KATHMANDU MEDICAL COLLEGE

Sinamangal, Kathmandu
Case Study of Oligohydramnious


Submitted To : Submitted By :
Department of Postnatal Shikshya Dhakal
Mrs. Gayatri Rajbhandari Bs. !ursing "
nd
year
!ursing Co#ordinator $
th
Bath




Acknowledgement
%his ase study report is prepared during my mid&ifery major nursing linial
pratium in '(athmandu Medial College )ospital'. %he report is prepared as a
re*uirement of Bahelor in nursing urriulum &hen + &as posted in postnatal
&ard.
+ had an opportunity to gain e,periene and kno&ledge in this field. + got
myself ompletely in-ol-ed in the are and management of the patient during the
period. )o&e-er the &ork &ouldn.t ha-e been aomplished suessfully &ith my
effort only.
So/ + &ould like to e,press and gi-e a great thank to my teahers &ho are in
the linial area. + am thankful to all the staffs in hospital for kind o#operation. +
am also thankful to my patient and her family for pro-iding me -aluable
information and trusting me. + am also thankful to my olleagues &ho o# operated
&ith me in preparing this ase study.
Shikshya Dhakal
Bs !ursing "
nd
year
$
th
bath
Roll no0 1
"

Table of contents
Preface
Bakground
Seletion of ase
Objeti-es
Part I
+ntrodution of patient
2. Biographial Data of the patient
". Obstetrial health history of patient
3. Physial 4,amination
Part II
2. +ntrodution of oligohydramnious
". Causes
3. Clinial features
5. Diagnosis
6. +n-estigation
7. Compliation
$. Management
1. %reatment
8. +ntrodution of Cesarean Setion
Part III
2. !ursing are plan
". Stress management
3. Disharge %eahing
Postface
Summari9ation
:hat + learnt from this ase study
Referenes
3

Background
;ording to our urriulum &e ha-e to do one ase study in mid&ifery
pratium/ %his ase study report is prepared as a partial re*uirement of Bahelors in
nursing urriulum of (athmandu uni-ersity.
During 5 &eeks of linial pratie of mid&ifery in Postnatal :ard of (athmandu
Medial ollege hospital/ &e &ere re*uired to do one ase study on high risk ase.
So + ha-e hose the ase of Oligohydramnious '. beause it is one of the ommon
ompliated pregnany ase.
Selection of the case study
2. + am interested to gain kno&ledge about disease Oligohydramnious/ and its
management.
". +t is one of high risk ase.
3. + hose this ase in order to gi-e holisti are to the patient and gi-e health
eduation for promotion and maintenane of life as &ell as pro-ide psyhologial and
emotional support.
5

Objectives of case study
%he general objeti-es of ase study are to gain omprehensi-e kno&ledge about disease
as &ell as pratial e,periene.
The specific objectives are
# %o identify major risk fator of mother.
# %o pro-ide holisti nursing are and management to the patient.
# %o teah mother and family to maintain and promote health of both mother and
baby so that it an minimi9e MMR/ !MR and +MR.
# %o gain omprehensi-e kno&ledge by omparison book &ith real patient.
# %o ollaborate &ith lient families and other health team member in management of
patient.
# %o gain through kno&ledge about oligohydramnious and its management and treatment.
#%o demonstrate skills &hih is needed for mother during hospitali9ation period.
#%o ollaborate &ith patient and other health team members for planning disharge and
follo&#up -isit.
Introduction of patient
Sita Rai of "7 yrs old/ &ife of Ramesh Rai/ the resident of Balkumari &as admitted in
Postnatal :ard on "<$<=<"="". She ame at hospital &ith the history of Pain abdomen.
Biographical ata of the patient
!ame0 Sita Rai
;ge=se,0 "7 yrs = >
Marital status0 Married for " years
)usband !ame0 Ramesh Rai
Religion0 )indu
4duation0 ?iterate @A" PassB
Oupation0 )ouse&ife
;ddress0 Balkumari#1/?alitpur
6

Gra-ida=para0 Primi
Date and time of admission0 <$<=<"="" at 10<<am
+npatient no0 2"$63
Bed no0 325
Diagnosis0 4mlss for oligohydramnious
:ard0 Postnatal &ard
Date of deli-ery0"<$<#"#"$ at 7pm.
Date of disharge0"<$<#3#2 at 2"md
!enstrual history
Menarhe # 25 yrs
Menstrual yle # "$#"8 days regular
Blood flo& # 3#5 days normal
Dysmenorrhoea # not present
!edical= surgical history
#!o history of P%B/ !%!/ DM or any other medial disorder
#!o hospitali9ation history.
#She had not other geneti or hereditary diseases.
#She had not done any operation.
Obstetrical history
"#BPast obstetrical history
Primi
$#%Present obstetrical history
?MP0 "<78=<6="2
4DD0 "<$<=<"="1
:eek of gestation0 38 &eeks A 5 day
;!C -isit0 5 -isits in (MC
+mmuni9ation0 " dose of %etanus
Problem during pregnany0 morning sikness
Drugs0 she had taken >oli ;id/+ron and alium.
7

&istory of family
She has $ family members. )er husband and others family members had no any health
problem. !o history of P%B/ )%!/ DM or any other medial problem &ith her family.
She has a single family &ith medium soio# eonomi ondition.
Physical '(amination
Physical '(amination
$
)amily Tree
!other Side
)ather Side

Physial e,amination is an important tool in assessing the patientCs health status.;bout
26D of information used in assessment omes from physial e,amination. +t is
performed to ollet objeti-e data and o#relate it &ith subjeti-e data. +t also re-eals
additional problems &hih the patient has not reogni9ed.
!ethod of physical e(amination
%he ommonly used method of physial e,amination are0
#+nspetion
#Palpation
#Perussion
#;usultation
#Measurement
"#% General appearane 0>air
State of health0 )ealthy
Blood pressure0 22<=1< mm of )g
Pulse 0$1= min
%emperature0 81>
)eight06." ft
:eight06"kg

$# %Skin
#Eniform olour and &arm
#!o dehydration
#!o lesion /!o &ound
#!o rashes
*# %&ead and )ace
#Colour and te,ture of hair0 !ormal
#)air distribution0 4*ual
#)ead uniform si9e and shape
#!o any injury in head and fae.
+#% 'ye
,ormal in si-e and shape
#Colour of slera0 !ormal
#Pupil reat to light
#Fision0normal
.# % 'ars
#%he top of the pinna met the middle anthus of the eye.
#!o ear disharge
#)earing0 good
1

#Slightly &a, present.
/# %,ose
#!o any nasal disharge
#si9e and shape e*ual
#!o polyps /no blokage
0#%!outh1 throat and neck
#olour of lip pink/ moist/ no rak
#%eeth0 no dental arries
#!o gum bleeding
#%ongue moist and pink
#%hyroid not palpable
#Cer-ial lymph node not palpable.
2#% Breast
#Both breasts and nipples are symmetrial/ uniform in shape.
#!o tenderness or dipling present.
#!o rak in nipples.
#;u,iliary lymph nodes are not palpable.
3#%Abdomen 4
# !o -isible blood -essels.
# !o any abdominal distension.
#?i-er and spleen are not palpable.
#?inea !igra and striae gra-idarum present
"5#%Arms and 6egs 7'(tremities%
#Both hands and legs are symmetrial.
#!ormal skin olour &ith sensation present.
#!o oedema/ yanosis/ lumbing nails.
#Capillary refill normal.
""#%Anus and )emale genitalia
#!o any disharge from genitalia.
#;nus pattern normal.
#!o history of bleeding during defeation.
Systemic '(amination
"# 8hest and 6ungs
#Symmetrial in shape
#Symmetrial in si9e of the breast/ not engorged/ no breast lump.
#Respiration normal and rhythm regular
#Chest lear no &hee9ing sound.
$# 8ardiovascular
#!o ynosis
#!o heart murmur
8

#!ormal lubdup sound
*# 9astrointestinal
#;bdominal shape of si9e0 >laid types.
#!o -isible -ein.
#!o abdomen mass
#Bo&el sound present
#?e-er not palpable
#Spleen not palpable
+# 9enitalia
#Slightly bro&n olour disharge
#>oul smelling
#Burning miturition
.# !usculo skeletal
#4asily mobility of hands and legs.
#Musle strength good.
#!o ontrature/ no deformity.
/# ,ervous: !ental
#Patient is fully onsious/ o# operati-e/ speeh lear/ no diffiulty in speaking.
0#Sleeping Pattern
#Before/ sleeping pattern &as normal but no& due to operation/ it is slightly disturbed.
elivery report;
%ype of deli-ery#4mlss
Date and time0 "<$<=<"="$ at 7pm
Blood loss0 1<ml
Baby :eight0 3.6 kilogram
Plaenta &eight0 5<<gm
Post delivery vital
%# 81.5 >
P # $1=min
R # "7=min
BP #Rt 2"<=1</ ?t 2"<=$<mm of )g
Baby<s report
Se,0 Male
Condition0 >air
;PG;R sore0 $=2</ 1=2<
:eight0 36<<gm
Post delivery note of patient
PatientCs general ondition &as fair. +=F drip ontinuing and ontinued till e-ening then
omitted drip.

2<

PatientCs general ondition &as fair. Patient &as in normal diet. Oral mediine started.
!ormal disharge of lohia &as seen.

Post natal e(am
Fitals0#
% G 81." >
P G 1<=min
R G ""=min
BP G Rt 22<=1</ ?t 2"<=1<
)eadahe G !ot present
4pigastri pain G !ot present
Blurred -ision G !ot present
Breast G !ormal
Perineal area G !o s&elling

)er general ondition &as impro-ing than the day before. + ad-ised her to ambulate ga-e
her psyhologial support. She &as planned to disharge ne,t day.
Baby<s Physical '(amination;4
=ital signs
%emperature G 81.1 >
Pulse G 231=min
Respiration G 31=min
:eight G 36<<gm
?ength G 6<m
Se, G Male
9eneral condition G )is mo-ement of limbs/ trunk/ head and nek are normal.
Skin G !o yanosis/ no jaundie/ no rash/ and olour is normal and lymph nodes are
normal.
Skull G Shape and si9e normal/ no aput and haematoma/ no any injury in head and both
fontanels are normal.
'yes G Shape/ si9e and position are normal/ !o disharge from eyes. !o redness and
s&elling of any part of eyes.
'ars G !ormal/ no disharge from both ears.
,ose G !ormal/ no disharge/ s&elling
!outh G ?ips are moist/ no raks/ no s&elling/ no left palate and hair
6ips G olour of lips is pink. Shape and si9e of tongue is normal.
,eck G no ongenital goiter/ no any abnormal presentation.
8hest G Shape and si9e normal.
Abdomen G Cylindrial in shape and slightly distended. !o ord bleeding/ no rashes
present in skin.
9enitalia G !ormal/ !o disharge
6imbs G Position of upper and lo&er limbs &ere normal. !o any ongenital deformity
found. !o rashes/ no e,tra fingers. Hoint mo-ement &as also normal.
Spinal cord G !ormal/ no spina Bifida/ no abnormalities
Anus G !ormal/ stool passed.
22

>ooting refle( G Present
Sucking refle( G Good
Swallowing refle( G Good
9agging refle( G !ot seen or obser-ed.
9rasping1 dancing1 Tonic neck refle(es G Present
Babinski refle(# present

evelopmental Task
Sita Rai is "7yrs old she belongs to young adulthood.
2.B;ge group#"2 to 38yrs.
".BIoung adulthood is the period of hallenges re&ards and risis.
Challenge of entering the job/ re&ard of a job &ell done and risis assoiated &ith aring
of parents and rearing of hildren or family.
;ording to book ;ording to patient
#%he young adults ahie-e
independene from parental ontrol.
4My patient &as totally dependent to her
husband beause she is house&ife.
#%hey begin to delo- strong friendship
and intimate relationship outside the
family.
#She has many friend outside the family.
#%hey establish personal set of -alues. #She has her personal identity and has
established self onept.
#%hey de-elop a sense of personal
identity.
#She had ertain -alues of her life.
4%hey prepare a life &ork and de-elop
the apaity for intimay#
#She got married and her husband is
-ery intimate.
#4stablishing and managing a home and
time shedule and life stress.
#She also manage her home.
#Deide and arry out task of parenting. #She has t&o hildren she perfetly rear
them and she is interested to beome
parent.
isease profile
Oligohydrominous
Introduction
+t is e,tremely rare ondition &here the li*uor amnii defiient in amount of less than
6<<ml.+t is often assoiated &ith the follo&ing ondition.
2"

iB :ith poor plaental funtion and fetal gro&th retardation.
iiB Seen &ith obstruti-e lesion of the fetal urinary trat and &ith
renal agenies.
iiiB +n unio-ular t&ins &hen one of the gestation sas has e,ess of
li*uor/ the other sa may ha-e -ery santy li*uor.
'tiology 7according to book%
iB ;mnion nodosum0#failure of amnioti fluid seretion.
iiB Obstrution of the urinary trat.
iiiB +GER assoiated &ith plaental insuffiieny
i-B Post maturity.
'tiology 7according to patient%
?nknown
iagnosis 7according to patientB
iB %he uterine si9e appears smaller than gestation period/
iiB %here are other features of +EGER.
iiiB %here may be fetal malpresentation @breeh ommonB.
i-B On abdominal palpation due to santy li*uor the fetal parts are prominent
and uterus feels full of fetus.
-B +t the membranes are artifiially ruptured for indution of labour or there is
spontaneous rupture of the membrane in labour/ there is -ery santy esape
of li*uor &hih is -ery often meonium stained.
-iB ?ess fetal mo-ement.
iagonosis during delivery
iB %hik meonium stained.
iiB Santy li*uor.
iiiB %he fetal skin is markedly thik dry and lathergy and there e-idene of
fetal deformity.
iagonosis 7according to patient%
iB Eterine si9e is muh smaller than the period of amenorrhoea.
iiB %he uterus is full of fetus beause of santy li*uor.
iiiB ?ess fetal mo-ement present.
Investigation done in patient
)b#2".3gm=dl
Blood Group#OA-e
FDR?#non#reati-e
)+F#negati-e
)BS;G#negati-e
ESG done
BPD Measures#8<mm.
23

>? Measures#$"mm.
;C Measures#32"mm.
J3$ :OG
+mpression#Single ?i-e >etus :ith Cephali Presentation.
#3$ :OG
#Plaenta ;nterior :all
#?i*uor ;>+ 6m
#4>: 3."(g
'ffect of oligohydramnious
'arly pregnancy

iB ;mnioti adhesion or bands may ause deformities like amputation of
fetal limbs or onstrition of the umblial ord.
iiB Pressure deformities suh as lub feet.
iiiB Pulmonary hypoplasia has been reported.
i-B %he skin beomes dry lethargy and &rinkled.
6ate pregnancy
iB +t is sign of fetal jeopardy as in ase +EGR.
iiB Close adoption bet&een the fetus and the uterine &all an lead to
pressure on umblial ord and obstrution to the flo& of blood to and
from the fetus. >etal asphy,ia may result.
iiiB Meoniun passed into a amnioti sa in &hih there is pauity of fluid
&ill not be diluted.
i-B ;spiration of this thik meonium by the fetus &ill lead to aspiration
pneumonia after birth.
!anagement 7According to book%
%here is no speifi R, for oligohydramnious. +n some ase termination of
pregnany is arried out to forestall se-ere fetal hypo,ia all fetal death in uterus.
!anagement 7According to patient%
!ormal deli-ery &as onduted.
Treatment 7According to book%
Prom is onfirmed labor may be protrated and ontration is more painful.
>etal distress ours fre*uently beause of fre*uent assoiation of fetal malformation
-aginal deli-ery is fa-orable.
Treatment7According to patient%
Prom done
8omplication
A# !aternal
iB Prolonged labor due to inertia.
iiB +nreased operati-e interferene due to malpresentation
25

iiiB ?ead to maternal mortality.
B# )etal
iB ;bortion
iiB Deformity due to intra#amnioti adhesion or due to ompression
iiiB >etal distress in labor
i-B Cord ompression
-B >etal lung hypoplasia
-iB Skeletal deformities due to ompression e.g. talipes
-iiB >etal mortality is high
rugs used in my patient
#%ab ifran 6<< mg BD
#+nj o,ytoin 2< unit +=M
#%ab ;ilo 26<mg BD
#+ron
#Calium
Tab 8ifran .55 mg B
Ciproflo,aillin is a broad spetrum and baterial drugs/ &hih &as introdued in
281$/&hih is 5#*uinolone deri-ati-e deri-ed from !alidi,i aid.+t is highly effeti-e
against Shigella/Salmonella/!eiseria/4#oli/Pseudomonas/).influn9a/)eliobater
infetion and methiillin resistant Staphylooi.
!echanism of action
+t inhibits the baterial D!; synthesis by inhibiting D!; gyrase/&hih re-erses the
super oiling of D!; stands/the en9ymes that maintains the helial t&ists in D!;. %hus/
it kills the bateria by inhibiting the D!; synthesis.
Indication
#4nteri fe-er
#Erinary trat infetion
#+ntra abdominal infetion
#Gynaeologial infetion
#Bone and joint infetion
#Gonorrhoea and septiemia aused by sensiti-e organism.
#Pel-i inflammatory disease
#Surgial prophyla,is in upper gastrointestinal proedures
ose
;dult
By mouth0
#General dose0"6<#6<<mg BD for days before meal.
#E%+06<<mg BD for $ days.
#Gonorrhoea0"6<#6<<mg in resistant ase@single doseB&ith metronida9ole and
Do,yyline.
#Contats meningooal meningitis06<<mg single dose.
26

By +=m=+F
#E%+0+F minor infetion "<<mg BD moderate infetion 5<<mg/se-ere infetion 5<<mg
%DS.
#Gonorrhoea02<<mg single dose.
#4nteri fe-er05<<mg BD for 2<days.
Child
By mouth0
#General dose02<#"<mg=kg 2" hrly before meal.
#4nteri fe-er03<mg=kg 2" hrly.
By +=F
Dose05#1mg=kg 2" hourly.
Adverse effect
G+%0 !ausea/ -omiting/ epigastri distress/ flatulene.
C!S0 )eadahe/ di99iness/ depression/ insomnia.
Erinary0 Crystal urea/ renal failure /nephritis.
Bone and joint0 Damage to gro&ing artilage/ arthralgia.
Skin0 Skin rash inluding -ery se-ere e,foloati-e dermatitis.
Blood0 +nrease blood urea and reatinine/ blood disorders.
?i-er0 )epatitis@disturbanes in li-er en9ymes and bilirubin.
Misellaneous0 ;naphyla,is/ Ste-ens#Hohns syndromes/ lyell syndrome.
8ontraindication
)ypersensiti-ity to fluro*uinolones.
,ursing implication
#+=F iproflo,ain should be administer infusion o-er a period of 7< min. %otal daily
dose should be hal-ed in se-ere renal impairment.
#:hile taking this mediine/ tell them to drink a lot of &ater.
#Gi-e this mediine in empty stomah food interfere its absorption.
#%he dose of the mediines should be ompleted.
#%he dose should not be skipped at all.
Tab calcium
Action4 Maintain ardia funtion ner-es ati-ities and musle ontration/ oagulation
of blood and for maintaining strutural integrity of ell membranes. +t plays an important
role during period of bone gro&th in hildhood adolesent/ during pregnany and
latation.
ose; %ab "6< mg # 6<<mg OD
Indiations # Osteomylitis/ pregnany /latation
Side effects
#;nore,ia
27

#!ausea/ Fomiting
#;bdominal pain
#Dry mouth/ thirsty
#Poly# urea
#Confusion
#Delirium and oma
,ursing Implication
#%o inrease fluids
#!ot to use antaid unless direted by physiian
#?a,ati-es or stool softeners onstipation ours.
8ap Iron
Action; Replaes iron store/ needed for red blood ell de-elopment/ energy and o,ygen
transport. +t &orks in iron defiieny anaemia/ prophyla,is for +ron defiieny in
pregnany.
Dose#5< mg OD
Indication 4 Pregnancy1 Anaemia
Side effects #
#!ausea/ -omiting
#Constipation
#4pigastri pain
#Blak and red torry stools
#diarrhoea
#%emporarily disoloured tooth enamel and 4yes.
,ursing Implication
#;ssess blood to,iity/ nausea/ -omiting/ diarrhiea haemat/ oemesis/ pallor/ yanosis/
shok/ oma/ dimination.
Introduction of 8esarean Section
8esarean Section
+t is an operati-e proedure &hereby the fetus after the end of "1
th
&eeks is deli-ered
through an inision on the abdominal and uterine &all. %his e,ludes deli-ery through an
abdominal inision of a fetus lying free in the abdominal a-ity follo&ing rupture of the
uterus.
Indication
Compliations of labor and fators impeding -aginal deli-ery/ suh as0
prolonged labour or a failure to progress @dystoiaB
fetal distress
ord prolapse
uterine rupture
2$

inreased blood pressure @hypertensionB in the mother or baby after amnioti
rupture
inreased heart rate @tahyardiaB in the mother or baby after amnioti
rupture
plaental problems @plaenta prae-ia/ plaental abruption or plaenta
aretaB
abnormal presentation @breeh or trans-erse positionsB
failed labour indution
failed instrumental deli-ery @by foreps or -entouse @Sometimes a trial of
foreps=-entouse deli-ery is attempted/ and if unsuessful/ it &ill be s&ithed
to a Caesarean setion.B
large baby &eighing K5<<<g @marosomiaB
umbilial ord abnormalities @-asa pre-ia/ multilobate inluding bilobate
and suenturiate#lobed plaentas/ -elamentous insertionB
Other ompliations of pregnany/ pre#e,isting onditions and onomitant
disease/ suh as0
pre#elampsia
hypertension
L3"M
multiple births
pre-ious @high riskB fetus
)+F infetion of the mother
Se,ually transmitted infetions/ suh as genital herpes @&hih an be passed
on to the baby if the baby is born -aginally/ but an usually be treated in &ith
mediation and do not re*uire a Caesarean setionB
pre-ious lassial@longitudinalB Caesarean setion
pre-ious uterine rupture
prior problems &ith the healing of the perineum @from pre-ious hildbirth
or Crohn.s diseaseB
Biornuate uterus
Rare ases of posthumous birth after the death of the mother
Contraindiations0
; patient &ho is pregnant or &ho &ants to beome pregnant in the
future. Pregnanies follo&ing ablation an be dangerous for both mother and fetus.
; patient &ith kno&n or suspeted endometrial arinoma @uterine anerB or pre#
malignant onditions of the endometrium/ suh as unresol-ed adenomatous
hyperplasia.
; patient &ith any anatomi ondition @e.g./ history of pre-ious lassial esarean
setion or transmural myometomyB or pathologi ondition @e.g./ long#term
medial therapyB that ould lead to &eakening of the myometrium.
; patient &ith ati-e genital or urinary trat infetion at the time of the proedure
@e.g./ er-iitis/ -aginitis/ endometritis/ salpingitis/ or ystitisB.
; patient &ith a intrauterine de-ie @+EDB urrently in plae.
21

; patient &ith a uterine a-ity length less than 5 m. %he minimum length of the
eletrode array is 5 m. %reatment of a uterine a-ity &ith a length less than 5 m
&ill result in thermal injury to the endoer-ial anal.
; patient &ith a uterine a-ity &idth less than ".6 m/ as determined by the
:+D%) dial of the disposable de-ie follo&ing de-ie deployment.
; patient &ith ati-e pel-i inflammatory disease.
%ypes of Cesarean Setion
2. 4leti-e Cesarean Setion
". 4mergeny Cesarean Setion
,ursing !anagement
2.Psyhologial support to patient and family.
".4nourage to -entilate her feelings.
3.4,plain about the intra#uterine fetal death and possible ompliation.
5.;d-ie to take fre*uent small amount of food it stimulate appetite and digesti-e.
6.;d-ie to take nutritious and iron ontaining food and -egetables.
7.;d-ie about personal hygiene.
$.Control of -isitors and noise near the pt.s room.
1.Counselling for family planning upto 2#3 yrs spaes minimum.
After elivery1 I assisted my patient to get out of the bed1 ambulation1 e(ercise1
morning care1 changing dresses etc#
+ ga-e health teahing on different topis as neessary. eg. the importane of
ambulation/ rest and e,erise/ diet/ breast feeding/ infetion pre-ention and oral
hygiene et.
28

,?>SI,9 8A>' P6A,
S#, ,ursing
iagnosis
,ursing goal ,ursing
implication
>ational 'valuation
"<

2.
$#
;n,iety
related to
unfamiliarity
&ith hospital
en-ironment
Pain related to
uterine
ontration@pr
ogress of
labourBand
desent of
foetus in the
pel-is.
#Pt &ill
e,press
redued
an,iety after
inter-entions.
#patient &ill
ha-e a rela,ed
body posture
and faial
e,pression
after
inter-ention.
Patient &ill
ha-e a rela,ed
faial and
body
appearane
bet&een
ontrations.
#Greet patient and
their family
&armly on arri-al.
#Briefly orient
patient about
birthing room/
e,plain any
e*uipment that is
inreased inluding
its purpose.
#%alk &ith &omen
about &hat they
e,pet of the birth
e,periene for
e,ample/ ask &ho
they plan on ha-ing
present at birth and
of mediations.
#;ssess for
presene and
harater of pain
ontinuously
during labour
suh as type of
ontration/
fre*ueny and
duration /faial
e,pression /rying
and moaning
during and bet&een
ontrations.
#Pro-ide general
omfort measures
suh as adjust the
room temperature.
# 4nourage
&omen to assume
position she finds
most omfortable
other than the
supine.
# Obser-ed for a
full bladder e-ery
one to t&o hrs.
#Makes family feel
&elome and that staff
&ill be onsiderate of
their needs and desires.
#%eahing helps derease
fear related to the
unkno&n and inreases a
sense of personal ontrol
o-er the situation.
#4nables nursing staff to
help &omen ahie-e their
e,peted e,periene
more losely/ &hih
promotes their
satisfation e-en if all
their e,petations are not
met. %hey &ill probably
be less an,ious of they
belie-e staff ares about
their desires.
# ;ssessment enables to
identify &hether pain is
normal for Patients.
?abour status and it also
helps to identity the best
inter -entions for plain
relief.
# 4-aluating non -erbal
and -erbal
ommuniation helps to
e-aluate need for pain
relief in pt.
# %hese general measures
redue outside irritants.
# Position Changes
promote omfort and
help the fetus adept to
si9e N shape of pt.s
pel-is.
# Supine position an
result to redued
plaental blood flo& and
fetal o,ygenation.
#Patient did not
e,press fears.
#patient sits in
bed in
omfortable
position.
Pain is minimi9e
after maintained
pt. position and
psyhologial
support.
"2

S.!o !sg
diagnosis
Goal +mplementation Rationale 4-aluation
2. ;n,iety
related to
kno&ledge
defiit
regarding
pain its
prognosis.
She gained
kno&ledge
about
pain
management
and its
rela,ation
tehni*ue and
prognosis
2. Reassurane the
patient and -isitors.
". Pro-ide positi-e
reinforement
&hen
desired response is
ahie-ed.
3. (eep in omfort
position helps
&hile
turning position.
5. ?isten
attenti-ely/
enourage
-erbali9ation
pro-ide a aring
touh.
6. Gi-e pain killer
mediine
si, hourly or
aording to
Dotor order.
7. %eah about pain
and
its prognosis.
2. Maintain a good
interpersonal
relationship.
". Positi-e feedbak
helps self onfidene.
3. %hese reassure the
patient that she is not
alone.
5. %hese tehni*ues
allo& an out for an,iety
and help to ontrol pain.
6. %o relie-e operation
site pain.
7. (no&ledge upgrade
and o#operation for her
ondition.
She has
gained
kno&ledge
about pain
and
rela,ation
tehni*ue .
)er pain
ontrol.
S.! !rsg Diagnosis Goal +mplementation Rationale 4-aluatio
n
". Potential to
de-elop
post deli-ery
ompliation.
#hest pain
#Deep -ein
thrombosis
Pre-ent from post
deli-ery
ompliation
during
hospitali9ation.
#%eah deep
breathing
and oughing
e,erise.
#+nstrutions
regarding the
importane of
deep.
#4nourage
e,erise and
ambulation.
#+mpro-e the pulmonary
-entilation/ mobili9es
seretions and stimulate
irulation.
#%eahing regarding
pulmonary mehanis
from foundation of self
are.
#;mbulation maintains
musle tone and pre-ents
musle atrophy and
pre-ents thrombophlebitis.
She has
not
de-elops
any post
deli-ery
ompliat
ions so
that my
goal &as
met.
""

S.!o !sg
Diagn
osis
Goal=Obj
eti-es
!sg
+nter-ention
Rationale 4-aluation
3. )igh
risk
for
infeti
on
2. Patient
&ill
remain
free
from
+nfetion
during
hospitali9
ation as
&ell as
at home.
2. Perineal
are done 2"
hrly
".4mphasi9ed
or hanging
sanitary pad.
3.Breast are
done daily and
teah
tehni*ue to
the patient.
5.4nourage
to take
nutritional
diet &ith
plenty of
fluids.
6.;d-ie hand
&ashing
before
%ouhing the
baby.
7. ;d-ie for
nail utting.
$. Baby bath
done.
1. 4ye are
and umbilial
are done.
8. ;ntibiotis
as ordered by
dotor
2. +t helps to limit potential
soure of +nfetion. +t also
pro-ides opportunity to see lohia
and its olour and order take
ation aordingly.
". +t helps to limit potential
soure of +nfetion. +t also
pro-ides opportunity to see lohia
and its olour and order take
ation aordingly
3. +t helps to promote irulation
to lean nipple for baby.
5. +t helps to pro-ide body
re*uirement for nutritional and
prompt health status.
6. %o pre-ent ross infetion.
7. %o pre-ent from injury and
infetions.
$. %o obser-e baby skin.
1. %o pre-ent from infetion.
8. Derease possibility of
introduing pathogens.
Mother and baby are
free from infetion
thatCs &hy objeti-es
&ere fulfilled.
"3

Stress !anagement
Stress is an unpleasant e,periene of the life. During hospitali9ation patient suffer
from stress beause of ne& en-ironment.
Stress is a hange in the en-ironment that is perei-ed as a threatening hallenging and
damaging to the personCs e*uilibrium as dynami balane .:hen stress is more se-ere or
more prolonged than usual/ ho&e-er a person may need a nurses help in oping &ith
stress.
My ase study patient Sita Rai &as suffering from stress due
to hospitali9ation and ne& en-ironment and she &as upsat of her baby.
%o minimi9e her stress/ + follo&ed the follo&ing tehni*ues &hih are as follo&s.
#+ pro-ide plenty of time to e,press her feeling.
#+ ga-e psyhologial support.
#+ built good rapport &ith patient and her family.
#;llo&ed her family member to -isit her.
#Gi-e proper information regarding eah and e-ery proedure.
#Rele-ant information has been gi-en day to day about treatment and prognosis of her
ondition.
ODi-ertional therapy has been applied for stress redution &hih are as follo&s0
#%alk therapy
#Pro-iding ne&spaper and other fa-ourate objets.
#;udio=-isual aids/ for e.g. tele-ision.
#+maginary tehni*ue.
#+maginary -isuali9ation.
#Distration.
#Progressi-e musle Rela,ation.
#;utogeni training.
"5

&ealth Teaching:ischarge Teaching
)ealth %eahing plays an important role to pre-ent disease/ promote health as &ell as to
ure disease more rapidly &ith out any ompliation .one of the most important roles of
the nurse is to pro-ide health eduation. So/ + being a nurse/ + had also gi-en health
eduation to patient and family.
%o promote the health.
%o moti-ate for early diagnosis and treatment.
%o help limit the disability
%o keep in relationship
@eeping above objectives in mind I had given health education to the patient about
following topics;4
%opis ;d-ie= )ealth 4duation
2.!utrition Postnatal mother needs balane diet &hih should ha-e ade*uate
protein/
arbohydrate/ alium/ iron et. Balane diet helps to regain her health
and
her babyCs health add to promote health and her babyCs health add to
promote
health and latation. She must eat 5 times per day &hih is re*uired for
latation.
Baby needs good nutrition So mother has to breast feed the hild
regularly till 5#6
month &ithout &ater also. %his is the only one soure of good nutrition
for the baby.
She has to take are about this.
".Rest and
;ti-ities
Rest and sleep is -ery important. So she has to rest in a day also. Sleep
pattern should
be good. ?ight e,erise an be done. ?ifting hea-y thing should be
a-oided. 4speially
post natal e,erise suh as abdominal breathing/ arm raises e,erises.
3.Personal hygiene %his should be done to pre-ent infetion. +nner lothes should be
leaned/ dry and hanged
fre*uently. Periare and breast are should be enouraged.
5.Se,ual +nterourse
and family planning
:e disussed about se,ual interourse and family planning method. +
taught her to pre-ent
some ompliation to the mother and + ad-ie to use temporary family
planning
method &hih she used to like after 56 days beause she &as primipara
mother
6. Care of the baby
Gently handling of baby are of eyes/ ears and groins &ith &arm loth/
periodi bath and oil
massage/ fre*uently hange of napkin/ hek fre*uently urine and stool
pass.
7. Breast feeding to + ad-ie to teah her about demand feeding/ e,lusi-e breast feeding.
"6

baby Breast milk seretion
high in amount in night than in day so breast feed in night as &ell as
day. 4,lusi-e breast feeding
help to temporary family planning method.
$.+mmunisation of
baby
+ e,plained about important of +mmunisation and shedule of
+mmunisation and its purpose.
1. Mediine Dotor has presribed the follo&ing mediine. %ab >errous sulphate 2
tab OD for 2 month. %ab
Calium 2 tab OD for 2 month. + e,plained about its usefulness.
8. >ollo& up Suggest for importane of routine hek up and health for follo& up
purpose.
2<. Others
+mmediate hek up if any signs of infetion/ fe-er/ se-ere headahe/
pain s&elling/ foul disharge/
Con-ulsion et. +f baby has any problem suh as dyspnoea fe-er/ not
suking breast milk/ inrease
Respiration et. to -isit the dotor as soon as possible.
ischarge teaching
+ had gi-en health teahing to the patient and her family on the follo&ing topis#
2.)a-ing ade*uate rest and sleep.
".!utritional diet.
3.Personal hygiene.
5.Regular mediation on time.
6.>ollo& #up -isit.
7.>amily planning method.
$.>or being more onsious and to do regular antenatal -isit in oming
pregnany.
"7


Summari-ation
;ording to our 5 &eeks mid&ifery pratial &e had to do t&o ase studies. + hose the
ase of Oligohydramnious. + got opportunity to obser-e the ases and pro-ide nursing
are aording to need.
+ seleted the ase of oligohydramnious. My patient name &as Sita Rai "7 yrs old
admitted in Postnatal :ard &ith the diagnosis of 4mlss for oligohydramnious.
During the &hole period of hospitali9ation + pro-ided holisti nursing are to her
onsidering her mental/ soio#ultural aspets of nursing are.
)er ondition &as impro-ed and reo-ered. So disharged on as per plan. During
hospitali9ation + ga-e health eduation /regarding nutrition/ rest/ breast/ feeding/ e,erise/
regular health hek up and follo& up et.

"$

Ahat I learnt from this case study B

>rom this ase study + learnt about oligohydramnious in depth. :hile doing
ase study/ + got many opportunities to gain sientifi kno&ledge and theories in
patient and e-aluate the outomes and finally &rite result. + gained onfidene in
aring and managing the ase of oligohydramnious.
Case study helps to gain lot of theoretial as &ell as pratial kno&ledge and it
helps to apply our theoretial kno&ledge in pratial. +t also impro-e &riting
skills. + got hane to study patient and family bakground/ soio#ultural/
en-ironmental bakground of the patient.
>eferences
2. D.C Dutta # %e,t book of obsetris 6th edition
".!ursing drug handbook #28863
3.Manual of mid&itery ;# Roshani %uitui


"1