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Name
: Mrs. Nishanthi.
Age
: 25 years
Educational level
: BA
Husbands name
: Mr. Kumar
Age
: 29 years
Educational level
: B.SC
Religion
: Hindu
Address
Occupation
: Electrician
Marital status
: Married
Admitted on
: 14.11.2014
IP no
: 32177
Ward
Obstetric score
: G2P1L1A0
LMP
: 08.02.14
EDD
: 15.11.14.
Diagnosis
: Retained placenta.
FAMILY HISTORY
PEDIGREE CHART:-
key:Male
female
60 yrs
28 yrs
56yrs
baby
25 yrs
29 yrs
2 days
FAMILY HEALTH HISTORY:There is no significant family history of hereditary diseases
SOCIO ECONOMIC HISTORY:She is living in a joint family. Her husband is the breadwinner of the family. She
is living in a house, which consists of all the adequate facilities such as water supply,
drainage and ventilation.
PERSONAL HISTORY:She is a non-vegetarian & not allergic to any foods. She takes habit of drinking
tea and coffee. She sleeps 6 hours at night. Her bowel and bladder habits are normal, no
habit of smoking and tobacco chewing.
MENSTRUAL HISTORY:Age at menarche
: 14
Menstrual cycle
MARITAL HISTORY:-
TYPE
OF
DELIV
ERY
CONDIT
ION
AT
BIRTH
HEAL
TH
STAT
US
PRIMI
TYPE
OF
DELIV
ERY
COMPLICA
TION
DURING
LABOUR
SEX BIR
TH
WT.
CONDIT
ION
AT
BIRTH
HEAL
TH
STAT
US
FTNVD
RETAINED
PLACENTA
GOOD
HEAL
THY
2014
3.1
PHYSICAL EXAMINATION.
Appearence
Mental status
Health status
S.L.
NO.
1.
ASSESSMENT
PATIENT FINDINGS
Hair
2.
Scalp
3.
Eyes
4.
Ears
5.
Nose
6.
Neck
7.
Lips
8.
Tongue
9.
Teeths
10.
Tonsil
Normal
11.
Lymph nodes
Absent
12.
Chest
Breast
14.
Abdomen
15.
Extremities
16.
Genetalia
17.
Lochia amount
18.
vulva
No odema present
VITAL SIGNS
Temperature
: 98.4 degree f
Pulse
: 82 beats / min
Respiration
: 24 breathes / min
Blood pressure
: 100/80 mm/hg
Pain
: 5/10
Height
: 162 cm
Weight
: 5o kg
INVESTIGATIONS
TEST DONE
Haemoglobin
Pvc
Platelet
Blood area
Sugar
Serum creatinine
OGCT
Urine:Sugar
Albumin
PATIENT
VALUE
8.4gms
26%
1.6 lakh
24 mg | dl
92 mg | dl
0.8 mg | dl
9.2 mg |dl
NORMAL
VALUE
13.5 mg | dl
45 %
1.5 5 lakh | mm
20 40 mg | dl
70 150 mg | dl
0.8 1.4 mg | dl
70 120 mg | dl
Nil
Nil
REMARKS
Anaemia
Anaemia
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
MEDICATIONS
Name of Dose
the drug
Tab.
5mg
Folic acid
Route
Action
P|o
P/O
Vitamin
Hypervitaminosi
supplement& s
maturation of
blood cells
Synthesis of
collagen
Hypervitaminsis
maintenance
of connective
tissue
Tab.
Calcium
Side effect
Nurses
Responsibilities
Nurse has to
motivate to take
medicine
Regularly
Advice to drink
more water
200 mg
P/O
Formation of
bone
and Hypercalcemia
Check
serum
electrolyte level
Inj.
Metrogyl
100mg
Inj.cipro
100 ml
IV
IV
maintainance
of coagulation
mechanism
antibiotic
antibiotic
Nausea
vomitting
Allergic
reactions
Nausea
vomitting
Maintain intake
output chart
NURSING DIAGNOSIS
Intervention
Monitor intake output
chart and hydration status
Implementation
Monitored intake output chart
Rationale
Provide baseline data
Monitored vitals
T-98.4 F
P-70/min
R-20/min BP-100/70mmhg
Place mother in
trendlenburg position
Administered RLand NS
To improve hydration
Intervention
Implementation
Rationale
Provide further
information
Promote maternal
comfort
2
Provide comfortable
position
3
Provide oxygen as needed
Reassess the client
4
Subjective data : Mother told that she is afraid of her disease condition.
Objective data: Mother looks restlessness , increased pulse rate
Nursing diagnosis: Anxiety related to the disease condition.
Goal: To decrease anxiety level
s.no
Intervention
Implementation
Provide positive
information
Rationale
Provide basic for care
planning
To decrease anxiety
Intake output and weight was assessed
Provide information
Supported the mother
To decrease anxiety
RETAINED PLACENTA
DEFINITION:
Retained placenta is a condition in which the placenta fails to be expelled within 30 minutes
after delivery of the fetus. The main cause is defective decidual reaction (decidua basalis)
leading to absence of line of cleavage through the spongy layer.
Retained placenta means that all or part of the placenta or membranes are left behind in your
uterus (womb) during the third stage of labour. The third stage is delivery of the placenta and
membranes.
The placenta is considered retained if it remains undelivered after 30 minutes of an actively
managed third stage and 60 minutes of a physiological third stage.
INCIDENCE:
About 0.5% of deliveries
CAUSES:
1) Retention of separated placenta:
Atony of the uterus with failure of expulsion of the separated placenta.
Contraction ring leading to hour glass deformity of the uterus.
Complete rupture of the uterus with passage of the placenta to the peritoneal
cavity.
2) Retention of non-separated placenta:
Atony of the uterus leading to absence of shearing mechanism needed for
placental separation.
Defective placentation in which the decidua basalis is either absent or
defective and so the chorionic villi penetrate the uterine muscles.
1) Placenta accreta.
2) Placenta increta.
3) Placenta percreta.
An analagous model for doing this may be practiced using a very large tangerine. This fruit
separates very easily from its peel. Cut a 1/2 inch strip of the peel off of the fruit from top to
bottom, then cut off the bottom section of the tangerine. Insert the side of your hand with your
baby fingers between the peel and the fruit. Gently use an up and down sawing motion to
separate the fruit from the peel. Proceed around the inside of the peel until the fruit falls into
your hand.
Another useful way to learn this technique, is to scrub in on a Caesarean birth with an
experienced obstetric surgeon. He or she can guide you in the process of the removal of the
placenta after the birth of the baby.
When the placenta is completely separated, draw it gently through the cervix, giving a slight
forward twist of your hand as you enter the vagina, to help peel the membranes off the wall
of the uterus, and also make a smaller bundle of the placenta as it is drawn out of the uterus
and vagina. Use care in making a thicker cord of trailing membranes, then grasp them with
your hand or a ring forceps to draw them out of the vagina without tearing a segment off and
leaving it behind.
Rapidly examine the placenta and membranes to assure yourself that nothing had been left
behind. It may be appropriate to make a second sweep of the uterus to identify, collect and
remove any clots, membranes or small pieces of tissue left behind. Some practitioners will use a
sterile gauze square in their hand to aid in this procedure. If you use a gauze sponge be sure to
keep it firmly in your grasp and remove it from the uterus and vagina.
If the placenta has already delivered
Start on the lateral side of the uterus and conduct the same careful sweep of the inside wall of
the uterus from side to side and top to bottom. Draw any clots or tissue into your hand in the
lower uterine segment, and out through the cervix and vagina.
In the course of your sweep you may find a cotyledon still attached to the inside wall of the
uterus. Use the same careful up and down sawing motion to establish a cleavage plane
between the tissue and the wall, and separate the cotyledon from its attachment. Do not
persist if it does not come away readily. It may be attached to the uterine muscle. Seek
consultation immediately.
You occasionally might also come across tissue which is attached to the inner wall of the
uterus with one or more "strings." Do not attempt to pull these strings out of the uterine wall.
They may be deeply attached into the myometrium. Instead, attempt to pinch them to
separate the cotyledon and remove it, leaving the string(s) behind. While not an easy
maneuver to accomplish, one can also try using two fingers to tear the string, while buffering
the string coming out of the wall with another finger so it does not put stress on the
attachment. This is done by wrapping the string around the two fingers and then tearing it
apart using two fingers. The strings left behind, or adherent tissue not able to be removed,
will later slough off as long as bleeding is minimal.
After removal of the placenta and membranes
Assist the uterus to contract by firm, not vigorous, massage of the uterus through the
abdominal wall. If bleeding is still brisk, immediately beginbimanual compression of
the uterus.
Once you are assured you do not need to enter the uterus again, anoxytocic agent should
be given This is effectively accomplished by an intravenous infusion of Pitocin, followed
by a course of oral Methergine, e.g. 0.2 mg Methergine tablets by mouth every 4 hours
for 6 doses.
Depending upon the degree of invasion of the uterus, it may be appropriate to give the
mother a course of antibiotic therapy.
POST-PROCEDURE CARE:
Observe the woman closely until the effect of IV sedation has worn off.
Monitor the vital signs (pulse, blood pressure, respiration) every 30 minutes for the next 6
hours or until stable.
Palpate the uterine fundus to ensure that the uterus remains contracted.
Check for excessive lochia.
Continue infusion of IV fluids.
Transfuse as necessary.
Umbilical vein injection of saline solution plus oxytocin appears to be effective in the
management of retained placenta. Saline solution alone does not appear be more effective
than expectant management. The difficulties in implementing this intervention are related
to the training of personnel in the technique of giving injections into the umbilical vein.
HEALTH EDUCATION
DIET:
Educated the mother
To take plenty of oral fulids and friut juices
To take iron rich foods
POSTNATAL EXCERCISES:
Adviced to do post natal exercises regularly and effectively
PERSONAL HYGIENE:
Adviced to maintain proper personal hygiene
BIBILIOGRAPHY:
1.KATHARYGN A MAY LAURA, COMPREHENSIVE MATERNITY NURSING,
SECOND EDITION ,JAYPEE PUBLICATIONS
2.MUDALIAR AND MENON, CLINCAL OBSTETRICS,TENTH EDITION
3. REEDER ET ALL, MATERNITY EDITION,NINEENTH EDITION,LIPPINCOTT
PUBLICATIONS
4.WWW.SCRIBD.COM
5.WHO CLINICAL GUIDELINESS FOR PPH AND RETAINED PLACENTA