CHAPTER I

A. Background
Along with the development of science and technology, many experts find a variety of
new discoveries, especially in the field of health. Like the way of childbirth, which was
originally by method vaginal that we know as normal childbirth, it can also be done by a
vagdominal, which is called a cesarean section or caesarean surgery. Caesarean section is
surgery to give birth to a fetus by opening the abdominal wall and uterine wall (Mansoer Arif,
et al, 2007).
According to statistics on 3,509 cesarean sectio cases compiled by Peel and
Chamberlain, indications for cesarean section weredisproportion pelvic fetalof 21%, fetal
distress 14%, placenta previa 11% had cesarean section 11%, fetal abnormalities 10%,
preeclampsia and hypertension 7% with maternal mortality before being corrected 17% and
after being corrected 0.5% while fetal death is 14.5% (Winkjosastro, 2005). According to
Andon from several studies it appears that the actual morbidity and maternal mortality rate in
caesarean section surgery is higher than vaginal delivery. The direct mortality rate for
cesarean section is 5.8 per 100,000 live births. While therate is morbidityaround 27.3 percent
compared to normal childbirth, only about 9 per 1000 events. WHO (World Health
Organization) recommends cesarean section is only about 10-15% of the total number of
births.recommendations WHO are certainly based on an analysis of the risks arising from
cesarean delivery. Both risks for mother and baby. (Nakita, 2008).
Mothers who have caesarean section with abdominal injuries that result must be
treated properly to prevent possible infections. The mother will also limit the movement
of her body due to surgical wounds so that the process of wound healing and removal of fluid
or dirty blood clots from the mother's womb are affected (Bobak, LJ, 2004).
Caesarean section actions can cause changes or physiological or
psychologicaladaptations. Thus the client and family need to get information about existing
problems, nurses are also expected to explain the procedure before caesarean section surgery
is performed and need to be informed to the mother who will be felt later after caesarean
section surgery. In addition nurses are also expected toto be ableovercome the problems that

1
 arise Caesarean post section. Therefore, the authors are very interested in finding out more
about care nursingin Caesarean section clients.
B. Objectives
The purpose of making this paper, among others, is to:
1. Know the definition, etiology and risk factors ofsection deliveries caesarian
2. Know the incidence or incidence of childbirth with caesarian section in Indonesia.
3. Describe the pathophysiology of labor with the caesarean section
4. Describe the maternal and neonatal effects in labor with sectio caesaria
5. Know the diagnostic test for labor with the caesarean section
6. Describe nursing care in labor with the caesarean section

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 CHAPTER II

A. Basic Concepts of Sectio Caesaria

1. Definition of Sectio Caesaria
Sectio Caesaria (SC) is an action to give birth to a baby weighing above 500
grams, through an incision in thewall intact uterine(Prawirohardjo, 2009). Sectio Caesaria
(SC) is a surgery to give birth to children through an incision in the abdominal wall and
uterus (Oxorn & Forte, 2010).
Sectio Caesaria is a way to give birth to a fetus by making an incision in the uterine
wall through the front wall of the abdomen or vagina (Mochtar, 2002). Sectio Caesaria is a
way to give birth to a fetus by making an incision in the uterine wall through the
abdominal wall (Sofian, 2012).

2. Types of Caesaria Sectio

According to Oxorn & Forte (2012), types of Caesaria Sectio are
a. Lower segment: transverse incision
This type of Sectio Caesaria allows the abdomen be opened and the uterus to be exposed.
folds Vesicouterina (bladder flaps) located with upper and lowersegment connections are
uterinedetermined and cut transversely, these folds are released from lower segments and
joint bladder are pushed down and pulled so that it does not cover the field of vision.
Advantages:
1) The incision is in the lower uterine segment
2) The muscle is not cut but separated laterally, this method reduces bleeding
3) The incision rarely occurs until the placenta
4) The fetal head is usually under the incision and easily extracted
5) The thin layer of muscle from the lower uterine segment more easily pressed
back than the thick upper segment.
Disadvantages:
1) If the incision is too far lateral, as in the case of a baby large.
2) This procedure is not recommended if there are abnormalities in the lower
segment.

3
 3) If the lower segment is not yet well formed, transverse surgery is difficult.
4) Sometimes the urinary vesica is attached to the cicatrix tissue that happened
before so that the urinary vesica can be injured.

b. Lower segment: longitudinal incision

Longitudinal incision is made with a scalpel and spread with blunt scissors to avoid
injury to the baby. The advantage of this type is that it can widen the incision upwards if
baby is large, the formation of the lower segment is ugly, there ismalposition fetalsuch as
latitude or the presence of fetal anomalies such as fused twin pregnancies. The
disadvantage is that the bleeding from the edges of the incision is more because of muscle
cuts.

c. Caesaria Sectio Classical

Longitudinal incision in the midline is made by scalpel into the anterior wall of the uterus
and spread up and down with blunt-tipped scissors.
Indications:
1) Difficulties in revealing the lower segment are the presence of large blood vessels in
the anterior wall, vesica urinaria which are located high and attached and thesegment
myoma lower.
2) Infants gripped at a latitude location
3) Some cases of anterior placenta previa
4) Certain uterine malformations

Disadvantages:
1) Myometrium must be cut, wide sinuses opened, and bleeding a lot
2) Babies are often extracted buttocks first so that the possibility of aspirations of
amniotic fluid greater
3) If the placenta is attached to the uterine front wall, the incision will cut it and can cause
blood loss from dangerous fetal cycles
4) Incidence of attachment of abdominal contents to suture wounds uterus is higher
5) Incidence of uterine rupture in subsequent pregnancies is higher

4
d. Extraperitoneal Caesaria Sectio
This surgery is performed to avoid the need for hysterectomy in cases of extensive
infection by preventing generalized peritonitis which is often fatal. The technique for this
procedure is relatively difficult, often accidentally entering the peritoneic cavity and the
incidence of urinary bladder injury increases.

e. Hysterectomy Caesaria
Surgeryis sectio Caesaria, followed by spending the uterus.
Indications:
1) Bleeding due to uterine atony after conservative treatment fails
2) cases of Uncontrollable bleeding in certainplacenta previa and abruptioplacenta
3) In certain cases of cervical or ovarian cancer
4) Irreversible arterial rupture
5) Cicatrix which causes defects in the uterus
Complications:
1) The morbidity rate is 20 percent
2) More blood loss
3) Damage to the urinary and intestinal tract including formation of fistula
4) Psychological trauma due to loss of uterus
Meanwhile, according to Rustam Mochtar (2002), the types of Sectio Caesariaare:
a. Transperitoneal Caesaria Sectio
1) cesarean Classic or corporateis by making a vertical incision to allow a better room
for the baby to escape.
2) Sectio Caesaria ismika or profunda that is by making an incision or transverse
incision from the left to the right in thesegment lower uterineand above the pubic
bone.
b. The Caesaria Sectio peritonalistis without opening theperitoneum parietal, thereby not
opening the abdominal cavity.

5
3.Indications Sectio Caesaria
Cesarean section is carried out if not possible pervaginal labor isdue to risks to the
mother or fetus, with consideration of the things that need to be taken by thesection cesareans
such as prolonged normal labor or failure of normal labor (Dystasia) (Saifudin, 2002).
According to Mochtar & Sarwono Prawirohardjo (2009), several indications of the
Caesaria Sectio are:
a. Placenta previa, especially placenta previa totalis and subtotalis
b. Narrow pelvis
c. Rupturi uteri threatens
d. Old parturition
e. Tumors that block the birth canal
f. Abnormalities or large babies
g. Circumstances where efforts to give birth to vaginal children fail
h. Fetal death
i. Amused
j. Complications of pre eclampasia and hypertension.
k. Soft tissue dystocia.
l. Pelvic head disproportion (CPD / FPD)
m. Uterine dysfunction.

4. Advantages and disadvantages of Sectio Caesaria.

a. The advantages of cesarean section are:
Saesaria section is safer chosen in undergoing labor because it has saved the lives
of many mothers who have had difficulty giving birth. The birth canal is not tested by
doing sectio Caesaria, which is diagnosed whenpelvis a narrowor fetal distress pelvimetry
backed up data. For mothers who are paranoid about pain, saesaria section ischoice the
rightin undergoing labor, because they are given anesthetics or pain barrier (Fauzi, 2007).
b.loss Caesarean section.
Sectio caesaria causes complications including damage to the bladder and
uterus,complications anesthesia, bleeding, infection and thromboembolism. Maternal
deaths are greater in caesarean sectionvaginam than in deliveriesbirths. Short-term

6
 takipneu for newborns is more common indeliveries sectio caesaria and the incidence
oftrauma laborcannot be ruled out. Long-term risks that can occur are the occurrence of
placenta previa,solution placental, placenta accreta and uterine rupture (Rasjidi, 2010).

5. Complications
According to Oxorn and Forte (2010), serious complications insurgery Caesarian Sectio
are
a. Bleeding.
Bleeding in the cesarean section occurs due to uterine atony, widening of the uterine
incision, difficulty removing the placenta and latum ligamentous hematoma.
b. Infection
Infection does Sectio caesaria not only occur in the incision area, but can occur in
other areas such as the genetical tracttract , the urinary, the lungs and the upper respiratory
tract.
c. Thromboplebitis
d. Injuries, with or without fistulas can occur in the urinary tract and intestine.
e. May cause intestinal obstruction both mechanical and paralytic.

6. Post Care Sectio Caesaria

According to Rasjidi (2009), postoperative patients need to get the following treatments:
a. Recovery room
In the recovery room, the patient carefully monitored for the amount of bleeding from
the vagina and palpated the uterine fundus to ensure that the uterus contracts strongly. In
addition, intravenous fluids are also needed. The need for intravenous fluids including blood
varies greatly. Anwoman with average weighta hematocrit less than or equal with 30 and
normal blood volume and extracellular fluid generally can tolerate blood loss of up to 2,000
ml.
b. Treatment Room
Some procedures performed in the treatment room are:
1) Monitor vital signs
Vital signs that need to be evaluated are blood pressure, pulse, amount of

7
 urine, amount of bleeding, uterine fundus status and body temperature.
2) Analgesics.
For patients with weight with an average body weight, it can be given at most
every 3 hours to relieve pain. Whereas for patients using opioids,should be routine
examinationsgiven every hour to monitor respiration, sedation and pain scores during
administration and at least 2 hours after stopping treatment.
3) fluid and food therapy.
Giving intravenous fluids, generally get 3 liters of adequate fluid for the first 24
hours after the procedure, but if urine output falls, below 30 ml / hour, the woman must
immediately be reassessed.
4) Supervision of urinary and intestinal vesic functions.
Urinary bladder catheters can generally be removed within 12 hours after surgery
or the next morning after surgery and solid food can be given after 8 hours, if there are
no complications.
5) Ambulation.
The ambulation time is adjusted so that the newly administered analgesic can
reduce pain.
6) Wound care.
Incision wounds are examined daily and skin seams (or clips) on the fourth day
after surgery. On the third day after delivery, bathing with a shower does not harm
thewound incision.
7) Laboratory examination.
Hematocrit is measured every morning after surgery. This examination is done
early if there is a lot of blood loss during surgery or oliguria or other signs that indicate
hypovolemia.
8) Breastfeeding.
Breastfeeding can begin on the postoperative day of cesarean section.
9) Prevention of postoperative infections.
Fever morbidity is quite common after cesarean section. Postoperative pelvic
infections are the cause of common from fever and still occurs in about 20 percent of
women even though they have been given prophylactic antibiotics.

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7. Anatomy of the pelvis and its contents

Figure 2.1: Pelvic Anatomy (Sarwono Prawirohardjo, 2010).

The anatomy of the pelvis and its contents consist of the following parts :
a. Pelvic Bones
According to Wiknjosastro (2007), the types of pelvis according to their morphology are
divided into 4, namely:
1) pelvis Gynecoid, with the characteristics of apelvic door roundor with a transverse
diameter that islonger slightly than the antersposterior diameter and with apelvis middle
and the underside of the pelvis is quite wide.
2) pelvis Anthropoid, with characteristics of anteposterior diameter that is longer than the
diameter of the tranversa, and with thearch pubicnarrowing slightly.
3) pelvis Android, with the characteristics of the top of the pelvic door that is shaped as a
triangle associated with narrowing forward, with ischial spinika protruding into and with
the pubic arch narrowed
4) pelvis Platypelloid, with characteristics of anteroposterior diameter that is clearly shorter
than the transverse diameter in upper pelvic door and with a broad arch pubic.
According to Oxorn & Forte (2010), the types of pelvis abnormalare:
1) Naegele pelvis which is imperfect growth or the absence of one of the alaossis sacri
causes the pelvis to be narrow and tilted.
2) Robert's pelvis is the shape of the pelvis that narrows symmetrically in the transverse
direction caused by the absence of the two alae assis sacri.
3) Split pelvis, ie the two os pubis do not become one, often accompanied by the
unification of the walls of thevesica urinaryand the anterior abdominal wall.

9
 4) Pelvic assimilation , which is an elongated pelvis where the last vertebral lumbar or
coccygealfirst vertebrate resembles thelumbar or coccygeal vertebrate.
5) The osteomalacia pelvis is the softening of the bone which then curves into the pelvic
cavity, thus greatly reducing all diameter sizes.
6) Spandylolisthetic pelvis is the last lumbar vertebrate shifted forward and down above
the promontorium.
A woman's framework is aimed at fulfilling reproductive functions. The thoracic form has
alower part wider for the purposes of pregnancy. Gynecoid-shaped pelvis with a larger iliac-style
and concave, promontorium less prominent, shorter symphysis. In the lumbar lordosis area more
clearly (Sarwono Prawirohardjo, 2010).
b. Abdomen
Wall The front wall of the abdomen consists of the skin,panniculus adiposus(fat layer)
which is sometimes quite thick, fascia and muscles: nectus muscle, external, olakus
muscularmusculus internusabdominis muscle, ousus and tranculusand apenourosis (Sarwono
Prawirohardjo, 2010 ).
c. Pelvic
Floor The pelvic floor needs to have the strength to with stand all the burdens placed on
it, especially the contents of the abdominal cavity. and intra-abdominal pressure. This burden is
held by the layers of muscles and fascia that are in the pelvic floor. In labor the layers of muscle
and fasio experience pressure and impulse,genetalio soprolapses can occur. The pelvic lower
door consists of the pelvic diaphragm, the urogenatal diaphragm and the layers of muscle that are
outside it. All muscles are under the influence of motor nerves and can be stretched actively. The
function of these muscles are
1) Muscle levator ani functions to hold the rectum and vagina down.
2) Musculus stringfer ani external serves to close the anus which is strengthened by the
muscular levator ani.
3) Bulbokavernesus musculature functions to shrink vaginal introitus while
strengthening the function of the muscle internal sphincter vesisaeconsisting of smooth
muscle (Sarwono Prawirohardjo, 2010).

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d. Genital devices
1) Outer genital devices

Figure 2.2. External female genetalia (Pearce Evelyn, 2008).

a) Vulva
Vulva is a place where thesystem urogenitalstarts. On the outside of the vulva
is circled by labia the backwardmajora (large lips) into one and forms the posterior and
perineal commissures. Under his skin is fat tissue. Medially from the large lip, it is
found that the small lip (labium minora) which istowards the directedperineum
becomes one and forms thelabiorum frenulum pudenda. In the future the labia minora
becomes one and forms the clitoridis prepusium and clitoridic frenulum. Under the
clitoridis preposium lies the clitoris. Approximately 1.5 cm below the clitoris is
theurethral orifice external(urinary hole). On either side of the urinary hole there are
two small holes of the clogged duct (the paraurethal duct and the venous duct).
b) Mons pubis
Mons pubis is a circular protruding section in front of the pubic symphysis
which is formed by fat tissuepubic under the skin, covering the area of hair growing on
puberty.
c) Labia majora (big lips)
Labia majora is aprominent fold of skin longitudinallythat extends downward
and backward from the mons pubis and forms a lateral border that contains many
nerves. Each labium has two surfaces namely the outside has pigment and is covered
by curly hair and the inside is slippery because it is surrounded by follicles sebaceous.

11
 In addition there are also blood vessels and glands that form the posterior labialis
commissures.
d) Labia minora (small lips)
Labia minora is a small fold that is located between the labia majora. Labia
minora extends from the obligatory clitoris down and behind the side along the 4 cm
side of the vaginal orifice. The posterior end of the labia minora is joined at the
median line by a fold of skin called frenolum. Each labia minora is divided into:
(1) The upper part: through the clitoris joins the others to form folds that hang
on the glans clitoral.
(2) Lower part: through the bottom of the clitoris and forming a interconnected
lower surface called frenolum clitoris.
e) Clitoris
The clitoris is a small circular bulge containing erectile tissue which is very
sensitive under the anterior labia commisura and partially hidden between the anterior
end of the labia minora, andmany containsnerves. The clitoris consists of:
(1) The corpus cavernosus: contains erectile tissue that is covered by a solid
layer.
(2) Membranes: joined along the surface Fibrousmedial by the septum pektini
formis.
f) Vestibulum (porch)
Is a cavity that is between the small lips (labia minora). In the vestibule there
are 6 holes, namely urethra external orifice, vaginal introitus, 2 estuaries of
Bartholini's gland, and 2 estuaries of the paraurethral gland. Bartholini's gland
functions to secretefluid mucoidwhen sexual stimulation occurs. Thegland
Bartholinialso prevents the entry of Neisseria gonorhoeae and pathogenic bacteria.
g) Peritoneum
The viselare peritoneum covers most of thegenetal organs internal. The part
that is not covered by the peritoneum is called retro or extra peritoneal.
h) The rectal
Anus is covered by the external anal sphincter muscle reinforced by the
bulbokavernosis muscle, the levatormuscle ani and the perineal connective tissue.

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2) Inner genital apparatus in

Figure 2.3. Internal female genetalia (Pearce Evelyn,2008).

a) Vagina
Vagina connects external and internal genetalia. The vaginal introitus is closed
to the hymen (membrane dora), a local vaginal membrane folds measuringin 6.5
cmfront and behind 9.5 cm, the axle runs approximately parallel to the direction of the
bottom edge of the symphysis to the promontorium.
The vagina (intercourse channel) has anfunction importantas a soft birth canal,
as a means of sexual intercourse, channeling it to drain mucus and menstrual blood
(Manuaba, 2009).
b) Uterus
Uterus in an adult is shaped like an advocate fruit or a slightly flattened peer
fruit. The length of the uterus is 7-7.5 cm, width 5, 25 cm and thickness 2.5 cm. The
weight of the uterus of women who have given birth between 50-70 grams, while
women who have never given birth weighs 80 grams or more. The uterus consists of
the corpus uteri (2/3 top) and cervical (1/3 bottom) Inside the uterine body there is a
cavity (uterine coval), which opens out through a channel (cervical canal) located in
the cervix. Between the corpus and cervix there is still a part called the uterine
isthmus.
The uterine muscle layer consists of three layers that have the ability to grow

13
 and develop so that they can maintain and sustain pregnancy for 9 months. The uterus
is also an important birth canal and has the ability to encourage the birth canal
(Manuaba, 2009).
c) Fallopian Tubes Fallopian
Tubes are fallopian tubes as well as the uterus of the mulleri duct. The average
tubal length is 11-14 cm. The outer part of the tube is covered by the peritoreum
viserale, whichlatent is part of the ligament.
Fallopian tubes are the most sensitive to infection and are the main cause of
infertility. The function of the fallopian tube is vital in the process of pregnancy, which
is to become the spermatozoa and ovum channel, where fertilization occurs, as a
channel and a place for growth of fertilization results before being able to implant
themselves in the inner layer of birth (Manuaba, 2009).
d) Ovaries
Ovaries or ovaries in an adult the size of the thumb, located on the left and
right, close to the pelvic wall dipossa ovarika.
Ovaries are female hormonal source the most importantso that they have
aimpact femalein regulating the menstrual process. The ovary secretes the ovum (egg)
each month alternately right and left. When an egg (ovum) is removed a woman is
called in the fertile period. The menopause period for all eggs to disappear (Manuaba,
2009).

8. Possible Diagnoses
According to Amin, Hardhi (2013), nursing diagnoses that appear on cesarean
section clients include:
a. Pain associated with physical injury agents (trauma of the birth canal, surgery,
episiotomy)
b. Risk of infection is associated with risk factors: episiotomy, laceration of the birth
canal, delivery assistance.
c. Disorders of sleep patterns associated with weakness
d. High risk of interconnected fluid deficiency with irregularities that affect fluid intake
e. Aspiration risk is associated with decreased level of consciousness

14
 f. Urinary elimination disorders associated withsensory disorders motor.
g. The ineffectiveness of breastfeeding is related to the lack of maternal knowledge,
cessation of breastfeeding.
h. Risk of injury
i. Constipation

9. Focus of the Intervention

According to NANDA (2008), the focus of the intervention of the diagnosis of cesarean
section is:
a. Pain associated with physical injury agents (trauma of the birth canal, surgery,
episiotomy)
NIC:
Pain Management:
1) Perform a comprehensive pain assessment (location, characteristics, duration,
frequency, quality and fracture factor
2) Observation of nonverbal reactions from discomfort
3) Use therapeutic techniques to determine thepain experience patient's
4) Assess cultures that affect pain response
5) Evaluate past pain experiences
6) Control the environment that can affect pain such as room temperature, lighting, and
noise
7) Teach about non-pharmacological techniques
8) Give analgesics to reduce pain

Analgesic Administration:
1) Determine the location, characteristics, quality and degree of pain before drug
administration
2) Check the doctor's instructions about the type of drug, dosage and frequency
3 ) Check the history of allergies
4) Select the required analgesics or a combination of analgesics when giving more of
one

15
 5) Give analgesics on time especially when severe pain

b. Risk of infection is associated with risk factors: episiotomy, laceration of the birth
canal, delivery assistance.
NIC:
Infection Control:
1) Clean the environment after patient use
2) Maintain isolation techniques
3) Limit visitors if necessary
4) Wash hands before and after nursing action
5) Use clothes, gloves as protective equipment
6) Give antibiotic therapy if necessary
Infection control:
1) Monitor systemic and local signs of infection
2) Monitor susceptibility to infections
3) Limit visitors
4) Use asepsis techniques
5) Encourage adequate nutritional input
6) Encourage fluid input
7) Instruct the patient to take antibiotics as prescribed

c. Sleep disturbance is associated withweaknesses

NIC:
Sleep Enhancement:
1) Determination of the effects of medication on sleep patterns
2) Explain the importance of adequate sleep
3) Facilities to maintain activities before going to sleep (reading)
4) Create a comfortable environment
5) Collaborative drug administration sleep
6) Monitor meal and drink time with sleep
7) Instruct to monitor patient's sleep

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d. The ineffectiveness of breastfeeding is related to the lack of knowledge of the mother,
the cessation of breastfeeding.
NOC:
1) Breastfeding Assistance
2) Breast Examination
3) Lactation Counseling
NIC:
Breastfeding Assistance:
1) Evaluate the pattern of sucking or swallowing a baby
2) Determine the desire and motivation of the mother to breastfeed
3) Evaluate the mother's understanding of breastfeeding cues from infants
4) Assess the baby's ability to latch on and suck effectively
5) Monitor the integrity of the mother's nipple skin
6) Monitor the baby's weight and elimination patterns
Breast Examination:
1) Facilitation of an interactive assistance process for help maintain the success of the
breastfeeding process
2) Provide information about lactation and techniques for pumping breast milk
(manually or electric pumps), how to collect and store breast milk
3) Teach parents to prepare, store, warm up in the possibility of supplementingmilk
formula.
Lactation Counseling:
1) Provide information about the advantages and disadvantages of breastfeeding
2) Demonstrate sucking exercises if necessary
3) Discuss alternative methods of infant feeding

e. High risk of fluid deficiency associated with

irregularities that affect fluid intake
NIC:
Fluid Management:
1) Weigh diapers or pads if needed

17
 2) Maintain an accurate intake and output
3) Monitor hydration status (humidity, mucous membrane,pulse adequate, orthostatic
blood pressure).
4) Monitor vital sign.
5) Monitor fluid / food input and calculatecalorie intake daily
6) Monitor nutritional status
7) Push oral input

Hypovolemia Management:
1) Monitor fluid status including fluid intake and output
2) Maintain IV line
3) Monitor Hb levels and hematocrit
4) Monitor vital signs
5) Monitor the patient's response to fluid addition
6) Monitor weight
7) Encourage the patient to increase oral intake
8) Monitor for kidney failure

f. Risk of aspiration is associated with decreased level of consciousness.

NIC:
Aspiration Precaution:
1) Monitor the level of awareness, cough reflexes and the ability to swallow
2) Monitor lung status, maintain airway
3) Perform suction if neededsuction
4) Checknasogastric before meals
5) Avoid eating if there is still a lot of residue
6) Cut small pieces of food
7) Blend the drug before administration
8) Keep the tracheal cuff increased

18
g. Urinary elimination disorders associated withsensory disorders motor.
NIC:
Urinary Retention Care:
1) Perform a comprehensive urinary assessment focusing on incontinence (eg urine
output, urinary patterns,function cognitive, and pre-explicit urinary problems)
2) Monitor drug use with anticholinergic properties or alpha agonist properties
3) Monitor the effects of drugs prescribed medicines.
4) Insert the urinary catheter
5) Encourage the patient or family to record urine output
6) Instruct ways to avoidconstipation or fecalimpaction
7) Monitor intake and output.
8) Applying intermittent catheterization of

h. Risk ofInjury
NIC:
Environment Management:
1) Provide a safe environment for patients
2) Avoid dangerous environments (eg avoid furniture)
3) Install bed side rails
4) Provide a comfortable and clean bed
5) Restrict visitors
6) Encourage families to accompany patients
7) Control the environment from noise
8) Move items that can be dangerous.

i. Constipation of
NIC:
Constipation / Impaction Management:
1) Monitor signs and symptoms of constipation
2) Monitor bowel noise
3) Monitor feces, frequency, consistency and volume

19
4) Consult a physician about decrease and decreasenoise bowel
5) Explain the etiology and rationalization of actions against patients
6 ) Collaborate laxative administration
7) Monitor signs and symptoms of constipation in
8) Teach patients and families aboutdigestive processes normal.

20
 REFERENCES
Carpenito, Lynda Jual. 2006. Buku Saku Diagnosa Keperawatan Edisi 10. Jakarta : EGC.
Cunningham, F, dkk. 2006. Obstetri William Edisi 21. Jakarta : EGC.
Farrer, Helen. 2001. Perawatan Maternitas Edisi 2 . Jakarta :EGC.
Manuaba, I.G.B. 2001. Kapita Selekta Penatalaksanaan Rutin Obstetri Ginekologi dan KB. Jakarta :
EGC.
Mitayani. 2009. Asuhan Keperawatan Maternitas. Jakarta: Penerbit Salemba Medika.
Prawirohardjo, S. 2008. Ilmu Kebidanan. Jakarta : Bina Pustaka.
Rasjidi, Imam. 2009. Manual Seksio Sesarea & Laparotomi Kelainan Adneksa. Jakarta : CV Sagung
Seto.

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