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GENERAL OBJECTIVE After 2 3 hours of case presentation, the BSN II AP students will be able to: being aided with

h the concept of Care of Mother and Child, to gain the exact knowledge, enhance our skills and develop positive attitude towards the care of the client.

SPECIFIC OBJECTIVES After 2-3 hours of case presentation, the BSN II AP students will be able to: orient ourselves to the physical set-up of the case presentation room and its policies create an environment conducive to learning like controlling the noise inside the room establish rapport with the panel list communicate effectively with the panel list and the audience obtain pertinent information about the case study analyze data appropriately open ourselves for any suggestions and entertain constructive criticisms from the panel list thoroughly discuss the Gordons Functional Health Pattern, nursing problem and the Nursing Care Plan evaluate the effectiveness of the nursing interventions

BIOGRAPHICAL AND DEMOGRAPHICAL DATA: Name: Mrs. R.C. Age: 36 yrs. Old Sex: Female Race: Asian Date and place of birth: December 16, 1975, Lutopan, Toledo City, Cebu Home Address: Das, Lutopan, Toledo City, Cebu Religion: Latter Day Saints (LDS) Marital Status: Married Occupation: Housewife

Nationality: Filipino Source of Data: Interview Contact person in case of emergency: Mr. R.C. Health Insurance: Philhealth Diagnosis: 38 weeks pregnant; G2, P2, T2, A0L1 Chief Complaint: Pre-natal visit every 3 days

Current Health Status Mrs. R.C said that she is on her 38th weeks of pregnancy and that this is her second pregnancy. She was advised to undergo prenatal visit every 3 days until she gives birth. The client also mentioned that she had caesarean section during her first pregnancy because the fetus was in transverse lie position. She said that she is on trial labor this time because the babys already in cephalic position. She made mention that her LMP was last December 9, 2011 and her EDC will be on September 16, 2012. It was also mentioned during the course of the conversation that she had her first menstruation when she was eleven years old.

Past Health History Client R.Cs previous hospitalization was when she had her caesarean delivery during her first pregnancy four years ago. She said that she suffered from childhood illnesses such as chicken pox and asthma attacks due to dust allergies. She said that she had complete vaccination when she was a child. She also has no food or medication allergies and does not have medication maintenance.

Family Health History The clients grandparents on her fathers side both died of old age. Her grandparents on her mothers side are still alive. Her father has four siblings and so does her mother. There are no known illnesses in the family tree from both of her parents side. The client has six siblings and she is the youngest. The eldest child died from an accident when he was one year old. The second and the third siblings were both stillborn. The fourth child died from a convulsion when he was two years old.

Genogram

OA 74

67 OA 76

69

59

56 57

50 58

56

55

54

A 1 1

SB SB CN 2 36 X 34

Remarks: No heredo-familial disease in the family tree

Legend: Male

Deceased Male

Client

A: Accident

CN: Convulsion

Female

Deceased Female

OA: Old Age

SB: Stillbirth

PSYCHOSOCIAL HEALTH HISTORY Client R.C. is 36 years of age, based on the theory of Erik Erickson the client belongs to 6 th stage of adulthood which is the Intimacy vs. Isolation. According to Ericksons theory, Intimacy vs. Isolation is when the individual is able to form close contact and relationship with others. If identity is not establish he or she may develop a feeling of isolation. But since the client is already married, she now have an intimate relationship with her husband. Mrs. RCs activity of daily living are as follows; every Monday to Friday, she wakes up at 5:30 A.M, defecates, cooks, eats breakfast, prepares her daughter for school. Her daughter will be off from school by 11:00 A.M. She will then prepare their lunch and eats at around 12:00 noon, take a nap at 2:00 P.M for about 30 minutes. She now takes a bath for 20 minutes. She prepares for dinner and eats dinner at 7:00-8:00 P.M, watch T.V then goes to bed around 9 oclock in the evening. On week-ends, she wakes up at 6:00 A.M, defecates, bathes for 20 minutes, and cook for breakfast. By 9:00 A.M she will then be washing their clothes and clean the house that would be enough exercise for her. She rests for an hour and then takes a bath for 20 minutes. In the afternoon, she do groceries for about two hours. She goes to church with her daughter every Sunday. If they have extra money for the week, they will eat dinner in the mall. They go to sleep at around 9 oclock in the evening.

Gordons Functional Health Pattern

HEALTH PERCEPTION AND HEALTH MANAGEMENT

The client viewed health as very important to me and to my family. The client answered when asked about her vitamin intake that she does not take vitamins and had never underwent annual check-up prior to her pregnancy.

During pregnancy, the client said that she religiously take her vitamins such as Folic Acid, Ferrous Sulfate and Vitamin B Complex. She had completed her Hep B vaccines. She regularly had her pre-natal visits for her, to have a safe pregnancy and delivery is my utmost concern. I dont want to undergo Caesarean Section this time.

Remarks: Risk-prone health behavior related to inadequate comprehension

Remarks: Readiness for enhanced Therapeutic Regimen Management related to enhanced wellness as evidenced by the eagerness in taking vitamins timely and having regular prenatal visits

NUTRITIONAL METABOLIC PATTERN Mrs. R.C.s 24 hrs diet recall was she had egg and rice with Milo for breakfast the day before she had her check-up at Reproductive Health Unit. For lunch, she only had fried fish and regular rice and drank a glass of water. For dinner, she again had fried fish and regular rice and a glass of water. As of today that, she had her pre-natal check-up, she had fried egg, regular rice and a glass of Anmum milk. Prior to pregnancy, she eats regularly breakfast, lunch snacks and dinner. She usually eats one cup of rice and one serving of viand. She drinks 6-8 glasses of water a day. During pregnancy, she has to be conscious on what she eats. She still eats regularly though she feels hungry most of the time especially in her last trimester. She still drinks 6-8 glasses of water a day in addition to her one glass of Anmum milk in the morning. Remarks: Risk for imbalanced nutrition: more than body requirements related to frequent repeated dieting and majority of foods consumed are concentrated, high calories or fat sources.

ELIMINATION PATTERN Patient R.C. usually defecates once a day. Right after waking up, its color is brown and its consistency is soft. Prior to pregnancy, she voids 4 times a day. During pregnancy, she voids 4 times in the morning, 3 times in the afternoon and even wakes up 3 times at night just to void. The client said that she had mild constipation right after she entered her third trimester.

Remarks: Urinary incontinence related to decreased bladder capacity

SELF-PERCEPTION/SELF-CONCEPT

Prior to pregnancy, Mrs. R.C is a woman who is tender-hearted that bears her child without the personal support of her husband. As of the present she doesnt feel any serious uncomfortable moment during her pregnancy. She doesnt like crowds and she has a shy personality. She likes to render her good and responsible character from her learning in caring.

During pregnancy, Mrs. R.C. slowly moving but she is relaxing herself in touching her womb. She can frequently control her voice level in calm way and can answer our questions attentively. She is assertive in her actions. Shes worry about her figure.

REMARKS: Disturbed Body Image related to biophysical mutilation - pregnancy.

ROLE-RELATIONSHIP

Prior to pregnancy, Mrs. R.C. lives with her daughter while her husband working abroad helping to earn a living that they could hardly see to the needs of their children. They are nuclear family. Sometimes she can feel loneliness due to lack of the presence of her husband but in general she enjoys living with appropriate income and satisfying production of their daily needs.

During pregnancy, Mrs. R.C. is with her daughter in dealing daily circumstances with the financial support of her husband.

Remarks: Impaired Social Interaction related to deficit about ways to enhance mutuality

SEXUALITY-REPRODUCTIVE

Prior to pregnancy, Mrs. R.C. never uses any contraceptives and she doesnt have any sexual reproductive problems. she had her first menstrual period when she was 11 years old.

During pregnancy, she had her last menstrual period on December 09, 2011. She is multigravida and the expected date of confinement is on September 16, 2012. As present the age of gestation is 39 weeks and three days. Mrs. R.C. currently having her pelvic examination and she had a good body posture.

Remarks: Readiness for Enhanced Childbearing Process as evidenced by good body posture

ACTIVITY EXERCISE

Prior to pregnancy, client R.C., wakes up at 5:30am and prepares food for breakfast. Takes a nap after lunch, does the laundry in the afternoon as well as taking a bath. She cooks food for dinner, watches television programs and usually sleeps at 9:00pm. Every weekend she does the grocery and cleaning the house which considered as a form of exercise. She would attend the mass together with her daughter during Sunday and going to the mall. During pregnancy, client R.C., seek some help from her mother doing the household chores. She cannot do

all the household chores alone this time because of her growing fetus.

Remarks: Impaired immobility related to reluctance to initiate movement.

SLEEP REST Prior to pregnancy, the client usually sleeps for 10 hrs. The client verbalized that she would wake up at 5:30am, takes a nap for 30 minutes in the afternoon and sleeps at 9:00pm and sleeps with only one pillow to support her head on supine position. No trouble in sleeping, she can directly go to sleep without any sleeping sedatives. During pregnancy, the client also verbalized that she doesnt have any trouble sleeping. That the environment she sleeps in is comfortable, free of noise and any disturbances. She also drinks a glass of Anmum milk before sleeping. She sleeps with 4 pillows; two under her head, two pillows to support her back in a side-lying position. No trouble in sleeping, she can directly go to sleep without any sleeping sedatives.

Remarks: No problem before and prior to pregnancy

COPING STRESS TOLERANCE Prior to pregnancy, when the client is stressed, she cooks and eats. She would also go to church and just stay there for long hours. During pregnancy, the client is dreading the idea that she will have to undergo another caesarean section. Her way of coping is to surrender everything to God.

Remarks:

VALUE/BELIEF

Patient R.C. is a very religious person. Her religion is Latter Day Saints (LDS). Shes very participative in their activities such as house to house visit and counselling to the other inactive members.

During pregnancy, she cant join the house-to-house visit because of her situation but her faith in God strengthened and surrendered everything to God.

Remarks: Readiness for enhanced spiritual well-being related to life changes.

Physical Examination (IPPA) GENERAL SURVEY A case of Mrs. R.C., 36 years old, female, married and a Filipino citizen had her prenatal visit last September 5, 2012. Gaining 1 lb. every week, she weighs 147 lbs. during her visit. Mrs. R.C. maintains eye contact with appropriate expressions; comfortable and cooperative with examiner; with speech clear; clothing appropriate to climate; looks clean and fit; appears clean and well groomed. She sits comfortably; walk is smooth and well balanced but cant move easily due to pregnancy with the following VITAL SIGNS: TEMPERATURE 36.8 C, PULSE RATE 78 bpm, RESPIRATORY RATE 16 cpm, BLOOD PRESSURE 120/70 mmHg, having the baseline of 120/70 mmHg.

SKIN: Fair complexion

Hyperpigmentation in the axilla and behind the neck. Skin is smooth, warm and has good skin turgor. No swelling and negative in lesions. Negative for edema, rashes and jaundice.

FACE: Fair No edema No chloasma EYES: Clear no loss of vision on both eyes

Doesnt use glasses or contact lenses.

BREAST: Enlarge Sag Brownish with darkened areola Nipples are tender ABDOMEN: With linea negra 30 cm (fundal height) With striae gravidarum (stretch marks)

BLADDER: No pain when palpated

VOIDING: Plenty Yellow in color Voids 10 times a day (3x in dawn; 4x in the morning; 3x in the afternoon).

LEGS: No tenderness Smooth texture No edema

READINGS A Cesarean section (C-section) is surgery to deliver a baby. The baby is taken out through the mother's abdomen. In the United States, about one in four women have their babies this way. Most C-sections are done when unexpected problems happen during delivery. These include

Health problems in the mother The position of the baby Not enough room for the baby to go through the vagina Signs of distress in the baby

C-sections are also more common among women carrying more than one baby. The surgery is relatively safe for mother and baby. Still, it is major surgery and carries risks. It also takes longer to recover from a C-section than from vaginal birth. After healing, the incision may leave a weak spot in the wall

of the uterus. This could cause problems with an attempted vaginal birth later. However, more than half of women who have a C-section can give vaginal birth later. All About C-Sections: Before, During, and After

Many expectant moms look forward to a beautiful childbirth. But what happens if you need a c-section? Two things are for sure: Your birth experience will not be as warm and intimate as you may have imagined, and your body will need more time to recover than if you had a vaginal birth. But in the grand scheme of parenthood, these are minor things; the c-section has the desired effect of delivering your baby safely into your arms. Here's the lowdown on having a c-section. The Preparation: The first order of business -- after consent forms are signed -- is anesthesia. If you already have an epidural in place, the anesthesiologist will increase the dosage. If not, your obstetrician and the anesthesiologist will most likely choose an intrathecal (spinal). Both involve an injection in your back (for which you'll be numbed), and both numb you from the rib cage down. Next, you'll drink some chalky stuff called Bicitra to neutralize your stomach

acids, and you'll be given a catheter and IV. Then it's on to the operating room, where your partner suits up in scrubs and a mask. In the operating room, a curtain will be pulled across your midsection so that in addition to not feeling the proceedings, you won't see them either. With so many of your senses out of commission, you may find yourself listening hard. You're likely to hear a fair amount of activity in the far half of the room: a scrub nurse, another nurse or two, the anaesthesiologist, and perhaps a hospital pediatrician. In a teaching hospital, an extra doctor may be observing. A nurse will shave just enough of your pubic hair to clear the way for the incision, which is usually about as long as your middle finger. When the surgery begins, you won't feel pain. According to Anne Wigglesworth, MD, an obgyn with 19 years of experience practicing in Manhattan, Kansas, many patients feel a bit of a pinch as the peritoneum -- the shiny, hard-to-anesthetize tissue that lines the abdomen -- is reached.

The Delivery Soon you may feel a fair amount of painless prodding, which means the baby is being moved into position. This part is not all that different from a vaginal birth, at least for the doctor. "I have to reach my hand underneath the baby's head to form a cradle so I can pull the head out," explains Amy Moore, MD, an ob-gyn in New York City. Because the mother can't push, she says, "I push the top of the uterus and elevate the head out of the pelvis, getting the shoulders and body to follow." Before you know it, there will be a baby in the room. From the time the incision is made, the baby can be delivered in as little as two minutes or as long as half an hour, depending on the circumstances. Usually you get to see your baby before he's whisked away for care. Now the spotlight moves off you as all those people across the room clean your baby, administer the APGAR test, and place him in the "warmer," which has radiant heat above it and keeps the baby's body temperature steady. Once the baby has been given a clean bill of health, the obstetrician comes back to close you up -- the most complex part of the c-section. "It's like putting together a puzzle," says Dr. Wigglesworth. The uterus is stitched

up, the outer layers are realigned, and the skin is closed, either with dissolving stitches (which take longer to put in) or staples (which require removal a few days later). You'll have a few minutes with your partner to marvel or cry or settle on your baby's name. You may experience nausea or a bout of the shakes (for which medical science has no explanation). You'll spend the next hour or so in the recovery room. You'll have a heart monitor and an oxygen saturation monitor attached to your finger. You will feel your legs coming back to life, sometimes gradually, sometimes in spurts. As the anaesthesia wears off, you may feel itchy all over for a while; if it gets bad, you'll be offered an antihistamine. The Recovery That first day, you'll likely have a pump to deliver a low dosage of a narcotic, such as morphine, as needed. Some doctors will let you eat solids, while others will have you wait 24 hours or until you pass gas, a sign that your intestines are functioning normally. You will need loads of rest, and you will still be bleeding and will need to wear pads for a few days.

On the second day, you'll be switched from the pump to an oral painkiller. The catheter will come out, and you'll be asked to walk to the bathroom, which will appear to be in North Dakota. If the nurses push you before you feel ready, they aren't being sadistic; it's always important to get your lungs and muscles working after surgery. Dr. Moore strongly recommends "as much pain medicine as you need so that you can move around as much as possible." The second day will also bring an unusual interest in your intestinal activity. You may even feel a sensation like a humming motor inside you, which means that your intestines are getting back into gear after pain medications, which slow down your bowels. By the third or fourth day, again depending on whether you're also recovering from labor, you will be sent home. If you're dead tired, push for as long a hospital stay as possible to rest. You will probably go home with a pain prescription in hand; don't hesitate to fill it. If breastfeeding is difficult, you may find that a nursing pillow is a godsend. After two weeks, you'll go back to the doctor for a wound check to make sure your incision is healing well. At six weeks, you'll have a postpartum visit. And by that point, you'll probably feel like a parenting pro.

ANATOMY & PHYPHYSIOLOGY OF C-SECTION

BIBLIOGRAPHY

Victoria, Alynna. "Anatomy and Physiology." Scribd. Scribd, 10 Sept. 2012. Web. 10 Sept. 2012. <http://www.scribd.com/doc/40199599/Anatomy-and-Physiology>. Karch, Amy Morrison. 2007 Lippincott's Nursing Drug Guide. Philadelphia, PA: Lippincott Williams & Wilkins, 2007. Print.

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