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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.
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
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
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
Slightly pale
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
Normal
Slightly curved toward Skin intact, no discharged, no discoloration Firm and not tender, pinna recoiled after its folded
Normal Normal
Normal
NOSE
Normal
MOUTH LIPS
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
EXTREMETIES
No edema
Edema
NAILS
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).
Release of the LH
Implantation
TRUE LABOR
Uterine Contraction
SHOW
Transverse Presentation
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