NCM 214 Aquino - Case Study

AQUINO, WASHRIEN S.
BSN II – C
NCM 214 – Care of Mother, Child and Adolescent (Well Clients) RLE
October 1, 2021
Case Scenario #1
PERINEAL TEAR
A woman has just delivered her third baby on the labor ward. She is 35 years old and had a
previous premature delivery at 35 weeks. In this pregnancy, she went into spontaneous labor at
38 weeks after an uncomplicated pregnancy.
The symphysiofundal height was consistent with dates until 37 weeks when the midwife
measured it as 41 cm. However, before an ultrasound scan for growth and liquor volume could
be arranged the woman went into spontaneous labor.
At the time of admission she was 5 cm dilated and spontaneous rupture of membranes
occurred soon after. The baby was delivered 30 min later in the direct occipitoanterior position.
The patient is experiencing dizziness and coolness of skin. Vital signs as follows: T-37.8C, HR-60,
RR-25, BP-90/60mmhg.
The placenta was delivered by controlled cord traction, after which the Nurse noticed a perineal
tear. The tear extended from the introitus in the midline and she could see torn muscle fibers
suggestive of the torn ends of the external anal sphincter. She has called you to review the
patient.
Questions:
1. What is the likely diagnosis?

‒ Perineal tear associated with vaginal birth
2. What factors predispose to this condition?

‒ Infections may occur such Obstetric anal sphincter injuries (OASI) if the situation is not
prompted immediately, notify the doctor or midwife of the client’s condition instantly.
3. How would you manage this patient?

‒ First thing to do is assess location and nature of discomfort or pain, rate pain on a 0–10
scale.
‒ Tell the client that perineal tear can happen and affects about 80% of women during
childbirth and assure her that she should not worry at all because this is a normal
occurrence. A small tear won't be closed with stitches and will be allowed to heal on its
own but if the client needs to have her perineum stitched; the stitches will dissolve in 1
to 2 weeks.
‒ Prepare ice packs right after the birth. Using ice packs in the first 24 hours after birth
decreases the swelling and helps with pain.
‒ After urination or having a bowel movement, spray warm water over the area and pat
dry with a clean towel or baby wipe and never use toilet paper.
4. Provide at least 3 Nursing Care Plan for this case.
NURSING CARE PLAN RATIONALE

Encourage application of moist heat in Water promotes cleansing. Heat dilates
the form of sitz baths and of dry heat in perineal blood vessels, increasing
the form of perineal lights for 15 min 2–4 localized blood flow and promotes
times daily. healing.
Encourage client to ask for pain
Pain is a lot easier to control before it
medications before the pain becomes
becomes severe.
severe/intolerable.
Enhances flow of lochia and
Encourage semi-Fowler’s position.
uterine/pelvic drainage.
Case Scenario #2
J.T. is a 43-year-old man who presented to his primary care doctor after 4 days of progressive
pain and swelling in his genital region, along with a low-grade fever. There was no history of
similar symptoms. He denied recent trauma. He had no nausea, vomiting, diarrhea,
constipation, abdominal pain, melena, or hematochezia. He also denied dysuria, urgency, and
frequency. He was in a monogamous relationship and had no history of sexually transmitted
diseases. Notably, he reported a 110-lb weight loss over 6 years.
His medical history was positive only for a urethral stricture treated with a urethral dilation on
cystoscopy in 1965. He had no allergies and was taking no medications. He did not smoke or
drink alcohol. His family history was significant for his grandmother with type 2 diabetes.
Physical examination showed a mildly ill-appearing man in moderate distress. He was awake
and alert. His vital signs included a blood pressure of 115/72 mmHg, heart rate of 110,
respiratory rate of 13, and temperature of 99.7 degrees. He was 5′9″ and weighed 140 lb.
Head, eyes, ears, nose, and throat were normal. Lungs were clear. Heart was tachycardic with a
normal s1 and s2 with no murmurs or gallops and no rub. Abdomen was non-tender and non-
distended with normal bowel sounds. His extremities had no edema, and pulses were normal
bilaterally.
J.T.’s genital exam revealed diffuse erythema and edema of his scrotum and perineal area,
along with severe tenderness. There were multiple areas of hemorrhagic necrosis involving a
large part of the scrotum but sparing the penis. His testicles were normal in size and contour
and were not tender. His perirectal area was erythematous, but there was no evidence of
fissures, ulcerations, or crepitus.
Laboratory data included a normal hemoglobin and hematocrit but a markedly elevated white
blood count to 35,000 k/mm3. His chem. 7 panel was also normal except for a mildly decreased
sodium of 132 mEq/l and an elevated glucose of 284 mg/dl. His HbA1c concentration was 12.8%
with a glycosylated hemoglobin of 17.7%. There were no other laboratory abnormalities. No
other laboratory tests or imaging procedures were ordered.
Questions
1. What is the diagnosis?

‒ Fournier gangrene as characterized by hemorrhagic necrosis, scrotum pain and swelling
in his genital region, Type 2 diabetes as characterized by complication of blood vessels
manifested by Fournier gangrene
2. What are the potential sources?
‒ Potential sources of infection may include Urinary Tract Infections (UTI), Bladder
infections, high blood sugar levels causing peripheral neuropathy, and any condition
that affects the flow of blood has the potential to cause.
3. How is this patient predisposed to developing this condition?

‒ Some disorders that increase the predisposition to Fournier gangrene are diabetes
mellitus, profound obesity, cirrhosis, interference with the blood supply to the pelvis,
and various malignancies.
4. How should this patient be managed?

‒ Fournier’s gangrene is a rarely occurring, life-threatening emergency situation and
delays in its diagnosis and treatment increase the rate of mortality. In order to keep
the patient alive, it is of critical importance to make a diagnosis as soon as possible,
start broad-spectrum antibiotics, perform emergency surgical debridement, support
the nutrition of the patient, and carry out suitable wound care.
‒ Consequently, the smallest complaints in the perineal, genital and perianal regions,
especially in elderly patients, should be evaluated with care. These complaints should
be considered within the pre-diagnoses of Fournier’s gangrene and suitable care should
be given to the patient.
5. Give at least 5 Nursing Care Plan for this case.
Encourage client to manage health conditions by keeping blood sugar levels under
control. Checking of hands, feet, and legs regularly for signs of injury, slow wound
healing, or other skin problems.
Encourage client to watch their wounds and get medical care right away if they see
signs of infection.
Encourage client to keep a healthy weight because extra pounds can put pressure on
the arteries, blocking blood flow.
Consistently assess for patient’s perception, cognition, orientation, and

communication capabilities.
Consistently assess for patient’s coping and stress mechanism during the healing
process (post-trauma responses, coping responses, anxiety, denial, grief,
powerlessness, sorrow...)

NCM 214 Aquino - Case Study

Uploaded by

Copyright:

Available Formats

NCM 214 Aquino - Case Study

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

NCM 214 Aquino - Case Study

Uploaded by

Copyright:

Available Formats

AQUINO, WASHRIEN S.

1. What is the likely diagnosis?

2. What factors predispose to this condition?

3. How would you manage this patient?

NURSING CARE PLAN RATIONALE

1. What is the diagnosis?

3. How is this patient predisposed to developing this condition?

4. How should this patient be managed?

5. Give at least 5 Nursing Care Plan for this case.

Consistently assess for patient’s perception, cognition, orientation, and

You might also like