IUFD

HOLY ANGEL UNIVERSITY
COLLEGE OF NURSING
ANGELES CITY
In Partial Fulfillment of the Requirements in Nursing Care Management II: Related

Learning Experience
A Case Study for Obstetric Cases:
CHORIOAMNIONITIS
Ms. Maryknoll Balboa, RN
Clinical Instructor
Submitted by:
GROUP 2A
N204
Dingal, Paolo Junelle

Flores, Chary
Galang, Aina
Garcia, Cyrielle Claire
Guintu, Anthony
Ordonez, Jesy
March 25, 2010
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TABLE OF CONTENTS
I. INTRODUCTION………………………………………………………3-4
II. NURSING HISTORY
a. Demographic Data………………………………………………4
b. Socio-economic and Cultural Factors…………………………..4-5
c. Environmental Factors………………………………………….5
d. Maternal-Child History…………………………………………5
e. Family-Health Illness History………………………………….. 6-7
f. History of Past Illness…………………………………………..7
g. History of Present Illness……………………………………….7
III. PHYSICAL ASSESSMENT…………………………………………..7-10
IV. DIAGNOSTIC AND LABORATORY PROCEDURES……………11-14
V. THE PATIENT AND HIS ILLNESS

a. Anatomy and Physiology………………………………….........15-22
b. Pathophysiology
i. Book-Based………………………………………………23-28
ii. Patient-Based…………………………………………….39-31
VI. THE PATIENT AND HIS CARE

a. Medical Management……………………………………………32-33
b. Drugs…………………………………………………………….34-41
c. Diet………………………………………………………………42
d. Activity…………………………………………………………..42-43
e. Surgical Management……………………………………………44-49
VII. NURSING CARE PLAN…………………………………………..50-57
VIII. LEARNING DERIVED FROM THE STUDY……………………58
IX. REFERENCES……………………………………………………… 59
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I. INTRODUCTION
Maternal fever during labor, and perhaps other signs and symptoms of chorioamnionitis,
often results in a call to the family practitioner, pediatrician, or neonatologist related to concern
for the neonate. Early onset bacterial infections in the newborn may occur when the mother has
abnormal bacterial colonization of the urogenital tract, an ascending but silent amniotic fluid
infection, or symptomatic chorioamnionitis. The said infection can either lead to premature labor
or intrauterine fetal death or demise.
Maternal chorioamnionitis, intra-amniotic infection or amnionitis, perhaps occurs when

protective mechanisms of the urogenital tract and/or uterus fail during pregnancy or when
increased numbers of microbial flora or highly pathogenic microorganisms are introduced into
the genital environment Ascending infection into the vagina, then the cervix, and finally into the
uterine cavity, fetal membranes, and placenta is the consequence of many factors (ie, innate host
defenses, healthy bacterial flora, bacterial burden, bacterial pathogenetic factors). Recently, a
short cervix has been recognized as either a risk factor or a surrogate for microbial invasion of
the amniotic fluid.
Urinary tract infection during pregnancy can bathe the vagina with bacterial pathogens and is a
recognized risk factor for chorioamnionitis. Abnormal bacterial colonization of the rectum and
anus during pregnancy may create an abnormal vaginal and cervical microbial environment.
Studies have demonstrated that other types of bacteria residing in the vagina, cervix, or both
ascend through intact or ruptured fetal membranes and initiate amniotic fluid infection.
The organisms usually responsible for chorioamnionitis are those that are normally present in
the vagina, including Escherichia coli (E. coli). Group B streptococcus may also cause the
infection.
The infection occurs in 0.5 percent to 10 percent of births.
The time-honored clinical signs and symptoms of chorioamnionitis include the following:
o Fever (an intrapartum temperature >100.4 º F or >37.8 º C)

o Significant maternal tachycardia (>120 beats per minute [bpm])
o Fetal tachycardia (>160-180 bpm)
o Purulent or foul-smelling amniotic fluid or vaginal discharge
o Uterine tenderness
o Maternal leukocytosis (total blood leukocyte count >15,000-18,000 cells/μL)
In addition to a complete medical history and physical examination, chorioamnionitis is

diagnosed by symptoms and by laboratory tests for infection. Testing of the amniotic fluid by
amniocentesis (withdrawing fluid with a needle) may be needed. Antibiotics are used to treat
chorioamnionitis as soon as the infection is diagnosed. Antibiotics are usually continued after
delivery as well. Delivery is often necessary to prevent complications in the mother, or if the
fetus is in danger.
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The case study was chosen by the group to be more knowledgeable on the distinctive
aspects of such conditions resulting for the students to be equipped with supplementary
information and acquaintance regarding the present situation. With this, provision of health
teachings and explanations about the patient’s condition as well as nursing care would be
operational and effective.
Consequently, confirming the principle that when the a health care provider become
much well-informed and prepared, the more efficient he/she becomes in imparting nursing care.
Nurse-centered Objectives:
After the completion of this case study for 2 to 3 days, the student-nurse will be able to:
1. Determine major causes of Intrauterine Fetal Death.

2. Enumerate the predisposing and precipitating factors that contribute to Intrauterine Fetal
Death.
3. Perform comprehensive assessment to the clientele cephalocaudally.
4. Identify the apparent signs and symptoms of the clientele in relation to Intrauterine Fetal
Death.
5. Decisively analyze the different laboratory and diagnostic procedures and relate the
results to the condition
6. State and identify the appropriate nursing diagnosis and make essential interventions.
7. Provide suitable health teachings to promote awareness, empowerment and wellness to
the clientele.
II. NURSING HISTORY
A. Personal History
a. Demographic Data
The group has decided to employ the pseudo name “Pooh Kwang” instead for the elected
patient’s authentic name to preserve her personal discretion and confidentiality.
Pooh Kwang is a 19 year-old female born as a Filipino citizen at December 21, 1990 in
San Juan , City of San Fernando, Pampanga. The patient herself currently resides in Sindalan,
City of San Fernando, Pampanga, together with her boyfriend and immediate family
members. Pooh Kwang was admitted in a certain hospital in City of San Fernando last
February 11, 2010 and was discharged at February 14, 2010.
b. Socioeconomic and Cultural Factors
Pooh is a vocational undergraduate with a course of computer operations at Systems Plus

College. She stays at home at present because she stopped studying this ongoing semester due to
the actuality that she was pregnant. She lives together with her mother, grandfather, her siblings
and her boyfriend. She is Roman Catholic by faith. The family is not experiencing any financial
constraints since their family’s income is 10,000 pesos which is given by their father who works
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abroad as a construction worker. They usually spent their money on their food, water, electricity
and for telecommunications expenditures. She does not seek advice from a “manghihilot” in
cases of illnesses but she does self-medication such as Paracetamol and Biogesic for fever and
body pains and is doing water therapy to relieve any discomforts. She is fond of eating fish and
vegetables and limits her fat and sugar intake since their family is at risk for hypertension and
diabetes, respectively. According to her, she sleeps at 11 in the evening and usually wakes up at
around 7 in the morning. After waking up, she usually eats breakfast and watches television. She
is fond of drinking soft drinks during lunch time and drinks coffee twice a day. Her grandfather
who is living with them is smoking and she is then predisposed to second-hand smoking.
c. Environmental Factors
Pooh lives at Sindalan, City of San Fernando Pampanga. They are currently renting their
house for 2 years since the subdivision where they are living was just recently constructed. The
location of their house was a great help in allocating their primary resources and their basic
needs. There is a barangay hall, health center, grocery near them.
d. Maternal-Child History
Pooh is not yet married to Manny Pookyaw because staying permanently together as
couples was still unplanned and evidently, of their young age. This is her first pregnancy and she
has not experienced any complications during the early stage except for recurrent headaches in
the course of her first trimester. She has an obstetric history of G1P0 (gravida 1, para 0, term 1,
preterm 0, abortion 0, live births 0, multiple 0). She did not attend to any prenatal check ups for
the first five months of her pregnancy and had just her first prenatal check up last November 11,
2009 at a certain hospital in Angeles City. Her OB-Gynecologist prescribed her to drink
supplements such as Beneforte and Natalvis. Subsequently, she also had her prenatal check up in
a certain hospital in City of San Fernando when her baby was already 34 weeks of gestation.
After so, she visited Dr. Dizon, an OB-Gynecologist in a certain hospital in City of San Fernando
last February 5, 2010 where she was then admitted. Pooh has attended three prenatal check-ups
to total up. She had her menarche when she was 11 years old and has an irregular menstrual
pattern. Her last menstrual period was May 14, 2009 while the estimated day for child’s delivery
will be on February 21, 2010. Upon evaluation, the age of gestation of her baby was 39 weeks.
After having an ultrasound check up on February 11 2010, that was the only time Pooh had
discovered that her baby died in utero. She stated that last February 10 which was the day prior
to her check up, Pooh has not felt any fetal movement the whole day. She was not bothered then
because she believed that her baby was healthy and was just preparing to be born.
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e. Family-Health Illness History (Diagram)
FATHER’s SIDE
MOTHER’s SIDE
Grandmother
Grandfather: Grandmother Grandfather:
: 69 y/o
65 y/o : 68 y/o 70 y/o
PK’s aunt ; PK ‘s aunt:

35 y/o 58 y/o
PK’s mother PK’s father ;

; 40 y/o 43 yrs old
Manny Pookyaw: 2nd sibling: 3rd sibling: 4th sibling:

PK ; 19 yrs 18 yrs old 17 yrs old 15 yrs old
19 yrs old
old
Poohpooh
**LEGENDS:
* PK= Pooh Kwang
- male - Pooh kwang - Hystorotomy - Deceased
- Diabetes Mellitus - Myoma - Asthma - Cancer
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e. Family- Health Illness History
Pooh has no history of reproductive or fertility problems. Her grandfather,

grandmother and aunt on her father side as well as her grandmother on her mother side
died because of old age. Her grandfather on her mother side was diagnosed with diabetes
mellitus same as with her aunt from the said side plus the history of breast. Pooh’s
mother has a history of asthma and is currently suffering from myoma where as her father
present no signs and symptoms of any major illness She never saw her father again for
the last 8 years counting at present. Among Pooh’s four siblings, she was the eldest and
the only one who had experienced intrauterine fetal death or IUFD and has undergone
hysterectomy in the family. She was living with her partner, Manny Pookyaw, in the
same house for almost 3 years and got pregnant.
f. History of Past Illness

According to Pooh, she had already experienced common coughs and colds,
fever, mumps, measles and chickenpox. She has no known allergies and was exposed to
any serious injuries. Pooh was always been susceptible to infection as evidenced by her
recurrent urinary tract infection even during her non-pregnant years. The said infection
started when she was 17 years old by which Pooh holds her urine instead of voiding
frequently since she was still studying by that time. Her physician prescribed her to drink
Amoxicillin TID for 3 days to treat the underlying pathogenic cause. She was never
hospitalized until the day she was diagnosed with intrauterine fetal death secondary to
chorioamnionitis and was admitted in a certain hospital in City of San Fernando. She has
received 2 doses of Tetanus Toxoid Immunization during the course of her pregnancy.
g. History of Present Illness
On the afternoon of February 11, 2010, Pooh was admitted at a certain hospital in
City of San Fernando for an unscheduled childbirth and her mother verbalized “Ena ne
kanu daramdaman ing baby na gagalo keng achan na buong aldo. Bala na matudtud
yamu”. Her mother then stated that a day prior to admission, patient Pooh had her pre-
natal checkup last February 5, 2010. Then she was scheduled to have her next pre-natal
checkup last February 7, 2010 but she was not able to attend. Pooh noticed that her baby,
aging 39 weeks of gestation, was no longer active which opted them to see a doctor.
Upon evaluation, the fetus presented absence of heart tone and heart beats as well as
movements or kicks. Pooh was the diagnosed with stillbirth or Intrauterine Fetal Death
which was related to maternal infection secondary to acute chorioamnionitis. Her doctor
observed for increased temperature or hyperpyrexia with a temperature of 37.6°C upon
admission and palpated uterine tenderness. Maternal tachycardia with a heart rate of 121
beats per minute was also taken into record. Foul smelling vaginal discharge was noted as
well during induced labor. Due to present condition, her OB-Gyne opted for CS delivery
and decided to perform hysterotomy by February 12, 2010.
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PHYSICAL ASSESSMENT (IPPA-CEPHALOCAUDAL APPROACH)
Initial Assessment: February 11, 2010, 1:00 pm
General Appearance upon NPI
Pooh is wearing a white shirt and pajama pants.. When the group arrived, Pooh
was in a supine position, unconscious and incoherent, with an IVF of D5LRS 1L at 650cc
level, running at 65 drops per minute, infusing well on the right hand, with foley catheter,
draining pinkish yellow urine @ 400 cc level.
During the Nurse-Patient Interaction (NPI) last February 11, 2010, the group obtained
Pooh’s vital signs, which are as follow:
Blood Pressure : 90/60mmHg

Pulse Rate : 121 beats per minute (bpm)
Respiratory Rate : 22 cycles per minute (cpm)
Temperature : 37.6°C/axilla
In addition with the NPI, the group also performed physical assessment
cephalocaudally. The data obtained are as follow:
INTEGUMENTARY
Skin
 Light brown in color
 Generally uniform, except in areas exposed to the sun
 Absence of edema
 Absence of abrasion, bruises, lesions
 Moist in skin folds and in the axillae
 Good skin turgor: when pinched, skin springs back to previous state within
2-4 seconds
Nails
 Had clean fingernails and toenails with no clubbing on both hands and feet
 Smooth texture
 Nail bed has pale pigmentation with intact epidermis
 Capillary refill test: prompt return of usual color for 3 seconds
Hair
 Evenly distributed
 Thick, greasy hair
 No infection/infestation
 With variable amount of body hair
HEAD
Skull and Face
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 Rounded (normocephalic and symmetrical, with
frontal, parietal, and occipital prominences)
 Smooth skull contour
 Absence of nodules, masses and edema
 Symmetric facial features
 Palpebral fissures equal in size
 Presence of pimples
EYES
 Eyebrows were symmetrically aligned with black
hair evenly distributed
 Eyelashes were black in color, equally distributed
and curled slightly outward
 Eyelids had intact skin with no discharges and
discoloration
 Palpebral conjunctiva was pale with no discharge
 Pupils were brown in color, equal in size, round and
with smooth border
EARS
 Auricle
s has same color as the facial skin, symmetrical, mobile, firm and not tender
 Auricle
aligned with outer canthus of eye and pinna recoils after it is folded
 Sticky,
wet cerumen in various shades of brown
NOSE AND SINUSES

 Extern
al nose was symmetric and straight, with no lesions and are not tender
 No
discharge or flaring
 Unifor
m color
 Nasal
septum intact and in midline
 Nasal
mucosa was pale
MOUTH AND THROAT

 Lips
are pale, soft but dry and symmetrical in contour
 Buccal
mucosa is pale pink in color , moist and smooth
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 Has 32
permanent teeth, 16 teeth in the upper jaw and in the lower jaw
 Smoot
h, white to yellow in color, shiny tooth enamel
 Pallor
in gums, moist and firm in texture
 Toung
e is in central position, moist, slight pink in color and is slightly rough
NECK
 Muscle
s equal in size
 Lymph
nodes are not palpable, not tender
 Head
centered
 Trache
a is in central placement in the midline of the neck and tracheal spaces are equal on
both sides
RESPIRATORY/CHEST
 Chest
symmetrical in shape
 Skin
intact
 Absenc
e of lesions, tenderness, masses
 Full
and symmetric chest expansion
 Quiet,
rhythmic and effortless respirations
 Absenc
e of sputum and cough
 Absenc
e of adventitious breath sounds
CARDIOVASCULAR/HEART
 S1
heard at all times, louder at apical area
 S2
heard at all times, louder at the base of the heart
 Carotid
arteries have symmetric pulse volume
 Jugular
veins are not visible
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 Periph
eral pulses have symmetric pulse volume
 Periph
eral perfusion: skin color of the hands and feet are slightly pink, skin temperature is
warm, no edema seen
 Capilla
ry refill test: immediate return of color within 3 seconds
GASTROINTESTINAL/ABDOMEN
 Abdo
minal
incisio
n with
dry
intact
dressin
g
present
 There
is a
line of
dark
pigmen
t on the
abdom
en
(Linea
Nigra)
 Presen
ce of
red
streaks
on her
abdom
en
(Striae
Gravid
arum)
 Distended
 No evidence of enlarged liver and spleen
 there is tenderness upon palpation,
GENITO-URINARY
 With tenderness upon palpation
 With foley catheter draining to pinkish yellow urine
@ 400 cc
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 With vaginal discharge (consumed 2 pads)
MUSCULOSKELETAL/EXTREMITIES
 Equal size on both sides of the body
 No contractures, fasciculation or tremors
 Normally firm and smooth
 No deformities, tenderness nor swelling
 Bones have no deformities, swellings or tenderness
 Joints have no swellings, no tenderness, no nodules
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IV. DIAGNOSTIC AND LABORATORY PROCEDURES
Diagnostic/ Date Ordered

Indications or Normal Analysis and Interpretations
Laboratory Date Results Results
Purpose Values of Results
Procedures were released
COMPLETE A CBC may be ordered D.O. February

BLOOD COUNT as part of a routine 11, 2010
checkup, or if Pooh is D.R. February
feeling more tired than 11, 2010
usual, seems to have an
infection, or has
unexplained bruising or
bleeding. The complete
blood count (CBC) is a
common blood test that
evaluates the three
major types of cells in
the blood: red blood
cells, white blood cells,
and platelets.
HEMOGLOBIN Indicated to Pooh to D.O. February 110 g/L 120-140 g/L The result showed a decreased
evaluate blood loss, 11, 2010 level of hemoglobin which
anemia and response to D.R. February indicates that Pooh is
therapy. 11, 2010 experiencing
blood loss and insufficient
oxygen going to the body
organs.
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HEMATOCRIT It measures the D.O: February 0.36 0.37-0.47 The result showed a decreased
percentage of RBC in 11, 2010 hematocrit of Pooh indicating
the blood of Pooh. D.R. February a blood loss or hemorrhage
11, 2010
WHITE BLOOD
CELLS It is done determine the D.O. February 18x10³/mm³ 5-10x10³/mm³ It showed that the number of
presence of an 11, 2010 WBC is increased which
infection of Pooh. D.R. February indicates that Pooh has a
11, 2010 presence of infection.
0.83
SEGMENTERS This test may D.O. February 0.40-0.60 The result is increased and
determine any Pooh’s 11, 2010 indicates an imflammatory
response to acute body D.R. February response of Pooh due to the
stress, whether from 11, 2010 presence of infection.
infection, infarction,
trauma, emotional
distress, or other
noxious stimuli.
LYMPHOCYTES This is measured to D.O. February 0.17 0.20-0.40 The result showed a decreased
determine if there’s a 11, 2010 number of lymphocytes
lowered immune status D.R. February indicating a lower immune
in the patient. 11, 2010 status of the Pooh.
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Nursing Responsibilities:
BEFORE:
• Explain the procedure to the patient or to the SO.

• Tell the patient that no fasting is required.
• Explain that the paient may experience mild pain on the site.
DURING:
• Apply sterile to sterile technique.
• Collect appropriate amount of blood.
• Provide support to the patient.
AFTER:
• Apply pressure to the venipuncture site.
• Document the procedure done.
Diagnostic/ Date Ordered Date Normal Values Analysis and

Indications or
Laboratory Results were Results (units used in the Interpretation of
purpose
Procedures released hospital) results
Obstetric It is one of the more D.O: 2/9/10 Intrauterine Intrauterine Intrauterine fetal
Sonography well-known uses of D.R: 2/11/10 pregnancy with the pregnancy with the death. Fetus is in
sonography: fetus in breech fetus in cephalic breech presentation.
examining the fetus presentation. Fetus presentation. Normohydramnios.
of a pregnant woman does not exhibit There is adequate Normal lying
like Pooh. spmatic movements amount of amniotic placenta.
Ultrasound scan is and cardiac activity. fluid and a 4- Posterofundal.
currently considered There is adequate quadrant AFI is
to be a safe, non- amount of amniotic 12cm. Placenta is
invasive, accurate fluid and a 4- intact and
and cost-effective quadrant AFI is posterofundal in
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investigation in the 12cm. Placenta is location. Placental
fetus. This intact and maturity is Grade II.
examination has posterofundal in
many indications, location. Placental
such as: to evaluate maturity is Grade II.
the position of the
fetus, diagnose
congenital
abnormalities, and to
determine if there
are multiple
pregnancies, etc.
BEFORE:
• Explain procedure to the patient.
• Tell the patient that the procedure will take 30 min to an hour
• Tell the patient that during the procedure that she will feel light pressure from the transducer.
• Tell the patient that the procedure has no known side effect.
DURING:
• Help the patient to position for the procedure.
AFTER:
• Help the patient remove jelly used for the procedure.
• Document the results.
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V. PATIENT AND HIS ILLNESS
a. Anatomy and Physiology
THE FEMALE REPRODUCTIVE SYSTEM
The changes that occur in the pregnant patient's body are caused by several factors. Many
of these changes are the result of hormonal influence, some are caused by the growth of the fetus
inside the uterus, and some are the result of the patient's physical adaptation to the changes that
are occurring. This lesson is closely related to anatomy and physiology.
CHANGES OF THE REPRODUCTIVE SYSTEM DURING PREGNANCY
Changes in the body during pregnancy are most obvious in the organs of the reproductive
system.
a. Uterus.
(1) Changes in the uterus are phenomenal. By the time

the pregnancy has reached term, the uterus will have
increased five times its normal size:
• In length from 6.5 to 32 cm.

• In depth from 2.5 to 22 cm.
• In width from 4 to 24 cm.
• In weight from 50 to 1000 grams.
• In thickness of the walls from 1 to 0.5 cm.
(2) The capacity of the uterus must expand to normally

accommodate a seven-pound fetus and the placenta, the
umbilical cord, 500 ml to 1000 ml of amniotic fluid, and the
fetal membranes.
(3) The abdominal contents are displaced to the sides as the uterus grows in size, which
allows for ample space for the uterus within the abdominal cavity.
• Growth of the uterus occurs at a steady, predictable pace.

• Measurement of the fundal height during pregnancy is an important factor that is noted
and recorded (see figure 5-1).
• Growth that occurs too fast or too slow could be an indication of problems.
(d) The size of the uterus usually reaches its peak at 38 weeks gestation. The uterus may drop
slightly as the fetal head settles into the pelvis, preparing for delivery. This dropping is referred
to as "lightening." This is more noticeable in a primigravida than a multigravida.
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b. Cervix.
(1) The cervix undergoes a marked softening which is referred to as the Goodell's sign."
(2) A mucus plug, which is known as "operculum" is formed in the cervical canal. This is
the result of enlarged and active mucus glands of the cervix. It serves to seal the uterus and to
protect the fetus and fetal membranes from infection. The mucus plug is expelled at the end of
the pregnancy. This may occur at the onset of labor or precede labor by a few days. When the
mucus is blood-tinged, it is referred to as a "bloody show."
(3) Additional changes and softening of the cervix occur prior to the beginning of labor.
c. Vagina.
Increased circulation to the vagina early in pregnancy changes the color from normal
light pink to a purple hue which is known as the "Chadwick's sign."
d. Ovaries.
(1) The follicle-stimulating hormone (FSH) ceases its activity due to the increased levels
of estrogen and progesterone secreted by the ovaries and corpus luteum. The FSH prevents
ovulation and menstruation.
(2) The corpus luteum enlarges during early pregnancy and may even form a cyst on the
ovary. The corpus luteum produces progesterone to help maintain the lining of the endometrium
in early pregnancy. It functions until about the 10th to 12th week of pregnancy when the placenta
is capable of producing adequate amounts of progesterone and estrogen. It slowly decreases in
size and function after the 10th to 12th week.
EMBRYONIC and FETAL STRUCTURES
1. THE DECIDUA
After fertilization, the corpus luteum in the ovary continues to function rather than
atrophying because of the influence of HCG or Human Chorionic Gonadotropin, a hormone
secreted by the trophoblast cells, which were the cells that will later form into placenta and
membranes. The uterine endometrium, instead of sloughing off, will continue to proliferate and
grow in thickness and vascularity.
Decidua is the term for the uterine lining (endometrium) during a pregnancy, which
forms the maternal part of the placenta. It is formed under the influence of progesterone and
forms highly-characteristic cells.
After ovulation, in mammals, the endometrial lining becomes transformed into a

secretory lining in preparation of accepting the embryo. Without implantation, the secretory
lining will be absorbed (estrous cycle) or shed (menstrual cycle).
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The decidua has three separate areas:
1. Decidua basalis, the part of the endometrium that lies directly under the embryo (or the
portion where the trophoblast cells are establishing communication with maternal blood
vessels).
2. Decidua capsularis, the portion of the endometrium that stretches or encapsulates the
surface of the trophoblast.
3. Decidua vera, the remaining portion of the uterine lining.
As the embryo continues to grow, it pushes the decidua capsularis before it like a blanket.
Eventually, enlargement brings the structure into contact with the opposite uterine wall.
Here, the decidua capsularis fuses with the endometrium of the opposite wall. This is why at
birth, the entire inner surface of the uterus is stripped away, leaving the organ highly
susceptible to hemorrhage and infection.
2. CHORIONIC VILLI
Chorionic villi are villi that sprout from the

chorion in order to give a maximum area of contact with
the maternal blood.
Embryonic blood is carried to the villi by the

branches of the umbilical arteries, and after circulating
through the capillaries of the villi, is returned to the
embryo by the umbilical veins. Thus, the villi are part of
the border between maternal and fetal blood during
pregnancy.
The chorion undergoes rapid proliferation and

forms numerous processes, the chorionic villi, which
invade and destroy the uterine decidua and at the same
time absorb from it nutritive materials for the growth of
the embryo.
3. THE PLACENTA
The placenta is an organ that connects the developing fetus to the uterine wall to allow
nutrient uptake, waste elimination and gas exchange via the mother's blood supply. The placenta
develops from the same sperm and egg cells that form the fetus, and functions as a fetomaternal
organ with two components, the fetal part (Chorion frondosum), and the maternal part (Decidua
basalis).
In humans, the placenta averages 22 cm (9 inch) in length and 2–2.5 cm (0.8–1 inch) in
thickness (greatest thickness at the center and become thinner peripherally). It typically weighs
approximately 500 grams (1 lb). It has a dark reddish-blue or maroon color. It connects to the
fetus by an umbilical cord of approximately 55–60 cm (22–24 inch) in length that contains two
arteries and one vein.[3] The umbilical cord inserts into the chorionic plate (has an eccentiric
attachment). Vessels branch out over the surface of the placenta and further divide to form a
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network covered by a thin layer of cells. This results in the formation of villous tree structures.
On the maternal side, these villous tree structures are grouped into lobules called cotyledons.
The placenta grows throughout pregnancy. Development of the maternal blood supply to the
placenta is suggested to be complete by the end of the first trimester of pregnancy
(approximately 12–13 weeks).
*Placental Circulation
a. Maternal placental circulation
In preparation for implantation, the uterine endometrium undergoes 'decidualisation'. Spiral

arteries in the decidua are remodelled so that they become less convoluted and their diameter is
increased. This increases maternal blood flow to the placenta and also decreases resistance so
that shear stress is reduced. The relatively high pressure as the maternal blood enters the
intervillous space through these spiral arteries bathes the villi in blood. An exchange of gases
takes place. As the pressure decreases, the deoxygenated blood flows back through the
endometrial veins.
Maternal blood flow is approx 600–700 ml/min at term.
b. Fetoplacental circulation
Deoxygenated fetal blood passes through umbilical arteries to the placenta. At the junction of
umbilical cord and placenta, the umbilical arteries branch radially to form chorionic arteries.
Chorionic arteries also branch before they enter into the villi. In the villi, they form an extensive
arteriocapillary venous system, bringing the fetal blood extremely close to the maternal blood;
but no intermingling of fetal and maternal blood occurs ("placental barrier"[5]).
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*Functions of the Placenta
Nutrition
The perfusion of the intervillous spaces of the placenta with maternal blood allows the
transfer of nutrients and oxygen from the mother to the fetus and the transfer of waste products
and carbon dioxide back from the fetus to the mother. Nutrient transfer to the fetus is both
actively and passively mediated by proteins called nutrient transporters that are expressed within
placental cells.
Adverse pregnancy situations, such as those involving maternal diabetes or obesity, can
increase or decrease levels of nutrient transporters in the placenta resulting in overgrowth or
restricted growth of the fetus.
Metabolic and endocrine activity
In addition to the transfer of gases and nutrients, the placenta also has metabolic and
endocrine activity. It produces, among other hormones, progesterone, which is important in
maintaining the pregnancy; somatomammotropin (also known as placental lactogen), which acts
to increase the amount of glucose and lipids in the maternal blood; estrogen; relaxin, and beta
human chorionic gonadotrophin (beta-hCG). This results in increased transfer of these nutrients
to the fetus and is also the main cause of the increased blood sugar levels seen in pregnancy. This
hormone (beta-hCG) ensures that progesterone and oestrogen are secreted; progesterone and
oestrogen thicken and maintain the uterine lining as well as inhibit the production and release of
more eggs. However after about 2 months the placenta takes on the role of producing
progesterone and therefore beta-hCG is no longer needed. Beta-hCG is excreted in urine and this
is what pregnancy tests detect. It also produces insulin-like growth factors (IGFs).
4. THE UMBILICAL CORD

The umbilical cord (also called the birth cord or
funiculus umbilicalis) is the connecting cord from the
developing embryo or fetus to the placenta. During prenatal
development, the umbilical cord comes from the same
zygote as the fetus and (in humans) normally contains two
arteries (the umbilical arteries) and one vein (the umbilical
vein), buried within Wharton's jelly. The umbilical vein
supplies the fetus with oxygenated, nutrient-rich blood from
the placenta. Conversely, the umbilical arteries return the
deoxygenated, nutrient-depleted blood.
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5. THE AMNIOTIC MEMBRANES
The villi on the medial surface of the trophoblast (those that are not involved in the
implantation because they do not touch the endometrium) gradually thin, leaving the surface of
the structure smooth (the smooth chorion). This eventually becomes the chorionic membrane,
outermost fetal membrane. Once it becomes smooth, it offers support to the sac that contains
amniotic fluid. A second membrane lining the chorionic membrane, the amniotic membrane or
amnion, forms beneath the chorion. The amnion is a membrane building the amniotic sac that
surrounds and protects an embryo.
Early in pregnancy, these membranes become so adherent that they seem as one at term. At
birth they can be seen covering the fetal surface of the placenta, giving that surface its typically
shiny appearance. Like the umbilical cord, they have no nerve supply. Therefore, when they
spontaneously rupture at term or artificially ruptured, neither mother nor child experiences any
pain.
The amniotic membrane produces amniotic fluid and phospholipids that initiate the
formation of prostaglandins, which can cause uterine contractions and may be the trigger that
initiates labor.
6. THE AMNIOTIC FLUID
Amniotic fluid or liquor amnii is the nourishing and protecting liquid contained by the
amniotic sac of a pregnant woman. The amniotic sac grows and begins to fill, mainly with water,
around two weeks after fertilization. After a further 10 weeks the liquid contains proteins,
carbohydrates, lipids and phospholipids, urea and electrolytes, all of which aid in the growth of
the fetus. In the late stages of gestation much of the amniotic fluid consists of fetal urine.
The amniotic fluid increases in volume as the fetus grows. The amount of amniotic fluid is
greatest at about 34 weeks after conception or 34 weeks ga (gestational age). At 34 weeks ga, the
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amount of amniotic fluid is about 800 ml. This amount reduces to about 600 ml at 40 weeks ga
when the baby is born.
Amniotic fluid is continually being swallowed and "inhaled" and replaced through being
"exhaled", as well as being urinated by the fetus. It is essential that the amniotic fluid be breathed
into the lungs by the fetus in order for the lungs to develop normally. Swallowed amniotic fluid
contributes to the formation of meconium. Amniotic fluid also 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.
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b. Pathophysiology (Book-Based)
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b.1 Synthesis of the Disease
Chorioamnionitis is caused by a bacterial infection that usually starts in the

mother’s urogenital tract. Abnormal bacterial colonization of the rectum and anus during
pregnancy may create an abnormal vaginal and cervical microbial environment.
Specifically, the infection can start in the vagina, anus, or rectum and move up into the
uterus where the fetus is located. Chorioamnionitis occurs in up to 2 percent of births in
the United States.
Chorioamnionitis is most often diagnosed by physical exam and the findings

listed above. Other clues can be found by taking a blood sample from the mother and
checking for bacteria. In addition, the doctor might take samples of the amniotic fluid to
look for bacteria. The doctor might also use ultrasound to check on the health of the fetus.
Part of the reason for our failure to successfully treat premature delivery leading
to IUFD is that its causes have been poorly understood. However, in the last ten years it
has become apparent that a significant proportion of women with preterm labour and fetal
death, perhaps up to 70%, have infections of the placenta or membranes that surround the
fetus in the womb. It appears that in many such cases, the infection is not clinically
obvious -- the mother does not have a fever or inflammation or tenderness in her womb
or vagina. However, biochemically it has been shown that inflammatory reactions are
established in the tissues that surround the fetus, and the chemical products of these
reactions (cytokines) are thought to be the agents that cause the onset of premature
labour.
To comprehend the process through which bacterial invasion can cause premature
labour then intrauterine fetal death, one must first have a working knowledge of the
organs that protect the fetus during pregnancy.
Throughout pregnancy the baby is immersed in a watery bath of amniotic fluid

surrounded by a tough semi-transparent membranous sack. This fluid is composed
principally of fetal urine, and is repeatedly swallowed and "breathed" by the baby as it
grows and develops (distasteful as this may seem). The membranous sack is actually
composed of three distinct layers: the inner membrane is called the amnion, the middle
layer is called the chorion, and the outer layer is the decidua. This outer tissue is actually
of maternal origin, originating from the cells that line the uterus before pregnancy, while
the other two are derived from the fetus itself. Only the decidua is supplied with blood;
the amnion and chorion are devoid of blood vessels and derive their oxygen and nutrients
from the amniotic fluid or from the decidua by diffusion.
The vagina contains a range of bacteria, the presence of which is normal and is usually
harmless. They are prevented from ascending into the amniotic cavity by the cervix,
which is not only constricted during pregnancy but is plugged with a thick mucus which
is an effective barrier against microbial invasion. However, under some circumstances
such as PROM, bacteria appear to gain access to the membranes or amniotic fluid. The
28 | P a g e
normal response of tissues to the presence of bacteria is an inflammatory reaction, and
this seems to occur during pregnancy following infection of the amniotic fluid,
membranes or placenta.
All humans have a repertoire of defences -- the immune system -- which can be
called upon to fight off an infection. One arm of the body's immunological armory
involves the production of special targeting proteins called antibodies. Antibodies are
produced by specific cells in the blood following activation by fragments of an invading
microorganism or cell. They bind to a unique recognition sequence on the foreign cell,
targeting it for destruction.
The other arm involves the release of chemical messengers which alert the body to the
presence of an invader and cause the recruitment of special cells which are able to engulf
and kill the foreigner with toxic chemicals. These cells, which include macrophages and
neutrophils, are present in blood and also to a lesser extent in many tissues of the body,
including the placenta and decidua. Since they can be recruited to the site of an infection,
macrophages and neutrophils are often found in large numbers in infected tissues.
Infection is usually associated with inflammation, which involves vasodilation or

widening of the blood vessels. This results in increased blood flow to the site of infection,
swelling (fluid build-up) and tissue destruction. Vasodilation is caused by the local
release of a variety of rapid-acting molecules, including lipid-like chemicals called
prostaglandins. These inflammatory reactions are coordinated, in part, by a family of
signalling proteins called cytokines.
The pro-inflammatory cytokines have powerful effects on the tissues surrounding the
baby. They are capable of stimulating the production of prostaglandins from cells in the
amnion, chorion, decidua and uterus; greatly elevated levels of prostaglandins are present
in the amniotic fluid of women with infected pregnancies.
As mentioned above, inflammation is often associated with tissue destruction. Cytokines

mediate this process through inducing the release of enzymes such as collagenase or
elastase which dissolve the connective matrix which holds cells together. TNFa may also
kill cells directly though the induction of a process known a apoptosis (programmed cell
death).
If the membranes become too thin and weak due to these processes they may
rupture prematurely, allowing the protective amniotic fluid to leak out and bacteria to get
in. Premature rupture of the membranes is a common occurrence with infected
pregnancies, and is a serious complication if it occurs more than a few weeks before
term.
If the mother has a serious case of chorioamnionitis, or if it goes untreated, she might
develop complications, including:
• Infections in the pelvic region and abdomen
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• Endometritis (an infection of the endometrium, the lining of the uterus)
• Blood clots in the pelvis and lungs
The newborn might also have complications from a bacterial infection, including
sepsis (infection of the blood), meningitis (infection of the lining of the brain and the
spinal cord), and respiratory problems.
b.2 Predisposing and Precipitating Factors
1. Premature rupture of membranes – The membranes that hold amniotic fluid

(the water surrounding the baby) usually break at the end of the first stage of
labor. With this, a portal of entry for the microorganism opens causing ascending
infection from the rectum, going to the vagina up to the amniotic fluid which may
then infects the fetl membranes leading to chorioamnionitis.
2. Prolonged rupture of membranes – If the membranes are ruptured beyond 12

hours prior to delivery, the fetus has an increased risk of fetal infection because of
the exposed membranes to the outside environment. Without the amnion and the
chorion which protects the fetus from infective bacteria and foreign substances, a
greater risk for infection may be posed.
3. Pre existing infection of the lower genital tract – UTI or urinary tract infection
can bathe the vagina with bacterial pathogens and is a recognized factor for
causing chorioamnionitis and neonatal sepsis. Because of the altered host
defenses, this allows ascending infection from the urogenital tract to placental
tissues and amniotic fluid.
4. Internal fetal and uterine monitoring – Internal fetal heart rate monitoring uses
an electronic transducer connected directly to the fetal skin. A wire electrode is
attached to the fetal scalp or other body part through the cervical opening and is
connected to the monitor. Entry of any foreign object carrying microorganisms
such as streptococcus B or Escerichia coli to any orifce or opening in the body
can possibly expose the fetal membranes to infection-causing organisms which
may go through the membranes and further cause damage.
5. Multiple vaginal examinations during labor – Quick vaginal exam and other
procedures done during labor inherently are invasive procedure that may be risky
in certain situations and is a great risk factor for maternal or fetal infection. Entry
of any foreign object carrying microorganisms such as streptococcus B or
Escerichia coli to any orifce or opening in the body can possibly expose the fetal
membranes to pathogens which may go through the membranes and further cause
damage.
b.3 Signs and symptoms
Symptoms may include:
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1. Fever - Fever happens when the immune system senses a threat such as infection
caused by the presence of Escerichia Coli which is a bacteria, and pumps out
chemicals called cytokines. They, in turn, set in motion a series of chemical
reactions that turn up the body's thermostat. The goal of a fever is to raise body
temperature - temporarily - to prompt infection-fighting white blood cells to fight
harder and kill the pathogenic microorganism.
Significant maternal tachycardia - Inflammation induces various adaptive responses

including tachycardia. Inflammation-associated tachycardia has been the
result from increased sympathetic discharge caused by inflammatory signals
of the immune system. The body tries to compensate to the said infection by
sending more and more blood components especially the WBCs to fight off
and phagocytize the Escerichia coli.
Fetal tachycardia – This symptom is a sign of fetal distress, meaning that the fetus is not
receiving adequate nutrition and oxygen in his body. Thus, because of this, his
heart pumps faster than normal to dispense oxygenated blood to the distal tissues
in his body nearly experiencing ischemia.
Tender and painful uterus – Due to vasodilatation in the placenta as an immune

response of the affected part to infection, swelling in the uterus occur which later
results to congestion. This then causes obstruction to blood vessels leading to
insufficient oxygen supply to tissues. Ischemia of the tissues in the uterus and
near organs as fallout of decreased supply in oxygen happens and so
consequently, ensuing pain in the uterus.
A foul odor of the amniotic fluid – After contamination of the amniotic fluid by the
bacterium such as Escerichia coli, the fluid turns malodorous and smells like
rotten.
Maternal leukocytosis – White blood cells (WBCs), or, are cells of the immune system
defending the body against both infectious disease and foreign materials.
Increase in leukocytes or white blood cells happen in response to presence of
infection such as Chorioamnionitis in which entry of E.coli into the amniotic
cavity took place endangering the fetus life.
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b. Pathophysiology (Patient-Based)
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34 | P a g e
b.2 Predisposing and Precipitating Factors
1. Pre existing infection of the lower genital tract – UTI or urinary tract infection
can bathe the vagina with bacterial pathogens and is a recognized factor for
causing chorioamnionitis and neonatal sepsis. Because of the altered host
defenses, this allows ascending infection from the urogenital tract to placental
tissues and amniotic fluid. Pooh had experienced UTI even before she was a
student. She does not void frequently and instead, holds her urine until her classes
were done. At present, her OB-gyne had assessed her for the said infection and
found positive through her urinalysis results. She was advised by her doctor to
take Amoxicillin.
b.3 Signs and symptoms
1. Fever - Fever happens when the immune system senses a threat such as infection
caused by the presence of Escerichia Coli which is a bacteria, and pumps out
chemicals called cytokines. They, in turn, set in motion a series of chemical
reactions that turn up the body's thermostat. The goal of a fever is to raise body
temperature - temporarily - to prompt infection-fighting white blood cells to fight
harder and kill the pathogenic microorganism. Pooh’s temperature by February
11, 2010 was 37.6°C.
Significant maternal tachycardia - Inflammation induces various adaptive responses

including tachycardia. Inflammation-associated tachycardia has been the
result from increased sympathetic discharge caused by inflammatory signals
of the immune system. The body tries to compensate to the said infection by
sending more and more blood components especially the WBCs to fight off
and phagocytize the Escerichia coli. Heart rate of Pooh was 121 beats per
minute as of February 11, 2010.
Tender and painful uterus – Due to vasodilatation in the placenta as an immune

response of the affected part to infection, swelling in the uterus occur which later
results to congestion. This then causes obstruction to blood vessels leading to
insufficient oxygen supply to tissues. Ischemia of the tissues in the uterus and
near organs as fallout of decreased supply in oxygen happens and so
consequently, ensuing pain in the uterus. This symptom was noted by February
11, 2010.
A foul odor of the amniotic fluid – After contamination of the amniotic fluid by the
bacterium such as Escerichia coli, the fluid turns malodorous and smells like
rotten. Foul smelling amniotic fluid was observed during induced labor by
February 12, 2010.
Maternal leukocytosis – White blood cells (WBCs), or, are cells of the immune system
defending the body against both infectious disease and foreign materials.
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Increase in leukocytes or white blood cells happen in response to presence of
infection such as Chorioamnionitis in which entry of E.coli into the amniotic
cavity took place endangering the fetus life. Pooh’s number of leukocytes was
18x10³/mm³ compared to 5-10x10³/mm³ which was the normal value.
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VI. MEDICAL MANAGEMENT:
Date Ordered; Date

Client’s response to the
Medical Management Performed; Date General Description Indication/ Purpose
treatment
Changed/Discontinue
D5LRS 1L + 10”u” DO: February 11, 2010 A hypertonic solution that > access for Iv meds
oxytocin x 9-10 gtts/min DP: February 11, 2010 exerts less osmotic
+ titrate Time Changed: 1:15am pressure than that of >to replace fluid loss > Pooh tolerated IV
blood plasma. These and electrolytes loss and infusion. Pooh did not
D5LRS 1L + 10”u” solutions draw water from maintain Pooh’s complained any pain or
oxytocin 65gtts/min DO: February 11, 2010 the intracellular hydration and nutritional irritation.
DP: February 11, 2010 compartment and cause status.
D5LRS 1L + 10”u” Time Changed: 8:30am cells to shrink. These
oxytocin 65gtts/min solution is given >to compensate for the
DO: February 11, 2010 cautiously and usually loss. There is the need to
D5LRS 1L +10”u” DP: February 11, 2010 when the serum replenish, to prevent
oxytocin Time Changed: osmolarity has decreased moisture loss and
10:02am to dangerously low level. dryness of Pooh.
Humidified O2 DO: February 11, 2010 Installation of oxygen to To alleviate difficulty of The group did not handle
inhalation @ 2-3 L/min DP: February 11, 2010 the patient breathing of Pooh after Pooh during the
the surgery (effect of administration of
anesthesia). Humidified O2
inhalation.
> IVF: D5 LRS

BEFORE:
1 Check the doctor’s order
2 Explain the procedure to the patient, whether in starting, changing, or removing the IVF.
3 Always check for the correct type of IVF
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DURING:
4 Apply sterile to sterile technique
5 Regulate IVF.
AFTER:
1 Check/observe the puncture site for bleeding, edema, or thrombophlebitis.
2 Always keep the IVF patent and properly regulated.
3 Monitor electrolytes.
> HUMIDIFIED O2 INHALATION

BEFORE:
1 Check for the doctor’s order.
2 Prepare the equipment needed.
3 Explain to the pt. the procedure to be done.
4 Place nasal cannula properly and check for the patency.
5 Regulate as ordered
DURING:
1 Attach delivery device to oxygen tubing.
2 Attach appropriate flow meter to oxygen source and attach oxygen tubing.
3 Check for the regulation and the amount of O2 in the tank.
4 Adjust oxygen flow rate to prescribed dosage.
5 Check for the patency every 2 hours.
AFTER:
1 Document the O2 therapy on the chart.
2 Monitor the response of the pt.
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DRUGS
Date ordered Route of
Date taken / Administration General Action, Indications or Client’s response to
Name of Drugs purposes
givenDate , Dosage and Functional Classification, the medication with
change / Frequency of Mechanism of Action actual side effect
discontinue Administration
Generic name: DO: February 11, 500mg orally Antibiotics that are used for Ampicillin is The group was not
Ampicillin 2010 q6˚ preventing or treating indicated to Pooh able to handle the
DP: February 11, bacterial infections. They for treatment of patient during the
Brand name: 2010 stop bacteria from E.coli infection administration of
Omnipen, multiplying by preventing causing UTI. the drug thus, not
Polycillin, Principen bacteria from forming the knowing the side
walls that surround them. effects of the drug
to Pooh.
Generic name: DO: February 11, 5mg SIVP q8˚ Indicated to treat The group was not
Nubain 2010 PRN moderate to severe able to handle the
DP: February 11, It is for preoperative and pain of Pooh and patient during the
Brand name: 2010 postoperative analgesia, and to boost the effects administration of
Nalbuphine- for obstetrical analgesia of anesthesia. the drug thus, not
Injection during labor and delivery. knowing the side
effects of the drug
to Pooh.
Generic name: DO: February 11, 10 mg IM Benzodiazepines are This drug is The group was not
Diazepam 2010 sedative-hypnotic drugs that indicated to Pooh able to handle the
DP: February 11, help to relieve nervousness, to relieve anxiety patient during the
Brand name: 2010 tension, and other anxiety and tension prior administration of
Valium, Diastat symptoms by slowing the to surgery. the drug thus, not
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central nervous system. To knowing the side
do this, they block the effects of the drug
effects of a specific to Pooh.
chemical involved in the
transmission of nerve
impulses in the brain ,
decreasing the excitement
level of the nerve cells. All
benzodiazepines, including
diazepam, cause sedation,
drowsiness, and reduced
mental and physical
alertness.
Generic name: DO: February 11, 50 mg oral q8˚ Is not used as an anti- Promethazine and The group was not
Promethazine 2010 psychotic. They prevent treats nausea and able to handle the
DP: February 11, histamine from binding and vomiting or pain patient during the
Brand name: 2010 stimulating the cells. after surgery of administration of
Phenergan, Promethazine also blocks Pooh. It is also the drug thus, not
Phenadoz, the action of acetylcholine used as a sedative knowing the side
Promethegan (anticholinergic effect), and or sleep aid. effects of the drug
this may explain its benefit to Pooh.
in reducing the nausea of
motion sickness.
Generic name: DO: February 11, 10 units by IV It is often used to induce Indicated only in The group was not
Oxytocin 2010 infusion in labor in difficult pregnancies that able to handle the
DP: February 11, 100ml of pregnancies or pregnancies have a medical patient during the
Brand name; 2010 intravenous at risk for complications reason for administration of
Pitocin fluid. (e.g., preeclampsia, inducing labor like the drug thus, not
40 | P a g e
eclampsia, diabetes). This Pooh’s. knowing the side
drug may also be used effects of the drug
during pregnancy to test the to Pooh.
heartbeat of the fetus; and to
remove the afterbirth
(placenta) and control
bleeding of the womb
(uterus) after childbirth.
Generic name: DO: 02-11-10 10mg oral q12˚ Stimulates motility of upper Prophylaxis of The group was not
Metoclopramide DP: 02-11-10 GI tract without stimulating post operative able to handle the
gastric, biliary, or pancreatic nausea and patient during the
Brand name: secretions, appears to vomiting when administration of
metoclopramide, sensitize tissues to action of nasogastric suction the drug thus, not
Reglan, Reglan acetylcholine; relaxes is undesireable. knowing the side
ODT, Metozol pyloric, which, when Metoclopramide effects of the drug
ODT, Octamide, combined with effects on interacts with the to Pooh.
motility, accelerate gastric dopamine
emptying and intestinal receptors in the
transit; little effect on brain and can be
gallbladder or colon effective in
motility; increase lower treating nausea of
esophageal sphincter Pooh.
pressure; has sedative
properties; induces release
of prolactin.
Generic name: DO: February 12, 2 doses ANST Diclofenac belongs to a Indicated The group was not
Diclofenac 2010 (-) 75 mg IM class of drugs called non- primarily for the able to handle the
q12˚ steroidal anti-inflammatory Pooh’s treatment patient during the
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Brand name: DP: February 12, drugs, that are used for the of inflammation administration of
Voltaren, Cataflam, 2010 treatment of mild to and pain. the drug thus, not
Voltaren-XR moderate pain, fever, and knowing the side
inflammation. effects of the drug
to Pooh.
*AMPICILLIN
BEFORE:
1. Check the doctor’s order.
2. Explain the procedure to the patient the importance of the drug, its uses, and effects.
3. Determine hypersensitivity to the drug.
4. Explain the procedure to the patient, the importance of the drug, it’s uses and effects.
5. Prepare the right medication at the right time and with the right dosage.
DURING:
1. Adhere to standard precautions.
2. Administer at the right route.
AFTER:
1. Monitor for hypersensitivity and adverse reactions such as erythematous maculopapular rash, urticaria, and anaphylaxis.
2. Check the IV site carefully for signs of thrombosis or drug reaction.
*NUBAIN
BEFORE:
1. Check doctor’s order.
3. Ask the patient if he/she has asthma, gallbladder disease or a history of drug or alcohol addiction.
4. Assess for the BP, PR, RR prior to admission.
6. Prepare the right medication at the right time with the right dosage.
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DURING:
2. Administer on the right route.
3. Nalbuphine (Nubain) is usually given every 3 to 6 hours.
AFTER:
1. Reassure patient about addiction liability: most patients who receive opiates for medical reasons do not develop
dependence syndrome.
2. Discuss to the patient the side effects of the drug.
*DIAZEPAM
BEFORE:
2. Assess for hypersensitivity and other contraindications.
DURING:
AFTER:
1. Monitor BP, PR,RR prior to periodically throughout therapy and frequently during IV therapy.
2. Assess IV site frequently during administration, diazepam may cause phlebitis and venous thrombosis.
3. Prolonged high-dose therapy may lead to psychological or physical dependence. Restrict amount of drug available to
patient. Observe depressed patients closely for suicidal tendencies.
4. Observe and record intensity, duration and location of seizure activity. The initial dose of diazepam offers seizure control for
15-20 min after administration.
5. IM injections are painful and erratically absorbed. If IM route is used, inject deeply into deltoid muscle for maximum
absorption.
6. Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication.
7. Effectiveness of therapy can be demonstrated by decrease anxiety level; control of seizures; decreased tremulousness.
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*PROMETHAZINE
BEFORE:
3. Reduce dosage for patients with hepatic impairment.
4. Reduce dosage of barbiturates given a concurrently with promethazine by at least a half.
5. Arrange for dosage reduction of opoid analgesics given concomitanly by one-fourt to one-half.
DURING:
3. Do not give tablets or rectal suppositories to children younger than 2 yrs.
4. Give IM injection deep into muscle.
5. Do not administer intratertially; arteriospasm and gangrene of the limb may result.
6. Instruct to take drug exactly as prescribed.
AFTER:
1. Instruct to avoid alcohol
2. Instruct to avoid driving or engaging in other dangerous activities of dizziness, drowsiness or vision changes occur.
3. Educate about avoiding prolonged exposure to the sun, or using of sunscreen or covering garments.
4. Maintain fluid intake, use precautions against heatstroke in hot weather.
5. Report sore throat, fever, unusual bleeding or brushing, rash, fever, urine, pale stools, yellowing of the skin or eyes.
*OXYTOCIN
BEFORE:
1. Assess for significant cephalopelvic disproportion, unfavorable fetal positions or presentations, severe toxemia, uterine inertia,
hypertonic uterine patterns,previous cesarean section
2. Assess fetal heart rate, uterine tone
3. Ensure fetal position and size and absence of complications.
DURING:
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3. Infuse via constant infusion pump to ensure accurate control of rate; rate determined by uterine response; begin with 1-
2mL/min and increase at 16- to 60-min intervals
4. Do not combine in solution with fibrinolysin or heparin
5. Monitor maternal BP
6. Monitor neonate for jaundice
7. Discontinue drug and notify physician at any sign of hypertensive emergency
AFTER:
1. Educate client on the side effects of the medication and what to expect.
2. Document that drug has been given.
*METOCLOPRAMIDE
BEFORE:
DURING:
3. Take the medicine with full glass of water.
4. The drug metoclopramide can be mixed with another liquid, such as water, fruit juice, soda, or soft foods.
5. Metoclopramide is usually taken before meals and at bedtime.
AFTER:
1. Assess the patient for N/V, abdominal distension, bowel sounds before and after, extrapyramidal side effects, tardive
dyskinesia, and for signs of depression.
2. Give motoclopramide exactly as directed by the doctor.
3. Give the missed dose as soon as you remember
4. Observed the patient for severe side effects.
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*DICLOFENAC
BEFORE:
3. Before taking the drug, ask the patient if he/she has a history of heart or kidney disease, stomach ulcers and asthma.
5. Prepare the right medication at the right time and with the right dosage.
DURING:
3. Instruct patient to take Diclofenac with a full glass of water and to remain in an upright position for 15-30 minutes after
administration.
4. Instruct the patient to swallow the drug whole. Do not crush or chew.
AFTER:
1. Caution the patient that the drug may cause drowsiness or dizziness. Caution patient to avoid any kind of activities that
requires alertness until response to medication is known.
2. Instruct patient to take missed dose as soon as possible within 1-2 hours if taking once o twice a day or unless almost most
of the time for the next dose if taking more than 2x a day.
3. Advise to the patient to avoid prolonged exposure to sunlight. Diclofenac may increase the sensitivity of the skin to
sunlight.
46 | P a g e
C. DIET
Date Ordered Client’s reaction

General Indications or
Type of Diet Date Started Specific food taken and/or response to
description Purposes
Date Changed the diet
Nothing Per Orem D.O: February 12, No foods or drinks This was ordered in Nothing Pooh was able to
2010 is allowed to be order to prevent comply with the diet
given to the patient, aspiration of Pooh. regimen.
D.S: February 12, also a type of diet
2010 modification and
fluid restriction
• Check doctor’s order.

• Explain the reason of such diet to the patient, as well as with he patient’s significant other.
• Remove all foods bedside.
• If the client eats or drinks, the physician should be notified at once.
D. ACTIVITY/EXERCISE
Date Ordered Client’s reaction

Indications or
Type of Exercise Date Started General description and/or response to the
Purposes
Date Changed activity / exercise
Flat on bed D.O : February 12, 2010 This is the usual position To prevent spinal Pooh maintained a flat-
ordered for post-op. headache of Pooh. on-bed position
D.S. February 12, 2010 patient like Pooh and is
47 | P a g e
positioned flat on bed,
the head is erect or
slightly flexed.
• Check doctor’s order.
• Explain the procedure and the reason to the patient.
• Assist the patient in assuming the position ordered.
• Observe if the patient can tolerate it.
48 | P a g e
Surgical Management
a) HYSTEROTOMY
A hysterotomy is an incision in the uterus, commonly combined with a laparotomy

during a cesarean section. Hysterotomies are also performed during fetal surgery.
DESCRIPTION OF PROCEDURE
• A general anesthesia is used.

• An incision is made in the abdomen and then in the uterus. Fetal tissue and
placenta are removed.
• The uterus wall is sewed back together and the abdominal opening closed.
*POST PROCEDURE CARE
GENERAL MEASURES
• Use sanitary pads for bleeding, which may last for several days. If bleeding
continues 10-14 days after surgery, you may then use tampons.
• If you have pain, place a heating pad or hot-water bottle on the abdomen or back.
Hot baths frequently promote muscle relaxation and relieve discomfort. Repeat
the baths as often as they provide comfort.
• If contraception is desired, it can often be initiated shortly after the procedure. If

you wish to take birth control pills, begin taking them either on the night you
return from surgery or the next day. If you prefer an IUD, diaphragm or cervical
cap, the fitting can be made during you next clinical appointment.
• Your next menstrual period should begin 4 to 6 weeks after the procedure. If you
take birth control pills, your first period will begin after you complete the first
cycle of pills.
MEDICATION
• Prescription pain medication should generally be required for only 2 to 7 days

following the procedure.
• You may use non-prescription drugs, such as acetaminophen, for minor pain.
• Antibiotics may be prescribed to reduce risk of infection.
• Stool softener laxative, if needed to prevent constipation.
ACTIVITY
• Have someone drive you home from surgery. Resume normal activities slowly.
• Avoid sexual relations for 4 to 6 weeks after the surgery.
49 | P a g e
b) CESAREAN SECTION
Cesarean sections, also called c-sections or cesarean deliveries, are performed

whenever abnormal conditions complicate labor and vaginal delivery, threatening the life
or health of the mother or the baby. Dystocia, or difficult labor, is the other common
cause of c-sections. Regional anesthesia, either a spinal or epidural, is the preferred
method of pain relief during a c-section. The benefits of regional anesthesia include
allowing the mother to be awake during the surgery, avoiding the risks of general
anesthesia, and allowing early contact between mother and child. Spinal anesthesia
involves inserting a needle into a region between the vertebrae of the lower back and
injecting numbing medications. An epidural is similar to a spinal except that a catheter is
inserted so that numbing medications may be administered continuously.
The most common reason that a cesarean section is performed (in 35% of all
cases, according to the United States Public Health Service) is the woman has had a
previous c-section. The "once a cesarean, always a cesarean" rule originated when the
uterine incision was made vertically (termed a "classical incision"); the resulting scar was
weak and had a risk of rupturing in subsequent deliveries. Today, the incision is almost
always made horizontally across the lower end of the uterus (called a low transverse
incision), resulting in reduced blood loss and a decreased chance of rupture. This kind of
incision allows many women to have a vaginal birth after a cesarean (VBAC).
The second most common reason that a c-section is performed (in 30% of all
cases) is difficult childbirth due to non-progressive labor (dystocia). Difficult labor is
commonly caused by one of the three following conditions: abnormalities in the mother's
birth canal; abnormalities in the position of the fetus; or abnormalities in the labor,
including weak or infrequent contractions. The mother's pelvic structure may not allow
adequate passage for birth. When the baby's head is too large to fit through the pelvis, the
condition is called cephalopelvic disproportion (CPD).
There are a number of reasons why a woman might choose a c-section in the
absence of the usual indications. These include:
• Convenience. A scheduled c-section would allow a woman to choose the time and
date of delivery to avoid conflicting with work or family obligations.
• Fear of childbirth. A woman might fear the pain of labor and delivery and feel
that a scheduled c-section would allow her to circumvent it.
• Avoiding risks of vaginal delivery. Certain risks inherent to vaginal delivery
(urinary or rectal incontinence, sexual dysfunction, dystocia) are avoided in a c-
section.
To remove a baby by cesarean section, an incision is made into the abdomen,

usually just above the pubic hairline (A). The uterus is located and divided (B), allowing
for delivery of the baby (C). After all the contents of the uterus are removed, the uterus is
repaired, and the rest of the layers of the abdominal wall are closed.
50 | P a g e
Once the uterus is opened,
the amniotic sac is ruptured and the
baby is delivered. The time from
the initial incision to birth is
typically five minutes. The
umbilical cord is clamped and cut,
and the newborn is evaluated. The
placenta is removed from the
mother, and her uterus and
abdomen are stitched closed
(surgical staples may be used
instead in closing the outermost
layer of the abdominal incision).
From birth through suturing may
take 30–40 minutes; the entire
surgical procedure may be performed in less than one hour.
The mother is at risk for increased bleeding (a c-section may result in twice the
blood loss of a vaginal delivery) from the two incisions, the placental attachment site, and
possible damage to a uterine artery. The mother may develop infection of the incision, the
urinary tract, or the tissue lining the uterus (endometritis); infections occur in
approximately 7% of women after having a c-section. Less commonly, she may receive
injury to the surrounding organs such as the bladder and bowel. When a general
anesthesia is used, she may experience complications from the anesthesia. Very rarely,
she may develop a wound hematoma at the site of either incision or other blood clots
leading to pelvic thrombophlebitis (inflammation of the major vein running from the
pelvis into the leg) or a pulmonary embolus (a blood clot lodging in the lung).
Procedures for Cesarean
What is the procedure for a cesarean?
Some of these may go in a different order, and a few left out, but these are the basics:
• A catheter inserted to collect urine

• An intravenous line inserted
• An antacid for your stomach acids
• Monitoring leads (heart monitor, blood pressure)
• Anesthesia
• Anti-bacterial wash of the abdomen, and partial
shaving of the pubic hair
• Skin Incision (vertical or midline(most
common))
• Uterine Incision
• Breaking the Bag of Waters
• Disengage the baby from the pelvis
51 | P a g e
• Birth
• Cord Clamping and cutting
• Newborn Evaluation
• Placenta removed and the uterus repaired
• Skin Sutured (Usually the top layers will be stapled and removed within 2 weeks.)
• You will be moved to the Recovery Room (If the baby is able s/he can go with
you.
Preoperative Interventions
a. Check vital signs as indicated (depending on severity).
b. Check amount of vaginal bleeding.
c. Check for signs of shock such as tachycardia, drop in blood pressure, and cool
clammy skin. (During pregnancy, signs of shock are not manifested until there
has been at least a 40 % blood volume loss.
d. Check state of mental acuity/level of consciousness.
e. Keep an accurate record of intake and output.
f. Urinary output during pregnancy is the best noninvasive indicator of circulatory
volume. Diminished cardiac output causes a shunting of blood away from the
skin, kidneys, and skeletal muscles in order to ensure blood delivery to heart
and brain.
g. Start an intravenous infusion with an 18-gauge intracatheter and maintain as
ordered.
h. Fluid replacement may reverse impending shock by increasing capillary blood
flow and thereby cardiac output increases. (Normal saline or Ringer’
i. Obtain blood as ordered for a complete blood count, prothrombin time, partial
thromboplastin time, Rh antibody screen, and type and cross match for 2 to 4
units of blood.
j. Administer oxygen at 8 to 10 L by mask as needed.
k. Carry out such preoperative protocol as giving the patient nothing by mouth,
l. Giving no enemas or cathartics since they could stimulate a tubal ectopic
pregnancy to rupture, being prepared to insert a Foley catheter as ordered, and
get the permit signed for surgery.
m. Notify the attending physician of any changes in vital signs, decreasing urinary
output, blood pressure that falls 10 mmHg or more, or a change in mental
acuity.
n. If the patient presents in shock, be prepared to assist with central line placement.
The internal jugular and subclavian veins are less likely to collapsed.
o. Be prepared to administer blood replacement therapy if the hemoglobin level is
below 7 g/dl or the patient is manifested signs of shock.
Postoperative Interventions
a. Check blood pressure, pulse, and respiration
 every 15 minutes, eight times;
 every 30 minutes two times;
 every hour, two times;
 every 4 hours, two times; and then routinely.
52 | P a g e
b. Assess vaginal bleeding by pad count.
c. Check dressing
 every hour four times and then
 every shift for bleeding
d. Refer to laboratory work, such as hemoglobin and hematocrit.
e. Keep an accurate intake and output records.
f. Assess for cyanosis.
g. Reinforce or change dressing as needed.
h. Carefully administer IV fluids as ordered.
i. Once the gastrointestinal tract resumes normal function, instruct regarding the
importance of a high protein, high-iron diet for body repair and replacement of
blood loss.
j. Notify physician if blood pressure drops to less than 90 systolic, pulse rises to
greater than 120 bpm, or anemia develops.
53 | P a g e
VII. NURSING CARE PLAN
PROBLEM # 1: ACUTE PAIN

NURSING SCIENTIFIC EXPECTED
ASSESSMENT OBJECTIVES INTERVENTION RATIONALE
DIAGNOSIS EXPLANATION OUTCOME
S: “masakit yung Short Term: Short term:
tahi ko,kumikirot Acute pain r/t Depending on the After 8 hours of -Monitor v/s esp. BP -To have base Pooh’s pain
siya” as verbalized stimulation of depth of injury, nursing line data will be decrease
by the patient. nerve endings nerve endings interventions, -Perform a -To know the from 8 to 6 out
secondary to either become Pooh’s pain will comprehensive precipitating of 10.
O: -pain scale of 8 surgical exposed, resulting be decreased assessment of pain factors of pain
out of 10 procedure in pain and from 8 to 6 out to include location, and to have
-facial grimace discomfort until of 10. characteristics, onset necessary
when moving wound closure are and duration, information
-guarding behavior damaged leaving Long Term: frequency, quality, about the case Long Term:
observed the innervated area After two days intensity or severity of the Pooh. Pooh will
insensate, with of nursing of pain and demonstrate
potential for intervention, the precipitating factors relaxation skills
permanent patient will -assess pt’s -Pain is a as indicated for
impairment of demonstrate perception of pain subjective cue. individual
ability to sense, relaxation skills -observe non-verbal -To confirm situation AEB
touch, pressure as indicated for cues pt’s pain. doing her ADL
and pain. individual -Provide comfort -To provide a independently.
situation AEB measures like non
doing her ADL repositioning pharmacologic
independently. al pain
management
such as
administering
pain relievers.
54 | P a g e
-Encourage adequate -To alleviate
rest period pain
-Encourage deep -To reduce

breathing exercise pain by
breathing
exercise.
-Encourage -To divert the
diversional activities pain by
like listening to a listening to a
music and watching music and
TV watching t.v.
-Administer -To treat

analgesics as underlying
ordered cause.
PROBLEM # 2: INEFFECTIVE TISSUE PERFUSION

S: Ø Short Term: Short term:
Ineffective Due to the CS After 8 hours of -Monitor v/s esp. PR -To have base Pooh will be
O: Patient Tissue surgery, there is a nursing line data able to
manifested: Perfusion r/t massive blood intervention, -Assess Pooh’s -To have base demonstrate
- Pallor decreased loss. This will lead Pooh will condition especially line data increased in
- Capillary refill hemoglobin to the decrease in demonstrate signs and symptoms perfusion AEB
concentration the concentration increased in of disease such as strong peripheral
55 | P a g e
of 3 secs in the blood of hemoglobin in perfusion AEB pulse rate and pulse and
- Weak pulse the blood and strong peripheral capillary refill capillary refill of
- Hgb: 110g/dl alteration in tissue pulse and -Review laboratory -To provide 1-2 secs.
perfusion. capillary refill of
studies comparison
1-2 secs. -Identify changes -To assess the
related to systemic extent of
and/or peripheral involvement
Long Term: alterations in Long Term:
After one day of circulation Pooh will
nurse patient -Encourage early -To promote verbalize
interaction, Pooh ambulation venous return understanding of
will be able to -Encourage quiet, -To conserve the condition
understand the restful atmosphere energy and and treatment
condition and lowers tissue regimen to
treatment oxygen improve tissue
regimen to demands. perfusion.
improve tissue -Provide comfort -To help
perfusion. measures such as patient to relax
repositioning
-Monitor signs of -To prevent
bleeding further injury
-Transfuse blood as - To replace
ordered blood loss
PROBLEM # 3: IMPAIRED SKIN INTEGRITY
56 | P a g e
Impaired skin Due to the incision After 4 hours of - Assess pt’s - To have Pooh will be
O: Patient integrity r/t done during nursing condition base line able to
manifest: abdominal surgery, there will interventions, - Assess skin data verbalize
- Presence of incision 2˚ be disruption of Pooh will be noted color, - To know for understanding
surgical surgery the skin surface able to turgor, sensation, the presence on how to
incision in the that will lead to understand on and signs of of infection promote
abdomen the impairment of how to promote infection wound
- Intact and dry the skin integrity. wound healing - Described and - Establishes healing and
dressing and prevent measured comparative prevent
- (+) pain further wounds and baseline further
complications. observed providing complications
changes. opportunity
Long Term: for timely Long Term:
After 2 days of intervention. Pooh will be
NPI, Pooh will - Determine the - To asses the able to
be able to depth of damage injury participate in
participate in - Keep the area - To promote prevention
prevention clean and dry healing measures and
measures and treatment
- Remove wet - To prevent
treatment program such
linens promptly. skin
program such as as eating
- Change dressing breakdown
eating nutritious nutritious
foods rich in everyday as - To prevent foods rich in
protein and Vit. ordered infection protein and
C such as citrus - Encourage early - To promote Vit. C. such as
fruits. ambulation circulation citrus fruits.
- Instruct to eat - To aid in
nutritious food healing
rich in protein
and Vit. C.
- Review - To promote 57 | P a g e
importance of wellness
measures to
maintain skin
function.
PROBLEM # 4: ACTIVITY INTOLERANCE

S: “hindi ako Short term: Short term:
gaano makagalaw, Activity Inadequate oxygen After 8 hours of - monitor the vital - to obtain Pooh will report
nanghihina pa kasi intolerance in the circulation nursing signs baseline data activity
ako saka nag- related to can develop intervention, - provide health - to provide intolerance with
aalala ako sa na- generalized weakness in our Pooh will report teaching to Pooh adequate enhanced energy,
opera ko” as weakness and muscles. Muscles activity regarding the knowledge and she will
verbalized by Pooh. presence of need oxygen to intolerance with organization and to Pooh. participate
pain secondary move and to do its enhanced time willingly in
O: The group to surgical function. If the energy, and she management desired activities.
observed that Pooh procedure patient cannot will participate technique to
is: tolerate any willingly in prevent while on
activities because desired activity
of the low activities. - adjust activities, - to prevent
- irritable oxygenation reduce intensity overexertion
- uncomfortable caused by the Long term: level or Long term:
- worried ventilation- After one day of discontinue Pooh will
- immobility perfusion NPI, Pooh will activities that identify
weakness imbalance caused identify cause undesired techniques to
by the pathological techniques to physiologic enhance activity
minimized lung enhance activity changes tolerance AEB
expansion. tolerance AEB - suggest use of - To enhance doing her ADL
doing her ADL relaxation sense of independently.
independently. techniques well-being
- assist Pooh to - To prevent
58 | P a g e
learn and or protect
demonstrate Pooh from
appropriate injuries
safety measures
PROBLEM # 5: RISK FOR INFECTION

Risk for A surgical After two hours - Monitor v/s esp. - To have Pooh will
O: Patient may infection incision is prone of nursing PR , RR and base line data, identify
manifest: related to to pathogenic interventions, temperature fever maybe interventions
- Increased inadequate bacteria that will Pooh will be secondary to to prevent the
environmental primary cause infection to able to identify infection risk for
exposure, tissue defenses due to the broken skin. interventions to - Assess Pooh’s - To have infection like
destruction tissue trauma The bacteria will prevent the risk condition base line hand washing
- Inadequate caused by be able to enter for infection like data after 2 hrs of
primary surgery. the incision and hand washing. - Assess the - To know for nursing
defenses due to may infect the surgical incision the presence interventions.
abdominal wound. Long Term: for signs of of infection
incision and After one day of infection
trauma brought nursing
about by interventions, - Stress proper - To prevent Long Term:
surgery Pooh will hand washing cross Pooh will be
- (+) pain demonstrate when the patient contaminati able to
techniques to is going to have on demonstrate
decrease risk for in contact to the techniques to
59 | P a g e
infection such as wound decrease risk
frequent - Encourage early - To mobilize for infection
changing of ambulation, deep respiratory such as
dressing. breathing, secretions frequent
coughing changing of
exercises, and dressing.
position changes
- Changed - To prevent
dressing as infection
ordered
- Administer - For
antibiotics as prophylaxis
ordered.
60 | P a g e
VIII. LEARNING DERIVED FROM THE STUDY
In a few women, for some reasons, there are unusual and unexpected deviations
or complications from the course of normal pregnancy. When this happens, it can place a
severe burden on a woman and her family. All families benefit from the support and skill
of a professional nurse who helps them work through the task of pregnancy and prepare
to become parents. It is our duty to provide our patients as well as their significant other
with adequate knowledge to prevent the occurrence of the possible complications of the
disease entity. That is why, as much as possible, nurses must guide their patients and their
family in identifying ways o how to manage the situation in order to prevent further
impediments and its progress to a more complicated one. This case study can help to
ensure that women are well-informed about the normal course of pregnancy so they can
recognize it when a complication is occurring. This is why prenatal check-ups are very
important for mothers and mothers-to-be.
Moreover, this case study thought the group how to stand on their own and by not
depending on others work. This provides us, students, indeed a big learning regarding
how to take care of our patients in the real clinical setting. Nursing really demands a
tender loving caring attitude. It also demands patience and its calling is not merely taken
for granted.
As future nurses, we must have competent skills, adequate knowledge and

acquaintance plus a compassionate heart. The nurse is not the sole determinant of the
failure or effectiveness of any treatment The patients themselves are the prime factors for
achieving the best possible results of interventions made, yet the nurse who spends
greater time with the patient functions not only to perform health assessments, a
administer medications, provide health teachings, but helping the patient process both the
physiological and psychological impact of the treatment.
61 | P a g e
IX. REFRENCES
• Black, Joyce and Hawk, Jane Hokanson (2005). Medical-Surgery Nursing:

Clinical Management for Positive Outcome 7th Edition. WB Saunder.
• Doenges M and Moorhouse M.F. Nurses Pocket Guide 7th edition; 2000 F.A.
Davis Company, Thailand
• Kozier B. et al. Fundamentals of Nursing 7th edition; 2004 Pearson Education;

South Asia PTE LTD.
• Nursing Drug Guide 2006. Pennsylvania, Springhouse Cooperation
• Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing and
Childbearing Family. Volume 1, 4th edition. Lippincott Williams and Wilkins.
2003.
• http://en.wikipedia.org/wiki/stillbirth
• http://en.wikipedia.org/wiki/placenta
• http://en.wikipedia.org/wiki/Hysterectomy
• http://www.medicinenet.com/hysterectomy/article.htm
• http://www.hysterectomyresources.com/blog.php/hysterectomy-surgical-
procedure
• http://www.surgeryencyclopedia.com/Ce-Fi/Cesarean-Section.html
• http://www.childbirth.org/section/CSFAQ.html
• http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Hysterectomy_sur
gical_procedures
62 | P a g e

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HOLY ANGEL UNIVERSITY

In Partial Fulfillment of the Requirements in Nursing Care Management II: Related

A Case Study for Obstetric Cases:

Dingal, Paolo Junelle

March 25, 2010

II. NURSING HISTORY

III. PHYSICAL ASSESSMENT…………………………………………..7-10

IV. DIAGNOSTIC AND LABORATORY PROCEDURES……………11-14

V. THE PATIENT AND HIS ILLNESS

VI. THE PATIENT AND HIS CARE

VII. NURSING CARE PLAN…………………………………………..50-57

VIII. LEARNING DERIVED FROM THE STUDY……………………58

Maternal chorioamnionitis, intra-amniotic infection or amnionitis, perhaps occurs when

The infection occurs in 0.5 percent to 10 percent of births.

o Fever (an intrapartum temperature >100.4 º F or >37.8 º C)

In addition to a complete medical history and physical examination, chorioamnionitis is

1. Determine major causes of Intrauterine Fetal Death.

II. NURSING HISTORY

b. Socioeconomic and Cultural Factors

Pooh is a vocational undergraduate with a course of computer operations at Systems Plus

PK’s aunt ; PK ‘s aunt:

PK’s mother PK’s father ;

Manny Pookyaw: 2nd sibling: 3rd sibling: 4th sibling:

* PK= Pooh Kwang

- male - Pooh kwang - Hystorotomy - Deceased

- Diabetes Mellitus - Myoma - Asthma - Cancer

Pooh has no history of reproductive or fertility problems. Her grandfather,

f. History of Past Illness

g. History of Present Illness

Initial Assessment: February 11, 2010, 1:00 pm

General Appearance upon NPI

Blood Pressure : 90/60mmHg

NOSE AND SINUSES

MOUTH AND THROAT

Diagnostic/ Date Ordered

COMPLETE A CBC may be ordered D.O. February

• Explain the procedure to the patient or to the SO.

Diagnostic/ Date Ordered Date Normal Values Analysis and

a. Anatomy and Physiology

THE FEMALE REPRODUCTIVE SYSTEM

CHANGES OF THE REPRODUCTIVE SYSTEM DURING PREGNANCY

(1) Changes in the uterus are phenomenal. By the time

• In length from 6.5 to 32 cm.

(2) The capacity of the uterus must expand to normally

• Growth of the uterus occurs at a steady, predictable pace.

EMBRYONIC and FETAL STRUCTURES

After ovulation, in mammals, the endometrial lining becomes transformed into a

Chorionic villi are villi that sprout from the

Embryonic blood is carried to the villi by the

The chorion undergoes rapid proliferation and

a. Maternal placental circulation

In preparation for implantation, the uterine endometrium undergoes 'decidualisation'. Spiral

Maternal blood flow is approx 600–700 ml/min at term.

Metabolic and endocrine activity

4. THE UMBILICAL CORD

6. THE AMNIOTIC FLUID

Chorioamnionitis is caused by a bacterial infection that usually starts in the

Chorioamnionitis is most often diagnosed by physical exam and the findings

Throughout pregnancy the baby is immersed in a watery bath of amniotic fluid

Infection is usually associated with inflammation, which involves vasodilation or

As mentioned above, inflammation is often associated with tissue destruction. Cytokines

• Infections in the pelvic region and abdomen

b.2 Predisposing and Precipitating Factors