This document provides a case study report of a 26-year-old pregnant woman, Sita Rai, who was admitted to the hospital with abdominal pain and diagnosed with oligohydramnios. The summary includes biographical data, obstetric history, physical examination findings, diagnosis of oligohydramnios, management including a cesarean section delivery, nursing care plan, and discharge teaching. Oligohydramnios is defined as a low amniotic fluid volume condition that can cause fetal complications. The case study objectives were to understand the condition and provide holistic nursing care to the patient.

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KATHMANDU MEDICAL COLLEGE
Sinamangal, Kathmandu
Case Study of Oligohydramnious

2. Submitted To : Submitted By :
Department of Postnatal Shikshya Dhakal
Mrs. Gayatri Rajbhandari Bsc. Nursing 2nd
year
Nursing Co-ordinator 7th
Batch
Acknowledgement
This case study report is prepared during my midwifery major nursing clinical
practicum in "Kathmandu Medical College Hospital". The report is prepared as a
requirement of Bachelor in nursing curriculum when I was posted in postnatal
ward.
I had an opportunity to gain experience and knowledge in this field. I got
myself completely involved in the care and management of the patient during the
period. However the work wouldn't have been accomplished successfully with my
effort only.
So, I would like to express and give a great thank to my teachers who are in
the clinical area. I am thankful to all the staffs in hospital for kind co-operation. I
am also thankful to my patient and her family for providing me valuable
information and trusting me. I am also thankful to my colleagues who co- operated
with me in preparing this case study.
2

3. Shikshya Dhakal
Bsc Nursing 2nd
year
7th
batch
Roll no: 8
Table of contents
Preface
• Background
• Selection of case
• Objectives
Part I
 Introduction of patient
1. Biographical Data of the patient
2. Obstetrical health history of patient
3. Physical Examination
Part II
1. Introduction of oligohydramnious
2. Causes
3. Clinical features
4. Diagnosis
3

4. 5. Investigation
6. Complication
7. Management
8. Treatment
9. Introduction of Cesarean Section
Part III
1. Nursing care plan
2. Stress management
3. Discharge Teaching
Postface
• Summarization
• What I learnt from this case study
• References
Background
According to our curriculum we have to do one case study in midwifery
practicum, This case study report is prepared as a partial requirement of Bachelors in
nursing curriculum of Kathmandu university.
During 4 weeks of clinical practice of midwifery in Postnatal Ward of Kathmandu
Medical college hospital, we were required to do one case study on high risk case.
So I have chose the case of Oligohydramnious ". because it is one of the common
complicated pregnancy case.
Selection of the case study
1. I am interested to gain knowledge about disease Oligohydramnious, and its
management.
4

5. 2. It is one of high risk case.
3. I chose this case in order to give holistic care to the patient and give health
education for promotion and maintenance of life as well as provide psychological and
emotional support.
Objectives of case study
The general objectives of case study are to gain comprehensive knowledge about disease
as well as practical experience.
The specific objectives are
- To identify major risk factor of mother.
- To provide holistic nursing care and management to the patient.
- To teach mother and family to maintain and promote health of both mother and
baby so that it can minimize MMR, NMR and IMR.
- To gain comprehensive knowledge by comparison book with real patient.
- To collaborate with client families and other health team member in management of
patient.
- To gain through knowledge about oligohydramnious and its management and
treatment.
-To demonstrate skills which is needed for mother during hospitalization period.
5

6. -To collaborate with patient and other health team members for planning discharge and
follow-up visit.
Introduction of patient
Sita Rai of 26 yrs old, wife of Ramesh Rai, the resident of Balkumari was admitted in
Postnatal Ward on 2070/02/22. She came at hospital with the history of Pain abdomen.
Biographical Data of the patient
Name: Sita Rai
Age/sex: 26 yrs / F
Marital status: Married for 2 years
Husband Name: Ramesh Rai
Religion: Hindu
Education: Literate (+2 Pass)
Occupation: Housewife
Address: Balkumari-8,Lalitpur
Gravida/para: Primi
Date and time of admission: 070/02/22 at 8:00am
Inpatient no: 12753
Bed no: 314
Diagnosis: Emlscs for oligohydramnious
Ward: Postnatal ward
Date of delivery:2070-2-27 at 6pm.
Date of discharge:2070-3-1 at 12md
Menstrual history
Menarche - 14 yrs
Menstrual cycle - 27-29 days regular
Blood flow - 3-4 days normal
Dysmenorrhoea - not present
Medical/ surgical history
-No history of PTB, NTN, DM or any other medical disorder
-No hospitalization history.
-She had not other genetic or hereditary diseases.
-She had not done any operation.
Obstetrical history
1.)Past obstetrical history
Primi
2.)Present obstetrical history
LMP: 2069/05/21
EDD: 2070/02/28
Week of gestation: 39 weeks + 4 day
ANC visit: 4 visits in KMC
6

7. Immunization: 2 dose of Tetanus
Problem during pregnancy: morning sickness
Drugs: she had taken Folic Acid,Iron and calcium.
History of family
She has 7 family members. Her husband and others family members had no any health
problem. No history of PTB, HTN, DM or any other medical problem with her family.
She has a single family with medium socio- economic condition.
7
Family Tree
Mother SideFather Side

8. Physical Examination
Physical Examination
Physical examination is an important tool in assessing the patient’s health status.About
15% of information used in assessment comes from physical examination. It is
performed to collect objective data and co-relate it with subjective data. It also reveals
additional problems which the patient has not recognized.
Method of physical examination
The commonly used method of physical examination are:
-Inspection
-Palpation
-Percussion
-Auscultation
-Measurement
1.) General appearance :Fair
State of health: Healthy
Blood pressure: 110/80 mm of Hg
Pulse :78/ min
Temperature: 98F
Height:5.2 ft
Weight:52kg
2. )Skin
8

9. -Uniform colour and warm
-No dehydration
-No lesion ,No wound
-No rashes
3. )Head and Face
-Colour and texture of hair: Normal
-Hair distribution: Equal
-Head uniform size and shape
-No any injury in head and face.
4.) Eye
Normal in size and shape
-Colour of sclera: Normal
-Pupil react to light
-Vision:normal
5. ) Ears
-The top of the pinna met the middle canthus of the eye.
-No ear discharge
-Hearing: good
-Slightly wax present.
6. )Nose
-No any nasal discharge
-size and shape equal
-No polyps ,no blockage
7.)Mouth, throat and neck
-colour of lip pink, moist, no crack
-Teeth: no dental carries
-No gum bleeding
-Tongue moist and pink
-Thyroid not palpable
-Cervical lymph node not palpable.
8.) Breast
-Both breasts and nipples are symmetrical, uniform in shape.
-No tenderness or dipling present.
-No crack in nipples.
-Auxiliary lymph nodes are not palpable.
9.)Abdomen -
- No visible blood vessels.
- No any abdominal distension.
-Liver and spleen are not palpable.
-Linea Nigra and striae gravidarum present
10.)Arms and Legs (Extremities)
-Both hands and legs are symmetrical.
9

10. -Normal skin colour with sensation present.
-No oedema, cyanosis, clumbing nails.
-Capillary refill normal.
11.)Anus and Female genitalia
-No any discharge from genitalia.
-Anus pattern normal.
-No history of bleeding during defecation.
Systemic Examination
1. Chest and Lungs
-Symmetrical in shape
-Symmetrical in size of the breast, not engorged, no breast lump.
-Respiration normal and rhythm regular
-Chest clear no wheezing sound.
2. Cardiovascular
-No cynosis
-No heart murmur
-Normal lubdup sound
3. Gastrointestinal
-Abdominal shape of size: Flaccid types.
-No visible vein.
-No abdomen mass
-Bowel sound present
-Lever not palpable
-Spleen not palpable
4. Genitalia
-Slightly brown colour discharge
-Foul smelling
-Burning micturition
5. Musculo skeletal
-Easily mobility of hands and legs.
-Muscle strength good.
-No contracture, no deformity.
6. Nervous/ Mental
-Patient is fully conscious, co- operative, speech clear, no difficulty in speaking.
7.Sleeping Pattern
-Before, sleeping pattern was normal but now due to operation, it is slightly disturbed.
Delivery report:
10

11. Type of delivery-Emlscs
Date and time: 2070/02/27 at 6pm
Blood loss: 80ml
Baby Weight: 3.5 kilogram
Placenta weight: 400gm
Post delivery vital
T- 98.4 F
P - 78/min
R - 26/min
BP -Rt 120/80, Lt 120/70mm of Hg
Baby’s report
Sex: Male
Condition: Fair
APGAR score: 7/10, 8/10
Weight: 3500gm
Post delivery note of patient
Patient’s general condition was fair. I/V drip continuing and continued till evening then
omitted drip.
Patient’s general condition was fair. Patient was in normal diet. Oral medicine started.
Normal discharge of lochia was seen.
Post natal exam
Vitals:-
T – 98.2 F
P – 80/min
R – 22/min
BP – Rt 110/80, Lt 120/80
Headache – Not present
Epigastric pain – Not present
Blurred vision – Not present
Breast – Normal
Perineal area – No swelling
Her general condition was improving than the day before. I advised her to ambulate gave
her psychological support. She was planned to discharge next day.
Baby’s Physical Examination:-
Vital signs
Temperature – 98.8 F
Pulse – 138/min
Respiration – 38/min
Weight – 3500gm
Length – 50cm
Sex – Male
General condition – His movement of limbs, trunk, head and neck are normal.
11

12. Skin – No cyanosis, no jaundice, no rash, and colour is normal and lymph nodes are
normal.
Skull – Shape and size normal, no caput and haematoma, no any injury in head and both
fontanels are normal.
Eyes – Shape, size and position are normal, No discharge from eyes. No redness and
swelling of any part of eyes.
Ears – Normal, no discharge from both ears.
Nose – Normal, no discharge, swelling
Mouth – Lips are moist, no cracks, no swelling, no cleft palate and hair
Lips – colour of lips is pink. Shape and size of tongue is normal.
Neck – no congenital goiter, no any abnormal presentation.
Chest – Shape and size normal.
Abdomen – Cylindrical in shape and slightly distended. No cord bleeding, no rashes
present in skin.
Genitalia – Normal, No discharge
Limbs – Position of upper and lower limbs were normal. No any congenital deformity
found. No rashes, no extra fingers. Joint movement was also normal.
Spinal cord – Normal, no spina Bifida, no abnormalities
Anus – Normal, stool passed.
Rooting reflex – Present
Sucking reflex – Good
Swallowing reflex – Good
Gagging reflex – Not seen or observed.
Grasping, dancing, Tonic neck reflexes – Present
Babinski reflex- present
Developmental Task
Sita Rai is 26yrs old she belongs to young adulthood.
1.)Age group-21 to 39yrs.
2.)Young adulthood is the period of challenges rewards and crisis.
Challenge of entering the job, reward of a job well done and crisis associated with caring
of parents and rearing of children or family.
According to book According to patient
-The young adults achieve
independence from parental control.
-My patient was totally dependent to her
husband because she is housewife.
-They begin to delov strong friendship
and intimate relationship outside the
family.
-She has many friend outside the family.
12

13. -They establish personal set of values. -She has her personal identity and has
established self concept.
-They develop a sense of personal
identity.
-She had certain values of her life.
-They prepare a life work and develop
the capacity for intimacy.
-She got married and her husband is
very intimate.
-Establishing and managing a home and
time schedule and life stress.
-She also manage her home.
-Decide and carry out task of parenting. -She has two children she perfectly rear
them and she is interested to become
parent.
Disease profile
Oligohydrominous
Introduction
It is extremely rare condition where the liquor amnii deficient in amount of less than
500ml.It is often associated with the following condition.
i) With poor placental function and fetal growth retardation.
ii) Seen with obstructive lesion of the fetal urinary tract and with
renal agencies.
iii) In uniovular twins when one of the gestation sacs has excess of
liquor, the other sac may have very scanty liquor.
Etiology (according to book)
i) Amnion nodosum:-failure of amniotic fluid secretion.
ii) Obstruction of the urinary tract.
iii) IGUR associated with placental insufficiency
iv) Post maturity.
Etiology (according to patient)
Unknown
Diagnosis (according to patient)
i) The uterine size appears smaller than gestation period,
ii) There are other features of IUGUR.
iii) There may be fetal malpresentation (breech common).
iv) On abdominal palpation due to scanty liquor the fetal parts are prominent
and uterus feels full of fetus.
v) It the membranes are artificially ruptured for induction of labour or there is
spontaneous rupture of the membrane in labour, there is very scanty escape
of liquor which is very often meconium stained.
vi) Less fetal movement.
Diagonosis during delivery
13

14. i) Thick meconium stained.
ii) Scanty liquor.
iii) The fetal skin is markedly thick dry and lathergy and there evidence of
fetal deformity.
Diagonosis (according to patient)
i) Uterine size is much smaller than the period of amenorrhoea.
ii) The uterus is full of fetus because of scanty liquor.
iii) Less fetal movement present.
Investigation done in patient
Hb-12.3gm/dl
Blood Group-O+ve
VDRL-non-reactive
HIV-negative
HBSAG-negative
USG done
BPD Measures-90mm.
FL Measures-72mm.
AC Measures-312mm.
=37 WOG
Impression-Single Live Fetus With Cephalic Presentation.
-37 WOG
-Placenta Anterior Wall
-Liquor AFI 5cm
-EFW 3.2Kg
Effect of oligohydramnious
Early pregnancy
i) Amniotic adhesion or bands may cause deformities like amputation of
fetal limbs or constriction of the umblical cord.
ii) Pressure deformities such as club feet.
iii) Pulmonary hypoplasia has been reported.
iv) The skin becomes dry lethargy and wrinkled.
Late pregnancy
i) It is sign of fetal jeopardy as in case IUGR.
ii) Close adoption between the fetus and the uterine wall can lead to
pressure on umblical cord and obstruction to the flow of blood to and
from the fetus. Fetal asphyxia may result.
iii) Meconiun passed into a amniotic sac in which there is paucity of fluid
will not be diluted.
14

15. iv) Aspiration of this thick meconium by the fetus will lead to aspiration
pneumonia after birth.
Management (According to book)
There is no specific Rx for oligohydramnious. In some case termination of
pregnancy is carried out to forestall severe fetal hypoxia all fetal death in uterus.
Management (According to patient)
Normal delivery was conducted.
Treatment (According to book)
Prom is confirmed labor may be protracted and contraction is more painful.
Fetal distress occurs frequently because of frequent association of fetal malformation
vaginal delivery is favorable.
Treatment(According to patient)
Prom done
Complication
A. Maternal
i) Prolonged labor due to inertia.
ii) Increased operative interference due to malpresentation
iii) Lead to maternal mortality.
B. Fetal
i) Abortion
ii) Deformity due to intra-amniotic adhesion or due to compression
iii) Fetal distress in labor
iv) Cord compression
v) Fetal lung hypoplasia
vi) Skeletal deformities due to compression e.g. talipes
vii) Fetal mortality is high
Drugs used in my patient
-Tab cifran 500 mg BD
-Inj oxytocin 10 unit I/M
-Tab Aciloc 150mg BD
-Iron
-Calcium
Tab Cifran 500 mg BD
Ciprofloxacillin is a broad spectrum and bacterial drugs, which was introduced in
1987,which is 4-quinolone derivative derived from Nalidixic acid.It is highly effective
against Shigella,Salmonella,Neiseria,E-coli,Pseudomonas,H.influnza,Helicobacter
infection and methicillin resistant Staphylococci.
Mechanism of action
It inhibits the bacterial DNA synthesis by inhibiting DNA gyrase,which reverses the
super coiling of DNA stands,the enzymes that maintains the helical twists in DNA. Thus,
it kills the bacteria by inhibiting the DNA synthesis.
15

16. Indication
-Enteric fever
-Urinary tract infection
-Intra abdominal infection
-Gynaecological infection
-Bone and joint infection
-Gonorrhoea and septicemia caused by sensitive organism.
-Pelvic inflammatory disease
-Surgical prophylaxis in upper gastrointestinal procedures
Dose
• Adult
By mouth:
-General dose:250-500mg BD for days before meal.
-UTI:500mg BD for 7 days.
-Gonorrhoea:250-500mg in resistant case(single dose)with metronidazole and
Doxycycline.
-Contacts meningococcal meningitis:500mg single dose.
By I/m/IV
-UTI:IV minor infection 200mg BD moderate infection 400mg,severe infection 400mg
TDS.
-Gonorrhoea:100mg single dose.
-Enteric fever:400mg BD for 10days.
• Child
By mouth:
-General dose:10-20mg/kg 12 hrly before meal.
-Enteric fever:30mg/kg 12 hrly.
By I/V
Dose:4-8mg/kg 12 hourly.
Adverse effect
GIT: Nausea, vomiting, epigastric distress, flatulence.
CNS: Headache, dizziness, depression, insomnia.
Urinary: Crystal urea, renal failure ,nephritis.
Bone and joint: Damage to growing cartilage, arthralgia.
Skin: Skin rash including very severe exfoloative dermatitis.
Blood: Increase blood urea and creatinine, blood disorders.
Liver: Hepatitis(disturbances in liver enzymes and bilirubin.
Miscellaneous: Anaphylaxis, Stevens-Johns syndromes, lyell syndrome.
Contraindication
Hypersensitivity to fluroquinolones.
16

17. Nursing implication
-I/V ciprofloxacin should be administer infusion over a period of 60 min. Total daily
dose should be halved in severe renal impairment.
-While taking this medicine, tell them to drink a lot of water.
-Give this medicine in empty stomach food interfere its absorption.
-The dose of the medicines should be completed.
-The dose should not be skipped at all.
Tab calcium
Action- Maintain cardiac function nerves activities and muscle contraction, coagulation
of blood and for maintaining structural integrity of cell membranes. It plays an important
role during period of bone growth in childhood adolescent, during pregnancy and
lactation.
Dose: Tab 250 mg - 500mg OD
Indiations - Osteomylitis, pregnancy ,lactation
Side effects
-Anorexia
-Nausea, Vomiting
-Abdominal pain
-Dry mouth, thirsty
-Poly- urea
-Confusion
-Delirium and coma
Nursing Implication
-To increase fluids
-Not to use antacid unless directed by physician
-Laxatives or stool softeners constipation occurs.
Cap Iron
Action: Replaces iron store, needed for red blood cell development, energy and oxygen
transport. It works in iron deficiency anaemia, prophylaxis for Iron deficiency in
pregnancy.
Dose-40 mg OD
Indication - Pregnancy, Anaemia
Side effects -
-Nausea, vomiting
-Constipation
-Epigastric pain
-Black and red torry stools
-diarrhoea
17

18. -Temporarily discoloured tooth enamel and Eyes.
Nursing Implication
-Assess blood toxicity, nausea, vomiting, diarrhiea haemat, oemesis, pallor, cyanosis,
shock, coma, dimination.
Introduction of Cesarean Section
Cesarean Section
It is an operative procedure whereby the fetus after the end of 28th
weeks is delivered
through an incision on the abdominal and uterine wall. This excludes delivery through an
abdominal incision of a fetus lying free in the abdominal cavity following rupture of the
uterus.
Indication
Complications of labor and factors impeding vaginal delivery, such as:
• prolonged labour or a failure to progress (dystocia)
• fetal distress
• cord prolapse
• uterine rupture
• increased blood pressure (hypertension) in the mother or baby after amniotic
rupture
• increased heart rate (tachycardia) in the mother or baby after amniotic
rupture
• placental problems (placenta praevia, placental abruption or placenta
accreta)
• abnormal presentation (breech or transverse positions)
• failed labour induction
• failed instrumental delivery (by forceps or ventouse (Sometimes a trial of
forceps/ventouse delivery is attempted, and if unsuccessful, it will be switched
to a Caesarean section.)
• large baby weighing >4000g (macrosomia)
• umbilical cord abnormalities (vasa previa, multilobate including bilobate
and succenturiate-lobed placentas, velamentous insertion)
Other complications of pregnancy, pre-existing conditions and concomitant
disease, such as:
• pre-eclampsia
• hypertension[32]
• multiple births
• previous (high risk) fetus
• HIV infection of the mother
• Sexually transmitted infections, such as genital herpes (which can be passed
on to the baby if the baby is born vaginally, but can usually be treated in with
medication and do not require a Caesarean section)
• previous classical(longitudinal) Caesarean section
18

19. • previous uterine rupture
• prior problems with the healing of the perineum (from previous childbirth
or Crohn's disease)
• Bicornuate uterus
• Rare cases of posthumous birth after the death of the mother
Contraindications:
A patient who is pregnant or who wants to become pregnant in the
future. Pregnancies following ablation can be dangerous for both mother and fetus.
A patient with known or suspected endometrial carcinoma (uterine cancer) or pre-
malignant conditions of the endometrium, such as unresolved adenomatous
hyperplasia.
A patient with any anatomic condition (e.g., history of previous classical cesarean
section or transmural myomectomy) or pathologic condition (e.g., long-term
medical therapy) that could lead to weakening of the myometrium.
A patient with active genital or urinary tract infection at the time of the procedure
(e.g., cervicitis, vaginitis, endometritis, salpingitis, or cystitis).
A patient with a intrauterine device (IUD) currently in place.
A patient with a uterine cavity length less than 4 cm. The minimum length of the
electrode array is 4 cm. Treatment of a uterine cavity with a length less than 4 cm
will result in thermal injury to the endocervical canal.
A patient with a uterine cavity width less than 2.5 cm, as determined by the
WIDTH dial of the disposable device following device deployment.
A patient with active pelvic inflammatory disease.
Types of Cesarean Section
1. Elective Cesarean Section
2. Emergency Cesarean Section
Nursing Management
1.Psychological support to patient and family.
2.Encourage to ventilate her feelings.
3.Explain about the intra-uterine fetal death and possible complication.
4.Advice to take frequent small amount of food it stimulate appetite and digestive.
5.Advice to take nutritious and iron containing food and vegetables.
6.Advice about personal hygiene.
7.Control of visitors and noise near the pt's room.
8.Counselling for family planning upto 1-3 yrs spaces minimum.
After Delivery, I assisted my patient to get out of the bed, ambulation, exercise,
morning care, changing dresses etc.
19

20. I gave health teaching on different topics as necessary. eg. the importance of
ambulation, rest and exercise, diet, breast feeding, infection prevention and oral
hygiene etc.
20

21. NURSING CARE PLAN
S.N Nursing
Diagnosis
Nursing goal Nursing
implication
Rational Evaluation
1.
2.
Anxiety
related to
unfamiliarity
with hospital
environment
Pain related to
uterine
contraction(pr
ogress of
labour)and
descent of
foetus in the
pelvis.
-Pt will
express
reduced
anxiety after
interventions.
-patient will
have a relaxed
body posture
and facial
expression
after
intervention.
Patient will
have a relaxed
facial and
body
appearance
between
contractions.
-Greet patient and
their family
warmly on arrival.
-Briefly orient
patient about
birthing room,
explain any
equipment that is
increased including
its purpose.
-Talk with women
about what they
expect of the birth
experience for
example, ask who
they plan on having
present at birth and
of medications.
-Assess for
presence and
character of pain
continuously
during labour
such as type of
contraction,
frequency and
duration ,facial
expression ,crying
and moaning
during and between
contractions.
-Provide general
comfort measures
such as adjust the
room temperature.
- Encourage
women to assume
-Makes family feel
welcome and that staff
will be considerate of
their needs and desires.
-Teaching helps decrease
fear related to the
unknown and increases a
sense of personal control
over the situation.
-Enables nursing staff to
help women achieve their
expected experience
more closely, which
promotes their
satisfaction even if all
their expectations are not
met. They will probably
be less anxious of they
believe staff cares about
their desires.
- Assessment enables to
identify whether pain is
normal for Patients.
Labour status and it also
helps to identity the best
inter ventions for plain
relief.
- Evaluating non verbal
and verbal
communication helps to
evaluate need for pain
relief in pt.
- These general measures
reduce outside irritants.
- Position Changes
promote comfort and
help the fetus adept to
size & shape of pt's
-Patient did not
express fears.
-patient sits in
bed in
comfortable
position.
Pain is minimize
after maintained
pt. position and
psychological
support.
21

22. position she finds
most comfortable
other than the
supine.
- Observed for a
full bladder every
one to two hrs.
pelvis.
- Supine position can
result to reduced
placental blood flow and
fetal oxygenation.
22

23. S.No Nsg
diagnosis
Goal Implementation Rationale Evaluation
1. Anxiety
related to
knowledge
deficit
regarding
pain its
prognosis.
She gained
knowledge
about
pain
management
and its
relaxation
technique and
prognosis
1. Reassurance the
patient and visitors.
2. Provide positive
reinforcement
when
desired response is
achieved.
3. Keep in comfort
position helps
while
turning position.
4. Listen
attentively,
encourage
verbalization
provide a caring
touch.
5. Give pain killer
medicine
six hourly or
according to
Doctor order.
6. Teach about pain
and
its prognosis.
1. Maintain a good
interpersonal
relationship.
2. Positive feedback
helps self confidence.
3. These reassure the
patient that she is not
alone.
4. These techniques
allow an out for anxiety
and help to control pain.
5. To relieve operation
site pain.
6. Knowledge upgrade
and co-operation for her
condition.
She has
gained
knowledge
about pain
and
relaxation
technique .
Her pain
control.
23

24. S.No Nsg
Diagn
osis
Goal/Obj
ectives
Nsg
Intervention
Rationale Evaluation
3. High
risk
for
infecti
on
1. Patient
will
remain
free
from
Infection
during
hospitaliz
ation as
well as
at home.
1. Perineal
care done 12
hrly
2.Emphasized
or changing
sanitary pad.
3.Breast care
done daily and
teach
technique to
the patient.
4.Encourage
to take
nutritional
diet with
plenty of
fluids.
5.Advice hand
washing
before
Touching the
baby.
6. Advice for
nail cutting.
1. It helps to limit potential
source of Infection. It also
provides opportunity to see lochia
and its colour and order take
action accordingly.
2. It helps to limit potential
source of Infection. It also
provides opportunity to see lochia
and its colour and order take
action accordingly
3. It helps to promote circulation
to clean nipple for baby.
4. It helps to provide body
requirement for nutritional and
prompt health status.
5. To prevent cross infection.
6. To prevent from injury and
infections.
7. To observe baby skin.
8. To prevent from infection.
9. Decrease possibility of
introducing pathogens.
Mother and baby are
free from infection
that’s why objectives
were fulfilled.
S.NNrsg Diagnosis Goal Implementation Rationale Evaluatio
n
2. Potential to
develop
post delivery
complication.
-chest pain
-Deep vein
thrombosis
Prevent from post
delivery
complication
during
hospitalization.
-Teach deep
breathing
and coughing
exercise.
-Instructions
regarding the
importance of
deep.
-Encourage
exercise and
ambulation.
-Improve the pulmonary
ventilation, mobilizes
secretions and stimulate
circulation.
-Teaching regarding
pulmonary mechanics
from foundation of self
care.
-Ambulation maintains
muscle tone and prevents
muscle atrophy and
prevents thrombophlebitis.
She has
not
develops
any post
delivery
complicat
ions so
that my
goal was
met.
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25. 7. Baby bath
done.
8. Eye care
and umbilical
care done.
9. Antibiotics
as ordered by
doctor
Stress Management
Stress is an unpleasant experience of the life. During hospitalization patient suffer
from stress because of new environment.
Stress is a change in the environment that is perceived as a threatening challenging and
damaging to the person’s equilibrium as dynamic balance .When stress is more severe or
more prolonged than usual, however a person may need a nurses help in coping with
stress.
My case study patient Sita Rai was suffering from stress due
to hospitalization and new environment and she was upsat of her baby.
To minimize her stress, I followed the following techniques which are as follows.
-I provide plenty of time to express her feeling.
-I gave psychological support.
-I built good rapport with patient and her family.
-Allowed her family member to visit her.
-Give proper information regarding each and every procedure.
-Relevant information has been given day to day about treatment and prognosis of her
condition.
*Divertional therapy has been applied for stress reduction which are as follows:
-Talk therapy
-Providing newspaper and other favourate objects.
-Audio/visual aids, for e.g. television.
-Imaginary technique.
-Imaginary visualization.
-Distraction.
-Progressive muscle Relaxation.
-Autogenic training.
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26. Health Teaching/Discharge Teaching
Health Teaching plays an important role to prevent disease, promote health as well as to
cure disease more rapidly with out any complication .one of the most important roles of
the nurse is to provide health education. So, I being a nurse, I had also given health
education to patient and family.
• To promote the health.
• To motivate for early diagnosis and treatment.
• To help limit the disability
• To keep in relationship
Keeping above objectives in mind I had given health education to the patient about
following topics:-
Topics Advice/ Health Education
1.Nutrition Postnatal mother needs balance diet which should have adequate
protein,
carbohydrate, calcium, iron etc. Balance diet helps to regain her health
and
her baby’s health add to promote health and her baby’s health add to
promote
health and lactation. She must eat 4 times per day which is required for
lactation.
Baby needs good nutrition So mother has to breast feed the child
regularly till 4-5
month without water also. This is the only one source of good nutrition
for the baby.
She has to take care about this.
2.Rest and
Activities
Rest and sleep is very important. So she has to rest in a day also. Sleep
pattern should
be good. Light exercise can be done. Lifting heavy thing should be
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27. avoided. Especially
post natal exercise such as abdominal breathing, arm raises exercises.
3.Personal hygiene This should be done to prevent infection. Inner clothes should be
cleaned, dry and changed
frequently. Pericare and breast care should be encouraged.
4.Sexual Intercourse
and family planning
We discussed about sexual intercourse and family planning method. I
taught her to prevent
some complication to the mother and I advice to use temporary family
planning
method which she used to like after 45 days because she was primipara
mother
5. Care of the baby Gently handling of baby care of eyes, ears and groins with warm cloth,
periodic bath and oil
massage, frequently change of napkin, check frequently urine and stool
pass.
6. Breast feeding to
baby
I advice to teach her about demand feeding, exclusive breast feeding.
Breast milk secretion
high in amount in night than in day so breast feed in night as well as
day. Exclusive breast feeding
help to temporary family planning method.
7.Immunisation of
baby
I explained about important of Immunisation and schedule of
Immunisation and its purpose.
8. Medicine Doctor has prescribed the following medicine. Tab Ferrous sulphate 1
tab OD for 1 month. Tab
Calcium 1 tab OD for 1 month. I explained about its usefulness.
9. Follow up Suggest for importance of routine check up and health for follow up
purpose.
10. Others
Immediate check up if any signs of infection, fever, severe headache,
pain swelling, foul discharge,
Convulsion etc. If baby has any problem such as dyspnoea fever, not
sucking breast milk, increase
Respiration etc. to visit the doctor as soon as possible.
Discharge teaching
I had given health teaching to the patient and her family on the following topics-
1.Having adequate rest and sleep.
2.Nutritional diet.
3.Personal hygiene.
4.Regular medication on time.
5.Follow -up visit.
6.Family planning method.
7.For being more conscious and to do regular antenatal visit in coming
pregnancy.
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28. Summarization
According to our 4 weeks midwifery practical we had to do two case studies. I chose the
case of Oligohydramnious. I got opportunity to observe the cases and provide nursing
care according to need.
I selected the case of oligohydramnious. My patient name was Sita Rai 26 yrs old
admitted in Postnatal Ward with the diagnosis of Emlscs for oligohydramnious.
During the whole period of hospitalization I provided holistic nursing care to her
considering her mental, socio-cultural aspects of nursing care.
Her condition was improved and recovered. So discharged on as per plan. During
hospitalization I gave health education ,regarding nutrition, rest, breast, feeding, exercise,
regular health check up and follow up etc.
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29. What I learnt from this case study ?
From this case study I learnt about oligohydramnious in depth. While doing
case study, I got many opportunities to gain scientific knowledge and theories in
patient and evaluate the outcomes and finally write result. I gained confidence in
caring and managing the case of oligohydramnious.
Case study helps to gain lot of theoretical as well as practical knowledge and it
helps to apply our theoretical knowledge in practical. It also improve writing
skills. I got chance to study patient and family background, socio-cultural,
environmental background of the patient.
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30. References
1. D.C Dutta - Text book of obsetrics 5th edition
2.Nursing drug handbook -19953
3.Manual of midwitery A- Roshani Tuitui
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