• PATIENT’S DEMOGRAPHIC DATA

NAME: MARIFE PRIMERO

AGE: 28 YEARS OLD
ADDRESS: GUIMBA
STATUS: SINGLE
OCCUPATION: HOUSE WIFE
RELIGION: ROMAN CATHOLIC
DIAGNOSIS: G1 P1 LCCS (PLACENTA PREVIA)
• Patient Marife Primero is a 28- year old Filipina female who is
living with her family at Guimba, Nueva Ecija. Her religion is
Roman Catholic. A non-smoker, non –alcoholic, and no allergies
reported. Patient has placenta previa with bleeding during her
delivery. Patient was admitted last March 11,2019 at ELJ,
because of abnormal separation of the placenta. With that,
patient undergone cesarean section.
Normal Placenta During Childbirth Process of placental
growth and uterine wall changes during pregnancy
• 1. The placenta grows with the placental site during
pregnancy.
• 2. During pregnancy and early labor the area of the
placental site probably changes little, even during
uterine contractions.
• 3.The semi rigid, non-contractile placenta cannot alter
its surface area.
• 1. The cotyledons of the maternal surface of the placenta
extend into the decidua basalis, which forms a natural cleavage
plane between the placenta and the uterine wall.
• 2. There are interlacing uterine muscle bundles, consisting of tiny
myofibrils, around the branches of the uterine arteries that run
through the wall of the uterus to the placental area.
• 3. The placental site is usually located on either the anterior or
the posterior uterine wall.
• 4. The amniotic membranes are adhered to the inner wall of the
uterus except where the placenta is located
I. Introduction to Disease
The upper part of the uterus is the most favorable area for placental implantation
because it is rich in blood and, therefore, nutrients and oxygen. The lower uterine
segment is not and, therefore, it is possible that if the baby implants too low (low-
lying placenta), risks of intrauterine growth restriction and preterm labor are much
higher .During the last trimester, and especially in the last month, the lower uterine
segment thins appreciably and pulls up a bit, which is what causes cervical
effacement(thinning) and early dilatation. If the placenta is impinging on the lower
segment and is not up in the fundus where it is supposed to be, then part of the
placenta may dislodge and hemorrhage may occur. This condition is called
PLACENTA PREVIA

PLACENTA PREVIA Is an abnormal low implantation of the placenta in proximity to

the internal cervical os.

Placenta previa is a condition in which the placenta attaches to the uterine wall in
the lower portion of the uterus and covers all or part of the cervix
 Mothers who are above 35 years old and below 18 years old
as well as to those
multiparous mothers are at risk in developing placenta previa. In
addition to that, mothers who have previous uterine surgery,
large placenta that would include multiple gestation and
erythroblastosis, and maternal smoking will also likely to develop
placenta previa. When true placenta previa at term is very
serious. Complications for the baby include (1) Problems for the
baby, secondary to acute blood loss, (2) Intrauterine growth
retardation due to poor placental perfusion, (3) Increased incide
nce of congenital anomalies. The signs and symptoms of placenta
previa vary, but the most common symptom is painless
bleeding during the third trimester. Other reasons to suspect
placenta previa would be include (a) Premature contractions, (b)
Baby is breech, or in transverse position, (c) Uterus measures
larger than it should according to gestational age.
• Some of the nursing actions that would manage the occurrence of
placenta
previa is to give drugs that can prevent premature labor or birth exa
mple is progesterone. Ultrasound exams to determine migration of an
early diagnosed previa or classification of the previa as total,
partial, marginal, or low-lying would also help in managing placenta
previa. When the client experience a small first bleed, client may sent
home on bed rest if she can return to hospital quickly and if bleeding
is more profuse client is required to be hospitalized on bed rest with
BRP, IV access; labs: Hgb and Hct, urinalysis, blood group and type
and cross match for 2 units of blood hold, possible transfusions; goal
is to maintain the pregnancy fetal maturity. No vaginal exams are
performed except under special conditions requiring a double set-up
for immediate cesarean birth should hemorrhage result. Instruct
patient to position herself in a low lying or marginal previas to allow
vaginal delivery if the fetal head acts as tamponade to prevent
hemorrhage. In some cases, procedure of Cesarean birth, often with
vertical uterine incision, is used for total placenta previa. Steroid shots
may be given to help mature the baby's lungs.
Predisposing Factors
1. Multiparity (80% of affected clients
are multiparous)
2. Advanced maternal age (older than 35
years old in 33% of cases
3. Multiple gestation
4. Previous Cesarean birth
5. Uterine Incisions
6. Prior placenta previa ( incidence is 12
times greater in women with previous
placenta previa)
• PLACENTA PREVIA THE EXACT CAUSE IS
UNKNOWN. HOWEVER, THERE ARE
SOME RISK FACTORS. MY PATIEnT HAS
NO RISK FACTORS FROM THOSE WHAT
I’VE MENTIONED. MOST PROBABLY, HER
CAUSE IS
UNKNOWN
 Predisposing Factors

Pregnancy

Placental implantation

Placental attachment and growth

Insufficient blood supply possibly secondary to inflammatory or atrophic changes

Placenta migrates to where there is sufficient blood supply

Placenta resides in the lower uterine segment

• Family History:
No family history of Placenta Previa.
• Past Medical/Surgical History - none
• Menstrual History
Age of menarche: 12 years old
Cycle: Regular
Duration of menarche: 28 days
Interval of cycle: 6 days
• Obstetric History:
Gravida- 1 Para- 1
Abortions- 0 Fetal Death- 0
Died- 0 Alive-1
 PHYSICAL ACTUAL VALUES NORMAL VALUES
EXAMINATION
COLOR STRAW CLEAR STRAW TO
COLORED LIQUID
APPEARANCE CLEAR CLEAR TO SLIGHTLY
HAZY
REACTION 6.5 4.6-8
SPECIFIC GRAVITY 1.010 1.005-1.025
 RESULT NORMAL VALUES IMPLICATIONS
WBC H 15.19X10^3/uL 5-10x10^3/uL
Hemoglobin 122g/L 115-155g/L
Hematocrit L 0.35 0.36-0.48
RBC L 4.02 4.20-6.10x10^6/uL

Differential Count RESULT NORMAL VALUES IMPLICATIONS

NEUTROPHIL 73% 55-75% NORMAL
LYMPHOCYTES L. 18% 20-35%
MONOCYTES 7% 2-10% NORMAL
EOSINOPHIL 2% 1-6% NORMAL
BASOPHIL 0% 0-1% NORMAL
MCV 88.1fl 79.40-94.80 fl NORMAL
MCH 30.3 pg 25.60-32.20pg NORMAL
MCHC 34.5 g/dL 32.20-35.30 g/dL NORMAL
ULTRASOUND
RESULT IMPRESSION
Presentation: Cephalic
Number: Single
Amniotic Fluid: AFI 11.1cm
Placental location: Anterior
Sex: Boy
LMP: June 10,2018
EDD: March 17,2019
FHB: 147bpm
Previa: Placenta Previa Totalis

Biophysical profile:
Amniotic Fluid: 2
Fetal Tone: 2
Fetal Breathing: 2
Gross Movement: 2
Total: 8
 ASSESSMENT NURSING SCIENTIFIC PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS INFERENCES
“Dinudugo Deficient Placenta pre After 8 hrs of INDEPENDENT - To gain GOAL
Fluid Volume via is an nursing - Establish patient’s PARTIALLY
ako. Sobrang related to obstetric interventio, Rapport. trust.
MET
dami. Pero - Monitor VS - - To obtain
Active Blood complication the patient - Assess color, baseline After 8 hrs of
wala namang Loss in which the will be able odor, data nursing
masakit Secondary to placenta is to: consistency - Provides interventio,
Disrupted attached to - Demonstrate and amount info about the patient
sakin.” As Placental the uterine improve fluid of vaginal active was able to:
verballized bleeding; bleeding
Implantation. wall close to balance as - Demonstrate
weighing versus old
by the or covering evidence by pads. blood, improve fluid
the stable vital - Assess hourly tissue loss balance as
patient. cervix. Placen signs, good intake and and evidence by
ta previa is a skin turgor output. degree of stable vital
life- and blood loss. signs, good
- Provides
threatening adequate skin turgor
info about
maternal ble urinary maternal and
eding typicall output. and fetal adequate
y physiologic urinary
necessitates t compensati output.
ermination of on to blood
loss
the pregnanc
y. Maternal
prognosis is
good if
hemorrhage
can be
controlled;
 ASSESSMENT NURSING SCIENTIFIC PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS INFERENCES
. fetal prognosis
depends on Dependent:
VITAL SIGN - For
the gestational - Initiate IV replacem
TEMPERATURE age and fluids as
ent of
amount ordered
: 36.6 °c of blood lost. - Provide blood
PULSE: 78 Anemia may supplemental loss
bpm be managed O2 as - Interventi
by blood ordered on
RESPIRATION: transfusion to - Preparation increases
19 cpm permit the for
available
medication to
BLOOD pregnancy to O2 to
be
continue in administered. saturate
PRESSURE: utero. It can - Preparation decrease
90/60 sometimes for possible d
occur in the
Painless later part of
OR hemoglob
Bright Red in
the first
Vaginal trimester, but
usually during COLLABORATIVE Lab works
Bleeding the second or Monitor lab. provides
Pallor third. It is a work as information
leading cause obtained: Hgb about degree
Restlessness of antepartum & Hct, Rh and of blood loss;
type, cross prepares for
hemorrhage
match for 2 possible
(vaginal bleed units RBCs, transfusion.
ing). It affects urinlaysis, etc. Ultrasound
approximately Scheduled for provides info
0.5% of all ultrasound as about the cause
labors. ordered of bleeding.
 CLASSIFICATIONS INDICATIONS AND SIDE EFFECTS NURSING EVALUATION
NAME OF ACTIONS CONTRAINDICATI AND ADVERSE RESPONSIBILITIES
DRUGS ONS
EFFECTS

CEFALEXIN Binds to 1 or Cephalosporin I: Skin of soft GI - Assess - Evaluat

more of the tissue disturbances patient for
infection.
e for
penicillin- infections. (eg. Nausea,
binding - Monitor therape
Uncomplicat vomiting,
proteins(PBPs) VS utic
ed UTI. Bone diarrhea, - Assess
which inhibits and joint abdominal respons
patient’s
the final e.
infections; discomfort) intake and
transpeptidat output - Evaluat
Respiratory dyspepsia;
ion step of - Assess
peptidoglyca tract allergic e for
infections. reactions patient’s
n synthesis in history to
any side
bacterial cell Streptococca (eg. Rash, determine effects
wall, thus l pharyngitis. urticaria, previous - Evaluat
inhibiting angioedema use of and e for
biosynthesis CI: ) genital reactions
and arresting Hypersensiti candidiasis, to signs
cell wall vity to vaginitis and penicillin and
assembly cefalexin, vaginal and sympto
resulting in cephalosp
other discharge, orin.
ms of
bacterial cell cephalospori dizziness, infection
wall. n fatigue, .
headache,
agitation.
 CLASSIFICATIONS INDICATIONS AND SIDE EFFECTS NURSING EVALUATION
NAME OF ACTIONS CONTRAINDICATI AND ADVERSE RESPONSIBILITIES
DRUGS ONS
EFFECTS

- Patients
with
negative
history of
sensitivity
to this kind
of
medication
may still
have an
allergic
response.
- Monitor
signs and
symptoms
of
anaphylax
is
- Proper
preparati
on and
dosage
medication
s.
 CLASSIFICATIONS INDICATIONS AND SIDE EFFECTS NURSING EVALUATION
NAME OF ACTIONS CONTRAINDICATI AND ADVERSE RESPONSIBILITIES
DRUGS ONS
EFFECTS

MEFENAMIC An NON I: Pain and CHF - Proper - Evaluate

ACID anthracitic Inflammator preparati therapeu
STEROIDAL (Congestive on and
acid ANTI y Heart tic
dosage of
derivative is response.
INFLAMMA Failure) medication
a CI: s. - Evaluate
prototypical TORY Hypersensiti HTN for any
- Check for
NSAID. It DRUGS vity to (Hypertensi any side
reversibly (NSAIDs) mefenamic on), allergy. effects.
inhibits the acid, aspirin tachycardi dose.
cyclooxygen or other - Check
a, syncope, doctor’s
ase-1 and - NSAIDs. arrhythmia, order.
2 (COX-1 Patient w/ vasculitis, - Assess for
and -2) inflammator history of
hypotensio
enzymes, y bowel allergies
thus resulting disease, n, to NSAIDs.
in reduced active palpitation - Educate
synthesis of ulceration, or s, patient
that
prostaglandi chronic abdominal prolonged
n precursors. inflammation pain, use of any
of the upper drug may
or lower GI damage
tract, liver.
 CLASSIFICATIONS INDICATIONS AND SIDE EFFECTS NURSING EVALUATION
NAME OF ACTIONS CONTRAINDICATI AND ADVERSE RESPONSIBILITIES
DRUGS ONS
EFFECTS

It has renal failure, vomiting, During:

History of dyspepsia, - Give drug
analgesic wit food,
and asthma, constipation,
milk or
urticarial, diarrhea,
antipyretic antacids.
allergic type nausea, - Do not
properties reactions. heart burn, increase
with minor Treatment of GI or double
anti- pre- perforation, dose,
inflammato operative peptic ulcer, follow
pain in the flatulence, exactly as
ry activity prescribed
setting of anemia and
CABG indicated.
(Coronary - Administer
artery drug with
bypass full glass
graft) of water.
surgery.
 CLASSIFICATIONS INDICATIONS AND SIDE EFFECTS NURSING EVALUATION
NAME OF ACTIONS CONTRAINDICATI AND ADVERSE RESPONSIBILITIES
DRUGS ONS
EFFECTS

Serrapeptase Is a Anti- I: Skin rash, - 10 rights - Evaluate

preteolytic Inflammatory of therapeu
Enzymes
Inflammati diarrhea,
enzyme of on and anorexia, medicati tic
Serratia spp on response.
edema. GI
source. - Take - Evaluate
disturbance history of for any
When taken s, epistaxis allergies. side
orally, it (rare) - Take effects.
relieves
vital
inflammatio
signs
n and - Watch
edema out for
associated allergies
with - Instruct
trauma, the
infection or patient
chronic about
venous the
insufficiency medicati
on.