V.

PATHOPHYSIOLOGY: y Exposure to small scale mining y Alcohol beverage drinker Genetic mutation Rapid proliferation and undifferentitation of epithelial cells Cyst formation Disruption of nephrogenesis y Environmental cold temperature y Sedentary lifestyle (Housewife) Increase OFI upto 3L/day + IVF infusion

Decreased thirst leading to decreased fluid intake y 1-2 glass of water a day

Decreased maternal plasma volume

Decreased water moving into the amnion

Renal dysplasia y UTZ reveals Multicystic Dysplastic Kidneys

Impaired function of kidneys leading to decreased fetal micturition Risk for fetal injury

Non production of proline

Oligohydramnios

Non formation of collagen and mesenchyme in the lung Decreased expansion of lungs and airways CTG y Bitagen y Aminogen-S Intrauterine hypoxia y UTZ reveals suspected asphyxiated fetus

Loss of lung fluid and reduction on amniotic fluid pressure

Pulmonary hypoplasia

Intrauterine growth restriction

Impaired gas exchange

Restriction of fetal turning and positioning

Breech presentation on UTZ

Advised for CS hence admission and subsequent hospitalization Anxiety Stress Financial problem Sudden change in environment Altered comfort

Impaired communication

Sleep pattern disturbance

I. Demographic Data Patients Name: Casionan, Marilyn Age: 26 y/o Sex: Female Address: Tublay, Benguet Civil Status: Married Birthdate: March 5, 1985 Nationality: Filipino Religion: Roman Catholic Date Admitted: December 12, 2011 II. Medical History Impression: Anhydramnios Chief Complaint: Anhydramnios History of the Present Illness: Patient was recently admitted last November 23, 2011 due to anhydramnios and was discharged after 4 days. Patient was advised for follow-up. Several hours PTA, when an UTZ was done revealing single live intrauterine fetus 35-36 weeks AOG, breech, severe oligohydramnios. Findings in the fetal kidneys may represent multicystic dysplastic kidneys, suspected asphyxiated fetus. Past Personal and Medical History: The patient has asthma but not in maintenance medication. The patient is not currently on maintenance medications. The patient does not have DM, CVD, or HPN. Vaccinations were unrecalled. The patient has no allergies to food and drugs. Family History: There is a note of family history of asthma and twinning on mother side. There is no family history of diseases such as HPN, CVD, DM, cancer, epilepsy or seizure disorders. Social and Environmental History: The patient is a non smoker but an occasional beverage drinker. The patient lives with the family on a non congested area. The patient has food preference for meat and vegetables. Water for domestic purposes and drinking is from the spring. Sexual History: Patients first sexual contact is at 25 years old, without bleeding and with dyspareuria. Subsequent contacts were comfortable without bleeding and dyspareuria. She claims to have 1 sexual partner. Last sexual activity was unrecalled. Gyne History: The patient has no history of gynecologic illness in the past. No paps smear and no family planning method used. There was no gynecologic hospitalization or operations in the past. VI. List of Identified Nursing Diagnosis and Prioritization 1. Risk for fetal injury related to decreased amniotic fluid This problem is most prioritized because the life of the fetus is at stake. If this problem is not given the proper attention immediately the fetus may die. The Amniotic fluid or liquor amnii is the nourishing and protecting liquid contained by the amniotic sac of a pregnant woman. Amniotic fluid is "inhaled" and "exhaled" by the fetus. It is essential that fluid be breathed into the lungs in order for them to develop normally. Swallowed amniotic fluid also creates urine and contributes to the formation of meconium. As well, amniotic fluid protects the developing baby by cushioning against blows to the mother's abdomen, allows for easier fetal movement, promotes muscular/skeletal development, and helps protect the fetus from heat loss. Because of the decreased level of amniotic fluid, the mother can experience certain birth defects in the baby, ruptured membranes (breaks or tears in the sac that holds the amniotic fluid), and an increased the risk of miscarriage, preterm birth and stillbirth. 2. Sleep disturbance related to altered comfort

Sleep is the natural periodic suspension of consciousness during which the powers of the body are restored. The sleep process is a very complex amalgam of physiological, biochemical, and behavioral events, which are absolutely necessary for the normal function of the body and maintenance of an internal state of homeostasis. In Abraham Maslows hierarchy of needs sleep falls on the first level of basic needs which is the physiologic needs. Basically, physiologic needs are the literal requirements for human survival. If these requirements are not met, the human body simply cannot continue to function. Poor sleep can have an effect on labor and delivery. Researchers from the University of California at San Francisco recently found that women who slept fewer than 6 hours per night had longer labors and were 4.5 times more likely to have cesarean deliveries. 3. Anxiety related to financial stress Pregnancy can be both an exciting and worrying time for parents-to-be. Pregnant women experience a range of physical and emotional changes, all of which may trigger anxiety. Fear of the unknown, stress, feelings of insecurity over work or money, and daily pressures add to hormonal changes during pregnancy and may make women feel overwhelmed. Couple this with the constant worry over the babys health, and anxiety becomes a real possibility. In the case of our patient, her hospitalization became a source of stress because of their financial status. According to Maslows hierarchy of needs, sleep falls on the safety aspect of the patient, which is the second most prioritized needs of a person. With the physical needs relatively satisfied, the individual's safety needs take precedence and dominate behavior. 4. Impaired communication related to sudden change in the environment After physiological and safety needs are fulfilled, the third layer of human needs is social involvement and feelings of belongingness. And this is where communication falls under. Deficiencies with respect to this aspect of Maslow's hierarchy can impact individual's ability to form and maintain emotionally significant relationships in general. IV. Course of Confinement Identified Laboratory/ Problem Diagnostic s 1. Anhydramnio s a) CTG

Significance/ Findings

Medication s

Indication related to patients condition

Nursing Diagnoses

Nursing Interventions

b) UTZ

c) CBC

FHT 130, Aminogen poor beat to MOA: beat variability,  A unique 6 accelerations enzymatic in 24 min compound interval, (-) that decelerations possibly assist 35-36 weeks protein AOG, breech assimilation presentation by creating with severe protein oligohydramnio peptides s. fetal kidneys and may represent preferentiall multicystic y liberating dysplastic branchkidneys, chain amino suspected acids from asphyxiated whole fetus proteins.  Enhances Hgb 135 g/l the Hct 43 % absorption WBC 9x10 of the

 Since the fetus does not acquire sufficient nutrients and is not capable to develop normally due to decreased amount of amniotic fluid, Aminogen is given to aid in the supplementatio n of protein, nutrition and water.

Risk for Fetal Injury related to decreased amount of amniotic fluid

> Assess and monitor continuously the vital signs of the mother and the fetus. > Assess hydration status of the mother. > Auscultate mothers abdomen to hear, assess and monitor the fetal heart tone, beat and movement. > Administer IV fluids and supplements, as indicated

g/l Normal findings d) Urinalysis

pH acidic color yellow bacteria (-) Ferrous pus cells (-) Sulfate Normal MOA: findings  Provides the iron needed by the body to produce red blood cells

amino acids present in the protein supplement .  Iron supplement is needed by a pregnant woman because the demand for supply of nutrients and oxygen is increased due to the growing fetus thus needing more red blood cells.

[Dependent]. > Provide safety measures (e.g. raise side rails and keeping off things that are sharp and edgy) > Promoting a clean and quiet environment. > Educate mother to have a complete bed rest. > Encourage the patient to increase fluid intake. > Prepare the patient and family members for the possibility of an emergency CS delivery, the delivery of a premature neonate and the changes to expect in the postpartum period Sleep pattern disturbance related to altered comfort > Assess sleep pattern disturbances that are associated with specific underlying illnesses. > Observe and obtain feedback from clients regarding usual bedtime, routines, number of

 Amniotic fluid Vitamin A is inhaled and MOA: exhaled by the  A fatfetus and it is soluble essential to be vitamin breathed into stored in the lungs for the liver them to that is develop important normally. for baby's Since there is embryonic insufficient growth fluid, the lungs including might not be the able to developme develop nt of the normally thus heart, Vitamin A is lungs, given. kidneys, eyes, and bones, and the circulatory, respiratory, and central nervous systems.  Also helps with infection resistance and fat metabolism.  Essential for women

who are about to give birth, because it helps with postpartum tissue repair. Bitagen MOA:  The fetus  A multivit needs glucose and glucose supplement supplement because due  A glucose to the polymer decreased which amniotic fluid provides that aids in the energy and nutrient supply for calcium for the fetus, absorption. there will be also an insufficient supply of nutrients to the fetus.

hours of sleep, and environmental needs. > Clustering of nursing care without waking the client, and clustering of nursing interventions while the patient is still awake. > Administer sleep medication as ordered. (Dependent) > Explain the necessity of disturbance for monitoring Vital Signs and care when hospitalized. > Encouraged wearing eye cover, drinking warm milk, and sleeping at the same time each night. > Suggest to the patient to do relaxing activities such as warm bath, and listening to calm music, etc. > Instruct the patient not to do strenuous exercises before bed Anxiety related >Assess level of anxiety to financial stress > Listen actively and focus on the

patients verbalization of feelings. >Use appropriate touch with patient permission. >Instructed deep breathing exercise. >Speak in brief statements using simple words. Impaired communicatio n related to sudden change in the environment >Assess type of impairment and cultural barriers. >Offer alternative forms of communicatio n such as gestures or actions >Encourage s/o to participate. >Validate patient's message by repeating aloud. >Use short repetitive directions. >Ask simple yes or no questions. >Speak on an adult level, speaking clearly