Introduction

Pregnancy is the carrying of the fetus inside the womb . The childbirth usually
occurs about 38-41 weeks from the mother’s last menstrual period (LMP). A pregnant female is
usually called gravida. Medically, a women who is never pregnant before is called nulligravida.
And for a woman who is pregnant for the first time is called primagravida. And lastly, for a
woman who is in her second or any subsequent pregnancy is called multigravida.
A woman will know if she is pregnant if she has these following signs: fetal heartbeat as
early as eight week with electronic device and after 16 th week with Fetoscope, fetal movements
felt by examiner, x-ray visualization of the fetus, and USD evidence.

The mother is expected to have her prenatal visits. In the first lunar month, she should
visit monthly. In the 8th and 9th lunar month, she should visit twice a month. And in the 10th lunar
month, she is expected to visit weekly until labor pains set in.

The nutrition of the pregnant woman is very important in the pregnancy. She is expected to have
2500 kcal of calories, 71 g/d of protein, 55% to 60% carbohydrate of the diet, fats that not
exceed 305 calories, 30-60mg supplement of iron, 1300mg of calcium, and 600mcg of folic acid
(Maternal & Child Health Nursing 6th edition, p.303). With the diet given, she is expected to gain
20 lbs during her pregnancy because sudden weight gain may indicate fluid retention. The
pregnant woman is also expected to cope up with her nutrients so that the growing fetus is able to
get his or her nutrients needed. With a healthy pregnant woman comes a healthy baby.

There are lots of complications in pregnancy. One of which is the placenta previa, where
it is the low implantation of the placenta. There are three types of placenta previa: Complete
placenta previa, marginal placenta previa, and low implantation of the placenta previa. The
placenta implanted in the lower portion covering the whole opening of the cervix is called the
complete placenta previa. Marginal placenta previa happens when half of the cervical opening is
covered by placenta with half of the placenta directed towards the lower segment of the cervix.

1
And the placenta is implanted on the lower portion of the uterus where less blood vessels are
present causing placental insufficiency to the fetus is called the low implantation placenta previa.

During our duty in the Ob ward at Southern Philippines Medical Center , the group
decided to take the case of Ms. Baniel in which she was diagnosed with placenta previa totalis
because we would like to have a deeper understanding about this condition so that we could
render the care the patient needed to arrive with a good prognosis. Management should therefore
always be based on appropriate clinical judgment. We would like to apply all the things that
we’ve learned through our lectures for the benefit of our patient and to enhance our skills as well.

We hope that this case study will enable us, student nurses to better understanding about
the disease process and that we will be more sensitive in attending to our patient’s need.

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 OBJECTIVES

The Group formulated the following objectives to be able to come up with a well directed
and organized case study.
General:
The group aims to provide an extensive study regarding Placenta Previa. This study intends to
resent a reliable and factual data for us to gain knowledge needed to impart relevant information
to others.
Specific
To be able to:
1. Establish a good interpersonal relationship with the patient and his significant others.
2. Aquire relevant data from the patient and the patient's family for the study.
3. Trace the health history of the patient, both past and present.
4. Trace her genogram or family tree
5. Trace the development data of the client
6. Perform physical assessment on client’s condition so as to attain baseline data
7. Present the definitions of the complete diagnosis that would explain the
illness of our client
8. Study the anatomy and physiology of female reproductive system
9. Trace the pathophysiology of placenta previa
10.Determine the diagnostic tests our client has undergone including their
implications and nursing responsibilities
11.Identify the drugs prescribed to our client, their action, side effects, indications,
contraindications and nursing responsibilities
12.Identify and prioritize the need of our patient
13.Formulate an appropriate nursing care plan based on the assessment identified needs
and problems of the patient
14.Render health teachings as part of our holistic care to alleviate problems identified
15.Evaluate complications to nursing practice, education and research
16. Present the references which are used to conduct this study.

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 PATIENT’S DATA

Name: Ms. Pepita

Address: Blk 2 Puan ,Talomo District, Davao City
Age/Sex: 28 years old / female
Birthday: April 7, 1982
Birthplace: Davao City
Civil Status: Single
Religion: Roman Catholic
Nationality: Filipino
Educational Attainment: High school Graduate
Occupation: Housekeeper
Spouse: None
Date Admitted: June 20,2010
Time Admitted: 08:15am
Ward: OB
Bed no.: 1
Admitting Diagnosis: Pregnancy uterine 36 1/7 weeks AOG, G1P1,
Placenta Previa Totalis
Final Diagnosis: Pregnancy uterine cephalic delivered pre-term
baby boy livebirth via low segment transverse
cesarean section;Placenta Previa Totalis G1P1
Chief Complaint: Vaginal Bleeding
Operation: Primary Low Segment Transverse Cesarean Section
Admitting Doctor: Dr. Maida Dizon
Consultant Doctor: Dr. Vega
Admitting Clerk:
Attending Physician: Dr. Lim

4
 Family Background

The patient's father, Paulino, died in the year 1989 due to hypertension while her mother,
died because of asthma.. Bendita has six siblings and all of them are still alive except for the
youngest of them, Evelyn, who died in the car accident. Her elder sister Margien has asthma
while her younger brother,Bernardo , has also hypertension and vices, which include smoking
and drinking alcohol.

The patient is the 3rd child in the family. She’s still single but living with Pepito (her
partner) for years now, and they are currently living at Blk 2 Puan ,Talomo District, Davao City.
They are what we call as “extended” family. They live together with her partner`s brother with
the wife and children. They eat three times a day and their food intake is usually fried foods such
as fish, eggs and rice in the morning while soup at noon and in the evening. They usually sleep at
9 pm and their waking time is at 6 am. Pedro goes to work at 7 am and come home late in the
afternoon while Baniel stays at home and do the household chores . The patient drink alcohol
and does even smoke.

The genogram shows that her family has history of heart disease, cataract and urinary
tract infection.

Past Health History

The patient verbalizes that her past illnesses were fever, headache and colds. She only
takes a rest and drink medicines such that are over the counter drugs, and also she had her
increase of fluid intake. She also said that when she was on her school age, she experienced
having a chicken pox. She said that she has never been hospitalized before, except on her
pregnancy.

When I asked Ms. Bendita about her diet, she said that she usually eat humba, fish, and
anything. She also drinks an average of two glasses of coke and two cups of coffee everyday.

5
She consumes two sticks of cigarette almost everyday. She does drink beverages often onlu
occasionally and consumes an average of one bottle.

Obstetrical History
Upon interview, the patient told us that her menarche started at the age of 12, regular,
with 28 – 30 days interval. Her menstrual period usually lasts from 4-7 days and she could use
up 2 napkins per day. On her pregnancy the patient also told us that her last menstrual period
was on October 10, 2009.
The patient told us that she used any contraceptive.

History of Present Illness

Her last menstrual period for her second pregnancy was on October 10, 2009. She has
her prenatal check-up only once. On her second trimester, she experienced her first vaginal
bleeding and because she’s afraid to lose her baby, she immediately goes for a check-up and has
an ultrasound, that’s when she discovers that she has placenta previa. She was advised to have a
full rest and move carefully. The estimated time of confinement is July 17, 2010, with the age of
gestation of 36 1/7 weeks. When June 20, 2010 arrived, she had the chief complaint of having a
vaginal bleeding, so she was confine immediately.

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GENOGRAM

Mother’s Side Father’s Side

Avelina Vicente Fajardo Corazon

Asuncia Pepito

Evelyn Bernardo Bendita Margien Noelyn

Bernie

LEGENDS:

- Hypertension
- Asthma
- Deceased
- Cataract
-Placenta Previa
− Urinary Tract Infection

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 −

Developmental Data
Robert Havighurst:Developmental Task Theory

Havighurst defines a developmental tasks as one that arises at a certain period in our
lives, the successful achievement of which leads to happiness and success with later tasks; while
leads to unhappiness, social disapproval, and difficulty with later tasks. Havighurst uses lightly
different age groupings, but the basic divisions are quite similar to those used in this book. He
identifies three sources of developmental tasks :

1.) Tasks that arise from physical maturation.For example, learning to walk, talk,
and behave acceptablly with the opposite sex during adolescence; adjusting to
menopause during middle age.

2.) Tasks that from personal sources. For example, those that emerge from the
maturing personality and take the form of personal values and aspirations, such as
learning the necessary skills for job success.

3.) Tasks that have their source in the pressures of society. For example, learning
to read or learning the role of a responsible citizen.

Patient is 28 years old. She belongs to Developmental Tasks of Early Adulthood from 20
to 40 years of age. The developmental tasks of our client are to select a mate, learn to live
with a partner, start a family, rear children, manage a home, get started in an occupation,
take on civic responsibility and find a congenial social group.
Developmental Tasks Result Justification
1. Selecting a life partner √ She accomplished this , the task of finding a
partner because she is living together with a guy
who considered him as a husband.
2. Learning to live with a partner √ She accomplished this task because she lives
together with her partner for 3 years eventhough

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3. Starting a family
4. Rearing children
5. Managing a home
6. Getting started in an
occupation
7. Taking on civic responsibility √
8. Finding a congenial social
group
they are not married yet.
√ She accomplished this task since she deliver
her first baby boy successfully.
x She is starting to accomplished this task since
she has now her first baby boy and she promise
us instill some good values as the baby grows.
x They don't have a house on there own they live
together with his husband's brother together with
the wife but they are separated in terms of room
and financial matters.
x She never accomplished this task since she
didn't finish her high-school years and at early
age she took the responsibility as an housewife.
She accomplished this task since she is
exercising her right to vote during the last may
2010 election. She is also aware on some issues
about what is happening to our city.
√ She accomplished this task since she joins
some activities in the community such as
seminars and also she avails some free goods in
there Barangay.
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Erik Erikson :Stages of Psychosocial Development

Erik Erikson explain eight stages through which a healthily developing humans should
pass from infancy to late adulthood. In each stage the person confronts, and hopefully masters,
new challenges. Each stage builds on the successful completion of earlier stages. The challenges
of stages not successfully completed may be expected to reappear as problems in the future.
Erikson believes that the greater the task achievement, the healthier the personality of the person;
failure to achieve a task influences the person’s ability to achieve the next task. Erikson’s eight
stages reflect both positive and negative aspects of the critical life periods. The resolution of the
conflicts at each stage enables the person to function effectively in the society.

Stage 6: Young Adulthood -- Age 19 to 40

Crisis:Intimacy vs. Isolation

Description:In this stage, the most important events are love relationships. No
matter how successful you are with your work, said Erikson, you are not developmentally
complete until you are capable of intimacy. An individual who has not developed
a sense of identity usually will fear a committed relationship and may retreat into
isolation.
Positive outcome:Adult individuals can form close relationships and share with
others if they have achieved a sense of identity.
Negative outcome:If not, they will fear commitment, feel isolated and unable to
depend on anybody in the world.

Result Justification
Since the patient is 28 years of age
She belongs to Eric Erikson’s stage of
Intimacy vs. Isolation. It is from 20 to
34 years of age. In Young adulthood, we
begin to share ourselves more She already accomplished this stage
intimately with others. We explore because She begin to share her selves
relationships leading toward longer more intimately with others. She explore

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term commitments with someone other relationships leading toward longer term
than a family member. Successful √ commitments with someone other than a
completion can lead to comfortable family member eventhough they are not
relationships and married with her partner still they love
a sense of commitment, safety, and care each other and obviously right now their
within a relationship. Avoiding love brought them there first baby boy.
intimacy, fearing commitment and
relationships can lead to isolation,
loneliness, and sometimes depression.

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Lawrence Kohlberg: Stages of Moral Development

The theory holds that moral reasoning, the basis for ethical behavior, has six
identifiable developmental stages, each more adequate at responding to moral dilemmas than its
predecessor. Kohlberg's six stages can be more generally grouped into three levels of two stages
each: pre-conventional, conventional and post-conventional. Following Piaget's constructivist
requirements for a stage model, as described in his theory of cognitive develpoment, it is
extremely rare to regress backward in stages—to lose the use of higher stage abilities.Stages
cannot be skipped; each provides a new and necessary perspective, more comprehensive and
differentiated than its predecessors but integrated with them.

Level 1 (Pre-Conventional)
1. Obedience and punishment orientation
(How can I avoid punishment?)
2. Self-interest orientation
(What's in it for me?)

Level 2 (Conventional)

3. Interpersonal accord and conformity

(Social norms)
(The good boy/good girl attitude)
4. Authority and social-order maintaining orientation
(Law and order morality)

Level 3 (Post-Conventional)\

5. Social contract orientation

6. Universal ethical principles
(Principled conscience)

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 The patients age falls to POST-CONVENTIONAL OR PRINCIPLED MORALITY
since there is a growing realization that individuals are separate entities from society, and that
the individual’s own perspective may take precedence over society’s view; they may disobey
rules inconsistent with their own principles. These people live by their own abstract principles
about right and wrong—principles that typically include such basic human rights as life,
liberty, and justice.

Stage of Moral Development Results Justification

She has a natural rights and liberties

Level 3 (Post-Conventional)
that are prior to society and must be
protected by society. She knows weather
5. Social contract orientation
that actions is right or wrong. When
6. Universal ethical principles
talking about aborting baby she told us
(Principled conscience)
that it is wrong and it is against the law
√ and it is really not right. When talking
about for example the rules in the OB
ward about “ Breastfeeding” she told us
not to use bottle feed since breastfeeding
is much better and convenient to used.

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 DEFINITION OF COMPLETE DIAGNOSIS

PLACENTA PREVIA TOTALIS

1. Placenta Previa Totalis – is implanted in the lower segment near or over the internal
cervical os. A total previa, the internal is entirely covered by the placenta.

SOURCE: Maternity Nursing, Lowdermilk, 7th ed.

2. Placenta previa is a low-lying placenta that covers part or all of the opening of the cervix.
This positioning of the placenta can block the baby's exit from the uterus. As the cervix
begins to thin and dilate in preparation for labor, blood vessels that connect the
abnormally placed placenta to the uterus may tear, resulting in bleeding. During labor and
delivery, bleeding can be severe, endangering mother and baby.

SOURCE: http://www.marchofdimes.com/professionals/14332_1154.asp

3. Placenta previa is an obstetric complication in which the placenta is attached to the

uterine wall close to or covering the cervix. It can sometimes occur in the later part of the

14
 first trimester, but usually during the second or third. It is a leading cause of vaginal
bleeding. It affects approximately 0.5% of all labors.

SOURCE: http://en.wikipedia.org/wiki/Placenta_praevia

4. Placenta previa is an obstetric complication that occurs in the second and third trimesters
of pregnancy. It may cause serious morbidity and mortality to both the fetus and the
mother. It is one of the leading causes of vaginal bleeding in the second and third
trimesters.

SOURCE: http://emedicine.medscape.com/article/796182-overview

5. Placenta previa is not usually a problem early in pregnancy. But if it persists into later
pregnancy, it can cause bleeding, which may require you to deliver early and can lead to
other complications. If you have placenta previa when it's time to deliver your baby,
you'll need to have a c-section.

SOURCE: http://www.babycenter.com/0_placenta-previa_830.bc

6. Placenta previa is a problem with the placenta during pregnancy. The placenta is a round,
flat organ that forms during pregnancy to give the baby food and oxygen from the
mother. The placenta forms on the inside wall of the uterus soon after conception.

Source:
http://www.seton.net/health_a_to_z/health_library/illnesses_and_conditions/placenta_pre

7. Placenta previa is defined as implantation of the placenta in the lower uterine segment in
advance of the fetal presenting part. The placenta either totally or partially lies within the
lower uterine segment.

There are different forms of placenta previa:

Marginal: The placenta is against the cervix but does not cover the opening.
Partial: The placenta covers part of the cervical opening.

Complete: The placenta completely covers the cervical opening.

SOURCE: http://www.womenshealthsection.com/content/obs/obs018.php3 h and

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 8. Placenta previa is a potentially dangerous condition that sometimes occurs during
pregnancy. Women with this condition often experience bleeding during pregnancy due to
the incorrect position of the placenta. In some cases, placenta previa does not result in
any serious problems. However, women with total placenta previa often require a c-
section and at are an increased risk of severe bleeding.

SOURCE: http://www.ehow.com/facts_5120480_definition-placenta-previa.html

9. Placenta previa is implantation of the placenta over or near the internal os of the cervix.
Typically, bright red painless vaginal bleeding occurs during late pregnancy. Diagnosis is
by transvaginal or abdominal ultrasonography. Treatment is bed rest for minor vaginal
bleeding before 36 wk gestation or, after 36 wk or in refractory cases, immediate
delivery, usually by cesarean section

10. Low Segment Transverse Cesarean Section - the incision is always made
horizontally across the lower end of the uterus , resulting in reduced blood
loss and a decreased chance of rupture.

Placenta Previa

The placenta is an organ that develops on the lining of the uterus around the third month
of pregnancy. The placenta is connected to the baby’s umbilical cord. It supplies the baby with
nutrients and oxygen and carries away waste products.

In one out of 200 pregnancies a condition called placenta previa develops. This occurs
when the fertilized egg attaches to the lower part of the uterus instead of to the top. The placenta
forms around the implanted embryo, resulting in a placenta positioned in the lower part of the
uterus, instead of in the normal position at the top. A placenta previa completely blocks the
opening of the cervix. Variations of this condition are partial previa, which partially covers the
cervical opening, and marginal previa, which extends just to the edge of the opening.

16
 The first sign of placenta previa is often bright red bleeding. There is usually no pain or
cramping. If bleeding occurs, the doctor will perform tests to confirm placenta previa. If placenta
previa is diagnosed, bed rest is usually necessary, sometimes in the hospital. Steroid shots may
be given to help speed the maturation of the baby’s lungs, in case an early delivery becomes
necessary. If bleeding is severe, a blood transfusion may be ordered for the mother. A Cesarean
delivery may be necessary. In cases of marginal or partial previa, a vaginal birth may still be
possible.

There is no way to prevent placenta previa. Once it is diagnosed, the best strategy's to
follow doctor’s instructions and to spend most of your time lying down.

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 PHSICAL ASSESSMENT
(June 21 and 22, 2010)

General appearance

The patient is lying on bed, awake, coherent and oriented . The patient is attentive and
cooperative during assessment She weighs 55 kgs . and 4’11” in height. The patient is quite dirty
and unkempt. Vital signs were taken as follows:

Shift: 11-7 4pm 8pm 12am

T: 36.3°C 36.7°C
PR : 92bpm 86bpm
RR : 21bpm 20bpm
BP : 120/80 120/70

Skin
The client’s skin is of normal racial tone. Skin is dry. Capillary refill time of 2 seconds.
Skin integrity was no longer intact due to transverse cesarean incision made through the maternal
abdomen. The body hair is evenly distributed. Skin is warm to touch.

Hair
The client’s hair are evenly distributed No swelling, lacerations, bruises and tenderness
was seen upon inspection. The hair is fine and shiny. Hair is black in color. No signs of scalp
lesions or flaking.

Head and Face

The client’s skull is proportionate to the body size;there were no tenderness in the scalp.
Her hair is evenly distributed and the strands are thick. Her head is round and symmetrical the
consistency is hard. She can control her head and the shape of her face is round and symmetrical.

18
 Eyes
The eyes did not display any abnormal protrusion. The condition of her eyes is straight
normal; the eye brows are evenly distributed. Eyelids have effectively closure. The blink
response is bilateral, eye balls are symmetrical, bulbar conjunctiva is clear, and the sclera are
white and clear. Pupils are equal in size. Pupils are equally round and reactive to light and
accommodation. She can execute the occular movements.

Ears
The color of the ears is of normal racial tone and symmetrical. The pinnas are elastic and
recoil when folded. Ears don't have any masses and tenderness. The external canal has some
cerumen. The color of the cerumen is brown.

Nose
Nose are symmetrical. Nose is of normal racial tone her septum is in the midline, mucosa
is pink. Nostrils are both patent. Nasal flaring is absent. She doesn’t have any tenderness in her
sinuses. No lesions and redness noted. There were no tenderness, masses, or bone displacement
upon palpation.

Mouth
The lips are symmetrical and pink in color, the consistency is smooth, buccal mucosa and
the gums are pink, the tongue is in the midline, the color is pink and it is smooth. The tongue
moves freely the and it is intact. .Upper front teeth were replaced with dentures. Breath is
slightly odorous.x

Throat
Trachea is in the midline, mucosa is pink, tonsils are not inflamed and the gag reflex is
present.

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 Neck
Neck muscles are equal in size she can resist force when asked to resist. . The trachea is
in the midline. No rigid and masses or any deformities are noted. Neck movements appear
normal.

Breast and axillae

Client has a rounded shape breast, slightly unequal in size, however generally symmetric.
Breasts are engorged, full and slightly tender with secretion of breast milk. Areola is dark brown
in color. Axilla is dark and moist. No masses were felt when palpated.

Chest and Lungs

Shape of chest is normal and with symmetrical lung expansion. Thorax is symmetrical.
Respiratory rate is 21 cycles per minute, with regular pattern and absence use of the accessory
muscles. Patient is not in any respiratory distress. There were no signs of productive cough.
Tachypnea is noted. Breath sounds is clear and heard almost of all of anterior lungs upon
auscultation.

Abdomen
The abdomen is firm and distended. No audible bowel sounds. Transverse type of
incision was made 1 to 2 inches above the pubic hair line and was secured with a binder.
Dressing of the operative site on patient’s abdominal area is dry and intact, however it was not
cleaned yet since the operation as verbalized by the client. Straie gravidarum and linea nigra
were evident upon inspection. Facial grimace and abdominal guarding is noted.

Genital
The patient has a foley catheter and was removed at 5pm. The urine color is yellow with
slight stains of blood and is clear. The client was able to void at 9pm. Client was using a diaper.
Minimal discharges was noted (lochia rubra).

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Upper extremities
The client can resist force when asked to resist. Muscle strength is 3/5. The peripheral
pulses are equal. With IV fluid of D5LR 1L + 10 U oxytocin at the left metacarpal vein running
at 120cc/hr.

Lower extremities
Lower extremities are symmetrical. Both legs can flex, rotate, extend and bend without
difficulty. Legs can support the body and can slightly move without difficulty. Lesions on the
right lower leg was noted. The patient need assistance when ambulation.

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 FEMALE REPRODUCTIVE SYSTEM

Internal Structure

Vagina

The vagina (from Latin vagĭna, literally "sheath" or "scabbard") is a fibromuscular

tubular tract leading from the uterus to the exterior of the body in female placental It extends
from the cervix of the uterus to the external vulva. Its function is to act as an organ of intercourse
and to convey sperm to the cervix so that sperm can meet to the ovum in the fallopian tube. With
childbirth it expands to serve the birth canal. When a woman is lying on her back the course of
the vagina is inward and downward. Because of this downward slant and the angle of the uterine
cervix, the length of the anterior wall of the vagina is approximately 6-7 cm; the posterior wall is

22
8-9 cm. At the cervical end of the structure, there are recesses on all the sides of the cervix,
termed fornices. Behind the cervix is the posterior fornix; at the front, the anterior fornix; and at
the sides, the lateral fornices. The posterior fornix serves as a place for the pulling of semen after
coitus; this allows a large number of sperm to remain close to the cervix and encourages sperm
migration into the cervix.

Ovary
The ovaries are a pair of organs in the female reproductive system. They are located in
the pelvis , one on each side of the uterus (the hollow, pear-shaped organ where a baby grows).
Each ovary is about the size and shape of an almond. The ovaries have two functions: they
produce eggs and female hormones (chemicals that control the way certain cells or organs
function).Ovaries are located close to and on both sides of the uterus and the lower abdomen.
The function of the two ovaries is to produce, mature and discharged ova. Ovarian function is
necessary for maturation and maintenance of secondary sex characteristics in females. The
ovaries are held suspended and in close contact with the ends of the fallopian tubes by three
strong supporting ligaments attached to the uterus or the pelvic wall.

Fallopian tubes

Named after Gabriel Fallopius (Gabriele Falloppio), also known as oviducts, uterine
tubes, and salpinges (singular salpinx) are two very fine tubes lined with ciliated epithelia,
leading from the ovaries of female mammals into the uterus, via the utero-tubal junction. In non-
mammalian vertebrates, the equivalent structures are the oviducts.These are narrow tubes that are
attached to the upper part of the uterusand serve as tunnels for the ova (egg cells) to travel from
the ovaries to theuterus. Conception, the fertilization of an egg by a sperm, normally occurs in
thefallopian tubes. The fertilized egg then moves to the uterus, where it implants to the uterine
wall.

Cervix
This part of your reproductive organs is situated between the vagina and uterus. It secretes
mucus that can help or obstruct sperm from fertilizing an egg. The cervix is the opening that

23
sperm must pass through in order to get to an egg. A baby must also go through the cervix as it
exits the uterus and enters the vagina.

Uterus
The uterus is a hollow, muscular, pear-shaped organ located in the lower pelvis
posterior to the bladder and anterior to the rectum. The function of the uterus is to receive the
ovum from the fallopian tube; provide a place for implantation and nourishment during fetal
growth; furnish protection to a growing fetus; and, at Immaturity of the fetus, expel it from the
woman’s body. Anatomically, the uterus consists of three divisions; the body or corpus, the
isthmus and the cervix. The body of the uterus is the uppermost part and forms the bulk of the
organ. The lining of the cavity is continuous with that of the fallopian tubes, which enter at its
upper aspects. The portion of the uterus between the points of attachment of the fallopian tubes
is termed the fundus.
During pregnancy, the body of the uterus is the portion of the structure that expands to
contain the growing fetus. The fundus is the portion that can be palpated abdominally to
determine the amount of uterine growth occurring during pregnancy, to measure the force of
uterine contractions during labor, and to assess that the uterus is returning to its non-pregnant
state after childbirth. The isthmus is a short segment between the body and cervix. During
pregnancy this portion also enlarges greatly to aid in accommodating the growing fetus. The
cervix, is the lowest portion of the uterus. It represents approximately one-third of the total
uterus size and is approximately 2-5 cm long. Approximately, half of it lies above the vagina and
half extends to the vagina. A central cavity is turned the cervical canal. The opening of the canal
at the junction of the cervix and the isthmus is the internal cervical os; the distal opening to the
vagina is the external os. The level of there external os is at the level of the ischial spines.

Placenta
The placenta is an organ that connects the developing fetus to the uterine wall to allow
nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. Placentas are
a defining characteristic of eutherian or "placental" mammals, but are also found in some snakes
and lizards with varying levels of development up to mammalian levels. The word placenta
comes from the Latin for cake, from Greek plakóenta/plakoúnta, "flat, slab-like", in reference to

24
its round, flat appearance in humans. Protherial (egg-laying) and metatherial (marsupial)
mammals produce a choriovitelline placenta that, while connected to the uterine wall, provides
nutrients mainly derived from the egg sac. The placenta develops from the same sperm and egg
cells that form the fetus, and functions as a fetomaternal organ with two components, the fetal
part (Chorion frondosum), and the maternal part (Decidua basalis).

Ovarian Ligament
- (also called the utero-ovarian ligament or proper ovarian ligament) is a fibrous ligament
that connects the ovary to the lateral surface of the uterus.This ligament should not be confused
with the suspensory ligament of the ovary, which extends from the ovary in the other direction.

The round ligament of the uterus originates at the uterine horns, in the parametrium.

It leaves the pelvis via the deep inguinal ring, passes through the inguinal canal and
continues on to the labia majora where its fibers spread and mix with the tissue of the mons
pubis.
-The function of the round ligament is maintenance of the anteversion of the uterus (a position
where the fundus of the uterus leans ventrally) during pregnancy. Normally, the cardinal
ligament is what supports the uterine angle (angle of anteversion). When the uterus grows during
pregnancy, these ligaments can stretch

The suspensory ligament of the ovary,

also infundibulopelvic ligament (commonly abbreviated IP ligament or simply IP), is a
fold of peritoneumthat extends out from the ovary to the wall of the pelvis. Some sources
consider it a part of the broad ligament of uteruswhile other sources just consider it a
"termination" of the ligament. The suspensory ligament is directed upward over the iliac vessels.

Cervix
The cervix (or neck of the uterus) is the lower, narrow portion of the uterus where it joins
with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the
upper anterior vaginal wall. Approximately half its length is visible with appropriate medical

25
equipment; the remainder lies above the vagina beyond view. It is occasionally called "cervix
uteri". Cervix means neck in Latin.

External os of the uterus

The external orifice of the uterus (or ostium of uterus, or external os) is a small,
depressed, somewhat circular aperture on the rounded extremity of the vaginal portion of the
cervix. Through this aperture, the cervical cavity communicates with that of the vagina.

The external orifice is bounded by two lips, an anterior and a posterior. The anterior is
shorter and thicker, though it projects lower than the posterior because of the slope of the cervix.
Normally, both lips are in contact with the posterior vaginal wall.

Prior to pregnancy, the external orifice has a rounded shape when viewed through the
vaginal canal (as through a speculum). Following parturition, the orifice takes on an appearance
more like a transverse slit or is "H-shaped".

Posterior Fornix
The posterior fornix is the larger recess, behind the cervix. It is close to the rectouterine pouch

Rectouterine pouch
The rectouterine pouch (or rectouterine excavation, rectovaginal, Ehrhardt-Cole Recess
or Pouch of Douglas) is the extension of the peritoneal cavity between the rectum and back wall
of the uterus in the female human body.

The rectouterine pouch is used in the treatment of end-stage renal failure in patients who
are treated by peritoneal dialysis. The tip of the dialysis catheter is placed into the deepest point
of the pouch.

In women it is the deepest point of the peritoneal cavity, posterior to (behind) the uterus
and anterior to (in front of) rectum. (The pouch on the other side of the uterus is the
vesicouterine excavation.)

26
It is near the posterior fornix of the vagina.

In men, the region corresponding to the rectouterine pouch is the rectovesical excavation, which
lies between the urinary bladder and rectum. (There is no equivalent to the vesicouterine
excavation.)

Endometrium
The endometrium is the inner membrane of the mammalian uterus.
The endometrium functions as a lining for the uterus, preventing adhesions between the opposed
walls of the myometrium, thereby maintaining the patency of the uterine cavity. During the
menstrual cycle or estrous cycle, the endometrium grows to a thick, blood vessel-rich, glandular
tissue layer. This represents an optimal environment for the implantation of a blastocyst upon its
arrival in the uterus. The endometrium is central, echogenic (detectable using ultrasound
scanners), and has an average thickness of 6.7mm.

Urinary bladder
-In anatomy, the urinary bladder is the organ that collects urine excreted by the kidneys
prior to disposal by urination. A hollowmuscular, and distensible (or elastic) organ, the bladder
sits on the pelvic floor. Urine enters the bladder via the ureters and exits via the urethra.

27
 External Structures

Mons pubis

In human anatomy or in mammals in general, the mons pubis (Latin for "pubic mound"),
also known as the mons veneris (Latin, mound of Venus) or simply the mons, is the adipose
tissue lying above the pubic bone of adult females, anterior to the symphysis pubis. The mons
pubis forms the anterior portion of the vulva.

The size of the mons pubis varies with the general level of hormone and body fat. After
puberty it is covered with pubic hair and enlarges. In human females this mound is made of fat
and is supposed to be larger. It provides protection of the pubic bone during intercourse.

In humans, the mons pubis divides into the labia majora (literally "larger lips") on either
side of the furrow, known as the cleft of Venus, that surrounds the labia minora, clitoris, vaginal

28
opening, and other structures of the vulval vestibule. The fatty tissue of the mons veneris is
sensitive to estrogen, causing a distinct mound to form with the onset of puberty. This pushes the
forward portion of the labia majora out and away from the pubic bone.

Prepuce of Clitoris
In female human anatomy, the clitoral hood, (also called preputium clitoridis and clitoral
prepuce), is a fold of skin that surrounds and protects the clitoral glans. It develops as part of the
labia minora and is homologous with the foreskin (equally called prepuce) in male genitals.

Glans of Clitoris
The head or glans of the clitoris is roughly the size and shape of a pea, although it can be
significantly larger or smaller. The clitoral glans is highly sensitive, containing as many nerve
endings as the analogous organ in males, the glans penis, making it particularly well-suited for
sexual stimulation. During arousal, the glans becomes engorged with blood and protrudes from
the clitoral hood.

Urethral Opening
In anatomy, the urethra (from Greek οὐρήθρα - ourethra) is a tube that connects the
urinary bladder to the outside of the body. In males, the urethra travels through the penis, and
carries semen as well as urine. In females, the urethra is shorter and emerges above the vaginal
opening.

The external urethral sphincter is a striated muscle that allows voluntary control over urination.

Opening of Paraurethral ducts

In human anatomy (female), the Skene's glands (also known as the lesser vestibular
glands, periurethral glands, skene glands, paraurethral glands,U-spot, or female prostate) are
glands located on the anterior wall of the vagina, around the lower end of the urethra. They drain
into the urethra and near the urethral opening. These glands are surrounded with tissue, which
includes the part of the clitoris that reaches up inside the vagina and swells with blood during
sexual arousal.

29
Vestibule of vagina
The Vulval vestibule (or "Vulvar vestibule") is a part of the vulva between the labia
minora into which the urethral opening and the vaginal opening open. Its edge is marked by the
Hart's Line.

The external urethral orifice (orificium urethræ externum; urinary meatus) is placed about 2.5 cm
behind the glans clitoridis and immediately in front of that of the vagina; it usually assumes the
form of a short, sagittal cleft with slightly raised margins. Nearby are the openings of the Skene's
ducts.

The vaginal orifice is a median slit below and behind the opening of the urethra; its size
varies inversely with that of the hymen.

Labia minora
The labia minora (singular: labium minus) or nymphae are two longitudinal cutaneous
folds on the human vulva. They are situated between the labia majora, and extend from the
clitoris obliquely downward, laterally, and backward on either side of the vulval vestibule,
ending between bottom of the vulval vestibule and the labia majora. In the virgin the posterior
ends of the labia minora are usually joined across the middle line by a fold of skin, named the
frenulum labiorum pudendi or fourchette. Labia minora may vary widely in size from woman to
woman.

On the front, each labium minus (nympha) divides into two portions: the upper division passes
above the clitoris to meet the labium minus of the opposite side—which may not be equal in size
—forming a fold which overhangs the glans clitoridis; this fold is named the preputium
clitoridis. The lower division passes beneath the glans clitoridis and becomes united to its under
surface, forming, with the labium minus of the opposite side—which also may not be equal in
size—the frenulum clitoridis. On the opposed surfaces of the labia minora are numerous
sebaceous follicles.

30
Labia majora
. The labia majora" (singular: labium majus) are two prominent longitudinal cutaneous
folds which extend downward and backward from the mons pubis to the perineum and form the
lateral boundaries of the cleft of venus, which contains the labia minora, interlabial sulci, clitoral
hood, clitoral glans, frenulum clitoridis, the Hart's Line, and the vulval vestibule, which contains
the external openings of the urethra and the vagina.

Each labium majus has two surfaces, an outer, pigmented and covered with strong, crisp hairs;
and an inner, smooth and beset with large sebaceous follicles.

Anus
The anus is an opening at the opposite end of an animal's digestive tract from the mouth.
Its function is to control the expulsion of feces, unwanted semi-solid matter produced during
digestion, which, depending on the type of animal, may be one or more of: matter which the
animal cannot digest, such as bones; food material after all the nutrients have been extracted, for
example cellulose or lignin; ingested matter which would be toxic if it remained in the digestive
tract; and dead or excess gut bacteria and other endosymbionts.

CONCEPTION OF FETUS

The First Month

The countdown to a baby's birth actually begins about two weeks before it is conceived,
or the first day of the woman's last menstrual period. This is because most women do not know
when actual conception was, but most do know when their last period began. Conception can
only occur during ovulation, which happens about the middle of the month between menstrual
periods. The ripened egg, propelled by tiny finger-like projections, travels to the fallopian tube,
which is where it needs to be if it is to be fertilized. If sexual intercourse happens during this
time, the perfect time, the egg can be fertilized. Out of the millions of microscopic sperm the
man deposits into the woman, only one of the tiny tadpole-like creatures is needed. Only one
sperm in ten finds its way into the cervix, one or two thousand make it into the fallopian tube
(about an hour after the race began), and only a few hundred make it to the egg. All will try to

31
break through the membrane surrounding the egg and the first one to do so is the winner. After
that one sperm breaks through, the membrane toughens up so no others can come in, too.

The sperm, which has half of the DNA required to make a human being (the egg has the
other half), will eventually slough off its tail and fertilization is complete. After that, the egg
divides into two cells, then four, then eight, and by the end of the process there will be billions -
the newborn baby.

At this point the body must make a home for the little one. The egg, which has become a
ball of cells, moves down the fallopian tube until it reaches the uterus. In a process called
implantation, the egg attaches itself to the uterine lining. The cells on the outside of the little ball
of cells will become the placenta. The cells inside will become the baby. A week after
implantation the level of progesterone, a hormone, dramatically increased in the woman's body.
This is to tell the body there will be no more menstruations, at least not until the baby is born.
(Pregnancy tests detect this hormone). After this the period is missed, the woman realizes
something is amiss - BINGO! she's pregnant.

The Second Month

The egg, or ball of cells, is now officially an embryo. It is only one-tenth of an inch long
and its cells are in three distinct layers. The outer layer forms complex structures such as the
brain and nerves and simple things such as hair and tooth enamel. The middle layer will turn into
bones, muscles, blood vessels, and the heart, as well as part of the lungs. The inner layer forms
the liver, intestines, urinary tract, and the other part of the lungs. A tuck forms at each end of the
embryo: one will be the head and the other will be the one that wears the diapers.

Around the time the embryo is six weeks old, tiny bumps are forming that will be the
arms and legs and vital organs like the stomach and lungs find their places. The two parts of the
heart, which had developed separately, fuse then begin to beat. Also during this time the
umbilical cord is forming, which is attached to the uterus at one end and the baby's navel at the
other end. This is the lifeline that provides the baby with nourishment.

32
 By the end of the second month the embryo starts to look more human. The eyes stem out
from the brain and place themselves on the face and the baby's webbed hands begin to separate
to form fingers. With the eyes still on either side of the head and not in front, though, the little
tyke still looks like an alien from The X-Files, though.

The Third Month

Even though minute, immature, and not all fully functioning yet, all of the major internal
organs are present at the beginning of the third month, or at the end of the first trimester. By the
middle of the month testes have formed in boys and the ovaries in girls. However, the external
sex organs are still indistinct; it is still not possible, even with the best ultrasound to determine
the sex yet.

When the age of the embryo hits nine weeks, it is no longer considered an embryo. In this
landmark week, it is officially a fetus. The fetal umbilical cord is fully formed at this point and
contains two large blood vessels: one huge artery and one huge vein. The cord is very stiff,
tightly filled with blood: this is to avoid any kinks from forming; such an event could be fatal to
the little one.

At this stage of development, eyelids form over the eyes. After this happens the eyes will remain
closed during most of the remainder of gestation. Despite this, after all is said and done, at the
end of this month the fetus most definitely looks human.
The Fourth Month

The pregnancy really begins to show during this month. It is now very difficult to hide it. This is
the time period a lot of couples wait for to tell others the wonderful news, because the chances of
miscarriage at this point on are slim.

During this month fingernails begin to form on the newly-shaped fingers, the gallbladder begins
to make bile, and the baby makes its very own blood with its own bone marrow. By the middle
of this month the external sex organs become distinctly male or female. All types of hair begin to
form, including hair on the head, eyelashes, eyebrows, and a fine downy hair that covers the

33
entire body called lanugo. This unique hair grows all over the body in swirly patterns and
disappears shortly after birth.

Four to six ounces of amniotic fluid surrounds the fetus at this point, which allows for an
amniocentesis to be taken. This fluid is mostly fetal urine and most of it is removed when the
baby swallows it. Yes, that does sound gross, that you drink your own pee when you're a fetus,
but don't worry, it doesn't do a bit of harm. The fluid is completely replaced every day.

Growth this month is rapid; the fetus, 5 inches long at this point, is just big enough to cradle in
the palm of your hand.

The Fifth Month

It's Quickening time! That's right: quickening refers to the first time the mother feels the baby
move inside of her. At this point all doubt about what is happening in there is quelched. If all
goes well, this baby's coming! The muscles and limbs, which are much stronger this month than
the last, give the baby the ability to move around to explore this little world it's in, as well as
push and kick at things. If the baby's thumb gets close enough to its face, it grabs it and begins
sucking on it. This instinct is for when, after birth, it is ready to breastfeed.

Lots of important stuff goes on in the brain during the fifth month. The number of nerve cells in
the front of the brain, the thinking section, grows rapidly. The sounds of the mother's stomach
rumbling or blood in her vessels gushing are constant noises for the little one that can both sooth
and annoy it.

Inside the intestines the baby's first stool, called meconium, forms. And, believe it or not, if the
baby is a girl she begins to develop her own eggs, which, decades later, will possibly begin this
life cycle again. The skin of the baby gets covered up by a fatty, yellowish substance called
vernix, which is produced by the same annoying glands that will give it pimples when it is an
adolescent. The lanugo will hold the vernix in place, which protects the baby's skin from
constant exposure to the amniotic fluid. By the end of this month most babies are about 7 inches
long and will weigh 10 to 12 ounces.

34
The Sixth Month

It is during this month that bones harden, growth and weight gain are rapid, and others can feel
the baby move. It's getting crowded in there for the baby at this point and when it pushes out you
can usually tell if it is a hand or a foot trying to break free of the womb. Also, its hearing
becomes good enough to where loud noises outside of the mother's body can startle it.

The only other significant thing this month is, even though the baby will not need to use them
until the moment of birth, the lungs become fully-formed and ready to breathe.

The Seventh Month

Things get even more cramped this month as the baby continues to grow. It goes into the typical
fetal position with its legs bent into its chest. The baby is very active during this month; indeed,
as the mother lies in bed at night, she might actually see her whole stomach change shape as her
baby shifts its position.

During this month the eyelids, which formed in the second month, begin to open, awakening the
baby's sense of sight! Now it can see as well as it can hear. The brain is also rapidly growing,
becoming folded and wrinkled; each section is assigned its duty, like controlling speech or
recording memories. If the baby is a boy, the testicles, which had formed in the abdomen, will
begin to move down to the scrotum.

At the end of this month, the baby will weight about 3 pounds and is roughly 11 inches long.

The Eighth Month

The baby needs some cardboard boxes at this point, because it's preparing to pack up and move
out! And if it is born during this month, it has a pretty good shot at surviving.

35
The baby gets lots of antibodies from the mother's immune system this month to protect it from a
plethora of diseases that could infect it after birth. But this is only a temporary immunity which
goes away after birth. However, the length of this immunity can be extended by breastfeeding.
Also, even though it cannot breathe on its own yet, it will hiccup.

It is important at this point to dispel an old wives' tale that purports that babies born in the eighth
month are more likely to survive than babies born in the ninth month. This is absolutely not true.
So don't believe it, no matter how much your mother insists it is. The closer to the due date the
little one is born, the better.

The Ninth Month

"Let me outta here!"

Growth finally begins to slow as the baby is ready to get out. The lanugo is almost all gone and
most of the vernix has been shed as well. The lanugo remains in grooves like the back of the
knees and groin. The baby moves into a position he or she will take during delivery. This is
commonly where the head is down, facing the mother's back. When the head slips down into the
mother's pelvis - an event called lightening - the mother will notice that she can breathe a lot
easier. But the bad news is after this happens it becomes much more difficult to sit or walk.

As if that isn't enough, movement increases exponentially: the baby is kicking so much you'd
think he was trying out for a soccer team! But don't worry, it'll be out soon. Even though what
exactly triggers labor is still a mystery, it will eventually happen.

One suspect trigger of labor, though, seems to be stretching of the uterus. Another theory is that
the levels of progesterone, the hormone that has supported the pregnancy all this time, declines,
which allows the womb to finally serve its nine-month guest an eviction notice.

36
 Fetal Development From conception to birth

Day 6: embryo begins implantation in the uterus.

Day 22: heart begins to beat with the child's own blood, often a different type than the mothers'.

Week 3: By the end of third week the child's backbone spinal column and nervous system are
forming. The liver, kidneys and intestines begin to take shape.

Week 4: By the end of week four the child is ten thousand times larger than the fertilized egg.

Week 5: Eyes, legs, and hands begin to develop.

Week 6: Brain waves are detectable; mouth and lips are present; fingernails are forming.

Week 7: Eyelids, and toes form, nose distinct. The baby is kicking and swimming.

Week 8: Every organ is in place, bones begin to replace cartilage, and fingerprints begin to
form. By the 8th week the baby can begin to hear.

Weeks 9 and 10: Teeth begin to form, fingernails develop. The baby can turn his head, and
frown. The baby can hiccup.

Weeks 10 and 11: The baby can "breathe" amniotic fluid and urinate. Week 11 the baby can
grasp objects placed in its hand; all organ systems are functioning. The baby has a skeletal
structure, nerves, and circulation.

Week 12: The baby has all of the parts necessary to experience pain, including nerves, spinal
cord, and thalamus. Vocal cords are complete. The baby can suck its thumb.

Week 14: At this age, the heart pumps several quarts of blood through the body every day.

37
Week 15: The baby has an adult's taste buds.

Month 4: Bone Marrow is now beginning to form. The heart is pumping 25 quarts of blood a
day. By the end of month 4 the baby will be 8-10 inches in length and will weigh up to half a
pound.
Week 17: The baby can have dream (REM) sleep.

Week 19: Babies can routinely be saved at 21 to 22 weeks after fertilization, and sometimes
they can be saved even younger.

Week 20: The earliest stage at which Partial birth abortions are performed. At 20 weeks the
baby recognizes its' mothers voice.

Months 5 and 6: The baby practices breathing by inhaling amniotic fluid into its developing
lungs. The baby will grasp at the umbilical cord when it feels it. Most mothers feel an increase
in movement, kicking, and hiccups from the baby. Oil and sweat glands are now functioning.
The baby is now twelve inches long or more, and weighs up to one and a half pounds.

Months 7 through 9: Eye teeth are present. The baby opens and closes his eyes. The baby is
using four of the five senses (vision, hearing, taste, and touch.) He knows the difference between
waking and sleeping, and can relate to the moods of the mother. The baby's skin begins to
thicken, and a layer of fat is produced and stored beneath the skin. Antibodies are built up, and
the baby's heart begins to pump 300 gallons of blood per day. Approximately one week before
the birth the baby stops growing, and "drops" usually head down into the pelvic cavity.

38
 Etiology

Predisposing & Remarks Rationale Justification

Precipitating
Factors
Women older than 30 years This is not applicable
Age are prone more likely to have to
placenta previa than women our patient since her

x younger than 20 years age

is 28 years old.
Having a family member or One of them does have
Family history of relative who had experienced hypertension ( father).
Hypertension is a risk factor for having

/ placenta previa.

Importance of race is fairly Since our patient is a

debatable. several studies Filipino Asian woman
Race propose an increased risk of so this factor is

/ placenta
African
previa
Americans
among considered
and contributory to her
to be

Asians, whereas ther studies condition.

mention no discrepancy.
Only pregnant women can Our patient is a women
Gender / experience this condition. and she can have the
risk
of having placenta
previa
Women who have large number of closely
had previous x spaced pregnancies are at
pregnancies higher risk.

39
Maternal Smoking also increases the The patient stated that
Smoking
/ risk
which
for placenta
occurs when
previa, she smokes but not all
the the time when she is
placenta blocks the birth not in labor yet.
canal, because the carbon
monoxide exposure
decreases oxygen flow to the
fetus and enlarges the
placenta.

Male Fetus Male fetus have hormones This is applicable to

/ that is not the same or the patient since with
compatible with female her is a male fetus.
hormones.

40
PATHOPYSIOLOGY OF PLACENTA PREVIA
Predisposing Factors: Precipiating Factors:
-Age -Male Fetus
-Gender -Maternal Smikong
-Family History of Hypertension -Multipara women
-Race

Increase Progesterone and Estrogen Level

Preembryonic Stage

Implantation of uterus

Embryonic Stage

Placenta arise from the opobalst tissue

Insuffiecient Blood

Palcenta migrates to where there is suffiecient blood supply

41
Plaventa resides on the lower uterine segment

Total Placenta Pelvis Low-Lying Placenta

Previa

Partial Placenta Marginal Placenta

Placenta covers the

the placenta encroaches the

Lower segment of the uterus

top of the cervix
but does not infage on the

cervical os
Placenta partially Placenta touches, but does
covers the top of the cervix
not cover the top of the cervix

Bright Red Bleeding Painless Vaginal BLeeding

42
 If treated and manage:
If NOT Treated and manage:
1. Frequent Check-ups
2. Medical Assistance
Hypotension
3. Avoidance of Sexual Intercourse and
Vaginal Examinations

Hypovolemic Shock

If treated, there will

Good Prognosis be a good maternal
VS and the fetus
Will be deivered
Without any
compliactions Birth Defects:
-Premature Delivery
-Anemia
-Infection
-FDIU
-Abnormal Placenta Attachments

43
44
 DOCTOR’S ORDER

DATE ORDER RATIONALE REMARKS

06-20-10 2. Please admit 2. For legal purposes DONE
8:15am
2. NPO • To prevent aspiration DONE
during the procedure.

• Vsq4 • To have baseline data.

DONE

• Labs : *Laboratory test help DONE

determine clients general

health status.

− CBC * CBC identifies the total DONE

number of white blood

cell and red blood cell,
the platelet count, and
hemoglobin and
hematocrit.

* UA a test to detect DONE

− UA
semi-quantitatively
measures various
compounds that are
eliminated in the urine.

* HBsAg is a test to DONE

− HbsAg
examine if patient is
immune from acquiring
hepatitis B.
 * BT is a test to
− BT determine if what ABO DONE
blood group and Rh
factor status the patient belong.

* IV administration is
performed to replace fluids, DONE
• Start IVF with D5lR administer medications and to
1L @ 120cc/hr provide water and electrolyte.

* Signed consent ensures that

the patient is properly informed DONE

• Secure Consent regarding the process, risks,

and possible complications of
the procedures and is not
forced to coerce to undergo the
said procedures.

* Inform OR and the DONE

• Inform OR anesthesiologist for the

(PROD/AROD) patient’s schedule of

operation.

* Cefazolin an antiinfective. DONE

Cefazolin 1g IVTT q 8º Treats skin skin structue

infection.

• Refer • For co-management DONE

06-20-10
1:15 pm * To secure 1 unit of PRBC of * To restore/increase DONE
patient’s blood type for on use. circulating blood volume
after childbirth.

POST OP ORDERS

• To PACU then to OB * For close monitoring of DONE

ward the recovery.

• NPO • The client is not DONE

allowed to take any
food until she can
flatus.

• VSq15 until stable then * Monitor closely of the DONE

q hourly patient’s condition

• IVF with D5LR * This intravenous fluid DONE

1L+10units oxytocin helps in supplying potassium

@ 120cc/hr and calcium to provide
adequate fluids and electrolytes
for maintenance of body
function. It also has
oxytocin to promote uterine
contractions and to reduce post
partum bleeding..
 • Meds:

- Tramadol 50 mg q 6 hours • Tramadol for

slow IVTT management of pain. DONE

− Ketorolac 30 mg q 8 • Ketorolac is an
hours IVTT analgesic, and it is a DONE
short-term management
of pain

− Ranitidine 50 mg q 8 • Ranitidine decreases

hours IVTT gastric acid secretion. DONE

• continue meds *For treatment

DONE

• Keep patient warm • To provide a good

environment for DONE
06-21-10 recovery.
7:00 am

• I & O monitoring q *Measurement of a patient's

hourly then q shift fluid intake and output will DONE
identify those patients at risk of
becoming dehydrated or
over hydrated.

• Watch out for * For closely monitoring

the patient’s condition.
 unusualites DONE

* It is ordered for easy

• General liquids and tolerance and digestion
crackers, soft diet as client’s peristaltic DONE
once with flatus movement is still slow.

* Monitor closely of the

• Vsq4 patient’s condition

* Consume and discontinue DONE

• C/D IVF and IVTT IVF and IVTT medication to

meds shift and continue medication
orally. DONE

• Meds:

− Cefadroxil 50 g 1 cup • Cefadroxil is the

BID treatment for skin and

skin structure infection. DONE

− FesO4 1 cup OD • Ferrous sulfate is used

to treat iron deficiency
anemia DONE
06-21-10 • M. Maleate directly
11:00 am − M. Maleate 1 tab TID stimulates unterine and
vascular smooth
muscle. DONE

• Diclofenac is a
− Diclofenac K+ 50 g 1 nonopoid analgesics,
tab TID that suppress pain and
inflammation. DONE

* Enhances circulation and

• Encourage ambulation return of normal
organ function DONE

06-23-10 * Soft diet as ordered for

• Soft diet, DAT once easy tolerance and digestion as DONE

with +BM client’s peristaltic movement is
still slow.

• Monitor closely of the

patient’s condition DONE
• Vsq4º

• This is to prevent
infection. DONE
• For wound dressing

* To assess patient for

DONE
• Remove foley catheter, urinary function
should void 4-6º
*This is for treatment and

• Continue PO meds continuity of care

 DONE

* The client May Go Home,

she is ready to stay at home but
• MGH should recommend continuing
the compliance of her
medication DONE

• Take home meds:

• Cefadroxil is the
treatment for skin and

− Cefadroxil 500mg 1cp skin structure infection.

BID
• Ferrous sulfate is used DONE
to treat iron deficiency
− FeO4 1g OD anemia (a lack of red
blood cells caused by
having too little iron in the DONE
body).
• To monitor client’s
progress and response
• Follow-up @ OPD on to the treatment and to
July 10, 2010 check if there are any
deviations in her health
 DIAGNOSTIC AND LABORATORY EXAMS

A. URINALYSIS

The urinalysis is used as a screening and/or diagnostic tool because it can help detect substances or cellular material in the
urine associated with different metabolic and k.idney disorders It is ordered widely and routinely to detect any abnormalities that
require follow up. The urinalysis is a set of screening tests that can provide a general overview of a person's health. Your doctor must
correlate the urinalysis results with your symptoms and clinical findings and search for the causes of abnormal findings with other
targeted tests, such as a CBC to look for urinary tract infection.

53
DATE ACTUAL NORMAL IMPLICATION RATIONALE NURSING
TEST
VALUES VALUES RESPONSIBILITIES
PHYSICAL EXAMINATION
M
A - To examine 1. Tell the patient
Y COLOR Yellow Clear straw to Liver problems the patient’s that the test is for
colored liquid or jaundice might urine for sign the detection or
1 have occur. of renal or renal and urinary
7 urinary tract tract disorders
disease. and assessment
2 of body function.
0 APPEARANCE Straw Clear to slightly Normal - To help discover
1 hazy diseases 2. Notify the
0 that is not in patient that the
relation with procedure
renal requires a urine
disorders. sample. Urine
must be acquired
REACTION 6.8 4.6-8 Normal most likely on the first void
in the
morning.
SPECIFIC 1.030 1.005-1.025 To demonstrate - To identify
GRAVITY the concentrating drugs or 3. Notify the
and diluting substances laboratory and
ability of the that has physician of any
kidneys. been taken. drugs that the
patient has taken
54
CHEMICAL EXAMINATION that may affect
the results.
 B. BLOOD TYPING

A blood type (also called a blood group) is a classification of blood based on the presence or absence of inherited antigenic
substances on the surface of red blood cells (RBCs).

Many pregnant women carry a fetus with a different blood type from their own, and the mother can form antibodies against
fetal RBCs. Sometimes these maternal antibodies are IgG, a small immunoglobulin, which can cross the placenta and cause hemolysis
of fetal RBCs, which in turn can lead to hemolytic disease of the newborn, an illness of low fetal blood count which can be temporary
or treatable, but can occasionally be severe.

DATE TEST ACTUAL NORMAL IMPLICATION RATIONALE NURSING

VALUES VALUES RESPONSIBILITIES
Blood Type A (+) In forward typing, None known - To check 1. Inform the
J (ABO+Rh) if compatibility patient that the
U there’s of the donor test determines
N agglutination and the her blood group.
E patient’s RBC’s patient before
are transfusion. 2. Notify the
0 mixed with anti-A patient that the
2 and test blood
anti-B serum, the sample thus
2 A venipuncture is

55
0 and B antigen is done.
1 present, thus
0 blood 3. Check the
type is O. patient’s history
for recent
administration of
blood, dextran or
I.V.

4. After the
procedure apply
direct pressure
to the
venipuncture to
the site until
bleeding stops.

56
 1.) COMPLETE BLOOD COUNT

A complete blood count (CBC) is a series of tests used to evaluate the composition and concentration of the cellular
components of blood. It consists of the following tests: red blood cell (RBC) count, white blood cell (WBC) count, and platelet count ;
measurement of hemoglobin and mean red cell volume; classification of white blood cells WBC inferential ; and calculation of
hematocrit and RBC indices.

The CBC provides valuable information about the blood and to some extent the bone marrow. which is the blood-forming
tissue. The CBC is used for the following purposes:

3. as a preoperative test to ensure both adequate oxygen carrying capacity and hemostasis
4. to identify persons who may have an infection
5. to diagnose anemia
6. to identify acute and chronic illness, bleeding tendencies, and white blood cell disorders such as leukemia

57
7. to monitor treatment for anemia and other blood diseases
8. to determine the effects of chemotheraphy and radiation therapy on blood cell production

58
DATE TEST ACTUAL NORMAL IMPLICATION RATIONALE NURSING
VALUES VALUES RESPONSIBILITIES
WBC H23.13 5-10 Leukemia, - To verify 1. Explain to the
J x10^3/uL bacterial infection or patient the necessity
U infection, severe inflammation in of undergoing the
N sepsis. the body and test that it helps
E observe its detect occurrence of
responses to anemia and
0 specific polycythemia.
2 therapies.

2
0
1 Hemoglobin L71 135-175 Normal - To recognize 2. Notify the patient
0 g/L Low HCT, the amount of that the test requires
suggest anemia, O2 carrying blood sample as well
hemodilution or protein as the person who
enormous blood contained within will perform the
loss. the RBC. venipuncture and the
time.
Hematocrit L0.22 0.36-0.48 Rule out anemia - To identify the
due to nutritional percentage of the 3. Inform the patient
deficiencies, blood that the procedure is
blood loss. volume of slight discomfort
occupied by red and may feel a little
blood cells.

59
RBC L2.60 4.20-6.10 Low RBC is due - To know the
x10^6/ uL to enormous amount of RBC
 2.) ULTRASOUND

Ultrasound
Ultrasound is a commonly used procedure that uses sound waves to produce an image. These sound waves pass
through the woman’s abdomen and reflect off the maternal and fetal structures to form a picture on a monitor.
Ultrasound during pregnancy may be used for the following:
· Early in pregnancy (six to twelve weeks) to confirm a heart beat, identify twins or triplets, or help predict the due date
· Detailed ultrasound after eighteen weeks, to see if the baby is growing and developing as it should, and to help make a
diagnosis when a fetal abnormality is found
· To locate the fetus and placenta during amniocentesis, which increases the safety of that procedure
· Along with fetal heart monitoring, when a pregnancy has gone beyond the due date, to check on

60
61
DATE TESTS RESULTS IMPRESSION RATIONALE NURSING
RESPONSIBILITIES
U -Presentation : Cephalic Single, live - To know fetal 1. Assure a consent form
M L -Number: single intrauterine and signed by the patient. Explain that
A T - Amniotic fluid: AFI 11.1 cm pregnancy, pregnancy the procedure
Y R -Placental location: anterior cephalic presentation, abnormalities and is painless an safe and that no
A -Placental grade: III with measurement radiation exposure is
2 S -Sex: male good cardiac and of organ size involved.
6 O -AOG: 36W 1D somatic activities; and structure.
U -FHB: 147bpm BPD= 36 weeks To identify and 2. Emphasize the
2 N Estimated Fetal Weight: 2323 and 1day; differentiate importance of
0 D g cyst and solid remaining still
1 -Normohydramnios (11.1 cm) Placenta anterior, tumor. during the scan to
0 -Amniotic fluid volume: early grade III, prevent distorted
normal totally covering - To ensure image.
10:21 -Previa: placenta previa totalis the OS (Placenta the
AM previa totalis) presentation 3. Assist the
and identify patient into a supine position; if
complications possible use pillows to support
of the fetus. the area to be examined. Coat the
To detect if target area with a water soluble
there is risk of jelly. If necessary to
pregnancy. assist the patient into lateral
positions for consequent view.

62
63
 Drug Study

Generic Name Diclofenac K

Brand Name Cataflam

Classification Anti-inflammatory
NSAID
Dosage 50g TID
Mode of Action .inhibits prostaglandin synthetase to cause antipyretic and anti-inflammatory
effects; the exact mechanism is unknown.
Indication • Acute or long-term treatment of mild to moderate pain.
Contraindication • Contraindicated with allergy to NSAIDs, significant renal
impairment, pregnancy, lactation.
• Use cautiously with impaired hearing, allergies, hepatic, CV, GI
conditions.
Drug Interaction • Increased serum levels and increased risk of lithium toxicity.
• Increased risk of bleeding with anticoagulants, monitor patient
closely.
Side / Adverse • CNS: headache, dizziness, somnolence, insomnia, fatigue, tiredness,
Effects tinnitus, ophthalmic effects
• Dermatologic: rash, pruritus, sweating, dry mucous membranes,
stomatitis
• GI: nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation,
flatulence
• GU: dysuria, renal impairment
• Hematologic: bleeding, platelet inhibition with hig her doses
• Other: peripheral edema, anaphylactoid reactions to fatal
anaphylactic shock
Nursing • Assess patient’s history of renal impairment, impaired hearing, CV
Responsibilities and GI conditions.
• Assess patient’s affect, orientation, and reflexes.

64
 • Administer drug with food or after meals if GI upset occurs.
• Institute emergency procedures if overdose occurs (gastric lavage,
induction of emesis).
• Instruct patient to take only the prescribed dosage.
• Instruct patient to report sore throat, rash, itching, weight gain,
swelling in ankles or fingers, changes in vision.
7. Monitor patient’s blood pressure, pulse rate, respiratory rate and
temperature.
8. Be watchful for occurrences of adverse effects.
9. Check for any drug interactions that causes interference to the effect
of the drug.
10. Stop drug immediately if anaphylaxis occurs.

Generic Name Ferrous sulfate

Brand Name Feosol, Fer-gen-sol, Fer-in-sol

Classification Iron preparation
Iron supplement
Dosage 1 cap OD
1 tab OD
Mode of Action Elevates the serum iron concentration, which then helps to form Hgb or
trapped in the reticuloendothelial cells for storage and eventual conversion to
a usable form of iron.
Indication • Prevention and treatment of iron deficiency anemia.
• Dietary supplement for iron.
Contraindication • Contraindicated with allergy to any ingredient; sulfite allergy;
hemochromatosis, hemosiderosis, hemolytic anemias.
• Use cautiously with normal iron balance; peptic ulcer, regional
enteritis, ulcerative colitis.
Drug Interaction • Decreased anti-infective response to ciprofloxacin, norfloxacin,

65
 ofloxacin.
• Decreased absorption with antacids, cimetidine.
• Decreased effects of levodopa if taken with iron.
• Increased serumlevels with chloramphenicol.
Side / Adverse • CNS: CNS toxicity, acidosis, coma and death with overdose
Effects • GI: GI upset, anorexia, nausea, vomiting, constipation, diarrhea, dark
stools, temporary staining of the teeth (liquid preparations)
Nursing • Assess patient’s history of allergy to any ingredient, sulfite; normal
Responsibilities iron balance.
• Assess patient’s skin lesions, color; gums, teeth (color); iron levels.
• Confirm that patient does have iron deficiency anemia before
treatment.
• Give drug with meals (avoiding milk, eggs, coffee and tea) if GI
discomfort is severe, and slowly increase to build up tolerance.
• Administer liquid preparations in water or juice to mask the taste and
prevent staining of teeth; have patient drink solution with a straw.
• Warn patient that stool may be dark green.
7. Monitor patient’s blood pressure, pulse rate, respiratory rate and
temperature.
8. Be watchful for occurrences of adverse effects.
9. Instruct patient to report severe GI upset, lethargy, rapid respirations,
and constipation.
10. Check for any drug interactions that causes interference to the effect
of the drug.
11. Stop drug immediately if anaphylaxis occurs

Generic Name Ketorolac

Brand Name Toradol

66
Classification Analgesic

Dosage 30 mg IVTT q6

Mode of Action Inhibits prostaglandin synthesis by decreasing an enzyme needed for

biosynthesis

Indication Short-term management of pain (not to exceed 5 days total for all routes
combined)

Contraindication Hypersensitivity; cross-sensitivity with other NSAIDs may exist; labor,

delivery or lactation; pre- or perioperative use; known alcohol intolerance

Drug Interaction 3. concurrent use with aspirin may decrease effectiveness

4. additive adverse GI effects with aspirin, other NSAIDs, potassium
supplements, corticosteroids or alcohol
5. chronic use with acetaminophen may increase the risk of adverse
renal reactions
6. may decrease the effectiveness of diuretics or hypertensive
7. may increase serum lithium levels and increase the risk of toxicity.
8. increased risk if bleeding with cefamandole, cefoten cefoperazone,
valproic acid, plicamycin, thrombolytic agents or anticoagulants
9. may increase the risk of nephrotoxicity from cyclosporine.
Side / Adverse −CV: hypertension, flushing, syncope, pallor, edema, vasodilation
Effects −CNS: dizziness, drowsiness, tremors
−EENT: tinnitus, blurred vision. Hearing loss
−GI: nausea, anorexia, vomiting, diarrhea, constipation, flatulence,
cramps
−GU: Nephrotoxicity: dysuria, hematuria, oliguria, azotemia
−HEMA: blood dyscrasias, prolonged bleeding
−INTEG: pupura, rash, pruritus, sweating

Nursing −Obtain patient’s vital signs to note for signs of hypertension.

Responsibilities −Assess for patient’s hypersensitivity reactions especially those who

67
 have asthma, aspirin-induced allergy.
−For patient’s experiencing pain, note the type, location and intensity
of pain prior to 1-2 hr following administration.
−Instruct patient to make medication exactly as directed. If dose is
missed, it should be taken as soon as remembered if not almost time
for next dose.
−Advice patient to call for assistance when ambulating and to avoid
driving or ithe activitiues requiring alertness until response to the
medication is known
−Tell patient to report any side effects
−Document after giving the drug and evaluate

Generic Name tramadol hydrochloride

Brand Name Ultram®

Classification Analgesic
Dosage 25mg slow IVTT q 6˚
Mode of Action Binds to mu-opioid receptors and inhibits the reuptake of norepinephrine and
serotonin; causes many effects similar to the opioids – dizziness, somnolence,
nausea, constipation – but does not have the respiratory depressant effects.
Indication 9. Relief of moderate to
moderately severe pain
Contraindication 10. Allergy to tramadol or

68
 opioids or acute intoxicatin with alcohol, opioids, or
psychoactive drugs.
Drug Interaction 11. Decreased effectiveness
with carbamazepine.
12. Increased risk of toxicity
with MAOIs
Side / Adverse 13. CNS: sedation, dizziness,
Effects vertigo, headache, cofusion, sweting, anxiety, seizures
14. CV: hypotension,
tachycardia, bradycardia
15. Dermatologic: sweating,
pruritus, rash, pallor
16. GI: nausea, vomiting, dry
mouth, constipation, flatulence
17. Other: potential for abuse,
anaphylactic reaction
Nursing − Assess patient’s history of hypersensitivity to tramadol, acute
Responsibilities intoxication with alcohol, opioids, or other centrally acting
analgesics; renal or hepatic impairment, past or present history of
opioid addiction.
− Assess patient’s skin color, texture and lesions, orientation, reflexes,
bilateral grip strengths, affect.
− Control environment (temperature, lighting) if sweating or CNS
effects occur.
− Limit use in patients with past or present history of addiction to or
dependence to opioids.
− Instruct patient to report severe nausea, dizziness.
− Monitor patient’s blood pressure, pulse rate, respiratory rate and
temperature.
− Establish safety precautions if CNS changes occur (use side rails,
accompany ambulatory patient).

− Be watchful for occurrences of adverse effects.

− Check for any drug interactions that causes interference to the effect
of the drug.

69
 − Stop drug immediately if anaphylaxis occurs.

Generic Name oxytocin

Brand Name
Classification Exogenous Agent

Dosage I.V.: 10-40 units by I.V. infusion in 1000 mL of intravenous fluid at a rate
sufficient to control uterine atony
Mode of Action Oxytocin
↓
Causes potent and
selective
stimulation of

70
 uterine and
mammary gland
smooth muscles
↓
producing sustained
contractions
↓
Induces labor and
milk ejection and
reduces post partum
bleeding
Indication 18. Induction of labor at term;
control of postpartum
bleeding; adjunctive therapy in management of abortion
Contraindication − Contraindicated in patients hypersensitive to the drug or any of its
component.
− Also contraindicated in cephalopelvicdisproportion or delivery
that requires conversion, as in tranverse lie; in fetal distress when
delivery isn’t imminent; in prematurity and in severe toxemia,
hypertonic uterine patterns, total placenta previa or vasa previa.

− Also contraindicated in fetal distress.

Drug Interaction
Side / Adverse • Cardiovascular: hypertension; increased heart rate, systemic venous
Effects return, and cardiac output, and arrhytmias
• CNS: seizures, coma from water intoxication
• Gastrointestinal: Nausea, vomiting,
• GU: titanic uterine contractions, abruption placentae, impaired uterine
blood flow, pelvic hematoma
• Hematologic: afibrinogenemia
• Respiratory: anoxia, asphyxia

71
Nursing • Monitor and record uterine contractions, heart rate, BP, intrauterine
Responsibilities pressure, fetal heart rate, and blood loss q15.
• Be alert for adverse reaction
• Monitor I/O. Antidiuretic effect may lead to fluid overload, seizures,
and coma
• Never give oxytocin simultaneously by more than one route.
• Have 20% solution magnesium sulfate available for relaxation of the
myometrium.

• If contractions are less than 2 minutes apart, if they’re above 50mm

Hg ,or if they last 90seconds or longer, stop infusion, and turn patient
on her side, and notify prescriber

Generic Name cefazolin

Brand Name Ancef

Classification Anti-infectives
Dosage 250 mg
Mode of Action • Bind to bacterial cell wall membrane, causing cell death.

• Active against many gram-positive cocci including: Streptococcus

pneumoniae, Group A beta-hemolytic streptococci; Penicillinas-
producing staphylococci.
Indication 19. Treatment:
Skin & skin structure infections; pneumonia; urinary tract

72
 infections; bone & joint infections
Contraindication 20. Contraindicated in:

- Hypersensitivity to cephalosphorins. Serious hypersensitivity to

penicillin.

21. Use Cautiously in:

- Renal impairment
- History of GI disease, especially colitis
- Geriatric patients (consider age-related decrease in body mass,
renal/hepatic/ cardiac function, concurrent medications and chronic
disease states)
- Pregnancy or Lactation

Drug Interaction 22. Probenecid increases the

blood level of Cefazolin.
23. Concurrent use of diuretic
with Cefazolin may increase the nephrotoxicity.
Side / Adverse • CNS: Seizures (high doses)
Effects
• GI: Pseudomembranous colitis, diarrhea, nausea, vomiting, cramps

• GU: Interstitial nephritis

• DERM: Rashes, urticaria

• HEMAT: Blood dyscrasias, hemolytic anemia

• LOCAL: Pain at IM site, phlebitis at IV site

• MISC: Allergic reactions including Anaphylaxis and Serum

sickness, superinfection

73
Nursing 3. Assess patient for infection (vital signs;
Responsibilities appearance of surgical site, urine; WBC) at beginning and during
therapy.
4. Before initiating therapy, obtain a history
to determine previous use of and reactions to penicillins or
cephalosphorins. Persons with a negative history of penicillin
sensitivity may still have an allergic response.
5. Obtain specimens for culture and
sensitivity before initiating therapy.
6. Observe patient for signs and symptoms
of anaphylaxis (rash, pruritis, laryngeal edema, wheezing).
Discontinue drug and notify physician or other health care
professional immediately if these problems occur. Keep epinephrine,
an antihistamine, and resuscitation equipment close by in case of
anaphylactic reaction.
7. Monitor site for thrombophlebitis (pain,
redness, swelling). Change sites every 48-72 hr to prevent phlebitis.
8. Instruct patient to report signs of
superinfection (furry overgrowth on the tongue, vaginal itching or
discharge, loose or foul-smelling stools) and allergy.
9. Instruct patient to notify health care
professional if fever and diarrhea develop, especially if diarrhea
contains blood, mucus, or pus. Advise not to treat diarrhea without
consulting healthcare professional.

Generic Name: Ranitidine

74
Brand Name: Zantac
Classification: H2 Receptor antagonist
Indication: •Treatment and prevention of heartburn, acid indigestion, and sour stomach.
Dosage: 50mg IVTT q8
Mode of Action: Competitively inhibits action of histamine on the H2 at receptor sites of
parietal cells, decreasing gastric acid secretion.
Drug Interactions: Antacids, diazepam, glipizide, warfarin
Side • CNS:
Effects/Adverse Confusion, dizziness, drowsiness, hallucinations, headache
Reactions:
• CV:
Arrhythmias

• GI:
Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced
hepatitis, nausea

• GU:
Decreased sperm count, impotence

• ENDO:
Gynecomastia

• HEMAT:
Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia

• LOCAL:

75
 Pain at IM site

• MISC:
Hypersensitivity reactions, vasculitis

Contraindications: Hypersensitivity, hepatic dysfunction

Nursing • Assess patient for epigastric or abdominal pain and frank or occult blood in
Responsibilities: the stool, emesis, or gastric aspirate.
• Nurse should know that it may cause false-positive results for urine protein;
test with sulfosalicylic acid.
• Inform patient that it may cause drowsiness or dizziness.
• Inform patient that increased fluid and fiber intake may minimize
constipation.
• Advise patient to report onset of black, tarry stools; fever, sore throat;
diarrhea; dizziness; rash; confusion; or hallucinations to health car
professional promptly.
• Inform patient that medication may temporarily cause stools and tongue to
appear gray black.

76
 NURSING THEORIES

Florence Nightingale's Environmental Theory

Ventilation, warmth, quiet, diet and cleanliness are only some of the things that
Nightingale's Theory stresses. As nurses, we needed to maintain adequate ventilation, promote
adequate and appropriate nutrition, maintain normal homeostatic body temperature, and
observe basic hygiene and comfort measure, including environmental sanitation for our client's
well being. When one or more elements of this theory is out of balance this will result to an
increase in the client's energy and this energy will be used to counter the environmental stresses
that he encounters. The environmental stresses drains the client's energy that he should be using
for his healing. And nurses have the control of the patient and his environment. Except, for a few
activities that entailed choice or preference. And it is the role of the nurse to manipulate the
client's environment for the client to be able to compensate for his needs.

Our patient was admitted at the OB Ward of SPMC after her cesarean delivery of her
baby due to placenta previa. The OB ward is a very warm place because there are so many
patients in the ward and to add up that there is no proper ventilation in the area. There are wall
fans but they are not functional. Air coolers but not the patients are able to benefit from this.
There were also a few numbers of windows that could be seen. The patients' body odors have
also been contributing to the unpleasant smell in the ward. There are also cockroaches that could
be seen the area which could cause nosocomial infections to the patients. Almost all of the beds
there are untucked, soiled and some don't even have bed linens. Our role as nurses is to impart
health teachings to our clients like advising the clients to dress lightly especially their babies to
prevent hyperthermia and to also take a bath everyday as to promote cleanliness and a sense of
well being. As for our client, we advised her to do the same things like dressing lightly and to
take a bath and change clothings and linens daily. We also added to increase adequate fluid
intake and to eat foods that are rich in nutrients like vegetables, rice and meats.

77
Lydia Hall's Care, Core, Cure Theory
According to Hall's theory, nurses work in three different arenas and is visually
presented by interlocking circles and each circle represents a particular aspect of nursing. First,
the care which is using the hands on bodily care. Second, the core which is using the self in
relationship to the patient. Lastly, the cure which is applying medical knowledge. In the core
Hall says that nurturing is component of care. She also said that It is exclusive to nursing which
is also what she called as “Mothering” and it provides teaching and learning activity. The goal
of the nurses here is to “comfort” the patient so that the patient may explore and share her
feelings with the nurse so as to provide the proper care and needs that the patient needs. For
Core, patient care is based on social sciences and it is the therapeutic use of self where it helps
patient learn their role is in the healing process, for the patient to be able to maintain who they
are and for the patient to be able to make informed decisions. Cure on the other hand is care
based on pathological and therapeutic sciences. It is the professional nurses that helps patient
through the rehabilitative phase of care. Nurse is a patient advocate in this area and the nurses
roles changes from positive quality to negative quality. These three aspects function
independently but they are interrelated and the circle’s size represents the progress in each
aspect.

In our patient, the care aspect shows the relationship between the patient and the health
care provider and by doing this the patient was able to get the health teaching and the support
that she needed. Our patient was able to follow the health teachings that we imparted to her so as
to prevent complications and to promote for betterment. We were also able to establish the
rapport we needed for us to communicate freely what she feelings so as to provide the care she
needs. In the core aspect, we were able to help the patient reflect on her situation and she was
also able to make decisions on her own and through that she was able to cope up with the
situation and was able to cope up easily and that promoted better healing for her part. As for the
cure aspect, the patient was able to follow what her doctor order .

78
Dorothea Orem's Self-Care Deficit Theory
Dorothea Orem's theory is a constellation of three interrelated theories namely the
nursing systems, self-care, and self-care deficit. The main goal of this theory is to enhance the
person's ability for self-care and this also extends to the care of dependents. There are also three
systems that exist within this professional nursing practice model which are the wholly
compensatory system, partially compensatory system and lastly the educative-development
system. The wholly compensatory system is where the nurse is the one who provides total care
for the patient. Partially compensatory system is where the nurse and patient shares the
responsibility for care. On the other hand, the educative-development system is where the client
has primary responsibility for personal health, with the nurse acting as a consultant. The basic
premise of the model is that individuals can take responsibility for their health and the health of
others.

The patient was not able to perform self-care for herself especially in the aspect of
personal hygiene not only herself but also her first baby. Acute pain is also the main compalints
in the women who gave birth through cesarean section and this caused our patient immobility
and she was fearful to move because of it. We encouraged ambulation so as to faster recovery
and for her to care for herself and her baby. We encouraged her to perform daily hygiene and
assissted her in the tasks that she cannot do alone like rising in bed and transfering her from bed
to a chair.

79
80
 NURSING CARE PLAN
Date Cues: Need Nursing Diagnosis: Objective of Interventions: Evaluation:
and Care:
Time:

Subjective : H Risk for infection Within the 4 1. Establish rapport with the GOAL MET
J “CS man ko E related to hours span of patient and July 21, 2010
U sa akong A presence of care, patient significant others. 9:30 pm
L pagpaanak” L surgical incision will be able to
Y, T secondary to identify R: Establishing rapport is The patient was able to
Objective: H cesarean section. personal activities essential in identify
2 - Client is 3 - to prevent/ gaining the trust and cooperation interventions
1, days P R: reduce risk of of the patient like taking a
postpartum. E Client’s infection. which can greatly help in meeting bath to
2 R undergoing a the goals set prevent/reduce
0 - Client C surgical for the patient risk of infection
1 underwent a E procedure impairs and as
0 cesarean P the body’s normal 2. Monitor and record vital signs evidence by
section on T defense “maligo dyud
delivery for her I mechanisms; R: Monitoring the patient helps in diay dapat ko
baby O thereby, the para malimpyo
N increasing the continuity of care. Vital signs are ko,” as
- Surgical - risk of being also essential verbalized by
Midline H invaded by to determine deviations from client.
incision on the E pathogenic organisms. normal.

81
@ abdomen A Source: Sue C.
L Delaune, 3.Note client reports of weakness,
5:30 - Client is T Patricia K. fatigue, pain, difficulty
pm lacking H Ladner, accomplishing tasks and/or
personal - Fundamentals of insomnia
hygiene M Nursing, 2006
A R: Symptoms may be result of/or
- Bed linens N contribute to intolerance of
are dirty and A activity.
is wrinkled G
E 4.Ascertain ability to stand and
- Binder is M move about and degree of
worn on E assistance necessary/use of
abdomen. N equipment.
T
- R: To determine current status
P and needs associated with
A participation in needed/desired
T activities
T
E 5. Observe for localized signs of
R infection at
N insertion sites of invasive lines,
sutures,

82
surgical incisions/ wounds.

R: Assessing the client helps

determine
prioritization of care.

6. Emphasize the importance of

perineal care
and proper hygiene (e.g., wiping
from front to
back and changing soaked
perineal pads regularly).

R: These reduce the risk of

ascending
urinary tract infection.

7. Change surgical/other wound

dressings as
indicated, using proper technique
for
changing/disposing of
contaminated materials.

83
R:: Sterile technique prevents
contamination and reduces risk
for infection.

8.Plan for progressive increase of

activity level/participation in
exercise training, as tolerated by
client.

R: Both activity tolerance and

health status may improve with
progressive training.

9:Give client information that

provides evidence of daily/weekly
progressing.

R: To sustain motivation.

10. Adjust activities for patient

R: To prevent over exertion for

recovery

84
Date Cues: Need Nursing Diagnosis: Objective of Interventions: Evaluation:
and Care:
Time:

J Subjective : C Acute pain related Within the 4 1. Monitor and record vital signs GOAL MET
U “Sakit gud O to presence of hours span of July 21, 2010
L akong opera G surgical incision care, patient will R: Monitoring the patient helps in 9:30 pm
Y, pag mulihok N secondary to be able to report the continuity of care. Vital signs
gamay” I cesarean section. reduced pain as are also important to determine After the 4
2 T evidenced by the difference between the normal hours span of
1, Objective: I R: client’s and the not. care, patient
- guarding V acute pain is an verbalization. was able to
2 behavior noted E unpleasant sensory 2. Assess for appropriate referred report

85
0 - and emotional pain. reduced pain
1 - pain scale of P experience arising and
0 6 out of 10 E from actual or R: Assessment helps determine verbalized,
R potential tissue possibility of underlying organ “dili na kaayo sakit. Di
- grimaced face C damage or dysfunction requiring treatment. pareha ganiha.”
E described in terms of Decreased pain scale of 3
-facial gestures P such damage 3. Acknowledge the pain out of 10.
differ when T (international experienced and express Respiratory rate of 20
@ moving. U Association for the acceptance of client’s response to cycles per minute.
-tachypnea A Study of Pain); pain.
5:30 noted with rr of L sudden or slow
pm 21 cpm. onset of any R: Pain is a subjective experience
P intensity from mild and cannot be felt by others.
-checked A to severe with an
wound dressing T anticipated or 4. Provide comfort measures such
dry and intact. T predictable end and as back rub and
E a duration of less than changing of position
-no foul smell R 6 months.
discharges and R: to provide nonpharmacological
redness noted Source: care
in the incision Sue C. Delaune, management.
site. Patricia K.
Ladner, 5. Teach patient relaxation
-first day post- Fundamentals of techniques like deep breathing

86
partum. Nursing, 2006 exercise

R: to alleviate pain

6. Promote sufficient resting

periods particularly
when apply too much effort to an
activity

R: Adequate rest period prevent

fatigue.

6. Evaluate measures done and

inform client when
management may cause pain.

R: the client’s knowledge

regarding episode

COLLABORATIVE:
1. Administer analgesics as
prescribed by the physician.

R: to help reduce pain.

87
Date Cues: Need Nursing Diagnosis: Objective of Interventions: Evaluation:
and Care:
Time:

Subjective : A Activity Intolerance At the end of our 1. Establish rapport GOAL

J “Makalakaw C related to shift, patient will PARTIALLY
U gud ko Dok dili T generalized use identified R: Patient will gain trust and MET
L lang kayo I weakness techniques to cooperation. July 22, 2010
Y, tarong” V secondary to post enhance activity 9:30 pm
22, I cesarean section such as walking. 2. Assist patient with activities
2 Objective: T and monitor patient’s The patient was
0 - weakness Y R: use of assistive devices such able to do activities
1 when moving is - Activity intolerance as chair. like sitting in bed
0 noted. E is insufficient and walking but
X physiological or R: It will protect the patient still needs
- movements E psychological from injury. assistance when
are slow. R energy to endure or walking.
C complete required 3.Note client reports of
- frequently I or desired daily act. weakness, fatigue, pain,
@ needs S difficulty accomplishing tasks
assistance to E and/or insomnia.
5:30 balance P Source:
pm before A Sue C. Delaune, R: Symptoms may be result
Standing up. T Patricia K. of/or contribute to intolerance
T Ladner, of activity.
E Fundamentals of
R Nursing, 2006
N 4. Promote comfort measures
and provide for relief
of pain.

R: It enhances the ability of

the patient to participate
in activities.

5. Plan for progressive

increase of activity
level/participation in exercise
training, as tolerated by client.

R: Both activity tolerance and

health status may improve
with progressive training.

6.Give client information that

provides evidence of
daily/weekly progressing

R: To sustain motivation.

7.Adjust activities for patient.

R: To prevent over exertion
for recovery.

8. Plan care with rest periods

between activities.

R: Reduces fatigue

9. Provide positive
atmosphere, while
acknowledging
difficulty of the situation for
the client.

R: Help minimize frustrations.

10. Assist client in learning

and demonstrating appropriate
safety measures.

R: to prevent client from

injuries.
Date Cues: Need Nursing Diagnosis: Objective of Interventions: Evaluation:
and Care:
Time:

J Subjective: A Self-Care Within the Independent: GOAL MET

U “Wala pako C Deficit span of 4 1. Assess exact cause of deficit July 23, 2010
L kaligo sukad T related to hours of care, 9:30 pm
Y, tong I post patient will be R: Different causes may require
23, nanganak V cesarean able to safely more specific interventions to After 4 hours,
2 ko.” I Section. perform self care enable client was able
0 T activities. self-care. to perform
1 Objective: Y R: safely self-care
0 -is unable to - Impaired 2. Situate short-term goals with activities
wash body or E ability to client. within level of
body parts X carry out, own ability like
E bathing/ R: To aid learning and decrease changing of
-untidy in R hygiene, aggravation. clothes and
appearance C dressing taking a bath and
@ I and 3. Promote independence, but brushing the
 -untrimmed S intercede when patient cannot teeth.
5:30pm nails noted E grooming, perform
or toileting
-physical activities R: To drop off disappointment.
Immobility for oneself
noted (on a 4. Make use of consistent
-2 days temporary, practices
post CS permanent, of daily hygiene.
or
-Foul odor progressing R: This facilitates the client to put
noted. basis) in
order and carry out self-care skills
-breath Source:
slightly Sue C. Delaune, 5. Provide recurrent support
odorous Patricia K. and
Ladner, assistance as needed with
Fundamentals of dressing.
Nursing, 2006
R: To reduce energy outflow and
aggravation

6. Encourage patient to do own

self
care practices.
R: To develop independence
7. Instruct client to select bath
time
when rested and unhurried.

R: This helps client to organize

and
carry out self-care skills

8. Offer frequent encouragement

of
doing daily perineal care/hygiene.

R: Clients often have difficulty

seeing progress

10. Assist client in

removing/replacing necessary
clothing.

R: This helps client to organize

and carry out self-care skills.
Date and Cues: Need Nursing Diagnosis: Objectives of Interventions: Evaluation:
Time: Care:

J Subjective: E Risk for Within the Independent: GOAL MET

U -”wala pa ko L constipation related span of 4 1. Evaluate current dietary and July 23, 2010
L kalibang I to post pregnancy hours of care, fluid intake and implications for 9:30 pm
Y, sugod tong M secondary to patient will be effect on bowel function.
nanganak I cesarean section. able to: After 8º of
23, ko.” as N a) maintain usual R: to identify individual risk nursing
verbalized A R: pattern of bowel factors or needs. interventions,
2 by the T at risk for decrease functioning. the patient was
0 patient. I in normal frequency 2. Review medications. able to identify
1 O of defecation b) verbalize measures to
0 Objective: N accompanied by understanding of R: for impact on or effects of prevent infection
-absence of difficult or risk factors and changes in bowel function. as manifested by
bowel P incomplete passage appropriate client’s
sounds. A of stool and/or interventions or 3. Instruct in or encourage verbalization of:
T passage of solutions related balanced fiber and bulk in diet “muinom na ko ug
-insufficient T excessively hard, to individual (eg fruits, vegetables, and whole daghan tubig.”
@ physical E dry stool. situation. grains) and fiber (eg wheat bran).
activity. R
5:30pm N Source: c) demonstrate R: to improve consistency of
-insufficient Marilynn E. behaviors or stool and facilitate passage

94
fiber and Doenges, Nurses' lifestyle changes through colon.
fluid intake. Pocket Guide, 11th to prevent
edition developing 4. Promote adequate fluid intake,
problems. including water and high-fiber
fruit juices also suggest drinking
warm fluids.

R: to promote soft stool and

stimulate bowel activity.

5. Encourage activity or exercise

within limits of individual
activity.

R: to stimulate contractions of the

intestines.
6. However, since she has had
cesarean, also encourage
adequate rest
periods.

R: To avoid stress on the

cesarean incision or wound.

95
COLLABORATIVE:
1. Administer bulk-
forming agents or
stool softeners such
as laxatives as
indicated or
prescribed by the
physician.

R: to promote defecation.

96
97
 Discharge Plan (METHOD)

Health Outpatient
Medications Exercis Treatment Diet
Teachings Care
e

• Teach • Instruc • Discus • Encour • A − Encour

patient t client s the age the fol age the
and her to purpos patient lo patient
family refrain e of to w to
or from treatme express up increas
signific strainin nts to feeling ch ed fluid
ant g be s and ec intake
others activiti done concer k- and to
the es. and ns up include
proper • Encour continu • Teach is fruits
dosage age ed at family ne and
and the ambula home or ce vegetab
right tion as and signific ssa les rich
time to a form report ant ry in
take the of light to the others for viatami
medicat exercis health to wo n C for
ion. e to profess foster un ythe
• Empha help in ional indepe d product
size to the when ndence ev ion of
the progres there is and to alu milk
patient sion of bleedin interve ati needed
the patient g to ne if on for
importa `s alleviat the an lactatio
nce of recover e patient d n.
taking y and sympto becom ta − Taking

103
 the wound ms of es ass food
prescri healing the fatigue ess rich in
bed . patient and the protien
medicat • Range `s unable pr is also
ions of conditi to og helpful
and the motion on and perfor res for
compli . monito m task sio tissue
cations Encour r for or n repair.
that age the her becom of
may patient recover es wo
arise if to do y. excessi un
medicat some • Encour vely d
ions are exercis age frustrat he
not e patient ed. ali
taken would to have • Encour ng
properl allow a age the .
y. good sufficie client
• Inform blood nt rest to eat
and circulat and foods
discuss ion as sleep to
the well as to stimula
possibl the maintai te the
e side prevent n produc
effects ion of interna tion of
and the l milk.
reactio occurre equilib Hygiene
ns that nce of rium.
• Discus
these bed • Provid
s the
drugs sores. e a safe
signific
might • Encour d
ance of
produc age comfor

103
 e patient table person
medical to do enviro al
attentio stretchi nment hygien
n ng to becaus e and
immedi prevent e it proper
ately. stiffnes could hand
• Discour s of the maek washin
age the bone the g in
use of due to patient prevent
Over less more ing
the activity relaxed infecti
Counte perfor which ons.
r med. is also • Give
medicat • Encour needed client
ions or age to some
at least patient arrived lecture
inform to first with a s about
the t sit up good proper
physici and progno wound
an if dangle sis. care
taking feet throug
other before h
OTC standin changi
medicat g from ng the
ions. the bed dressin
This is to g as
to prevent often
prevent orthost as
any atic possibl
occurre hypote e so as
nce of nsion. to the

103
drug wound
interact from
ions. invasio
n of
microo
rganis
m as
well as
to
reduce
the risk
of
microo
rganis
ms
transmi
ssion
to
others.

103
 PROGNOSIS
Criteria Good Fair Poor Justification Rationale
Onset of / The patient immediately Time should be given
illness went to the doctor upon time as early as possible
the start of bleeding and when the manifestation
has undergone ultrasound. are being experienced
She was detected with and unusualities are
placenta previa and was being detected so as not
advice to take a lot of rest to make things
that would lessen the complicated. Through
bleeding. the help of medical
assistance and diagnostic
examinations,it would
help lot in identifying
the condition.

Duration of / The patient consulted the The patient’s

illness doctor immediately when initiative to
she had her first bleeding obey the doctor
and was advised to take a is one way or
lot of rest and to consult another a help in
the doctor again if preventing
bleeding occurs again. On further
her second time she had complications.
her bleeding, she went It would also be
back immediately to the a factor in the
doctor. progress of the
patient’s
condition.
Environment / The client`s condition is The
not conducive to their continuance of
home. They live in a clean
polluted crowed area. environment
Their place is clean but plays a role in

103
 not sanitized. the recovery of
the patient. The
environment is
a factor that
affects the
health and
illness of the
individual
Family / The patient is well The motivation of the
Support supported by her family family members to offer
from the start of her encouragement and
condition. The assistance to the sick
husband told family member is a
her to stop great help in the progress
from her work of the client`s condition.
so that she
could take a
lot of rest. Her
sister in laws
took over of
the household support.
Willingness / The patient takes her The compliance
to take medication as indicated to the treatment
medications by the doctor but in some regimen is one
instances. they cannot of the best
afford some medication. ways to have a
good
advancement in
the condition of
the client.
Precipitating / The pregnacy of the client these factors
Factors causes her to develop a are modified
placenta previa, a low the occurrence
implantation of the of the illness

103
 placenta covering the will be
cervical os. Another prevented or
factors would be the less
maternal smoking and the complication.
gender of the fetus is
male.
Predisposing / Among the The
Factors predisposing predisposing
factors factors play a
present in the critical role in
client are setting risks for
gender and the client to
race. acquire such
disease. This
factors can’t be change.
TOTAL: 4 2 1

CALCULATIONS:

Good: 3 x 4 = 12
Fair: 2 x 2 = 4
Poor: 1 x 1= 1
TOTAL: 15 = 17/ 7 = 2.43

Range of Value:
1. - 1.6
for Poor;
2. 1.7 -
2.3 for Fair;
3. 2.4 –
3.0 for Good

103
Client has a GOOD prognosis as shown in the computation.

103
CONCLUSION

Nurses can help the nation achieve National Health Goals. These goals speak directly to
both fetus and the mother because pregnancy is a high risk factor for them. Close monitoring in
pregnant women and health teaching as much as possible about pregnancy could definitely
reduce life threatening complications. In this case study, we've established a good interpersonal
relationship with the patient their significant others,aquired relevant data from the patient and the
patient's family for the study, traced the health history of the patient both past and present and
pathophysiology of placenta previa, the development data of the client, studied the anatomy and
physiology of female reproductive system,determined the diagnostic tests of our client including
their implications and nursing responsibilities,identified the drugs prescribed to our client, their
action, side effects, indications,contraindications and nursing responsibilities,evaluated the
complications to nursing practice, education and research and also we've formulated an
appropriate nursing care plan based on the assessment ,identified needs and problems of the
patient.
RECOMMENDATIONS

With this study, the student nurses were able to gain more knowledge and wider view and
perspective of the complication of pregnancy which is placenta previa. Thus, the student nurses
would like recommend and share some pointers on how to deal with different diseases with
pregnancy specifically placenta previa.
To the government, primarily they should allocate sufficient budget to sustain and
provide better facilities. They must be responsible enough to create awareness program for care
and management for all the Filipino people.
To the health care team, they should righteously implementing basic and ideal procedures
regardless of the health care facilities where they belong. They must observe and always
remember to keep in line with their duties towards both the mother and the child during the
pregnancy.
To the community and the family, that they must be insufficient coordination with the
government and the health care team regarding promotion of health before, during, and after the
delivery of the baby.
References:

Maternal and Child Nursing Crae Plans by Mosby

Maternal & Child Nursing Seventh Edition Vol.1 page 413.
Maternity nursing, Lowdermilk Perry, seventh edition, chapter 23, page 751.
Maternity Nursing, Lowdermilk, 7th ed.
Maternal Neonatial Nursing Lippincott manual of Nursing Practice

http://www.ehow.com
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http://emedicine.medscape.com/article/796182-overview

http://nursingcrib.com
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http://wikipedia.org
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http://schools-wikipedia.org/wp/b/Blood_type.ht
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