NORTH VALLEY COLLEGE FOUNDATION INC

Nat’l Highway, Lanao, Kidapawan City, 9400

A Case Study Presentation

Presented to The College of Nursing
North Valley College Foundation Inc.

In Partial Fulfillment of the Requirement for the degree

Bachelor of Science in Nursing

A Case Study of Caesarean Section due to Arrest in Cervical Dilatation

Secondary to Cephalopelvic Disproportion

Submitted by:
CABALLERO, SETH ELIJAH
CALIGDONG, RASTHY JAY
DASARGO, HENGIELYN

BORLAZA, KIZZA FAITH

ELEVADO, FREDERICK

DIMANALAO, MERLIZA

DAGOHOY, REA MAE

EBRAHIM, SHARINA

DIAGAO, NORHATA

ENIDAL, JOHANIE

MARC 2024
 ACKNOWLEDGEMENT

In this case study, the combined efforts of teamwork and unwavering

dedication were pivotal to its successful completion. However, none of this would

have been achievable without the invaluable assistance and support of

numerous individuals. The group extends heartfelt gratitude to those mentioned

below for their invaluable contributions to the development of our manuscript.

Your counsel, aid, motivation, and endorsement were instrumental in shaping

each page of our paper.

First and foremost, we dedicate this work to the Lord Our God Almighty,

whose boundless grace provided us with the willpower, wisdom, fortitude, and

patience to bring this paper to fruition. His unconditional love served as the

steadfast anchor guiding us through every stage of the process. We extend our

deepest appreciation to Patient’s RM for granting us permission to conduct study,

and for addressing all our inquiries. Without your consent and assistance, this

study would not have been possible.

We extend our heartfelt thanks to our Dean of Nursing, VPAA Dr. April S.

Babol, for his generous support and for granting us the privilege to conduct this

case study presentation. Our gratitude also goes to our RLE Coordinator, Mrs.

Leda Pacate R.N., for her unwavering guidance and support throughout the

completion of this paper. Additionally, we are deeply appreciative of our clinical

instructors, particularly Mr. Richard Jay Romero R.N., for their unwavering

II
supervision and guidance. Their combined expertise and support have propelled

us towards productivity and progress, and we are immensely grateful for their

belief in our capabilities.

To our families and friends, we are profoundly thankful for your enduring

love and support. Your encouragement and inspiration paved the way for us to

persevere and achieve success in our endeavors. The student nurses involved in

this study are deeply indebted to the institution of North Valley College

Foundation Inc., College of Nursing, for affording us the opportunity to refine our

skills and expand our knowledge. We are truly honored to have had this

invaluable experience.

III
TABLE OF CONTENTS Pages

IV
FRONT PAGE i
ACKNOWLEDGEMENT iii
TABLE OF CONTENTS vi
CHAPTER I
INTRODUCTION 1
CHAPTER II
OBJECTIVES 3
General Objectives 3
Specific Objectives 4
CHAPTER III
PATIENT’S DATA 5
CHAPTER IV
FAMILY BACKGROUND 7
Family Health History 8
Effects and Expectations of Illness to Self/Family 8
Clients Health History 8
Past Illnesses 8
Present Illnesses 9
CHAPTER V
DEVELOPMENT DATA 10
CHAPTER VI
DEFINITION OF COMPLETE DIAGNOSIS 13
CHAPTER VII
DEFINITION OF TERMS 16
CHAPTER VIII
PHYSICAL ASSESSMENT 18
CHAPTER IX

V
 ANATOMY AND PHYSIOLOGY 22
CHAPTER X
ETIOLOGY AND SYMPTOMATOLOGY 27
CHAPTER XI
PATHOPHYSIOLOGY 30
CHAPTER XII
DOCTOR’S ORDER 32
CHAPTER XIII
DIAGNOSTIC EXAM 35
CHAPTER XIV
DRUG STUDY 39
KETOROLAC 39
METOCLOPRAMIDE 40
PARACETAMOL 41
TRAMADOL 42
RANITIDINE 43
CHAPTER XV
SURGICAL PROCEDURE 44
CHAPTER XVI
NURSING THEORIES 45
CHAPTER XVII
NURSING CARE PLAN 46
CHAPTER XVIII
PROGNOSIS 53
CHAPTER XIX
DISCHARGE PLAN 55
CHAPTER XX

VI
 SUMMARY, FINDINGS, RECOMMENDATION 57
Summary 57
Findings 57
Recommendation 58
Patients 58
Nurses 58
Future Researchers 58
CHAPTER XXI
REFERENCES 59

VII
 CHAPTER I

INTRODUCTION

In this present time, majority of women anticipate to carry a child and bring forth

to this world. Pregnancy is a natural process that occur in every woman especially in

giving birth to a complete wellbeing. The euphoria you will get the moment you know

that another life has been made inside of you is exceptional. Anxiety may arise,

emotions may tense up, physiologic changes may occur, nevertheless it can’t compare

to the enthusiasm and gratitude most of the pregnant women feels.

Caesarean section is a major abdominal surgery involving 2 incisions(cuts), One

is an incision through the abdominal wall (Laparatomy) and the second is an incision

involving the uterus (Hysterectomy) to deliver the baby (Louis, 2020). The recent years

have seen a worldwide increase in the rates of Caesarean deliveries. Black C and Kaye

JA, (2019) This can be attributed to several reasons, including lower procedure-related

risks, increasing incidence of maternal requests and multiple pregnancies due to

advances in fertility treatment. Menacker F, (2019) While these factors account for most

of the rise in elective Caesarean sections (CSs), there has been a similar increase in

the proportion of emergency CSs performed. Shiono PH, McNellis D, (2020).

Cephalopelvic disproportion occurs when there is mismatch between the size of the

fetal head and size of the maternal pelvis, resulting in "failure to progress" in labor for

mechanical reasons. Untreated, the consequence is obstructed labor that can endanger the

lives of both mother and fetus. Maharaj D. (2019). Cephalopelvic disproportion is rare.

1
According to the American College of Nurse-Midwives (ACNM), CPD occurs in 1 out of 250

pregnancies. Scott, James R., et al, (2020)

The 2019 National Demographic and Health Survey (NDHS) showed that 1 in 10

young Filipino women aged 15–19 years are childbearing. Yet, teenage pregnancy is

known to be associated with complications in the mother and the child. Filipino women

with heights of 150cm and less are at risk of obstructed labor due to cephalopelvic

disproportion and should be referred early to tertiary hospitals where labor can be

closely monitored and cesarean section performed if necessary. Domingo N.A, (2021).

This study is about a Caesarean Section due to Arrest in Cervical Dilatation

Secondary to Cephalopelvic Disproportion (CPD). Patient with gynecological history of

gravida 1 parity 1. A 34-year-old Filipino and who was admitted to Ward Room 106 on

January 31, 2024. Upon assessing the patient’s condition, the recorded vital signs were

as follows: blood pressure 110/70 mmHg, respiratory rate of 20 cpm, pulse rate of 87

bpm, temperature of 36.8°C and oxygen saturation of 97%. Hence, this case study will

provide an in-depth analysis and deeper understanding of the patient's particular

medical condition, allowing us to develop a more complex understanding of the patient’s

current condition.

In conclusion, this case study carries a substantial information to provide

particular nursing interventions, analyze and build suitable critical thinking abilities, and

maintain a positive outlook that improve the capacity to provide nursing care

management. In addition, it can serve as a pillar to improve our skills in doing relevant

interventions which promote wellness to the patient.

2
 CHAPTER II

OBJECTIVES

To further understand and to have a course of directions, organization and

recognize the essence of this study, we have set the following objectives:

General Objectives:

The student nurses who worked hard for this case study will be able to acquire

knowledge about the Arrest in Cervical Dilatation second to CPD. They will also be

equipped with competence and to enhance critical thinking skills in giving appropriate

nursing care management related situations in the future;

 To improve our skills in doing relevant interventions which promote wellness to the

patient.

 To provide particular nursing interventions, analyze and build suitable critical

thinking abilities, and maintain a positive outlook that improve their capacity to

provide nursing care management.

 To recognize the clinical signs of the disease process through information gathered

in a thorough nursing health history documentation.

3
Specific Objectives:

At the end of the presentation the students will be able to;

 Acquired information about the Arrest in Cervical Dilatation second to CPD

 To Obtain a thorough understanding of the patient’s medical history, encompassing

past and present hospitalizations.

 Defined the complete diagnosis of the patient.

 To Acquire knowledge about the etiology, causative factors, and clinical

manifestations of arrest in cervical dilatation secondary to CPD.

 To determine the patient's recommended course of medical and surgical care.

 To be familiar with the drugs that have been prescribed for the patient, taking note

of both the therapeutic effects and adverse reactions.

 To create the health education and discharge planning that are required for the

patient's quick recovery and to avoid any complications.

 Provide recommendations for better management about Arrest in Cervical Dilatation

second to CPD that will be helpful in the patient, patient's family, community, and

future researchers.

4
 CHAPTER III

PATIENT'S DATA

PATIENT CASE PRESENTATION

Patient’s Profile

Name: Patient’s RM

Age: 34 y/o

Sex: Female

Nationality: Filipino

Civil status: Married

Occupation: Attorney

Religion: Born Again

Educational Attainment: College graduate

Room Number: Ward Room 106

Date of Admission: January 31, 2024

Date of Discharge: N/A

Chief Complaint: Labor pain

5
VITAL SIGNS

Blood Pressure: 110/70mmHg

Pulse Rate: 87 beats per minute

Respiratory Rate: 20 cycles per minute

Temperature: 36.8 °C

Oxygen Saturation: 97%

Weight: 71 klg

Height: 160 cm

Pain Scale: 7

Admitting Diagnosis: G1, P1, Pregnancy Uterine, 38 weeks AOG, Cephalic in latent

phase of labor

Surgical Procedure: Caesarean section

Attending Physician: DR. D.B.A.

Source of Information: Patient RM

6
 CHAPTER IV

FAMILY BACKGROUND/HEALTH HISTORY (GENOGRAM)

MOTHER SIDE FATHER SIDE

GRANDPARENTS

PARENTS

LEGENDS

MALE

FEMALE

PATIENT PATIENT

HYPERTENSION

CANCER

7
Family Health history

During the medical consultation, the patient said pertinent information regarding

their family health history. Specifically, the patient indicated that a prevalent health

concern within their maternal family lineage are both Cancer and hypertension and

paternal family lineage is Hypertension. This observation, supported by a notable

history of high blood pressure among family members on the mother and father side.

Effects/Expectations of illness to self/family

The recent childbirth, where the baby was delivered by cesarean section

because of difficulties during labor, brings a bunch of effects and expectations for both

the mother and her family. The mother will need time to recover from the surgery, deal

with any pain, and keep an eye on her blood pressure because it was high during

pregnancy. She might feel stressed and worried, especially about having more babies in

the future.

Client’s Health History

Past Illness/es

The patient had previously experienced elevated blood pressure during pregnancy

8
Present Illness/es

Condition started 1 day prior to the admission, onset of labor pains associated

with mucoid discharge hense this admission.

The patient first arrived at the emergency room and presented to the delivery

room with Gravida 1, Parity 1, Pregnancy uterine 38 weeks AOG by LMP, and cephalic

in labor on January 31, 2024. The patient gave birth to her first child via cesarian

section cause Arrest in Cervical Dilatation secondary to CPD.

9
 CHAPTER V

DEVELOPMENTAL DATA

ERIK ERIKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT

Theory Stages Results and Justification

Known for his theory of Intimacy vs. Isolation (34 She achieves intimacy due to
psychosocial development, years old) During her partner's closeness,
Erik Erikson was a which has kept their family
this stage, our long- term
developmental psychologist together up to this point. She
relationships are more
and also examined her own
likely to be stable and
psychoanalyst.According to personality and ideals,
secure if we establish
Erikson's theory, your ego allowing her to make wise
intimate, committed
identity evolves over the relationship decisions. She
partnerships in our early
course of your entire life in managed to maintain a
adult years. Since each
eight distinct stages. healthy balance between
stage of development
Additionally, according to his independence and
builds on the previous
theory, a person's ability to closeness, adjusting to
one, the formation of a
respond to social crises over difficulties in her relationships
strong sense of self
the course of a lifetime without withdrawing or
during adolescence has
determines where they are isolating herself
a significant impact on
in the developmental
our ability to form healthy
spectrum. The way people
relationships. People
respond to their environment
who lack a strong sense
is being taught by.
of self are more prone to
engage in casual
relationships, experience
loneliness, and feel
isolated.

10
SIGMUND FREUD’S PSYCHOSEXUAL THEORY OF DEVELOPMENT

THEORIES STAGES RESULTS AND

JUSTIFICATION

Psychoanalysis, or Sigmund Genital Stage (Puberty The patient had reached and
to Adult) completed this period; she
Freud's theory, is based on
had been affected by his live-
the notion that our The genital stage. It's
in partner, and they had given
unconscious wants, conflicts, when the libido
one child. She learnt how to
and thoughts have a reemerges. Freud
handle circumstances
significant impact on both our claimed that at this
maturely and effectively
behavior and personality. He point, a person starts
demonstrated independence.
developed ideas such as the to feel intense sexual
id (primal instincts), ego desire for the other
(mediator), and superego sex. If the stage is
(internalized morals), and successful, people will
suggested that human growth engage in
happens in stages, with heterosexual sexual
psychosexual factors playing a activity and form
role. enduring relationships
with people of the
opposite sex.

11
JEAN PIAGET’S THEORY OF COGNITIVE DEVELOPMENT

THEORY STAGES RESULT AND

JUSTIFICATION

According to Jean Piaget's Formal Operational Stage The patient is capable of

Theory of Cognitive (12 years old and up) developing to the formal
Development, a child's operative stage. She can
intellect fluctuates as they think abstractly and has
mature. To develop According to Piaget's already accepted her
cognitively, children must hypothesis, the final stage health situation. She
form or establish a mental includes the development of demonstrates
model of their world. This logic, the capacity for logical metacognition by being
procedure is not only thinking, and the aware of her own
concerned with knowledge comprehension of abstract lifestyle,regularly
acquisition. Piaget's theory concepts. By this age, reflecting on her
of cognitive development is teenagers and young adults decisions, and adjusting
based on the idea that may think more clearly every day
children go through four about their surroundings and
developmental stages, each perceive multiple solutions
with its unique set of to problems.
characteristics and talents.

12
 CHAPTER VI

DEFINITION OF COMPLETE DIAGNOSIS

FINAL DIAGNOSIS:

Gravida 1 Parity 1 (1001) pregnancy uterine delivered term cephalic live birth

baby girl by cesarean section cause by Arrest in cervical dilatation secondary to CPD

Cephalopelvic Disproportion (CPD)

Cephalopelvic disproportion (CPD) is one of the most common obstetric

complications. Since CPD is the disproportion between the fetal head and maternal

bony pelvis, evaluation of the head circumference (HC) relative to the maternal bony

pelvis may be a useful adjunct to pre-labor CPD evaluation. The aim of the present

study was a proof-of-concept evaluation of the ratio between HC and pelvic

circumference (PC) as a predictor of CPD. (Karger, 2021)

Cephalopelvic disproportion (CPD) is a pregnancy problem that occurs when the

mother's pelvis and the baby's head are not the same size. The baby's head is

proportionately too large, or the mother's pelvis is too tiny to allow the infant to pass

freely through the pelvic opening. This can render vaginal delivery hazardous or difficult.

If a vaginal birth fails, physicians should swiftly perform a C-section. If they do not do so,

CPD-induced prolonged/obstructed labor can lead to birth complications such hypoxic-

ischemic encephalopathy (HIE) and cerebral palsy (CP). (Reiter & Walsh, 2024)

13
 Cephalopelvic disproportion (CPD) occurs when there is an imbalance between

the size and/or shape of the fetal head and the size and/or form of the maternal pelvis,

resulting in "failure to progress" in labor due to mechanical factors. Untreated, the result

is obstructed labor, which can increase maternal or perinatal mortality or morbidity for

the mother and/or baby in the absence of a cesarean section (CS). Approximately 10%

of parturient in affluent countries with cephalic presentation at term have aberrant labor

progression4,5. In 75-80% of instances, delivery is completed naturally; in 20-25% of

situations, a CS is necessary. Thus, dystocia is the most prevalent indication for CS

during delivery, followed by fetal distress. Obstructed labor caused by CPD accounts for

3-8% of all maternal fatalities globally. (Ami, Olivier, et al., 2023)

Arrest of Dilatation

The arrest of dilation is an abnormality that occurs during pregnancy. Normal

labor is progressive dilation and effacement of the cervix due to uterine contractions.

Several milestones have been defined to identify normal labor. The failure to meet these

milestones suggests an increased risk and is categorized as abnormal labor. The arrest

of dilation may be the slowing of labor below an expected rate or maybe a complete

arrest in which no progress is made for at least two hours. ( Friedman, E., 2023)

A cesarean birth was regarded to have been conducted for dilation arrest if the

procedure was indicated by failure to progress, cephalopelvic disproportion, or

unsuccessful inducement. Augmentation was defined as stimulation after spontaneous

labor had already been diagnosed. The analysis covered both the latent and active

14
periods of work. Cervical dilation of ≥4 cm with uterine contractions indicates the active

phase of labor. (Elsevier, 2020)

Women delivered by CS owing to arrest of descent are more likely to fail in a trail

of labor in subsequent pregnancies and require repeat CS because of this indication.

However, current research suggests that cesarean delivery during the second stage

increases the chance of various issues in later pregnancies, such as preterm birth.

During the second stage of labor, it is difficult to discern between the cervix and the

lower uterine segment, raising the possibility that the uterine incision will be made

through the cervix rather than the lower uterine segment. Thus, possible injury to the

proximal vagina or uterine cervix may cause varying degrees of cervical insufficiency in

later pregnancies. It has previously been documented that cervical damage during CS

to halt the second stage of labor may result in greater incidence of spontaneous

premature birth in subsequent pregnancies. Furthermore, the rate of subsequent

spontaneous preterm delivery among women with CS owing to arrest in the second

stage of labor was greater than the average national USA spontaneous preterm rate

and that of women with CS due to arrest in the first stage of labor. (Taylor & Francis,

2023)

15
 CHAPTER VII

DEFINITION OF TERMS

Gravida - refers to the number of times a female has been pregnant, regardless of the

pregnancy outcome.

Parity- indicates the number of live births where pregnancies reached viable gestational

age (at least 20 weeks).

Cephalic presentation - is a birth position where the fetus is head down, facing

backward, with their chin tucked and the back of their head ready to enter the birth

canal. It is one of the variations of how a fetus rests in the womb and is considered an

ideal baby birth position.

Cesarean section - is the surgical delivery of a baby through a cut (incision) made in

the mother's abdomen and uterus. Health care providers use it when they believe it is

safer for the mother, the baby, or both.

Arrest of labor- may be simple slowing of the labor below the expected rate, or may

represent a complete arrest, in which there is no further progress for at least 2 hours.

Cervical dilation- refers to the process by which the cervix, which is the lowest part of

the uterus, opens during labor. It’s a crucial part of childbirth, allowing the baby to move

through the birth canal.

16
Cephalopelvic disproportion- can occur when a woman’s anatomy doesn’t match the

size of her baby’s head through the birth canal due to a contracted or abnormally

shaped pelvis.

17
 CHAPTER VIII
PHYSICAL ASSESSMENT
Personal Data

Patient 34 years old female admitted January 31, 2024 with the Chief complain of

Labor pain and admitting diagnosis of G1, P1, Pregnancy Uterine, 38 weeks AOG,

Cephalic in latent phase of labor

Vital Signs

Blood Pressure: 110/70mmHg

Pulse Rate: 87 beats per minute

Respiratory Rate: 20 cycles per minute

Temperature: 36.8 °C

Oxygen Saturation: 97%

Weight: 71 klg

Height: 160 cm

Pain Scale: 7

18
Head

Upon inspection, it was noted that the head shape is round, normocephalic and the

face is symmetric. Upon palpation, there were no nodules or masses identified on the

head, and the face appeared smooth with no nodules or masses present.

Hair

Upon inspection, the distribution of the hair is even and appears black in color, with

no signs of dandruff. On palpation, there is no tenderness on the scalp, infestation is not

evident and no lesions noted, although the hair is found to be dry.

Face

During the examination, the patient's facial features appear symmetrical, but a

grimace is evident, indicating pain in his left knee.

Eyes

During the inspection, it was noted that the eyebrows is even distributed,

symmetrically aligned and showed equal movement when asked to raise and lower

eyebrows the eyelashes appeared to be equal. The pupils of the eyes are black in color.

Additionally, the pupils were found to be round, reactive to light and accommodation,

the bulbar conjunctiva appeared transparent however the palpebral conjunctiva

appeared whitish in color.

19
Ears

Upon inspection, the auricles are symmetrical. When palpating for the texture, the

auricles were mobile and firm.

Nose

During the inspection, it was observed that the patient’s nostrils were symmetric with

no discharge, and both nostrils were patent allowing the patient to breathe through each

nostril. On palpation, no tenderness or sinuses were noted.

Mouth

During the inspection, pinkish and dry lips were observed while the tongue appeared

whitish. Discoloration of the enamels is evident but the buccal mucosa is uniformly pink

in color.

Skin

Upon inspection, the skin in the upper and lower extremities is uniform in color with

no visible pigment and there is no edema or lesions observed on the patients. On

palpation, the skin appears dry, and warm and the skins temperature is within normal

limits.

Nail Bed

During inspection, it was observed that the shape is convex curve, and during

palpation (Capillary Refill Test), when nails pressed with fingers, the nails appear to be

whitish in color.

20
Chest/Thorax

During the examination, it was observed that the chest was asymmetric upon

inspection. The client manifested quiet rhythmic respiration's. However, no

abnormalities were found during palpation and percussion and auscultation.

Abdomen

No visible distension, masses, or abnormalities are noted. Upon palpation the

abdomen is soft and non-tender to palpation.

Extremities

The extremities are symmetrical in size and length.

21
 CHAPTER IX

ANATOMY AND PHYSIOLOGY

FEMALE REPRODUCTIVE SYSTEM

The female produces the ova or the female gametes and must also nurture and

protect a developing fetus within the course of pregnancy. The following are the parts of

the female reproductive system:

 Ovaries

 Duct System

 External Genitalia

22
Ovaries

Ovaries are the primary female reproductive organs. The paired ovaries are shaped

like an almond but are nearly twice as large. The function of the ovaries is to develop

and release egg cells and to produce hormones such as estrogen, progesterone, and

testosterone.

Fallopian Tubes

The fallopian tubes or the uterine tubes, form the initial part of the duct system. The

fallopian tubes receive the ovulated oocyte and provide a site for fertilization. The

fallopian tubes are about 10 cm (4 inches) long and extends medially from an ovary to

empty into the superior region of the uterus. To reach the oocyte, the sperm must pass

through the vagina and uterus to reach the fallopian tubes.

Uterus

The uterus or the womb is a pear-shaped muscular organ, that functions to receive,

retain, and nourish a fertilized egg. The uterus is located between the pelvis, the urinary

bladder and rectum. During pregnancy, the uterus increases excessively in size, and it

can be felt during the latter part of the pregnancy just above the umbilicus.

23
Layers of the Uterus

 Endometrium: The inner layer of the uterus wall. During the fertilization, the

fertilized egg stays into the endometrium and resides there for the rest of the

pregnancy.

 Myometrium: The middle layer of the uterus wall which is composed of

interlacing bundles of smooth muscle. The myometrium plays an active role

during childbirth, as it contracts rhythmically to force the baby out of the mother’s

body.

 Perimetrium: Also known as visceral peritoneum. The outermost serous layer of

the uterus wall.

Vagina

The vagina is a thin-walled tube that is 3 to 4 inches long. It lies between the bladder

and rectum and extends from the cervix to the body exterior. It allows the passage of

menstrual flow, receives the penis during sexual intercourse, and serves as the lower

portion of the birth canal during delivery.

24
External Genitalia

The external genitalia are called the vulva, it includes the mons pubis, labia, clitoris,

urethral and vaginal orifices, and greater vestibular glands.

25
26
 CHAPTER X
ETIOLOGY AND SYMPTOMATOLOGY

ETIOLOGY

BASIC PRESENT RATIONALE ACTUAL

ETIOLOGY /
ABSENT
PREDISPOSING
FACTORS
Nulliparity ✔ Many women may choose not
to have children for personal,
career, or lifestyle reasons.
Decision to remain nulliparous
is often a personal choice
influenced by individual
values, goals, and priorities.

Gender (Female) Gender-related issues may

involve societal expectations,
✔ stereotypes, and inequalities
that affect women's health
and well-being.
Age (34yrs old) ✔ A woman's health and well-
being, both physical and
emotional, influence the
decision to become pregnant.
Prioritizing one's health,
addressing pre-existing
medical conditions, and
achieving a healthy lifestyle
can contribute to a successful
and healthy pregnancy.

27
 ETIOLOGY

BASIC PRESENT/ RATIONALE ACTUAL

ETIOLOGY ABSENT

PRECIPITATING
FACTORS
 Lifestyle ✔ Poor nutrition in
childhood, adolescence,
and adulthood can
hinder pelvic bone
development, increasing
CPD risk during
childbirth.
 BMI (21.13) ✔ Obesity also distorts
pelvic shape and
reduces space for fetal
passage, further raising
CPD likelihood.

28
 SYMPTOMATOLOGY

SYMPTOMS PRESENT/ RATIONALE ACTUAL

ABSENT

Labor Pains ✔ The discomfort associated

with labor pains aids in the
descent of the fetus
through the birth canal.
The rhythmic contractions
and pressure on the cervix
guide the baby's
movement, facilitating the
birthing process.

Weakness and ✔ Chronic stress or anxiety

Restlessness can lead to both physical
and mental fatigue, as well
as restlessness. Elevated
stress hormones and
psychological tension can
contribute to a sense of
weakness and nervous
energy.

Fatigue ✔ Persistent stress or anxiety

can lead to mental and
physical fatigue. The
release of stress hormones
and the constant activation
of the body's "fight or flight"
response can contribute to
feelings of exhaustion.

29
 CHAPTER XI

30
 PATHOPHYSIOLOGY

Predisposing Factors Precipitating Factors

 Nulliparity  Lifestyle
 Age: 59  BMI (21.13)
 Gender: Male

Baby’s Cranium Mother’s Pelvis

Increasing diameter of cranium Pelvic canal is widening

(development of baby)

Wide but not enough

Large Cranium

Third Trimester

Poor Fetal Descent

Prolonged 1st stage of Labor

Caesarean Birth

Signs and Symptoms

 Labor pains
 Weakness and
 Restlessness
Management

 Caesarean section

31
If Treated: If not treated:

Tests must be done for early CS is considered if there’s a

detection of CPD. Monitor Baby for second birth.
signs of neurologic Defects.

Bad Prognosis
Good Prognosis

CHAPTER XII

32
 DOCTOR’S ORDER

Date/Time Order Rationale Remarks

01-31-24 Will do IE today at To confirm the diagnosis of Done

2pm today preterm labor
10:35 AM
Diet DAT It is interpreted according to Done
the client's appetite and
ability to eat and to tolerate
food
IVF D5LR 1L at The physician ordered to Done
120cc/hr. maintain of body fluids and
nutrition and for hydration.

01-01-24 Sched. For CS Done

3:40 AM now
Secure consent To ensures an ongoing Done
and approval communication process
between the patient and the
health care provider.
Meds: To prevent postoperative Done
Metoclopramide 1 nausea and vomiting
ampule IVTT
Ranitidine 1 To prevent them from Done
ampule IVTT coming back after they
have healed.
Cefuroxime 750mg To treat bacterial infections Done
IVTT in your body

02-01-24 NPO Having a full stomach can Done

4:45 AM raise the risk of serious
health issues from sedation
and anesthesia
Continue IVF To prevent passing on Done
genetic problems to a child.
NPO x 6° then Reducing the volume and Done
may have seps of acidity of the stomach
H2O VSq content so as to reduce the
15mins.x2° then risk of regurgitation and
q4 aspiration of gastric
contents during the
procedure.

33
 Present IVF: DLR To induce or strengthen Done
1L + 100 oxytocin uterine contractions in
to run @ 120cc/hr. pregnant women to aid in
labor
TF: D5LR 1L + To treat low blood sugar Done
100 oxytocin run to (hypoglycemia), insulin
SR shock, or dehydration (fluid
loss).
TF: D5LR to run @ To provides electrolytes Done
SR and calories, and is a
source of water for
hydration.

12:20 PM Meds. This is ordered by the Done

Ketorolac 30mg physician for anesthetic
IVTT q 6° to start induction as well as the
@ 6AM X 3 doses treatment of seizures.
Paracetamol This is ordered by the Done
600mg IVTT q 8° physician for analgesic
to start @ 6AM x 3 induction as well as the
doses treatment of mild to
moderate pain
Tramadol 25mg This is ordered by the Done
IVTT q 8° to start physician for analgesic
6AM x 2 doses induction as well as the
treatment of moderate to
severe pain.
Ranitidine 50mg This is ordered by the Done
IVTT q 8° physician to reduces the
risk of acid aspiration
Metoclopramide This is ordered by the Done
10mg IVTT q 8° physician for prophylaxis
PRN to PONV and treatment of intra- and
postoperative nausea and
vomiting
Diphenhydramine To treat life-threatening Done
25mg IVTT q 8° allergic reactions
PRN for pruritus (anaphylaxis) along with
epinephrine and other
treatments.
Tramadol 25mg This is ordered by the Done
IVTT q 6° PRN for physician for analgesic
severe pain induction as well as the
treatment of moderate to

34
 severe pain.
Keep patient well It can help you avoid or Done
thermoregulated recover from potentially
1&0 monitoring q dangerous conditions like
4° hypothermia.
keep uterus well To stop the bleeding as Done
contracted soon as possible and
replace any lost blood or
fluids.
Remove foley To prevent risk for urinary Done
catheter tomorrow, tract infection
02-02-24 at 10AM
should void 4-6
hours after
May sit up on bed To prevent the patient from Done
with assistance falling.
02--02-24 May have DAT for he physician ordered to Done
dinner have a DAT for dinner to
12:30 PM preventing hair loss, and
also promoting milk
production
For discharge Done
tomorrow

35
 CHAPTER XIII

DIAGNOSTIC EXAM

Date Test Normal Patient’s Clinical Nursing responsibility

ordered value significance
Result

01/01/24 White blood 5.00- 15.61 (H) A high white Assess the patient for
cell 10.00x10^ blood cell count sign and symptoms
9/L can be sign of a related to underlying
multiple illnesses condition such as
such as fever, pain or swelling.
infections, Administer medication
inflammation, as prescribed.
injuries, and
immune system
problems.

Neutrophils% 41.8- 74.0% Normal Throughout the course

79.7% of care,
nurses monitor the
results of diagnostic
tests and modify the
plan of care, as
indicated.

Lymphocytes 0.25-0.35 0.30 Normal Throughout the course

% of care,
nurses monitor the
results of diagnostic
tests and modify the
plan of care, as
indicated.

Monocytes% 0.03-0.07 0.07 (H) Normal Throughout the course

of care,
nurses monitor the
results of diagnostic
tests and modify the
plan of care, as
indicated.

Eosinophils% 0.02-0.04 0.4 Normal Throughout the course

of care,
nurses monitor the

36
 results of diagnostic
tests and modify the
plan of care, as
indicated.

Basophils% 0-0.03 Normal Throughout the course

of care,
nurses monitor the
results of diagnostic
tests and modify the
plan of care, as
indicated.

Red blood 4.50- 4.75 Normal. Nursing priorities for

cells 5.50x10^1 patients with anemia
2/L involve addressing
inadequate
oxygenation,
managing fatigue and
activity intolerance,
identifying nutritional
deficiencies,
administering
prescribed
medications,
monitoring blood
transfusions, providing
education and support,
and collaborating with
the healthcare team
for comprehensive
care.

Hemoglobin 120-140 147 (H) Normal Throughout the course

g/L of care,
nurses monitor the
results of diagnostic
tests and modify the
plan of care, as
indicated.

Hematocrit 0.37-0.43 0.42 Normal Throughout the course

% of care,
nurses monitor the
results of diagnostic
tests and modify the
plan of care, as

37
 indicated.

Mean corposal 81.1-96.0 88.2 Normal Management of

volume fL macrocytosis consists
of finding and treating
the underlying cause.
In the case of vitamin
B-12 or folate
deficiency, treatment
may include diet
modification and
dietary supplements or
injections. If the
underlying cause is
resulting in severe
anemia, you might
need a blood
transfusion.

Mean 27.5-32.2 30.9 Normal Adding more vitamin

corpuscular pg B12 and folic acid to
hemoglobin the diet can be a good
way to address high
MCH levels. It is best
to get these from a
varied and balanced
diet, but supplements
may also help keep
these levels where
they need to be.

Mean 318-354 350 Normal Throughout the course

corpuscular g/L of care,
hemoglobin nurses monitor the
concentration results of diagnostic
tests and modify the
plan of care, as
indicated.

Red cell 11.5- 11.84% Normal Throughout the course

distribution 14.5% of care,
width- nurses monitor the
Coefficient of results of diagnostic
Variation tests and modify the
plan of care, as
(RDW-CV) indicated.

38
Platelet 150- 173 Normal Throughout the course
350x10^9/l of care,
nurses monitor the
results of diagnostic
tests and modify the
plan of care, as
indicated.

39
 CHAPTER XIV

DRUG STUDY

Name of Drug Drawing Classification Dosage/ Indication Mechanism of Side Effects Nursing
Time/Route Action Responsibilities
Generic Name: Nonsteroidal 10mg every Short term Inhibition of -Hypertension Assess the
KETOROLAC anti- 6 hours management of prostaglandin --Bruising at place patient's pain
inflammatory moderately synthesis by of injection level before
Brand Name: drugs severe, acute competitive blocking -Constipation administering
TORADOL (NSAIDs) pain for single of the enzyme -Heart failure and ketorolac.
dose treatment cyclooxygenase edema
(COX). Ketorolac is -Hemorrhage Monitor vital
Short term a non-selective COX -Nausea signs, particularly
management of inhibitor. It is -Renal effects blood pressure,
moderately considered a first- -Skin reactions heart rate, and
severe, acute generation NSAID. -Diarrhea respiratory rate,
pain for multiple -Dyspepsia before and after
dose treatment -Headache administration of
ketorolac.
Short term
management of Educate the
moderately patient on proper
severe, acute administration
pain when and potential side
switching from effects of
parenteral to ketorolac.
oras
administration

40
Name of Drug Drawing Classification Dosage/ Indication Mechanism of Side Effects Nursing
Time/Route Action Responsibilities
Generic Name: Dopamine Injection; -To prevent Metoclopramid -Feeling sleepy Assess for
METOCLOPRA Antagonist 5mg/ml or reduced e is principally -Low mood extrapyramidal
MIDE nausea and a dopamine D2 -Lack of energy symptoms and tardive
vomiting antagonist but -Feeling dizzy dyskinesia
Brand Name: from also acts as an
REGLAN emetogeni agonist on -Assess for
cancer serotonin 5- gastrointestinal
chemothera HT4 receptors complaints, such as
py and causes nausea, vomiting and
weak inhibition constipatiion
-To prevent of 5-HT3
or reduced receptors. - Check the right route
postoperativ and dosage
e nausea
and vomiting -Monitoring the
patient's response to
-To facilitate the medication and
small bowel documenting any
intubation changes in symptoms
or vital signs.
-To aid and
radiologic - Assessing the
exam patient's medical
history, allergies, and
current medications.

41
 Name of Drug Drawing Classification Dosage/ Indication Mechanism of Side Effects Nursing
Time/Route Action Responsibilities
Generic Name: Analgesic and 80mg q4 -Mild pain or Paracetamol has -Pin point red Assessing the
PARACETAMOL Antipyretics hours fever PO a central spots on the patient's pain
analgesic effect skin levels and
Brand Name: -Mild to that is mediated -Loss of appetite determining if
TYLENOL moderate pain through -Yellow eyes or paracetamol is an
activation of skin appropriate
-Mild to descending -Diarrhea analgesic for their
moderate ate serotonergic -Right upper needs.
pain with pathways. stomach -
adjunctive Debate exists Tenderness Educating patients
opioid analgesic about its primary on the proper
fever site of action, dosage and
which may be administration of
-Relieving inhibition of paracetamol.
postoperative prostaglandin
pain. (PG) synthesis Monitoring the
or through an patient for any
active metabolite signs of adverse
influencing reactions or side
cannabinoid effects from taking
receptors. paracetamol.

42
Name of Drug Drawing Classification Dosage/ Indication Mechanism of Side Effects Nursing
Time/Route Action Responsibilities
Generic Name: Analgesics 50-100mg Management Tramadol inhibits -Nausea and Assessing the patient's
TRAMADOL every 4-6 of moderate serotonin vomiting pain level and history
hours to severe reuptake and (-)- - Dizziness or before administering
Brand Name: pain tramadol inhibits light tramadol.
ULTRAM norepinephrine headedness
Pain relief reuptake, -Constipation Educating the patient on
following enhancing - Drowsiness the proper use and
surgery or inhibitory effects - Sweating potential side effects of
injury on pain - Dry mouth tramadol.
transmission in - Fatigue
Chronic pain the spinal cord. - Loss of Monitoring the patient
conditions The appetite for signs of allergic
such as complementary -Insomnia reactions or adverse
fibromyalgia and synergistic effects after
or actions of the two administration.
osteoarthritis enantiomers
improve the Documenting the dose,
analgesic time, and route of
efficacy and tramadol administration.
tolerability profile
of the racemate. Monitoring for signs of
respiratory depression,
especially in patients
with a history of
respirator

43
Name of Drug Drawing Classification Dosage/ Indication Mechanism of Side Effects Nursing
Time/Route Action Responsibilities
Generic Name: Therapeutic: 150mg q8 Treatment Inhibits the action CNS: Report signs of
RANITIDINE anti-ulcer agents hours and of histamine at Confusion, agranulocytosis and
prevention of the H2 receptor Dizziness, neutropenia (fever, sore
Brand Name: Pharmacologic: heartburn,ac site located Drowsiness, throat, mucosal lesions,
ZANTAC histamine id primarily in Hallucination signs of infection,
H2 antagonists indigestion gastric parietal and bruising), aplastic
and sour cells, resulting in Headache. anemia (unusual fatigue,
stomach. inhibition of weakness), or
gastric acid CV: thrombocytopenia
secretion. Arrhythmias (bruising, bleeding
gums, nose bleeds).
GI: Altered
taste, Black
tongue Monitor signs of
hypersensitivity
Endo: reactions, including
Gynecomastia pulmonary symptoms
(tightness in the throat
or chest, wheezing,
cough, dyspnea).

44
 CHAPTER XV

SURGICAL PROCEDURE

Date Cues Need Nursing Objective of care Nursing Evaluation

Diagnosis Intervention

Subject: Immediate Relieve Pain and Pre-Procedure: Goal Partially

Relief: Inflammation: met:
Objective:

Post-Procedure:

Laboratory Tests:

45
 CHAPTER XVI
NURSING THEORIES

Nursing theories are conceptual frameworks that provide a systematic way to

understand and analyze nursing practice. They encompass a set of principles,

assumptions, and concepts that guide nurses in their approach to patient care. The

three theories help nurses understand the nature of nursing, the factors that influence

health and illness, and the strategies for promoting and maintaining health. They serve

as a foundation for nursing education, research, and practice, shaping the way nurses

assess, plan, implement, and evaluate patient care.

Jean Watson's Theory of Caring

Jean Watson’s theory, known as the Theory of Human Caring emphasizes the

importance of caring of our patients. It views caring as central to nursing, the value of

care, and interpersonal interactions as the fundamental principles of nursing practice,

and proposes that the quality of the nurse-patient relationship significantly impacts

health outcomes. Watson’s theory includes ten carative factors, which are principles

that guide nursing practice to promote healing , encouraging recovery, and well-being.

We, the student nurses, also encourage her active participation in her care and provide

education about her recovery.

These factors focus on aspects such as cultivating a trusting relationship,

promoting a supportive environment, and integrating scientific knowledge with the art of

caring. The Theory of Human Caring by Jean Watson is pertinent in the context

46
cesarean section cause by Arrest in Cervical Dilatation secondary to Cephalopelvic

Disproportion, as it emphasizes the significance of healthcare professionals connecting

with and caring for the mother on both an emotional and physical level. This method

lays a lot of attention regarding the need for empathy and compassion therapy during a

vulnerable time. This could enhance the mother’s overall health, cultivate confidence,

and support her recovery and resilience in the face of a difficult medical conditions.

Dorothea Orem’s Self Care Deficit Nursing Theory

According to Dorothea Orem, every individual has the ability and responsibility to

care for themselves to some extent. However, when individuals are unable to meet their

own self-care needs due to illness, injury, or other limitations, they experience a self-

care deficit. She emphasize the role of nurses in identifying self-care deficits, providing

support and education to individuals to enhance their ability to perform self-care

activities, and implementing nursing interventions to meet their self-care needs. The

goal of nursing, according to Orem, is to help individuals achieve self-care

independence whenever possible and to provide assistance when necessary to

maintain or restore health. As a student nurses, we help the patient suffering from

cesarean section cause by Arrest in Cervical Dilatation secondary to Cephalopelvic

Disproportion, motivating her to set short-term goals and giving her opportunities for

independence. We advise her to keep a watch on her, drink plenty of water, eating a

healthy diet, and seek medical help if her symptoms worsen. Dorothea Orem’s Self-

Care Deficit Nursing Theory, is important in cesarean section cause by Arrest in

47
Cervical Dilatation secondary to Cephalopelvic Disproportion because it emphasizes the

importance of teaching mothers to recognize warning signs and actively participate in

their recovery through self-care, potentially resulting in better outcomes and fewer

complications.

Betty Neuman’s System Model Theory

Betty Neuman’s theory, describes the individual as a system composed of

several interconnected components, including physiological, psychological,

sociocultural, developmental, and spiritual factors.The Neuman Systems Model

proposes that stressors, whether internal or external, can disrupt the individual’s

equilibrium and lead to illness or disease. In order to assess the patient’s physiological

and psychological impacts of the condition, we the student nurses, apply this theory to

the patient’s situation. In addition, we keep an eye on her vital signs to identify any

issues following her delivery, because it provides a comprehensive method for

evaluating and addressing the patient’s physical, psychological, environmental, and

spiritual requirements, Betty Neuman’s Systems Model is significant. By helping medical

professionals to better understand and assist the mother’s well-being, this promotes the

mother’s healing and stability. Overall, Betty Neuman’s theory provides a holistic

framework for understanding the complex interactions between individuals and their

environment and guides nursing practice in promoting health and well-being through

interventions aimed at maintaining or restoring equilibrium

48
 CHAPTER XVII

NURSING CARE PLAN

CUES NSG. DX. W/SCIENTIFIC OBJECTIVE OF NSG. ACTION EVALUATION

BASIS CARE

SUBJECTIVE Pain related to uterine After 4 hours of INDEPENDENT After 4 hours of

contractions secondary to nursing care nursing care
Nag sigisigig sakit akong labor process interventions the  Establish rapport. interventions the
tyan og likod as verbalized patient must be able patient reports that
 Monitor V/S.
to report that pain is in pain is in
manageable level.  Encourage rhythmic manageable level.
Scientific Explanation:
OBJECTIVE breathing patterns to
pain related to uterine promote relaxation
 Facial grimace contractions during labor is GOAL MET
 Discomfort a normal physiological  Advise positioning
response to the labor technique
Pain scale 4/10 process and is an essential
 Educate client of proper
VS taken as follows: part of childbirth.
breathing/relaxation
Understanding the
techniques.
BP: 110/80 mechanisms of labor pain
and implementing DEPENDENT
mmHg appropriate pain
management strategies can  Administer analgesic as
PR: 85 bpm doctors order.
help support mothers
RR: 23 bpm through the birthing process
and promote a positive
Oxygen Sat: 95% childbirth experience.

49
 CUES NSG. DX. W/SCIENTIFIC OBJECTIVE OF NSG. ACTION EVALUATION
BASIS CARE

SUBJECTIVE Impaired Mobility Related to After 6 hours of INDEPENDENT After 6 hours of

postoperative pain as evidence nursing care nursing care
Dili kaayo ko by reluctance to move due to interventions the  Establish rapport.
kalakaw paadtu sa interventions the
pain or discomfort. patient will do  Monitor V/S.
cr kay sakit akong patient is able to do
simple activity
tahi. As patient independently  Present a safe environment: simple activity
verbalized without pain or independently
Scientific Explanation: bed rails up
discomfort. without pain or
OBJECTIVE  Instruct in use of siderails,
Impaired mobility following discomfort.
 Appears surgery is a common overhead trapeze, roller pads,
weak occurrence and can be
walker, cane.
attributed to postoperative pain,
VS taken as follows: which limits a patient's ability to GOAL MET
 Promote proper nutrition and
move freely. Postoperative pain
BP: 110/80 hydration.
is a complex physiological
mmHg response to tissue injury during  Advice client to a complete
surgery, resulting in the
PR: 85 bpm bed rest.
activation of nociceptive
pathways and the release of
RR: 23 bpm inflammatory mediators. This
Oxygen Sat: 95% pain can manifest as a sharp,
DEPENDENT
dull, or throbbing sensation and
can significantly impact a  Administer analgesic as
patient's mobility and functional doctors ordered
status.

50
 CUES NSG. DX. W/SCIENTIFIC OBJECTIVE OF NSG. ACTION EVALUATION
BASIS CARE

SUBJECTIVE Severe pain related to After 8 hours of INDEPENDENT After 8 hours of

disruption of skin, tissue and nursing nursing
Sakit akong tyan labi muscle integrity. interventions the  Establish rapport. interventions the
na mag lihuk2 ko as patient pain will patient pain
patients verbalized  Monitor V/S.
verbalize verbalized
decreased pain  Encourage positioning decreased pain from
OBJECTIVE Scientific Explanation:
from pain scale of technique pain scale of 0-10
Observation Acute pain related to the 4-10 to 0-10
 Promote bed rest GOAL MET
Guarding behavior, disruption of skin, tissue, and
and Facial grimace. muscle is a common clinical
 Evaluate pain characteristics
diagnosis following surgical
Pain Scale 4-10 and intensity
procedures or traumatic
injuries. This type of pain is  Encourage verbalization of
VS taken as follows:
typically characterized by its feelings about the pain
BP: 110/80 sudden onset, sharp or
throbbing quality, and
mmHg localized nature at the site of
injury or surgical incision. The DEPENDENT
PR: 85 bpm disruption of skin, tissue, and  Administer analgesic and
RR: 23 bpm muscle during surgery or nonsteroidal anti-inflammatory
trauma triggers a cascade of drugs, opioids) as doctors
Oxygen Sat: 95% inflammatory responses, ordered
nerve sensitization, and tissue
damage, leading to the
perception of pain.

51
 CUES NSG. DX. W/SCIENTIFIC OBJECTIVE OF NSG. ACTION EVALUATION
BASIS CARE

SUBJECTIVE Fluid Volume deficit related to After 4 to 8 hours INDEPENDENT After 4 to 8 hours
excessive blood loss after shift of nursing shift of nursing
Pag tindug nako sir birth as evidenced by intervention the  Establish rapport. intervention the
kay grabe ang agas changes in mental status and healthcare provider healthcare provider
 Monitor V/S
sa dugo. increased heart rate. should be able to has able to prevent
prevent  Encourage fluid intake dysfunctional
OBJECTIVE Scientific Explanation: dysfunctional  Document and report any bleeding and
Heavy Bleeding bleeding and improve fluid
Deficient Fluid Volume related abnormal findings.
(blood saturating the improve fluid volume.
to excessive blood loss after
bed and pooling in volume.  Encourage green vegetables
birth can lead to changes in GOAL MET
floor) mental status and increased  Positioning technique Elevate
heart rate due to inadequate
oxygen and nutrient delivery the client’s legs if possible.
VS taken as follows: to tissues. Prompt medical Place a pregnant client in a
intervention, such as fluid
BP: 110/80 replacement therapy and left side-lying position.
blood transfusions, is
mmHg essential to restore fluid
PR: 85 bpm volume and prevent further
complications.
RR: 23 bpm
Oxygen Sat: 95%

52
 CUES NSG. DX. W/SCIENTIFIC OBJECTIVE OF NSG. ACTION EVALUATION
BASIS CARE

SUBJECTIVE Risk for Infection Related to After 8 hours of INDEPENDENT After 8 hours of
Surgical incision as Evidence by nursing care nursing care
Presence of surgical wound and interventions the  Establish rapport. interventions the
elevated white blood cell count. patient will be free patient is free from
OBJECTIVE  Monitor V/S
from any signs of any signs of
Increase WBC infection.  Monitor white blood cell infection.
Scientific Explanation: (WBC) count.
VS taken as follows: GOAL MET
Risk for infection related to a  Encourage the intake of
BP: 160/80 protein-rich and calorie-rich
surgical incision is a common
concern following surgical foods and encourage a
mmHg
procedures. The risk for balanced diet.
PR: 85 bpm infection is heightened when
 Observed for localized sign of
there is evidence of a surgical
RR: 23 bpm infection at insertion sites of
wound and an elevated white
invasive lines, surgical
Oxygen Sat: 90% blood cell count. the increased
incisions or wounds
vulnerability of a patient to
develop an infection following  Educate the necessity of
surgery. It underscores the taking antibiotics, as directed
importance of proactive
monitoring, preventive
measures, and prompt
intervention to minimize the risk DEPENDENT
of infection and promote the  Administer antibiotic as
patient's recovery. doctors ordered

53
 CHAPTER XVIII

PROGNOSIS

ACTUAL GOOD FAIR POOR JUSTIFICATION

DURATION  The patient stayed in the hospital for

almost more than a 3 days, which is
normal expected number of days of
clients who undergone cesarean
section. Despite the difficulties she had
faced since the beginning of her
delivery, the patient is still recovering
with the assistance of healthcare
professionals.

ONSET OF  The patient experienced arrest In

ILLNESS cervical dilatation secondary to
cephalopervic desproportion.

COMPLIANCE  The patient has complied with all of the

OF physician’s prescribed medication.
MEDICATION

FAMILY  The family is concerned about how the

SUPPORT patient is feeling. They also assisted
the patient with her prescribed
medication and treatment.

AGE  Cephalopelvic disproportion can affect

people of all ages. In terms of recovery
in relation to age, the patient is
relatively young, which can be an
advantage to have a faster recovery.

54
 COMPUTATION 2/5x10 2/5x1 1/5x10
0 00 0

40% 40% 20%

After assessing the client's condition, we came up with a good prognosis of 60%.

Despite the disease, the client's family and healthcare team are collaborating to restore

the client's normal health and maintain the patient's wellness.

55
 CHAPTER XIX
DISCHARGE PLAN (M.E.T.H.O.D)

Medication  Remind the patient and her family to take their medications
as prescribed by the physician.
 Inform the patient the possible adverse effects and to
contact the physician right away if she experience any
unusual symptoms.
 Always emphasize the importance of medication’s time and
dosage.
Exercise  Advice the patient to avoid any vigorous activities that
could strain her muscles.
The patient may do minimal exercises such as:

 Walking
 Pelvic tilts
 Kegel exercises
 Controlled breathing
Treatment  Continue present medications

 Ensure the patient get enough rest

 Emphasize the importance of maintaining hydration, and

maintain proper nutrition

Health Education  Educate the patient the importance of clean environment.

 Educate the patient how important the compliance with

prescribed medications.

Out-patient  Visit health care provider and follow up laboratory testing.

Schedule  Regular check up with the primary physician

Diet  Ensure a colorful fruits and vegetables for a variety of

56
 vitamins and minerals

 Ensure the patient to drink plenty of water to stay well-

hydrated, especially important if breastfeeding

 Legumes (beans, lentils, chickpeas)

 Leafy Greens vegetables (kale, broccoli)

 Whole grains

 Fortified plant based-milk

57
 CHAPTER XX
SUMMARY, FINDINGS, AND RECOMMENDATION

Summary

Pregnancy is a transformative experience for women, characterized by

both excitement and anticipation despite the inherent anxieties and physiological

changes. In cases where natural childbirth is not feasible, Caesarean section (CS)

emerges as a necessary intervention, contributing to a global uptick in recent years.

Cephalopelvic disproportion (CPD), although rare, presents a significant obstetric

challenge. It occurs when the size of the fetal head exceeds the capacity of the

maternal pelvis, resulting in obstructed labor. This complication poses substantial risks

to both the mother and the fetus.

A specific case study exemplifies the complexities associated with CPD in

obstetric care. Through the case of a 34-year-old Filipino woman requiring Caesarean

section due to Arrest in Cervical Dilatation Secondary to Cephalopelvic Disproportion

(CPD), healthcare professionals gain valuable insights into optimal patient management

strategies. This case underscores the importance of early intervention and meticulous

monitoring to address CPD-related challenges during childbirth effectively.

Finding

Gravida 1 Parity 1 (1001) pregnancy uterine delivered term cephalic live birth

baby girl by cesarean section cause by Arrest in cervical dilatation secondary to CPD

58
Recommendation

Based on the outcome of this study, this study would be beneficial to the

following:

Patient: The patient should have full awareness about the disease on how to consider

those interventions and methods that best suits to his disease. And by this study It can

also make the aware of what are the adjustment that he/she need to do or what are the

things that he/she need to refrain of doing.

Nurses: This study is important especially to the nurses since it will also serve as their

guide on how to formulate some therapeutic and non-therapeutic interventions that can

really provide quality care to the patients having this kind of disease.

Community: This study will be beneficial to the community since it will serve as their

reference guide on how to patient's recovery

Future Researchers: The findings of the study served as a reference material and a

guide for future researcher who wish to conduct the same study or any study related to

patient

59
 REFFERENCES

Abdelmounaim, L. G., Rjafallah, A., Nhiri, N., Biougnache, N., Benafitou, R., Barka, R., ... & Lafkir, S.

(2021). Oxytocin and uterine atony during cesarean section. Open Journal of Obstetrics and

Gynecology, 11(6), 815-822.

Ahmeidat, A., Kotts, W. J., Wong, J., McLernon, D. J., & Black, M. (2021). Predictive models of

individual risk of elective caesarean section complications: a systematic review. European Journal of Obstetrics

& Gynecology and Reproductive Biology, 262, 248-255.

Luke, B., Brown, M. B., Wantman, E., Baker, V. L., Doody, K. J., Seifer, D. B., & Spector, L. G. (2019).

Risk of severe maternal morbidity by maternal fertility status: a US study in 8 states. American journal of

obstetrics and gynecology, 220(2), 195-e1.

Bank, T. C., Macones, G., & Sciscione, A. (2023). The “30-minute rule” for expedited delivery: fact or

fiction?. American Journal of Obstetrics and Gynecology.

Kalev-Altman, R., Becker, G., Levy, T., Penn, S., Shpigel, N. Y., Monsonego-Ornan, E., & Sela-

Donenfeld, D. (2023). Mmp2 Deficiency Leads to Defective Parturition and High Dystocia Rates in

Mice. International Journal of Molecular Sciences, 24(23), 16822.

Hanson, L., Malloy, E., & Simkin, P. (Eds.). (2024). Simkin's Labor Progress Handbook: Early

Interventions to Prevent and Treat Dystocia. John Wiley & Sons.

Pepito, V. C., Amit, A. M. L., Tang, C. S., Aliazas, N. A. K., Sarah, J., Baquiran, R. S., & Tanchanco, L.

B. S. (2021). Factors Associated with Pregnancy Among Filipino Women Aged 15-19: Results from the 2017

Philippine National Demographic and Health Survey.

Liberty, G., Gemer, O., Siyanov, I., Anteby, E. Y., Apter, A., Cohen, S. M., ... & Yagel, S. (2022). The

Relation between Head Circumference and Mid-Pelvic Circumference: A Simple Index for Cephalopelvic

Disproportion Evaluation. Fetal Diagnosis and Therapy, 48(11-12), 840-848.

60
 Romero, L. O., Mugarra, R. C. C., Victor, A. K., Ramirez, J., Valdez, F. J. S., Walsh, P., ... & Vásquez,

V. (2024). Linoleic acid improves Piezo 2 dysfunction in a mouse model of Angelman syndrome. Biophysical

Journal, 123(3), 244a.

Ami, O., Maran, J. C., Cohen, A., Hendler, I., Zabukovek, E., & Boyer, L. (2023). Childbirth simulation

to assess cephalopelvic disproportion and chances for failed labor in a French population. Scientific

Reports, 13(1), 1110.

Friedman, E. A., & Cohen, W. R. (2023). The active phase of labor. American Journal of Obstetrics

and Gynecology.

Thornton, J. M., Browne, B., & Ramphul, M. (2020). Mechanisms and management of normal

labour. Obstetrics, Gynaecology & Reproductive Medicine, 30(3), 84-90.

Adams, D., Tournev, I. L., Taylor, M. S., Coelho, T., Planté-Bordeneuve, V., Berk, J. L., ... & HELIOS-A

Collaborators. (2023). Efficacy and safety of vutrisiran for patients with hereditary transthyretin-mediated

amyloidosis with polyneuropathy: a randomized clinical trial. Amyloid, 30(1), 18-26.

Nelson, D. B., & Fomina, Y. Y. (2024). Challenges in Using Progestin to Prevent Singleton Preterm

Births: Current Knowledge and Clinical Advice. International Journal of Women's Health, 119-130.

61