16

B. PHYSICAL EXAMINATION

Vital Signs: Temperature: 36.5 oC Pulse Rate: 88 bpm.

Respiratory Rate: 21 cpm Blood Pressure: 150/90 mmHg.

General Observations:

Received patient lying in bed, conscious, coherent and mentally-

oriented to time, people and place. Patient has fair skin with stitches on the

incision site of the lower abdomen. Overall, patient is in a normal

appearance.

Skin: Patient has fair, moist warm and smooth skin. Its turgor is within 1 to 2

seconds.

Hair: Patient has long, black hair. It is distributed evenly. It is smooth and silky.

Scalp: The scalp is free from lesions. Tenderness and masses are not noted.

Nails: Nails of patient are pinkish in color. It is a bit square. It is smooth.

Capillary refill is 2 to 3 seconds. No lesions found.

Skull: Patient has a normocephalic head, symmetrical and no masses were

found.

Face:The face is able to do any impressions or expressions. It is oblong-shaped,

symmetrical and free from edema and/or masses.

17

Eyes: Eyes are functioning properly. No inflammation on the eyelids,

lacrimal glands and other surrounding the eyes. The eyes are wet and moist.

Sclera on both sides is dirty white. Conjuctiva has small blood vessels.

Ears: Ears are symmetrical, fair, and no noted discharge and swelling. The

ears can hear perfectly.

Nose and Sinuses: Nose is symmetrical with no inflammation and

discharges noted. Airway patency is present. Sinuses are palpable and

resonant when percussed.

Mouth and Pharynx: Patient has good breathe. Lips are pinkish and

smooth with moist. Buccal mucosa, gums and tongue are pinkish in color,

teeth are dirty white, and the hard and soft palate are pinkish in color as

well.

Neck: The neck is symmetrical. Lymph nodes are palpable. Bruit sounds are

heard on the trachea. It is felt and palpable. Thyroid gland is palpable. No

inflammation or lesions noted.

Posterior Chest: The posterior chest is symmetrical with the

anteroposterior diameter at a ratio of 2:1. Tenderness and masses are not

found. Thoracic expansion is 2 to 3 cm. vibrations were felt during tactile

fremitus. Resonance upon percussion, and no wheezing or crackling sounds

upon auscultation.

18

Anterior Chest: Pulsations are felt. No wheezing or crackle sounds are

heard upon auscultation.

Heart: Heart is positioned right and correctly with the cardiac landmarks.

Heartbeats are heard during auscultation.

Vascular System: Carotid arteries are present with pulsations felt. It is

palpable and no lumps are felt. Blood pressure is within normal range.

Lymphatic system: Epitochlear nodes are palpable, as well as, the

superficial inguinal nodes. No tenderness noted.

Breast: The breasts are big due to lactation. There are no dimplings, nipple

discharges, tenderness nor lumps noted. Patient is aware of breast self-

examination and learned it.

Abdomen: Abdomen is round. The umbilicus is inverted. Respiration and

surface motion are present. Pulsations on the abdomen are felt. The

abdomen is palpable.

Female External Genitalia and Anus: Patient has stitches on her

perineum.

Musculoskeletal System: Patient has grip strength. Temporomandibular

joint is felt. The neck, shoulder, hip, spine, knees, feet, ankles, hands, elbow

and wrists can do the different ranges of motion easily.

19

Deep Tendon Reflexes: Biceps, triceps, Brachioradialis, patellar, Achilles

and plantar reflexes are present.

Neurologic Screening Assessment: Patient is conscious, coherent and

alert. She has good memory and is mentally-oriented with people, place and

time. She has goos speech patterns and walks properly.

Cranial Nerves Assessment

Cranial Nerve

Function Method Client’s Responses

I Olfactory

Smell reception and interpretation

Ask client to close eyes and identify different mild aromas such alcohol, powder and vinegar.(Weber & Kelley; 2011).

The Client is able to distinguish different smells

II Optic Visual acuity and fields

Ask client to read newsprint and determine objects about 20 ft. away (Weber & Kelley; 2011).

The Client is able to read newsprint and determine far objects

III Oculomotor

Extraocular eye movements, lid elevation, papillary constrictions lens shape

Assess ocular movements and pupil reaction(Weber & Kelley; 2011).

The Client is able to exhibit normal EOM and normal reaction of pupils to light and accommodation

IV Trochlear

Downward and inward eye movement

Ask client to move eyeballs obliquely(Weber & Kelley; 2011).

The Client is able to move eyeballs obliquely

V Trigemi Sensation of Elicit blink reflex by The Client blinks

20

nal face, scalp, cornea, and oral and nasal mucous membranes. Chewing movements of the jaw

lightly touching lateral sclera; to test sensation, wipe a wisp of cotton over client’s forehead for light sensation and use alternating blunt and sharp ends of safety pin to test deep sensation

Assess skin sensation as of ophthalmic branch above

Ask client to clench teeth(Weber & Kelley; 2011).

whenever sclera is lightly touched; able to feel the wisp of cotton over the area touched; able to discriminate blunt and sharp stimuli

The Client is able to sense and distinguish different stimuli

The Client is able to clench teeth

VI Abducens

Lateral eye movement Ask client to move

eyeball laterally ( Weber & Kelley; 2011).

The Client is able to move eyeballs laterall

VII

Facial Taste on anterior 2/3 of the tongueFacial movement, eye closure, labial speech

Ask client to do different facial expressions such as smiling, frowning and raising of eyebrows; ask client to identify various tastes placed on the tip and sides of the mouth: sugar, salt and coffee(Weber & Kelley; 2011).

The Client is able to do different facial expressions such as smiling, frowning and raising of eyebrows; able to identify different tastes such as sweet, salty and bitter taste

VIII

Acoustic Hearing and balance

Assess client’s ability to hear loud and soft spoken words; do the watch tick test (Weber & Kelley; 2011).

Client is able to hear loud and soft spoken words; able to hear ticking of watch on both ears

IX Glossop Taste on Apply taste on Client is able to

21

haryngeal

posterior 1/3 of tongue, pharyngeal gag reflex, sensation from the eardrum and ear canal.Swallowing and phonation muscles of the pharynx

posterior tongue for identification (sugar, salt and coffee); ask client to move tongue from side to side and up and down; ask client to swallow and elicit gag reflex through sticking a clean tongue depressor into client’s mouth(Weber & Kelley; 2011).

identify different tastes such as sweet, salty and bitter taste; able to move tongue from side to side and up and down; able to swallow without difficulty, with (+) gag reflex

X Vagus Sensation from pharynx, viscera, carotid body and carotid sinus

Ask client to swallow; assess client’s speech for hoarseness (Weber &Kelley; 2011).

The Client is able to swallow without difficulty; has absence of hoarseness in speech

XI Spinal accessory

Trapezius and sternocledomastoid muscle movement

Ask client to shrug shoulders and turn head from side to side against resistance from nurse’s hands (Weber & Kelley; 2011).

The Client is able to shrug shoulders and turn head from side to side against resistance from nurse’s hands

XII

Hypoglossal

Tongue movement for speech, sound articulation and swallowing

Ask client to protrude tongue at midline, then move it side to side(Weber & Kelley; 2011).

The Client is able to protrude tongue at midline and move it side to side

Janet Weber & Jane Kelley; 2011

IV. ANATOMY AND PHYSIOLOGY

22

A. External Structures:

1. Mons Veneris/Pubis – Pad of fat which lies over the symphysis pubis

where dark and curly hair grow in triangular shape that begins 1-2 years

before the onset of menstruation. It protects the surrounding delicate

tissues from trauma. (Marieb; 2011).

2. Labia Majora – Two (2) lengthwise fatty folds of skin extending from

mons veneris to the perineum that protect the labia minora, urinary meatus

and vaginal orifice. (Marieb; 2011).

3. Labia Minora – 2 thinner, lenghtwise folds of hairless skin extending

from clitoris to fourchette (Marieb; 2011).

Glands in the labia minora lubricates the vulva

23

4. Very sensitive because of rich nerve supply Space between the labia is

called the Vestibule (Marieb; 2011).

5. Clitoris – small, erectile structure at the anterior junction of the labia

minora that contains more nerve endings. It is very sensitive to

temperature and touch, and secretes a fatty substance called Smegma. It

is comparable to the penis in it’s being extremely sensitive (Marieb; 2011).

6. Vestibule – the flattened smooth surface inside the labia. It encloses the

openings of the urethra and vagina. (Marieb; 2011).

7. Skene’s Glands/Paraurethral Glands – located just lateral to the

urinary meatus on both sides. Secretion helps lubricate the external

genital during coitus. (Marieb; 2011).

8. Bartholin’s Gland/Vulvovaginal Glands – located lateral to the vaginal

opening on both sides. It lubricates the external vulva during coitus and

the alkaline pH of their secretion helps to improve sperm survival in the

vagina. (Marieb; 2011).

9. Fourchette – thin fold of tissue formed by the merging of the labia

majora and labia minora below the vaginal orifice. (Marieb; 2011).

10. Perineum – muscular, skin-covered space between the vaginal

opening and the anus. It is easily stretched during childbirth to allow

24

enlargement of vagina and passage of the fetal head. It contains the

muscles (pubococcygeal and levator ani) which support the pelvic organs,

the arteries that supply blood and the pudendal nerves which are

important during delivery under anesthesia. (Marieb; 2011).

11. Urethral meatus – external opening of the urethra. It contains the

openings of the Skene’s glands which are often involved in the infections

of the external genitalia. (Marieb; 2011).

12. Vaginal Orifice/Introitus – external opening of the vagina, covered

by a thin membrane called Hymen. (Marieb; 2011).

B. Internal Structures:

25

1. Fallopian tube/Oviduct – 4 inches long from each side of the uterus

(fundus). It transports the mature ova form the ovaries to the uterus and

provide a place for fertilization of the ova by the sperm in it’s outer 3rd or

outer half. Parts: (Marieb; 2011).

Interstitial – lies within the uterine wall

Isthmus – portion that is cut or sealed in a tubal ligation.

Ampulla – widest, longest portion that spreads into fingerlike

projections/fimbriae and it is where fertilization usually occurs.

26

Infundibulum - rim of the funnel covered by fimbriated cells

(hair covered fingerlike projections) that help to guide the ova

into the fallopian tube. (Marieb; 2011).

2. Ovaries – Oval, almond sized, dull white sex glands on either side of the

uterus that measures 4 by 2 cm in diameter and 1.5 cm thick. It is

responsible for the production, maturation and discharge of ova and

secretion of estrogen and progesterone. (Marieb; 2011).

3. Uterus – hollow, pear-shaped muscular organ, 3 inches long, 2 inches

wide, weighing 50-60 grams held in place by broad and round ligaments, and

abundant blood supply from the uterine and ovarian arteries. It is located in

the lower pelvis, posterior to the bladder and anterior to the rectum. Organ

of menstruation, site of implantation and provide nourishment to the

products of conception. (Marieb; 2011).

Layers:

1. Perimetrium – outermost layer of the uterus comprised of connective

tissue, it offers added strenght and support to the structure. (Marieb; 2011).

2. Myometrium – middle layer, comprised of smooth muscles running in

3 directions; expels fetus during birth process then contracts around

blood vessels to prevent hemorrhage. (Marieb; 2011).

3. Endometrium – Inner layer which is visibly vascular and is shed

during menstruation and following delivery. (Marieb; 2011).

Divisions of the Uterus:

27

1. Fundus – upper rounded, dome-shaped portion that can be palpated to

determine uterine growth during pregnancy and the force of contractions

and for the assessment that the uterus is returning to it’s non-pregnant

state following child birth. (Marieb; 2011).

2. Corpus – body of the uterus. (Marieb; 2011).

3. Isthmus – area between corpus and cervix which forms part of the

lower uterine segment. It enlarges greatly to aid in accommodating the

fetus. The portion that is cut when a fetus is delivered by a caesarian

section. (Marieb; 2011).

4. Cervix – lower cylindrical portion that represents 1/3 of the total

uterus. Half of it lies above the vagina; half of it extends to the vagina.

(Marieb; 2011).

5.Vagina – a 3-4 inch long dilatable canal located between the bladder

and the rectum, it contains rugnae which permit considerable stretching

without tearing. It acts as a organ of intercourse/copulation and

passageway for menstrual discharges and fetus. (Marieb; 2011).

V. CONCEPTUAL FRAMEWORK OF THE PATHOPHYSIOLOGY OF

PREGNANCY

Sexual intercourse

MALE FEMALE

28

Release of FSH by the anterior Pituitary Gland

Development of the graafian follicle

Production of estrogen(thickening of the endometrium)

Release of the Luteinizing Hormone

Ovulation

(release of mature ovum from the graafian follicle)

Ovum travels into the graafa tube

Fertilization

(union of the ovum and sperm in the ampulla)

Zygote travels from the fallopian tube to the uterus

Implantation

Development of the fetus/ embryo and placental structure until full term

Preliminary signs of labor

29

Lightening Braxton Hicks Contraction Ripening of the cervix

(descent of the fetal wherein (or false labour or practice (the softened, effaced andhead into the pelvis softer like contractions) dilated condition of the earlobe) cervix just prior to labor)

True labor

Uterine contractions Show Rupture of the membranes

(at regular intervals that begin (After the discharge of the mucous (rupture of the amniotic sac at the onset before the fetus is mature, plug that has filled the cervical canal of, or during, labor.) usually before the due date during pregnancy, the pressure of delivery) of the descending presenting part of the fetus causes the minute capillaries in the cervix to rupture. )

Pregnant woman with blood pressure higher than 140/90 mmHg

Before 20 weeks Gestation After 20 weeks

Gestation

No/stable Proteinuria increase blood pressure Proteinuria No Proteinuria/ HEELP syndrome

Preeclampsia Gestational HPN

Preeclampsia

Eclampsia

30

VI . EXPLANATION OF THE PATHOPHYSIOLOGY OF THE DISEASE

CONDITION / SYMPATHOMATOLOGY

The current concepts regarding the pathophysiology of eclampsia

recognize that eclampsia is a multisystem disorder characterized by

vasoconstriction, metabolic changes, endothelial dysfunction, and

activation of the coagulation cascade in conjunction with an

inflammatory response. Women with underlying microvascular disease,

such as diabetes, hypertension, and collagen vascular disease, have a

higher incidence of eclampsia.

Normal placental development involves progressive loss of the

musculoelastic tissue in the spiral arteries that feed the vessels of the

intervillous spaces, which results in uterine blood flow increases of nearly

25% during the first trimester. This process of remodeling the maternal

spiral arteries that branch from the uterine artery is typically

completed by 18-20 weeks' gestation.

This physiologic dilatation of the spiral arteries does not occur

because the placental trophoblast cells do not invade the spiral arteries,

resulting in maintenance of narrow vessels with resultant placental

hypoperfusion and ischemia. In severe cases, not only do the spiral arteries

maintain their muscular structure, but other pathologic changes also

occur. Accumulation of fat-laden macrophages with fibrinoid necrosis (ie,

acute atherosis), disruption of the basement membranes, platelet

31

deposition, mural thrombi, and proliferation of intimal and smooth muscle

cells all decrease the luminal diameter.

The narrowed and damaged spiral arteries become thrombosed,

resulting in placental infarction and necrosis. Uteroplacental blood flow is

then reduced by 50-75%. The anatomical reduction in blood flow may be

complicated by vasospasm of the uteroplacental bed.

The primary defect in preeclampsia appears to originate at the

maternal-fetal interface (the placenta). Decreased placental perfusion is

thought to lead to fetoplacental ischemia. The ischemic placenta may

produce circulating antiangiogenic factors that promote generalized

maternal vascular endothelium dysfunction, leading to systemic

manifestations of preeclampsia. Associated abnormalities in clotting and

platelet function contribute to vasoconstriction and platelet adhesion and

aggregation, as well as to the activation of coagulation factors that

increase the risk of thromboembolic formation.

The primary feature of clampsia, development of hypertension, occurs

when normally extreme vasodilatation does not occur. Although cardiac

output increases 30-50%, the decreased peripheral vascular resistance

(PVR) results in decreased BP, even in women with chronic hypertension.

Women who develop preeclampsia experience an increase in PVR and

alterations in vascular sensitivity to endogenous hormones (eg,

angiotensin II, catecholamines, vasopressin). This increase in vascular

32

reactivity to pressor hormones may be mediated, at least in part,

through damage to vascular endothelial cells, disrupting the normal

prostaglandin balance.

The normal expansion of blood volume by 50% that occurs with

pregnancy is decreased by 15-20% in patients with preeclampsia. This

is the result of diminished plasma volume, leading to the relative

hemoconcentration observed in preeclampsia. The plasma volume

abnormality involves a redistribution of extracellular fluid, such that

interstitial fluid volume is increased while the plasma volume is

decreased. The hematocrit increases as the severity of preeclampsia

increases. Circulating blood volume is maintained by the increased

vascular tone.

(Pillitteri; 2011)

33

VII. CLINICAL MANAGEMENT

A. MEDICAL MANAGEMENT

A.1 LABORATORY AND DIAGNOSTIC EXAMINATIONS

Diagnostic orLaboratory

Procedure

Indication orPurpose

Results NormalValues

Analysis andInterpretation

of Results

WBC CountTo determine

infection orInflammation Pre-operation

Assessment of the patient.

19.5 H 108/L 3.5-10.0 H No infection orinflammation

is present.

RBC CountPre-operation

assessment ofThe patient.

4.23 1012/L 3.80-5.80Decreased RBC count on

pregnant is normalbecause of the increase

inplasma volume during

pregnancy.

Hemoglobin

Pre-operation assessment of

the patient.

133 g/L 110-165 L g/L

The result indicates that a1000 ml sample of

blood contains 96 g ofhemoglobin. Decreased hemoglobin on pregnant

isnormal because of their

increase in plasma.

Hematocrit Pre-operation

assessment of

.

366 L 1/1 .350-.500 L 1/1

The result indicates that a1000 ml sample of

blood contains .29 g of

34

the patient. hemoglobin. Decreasedhematocrit on pregnant isnormal because of their

increasein plasma volume.

URINALYSIS

TEST NAME RESULT SIGNIFICANCE

MACROSCOPIC

color

pH

protein

glucose

MICROSCOPIC

RBC

WBC

Epithelial cells

Mucus Threads

Amorphous

material

Bacteria

Yellow

6.0

(+)

(-)

0-1

0-2

Few

Few

Few

Few

Normal

Normal

High

Low

Low

Low

Low

Low

Low

Low

35

A.2 Treatment and Procedures

1. Vitals Signs Taking

vital signs will be continually monitored while recovering. The Client’s

Respiratory rate, Pulse rate, blood pressure, and temperature are typically

tracked while recovering. (Pillitteri; 2011).

2. Intake and Output Monitoring

Intake Is any measurable fluid that goes into the patient's body. Intake

includes fluids (such as water, soup, and fruit juice) and "solids" composed

primarily of liquids (such as ice cream and gelatin) that are taken by mouth

(orally), fluids that are introduced by IV, and fluids that are introduced by

irrigation (through a tube) (Pillitteri; 2011).

Output Is any measurable fluid that comes from the body. Water given off in

the form of perspiration and water vapor (exhaled breath) is also output, but

it is not recorded on the DD Form 792, since it cannot be accurately

measured. (An adult usually looses about 500 milliliters (ml) a day through

perspiration and moisture exhaled in breathing.) The major forms of output

36

recorded on the worksheet are urine, drainage, vomitus (matter vomited),

and stools (fecal discharge from the bowels). (Pillitteri; 2011).

3. Perineal Care

Cleaning of perineum and the materials it uses is inb accordance to the

policy of the institution. In SVGH, the perineum is clean with lukewarm water

and an antiseptic agent like betadine solution before birth. Following delivery

of the placenta, the perineal area of the mother is washed with tap water as

vaginal canal is clean manually. (Pillitteri; 2011).

4. Delivery

Before the cesarean section procedure, the patient was given anesthesia to

numb the pain. The doctor then made horizontal incision in the abdomen and

uterus. After the incision was made, the baby was delivered through it, and

the placenta was removed. After the cesarean section procedure, the

incision was closed with stitches. When the cesarean section was started, the

doctor made a 6- to 8-inch incision in the abdomen directly over the uterus.

The incision was horizontal, which was side to side. The baby was then

delivered through this opening. (Pillitteri; 2011).

37

5. New born Care

The umbilical cord was cut, and the baby was handed to the healthcare

provider, who took him to a small, warmly lit plastic crib called a warmer.

Then the baby was cleaned and dried and eventually checked by the

pediatrician.

After the baby had been delivered, the placenta was carefully removed from

the uterus. At that time, the patient received oxytocin, a drug that causes the

uterus to contract and helps prevent serious bleeding. The doctor then closed

the incision on the uterus, and the incisions in the skin were closed with

stitches that would dissolve on their own. (Pillitteri; 2011).

A.3 Medications

See Appendix E

A.4 DIET

1. NPO

After the surgery the doctor ordered the NPO diet. NPO is a type of diet

people are placed on by their medical professionals. A NPO diet is most often

seen in a hospital setting. Some patients can be placed on a NPO diet for just

a short time while others may have to stay on it for a much longer time.

38

Patient cannot have anything that would go in the mouth including food,

beverages and oftentimes medications. Patient can be made NPO for a

variety of reasons including an upcoming surgery, medical procedure or test.

She cannot have anything to eat or drink prior to surgery to honoring the NPO

status is very important.

2. Clear Liquid/ General Liquid

Patient is on a clear liquid diet consists of clear liquids, such as water and plain

gelatin, that are easily digested and leave no undigested residue in your intestinal

tract. The doctor may prescribe a clear liquid diet before certain medical

procedures or have certain digestive problems. Because a clear liquid diet can’t

provide with adequate calories and nutrients, it shouldn’t be continued for more

than a few days. A clear liquid diet is often used before tests, procedures or

surgeries that require no food in the stomach or intestines, such as before

colonoscopy.

BREAKFAST ½ cup of oatmeal & 1 glass of milkLUNCH ½ cup of corn soup & 1 glass of waterDINNER ½ cup of chicken soup & 1 glass of juice

3. Soft Diet

After the clear liquid the doctor ordered a soft diet. A soft diet is recommended

in many situations, including surgery involving the mouth or gastrointestinal tract,

and pain from newly adjusted dental braces. A soft diet can include many foods if

they are mashed, pureed, combined with sauce or gravy, or cooked in soups, chili,

or curries.

BREAKFAST 1 cup of rice, 1 bacon & 1 glass of milkLUNCH 1 cup of rice, 1 serving of chicken soup, 1 banana & 1 glass of

waterDINNER 1 cup of rice, I serving of vegetable soup with 1 ripe of mango &

1 glass of water

39

4. Full Diet

After the soft diet, the patient is ordered DAT. Diet is tolerated is a term that

indicates that the gastrointestinal tracts is tolerating food and is ready for

achievement to the next stage. Therefore, this statement is most effectively in

regard to the diet after abdominal or gastrointestinal surgery, signifying the

patient’s wellness of her diet.

BREAKFAST 1 cup of rice, 1 hotdog & 1 cup of milkLUNCH ½ of rice, 1 slice of meat, & glass of juiceDINNER ½ cup of rice, 1 fish, & glass of water

B. NURSING MANAGEMENT

B.1 Nursing Care Plan

See Appendix C

B.2 Discharge Plan

See Appendix D

ACTUAL CARE GIVEN

1. Vitals Signs Taking

Monitoring of vital signs was done every shift, intake and output

measurement were not strict operating procedure yet we were required t

monitor the client’s intake and output.

2. Administration of Medication

Medications were administered via oral route TID as prescribed by the

physician with a full stomach to decrease GI upset.

3. Bedside Care

40

Giving optimal health both to the mother and client served as our goal as we

performed some nursing interventions like promoting a conducive

environment through bedmaking and adjusting the room temperature. We as

well assisted the client with her needs such as changing of position and

guiding her as she walked.

4. Health Teaching

As a health care provider, I discussed the concept of Family Planning to the

client and gave her information on the proper newborn care & the

importance of proper nutrition and exercise to promote health and

prevention of disease

See Appendix F

PROBLEMS ENCOUNTERED DURING THE CARE

The patient was very cooperative as I deal with her. She was a bit shy and

aloof at first but as the establishing rapport progresses she was able to

manage the timidity and shared her predicaments of pregnancy and

delivery. When I was about to give the medications due for 6pm. I wasn’t

able to do it on time for the client never had her lunch yet. She was still

waiting for her SO to arrived whom brought her meals. For 2 days of nursing

41

care, there were no aberration present; hence, nursing care was done

spontaneously.

IX. CONCLUSION AND RECOMMENDATION

Conclusion

Nurses can help the nation achieve National Health Goals. These goals

speak directly to both fetus and the mother because pregnancy is a high risk

factor for them. Close monitoring in pregnant women and health teaching as

much as possible about pregnancy could definitely reduce life threatening

complications.

Studies show that there is no certain facts that will give us the idea

where Eclampsia arise. But there so many factors that could prevent this

complication such as diet modifications, proper compliance with the health

care providers, proper exercise. And if the complication is already present,

proper monitoring, proper diet and drug compliance should be ruled in.

42

The main purpose of the study was successfully met. The major

reason why the patient underwent a surgical procedure called LSTCS was

due to Eclampsia. The baby exhibited non-recessing fetal heart tone as

uterine contractions occur. The operation was done to resolve the risk of

pregnancy and eventually save the baby’s life.

Further run through of the study showed that there are many

other complications that would pose a risk to pregnant women. These were

more complicated and rare. Unlike those, Pre-eclampsia are seen most

commonly in pregnant women experiencing labor.

Recommendation

As a nursing student, it is a responsibility to give a pregnant patient

the proper recommendation so she can make herself ready if any problem

will arise. She should be monitored frequently—her blood pressure, medical

history and also check the baby inside if he/she is doing well or in the proper

position. The most important one is the mother’s health. The mother should

be given the proper care for herself and for the baby. There is a possibility

that a caesarean delivery might be planned advance if a medical reason is

needed or it might be unplanned and take place during the labor if some

problems occur.

The mother must be given the proper knowledge regarding a vaginal

or caesarean delivery right from her first pregnancy. For caesarean section,

43

it is very complicated operation which can have some risks like death for the

mother, sometimes have some initial trouble breathing for the newborn

babies and will make them drowsy from the pain medication administered to

the mother. Breastfeeding maybe difficult due to the limited mobility of the

mother after the operation. A pregnant woman must be well cared by a

nurse with her personal attending obstetrician.

With this study, the student nurses were able to gain more knowledge

and wider view and perspective of the complication of pregnancy which is

Eclampsia. Thus, the student nurses would like recommend and share some

pointers on how to deal with different diseases with pregnancy specifically

Eclampsia.

To the health care team, they should righteously implementing basic

and ideal procedures regardless of the health care facilities where they

belong. They must observe and always remember to keep in line with their

duties towards both the mother and the child during the pregnancy.

X. IMPLICATIONS OF THE STUDY TO

A. Nursing Education

This study helps in enriching the knowledge base of the nurses

regarding the concepts of this kind of complication. This would greatly help

in determining the risk factors that would possibly be prevented from

44

occurring once there is an application of this study. This can cater all the

questions regarding how and why this certain kind of operation is performed.

The best thing about this study is that there is a comprehensive explanation

of the relationship between the surgery performed and the cause of this

high-risk pregnancy. The cause is highly fatal if not given attention so this

gave motivation to performing CS. This broad information would really

enhance the previously learned concepts of the nurse so as to help him/her

in becoming a competent nurse.

B. Nursing Practice

This study helps in giving care to a woman experiencing high-risk

pregnancy. Appropriate measures and interventions can be taken which are

very useful in promoting the health status of the client. The nurse’s skills are

further guided as to how he/she manages the implementation of nursing

procedures in order to meet the varying needs of his/her patient. This study

alarms the nurses when to act immediately in cases of unexpected or

unusual situations which might pose a risk to the mother or the baby or

maybe both. Having competency in performing the procedures is the most

effective way of responding the needs of the client. That is why this study is

45

equipped with numerous appropriate and effective interventions that would

somehow guide and develop the nurse in his/her nursing practice.

C. Nursing Research

As it is a comprehensive compilation, this study greatly helps in the

development of nursing profession. It typically shows how an individual was

able to cope up with this kind of complication. As we all know, each

individual has a unique adaptive mechanism. This study gives relevant

contribution to modern studies at it is of a high-technologically based study.

Modern facilities are used in the performance of care to the patient,

monitoring and as well as the operation. Moreover, there is a good

complementation since the patient is at high risk. It shows the beneficial

relationship of our technological advances to science nowadays. This study

will further be a basis of improving the nursing approach to high-risk

pregnancies.

BIBLIOGRAPHY

Book Sources:

Doenges, Marilyn E., et al. Nurse’s Pocket Guide. 7th edition. F.A. Davis

Company, Philadelphia, 2009.

Kozier et al Fundamentals of Nursing: Concepts, Processes, and Practice. 5th

ed. Addison – Wesley Publishing Co. Inc.

46

Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing and

Childrearing Family. 6th ed. Lippincott Williams and Wilkins, 2008

Tate, P., et al Seeley’s Principles of Anatomy & Physiology. McGraw-Hill

Companies, Inc., 2009

Internet Sources:

www.nursingcrib.com/nursing-notes-reviewer/ectopicpregnancy/

Retrieved (March19, 2012)

www.wikipedia.com/eclampsia/pregnancy/

Retrieved (March 20, 2012)