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CAESAREAN

DELIVERY
I. INTRODUCTION

Cesarean birth is the birth of a baby by surgery. The doctor makes an incision (cut) in the
belly and uterus (womb) and then removes the baby. The surgery is called a cesarean
section or c-section.
The natural way for a baby to be born is through the mother's vagina (birth canal). But
sometimes vaginal birth isn't possible. If the baby have certain problems before or during
labor, c-section may be safer than vaginal birth.
The health care provider may plan your cesarean in advance. Or one may need an
emergency (unplanned) c-section because of a complication that arises for the baby
during pregnancy or labor.
The health care provider may suggest to have a c-section for one or more of these
reasons:
• The mother already had a c-section in another pregnancy or other surgeries
on your uterus.
• The baby is too big to pass safely through the vagina.
• The baby's buttocks or feet enter the birth canal first, instead of the head.
This is called a breech position.
• The baby's shoulder enters the birth canal first, instead of the head. This is
called a transverse position
• There are problems with the placenta. This is the organ that nourishes your
baby in the womb. Placental problems can cause dangerous bleeding during vaginal birth.
• Labor is too slow or stops.
• The baby's umbilical cord slips into the vagina, where it could be squeezed
or flattened during vaginal delivery. This is called umbilical cord prolapsed.
• The mother have an infection like HIV or genital herpes.
• The mother having twins, triplets or more.
• The baby has problems during labor that show it is under stress, such as a
slow heart rate. This is sometimes called “fetal distress.”
• The mother have a serious medical condition that requires intensive or
emergency treatment (such as diabetes or high blood pressure).
• The baby has a certain type of birth defect.

A woman who has a c-section usually takes longer to recover than a woman who has
had a vaginal birth. Women can expect to stay 3 to 4 days in the hospital after a c-section.
Full recovery usually takes 4 to 6 weeks. Usually, the hospital stay for vaginal birth is 2
days, with full recovery taking less time than a cesarean. C-section may be more
expensive than a vaginal birth.
II. OBJECTIVES

General Objectives
To gain knowledge about Cesarean birth and to relate it with the client in
terms of providing proper nursing management.

Specific Objectives
➢ To describe specific indications for Cesarean birth such as previous
Cesarean birth by classic incision and fetal distress
➢ To assess a woman for effective post operative needs.
➢ To formulate appropriate nursing care plan related to Cesarean birth for the
achievement and effectiveness if management.
➢ To develop preventive strategies for the client who is at risk for Cesarean
birth complications.
III. PATIENT’S PROFILE
Patient X is a 28-year old woman who delivered her third baby last August
10, 2008. She and her family is recently residing at Sabang, Lipa City. Her attending
physician, Dr. Duque scheduled her for an immediate delivery since she already
experiences symptoms of early preterm labor. Patient X undergone Cesarean birth in
order to reduce the possibility of further complications since the fetus is very immature.
Likewise, her previous Cesarean birth with her second kid whom she delivered just a year
ago by classic incision was contraindicated for vaginal birth or normal delivery.
IV. CLINICAL APPRAISAL

A. Past Health History


Patient X, at her third pregnancy has already completed her tetanus toxoid
immunizations. She restricted taking medicines by the entire period of pregnancy except
for prescribed mild analgesics such as paracetamol. She has no noted allergic responses
to drugs.
During her 7th month of pregnancy, she complained that she always
experience difficulty in walking or even with minimal activities because of abdominal
tightening and cramping, also because of her varicosities. On the other hand, during her
8th months of gestation, she noticed increased vaginal discharge and spotting which
leads her to consult her physician and there she realized that she will be having preterm
labor through Cesarean birth.

B. Family History of Diseases


A family history of respiratory disorder especially tuberculosis was reported
by Patient X.

C. Personal History

Walking for 30 minutes early in the morning was the usual daily exercise of
Patient X before starting the day. Since she’s the home-maker of the family, while his
husband is working in feed-mill company, all the household chores were left alone to her,
together with rearing and their children. But discomforts she experienced during the later
months of her pregnancy interfered with her activities at home.
Due to insufficient income, nutrition during her pregnancy was given little
attention and importance. According to her, she seldomly are fruits and consumed milk,
as well as those foods she craved for.
D. Social History
Patient X finished her secondary studies. At an early age, she has been
through a lot of work experiences but she spent most of her years working at an electronic
company in Cabuyao, Laguna where she assembled fluorescent bulbs and the like. As
soon as he got married and pregnant, she resigned at work and relied family’s needs to
his husband. His husband’s income which is P4,000-4,300 a month was sometimes not
enough but their parents readily sustain additional support if they’re in need.

E. Psychological History
Patient X experienced great burden as her baby was detected to be very
immature and has some complications. Her baby was gray in color which is indicative of
infection. Furthermore, her baby has severe sternal retractions as sign of respiratory
distress that’s why the baby was placed on ventilator and must undergo a lot of
examinations. Due to this situations, she felt like almost over-stressed. Though in the
midst of problems, she tried to be positive thinker and lean on God. She consulted all her
inner feelings to his husband and together they made decisions to solve problems.

F. History of Present Illness


During her 7th month of pregnancy, she complained that she always experience difficulty
in walking or even with minimal activities because of abdominal tightening and cramping,
also because of her varicosities. On the other hand, during her 8th months of gestation,
she noticed increased vaginal discharge and spotting which leads her to consult her
physician and there she realized that she will be having preterm labor through Cesarean
birth
V. PHYSICAL ASSESSMENT

ORGANS METHOD FINDINGS ANALYSIS and


RATIONALE
1. General Observation > Exerts energy Normal. Pain after
Appearance when reaching for surgery is inevitable.
something Minimal movement and
>Hand pressure activity may lessen her
against her discomfort. And
abdomen probably because of
>Seldomly combed uneasiness, the client
her hair and wear will not bother her
on her clothing appearance.
2. Hair Inspection and >Tend to lose Normal. During
palpation quantity of hair pregnancy, metabolism
was increased and hair
growth was rapid, so
many hairs reached
maturity at the same
time. As the womanÕs
body returns to a normal
metabolism level, her
hair is lost.
Palpation >Listless and Abnormal. Diet during
ÒstringyÓ pregnancy is deficient in
nutrients.
3. Face Inspection and >No noted edema Normal
Palpation
4. Eyes Inspection >Has pale Abnormal. The client is
conjunctiva anemic from poor
pregnancy nutrition or
excessive blood loss at
>Pupils are equal birth.
and reactive to Normal
light.
5. Breasts Inspection >Nipples are erect. Normal
>No noted cracks
Palpation and fissures Normal. During the 3rd
>Feel firm and postpartal day/breast
warm tissue increases in size
as milk forms within
breasts ducts(filing)
6. Pulse Palpation >Pulse Rate: Normal: WomanÕs pulse
70bpm rate during post partal
Site: Radial period is usually
slightly slower than
normal. During
pregnancy, the
distended uterus
obstructed the amount
of venous blood
returning to the heart;
after birth to
accommodate the
increased blood volume
returning to the heart,
stroke volume reduces
the pulse rate to below
60-70bpm
7. Respiration Auscultation >Respiratory Rate: Normal
21bpm
>No noted
adventitious
8. BP Palpation and >110/70 mmHg Normal. The clientÕs
Auscultation normal pressure during
pre-pregnancy is always
110/70 Ğ 110/80 mmHg.
*Comparing the
womanÕs pressure with
her pre-pregnancy level
is much better to
evaluate BP rather than
with standard BP
ranges.
9. Temperature >36.9oC Normal: A postpartal
Site: Axill ary woman show s a slight
inc rease in temperature
during the first 24 hours
after birth bec ause of
dehydration that
oc c urred during labor.
But if s he already
rec eives adequate fluid
through IV fluid,
temperature elevation
will return to normal.
10. Abdomen Inspection >Presenc e of Normal. During
Uterus pinkish streaks, pregnancy, as the uterus
some are silvery- inc reases in size, the
white in color on abdominal w all must
the sides of stretch to ac c ommodate
abdominal w all. it. This stretching (plus
possibly inc reased
adrenal cortex activity)
c an rupture and atrophy
of small segments of
connective layer of the
skin. This leads to
pinkish streaks which
>Vertic al incisicion are c alled stride
through both the gravidarum. These
abdominal skin and lighten days to weeks
uterus after birth which are
Palpation >Old wide sc ar c alled striae albic antes
which also runs or atrophic ae.
through the Normal. The client
contractile portion undergone c esarean
of the uterus. birth. This incision is
c alled classic cesarean
>Position in cm: incision.
palpable 2 Normal. This w as the
fingerbreaths / 2 cm disadvantage of classic
below the umbili c us type of incision. The
clients first 2 k ids w ere
delivered with this type
of c esarean incision.
Normal. This part of the
proc ess c alled
involution whereby the
uterus and other
reproductive organs
return to t heir
nonpregnant state.
11. Lochia Inspection >Amount: Tends to Normal. It is the clientÕs
increase. first few times out of
bed. This is the result of
vaginal discharge of
pooled lochia.
Furthermore, the client is
not yet breastfeeding her
baby. Mothers who
breastfeed tend to h ave
less lochial discharge
from those who do not
>Consistency: because the natural
Contain no large release of the hormone
clots. oxytycin during
breastfeeding
>Color: Red strengthens uterine
contractions.
Normal. Indicates that
nothing in the portion of
the placenta has been
retained. This also show s
good uterine contraction.
>Odor: The same as Normal. Lochia is red
menstrual blood for the 1st 3 days (lochia
rubra). Red must first
occur before the rest. If
pattern /color is
reversed/ that indicates
that placental fragments
have been retained or
that uterine contraction
is decreasing and new
bleeding is beginning.
Normal. Lochia should
not have offensive odor.
An offensie odor usually
indicated that uterus has
been infected.
12. Perineal Inspection >Absence of Normal. Delivery w as
Area laceration or done through Cesarean
episiotomy birth.
>No noted
ecchymosis,
hematoma, erythema,
edema
13. Bowel Auscultation >Active, but Normal. Bowel
Sounds passage of stool evacuation may be
Inspection through the bowel difficult due to the pain
may be slow of incision.
>Hard, small Normal. This may be
amount of stool effect of abdominal
surgery and anesthesia
14. Bladder Inspection >Urinary output Normal. The bladder
per day is more was handles and
than 30mL but only displaced during
Palpation voids twice daily surgery its tome or
Percussion after surgery. abili ty to sense filli ng
may be inadequate to
>Sounds dull. initiate voiding after
surgery.
Normal. This is during
empty bladder.
15. Peripherals Inspection >No noted edema. Normal. During
>Presence of pregnancy, additional
varicosities weight by the growing
(distended veins) fetus tends to b e push
downward by gravity.
This leads to
obstruction to blood
flow specially to
superficial veins of the
legs.
VI. LABORATORY RESULTS

TEST RESULT UNIT REFERENCE VALUE


WBC 6.9 10^3/UL 5.0 Ğ 10.0
LY 22.7 % 22.0 Ğ 40.0
MO 2.5 % 4.0 Ğ 8.0
GR 74.8 H% 36.0 Ğ 66.0
LY# 1.6 10^3/UL 1.2 Ğ 3.4
MO# 0.2 10^3/UL 0.1 Ğ 0.6
GR# 5.2 10^3/UL 1.4 Ğ 6.5
RBC 3.73 10^6/UL 4.20 Ğ 5.40
Hgb 11.5 g/dL 12.0 Ğ 16.0
Hct 34.1 % 38.0 Ğ 51.0
MCV 91.4 fL 80.0 Ğ 96.0
MCH 30.7 pg 27.0 Ğ 31.0
MCHC 33.6 g/dL 32.0 Ğ 36.0
RDW 18.1 *H % 11.6 Ğ 13.7
PKT 419 * H10^g/L 150 Ğ 450
MPV 6.1 * L fL 7.8 Ğ 11.0
PCT 0.435 * H% 0.190 Ğ 0.360
PDW 15.7 15.5 Ğ 17.1
Bt ÒOÓ+
HBS Ag Ğnon-reactive
VII. ANATOM Y AND PHYSIOLOGY

.
.

UTERUS
The uterus (womb) is a hollow, pear-shaped organ located in a woman's lower abdomen between the
bladder and the rectum. The narrow, lower portion of the uterus is the cervix; the broader, upper part is
the corpus. The corpus is made up of two layers of tissue.
In women of childbearing age, the inner layer of the uterus (endometrium) goes through a series of
monthly changes known as the menstrual cycle. Each month, endometrial tissue grows and thickens in
preparation to receive a fertilized egg. Menstruation occurs when this tissue is not used, disintegrates,
and passes out through the vagina. The outer layer of the corpus (myometrium) is muscular tissue that
expands during pregnancy to hold the growing fetus and contracts during labor to deliver the child.
The lower narrow portion of the uterus is called the cervix and it protrudes downward into the opening
of the vaginal canal. The vaginal canal extends downward to the external female genitalia.
The uterine tubes, or Fallopian tubes, extend from either side of the uterus and act as a channel for eggs
from the ovary to travel to the uterus.
When an egg is fertilized (joined with sperm), it becomes embedded in the wall of the uterus (whose
lining becomes thickened) where the fertilized egg grows into an embryo and later a fetus.
If an egg is not fertilized, the thickened uterine lining sloughs off in a process known as menstruation
VIII. PATHOPHYSIOLOGY

Risk Factors Consequences Delivery

previous cesarean with a "classical" vertical the prev io us sc ar m ay b e rup t ured if vag i na l d e li very w ill be

uterine incision or more than one previous c- done

section

diabetic mother the baby i s ex pected to be v ery l a r ge ( a cond i t i on kno w n as

m ac ros o m i a).

baby's buttocks or feet enter the birth canal


first, instead of the head the baby i s in a b r eech ( bott o m f i rst ) or t rans v erse (s id e w ay s)

baby's shoulder enters the birth canal first, pos i t i on

instead of the head Quic kTime™ and a


dec ompress or
are needed to see this picture.

can cause dangerous bleeding during vaginal birth


placental problems

baby has p rob le m s dur i ng l ab o r that s ho w i t Òfetal distressÓ


i s under s t ress , s u c h as a s l o w hear t rate

prevents pushing to accomplish the pelvic division of labor


hypertensive mother
IX. NURSING CARE PLAN

ASSESSM ENT NUR SING SCIENTIFIC PLANNING INTERVENTION RATIONA LE EXPECTED


DIAGNOSIS EXPLANATION OUTC OME
S: ÒNahihirapan akong Constip ation related to Decreased in normal After 1 hour of nursing 1. Monitor vital signs > to serve as base line After 1 hour of nursing
dumumiÓ post partum delivery frequency of intervention, the client data. To check if there intervention, the client
defecation w ill regain her normal are any elevation in the w ill regain her normal
O:>hard, formed stool accompan ied by defecation pattern. normal vital sign. defecation pattern.
>staining with difficult or incomplete 2. Identify elements >to know the
defecation passage of stool and that usually stimulate contributing factors of
>distended or passage of bow el activity like the problem.
abdomen excessively hard, dry caffeine, walkin g,
>percussed stool laxative use and any
abdominal dullness interfering factors like
taking opioid pain
medic ations. >to improve bow el
3. Encour age a diet of motility
balanced fiber and bulk
like fruits, vegetables
and whole grains to
improv e consistency of
stool and facilitate
passage through >to increase intestinal
colon. peristalsis
4. Encour age activity
and exercise within
limits of individual
ability to stimulate >to aid in easy
contraction of the defecation
intestine.
5.Pprovide laxatives or
suppositories
ASSESSMENT NURSING DIAGNOSIS SCIENTIFIC PLANN ING INTERVENTION RATIONALE EXPECTED OUTCOME
EXPLAN ATION
S: ÒNoong 11 pa ako Risk for Impaired Urinary The state in which an After 2 hours of nursing 1. Assessed the client if > This helps the nurse utilize After 2 hours of nursing
umanak, dapat normal sana Elimination related to individual experiences a interv ention, the client will there is contributing to proper adaptiv e equipment interv ention, the client began
kaya lang sabi ng doctor surgical procedure diff iculty to void in due begin to void at least 30 incontinence. and interventions. to v oid at least 30 ml/hr,
mahina daw ang bata at urgency because the bladder ml/hr, patient will report >Increased f luid intake is patient reported frequency
wala pang 3 taon yung huli was handled and displaced frequency and no hesitancy 2. Maintain optimal hydration necessary to increase the and no hesitancy on voiding
kong pagkaanak na CS during surgery; itÕstone or on voiding.. if not contraindicated or clientÕsurge to v oid. If a as evidence by the clientÕs
din.Dalawang araw na akong ability to sense fillings may restricted. Monitor intake and bladder has filled to capacity verbalization of Ònakaihi na
di pa ulit umiihi. Hindi pa ako be inadequate to initiate output. but cannot empty properly, ako, hindi na gaanong
makaramdam eh.Ó voiding after surgery. the woman may haveÓ mahirap at masakit.Ó
O:> f irm abdomen retention with overflowÓ.This
>no residual urine voiding pattern is dangerous
>bladder sounds dull because .it means that the
(empty bladder) womanÕsbladder is
continuously under tension.
> Ensuring privacy and
comfort as well as assisting
the client to bathroom is of
great help to facilitate
3. Promote micturation. urination.
>These procedures stimulate
the surface to trigger the
voiding reflex.
4. Advice the client to do the
f fg.:
-Brush/ Stroke inner thigh or
abdomen.
-Pour warm water over
perineum > This promotes personal
-Drink glass of water while hygiene.
sitting on the toilet.
5. Advice the client to
shower rather than baths to
prev ent bacteria from
entering the urethra. Instruct > This
women to cleanse the promotes personal integrity
perineum and urethra from and provide motivation to
front to back. increase bladder control.
6. Encourage the client to > Relax
share his feelings about abdominal musculature.
incontinence and determine
the effect.

7. Assist administering he
prescribed analgesic.
X. DRUG S TUDY
Name of Drug Classification/Action Indications Adverse Reaction Contraindications Nursing Responsibility Parameters
st
Brand Name:  Drug that acts on  To prevent and treat  Common:  Pregn ancy:1  Monitor and  Check for the
nd
Methergine uterus poatpartum Headach e, and 2 stage of record blood blood pressure of
hemorrha ge caused hypertension, skin labor and before pressure, pulse the patient.
Generic Name:  Increases motor by uterine atony or eruptions, abdominal crow ning of the rate and uterine Norma l range is
Methylergonovine activity of the uterus subinvolution. pain head; severe response,; report 120/80 mmHg.
male ate by direct stimulation  Uncommon: hypertension; sudden change
of the smooth Dizziness, preeclampsia in vital signs,
Dosage and Frequency: muscle, shortening of convulsions, chest and eclamps ia; frequent periods
 0.2 mg IM q2-4 hours the third stage of pain, hypotension, occlusive of uterine
to a maximum of 5 labor and reducing nausea, vomiting, vascular disease; relaxation, and
dosages. blood loss. hyperhidrosis sepsis character and
  Rare:  Not to be used amou nt o vaginal
 0.2 mg IV over 1 mi n Bradycardia, for induction or bleeding.
w hile monitoring tachycardia, enhancement of  Monitor
blood pressure and palpitations, arterial labor. contractions,
uterine contractions. spasm,  Hypersensitiv ity w hich may begi n
thromboph lebitis, to ergot immediately.
 After first IM or IV nasal congestion, alkaloid s. Contrac tions ma y
dose, 0.2 mg PO q6 diarrhea, muscle continue for up to
to 8 hours for 2-7 cramps, reduction of 45 mins. after IV
days. Decreases milk secretion, use of for 3 hours
dosage if severe or more after
crampin g occurs. P.O. or IM use.
 Store tablets
tightly closed,
light resistant
container.
Discard if
discolored.
 DonÕt be
confused with
methergine with
terbutaline.
Name of Drug Classification/Action Indications Adverse Reaction Contraindications Nursing Responsibility
Generic Name:  Nonsteroidal  Ankylosing  CNS:  Contraindicated in patients  Because NSAIDs impair
Diclofenalac Sodium inf lammatory drugs spondylitis Aseptic meningitis, hypersensitive to drug and the synthesis of renal
  Osteoarthritis anxiety, depression, in those with hepatic prostaglandins, they can
Brand Na me:  May inhibit  Rheumatoid Arthritis dizziness, drowsiness, porphyria or history of decrease renal blood flow
Fenac prostaglandin  Analgesia headache, insomnia, asthma, urticaria, or other and lead to reversible
Voltaren synthesis, to produce  Primary irritability allergic reactions after renal impairment,
anti-inflammatory, Dysmenorrhea  CV: taking aspirin or other especially in patients with
Dosage and Frequency: analgesic and Heart failure, edema, fluid NSAIDs. renal or heart failure or
 Suppositories: antipyretic effects. retention, hypertension liver dysfunction, in elderly
50 mg; 100 mg  EENT:  Avoid using during late patients, and in those
 Tablets: laryngeal edema, pregnancy or while taking diuretics. Monitor
25 mg,; 50 mg; 75 mg; 100 blurred vision, breastfeeding. these patients closely.
mg epistaxis, eye pain,  Liver function test values
night blindness,  Use cautiously in patients may increase during
reversible hearing with history of peptic ulcer therapy. Monitor
loss, swelling of the disease, hepatic transaminase, especially
lips and tongue, dysfunction, cardiac ALT, levels periodically in
tinnitus disease, hypertension, patients undergoing long-
 GI: fluid retention, or impaired term therapy. Make first
Abdominal distention, renal function measurement of
abdominal pain or transaminase no late than
cramps,bleeding, 8 weeks af ter therapy
constipation, diarrhea, begins.
flatulence, indigestion,  Because of their
melena, nausea, peptic antipyretic and anti-
ulceration, taste disorder, inf lammatory reactions,
bloody diarrhea, appetite NSAIDs may mask the
change, colitis signs and symptoms of
 GU: infection.
Nephritic syndrome, acute  Serious GI toxicity,
renal failure, fluid including peptic ulcers and
retention, interstitial bleeding, can occur in
nephritis, oliguria, papillary patient taking NSAIDs,
necrosis, proteinuria despite lack of symptoms.
 Hepatic:
Jaundice, hepatitis,
hapatotoxicity
 Metabolic:
Hypoglycemia,
hyperglycemia
 Musculoskeletal:
Back, leg or joint pain
 Respiratory:
Asthma
 Skin:
Stev ens-Johnson
syndrome, allergic
purpura, alopecia, bullous
eruption, dermatitis,
eczema, photosensitivity
reaction, pruritis, rash,
urticaria
 Other:
Anaphylactoid reactions,
anaphylaxis, angioedema
Name of Drug Classification/Action Indications Adverse Reactions Contraindications Nursing Responsibility Parameters
Generic Name: Classification:  Treatment of  Central nervous  Hypersensitiv ity to  Ask patient about  Dosage adjustment
Ampic illin Antibiotic infections caused system: Fever, ampic illin, any allergic reactions to may be necessary in
by susceptible penicillin compon ent of the penicillin. patients w ith renal
Brand Name: Action: strains of micro- encephalo pathy, formulation, or other  Obtain specimen for imp airment; a low
Ampine x, Clovilin, Vatacil  Belonging to the organisms seizure penicillins culture and sensitivity incidenc e of cross-
penicillin group of  Dermatologic: test before giving. allergy with other
Route of Administration: beta-lactam Erythema  Watch for signs and beta-lactams exists;
I.V. antibiotics, multiforme, symptoms of high percentage of
ampic illin is able exfoliative hypersensitivity such patients w ith
to penetrate dermatitis, rash, as erythematous infectious
Dosage and Frequenc y: Gram-positive urticaria maculo papular rash, mono nucleosis have
I. V.: 250-500 mg every and some Gram-  Gastrointestinal: urticaria, and develope d rash
6 hours negative Black hairy anaphylaxis. during therapy with
bacteria. It differs tongue, diarrhea, ampic illin.
from penicillin enterocolitis,
only by the glossitis, nausea,
presence of an pseudomemb ran
amin o group. ous colitis, sore
That amin o mouth or tongu e,
group helps the stomatitis,
drug penetrate vomiting
the outer  Hematologic:
membran e of Agranulocytosis,
gram-negative anemia,
bacteria. hemol ytic
Ampici llin acts as anemia,
a competitive eosinoph ilia,
inhib itor of the leukopen ia,
enzyme thrombocytopeni
transpeptidase. a purpura
Transpeptidase  Hepatic: AST
is needed by increased
bacteria to mak e  Renal: Inter stitial
their cell w alls. It nephritis (rare)
inhib its the third  Respiratory:
and final stage of Laryngeal stridor
bacterial cell wall  Miscellaneous:
synthesis, w hich Anaphylaxis,
ultimately leads serum sickness -
to cell lysis. like rea ction
XI. PROGNOSIS

Treatment and management

If given an epidural or spinal for your c-section, morphine may be added, which can provide excellent
postpartum pain relief for up to 24 hours without the grogginess from systemic narcotics.

If given general anesthesia for surgery, they should be given systemic narcotics for immediate postpartum
pain relief.

If feeling groggy and possibly nauseated right after surgery, the caregiver can give medication to minimize
discomfort.

Breastfeed on side-lying position or using the football hold, so there won’t be pressure on your incision.

Instruct on how to cough or do regular breathing exercises to expand the lungs and clear them of any
accumulated fluid, which is particularly important if you’ve had general anesthesia. (This will reduce the risk
of pneumonia.)

Be sure to use both hands or a pillow to support the incision when you cough (good advice for sneezing and
laughing, too.)

There might also be some gas pain and bloating during the first two days. Gas tends to build up because
the intestines are sluggish after the surgery. Getting up and moving around will help your digestive system
get going again.

Note: If you’re in great discomfort, the nurses may give you some over-the-
counter medication that contains simethicone, a substance that allows gas bubbles to come again more
easily, making the gas easier to expel. Simethicone is safe to take while breastfeeding.

Get the blood going in your legs by wiggling your feet, rotating your ankles, and moving and stretching your
legs.

By the second day, they should be taking a couple of short walks with help from their partner or from a
nurse. This will help your circulation, make your bowels less sluggish, and make it much less likely that
you’ll develop blood clots.
XII. DISCHARGE PLANNING
M- Advice client to take prescribed medications and to finish the entire prescription even if
it starts feeling better.
E- Tell the client that it is normally safe to resume an exercise routine 6-8 weeks after a
Caesarean. It is important though, before resuming any exercising, to consult with the
doctor. He or she will tell how much exercise is safe at this point. Most likely he or she will
instruct to begin light exercise, avoiding crunches and sit-ups at first. Try beginning with a
light exercise routine. Remember, don´t jump into anything too quickly. If one begin to
feel pain in the incision area, stop exercising at once. If the pain continues, be sure to let
the doctor know as soon as possible.
As tempting at the first days at home, advice her to try best to keeps the house cleaning
to a minimum. Avoid heavy duty cleaning such as mopping, vacuuming, or moving
furniture. General light cleaning such as folding laundry, loading the dishwasher, etc, is
fine, but make sure that you don't over work yourself
T- Advice the patient to follow all the doctor’s order and prescriptions. Inform the client of
the importance of the entire therapy.
H- Advice the client to take shower if not tolerated having baths. Instruct her to cleanse
the genitals giving special attention to perineum and urethra.
O- Encourage the client to comply with the doctor’s scheduled follow up check-up for
evaluation and continued care.
D- Advice client to maintain optimal hydration by drinking 6-8 ounces of water every day.
Eat plenty of fruits and vegetables to prevent constipation.
S- Recommend the couple to sustain intercourse for 6 weeks after the birth of your baby.
This holds true for Caesarean deliveries.
XIII. ACKNOWLEDGMENT

We would like to express our sincerest gratitude and appreciation to the following:
To Lipa City District Hospital, to the entire management and staff for providing us new
hospital experiences that challenged us to grow, learn and appreciate more the essence
of nursing and rendering care to clienteles,
To Lyceum of the Philippines- Bats., Department of Nursing for developing competitive
students by integrating learning experiences outside the school premises,
To our Clinical Instructor, Mrs. Jinny M. Brucal, for giving us professional and moral
support, not only by nudging us to acquire new approaches at work and nursing
management but also acceptable behaviors and attitudes,
To all our friends who didn’t wait for us to call them in finishing this requirement,
And most of all to God Heavenly Father for blessing us talents and opportunities we have,
guiding our minds and hearts to be open to the needs of others and letting us fulfill this
project.
XIV. BIBLIOGRAPHY

Pilliteri, Adele.: Maternal and Child Health Nursing. Vol. 1, 5th edition. Lippincott
Williams & Wilkins, 2007.
Carpenito, Lynda Juall.:Nursing Diagnosis:Application to Clinical Practice. 4th edition.
J.B Lippincott Company, 1992.
Doenges, Marilyn, et al.: Nurse’s Pocket Guide: Prioritized Interventions and Rationales.
F.A. davis Company.1992.
Marieb, Elaine. :Essentials of Anatomy and Physiology. 6th edition. Addison-Wesley
Longman, Inc., 2000.
Doyle, Rita, et al.: Nursing 2008. Drug Hand Book. Lipppincott Williams & Wilkins, a
Woters Kluwer Company,2008.
Martin, Elizabeth.: Minidictionary for Nurses. 5th edition. Oxford University Press, New
York, 2003.

WEBSITES

http://www.americanpregnancy.org/labornbirth/cesareanrisks
http://www.nlm.nih.gov/MEDLINEPLUS.htm
http://images.google.com.ph