WEL COME

1
WEL COME
2
PLACENTA ACRETA EMERGENCY C/S FOLLOWEDBY
HYSTERECTOMY

• PRESENTED BY
• AMBILY K.M
• OPERATING ROOM

3
DEMOGRAPHIC DATA
4

• Name Mrs.A D
  M
  
  
  
  
  
• Age sex 47yrs /
  female
• M R No. 193857
• Date of admission 05 .01.2013
• G P L A G9 P7
  L7 A1
• Gestationational Age 30 wks 6 days
• Pre- op diagnosis Placenta acreta
• Surgery Emergency
  C S Followed by Hystrectomy
• Date of surgery 16.01.2013
• Date of discharge 19.01.2013

5
PHYSICAL ASSESSMENT
6

• 1. General Apperance
• Patient is 47 yrs old female weighs 88 kg
• Concious oriented
• Looks weak fatigue due to pain
•  Vital signs of the patient are
• Bp 108/62 mm of hg
• PR 76/mnt
• RR 20/mnt
• SPO2 99

7

• 2. Skin
• Skin is warm
• Has edema on legs
• Warm with good turgor
• 
  

8

• 3. Head and Neck
• Hair Is Equally distributed
• Absence Of Dandruff alopecia
• 4. Eyes
• Able to move both eyes.

9

• 5. Ears
• Patients pinna is same colour as fascial.
• Able to hear sounds clearly .
• No discharges.
• 6.Nose
• Nasal mucosa is pink
  
• Nasal congestion present

10

• 7.Neck And Throat
• Lips are pale dry.
• Teeth is propely aligned with no dentures.
• No tenderness of node.
• No palpable masses or leisions

11

• 8.Thorax
• The Thorax Is Symmetric On Inspection.
• Dry cough present
• Clear breath sounds
  

12

• 9.Cardio Vascular
• E C G is normal
• No cardiomegaly
• Apical pulse is 76 bpm

13

• 10. Breast
• 
  
  
  
• Symmetrically enlarged .
• Montgomerys tubercle present.
• Nipples darkish in colour.
• 
  
  
  

14

• 11.Abdomen
  
• Flaby abdomen.
• Strae gravidarum linea nigra present.
• Classic incision scar dressing present.
  
  
  
  
• 12 Genito Urinary
• With foley catheter fr.16

15

• 13. Gastro Intestinal
  
  
  
• No bowel distension present.
• 14. Neurologic
  
  
• Patient Is mentally alert and oriented with
  circumstances.
• Able to follow commands.
• No neurovascular deficit.

16
PATIENT HISTORY
17

• A . Past medical history
• She is a known case of hypothyroidism on
  Thyroxin 150 mg O D.

18

• B .Past obstretric history
• 2 F T N D, 5 L S C S 1 abortion.
• Previous antenatal period was good C S done due
  to fetal distress at term.

19
C.Present obstrectric history



20

• G 9 P 7 L 7 A 1
• gestational age 292 WKS
• spotting P V abdominal pain on 05.01.13.
• admitted in OB antenatal ward.
• U S G diagnosed as a case of placenta acreta
  treated.
• on 16 .01. 2013-she experienced severe lower
  abdominal pain fresh bleeding with clots
  through vagina.

21

• Emergency c/s followed by hysterectomy was done.
• as an emergency and life saving treatment.
• A viable male baby (306 WKS) extracted
• at 0225H
• weighing 1.77 kg .
• Apgar score was 7/10.

22

• INVESTIGATIONS DONE
• FOR THE PATIENT
• 1.U SG Abdomen
• 2.blood investigations like
• CBC
• PT-INR
• RH TYPING
• ELECTROLYTES

23
LAB INVESTIGATIONS
24

TEST on 17/12/12 RESULT REFERENCE RANGE
CBC HB HCT RBC 10.6g/dl 35.8g/dl 3.81 13.7-17.5g/dl 40.1-51.0g\dl 4.63-6.08 106/ul
PLT 198 163-337/ul
Sodium 133 135-150 mmol/l
Pottassium 3.8 3.5-5.0mm0l/l
PT 12.4 10.0-17.0sec
APTT 29.2 26.1-36.3sec
INR 0.96 2.4theraputic
Rh typing Ove
25
Anatomy Physiology Of Uterus
26

• inverted pear-shaped muscular organ.
• located between the bladder and rectum.
• nourish and house the fertilized egg until
  offspring.
• It is suspended in the pelvis by broad
  ligaments.
• Weight of a normal uterus is 60 to 80 grms.
  

27

• The uterus consists of -
• body or corpus
• Fundus
• Cervix
• isthmus
• 
  
  
  
  
  
  
  

28

• Walls of the uterus
• The walls are thick and are composed of 3
  layers
• the endometrium
• the myometrium
• the perimetrium

29

• VAGINA
• 6 inches long
• leading from the uterus to the external
  genitalia.
• located between the bladder and the rectum.
  
  
• provides the passageway for childbirth and
  menstrual flow.

30

• Fallopian Tubes (Two)
• each tube is about 4 inches long.
• transport ovum from the ovaries to the uterus.
• no contact of fallopian tubes with the ovaries.
• The distal end of each fallopian tube has
  finger-like projections called fimbriae.
• most desirable place for fertilization is the
  fallopian tube.

31

• OVARIES
• Functions are for oogenesis and hormone
  production.
• ovaries are about the size and shape of almonds.
  
• lie against the lateral walls of the pelvis, one
  on each side.
• They are enclosed and held in place by the broad
  ligament.

32
THE LIGAMENTS OF THE UTERUS
33
UTERINE ARTERY
34
(No Transcript)
35
(No Transcript)
36
TOPIC PRESENTATION
37
PLACENTA ACCRETA

• Placenta accreta is a potentially life
  threatening obstetric condition in which the
  placenta is abnormally attached to the uterus.
  This can lead to massive blood loss during or
  following delivery.

38
TYPES OF ABNORMAL PLACENTALIMPLANTATIONS
39
(No Transcript)
40
(No Transcript)
41
(No Transcript)
42
The risks of placenta accreta to the baby

43
The risks of placenta accreta to the mother
44
(No Transcript)
45
(No Transcript)
46
Complications
47
Treatment of placenta acreta
48
Effectively there are three treatment options-
49
(No Transcript)
50
Hysterectomy

• A hysterectomy is the surgical removal of
  all or part of the uterus, or womb. The doctor
  may also remove the fallopian tubes, ovaries
  and/or the cervix during the same surgery

51
Types of hysterectomy
52
(No Transcript)
53
PRIORITIZATION OF NURSINGpROBLEMS
54
(No Transcript)
55
NURSING CARE PLAN
56
ASSESSMENT ASSESSMENT PLANNING IMPLEMENTATION IMPLEMENTATION EVALUATION
Cues/Evidence Nursing Diagnosis Goals and desired outcome Nursing order/action Rationale for action Evaluation
Patient verbalizes that my lips become dry I feel so thirsty. Patient shows the symptoms like- Lips looks pale dry. Hypotention tachycardia. Decreased urine out put. Hb level is 10.6 gm/dl. Cold clammy skin. Restlessness Poor skin turgour. High risk for hypovolemia related to haemorrhage during child birth hysterectomy Patient will have adequate perfusion as manifested by- Stable vital signs Lips become pink in colour. Good capillary refill palpable pulses. Adequate urine out put. Normal Hb levels. Looks calm quiet. Adequate skin turgour. Maintained vital signs with in normal limits by providing warmth with bear hugger. Watched the site for evidence haemorrhage on dressing drain. Maintained Hb levels with 3 units of PRBC IV fluids. Maintained intake output chart. To maintain adequate perfusion. To prevent hypovolemia shock. To keep the vitalsigns with in normal range. Early identification of risk factors can decrease occurance complications associated with hypovolemia After 12 hrs of nursing interventions the goals were met as evidenced by- Stable vitalsigns.BP-110/78mmof hg,T-98.6F, P-76bpm,R-18pm. Fluid and electrolyte balance. Normal urine output. Normal laboratory results( Hb become 11.2 gm/dl)
57

• Health education
• Encouraged to do early ambulation to prevent
  DeepVeinThrombosis .
• Taught about the signs symptoms of D V T.
• Adviced to take high protein diet to enhance
  healing.
• Taught to do deep breathing coughing exercises.
• Assessed the level of knowledge regarding new
  born care .
• Adviced to take medication as per drs order.
• Proper follow up medical supervision.

58
CONCLUSION
59
BIBLIOGRAPHY
1.www.virtual medical centre.com 2.www.meds
cape.com 3.www.myoclinic.com
60
THANK YOU