Case Study
Case Study
Case Study
INTRODUCTION
multiple
pregnancy
(genetics),
mothers
use
of fertility
drugs:
more likely to result in premature birth and SGA than those from single
pregnancies and that might also result to Cerebral Palsy. Multiples may
become monochorionic, sharing the same chorion, with resultant risk
of twin-to-twin transfusion syndrome. Monochorionic multiples may even
become monoamniotic, sharing the same amniotic sac, resulting in risk
of umbilical cord compression and entanglement. In very rare cases,
there may be conjoined twins, possibly impairing function of internal
organs. Multiple pregnancy often result to malpresentation of the fetuses.
Some of the managements of the multiple pregnancy are Another
procedure that the medical world is using today is known as selective
reduction, i.e. the termination of one or more, but not all, of the fetuses.
This is often done in pregnancies with multiple gestations to increase the
likelihood that one child may live a healthy life. Multiple pregnancy can
also be delivered either through normal spontaneous delivery or cesarean
section. Usually, in a twin pregnancy the first twin is in cephalic
presentation, planned Cesarean section does not significantly decrease
or
increase
the
risk
of fetal
or
neonatal
death or
serious
made
through
is
termed
a hysterotomy
abortion and
is
very
rarely
performed.
Caesarean
section
is
associated
with
risks
of
Patient-centered objectives:
1. The patient will be relieved from her present discomfort.
2. The patient will show interest and will cooperate on her treatment
for fast recovery.
3. The patient will manifest a sense of well-being.
4. The patient will be able to share emotions, feelings and out-look
about her present condition.
5. The patient and the patients family will be aware on the risk
factors brought my cesarean section.
CHAPTER II
PATIENTS PROFILE
A) Biography
Patient JLJ is a 23 year old Filipina born on July 16, 1980 at
Pozorrubio
Community
Hospital.
She
is
currently
residing
at
Pozorrubio, Pangasinan with her husband and son together with her
parents. She is affiliated with Iglesia ni Cristo. She is a college
undergraduate and is fluent in tagalog, ilocano and english.
JLJ
was
fully
immunized
and
has
complete
usually eats banana after meal and also apples, pears and oranges
during daytime.
vii.
Social Activities
The patient usually socialize with her neighbors by spending
some of her free tome talking and sharing stories with them. She
also attends celebrations such as birthdays or weddings when she
is invited.
CHAPTER III
PHYSICAL ASSESSMENT
A. General Appearance
A female patient that is conscious and conversant. The patient
has a normal body built with no abnormal appearance but has a little
difficulty in moving. The assessed vital signs are as follows: BP =
110/80 mmhg, temperature = 36.5C, RR = 20 bpm, PR = 82 bpm.
B. Integumentary
The skin color is fair and has no presence of jaundice. It is
warm to touch, dry, has no pallor and has no edema. The fingernails
have a good capillary refill that lasts for less than 2 seconds. The
fingernails are complete and pinkish in color.
D. Neck
The neck has no tenderness during palpation and no visible
mass.
E. Chest/Thorax/Lungs
Symmetrical chest expansion, no retractions, RR =20 bpm.
F. Heart
No abnormal heart sounds during auscultation.
G. Abdomen
Distended abdomen. Has a vertical cesarean section suture.
linea nigra and striae gravidarum were visible. Has no abnormal
bowel sounds.
CHAPTER V
ANATOMY AND PHYSIOLOGY
Vulva
The vulva is the collective name for the external female genitalia
located in the pubic region of the body. The vulva surrounds the external
ends of the urethral opening and the vagina and includes the mons
pubis, labia majora, labia minora, and clitoris. The mons pubis, or pubic
mound, is a raised layer of adipose tissue between the skin and the
pubic bone that provides cushioning to the vulva. The inferior portion of
the mons pubis splits into left and right halves called the labia majora.
The mons pubis and labia majora are covered with pubic hairs. Inside of
the labia majora are smaller, hairless folds of skin called the labia
minora that surround the vaginal and urethral openings. On the superior
end of the labia minora is a small mass of erectile tissue known as
the clitoris that contains many nerve endings for sensing sexual
pleasure.
Ovaries
The ovaries are a pair of small glands about the size and shape of
almonds, located on the left and right sides of the pelvic body cavity
lateral to the superior portion of the uterus. Ovaries produce female sex
hormones such as estrogen and progesterone as well as ova (commonly
called "eggs"), the female gametes. Ova are produced from oocyte cells
that slowly develop throughout a womans early life and reach maturity
after puberty. Each month during ovulation, a mature ovum is released.
The ovum travels from the ovary to the fallopian tube, where it may be
fertilized before reaching the uterus.
Fallopian Tubes
The fallopian tubes are a pair of muscular tubes that extend from
the left and right superior corners of the uterus to the edge of the
ovaries. The fallopian tubes end in a funnel-shaped structure called the
infundibulum, which is covered with small finger-like projections called
fimbriae. The fimbriae swipe over the outside of the ovaries to pick up
released ova and carry them into the infundibulum for transport to the
uterus.
Uterus
The uterus is a hollow, muscular, pear-shaped organ located
posterior and superior to the urinary bladder. Connected to the two
fallopian tubes on its superior end and to the vagina (via the cervix) on
its inferior end, the uterus is also known as the womb, as it surrounds
and supports the developing fetus during pregnancy. The inner lining of
the uterus, known as the endometrium, provides support to the embryo
during early development. The visceral muscles of the uterus contract
during childbirth to push the fetus through the birth canal.
Vagina
The vagina is an elastic, muscular tube that connects the cervix of
the uterus to the exterior of the body. It is located inferior to the uterus
and posterior to the urinary bladder. The vagina functions as the
receptacle for the penis during sexual intercourse and carries sperm to
the uterus and fallopian tubes. It also serves as the birth canal by
stretching to allow delivery of the fetus during childbirth. During
menstruation, the menstrual flow exits the body via the vagina.
Fertilization
Once the mature ovum is released from the ovary, the fimbriae
catch the egg and direct it down the fallopian tube to the uterus. It takes
about a week for the ovum to travel to the uterus. If sperm are able to
reach and penetrate the ovum, the ovum becomes a fertilized zygote
Menstruation
While the ovum matures and travels through the fallopian tube,
the endometrium grows and develops in preparation for the embryo. If
the ovum is not fertilized in time or if it fails to implant into the
endometrium, the arteries of the uterus constrict to cut off blood flow to
the endometrium. The lack of blood flow causes cell death in the
endometrium and the eventual shedding of tissue in a process known as
menstruation. In a normal menstrual cycle, this shedding begins around
day 28 and continues into the first few days of the new reproductive
cycle.
Pregnancy
If the ovum is fertilized by a sperm cell, the fertilized embryo will
implant itself into the endometrium and begin to form an amniotic cavity,
umbilical cord, and placenta. For the first 8 weeks, the embryo will
develop almost all of the tissues and organs present in the adult before
entering the fetal period of development during weeks 9 through 38.
During the fetal period, the fetus grows larger and more complex until it
is ready to be born.
Lactation
Lactation is the production and release of milk to feed an infant.
The production of milk begins prior to birth under the control of the
hormone prolactin. Prolactin is produced in response to the suckling of
an infant on the nipple, so milk is produced as long as active
breastfeeding occurs. As soon as an infant is weaned, prolactin and milk
production end soon after. The release of milk by the nipples is known as
the milk-letdown reflex and is controlled by the hormone oxytocin.
Oxytocin is also produced in response to infant suckling so that milk is
only released when an infant is actively feeding.
CHAPTER V
LABORATORY AND DIAGNOSIS PROCEDURE
HEMATOLOGY RESULT
Parameter
Result
Unit
WBC
15.99
Neu%
67.7
50.0 70.0
Lym%
26.8
20.0 40.0
Mon%
2.3
3.0 12.0
Eos%
3.0
0.5 - 5.0
Bas%
0.2
0.0 1.0
RBC
4.20
HGB
111
g/L
110 150
HCT
34.5
37.0 47.0
MCV
82.1
fL
80.0 100.0
MCH
26.4
pg
27.0 34.0
MCHC
322
g/L
320 360
RDW-CV
14.1
11.0 16.0
RDW-SD
48.7
fL
35.0 56.0
PLT
433
x10^9/L
x10^12/L
x10^9/L
Ref. Range
4.0 10. 00
3.50 5.00
150 450
MPV
7.3
fL
6.5 12.0
PCT
0.316
0.108 0.282
Blood type O
Bleeding Time: (1 3 minutes)
Clotting Time:
(2 4 minutes)
INTERPRETATION:
Hematology result shows that the elevated WBC, clients first line
of defense, responded to the process undergone by the client.
ULTRASOUND REPORT
GENERAL PRESENTATION(Twin):
A Breech
Normal
PLACENTA LOCATION:
Posterior
PREVIA:
No Previa
B - Vertex
MEASUREMENTS: (Twin)
A
CRL
BPO
cm
7.8
8.2
cm
HC
28.3
29
cm
AC
26.8
27
cm
FL
5.7
cm
OFD
cm
A
Best Estimated U/S Gest. Ages:
Expected Date of Delivery:
Estimated Fetal Weight
(TWIN)
31
2014/02/04
1673
B
31 weeks
5 days
2014/02/04
1735 gms
FINAL IMPRESSION:
Multiple Pregnancy Uterine 31 31 weeks 0 5 days AOG by Fetal
Biometry Breech Cephalic Presentation, live, singleton, male male
fetuses
Estimated Fetal Weight (1673 1735 gms.)
Good Cardiac Activity (Fetal Heart Rate 145
138 BPM)
Grade 2
Previa no
2014/02/04
INTERPRETATION:
Multiple Fetal Pregnancy Breech- Cephalic Presentation
Diamniotic Dichronic Type of Twinning
Placenta Posterior Grade 2, no Previa
Twin
FHB
145 BPM
male fetus
Twin
FHB
138 BPM
male fetus
CHAPTER IX
EVALUATION