CASE STUDY OF PLACENTA PREVIA

Patient’s Demographic Data

Patient’s Initial: Z.F

Age: 42 years old
Address: Purok Orchids, Kagawasan Pagadian City
Level of Education: High School
Date of Admission: September 17, 2018

Chief Complaints

Patient was not complaining of pain, only she was referred from City Health after Ultrasound
showed that she have placenta previa.

Patient’s History

No family history of placenta previa, no history if DM

Obstetric History

Gravida: 10 Para: 8 Abotion: 1

LMP: December 25, 2017 EDD: October 1, 2018
38 2/7 wks aog by utz

Laboratoty Results:
CBC: wbc- 13.90, hgb- 11.7, hct- 39, rbc- 450,000, platelet – 254,000
Urinalysis: pus cells 12-15, rbc- TNTC, glucose negative
UTZ- Partial placenta previa

Physical Assessment

Normal breathing, no vaginal bleeding, good peripheral perfusion, no deep vein thrombosis, no
edema in limbs, body is well dehydrated, fetal heart beat 145 bpm RLQ

What is Placenta Previa?

It is a problem of pregnancy I which the placenta grows in the
lowest part of the womb (uterus) and covers all part of opening
to the cervix.

The placenta provides oxygen and nutrients to the growing

baby and removes waste products from baby’s blood. It
attaches to the wall of the uterus, and the baby’s umbilical cord
arises from it.
 Pathophysiology

Placental implementation initiated by the embryo (embryonic plate)

The embryo adhering in the lower uterus

With the placental attachment and growth, the developing placenta may cover the cervical os.

Etiology

According to the book In my patient

Increased parity Increased parity

Advanced maternal age Advanced maternal age
Past cesarean birth
Past uterine curettage
Multiple gestation

Management
Emergency Cesarean Section

Drug Study
1. GENERIC NAME: Cefuroxime
CLASSIFICATION: Antibiotic
DOSAGE: 750 mg
ROUTE: IVTT
FREQUENCY: Every 8 hours
ACTIONS: Bind to bacterial cell wall membrane causing cell death
INDICATIONS: for surgical prophylaxis, reducing or eliminating infection, treatment for
gynecologic infections, lower respiratory tract infections, skin and soft
tissue, urinary tract infections.
CONTRAINDICATIONS: Hypersensitivity to cephalosporin and related antibiotics; category
B, lactation.
SIDE EFFECTS: GI: diarrhea, nausea, unpleasant taste of the mouth.
SKIN: rash, pruritus, urticarial
EENT: Stuffy nose
CNS: Seizures
NURSING RESPONSIBILITY: 1. Asses patient for signs and symptoms of infection prior to and
throughout therapy.
2. Before initiating therapy, obtain a history to determine
previous use of and reactions to penicillin. Persons with a
negative sensitivity may still have an allergic response.
3. Observe patient for signs and symptoms of anaphylaxis (rash,
pruritus, laryngeal edema, wheezing). Discontinue the drug an
notify physician.
4. Instruct patient to report signs of hypersensitivity.

2. GENERIC NAME: Ketorolac Tromethamine

CLASSIFICATION: Anti-pyretic

DOSAGE: 30mg (3 doses)

ROUTE: IVTT

FREQUENCY: Every 6 hours PRN

MECHANISM OF ACTION: Anti- inflammatory analgesic activity, inhibits prostaglandins and

leukotriene synthesis.
INDICATION: Short term management of pain (up to 5 days)

CONTRAINDICATION: Contraindicated with significant renal impairment, aspirin allergy,

recent GI bleed or perforation. Use cautiously with impaired
hearing, allergies and hepatic condition.

ADVERSE EFFECTS: CNS: Headache, dizziness, somnolence, insomnia, fatigue and

ophthalmologic effects.

NURSING RESPONSIBILITIES:

1. be aware that patient may be at risk for CV events, GI bleeding, renal toxicity, monitor
accordingly.
2. Keep emergency equipment ready available at time of initial dose, in case of severe
hypersensitivity reaction.

3. Protect drug from light.

4. Administer every 6 hours to maintain serum levels and control pain.

3. GENERIC NAME: Ranitidine

CLASSIFICATION: Anti-ulcer

DOSAGE: 50 mg

FREQUENCY: Every 8 hours

ACTION: Inhibits action of histamine at the H2 receptor site located primarily in

gastric parietal cells, resulting in inhibition of gastric acid and secretion.
 Has some anti-bacterial action against H. pyloric.

CONTRAINDICATION: Hypersensitivity, cross- sensitivity may occur some oral liquid contain
alcohol and should be avoided in patients with known intolerance.

ADVERSE EFFECTS: GI: nausea, abdominal pain, diarrhea, constipation

SKIN: rash

CNS: drowsiness, dizziness, headache, insomnia

CV: bradycardia

NURSING RESPONSIBILITY:
1. Instruct patient not to take new medication without o consulting physician.
4. Allow 1 hour between any other antacid and ranitidine.

5. Monitor creatinine clearance if renal dysfunction is present.

6. Be alert for early signs of hepatoxicity.

A CASE STUDY ON NORMAL SPONTANEOUS VAGINAL
DELIVERY

Patient’s Demographic Data

Patient’s Initial: B.I

Age: 22 years old
Address: Purok Curvada, Dao, Pagadian City
Level of Education: College Graduate
Date of Admission: September 19, 2018

Chief Complaints

Three hours prior to admission, patient complaints of intermittent lumbosacral pain associated
with watery vaginal discharge.

Patient’s History

Previously admitted last 2010 for NSVD. No diabetic and hypertension family member.

Obstetric History
G2P1 PU 36-37 wks. Aog by lmp January 2, 2018

Assessment:
Internal Exam 8-9 cm leaking bag of water, BP 130/80 mmhg, HR 94 bpm, RR 23 cpm,
temperature 37.1Ċ, coherent upon interaction but irritable due to her active labor.

Laboratory Reults:
CBC: wbc 6-7, rbc 390,000, hgb 14.2, hct 42, platelet 180,000

DIFFINITION
Pregnancy is the state of carrying a developing embryo or fetus within the female body. This condition can be
indicated by positive results on over-the-counter urine test, and confirmed through a blood test, ultrasound,
detection of fetal heartbeat, or an X-ray. Pregnancy last for about nine months, measured from the date of the
woman’s last menstrual period (LMP). It is conventionally divided into three months long. When gestation has
completed, and it goes through a process called Delivery, where the developed fetus is expelled from the
mother’s womb.
There are two options of delivery: Cesarean section and Normal Spontaneous Vaginal Delivery (NSVD). A
cesarean section is a surgical incision through the, other’s abdomen and uterus to deliver one or more fetuses.

NSVD is the delivery of the baby through vaginal route. It can also be called NSD or normal spontaneous
delivery, where the mother delivers the baby with effort and force exertion.
 PATHOPHYSIOLOGY

AGENT
Fertilization
(Union of sperm an ovum)

Zygote- Unicellular
(intermingling of haploid paternal 23 X or Y and maternal 23 X chromosomes)

Series of Mitotic Cell division- Cleavage

(In 24 hours become two cell organism)

In 72 hours 16 cell organism called morula

Morula enters the uterus on the 3rd day through peristaltic movement
Separate into two by fluid from the uterus on the 4rth day

The outer layer gave rise to the placenta. The inner layer gave rise to the embryo
( trophoblast ) (embryoblast)

Blastocysts attaches to endometrium on the 6th day

Implantation

Embryonic development begins during second week continue through the eight week

3 stages Fetal Development is from ninth week to birth

 1st stage - increase in cell number and with
Elaboration of cell products Newborn baby via Vaginal Delivery
 2nd stage – morphogenesis/ molecules
Mass cell movement
 3rd stage differentiation of maturation of
Physiologic process
DRUG STUDY 

(ORAL MEDS)GENERIC NAME:

CEPHALEXIN
CLASSIFICATION:
Anti-Infective
ACTION:
Inhibits DNA synthesis by inhibiting DNA gyrase in susceptible gram negative and gram positive

organisms
INDICATIONS:
I n f e c ti o u s   d i a r r h e a ,   r e s p i r a t o r y   t r a c t   i n f e c ti o n , infection on the skin structures,
bones and joints

CONTRAINDICATIONS:
Hypersensitivity to drugs

ADVERSE REACTIONS:
•CNS: Headache
•CV: Orthostatic Hypotension
•EENT: Blurred Vision
•GI: Nausea and Vomiting, Diarrhea, constipation
INTERACTIONS: Oral anticoagulants: Increased anti-coagulant effects

NURSING CONSIDERATIONS:
•Advise Patient not to take drugs with dairy or caffeinated products
•Inform physician if allergies or rashes abruptly develop
 
GENERIC NAME:
MEFENAMIC ACID
CLASSIFICATION:
Anti-Inflammatory, Analgesic
ACTION:
Inhibits reuptake of serotonin norepinephrine CNS
INDICATIONS:
Moderate to moderately severe pain
CONTRAINDICATIONS:
Hypersensitivity with drugs, intoxication with alcohol, physical opioid dependence.

ADVERSE REACTIONS:
•CNS: dizziness
•CV: Vasodilation
•EENT: visual disturbances
•GI: Nausea and Vomiting
•GU: urinary retention
•SKIN: pruritus

NURSING CONSIDERATIONS:
• Tell patient that drug works best when taken before pain becomes severe
• Recommend abstinence from alcohol when taking medication.
• Caution patient that drug can cause dependence.
HEALTH TEACHING

Breast
 Wash breast daily at bath
 Wear supportive bra
 Wash hands before and after feeding
 Breastfeed frequently to avoid engorgement
 Apply warm packs between feeding
 Pumping or manually expressing breast milk
 Rotate the position of the baby for each feeding

Bladder
 May complain of frequent urination in small amounts: explain that this is due to urinary retention with
overflow
 May have difficulty voiding because of abdominal pressure to the trigone of bladder
 Encourage the client to go to comfort room every 4 to 6 hours
 Instruct to avoid garters or constricting clothing that can impair circulation
Episiotomy
 Sim’s position minimize strain on the suture line
 Perineal heat lamp or warm sitz bath twice a day to vasodilation increase blood supply
that promotes healing
 Administration of mild oral analgesics as ordered
Emotional Status
 Taking – hold pahse 1st 2-7 days postpartum
= need for sleep and rest
 Taking – hold phase 3rd day to 2 weeks postpartum
=control body function
=ability to assume the mother role
 Letting Go
= realize that the infant is separate individual and not a part of herself
=feeling of loss
=adjustment phase