CASE STUDY IN

POLYHYDRAMNIOS

Submitted by:Aliza Savarez

Ma. Loisa Faresa LimPeter LagulosMa. Mil Pama

BSN 2A

INTRODUCTION

• Delivery Room Rotation, is all about the goal of the student nurses to provide a safe and supportive environment for the mother and the baby during delivery.

• Patient ML admitted• Onset of irreg. abdominal contractions• No pain, bloody and watery vaginal

discharges• 37 weeks and 6 days• 35 y.o• Edc : dec. 26, 14• polyhydramnios

We chose this client: ( reason )• Show the readers the process;• Causes;• Effects;• s/s;• Probable risk that might

happen in the later course• and for the readers to fully

understand and be reminded on one of the complications, associated in pregnancy.

• According to Carlo WA, Polyhydramnios,

• Early in the second trimester;• the baby starts to swallow the fluid

and excrete urine which is swallowed again

• Cunningham FG, Polyhydramnios,• Complications are;• prolapsed of the umbilical cord,• increased incidence of

malpresentations• increased incidence of postpartum

maternal hemorrhage.

• Gilbert WM stated:• A high-resolution

ultrasound is needed to check for abnormalities

•  amniocentesis to test for a genetic defect and infections.

• must have regular non stress tests 

• (Statistically,)According to Washington’s State ,

• conducted a population-based case-control study

• This assess possible association of maternal smoking with polyhydramnios

• which is 70 % Result as of 2014

(Davis M, Am J Public Health)

• Nationally, in Manila Philippines St. Lukes Hospital

• mild Polyhydramnios, 85 %;• And for the moderate

Polyhydramnios is 17 % ( DOH 2013 ) • Locally, in Davao city • Davao doctors Hospital • reach a 15% percent incidence

rate of pregnant women diagnosed with Polyhydramnios.

(MindaNews March 4, 2014)

• Nursing Education;• Enhance the:• reasoning skills as an act of

discovering new diseases and complications.

• NursingPractice;• Enhaced:• excellent communication skills

for counseling and educating clients

• Lastly,• In Nursing Research• Research is becoming more

wider in view;• In Complications of pregnancy• Share some points• On how to deal with

complications in pregnancy.

General Objectives:At the end of this

Case Study, we the students of BSN 2A group 3 will enhance our knowledge, develop our skills, and acquire the necessary attitude with the care of our client.

Specific Objectives: We would like to achieve the following:• Establish rapport to the patient during Initial Assessment;

• conduct an Interview;• gather pertinent data’s of the patient;• describe what is delivery room rotation;• define polyhydramnious;• get the statistical data of polyhydramnious

globally, nationally and locally;• relate the case in the nursing education

and nursing implications;• get our clients demographic data;• obtain clients obstetric data;

• calculate clients EDC;• recall the clients obstetric history;• search out the clients past health history;• dig up the clients past health history;• trace the hereditary diseases that are acquired by

the patient;• perform physical assessment;• monitor contractions and fetal heart tone• make a drug study on the client’s ordered

medication

• relate our case to the nursing theories• prioritize our nursing care plans;• formulate a related nursing diagnosis

from the patient’s health data and to current problems patient is experiences and to come out with different nursing interventions effective for the patient and to improve and progress on the most possible time;

• set realistic objectives of care• perform and implement the nursing

interventions• evaluate the nursing interventions

that have been done.

Demographic Data • Mirasol Libaton• 35 years old• Poblacion Marasugusan Comval Province• Roman Catholic• Married• Self-employed in RTWs Clothing Line• August 27, 1979• Jerry Libaton• Self-employed in RTWs Clothing Line• 20-25 thousand monthly • College Graduate in Commerce

Obstetric Data• Menarche: 13 years old• Coitarche: 20 years old• Sexual Partner: 1• LMP: March 19, 2014• EDC: December, 26, 2014• PMP: February 2014• AOG: 37 weeks and 6 days• Menstrual Cycle: regular 5 days*5 pads• Quickening 4 months• USD: May 25, 2014• Adjusted EDC: January 1, 2015• AOG: 37 weeks• G4 P3 A0• T3 P0 A0 L2

LMP calculations  

LMP- March 19, 2014 3 19 2014 -3 +7 +1

0 26 2015 +12 -1 12 26 2014

PRESENT HEALTH HISTORY

• Diagnosed with UTI 3 months prior to admission

• Measles after 2 months

• Irregular abdominal contractions 2 days prior to admission

PAST HEALTH HISTORY• 11 years of age, surgery due

to strabismus or cross eyed• 2 years ago.

Cholecystectomy;• contraceptive pills without

approval,• fatty foods and, • eating peanuts.• asymptomatic • rupture of gallbladder

through USD

Family History

On the first generation, paternal side, both grandparents were deceased already. Wherein, paternal grandfather was asthmatic and hypertensive. On its second generation, they are all 7 in the siblings these are, Rosalinda the eldest, followed by Rudy,then Sam which is hypertensive, Estrella which is also hypertensive as well, and then followed by Roland, Carla, and lastly Ernes.

On the first generation, maternal side, both grandparents were deceased already, wherein only maternal Grandfather was ill because of leukemia. On its second generation,maternal side, they are all 5 in the siblings these are Ferdinand the eldest, followed by Edwin, then Rosy, Felly, and lastly Fredo, wherein Maternal Uncle Edwin is diabetic. Sam and Rosy met together and third genetion is followed.

On the third generation, they are 10 members of siblings. These are Robesrt, Floredel, Rick, Mirasol our patient, followed by Robilito, Ronnie, Richie, Roland, Charlene, and Frederick the youngest. Wherein, Floradel is hypertensive, as well as Richie who is asthmatic.

Physical Assessment

General Survey• receive the patient sitting down on the bed• wearing her delivery room slippers, • delivery room gown • with an IVF of D5LR 1L @120cc/hr infused • Right metacarpal vein, • awake • and conscious,• and is experiencing labor pain.• Signs of distress present, • grimaced face • and was in labor breathing. • height of 5’2 inches • weight of 75.4 kg

• Temperature- 35.8 degree Celsius

• Pulse rate -79 bpm

• Cardiac rate- 81 bpm

• Respiratory rate- 20 cpm

• Blood pressure -100/ 70 mmhg

Head and Scalp• Oily hair • dandruff noted. • some tangled hair from the bottom part • head is normocephalic,• there are no deformities of the head noted.

Nails• Capillary Refill- blanch test- of 2 seconds (< 3

sec); may indicate circulatory or respiratory problem.

• nails are not properly trimmed• some dirt in each sides of it. • There are no clubbing of fingers

Skin• brown which is even to other parts of the

body, • There is an absence of lesions

Eyes• The conjunctiva is pink,. • Has a good vision of 20/20 ,• the eyelids are blinking normally .

Nose• Normal nasal congestion noted, • no signs of tenderness • and swelling

Ears• no discharges noted • no tenderness • pinna is level at the outer canthus of the eye ,• no lesions noted. • some dirt at the back of the ear as observed. • no Nasal painfulness/swelling/tenderness

Mouth and Teeth• cracked lips not noted, • moist lips noted. • There are Dental carries

Neck• There are no tenderness, • there are no any enlarged or painful nodes.

Thorax• respiratory rate, it is 20 cpm• Pt. in labored breathing at the time of

contraction• clear breath sounds all through lung

fields.

Heart• cardiac rate in supine which is 81

bpm. • heard the two basic normal

sounds which ‘lub” dub”.

Breast• enlargement of the breast • wider and darker areola• Colostrum,• a thin watery fluid, can be expressed from the

nipple as verbalized by our client.

Skin in the abdomen• Purple striae is present • linea nigra as inspected. • Fetal heart tone of 140 bpm

Back• a lumbar curve

Extremities• feet edema ;• both ankles and• Waddling walk is observed

Genitals• Small amount of Vaginal discharge• IE: 3cm dilatation • No lumps, • no rashes, • no tenderness noted. • Bloody smell • She can also feel that there is a discharge coming

out from her rectum during contraction as verbalized.

Medical Management/ medical orders

• December 9,2014-Fleet enema

• December 9,2014-D5LR 120cc/hr

• December 10, 2014-Multivitamins and ferrous sulfate

Generic name Ferrous Sulfate

Classification Antianemic Iron

Pregnancy Category

A

OTC Feosol, Fer-Gen-Sol, Fer-in-Sol, FeroSul

DOSAGE Dose: 2-3mg/kg

Frequency: Once a day

Route: PO.

USES Prophylaxis and treatment of iron deficiency and iron-deficiency anemias.

Dietary supplement for iron. Optimum therapeutic responses are usually noted within

2-4 weeks.

MOA Ferrous Sulfate is an essential component in the formation of hemoglobin, myoglobin

and enzymes. It is necessary for effective erythropoiesis and transport or utilization

of oxygen.

CONTRAINDICATIONS

Hemosiderosis, hemochromatosis, peptic ulcer, regional enteritis, and ulcerative

colitis.Hemolytic anemia, pyridoxine-responsive anemia, and cirrhosis of the liver. Uses in

those with normal iron balance.

Generic Name Multivitamins 

 prenatal multivitamin (pree-NATE-al muhl-tee-VYE-ta-min

Brand Name Prenate AM and Vitafol-Ultra

Classification A 22.1 Multivitamins with minerals

Dosage One to two tablets daily.

Side Effect Constipation; darkened or green stools; diarrhea; loss of appetite; nausea; stomach cramps, pain, or upset;

vomiting.

Adverse Effect Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth,

face, lips, or tongue); black, tarry stools; blood or streaks of blood in the stools; fever; severe or persistent

nausea, stomach pain, or vomiting; vomit that looks like blood or coffee grounds.

Mode of Action: Prenatal multivitamin is a vitamin and other supplement combination. It works by providing vitamins and

minerals to the body to help meet nutritional requirements

Drug Interaction Multivitamins can interact with certain medications, or affect how medications work in your body. Ask a doctor or

pharmacist if it is safe for you to use multivitamins if you are also using any of the following drugs:

tretinoin or isotretinoin; an antacid; an antibiotic; a diuretic or "water pill"; heart or blood pressure medications; a sulfa drug; or NSAIDs (nonsteroidal anti-inflammatory drugs)--ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib,

diclofenac, indomethacin, meloxicam, and others.

Nursing Responsibility: Do not take large doses of vitamins (megadoses or

megavitamin therapy) while you use prenatal

multivitamin unless your doctor tells you to.

Prenatal multivitamin may cause darkened or green

stools. This is normal and not a cause for concern.

Prenatal multivitamin may interfere with certain lab

tests. Be sure the doctor and lab personnel know

your patient are taking prenatal multivitamin.

Tell the patient do not take an antacid within 2

hours of prenatal multivitamin.

Advices the patients do not take dairy products with

this drug. Dairy products may make this drug not

work as well.

Generic Name Sodium Phosphate

Brand Name Fleet Enema Extra

Classification Laxative

DOSAGE Adults: Enema/Enema Extra: 1 bottle (133mL or 230mL)/24 hrs.

Rectal route

MOA Saline laxative; induces complete emptying of the left colon, usually within 1-5 min, without pain

or spasm.

Side Effects Abdominal or stomach pain

Bloating

Nausea

Vomiting

Adverse Effects

Hypersensitivity, Pruritus, Dehydration, Hyperphosphatemia, hypocalcemia, hypokalemia,

hypernatremia, metabolic acidosis

Drug Interaction

Do not coadminister with other sodium phosphate preparations. Electrolyte disturbances and

hypovolemia from purgation may be exacerbated by concomitant use of diuretics, ACE

inhibitors, ARBs, NSAIDs, and lithium or other medications that may affect electrolyte levels.

May lower lithium levels, causing reduced effectiveness. Caution with medications that affect

renal perfusion/function or hydration status, or known to prolong the QT interval.

Generic Name dextrose monohydrate sodium chloride sodium lactate

Brand Name 5% Dextrose in Lactated Ringer's

Classification Hypertonic Nonpyrogenic Parenteral fluid Electrolyte Nutrient replenisher

DOSAGE D5LRs is supplied in single-dose 500 and 1000 mL flexible plastic containers. 1000 mL @ 30 gtts/min or as prescribed by the physician.

MOA Hypertonic solutions are those that have an effective osmolarity greater than the body

fluids. This pulls the fluid into the vascular by osmosis resulting in an increase vascular

volume. It raises intravascular osmotic pressure and provides fluid, electrolytes and calories

for energy.

Side Effects ncreasedserumosmolality Hypernatremia Hypokalemia Alteredthermoregulation Pulmonaryedema Cardiovascularoverload

Adverse Effects Immune System Disorders: Hypersensitivity/infusion reactions, including

anaphylactic/anaphylactoid reactions, and the following manifestations: angioedema,

chest pain, chest discomfort, bronchospasm, dyspnea, cough, urticaria, rash, pruritus,

erythema, nausea and pyrexia

Drug Interaction

Nursing Responsibility Do not administer unless solution is clear and container is undamaged. Caution must be exercised in the administration of parenteral fluids, especially

those containing sodium ions to patients receiving corticosteroids or

corticotrophin. Solution containing acetate should be used with caution as excess administration

may result in metabolic alkalosis. Solution containing dextrose should be used with caution in patients with known

subclinical or overt diabetes mellitus. Discard unused portion. In very low birth weight infants, excessive or rapid administration of dextrose

injection may result in increased serum osmolality and possible intracerebral

hemorrhage. Properly label the IV Fluid Observe aseptic technique when changing IV fluid

Diagnostic TestDate Result Rationale

October 10 2014 Bilateral cleft lip and

palate

Defects caused by congenital infections result when a mother gets an

infection before or during the pregnancy. Infections that can cause

birth defectsinclude rubella (German measles), 

cytomegalovirus (CMV), syphilis, toxoplasmosis, Venezuelan equine

encephalitis, parvovirus, and, rarely,  chickenpox. If the mother is

infected during early pregnancy, rubella carries the highest risk for

birth defects.

October 20, 2014 Fetal 2Decho done around 20 weeks provide general information on different parts

of the fetus including the head, chest, abdomen, and extremities.  The

regular ultrasound checks the fetus' heart to make sure it has all four

chambers.

December 5,2014 Polyhydamios a baby will have a medical problem or birth defect that causes him to

stop swallowing fluid while his kidneys continue to produce more. This

may include any condition that makes it hard for him to swallow, such

as pyloric stenosis, a cleft lip or palate, or some kind of blockage in

the gastrointestinal tract. Certain neurological problems, such as with

a neural tube defect or hydrocephaly, can keep the baby from

swallowing as well

Medical OrdersDate Ordered Medical Order Rationale

December 9,2014 Fleet enema A fleet enema is a saline-based enema, which pulls water from your body, into the bowels, so that your stools are softened, making it easier for you to have a bowel movement. People all over the world use fleet enema as a measure for constipation. Since constipation is one of the signs of pregnancy, many women check with their doctors if it is safe for them to use a fleet enema during pregnancy.

December 9,2014 D5LR 120cc/hr  Lactated Ringer's maintains fluid volumes in balance between the space

inside and outside the blood vessels. It contains electrolytes, substances

necessary for cell functioning, such as sodium, chloride, potassium and

calcium, but not in the same proportion as the human body. It is used

when intravascular volume is low or to maintain fluid volume during

surgery or labor. Dehydration, burns, gastrointestinal fluid loss and acute

blood loss may all dictate Lactated Ringer's administration to replace

large fluid losses quickly.

December 10, 2014 Multivitamins

and ferrous

sulfate

Ferrous sulfate is given during pregnancy when the potential benefits

outweigh the potential risks also it is given on both anemic and non-

anemic patient. Ferrous sulfate administration during lactation is

generally considered safe for the infant.   Pregnancy multivitamins give

you 100 per cent of the recommended daily allowance of all the essential

vitamins and most minerals. 

Diagnostic test

• October 10 2014 - Bilateral cleft lip and palate

• October 20, 2014 -Fetal 2Decho

• December 5,2014 -Polyhydamios

Nursing Theories1. Maternal Role Attainment

Theory• Theorist: Ramona Mercer• head nurse in pediatric • staff nurse in intrapartum,

postpartum and newborn• experience in nursing care of

mother and infants

The Theory Contain 4 Stages of Acquisition

• Anticipatory Stage• Formal Stage• Informal Stage• Personal Stage• development of mother-child

relationship

• Theorist : Virginia Henderson• “First Lady of Nursing” & “First

Truly International Nurse”• health as a quality of life

14 Basic needs of the theory

1. Breathing Normally2. Eating and drinking 3. Elimination of wastes4. Moving and maintaining a desirable

position5. Sleeping and resting6. Selecting suitable clothes7. Maintaining normal body

temperature by adjusting clothing

8. Clean body and well groomed 9. Avoiding dangers and injuries10. Communicating11. Worshipping12. Working for accomplishment13. Planning or participating 14. Learning, discovering ,satisfying

the curiosity

Henderson’s theory

• Patient and Family as a single unit

• support system (emotional needs)

THANKYOU