b MMe Mb Xb Bh Hp Bp Me Xp Uh Hp Mh Mh Nh Mp Hh Th Hp Me Hh Mb Hp Mh Wh Mh Wh Hh Mh Hh Ke Mp Mh Mp Uh Mp Uh Mh Ub Mh Xp Mh Mh Mh Wh Nb Wp Uh Wh Mh Wh Uh Ih Yh Wh Mh Hh Wh HS CASE PRESENTATION ON POLYHYDRAMNIOS Guide - Mrs. Geetanjali Sharma Name - Mrs, Manju Kumar Dhaker Group = MSc. Nursing 2 nd ‘ year student Subject - Obstetrics &gynaecology Date - 25/06/2016 Time - 10am Method of teaching - ~—_lecture,discussion AV AIDS - poster ,ohp, blackboard General objectives - —_At the end of the class the student will be able To gain knowledge about polyhydramnios ‘And they will be able to apply this Knowledge in their clinical and teaching area Specific objectives - All he of the class the student will be able to:- > To introduce about polyhydramnios > To know about definition of polyhydramnios > To know about classification/type polyhydramnios > To know about etiology of polyhydramnios > To know about sign and symptom of polyhydramnios > To know about medical and nsg management of polyhydramnios > to know about complication of polyhydramnios Rb Xe Xb Xp a Hp Nh Xp Me Xp Uh Xp Uh A Mp Mp Xp Tp Hp Mh Xp Uh Hp Hh Uh Hh Lh Xp Mh Hp Uh Hp Ue Up Uh Xp Uh Mh Hh Mh Xp Yh Xb Up Xp Uh Up Uh Uh Uh Wh Hh Ih Hh Wh Uh HS IhTH Hh MW Mh HW Hh Hh MS Wh HH Hh Hh Mh MH Hh HH Mh Hh Mh Mp Uh WS Hp Mh Hh Mh Hh Mh Mh Mp Wh Mh Wh Yh Mh Mh Mh Hh Wh Mp Uh Up Uh Hh Uh HS Uh Wh Mh Mh Mh Wh Me Hh Th) MIDWIFERY CASE STUDY Name of the patient : Mrs, Aarti Name of husband : Mr. Chandan Age 224 year Marital status : Married Doctors name : Mrs, Ratna singh thakur Address : 38415, khedlya goan . Date of admission Hospital number/ IPD number LMP EDD GPLA Diagnosis, 2 06/01/19 1 165498, 205/6/18 212/019 :G.PiLi 32 weeks of pregnancy, with severe polyhydramnios My patient admitted with the complaint of backache,nausea and vomiting TID_LANTENATAL EXAMINATION: Medical history:no any history of DM/TB/ASTHMA/ Chronic illness: she has no history of chronic illness Surgery: not having any type of surgery Allergy: my patient is not allergic to any thing. Communicable disease: no history of communicable disease in her family. EAMILY HISTORY: TYPE OF FAMILY: KktreakrrrtrrrrkrrAtkrrteerAAre errr e Ae WH Hp Hp HH Hp Hh Hh Hh Hh Hh Hp Hh Hp Hh Hp Hh Wp Yh Hp Up Wh Hh Hh Mh Hh Hp HH Wh Hh Hh Mh Uh Hp Wh Hp Wh Wp Up Hp Yh Hh Uh Uh Hh WS Mh hh)XW XW HW Hh HH Hh HS Hh HH He HS Hh HS Hh MS Mh Hh pM Hh Hh Hh Mp Mh Mp Hh pM Hh Me Hp Uh Wh Hh MS Mh Mh Mh Hh Mh Mh Yh Wh Wh Uh WS Nh Mh Mh Hh Ih Mh She belongs to 1 joint family and there are total 7 members in the family. Histay of muliple tirths: no history of multiple pregnancy SOCIOECONOMIC BACKGROUND: Religion: Family Income: Education: Husband Wife Occupation: Husband: ‘Wife: ‘MENSTRUAL HISTORY: Menarche: Duration: Flow: Interval: MARITAL HISTORY: ‘Age of marriage: Married life: DIETARY PATTERN: Hindu; Rs,10000/to Rs.18000/- Re 10" family business Housewife 14 years old 45 days regular. 30 days 20 years. 4 years. My patient Is non- vegetarian, She has no special likes; she sald she would eat everything that Is. cooked well. She has no special dislikes. Habits: My patient no habits of smoking, drinking alcohol, chewing pan, tobacco. HW Mp WH Wp Hp Hp Hh Hp HH Uh Hp He HS Hp WS Hh Uh Hp Wh Hh Hp WH Hh Hp Uh Hp Up ep Uh Ih Mh Hh Hp Mh Hh Uh Hh Hh Mh Yh IS Mh Ih Hh Wh Hh Wh Uh HS Mh HhSEEMED AE AE A ah ah A a Wh Hh Oh S. | YEAR |FULL |PRE- | ABORT] MODE Baby N TERM |TERM |ION | OF ° DELIV ERY sex | alive | stillb | weight ) Remark rth male | alive 28 1, | 2010 | Ful BEND * term PRENATAL HISTORY DATE | HEI] WEI | UR] BP] FHR| GEST] HT | ABD] PRESENT | POSITIO] TREAT Gu | GHT | IN ATIO | OF | GIR| ATION N MENT T E N | FUND] TH AND us REMA KS 10-09- | 154e| S4kg [S>| a1 | 140 | 20 | i3em| 63 | Cephalic | LOA | Irontb uo | m nat| 077 weeks em Caleta o m tab A Tri Nil dose 10-10- | 154 | S5kg | S>[ 12] 140 | 24 | 18cm] 69 |” cephalic Toa | Tron tab uw om nal | 08 weeks cm Calelu 0 m tab A Tr2" Nil dose OBSERVATION & ASSESSMENT GENERAL APPEARANCE: good ‘SENSORIUM: conscious EMOTIONAL STATE: = stable FOUL BODY ODOUR: = Absent FOUL BREATH: ~ Absent | PHYSICAL EXAMINATION; ‘TEMPERATURE: -98.8°F, ‘PULSE: -82 beats/ min RESPIRATION: -22 breath / min BP: = 120/80 mm/hg, % Ub Hp ph a Wp HH HW Hp Hh Mh HS pH Hp Wh Hp Hh Hp Hh Hp Uh HS Uh Mh Hh Hp Uh Hh He ep Hh Hh Hp Hh Hh Wh Hp Wh Hp Hp Hh Hh HS Hh HW pH Hh HETWe ah a rp ae He seca abo iene aba aba saa a aba aa a aaa aa aes ae ae ‘SKIN COLOUR: =pale: POSTURE: = Normal GAIT: = Normal BLEEDING: = absent HAIR: =Clean,normal hair growth dandraff ies absent Eye/ ENT: = normal vision,selera pink in colour, pupils response to Hightynot Having any complication TEETH & GUMS: = number of teeth 32. No Denial caries present ‘ORAL MUCOSA: = Healthy GLANDS: =Not enlarged CHES -Normal, Bilateral movement present,normal breathing pattern, breast Enlarged.nipple dark in colour | ABDOMEN: - * Fundus height-37 em * Abdominal girth- 85cm © Fundal hard irregular surface absent * Lateral palpation-cephalic presentation * Pawlik’s grip- ballotment is present,head is not engaged * Pelvic palpation-head is not engaged + FHR-140 beats/mint FLUID: -more than normal ‘SHAPE: -oval shape [BISTENSION: present LIMBS: = Normal,pedal oedema present ‘TOES AND NAILS: = Normal BAC Pain present fin back] ‘SKIN: -Hydrated DEPENDENCY LEVEL OF THE PATIENT: Partial dependent BLOOD GROUP > AB+VE HIV, AUSTRALIAN ANTIGEN > NEGATIVE, Hb> 12.6 gm% T&D> 12,400 per cum PIT> 28.4 SEC. PLATELET COUNT > 2.63 RBS> 120mg% URINE ROUTINE, 00 ‘ALBUMIN ‘ABSENT, PCD O/HPF EC> W/HPF RBC> NIL ‘Specific gravity- 1.025 Acetone- nil Sugar nil BLOOD TEST- Blood glucose{randomy/post prandial]- 107 [normal value-70-140 mg/dl] Blood urea nitrogen =12___{8-25 mg/dl] SEESE RH! spo ab ah oh oh ab Hh Fh A mE a a aE a a a aIE Hb He HS Hp HH HS HS HS HH HH Hh He HH HH Hh Mp Mh Hp Hh I Hh Mh MS Hh Mh HS Uh Hh HH Mh Ih Ih Hp Mh HH Hh Hh HS Mh Sh ‘USG a single live Interanterine fetus 32 weeks with no gross anomaly seen,AFI-27- 28cm,EFW-2.3 kg DERINITION- Polyhydramnios is an excessive amount of amniotic fluid, which exceeds 1,500 ml. it occurs in 0.9 percent of pregnancies. It is typically diagnosed when the amniotic fluid index (AFI) is greater than 20 cm (> 20 em). ETIOLOGY- IN GENERAL, IN MY PATIENT ¢ FETAL ANOMALIES- 1, Anencephaly. Cause unknown 2. Open spina bifida. 3. Oesophageal Artesia. 4, Facial cleft and neck masses. 5. Hydrops fetalis. ¢ PLACENTA- 1. Chorioangioma of the placenta. MULTIPLE PREGNANCIES MATERNAL + Diabetes. cardiac or renal disease, TYPES OF POLYHYDRAMNIOS- In general ‘In my patient > Chronic polyhydramnios. v Acute hydramnios © CHRONIC POLYHYDRAMNIOS it is gradual in onset, usually from about 30" week of pregnancy. This most common type. © ACUTE POLYHYDRAMNIOS -t is very rare. It occurs at about 20 weeks and comes on very suddenly.th uterus reaches the xiphisternum in about 3-4 days .it is often associated with monozygotic twins and severe foetal abnormalities. SIGN AND SYMPTOMS-The sign and symptom of polyhydramnios include the following In general In my patient © Uterine inlargement, abdominal girth v and fundal height are far beyond expected for gestational age. © Tenseness of the uterine wall making sa it difficult to-auscultate foetal heart AAKRAAKAA AAA AKAAAAAKAAAKAAKAAAKAAAKAAAAAAADY Ab A Xb Ae Mb Bb Mh Ae Mh Wh Bh Hp HB Nh HS Mh Mh Wp Mp Wh Mh Mp Mh Mh Wh Wp Hh Mh Bh NS Hh Mh Wh Wh Hh Hp MH Wh Mh Xb MW Xp Mb Mh Wh Wh Hh Mh Wh Wh Hh Wh Wh pH Wh HhCHESSER EEEESEEEEEEEEEEE EEE EEE SEER SEER SEES EERE EE EE EEE EEE EE tones; palpate the foetal outline, large and small part, © Elicitation of uterine fluid thrill. © Mechanical problem such as- 1. Severe dyspnoea. v 2. Lower extremity and vulval Pedal ocdema edema. 3. Pressure pains in back, abdomen and thighs. 4, Nausea and vomiting. Frequent change in fetal li. * Auscultation of the fetal heart is difficult Screening for diabetes. Serecning for ABO/RH disease SAK COMPLICATIONS- In general [in my patient ‘© Maternal. © Fetal. MATERNAL- * DURING PREGNANCY- 1, Proédlameia, No complication 2. Malpresentation 3. PROM 4. Preterm labour 5. Accidental haemorrhage * DURINGLABOUR- . Early rupture of membrane . Cord prolapsed . Retained placenta |. Postpartum haemorrhage Shock . Increased operative delivery due to malpresentation. © Puerperium- 1. Sub involution 2. Increased puerperal morbidity. eunune FETAL- * Increased perinatal mortality. INVESTIGATION- In general In my patient * SONOGRAPHY-To detect “ abnormally large single pool>8 tele bl Rett Rides a 8 ee ne Me MN he MM Hh Mh Mh Mh HM Mh Mh He Mh Nh Xb Hh Mb Nh Mh Mh Mh Hp XS Mh Wh pM Mh Np Nh Mh Mh Mp Xp Mh Mh Nh Np Mh Mh Mp Yh Mh Wh Xp Mh Bh Xp Nb Mh Bh Xb Mh Nh Mh Th HhS&T NeW Hp HH HH pM Wh MH Hh HH Wh Hp HW Hh WS Hh Hh Hh Wh Mh Up Wh Mh Wh Hh Mh Mh Mh Hh Uh Mh Me Hh Hh Wh Mh Hh Mh Bh Hp Mh Mh Wh Mh Mh Mh Wh Mh I em.AF1 is More than 25 CM. * RADIOGRAPHY-not commonly performed. it is used to detect bony congenital malformation of the fetus. v ABO AND RH GROUPING-thesus isoimmunisation may cause hydrops fetalis and fetal ascites. * AMNIOTIC FLUID-cstimation of alfa feto protein which is markedly elevated in the presence of fetus with open neural tube defect. MANAGEMENT -[in general] PRINCIPLES- * Torelieve the symptoms. © To find out the cause. * Toavoid and deal with the complication. MILD ASYMPTOMATIC POLYHDRAMNIOS -is managed expectantly. The woman is not admitted. She is advised to get adequate rest. She should be advised that if she suspects that membranes have ruptured, immediate admission would be necessary. FOR A WOMAN WITH SYMPTOMATIC POLYHYDRAMNIOS -admission to a hospital is required. Care will depend on the condition of the woman and fetus, the cause and degree of hydramnios and the stage of pregnancy. Upright position will help to relieve heartbum and nausea. SUPPORTIVE THERAPY - includes bed rest with back rest,analgesies and treatment of theassociated conditions like pre-eclampsia,diabetes.indomethacin given orally to the mother 25 mg 6 hourly has been found to decrease amniotic fluid. INVESTIGATIONS ARE TO BE DONE. PREGNANCY LESS THAN 37 WEEKS-If the discomfort from the swollen abdomen is severe, amniocenteses or amniocentesis or amnioreduction may beconsidered. Up to 500 ml of amniotic fluid may be removed to provide temporary relief, Fluid will accumulate again and there is risk of introducing infection with this procedure. PREGNANCY MORE THAN 37 WEEKS-Labor will be induced if the symptoms ‘become worse or gross abnormality is diagnosed. For induction, the fetal lie must be corrected if it is not longitudinal. Membranes will be ruptured cautiously; allowing the amniotic fluid to drain out very slowly in order to avoid altering the lic and SH He Wh Hp HW HH HM Hh Hh HH Hh Hp Hh HS Hh Hh Hh HH Hp Mh Hh He Hp Hp Wh Xp Hh Hp Uh Mp Uh Hp Wh Hp Yh Wh Up Mh Mh Mh Hp Mh Mh Uh Mp Wh Hp Ih Hh Hh Hhprevent cord prolapsed of placental abruption. Labour will be usually normal, but postpartum haemorrhage is a possibility. Te baby will need to be examined for abnormalities. * WITH COGENITAL FETAL ABNORMALITY -termination of pregnancy is to be done irrespective of the duration of pregnancy. * DURING LABOUR- if intrauterine contraction become sluggish, oxytocin infusion may be started if not contraindicated. To prevent PPH intravenous methargin 0.2 mg should be given with the delivery of anterior shoulder PREVENTIVE MEASURE- ‘Regular antcnatal check up at frequent interval from the beginning of pregnancy to detect at the carliest the rapid gain in weight or a tendancy of rising blood pressure especially the diastolic pressure *% Advice to take adequate rest in bed on her left side at least for two hours in the ftemoon from the 20 week of pregnancy onwards. 4 Calcium suplimentation [2 gm/day] * Antioxidants ,vitamin o,and c from 16-22 week onward 4 Well balance dict NURSING PROCESS -[in general] ASSESSMENT- Ballottement results in fluid waves. Fundal height excessive for gestation. Fetus difficult to outline with palpation. Supine hypotension. Fetal abnormalities of central nervous system or GI tract. Easy fatigability. eo eeee ANALYSIS AND NURSING DIAGNOSIS- RISK for fetal injury. Impaired physical mobility. ‘Actual risk for fluid volume deficit. Anxiety, Anticipatory grieving. ee eee PLANNING- Promot maternal comfort. Promote matemal —fetal well being. Provide opportunities for counselling and support. Provide education for selfcare measures in increasing comfort. coos IMPLEMENTATION- He MW MW Hp Me Hp Uh Hh We Wh Hh MS Hh Hh Hp Me Hp Mh Hh He Hh Hh Mh Mp Mh Hp Mh Hp Mh Hh Uh Hh Hh Wh Uh MS Mh Mh Hh Mh Hh Mh Mh Mh Mh Mp Wh Nh Mh Yh Wh Hh WS Mh Hh Mh Hh We Hp Wb Hp Nb Mp Uh Xp Hh Xp Me Xp pH Hp Hh ep ep Mh Hp He Hp Mp Wh Hp Hh Hp Mh Xp Ue Hp Uh Wp Hh Xp Yh WS Yh Mh pH Xp Yh Hh Hp Up Up Uh Hh Wh Yh Wh Hh IS Uh HH HS Hh© XS Th XW HW HH Mh HH SH HH HSH HS Hh Wh Hh Hp Mh HM Mh Hh Wh Me Hh Mp Uh Hp Mh Mh Mh Hp Uh Wh Ue Wh Uh Mh Mh Wh Wh Hh Hh Mh hh Wh Hh HST Facilitate testing ~amniocentasis, sonography. Assess FHR. Anticipate premature labour and postpartum haemorrhages caused by over distension of the uterine muscle Instruct and explain-nature of problem. -need to obtain immediate medical attention for problems -need to observe for preeclampsia. EVALUATION- coer Verbalize increased expectant mother. Progresses to uneventful birth, as dos her baby. Verbalizes support. Verbalizes self-care measures. -Management;- [in my patient] ‘Treatment modallties- REST-admission in hospital and rest is helpful for continued evaluation and treatment of the patient patient should be in upright position will help to relicve heart bum and nausea Rest inerease the renal blood flow ,Increase the uterine blood flow DIET-the diet contain adequate amount of protein{about 100 gm|.fluid need not be restricted total calories approximate 1600 cal/day. DRUG- indomethacin given orally to the mother 25 mg 6 hourly has been found to decrease amniotic fluid DRUG Dose ‘¢ Tab.indomethacin 25 mg,6 hourly ¢_Tab.Hb -14 plus ‘OD © Tab. Com ‘OD ¢ Tab. Domped BD ‘© Protein powder 2 sf with milk OD ‘NURSING CARE PLAN OF MY PATIENT: XW Xp Wh HW Hp HH HH ph HH HH Hp HH Hh Hh Hh Mp Wh HH HH Eh Mh Hh Mh Lh Hp Wh Hp Uh Hp Uh Hh Uh I Uh Wh Yh Wh Hh > Hp Wh Hh Uh Hh Ih Hh I HHTMe Nb Mp We Hp Mh Xp Me Wh Hp Hh Xp We Mp Mh Wh Xp Mh Xp He Xp Hh Hh Hh Wh Xp Me Mp Hh Mh Hp Mh Mp Mh Mp Kh Wh Mp Mh Hp Uh Xp Wh Wp Np Uh Xp Mh Mp Uh Hp Mp Ih Mh Wh Hh Ih Hh HS Hh) eae! HEALTH EDUCATION; SNO [TOPIC (CONTENT 1 | PERSONAL ‘* Explained the importance of maintaining good personal hygiene. HYGIENE, ‘© Keep perineum clean, dry. ‘© Told the patient to take regular bath & change cloth. 2 | DIET ‘* Explained the importance of high caloric diet & protein rich dict. ‘* Alsocxplained iron rich diet & calcium dict. * Advice to take green leafy vegetables. Take plenty of oral fluid. 3 | REST & SAFETY ‘© Explained the importance of strict bed rest. © Todecrease anxiety by providing accurate information. . patter © Monitor accurate intake & output + Encourage time for women & partner, 4 | MEDICATIONS * Explained the importance of medication. © Instruct fo take regular medicine ‘© Educated regarding side effects of medication. Prognosis:- In my patient having some anxiety about there condition She feel some time sad because of their problem .In my patient the prognosis was good; she recovered and developed no complication till date of discharge CONCLUSION:- Polyhydramnios is an excessive amount of amniotic fluid, which exceeds 1,500 ml. it occurs in 0.9 percent of pregnancies. It is typically diagnosed when the amniotic fluid index (AFI) is greater than 20 cm (220 em). But many timesit is very essential to the couple to preserve the life of the either mother or fetus or both but it has very good & effective medical & nursing management so that potential complications & solutions to the problems are carried out & help to preserve all aspects of the health is met. Summary and conclusion: My paticnt Mrs. Aarti admitted with the complaint with backache and nausca and vomiting Paticnt ‘was fine at the time of discharge and developed no complication. SESE EEL ESSER EE EE EE EEE EEE EE ES EE EEE EERE EENfrites tet fei fete eee fe te fe tee effet tte * * = = # [assissment [wunsne[eoaL TNTERVENTION/PLANNING | IMPLEMENTATION RATIONAL] EVALUAT = oucnoss ton $ [SumECHVE Poin related | To reduce the | To Assess patient condition. | Vitalsigns of the elent & checked at | TOTind out % | DATA Pthaving| to increased intensity of | To ossess vital signs 10:30am, anyatether | Pt $ | backache | excessive | pain. To palpate the fundus for deviation | express £ emount of height, location, and frrmess.| Up right postion isgiven top from | reef E Jomecnve — | emoiotc | pewitexpress | To provide comfortoble postion rormat | from E | oarasobserve | puid refeffrom pain | To provide relaxation therapy condition | pain and | tharpt having and comfort ‘comfort % | mia backache Torcliove £ pan = & | subjective dato. {uid volume | To provide adequate amount of | Assess pt Conition Toreduce | ptstoldme that | mist for | tevel in the | fu Tab damped 80 adminstred rausea |stetoving — | tered | bodywitbe | Intake output should be Tab. Indomethacin 25 mg6 hourly is Nowseo $ |roueoons | ud — | moaned | mantored cximinsteredtodeceeseamauntey |r | reseed ¥ | vomiting volume snot fid mmatnain | gradual * depcient | nausea wil be Instruct patient to rake adeqvote | ruidand % | objective data | related to. | redueed ‘mount of i ite ft juices slectroyte | Ptwas H | observe that pt | tessintake Monier intake andovtput chart | balance | well & | otsethorgc ‘poet $ | ondweak die | Nousea # | tonmuseoond | reltedto % | vamorting | physoioge + alchanges z during = ‘pregnancy z Pe wibe fee | Tocasses pt For sian of infection | Hand woshing must be done before and | Toreduce & | subjective dota. om infection after procedure chances of & Let Poldme that To maintained proper aseptic tech Infection + * = 3 FERRIER LIAR PERLITE TITER PPE RTPI PE PPR T ERP PR EITfe fe Sf et et tf ff tf DBD ff tt ft fff tt tft fff tt ft ttt tt he having Objective data-i observe that pt fooksIthargle Subjective dato- Petold me that ‘she not take roper diet Objective datari ‘observe that pt, ‘not take proper diet surgical condition, ‘Subjective data- PUtold me that she having ‘anvlety ‘Objective data- observe that pt having anxlety ‘due to disease ‘condition and Looks tense BRREEER ERE R ER ERE REE EER ER ERR EER R REE REE RRR eR Ee Imbalanced utrtion Jess than requiremen treloted to ‘poor intake Anwiety related to disease condition ‘Nutritionat stotus will be maintoined Pe wil have ess anxiety nique To assess nutritional status of the potient To provide knowledge regarding antenatal diet To assess analety level of pt. ‘To provide information regarding disease condition ‘To provide psychological support ‘nal procedure aseptic technique must ‘be maintoined Vito! signs are monitored and ‘observed for any signs infection .2ssess nutritional status ofthe patient ‘heath education given regarding ‘ontenotol diet according to economical status and p's ke and dishite include green ieofy vegetables fruits frultjuiees sprouted seeds dry fruits plenty of woter,ice dal _chapates,rilcurd et ‘assess pt. Condition provide information regarding disease condition and treatment provide psychological support tothe patient Tomaintain rutiitlonal status of the patient Toreduce anmiety Deft fff Deft ff fff Dt fff ff at fff a ttt ff ttt ttt Puhavin giles ; ; "