A Case Study of

Cesarean Delivery
(Breech Presentation)

Submitted by: Corpus. Nichelle

Urbano, Mary Ann
Ursua, John humprey
Villarta, John Harley
Ylanan, Narissa
Ylanan, Nina
Submitted to: Mrs. Rebecca Kagahastian-Dominguez, RN
Clinical Instructor
 I. INTRODUCTION

Nursing process is a patient centered, goal oriented method of caring that provides a frame
work to the nursing care. The nursing process exists for every problem that the patient has, and
for every element of patient care, rather than once for each patient. The nurse's evaluation of
care will lead to changes in the implementation of the care and the patient's needs are likely to
change during their stay in hospital as their health either improves or deteriorates. Nursing
process was used in this case study for a more systematic to care for a client who have
undergone a cesarean section birth.

Cesarean section is commonly called a c - section. Instead of a vaginal birth, during a c - section,
your baby is delivered through your abdomen. It is accomplished through an abdominal incision
into the uterus and is one of the oldest types of surgical procedures known. It is a procedure
always slightly more hazardous than vaginal birth. However, when compared to other surgical
procedures, it is one of the safest types of surgeries and one with few complications.
Caesarean delivery is a surgical procedure to remove the baby from the uterus through an
abdominal incision.

Recovery after a caesarean section takes more time than recovery from a vaginal birth. After a
cesarean section is common to remain in the hospital 3 to 4 days and full recovery will take
between 4 to 6 weeks. Usually, hospitalization for a vaginal delivery is 2 days, and requires less
recovery time as a caesarean birth. Caesarean section is also more costly economically than
vaginal birth.

Breech birth is the birth of a baby from a breech presentation. In the breech presentation the
baby enters the birth canal with the buttocks or feet first as opposed to the normal head first
presentation.
The bottom-down position, called breech presentation, presents some hazards to the baby
during the process of birth, and the mode of delivery (vaginal versus Caesarean) is controversial
in the fields of obstetrics and midwifery.

This means that your baby is in a bottom-down position. If this is your first baby, he will
probably settle into a head-down position in your pelvis around the eighth month of pregnancy.
This is called a vertex or cephalic position. When labor begins, nearly all (96 percent) babies are
lying head down in the uterus, but a few (about 3 to 4 percent), will settle into a bottom first, or
breech, position.
 II. OBJECTIVES

The significance of the study is for us third year students to apply the principles and concepts
that we have learned in the NCM 201 (Maternal and Child Nursing) in our rotation at Ospital ng
Sampaloc, with the following learning objectives:

1. Cognitive
 To be able to review concepts and theories in maternal and child nursing.
 To be able to describe the development, pathophysiology, medical-surgical
management, and nursing care of a client who have undergone a cesarean
section birth.
 To be able to design a Nursing Care Plan for the patient who have
undergone cesarean birth.
 To be able to provide information and heath teachings to the patient in
the postpartum period.
2. Psychomotor
 To be able carry-out hospital routines and the treatment prescribed to the
patient.
 To be able to perform nursing procedures and nursing considerations for a
client in the postoperative stage.
 To be able to implement the nursing care plan.
3. Affective
 To be able to establish a good working relationship with the patient and
hospital staff.

III. PATIENT’S PROFILE

Demographic Profile:
Name : Precy Codillo
Age : 27 years old
Address : 2432 Legarda St. Sampaloc Manila
Name of Spouse : Joseph Codillo, 28 yrs. old
Name of Father : Victorino Codillo, 56 yrs. old
Name of Mother : Elsa Codillo, 56 yrs. old
Nationality : Filipino
Occupation : Housewife
Educational Attainment: College undergraduate ( I.T)
LMP : February 15,2011
EDC : November 22,1011
Admission Date : November 21, 2011
Date of Delivery : November 22, 2011
Discharge Date : November 25, 2011
Surgery Performed : Cesarean Sect
 IV. HISTORY OF PAST AND PRESENT ILLNESS

The patient stands 153 centimeters and weighs about 58 kilograms. Her AOG is 31 weeks
and 1 day, LMP was last February 15,2011 and her EDC was on April 8, 2009. Her OB score is
G2P2 (2,0,0,2). She was married at the age of 23 years old.She gave birth to her first child
through Normal Spontaneous Delivey,

It was on November 21,2011 at around 9:00pm when Precy was admitted and was sent
to the OR/DR for an internal examination. The midwife opted for cesarean section for this
pregnancy because of the baby’s presentation(breech presentation).
V. PHYSICAL ASSESSMENT

BODY PART TECHNIQUE USED FINDINGS INTERPRETATION

◊ HEAD ◊ palpation ◊ proportional to ◊ Normal
Skull the size of the body,
round, with
prominences in the
frontal area
anteriorly & the
occipital area
posteriorly,
symmetrical in all
planes, gently
curved

Scalp/ Hair ◊ inspection ◊ scalp is white, ◊ Normal

◊ palpation clean, free from
masses, lumps, nits,
dandruff & lesions,
with no areas of
tenderness upon
palpation; hair is
black, evenly
distributed & covers
the whole scalp,
thick & shiny

Face ◊ inspection ◊ oblong shaped, ◊ Normal

symmetrical, smooth
& no involuntary
muscle movements

Eyes/ Vision ◊ inspection ◊ eyes are parallel ◊ Normal

◊ palpation & evenly placed,
symmetrical, nonprotruding,
with
scant amount of
secretions, both
eyes black & clear;
sclera is white &
clear; eyebrows
are black,
symmetrical, thick,
can raise both
symmetrically &
without difficulty,
evenly distributed &
parallel with each
other; eyelashes
are evenly distributed &
turned
outward; upper
eyelids cover a
small portion of the
iris, cornea & the
sclera when the
eyes are open, when
the eyes are closed
the lids meet
completely,
symmetrical & the
color is the same as
the surrounding
 skin; lid margins
are clear, without
scaling or
secretions; lower
palpebral
conjunctiva are
shiny, moist,
transparent &
salmon pink in color;
iris are proportional
to the size of the
eye, round &
symmetrical; pupils
are from pinpoint to
almost the size of
the iris, round,
symmetrical,
constricts with
increasing light &
accommodation;
able to move eyes in
full range of
direction
◊ Normal
◊ ears are parallel,
Ears/ Hearing ◊ inspection symmetrical,
◊ palpation proportional to the
size of the head,
bean-shaped, helix
is in line with the
outer canthus of the
eye, skin is the
same color as the
surrounding area &
clean; ear canal is
pinkish, clean, with
scant amount of
cerumen & a few
cilia; able to hear whisper
spoken 2
feet away; 2
piercing are found in
left ear and 1
piercing in right ear
Nose ◊ nose is in midline,
◊ inspection symmetrical, patent; ◊ Normal
◊ palpation internal nares are
clean, dark pink with
few cilia

Mouth/ Lips ◊ lips are pinkish,

◊ inspection symmetrical, lip
◊ Normal
◊ palpation margin is welldefined,
smooth &
moist; gums are
pinkish, smooth,
moist, no swelling,
no retraction, no
discharge; 32 teeth
are present, aligned,
with no dental
caries; tongue is
pinkish, slightly
rough on top,
smooth along the
lateral margins,
moist, shiny & freely
 movable;
cheeks are pinkish,
moist & smooth;
frenulum is in
midline, straight &
thin; soft palate is
pinkish, smooth &
moist; hard palate
is slightly pinkish;
uvula is at the
center, symmetrical
& freely movable
◊ inspection
◊ palpation ◊ proportional to ◊ Normal
◊ NECK the size of the body
& head, symmetrical
& straight, no
palpable lumps,
masses or areas of
tenderness
◊ inspection
◊ palpation ◊ chest contour is ◊ Normal
◊ THORAX & ◊ percussion symmetrical, spine is
LUNGS ◊ auscultation straight, no lumps, no masses,
no
tender areas, with
clear breath sounds
◊ inspection
◊ palpation ◊ no abnormal ◊ Normal
◊ HEART ◊ percussion pulsations,
◊ auscultation pulsations are
palpable & visible in
apical area
◊ inspection ◊ Normal
◊ palpation ◊ symmetrical,
◊ BREAST pinkish nipples, no
cracks & discharges,
uniform in skin
color, smooth &
intact, no lumps,
masses &
tenderness
◊ inspection
◊ auscultation ◊ presence of horizontal
◊ ABDOMEN ◊ percussion incision on the lower part of
◊ palpation the abdomen due to her
recent cesarean delivery
surgery

◊ symmetrical, with
visible veins, fine
hair evenly
distributed, warm,
dry & elastic upon
palpation, with area
◊ Normal
◊ inspection of tenderness on the
◊ palpation left arm; palms are
◊ UPPER pinkish, warm, soft
EXTREMITIES & elastic; nails are
transparent, smooth
& convex with light
pink nail beds &
white translucent
tips; 5 fingers in
each hand; both
shoulders, arms,
elbows, hands &
 wrists can be
moved in different
range of motion with

relative ease; c
marks of petechial
rashes
◊ skin is smooth,
fine hair is evenly
distributed, absence
of varicose veins, ◊ Normal
◊ inspection muscles
◊ LOWER ◊ palpation symmetrical, length
EXTREMITIES symmetrical, 5 toes
in each foot, sole &
dorsal surface is
smooth with pink
nail beds & white
translucent tips;
both legs, knees,
ankles, & toes can
be moved in
different range of
motion with relative
ease; scar on both
patellar; c non
pitting bipedal
edema

VI. GORDON’S FUNCTIONAL PATTERNS

PATTERN OF HEALTH PERCEPTION & HEALTH MANAGEMENT

She does not feel anything wrong in herself, she does not feel weak. Though, she feels
pain in her wound from her cesarean incision. She eats a balanced diet of meat, vegetables and
fish. She does not exercise but she always does her daily household chores and treats it as her
exercise to maintain her physical health. She has no allergy. Her mother has high blood
pressure. She was not yet hospitalized until recently she had to undergo cesarean delivery
because her child was in breech presentation.

NUTRITIONAL - METABOLIC PATTERN

She eats vegetables, meat and fish. She drinks coffee and juices. She always drinks soft
drinks and eats a lot of salty foods. She does not have any disease that affects her nutritional-
metabolic function.
PATTERN OF ELIMINATION

She urinates every day and has a regular bowel movement. She has no diseases on her
digestive system, urinary system and has no skin problems.

PATTERN OF ACTIVITY & EXERCISE

Ever since she got married and when she had her first baby, she just stays at home taking
care of her baby and their household chores. She does not do exercise, her main work out is
doing the household chores. Twice or thrice a month, she goes to church along with her family.
When they have their free time, they spend it by going to Luneta Park.

COGNITIVE - PERCEPTUAL PATTERN

She does not have any sensory deficits. She is a college undergraduate(2 nd year I.T). She
worked as a service crew in a fast-food chain and she was not yet married at that time. She does
not have any disease that affects her mental or sensory functions. She feels pain in her wound
that she got from her recent surgery regarding her cesarean delivery. In a scale of 1-10, she
stated that the pain she feels is at 6.

PATTERN OF SLEEP & REST

She always sleeps early at night and gets up early in the morning. Sometimes, she takes
a nap in the afternoon. She does appear physically rested and relaxed.

PATTERN OF SELF PERCEPTION & SELF CONCEPT

There was nothing unusual in her appearance, and she’s quite comfortable with her
appearance.

ROLE - RELATIONSHIP PATTERN

She is an attentive mother to her child and a responsible wife to her husband. She does
not have any problem with her husband for he doesn’t have any vices. Family is the most
important thing in her life.

SEXUALITY - REPRODUCTIVE PATTERN

She is satisfied being a woman and a mother to her child. They do not use
contraceptives and pills. They had a 4-year interval before they had their second child. She does
not have any disease regarding her reproductive system.

PATTERN OF COPING & STRESS TOLERANCE

Whenever she has problems, she prays and she talks to her husband about it to get an
advice or an opinion. She has not had any treatment for emotional distress.
PATTERN OF VALUES & BELIEFS

She was born and raised as a roman catholic by her parents. She goes to church at least
twice or thrice a month.

VII. ANATOMY AND PHYSIOLOGY

Vagina

The vagina is a muscular, hollow tube that extends from the vaginal opening to the cervix of the
uterus. It is situated between the urinary bladder and the rectum. It is about three to five inches
long in a grown woman. The muscular wall allows the vagina to expand and contract. The
muscular walls are lined with mucous membranes, which keep it protected and moist. A thin
sheet of tissue with one or more holes in it, called the hymen, partially covers the opening of
the vagina. The vagina receives sperm during sexual intercourse from the penis. The sperm that
survive the acidic condition of the vagina continue on through to the fallopian tubes where
fertilization may occur.

The vagina is made up of three layers, an inner mucosal layer, a middle muscularis layer, and an
outer fibrous layer. The inner layer is made of vaginal rugae that stretch and allow penetration
to occur. These also help with stimulation of the penis. The middle layer has glands that secrete
an acidic mucus (pH of around 4.0.) that keeps bacterial growth down. The outer muscular layer
is especially important with delivery of a fetus and placenta.

Purposes of the Vagina

 Receives a males erect penis and semen during sexual intercourse.
 Pathway through a woman's body for the baby to take during childbirth.

 Provides the route for the menstrual blood (menses) from the uterus, to leave the body.

 May hold forms of birth control, such as a diaphragm, FemCap, Nuva Ring, or female
condom.
The cervix (from Latin "neck") is the lower, narrow portion of the uterus where it joins with the
top end of the vagina. Where they join together forms an almost 90 degree curve. It is
cylindrical or conical in shape and protrudes through the upper anterior vaginal wall.
Approximately half its length is visible with appropriate medical equipment; the remainder lies
above the vagina beyond view. It is occasionally called "cervix uteri", or "neck of the uterus".

During menstruation, the cervix stretches open slightly to allow the endometrium to be shed.
This stretching is believed to be part of the cramping pain that many women experience.
Evidence for this is given by the fact that some women's cramps subside or disappear after their
first vaginal birth because the cervical opening has widened.

The portion projecting into the vagina is referred to as the portio vaginalis or ectocervix. On
average, the ectocervix is three cm long and two and a half cm wide. It has a convex, elliptical
surface and is divided into anterior and posterior lips. The ectocervix's opening is called the
external os. The size and shape of the external os and the ectocervix varies widely with age,
hormonal state, and whether the woman has had a vaginal birth. In women who have not had a
vaginal birth the external os appears as a small, circular opening. In women who have had a
vaginal birth, the ectocervix appears bulkier and the external os appears wider, more slit-like
and gaping.

The passageway between the external os and the uterine cavity is referred to as the
endocervical canal. It varies widely in length and width, along with the cervix overall. Flattened
anterior to posterior, the endocervical canal measures seven to eight mm at its widest in
reproductive-aged women. The endocervical canal terminates at the internal os which is the
opening of the cervix inside the uterine cavity.

During childbirth, contractions of the uterus will dilate the cervix up to 10 cm in diameter to
allow the child to pass through. During orgasm, the cervix convulses and the external os dilates.

The uterus is shaped like an upside-down pear, with a thick lining and muscular walls. Located
near the floor of the pelvic cavity, it is hollow to allow a blastocyte, or fertilized egg, to implant
and grow. It also allows for the inner lining of the uterus to build up until a fertilized egg is
implanted, or it is sloughed off during menses.

The uterus contains some of the strongest muscles in the female body. These muscles are able
to expand and contract to accommodate a growing fetus and then help push the baby out
during labor. These muscles also contract rhythmically during an orgasm in a wave like action. It
is thought that this is to help push or guide the sperm up the uterus to the fallopian tubes
where fertilization may be possible.

The uterus is only about three inches long and two inches wide, but during pregnancy it
changes rapidly and dramatically. The top rim of the uterus is called the fundus and is a
landmark for many doctors to track the progress of a pregnancy. The uterine cavity refers to the
fundus of the uterus and the body of the uterus.
Helping support the uterus are ligaments that attach from the body of the uterus to the pelvic
wall and abdominal wall. During pregnancy the ligaments prolapse due to the growing uterus,
but retract after childbirth. In some cases after menopause, they may lose elasticity and uterine
prolapse may occur. This can be fixed with surgery.

Some problems of the uterus include uterine fibroids, pelvic pain (including endometriosis,
adenomyosis), pelvic relaxation (or prolapse), heavy or abnormal menstrual bleeding, and
cancer. It is only after all alternative options have been considered that surgery is recommended
in these cases. This surgery is called hysterectomy. Hysterectomy is the removal of the uterus,
and may include the removal of one or both of the ovaries. Once performed it is irreversible.
After a hysterectomy, many women begin a form of alternate hormone therapy due to the lack
of ovaries and hormone production.

At the upper corners of the uterus are the fallopian tubes. There are two fallopian tubes, also
called the uterine tubes or the oviducts. Each fallopian tube attaches to a side of the uterus and
connects to an ovary. They are positioned between the ligaments that support the uterus. The
fallopian tubes are about four inches long and about as wide as a piece of spaghetti. Within
each tube is a tiny passageway no wider than a sewing needle. At the other end of each
fallopian tube is a fringed area that looks like a funnel. This fringed area, called the
infundibulum, lies close to the ovary, but is not attached. The ovaries alternately release an egg.
When an ovary does ovulate, or release an egg, it is swept into the lumen of the fallopian tube
by the frimbriae.

Once the egg is in the fallopian tube, tiny hairs in the tube's lining help push it down the narrow
passageway toward the uterus. The oocyte, or developing egg cell, takes four to five days to
travel down the length of the fallopian tube. If enough sperm are ejaculated during sexual
intercourse and there is an oocyte in the fallopian tube, fertilization will occur. After fertilization
occurs, the zygote, or fertilized egg, will continue down to the uterus and implant itself in the
uterine wall where it will grow and develop.

If a zygote doesn't move down to the uterus and implants itself in the fallopian tube, it is called
a ectopic or tubal pregnancy. If this occurs, the pregnancy will need to be terminated to prevent
permanent damage to the fallopian tube, possible hemorrhage and possible death of the
mother.
VIII. PATHOPHYSIOLOGY

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 fallopian 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 &

placental structure until full term

PRELIMINARY SIGNS OF LABOR

Lightening Braxton Hicks Contraction Ripening of the cervix

(descent of the fetal (false labor) (Goodell’s Sign wherein
feet into the pelvis) >begin and remain irregular the cervix feels softer like
>1st felt abdominally consistency of the earlobe
>pain disappears with
ambulation
>do not increase in duration
and intensity
>do not achieve cervical
dilatation

TRUE LABOR

Uterine Contractions SHOW Rupture of

Membranes
>increase in duration (pink-tinge of blood, (rupture of the
and intensity a mixture of blood and fluid) amniotic sac)
>1st felt at the back &
radiates to the abdomen
>pain is not relieved no
matter what the activity
>achieve cervical dila-
tation

Failed to progress labor

(cervical atrophy)

increase risk for fetal distress

(meconium staining, hypoxia)
 Increase risk of fetal death

Emergent cesarean delivery

(the incision made on the lower part of the abdomen)

Expulsion of the fetus

Expulsion of the placenta

(Accompanied by blood)

IX. LABORATORY PROCEDURES

Actual Normal Nursing

Procedure / Date Implications
Findings Findings Responsibilities
1. CBC Pre:
 Check Doctor’s
Hemoglobin 116 120 – 140 g/dL Decrease Order.
- Indicates  Inform client and
occurrence of explain the
0.30 anemia procedure.
Hematocrit 0.35 Increase  No need for NPO.
- Indicates
5 - 10 hypercoagulation Intra:
WBC 8.0 0.36 - 0.66 Normal  Perform blood
Segmenters 0.60 0.22 - 0.40 Normal extraction
Lymphocytes 0.14 Decrease (venipuncture
- Indicates high risk technique) using
for acquiring aseptic technique.
 Actual Normal Nursing
Procedure / Date Implications
Findings Findings Responsibilities
infection  Put extracted blood
Eosinophils 0.02 0.01 - 0.04 Normal in ethyldiamino-
Stab Cells 0.04 0.02 - 0.05 Normal tetracetate (EDTA)
Platelets 320 150 – 400x9/L Normal or the lavender top
vacuum tube.

Post:
 Label the container
properly and
correctly.
 Send specimen to
the lab
immediately.
 Document the
result to the chart
and inform
physician that the
result is out.

URINE ANALYSIS
 Microscopic Exam Chemical Exam

Color: Yellow Albumin: Negative

Transparency: Hazy Sugar: Negative

pH: 6.0 (7.35 – 7.45)

Specific Gravity: 1.010 (1.010 – 1.025)

Epithelial Cells: Moderate

X. NURSING MANAGEMENT
 NURSING CARE PLAN

ACTUAL

Assessment Diagnosis Inference Planning Intervention Rationale Evaluation

Subjective: Acute pain Caesarean After 8 hours Independent: After 8 hours
related to delivery is the of nursing -Evaluate pain -Provides Of Nursing
“Masakit ung tahi disruption of surgical interventions regularly noting information interventions,
ko” as verbalized skin, tissue, removal of the ,the patient characteristics, about need for the patient pain
by patient. and muscle infant from the pain will be location, intensity or effectiveness was relieved
Integrity. uterus through relieved or (0-10 scale). of interventions. or controlled
Objective: an incision controlled
made in the -Identify specific -Prevents undue
abdominal wall activity strain on
-Facial mask of
and the uterus. limitations. Operative site.
pain.
Size and
location of the -Recommend - Promotes
-Guarding
incision vary, planned or return of normal
behavior.
but abdominal progressive function and
and uterine exercise. enhances
-Narrowed
incisions of feelings of
focus.
choice are low general well
and horizontal. being.
-V/S taken as
Vertical
follows:
incisions may -Schedule -Prevents
T: 37.3
be necessary adequate rest fatigue and
P: 80
for quicker periods. conserves
R: 18
procedures, the energy for
BP: 110/90
presence of healing.
adhesions and
other complications. -Review -Provides
importance of elements
nutritious diets necessary for
and adequate tissue
fluid intake. regeneration or
healing.
-Reposition as -May relieve
indicated. pain and
enhance
circulation.

-Provide additional -Improves

comfort circulation,
measures like reduces muscle
back rub. tension and
anxiety
associated with
pain.
-Encourage use of -Relieves
relaxation muscle and
technique like emotional
deep breathing tension.
exercises.

Dependent:

-Administer -To relieve mild

analgesics or non or moderate
steroidal anti- pain.
inflammatory
drugs as
prescribed.
POTENTIAL

CUES DIAGNOSIS INFERENCE PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Risk for Due to an STG: Independent: Patient is

- Patient infection elective After 4 hours of -Monitor vital -To establish a expected to be
verbalized related cesarean nursing signs baseline data free of
“hndi pa inadequate section, intervention, infection, as
nalilinisan primary patient’s skin patient will be -Inspect dressing -Moist from evidenced by
yung tahi ko defenses and tissue were able to and perform drainage can be a normal vital
ngaung araw secondary to mechanically understand wound care source of signs and
na to ” surgical incision interrupted. causative infection absence of
Thus, the factors, identify purulent
Objective: wound is at risk signs of - Monitor drainage from
- dressing dry of developing infection and Elevated -These are signs wounds,
and intact infection. report them to temperature, of infection incisions, and
-V/S taken as health care Redness, tubes.
follows: provider swelling,
T: 37.3 accordingly. increased pain,
P: 80 or purulent
R: 19 LTG: drainage at
BP: 120/90 After 2-3 days incisions
of nursing
intervention, .- Encourage fluid
patient will intake of 2000 ml - Fluids promote
achieve timely to 3000 ml of diluted urine and
wound healing, water per day frequent
be free of (unless emptying of
purulent contraindicated). bladder; reducing
drainage or stasis of urine, in
erythema, be turn, reduces risk
afebrile and be of bladder
free of infection or
infection. urinary tract
- Encourage infection (UTI).
coughing and
deep breathing. - These measures
reduce stasis of
secretions in the
lungs and
bronchial tree.
When stasis
occurs, pathogens
can cause upper
respiratory
infections,
including
Interdependent: pneumonia.
-Administer
antibiotics(as
prescribed by -Antibiotics have
the physicisian). bactericidal effect
that combats
pathogens.
 XI. DRUG STUDY

MEFENAMIC ACID
Drug Class: Non steroidal anti-inflammatory drug (NSAID)
Therapeutic Actions:
 Anti Inflammatory, analgesic, and antipyretic activities related to inhibition of prostaglandin synthesis; exact mechanism of
action are not known.
Indications:
 Relief of moderate pain when therapy will not exceed in 1 week.
Treatment of temporary dysmenorrhea
Contraindications & Cautions:
 Contraindicated with hypersensitivity to mefenamic acid, pregnancy, Lactation.
Use cautiously with asthma, renal or liver dysfunction, peptic ulcer disease, G.i. bleeding hypertension.

FERROUS SULFATE
Drug Class: Iron preparation
Therapeutic Actions:
 Elevates the serum iron concentration and is then converted to hemoglobin or trapped in the reticuloendothelial cell for
storage and eventual conversion to a usuable form of iron.
Indications:
 Prevention and treatment of iron deficiency anemia.
 Dietary supplement for iron
  Unlabeled use: supplemental use during epotin therapy to ensure proper hematologic response to epotin.
Contraindications & Cautions:
 Allergy to any ingredients, sulfate allergy hemochromatosis, hemosiderosis, hemolytic anemis, normal iron balance, peptic ulcer, regional enteritis,
ultraterative colitis.

CEFUROXIME
Drug Classes:
 Antibiotic
 Cephalosporin (2nd generation)
Therapeutic Actions:
 Bactericidal
 Inhibits synthesis of bacterial cell wall, causing cell death
Indications: Oral cefuroxime
 Pharyngitis
 Tonsilitis
 Otitis Media
 Lower respiratory Tract infection
 Urinary tract infection
 Dermatologic infections including impetigo
 Treatment of early lyme disease
Contraindications and caution:
 Allergy to cephalosorins or penicillin renal failure, lactation
 XII. DISCHARGE PLANNING

M – Medication

 Methylgonometrine 1 tab TID

 Mefenamic Acid 250mg 1 tab q4 hrs
 Ferrous sulfate 1 tab once a day

E – Environment

 Instructed patient to stay in calm, quiet environment

 Home environment must be free from slipping or accident hazards

T – Treatment

 Informed patient to have a follow-up check up after 1- 2 weeks

H – Health Teachings

 Informed patient to avoid lifting heavy objects for 1-2 weeks

 Stressed the importance of perineal cleanliness
 Encouraged client to have hot sitz bath
 Instructed patient to increase intake of protein-rich foods to promote faster
wound healing
 Instructed to promote adequate fluid intake
 Discouraged patient to participate in strenuous activities that might precipitate
stress and trauma to the wound
 Instructed patient to promote breastfeeding

O – Observable Signs and Symptoms

 Observe for dehiscence and evisceration

 Instructed patient to report to physician any signs of infection
 Instructed patient to report any case of hemorrhage or abnormal bleeding

D – Diet

 Encouraged client to increase intake of fiber to avoid constipation

 Instructed to increase fluid intake
 Instructed to increase intake of nutritious foods such as fruits and vegetables.