Samar State University College of Nursing Catbalogan, City

CASE STUDY OF CESAREAN SECTION

Submitted to: Mr. Leodoro Labrague, RN Clinical Instructor Submitted by: Jonathan Gabriel J. Paquit

BSN
INTRODUCTION
A cesarean section is also known as a c-section, which is sometimes also written as c/s. This type of birth is done by a surgical incision in the abdomen and uterus to allow a baby or babies to be born safely when a vaginal birth is not the safest route. Why would a cesarean section be performed? A cesarean section might be performed for a number of reasons, including:

Placenta previa A breech baby Fetal distress Higher order multiples Other maternal or fetal complications

How is a cesarean section performed? You will normally check into the hospital either in labor or before a scheduled c-section. From there they will do blood work to ensure they have information to help you find the right medications and treatments. You will be given a medications to help neutralize the acid in your stomach and you will be given an IV. You will also have part of your pubic hair shaved. After anesthesia, you will have the surgery for the birth of your baby. How is the recovery from a cesarean section? Since a c-section is a surgery, your recovery will usually be longer than that of a vaginal birth. Your incision will be sore and most women will say that walking the first few times after birth is very painful. You will be given medications to help you with the pain of recovery. Remember that walking is actually a good thing as it speeds healing. The first few weeks rest as much as possible and carry nothing heavier than the baby. After the few days, you will have any remaining stitches or staples removed. Minor Cesarean Complications Minor cesarean complications can include, but are not limited to:

Infections in the mother or baby Minor bleeding Separation of a scar on the uterus from a previous cesarean delivery Hemorrhoids

Constipation Urinary tract infection Ileus (a temporary stoppage of bowel activity) Abnormal or painful scar Allergic skin reaction.

In most cases, minor problems are temporary and are easily taken care of by your healthcare providers. Risk Factors for Major Cesarean Complications Although major complications are uncommon with a cesarean section, your overall health will play a role in your likelihood of developing complications and how well you recover from them. For example, women have a higher chance of developing cesarean complications if they have:

Diabetes Heart, lung, or kidney disease Seizure disorders Sexually transmitted diseases (STDs) Hepatitis. This risk for complications is also higher for women who are overweight or who use alcohol, tobacco products, or other drugs, such as cocaine

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.

The classical Caesarean section involves a midline longitudinal incision which allows a larger space to deliver the baby. However, it is rarely performed today as it is more prone to complications. The lower uterine segment section 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. An emergency Caesarean section is a Caesarean performed once labour has commenced. A crash Caesarean section is a Caesarean performed in an obstetric emergency, where complications of pregnancy onset suddenly during the process of labour, and swift action is required to prevent the deaths of mother, child(ren) or both. A Caesarean hysterectomy consists of a Caesarean section followed by the removal of the uterus. This may be done in cases of intractable bleeding or when the placenta cannot be separated from the uterus.

Traditionally other forms of Caesarean section have been used, such as extraperitoneal Caesarean section or Porro Caesarean section. a repeat Caesarean section is done when a patient had a previous Caesarean section. Typically it is performed through the old scar.

Anaesthesia Both general and regional anaesthesia (spinal, epidural or combined spinal and epidural anaesthesia) are acceptable for use during caesarean section. Regional anaesthesia is preferred as it allows the mother to be awake and interact immediately with her baby. [45] Other advantages of regional anesthesia include the absence of typical risks of general anesthesia: pulmonary aspiration (which has a relatively high incidence in patients undergoing anesthesia in late pregnancy) of gastric contents and Oesophageal intubation.[46] Regional anaesthesia is used in 95% of deliveries, with spinal and combined spinal and epidural anaesthesia being the most commonly used regional techniques in scheduled caesarean section.[47] Regional anaesthesia during caesarean section is different to the analgesia (pain relief) used in labor and vaginal delivery. The pain that is experienced because of surgery is greater than that of labor and therefore requires a more intense nerve block. The dermatomal level of anesthesia required for caesarean delivery is also higher than that required for labor analgesia.[46] General anesthesia may be necessary because of specific risks to mother or child. Patients with heavy, uncontrolled bleeding may not tolerate the hemodynamic effects of regional anesthesia. General anesthesia is also preferred in very urgent cases, such as severe fetal distress, when there is no time to perform a regional anesthesia.

PERTINENT PHYSICAL EXAMINATION FINDINGS

Date: March 02, 2010 Time: 6:00 am Preoperative Vital Signs NORMAL FINDINGS Temperature Pulse Rate Respiratory Rate Blood Pressure 36.6-37.40C 60-100 bpm 12-20 cpm ACTUAL FINDINGS 370C 82 bpm 20 cpm ANALYSIS

Normal Normal Normal Normal

120/80 mmHg 120/70 mmHg Date: March 03, 2010 Time:6:00 am Postoperative Vital Signs NORMAL FINDINGS ACTUAL FINDINGS 38.40C 88 bpm

ANALYSIS

Temperature Pulse Rate

36.6-37.40C 60-100 bpm

Deviated because of Operation Normal

Respiratory Rate Blood Pressure

12-20 cpm 120/80 mmHg

24cpm 120/70 mmHg

Slightly elevated Normal

PHYSICAL ASSESSMENT BODY PARTS NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION

HEAD Skull Hair Rounded, smooth skull contour Smooth, absence of nodules evenly distributed, thick hair, silky. Varies from light brown to deep brown Rounded, Smooth Normal Normal

SKIN EYE S Eyebrows

Slightly pale

Deviation because of blood loss

Evenly distributed, skin intact, symmetrically aligned, equal movement. Equally distributed, curled, slightly toward Skin intact, no discharged, no discoloration Firm and not tender, pinna recoiled after its folded

Evenly distribute skin intact

Normal

Eyelashes Eyelid s EARS

Slightly curved toward Skin intact, no discharged, no discoloration Firm and not tender, pinna recoiled after its folded

Normal Normal

Normal

NOSE

Straight, no discharge/flaring uniform color

no discharge/flaring uniform color

Normal

MOUTH LIPS

Uniform pink color, smooth texture, moist, soft

Dry, rough texture

Deviated from normal because of dehydration caused by pregnancy

BREAST & AXILLA Breast Even at the chest wall Skin uniform in color Skin smooth & intact No tenderness & nodules Unblemished skin, flat, rounded Even at the chest wall Skin uniform in color Skin smooth & intact Tender upon palpation Normal Normal Normal Deviation from normal due to development of milk. Deviated from normal caused by passed CS delivery through classical incision Deviated from normal due to pregnancy

ABDOMEN

Presence of scar in the abdomen

EXTREMETIES

No edema

Edema

NAILS

ANATOMY AND PHYSIOLOGY

THE FEMALE REPRODUCTIVE SYSTEM The external organs of the female reproductive system include the mons pubis, labia majora, labia minora, vestibule, perineum, and the Bartholin's glands. As a group, these structures that surround the openings of the urethra and vagina compose the vulva, from the Latin word meaning covering. See Figure 1-6. a. Mons Pubis. This is the fatty rounded area overlying the symphysis pubis and covered with thick coarse hair. b. Labia Majora. The labia majora run posteriorly from the mons pubis. They are the 2 elongated hair covered skin folds. They enclose and protect other external reproductive organs. c. Labia Minora. The labia minora are 2 smaller folds enclosed by the labia majora. They protect the opening of the vagina and urethra. d. Vestibule. The vestibule consists of the clitoris, urethral meatus, and the vaginal introitus. (1) The clitoris is a short erectile organ at the top of the vaginal vestibule whose function is sexual excitation. (2) The urethral meatus is the mouth or opening of the urethra. The urethra is a small tubular structure that drains urine from the bladder. (3) The vaginal introitus is the vaginal entrance. External female genitalia. e. Perineum. This is the skin covered muscular area between the vaginal opening (introitus) and the anus. It aids in constricting the urinary, vaginal, and anal opening. It also helps support the pelvic contents.

f. Bartholin's Glands (Vulvovaginal or Vestibular Glands). The Bartholin's glands lie on either side of the vaginal opening. They produce a mucoid substance, which provides lubrication for intercourse.

INTERNAL FEMALE ORGANS The internal organs of the female consists of the uterus, vagina, fallopian tubes, and the ovaries a. Uterus. The uterus is a hollow organ about the size and shape of a pear. It serves two important functions: it is the organ of menstruation and during pregnancy it receives the fertilized ovum, retains and nourishes it until it expels the fetus during labor. b .Vagina. (1) Location. The vagina is the thin in walled muscular tube about 6 inches long leading from the uterus to the external genitalia. It is located between the bladder and the rectum. (2) Function. The vagina provides the passageway for childbirth and menstrual flow; it receives the penis and semen during sexual intercourse. c. Fallopian Tubes (Two). (1) Location. Each tube is about 4 inches long and extends medially from each ovary to empty into the superior region of the uterus. (2) Function. The fallopian tubes transport ovum from the ovaries to the uterus. There is no contact of fallopian tubes with the ovaries. (3) Description. The distal end of each fallopian tube is expanded and has finger-like projections called fimbriae, which partially surround each ovary. When an oocyte is expelled from the ovary, fimbriae create fluid currents that act to carry the oocyte into the fallopian tube. Oocyte is carried toward the uterus by combination of tube peristalsis and cilia, which propel the oocyte forward. The most desirable place for fertilization is the fallopian tube. d. Ovaries

(1) Functions. The ovaries are for oogenesis-the production of eggs (female sex cells) and for hormone production (estrogen and progesterone).

PHYSIOLOGY OF CESAREAN DELIVERY Release of FSH by the APG

Development of graafian follicle

Production of estrogen ( thickening of the endometrium)

Release of the LH

Ovulation (release of mature ovum from the graafian follicle)

Ovum travels into the fallopian tube

Fertilization (union of the ovum and sperm in the ampulla)

Zygote travels from the fallopian tube to the uterus

Implantation

Development of the fetus/embryo and placental structure until full term

PRELIMINARY SIGNS OF LABOR

Lightening (descent of the fetal Head into the pelvis)

Brackston Hicks Contraction (false Labor)

Ripening of the cervix (Goodells Sign)

TRUE LABOR

Uterine Contraction

SHOW

Rupture of amniotic sac

Transverse Presentation

Increase risk for fetal distress

Increase risk of fetal distress

Emergent Cesarean Delivery

Expulsion of the fetus

Placental Expulsion

LABORATORY ANALYSIS

HEMATOLOGY DATE: March 3,2010 DIANOSTIC TEST Hemoglobin FINDINGS NORMAL VALUES 120-60 g/L I INTERPRETATION SIGNIFICANCE

92.6g/L

DEVIATED

Deficient blood volume due to blood loss from the Operation Deficient blood volume due to blood loss from the Operation

Hematocrit

0.28

0.36-0.46

DEVIATED