood and the pudendal nerves which are important during
10. Urethral meatus – external opening of the urethra. It contains the openings of the
Skene’s glands which are often involved in the infections of the external genitalia.
11. Vaginal Orifice/Introitus – external opening of the vagina, covered by a thin membrane
called Hymen.
B. Internal Structures:
12. Fallopian tube/Oviduct – 4 inches long from each side of the uterus (fundus). It
transports the mature ova form the ovaries to the uterus and provide a place for
fertilization of the ova by the sperm in it’s outer 3rd or outer half. Parts:
fingerlike projections) that help to guide the ova into the fallopian tube.
13. Ovaries – Oval, almond sized, dull white sex glands on either side of the uterus that
50-60 grams held in place by broad and round ligaments, and abundant blood supply
and ovarian arteries. It is located in the lower pelvis, posterior to the bladder and anterior to
the rectum. Organ of menstruation, site of implantation and provide nourishment to the
products of conception.
Layers:
directions; expels fetus during birth process then contracts around blood vessels to
prevent hemorrhage.
determine uterine growth during pregnancy and the force of contractions and for
the assessment that the uterus is returning to it’s non-pregnant state following
child birth.
4. Cervix – lower cylindrical portion that represents 1/3 of the total uterus. Half
of it lies above the vagina; half of it extends to the vagina. The cavity is termed
the cervical canal. It has 2 openings/Os: internal os that open to the uterine cavity
5. Vagina – a 3-4 inch long dilatable canal located between the bladder and the
and fetus. Doderlein’s bacillus is the normal flora of the vagina which makes the
PREGNANCY
Production of estrogen
(thickening of the endometrium)
Fertilization
(union of the ovum and sperm in the ampulla)
Implantation
Development of the fetus/ embryo and placental structure until full term
True labor
Caesarean Section
(The baby is taken out through the mother's abdomen and uterus.)
Variable decelerations are characterized by slowing of the FHR with an abrupt onset and
return. They are frequently followed by small accelerations of the FHR. They vary in depth,
duration, and shape. Variable decelerations coincide with cord compression, and they usually
coincide with the timing of the uterine contractions. Variable decelerations are the most common
decelerations seen in labor, and they are caused by umbilical cord compression. They are
generally associated with a favorable outcome. Persistent, deep, and long lasting variable
Persistent variable decelerations to less than 70 bpm, lasting more than 60 seconds are
concerning. Variable decelerations with persistently slow return to baseline are considered
Variable decelerations are transitory decreases in fetal heart rate caused by umbilical cord
compression.
A variable deceleration is unrelated to contractions. They mean umbilical cord
throughout the 9 months of her pregnancy, it would be apparent that variable decelerations occur
transiently as the baby grabs the umbilical cord or the cord gets compressed between the baby
and the uterine wall during fetal movement. As many as fifty percent of all monitored babies
experience variable decelerations during labor. If the baseline fetal heart rate remains stable and
the variability remains good, variable decelerations are not associated with poor fetal outcome.
HEMATOLOGY SECTION
URINALYSIS
Before the cesarean section procedure, the patient was given anesthesia to numb the pain.
The doctor then made horizontal incision in the abdomen and uterus. After the incision was
made, the baby was delivered through it, and the placenta was removed. After the cesarean
After receiving cesarean section anesthesia, a catheter (plastic tube) was placed in the
bladder for urine drainage during the surgery. The lower abdomen was then washed with a
special disinfectant cleanser, and the patient was covered with sterile sheets to help protect the
When the cesarean section was started, the doctor made a 6- to 8-inch incision in the
abdomen directly over the uterus. The incision was horizontal, which was side to side. The baby
was then delivered through this opening. The umbilical cord was cut, and the baby was handed to
the healthcare provider, who took him to a small, warmly lit plastic crib called a warmer. Then
the baby was cleaned and dried and eventually checked by the pediatrician.
After the baby had been delivered, the placenta was carefully removed from the uterus.
At that time, the patient received oxytocin, a drug that causes the uterus to contract and helps
prevent serious bleeding. The doctor then closed the incision on the uterus, and the incisions in
the skin were closed with stitches that would dissolve on their own.
A.3 Medications
See Appendix B
A.4 Diet
According to the Centers for Disease Control and Prevention, more than 30 percent of
births take place by cesarean section surgery. This means that each year over one million women
deal with recovering from major surgery. Diet and nutrition play a vital role in the health of a
cesarean mother. Getting adequate rest, healthy food, and keeping the immune system strong are
important in the months following a cesarean. It is important to eat a healthy, well-balanced diet
which includes all four food groups. Particularly important to post-cesarean health are fresh
fruits and vegetables, dairy foods and protein. Since a woman who delivered via C-section will
probably experience increased gas after the procedure, limiting foods which produce gas, such as
fried foods and carbonated drinks, is highly recommended. Women who have undergone a
cesarean section should take care to get adequate vitamins from food and supplements, especially
vitamins E and C as these promote health and healing and help the body resist infection.
B. NURSING MANAGEMENT
See Appendix C
DISCHARGE PLAN
ASSESSMENT
-Assess level of understanding on how to perform Encourage patient to do perineal care. The proper to
perineal care. do this is:
PLANNING
-Plan ahead the return visit to the doctor’s hospital Remind the patient to schedule a return visit for
monitoring.
IMPLEMENTATION
1.Medication
Comply with the medication Discuss to the patient the importance of completing
regimen one’s medication. Encourage the patient to follow
the medication regimen religiously.
2.Exercise
Coordinate with social services, Discuss to the patient that such services enhance
physical therapy and occupational adequate discharge planning for home treatments
therapy. after discharge.
6.Diet
7.Spiritual
Emphasize to the patient the need for spiritual
Allocate a time for reflection, guidance.
Praying and reading the bible.
EVALUATION
2.Evaluate progress of the patient’s health Encourage the patient and the S.O to evaluate any
condition. progress on patient’s health.
IX. CONCLUSION AND RECOMMENDATION
Conclusion
The main purpose of the study was successfully met. The major reason why the
patient underwent a surgical procedure called LSTCS was due to persistent variable
decelerations. The baby exhibited non-recessing fetal heart tone as uterine contractions occur.
The operation was done to resolve the risk of pregnancy and eventually save the baby’s life.
Further run through of the study showed that there are many other complications
that would pose a risk to pregnant women. These were more complicated and rare. Unlike those,
variable decelerations are seen most commonly in pregnant women experiencing labor.
Recommendation
recommendation so she can make herself ready if any problem will arise. She should be
monitored frequently—her blood pressure, medical history and also check the baby inside if
he/she is doing well or in the proper position. The most important one is the mother’s health.
The mother should be given the proper care for herself and for the baby. There is a possibility
that a caesarean delivery might be planned advance if a medical reason is needed or it might be
unplanned and take place during the labor if some problems occur. The mother must be given the
proper knowledge regarding a vaginal or caesarean delivery right from her first pregnancy. For
caesarean section, it is very complicated operation which can have some risks like death for the
mother, sometimes have some initial trouble breathing for the newborn babies and will make
them drowsy from the pain medication administered to the mother. Breastfeeding maybe difficult
due to the limited mobility of the mother after the operation. A pregnant woman must be well
A. Nursing Education
This study helps in enriching the knowledge base of the nurses regarding the
concepts of this kind of complication. This would greatly help in determining the risk factors that
would possibly be prevented from occurring once there is an application of this study. This can
cater all the questions regarding how and why this certain kind of operation is performed. The
best thing about this study is that there is a comprehensive explanation of the relationship
between the surgery performed and the cause of this high-risk pregnancy. The cause is highly
fatal if not given attention so this gave motivation to performing CS. This broad information
would really enhance the previously learned concepts of the nurse so as to help him/her in
B. Nursing Practice
This study helps in giving care to a woman experiencing high-risk pregnancy.
Appropriate measures and interventions can be taken which are very useful in promoting the
health status of the client. The nurse’s skills are further guided as to how he/she manages the
implementation of nursing procedures in order to meet the varying needs of his/her patient. This
study alarms the nurses when to act immediately in cases of unexpected or unusual situations
which might pose a risk to the mother or the baby or maybe both. Having competency in
performing the procedures is the most effective way of responding the needs of the client. That is
why this study is equipped with numerous appropriate and effective interventions that would
C. Nursing Research
of nursing profession. It typically shows how an individual was able to cope up with this kind of
complication. As we all know, each individual has a unique adaptive mechanism. This study
Modern facilities are used in the performance of care to the patient, monitoring and as well as the
operation. Moreover, there is a good complementation since the patient is at high risk. It shows
the beneficial relationship of our technological advances to science nowadays. This study will