Preterm Labor To Ceasarean Section FINAL

PRETERM LABOR AT CESARIAN
SECTION
I. Introduction
The rate of cesarean sections around the world is increasing at an "alarming"

rate, reported an international team of doctors, Since 1985, the international
health care community has considered the ideal rate for cesarean sections to be
between 10-15%. Since then, cesarean sections have become increasingly
common in both developed and developing countries. When medically
necessary, a Caesarean section can effectively prevent maternal and newborn
mortality. Two new HRP studies show that when cesarean section rates rise
towards 10% across a population, the number of maternal and newborn deaths
decreases. When the rate goes above 10%, there is no evidence that mortality
rates improve.
(https://www.who.int/reproductivehealth/topics/maternal_perinatal/cs-
statement/en/)
Among the total number of deliveries handled and admitted, 86% delivered
by NSD and 14% by Caesarean Section. Of all those delivered through NSD,
52% (N=1358) were with High Risk conditions. High risk condition was based on
the WHO High Risk coding for pregnant women.
CS rate is 14%, this is higher than the acceptable level of 3-4% based on
Western Standards, as per FOGS indicator their acceptable level is 15%.
(http://lpghstc.doh.gov.ph/index.php/statistics)
The risk of cesarean birth was greater in a private facility than in a
government hospital by 36–4. Regional gradients in cesarean birth were found to
be steeper for deliveries in private facilities than in government hospitals in
Philippines. the residents of the Philippine's medium ‐use provinces, giving birth in
a government facility increased the likelihood of a cesarean delivery by 84
percent and by 173 percent in a private facility.(Regional Gradients in
Institutional Cesarean Delivery Rates)
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II. Objectives
General:
After 2 weeks of exposure in Southern Philippines Medical Center lnc., we

the BSN student will be able to understand and promote the general health of the
patient with Lower Uterine Caesarean Section. This study aims to provide skills,
knowledge and attitude to the students.
Specific Objectives:
Knowledge:
 To define what Lower Uterine Cesarean section;

 Discuss the anatomy and physiology;
 Trace the pathophysiology of Lower Uterine Cesarean section;
 Understanding about the disease process: the causes, effects,
management, treatment and possible preventions of the condition;
 To know and identify the drugs given by the patient;
 Formulate Nursing Care Plan related to the case and determine the
possible intervention.
Skills:
 Perform efficient physical assessment to the patient;

 Gather pertinent data regarding family background and health history from
patient and significant others;
 Participate in the course of care of patient;
 Promote and provide health teachings and interventions to the family and
significant others.
Attitude:
 Establish a good interpersonal relationship to the patient and to his family;

 Provide the patient and family with proper discharge planning.
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III. PATIENT’S DEMOGRAPHIC DATA
Patient’s Code Name: Patient L

Age: 21
Birthday: January 9, 1999
Birthplace: Culagsing, Sta Maria Davao Occidental
Sex: Female
Status: Married
Religion: IFI
Nationality: Filipino
Address: Barangay Culagsing, Sta Maria Davao Occidental
Educational Attainment: Senior High School Graduate
Occupation: Sales lady
Date of Admission: february 16, 2020
Time of Admission: 10:24 pm
Admitting Vital signs:
BP: 110/800 mmHg
HR: 85bpm
RR: 22 Cpm
Temp: 36.3 celsuis
Physician: Dr ML Lim
Station/Room: Labor room, Bed 2
Chief complaint: Labor pain
Admitting Diagnosis : Patient and chart
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HEALTH HISTORY
a. Family Socio-Economic Background

Patient L is 21 years old, she was lives and born at Sta. Maria Davao
Occidental. She was a Senior High School Graduate, at sta. Maria National
High School. After she graduate she got a work at the hardware, and the
monthly income was 2500 pesos. at the early aged of 21, she got married to
his boyfriend, not in long time both Parents make a decision to have a
wedding. September 5, 2019 they got married. but she still living together with
her parents and she is 6 months pregnant, the usual diet of the patient during
with her pregnancy she eat junck foods like mangjuan and crucklings she
consume about 3 pax of junck foods ever day,she drink soft drink like ever
day she consume about 2 cups of it. She eat vegetable like malunggay and
eggplant and she love to eat bulad. She got stressed because of her father.
Her parents were always fighting for the reason of jealousy and the vices of
her father. About 8 months her of pregnancy she decided to separate from
her parents to lived together with her husband. The work of her husband is a
fish cadge taker ate sta. Maria the monthly income of her husband is 4000
pesos. She budget the money properly for their needs. so the main source of
income is her husband. during of her pregnancy she like to have an exercise
every day she love to walk every morning, she said that when the cousin of
her come o there house she was exposed to smoke of cigarette.
b. History of Past Illness

Patient L was hospitalized at Bulingay General Hospital, because of fever,
vomiting and headache that were 5 years ago. At the aged of 17 she was
hospitalized at Pinida hospital due to Amenorrhea for 6 months with fever.
During four months of her pregnancy she has Urinary Tract Infection (UTI)
and she was given antibiotic. About 6 months of her pregnancy she was
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hospitalized at Bulingay General Hospital Due Abnormal Fetal Hearth Beat,
she was given a medication for the baby.
c. Gynaecology
The first menarche of the patient is when she was 14 years old,
irregular in cycle 5days, but sometimes she was experiencing
Dysmenorrhea. The time that she was pregnant she visits the canter
regularly, the first visit September 17, 2019. The last menstrual period
June 15, 2019, the expected date of delivery March 21, 2020. the second
check-up of the patient was October 15, 2019, the weight of the patient is
45kg, the age of gestation is 16 weeks, blood pressure100/64mmHg, the
advice given to her is continue ferrous sulphate once a day, Increased
OFI. The last check-up was November 10, 2019 the weight of the patient
is 50kg, age of gestation 21, and blood pressure 100/59mmhg in same
advice given. the ultrasound report was on October 24, 2019 was intra
uterine pregnancy 21 weeks first day, live in breech presentation.
February 16, 2020 is the second Ultrasound the imprecision was intra
uterine pregnancy 36 weeks and 3 days, live in cephalic presentation.
d. History of Present Illnesses

One day prior to admission patient L was complaining of mild
abdominal pain, and she never think about that. 12 hours prior admission
patient was planning to go in church but about 10:00 am she complaining
of severe abdominal pain and cramping of legs.
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PRETERM LABOR AT CESARIAN SECTION
e. Genogram
Maternal Paternal
67yrs.
old
45yrs.
46yrs.
old old
21 yrs
old
legend:
male
female
death
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IV. DEVELOPMENTAL DATA
Erikson’s Stages of Psychosocial Development
Outcome
(Achieve
Psychosocial d or Not
Age Rationale Significance
Crisis Achieved
/ Fixated
or Not)
During this stage,
the infant is
uncertain about the
world in which they
live. To resolve
these feelings of
uncertainty, the
infant looks towards
their primary
caregiver for
stability and
consistency of care.
if the care has been
harsh or
inconsistent, Patient L was
unpredictable and breastfed by
unreliable, then the her mother.
Infant- 18 Trust vs infant will develop a She was
Achieved
mos Mistrust sense of mistrust breastfed by
and will not have his mother up
confidence in the to 3 years
world around them old.
or in their abilities to
influence events.
This infant will carry
the basic sense of
mistrust with them
to other
relationships. It may
result in anxiety,
heightened
insecurities, and an
over feeling of
mistrust in the world
around them.
18 mos- 3 Autonomy vs Achieved The child is Patient L
yrs Shame and developing achieved this
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physically and
becoming more
mobile, and
discovering that he
or she has many
skills and abilities,
such as putting on
clothes and shoes,
playing with toys,
etc. Such skills
illustrate the child's
growing sense of
independence and
autonomy. If
children in this
stage are
encouraged and
supported in their stage
increased because he
independence, they started to
Doubt become more socialized in
confident and people
secure in their own around him.
ability to survive in
the world.
If children are
criticized, overly
controlled, or not
given the opportunity
to assert themselves,
they begin to feel
inadequate in their
ability to survive, and
may then become
overly dependent
upon others, lack
self-esteem, and feel
a sense of shame or
doubt in their
abilities.
3-5 yrs Initiative vs Achieved During this period Patient

Guilt the primary feature achieved this
involves the child stage
regularly interacting because he
with other children is already
at school. Central to aware of
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this stage is play, as
it provides children
with the opportunity
to explore their
interpersonal skills
through initiating
activities.
Conversely, if this
tendency is what is right
squelched, either and wrong in
through criticism or playing to her
control, children friends.
develop a sense of
guilt. They may feel
like a nuisance to
others and will,
therefore, remain
followers, lacking in
self-initiative.
5-13 yrs Industry vs Achieved At this stage that
Inferiority the child’s peer Patient
group will gain achieved this
greater significance stage
and will become a because his
major source of the family can
child’s self-esteem. send him to
The child now feels school and
the need to win he already
approval by knows how to
demonstrating work simple
specific in there
competencies that house.
are valued by
society and begin to
develop a sense of
pride in their
accomplishments.
If children are
encouraged and
reinforced for their
initiative, they begin
to feel industrious
(competent) and
feel confident in
their ability to
achieve goals. If
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this initiative is not
encouraged, if it is
restricted by
parents or teacher,
then the child
begins to feel
inferior, doubting his
own abilities and
therefore may not
reach his or her
potential.
If the child cannot
develop the specific
skill they feel
society is
demanding (e.g.,
being athletic) then
they may develop a
sense of inferiority.
21-39 yrs Intimacy vs Achieve During this period, Patient L
Isolation d the major conflict achieved this
centers on forming stage
intimate, loving because at
relationships with the age of 2
other people. she already
During this period, married.
we begin to share
ourselves more
intimately with
others. We explore
relationships
leading toward
longer-term
commitments with
someone other than
a family member.
Successful
completion of this
stage can result in
happy relationships
and a sense of
commitment, safety,
and care within a
relationship.
Avoiding intimacy,
fearing commitment
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and relationships
can lead to
isolation, loneliness,
and sometimes
depression.
Success in this
stage will lead to
the virtue of love.
Jean Piaget Cognitive Developmental Theory
Outcome
(Achieved or
Psychosocial
Age Not Achieved/ Rationale Significance
Crisis
Fixated or
Not)
Birth to 18–24 Sensorimotor Motor activity Patient L

months old without use of cannot
symbols. All remember.
things learned
are based on
experiences,
or trial and
error.
2 to 7 years Preoperationa Achieved Development At the age of
old l of language, 2 patients
memory, and started to talk
imagination. simple words
Intelligence is like papa and
both mama.
egocentric
and intuitive.
7 to 11 years Concrete Achieved More logical Patient L
old operational and Achieved achieved this
methodical stage
manipulation because he
of symbols. was enrolled
Less by his parents
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egocentric, at Elementary
and more School and
aware of the aware a lot of
outside world things.
and events.
Adolescence Formal Achieved Use of Patient L
to adulthood operational symbols to achieved this
relate to stage
abstract because he is
concepts. already aware
Able to make in past illness
hypotheses and became a
and grasp compliant in
abstract taking her
concepts and medicine
relationships. during her
pregnancy.
1
Sigmund Freud Psychosexual Developmental Theory
Outcome
(Achieved or
Psychosocial Not Rationale Significance
Age
Crisis Achieved/ (Ideal) (Justification)
Fixated or
Not)
Birth to 1 year Oral Achieved Pleasure is Patient L was
accomplish by breastfed by
exploring the his mother up
mouth and by to 3 years old.
sucking
1 to 3 years Anal Not Achieved Pleasure in Patient L able
accomplished to tell his
by exploring mother when
the organs of he wants to
elimination defecate.
3 to 6 years Phallic Achieved Pleasure is Patient J able
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accomplish by to distinguish
exploring the that she was a
genitals girl.
6 to puberty Latent Achieved Pleasure is Patient L
directed by playmates are
focusing on GIRLS
relationships
with same sex
peers and the
parent of the
same sex.
Puberty to Genital Achieved Pleasure At the age of

Death directed in the 21 She was
development getting married.
of sexual
relationship.
V. DEFINITION OF COMPLETE DIAGNOSIS
Caesarean delivery (also called a caesarean section or C-section)

is the surgical delivery of a baby by an incision through the mother's
abdomen (belly) and uterus (womb). This procedure is done when it is
determined to be a safer method than a vaginal delivery for the mother,
baby, or both.
In a caesarean delivery, an incision (cut) is made in the skin and
into the uterus at the lower part of the mother’s abdomen. The incision in
the skin may be vertical (longitudinal) or transverse (horizontal), and the
incision in the uterus may be vertical or transverse.
A transverse incision extends across the pubic hairline, whereas, a
vertical incision extends from the navel to the pubic hairline. A transverse
uterine incision is used most often, because it heals well and there is less
bleeding. Transverse uterine incisions also increase the chance for
vaginal birth in a future pregnancy. However, the type of incision depends
on the conditions of the mother and the fetus.
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There are two main techniques that doctors nowadays use to

perform C-sections:
Transverse C-Section Steps
The transverse incision is a horizontal cut across the mother's
abdomen, and the classic C-section is a vertical cut down the mother's
abdomen. Of the two, the transverse incision is usually preferred due to a
lower chance of blood loss and quicker healing. In this procedure, the
doctor makes a horizontal incision across the mother's abdominal muscles
- below the curve of the belly but above the bladder. If you think about the
location of a bikini, the incision would be made right above the bikini line,
like this:
Location of a transverse incision.
transverse incision during c-section
Next, another identical incision is made through the uterine wall.
Classic C-Section Steps
Delivery of a baby through C-section
C Section Birth
In the classic C-section, a vertical incision is made down the center
of the mother's belly. Just like in the transverse procedure, the first incision
cuts through the tissue and the muscle, and then a second incision is
made through the uterine wall.
VI. ANATOMY AND PHYSIOLOGY
Vagina
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The vagina is a muscular, hollow tube that extends from the vaginal
opening to the cervix of the uterus. It is situated between the urinary bladder and
the rectum. It is about three to five inches long in a grown woman. The muscular
wall allows the vagina to expand and contract. The muscular walls are lined with
mucous membranes, which keep it protected and moist. A thin sheet of tissue
with one or more holes in it, called the hymen, partially covers the opening of the
vagina. The vagina receives sperm during sexual intercourse from the penis. The
sperm that survive the acidic condition of the vagina continue on through to the
fallopian tubes where fertilization may occur.
The vagina is made up of three layers, an inner mucosal layer, a middle
muscularis layer, and an outer fibrous layer. The inner layer is made of vaginal
rugae that stretch and allow penetration to occur. These also help with
stimulation of the penis. The middle layer has glands that secrete an acidic
mucus (pH of around 4.0.) that keeps bacterial growth down. The outer muscular
layer is especially important with delivery of a fetus and placenta.
 Purposes of the Vagina
 Receives a males erect penis and semen during sexual intercourse.
 Pathway through a woman's body for the baby to take during childbirth.
 Provides the route for the menstrual blood (menses) from the uterus, to
leave the body.
 May hold forms of birth control, such as a diaphragm, FemCap, Nuva Ring,
or female condom.
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The cervix (from Latin "neck") is the lower, narrow portion of the uterus
where it joins with the top end of the vagina. Where they join together forms an
almost 90 degree curve. It is cylindrical or conical in shape and protrudes through
the upper anterior vaginal wall. Approximately half its length is visible with
appropriate medical equipment; the remainder lies above the vagina beyond
view. It is occasionally called "cervix uteri", or "neck of the uterus".
During menstruation, the cervix stretches open slightly to allow the endometrium
to be shed. This stretching is believed to be part of the cramping pain that many
women experience. Evidence for this is given by the fact that some women's
cramps subside or disappear after their first vaginal birth because the cervical
opening has widened.
The portion projecting into the vagina is referred to as the portio vaginalis
or ectocervix. On average, the ectocervix is three cm long and two and a half cm
wide. It has a convex, elliptical surface and is divided into anterior and posterior
lips. The ectocervix's opening is called the external os. The size and shape of the
external os and the ectocervix varies widely with age, hormonal state, and
whether the woman has had a vaginal birth. In women who have not had a
vaginal birth the external os appears as a small, circular opening. In women who
have had a vaginal birth, the ectocervix appears bulkier and the external os
appears wider, more slit-like and gaping.
The passageway between the external os and the uterine cavity is
referred to as the endocervical canal. It varies widely in length and width, along
with the cervix overall. Flattened anterior to posterior, the endocervical canal
measures seven to eight mm at its widest in reproductive-aged women. The
endocervical canal terminates at the internal os which is the opening of the cervix
inside the uterine cavity.
During childbirth, contractions of the uterus will dilate the cervix up to 10
cm in diameter to allow the child to pass through. During orgasm, the cervix
convulses and the external os dilates.
The uterus is shaped like an upside-down pear, with a thick lining and muscular
walls. Located near the floor of the pelvic cavity, it is hollow to allow a blastocyte,
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or fertilized egg, to implant and grow. It also allows for the inner lining of the
uterus to build up until a fertilized egg is implanted, or it is sloughed off during
menses.
The uterus contains some of the strongest muscles in the female body.
These muscles are able to expand and contract to accommodate a growing fetus
and then help push the baby out during labor. These muscles also contract
rhythmically during an orgasm in a wave like action. It is thought that this is to
help push or guide the sperm up the uterus to the fallopian tubes where
fertilization may be possible.
The uterus is only about three inches long and two inches wide, but during
pregnancy it changes rapidly and dramatically. The top rim of the uterus is called
the fundus and is a landmark for many doctors to track the progress of a
pregnancy. The uterine cavity refers to the fundus of the uterus and the body of
the uterus.
Helping support the uterus are ligaments that attach from the body of the
uterus to the pelvic wall and abdominal wall. During pregnancy the ligaments
prolapse due to the growing uterus, but retract after childbirth. In some cases
after menopause, they may lose elasticity and uterine prolapse may occur. This
can be fixed with surgery.
Some problems of the uterus include uterine fibroids, pelvic pain (including
endometriosis, adenomyosis), pelvic relaxation (or prolapse), heavy or abnormal
menstrual bleeding, and cancer. It is only after all alternative options have been
considered that surgery is recommended in these cases. This surgery is called
hysterectomy. Hysterectomy is the removal of the uterus, and may include the
removal of one or both of the ovaries. Once performed it is irreversible. After a
hysterectomy, many women begin a form of alternate hormone therapy due to
the lack of ovaries and hormone production.
At the upper corners of the uterus are the fallopian tubes. There are two
fallopian tubes, also called the uterine tubes or the oviducts. Each fallopian tube
attaches to a side of the uterus and connects to an ovary. They are positioned
between the ligaments that support the uterus. The fallopian tubes are about four
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inches long and about as wide as a piece of spaghetti. Within each tube is a tiny
passageway no wider than a sewing needle. At the other end of each fallopian
tube is a fringed area that looks like a funnel. This fringed area, called the
infundibulum, lies close to the ovary, but is not attached. The ovaries alternately
release an egg. When an ovary does ovulate, or release an egg, it is swept into
the lumen of the fallopian tube by the fimbriae.
Once the egg is in the fallopian tube, tiny hairs in the tube's lining help
push it down the narrow passageway toward the uterus. The oocyte, or
developing egg cell, takes four to five days to travel down the length of the
fallopian tube. If enough sperm are ejaculated during sexual intercourse and
there is an oocyte in the fallopian tube, fertilization will occur. After fertilization
occurs, the zygote, or fertilized egg, will continue down to the uterus and implant
itself in the uterine wall where it will grow and develop.
If a zygote doesn't move down to the uterus and implants itself in the
fallopian tube, it is called a ectopic or tubal pregnancy. If this occurs, the
pregnancy will need to be terminated to prevent permanent damage to the
fallopian tube, possible haemorrhage and possible death of the mother.
Mammary glands are the organs that produce milk for the sustenance of
a baby. These exocrine glands are enlarged and modified sweat glands.
The basic components of the mammary gland are the alveoli (hollow cavities, a
few millimetres large) lined with milk-secreting epithelial cells and surrounded by
myoepithelial cells. These alveoli join up to form groups known as lobules, and
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each lobule has a lactiferous duct that drains into openings in the nipple. The
myoepithelial cells can contract, similar to muscle cells, and thereby push the
milk from the alveoli through the lactiferous ducts towards the nipple, where it
collects in widenings (sinuses) of the ducts. A suckling baby essentially squeezes
the milk out of these sinuses.
The development of mammary glands is controlled by hormones. The
mammary glands exist in both sexes, but they are rudimentary until puberty when
- in response to ovarian hormones - they begin to develop in the female.
Estrogen promotes formation, while testosterone inhibits it.
At the time of birth, the baby has lactiferous ducts but no alveoli. Little branching
occurs before puberty when ovarian estrogens stimulate branching differentiation
of the ducts into spherical masses of cells that will become alveoli. True
secretory alveoli only develop in pregnancy, where rising levels of estrogen and
progesterone cause further branching and differentiation of the duct cells,
together with an increase in adipose tissue and a richer blood flow.
Colostrum is secreted in late pregnancy and for the first few days after
giving birth. True milk secretion (lactation) begins a few days later due to a
reduction in circulating progesterone and the presence of the hormone prolactin.
The suckling of the baby causes the release of the hormone oxytocin which
stimulates contraction of the myoepithelial cells.
The cells of mammary glands can easily be induced to grow and multiply by
hormones. If this growth runs out of control, cancer results. Almost all
instances of breast cancer originate in the lobules or ducts of the mammary
glands.
ABDOMINAL LAYERS
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1.skin
The skin of the lower abdominal wall is incised in a transverse direction
just above the pubic hairline in the majority of cases (side to side rather than
up and down). A longitudinal (up and down) incision is infrequently employed.
2. subcutaneous tissue
3.fascia
rectus fascia- a dense shiny white layer of fascia. This fascia layer is incised
to expose the two rectus abdominal muscles which are big muscles running
from the rib cage to the pubic bone.
4. muscle
These are the main muscles employed to do sit-ups (rectus). The two
muscles meet in the midline where they are sometimes fused but quite often,
however, they are separated as the result of the stretching from the distended
uterus. These muscles are now separated (without cutting them) and pulled to
the sides to create a space between them.
5. Peritoneum
The peritoneal layer is a very thin membrane-like layer, which can be
described as the lining of the abdominal cavity.
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VII. PHYSICAL ASSESSMENT

a. Review of Systems
1. Head
“oo labad pod akong ulo ”
2. Eyes
“dili man labu akong mata”
3. Ears
“Tarung man akong pag dungog”
4. Nose and sinuses
“Wala man ko ga lisod og ginahawa maam”
5. Mouth and oropharynx
“Dili man ko mag lisod ug tulon”
6. Thorax and lungs
“Wala man ko gina ubo ug dili ko malisodan ug ginhawa”
7. Heart and central vessels
“Wala man gasakit sir”
10. Abdomen
“sakit kaayu akong tiyan gyud sir ay ”
11. Musculoskeletal system
“Medyo kapoy na gyud maam”
12. Genitals and inguinal area
“Wala may problema maam, maka ihi man sad kog tarong”
13. Rectum and anus
“Wala may problema sa akong paglibang ma’am”
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General Appearance and Mental Status

Patient L received on bed, bed 2, Labor room lying on bed, in flat
position, with ongoing IVF of bottle 1 PNSS 1L. @ 120cc/hr. Patient L is
wearing white patient’s gown. Patient L is oriented and responsive to all
questions asked. Initial vital signs taken and recorded as follows:
Vital Signs/Measurements
BP: 110/80 mmHg
PR: 85bpm
RR: 22 Cpm
Temp: 36.3 Celsius
SKIN, HAIR AND NAILS
Skin is soft and well-hydrated. No lesions noted. Hair is black, clean
with normal distribution of hair on scalp, and no infestations are found.
Nails are trimmed, smooth, immobile and with less than 3 seconds of
capillary refill.
HEAD AND NECK
Head symmetrically round, hard, without lesions. Face smooth and
symmetrical. Neck symmetric with centered head position and no bulging
masses. Has smooth, controlled, full range of motion of neck. Trachea in
midline. Lymph nodes are not inflamed.
EYE AND EAR
Pupils are round and reactive to light accommodation and pupils
converge evenly. Eyelids in normal position with no abnormal widening or
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ptosis. No discharge or crusting noted. Conjunctiva and sclera appear
moist and smooth.
Ears are equal in size bilaterally. Auricles are aligned with the
corner of each eye. Skin smooth, no lumps, lesions.
MOUTH, THROAT, NOSE, AND SINUS
Lips are pinkish and moist without any lesions.
Both nares are patent and is smooth and symmetric. No lesions. No discharge
noted.
THORAX AND LUNG
Respiration /minute, relaxed and even.
Chest expansion symmetric. No pain or tenderness on palpation.
Clear lung sounds noted upon auscultation.
HEART AND NECK VESSELS
No enlargement of lymph nodes upon palpation. No heart murmurs
upon auscultation.
ABDOMEN
Abdomen is symmetric with no bulges or lumps. Abdominal pain
noted upon palpation, fetal movement noted upon palpation.
UPPER AND LOWER EXTREMITIES
Joints are symmetrical. No swelling and redness of the joints.
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VIII. ETIOLOGY AND SYMPTOMATOLOGY
ETIOLOGY
PREDISPOSING FACTORS
Factors Remarks Rationale Significance
Age  Preterm labor have no The aged of
known risk factors. But some my patient is
things raise a woman's risk 22 years old.
for preterm labor, Aged
under 20 years or over 35
years old.
Maternal  Stress can be more My patient
Stress challenging to manage experienced
during pregnancy, it's Stress during
important to try to relax. her pregnancy
Stress, especially chronic , its because
stress, can increase your risk to her father.
of having a small baby or
going into premature labor
(also known as preterm
labor).
PRECIPITATING FACTORS
Passive  Exposure that has been My patient
Smoking was exposed
studied in relation to
to those
premature birth is air people who
smoke like
pollutants. These can be
every day.
divided into two types:
tobacco-related (e.g.,
passive smoking,
environmental tobacco
smoke) and traditional air
pollutants (e.g., particulates,
sulfur).
Urinary Tract  UTI are common during My patient
infection pregnancy,That’s because Experienced
24
SECTION
infections increase the risk of UTI during
premature labor. pregnancy
about 6
months on her
pregnancy.
SYMPTOMATOLOGY
Ideal S/Sx Actual Rationale Significance
A headache can My patient
be a sign of experienced
stress or head ache while
emotional in labor.
distress, or it
can result from
Headache
 a medical
disorder, such
as migraine or
high blood
pressure,
anxiety, or
depression.
Stress can be My patient
more experienced
challenging to Stress during
manage during her pregnancy ,
pregnancy, it's its because to
important to try her father.
to relax. Stress,
especially
Maternal Stress
 chronic stress,
can increase
your risk of
having a small
baby or going
into premature
labor (also
known as
preterm labor).
sudden pain
between
 Premature
labor occurs
My patient
experienced
contractions between the pain every
20th and 37th during
week of contraction.
pregnancy,
25
SECTION
when uterine
contractions
cause the
cervix, the
mouth of the
uterus or womb,
to open earlier
than normal.
This can result
in premature
birth.
26
IX. PATHOPHYSIOLOGY
Predisposing Factor Precipitating Factor
Age Maternal Passive Urinary Tract

Stress Smoking Infection
Risk of preterm Linking stress to Exposure that Infection

of preterm labor prematurity are has in relation to increase of
aged fewer than mediated by premature birth premature labor
20 or 30 years placental CRH
old
Increase cortisol
and epinephrine The larger urinary
tract, along with
increase bladder
volume, decrease
bladder tone
27
Release of FSH by the anterior pituitary

gland
Developmental of the Gratian Follicle
Production of the estrogen --------------- Thickening of the endometrium
Release of the Luteinizing Hormone
Ovulation Release of mature ovum

-------------
from the graafian follicle
Ovum Travels into the

fallopian tube.
28
Union of the ovum

Fertilization
---------- and sperm in the
ampulla
Zygote travels from the fallopian

tube to the uterus
Headache increase progesterone

Nausea or Morning Sickness
Implantation -----------
Tender breast
HCG
Progesterone
Estrogen
Development of the fetus

embryo and placental structure
until full term.
29
Signs of Labor (preterm 35 weeks and 1 day)
Lengthening Descent of the fetal head into the

-------------
pelvis
Contraction ------------- 35 weeks, cramping or contractions are expected

and release of oxytocin.
Irregular contraction noted
Ripening of the cervix ----------- Goodell’s

sign
Spotting
Water breaking ---------- Gush or a trickle that probably amniotic fluid
30
LABORATORY TEST
 serology
 hematology
 Clinical Microscopy
 Coversion factor
 Fetal Fibronectin
 Pelvic Exam
PRETERM LABOR 35 WEEKS, 1 DAY
(+) Fetal distress

(+) Bad FHT
Failed to progress labor ----------
^ Risk of fetal Death
(+) Oligohydramnios
EMERGENT CESARIAN DELIVERY

(the incision made of the lower party of the
--------------- (+) vertical Incision
abdomen)
31
Expulsion of the fetus
Expulsion of the Placenta (accompanied by

blood approximately 500-1000mL
If not treated If Treated
BAD PROGNOSIS
Fetal Death
32
Under the service

 collados Funeral SURGICAL MEDICAL NURSING MANAGEMENT
 Sta. Maeia Funeral MANAGEMENT MANAGEMENT  Deficient Knowledge
 Caesarean  Standard Diet  Anxiety
Section  Early Solid IET  Risk for Situational
Bigue Cementery Low Self Esteem
PROTOCOL
 Intravenous Fluids  Powerlessness
 Contact Physician  Risk for Acute pain
 Risk For Infection
 Risk For Maternal
Injury
 Risk For Impaired Gas
Exchanged
GOOD PROGNOSIS
Home Sweet Home
33
SECTION
MEDICAL MANAGEMENT
a. Doctors Order
Date/Time Progress Notes Doctors Order Rationale and
Significance
February 16, 2020 (S.O.A.P) - please admit
@ 10:15pm CIC: Dr. ML Lim patient under green
RIC: DR. Duque service
- to AICU
-secure consent to
care
-DAT
-IVF PNSS1l
@20cc/hour
-Labs: CBC, UA,

HBsAg, VDRL, BT,
CVD GS/KOH
-Meds:
1. Dexamethasone
6mg IM now then
every 12 hours x 3
more doses
2. Heragest 200mg
per cap 1 cap BID
per vagina
3. Nifedipine 10mg
1tab 1tab every 20
mins. x 3 doses,
then 30mg 1 tab.
every 8hours PO
4. Ca + vit. D tab. 1
tab OD PO
5. MV +Feso4 tab 1
tab OD PO
- for tocolysis,
dexamethasone
completion
-baseline 1pm
- NST every BH
-VS every 4hours
-FHT every hour
-monitor progress
34
SECTION
-watch out for
unusuallities
-refer to
perinatology for co-
management
-refer
10:30 pm -for BPS with fetal

biometry tomorrow
-refer
February 17, 2020 SUP 34 5/7 weeks -to labor room

@12:15am BPS=6/8 -stat 1pm
oligohydramions -look unusualities
EFW= 243 per -refer
grams
FDD=03/24/20
35
SECTION
b. Diagnostic Examinations
SEROLOGY AND IMMUNOLOGY

Date and time: February 17, 2020 @ 12:42 pm
Test Result Reference range
HBsAg Qulitative Non-reactive
HEMATOLOGY
Date and time: February 17, 2020 @ 12:32 am
Test Result Normal Rationale and Significance
Value
Blood type
(ABO+Rh)
Blood type A
positive
Blood type
RH
CLINICAL MICROPSCOPY URINE EXAMINATION

Date and time: February 17, 2020
Test Result Reference range

Appearance Clear
Color Light Yellow
Protien Negative
pH 7.0
Specific 1.006
Gravity
Glucose negative
Micro-Albumin Negative 10-20
mg/dl
Urine Bilirubin Negative 0-16
Urine 3-4 normal 3.3-17.0
Urobilinogen mmol/L
Nitrite Negative negative
Leukocyte Negative 0-0.14
Esterose WBC/uL
36
SECTION
RBC 0/uL 0-28/uL
WBC 0/uL 0-27/uL
Epithelial cells 0/uL 0-7/uL
COMPLETE BLOOD COUNT

Date and time: February 17, 2020 @ 12:29 am
Test result Reference range
WBC 9.29x10^3/UT 5.0-10.0
Hemoglobin 118.0g/L 115.0-155.0
Hematocrit 0.35 0.36-0.48
RBC 3.86x10^6/YUL 4.20-6.10
Neutrophil 65% 55.0-75.00
Lymphocytes 23% 20-35
Monocytes 7.0% 2-10
Eosinophil 4% 1-8
Basophil 1.000%
Platelet count 194x10^3/UT 150-400
PELVIS ULTRASOUND
Date and time: February 16, 2020
1. No. of fetus – single

2. Presentation – cephalic
3. Placenta – anterior grade 3 high lying
4.FHB – 116 beats per minute
5. Gender - female
6. EDD-03-12-2020 +/- 2 weeks
7. Fetal biometry
BPD 9.10cm 36 W6D
HC 32.39cm 36 W5D
37
SECTION
AC 32.89cm 36 W6D
FL 6.83cm 325W0D
8. AFI – 9.93cm
9. Ave-gestational age = 36 W3D
10. Fetal weight = 2918 grams
IMPRESSION: Intra uterine pregnancy 36 weeks 3 days, live in cephalic

presentation.
BIOMETRY/ BIOPHYSICAL PROFILE

Resutation: Cephalic Number of fetus
Singleton
Biometry:
Fetal heart activity 139 beats per minute
Biparietal Diameter (BPD) 8.71cm 35 1/7 weeks
Head circumference (HD) 31.38cm 35 1/7 weeks
Femoral length (FL) 6.88cm 35 2/7 weeks
Abdominal Circumference (AC) 29.70cm 33 4/7 weeks
Estimated Fetal Weight
(EFW) Hadlock 10th to 90th percentile: 2250-3325 grams
38
SECTION
2431+-355 grams
BIOPHYSICAL PROFILE: SCORE 6/8

Fetal tone 1 2
Fetal movement 3 2
Fetal Breathing 2
Amniotic Fluid 0 0
Index CAFI 2.73 1.36 = 4.09cm 0
Note: Planes not ideal to strong uterine contraction (+) DFE, (+)RTE, (+)PHE
Impression:
>single live, intrauterine pregnancy , in cephalic presentation, with good
cardiac and somatic activities.
>34 5/7 weeks by composite sonar age
>Placenta anterior , grade III no previa
>BPS= 6/8 with oligohydramnios
> sonographic estimated fetal weight is appropriate for gestational age
39
XI. Drug Study
February 16, 2020 @ 10:15pm

DRUG NAME ACTION INDICATION CONTRAINIDICA ADVERSE NURSING
TION EFFECT RESPONSIBILITY
Dexamethasone Prevent Cerebral edema Systhemic fungal CNS: Euphoria, -established

accumulation of Allergic and infection, acute insomnia, rapport
BRAND NAME: inflammatory inflammatory infections, active covulsions, - check the doctors
cells at sites of conditions, or resting increased ICP, order
infection; inhibits shocks, tuberculosis, vertigo,headache, - observe ten
CLASSIFICATION phagocytosis, tuberculosis and vaccinia, psychic rights
: hormones and lysosomal meningitis. varicella, disturbance. -observe for signs
synthetic enzyme release, administration of VC: CHF, and adverse
substitute, adrenal and synthesis of live virus vaccines hypertension, reaction
corticosteroid; selectedchemical (to patient, family edema. -monitor blood
glucocorticoid;ster mediators of member), latent Endocrine: pressure
oid. inflammation; or active Menstrual
reducescapillary amebiasis. irregularities,
Frequency/Dosage dilation and hyperglycemia;
Route: 6mg, IM, permeability. cushingoid state;
Every 12hours x 3 growh suppression
more doses in
children;hirsutism.
Specialm sense:
Posterior
subcapsular
cataract, increased
IOP, glaucoma,
exophthalmos.
40
GI: Peptic
ulcerwith possible
perforation,
abdominal
distension,
nausea, increased
appetite,
heartburn,
dyspepsia,
pancreatitis, bowel
perforation, oral
candidiasis.
Musculoskeletal:
Muscla weakness,
loss of muscle
mass, vertebral
compression
fracture,pathologic
fracture of long
bones, tendon
rupture.
Skin: Acne,
impaired wound
healing, petechiae,
ecchymoses,diaph
oresis, allergic
dermatitis, hypo
or
hyperpigmentation
, SC and
cuntaneous
41
atrophy, burning
and tingling in
perineal
area(following IV
injection).
February 16, 2020 @ 10:15pm

Nifedipine Calcium channel Hypertension, Known Body as whole: -established

blocking agent stable angina hypersensitivity to sore throat, rapport
Brand name: that selectively without nifedipine. safety weakness, fever, - check the doctors
procardia blocks calcium vaospasm durin pregnancy sweating, chills, order
ion influx across (category C) or in febrile reaction. -observe ten rights
Classification: cell membranes children is not CNS: dizziness, -monitor blood
Cardio vascular of cardiac established. light-headedness, pressure and
agent; calcium muscle and nervousness, pulse
channel blocker; vascular smooth mood changes,
42
antiarrhythmic muscle without weakness,

( class IV); non- changing serum jitteriness, sleep
nitratevasodilator. calcium disturbances,
concentrations. blurred vision,
class IV retinal
antiarrythmic ischemia,difficulty
in balance,
Frequency/dosag headache.
e/route: CV: hypotension,
10mg 1tab 20 facial flushing,
mins. x 3 doses, beat sensation,
then 30 mg 1 tab. palpitations,
every 8huours peripheral edema,
P.O. MI (rare), prolonge
systemic
hypotension with
overdose.
GI: nausea,
heartburn,
diarrhea,
constipation,
cramps, flatulence,
gingival
hyperplasia
hepatotoxicity.
Musculoskeletal:
inflammation, joint
stiffness, muscles
cramps.
Respiratory:
nasal congestion,
43
dyspnea, cough,
wheezing.
Skin: dermatitis,
pruritus, urticarial.
Urogenital: sexual
difficulties,
possible malwe
infertility.

Heragest Micronized Provide luteal Hypersensitivity Aggression, -established
progesterone is support in luteal to progesterone, anxiety, confusion, rapport
Brand name: absorbed in the phase defects in or to any disorientation, -check the doctors
gastrointestinal threatened/recur ingredient in the drowsiness, order
Classification: tract. rent abortion. product. dysarthria -observed ten
Progesterone; rights
belongs to the -asses patient for
class of pregnen edema, blood
(4) derivative pressure and
44
progesterone. weight.
Frequency/dosag
e/route:
200mg/cap 1cap
BID per vagina
45
SECTION
XII. NURSING THEORIES
Theorist Theory Application to the Case

Lydia Hall (1962) Her theory on the three-fold In relation to Cesarean
aspect of nursing was best section, patient L needs
described during the care by the nurse with
implementation phase where the help of the Doctor.
nursing actions are
categorized based on the
therapeutic use of self (core),
intimate bodily care (care),
and assisting in the medical
plan (cure).
Dorothea Elizabeth Nursing’s concern-“Mans In relation to Cesarean
Orem (1970-1985) need for self-care action and section, patient L must
the provision and take care herself with the
management of it on a support of his significant
continuous basis in order to others because SC can
sustain life and health recover be life threatening
from disease or injury and condition.
cope with their effects.
Hildegard Peplau Theory of psychodynamic In a relation of cesarean

(1952) nursing enables this process Section patient L must
to occur in collaborative seek assistance to the
identification and resolution of nurse to strengthen and
need. build rapport for nurse
and patient interaction.
46
XIII. NURSING CARE PLAN (Actual)
ASSESSMENT DIAGNOSIS BACKGROUND PLANNING IMPLEMENTATION RATIONALE EVALUATION

STUDY
02/16/2020 Acute pain is defined as an
8:00am related to unpleasant At the end of my  Established  To gain Goal met AS
Labor pain. sensory and 8-hours span of rapport trust and evidence by
S’’ Sakit gyud emotional care, Patient elicits patient was a
kaayu akong tiyan experience describes cooperati satisfied in pain
sir subra’ as arising from satisfactory pain on by the pain
patients actual or control at a level  VS taken and  To have scale of 3/10.
verbalized potential tissue less than 3 to 4 monitored baseline
damage or on a rating scale data
O’’ described in of 0 to 10.  IVF regulated  To
 Pain scale of terms of such @ prescribed Replenis
10/10 damage rate h the
 grimace face (International electrolyt
noted Association for e and
 BP 100/80 the Study of fluids in
mmHg Pain); sudden or the body
 PR : 80cpm slow onset of
any intensity  Provided safe  To
from mild to and well- provide
severe with an ventilated safety
anticipated or environment and
predictable end secure
and a duration of environm
less than six (6) ent
months.  Assessment
47
 Assess pain of pain

characteristics: experience
Quality (e.g., is the first
burning, sharp, step in
shooting) planning
pain
managemen
t strategies.
 Some
 Assess the patients
patent’s may be
anticipation for satisfied
pain relief. when pain is
no longer
massive;
others will
demand
complete
elimination
of pain. This
influences
the
perceptions
of the
effectivenes
s of the
treatment of
the
treatment
modality
and their
48
eagerness
to engage in
further
treatments.
49
STUDY
02/16/2020
8:00am Deficient A lack of At the end of my  Established  To gain trust  Goal met
S: “ wla ko kabalo knowledge cognitive 8-hours span of rapport and elicits as
nga ing-ani diay related to information or care, Patient will cooperation evidenced
mahitabo sa akoa, insufficient psychomotor Verbalize by client
sakit na kayo ang interest in ability needed for understand of  VS taken and  To have Verbalized
akong tiyan gusto learning. health restoration, self care monitored baseline understan
nako magpa CS” preservation, measures data d about
as patient or health required to  Determine  To know the self care
verbalized. promotion is prevent clients ability clients ability measures
identified complication. to learn to learn required
O: abdominal pain as Knowledge to prevent
noted Deficit or Deficie  Provided safe  To provide complicati
nt Knowledge. and well- safety and on.
Knowledge plays ventilated secure
an influential and environment environment
significant part of
a patient’s life
and recovery. It
may include any
of the three
domains:
cognitive domain
(intellectual
activities,
problem-solving,
and others);
affective domain
(feelings,
attitudes, belief);
50
and psychomotor
domain (physical
skills or
procedures). It is
the duty of
the nurse to
determine with
the patient what
to teach, when to
teach, and how to
teach certain
matters and
concerns on
health. Adult
learning
principles guide
the teaching-
learning process.
https://nurseslabs.
com/deficient-
knowledge/

STUDY
S: “wala naku Anxiety Anxiety is one of With my 8hours >Familiarize patient >Awareness of the Goal met as
kabalo kung related to many problems span of care with the environment evidence by
unsa akong prolonged in human being. patient will be able environment and promotes comfort patient was
51
buhaton kay ako and preterm Everyone has it, to demonstrate new experiences or and may decrease demonstrate
ra isa dre” as labor. because it increased external people as needed. anxiety improved
patient relates to man’s focus. experienced by the concentration.
verbalized physical life. patient.
Anxiety is a >Interact with >The patient’s
O: restlessness, problem in the patient in a peaceful feeling of stability
worrying and real world, in the manner. increases in a calm
crying noted. daily life. It may and non-
occur in threatening
household, such environment.
as when >Use >Being supportive
children have presence, touch (with and approachable
conflicting permission), promotes
opinion with verbalization, and communication
their father. As a demeanour to remind
family’s leader, patients that they are
father feels that not alone and to
he has authority encourage expression
to his children or clarification of
and he was needs, concerns,
entitled to unknowns, and
decide what the questions.
best thing for
them while the >Allow patient to
children express her feelings >.Talking or
themselves otherwise
have no power expressing feelings
to fight their sometimes reduces
father’s anxiety.
authority
although it is
52
opposite with
their
conscience.
These cases
are caused by
fear of their
parental
punishment for
doing or thinking
something
breaking the
rule. When they
get this problem
and they cannot
solve it, they do
not get
satisfaction,
composure, and
happiness. They
find themselves
in dignity,
disappointment,
unrest and
anxiety
including moral
anxiety,
because of their
feeling guilty.
http://eprints.ums.
ac.id/27766/2/Bb
53
a_I.pdf

STUDY
S: Risk of At increased Within my 8-hours

infection risk for being span of care, my  Established  To gain Goal met as
related to invaded by patient will be able rapport trust and evidenced by
break in the pathogenic to: elicits patient is able to:
skin due to organisms.  Patient  VS taken and cooperation
Cesarean achieves monitored  To  Patient
have
o. Section. timely  IVF regulated baseline achieves
wound @ prescribed data timely wound
healing rate healing
without  Provided safe  To provide without
complicatio and well- safety and complication
ns. ventilated secure s.
environment. environmen
t
 Assess signs  Rupture of

and symptoms membranes
of infection (e.g., occurring 24
elevated hr before the
temperature, surgery may
pulse, WBC; result in
54
abnormal odor chorioamnionit

or color of is prior to
vaginal surgical
discharge, or intervention
fetal and may
tachycardia). impair wound
healing.
 Record Hb and  Risk
Hct, and of
estimated blood postdelivery
loss during infection
surgical and poor
procedure. healing is
increased if
Hb levels
are low and
blood loss
is
excessive.
Note:
Greater
blood loss
is
associated
with classic
incision
than with
lower
uterine
segment
incision.
55
56
SECTION
XIV. LEVELS OF PREVENTION

Primary
Patient should include preconception education, public and professional
policies (eg, paid pregnancy leave), nutritional supplements, and smoking
cessation. Public education efforts must stress that the problems of preterm
infants have not been solved even though neonatal care has improved.
Secondary
Patient should efforts are directed at women with known risk
of preterm birth or other risk factors. Preconception interventions are based on
a history of preterm birth, with risk of recurrence increased for spontaneous and
indicated preterm births.
Tertiary
Tertiary measures are aimed as the interventions, such as
regionalised care, and treatment with antenatal corticosteroids, tocolytic agents,
and antibiotics.
57
SECTION
XV. PROGNOSIS
Category Poor Fair Good Rationale
4 hours prior to admission, patient L

Onset of Illness  experiences Labor pain, numbness of
legs.
4 hours prior to admission, patient L

Duration of Illness  experiences Labor pain, numbness of
legs.
Attitude/ The patient is willing to undergo

Willingness of  treatments for the improvement of his
Treatment condition.
According to patient L, she was exposed
back then in chemical substance like
Environment  cigarette smoking and Stressed that
contribute to the development of his
condition.
Age  The patient is 21 years old
The patient’s family are supportive and

Family Support  they’re able to give the needs of the
patient.
CALCULATION
Variables Amount Constant Product Quotient Result

factor
POOR 0 x1 0 1.0-1.6
58
SECTION
FAIR 0 x2 0 18/6 1.7-2.3

=
3.0
GOOD 6 x3 18 2.4-3.0
TOTAL 6 18
RESULT: GOOD PROGNOSIS

Experiences numbness of legs for 4 hours then seek medical attention.
According to patient L, She was exposed back then in chemical substance like
cigarette smoking and also Stressed that contribute to the development of his
condition. So the optimum level of treatment is sufficient to meet the goal of the
patient. And the patient’s family are supportive and they are willing to treat the
patient’s condition.
XVI. EVALUATION
General:
This case presented was able to identify and determined the
general health problems and needs of the patient with a diagnosis of
59
SECTION
Preterm Labor and Cesarean Section. The study promoted health and
medical understand of such condition through the application of the
nursing skills and with the help of the doctors.
Specific:
 We enhanced the knowledge and I acquire more information about
Preterm Labor and Cesarean Section.
 We gave idea on how to render nursing care for clients with this condition.
Thus, it can apply for future exposure in hospitals.
 We gathered the needed data that help me to understand how and why
the disease occur
 We identified laboratory and diagnostic studies used.
 We traced the Pathophysiology of the condition with their rationale for

occurrence of its manifestation.
 We understand the disease process, and determined the medication on

this condition.
 It is our responsibility to served my patients well, and we know the causes

and effects of this and also the symptoms and the treatments and we
handle and served patients right.
XVII. RECOMMENDATIONS
To the patient
 Patient should have a follow up check-up as advised by doctor.
 Practice healthy lifestyle and proper hygiene.
60
SECTION
 Adhered therapeutic regimen planned by the doctor.
To the family
 Assist client in his activity.
 Should actively participate in providing, promoting, assisting the client to
perform health activities.
 Should be knowledgeable of the signs and symptoms of complication to be
reported.
 Should understand the importance of follow up check-up for the monitoring of
complications.
To the institution
 Should be concern to every patient and give their tender loving care to them.
 Must give proper health education to the family and the patient especially on
ways how to prevent from getting infectious organisms that causes problems
and its complications.
 Must have proper isolation spaces and privacy of patient regarding with the
level of their condition.
To the Paramedical students:
 Should provide appropriate health teaching to every individual regarding the
signs and symptoms and complications of the disease as well as on how to
prevent acquiring such condition.
 Should act as an advocate in spreading information about Preterm Labor and
Cesarean Section every individual in a certain community.
XVIII. REFERENCE
Books
Medical Surgical Nursing
Drug Hand Book
61
SECTION
NANDA
Internet
https://www.who.int/reproductivehealth/topics/maternal_perinata
l/ cs-statement/en/)
http://lpghstc.doh.gov.ph/index.php/statistics)
.(Regional Gradients in Institutional Cesarean Delivery Rates)
https://www.stanfordchildrens.org/en/topic/default?id=cesarean-
delivery-92-P07768
Obstetric and Non-Obstetric Risk Factors for Cesarean Section in
Oman
https://www.scribd.com/doc/27054680/CESARIAN-SECTION-
CASE-PRESENTATION
https://www.healthline.com/health/pregnancy/c-section-
reasons#Whats-a-planned-C-section?
https://www.thebump.com/pregnancy-week-by-week/37-weeks-
pregnant
https://www.nap.edu/read/11622/chapter/9#178
https://nurseslabs.com/deficient-knowledge/
http://eprints.ums.ac.id/27766/2/Bba_I.pdf
62

Preterm Labor To Ceasarean Section FINAL

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Preterm Labor To Ceasarean Section FINAL

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PRETERM LABOR AT CESARIAN

The rate of cesarean sections around the world is increasing at an "alarming"

After 2 weeks of exposure in Southern Philippines Medical Center lnc., we

 To define what Lower Uterine Cesarean section;

 Perform efficient physical assessment to the patient;

 Establish a good interpersonal relationship to the patient and to his family;

III. PATIENT’S DEMOGRAPHIC DATA

Patient’s Code Name: Patient L

a. Family Socio-Economic Background

b. History of Past Illness

d. History of Present Illnesses

3-5 yrs Initiative vs Achieved During this period Patient

Jean Piaget Cognitive Developmental Theory

Birth to 18–24 Sensorimotor Motor activity Patient L

Puberty to Genital Achieved Pleasure At the age of

V. DEFINITION OF COMPLETE DIAGNOSIS

Caesarean delivery (also called a caesarean section or C-section)

There are two main techniques that doctors nowadays use to

VI. ANATOMY AND PHYSIOLOGY

VII. PHYSICAL ASSESSMENT

General Appearance and Mental Status

position, with ongoing IVF of bottle 1 PNSS 1L. @ 120cc/hr. Patient L is

wearing white patient’s gown. Patient L is oriented and responsive to all

questions asked. Initial vital signs taken and recorded as follows:

SKIN, HAIR AND NAILS

Skin is soft and well-hydrated. No lesions noted. Hair is black, clean

with normal distribution of hair on scalp, and no infestations are found.

HEAD AND NECK

Head symmetrically round, hard, without lesions. Face smooth and

symmetrical. Neck symmetric with centered head position and no bulging

masses. Has smooth, controlled, full range of motion of neck. Trachea in

midline. Lymph nodes are not inflamed.

EYE AND EAR

Pupils are round and reactive to light accommodation and pupils

converge evenly. Eyelids in normal position with no abnormal widening or

moist and smooth.

corner of each eye. Skin smooth, no lumps, lesions.

MOUTH, THROAT, NOSE, AND SINUS

Lips are pinkish and moist without any lesions.

THORAX AND LUNG

Respiration /minute, relaxed and even.

Chest expansion symmetric. No pain or tenderness on palpation.

Clear lung sounds noted upon auscultation.

HEART AND NECK VESSELS

No enlargement of lymph nodes upon palpation. No heart murmurs

Abdomen is symmetric with no bulges or lumps. Abdominal pain

noted upon palpation, fetal movement noted upon palpation.

UPPER AND LOWER EXTREMITIES

Joints are symmetrical. No swelling and redness of the joints.

VIII. ETIOLOGY AND SYMPTOMATOLOGY

Age Maternal Passive Urinary Tract

Risk of preterm Linking stress to Exposure that Infection

Release of FSH by the anterior pituitary

Developmental of the Gratian Follicle

Production of the estrogen --------------- Thickening of the endometrium

Release of the Luteinizing Hormone

Ovulation Release of mature ovum

Ovum Travels into the

Union of the ovum

Zygote travels from the fallopian

Headache increase progesterone

Development of the fetus