DEMOGRAPHIC DATADEMOGRAPHIC DATA

Name : Mrs.A D M

Age & sex : 47yrs / female M R No. : 193857 Date of admission : 05 .01.2013 G P L A : G9 P7 L7 A1 Gestationational Age : 30 wks +6 days Pre- op diagnosis : Placenta acreta Surgery : Emergency C

S Followed by Hystrectomy

Date of surgery : 16.01.2013 Date of discharge : 19.01.2013

PHYSICAL

ASSESSMENT

1. General Apperance Patient is 47 yrs old female weighs 88 kg Concious & oriented Looks weak & fatigue due to pain

 Vital signs of the patient are

Bp : 108/62 mm of hg

PR : 76/mnt

RR : 20/mnt

SPO2 : 99%

2. Skin

•Skin is warm •Has edema on legs•Warm with good turgor

3. Head and Neck•Hair Is Equally distributed•Absence Of Dandruff & alopecia 4. Eyes •Able to move both eyes.

5. Ears• Patients pinna is same colour as fascial. • Able to hear sounds clearly . • No discharges.

6.Nose • Nasal mucosa is pink • Nasal congestion present

7.Neck And Throat

•Lips are pale & dry.•Teeth is propely aligned with no dentures.•No tenderness of node.•No palpable masses or leisions

8.Thorax

•The Thorax Is Symmetric On Inspection. •Dry cough present •Clear breath sounds

9.Cardio Vascular

• E C G is normal• No cardiomegaly

• Apical pulse is 76 bpm

10. Breast • Symmetrically enlarged .• Montgomerys tubercle present.• Nipples darkish in colour.

11.Abdomen • Flaby abdomen. •Strae gravidarum & linea nigra present. •Classic incision scar & dressing present. 12 Genito Urinary • With foley catheter fr.16

13. Gastro Intestinal •No bowel distension present.

14. Neurologic •Patient Is mentally alert and oriented with circumstances.•Able to follow commands.•No neurovascular deficit.

PATIENT PATIENT HISTORYHISTORY

A . Past medical history

•She is a known case of hypothyroidism & on Thyroxin 150 mg O D.

B .Past obstretric history •2 F T N D, 5 L S C S & 1 abortion. •Previous antenatal period was good & C S done due to fetal distress at term.

C.Present obstrectric

history

G 9 P 7 L 7 A 1 gestational age 29+2 WKS spotting P V & abdominal pain on 05.01.13. admitted in OB antenatal ward. U S G diagnosed as a case of placenta acreta & treated. on 16 .01. 2013-she experienced severe lower abdominal pain & fresh bleeding with clots through vagina.

Emergency c/s followed by hysterectomy was done. as an emergency and life saving treatment. A viable male baby (30+6 WKS) extracted at 0225H weighing 1.77 kg .Apgar score was 7/10.

INVESTIGATIONS DONE FOR THE PATIENT

1.U SG Abdomen 2.blood investigations like

•CBC•PT-INR•RH TYPING•ELECTROLYTES

LAB INVESTIGATIONS

TEST on 17/12/12 RESULT REFERENCE RANGE

CBC HB HCT RBC

10.6g/dl 35.8g/dl 3.81

13.7-17.5g/dl40.1-51.0g\dl4.63-6.08 *10^6/ul

PLT 198 163-337/ul

Sodium 133 135-150 mmol/l

Pottassium 3.8 3.5-5.0mm0l/l

PT 12.4 10.0-17.0sec

APTT 29.2 26.1-36.3sec

INR 0.96 2.4theraputic

Rh typing O+ve

Anatomy & Physiology Of Uterus

inverted pear-shaped muscular organ. located between the bladder and rectum. nourish and house the fertilized egg until offspring. It is suspended in the pelvis by broad ligaments.Weight of a normal uterus is 60 to 80 grms.

The uterus consists of :-

body or corpus

Fundus

Cervix

isthmus

Walls of the uterus Walls of the uterus

The walls are thick and are composed of 3 layers:

the endometrium

the myometrium

the perimetrium

VAGINA

6 inches long leading from the uterus to the external genitalia. located between the bladder and the rectum. provides the passageway for childbirth and menstrual flow.

Fallopian Tubes (Two)

each tube is about 4 inches long.transport ovum from the ovaries to the uterus. no contact of fallopian tubes with the ovaries.The distal end of each fallopian tube has finger-like projections called fimbriae. most desirable place for fertilization is the fallopian tube.

OVARIES

Functions are for oogenesis and hormone production. ovaries are about the size and shape of almonds. lie against the lateral walls of the pelvis, one on each side. They are enclosed and held in place by the broad ligament.

THE LIGAMENTS OF THE UTERUS

UTERINE ARTERYUTERINE ARTERY

Placenta accreta is a potentially life threatening obstetric condition in which the placenta is abnormally attached to the uterus. This can lead to massive blood loss during or following delivery.

ComplicationsComplications

Effectively there are Effectively there are three treatment three treatment options:-options:-

A hysterectomy is the A hysterectomy is the surgical removal of all or part of surgical removal of all or part of the uterus, or womb. The doctor the uterus, or womb. The doctor may also remove the may also remove the fallopian fallopian tubestubes, , ovariesovaries and/or the and/or the cervixcervix during the same surgeryduring the same surgery

ASSESSMENTASSESSMENT

PLANNINGPLANNING

IMPLEMENTATIONIMPLEMENTATION

EVALUATIONEVALUATIONCues/Evidence Nursing

DiagnosisGoals and desired outcome

Nursing order/action

Rationale for action

Evaluation

Patient verbalizes that “ my lips become dry & I feel so thirsty”.Patient shows the symptoms like:-Lips looks pale &dry.Hypotention &tachycardia.Decreased urine out put.Hb level is 10.6 gm/dl.Cold & clammy skin.RestlessnessPoor skin turgour.

High risk for hypovolemia related to haemorrhage during child birth & hysterectomy

Patient will have adequate perfusion as manifested by:-Stable vital signsLips become pink in colour.Good capillary refill &palpable pulses.Adequate urine out put.Normal Hb levels.Looks calm & quiet.Adequate skin turgour.

Maintained vital signs with in normal limits by providing warmth with bear hugger.Watched the site for evidence haemorrhage on dressing &drain. Maintained Hb levels with 3 units of PRBC & IV fluids.Maintained intake output chart.

•To maintain adequate perfusion. •To prevent hypovolemia & shock.•To keep the vitalsigns with in normal range.•Early identification of risk factors can decrease occurance &complications associated with hypovolemia

After 12 hrs of nursing interventions the goals were met as evidenced by:-Stable vitalsigns.BP-110/78mmof hg,T-98.6F, P-76bpm,R-18pm. Fluid and electrolyte balance.Normal urine output.Normal laboratory results( Hb become 11.2 gm/dl)

Health educationEncouraged to do early ambulation to Encouraged to do early ambulation to prevent DeepVeinThrombosis .prevent DeepVeinThrombosis .Taught about the signs &symptoms of D V Taught about the signs &symptoms of D V T.T.Adviced to take high protein diet to enhance Adviced to take high protein diet to enhance healing.healing.Taught to do deep breathing & coughing Taught to do deep breathing & coughing exercises.exercises.Assessed the level of knowledge regarding Assessed the level of knowledge regarding new born care .new born care .Adviced to take medication as per dr’s Adviced to take medication as per dr’s order. order. Proper follow up medical supervision.Proper follow up medical supervision.

CONCLUSION

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2.www.medscape.com

3.www.myoclinic.com