2.  This case study will help us, student nurses in understanding the
disease process of the patient. This would also help us identify the
primary needs of the patient have undergone Cesarean Section.
Effective management of the problems identified will help the
patient to recover faster and maintain a holistic sense of wellness
even in the hospital.
 Giving a sufficient nursing care for the patients enhances its
capabilities in recovery. Doing a nursing research or study about the
patient’s condition gives adequate information on how to assess
thoroughly the patient, what specific intervention we could give as
a nurse and what will be the possible complication could happen if
the disease aggravated. This case study make us student nurse be
more confident in dealing with the patients and give as an
additional understanding about the disease and the disease
process. This is one way also of showing the student’s intellectual
capacity.
 A Cesarean Section is the delivery of a baby through a cut (incision)
in the mother's belly and uterus. It is often called a C-section. In most
cases, a woman can be awake during the birth and be with
her newborn soon afterward. If you are pregnant, chances are
good that you will be able to deliver your baby through the birth
canal (vaginal birth). But there are cases when a C-section is
needed for the safety of the mother or baby.

3.  A C-section may be planned or unplanned. In most cases, doctors
do cesarean sections because of problems that arise during labor.
Reasons you might need an unplanned C-section include: Labor is
slow and hard or stops completely; the baby shows signs of distress,
such as a very fast or slow heart rate; a problem with the placenta
or umbilical cord puts the baby at risk; the baby is too big to be
delivered vaginally.
 When doctors know about a problem ahead of time, they may
schedule a C-section. Reasons you might have a planned C-section
include: The baby is not in a head-down position close to your due
date; you have a problem such as heart disease that could be
made worse by the stress of labor; you have an infection that you
could pass to the baby during a vaginal birth; you are carrying more
than one baby (multiple pregnancy); you had a C-section before,
and you have the same problems this time or your doctor thinks
labor might cause your scar to tear (uterine rupture).
 In some cases, a woman who had a C-section in the past may be
able to deliver her next baby through the birth canal. This is
called vaginal birth after cesarean (VBAC). If you have had a
previous C-section, ask your doctor if VBAC might be an option this
time.
 In the past 40 years, the rate of cesarean deliveries has jumped from
about 1 out of 20 births to about 1 out of 4 births. This trend has
caused experts to worry that C-section is being done more often
than it is needed. Because of the risks, experts feel that C-section
should only be done for medical reasons.

4.  This case study will help the group in understanding
the disease process of the patient. This would also
help the group in identifying the primary needs of the
patient who has a final diagnosis of Pregnancy
uterine, term, breech, livebirth, delivered via LTCSI for
Placenta Previa Totalis in hemorrhage to a Baby girl.
By identifying such needs and health problems arise
the group can now formulate an individualized care
plan for the patient that would address these needs
and problems effectively. Effective management of
the problems identified will help the patient to
recover faster and maintain a holistic sense of
wellness even while in the hospital.
 This case study would also equip the group with
knowledge, skills and attitude on how to manage
future patients with the same or similar disease.

5.  This case presentation aims to identify and
determine the general health problems and
needs of the patient who had Low
Transerve Cesarian Section I. This
presentation also intends to help patient
promote health and medical
understanding of such condition through
the application of the nursing skills. To be
knowledgeable about the nature of C-
Section management and treatment to be
able to render effective nursing care to the
client.

6.  To assess client’s acceptance or non-acceptance of
situation.
 To raise the level of awareness of patient on health
problems that she may encounter.
 To facilitate patient in taking necessary actions to
solve and prevent the identified problems on her
own.
 To help patient in motivating her to continue the
health care provided by the health workers.
 To render nursing care and information to patient
through the application of the nursing skills.


7. Dorothy Johnson’s Behavioral System Model
 Dorothy first proposed her model of nursing care in 1968 as fostering
of ―the efficient and effective behavioral functioning in the patient
to prevent illness".
 She also stated that nursing was ―concerned with man as an
integrated whole and this is the specific knowledge of order we
require‖.
 In 1980 Johnson published her conceptualization of ―behavioral
system of model for nursing‖where she explains her definitions of the
behavioral system model.
Johnson’s Behavioral Subsystem
 Attachment or affiliative subsystem: ―social inclusion intimacy and
the formation and attachment of a strong social bond.‖
 Dependency subsystem: ―approval, attention or recognition and
physical assistance‖
 Ingestive subsystem: ―the emphasis is on the meaning and structures
of the social events surrounding the occasion when the food is
eaten‖
 Eliminative subsystem: “human cultures have defined different
socially acceptable behaviors for excretion of waste, but the
existence of such a pattern remains different from culture to
Culture.‖
 Sexual subsystem:" both biological and social factor affect the
behavior in the sexual subsystem‖

8.  Aggressive subsystem: " it relates to the behaviors concerned with
protection and self-preservation Johnson views aggressive subsystem as
one that generates defensive response from the individual when life or
territory is being threatened‖
 Achievement subsystem: “provokes behavior that attempt to control
the environment intellectual, physical, creative, mechanical and social
skills achievement are some of the areas that Johnson recognizes".
The four major concepts
 ―Human being‖ as having two major systems, the biological system and
the behavioral system. It is role of the medicine to focus on biological
system where as Nursling's focus is the behavioral system.
 ―Society‖ relates to the environment on which the individual exists.
According to Johnson an individual’s behavior is influenced by the
events in the environment
 ―Health‖ is a purposeful adaptive response, physically mentally,
emotionally, and socially to internal and external stimuli in order to
maintain stability and comfort.
 ―Nursing‖ has a primary goal that is to foster equilibrium within the
individual. Nursing is concerned with the organized and integrated
whole, but that the major focus is on maintaining a balance in the
Behavior system when illness occurs in an individual.


9.  Name: Patient RV
 Age: 35 years old
 Birth date: June 27, 1977
 Sex: Female
 Civil Status: Married
 Religion: Roman Catholic
 Date of Admission: February 19, 2013
 Chief Complaint: Vaginal Bleeding
 Impression/Diagnosis: 37-38 weeks AOG, Breech, Placenta Previa
Totalis in Hemorrhage
PATIENT HISTORY
 Patient had her regular prenatal check-up and intake of
multivitamins. Few hours prior to admission, patient had vaginal
bleeding consuming 2 pads fully soaked associated with uterine
contractions 10 to 15 minutes lasting for a few minutes with a
pain scale of 5/10 persistence of symptoms prompted consult
was subsequently admitted.

10. Past Medical History
 Patient had known history of Sciatica (2008).
She had a symptom of back pain and was
treated via Vitamin B Complex. No known
allergies were noted.
Social History
 Patient was an occasional drinker of alcohol
approximately 2-3 bottles of beer but when she
got pregnant, patient doesn’t drink alcohol
anymore. She doesn’t smoke at all. Before she
got pregnant, she was a traveler.
Environmental History
 Patient lives near the river, where there are a
lot of trees that made their place a well-
ventilated area. Although they live near the
river, their residence is not a total danger zone.

11.  Menstruation History
 Menarche: 12 years old
 Interval: Regular
 Duration: 3 days
 Amount: 3 pads
 Symptoms: (+) Occasional Dysmenorrhea
 Gynecological History
 Pap’s Smear (2010) normal
 One Combination Oral Pill (2004)
 OB History

 LMP: June 4 – 7, 2012
 PMP: May 2012

13. EXAM NAME RESULTS NORMAL RANGE ANALYSIS
Hemoglobin 142 120-150 Normal
Hematocrit 0.41 0.37-0.48 Normal
Erythrocytes 4.88 4.0-5.0 Normal
MCV 83.40 80-96 Normal
MCH 29.10 27-33 Normal
MCHC 34.90 33-36 Normal
Total WBC 10.7 5.0-10.0 Infected
Platelet Estimate Normal Normal
Neutrophils 0.71 0.55-0.65 Infected
Lymphocytes 0.19 0.25-0.40 Normal
Eosinophils 0.02 0.01-0.05 Normal
Monocytes 0.08 0.02-0.06 Normal

14.  GENERAL SURVEY (February 21, 2013)
 Patient was seen on bed awake, conscious
and coherent, with her baby. Listening to
our questions, oriented about the interview
and the patient is cooperative. There is no
sign of dizziness, headache or pain.
 PR : 80
 T. :36.2 ºC
 RR : 20
 BP : 110/80 mm/Hg

15.  Female Reproductive System

16.  Ovaries — A woman normally has a pair of ovaries that resemble almonds in size
and shape. They are home to the female sex cells, called eggs, and they also
produce estrogen, the female sex hormone. Women’s ovaries already contain
several hundred thousand undeveloped eggs at birth, but the eggs are not called
into action until puberty. Roughly once a month, starting at puberty and lasting
until menopause, the ovaries release an egg into the fallopian tubes; this is called
ovulation. When fertilization does not occur, the egg leaves the body as part of
the menstrual cycle.
 Fallopian tubes — The ovaries connect to the uterus via the fallopian tubes.
Fertilization usually happens within the fallopian tubes. Then, the fertilized egg
makes its way down to the uterus.
 Uterus — The uterus is located in the pelvis of a woman’s body and is made up of
smooth muscle tissue. Commonly referred to as the womb, the uterus is hollow
and holds the fetus during pregnancy. Each month, the uterus develops a lining
that is rich in nutrients. The reproductive purpose of this lining is to provide
nourishment for a developing fetus. Since eggs aren’t usually fertilized, the lining
usually leaves the body as menstrual blood during a woman’s monthly period.
 Cervix — The lower part of the uterus, which connects to the vagina, is known as
the cervix. Often called the neck or entrance to the womb, the cervix lets
menstrual blood out and semen into the uterus. The cervix remains closed during
pregnancy but can expand dramatically during childbirth.
 Vagina — The vagina has both internal and external parts and connects the
uterus to the outside of the body. Made up of muscle and skin, the vagina is a
long hollow tube that is sometimes called the ―birth canal‖ because, if you are
pregnant, the vagina is the pathway the baby will take when it’s ready to be
born. The vagina also allows menstrual blood to leave a woman's body during
reproduction and is where the penis deposits semen during sexual intercourse.

17.  Female Sexual Anatomy: External Parts
 The entrance to the vagina is surrounded by external
parts that generally serve to protect the internal
organs; this area is called the vulva. The vulva consists
of the following:
 Labia majora — Translated as ―large lips,‖ this flap of
skin protects the vagina from foreign particles.
 Labia minora — The ―small lips‖ also surround and
protect the vaginal opening and are located inside
the labia majora.
 Clitoris — The clitoris is a sensitive organ located
above the vaginal opening. The clitoris does not
directly affect reproduction, but it is an important
part of the female sexual anatomy; many women
need clitoral stimulation to orgasm.
 Mons pubis — The fatty mound of tissue that covers
the pubic bone. Often called the "mons."
 Perineum — A stretch of hairless, sensitive skin that
extends from the bottom of the vaginal opening
back to the anus

19.  Description
 A C-section delivery is done when it is not possible or safe for the mother to deliver the baby through
the vagina.
 The procedure is usually done while the woman is awake. The body is numbed from the chest to the
feet using epidural or spinal anesthesia.
 The surgeon make a cut across the belly just above the pubic area. The womb (uterus) and amniotic
sac are opened, and the baby is delivered.
 The health care team clears the baby's mouth and nose of fluids, and the umbilical cord is cut. The
pediatrician or nurse makes sure that the infant's breathing is normal and that the baby is stable.
 The mother is awake, and she can hear and see her baby. The father or another support person is
often able to be with the mother during the delivery.
 Why the Procedure Is Performed
 The decision to have a C-section delivery depends on:
 Your doctor
 Where you are having the baby
 Previous childbirth
 Your medical history
 Some reasons for having C-section instead of vaginal delivery include:
 Problems with the baby:
 Abnormal heart rate in the baby
 Abnormal position of the baby in the womb, such as crosswise (transverse) or feet-first (breech)
 Developmental problems such as hydrocephalus or spina bifida
 Multiple pregnancy (triplets, and sometimes, twins)

20. Health problems and medical history in the mother:
 Active genital herpes infection
 Large uterine fibroids near the cervix
 HIV infection in the mother
 Previous C-section
 Previous uterine surgery
 Severe illness in the mother, including heart
disease, preeclampsia or eclampsia
 Problems with labor or delivery:
 Baby's head is too large to pass through the birth canal
 Labor that takes too long or stops
 Very large baby
 Problems with the placenta or umbilical cord:
 Placenta covers all or part of the opening to the birth canal
(placenta previa)
 Placenta prematurely separated from uterine wall (placenta
abruptio)
 Umbilical cord comes through the opening of the birth canal
before the baby (umbilical cord prolapse)

21. Risks
 A C-section is a safe procedure. The rate of serious complications is
extremely low. However, certain risks are higher after C-section than after
vaginal delivery. These include:
 Infection of the bladder or uterus
 Injury to the urinary tract
 Injury to the baby
 A C-section may also cause problems in future pregnancies. This includes a
higher risk for:
 Placenta previa
 Placenta growing into the muscle of the uterus and has trouble separating
after the baby is born (placenta accreta)
 Uterine rupture
 These conditions can lead to severe bleeding (hemorrhage), which may
require blood transfusions or removal of the uterus (hysterectomy).
 All surgeries carry risks. Risks due to anesthesia may include:
 Reactions to medications
 Problems breathing
 Risks related to surgery in general may include:
 Bleeding
 Blood clots in the leg or pelvic veins
 Infection

22.  Outlook (Prognosis)
 Most mothers and infants do well after a c-section.
 Women who have a C-section may have a vaginal
delivery if another pregnancy occurs, depending on:
 The type of C-section done
 Why the C-section was done
 Vaginal birth after cesarean (VBAC) delivery is usually
successful. However, there is a small risk of uterine
rupture, which can harm the mother and the baby. It
is important to discuss the benefits and risks of VBAC
with your health care provider.
 Recovery
 The average hospital stay after C-section is 2 - 4 days.
Recovery takes longer than it would from a vaginal
birth. You should walk around after the C-section to
speed recovery. Pain medication taken by mouth
can help ease any pain.

25. Medication
 Continue medicines as ordered by the physician
 Zegen 500g BID
 Cataflam 50mg TID
Exercise
 Ambulation in the house
 Deep breathing exercises
 Coughing exercises
Treatment
 Informed patient to have a follow-up check up after
1- 2 weeks

26. Health Teachings
 Informed patient to avoid lifting heavy objects for 1-2 weeks
 Stressed the importance of perineal cleanliness
 Encouraged client to have hot sitz bath
 Instructed patient to increase intake of protein-rich foods to promote faster
wound healing
 Instructed to promote adequate fluid intake
 Discouraged patient to participate in strenuous activities that might
precipitate stress and trauma to the wound
 Instructed patient to promote breastfeeding
Out Patient
 Have a follow up check up after a week with her Ob-gyne and pediatrician
Diet
 Encouraged client to increase intake of fiber to avoid constipation
 Instructed to increase fluid intake
 Instructed to increase intake of nutritious foods such as fruits and vegetables
Sexual/Spiritual
 Advised the patient that she and her husband can resume sexual activity
 Advised the patient that she can resume her rituals during Sunday since she is
a Roman Catholic.