Placenta Acrreta Essay Example

I. INTRODUCTION PLACENTA ACCRETA The abnormal adherence of the chorionic villi (vascular fingers of the chorion, a part of the placenta) to the myometrium (the muscle of the uterus). Normally, there is tissue intervening between the chorionic villi and the myometrium but in placenta accreta, these vascular processes of the chorion grow directly in the myometrium. Placenta accreta occurs when your placenta attaches too firmly to the inside wall of your uterus.Placenta Acrreta Essay Example. This is a rare disorder, occurring in only 1 in 5000 pregnancies, and is associated with serious complications.
There are three variants of placenta accreta:  Placenta Accreta: occurs when the placenta attaches too deep in the uterine wall but it does not penetrate the uterine muscle. This is the most common accounting for approximately 75% of all cases. Placenta Increta: occurs when the placenta attaches even deeper into the uterine wall and does penetrate into the uterine muscle. This accounts for approximately 15% of all cases. Placenta Percreta: occurs when the placenta penetrates through the entire uterine wall and attaches to another organ such as the bladder.
This is the least common of the three conditions accounting for approximately 5% of all cases. Risk Factors for Placenta Accreta You are at increased risk for placenta accreta if: * you have placenta previa (the placenta covers the cervix); * you have a history of cesarean section or other operations on the uterus; * your placenta is implanted over a scar in the uterus * you are over age 35; * you have been pregnant before; or * you have had your uterine lining scraped during dilation and curettage procedure. * Ruptured uterus that cause scar Complications of Placenta Accreta Placenta accreta is connected with severe complications.

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Because the placenta is so firmly attached to the uterus, it can make it difficult for you to deliver the placenta after you have given birth. It is possible that the uterus will become damaged or torn as you try to pass the placenta afterbirth. Placenta accreta also causes those contractions that occur after labor to stop. These contractions play a role in minimizing blood loss. As a result, placenta accrete can cause serious hemorrhaging. MEDICAL MANAGEMENT Conservative treatment is done if the woman wants to maintain her fertility under the condition that no active bleeding is present.
This treatment saves the uterus but poses higher risk of complications and low successful rate. Techniques for this treatment are as follows: * The placenta is left in the uterus and the cord is ligated. * Closure of the uterus is performed. * Methotrexate (an antineoplastic agent) is usually given to the woman to destroy the still attached placenta. Women taking Methotrexate should be monitored for: * WBC and platelet count (thrombocytopenia and leucopenia may occur 7-14 days after the initiation of treatment) * Blood Urea Nitrogen (BUN), Creatinine, and urine pH (should be above 7. ) * Presence of dry and nonproductive cough may be an early sign of pulmonary toxicity * Symptoms of gout must be assessed frequently (increased uric acid, joint pain, edema). Methotrexate causes increase serum uric acid. Allopurinol may be given to decrease uric acid levels.Placenta Acrreta Essay Example. After the techniques are implemented, prophylactic antibiotic is started to prevent infection.  Follow-up includes frequent or daily ultrasound sessions to monitor uterine involution and placental condition. Surgical Management Early detection of placenta accreta will prevent serious complication.
The safest modality is aplanned cesarean section and hysterectomy (surgical removal of the uterus). Nursing Management 1. Obtain a detailed obstetric history. 2. Assist with modalities implemented. 3. For clients taking Methotrexate, instruct the woman to increase fluid intake to at least 2 L each day as uric acid formation is increased with the drug use. 4. Provide emotional support to the woman and family. Patient’s Profile Name: Mrs. K. B. Age: 27 years old Gender: Female Religion: Roman Catholic Marital Status: Live In Address: Zone 2 Sitio Halang San Isidro, Cainta Rizal.
Date of Birth: February 22, 1983 Date of Admission: November 17, 2010 Chief Complain: Retained Placenta and Vaginal Bleeding History of Present illness: The time Mrs. K. B. admits, she had a post non institutional delivery for 3 hrs G2P2 (2wks) History of Past illness: Mrs. K. B. with Post Partum Hemorrhage secondary 2 to retained Placenta probably due to uterine atony, uterine rupture hypovolemic shock anemia severe. Family History: The Family of Mrs. K. B. was no manifestation of illness. The Grandmother and the father of Mrs. K. B. has a diabetes mellitus. Social History
Cainta, Rizal is the residence of Mrs. K. B. together with her husband E and their child C. M was 3 years old and a 6 days baby boy S. Mrs. K. B. was an undergraduate. She is a house wife. Roman Catholic is her religion. She does not any vices like smoking and alcohol use. His husband is a tricycle driver which sustains their financial status. Placenta Acrreta Essay Example. Mrs. K. B. spends her time on their family. Medication Cefuroxime1. 5g TIV Retorolac20mg TIV Nalbuphine5mg TIV FeSO41 tab BID Ascorbic Acid500mg Mefenamic Acid500mg Patient’s Profile Name: Mrs. K. B. Age: 27 years old Gender: Female
Religion: Roman Catholic Marital Status: Live In Address: Zone 2 Sitio Halang San Isidro, Cainta Rizal. Date of Birth: February 22, 1983 Date of Admission: November 17, 2010 Chief Complain: Retained Placenta and Vaginal Bleeding History of Present illness: The time Mrs. K. B. admits, she had a post non institutional delivery for 3 hrs G2P2 (2wks) History of Past illness: Mrs. K. B. with Post Partum Hemorrhage secondary 2 to retained Placenta probably due to uterine atony, uterine rupture hypovolemic shock anemia severe. Family History: The Family of Mrs. K. B. was no manifestation of illness.
The Grandmother and the father of Mrs. K. B. has a diabetes mellitus. Social History Cainta, Rizal is the residence of Mrs. K. B. together with her husband E and their child C. M was 3 years old and a 6 days baby boy S. Mrs. K. B. was an undergraduate. She is a house wife. Roman Catholic is her religion. She does not any vices like smoking and alcohol use. His husband is a tricycle driver which sustains their financial status. Mrs. K. B. spends her time on their family. Medication Cefuroxime1. 5g TIV Retorolac20mg TIV Nalbuphine5mg TIV FeSO41 tab BID Ascorbic Acid500mg Mefenamic Acid500mg DRUG STUDY
MEDICATION| CLASSIFI-CATION| INDICATION/ DOSAGES| CONTRAINDICATION| DRUG-DRUG INTEREACTION| PHARMACOKINETICS/ PHARMACODYNAMIC| NURSING INTERVENTION| ADVERSE EFFECT| Generic Name:Ranitidine hydrochlorideBrand Name:Zantac| Drug Class: Histamine-2 ceptor antagonistPregnancy Category: B | >reduces gastric acid secretion and increases gastric mucus and bicarbonate production, creating a protective coating on the gastric mucosaDOSAGES:50mg TIV TID| >Contraindicated for patients with hypersensitivity to ranitidine, with history of porphyria>Use cautiously by patients with renal hepatic impairment, heart rhythm disturbances, pregnancy| >increased effect of the warfarin, TCA’s. onitor patient closelyand adjust dosages as needed| Route | Onset| Peak | Duration| >Monitor rapid IV injectionRATIONALE: Rapid IV injection can cause hypotension>Arrange for follow-up including blood testRATIONALE: to evaluate effects> Inform patient that increased fluid and fibers intakeRATIONALE:may minimize constipation. | >CNS:Headache, insomniaGI:Nausea or pain. Placenta Acrreta Essay Example. Skin:Rash| | | | | | Oral| varies| 1-3 hr | 8-12 hr| | | | | | | | IM | rapid| 15min| 8-12 hr| | | | | | | | Iv | immediate| 5-10 min| 8-12 hr| | | | | | | | Metabolism : hepatic T ? : 2-3 hrDistribution: crosses placenta, enters breast milkExcretion: Urine| | |
MEDICATION| CLASSIFI-CATION| INDICATION/ DOSAGES| CONTRAINDICATION| DRUG-DRUG INTEREACTION| PHARMACOKINETICS/ PHARMACODYNAMIC| NURSING INTERVENTION| ADVERSE EFFECT| Generic Name:Ferrous SulfateBrand Name:Fer-gen-sol| Drug Class: Iron preparationPregnancy Category: A| Provides elemental iron, an essential component in the formation of hemoglobinDOSAGES:1 tab BID| >Contraindicated for patients with primary hemolytic anemia, peptic ulceration, ulcerative colitis, regional enteritis| > antacids decrease iron absorption, iron decreases absorption of tetracyclines, ciprofloxacin, ofloxacin; chloramphenicol may delay iron’s effects, iron may decrease absorption of penicillamine, ascorbic acid may increase iron absorption. Route | Onset| Peak | Duration| ; Caution patient to make position changes slowlyRATIONALE: to minimize orthostatic hypotension;Instruct patient to avoid use alcohol or over the counter medicine without consulting the patientRATIONALE: to avoid delayed absorption of Ferrous Sulfate| ;Nausea, rash, Dizziness, Headache| | | | | | Oral| 4 days| 7-10 days | 2-4 mos. | | | | | | | | Metabolism : recycled for use ? : not knownDistribution: crosses placenta, enters breast milkExcretion: Unknown| | | MEDICATION| CLASSIFI-CATION| INDICATION/ DOSAGES| CONTRA-INDICATION| DRUG-DRUG INTEREACTION| PHARMACOKINETICS/ PHARMACODYNAMIC| NURSING INTERVENTION| ADVERSE EFFECT| Generic Name:Ascorbic AcidBrand Name:Cecon| Drug Class: VitaminsPreg-nancy Category: C| ;Water-soluble vitamin with antioxidant properties; stimulates ollagen formation and enhances tissue repairDOSAGES:750mg OD| ;Contraindicated for patients with diabetes mellitus, sodium- restricted diet, concurrent anticoagulant use and history of renal calculi;Contraindicated to patients with hypersensitivity to ascorbic acid and its content, breastfeeding patients| Ascorbic acid increases the amount of aluminum absorbed from aluminum-containing antacids. | Route | Onset| Peak | Duration| ;when giving for urine acidification check for urine phRATIONALE:;to ensure efficacy;stress proper nutritional habitRATIONALE:;to prevent recurrence of the deficiency;avoid over dosing of vit. CRATIONALE:;it can cause nausea and diarrhea;women should consult to doctor before taking vit. RATIONALE:;large amount of vit. C cause increase in estrogen level| ;dizziness, headache| | | | | | Oral| varies| 1-3 hr | 8-12 hr| | | | | | | | | | | | | | | | | | Metabolism : hepatic T ? : 2-3 hrDistribution: crosses placenta, enters breast milkExcretion: urine| | | MEDICATION| CLASSIFI-CATION| INDICATION/ DOSAGES| CONTRA-INDICATION| DRUG-DRUG INTEREACTION| PHARMACOKINETICS/ PHARMACODYNAMIC| NURSING INTERVENTION| ADVERSE EFFECT| Generic Name:Mefenamic AcidBrand Name:Ponstan| Drug Class: NSAIDPreg-nancy Category: C| ;Indicated for the treatment of mild to moderate pain, inflammation, and fever. Placenta Acrreta Essay Example. DOSAGES:1mg cap QID| ;Contraindicated in patients with active ulceration or chronic inflammation of either the upper or lower gastrointestinal tract;Contraindicated in patients with preexisting renal disease. gt;Contraindicated to patients with hypersensitivity to drug and pregnant women| ;Mefenamic acid may interact with the following medications:;Angiotensin converting enzyme(ACE) inhibitors, Aspirin, Diuretics, Lithium, Methotrexate, Warfarin and other anticoagulants, Antacids. | Route | Onset| Peak | ; Instruct the patient to take this drug after mealRATIONALE: to lessen stomach upset;Advise patient to increase fluid intakeRATIONALE: To prevent dehydration;Position the client comfortablyRATIONALE: to provide comfort| ;headache;dizziness;rash| | | | | | Oral| varies| 1-3 hr | | | | | | | | Metabolism : hepatic T ? : 2-4 hrDistribution: crosses placenta, enters breast milkExcretion: feces, urine| | |
MEDICATION| CLASSIFI-CATION| INDICATION/ DOSAGES| CONTRA-INDICATION| DRUG-DRUG INTEREACTION| PHARMACOKINETICS/ PHARMACODYNAMIC| NURSING INTERVENTION| ADVERSE EFFECT| Generic Name:nalbuphine hydrochlorideBrand Name:Nubain| Drug Class: Opioid angonist- antagonist analgesicPreg-nancy Category: B (D in prolonged use or high doses at term)| ;Relief of moderate to severe pain;Pre operative analgesia, and for obstetric analgesia during labor and delivery. DOSAGES:5 mg TIV q 4hrPRN for severe pain| ; Contraindicated with hypersensitivity to nalbuphine, sulfites. ; Who are especially sensitive to respiratory depressant effects of opioids bronchial asthma, respiratory depression. | ;Potentiating of effects with barbiturate anesthetics| Route | Onset| Peak | Duration| ;Taper dosage when discontinuing after prolonged useRATIONALE:;To avoid withdrawal symptoms;Keep opioid antagonist and facilities for assisted or controlled respiration available RATIONALE:; Incase of respiratory depression. | .
CNS: headache, nervousness, dizziness. GI: nausea| | | | | | IV| 2-3 min. | 15-20 min| 3-6 hr| | | | | | | | subcu | less than| 30-60 min| 3-6 hr| | | | | | | | Im| 15 min| | | | | | | | | | Metabolism : hepatic T ? : 5 hrDistribution: crosses placenta, enters breast milkExcretion: urine| | | MEDICATION| CLASSIFI-CATION| INDICATION/ DOSAGES| CONTRA-INDICATION| DRUG-DRUG INTEREACTION| PHARMACOKINETICS/ PHARMACODYNAMIC| NURSING INTERVENTION| ADVERSE EFFECT| Generic Name:Cefuroxime sodiumBrand Name:Zinacef| Drug Class: AntibioticPreg-nancy Category: B| ;Skin and skin structure infections, including impetigo caused by streptococcus aureus. S. yogenesDOSAGES:Cefuroxime 1g TIV q 12 hrs ANST| ; Contraindicated with allergy to cephalosporins or penicillines. | ; Increased nephrotoxicity with aminoglycocides. ;Increased bleeding effects with oral anticoagulants. ;Risk for disulfiramlike reaction with alcohol. | Route | Onset| Peak | Duration| ;Discontinue if hypersensitivity reaction occurs. RATIONALE:;To avoid allergies;Have vitamin k availableRATIONALE:;Increase hypo rprothrombinemia occurs. ;Culture infection, And during therapyRATIONALE:;If expected response is not seen. | CNS: headache, dizzinessGI: nausea, abdominal pain| | | | | | IV| rapid| immediate| 18-24 hr| | | | | | | | IM | 20 min. 30 min. | 18-24 hr| | | | | | | | Oral| varies| 2 hr| 18-24 hr| | | | | | | | Metabolism : hepatic T ? : 1-2 hrDistribution: crosses placenta, enters breast milkExcretion: urine| | | MEDICATION| CLASSIFI-CATION| INDICATION/ DOSAGES| CONTRA-INDICATION| DRUG-DRUG INTEREACTION| PHARMACOKINETICS/ PHARMACODYNAMIC| NURSING INTERVENTION| ADVERSE EFFECT| Generic Name:KetorolacBrand Name:Toradol| Drug Class: AntipyreticPreg-nancy Category: C (First and second trimester)| ;Short term management of pain ( up to 5 days)DOSAGES:Ketorolac 30mg TIV q 6 hrs x 6 doses| ;Contraindicated with significant renal impairment, during labor and delivery, lactation. ;Increased risk of nephrotoxicity with other nephrotoxins( aminoglycosides, cyclosporine);Increased risk of bleeding with anticoagulants(warfarin), aspirin| Route | Onset| Peak | Duration| ; Keep emergency equipment readily available at time of initial doseRATIONALE:; In case of severe hypersensitivity reaction. ; Ensure the proper dose of the drugRATIONALE:;. To avoid overdose. | CNS: headache, dizziness, Dermatologic: rashGI: nausea| | | | | | oral | varies| 30-60 mins| 6 hr| | | | | | | | IM| 3o mins| 1-2 hr| 6 hr| | | | | | | | IV| 3o mins| 1-2 hr| 6 hr| | | | | | | | Metabolism : hepatic T ? : 2. 4 -8. 6 hrDistribution: crosses placenta, enters breast milkExcretion: urine| | | PHYSICAL ASSESSMENT
BODY PARTS| NORMAL FINDINGS| ACTUAL FINDINGS| ANALYSIS| GENERAL APPEARANCE| * Proportional varies with lifestyle * Relaxed erect posture: coordinated movement * Clean and neat * No breath odor * Cooperative * Understandable, moderate pace exhibits thought association| * Conscious and coherent * Well cooperative * Able to answer questions * Has the sense of reality * Well groomed| Normal| SKIN| * Dark skin: light to dark brown; olive * Texture: smooth, soft * Warm| * Light to dark brown: olive * Smooth, soft * warm| Normal| HAIR| * Can be black, brown, burgundy depending on the race * Evenly distributed| * Black hair * Silky resilient * Thick hair * Evenly distributed| Normal| SCALP| * Symmetrical * Smooth, firm * No lesion | * Dry flakes are seen in the dermatitis| Abnormal| FINGERS AND NAILS| * smooth texture * intact epidermis * no lesions * convex curvature: angle of the nail plate about 160 degrees| * dirty finger nails * no lesions| Abnormal| SKULL| * Generally round with prominence in frontal and occipital lobe * Smooth skull contour * Absence of nodule or masses| * Generally round with prominence in the frontal and occipital * No masses| Normal| FACE| * Symmetrical/ slightly asymmetrical facial features * Symmetrical facial movement. * Face is symmetrical * Rounded * No involuntary muscle movement * Can move facial| Normal| EYES| * Symmetrical in line with each other, equal palpebral fissure, no sign of protrusion and discoloration * No tenderness over lachrymal gland * Bulbar conjunctiva: transparent; sclera appears white * Palpebral conjunctiva: shiny, smooth and pink to red * When looking straight ahead, the client can see objects in peripheryVISUAL ACUITY: near vision * Able to read prints from book| * Evenly placed and in line with each other * Both eyes coordinates, move in unison with parallel alignment * Transparent; sclera appears white * Shiny, smooth pink * Pupil constrict in reaction to light * No edema or tenderness over achrymal gland * Approximately 15-20 blinks/min * Was able to see objects in the periphery * Able to read words from the book| Normal| NOSEEARS| * Symmetric and straight * Air moves freely as the client breaths * No discharge * External nose: not tender; no lesions * Facial sinuses: maxillary and frontal sinuses * GROSS EARING ACUITY TEST: Response to normal voice tone * Watch Tick Test| * Symmetric in shape and straight * Air moves freely as client breaths * Not audible in normal voce tone * Able to hear tickling in both ear| NormalAbnormalNormal| LIPS| * Uniform pink in color * Symmetric in contour * Able to purse lips| * pink in color * Can purse lips| Normal| TEETH | * 32 adult teeth| * 30 teeth present smooth and white | Normal| gumspalates and uvulaOROPHARYNX AND TONSILS| * Pink gums * Light pink and smooth in soft palate; lighter pink in hard palate more irregular texture * Uvula positioned in midline of soft palate * Pink and smooth posterior wall * Tonsil’s color pink and smooth * Present Gag reflex| * Pink gums * Soft palate: smooth and pink; Hard palate: texture is more irregular and lighter pink * Uvula positioned in midline * Pink smooth posterior . Placenta Acrreta Essay Example.wall * Tonsil is pink and smooth * Present Gag reflex| Normal| TOUNGE| * Central position * Pink in color * Thin whitish coating * No lesion * Moves freely| * Pink in color with thin whitish coating * No lesions noted * Able to move freely| Normal| NECK| * Muscle equally in size: head center * Coordinated, smooth movement with no discomfort * Equal strength * Entire neck’s enlarged lymph nodes; not palpable * Absence of bruit| * Muscle equally in size: head center * Coordinated, smooth movement with no discomfort * Equal strength * Not palpable * Absence of bruit| Normal| POSTERIOR THORAX| * Chest symmetric * Spine vertically aligned * Symmetric and full expansion * Skin is intact: uniform in temperature| * Spine vertically aligned; spinal column is straight * Chest symmetric * With normal breath sound * Full and symmetric expansion| Normal| ANTERIOR THORAX| * Quite, rhythmic, effortless respiration * Same as posterior vocal fremitus * Full symmetry| * Quite, rhythmic, effortless respiration * Same as posterior vocal fremitus * Full symmetry| Normal|
HEART | * No pulsation o f the aortic, pulmonic, apical and tricuspid area * No lift or heave of the tricuspid area * No heard sound in auscultation of carotid artery * Jugular veins not visible | * No pulsation o f the aortic, pulmonic, apical and tricuspid area * No lift or heave of the tricuspid area * No heard sound in auscultation of carotid artery * Jugular veins not visible | Normal| BREAST| Females:Rounded shape; slightly unequal in size; generally symmetric| Females:Rounded shape; slightly unequal in size; generally symmetric| Normal| ABDOMEN| * No evidence of the enlargement of liver / spleen * Symmetric movement caused respiration * No visible vascular pattern| * No evidence of the enlargement of liver / spleen * Symmetric movements caused respiration * tenderness with not relaxed abdomen * pain in the abdominal incision| NormalAbnormal| UPPER AND LOWER EXTREMITIES| * no tenderness or pain * temperature same as the rest of the body * normally firm| * tenderness or pain * temperature is warm to touch * normally firm| Normal| RANGE OF MOTION OF UPPER AND LOWER ETREMITIES| * smooth coordinated movements * equal strength on each side of the body * joints move freely| * smooth coordinated movements * equal strength on each side of the body * joints move freely| Normal| ANATOMY ; PHYSIOLOGY The female reproductive system is a complex system that consists of external and internal organs that work together in order for reproduction to be possible. It produces the female egg cells needed for fertilization. This system is designed to move the eggs to the correct place in the body to be conceived. Placenta Acrreta Essay Example. Female hormones are required to maintain this reproductive cycle. External Genitalia
Vulva The vulva is made up of several female organs which are external. These include a small, rounded pad of fat which protects the pubic bone. Reaching down almost to the anus are two folds of fatty tissue, called the larger lips,” to protect the inner genitals. Just inside are two smaller lips,” which enclose the opening of the urethra (which comes down from the bladder) and the vagina. At the upper end, are small projections, called the prepuce,” that protect the clitoris. The clitoris is a very small, sensitive organ with numerous nerve endings that, like the penis, contain tissues which fill with blood when sexually aroused. Mons Veneris
The mons pubis (Latin for pubic mound”), also known as the mons veneris (Latin, mound of Venus) or simply the mons, is the adipose tissue lying above the pubic bone of adult females, anterior to the symphysis pubis. The mons pubis forms the anterior portion of the vulva. It provides protection of the pubic bone during intercourse. the mons pubis divides into the labia majora(literally larger lips”) on either side of the furrow, known as the cleft of Venus, that surrounds the labia minora, clitoris,vaginal opening, and other structures of the vulval vestibule. The fatty tissue of the mons veneris is sensitive to estrogen, causing a distinct mound to form with the onset of puberty. This pushes the forward portion of the labia majora out and away from the pubic bone. Labia Majora
The labia majora are the outer lips” of the vulva. They are pads of loose connective and adipose tissue, as well as some smooth muscle. The labia majora wrap around the vulva from the mons pubis to the perineum. The labia majora generally hides, partially or entirely, the other parts of the vulva. There is also a longitudinal separation called the pudendal cleft. These labia are usually covered with pubic hair. The color of the outside skin of the labia majora is usually close to the overall color of the individual, although there may be some variation. The inside skin is usually pink to light brown. They contain numerous sweat and oil glands. Placenta Acrreta Essay Example.
It has been suggested that the scent from these oils are sexually arousing. It functions is enclosing and offering protection to the other external female reproductive organs. Labia Minora The labia minora is considered to be the small lips of the female reproductive system and are rather small; at the most, 2 inches wide. The labia minora is found on the inner side of the labia majora and surrounds both the openings of the urethra and vagina. The meeting point of both the labia minora is the clitoris, which is a small and sensitive protrusion. The labia minora does not have any pubic hair, and is a horizontal piece of skin that covers the vestibule.
It also help to protect your vaginal introitus (the anatomical name for the opening) when it’s not being used. When you are sexually aroused, the labia minora swell up with some blood as part of an anatomical display saying, I’m ready! ” They have some nerve endings, which helps enhance sexual pleasure. Clitoris The clitoris, visible as the small white oval between the top of the labia minora and the clitoral hood, is a small body of spongy tissue that functions solely for sexual pleasure. Only the tip or glans of the clitoris shows externally, but the organ itself is elongated and branched into two forks, the crura, which extend downward along the rim of the vaginal opening toward the perineum.
Thus the clitoris is much larger than most people think it is, about 4″ long on average. The clitoral glans or external tip of the clitoris is protected by the prepuce, or clitoral hood, a covering of tissue similar to the foreskin of the male penis. However, unlike the penis, the clitoris does not contain any part of the urethra. During sexual excitement, the clitoris erects and extends, the hood retracts, making the clitoral glans more accessible. The size of the clitoris is variable between women. On some, the clitoral glans is very small; on others, it is large and the hood does not completely cover it. Bartholin’s Glands Bartholin’s Glands are part of a woman’s internal genitals.
They are located on each side of the labia minora (inner lips of the vaginal opening; see vulva), and they secrete small amounts (a drop or two) of fluid when a woman is sexually aroused. The fluid may slightly moisten the opening of the vagina (labia), making contact on this sensitive area more comfortable. Fourchette A small band or fold of mucous membrane forming the posterior margin of the vulva and connecting the posterior ends of the labia majora. External urethral orifice The opening to the urethra is just below the clitoris. Although it is not related to sex or reproduction, it is included in the vulva. Placenta Acrreta Essay Example. The urethra is actually used for the passage of urine.
The urethra is connected to the bladder. In females the urethra is 1. 5 inches long, compared to males whose urethra is 8 inches long. Because the urethra is so close to the anus, women should always wipe themselves from front to back to avoid infecting the vagina and urethra with bacteria. This location issue is the reason for bladder infections being more common among females. Perineum The perineum is the area of skin rich in nerve endings that is located below the anus (the opening for bowel movements). For women, the perineum extends to the vaginal opening. Because the perineum is so rich in nerve endings it often feels pleasing to have it touched or stroked.
If one is comfortable with being touched on the perineum, its stimulation can be incorporated into a couple’s lovemaking to further enhance sexual arousal. The perineum in some women may tear during the birth of an infant and this is apparently natural. Some physicians however, may cut the perineum preemptively on the grounds that the tearing” may be more harmful than a precise cut by a scalpel. If a physician decides the cut is necessary, they will perform it. The cut is called an episiotomy. Vagina * Providing a path for menstrual fluids to leave the body. * Giving birth * Admitting the male penis for sexual intercourse The vagina admits the male penis for sexual intercourse and ultimately male sperm for the fertilization of ova for reproduction. See: sexual intercourse) The concentration of nerve endings particularly close to the mouth of the vagina causes pleasure to be experienced during sexual activity. The opening of the vagina is home to the clitoris, which is located at the anterior of the vaginal opening; for most women, the clitoris is the main source of sexual pleasure (although it can be too sensitive for direct stimulation in some women). Some women have a very sensitive erogenous zone called the G-spot” inside their vagina (in the anterior of the vagina, about five cm. in from the entrance), which can produce very intense orgasms if stimulated properly, possibly responsible for the disputed female ejaculation. Not all women have a g-spot that is responsive to stimulation, however.
During live birth, the vagina provides the route to deliver the fetus from the uterus to its independent life outside the body of the mother. During birth, the vagina is often referred to as the birth canal. The vagina provides a path for menstrual fluids to leave the body. In modern societies, tampons, menstrual cups and sanitary towels may be used to absorb these fluids. Internal Genitals Uterus and Cervix The uterus is a thick-walled, muscular, pear-shaped organ located in the middle of the pelvis, behind the bladder, and in front of the rectum. The uterus is anchored in position by several ligaments. The main function of the uterus is to sustain a developing fetus. Placenta Acrreta Essay Example.
The uterus consists of the cervix and the main body (corpus). The cervix is the lower part of the uterus, which protrudes into the upper end of the vagina. It can be seen during a pelvic examination. Like the vagina, the cervix is lined with a mucous membrane, but the mucous membrane of the cervix is smooth. Sperm can enter and menstrual blood can exit the uterus through a channel in the cervix. The channel is usually narrow, but during labor, the channel widens to let the baby through. The cervix is usually a good barrier against bacteria, except around the time an egg is released by the ovaries (ovulation), during the menstrual period, or during labor.
Bacteria that cause sexually transmitted diseases can enter the uterus through the cervix during sexual intercourse. The channel through the cervix is lined with glands that secrete mucus. This mucus is thick and impenetrable to sperm until just before ovulation. At ovulation, the consistency of the mucus changes so that sperm can swim through it and fertilization can occur. At this time, the mucus-secreting glands of the cervix can store live sperm for up to about 5 days, but occasionally slightly longer. These sperm can later move up through the corpus and into the fallopian tubes to fertilize an egg. Almost all pregnancies result from intercourse that occurs during the 3 days before ovulation.
However, pregnancies sometimes result from intercourse that occurs up to 6 days before ovulation or during the 3 days after ovulation. For some women, the time between a menstrual period and ovulation varies from month to month. Consequently, pregnancy can occur at different times during a menstrual cycle. The corpus of the uterus, which is highly muscular, can stretch to accommodate a growing fetus. Its muscular walls contract during labor to push the baby out through the cervix and the vagina. During the reproductive years, the corpus is twice as long as the cervix.Placenta Acrreta Essay Example.  After menopause, the reverse is true. As part of a woman’s reproductive cycle (which usually lasts about a month), the lining of the corpus (endometrium) thickens.
If the woman does not become pregnant during that cycle, most of the endometrium is shed and bleeding occurs, resulting in the menstrual period. Fallopian Tubes The two fallopian tubes, which are about 2 to 3 inches (about 5 to 7 centimeters) long, extend from the upper edges of the uterus toward the ovaries. The tubes do not directly connect with the ovaries. Instead, the end of each tube flares into a funnel shape with fingerlike extensions (fimbriae). When an egg is released from an ovary, the fimbriae guide the egg into the relatively large opening of a fallopian tube. The fallopian tubes are lined with tiny hairlike projections (cilia). The cilia and the muscles in the tube’s wall propel an egg downward through the tube to the uterus.
The egg may be fertilized by a sperm in the fallopian tube. Infundibulum A funnel-shaped lateral end that projects beyond the broad ligament and overlies the ovary The free edge is broken up into a number of fingers like processes, the fimbriae, which are draped over the ovary Ampulla It is thin walled, dilated, tortuous and widest part of the tube. The ampulla is around 4 mm in diameter. It is the usual site of fertilization and it is also most common site of tubal ectopic pregnancy Isthmus It is the narrowest part of the tube and lies just lateral to the uterus Ovaries The ovaries are usually pearl-colored, oblong, and about the size of a walnut.
They are attached to the uterus by ligaments. In addition to producing female sex hormones (estrogen and progesterone ) and male sex hormones, the ovaries produce and release eggs. The developing egg cells (oocytes) are contained in fluid-filled cavities (follicles) in the wall of the ovaries. Each follicle contains one oocyte. Placenta an organ characteristic of true mammals during pregnancy, joining mother and fetus, providing endocrine secretion and selective exchange of soluble bloodborne substances through apposition of uterine and trophoblastic vascularized parts. The placenta begins to develop upon implantation of the blastocyst into the maternal endometrium. Placenta Acrreta Essay Example.
The outer layer of the blastocyst becomes the trophoblast which forms the outer layer of the placenta. This outer layer is divided into two further layers: the underlying cytotrophoblast layer and the overlying syncytiotrophoblast layer. The syncytiotrophoblast is a multinucleate continuous cell layer which covers the surface of the placenta. It forms as a result of differentiation and fusion of the underlying cytotrophoblast cells, a process which continues throughout placental development. The syncytiotrophoblast (otherwise known as syncytium), thereby contributes to the barrier function of the placenta. The placenta grows throughout pregnancy.
Development of the maternal blood supply to the placenta is suggested to be complete by the end of the first trimester of pregnancy (approximately 12–13 weeks). . GORDON’S FUNCTIONAL LEVEL | BEFORE| AFTER| INTERPRETATION| * HEALTH PERCEPTION – HEALTH MANAGEMENT PATTERN”|  She has experienced a low blood pressure every time when she has taken her vital sign. |  And it becomes normal after few days of surgery and some procedures that she have engaged in. |  The mother’s perception about health has change after her blood pressure was normalize when she was admitted. | * Nutritional  – Metabolic Pattern”| She eats a right amount of food to sustain her energy and fulfilled her ADL’s.   She is on diet because of the last operation regarding to her complication during the delivery of the baby. |  The nutritional intake of the patient has been imbalance seen she was hospitalize and undergo operation| * ELIMINATION  PATTERN”|  when she’s not being admitted in the hospital, she eliminate alternately. |  Now after the procedures that she has taken through, she can normally eliminateEveryday. | The patient elimination pattern becomes regular after she was admitted | * ACTIVITY – EXERCISE PATTERN”|  She is agile/lively before and can do all their household chores every day. | And now, the thing that she always do is to sit and lay down on bed only. the patient condition disrupt her ADL’s |  * SLEEP – RESTPATTERN” | She can sleep well and relax harmoniously. |  She can’t sleep and easily irritate in the noisy environment in where she is. |  The patient has a difficulty in sleeping due to environment |  * COGNITIVE – PERCEPTUAL PATTERN” | She can hear all things and sounds clearly around her. | She actually experience low hearing tone. | After she was admitted , the patient was suffering from a low hearing tone| * SELF – PERCEPTION – SELF – CONCEPT PATTERN”|  She is happy and enjoyed everything around her. | She now becomes so patience and something bother her that affect her attitude for being happy. The patient was suffering from anxiety from her condition  | * ROLE – RELATIONSHIP PATTERN”| She can fulfill her responsibilities to her family. | It becomes a little harder for her to fulfill it. |  the patient’s responsibility of being a mother and wife interrupt due to his conditoion| * SEXUALITY – REPRODUCTIVE PATTERN”| She use pills and to plan a family properly. | She stops using it. | The patient believed that using pills will affect her condition | * COPING – STRESS TOLERANCE PATTERN”| She usually talked to her husband about their personal lives and problems even their relatives are always there. | Nothing has change and it’s only her husband that she talks too. The patient’s coping mechanism is thru her husband and has a difficulty open her problem to other relatives| * VALUES – BELIEF PATTERN”| She is totally believed in God. | Nothing has change and she still believes in God no matter what happens even to herself. | The patient has a great faith in God even with her condition| | | | | | . GORDON’S FUNCTIONAL LEVEL NURSING CARE PLAN ASSESSMENT| NSG Dx| PLANNING| NSG INTERVENTION| RATIONALE| EVALUATION|  O; Hysterectomy|  ;Risk for infection r/t Surgical removal of uterus|  ;After8 hrs of NSG intervention the pt. will be aware on it and able to know on how to reduce/prevent bacterial infection.  ;Observe for localized sign of infection at insertion site of invasive lines, suture, surgical incision/wound ;Provide information/involve an appropriate community and national education program ;Instruct client in techniques to protect the integrity of skin, care for lesions and prevention of spread if infection ;Discuss importance of not taking antibiotics/using”leftover” drugs unless specifically instructed by health care provider >Change surgical/other wound dressing, as indicated using proper techniques for changing/dispose of contaminated materials    |  >to provide easily an appropriate care for the pt. and to prevent/reduce infection and achieve timely wound healing >to increase awareness of and prevention of communicable dse. >to promote wellness and safe environment >inappropriate use can lead to development to drug resistant strain/secondary infection   >for proper caring of wound and to prevent further   infection|  >>After8 hrs of NSG intervention the pt. was aware on it and able to know on how to reduce/prevent bacterial infection|
Assessment| Diagnosis| Planning/Outcome| Intervention| Rationale| Evaluation| Objective:> Disruption of skin surface. > irritability> pain scale: 7| > Impaired integrity related to deep attachment of placentaa. m. b distruption of skin surface, destruction of tissue layer, pain scale of 7| > after 3 hours of nursing intervention the patient’s condition will comfortable and will be able to participate in prevention measures and treatment program. | > Maintain bed restor chair rest whenIndicated. Providefrequent restperiods anduninterruptednight time sleep> Monitor vital sign> Assist client to learn stress reduction and alternate therapy techniques. gt;Assist the patient in understanding and following medical regimen and developing program of preventive care and daily maintenance. >use appropriate barrier dressings, wound coverings and skin protective agents for open or draining wounds. | > Systemic rest ismandatory andimportantthroughout allphases ofdisease toreduce fatigue,and improveStrength. > Provide baseline data on maternal blood loss> To control feeling of helplessness and deal with situation. > To promote wellness. > To protect the wound and surrounding tissues. Placenta Acrreta Essay Example. | > after 3 hours of nursing intervention the patient’s condition was comfortable and able to participate in prevention measures and treatment program. |

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ASSESSMENT| NURSING DIAGNOSIS| PLANNING| NURSING INTERVENTION| RATIONALE| EVALUATION| S>”Hindi pa ako masyado malakas medjo nanghihina pa ako dahil siguro sa nwalgn dugo sakin” as verbalized by the patient. O> BP: 90/60mmhg>Dry skin| Deficient fluid volume r/t excessive blood loss A. M. B dry skin| After 8hrs of nursing intervention the patient will be able to maintain fluid volume at a functional level as evidenced by individually stable vital sign and good skin turgor. | >Established 24 hrs replacement needs and routes to be used. >provide optimal skin care with suitable emollients. >Discuss factors related to occurrence of deficit, as individually appropriate. >Provide frequent oral and eye care. >Administer or discontinue medications, as indicated. >Steady rehydration over time prevents peaks/valley in fluid level. >To maintain skin integrity and prevent excessive dryness. >Early identification of risk can decrease occurrence and severity of complication associated with hypovolemia. >To prevent injury from dryness. >When disease process or medications are contributing to dehydration. | After 8hrs of nursing intervention the was able to maintain fluid volume at a functional level as evidenced by individually stable vital sign and skin turgor. | ASSESSMENT| DIAGNOSIS| PLANNING| NURSING INTERVENTION| RATIONALE| EVALUATION| Subjective: Minsan kailangan ko pa ipaulit ang sinasabi ng kausap ko para marinig ko” as verbalized by the patient.
Objective: * Change in sensory acuity * Impaired communication * Poor concentration * Disorientation| Disturbed sensory perception related to impaired hearing as manifested by: * Change in sensory acuity * Impaired communication * Poor concentration * Disorientation | After 1 hour of nursing intervention the patient will able to verbalize awareness of sensory needs. | * Assess patient’s ability to hear and respond to simple question. * Promote a stable environment. * Provides undisturbed rest or sleep periods. * Evaluate sensory awareness: stimulus of hearing. * Encourage use of listening devices properly. | * To obtain an overview of clients mental status and ability to interpret in stimuli. * To promote normalization of response to stimuli. * To prevent patient become irritated. * To assess causative and degree of impairment. * To assist in managing auditory impairment. | After 1 hour of nursing intervention the patient was able to verbalized awareness of sensory needs. Goal met. Placenta Acrreta Essay Example.