OPERATING ROOM Write-UP

Name of Student: Arian May S. Marcos Section & Group: BSN 3-B Dates of Exposure: September 6-8, 2021
Date of Admission: September 8, 2021
Hospital: Baguio General Hospital Ward: Operating Room
Age: 26 Sex: Female Civil Status: Married Religion: Roman Catholic
Admitting Diagnosis: G1P3, 41 weeks of gestation of high risk, and late prenatal care
Final diagnosis: Breech presentation-footling
Operation Performed: Cesarean Section (C-Section)

Instrument Nurse: Arian May S. Marcos Sponge Nurse: Lorhen L. Mapangdol

Type of Anesthesia: Spinal (Subarachnoid Block)
History of Present Illness:
The patient is a 26-year-old female, gravida 4, para 3 with 41 weeks of high-risk pregnancy, and late prenatal care.
According to the patient’s medical chart, she has reported abdominal pain, edema in the feet and legs, and no contraception
use prior to conception. The patient is morbidly obese.
Pathophysiology / Explanation of the Problem:
PATHOPHYSIOLOGY
Which is a surgical procedure
Due to the complications during performed when a vaginal delivery
pregnancy, and complications that CESAREAN SECTION
is not possible or safe, or when the
affect your baby, labour and birth health of the mother or the baby is at
may lead to: risk.

Precipitating
Precipitating Factors:
Factors:
Previous Cesarean Section
Fetal Suffering
Predisposing Factors: Cephalopelvic
Cephalopelvic Disproportion
Disproportion
Over 28 years old Fetal Podalic Version
Double or Triple Umbilical Cord
Obesity
Obesity

COMPLICATIONS

SIGNS AND SYMPTOMS:

INFECTION
INFECTION Fever, chills and sweats, redness, soreness or swelling in
any area including surgical wounds and ports.

DIAGNOSTICS:
POSTPARTUM
Infection - Immunologic
HEMORRHAG SIGNS AND SYMPTOMS:
test
E PPH - blood tests, pelvic
Heavy bleeding, hypotension, nausea, pale skin, swelling exam, physical exam,
and pain around the vagina or perineum.
ultrasound
DVT - Duplex
ultrasonography

SIGNS AND SYMPTOMS:

DEEP VEIN
THROMBOSIS DIAGNOSTICS:
Throbbing or cramping pain in 1 leg, swelling in 1 leg,
warm skin around the painful area, red or darkened skin
SIGNS AND SYMPTOMS: Infection - Immunologic
around the painful area, swollen veins that are hard or
sore when you touch them.
test
Throbbing or cramping pain in 1 PPH - blood tests, pelvic
SIGNS AND SYMPTOMS: exam, physical exam,
leg, swelling in 1 leg, warm skin
Brief Discussion of Proposed Operation
around(How the surgeon
the painful performed
area, red or the procedure): ultrasound
Heavy
The patient was taken to the operating room bleeding,
darkened andskin
beforearound
the operation;
the anesthesia was injectedDVT at the spinal- area byDuplex
the
hypotension,
anesthesiologist. Patient was placed comfortably
painful area, on nausea,
swollen apale
bed inveins
supine
that position, a bolster was positioned under
ultrasonography the patient’s
right hip to offset abdominal weight are
and
skin,thus reduce
swelling
hard or uterine
and
sore when pressure
pain
you touch on the vena cava, safety strap was secured, and a
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around the vagina or Page 1 of 4
POSTPARTUM
JUNE 2012 REV:00
HEMORRHAG perineum.
INFECTION
E
Foley catheter was inserted, a blood pressure cuff, thermometer, ECG electrodes and pulse oximeter were placed on the
patient, grounding pad was then positioned as close to the operative site as possible, taking care to avoid bony
prominences, cardiac monitor also is attached.

An oxygen inhalation is administered at 2 LPM per nasal cannula, skin preparation solution was applied from mid-chest to
the pubis and to the sides of the patient all the way down to the operating room table as far as possible, vaginal region
extending to the inner thighs was prepared, prior to preparation, the circulator shaved the area with disposable clippers,
folded towels were used to square off the operative site, and a specialized C-section drape was placed.

A small transverse incision was made in the lower uterine segment and carried bilaterally with Lister bandage scissors,
neonate’s legs were grasped and drawn from inside the uterus, torso was delivered next, followed by the shoulders (left
first), then the head was delivered by arching the baby’s torso toward the mother’s abdomen, umbilical cord was clamped
with two Mayo clamps and then cut with Lister bandage scissors, three loops of the cord were unwrapped from around the
neonate’s neck, and a cord blood sample was collected, neonate was then passed to the awaiting neonatal team, Cesarean
Section done.

Uterine incision was closed in two layers using 0 synthetic absorbable sutures, homeostasis was achieved by use of the
electrosurgical unit, skin was approximated and closed using staples and two Adson tissue forceps, and the patient
tolerated the procedure well and was sent to recovery in stable condition.

Instruments (Uses / Functions)

STRAIGHT MAYO SCISSOR
- Used for cutting sutures and dressings.

CURVED MAYO SCISSOR

- Used for cutting heavy tissue (fascia, muscle, uterus,
and breast) and dissecting heavy tissue.

KELLY HEMOSTATIC CLAMP

- Used for clamping large blood vessel or tissue.

TISSUE FORCEP
- Used for grasping tissue and for wound closure.

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 ALLIS CLAMP
- Used for grasping organs or tissue during removal.

METZENBAUM SCISSOR
- Used for cutting or dissecting delicate tissue.

NEEDLE HOLDER
- Used to hold a suturing needle.

RICHARDSON RETRACTOR
- Used for exposing wound.

ROCHESTER PEAN FORCEP

- Used to clamp bigger blood vessels.

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 BANDAGE SCISSOR
- Used to cut through padding and stockinet, and the
limb is then extracted from the open cast.

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